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Nawrocki ST, Olea J, Villa Celi C, Dadrastoussi H, Wu K, Tsao-Wei D, Colombo A, Coffey M, Fernandez Hernandez E, Chen X, Nuovo GJ, Carew JS, Mohrbacher AF, Fields P, Kuhn P, Siddiqi I, Merchant A, Kelly KR. Comprehensive Single-Cell Immune Profiling Defines the Patient Multiple Myeloma Microenvironment Following Oncolytic Virus Therapy in a Phase Ib Trial. Clin Cancer Res 2023; 29:5087-5103. [PMID: 37812476 PMCID: PMC10722139 DOI: 10.1158/1078-0432.ccr-23-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/26/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Our preclinical studies showed that the oncolytic reovirus formulation pelareorep (PELA) has significant immunomodulatory anti-myeloma activity. We conducted an investigator-initiated clinical trial to evaluate PELA in combination with dexamethasone (Dex) and bortezomib (BZ) and define the tumor immune microenvironment (TiME) in patients with multiple myeloma treated with this regimen. PATIENTS AND METHODS Patients with relapsed/refractory multiple myeloma (n = 14) were enrolled in a phase Ib clinical trial (ClinicalTrials.gov: NCT02514382) of three escalating PELA doses administered on Days 1, 2, 8, 9, 15, and 16. Patients received 40 mg Dex and 1.5 mg/m2 BZ on Days 1, 8, and 15. Cycles were repeated every 28 days. Pre- and posttreatment bone marrow specimens (IHC, n = 9; imaging mass cytometry, n = 6) and peripheral blood samples were collected for analysis (flow cytometry, n = 5; T-cell receptor clonality, n = 7; cytokine assay, n = 7). RESULTS PELA/BZ/Dex was well-tolerated in all patients. Treatment-emergent toxicities were transient, and no dose-limiting toxicities occurred. Six (55%) of 11 response-evaluable patients showed decreased paraprotein. Treatment increased T and natural killer cell activation, inflammatory cytokine release, and programmed death-ligand 1 expression in bone marrow. Compared with nonresponders, responders had higher reovirus protein levels, increased cytotoxic T-cell infiltration posttreatment, cytotoxic T cells in significantly closer proximity to multiple myeloma cells, and larger populations of a novel immune-primed multiple myeloma phenotype (CD138+ IDO1+HLA-ABCHigh), indicating immunomodulation. CONCLUSIONS PELA/BZ/Dex is well-tolerated and associated with anti-multiple myeloma activity in a subset of responding patients, characterized by immune reprogramming and TiME changes, warranting further investigation of PELA as an immunomodulator.
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Affiliation(s)
- Steffan T. Nawrocki
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona
| | - Julian Olea
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Claudia Villa Celi
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Homa Dadrastoussi
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Kaijin Wu
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Denice Tsao-Wei
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anthony Colombo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matt Coffey
- Oncolytics Biotech, Inc, Calgary, Alberta, Canada
| | | | - Xuelian Chen
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Gerard J. Nuovo
- The Ohio State University Comprehensive Cancer Center Columbus, Columbus, Ohio
| | - Jennifer S. Carew
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona
| | - Ann F. Mohrbacher
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Paul Fields
- Formerly, Adaptive Biotechnologies, Seattle, Washington; currently, Tempus Labs, Seattle, Washington
| | - Peter Kuhn
- USC Michelson Center for Convergent Biosciences and Department of Biological Sciences, University of Southern California, Los Angeles
| | - Imran Siddiqi
- Department of Pathology, University of Southern California, Los Angeles, California
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin R. Kelly
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
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