PT  - JOURNAL ARTICLE
AU  - Teilo H Schaller
AU  - David J Snyder
AU  - Ivan Spasojevic
AU  - Patrick C Gedeon
AU  - Luis Sanchez-Perez
AU  - John H Sampson
TI  - First in human dose calculation of a single-chain bispecific antibody targeting glioma using the MABEL approach
AID  - 10.1136/jitc-2019-000213
DP  - 2020 Apr 01
TA  - Journal for ImmunoTherapy of Cancer
PG  - e000213
VI  - 8
IP  - 1
4099  - http://jitc.bmj.com/content/8/1/e000213.short
4100  - http://jitc.bmj.com/content/8/1/e000213.full
SO  - J Immunother Cancer2020 Apr 01; 8
AB  - Background First-in-human (FIH) clinical trials require careful selection of a safe yet biologically relevant starting dose. Typically, such starting doses are selected based on toxicity studies in a pharmacologically relevant animal model. However, with the advent of target-specific and highly active immunotherapeutics, both the Food and Drug Administration and the European Medicines Agency have provided guidance that recommend determining a safe starting dose based on a minimum anticipated biological effect level (MABEL) approach.Methods We recently developed a T cell activating bispecific antibody that effectively treats orthotopic patient-derived malignant glioma and syngeneic glioblastoma in mice (hEGFRvIII:CD3 bi-scFv). hEGFRvIII:CD3 bi-scFv is comprized of two single chain antibody fragments (bi-scFvs) that bind mutant epidermal growth factor receptor variant III (EGFRvIII), a mutation frequently seen in malignant glioma, and human CD3ε on T cells, respectively. In order to establish a FIH dose, we used a MABEL approach to select a safe starting dose for hEGFRvIII:CD3 bi-scFv, based on a combination of in vitro data, in vivo animal studies, and theoretical human receptor occupancy modeling.Results Using the most conservative approach to the MABEL assessment, a dose of 57.4 ng hEGFRvIII:CD3 bi-scFv/kg body weight was selected as a safe starting dose for a FIH clinical study.Conclusions The comparison of our MABEL-based starting dose to our in vivo efficacious dose and the theoretical human receptor occupancy strongly supports that our human starting dose of 57.4 ng hEGFRvIII:CD3 bi-scFv/patient kg will be safe.