title: Ex vivo antibody-dependent cellular cytotoxicity inducibility predicts efficacy of cetuximab.
abstract: We conducted in vitro studies and a clinical trial for patients with squamous cell carcinoma of the head and neck (SCCHN) to study the relationship between FcγRIIIa polymorphisms and antibody-dependent cellular cytotoxicity (ADCC). In vitro, FcγRIIIa genotype was correlated with ADCC and innate cytotoxicity using natural killer (NK) cells harvested from healthy donors. In the phase II study, patients with recurrent or metastatic SCCHN were treated with cetuximab (500 mg/m(2) i.v. every 2 weeks) and lenalidomide (25 mg daily). FcγRIIIa genotype and ex vivo ADCC were correlated with clinical response, progression-free survival (PFS), and overall survival (OS). In vitro, healthy donors with a FcγRIIIa 158-V allele demonstrated more effective ADCC against two colon cancer cell lines HT29 and SW480, mean cytotoxicity: FF 16.1%, VF/VV 24.3% (P = 0.015) and FF 11.7%, VF/VV 21.0% (P = 0.008), respectively. We observed a linear relationship between ADCC response and innate cytotoxicity. In the phase II trial, 40 patients received cetuximab and lenalidomide with median PFS of 7.2 weeks and OS of 16.4 weeks. Thirty-six patients had FcγRIIIa genotype: VV (2), VF (20), and FF (14), and 25 patients had sufficient NK-cell yield to perform ex vivo ADCC. FcγRIIIa genotype was not associated with any clinical outcomes. Patients mounting ex vivo ADCC response had a higher likelihood of stable disease (P = 0.01) and showed a trend toward increased PFS: 14 weeks versus 6.8 weeks, respectively (P = 0.13). Enhanced ex vivo ADCC and innate immunity responses were more predictive of clinical response than FcγRIIIa and may offer a functional assay to select patients suitable for cetuximab therapy.
authors.affiliation: University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland. rtaylor@smail.umaryland.edu.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Taylor
authors.affiliation: University of Chicago Department of Medicine, Chicago, Illinois.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Saloura
authors.affiliation: University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland.
authors.forename: Ajay
authors.initials: A
authors.lastname: Jain
authors.affiliation: University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland.
authors.forename: Olga
authors.initials: O
authors.lastname: Goloubeva
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Stuart
authors.initials: S
authors.lastname: Wong
authors.affiliation: University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland.
authors.forename: Shari
authors.initials: S
authors.lastname: Kronsberg
authors.affiliation: University of Chicago Department of Medicine, Chicago, Illinois.
authors.forename: Madhavi
authors.initials: M
authors.lastname: Nagilla
authors.affiliation: University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland.
authors.forename: Lorna
authors.initials: L
authors.lastname: Silpino
authors.affiliation: University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: Jonas
authors.initials: J
authors.lastname: de Souza
authors.affiliation: University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: Tanguy
authors.initials: T
authors.lastname: Seiwert
authors.affiliation: University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: Everett
authors.initials: E
authors.lastname: Vokes
authors.affiliation: University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois.
authors.forename: Victoria
authors.initials: V
authors.lastname: Villaflor
authors.affiliation: University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Ezra E W
authors.initials: EE
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000920:Antibody-Dependent Cell Cytotoxicity / Q000187:drug effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology*; D045744:Cell Line, Tumor; D000068818:Cetuximab / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005838:Genotype; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007694:Killer Cells, Natural / Q000187:drug effects* / Q000276:immunology; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D017452:Receptors, IgG / Q000235:genetics; D000077195:Squamous Cell Carcinoma of Head and Neck; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: C496124:FCGR3A protein, human; D017452:Receptors, IgG; D013792:Thalidomide; D000077269:Lenalidomide; D000068818:Cetuximab