Focusing on preventing antigen escape in MM following CAR T cell therapy, Zah et al. designed and evaluated 10 single-chain bispecific BCMA/CS1 (OR-gate) CAR T cells to combine uniform CS1 expression and potent antitumor BCMA efficacy. Several BCMA/CS1 CAR T cell designs had superior expression, function, and manufacturability, and in vivo, prevented antigen escape compared to T cells that co-expressed individual BCMA and CS1 (Dual) CARs. Combination with anti-PD-1 increased initial antitumor efficacy, but relapsed at later time points, suggesting anti-PD-1 mediated exhaustion in the absence of antigen.
Contributed by Katherine Turner
ABSTRACT: Chimeric antigen receptor (CAR)-T cell therapy has shown remarkable clinical efficacy against B-cell malignancies, yet marked vulnerability to antigen escape and tumor relapse exists. Here we report the rational design and optimization of bispecific CAR-T cells with robust activity against heterogeneous multiple myeloma (MM) that is resistant to conventional CAR-T cell therapy targeting B-cell maturation antigen (BCMA). We demonstrate that BCMA/CS1 bispecific CAR-T cells exhibit superior CAR expression and function compared to T cells that co-express individual BCMA and CS1 CARs. Combination therapy with anti-PD-1 antibody further accelerates the rate of initial tumor clearance in vivo, while CAR-T cell treatment alone achieves durable tumor-free survival even upon tumor re-challenge. Taken together, the BCMA/CS1 bispecific CAR presents a promising treatment approach to prevent antigen escape in CAR-T cell therapy against MM, and the vertically integrated optimization process can be used to develop robust cell-based therapy against novel disease targets.