Antibody-drug Conjugates For Treatment Research Articles

Abstract B075: Anti-human LIV-1 antibody drug conjugate for treatment of metastatic prostate cancer

Abstract In the worldwide male population, prostate cancer has the most frequent malignancy; out of all the cancer-related causes of deaths, it is also one of the most common. With the advance of new therapies of androgen receptor pathway inhibitors, patient survival rates have improved significantly. There are still tremendous unmet needs, however, for the patients with treat-refractory metastatic castration-resistant prostate cancer (mCRPC). LIV-1, also known as SLC39A6 or ZIP6, is a member of the zinc transporter family and was first identified as an estrogen-inducible gene in breast cancer. Previous studies with immunohistochemical (IHC) analysis showed that LIV-1 is expressed by estrogen receptor-positive (ER+), hormone-treated tumors (both primary and metastatic sites) and ER-/PR-/Her2- (triple-negative) breast cancers. These studies also showed that in healthy human tissues, LIV-1 expression is limited to hormonally-regulated organs (prostate, uterus, and breast). The broad expression of LIV-1 in prostate and breast cancer tumors in combination with the limited expression in vital organs makes LIV-1 an excellent target for an antibody-drug conjugate (ADC). We generated an ADC, BRY812, consisting of a humanized anti-LIV-1 mAb conjugated to monomethyl auristatin E (MMAE), via a novel conjugation method that prevents MMAE from coming off of the antibody during the circulation. The PK studies in rat and monkey showed that the free MMAE released from ADC is 1 to 2 log lower compared with approved ADCs prepared by the standard conjugation method. Low free MMAE concentration significantly lowers the risk of off target toxicity by the ADC. In vitro and in vivo studies demonstrated the antitumor activity of BRY812 for the treatment of prostate and ER+ and triple-negative breast cancers with a better safety profile and a larger therapeutic window. The humanized LIV-1 ADC, BRY812 is currently in preclinical toxicity studies and will advance to First-in-Human trials in April, 2023. Citation Format: Xiaobei Zhao, Gang Chen. Anti-human LIV-1 antibody drug conjugate for treatment of metastatic prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr B075.

Abstract 1133: A B7-H4 targeting antibody-drug conjugate shows anti-tumor activity in PARPi and platinum resistant cancers with B7-H4 expression

Abstract Purpose: Platinum and PARP inhibitors (PARPi) demonstrate activity in breast and ovarian cancers, but drug resistance ultimately emerges. B7-H4 is over expressed in breast and ovarian cancer compared to normal tissues making it a promising target for therapies, however, to date it has not been evaluated if the expression is maintained in drug resistant cancer. Here we examine B7-H4 expression in high grade serous ovarian carcinoma (HGSOC) tumors at diagnosis and post-platinum or PARPi-resistance. We also evaluate the activity of a novel B7-H4-directed antibody-drug conjugate (ADC) bearing the pyrrolobenzodiazepine-dimer payload tesirine, in preclinical models of breast and ovarian cancer, including those resistant to standard of care therapies. Experimental Design: B7-H4 expression was measured by quantitative flow cytometry and immunohistochemistry. ADC efficacy was tested against multiple cell lines in vitro and patient-derived xenografts (PDX) in vivo. The effect of ADC treatment on cell cycle, DNA damage, and apoptosis was measured using flow cytometry. Results: B7-H4 was over-expressed in 92% of HGSOC tumors at diagnosis (n = 12), persisted in recurrent matched samples after platinum treatment, and was expressed at similar levels at multiple metastatic sites after acquired multi-drug resistance (n = 4 donors). Treatment with the ADC resulted in target-specific growth inhibition in a panel of ten B7-H4 expressing ovarian and breast cancer cell lines (IC50 6.18-273.9 pM, median 48.3 pM). Co-cultures of B7-H4 +/- lines support bystander killing effects leading to further tumor cell death in B7-H4- clones. In platinum- or PARPi-resistant ovarian cancer cells, ADC treatment significantly decreased viability and colony formation (P < 0.001) while increasing S or G2/M phase cell cycle arrest (P < 0.001) and DNA damage (P < 0.0001), ultimately leading to apoptosis (P < 0.01). A single 0.3 mg/kg dose of the ADC resulted in tumor regression in 61% of breast and ovarian PDX models tested (n = 23), where lower activity was identified in B7-H4 low or negative expressing models (P = 0.048). In PARPi- and platinum-resistant HGSOC models (n = 3), continuous B7-H4 ADC treatment (dosed once every 28 days) resulted in sustained anti-tumor activity, leading to complete (7 of 16) or partial responses (3 of 16) and increased survival (P < 0.004). Conclusions: These data support B7-H4 as an attractive ADC target for treatment of drug-resistant HGSOC. Citation Format: Sarah B. Gitto, Margaret Whicker, Gareth Davies, Sushil Kumar, Krista Kinneer, Arthur Lewis, Srinivas Mamidi, Sergey Medvedev, Judith Anderton, Jessica Tang, Benjamin Ferman, Steve Coats, Robert W. Wilkinson, Eric J. Brown, Daniel J. Powell, Fiona Simpkins. A B7-H4 targeting antibody-drug conjugate shows anti-tumor activity in PARPi and platinum resistant cancers with B7-H4 expression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1133.

Abstract P4-07-12: Development of Triple-negative breast cancer (TNBC) syngeneic models and TROP2-directed antibody-drug conjugate (ADC) surrogate to model therapeutic combinations

Abstract Background: Sacituzumab govitecan (SG, Trodelvy®) is a human trophoblast cell surface antigen 2 (TROP-2) directed antibody drug conjugate (ADC) coupled to an active form of irinotecan (SN-38) via our novel hydrolyzable linker (CL2A). SG is the only FDA-approved ADC treatment for TNBC patients in the second-line setting. TROP-2 is a transmembrane protein encoded by the tumor-associated calcium signal transducer 2 (TACSTD2) gene and highly expressed in TNBC, an aggressive type of cancer accounting for approximately 15% of all breast cancers. TROP-2 overexpression is associated with poor survival and relapse, but its biological function in TNBC remains poorly understood. Hypothesis/rationale: To better understand TROP-2 and TROP-2-directed ADC biology, we developed and characterized TROP2high vs TROP2low TNBC syngeneic tumors and an SG surrogate directed to murine TROP-2. Experimental design: We established 2 syngeneic TNBC models with differential TROP-2 expression: 4T1 cells were flow sorted into high (>95%) vs low (< 7%) TROP-2 expressors and EMT6 cells were transduced with a murine TACSTD2-encoding lentivirus. Balb/c mice were subcutaneously implanted with 0.5 × 10 E6 TROP-2high, TROP-2low, or parental tumor cells (4T1 or EMT6). Tumor immunophenotyping and transcriptomic analyses were performed 15 and 24 days after implantation. An SG mouse surrogate was engineered to mimic SG, using an anti-TROP-2 antibody (Rab64) that cross-reacts with human and murine TROP-2 covalently attached to SN-38 by the CL2A linker. SG surrogate activity was characterized in vitro and in 4T1 syngeneic models. Results: SG surrogate demonstrated high affinity for human and mouse TROP-2 (KD=1.1 and 1.4 nM, respectively) with SN-38 release rates and PK similar to that of SG. Flow cytometry analysis after bulk cell sorting of 4T1 or lentivirus transduction of EMT6 confirmed high TROP2 expression after at least 3 in vitro passages. Fifteen days after subcutaneous implantation, flow cytometry analysis of tumor single-cell suspensions revealed significant differences in immune infiltrates between 4T1-derived tumor groups (n=5/group; mean percentages in TROP2high vs TROP2low 4T1-derived tumors of cells expressing CD45: 65% vs 10%, P < 0.0001; CD8: 5.5% vs 1%, P = 0.0033; CD4: 22% vs 4%, P = 0.0055; macrophages: 12.5% vs 2.5%, P = 0.0002; myeloid cells: 52% vs 75%, P = 0.0066). In addition, TROP2high 4T1-derived tumors were smaller and had significantly less necrosis than TROP2low and unsorted 4T1-derived tumors 25 days after implantation. Finally, transcriptomics analyses of TROP2high vs TROP2low 4T1-derived tumors demonstrated the association of TACSTD2 expression levels with regulation of distinct molecular pathways. Conclusion: Syngeneic tumors derived from 4T1 cells with differential TROP2 expression levels are associated with differential cellular states and tumor microenvironment composition. In contrast, no significant phenotypic changes were observed in tumors derived from TACSTD2-transduced compared with mock-transduced EMT6 cells. Taken together, these results suggest that expression of the TACSTD2 gene is associated with, but not causative of, different tumor phenotypic states. Additional studies to investigate TROP-2 expression as a correlative marker of patient prognosis and the antitumor immune response are warranted. The effects of in vivo treatment with an SG surrogate on 4T1 tumor growth and immune phenotype will be discussed at the time of the presentation. Citation Format: Chih-Chien Chou, Jordan Kardos, Becky Yang, Jessica Orf, Rutwij Dave, Yurong Lai, Chingwei V. Lee, Giuseppe A. Papalia, Kelli Boyd, Lauri Diehl, Nathalie Scholler. Development of Triple-negative breast cancer (TNBC) syngeneic models and TROP2-directed antibody-drug conjugate (ADC) surrogate to model therapeutic combinations [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-12.

Distribution, dynamic evolution, and clinical outcomes of patients with advanced breast cancer according to HER2 expression

BackgroundNovel antibody‒drug conjugates (ADC) have shown great efficacy in HER2-low advanced breast cancer. However, the clinical features of HER2-low disease still need to be clarified. The current study aims to evaluate the distribution and dynamic change in HER2 expression in patients with disease recurrence and the clinical outcome of those patients.MethodsPatients with pathologically diagnosed relapsed breast cancer between 2009 and 2018 were included. Samples were considered HER2-zero when the immunohistochemistry (IHC) score was 0, HER2-low when the IHC score was 1 + or 2 + with negative fluorescence in situ hybridization (FISH) results, and HER2-positive when the IHC score was 3 + or the FISH results were positive. Breast cancer-specific survival (BCSS) was compared among the three HER2 groups. Changes in HER2 status were also evaluated.ResultsA total of 247 patients were included. Among recurrent tumors, 53 (21.5%) were HER2-zero, 127 (51.4%) were HER2-low, and 67 (27.1%) were HER2-positive. The HER2-low subtype represented 68.1% of the HR-positive breast cancer group and 31.3% of the HR-negative group (P < 0.001). This three-group classification of HER2 status was prognostic in advanced breast cancer (P = 0.0011), with HER2-positive patients having the best clinical outcome after disease recurrence (P = 0.024), while only marginal survival advantages were observed in HER2-low patients versus HER2-zero patients (P = 0.051). In the subgroup analysis, the survival difference was observed only in patients with HR-negative recurrent tumors (P = 0.0006) or with distant metastasis (P = 0.0037). The overall discordance rate of HER2 status between primary and recurrent tumors was 38.1%, with 25 (49.0%) primary HER2-zero patients and 19 (26.8%) HER2-positive patients shifting to HER2-low at recurrence.ConclusionNearly half of the advanced breast cancer patients had HER2-low disease, which indicates a poorer prognosis than HER2-positive disease and marginally better outcomes than HER2-zero disease. During disease progression, one-fifth of tumors convert to HER2-low entities, and the corresponding patients may benefit from ADC treatment.

Antibody-Drug Conjugates in Prostate Cancer: A Systematic Review.

The prognosis in the setting of metastatic castration-resistant prostate cancer patients (mCRPC) remains limited. Therefore, novel treatment strategies remain an unmet need. Antibody-drug conjugates (ADC) emerged as a new drug concept with the potential to deliver a cytotoxic payload with limited off-target toxicity and potentially bystander effect. Following the success of ADCs in breast cancer and urothelial tumours, their activity in prostate cancer is now under investigation. Thus, the aim of this systematic review was to identify published and ongoing prospective clinical trials regarding ADC treatment in prostate cancer. A systematic search of PubMed, MEDLINE, and Web of Science was conducted as per PRISMA guidelines to identify prospective clinical trials of ADCin prostate cancer. Trials are currently ongoing on ClinicalTrials.gov and in the EU. The Clinical Trials Register was also identified. Abstracts, publications in languages other than English, review articles, retrospective analyses, and phase I trials were excluded. A total of six phase I/II prospective clinical trials already published were included. Seven ongoing trials were also identified. All studies were in the refractory/advanced tumour setting, and two included only mCRPC patients. The ADC targets were prostate-specific membrane antigen (PSMA), trophoblast cell surface antigen-2 (TROP-2), six-transmembrane epithelial antigen of prostate-1 (STEAP-1), tissue factor (TF), delta-like protein 3 (DLL-3), B7-H3 family of proteins (B7-H3), and human epidermal growth factor receptor 2 (HER2). Regarding the efficacy of PSMA ADC treatment in the second-line or beyond mCRPC setting, a PSA ≥ 50% decline rate in 14% of all treated patients was reported. One patient achieved a complete response with TROP-2 ADC. Overall, a wide range of safety issues were raised, particularly in connection with neuropathy and hematologic toxicity. Novel therapies have been changing the scope of treatment in mCRPC. ADCs seem to provide efficacy benefits, even with potential toxicity. The results of most prospective ongoing studies are still awaited, and a longer follow-up time is warranted to evaluate the real impact of ADCs in PCa.

A Novel Antibody-Drug Conjugate Directed Towards the Surrogate Light Chain of Malignantly-Transformed B-Cell Precursors Reverses Leukemic Progression in NSG Mice

Background: Antibody-drug conjugates (ADC) utilizing AcBut-linked calicheamicin have improved survival for B- and myeloid lineage hematopoietic malignancies for both adults and children. We recently showed that the VpreB1 component (CD179a) of the B-cell surrogate light chain is ubiquitously expressed on B-lineage lymphoblasts, which may present a suitable target for an immunotherapeutic intervention. Specifically, the VpreB1 component of the surrogate light chain was identifiable in 36 / 36 (100%) of primary patient samples obtained from COG studies AALL0232 and AALL1131 (Blood Adv6(2): 585-589; 2022.) Materials and Methods: Using a human IgG1 subclass monoclonal antibody (mAb) against the VpreB1 component of the surrogate light chain, we created an ADC that is comprised of an AcBut-linker to calicheamicin. Using ex vivo testing conditions, we assessed 50% inhibitory concentrations (IC50s) in the Nalm6, REH and SEM B-ALL cells lines, and in PDXB1 and PDXB2 patient-derived xenographs (PDXs). We tested the VpreB1 ADC to evaluate its potential to rescue NSG mice that were engrafted with Nalm-6 B-lymphoblasts using VpreB1 ADC doses ranging from 0.1 to 3 mg/kg given intraperitonealy three times, four days at apart at leukemic engraftment to assess responses. To assess leukemic burden in the experimental and control conditions, we utilized human FITC-labelled CD45/CD19 antigen expression and Nalm-6-Luciferase imaging to track disease progression in mock, CD179a mAb (alone) and VpreB1 ADC-treated NSG mice. Results: We found a spectrum of IC50s in the B-ALL samples tested under ex vivo conditions, which ranged from 59 ng/ml (Nalm6), 81 ng/ml (REH), 108 ng/ml (PDXB2), 2499 ng/ml (PDXB1) to 5105 ng/ml (SEM), suggesting a range of sensitivities to the mAb. Using flow cytometric analyses of Nalm-6 engraftment, we found that human CD19-expressing cell populations were absent in the VpreB1 ADC treatment group, but present in the mock and CD179a mAb-alone control groups. We employed a series of dose-finding studies and found that a dose of 2 mg/kg (~105 mcg/kg calicheamicin dose) in the experimental group was sufficient to reverse progressive disease. Using Nalm-6-engrafted NSG mice, we found that the VpreB1 ADC (2 mg/kg) treatment cohort had significantly extended lifespans in comparison to those treated with mock or naked mAb control groups (Mantel-Cox log-rank; P<0.0001). Using Nalm-6-luciferase imaging, we determined that the surviving animal population showed no signs of leukemic infiltration in comparison to the negative control groups, and that (4/6; 67%) of the animals in the VpreB1 ADC treatment group survived without evidence for relapsed leukemia for more than 100 days. Two of the animals died for inexplicable reasons, but did not have progressive disease by luciferase imaging. At necropsy, none of the four surviving animals in the experimental treatment group had flow cytometric evidence for leukemia. These findings suggest that the VpreB1 ADC induced "cures” in the surviving Nalm-6-Luciferase treatment group. Conclusions: We have created a novel ADC that neutralizes leukemic progression in our NSG Nalm-6 engrafted murine model. Our preliminary data supports the further evaluation of the ADC in patient-derived xenografts (currently underway). Further studies will be performed in preparation for Phase 1 clinical testing in adults and children with B-lineage acute lymphoblastic leukemia/lymphoma.

Abstract 1751: Developing a next generation antibody drug conjugate for treatment of gastrointestinal cancers

Abstract Background: Gastrointestinal cancers (GI) are among the most common cancers worldwide. Current treatment options rely on a chemotherapy backbone combined with targeted antibody therapies, but the prognosis generally remains poor. Iksuda has developed a next-generation Antibody Drug Conjugate (ADC) targeting a cancer-specific carbohydrate antigen (CanAg) which is highly overexpressed in GI cancers but has no expression on normal tissues. This CanAg-targeting ADC is comprised of a proprietary PBD prodrug coupled to an anti-CanAg antibody using PermaLink conjugation technology. The PBD prodrug is designed with a tumor-selective trigger to attenuate its potency before entry of the ADC into the target cancer cells. PermaLink conjugation chemistry ensures conjugate stability. Here, the potential of this anti-CanAg ADC was explored in preclinical models as a proof of concept for targeting GI cancers. Methods: The ADC is composed of a PBD prodrug conjugated to an anti-CanAg antibody through PermaLink to generate conjugate with a drug to antibody ratio of approximately 2. This CanAg-targeting ADC was evaluated in vitro in the CanAg-expressing Colo205 cancer cell line. In vivo efficacy studies were conducted in SCID mice with CanAg-expressing human cancer xenografts representing colorectal (Colo 205), gastric (N87) and pancreatic cancers (BxPC3). An exploratory toxicology study was conducted in cynomolgus monkeys. Results: The CanAg-targeting ADC showed highly potent, specific activity in the Colo205 colorectal cancer cell line with IC50 values in the pM range. A single administration of anti-CanAg ADC in CanAg-positive GI xenograft models showed significant dose-dependent antitumor activity and induced complete tumor regressions with no observable toxicity. In the gastric cancer model, the anti-CanAg ADC gave a complete response by day 36 when dosed at 0.3 mg/kg, and 1 and 3 mg/kg doses exhibited long-lasting tumor regression. In the pancreatic cancer model, administration of anti-CanAg ADC at 0.3 mg/kg induced 76% tumor growth inhibition (TGI) on day 21, and at 1 mg/kg, and 3 mg/kg showed complete tumor regression by day 40 with no subsequent tumor recurrence for the 3mg/kg dose. In colorectal cancer, the anti-CanAg ADC exhibited 58% and 98% TGI with 0.3 mg/kg and 1 mg/kg doses respectively, and with the 3 mg/kg dose regressed tumor with no recurrence. The anti-CanAg ADC was well tolerated in cynomolgus monkeys with 1 mg/kg defined as the highest non-severely toxic dose (HNSTD). Conclusions: This anti-CanAg ADC has shown favorable preclinical anti-tumor activity in gastrointestinal cancers. Our findings support the clinical development of the anti-CanAg ADC for the treatment of GI cancers. Citation Format: Justyna H. Mysliwy, Adam Lodge, Daniel Williamson, Jenny Thirlway, Jutta Deckert, Robert J. Lutz. Developing a next generation antibody drug conjugate for treatment of gastrointestinal cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1751.

Antibody-drug conjugate and free geldanamycin combination therapy enhances anti-cancer efficacy

Antibody drug-conjugates (ADCs) targeting human epidermal growth factor (HER2) are a rapidly expanding class of cancer therapeutics. Such ADCs are known to suffer from inefficient trafficking to the lysosome due to HER2 endosomal recycling, leaving most bound ADCs at the cell surface or in early endosomes. This study aims to increase the maximum cytotoxicity of ADC treatment by co-delivering a small molecule inhibitor targeting the primary chaperone of HER2, heat shock protein 90 (HSP90). We hypothesized that inhibiting HSP90 could aid ADC cytotoxicity by overcoming HER2 endosomal recycling. Flow cytometric studies tracking HER2 surface expression revealed ∼ 10 nM geldanamycin (GA) as the threshold for inhibiting HSP90 mediated HER2 recycling. Cytotoxicity studies in HER2 overexpressing cancer cell lines NCI-N87, MDA-MB-453, and SKOV3 demonstrated that co-administration of ADC alongside 100 nM GA significantly increased cytotoxicity compared to ADC alone. In all cases, baseline cytotoxicity was observed even in low HER2 expressing line MDA-MB-231 cells, indicating possible off-target effects. To mitigate this baseline cytotoxicity, a “pulse treatment” regime was adopted where cells are pre-loaded with T-DM1 or T-MMAE ADCs for 4 h, followed by a 4-hour pulse treatment with ADC and 100 nM GA to initiate trafficking of HER2 bound ADC to the lysosome. Afterwards, GA is removed, and ADC treatment is continued. GA pulse co-treatment decreased the amount of ADC required to achieve maximum cytotoxicity while minimizing baseline cytotoxicity. No such co-treatment regime featuring a pulse sequence has been explored before. Such co-treatments could offer a viable solution to increase ADC efficacy in hard to treat or resistant HER2-positive cancers.

Corneal in vivo confocal microscopy to detect belantamab mafodotin-induced ocular toxicity early and adjust the dose accordingly: a case report

BackgroundNew targeted antibody–drug conjugates (ADCs) against multiple myeloma are known to induce adverse effects that may lead to treatment discontinuation. Preclinical studies reported early severe ocular damage related to the use of belantamab mafodotin (belamaf), including ocular surface inflammation, severe dry eye, and a specific toxicity to the cornea, namely microcystic keratopathy. While belamaf-induced ocular changes have not been prospectively studied, a better understanding of mechanisms involved as well as kinetics may aid in anticipating dose adjustment rather than stopping the treatment once clinical ocular damage is too severe.Case presentationA 61-year-old woman scheduled for belamaf as a fifth-line treatment against multiple myeloma was prospectively included. Clinical examinations were performed before and every 3 weeks afterward, together with in vivo confocal microscopy (IVCM) of the cornea. Visual acuity, symptoms, slit-lamp examination, and ultrastructural changes of the cornea were recorded according to the received dose of belamaf. More precisely, kinetics, shape, density, and location of the toxic corneal lesions have been followed and analyzed using IVCM. Also, specific lesions at the sub-basal nerve plexus layer were detected and characterized for the first time. This advanced approach allowed a better understanding of the belamaf-induced toxicity, further balancing the dose to maintain good vision and eye health while continuing the treatment.ConclusionsSystematic ultrastructural analysis and follow-up of the corneal state during ADCs treatment for multiple myeloma may open new avenues in the therapeutic approach. Early preclinical detection of ocular damage may accurately contribute to finding the correct dose for each patient and not stopping the treatment due to severe ocular adverse effects.

Caution the arrhythmia association with antibody-drug conjugates: a pharmacovigilance study.

Arrhythmias associated with antibody-drug conjugates (ADCs) are rare but potentially life-threatening adverse events (AEs). No study has systemically compared arrhythmias associations for various marketed ADCs. This needs to be clarified to guide antitumor therapies. We extracted data of patients treated with ADCs registered between 2004 q1 and 2020 q3 from the US Food and Drug Administration adverse event reporting system (FAERS). The medical dictionary for regulatory activities was used to identify arrhythmias cases. Disproportionality analysis was performed by calculating the reporting odds ratios (ROR) with corresponding 95% confidence intervals (95% CI). Clinical characteristics of patients with ADCs-associated arrhythmias and the time to onset of arrhythmias following different ADCs were collected. A total of 140 reports were considered after inclusion criteria were used. Exposure to gemtuzumab ozogamicin (2.23, 1.67-2.97; 48 cases) and brentuximab vedotin (1.27, 1.00-1.61; 67 cases) were associated with a positive signal of arrhythmia. The highest number of arrhythmia reports was for brentuximab vedotin (n = 67). Also 88.00% of arrhythmia occurred within 60 days for all these ADCs. Arrhythmia was commonly reported in patients with hematologic tumors and breast cancer. In the time to onset of adverse events after administration, brentuximab vedotin was significantly earlier than gemtuzumab ozogamicin (38.21 vs. 40.50 days; P = 0.0093), and gemtuzumab ozogamicin was significantly earlier than trastuzumab emtansine (40.50 vs. 147.50 days; P = 0.0035). We reviewed arrhythmia adverse drug reactions associated with ADCs from the FAERS database. This study is practical for clinicians to enhance the management of arrhythmia associated with ADCs and improve ADCs treatment safety.

Generation of Antibody-Drug Conjugate Resistant Models.

Simple SummaryAntibody-drug conjugates (ADCs) constitute new and effective therapies in cancer. However, resistance is frequently observed in treated patients after a given period of time. That resistance may be present from the beginning of the treatment (primary or de novo resistance) or raise after an initial response to the ADC (secondary resistance). Knowing the causes of those resistances is a necessity in the field as it may help in designing strategies to overcome them. Because of that, it is necessary to develop models that allow the identification of mechanisms of resistance. In this review, we present different approaches that have been used to model ADC resistance in the preclinical setting, and that include the use of established cell lines, patient-derived ex vivo cultures and xenografts primarily or secondarily resistant to the ADC. In the last 20 years, antibody-drug conjugates (ADCs) have been incorporated into the oncology clinic as treatments for several types of cancer. So far, the Food and Drug Administration (FDA) has approved 11 ADCs and other ADCs are in the late stages of clinical development. Despite the efficacy of this type of drug, the tumors of some patients may result in resistance to ADCs. Due to this, it is essential not only to comprehend resistance mechanisms but also to develop strategies to overcome resistance to ADCs. To reach these goals, the generation and use of preclinical models to study those mechanisms of resistance are critical. Some cells or patient tumors may result in primary resistance to the action of an ADC, even if they express the antigen against which the ADC is directed. Isolated primary tumoral cells, cell lines, or patient explants (patient-derived xenografts) with these characteristics can be used to study primary resistance. The most common method to generate models of secondary resistance is to treat cancer cell lines or tumors with an ADC. Two strategies, either continuous treatment with the ADC or intermittent treatment, have successfully been used to develop those resistance models.

Abstract 514: Specific anti-HER2 host immunity conferred by HER2-targeted antibody drug conjugate therapy and checkpoint blockade

Abstract Using HER2-targeted antibody drug conjugates (ADC), we tested the therapeutic efficacy, direct impact on cancer stem cells (CSCs), and potential added benefit when combined with PD-L1 blockade in immunocompetent mouse tumor models. Two murine mammary tumor models were used in this study: D2F2/E2, a cell line resulting from stable transfection of parental D2F2 murine mammary tumor cells with wild-type human HER2, and 4T1-HER2, derived from parental 4T1 by stable transduction with wild-type human HER2. We demonstrate that HER2-targeted ADC treatment induced both cellular and humoral anti-HER2 adaptive immune responses which effectively targeted both bulk tumor and cancer stem cells. We recently investigated induction of host immunity using a tumor re-challenge strategy in tumor free animals subjected to ADC or ADC + anti-PD-L1 therapy. D2F2/E2 tumor-bearing mice were treated with ADC or ADC + anti-PD-L1 to generate tumor free mice. These tumor free animals were re-challenged with the relevant tumor D2F2/E2 or irrelevant tumor WT 4T1 respectively. While all the tumor free animals re-challenged with WT 4T1 showed aggressive tumor growth, ADC-treated tumor free animals re-challenged with D2F2/E2 demonstrated significantly (p&amp;lt;0.0001) slower tumor growth compared with the age-matched naive mice, and this protection was significantly (p=0.0078) enhanced in ADC + anti-PD-L1-treated tumor free animals, resulting in completely rejection of the re-challenge and thus documenting immunological memory formation. B cell activation was obvious by the significant upregulation of Ki67 and GL7 CD86 on both CD45+CD19+ tumor-infiltration lymphocytes (TILs) and splenocytes. B cell differentiation was evident by the upregulation of GL7 on both TILs and splenocytes, as well as the expression of CD138 on splenotytes. We found that IgG1 was the predominant isotype in treated mice vs. IgG2a, IgG2b, IgG3, and ADC + anti-PD-L1 dual treatment drastically increased the amount of IgG1 in serum. In addition, ADC+ anti-PD-L1 dual treatment significantly increased the frequency of CD8+IFNγ+ cells in TILs. Both ADC alone (p=0.0004) and ADC+anti-PD-L1 dual treatment (p=0.01) significantly decreased CD4+FoxP3+ regulatory T cells. These results provide evidence that HER2-targeted ADC + anti-PD-L1 immunotherapy-induced B cell activation and differentiation along with the modulation of T cell subsets could confer host anti-HER2 immunity. Citation Format: You Qin, Hannah E. Dobson, Frank I. Comer, Alfred E. Chang, Max S. Wicha, Qiao Li. Specific anti-HER2 host immunity conferred by HER2-targeted antibody drug conjugate therapy and checkpoint blockade [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 514.

Abstract 1773: Tumor cell-intrinsic STING pathway activation leads to robust induction of Type III Interferons and contributes to the anti-tumor activity elicited by STING agonism

Abstract STING pathway plays a critical role in inducing anti-tumor immunity by upregulating Type 1 Interferon (IFN) and IFN-stimulated genes within the tumor microenvironment in response to cytosolic nucleic acid ligands. Therefore, the STING pathway agonism has emerged as a potential therapeutic mechanism to stimulate an anti-tumor innate immune response. Intratumorally injected free STING-agonists that are currently being evaluated in the clinic by others have shown limited effects in non-injected lesions. Antibody-drug conjugates (ADCs) constitute a proven therapeutic modality that enables tumor-targeted drug delivery with systemic administration. We have previously demonstrated that the tumor cell-intrinsic STING pathway is activated in the presence of cues from immune cells and contributes to the anti-tumor activity of tumor cell-targeted Immunosynthen STING-agonist ADCs, in which a STING-agonist payload is conjugated to a tumor cell-targeting antibody. Here we investigated the nature of the STING pathway activation in tumor cells and its contribution to the anti-tumor activity elicited by STING agonism. Leveraging ADCs with a wild type (wt) or mutant Fc (deficient in Fcγ receptor -FcγR- binding), we delivered a STING-agonist simultaneously to tumor-resident immune and cancer cells or only to cancer cells through FcγR-mediated and/or tumor antigen-mediated ADC internalization. We utilized these ADCs in in vivo human tumor xenograft models and STING wt or knock out (ko) cancer cell:immune cell co-cultures and evaluated gene expression, cytokine production, and anti-tumor activities induced by STING-agonist ADCs. Surprisingly, Nanostring analysis of the human tumor xenografts from mice treated with tumor cell-targeted STING-agonist ADCs revealed human tumor cell-specific activation of Type III IFNs. In human cancer cell:immune cell co-cultures, treatment with tumor cell-targeted STING-agonist ADCs also led to marked upregulation of Type III IFNs, which was significantly reduced in STING ko cancer cell:immune cell co-cultures, suggesting that the cancer cells may contribute majority of the Type III IFNs downstream of STING pathway activation. Blocking Type III IFNs with neutralizing antibodies in cancer cell:immune cell co-cultures inhibited the production of key cytokines, including Type I IFN, and nearly abolished tumor cell-killing in response to STING-agonist ADC treatment, indicating that the Type III IFNs play an important role in the anti-tumor activity induced by STING activation. These studies reveal a previously underappreciated mechanism of STING agonist anti-tumor activity. The ability of tumor cell-targeted STING-agonist ADCs to activate STING in both tumor cells and in tumor-resident immune cells may represent a significant therapeutic advantage of an Immunosynthen ADC approach to STING agonism. Citation Format: Naniye Malli Cetinbas, Travis Monnell, Kalli Catcott, Winnie Lee, Pamela Shaw, Kelly Slocum, Kenneth Avocetien, Keith Bentley, Susan Clardy, Brian Jones, Eoin Kelleher, Rebecca Mosher, Joshua D. Thomas, Dorin Toader, Jeremy Duvall, Raghida A. Bukhalid, Marc Damelin, Timothy B. Lowinger. Tumor cell-intrinsic STING pathway activation leads to robust induction of Type III Interferons and contributes to the anti-tumor activity elicited by STING agonism [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1773.

Emerging Immune Targets for Treatment of Multiple Myeloma

Introduction:Multiple myeloma (MM) is the 14th leading cause of cancer deaths in the USA. According to NIH cancer statistics, there will be estimated 30,280 new cases and 12,590 deaths due to MM in 2017. Immunotherapy appears to be an appealing treatment modality for MM. Various immunotherapeutic approaches are being used and our aim is to summarize current knowledge on efficacy of non-FDA approved monoclonal antibodies (mAbs), chimeric antigen receptor modified (CAR-T) cells and their targets.Methods:For CAR-T cells literature search was performed on 7/16/2017 in following databases: PubMed, Cochrane, EMBASE, Web of Science and Clinicaltrilas.gov. Only English language studies were included and no publication date limit was applied. For mAbs, phase I/II trials that were complete or recruiting participants were retrieved from clinicaltrials.gov on 7/19/2017. Trials on elotuzumab and daratumumab that have already proven efficacy were not included.Results:Literature search identified a total of 287 articles on CAR-T cells. After detailed scrutiny, 6 studies were included. Citation analysis retrieved one additional study. 7 studies included 86 relapsed and refractory MM (RRMM) patients. Targeted antigens included B-cell maturation antigen (BCMA) (n=4 studies), CD138 (n=1), CD19(n=1) and kappa light chain (n=1). There was significant variation in CAR T cell dose ranging from 1 x 10⁷ to 5 x 10⁸ per patient. Most patients were heavily pretreated with ≥ 6 median prior lines of therapy. Only one study additionally incorporated ASCT. No objective response (OR) was achieved with CD138 and kappa light chain directed CAR T cell therapy. For BCMA and CD19 directed CAR T cell therapy, there was significant variation in efficacy outcomes reported with PR ranging from 2 weeks to 3.2 months (m), VGPR 2m to 5m and sCR 2m to 7+m. Highest incidence of cytokine release syndrome (CRS) of all grades was reported with BCMA directed CAR T cell therapy, ranging from 58-83%. One case of posterior reversible encephalopathy syndrome was reported with BCMA targeted CAR T cell therapy.mAb targets included ICAM-I (BI-505), IL-6 (siltuximab), VEGF (bevacizumab), GRP78 (PAT-SMX), CD40 (dacetuzumab, lucatumumab), CD138 (indatuximab), PD-1 (pembrolizumab, nivolumab, pidilizumab), CD20 (rituximab), CD38 (isatuximab), CD56 (lorvotuzumab), IGF-1R (AVE1642, figitumumab), VEGF (bevacizumab), BAFF (atacicept, tabalumumab) and CD74 (milatuzumab). No objective response (≥PR) was observed with monotherapy with BI-505, siltuximab, bevacizumab, PAT-SMX, AVE-1642, figitumumab, atacicept, milatuzumab, dacetuzumab and nivolumab. Isatuximab (anti-CD38) was the only mAb with promising results (OR 24%) as monotherapy in patients with 6 prior lines of therapy. Most trials employed RRMM patients. Siltuximab in combination with VMP (velcade, melphalan and prednisone) was evaluated in frontline setting without significant improvement reported (CR of 22% vs 27% with VMP alone and PFS of 17 months in both arms). Antibodies tested as conjugates include indatuximab, ravtansine (anti CD138) and lorvotuzumab mertansine (anti CD56). Their results were encouraging when used in combination with Rd (lenalidomide and dexamethasone), OR of 78% with indatuximab +Rd and 56.4% with lorvotuzumab +Rd. MAbs that've been tested in combination therapy include siltuximab (S+Vd, OR 66%), dacetuzumab (D+Rd, OR 39%), indatuximab (I+Rd, OR 78%), isatuximab (I+Rd, OR 64.5%), lorvotuzumab (L+Rd, OR 56.4%) and pembrolizumab (P+Pd, OR 50%).Conclusion:Immunotherapy with mAb and CAR-T therapy seems to offer very promising results. Short term and log term toxicity with mAb and cellular therapy demands thorough understanding of mechanism, biology behind the “ on target” and “off target” effects, side effect profile and their prevention. Further trials are warranted to determine best CAR-T cell construct and design for treating MM. Outcomes with many single agent mAb therapy were not encouraging and provide a rationale that future trials with mAbs should be done as multi-agent therapies. Promising results with isatuximab warrants further trials. Antibody-drug conjugate treatment is worth further evaluation both as single agent and in combination with standard anti-MM agents. Individualized treatment approach based on surface CD marker expression need to be developed and may produce better outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Human Endogenous Retrovirus-H Long Terminal Repeat- Associating Protein 2 (HHLA2) is a Novel Immune Checkpoint Protein in Lung Cancer which Predicts Survival.

Background:Lung cancer is one of the most frequently diagnosed malignancies. Human endogenous retrovirus-H long terminal repeat-associating protein 2 (HHLA2) is a recently discovered ligand of the B7 family. Blocking this immune checkpoint has become an important treatment option for lung cancer. Methods:The study includes 62 biopsy specimens either bronchoscopic or CT-guided biopsies diagnosed as lung cancer in Hospitals of Faculty of Medicine, Mansoura University, Egypt during the period from 2016 to 2020. Immunohistochemical Staining for HHLA2 and EGFR was performed. HHLA2 expression was assessed in different pathological types of lung Cancer, and it was correlated with other clinicopathologic parameters and patient prognosis. Results:We found a significant association between HHLA2 expression and metastasis. About 83% of patients presented with metastasis showed positive expression of HHLA2 compared to 44.4% in patients with no metastasis (p=0.02). Also, results show significant mild positive correlation between expression of HHLA2 and EGFR markers (p=0.045). The mean OS time in cases with positive HHLA2 expression was nearly half that of patients with negative expression of the markers. However, this difference was not statistically significant. But, PFS of patients was significantly lower among the group with positive expression of HHLA2 compared to the group with negative expression of HHLA2 (p= 0.01). Conclusions:This study reports that recently discovered, HHLA2 is over expressed in lung cancer associating with higher stage. It is also correlated with EGFR overexpression. HHLA2 could serve as a predictor of progression and distant metastasis. Also, it has potential to be effective immune target in lung cancer immunotherapy such as checkpoint blockade and antibody-drug conjugate treatment.

Abstract PD13-05: Delivery and activity of SN-38 by sacituzumab govitecan in breast cancer brain metastases

Abstract BACKGROUND: Sacituzumab Govitecan (SG, TRODELVY™) is an FDA approved antibody drug conjugate for treatment of metastatic triple negative breast cancer (TNBC). SG has payload and linker characteristics preferable for CNS delivery including a pH hydrolysable, a payload (SN-38) that is the active 1000-fold more potent than the parent compound CPT-11 and crosses the blood brain barrier. Our preliminary data showed SG activity in intracranial xenografts leading to our hypothesis that SG would achieve concentration of SN-38 within the breast cancer brain metastases (BCBM) that would be therapeutically relevant. METHODS: We undertook a single center, prospective, window of opportunity trial (NCT03995706) to examine the concentrations of SG, SN-38, and SN-38G in tumors patients undergoing craniotomy for BCBM (n=20) or recurrent glioblastoma (rGBM, n=10). A single dose of SG was administered at 10mg/kg IV the day prior to craniotomy. Tumor was collected and [SN-38] was analyzed via mass spectrometry (UHPLC-HRMS). following recovery patients resumed SG at 10mg/kg IV days 1 and 8 of 21 day cycle and were assessed for response or progression every third cycle by MRI. RESULTS: To date 21 patients have been treated, including 11 BCBM and 10 rGBM. UHPLC-HRMS analysis was performed in the first 10 tumors (n=4 and 6 respectively). For BCBM, total concentration of SN-38 varied from 173nM to 1160nM, with a mean concentration of 626nM. All GBM patients had residual measurable disease and 4 breast patients had measurable disease. With a median follow-up of 12 weeks from the first postoperative cycle in the first 14 patients, 2 partial responses from each group were observed (ORR of 28% and 50% at 12 weeks respectively). Updated results will be presented. CONCLUSIONS: SG achieves therapeutically relevant concentrations of SN-38 at 150-fold mean IC50s for BCBM. Early intracranial responses are encouraging and merit further evaluation. A multi-center trial of SG for HER2 negative BCBM (SWOG S2007) will be enrolling soon. Citation Format: Andrew J Brenner, Renu Pandey, Jennifer Chiou, John Floyd, Prathiba Surapreneni, Virginia Kaklamani, Kate Lathrop, Richard Crownover, Stefano Tiziani. Delivery and activity of SN-38 by sacituzumab govitecan in breast cancer brain metastases [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD13-05.

Tumor volumes as a predictor of response to the anti-EGFR antibody drug conjugate depatuxizumab mafadotin.

BackgroundThe adverse impact of increasing brain tumor size on the efficacy of antibody-drug conjugates (ADCs) was investigated preclinically then validated with clinical data.Methods—Preclinical studyThe impact of tumor size on ADC tumor delivery and treatment response was evaluated in an EGFR-amplified patient-derived glioblastoma (GBM) model following treatment with Depatuxizumab mafadotin (Depatux-M). Biodistribution and imaging studies correlated drug distribution with starting treatment volume and anti-tumor activity.Methods—Clinical studyM12-356 was a Phase I study of Depatux-M in patients with GBM. Blinded volumetric analysis of baseline tumor volumes of M12-356 patients was undertaken by two reviewers and results correlated with response and survival.ResultsPreclinically, imaging and biodistribution studies showed specific and significantly higher tumor uptake of zirconium-89 labeled Depatux-M (89Zr-Depatux-M) in mice with smaller tumor volume (~98 mm3) versus those with larger volumes (~365 mm3); concordantly, mice with tumor volumes ≤100 mm3 at treatment commencement had significantly better growth inhibition by Depatux-M (93% vs 27%, P < .001) and significantly longer overall survival (P < .0001) compared to tumors ≥400 mm3. Clinically, patients with tumor volumes <25 cm3 had significantly higher response rates (17% vs. 0%, P = .009) and longer overall survival (0.5 vs 0.89 years, P = .001) than tumors above 25 cm3.ConclusionBoth preclinical and clinical data showed intra-tumoral concentration and efficacy of Depatux-m inversely correlated with tumor size. This finding merit further investigation with pretreatment tumor volume as a predictor for response to ADCs, in both gliomas and other solid tumors.

LRRC15 antibody-drug conjugates show promise as osteosarcoma therapeutics in preclinical studies.

Osteosarcoma (OS), the most common bone tumor in children and adolescents, has high rates of metastasis leading to poor survival. Leucine-rich repeat containing 15 (LRRC15), a transmembrane protein whose expression is modulated by TGFβ, was recently shown to be highly expressed on the surface of OS tumor cells. Here, we evaluate a novel antibody-drug conjugate (ADC) targeting LRRC15 in OS human cell lines and murine xenografts. We compare this new ADC, which is conjugated to the anthracycline derivative PNU-159682 (PNU), to a previously studied LRRC15 ADC that is conjugated to the tubulin inhibitor monomethyl auristatin E (MMAE), since anthracyclines are standard of care in OS. We evaluated LRRC15 expression in OS cells using Western blots and flow cytometry, and analyzed the epigenetic landscape of the LRRC15 locus using chromatin immunoprecipitation. Efficacy of ADCs on cell growth was analyzed by IncuCyte live cell imaging. Intramuscular xenograft tumor growth was assessed by bioluminescence imaging and hematoxylin and eosin staining. LRRC15-PNU is more effective at inhibiting growth in vitro and in vivo than an isotype antibody control or the LRRC15-MMAE ADC in two high LRRC15 expressing OS cell lines. Low expressing cell lines are not sensitive to either ADC. Importantly, cells with low LRRC15 expression are amenable to re-expression after TGFβ treatment, suggesting a potential to sensitize insensitive OS cells to LRRC15 ADC treatment. In vivo, LRRC15-PNU had cure rates of 40-100% in OS xenograft models. Overall, LRRC15-directed ADCs are a promising new avenue for OS treatment.

2013 – CONTROLLING CLONAL HEMATOPOIESIS-DRIVEN ATHEROSCLEROSIS BY TARGETED CONDITIONING AND STEM CELL TRANSPLANTATION

Clonal hematopoiesis (CH) is an age-related phenomenon linked to increases in cardiac mortality, all-cause mortality and myeloid malignancies. The magnitude of risk rivals that of known risk factors like high cholesterol or hypertension. Unlike those settings, CH has no ready intervention to mitigate it. Theoretically, bone marrow transplantation (BMT) might impact the abundance of disease driving clones, but the risks of that therapy as currently practiced are too extreme. Further, it is not clear that this intervention would impact atherosclerosis. We have defined antibody drug conjugates (ADC) against CD45 that enable high levels of chimerism in transplant settings. These ADC have been well tolerated in pre-clinical models and do not involve genotoxins that might incur long term risks. We therefore tested if CD45-ADC could be used to deplete Tet2 deficient HSPCs and their mature progeny and if that in turn could impact atherosclerotic disease. CH-related atherosclerosis was modeled in LDLR knockout mice bearing wild-type (WT) or 20% Tet2-/- hematopoietic cells. After week 6 of 12, the mice received one dose of isotype- or CD45-ADC followed by WT bone marrow infusion. 6 weeks later there was a 3-fold reduction of Tet2-/- cells and 75% of peripheral blood was derived from the WT graft. Notably, a single dose of ADC reduced the number of CD11b+ myeloid cells in the atherosclerotic plaques of both the WT and Tet2 mutant hosts. In the Tet2-/- hosts, the area of the aortic plaques strikingly regressed. These data indicate that ADC treatment can deplete plaque macrophages associated with disease. It can enable regression of atherosclerosis while replacing the disease causing mutant clones. If ADC conditioning proves itself clinically, the potential for extending BMT to clonal hematopoiesis may have broad based health benefits.

Antibody-Drug Conjugates in Urothelial Carcinomas.

Urothelial carcinoma (UC) is a common malignancy with an urgent need for more effective and less toxic treatment strategies. Antibody-drug conjugate (ADC) represents a novel therapeutic approach, which combines the high specificity of monoclonal antibodies covalently linked with highly active cytotoxic agents. UC is an appropriate candidate for these drugs, as it expresses unique cell surface antigens that allow for specific targeting of these cells. We hereby present a review of the current literature and future perspectives of ADC treatment in early-stage and metastatic UC. Several ADCs are in advanced stages of development and approval, such as intravesical oportuzumab monatox in BCG-refractory non-muscle invasive bladder cancer and enfortumab vedotin and sacituzumab govitecan in pretreated metastatic UC. Other agents are in earlier stages of development, including some promising anti-Her2 agents. The favorable toxicity profile of these agents led to several combination strategies, especially with checkpoint inhibitors. In light of the encouraging results presented in this review and the recent FDA approval of enfortumab vedotin, ADCs will likely be incorporated in the management of UC in the near future.