Solid tumors consist of malignant and nonmalignant cells that together create the local tumor microenvironment (TME). Additionally, the TME is characterized by the expression of numerous soluble factors such as TGF-β. TGF-β plays an important role in the TME by suppressing T cell effector function and promoting tumor invasiveness. Up to now CAR T cells exclusively target tumor-associated antigens (TAA) located on the cell membrane. Thus, strategies to exploit soluble antigens as CAR targets within the TME are needed. This study demonstrates a novel approach using Adapter CAR (AdCAR) T cells for the detection of soluble latent TGF-β within the TME of a pancreatic tumor model. We show that AdCARs in combination with the respective adapter can be used to sense soluble tumor-derived latent TGF-β, both in vitro and in vivo . Sensing of the soluble antigen induced cellular activation and effector cytokine production in AdCAR T cells. Moreover, we evaluated AdCAR T cells for the combined targeting of soluble latent TGF-β and tumor cell killing by targeting CD66c as TAA in vivo . In sum, our study broadens the spectrum of targetable moieties for AdCAR T cells by soluble latent TGF-β.

Leadership structures in German clinics are adjusting parallel to DRG (diagnose-related groups)-induced economic reorientation of the health care system. A Chief Medical Clinic Manager (CMCM) is a new job description and an innovative approach to combine medical competence and business economics at the operational level of care. The ideal qualification is a medical specialist in the clinical field with practical experience in patient care and leadership as well as in hospital economics and quality control. A CMCM is placed at a superior level in the clinic, with authorizing competence for the entire physician team. Main tasks are cost transparency within the clinic, organizational development by structured processes, and financial and strategic controlling of all business aspects. A CMCM induces change management and financial adjustment of care to reimbursement with maintaining the standard of care. In cooperation with the director of the clinic, a CMCM develops a vision for clinic development, an investment strategy, and a business plan. The success parameters are positive operative results of the clinic, cost-covering care, increased investment rate, employee satisfaction, and implementation of innovations in research and therapy. A CMCM thereby increases financial and organizational freedom of action at the clinic level in a non-profit public health care system.

Major advances have been achieved in targeted immunotherapy with significant clinical benefits for patients. However, on-target/off-tumor toxicity is a major concern. This issue highlights the clinical need for better targets to improve the safety profile of immunotherapies. On-target/off-tumor toxicity is mainly based on the expression of tumor-associated antigens (TAA) in healthy tissues under physiological conditions. Thus, new approaches have to be developed to restrict specificity of targeted immunotherapy selectively towards cancerous cells. One way to improve target specificity is multi-targeting of cancer cells, i.e. targeting more than one TAA per cancer cell. We developed a workflow to identify new tumor markers employing an unbiased high throughput flow cytometry-based screen on primary ovarian cancer samples. Co-expression of THY1, a marker of fibroblasts and hematopoietic stem cells, was revealed on cancer cells characterized by EPCAM expression, a marker of epithelial cells. We confirmed our findings by high content imaging analyzing several ovarian carcinoma samples. Next we assessed the safety profile of the target combination THY1-EPCAM by analyzing the expression across a multitude of healthy human tissue samples using again high content imaging. Cluster analysis showed correlation patterns within the datasets confirming our previous findings. In order to investigate the functionality of THY1-EPCAM as therapeutic t we combined this target pair with the adaptor CAR technology, a modular system composed of a CAR recognizing biotin and biotinylated antibodies which are specific for a certain antigen. This technology combines the flexibility and controllability of antibodies with the efficacy of CAR T cell-dependent killing of target cells. The functional in vitro characterization of adaptor CAR T cells targeting the THY1-EPCAM pair shows high specificity and efficacy. Moreover, we are going to conduct in vivo studies with adaptor CAR T cells to investigate the efficacy and safety of targeting THY1-EPCAM in a solid tumor model. In conclusion, we successfully identified a novel target combination in ovarian cancer utilizing flow cytometry-based screening complemented by high content imaging. The new target pair combination shows promising results in vitro in combination with adaptor CAR T cells indicating its potential use as future immunotherapy. Citation Format: Christoph Herbel, Vera Dittmer, Manuel Martinez-Osuna, Sandy Reiß, Peter Mallmann, Dominik Ratiu, Michael Mallmann, Paurush Praveen, Werner Müller, Dominik Eckardt, Andreas Bosio. Identification of a novel tumor marker combination THY1-EPCAM for adaptor CAR T cell therapy in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2813.

Background: Cost-covering in-patient care is increasingly important for hospital providers in Germany, especially with regard to expensive oncological pharmaceuticals. Additional payments (Zusatzentgelte; ZE) on top of flat rate diagnose-related group (DRG) reimbursement can be claimed by hospitals for in-patient use of selected medications. To verify cost coverage of in-patient chemotherapies, the costs of medication were compared to their revenues. Method: From January to June 2010, a retrospective costrevenue study was performed at a German obstetrics/gynecology university clinic. The hospital’s pharmacy list of inpatient oncological therapies for breast and gynecological cancer was checked for accuracy and compared with the documented ZEs and the costs and revenues for each oncological application. Results: N = 45 in-patient oncological therapies were identified in n = 18 patients, as well as n = 7 bisphosphonate applications; n = 11 ZEs were documented. Costs for oncological medication were € 33,752. The corresponding ZE revenues amounted to only € 13,980, resulting in a lossof € 19,772. All in-patient oncological therapies performed were not cost-covering. Data discrepancy, incorrect documentation and cost attribution, and process aborts were identified. Conclusions: Routine financial quality control at the medicine-pharmacy administration interface is implemented, with monthly comparison of costs and revenues, as well as admission status. Non-cost-covering therapies for in-patients should be converted to out-patient therapies. Necessary adjustments of clinic processes are made according to these results, to avoid future losses.