Abstract
Despite the recent advances in the treatment of ovarian cancer, it remains an area of high unmet medical need. Epithelial ovarian cancer is associated with high levels of mesothelin expression, and therefore, mesothelin is an attractive candidate target for the treatment of this disease. Herein, we investigated the antitumor efficacy of the mesothelin-targeting antibody-drug conjugate (ADC) anetumab ravtansine as a novel treatment option for ovarian cancer in monotherapy and in combination with the antitumor agents pegylated liposomal doxorubicin (PLD), carboplatin, copanlisib and bevacizumab. Anetumab ravtansine showed potent antitumor activity as a monotherapy in ovarian cancer models with high mesothelin expression. No activity was seen in mesothelin-negative models. The combination of anetumab ravtansine with PLD showed additive anti-proliferative activity in vitro, which translated into improved therapeutic in vivo efficacy in ovarian cancer cell line- and patient-derived xenograft (PDX) models compared to either agents as a monotherapy. The combination of anetumab ravtansine with the PI3Kα/δ inhibitor copanlisib was additive in the OVCAR-3 and OVCAR-8 cell lines in vitro, showing increased apoptosis in response to the combination treatment. In vivo, the combination of anetumab ravtansine with copanlisib resulted in more potent antitumor activity than either of the treatments alone. Likewise, the combination of anetumab ravtansine with carboplatin or bevacizumab showed improved in vivo efficacy in the ST081 and OVCAR-3 models, respectively. All combinations were well-tolerated. Taken together, these data support the development of anetumab ravtansine for ovarian cancer treatment and highlight its suitability for combination therapy with PLD, carboplatin, copanlisib, or bevacizumab.
Highlights
With 239,000 new cases per year, ovarian cancer is the seventh most frequent cancer in women in the world [1]
To study the mechanism of action of anetumab ravtansine, OVCAR-3 human ovarian cancer cells endogenously expressing mesothelin were incubated with 100 nM anetumab ravtansine for 4, 16, 24 or 48 h and the expression level of mesothelin was detected by Western blot
The OVCAR-3 cells treated with anetumab ravtansine showed decreased mesothelin expression compared to untreated cells, with the highest difference observed at 24 h (Figure 2A, 2B)
Summary
With 239,000 new cases per year, ovarian cancer is the seventh most frequent cancer in women in the world [1]. The highest age-adjusted incidence rates are seen in developed countries. In the United States alone, approximately 14,000 women per year die of ovarian cancer. Most patients are diagnosed at an advanced stage of disease [1]. Patients are initially treated with surgical debulking followed by platinum-based chemotherapy [2,3,4]. 75% of patients respond to primary treatment but quickly develop recurrent disease [5,6,7,8,9]
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