Article
Author: Huynh, Truc N. ; Sakemura, R. Leo ; DeFranco, Grace E. ; Smallridge, Robert C. ; Stewart, Carli M. ; Miller, Erin E. ; Siegler, Elizabeth L. ; Feigin, Jennifer M. ; Redig, Michael ; Tun, Han W. ; Pawlush, Matthew L. ; Xia, Hong ; Olivier, Gloria ; Manriquez Roman, Claudia ; Kimball, Brooke L. ; Sirpilla, Olivia L. ; Schick, Kendall J. ; Qiu, Yushi ; Mai, Long K. ; Ogbodo, Ekene J. ; Yun, Kun ; Gutierrez Ruiz, Omar L. ; Copland, John A. ; Zubair, Abba ; Gleba, Justyna J. ; Kenderian, Saad S. ; Alasonyalilar Demirer, Aylin ; Hefazi Torghabeh, Mehrdad ; Miller, James L. ; Klinge, Skyeler M. ; Can, Ismail ; Tapper, Erin E.
ABSTRACT:
Most thyroid cancer deaths are attributed to a subset of poorly differentiated, metastatic tumors. To improve treatment options for aggressive thyroid cancers, we developed a novel thyroid-stimulating hormone receptor (TSHR)-targeted chimeric antigen receptor T (CART) cell therapy, which demonstrated antigen-specific activation and antitumor efficacy against TSHR
+
cell lines
in vitro
and
in vivo
. However, de-differentiated thyroid cancers downregulate TSHR. We therefore developed a potent treatment strategy by combining our novel TSHR-CART cells with mitogen-activated protein kinase (MAPK) inhibitors, which redifferentiate thyroid tumors and upregulate TSHR expression. In patient-derived anaplastic thyroid cancer xenografts, combination therapy of TSHR-CART cells and MAPK inhibitors led to increased TSHR expression on the tumor tissue and significantly enhanced antitumor efficacy and prolonged survival compared to TSHR-CART monotherapy. Based on our data, we are launching a phase I clinical trial for TSHR-CART cell therapy alone or in combination with MAPK inhibitors in patients with metastatic thyroid cancers.
STATEMENT OF SIGNIFICANCE:Poor target selection and antigen escape limit CART cell efficacy in solid tumors. We developed TSHR-CART cells to treat differentiated thyroid cancers but observed TSHR downregulation in dedifferentiated thyroid cancers. We found that MAPK inhibitors restored TSHR expression and sensitized these cancers to TSHR-CART cell therapy.