Interferon-␣ (IFN-␣
IntroductionMultiple studies have shown that interferon-␣ (IFN-␣) can have antitumor activity in both animal models 1-3 and cancer patients. 4 IFN-␣ can exert a variety of direct antitumor effects, including down-regulation of oncogenes, up-regulation of tumor suppressors, enhancement of immune recognition via increased expression of tumor surface major histocompatibility complex class I proteins, potentiation of apoptosis, and sensitization to chemotherapeutic agents. [5][6][7][8][9] For some tumors, IFN-␣ can have a direct and potent antiproliferative effect through activation of STAT1. 10 Indirectly, IFN-␣ can inhibit angiogenesis 11 and stimulate host immune cells, which may be vital to the overall antitumor response but has been largely underappreciated. 12 IFN-␣ has a pleiotropic influence on immune responses through effects on myeloid cells, 13,14 T cells, 15,16 and B cells. 17 As an important modulator of the innate immune system, IFN-␣ induces the rapid differentiation and activation of dendritic cells [18][19][20] and enhances the cytotoxicity, migration, cytokine production, and antibody-dependent cellular cytotoxicity (ADCC) of natural killer (NK) cells. 21,22 The promise of IFN-␣ as a cancer therapeutic has been hindered primarily because of its short circulating half-life (t 1/2 ) and systemic toxicity. PEGylated forms of IFN-␣2 display increased circulation time, which augments their biologic efficacy. 23,24 Fusion of IFN-␣ to a monoclonal antibody (mAb) can provide similar benefits as PEGylation, including reduced renal clearance, improved solubility and stability, and markedly increased circulating t 1/2 . The immediate clinical benefit of this is less frequent and lower doses, allowing prolonged therapeutic concentrations. Targeting IFN-␣ to tumors using mAbs to a tumor-associated antigen can significantly increase its tumor accretion and retention while limiting its systemic concentration, thereby increasing the therapeutic index. Increased tumor concentrations of IFN-␣ can augment its direct antiproliferative, apoptotic, and antiangiogenic activity, as well as prime and focus an antitumor immune response. Indeed, studies in mice using syngeneic murine IFN-␣-secreting transgenic tumors demonstrated an enhanced immune response elicited by a localized concentration of CD20 is an attractive candidate tumor-associated antigen for the therapy of B-cell lymphomas using a mAb-IFN-␣ conjugate (mAb-IFN-␣). Anti-CD20 immunotherapy with rituximab is one of the most successful therapies against lymphoma with relatively low toxicity. 26 Because rituximab is a chimeric antibody that can show immunogenicity in some patient populations and has considerably long infusion times for the initial administration, 27 we chose the humanized mAb, veltuzumab (v-mab), 28 for CD20 targeting.Combination therapies with rituximab and IFN-␣ currently under clinical evaluation have shown improved efficacy over rituximab alone. 29,30 These studies demonstrate both advantages of this combination and drawb...