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Author Manuscript Published OnlineFirst on December 9, 2020; DOI: 10.1158/1535-7163.

MCT-20-0406
Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited.

Title Page:
ABBV-085, antibody-drug conjugate targeting LRRC15, is effective in osteosarcoma: A
report by the Pediatric Preclinical Testing Consortium
Authors: Pooja Hingorani1, Michael E. Roth1, Yifei Wang1, Wendong Zhang1, Jonathan D.
Gill1, Douglas J. Harrison1, Beverly Teicher2, Stephen Erickson3, Gregory Gatto3, Malcolm A.
Smith2, Edward A. Kolb4, Richard Gorlick1*

1. Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX,


77030
2. Cancer Therapeutics Evaluation Program, National Cancer Institute, Bethesda, MD 20892
3. Global Health Technologies, RTI International
4. Division of Pediatric Hematology/Oncology, Nemours/Alfred I. duPont Hospital for
Children, Wilmington, DE 19803

Short Running Title- Activity of ABBV-085 in osteosarcoma

Keywords
OS Osteosarcoma
PPTC Pediatric Preclinical Testing Consortium
PDX Patient Derived Xenograft

*Corresponding Author:
Richard Gorlick, MD
Mosbacher Chair and Division Head, Pediatrics
The University of Texas MD Anderson Cancer Center
Department of Pediatrics
Houston, TX 77030
Office Number: (713) 792-6620
Email: RGorlick@mdanderson.org

Conflict of Interest: The authors have no conflicts to report


Acknowledgements: Financial Support: This work was funded by the National Cancer
Institute’s grant 5U01CA199221-06

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Author Manuscript Published OnlineFirst on December 9, 2020; DOI: 10.1158/1535-7163.MCT-20-0406
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Abstract
Membrane protein leucine-rich repeat containing 15 (LRRC15) is known to be expressed in

several solid tumors including osteosarcoma. ABBV-085, an antibody-drug conjugate against

LRRC15, conjugated to monomethyl auristatin E (MMAE) was studied in osteosarcoma patient

derived xenografts (PDX) by the Pediatric Preclinical Testing Consortium (PPTC). LRRC15

expression data was obtained from PPTC RNA sequencing data for the PDX models. The

TARGET database was mined for LRRC15 expression in human osteosarcoma. Protein

expression was confirmed via immunohistochemistry in three PDX models. Seven osteosarcoma

PDX models (OS1, OS9, OS33, OS34, OS42, OS55 and OS60) with varying LRRC15 gene

expression were studied. ABBV-085 was administered at 3mg/kg (OS33), 6 mg/kg (all 7 PDX)

and 12mg/kg (OS60) weekly for 4 consecutive weeks via intraperitoneal injection. Control

cohorts included vehicle and an isotype MMAE-linked antibody. Tumor volumes and responses

were reported using PPTC statistical analysis. OS1, OS33, OS42, OS55 and OS60 had high

LRRC15 expression while OS9 and OS34 had low LRRC15 expression. ABBV-085 inhibited

tumor growth in 6/7 PDX models as compared to vehicle control and significantly improved

event-free survival in 5/7 models as compared to isotype controls. Two models showed

maintained complete responses while all others showed progressive disease. Response correlated

with LRRC15 expression. ABBV-085’s antitumor activity against osteosarcoma PDX suggests

LRRC15 may be a rational target for pursuing clinical trials in patients with this disease.

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Author Manuscript Published OnlineFirst on December 9, 2020; DOI: 10.1158/1535-7163.MCT-20-0406
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Introduction
The outcome of patients with osteosarcoma (OS), both localized and metastatic, has not changed

for several decades since the advent of adjuvant chemotherapy 1. This is especially frustrating

given the tremendous advances that have occurred in the ability to analyze and understand its
2-4
very complex genome . Due to the lack of identification of recurrent targetable genetic

alterations in a large proportion of patients, these biologic discoveries have thus far not led to

significant therapeutic advancements. Thus, other strategies that are broadly applicable in OS are

needed to target this disease.

Membrane protein leucine-rich repeat containing 15 (LRRC15), a 581 amino acid Type 1

membrane protein with no obvious intracellular signaling domains, is highly expressed on cancer

associated fibroblasts in the stromal microenvironment of many solid tumors. In some tumors

such as sarcomas including OS, melanoma and glioblastoma, it is expressed both on stromal

fibroblasts as well as tumor cells 5. LRRC15 has limited expression in normal tissue and thus

may be an attractive target for drug therapy.

Antibody-drug conjugates (ADC) are a therapeutic strategy in which a cytotoxic payload is

attached to an antibody against a surface protein expressed on cancer and/ or cancer associated

stromal cells via a linker, with the goal of delivering the payload to these cells via antigen-

antibody interaction and internalization. The antibody, by targeting a specific cell population

enhances the therapeutic index and permits the delivery of drug doses that would otherwise be

too toxic with systemic administration 6.

ABBV-085 is an antibody drug conjugate (ADC) directed against LRRC15 that contains the
7, 8
tubulin inhibitor monomethyl auristatin E (MMAE) . Preclinical testing of ABBV-085 in rats

and cynomolgus monkeys have not shown any significant targeted toxicities at sites of normal

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expression such as skin9. ABBV-085 has also been shown to be active against several adult

tumor xenografts such as non-small cell lung cancer, breast and glioblastoma multiforme as well

as against a multi-drug resistant OS xenograft when administered at dose of 6mg/kg every 4

days9. A recent phase 1 study of ABBV-085 in patients with advanced sarcoma demonstrated the

agent is well-tolerated and more than 50% of patients had a partial response (PR) or stable

disease. Two of the 10 OS patients enrolled on study had a PR 10.

In this study, the in vivo activity of ABBV-085 was assessed in a panel of OS PDX models with

high and low LRRC15 expression, as part of Pediatric Preclinical Testing Consortium (PPTC).

Materials and Methods

Pediatric Preclinical Testing Consortium Models

PPTC is an NCI-funded collaborative initiative that includes researchers within and outside

United States that contribute preclinical models and help evaluate new agents across a variety of

pediatric cancers. All of these models have been well validated through multiple different

technologies over the years and all of the current available data on these models including their

molecular and histologic characterization is in the public domain at PedcBioPortal


11-14
https://pedcbioportal.kidsfirstdrc.org/study/summary?id=pptc . Supplemental Table 1 lists

the passage number and growth characteristics of each of the tested xenografts.

LRRC15 expression analysis

The in vivo anticancer effects of ABBV-085 were assessed in a panel of seven OS models (OS1,

OS9, OS33, OS34, OS42, OS55 and OS60). PPTC xenograft RNA-seq data

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(www.cBioPortal.org) was mined for LRRC15 mRNA expression. The panel of OS xenografts

selected for the study was based on the RNA expression data with the goal of including both

high and low expression models. In addition, LRRC15 protein expression was assessed in 3 of

the PDX models (OS9, OS33, OS60) via immunohistochemistry by Abbvie Inc. using the

LRRC15 antibody-Biotin: ABR, MouseIgG2a, Lot#17S56. Isotype antibody was used for

negative control. Staining was assessed by determining the intensity (0-3) as well as percentage

of positive cells and calculating an H score as previously described 15.

LRRC15 gene expression was also evaluated in human OS samples. RNA-seq data from 101 OS

patients was mined from the Therapeutically Applicable Research to Generate Effective

Treatments (TARGET) database (https://ocg.cancer.gov/programs/target). Further, OS tumor

LRRC15 expression data was compared with normal tissue RNA-sequencing data from the NIH

Genotype-Tissue Expression database (GTEx; https://www.gtexportal.org)

In vivo testing

ABBV-085 was provided by Abbvie Inc. (Chicago, IL). C.B.17SC scid-/- female mice were used

to propagate subcutaneous flank tumors. Ten mice were used in each control or treatment group.

First, ABBV-085 was tested at two doses of 6mg/kg and 12mg/kg administered via

intraperitoneal injection once per week for 4 consecutive weeks in two models with highest

LRRC15 expression (OS33 and OS60) to select appropriate dose for testing in all models. Then

all the remaining models were tested at 6mg/kg once per week for 4 weeks. OS33 underwent 2

sets of experiments – OS33-1 (initial dose finding) and OS33-2 (repeat 6mg/ kg and a lower dose

of 3mg/kg) to determine dose sensitivity. A control cohort that received vehicle and an

additional control cohort that received an isotype MMAE linked antibody were included in all

PDX models assessed. Tumor volumes were measured biweekly as previously described 11. All

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Author Manuscript Published OnlineFirst on December 9, 2020; DOI: 10.1158/1535-7163.MCT-20-0406
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mice were maintained under barrier conditions and experiments were conducted using protocols

and conditions in accordance with the Institutional Animal Care and Use Committee at M. D.

Anderson Cancer Center (ACUF Study #00001656-RN00).

The in vivo activity of ABBV-085 was evaluated using standard PPTC measures. Briefly, for

solid tumor experiments, an event is defined as a quadrupling of tumor volume from day 0. The

median time to event was assessed between the experimental and control cohorts. Differences in

event-free survival (EFS) between experimental groups (e.g., treated vs controls) were tested

with α = 0.05, two-sided alternative with ρ = 1, which is equivalent to the Peto & Peto

modification of Gehan-Wilcoxon. Objective responses reported as maintained complete

response, complete response, partial response, and stable disease were described for each model

as defined previously 11. Details of the statistical analysis methods are provided Appendix 1.

Results

LRRC15 expression in OS PDX models

We reviewed PPTC Agilent microarray gene expression data which showed overexpression of

LRRC15 for OS xenografts. The average LRRC15 gene expression value for non-OS/non-

glioblastoma multiforme xenograft lines was 35, while the OS xenograft expression values

ranged from 232 to 12,582 (Supplemental Table 2). Review of the RNA-seq data for PDX

models showed that OS1, OS33, OS42, OS55 and OS60 demonstrated high relative mRNA

expression compared with PDX models OS9 and OS42, with OS9 demonstrating the lowest

expression (Figure1A). LRRC15 protein expression was assessed in OS9, OS33, and OS60 and

mirrored the mRNA findings with minimal expression in OS9 and strong expression in OS33

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and OS60. OS60 demonstrated the highest intensity (3/3) and greatest proportion of cells staining

positive (100%), whereas OS9 did not demonstrate any positive staining (Figure1B-D). H scores

were calculated for these three models (Figure 1E).

LRRC15 expression in human OS tumors

LRRC15 gene expression on human OS samples from TARGET database showed variable

expression levels in >90% of the samples with a median of 51.92 TPM (Figure 2A). Comparison

to normal human tissues showed significantly higher expression level in OS (median normal

tissue expression= 0.184 TPM; log fold change tumor versus normal = 4.36; p <0.01) (Figure

2B).

In vivo efficacy of ABBV-085

ABBV-085 was initially tested in 2 PDX models (OS33 and OS60) predicted to be responsive

due to high LRRC15 expression at doses 6mg/kg and 12mg/kg once per week for four weeks to

determine the optimal dose for testing in additional models. In addition, OS33 was also tested at

the lower dose of 3mg/kg. ABBV-085 at both 6 mg/kg and 12mg/kg significantly inhibited

tumor growth and prolonged EFS in the OS60 model compared to both the vehicle control

animals, with EFS T/C values > 4.0 and with PD2 objective responses. The isotype MMAE

control at 12 mg/kg did not significantly extend EFS compared to vehicle controls. In OS33,

ABBV-085 at both 6 mg/kg and 12 mg/kg was highly active with EFS T/C > 5.0, and with PR

and MCR objective responses, respectively. The isotype MMAE control at 12mg/kg showed

comparable levels of activity as ABBV-085 with an MCR suggesting non-specific activity of

payload in this model unrelated to LRRC15 at high doses. No significant weight loss was

observed in the treated mice and no mice experienced death due to toxicity. Details of these

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testing results are provided in Table 1. Based on these studies, dose of 6mg/kg was selected for

testing in remaining models.

ABBV-085 significantly inhibited tumor growth at 6 mg/kg in 6/7 of the models tested compared

with the vehicle control cohorts (Table 1 and Figure 3A). OS9 was the only model that did not

demonstrate significantly delayed tumor growth compared to the vehicle control. We also

compared the response of ABBV-085 cohort to isotype MMAE antibody cohort. A difference in

tumor growth inhibition was seen in 3/7 models (OS1, OS33 and OS60) suggesting some non-

specific activity of isotype antibody in some of the OS models (Figure 3A). ABBV-085

treatment resulted in an objective response in 2/7 of models at 6 mg/kg, with OS33 and OS55

experiencing a maintained complete response (Figure 3A). All other models experienced

progressive disease with median time to event for treated versus control animals (EFS T/C)

ranging from 0.95 for OS9 to >4.65 for OS33. At 3mg/kg, ABBV-085 showed a PR in OS33

(Table 2).

OS33 was tested again at 6 mg/kg (OS 33-2), while results for OS-60 are from the initial dose-

finding experiments. In this second set of experiments with OS33 at 6mg/kg dose, a MCR was

observed. The discrepancy between the two sets of experiments is explained by the fact that in

the first experiment half of the mice in the test group achieved a CR and the other achieved PR,

therefore by PPTC convention, the response was reported as PR. In the second experiment, 2/ 10

mice had a PR and 8 had an MCR so the response was reported as MCR.

ABBV-085 treatment led to significantly prolonged EFS in 5/7 of these models compared with

the isotype control (Table 2 and Figure 3B). OS9 and OS34, the two models with the lowest

LRRC15 expression, were the only models that did not demonstrate significantly prolonged EFS

compared with the isotype control (Table 2 and Figure 3B).

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Discussion

ABBV-085 exhibited significant antitumor activity against the PPTC OS PDX models with high

expression of LRRC15, demonstrated by prolonged EFS and objective responses. LRRC15 is

highly expressed on both cancer cells as well as tumor stroma of mesenchymal origin. High

LRRC15 expression is also seen in breast cancer, head and neck cancer, non-squamous cell lung

cancer and pancreatic cancer making it a potential target in a wide variety of solid tumors. The

mRNA expression is generally highly concordant with protein expression via IHC. Data suggests
16
that LRRC15 is a regulator of osteogenesis of mesenchymal stem cells . Further, presence of

LRRC15 expressing fibroblasts in tumor microenvironment portend a poor response to immune


17
checkpoint blockade . While LRRC15 mRNA expression in a large cohort of human OS

patients from the TARGET database is suggestive of strong expression in majority of the tumors,

additional studies establishing the prevalence of LRRC15 protein expression in OS patient

samples may be warranted. Our data provide proof of principle that LRRC15 may be a potential

target for antibody delivered cytotoxic payloads and worthy of further clinical trials.

ABBV-085 has entered clinical testing with a focus on patients with sarcomas 18. Following dose

escalation, an expansion cohort was evaluated using a dose of 3.6 mg/kg administered every two

weeks. Anticipated auristatin safety findings of ocular toxicity (may be related to the linker) and

peripheral neuropathy were observed. Other toxicities included fatigue and neutropenia. No

targeted toxicities at sites of normal LRRC15 expression such as skin were observed. Durable

responses were observed for relapsed refractory undifferentiated pleomorphic sarcoma (2

confirmed partial responses in 10 patients) and for OS (2 confirmed partial responses in 10

patients) providing essential human activity data for further OS specific trials.

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ADCs are a relatively newer therapeutic approach in cancer therapy. ADCs comprise of an

antibody to a surface protein of interest such as LRRRC15, a linker and a payload cytotoxic

agent. The goal of an ADC is to be able to deliver large doses of the cytotoxic agent specifically

to the malignant cells that express the antigen without exposure to normal tissues. The

prerequisite characteristic for an effective ADC would not require the surface antigen to be

oncogenic although a dependency on the protein is preferable. ADC against oncogenic antigens
19
such as HER2 are being explored in OS . However, the antigen against which the ADC is

developed has to be present in a large proportion of OS tumors along with minimal expression in

normal tissues. If further study of LRRC15 expression in OS tumors confirms a strong

ubiquitous expression in majority of patient samples, it would make this protein an attractive

strategy for using the ADC approach to treat OS.

It is also important to consider what payload or cytotoxic agent the ADC is delivering and its

activity towards the tumor cells. Cytotoxic agents used as payloads include microtubule

inhibitors, topoisomerase inhibitors, and DNA damaging agents 6. The role of tubulin targeted

drug conjugates is not yet clear in OS, though there is preclinical evidence of target-specific

effects. However, other classes of cytotoxic agents such as DNA damaging agents may be more
20
relevant in the case of OS . One potential issue with using the ADC approach may be

development of resistance by downregulation of cell surface protein on the tumor cells, and this

would need to be monitored in preclinical and clinical studies. Nonetheless, identification of

novel surface proteins expressed on a majority of OS tumor cells and samples and developing

specific ADCs against them provides an exciting new therapeutic avenue in this disease.

10

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Table 1: Response to ABBV-085 at varying doses in two OS PDX models for dose finding
KM
EFS p-value minRTV minRTV Objective
Dose med EFS
Model Agent (days) T-C Gehan- mean±SD p-value Response
(mg/k) T/C
Wilcoxon Measure+
(days)
Vehicle
16.7 1.997±0.228 PD
Control
ABBV- p<
6 80.1 63.4 4.79 p < 0.001 1.022±0.167 PD2
OS-60 085 0.001
ABBV- p<
12 >86 >69.3 >5.14 p < 0.001 0.977±0.213 PD2
085 0.001
MMAE- p=
12 19.9 3.2 1.19 p = 0.024 1.634±0.347 PD1
antibody 0.023
Vehicle
15.6 1.990±0.264 PD
Control
ABBV- p=
6 >86 >70.4 >5.53 p < 0.001 0.117±0.138 PR
OS-33 085 0.001
ABBV- p=
12 >86 >70.4 >5.53 p < 0.001 0.080±0.148 MCR
085 0.001
MMAE- p=
12 >86 >70.4 >5.53 p <0.001 0.065±0.116 MCR
antibody 0.002

+ All the response measures are defined in Appendix 1

12

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Table 2: Activity of ABBV-085 and isotype MMAE antibody vs. vehicle control for all PDX
models

KM
EFS p-value minRTV minRTV Objective
Dose med EFS
Model Agent (days) T-C Gehan- mean±SD p-value Response
(mg/k) T/C
Wilcoxon Measure+
(days)
ABBV- p<
6 72.6 47.4 2.88 p < 0.001 1.162±0.234 PD2
085 0.001
OS-1
MMAE- p=
6 32.5 7.3 1.29 p < 0.001 1.383±0.098 PD1
antibody 0.004
ABBV- p=
6 23.6 -1.2 0.95 p = 0.447 1.687±0.389 PD1
085 0.673
OS-9
MMAE- p=
6 23.4 -1.4 0.94 p = 0.631 1.684±0.268 PD1
antibody 0.370
ABBV- p<
6 > 84 > 65.9 > 4.65 p < 0.001 0.026±0.056 MCR
085 0.001
ABBV- p<
OS-33 3 81.4 63.4 4.51 p < 0.001 0.520±0.330 PR
085 0.001
MMAE- p=
6 29.4 11.3 1.62 p < 0.001 1.269±0.150 PD1
antibody 0.002
ABBV- p=
6 49.9 17.6 1.54 p < 0.001 1.136±0.113 PD1
085 0.001
OS-34
MMAE- p=
6 38.8 6.5 1.2 p = 0.025 1.233±0.121 PD1
antibody 0.052
ABBV- p=
6 25 4.8 1.24 p < 0.001 1.251±0.194 PD1
085 0.035
OS-42
MMAE- p=
6 21.3 1.1 1.06 p = 0.226 1.430±0.223 PD1
antibody 0.393
ABBV-
6 >168 >117.6 >3.34 p < 0.001 0.176±0.211 p <0.001 MCR
085
OS-55
MMAE-
6 151 101.1 3.01 p = 0.003 0.499±0.369 p<0.001 PR
antibody
ABBV- p<
6 80.1 63.4 4.79 p < 0.001 1.022±0.167 PD2
085 0.001
OS-60
MMAE- p=
12 19.9 3.2 1.19 p = 0.024 1.634±0.347 PD1
antibody 0.023

+ All the response measures are defined in Appendix 1

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Figure Legends:
Figure 1. LRRC15 expression across OS PDX models. (A) Relative mRNA expression of

LRRC15 assessed by RNASeq in 33 OS PDX models. LRRC15 protein expression assessed by

immunohistochemistry in OS models (B) OS9, (C) OS33, and (D) OS60. (E) H-score for the

three models tested

Figure 2: LRRC15 expression (A) across human osteosarcoma tumors from TARGET database

and (B) in comparison to normal tissues

Figure 3: (A) Tumor Growth Inhibition with ABBV-085 across OS PDX models: ABBV-

085 induced significant inhibition in tumor growth in 6/7 of the osteosarcoma models (except

OS9) as compared to vehicle control and 3/7 models (OS1, 33 and 60) as compared to isotype

MMAE, when given once a week for 4 consecutive weeks. The lighter lines represent individual

mice and the bolder lines represent median tumor growth in each group. Two sets of experiments

were performed for OS33. OS-33-1 included control, ABBV-085-6mg/kg and 12 mg/kg and

isotype MMAE 12mg/kg. OS-33-2 included control, ABBV-085-3mg/kg and 6mg/kg and

isotype MMAE at 6mg/kg. (B) Event-free Survival to ABBV-085 across OS PDX models.

ABBV-085 induced significant improvements in event-free survival (EFS) compared to vehicle

(except OS9 and OS42) and isotype MMAE (except OS9 and OS34) control in 5/7 of the

osteosarcoma models tested.

14

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Figure 1

A.

200 LRRC 15
150
100
50
0

E.

PDX % Positive
Intensity H-score
Model Tumor Cells
OS9 0 0 0
OS33 2 90 180
OS60 3 100 300

15

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Figure 2

A.

B.

16

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Figure 3

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ABBV-085, antibody-drug conjugate targeting LRRC15, is


effective in osteosarcoma: A report by the Pediatric Preclinical
Testing Consortium
Pooja Hingorani, Michael E. Roth, Yifei Wang, et al.

Mol Cancer Ther Published OnlineFirst December 9, 2020.

Updated version Access the most recent version of this article at:
doi:10.1158/1535-7163.MCT-20-0406

Supplementary Access the most recent supplemental material at:


Material http://mct.aacrjournals.org/content/suppl/2020/12/09/1535-7163.MCT-20-0406.DC1

Author Author manuscripts have been peer reviewed and accepted for publication but have not yet been
Manuscript edited.

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