title: Intrapatient dose escalation of anti-CTLA-4 antibody in patients with metastatic melanoma.
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.
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20814, USA.
authors.forename: Ajay V
authors.initials: AV
authors.lastname: Maker
authors.forename: James C
authors.initials: JC
authors.lastname: Yang
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sherry
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Topalian
authors.forename: Udai S
authors.initials: US
authors.lastname: Kammula
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Marybeth
authors.initials: M
authors.lastname: Hughes
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Yellin
authors.forename: Leah R
authors.initials: LR
authors.lastname: Haworth
authors.forename: Catherine
authors.initials: C
authors.lastname: Levy
authors.forename: Tamika
authors.initials: T
authors.lastname: Allen
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Mavroukakis
authors.forename: Peter
authors.initials: P
authors.lastname: Attia
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000276:immunology; D000912:Antibodies, Neoplasm / Q000008:administration & dosage* / Q000276:immunology; D015703:Antigens, CD; D000943:Antigens, Differentiation / Q000276:immunology*; D000951:Antigens, Neoplasm; D015551:Autoimmunity; D060908:CTLA-4 Antigen; D003131:Combined Modality Therapy; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged
chemical_list: D000911:Antibodies, Monoclonal; D000912:Antibodies, Neoplasm; D015703:Antigens, CD; D000943:Antigens, Differentiation; D000951:Antigens, Neoplasm; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human