title: Dual targeting of glioblastoma with chimeric antigen receptor-engineered natural killer cells overcomes heterogeneity of target antigen expression and enhances antitumor activity and survival.
abstract: Epidermal growth factor receptor (EGFR) and its mutant form EGFRvIII are overexpressed in a large proportion of glioblastomas (GBM). Immunotherapy with an EGFRvIII-specific vaccine has shown efficacy against GBM in clinical studies. However, immune escape by antigen-loss variants and lack of control of EGFR wild-type positive clones limit the usefulness of this approach. Chimeric antigen receptor (CAR)-engineered natural killer (NK) cells may represent an alternative immunotherapeutic strategy. For targeting to GBM, we generated variants of the clinically applicable human NK cell line NK-92 that express CARs carrying a composite CD28-CD3ζ domain for signaling, and scFv antibody fragments for cell binding either recognizing EGFR, EGFRvIII, or an epitope common to both antigens.In vitroanalysis revealed high and specific cytotoxicity of EGFR-targeted NK-92 against established and primary human GBM cells, which was dependent on EGFR expression and CAR signaling. EGFRvIII-targeted NK-92 only lysed EGFRvIII-positive GBM cells, while dual-specific NK cells expressing a cetuximab-based CAR were active against both types of tumor cells. In immunodeficient mice carrying intracranial GBM xenografts either expressing EGFR, EGFRvIII or both receptors, local treatment with dual-specific NK cells was superior to treatment with the corresponding monospecific CAR NK cells. This resulted in a marked extension of survival without inducing rapid immune escape as observed upon therapy with monospecific effectors. Our results demonstrate that dual targeting of CAR NK cells reduces the risk of immune escape and suggest that EGFR/EGFRvIII-targeted dual-specific CAR NK cells may have potential for adoptive immunotherapy of glioblastoma.
authors.affiliation: Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy , Frankfurt am Main, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Genßler
authors.affiliation: Institute for Neurooncology, Goethe University, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Burger
authors.affiliation: Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Congcong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy , Frankfurt am Main, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Oelsner
authors.affiliation: Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt am Main, Germany; Institute for Neurooncology, Goethe University, Frankfurt am Main, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Mildenberger
authors.affiliation: Institute of Neuroradiology, Goethe University , Frankfurt am Main, Germany.
authors.forename: Marlies
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Institute for Neurooncology, Goethe University, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Germany.
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Steinbach
authors.affiliation: Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Germany.
authors.forename: Winfried S
authors.initials: WS
authors.lastname: Wels
keywords: Cetuximab; EGFR; EGFRvIII; chimeric antigen receptor; glioblastoma; natural killer cells