Chimeric antigen receptor T cell therapy
The disclosure provides methods of treating a malignancy comprising administering an effective dose of a chimeric antigen receptor genetically modified T cell immunotherapy and methods for manufacturing such immunotherapy. Some aspects of the disclosure relate to methods of determining objective response of a patient to a T cell immunotherapy based on the levels of attributes prior to and after administration of the immunotherapy to the patient.
1. A method of increasing the efficacy or reducing the toxicity of immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment in a subject in need thereof, comprising:
(i) administering to the subject a JAK/STAT inhibitor and decreasing the subject's systemic inflammatory state; or
(ii) administering to the subject a JAK/STAT inhibitor and reducing the activity of myeloid cells, MCP-1, IL-6, or activated T cells in the subject,
prior to, during, or after immunotherapy, BiTEs, or immune checkpoint blockade treatment, or T cell immunotherapy, wherein the JAK/STAT inhibitor is filgotinib metabolite GS-829845 and is administered to the subject in need thereof at a dose of about 200 mg one or more times, optionally daily, and
(iii) further comprising administering to the subject a monoclonal antibody against monocyte chemoattractant protein-1 (MCP-1).
2. The method of claim 1 , wherein reducing myeloid cell activity, or IL-6 activity further comprises administering to the subject a monoclonal antibody against IL-6, IL-1, CSF1R, GM-CSF or a small molecule.
3. The method of claim 1 , wherein the JAK/STAT inhibitor is administered:
(i) prophylactically as part of a bridging therapy or as part of a conditioning regimen prior to immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment administration;
(ii) during the acute response window post-immunotherapy, BiTEs, or immune checkpoint blockade treatment administration, before the onset of toxicity signs;
(iii) post-neurotoxicity or cytokine release syndrome (CRS) onset to manage toxicity and/or accelerate recovery time; or
(iv) as part of a bridging regimen, conditioning regimen, or during the acute interval of 2-4 weeks post-immunotherapy, BiTEs, or immune checkpoint blockade administration treatment to increase efficacy of the immunotherapy, BiTEs, or immune checkpoint blockade treatment.
4. The method of claim 1 , wherein the treatment is CAR T cell immunotherapy.
5. The method of claim 1 , wherein filgotinib metabolite GS-829845 is combined with one or more other agents used to manage adverse events that are associated with immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment.
6. The method of claim 1 , wherein administering the JAK/STAT inhibitor further:
(i) treats or/and prevents neurologic events or cytokine release syndrome (CRS) that are associated with immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment, which may be assessed, optionally, by determining a decrease in the Grade of NE/ICANS or CRS, or a decrease in the number of symptoms, in the context of JAK/STAT inhibitor administration;
(ii) decreases the serum levels of one or more inflammatory cytokines pre- and post-immunotherapy, BiTEs, or immune checkpoint blockade treatment administration, optionally, after conditioning therapy; or
iii) decreases pro-inflammatory activity by T cells or attenuates excess T cell activity, while maintaining their tumor killing capacity or persistence.
7. The method of claim 6 , wherein a cytokine is selected from IL6, IFNgamma, GM-CSF, IL1, IL8, IL10, MCP1, MIP-1a/b, TNFalpha, and combinations thereof.
8. The method of claim 6 , wherein administration of the JAK/STAT inhibitor does not interfere with CAR T cell expansion or CAR T cell anti-tumor activity.
9. The method of claim 1 , wherein the JAK/STAT inhibitor filgotinib metabolite GS-829845 is administered during, prior to, or after administration of a dose of immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment.
10. The method of claim 1 , wherein the JAK/STAT inhibitor filgotinib metabolite GS-829845 is administered prophylactically, prior to the observation of any symptoms of CRS or neurotoxicity.
11. The method of claim 1 , wherein filgotinib metabolite GS-829845 is administered in an amount sufficient to improve the therapeutic efficacy of immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment without necessarily having to exert any benefit relatively to adverse events or wherein the amount of filgotinib metabolite GS-829845 that is administered to the subject is lower than the amount of the other JAK/STAT inhibitors that may be administered for the same purpose.
12. The method of claim 1 , wherein the method decreases the risk or extent of Hematophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) post-treatment with immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade.
13. The method of claim 12 , wherein the T cell immunotherapy is anti-CD19 CAR T cell therapy.
14. The method of claim 1 , wherein the T cell immunotherapy is autologous or allogeneic chimeric antigen receptor (CAR) therapy.
15. A method of treating, preventing, delaying, reducing or attenuating the development or risk of a toxicity or for improving immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment therapy efficacy in a subject in need thereof, comprising administering to the subject a JAK/STAT inhibitor before, after, or during immunotherapy, BiTEs, or immune checkpoint blockade treatment, wherein the JAK/STAT inhibitor is filgotinib metabolite GS-829845 and is administered to the subject in need thereof at a dose of about 200 mg one or more times, optionally daily, further comprising administering to the subject a monoclonal antibody against monocyte chemoattractant protein-1 MCP-1).
16. A method of reducing cytokine signaling and the inflammatory state in a tumor treated by immunotherapy, bi-specific T-cell engagers (BiTEs), or immune checkpoint blockade treatment in a subject in need thereof, comprising administering to the subject a JAK/STAT inhibitor prior to, during, or after immunotherapy, BiTEs, or immune checkpoint blockade treatment administration, wherein the JAK/STAT inhibitor is filgotinib metabolite GS-829845 and is administered to the subject in need thereof at a dose of about 200 mg one or more times, optionally daily, further comprising administering to the subject a monoclonal antibody against monocyte chemoattractant protein-1 (MCP-1).