title: Clinical activity and immune modulation in cancer patients treated with CP-870,893, a novel CD40 agonist monoclonal antibody.
abstract: OBJECTIVE
  The cell-surface molecule CD40 activates antigen-presenting cells and enhances immune responses. CD40 is also expressed by solid tumors, but its engagement results in apoptosis. CP-870,893, a fully human and selective CD40 agonist monoclonal antibody (mAb), was tested for safety in a phase I dose-escalation study.
  
  
  METHODS
  Patients with advanced solid tumors received single doses of CP-870,893 intravenously. The primary objective was to determine safety and the maximum-tolerated dose (MTD). Secondary objectives included assessment of immune modulation and tumor response.
  
  
  RESULTS
  Twenty-nine patients received CP-870,893 in doses from 0.01 to 0.3 mg/kg. Dose-limiting toxicity was observed in two of seven patients at the 0.3 mg/kg dose level (venous thromboembolism and grade 3 headache). MTD was estimated as 0.2 mg/kg. The most common adverse event was cytokine release syndrome (grade 1 to 2) which included chills, rigors, and fever. Transient laboratory abnormalities affecting lymphocytes, monocytes, platelets, D-dimer and liver function tests were observed 24 to 48 hours after infusion. Four patients with melanoma (14% of all patients and 27% of melanoma patients) had objective partial responses at restaging (day 43). CP-870,893 infusion resulted in transient depletion of CD19+ B cells in blood (93% depletion at the MTD for < 1 week). Among B cells remaining in blood, we found a dose-related upregulation of costimulatory molecules after treatment.
  
  
  CONCLUSIONS
  The CD40 agonist mAb CP-870,893 was well tolerated and biologically active, and was associated with antitumor activity. Further studies of repeated doses of CP-870,893 alone and in combination with other antineoplastic agents are warranted.
authors.affiliation: Abramson Family Cancer Research Institute, Abramson Cancer Center, Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. rhv@mail.med.upenn.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Vonderheide
authors.forename: Keith T
authors.initials: KT
authors.lastname: Flaherty
authors.forename: Magi
authors.initials: M
authors.lastname: Khalil
authors.forename: Molly S
authors.initials: MS
authors.lastname: Stumacher
authors.forename: David L
authors.initials: DL
authors.lastname: Bajor
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Hutnick
authors.forename: Patricia
authors.initials: P
authors.lastname: Sullivan
authors.forename: J Joseph
authors.initials: JJ
authors.lastname: Mahany
authors.forename: Maryann
authors.initials: M
authors.lastname: Gallagher
authors.forename: Amy
authors.initials: A
authors.lastname: Kramer
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Green
authors.forename: Peter J
authors.initials: PJ
authors.lastname: O'Dwyer
authors.forename: Kelli L
authors.initials: KL
authors.lastname: Running
authors.forename: Richard D
authors.initials: RD
authors.lastname: Huhn
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Antonia
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019013:CD40 Antigens / Q000819:agonists*; D016207:Cytokines / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D019013:CD40 Antigens; D016207:Cytokines; C518149:selicrelumab