A novel case of BiTE (EGFRxCD28) plus anti-PD-1: Targeting the 'right' patients counts!
Colon cancer with microsatellite stability (MSS), 85% of patients¹, is non-responsive to anti-PD-1 therapy²⁻³. Recently, REGN7075, a EGFRxCD28 BiTE, plus anti-PD-1 showed encouraging efficacy, 6% (3/51) objective response rate (ORR); moreover, all responders were non-metastatic patients. Among the subset of non-metastatic patients (15), ORR became 20% (3/15)³. This validated our proposal that BiTE or anti-PD-1 or duo is more applicable to early-stage non-metastatic, instead of late-stage metastatic, solid-tumour cancer patients (see recent POSTs).
The wild-type (WT) EGFRs are expressed on normal and cancer cells⁴, and colon cancer expresses WT EGFR⁵. A novel EGFR mAB targeted the epitope in Domain II (CR1) of extracellular domains⁵. The Domain II is masked in quiescent EGFRs of normal tissues, yet is exposed in EGFRs of cancer cells⁵. We deduced that REGN7075 also targeted the epitopes in Domain II, resulting in minimal on-target off-tumour toxicity of normal cells.
TGN1412, a CD28 mAB, induced severe cytokine release syndrome⁶ (CRS); however, a novel CD28 mAB had shown lower CD28 affinity by targeting the epitope near the apex, instead of TGN1412's targeting the lateral epitope near cell membrane⁷. We deduced that REGN7075 also targeted the epitope near the apex of CD28, resulting in low CRS rate.
By targeting novel epitopes of EGFR & CD28 presumably, REGN7075 incurred 35% of patients with grade 3/4 adverse events³ vs typical BiTE's 62-87%⁸⁻⁹.
The CD3-based BiTE mimics signal 1 for T-cell activation by binding CD3. The CD28-based BiTE mimics signal 2 by binding the costimulatory CD28 receptor (ligands: CD80/86). The 'functional' DCs have become rare in tumour milieu and tumour itself does NOT emit danger signals to activate these rare DCs for upregulating CD80/86. Thus, there is the scarcity of CD80/86 (signal 2) in tumour milieu for properly 'reactivating' subprimed PD-1⁺ tumour-infiltrating T cells, which were initially 'subprimed' in lymph nodes by only signal 1 (see recent POSTs). By using anti-PD-1 (low dose) for T-cell 'reactivation'¹⁰ as signal 1 and CD28-based BiTE for direct CD28 binding as signal 2, the sub-primed PD-1ˡᵒʷ⁻ᶦⁿᵗ CD8⁺ T cells can resume cytotoxic effector function (granzymes and perforin) to kill tumours. Thus, Regeneron's novel duo of CD28-based BiTE plus anti-PD-1 is an encouraging therapy for early-stage non-metastatic colon cancer patients with MSS.
1. Brenner, Lancet, 2014
2. Lin, Cancer Immunol Immunother, 2023
3. https://lnkd.in/gH876tXN
4. S Khaznadar, Oncotarget
5. Gan, Cancer Res, 2012
6. S Suntharalingam, New Engl J Med
7. A Elsayed, MABS
8. Dickinson, New Engl J Med, 2022
9. Kantarjian, New Engl J Med, 2017
10. T Elliot, Immunity
#Immunotherapy #ImmunoOncology #BiTE #PD1 #Costimulation #Pharmaceutical
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