title: The biologic window for chimeric L6 radioimmunotherapy.
abstract: BACKGROUND
  There has been little success in using radioimmunotherapy in patients with adenocarcinoma, partly because of the low tumor uptake of the administered monoclonal antibody (MoAb). The authors recently reported therapeutic response in advanced cancer patients who received 131I chimeric-L6 MoAb. The L6 MoAb identifies abundant, nonshed antigen that is expressed in many human carcinomas, including carcinomas of the lung, breast, colon, and ovary. In vitro both mouse L6 (L6) and chimeric L6 (ChL6) mediate complement-dependent tumor cytolysis with human serum, and antibody-dependent tumor cell cytolysis with normal human peripheral blood mononuclear cells. The authors have used L6 or ChL6 for radioimmunotherapy to exploit their biologic activity to create a "therapeutic window" of increased vascular permeability, allowing more 131I MoAb to reach the tumor. A reactive target is present in the vascular endothelium but can be covered by unlabeled L6 or ChL6.
  
  
  METHODS
  Nine patients with metastatic breast cancer were treated on a therapy protocol and received imaging and therapy doses of 131I ChL6 on two sequential days at 4 week intervals. During each treatment cycle, serum cytokines, complement, albumin, and 131I ChL6 blood clearance were monitored, peripheral blood mononuclear cell activation was assessed, and tumor uptake and response were documented.
  
  
  RESULTS
  After L6 or ChL6 was infused, patients demonstrated immediate serum-complement activation, manifested by rapidly decreasing levels of serum complements 3 and 4. Tumor uptake of the second 131I MoAb (therapeutic) injection, given after the second daily injections of 200 mg MoAb, was usually higher than the tumor uptake of the first 131I MoAb (imaging) dose given after a single 200 mg infusion of MoAb. Although serum complement frequently decreased after the first 50-100 mg dose of L6 or ChL6, elevation of soluble interleukin-2 receptor (IL-2R) in serum was seen only in patients who received 150 mg or more of L6 or ChL6. In the nine treated patients, with only one exception, the higher grade of therapeutic tumor response was seen in patients with a greater increase in IL-2R levels.
  
  
  CONCLUSIONS
  The clinical importance of understanding these mechanisms is emphasized by the occurrence of measurable tumor regressions in five of the first nine advanced metastatic breast cancer patients treated in this manner. Absence of pulmonary edema and delayed release of dose-dependent IL-2R suggest that targeting of the pulmonary endothelium by L6 or ChL6 is not the major cause of the observed biologic effects. This unique response of a solid tumor to radioimmunoconjugate therapy may be secondary to both the increased delivery of the radioimmunoconjugate to tumor cells caused by enhanced vascular permeability, and to synergistic effects of radiation and activated effector cell mechanisms.
authors.affiliation: University of California, Davis Medical Center, Sacramento.
authors.forename: S J
authors.initials: SJ
authors.lastname: DeNardo
authors.forename: G R
authors.initials: GR
authors.lastname: Mirick
authors.forename: L A
authors.initials: LA
authors.lastname: Kroger
authors.forename: L F
authors.initials: LF
authors.lastname: O'Grady
authors.forename: K L
authors.initials: KL
authors.lastname: Erickson
authors.forename: A
authors.initials: A
authors.lastname: Yuan
authors.forename: K R
authors.initials: KR
authors.lastname: Lamborn
authors.forename: I
authors.initials: I
authors.lastname: Hellstrom
authors.forename: K E
authors.initials: KE
authors.lastname: Hellstrom
authors.forename: G L
authors.initials: GL
authors.lastname: DeNardo
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000951:Antigens, Neoplasm / Q000276:immunology*; D001943:Breast Neoplasms / Q000378:metabolism / Q000532:radiotherapy*; D003167:Complement Activation; D003165:Complement System Proteins / Q000378:metabolism; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008875:Middle Aged; D016499:Radioimmunotherapy; D011879:Radiotherapy Dosage; D017472:Receptors, Interleukin-1 / Q000378:metabolism; D015375:Receptors, Interleukin-2 / Q000378:metabolism; D016185:Receptors, Interleukin-3 / Q000378:metabolism
chemical_list: D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D007457:Iodine Radioisotopes; D017472:Receptors, Interleukin-1; D015375:Receptors, Interleukin-2; D016185:Receptors, Interleukin-3; D003165:Complement System Proteins