Disclosures: All authors are employees of AbbVie. The design, study conduct, and financial support for this research were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication.

Ovarian cancer describes a group of malignancies that remain a serious threat to women's health and claim more than 14,000 deaths in the US each year. Among these, high-grade serous ovarian cancers (HGSC) represent the most common and aggressive form, and tumor recurrence is near-universal following initial response to carboplatin and paclitaxel. While multiple treatment options are available for platinum-sensitive recurrent HGSC, such as continued use of carboplatin/paclitaxel with or without bevacizumab, as well as several FDA-approved PARP inhibitors, there are few effective treatment options for platinum-resistant HGSC. Its inherent heterogeneity, characterized by genomic instability and numerous DNA copy number aberrations, poses challenges to the discovery of novel therapeutic targets.

Patient-derived xenograft (PDX) models are an important platform for target identification and efficacy testing of therapeutic agents, as they sustain the intratumoral heterogeneity observed in advanced human tumors more faithfully than established cell lines. The isolation of distinct tumor cell populations by flow cytometry and subsequent testing of their tumorigenic potential can identify tumor-initiating cells (TICs), which have the potential to propagate the tumor over multiple generations in immune-deficient NOD/SCID mice. Thorough characterization of these TIC populations by transcriptome profiling and flow cytometry has identified TIC-enriched cell surface proteins that are targetable by antibody drug conjugates (ADCs), including EFNA4 in mixed Müllerian and ovarian cancers and PTK7 in triple-negative breast and ovarian cancers. ADCs consist of a monoclonal antibody directed against a cell surface epitope linked to a cytotoxic agent, such as auristatin, maytansinoid, or pyrrolobenzodiazepine (PBD).

Here, we describe the generation and characterization of a PDX bank for ovarian cancers that led to the identification of dipeptidase 3 (DPEP3) as a TIC-associated target in HGSC. We show that DPEP3 is enriched in the TIC fraction of platinum-sensitive and platinum-resistant HGSC PDX models, where it localizes to the plasma membrane and is detected by flow cytometry and immunohistochemistry (IHC). In contrast, DPEP3 expression is low or absent in most normal adult tissues, thus providing a therapeutic window for an antibody-based therapeutic agent. In order to target DPEP3-expressing ovarian cancer cells, we developed SC-003, an ADC consisting of a humanized monoclonal antibody linked to a PBD dimer via a cleavable linker. We show that SC-003 specifically binds to DPEP3-expressing cells and, upon internalization, elicits cytotoxicity via release of its PBD warhead following lysosomal degradation of the antibody component. A single dose of SC-003 induced tumor regression in DPEP3-positive HGSC PDX models, including platinum-resistant PDX models. Mechanistically, we show that the anti-tumor effect of SC-003 is mediated by a significant reduction in TIC frequency. Moreover, combination with an anti-PD1 antibody potentiated SC-003 efficacy in a syngeneic mouse model engineered to overexpress human DPEP3. In summary, these findings support the clinical development of SC-003 as a novel therapeutic agent for HGSC.

Citation Format: Wolf R. Wiedemeyer, Sheila Bheddah, Christine Saechao, Dorothy French, Erik Huntzicker, Aaron Kempema, Julia Gavrilyuk, David Liu, Vikram Sisodiya, Alina He, Zhaomei Zhang, Monette A. Aujay, Kristyn Hayashi, Sandro Vivona, Xi Zhao, Kimberly Walter, Laura R. Saunders, Johannes Hampl, Shravanthi Madhavan, Marybeth Pysz, Alexander J. Bankovich, Holger Karsunky, Scott J. Dylla. SC-003, AN ANTIBODY-DRUG CONJUGATE TARGETING DIPEPTIDASE 3, EXHIBITS POTENT ANTI-TUMOR ACTIVITY IN PATIENT-DERIVED XENOGRAFT MODELS OF HIGH GRADE SEROUS OVARIAN CANCER [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-113.