Biology:Monoclonal antibody therapy

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Short description: Form of immunotherapy
Each antibody binds only one specific antigen.

Monoclonal antibodies (mAbs) have varied therapeutic uses. It is possible to create a mAb that binds specifically to almost any extracellular target, such as cell surface proteins and cytokines. They can be used to render their target ineffective (e.g. by preventing receptor binding),[1] to induce a specific cell signal (by activating receptors),[1] to cause the immune system to attack specific cells, or to bring a drug to a specific cell type (such as with radioimmunotherapy which delivers cytotoxic radiation).

Major applications include cancer, autoimmune diseases, asthma, organ transplants, blood clot prevention, and certain infections.

Antibody structure and function

Immunoglobulin G (IgG) antibodies are large heterodimeric molecules, approximately 150 kDa and are composed of two kinds of polypeptide chain, called the heavy (~50kDa) and the light chain (~25kDa). The two types of light chains are kappa (κ) and lambda (λ). By cleavage with enzyme papain, the Fab (fragment-antigen binding) part can be separated from the Fc (fragment crystallizable region) part of the molecule. The Fab fragments contain the variable domains, which consist of three antibody hypervariable amino acid domains responsible for the antibody specificity embedded into constant regions. The four known IgG subclasses are involved in antibody-dependent cellular cytotoxicity.[2] Antibodies are a key component of the adaptive immune response, playing a central role in both in the recognition of foreign antigens and the stimulation of an immune response to them. The advent of monoclonal antibody technology has made it possible to raise antibodies against specific antigens presented on the surfaces of tumors.[3] Monoclonal antibodies can be acquired in the immune system via passive immunity or active immunity. The advantage of active monoclonal antibody therapy is the fact that the immune system will produce antibodies long-term, with only a short-term drug administration to induce this response. However, the immune response to certain antigens may be inadequate, especially in the elderly. Additionally, adverse reactions from these antibodies may occur because of long-lasting response to antigens.[4] Passive monoclonal antibody therapy can ensure consistent antibody concentration, and can control for adverse reactions by stopping administration. However, the repeated administration and consequent higher cost for this therapy are major disadvantages.[4]

Monoclonal antibody therapy may prove to be beneficial for cancer, autoimmune diseases, and neurological disorders that result in the degeneration of body cells, such as Alzheimer's disease. Monoclonal antibody therapy can aid the immune system because the innate immune system responds to the environmental factors it encounters by discriminating against foreign cells from cells of the body. Therefore, tumor cells that are proliferating at high rates, or body cells that are dying which subsequently cause physiological problems are generally not specifically targeted by the immune system, since tumor cells are the patient's own cells. Tumor cells, however are highly abnormal, and many display unusual antigens. Some such tumor antigens are inappropriate for the cell type or its environment. Monoclonal antibodies can target tumor cells or abnormal cells in the body that are recognized as body cells, but are debilitating to one's health.[citation needed]

History

Monoclonal antibodies for cancer. ADEPT: antibody directed enzyme prodrug therapy; ADCC: antibody-dependent cell-mediated cytotoxicity; CDC: complement-dependent cytotoxicity; MAb, monoclonal antibody; scFv, single-chain Fv fragment.[5]

Immunotherapy developed in the 1970s following the discovery of the structure of antibodies and the development of hybridoma technology, which provided the first reliable source of monoclonal antibodies.[6][7] These advances allowed for the specific targeting of tumors both in vitro and in vivo. Initial research on malignant neoplasms found mAb therapy of limited and generally short-lived success with blood malignancies.[8][9] Treatment also had to be tailored to each individual patient, which was impracticable in routine clinical settings.[citation needed]

Four major antibody types that have been developed are murine, chimeric, humanised and human. Antibodies of each type are distinguished by suffixes on their name.[citation needed]

Murine

Initial therapeutic antibodies were murine analogues (suffix -omab). These antibodies have: a short half-life in vivo (due to immune complex formation), limited penetration into tumour sites and inadequately recruit host effector functions.[10] Chimeric and humanized antibodies have generally replaced them in therapeutic antibody applications.[11] Understanding of proteomics has proven essential in identifying novel tumour targets.[citation needed]

Initially, murine antibodies were obtained by hybridoma technology, for which Jerne, Köhler and Milstein received a Nobel prize. However the dissimilarity between murine and human immune systems led to the clinical failure of these antibodies, except in some specific circumstances. Major problems associated with murine antibodies included reduced stimulation of cytotoxicity and the formation of complexes after repeated administration, which resulted in mild allergic reactions and sometimes anaphylactic shock.[10] Hybridoma technology has been replaced by recombinant DNA technology, transgenic mice and phage display.[11]

Chimeric and humanized

To reduce murine antibody immunogenicity (attacks by the immune system against the antibody), murine molecules were engineered to remove immunogenic content and to increase immunologic efficiency.[10] This was initially achieved by the production of chimeric (suffix -ximab) and humanized antibodies (suffix -zumab). Chimeric antibodies are composed of murine variable regions fused onto human constant regions. Taking human gene sequences from the kappa light chain and the IgG1 heavy chain results in antibodies that are approximately 65% human. This reduces immunogenicity, and thus increases serum half-life.[citation needed]

Humanised antibodies are produced by grafting murine hypervariable regions on amino acid domains into human antibodies. This results in a molecule of approximately 95% human origin. Humanised antibodies bind antigen much more weakly than the parent murine monoclonal antibody, with reported decreases in affinity of up to several hundredfold.[12][13] Increases in antibody-antigen binding strength have been achieved by introducing mutations into the complementarity determining regions (CDR),[14] using techniques such as chain-shuffling, randomization of complementarity-determining regions and antibodies with mutations within the variable regions induced by error-prone PCR, E. coli mutator strains and site-specific mutagenesis.[15]

Human monoclonal antibodies

Human monoclonal antibodies (suffix -umab) are produced using transgenic mice or phage display libraries by transferring human immunoglobulin genes into the murine genome and vaccinating the transgenic mouse against the desired antigen, leading to the production of appropriate monoclonal antibodies.[11] Murine antibodies in vitro are thereby transformed into fully human antibodies.[3]

The heavy and light chains of human IgG proteins are expressed in structural polymorphic (allotypic) forms. Human IgG allotype is one of the many factors that can contribute to immunogenicity.[16][17]

Targeted conditions

Cancer

Anti-cancer monoclonal antibodies can be targeted against malignant cells by several mechanisms. Ramucirumab is a recombinant human monoclonal antibody and is used in the treatment of advanced malignancies.[18] In childhood lymphoma, phase I and II studies have found a positive effect of using antibody therapy.[19]

Monoclonal antibodies used to boost an anticancer immune response is another strategy to fight cancer where cancer cells are not targeted directly. Strategies include antibodies engineered to block mechanisms which downregulate anticancer immune responses, checkpoints such as PD-1 and CTLA-4 (checkpoint therapy),[20] and antibodies modified to stimulate activation of immune cells.[21]

Autoimmune diseases

Monoclonal antibodies used for autoimmune diseases include infliximab and adalimumab, which are effective in rheumatoid arthritis, Crohn's disease and ulcerative colitis by their ability to bind to and inhibit TNF-α.[22] Basiliximab and daclizumab inhibit IL-2 on activated T cells and thereby help preventing acute rejection of kidney transplants.[22] Omalizumab inhibits human immunoglobulin E (IgE) and is useful in moderate-to-severe allergic asthma.[citation needed]

Alzheimer's disease

Alzheimer's disease (AD) is a multi-faceted, age-dependent, progressive neurodegenerative disorder, and is a major cause of dementia.[23] According to the Amyloid hypothesis, the accumulation of extracellular amyloid betapeptides (Aβ) into plaques via oligomerization leads to hallmark symptomatic conditions of AD through synaptic dysfunction and neurodegeneration.[24] Immunotherapy via exogenous monoclonal antibody (mAb) administration has been known to treat various central nervous disorders, such as AD, by inhibiting Aβ-oligomerization thereby preventing neurotoxicity. However, mAbs are large for passive protein channels and are therefore inefficient due to the blood–brain barrier preventing mAb passage into the brain. However, the Peripheral Sink hypothesis proposes a mechanism where mAbs may not need to cross the blood–brain barrier.[25] Therefore, many research studies are being conducted from failed attempts to treat AD in the past.[24]

However, anti-Aβ vaccines can promote antibody-mediated clearance of Aβ plaques in transgenic mice models with amyloid precursor proteins (APP), and can reduce cognitive impairments.[23] Vaccines can stimulate the immune system to produce its own antibodies,[26] in this case by introducing Aβ into transgenic animal models, known as active immunization. They can also introduce antibodies into animal models, known as passive immunization. In mice expressing APP, both active and passive immunization of anti-Aβ antibodies has been shown to be effective in clearing plaques, and can improve cognitive function.[24] Currently, there are no approved monoclonal antibody therapies for Alzheimer's disease, but several clinical trials using passive and active immunization approaches by development of certain drugs approved by the FDA are currently underway, and are expected to yield results in a couple of years.[24] The implementation of these drugs is during the onset of AD. Other research and drug development for early intervention and AD prevention is ongoing. Various drugs that are under research to treat AD include Bapineuzumab, Solanezumab, Gautenerumab, and BAN2401.[citation needed]

Bapineuzumab

Bapineuzumab, a humanized anti-Aβ mAb, is directed against the N-terminus of Aβ. Phase II clinical trials of Bapineuzumab in mild to moderate AD patients resulted in reduced Aβ concentration in the brain. However, in patients with increased apolipoprotein (APOE) e4 carriers, Bapineuzumab treatment is also accompanied by vasogenic edema,[27] a cytotoxic condition where the blood brain barrier has been disrupted thereby affecting white matter from excess accumulation of fluid from capillaries in intracellular and extracellular spaces of the brain.[28] In Phase III clinical trials, Bapineuzumab treatment is associated with reduced rate of accumulation of Aβ in the brain in APOE e4 patients, and no significant reduction of Aβ concentration in APOE e4 patients and non-APOE e4 patients. Therefore, Aβ plaque concentration was not reduced, and there is no significant clinical benefits in cognitive functioning. Bapineuzumab was discontinued after failing in Phase III clinical trial.[28]

Solanezumab

Solanezumab, an anti-Aβ mAb, targets the N-terminus of Aβ. In Phase I and Phase II of clinical trials, Solanezumab treatment resulted in cerebrospinal fluid elevation of Aβ, thereby showing a reduced concentration of Aβ plaques. Additionally, there are no associated adverse side effects. Phase III clinical trials of Solanezumab brought about significant reduction in cognitive impairment in patients with mild AD, but not in patients with severe AD. However, Aβ concentration did not significantly change, along with other AD biomarkers, including phospho-tau expression, and hippocampal volume. Phase III clinical trials are currently ongoing.[25]

BAN2401

BAN2401, is a humanized mAb that selectively targets toxic soluble Aβ protofibrils,[29] and the therapy is currently undergoing a phase 3 clinical trial which is expected to be completed in 2022.[30]

Preventive trials

Failure of several drugs in Phase III clinical trials has led to AD prevention and early intervention for onset AD treatment endeavours. Passive anti-Aβ mAb treatment can be used for preventive attempts to modify AD progression before it causes extensive brain damage and symptoms. Trials using mAb treatment for patients positive for genetic risk factors, and elderly patients positive for indicators of AD are underway. This includes anti-AB treatment in Asymptomatic Alzheimer's Disease (A4), the Alzheimer's Prevention Initiative (API), and DIAN-TU.[25] The A4 study on older individuals who are positive for indicators of AD but are negative for genetic risk factors will test Solanezumab in Phase III Clinical Trials, as a follow-up of previous Solanezumab studies.[25] DIAN-TU, launched in December 2012, focuses on young patients positive for genetic mutations that are risks for AD. This study uses Solanezumab and Gautenerumab. Gautenerumab, the first fully human MAB that preferentially interacts with oligomerized Aβ plaques in the brain, caused significant reduction in Aβ concentration in Phase I clinical trials, preventing plaque formation and concentration without altering plasma concentration of the brain. Phase II and III clinical trials are currently being conducted.[25]

Therapy types

Radioimmunotherapy

Radioimmunotherapy (RIT) involves the use of radioactively-conjugated murine antibodies against cellular antigens. Most research involves their application to lymphomas, as these are highly radio-sensitive malignancies. To limit radiation exposure, murine antibodies were chosen, as their high immunogenicity promotes rapid tumor clearance. Tositumomab is an example used for non-Hodgkin's lymphoma.[citation needed]

Antibody-directed enzyme prodrug therapy

Antibody-directed enzyme prodrug therapy (ADEPT) involves the application of cancer-associated monoclonal antibodies that are linked to a drug-activating enzyme. Systemic administration of a non-toxic agent results in the antibody's conversion to a toxic drug, resulting in a cytotoxic effect that can be targeted at malignant cells. The clinical success of ADEPT treatments is limited.[31]

Antibody-drug conjugates

Antibody-drug conjugates (ADCs) are antibodies linked to one or more drug molecules. Typically when the ADC meets the target cell (e.g. a cancerous cell) the drug is released to kill it. Many ADCs are in clinical development. (As of 2016) a few have been approved.[citation needed]

Immunoliposome therapy

Immunoliposomes are antibody-conjugated liposomes. Liposomes can carry drugs or therapeutic nucleotides and when conjugated with monoclonal antibodies, may be directed against malignant cells. Immunoliposomes have been successfully used in vivo to convey tumour-suppressing genes into tumours, using an antibody fragment against the human transferrin receptor. Tissue-specific gene delivery using immunoliposomes has been achieved in brain and breast cancer tissue.[32]

Checkpoint therapy

Checkpoint therapy uses antibodies and other techniques to circumvent the defenses that tumors use to suppress the immune system. Each defense is known as a checkpoint. Compound therapies combine antibodies to suppress multiple defensive layers. Known checkpoints include CTLA-4 targeted by ipilimumab, PD-1 targeted by nivolumab and pembrolizumab and the tumor microenvironment.[20]

The tumor microenvironment (TME) features prevents the recruitment of T cells to the tumor. Ways include chemokine CCL2 nitration, which traps T cells in the stroma. Tumor vasculature helps tumors preferentially recruit other immune cells over T cells, in part through endothelial cell (EC)–specific expression of FasL, ETBR, and B7H3. Myelomonocytic and tumor cells can up-regulate expression of PD-L1, partly driven by hypoxic conditions and cytokine production, such as IFNβ. Aberrant metabolite production in the TME, such as the pathway regulation by IDO, can affect T cell functions directly and indirectly via cells such as Treg cells. CD8 cells can be suppressed by B cells regulation of TAM phenotypes. Cancer-associated fibroblasts (CAFs) have multiple TME functions, in part through extracellular matrix (ECM)–mediated T cell trapping and CXCL12-regulated T cell exclusion.[33]

FDA-approved therapeutic antibodies

For a more comprehensive list, see Biology:List of therapeutic monoclonal antibodies.

The first FDA-approved therapeutic monoclonal antibody was a murine IgG2a CD3 specific transplant rejection drug, OKT3 (also called muromonab), in 1986. This drug found use in solid organ transplant recipients who became steroid resistant.[34] Hundreds of therapies are undergoing clinical trials. Most are concerned with immunological and oncological targets.

FDA approved therapeutic monoclonal antibodies
Antibody Brand name Company Approval date Route Type Target Indication
(Targeted disease)		 BLA STN Drug Label
abciximab ReoPro Centocor 12/22/1994 intravenous chimeric Fab GPIIb/IIIa Percutaneous coronary intervention 103575 Link
adalimumab Humira Abbvie 12/31/2002 subcutaneous fully human TNF Rheumatoid arthritis 125057 Link
adalimumab-atto Amjevita Amgen 9/23/2016 subcutaneous fully human, biosimilar TNF Rheumatoid arthritis
Juvenile idiopathic arthritis
Psoriatic arthritis
Ankylosing spondylitis
Crohn's disease
Ulcerative colitis
Plaque psoriasis		 761024 Link
ado-trastuzumab emtansine Kadcyla Genentech 2/22/2013 intravenous humanized, antibody-drug conjugate HER2 Metastatic breast cancer 125427 Link
alemtuzumab Campath, Lemtrada Genzyme 5/7/2001 intravenous humanized CD52 B-cell chronic lymphocytic leukemia 103948 Link
alirocumab Praluent Sanofi Aventis 7/24/2015 subcutaneous fully human PCSK9 Heterozygous familial hypercholesterolemia
Refractory hypercholesterolemia		 125559 Link
atezolizumab Tecentriq Genentech 5/18/2016 intravenous humanized PD-L1 Urothelial carcinoma 761034 Link
atezolizumab Tecentriq Genentech 10/18/2016 intravenous humanized PD-L1 Urothelial carcinoma
Metastatic non-small cell lung cancer		 761041 Link
avelumab Bavencio EMD Serono 3/23/2017 intravenous fully human PD-L1 Metastatic Merkel cell carcinoma 761049 Link
basiliximab Simulect Novartis 5/12/1998 intravenous chimeric IL2RA Prophylaxis of acute organ rejection in renal transplant 103764 Link
belimumab Benlysta Human Genome Sciences 3/9/2011 intravenous fully human BLyS Systemic lupus erythematosus 125370 Link
bevacizumab Avastin Genentech 2/26/2004 intravenous humanized VEGF Metastatic colorectal cancer 125085 Link
bezlotoxumab Zinplava Merck 10/21/2016 intravenous fully human Clostridium difficile toxin B Prevent recurrence of Clostridium difficile infection 761046 Link
blinatumomab Blincyto Amgen 12/3/2014 intravenous mouse, bispecific CD19 Precursor B-cell acute lymphoblastic leukemia 125557 Link
brentuximab vedotin Adcetris Seattle Genetics 9/19/2011 intravenous chimeric, antibody-drug conjugate CD30 Hodgkin lymphoma
Anaplastic large-cell lymphoma		 125388 Link
brodalumab Siliq Valeant 2/15/2017 subcutaneous chimeric IL17RA Plaque psoriasis 761032 Link
canakinumab Ilaris Novartis 6/17/2009 subcutaneous fully human IL1B Cryopyrin-associated periodic syndrome 125319 Link
capromab pendetide ProstaScint Cytogen 10/28/1996 intravenous murine, radiolabeled PSMA Diagnostic imaging agent in newly diagnosed prostate cancer or post-prostatectomy 103608 Link
certolizumab pegol Cimzia UCB (company) 4/22/2008 subcutaneous humanized TNF Crohn's disease 125160 Link
cetuximab Erbitux ImClone Systems 2/12/2004 intravenous chimeric EGFR Metastatic colorectal carcinoma 125084 Link
daclizumab Zenapax Roche 12/10/1997 intravenous humanized IL2RA Prophylaxis of acute organ rejection in renal transplant 103749 Link
daclizumab Zinbryta Biogen 5/27/2016 subcutaneous humanized IL2R Multiple sclerosis 761029 Link
daratumumab Darzalex Janssen Biotech 11/16/2015 intravenous fully human CD38 Multiple myeloma 761036 Link
denosumab Prolia, Xgeva Amgen 6/1/2010 subcutaneous fully human RANKL Postmenopausal women with osteoporosis 125320 Link
dinutuximab Unituxin United Therapeutics 3/10/2015 intravenous chimeric GD2 Pediatric high-risk neuroblastoma 125516 Link
dupilumab Dupixent Regeneron Pharmaceuticals 3/28/2017 subcutaneous fully human IL4RA Atopic dermatitis, asthma 761055 Link
durvalumab Imfinzi AstraZeneca 5/1/2017 intravenous fully human PD-L1 Urothelial carcinoma 761069 Link
eculizumab Soliris Alexion 3/16/2007 intravenous humanized Complement component 5 Paroxysmal nocturnal hemoglobinuria 125166 Link
elotuzumab Empliciti Bristol-Myers Squibb 11/30/2015 intravenous humanized SLAMF7 Multiple myeloma 761035 Link
evolocumab Repatha Amgen 8/27/2015 subcutaneous fully human PCSK9 Heterozygous familial hypercholesterolemia
Refractory hypercholesterolemia		 125522 Link
golimumab Simponi Centocor 4/24/2009 subcutaneous fully human TNF Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis		 125289 Link
golimumab Simponi Aria Janssen Biotech 7/18/2013 intravenous fully human TNF Rheumatoid arthritis 125433 Link
ibritumomab tiuxetan Zevalin Spectrum Pharmaceuticals 2/19/2002 intravenous murine, radioimmunotherapy CD20 Relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma 125019 Link
idarucizumab Praxbind Boehringer Ingelheim 10/16/2015 intravenous humanized Fab dabigatran Emergency reversal of anticoagulant dabigatran 761025 Link
infliximab Remicade Centocor 8/24/1998 intravenous chimeric TNF alpha Crohn's disease 103772 Link
infliximab-abda Renflexis Samsung Bioepis 4/21/2017 intravenous chimeric, biosimilar TNF Crohn's disease
Ulcerative colitis
Rheumatoid arthritis
Ankylosing spondylitis
Psoriatic arthritis
Plaque psoriasis		 761054 Link
infliximab-dyyb Inflectra Celltrion Healthcare 4/5/2016 intravenous chimeric, biosimilar TNF Crohn's disease
Ulcerative colitis
Rheumatoid arthritis
Ankylosing spondylitis
Psoriatic arthritis
Plaque psoriasis		 125544 Link
ipilimumab Yervoy Bristol-Myers Squibb 3/25/2011 intravenous fully human CTLA-4 Metastatic melanoma 125377 Link
ixekizumab Taltz Eli Lilly 3/22/2016 subcutaneous humanized IL17A Plaque psoriasis 125521 Link
mepolizumab Nucala GlaxoSmithKline 11/4/2015 subcutaneous humanized IL5 Severe asthma 125526 Link
natalizumab Tysabri Biogen Idec 11/23/2004 intravenous humanized alpha-4 integrin Multiple sclerosis 125104 Link
necitumumab Portrazza Eli Lilly 11/24/2015 intravenous fully human EGFR Metastatic squamous non-small cell lung carcinoma 125547 Link
nivolumab Opdivo Bristol-Myers Squibb 12/22/2014 intravenous fully human PD-1 Metastatic melanoma 125554 Link
nivolumab Opdivo Bristol-Myers Squibb 3/4/2015 intravenous fully human PD-1 Metastatic squamous non-small cell lung carcinoma 125527 Link
obiltoxaximab Anthem Elusys Therapeutics 3/18/2016 intravenous chimeric Protective antigen of the Anthrax toxin Inhalational anthrax 125509 Link
obinutuzumab Gazyva Genentech 11/1/2013 intravenous humanized CD20 Chronic lymphocytic leukemia 125486 Link
ocrelizumab Ocrevus Genentech 3/28/2017 intravenous humanized CD20 Multiple sclerosis 761053 Link
ofatumumab Arzerra Glaxo Grp 10/26/2009 intravenous fully human CD20 Chronic lymphocytic leukemia 125326 Link
olaratumab Lartruvo Eli Lilly 10/19/2016 intravenous fully human PDGFRA Soft tissue sarcoma 761038 Link
omalizumab Xolair Genentech 6/20/2003 subcutaneous humanized IgE Moderate to severe persistent asthma 103976 Link
palivizumab Synagis MedImmune 6/19/1998 intramuscular humanized F protein of RSV Respiratory syncytial virus 103770 Link
panitumumab Vectibix Amgen 9/27/2006 intravenous fully human EGFR Metastatic colorectal cancer 125147 Link
pembrolizumab Keytruda Merck 9/4/2014 intravenous humanized PD-1 Metastatic melanoma 125514 Link
pertuzumab Perjeta Genentech 6/8/2012 intravenous humanized HER2 Metastatic breast cancer 125409 Link
ramucirumab Cyramza Eli Lilly 4/21/2014 intravenous fully human VEGFR2 Gastric cancer 125477 Link
ranibizumab Lucentis Genentech 6/30/2006 intravitreal injection humanized VEGFR1
VEGFR2		 Wet age-related macular degeneration 125156 Link
raxibacumab Raxibacumab Human Genome Sciences 12/24/2012 intravenous fully human Protective antigen of Bacillus anthracis Inhalational anthrax 125349 Link
reslizumab Cinqair Teva 3/23/2016 intravenous humanized IL5 Severe asthma 761033 Link
rituximab Rituxan Genentech 11/26/1997 intravenous chimeric CD20 B-cell non-Hodgkin's lymphoma 103705 Link
secukinumab Cosentyx Novartis 1/21/2015 subcutaneous fully human IL17A Plaque psoriasis 125504 Link
siltuximab Sylvant Janssen Biotech 4/23/2014 intravenous chimeric IL6 Multicentric Castleman's disease 125496 Link
tocilizumab Actemra Genentech 1/8/2010 intravenous humanized IL6R Rheumatoid arthritis 125276 Link
tocilizumab Actemra Genentech 10/21/2013 intravenous
subcutaneous		 humanized IL6R Rheumatoid arthritis
Polyarticular juvenile idiopathic arthritis
Systemic juvenile idiopathic arthritis		 125472 Link
trastuzumab Herceptin Genentech 9/25/1998 intravenous humanized HER2 Metastatic breast cancer 103792 Link
ustekinumab Stelara Centocor 9/25/2009 subcutaneous fully human IL12
IL23		 Plaque psoriasis 125261 Link
ustekinumab Stelara Janssen Biotech 9/23/2016 subcutaneous
intravenous		 fully human IL12
IL23		 Plaque psoriasis
Psoriatic arthritis
Crohn's disease		 761044 Link
vedolizumab Entyvio Takeda 5/20/2014 intravenous humanized integrin receptor Ulcerative colitis
Crohn's disease		 125476 Link
sarilumab Kevzara Sanofi Aventis 5/22/17 subcutaneous fully human IL6R Rheumatoid arthritis 761037 Link
rituximab and hyaluronidase Rituxan Hycela Genentech 6/22/17 subcutaneous chimeric, co-formulated CD20 Follicular lymphoma
Diffuse large B-cell lymphoma
Chronic lymphocytic leukemia		 761064 Link
guselkumab Tremfya Janssen Biotech 7/13/17 subcutaneous fully human IL23 Plaque psoriasis 761061 Link
inotuzumab ozogamicin Besponsa Wyeth 8/17/17 intravenous humanized, antibody-drug conjugate CD22 Precursor B-cell acute lymphoblastic leukemia 761040 Link
adalimumab-adbm Cyltezo Boehringer Ingelheim 8/25/17 subcutaneous fully human, biosimilar TNF Rheumatoid arthritis
Juvenile idiopathic arthritis
Psoriatic arthritis
Ankylosing spondylitis
Crohn's disease
Ulcerative colitis
Plaque psoriasis		 761058 Link
gemtuzumab ozogamicin Mylotarg Wyeth 9/1/17 intravenous humanized, antibody-drug conjugate CD33 Acute myeloid leukemia 761060 Link
bevacizumab-awwb Mvasi Amgen 9/14/17 intravenous humanized, biosimilar VEGF Metastatic colorectal cancer
Non-squamous Non-small-cell lung carcinoma
Glioblastoma
Metastatic renal cell carcinoma
Cervical cancer		 761028 Link
benralizumab Fasenra AstraZeneca 11/14/17 subcutaneous humanized interleukin-5 receptor alpha subunit Severe asthma, eosinophilic phenotype 761070 Link
emicizumab-kxwh Hemlibra Genentech 11/16/17 subcutaneous humanized, bispecific Factor IXa, Factor X Hemophilia A (congenital Factor VIII deficiency) with Factor VIII inhibitors. 761083 Link
trastuzumab-dkst Ogivri Mylan 12/1/17 intravenous humanized, biosimilar HER2 HER2-overexpressing breast cancer, metaststic gastric or gastroesophageal junction adenocarcinoma 761074 Link
infliximab-qbtx Ixifi Pfizer 12/13/17 intravenous chimeric, biosimilar TNF Crohn's disease
Ulcerative colitis
Rheumatoid arthritis
Ankylosing spondylitis
Psoriatic arthritis
Plaque psoriasis		 761072 Link
ibalizumab-uiyk Trogarzo TaiMed Biologics 3/6/18 intravenous humanized CD4 HIV 761065 Link
tildrakizumab-asmn Ilumya Merck 3/20/18 subcutaneous humanized IL23 Plaque psoriasis 761067 Link
burosumab-twza Crysvita Ultragenyx 4/17/18 subcutaneous fully human FGF23 X-linked hypophosphatemia 761068 Link
erenumab-aooe Aimovig Amgen 5/17/18 subcutaneous fully human CGRP receptor Migraine headache prevention 761077 Link

Tositumomab – Bexxar – 2003 – CD20

Mogamulizumab – Poteligeo – August 2018 – CCR4

Moxetumomab pasudotox – Lumoxiti – September 2018 – CD22

Cemiplimab – Libtayo – September 2018 – PD-1

Polatuzumab vedotin – Polivy – June 2019 – CD79B

The bispecific antibodies have yielded promising results in clinical trials. In April 2009, the bispecific antibody catumaxomab was approved in the European Union.[35][36]

Economics

Since 2000, the therapeutic market for monoclonal antibodies has grown exponentially. In 2006, the "big 5" therapeutic antibodies on the market were bevacizumab, trastuzumab (both oncology), adalimumab, infliximab (both autoimmune and inflammatory disorders, 'AIID') and rituximab (oncology and AIID) accounted for 80% of revenues in 2006. In 2007, eight of the 20 best-selling biotechnology drugs in the U.S. are therapeutic monoclonal antibodies.[37] This rapid growth in demand for monoclonal antibody production has been well accommodated by the industrialization of mAb manufacturing.[38]

References

  1. ↑ 1.0 1.1 Yao, Sheng; Zhu, Yuwen; Chen, Lieping (2013). "Advances in targeting cell surface signalling molecules for immune modulation". Nature Reviews. Drug Discovery 12 (2): 130–146. doi:10.1038/nrd3877. ISSN 1474-1776. PMID 23370250. 
  2. ↑ Janeway, Charles; Paul Travers; Mark Walport; Mark Shlomchik (2001). Immunobiology; Fifth Edition. New York and London: Garland Science. ISBN 978-0-8153-4101-7. https://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.View..ShowTOC&rid=imm.TOC&depth=10. 
  3. ↑ 3.0 3.1 Janeway CA Jr. (2005). Immunobiology (6th ed.). Garland Science. ISBN 978-0-443-07310-6. 
  4. ↑ 4.0 4.1 Baxter, David (December 2007). "Active and passive immunity, vaccine types, excipients and licensing". Occupational Medicine 57 (8): 552–6. doi:10.1093/occmed/kqm110. PMID 18045976. 
  5. ↑ Modified from "Improving the efficacy of antibody-based cancer therapies". Nature Reviews. Cancer 1 (2): 118–29. November 2001. doi:10.1038/35101072. PMID 11905803. 
  6. ↑ Prof FC Breedveld (2000). "Therapeutic monoclonal antibodies". Lancet 355 (9205): 735–740. doi:10.1016/S0140-6736(00)01034-5. PMID 10703815. 
  7. ↑ "Continuous cultures of fused cells secreting antibody of predefined specificity". Nature 256 (5517): 495–7. August 1975. doi:10.1038/256495a0. PMID 1172191. Bibcode: 1975Natur.256..495K. 
  8. ↑ "Serotherapy of a patient with a monoclonal antibody directed against a human lymphoma-associated antigen". Cancer Research 40 (9): 3147–54. September 1980. PMID 7427932. 
  9. ↑ "Utilization of monoclonal antibodies in the treatment of leukemia and lymphoma". Blood 59 (1): 1–11. January 1982. doi:10.1182/blood.V59.1.1.1. PMID 7032624. 
  10. ↑ 10.0 10.1 10.2 "Overview of monoclonal antibodies in cancer therapy: present and promise". Critical Reviews in Oncology/Hematology 54 (1): 11–29. April 2005. doi:10.1016/j.critrevonc.2004.10.011. PMID 15780905. 
  11. ↑ 11.0 11.1 11.2 "Engineered antibodies". Nature Medicine 9 (1): 129–34. January 2003. doi:10.1038/nm0103-129. PMID 12514726. 
  12. ↑ "Humanization of an anti-p185HER2 antibody for human cancer therapy". Proceedings of the National Academy of Sciences of the United States of America 89 (10): 4285–9. May 1992. doi:10.1073/pnas.89.10.4285. PMID 1350088. Bibcode: 1992PNAS...89.4285C. 
  13. ↑ "Humanization of an antibody directed against IgE". Journal of Immunology 151 (5): 2623–32. September 1993. doi:10.4049/jimmunol.151.5.2623. PMID 8360482. 
  14. ↑ "Conformations of immunoglobulin hypervariable regions". Nature 342 (6252): 877–83. 1989. doi:10.1038/342877a0. PMID 2687698. Bibcode: 1989Natur.342..877C. 
  15. ↑ "Immunotherapy: past, present and future". Nature Medicine 9 (3): 269–77. March 2003. doi:10.1038/nm0303-269. PMID 12612576. https://zenodo.org/record/1233435. 
  16. ↑ "Human immunoglobulin allotypes: possible implications for immunogenicity". mAbs 1 (4): 332–8. July–August 2009. doi:10.4161/mabs.1.4.9122. PMID 20073133. 
  17. ↑ "Preclinical development of monoclonal antibodies: considerations for the use of non-human primates". mAbs 1 (5): 505–16. 2009. doi:10.4161/mabs.1.5.9676. PMID 20065651. 
  18. ↑ "Evolution of ramucirumab in the treatment of cancer – A review of literature". Journal of Oncology Pharmacy Practice 23 (7): 525–539. June 2016. doi:10.1177/1078155216655474. PMID 27306885. 
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  20. ↑ 20.0 20.1 "The future of immune checkpoint therapy". Science 348 (6230): 56–61. April 2015. doi:10.1126/science.aaa8172. PMID 25838373. Bibcode: 2015Sci...348...56S. 
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  25. ↑ 25.0 25.1 25.2 25.3 25.4 Panza, F.; Imbimbo, B. P.; Logroscino, G. (2014). "Amyloid-directed monoclonal antibodies for the treatment of Alzheimer's disease: The point of no return?". Expert Opinion on Biological Therapy 14 (10): 1465–76. doi:10.1517/14712598.2014.935332. PMID 24981190. 
  26. ↑ Hanan, Eilat; Solomon, Beka (January 1996). "Inhibitory effect of monoclonal antibodies on Alzheimer's P-amyloid peptide aggregation". Amyloid 2 (3): 130–133. doi:10.3109/13506129609014365. 
  27. ↑ Goel, Ayush (20 August 2013). "Vasogenic cerebral oedema" (in en). https://radiopaedia.org/articles/vasogenic-cerebral-oedema. 
  28. ↑ 28.0 28.1 Panza, F.; Imbimbo, B.P.; D'aOnofrio, G.; Pietrarossa, G.; Seripa, Davide; Frisardi, V. (November 2010). "Bapineuzumab: anti-β-amyloid monoclonal antibodies for the treatment of Alzheimer's disease". Immunotherapy 2 (6): 767–82. doi:10.2217/imt.10.80. PMID 21091109. 
  29. ↑ Logovinsky, Veronika; Satlin, Andrew; Lai, Robert; Swanson, Chad; Kaplow, June; Osswald, Gunilla; Basun, Hans; Lannfelt, Lars (December 2016). "Safety and tolerability of BAN2401 – a clinical study in Alzheimer's disease with a protofibril selective Aβ antibody" (in en). Alzheimer's Research & Therapy 8 (1): 14. doi:10.1186/s13195-016-0181-2. ISSN 1758-9193. PMID 27048170. 
  30. ↑ "A Study to Confirm Safety and Efficacy of BAN2401 in Participants With Early Alzheimer's Disease". Case Medical Research. 2019-03-25. doi:10.31525/ct1-nct03887455. ISSN 2643-4652. http://dx.doi.org/10.31525/ct1-nct03887455. 
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  32. ↑ "Emerging antibody-based HER2 (ErbB-2/neu) therapeutics". Breast Disease 11: 113–24. 2000. doi:10.3233/bd-1999-11110. PMID 15687597. 
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  35. ↑ "Bispecific antibodies for cancer therapy: the light at the end of the tunnel?". mAbs 1 (6): 539–47. 2009. doi:10.4161/mabs.1.6.10015. PMID 20073127. 
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  37. ↑ "mAbs: a business perspective". mAbs 1 (2): 179–84. 2009. doi:10.4161/mabs.1.2.7736. PMID 20061824. 
  38. ↑ "Industrialization of mAb production technology: the bioprocessing industry at a crossroads". mAbs 1 (5): 443–52. 2009. doi:10.4161/mabs.1.5.9448. PMID 20065641. 

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