Anti-Mesothelin CAR T cell therapy for malignant mesothelioma

Biomarker Research

Nico van Zandwijk¹  Laura Castelletti²  Dannel Yeo²  John E. J. Rasko³ 

[1] Concord Repatriation General Hospital, Sydney Local Health District (SLHD), Concord, Australia;Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia;Cell and Molecular Therapies, Royal Prince Alfred Hospital, Sydney Local Health District (SLHD), Camperdown, Australia;Li Ka Shing Cell & Gene Therapy Program, The University of Sydney, Camperdown, Australia;Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia;Cell and Molecular Therapies, Royal Prince Alfred Hospital, Sydney Local Health District (SLHD), Camperdown, Australia;Li Ka Shing Cell & Gene Therapy Program, The University of Sydney, Camperdown, Australia;Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia;Cell and Molecular Therapies, Royal Prince Alfred Hospital, Sydney Local Health District (SLHD), Camperdown, Australia;Gene and Stem Cell Therapy Program Centenary Institute, The University of Sydney, Camperdown, Australia;

关键词: Cancer;    Malignant mesothelioma;    Malignant pleural mesothelioma;    Mesothelin;    CAR T cells;    Tumor microenvironment;    Immunotherapy;   

DOI  :  10.1186/s40364-021-00264-1

来源: Springer

【 摘 要 】

Malignant mesothelioma (MM) is a treatment-resistant tumor originating in the mesothelial lining of the pleura or the abdominal cavity with very limited treatment options. More effective therapeutic approaches are urgently needed to improve the poor prognosis of MM patients. Chimeric Antigen Receptor (CAR) T cell therapy has emerged as a novel potential treatment for this incurable solid tumor. The tumor-associated antigen mesothelin (MSLN) is an attractive target for cell therapy in MM, as this antigen is expressed at high levels in the diseased pleura or peritoneum in the majority of MM patients and not (or very modestly) present in healthy tissues. Clinical trials using anti-MSLN CAR T cells in MM have shown that this potential therapeutic is relatively safe. However, efficacy remains modest, likely due to the MM tumor microenvironment (TME), which creates strong immunosuppressive conditions and thus reduces anti-MSLN CAR T cell tumor infiltration, efficacy and persistence. Various approaches to overcome these challenges are reviewed here. They include local (intratumoral) delivery of anti-MSLN CAR T cells, improved CAR design and co-stimulation, and measures to avoid T cell exhaustion. Combination therapies with checkpoint inhibitors as well as oncolytic viruses are also discussed. Preclinical studies have confirmed that increased efficacy of anti-MSLN CAR T cells is within reach and offer hope that this form of cellular immunotherapy may soon improve the prognosis of MM patients.

【 授权许可】

CC BY