A potential therapy for chordoma via antibody-dependent cell-mediated cytotoxicity employing NK or high-affinity NK cells in combination with cetuximab

J Neurosurg. 2018 May;128(5):1419-1427. doi: 10.3171/2017.1.JNS162610. Epub 2017 Jul 28.


OBJECTIVE Chordoma is a rare bone tumor derived from the notochord and is resistant to conventional therapies such as chemotherapy, radiotherapy, and targeting therapeutics. Expression of epidermal growth factor receptor (EGFR) in a large proportion of chordoma specimens indicates a potential target for therapeutic intervention. In this study the authors investigated the potential role of the anti-EGFR antibody cetuximab in immunotherapy for chordoma. METHODS Since cetuximab is a monoclonal antibody of the IgG1 isotype, it has the potential to mediate antibody-dependent cell-mediated cytotoxicity (ADCC) employing natural killer (NK) cells as effectors. Polymorphisms in the CD16 allele expressed on NK cells have been shown to influence the degree of ADCC of tumor cells, with the high-affinity valine (V)/V allele being responsible for more lysis than the V/phenylalanine (F) or FF allele. Unfortunately, however, only approximately 10% of the population expresses the VV allele on NK cells. An NK cell line, NK-92, has now been engineered to endogenously express IL-2 and the high-affinity CD16 allele. These irradiated high-affinity (ha)NK cells were analyzed for lysis of chordoma cells with and without cetuximab, and the levels of lysis observed in ADCC were compared with those of NK cells from donors expressing the VV, VF, and FF alleles. RESULTS Here the authors demonstrate for the first time 1) that cetuximab in combination with NK cells can mediate ADCC of chordoma cells; 2) the influence of the NK CD16 polymorphism in cetuximab-mediated ADCC for chordoma cell lysis; 3) that engineered haNK cells-that is, cells transduced to express the CD16 V158 FcγRIIIa receptor-bind cetuximab with similar affinity to normal NK cells expressing the high-affinity VV allele; and 4) that irradiated haNK cells induce ADCC with cetuximab in chordoma cells. CONCLUSIONS These studies provide rationale for the use of cetuximab in combination with irradiated haNK cells for therapy for chordoma.

Keywords: ADCC; ADCC = antibody-dependent cell-mediated cytotoxicity; E/T ratio = effector cell/target cell ratio; EGFR; EGFR = epidermal growth factor receptor; F = phenylalanine; FITC = fluorescein isothiocyanate; MFI = mean fluorescence intensity; NK = natural killer; PBMC = peripheral blood mononuclear cell; PCR = polymerase chain reaction; V = valine; antibody-dependent cell-mediated cytotoxicity; cetuximab; chordoma; epidermal growth factor receptor; haNK = high-affinity natural killer; immunotherapy; mAb = monoclonal antibody; oncology.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibody-Dependent Cell Cytotoxicity
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Cell Line, Tumor
  • Cell Survival
  • Cell- and Tissue-Based Therapy / methods
  • Cetuximab / therapeutic use*
  • Chordoma / immunology
  • Chordoma / therapy*
  • GPI-Linked Proteins / genetics
  • GPI-Linked Proteins / immunology
  • Humans
  • Immunotherapy* / methods
  • Killer Cells, Natural / immunology*
  • Receptors, IgG / genetics
  • Receptors, IgG / immunology


  • Antineoplastic Agents, Immunological
  • FCGR3B protein, human
  • GPI-Linked Proteins
  • Receptors, IgG
  • Cetuximab