mitazalimab (ADC-1013)

These encouraging results from OPTIMIZE-1 form the basis of a future randomized confirmatory trial of mitazalimab in combination with mFOLFIRINOX in mPDAC. Ethics Approval The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines as defined by the International Conference on Harmonisation, in 14 European University Hospitals according to the study protocol and amendments, approved by local Institutional Review Boards and independent ethics committees: France:Comité de protection des personnes Est I, Centre hospitalier la Chartreuse - 1 Bld Chanoine Kir, BP 23314 21033 DIJON France Belgium: CHU UCL Namur, site Godinne, Comité d'éthique, Avenue Docteur G. Thérasse 1, 5530 YVOIR Spain: The CEIm of the Ramón y Cajal University Hospital, Madrid, Spain Patients provided written informed consent before enrolment.Download figure Open in new tab Download powerpoint Abstract 592 Figure 1 OPTIMIZE-1 dosing regimen and biomarker planView this table:View inline View popup Download powerpoint Abstract 592 Table 1 OPTIMIZE-1 outcomes

P1/2, N=94, Active, not recruiting, Alligator Bioscience AB | Recruiting --> Active, not recruiting

P1, N=18, Recruiting, University of California, San Diego | Not yet recruiting --> Recruiting

Mitazalimab with mFOLFIRINOX demonstrated manageable safety and encouraging activity, warranting continued development in a phase 3, randomised, controlled trial. The results from OPTIMIZE-1 pave the way for further exploration and confirmation of a novel immunotherapy treatment regimen for metastatic pancreatic ductal adenocarcinoma, which is a complex and aggressive cancer with very low survival rates and restricted treatment options.

P1, N=18, Not yet recruiting, University of California, San Diego | Initiation date: Feb 2024 --> Jun 2024

P1/2, N=90, Recruiting, Alligator Bioscience AB | Active, not recruiting --> Recruiting | Phase classification: P1b/2 --> P1/2 | Trial primary completion date: Feb 2024 --> Feb 2025

P1, N=18, Not yet recruiting, University of California, San Diego

In this review, we present the current understanding of the mechanism of action for CD40, along with results from the clinical development of agonistic human CD40 antibodies in cancer treatment (selicrelumab, CDX-1140, APX005M, mitazalimab, 2141-V11, SEA-CD40, LVGN7409, and bispecific antibodies). This review also examines the safety profile of CD40 agonists in both preclinical and clinical settings, highlighting optimized dosage levels, potential adverse effects, and strategies to mitigate them.

Lastly, distinct patient subgroups based on the pattern of transcriptomic alterations could be identified. In summary, the data presented herein reinforce the anticipated mode of action of mitazalimab and support its ongoing clinical development.

P1, N=22, Completed, Joachim Aerts, MD PhD | Recruiting --> Completed | Trial completion date: Oct 2023 --> May 2023 | Trial primary completion date: Oct 2023 --> May 2023

Mitazalimab has a manageable safety profile with acceptable pharmacokinetic and pharmacodynamic properties. Future clinical development will evaluate combination with existing treatment options. Trial registration NCT02829099 (ClinicalTrials.gov; July 7, 2016).

P1, N=30, Recruiting, Joachim Aerts, MD PhD

Furthermore, corticosteroid pretreatment reduced the immune stimulatory activity of mitazalimab. The presented gene expression data confirms the biological activity of mitazalimab, further strengthening the proof of mechanism.

Mitazalimab, administered repeatedly together with FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil and folinic acid), synergized effectively with chemotherapy, inducing long-term survival. By converting the MB49 tumor cell line resistant to FOLFIRINOX treatment, we could further demonstrate that the combination of mitazalimab and FOLFIRINOX induced a strong anti-tumor activity also in a chemoresistant variant of the MB49 cell line.In conclusion, mitazalimab synergizes effectively with chemotherapy, leading to induction of long-term survival in a preclinical tumor model by reducing immunosuppressive M2 macrophages and improving T cell responses intratumorally. These preclinical data, together with the clinical data of mitazalimab from the phase 1 study (NCT02829099), where mitazalimab was well tolerated up to 1200 μg/kg with a manageable safety profile, support the ongoing clinical phase 2 study OPTIMIZE-1 (NCT04888312) of mitazalimab in combination with chemotherapy in pancreatic cancer.

In the ovalbumin-transfected tumor E.G7-OVA lymphoma, mitazalimab administered with either ovalbumin protein or SIINFEKL peptide prolonged the survival of E.G7-OVA tumor-bearing mice, as prophylactic and therapeutic treatment. Thus, mitazalimab activates antigen-presenting cells, which improves expansion and activation of antigen-specific T cells and enhances the anti-tumor efficacy of a model cancer vaccine.

The reduction in tumor growth and ability to reprogram the tumor microenvironment in preclinical models lays the foundation for clinical development of agonistic CD40 antibodies (APX005M, ChiLob7/4, ADC-1013, SEA-CD40, selicrelumab, and CDX-1140) that are currently being evaluated in early phase clinical trials. In this article, we focus on CD40 expression and immunity in cancer, agonistic human CD40 antibodies, and their pre-clinical and clinical development. With the broad pro-inflammatory effects of CD40 and its ligand on dendritic cells and macrophages, and downstream B and T cell activation, agonists of this pathway may enhance the anti-tumor activity of other systemic therapies.

Mitazalimab, administered repeatedly together with FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil and folinic acid), synergized effectively with chemotherapy and induced a long-term survival. Further, it was also demonstrated that mitazalimab induced a concentration-dependent activation of tumor-associated macrophages (TAMs), purified from human tumor samples, into a more tumoricidal M1 like phenotype, by upregulation of cell surface markers such as CD83.In conclusion, mitazalimab re-directs human macrophages into a M1 like tumoricidal, less immunosuppressive phenotype, and synergizes effectively with chemotherapy, leading to induction of a long-term survival in a preclinical tumor mouse model. These preclinical data, together with the clinical data of mitazalimab from the phase 1 study (NCT02829099) where mitazalimab was well tolerated up to 1200 μg/kg with manageable side effects, support further clinical development of mitazalimab in combination with chemotherapy in pancreatic cancer.

It was also reported that a CD40 agonist, SGN-40, induced direct cytotoxicity in diffuse large B cell lymphoma (DLBCL) cell lines (Burlington 2011), and clinical responses have been noted in this indication (Advani 2009). p65 and p52 fold induction was determined by Western blot of whole lysates. Representative data of 2 independent experiments are shown.