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Kadcyla: genotox, carcinogenicity and repro: done or skipped?

ado-trastuzumab emtansine · HER2
Genotoxicity
Conducted on DM1: Ames negative; rat micronucleus positive (aneugenic/clastogenic); monkey micronucleus inconclusive
“DM1 was positive in an in vivo rat bone marrow micronucleus assay at exposures similar to the mean maximum concentrations of DM1 in patients in clinical trials, which is consistent with its mechanism of action.”
✓ VerifiedFDA pharmacology/toxicology review, p. 6Source ↗
Carcinogenicity
Not conducted (not required, advanced cancer)
“8 Carcinogenicity Not required and not submitted.”
✓ VerifiedFDA pharmacology/toxicology review, p. 132Source ↗
Reproductive & developmental
Not conducted (ICH S9; relied on trastuzumab data and DM1 mechanism); fertility effects from general tox
“Based on these findings and consistent with ICH S9, embryo-fetal developmental toxicity studies were not required for the indicated patient population.”
✓ VerifiedFDA pharmacology/toxicology review, p. 6Source ↗
Safety pharmacology
Dedicated single-dose CV/respiratory telemetry study in female cynomolgus plus in vitro hERG with DM1
“Free DM1 does not inhibit the cardiac slow rectifier current at physiologically relevant concentrations. Trastuzumab emtansine does not cause changes in the monkey ECG but it does cause some elevation in blood pressures.”
✓ VerifiedFDA pharmacology/toxicology review, p. 15Source ↗

Same question, other ADCs

Adcetris

brentuximab vedotin · CD30
Conducted on MMAE: Ames and mouse lymphoma negative; rat micronucleus positive (aneugenic)

Besponsa

inotuzumab ozogamicin · CD22
Conducted: calicheamicin positive in Ames and in vitro micronucleus; ADC clastogenic in mouse micronucleus

Datroway

datopotamab deruxtecan · Trop-2
Not conducted with ADC; DXd Ames negative, clastogenic in vitro chromosome aberration and in vivo rat micronucleus

Decnupaz

pivekimab sunirine · CD123
Not conducted with ADC (ICH S9); FGN849 positive in Ames TA102, in vitro and in vivo micronucleus

Elahere

mirvetuximab soravtansine · FRα
Not conducted with ADC; DM4 and S-methyl-DM4 Ames negative, rat bone marrow micronucleus positive

Emrelis

telisotuzumab vedotin · c-Met
Not conducted with ADC; MMAE aneugenic (positive rat micronucleus), Ames and mouse lymphoma negative

Enhertu

fam-trastuzumab deruxtecan · HER2
Not conducted with ADC; DXd clastogenic (rat micronucleus, CHL chromosome aberration), Ames negative

Mylotarg

gemtuzumab ozogamicin · CD33
Conducted: ADC clastogenic in mouse micronucleus; free calicheamicin DMH mutagenic and clastogenic in vitro

Padcev

enfortumab vedotin · Nectin-4
Not conducted with ADC; MMAE Ames and mouse lymphoma negative, rat micronucleus positive (aneugenic)

Polivy

polatuzumab vedotin · CD79b
Not conducted with ADC; MMAE Ames and mouse lymphoma negative, rat micronucleus positive (aneugenic)

Tivdak

tisotumab vedotin · Tissue factor
Not conducted with ADC; MMAE: Ames and mouse lymphoma negative, rat micronucleus positive (aneugenic)

Trodelvy

sacituzumab govitecan · Trop-2
Not conducted with ADC; SN-38 Ames negative, in vitro micronucleus positive (clastogenic)

Zynlonta

loncastuximab tesirine · CD19
Not conducted with ADC; SG3199 clastogenic in vitro (micronucleus, chromosome aberration); Ames not assessable (cytotoxicity)

Summary across all 14 ADCs →