ADC Top Trumps: #Ozogamicin

For the uninitiated amongst you, Top Trumps is a popular card game where any given subject is assigned descriptors and number values that are compared together with the aim to try to trump and win an opponent’s card. Many a youthful long hour was spent memorising the best cards, or more pertinently how to win with the worst cards. Having not picked up a pack of cards in earnest for more decades than I care to remember, I was recently invited by my young nephew to play a game of Top Trumps, and it rekindled my love of all things comparative. I lost of course, although telling myself it was to let my nephew win, the reality was that I was outplayed. The game though was about Star Wars, and I hadn’t banked on two things: firstly my nephews love of the film series and secondly his extremely erudite recollection of the winning numbers and cards.

I thought that my game was more suited to ADC Top Trumps, at least that was one I had a fighting chance of winning, so thought it would be something to share. Purely subjective, with my own and very personal take on how I allocated the numbers, I have put together a series of Top Trumps cards for ADCs. The first is on #Ozogamicin, and expect follow-ups for #Vedotin, #Mafedotin, #Govitecan, #Deruxtecan, #Ravtansine to complete the deck. More to follow I am sure.

Summary: With two commercially approved ADCs Mylotarg® and Besponsa® including the first back in 2000, the Ozogamicin ADCs are truly pioneering.

Commercial approval: Mylotarg® was approved in 2000 but was voluntarily withdrawn in 2010 and then subsequent re-approval at the same time as Besponsa® in 2017 based on dose fractionation regimens.

Clinical dose: Depending on whether the patient is newly diagnosed or relapsed or refractory, the clinical dosing from induction to continuation is 3-6 mg/m2 for Mylotarg® and 0.8-0.5 mg/m2 for Besponsa®, with follow-up cycles.

Clinical trials by number and disease: Perhaps not unexpectedly due to the length of approval time for the two Ozogamicin ADCs, there are a plethora of clinical trials being conducted, perhaps over 150 across the drugs. This is also reflected in the breadth of disease indications.

Sales: Overall sales remain on the lower side, likely from the other available treatments, the patient size and the question over reapproval and off-target toxicities.

Over time, as we continue to see the increasing approval rates of ADCs through this decade, we will have a full Top Trumps card deck. And maybe I can convince my nephew to have a game, although I suspect before long he would win.