Elotuzumab for Treatment of Multiple Myeloma (Literature Review)

OM Votyakova

NN Blokhin Russian Cancer Research Center, 24 Kashirskoye sh., Moscow, Russian Federation, 115478

For correspondence: Ol’ga Mikhailovna Votyakova, PhD, 24 Kashirskoye sh., Moscow, Russian Federation, 115478; Tel: +7(499)324-92-09; e-mail: omvtk@yandex.ru

For citation: Votyakova OM. Elotuzumab for Treatment of Multiple Myeloma (Literature Review). Clinical oncohematology. 2016;9(4):438–45 (In Russ).

DOI: 10.21320/2500-2139-2016-9-4-438-445


ABSTRACT

Chemotherapy has been the main treatment option for multiple myeloma for several decades. However, a considerable increase in the life expectancy was observed in multiple myeloma patients when thalidomide, bortezomib and lenalidomide had been introduced into clinical practice. Nevertheless, the disease remains incurable and there is an unmet need in fundamentally new treatment methods. Elotuzumab is a humanized IgG1 monoclonal antibody that specifically targets SLAMF7, an antigen belonging to the signaling lymphocytic activation molecule family, with its high expression detected on myeloma cells. This review presents the mechanism of action of elotuzumab, preclinical data and the main clinical studies of this monoclonal antibody.


Keywords: monoclonal antibodies, elotuzumab, clinical studies, multiple myeloma.

Received: May 25, 2016

Accepted: June 15, 2016

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REFERENCES

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403. doi: 10.1016/j.ejca.2012.12.027.
  2. Статистика злокачественных новообразований в России и странах СНГ в 2012 г. Под ред. М.И. Давыдова, Е.М. Аксель. М.: Издательская группа РОНЦ им. Н.Н. Блохина, 2014. 226 с.
    [Davydova MI, Aksel’ EM, eds. Statistika zlokachestvennykh novoobrazovanii v Rossii i stranakh SNG v 2012 g. (Statistics of malignancies in Russia and CIS in) Moscow: Izdatel’skaya gruppa RONTs im. N.N. Blokhina Publ.; 2014. 226 p. (In Russ)]
  3. EER Stat Fact Sheets: Myeloma, 2004–2010. [Internet] Available from: http://seer.cancer.gov/statfacts/html/mulmy.html. (accessed 25.08.2014).
  4. Kumar SK, Rajkumar SV, Dispenzieri A, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood. 2008;111(5):2516–20. doi: 10.1182/blood-2007-10-116129.
  5. Madan S, Lacy M, Dispenzieri A, et al. Efficacy of retreatment with immunomodulatory compounds in patients receiving initial therapy for newly diagnosed multiple myeloma. Blood. 2010;116(21): Abstract 1964.
  6. Knopf KB, Duh MS, Lafeuille M-H, et al. Meta-Analysis of the Efficacy and Safety of Bortezomib Re-treatment in Patients with Multiple Myeloma. Clin Lymph Myel 14(5):380–8. doi: 10.1016/j.clml.2014.03.005.
  7. Kumar SK, Therneau TM, Gertz MA, et al. Clinical course of patients with relapsed multiple myeloma. Mayo Clin Proc. 2004;79(7):867–74. doi: 10.4065/79.7.867.
  8. Kumar SK, Lee JH, Lahuerta JJ, et al. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia. 2012;26(1):149–57. doi: 10.1038/leu.2011.196.
  9. San Miguel J, Weisel K, Moreau P, et al. Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, Phase III trial. Lancet Oncol. 2013;14(11):1055–66. doi: 10.1016/S1470-2045(13)70380-2.
  10. Siegel DS, Martin T, Wang M, et al. A Phase 2 study of single-agent carfilzomib (PX-171-003-A1) in patients with relapse and refractory multiple myeloma. Blood. 2012;120(14):2817–25. doi: 10.1182/blood-2012-05-425934.
  11. Abdi J, Chen G, Chang H. Drug resistance in multiple myeloma: latest findings and new concepts on molecular mechanisms. Oncotarget. 2013;4(12):2186–207. doi: 10.18632/oncotarget.1497.
  12. Palumbo A, Sonneveld P. Preclinical and clinical evaluation of elotuzumab, a SLAMF7-targeted humanized monoclonal antibody in development for multiple myeloma. Exp Rev Hematol. 2015;8(4):481–91. doi: 10.1586/17474086.2015.1053866.
  13. Pratt G, Goodyear O, Moss P. Immunodeficiency and immunotherapy in multiple myeloma. Br J Haematol. 2007;138(5):563–79. doi: 10.1111/j.1365-2141.2007.06705.x.
  14. Kellner J, Liu B, Kang Y, Li Z. Fact or fiction–identifying the elusive multiple myeloma stem cell. J Hematol Oncol. 2013;7(6):91. doi: 10.1186/1756-8722-6-91.
  15. Stewart AK, Rajkumar SV, Dimopoulos MA, et al.; ASPIRE Investigators. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015;372(2):142–52. doi: 10.1056/NEJMoa1411321.
  16. Mentlik JA, Cohen AD, Campbell KS. Combination immune therapies to enhance anti-tumor responses by NK cells. Front Immunol. 2013;23(4):481. doi: 10.3389/fimmu.2013.00481.
  17. Rossi M, Botta C, Correale P, et al. Immunologic microenvironment and personalized treatment in multiple myeloma. Expert Opin Biol Ther. 2013;13(Suppl 1):S83–93. doi: 10.1517/14712598.2013.799130.
  18. Palumbo A, Cavallo F. Have drug combinations supplanted stem cell transplantation in myeloma? Blood. 2012;120(24):4692–8. doi: 10.1182/blood-2012-05-423202.
  19. Teh BW, Harrison SJ, Pellegrini M, et al. Changing treatment paradigms for patients with plasma cell myeloma: impact upon immune determinants of infection. Blood Rev. 2014;28(2):75–86. doi: 10.1016/j.blre.2014.01.004.
  20. Feyler S, Selby PJ, Cook G. Regulating the regulators in cancer-immunosuppression in multiple myeloma (MM). Blood Rev. 2013;27(3):155–64. doi: 10.1016/j.blre.2013.04.004.
  21. Yi Q. Novel immunotherapies. Cancer J. 2009;15(6):502–10. doi: 10.1097/PPO.0b013e3181c51f0d.
  22. Lonial S, Kaufman J, Laubach J, Richardson P. Elotuzumab: a novel anti-CS1 monoclonal antibody for the treatment of multiple myeloma. Expert Opin Biol Ther. 2013;13(12):1731–40. doi: 10.1517/14712598.2013.847919.
  23. Hsi ED, Steinle R, Balasa B, et al. CS1, a potential new therapeutic antibody target for the treatment of multiple myeloma. Clin Cancer Res. 2008;14(9):2775–84. doi: 10.1158/1078-0432.CCR-07-4246.
  24. Veillette A. SLAM-family receptors: immune regulators with or without SAP-family adaptors. Cold Spring Harb Perspect Biol. 2010;2(3):a002469. doi: 10.1101/cshperspect.a002469.
  25. Bouchon A, Cella M, Grierson HL, et al. Cutting edge: activation of NK cell-mediated cytotoxicity by a SAP-independent receptor of the CD2 family. J Immunol. 2001;167(10):5517–21. doi: 10.4049/jimmunol.167.10.5517.
  26. Cruz-Munoz ME, Dong Z, Shi X, et al. Influence of CRACC, a SLAM family receptor coupled to the adaptor EAT-2, on natural killer cell function. Nat Immunol. 2009;10(3):297–305. doi: 10.1038/ni.1693.
  27. Collins SM, Bakan CE, Swartzel GD, et al. Elotuzumab directly enhances NK cell cytotoxicity against myeloma via CS1 ligation: evidence for augmented NK cell function complementing ADCC. Cancer Immunol Immunother. 2013;62(12):1841–9. doi: 10.1007/s00262-013-1493-8.
  28. Tai YT, Dillon M, Song W, et al. Anti-CS1 humanized monoclonal antibody HuLuc63 inhibits myeloma cell adhesion and induces antibody-dependent cellular cytotoxicity in the bone marrow milieu. Blood. 2008;112(4):1329–37. doi: 10.1182/blood-2007-08-107292.
  29. Veillette A, Guo H. CS1, a SLAM family receptor involved in immune regulation, is a therapeutic target in multiple myeloma. Crit Rev Oncol Hematol. 2013;88(1):168–77. doi: 10.1016/j.critrevonc.2013.04.003.
  30. Moreau Ph, Touzeau K. Elotuzubab for the treatment multiple myeloma. Fut Oncol. 2014;10(6):949–56. doi: 10.2217/fon.14.56.
  31. Benson DM. Jr, Byrd JC. CS1-directed monoclonal antibody therapy for multiple myeloma. J Clin Oncol. 2012;30(16):2013–5. doi: 10.1200/jco.2011.40.4061.
  32. Balasa B, Yun R, Belmar NA, et al. Elotuzumab enhances natural killer cell activation and myeloma cell killing through interleukin-2 and TNF-a Cancer Immunol Immunother. 2015;64(1):61–73. doi: 10.1007/s00262-014-1610-3.
  33. van Rhee F, Szmania SM, Dillon M, et al. Combinatorial efficacy of anti-CS1 monoclonal antibody elotuzumab (HuLuc63) and bortezomib against multiple myeloma. Mol Cancer Ther. 2009;8(9):2616–24. doi: 10.1158/1535-7163.MCT-09-0483.
  34. Zonder JA, Mohrbacher AF, Singhal S, et al. A Phase 1, multicenter, open-label, dose escalation study of elotuzumab in patients with advanced multiple myeloma. Blood. 2012;120(3):552–9. doi: 10.1182/blood-2011-06-360552.
  35. Jakubowiak AJ, Benson DM, Bensinger W, et al. Phase I trial of anti-CS1 monoclonal antibody elotuzumab in combination with bortezomib in the treatment of relapsed/refractory multiple myeloma. J Clin Oncol. 2012;30(16):1960–5. doi: 10.1200/jco.2011.37.7069.
  36. Lonial S, Vij R, Harousseau JL, et al. Elotuzumab in combination with lenalidomide and low-dose dexamethasone in relapsed or refractory multiple myeloma. J Clin Oncol. 2012;30(16):1953–9. doi: 10.1200/jco.2011.37.2649.
  37. Eleutherakis-Papaiakovou V, Bamias A, Gika D, et al. Renal failure in multiple myeloma: incidence, correlations, and prognostic significance. Leuk Lymphoma. 2007;48(2):337–41. doi: 10.1080/10428190601126602.
  38. Berdeja J, Jagannath S, Zonder J, et al. Pharmacokinetics and Safety of Elotuzumab Combined With Lenalidomide and Dexamethasone in Patients With Multiple Myeloma and Various Levels of Renal Impairment: Results of a Phase Ib Study. Clin Lymph Myel Leuk. 2016;16(3):129–38. doi: 1016/j.clml.2015.12.007.
  39. Richardson PG, Barlogie B, Berenson J, et al. A phase 2 study of bortezomib in relapsed, Refractory myeloma. N Engl J Med. 2003;348(26):2609–17. doi: 1056/nejmoa030288.
  40. Richardson PG, Sonneveld P, Schuster MW, et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med. 2005;352(24):2487–98. doi: 10.1056/nejmoa043445.
  41. Dimopoulos MA, Chen C, Spencer A, et al. Long-term follow-up on overall survival from the MM-009 and MM-010 phase III trials of lenalidomide plus dexamethasone in patients with relapsed or refractory multiple myeloma. 2009;23(11):2147–52. doi: 10.1038/leu.2009.147.
  42. Jakubowiak A, Offidani M, Pegourie B, et al. Randomized phase 2 study: elotuzumab plus bortezomib/dexamethasone vs bortezomib/dexamethasone for relapsed/refractory MM. 2016;127(23):2833–40. doi: 10.1182/blood-2016-01-694604.
  43. Richardson PG, Jagannath S, Moreau P, et al. Final results for the 1703 phase 1b/2 study of elotuzumab in combination with lenalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma. 2014;124(21): Abstract 302.
  44. Phase III Study of Lenalidomide and Dexamethasone With or Without Elotuzumab to Treat Newly Diagnosed, Previously Untreated Multiple Myeloma (ELOQUENT-1). [Internet] Available from: clinicaltrials.gow/ct2/show/NCT01335399. (accessed 21.05.2016).
  45. Lonial S, Dimopoulos M, Palumbo A, et al. Elotuzumab Therapy for Relapsed or Refractory Multiple Myeloma. N Engl J Med. 2015;373(7):621–31. doi: 10.1056/NEJMoa1505654.
  46. Lonial S, Dimopoulos M, Palumbo A, et al. ELOQUENT-2: A phase III, randomized, open-label study of lenalidomide (Len)/dexamethasone (dex) with/without elotuzumab (Elo) in patients (pts) with relapsed/refractory multiple myeloma (RRMM). J Clin Oncol. 2015;33(Suppl): Abstract 8508.
  47. Genzen JR, Kawaguchi KR, Furman RR. Detection of a monoclonal antibody therapy (ofatumumab) by serum protein and immunofixation electrophoresis. Br J Haematol. 2011;155(1):123–5. doi: 10.1111/j.1365-2141.2011.08644.x.
  48. McCudden CR, Voorhees PM, Hainsworth SA, et al. Interference of monoclonal antibody therapies with serum protein electrophoresis tests. Clin Chem. 2010;56(12):1897–9. doi: 10.1373/clinchem.2010.152116.
  49. Axel AE, McCudden CR, Xie H, et al. Development of clinical assay to mitigate daratumumab, an IgG1K monoclonal antibody, interference with serum immunofixation (IFE) and clinical assessment of M-protein response in multiple myeloma. Cancer Res. 2014;74(19):2563. doi: 10.1158/1538-7445.am2014-2563.
  50. US Food and Drug Administration. Elotuzumab [media release]. [Internet] Available from: http://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm474719.htm. (accessed 22.05.2016).
  51. European commission Community register of medicinal products for human usе. [Internet] Available from: http://ec.europa.eu/health/documents/community-register/html/h1088.htm. (accessed 22.05.2016).
  52. NCCN Clinical Guidelines Version 3.2016. [Internet] Available from: https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/PDF/myeloma.pdf. (accessed 23.05.2016).