Sotigalimab

As per DelveInsight's estimates, among the 7MM, the US captured the highest market of intra-tumoral cancer therapies of nearly USD 74 million in 2024, which is expected to increase due to the launch of emerging therapies such as CAN-2409, RP1 (vusolimogene oderparepvec), SP-002 (ASN-002), Bizaxofusp (MDNA55), and others. LAS VEGAS, May 19, 2025 /PRNewswire/ -- DelveInsight's Intra-tumoral Cancer Therapies Market report includes a comprehensive understanding of current treatment practices, emerging intra-tumoral cancer therapies, market share of individual therapies, and current and forecasted intra-tumoral cancer therapies market size from 2020 to 2034, segmented into 7MM [the United States, the EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan]. Key Takeaways from the Intra-tumoral Cancer Therapies Market Report Currently, only three Intra-tumoral Cancer Therapies are approved; namely, IMLYGIC (Talimogene laherparepvec/T-VEC; Amgen), approved in the US and Europe in 2015, DELYTACT (teserpaturev/G47Δ; Daiichi Sankyo) approved in Japan in 2021, and HENSIFY in Europe in 2019. As per DelveInsight's analysis, the total market size of intra-tumoral cancer therapies in the 7MM was USD 109 million in 2024 and is projected to grow during the forecast period (2025-2034). In 2024, the total cases of selected indication (based on current landscape and pipeline activity) were 8.9 million in the 7MM, which is anticipated to increase by 2034. Leading intra-tumoral cancer therapies companies, such as Janssen, Stamford Pharmaceuticals, Ascend Biopharmaceuticals, Replimune, Highlight Therapeutics, Cytovation ASA, Intensity Therapeutics, Ascendis Pharma, Treovir, Matica Biotechnology, QBiotics, NanOlogy, Lokon Pharma AB, EpicentRx, Medicenna Therapeutics, Philogen S.p.A., Candel Therapeutics, Lytix Biopharma, Verrica Pharmaceuticals, CEI-SCI, and others, and others, are developing novel intra-tumoral cancer therapies that are expected to enter the intra-tumoral cancer therapies market in the coming years. Some of the key intra-tumoral cancer therapies in the pipeline include INT230-6, Vusolimogene oderparepvec (RP1), Nidlegy (Daromun), G207, Ilixadencel (INTUVAX), Tigilanol tiglate, SP-002 (ASN-002), BO-112, Bizaxofusp (MDNA55), and others. In March 2025, NANOBIOTIX announced topline data from the completed dose-escalation portion of a Phase I study, conducted under the sponsorship of The University of Texas MD Anderson Cancer Center, evaluating JNJ-1900 (NBTXR3) activated by radiation therapy as a second-line or later (2L+) treatment for patients with locally advanced NSCLC eligible for re-irradiation. In March 2025, NANOBIOTIX announced an amendment to its global licensing agreement with Janssen Pharmaceutica NV. The amendment removes NANOBIOTIX's funding obligation for NANORAY- 312 and releases Johnson & Johnson from select future potential milestone payments while safeguarding NANOBIOTIX's path to sustainable cash flow through significant potential milestone payments. In March 2025, Candel Therapeutics and IDEA Pharma announced a strategic commercial partnership. Under this agreement, IDEA will provide strategic commercial input throughout the development and commercialization process for Candel's lead asset, CAN-2409. In January 2025, Lokon Pharma AB announced that the Food and Drug Administration (FDA) had granted Fast Track Designation (FTD) for the company's product candidate LOAd703 for the treatment of pancreatic cancer. In January 2025, Intensity Therapeutics announced that the Data Monitoring Committee (DMC) recommended the continuation of its Phase III sarcoma trial (INT230-6, INVINCIBLE-3) without modification based on data reviewed from July 2024 to December 2024. Some factors, such as the precedence of failure of emerging therapies, insufficient knowledge about Intra-tumoral Cancer Therapies , and several other drawbacks, might hinder the Intra-tumoral Cancer Therapies market growth. Discover which therapies are expected to grab the intra-tumoral cancer therapies market share @ Intra-tumoral Cancer Therapies Market Report Intra-tumoral Cancer Therapies Market Dynamics The intra-tumoral cancer therapies market dynamics are expected to change in the coming years. Various classes of intra-tumoral immunotherapies, including radioenhancer nanoparticles, recombinant fusion proteins, oncolytic therapy, gene therapy, synthetic dsRNA complexes, and others, are currently in preclinical and clinical development. These therapies increase drug concentration and availability within the tumor microenvironment while limiting systemic exposure and reducing the likelihood of immune-related side effects in other parts of the body. Intra-tumoral therapeutic strategies offer a powerful approach to in situ vaccine development, utilizing immune-stimulating agents to trigger local and systemic anti-tumor immune responses. Additionally, the ability of intra-tumoral immunotherapy combinations to elicit both T-cell and B-cell antitumor responses presents a potential strategy to overcome immune escape mechanisms, such as the loss of HLA-I expression on tumor cells, which are often associated with immune checkpoint therapy monoclonal antibody monotherapies. Furthermore, potential therapies are being investigated, and it is safe to predict that the treatment space will significantly impact the intra-tumoral cancer therapies market during the forecast period. Moreover, the anticipated introduction of emerging therapies with improved efficacy and a further improvement in the diagnosis rate are expected to drive the growth of the intra-tumoral cancer therapies market in the 7MM. However, several factors may impede the growth of the intra-tumoral cancer therapies market. The lack of standardized guidelines for intra-tumoral immunotherapy delivery results in variations in lesion selection, injection frequency, and needle technique, which directly affect treatment outcomes and safety. Patients are required to visit clinics for each dosing session, and the administration necessitates both trained radiologists and logistics support alongside skilled physicians. While research into intra-tumoral therapies has grown in recent years, several therapies, such as tilsotolimod/Ipilimumab, sotigalimab (APX005M), and vidutolimod (CMP-001), have failed clinical trials, impacting the market. Additionally, tumors with high intra-tumoral heterogeneity may lead to poorer clinical outcomes for patients. Intra-tumoral Cancer Therapies Therapeutics Market Although significant progress has been made in cancer treatment through methods like surgery, chemotherapy, radiation, immunotherapy, and targeted therapies, many of these treatments still face limitations such as systemic toxicity, inadequate tumor penetration, and poor targeting. These issues contribute to high mortality rates, underscoring the need for more precise and localized treatment options. Recently, cancer treatment strategies have increasingly focused on alternative delivery methods, including intra-tumoral administration. This approach is being actively researched, with several therapeutic candidates—such as immune receptor agonists, viral therapies, fusion proteins, monoclonal antibodies, and gene therapies—currently undergoing preclinical and clinical trials. Intra-tumoral immunotherapy, which involves directly delivering agents into or near the tumor site, is emerging as a promising approach. This strategy aims to boost localized immune responses while reducing systemic side effects. The first oncolytic virus, IMLYGIC (T-Vec; Amgen), was approved by the US FDA for treating unresectable melanoma lesions after surgery, following a Phase III trial. The European Commission approved the treatment of advanced melanoma in 2015. In 2019, Nanobiotix's HENSIFY (NBTXR3), a hafnium oxide nanoparticle therapy combined with radiation, received European approval for soft tissue sarcoma, with plans for data releases through 2025-2026 across multiple cancers. For STS the drug is approved in Europe but not yet launched. In Japan, DELYTACT (G47∆; Daiichi Sankyo) was granted conditional approval for malignant glioma, marking the first oncolytic virus for brain cancer, and is still under evaluation for its clinical benefits. IMLYGIC from Amgen is the first and only FDA-approved viral therapy that is injected directly into melanoma tumors. Despite the initial hype for this exciting intra-tumoral mode of cancer gene therapy, IMLYGIC's debut did not translate into much commercial success in the melanoma market. Limitations of the intra-tumoral administration, no statistically significant benefit in overall survival (OS), and the intense competition from immune checkpoint inhibitors (ICIs) due to their efficacy and manageable side effects are some of the main factors for ithe nsignificant revenues of this novel therapy. Learn more about the FDA-approved intra-tumoral cancer therapies @ Intra-tumoral Cancer Therapies Treatment Key Emerging Intra-tumoral Cancer Therapies and Companies The emerging pipeline of intra-tumoral cancer therapies is robust, including drugs from key players such as Candel Therapeutics (CAN-2409), Lytix Biopharma/Verrica Pharmaceuticals (LTX-315 [VP-315]), CEI-SCI (MULTIKINE), Philogen (Daromun [NIDLEGY; a combo of L19IL2 + L19TNF]), Replimune (RP2 and RP1 [vusolimogene oderparepvec]), Highlight Therapeutics (BO-112), Cytovation ASA (CY-101), Intensity Therapeutics (INT230-6), Ascendis Pharma (TransCon IL-2 β⁄γ), Treovir/Matica Biotechnology (G207), QBiotics (Tigilanol tiglate), NanOlogy (NanoPac), EpicentRx (AdAPT-001), Medicenna Therapeutics (Bizaxofusp [MDNA55]), and others. RP1 (vusolimogene oderparepvec), Replimune's lead product candidate, is based on a proprietary strain of Herpes Simplex Virus (HSV) engineered with a fusogenic protein (GALV-GP R-) and GM-CSF to enhance tumor killing potency, immunogenicity, and activation of a systemic antitumor immune response. In November 2024, Replimune announced that the FDA granted Breakthrough Therapy Designation (BTD) to RP1 in combination with nivolumab for the treatment of advanced melanoma in adult patients who have previously received an anti-PD1 regimen. Nidlegy is a biopharmaceutical product, proprietary to Philogen, designed for the treatment of skin cancer. It consists of two active ingredients, L19IL2 and L19TNF, which are manufactured independently and which are mixed prior to intralesional administration. In July 2024, Philogen and Sun Pharmaceutical announced that the European Medicines Agency (EMA) validated the submission of the Marketing Authorization Application (MAA) for Nidlegy. CAN-2409 (Candel Therapeutics) is an investigational, off-the-shelf, replication-defective adenovirus designed to deliver the HSV thymidine kinase (HSV-tk) gene to a patient's specific tumor and induce an individualized, systemic immune response against the tumor. In March 2025, according to the company's corporate highlights, the preparations for Biologics License Application (BLA) for CAN-2409 in prostate cancer are underway, with submission expected in Q4 2026. The anticipated launch of these emerging therapies are poised to transform the intra-tumoral cancer therapies market landscape in the coming years. As these cutting-edge therapies continue to mature and gain regulatory approval, they are expected to reshape the intra-tumoral cancer therapies market landscape, offering new standards of care and unlocking opportunities for medical innovation and economic growth. To know more about intra-tumoral cancer therapies clinical trials, visit @ Intra-tumoral Cancer Therapies Intra-tumoral Cancer Therapies Overview Cancer is a highly diverse disease, with its signs, symptoms, and treatments varying across different types, making it crucial to create targeted therapies for individual patients. Current treatment options for cancer include immunotherapy, radiotherapy, chemotherapy, targeted drug therapies, and more. While these approaches have improved OS and patient outcomes, they still have limitations and are not effective for everyone. Researchers are therefore working to develop new treatments that can overcome these challenges, with intra-tumoral cancer therapies emerging as a promising strategy. Intra-tumoral immunotherapy represents an innovative approach, where sophisticated antibodies are directly injected into tumors instead of being administered intravenously. This method focuses on delivering immunostimulatory agents straight into primary or metastatic tumor sites to initiate or enhance an antitumor immune response. Normally, the immune system detects and eliminates early tumors, but in immunosuppressive tumor environments, malignant cells can proliferate undetected. Regulatory T cells (Tregs), drawn to the tumor by chemokines, suppress Antigen-Presenting Cells (APCs) that would otherwise trigger an immune attack on tumor antigens. Moreover, tumor cells often release anti-inflammatory and regulatory cytokines like TGF-β and IL-10, which promote tumor growth and inhibit dendritic cell (DC) activation. To counteract this immunosuppressive environment, immunostimulants can be introduced. These agents work by attracting immune cells to the tumor or by activating the immune system to recognize and destroy cancer cells. Immunostimulants activate immune cells in the presence of tumor antigens, allowing them to travel to lymph nodes, where they stimulate tumor antigen-specific T cells through cross-presentation. These activated T cells can then return to the tumor or spread to distant tumors, leading to the targeted destruction of cancer cells. Intra-tumoral Cancer Therapies Epidemiology Segmentation In 2024, the total indication-wise treated cases of Intra-tumoral Cancer Therapies were 3.3 million in the 7MM, which is anticipated to increase by 2034. The intra-tumoral cancer therapies market report proffers epidemiological analysis for the study period 2020–2034 in the 7MM segmented into: Total Cases of Selected Indications Indication-wise Target Patient Pool of Intra-tumoral Cancer Therapies Indication-wise Treated Cases of Intra-tumoral Cancer Therapies Scope of the Intra-tumoral Cancer Therapies Market Report Intra-tumoral Cancer Therapies Therapeutic Assessment: Intra-tumoral current marketed and emerging therapies Intra-tumoral Cancer Therapies Market Dynamics: Conjoint Analysis of Emerging Intra-tumoral Cancer Therapies Competitive Intelligence Analysis: SWOT analysis and Market entry strategies Unmet Needs, KOL's views, Analyst's views, Intra-tumoral Cancer Therapies Market Access and Reimbursement Discover more about intra-tumoral cancer therapies in development @ Intra-tumoral Cancer Therapies Clinical Trials Table of Contents Related Reports Oncolytic Virus Market Oncolytic Virus Market Size, Target Population, Competitive Landscape & Market Forecast – 2034 report deliver an in-depth understanding of oncolytic virus, historical and forecasted epidemiology, as well as the market trends, market drivers, market barriers, and key oncolytic virus companies, including Targovax, Genelux, Imugene, EpicentRx, Replimune, Genelux Corporation, Candel Therapeutics, DNAtrix, SillaJen, Treovir, Lokon Pharma AB, Istari Oncology, CG Oncology, Amgen, Daiichio Sankyo, among others. 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Prostate Cancer Market Prostate Cancer Market Insights, Epidemiology, and Market Forecast – 2034 report deliver an in-depth understanding of the disease, historical and forecasted epidemiology, market share of the individual therapies, and key prostate cancer companies including Janssen Research and Development, Sanofi, AstraZeneca, Merck, Pfizer, Astellas Pharma, Bayer, Novartis, Curium, Merck, Orion, Janssen Pharmaceutical, Pfizer, Exelixis, Ipsen Pharma, Takeda, AB Science, Lantheus, Eli Lilly, POINT Biopharma, Telix Pharmaceuticals, Tavanta Therapeutics, Jiangsu Hengrui Pharmaceuticals, Kangpu Biopharmaceuticals, Fusion Pharma, Merus, Bristol-Myers Squibb, Syntrix Pharmaceuticals, Promontory Therapeutics, Xencor, Taiho Pharmaceutical, Madison Vaccines, MacroGenics, Zenith Epigenetics, Modra Pharmaceuticals, Arvinas, Laekna Therapeutics, Blue Earth Therapeutics, Oncternal Therapeutics, Essa Pharma, Clarity Pharmaceuticals, BioNTech, DualityBio, Daiichi Sankyo, Fortis Therapeutics, ORIC Pharmaceuticals, Amgen , among others. 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-01-引言目前，肿瘤免疫治疗已成为第三代肿瘤治疗中最活跃的研究领域。以PD-1、CTLA-4和PD-L1为靶点的免疫检查点抑制（ICI）疗法在多种癌症的治疗中显示出卓越的效果，并且ICI的免疫疗法随着新的免疫检查点的开发（如TIM-3、LAG-3和TIGIT）而继续扩大。然而，ICI治疗的主要目的是维持先前已建立的抗肿瘤活性。相比之下，刺激性免疫治疗靶点，如CD40、ICOS、CD27、GITR、OX40和4-1BB则用激动剂来激活免疫，主要集中在免疫反应的早期阶段。这些分子最先起作用的很可能是CD40，因为它在抗原呈递过程中起着关键作用，间接地激活T细胞。最新研究显示，CD40激动剂不仅可直接激活树突状细胞（DC）、B细胞等免疫“指挥官”，还能重塑肿瘤微环境（TME），甚至让“冷肿瘤”变得对免疫治疗敏感。CD40激动剂在癌症免疫治疗中正展现出巨大的潜力。-02-一、CD40/CD40L的表达为了获得强大而特异的免疫反应，固有免疫系统和适应性免疫系统需要在多个环节上进行协调。免疫反应的许多关键阶段是由肿瘤坏死因子超家族（TNFSF）的配体及其受体介导的，包括CD40/CD40L。抗原特异性T细胞的有效抗原识别关键取决于特异性抗原呈递细胞（APC）的存在和功能，如B细胞和DC细胞。这些APC通常在细胞表面表达共刺激表面受体CD40（TNFRSF5）。CD40是一种48kda大小的Ⅰ型跨膜蛋白，是连接固有免疫和适应性免疫的重要免疫细胞通讯介质。CD40存在于血小板、B细胞和髓系细胞，但也存在于非造血细胞，如内皮细胞、成纤维细胞、平滑肌细胞甚至某些类型的肿瘤细胞。CD40的同源配体是CD154（TNFSF5/CD40L），一种39kda的II型跨膜蛋白。CD40L的表达通常可诱导并局限于造血系统的细胞，如血小板、粒细胞、活化T细胞、活化B细胞和活化自然杀伤细胞（NK）细胞，但内皮细胞和平滑肌细胞也有弱表达。-03- 二、CD40/CD40L的结构、组成及信号通路TNFRSF信号传导的结构已经比较明确，需要恰当的三维受体聚集和三聚体化。虽然TNFSF配体天然以三价功能单位存在，但受体通常分散分布在细胞表面。TNFSF配体以同源三聚体的形式自然地聚集在细胞表面，其中三个受体结合位点位于相邻单体之间的三个完全相同的缝隙处。关键的是，受体组装成功能性的三聚体复合物是通过天然配体单元的结合发生的。这些三聚体TNFSF配体与在其他细胞表面表达的相应受体的相互作用导致了非常精确的受体聚集。配体对细胞外受体的指令传递给邻近的受体细胞内结构域，然后是细胞内信号复合物的有序组装。TNFSF配体的三聚体结构和由此产生的受体簇是信号传递到细胞的前提。由于这种特殊的要求，一价和二价的结构在体内通常被证明是极低效的。与TNFRSF的其他成员一样，CD40是一种膜结合分子，可以通过细胞间直接接触被膜结合配体激活，也可以被溶液中的可溶性配体激活。多种下游分子和细胞反应进程已被证明受到CD40结合的调节。同源配体连接受体可诱导形成空间上明确的三聚体信号复合物，促进TNF受体相关因子（TRAFs）和NFκB激活剂-1（Act1）的招募。信号复合物的特定组成，主要取决于细胞类型，触发各种途径。例如，与TRAF6的结合主要激活JAK/Stat3通路，TRAF1/2诱导MKK/p38/ERK1/2信号传导，Act1在NFkB通路、JNK和PI3K信号传导中具有多种功能，并与TRAF3一起放大MKK/p38/ERK1/2信号。此外，根据特定的环境，CD40结合可以激活“经典”和非典型的NFkB通路。-04-三、CD40/CD40L的生物学作用CD40在单核细胞及其子代巨噬细胞和DC细胞以及B细胞上的表达在发挥免疫细胞的功能中起着重要作用。单核细胞是固有免疫前体细胞，具有很高的可塑性。它们具有分化为多种细胞类型的能力，如巨噬细胞、髓源性抑制细胞（MDSC）和DC细胞。CD40信号是单核细胞成熟过程的重要触发因素，主要驱动分化为M1谱系的巨噬细胞和DC细胞。CD40与DC细胞表面的结合促进了细胞因子和趋化因子的产生，诱导共刺激分子的表达，并促进抗原的交叉呈递。CD40L的主要功能之一是通过激活DC细胞来增强抗原对T细胞的提呈。这一步称为“许可”，通过上调表面蛋白如CD54和CD86，增加DC与T细胞的相互作用，从而激活后者。B细胞也是CD40L活性的靶点。在胸腺中，T细胞和B细胞之间广泛的串扰使之必须维持表达CD40的B细胞，从而保持自体反应性T细胞对B细胞的阴性选择。B细胞与CD4+T细胞的直接相互作用诱导T细胞表达CD40L，进而保护B细胞不受凋亡的影响。在这个功能中，CD40L通过激活PI3K/Akt提供一个生存信号，使活化的B细胞维持寿命并向浆细胞分化。抗原特异性B细胞通过CD40的稳态增殖和生存机制是通过抗凋亡成员Bcl-2家族的上调来维持的。事实上，CD40/CD40L系统的缺陷与B细胞的抗体类别转换以及细胞超突变的缺陷（hyper-IgM综合征）有关。B细胞与活化的表达CD40L的T细胞的相互作用也增加了MHC-II和CD80或CD86等共刺激分子的表达，并诱导B细胞中的Ig类别转换。活化的B细胞迁移到淋巴器官，在那里向T细胞呈递抗原，CD40激活的DC和B细胞通过释放免疫刺激性细胞因子和趋化因子如IL-6、IL-12p70、IFNγ、CXCL10和TNFα来支持免疫应答。此外，CD40活化的B细胞能够通过促进TNFα和IFNγ等细胞因子的分泌来诱导抗原特异性CD8+T细胞。一些研究证明，体外活化的表达CD40的B细胞是完全功能性抗原提呈的B细胞，随后用这些细胞进行过继细胞转移（ACT）治疗可提高抗肿瘤的疗效。-05-四、CD40/CD40L与肿瘤免疫数十年来，CD40/CD40L信号传导同步免疫反应的固有、细胞和体液分支的非凡能力激发了基础和临床研究的灵感。鉴于CD40的一般表达谱和生物学活性，人们已经做了许多尝试来探索CD40/CD40L信号在抗肿瘤免疫中的作用。CD40激活的DC细胞可用于癌症和传染性疾病（如结核病）的疫苗治疗。CD40信号的另一个有趣结果是表型从“另类活化”的M2型向抗肿瘤或“经典活化”的M1型的转变。这种M1/M2型的命名与肿瘤相关巨噬细胞（TAM）在肿瘤免疫治疗中特别相关。所谓的M1型的“经典活化”巨噬细胞产生于对GM-CSF以及IFNγ和LPS等刺激物的反应，通常被认为具有促炎性免疫反应和抗原交叉呈递的作用。M1型巨噬细胞主要与良好的抗肿瘤免疫反应相关。“另类活化”的M2型巨噬细胞是由于暴露于M-CSF和细胞因子（如IL-4和IL-10）而产生的，并参与组织修复和消除炎症状态。肿瘤相关的M2型被认为是癌症进展和转移的关键驱动因素。肿瘤和浸润性巨噬细胞的紧密相互作用强烈地塑造了肿瘤微环境，从而建立了炎症或促肿瘤的局部条件。有人提出，改善肿瘤内M2/M1谱系的平衡可以通过促进细胞毒性T细胞的浸润和激活来提高抗肿瘤免疫反应。这一点已经在多个模型中进行了描述，例如胰腺癌和小鼠异种移植胶质母细胞瘤模型。巨噬细胞复极化与CD40活化诱导CD206下调和CD54表达增加一致，表明巨噬细胞迁移能力的改变和有效激活。有趣的是，尽管CD40在许多组织中广泛表达，肿瘤细胞似乎更易受膜结合CD40L诱导的CD40杀伤。在B16黑色素瘤小鼠模型中，DC细胞上表达的膜结合CD40L可直接诱导CD40阳性肿瘤细胞凋亡，而非T细胞依赖的的细胞生长抑制活性则源于CD40刺激的IFNγ激活的巨噬细胞。这一现象的部分原因可能不是CD40信号的直接作用，而是对易感细胞类型死亡受体的二次上调。然而，抗CD40抗体Lucatumumab和dacetuzumab对B细胞恶性肿瘤有一定的临床效果，这可能归因于抗体介导的巨噬细胞吞噬和抗体依赖性细胞毒性（ADCC）的作用。结合CD40后，肿瘤细胞显示出DNA损伤的迹象，分泌促血管生成因子，如VEGF和IL-8，并且通常表现出衰老相关分泌表型（SASP）的状态，这是由于CD40诱导的NFκB通路的激活。-06-五、CD40激动剂的药物开发现状基于其独特的受体聚集模式，从TNFRSF产生的下游信号依赖于具有非常精确的结构和三维组成的激动剂化合物。由于CD40在抗肿瘤免疫反应中发挥关键作用，诱导CD40信号的各种策略已经被广泛地研究探索。大致可分为基于激动剂抗体的方法或基于CD40L的方法。目前，临床开发中有9种激动性人抗CD40抗体：4种IgG1抗体（APX005M、mitazalimab、2141-V11、SEA-CD40），2种IgG2抗体（selicrelumab和CDX-1140），1种IgG突变抗体（LVGN7409）和2种双特异性抗体（RO7300490、ABBV-428）。SelicrelumabSelicrelumab（也称为CP-870893，RO7009789）是一种完全人IgG2抗体，不依赖于通过Fc结构域交联来激活CD40。selicrelumab是临床试验中研究最广泛的CD40激动剂。最近，一项1期研究评估了selicrelumab在胰腺导管腺癌（PDAC）患者手术前使用或不使用化疗（nab-紫杉醇和吉西他滨）的新辅助治疗（NCT02588443）。接受selicrelumab单药治疗的患者的1年OS率（中位数+SE）分别为81.8%+11.8%，接受selicreumab联合化疗的患者为100%。Selicrelumab耐受性良好，相关不良事件（AE）大多较轻。此外，发现了selicrelumab诱导TME调节的证据，包括T细胞浸润、DC成熟、巨噬细胞复极化和肿瘤基质密度降低。CDX-1140CDX-140是一种人IgG2单克隆抗体，可驱动NF-kB激活。它结合CD40L结合位点之外的结构域，其激活机制独立于FcR交联。来自评估CDX-1140与抗PD-1治疗（pembrolizumab）联合使用或不使用的I期试验的数据显示，1.5 mg/kg CDX-1140联合200 mg pembrolizumab的剂量具有良好的安全性。观察到临床益处，尤其是在非小细胞肺癌（NSCLC）患者中，有80%的可评估患者具有稳定疾病（SD），而所有患者在之前的基于抗PD-1/L1的治疗中都经历了进展性疾病（PD）（NCT03329950）。APX005MAPX005M是一种人源化IgG1单克隆CD40抗体。通过Fc结构域中的点突变，APX005M增强了与FcγRIIb的结合亲和力，促进了CD40的交联并介导了ADCC。多个早期临床试验评估了APX005M与免疫疗法的联合应用。一项II期研究评估了APX005M与化疗（nab-paclitaxel和吉西他滨）联合使用或不使用抗PD-1（nivolumab）治疗转移性胰腺癌患者的疗效。研究表明，APX005并没有显著改善OS：在105名患者中，nivo/化疗达到了1年总生存期（OS）的主要终点，但APX005M/化疗或APX005M/Cnivo/化学均未达到。然而，APX005M/化疗后的存活率与更显著的肿瘤内CD4+T细胞浸润、循环分化的CD4+T细胞和APCs相关（NCT03214250）。最近，在随后的一项II期研究中，研究了APX005M与纳武单抗联合治疗抗PD-1疾病进展后的转移性黑色素瘤患者。客观反应率（ORR）为15%，中位反应持续时间至少为26个月。MitazalimabMitazalimab（也称为ADC-1013和JNJ-64457107）是一种靶向CD40的人IgG1单克隆抗体。它被设计为以FcγR依赖的方式与CD40结合，具有高效力和亲和力，这有利于肿瘤内给药，以减少剂量和不良免疫相关事件。在一项针对晚期实体瘤患者的I期研究中，静脉注射0.075-2mg/kg的Mitazalimab显示出可控的安全性。 2141-V112141-V11是一种完全人IgG1 CD40抗体，是selicrelumab的Fc优化版本，其中人IgG1 Fc经过5位点突变改造，可增强Fc与FcγRIIB的结合。一项I期研究评估了2141-V11在皮肤转移的实体瘤患者中的作用，在局部和远处病变中显示出抗肿瘤活性的迹象（NCT04059588）。另一项I期研究调查了2141-V11单药治疗对标准治疗无效的非肌肉浸润性癌症（NMIBC）患者的安全性和剂量（NCT05126472）。局部膀胱内给药用于减轻全身毒性。此外，在复发性胶质母细胞瘤患者的I期研究中，通过增强递送（CED）将2141-V11与免疫毒素（D2C7-IT）联合用于肿瘤内给药是安全且有一定疗效的：在入组的5名患者中，一名0.70 mg剂量的患者和两名2.0 mg剂量的患者观察到肿瘤响应的早期迹象。SEA-CD40SEA-CD40是一种全人源的非岩藻糖基化IgG1单克隆CD40抗体。非岩藻糖基化抗体增强了与FcγRIIIa受体的结合，可能提高了激动疗效。一项首次人体I期试验评估了晚期实体瘤和淋巴瘤患者的静脉注射SEA-CD40单一疗法。然而，SEA-CD40的抗肿瘤作用很小，在基底细胞癌患者中有1.8%（1/56）的部分反应，在滤泡性淋巴瘤患者中有1.8%（1/56）的完全反应。另一项研究检查了SEA-CD40联合化疗（nab紫杉醇和吉西他滨）和pembrolizumab治疗转移性PDAC患者的疗效。在10μg/kg和30μg/kg的剂量组中，分别有48%和38%的患者观察到了客观响应。两个剂量组的中位反应持续时间均为5.7个月（NCT02376699）。LVGN7409LVGN7409是一种IgG突变重组单克隆CD40抗体，具有工程Fc片段，可选择性结合FcγRIIB。LVGN7409以FcγRIIB交联依赖的方式激活CD40，因此在富含CD40和FcγRIIB的TME中发挥最佳作用。目前，有两项LVGN7409的I期研究。LVGN7409的第一项人体I期研究是在有或没有抗PD-1抗体（LVGN3616）和/或CD137激动剂抗体（LVGD6051）的情况下评估LVGN7407。静脉注射LVGN7409单药治疗在2 mg/kg以下具有良好的耐受性（NCT04635995）。RO7300490RO7300490是一种针对CD40和成纤维细胞激活蛋白（FAP）的新型双特异性抗体，后者在肿瘤组织中经常过表达，在健康组织中表达较低。因此，RO7300490能够直接重塑TME，同时可能避免与全身CD40激活相关的毒性。目前，一项I期研究正在评估RO7300490在晚期实体瘤患者中使用或不使用atezolizumab的疗效（NCT04857138）。ABBV-428ABBV-428是另一种双特异性抗体，旨在通过与肿瘤抗原间皮素相互作用实现CD40的局部激活。第一项人体I期研究评估了ABBV-428在晚期实体瘤患者中使用或不使用纳武单抗的情况（NCT02955251）。根据接受ABBV-428单药治疗的患者的中期数据，36%的患者在推荐的II期剂量（3.6 mg/kg）下的最佳临床反应为SD。未观察到CD40激动剂的毒性。然而，ABBV-428产生的临床活性很小，这可以用肿瘤细胞上间皮素的低表达来解释，这将限制肿瘤的可及性和ABBV-428对CD40的交联。-07-结语增强抗肿瘤免疫应答的策略是肿瘤学最有希望的新进展之一，而TNFRSF成员，如CD40，是其中重要的靶点。由于产生高效TNF-R-SF信号的独特要求，激动剂分子必须产生非常精确的受体结构和三维结构。虽然已经探索了诱导CD40信号的各种策略，但是20年来有限的临床成功表明需要探索新的方法，这种信号通路激动剂的真正威力尚未在临床开发中充分释放出来。目前CD40激动剂临床疗效有限的原因归咎于抗体的结构和功能特性，包括每个分子只有两个靶结合位点，不适合刺激TNFRSF。由于这一信号通路具有广泛的靶向性，因此也可与其他药物和疗法联合应用。相信不久的将来会产生更多令人鼓舞的临床数据，提高治疗效果，并拓宽更多癌症患者的治疗选择。参考资料：1.Concepts for agonistic targeting of CD40 in immuno-oncology. Hum Vaccin Immunother. 2020;16(2):377-387.2. Harnessing the Potential of CD40 Agonism in Cancer Therapy. Cytokine Growth Factor Rev. 2023 Dec 4;75:40–56公众号内回复“ADC”或扫描下方图片中的二维码免费下载《抗体偶联药物：从基础到临床》的PDF格式电子书！公众号已建立“小药说药专业交流群”微信行业交流群以及读者交流群，扫描下方小编二维码加入，入行业群请主动告知姓名、工作单位和职务。