Abstract B21: Synergistic antitumor immunity observed with combination FRα-targeting antibody-drug conjugate plus anti-PD-1 therapy is CD8+ cell dependent

Background: Immune checkpoint blockade, specifically targeting PD-1/PD-L1, is a promising approach for cancer therapy. However, for some common cancers, such as epithelial ovarian cancer (EOC), PD1/PDL1 blockade as monotherapy has a low response rate. In these less immunogenic cancer types, focus has turned to combining checkpoint inhibitors with cancer therapies that elicit immunologic cell death (ICD). Antibody-drug conjugates (ADCs), comprising a tumor-targeting antibody armed with highly potent small-molecule payloads, are a clinically validated anticancer therapy. Mirvetuximab soravtansine is an ADC comprised of a folate receptor alpha (FRα)-binding antibody linked to the potent tubulin-disrupting maytansinoid DM4 via a cleavable disulfide sulfo-SPDB linker and is currently being evaluated in combination with pembrolizumab (anti-PD1 antibody) in a phase 1b study (FORWARDII, NCT02606305). Here we report preclinical studies that provide a mechanistic understanding for the antitumor activity of combination therapy consisting of PD-1/PD-L1 blockade and an FRα targeting disulfide linked DM4 ADC.

Methods: A chimeric anti-mouse FRα antibody (rmFR1-12) was generated and its specificity for murine FRα was assessed by ELISA and FACS. rmFR1-12 was conjugated to DM4 via a s-SPDB linker to generate rmFR-1-12-s-SPDB-DM4 ADC, which was quality checked using standard analytical methods. In vitro assays were used to assess cytotoxicity against FRα-positive cell lines, as well as the ability of rmFR1-12-s-SPDB-DM4 to induce ICD and engage cells of the immune system. In vivo studies performed in albino C57/B6 mice evaluated the antitumor activity of rmFR1-12-s-SPDB-DM4, anti-PD-1 or the combination therapy against ID8 tumors, a translationally relevant murine model of EOC.

Results: rmFR1-12 binding was specific for FRα. The rmFR1-12-s-SPDB-DM4 ADC was cytotoxic against FRα-positive cell lines and induced ICD as measured by upregulation of ICD markers. In vivo studies using syngeneic ID8 tumors demonstrated that rmFR1-12-s-SPDB-DM4 or anti-PD-1 monotherapy treatment resulted in modest antitumor activity. In contrast, combination treatment demonstrated synergistic antitumor activity, inducing complete tumor regressions and increased survival over control or monotherapy regimens. Depletion of CD8+ cells abrogated the antitumor activity of the combination, whereas depletion of CD4+ cells had no impact. Finally, combination-treated mice generated a robust memory response when rechallenged with ID8 cells.

Conclusion: Anti-FRα-s-SPDB-DM4 induces ICD in FRα-positive cell lines and demonstrates synergistic antitumor activity when combined with anti-PD1 in a murine EOC model. The antitumor immunity is dependent upon CD8+ cells. These findings support the clinical assessment of mirvetuximab soravtansine and pembrolizumab.

Citation Format: L. Cristina Gavrilescu, Yulius Setiady, Ling Dong, Sharon Chicklas, Luke Harris, Jan Pinkas, Richard Gregory, Joe Ponte. Synergistic antitumor immunity observed with combination FRα-targeting antibody-drug conjugate plus anti-PD-1 therapy is CD8+ cell dependent [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr B21.

Abstract 4817: Preclinical evaluation of a new, non-agonist ADC targeting MET-amplified tumors with a peptide-linked maytansinoid

With cancer among the leading causes of death worldwide, the search for better, personalized treatments is imperative. Novel techniques such as next generation sequencing have identified many assayable genetic biomarkers associated with cancer in patient samples. The tyrosine kinase receptor cMet is one such biomarker that is upregulated in various solid tumors and associated with poor prognosis, disease progression and metastasis. While most patients with elevated cMet show increased levels through protein upregulation, a small population harbors gene amplification. These patients face worse outcomes which could be improved with therapies specifically targeting MET-amplification. Antibody-drug conjugates (ADCs) are a modality designed to selectively deliver highly potent cytotoxic agents to tumors. cMet is an attractive target for ADCs which may address the unmet treatment need for patients with tumors harboring MET amplification. Since dimerization of cMet receptors by ligand HGF leads to agonistic proliferative events, a carefully selected antibody should be chosen to avoid triggering activation. As previously described, we identified and humanized an antibody with minimal agonism. Introducing an additional disulfide in the hinge region while maintaining the IgG1 isotype further reduced agonism as measured in vitro in both cell proliferation and phosphorylation signaling assays, while retaining high affinity to human and cynomolgus cMet, and acceptable expression and biophysical properties. To assess potential toxicity due to normal tissue expression, we measured binding of our antibody to normal hepatocytes from humans and cynos. Here we found very low expression and binding versus tumor cell lines. Next, we demonstrated that the cytotoxic activity of disulfide-cleavable maytansinoid ADCs prepared from the hinge-variant cMet antibody were equivalent to the parental form in in vivo models. In a MET-amplified xenograft model of gastric cancer, Hs746T, both parental and modified hucMet-sSPDB-DM4 ADCs demonstrated tumor eradication and comparable plasma clearance at 5 mg/kg. Similar results were found in the MET-amplified NSCLC model EBC-1 at 2.5 mg/kg. Conjugation to the newly-described dipeptide-linked maytansinoid DM21 further improved anti-tumor activity in both Hs746T and EBC-1 models, with a 2-fold decrease in minimally-efficacious dose. The activity of hucMet27Gv1.3Hinge-L-DM21 was durable, with a single dose yielding full regressions and tumor-free survivors in both models (EBC-1, 1.25 mg/kg dose, 6/6 TFS d49; Hs746T, 2.5 mg/kg dose, 8/8 TFS d55). Taken together, these data demonstrate compelling cMet-targeted activity of hucMet27Gv1.3Hinge-L-DM21 in MET-amplified models of NSCLC and gastric cancer with a wide margin of safety. These data merit further exploration of this ADC as a novel treatment option for patients with MET-amplified tumors.

Citation Format: Katharine C. Lai, Min Li, Kathryn Selvitelli, Surina Sikka, Steven Boulé, L Cristina Gavrilescu, Stuart W. Hicks, Kerry Donahue. Preclinical evaluation of a new, non-agonist ADC targeting MET-amplified tumors with a peptide-linked maytansinoid [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4817.

The Antitumor Activity of IMGN529, a CD37-Targeting Antibody-Drug Conjugate, Is Potentiated by Rituximab in Non-Hodgkin Lymphoma Models

Naratuximab emtansine (IMGN529) is an investigational antibody-drug conjugate consisting of a CD37-targeting antibody conjugated to the maytansine-derived microtuble disruptor, DM1. IMGN529 has shown promising preclinical and clinical activity in non-Hodgkin lymphoma, including diffuse large B-cell lymphoma (DLBCL). Due to the aggressive nature of the disease, DLBCL is often treated with combination therapies to maximize clinical outcomes; therefore, we investigated the potential of combining IMGN529 with both standard-of-care and emerging therapies against multiple oncology-relevant targets and pathways. The strongest enhancement in potency was seen with anti-CD20 antibodies, including rituximab. The combination of IMGN529 and rituximab was more potent than either agent alone, and this combinatorial benefit was associated with increased apoptotic induction and cell death. Additional studies revealed that rituximab treatment increased the internalization and degradation of the CD37-targeting antibody moiety of IMGN529. The combination of IMGN529 and rituximab was highly efficacious in multiple xenograft models, with superior antitumor efficacy seen compared to either agent alone or treatment with R-CHOP therapy. These findings suggest a novel mechanism whereby the potency of IMGN529 can be enhanced by CD20 binding, which results in the increased internalization and degradation of IMGN529 leading to the generation of greater amounts of cytotoxic catabolite. Overall, these data provide a biological rationale for the enhanced activity of IMGN529 in combination with rituximab and support the ongoing clinical evaluation of IMGN529 in combination with rituximab in patients with relapsed and/or refractory DLBCL.

Murine retroviral bone marrow transplantation models for the study of human myeloproliferative disorders

Human myeloproliferative diseases are common hematologic disorders characterized by clonal overproduction of maturing myeloid or erythroid cells, often caused by expression of a mutant, dysregulated tyrosine kinase (TK). These diseases can be accurately modeled in laboratory mice by the retroviral transfer of a mutant TK gene into murine hematopoietic stem and progenitor cells, followed by transplantation of these cells into irradiated recipient mice. This yields a model system for analyzing the molecular pathophysiology of these conditions and provides a platform for testing therapies, particularly molecularly targeted new chemical entities (NCEs). The Basic Protocol in this unit describes the preparation of mouse bone marrow cells to express the relevant human oncogene before transplanting them into irradiated recipient mice. An alternate protocol describes a similar technique that allows specific induction of lymphoproliferative disease by some TKs. Support protocols for generating and titering retroviral stocks are also included.

Conformational control inhibition of the BCR-ABL1 tyrosine kinase, including the gatekeeper T315I mutant, by the switch-control inhibitor DCC-2036

Acquired resistance to ABL1 tyrosine kinase inhibitors (TKIs) through ABL1 kinase domain mutations, particularly the gatekeeper mutant T315I, is a significant problem for patients with chronic myeloid leukemia (CML). Using structure-based drug design, we developed compounds that bind to residues (Arg386/Glu282) ABL1 uses to switch between inactive and active conformations. The lead "switch-control" inhibitor, DCC-2036, potently inhibits both unphosphorylated and phosphorylated ABL1 by inducing a type II inactive conformation, and retains efficacy against the majority of clinically relevant CML-resistance mutants, including T315I. DCC-2036 inhibits BCR-ABL1(T315I)-expressing cell lines, prolongs survival in mouse models of T315I mutant CML and B-lymphoblastic leukemia, and inhibits primary patient leukemia cells expressing T315I in vitro and in vivo, supporting its clinical development in TKI-resistant Ph(+) leukemia.

GCK is essential to systemic inflammation and pattern recognition receptor signaling to JNK and p38

Systemic inflammation arising from the organismal distribution of pathogen-associated molecular patterns is a major cause of clinical morbidity and mortality. Herein we report a critical and previously unrecognized in vivo role for germinal center kinase (GCK, genome nomenclature: map4k2), a mammalian Sterile 20 (STE20) orthologue, in PAMP signaling, and systemic inflammation. We find that disruption of gck in mice strongly impairs PAMP-stimulated macrophage cytokine and chemokine release and renders mice resistant to endotoxin-mediated lethality. Bone marrow transplantation studies show that hematopoietic cell GCK signaling is essential to systemic inflammation. Disruption of gck substantially reduces PAMP activation of macrophage Jun-N-terminal kinase (JNK) and p38 mitogen-activated protein kinases (MAPKs) via reduced activation of the MAPK-kinase-kinases (MAP3Ks) mixed lineage kinases (MLKs)-2 and -3. Extracellular signal-regulated kinase (ERK) and nuclear factor-kappaB (NF-kappaB) activation are largely unaffected. Thus, GCK is an essential PAMP effector coupling JNK and p38, but not ERK or NF-kappaB to systemic inflammation.

AMP-activated protein kinase is essential for survival in chronic hypoxia

This study was undertaken to interrogate cancer cell survival during long-term hypoxic stress. Two systems with relevance to carcinogenesis were employed: Fully transformed BJ cells and a renal carcinoma cell line (786-0). The dynamic of AMPK activity was consistent with a prosurvival role during chronic hypoxia. This was further supported by the effects of AMPK agonists and antagonists (AICAR and compound C). Expression of a dominant-negative AMPK alpha resulted in a decreased ATP level and significantly compromised survival in hypoxia. Dose-dependent prosurvival effects of rapamycin were consistent with mTOR inhibition being a critical downstream mediator of AMPK in persistent low oxygen.

Production of replication-defective retrovirus by transient transfection of 293T cells

Our lab studies human myeloproliferative diseases induced by such oncogenes as Bcr-Abl or growth factor receptor-derived oncogenes (ZNF198-FGFR1, Bcr-PDGFRalpha, etc.). We are able to model and study a human-like disease in our mouse model, by transplanting bone marrow cells previously infected with a retrovirus expressing the oncogene of interest. Replication-defective retrovirus encoding a human oncogene and a marker (GFP, RFP, antibiotic resistance gene, etc.) is produced by a transient transfection protocol using 293T cells, a human renal epithelial cell line transformed by the adenovirus E1A gene product. 293 cells have the unusual property of being highly transfectable by calcium phosphate (CaPO4), with up to 50-80% transfection efficiency readily attainable. Here, we co-transfect 293 cells with a retroviral vector expressing the oncogene of interest and a plasmid that expresses the gag-pol-env packaging functions, such as the single-genome packaging constructs kat or pCL, in this case the EcoPak plasmid. The initial transfection is further improved by use of chloroquine. Stocks of ecotropic virus, collected as culture supernatant 48 hrs. post-transfection, can be stored at -80 degrees C and used for infection of cell-lines in view of transformation and in vitro studies, or primary cells such as mouse bone marrow cells, that can then be used for transplant in our mouse model.

STAT1 is essential for antimicrobial effector function but dispensable for gamma interferon production during Toxoplasma gondii infection

The opportunistic protozoan Toxoplasma gondii is a prototypic Th1-inducing pathogen inducing strong gamma interferon (IFN-gamma) cytokine responses that are required to survive infection. Intracellular signaling intermediate STAT1 mediates many effects of IFN-gamma and is implicated in activation of T-bet, a master regulator of Th1 differentiation. Here, we show that T. gondii-infected STAT1-null mice fail to upregulate the IFN-gamma-dependent effector molecules inducible nitric oxide synthase (iNOS), IGTP, and LRG-47, which are required for mice to survive infection. Both T-bet and interleukin-12 receptor beta2 (IL-12Rbeta2) failed to undergo normal upregulation in response to T. gondii. Development of IFN-gamma-producing CD4(+) and CD8(+) T lymphocytes was severely curtailed in the absence of STAT1, but a substantial level of STAT1-independent non-T-cell-derived IFN-gamma was induced. Absence of STAT1 also resulted in increased IL-4, Arg1, Ym1, and Fizz1, markers of Th2 differentiation and alternative macrophage activation. Together, the results show that T. gondii induces STAT1-dependent T-lymphocyte and STAT1-independent non-T-cell IFN-gamma production, but that effector functions of this type 1 cytokine cannot operate in the absence of STAT1, resulting in extreme susceptibility to acute infection.

Interleukin-12 p40- and Fas ligand-dependent apoptotic pathways involving STAT-1 phosphorylation are triggered during infection with a virulent strain of Toxoplasma gondii

Toxoplasma gondii is an opportunistic intracellular parasite. Infection with the high-virulence T. gondii strain RH induces inflammatory cytokine overproduction and uncontrolled apoptosis in lymphoid organs. Here, we show by fluorescent terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) assay and binding of fluorescein isothiocyanate-conjugated VAD-FMK, an irreversible pan-caspase inhibitor, that parasite-triggered apoptosis occurs among CD4(+), CD8(+), B220(+), Gr-1(+), and NK1.1(+) splenic populations. Caspases 8 and 9 were activated during infection, implicating cell surface death receptors and mitochondria in apoptosis. Induction of apoptosis was absent among all cell populations in both interleukin-12 (IL-12) p40- and Fas ligand (FasL)-negative mice. STAT-1 phosphorylation correlated with onset of apoptosis during infection, but in the absence of IL-12 p40 and functional FasL, activation of this transcription factor failed to occur. The results demonstrate T. gondii-induced activation of multiple apoptotic pathways, dependent upon both IL-12 p40 and FasL, that may play a role in the lethal pathology of infection.

Neutrophil depletion during Toxoplasma gondii infection leads to impaired immunity and lethal systemic pathology

The immunomodulatory role of neutrophils during infection with Toxoplasma gondii was investigated. Monoclonal antibody-mediated depletion revealed that neutrophils are essential for survival during the first few days of infection. Moreover, neutrophil depletion was associated with a weaker type 1 immune response as measured by decreased levels of gamma interferon, interleukin-12 (IL-12) and tumor necrosis factor alpha. IL-10 was also decreased in depleted animals. Additionally, splenic populations of CD4(+) T cells, CD8(+) T cells, and NK1.1(+) cells were decreased in depleted mice. Neutrophil-depleted mice exhibited lesions of greater severity in tissues examined and a greater parasite burden as determined by histopathology and reverse transcription-PCR. We conclude that neutrophils are critical near the time of infection because they influence the character of the immune response and control tachyzoite replication.

IFN-gamma overproduction and high level apoptosis are associated with high but not low virulence Toxoplasma gondii infection

Toxoplasma gondii is an opportunistic intracellular parasite which induces a highly strong type 1 cytokine response. The present study focuses on defining the factors influencing the outcome of infection with tachyzoites of the type I, highly lethal RH strain, relative to the type II, low virulence strain ME49. Infection with the RH strain led to widespread parasite dissemination and rapid death of mice; in contrast, mice survived low virulence strain ME49 infection, and tachyzoite dissemination was much less extensive. Furthermore, massive apoptosis and disintegration of the splenic architecture was characteristic of RH, but not ME49, infection. In addition, hyperinduction of IFN-gamma and lack of NO production were found during RH, in contrast to ME49 infection. These data demonstrate that Toxoplasma strain characteristics exert a profound effect on the host immune response and that the latter itself is a crucial determinant in parasite virulence.