BackgroundImmunotherapy with immune checkpoint inhibitors such as PD-(L)1 and CTLA-4 blocker has become an important part of cancer treatment. For the cancers resistant to these drugs, however, many other therapeutic targets are being tested to modulate the tumor microenvironment (TME) toward anti-cancer immunity. Due to the functional flexibility, macrophages play an essential role in orchestrating tissue immunity including TME. CD47 is one of the key targets that modulate macrophages, which is often overexpressed on cancer cells.1 When it binds to its receptor, SIRPα, it gives a ‘don’t-eat-me’ signal and inhibits phagocytosis of cancer cells by macrophages.2 IMC-002 is a fully human IgG4 monoclonal antibody targeting human CD47, which has been engineered to possess optimal efficacy and safety profile. IMC-002 does not induce hemagglutination and contains a hinge stabilizing S228P mutation to prevent Fab arm exchange.MethodsA series of in vitro functional assays including ligand binding, cell surface binding and phagocytosis assays were performed. Putative epitopes for IMC-002 were identified using synthetic peptide libraries. In vivo efficacy of IMC-002 was tested in human breast cancer models. Pharmacokinetic parameters and toxicity profiles were assessed in mice and cynomolgus monkeys.ResultsIMC-002 strongly bound to CD47 ligand and to various types of CD47-expressing cancer cells including solid and hematological cancers. IMC-002 also bound to human CD4 T cells and, to a lesser degree, to CD8 T cells, but not to NK or B cells. Interestingly, IMC-002 showed no binding to RBCs which highly express CD47 and thus, did not induce RBC agglutination in vitro. IMC-002 induced phagocytosis of cancer cells by human blood CD14+ monocyte-derived macrophages and strongly suppressed tumor growth in a dose-dependent manner in xenograft animal models. Treating IMC-002 with tumor antigen targeting IgG1 type therapeutics increased phagocytosis compared to single treatment. Epitope mapping analysis revealed that compared to RBC-binding anti-CD47 antibody and a natural ligand, SIRRα-Fc, IMC-002 bound to distinct parts of CD47 antigen, which may be responsible for the cell-selective binding of IMC-002. Consistent with the in vitro data, IMC-002 was well tolerated in cynomolgus monkeys with no adverse effects including hematologic toxicity at doses up to 100 mg/kg. IMC-002 showed a typical pharmacokinetic profile of therapeutic antibody with a half-life of 5–10 days. Given its differential binding profile toward tumor cells vs normal cells such as RBC, preclinical data was thoroughly analyzed to simulate human PK and to come up with the optimal first-in-human dose.ConclusionsPreclinical efficacy and safety profiles of IMC-002 provide a strong rationale for assessing therapeutic potential in clinical studies. Particularly, IMC-002 is expected to be beneficial for hematologic cancer patients because it has been engineered to minimize hematological toxicities such as anemia which is a class effect of the CD47-targeting antibodies. The first-in-human (FIH) study of IMC-002 is ongoing in the US sites. The purpose of the study is to assess the safety and tolerability of IMC-002 and determine the recommended Phase 2 dose (RP2D) of IMC-002 in subjects with metastatic or locally advanced solid tumors and relapsed or refractory lymphomas.Ethics ApprovalAll experimental procedures were performed according to the guidelines of the Institutional Animal Care and Use Committee (IACUC) of the contract research organizations.ReferencesWillingham, S. B. et al. The CD47-signal regulatory protein alpha (SIRPα) interaction is a therapeutictarget for human solid tumors. Proc. Natl Acad. Sci. USA 2012;109:6662–6667.Majeti, R. et al. CD47 is an adverse prognostic factor and therapeutic antibody target on human acute myeloid leukemia stem cells. Cell 2009;138:286–299.
Therapeutic Antibody-Induced Vascular Toxicity Due to Off-Target Activation of Nitric Oxide in Cynomolgus Monkeys