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Rached L, Geraud A, Frelaut M, Ap Thomas Z, Goldschmidt V, Beraud-Chaulet G, Nagera-Lazarovici C, Danlos FX, Henon C, Parisi C, Gazzah A, Bahleda R, Postel Vinay S, Smolenschi C, Hollebecque A, Michot JM, Ribrag V, Loriot Y, Champiat S, Ouali K, Massard C, Ponce Aix S, Bringuier M, Baldini C. Antibody drug conjugates in older patients: State of the art. Crit Rev Oncol Hematol 2024; 193:104212. [PMID: 38007063 DOI: 10.1016/j.critrevonc.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023] Open
Abstract
More than half of cancer cases occur in patients aged 65 years or older. The efficacy and safety of antibody drug conjugates (ADCs) in older patients remains an unclear subject as available evidence is limited. Geriatric population is underrepresented in clinical trials. Consequently, most of our knowledge regarding innovative therapeutics was studied on a younger population. In this review of published literature, we report the available information on efficacy, safety and pharmacokinetics of FDA approved ADCs for hematologic malignancies and solid tumors in the geriatric population. We explore the results of clinical trials dedicated for older individuals as well as subgroup analyses of the geriatric population in major trials evaluating these drugs. Available data suggest a similar efficacy in older adults as compared to general population. However, older patients might be prone to a higher rate of adverse events in incidence with a potential impact on quality of life. We lack data to support primary dose reductions or schedule modifications in this category of patients. No pharmacokinetic differences were reported between age groups. It is crucial to encourage the development of clinical trials dedicated to older patients with geriatric parameters (G8 score, G-CODE…) so that results can be more representative of this population outside of clinical trials.
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Affiliation(s)
- Layal Rached
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Arthur Geraud
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Maxime Frelaut
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Zoe Ap Thomas
- Gustave Roussy, Department of Medical Oncology , 94805 Villejuif, France.
| | - Vincent Goldschmidt
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | | | | | - Francois-Xavier Danlos
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Clemence Henon
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Claudia Parisi
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Anas Gazzah
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Rastilav Bahleda
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Sophie Postel Vinay
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Cristina Smolenschi
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Antoine Hollebecque
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Jean-Marie Michot
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Vincent Ribrag
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Yohann Loriot
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Stephane Champiat
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Kaissa Ouali
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Christophe Massard
- Centre Eugène Marquis, Department of Medical Oncology, 35000 Rennes, France.
| | - Santiago Ponce Aix
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
| | - Michael Bringuier
- Institut Curie, PSL Research University, Department of Medical Oncology and Department of Supportive Care, UCOG Paris Ouest, F-92210 Saint-Cloud, France.
| | - Capucine Baldini
- Gustave Roussy, Department of Therapeutic Innovation and Early Phase Trials, 94805 Villejuif, France.
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Teicher BA, Morris J. Antibody-Drug Conjugate Targets, Drugs and Linkers. Curr Cancer Drug Targets 2022; 22:463-529. [PMID: 35209819 DOI: 10.2174/1568009622666220224110538] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
Antibody-drug conjugates offer the possibility of directing powerful cytotoxic agents to a malignant tumor while sparing normal tissue. The challenge is to select an antibody target expressed exclusively or at highly elevated levels on the surface of tumor cells and either not all or at low levels on normal cells. The current review explores 78 targets that have been explored as antibody-drug conjugate targets. Some of these targets have been abandoned, 9 or more are the targets of FDA-approved drugs, and most remain active clinical interest. Antibody-drug conjugates require potent cytotoxic drug payloads, several of these small molecules are discussed, as are the linkers between the protein component and small molecule components of the conjugates. Finally, conclusions regarding the elements for the successful antibody-drug conjugate are discussed.
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Affiliation(s)
- Beverly A Teicher
- Developmental Therapeutics Program, DCTD, National Cancer Institute, Bethesda, MD 20892,United States
| | - Joel Morris
- Developmental Therapeutics Program, DCTD, National Cancer Institute, Bethesda, MD 20892,United States
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Kong FC, Yu M, Zhou YL, Wang SX, Li F. [Efficacy and safety of Polatuzumab Vedotin in combination with rituximab plus bendamustine in patients with relapsed/refractory diffuse large B-cell lymphoma: a single center analysis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:66-69. [PMID: 35231996 PMCID: PMC8980657 DOI: 10.3760/cma.j.issn.0253-2727.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- F C Kong
- Center of Hematology, Institute of Lymphoma of Nanchang University, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - M Yu
- Center of Hematology, Institute of Lymphoma of Nanchang University, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Y L Zhou
- Center of Hematology, Institute of Lymphoma of Nanchang University, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - S X Wang
- Center of Hematology, Institute of Lymphoma of Nanchang University, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - F Li
- Center of Hematology, Institute of Lymphoma of Nanchang University, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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Ceci C, Lacal PM, Graziani G. Antibody-drug conjugates: Resurgent anticancer agents with multi-targeted therapeutic potential. Pharmacol Ther 2022; 236:108106. [PMID: 34990642 DOI: 10.1016/j.pharmthera.2021.108106] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 12/18/2022]
Abstract
Antibody-drug conjugates (ADCs) constitute a relatively new group of anticancer agents, whose first appearance took place about two decades ago, but a renewed interest occurred in recent years, following the success of anti-cancer immunotherapy with monoclonal antibodies. Indeed, an ADC combines the selectivity of a monoclonal antibody with the cell killing properties of a chemotherapeutic agent (payload), joined together through an appropriate linker. The antibody moiety targets a specific cell surface antigen expressed by tumor cells and/or cells of the tumor microenvironment and acts as a carrier that delivers the cytotoxic payload within the tumor mass. Despite advantages in terms of selectivity and potency, the development of ADCs is not devoid of challenges, due to: i) low tumor selectivity when the target antigens are not exclusively expressed by cancer cells; ii) premature release of the cytotoxic drug into the bloodstream as a consequence of linker instability; iii) development of tumor resistance mechanisms to the payload. All these factors may result in lack of efficacy and/or in no safety improvement compared to unconjugated cytotoxic agents. Nevertheless, the development of antibodies engineered to remain inert until activated in the tumor (e.g., antibodies activated proteolytically after internalization or by the acidic conditions of the tumor microenvironment) together with the discovery of innovative targets and cytotoxic or immunomodulatory payloads, have allowed the design of next-generation ADCs that are expected to possess improved therapeutic properties. This review provides an overview of approved ADCs, with related advantages and limitations, and of novel targets exploited by ADCs that are presently under clinical investigation.
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Affiliation(s)
- Claudia Ceci
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | | | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; IDI-IRCCS, Via Monti di Creta 104, 00167 Rome, Italy.
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Wang X, McIntosh L, Selove WJ, Zivny J, Cerny J. Pseudoprogression of triple-hit diffuse large B-cell lymphoma following polatuzumab vedotin-based salvage therapy. Leuk Lymphoma 2021; 62:2022-2025. [PMID: 33719894 DOI: 10.1080/10428194.2021.1894646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Xin Wang
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lacey McIntosh
- Division of Oncologic Imaging, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - William J Selove
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jaroslav Zivny
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Burke JM, Morschhauser F, Andorsky D, Lee C, Sharman JP. Antibody-drug conjugates for previously treated aggressive lymphomas: focus on polatuzumab vedotin. Expert Rev Clin Pharmacol 2020; 13:1073-1083. [PMID: 32985934 DOI: 10.1080/17512433.2020.1826303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Antibody-drug conjugates (ADCs) are immunoconjugates and comprise a monoclonal antibody that is chemically attached to a cytotoxic drug (or payload) via a stable chemical linker. Since the approval of the first ADC in 2000, there are now nine different approved agents and over 100 ADCs in the drug-development pipeline. AREAS COVERED This review briefly describes the ADCs approved for treatment of lymphoma and their distinguishing factors in terms of target, linker and payload. The clinical implications of the use of ADCs are also considered. Here, we focus on polatuzumab vedotin, an ADC targeted to CD79b, which is approved for the treatment of patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) who have received at least one (EU approval) or two (US approval) prior therapies and are not eligible for bone marrow transplantation. The characteristics of polatuzumab vedotin are discussed and clinical data are presented. The future of polatuzumab vedotin clinical development, and ADCs in general, are also considered. EXPERT OPINION ADCs represent a significant advance in the treatment of lymphoma. Polatuzumab vedotin has shown clinical efficacy and a tolerable safety profile in both first-line and R/R DLBCL; future studies are planned to further investigate this ADC.
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Affiliation(s)
- J M Burke
- The US Oncology Network, Rocky Mountain Cancer Centers , Aurora, CO, USA
| | - F Morschhauser
- Centre Hospitalier Régional Universitaire De Lille, Université Lille , Lille, France
| | - D Andorsky
- The US Oncology Network, Rocky Mountain Cancer Centers , Boulder, CO, USA
| | - C Lee
- Genentech , South San Francisco, CA, USA
| | - J P Sharman
- The US Oncology Network, Willamette Valley Cancer Institute , Springfield, OR, USA
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Harker-Murray PD, Pommert L, Barth MJ. Novel Therapies Potentially Available for Pediatric B-Cell Non-Hodgkin Lymphoma. J Natl Compr Canc Netw 2020; 18:1125-1134. [PMID: 32755987 DOI: 10.6004/jnccn.2020.7608] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022]
Abstract
Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary mediastinal B-cell lymphoma are the most common aggressive pediatric mature B-cell non-Hodgkin lymphomas (B-NHLs). Despite excellent survival with current chemotherapy regimens, therapy for Burkitt lymphoma and DLBCL has a high incidence of short- and long-term toxicities. Patients who experience relapse generally have a very poor prognosis. Therefore, novel approaches using targeted therapies to reduce toxicities and improve outcomes in the relapse setting are needed. The addition of rituximab, a monoclonal antibody against CD20, to upfront therapy has improved survival outcomes for high-risk patients and may allow decreased total chemotherapy in those with low-risk disease. Antibody-drug conjugates have been combined with chemotherapy in relapsed/refractory (R/R) NHL, and multiple antibody-drug conjugates are in development. Additionally, bispecific T-cell-engaging antibody constructs and autologous CAR T-cells have been successful in the treatment of R/R acute leukemias and are now being applied to R/R B-NHL with some successes. PD-L1 and PD-L2 on tumor cells can be targeted with checkpoint inhibitors, which restore T-cell-mediated immunity and antitumor responses and can be added to conventional chemotherapy and immune-directed therapies to augment responses. Lastly, trials of small molecule inhibitors targeting cell signaling pathways in NHL subtypes are underway. This article reviews many of the targeted therapies under development that could be considered for future trials in R/R pediatric mature B-NHL.
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Affiliation(s)
| | - Lauren Pommert
- Pediatric Oncology, Midwest Children's Cancer Center, Milwaukee, Wisconsin; and
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Lee ATJ, Attygale AD, Sharma RK, Iyengar S, El‐Sharkawi D, Chau I, Vroobel KM, Fotiadis N, Khan N, Butterfield N, Wotherspoon A, Cunningham D, Sharma B. LyRIC indeterminate response and Immune‐mediated pseudoprogression of diffuse large B‐cell lymphoma following polatuzumab‐based salvage therapy. Br J Haematol 2020; 189:e248-e251. [DOI: 10.1111/bjh.16679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | | | | | - Ian Chau
- The Royal Marsden NHS Foundation Trust LondonUK
| | | | | | - Nasir Khan
- The Royal Marsden NHS Foundation Trust LondonUK
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