Intrapatient dose escalation of anti-CTLA-4 antibody in patients with metastatic melanoma

Ajay V. Maker, James C. Yang, Richard M. Sherry, Suzanne L. Topalian, Udai S. Kammula, Richard E. Royal, Marybeth Hughes, Michael J. Yellin, Leah R. Haworth, Catherine Levy, Tamika Allen, Sharon A. Mavroukakis, Peter Attia, Steven A. Rosenberg

Research output: Contribution to journalArticle

Abstract

We previously reported our experience in treating 56 patients with metastatic melanoma using a human anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibody. Durable tumor regressions were seen that correlated with the induction of autoimmune toxicities. In this study, we treated 46 additional patients using an intrapatient dose escalation schema to test whether higher doses of anti-CTLA-4 antibody would induce increased autoimmunity and concomitant tumor regression. Twenty-three patients started anti-CTLA-4 antibody administration at 3 mg/kg and 23 patients started treatment at 5 mg/kg, receiving doses every 3 weeks. Patients were dose-escalated every other dose to a maximum of 9 mg/kg or until objective clinical responses or grade III/IV autoimmune toxicity were seen. Escalating doses of antibody resulted in proportionally higher plasma concentrations. Sixteen patients (35%) experienced a grade III/IV autoimmune toxicity. Five patients (11%) achieved an objective clinical response. Two of the responses are ongoing at 13 and 16 months, respectively. Flow cytometric analysis of peripheral blood revealed significant increases in both T-cell surface markers of activation and memory phenotype. Thus, higher serum levels and prolonged administration of anti-CTLA-4 antibody resulted in a trend toward a greater incidence of grade III/IV autoimmune toxicity than previously reported, but did not seem to increase objective response rates.

Original languageEnglish (US)
Pages (from-to)455-463
Number of pages9
JournalJournal of Immunotherapy
Volume29
Issue number4
DOIs
StatePublished - Jul 1 2006

Keywords

  • Autoimmunity
  • Cell activation
  • Human
  • T-cells
  • Tumor immunity

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pharmacology
  • Cancer Research

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  • Cite this

    Maker, A. V., Yang, J. C., Sherry, R. M., Topalian, S. L., Kammula, U. S., Royal, R. E., Hughes, M., Yellin, M. J., Haworth, L. R., Levy, C., Allen, T., Mavroukakis, S. A., Attia, P., & Rosenberg, S. A. (2006). Intrapatient dose escalation of anti-CTLA-4 antibody in patients with metastatic melanoma. Journal of Immunotherapy, 29(4), 455-463. https://doi.org/10.1097/01.cji.0000208259.73167.58