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A Phase I Radioimmunotherapy Trial Evaluating ⁹⁰Yttrium-labeled Anti-Carcinoembryonic Antigen (CEA) Chimeric T84.66 in Patients with Metastatic CEA-producing Malignancies¹

Divisions of Radiation Oncology and Radiation Research [J. Y. C. W., A. A. R.], Radioimmunotherapy [A. A. R., J. Y. C. W., A. L.], Radiology [L. E. W., D. Y.], Surgery [D. Z. C.], Medical Oncology [J. H. D.], Pathology [S. W.], Molecular Biology [A. M. W.], and Immunology [J. E. S.], Beckman Research Institute and City of Hope National Medical Center, Duarte, California 91010

Chimeric T84.66 (cT84.66) is a genetically engineered human/murine chimeric IgG₁ with high affinity and specificity to carcinoembryonic antigen (CEA). The purpose of this Phase I dose escalation therapy trial was to evaluate the toxicities, biodistribution, pharmacokinetics, tumor targeting, immunogenicity, and organ and tumor absorbed dose estimates of cT84.66 labeled with ⁹⁰Y. Patients with metastatic CEA-producing malignancies were first administered 5 mCi ¹¹¹In-labeled DTPA-cT84.66 (5 mg), followed by administration of the therapy dose of ⁹⁰Y-labeled DTPA-cT84.66 1 week later. The therapy infusion was immediately followed by a 72-h administration of DTPA at 250 mg/m²/24 h. Dose levels of administered activity ranged from 5 to 22 mCi/m² with three to six patients per level. Serial nuclear scans, blood samples, and 24-h urine collections were performed out to 5 days after infusion. Human antichimeric antibody response was assayed out to 6 months. Patients were administered up to 3 cycles of therapy every 6 weeks. Radiation absorbed doses to organs were estimated using a five compartment model and MIRDOSE3. Twenty-two patients received at least one cycle of therapy, with one individual receiving two cycles and two receiving three cycles of therapy. All were heavily pretreated and had progressive disease prior to entry in this trial. Reversible leukopenia and thrombocytopenia were the primary dose-limiting toxicities observed. Maximum tolerated dose was reached at 22 mCi/m². In general, patients with liver metastases demonstrated more rapid blood clearance of the antibody. Thirteen patients developed an immune response to the antibody. Average radiation doses to marrow, liver, and whole body were 2.6, 29, and 1.9 cGy/mCi ⁹⁰Y, respectively. Dose estimates to tumor ranged from 66 to 1670 cGy (8.7 to 52.2 cGy/mCi ⁹⁰Y) for each cycle of therapy delivered. Although no major responses were observed, three patients demonstrated stable disease of 12–28 weeks duration and two demonstrated a mixed response. In addition, a 41–100% reduction in tumor size was observed with five tumor lesions. ⁹⁰Y-labeled cT84.66 was well tolerated, with reversible thrombocytopenia and leukopenia being dose limiting. Patients with extensive hepatic involvement by tumor demonstrated unfavorable biodistribution for therapy with rapid blood clearance and poor tumor targeting. Average tumor doses when compared with red marrow doses indicated a favorable therapeutic ratio. Stable disease and mixed responses were observed in this heavily pretreated population with progressive disease. This trial represents an important step toward further improving the therapeutic potential of this agent through refinements in the characteristics of the antibody and the treatment strategies used. Future trials will focus on the use of peripheral stem cell support to allow for higher administered activities and the use of combined modality strategies with radiation-enhancing chemotherapy drugs. Further efforts to reduce immunogenicity through humanization of the antibody are also planned. Finally, novel engineered, lower molecular weight, faster clearing constructs derived from cT84.66 continue to be evaluated in preclinical models as potential agents for radioimmunotherapy.

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