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Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma

DG Maloney, TM Liles, DK Czerwinski, C Waldichuk, J Rosenberg, A Grillo-Lopez and R Levy

Department of Medicine, Stanford University Medical Center, CA.

The B-cell antigen CD20 is expressed on normal B cells and by nearly all B-cell lymphomas. This nonmodulating antigen provides an excellent target for antibody-directed therapies. A chimeric anti-CD20 antibody (IDEC-C2B8), consisting of human IgG1-kappa constant regions and variable regions from the murine monoclonal anti-CD20 antibody IDEC- 2B8, has been produced for clinical trials. It lyses CD20+ cells in vitro via complement and antibody-dependent cell-mediated lysis. Preclinical studies have shown that the chimeric antibody selectively depletes B cells in blood and lymph nodes in macaque monkeys. In this phase I clinical trial, 15 patients (3 per dose level) with relapsed low-grade B-cell lymphoma were treated with a single dose (10, 50, 100, 250, or 500 mg/m2) of antibody administered intravenously. Treatment- related symptoms correlated with the number of circulating CD20 cells and grade II events consisted of fever (5 patients); nausea (2), rigor (2), orthostatic hypotension (2), bronchospasm (1), and thrombocytopenia (1). No significant toxicities were observed during the 3 months of follow-up. Serum C3, IgG, and IgM levels, neutrophils, and T cells were largely unchanged. At the three higher dose levels, pharmacokinetics of the free antibody showed a serum half-life of 4.4 days (range, 1.6 to 10.5). Levels greater than 10 micrograms/mL persisted in 6 of 9 patients for more than 14 days. No quantifiable immune responses to the infused antibody have been detected. CD20+ B cells were rapidly and specifically depleted in the peripheral blood at 24 to 72 hours and remained depleted for at least 2 to 3 months in most patients. Two-week postinfusion tumor biopsies showed the chimeric antibody bound to tumor cells and a decrease in the percentage of B cells. Tumor regressions occurred in 6 of 15 patients (2 partial and 4 minor responses). The results of this single-dose trial have been used to design a multiple-dose phase I/II study.

Volume 84, Issue 8, pp. 2457-2466, 10/15/1994
Copyright © 1994 by The American Society of Hematology


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Anti-CD20 Monoclonal Antibody Treatment of Human Herpesvirus 8-Associated, Body Cavity-Based Lymphoma with an Unusual Phenotype in a Human Immunodeficiency Virus-Negative Patient
Clin. Vaccine Immunol., September 1, 2001; 8(5): 993 - 996.
[Abstract] [Full Text] [PDF]


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BloodHome page
W.-K. Weng and R. Levy
Expression of complement inhibitors CD46, CD55, and CD59 on tumor cells does not predict clinical outcome after rituximab treatment in follicular non-Hodgkin lymphoma
Blood, September 1, 2001; 98(5): 1352 - 1357.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
S. Alas and B. Bonavida
Rituximab Inactivates Signal Transducer and Activation of Transcription 3 (STAT3) Activity in B-Non-Hodgkin's Lymphoma through Inhibition of the Interleukin 10 Autocrine/Paracrine Loop and Results in Down-Regulation of Bcl-2 and Sensitization to Cytotoxic Drugs
Cancer Res., July 1, 2001; 61(13): 5137 - 5144.
[Abstract] [Full Text] [PDF]


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JCOHome page
J. C. Byrd, T. Murphy, R. S. Howard, M. S. Lucas, A. Goodrich, K. Park, M. Pearson, J. K. Waselenko, G. Ling, M. R. Grever, et al.
Rituximab Using A Thrice Weekly Dosing Schedule in B-Cell Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Demonstrates Clinical Activity and Acceptable Toxicity
J. Clin. Oncol., April 15, 2001; 19(8): 2153 - 2164.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
S. Alas, C. Emmanouilides, and B. Bonavida
Inhibition of Interleukin 10 by Rituximab Results in Down-Regulation of Bcl-2 and Sensitization of B-cell Non-Hodgkin's Lymphoma to Apoptosis
Clin. Cancer Res., March 1, 2001; 7(3): 709 - 723.
[Abstract] [Full Text]


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J. Immunol.Home page
S. Depraetere, L. Verhoye, G. Leclercq, and G. Leroux-Roels
Human B Cell Growth and Differentiation in the Spleen of Immunodeficient Mice
J. Immunol., March 1, 2001; 166(5): 2929 - 2936.
[Abstract] [Full Text] [PDF]


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JCOHome page
J. M. Vose, B. K. Link, M. L. Grossbard, M. Czuczman, A. Grillo-Lopez, P. Gilman, A. Lowe, L. A. Kunkel, and R. I. Fisher
Phase II Study of Rituximab in Combination With CHOP Chemotherapy in Patients With Previously Untreated, Aggressive Non-Hodgkin's Lymphoma
J. Clin. Oncol., January 15, 2001; 19(2): 389 - 397.
[Abstract] [Full Text] [PDF]


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ASH Education BookHome page
O. W. Press, J. P. Leonard, B. Coiffier, R. Levy, and J. Timmerman
Immunotherapy of Non-Hodgkin's Lymphomas
Hematology, January 1, 2001; 2001(1): 221 - 240.
[Abstract] [Full Text] [PDF]


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BloodHome page
J. Yang, Q. Tao, I. W. Flinn, P. G. Murray, L. E. Post, H. Ma, S. Piantadosi, M. A. Caligiuri, and R. F. Ambinder
Characterization of Epstein-Barr virus-infected B cells in patients with posttransplantation lymphoproliferative disease: disappearance after rituximab therapy does not predict clinical response
Blood, December 15, 2000; 96(13): 4055 - 4063.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
R. L. Ward, D. Packham, A. M. Smythe, J. Murray, P. Anderson-Stewart, N. Kitchen, R. Muirhead, P. Phillips, P. Gray, G. Bigg-Wither, et al.
Phase I Clinical Trial of the Chimeric Monoclonal Antibody (c30.6) in Patients with Metastatic Colorectal Cancer
Clin. Cancer Res., December 1, 2000; 6(12): 4674 - 4683.
[Abstract] [Full Text]


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Clin. Cancer Res.Home page
T. A. Davis, D. G. Maloney, A. J. Grillo-López, C. A. White, M. E. Williams, G. J. Weiner, S. Dowden, and R. Levy
Combination Immunotherapy of Relapsed or Refractory Low-Grade or Follicular Non-Hodgkin's Lymphoma with Rituximab and Interferon-{{alpha}}-2a
Clin. Cancer Res., July 1, 2000; 6(7): 2644 - 2652.
[Abstract] [Full Text]


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BloodHome page
J. Golay, L. Zaffaroni, T. Vaccari, M. Lazzari, G.-M. Borleri, S. Bernasconi, F. Tedesco, A. Rambaldi, and M. Introna
Biologic response of B lymphoma cells to anti-CD20 monoclonal antibody rituximab in vitro: CD55 and CD59 regulate complement-mediated cell lysis
Blood, June 15, 2000; 95(12): 3900 - 3908.
[Abstract] [Full Text] [PDF]


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Mol. Pathol.Home page
P N Nelson, G M Reynolds, E E Waldron, E Ward, K Giannopoulos, and P G Murray
Demystified ...: Monoclonal antibodies
Mol. Pathol., June 1, 2000; 53(3): 111 - 117.
[Abstract] [Full Text]


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JCOHome page
J. M. Foran, A. Z. S. Rohatiner, D. Cunningham, R. A. Popescu, P. Solal-Celigny, M. Ghielmini, B. Coiffier, P. W. M. Johnson, C. Gisselbrecht, F. Reyes, et al.
European Phase II Study of Rituximab (Chimeric Anti-CD20 Monoclonal Antibody) for Patients With Newly Diagnosed Mantle-Cell Lymphoma and Previously Treated Mantle-Cell Lymphoma, Immunocytoma, and Small B-Cell Lymphocytic Lymphoma
J. Clin. Oncol., January 14, 2000; 18(2): 317 - 317.
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ASH Education BookHome page
T. A. Waldmann, R. Levy, and B. S. Coller
Emerging Therapies: Spectrum of Applications of Monoclonal Antibody Therapy
Hematology, January 1, 2000; 2000(1): 394 - 408.
[Abstract] [Full Text] [PDF]


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JCOHome page
R. Levy
Karnofsky Lecture: Immunotherapy of Lymphoma
J. Clin. Oncol., November 1, 1999; 17(90001): 7 - 12.
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Rheumatology (Oxford)Home page
A. Protheroe, J. C. W. Edwards, A. Simmons, K. Maclennan, and P. Selby
Remission of inflammatory arthropathy in association with anti-CD20 therapy for non-Hodgkin's lymphoma
Rheumatology, November 1, 1999; 38(11): 1150 - 1152.
[Abstract] [Full Text] [PDF]


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JCOHome page
T. A. Davis, C. A. White, A. J. Grillo-Lopez, W. S. Velasquez, B. Link, D. G. Maloney, R. O. Dillman, M. E. Williams, A. Mohrbacher, R. Weaver, et al.
Single-Agent Monoclonal Antibody Efficacy in Bulky Non-Hodgkin's Lymphoma: Results of a Phase II Trial of Rituximab
J. Clin. Oncol., June 1, 1999; 17(6): 1851 - 1851.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
T. A. Davis, D. K. Czerwinski, and R. Levy
Therapy of B-Cell Lymphoma with Anti-CD20 Antibodies Can Result in the Loss of CD20 Antigen Expression
Clin. Cancer Res., March 1, 1999; 5(3): 611 - 615.
[Abstract] [Full Text] [PDF]


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JCOHome page
M. S. Czuczman, A. J. Grillo-Lopez, C. A. White, M. Saleh, L. Gordon, A. F. LoBuglio, C. Jonas, D. Klippenstein, B. Dallaire, and C. Varns
Treatment of Patients With Low-Grade B-Cell Lymphoma With the Combination of Chimeric Anti-CD20 Monoclonal Antibody and CHOP Chemotherapy
J. Clin. Oncol., January 1, 1999; 17(1): 268 - 268.
[Abstract] [Full Text] [PDF]


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J. Immunol.Home page
M. A. Coccia and P. Brams
High Titer, Prostate Specific Antigen-Specific Human IgG Production by hu-PBL-SCID Mice Immunized with Antigen-Mouse IgG2a Complex-Pulsed Autologous Dendritic Cells
J. Immunol., November 15, 1998; 161(10): 5772 - 5780.
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BloodHome page
M. Benkerrou, J.-P. Jais, V. Leblond, A. Durandy, L. Sutton, P. Bordigoni, J. L. Garnier, J. Le Bidois, F. Le Deist, S. Blanche, et al.
Anti-B-Cell Monoclonal Antibody Treatment of Severe Posttransplant B-Lymphoproliferative Disorder: Prognostic Factors and Long-Term Outcome
Blood, November 1, 1998; 92(9): 3137 - 3147.
[Abstract] [Full Text] [PDF]


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J. Immunol.Home page
A. L. Tutt, R. R. French, T. M. Illidge, J. Honeychurch, H. M. McBride, C. A. Penfold, D. T. Fearon, R. M. E. Parkhouse, G. G. B. Klaus, and M. J. Glennie
Monoclonal Antibody Therapy of B Cell Lymphoma: Signaling Activity on Tumor Cells Appears More Important Than Recruitment of Effectors
J. Immunol., September 15, 1998; 161(6): 3176 - 3185.
[Abstract] [Full Text] [PDF]


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BloodHome page
B. Coiffier, C. Haioun, N. Ketterer, A. Engert, H. Tilly, D. Ma, P. Johnson, A. Lister, M. F. Buske, J.A. Radford, et al.
Rituximab (Anti-CD20 Monoclonal Antibody) for the Treatment of Patients With Relapsing or Refractory Aggressive Lymphoma: A Multicenter Phase II Study
Blood, September 15, 1998; 92(6): 1927 - 1932.
[Abstract] [Full Text] [PDF]


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BloodHome page
H. J. Haisma, M. F. Sernee, E. Hooijberg, R. H. Brakenhoff, I. H. v.d. Meulen-Muileman, H. M. Pinedo, and E. Boven
Construction and Characterization of a Fusion Protein of Single-Chain Anti-CD20 Antibody and Human beta -Glucuronidase for Antibody-Directed Enzyme Prodrug Therapy
Blood, July 1, 1998; 92(1): 184 - 190.
[Abstract] [Full Text] [PDF]


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J. Immunol.Home page
P. Brams, M.-L. Nguyen, S. Chamat, I. Royston, and P. R. Morrow
Antigen-Specific IgG Responses from Naive Human Splenocytes: In Vitro Priming Followed by Antigen Boost in the SCID Mouse
J. Immunol., March 1, 1998; 160(5): 2051 - 2058.
[Abstract] [Full Text] [PDF]


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BloodHome page
D. Shan, J. A. Ledbetter, and O. W. Press
Apoptosis of Malignant Human B Cells by Ligation of CD20 With Monoclonal Antibodies
Blood, March 1, 1998; 91(5): 1644 - 1652.
[Abstract] [Full Text] [PDF]


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BloodHome page
D. G. Maloney, A. J. Grillo-Lopez, C. A. White, D. Bodkin, R. J. Schilder, J. A. Neidhart, N. Janakiraman, K. A. Foon, T.-M. Liles, B. K. Dallaire, et al.
IDEC-C2B8 (Rituximab) Anti-CD20 Monoclonal Antibody Therapy in Patients With Relapsed Low-Grade Non-Hodgkin's Lymphoma
Blood, September 15, 1997; 90(6): 2188 - 2195.
[Abstract] [Full Text] [PDF]


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BloodHome page
J. L. Hornick, L. A. Khawli, P. Hu, M. Lynch, P. M. Anderson, and A. L. Epstein
Chimeric CLL-1 Antibody Fusion Proteins Containing Granulocyte-Macrophage Colony-Stimulating Factor or Interleukin-2 With Specificity for B-Cell Malignancies Exhibit Enhanced Effector Functions While Retaining Tumor Targeting Properties
Blood, June 15, 1997; 89(12): 4437 - 4447.
[Abstract] [Full Text] [PDF]



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