Mechanism of Action Magnifier – 2016 Desk Reference
Bavituximab: a Novel, Investigational Immunotherapy Agent Targeting Phosphatidylserine in the Vasculature of the Tumor Microenvironment
Bavituximab is a first-in-class phosphatidylserine (PS)-targeting monoclonal antibody that blocks PS-mediated immunosuppression by multifocal reprogramming of immune cells in the tumor microenvironment to support immune activation.1 PS is a highly immunosuppressive molecule usually located inside the membrane of healthy cells, but “flips” and becomes exposed on the outside of cells that line tumor blood vessels, creating a specific target for anticancer treatments. PS-targeting agents block PS-mediated immunosuppression by multifocal reprogramming of immune cells in the tumor microenvironment to support immune activation.1
Preclinical data demonstrate that bavituximab:
- Blocks PS-mediated immunosuppressive signaling
- Provides specificity for innate immune responses
- Activates T-cell–driven adaptive immunopathways to stimulate an effective immune response to the tumor.2
After binding exposed PS in tumors, bavituximab engages Fc-γ receptors on tumor-promoting myeloid-derived suppressor cells (MDSCs), M2-like tumor-associated macrophages (which fail to differentiate into M1-like tumor-killing macrophages and natural killer cells), and immature dendritic cells, leading to multiple immunostimulatory changes in the tumor environment.2 These changes include:
- An increase in immunostimulatory cytokines (including tumor necrosis factor alpha [TNF-α] and interleukin (IL)-12)
- Macrophage polarization from an M2 state to a tumor-fighting M1 state
- Differentiation of tumor-promoting MDSCs into M1 macrophages and mature dendritic cells.2
Thus, antibody-mediated PS blockade reduces the levels of MDSCs, transforming growth factor beta (TGF-β) and IL-10 and increases the levels of TNF-α and IL-12.1 M1 macrophages contribute to tumor destruction through antibody-dependent cellular cytotoxicity, while mature dendritic cells educate T cells, inducing tumor-specific cytotoxic T-cell responses.2,3
- Yopp A, Kallinteris N, Huang X, et al. Antibody-mediated blockade of phosphatidylserine enhances the antitumor activity of targeted therapy and immune checkpoint inhibitors by affecting myeloid and lymphocyte populations in the tumor microenvironment. J Immunother Cancer. 2014;2(suppl 3):P266.
- Belzile O, Zhang Z, Huang X, et al. Antibody-mediated blockade of phosphatidylserine combined with radiation improves survival and tumor eradication in a rat model of non-small cell lung cancer. Cancer Res. 2014;74(19 suppl). Abstract 639.
- Yin Y, Barbero G, Brownlee Z, et al. Targeting phosphatidylserine to improve androgen deprivation therapy of prostate cancer. Cancer Res. 2011;71(8 suppl). Abstract 621.
Tazverik Receives FDA Approval as First Treatment Specifically for Metastatic or Locally Advanced Epithelioid Sarcoma
On January 23, 2020, the FDA granted accelerated approval to tazemetostat (Tazverik; Epizyme), a methyltransferase inhibitor, for the treatment of metastatic or locally advanced epithelioid sarcoma in adults and pediatric patients aged ≥16 years who are not eligible for complete resection.
Anxiety is a common symptom in patients with advanced cancer, and is associated with reduced quality of life, increased symptom burden, poor medication adherence, and suboptimal treatment decisions at the end of life. Anxiety also tends to cluster with disease- and treatment-related side effects such as fatigue, pain, breathlessness, nausea, vomiting, and sleep disturbance.