Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

Abstract

EGFR activation induces cell proliferation, neoformation of blood vessels, survival, and metastasis of the cancer cells. Nimotuzumab is an engineered, intermediate affinity anti-EGFR antibody, that apart from other drugs in its class, is very safe and does not cause hypomagnesemia or grade 3-4 cutaneous rash. The antibody inhibits cell proliferation and angiogenesis, activates natural killer cells, stimulates dendritic cell maturation, and induces cytotoxic T cells. Nimotuzumab restores MHC-I expression on tumor cells, hindering one of the EGFR immune-escape ways. The antibody has been extensively studied in 7 clinical trials, concurrently with irradiation or irradiation plus chemotherapy in subjects with inoperable head and neck tumors. Nimotuzumab was safe and efficacious in unfit patients receiving irradiation alone and in subjects treated with cisplatin and radiotherapy. In patients with locally advanced squamous cell carcinomas of the head and neck, nimotuzumab in combination with low dose cisplatin and radiotherapy was superior to cisplatin and radiotherapy in progression free survival, disease free survival, and locoregional tumor control.

Blocking Egfr with Nimotuzumab: A Novel Strategy for Covid-19 Treatment

“…Nimotuzumab was very safe, and only two patients had tremors, chills or headache. Adverse reactions commonly seen in cancer trials consist mostly of fatigue, nausea, vomiting, chills, anorexia and fever [ 16 , 20 , 35 ]. Other recently recommended anti-inflammatory drugs for COVID-19, like tocilizumab or baricitinib, might provoke serious adverse reactions including bacteremia and lung abscess [ 36 ] or grade 3 or 4 adverse events such as hyperglycemia, anemia, decreased lymphocyte count and acute kidney injury, respectively [ 37 ].…”

“…Nimotuzumab efficacy results have been reported in more than 40 clinical trials, conducted primarily in patients with advanced cancer, including glioblastoma, squamous cell carcinoma of the head and neck, and esophageal, nasopharyngeal, pancreatic and non-small-cell lung cancers [ 14 , 16–21 ].…”

Nimotuzumab for COVID-19: Case Series

“…In general, nimotuzumab is a very safe drug because it has an intermediate affinity against EGFR which facilitates preferential uptake by tissues with high EGFR expression [ 27 ]. Most frequent nimotuzumab-related events in cancer comprise mild or moderate anorexia, chills, headache, fatigue and fever; nimotuzumab does not induce skin rash or hypomagnesemia like other EGFR-targeting drugs [ 29 ].…”

“…Preclinical and clinical studies have shown that the antitumor response evoked by nimotuzumab is mediated by antiproliferative, antiangiogenic and proapoptotic mechanisms [ 27 , 28 ]. Clinical trials have demonstrated that the antibody, in combination with radiation and chemotherapy, significantly increases the survival and objective response rate of patients with advanced epithelial tumors [ 29–35 ].…”

Emerging Therapies in Penile Cancer

“…Nimotuzumab is an intermediate affinity anti-EGFR antibody that inhibits cell proliferation and angiogenesis, activates natural killer cells, stimulates dendritic cell maturation, induces cytotoxic T cells, and restores MHC-I expression on tumor cells, hindering one of the EGFR immune-escape ways. In patients with locally advanced SCC of the head and neck, nimotuzumab in combination with low-dose cisplatin and radiotherapy was superior to cisplatin and radiotherapy in progression-free survival, disease-free survival, and locoregional tumor control ( 42 ). Triprilimab (JS001) is a recombinant humanized IgG4 anti-PD-1antibody that has demonstrated clinical activity in heavily pretreated nasopharyngeal cancer ( 43 ).…”