The chimeric monoclonal antibody cBR96 conjugated to doxorubicin (cBR96-Dox) is selectively internalized by a wide variety of human carcinomas expressing an extended form of Lewis Y antigen (Le y ). Endocytosis is followed by cleavage and release of free doxorubicin from the endocytic vesicles and subsequent cytotoxicity. Combination studies with standard anti-cancer agents, undertaken to further increase the potency of this targeted therapy, identified significant synergistic anti-tumor activity of cBR96-Dox and either of the taxanes paclitaxel or docetaxel. Treatment with cBR96-Dox 24 hr prior to paclitaxel resulted in a steady increase in the percentage of G 2 tumor cells and corresponding increase in sensitivity to taxanes. Cell cycle analysis indicated the cBR96-delivered doxorubicin was most effective against S-phase cells, yet cells exposed to even subtoxic levels progressed to and arrested in G 2 , at a point of high sensitivity to the antitubulin agent paclitaxel. The synergy obtained by staged combination of cBR96-Dox and paclitaxel in vitro was reflected in significant anti-tumor efficacy in vivo against xenograft models of human lung and breast tumors that could not be achieved by either agent alone. The staged combination elicited significant or complete regressions of established human Le y -positive tumor xenografts using significantly reduced drug levels. Taken together, these data demonstrate a mechanistic approach to the selective elimination of Le ypositive tumors by using targeted doxorubicin followed by taxane treatment. © 2001 Wiley-Liss, Inc.
Key words: doxorubicin; paclitaxel; immunoconjugate; antitumortargeting; antibody-mediatedMonoclonal antibodies (mAbs) directing drugs or toxins to tumor-specific antigens have held the promise of selective tumor cell elimination with reduced collateral damage to normal tissue. 1,2 In addition to mAb accessory functions that mobilize natural killer and complement-mediated cytotoxicity (antibody-dependent cellmediated cytotoxicity [ADCC] and complement-dependent cytotoxicity [CDC]) responses against the tumor, internalizing mAbs can direct delivery of cytotoxics to the tumor. Despite these qualities, and despite demonstrated efficacy in hematologic disease, 3 mAb-directed therapy as a single agent has not shown great success in eliminating established solid carcinomas in the clinic. The reasons for this shortcoming include the fact that most tumor antigens are preferentially expressed by, but not restricted to, tumor cells; thus, dose-limiting toxicity is still seen in normal tissues expressing significant levels of the antigen. Second, most solid tumors not amenable to surgical removal represent significant and well-established masses. The effectiveness of mAb-based therapeutics relative to small molecules in this setting may be reduced by poor tumor vascularization and increased internal pressure of the tumor compared with surrounding tissue, which reduces the ability of large molecules such as mAbs to penetrate a large tumor mass. 4 -6 Interestingl...