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Monoclonal antibody
TypeTrifunctional antibody
SourceRat/mouse hybrid
TargetEpCAM, CD3
Clinical data
Trade namesRemovab
AHFS/Drugs.comInternational Drug Names
License data
Routes of
intraperitoneal infusion
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
CAS Number
  • none
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Catumaxomab[1] (trade name Removab) is a rat-mouse hybrid monoclonal antibody which is used to treat malignant ascites, a condition occurring in people with metastasizing cancer. It binds to antigens CD3 and EpCAM. It was developed by Fresenius Biotech and Trion Pharma (Germany).

Medical use

The drug is used for the treatment of malignant ascites in people with EpCAM-positive cancer if a standard therapy is not available.[2][3] Ascites is an accumulation of fluid in the peritoneal cavity.

The usual treatment of malignant ascites is to puncture the peritoneum to let the accumulated fluid drain out. After the puncture, catumaxomab is given as an intraperitoneal infusion. The procedure is repeated four times within about eleven days. It has been shown that puncture free survival can be increased from 11 to 46 days with this treatment.[4]

Adverse effects

Common adverse effects include fever, nausea and vomiting. Fever and pain should be controlled by giving NSAIDs, analgetics or antipyretics before application of catumaxomab.[5] All side effects were fully reversible in studies. Most are caused by the liberation of cytokines.[2]

Mechanism of action

Catumaxomab mechanism.svg

Many types of cancer cells carry EpCAM (epithelial cell adhesion molecule) on their surface. By binding to such a cell via one arm, to a T lymphocyte via the other arm and to an antigen-presenting cell like a macrophage, a natural killer cell or a dendritic cell via the heavy chains, an immunological reaction against the cancer cell is triggered. Removing cancer cells from the abdominal cavity reduces the tumour burden which is seen as the cause for ascites in people with cancer.[2][6][7]

Chemical structure

Catumaxomab consists of one "half" (one heavy chain and one light chain) of an anti-EpCAM antibody and one half of an anti-CD3 antibody, so that each molecule of catumaxomab can bind both EpCAM and CD3. In addition, the Fc-region can bind to an Fc receptor on accessory cells like other antibodies, which has led to calling the drug a trifunctional antibody.

Catumaxomab structure.svg


Catumaxomab was developed by Trion Pharma, based on preliminary work by the Helmholtz Zentrum München. Dr. Horst Lindhofer is listed at the primary inventor of the patent.[8] Fresenius Biotech conducted clinical trials and filed the drug for approval with the European Medicines Agency (EMA). It was approved in Europe on 20 April 2009.[9] In 2013, catumaxomab was voluntarily withdrawn from the US market and in 2017 in the EU market for commercial reasons.[10] The product had not been marketed in the EU since 2014.[11]


  1. ^ Linke R, Klein A, Seimetz D (2010). "Catumaxomab: clinical development and future directions". mAbs. 2 (2): 129–36. doi:10.4161/mabs.2.2.11221. PMC 2840231. PMID 20190561.
  2. ^ a b c "European Public Assessment Report for March 2009" (PDF). European Medicines Agency. March 2009.
  3. ^ Heiss MM, Murawa P, Koralewski P, Kutarska E, Kolesnik OO, Ivanchenko VV, et al. (November 2010). "The trifunctional antibody catumaxomab for the treatment of malignant ascites due to epithelial cancer: Results of a prospective randomized phase II/III trial". International Journal of Cancer. 127 (9): 2209–21. doi:10.1002/ijc.25423. PMC 2958458. PMID 20473913.
  4. ^ Lordick F, Ott K, Weitz J, Jäger D (September 2008). "The evolving role of catumaxomab in gastric cancer". Expert Opinion on Biological Therapy. 8 (9): 1407–15. doi:10.1517/14712598.8.9.1407. PMID 18694358. S2CID 73237824.
  5. ^ Schubert-Zsilavecz M, Wurglics M (2009). Neue Arzneimittel.
  6. ^ "Capital Market Day Fresenius Biotech: Fresenius concentrates biotechnology activities on antibody and innovative cell therapies". Fresenius SE. Archived from the original on 26 August 2010.
  7. ^ Ruf P, Gires O, Jäger M, Fellinger K, Atz J, Lindhofer H (August 2007). "Characterisation of the new EpCAM-specific antibody HO-3: implications for trifunctional antibody immunotherapy of cancer". British Journal of Cancer. 97 (3): 315–21. doi:10.1038/sj.bjc.6603881. PMC 2360319. PMID 17622246.
  8. ^ EP 1315520, Lindhofer H, "Use of Trifunctional Bispecific and Trispecific Antibodies for the Treatment of Malignant Ascites", assigned to Trion Pharma GmbH 
  9. ^ "TRION Pharma: Trifunctional Antibody Catumaxomab Kills Cancer Stem Cells". Archived from the original on 2011-07-13. Retrieved 2009-11-19.
  10. ^ "Neovii completes marketing authorisation withdrawal of Removab in the European Union". Neovii Biotech GmbH. 26 July 2017.
  11. ^ "Removab: Withdrawal of the marketing authorisation in the European Union" (PDF). European Medicines Agency. 10 July 2017.

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