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Hashmi H, Darwin A, Nishihori T. Therapeutic roles of antibody drug conjugates (ADCs) in relapsed/refractory lymphomas. Hematol Oncol Stem Cell Ther 2021; 16:21-34. [PMID: 36634275 DOI: 10.1016/j.hemonc.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/28/2021] [Accepted: 07/10/2021] [Indexed: 01/18/2023] Open
Abstract
Relapsed or refractory lymphoma is commonly treated with combination chemoimmunotherapy and cellular immunotherapy. Modest response rates and associated toxicities are obstacles to achieving durable remission using traditional cytotoxic chemotherapy, especially in frail patients with advanced disease. Antibody drug conjugates represent a new class of novel targeted agents with significant improvement in therapeutic efficacy in the treatment of lymphomas. Several of these agents, which offer improved targeting, greater potency, and better therapeutic index over traditional chemotherapy, are changing the treatment landscape for lymphomas and other hematological malignancies. Despite the therapeutic potential of these agents, the delivery and release of cytotoxic agents to malignant cells through the combination of a monoclonal antibody, payload, and linker represents a complex design challenge. This article reviews the clinical data on currently available antibody drug conjugates and the ongoing development of novel antibody drug conjugates. Antibody drug conjugates constitute an important armamentarium for treatment of lymphomas and their evolving roles in the treatment spectrum are discussed.
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Affiliation(s)
- Hamza Hashmi
- Division of Hematology/Oncology, Medical University of South Carolina, United States
| | - Alicia Darwin
- University of South Florida, Morsani College of Medicine, United States
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, United States
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Abstract
Non-Hodgkin lymphomas (NHL) are a diverse group of diseases, encompassing mature B-cell, T-cell, and natural killer cell malignancies and ranging in behavior from indolent to highly aggressive. For many years, the traditional treatment of NHL centered on chemotherapy. However, the introduction of rituximab ushered in the era of immunotherapy for NHLs. This article reviews novel immune therapies that have been used for the treatment of NHL. The data supporting the use of rituximab have been reviewed extensively; this article focuses on novel immunotherapies other than rituximab that remain in use or are actively being studied in clinical trials.
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Jackson PJM, Kay S, Pysz I, Thurston DE. Use of pyrrolobenzodiazepines and related covalent-binding DNA-interactive molecules as ADC payloads: Is mechanism related to systemic toxicity? DRUG DISCOVERY TODAY. TECHNOLOGIES 2018; 30:71-83. [PMID: 30553523 DOI: 10.1016/j.ddtec.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
Antibody-drug conjugates (ADCs) consist of monoclonal antibodies (mAbs) or antibody fragments conjugated to biologically active molecules (usually highly cytotoxic small molecules) through chemical linkers. Although no ADCs containing covalent-binding DNA-interactive payloads have yet been approved (although two containing the DNA-cleaving payload calicheamicin have), of those in clinical trials systemic toxicities are beginning to emerge. This article discusses the observed toxicities in relation to the structures and mechanisms of action of payload type.
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Affiliation(s)
- Paul J M Jackson
- Femtogenix Ltd., Biopark, Broadwater Road, Welwyn Garden City AL7 3AX, United Kingdom
| | - Syafiq Kay
- Femtogenix Ltd., Biopark, Broadwater Road, Welwyn Garden City AL7 3AX, United Kingdom; Institute for Pharmaceutical Science, King's College London, Faculty of Life Sciences and Medicine, Franklin Wilkins Building, London SE1 9NH, United Kingdom
| | - Ilona Pysz
- Femtogenix Ltd., Biopark, Broadwater Road, Welwyn Garden City AL7 3AX, United Kingdom; Institute for Pharmaceutical Science, King's College London, Faculty of Life Sciences and Medicine, Franklin Wilkins Building, London SE1 9NH, United Kingdom
| | - David E Thurston
- Femtogenix Ltd., Biopark, Broadwater Road, Welwyn Garden City AL7 3AX, United Kingdom; Institute for Pharmaceutical Science, King's College London, Faculty of Life Sciences and Medicine, Franklin Wilkins Building, London SE1 9NH, United Kingdom.
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Investigational Antibody–Drug Conjugates for Treatment of B-lineage Malignancies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:452-468.e4. [DOI: 10.1016/j.clml.2018.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 02/01/2023]
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Zammarchi F, Corbett S, Adams L, Tyrer PC, Kiakos K, Janghra N, Marafioti T, Britten CE, Havenith CEG, Chivers S, D'Hooge F, Williams DG, Tiberghien A, Howard PW, Hartley JA, van Berkel PH. ADCT-402, a PBD dimer-containing antibody drug conjugate targeting CD19-expressing malignancies. Blood 2018; 131:1094-1105. [PMID: 29298756 DOI: 10.1182/blood-2017-10-813493] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/21/2017] [Indexed: 12/25/2022] Open
Abstract
Human CD19 antigen is a 95-kDa type I membrane glycoprotein in the immunoglobulin superfamily whose expression is limited to the various stages of B-cell development and differentiation and is maintained in the majority of B-cell malignancies, including leukemias and non-Hodgkin lymphomas of B-cell origin. Coupled with its differential and favorable expression profile, CD19 has rapid internalization kinetics and is not shed into the circulation, making it an ideal target for the development of antibody-drug conjugates (ADCs) to treat B-cell malignancies. ADCT-402 (loncastuximab tesirine) is a novel CD19-targeted ADC delivering SG3199, a highly cytotoxic DNA minor groove interstrand crosslinking pyrrolobenzodiazepine (PDB) dimer warhead. It showed potent and highly targeted in vitro cytotoxicity in CD19-expressing human cell lines. ADCT-402 was specifically bound, internalized, and trafficked to lysosomes in CD19-expressing cells and, following release of the PBD warhead, resulted in formation of DNA crosslinks that persisted for 36 hours. Bystander killing of CD19- cells by ADCT-402 was also observed. In vivo, single doses of ADCT-402 resulted in highly potent, dose-dependent antitumor activity in several subcutaneous and disseminated human tumor models with marked superiority to comparator ADCs delivering tubulin inhibitors. Dose-dependent DNA crosslinks and γ-H2AX DNA damage response were measured in tumors by 24 hours after single dose administration, whereas matched peripheral blood mononuclear cells showed no evidence of DNA damage. Pharmacokinetic analysis in rat and cynomolgus monkey showed excellent stability and tolerability of ADCT-402 in vivo. Together, these impressive data were used to support the clinical testing of this novel ADC in patients with CD19-expressing B-cell malignancies.
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MESH Headings
- Antigens, CD19/biosynthesis
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Agents/pharmacology
- Cell Line, Tumor
- Dose-Response Relationship, Drug
- Gene Expression Regulation, Leukemic
- Humans
- Immunoconjugates/pharmacokinetics
- Immunoconjugates/pharmacology
- Leukemia, B-Cell/drug therapy
- Leukemia, B-Cell/metabolism
- Leukemia, B-Cell/pathology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/pathology
- Lysosomes/metabolism
- Lysosomes/pathology
- Neoplasm Proteins/biosynthesis
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Affiliation(s)
| | - Simon Corbett
- Spirogen/Medimmune Ltd, London, United Kingdom; and
- Cancer Research UK Drug DNA Interactions Research Group and
| | - Lauren Adams
- Spirogen/Medimmune Ltd, London, United Kingdom; and
| | | | | | - Narinder Janghra
- Department of Pathology, University College London Cancer Institute, London, United Kingdom
| | - Teresa Marafioti
- Department of Pathology, University College London Cancer Institute, London, United Kingdom
| | | | | | - Simon Chivers
- ADC Therapeutics (UK) Limited, London, United Kingdom
| | | | | | | | | | - John A Hartley
- ADC Therapeutics (UK) Limited, London, United Kingdom
- Spirogen/Medimmune Ltd, London, United Kingdom; and
- Cancer Research UK Drug DNA Interactions Research Group and
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