Annals of Oncology 2015 September 18 [Epub ahead of print] [Link]
Nowak AK, Cook AM, McDonnell AM, Millward MJ, Creaney J, Francis RJ, Hasani A, Segal A, Musk AW, Turlach BA, McCoy MJ, Robinson BW, Lake RA.
Data from murine models suggests that CD40 activation may synergise with cytotoxic chemotherapy. We aimed to determine the maximum tolerated dose (MTD) and toxicity profile and to explore immunological biomarkers of the CD40 activating antibody CP-870,893 with cisplatin and pemetrexed in patients with malignant pleural mesothelioma (MPM).
Patients and Methods
Eligible patients had confirmed MPM, ECOG performance status 0-1, and measurable disease. Patients received cisplatin 75 mg/m2 and pemetrexed 500 mg/m2 on day 1 and CP-870,893 on day 8 of a 21 day cycle for maximum 6 cycles with up to 6 subsequent cycles single agent CP-870,893. Immune cell subset changes were examined weekly by flow cytometry.
15 patients were treated at three dose levels. The MTD of CP-870,893 was 0.15 mg/kg, and was exceeded at 0.2 mg/kg with one grade 4 splenic infarction and one grade 3 confusion and hyponatremia. Cytokine release syndrome occurred in most patients (80%) following CP-870,893. Haematological toxicities were consistent with cisplatin and pemetrexed chemotherapy. 6 partial responses (40%) and 9 stable disease (53%) as best response were observed. Median overall survival was 16.5 months; median progression free survival was 6.3 months. 3 patients survived beyond 30 months. CD19+ B cells decreased over 6 cycles of chemoimmunotherapy (p<0.001) with a concomitant increase in the proportion of CD27+ memory B cells (p<0.001) and activated CD86+CD27+ memory B cells (p<0.001), as an immunopharmacodynamic marker of CD40 activation.
CP-870,893 with cisplatin and pemetrexed is safe and tolerable at 0.15 mg/kg although most patients experience cytokine release syndrome. Whilst objective response rates are similar to chemotherapy alone, three patients achieved long term survival.