To improve the success of IL-15 supplementation for CAR T cell therapy, Hirayama and Chou et al. evaluated a novel pegylated polymer-conjugated IL-15 (NKTR-255) with improved pharmacokinetic and pharmacodynamic properties. In non-human primates, NKTR-255 enhanced T (CD8+ and CD4+) and NK cell proliferation in vitro and induced dose-dependent human CD19 CAR T proliferation, even at low target levels. In a murine lymphoma model, the addition of NKTR-255 resulted in superior human CD19 CAR T efficacy and robust and sustained persistence of functional CAR T cells, compared with CAR T cell therapy alone.

Contributed by Katherine Turner

Chimeric antigen receptor (CAR)-modified T cell (CAR-T) therapies targeting CD19 represent a new treatment for patients with relapsed/refractory (R/R) B-cell malignancies. However, CAR-T therapy fails to elicit durable responses in a significant fraction of patients. Limited in vivo proliferation and survival of infused CAR-T are key causes of failure. In a phase I/II clinical trial of CD19 CAR-T for B-cell malignancies (NCT01865617), low serum interleukin-15 (IL-15) concentration after CAR-T infusion was associated with inferior CAR-T kinetics. IL-15 supports T cell proliferation and survival, and therefore supplementation of IL-15 may enhance CAR-T therapy. However, clinical use of native IL-15 is challenging due to its unfavorable pharmacokinetics and toxicity. NKTR-255 is a polymer-conjugated IL-15 that engages the entire IL-15 receptor complex (IL-15R/IL-2Rβɣ) and exhibits reduced clearance, providing sustained pharmacodynamic responses. We investigated pharmacokinetics and immune cell pharmacodynamics in non-human primates treated with NKTR-255 and found that NKTR-255 enhanced in vivo proliferation of T and NK cells. In vitro, NKTR-255 induced dose-dependent proliferation and accumulation of human CD19 CAR-T, especially at low target cell abundance. In vivo studies in lymphoma-bearing immunodeficient mice demonstrated enhanced antitumor efficacy of human CD19 CAR-T. In contrast to mice treated with CAR-T alone, those that received CAR-T and NKTR-255 had markedly higher CAR-T counts in blood and marrow that were sustained after tumor clearance, without evidence of persistent proliferation or ongoing activation/exhaustion assessed by Ki-67 and inhibitory receptor co-expression. These data support an ongoing phase I clinical trial of combined CD19 CAR-T and NKTR-255 for R/R B-cell malignancies. This trial is registered at www.clinicaltrials.gov as NCT01865617.

Author Info: (1) Fred Hutchinson Cancer Center, Seattle, Washington, United States. (2) Genentech, South San Francisco, California, United States. (3) Nektar Therapeutics, San Francisco (CA), U

Author Info: (1) Fred Hutchinson Cancer Center, Seattle, Washington, United States. (2) Genentech, South San Francisco, California, United States. (3) Nektar Therapeutics, San Francisco (CA), USA, San Francisco, California, United States. (4) Fred Hutchinson Cancer Research Center, Seattle, Washington, United States. (5) Fred Hutchinson Cancer Center, Seattle, Washington, United States. (6) Institute for Medical Microbiology Immunology and Hygiene, Technical University Munich, Munich, Germany. (7) Fred Hutchinson Cancer Research Center, Seattle, Washington, United States. (8) Fred Hutchinson Cancer Center, Seattle, Washington, United States. (9) Fred Hutchinson Cancer Research Center, Seattle, United States. (10) Nektar Therapeutics, San Francisco (CA), USA, San Francisco, California, United States. (11) Fred Hutchinson Cancer Research Center, Seattle, Washington, United States. (12) Nektar Therapeutics, San Francisco, California, United States. (13) Fred Hutchinson Cancer Research Centre, Seattle, Washington, United States.