Adcetris
brentuximab vedotin · CD30Anti-drug antibodies (PAHA) in monkeys reduced ADC exposure but increased MMAE exposure without added toxicity
Trodelvy: which risks did reviewers probe?
sacituzumab govitecan · Trop-2
Immune & cytokine safety
ADA in all monkeys at all doses in 13-week study, reducing low-dose exposure; reduced thymic/lymphoid cellularity
“Anti-drug antibodies were detected in all animals at all doses tested in the chronic toxicity study.”
Biodistribution & persistence
Mouse xenograft: radiolabeled ADC to tumour plus liver, spleen, kidney, lung; SN-38 released in serum (t1/2 ~1-2 days); free SN-38 ~2.3% of total
“In addition to tumour, both hRS7 and sacituzumab govitecan distributed to normal tissues, primarily to liver, spleen, kidney and lungs among the normal tissues analysed.”
Modality-specific risk
SN-38 payload myelosuppression and GI toxicity (UGT1A1-dependent), Trop-2-dependent skin toxicity; hydrolysable linker releases payload
“Findings in the gastrointestinal tract and reductions in white blood cells are known toxicities of irinotecan-derived SN-38. Findings in skin may represent Trop-2-dependent toxicity.”
Anti-drug antibodies: animals
ADA in all treated monkey groups; reduced exposure mainly in the low-dose group
“ADA were detected in all sacituzumab govitecan treated groups and appeared to affect primarily the exposure in the low dose group, as exposures to total Ab, total SN-38 and free SN-38 were lower on after last dose compared to the first dose.”
Anti-drug antibodies: patients
1.2% (13/1058) treatment-emergent ADA (single agent); 77% of ADA-positive neutralizing
“Among patients who received TRODELVY as a single agent over a median 5-month treatment period across 5 clinical studies, 1.2% (13/1058) of patients developed treatment-emergent ADA to sacituzumab govitecan and 77% (10/13) of ADA-positive patients developed neutralizing antibodies against sacituzumab govitecan.”
Same question, other ADCs
Besponsa
inotuzumab ozogamicin · CD22Low ADA incidence in rats (10-13%); no ADA detected in monkeys
Datroway
datopotamab deruxtecan · Trop-2ADA in 5/6 monkeys at 10 mg/kg reducing exposure; minimal in vitro cytokine release; transient CRP increases
Decnupaz
pivekimab sunirine · CD123ADA in monkeys reduced exposure; thymic lymphoid depletion and lymphopenia; ADCC present in vitro
Elahere
mirvetuximab soravtansine · FRαNo ADA in any monkey up to 8 mg/kg; bone marrow and lymphoid depletion; no stand-alone immunotox
Emrelis
telisotuzumab vedotin · c-MetNo substantial cytokine release from human PBMC; no ADA in 13-week monkey study; low C1q, no complement activation
Enhertu
fam-trastuzumab deruxtecan · HER2No treatment-emergent ADA in rat or monkey studies; ADCC activity retained in vitro
Kadcyla
ado-trastuzumab emtansine · HER2No ADA detected after single dose in monkey safety pharmacology study; ADA assessed across monkey studies
Mylotarg
gemtuzumab ozogamicin · CD33ADA in rats (reduced exposure) and some monkeys; marked eosinophilia and hypersensitivity reactions in monkeys
Padcev
enfortumab vedotin · Nectin-4ADA in rats and monkeys reduced exposure on repeat dosing; no ADCC/CDC, ADCP activity in vitro
Polivy
polatuzumab vedotin · CD79bSurrogate ADC depleted B cells (expected pharmacology); ADA in monkeys without exposure impact
Tivdak
tisotumab vedotin · Tissue factorADA in most monkeys after repeat dosing, reduced exposure in some; immunotoxic potential minimal
Zynlonta
loncastuximab tesirine · CD19Pro-inflammatory responses (WBC, fibrinogen, multi-organ inflammation) typical of PBD ADCs; ADA in few monkeys