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Enapotamab vedotin, an AXL-specific antibody-drug conjugate, shows preclinical antitumor activity in non-small cell lung cancer
Louise A. Koopman, Mikkel G. Terp, Gijs G. Zom, Maarten L. Janmaat, Kirstine Jacobsen, Elke Gresnigt-van den Heuvel, Marcel Brandhorst, Ulf Forssmann, Freddy de Bree, Nora Pencheva, Andreas Lingnau, Maria A. Zipeto, Paul W.H.I Parren, Esther C.W. Breij, Henrik J. Ditzel
Louise A. Koopman, Mikkel G. Terp, Gijs G. Zom, Maarten L. Janmaat, Kirstine Jacobsen, Elke Gresnigt-van den Heuvel, Marcel Brandhorst, Ulf Forssmann, Freddy de Bree, Nora Pencheva, Andreas Lingnau, Maria A. Zipeto, Paul W.H.I Parren, Esther C.W. Breij, Henrik J. Ditzel
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Research Article Oncology Therapeutics

Enapotamab vedotin, an AXL-specific antibody-drug conjugate, shows preclinical antitumor activity in non-small cell lung cancer

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Abstract

Targeted therapies and immunotherapy have shown promise in patients with non-small cell lung cancer (NSCLC). However, the majority of patients fail or become resistant to treatment, emphasizing the need for novel treatments. In this study, we confirm the prognostic value of levels of AXL, a member of the TAM receptor tyrosine kinase family, in NSCLC and demonstrate potent antitumor activity of the AXL-targeting antibody-drug conjugate enapotamab vedotin across different NSCLC subtypes in a mouse clinical trial of human NSCLC. Tumor regression or stasis was observed in 17/61 (28%) of the patient-derived xenograft (PDX) models and was associated with AXL mRNA expression levels. Significant single-agent activity of enapotamab vedotin was validated in vivo in 9 of 10 AXL-expressing NSCLC xenograft models. In a panel of EGFR-mutant NSCLC cell lines rendered resistant to EGFR inhibitors in vitro, we observed de novo or increased AXL protein expression concomitant with enapotamab vedotin–mediated cytotoxicity. Enapotamab vedotin also showed antitumor activity in vivo in 3 EGFR-mutant, EGFR inhibitor–resistant PDX models, including an osimertinib-resistant NSCLC PDX model. In summary, enapotamab vedotin has promising therapeutic potential in NSCLC. The safety and preliminary efficacy of enapotamab vedotin are currently being evaluated in the clinic across multiple solid tumor types, including NSCLC.

Authors

Louise A. Koopman, Mikkel G. Terp, Gijs G. Zom, Maarten L. Janmaat, Kirstine Jacobsen, Elke Gresnigt-van den Heuvel, Marcel Brandhorst, Ulf Forssmann, Freddy de Bree, Nora Pencheva, Andreas Lingnau, Maria A. Zipeto, Paul W.H.I Parren, Esther C.W. Breij, Henrik J. Ditzel

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Figure 4

Increased sensitivity to EnaV treatment of EGFR-driven NSCLC PDX model LXFA677 upon acquiring EGFRi resistance.

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Increased sensitivity to EnaV treatment of EGFR-driven NSCLC PDX model L...
(A and B) Percentage of AXL-expressing parental LXFA677 cells, subdivided into percentage of low (1+), intermediate (2+), and strong (3+) staining cells of parental (A) and EGFRi-resistant (B) LXFA677 PDX models. Insert: representative cropped image of staining and calculated H-score for parental (A) and EGFRi-resistant (B) LXFA677 PDX models. (C and D) Tumor growth curves of parental (C) and EGFRi-resistant (D) LXFA677 PDX models, treated with EnaV (2 and 4 mg/kg), isotype-ADC, or erlotinib only. Red arrowheads indicate days of EnaV treatment; black arrowheads indicate days of erlotinib treatment. Tumor sizes are presented as mean tumor size of each group of mice (n = 8 per group) up to the day the first mouse of a group was sacrificed. (E and F) Statistical analysis (Mann-Whitney U test + Bonferroni’s post hoc test; P values: *P < 0.05, and ***P ≤ 0.001) was performed on the last day that both groups were intact, but no later than day 25 after randomization, because PK studies indicated all administered drug was cleared by day 25 (data not shown), to identify significant differences in tumor sizes between groups. (E) Tumor sizes in parental model LXFA677, compared on day 21 after randomization. (F) Tumor sizes in EGFRi-resistant model LXFA677_R, compared on day 23 after randomization.

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