The anti-CD20 antibody rituximab has substantially improved outcomes in patients with B-cell non-Hodgkin lymphomas. However, many patients are not cured by rituximab-based therapies, and overcoming de novo or acquired rituximab resistance remains an important challenge to successful treatment of Bcell malignancies. Interferon-alpha (IFN␣) has potent immunostimulatory properties and antiproliferative effects against some B-cell cancers, but its clinical utility is limited by systemic toxicity. To improve the efficacy of CD20-targeted therapy, we constructed fusion proteins consisting of anti-CD20 and murine or human IFN␣. Fusion proteins had reduced IFN␣ activity in vitro compared with native IFN␣, but CD20 targeting permitted efficient antiproliferative and proapoptotic effects against an aggressive rituximab-insensitive human CD20 ؉ murine lymphoma (38C13-huCD20) and a human B-cell lymphoma (Daudi). In vivo efficacy was demonstrated against established 38C13-huCD20 grown in syngeneic immunocom-
IntroductionThe anti-CD20 antibody rituximab (C2B8/Rituxan; Genentech/ Biogen-IDEC) has substantially improved treatment outcomes in B-cell non-Hodgkin lymphomas (NHLs), achieving high response rates in low-grade B-cell lymphomas, 1 and improving survival in both indolent and aggressive lymphomas in combination with chemotherapy. 2,3 However, many tumors do not respond to or relapse after rituximab-based therapies. 4 Thus, new approaches are needed to improve anti-CD20 efficacy and overcome rituximab resistance.The in vivo antilymphoma effects of rituximab are believed to be mediated by antibody dependent cell-mediated cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), induction of apoptosis in tumor cells, and recruitment of T cells responding to tumor antigens released upon antibody-mediated tumor lysis. [5][6][7] Clinical studies have suggested that ADCC plays a dominant role in rituximab action in humans. 8,9 Thus, attempts have been made to boost rituximab-mediated ADCC by activation of Fc receptorbearing natural killer (NK) cells, monocytes/macrophages, or granulocytes via systemic administration of cytokines such as interleukin-2, interleukin-12, or granulocyte-macrophage colonystimulating factor, 10-12 with limited efficacy. None of these trials involving systemic administration of cytokines offered a clear advantage over the expected efficacy of rituximab alone, likely due to the inability of systemically administered agents to achieve high concentrations within the tumor bed.Interferon-alpha (IFN␣), a member of the type I interferon family (␣, , ), is a pleiotropic cytokine with attractive features for combination with rituximab in treating NHL. 13,14 Beneficial properties of IFN␣ against NHL and other cancers include direct antiproliferative and proapoptotic effects, 15-17 blockade of autocrine growth factor loops, 18 repression of c-myc oncogene expression, 19 down-regulation of telomerase activity, 20 and inhibition of angiogenesis. 21 Favorable immunologic effects of IFN␣ for lymphoma treatment...