American Association for Cancer Research
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Supplementary Table S2 from Safety and Activity of the First-in-Class Sym004 Anti-EGFR Antibody Mixture in Patients with Refractory Colorectal Cancer

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journal contribution
posted on 2023-04-03, 20:45 authored by Rodrigo Dienstmann, Amita Patnaik, Rocio Garcia-Carbonero, Andrés Cervantes, Marta Benavent, Susana Roselló, Bastiaan B.J. Tops, Rachel S. van der Post, Guillem Argilés, Niels J.Ø. Skartved, Ulla H. Hansen, Rikke Hald, Mikkel W. Pedersen, Michael Kragh, Ivan D. Horak, Stephan Braun, Eric Van Cutsem, Anthony W. Tolcher, Josep Tabernero

Supplementary Table S2. Sym004 pharmacokinetic derived measures - dose-escalation and dose-expansion cohorts.



Tumor growth in the context of EGFR inhibitor resistance may remain EGFR-dependent and is mediated by mechanisms including compensatory ligand upregulation and de novo gene alterations. Sym004 is a two-antibody mixture targeting nonoverlapping EGFR epitopes. In preclinical models, Sym004 causes significant EGFR internalization and degradation, which translates into superior growth inhibition in the presence of ligands. In this phase I trial, we observed grade 3 skin toxicity and hypomagnesemia as mechanism-based dose-limiting events during dose escalation. In dose-expansion cohorts of 9 and 12 mg/kg of Sym004 weekly, patients with metastatic colorectal cancer and acquired EGFR inhibitor resistance were enrolled; 17 of 39 patients (44%) had tumor shrinkage, with 5 patients (13%) achieving partial response. Pharmacodynamic studies confirmed marked Sym004-induced EGFR downmodulation. MET gene amplification emerged in 1 patient during Sym004 treatment, and a partial response was seen in a patient with EGFRS492R mutation that is predictive of cetuximab resistance.Significance: Potent EGFR downmodulation with Sym004 in patients with metastatic colorectal cancer and acquired resistance to cetuximab/panitumumab translates into significant antitumor activity and validates the preclinical hypothesis that a proportion of tumors remains dependent on EGFR signaling. Further clinical development and expanded correlative analyses of response patterns with secondary RAS/EGFR mutations are warranted. Cancer Discov; 5(6);598–609. ©2015 AACR.See related commentary by Stintzing and Heinemann, p. 578This article is highlighted in the In This Issue feature, p. 565