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GD2-CART01 for Relapsed or Refractory High-Risk Neuroblastoma
Francesca Del Bufalo1, Biagio De Angelis1, Ignazio Caruana1
1From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.).
Background:
Immunotherapy with chimeric antigen receptor (CAR)-expressing T cells that target the disialoganglioside GD2 expressed on tumor cells may be a therapeutic option for patients with high-risk neuroblastoma.
Methods:
In an academic, phase 1-2 clinical trial, we enrolled patients (1 to 25 years of age) with relapsed or refractory, high-risk neuroblastoma in order to test autologous, third-generation GD2-CAR T cells expressing the inducible caspase 9 suicide gene (GD2-CART01).
Results:
A total of 27 children with heavily pretreated neuroblastoma (12 with refractory disease, 14 with relapsed disease, and 1 with a complete response at the end of first-line therapy) were enrolled and received GD2-CART01. No failure to generate GD2-CART01 was observed. Three dose levels were tested (3-, 6-, and 10×106 CAR-positive T cells per kilogram of body weight) in the phase 1 portion of the trial, and no dose-limiting toxic effects were recorded; the recommended dose for the phase 2 portion of the trial was 10×106 CAR-positive T cells per kilogram. Cytokine release syndrome occurred in 20 of 27 patients (74%) and was mild in 19 of 20 (95%). In 1 patient, the suicide gene was activated, with rapid elimination of GD2-CART01. GD2-targeted CAR T cells expanded in vivo and were detectable in peripheral blood in 26 of 27 patients up to 30 months after infusion (median persistence, 3 months; range, 1 to 30). Seventeen children had a response to the treatment (overall response, 63%); 9 patients had a complete response, and 8 had a partial response. Among the patients who received the recommended dose, the 3-year overall survival and event-free survival were 60% and 36%, respectively.
Conclusions:
The use of GD2-CART01 was feasible and safe in treating high-risk neuroblastoma. Treatment-related toxic effects developed, and the activation of the suicide gene controlled side effects. GD2-CART01 may have a sustained antitumor effect. (Funded by the Italian Medicines Agency and others; ClinicalTrials.gov number, NCT03373097.).
Insights
Chimeric antigen receptor (CAR) T-cell therapy targeting GD2 (GD2-CART01) shows feasibility and safety in high-risk neuroblastoma patients. The treatment demonstrated antitumor effects and manageable toxicity, offering a potential therapeutic option.
Area of Science:
- Oncology
- Immunotherapy
- Pediatric Cancer
Background:
- High-risk neuroblastoma remains a significant challenge in pediatric oncology.
- Chimeric antigen receptor (CAR) T-cell therapy targeting disialoganglioside GD2 is a potential treatment strategy.
- GD2-CART01 is an autologous, third-generation GD2-CAR T-cell therapy incorporating an inducible caspase 9 suicide gene.
Purpose of the Study:
- To evaluate the safety and feasibility of GD2-CART01 in patients with relapsed or refractory high-risk neuroblastoma.
- To determine the optimal dose and assess the preliminary efficacy of GD2-CART01.
Main Methods:
- A phase 1-2 clinical trial enrolled 27 pediatric patients (1-25 years) with heavily pretreated neuroblastoma.
- Patients received autologous GD2-CAR T cells (GD2-CART01) at three dose levels (3, 6, and 10 × 10^6 CAR-positive T cells/kg).
- The inducible caspase 9 suicide gene was included for safety control.
Main Results:
- GD2-CART01 generation was successful in all patients.
- The recommended phase 2 dose was established as 10 × 10^6 CAR-positive T cells/kg.
- Cytokine release syndrome occurred in 74% of patients, primarily mild.
- The suicide gene was activated in one patient, leading to rapid GD2-CART01 elimination.
- In vivo expansion and persistence of GD2-CART01 were observed in most patients.
- An overall response rate of 63% was achieved (9 complete responses, 8 partial responses).
- Three-year overall survival and event-free survival were 60% and 36% respectively, at the recommended dose.
Conclusions:
- GD2-CART01 is a feasible and safe immunotherapy for high-risk neuroblastoma.
- The inducible suicide gene effectively controlled treatment-related toxicities.
- GD2-CART01 demonstrated potential for sustained antitumor activity in this patient cohort.
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