Abstract

Gangliosides are carbohydrate-containing sphingolipids that are widely expressed in normal tissues, making most subtypes unsuitable as targets for cancer therapy. However, the disialoganglioside GD2 subtype has limited expression in normal tissues but is overexpressed across a wide range of tumors. Disialoganglioside GD2 can be considered a tumor-associated antigen and well-suited as a target for cancer therapy. Disialoganglioside GD2 is implicated in tumor development and malignant phenotypes through enhanced cell proliferation, motility, migration, adhesion, and invasion, depending on the tumor type. This provides a rationale for targeting disialoganglioside GD2 in cancer therapy with the development of anti-GD2 monoclonal antibodies and other therapeutic approaches. Anti-GD2 monoclonal antibodies target GD2-expressing tumor cells, leading to phagocytosis and destruction by means of antibody-dependent cell-mediated cytotoxicity, lysis by complement-dependent cytotoxicity, and apoptosis and necrosis through direct induction of cell death. Anti-GD2 monoclonal antibodies may also prevent homing and adhesion of circulating malignant cells to the extracellular matrix. Disialoganglioside GD2 is highly expressed by almost all neuroblastomas, by most melanomas and retinoblastomas, and by many Ewing sarcomas and, to a more variable degree, by small cell lung cancer, gliomas, osteosarcomas, and soft tissue sarcomas. Successful treatment of disialoganglioside GD2-expressing tumors with anti-GD2 monoclonal antibodies is hindered by pharmacologic factors such as insufficient antibody affinity to mediate antibody-dependent cell-mediated cytotoxicity, inadequate penetration of antibody into the tumor microenvironment, and toxicity related to disialoganglioside GD2 expression by normal tissues such as peripheral sensory nerve fibers. Nonetheless, anti-GD2 monoclonal antibody dinutuximab (ch14.18) has been approved by the U.S. Food and Drug Administration and dinutuximab beta (ch14.18/CHO) has been approved by the European Medicines Agency for the treatment of high-risk neuroblastoma in pediatric patients. Clinical trials of anti-GD2 therapy are currently ongoing in patients with other types of disialoganglioside GD2-expressing tumors as well as neuroblastoma. In addition to anti-GD2 monoclonal antibodies, anti-GD2 therapeutic approaches include chimeric antigen receptor T-cell therapy, disialoganglioside GD2 vaccines, immunocytokines, immunotoxins, antibody–drug conjugates, radiolabeled antibodies, targeted nanoparticles, and T-cell engaging bispecific antibodies. Clinical trials should clarify further the potential of anti-GD2 therapy for disialoganglioside GD2-expressing malignant tumors.

Highlights

  • Gangliosides are carbohydrate-containing sphingolipids (glycosphingolipids) composed of a ceramide (usually sphingosine, a long-chain amino alcohol, attached by an amide group to a fatty acid core that varies in chain length from C18 to C20) bound to N-acetylneuraminic acid (Neu5Ac) or another sialic acid (an acidic carbohydrate with a ninecarbon backbone) linked to one or more monosaccharide units [1,2,3]

  • Gangliosides are carbohydrate-containing sphingolipids composed of a ceramide bound to N-acetylneuraminic acid (Neu5Ac) or another sialic acid linked to one or more monosaccharide units [1,2,3]

  • Furman et al reported the results of a non-randomized phase II trial in which the humanized disialoganglioside GD2 mAb hu14.18K322A was coadministered with six courses of induction chemotherapy in 42 children with newly diagnosed high-risk neuroblastoma [84] Thirty two patients (76.2%) experienced at least a partial response following two courses of chemoimmunotherapy, together with a median reduction of volume of the primary tumor of 76%

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Summary

Introduction

Gangliosides are carbohydrate-containing sphingolipids (glycosphingolipids) composed of a ceramide (usually sphingosine, a long-chain amino alcohol, attached by an amide group to a fatty acid core that varies in chain length from C18 to C20) bound to N-acetylneuraminic acid (Neu5Ac) or another sialic acid (an acidic carbohydrate with a ninecarbon backbone) linked to one or more monosaccharide units [1,2,3]. Clinical trials of anti-GD2 therapy are currently ongoing in patients with other types of disialoganglioside GD2-expressing tumors as well as neuroblastoma.

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