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Bispecific T-cell engager (BiTE) molecules have great potential to treat cancer. Nevertheless, dependent on the targeted tumor antigen, the mechanism of action that drives efficacy may also contribute to on-target/off-tumor toxicities. In this study, we characterize an anti-CD70 half-life extended BiTE molecule (termed N6P) which targets CD70, a TNF family protein detected in several cancers. First, the therapeutic potential of N6P was demonstrated using in vitro cytotoxicity assays and an orthotopic xenograft mouse study resulting in potent killing of CD70+ cancer cells. Next, in vitro characterization demonstrated specificity for CD70 and equipotent activity against human and cynomolgus monkey CD70+ cells. To understand the potential for on-target toxicity, a tissue expression analysis was performed and indicated CD70 is primarily restricted to lymphocytes in normal healthy tissues and cells. Therefore, no on-target toxicity was expected to be associated with N6P. However, in a repeat-dose toxicology study using cynomolgus monkeys, adverse N6P-mediated inflammation was identified in multiple tissues frequently involving the mesothelium and epithelium. Follow-up immunohistochemistry analysis revealed CD70 expression in mesothelial and epithelial cells in some tissues with N6P-mediated injury, but not in control tissues or those without injury. Collectively, the data indicate that for some target antigens such as CD70, BiTE molecules may exhibit activity in tissues with very low antigen expression or the antigen may be upregulated under stress enabling molecule activity. This work illustrates how a thorough understanding of expression and upregulation is needed to fully address putative liabilities associated with on-target/off-tumor activity of CD3 bispecific molecules.

Figure S2. Enzalutamide increases PSMA expression levels and may enhance AMG 160-dependent cytotoxicity.

Purpose:Metastatic castration-resistant prostate cancer (mCRPC) remains a disease with high unmet medical need, as most patients do not achieve durable response with available treatments. Prostate-specific membrane antigen (PSMA) is a compelling target for mCRPC. It is highly expressed by primary and metastatic prostate cancer cells, with increased expression after progression on androgen deprivation therapy.Experimental Design:We developed AMG 160, a half-life extended, bispecific T-cell engager immuno-oncology therapy that binds PSMA on prostate cancer cells and cluster of differentiation 3 on T cells for treatment of mCRPC. AMG 160 was evaluated in vitro and in mCRPC xenograft models. AMG 160 tolerability was assessed in nonhuman primates (NHP). AMG 160 activity as monotherapy and in combination with a PSMA-imaging agent, novel hormonal therapy, and immune checkpoint blockade was evaluated.Results:AMG 160 induces potent, specific killing of PSMA-expressing prostate cancer cell lines in vitro, with half-maximal lysis of 6–42 pmol/L. In vivo, AMG 160 administered weekly at 0.2 mg/kg engages T cells administered systemically and promotes regression of established 22Rv-1 mCRPC xenograft tumors. AMG 160 is compatible with the imaging agent gallium 68–labeled PSMA-11, and shows enhanced cytotoxic activity when combined with enzalutamide or an anti-programmed death-1 antibody. AMG 160 exhibits an extended half-life and has an acceptable safety profile in NHPs.Conclusions:The preclinical characterization of AMG 160 highlights its potent antitumor activity in vitro and in vivo, and its potential for use with known diagnostic or therapeutic agents in mCRPC. These data support the ongoing clinical evaluation of AMG 160 in patients with mCRPC.See related commentary by Kamat et al., p. 2675

Tables S1 to S6

Affinity measurements and antibody panels

Supplementary methods, tables, and references.

Purpose:Despite advances in the treatment of multiple myeloma, new therapies are needed to induce more profound clinical responses. T-cell–redirected lysis triggered by bispecific antibodies recruiting T cells to cancer cells is a clinically validated mechanism of action against hematologic malignancies and CD38 is a tumor-associated antigen with near-universal expression in multiple myeloma. Thus, an anti-CD38/CD3 bispecific T-cell–recruiting antibody has the potential to be an effective new therapeutic for multiple myeloma.Experimental Design:Anti-CD38/CD3 XmAb T-cell–recruiting antibodies with different affinities for CD38 and CD3 were assessed in vitro and in vivo for their redirected T-cell lysis activity against cancer cell lines, their lower levels of cytokine release, and their potency in the presence of high levels of soluble CD38. Select candidates were further tested in cynomolgus monkeys for B-cell depletion and cytokine release properties.Results:AMG 424 was selected on the basis of its ability to kill cancer cells expressing high and low levels of CD38 in vitro and trigger T-cell proliferation, but with attenuated cytokine release. In vivo, AMG 424 induces tumor growth inhibition in bone marrow–invasive mouse cancer models and the depletion of peripheral B cells in cynomolgus monkeys, without triggering excessive cytokine release. The activity of AMG 424 against normal immune cells expressing CD38 is also presented.Conclusions:These findings support the clinical development of AMG 424, an affinity-optimized T-cell–recruiting antibody with the potential to elicit significant clinical activity in patients with multiple myeloma.

Therapeutic approaches are needed to promote T cell-mediated destruction of poorly immunogenic, "cold" tumors typically associated with minimal response to immune checkpoint blockade (ICB) therapy. Bispecific T cell engager (BiTE) molecules induce redirected lysis of cancer cells by polyclonal T cells and have demonstrated promising clinical activity against solid tumors in some patients. However, little is understood about the key factors that govern clinical responses to these therapies. Using an immunocompetent mouse model expressing a humanized CD3e chain (huCD3e mice) and BiTE molecules directed against mouse CD19, mouse CLDN18.2, or human EPCAM antigens, we investigated the pharmacokinetic and pharmacodynamic parameters and immune correlates associated with BiTE efficacy across multiple syngeneic solid-tumor models. These studies demonstrated that pretreatment tumor-associated T cell density is a critical determinant of response to BiTE therapy, identified CD8+ T cells as important targets and mediators of BiTE activity, and revealed an antagonistic role for CD4+ T cells in BiTE efficacy. We also identified therapeutic combinations, including ICB and 4-1BB agonism, that synergized with BiTE treatment in poorly T cell-infiltrated, immunotherapy-refractory tumors. In these models, BiTE efficacy was dependent on local expansion of tumor-associated CD8+ T cells, rather than their recruitment from circulation. Our findings highlight the relative contributions of baseline T cell infiltration, local T cell proliferation, and peripheral T cell trafficking for BiTE molecule-mediated efficacy, identify combination strategies capable of overcoming resistance to BiTE therapy, and have clinical relevance for the development of BiTE and other T cell engager therapies.

Background Metastatic castration-resistant prostate cancer (mCRPC) and Ewing sarcoma (EWS) are diseases for which immune therapies could potentially provide benefit. STEAP1 (Six Transmembrane Epithelial Antigen of the Prostate 1) is a cell surface protein with elevated expression in mCRPC 1 and EWS.2 Methods We designed AMG 509, a novel, half-life extended, STEAP1 x CD3 XmAb® 2+1 bispecific antibody to induce T cell-mediated cytotoxicity against STEAP1-expressing cancer cells. AMG 509 contains two identical anti-STEAP1 Fab domains, an anti-CD3 scFv domain, and an effectorless Fc domain that extends serum half-life. We characterized STEAP1 expression in normal and tumor tissues by immunohistochemistry, and we assessed the pharmacological properties of AMG 509 including binding, T cell-mediated redirected lysis, and in vivo antitumor activity. Results We detected high STEAP1 surface expression on 80% of primary prostate tumors (n=88), 89% of mCRPC lesions (n=114), including 84% of mCRPC bone metastases (n=31), and 63% of EWS samples (n=35). In contrast, in normal tissues (n=72), low STEAP1 expression was detected in only six other tissues, including the normal prostate. AMG 509 bound to recombinant human CD3e with a KD of 27.6 nM, and it bound specifically to 293T cells transfected with human STEAP1 with an EC50 of 3.8 nM. AMG 509 triggered potent T cell-redirected lysis of STEAP1-positive cancer cells, with a median EC50 of 37 pM across 19 cancer cell lines that endogenously express various levels of STEAP1. AMG 509-mediated cytotoxicity was specific, as it showed no activity against prostate cancer cells in which STEAP1 was knocked out. AMG 509 was 65-fold more potent in inducing the redirected lysis of prostate cancer cells in vitro than an XmAb® molecule with a single anti-STEAP1 Fab domain. AMG 509 had greater cytotoxic activity against high STEAP1-expressing cancer cells than against low STEAP1-expressing cancer cells, and it had minimal activity against normal cells. This preferential killing of high STEAP1-expressing cells is likely driven by the avidity conferred by the dual STEAP1-binding domains, a feature that may help reduce off-target effects in the clinic. In vivo, AMG 509 induced robust anti-tumor activity in prostate cancer and EWS mouse xenograft models, with concomitant CD8+ T-cell activation and expansion in tumors. Conclusions AMG 509 is a specific, first-in-class T cell-recruiting antibody with avidity-driven activity against STEAP1-positive malignancies. AMG 509 is currently being evaluated for safety, pharmacokinetics, and efficacy in a phase 1, first-in-human study in patients with mCRPC (NCT04221542). Acknowledgements The authors acknowledge Micah Robinson, PhD of Amgen Inc. for medical writing support. Trial Registration ClinicalTrials. gov Identifier: NCT04221542 Ethics Approval All animal experimental protocols were approved by an Institutional Animal Care and Use Committee (IACUC protocol number 2015-01243) and were conducted in accordance with the guidelines of the Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC) (Amgen) or the standards of the Public Health Service (PHS) Policy on Humane Care and Use of Laboratory Animals (IACUC protocol number 15015x) in a facility certified with an Office of Laboratory Animal Welfare (OLAW) (UTHSA). References Grunewald TGP, Ranft A, Esposito I, Silva-Buttkus P da, Aichler M, Baumhoer D, Schaefer KL, Ottaviano L, Poremba C, Jundt G, Jurgens H, Dirksen U, Richter GHS, Burdach S. High STEAP1 expression is associated with improved outcome of Ewing’s sarcoma patients. Ann Oncol 2012; 23:2185–2190. Hubert RS, Vivanco I, Chen E, Rastegar S, Leong K, Mitchell SC, Madraswala R, Zhou Y, Kuo J, Raitano AB, Jakobvits A, Saffran SC, Afar DE. STEAP: a prostate-specific cell-surface antigen highly expressed in human prostate tumors. Proc Natl Acad Sci USA 1999;96:14523–14528.

BackgroundBispecific T-cell engager (BiTE) molecules induce redirected lysis of cancer cells by T cells and are an emerging modality for solid tumor immunotherapy. While signs of clinical activity have been demonstrated, efficacy of T-cell engagers (TCEs) in solid tumors settings, molecular determinants of response, and underlying mechanisms of resistance to BiTE therapy require more investigation.MethodsTo uncover cancer cell-intrinsic genetic modifiers of TCE-mediated cytotoxicity, we performed genome-wide CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) loss-of-function and CRISPRa (CRISPR activation) gain-of-function screens using TCEs against two distinct tumor-associated antigens (TAAs). By using in vitro T-cell cytotoxicity assays and in vivo efficacy studies, we validated the roles of two common pathways identified in our screen, T-cell costimulation pathway and apoptosis pathway, as key modifiers of BiTE activity.ResultsOur genetic screens uncovered TAAs-independent cancer cell-intrinsic genes with functions in autophagy, T-cell costimulation, the apoptosis pathway, chromatin remodeling, and cytokine signaling that altered responsiveness to BiTE-mediated killing. Notably, loss of CD58 (the ligand of the CD2 T-cell costimulatory receptor), a gene frequently altered in cancer, led to decreased TCE-mediated cytotoxicity, T-cell activation and antitumor efficacy in vitro and in vivo. Moreover, the effects of CD58 loss were synergistically compounded by concurrent loss of CD80/CD86 (ligands for the CD28 T-cell costimulatory receptor), whereas joint CD2 and CD28 costimulation additively enhanced TCE-mediated killing, indicating non-redundant costimulatory mechanisms between the two pathways. Additionally, loss of CFLAR (Caspase-8 and FADD Like Apoptosis Regulator), BCL2L1, and BID (BH3 Interacting Domain Death Agonist) induced profound changes in sensitivity to TCEs, indicating that key regulators of apoptosis, which are frequently altered in cancer, impact tumor responsiveness to BiTE therapy.ConclusionsThis study demonstrates that genetic alterations central to carcinogenesis and commonly detected in cancer samples lead to significant modulation of BiTE antitumor activity in vitro and in vivo, findings with relevance for a better understanding of patient responses to BiTE therapy and novel combinations that enhance TCE efficacy.

Purpose: Metastatic castration-resistant prostate cancer (mCRPC) remains a disease with high unmet medical need, as most patients do not achieve durable response with available treatments. Prostate-specific membrane antigen (PSMA) is a compelling target for mCRPC. It is highly expressed by primary and metastatic prostate cancer cells, with increased expression after progression on androgen deprivation therapy. Experimental Design: We developed AMG 160, a half-life extended, bispecific T-cell engager immuno-oncology therapy that binds PSMA on prostate cancer cells and cluster of differentiation 3 on T cells for treatment of mCRPC. AMG 160 was evaluated in vitro and in mCRPC xenograft models. AMG 160 tolerability was assessed in nonhuman primates (NHP). AMG 160 activity as monotherapy and in combination with a PSMA-imaging agent, novel hormonal therapy, and immune checkpoint blockade was evaluated. Results: AMG 160 induces potent, specific killing of PSMA-expressing prostate cancer cell lines in vitro, with half-maximal lysis of 6–42 pmol/L. In vivo, AMG 160 administered weekly at 0.2 mg/kg engages T cells administered systemically and promotes regression of established 22Rv-1 mCRPC xenograft tumors. AMG 160 is compatible with the imaging agent gallium 68–labeled PSMA-11, and shows enhanced cytotoxic activity when combined with enzalutamide or an anti-programmed death-1 antibody. AMG 160 exhibits an extended half-life and has an acceptable safety profile in NHPs. Conclusions: The preclinical characterization of AMG 160 highlights its potent antitumor activity in vitro and in vivo, and its potential for use with known diagnostic or therapeutic agents in mCRPC. These data support the ongoing clinical evaluation of AMG 160 in patients with mCRPC. See related commentary by Kamat et al., p. 2675

AMG509, a novel STEAP1 x CD3 T cell-recruiting XmAb® 2+1 bispecific immune therapy for the treatment of prostate cancer and Ewing sarcoma. Metastatic castration resistant prostate cancer (mCRPC) and Ewing sarcoma (EWS) are both diseases with unmet medical needs. Six Transmembrane Epithelial Antigen of the Prostate 1 (STEAP1) is a cell surface antigen that is induced by androgens and highly expressed in prostate cancer. STEAP1 is also highly expressed in EWS, and it is a target of the EWS/FLI1 fusion, the primary oncogenic driver in this pediatric malignancy. AMG 509 is a novel, half-life extended, cynomolgus monkey cross-reactive, STEAP1 x CD3 T cell-recruiting XmAb® 2+1 bispecific antibody designed to treat STEAP1-expressing cancers. AMG 509 contains two identical humanized anti-STEAP1 Fab domains that bind STEAP1-expressing cells, an anti-CD3 scFv domain that binds T cells, and an Fc domain engineered to lack effector function and extend serum half-life. We found that membranous STEAP1 expression, as measured by IHC, was absent from most normal tissues (FDA normal organ tissue array, n = 72) except the prostate epithelium and a subset of lung macrophages. In contrast, we found membranous STEAP1 expression by IHC in 80% of primary prostate cancer tumors (n = 80) and moderate to high expression in 83% of metastatic prostate cancer lesions (n = 181) and 77% of bone metastases (n = 31). In addition, we found STEAP1 expression by IHC in all EWS cell lines (n=13) and xenograft models tested (n=12). AMG 509 bound to recombinant human and cynomolgus monkey CD3ϵ with a KD of 27.6 nM and 25.8 nM, respectively, and to 293T cells transfected with human or cynomolgus monkey STEAP1 with an EC50 of 3.8 nM and 3.1 nM, respectively. AMG 509 triggered potent T cell-redirected lysis of STEAP1-positive cancer cells, with a median EC50 of 18.9 pM across 17 different STEAP1-expressing prostate, EWS, gastric, and melanoma cancer cell lines. AMG 509 was 50-fold more potent in inducing the redirected lysis of C4-2B prostate cancer cells in vitro than an XmAb® molecule with a single anti-STEAP1 Fab domain. AMG 509 was also specific, as it showed no activity against C4-2B cancer cells engineered to lack STEAP1 expression. AMG 509 exhibited hallmarks of T-cell engagement in vitro, including T-cell proliferation and cytokine release. It also induced robust in vivo anti-tumor activity in prostate cancer and EWS xenograft models, with concomitant CD8+ T-cell activation and expansion in tumors. Data from a nonclinical safety study conducted in the cynomolgus monkey suggest that AMG 509 can be administered safely at doses that are predicted to be clinically active. AMG 509 is a potent and specific first-in-class T cell-recruiting antibody for the treatment of STEAP1-positive malignancies. We are currently evaluating the safety, tolerability, pharmacokinetics, and efficacy of AMG 509 in a phase 1, first-in-human study in patients with mCRPC (NCT04221542). Citation Format: Olivier Nolan-Stevaux. AMG 509: A novel, humanized, half-Life extended, bispecific STEAP1 × CD3 T cell recruiting XmAb® 2+1 antibody [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr DDT02-03.

BiTE® constructs redirect T cell cytotoxicity against cancer cells through simultaneous binding to CD3 on T cells and a tumor-associated antigen (TAA) on cancer cells. Blinatumomab, an anti-CD19 BiTE® molecule used to treat pre-B-ALL patients, leads to more than 40% complete remission rates. Only 30% of relapsed patients exhibit loss of CD19 on leukemia cells, indicating that the majority of patients acquire blinatumomab resistance independently of target loss. Understanding such mechanisms could lead to new predictive biomarkers and help improve current BiTE® immunotherapy. To gain insight into the mechanism of resistance to BiTE® cytotoxicity, we performed CRISPR screens to identify tumor-intrinsic genetic factors that modulate BiTE® molecule efficacy in vitro. Cas9 expressing human cancer cells transduced with a genome-wide sgRNA library were incubated with T cells and either a control BiTE® molecule that did not recognize the cancer cells, or an anti-TAA BiTE® molecule at a concentration that induced the lysis of ~90% of target cells. Next-gen sequencing was used to identify enriched or depleted sgRNA, indicative of genes whose loss confers resistance or susceptibility to BiTE®-mediated T cell killing. As expected, the most enriched candidates from the screen were involved in the expression, post-translational modification or surface presentation of the TAA targeted by the BiTE® molecules. In the case of a screen using an anti-MSLN BiTE® molecule, a panel of genes involved in GPI-anchor biosynthesis, required to anchor MSLN to the plasma membrane was uncovered. The screen also revealed genes known to promote immune evasion such as PD-L1 as well as novel genes whose roles in immunotherapy were not extensively studied before, including genes involved in apoptosis and the NF-κB pathway. One of the top enriched candidates was CD58, which encodes a co-stimulatory molecule that binds to CD2 on T cells. Genetic perturbation and pharmacological blockade of CD58-CD2 interaction significantly reduced BiTE®-mediated killing of target cells. Furthermore, re-establishment of CD58-CD2 interaction either by overexpressing CD58 in cancer cells or by using CD2-agonist large molecules improved T cell activation and target cell killing. Moreover, concurrent blocking of CD2 and CD28 co-stimulation inhibited BiTE®-mediated killing more profoundly than blocking either pathway alone, indicating redundancy between CD58- and CD80/86-mediated co-stimulation. Our study reveals an important role of T cell co-stimulatory signals in BiTE®-mediated cytotoxicity. Considering that loss of CD58 is highly prevalent in DLBCL and relapsed Hodgkin lymphoma patients, it could potentially serve as a biomarker to predict response to BiTE®-based therapies. Our study also demonstrates that restoring CD58-CD2 interaction could sensitize cancer cells to BiTE®-mediated killing. Citation Format: Ye Shen, Patrick Collins, Jason Eng, Flordeliza Fajardo, Wendy Zhong, Olivier Nolan-Stevaux. Genetic screens identify T cell co-stimulation as a key modifier of the redirected cytotoxicity of bispecific T cell engager (BiTE®) molecules [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6714.

The development and success of Blincyto®, a Bi-Specific T cell Engager (BiTE®), to treat acute lymphoblastic leukemia has expanded the class of anticancer immunotherapy agents. BiTE® molecules consist of a single-chain Fc antibody containing tandem single-chain variable fragments (scFv) recognizing the CD3 receptor on T lymphocytes and a tumor-associated antigen and induce redirected T-cell cytotoxicity and tumor cell lysis. Despite the clinically validated efficacy of BiTE® molecules, there has been little elucidation of the parameters governing their in vivo activity. This is due, in part, to a lack of immunocompetent murine tumor models that allow for engagement of endogenous T cells in the context of an intact immune system, which more accurately mimic the human therapeutic setting. We have developed a genetically engineered mouse model (huCD3 mouse) in which a human/mouse chimeric CD3ϵ receptor recognized by BiTE® molecules was engineered into the mouse CD3ϵ genomic locus. Here, we characterize the immune cell distribution of the huCD3 mouse and utilize BiTE® molecules and syngeneic tumor models to elucidate pharmacokinetic, pharmacodynamic, and efficacy relationships in vivo. The peripheral B and T cell distribution profile of huCD3 mice and WT littermates are comparable, but T cells isolated from huCD3 mice express lower levels of. In T cell-dependent cytotoxic (TDCC) assays, an anti-huEpCAM BiTE® molecule exhibited similar potency against MC38 mouse cells expressing human EpCAM co-cultured with T cells from the huCD3 mice or a human donor, if mouse T-cells were preactivated in vitro. In vivo, MC38-huEpCAM tumors grew robustly and anti-huEpCAM BiTEÂ treatment resulted in dose-dependent tumor growth inhibition, with several tumor-free animals at higher doses. Flow cytometry analysis of disaggregated tumors and serum cytokine analysis indicated that BiTE® treatment resulted in T-cell activation and a cytokine response at doses that correlate with tumor regression. In vivo studies were also performed using B16F10-huEPCAM cells, which generate tumors with reduced T-cell infiltration compared to MC38-huEpCAM. Additionally, we used WT mice reconstituted with different ratios of huCD3e and WT bone marrow to investigate the T-cell number requirement for optimal BiTE®-mediated efficacy. We also evaluated the efficacy of an anti-mouse CD19 BiTE® molecule against MC38-CD19 tumor cells to compare the requirements for antitumor efficacy versus normal B-cell depletion in the blood and in lymphoid organs. Finally, we performed a rational combination study using BiTE® molecules and a PD1 inhibitor, demonstrating that this combination can lead to the eradication of poorly T cell-infiltrated solid tumors. These data begin to elucidate the in vivo mechanisms regulating the efficacy of BiTE® molecules under physiologically relevant conditions. This abstract is also being presented as Poster A29. Citation Format: Brian Belmontes, Hong Tan, Wendy Zhong, Danny Chui, Kevin Cook, Sarah O'Brien, Melissa Martin, Brandy Alexander, Jason Eng, John Harrold, Famke Aeffner, Matthew Chun, Alice Bakker, Mercedesz Balazs, Jason DeVoss, Angela Coxon, Jude Canon, Jackson Egen, Olivier Nolan-Stevaux. Assessing in vivo mechanisms regulating the therapeutic activity of bi-specific T-cell engager (BiTE®) molecules in immunocompetent mice expressing a chimeric human/mouse CD3ϵ receptor [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr PR12.

Purpose: Despite advances in the treatment of multiple myeloma, new therapies are needed to induce more profound clinical responses. T-cell–redirected lysis triggered by bispecific antibodies recruiting T cells to cancer cells is a clinically validated mechanism of action against hematologic malignancies and CD38 is a tumor-associated antigen with near-universal expression in multiple myeloma. Thus, an anti-CD38/CD3 bispecific T-cell–recruiting antibody has the potential to be an effective new therapeutic for multiple myeloma. Experimental Design: Anti-CD38/CD3 XmAb T-cell–recruiting antibodies with different affinities for CD38 and CD3 were assessed in vitro and in vivo for their redirected T-cell lysis activity against cancer cell lines, their lower levels of cytokine release, and their potency in the presence of high levels of soluble CD38. Select candidates were further tested in cynomolgus monkeys for B-cell depletion and cytokine release properties. Results: AMG 424 was selected on the basis of its ability to kill cancer cells expressing high and low levels of CD38 in vitro and trigger T-cell proliferation, but with attenuated cytokine release. In vivo, AMG 424 induces tumor growth inhibition in bone marrow–invasive mouse cancer models and the depletion of peripheral B cells in cynomolgus monkeys, without triggering excessive cytokine release. The activity of AMG 424 against normal immune cells expressing CD38 is also presented. Conclusions: These findings support the clinical development of AMG 424, an affinity-optimized T-cell–recruiting antibody with the potential to elicit significant clinical activity in patients with multiple myeloma.

Factors associated with tumor sensitivity to epidermal growth factor receptor (EGFR) inhibitors in the context of wild-type EGFR remain elusive. This study investigates the mechanistic basis of responsiveness to EGFR inhibitors in the RIP1-Tag2 (RT2) mouse model of pancreatic neuroendocrine tumorigenesis (PNET). Upon treatment of RT2 mice with EGFR inhibitors, PNET tumors harboring wild-type, nonamplified alleles of Egfr grow at a markedly reduced rate and display a significant increase in tumor cell apoptosis, as well as reduced neovascularization. The authors identify Tgf-α and Hb-egf as key limiting mediators of separable pathological functions of Egfr in neuroendocrine tumor progression: Tgf-α mutant tumors present with an elevated apoptotic index, whereas Hb-egf mutant lesions exhibit decreased angiogenic switching and neovascularization. This study not only associates Tgf-α and Hb-egf expression with wild-type Egfr oncogenicity but also ascribes the proangiogenic activity of Egfr in this tumor model to a novel mesenchymal Hb-egf/Egfr signaling axis, whereby endothelial and pericyte-derived Hb-egf activates Egfr specifically in tumor-associated perivascular cells, leading to increased pericyte coverage of the tumor endothelium and enhanced angiogenesis.

Pancreatic ductal adenocarcinoma (PDAC) is characterized by the deregulation of the hedgehog signaling pathway. The Sonic Hedgehog ligand (Shh), absent in the normal pancreas, is highly expressed in pancreatic tumors and is sufficient to induce neoplastic precursor lesions in mouse models. We investigated the mechanism of Shh signaling in PDAC carcinogenesis by genetically ablating the canonical bottleneck of hedgehog signaling, the transmembrane protein Smoothened (Smo), in the pancreatic epithelium of PDAC-susceptible mice. We report that multistage development of PDAC tumors is not affected by the deletion of Smo in the pancreas, demonstrating that autocrine Shh–Ptch–Smo signaling is not required in pancreatic ductal cells for PDAC progression. However, the expression of Gli target genes is maintained in Smo-negative ducts, implicating alternative means of regulating Gli transcription in the neoplastic ductal epithelium. In PDAC tumor cells, we find that Gli transcription is decoupled from upstream Shh–Ptch–Smo signaling and is regulated by TGF-β and KRAS, and we show that Gli1 is required both for survival and for the KRAS-mediated transformed phenotype of cultured PDAC cancer cells.

Advances in the fields of cancer initiating cells and high-throughput in vivo shRNA screens have highlighted a need to observe the growth of tumor cells in cancer models at the clonal level. While in vivo cancer cell growth heterogeneity in xenografts has been described, it has yet to be measured. Here, we tested an approach to quantify the clonal growth heterogeneity of cancer cells in subcutaneous xenograft mouse models. Using a high-throughput sequencing method, we followed the fate in vitro and in vivo of ten thousand HCT-116 cells individually tagged with a unique barcode delivered by lentiviral transduction. While growth in vitro was less homogeneous than anticipated, we still find that 95% of the final cells derived from 80% of the original cells. In xenografts, however, 95% of the retrieved barcoded cells originated from only 6% of the initially injected cells, an effect we term "clonal dominance". We observed this clonal dominance in two additional xenograft models (MDA-MB-468 and A2780(cis)) and in two different host strains (NSG and Nude). By precisely and reproducibly quantifying clonal cancer cell growth in vivo, we find that a small subset of clones accounts for the vast majority of the descendant cells, even with HCT-116, a cell line reported to lack a tumor-initiating compartment. The stochastic in vivo selection process we describe has important implications for the fields of in vivo shRNA screening and tumor initiating cells.

Endoglin (ENG), a co-receptor for several TGFβ-family cytokines, is expressed in dividing endothelial cells alongside ALK1, the ACVRL1 gene product. ENG and ACVRL1 are both required for angiogenesis and mutations in either gene are associated with Hereditary Hemorrhagic Telangectasia, a rare genetic vascular disorder. ENG and ALK1 function in the same genetic pathway but the relative contribution of TGFβ and BMP9 to SMAD1/5/8 activation and the requirement of ENG as a co-mediator of SMAD phosphorylation in endothelial cells remain debated. Here, we show that BMP9 and TGFβ1 induce distinct SMAD phosphorylation responses in primary human endothelial cells and that, unlike BMP9, TGFβ only induces SMAD1/5/8 phosphorylation in a subset of immortalized mouse endothelial cell lines, but not in primary human endothelial cells. We also demonstrate, using siRNA depletion of ENG and novel anti-ENG antibodies, that ENG is required for BMP9/pSMAD1 signaling in all human and mouse endothelial cells tested. Finally, anti-ENG antibodies that interfere with BMP9/pSMAD1 signaling, but not with TGFβ1/pSMAD3 signaling, also decrease in vitro HUVEC endothelial tube formation and inhibit BMP9 binding to recombinant ENG in vitro. Our data demonstrate that BMP9 signaling inhibition is a key and previously unreported mechanism of action of TRC105, an anti-angiogenic anti-Endoglin antibody currently evaluated in clinical trials.

USP8 and the ESCRT pathway (endosomal sorting complex required for transport) are required for cellular homeostasis through key functions in shuttling ubiquitinated proteins towards lysosomal degradation, and through regulating the maturation of autophagosomal structures. In large-scale siRNA screens, the vast majority of cancer cell lines do not demonstrate dependency on USP8 or ESCRT pathway components for viability. However, we identified three cell lines (HCC70, HCC1954 and PFSK1) that are acutely dependent on USP8 and other ESCRT components (HGS, TSG101) for viability. Using a transcriptome-wide association approach, we found that these three USP8-dependent cell lines also had in common the expression of SerpinB3, also known as SCCA1 (Squamous Cell Carcinoma Antigen 1). After selecting additional Squamous Cell Carcinoma cell lines for further validation of USP8-dependency by siRNA screening, we found that Squamous Carcinoma cell lines, irrespective of their SerpinB3 expression status, were far more likely to be dependent on USP8 for viability (23%; N = 22) than cancer cell lines of non-Squamous epithelial origin (4.5%; N = 67). To unravel possible molecular mechanisms underpinning the requirement of USP8 for the viability of USP8-dependent Squamous Carcinoma cell lines (including SCABER, BICR22, CALU1 and EBC1), we conducted additional transcriptome association studies and genetic interaction screens to uncover genes that are synthetic lethal with USP8 knock-down. Citation Format: Wendy Zhong, Elissa Cosgrove, Elissa Swearingen, Mike Ollmann, Jayee Banerjee, Vivienne Watson, Peter Jaeckel, Mariana Pfreimer, Silvia Materna-Reichelt, Holger Beckmann, Paul Kassner, Astrid Ruefli-Brasse, Olivier Nolan-Stevaux. High throughput siRNA screens uncover a high rate of USP8 and ESCRT pathway dependency in squamous carcinoma cell lines. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4548.

BiTE® therapeutics are single chain antibody constructs harboring two binding moieties: one directed at a tumor associated antigen and one directed at the CD3e protein, which trigger T cell dependent cellular cytotoxicity (TDCC) against targeted cancer cells. Here, we evaluated the suitability of ENPP3 as a potential BiTE® target. The ENPP3 mRNA is highly differentially expressed in clear cell Renal Cell Carcinoma (ccRCC) and the ENPP3 protein is detected with high uniformity and intensity in ccRCC tumor samples by immunohistochemistry. We demonstrated the surface expression of this protein in Renal Cancer cell lines and confirmed that the ENPP3 protein was highly restricted to the luminal side of normal epithelial layers in which it was detected (proximal renal tubules, bronchial epithelium, salivary glands). We developed highly potent anti-ENPP3 BiTE® molecules and demonstrated the in vitro TDCC activity of these molecules. Two anti-ENPP3 BiTE® molecules further demonstrated tumor formation inhibition activity in a human T cell / human target cell admixture mouse xenograft model. Citation Format: Olivier Nolan-Stevaux, Flordeliza Fajardo, Lily Liu, Suzanne Coberly, Patricia McElroy, Aaron Nazarian, Franziska Bott, Elisabeth Nahrwold, Tobias Raum, Roman Kischel, Ralf Lutterbuese, Patrick Hoffmann, Peter Kufer. Assessing ENPP3 as a renal cancer target for bispecific T-cell engager (BiTE) therapy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 585.

The clinical validation of several anti-angiogenic agents targeting the VEGF pathway for the treatment of metastatic colorectal cancer (Hurwitz et al., 2004), non-small cell lung cancer (Sandler et al., 2006), hepatocellular carcinoma (Llovet et al., 2008) and metastatic renal cell carcinoma (mRCC) (Motzer et al., 2009) has provided evidence that angiogenesis inhibition can lead to increased overall patient survival. Although these treatments achieve sustained tumor regression in isolated cases, the average clinical gains from individual therapeutics are measured in only weeks to months. In most patients, cancer progression resumes following initial disease stabilization as tumors acquire resistance to anti-angiogenic agents (Ellis and Hicklin, 2008; Rini and Atkins, 2009). In some disease, such as metastatic breast cancer (Miller et al., 2007), the clinical benefits from VEGF-targeted therapies appear marginal from the outset, while still other cancer types, such as melanoma (Hauschild et al., 2009) and pancreatic ductal adenocarcinoma (Kindler et al., 2007), appear to be refractory to anti-angiogenic drugs from the outset and are deemed “intrinsically” resistant (Bergers and Hanahan, 2008). Acquired and intrinsic resistance to VEGF-targeted therapies stem from multiple proangiogenic mechanisms: VEGF signaling upregulation (Rini and Atkins, 2009); secretion of alternative angiogenic factors (Casanovas, 2011; Kopetz et al., 2010; Loges et al., 2010); acquisition of new blood vessels in an angiogenesis-independent manner via vasculogenesis, vessel co-option or vascular mimicry (Kerbel, 2008; Loges et al., 2010); and activation of stromal components such as myeloid cells and cancer associated fibroblasts, which can cooperate to rescue or expand the tumor vasculature (Bergers and Hanahan, 2008; Crawford and Ferrara, 2009). To overcome acquired resistance mechanisms, some clinicians currently shift patients from one VEGF-targeted therapy to another and are able to achieve lasting clinical benefit at least in the case of metastatic renal cell carcinoma (mRCC), suggesting that upregulation of the VEGF signaling pathway itself is one of the major initial routes of resistance in this cancer type (Rini and Atkins, 2009). However, all cancers eventually acquire resistance to even the most potent VEGF receptor inhibitors, underscoring the need for additional anti-angiogenic therapies targeted at alternative signaling pathways to overcome these resistance mechanisms. In this chapter, we will review two signaling pathways that play critical functions at distinct phases of angiogenesis and against which experimental drugs are currently in development: the NOTCH and BMP9-ALK1 signaling axes. In each case, we will present the genetic and experimental evidence demonstrating the function of these signaling axes in angiogenesis

Preclinical trials in mice represent a critical step in the evaluation of experimental therapeutics. Genetically engineered mouse models (GEMMs) represent a promising platform for the evaluation of drugs, particularly those targeting the tumor microenvironment. We evaluated sunitinib, an angiogenesis inhibitor that targets VEGF and PDGF receptor signaling, in two GEMMs of pancreatic cancer. Sunitinib did not reduce tumor burden in pancreatic ductal adenocarcinoma (PDAC), whereas tumor burden was reduced in the pancreatic neuroendocrine tumor (PNET) model, the latter results confirming and extending previous studies. To explore the basis for the lack of pathologic response in PDAC, we used noninvasive microbubble contrast-enhanced ultrasound imaging, which revealed that sunitinib reduced blood flow both in PDAC and in PNET, concomitant with a reduction in vessel density; nevertheless, PDAC tumors continued to grow, whereas PNET were growth impaired. These results parallel the response in humans, where sunitinib recently garnered FDA and European approval in PNET, whereas two antiangiogenic drugs failed to demonstrate efficacy in PDAC clinical trials. The demonstration of on-target activity but with discordant benefit in the PDAC and PNET GEMMs illustrates the potential value of linked preclinical and clinical trials.

Endoglin (ENG), a co-receptor for several TGFβ-family cytokines, is expressed in activated endothelial cells alongside ALK1, the ACVRL1 gene product. ENG and ACVRL1 are both required for angiogenesis and mutations in either gene are associated with Hereditary Hemorrhagic Telangectasia, a rare genetic vascular disorder. ENG and ALK1 function in the same genetic pathway but the relative contribution of TGFβ and BMP9 to SMAD1/5/8 activation and the requirement of ENG as a co-mediator of SMAD phosphorylation in endothelial cells remain debated. Here, we show that BMP9 and TGFβ1 induce distinct SMAD phosphorylation responses in primary human endothelial cells and that, unlike BMP9, TGFβ1 only induces SMAD1/5/8 phosphorylation in a subset of immortalized mouse endothelial cell lines, but not in primary human endothelial cells. We also demonstrate, using siRNA depletion of ENG and novel neutralizing anti-ENG antibodies, that ENG is required for BMP9/pSMAD1 signaling in all human and mouse endothelial cells tested. Finally, anti-ENG antibodies that interfere with BMP9/pSMAD1 signaling, but not with TGFβ1/pSMAD3 signaling, including the TRC105 clinical candidate, also decrease in vitro HUVEC endothelial tube formation and inhibit BMP9 binding to recombinant ENG in vitro. Our data demonstrate that BMP9 signaling inhibition is a key and previously unreported mechanism of action of TRC105, an anti-angiogenic anti-ENG antibody currently evaluated in clinical trials. Citation Format: Olivier P. Nolan-Stevaux, Wendy Zhong, Dineli Wickramasinghe, Astrid Ruefli-Brasse. Endoglin requirement for BMP9 signaling in endothelial cells reveals new mechanism of action for selective anti-Endoglin antibodies. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5079. doi:10.1158/1538-7445.AM2013-5079