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Marshall RF, Xu H, Berkenstock M. Ocular toxicities associated with antibody drug conjugates. Curr Opin Ophthalmol 2024:00055735-990000000-00172. [PMID: 38814581 DOI: 10.1097/icu.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW To review the structure, mechanism of action, and pathophysiology of antibody-drug conjugates (ADCs) used to treat gynecological malignancies associated with ocular adverse effects. RECENT FINDINGS Recent research shows tisotumab vedotin causes ocular toxicity localized to the conjunctiva, with common adverse effects being conjunctivitis, dry eye, blepharitis, and keratitis. Toxicity is likely due to targeting tissue factor (TF) in the conjunctiva, leading to direct delivery of the cytotoxic payload resulting in apoptosis and bystander killing. Mirvetuximab soravtansine causes blurred vision, keratitis, or dry eye with toxicity often localized in the cornea. Off-target inflammation appears to cause ocular adverse effects, with nonreceptor mediated macropinocytosis by corneal stem cells. SUMMARY Collaboration between oncologists and ophthalmologists with adherence to mitigation protocols can decrease the risk of ocular adverse events.
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Affiliation(s)
- Rayna F Marshall
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Hannah Xu
- University of California San Diego, San Diego, California
| | - Meghan Berkenstock
- Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Jaffry M, Choudhry H, Aftab OM, Dastjerdi MH. Antibody-Drug Conjugates and Ocular Toxicity. J Ocul Pharmacol Ther 2023; 39:675-691. [PMID: 37615544 DOI: 10.1089/jop.2023.0069] [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] [Indexed: 08/25/2023] Open
Abstract
Antibody-drug conjugates (ADCs) are a growing class of chemotherapeutic agents for the purpose of treating cancers that often have relapsed or failed first- and second-line treatments. ADCs are composed of extremely potent cytotoxins with a variety of side effects, one of the most significant being ocular toxicity. The available literature describes these toxicities as varying in severity and in incidence, although with disparate methods of evaluation and management. Some of the most common toxicities include microcyst-like epithelial keratopathy and dry eye. We discuss proposed mechanisms of ocular toxicity and describe the reports that mention these toxicities. We focus on ADCs with the most published literature and the most significant effects on ocular tissue. We propose areas for further investigation and possible ideas of future management. We provide a comprehensive look at the reports of ADCs in current literature to better inform clinicians on an expanding drug class.
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Affiliation(s)
- Mustafa Jaffry
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam Choudhry
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Owais M Aftab
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mohammad H Dastjerdi
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Bussing D, Li Y, Guo L, Verma A, Sullivan JM, Shah DK. Pharmacokinetics of Monoclonal Antibody and Antibody Fragments in The Mouse Eye Following Intravitreal Administration. J Pharm Sci 2023; 112:2276-2284. [PMID: 37062415 DOI: 10.1016/j.xphs.2023.04.006] [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: 12/23/2022] [Revised: 04/08/2023] [Accepted: 04/09/2023] [Indexed: 04/18/2023]
Abstract
Mice are rarely used in pharmacokinetic (PK) studies of ocular therapeutics due to the small size of their eyes and challenges in drug administration, tissue collection, and analysis of drug concentrations. Therefore, ocular PK of protein therapeutics in mouse eye following intravitreal (IVT) administration is not known. Here, we have presented the first of its kind investigation, to study the PK of 4 different size non-binding protein therapeutics in mouse plasma, cornea/ICB, vitreous humor, retina, and posterior cup (including choroid) following IVT administration. Administered proteins include trastuzumab (150 kDa) and F(ab)2 (100 kDa), Fab, and scFv (27 kDa) fragments of trastuzumab. An imaging and injection apparatus suitable for performing small (50 nL) IVT injections in mice was developed, and techniques for enucleation of the eye and dissection of ocular tissues were developed. Furthermore, a sensitive enzyme-linked immunosorbent assay (ELISA) for detection of proteins in very small amounts of ocular tissues were developed. It was observed that elimination from the vitreous chamber was the primary driver of PK in the cornea/ICB, retina, posterior cup, and plasma. Trastuzumab displays first-order kinetics in the vitreous humor with a half-life of 18.8 h. F(ab)2, Fab, and ScFv show biphasic PK profiles with distribution phases becoming more rapid as molecular weight decreases, and terminal elimination becoming longer as molecular weight decreases, with terminal half-lives of 16.3, 20.6, and 48.9 h, respectively. The mean residence times of trastuzumab, F(ab)2, Fab, and scFv in the vitreous humor were 26.0, 12.2, 10.7, and 8.16 h, respectively. It was found that the mean residence time in vitreous humor doubles with an increase in molecular weight of ∼69 kDa. Interestingly, the PK of proteins measured in the un-injected eye suggest the presence of a pathway for drug transfer between the eyes, which needs to be further validated. Overall, the findings presented here pave the way for drug discovery and development studies of protein therapeutics for ophthalmic indications in mice.
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Affiliation(s)
- David Bussing
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Yingyi Li
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Leiming Guo
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Ashwni Verma
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Jack M Sullivan
- Department of Ophthalmology, Jacobs School of Medicine & Biomedical Sciences, Buffalo, New York, USA; VA Western NY Healthcare System, Buffalo, New York, USA
| | - Dhaval K Shah
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York, USA.
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Vollmar BS, Fei M, Liang WC, Bravo DD, Wang J, Yu L, Corr N, Zhang G, McNamara E, Masih S, Chee E, Shin G, Ohri R, Leipold DD, Wu C, Dere E, Wang J, Huang H, Wu Y, Yan M. PEGylation of anti-MerTK Antibody Modulates Ocular Biodistribution. Bioconjug Chem 2022; 33:1837-1851. [DOI: 10.1021/acs.bioconjchem.2c00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Breanna S. Vollmar
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Mingjian Fei
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Wei-Ching Liang
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Daniel D. Bravo
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Joy Wang
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Lanlan Yu
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Nick Corr
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Gu Zhang
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Erin McNamara
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Shabkhaiz Masih
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Elin Chee
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Gawon Shin
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Rachana Ohri
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Douglas D. Leipold
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Cong Wu
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Edward Dere
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Jianyong Wang
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Haochu Huang
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Yan Wu
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Minhong Yan
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
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