Dr. Lewis has been Dartmouth PI on a first in man study of the
combination of cyclophosphamide pretreatment with a humanized immunoconjugate of an anti-EpCAM antibody linked to two molecules of IL - 2.
The experiments point to an immune system cell that evades the toxic
effects of cyclophosphamide and protects patients from a lethal form of GVHD.
In the early 2000s, Johns Hopkins scientists Leo Luznik and Ephraim Fuchs found that giving patients high
doses of cyclophosphamide — a drug derived from nitrogen mustard and used to treat blood cancers — three days after bone marrow transplant successfully thwarts acute and chronic GVHD.
In a statement yesterday, Juno said it has asked the FDA for permission to change the trial protocol by ending the use of fludarabine as a preconditioning drug along with cyclophosphamide and going back to the trial's earlier protocol — changed during the second quarter —
of cyclophosphamide preconditioning alone.
After the transplant, patients receive two
days of cyclophosphamide to prevent GVHD and rejection of the new bone marrow.
This study established the
MTD of the cyclophosphamide - huKS - IL2 combination (mainly limited by IL - 2 side effects), the pharmacokinetics of huKS - IL2 and its systemic immunologic and immunogenic effects in patients with solid tumors (BMC Cancer.
In the ROCKET trial assessing JACR015, the first clinical hold imposed in July followed the deaths of three patients, which the company blamed on a change to the trial's original protocol to precondition patients by using a
combination of cyclophosphamide and fludarabine.
Luznik and colleagues have sought the right balance by giving high
doses of cyclophosphamide, a chemotherapy drug with immunosuppressive effects, shortly after transplantation.
The ALDH - laden stem cells evade the toxic effects
of cyclophosphamide and rebuild the patient's immune system.
The intestinal microbiota modulates the anticancer immune effects
of cyclophosphamide.
Prognosis - It has been suggested that administration of a combination
of cyclophosphamide, vincristine, doxorubicin, and prednisolone may result in survival times ranging from several months to 6 years.
Chemotherapy uses a combination
of cyclophosphamide, vincristine and prednisone (CHOP chemotherapy protocol is commonly used).