1.
First-in-Human Chimeric antigen receptor (CAR) T
cell Therapies: Promises and Challenges
Prof. Eric RAYMOND MD, PhD
Chair of Medical Oncology @ Groupe Hospitalier Paris Saint-Joseph – France
(eraymond@hpsj.fr)

2.
Disclosures
• Pfizer
• Novartis
• Eli Lilly
• Ipsen
• Celgen
• AFR-Oncology
• Genoscience Pharma
• SCOR

3.
Phase I Trial of CD19-Targeted T-Cell Therapy in Adults With R/R B-Cell ALL
• Patient characteristics:
• 51 pts evaluable for toxicity assessment
• 50 pts evaluable for response assessment with ≥ 1 mos of follow-up
• Activity results:
• Morphologic disease: 31/51 (61%) pts
• Minimal disease: 20/51 (39%) pts
• Follow-up:
• Median: 8.5 mos (range: 1-54), data cutoff date of 5/2/16
• 29/50 (58%) pts with ≥ 6 mos of follow-up
• 17/50 (34%) pts with ≥ 1 yr of follow-up
Park JH, et al. ASCO 2016. Abstract 7003.

4.
Various ways of directing immunity against cancer cells

5.
Engineering of CAR-T cell receptor
CAR, chimeric antigen receptor; mAb,
monoclonal antibody; TAA, tumor-associated
antibody; TCR, T-cell receptor.
Sadelain M, et al. Nat Rev Cancer. 2003;3:35-45.

6.
CAR gene transduction in T-cells
Sadelain M, et al. Nat Rev Cancer. 2003;3:35-45. Brentjens RJ, et al. Nat Med. 2003;9:279-286.

7.
Upgraded generations of CARs
Jessica Hartmann et al. EMBO Mol Med. 2017

8.
General processes for TCR/CAR-T cell therapy
Jessica Hartmann et al. EMBO Mol Med. 2017

9.
Theoretical benefits of CAT-T cell therapy
• HLA-independent antigen recognition
• Active in both CD4+ and CD8+ T-cells
• Target antigens include proteins, carbohydrates, and glycolipids
• Rapid generation of tumor specific T-cells
• Minimal risk of autoimmunity or GVHD
• A living drug, single infusion

10.
Main companies involved in CAR-T cell therapy
• JONO Therapeutics (Celgene)
• KITE pharma (Gilead)
• Novartis
• Cellectis (Pfizer – Servier)

11.
Overview of clinical trials using CAT-T cells
Jessica Hartmann et al. EMBO Mol Med. 2017

12.
Overview of clinical trials using CAR-T cells
Jessica Hartmann et al. EMBO Mol Med. 2017

13.
Phase I Trial of CD19-Targeted T-Cell Therapy in Adults With R/R B-Cell ALL
Brentjens RJ, et al. Sci Transl Med. 2013;5:177ra38.

14.
Phase I Trial of CD19-Targeted T-Cell Therapy in Adults With R/R B-Cell ALL
• Patient characteristics:
• 51 pts evaluable for toxicity assessment
• 50 pts evaluable for response assessment with ≥ 1 mos of follow-up
• Activity results:
• Morphologic disease: 31/51 (61%) pts
• Minimal disease: 20/51 (39%) pts
• Follow-up:
• Median: 8.5 mos (range: 1-54), data cutoff date of 5/2/16
• 29/50 (58%) pts with ≥ 6 mos of follow-up
• 17/50 (34%) pts with ≥ 1 yr of follow-up
Park JH, et al. ASCO 2016. Abstract 7003.

15.
Scans from Dr. Rosenberg NCI
Ongoing Complete Response
15+ months in a patient with
chemo-refractory PMBCL
A patient with recurrent DLBCL
post-SCT treated with anti-
CD19 CAR T cells
Example of response under CAR-T cell therapy
Before Treatment Post Treatment
Kochenderfer Blood 2012; Kochenderfer JCO 2015; Kochenderfer ASH 2014

16.
Phase I Trial of CD19-Targeted T-Cell Therapy in Adults With R/R B-Cell ALL
•Post–CAR T-Cell Infusion Clinical Courses
• 16 of 41 CR (39%) pts proceeded to allogeneic HSCT after
achieving CR to CAR T-cells
• By disease burden cohort:
• 9/23 (39%) pts in morphologic disease cohort
• 7/18 (39%) pts in minimal disease cohort
• 15/33 MRD-CR (45%) pts relapsed
• 4/15 (27%) relapses were CD19 negative/undetectable
• 9/33 (27%) pts remain disease free for > 1 yr
Park JH, et al. ASCO 2016. Abstract 7003.

17.
Outcomes of CD19-Specific CAR T-Cell Therapy in Pts With B-Cell ALL
Preconditioning chemo was used in all trials
Jackson HJ, et al. Nat Rev Clin Oncol. 2016;13:370-383.
Institution
CAR
Design
Pt Population CR, % Toxicities NCT#
MSKCC CD28, CD3ζ
§ n = 32 adults
§ R/R B-cell ALL
91
§ B-cell aplasia
§ CRS
NCT01044069
UPenn/Children’s
Hospital of
Philadelphia
4-1BB, CD3ζ
§ n = 30 children and
young adults
§ B-cell ALL
90
§ B-cell aplasia
§ CRS
NCT01626495
NCI CD28, CD3ζ
§ n = 20 children and
young adults
§ B-cell ALL
70
§ B-cell aplasia
§ CRS
NCT01593696
Fred Hutchinson
Cancer Center
4-1BB, CD3ζ
§ n = 20 adults
§ B-cell ALL
83 § CRS NCT01865617

18.
Overview of activity of CAR-T cell therapy
Jessica Hartmann et al. EMBO Mol Med. 2017

19.
Adverse events in CAR T-Cell Therapy
• Often severe and require specific/hematologic resuscitation units
• Cytokine release syndrome (CRS) G3/4 in 42% of patients
• Fever
• Hypotension
• Respiratory insufficiency
• Neurologic toxicity in G3/4 in 35% of patients
• Delirium
• Global encephalopathy
• Aphasia
• Seizure-like symptom/seizure
• Neurologic symptoms are reversible and can occur independent of CRS
• Treatment related death in about 10% of patients
Park JH, et al. ASCO 2016. Abstract 7003.

20.
Severe toxicities related to CAR-T cell therapy
Jessica Hartmann et al. EMBO Mol Med. 2017

21.
Hurdles and possible solutions for CAR T cell therapy
Jessica Hartmann et al. EMBO Mol Med. 2017

22.
Ipilimumab, marketed as Yervoy. The cost for four doses
administered over 12 weeks: $120,000 US
Novartis’ just-approved chimeric antigen
receptor (CAR) T-cell therapy tisagenlecleucel
(KYMRIAH) is going to be introduced on the
market at a price of $475,000 for a single
infusion (total cost 1,5 millions US dollars)
Cost of CAR-T cell therapy compared to other immunotherapy

23.
Conclusions
• CAR-T cell therapy is the first model where industry enters into industrial gene
engineering for cell therapy using limited numbers of selected centers (for technology and
safety issues) where patients have to be referred for therapy
• Proof of concept has been demonstrated in CD19-expressing leukemia, also showing a
high level of toxicity making this therapy restricted to a limited number of patients (at least
until safety and drug-related death could be improved)
• Tumor heterogeneity (variation of antigens of interest) & CAR-T cell number (dose) and
distribution (how much CAR-T cell reach cancer sites) in tumor appear far more complex
than expected both in leukemia (potentially explain failures) and in solid tumors (where
activity seems to be lower)

24.
Thanks for your attention
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