Preclinical Analysis of the Combined Activity of SGN-40, Anti-CD40 Monoclonal Antibody, with Rituximab in Non-Hodgkin Lymphoma.

SGN-40 is a humanized monoclonal antibody against CD40, a TNF receptor family member expressed in non-Hodgkin lymphoma (NHL), multiple myeloma, and several carcinomas. SGN-40 is cytotoxic to NHL cell lines via activation of proapoptotic signal transduction pathways and mediates antibody dependent cellular cytotoxicity (ADCC) effector function activity. In this study we examined the anti-tumor activity of SGN-40 in combination with the anti-CD20 antibody, rituximab, in lymphoma cell line models. Cell proliferation data (³H-thymidine incorporation assay) was generated for SGN-40 and rituximab alone and in combination for three NHL cell lines (Ramos, RL, and SU-DHL-4) and combination index (CI) analyses performed. SGN-40 was reproducibly synergistic with rituximab in Ramos cells and additive in the RL and SU-DHL-4 cell lines in this assay. This suggested that different anti-proliferative signaling events are activated by these antibodies, which produce a greater anti-tumor effect when combined. To better understand the combined activity of SGN-40 and rituximab, the signal transduction pathways activated by each antibody were examined. In Ramos cells SGN-40 signaling caused the degradation of pro-survival BCL-6 oncoprotein and upregulation of TAp63α, a proapoptic p53 family member, while only BCL-6 degradation was triggered in the RL and SU-DHL-4 cell lines. In contrast, rituximab signaling degraded BCL-6 protein in only one cell line (SU-DHL-4), and did not upregulate TAp63α expression in any of the cell lines examined. To further define the combined activity of SGN-40 with rituximab the effector function activity of both antibodies were examined in vitro. ADCC assays in the WIL2-S and Raji cell lines both showed a greater percent cell lysis in the presence of both SGN-40 and rituximab compared to either drug alone. Next, the SGN-40 and rituximab were tested in subcutaneous mouse models of NHL to evaluate this combination in vivo. In a Ramos model, SGN-40 and rituximab (dosed at 4.0mg/kg, q4dx4, ip) had significantly greater anti-tumor response when combined compared to the equivalent dose of either antibody alone. The anti-tumor response achieved with dual dosing of SGN-40 and rituximab was greater than the response expected if the combination was additive. Our data suggests that the improved efficacy of SGN-40, rituximab combination therapy in vivo is due to distinct apoptotic signaling pathways activated by these two antibodies in addition to augmented effector function activity. The combination of SGN-40 and rituximab is currently being studied in clinical trials of NHL.