MEDI-0680

MEDI0680 is a humanized immunoglobulin monoclonal antibody that targets human programmed cell death protein 1 (PD-1) for the treatment of cancer. A population two-compartmental pharmacokinetic (PK) model and a sequential direct maximal effective drug concentration receptor occupancy (RO) model with baseline parameters were developed to quantify PK variability, identify significant covariates, and characterize the relationship between the PK and the RO of MEDI0680. A total of 58 patients with advanced malignancies received MEDI0680 by intravenous infusion at a dose of 0.1-20 mg/kg in a phase 1 study. The clearance was 0.27 L per day and the central volume of distribution (V₁) was 3.14 L, with a modest between-subject variability of 30 and 19%, respectively. None of the evaluated covariates showed any impact on PK parameters except for a nonclinically meaningful relevant impact of body weight on V₁. The estimated half-maximal effective concentration for MEDI0680 binding to the PD-1 antigen was approximately 1.88 µg/mL. Visual predictive check results demonstrated good predictability of the final population PK-RO model. PK-RO simulations demonstrated that > 90% RO could be maintained in all subjects after a 20-mg/kg dose every 2 weeks (Q2W). Therefore, 20 mg/kg Q2W and an equivalently fixed dose of 1500 mg was recommended for phase 2 studies.

Chemotherapy and targeted therapy have significantly improved the progression of non-small cell lung cancer (NSCLC), but patients are inevitably suffering from drug resistance and relapse. With this background, the immunotherapy brings a turnaround for a subset of cancer patients. Over two decades, with the development of immunotherapy, immune checkpoint inhibitors (ICIs) have made a breakthrough in NSCLC patients. ICIs targeting the programmed death 1 receptor (PD-1), programmed cell death receptor ligand 1 (PD-L1) and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) showed significantly antitumor efficacy, produced durable clinical responses, and prolonged survival by regulating T cell-mediated immunologic responses in patients with advanced/refractory and metastatic NSCLC in clinical trials. This review aims to summarize the recent advances and challenges of ICIs including nivolumab, pembrolizumab, PF-06801591, MEDI0680, atezolizumab, durvalumab, ipilimumab, tremelimumab, and other new PD-1/PD-L1 and CTLA-4 inhibitors in immunotherapy of NSCLC. We hope to provide a better understanding of the mechanisms, clinical research progress and future research directions of NSCLC immunotherapy.