Nonclinical evaluation of the serum pharmacodynamic biomarkers HGF and shed MET following dosing with the anti-MET monovalent monoclonal antibody onartuzumab

Onartuzumab, a humanized, monovalent monoclonal anti-MET antibody, antagonizes MET signaling by inhibiting binding of its ligand, hepatocyte growth factor (HGF). We investigated the effects of onartuzumab on cell-associated and circulating (shed) MET (sMET) and circulating HGF in vitro and nonclinically to determine their utility as pharmacodynamic biomarkers for onartuzumab. Effects of onartuzumab on cell-associated MET were assessed by flow cytometry and immunofluorescence. sMET and HGF were measured in cell supernatants and in serum or plasma from multiple species (mouse, cynomolgus monkey, and human) using plate-based immunoassays. Unlike bivalent anti-MET antibodies, onartuzumab stably associates with MET on the surface of cells without inducing MET internalization or shedding. Onartuzumab delayed the clearance of human xenograft tumor-produced sMET from the circulation of mice, and endogenous sMET in cynomolgus monkeys. In mice harboring MET-expressing xenograft tumors, in the absence of onartuzumab, levels of human sMET correlated with tumor size, and may be predictive of MET-expressing tumor burden. Because binding of sMET to onartuzumab in circulation resulted in increasing sMET serum concentrations due to reduced clearance, this likely renders sMET unsuitable as a pharmacodynamic biomarker for onartuzumab. There was no observed effect of onartuzumab on circulating HGF levels in xenograft tumor-bearing mice or endogenous HGF in cynomolgus monkeys. Although sMET and HGF may serve as predictive biomarkers for MET therapeutics, these data do not support their use as pharmacodynamic biomarkers for onartuzumab.

Population pharmacokinetic analysis from phase I and phase II studies of the humanized monovalent antibody, onartuzumab (MetMAb), in patients with advanced solid tumors

Onartuzumab is a unique, humanized, monovalent (one-armed) monoclonal antibody (mAb) against the MET receptor. The intravenous (IV) pharmacokinetics (PK) of onartuzumab were investigated in a phase I study and a phase II study in recurrent non-small cell lung cancer (NSCLC) patients. The potential for drug-drug interaction (DDI) was assessed during co-administration of IV onartuzumab with oral erlotinib, by measuring the PK of both drugs. The concentration-time profiles of onartuzumab were adequately described using a two-compartment model with linear clearance (CL) at doses between 4 and 30 mg/kg. The estimates for CL, central compartment volume (V1 ), and median terminal half-life were 0.439 L/day, 2.77 L, and 13.4 days, respectively. Statistically significant covariates included creatinine clearance (CrCL) on clearance, weight and gender on V1 , and weight on peripheral compartment volume (V2 ), but the clinical relevance of these covariates needs to be further evaluated. The current analysis did not indicate obvious DDI between onartuzumab and erlotinib. MET diagnostic status did not impact the exposure of either agent. Despite the slightly faster clearance compared with typical bivalent mAbs, the PK of onartuzumab support dosing regimens of 15 mg/kg every 3 weeks or doses equivalent to achieve the target minimum tumoristatic concentration in patients.

[A new drug in thoracic oncology: MetMab (onartuzumab)]

Met pathway is activated in many solid cancers. In advanced non-small cell lung cancer (NSCLC), Met amplification is involved in 5 to 20% of acquired resistance to EGFR tyrosine kinase inhibitors (TKI) in tumors with initially sensitive EGFR mutation. MetMab (onartuzumab) is a monoclonal single-arm humanized anti-Met antibody. Its fixation on the Met receptor prevents the binding of the ligand (Hepatocyte Growth factor [HGF]) and the signal transduction. After promising results in preclinical and phase I trials, a randomized phase II trial has been conducted in advanced NSCLC in 2nd or 3rd line treatment. One hundred and twenty-eight patients have been randomized between an association of erlotinib+placebo and erlotinib+MetMab (15mg/kg IV every 3 weeks) until progression or toxicity. Patients with overexpression of Met in immunohistochemistry (IHC) had a progression-free survival (PFS) and an overall survival (OS) two-fold (median 1.5 versus 2.9 months; HR=0.53; P=0.04) and three-fold (median 3.8 versus 12.6 months; HR=0.37; P=0.002) longer, respectively, than patients with negative IHC score. The erlotinib+MetMab association had a worse effect on SSP and OS than the control arm in patients with negative IHC. The toxicity profile of MetMab is very good, and the main adverse effect is the occurrence of peripheral edemas, most of the time of low grade. A randomized phase III is on going to validate these results.