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Döhner H, Weber D, Krzykalla J, Fiedler W, Kühn MWM, Schroeder T, Mayer K, Lübbert M, Wattad M, Götze K, Fransecky L, Koller E, Wulf G, Schleicher J, Ringhoffer M, Greil R, Hertenstein B, Krauter J, Martens UM, Nachbaur D, Samra MA, Machherndl-Spandl S, Basara N, Leis C, Schrade A, Kapp-Schwoerer S, Cocciardi S, Bullinger L, Thol F, Heuser M, Paschka P, Gaidzik VI, Saadati M, Benner A, Schlenk RF, Döhner K, Ganser A. Intensive chemotherapy with or without gemtuzumab ozogamicin in patients with NPM1-mutated acute myeloid leukaemia (AMLSG 09-09): a randomised, open-label, multicentre, phase 3 trial. Lancet Haematol 2023; 10:e495-e509. [PMID: 37187198 DOI: 10.1016/s2352-3026(23)00089-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Acute myeloid leukaemia with mutated NPM1 is associated with high CD33 expression and intermediate-risk cytogenetics. The aim of this study was to evaluate intensive chemotherapy with or without the anti-CD33 antibody-drug conjugate gemtuzumab ozogamicin in participants with newly diagnosed, NPM1-mutated acute myeloid leukaemia. METHODS This open-label, phase 3 trial was conducted at 56 hospitals in Germany and Austria. Eligible participants were 18 years or older and had newly diagnosed NPM1-mutated acute myeloid leukaemia and an Eastern Cooperative Oncology Group performance status of 0-2. Participants were randomly assigned, using age as a stratification factor (18-60 years vs >60 years), 1:1 to the two treatment groups using allocation concealment; there was no masking of participants and investigators to treatment groups. Participants received two cycles of induction therapy (idarubicin, cytarabine, and etoposide) plus all-trans retinoic acid (ATRA) followed by three consolidation cycles of high-dose cytarabine (or an intermediate dose for those older than 60 years) and ATRA, without or with gemtuzumab ozogamicin (3 mg/m2 administered intravenously on day 1 of induction cycles 1 and 2, and consolidation cycle 1). The primary endpoints were short-term event-free survival and overall survival in the intention-to-treat population (overall survival was added as a co-primary endpoint after amendment four of the protocol on Oct 13, 2013). The secondary endpoints were event-free survival with long-term follow-up, rates of complete remission, complete remission with partial haematological recovery (CRh), and complete remission with incomplete haematological recovery (CRi), cumulative incidences of relapse and death, and number of days in hospital. This trial is registered with ClinicalTrials.gov (NCT00893399) and has been completed. FINDINGS Between May 12, 2010, and Sept 1, 2017, 600 participants were enrolled, of which 588 (315 women and 273 men) were randomly assigned (296 to the standard group and 292 to the gemtuzumab ozogamicin group). No difference was found in short-term event-free survival (short-term event-free survival at 6-month follow-up, 53% [95% CI 47-59] in the standard group and 58% [53-64] in the gemtuzumab ozogamicin group; hazard ratio [HR] 0·83; 95% CI 0·65-1·04; p=0·10) and overall survival between treatment groups (2-year overall survival, 69% [63-74] in the standard group and 73% [68-78] in the gemtuzumab ozogamicin group; 0·90; 0·70-1·16; p=0·43). There was no difference in complete remission or CRi rates (n=267 [90%] in the standard group vs n=251 [86%] in the gemtuzumab ozogamicin group; odds ratio [OR] 0·67; 95% CI 0·40-1·11; p=0·15) and complete remission or CRh rates (n=214 [72%] vs n=195 [67%]; OR 0·77; 0·54-1·10; p=0·18), whereas the complete remission rate was lower with gemtuzumab ozogamicin (n=172 [58%] vs n=136 [47%]; OR 0·63; 0·45-0·80; p=0·0068). Cumulative incidence of relapse was significantly reduced by gemtuzumab ozogamicin (2-year cumulative incidence of relapse, 37% [95% CI 31-43] in the standard group and 25% [20-30] in the gemtuzumab ozogamicin group; cause-specific HR 0·65; 0·49-0·86; p=0·0028), and there was no difference in the cumulative incidence of death (2-year cumulative incidence of death 6% [4-10] in the standard group and 7% [5-11] in the gemtuzumab ozogamicin group; HR 1·03; 0·59-1·81; p=0·91). There were no differences in the number of days in hospital across all cycles between treatment groups. The most common treatment-related grade 3-4 adverse events were febrile neutropenia (n=135 [47%] in the gemtuzumab ozogamicin group vs n=122 [41%] in the standard group), thrombocytopenia (n=261 [90%] vs n=265 [90%]), pneumonia (n=71 [25%] vs n=64 [22%]), sepsis (n=85 [29%] vs n=73 [25%]). Treatment-related deaths were documented in 25 participants (4%; n=8 [3%] in the standard group and n=17 [6%] in the gemtuzumab ozogamicin group), mostly due to sepsis and infections. INTERPRETATION The primary endpoints of the trial of event-free survival and overall survival were not met. However, an anti-leukaemic efficacy of gemtuzumab ozogamicin in participants with NPM1-mutated acute myeloid leukaemia is shown by a significantly lower cumulative incidence of relapse rate, suggesting that the addition of gemtuzumab ozogamicin might reduce the need for salvage therapy in these participants. The results from this study provide further evidence that gemtuzumab ozogamicin should be added in the standard of care treatment in adults with NPM1-mutated acute myeloid leukaemia. FUNDING Pfizer and Amgen.
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Affiliation(s)
- Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany.
| | - Daniela Weber
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Walter Fiedler
- Hubertus Wald University Cancer Center, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael W M Kühn
- Department of Hematology, Medical Oncology & Pneumology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Karin Mayer
- Department of Hematology, Oncology, University Hospital Bonn, Bonn, Germany
| | - Michael Lübbert
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mohammed Wattad
- Klinik für Hämatologie, Internistische Onkologie & Stammzelltransplantation, Evang. Krankenhaus Essen-Werden, Essen-Werden, Germany; Klinikum Hochsauerland, Meschede, Germany
| | - Katharina Götze
- Department of Medicine III, Hematology and Medical Oncology, Technical University of Munich, Munich, Germany
| | - Lars Fransecky
- Department of Internal Medicine II, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Elisabeth Koller
- Department of Internal Medicine III, Hanusch Krankenhaus Wien, Wien, Austria
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Jan Schleicher
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Mark Ringhoffer
- Department of Internal Medicine III, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Richard Greil
- 3rd Medical Department Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Trials and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Bernd Hertenstein
- Department of Hematology and Oncology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Jürgen Krauter
- Medizinische Klinik III, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Uwe M Martens
- Klinik für Innere Medizin III, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - David Nachbaur
- Universitätsklinik für Innere Medizin V, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Maisun Abu Samra
- Medizinische Klinik IV, Universitätsklinikum Gießen, Gießen, Germany
| | | | - Nadezda Basara
- Medizinische Klinik I, Malteser Krankenhaus St Franziskus-Hospital Flensburg, Flensburg, Germany
| | - Claudia Leis
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Anika Schrade
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | | | - Sibylle Cocciardi
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Peter Paschka
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Verena I Gaidzik
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Maral Saadati
- Freelance Statistician, Saadati Solutions, Ladenburg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Richard F Schlenk
- National Center of Tumor Diseases, German Cancer Research Center, Heidelberg, Germany; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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Zuo P. Capturing the Magic Bullet: Pharmacokinetic Principles and Modeling of Antibody-Drug Conjugates. AAPS J 2020; 22:105. [PMID: 32767003 DOI: 10.1208/s12248-020-00475-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 12/21/2022]
Abstract
Over the past two decades, antibody-drug conjugates (ADCs) have emerged as a promising class of drugs for cancer therapy and have expanded to nononcology fields such as inflammatory diseases, atherosclerosis, and bacteremia. Eight ADCs are currently approved by FDA for clinical applications, with more novel ADCs under clinical development. Compared with traditional chemotherapy, ADCs combine the target specificity of antibodies with chemotherapeutic capabilities of cytotoxic drugs. The benefits include reduced systemic toxicity and enhanced therapeutic index for patients. However, the heterogeneous structures of ADCs and their dynamic changes following administration create challenges in their development. The understanding of ADC pharmacokinetics (PK) is crucial for the optimization of clinical dosing regimens when translating from animal to human. In addition, it contributes to the optimization of dose selection and clinical monitoring with regard to safety and efficacy. This manuscript reviews the PK characteristics of ADCs and summarizes the diverse approaches for PK modeling that can be used to evaluate an ADC at the preclinical and clinical stages to support their successful development. Despite the numerous available options, fit-for-purpose modeling approaches for the PK and PD of ADCs should be critically planned and well-thought-out to adequately support the development of an ADC.
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Affiliation(s)
- Peiying Zuo
- Pharmacometrics US, Clinical Pharmacology & Exploratory Development, Astellas Pharma, Inc., USA, 1 Astellas Way, Northbrook, Illinois, 60062, USA.
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Hedrich WD, Fandy TE, Ashour HM, Wang H, Hassan HE. Antibody-Drug Conjugates: Pharmacokinetic/Pharmacodynamic Modeling, Preclinical Characterization, Clinical Studies, and Lessons Learned. Clin Pharmacokinet 2018; 57:687-703. [PMID: 29188435 DOI: 10.1007/s40262-017-0619-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antibody-drug conjugates are an emerging class of biopharmaceuticals changing the landscape of targeted chemotherapy. These conjugates combine the target specificity of monoclonal antibodies with the anti-cancer activity of small-molecule therapeutics. Several antibody-drug conjugates have received approval for the treatment of various types of cancer including gemtuzumab ozogamicin (Mylotarg®), brentuximab vedotin (Adcetris®), trastuzumab emtansine (Kadcyla®), and inotuzumab ozogamicin, which recently received approval (Besponsa®). In addition to these approved therapies, there are many antibody-drug conjugates in the drug development pipeline and in clinical trials, although these fall outside the scope of this article. Understanding the pharmacokinetics and pharmacodynamics of antibody-drug conjugates and the development of pharmacokinetic/pharmacodynamic models is indispensable, albeit challenging as there are many parameters to incorporate including the disposition of the intact antibody-drug conjugate complex, the antibody, and the drug agents following their dissociation in the body. In this review, we discuss how antibody-drug conjugates progressed over time, the challenges in their development, and how our understanding of their pharmacokinetics/pharmacodynamics led to greater strides towards successful targeted therapy programs.
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Lucas AT, Robinson R, Schorzman AN, Piscitelli JA, Razo JF, Zamboni WC. Pharmacologic Considerations in the Disposition of Antibodies and Antibody-Drug Conjugates in Preclinical Models and in Patients. Antibodies (Basel) 2019; 8:E3. [PMID: 31544809 PMCID: PMC6640706 DOI: 10.3390/antib8010003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/11/2022] Open
Abstract
The rapid advancement in the development of therapeutic proteins, including monoclonal antibodies (mAbs) and antibody-drug conjugates (ADCs), has created a novel mechanism to selectively deliver highly potent cytotoxic agents in the treatment of cancer. These agents provide numerous benefits compared to traditional small molecule drugs, though their clinical use still requires optimization. The pharmacology of mAbs/ADCs is complex and because ADCs are comprised of multiple components, individual agent characteristics and patient variables can affect their disposition. To further improve the clinical use and rational development of these agents, it is imperative to comprehend the complex mechanisms employed by antibody-based agents in traversing numerous biological barriers and how agent/patient factors affect tumor delivery, toxicities, efficacy, and ultimately, biodistribution. This review provides an updated summary of factors known to affect the disposition of mAbs/ADCs in development and in clinical use, as well as how these factors should be considered in the selection and design of preclinical studies of ADC agents in development.
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Affiliation(s)
- Andrew T Lucas
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Ryan Robinson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Allison N Schorzman
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Joseph A Piscitelli
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
| | - Juan F Razo
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
| | - William C Zamboni
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
INTRODUCTION Gemtuzumab ozogamicin (GO) is a combination of calicheamicin and a recombinant humanized IgG4 antibody directed against CD33. From 2000 to 2010, it was approved by the FDA for treatment of relapsed, older patients with CD33(+) acute myeloid leukemia (AML). After withdrawal from the market, several trials have provided new evidence on the safety and clinical efficacy of GO. AREAS COVERED In this review, we discuss pharmacological and clinical aspects of GO. GO was found to show benefit in AML patients as adjunct to intensive chemotherapy when it was given in parallel to induction therapy. The benefit was restricted to patients with a favorable- or an intermediate-risk cytogenetic profile. Higher doses of GO above 6 mg/m(2) per administration were associated with increased toxicity without survival benefit, whereas repetitive doses of 3 mg/m(2) resulting in cumulative doses of 9 mg/m(2) were well tolerated. Predictive markers for response to GO other than the cytogenetic profile and P-glycoprotein activity are still missing. EXPERT OPINION GO as adjunct and in parallel to intensive induction chemotherapy does significantly improve survival end points in AML patients with favorable/intermediate-risk cytogenetics. A dose of 3 mg/m(2) per administration appears safer compared with 6 mg/m(2) and even 9 mg/m(2).
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Affiliation(s)
- Felicitas Thol
- Hannover Medical School, Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation , Carl-Neuberg-Str. 1, 30625, Hannover , Germany
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Felice B, Prabhakaran MP, Rodríguez AP, Ramakrishna S. Drug delivery vehicles on a nano-engineering perspective. Mater Sci Eng C Mater Biol Appl 2014; 41:178-95. [PMID: 24907751 DOI: 10.1016/j.msec.2014.04.049] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/04/2014] [Accepted: 04/18/2014] [Indexed: 12/21/2022]
Abstract
Nanoengineered drug delivery systems (nDDS) have been successfully used as clinical tools for not only modulation of pharmacological drug release profile but also specific targeting of diseased tissues. Until now, encapsulation of anti-cancer molecules such as paclitaxel, vincristin and doxorubicin has been the main target of nDDS, whereby liposomes and polymer-drug conjugates remained as the most popular group of nDDS used for this purpose. The success reached by these nanocarriers can be imitated by careful selection and optimization of the different factors that affect drug release profile (i.e. type of biomaterial, size, system architecture, and biodegradability mechanisms) along with the selection of an appropriate manufacture technique that does not compromise the desired release profile, while it also offers possibilities to scale up for future industrialization. This review focuses from an engineering perspective on the different parameters that should be considered before and during the design of new nDDS, and the different manufacturing techniques available, in such a way to ensure success in clinical application.
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Affiliation(s)
- Betiana Felice
- Laboratorio de Medios e Interfases, Departamento de Bioingeniería, Universidad Nacional de Tucumán, Av. Kirchner 1800, Tucumán, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, Buenos Aires, Argentina.; START - Thrust 3, Create Research Wing, #03-08, 1 Create Way, National University of Singapore, Singapore 138602
| | - Molamma P Prabhakaran
- START - Thrust 3, Create Research Wing, #03-08, 1 Create Way, National University of Singapore, Singapore 138602.
| | - Andrea P Rodríguez
- Laboratorio de Medios e Interfases, Departamento de Bioingeniería, Universidad Nacional de Tucumán, Av. Kirchner 1800, Tucumán, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, Buenos Aires, Argentina
| | - Seeram Ramakrishna
- START - Thrust 3, Create Research Wing, #03-08, 1 Create Way, National University of Singapore, Singapore 138602; Department of Mechanical Engineering, National University of Singapore, Singapore
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Sapra P, Betts A, Boni J. Preclinical and clinical pharmacokinetic/pharmacodynamic considerations for antibody–drug conjugates. Expert Rev Clin Pharmacol 2014; 6:541-55. [DOI: 10.1586/17512433.2013.827405] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cowan AJ, Laszlo GS, Estey EH, Walter RB. Antibody-based therapy of acute myeloid leukemia with gemtuzumab ozogamicin. Front Biosci (Landmark Ed) 2013; 18:1311-34. [PMID: 23747885 DOI: 10.2741/4181] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Antibodies have created high expectations for effective yet tolerated therapeutics in acute myeloid leukemia (AML). Hitherto the most exploited target is CD33, a myeloid differentiation antigen found on AML blasts in most patients and, perhaps, leukemic stem cells in some. Treatment efforts have focused on conjugated antibodies, particularly gemtuzumab ozogamicin (GO), an anti-CD33 antibody carrying a toxic calicheamicin-g 1 derivative that, after intracellular hydrolytic release, induces DNA strand breaks, apoptosis, and cell death. Serving as paradigm for this strategy, GO was the first anti-cancer immunoconjugate to obtain regulatory approval in the U.S. While efficacious as monotherapy in acute promyelocytic leukemia (APL), GO alone induces remissions in less than 25-35% of non-APL AML patients. However, emerging data from well controlled trials now indicate that GO improves survival for many non-APL AML patients, supporting the conclusion that CD33 is a clinically relevant target for some disease subsets. It is thus unfortunate that GO has become unavailable in many parts of the world, and the drug's usefulness should be reconsidered and selected patients granted access to this immunoconjugate.
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Affiliation(s)
- Andrew J Cowan
- Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA, USA
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Lin K, Tibbitts J. Pharmacokinetic Considerations for Antibody Drug Conjugates. Pharm Res 2012; 29:2354-66. [DOI: 10.1007/s11095-012-0800-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 05/31/2012] [Indexed: 02/04/2023]
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Abstract
Antibody-drug conjugates (ADC) are an attractive approach for the treatment of acute myeloid leukemia and non-Hodgkin lymphomas, which in most cases, are inherently sensitive to cytotoxic agents. CD33 and CD22 are specific markers of myeloid leukemias and B-cell malignancies, respectively. These endocytic receptors are ideal for an ADC strategy because they can effectively carry the cytotoxic payload into the cell. Gemtuzumab ozogamicin (GO, Mylotarg) and inotuzumab ozogamicin consist of a derivative of calicheamicin (a potent DNA-binding cytotoxic antibiotic) linked to a humanized monoclonal IgG4 antibody directed against CD33 or CD22, respectively. Both of these ADCs have a target-mediated pharmacokinetic disposition. GO was the first drug to prove the ADC concept in the clinic, specifically in phase II studies that included substantial proportions of older patients with relapsed acute myeloid leukemia. In contrast, in phase III studies, it has thus far failed to show clinical benefit in first-line treatment in combination with standard chemotherapy. Inotuzumab ozogamicin has shown remarkable clinical activity in relapsed/refractory B-cell non-Hodgkin lymphoma, and it has started phase III evaluation. The safety profile of these ADCs includes reversible myelosuppression (especially neutropenia and thrombocytopenia), elevated hepatic transaminases, and hyperbilirubinemia. There have been postmarketing reports of hepatotoxicity, especially veno-occlusive disease, associated with GO. The incidence is ~2%, but patients who undergo hematopoietic stem cell transplantation have an increased risk. As we steadily move toward the goal of personalized medicine, these kinds of agents will provide a unique opportunity to treat selected patient subpopulations based on the expression of their specific tumor targets.
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Affiliation(s)
- Alejandro D Ricart
- Biotechnology Unit and Oncology Clinical Research, Pfizer Inc., San Diego, California, USA.
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Abstract
INTRODUCTION Gemtuzumab ozogamicin (GO) has been used in relapsed, refractory and newly diagnosed acute myeloid leukemia (AML) as a single agent and in combination with intensive chemotherapy. Results of recent Phase III trials have led to its withdrawal in the USA although a beneficial effect of GO in genetically defined AML subgroups was evident. AREAS COVERED This review examines the use of GO as a single agent or in combination with intensive chemotherapy in non-acute promyelocytic AML. The literature search was based on publications on GO indexed in the PubMed electronic database and selected meeting abstracts. GO has shown moderate activity as a single agent but promising activity in combination with intensive chemotherapy in refractory or relapsed AML. Relapsed AML defined molecularly by mutant nucleophosmin-1 without concurrent fms-related tyrosine kinase 3 (FLT3) internal tandem duplication seems to benefit most from GO. In newly diagnosed AML two up-front randomized Phase III trials evaluating GO in induction therapy failed to demonstrate an improvement in response and survival. Again, genetically defined subgroups may benefit. EXPERT OPINION Future challenges of personalized therapy in AML will be to integrate the signals from current subgroup analyses underlining the role of GO in genetically defined AML entities.
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Affiliation(s)
- Marie-Luise Hütter
- University of Ulm, Department of Internal Medicine III, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Abstract
As the overall prognosis and treatment response rate to standard chemotherapy for acute myeloid leukemia (AML) remains poor in the older adult population, there is a need for more effective therapeutic agents with lower toxicity profiles that can be offered to these patients. Gemtuzumab ozogamicin (GO) is an anti-CD33 monoclonal antibody that was approved by the US Food and Drug Administration for use as monotherapy in patients 60 years of age and older with relapsed AML. GO consists of a humanized anti-CD33 antibody (hP67.6) which is linked to N-acetyl-gamma calicheamicin 1,2-dimethyl hydrazine dichloride. Once the antibody attaches to the surface antigen, it is rapidly internalized. Calicheamicin, a potent enediyne, is subsequently released and acts as a cytotoxic anti-tumor agent. In this population, GO has an acceptable toxicity and yields response rates approaching 30%. The efficacy of GO as monotherapy and in combination therapy for treatment of both de novo and relapsed AML continues to be investigated.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Aminoglycosides/administration & dosage
- Aminoglycosides/pharmacology
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/drug effects
- Antigens, Differentiation, Myelomonocytic/drug effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Gemtuzumab
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/physiopathology
- Middle Aged
- Sialic Acid Binding Ig-like Lectin 3
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Hien K Duong
- Cleveland Clinic Taussig Cancer Institute Cleveland, Ohio USA
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Kobayashi Y, Tobinai K, Takeshita A, Naito K, Asai O, Dobashi N, Furusawa S, Saito K, Mitani K, Morishima Y, Ogura M, Yoshiba F, Hotta T, Bessho M, Matsuda S, Takeuchi J, Miyawaki S, Naoe T, Usui N, Ohno R. Phase I/II study of humanized anti-CD33 antibody conjugated with calicheamicin, gemtuzumab ozogamicin, in relapsed or refractory acute myeloid leukemia: final results of Japanese multicenter cooperative study. Int J Hematol 2009; 89:460-469. [PMID: 19360457 DOI: 10.1007/s12185-009-0298-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 02/04/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
Abstract
The primary objective of this study was to investigate the tolerability, efficacy and pharmacokinetic profile of gemtuzumab ozogamicin (GO) in patients with relapsed and/or refractory CD33-positive acute myeloid leukemia (AML). Patients received 2-h infusions of GO twice with an interval of approximately 14 days. Tolerability was assessed using the National Cancer Institute Common Toxicity Criteria Version 2.0. Samples for pharmacokinetics were taken on day 1 and day 8 of the first treatment cycle. The dose was increased stepwise and, in each cohort, patients were treated at the same dose. Forty patients, median age 58 years (range 28-68) were treated; 20 and 20 patients were enrolled to the phase I and II parts, respectively. In the phase I part, dose-limiting toxicities (DLTs) were hepatotoxicities, and the recommended dose was established as 9 mg/m2 given as two intravenous infusions separated by approximately 14 days. The pharmacokinetic study revealed that Cmax and AUC were equivalent to those of non-Japanese patients. In the phase II part, complete remission was observed in 5 patients, and one patient had complete remission without platelet recovery. Four of these 6 in remission and one in the phase I are long-term survivors (alive for at least 44 months). GO is safe and effective as a single agent among Japanese CD33-positive AML patients. Remission lasted longer in a subset of patients than in non-Japanese patients in earlier studies. Further studies of this agent are warranted to establish standard therapy.
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MESH Headings
- Adult
- Aged
- Aminoglycosides/adverse effects
- Aminoglycosides/immunology
- Aminoglycosides/pharmacology
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/immunology
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/immunology
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/immunology
- Dose-Response Relationship, Drug
- Female
- Gemtuzumab
- Humans
- Japan
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3
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Affiliation(s)
- Yukio Kobayashi
- Hematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Kensei Tobinai
- Hematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihiro Takeshita
- The Third Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kensuke Naito
- The Third Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Hamamatsu Medical Center, Hamamatsu, Japan
| | - Osamu Asai
- Department of Clinical Oncology and Hematology, School of Medicine, The Jikei University, Tokyo, Japan
| | - Nobuaki Dobashi
- Department of Clinical Oncology and Hematology, School of Medicine, The Jikei University, Tokyo, Japan
| | - Shinpei Furusawa
- Department of Hematology, Dokkyo Medical School of Medicine, Tochigi, Japan
| | - Kenji Saito
- Department of Hematology, Dokkyo Medical School of Medicine, Tochigi, Japan
- Saito Clinic, Tochigi, Japan
| | - Kinuko Mitani
- Department of Hematology, Dokkyo Medical School of Medicine, Tochigi, Japan
| | - Yasuo Morishima
- Hematology and Cell Therapy Division, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Michinori Ogura
- Hematology and Cell Therapy Division, Aichi Cancer Center Hospital, Nagoya, Japan
- Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Fumiaki Yoshiba
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Tomomitsu Hotta
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
- National Nagoya Hospital, Nagoya, Japan
| | - Masami Bessho
- Department of Hematology, Saitama Medical University, School of Medicine, Saitama, Japan
| | - Shin Matsuda
- Center for Hematopoietic Disorders, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Jin Takeuchi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Shuichi Miyawaki
- Leukemia Treatment Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Tomoki Naoe
- Department of Hematology and Oncology, Nagoya University School of Medicine, Nagoya, Japan
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, School of Medicine, The Jikei University, Tokyo, Japan
| | - Ryuzo Ohno
- Hematology and Cell Therapy Division, Aichi Cancer Center Hospital, Nagoya, Japan
- Aichi Shukutoku University, Nagoya, Japan
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14
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15
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Rao AV, Schmader K. Monoclonal antibodies as targeted therapy in hematologic malignancies in older adults. ACTA ACUST UNITED AC 2007; 5:247-62. [PMID: 17996665 DOI: 10.1016/j.amjopharm.2007.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Biological agents are proving to be increasingly useful and exciting additions to the antineoplastic armamentarium, but many clinicians are unfamiliar with the properties of these types of agents. OBJECTIVES This review focuses on monoclonal antibodies (MAbs) that are used in the treatment of hematologic malignancies. Our goal was to provide the reader with information on trials that led to US Food and Drug Administration (FDA) approval of commonly used MAbs in hematologic malignancies, including their mechanisms of action and pharmacokinetics, with specific emphasis on use in elderly patients; we also present data on toxicities and precautions to be aware of when administering these drugs. METHODS Materials for this review were gathered based on a computerized literature search (English-language articles only) using the PubMed database covering the period January 1998 to December 2005. Search terms used included the following: elderly, monoclonal antibodies, and neoplasms. RESULTS Alemtuzumab is a recombinant DNA-derived, humanized MAb directed against the CD52 B-cell antigen. It is indicated for the treatment of B-cell chronic lymphocytic leukemia (CLL) in patients who have been treated with alkylating agents and who have failed to respond to fludarabine therapy. Gemtuzumab ozogamicin is an MAb conjugated with a cytotoxic antitumor antibiotic, calicheamicin. It has been approved for use in patients with CD33-positive acute myeloid leukemia (AML) in first relapse who are aged > or =60 years and who are not considered candidates for other cytotoxic chemotherapy. Rituximab, one of the first MAbs approved by the FDA for use in human cancers, is an antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. It is extensively used in the treatment of B-cell malignancies, such as CLL, and non-Hodgkin's lymphomas (NHLs), such as follicular lymphoma and diffuse large B-cell lymphoma. CONCLUSIONS It is noteworthy that while there have been a number of studies using these agents in the younger population, there continues to be a paucity of clinical trials targeting the elderly patient in particular; this continues to be an area of research interest. More clinical studies of these agents--conducted specifically in elderly patients with CLL, NHL, AML, and other hematologic malignancies--are needed.
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16
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Stasi R, Evangelista ML, Buccisano F, Venditti A, Amadori S. Gemtuzumab ozogamicin in the treatment of acute myeloid leukemia. Cancer Treat Rev 2007; 34:49-60. [PMID: 17942233 DOI: 10.1016/j.ctrv.2007.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Accepted: 09/03/2007] [Indexed: 01/24/2023]
Abstract
Gemtuzumab ozogamicin (GO) is a chemotherapeutic agent that consists of a humanized anti-CD33 antibody (hP67.6) linked to N-acetyl-calicheamicin 1,2-dimethyl hydrazine dichloride, a potent enediyne antitumor antibiotic. GO was approved conditionally by the Federal Drug Administration in May 2000 as single-agent therapy for first recurrence of acute myeloid leukemia (AML) in patients over the age of 60 years who are unfit for conventional cytotoxic therapy. In this setting, it produces a complete response (CR) rate of 13%, with another 13% achieving CR with inadequate platelet recovery (CRp). The most common adverse effects associated with GO are infusion-related reactions and myelosuppression. GO monotherapy at the dose of 9 mg/m(2) is complicated with hepatic veno-occlusive disease in approximately 5% of cases, particularly prior to or following stem cell transplantation. Attenuated doses of GO or fractionated doses appear to be equally effective and better tolerated. GO has shown remarkable activity in acute promyelocytic leukemia, particularly for the elimination of minimal residual disease. Combinations of GO with chemotherapy as induction or post-remission therapy are promising, and phase III trials are ongoing.
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Affiliation(s)
- Roberto Stasi
- Department of Medical Sciences, Ospedale Regina Apostolorum, Regina Apostolorum Hospital, Via S Francesco, 50, Albano Laziale, Italy.
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17
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Molnár I, Powell BL. What role does gemtuzumab ozogamicin have in the treatment of acute myelogenous leukemia? Curr Hematol Malig Rep 2007; 2:104-10. [PMID: 20425358 DOI: 10.1007/s11899-007-0015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gemtuzumab ozogamicin (GO) is a novel, targeted chemotherapy designed to treat acute myeloid leukemia (AML). GO consists of an antitumor antibiotic, calicheamicin, linked to a humanized monoclonal antibody against CD33. It has been approved in the United States since 2000 to treat CD33+ AML in first relapse in older adults who are not candidates for cytotoxic therapy. Beyond this indication, the role of GO is evolving. Single-agent GO has a limited role in de novo AML. Incorporation of GO into standard induction treatment in de novo and relapsed AML is feasible. Comparative phase III studies of such an approach are ongoing. GO is associated with serious toxicities, such as infusional reactions, transient liver function test abnormalities, and veno-occlusive disease of the liver, especially in patients who undergo hematopoietic stem cell transplantation.
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Affiliation(s)
- István Molnár
- Section on Hematology and Oncology, Department of Medicine,Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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18
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Ricart AD, Tolcher AW. Technology Insight: cytotoxic drug immunoconjugates for cancer therapy. ACTA ACUST UNITED AC 2007; 4:245-55. [PMID: 17392715 DOI: 10.1038/ncponc0774] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 11/21/2006] [Indexed: 12/19/2022]
Abstract
The successful introduction of genetically engineered human and chimeric immunoglobulin proteins has established monoclonal antibodies (mAbs) as a validated approach for treating malignancies. The unique properties of mAb therapies including their high affinity and specificity, and the differential expression of target antigen in tumor cells versus normal cells make them attractive agents for cancer immunotherapy. The field of immunoconjugate development attempts to combine the specificity of mAb therapies with cytotoxic and radionuclide molecules, thereby combining the best characteristics of these two different modalities. Two radiolabeled mAbs, (90)Y-ibritumomab tiuxetan and (131)I-tositumomab, and one drug conjugate, gemtuzumab ozogamicin have been approved for the treatment of malignancies. Other conjugates carrying toxic payloads of calicheamicin, geldanamycin, maytansinoids and taxoids as well as peptide exotoxins are undergoing preclinical and clinical development. Nevertheless, several obstacles have limited robust antitumor activity and broad application of imunoconjugates, including the optimization of three structural components of the immunoconjugate (i.e. mAb and target specificity, chemical linker design, and the cytotoxin), as well as issues common to mAb therapy such as heterogeneous antigen expression, which can limit uniform antibody delivery. This Review examines optimal design, the lessons learned from clinical immunoconjugate development, and the promising agents in early preclinical/clinical development for the treatment of cancer.
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Affiliation(s)
- Alejandro D Ricart
- Institute for Drug Development, University of Texas Health Science Center, Suite Z418, 7979 Wurzbach Road, San Antonio, TX 78229, USA
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19
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Abstract
The use of monoclonal antibodies for patients with acute myeloid leukemia is based on targeting cell-surface antigens preferentially expressed on leukemic blasts while sparing normal cells and tissues. The majority of studies performed to date have used antibodies reactive with the CD33 antigen. Phase II studies have demonstrated antileukemic responses with all agents, although less so with unlabeled antibodies. The most promising results have been obtained in the treatment of minimal residual disease in patients with acute promyelocytc leukemia. Antibody-targeted chemotherapy with gemtuzumab ozogamicin has also shown significant activity in patients with relapsed acute myeloid leukemia. Radioimmunotherapy with beta-particle emitters may be most effective for the treatment of bulky disease or as part of a conditioning regimen for hematopoietic stem-cell transplantation, whereas radioimmunotherapy with alpha-particle emitters may be better suited to the treatment of small-volume or minimal residual leukemia. Whether or not monoclonal antibody therapy will improve disease outcome compared with conventional treatment regimens remains to be demonstrated by well-designed clinical trials.
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Affiliation(s)
- Sergio Amadori
- Department of Hematology, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy.
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20
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Abstract
Gemtuzumab ozogamicin (Mylotarg) is a conjugate of a monoclonal antibody and calicheamicin, which targets the membrane antigen CD33 in CD33-positive acute myeloid leukaemia (AML) and, after cell internalisation, releases a derivative of the cytotoxic calicheamicin component. In the US, it is approved as monotherapy in patients aged > or =60 years with a first relapse of AML who are ineligible for other cytotoxic therapy. Monotherapy with gemtuzumab ozogamicin results in complete remission (CR) or CR with incomplete platelet recovery (CRp) in approximately =25% of adults (including those aged > or =60 years) with CD33-positive AML in first relapse. Preliminary data indicate a potential role for gemtuzumab ozogamicin as a component of induction or consolidation regimens in adults and, based on an early study, in the treatment of children with AML, although randomised, controlled studies are needed. Serious adverse events, notably hepatotoxicity, characterise its tolerability profile, but gemtuzumab ozogamicin is comparatively well tolerated by most patients. Gemtuzumab ozogamicin is a valuable new treatment option for patients aged > or =60 years with CD33-positive AML in first relapse for whom other cytotoxic chemotherapy is not considered appropriate; patients with a first CR (CR1) of >12 months are likely to have the best outcome.
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21
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Linenberger ML. CD33-directed therapy with gemtuzumab ozogamicin in acute myeloid leukemia: progress in understanding cytotoxicity and potential mechanisms of drug resistance. Leukemia 2004; 19:176-82. [PMID: 15592433 DOI: 10.1038/sj.leu.2403598] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CD33 is expressed on the malignant blast cells in most cases of acute myeloid leukemia (AML) but not on normal hematopoietic pluripotent stem cells. Antibody-based therapies for AML have, therefore, focused on CD33 as a suitable tumor-associated target antigen. The most promising results have been obtained with gemtuzumab ozogamicin (GO, Mylotarg), a humanized IgG(4) anti-CD33 monoclonal antibody joined to a calicheamicin-gamma(1) derivative. Engagement of CD33 by GO results in immunoconjugate internalization and hydrolytic release of the toxic calicheamicin moiety, which, in turn, causes DNA damage and cell death. Since 2000, when GO was approved for clinical use, treatment trials and pilot studies have revealed potential expanded applications along with additional limitations. At the same time, correlative biological and in vitro functional studies have further characterized CD33 expression patterns in AML, the significance of CD33-antibody interactions, pathways involved in GO-induced cytotoxicity and potential drug resistance mechanisms. This review summarizes the recent data addressing mechanisms of GO action and discusses their relevance with regard to clinical applications and the limitations of using experimental model systems to mimic in vivo conditions. As the first drug conjugate approved for clinical use, GO serves as an important paradigm for other immunoconjugates against internalizing tumor antigens.
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Affiliation(s)
- M L Linenberger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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22
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Berger MS, Leopold LH, Dowell JA, Korth-Bradley JM, Sherman ML. Licensure of gemtuzumab ozogamicin for the treatment of selected patients 60 years of age or older with acute myeloid leukemia in first relapse. Invest New Drugs 2002; 20:395-406. [PMID: 12448657 DOI: 10.1023/a:1020658028082] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper discusses background information and the body of clinical data that has been accumulated to demonstrate the efficacy and safety of gemtuzumab ozogamicin (Mylotarg, Wyeth Pharmaceuticals, Philadelphia, PA). Based on these data, gemtuzumab ozogamicin was approved by the United States Food and Drug Administration for the treatment of patients with CD33-positive acute myeloid leukemia in first relapse who are 60 years of age or older and who are not considered candidates for other cytotoxic chemotherapy. The recommended dosage of gemtuzumab ozogamicin is 9 mg/m2, administered as a 2-hour intravenous infusion for a total of 2 doses with 14 days between doses.
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Affiliation(s)
- Mark S Berger
- Department of Clinical Research & Development, Wyeth Research, Collegeville, PA, USA.
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23
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Abstract
Gemtuzumab Ozogamicin (GO, CMA-676) is a monoclonal antibody against the cellular surface antigen CD33 conjugated with the cytotoxic antibiotic calicheamicin. In the beginning of 2000 it obtained US Food and Drug Administration approval for the treatment of refractory acute myeloid leukemia (AML) expressing CD33 in patients older than 60 years who are not candidates for other chemotherapy. After ligation with the CD33 on the cell surface, GO is internalized and hydrolyzed. Its two components are released into the cytoplasm and calicheamicin enters the nucleus where it associates with the DNA, causing double helix breaks and finally cell death. GO is in general well tolerated. The most frequent adverse effect observed is myelotoxicity, with prolonged neutropenia and thrombocytopenia. Veno-occlusive disease of the liver is a less frequent but severe adverse effect. A phase II study points towards a percentage of overall hematologic response around 30% in the setting of refractory or relapsed disease. Future phase III trials will show the most suitable place of GO in the treatment of AML.
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MESH Headings
- Aminoglycosides
- Animals
- Anti-Bacterial Agents/adverse effects
- Anti-Bacterial Agents/pharmacokinetics
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/immunology
- Clinical Trials as Topic
- Drug Resistance, Neoplasm
- Gemtuzumab
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/immunology
- Leukemia, Myeloid/pathology
- Sialic Acid Binding Ig-like Lectin 3
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Affiliation(s)
- Ioannis A Voutsadakis
- Service d'Hématologie, Department of Medicine and INSERM U487, Institut Gustave-Roussy, 94805 Villejuif, France.
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