Phase I Clinical Trial of the Chimeric Monoclonal Antibody (C30.6) in Patients with Metastatic Colorectal Cancer1
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4674 Vol. 6, 4674–4683, December 2000 Clinical Cancer Research Phase I Clinical Trial of the Chimeric Monoclonal Antibody (c30.6) in Patients with Metastatic Colorectal Cancer1 Robyn L. Ward,2 Deborah Packham, uptake. At the 50 mg/m2 level the half-life and maximum -Anne M. Smythe, Jayne Murray, serum concentration were 81 ؎ 15 h and 7.9 g/ml, respec Peter Anderson-Stewart, Neil Kitchen, tively. One patient developed a low-level human anti-c30.6 response. Tumor response was assessed by computed tomog- Rosyln Muirhead, Peter Phillips, Peter Gray, raphy, positron emission tomography scanning, and serial Grant Bigg-Wither, Krishnan Prabakaran, carcinoembryonic antigen measurements. There were no Judy Freund, Michael Fullham, Michele Rule, partial responses, although positron emission tomography David Dalley, Alan Meagher, scanning demonstrated some reduction in tumor activity in Nicholas J. Hawkins, and Glenn M. Smith three individuals. The chimerized c30.6 antibody is not immunogenic in Cooperative Research Centre for Biopharmaceutical Research Ltd., Darlinghurst 2010, New South Wales [R. L. W., D. P., A. M. S., P. A- humans and appears worthy of further study. It does, how- S., N. K., R. M., P. P., G. M. S.]; Departments of Medical Oncology ever, produce a unique profile of side effects that can be well [R. L. W., M. R., D. D.], Nuclear Medicine [K. P., J. S.], Colorectal controlled with premedication. Surgery [A. M.], and Radiology [G. B-W.], St. Vincent’s Hospital, Darlinghurst 2010, New South Wales; Schools of Biotechnology [N. K., P. P., P. G., G. M. S.] and Pathology [R. L. W., N. J. H.], INTRODUCTION University of New South Wales, Sydney 2052, New South Wales; Over the last few years, a number of clinical studies have and Department of Nuclear Medicine [M. F.], Royal Prince Alfred provided evidence that monoclonal antibodies are of value in the Hospital, Sydney 2050, New South Wales, Australia treatment of a variety of cancers, including breast, lymphoma and colorectal tumors (1–3).3,4 Although adjuvant chemother- ABSTRACT apy modestly improves the disease-free and overall survival of patients with Dukes stage C colorectal cancer, there is a need for The murine antibody 30.6 recognizes an antigen that is new adjuvant therapies that have both improved efficacy and expressed on a high proportion of colorectal carcinomas and fewer side effects. In this regard, the proven efficacy of adjuvant their metastases. We report the results of single-dose esca- 17-1A therapy in a small group of patients with Dukes stage C lation studies of the chimeric 30.6 (c30.6) monoclonal anti- colon cancer has shown that antibodies may have optimal effi- body in metastatic colorectal cancer, to evaluate its safety, cacy when used in the setting of minimal residual disease (2). pharmacokinetics, and biodistribution. Furthermore, there is a good rationale for the use of combina- Recombinant c30.6 (IgG1) antibody was secreted tions of antibodies or indeed for their use with traditional from Chinese hamster ovary cells and purified by a multi- chemotherapy, so as to deliver a range of potentially synergistic step chromatography process. Seventeen patients with met- antitumor activities (4–6). astatic colorectal cancer were enrolled in this dose escalation The murine monoclonal antibody 30.6 recognizes an anti- study. The first four patients were treated with 3 mg of 123 gen that is expressed on colorectal carcinomas and their metas- I-labeled c30.6, whereas the next 13 received a single dose 2 tases. Expression of the antigen is greatest on well-differentiated of unlabeled antibody (maximum dose, 50 mg/m ). colorectal adenocarcinomas, is less pronounced on poorly dif- The most frequent side effect was a novel syndrome of ferentiated adenocarcinomas, and is usually absent from most severe burning and erythema of the face, chest, neck, ears, undifferentiated carcinomas (7). The biochemical nature of the palms, soles, and genitalia. The frequency of this syndrome 30.6 antigen has not been elucidated, but it is expressed only on was markedly reduced in those patients premedicated with the luminal surface of glandular cells and is not released into the high doses of histamine receptor 1 and histamine receptor 2 circulation. The antigen is found in gastrointestinal epithelium blockers. Other side effects were mild and predictable. Bio- as well as in pancreatic acini, hepatocytes, alveolar pneumo- distribution studies showed a rapid and intensive hepatic cytes, and prostatic acinar epithelium. However, it is not ex- pressed in other organs or tissues of the urogenital tract or central nervous system (7). The murine 30.6 antibody has been shown to localize to s.c. human colorectal cancer xenografts in Received 6/6/00; revised 9/15/00; accepted 9/18/00. The costs of publication of this article were defrayed in part by the nude mice (8) as well as to primary and secondary tumor payment of page charges. This article must therefore be hereby marked deposits in patients with metastatic colorectal cancer (8, 9). advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. 1 Supported by the Australian Government Cooperative Research Pro- gram. 2 To whom requests for reprints should be addressed, at Department of 3 Internet address for Rituxan full prescribing information, 2000: http:// Medical Oncology, St. Vincent’s Hospital, Victoria Street; Darlinghurst www.genentech.com/Medicines/rituxan_insert.html. 2010, New South Wales, Australia. Phone: 61292958412; Fax: 4 Internet address for healthcare professionals prescribing information 61283823386; E-mail: [email protected]. for Herceptin, 2000: http://www.herceptin.com/prof/pi000.html. Downloaded from clincancerres.aacrjournals.org on September 27, 2021. © 2000 American Association for Cancer Research. Clinical Cancer Research 4675 Furthermore, the antibody, whether used alone, radiolabeled, or chromatography and then treated with solvent/detergent to in- conjugated to cytotoxic drugs, is able to strongly inhibit the activate lipid-enveloped viruses. Additional purification by an- growth of human colorectal carcinoma xenografts in nude mice ion and cation exchange chromatography removed residual pro- (10). Phase I clinical studies of N-acetylmelphalan coupled to teins, solvent/detergents, and nucleic acids. The purified c30.6 30.6 showed that patients produced a HAMA5 that precluded was additionally purified and formulated into 0.9% saline using additional dosage escalation (11, 12). two gel filtration columns. Finally, the formulated bulk was The development of HAMA could impair the therapeutic sterile- and viral-filtered before dispensing into Hypak glass effectiveness of 30.6, either by interfering with its binding to syringes (Becton Dickinson, Lincoln Park, NJ). Stability studies antigen or by reducing its bioavailability. Replacing the murine showed that the c30.6 antibody was stable in this formulation for constant regions with a human ␥1 region was likely to reduce at least 16 months. Purity, identity, activity, and safety were the immunogenicity of the antibody and also maximize its confirmed before release of the vialed product for clinical use. effector function. Mount et al. described a chimeric version of Radiolabeling of c30.6. The c30.6 antibody (5 mg in 2 ϭ 123 this antibody (c30.6) that binds with moderate affinity (Ka ml) was labeled with I (2 GBq in 1 ml; ARI, Sydney) using 8 Ϫ1 1 ϫ 10 M ) to its antigen and can mediate in vitro ADCC (13). the Iodogen method, and the labeled antibody was purified by Although this chimeric antibody was not able to lyse cells in the gel filtration using a Superose 12 HR column (Pharmacia, presence of either human or rabbit complement, it had antitumor Uppsala, Sweden) coupled with fast protein liquid chromatog- activity in mice with SCID bearing s.c. human colorectal cancer raphy. Before purification, the iodine incorporation was 68.0 Ϯ xenografts. A 40% reduction in tumor size was observed after 7.0%. The immunoreactive fraction of the labeled antibody was i.p. c30.6 administration, with maximal antitumor activity while estimated by the Lindmo method (14) using the human colorec- the c30.6 antibody was being administered. tal cell line HT-29. The average immunoreactivity of the radio- The chimerized 30.6 antibody, therefore, has a number of labeled preparations was 60.7 Ϯ 8.6%. The radiolabeling characteristics that make it an attractive antibody for additional method was validated to produce sterile and pyrogen-free prod- clinical development. These include its ability to induce ADCC, uct. Serum samples from patients injected with radiolabeled its pattern of tissue reactivity, affinity, potential for reduced antibody were analyzed by gel filtration chromatography for the immunogenicity, and documented antitumor activity in animal presence of aggregates and free iodide using a Superose 12 models. We report here the results of single-dose escalation HR10/30 gel filtration column. studies of the chimeric 30.6 monoclonal antibody in patients Patient Selection. For entry to the study, the patients with metastatic colorectal cancer. The primary objectives of the were required to have histologically proven metastatic colorec- study were to evaluate safety, pharmacokinetics, and biodistri- tal cancer and to have adequate renal (creatinine Ͻ125% of the bution of the c30.6 antibody in this patient population. upper limit of the normal range), hepatic (bilirubin Ͻ125% of the upper limit of the normal range; prothrombin time Ͻ 1.3 PATIENTS AND METHODS times control), and hematological function (white blood count Ͼ ϫ 9 Ͼ ϫ 9 Production of c30.6. Recombinant c30.6 (IgG1) anti- 4.0 10 /liter; platelet count 100 10 /liter; hemoglobin Ͼ body is secreted from CHO cells. The cloned 30.6 antibody 100 g/liter) as well as the presence of measurable metastatic Ն heavy- and light-chain, variable region cDNAs (obtained from disease (at least one site 1 cm). Each patient was also required Ͻ the Austin Research Institute, Melbourne) were subcloned into to have a WHO performance status of 2 and a life expectancy the antibody expression vectors pG1D102 and pKN100 (Med- of at least 3 months.