@article {Ishiharae003811, author = {Mikiya Ishihara and Shigehisa Kitano and Shinichi Kageyama and Yoshihiro Miyahara and Noboru Yamamoto and Hidefumi Kato and Hideyuki Mishima and Hiroyoshi Hattori and Takeru Funakoshi and Takashi Kojima and Tetsuro Sasada and Eiichi Sato and Sachiko Okamoto and Daisuke Tomura and Ikuei Nukaya and Hideto Chono and Junichi Mineno and Muhammad Faris Kairi and Phuong Diem Hoang Nguyen and Yannick Simoni and Alessandra Nardin and Evan Newell and Michael Fehlings and Hiroaki Ikeda and Takashi Watanabe and Hiroshi Shiku}, title = {NY-ESO-1-specific redirected T cells with endogenous TCR knockdown mediate tumor response and cytokine release syndrome}, volume = {10}, number = {6}, elocation-id = {e003811}, year = {2022}, doi = {10.1136/jitc-2021-003811}, publisher = {BMJ Specialist Journals}, abstract = {Background Because of the shortage of ideal cell surface antigens, the development of T-cell receptor (TCR)-engineered T cells (TCR-T) that target intracellular antigens such as NY-ESO-1 is a promising approach for treating patients with solid tumors. However, endogenous TCRs in vector-transduced T cells have been suggested to impair cell-surface expression of transduced TCR while generating mispaired TCRs that can become self-reactive.Methods We conducted a first-in-human phase I clinical trial with the TCR-transduced T-cell product (TBI-1301) in patients with NY-ESO-1-expressing solid tumors. In manufacturing TCR-T cells, we used a novel affinity-enhanced NY-ESO-1-specific TCR that was transduced by a retroviral vector that enables siRNA (small interfering RNA)-mediated silencing of endogenous TCR. The patients were divided into two cohorts. Cohort 1 was given a dose of 5{\texttimes}108 cells (whole cells including TCR-T cells) preconditioned with 1500 mg/m2 cyclophosphamide. Cohort 2 was given 5{\texttimes} 109 cells preconditioned with 1500 mg/m2 cyclophosphamide.Results In vitro study showed that both the CD8+ and CD4+ T fractions of TCR-T cells exhibited cytotoxic effects against NY-ESO-1-expressing tumor cells. Three patients and six patients were allocated to cohort 1 and cohort 2, respectively. Three of the six patients who received 5{\texttimes}109 cells showed tumor response, while three patients developed early-onset cytokine release syndrome (CRS). One of the patients developed a grade 3 lung injury associated with the infiltration of the TCR-T cells. No siRNA-related adverse events other than CRS were observed. Cytokines including interleukin 6 I and monocyte chemotactic protein-1/chemokine (C-C motif) ligand (CCL2)increased in the sera of patients with CRS. In vitro analysis showed these cytokines were not secreted from the T cells infused. A significant fraction of the manufactured T cells in patients with CRS was found to express either CD244, CD39, or both at high levels.Conclusions The trial showed that endogenous TCR-silenced and affinity-enhanced NY-ESO-1 TCR-T cells were safely administered except for grade 3 lung injury. The TCR-T cell infusion exhibited significant tumor response and early-onset CRS in patients with tumors that express NY-ESO-1 at high levels. The differentiation properties of the manufactured T cells may be prognostic for TCR-T-related CRS.Trial registration number NCT02366546.Data are available on reasonable request.}, URL = {https://jitc.bmj.com/content/10/6/e003811}, eprint = {https://jitc.bmj.com/content/10/6/e003811.full.pdf}, journal = {Journal for ImmunoTherapy of Cancer} }