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      Targeting CLDN18.2 by CD3 Bispecific and ADC Modalities for the Treatments of Gastric and Pancreatic Cancer

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          Abstract

          Human CLDN18.2 is highly expressed in a significant proportion of gastric and pancreatic adenocarcinomas, while normal tissue expression is limited to the epithelium of the stomach. The restricted expression makes it a potential drug target for the treatment of gastric and pancreatic adenocarcinoma, as evidenced by efforts to target CLDN18.2 via naked antibody and CAR-T modalities. Herein we describe CLDN18.2-targeting via a CD3-bispecific and an antibody drug conjugate and the characterization of these potential therapeutic molecules in efficacy and preliminary toxicity studies. Anti-hCLDN18.2 ADC, CD3-bispecific and diabody, targeting a protein sequence conserved in rat, mouse and monkey, exhibited in vitro cytotoxicity in BxPC3/hCLDN18.2 (IC 50 = 1.52, 2.03, and 0.86 nM) and KATO-III/hCLDN18.2 (IC 50 = 1.60, 0.71, and 0.07 nM) respectively and inhibited tumor growth of pancreatic and gastric patient-derived xenograft tumors. In a rat exploratory toxicity study, the ADC was tolerated up to 10 mg/kg. In a preliminary assessment of tolerability, the anti-CLDN18.2 diabody (0.34 mg/kg) did not produce obvious signs of toxicity in the stomach of NSG mice 4 weeks after dosing. Taken together, our data indicate that targeting CLDN18.2 with an ADC or bispecific modality could be a valid therapeutic approach for the treatment of gastric and pancreatic cancer.

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          Claudin-18 splice variant 2 is a pan-cancer target suitable for therapeutic antibody development.

          Antibody-based cancer therapies have emerged as the most promising therapeutics in oncology. The purpose of this study was to discover novel targets for therapeutic antibodies in solid cancer. We combined data mining and wet-bench experiments to identify strictly gastrocyte lineage-specific cell surface molecules and to validate them as therapeutic antibody targets. We identified isoform 2 of the tight junction molecule claudin-18 (CLDN18.2) as a highly selective cell lineage marker. Its expression in normal tissues is strictly confined to differentiated epithelial cells of the gastric mucosa, but it is absent from the gastric stem cell zone. CLDN18.2 is retained on malignant transformation and is expressed in a significant proportion of primary gastric cancers and the metastases thereof. In addition to its orthotopic expression, we found frequent ectopic activation of CLDN18.2 in pancreatic, esophageal, ovarian, and lung tumors, correlating with distinct histologic subtypes. The activation of CLDN18.2 depends on the binding of the transcription factor cyclic AMP-responsive element binding protein to its unmethylated consensus site. Most importantly, we were able to raise monoclonal antibodies that bind to CLDN18.2 but not to its lung-specific splice variant and recognize the antigen on the surface of cancer cells. Its highly restricted expression pattern in normal tissues, its frequent ectopic activation in a diversity of human cancers, and the ability to specifically target this molecule at the cell surface of tumor cells qualify CLDN18.2 as a novel, highly attractive pan-cancer target for the antibody therapy of epithelial tumors.
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            Systemic therapy for patients with advanced human epidermal growth factor receptor 2-positive breast cancer: American Society of Clinical Oncology clinical practice guideline.

            To provide evidence-based recommendations to practicing oncologists and others on systemic therapy for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer.
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              Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study

              Background Pancreatic cancer is the fourth-leading cause of cancer deaths in the United States. The silent nature of the disease and its poor prognosis, the need for further research, along with the need to assess the outcomes of current approaches necessitate an ongoing evaluation of the epidemiology and mortality-trends of this malignancy. Continuous monitoring of disease-patterns, on population-levels, may help scientists assess the quality of healthcare delivery, boost their understanding of diseases' characteristics and risk factors, and detect gaps whereby further research is needed. None of the previous reports shed light on pancreatic adenocarcinomas (PAC), the most common type of Pancreatic Cancer, as the primary outcome. In this study we aim to investigate PAC’s incidence and mortality trends over the last four decades in the United States. Methods We used SEER 9 database to study PAC cases during 1974-2014. Incidence and mortality rates were calculated by sex, age, race, state and stage of PAC. Annual percent change (APC) was calculated using joinpoint regression software. Results We reviewed 67,878 PAC cases; most of these cases were in the head of pancreas. Overall PAC incidence rates increased 1.03% (95% CI, 0.86-1.21, p <.001) per year over the study period. Rates of adenocarcinoma of the head of pancreas increased 0.87% (95% CI, 0.68-1.07, p <.001), and rates of adenocarcinoma of the body and tail of pancreas increased 3.42% (95% CI, 3.06-3.79, p <.001) per year during 1973-2014. PAC incidence-based mortality increased 2.22% (95% CI, 1.93-2.51, p <.001) per year. However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality; APC, -24.70% (95% CI, -31.78 - -16.88, p <.001). Conclusion PAC’s incidence and mortality rates have been increasing for decades. However, the last few years have shown a promising decrease in mortality. We believe that further advances in healthcare delivery and research can lead to a further mortality decrease. Future studies can use this paper as a baseline to keep monitoring the outcomes of PAC's therapy. Electronic supplementary material The online version of this article (10.1186/s12885-018-4610-4) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                gzhu108@live.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                10 June 2019
                10 June 2019
                2019
                : 9
                : 8420
                Affiliations
                [1 ]ISNI 0000 0000 8800 7493, GRID grid.410513.2, Pfizer Cancer Immunology Discovery, , Pfizer Worldwide Research and Development, ; 230 E. Grand Avenue, South San Francisco, CA 94080 USA
                [2 ]ISNI 0000 0000 8800 7493, GRID grid.410513.2, Drug Safety Research and Development, , Pfizer Worldwide Research and Development, ; 10646 Science Center Dr., San Diego, CA 92121 USA
                [3 ]ISNI 0000 0000 8800 7493, GRID grid.410513.2, BioMedicine Design, , Pfizer Worldwide Research and Development, ; 10646 Science Center Dr., San Diego, CA 92121 USA
                [4 ]ISNI 0000 0000 8800 7493, GRID grid.410513.2, Drug Safety Research and Development, , Pfizer Worldwide Research and Development, ; 280 Shennecossett Rd, Groton, CT 06340 USA
                [5 ]Present Address: 23 and Me, 349 Oyster Point Blvd, South San Francisco, CA 94080 USA
                [6 ]ISNI 0000 0004 0402 1634, GRID grid.418227.a, Present Address: Gilead Sciences, ; 333 Lakeside Drive, Foster City, CA 94404 USA
                [7 ]Present Address: Grifols Diagnostic Solutions, 6455 Christie Ave B-334C, Emeryville, CA 94608 USA
                [8 ]Present Address: Kodiak Sciences Inc., 2631 Hanover St, Palo Alto, CA 94304 USA
                [9 ]Present Address: Applied Molecular Transport, 1 Tower Place, Suite 850, South San Francisco, CA 94080 USA
                [10 ]Present Address: Covance Inc. Early Phase Development Solutions, 3301 Kinsman Blvd, Madison, WI 53704 USA
                [11 ]ISNI 0000 0004 0393 4335, GRID grid.418019.5, Present Address: GSK, ; 1250 South Collegeville Road, Collegeville, PA 19426 USA
                [12 ]GRID grid.504110.1, Present Address: Alector, ; 151 Oyster Point Blvd #300, South San Francisco, CA 94080 USA
                [13 ]Present Address: Allogene Therapeutics, 210 E. Grand Avenue, South San Francisco, CA 94080 USA
                [14 ]GRID grid.419971.3, Present Address: Bristol-Myers Squibb, ; 700 Bay Rd suite A, Redwood City, CA 94063 USA
                [15 ]Present Address: Multitude Therapeutics, Abmart, 3698 Haven Avenue Suite A, Redwood City, CA 94063 USA
                Article
                44874
                10.1038/s41598-019-44874-0
                6557842
                31182754
                6911ac7c-7587-43ca-a71c-b05ddc2737ed
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 21 January 2019
                : 27 May 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/100004319, Pfizer (Pfizer Inc.);
                Funded by: All authors are current or former employees of Pfizer Inc.
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                © The Author(s) 2019

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                cancer,gastrointestinal cancer
                Uncategorized
                cancer, gastrointestinal cancer

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