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Antibody immune checkpoint modulators in the clinic

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The treatment of cancer via antibody therapeutics that modulate immune responses is the focus of substantial research and development by the biopharmaceutical industry. To date, 6 monoclonal antibodies (mAbs) that function by modulating immune checkpoints have been approved in the US: ipilimumab (anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA4)); pembrolizumab and nivolumab (anti-programmed death receptor 1 (PD-1)); durvalumab, avelumab, and atezolizumab (anti-programmed death ligand 1 (PD-L1)). Cemiplimab, another anti-PD-1 mAb, is currently undergoing regulatory review. Antibody immune checkpoint modulators can be used to treat many types of cancer,[1] which makes them highly attractive for biopharmaceutical development. For example, the approved products, which target only 3 of the many proteins involved in either stimulating or inhibiting immune responses, are used to treat melanoma, non-small-cell lung cancer, head and neck cancer, Hodgkin’s lymphoma, bladder cancer, gastric/gastroesophageal junction adenocarcinoma, renal cell cancer, hepatocellular cancer, Merkel cell carcinoma and colorectal cancer. [2]

More than 80 antibody immune checkpoint modulators sponsored by commercial firms are in clinical development, and they comprise ~ 24% of the clinical pipeline of antibody therapeutics for cancer. Most are in early development, with 50 and 28 antibody immune checkpoint modulators undergoing evaluation in Phase 1 and Phase 2 clinical studies, respectively. Seven (IBI308, BCD-100, PDR001, tislelizumab, camrelizumab, utomilumab, and tremelimumab) are undergoing evaluation in late-stage studies.[3]

Despite the fact that 5 antibodies targeting the PD-1 pathway are already marketed, PD-1 and PD-L1 remain popular as targets for antibodies in development. Of the antibody immune checkpoint modulators currently in the clinic, 21 molecules target PD-1, including five in late-stage clinical studies, and 9 antibodies target PD-L1. Other popular antigens for antibodies in clinical development include glucocorticoid-induced tumor necrosis factor receptor (GITR; target of 7 antibodies); CD40, LAG-3 and OX40 (each the target of 6 antibodies); as well as T-cell immunoglobulin and mucin-domain-containing molecule (TIM-3), T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) and CTLA4 (each the target of 4 antibodies). In addition, two bispecific antibodies (anti-PD-1, LAG-3 MGD013; anti-PD-L1, CTLA-4 AK104) targeting these immune checkpoints are in clinical studies; to avoid double counting, these two were excluded from the totals given above.

Over 100 antibody immune checkpoint modulators have entered commercially sponsored clinical studies since 2000, but ~60% of the molecules first entered such studies in the past 3 years. The ultimate fates (approval or termination) for most of the molecules are thus not yet known, but the available data is sufficient to calculate a Phase 1 to 2 transition rate, which is 74%. This rate compares favorably with that for all antibody therapeutics (75%) and anti-cancer antibody therapeutics (69%). The current data suggest that antibody immune checkpoint modulators, as a group, has a notably higher Phase 2 to 3 transition rate compared with all antibody therapeutics. This result, however, is based on outcomes for relatively few molecules. It should be noted that clinical studies may be terminated for business reasons, as well as safety or efficacy issues. For example, although PD-1 and PD-L1 are well-validated targets, the market for anti-PD-1 and anti-PD-L1 antibodies in the future may not be sufficient to justify continued development of all such antibodies in the current pipeline. Termination of molecules at Phase 2 for business reasons would decrease the Phase 2 to 3 transition rate. To date, no antibody immune checkpoint modulators have been terminated during regulatory review; the transition rate at that phase is thus 100%.

The Antibody Society has partnered with Hanson Wade to track trends in the clinical development of innovative cancer therapies, with a focus on immune checkpoint modulators and antibody-drug conjugates. As the date for ICI Boston 2018 (March 19-21) approaches, Hanson Wade has prepared a comprehensive e-book that provides insights into combination strategies involving immune checkpoint inhibitors, which can be downloaded here. Members of The Antibody Society qualify for a 20% discount to ICI Boston 2018. Please contact us at membership@antibodysociety.org for the code.

  1. Torphy RJ, Schulick RD, Zhu Y. Newly Emerging Immune Checkpoints: Promises for Future Cancer Therapy. Int J Mol Sci. 2017; 18(12). pii: E2642. doi: 10.3390/ijms18122642.
  2. Iwai Y, Hamanishi J, Chamoto K, Honjo T. Cancer immunotherapies targeting the PD-1 signaling pathway. J Biomed Sci 2017; 24:26. doi.org/10.1186/s12929-017-0329-9.
  3. Kaplon H, Reichert JM. Antibodies to watch in 2018. MAbs. 2018 Jan 4:1-21. doi: 10.1080/19420862.2018.1415671.

The Antibody Society tracks the progress of commercially sponsored antibody therapeutics in clinical development on a continuous basis. We collect information, including molecular composition (e.g., format, isotype, target), phase of development and indications studied, from publicly available sources (e.g., press releases, company websites, meeting abstracts, published literature, clinicaltrials.gov, regulatory agency websites). Our data are cross-checked against databases generously provided by our corporate partners, including Hanson Wade’s Beacon Targeted Therapies and the Therapeutic Antibody Database. It should be noted that companies may not publicly disclose all information for all molecules in the pipeline, especially those in the early stages of development. The numbers of molecules discussed above should thus be considered minimums, as targets have not been disclosed for all the molecules we are tracking. We look forward to reporting additional trends and metrics for antibody therapeutics development in the future.

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Antibody-based innovations in the tumor microenvironment

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Please join us at the Society’s annual meeting, Antibody Engineering & Therapeutics on December 11-15, 2017 at the Manchester Grand Hyatt, San Diego, CA!

Clinical successes of the checkpoint modulators have revived the ambition to cure cancer by manipulation of the tumor microenvironment, or by unleashing or even priming (novel) adaptive immune responses. Hence, understanding the tumor microenvironment is an increasingly vital theme in the field of antibody-based therapeutics. This theme is excitingly addressed during two sessions “Antibody-based innovations in the tumor microenvironment 1 & 2”, jointly chaired by Kerry Chester and Janine Schuurman, which will be held on Thursday December 14, 2017. The sessions’ antibody-focused complementary topics are intended to expand knowledge at the cutting edge of the tumor microenvironment field, and are anticipated to boost lively discussions and stimulate new lines of thinking.

Antibody-based innovations in the tumor microenvironment (I, morning session)

Chairwomen: Kerry Chester, Professor of Molecular Medicine, UCL Cancer Institute, University College London, United Kingdom, and Janine Schuurman, Vice President Research, Genmab, Utrecht, The Netherlands

The sessions will open with a presentation by John Anderson (UCL) who will examine current thinking on immune evasion as a hallmark of cancer and why the solid tumor microenvironment is particularly hostile to immunotherapeutic function of effector cells. He will explain that, unlike adult cancers, pediatric cancers generally arise with few mutations and tend to be insensitive to existing immune modulators. Treatment approaches designed to target cell surface antigens in combination with agents to reverse immune evasion are likely to be required for this special group of patients.  New data will be presented in support of this hypothesis.

Syd Johnson (MacroGenics) will then share data on how to achieve co-stimulation of immune cells specifically within the tumor microenvironment using bispecific Dual-Affinity Re-Targeting (DART) and TRIDENT antibodies that bind both tumor-specific antigens and T-cell costimulatory molecules. Importantly, tumor binding is required to trigger costimulation. The talk will be illustrated with a case study showing how to achieve optimal tumor dependent T cell engagement by varying the relative position and valence of each antibody binding site in the molecule; manufacturability, stability and PK will also be addressed.

Natalia Arenas Ramirez (University Hospital Zurich) will then present an elegant antibody-based solution to problems associated with IL-2 immunotherapy.  IL2 binding to the IL-2 receptor α (CD25) subunit leads to unwanted side effects, including stimulation of immunosuppressive Tregs.  The talk will describe development of NARA1, an anti-IL-2 monoclonal antibody that acts as a high-affinity CD25 mimic, preferentially stimulating CD8+ cells while keeping the Tregs low.  Potent antitumor responses are achieved.

After the Networking Break, Volker Schellenberger (Amunix) will present an interesting approach to achieving activation in the tumor environment using bispecific T-cell engagers based on the ProTIA (Protease Triggered Immune Activator) platform. ProTIA combines tumor binding, proteolytic activation and polymer targeting due to an attached XTEN. Amunix’ lead molecule, AMX-168, is expected to enter clinical development in 2018.

Next, Shautong Song (Icell Kealex Therapeutics) will showcase an innovative way to focus treatment within the tumor microenvironment via bi-specific T-cell engager-armed oncolytic vaccinia virus. The treatment has several modes of action: vaccinia virus can directly lyse tumor cells and bi-specific T-cell engagement directs T-cells to kill both tumor and by-stander cells. In addition, T-cell engagement promotes T-cell infiltration into tumors and the cytokines released upon activation create a pro-inflammatory microenvironment that inhibits tumor growth. The strategy provides a sophisticated means of reducing systemic side effects associated with bi-specific T-cell engagers.

To complete the morning session, Dane Wittrup (Massachusetts Institute of Technology) will explore how classical monoclonal anti-tumor antibodies, such as anti-HER2 or anti-CD20, synergize with immune oncology antibodies, such as anti-PD-1. This is achieved not only by delivery of  tumor debris to antigen presenting cells for cross presentation, but also by creating a more inflammatory state and a localized cytokine storm in the tumor microenvironment.

Antibody-based innovations in the tumor microenvironment (II, afternoon session)

Chairwomen: Janine Schuurman, Vice President Research, Genmab, Utrecht, The Netherlands and Kerry Chester, Professor of Molecular Medicine, UCL Cancer Institute, University College London, United Kingdom

The afternoon session opens with a presentation centering on adaptive immune responses boosted by therapeutic cancer vaccines using RNA. Sebastian Kreiter (BioNTech) will focus on preclinical and clinical efforts to use personalized neoepitope vaccines in combination with immunomodulatory antibodies.

Edward Roberts (UCSF) will follow with a complementary line of thinking harnessing long term anti-tumor therapeutic effects. He will share data, including imaging data, to give us insights in the requirements for effective tumor antigen trafficking to the lymph nodes by the dendritic cells. These understandings may stimulate ideas for effective T cell priming approaches.

The TNFR super family (TNFR-SF) is a highly represented target class in the immunomodulatory targets space. Clustering is an important prerequisite for agonistic effects of antibodies against these targets. Nick Wilson (Agenus) will share emerging data on the role of antibody Fc and Fc-receptor biology to optimize the agonistic properties of antibodies against this target class.

Daratumumab, an anti-CD38 antibody that is approved for the treatment of relapsed / refractory myeloma, has multiple mechanisms of actions. Apart from rapid tumor cell reduction and direct anti-tumor effects, daratumumab significantly reduces CD38+ immune suppressive cells in the tumor microenvironment. Kate Sasser (Genmab) will focus on the immune modulatory activity of this antibody substantiated with data from in vitro evaluations and clinical studies.

Bispecific antibodies directed against both CD3and a tumor target can engage non-tumor-specific T cells, resulting in effective tumor-specific cell killing. Dirk Hose (Heidelberg University) will share data on a bispecific IgG-based molecule that targets CD3 and the B-cell maturation antigen (BCMA), which has been implicated in multiple myeloma. This presentation will cover the generation of this molecule and include early stage clinical learnings.

Anti-CD3 bispecifics can have severe toxicity profiles related to the expression profile of the tumor antigen. The last speaker of this full-day session on the tumor microenvironment will share data on the improvement of the therapeutic index of an anti-CD3 bispecific antibody also directed against a widely expressed antigen, epidermal growth factor receptor (EGFR). In this case study, Leila Boustany, (CytomX) will present the localization of the activity to the tumor microenvironment, which is accomplished by an engineering approach, i.e., a protease activatable EGFRxCD3 bispecific exploiting the protease activity present in the tumor microenvironment.

We anticipate that these complementary scientific insights focusing around antibody-based innovations in the tumor microenvironment will excite us all and inspire our forward-looking capabilities.

Interested in attending the meeting? Learn more from this PDF, which includes all session summaries written by the chairpersons.

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IMMUNO-ONCOLOGY: CHECKPOINTS

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The Antibody Society invites you to attend its annual meeting, Antibody Engineering & Therapeutics, on December 11-15, 2017 at the Manchester Grand Hyatt, San Diego, CA! In this summary, chairperson James Larrick, M.D., Ph.D., Managing Director and Chief Medical Officer, Panorama Research Institute and Velocity Pharmaceutical Development, discusses what you will learn at his session on immune-oncology checkpoints, which will be held on Friday December 15.

The management of cancer has dramatically changed over the past decade with the introduction of novel immunotherapies, chief among them inhibitors of checkpoint receptors — molecules whose function is to restrain the host immune response.  Antibodies inhibiting CTLA4 and PD1-PD-L1 have shown remarkable clinical benefit.  The field is evolving rapidly, with many clinical trials testing novel checkpoint inhibitors (e.g., anti-LAG3, anti-TIM3), alone, in combination, or with other targeted therapies. A sampling of novel approaches will be covered in this symposium.

This Friday morning (December 15, 2017) session will be led off by Mickey Hu (Panorama Institute of Molecular Medicine) who has developed a series of novel immunomodulatory drugs that suppress PD-L1 expression in tumor cells and inhibit the PD-L1/PD-1 checkpoint, resulting in the recruitment of natural killer (NK) cells into the tumor microenvironment that leads to tumor suppression. Efforts to combine immunomodulatory drugs with checkpoint blockades to overcome difficult-to-treat cancers with tolerable side effects will be described.

Clinical lead candidate antibodies often lack species cross-reactivity, necessitating the development of substitute antibodies for pre-clinical development in mice or monkeys. Next, Erik Hofman, (Argenx) will describe the use of the SIMPLE Antibody platform to generate functional human-mouse cross-reactive antibodies against several validated immune checkpoint proteins, including PD-1, VISTA and LAG-3.

Xin Lu (University of Notre Dame) will present data indicating that targeted therapy against myeloid-derived suppressor cells, using multikinase inhibitors such as cabozantinib and dactolisib, can synergize with immune checkpoint blockade antibodies (e.g., anti-CTLA4, anti-PD1) to eradicate metastatic castration-resistant prostate cancer.

A key feature of effective cancer immunotherapy relies on enhanced anti-tumor immune response and reduced suppressive effects. As natural cytokines are made to maintain a balance between activation and suppression, they are often unable to achieve desired therapeutic efficacy. Cheng-I Wang (Biomedical Sciences Institutes, ASTAR, Singapore) will describe a cytokine receptor agonist antibody that mimics IL-2’s immune stimulatory effects on CD8 T cells with minimal Treg activation.

Cow antibodies have unusually long CDR3 regions. Vaughn Smider (The Scripps Research Institute) has characterized the genetic and structural properties of these antibodies, and has identified novel antibodies against HIV and exhausted T-cell targets utilizing this approach.

The final speaker, Sarah Crome, (Princess Margaret Cancer Centre, University Health Network, Canada) will describe efforts to characterize a unique innate lymphoid cell (ILC) population that suppresses the expansion and function of tumor-associated T cells, and is associated with early recurrence in high-grade cancer. This regulatory ILC population has properties that overlap with NK cells and other defined ILCs, yet can be differentiated by a distinct gene expression signature. Studies defining molecular interactions that control regulatory ILC function and ways to target this population to enhance immunotherapy will be presented.

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Membership is free for students and employees of the Society’s corporate sponsors.

First approval for durvalumab

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On May 1, 2017, the US Food and Drug Administration (FDA) granted an approval to the anti-PD-L1 antibody durvalumab (IMFINZI) for the treatment of patients with urothelial carcinoma, and FDA approved a complementary diagnostic, the VENTANA PD-L1 assay, for assessment of PD-L1 protein in suitably prepared urothelial carcinoma tissue. Durvalumab’s license application received accelerated approval, priority review, and Breakthrough Therapy Designation from FDA. The approval was based on one single-arm trial of 182 patients with locally advanced or metastatic urothelial carcinoma whose disease progressed after prior platinum-containing chemotherapy. An ongoing clinical trial to confirm the clinical benefit of durvalumab must be completed to fulfill the conditions of the accelerated approval.
Durvalumab is the sixth antibody therapeutic to be granted a first marketing approval in any country so far in 2017, and the second human IgG1 anti-PD-L1 antibody therapeutic to be approved by FDA in 2017, following the approval of avelumab (Bavencio) for Merkel cell carcinoma in March 2017. It is also the second anti-PD-L1 antibody therapeutic to be granted an approval for urothelial carcinoma, following FDA’s approval of atezolizumab (Tecentriq) in May 2016.
The Antibody Society maintains a comprehensive table of approved antibody therapeutics and those in regulatory review in the EU or US. As of May 1, 2017, marketing applications for a total of 9 antibody therapeutics that have not been approved in any country are undergoing review in the EU or US. In addition, marketing applications for sarilumab, which is approved in Canada, and gemtuzumab ozogamicin, which was FDA approved in 2000 and subsequently withdrawn from the US market, are undergoing review in the EU and US.

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New antibodies for cancer start clinical testing

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During 2014-2016, the pharmaceutical industry initiated first-in-human studies for an average of ~80 antibody-based therapeutics per year, and over 60% of these were designed to be treatments for cancer. The safety and tolerability of drugs are evaluated in Phase 1 studies, but preliminary efficacy may also be evaluated if the studies include patients rather than healthy volunteers. The anti-cancer antibodies new to the clinical pipeline in 2017 include two (CX-072, KN035) that target the programmed death-1 receptor ligand (PD-L1), and one each (CBT-501, FLYSYN) that target programmed death-1 receptor (PD-1) and Fms-like tyrosine kinase (FLT3), respectively.

PD-1 and PD-L1 are immune-checkpoint proteins that are frequently selected as targets for antibody therapeutics. Currently, two anti-PD-1 antibodies (pembrolizumab (Keytruda®), nivolumab (Opdivo®)) and two anti-PD-L1 antibodies (atezolizumab (Tecentriq®), avelumab (Bavencio®)) are approved for marketing, and one anti-PD-L1 antibody (durvalumab) is undergoing regulatory review. An additional 19 antibody-based therapeutics that target either PD-1 or PD-L1 are in clinical studies, with most (63%) in Phase 1 studies. Among these 19 are three antibodies, CX-072, KN035 and CBT-501, that recently entered their first clinical study. Developed by CytomX Therapeutics, CX-072 is a Probody targeting PD-L1. The first-in-human study (NCT03013491) of CX-072 as monotherapy and in combination with ipilimumab or with vemurafenib in patients with advanced or recurrent solid tumors or lymphomas started in January 2017. Probody therapeutics are designed to be activated by tumor-specific proteases, and thus may have minimal off-target effects. KN035, comprising an anti-PD-L1 single domain antibody fused with an Fc, is being evaluated in two Phase 1 studies (NCT02827968, NCT03101488) that started in 2017. Sponsored by 3D Medicines (Sichuan) Co., Ltd, the NCT02827968 study will evaluate the safety and tolerability of KN035 in patients with advanced and metastatic solid tumors, and the NCT03101488 study will evaluate and characterize the tolerability and safety profile of single agent KN035 in Chinese adults with unresectable advanced carcinoma. Anti-PD-1 CBT-501 (genolimzumab, GB-226) is a humanized IgG4 antibody with low antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity activity. A Phase 1 dose-escalation study (NCT03053466) sponsored by CBT Pharmaceuticals, Inc. of CBT-501 in patients with select advanced or relapsed/recurrent solid tumors was started in Australia in March 2017.
Developed by the University of Tübingen and SYNIMMUNE GmbH, FLYSYN is a chimeric antibody that targets the extracellular domain of FLT3 and is optimized for enhanced ADCC. The Phase 1 NCT02789254 study, which was initiated in February 2017, will evaluate the safety, tolerability and preliminary efficacy of FLYSYN for the treatment of acute myeloid leukemia patients with minimal residual disease.

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