Overcome trastuzumab resistance of breast cancer using anti-HER2 chimeric antigen receptor T cells and PD1 blockade

Trastuzumab-resistance is still a major challenge in treating patients with HER2 positive breast cancer. In this study, we tried to overcome transtuzumab-resistance by examining the therapeutic efficacy of third generation anti-HER2 chimeric antigen receptor (CAR)-T cells alone and in combination with PD1 blockade against HER2 positive and trastuzumab-resistance breast cancer cells in vitro and xenograft model. The anti-HER2 CAR-T cells were generated by infecting CD3/CD28 activated peripheral blood mononuclear cells with lentivirus expressing third generation anti-HER2 CAR. Anti-HER2 CAR-T cells were specifically targeted to HER2 positive BT474 and trastuzumab resistant HCC1954 cells compared with HER2 negative breast cancer cells. Results from ELISA revealed that the secretion of IL-2 and IFN-γ was increased in anti-HER2 CAR-T cells after being co-cultured with HCC1954 cells, and was further increased with the addition of anti-PD1 antibody in the co-culture system. Furthermore, data from lactate dehydrogenase assay showed that anti-HER2 CAR-T cells displayed a potent cytotoxicity against HCC1954 and BT474 cells. Addition of anti-PD1 antibody further enhanced the cytotoxicity of anti-HER2 CAR-T cells against HCC1954 cells. Lastly, injection of anti-HER2 CAR-T cells significantly reduced the growth of HCC1954 xenograft tumors. Combining anti-HER2 CAR-T cells with anti-PD1 antibody further impaired the growth of HCC1954 tumors. The present results indicate that anti-HER2 CAR-T cells have therapeutic efficacy against trastuzumab resistant breast tumors and addition of the PD1 antibody can further enhance the therapeutic effect of anti-HER2 CAR-T cells. Thus, third generation anti-HER2 CAR-T cells along with PD1 blockade is a potential therapy to overcome trastuzumab resistance of breast cancer.