In this thesis, mathematical modeling and simulation was applied as a tool to inform quantitative decision making in oncology drug discovery and development. Modeling based approaches were shown to... Show moreIn this thesis, mathematical modeling and simulation was applied as a tool to inform quantitative decision making in oncology drug discovery and development. Modeling based approaches were shown to be useful to understand the mechanism of action and deconvolve the complexities of novel biotherapeutic modalities being used to treat cancer, including monospecific and bispecific monoclonal antibodies and antibody drug conjugates. Several key observations and learnings were made. For example, modeling was shown to be a useful method to reduce animal experimentation, by enabling in vitro to in vivo correlations or use of simulation to replace experimental methodologies. Mechanism based modeling and simulation was found to be a useful means to translate from preclinical studies to the clinic to ensure progression of the best drug to clinical trials. These models could then be used to optimize design of clinical studies from selection of starting doses to recommended efficacious doses for pivotal trials. Modeling was shown to be beneficial to understand variability in the clinic and to identify factors impacting drug response in individual patients, paving the way for precision medicine strategies, informing clinical diagnostics, biomarkers, and doses for different oncology indications. Show less
Background: DuoBody (R)-CD3xCD20 (GEN3013) is a full-length human IgG1 bispecific antibody (bsAb) recognizing CD3 and CD20, generated by controlled Fab-arm exchange. Its Fc domain was silenced by... Show moreBackground: DuoBody (R)-CD3xCD20 (GEN3013) is a full-length human IgG1 bispecific antibody (bsAb) recognizing CD3 and CD20, generated by controlled Fab-arm exchange. Its Fc domain was silenced by introduction of mutations L234F L235E D265A.Methods: T-cell activation and T-cell-mediated cytotoxicity were measured by flow cytometry following co-culture with tumour cells. Anti-tumour activity of DuoBody-CD3xCD20 was assessed in humanized mouse models in vivo. Non-clinical safety studies were performed in cynomolgus monkeys.Findings: DuoBody-CD3xCD20 induced highly potent T-cell activation and T-cell-mediated cytotoxicity towards malignant B cells in vitro. Comparison of DuoBody-CD3xCD20 to CD3 bsAb targeting alternative B-cell antigens, or to CD3xCD20 bsAb generated using alternative CD20 Ab, emphasized its exceptional potency. In vitro comparison with other CD3xCD20 bsAb in clinical development showed that DuoBody-CD3xCD20 was significantly more potent than three other bsAb with single CD3 and CD20 binding regions and equally potent as a bsAb with a single CD3 and two CD20 binding regions. DuoBody-CD3xCD20 showed promising anti-tumour activity in vivo, also in the presence of excess levels of a CD20 Ab that competes for binding. In cynomolgus monkeys, DuoBody-CD3xCD20 demonstrated profound and long-lasting B-cell depletion from peripheral blood and lymphoid organs, which was comparable after subcutaneous and intravenous administration. Peak plasma levels of DuoBody-CD3xCD20 were lower and delayed after subcutaneous administration, which was associated with a reduction in plasma cytokine levels compared to intravenous administration, while bioavailability was comparable.Interpretation: Based on these preclinical studies, a clinical trial was initiated to assess the clinical safety of subcutaneous DuoBody-CD3xCD20 in patients with B-cell malignancies. (C) 2020 The Authors. Published by Elsevier B.V. Show less
Antibody drug conjugates (ADCs) are emerging as powerful anti-cancer treatments. They are designed to combine the tumor specificity, pharmacokinetics and biodistribution properties of antibodies... Show moreAntibody drug conjugates (ADCs) are emerging as powerful anti-cancer treatments. They are designed to combine the tumor specificity, pharmacokinetics and biodistribution properties of antibodies with the potent cell-killing activity of small molecules. The approval of brentuximab vedotin (Adcetris) for the treatment of Hodgkin lymphoma and trastuzumab emtansine (Kadcyla) for the treatment of metastatic breast cancer has spurred clinical development of ADCs. As the field of ADCs is rapidly emerging, a better understanding of the requirements needed for optimal intracellular delivery of ADCs seems mandatory. The aim of this thesis was to better understand the antibody and antigen requirements that are needed for effective ADC treatment. Different tumor antigens and targeting antibodies were compared for their capacity to deliver a cytotoxic payload to tumor cells, uncovering general mechanisms. In the course of this work, TF was identified as an excellent ADC target because of its rapid internalization and lysosomal targeting characteristics. Furthermore we have explored a novel Ab platform that improves the intracellular delivery of cytotoxic payloads. These findings provide a better insight in the Ab and antigen requirements needed for optimal payload delivery and support the development of novel and further improved ADCs for the treatment of cancer. Show less
