ASCO Highlight With Kim A. Reiss, MD, on CAR Macrophages and Different Developments in Pancreatic Most cancers

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Kim A. Reiss, MD, assistant program director, assistant professor of medication, Hospital of the College of Pennsylvania, Philadelphia, discusses 2 abstracts introduced throughout ASCO.

Kim A. Reiss, MD, mentioned with Proof-Based mostly Oncology™ (EBO) pancreatic most cancers analysis introduced through the 2022 American Society of Scientific Oncology (ASCO) Annual Assembly in June on high quality of life for sufferers on investigational noncytotoxic chemotherapies and promising developments in chimeric antigen receptor macrophages (CAR-M) to be used in strong tumors. Reiss is assistant program director of the Hematology/
Oncology Fellowship Program and assistant professor of medication on the Hospital of the College of Pennsylvania in Philadelphia.

EBO: What are the quality-of-life concerns for sufferers with superior pancreatic most cancers taking a PARP inhibitor with ipilimumab (Yervoy)?

Reiss: One of many issues that we frightened about after we opened the research is whether or not [patients] would conform to do it. So we’re taking a look at an all-comer inhabitants, not a DDR [DNA damage repair]–particular inhabitants, and these had been sufferers who had been secure on the chemotherapy they had been receiving.1 One of many questions was: Would these sufferers and their physicians be prepared to discontinue efficient chemotherapy within the face of a really deadly illness and soar right into a noncytotoxic upkeep remedy? And the reply was an amazing “Sure.”

Oncologists really helpful sufferers strive the research, and sufferers had been very, very enthusiastic and . In truth, we enrolled all 84 sufferers at solely the College of Pennsylvania in lower than 3 years. There was an enormous quantity of curiosity in attempting to get away from cytotoxic therapies.

My very own expertise on this, other than the couple of sufferers who had toxicity with IPI [ipilimumab] that was grade 2 or 3 and a few [who had toxicity] with niraparib [Zejula], nearly universally sufferers shared that their life was higher, that their high quality of life was higher, that they might do issues that they weren’t in a position to do whereas on chemotherapy. That is likely one of the causes that this technique is so vital for sufferers with pancreatic most cancers. Perpetual chemotherapy is just not an inexpensive factor to ask of a affected person to do. And for individuals who do effectively and are on remedy for a very long time, the [adverse] results accumulate. They’re extra fatigued, they’re marrow suppressed, they get extra neuropathy, and so we actually have to do higher. What this research hopefully [will] open the door to discover upkeep for a broader inhabitants than for simply the small variety of sufferers with BRCA and PALB2 variants.

EBO: Are you able to focus on the CAR macrophage information you introduced
throughout ASCO?2

Reiss: Traditionally, CAR [chimeric antigen receptor] T-cell remedy has not been efficient in strong tumors, and so one of many questions that the [Carisma Therapeutics with its] CAR macrophage is attempting to reply is whether or not macrophages might be used as a substitute for CAR T cells to see if they’ve energetic efficacy in strong tumors.

This specific research appears at a [human epidermal growth factor receptor] HER2-directed CAR. Sufferers acquired GCSF [granulocyte colony-stimulating factor] and so they then underwent plasmapheresis with siphoning off of monocytes. These are then grown up ex vivo into macrophages and are transduced with a HER2 CAR, and the product is then shipped again and thawed at bedside and reinfused into sufferers. This specific research once more is [using] a HER2-directed CAR, in order you may think about, these are sufferers with HER2-positive strong tumors of any selection—any strong tumor with a HER2 amplification both by IHC [immunohistochemistry] or by PCR [polymerase chain reaction] is admitted.

The explanation that macrophages had been chosen is that they spend plenty of time inside tumors within the tumor microenvironment. They’re a significant antigen-presenting cell, and so they even have direct cytotoxic results, so there have been 2 angles. One is the direct toxicity to the tumor of macrophages, [and the other was] their capability to recruit T cells to trigger irritation and hopefully in that method be antitumor.

The first finish factors of this specific research are feasibility and security. The primary query was: Can we do it? Can we get sufficient monocytes from these closely pretreated sufferers? And the second is: Is it secure to place macrophages again into people this manner? The reply to each questions seems to be sure.

The poster [presented at ASCO reviews] the primary 7 sufferers who had been handled; we’ve now handled 9. There may be not plenty of toxicity related to this remedy; there’s a transient cytokine launch, after which a number of sufferers could stand up to grade 2 CRS [cytokine release syndrome] that resolves in a short time. Aside from that, we’ve not seen a lot in the way in which of toxicity. And so the research will probably be transferring ahead.

One of many large questions that is still unanswered, however will probably be answered hopefully by the following steps on this research, is how lengthy do these CAR-Ms final in tumor? We all know by RNA scope that they do get there in some sufferers a day 8 after which at week 4. However the different questions are, do they keep, how lengthy do they keep, and is there heterogeneity? As a result of we all know that there’s HER2 heterogeneity, probably in tumor, so are the macrophages heading solely to sure areas?

Within the second half of the research, we will probably be tagging a part of the product with zirconium 289 after which taking PET-type photos of those sufferers over a interval of days and weeks after that to see if we will reply these questions as effectively.

[The product is] actually cool. They ship it again to Penn, they take a 3rd of the product and label it with zirconium 289, after which we do the entire infusion on the identical time that the product will get put again all collectively, after which they picture these sufferers and you may see areas the place, hopefully, the macrophages are hanging out after which how lengthy they’re there. It’s very thrilling. 

1. Reiss KA, Mick R, Teitelbaum UR, et al. A randomized part Ib/II research of niraparib (nira) plus nivolumab (nivo) or ipilimumab (ipi) in sufferers (pts) with platinum-sensitive superior pancreatic most cancers (aPDAC). J Clin Oncol. 2022;40(suppl 16):4021. doi:10.1200/JCO.2022.40.16_suppl.4021
2. Reiss KA, Yuan Y, Ueno NT, et al. A part 1, first-in-human (FIH) research of adenovirally transduced autologous macrophages engineered to comprise an anti-HER2 chimeric antigen receptor (CAR) in contributors with HER2 overexpressing strong tumors. J Clin Oncol. 2022;40(suppl 16):TPS2677. doi:10.1200/JCO.2022.40.16_suppl.TP22677


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