Review Article

Antibody-Based Therapies in Multiple Myeloma

Table 1

Antigens targeted by antibodies in multiple myeloma in different stages of preclinical/clinical development.

TargetBrand nameCompany/SponsorType of mAb (conjugate)PhaseRemarks

CD138B-B4-DM1ImmunoGenthe maytansinoid immunoconjugate mouse IgG1 mAb B-B4preclinicalTassone Blood 2004,104:3688–96

HM1.24humanized HM1.24Chugai PharmaceuticalhumanizedpreclincialOzaki Blood 1999,93:3922–3930

humanized HM1.24Xencor IncFc-engineered humanized IgG1preclincial

IL-6OP-R003-1, 1339 Elsilimomab, AzintrelOPi EUSA Pharma; Vaccinex licensed to Glaxo Smith Klinehuman IgG1preclincialFulciniti Clin Cancer Res 2009,15:7144–52

HLA-DR1D09C3GPC Biotech, AGhuman IgG1preclincialCarlo-Stella Cancer Res 2007

kininogenC11C1Temple University School of MedicinemousepreclincialSainz Cancer Immunol Immunother 2006 C11C1 mAb inhibits its own tumor growth in vivo, slows down B38-MM growth rate when both MM are implanted together and when mAb C11C1 is injected intraperitoneally. MAb C11C1-treated-MM showed decreased MVD and kininogen binding in vivo without FGF-2, B1R, or B2R expression changes

HLA class I2D7-DBChugai Pharmaceutical Co. Ltd.converted from mouse IgG2b, single-chain Fv diabodypreclincialSekimoto Cancer Res 2007; 67:1184–92. a recombinant single-chain Fv diabody 2D7-DB specifically induces multiple myeloma cell death in the bone marrow environment

β2-microglobulinanti-β2M mAbsMD Anderson Cancer CentermousepreclincialYang Blood 2007; 110:3028–35. & Clin Cancer Res 2009; 15:951–9. Strong apoptotic effect on myeloma cells and low toxocity in the mice suppports potential use as therapeutic agents

CD38MOR202MorphoSys AGhuman IgG1preclincialTesar et al. J. Clin Oncol 2007, 25(18S): 8106

CD32BMGA321(2B6)MacroGenicshumanized IgG1preclincialZhou Blood 2008; 111:549–557. humanized 2B6 MoAb may target in patients with systemic AL-amyloidosis. It blocks Fc engagement of CD32B and may improve the performance of other cancer Mabs when combined with them during administration

FGFR3PRO-001Prochon Biotech Ltd.human IgG1preclincialTrudel Blood 2006; 2:4908–4915. The inhibitory anti-FGFR3 antibody, PRO-001, is cytotoxic to t(4;14) MM cells and deserves further study for the treatment of FGFR3-expressing myeloma

ICAM-1cUV3Abiogenchimeric IgG1preclincialSmallshaw J Immunother 2004; Coleman J Immunother 2006 cUV3 significantly prolongs the survival of SCID/ARH-77 mice

BLySBLyS/rGelTarga TherapeuticsFusion protein of an antibody tethered to a toxinpreclincialLyu et al. Mol Cancer Ther 2007; 6:460–70

TACIAtacicept (TACI-Ig)ZymoGenetics Inc.fusion proteinpreclincialYaccoby Leukemia 2008 22, 406–413

CD70SGN-70Seatle Geneticshumanized IgG1preclincialMcEarchern Clin Cancer Res 2008 14, 7763–72

TRAIL-R2(DR5)lexatumumabHuman Genome ScienceshumanpreclincialMenoret et al. Blood 2006;132: 1356–62

IL-6RNRI (engineered Tocilizumab)Roche Pharmaceuticalsa single-chain fragment format dimerized by fusing to the Fc portion of human immunoglobulin G1preclincialYoshio-Hoshino Cancer Res 2007; 67:871–5. the NRI gene introduction combined with adenovirus gene delivery inhibited the in vivo S6B45 cell growth significantly

BCMASG1Seatle GeneticsAuristatin-BCMA mAbpreclincialRyan et al. Mol Cancer Ther 2007; 6:3009–18

matriptaseM24-DOXUMDNJ—The Cancer Inst. of New Jerseyimmunoconjugate with doxorubicinpreclincialBertino et al. 2010 AACR abtract no. 2596. M24-DOX is as potent as free doxorubicin to inhibit the growth of MM cells. But target delivery of doxorubicin by the matriptase antibody significantly reduced the toxicity toward cardiomyocytes that lack matriptase expression

IL-1betaXOMA 052XOMA (US) LLCHuman Engineered IgG2preclincialLust 2010 AACR abstract no. 2449. XOMA 052 is highly effective at inhibiting IL-1 induced IL-6 production in myeloma patients in vitro

CD20RituxanNCI & Memorial Sloan-Kettering Cancer Centerchimeric with a human IgG1 FcII (ongoing)NCT00258206 (with cyclophosphamide): NCT00505895. High-dose cyclophosphamide in combination with rituximab in patients with primary refractory, high-risk, or relapsed myeloma, also being studied for the treatment of peripheral neuropathy in patients with MGUS

CD20Zevalin (yttrium Y 90 ibritumomab tiuxetan)NCImouse IgG1I (ongoing)NCT00477815: Zevalin radioimmunotherapy with high-dose melphalan and stem cell transplant for MM

CD40SGN-40 (Dacetuzumab)Seatle Genetics/Genentechhumanized IgG1I b (ongoing)NCT00664898: safety and pharmacology of SGN-40 administered in combination with Bortezomib (Velcade, PS-341) in patients with relapsed or refractory MM. NCT00525447 is the study of SGN40, lenalidomide, and dex in MM patients

CD40HCD122 (Lucatumumab)Novartishuman IgG1I (ongoing)NCT00231166 Dose-finding trial of HCD122 in MM patients that is relapsed or has not responded to prior therapy

CD20Bexxar (131-tositumomab)GlaxoSmithKlineradioactive iodine 131 attaching to anti-CD20; muIgG2a (131)II (ongoing)NCT00135200: to see whether the treatment with Bexxar will decrease and possibly eliminate residual myeloma cells resistant to chemotherapy

CD56BB-10901 (IMGN901)ImmunoGen, Inc.humanized (maytansine DM1 conjugation)I (ongoing)NCT00346255: given as an intravenous infusion weekly for two consecutive weeks every three weeks to relapsed and relapsed refractory CD56-positive MM; NCT00991562: IMGN901 in combination with lenalidomide and dexamethasone

RANKLDenosumabAmgenhuman IgG2II/III (ongoing)NCT00259740: to determine if denosumab is effective in the treatment of relapsed or plateau-phase MM; NCT00104650: to determine the effectiveness of AMG 162 in reducing urinary N-telopeptide in advanced cancer subjects with bone metastases; NCT00330759: Phase III Study of Denosumab Compared With Zoledronic Acid (Zometa) in the Treatment of Bone Metastases in Subjects With Advanced Cancer (Excluding Breast and Prostate Cancer) or MM

VEGFAvastin beuacizumabGenentechhumanizedII (ongoing)NCT00428545 (in combination with bortezomib); NCT00410605 (added with lenalidomide and dexamethasone)

CD52Campath-1H (alemtuzumab)NCI; Fred Hutchinson Cancer Research InstitutehumanizedII (ongoing)NCT00625144: studying the side effects of giving fludarabine and busulfan together with alemtuzumab followed by donor stem cell transplant and to see how well it works in treating patients with hematological cancer or other disease

IL-6CNTO 328Centocor, Incchimerized IgG1I/II (ongoing)NCT00401843 (in combination with bortezomib); NCT00911859 (added with Velcade-Melphalan-Prednisone); NCT00402181 (in combination with dexamethason)

IL-6B-E8 (Elsilimomab)Orphan Pharma International and Diaclone SAmurineIIPreliminary efficacy was seen but there is a limitation for the clinical use of a murine monoclonal antibody since it frequently induces human anti-mouse antibodies (HAMA)

IL-6RMRA (Tocilizumab)Roche PharmaceuticalshumanizedII

TRAIL-R1(DR4)Mapatumumab(TRM-1)Human Genome ScienceshumanII (ongoing)NCT00315757 (in combination with bortezomib)

EGFRErbitux(EMMA-1)Imclone; Bristol Meyers-SquibbchimerizedII (ongoing)NCT00368121 (in combination with dexamethasone)

CS1elotuzumab/HuLuc63Facet Biotech; Bristol-Myers SquibbhumanizedI /II (ongoing)NCT00742560 & NCT00726869 (in combination with bortezomib)

CD38HuMax-CD38Genmabhuman IgG1I/II (ongoing)NCT00574288: to establish safety profile of HuMax-CD38, given as monotherapy in patients with MM relapsed or refractory to at least 2 different cytoreductive therapies and without further established treatment options

CD38SAR650984Sanofi-Aventis; ImmunoGenhumanized IgG1I (ongoing)NCT01084252: to determine the maximum tolerated dose (MTD)/maximum administered dose (MAD)

DKKBHQ880Novartishuman IgG1I/II (ongoing)NCT00741377: in combination with Zoledronic Acid in relapsed/refractory myeloma

CD138BT062Biotest; ImmunoGenchimeric (B-B4-maytansinoid DM4)I (ongoing)NCT00723359

the activin receptor type IIA (ActRIIA)ACE-011Acceleron Pharma, Inchuman IgG1I/IIa (ongoing)NCT00747123 (in patients with osteolytic lesions with MM)

IGF-1RAVE1642Sanofi-AventishumanizedI/II (ongoing)Descamps et al. (B J Cancer 2009; 100:366) Anti-IGF-1R Monoclonal Antibody combined with bortezomib for patients with rel/ref MM

Ganglioside GM2BIW-8962BioWa, IncorporatedhumanizedI/II (ongoing)Dosing study of anti-GM-2 ganglioside (expressed at high levels on the surface of MM cells) followed by efficacy study

CD74 (variant MHC II)milatuzumab (hLL1, IMMU-110)Immunomedics, Inc.humanized IgG1 or humanized IgG1 doxorubicin conjugateI/II (ongoing)NCT00421525: in patients with recurrent or refractory multiple myeloma who have failed at least two prior standard systemic treatments. Its isotope, drug, and toxin conjugates have high antitumor activity in non-Hodgkin's lymphoma and multiple myeloma in vitro and in tumor xenograft models. Stein et al. 2007 & 2009

Alpha-4 integrinnatalizumab (Tysabri)Biogen Idechumanized IgG4I/II (ongoing)NCT00675428: patients with relapsed or refractory multiple myeloma

MHC II (HLA-DR)1D09C3GPC Biotechhuman IgG4ICarlo-Stella et al. 2007 showed that IFN-gamma-induced up-regulation of HLA-DR results in a potent enhancement of the in vivo antimyeloma activity of 1D09C3 in mice. Initial clinical testing with 1D09C3 has not raised any unexpected or unacceptable safety concerns and the maximum tolerated dose has not yet been reached. GPC Biotech has decided to not put further internal resources into developing 1D09C3 due to potential swapping of IgG4 antibody one half of its Y-shaped structure with the half of a different antibody, thus resulting in a new molecule whose properties are unknown. However, the Company will seek a partner for the intellectual property relating to this program

IGF-1RCP-751,871/figitumumabPfizerhuman IgG2ILacy et al. (J. Clin Onclo 26:3196) reported that CP-751,871 is well tolerated and may constitute a novel agent in the treatment of multiple myeloma

KIRIPH 2101Innate Pharmahuman IgG4I/IIa (ongoing)NCT00552396 (ASCO May 30 2009 abstract 09-AB-3032) safety and tolerability study for patients with relapsed/refractory MM. Preclinical characterization of 1-7F9, a novel human anti-KIR therapeutic antibody that augments NK-mediated killing of tumor cells (Romagne et al. 2009)

Every effort has been made to obtain reliable data from multiple sources including http://clinicaltrials.gov/, company, and other web sites, but accuracy cannot be guaranteed.