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Dong W, Wang W, Cao C. The Evolution of Antibody-Drug Conjugates: Toward Accurate DAR and Multi-specificity. ChemMedChem 2024; 19:e202400109. [PMID: 38758596 DOI: 10.1002/cmdc.202400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
Antibody-drug conjugates (ADCs) consist of antibodies, linkers and payloads. They offer targeted delivery of potent cytotoxic drugs to tumor cells, minimizing off-target effects. However, the therapeutic efficacy of ADCs is compromised by heterogeneity in the drug-to-antibody ratio (DAR), which impacts both cytotoxicity and pharmacokinetics (PK). Additionally, the emergence of drug resistance poses significant challenges to the clinical advancement of ADCs. To overcome these limitations, a variety of strategies have been developed, including the design of multi-specific drugs with accurate DAR. This review critically summarizes the current challenges faced by ADCs, categorizing key issues and evaluating various innovative solutions. We provide an in-depth analysis of the latest methodologies for achieving homogeneous DAR and explore design strategies for multi-specific drugs aimed at combating drug resistance. Our discussion offers a current perspective on the advancements made in refining ADC technologies, with an emphasis on enhancing therapeutic outcomes.
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Affiliation(s)
- Wenge Dong
- State Key Laboratory of Elemento-Organic Chemistry and Frontiers Science Center for New Organic Matter, College of Chemistry, Nankai University, Tianjin, 300071, China
| | - Wanqi Wang
- State Key Laboratory of Elemento-Organic Chemistry and Frontiers Science Center for New Organic Matter, College of Chemistry, Nankai University, Tianjin, 300071, China
| | - Chan Cao
- State Key Laboratory of Elemento-Organic Chemistry and Frontiers Science Center for New Organic Matter, College of Chemistry, Nankai University, Tianjin, 300071, China
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2
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Dumontet C, Reichert JM, Senter PD, Lambert JM, Beck A. Antibody-drug conjugates come of age in oncology. Nat Rev Drug Discov 2023; 22:641-661. [PMID: 37308581 DOI: 10.1038/s41573-023-00709-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Antibody-drug conjugates (ADCs) combine the specificity of monoclonal antibodies with the potency of highly cytotoxic agents, potentially reducing the severity of side effects by preferentially targeting their payload to the tumour site. ADCs are being increasingly used in combination with other agents, including as first-line cancer therapies. As the technology to produce these complex therapeutics has matured, many more ADCs have been approved or are in late-phase clinical trials. The diversification of antigenic targets as well as bioactive payloads is rapidly broadening the scope of tumour indications for ADCs. Moreover, novel vector protein formats as well as warheads targeting the tumour microenvironment are expected to improve the intratumour distribution or activation of ADCs, and consequently their anticancer activity for difficult-to-treat tumour types. However, toxicity remains a key issue in the development of these agents, and better understanding and management of ADC-related toxicities will be essential for further optimization. This Review provides a broad overview of the recent advances and challenges in ADC development for cancer treatment.
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Affiliation(s)
- Charles Dumontet
- CRCL INSERM 1052/CNRS 5286, University of Lyon, Hospices Civils de Lyon, Lyon, France.
| | | | | | | | - Alain Beck
- Institut de Recherche Pierre Fabre, CIPF, Saint-Julien-en-Genevois, France
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3
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Abstract
Gastroenterologists and hepatologists will encounter oncology patients who develop abnormal liver tests, patients with hepatic malignancies, and patients with acute and chronic liver disease who require chemotherapy or immediate evaluation. Chemotherapy can cause liver injury owing to toxic effects or idiosyncratic reactions. Immune checkpoint inhibitors may be associated with autoimmune-mediated liver toxicities. Venoocclusive disease requires immediate evaluation. Nodular regenerative hyperplasia is a chronic progressive disorder. Screening and prophylaxis for reactivation of hepatitis B is important to minimize complications in patients receiving chemotherapy. Patients with metastatic lesions can undergo resection or ablation. Hepatic injury may occur in those receiving radiation-based therapies.
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Affiliation(s)
- Renu Dhanasekaran
- Department of Medicine, Stanford University School of Medicine, 750 Welch Road #210, Palo Alto, CA 94304-1507, USA
| | - Paul Y Kwo
- Department of Medicine, Stanford University School of Medicine, 750 Welch Road #210, Palo Alto, CA 94304-1507, USA.
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4
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Donaghy H. Effects of antibody, drug and linker on the preclinical and clinical toxicities of antibody-drug conjugates. MAbs 2016; 8:659-71. [PMID: 27045800 PMCID: PMC4966843 DOI: 10.1080/19420862.2016.1156829] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/15/2022] Open
Abstract
Antibody-drug conjugates (ADCs) represent a new class of cancer therapeutics. Their design involves a tumor-specific antibody, a linker and a cytotoxic payload. They were designed to allow specific targeting of highly potent cytotoxic agents to tumor cells whilst sparing normal cells. Frequent toxicities that may be driven by any of the components of an ADC have been reported. There are currently more than 50 ADCs in active clinical development, and a further ∼20 that have been discontinued. For this review, the reported toxicities of ADCs were analysed, and the mechanisms for their effects are explored in detail. Methods to reduce toxicities, including dosing strategies and drug design, are discussed. The toxicities reported for active and discontinued drugs are important to drive the rational design and improve the therapeutic index of ADCs of the future.
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5
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A Humanized Anti-CD22-Onconase Antibody-Drug Conjugate Mediates Highly Potent Destruction of Targeted Tumor Cells. J Immunol Res 2015; 2015:561814. [PMID: 26605343 PMCID: PMC4641194 DOI: 10.1155/2015/561814] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/01/2015] [Indexed: 11/25/2022] Open
Abstract
Antibody-drug conjugates (ADCs) have evolved as a new class of potent cancer therapeutics. We here report on the development of ADCs with specificity for the B-cell lineage specific (surface) antigen CD22 being expressed in the majority of hematological malignancies. As targeting moiety a previously generated humanized anti-CD22 single-chain variable fragment (scFv) derivative from the monoclonal antibody RFB4 was reengineered into a humanized IgG1 antibody format (huRFB4). Onconase (ranpirnase), a clinically active pancreatic-type ribonuclease, was employed as cytotoxic payload moiety. Chemical conjugation via thiol-cleavable disulfide linkage retained full enzymatic activity and full binding affinity of the ADC. Development of sophisticated purification procedures using size exclusion and ion exchange chromatography allowed the separation of immunoconjugate species with stoichiometrically defined number of Onconase cargos. A minimum of two Onconase molecules per IgG was required for achieving significant in vitro cytotoxicity towards lymphoma and leukemia cell lines. Antibody-drug conjugates with an Onconase to antibody ratio of 3 : 1 exhibited an IC50 of 0.08 nM, corresponding to more than 18,400-fold increased cytotoxicity of the ADC when compared with unconjugated Onconase. These results justify further development of this ADC as a promising first-in-class compound for the treatment of CD22-positive malignancies.
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Podhorecka M, Markowicz J, Szymczyk A, Pawlowski J. Target Therapy in Hematological Malignances: New Monoclonal Antibodies. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:701493. [PMID: 27433507 PMCID: PMC4897146 DOI: 10.1155/2014/701493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/17/2022]
Abstract
Apart from radio- and chemotherapy, monoclonal antibodies (MoAbs) represent a new, more selective tool in the treatment of hematological malignancies. MoAbs bind with the specific antigens of the tumors. This interaction is a basis for targeted therapies which exhibit few side effects and significant antitumor activity. This review provides an overview of the functional characteristics of MoAbs, with some examples of their clinical application. The promising results in the treatment of hematological malignancies have led to the more frequent usage of MoAbs in the therapy. Development of MoAbs is a subject of extensive research. They are a promising method of cancer treatment in the future.
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Affiliation(s)
- Monika Podhorecka
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Justyna Markowicz
- Students Scientific Association at the Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Szymczyk
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Johannes Pawlowski
- Students Scientific Association at the Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
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7
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Abstract
Toxin payloads, or drugs, are the crucial components of therapeutic antibody-drug conjugates (ADCs). This review will give an introduction on the requirements that make a toxic compound suitable to be used in an antitumoral ADC and will summarize the structural and mechanistic features of four drug families that yielded promising results in preclinical and clinical studies.
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Affiliation(s)
- Jan Anderl
- Heidelberg Pharma GmbH, Ladenburg, Germany
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8
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Ricart AD. Antibody-drug conjugates of calicheamicin derivative: gemtuzumab ozogamicin and inotuzumab ozogamicin. Clin Cancer Res 2012; 17:6417-27. [PMID: 22003069 DOI: 10.1158/1078-0432.ccr-11-0486] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antibody-drug conjugates (ADC) are an attractive approach for the treatment of acute myeloid leukemia and non-Hodgkin lymphomas, which in most cases, are inherently sensitive to cytotoxic agents. CD33 and CD22 are specific markers of myeloid leukemias and B-cell malignancies, respectively. These endocytic receptors are ideal for an ADC strategy because they can effectively carry the cytotoxic payload into the cell. Gemtuzumab ozogamicin (GO, Mylotarg) and inotuzumab ozogamicin consist of a derivative of calicheamicin (a potent DNA-binding cytotoxic antibiotic) linked to a humanized monoclonal IgG4 antibody directed against CD33 or CD22, respectively. Both of these ADCs have a target-mediated pharmacokinetic disposition. GO was the first drug to prove the ADC concept in the clinic, specifically in phase II studies that included substantial proportions of older patients with relapsed acute myeloid leukemia. In contrast, in phase III studies, it has thus far failed to show clinical benefit in first-line treatment in combination with standard chemotherapy. Inotuzumab ozogamicin has shown remarkable clinical activity in relapsed/refractory B-cell non-Hodgkin lymphoma, and it has started phase III evaluation. The safety profile of these ADCs includes reversible myelosuppression (especially neutropenia and thrombocytopenia), elevated hepatic transaminases, and hyperbilirubinemia. There have been postmarketing reports of hepatotoxicity, especially veno-occlusive disease, associated with GO. The incidence is ~2%, but patients who undergo hematopoietic stem cell transplantation have an increased risk. As we steadily move toward the goal of personalized medicine, these kinds of agents will provide a unique opportunity to treat selected patient subpopulations based on the expression of their specific tumor targets.
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Affiliation(s)
- Alejandro D Ricart
- Biotechnology Unit and Oncology Clinical Research, Pfizer Inc., San Diego, California, USA.
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Fontanilla T, Hernando CG, Claros JCV, Bautista G, Minaya J, Del Carmen Vega M, Piazza A, Méndez S, Rodriguez C, Arangüena RP. Acoustic radiation force impulse elastography and contrast-enhanced sonography of sinusoidal obstructive syndrome (Veno-occlusive Disease): preliminary results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1593-1598. [PMID: 22039033 DOI: 10.7863/jum.2011.30.11.1593] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report quantitative liver acoustic radiation force impulse (ARFI) elastographic findings in 2 cases of sinusoidal obstructive syndrome and liver contrast-enhanced sonographic features in one of these cases. To our knowledge, findings in this condition from these techniques have not been reported previously. Acoustic radiation force impulse elastography showed median high shear wave velocities (case 1, 2.75 m/s; case 2, 2.58 m/s) that normalized after specific treatment for sinusoidal obstructive syndrome; therefore, ARFI elastography provided quantitative information that helped diagnose this condition as well as monitor the response to treatment. Contrast-enhanced sonographic findings in one of the cases showed patchy liver enhancement that correlated with the high-velocity patchy distribution on ARFI elastography in that case and enhanced multidetector row computed tomographic findings in the other case. This contrast-enhanced sonographic pattern progressively normalized during follow-up after specific treatment. The elastographic features in both cases and contrast-enhanced sonographic features in one of them contributed to early diagnosis and follow-up of sinusoidal obstructive syndrome in both patients. Further prospective studies are necessary to define the role of ARFI elastography and contrast-enhanced sonography in the early diagnosis and clinical follow-up of this condition.
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Affiliation(s)
- Teresa Fontanilla
- Departments of Diagnostic Radiology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
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10
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Kobayashi Y, Tobinai K, Takeshita A, Naito K, Asai O, Dobashi N, Furusawa S, Saito K, Mitani K, Morishima Y, Ogura M, Yoshiba F, Hotta T, Bessho M, Matsuda S, Takeuchi J, Miyawaki S, Naoe T, Usui N, Ohno R. Phase I/II study of humanized anti-CD33 antibody conjugated with calicheamicin, gemtuzumab ozogamicin, in relapsed or refractory acute myeloid leukemia: final results of Japanese multicenter cooperative study. Int J Hematol 2009; 89:460-469. [PMID: 19360457 DOI: 10.1007/s12185-009-0298-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 02/04/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
Abstract
The primary objective of this study was to investigate the tolerability, efficacy and pharmacokinetic profile of gemtuzumab ozogamicin (GO) in patients with relapsed and/or refractory CD33-positive acute myeloid leukemia (AML). Patients received 2-h infusions of GO twice with an interval of approximately 14 days. Tolerability was assessed using the National Cancer Institute Common Toxicity Criteria Version 2.0. Samples for pharmacokinetics were taken on day 1 and day 8 of the first treatment cycle. The dose was increased stepwise and, in each cohort, patients were treated at the same dose. Forty patients, median age 58 years (range 28-68) were treated; 20 and 20 patients were enrolled to the phase I and II parts, respectively. In the phase I part, dose-limiting toxicities (DLTs) were hepatotoxicities, and the recommended dose was established as 9 mg/m2 given as two intravenous infusions separated by approximately 14 days. The pharmacokinetic study revealed that Cmax and AUC were equivalent to those of non-Japanese patients. In the phase II part, complete remission was observed in 5 patients, and one patient had complete remission without platelet recovery. Four of these 6 in remission and one in the phase I are long-term survivors (alive for at least 44 months). GO is safe and effective as a single agent among Japanese CD33-positive AML patients. Remission lasted longer in a subset of patients than in non-Japanese patients in earlier studies. Further studies of this agent are warranted to establish standard therapy.
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MESH Headings
- Adult
- Aged
- Aminoglycosides/adverse effects
- Aminoglycosides/immunology
- Aminoglycosides/pharmacology
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/immunology
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/immunology
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/immunology
- Dose-Response Relationship, Drug
- Female
- Gemtuzumab
- Humans
- Japan
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3
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Affiliation(s)
- Yukio Kobayashi
- Hematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Kensei Tobinai
- Hematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihiro Takeshita
- The Third Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kensuke Naito
- The Third Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Hamamatsu Medical Center, Hamamatsu, Japan
| | - Osamu Asai
- Department of Clinical Oncology and Hematology, School of Medicine, The Jikei University, Tokyo, Japan
| | - Nobuaki Dobashi
- Department of Clinical Oncology and Hematology, School of Medicine, The Jikei University, Tokyo, Japan
| | - Shinpei Furusawa
- Department of Hematology, Dokkyo Medical School of Medicine, Tochigi, Japan
| | - Kenji Saito
- Department of Hematology, Dokkyo Medical School of Medicine, Tochigi, Japan
- Saito Clinic, Tochigi, Japan
| | - Kinuko Mitani
- Department of Hematology, Dokkyo Medical School of Medicine, Tochigi, Japan
| | - Yasuo Morishima
- Hematology and Cell Therapy Division, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Michinori Ogura
- Hematology and Cell Therapy Division, Aichi Cancer Center Hospital, Nagoya, Japan
- Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Fumiaki Yoshiba
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Tomomitsu Hotta
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
- National Nagoya Hospital, Nagoya, Japan
| | - Masami Bessho
- Department of Hematology, Saitama Medical University, School of Medicine, Saitama, Japan
| | - Shin Matsuda
- Center for Hematopoietic Disorders, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Jin Takeuchi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Shuichi Miyawaki
- Leukemia Treatment Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Tomoki Naoe
- Department of Hematology and Oncology, Nagoya University School of Medicine, Nagoya, Japan
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, School of Medicine, The Jikei University, Tokyo, Japan
| | - Ryuzo Ohno
- Hematology and Cell Therapy Division, Aichi Cancer Center Hospital, Nagoya, Japan
- Aichi Shukutoku University, Nagoya, Japan
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11
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Gleissner B, Schlenk R, Bornhäuser M, Berdel WE. Gemtuzumab Ozogamicin (Mylotarg) for the Treatment of Acute Myeloid Leukemia – Ongoing Trials. Oncol Res Treat 2007; 30:657-62. [DOI: 10.1159/000109956] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Abstract
Although chemotherapy generally is accompanied by regular testing for liver enzyme abnormalities, atypical reactions may occur that escape ordinary detection, because hepatocyte injury is not the primary event. The presence of fatty liver, mitochondrial changes, and even biliary abnormalities can be associated with normal or nearly normal liver enzyme levels. This article discusses unique aspects of liver damage associated with cancer chemotherapy. These unique reactions merit special attention and a special vigilance from clinicians.
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Affiliation(s)
- Edmundo A Rodriguez-Frias
- Department of Internal Medicine, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390, USA
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13
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Pagano L, Fianchi L, Caira M, Rutella S, Leone G. The role of Gemtuzumab Ozogamicin in the treatment of acute myeloid leukemia patients. Oncogene 2007; 26:3679-90. [PMID: 17530021 DOI: 10.1038/sj.onc.1210364] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Gemtuzumab Ozogamicin (GO) is an antibody-targeted chemotherapy agent consisting of the humanized murine CD33 antibody (clone P67.6) to which the calicheamicin-g1 derivative is attached via a hydrolysable bifunctional linker. GO is able to induce apoptosis in vitro in CD33-expressing cells and it has been approved in USA and in Europe as monotherapy for the treatment of elderly patients (older than 60 years) with relapsed acute myeloid leukemia (AML). GO administered as a single agent has resulted in overall response rates of about 30% in previously relapsed adults AML patients (including also with incomplete platelet recovery). Preliminary data indicate a potential role for GO also as a component of induction or consolidation regimens in adults and children. As for adverse events, veno-occlusive syndrome characterizes its tolerability profile, but GO is comparatively well tolerated by most patients.
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MESH Headings
- Aminoglycosides/adverse effects
- Aminoglycosides/immunology
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Gemtuzumab
- Hematologic Tests
- Humans
- Immunotherapy
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Sensitivity and Specificity
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Affiliation(s)
- L Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
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14
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Molnár I, Powell BL. What role does gemtuzumab ozogamicin have in the treatment of acute myelogenous leukemia? Curr Hematol Malig Rep 2007; 2:104-10. [PMID: 20425358 DOI: 10.1007/s11899-007-0015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gemtuzumab ozogamicin (GO) is a novel, targeted chemotherapy designed to treat acute myeloid leukemia (AML). GO consists of an antitumor antibiotic, calicheamicin, linked to a humanized monoclonal antibody against CD33. It has been approved in the United States since 2000 to treat CD33+ AML in first relapse in older adults who are not candidates for cytotoxic therapy. Beyond this indication, the role of GO is evolving. Single-agent GO has a limited role in de novo AML. Incorporation of GO into standard induction treatment in de novo and relapsed AML is feasible. Comparative phase III studies of such an approach are ongoing. GO is associated with serious toxicities, such as infusional reactions, transient liver function test abnormalities, and veno-occlusive disease of the liver, especially in patients who undergo hematopoietic stem cell transplantation.
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Affiliation(s)
- István Molnár
- Section on Hematology and Oncology, Department of Medicine,Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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15
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Ricart AD, Tolcher AW. Technology Insight: cytotoxic drug immunoconjugates for cancer therapy. ACTA ACUST UNITED AC 2007; 4:245-55. [PMID: 17392715 DOI: 10.1038/ncponc0774] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 11/21/2006] [Indexed: 12/19/2022]
Abstract
The successful introduction of genetically engineered human and chimeric immunoglobulin proteins has established monoclonal antibodies (mAbs) as a validated approach for treating malignancies. The unique properties of mAb therapies including their high affinity and specificity, and the differential expression of target antigen in tumor cells versus normal cells make them attractive agents for cancer immunotherapy. The field of immunoconjugate development attempts to combine the specificity of mAb therapies with cytotoxic and radionuclide molecules, thereby combining the best characteristics of these two different modalities. Two radiolabeled mAbs, (90)Y-ibritumomab tiuxetan and (131)I-tositumomab, and one drug conjugate, gemtuzumab ozogamicin have been approved for the treatment of malignancies. Other conjugates carrying toxic payloads of calicheamicin, geldanamycin, maytansinoids and taxoids as well as peptide exotoxins are undergoing preclinical and clinical development. Nevertheless, several obstacles have limited robust antitumor activity and broad application of imunoconjugates, including the optimization of three structural components of the immunoconjugate (i.e. mAb and target specificity, chemical linker design, and the cytotoxin), as well as issues common to mAb therapy such as heterogeneous antigen expression, which can limit uniform antibody delivery. This Review examines optimal design, the lessons learned from clinical immunoconjugate development, and the promising agents in early preclinical/clinical development for the treatment of cancer.
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Affiliation(s)
- Alejandro D Ricart
- Institute for Drug Development, University of Texas Health Science Center, Suite Z418, 7979 Wurzbach Road, San Antonio, TX 78229, USA
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16
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Song JS, Seo JJ, Moon HN, Ghim T, Im HJ. Prophylactic low-dose heparin or prostaglandin E1 may prevent severe veno-occlusive disease of the liver after allogeneic hematopoietic stem cell transplantation in Korean children. J Korean Med Sci 2006; 21:897-903. [PMID: 17043426 PMCID: PMC2722002 DOI: 10.3346/jkms.2006.21.5.897] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Studies investigating the effect of prophylactic drugs on hepatic veno-occlusive disease (VOD) development are rare in children that have undergone allogeneic hematopoietic stem cell transplantation (HSCT). This study examined risk factors for VOD, the effect of prophylactic low-dose heparin or lipo-prostaglandin E1 (lipo-PGE1) and the survival rate at day +100 in children undergoing allogeneic HSCT. Eighty five children underwent HSCT between June 1997 and September 2004. Patients were diagnosed and classified as having mild, moderate or severe VOD according to Seattle clinical criteria. Among 85 patients, 25 (29%) developed VOD. VOD occurred more frequently in patients receiving busulfan-based conditioning (24/65, 37%) than in those receiving TBI-based (1/10, 10%) or other (0/10, 0%) regimens (p<0.05). The incidence of VOD was lower in patients with non-malignant disease compared to those with malignant disease (p<0.05). Survival at day +100 for non-VOD patients was better than that for VOD patients (92% vs. 76%, p<0.05). No patients receiving prophylactic heparin or lipo-PGE1 were found to develop severe VOD, whereas 5 of 35 patients not receiving such prophylaxis developed severe VOD. Given severe VOD is associated with a high mortality rate, this study indicates that prophylactic heparin or lipo-PGE1 may decrease mortality in children undergoing HSCT.
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Affiliation(s)
- Joon Sup Song
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Seo
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Nam Moon
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Thad Ghim
- Pediatric Hematology-Oncology Center, Korean National Cancer Center, Goyang, Korea
| | - Ho Joon Im
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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McKoy JM, Angelotta C, Bennett CL, Tallman MS, Wadleigh M, Evens AM, Kuzel TM, Trifilio SM, Raisch DW, Kell J, DeAngelo DJ, Giles FJ. Gemtuzumab ozogamicin-associated sinusoidal obstructive syndrome (SOS): an overview from the research on adverse drug events and reports (RADAR) project. Leuk Res 2006; 31:599-604. [PMID: 16959316 DOI: 10.1016/j.leukres.2006.07.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/11/2006] [Accepted: 07/12/2006] [Indexed: 12/22/2022]
Abstract
Gemtuzumab ozogamicin (GO) was approved for marketing in 2000 by the United States Food and Drug Administration (FDA) for older patients with relapsed acute myeloid leukemia (AML). Four months later, 14 phase II clinical trial participants who received novel GO-containing combination chemotherapy regimens developed an unexpected hepatic toxicity termed sinusoidal obstructive syndrome (SOS) or hepatic veno-occlusive disease (VOD). Investigators associated with the Research on Adverse Drug Events and Reports (RADAR) project reviewed safety reports for GO included in reports of clinical trials and observational studies, interim reports from an FDA mandated Prospective Observational Registry, and the Food and Drug Administration's Adverse Event Reporting System. Medline searches provided incidence estimates of GO-associated SOS and comparative rates of SOS without GO. SOS is characterized by hyperbilirubinemia, painful hepatomegaly, ascites, and sudden weight gain developing at a median of 10 days following GO administration for patients who did not undergo an allogeneic SCT procedure and 13 days following an allogeneic SCT for patients who had previously received GO. Among adult AML patients who received GO in clinical trials, SOS incidence was 3% at doses < or =6 mg/m(2) if administered as monotherapy or in combination with non-hepatotoxic agents versus 28% if administered with thioguanine and 15% when administered as monotherapy at a dose of 9 mg/m(2). Observational studies identified SOS rates between 15% and 40% if an SCT is performed within 3 months of GO administration. The FDA mandated Prospective Observational Registry of patients who receive care at 60 medical centers has identified GO-associated SOS rates of 14% if an SCT is performed and 9% otherwise. Caution is advised when administering GO in routine clinical practice, particularly if administered with other hepatotoxic agents, at doses and schedules more intensive than those approved by the FDA, or within 3 months of a SCT procedure.
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Affiliation(s)
- June M McKoy
- Division of Geriatric Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, 303 E. Chicago, Chicago, IL 60611, USA
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Tsimberidou AM, Giles FJ, Estey E, O'Brien S, Keating MJ, Kantarjian HM. The role of gemtuzumab ozogamicin in acute leukaemia therapy. Br J Haematol 2006; 132:398-409. [PMID: 16412015 DOI: 10.1111/j.1365-2141.2005.05872.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gemtuzumab ozogamicin (GO) is an immunoconjugate that binds to CD33 on the surface of acute myeloid leukaemia (AML) blasts and, after internalisation, releases a cytotoxic drug, calicheamicin. GO is approved by the US Food and Drug Administration for the treatment of CD33-positive AML at first relapse in patients 60 years and older who are not candidates for other cytotoxic therapy. GO as a single agent has low antileukaemic activity. When given to patients meeting the criteria noted above, it produces a complete response (CR) rate of only 12%, with another 12% achieving CR with inadequate platelet recovery (CRp). The median survival of patients treated with GO monotherapy is 11.2 months. GO therapy at 9 mg/m(2) is complicated with hepatic veno-occlusive disease in 5-10% of patients, particularly prior to or following stem cell transplantation. GO at lower doses combined with chemotherapy as induction or postremission therapy is promising, however, and phase III trials are ongoing. GO is probably most active in acute promyelocytic leukaemia (APL). It is used for induction regimens in high-risk APL and for the elimination of minimal residual APL. Case reports suggest that GO also has activity in CD33-positive acute lymphoblastic leukaemia. In conclusion, single agent GO can induce responses in patients with CD33-positive AML in first recurrence. The future of GO is its use in combination with other cytotoxic agents. Ongoing clinical trials may better define the role of GO combinations, particularly in untreated AML.
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MESH Headings
- Acute Disease
- Aminoglycosides/administration & dosage
- Aminoglycosides/metabolism
- Aminoglycosides/therapeutic use
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/therapeutic use
- Antibodies, Monoclonal/metabolism
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Drug Resistance
- Enediynes
- Gemtuzumab
- Humans
- Immunotoxins/metabolism
- Immunotoxins/therapeutic use
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/metabolism
- Protein Binding
- Randomized Controlled Trials as Topic
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3
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19
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Linenberger ML. CD33-directed therapy with gemtuzumab ozogamicin in acute myeloid leukemia: progress in understanding cytotoxicity and potential mechanisms of drug resistance. Leukemia 2004; 19:176-82. [PMID: 15592433 DOI: 10.1038/sj.leu.2403598] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CD33 is expressed on the malignant blast cells in most cases of acute myeloid leukemia (AML) but not on normal hematopoietic pluripotent stem cells. Antibody-based therapies for AML have, therefore, focused on CD33 as a suitable tumor-associated target antigen. The most promising results have been obtained with gemtuzumab ozogamicin (GO, Mylotarg), a humanized IgG(4) anti-CD33 monoclonal antibody joined to a calicheamicin-gamma(1) derivative. Engagement of CD33 by GO results in immunoconjugate internalization and hydrolytic release of the toxic calicheamicin moiety, which, in turn, causes DNA damage and cell death. Since 2000, when GO was approved for clinical use, treatment trials and pilot studies have revealed potential expanded applications along with additional limitations. At the same time, correlative biological and in vitro functional studies have further characterized CD33 expression patterns in AML, the significance of CD33-antibody interactions, pathways involved in GO-induced cytotoxicity and potential drug resistance mechanisms. This review summarizes the recent data addressing mechanisms of GO action and discusses their relevance with regard to clinical applications and the limitations of using experimental model systems to mimic in vivo conditions. As the first drug conjugate approved for clinical use, GO serves as an important paradigm for other immunoconjugates against internalizing tumor antigens.
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Affiliation(s)
- M L Linenberger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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