Oral Presentation Australasian Melanoma Conference 2018

Lessons from CAR-T-cell therapy for GD2-positive melanomas (56398)

Tessa Gargett 1
  1. Translational Oncology Laboratory, Royal Adelaide Hospital, Adelaide, SA, Australia

Chimeric antigen receptor (CAR) T cells are genetically engineered to recognize tumour-associated antigens and have potent cytolytic activity against tumours. Adoptive therapy with CAR T cells has been highly successful in haematological cancers.  Our research team is currently conducting the CARPETS study, a phase I clinical trial of third generation GD2-specific CAR T cells in metastatic melanoma patients at the Royal Adelaide Hospital. This trial was a world-first in using CAR T-cell therapy for melanoma, and in combining CAR T cells with standard kinase inhibitor-targeted therapy. So far, six patients have been treated safely with a further six to be recruited. Dose escalation has been completed and the treatment has been shown to be safe with no serious adverse events.  However CAR T cells failed to persist beyond four weeks in five of six patients; the only patient to demonstrate long-term persistence was pre-treated with lympho-depleting chemotherapy.  Our research suggests that GD2-specific CAR T cells have a predominately effector memory phenotype and a subset of CAR T cells upregulate and maintain PD-1 expression following antigen encounter.  CAR T cells also demonstrate loss of function and increased susceptibility to activation-induced cell death with repeated stimulation.  To counter this we have optimised CAR T cell manufacturing conditions to promote a more favourable T cell phenotype, and investigated a combination therapy approach with anti-PD1 monoclonal antibody, with the aim of promoting improved persistence and function of CAR T cells for the remaining CARPETS trial patients. Our aim is to improve CAR T cell efficacy for both melanoma and other solid cancers.