he development of a laboratory technique for making monoclonal antibodies (mAbs) by Milstein and Köhler in 1975 1) allowed the massive production of mAbs against cancer cells. Consequently, it was expected that highly specific and effective antibody therapy would be developed. However, the results obtained from several clinical trials in the early 1980s revealed limited clinical responses and adverse effects mainly due to the xenogenicity of the mAbs. Through numerous subsequent preclinical studies on a variety of mAbs, the efficacy of shutting off receptor-mediated signaling as a means of blocking cell growth and viability was noted. Remarkable objective responses were observed during clinical trials using rituximab (chimeric anti-CD20 mAb)2) or trastuzumab (humanized anti-HER2/neu/ErbB-2 mAb), 3) resulting in a second wave of mAb therapy. Various mAbs against human epidermal growth factor receptor 2 (HER2), [3][4][5][6][7] epidermal growth factor receptor (EGFR), [8][9][10][11][12][13] vascular endothelial growth factor (VEGF), 14,15) and VEGF receptor (VEGFR) 16) were then subjected to clinical trials. In addition to this mAb group, anti-idiotype mAbs are worthy of note, since they are uniquely used for active immunotherapy. This article reviews some of the recent remarkable findings concerning cancer therapy with these mAbs, especially against solid tumors.
Anti-HER2 mAbsTrastuzumab (Herceptin) is a humanized mAb, which was approved by the United States Food and Drug Administration in 1998 for the treatment of advanced breast cancer. This was the first approval of a mAb for use in solid tumor therapy. Three years later, it was approved in Japan. The approved use of trastuzumab in HER2-positive metastatic diseases includes as a first-line treatment in combination with paclitaxel and as a monotherapy in patients who have received one or more chemotherapeutic regimens. HER2 overexpression is observed in 15-30% of breast cancers. 17,18) There are currently four major phase III multicenter trials that in total will randomize approximately 12,000 patients to chemotherapeutic regimens with or without trastszumab.19) HER2 expression is examined using validated fluorescence in situ hybridization or immunohistochemistry assays. The duration of trastuzumab maintenance is 1 or 2 years after chemotherapy with or without trastuzumab. In Japan, Sawaki et al. 20) reported the clinical response of 27 metastatic breast cancer patients to trastuzumab as a single agent. Complete response, partial response, no change, and progressive disease were observed in 3, 3, 3 and 17 patients, respectively, with one case being not evaluated, and the therapy was well tolerated.The most serious, but unexpected, toxicity observed during the pivotal trials was cardiac dysfunctions, including clinically manageable left ventricular systolic dysfunction, and occasionally advanced congestive heart failure in a small percentage of patients.21) The incidence and severity of cardiac dysfunction was greatest in patients receiving concomitant tras...