Efficacy and safety of antibody-drug conjugates in the treatment of breast cancer：a meta-analysis / 中国药房

OBJECTIVE To evaluate the efficacy and safety of antibody-drug conjugates （ADC） in the treatment of breast cancer， so as to provide an evidence-based reference for clinical medication. METHODS Retrieved from CNKI， Wanfang database， VIP， PubMed， the Cochrane Library， Embase， and Web of Science， randomized controlled trials （RCTs） about trastuzumab emtansine， trastuzumab deruxtecan and sacituzumab govitecan （trial group） versus chemotherapy or other anti-tumor drugs （control group）， were collected during the inception to April 2023. After screening the literature， extracting data， and evaluating the quality of the literature， a meta-analysis was conducted by using RevMan 5.4.1 software. RESULTS A total of 8 RCTs were included， with a total of 5 577 patients. The results of the meta-analysis showed that the progression-free survival （PFS） [HR＝0.76， 95%CI （0.69， 0.83）， P＜0.000 01]， overall survival （OS） [HR＝0.87， 95%CI （0.81， 0.93）， P＜0.000 1]， and clinical benefit rate （CBR） [OR＝2.70， 95%CI （1.15， 6.33）， P＝0.02] of the trial group were significantly higher than control group. There was no statistically significant difference in objective response rate （ORR） between the two groups [OR＝2.34， 95%CI （0.59， 9.33）， P＝0.23]. The results of subgroup analysis showed that the PFS of HER2-positive patients and HER2-negative patients， and the OS of HER2-positive patients in the trial group were significantly higher than control group （P＜0.05）. The incidence of anemia and increase of aspartic acid transaminase （AST） in the trial group was significantly higher than control group （P＜0.05）. The results of sensitivity analysis showed that the results obtained with PFS， OS， and ORR as indicators were relatively robust， while the results obtained with CBR as indicators lacked robustness. CONCLUSIONS ADC drugs have significant effects on breast cancer， but will increase the risk of anemia and elevated AST.

General considerations for clinical pharmacology of antitumor antibody-conjugated drugs: Implications from FDA review cases / 中国临床药理学与治疗学

Antibody-drug conjugates (ADCs) are conjugated by a linker between an antibody drug targeting a specific antigen and a payload, such as a small cytotoxic drug. ADCs combine the potent killing effect of traditional small cytotoxic drugs with the tumor targeting property of antibody drugs. As of February 2022, the U.S. Food and Drug Administration (FDA) had approved 12 ADC antitumor agents. Based on the analysis of clinical pharmacology review reports of approved ADC drugs combined with relevant guidelines, it is found that in the development of ADC, in addition to the general research in clinical pharmacology, there are special considerations in dose selection and dose modification for special population due to the special anti-tumor mechanism of ADC. It is hoped that this paper will be enlightening to domestic researchers when developing ADC.

Antibody-drug conjugates: Recent advances in payloads

Antibody‒drug conjugates (ADCs), which combine the advantages of monoclonal antibodies with precise targeting and payloads with efficient killing, show great clinical therapeutic value. The ADCs' payloads play a key role in determining the efficacy of ADC drugs and thus have attracted great attention in the field. An ideal ADC payload should possess sufficient toxicity, low immunogenicity, high stability, and modifiable functional groups. Common ADC payloads include tubulin inhibitors and DNA damaging agents, with tubulin inhibitors accounting for more than half of the ADC drugs in clinical development. However, due to clinical limitations of traditional ADC payloads, such as inadequate efficacy and the development of acquired drug resistance, novel highly efficient payloads with diverse targets and reduced side effects are being developed. This perspective summarizes the recent research advances of traditional and novel ADC payloads with main focuses on the structure-activity relationship studies, co-crystal structures, and designing strategies, and further discusses the future research directions of ADC payloads. This review also aims to provide valuable references and future directions for the development of novel ADC payloads that will have high efficacy, low toxicity, adequate stability, and abilities to overcome drug resistance.

Click chemistry and drug delivery: A bird's-eye view

Click chemistry has been proven to be very useful in drug delivery. Due to the availability of a large number of click reactions with a various characteristics, selection of appropriate chemistry for a given application is often not a trivial task. This review is written for pharmaceutical researchers who are interested in click chemistry applications and yet may not be click chemistry experts. For this, the review gives an overview of available click reactions organized by application types. Further, the general understanding of click reactions being fast and high yielding sometimes overshadows the need to analyze reaction kinetics in assessing suitability of a given reaction for certain applications. For this, we highlight the need to analyze the relationship among reaction kinetics, concentration effects, and reaction time scales, knowing that lack of such analysis could easily lead to failures. Further, possible issues such as chemical stability with various click reagents are also discussed to aid experimental designs. Recent examples and extensive references are also provided to aid in-depth understanding of technical details. We hope this review will help those interested in using click chemistry in drug delivery to select the appropriate reactions/reagents and minimize the number of pitfalls.

Research Progress of Antibody-drug Conjugates in Small-cell Lung Cancer / 肿瘤防治研究

Antibody-drug conjugates (ADCs) are novel drugs consisting of monoclonal antibodies targeting tumor-specific or tumor-associated antigens coupled with different numbers of payloads via linkers. ADCs have shown promising clinical benefits in the treatment of a variety of malignancies. Small-cell lung cancer (SCLC) is a hypo-differentiated neuroendocrine tumor with an extremely high degree of malignancy. Although SCLC is sensitive to radiotherapy and chemotherapy, it has a poor prognosis due to characteristics such as early susceptibility to metastasis and recurrence. Progress in the treatment of SCLC is very limited, and more durable and effective therapies should be developed to improve prognosis. However, the progress of SCLC-related therapeutic agents has been limited by the lack of specific molecular targets. This article reviews the basic principles and mechanisms of ADCs, highlights the research progress of relevant drugs against some targets in SCLC, and summarizes new targets that may be developed as targeted drugs.

Enzyme-linked immunosorbent assays for quantification of MMMAE-conjugated ADCs and total antibodies in cynomolgus monkey sera / 药物分析学报

Antibody-drug conjugates(ADCs)are commonly heterogeneous and require extensive assessment of exposure-efficacy and exposure-safety relationships in preclinical and clinical studies.In this study,we report the generation of a monoclonal antibody against monomethyl auristatin E(MMAE)and the development,validation,and application of sensitive and high-throughput enzyme-linked immunosor-bent assays(ELISA)to measure the concentrations of MMAE-conjugated ADCs and total antibodies(tAb,antibodies in ADC plus unconjugated antibodies)in cynomolgus monkey sera.These assays were suc-cessfully applied to in vitro plasma stability and pharmacokinetic(PK)studies of SMADC001,an MMAE-conjugated ADC against trophoblast cell surface antigen 2(TROP-2).The plasma stability of SMADC001 was better than that of similar ADCs coupled with PEG4-Val-Cit,Lys(m-dPEG24)-Cit,and Val-Cit linkers.The developed ELISA methods for the calibration standards of ADC and tAb revealed a correlation be-tween serum concentrations and the OD450 values,with R2 at 1.000,and the dynamic range was 0.3-35.0 ng/mL and 0.2-22.0 ng/mL,respectively;the intra-and inter-assay accuracy bias％ranged from-12.2％to-5.2％,precision ranged from-12.4％to-1.4％,and the relative standard deviation(RSD)was less than 6.6％and 8.7％,respectively.The total error was less than 20.4％.The development and validation steps of these two assays met the acceptance criteria for all addressed validation parameters,which suggested that these can be applied to quantify MMAE-conjugated ADCs,as well as in PK studies.Furthermore,these assays can be easily adopted for development of other similar immunoassays.

Current Progress and Future Developments of Antibody Drug Conjugates in Lung Cancer / 中国肺癌杂志

Antibody drug conjugates (ADCs) are a novel class of anti-cancer drugs, which combined the specificity of monoclonal antibodies with the cytotoxic palyload via the linkers. Many ADCs have not only verified impressive activity in a variety of cancers, including breast cancer and hematological system tumors, but also in lung cancer. The aim of this study was to provide informations for practice by summarizing the mechanism of action, clinical application and problems and challenges of ADCs.
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Research Progress of Antibody-drug Conjugates in Advanced Non-small Cell Lung Cancer / 中国肺癌杂志

Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. Non-small cell lung cancer (NSCLC) is one of the most important pathological types of lung cancer. The prognosis of advanced NSCLC is poor and medical treatment is still the main treatment option. Antibody-drug conjugates (ADCs) are the kind of potentially new anti-tumor drugs, consisting of monoclonal antibodies conjugated to the cytotoxic payloads via the synthetic linkers. They have a broad application prospect in solid tumors such as lung cancer. This article focuses on the mechanism of action and research progress of ADCs in advanced NSCLC.
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Research Advances of Immunotherapy for Follicular Lymphoma --Review / 中国实验血液学杂志

Follicular lymphoma is an indolent malignant tumor originating from lymph nodes and lymphoid tissues, which may affect the patients' quality of survival due to the recurrence and progression. In recent years, with the deepening understand of the molecular biology and signaling pathways, many new targeted drugs for follicular lymphoma have been discovered, such as monoclonal antibodies, checkpoint inhibitors, epigenetic regulation related targeted therapies and signaling pathway inhibitors. In this review, the new progress of immunotherapy for follicular lymphoma is summarized briefly.

Research Progress of Antibody-drug Conjugates in Advanced Non-small Cell Lung Cancer / 肿瘤防治研究

Although targeted, immune and other therapeutic strategies have become the first-line standard therapy for patients with advanced lung cancer, acquired drug resistance is still inevitable in most cases. The advent of antibody-drug conjugates (ADC) provides a new choice. ADC is a new anticancer drug formed by the coupling of targeted anti-tumor monoclonal antibodies and cytotoxic drugs. Compared with chemotherapeutic drugs, ADC has the advantages of high tolerance, accurate target recognition and little effect on non-cancer cells, and has shown good clinical benefits in the treatment of a variety of malignant tumors. This article reviews the application of ADC in advanced non-small cell lung cancer.

The role of caveolin-1 in the biofate and efficacy of anti-tumor drugs and their nano-drug delivery systems

As one of the most important components of caveolae, caveolin-1 is involved in caveolae-mediated endocytosis and transcytosis pathways, and also plays a role in regulating the cell membrane cholesterol homeostasis and mediating signal transduction. In recent years, the relationship between the expression level of caveolin-1 in the tumor microenvironment and the prognostic effect of tumor treatment and drug treatment resistance has also been widely explored. In addition, the interplay between caveolin-1 and nano-drugs is bidirectional. Caveolin-1 could determine the intracellular biofate of specific nano-drugs, preventing from lysosomal degradation, and facilitate them penetrate into deeper site of tumors by transcytosis; while some nanocarriers could also affect caveolin-1 levels in tumor cells, thereby changing certain biophysical function of cells. This article reviews the role of caveolin-1 in tumor prognosis, chemotherapeutic drug resistance, antibody drug sensitivity, and nano-drug delivery, providing a reference for the further application of caveolin-1 in nano-drug delivery systems.

Anticuerpos conjugados a fármaco: la nueva generación de terapias biotecnológicas contra el cáncer / Antibody-drug conjugates: the new generation of biotechnological therapies against cancer

Resumen Los anticuerpos terapéuticos son proteínas recombinantes empleadas en el tratamiento del cáncer. Existe una nueva generación de anticuerpos monoclonales con actividad contra las células cancerosas, conocidos como anticuerpos conjugados a fármacos. Estas moléculas están integradas por tres elementos: un anticuerpo monoclonal, un fármaco citotóxico con alta potencia y un enlazador químico que los une. El anticuerpo reconoce antígenos tumorales, por lo que permite la entrega dirigida del agente citotóxico hacia las células cancerosas. Tras el reconocimiento de su antígeno, el anticuerpo conjugado a fármaco es endocitado por las células blanco, donde se induce la degradación lisosomal de la fracción proteica y se libera el fármaco citotóxico. En el presente artículo se revisan las características generales de los anticuerpos conjugados a fármacos y se describe la evidencia clínica de la eficacia y seguridad de los primeros cuatro aprobados por las agencias reguladoras de Estados Unidos y Europa.

Abstract Therapeutic antibodies are recombinant proteins used in the treatment of cancer. There is a new generation of monoclonal antibodies with activity against cancer cells, known as antibody-drug conjugates. These molecules are made up of three elements: a monoclonal antibody, a highly potent cytotoxic drug, and a chemical linker that binds them together. The antibody recognizes tumor antigens, thereby allowing targeted delivery of the cytotoxic agent to cancer cells. After recognizing its antigen, the antibody-drug conjugate is endocytosed by the target cells, where the protein fraction is degradated into lysosomes, releasing the cytotoxic drug. This article reviews antibody-drug conjugates general characteristics and describes the clinical evidence of efficacy and safety of the first four approved by regulatory agencies in the United States and Europe.

Research progress in new anti-tumor drugs on different targets derived from microorganisms / 药学学报

The metabolites produced by complex and diverse microorganisms are important resources for drug research and development. Using new targets to screen microbial metabolites, many anti-cancer drugs acting on different targets are discovered. Anti-tumor antibiotics acting on various targets and signaling pathways are important members in the study of specific targets for anti-tumor, and some anticancer antibiotics with potent antitumor activity are used as "warheads" of antibody-drug conjugates. Microbial-derived anti-tumor substances acting on different targets with high-efficiency "warheads" molecules are reviewed to provide a literature basis for research on the anti-cancer drugs for specific targets derived from microorganisms.

MetFab-DOX reduces doxorubicin-resistance of HepG2 / DOX human hepatocellular carcinoma cells / 医学研究生学报

Objective MetFab-DOX can inhibit the proliferation of hepatocellular carcinoma HepG2 cells, but few researches have been conducted on the effect of MetFab-DOX on doxorubicin-resistant HepG2 cells. This study aimed to constructed doxorubicin-resistant HepG2 cell lines and explored the effect of MetFab-DOX on their drug resistance.Methods Using high-dose intermittent induction, we constructed the doxorubicin-resistant hepatocellular carcinoma cell model HepG2/DOX and divided the cells into a blank control, a DOX (5 μg/mL), and an MetFab-DOX group (containing 5 μg/mL doxorubicin). After treatment, we detected the effects of MetFab-DOX on the proliferation, apoptosis, internalization and biological function of the HepG2/DOX cells by CCK8 assay, FCM, cell immunofluorescence, wound healing assay and Transwell invasion assay, respectively. We also established a tumor-bearing model in the nude mouse and examined the effects of MetFab-DOX on the volume and morphology of the tumor.Results The drug resistance index of the HepG2/DOX cells treated with DOX and MetFab-DOX was markedly reduced, with statistically significant difference between the HepG2 and HepG2/DOX cells (P<0.05). After 24 hours of treatment, the cell apoptosis rate was remarkably higher in the MetFab-DOX than in the DOX group (19.87% vs 8.09%, P<0.05), and so was it at 48 hours (41.27% vs 16.15%, P<0.01). The internalization in the cells showed no statistically significant difference between the MetFab-DOX and DOX groups at 30 minutes, while the fluorescence intensity of doxorubicin was markedly higher in the former than in the latter group at 60 and 120 minutes. The cell scratch healing rate was lower in the MetFab-DOX than in the DOX and blank control groups at 24 hours (14.46% vs 16.80% and 19.88%, P<0.05), but higher in the former than in the latter two groups at 48 hours (22.60% vs 36.96% and 56.43%, P<0.01). The number of the membrane-penetrating cells per visual field was significantly decreased in the MetFab-DOX and DOX groups as compared with that in the blank control (646.18 and 880.51 vs 1043.52, P<0.05), and even lower in the MetFab-DOX than in the DOX group (P<0.05). After 40 days of treatment, the tumor inhibition rate was remarkably higher in the MetFab-DOX than in the DOX group (64% vs 35.27%, P<0.05). In the blank control group, the transplanted tumor cells were irregularly arranged and proliferative tumors varied in volume and constituted a larger proportion. The proliferation of the cells was slightly reduced in the DOX group as compared with that in the control. In the MetFab-DOX group, the tumor cells showed a significant shrinkage and a decreased number.Conclusion MetFab-DOX can effectively reduce the doxorubicin-resistance of hepatocellular carcinoma, and the underlying mechanism may be associated with its abilities of increasing the accumulation in drug-induced cells and inducing cell apoptosis.

Marine drugs for cancer: surfacing biotechnological innovations from the oceans

This review will discuss the contributions of marine natural molecules, a source only recently found to have pharmaceutical prospects, to the development of anticancer drugs. Of the seven clinically utilized compounds with a marine origin, four are used for the treatment of cancer. The development of these drugs has afforded valuable knowledge and crucial insights to meet the most common challenges in this endeavor, such as toxicity and supply. In this context, the development of these compounds will be discussed herein to illustrate, with successful examples provided by cytarabine, trabectedin, eribulin and brentuximab vedotin, the steps involved in this process as well as the scientific advances and technological innovation potential associated with developing a new drug from marine resources.

Antibody-drug conjugates: recent advances in conjugation and linker chemistries

The antibody-drug conjugate (ADC), a humanized or human monoclonal antibody conjugated with highly cytotoxic small molecules (payloads) through chemical linkers, is a novel therapeutic format and has great potential to make a paradigm shift in cancer chemotherapy. This new antibody-based molecular platform enables selective delivery of a potent cytotoxic payload to target cancer cells, resulting in improved efficacy, reduced systemic toxicity, and preferable pharmacokinetics (PK)/pharmacodynamics (PD) and biodistribution compared to traditional chemotherapy. Boosted by the successes of FDA-approved Adcetris and Kadcyla, this drug class has been rapidly growing along with about 60 ADCs currently in clinical trials. In this article, we briefly review molecular aspects of each component (the antibody, payload, and linker) of ADCs, and then mainly discuss traditional and new technologies of the conjugation and linker chemistries for successful construction of clinically effective ADCs. Current efforts in the conjugation and linker chemistries will provide greater insights into molecular design and strategies for clinically effective ADCs from medicinal chemistry and pharmacology standpoints. The development of site-specific conjugation methodologies for constructing homogeneous ADCs is an especially promising path to improving ADC design, which will open the way for novel cancer therapeutics.

Research and development of innovative antibody-based drugs / 药学学报

With the development of antibody manufacturing technology and improvement in new drug research and development (R&D) capabilities in domestic industry, more and more innovative antibody-based drugs were registered at the Investigational New Drug (IND). This type of drugs could be divided into three categories:new sequence antibodies (biobetter or new target antibodies), bispecific antibodies (or antibody cocktails), and antibody drug conjugates. Comparing with biosimilar antibodies, the innovative antibodies R&D was characterized by some significant features including "innovation", "clinical phase-appropriate" and "progressing". The minimum requirements of Chemical, Manufacturing and Control (CMC) content for innovative antibodies were obviously different from biosimilar antibodies. Here, the recent progress of antibody engineering and IND date of innovative antibodies in domestic are summarized. The general regulatory requirement and special considerations for representative innovative antibodies were proposed. Some common problems concerning innovative antibodies R&D are discussed.

Maytansine class antibody drug conjugates: Research advances / 国际药学研究杂志

Compared with the traditional anti-tumor therapy, the antibody-based therapeutic strategies have shown considerably higher targeting selectivity and lower side effects. Antibody drug conjugates (ADC), combining the advantage of the biological antibodies and small molecule toxins, is regarded as a new way for the future cancer therapy. Maytansines are one of the cytotoxins widely used in ADC and the postmarketing ADC ado-trastuzumab emtansine (Kadcyla, ATE) which use such toxins successfully has expanded the indications from leukemia to other solid tumors. Currently, the clinical research progress in such ADC goes smoothly. This paper reviews the characteristics, metabolic characteristics, preparation of each component and the latest clinical research progress in the maytansine class ADC.

Antibody drug conjugate ado trastuzumab emtansine: An updated review / 国际药学研究杂志

As a new design strategy of anticancer drugs, antibody-drug conjugates have become a research hotspot in recent years. In 2013, the successful launch of ado trastuzumab emtansine(Kadcyla) provided a new solution for second-line treatment with trastuzumab-resistant HER2-positive advanced breast cancer patients. Based on its excellent clinical performance and HER2‘s overexpressing in many tumors, Roche further attempts to expand it for the therapy of HER2-positive metastatic breast cancer of each line and neoadjuvant for early breast cancer treatment, as well as applications to gastric cancer and non-small cell lung cancer(NSCLC) treatment. In general, results are mixed. Its position as second-line drugs of is further established, but factors such as tumor heterogeneity are still a big challenge. This paper reviews the recent progress in these areas after its launch.

Heterogenecity analysis of anti-cluster of differentiation 30-vc-MMAE / 中国药学杂志

OBJECTIVE: To develop a heterogeneity analysis method of an antibody-drug conjugate (anti-CD30-vc-MMAE). METHODS: The size and charge heterogeneity of the antibody-drug conjugate (anti CD30-vc-MMAE) was analyzed by SEC-HPLC, CE-SDS, and iCIEF. RESULTS: The main peak purity was (95.69±0.01)% as shown by SEC-HPLC. The total peak purity of the heavy and light chains determined by reduced CE-SDS was (98.38±0.25%)%. At non-reduced CE-SDS level, there were six main peaks, and the total purity of which was (97.82±0.44)%. The acid modification, base modification, and main proportion could be separated effectively by iCIEF, and the peak area percentage of the main peak was (43.52±2.03)%. CONCLUSION: A heterogenecity analysis method of the antibody-drug conjugate (anti-CD30-vc-MMAE) has been preliminarily established and can provide reference for the quality control of this product.