Phase I trial of a novel anti-GD2 monoclonal antibody, hu14.18K322A, designed to decrease toxicity in children with refractory or recurrent neuroblastoma

Fariba Navid, Paul M. Sondel, Raymond Barfield, Barry L. Shulkin, Robert A. Kaufman, Jim A. Allay, Jacek Gan, Paul Hutson, Songwon Seo, Kyung Mann Kim, Jacob Goldberg, Jacquelyn A. Hank, Catherine A. Billups, Jianrong Wu, Wayne L. Furman, Lisa M. McGregor, Mario Otto, Stephen D. Gillies, Rupert Handgretinger, Victor M. Santana

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84 Scopus citations

Abstract

Purpose: The addition of immunotherapy, including a combination of anti-GD2 monoclonal antibody (mAb), ch14.18, and cytokines, improves outcome for patients with high-risk neuroblastoma. However, this therapy is limited by ch14.18-related toxicities that may be partially mediated by complement activation. We report the results of a phase I trial to determine the maximum-tolerated dose (MTD), safety profile, and pharmacokinetics of hu14.18K322A, a humanized anti-GD2 mAb with a single point mutation (K322A) that reduces complement-dependent lysis. Patients and Methods: Eligible patients with refractory or recurrent neuroblastoma received escalating doses of hu14.18K322A ranging from 2 to 70 mg/m2 per day for 4 consecutive days every 28 days (one course). Results: Thirty-eight patients (23 males; median age, 7.2 years) received a median of two courses (range, one to 15). Dose-limiting grade 3 or 4 toxicities occurred in four of 36 evaluable patients and were characterized by cough, asthenia, sensory neuropathy, anorexia, serum sickness, and hypertensive encephalopathy. The most common non-dose-limiting grade 3 or 4 toxicities during course one were pain (68%) and fever (21%). Six of 31 patients evaluable for response by iodine-123 metaiodobenzylguanidine score had objective responses (four complete responses; two partial responses). The first-course pharmacokinetics of hu14.18K322A were best described by a two-compartment linear model. Median hu14.18K322A α (initial phase) and β (terminal phase) half-lives were 1.74 and 21.1 days, respectively. Conclusion: The MTD, and recommended phase II dose, of hu14.18K322A is 60 mg/m2 per day for 4 days. Adverse effects, predominately pain, were manageable and improved with subsequent courses.

Original languageEnglish (US)
Pages (from-to)1445-1452
Number of pages8
JournalJournal of Clinical Oncology
Volume32
Issue number14
DOIs
StatePublished - May 10 2014

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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    Navid, F., Sondel, P. M., Barfield, R., Shulkin, B. L., Kaufman, R. A., Allay, J. A., Gan, J., Hutson, P., Seo, S., Kim, K. M., Goldberg, J., Hank, J. A., Billups, C. A., Wu, J., Furman, W. L., McGregor, L. M., Otto, M., Gillies, S. D., Handgretinger, R., & Santana, V. M. (2014). Phase I trial of a novel anti-GD2 monoclonal antibody, hu14.18K322A, designed to decrease toxicity in children with refractory or recurrent neuroblastoma. Journal of Clinical Oncology, 32(14), 1445-1452. https://doi.org/10.1200/JCO.2013.50.4423