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Norbert Vey from the Institut Paoli-Calmettes, Marseille, France and colleagues presented interim data at the European Society for Medical Oncology (ESMO) 2017 congress (10th September 2017 in Madrid, Spain), from a phase I First-in-Human study of flotetuzumab (MGD006), a CD123 x CD3 bispecific Dual-Affinity Re-Targeting (DART®) molecule, in patients with Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS).1
CD123, the Interleukin 3 α-chain receptor (IL3Rα), is differentially and significantly overexpressed in a majority (93%) of patients with AML and MDS. Binding of Interleukin 3 (IL-3) to CD123 can induce hematopoietic progenitor cell differentiation, proliferation and also up-regulation of anti-apoptotic proteins. Additionally, CD123 has been identified as a marker for Leukemic Stem Cells (LSCs)2, which are a small population of stem cells that have properties of differentiation, self-renewal and homeostatic control, and which contribute to the maintenance and propagation of AML. In AML, a LSC reservoir can lead to disease resistance, relapse and often death in patients.3
Flotetuzumab is a humanized DART® molecule that is generated from antibodies to CD3 and CD123. Flotetuzumab acts to redirect T cells via CD3 to target blasts cells expressing CD123. This interaction can mediate, target-effector cell association, T- cell activation, proliferation and receptor diversification.2 The proposed mechanism of action of flotetuzumab is shown in Figure 1.
Figure 1: Mechanism of action of flotetuzumab (reproduced with permission © 2017 MacroGenics, City)
In this phase 1 dose-escalation study (NCT02152956), the safety and the preliminary clinical activity of flotetuzumab was assessed in 47 patients (median age = 64 years) with Relapsed or Refractory (R/R) AML (n = 42) or intermediate-2/high-risk MDS (n = 5). The objectives of the study were to define the Maximal Tolerated Dose-Schedule and to optimize the management of Cytokine Release Syndrome using lead-in doses and anti-cytokine antibodies in order to minimize the use of corticosteroids
The lead author, Norbert Vey, concluded by stating that flotetuzumab demonstrated “an acceptable safety profile” with an MTDS at 500 ng/kg/day 7-day continuous infusion. Infusion reactions were manageable with two lead-in doses and early use of tocilizumab. Additionally, flotetuzumab demonstrated an “encouraging initial anti-leukemic activity at ≥ 500 ng/kg/day”.
Flotetuzumab was granted Orphan Drug Designation by the US Food and Drug Administration (FDA) in January 2017.
Acknowledgement: This article was developed from slides kindly provided by Professor Norbert Vey (member of the AGP European Steering Committee). Figure 1 is reproduced with the kind permission of MacroGenics.
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