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Viala M, Vinches M, Alexandre M, Mollevi C, Durigova A, Hayaoui N, Homicsko K, Cuenant A, Gongora C, Gianni L, Tosi D. Strategies for clinical development of monoclonal antibodies beyond first-in-human trials: tested doses and rationale for dose selection. Br J Cancer 2018; 118:679-697. [PMID: 29438365 PMCID: PMC5846071 DOI: 10.1038/bjc.2017.473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Our previous survey on first-in-human trials (FIHT) of monoclonal antibodies (mAbs) showed that, due to their limited toxicity, the recommended phase II dose (RP2D) was only tentatively defined. METHODS We identified, by MEDLINE search, articles on single-agent trials of mAbs with an FIHT included in our previous survey. For each mAb, we examined tested dose(s) and dose selection rationale in non-FIHTs (NFIHTs). We also assessed the correlation between doses tested in the registration trials (RTs) of all FDA-approved mAbs and the corresponding FIHT results. RESULTS In the 37 dose-escalation NFIHTs, the RP2D indication was still poorly defined. In phase II-III NFIHTs (n=103 on 37 mAbs), the FIHT RP2D was the only dose tested for five mAbs. For 16 mAbs, only doses different from the FIHT RP2D or the maximum administered dose (MAD) were tested and the dose selection rationale infrequently indicated. In the 60 RTs on 27 FDA-approved mAbs with available FIHT, the FIHT RP2D was tested only for two mAbs, and RT doses were much lower than the FIHT MAD. CONCLUSIONS The rationale beyond dose selection in phase II and III trials of mAbs is often unclear in published articles and not based on FIHT data.
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Affiliation(s)
- Marie Viala
- Institut du Cancer de Montpellier, Montpellier, France
| | - Marie Vinches
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Nadia Hayaoui
- Institut du Cancer de Montpellier, Montpellier, France
| | | | - Alice Cuenant
- Institut du Cancer de Montpellier, Montpellier, France
| | - Céline Gongora
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Montpellier, France
| | - Luca Gianni
- San Raffaele – Scientific Institute, Milan, Italy
| | - Diego Tosi
- Institut du Cancer de Montpellier, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier, Inserm U1194, Montpellier, France
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Tosi D, Laghzali Y, Vinches M, Alexandre M, Homicsko K, Fasolo A, Del Conte G, Durigova A, Hayaoui N, Gourgou S, Gianni L, Mollevi C. Clinical Development Strategies and Outcomes in First-in-Human Trials of Monoclonal Antibodies. J Clin Oncol 2015; 33:2158-65. [PMID: 26014300 DOI: 10.1200/jco.2014.58.1082] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We conducted a comprehensive review of the design, implementation, and outcome of first-in-human (FIH) trials of monoclonal antibodies (mAbs) to clearly determine early clinical development strategies for this class of compounds. METHODS We performed a PubMed search using appropriate terms to identify reports of FIH trials of mAbs published in peer-reviewed journals between January 2000 and April 2013. RESULTS A total of 82 publications describing FIH trials were selected for analysis. Only 27 articles (33%) reported the criteria used for selecting the starting dose (SD). Dose escalation was performed using rule-based methods in 66 trials (80%). The median number of planned dose levels was five (range, two to 13). The median of the ratio between the highest planned dose and the SD was 27 (range, two to 3,333). Although in 56 studies (68%) at least one grade 3 or 4 toxicity event was reported, no dose-limiting toxicity was observed in 47 trials (57%). The highest planned dose was reached in all trials, but the maximum-tolerated dose (MTD) was defined in only 13 studies (16%). The median of the ratio between MTD and SD was eight (range, four to 1,000). The recommended phase II dose was indicated in 34 studies (41%), but in 25 (73%) of these trials, this dose was chosen without considering toxicity as the main selection criterion. CONCLUSION This literature review highlights the broad design heterogeneity of FIH trials testing mAbs. Because of the limited observed toxicity, the MTD was infrequently reached, and therefore, the recommended phase II dose for subsequent clinical trials was only tentatively defined.
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Affiliation(s)
- Diego Tosi
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy.
| | - Yassine Laghzali
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Marie Vinches
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Marie Alexandre
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Krisztian Homicsko
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Angelica Fasolo
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Gianluca Del Conte
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Anna Durigova
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Nadia Hayaoui
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Sophie Gourgou
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Luca Gianni
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Caroline Mollevi
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
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