Immune cell engagers (ICE) such as bispecific antibodies (bsAbs), within an immunological synapse, bind and link CD3 on a T cell to a target antigen (TAA) on a cancer cell, forming a trimer (CD3:bsAb:TAA complex). With sufficient trimer numbers within the synapse, the T cell can become activated and promote cancer cell killing. Elranatamab, a CD3-bispecific antibody for multiple myeloma, has received FDA and EMA filing acceptance (August 2023 and December 2023, respectively) adding to a growing list of bsAbs that are treating patients. In the drug development stages of ICE bsAbs, mechanistic modeling approaches are often used to attain a greater quantitative understanding of the modality, preclinically, and provide human pharmacokinetic and efficacious dose predictions to aide in Phase 1 trial design. To date, the majority of ordinary differential equation (ODE) trimer models treat the tumor compartment as well-mixed and trimer formation is governed by a bulk population reaction not accounting for individual synapses. This lack of discrimination can lead to imprecise analysis when analyzing results across E:T ratios using metrics like trimers per T cell or trimers per target cell. To this end we developed an ODE trimer model based on single-synapse complexes (one target cell/one immune cell) with 2D cross-linking trimer formation. We show computationally that the number of trimers per synapse is invariant to the value of the E:T ratio for a given free bsAb concentration, a property that cannot be captured by non-synapse models. A simple demonstration of this discrepancy using the well-known Betts trimer model is presented. We then apply the Betts trimer model coupled to a tumor growth inhibition (TGI) module to show that our synapse-based trimer model is easy to substitute in to model TGI, including the addition of a trimer-per-synapse activation threshold function for cell killing. Overall, our model attempts to balance mechanistic fidelity while limiting the complexity of the model.
Chevalier, M., Zhang, Z., Tolsma, J., Zager, M.
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