A novel Fc-optimized antibody-drug conjugate targeting CD7 for the therapy of T-cell acute lymphoblastic leukemia

While treatment for patients with T-cell acute lymphoblastic leukemia (T-ALL) has improved in the last decades, therapeutic options for patients refractory to standard therapy or with relapsing disease are limited. In particular, no immunotherapy option has been approved in T-ALL yet. Here, a novel dual antibody engineering approach for targeting CD7 was evaluated. The chimeric CD7 antibody chimTH69 was modified by Fc engineering to improve antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP). In addition, it was conjugated to monomethyl auristatin E (MMAE), a microtubule-disrupting agent. The resulting Fc-optimized antibody-drug conjugate (ADC), designated chimTH69-DE-vcMMAE, showed a unique set of effector functions in vitro . It triggered ADCC by mononuclear cells at picomolar concentrations, mediated ADCP by macrophages and directly inhibited the growth of a panel of T-ALL cell lines by delivering the cytotoxic compound to induce G2 cell cycle arrest and apoptosis. In addition, due to its specific linker design, chimTH69-DE-vcMMAE demonstrated bystander killing activity against CD7-negative leukemia cells. In mice, CD7-directed therapy with chimTH69-DE-vcMMAE inhibited the growth of subcutaneous CCRF-CEM T-ALL xenografts. Moreover, chimTH69-DE-vcMMAE exerted strong antileukemic effects in a phase II-like patient-derived xenograft preclinical trial in pediatric and adult patients when applied in an experimental overt leukemia setting. ChimTH69-DE-vcMMAE induced minimal residual disease-negativity in one PDX model. These findings indicate that targeting CD7 with the novel Fc-optimized ADC is a potent strategy to trigger anti-leukemia responses and may open a novel therapeutic avenue for T-ALL treatment.