Tumor response and endogenous immune reactivity after administration of HER2 CAR T cells in a child with metastatic rhabdomyosarcoma

M Hegde, SK Joseph, F Pashankar, C DeRenzo… - Nature …, 2020 - nature.com
Nature communications, 2020nature.com
Refractory metastatic rhabdomyosarcoma is largely incurable. Here we analyze the
response of a child with refractory bone marrow metastatic rhabdomyosarcoma to
autologous HER2 CAR T cells. Three cycles of HER2 CAR T cells given after
lymphodepleting chemotherapy induces remission which is consolidated with four more
CAR T-cell infusions without lymphodepletion. Longitudinal immune-monitoring reveals
remodeling of the T-cell receptor repertoire with immunodominant clones and serum …
Abstract
Refractory metastatic rhabdomyosarcoma is largely incurable. Here we analyze the response of a child with refractory bone marrow metastatic rhabdomyosarcoma to autologous HER2 CAR T cells. Three cycles of HER2 CAR T cells given after lymphodepleting chemotherapy induces remission which is consolidated with four more CAR T-cell infusions without lymphodepletion. Longitudinal immune-monitoring reveals remodeling of the T-cell receptor repertoire with immunodominant clones and serum autoantibodies reactive to oncogenic signaling pathway proteins. The disease relapses in the bone marrow at six months off-therapy. A second remission is achieved after one cycle of lymphodepletion and HER2 CAR T cells. Response consolidation with additional CAR T-cell infusions includes pembrolizumab to improve their efficacy. The patient described here is a participant in an ongoing phase I trial (NCT00902044; active, not recruiting), and is 20 months off T-cell infusions with no detectable disease at the time of this report.
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