Safety and efficacy of a novel anti-CD20 chimeric antigen receptor (CAR)-T cell therapy in relapsed/refractory (r/r) B-cell non-Hodgkin lymphoma (B-NHL) patients after failing CD19 CAR-T therapy.
Authors: Aibin Liang, Shiguang Ye, Ping Li, Jiaqi Huang, Shigui Zhu, Xin Yao, Lili Zhou, Yangyang Xu, Judy Zhu, Chengxiao Zheng, Shiyi Chen, Liping Lan, Xiaoteng Lv, Yutian Wei, Michael Humphries, Yihong Yao
Journal: Journal of Clinical Oncology (2021)

2508 Background: Relapse due to loss of the CD19 targeted epitope presents a therapeutic challenge of CD19 CAR-T therapy. These patients universally have a poor outcome and the unmet medical need is high. CD20 is a proven therapeutic target for B-NHL, supported by approved and widely used monoclonal antibody therapy. C-CAR066 is a novel 2nd generation chimeric antigen receptor T (CAR-T) therapy targeting CD20 antigen. Preclinical studies suggest that C-CAR066 has superior anti-tumor activity compared to CAR-Ts derived from scFVs of Leu16, Rituximab and Obinutuzumab and anti-CD19 BBZ CAR with FMC63. Methods: A phase I clinical trial (NCT04036019) was conducted to evaluate the safety and efficacy of C-CAR066 in subjects with r/r B-NHL who were previously treated with anti-CD19 CAR-T therapy. Patients (≥ 18 years) with r/r DLBCL, r/r FL or r/r MCL, ECOG &lt; 2 were eligible. GMP manufacture of C-CAR066 was in a serum free and fully closed semi-automatic system. A 3-day cyclophosphamide plus fludarabine regimen was followed by a single infusion of C-CAR066. Bridging therapy was allowed. Results: As of Jan 31, 2021, 7 patients (6 DLBCL, 1 tFL) were enrolled and infused with C-CAR066 at dose ranges of 2.0 x 10 6 to 4.8x10 6 CAR-T cells/kg. The manufacturing success rate was 100%. The median age was 51 (range, 41-62) years, and 42.9% (3/7) patients were male. The median number of prior lines of therapy was 5 (range, 2-6). One patient (14.3%) underwent autologous stem cell transplant (ASCT) and one patient received bridging therapy. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were graded according to ASTCT 2019 criteria. All 7 patients experienced CRS and most (85.7%) were grade 1 or 2. One patient had grade 4 CRS and recovered after treatment with tocilizumab and corticosteroids. Median time to onset of CRS was 5 days (range, 1-9), with median duration of 4 days (range, 2-17). There were no episodes of ICANS. Grade ≥3 neutropenia, anemia, thrombocytopenia, and infections were reported in 57.1%, 42.9%, 28.6%, and 14.3% of patients, respectively. At a median follow-up of 7.8 months, the best overall response rate was 100%, with 71.4% (5/7) achieving complete response (CR). Median time to response was 1.0 month (range, 0.9-2.7). Median time to CR was 2.7 months (range, 0.9-2.8). By the cutoff date, 3 patients (2 PR, 1 CR) had disease progression. Median duration of response was not reached. Conclusions: C-CAR066 has shown a favorable safety profile and promising efficacy in patients with r/r B-NHL following failure of CD19 CAR-T therapy. These results show that C-CAR066 has a different mechanism of action compared to anti-CD-19 CAR-T therapy and could provide a solution to address the unmet medical need in B-NHL patients that have failed anti-CD19 CAR-T therapy. Clinical trial information: NCT04036019.