Development of antibody based therapeutics translational considerations challenges mohammad a. tabri
Development of Antibody Based Therapeutics Translational Considerations Challenges Mohammad A. Tabrizi
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Antisense-based drugs and therapeutics: preclinical and clinical considerations for development Ferrari
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1 Introduction 1
Mohammad A. Tabrizi
2 Translational Considerations and Challenges: An Overview 5
Vaishnavi Ganti and Mohammad A. Tabrizi
3 Considerations for Construct and Affinity Design Goals 19
Mohammad A. Tabrizi and Scott L. Klakamp
4 Epitope Characterization and Isotype Selection 41
Gopalan Raghunathan, Edward Hsieh, and Grigori Ermakov
5 Biophysical Considerations for Development of Antibody-Based Therapeutics 71
Andrew W. Drake, Yasmina N. Abdiche, and Giuseppe A. Papalia
6 Novel Technologies for Generation of Bispecific Constructs . . . . . . . 133
Laurence Fayadat-Dilman
7 Stimulus-Response Mechanisms: An Overview . . . . .
Mohammad A. Tabrizi, Shraddha S. Sadekar, Isabel Figueroa, and Ayse M. Ovacik
8 Evaluation of Tumor Growth Inhibition in Preclinical Tumor Models: A Quantitative Approach .
Shraddha Sadekar, Isabel Figueroa, and Harish Shankaran
9 Application of Proof-of-Mechanism Biomarkers (POM) in Design and Development of Biologics Modalities .
Glareh Azadi, Gulesi Ayanoglu, Vaishnavi Ganti, Harish Shankaran, and Mohammad A. Tabrizi
10 Antibody Drug Conjugates: Translational Considerations. .
Mohammad A. Tabrizi, Isabel Figueroa, Wendy Blumenschein, and Jeff Grein
161
11 Application of PK-PD Modeling and Simulation Approaches for Immuno-Oncology Drugs
207 Xiaochen Zhao, Xiaoning Wang, Yan Feng, Shruti Agrawal, and Dhaval K. Shah
12 Translational Biomarkers: Application in the Clinical Development of Combination Therapies
223 Selvakumar Sukumar and Niña G. Caculitan
Correction to: Considerations for Construct and Affinity Design Goals
Contributors
Yasmina N. Abdiche Carterra, Inc., Salt Lake City, UT, USA
Shruti Agrawal Clinical Pharmacology and Pharmacometrics, Bristol-Myers Squibb, Princeton, NJ, USA
Gulesi Ayanoglu Merck & Co., Inc., Palo Alto, CA, USA
Glareh Azadi Merck & Co., Inc., Palo Alto, CA, USA
Wendy Blumenschein Merck & Co., Inc., Palo Alto, CA, USA
Gadi G. Bornstein Biologics Discovery, TESARO, Waltham, MA, USA
Niña G. Caculitan Gritstone Oncology, Emeryville, CA, USA
Andrew W. Drake Compugen Inc., South San Francisco, CA, USA
Grigori Ermakov Bioanalytics, Merck Research Laboratories, Palo Alto, CA, USA
Laurence Fayadat-Dilman Merck & Co., Inc., Palo Alto, CA, USA
Yan Feng Clinical Pharmacology and Pharmacometrics, Bristol-Myers Squibb, Princeton, NJ, USA
Isabel Figueroa Department of Preclinical Translational Pharmacokinetics, Genentech, South San Francisco, CA, USA
Vaishnavi Ganti Merck & Co., Inc., Palo Alto, CA, USA
Jeff Grein Merck & Co., Inc., Palo Alto, CA, USA
Edward Hsieh Bioanalytics, Merck Research Laboratories, Palo Alto, CA, USA
Scott L. Klakamp SKD Consulting LLC, Broomfield, CO, USA
Ayse M. Ovacik Department of Preclinical Translational Pharmacokinetics, Genentech, South San Francisco, CA, USA
Giuseppe A. Papalia Gilead Sciences Inc., Foster City, CA, USA
Gopalan Raghunathan Protein Sciences, Merck Research Laboratories, Palo Alto, CA, USA
Shraddha S. Sadekar Department of Preclinical Translational Pharmacokinetics, Genentech, South San Francisco, CA, USA
Dhaval K. Shah Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
Harish Shankaran Merck & Co., Inc., Palo Alto, CA, USA
Selvakumar Sukumar CSL Behring, King of Prussia, PA, USA
Mohammad A. Tabrizi Merck & Co., Inc., Palo Alto, CA, USA
Xiaoning Wang Clinical Pharmacology and Pharmacometrics, Bristol-Myers Squibb, Princeton, NJ, USA
Xiaochen Zhao Clinical Pharmacology and Pharmacometrics, Bristol-Myers Squibb, Princeton, NJ, USA
Introduction
Mohammad A. Tabrizi
“Life is like riding a bicycle. To keep your balance you must keep moving.”
—Albert Einstein
Abstract
This book will expand on the content provided in the First Edition (Development of Antibody-Based Therapeutics: Translational Considerations, 1st Edition, 2012). Although the first publication provided a comprehensive review of the critical topics relevant for development of antibody-based therapeutics, this Second Edition will provide in-depth coverage of the key topics related to development of targeted therapeutics with key focus on the recent developments in the field. Recent advances span development of targeted modalities in exciting therapeutic areas such as immuno-oncology (IO) and application of combination therapies, novel technologies, and advances in therapeutic application of antibody-drug conjugates. We hope that this collection has successfully captured new advances relevant to the development of targeted therapeutics and will provide interested reader with an advanced knowledge of the field.
M. A. Tabrizi et al. (eds.), Development of Antibody-Based Therapeutics, https://doi.org/10.1007/978-981-13-0496-5_1
1.1 Prelude
Biologics are one of the fastest growing subsets of pharmaceuticals today. In 2016, ten monoclonal antibodies were approved by the FDA for diverse conditions such as psoriasis and cancer. This high number of approvals followed the previous record number of approvals of ten monoclonal antibodies in 2015. The high approval rate for biologics is a testament to advances in antibody technology and the unique advantage that this class of therapeutics can offer. In addition to monoclonal antibodies, other biologics such as antibody-drug conjugates, multi-specific constructs, and antibody-derived modalities are also being considered as viable drug candidates for development. With so many players in the market, it becomes imperative to have an efficient and effective translational approach early on in the drug development process. Clarity on patient-related variables, construct manufacturing considerations, underlying pharmacology and pathophysiology, as well as integration of key translational considerations can accelerate drug development processes, ultimately benefiting patients in need of such therapies.
With advances in antibody technology, it is possible to rapidly and effectively generate highly tailored and specific antibody-based therapeutics that interact with a diverse array of soluble or cell-associated antigen targets. Biologics and antibodybased therapeutics are becoming progressively complex. With such complexities in the design of novel constructs, foundational and robust approaches in translation of preclinical data in support of the later stages of drug development are becoming increasingly vital. Understanding of target biology across species and application of a science-based approach for integration of pharmacology principles are an essential cornerstone for translational efficiency across species. Hence, an important question to be addressed from early stages of lead selection is to identify and establish an efficient translational strategy for successful development of such novel constructs.
Antibody-drug conjugates (ADCs) are increasingly employed as novel targeted therapies. Translational challenges important for ADCs are highly specific and require establishing an integrated approach for evaluation of many relevant variables. Antibody-drug conjugates combine the exquisite selectivity of targeted antibodies and the high potency of small molecule drugs with the aim of achieving durable responses in patients. As application of highly potent small molecule drugs can be limited by their undesirable toxicity, targeted delivery of highly potent small molecule drugs to specific cells is intended to augment the therapeutic window for the payload in the clinical setting. A successful transition of ADCs into the clinic will be highly dependent on effective translation of critical attributes governing exposure-response relationships across species. Similarly, combination therapies, using single agents, could benefit from the “synergistic” effect profile and offer a unique spatial configuration where each construct can engage the intended target in a flexible manner. However, multi-specific modalities may not benefit from a similar spatial flexibility to engage targets in a comparable manner. Therefore, translational challenges important for this class of molecules are highly specific and require establishing novel design and development approaches.
M. A. Tabrizi
Inclusion of pharmacology principles in drug development is a foundational step for effective modality design and selection of antibody-based therapeutics. Clarity on patient-related variables, manufacturing considerations, underlying biology and pathophysiology, as well as integration of key translational variables can accelerate drug development processes, ultimately benefiting patients in need of such therapies. Establishing design goals with respect to antibody affinity is a necessary step and should be incorporated into the development strategies from the earliest stages of the discovery process for biologic modalities. Evaluation of affinity design goals is a complex process contingent on many critical variables. Knowledge of the target antigen biology and its role in the pathogenesis of disease is of high importance for achieving this objective. Selection of the adequate affinity for a functional biologic construct should allow achievement of the maximum therapeutic benefit at a dose associated with a manageable cost of goods.
Additionally, the post-genomic era has witnessed the emergence of new and improved state-of-the-art technologies to characterize structure-function relationships. The emergence of these technologies has been further facilitated by faster computer processors, expanded memory, increased storage capacity, and newer algorithms. The need to obtain critical information on protein structures has resulted in significant improvements in methods such as protein crystallography and NMR (nuclear magnetic resonance). Bi- and multi-specific molecules can be differentiated from traditional monoclonal antibodies as they are able to bind multiple antigen targets simultaneously. These modalities may offer additional advantages with respect to target engagement that may not be feasible by traditional combination therapies with single agents. Therefore, design of multi-specific constructs requires particular attention to target and drug selection for successful application of this class of therapeutics. In the past, progress in advancing bispecific molecules into the clinical arena was slow, mainly due to challenges associated with generating bispecific molecules in sufficient quality and quantity. However, due to recent progress in rapidly evolving technologies that encompass state-of-the-art engineering, production, and development of recombinant protein scaffolds, development of novel bispecific modalities has witnessed exponential growth.
With the progress in cancer immunotherapy, it is now evident that antigenspecific activation of patients’ immune responses can be utilized for achieving significant therapeutic benefits. Novel molecules have been developed, and promising advances have been achieved in cancer therapy. The latest success of cancer immunotherapy clearly reflects the novelty of the approach and importance of this class of therapeutics. Due to the nature of immunotherapy, i.e., harnessing the patient’s immune system, it becomes critical to evaluate the important variables that can guide preclinical development, translational strategies, patient selection, and effective clinical dosing paradigms following single and combination therapies. There is now considerable interest in evaluation of the key regulatory mechanisms involved in activation of the immune system while identifying sources of variability in the clinical response to such therapies. Hence, it is evident that application of quantitative approaches can highly enhance knowledge regarding the underlying variables important for designing effective dosing strategies in IO therapies.
A critical consideration during the development of antibody-based therapeutics is selection and evaluation of relevant biomarkers during early preclinical stages. Effective application of biomarkers not only lessens the time and cost associated with the drug development process but also fosters implementation of rational development progress throughout various development phases. When appropriate immunoassay methodologies are available, relationships between antibody pharmacokinetics (PK) and the ensuing effects on biomarkers can be effectively examined. Evaluation of exposure-response relationships in vivo can provide invaluable information with respect to antibody potency and the pharmacodynamic response efficiency. Additionally, development of appropriate safety markers early in drug development can result in a higher probability of success for new drug candidates. As the overarching goal of cancer therapy is to effectively eradicate cancer in a manner that is tolerable and safe for use in the intended patient population, application of biomarkers can facilitate effective patient selection with a positive impact on the final therapeutic outcome. Additionally, combination therapies for the treatment of cancer have emerged as an effective way to anticipate and overcome cancer heterogeneity and resistance. With the emergence of cancer immune therapy, clinical trials for the combination of traditional oncology drugs and immune checkpoint inhibitors are ongoing.
Drug discovery and development, much like Einstein’s quote on “life adventures similarity to riding a bicycle”, are an analogous process. Despite numerous setbacks, we as scientists “must keep moving.” In this book, we have attempted to provide a comprehensive discussion of various topics that highlight the progress in the field and are critical for establishing successful strategies for the development of antibody-based therapeutics. An understanding of the relationship between the “unit dose” and “unit effect” with respect to both beneficial and deleterious effects is essential for developing an effective translational strategy that will deliver a superior therapeutic candidate into clinical development. With this objective in mind, we have carefully assembled topics that highlight a science-based approach with the underlying theme of “translatability” throughout the various drug development phases. The ensuing chapters were prepared by scientific experts in the field to whom we are greatly indebted for their valuable contributions to enable publication of this unique book. Each chapter has a particular focus on a specific relevant topic for the development of antibody-based therapeutics. Although some topics may not appear to be directly concerned with translational considerations or are technical in nature, addressing the ancillary aspects of antibody-drug discovery and development provides the reader with a broader understanding of the strategies involved in the drug development process of these agents. We envision that someone who has little if any current knowledge about therapeutic antibodies will be able to use both publications as valuable references and glean substantial insights from leading scientists across a broad range of expertise.
Let the beauty of what we love be what we do.
—Rumi
M. A. Tabrizi
Translational Considerations and Challenges: An Overview
Vaishnavi Ganti and Mohammad A. Tabrizi
Abstract
Biologics are one of the fastest growing subsets of pharmaceuticals today. In 2016, ten monoclonal antibodies were approved by the FDA for diverse conditions such as psoriasis and cancer. This high number of approvals followed the previous record number of approvals of ten monoclonal antibodies in 2015. Such high approval rate for biologics is a testament to advances in antibody technology and the unique advantage that this class of therapeutics offers. In addition to monoclonal antibodies, other biologics such as antibody-drug conjugates, multi-specific constructs, and antibody-derived modalities are also being considered as viable drug candidates for development. With so many players in the market, it becomes imperative to have an efficient and effective translational approach early on in the drug development process. Clarity on patient-related variables, construct manufacturing considerations, underlying pharmacology and pathophysiology, as well as integration of key translational considerations can accelerate drug development processes, ultimately benefiting patients in need of such therapies. In the previous edition of this book (First Edition), translational considerations for development of antibody-based therapeutics were discussed. This publication deals with topics related to novel and more complex modalities.
M. A. Tabrizi et al. (eds.), Development of Antibody-Based Therapeutics, https://doi.org/10.1007/978-981-13-0496-5_2
2
2.1 Introduction
Biologics are one of the fastest growing subsets of pharmaceuticals today. In 2016, various monoclonal antibodies were approved by the FDA for diverse conditions such as psoriasis and cancer. This trend followed the previous record number of approvals of many monoclonal antibodies in 2015. Such high approval rate for biologics is a testament to advances in antibody technology and the unique advantage that this class of therapeutics offers. Biologics and antibody-based therapeutics are becoming progressively more complex. Increasingly, drug candidates are designed to address multiple targets simultaneously. With such complexities in the design of novel constructs (Fig. 2.1), foundational and robust approaches in translation of preclinical data in support of the later stages of drug development are becoming increasingly vital. Understanding of target biology across species and application of a science-based approach for integration of pharmacology principles are essential cornerstones for translational efficiency across species. Hence, an important question to be addressed from early days of lead selection is to identify and establish an efficient translational strategy for successful development of such novel constructs.
Translational considerations for development of drug candidates, small molecules or biologics, should encompass considerations as related to (a) therapeutic application and target patient population, (b) cost of goods, (c) relevance of species selection, and (d) nuances in the pharmacological system response that define the relationships between the “unit dose” and the “unit effect” across species (First Edition). Hence, a clear understanding of the target antigen biology and its role in
Surrogate/ Transgenic models
Fig. 2.1 Construct complexity and selection of the pharmacologically relevant species
V. Ganti and M. A. Tabrizi
the pathogenesis of disease is of primary importance. Surveying appropriate tissues for validation of target expression by immunohistochemistry, or equivalent methodologies, is vital to establishing disease linkage, and verifying the target antigen is not abundantly expressed in normal tissues. Also, functional validation of the target is critical in appropriate disease models. Functional redundancy of the target is an additional consideration; if the target antigen belongs to a conserved protein family, down-modulation of the target may not result in the desired phenotypic outcome. However, interpretation of the preclinical findings and implications for human disease obtained from preclinical models is rarely straightforward and is limited by various factors such as choice of species, target properties, drugs’ mode of action (MOA; viz., construct-related factors: cytotoxic vs. cytostatic properties, immune modulation requirements, effect-site localization, biodistribution, and PD system efficiency). For example, with immuno-oncology drugs, the presence and comparability of the functional immune system are essential for translation of the immunerelated effects; hence, considerations regarding the pharmacological differences in immune function and activation across species are of great significance.
Establishing relevant bioanalytical (BA) methodologies from early preclinical stages is necessary for implementation of effective strategies and successful translation of information into the later drug development phases (Tabrizi et al. 2010). Robust and effective BA methodologies assist in addressing important questions regarding PK, immunogenicity (IM), and PD of drug candidates. Moreover, BA methodologies are critical for translation of exposure-response data from preclinical efficacy and nonclinical safety studies in support of the effective design of firstin-human clinical programs. To achieve these objectives, BA methods must be well characterized and provide a certain degree of robustness even at early stages of preclinical development. Evaluation of relevant biomarkers in appropriate animal models can greatly enhance translation of exposure-response relationships across species. When appropriate immunoassay methodologies are available, relationships between construct exposure and the ensuing effects on proof-of-mechanism and proof-of-principle biomarkers can be effectively examined (see First Edition, Chap. 13). Application of biomarkers should guide the selection of safe and effective firstgeneration leads for advancement through various development stages. Additionally, relevant biomarkers can further provide a clear opportunity for evaluation of differentiating characteristics relevant to development of second-generation antibodybased candidates and drive lead evaluation during the preclinical phases.
Characterization of safety in relevant species is pivotal to effective translational strategies. The purpose of preclinical safety evaluation for small and large molecules is to identify potential risks to humans. These data are used to recommend a safe starting dose and guide dose escalation schemes, as well as other risk mitigation strategies during early clinical development. The objective is to reveal potential target organs of toxicity with an assessment of dose-response, reversibility, ability to monitor, as well as establishing adverse effect levels or minimally anticipated biological effect levels. It is essential that these pivotal preclinical studies are conducted in a pharmacologically relevant species. Safety concerns associated with many monoclonal antibodies are often an extension of their intended
Ganti and M. A. Tabrizi
pharmacological activity. This “exaggerated” pharmacological response may be the result of a more profound modulation of the target or may occur as a consequence of antigen expression on nontarget cells (First Edition). When an appropriate species cannot be identified, as in the case when the antigen target is not expressed in preclinical models, or when there is low conservation of the epitope across species, additional approaches should be considered. This might include the use of a surrogate antibody(s) that exhibits similar characteristics to that of the intended therapeutic antibody or the generation of transgenic animals that express the human antigen. Development and validation of transgenic animals or surrogate antibodies are likely to incur significant time and resource demands. The transgenic animal must be characterized for antigen expression and integrity of pharmacology. In the case of surrogates, an antibody is required that reflects as closely as possible the characteristics of the clinical candidate with respect to affinity, isotype, and functional activity (Chapman et al. 2007).
Conducting PK and PD studies in appropriate animal models can greatly enhance translation of information across species. For biologics, the specific interactions between drug and antigen can be characterized closely due to their exquisite specificity and selectivity (Tabrizi et al. 2009). Depending on the target expression profile (blood vs. tissue), nature of expression (membrane bound vs. soluble), and target density, the antibody pharmacokinetics (PK) can be impacted. The PK/PD properties of biologics can be as diverse as the target antigen they interact with (Fig. 2.2).
Fig. 2.2 Biologic constructs are as diverse as the targets they interact with
V.
Soluble monomeric antigens have minimal impact on antibody PK properties; however, multi-meric soluble or membrane-associated antigens can impact antibody PK greatly (Samineni et al. 2016). Additionally, the interaction of antibody and antigen is a prerequisite step for the ensuing pharmacodynamic properties, and hence assessment of the close interaction between the biologic construct and the target antigen(s) is the critical step governing the behaviors of pharmacological systems.
Due to this close relationship between biologic constructs and their intended targets, development of this class of drug requires rigorous measurements of the kinetic and thermodynamic binding properties of the construct to antigen for candidate optimization and the design of the clinical dosing strategies. Several complex factors can influence the ideal affinity required for a therapeutic antibody, namely, the nature and prevalence of the therapeutic target in the diseased tissue, as well as the desired functionality of the antibody (discussed in Chap. 3). Hence, predicting the optimal efficacious affinity for a therapeutic antibody to its target antigen is challenging albeit crucial to understand. As a result, biophysical measurements are one of the critical components necessary for developing effective translational strategies with respect to lead selection, evaluation of the relevant animal species for the conduct of safety and efficacy studies, design of effective clinical dosing strategies, and evaluation of the cost of goods (discussed in Chap. 5).
Additionally, considerations of modality selection are also impacted by the intended therapeutic application (e.g., liquid vs. solid tumors) or when the approach demands an agonist vs. an antagonist for target modulation (discussed in Chap. 3). In the previous edition (First Edition), we had succinctly described all these processes (Fig. 2.3). In this chapter, we aim to delve deeper into translational considerations as relevant for development of more complex modalities such as ADCs and multi-specific constructs.
2.2 Monoclonal Antibodies
With advances in technologies and scientific depth, it is possible to rapidly and effectively generate highly tailored and specific antibody-based therapeutics that interact with a diverse array of soluble or cell-associated target antigens. Engineering efforts in the hope of improving the efficacy, safety, and duration of effects of antibody-based drugs have now become a reality. Advances in protein engineering technologies have afforded the ability to overcome problems associated with introducing foreign antibodies into humans. These efforts have included antibody chimerization, humanization, and the more recent development of human antibodies, all of which have reduced anti-drug immune responses. In addition, efforts have been made to engineer antibody variable domains that encode multiple specificities into a single molecular entity. Apart from optimizing antigen-binding capabilities and reducing immunogenicity, many advances have been made to modulate an antibody’s ability to interact with cells and serum components of the immune system. Manipulation of antibody glycosylation or the amino acid sequence has had a significant impact on recruitment of Fc-dependent effector functions (First Edition).
V. Ganti and M. A. Tabrizi
• Preclinical Efficacy studies
Humanized or surrogate candidates
• Developability
Biophysical characterization
Large scale production criteria
Stability
In vitro characterization/functional assays and requisite biological activity of lead
mAb(s)
Screening and epitope binning
• Translational strategy
Establishing of the relevant tox species
Selection of relevant target engagement biomarkers
Selection of PK-PD assays
• IND enabling studies
Lead PK PD studies
Lead TOX studies
• FIH dose strategy
• FIH
Single ascending dose
Safety(primar y) efficacy(secondar y)
Required phase 2 dose
Fig. 2.3 Critical considerations for development of antibody-based therapeutics. The continuum of information flow as relevant for the development of antibody-based therapeutics
Enhanced understanding of the physiological factors that regulate antibody processing, and advances in elucidation of antibody structure-activity relationships across species, has allowed successful and efficient translation of preclinical exposure and response into the clinical setting (First Edition). Clarity regarding the processes that govern antibody distribution, clearance, and interaction with Fc-related biological receptors (FcRn and Fc��Rs) found on the surface of immune cells in multiple species has contributed tremendously to intelligent translation of exposureresponse data across species. The Fc domain links the antibody to immune effector pathways. The hinge region of IgG, as well as discrete locations further along the CH2 domain, contains critical residues that facilitate interactions with the Fc gamma family of receptors (Fc��Rs) and complement pathway. Engagement of Fc��Rs on immune effector cells triggers cellular responses, such as antibody-dependent Target validation
cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP), whereas complement fixation leads to activation and formation of the membrane attack complex, which results in cellular lysis. Additionally, IgG antibodies contain an N-glycosylation site at asparagine 297 in the CH2 domain. Modification of this N-linked glycan can have profound effects on Fc-mediated effector functions. Amino acid residues located near the CH2-CH3 junction engage the MHC class I-related receptor, known as the neonatal Fc receptor (FcRn). Fc interactions with FcRn are responsible for transporting IgGs across the fetal/maternal barrier, protecting IgGs from catabolism and thereby contributing to the long circulating half-life of IgGs compared to other serum proteins of comparable size (Roopenianand and Akilesh 2007). Currently, the majority of marketed antibodies have constant regions based on IgG1, IgG2, or IgG4. All three isotypes have comparable affinity to the neonatal Fc receptor (FcRn), which provides the antibody with the requisite pharmacokinetic properties (15–20 days t1/2 in humans). These isotypes, however, have different affinities to the Fc gamma receptors (Fc��R). IgG1 in comparison to IgG2 and IgG4 has more potent effector functions (Vidarsson et al. 2014). The choice of antibody isotype and translation of the effector cell interactions in vivo and across species are of great translational significance. Many published examples are available that elucidate the recent translational approaches for this class of drug.
For biologic constructs, due to their exquisite specificity for their targets, successful translation of preclinical PK and PD data into the clinical stage has been realized. AMG 181 is an anti-��4��7 antibody that is being developed for the treatment of inflammatory bowel disease. In a recent publication (Li et al. 2014), a successful translational approach for determination of the clinical dosing strategy, using preclinical data in a pharmacologically relevant species, was described. In this approach, target-mediated drug disposition for AMG 181 in monkeys was used as an effective proof-of-mechanism (POM) biomarker to address target interaction and for translation of exposure in support of clinical study design. Due to the lack of information regarding the relative abundance of the protein in cynomolgus monkeys and humans, the authors assumed the target pool to be similar between humans and monkeys. This assumption was supported experimentally by evaluation of the in vitro binding and activity data using relevant bioassay methodologies. This information along with appropriate allometric scaling methods was employed for projecting exposures in human. Additionally, clinical data from the approved anti-��4��7 antibody (vedolizumab) was considered as a guide to determine AMG 181 clinical study design, using EC75 and EC90 for receptor occupancy (Li et al. 2014).
In the rapidly evolving immuno-oncology space, recent publications have highlighted the biological readout following anti-PD-1 blockade. Pembrolizumab (MK3475) is a humanized monoclonal IgG4 antibody against programmed death receptor 1 (PD-1). In a recent publication (Hirsch et al. 2015), the response to the surrogate anti-PD-1 antibody (DX-400) in syngeneic mouse tumor models was evaluated. The results from these tumor efficacy studies were characterized at the molecular and cellular levels using sophisticated approaches such as gene expression profiling and whole exome sequencing. Comparing findings from the
V. Ganti and M. A. Tabrizi
syngeneic tumor studies with the ongoing clinical trials for MK-3475, comparable gene modulation patterns associated with efficacy were observed (Hirsch et al. 2015). It is important to note that this “retrospect” analysis allows comparison of the clinical data, upon availability, to those observed in mouse preclinical models and hence are of reverse-translational value (back translation from man to mouse).
2.3 Antibody-Drug Conjugates
Antibody-drug conjugates (ADCs) are increasingly employed as novel targeted therapies. Antibody-drug conjugates combine the exquisite selectivity of targeted antibodies and the high potency of small molecule drugs with the aim of achieving the desired therapeutic objectives. As application of highly potent small molecule drugs can be limited by their undesirable toxicity, targeted delivery of highly potent small molecule drugs to specific cells is intended to expand the therapeutic window for the payload in the clinical setting via curtailing the anticipated adverse effects. A successful transition of ADCs into the clinic will be highly dependent on effective translation of critical attributes governing exposure-response relationships across species. Effective translational strategies for development of ADCs should deliver superior and safe therapeutic candidates for clinical development of the intended patient population(s). Effective strategies for the design, selection, and development of ADCs will need to be established from the early days during the discovery stage. Considerations regarding target selection and modality design have been discussed previously and are extremely important for application of ADCs in preclinical and clinical studies (Sadekar et al. 2015). Quantitative approaches can establish an effective framework for evaluation of the interplay between drug- and systemdependent properties with considerations given to the cellular and physiological properties. Successful strategies for the development of the lead candidate will require comparative investigations and integration of knowledge with respect to target- and modality-related considerations across species (Chap. 10). The most important driver underlying the efficacy profile for an ADC is the successful delivery of the payload (drug) to the intended cells. Therefore, evaluation of the intracellular trafficking post-construct binding and internalization of the ADC are of critical importance (Chap. 10). Delivery of potent payloads to the biophase is a result of the interplay between target- and modality-related properties, and it is not surprising that these same parameters are critical for translation of preclinical results into clinical settings (Fig. 2.4).
For ADCs, the antibody is a mere mode of transport that delivers the drug from the systemic circulation to the desired effect site. Efficacy for an ADC is determined by the efficient delivery of the drug conjugated to the antibody (payload). Obviously, a clear understanding of the target for the antibody is essential. Key parameters to be considered for the target are (a) target density and expression, (b) target kinetics (internalization rate, recycling rate), and (c) functional relevance to human disease. For an ADC to deliver the payload to the cell, efficient internalization of the antibody/antigen complex is required. Consequently, the target is either lysed or
PK - linear/nonlinear
Isotype: IgGI/IgG2/IgG4
Affinity, Cross species reactivity
ADME
In vivo/in vitro potency
Release rate
Target expression
Target density
Turnover rate
Relevance to phar macology of diesase
recycled to the surface while delivering the payload inside the cell. Within the cell, the drug bound to antibody needs to be cleaved, leaving the drug active and at the site of action. For the antibody, critical considerations are (a) target specificity, (b) species cross-reactivity, (c) isotype selection, and (d) target affinity across species. With regard to the payload, the properties that are important are (a) the ADME characteristics (e.g., the role of drug-metabolizing enzymes and efflux transporters that can potentially remove the drug from the cell) and (b) potency of the drug.
Currently there are two ADCs, marketed in the USA: Adcetris® (SGN-35) and Kadcyla® (T-DM1) (Perez et al. 2014). Additionally, there are more than 40 ADCs in different stages of clinical development. However, the low number of approvals for this class of therapeutics is a testament to the complexities that are involved in the design and development of ADCs. In a recent publication (Sadekar et al. 2015), investigators highlighted the quantitative challenges for the modality design and target selection for ADCs. This publication describes, in detail, relevant parameters pertinent to the target, antibody, and payload that would impact the disposition and the PD of the ADC in vivo (Fig. 2.4).
Moreover, Betts et al. (2016) published a mechanistic PK-PD approach for preclinical to clinical progression of inotuzumab ozogamicin (IO), a CD22-targeting antibody-drug conjugate (ADC) for B-cell malignancies including non-Hodgkin’s lymphoma (NHL) and acute lymphocytic leukemia (ALL). Mechanistic preclinical PK-PD data were applied to evaluate the intracellular tumor concentrations of the payload. The same model was translated to the clinic, with adjustments made for the target expression, tumor volumes (initial and maximum possible), and growth rate kinetics for different tumor types. Appropriate translation of the antibody PK and
Fig. 2.4 Critical translational consideration for complex ADC (see Chap. 10)
V. Ganti and M. A. Tabrizi
small molecule payload were included. The predicted profiles from this effort were in agreement with the observed clinical findings.
2.4 Multi-Specific Constructs
To further boost the durability and efficacy profiles for targeted biologics, novel combination therapies are being sought. With the recent advances in therapies focusing on immuno-oncology (IO), it is anticipated that the antigen-specific activation of patients’ immune responses can be utilized to significant therapeutic benefit. With the approval of Blincyto® and Removab® for cancer immunotherapy, bispecific antibodies are rapidly increasing their foothold in therapeutic management of various ailments. There are more than 50 antibodies currently in clinical development. In light of the promise that this novel therapy has bestowed to cancer therapy, combination strategies have become even more critical for achieving the most effective clinical outcome, namely, by enhancing antitumor immunity in a broader cancer indication with a concomitant decrease in potential adverse events.
Combination therapies, where two or more biologics are combined as single agents, could benefit from the “synergistic” effect profile that is the result of engagement of two or more receptors/pathways simultaneously and hence enhance the anticipated effect resulting from engagement of either of the receptors or pathways alone (Fig. 2.5). In general, the observed synergistic effects could arise from (a) amplification of the signaling components and/or (b) recruitment of effector functions via activation of the relevant immune cells. Currently, comprehensive methods have been developed to quantify the “synergistic” combination effect profiles in relevant preclinical models (Chap. 8). Further evaluation of the signaling and
Fig. 2.5 Pathway analysis for drug combinations—evaluation of “signature” network (pharmaconetwork) characteristic when two drugs are combined
pathway components can potentially establish a unique “signature” network (pharmaco-network) characteristic for specific combination therapies following modulation of various immune modulatory receptors (IMRs; Fig. 2.5).
The therapeutic approach via recruitment of effector functions and activation of the relevant immune cells has been successfully implemented for the bispecific T-cell engager or BiTE®. Blincyto® (blinatumomab) is an anti-CD19/CD3 bispecific T-cell-engaging (BiTE®) antibody approved for acute lymphoblastic leukemia in 2014. Blinatumomab is unique in engaging the two targets, in “trans” configuration, such that engagement of both targets is required for the ensuing biological effect(s). The mode of action of blinatumomab includes engaging cytotoxic effector T cells to bind the CD19-expressing B cells, ultimately causing T-cell-redirected cell lysis of the engaged B cells. Translational conditions for such entities are extremely complex. Appropriate assessment of two targets instead of a single target across species needs to be considered. For blinatumomab, recruitment efficiency of effector T cells is critical since the mode of action for this drug is T-cell-mediated killing. Also, the ratio of CD3+ T cells to CD19+ B cells should be considered across different populations (i.e., preclinical, adult humans, human pediatric populations) (Zhu et al. 2016) (Chap. 7). With respect to PK considerations, potential properties of two targets need to be considered. However, blinatumomab exhibits linear PK, with a half-life of 2 h (no FcRnmediated recycling present). The short half-life necessitates the drug to be infused constantly over long periods of time (Zhu et al. 2016; Hoffmanand and Gore 2014). This dosing regimen does add complexities in terms of potential immunogenicity and target modulation; however, because blinatumomab lyses B cells, drug-mediated immunogenicity is rare (Trivedi et al. 2017).
Combination therapies using “single agents” offer a unique spatial configuration where each construct can engage the intended target in a flexible manner. However, “multi-specific” modalities may not benefit from a similar spatial flexibility to engage targets in a comparable manner. Hence, target and construct selections are critical considerations for successful design and application of multi-specific modalities. The capability of multi-specific modalities to engage targets will depend on target expression and density profiles in either cis (expressed on the same cell, i.e., T cells) or trans (expressed on different cells, i.e., T cells and antigen-presenting cells) configurations (Fig. 2.6). Potential anchoring effects with multi-specific modalities may impact their pharmacological effect profiles by (a) stabilizing the
Fig. 2.6 Graphical representation of a cis and trans binding configuration with a multi-specific construct
V. Ganti and M. A. Tabrizi
receptor complex on the surface (cis configuration) and/or (b) cross-linking of receptor complex in a trans configuration, hence modulating the anticipated effector function profiles.
Additionally, the potential impact on target internalization properties due to cross-linking effects (rosette formation) may impact the anticipated activity profiles (reversal of receptor activation to inhibition or vice versa). Hence, a thorough in vitro-in vivo evaluation of the multi-specific constructs’ activity profiles and sideby-side comparisons with their single-agent counterparts will be necessary for successful modality design and target selection. Appropriate tools and relevant controls are necessary to evaluate multi-specific construct properties. These will include but are not limited to relevant single/double arm modalities, isotype controls, and multispecific constructs. Cellular models/systems for the conduct of in vitro studies should be characterized carefully to establish target expression profiles and density, internalization, and other related properties. Translational challenges important for this class of molecules are highly specific and require establishing a science-based approach for evaluation of (a) synergistic target and antibody selection, (b) evaluation of target anchoring effects in vitro, (c) evaluation of in vitro activity profiles in relevant cellular models/systems, (d) evaluation of in vivo dispositional properties, and (e) evaluation of in vivo pharmacological activity properties in relevant species. Additionally, assessment of pharmacokinetic, metabolism, and biodistributional properties (target independent) and the impact of target(s) expression on the fate of selected experimental constructs in relevant preclinical models is a vital translational necessity. Successful implementation of rich biomarker strategies during early preclinical development should allow evaluation of (a) target binding, (b) target modulation (i.e., downstream signaling), and (c) correlation with relevant systemic pharmacological effects.
As with monospecific constructs, rigorous measurements of the kinetic and thermodynamic binding properties of multi-specific constructs to their respective antigens is highly important (Chap. 5). The mechanism of action for multi-specific modalities relies on their simultaneous binding to two or more target antigens; therefore, it is more informative to qualitatively and quantitatively assess the binding of the construct in the presence of multiple targets in vitro. For bispecific constructs that bind to their antigens in a trans configuration, the biophysical characterization methodologies described in Chap. 5 should allow determination of the site-binding KD constants for each antigen accurately. However, there is added complexity in biophysical characterization of bispecific drugs that bind to their target antigens in a cis orientation due to avidity. Avidity is the overall binding strength of an interaction due to simultaneous binding of the multi-specific constructs to two or more target antigens (Chap. 3). In the case of a bispecific construct that binds in a cis configuration, the avidity cannot be predicted from knowledge of the experimental KD (site-binding constants). A general rule of thumb is that formation of an avid complex will increase the overall binding strength relative to that of the sitebinding constant between 10- and 1000-folds (Mack et al. 2011, 2012). Hence, with these additional challenges, evaluation of affinity and construct design for multispecific modalities can be further complicated by (a) construct interaction
configuration (cis or trans); (b) antigen expression profiles and antigen density ratio; and (c) intended pharmacology, i.e., activation, inhibition, cell depletion, and efficiency of the PD systems.
Conclusions
With advances in antibody technology, it is possible to rapidly and effectively generate highly tailored and specific antibody-based therapeutics that interact with a diverse array of soluble or cell-associated target antigens. Biologics and antibody-based therapeutics are becoming progressively complex. Increasingly, drug candidates are designed to address multiple targets simultaneously. With such complexities in the design of novel constructs, foundational and robust approaches in translation of preclinical data in support of the later stages of drug development are vital. Translational challenges important for ADCs are highly specific and require establishing a science-based approach for evaluation of many relevant variables. Similarly, combination therapies, using single agents, could benefit from the “synergistic” effect profile and offer a unique spatial configuration where each construct can engage the intended target in a flexible manner. However, multi-specific modalities may not benefit from a similar spatial flexibility to engage targets in a comparable manner. Therefore, translational challenges important for this class of molecules are highly specific and require establishing a novel science-based approach for this class of therapeutics.
References
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Chapman K, Pullen N, Graham M, Ragan I. Preclinical safety testing of monoclonal antibodies: the significance of species relevance. Nat Rev. 2007;6:120–6.
Hirsch H, Pinheiro E, Ayers M, Lunceford J, Nebozhyn M, Murphy E, Cai M, Ma Y, Sathe M, McClanahan T. Preclinical to clinical translation of anti-PD-1 blockade. J Immunother Cancer. 2015;3:P92.
Hoffmanand LM, Gore L. Blinatumomab, a bi-specific anti-CD19/CD3 BiTE((R)) antibody for the treatment of acute lymphoblastic leukemia: perspectives and current pediatric applications. Front Oncol. 2014;4:63.
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Mack ET, Snyder PW, Perez-Castillejos R, et al. Using covalent dimers of human carbonic anhydrase II to model bivalency in immunoglobulins. J Am Chem Soc. 2011;133:11701–15.
Mack ET, Bracher PJ, Perez-Castillejos. Thermodynamic analysis to assist in the design of recombinant antibodies. Crit Rev Immunol. 2012;32:503–27.
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Considerations for Construct and Affinity Design Goals
Mohammad A. Tabrizi and Scott L. Klakamp
Abstract
Application of an integrated approach for inclusion of pharmacology principles in drug development is a foundational step for effective modality design and selection of antibody-based therapeutics. Clarity on patient-related variables, manufacturing considerations, underlying biology and pathophysiology, as well as integration of key translational variables can accelerate drug development processes, ultimately benefiting patients in need of such therapies. Establishing design goals with respect to antibody affinity is a necessary step for achieving this goal and should be incorporated into the development strategies from the earliest stages of the discovery process for biologic modalities. Evaluation of affinity design goals is a complex process contingent on many critical variables. Knowledge of the target antigen biology and its role in the pathogenesis of disease is of high importance in establishing affinity design goals. Selection of the adequate affinity for a functional biologic construct should allow achievement of the maximum therapeutic benefit at a dose associated with a manageable cost of goods. This chapter will further expand on the topics discussed previously (Development of antibody-based therapeutics: translational considerations, Springer, New York, 2012).
The original version of the chapter was revised. Owing to an oversight on the part of the Springer Figure 3.3 in Chapter 3 was initially published with errors. The correction to the chapters is available at https://doi.org/10.1007/978-981-13-0496-5_13
M. A. Tabrizi et al. (eds.), Development of Antibody-Based Therapeutics, https://doi.org/10.1007/978-981-13-0496-5_3
M. A. Tabrizi and S. L. Klakamp
3.1 Introduction
A unique feature of antibody-based therapeutics is the high specificity conferred by the antibody interaction (via the variable domain, i.e., paratope) with a specific region on the targeted antigen (epitope); hence, it is not surprising that efficacy and safety of this class of therapeutic are generally correlated with the extent of their interaction with their intended target antigen (Tabrizi et al. 2009a, 2010). For functional antibodies, determination of the “optimal” equilibrium dissociation constant (affinity) should allow achievement of the maximum therapeutic benefit, at a dose associated with a manageable cost of goods, as affinity could directly impact the construct potency. As thermodynamic principles govern the reversible bimolecular interactions between antibody and antigen molecules, quantitative evaluation of this bimolecular interaction makes it possible to determine the impact of antibody affinity on the required clinical dose. Binding principles from physical chemistry can be applied to describe the association rate constant (ka), the dissociation rate constant (kd), and the equilibrium dissociation constant (KD), also known as the “affinity” of the antibody-antigen interaction (discussed in Chap. 5). Knowledge of the affinity as well as construct and antigen properties is essential for evaluating the link between affinity and potency for a functional antibody.
Evaluation of affinity design goals is a complex process contingent on critical variables (Fig. 3.1). Integration of pharmacology must be the guiding principle for construct design and selection from the earliest development phases. Clarity on patient-related variables, manufacturing considerations, underlying pharmacology and pathophysiology, and an in-depth awareness of the key translational challenges can accelerate drug development processes, ultimately benefiting patients in need of such therapies. A clear understanding of the target antigen biology and its role in the pathogenesis of disease is of primary importance. Surveying appropriate tissues for validation of target expression by immunohistochemistry or equivalent methodologies is vital to establishing disease linkage, and verifying the target antigen is not abundantly expressed in normal tissues. Also, functional validation of the target is critical. Functional redundancy of the target is an additional consideration when applicable (usually not relevant to ADCs; discussed in Chap. 10). Antibodies can mediate their biological activities via multiple mechanisms, primarily resulting in target-ligand inhibition or activation. Many of the first-generation marketed antibodies were raised against soluble antigens with the aim of blocking the interaction of these ligands with their receptors (Sect. 3.6.1). Recently, monoclonal antibodies have been used to activate biological receptors such as the TNF family of receptors (Bodmer et al. 2002). For these antibodies, evaluation of affinity design considerations requires inclusion of receptor activation efficiency, correlation to receptor-binding affinity (as well as avidity), and PD system efficiency (Sect. 3.6.2).
Fig. 3.1 Application of a science-based approach for integration of pharmacology principles is an essential foundational step for effective construct design. Evaluation of the target antigen biology and its role in the pathogenesis of disease is the first step necessary for establishing affinity design goals. Biologics can be designed to target soluble (S), membrane -associated (MA), or both types of antigens (S & MA). Inclusion of the construct’s desired mechanism of action (MOA), target inhibition or activation, is another important attribute necessary for inclusion in the construct design strategies
Soluble (s)
IgG
Affinity Deter mination
Inhibition
F(ab’)2 Fab’
Construct Design
Activation
Mechanism of Action (MOA)
S & MA
Membrane Associated (MA)
Target Antigen
Disease Modulation
3.2 Affinity Limits
It is of great importance to recognize when improvements in construct affinity are needed and when they may or may not be beneficial (Tabrizi et al. 2012). This knowledge can be attained by evaluation of complexities outlined in Fig. 3.1 and as discussed in this chapter. Precise and accurate evaluation of the affinity for an antigen-antibody interaction is an important measurement for establishing affinity limits and the “potency ceiling” for a therapeutic antibody (discussed in Chap. 5). The potency ceiling for affinity is highly dependent on antigen concentration. In general, when antigen concentration is lower than antibody affinity ([Ag] ≪ KD), higher affinity antibodies may be more efficacious because more antigen will be bound at a lower antibody dose. However, when [Ag] ≫ KD, binding is stoichiometric and antigen-dependent; in these instances, improvements in affinity will not impact the dose requirements. The theoretical association between the antibody
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read, and the others working, but all casting anxious looks towards the door.
By and bye comes laughter and voices and ringing footsteps up the stair, but only Charteris enters the drawing-room; for Harry and his other friends are climbing further up to the turret, where he has fitted up a little “den,” as Gilbert Allenders calls it, for himself. And their good friend, Mr. Charteris, looks very grave; they think Harry has lowered himself in Cuthbert’s eyes—they think this seriousness is the painful regret with which a strong man sees a weak one sink under temptation; and their hearts flutter within them with restless anxiety, and they listen to Harry’s laugh in the distance till its echo makes them sick. While, all the time, Cuthbert is too much interested not to notice how uneasily the young wife moves upon her chair, and the abstraction from which Martha starts with a dismal resolution to be gay again. Poor Harry! But Cuthbert stands behind the chair of Rose, and feels that he is consoling her—feels that he is occupying with his presence something of the space which, without him, might have been wholly given to anxiety and fear.
The children are already out under the windows, playing on the lawn; and, at Cuthbert’s suggestion, Rose and Martha accompany him to the mall on the river-side. He tells them how he admired this when he came first with Harry to see Allenders, and that he often fancies how they must enjoy this verdant cloister when he is shut up in his office at Edinburgh. The sun slants in through the great oak which rounds the end of the mall, and just touches here and there a heavy alder leaf, and lights up one little branch upon a stately elm, with tender golden rays, cool and dewy; and there is wind enough to disturb the long willow branches and ruffle the fleecy lining of their leaves. A narrow strip of path, sandy and yellow, breaks the soft green turf which slopes down to the water on one side, and on the other, rich with flower-beds, stretches up in a slight incline to the walls of Allenders; and Cuthbert, with Martha on his arm, walks slowly, silently, looking after the white figure which has strayed a step or two before. Slightly turning towards them, with a shy, halfconscious look backwards, Rose says something to Martha about the wild flowers in the grass; and Rose guesses, with a tremor, that
Cuthbert has had visions of herself under the shadow of these trees, and feels that his eye just now is dwelling upon her, and that he is saying words to her in his heart. But the charmed silence lasts, and even Martha, looking on, has not the heart to break its spell.
But look up yonder at the turret. With the sun glancing in his hair, Harry stands in the little battlemented gallery, and holds up a glass of sparkling wine, and bows and smiles, and drinks to them. Immediately both the sisters look at Cuthbert; and Cuthbert, with a gaiety he does not feel, takes off his hat, and returns the salutation with playful stateliness. His gesture cheers them, and they become again quite tremulously glad, when he calls to Harry to come down, and Harry nods in assent, and disappears upon the turret stair. It is true that the momentary smile flits away from Cuthbert’s face, and he becomes very serious. But they are looking for Harry—they do not see the deep regret and gravity which clouds the brow of his friend, who, within himself, says “Poor Harry!” with a heavy sigh.
And Harry is now more excited than ever, and they are constantly calming and soothing him to keep him within bounds—trying to be gay themselves that his unreal gaiety may be less marked—and carefully avoiding everything which could possibly irritate his feelings. Poor Harry! some wistful eye is always following him, some solicitous voice constantly interposing to bring down to the ordinary quietness and moderation his unconscious extravagance—eyes which are afraid to meet—afraid to confide to each other, even by a glance, this new pain which Harry has brought upon them; for hitherto they have seen principally the remorse which followed his fall, and never before have beheld others conscious, of what so greatly humiliated themselves. Now the sneer and patronizing forbearance of Gilbert Allenders, who has too cool a head to be moved as Harry is, chafes Martha beyond endurance, and excites the gentle little Agnes to such a pitch of anger, that her hand clenches involuntarily, and she could almost strike him in a burst of weeping petulance. But the long, long painful hours pass away, and at last it is night.
“It is nothing—it is nothing. Nobody thinks anything of this but us. We are always so anxious!” sobs Agnes, as she wakes in the middle
of the night, and weeps; but Martha, who does not need to wake— who has never slept—suffers her heart to say nothing, but only prays, and tries to forget—tries to think of anything rather than Harry; and cannot weep, if she should try for ever.
CHAPTER XIV.
And gentle hands the breakfast-rite begin, Then the bright kettle sings its matin song. Then fragrant clouds of Mocha and Souchong Blend as they rise.