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2066 Phase 1 Dose-Escalation and Dose-Expansion Study to Evaluate the Safety and Tolerability of Anti-CD7 Allogeneic CAR T-Cells (WU-CART-007) in Patients with CD7+ T-Cell Non-Hodgkin Lymphoma

Program: Oral and Poster Abstracts
Session: 704. Cellular Immunotherapies: Early Phase Clinical Trials and Toxicities: Poster I
Hematology Disease Topics & Pathways:
Research, Clinical trials, Adult, Lymphomas, Non-Hodgkin lymphoma, Clinical Research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, T Cell lymphoma, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies, Study Population, Human
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Michael H. Kramer, MD, PhD1, Neha Mehta-Shah, MD2, Michael P. Rettig, PhD3, Katherine Stricker3*, Melinda Harding3*, Feng Gao4*, Brett Ramsey, MBA5*, Peter Westervelt, MD3, Jan K Davidson-Moncada, MD, PhD, MSc5, Armin Ghobadi, MD2, John F. DiPersio, MD, PhD3 and Geoffrey L. Uy, MD6

1Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
2Division of Oncology, Washington University School of Medicine, St. Louis, MO
3Division of Oncology, Washington University School of Medicine, Saint Louis, MO
4Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, Saint Louis, MO
5Wugen, Saint Louis, MO
6Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO

INTRODUCTION: Effective treatment options for relapsed/refractory T-cell non-Hodgkin lymphoma (T-NHL) represent a significant unmet medical need. Chimeric antigen receptor (CAR) T-cell therapy has offered durable remissions and cures in B-cell malignancies. There are not yet FDA approved CAR T cell therapies for T-NHL, partially due to a lack of suitable markers. One potential therapeutic target is CD7, which is expressed on mature T-cells and NK-cells and is retained in many patients with T-cell lymphoma. In this study (NCT05377827), we hypothesized that CAR T therapy directed against CD7 may offer clinical benefit for patients with CD7+ T-NHL.

METHODS: WU-CART-007 is a CD7-directed, genetically modified, allogeneic, fratricide-resistant, second-generation CAR T-cell product with a 4-1BB costimulatory domain for the treatment of CD7+ hematologic malignancies. These cells have two key changes from conventional, autologous CAR T-cells. First, CD7 is deleted from WU-CART-007. This allows targeting of CD7 without fratricide (killing of WU-CART-007 cells by other WU-CART-007 cells). Second, the T-cell receptor alpha constant (TRAC) is deleted. This prevents WU-CART-007 cells from recognizing antigens other than CD7 and allows for the use of an allogeneic product while limiting the risk Graft-versus-Host-Disease (GvHD). WU-CART-007 has been tested in a recently completed phase 1 dose-escalation study for patients with T-cell acute lymphoblastic leukemia/lymphoma (NCT04984356). In this study, we are testing the safety and efficacy of WU-CART-007 in two cohorts of patients (CD7+ T-NHL and CD7+ AML). Only interim results from the T-NHL cohort are reported here. This phase 1 dose-escalation study uses an accelerated titration 3+3 design with dose-expansion of 9 additional patients for each of the two independent cohorts. All patients must have confirmed CD7 expression by IHC or flow cytometry on pre-treatment biopsy. Patients receive “enhanced” lymphodepletion with fludarabine (30 mg/m2 daily x4) and cyclophosphamide (1000 mg/m2 daily x3) followed by WU-CART-007 infusion 3 days after the last dose of chemotherapy. The primary objective of Part A (dose escalation) is to determine the recommended phase 2 dose of WU-CART-007 for CD7+ T-NHL. The primary objective of Part B (dose expansion) is to determine the objective response rate of WU-CART-007 for CD7+ T-NHL.

RESULTS: Five patients with T-NHL have received treatment with WU-CART-007, have completed the DLT evaluation period and are evaluable for response. In these 5 patients, toxicities have included grade 4 neutropenia (5 patients), grade 4 thrombocytopenia (5 patients), cytokine release syndrome (grade 1 in 3 patients, grade 2 in 2 patients), 1 patient with grade 2 Immune Effector Cell-Associated Hemophagocytic Lymphohistiocytosis-Like Syndrome, and 1 patient with a grade 5 opportunistic fungal infection (mucormycosis). No patients have experienced Immune Effector Cell Associated Neurotoxicity Syndrome or GvHD. Of the 5 patients evaluable for response, 2 achieved a complete remission (CR; 1 with peripheral T-cell lymphoma, 1 with T-cell prolymphocytic leukemia), 2 achieved a partial remission (PR; 1 with T-cell prolymphocytic leukemic/PLL with no evidence of disease by PET/CT or bone marrow biopsy and partial count recovery; 1 with gamma-delta T-cell lymphoma) and 1 had stable disease (SD; patient with gamma-delta T-cell lymphoma). 1 patient died of mucormycosis while in a complete remission on day 37, 2 patients died of disease progression with CD7-negative/dim disease (after PR and SD), 1 patient with T-PLL continues in a PR with no evidence of disease and partial count recovery, and 1 patient with T-PLL continues in CR 4 months after treatment with complete loss of CD7 in the bone marrow despite recovery of blood counts and presence of otherwise normal appearing T-cells. Flow cytometry from peripheral blood has detected expansion of CAR T cells in several patient samples and studies to evaluate persistence of CAR T cells in this patient population are underway.

CONCLUSION: WU-CART-007, a promising therapy in patients with relapsed/refractory T-NHL, has demonstrated early signs of activity in this heavily pretreated patient population. Study enrollment (NCT05377827) is ongoing to determine the safety and preliminary efficacy of WU-CART-007 in patients with CD7+ T-NHL and AML.

Disclosures: Mehta-Shah: Bristol Myers-Squibb: Research Funding; C4 Therapeutics: Consultancy, Research Funding; Pfizer: Consultancy; Johnson & Johnson/Janssen: Consultancy; Innate Pharmaceuticals: Research Funding; Morphosys: Research Funding; Genetech/Roche: Consultancy, Research Funding; Dizal Pharmaceuticals: Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Celgene: Research Funding; Secura Bio: Consultancy, Research Funding; Verastem Oncology: Research Funding; Yingli Pharmaceuticals: Research Funding; Astra Zeneca: Consultancy, Research Funding; Corvus Pharmaceuticals: Research Funding; Kyowa Hakko Kirin, Karyopharm Therapeutics: Consultancy. Ramsey: Wugen: Current Employment, Current holder of stock options in a privately-held company. Davidson-Moncada: Wugen: Current Employment, Current holder of stock options in a privately-held company. Ghobadi: Genentech: Research Funding; Wugen Inc: Consultancy; CRISPR Therapeutics: Consultancy; Bristol Myers Squibb: Consultancy; ATARABio: Consultancy; Amgen: Consultancy, Research Funding; Kite (Gilead company): Consultancy, Honoraria, Research Funding. DiPersio: Bioline Rx: Research Funding; hC Bioscience, Inc.: Membership on an entity's Board of Directors or advisory committees; Magenta Therapeutics: Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees; NeoImmune Tech: Research Funding; Macrogenics: Research Funding; SPARC: Consultancy; Vertex: Consultancy; RiverVest Venture Partners: Consultancy, Membership on an entity's Board of Directors or advisory committees; WUGEN: Current equity holder in private company, Research Funding.

*signifies non-member of ASH