Tumour-derived glucocorticoids amplify ROR1 and are exploited with glucocorticoid-resistant ROR1 CAR-T cells

Abstract

Exogenous glucocorticoids (GCs) suppress T cell-based immunotherapy, yet the consequences of endogenous GCs produced or regenerated by tumours remain poorly understood. Here, we show that tumour-derived GCs couple immune evasion to therapeutic antigenicity. In adrenocortical carcinoma, autonomous GC production activates hGR-STAT3 signaling to increase the surface antigen ROR1. This creates an immunological paradox in which GC excess promotes therapeutic antigen expression while suppressing T cell-mediated antitumor activity. Selective hGR-knockout renders ROR1 CAR-T cells GC-resistant while preserving GC-driven ROR1 expression in tumor cells, resulting in durable tumor control in vivo. Non-endocrine pancreatic and triple-negative breast cancers recreate this circuit through HSD11B1-mediated GC recycling, which is further induced by CAR-T cell-derived cytokines under immune pressure. Thus, GC-resistant CAR-T cells exploit a tumor-derived endocrine program that couples immune suppression to therapeutic antigenicity.