Final Analysis of Chimeric Fibril-Reactive Monoclonal Antibody 11-1F4 in Pts with RR Amyloidosis
Description: Final Analysis of the Phase 1a/b Study of Chimeric Fibril-Reactive Monoclonal Antibody 11-1F4 in Patients with RR Amyloidosis
Suzanne Lentzsch, MD, PhD
Columbia University Medical Center
New York, NY, USA
Background: AL amyloidosis has a very poor prognosis with a variable median survival of 12 to 18 months depending largely on the severity of organ involvement. Current treatment focusing on eliminating the plasma cell clone that produces amyloidogenic light chains have improved overall survival in these patients [Kumar 2011]. However, the risk of early mortality remains high due to multi-organ dysfunction caused by persistent, insoluble amyloid fibril deposits. To address this, amyloid fibril-reactive monoclonal antibody (mAb) 11-1F4 was designed to target amyloid deposits by directly binding to a conformational epitope present on human light-chain amyloid fibrils. The mAb was tested in a murine (Mu) and later a chimeric (Ch) form in mice with induced human AL amyloidomas; to which there was rapid destruction of amyloid fibrils without any evidence of toxicity in the animals [Hrncic 2000; Solomon 2003]. Confirmation of the mAb’s specificity for amyloid fibrils was further demonstrated when the I-124 labeled Mu mAb was visualized in amyloid-laden organs on PET/CT imaging in human subjects [Wall 2010]. These promising results led to the development of GMP-grade amyloid fibril-reactive chimeric IgG1 mAb 11-1F4 by NCI’s Biological Resource Branch. Here we report the final data from the open-label, dose-escalation phase 1a/b study of Ch IgG1 mAb 11-1F4 (NCT02245867).
Conclusions: We found that mAb 11-1F4 is well tolerated and safe without grade 4 or 5 AEs nor dose limiting toxicity (MTD of 500mg/m2). Moreover, we postulate that in patients with persistent organ dysfunction after plasma-cell directed therapy; mAb 11-1F4 leads to fast, early and sustained organ response. Overall, amyloid fibril targeted therapy with mAb 11-1F4 represents both a promising and innovative approach to the management of patients with AL Amyloidosis. The rapid destruction of amyloid fibrils by mAb 11-1F4 can improve organ function and, potentially improve mortality in patients with this uniformly fatal disease. Larger randomized trials to evaluate the efficacy of this mAb are planned.
Camille Vanessa Edwards, MBBS, BSc, Julia Gould, BA, Arielle L Langer, MD, MPH, Markus Y Mapara, MD, PhD, Jai Radhakrishnan, MD, Mathew S. Maurer, MD, Shahzad Raza, MD, John G. Mears, MD, Siyang Leng, MD, Jonathan S. Wall, PhD, Andrew Eisenberger, MD, Alan Solomon, MD and Suzanne Lentzsch, MD, PhD