Abstract 5574: In vivo characterization of a novel CAR-T cell therapy directed towards LGR5 for the treatment of colorectal cancer

Abstract

Abstract Colorectal cancer (CRC) is the third most diagnosed cancer and incidence rates are rapidly increasing among young adults. Despite current treatments, the 5-year survival rate is approximately 65%, highlighting an urgent need for new therapies. Leucine-rich repeat-containing G-protein coupled receptor (LGR5) is a promising antigen target for chimeric antigen receptor (CAR)-T cell therapy, which may represent a novel effective treatment for CRC. LGR5 binds R-spondins and functions to enhance Wnt and β-catenin signalling involved in maintenance and proliferation of adult stem cells. Expression of LGR5 has been previously reported on cancer stem cells in CRC, and has been demonstrated to play a crucial role in CRC tumor initiation and metastasis. Flow cytometric analysis of LGR5 cell surface expression on in vitro and ex vivo human CRC tumour cells revealed a subpopulation of LGR5+ cells. Six LGR5-targetting CD3+ CAR-T cell variants were developed, which differed in CAR variable heavy (VH) and variable light (VL) chain orientation and hinge length. As preliminary experimentation identified that four of the six CAR-T cell variants displayed robust anti-tumour cytotoxicity in vitro, these CAR-T cell variants were tested for in vivo anti-tumour efficacy using a subcutaneous human colorectal tumor xenograft mouse model. Pre-injection phenotyping after freeze-thawing of the CAR-T cells revealed greater than 94% transduction efficiency, low expression of co-inhibitory receptors CTLA-4 and PD-1 and a high frequency of central memory T cells (CD62L+ CD45RO+). Additionally, a high frequency of the CD8+ compartment of these CAR-T cells expressed perforin, CD107a, Granzyme B and TNFα. For each variant, intravenous injection of 20x106 LGR5-targeting CAR-T cells induced significant tumor regression and gave 100-day survival post-tumor injection. Ex vivo analyses of tumors and spleens via flow cytometry at endpoint indicated CAR-T cell persistence to 100-days post-tumor injection. Of the CAR-T cells isolated from tumours ex vivo, high level expression of co-inhibitory receptors PD-1, CTLA-4, and TIM-3 was observed. The splenic T cell population was enriched for central memory T cells and expressed high levels of PD-1. Complete tumor remission was achieved in 100% of mice receiving the VH-VL orientation, medium hinge CAR construct (designated CNA3103), prompting further investigation of this variant. Intravenous injection of 5x106 CNA3103 CAR-T cells was sufficient to induce tumour remission and 100-day survival. Similarly, complete tumour rejection was achieved with a dose of 2.5x106 CNA3103 CAR-T cells in a 30-day in vivo experiment. These results demonstrate that LGR5-targeting CAR-T cells exhibit potent in vivo anti-tumor efficacy and position LGR5 as a promising CAR target antigen, prompting investigation of LGR5-targeting CAR-T cells as a therapeutic for CRC in future clinical trials. Citation Format: Dylan J. McPeake, Timona S. Tyllis, Jade Foeng, Veronika Bandara, Caitlin A. Abbott, Batjargal Gundsambuu, Elaheh Rohani-Rad, Silvana Napoli, Timothy Sadlon, Simon C. Barry, Shaun R. McColl. In vivo characterization of a novel CAR-T cell therapy directed towards LGR5 for the treatment of colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5574.