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      Therapeutic Targeting of Lewis y and Lewis b with a Novel Monoclonal Antibody 692/29

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          Abstract

          Background

          Several monoclonal antibodies (mAbs) recognising Lewis y, such as BR96, have reached the clinic but have failed to show good anti-tumour responses with an acceptable level of toxicity. No Lewis b mAbs have been trialled in patients. In this study we compare the specificity of three mAbs; BR96 (Lewis y), 2-25 LE (Lewis b) and 692/29 that recognises a unique facet of both Lewis y and Lewis b. We then assessed the in vivo therapeutic effect of 692/29 using xenograft models.

          Methodology/Principal Findings

          Using a glycan array, each mAb was shown to display a different binding pattern with only 692/29 binding to both Lewis y and Lewis b. 692/29 was able to kill tumour cells over-expressing Lewis y/b directly, as well as by antibody and complement mediated cytotoxicity (ADCC/CDC), but failed to kill cells expressing low levels of these haptens. In contrast, BR96, directly killed cells expressing either high or low levels of Lewis y perhaps explaining its toxicity in patients. 2-25 LE failed to cause any direct killing but did mediate ADCC/CDC. Both 692/29 and BR96 bound to >80% of a panel of over 400 colorectal tumours whereas 2-25 LE showed lower reactivity (52%). 692/29 demonstrated more restricted normal tissue reactivity than both BR96 and 2-25 LE. 692/29 anti-Lewis y/b mAb also showed good in vivo killing in xenograft models.

          Conclusions/Significance

          MAbs targeting both Lewis y and Lewis b may have a therapeutic advantage over mAbs targeting just one hapten. 692/29 has a more restricted normal tissue distribution and a higher antigen threshold for killing which should reduce its toxicity compared to a Lewis y specific mAb. 692/29 has an ability to directly kill tumours whereas the anti-Lewis b mAb does not. This suggests that Lewis y but not Lewis b are functional glycans. 692/29 showed good anti-tumour responses in vivo and is a strong therapeutic candidate.

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          Most cited references28

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          Intratumoral T cell infiltration, MHC class I and STAT1 as biomarkers of good prognosis in colorectal cancer.

          To evaluate immunosurveillance/editing in colorectal cancer. Transformation stimulates the production of interferon gamma (IFNgamma) which signals via the IFNgamma receptor (IFNGR1) on tumours. This results in stimulation of nuclear STAT1 (nSTAT1), inhibition of tumour growth and upregulation of major histocompatibility complex (MHC) while promoting T cell extravasation. In contrast, downregulation of MHC class I by allele loss results in loss of T cell recognition. A tissue microarray of 462 colorectal tumours with mean follow-up of 42 months (range 1-116) was stained by immunohistochemistry for markers which predict immunosurveillance/editing. The presence of a high level of intratumoral T cells (ITTC) correlated with improved survival compared with a low level of ITTC, with a mean difference in survival of 16.3 months (p=0.006). There was a direct correlation between nSTAT1 expression and ITTC (p<0.001). Patients whose tumours had a high level of ITTC and nSTAT1 survived 20 months longer than those whose tumours had a low level of ITTC and no nSTAT1. A strong correlation was seen between ITTC and MHC class I expression (p=0.0002). A mean survival advantage of 26.1 months was seen in patients whose tumours had strong MHC I expression and high levels of ITTC over those who had weak MHC I and low levels of ITTC (log-rank test=12.023, p=0.034). Both MHC I and ITTC are independent predictors of good survival. ITTC, nSTAT1 and strong MHC class I expression on tumours identify patients with improved survival and an intact tumour immune system that may benefit from immunotherapy. Conversely, loss of these markers identifies patients whose tumours have escaped immunosurveillance and are unlikely to benefit from immunotherapy.
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            Aberrant glycosylation in cancer cell membranes as focused on glycolipids: overview and perspectives.

            S Hakomori (1985)
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              Randomized phase II study of BR96-doxorubicin conjugate in patients with metastatic breast cancer.

              BMS-182248-1 (BR96-doxorubicin immunoconjugate) is a chimeric human/mouse monoclonal antibody linked to approximately eight doxorubicin molecules. The antibody is directed against the Lewis-Y antigen, which is expressed on 75% of all breast cancers but is limited in expression on normal tissues. Preclinical xenograft models demonstrated significant antitumor activity, including cures. A randomized phase II design was chosen to estimate the activity of the BR96-doxorubicin conjugate in metastatic breast cancer in a study population with confirmed sensitivity to single-agent doxorubicin. Patients with measurable metastatic breast cancer and immunohistochemical evidence of Lewis-Y expression on their tumor received either BR96-doxorubicin conjugate 700 mg/m2 IV over 24 hours or doxorubicin 60 mg/m2 every 3 weeks. Patients were stratified on the basis of prior doxorubicin exposure, visceral disease, and institution. Cross-over to the opposite treatment arm was allowed with progressive or persistently stable disease. Twenty-three patients who had received a median of one prior chemotherapy regimen were assessable. There was one partial response (7%) in 14 patients receiving the BR96-doxorubicin conjugate and one complete response and three partial responses (44%) in nine assessable patients receiving doxorubicin. No patient experienced a clinically significant hypersensitivity reaction. The toxicities were significantly different between the two treatment groups, with the BR96-doxorubicin conjugate group having limited hematologic toxicity, whereas gastrointestinal toxicities, including marked serum amylase and lipase elevations, nausea, and vomiting with gastritis, were prominent. The BR96-doxorubicin immunoconjugate has limited clinical antitumor activity in metastatic breast cancer. The gastrointestinal toxicities likely represent binding of the agent to normal tissues expressing the target antigen and may have compromised the delivery of the immunoconjugate to the tumor sites.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                8 February 2013
                : 8
                : 2
                : e54892
                Affiliations
                [1]Academic Department of Clinical Oncology, City Hospital Campus, University of Nottingham, Nottingham, United Kingdom
                Technische Universitaet Muenchen, Germany
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: PN IS SH TP LD. Performed the experiments: PN SH TP. Analyzed the data: PN IS SH TP LD. Wrote the paper: PN TP LD.

                Article
                PONE-D-12-25186
                10.1371/journal.pone.0054892
                3568143
                23408949
                71bc27c3-d553-49ad-a6ec-c9be51daa92b
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 August 2012
                : 17 December 2012
                Page count
                Pages: 12
                Funding
                The authors thank the MRC for funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Biochemistry
                Glycobiology
                Carbohydrates
                Glycolipids
                Immunology
                Immunoglobulins
                Medicine
                Clinical Immunology
                Immunoglobulins
                Oncology
                Cancer Treatment
                Antibody Therapy
                Immunotherapy
                Cancers and Neoplasms
                Gastrointestinal Tumors
                Colon Adenocarcinoma
                Rectal Cancer

                Uncategorized
                Uncategorized

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