Advanced peritoneal carcinomatosis including high-grade ovarian cancer has poor prognoses and a poor response rate to current checkpoint inhibitor immunotherapies; thus, there is an unmet need for effective therapeutics that would provide benefit to these patients. Here we present the preclinical development of SENTI-101, a cell preparation of bone marrow-derived mesenchymal stromal (also known as stem) cells (MSC), which are engineered to express two potent immune-modulatory cytokines, IL12 and IL21. Intraperitoneal administration of SENTI-101 results in selective tumor-homing and localized and sustained cytokine production in murine models of peritoneal cancer. SENTI-101 has extended half-life, reduced systemic distribution, and improved antitumor activity when compared with recombinant cytokines, suggesting that it is more effective and has lower risk of systemic immunotoxicities. Treatment of tumor-bearing immune-competent mice with a murine surrogate of SENTI-101 (mSENTI-101) results in a potent and localized immune response consistent with increased number and activation of antigen presenting cells, T cells and B cells, which leads to antitumor response and memory-induced long-term immunity. Consistent with this mechanism of action, co-administration of mSENTI-101 with checkpoint inhibitors leads to synergistic improvement in antitumor response. Collectively, these data warrant potential clinical development of SENTI-101 for patients with peritoneal carcinomatosis and high-grade ovarian cancer. Graphical abstract: SENTI-101 schematic and mechanism of action SENTI-101 is a novel cell-based immunotherapeutic consisting of bone marrow–derived mesenchymal stromal cells (BM-MSC) engineered to express IL12 and IL21 intended for the treatment of peritoneal carcinomatosis including high-grade serous ovarian cancer. Upon intraperitoneal administration, SENTI-101 homes to peritoneal solid tumors and secretes IL12 and IL21 in a localized and sustained fashion. The expression of these two potent cytokines drives tumor infiltration and engagement of multiple components of the immune system: antigen-presenting cells, T cells, and B cells, resulting in durable antitumor immunity in preclinical models of cancer.

While immunotherapies based on single recombinant cytokines such as IL12 and IL21 have shown great promise in preclinical models of solid tumors, clinical translation has proven challenging due to limited mechanisms of action, narrow therapeutic windows upon systemic administration, and short half-lives resulting in poor pharmacokinetics and distribution. Thus, there is a need for tumor-localized cytokine therapies capable of driving sustained efficacy with a wide therapeutic window. SENTI-101 is a cell-based immunotherapy comprising allogeneic bone marrow-derived mesenchymal stromal cells (BM-MSCs) genetically modified to express IL12 and IL21. Consistent with prior studies, we demonstrated that SENTI-101 innately homes to disseminated tumors in the peritoneal cavity and induces durable anti-tumor responses and immune memory in various preclinical models of peritoneal tumors. In this study, we investigated the mechanisms of action of SENTI-101. Our results demonstrate that the IL12 and IL21 combination elicits pleiotropic and complementary effects that drive a multi-modal immune response across various steps of the cancer immunity cycle. Treatment of preclinical murine models of peritoneal tumors (e.g., CT26 and B16F10) with SENTI-101 significantly increased the local production of IFNg by more than 40-fold (p<0.02). Concurrently, mice treated with SENTI-101 had significantly increased levels of cytokines and chemokines such as CXCL9 (p<0.02), which have previously been associated with better prognosis and response to immunotherapy in multiple cancer types. We used flow cytometry and multiplexed IHC to characterize the immune landscape in response to SENTI-101. The number of antigen-presenting cells (F4/80negCD11c+MHC-II+CD103+) more than doubled in peritoneal lymph nodes 72 h after treatment with SENTI-101 (p=0.016). We also observed an increase in pSTAT1 positivity in the myeloid compartment, indicating a favorable immune phenotype. This change was accompanied by an increase in T-cell infiltrates into tumors (p=0.0003) that were in close proximity with B-cells and that were organized in tertiary lymphoid structures, which are known to correlate with improved prognosis in cancer patients. T-cell activation markers (CD38, CD25, IFNg, GranzymeB) also increased by more than 6 times (p=0.015) in the tumor microenvironment (TME) and peritoneal fluid after treatment with SENTI-101. In accordance with increased T-cell infiltration and activation in the TME, SENTI-101 showed a synergistic anti-tumor effect when combined with checkpoint inhibitor anti-PD1. Overall, our preclinical studies show that SENTI-101 modulates the tumor immune landscape via multiple complementary modes of action, resulting in long-term anti-tumor immunity. Furthermore, this work demonstrates the therapeutic potential of tumor-localized cell therapies armed with gene circuits expressing combinatorial immune effectors to trigger a multi-factorial anti-tumor response. Citation Format: Alba Gonzalez, Frances D. Liu, Archana Nagaraja, Alyssa Mullenix, Russell M. Gordley, Daniel O. Frimannsson, Anissa Benabbas, Chen-Ting Lee, Tiffany A. Truong, Allison Quach, Mengxi Tian, Rowena Martinez, Rishi Savur, Alyssa Perry-McNamara, Don-Hong Wang, Ori Maller, Dharini Iyer, Ashita Magal, Sravani Mangalampalli, Christina J. Huynh, Carmina C. Blanco, Jack T. Lin, Brian S. Garrison, Philip Lee, Timothy K. Lu, Gary Lee. SENTI-101, a novel genetically modified allogeneic cell product expressing IL12 and IL21, elicits a tumor-localized, robust, and multimodal immune response in preclinical models of solid tumors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4246.