Intratumoral Administration of Recombinant Circularly Permuted Interleukin-4-Pseudomonas Exotoxin in Patients with High-Grade Glioma

Intratumoral Administration of Recombinant Circularly Permuted Interleukin-4-Pseudomonas Exotoxin in Patients with High-Grade Glioma1

Department of Neuro-Oncology, John Wayne Cancer Institute, Santa Monica, California 90404 [R. W. R.]; Laboratory of Molecular Biology, Division of Basic Sciences, National Cancer Institute, NIH, Bethesda, Maryland 20892 [R. J. K., I. P.]; Neuroradiology Department, NIH, Bethesda, Maryland 20892 [N. P.]; Division of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Rockville, Maryland 20850 [F. V.]; and Laboratory of Molecular Tumor Biology, Division of Cellular and Gene Therapies, Center for Biologics Evaluation and Research, United States Food and Drug Administration, Bethesda, Maryland 20892 [R. K. P.]

Abstract

Human glioblastoma but not normal brain cells express numerous receptors for the cytokine interleukin (IL)-4. To target these receptors, we have investigated the safety and activity of directly infusing IL-4(38-37)-PE38KDEL, a chimeric protein composed of circularly permuted IL-4 and a truncated form of Pseudomonas exotoxin (PE), into recurrent malignant high-grade gliomas. IL-4(38-37)-PE38KDEL (IL-4-toxin) was infused over a 4–8-day period into gliomas of nine patients by one to three stereotactically placed catheters. No apparent systemic toxicity occurred in any patient. The infusion of IL-4-toxin in six of nine patients showed glioma necrosis as evidenced by diminished gadolinium enhancement on magnetic resonance imaging. Seven of nine patients underwent craniotomy because of increased intracranial pressure at 16–101 days after the beginning of infusion. In six of these seven patients, partial-to-extensive tumor necrosis with edema was confirmed pathologically. No histological evidence of neurotoxicity to normal brain was identified in any patient. Two patients were not operated on; by magnetic resonance imaging, one showed mottled gadolinium enhancement, and the other showed extensive necrosis of tumor leading to complete remission; this patient remains disease-free >18 months after the procedure. We conclude that direct glioma injection of IL-4(38-37)-PE38KDEL is safe without systemic toxicity. Local toxicity seemed attributable mainly to tumor necrosis or occasionally to the volume of infusion. Histological evidence of toxicity to normal brain was not observed and in many patients, could be pathologically excluded. Additional patients are being treated to determine the maximal tolerated concentration and volume of IL-4(38-37)-PE38KDEL.

Footnotes

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
↵1 Supported in part by the Kadoorie Foundation, the Lou Ehlers Foundation, the Frank G. Lyon foundation, and individual donations that were made in memory of patients.
↵2 To whom requests for reprints should be addressed, at Laboratory of Molecular Tumor Biology, Division of Cellular and Gene Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, NIH, Building 29B, Room 2NN10, 29 Lincoln Drive, MSC 4555, Bethesda, Maryland 20892. E-mail: puri{at}cber.fda.gov
↵3 The abbreviations used are: GBM, glioblastoma multiforme; MR, magnetic resonance; MRI, MR imaging; CNS, central nervous system; IL, interleukin; IL-4R, IL-4 receptor; PE, Pseudomonas exotoxin; PET, positron emission tomography; USFDA, United States Food and Drug Administration; MTD, maximum tolerated dose; ICP, intracranial pressure; V-P, ventriculoperitoneal (shunt); CSF, cerebrospinal fluid.
- Accepted March 9, 2000.
- Received January 27, 2000.
- Revision received March 9, 2000.