Antitumor Efficacy of the Anti-Interleukin-6 (IL-6) Antibody Siltuximab in Mouse Xenograft Models of Lung Cancer Lanxi Song, MS, Matthew A. Smith, PhD,

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Antitumor Efficacy of the Anti-Interleukin-6 (IL-6) Antibody Siltuximab in Mouse Xenograft Models of Lung Cancer Lanxi Song, MS, Matthew A. Smith, PhD, Parul Doshi, PhD, Kate Sasser, PhD, William Fulp, MS, Soner Altiok, MD, Eric B. Haura, MD Journal of Thoracic Oncology Volume 9, Issue 7, Pages 974-982 (July 2014) DOI: 10.1097/JTO.0000000000000193 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Interleukin-6 (IL-6) and STAT3 activation patterns in non–small-cell lung cancer (NSCLC) specimens. A, histogram indicating distribution of IL-6, PY-STAT3, and PS-STAT3 levels in frozen NSCLC specimens from 100 patients by Luminex multiplex assay. (B) Bar graph indicating differences in IL-6 levels in adenocarcinoma and squamous cell carcinoma tissue based on tumor histology. IL-6 levels (pg/mg) were calculated by standardized regression linear curve and normalized with the protein extracts from tissue (mg). p values indicate comparisons versus controls: *p less than 0.05, **p less than 0.01, and ***p less than 0.005. (C) Bar graph indicating differences in PS-STAT3 wild-type and KRAS tumor through polymerase chain reaction sequencing results. p values indicate comparisons versus controls: *p less than 0.05, **p less than 0.01, and ***p less than 0.005. (D) Immunohistochemistry for IL-6 in two high expressing cells. Top: stromal cell (S) expressing IL-6 (arrow); bottom: tumor cells (T) expressing IL-6 (arrow). Journal of Thoracic Oncology 2014 9, 974-982DOI: (10.1097/JTO.0000000000000193) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Patterns of in vitro interleukin-6 and STAT3 activation in lung cancer cells. H322, H157, and H1650 cells were cultured in 10 ml of RPMI 1640 with 10% fetal bovine serum (FBS), and cancer-associated fibroblasts (CAF) was cultured in 10 ml of DMEM with 10% FBS for 48 hours in 10 cm dishes. Protein and culture medium were collected for Luminex or immunoblot assay. A, Luminex results show the endogenous levels of PY-STAT3 and PS-STAT3. (B) Luminex results indicate interleukin-6 (IL-6) levels from cell culture medium that normalized by cell numbers. (C) CellTiter-GLO assay results performed after 72 hours after incubation with siltuximab or phosphate-buffered saline as vehicle control. (D) Immunoblot results indicate PY-STAT3 levels change through stimulation with IL-6 or treated with siltuximab. Cells were collected after 10 minutes of IL-6 stimulation or 16 hours of siltuximab. Journal of Thoracic Oncology 2014 9, 974-982DOI: (10.1097/JTO.0000000000000193) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Effects of siltuximab(+) in mouse xenograft models of lung cancer. CD-1 nu/nu mice were divided into four treatment groups of 15 mice of each for H322, H1650, and H157 xenograft models The single-agent treated group was exposed to 10 mg/kg of each antihuman interleukin-6 (IL-6) and antimouse IL-6 antibodies (siltuximab +) three times per week or 50 mg/kg of erlotinib daily; the combination group was exposed to both siltuximab(+) and erlotinib. The control group was treated identically as the single-agent and combined groups, but with control vehicle (phosphate-buffered saline) intraperitoneally and 0.5% of hydroxypropyl methylcellulose orally. Tumor growth (in mm3) was assessed every 2–3 days. Error bars indicate variation of tumor volume, and p values indicate the significant comparison in two groups: *p less than 0.05, **p less than 0.01, and ***p less than 0.005. A, Tumor growth in H322 and H322 + CAF xenografts, with significant differences shown in control and siltuximab(+) groups. (B) Tumor growth in H1650 and H1650 + cancer-associated fibroblast (CAF) xenografts, with significant differences observed in control versus siltuximab(+) and in erlotinib versus combination group. (C) Tumor growth in H157 and H157 + CAF xenograft. No significant differences were found. (D) Representative images of tumor cells in cell line xenograft models, demonstrating IL-6 and PY-STAT3 (Tyr705) staining. Black scale bars represent 40 μM. (E) Quantification of nuclear PY-STAT3(Tyr705) using Spectrum nuclear algorithm (Aperio). Graphs show mean percentage of nuclei staining positive per treatment (N = 3), with error bars representing SD. All p values greater than 0.05 for control versus siltuximab(+). Journal of Thoracic Oncology 2014 9, 974-982DOI: (10.1097/JTO.0000000000000193) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Effects of siltuximab(+) on non–small-cell lung cancer primary explant model. NOD/SCID mice were divided into two groups with six pairs of mice for each primary xenograft, as described in Materials and Methods. The single-agent treatment group was given 10 mg/kg of siltuximab(+) (injected intraperitoneally) three times per week; controls were given the same volume of phosphate-buffered saline. Tumor growth (in mm3) was assessed every 2–3 days. Error bars indicate variation of tumor volume, and p values indicate the significant comparison in two groups: *p less than 0.05, **p less than 0.01, ***p less than 0.005. Journal of Thoracic Oncology 2014 9, 974-982DOI: (10.1097/JTO.0000000000000193) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions