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Siebert N, Troschke-Meurer S, Marx M, Zumpe M, Ehlert K, Gray J, Garaventa A, Manzitti C, Ash S, Klingebiel T, Beck J, Castel V, Valteau-Couanet D, Loibner H, Ladenstein R, Lode HN. Impact of HACA on Immunomodulation and Treatment Toxicity Following ch14.18/CHO Long-Term Infusion with Interleukin-2: Results from a SIOPEN Phase 2 Trial. Cancers (Basel) 2018; 10:cancers10100387. [PMID: 30336605 PMCID: PMC6210332 DOI: 10.3390/cancers10100387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/17/2018] [Accepted: 10/11/2018] [Indexed: 12/24/2022] Open
Abstract
GD2-directed immunotherapies improve survival of high-risk neuroblastoma (NB) patients (pts). Treatment with chimeric anti-GD2 antibodies (Ab), such as ch14.18, can induce development of human anti-chimeric Ab (HACA). Here, we report HACA effects on ch14.18/CHO pharmacokinetics, pharmacodynamics and pain intensity in pts treated by long-term infusion (LTI) of ch14.18/CHO combined with IL-2. 124 pts received up to 5 cycles of ch14.18/CHO 10 days (d) infusion (10 mg/m2/d; d8–18) combined with s.c. IL-2 (6 × 106 IU/m2/d; d1–5, d8–12). HACA, treatment toxicity, ch14.18/CHO levels, Ab-dependent cellular- (ADCC) and complement-dependent cytotoxicity (CDC) were assessed using respective validated assays. HACA-negative pts showed a steadily decreased pain in cycle 1 (74% pts without morphine by d5 of LTI) with further decrease in subsequent cycles. Ch14.18/CHO peak concentrations of 11.26 ± 0.50 µg/mL found in cycle 1 were further elevated in subsequent cycles and resulted in robust GD2-specific CDC and ADCC. Development of HACA (21% of pts) resulted in strong reduction of ch14.18/CHO levels, abrogated CDC and ADCC. Surprisingly, no difference in pain toxicity between HACA-positive and -negative pts was found. In conclusion, ch14.18/CHO LTI combined with IL-2 results in strong activation of Ab effector functions. Importantly, HACA response abrogated CDC but did not affect pain intensity indicating CDC-independent pain induction.
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Affiliation(s)
- Nikolai Siebert
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Sascha Troschke-Meurer
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Madlen Marx
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Maxi Zumpe
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Karoline Ehlert
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton, Southampton SO14 0YG, UK.
| | | | - Carla Manzitti
- Oncology Unit, Istituto Giannina Gaslini, 16147 Genova, Italy.
| | - Shifra Ash
- Pediatric Hemato-Oncology Division, Schneider Children Medical Center, Kaplan 14, Petach Tikva 4920235, Israel.
| | - Thomas Klingebiel
- University Children's Hospital, Goethe University Frankfurt, 60596 Frankfurt, Germany.
| | - James Beck
- University Children's Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany.
| | - Victoria Castel
- Pediatric Hemato-Oncology Unit, University Hospital La Fe, 46026 Valencia, Spain.
| | | | - Hans Loibner
- Advisor to Apeiron Biologics AG, 1030 Vienna, Austria.
| | - Ruth Ladenstein
- St. Anna Children's Hospital and Children's Cancer Research Institute (CCRI), Department of Paediatrics, Medical University, Kinderspitalgasse 6, 1090 Vienna, Austria.
| | - Holger N Lode
- Department of Pediatric Oncology and Hematology, University Medicine Greifswald, 17475 Greifswald, Germany.
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Ding YY, Panzer J, Maris JM, Castañeda A, Gomez-Chiari M, Mora J. Transverse myelitis as an unexpected complication following treatment with dinutuximab in pediatric patients with high-risk neuroblastoma: A case series. Pediatr Blood Cancer 2018; 65. [PMID: 28748630 DOI: 10.1002/pbc.26732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/10/2017] [Accepted: 06/25/2017] [Indexed: 11/06/2022]
Abstract
Immunotherapy with the anti-GD2 monoclonal antibody ch14.18, or dinutuximab, represents an important therapeutic advance in the treatment of pediatric high-risk neuroblastoma and is now considered part of standard of care in this patient population. To date, transverse myelitis as a result of dinutuximab therapy has not been reported in clinical trials or in the published literature. We describe three patients with clinical symptoms of transverse myelitis, confirmed via magnetic resonance imaging, shortly following initiation of dinutuximab. All patients were discontinued from dinutuximab treatment and received urgent treatment, with rapid improvement in symptoms and resultant functional recovery.
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Affiliation(s)
- Yang-Yang Ding
- Department of Pediatric Hematology and Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica Panzer
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John M Maris
- Department of Pediatric Hematology and Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alicia Castañeda
- Departments of Pediatric Heamtology and Oncology and radiology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Marta Gomez-Chiari
- Departments of Pediatric Heamtology and Oncology and radiology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Jaume Mora
- Departments of Pediatric Heamtology and Oncology and radiology, Hospital Sant Joan de Deu, Barcelona, Spain
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Vriesendorp HM, Vriesendorp FJ. A review of the intravenous administration of radiolabeled immunoglobulin G to cancer patients. High or low protein dose? Cancer Biother Radiopharm 2003; 18:35-46. [PMID: 12667307 DOI: 10.1089/108497803321269313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This retrospective analysis of preclinical and clinical radiolabeled immunoglobulin studies focuses on three well-known observations: (1) IV tumor reactive IgG provides higher response rates in patients with hematological malignancies than in patients with solid tumors. (2) Patients with CD20 positive B cell lymphoma require a high IV IgG protein dose for effective tumor targeting. (3) Most patients experience high uptake of IV administered radiolabeled IgG in normal liver. This review supports the following new hypotheses: (1) The blood-tumor barrier in most solid tumors is higher than in most hematological malignancies. (2) The blood-tumor barrier in CD20 positive B cell lymphomas is lowered by the IV administration of high doses [> 100 mg] of anti-CD20 IgG, presumably due to IgG induced intra-tumoral production of vaso-active biological response modifiers. (3) The blood-tumor barrier is low in Hodgkin's disease, presumably due to the continuous and innate production of biological response modifiers in tissues containing Hodgkin's disease. (4) The uptake of tumor reactive IgG in the normal liver is controlled by the Fc portion of the IgG. The radioimmunoconjugate is not catabolized in the liver. This appears to indicate that the F(c) portion of the IgG binds to the MHC class I like, F(c)gammaRn receptors in liver endothelium and hepatocytes and not to F(c)gamma RI, RII or RIII receptors The new hypotheses require verification and can be instrumental in the design of new more effective clinical RIT studies.
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Affiliation(s)
- Huib M Vriesendorp
- Department of Radiation Oncology, Marshfield Clinic, Marshfield, Wisconsin, USA.
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Watkins LR, Maier SF. Beyond neurons: evidence that immune and glial cells contribute to pathological pain states. Physiol Rev 2002; 82:981-1011. [PMID: 12270950 DOI: 10.1152/physrev.00011.2002] [Citation(s) in RCA: 514] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Chronic pain can occur after peripheral nerve injury, infection, or inflammation. Under such neuropathic pain conditions, sensory processing in the affected body region becomes grossly abnormal. Despite decades of research, currently available drugs largely fail to control such pain. This review explores the possibility that the reason for this failure lies in the fact that such drugs were designed to target neurons rather than immune or glial cells. It describes how immune cells are a natural and inextricable part of skin, peripheral nerves, dorsal root ganglia, and spinal cord. It then examines how immune and glial activation may participate in the etiology and symptomatology of diverse pathological pain states in both humans and laboratory animals. Of the variety of substances released by activated immune and glial cells, proinflammatory cytokines (tumor necrosis factor, interleukin-1, interleukin-6) appear to be of special importance in the creation of peripheral nerve and neuronal hyperexcitability. Although this review focuses on immune modulation of pain, the implications are pervasive. Indeed, all nerves and neurons regardless of modality or function are likely affected by immune and glial activation in the ways described for pain.
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Affiliation(s)
- Linda R Watkins
- Department of Psychology and the Center for Neuroscience, University of Colorado at Boulder, Boulder, Colorado.
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Sorkin LS, Yu AL, Junger H, Doom CM. Antibody directed against GD(2) produces mechanical allodynia, but not thermal hyperalgesia when administered systemically or intrathecally despite its dependence on capsaicin sensitive afferents. Brain Res 2002; 930:67-74. [PMID: 11879797 DOI: 10.1016/s0006-8993(01)03408-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anti-GD(2) antibodies have been shown to be effective for immunotherapy of neuroblastoma and other GD(2) enriched malignancies. Infusion of anti-GD(2) antibodies frequently causes spontaneous pain and allodynia for the duration of the immunotherapy and occasionally longer lasting neuropathic pain. Bolus intravenous injection of anti-GD(2) in rats initiates mechanical allodynia as measured by withdrawal threshold of the hindpaws. In this study, thermal thresholds were measured prior to and for up to 6 h following systemic anti-GD(2) administration in adult rats. In addition, both thermal and mechanical thresholds were tested following intrathecal administration of anti-GD(2) and IgG(2a). Murine anti-GD(2) elicited mechanical allodynia when administered into either the vasculature or the intrathecal space. Effective systemic doses were 1--3 mg/kg as previously shown. Intrathecally, optimal doses ranged from 0.01 to 0.1 ng; a higher dose was ineffective. Thermal hyperalgesia was not observed via either route of administration. Intrathecal pretreatment 48--72 h prior to the experiment with capsaicin at doses sufficient to cause a 50% depletion of dorsal horn CGRP, caused a total blockade of the mechanical allodynia indicating an involvement of peptidergic fine afferent fibers. It is likely that the antibody reacts with an antigen on peripheral nerve and/or myelin to initiate its effect. The lack of observed thermal hyperalgesia is surprising especially in light of the capsaicin-associated blockade, however, it is consistent with several other immune system related models of pain.
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Affiliation(s)
- L S Sorkin
- Anesthesiology Research Laboratories, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0818, USA.
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Abstract
Over the past decade, remarkable progress has been made in our understanding of the pathogenesis of Miller Fisher syndrome (MFS), a clinical variant of Guillain Barré syndrome (GBS). MFS comprises the clinical triad of ataxia, areflexia and ophthalmoplegia. It is associated with acute-phase IgG antibodies to GQ1b and GT1a gangliosides in over 90% of cases which are highly disease specific. Like GBS, MFS is a post-infectious syndrome following diverse infections, but particular attention has been paid to its association with Campylobacter jejuni enteritis. Serostrains of C. jejuni isolated from infected patients bear ganglioside-like epitopes in their lipopolysaccharide core oligosaccharides, which elicit humoral immune responses exhibiting molecular mimicry with GQ1b/GT1a gangliosides. These antibodies are believed to be the principal cause of the syndrome and physiological studies aimed at proving this have focused on the motor-nerve terminal as a potential site of pathogenic action. This review describes these findings and formulates a pathogenesis model based on our current state of knowledge.
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Affiliation(s)
- H J Willison
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK.
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