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Singh K, Hotchkiss KM, Mohan AA, Reedy JL, Sampson JH, Khasraw M. For whom the T cells troll? Bispecific T-cell engagers in glioblastoma. J Immunother Cancer 2021; 9:e003679. [PMID: 34795007 PMCID: PMC8603282 DOI: 10.1136/jitc-2021-003679] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 01/11/2023] Open
Abstract
Glioblastoma is the the most common primary brain tumor in adults. Onset of disease is followed by a uniformly lethal prognosis and dismal overall survival. While immunotherapies have revolutionized treatment in other difficult-to-treat cancers, these have failed to demonstrate significant clinical benefit in patients with glioblastoma. Obstacles to success include the heterogeneous tumor microenvironment (TME), the immune-privileged intracranial space, the blood-brain barrier (BBB) and local and systemic immunosuppressions. Monoclonal antibody-based therapies have failed at least in part due to their inability to access the intracranial compartment. Bispecific T-cell engagers are promising antibody fragment-based therapies which can bring T cells close to their target and capture them with a high binding affinity. They can redirect the entire repertoire of T cells against tumor, independent of T-cell receptor specificity. However, the multiple challenges posed by the TME, immune privilege and the BBB suggest that a single agent approach may be insufficient to yield durable, long-lasting antitumor efficacy. In this review, we discuss the mechanism of action of T-cell engagers, their preclinical and clinical developments to date. We also draw comparisons with other classes of multispecific antibodies and potential combinations using these antibody fragment therapies.
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Affiliation(s)
- Kirit Singh
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
- Biomedical Engineering, Duke Universtiy, Durham, NC, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, 27703
| | - Kelly M Hotchkiss
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, 27703
| | - Aditya A Mohan
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Jessica L Reedy
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, 27703
| | - John H Sampson
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
- Biomedical Engineering, Duke Universtiy, Durham, NC, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, 27703
| | - Mustafa Khasraw
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, 27703
- Duke Cancer Institute, Durham, North Carolina, USA
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