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Phase I and Imaging Trial of a Monoclonal Antibody Directed against Gastrin-releasing Peptide in Patients with Lung Cancer¹

Intervention Section, Department of Cell and Cancer Biology, Medicine Branch, Division of Clinical Sciences, National Cancer Institute [A. C., I. L. A., F. C., B. E. J., J. L. M.] and Nuclear Medicine Department, Warren E. Magnuson Clinical Center, NIH, Bethesda, Maryland 20892-1906 [J. A. C., N. S., J. C. R., S. M. L.], and Hybritech, Inc., San Diego, California 92121 [R. B.]

Small cell lung cancer (SCLC) cells express and secrete bombesin-like peptides (BLP) that can activate specific receptors that stimulate the growth of these cells. A murine monoclonal antibody, 2A11, which binds to the BLP, gastrin-releasing peptide with high affinity, has been reported to decrease the growth of SCLC cells in vitro and in athymic nude mice. A Phase I trial in lung cancer patients was performed using multiple doses of 2A11. Thirteen patients with lung cancer received 12 doses of 2A11 antibody three times a week for 4 weeks at one of four dose levels. Serum samples were obtained prior to initiation and before each dose of 2A11 antibody therapy for measurement of 2A11 antibody levels and determination of serum human antimouse antibody levels. A pilot imaging evaluation using ¹¹¹In conjugated 2A11 monoclonal antibody was also performed in the same patients to aid in the study of pharmacokinetics and biodistribution. No toxic reactions were observed, and none of the patients developed detectable human antimouse antibody; however, no objective antitumor responses were observed. The mean trough serum 2A11 levels in patients increased with increasing dose level: 0.26 ± 0.2 µg/ml, 6.7 ± 6 µg/ml, 71.5 ± 60 µg/ml, 248 ± 184 µg/ml for dose levels 1 mg/m², 10 mg/m², 100 mg/m², and 250 mg/m², respectively. At each dose level, sustained detectable serum levels of the monoclonal antibody were achieved. Tumor uptake was noted in 11 of 12 patients who were injected with ¹¹¹In conjugated 2A11. Because no dose-limiting clinical toxicity was observed, a mathematical model was used to define the recommended Phase II dose of 250 mg/m². This trial established that repeated doses of monoclonal antibody 2A11 could be given safely to patients, and sustained levels could be achieved for a 4-week schedule. Further evaluation of the antitumor effects of 2A11 is warranted.

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