Bottle-neck Problems of Current Human Cancer Therapy

Transcription

1 International Conference on Human Cell, Tissue-based Products and Tissue Banks, Oct ,Taipei, Taiwan Autologous Dendritic Cell-based Immunotherapy of Glioblastoma Multiforme: Post-Phase-I Clinical Trial Translational Research for Improving Safety and Efficay of Phase II/III Trails Wen-Kuang Yang, M.D.,Ph.D. [ 楊 文 光 ] Cell/Gene Therapy Research Laboratory Department of Clinical Research China Medical University Hospital-Taichung Introduction: Rationale and pre-clinical translational research (how basic model results can be applied to human patients?) Phase-I trial: Proof of concept and feasibility of technology platforms (safety and efficacy) Translational research to address and solve the problems raised from clinical trials Phase-II/III trials for improvement of survival benefit

2 Bottle-neck Problems of Current Human Cancer Therapy Surgery, radiotherapy, chemotherapy (including targeting drugs ) can achieve tumor removal or regression but not necessarily permanent cure. When relapsed, most cancers are resistant to previously effective chemotherapeutic agents and/or radiotherapy and no more subject to surgical treatment, becoming un-controllable and often lethal. Novel approaches are urgently needed [1] to prevent tumor recurrence; [2] to treat, if not cure, the incurable

3 What Novel Approaches? Gene Therapy? Cell Therapy? Immunotherapeutics?

4 W.K.Yang, Oak Ridge National Laboratory [ ] Mechanisms of Mouse Fv-1 Restriction of Viral Leukemogenesis US NCI National Virus Cancer Program [1] Fv-1 is a mouse genetic locus (host hereditary factor) that restricts leukemogenesis by murine leukemia viruses [ 抗 癌 之 遺 傳 基 因 ] [2] These and subsequent research works, such molecular cloning of retroviral DNA and gene vectors, provide scientific concepts and technological basis for gene therapy approaches [ 研 發 基 因 治 療 術 之 科 學 基 礎 ]

5 DNA Transfection Technology for Gene Therapy - [W.K.Yang, Oak Ridge National Laboratory ] 許 溢 昌 博 士 Proc Nat Acad Sci USA 75: (1978) [Embryomal Stem Cells]

6 Retroviral Vector Research & Development for Gene Therapy - [W.K.Yang, Oak Ridge National Laboratory ] 劉 瑞 賢 博 士 Retroviral Vector Transduction of Exogenous Genes into the Cell 歐 晉 義 博 士

7 Cancer Gene Therapy 封 面 論 文 魏 松 仁 博 士 趙 毅 醫 師 Cancer gene therapy remains highly controversial, mainly because gene vectors are possibly hazardous. Examples: Insertion mutagenesis by retroviral vectors, leading to leukemias in mice and human patients.

8 Leukemias in young SCID children after retroviral vector-mediated gene therapy Chromosome 13 translocation Insertion activation of LMO2

9 Novel Therapeutic Approaches to Currently Incurable Human Cancers? Gene therapy remains highly controversial!!! Cell therapy may be safe and effective, especially by using autologous cells. Immunotherapeutic approaches?

10 From Gene Therapy to Cell Therapy of Human Cancer Diseases Most promising genes in cancer gene therapy approaches exploit the functions of dendritic cells (DC), the professional antigen presenting cells of the immune system (Leder; Mulligan; Allison; Rosenberg; Lotze) GM-CSF, IL-4 [Monocyte differentiation into DC] IL-3, Flt-3 [Growth factors of DC precursors] B7-1, B7-2 [CD80 & CD86 antigen presentation of DC] TNF-α [stimulation of DC maturation] IL-12, IL-18, IL23 [Cytokines produced by mature DC] Interferon-γ, IL-2 [Cytokines of DC-stimulated Th1 lymphocytes] Why not prepare autologous dendritic cells and use directly for cancer immunotherapy?

11 Pre-requisites for Clinical Trials of Cell-based Therapeutics Possible Efficacy Assurance of Safety

12 Cell-based Immunotherapy of Human Cancer Clinical Trials Safety Factors [ 安 全 因 素 ] Therapeutic approach 治 療 方 式 Procedures & Reagents 步 驟 試 劑 cglp hard/softwares 實 驗 室 軟 硬 體 Efficacy Factors [ 療 效 因 素 ] Cell Preparation 疫 苗 製 品 Disease Condition 疾 病 狀 況 Clinical Expertise 臨 床 專 家

13 Safety Protection in Cell Therapy Whom to protect? **Patients [Safe & Effective Therapeutics] Laboratory Personnel [Contamination-free working environment and conditions] Environmental Safety [Transmissible infectious agents & communicable diseases] What to prevent? - Physical hazards, Chemicals, Toxins, - Prion, Viruses, Bacteria, Protozoa, Fungi, - Animals, Human [Incompatible Cells]

14 [ 自 體 樹 突 細 胞 腫 瘤 疫 苗 輔 助 療 法 ] Autologous Dendritic Cell Tumor Vaccine Adjuvant Therapy 治 療 法 之 安 全 考 量 Safety Aspects and Factors - [1] Therapeutic Cells Cell therapy already in wide clinical use [ 臨 床 醫 界 已 經 普 遍 應 用 之 細 胞 療 法 ] Blood transfusion [ISOLOGOUS] Bone marrow transplantation [ISOLOGOUS] Cornea transplatation [ISOLOGOUS] Kidney, heart, liver, other organs [ISOLOGOUS] In vitro fertilization [autologous ova & isologous sperms] *Possible problems: [1] GvH and HvG; [2] infectious agent (virus, bacteria or micro-organism) from isologous donor; [3] contamination during transportation, processing, storage and handling DC-tumor vaccine therapy [clinical trials] Patient s own plasma, PB-derived immune cells and de-vitalized immunogenic tumor cells [AUTOLOGOUS] * Possible problems: [1] chronic carrier of an infectious virus (HBV, EBV, HIV etc) or bacterium (syphilis, TB); [2] contamination during transportation, processing, storage and handling

15 [ 自 體 樹 突 細 胞 腫 瘤 疫 苗 輔 助 療 法 ] Autologous Dendritic Cell Tumor Vaccine Adjuvant Therapy 步 驟 與 試 劑 之 安 全 考 量 Safety Aspects and Factors - [2] Procedures & Reagents * Apheresis & ficoll-hypaque [Peripheral blood MNC] * Serum-free culture [dendritic cells] * Surgery [tumor specimen] short-term culture using patient s own plasma, [tumor cells] - irradiation [immunogens] * Clinical grade reagents: GM-CSF, Interferons, interleukins, saline, human serum albumin, insulin (0.1 mu), hydrocortisone (0.1 microgram) no fetal calf serum e.g. one dose of GM-CSF = 0.15 mg = ng = 50 ng/ml x100 ml [for 30 patients; 300 vaccine preparations] * Reagents- minimal patient exposure * Subcutaneous/intradermal innoculation: less hazardous than Cytokine Therapy Cancer chemotherapy Radiotherapy Flu vaccine and Pneumo-vac

16 [ 自 體 樹 突 細 胞 腫 瘤 疫 苗 輔 助 療 法 ] Autologous Dendritic Cell Tumor Vaccine Adjuvant Therapy 軟 硬 體 操 作 等 之 安 全 考 量 Safety Aspects and Factors - [3] hard and soft wares etc. Limited number of informed consent patients [ 病 人 限 額 ] Personalized individual therapy [ 個 別 治 療 ] Personnel expertise [ 專 精 人 才 ] Translational medicine procedures [ 譯 轉 醫 學 方 法 ] Hardwares cglp facility (HEPA barrier humidity temperature controlled), biogard hoods, autoclavable incubator, etc [ 無 塵 溫 濕 控 設 施 護 安 操 作 台 消 毒 培 養 箱 等 ] E.L.S.I. privacy rights [ 倫 理 法 律 社 會 ; 隱 私 權 ] Environmental protection [ 環 保 ] Official guidance & regulatory compliance [ 符 合 法 則 與 規 範 ]

17 Particle(Germ)-free cglp/gmp barrier facility Technology know-how for hardware construction US Experiences [ ] Oak Ridge Y-12 nuclear plant air filter system for radioactive plutonium manufacturing factories; ORNL Biol. Div. building 9220 barrier bio-safety pilot facility of National Cancer Virus Program (NCVP); NHI-NCI building 41 [NCVP virus containment building] Tissue culture facility of RNA tumor virus research laboratory Taiwan Experiences [1993-present] Establishment of 4 Good Laboratory Practice facilities, respectively, at [1] DOH National Taiwan University Hospital 5E 2nd floor; [2] Academia Sinica Institute of Biomedical Sciences New Building, 2nd floor; [3] China Medical University Hospital- Taichung Cell/Gene Therapy Research Laboratory]; [4] Kaohsiung Medical University; Work with engineers with air cleaning technology know-how in the construction of computer chip manufacturing factories [Electronic industries of Taiwan]

18 臨 床 前 轉 譯 醫 醫 學 研 究 [ ] 6 Years of Pre-Clinical Trial Translation Research Autologous Dendritic Cell (DC)-Based Tumor Vaccine Therapy for Human Cancer 1. Human DC preparations? How to derive functional DC from peripheral blood monocyte? 2. Immuno-pathophysiology of cancer patients How to remove immuno-suppressive effects? 3. Tumor ( regression ) antigens How to prepare patient s own tumor cells with increased immunogenicity? 4. Vaccine preparation: DC functions of antigen processing and presentation Immature (phagocytic) vs. mature DC? 5. Physiology of DCs in vivo Homing (CCR7) to T cell area of local lymph nodes? 6. GLP, GCP lab/clinical SOPs - Safe for human use 7. Collaborative efforts with surgeons/physicians in active clinical practice E.L.S.I. and particular clinical aspects of cancer disease selected for the study?