Oral Presentation Advances in Neuroblastoma Research Congress 2016

Oncolytic herpes Simplex-1 virotherapy augments chimeric antigen receptor T-Cell (CAR-T) therapy in Neuroblastomas (#50)

Kellie Haworth 1 , Samuel Haile 2 , Crystal Mackall 2 , Timothy Cripe 1
  1. Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OHIO, United States
  2. Stanford University, Stanford, CA, USA
While chimeric antigen receptor T-cell (CAR-T) therapies have demonstrated extraordinary clinical effectiveness in relapsed/refractory lymphoid leukemias, their efficacy against solid tumors has thus far lacked success, with modest migration to tumors and insufficient persistence. These challenges may be attributed to the characteristically immunosuppressive microenvironment found within solid tumors. Oncolytic virotherapy, a unique immune-based therapy, is an attractive potential adjunct to cellular therapies which may potentiate the competence of CAR-T within solid tumors. These attenuated viruses cause tumor-specific cell death not only through direct cell lysis, but also through the induction of pro-inflammatory responses. HSV1716 (trade name Seprehvir, Virttu Biologics, Ltd), an oncolytic Herpes Simplex-1 virus (oHSV) lacking the virulence factor ICP34.5 similar to the recently FDA-approved T-VEC, has established safety in multiple phase I clinical trials, including an ongoing trial for adolescents and young adults with refractory solid tumors initiated by our team (NCT00931931). We sought to determine whether Seprehvir might enhance CAR-T efficacy against neuroblastomas. We characterized oHSV-induced chemokine and cytokine gene expression in human neuroblastoma models, showing increases in T-cell attractant chemokines CXCL-10 and CCL-5 and T-cell activating cytokines IFN-gamma and TNF-alpha, but decreased inhibitory cytokine TGF-beta. Flow cytometry revealed variable tumoral cell GD2 expression, while third-generation (containing CD28, OX40, and CD3zeta signaling domains) GD2-directed human CAR-T displayed high CXCR-3 and CCR-5 expression, allowing for chemotactic signaling through CXCL-10 and CCL-5, respectively. We performed transwell assays and found increased CAR-T migration toward Seprehvir-infected neuroblastoma cells over non-infected cells. Neuroblastoma xenograft tumor-bearing athymic nude mice treated with combination therapy displayed prolonged survival (median 27, range 17-61 days) compared to mice treated with oHSV (median 19, range 17-21 days) or CAR-T monotherapies (median 10, range 10-12 days). These results indicate oHSV as a beneficial adjunct to CAR-T therapy for neuroblastoma and should be further explored in clinical trials.