Remnant tumor infiltrating lymphocytes and methods of preparing and using the same
In some embodiments, methods of delivering a therapeutically effective amount of an expanded number of tumor infiltrating lymphocytes obtained from tumor remnants to a patient in need thereof, for the treatment of a cancer, are disclosed.
1. A method for preparing remnant tumor infiltrating lymphocytes (rTILs) for adoptive T cell therapy, the method comprising:
(a) obtaining tumor tissue from a patient, wherein the tumor tissue comprises tumor infiltrating lymphocytes (TILs);
(b) fragmenting the tumor tissue to provide a fragmented tumor tissue;
(c) treating the fragmented tumor tissue in a gas permeable container with a first cell culture medium and interleukin 2 (IL-2) to provide emergent TILs (eTILs) and tumor remnants comprising remnant TILs (rTILs);
(d) removing at least a plurality of the eTILs;
(e) enzymatically digesting the tumor remnants into tumor remnant cells using a digest mixture; and
(f) expanding the tumor remnant cells with a second cell culture medium comprising cell culture media, irradiated feeder cells, OKT-3 antibody, and IL-2 in a gas permeable container to provide an expanded number of the rTILs;
wherein the rTILs express reduced levels of a T cell exhaustion marker relative to the eTILs, and wherein the T cell exhaustion marker is selected from the group consisting of TIM3, LAG3, TIGIT, PD-1, CTLA-4, and combinations thereof.
2. The method of claim 1 , wherein the tumor tissue is selected from the group consisting of melanoma tumor tissue, head and neck tumor tissue, breast tumor tissue, renal tumor tissue, pancreatic tumor tissue, glioblastoma tumor tissue, lung tumor tissue, colorectal tumor tissue, sarcoma tumor tissue, triple negative breast tumor tissue, cervical tumor tissue, ovarian tumor tissue, and acute myeloid leukemia bone marrow or tumor tissue.
3. The method of claim 1 , wherein the irradiated feeder cells comprise irradiated allogeneic peripheral blood mononuclear cells.
4. The method of claim 1 , wherein IL-2 is present in the second cell culture medium at an initial concentration of about 3000 IU/mL and OKT-3 antibody is present in the second cell culture medium at an initial concentration of about 30 ng/mL.
5. The method of claim 1 , wherein at least one T cell exhaustion marker in CD8+ and CD4+ T cells in the rTILs is reduced by at least 10% relative to the eTILs.
6. The method of claim 1 , wherein the T cell exhaustion marker is a LAG3 marker in CD8+ T cells, and wherein the LAG3 marker in the rTILs is reduced by at least 2-fold relative to the eTILs.
7. The method of claim 1 , wherein the T cell exhaustion marker is a TIM3 marker in CD8+ T cells, and wherein the LAG3 marker in the rTILs is reduced by at least 3-fold relative to the eTILs.
8. The method of claim 1 , wherein the T cell exhaustion marker is a TIM3 marker in CD4+ T cells, and wherein the LAG3 marker in the rTILs is reduced by at least 2-fold relative to the eTILs.
9. The method of claim 1 , wherein the TIM3 marker and the LAG3 marker in the rTILs are undetectable by flow cytometry.
10. The method of claim 1 , wherein CD56+ expression in the rTILs is reduced by at least 3-fold relative to CD56+ expression in the eTILs.
11. The method of claim 1 , wherein CD69+ expression in the rTILs is increased by at least 2-fold relative to CD69+ expression in the eTILs.
12. The method of claim 1 , wherein the digest mixture comprises deoxyribonuclease, collagenase, and hyaluronidase.
13. The method of claim 1 , wherein the first cell culture medium further comprises a cytokine selected from the group consisting of IL-4, IL-7, IL-15, IL-21, and combinations thereof.
14. The method of claim 1 , wherein the second cell culture medium further comprises a cytokine selected from the group consisting of IL-4, IL-7, IL-15, IL-21, and combinations thereof.
15. The method of claim 1 , further comprising the steps of cryopreserving the expanded number of rTILs to form a cryopreserved rTIL population.
16. The method of claim 15 , further comprising the step of thawing the cryopreserved rTIL population.
17. The method of claim 1 , wherein the step of expanding the tumor remnant cells with the second cell culture medium comprises adding eTILs to the second cell culture medium at a selected rTIL to eTIL ratio.
18. The method of claim 1 , further comprising the step of adding eTIL to the rTIL at a selected rTIL to eTIL ratio.
19. The method of claim 18 , wherein the selected rTIL to eTIL ratio is at least 1% rTIL to eTIL.
20. The method of claim 19 , wherein the selected rTIL to eTIL ratio is at most 99.9% rTIL to eTIL.
21. The method of claim 18 , wherein the selected rTIL to eTIL ratio is selected from the group consisting of about 1:99, about 5:95, about 10:90, about 15:85, about 20:80, about 25:75, about 30:70, about 35:65, about 40:60, about 45:55, about 50:50, about 55:45, about 60:40, about 65:35, about 70:30, about 75:25, about 80:20, about 85:15, about 90:10, about 95:5, and about 99:1 rTIL to eTIL.
22. A method of treating a cancer in a patient in need of such treatment, wherein the treatment comprises delivering a therapeutically effective amount of rTILs to a patient, wherein the rTILs are prepared according to the method of claim 1 .
23. The method of claim 22 , wherein the cancer is selected from the group consisting of melanoma, double-refractory melanoma, uveal melanoma, ovarian cancer, cervical cancer, lung cancer, bladder cancer, breast cancer, head and neck cancer, renal cell carcinoma, acute myeloid leukemia, colorectal cancer, and sarcoma.
24. The method of claim 23 , wherein the cancer is breast cancer, and wherein the breast cancer is selected from the group consisting of triple negative breast cancer, estrogen receptor-positive breast cancer, progesterone receptor-positive breast cancer, and estrogen receptor-positive/progesterone receptor-positive breast cancer.
25. The method of claim 23 , wherein the cancer is lung cancer, and the lung cancer is selected from the group consisting of non-small cell lung cancer and small cell lung cancer.
26. A method of treating a cancer in a patient in need of such treatment, comprising the steps of:
(a) obtaining rTILs from a tumor resected from a patient according to the method of claim 1 ;
(b) treating the patient with a non-myeloablative lymphodepletion regimen prior to administering the rTILs to the patient;
(c) administering a therapeutically effective amount of rTILs to the patient, wherein the therapeutically effective amount of rTILs may be optionally cryopreserved and thawed prior to the administering to the patient; and
(d) treating the patient with a high-dose IL-2 regimen starting on the day after administration of the rTILs to the patient.
27. The method of claim 26 , wherein the non-myeloablative lymphodepletion regimen comprises the steps of administration of cyclophosphamide at a dose of 60 mg/m 2 /day for two days followed by administration of fludarabine at a dose of 25 mg/m 2 /day for five days.
28. The method of claim 26 , wherein the high-dose IL-2 regimen comprises 600,000 or 720,000 IU/kg of aldesleukin, or a biosimilar or variant thereof, administered as a 15-minute bolus intravenous infusion every eight hours until tolerance.