Abstract

<div>Abstract<p>Adoptive cellular therapy (ACT) targeting neoantigens can achieve durable clinical responses in patients with cancer. Most neoantigens arise from patient-specific mutations, requiring highly individualized treatments. To broaden the applicability of ACT targeting neoantigens, we focused on <i>TP53</i> mutations commonly shared across different cancer types. We performed whole-exome sequencing on 163 patients with metastatic solid cancers, identified 78 who had <i>TP53</i> missense mutations, and through immunologic screening, identified 21 unique T-cell reactivities. Here, we report a library of 39 T-cell receptors (TCR) targeting <i>TP53</i> mutations shared among 7.3% of patients with solid tumors. These TCRs recognized tumor cells in a <i>TP53</i> mutation- and human leucocyte antigen (HLA)-specific manner <i>in vitro</i> and <i>in vivo</i>. Twelve patients with chemorefractory epithelial cancers were treated with <i>ex vivo</i>–expanded autologous tumor-infiltrating lymphocytes (TIL) that were naturally reactive against <i>TP53</i> mutations. However, limited clinical responses (2 partial responses among 12 patients) were seen. These infusions contained low frequencies of mutant p53–reactive TILs that had exhausted phenotypes and showed poor persistence. We also treated one patient who had chemorefractory breast cancer with ACT comprising autologous peripheral blood lymphocytes transduced with an allogeneic HLA-A*02–restricted TCR specific for p53<sup>R175H</sup>. The infused cells exhibited an improved immunophenotype and prolonged persistence compared with TIL ACT and the patient experienced an objective tumor regression (-55%) that lasted 6 months. Collectively, these proof-of-concept data suggest that the library of TCRs targeting shared p53 neoantigens should be further evaluated for the treatment of patients with advanced human cancers.</p><p><a href="https://aacrjournals.org/cancerimmunolres/article/doi/10.1158/2326-6066.CIR-22-0386" target="_blank"><i>See related Spotlight by Klebanoff, p. 919</i></a></p></div>

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