Tremelimumab

Tremelimumab
Fab fragment of tremelimumab (blue) binding CTLA-4 (green). From PDB entry 5GGV.
Monoclonal antibody
TypeWhole antibody
SourceHuman
TargetCTLA-4
Names
Trade namesImjudo
Other namestremelimumab-actl; ticilimumab; CP-675; CP-675,206[1]
Clinical data
Drug classImmune checkpoint blocker[2]
Main usesHepatocellular cancer (HCC), non-small cell lung cancer (NSCLC)[3]
Side effectsRash, diarrhea, tiredness, itchiness, muscle pain, immune system problems[3]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Routes of
use		Intravenous
External links
AHFS/Drugs.comMonograph
Legal
License data
Legal status
Chemical and physical data
FormulaC6500H9974N1726O2026S52
Molar mass146382.47 g·mol−1

Tremelimumab, sold under the brand name Imjudo, is a medication used to treat hepatocellular cancer that cannot be removed by surgery alone and certain types of non-small cell lung cancer (NSCLC) which has spread to other parts of the body.[3] It is generally used with durvalumab.[3] It is given by gradual injection into a vein.[3]

Common side effects include rash, diarrhea, tiredness, itchiness, and muscle pain.[3] Other side effects may include immune system problems such as pneumonitis, colitis, and hepatitis; and infusion reactions.[3] Use in pregnancy may harm the baby.[3] It is a monoclonal antibody and immune checkpoint blocker that blocks cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4).[3][2]

Tremelimumab was approved for medical use in the United States in 2022.[3] As of 2022 the manufacturer has applied for approval in Europe.[4] In the United States 75 mg costs about 10,300 USD as of 2022.[5]

Medical uses

Tremelimumab is indicated, in combination with durvalumab, for the treatment of adults with unresectable hepatocellular carcinoma.[3] For those who weight more than 30 kg a dose of 75 to 300 mg may be used.[3]

Dosage

The dose used depends on a persons weight and the cancer being treated.[3]

Mechanism of action

Tremelimumab aims to stimulate an immune system attack on tumors. Cytotoxic T lymphocytes (CTLs) can recognize and destroy cancer cells. However, there is also an inhibitory mechanism (immune checkpoint) that interrupts this destruction. Tremelimumab turns off this inhibitory mechanism and allows CTLs to continue to destroy the cancer cells.[6]

Tremelimumab binds to the protein CTLA-4, which is expressed on the surface of activated T lymphocytes and inhibits the killing of cancer cells.[1] Tremelimumab blocks the binding of the antigen-presenting cell ligands B7.1 and B7.2 to CTLA-4, resulting in inhibition of B7-CTLA-4-mediated downregulation of T-cell activation; subsequently, B7.1 or B7.2 may interact with another T-cell surface receptor protein, CD28, resulting in a B7-CD28-mediated T-cell activation unopposed by B7-CTLA-4-mediated inhibition.[1]

Unlike Ipilimumab (another fully human anti-CTLA-4 monoclonal antibody), which is an IgG1 isotype, tremelimumab is an IgG2 isotype.[7][8]

History

Previously in development by Pfizer,[9] it is in investigation by MedImmune, a wholly owned subsidiary of AstraZeneca.[10]

Society and culture

Names

Tremelimumab is the international nonproprietary name (INN).[11]

Resarch

Melanoma

Phase I and II clinical studies in metastatic melanoma showed some responses.[12] However, based on early interim analysis of phase III data, Pfizer designated tremelimumab as a failure and terminated the trial in April 2008.[9][13]

However, within a year, the survival curves showed separation of the treatment and control groups.[14]

Mesothelioma

Although it was designated in April 2015 as orphan drug status in mesothelioma,[15] tremelimumab failed to improve lifespan in the phase IIb DETERMINE trial, which assessed the drug as a second or third-line treatment for unresectable malignant mesothelioma.[16][17]

Non-small cell lung cancer

In a phase III trial, AstraZeneca paired tremelimumab with a PD-L1 inhibitor, durvalumab, for the first-line treatment of non-small cell lung cancer.[18] The trial was conducted across 17 countries, and in July 2017, AstraZeneca announced that it had failed to meet its primary endpoint of progression-free survival.[19]

References

  1. 1 2 3 "Tremelimumab". National Cancer Institute. Archived from the original on 10 August 2019. Retrieved 27 October 2022. Public Domain This article incorporates text from this source, which is in the public domain.
  2. 1 2 Wang, BC; Li, PC; Fan, JQ; Lin, GH; Liu, Q (10 July 2020). "Durvalumab and tremelimumab combination therapy versus durvalumab or tremelimumab monotherapy for patients with solid tumors: A systematic review and meta-analysis". Medicine. 99 (28): e21273. doi:10.1097/MD.0000000000021273. PMID 32664183.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 "DailyMed - IMJUDO- tremelimumab injection, solution". dailymed.nlm.nih.gov. Archived from the original on 18 November 2022. Retrieved 16 December 2022.
  4. ↑ "Tremelimumab". SPS - Specialist Pharmacy Service. 28 November 2020. Archived from the original on 15 December 2021. Retrieved 16 December 2022.
  5. ↑ "Imjudo Prices, Coupons, Copay & Patient Assistance". Drugs.com. Retrieved 16 December 2022.
  6. ↑ Ribas A (June 2012). "Tumor immunotherapy directed at PD-1". The New England Journal of Medicine. 366 (26): 2517–9. doi:10.1056/NEJMe1205943. PMID 22658126.
  7. ↑ Tomillero A, Moral MA (October 2008). "Gateways to clinical trials". Methods Find Exp Clin Pharmacol. 30 (8): 643–72. doi:10.1358/mf.2008.30.5.1236622. PMID 19088949.
  8. ↑ Poust J (December 2008). "Targeting metastatic melanoma". Am J Health Syst Pharm. 65 (24 Suppl 9): S9–S15. doi:10.2146/ajhp080461. PMID 19052265.
  9. 1 2 "Pfizer Announces Discontinuation of Phase III Clinical Trial for Patients with Advanced Melanoma". Pfizer.com. 1 April 2008. Archived from the original on 8 December 2015. Retrieved 5 December 2015.
  10. ↑ Mechanism of Pathway: CTLA-4 Inhibition
  11. ↑ World Health Organization (2008). "International nonproprietary names for pharmaceutical substances (INN): recommended INN: list 59". WHO Drug Information. 22 (1). hdl:10665/74120.
  12. ↑ Reuben JM, Lee BN, Li C, Gomez-Navarro J, Bozon VA, Parker CA, et al. (June 2006). "Biologic and immunomodulatory events after CTLA-4 blockade with ticilimumab in patients with advanced malignant melanoma". Cancer. 106 (11): 2437–44. doi:10.1002/cncr.21854. PMID 16615096.
  13. ↑ Ribas A, Kefford R, Marshall MA, Punt CJ, Haanen JB, Marmol M, et al. (February 2013). "Phase III randomized clinical trial comparing tremelimumab with standard-of-care chemotherapy in patients with advanced melanoma". Journal of Clinical Oncology. 31 (5): 616–22. doi:10.1200/JCO.2012.44.6112. PMC 4878048. PMID 23295794.
  14. ↑ Marshall MA, Ribas A, Huang B (May 2010). "Evaluation of baseline serum C-reactive protein (CRP) and benefit from tremelimumab compared to chemotherapy in first-line melanoma". Journal of Clinical Oncology. 28 (15S): 2609. doi:10.1200/jco.2010.28.15_suppl.2609.
  15. ↑ Duff J (17 April 2015). "FDA Grants AstraZeneca's Tremelimumab Orphan Drug Status for Mesothelioma". Mesothelioma Cancer Alliance. Archived from the original on 31 July 2016.
  16. ↑ Krassenstein B (29 February 2016). "Tremelimumab Fails Mesothelioma Drug Trial". FDA News Alert. Archived from the original on 2016-03-06. Retrieved 2016-03-06.
  17. ↑ McKee S (1 March 2016). "AZ' tremelimumab fails in mesothelioma trial". PharmaTimes. Archived from the original on 6 March 2016. Retrieved 6 March 2016.
  18. ↑ Adams B (27 July 2017). "AstraZeneca's immuno-oncology combo fails crucial Mystic trial in lung cancer". FierceBiotech. Archived from the original on 17 May 2022. Retrieved 6 December 2022.
  19. ↑ "AstraZeneca reports initial results from the ongoing MYSTIC trial in Stage IV lung cancer". AstraZeneca (Press release). 27 July 2017. Archived from the original on 28 August 2021. Retrieved 6 December 2022.
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