Bispecific antibody-drug conjugates targeting EGFR and LGR5 exert potent antitumor activity in colorectal cancer models

Colorectal cancer (CRC) remains a significant contributor to cancer-associated deaths worldwide, indicating the need for new therapeutic targets and modalities. Antibody-drug conjugates (ADCs) have demonstrated remarkable potential for the treatment of various cancer types, although their efficacy as monotherapies is often limited by insufficient targeting of tumor heterogeneity, dose-limiting toxicities, and drug resistance. Accordingly, multi-targeting therapeutic strategies, such as bispecific ADCs (bsADCs), which simultaneously target two cancer-associated antigens or non-overlapping epitopes on the same antigen, may prove more effective at overcoming resistance and eliminating tumors compared to monospecific ADCs. In this work, we describe the development of EGFR:LGR5 bispecific antibodies (bsAbs) and bsADCs. EGFR:LGR5 bsAbs were shown to internalize to the lysosome to a greater extent than EGFR- and LGR5-targeting monoclonal antibodies (mAbs) and drive EGFR lysosomal degradation in an LGR5-mediated fashion. However, EGFR:LGR5 bsAbs exerted suboptimal cytotoxicity in CRC cell lines. We therefore engineered an EGFR:LGR5 bsADC that demonstrated 100- to 1000-fold enhanced efficacy over a previously developed LGR5-targeting monospecific ADC (8E11-CPT2) with an identical linker-payload in CRC cell lines of various genetic backgrounds and EGFR and LGR5 expression levels. EGFR:LGR5 bsADC potency was strongly correlated with cell line sensitivity to the CPT2 payload. EGFR:LGR5 bsADC induced tumor regression in select RASMUT CRC xenograft models and demonstrated superior antitumor activity and prolonged survival benefit in all evaluated models versus EGFR mAb cetuximab (CTX), bsAb, and 8E11-CPT2. These findings strongly support the further development of EGFR and LGR5 dual-targeting approaches for CRC and other EGFR- and LGR5-expressing malignancies. One Sentence SummaryEGFR:LGR5 bsADCs exert robust antitumor activity and outperform EGFR:LGR5 bsAb and LGR5 monospecific ADC in RASWT and RASMUT colorectal cancer models.