Prospective BASECAMP-1 experience in patients with gastrointestinal (GI) cancer: Identifying patients with human leukocyte antigen (HLA) loss of heterozygosity (LOH) for a future therapeutic trial exploiting LOH as a tumor vulnerability.

Authors

null

J. Randolph Hecht

David Geffen School of Medicine at UCLA, Los Angeles, CA;

J. Randolph Hecht , Scott Kopetz , Theodore Welling , Maria Pia Morelli , Julian R. Molina , Kedar Kirtane , Paul Eliezer Oberstein , Daniel R. Greenwald , Yi Lin , Armen Mardiros , Karl Beutner , Ariane Lozac'hmeur , Ameen Salahudeen , Kirstin B. Liechty , Judy Vong , Eric Wai-Choi Ng , David G. Maloney , William Y. Go , John Sutton Welch , Diane M. Simeone

Organizations

David Geffen School of Medicine at UCLA, Los Angeles, CA; , The University of Texas MD Anderson Cancer Center, Houston, TX; , New York University Langone Health, New York, NY; , University of Texas MD Anderson Cancer Center, Houston, TX; , Mayo Clinic, Rochester, MN; , H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; , University of California Los Angeles, Santa Barbara, CA; , A2 Biotherapeutics, Inc., Agoura Hills, CA; , Tempus, Chicago, IL; , Fred Hutchinson Cancer Research Center, Seattle, WA;

Research Funding

Other
A2 Biotherapeutics, Inc.

Background: Metastatic colorectal (CRC), pancreatic (PANC), and gastroesophageal cancers are the leading causes of GI cancer–related mortality (5-y survival: 15%, 3%, and 5%-6%, respectively) (ACS 2022). HLA LOH is a recurrent mechanism of immune escape observed in 15%-20% of GI cancers (Hecht R., ASCO GI 2022). The Tmod platform is a logic-gated chimeric antigen receptor (CAR) T-cell modular system, comprising a carcinoembryonic antigen (CEA)- or mesothelin (MSLN)-targeting CAR activator and a separate HLA-A*02-targeting blocker receptor. Both in vitro/in vivo, Tmod CAR T therapy kills cells with HLA-A*02 LOH (tumor) without harming cells with retained HLA-A*02 expression (normal). However, HLA-A*02 LOH can only be therapeutically exploited if patients are identifiable through a feasible and timely clinical workflow. Methods: We established a biobanking protocol (BASECAMP-1, NCT04981119) to determine whether HLA-A*02 LOH patients can be prospectively identified. Patients with CRC, PANC, or non-small cell lung cancer (NSCLC), and a high risk for incurable relapse, were screened first using a standard HLA assay. Heterozygous HLA-A*02 positive tumor samples were then assessed for LOH using a bioinformatic algorithm applied via the Tempus xT platform. Results: As of Sep 1, 2022, 83 patients were consented at 4 institutions. HLA status was obtained from 70 patients and 28 were identified as HLA-A*02:01 heterozygous (40%; expected frequency based on USA NMDP data, 27.6%). LOH results were available for 16 patients; 4 LOH-positive patients were identified (25%, 2 PANC, 2 NSCLC). The LOH assay sensitivity declines below a tumor purity of 40% (Hecht R., ASCO GI 2022). Six patients had a tumor purity of 20% (all with PANC, a tumor known for high stromal content), limiting possible LOH detection. The impact of tumor purity on LOH sensitivity was highlighted in a patient with a low initial sample tumor purity (30%) that resulted in a 41% probability of HLA-A*02:01 LOH (below positive threshold). A second sample with a higher tumor purity (70%), obtained from formalin-fixed, paraffin-embedded sections, resulted in a 92% probability of HLA-A*02:01 LOH (positive). Conclusions: BASECAMP-1 prospective identification of HLA-A*02 LOH is feasible in the real-world setting. The frequencies of the HLA-A*02 allele and of HLA-A*02 LOH in this cohort mirrored expected population frequencies. LOH results can be obtained within a clinically feasible workflow and timeframe, although samples with a < 40% tumor purity have a reduced sensitivity for LOH detection, an issue recurrently observed in patients with PANC. The BASECAMP-1 strategy enables prospective identification of appropriate patients for future therapeutic clinical trials using Tmod CEA and MSLN logic-gated CAR T cells. Clinical trial information: NCT04981119.

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Tumor Biology, Biomarkers, and Pathology

Clinical Trial Registration Number

NCT04981119

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 209)

DOI

10.1200/JCO.2023.41.4_suppl.209

Abstract #

209

Poster Bd #

L11

Abstract Disclosures