Phase Ia/Ib trial of Anti-GD2 chimeric monoclonal antibody 14.18 (ch l4.18) and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in metastatic melanoma

We performed a phase Ia/Ib trial of chimeric anti-GD2 monoclonal antibody 14.18 (chl4.18) in combination with recombinant human granulocytemacrophage colony-stimulating factor (rhGM-CSF) to determine the maximum tolerated dose as well as immunologic and biologic responses to the regimen. Sixteen patients with metastatic malignant melanoma received escalating doses of ch 14.18 (15-60 mg/m²) administered intravenously for 4 h on day 1. Twentyfour hours later, subcutaneous injections of rhGM-CSF were administered daily for a total of 14 days. Significant side effects were related to chl4.18 infusion and consisted of moderate to severe abdominal and/or extremity pain, blood pressure changes, headache, nausea, diarrhea, peripheral nerve dysesthesias, myalgias, and weakness. Dose-limiting toxicity was observed at 60 mg/m² and consisted of severe hypertension, hypotension, and atrial fibrillation in one patient each, respectively. Significant increases in white blood cell count, granulocyte count, eosinophil count, and monocyte count occurred after rhGM-CSF treatment. Significant enhancement of in vitro and in vivo monocyte and neutrophil tumoricidal activity and antibody-dependent cellular cytotoxicity along with significant elevations in C-reactive protein and neopterin were observed. Despite these immunological and biological changes, no antitumor activity was seen. In short, the combination of chl4.18 and rhGMCSF resulted in toxicity similar to that observed with chl4.18 alone without improvement in tumor response.