Method for expansion of tumour-reactive T-lymphocytes for immunotherapy of patients with specific cancer types
Methods for treating a patient suffering from a neoplastic disease are disclosed and described. A number of diseases can be treated under the present methods, including without limitation gall bladder cancer, hepato cellular cancer, ovarian cancer, small intestine cancer, lung cancer, mesothelioma, breast cancer, kidney cancer, pancreas cancer, prostate cancer, carcinoid cancer, leiomyosarcoma, or metastasis thereof. A general method for providing such treatment may include: 1) identifying in a patient one or more sentinel and/or metinel lymph nodes draining the neoplasm; 2) resecting the one or more nodes and, optionally all or part of the tumour or metastasis; 3) isolating tumour-reactive T-lymphocytes from said lymph nodes; 4) in vitro expanding said tumour-reactive T-lymphocytes; and 5) administering the thus obtained tumour-reactive T-lymphocytes to the patient.
1. A method for treating a patient suffering from a neoplastic disease selected from gall bladder cancer, hepato cellular cancer, ovarian cancer, small intestine cancer, lung cancer, mesothelioma, breast cancer, kidney cancer, pancreas cancer, prostate cancer, carcinoid cancer, leiomyosarcoma, or metastasis thereof, the method comprising:
a) isolating tumour-reactive T-lymphocytes from either the patient's blood, or from the patient's lymph nodes, wherein tumour-reactive T-lymphocytes isolated from the patient's lymph nodes are obtained by:
i) identifying in a patient one or more sentinel and/or metinel lymph nodes draining a neoplasm selected from gall bladder cancer, hepato cellular cancer, ovarian cancer, small intestine cancer, lung cancer, mesothelioma, breast cancer, kidney cancer, pancreas cancer, prostate cancer, carcinoid cancer, leiomyosarcoma, or metastasis thereof,
ii) resecting the one or more nodes and, optionally all or part of the tumour or metastasis, and
iii) isolating tumour-reactive T-lymphocytes from said lymph nodes;
b) in vitro expanding said tumour-reactive T-lymphocytes isolated from either the patient's blood or lymph nodes using:
i) a first phase of stimulating tumour-reactive CD4+ helper and/or CD8+ T-lymphocytes with tumour-derived antigen together with at least one substance having agonistic activity towards an IL-2 receptor to promote survival of tumour-reactive CD4+ helper and/or CD8+ T-lymphocytes; and
ii) a second phase of activating and promoting growth of tumour-reactive CD4+ helper and/or CD8+ T-lymphocytes, wherein the second phase is initiated when a CD25 cell surface marker or IL-2R marker is down-regulated on T-lymphocytes; and
c) administering the thus obtained tumour-reactive T-lymphocytes to the patient.
2. A method according to claim 1 , wherein the one or more lymph nodes are identified by injecting one or more lymph node locators into the patient.
3. A method according to claim 2 , wherein the one or more lymph node locators are affinity based.
4. A method according to claim 2 , wherein the one or more lymph node locators are non-affinity based.
5. A method according to claim 2 , wherein one or more lymph node locators are injected into, above, around, adjacent and/or under the tumour or metastasis.
6. A method according to claim 1 , wherein the down-regulation is defined as that 5% or less of the T-lymphocyte population which expresses CD25.
7. A method according to claim 1 , wherein the first phase is initiated by adding the at least one substance having agonistic activity towards the IL-2 receptor.
8. A method according to claim 1 , wherein the tumour-derived antigen is a denatured homogenate of a tumour.
9. A method according to claim 1 , wherein the second phase is initiated by the addition of tumour-derived antigen to the T-lymphocytes for activating tumour-reactive CD25-negative T-lymphocytes.
10. A method according to claim 1 or 9 , which further comprises addition to the T-lymphocytes of antigen presenting cells together with the tumour-derived antigen.
11. A method according to claim 10 , wherein the antigen presenting cells are irradiated peripheral blood leucocytes containing antigen-presenting B-cells and/or monocytes.
12. A method according to claim 1 , wherein the second phase comprises adding at least one substance capable of up-regulating IL-12R on the T-lymphocytes.
13. A method according to claim 1 , wherein the second phase comprises adding one or more substances capable of antagonizing development of Th2 type T-lymphocytes.
14. A method according to claim 13 , wherein the one or more substances capable of antagonizing development of Th2 type T-lymphocytes are one or more substances capable of neutralizing IL-4, IL-5, IL-10, and/or TGF-beta.
15. A method according to claim 14 , wherein the one or more substances capable of neutralizing IL-4, IL-5, IL-10, and/or TGF-beta are anti IL-4 antibody, anti IL-5 antibody and/or anti IL-10 antibody.
16. A method according to claim 13 , wherein the one or more substances capable of antagonizing development of Th2 type T-lymphocytes, is added on day 1 of the second phase.
17. A method according to claim 1 , wherein the second phase comprises adding one or more substances promoting the development of Th1 type T-lymphocytes.
18. A method according to claim 17 , wherein the one or more substances promoting the development of Th1 type T-lymphocytes is substances having agonistic activity towards the IL-7, IL-12, IL-15 and/or IL-21 receptor.
19. A method according to claim 18 , wherein the one or more substances is selected from IL-7, IL-12, IL-15 and IL-21.
20. A method according to claim 1 , for the preparation of CD4+ helper T lymphocytes.
21. A method according to claim 1 , for the preparation of effector T-lymphocytes.
22. A method according to claim 1 , for the preparation of memory T-lymphocytes.
23. A method according to claim 1 , for the preparation of Th1 type T-lymphocytes.
24. A method according to claim 1 , which further comprises monitoring the expression of cell surface markers, on the T-lymphocytes continuously during the first phase and second phase.
25. A method according to claim 24 , wherein the T-lymphocytes are harvested when CD25 on T-lymphocytes in the second phase is down-regulated.
26. A method according to claim 1 , further comprising a step of freezing the tumour-reactive T-lymphocytes obtained in the second phase.
27. A method according to claim 1 , wherein the T-lymphocytes are derived from blood and wherein the tumour-derived antigen is added essentially at the same time as when phase is initiated or at the most up to 2 days thereafter.
28. A method according to claim 1 , wherein the tumour-reactive T-lymphocytes are administered to the patient intravenously, intraarterially or intrathecally, intraperitonally.
29. A method according to claim 1 , wherein the amount of tumour-reactive T-lymphocytes administered is at least 10 million.
30. A method according to claim 1 , wherein the tumour-reactive T-lymphocytes administered are a combination of effector T-lymphocytes and memory T-lymphocytes.
31. A method according to claim 30 , wherein the percentage of effector T-lymphocytes is from about 10% to about 65.