U.S. patent application number 16/218658 was filed with the patent office on 2019-04-25 for methods of preparing anti-human papillomavirus antigen t cells.
This patent application is currently assigned to The United States of America,as represented by the Secretary,Department of Health and Human Services. The applicant listed for this patent is The United States of America,as represented by the Secretary,Department of Health and Human Services, The United States of America,as represented by the Secretary,Department of Health and Human Services. Invention is credited to Christian S. Hinrichs, Steven A. Rosenberg.
Application Number | 20190117761 16/218658 |
Document ID | / |
Family ID | 51257632 |
Filed Date | 2019-04-25 |
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United States Patent
Application |
20190117761 |
Kind Code |
A1 |
Hinrichs; Christian S. ; et
al. |
April 25, 2019 |
METHODS OF PREPARING ANTI-HUMAN PAPILLOMAVIRUS ANTIGEN T CELLS
Abstract
Disclosed are methods of preparing an isolated population of
human papillomavirus (HPV)-specific T cells comprise dividing an
HPV-positive tumor sample into multiple fragments; separately
culturing the multiple fragments; obtaining T cells from the
cultured multiple fragments; testing the T cells for specific
autologous HPV-positive tumor recognition; selecting the T cells
that exhibit specific autologous HPV-positive tumor recognition;
and expanding the number of selected T cells to produce a
population of HPV-specific T cells for adoptive cell therapy.
Related methods of treating or preventing cancer using the T cells
are also disclosed.
Inventors: |
Hinrichs; Christian S.;
(Bethesda, MD) ; Rosenberg; Steven A.; (Potomac,
MD) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
The United States of America,as represented by the
Secretary,Department of Health and Human Services |
Bethesda |
MD |
US |
|
|
Assignee: |
The United States of America,as
represented by the Secretary,Department of Health and Human
Services
Bethesda
MD
|
Family ID: |
51257632 |
Appl. No.: |
16/218658 |
Filed: |
December 13, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14905138 |
Jan 14, 2016 |
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PCT/US2014/046478 |
Jul 14, 2014 |
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16218658 |
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61846161 |
Jul 15, 2013 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
C12N 2501/2302 20130101;
C12N 2502/30 20130101; C12N 5/0636 20130101; C12N 2710/20011
20130101; A61K 2039/585 20130101; A61K 2039/5158 20130101; C12N
7/00 20130101; A61P 11/04 20180101; C12N 5/0638 20130101; A61P
35/00 20180101; A61P 15/00 20180101; A61K 35/17 20130101; A61K
39/12 20130101; A61P 15/02 20180101; A61P 1/04 20180101; A61K
2039/572 20130101 |
International
Class: |
A61K 39/12 20060101
A61K039/12; C12N 5/0783 20060101 C12N005/0783; A61K 35/17 20060101
A61K035/17; C12N 7/00 20060101 C12N007/00 |
Claims
1-19. (canceled)
20. A method of treating or preventing a head and neck cancer in a
mammal, the method comprising: (a) dividing the head and neck tumor
sample into multiple fragments; (b) culturing the multiple
fragments in the presence of at least one cytokine; (c) obtaining
T-cells from the cultured fragments; (d) expanding the number of
T-cells to produce an expanded population of HPV-specific T-cells
using one or both of (i) irradiated allogenic feeder cells and (ii)
irradiated autologous feeder cells; and one or both of (iii) OKT3
antibody and (iv) interleukin-2; (e) optionally, adding a second
culturing step following (c); and (f) administering the population
of head and neck tumor-specific T-cells to the mammal in an amount
effective to treat or prevent the head and neck cancer in the
mammal.
21. The method of claim 20, wherein the cancer is head and neck
squamous-cell carcinoma (HNSCC).
22. The method of claim 20, wherein the cancer is HPV-positive
oropharyngeal cancer.
23. The method of claim 20, wherein the cancer is selected from the
group consisting of laryngeal cancer, hypopharyngeal cancer, nasal
cavity cancer, nasopharyngeal cancer, oral cancer, oropharyngeal
cancer, and salivary gland cancer.
24. The method of claim 20, wherein a second culturing step is
added after step (c) to further expand the number of selected
T-cells.
25. The method of claim 20, wherein the cytokine in step (b) is
IL-2.
26. The method of claim 20, wherein the head and neck tumor is
HPV.sup.+.
27. The method of claim 20, wherein the population of cells
obtained in step (f) are enriched for HPV-specific T-cells.
28. The method of claim 27, wherein the population of HPV-specific
T-cells recognizes HPV 16-positive cancer cells.
29. The method of claim 27, wherein the population of HPV-specific
cells recognizes an HPV antigen selected from the group consisting
of HPV 16 E6 and HPV 16 E7.
30. The method of claim 27, wherein the population of HPV-specific
cells recognizes an HPV antigen selected from the group consisting
of HPV 18 E6 and HPV 18 E7.
31. The method of claim 20, further comprising administering to the
mammal nonmyleoablative lymphodepleting chemotherapy prior to step
(f).
32. A method of treating or preventing head and neck squamous-cell
carcinoma in a human, the method comprising: (a) dividing a head
and neck squamous-cell carcinoma tumor sample into multiple
fragments; (b) culturing the multiple fragments in the presence of
at least one cytokine; (c) obtaining T-cells from the cultured
fragments; (d) expanding the number of T-cells to produce an
expanded population of HPV-specific T-cells using one or both of
(i) irradiated allogenic feeder cells and (ii) irradiated
autologous feeder cells; and one or both of (iii) OKT3 antibody and
(iv) interleukin-2; (e) optionally, adding a second culturing step
following (c); (f) administering to the human nonmyleoablative
lymphodepleting chemotherapy, and (g) administering the population
of head and neck squamous-cell carcinoma tumor-specific T-cells to
the human in an amount effective to treat or prevent the head and
neck squamous cell carcinoma in the human.
33. A method of treating or preventing an HPV+ cancer in a female
subject, the method comprising: (a) dividing an HPV.sup.+ tumor
sample into multiple fragments; (b) culturing the multiple
fragments in the presence of at least one cytokine; (c) obtaining
T-cells from the cultured fragments; (d) expanding the number of
T-cells to produce an expanded population of HPV-specific T-cells
using one or both of (i) irradiated allogenic feeder cells and (ii)
irradiated autologous feeder cells; and one or both of (iii) OKT3
antibody and (iv) interleukin-2; (e) optionally, adding a second
culturing step following (c); and (f) administering the population
of HPV.sup.+ tumor-specific T-cells to the female subject in an
amount effective to treat or prevent the HPV+ cancer in the female
subject.
34. The method of claim 33, wherein the HPV.sup.+ cancer is
cervical cancer.
35. A method of treating or preventing HPV+ cervical cancer in a
human female, the method comprising: (a) dividing an HPV.sup.+
cervical cancer tumor sample into multiple fragments; (b) culturing
the multiple fragments in the presence of at least one cytokine;
(c) obtaining T-cells from the cultured fragments; (d) expanding
the number of T-cells to produce an expanded population of
HPV-specific T-cells using one or both of (i) irradiated allogenic
feeder cells and (ii) irradiated autologous feeder cells; and one
or both of (iii) OKT3 antibody and (iv) interleukin-2; (e)
optionally, adding a second culturing step following (c); and (f)
administering the population of HPV.sup.+ cervical cancer
tumor-specific T-cells to the human female in an amount effective
to treat or prevent the HPV+ cervical cancer in the human
female.
36. The method of claim 33, further comprising administering to the
female subject nonmyleoablative lymphodepleting chemotherapy prior
to step (f).
37. The method of claim 35, further comprising administering to the
human female nonmyleoablative lymphodepleting chemotherapy prior to
step (f).
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This patent application claims the benefit of U.S.
Provisional Patent Application No. 61/846,161, filed Jul. 15, 2013,
which is incorporated herein by reference in its entirety.
BACKGROUND OF THE INVENTION
[0002] The primary cause of some cancer types such as, for example,
uterine cervical cancer, is human papillomavirus (HPV) infection.
Despite advances in treatments such as chemotherapy, the prognosis
for many cancers, including HPV-associated cancers, may be poor.
Accordingly, there exists an unmet need for additional treatments
for cancer, particularly HPV-associated cancers.
BRIEF SUMMARY OF THE INVENTION
[0003] An embodiment of the invention provides a method of
preparing a population of HPV-specific T cells, the method
comprising: dividing an HPV-positive tumor sample into multiple
fragments; separately culturing the multiple fragments in the
presence of only one cytokine; obtaining T cells from the cultured
multiple fragments; testing the T cells for one or both of specific
autologous HPV-positive tumor recognition and HPV antigen
recognition; selecting the T cells that exhibit one or both of
specific autologous HPV-positive tumor recognition and HPV antigen
recognition; and expanding the number of selected T cells to
produce a population of HPV-specific T cells.
[0004] Another embodiment of the invention provides a method of
preparing a population of HPV-specific T cells, the method
comprising: dividing an HPV-positive tumor sample into multiple
fragments; separately culturing the multiple fragments; obtaining T
cells from the cultured multiple fragments; testing the T cells for
one or both of specific autologous HPV-positive tumor recognition
and HPV antigen recognition; selecting the T cells that exhibit one
or both of specific autologous HPV-positive tumor recognition and
HPV antigen recognition; and expanding the number of selected T
cells using one or both of (i) OKT3 antibody and (ii) interleukin
(IL)-2 to produce a population of HPV-specific T cells.
[0005] Still another embodiment of the invention provides a method
of treating or preventing cancer in a mammal, the method
comprising: dividing an HPV-positive tumor sample into multiple
fragments; separately culturing the multiple fragments; obtaining T
cells from the cultured multiple fragments; testing the T cells for
one or both of specific autologous HPV-positive tumor recognition
and HPV antigen recognition; selecting the T cells that exhibit one
or both of specific autologous HPV-positive tumor recognition and
HPV antigen recognition; expanding the number of selected T cells
to produce a population of HPV-specific T cells for adoptive cell
therapy; and administering the expanded number of T cells to the
mammal in an amount effective to treat or prevent cancer in the
mammal.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0006] FIG. 1A is a graph showing interferon gamma (IFN-.gamma.)
(pg/mL) secreted by effector tumor infiltrating lymphocytes (TIL)
generated from 22 tumor fragments (F1-F22) from Patient 1 or
melanoma TIL upon co-culture with a target gp100 peptide pool
(shaded bars) or an HPV 18 E7 peptide pool (unshaded bars).
[0007] FIG. 1B is a graph showing IFN-.gamma. (pg/mL) secreted by
effector melanoma TIL or TIL generated from 22 tumor fragments
(F1-F22) from Patient 1 upon co-culture with a target autologous
tumor cell line (unshaded bars) or 624 cells (a melanoma cell line)
(shaded bars).
[0008] FIG. 2A is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL generated from tumor fragment F16, F17, or F22 of
Patient 1, or by the cells given to the patient for treatment
("infusion bag") upon co-culture with target autologous tumor cells
(shaded bars), peripheral blood mononuclear cells (PBMC) from
autologous tissue (forward slash hatched bars), tumor cells matched
at all class I loci (backslash hatched bars), HLA-mismatched HeLa
cells (vertical striped bars), or HLA-mismatched CaSki cells
(horizontal striped bars).
[0009] FIG. 2B is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL from Patient 1 cultured alone (no tumor) or upon
co-culture with autologous tumor cells that were transfected with
silencing RNA against HLA-A, HLA-B, HLA-C, or RNA against an
irrelevant target (non-targeting).
[0010] FIG. 2C is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL upon co-culture with target cells (effector/targets:
Patient 1 TIL/autologous tumor cells; DMFS/624 cells; or
F15/HPV18E6.sub.121-135) without antibody (black bars), with
anti-HLA-A2 antibody (back slash hatched bars), or with anti-Class
II antibody (forward slash hatched bars). White bars indicate
effector cells cultured alone.
[0011] FIG. 3 is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL from tumor fragment F16 or F22 of Patient 1; cells
given to the patient for treatment ("infusion bag"); melanoma TIL
1, 2, or 3 (TIL cultured from melanoma tumors); mE7 TCR (T cells
transduced to express a TCR against HPV 16 E7.sub.11-19); or F15
TIL (TIL from another patient that were reactive against HPV 18
E6.sub.121-135, class II-restricted, and therefore blockable with
HB145) upon co-culture with a gp100 peptide pool (white bars), OKT3
antibody (horizontal striped bars), or dendritic cells (DCs) pulsed
with an HPV 18 E7 peptide pool (black bars), HPV 18 E7 peptide pool
and W6/32 (thin forward slash hatched bars), HPV 16 E7.sub.11-19
(thick forward slash hatched bars), HPV 16 E7.sub.11-19 and W6/32
(checkered bars), HPV 16 E7.sub.11-19 and HB145 (perpendicular
crossed bars), HPV 18 E6.sub.121-135 (back slash hatched bars), HPV
18 E6.sub.121-135 and W6/32 (crossed bars), or HPV 18
E6.sub.121-135 and HB 145 (bars with white-outlined black
rectangles).
[0012] FIGS. 4A and 4B are graphs showing IFN-.gamma. (pg/mL)
secreted by effector TIL clones 1-24 (A) or clones 24-48 (B) that
were cloned from the F16 tumor fragment from Patient 1 upon
co-culture with a gp100 peptide pool (grey bars) or an HPV 18 E7
peptide pool (black bars).
[0013] FIG. 5 is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL from 36 different tumor fragments (F1-F36) from
Patient 12 or melanoma TIL (DM5) (control) upon co-culture with
dendritic cells pulsed with the HPV 18 E6 peptide pool (black
bars), the HPV 18 E7 peptide pool (grey bars) or a gp100 peptide
pool (control).
[0014] FIG. 6 is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL generated from tumor fragment F1 of Patient 12, or
melanoma TIL 1, 2, or 3, upon co-culture with DCs that were
transduced with a lentiviral vector encoding green fluorescent
protein (GFP) (white bars) or HPV 18 E6 (grey bars) or pulsed with
a gp100 peptide pool (forward slash hatched bars) or a HPV 18 E6
peptide pool (back slash hatched bars). Horizontal striped bars
indicate TIL cultured with OKT3 antibody.
[0015] FIG. 7A is a graph showing tumor necrosis factor (TNF)
.alpha. (pg/mL) secreted by clones 1, 3, 12, and 20 upon culture
alone (grey bars) or with an HPV18 E6 peptide pool (black
bars).
[0016] FIG. 7B is a graph showing TNF.alpha. (pg/mL) secreted by
clones 3, 12, and 20 upon culture alone (white bars) or with an
HPV18 E6 peptide pool (grey bars) or with HPV 18 E6 peptide subpool
1 (forward slash hatched bars), subpool 2 (back slash hatched
bars), subpool 3 (horizontal striped bars), subpool 4 (vertical
striped bars), or subpool 5 (black bars).
[0017] FIG. 7C is a graph showing TNF.alpha. (pg/mL) secreted by
clones 3, 12, and 20 upon culture alone (white bars) or with an
HPV18 E6 peptide 30 (dotted bars), peptide 31 (black bars), peptide
32 (grey bars), peptide 33 (vertical striped bars), peptide 34
(forward slash hatched bars), peptide 35 (back slash hatched bars),
peptide 36 (squared bars), or peptide 37 (herringbone bars).
[0018] FIGS. 8A-8C are graphs showing TNF.alpha. (pg/mL) secreted
by clones 3 (A), 12 (B), and 20 (C) upon co-culture with autologous
PBMC (P12) or PBMC from one of Donors 1-6.
[0019] FIG. 9A is a graph showing IFN-.gamma. (pg/mL) secreted by
clone 3 of tumor fragment F15 of Patient 12 upon co-culture with
autologous PBMC (P12) or DRB1*15, DQB1*06 donor PBMC, DRB1*15 donor
PBMC, or DQB1*06 donor PBMC pulsed with HPV 18 E6.sub.77-91
(unshaded bars) or HPV 18 E6.sub.121-135 peptide (shaded bars).
[0020] FIG. 9B is a graph showing IFN-.gamma. (pg/mL) secreted by
clone 20 of tumor fragment F15 of Patient 12 upon co-culture with
PBMC pulsed with HPV 18 E6.sub.121-135 peptide or mF5 T cells
(transduced to express anti-MART-1 TCR) co-cultured with 624 cells
with antibodies against HLA-DR (horizontal striped bars), HLA-DQ
(back slash hatched bars), HLA-DP (forward slash hatched bars),
pan-class I antibodies (black bars), or pan-class II antibodies
(white bars).
[0021] FIG. 10 is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL from 24 different tumor fragments (F1-F24) from
Patient 4 or melanoma TIL (control) upon co-culture with dendritic
cells pulsed with the HPV 16 E6 peptide pool (back slash hatched
bars), the HPV 16 E7 peptide pool (forward slash hatched bars) or a
gp100 peptide pool (control) (black bars). Asterisk (*) indicates
TIL infused into patient.
[0022] FIG. 11A is a graph showing IFN-.gamma. (pg/mL) secreted by
CD8 positive effector TIL clones from Patient 4 upon co-culture
with dendritic cells pulsed with an HPV 16 E7 peptide pool (shaded
bars) or no peptide (unshaded bars).
[0023] FIG. 11B is a graph showing IFN-.gamma. (pg/mL) secreted by
CD4 positive effector TIL clones from Patient 4 upon co-culture
with dendritic cells pulsed with an HPV 16 E7 peptide pool (shaded
bars) or no peptide (unshaded bars).
[0024] FIG. 11C is a graph showing IFN-.gamma. (pg/mL) secreted by
CD8 positive effector TIL clones from Patient 4 upon co-culture
with dendritic cells pulsed with an HPV 16 E6 peptide pool (shaded
bars) or no peptide (unshaded bars).
[0025] FIG. 11D is a graph showing IFN-.gamma. (pg/mL) secreted by
CD4 positive effector TIL clones from Patient 4 upon co-culture
with dendritic cells pulsed with an HPV 16 E6 peptide pool (shaded
bars) or no peptide (unshaded bars).
[0026] FIGS. 12A-B are computed tomography (CT) scans of the chest
of Patient 4 before (A) and nine months after (B) treatment with
adoptive cell therapy. The arrow in A points to a cancerous lesion
in the paraaortic lymph node.
[0027] FIGS. 12C-D are CT scans of the chest of Patient 4 before
(C) and nine months after (D) treatment with adoptive cell therapy.
The arrow in C points to a cancerous lesion in the left lung hilar
lymph node.
[0028] FIGS. 12E-F are CT scans of the pelvis of Patient 4 before
(E) and nine months after (F) treatment with adoptive cell therapy.
The arrow in E points to a cancerous lesion in the common iliac
lymph node.
[0029] FIG. 13 is a graph showing IFN-.gamma. (pg/mL) secreted by
effector TIL from 24 different tumor fragments from Patient 8 or
melanoma TIL (control) upon co-culture with dendritic cells pulsed
with the HPV 18 E6 peptide pool (back slash hatched bars), the HPV
18 E7 peptide pool (forward slash hatched bars) or a gp100 peptide
pool (control) (black bars). Asterisk (*) indicates TIL infused
into patient.
[0030] FIGS. 14A-B are magnetic resonance imaging (Mill) scans of
the liver of Patient 8 before (A) and two months after (B)
treatment with adoptive cell therapy. The arrow in A points to a
cancerous liver mass.
[0031] FIGS. 14C-D are CT scans of the abdomen of Patient 8 before
(C) and two months after (D) treatment with adoptive cell therapy.
The arrow in C points to a cancerous lesion in the retroperitoneal
lymph node.
[0032] FIGS. 14E-F are CT scans of the abdomen of Patient 8 before
(E) and two months after (F) treatment with adoptive cell therapy.
The arrow in E points to a cancerous abdominal wall mass.
[0033] FIGS. 14G-H are CT scans of the pelvis of Patient 8 before
(G) and two months after (H) treatment with adoptive cell therapy.
The arrow in G points to a cancerous left pericolic mass.
[0034] FIG. 15A is a graph showing paraaortic (circles), left hilar
(squares), right hilar (4), and common iliac (V) tumor size
measurement (% change from baseline) of Patient 4 at time points
(number of months) after HPV-TIL infusion.
[0035] FIG. 15B is a graph showing abdominal wall (circles),
paraaortic (squares), left pelvis (4), and right ureter (V) tumor
size measurement (% change from baseline) of Patient 8 at time
points (number of months) after HPV-TIL infusion.
[0036] FIGS. 16A-D are delayed gadolinium-enhanced T1-weighted MRI
images of Patient 8. A and C each show a tumor on the liver surface
before treatment. B and D show that neither tumor was present 11
months following treatment. Arrows in A and C indicate locations of
the tumors.
[0037] FIG. 17A is a graph showing the serum cytokine level (pg/ml)
measured in Patient 4 at time points (number of days) after
treatment. Cytokines measured include interleukin (IL)-2 (closed
circles), IL-4 (squares), IL-6 (.tangle-solidup.), IL-13 (),
granulocyte colony-stimulating factor (G-CSF) (diamonds), and tumor
necrosis factor alpha (TNF-a) (open circles). Cytokines that were
administered to the patient are underlined.
[0038] FIG. 17B is a graph showing the serum cytokine level (pg/ml)
measured in Patient 8 at number of days after treatment. Cytokines
measured include IL-2 (closed circles), IL-5 (closed squares), IL-6
(.tangle-solidup.), IL-8 (), G-CSF (diamonds), monocyte
chemoattractant protein-1 (MCP-1) (open circles), and TNF-a (open
squares). Cytokines that were administered to the patient are
underlined.
[0039] FIGS. 18A-D are graphs showing the reactivity of TIL to be
administered to Patient 4 (A and C) or Patient 8 (B and D) (shaded
bars) against HPV E6, HPV E7, or Epstein Barr virus (EBV) (control)
as measured by IFN-gamma secretion (pg/ml) (A and B) and ELISPOT
assays (C and D). Unshaded bars represent the reactivity of
EBV-reactive T cells from the same patient (control).
[0040] FIGS. 19A-B are graphs showing lymphocyte counts
(cells/mm.sup.3) for Patient 4 (A) and Patient 8 (B) at various
time points (days) after infusion of TIL. Cells counted include CD8
T cells (squares), CD4 T cells (circles), NK cells
(.tangle-solidup.), and B cells ().
[0041] FIGS. 19C-D are graphs showing HPV-reactive T cells detected
in peripheral blood of Patient 4 (C) or Patient 8 (D) at various
time points (months) after infusion of TIL as measured by IFN-gamma
(pg/ml). Reactivity against HPV E6 (grey bars), HPV E7 (black
bars), or gp100 (control) (unshaded bars) was measured.
[0042] FIGS. 19E-F are graphs showing the quantification of
HPV-reactive T cells detected in peripheral blood of Patient 4 (E)
or Patient 8 (F) at various time points (months) after infusion of
TIL as measured by ELISPOT. Reactivity against HPV E6 (grey bars),
HPV E7 (black bars), or gp100 (control) (unshaded bars) was
measured.
[0043] FIGS. 20A-J are magnetic resonance imaging (MRI) scans of
Patient 13 who had a metastatic tonsil cancer before (A, C, E, G,
and I) and four months after (B, D, F, H, and J) treatment with
adoptive cell therapy. The arrows point to multiple malignant
tumors in the lungs and the right lung hilum.
[0044] FIGS. 21A-B are CT scans of the chest of Patient 4 before
(A) and 18 months after (B) treatment with adoptive cell therapy.
The arrow in A points to a cancerous lesion in a paraaortic lymph
node.
[0045] FIGS. 21C-D are CT scans of the chest of Patient 4 before
(C) and 18 months after (D) treatment with adoptive cell therapy.
The arrows in C point to a left hilar lesion and a subcarinal
lesion.
[0046] FIGS. 21E-F are CT scans of the chest of Patient 4 before
(E) and 18 months after (F) treatment with adoptive cell therapy.
The arrows in E point to bilateral hilar lesions.
[0047] FIGS. 21G-H are CT scans of the pelvis of Patient 4 before
(G) and 18 months after (H) treatment with adoptive cell therapy.
The arrow in G points to a cancerous lesion in the common iliac
lymph node.
[0048] FIGS. 22 A-B are CT scans of the abdomen of Patient 8 before
(A) and 11 months after (B) treatment with adoptive cell therapy.
The arrow in A points to a cancerous lesion in a retroperitoneal
lymph node.
[0049] FIGS. 22C-D are CT scans of the abdomen of Patient 8 before
(C) and 11 months after (D) treatment with adoptive cell therapy.
The arrows in C point to a cancerous abdominal wall mass and a
retroperitonal tumor.
[0050] FIGS. 22E-F are CT scans of the abdomen of Patient 8 before
(E) and 11 months after (F) treatment with adoptive cell therapy.
The arrow in E points to a cancerous paracolic mass.
[0051] FIGS. 22G-H are CT scans of the pelvis of Patient 8 before
(G) and 11 months after (H) treatment with adoptive cell therapy.
The arrow in G points to a cancerous left pelvic mass. The triangle
in H points to an uretal stent.
DETAILED DESCRIPTION OF THE INVENTION
[0052] It has been discovered that populations of human
papillomavirus (HPV)-specific T cells can be prepared for a variety
of applications, for example, adoptive cell therapy. The inventive
methods may generate cells that are useful for treating a variety
of conditions, e.g., cancer.
[0053] The inventive methods provide numerous advantages. For
example, the inventive methods may, advantageously, generate T
cells from HPV-positive cancers at a grade and scale suitable for
clinical use. Additionally, the inventive methods may,
advantageously, generate T cells that recognize the HPV antigens E6
and E7, which are constitutively and specifically expressed by
cancer cells and are not expressed by normal cells. Therefore,
without being bound to a particular theory or mechanism, it is
believed that T cells generated by the inventive methods
advantageously target the destruction of cancer cells while
minimizing or eliminating the destruction of normal, non-cancerous
cells, thereby reducing, for example, by minimizing or eliminating,
toxicity. In addition, because an embodiment of the inventive
methods includes nonmyeloablative chemotherapy, the inventive
methods can advantageously be used to treat patients that would not
be eligible for treatments that involve total body irradiation
(TBI) such as, for example, patients that have already undergone
myeloablative therapy, e.g., radiotherapy, prior to treatment;
patients with comorbid conditions; and patients with less than
2.times.10.sup.6 CD34.sup.+ cells/kg. Moreover, the inventive
methods of treating cancer may, advantageously, successfully treat
or prevent HPV-positive cancers that do not respond to other types
of treatment such as, for example, chemotherapy alone, surgery, or
radiation.
[0054] An embodiment of the invention comprises obtaining an
HPV-positive tumor sample from a mammal. The tumor sample may be
obtained from a mammal in any suitable manner such, for example,
biopsy or surgical resection.
[0055] In an embodiment, the method may comprise testing the tumor
sample for HPV infection. The HPV may be any HPV subtype.
Preferably, the HPV subtype is HPV 16 or HPV 18. The testing may
comprise testing for the expression of any protein (e.g., an
antigen) specifically expressed by HPV-infected cells such as, for
example, any one or more of HPV 16 E6, HPV 16 E7, HPV 18 E6, and
HPV 18 E7, expression of any RNA encoding the HPV-specific protein,
or a combination thereof. Testing for HPV infection may be carried
out in any suitable manner known in the art. Exemplary HPV tests
may include any one or more of reverse transcriptase (RT)
polymerase chain reaction (PCR)-based genotyping and Western blots.
The tumor sample may be positive for any subtype of HPV infection
such as, for example, HPV 16 or HPV 18 infection.
[0056] An embodiment of the invention comprises dividing the
HPV-positive tumor sample into multiple fragments. The tumor sample
may be divided into any suitable number of fragments such as, for
example, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40 or more fragments.
Preferably, the tumor sample is divided into 24 fragments. The
tumor sample may be divided in any suitable manner e.g.,
mechanically (disaggregating the tumor using, e.g., a
gentleMACS.TM. Dissociator, Miltenyi Biotec, Auburn, Calif.) or
enzymatically (e.g., collagenase or DNase).
[0057] An embodiment of the invention comprises separately
culturing the multiple fragments. In this regard, the fragments may
be cultured in separate containers, e.g., separate plates or
separate wells of a plate. The multiple fragments may be cultured
in any suitable manner. For example, the fragments may be cultured
in a gas permeable container as described in U.S. Patent
Application Publication No. 2012/0244133. In an embodiment of the
invention, the tumor fragments are cultured in the presence of a
combination of two or more cytokines. In a preferred embodiment,
however, the method comprises culturing the tumor fragments in the
presence of only one cytokine. The cytokine may be any suitable
cytokine such as, for example, interleukin (IL)-2, IL-7, IL-15, or
IL-12. Preferably, the cytokine is IL-2. The tumor fragments may be
cultured in any suitable amount of cytokine (e.g., from about 30
IU/mL to about 6,000 IU/mL, preferably about 6,000 IU/mL).
Preferably, the method comprises culturing tumor fragments in about
6,000 IU/mL IL-2.
[0058] The method may comprise obtaining T cells from the cultured
multiple fragments. The method may comprise culturing the T cells
until confluence (e.g., about 2.times.10.sup.6 lymphocytes per mL
in a 24-well plate), e.g., from about 12 to about 28 days.
[0059] The method may comprise testing the T cells for one or both
of specific autologous HPV-positive tumor recognition and HPV
antigen recognition. Specific autologous HPV-positive tumor
recognition can be tested by any method known in the art, e.g., by
measuring cytokine release (e.g., interferon (IFN)-.gamma.)
following co-culture with autologous HPV-positive tumor cells. T
cells may be considered to recognize HPV-positive tumor if, for
example, co-culture with autologous HPV-positive tumor cells
results in IFN-.gamma. release that is one or more of (i) twice the
amount of IFN-.gamma. that is measured when the T cells are
cultured alone (background); (ii) at least about 200 pg/mL or more
(e.g., 200 pg/mL or more, 300 pg/mL or more, 400 pg/mL or more, 500
pg/mL or more, 600 pg/mL or more, 700 pg/mL or more, 1000 pg/mL or
more, 5,000 pg/mL or more, 7,000 pg/mL or more, 10,000 pg/mL or
more, or 20,000 pg/mL or more); and (iii) blocked by MEW Class I
antibody by greater than about 40%, greater than about 50%, or
greater than about 60%.
[0060] Specific HPV antigen recognition can be tested by any method
known in the art, e.g., by measuring cytokine release (e.g.,
IFN-.gamma.) following co-culture with antigen-negative antigen
presenting cells (e.g., dendritic cells) that have been pulsed with
a peptide of an HPV antigen. T cells may be considered to recognize
HPV antigen if, for example, IFN-.gamma. release is one or both of
(i) twice the amount of IFN-.gamma. that is measured when the T
cells are cultured with antigen presenting cells that are pulsed
with a negative control peptide and (ii) at least about 200 pg/mL
or more (e.g., 200 pg/mL or more, 300 pg/mL or more, 400 pg/mL or
more, 500 pg/mL or more, 600 pg/mL or more, 700 pg/mL or more, 1000
pg/mL or more, 5,000 pg/mL or more, 7,000 pg/mL or more, 10,000
pg/mL or more, or 20,000 pg/mL or more) of IFN-.gamma. upon
co-culture with antigen-negative antigen presenting cells pulsed
with a low concentration of HPV 16 or HPV 18 peptide (e.g., about
0.05 ng/mL to about 5 ng/mL, 0.05 ng/mL, 0.1 ng/mL, 0.5 ng/mL, 1
ng/mL, or 5 ng/mL). The T cells may also secrete IFN-.gamma. upon
co-culture with antigen-negative antigen presenting cells pulsed
with higher concentrations of HPV peptide.
[0061] The HPV antigen may be any HPV antigen. For example, the HPV
antigen may be any one or more of HPV 16 E6, HPV 16 E7, HPV 18 E6,
and HPV 18 E7. While in some embodiments, the population of T cells
may specifically recognize only one HPV antigen, in some
embodiments, the population of T cells may specifically recognize
more than one HPV antigen. In this regard, the population of T
cells may comprise multiple T cells each having different HPV
specificities. For example, the population of T cells may include
some T cells that specifically recognize HPV 16 E6 and other T
cells that specifically recognize HPV 16 E7, or the population may
include some T cells that specifically recognize HPV 18 E6 and
other T cells that specifically recognize HPV 18 E7.
[0062] The method may comprise selecting the T cells that exhibit
one or both of specific autologous HPV-positive tumor recognition
and HPV antigen recognition. In an embodiment of the invention,
while testing the T cells for one or both of specific autologous
HPV-positive tumor recognition and HPV antigen recognition may
identify those cultures that contain T cells that recognize HPV,
those cultures that contain the HPV-reactive T cells may also
contain additional T cells that are reactive against other, non-HPV
tumor antigens. Accordingly, the selected population of T cells may
include polyclonal T cells with multiple specificities. In another
embodiment of the invention, the testing identifies cultures that
only contain T cells that recognize HPV. In this regard, the
selected population of T cells may include T cells with only HPV
specificity.
[0063] The method may further comprise expanding the number of
selected T cells to produce a population of HPV-specific T cells.
Rapid expansion provides an increase in the number of
antigen-specific T-cells of at least about 100-fold (or 200-, 300-,
400-, 500-, 600-, 700-, 800-, 900-fold, or greater) over a period
of about 10 to about 14 days, preferably about 14 days. More
preferably, rapid expansion provides an increase of at least about
1000-fold (or 1500-, 2000-, 2500-, 3000-fold, or greater) over a
period of about 10 to about 14 days, preferably about 14 days. Most
preferably, rapid expansion provides an increase of at least about
1000-fold to about 3000-fold over a period of about 10 to about 14
days, preferably about 14 days.
[0064] Expansion of the numbers of T cells can be accomplished by
any of a number of methods as are known in the art as described in,
for example, U.S. Pat. Nos. 8,034,334; 8,383,099; U.S. Patent
Application Publication No. 2012/0244133; Dudley et al., J.
Immunother., 26:332-42 (2003); and Riddell et al., J. Immunol.
Methods, 128:189-201 (1990). For example, the numbers of T cells
can be rapidly expanded using non-specific T-cell receptor
stimulation in the presence of feeder lymphocytes and either
interleukin-2 (IL-2) or interleukin-15 (IL-15), with IL-2 being
preferred. The non-specific T-cell receptor stimulus can include
around 30 ng/mL of OKT3, a mouse monoclonal anti-CD3 antibody
(available from Ortho-McNeil, Raritan, N.J.). Alternatively, the
number of T cells can be rapidly expanded by stimulation in vitro
with an antigen (one or more, including antigenic portions thereof,
such as epitope(s), or a cell) of the cancer, which can be
optionally expressed from a vector, e.g., 0.3 .mu.M MART-1:26-35
(27L) or gp100:209-217 (210M), in the presence of a T-cell growth
factor, such as 300 IU/mL IL-2 or IL-15, with IL-2 being preferred.
The numbers of in vitro-induced T-cells may be rapidly expanded by
re-stimulation with the same antigen(s) of the cancer pulsed onto
antigen-presenting cells. In an embodiment, the numbers of T cells
are expanded in a gas permeable container as described in U.S.
Patent Application Publication No. 2012/0244133.
[0065] In an embodiment of the invention, the method comprises
expanding the number of T cells using one or both of (i) irradiated
allogeneic feeder cells and (ii) irradiated autologous feeder cells
and one or both of (iii) OKT3 antibody and (iv) a T-cell growth
factor, such as IL-2 or IL-15, with IL-2 being preferred. The
method may comprise expanding the number of T cells using one or
both of (i) irradiated allogeneic feeder cells and (ii) irradiated
autologous feeder cells and one or both of (iii) OKT3 antibody and
(iv) interleukin (IL)-2. Preferably, the method comprises expanding
the number of T cells using one or both of (i) irradiated
allogeneic feeder cells and (ii) irradiated autologous feeder cells
and both of (iii) OKT3 antibody and (iv) interleukin (IL)-2. In an
especially preferred embodiment, the method comprises expanding the
number of T cells using (i) irradiated allogeneic feeder cells,
(ii) OKT3 antibody and (iii) interleukin (IL)-2.
[0066] In still another embodiment, the method comprises expanding
the number of selected T cells using one or both of (i) OKT3
antibody and (ii) interleukin (IL)-2 to produce a population of
HPV-specific T cells, optionally in combination with one or both of
irradiated allogeneic feeder cells and irradiated autologous feeder
cells. In this regard, an embodiment of the invention provides a
method of preparing a population of HPV-specific T cells, the
method comprising: dividing an HPV-positive tumor sample into
multiple fragments; separately culturing the multiple fragments;
obtaining T cells from the cultured multiple fragments; testing the
T cells for one or both of specific autologous HPV-positive tumor
recognition and HPV antigen recognition; selecting the T cells that
exhibit one or both of specific autologous HPV-positive tumor
recognition and HPV antigen recognition; and expanding the number
of selected T cells using one or both of (i) OKT3 antibody and (ii)
interleukin (IL)-2 to produce a population of HPV-specific T cells.
Dividing the tumor sample, culturing the tumor fragments, obtaining
T cells, testing the T cells, selecting the T cells, and expanding
the numbers of selected T cells may be carried out as described
herein with respect to other aspects of the invention.
[0067] The population of expanded numbers of T cells produced by
the inventive methods may specifically recognize HPV-positive
cells, e.g., HPV-positive cancer cells. The cells that are
recognized by the T cells may be positive for any subtype of HPV
such as, for example, HPV 16 or HPV 18. Alternatively or
additionally, the population of T cells produced by the inventive
methods may specifically recognize any HPV antigen such as, for
example, any one or more of HPV 16 E6, HPV 16 E7, HPV 18 E6, and
HPV 18 E7. While in some embodiments, the population of T cells may
specifically recognize only one HPV antigen, in some embodiments,
the population of T cells may specifically recognize more than one
HPV antigen. In this regard, the population of expanded numbers of
T cells may comprise multiple T cells each having different HPV
specificities. For example, the population of expanded numbers of T
cells may include some T cells that specifically recognize HPV 16
E6 and other T cells that specifically recognize HPV 16 E7, or the
population may include some T cells that specifically recognize HPV
18 E6 and other T cells that specifically recognize HPV 18 E7. The
ability of the population of expanded numbers of T cells produced
by the inventive methods to specifically recognize HPV-positive
cells and to specifically recognize a HPV antigen may be measured
as described herein with respect to other aspects of the
invention.
[0068] The population of T cells produced by the inventive methods
may be useful for treating or preventing HPV-associated conditions,
e.g., cancer. Accordingly, another embodiment of the invention
provides a method of treating or preventing cancer in a mammal, the
method comprising preparing a population of HPV-specific T cells
according to any of the inventive methods described herein and
administering the population of T cells to the mammal in an amount
effective to treat or prevent cancer in the mammal.
[0069] Another embodiment of the invention provides a method of
treating or preventing cancer in a mammal, the method comprising:
dividing an HPV-positive tumor sample into multiple fragments;
separately culturing the multiple fragments; obtaining T cells from
the cultured multiple fragments; testing the T cells for one or
both of specific autologous HPV-positive tumor recognition and HPV
antigen recognition; selecting the T cells that exhibit one or both
of specific autologous HPV-positive tumor recognition and HPV
antigen recognition; expanding the number of selected T cells to
produce a population of HPV-specific T cells for adoptive cell
therapy; and administering the expanded number of T cells to the
mammal in an amount effective to treat or prevent cancer in the
mammal. Dividing the tumor sample, culturing the tumor fragments,
obtaining T cells, testing the T cells, selecting the T cells, and
expanding the numbers of selected T cells may be carried out as
described herein with respect to other aspects of the invention.
Another embodiment of the invention provides a method of treating
or preventing a condition in a mammal, the method comprising
preparing a population of HPV-specific T cells according to any of
the inventive methods described herein and administering the
population of T cells to the mammal in an amount effective to treat
or prevent the condition in the mammal wherein the condition is
cancer, HPV 16 infection, or HPV-positive premalignancy.
[0070] An embodiment of the invention comprises administering to
the mammal nonmyeloablative lymphodepleting chemotherapy. The
nonmyeloablative lymphodepleting chemotherapy can be any suitable
such therapy, which can be administered by any suitable route. The
nonmyeloablative lymphodepleting chemotherapy can comprise the
administration of cyclophosphamide and fludarabine, particularly if
the cancer is an HPV-positive cancer, which can be metastatic. A
preferred route of administering cyclophosphamide and fludarabine
is intravenously. Likewise, any suitable dose of cyclophosphamide
and fludarabine can be administered. Preferably, around 60 mg/kg of
cyclophosphamide is administered for two days after which around 25
mg/m.sup.2 fludarabine is administered for five days, particularly
if the cancer is an HPV-positive cancer. In an embodiment of the
invention, the nonmyeloablative lymphodepleting chemotherapy is
administered prior to administering the T cells.
[0071] An embodiment of the invention comprises, after
administering the nonmyeloablative lymphodepleting chemotherapy,
administering to the mammal the population of HPV-specific T cells
prepared by any of the inventive methods described herein.
[0072] The T-cells can be administered by any suitable route as
known in the art. Preferably, the T-cells are administered as an
intra-arterial or intravenous infusion, which preferably lasts
about 30 to about 60 minutes. Other examples of routes of
administration include intraperitoneal, intrathecal and
intralymphatic.
[0073] Likewise, any suitable dose of T-cells can be administered.
Preferably, from about 1.0.times.10.sup.10 T-cells to about
13.7.times.10.sup.10 T-cells are administered, with an average of
around 5.0.times.10.sup.10 T-cells, particularly if the cancer is
an HPV-positive cancer. Alternatively, from about
1.2.times.10.sup.10 to about 4.3.times.10.sup.10 T-cells are
administered.
[0074] In an embodiment of the invention, any of the methods
described herein may further comprise combining the population of
HPV-specific T cells with a pharmaceutically acceptable carrier.
The pharmaceutically acceptable carrier may be any pharmaceutically
acceptable carrier that is suitable for adoptive cell therapy. For
example, the pharmaceutically acceptable carrier may include any
isotonic carrier such as, for example, normal saline (about 0.90%
w/v of NaCl in water, about 300 mOsm/L NaCl in water, or about 9.0
g NaCl per liter of water), NORMOSOL R electrolyte solution
(Abbott, Chicago, Ill.), PLASMA-LYTE A (Baxter, Deerfield, Ill.),
about 5% dextrose in water, or Ringer's lactate. In an embodiment,
the pharmaceutically acceptable carrier is supplemented with human
serum albumen.
[0075] An embodiment of the invention comprises enriching cultured
T cells for CD8.sup.+ T cells prior to rapid expansion of the
cells. Following culture of the T cells, the T cells are depleted
of CD4.sup.+ cells and enriched for CD8.sup.+ cells using, for
example, a CD8 microbead separation (e.g., using a
CliniMACS.sup.plus CD8 microbead system (Miltenyi Biotec)). Without
being bound to a particular theory, it is believed that CD8.sup.+
enrichment of some T cell cultures reveals in vitro tumor
recognition that may not be evident in the bulk culture, and
improved in vitro recognition of tumor in other cultures.
Additionally, the enriched CD8.sup.+ T cells are believed to behave
more reliably and predictably in clinical scale rapid expansions
than the bulk T cells.
[0076] An embodiment of the invention comprises enriching cultured
T cells for CD4.sup.+ T cells prior to rapid expansion of the
cells. Following culture of the T cells, the T cells are depleted
of CD8.sup.+ cells and enriched for CD4.sup.+ cells using, for
example, a CD4 microbead separation (e.g., using a
CliniMACS.sup.Plus CD8 microbead system (Miltenyi Biotec)).
[0077] In an embodiment, a T-cell growth factor that promotes the
growth and activation of the autologous T cells is administered to
the mammal either concomitantly with the autologous T cells or
subsequently to the autologous T cells. The T-cell growth factor
can be any suitable growth factor that promotes the growth and
activation of the autologous T-cells. Examples of suitable T-cell
growth factors include interleukin (IL)-2, IL-7, IL-15, and IL-12,
which can be used alone or in various combinations, such as IL-2
and IL-7, IL-2 and IL-15, IL-7 and IL-15, IL-2, IL-7 and IL-15,
IL-12 and IL-7, IL-12 and IL-15, or IL-12 and IL2. IL-12 is a
preferred T-cell growth factor.
[0078] In an embodiment, the autologous T-cells are modified to
express a T-cell growth factor that promotes the growth and
activation of the autologous T-cells. Suitable T-cell growth
factors include, for example, any of those described above.
Suitable methods of modification are known in the art. See, for
instance, Green and Sambrook, Molecular Cloning: A Laboratory
Manual, 4.sup.th ed., Cold Spring Harbor Press, Cold Spring Harbor,
N.Y. 2012; and Ausubel et al., Current Protocols in Molecular
Biology, Greene Publishing Associates and John Wiley & Sons, N
Y, 1994. Desirably, modified autologous T-cells express the T-cell
growth factor at high levels. T-cell growth factor coding
sequences, such as that of IL-12, are readily available in the art,
as are promoters, the operable linkage of which to a T-cell growth
factor coding sequence promote high-level expression.
[0079] The T-cell growth factor can be administered by any suitable
route. If more than one T-cell growth factor is administered, they
can be administered simultaneously or sequentially, in any order,
and by the same route or different routes. Preferably, the T-cell
growth factor, such as IL-2, is administered intravenously as a
bolus injection. The dosage of the T-cell growth factor may be
chosen based on patient tolerance. For example, the T-cell growth
factor may be administered until one or more limiting adverse
events occur. Desirably, the dosage of the T-cell growth factor,
such as IL-2, is what is considered by those of ordinary skill in
the art to be high. Preferably, a dose of about 720,000 IU/kg of
IL-2 is administered three times daily until tolerance,
particularly when the cancer is an HPV-positive cancer. Preferably,
about 5 to about 15 doses of IL-2 are administered, with an average
of around 9 doses.
[0080] In an embodiment, the autologous T-cells may be modified to
express a T cell receptor (TCR) having antigenic specificity for an
HPV antigen, e.g., any of the HPV antigens described herein.
Suitable methods of modification are known in the art. See, for
instance, Green and Sambrook and Ausubel, supra. For example, the T
cells may be transduced to express a T cell receptor (TCR) having
antigenic specificity for an HPV antigen using transduction
techniques described in Heemskerk et al. Hum Gene Ther. 19:496-510
(2008) and Johnson et al. Blood 114:535-46 (2009).
[0081] With respect to the inventive methods, the cancer can be any
cancer, including any of acute lymphocytic cancer, acute myeloid
leukemia, alveolar rhabdomyosarcoma, bone cancer, brain cancer,
breast cancer, cancer of the anus, anal canal, or anorectum, cancer
of the eye, cancer of the intrahepatic bile duct, cancer of the
joints, cancer of the neck, gallbladder, or pleura, cancer of the
nose, nasal cavity, or middle ear, cancer of the oral cavity,
cancer of the vagina, cancer of the vulva, chronic lymphocytic
leukemia, chronic myeloid cancer, colon cancer, esophageal cancer,
cervical cancer, gastrointestinal carcinoid tumor, glioma, Hodgkin
lymphoma, hypopharynx cancer, kidney cancer, larynx cancer, liver
cancer, lung cancer, malignant mesothelioma, melanoma, multiple
myeloma, nasopharynx cancer, non-Hodgkin lymphoma, cancer of the
oropharynx, ovarian cancer, cancer of the penis, pancreatic cancer,
peritoneum, omentum, and mesentery cancer, pharynx cancer, prostate
cancer, rectal cancer, renal cancer, skin cancer, small intestine
cancer, soft tissue cancer, stomach cancer, testicular cancer,
thyroid cancer, cancer of the uterus, ureter cancer, and urinary
bladder cancer. A preferred cancer is cancer is cancer of the
uterine cervix, oropharynx, anus, anal canal, anorectum, vagina,
vulva, or penis. A particularly preferred cancer is HPV-positive
cancer. The HPV-positive cancer may be, for example, HPV
16-positive or HPV 18-positive cancer. While the cancers most
commonly associated with HPV infection include cancer of the
uterine cervix, oropharynx, anus, anal canal, anorectum, vagina,
vulva, and penis, the inventive methods may be used to treat any
HPV-positive cancer, including those that occur at other anatomical
areas.
[0082] As used herein, the term "mammal" refers to any mammal,
including, but not limited to, mammals of the order Rodentia, such
as mice and hamsters, and mammals of the order Logomorpha, such as
rabbits. It is preferred that the mammals are from the order
Carnivora, including Felines (cats) and Canines (dogs). It is more
preferred that the mammals are from the order Artiodactyla,
including Bovines (cows) and Swines (pigs) or of the order
Perssodactyla, including Equines (horses). It is most preferred
that the mammals are of the order Primates, Ceboids, or Simoids
(monkeys) or of the order Anthropoids (humans and apes). An
especially preferred mammal is the human.
[0083] The terms "treat," and "prevent" as well as words stemming
therefrom, as used herein, do not necessarily imply 100% or
complete treatment or prevention. Rather, there are varying degrees
of treatment or prevention of which one of ordinary skill in the
art recognizes as having a potential benefit or therapeutic effect.
In this respect, the inventive methods can provide any amount of
any level of treatment or prevention of cancer in a mammal.
Furthermore, the treatment or prevention provided by the inventive
method can include treatment or prevention of one or more
conditions or symptoms of the disease, e.g., cancer, being treated
or prevented. For example, the treatment or prevention provided by
the inventive method can include promoting the regression of a
tumor. Also, for purposes herein, "prevention" can encompass
delaying the onset of the disease, or a symptom or condition
thereof.
[0084] The following examples further illustrate the invention but,
of course, should not be construed as in any way limiting its
scope.
Example 1
[0085] This example demonstrates a method of preparing HPV-positive
tumor-infiltrating lymphocytes (TIL) for adoptive cell therapy.
[0086] Patients were entered into clinical protocols and signed
informed consents that were approved by the Institutional Review
Board of the National Cancer Institute prior to tumor resection.
Tumors were excised from patients. Tumors were tested for HPV 16
E6, HPV 16 E7, HPV 18 E6, and HPV 18 E7 expression using reverse
transcriptase (RT) polymerase chain reaction (PCR) genotyping.
[0087] Multiple (24) independent cultures of HPV 16 E6 positive,
HPV E7 positive, HPV 18 E6 positive, and HPV E7 positive TIL were
set up using enzymatic digests and tumor fragments (1-2 mm.sup.3)
procured by sharp dissection. TIL from tumor digests were generated
by culturing single-cell suspensions (5.times.10.sup.5/mL) obtained
by overnight enzymatic digestion of tumor fragments in media
containing collagenase, hyaluronidase, and DNAse. Cultures of tumor
fragments and digests were initiated in 2 mL wells of complete
medium (CM) and IL-2 (6000 IU/mL, Chiron Corp., Emeryville, Calif.)
in a humidified 37.degree. C. incubator with 5% CO.sub.2. CM
included RPMI1640 with glutamine, plus 10% human AB serum, 25 mM
HEPES, 10 .mu.g/mL gentamicin, and 5.5.times.10.sup.-5M
2-mercaptoethanol. Five days after initiation, one half of the
media was aspirated from the wells and replaced with fresh CM and
IL-2, and media was replaced every two to three days thereafter as
needed. Under these conditions, lymphocytes will first lyse the
adherent cells in the well, and then begin to multiply and
grow.
[0088] TIL cultures achieved confluent growth of the original 2-mL
well and eliminated adherent tumor cells, typically about 12-28
days after initiation. In practice, this was about 4.times.10.sup.6
lymphocytes from each original tumor fragment or digest well. By
pooling all the wells in a single 24 well plate, approximately
5.times.10.sup.7 TIL cells would be obtained.
[0089] When cultures designated for TIL generation expanded to
confluence in 2-mL wells, they were tested for HPV specific
reactivity. Because the TIL were set up in large numbers (typically
groups of 24 per tumor) it was not feasible to count each TIL
culture individually. The TIL specificity assay measures activity
per volume rather than activity per cell. Each well was mixed
thoroughly, and one hundred microliters of lymphocytes (estimated
1.times.10.sup.5 cells) were washed and cocultured overnight with
autologous tumor digest or autologous monocyte-derived dendritic
cells (DCs) pulsed with HPV 16 and HPV 18 E6 and E7 MACS PEPTIVATOR
peptide pools. The peptide pools included 15-mer peptides with
11-amino-acid overlaps that covered the complete sequence of E6 or
E7 (HPV 16 or HPV 18). The peptide pools were over 75% pure and low
in endotoxin. IFN-.gamma. release was then measured with
enzyme-linked immunosorbent assay (ELISA). The results are shown in
Table A.
TABLE-US-00001 TABLE A Tumor Peptide digest reactivity reactivity
(number (number Patient Primary Site HPV of tumor of tumor Number
of Cancer type fragments).sup.1 fragments).sup.2 1 cervix HPV-18 E7
(22) Yes (4) 2 tonsil HPV-16 E7 (5) -- 3 cervix HPV-18 E6 (7), E7
(19) Yes (3) 4 cervix HPV-16 E6 (18), E7 (23) No 5 cervix HPV-16 E6
(1) No 6 unknown (neck) HPV-16 E6 (23), E7 (22) -- 7 cervix HPV-18
E6 (1), E7 (5) -- 8 cervix HPV-18 E7 (3) -- 9 cervix HPV-18 none No
10 unknown (pelvic) HPV-16 E6 (1) Yes (1) 11 cervix HPV-18 none No
12 cervix HPV-18 E6, E7 -- 13 anus HPV-16 none -- 14 anus HPV-16 E6
-- 15 cervix HPV-16 E6, E7 -- .sup.1Defined as at least one tumor
fragment with >200 pg/mL and twice background (negative control
peptide pool). .sup.2Defined as >200 pg/mL IFN-.gamma., twice
background (TIL alone), and >50% blocking with W6/32 MHC class I
Antibody. "--" indicates not tested.
[0090] Rapid expansion of the numbers of HPV reactive TIL were
performed using the Rapid Expansion Protocol (REP) as previously
described (Dudley et al., J. Immunother., 26:332-42 (2003) and
Riddell et al., J. Immunol. Methods, 128:189-201 (1990)). Briefly,
TIL cells were cultured in gas permeable, G-REX flasks with a 200
fold excess of irradiated (40 Gy) allogeneic peripheral blood
mononuclear "feeder" cells in complete medium (CM) with 30 ng/mL
anti-CD3 antibody and 6000 IU/mL IL-2. Half of the media was
exchanged on day 5 using CM with 6000 IU/mL IL-2, and cells were
split as needed thereafter. TIL expanded an average of more than
3000 fold.
Example 2
[0091] This example demonstrates the reactivity of the TIL from
Patient 1.
[0092] TIL were generated as described in Example 1 from 22
different tumor fragments (F1-F22) from Patient 1. The TIL from
Patient 1 or melanoma TIL (control) were co-cultured with dendritic
cells pulsed with the HPV 18 E7 peptide pool or a gp100 peptide
pool (control) and IFN-.gamma. was measured. The results are shown
in FIGS. 1A-1B. As shown in FIGS. 1A-1B, the TIL from tumor
fragment 22 of Patient 1 recognized an autologous tumor line but
not HPV 18 E7 peptides.
[0093] The TIL from tumor fragments F16, F17, or F22 of Patient 1
or cells given to the patient for treatment ("infusion bag") were
co-cultured with autologous tumor, peripheral blood mononuclear
cells (PBMC) from autologous tissue, tumor cells matched at all
class I loci, HeLa cells (HLA mismatched), or CaSki cells (HLA
mismatched). IFN-.gamma. was measured. The results are shown in
FIG. 2A. As shown in FIG. 2A, TIL from tumor fragments F16 and F22
showed autologous tumor recognition.
[0094] Autologous tumor cells were transfected with silencing RNA
against HLA-A, HLA-B, HLA-C, or irrelevant RNA (non-targeting) and
were co-cultured with TIL from Patient 1. IFN-.gamma. was measured.
The results are shown in FIG. 2B. As shown in FIG. 2B, recognition
of TIL from Patient 1 was diminished by HLA-A silencing.
[0095] Effector/target cells (Patient 1 TIL/autologous tumor cells;
DMFS/624 cells; or Patient 12 (P12) F15/HPV18E6.sub.121-135) were
cultured alone or co-cultured without antibody, with anti-HLA-A2
antibody, or anti-Class II antibody. DMFS cells are T cells
transduced to express a MEW class I-restricted TCR against MART-1.
The results are shown in FIG. 2C. As shown in FIG. 2C, recognition
of TIL from Patient 1 was not inhibited by HLA-A*02 blocking, which
suggested HLA-A*01 restricted tumor recognition. Patient 1's
haplotype was HLA-A*01, HLA-A*02.
[0096] TIL from tumor fragment F16 or F22 of Patient 1; cells given
to the patient for treatment ("infusion bag"); melanoma TIL 1, 2,
or 3 (TIL cultured from melanoma tumors); mE7 TCR (T cells from
PBMC that were transduced to express a TCR against HPV 16 E7ii-19);
or F15 TIL (TIL from another patient that were reactive against HPV
18 E6.sub.121-135, class II-restricted, and therefore blockable
with HB145) were co-cultured with a gp100 peptide pool, OKT3
antibody, or DCs pulsed with an HPV 18 E7 peptide pool, HPV 18 E7
peptide pool and W6/32, HPV 16 E7.sub.11-19, HPV 16 E7.sub.11-19
and W6/32, HPV 16 E7.sub.11-19 and HB145, HPV 18 E6.sub.121-135,
HPV 18 E6.sub.121-135 and W6/32, or HPV 18 E6.sub.121-135 and HB
145. The results are shown in FIG. 3. As shown in FIG. 3, TIL from
tumor fragment F16 of Patient 1 showed class I restricted
recognition of HPV 18 E7 peptides.
Example 3
[0097] This example demonstrates the cloning of TIL from tumor
fragment 16 of Patient 1 to isolate HPV 18 E7 reactive CD8 positive
T cells.
[0098] DCs were loaded with HPV 18 E7 and co-cultured with TIL from
tumor fragment 16 (F16) of Patient 1. The TIL were sorted for 4-1BB
positive cells using fluorescence activated cell sorting (FACS).
The sorted cells were cultured in 96-well plates with two cells per
well. The clones were screened for tumor reactivity against a gp100
peptide pool or a HPV 18 E7 peptide pool. The results are shown in
FIGS. 4A and 4B. As shown in FIGS. 4A and 4B, CD8 positive T cell
cloning from tumor fragment F16 using 4-1BB-based FACS sorting
resulted in the isolation of two clones (12 and 21) with E7 peptide
pool reactivity.
Example 4
[0099] This example demonstrates the reactivity of the TIL
generated in Example 1 from Patient 12.
[0100] TIL were generated as described in Example 1 from 36
different tumor fragments (F1-F36) from Patient 12. The TIL from
Patient 12 or melanoma TIL (control) were co-cultured with
dendritic cells pulsed with the HPV 18 E6 peptide pool, the HPV 18
E7 peptide pool or a gp100 peptide pool (control) and IFN-.gamma.
was measured. The results are shown in FIG. 5. As shown in FIG. 5,
the TIL from the F1 and F15 tumor fragments from Patient 12 showed
the highest levels of IFN-.gamma. production.
[0101] Autologous DCs were transduced with an HPV 18 E6 lentiviral
vector or a green fluorescent protein (GFP) lentiviral vector.
Other autologous cells were pulsed with a gp100 peptide pool or a
HPV 18 E6 peptide pool. Transduced cells were co-cultured with TIL
from tumor fragment F1 of Patient 12, or melanoma TIL 1, 2, or 3.
The results are shown in FIG. 6. As shown in FIG. 6, TIL generated
from tumor fragment F1 of Patient 12 recognized DCs transduced with
HPV 18 E6, suggesting that the TIL target a naturally processed and
presented antigen.
Example 5
[0102] This example demonstrates the reactivity of TIL clones from
tumor fragments 1 and 15 of Patient 12 to isolate HPV 18 E6
reactive CD8 positive T cells.
[0103] DCs were loaded with HPV 18 E6 and co-cultured with TIL from
tumor fragments 1 and 15 of Patient 12. The TIL were sorted for
4-1BB positive cells using FACS. Cells were further sorted into CD4
positive and CD 8 positive populations. The sorted cells were
cultured in 96-well plates with two cells per well. The clones were
screened for tumor reactivity against a HPV 18 E6 peptide pool. Out
of 480 wells of CD4 positive cells from F1, 14 grew and 2 were
reactive. Out of 912 wells of CD8 positive cells from F1, 33 grew
and none were reactive. Out of 470 wells of CD4 positive cells from
F15, 163 grew and 32 were reactive. Out of 960 wells of CD8
positive cells from F15, 41 grew and none were reactive.
[0104] The CD4 sorted cells were also tested for reactivity as
measured by tumor necrosis factor (TNF) a secretion upon co-culture
with a HPV 18 E6 peptide pool (a pool spanning the entire E6
protein), no peptide, subpools of the HPV 18 E6 protein, or
peptides 30-37 of the HPV 18 E6 peptide pool. Each subpool
contained a portion of the initial peptide pool. The results are
shown in FIGS. 7A-7C. As shown in FIGS. 7A-7C, clones 3, 12, and 20
of tumor fragment F1 from Patient 12 were reactive against HPV 18
E6. The CD4 positive T cell clones that were generated recognized
two sequential 15-mers with an 11 amino acid overlap. The peptides
shared the epitope HPV 18 E6.sub.125-135.
Example 6
[0105] This example demonstrates that the clones generated from the
F15 tumor fragment of Patient 12 recognize HPV 18 E6.sub.121-135 in
an HLA-DRB1*15 restricted manner.
[0106] Clones 3, 12, and 20 were co-cultured with donor PBMC with
the haplotypes set forth in Table B. The donor PBMC were pulsed
with HPV 18 E6.sub.121-135.
TABLE-US-00002 TABLE B HLA-DR HLA-DQ HLA-DP Donor 1 13:02 15:01 06
06 04:02 03:01 Donor 2 03:01 04:01 02 03:02 04:02 02:01 Donor 3
13:01 15 06 06 02:01 03:01 Donor 4 03 07:01 02:01 02:02 04:01 01:01
Donor 5 01:02 14 05:01 05:03 04:01 0501 Donor 6 01:01 13:02 05:01
06 5:02 9:01 Patient 12 03 15:01 02 06:02 04:01 09
[0107] TNF.alpha. secretion was measured. The results are shown in
FIGS. 8A-8C. As shown in FIGS. 8A-8C, the clones generated from the
F15 fragment of Patient 12 recognized HPV 18 E6.sub.121-135 pulsed
onto PBMC that were matched at both HLA-DRB1*15 and HLA-DQB1*06,
but not PBMC that were matched at only HLA-DQB1*06, suggesting
HLA-DRB1*15 restriction. The phenotypic allele frequency of
HLA-DRB1*15 is 25 percent.
[0108] The TIL from clone 3 of tumor fragment F15 of Patient 12
were co-cultured with autologous PBMC or donor PBMC pulsed with HPV
18 E6.sub.77-91 or HPV 18 E6.sub.121-135. The results are shown in
FIG. 9A. As shown in FIG. 9A, the TIL from clone 3 of tumor
fragment F15 of Patient 12 recognized PBMC matched only at DRB1*15
but not at only DRB1*06.
[0109] The TIL from clone 20 of tumor fragment F15 of Patient 12
were co-cultured with HPV 18 E6.sub.121-135 in the presence of
antibodies against HLA-DR, HLA-DQ, HLA-DP, pan-class I antibodies,
or pan-class II antibodies. Pan-class I and II antibodies block T
cell binding to MHC Class I or Class II molecules, respectively.
The results are shown in FIG. 9B. As shown in FIG. 9B, the
recognition of cognate peptide by TIL from clone 20 of tumor
fragment F15 of Patient 12 was inhibited by blocking antibodies
against HLA-DR. As shown in FIGS. 9A and 9B, the TIL from tumor
fragment F15 of Patient 12 recognize HPV 18 E6.sub.121-135 in a
DRB1*15 restricted manner.
Example 7
[0110] This example demonstrates the reactivity of TIL from
Patients 4 and 8.
[0111] TIL were generated as described in Example 1 from 24
different tumor fragments (F1-F24) from Patient 4 or Patient 8. The
TIL from Patient 4 or melanoma TIL (control) were co-cultured with
autologous DCs pulsed with the HPV 16 E6 peptide pool, the HPV 16
E7 peptide pool or a gp100 peptide pool (control) and IFN-.gamma.
was measured. The results are shown in FIG. 10. As shown in FIG.
10, the TIL from F4, F5, F14, F19, and F22 tumor fragments were
among those tumor fragments that showed reactivity against
autologous DCs pulsed with HPV 16 E6 and E7 peptide pools.
[0112] The TIL from Patient 8 or melanoma TIL (control) were
co-cultured with autologous DCs pulsed with the HPV 18 E6 peptide
pool, the HPV 18 E7 peptide pool or a gp100 peptide pool (control)
and IFN-.gamma. was measured. The results are shown in FIG. 13. As
shown in FIG. 13, TIL were generated that showed reactivity against
autologous DCs pulsed with the HPV 18 E7 peptide pool.
Example 8
[0113] This example demonstrates the cloning of TIL from tumor
fragments of Patient 4 to isolate HPV reactive CD4 and CD8 positive
T cells.
[0114] DCs were loaded with HPV 16 E6 or HPV 16 E7 and co-cultured
with TIL from tumor fragments of Patient 4. The HPV 16 E6 and HPV
16 E7 reactive TIL were separately sorted for 4-1BB positive cells
using FACS. The numbers of cells were expanded as described in
Example 1. Cells were further sorted into 4-1BB positive cells by
FACS. The sorted cells were cultured in 96-well plates with two
cells per well. Cells were further sorted into CD4 positive and CD8
positive populations. The clones were screened for tumor reactivity
against a HPV 16 E6 or E7 peptide pool.
[0115] The results are shown in FIGS. 11A-11D. As shown in FIGS.
11A-11D, CD8 positive and CD4 positive T cell clones with
reactivity against HPV 16 E6 and E7 were generated.
Example 9
[0116] This example demonstrates that adoptive cell therapy using
anti-HPV T cells treats cancer.
[0117] Inclusion Criteria for the study included (1)
recurrent/refractory or metastatic cervical cancer or high-risk
HPV-positive cancer from any site and (2) prior chemotherapy with
platinum, including chemoradiation.
[0118] Tumors were resected from patients. TIL were obtained from
the tumor, grown, the numbers of TIL were expanded, and the
expanded numbers of TIL were screened for HPV reactivity as
described in Example 1.
[0119] Patients received a non-myeloablative, lymphodepleting
preparative regimen of cyclophosphamide (60 mg/kg/day)
intravenously (IV) on days -7 and -6 and fludarabine (25 mg/m2/day)
IV on days -5 through -1.
[0120] TIL were intravenously administered to the patients on Day
0. A high dose of aldeskeukin (interleukin (IL)-2) (720,000 IU/kg)
was intravenously administered to the patients on Days 0 through
4.
[0121] Patients underwent complete evaluation of tumor 4 to 6 weeks
after the completion of the initial treatment regimen (defined as
the last day of aldesleukin administration). If the patient had
stable disease or tumor shrinkage, repeat complete evaluations were
performed monthly for approximately 3-4 months, and then every 3-4
months until off study criteria are met. All measurable lesions up
to a maximum of 10 lesions representative of all involved organs
were identified as target lesions and recorded and measured at
baseline. All other lesions (or sites of disease) were identified
as non-target lesions and were also recorded at baseline. Lesions
were evaluated according to the Response Evaluation Criteria in
Solid Tumors (RECIST) guideline (version 1.0) as set forth in Table
C (target lesions) and Table D (non-target lesions).
TABLE-US-00003 TABLE C Complete Response (CR) Disappearance of all
target lesions Partial Response (PR) At least a 30% decrease in the
sum of the longest diameter (LD) of target lesions taking as
reference the baseline sum LD. Progression (PD) At least a 20%
increase in the sum of LD of target lesions taking as reference the
smallest sum LD recorded since the treatment started or the
appearance of one or more new lesions. Stable Disease (SD) Neither
sufficient shrinkage to qualify for PR nor sufficient increase to
qualify for PD taking as references the smallest sum LD.
TABLE-US-00004 TABLE D Complete Response (CR) Disappearance of all
non-target lesions and normalization of tumor marker level
Non-Complete Response Persistence of one or more non-target lesions
Progression (PD) Appearance of one or more new lesions. Unequivocal
progression of existing non- target lesions
[0122] Eleven patients were treated. The results are summarized in
Table E.
TABLE-US-00005 TABLE E Response Primary Cells IL-2 (duration in
Patient Gender Age site Histology Disease sites Prior systemic
therapy TIL site (.times.10.sup.9) doses months)* 1 F 30 Cervix
Adeno- Lungs, hilum, Cisplatin Lung 101 7 NR squamous
retroperitoneal, iliac, vaginal cuff 2 M 54 Tonsil Squamous Neck,
soft tissue Docetaxel, cisplatin, 5- Neck soft tissue 89 1 NR
Fluorouracil (FU), cetuximab 3 F 53 Cervix Squamous Lungs, liver,
pelvis Cisplatin, paclitaxel, Lung 126 3 PR (2) carboplatin,
topotecan, ixabepilone, phase I 4 F 35 Cervix Squamous Mediastinum,
hilum, Cisplatin, gemcitabine, Paratracheal 152 2 PR (9+) lung
topotecan, paclitaxel node 5 F 55 Cervix Squamous Axilla, abdominal
Carboplatin, 5-FU, Axillary lymph 7 NR wall irinotecan node (LN) 6
M 60 Unknown Squamous Liver, neck, bone, Carboplatin, cisplatin,
Liver 150 6 NR (neck) chest wall, capecitabine retroperitoneal,
periportal 7 F 44 Cervix Squamous Mediastinum, Cisplatin
aortopulmonary 90 5 NR supraclavicular, brain (AP) window LN 8 F 37
Cervix Adeno Intraperitoneal, Cisplatin right upper 75 8 PR (2+)
retroperitoneal, quadrant (RUQ) abdominal wall, liver
intraperitoneal surface 9 F 59 Cervix Adeno Abdominal wall, lung
Cisplatin, carboplatin, Lung 33 8 Pending paclitaxel, bevacizumab
10 F 58 Unknown Squamous Mediastinum, hilum, Cisplatin, 5-FU, AP
window LN 32 2 Pending (pelvis) lung carboplatin, paclitaxel,
cetuximab, irinotecan 11 F 31 Cervix Adeno- Perihepatic, pelvic
Cisplatin, paclitaxel Pericecal squamous intraperitoneal NR = No
response.
[0123] As shown in Table E, out of the eight patients for which
results were available, adoptive cell therapy with HPV reactive TIL
resulted in three objective responders (OR), all of which were
partial responders (PR). Two partial responses are ongoing at two
months (Patients 3 and 4) following treatment and one partial
response (Patient 8) is ongoing at nine months following
treatment.
[0124] Computed tomography (CT) scans of the chest and pelvis of
Patient 4 were carried out before treatment and nine months after
treatment. The results are shown in FIGS. 12A-F. As shown in FIGS.
12A-B, the cancerous lesion in the paraaortic lymph node had shrunk
by 100% nine months after treatment. As shown in FIGS. 12C-D, the
cancerous lesion in the left lung hilar lymph node had also shrunk
by 100% nine months after treatment. As shown in FIGS. 12E-F, the
cancerous lesion in the common iliac lymph node had also shrunk by
100% nine months after treatment.
[0125] Magnetic resonance imaging (MRI) scans of the liver of
Patient 8 were carried out before treatment and two months after
treatment. The results are shown in FIGS. 14A-14B. As shown in
FIGS. 14A-B, the cancerous mass on the liver shrunk by 100% two
months after treatment. CT scans of the abdomen and pelvis of
Patient 8 were also carried out before treatment and two months
after treatment. The results are shown in FIGS. 14C-H. As shown in
FIGS. 14C-D, the cancerous lesion in the retroperitoneal lymph node
had also shrunk by 100%. As shown in FIGS. 14E-F, the cancerous
mass in the abdominal wall had also shrunk by 100%. In addition, as
shown in FIGS. 14G-H, the cancerous left pericolic mass shrunk
dramatically.
Example 10
[0126] This example provides updated results of the clinical study
described in Example 9 that were obtained nine months after the
results described in Example 9 were obtained. This example
demonstrates that adoptive cell therapy using anti-HPV T cells
treats cancer.
[0127] Methods:
[0128] A clinical trial to treat metastatic HPV+ cancers with
tumor-infiltrating lymphocytes (TIL) selected for HPV E6- and
E7-reactivity (HPV-TIL) was carried out as described in Example 9.
HPV-TIL infusion was preceded by non-myeloablative conditioning and
followed by high-dose bolus aldesleukin as described in Example 9.
HPV-reactivity was assessed by ELISPOT, IFN-gamma production, and
CD137 expression assays.
[0129] Results:
[0130] Nine cervical cancer patients were treated on the study.
They received a median of 81.times.10.sup.9 T cells (range 33 to
152.times.10.sup.9) as a single infusion. The infused cells
possessed reactivity against high-risk HPV E6 and/or E7 in 6/8
patients. The two patients with no HPV reactivity did not respond
to treatment. Three out of six patients with HPV reactivity
demonstrated objective tumor responses by RECIST (1 PR and 2 CR).
One patient had a 39% best response. Two patients with widespread
metastases had complete tumor responses that were ongoing 18 and 11
months after treatment. One patient with a complete response had a
chemotherapy-refractory HPV-16+ squamous cell carcinoma (Patient 4
of Example 9) and the other a chemoradiation-refractory HPV-18+
adenocarcinoma (Patient 8 of Example 9). Both patients demonstrated
prolonged repopulation with HPV-reactive T cells following
treatment. Increased frequencies of HPV-specific T cells were
detectable after 13 months in one patient and 6 months in the
other. Two patients with HPV-reactive TIL that did not respond to
treatment did not display repopulation with HPV-reactive T
cells.
[0131] Six non-cervical cancer patients were also treated on the
study. One patient experienced an objective clinical response, that
is, a partial response of a metastatic tonsil cancer that was
ongoing four months after treatment (FIGS. 20A-J).
[0132] The results are shown in Tables F-G.
TABLE-US-00006 TABLE F HPV-TIL cervical cancer cohort Response HPV
Cells IL-2 (duration in Patient Age Histology type Disease sites
Prior systemic therapy TIL site (.times.10.sup.9) doses months)* 1
30 Adenosquamous HPV- Lungs, hilum, Cisplatin Lung 101 7 PD 18
retroperitoneal, iliac, vaginal cuff 3 53 Squamous HPV- Lungs,
liver, pelvis Cisplatin, paclitaxel, Lung 126 3 PR (3) 18
carboplatin, topotecan, ixabepilone, phase I 4 35 Squamous HPV-
Mediastinum, hilum, lung, Cisplatin, gemcitabine, Paratracheal 152
2 CR (18+) 16 illiac topotecan, paclitaxel node 5 55 Squamous HPV-
Axilla, abdominal wall Carboplatin, 5-FU, Axillary LN 81 7 PD 16
irinotecan 7 44 Squamous HPV- Mediastinum, Cisplatin AP window LN
90 5 PD 18 supraclavicular, brain 8 37 Adeno HPV- Paracolic,
retroperitoneal, Cisplatin RUQ 75 8 CR (11+) 18 abdominal wall,
liver intraperitoneal surface 9 59 Adeno HPV- Abdominal wall, lung
Cisplatin, carboplatin, Lung 33 8 PD 18 paclitaxel, bevacizumab 11
31 Adenosquamous HPV- Perihepatic, pelvic Cisplatin, paclitaxel
Pericecal 46 9 PD 18 12 37 Adeno HPV- Pelvis, retropertioneum,
Carboplatin, paclitaxel, Supraclavicular 70 1 PD 18 axilla,
mediastinum, lung ipilimumab LN *Measured in months from cell
infusion.
TABLE-US-00007 TABLE G HPV-TIL non-cervical cancer cohort Response
Primary Cells IL-2 (duration in Patient Gender Age site Histology
Disease sites Prior systemic therapy TIL site (.times.10.sup.9)
doses months)* Head and neck 2 M 54 Tonsil Squamous Neck, soft
tissue Docetaxel, cisplatin, 5- Neck 89 1 PD FU, cetuximab soft
tissue 6 M 60 Unknown Squamous Liver, neck, bone, chest
Carboplatin, cisplatin, Liver 150 6 PD (neck) wall,
retroperitoneum, capecitabine periportal 13 M 60 Tonsil Squamous
Lung, hilum Docetaxel, cisplatin, Lung 131 5 PR (4+) bevacizumab,
cetuximab, gemcitabine Anal 10 F 58 Unknown Squamous Mediastinum,
hilum, lung Cisplatin, 5-FU, AP 32 2 PD (pelvis carboplatin,
paclitaxel, window with AIN) cetuximab, irinotecan LN 14 F 49 Anal
Squamous Mediastinum, 5-FU, mitomycin, Neck LN 69 3 PD
retroperitoneum, pelvis cisplatin, carboplatin, protein-bound
paclitaxel 15 F 58 Anal Squamous Liver, retroperitoneum, 5-FU,
mitomycin, Liver 48 6 PD pelvis cisplatin *Measured in months from
cell infusion.
[0133] These data show that HPV-TIL can mediate durable, complete
regression of metastatic cervical cancer and that cellular therapy
can mediate complete regression of an epithelial malignancy. These
data also show that HPV-TIL can mediate regression of a metastatic
tonsil cancer.
Example 11
[0134] This example further describes the complete tumor responses
obtained in Example 10 with adoptive cell therapy using anti-HPV T
cells.
Methods
[0135] Hpv-Til Generation:
[0136] Tumor-infiltrating lymphocytes (TIL) were grown from 2 mm
fragments of excised tumors as described previously (Dudley et al.,
J. Immunother., 26(4): 332-42 (2003)). After two to three weeks of
lymphocyte outgrowth, the cultures were assessed for cellular
composition by flow cytometry and for reactivity against HPV
type-specific E6 and E7 by interferon (IFN)-gamma production assay
as described in the Assessment of HPV oncoprotein reactivity
section below. Flow cytometric analysis was performed with
fluorescent antibodies specific for CD3, CD4, CD8, and CD56 (BD
Biosciences). Cultures were selected for additional expansion based
on reactivity against the HPV oncoproteins, rapid growth, high T
cell purity, and high frequency of CD8+ T cells. Expansion to the
cell numbers used for treatment was accomplished with a rapid
expansion protocol with G-REX gas permeable flasks (Dudley et al.,
J. Immunother., 26(4): 332-42 (2003); Jin et al., J. Immunother.,
35(3): 283-92 (2012)). Infusion products were certified for viable
cell numbers, T cell purity (flow cytometry), potency (IFN-.gamma.
production), sterility (microbiological studies), and absence of
tumor cells (cytopathology).
[0137] Patient treatments: Patients had metastatic cervical cancer
and measurable disease. Prior treatment with a platinum agent in
either the primary chemoradiation or metastatic setting was
required. The conditioning regimen consisted of cyclophosphamide 60
mg/kg IV daily for two days followed by fludarabine 25 mg/m.sup.2
IV daily for five days. Cells were administered IV over 20 to 30
minutes. Aldesleukin 720,000 IU/kg/dose IV was initiated within 24
hours of cell infusion and continued every eight hours until
stopped for toxicity or for a maximum of 15 doses. Filgrastim was
initiated the day after cell infusion and continued until
neutrophil counts recovered.
[0138] Tumor Responses:
[0139] Baseline imaging studies were obtained within four weeks
before initiating the conditioning regimen. Follow-up imaging was
obtained six weeks after treatment, monthly for three assessments,
every three months for three assessments, and then every 6 months
for two assessments.
[0140] Assessment of HPV Oncoprotein Reactivity:
[0141] HPV reactivity was determined by coculture of T cells
(40,000 to 100,000 cells) with autologous immature dendritic cells
(40,000 cells) loaded with 1 .mu.M of peptide pools spanning E6,
E7, gp100, or EBNA1 and BZLF1 (Miltenyi Biotec, Bergisch Gladbach,
Germany). Peptide pools included 15-mer peptides overlapping by 11
amino acids. Dendritic cells were generated from the adherent
fraction of peripheral blood mononuclear cells (PBMC) or from CD14+
cells isolated from PBMC using magnetic bead isolation (Miltenyi
Biotec) by culturing in DMEM supplemented with 10% human serum and
1000 IU/ml GM-CSF and 500 IU/ml IL-4 for five to six days. Anti-EBV
control T cells were generated before treatment by culturing PBMC
with EBNA1 and BZLF1 peptide pools (10 .mu.g/mL) in AIM-V/RPMI
media supplemented with 10% human serum and 3000 IU/ml IL-2. For
IFN-.gamma. production assays, the concentration of IFN-.gamma. in
the supernatants was determined after overnight coculture (R&D
Systems (Minneapolis, Minn.) or Thermo Fisher Scientific (Waltham,
Mass.)).
[0142] ELISPOT (Mabtech (Cincinnati, Ohio)) analysis was performed
according to the manufacturer's instructions. Briefly, ELIIP plates
(WAIPSWU from Millipore (Billerica, Mass.)) precoated with capture
antibody (clone 1-D1K, Mabtech) were seeded with 10,000 effector
cells and 40,000 target cells. After 16 to 18 hours of incubation,
IFN-.gamma. secretion was detected by addition of a biotinylated
anti-IFN-.gamma. antibody (7-B6-1 biotin, Mabtech) for two hours at
room temperature. Following incubation with streptavidin-alkaline
phosphatase (Mabtech) for one hour, substrate reagent
(5-bromo-4-chloro-3'-indolyphosphate p-toluidine/nitro-blue
tetrazolium chloride, Kirkegaard & Perry Laboratories, Inc.
(Gaithersburg, Md.)) was added to allow spot formation. Spot
formation was stopped by rinsing with tap water. Spots were counted
using an IMMUNOSPOT automated reader (Cellular Technology, Ltd.
(Shaker Heights, OH)). ELIPSOT responses against E6 or E7 were
defined as positive if more than two times the negative control and
greater than 10 spots/well.
[0143] CD137 upregulation assays were performed by flow cytometric
analysis after 20 to 24 hour coculture (Wolff et al., Blood,
110(1): 201-10 (2007)). Cells were labeled with fluorescent
antibodies against CD137, CD4, CD8, and CD3 (BD Biosciences, San
Jose, Calif.). They were counterstained with propidium iodide (BD
Pharmingen, Franklin Lakes, New Jersey) prior to data acquisition
with a BD FACSCANTO II cell analyzer (BD Biosciences). Data was
analyzed with FLOWJO software, Mac version 10 (TreeStar, Ashland,
Oreg.).
[0144] Immunohistochemistry:
[0145] Immunohistochemical stainings were performed in the
Laboratory of Pathology, NCI, on 4 .mu.M sections from
formalin-fixed, paraffin-embedded metastatic tumors according to
standard procedures. After deparaffinization, rehydration, and
antigen retrieval, tumor sections were incubated with anti-human
CD4 clone 1F6 (Novocastra, Wetzlar, Germany) at a 1:80 dilution for
2 hours, anti-human CD8 clone CD8/144B (Dako Corp., Glostrup,
Denmark) at a 1:50 dilution for 2 hours, or anti-human p16 clone
JC8 (Santa Cruz, Dallas, Tex.) at a 1:200 dilution for 32 minutes.
The CD4 stained slides were stained on an AUTOSTAINER Link 48 (Dako
Corp.) and visualized with the ENVISION FLEX+ detection system
(Dako Corp.). The CD8 and p16 stained slides were stained on a
VENTANA Benchmark XT (Ventana Medical Systems, Tucson, Ariz.) and
visualized with the ULTRAVIEW detection system (Ventana Medical
Systems). Images were captured with 10.times. microscopy.
[0146] Determination of Lymphocyte Subsets from Peripheral
Blood:
[0147] Complete blood counts with manual differential determination
were performed by the Clinical Center Hematology Laboratory.
Lymphocyte phenotyping for T, B, and NK cells was performed by the
NIH Immunology Flow Cytometry Laboratory using standardized
criteria.
[0148] Real-Time Reverse Transcription Polymerase Chain Reaction
(RT-PCR):
[0149] RNA was isolated from a 2 mm fragment of fresh tumor tissue
using an RNEASY kit (Qiagen, Valencia, Calif.). Reverse
transcription first-strand DNA synthesis was performed using
QSCRIPT cDNA supermix (Quanta BioSciences, Gaithersburg, Md.).
Custom made TAQMAN primer and probe sequences (Applied Biosciences,
Foster City, Calif.) were used for HPV16-E6, HPV16-E7, HPV18-E6,
and HPV18-E7. Readily available glyceraldehyde-3-phosphate
dehydrogenase (GAPDH) primer probe set was used to standardize
oncoprotein expression levels (Hs02758991 gl, Applied Biosciences,
Foster City, Calif.). RT-PCR was performed on a 7500 FAST REAL-TIME
PCR System (Applied Biosciences).
[0150] Analysis of Serum Cytokine Levels:
[0151] Levels of 17 cytokines (IL-1(3, IL-2, IL-4, IL-5, IL-6,
IL-7, IL-8, IL-10, IL-12p70, IL-13, IL-17, granulocyte-colony
stimulating factor (G-CSF), granulocyte monocyte-colony stimulating
factor (GM-CSF), IFN-.gamma., monocyte chemotactic protein (MCP)-1,
macrophage inflammatory protein (MIP)-1.beta., and tumor necrosis
factor (TNF)-.alpha. were measured in sera from patients collected
before and after treatment with HPV-TIL using BIO-PLEX Pro Human
Cytokine 17-plex Assay (Bio-Rad Laboratories) according to the
manufacturer's instructions. The cytokine levels were acquired by
the BIO-PLEX 200 system (Bio-Rad).
Case Reports
[0152] Patient 4 was diagnosed with stage 3B poorly-differentiated,
squamous cell cervical cancer fourteen months before treatment with
HPV-TIL. The patient was initially treated with cisplatin,
vincristine, and bleomycin followed by chemoradiotherapy with
gemcitabine plus cisplatin, and brachytherapy. Two months later,
metastatic cancer was detected in paratracheal (biopsy-confirmed),
subcarinal, and bilateral hilar lymph nodes. She received four
cycles of topotecan and paclitaxel before disease progression, and
then was referred for the clinical trial described in Examples 9
and 10. HPV-TIL was prepared from a resected paratracheal lymph
node. The patient received lymphocyte-depleting chemotherapy
followed by a single intravenous infusion of 152.times.10.sup.9
HPV-TIL and two doses of aldesleukin. Aldesleukin dosing was
stopped for patient fatigue. She was discharged from the hospital
after hematological recovery, 12 days after cell infusion.
[0153] Patient 8 was diagnosed with stage IB2 adenocarcinoma of the
uterine cervix 17 months before treatment with HPV-TIL. Her primary
tumor was treated with chemoradiation with cisplatin followed by
brachytherapy. Five months later, she was noted to have a
chemoradiation-refractory primary tumor (biopsy-confirmed). Salvage
surgery identified paraaortic and iliac lymph node involvement and
residual pelvic disease. Her cancer progressed to involve
additional retroperitoneal lymph nodes and the liver surface, and
she developed right hydroureteronephrosis and bilateral pulmonary
emboli, which required a ureteral stent and anticoagulation
therapy. The patient was then treated according to the protocol
described in this Example using HPV-TIL generated from two
peritoneal nodules. She received lymphocyte-depleting chemotherapy
followed by 75.times.10.sup.9 HPV-TIL cells and eight doses of
aldesleukin. Aldesleukin dosing was stopped for hypoxia secondary
to pulmonary edema, which required supplemental oxygen and resolved
with diuresis. Discharge from the hospital was 11 days after cell
infusion.
Complete Clinical Responses
[0154] Both patients had disseminated progressive disease before
treatment (FIG. 12A-F; FIG. 14A-H; FIG. 15 A-B; FIG. 16A-D; FIG.
21A-H; and FIG. 22A-H). Patient 4 had metastatic tumors involving a
paraaortic mediastinal lymph node, bilateral lung hila, subcarinal
lymph nodes, and iliac lymph nodes (FIG. 15 A; FIG. 12A-F; and FIG.
21A-H). Patient 8 had metastatic cancer involving at least seven
sites: two tumors on the liver surface, paraaortic and aortocaval
lymph nodes, the abdominal wall, a pericolic mass in the left
pelvis, and a nodule obstructing the right ureter (FIG. 15 B; FIG.
14A-H; FIG. 16A-D; and FIG. 22A-H). Each patient was treated with a
single infusion of T cells, which resulted in tumor regression that
occurred over months (FIG. 15A-B). Both patients experienced
objective complete tumor responses, which were ongoing 18 and 11
months after treatment (FIG. 21A-H (Patient 4) and FIG. 22A-H
(Patient 8). A previously placed ureteral stent was removed from
Patient 8 following regression of the tumor obstructing her right
ureter (FIGS. 22G and H). Neither patient received additional
therapy. Both patients have returned to full-time employment.
Toxicity of HPV-TIL
[0155] There were no acute toxicities related to cell infusion. No
autoimmune adverse events occurred. Both patients displayed
transient serum cytokine elevations (FIG. 17A-B) that were
associated with fevers, but neither patient developed severe
cytokine release syndrome. The levels of cytokines in cryopreserved
serum were determined. Testing was for the following cytokines:
IL-1(3, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12(p70),
IL-13, IL-17, G-CSF, Granulocyte macrophage colony-stimulating
factor (GM-CSF), IFN-.gamma., MCP-1, Macrophage inflammatory
protein 1 beta (MIP-1(3), and TNF-.alpha.. Cytokines with levels
greater than twofold baseline on two consecutive measurements are
displayed. Aldesleukin was dosed every eight hours after cell
infusion (Patient 4 received two doses and Patient 8 received eight
doses). GCSF was administered daily beginning the day after cell
infusion and continued until neutrophil counts recovered (Patient 4
received 11 doses and Patient 8 received nine doses).
[0156] Aldesleukin was dosed to tolerance by protocol design,
stopping for fatigue in Patient 4 and dyspnea in Patient 8. Grade 3
and grade 4 adverse events are listed in Table H. The most common
toxicities were hematological and the expected effects of the
lymphocyte-depleting conditioning regimen (cyclophosphamide and
fludarabine).
TABLE-US-00008 TABLE H Toxicity Patient 4 Patient 8 Anemia X X
Neutropenia X X Lymphopenia X X Leukopenia X X Thrombocytopenia X X
Febrile Neutropenia X X Infection X Fatigue X Nausea/Vomiting X X
Syncope.sup..dagger. X Lower gastrointestinal (GI) X hemorrhage*
Hematuria* X Hypophosphatemia X .sup..dagger.A single episode of
unknown etiology 15 days after treatment. *Associated with
radiation cystitis and colitis.
Tumor Antigen Expression and T Cell Infiltration
[0157] Metastatic tumors excised for the generation of HPV-TIL were
a squamous cell carcinoma from Patient 4 and an adenocarcinoma from
Patient 8. The malignant cells expressed p16INK4A, a sensitive
indicator of high-risk HPV-infection. The HPV type and the
expression levels of E6 and E7, the target antigens of HPV-TIL,
were determined for each patient's tumor by real-time reverse
transcription polymerase chain reaction (RT-PCR). Patient 4 had a
HPV-16+ cancer and Patient 8 had a HPV-18+ cancer. The T cell
infiltrate in tumors from both patients showed a mixed composition
with predominantly CD8+ cells in Patient 4 and CD4+ cells in
Patient 8. Both CD4+ and CD8+ T cells grew from the excised tumors.
The infused HPV-TIL were composed of 19% CD4+ and 79% CD8+ T cells
for Patient 4, and 15% CD4+ and 87% CD8+ T cells for Patient 8.
HPV Oncoprotein Targeting by HPV-TIL
[0158] The HPV-TIL administered to Patient 4 were reactive against
both the E6 and E7 oncoproteins as demonstrated by interferon
(IFN)-.gamma. production and ELISPOT assays (FIGS. 18A and C). Five
percent and greater than seven percent of the infused cells showed
responses to E6 or E7, respectively by ELISPOT assay (FIGS. 18C and
D). E6 responses were CD8+ T cell-mediated, and E7 responses were
CD4+ and CD8+ T cell-mediated. In total, 14 percent of the infused
cells displayed HPV reactivity as measured by CD137 upregulation
assay. For Patient 8, HPV-TIL were reactive against E7 (FIG. 18B),
with four percent of T cells responding to the antigen by ELISPOT
assay (FIG. 18D). This response was primarily mediated by CD4+ T
cells.
Repopulation with Oncoprotein Reactive T Cells
[0159] HPV-TIL infusion was followed by rapid increases in
peripheral blood CD4+ and CD8+ T cells but not NK and B cells (FIG.
19A-B). Expansion of the numbers of infused T cells was associated
with establishment and persistence of peripheral blood T cell
reactivity against the HPV oncoproteins as measured by IFN-.gamma.
production, ELISPOT, and CD137 upregulation assays (FIG. 19C-F).
Both patients had little, if any, reactivity against E6 or E7 prior
to treatment. Following treatment, Patient 4 acquired robust T cell
recognition of E6 and E7. For Patient 8, this recognition was
weaker but nonetheless detectable and, consistent with the infused
T cells, directed against only E7. One-month after treatment, 12
percent of Patient 4's peripheral blood T cells were oncoprotein
reactive (seven percent against E6 and five percent against E7)
(FIG. 19E). Reactivity against these antigens was sustained with
one percent of peripheral blood T cells showing oncoprotein
recognition four and 13 months after cell infusion (FIG. 19E).
Patient 8 showed 0.4 percent HPV reactive T cells one-month after
treatment (FIG. 19F). This reactivity was sustained, albeit at
lower levels, three and six months after treatment (FIGS. 19 D and
F). Consistent with the reactivity of the T cell subsets in the
infused HPV-TIL, the HPV specific T cells that repopulated the
patients were primarily E6 and E7 reactive CD8+ T cells for Patient
4, and E7 reactive CD4+ T cells for Patient 8.
Example 12
[0160] This example provides updated results of Patients 4 and 8
from the clinical study described in Examples 10 and 11 that were
obtained four months after the results described in Examples 10 and
11 were obtained. This example demonstrates that adoptive cell
therapy using anti-HPV T cells treats cancer.
[0161] The objective complete tumor responses of Patients 4 and 8,
who were treated as described in Examples 10 and 11, were ongoing
22 and 15 months after treatment, respectively.
[0162] All references, including publications, patent applications,
and patents, cited herein are hereby incorporated by reference to
the same extent as if each reference were individually and
specifically indicated to be incorporated by reference and were set
forth in its entirety herein.
[0163] The use of the terms "a" and "an" and "the" and "at least
one" and similar referents in the context of describing the
invention (especially in the context of the following claims) are
to be construed to cover both the singular and the plural, unless
otherwise indicated herein or clearly contradicted by context. The
use of the term "at least one" followed by a list of one or more
items (for example, "at least one of A and B") is to be construed
to mean one item selected from the listed items (A or B) or any
combination of two or more of the listed items (A and B), unless
otherwise indicated herein or clearly contradicted by context. The
terms "comprising," "having," "including," and "containing" are to
be construed as open-ended terms (i.e., meaning "including, but not
limited to,") unless otherwise noted. Recitation of ranges of
values herein are merely intended to serve as a shorthand method of
referring individually to each separate value falling within the
range, unless otherwise indicated herein, and each separate value
is incorporated into the specification as if it were individually
recited herein. All methods described herein can be performed in
any suitable order unless otherwise indicated herein or otherwise
clearly contradicted by context. The use of any and all examples,
or exemplary language (e.g., "such as") provided herein, is
intended merely to better illuminate the invention and does not
pose a limitation on the scope of the invention unless otherwise
claimed. No language in the specification should be construed as
indicating any non-claimed element as essential to the practice of
the invention.
[0164] Preferred embodiments of this invention are described
herein, including the best mode known to the inventors for carrying
out the invention. Variations of those preferred embodiments may
become apparent to those of ordinary skill in the art upon reading
the foregoing description. The inventors expect skilled artisans to
employ such variations as appropriate, and the inventors intend for
the invention to be practiced otherwise than as specifically
described herein. Accordingly, this invention includes all
modifications and equivalents of the subject matter recited in the
claims appended hereto as permitted by applicable law. Moreover,
any combination of the above-described elements in all possible
variations thereof is encompassed by the invention unless otherwise
indicated herein or otherwise clearly contradicted by context.
* * * * *