By analyzing tumor biopsies from 51 patients in the phase 2 trial for Axicabtagene ciloleucel (anti-CD19 CAR T cell therapy approved for r/rLBCL), Scholler et al. showed differences between the rapid (2-4 wk) broad changes in immune profiles in the post-treatment TME of responders and nonresponders. Patients with high Th cell TME density and low tumor burden had CR and higher T cell TME density pre- and post- therapy. Low blood CAR T cell expansion was associated with exhausted CTLs in the post-treatment TME. High Treg cell density in the pre-treatment TME was associated with less therapy-related neurologic toxicity and, unexpectedly, other favorable TME features.
Contributed by Paula Hochman
ABSTRACT: Axicabtagene ciloleucel (axi-cel) is an anti-CD19 chimeric antigen receptor (CAR) T cell therapy approved for relapsed/refractory large B cell lymphoma (LBCL) and has treatment with similar efficacy across conventional LBCL subtypes. Toward patient stratification, we assessed whether tumor immune contexture influenced clinical outcomes after axi-cel. We evaluated the tumor microenvironment (TME) of 135 pre-treatment and post-treatment tumor biopsies taken from 51 patients in the ZUMA-1 phase 2 trial. We uncovered dynamic patterns that occurred within 2 weeks after axi-cel. The biological associations among Immunoscore (quantification of tumor-infiltrating T cell density), Immunosign 21 (expression of pre-defined immune gene panel) and cell subsets were validated in three independent LBCL datasets. In the ZUMA-1 trial samples, clinical response and overall survival were associated with pre-treatment immune contexture as characterized by Immunoscore and Immunosign 21. Circulating CAR T cell levels were associated with post-treatment TME T cell exhaustion. TME enriched for chemokines (CCL5 and CCL22), γ-chain receptor cytokines (IL-15, IL-7 and IL-21) and interferon-regulated molecules were associated with T cell infiltration and markers of activity. Finally, high density of regulatory T cells in pre-treatment TME associated with reduced axi-cel-related neurologic toxicity. These findings advance the understanding of LBCL TME characteristics associated with clinical responses to anti-CD19 CAR T cell therapy and could foster biomarker development and treatment optimization for patients with LBCL.