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Majority of patients with head and neck squamous cell carcinomas (HNSCC) are diagnosed during the locally advanced (LA) stage and are given standard treatments such as primary radiochemotherapy (RCTx) or postoperative radiochemotherapy (PORT-C). Due to heterogenous tumor response, patients show various treatment outcomes. Our previous retrospective biomarker analyses showed that SLC3A2 is a promising biomarker for locoregional control (LRC) in LA HNSCC patients with HPV-negative tumors treated with primary RCTx or PORT-C, with increased LRC rates in patients with low SLC3A2 mRNA and its protein product CD98hc levels (1,2). The siRNA- and CRISPR-Cas9 mediated inhibition of CD98hc expression increased radiosensitivity of HNSCC cells. Hence, CD98hc is a promising target for radiosensitization of the HNSCC. One of the strategies for radiosensitization is targeted immunotherapy. However, Chimeric Antigen Receptor (CAR)-equipped T-cell therapy cannot be fully controlled. Therefore, the switchable Universal CAR (UniCAR) system was developed (3, 4) that is currently in phase I clinical trial (NCT04230265) (5). UniCAR T cell activity and specificity is controlled by the presence of target modules (TM) with short half-lives (3). We aim to define the clinical value of new treatment approaches by combining radio(chemo)therapy with CD98hc-targeted immunotherapy. We have used previously described radioresistant Cal33 HNSCC cells (2, 6). These tumor cells were co-cultured with UniCAR T cells in the presence or absence of a novel CD98 TM. Our data shows that CD98-redirected UniCAR T cells have the capability to induce cell lysis of radioresistant HNSCC cells in in vitro 3D culture. The most promising combination of therapeutic approach will be further tested in xenograft tumor models to evaluate the best performing combination of immunotherapy and radio(chemo)therapy. This system can be potentially used to approach the combination of the UniCAR system with radio(chemo)therapy for synergistic improvement of treatment efficacy of patients with metastatic radioresistant tumors.

Induction or selection of radioresistant cancer (stem) cells following standard radiotherapy is presumably one of the major causes for recurrence of metastatic disease. One possibility to prevent tumor relapse is the application of targeted immunotherapies including, e.g., chimeric antigen receptor (CAR) T cells. In light of long-term remissions, it is highly relevant to clarify whether radioresistant cancer cells are susceptible to CAR T cell-mediated killing. To answer this question, we evaluated the anti-tumor activity of the switchable universal chimeric antigen receptor (UniCAR) system against highly radioresistant head and neck squamous cell carcinoma cells both in vitro and in vivo. Following specific UniCAR T cell engagement via EGFR or CD98 target modules, T cell effector mechanisms were induced including secretion of pro-inflammatory cytokines, up-regulation of granzyme B and perforin, as well as T cell proliferation. CD98- or EGFR-redirected UniCAR T cells further possess the capability to efficiently lyse radioresistant tumor cells. Observed anti-tumor effects were comparable to those against the radiosensitive parental cell lines. Finally, redirected UniCAR T cells significantly inhibited the growth of radioresistant cancer cells in immunodeficient mice. Taken together, our obtained data underline that the UniCAR system is able to overcome radioresistance. Thus, it represents an attractive technology for the development of combined radioimmunotherapeutic approaches that might improve the outcome of patients with metastatic radioresistant tumor diseases.