RESUMO
INTRODUCTION: Racotumomab is a therapeutic vaccine based on a monoclonal anti-idiotypic antibody developed by the Molecular Immunology Center in Havana, Cuba, that is registered in Cuba and Argentina for treatment of non-small cell lung cancer. It induces a specific humoral and cellular immune response against the N-glycolyl GM3 (NeuGcGM3) ganglioside present in tumor cells, thereby provoking the death of these cells. OBJECTIVE: Evaluate racotumomab vaccine use as switch maintenance and second-line therapy for patients with inoperable non-small cell lung cancer in routine clinical practice, outside the framework of clinical studies, and assess the overall survival, stage-specific survival and safety in these patients. METHODS: A descriptive, retrospective study was carried out in patients diagnosed with non-small cell lung cancer not suitable for surgical treatment, who received racotumomab as a part of switch maintenance or second-line treatments. Overall survival was defined from diagnosis and from the first immunization, until death. RESULTS: We included 71 patients treated with racotumomab, 57.7% (41/71) of whom were in stages IIIB and IV of non-small cell lung cancer. Of the patients, 84.5% (60/71) had no adverse events, and 15.5% (11/71) had mild adverse reactions. The median overall survival was 24.5 months, calculated from the first immunization, 17.2 months for those who received racotumomab as switch maintenance and 6.8 months for patients who had progressed after the first line of treatment. CONCLUSIONS: Racotumomab in routine clinical practice prolonged overall survival in patients with non-small cell lung cancer treated in switch maintenance, and in stage IV patients who received the treatment as second-line therapy. The vaccine was well tolerated.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Anticorpos Monoclonais Murinos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cuba , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Estudos RetrospectivosRESUMO
Se presenta el caso clínico de un anciano de 84 años de edad, fumador, con diagnóstico de cáncer de pulmón en etapa IV, quien fue incluido en el ensayo clínico de fase III para ser tratado con racotumumab. Se observó mejoría clínica y del estado general del paciente, pues según la escala funcional concluyó el estudio con ECOG 0. Por tanto, es oportuno destacar que esta vacuna incrementa la supervivencia de los afectados por cáncer de pulmón de células no pequeñas recurrentes o en estadios avanzados.
The case report of a 84 years elderly smoker, is presented with diagnosis of lung cancer in stage IV who was included in the phase III clinical trial to be treated with racotumomab. Clinical improvement and recovery of the patient's general state was observed, because according to the functional scale the study concluded with ECOG 0. Therefore, it is opportune to highlight that this vaccine increases the survival of those affected by recurrent non-small cells lung cancer or in advanced stages.
Assuntos
Imunoterapia Ativa , Carcinoma Pulmonar de Células não Pequenas/terapia , Ensaio Clínico Fase III , SobrevivênciaRESUMO
RESUMEN Fundamento: El cáncer de pulmón de células no pequeñas es el cáncer de origen epitelial que más muertes provoca; por lo que el estudio de nuevas terapias es una prioridad investigativa en Cuba; para ello se realizaron estudios multicéntricos que evaluaron entre otros aspectos, el perfil de seguridad del nimotuzumab y racotumomab, anticuerpos monoclonales de origen cubano en el tratamiento de esta enfermedad. Objetivo: Evaluar el perfil de seguridad del nimotuzumab y racotumomab en pacientes con cáncer de pulmón de células no pequeñas avanzado después de la primera línea de tratamiento oncoespecífico. Metodología: Se diseñó un estudio multicéntrico, prospectivo, longitudinal en 32 pacientes adultos con cáncer de pulmón de células no pequeñas avanzado después de la primera línea del tratamiento oncoespecífico en la provincia Sancti Spíritus entre junio del 2014 a junio del 2015. Resultados: De los 6 pacientes que recibieron nimotuzumab y 26 pacientes que recibieron racotumomab, en estadio tumoral IIIB o IV, el 75 % entró al estudio con buen estado clínico. El 66 % de ellos no presentó efectos adversos, entre los que se presentaron está, dolor en el sitio de inyección, torácico y la fiebre, todos de intensidad leve o moderada. No se encontraron diferencias significativas entre las proporciones de eventos adversos leves en ambos grupos de sujetos. No se reportaron eventos adversos severos. Todos los eventos se clasificaron en no serios, no graves y del 98.33 % de ellos el paciente se recuperó sin ayuda médica. Conclusiones: Los resultados sugieren que los productos empleados son seguros, expresado en la baja frecuencia de aparición de eventos adversos, la generalidad de ellos leves no graves/no serios, sin que dejaran secuela en los pacientes(AU)
ABSTRACT Background: Non-small cell lung cancer is the cancer of epithelial origin that causes most of deaths; so the study of new therapies is a research priority in Cuba; thus, multicenter studies are carried out which evaluate, among other aspects, the safety profile of nimotuzumab and racotumomab, monoclonal antibodies of Cuban origin in the treatment of this disease. Objective: To evaluate the safety profile of nimotuzumab and racotumomab in patients with advanced non-small cell lung cancer after the first-line of oncospecific treatment. Methodology: A multicenter, prospective, longitudinal study was designed in 32 adult patients with advanced non-small cell lung cancer after the first-line of oncospecific treatment in Sancti Spíritus province from June 2014 to June 2015. Results: The six patients who received nimotuzumab and the twenty-six patients who received racotumomab, in tumor stage IIIB or IV, 75 % participated in the study with good clinical conditions. The 66% of them did not present adverse effects, among which there were, pain at the location of injection, thoracic pain and fever, all of mild or moderate intensity. No significant differences were found between the proportions of mild adverse events in both groups of subjects. No severe adverse events were reported. All events were classified as non-serious, non-very serious and 98.33 % of them recovered without medical help. Conclusions: The results suggest that the products used are safe, expressed in the low frequency of occurrence of adverse events, the generality of them mild non-very serious / non-serious, without no sequel in patients(AU)
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Anticorpos MonoclonaisRESUMO
RESUMEN Fundamento: El cáncer de pulmón de células no pequeñas es el cáncer de origen epitelial que más muertes provoca; por lo que el estudio de nuevas terapias es una prioridad investigativa en Cuba; para ello se realizaron estudios multicéntricos que evaluaron entre otros aspectos, el perfil de seguridad del nimotuzumab y racotumomab, anticuerpos monoclonales de origen cubano en el tratamiento de esta enfermedad. Objetivo: Evaluar el perfil de seguridad del nimotuzumab y racotumomab en pacientes con cáncer de pulmón de células no pequeñas avanzado después de la primera línea de tratamiento oncoespecífico. Metodología: Se diseñó un estudio multicéntrico, prospectivo, longitudinal en 32 pacientes adultos con cáncer de pulmón de células no pequeñas avanzado después de la primera línea del tratamiento oncoespecífico en la provincia Sancti Spíritus entre junio del 2014 a junio del 2015. Resultados: De los 6 pacientes que recibieron nimotuzumab y 26 pacientes que recibieron racotumomab, en estadio tumoral IIIB o IV, el 75 % entró al estudio con buen estado clínico. El 66 % de ellos no presentó efectos adversos, entre los que se presentaron está, dolor en el sitio de inyección, torácico y la fiebre, todos de intensidad leve o moderada. No se encontraron diferencias significativas entre las proporciones de eventos adversos leves en ambos grupos de sujetos. No se reportaron eventos adversos severos. Todos los eventos se clasificaron en no serios, no graves y del 98.33 % de ellos el paciente se recuperó sin ayuda médica. Conclusiones: Los resultados sugieren que los productos empleados son seguros, expresado en la baja frecuencia de aparición de eventos adversos, la generalidad de ellos leves no graves/no serios, sin que dejaran secuela en los pacientes.
ABSTRACT Background: Non-small cell lung cancer is the cancer of epithelial origin that causes most of deaths; so the study of new therapies is a research priority in Cuba; thus, multicenter studies are carried out which evaluate, among other aspects, the safety profile of nimotuzumab and racotumomab, monoclonal antibodies of Cuban origin in the treatment of this disease. Objective: To evaluate the safety profile of nimotuzumab and racotumomab in patients with advanced non-small cell lung cancer after the first-line of oncospecific treatment. Methodology: A multicenter, prospective, longitudinal study was designed in 32 adult patients with advanced non-small cell lung cancer after the first-line of oncospecific treatment in Sancti Spíritus province from June 2014 to June 2015. Results: The six patients who received nimotuzumab and the twenty-six patients who received racotumomab, in tumor stage IIIB or IV, 75 % participated in the study with good clinical conditions. The 66% of them did not present adverse effects, among which there were, pain at the location of injection, thoracic pain and fever, all of mild or moderate intensity. No significant differences were found between the proportions of mild adverse events in both groups of subjects. No severe adverse events were reported. All events were classified as non-serious, non-very serious and 98.33 % of them recovered without medical help. Conclusions: The results suggest that the products used are safe, expressed in the low frequency of occurrence of adverse events, the generality of them mild non-very serious / non-serious, without no sequel in patients.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Anticorpos MonoclonaisRESUMO
Antitumor strategies based on positive modulation of the immune system currently represent therapeutic options with prominent acceptance for cancer patients' treatment due to its selectivity and higher tolerance compared to chemotherapy. Racotumomab is an anti-idiotype (anti-Id) monoclonal antibody (mAb) directed to NeuGc-containing gangliosides such as NeuGcGM3, a widely reported tumor-specific neoantigen in many human cancers. Racotumomab has been approved in Latin American countries as an active immunotherapy for advanced non-small cell lung cancer (NSCLC) treatment. In this work, we evaluated the induction of Ab-dependent cell-mediated cytotoxicity (ADCC) in NSCLC patients included in a phase III clinical trial, in response to vaccination with racotumomab. The development of anti-NeuGcGM3 antibodies (Abs) in serum samples of immunized patients was first evaluated using the NeuGcGM3-expressing X63 cells, showing that racotumomab vaccination developed antigen-specific Abs that are able to recognize NeuGcGM3 expressed in tumor cell membranes. ADCC response against NeuGcGM3-expressing X63 (target) was observed in racotumomab-treated- but not in control group patients. When target cells were depleted of gangliosides by treatment with a glucosylceramide synthase inhibitor, we observed a significant reduction of the ADCC activity developed by sera from racotumomab-vaccinated patients, suggesting a target-specific response. Our data demonstrate that anti-NeuGcGM3 Abs induced by racotumomab vaccination are able to mediate an antigen-specific ADCC response against tumor cells in NSCLC patients.
Assuntos
Anticorpos Monoclonais/farmacologia , Citotoxicidade Celular Dependente de Anticorpos , Carcinoma Pulmonar de Células não Pequenas/terapia , Gangliosídeo G(M3)/análogos & derivados , Imunoterapia Ativa , Neoplasias Pulmonares/terapia , Anticorpos Monoclonais Murinos , Apoptose , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Gangliosídeo G(M3)/imunologia , Humanos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Células Tumorais CultivadasRESUMO
Se realizó un estudio descriptivo y retrospectivo sobre la conducción de ensayos clínicos durante 23 años en Santiago de Cuba, con el objetivo de describir la aplicación de 3 productos inmunoterapéuticos (CIMAher-Nimotuzumab, CIMAvax-EGF y Vaxira-Racotumomab) para el tratamiento de pacientes con cáncer en hospitales y policlínicos de la provincia. Se revisaron los informes finales de dichos ensayos, así como la información disponible del centro promotor desde 1992 hasta 2015. Se ejecutaron 20 protocolos de ensayos clínicos por 500 investigadores de 25 especialidades, distribuidos en 4 hospitales de la provincia y 2 se extendieron a 4 áreas de atención primaria de salud. Se concluyó que la aplicación de estos productos inmunoterapéuticos contribuyó al registro sanitario de estos, lo cual enriqueció el arsenal terapéutico para los afectados por cáncer en Santiago de Cuba, con un elevado impacto social(AU)
A retrospective descriptive study on the presentation of clinical trials was carried out during 23 years in Santiago de Cuba, with the objective of describing the implementation of 3 immunotherapeutical products (CIMAher-Nimotuzumab, CIMAvax-EGF and Vaxira-Racotumomab) for the treatment of patients with cancer in hospitals and polyclinics from the province. The final reports of each clinical trial and the available information of the promoter center were reviewed from 1992 to 2015. Twenty protocols of clinical trials were implemented by 500 investigators of 25 specialties distributed in 4 hospitals of the province and 4 primary health care areas, where 2 clinical trials in patients with lung cancer were carried out. It was concluded that the implementation of these immunotherapeutical products contributed to the health registration of them, enriching the therapeutic arsenal for the treatment of patients with cancer in Santiago de Cuba, with a high social impact(AU)
Assuntos
Humanos , Masculino , Feminino , Imunoensaio , Imunoterapia , Oncologia , Ensaios de Seleção de Medicamentos Antitumorais , Neoplasias/terapia , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Se realizó un estudio descriptivo y retrospectivo sobre la conducción de ensayos clínicos durante 23 años en Santiago de Cuba, con el objetivo de describir la aplicación de 3 productos inmunoterapéuticos (CIMAher-Nimotuzumab, CIMAvax-EGF y Vaxira-Racotumomab) para el tratamiento de pacientes con cáncer en hospitales y policlínicos de la provincia. Se revisaron los informes finales de dichos ensayos, así como la información disponible del centro promotor desde 1992 hasta 2015. Se ejecutaron 20 protocolos de ensayos clínicos por 500 investigadores de 25 especialidades, distribuidos en 4 hospitales de la provincia y 2 se extendieron a 4 áreas de atención primaria de salud. Se concluyó que la aplicación de estos productos inmunoterapéuticos contribuyó al registro sanitario de estos, lo cual enriqueció el arsenal terapéutico para los afectados por cáncer en Santiago de Cuba, con un elevado impacto social
A retrospective descriptive study on the presentation of clinical trials was carried out during 23 years in Santiago de Cuba, with the objective of describing the implementation of 3 immunotherapeutical products (CIMAher-Nimotuzumab, CIMAvax-EGF and Vaxira-Racotumomab) for the treatment of patients with cancer in hospitals and polyclinics from the province. The final reports of each clinical trial and the available information of the promoter center were reviewed from 1992 to 2015. Twenty protocols of clinical trials were implemented by 500 investigators of 25 specialties distributed in 4 hospitals of the province and 4 primary health care areas, where 2 clinical trials in patients with lung cancer were carried out. It was concluded that the implementation of these immunotherapeutical products contributed to the health registration of them, enriching the therapeutic arsenal for the treatment of patients with cancer in Santiago de Cuba, with a high social impact
Assuntos
Humanos , Masculino , Feminino , Imunoensaio , Ensaios de Seleção de Medicamentos Antitumorais , Imunoterapia , Neoplasias/terapia , OncologiaRESUMO
BACKGROUND: Pediatric neuroectodermal malignancies express N-glycolylated gangliosides including N-glycolyl GM3 (NeuGcGM3) as targets for immunotherapy. PROCEDURE: We evaluated the toxicity and maximum tolerated dose and immunological response of racotumomab, an anti-idiotype vaccine targeting NeuGcGM3 through a Phase I study enrolling children with relapsed or resistant tumors expressing NeuGcGM3. MATERIALS AND METHODS: Drug dose was escalated to three levels (0.15-0.25-0.4 mg) of racotumomab administered intradermally. Each drug level included three patients receiving a total of three doses, every 14 days. A confirmation cohort was added to the highest dose level. Antibody response was assessed upon study entry and at 4-week intervals for at least three immunological determinations for each patient. RESULTS: Fourteen patients were enrolled (10 with neuroblastoma, one with retinoblastoma, one with Wilms' tumor, and two with brainstem glioma). Three patients completed the three drug levels and three were enrolled in the confirmation cohort. One patient died of tumor progression before completing the three applications. Racotumomab was well tolerated. The only side effect observed was grade 1-2 toxicity at the injection site. Racotumomab elicited an IgM and/or IgG antibody response directed against NGcGM3 in nine patients and IgM against racotumomab in 11 of 13 evaluable patients. The maximum tolerated dose was not reached and no dose-limiting toxicity was seen. CONCLUSIONS: Racotumomab vaccination has a favorable toxicity profile up to a dose of 0.4 mg, and most patients elicited an immune response. Its activity as immunotherapy for neuroectodermal malignancies will be tested in further clinical trials.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Neoplasias do Tronco Encefálico/tratamento farmacológico , Vacinas Anticâncer/administração & dosagem , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Glioma/tratamento farmacológico , Neuroblastoma/dietoterapia , Tumor de Wilms/tratamento farmacológico , Anticorpos Monoclonais Murinos , Anticorpos Antineoplásicos/sangue , Neoplasias do Tronco Encefálico/sangue , Criança , Pré-Escolar , Feminino , Gangliosídeos/biossíntese , Regulação Neoplásica da Expressão Gênica , Glioma/sangue , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Masculino , Neuroblastoma/sangue , Vacinação , Tumor de Wilms/sangueRESUMO
Immunotherapy targeting ganglioside antigens is a powerful tool for the treatment of high risk neuroblastoma. However, only treatment with anti-GD2 antibodies has been used in clinical practice and other options may be pursued. We report the use of racotumomab, an anti-idiotype vaccine against N-glycolyl neuraminic acid (NeuGc)- containing gangliosides, eliciting an immune response in a child with relapsed neuroblastoma expressing the NeuGcGM3 ganglioside.
RESUMO
Active immunotherapy is an interesting field from the industry's perspective and in the last years, regulatory agencies and the medical community have showed renewed expectations and interest in cancer vaccines. The development of new immune therapies offers many challenges, and this is reflected in the small number of phase III trials showing clear benefits. Traditional concepts applied in clinical trials for the development of chemotherapeutic agents may be inadequate for immunotherapies and a new paradigm is emerging. It is possible that organized efforts and funding will accelerate the development of therapeutically effective cancer vaccines. This article reviews the attributes of cancer vaccines which make them attractive from the industry's perspective, and focuses especially in the characteristics of Racotumomab, an anti-idiotype antibody vaccine.
RESUMO
Racotumomab is a murine anti-idiotype cancer vaccine targeting NeuGcGM3 on melanoma, breast, and lung cancer. In order to characterize the immunogenicity of alum-adsorbed racotumomab in a non-clinical setting, Leghorn chickens were immunized in dose levels ranging from 25 µg to 1600 µg. Racotumomab was administered subcutaneously in the birds' neck with three identical boosters and serum samples were collected before, during and after the immunization schedule. A strong antibody response was obtained across the evaluated dose range, confirming the immunogenicity of racotumomab even at dose levels as low as 25 µg. As previously observed when using Freund's adjuvant, alum-adsorbed racotumomab induced an idiotype-specific response in all the immunized birds and ganglioside-specific antibodies in 60-100% of the animals. In contrast to the rapid induction anti-idiotype response, detection of ganglioside-specific antibodies in responsive animals may require repeated boosting. Kinetics of anti-NeuGcGM3 antibody titers showed a slight decline 2 weeks after each booster, arguing in favor of repeated immunizations in order to maintain antibody titer. Interestingly, the intensity of the anti-NeuGcGM3 response paralleled that of anti-mucin antibodies and anti-tumor antibodies, suggesting that the in vitro detection of anti-ganglioside antibodies might be a surrogate for an in vivo activity of racotumomab. Taken together, these results suggest that Leghorn chicken immunization might become the means to test the biological activity of racotumomab intended for clinical use.