941 STK-026, a detoxified IL-12 partial agonist is well-tolerated and sustains CD8+ T cell activity with repeat doses in cynomolgus macaques
BackgroundInterleukin-12 (IL-12) is a pro-inflammatory cytokine produced by antigen-presenting cells which activates NK cells and cytotoxic CD8+ T cells and drives Th1 polarization in CD4+ T cells. In murine tumor models, IL-12 has potent T cell-mediated anti-tumor effects,1 2 but induces a systemic cytokine release syndrome (CRS) primarily via NK cell activation.2 3 In patients, use of wildtype IL-12 is hampered by early dose-limiting toxicities, including CRS, hepatotoxicity, lymphopenia (especially NK cytopenia), neutropenia, and rapid tachyphylaxis on repeat dosing.4–6STK-026 is an Fc-fused human IL-12 partial agonist with diminished binding to IL-12Rb1, leading to decreased sensitivity to NK cells and increased selectivity towards T cells, which strongly upregulate IL-12Rb1 upon antigen activation. Previously, mouse STK-026 demonstrated strong anti-tumor immunity while avoiding acute NK activation and toxicity seen with WT mouse IL-12.2 Similarly, a single dose of human STK-026 in monkeys avoided early NK activation yet induced T cell proliferation.2 Here, the results from a repeat-dose GLP toxicity study of STK-026 in cynomolgus monkeys are described.MethodsCynomolgus macaques were intravenously administered 0.5, 1.5 or 5 mg/kg STK-026, or vehicle, every other week for 3 cycles. Toxicity was evaluated by monitoring clinical symptoms, body weight, respiratory rate, cardiac function, clinical chemistry, and hematology. Immunological responses were assessed by blood immunophenotyping.ResultsAll doses of STK-026 were well-tolerated with no drug-related clinical symptoms. Body weights and weekly peripheral lymphocyte, NK cell, platelet, and neutrophil counts remained stable upon treatment. Minor increases (<3-fold) in alanine aminotransferase and aspartate transaminase were observed 2 weeks after the first cycle of STK-026, while bilirubin remained stable, suggesting minimal liver-related toxicities. Total NK and T cell frequencies remained stable throughout the dosing. STK-026 induced transient NK cell proliferation only after the first dose. In contrast, STK-026 specifically, robustly and repeatedly increased and maintained CD38+Ki67+ and GranzymeB+Ki67+ memory CD8+ T cell activation at all dose levels without inducing PD-1. Similarly, STK-026 induced and maintained proliferation of CD4+ effector memory T cells. Lastly, STK-026 increased MHC-I and CD64 on monocytes and granulocytes, consistent with IFNγ pathway activation.ConclusionsSTK-026 is well-tolerated with minimal cytopenias or transaminase changes in cynomolgus macaques over 3 cycles of treatment up to 5 mg/kg. STK-026 induced transient NK cell proliferation, but sustained memory CD8+ T cell responses. These data indicate that STK-026 is a biased IL-12 partial agonist that could retain T cell responses while avoiding NK-mediated toxicities.ReferencesBrunda MJ, Luistro L, Warrier, et al. Gately MK. Antitumor and antimetastatic activity of interleukin 12 against murine tumors. J Exp Med 1993 Oct 1;178(4):1223–30.Koliesnik Z, Totagrande M, Burgess R, et al. Preclinical pharmacodynamic characterization of STK-026: a novel IL-12 partial agonist for cancer with maintained CD8 T cell activity, reduced NK-mediated toxicity and an improved therapeutic window. J ImmunoTher Cancer 2023;11:1053.Carson W, Yu H, Dierkshiede J, et al. A fatal cytokine-induced systemic inflammatory response reveals a critical role for NK cells. J Immunol 1999;162(8):4943–51.Atkins MB, Robertson MJ, Gordon M, et al. Phase I evaluation of intravenous recombinant human interleukin 12 in patients with advanced malignancies. Clin Cancer Res 1997;3(3):409–17.Portielje J, Lamers C, Kruit V, et al. Repeated Administrations of Interleukin-12 Are Associated with Persistently Elevated Plasma Levels of IL-10 and Declining IFNγ, TNFα, IL-6 and IL-8 responses. Clin Canc Res 2003;9:76–83.Portielje J, Kruit V, Eerenberg A. Subcutaneous injection of interleukin 12 induces systemic inflammatory responses in humans; implications for the use of IL-12 as a vaccine adjuvant. Cancer Immunol Immunother 2005;54:37–43.Ethics ApprovalAll animal experiments were carried out in accordance with local government and institutional guidelines and regulations. All in vivo protocols were approved by a local Institutional Animal Care and Use Committee, or other appropriate review board, before study execution. All animals were housed in accordance with local regulations.
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