T cell engagers control solid tumors through clonal replacement and IL2-driven effector differentiation of CD8 T cells

Abstract Bispecific T cell engagers (TCEs) often exhibit limited efficacy in solid tumors, in part due to immunosuppressive cues in the tumor microenvironment and low expression of targetable tumor antigens. Therapeutic strategies to improve TCE target sensitivity and enhance T cell effector functions therefore have significant translational potential. Here, we engineered TCEs that induce T cell activation in vitro against the low-abundance target antigens, TRP2/Kb and DLL3. Despite in vitro activity in these models, TCE monotherapy showed limited control of tumor growth in immunocompetent mice. Leveraging this in vivo model of TCE treatment failure, we discovered that co-treatment with TCE and a CD25-biased Interleukin-2 (IL2) rescues anti-tumor activity. Further, multimodal single-cell transcriptomic and immune repertoire analyses revealed that TCE-IL2 combination therapy controlled tumors by recruiting and activating new CD8+ T cells into the tumor microenvironment. These findings demonstrate that TCE-mediated anti-tumor responses function through a CD8+ T cell clonal replacement mechanism that can be augmented by cytokine therapy. One Sentence Summary Combining TCE therapy with IL-2 enhances TCE efficacy in aggressive small-cell lung cancer and melanoma models with low target antigen density through T cell clonal replacement and CD8+ effector T cell differentiation. Competing Interest Statement CSM holds patents related to MULTI-seq. ATS is a founder of Immunai, Cartography Biosciences, Santa Ana Bio, and Arpelos Biosciences, an advisor to 10x Genomics and Wing Venture Capital, and receives research funding from Astellas and Northpond Ventures. JS has equity in and is an advisor for DISCO Pharmaceuticals. KCG is the founder of Synthekine and co-founder of Dispatch Therapeutics. All other authors declare that they have no competing interests. Footnotes Main text reformatting, fixed typos, merging of supplemental figures 1 and 2. Addition of new Methods sections.