Predicting response to a HER dimerisation inhbitor based on low HER3 expression
105 claims: 32 independent, 73 dependent
- 1REIVINDICAÇÕES 1. Composição compreendendo um inibidor da dimerização de HER para uso em um método para tratar um paciente com um tipo de câncer que é capaz de responder a um inibidor da dimerização de HER, compreen5 dendo administrar uma quantidade terapeuticamente eficaz do dito inibidor da dimerização de HER ao paciente, em que o câncer do paciente expressa HER3 em um nível que é menor do que o nível mediano da expressão de HER3 no tipo de câncer.
- 2Composição de acordo com a reivindicação 1, em que o cân10 cer do paciente expresse HER3 em um nível que é menor do que o 25° percentil de expressão de HER3 no tipo de câncer.
- 3Composição de acordo com a reivindicação 1 ou reivindicação 2, em que a expressão de HER3 foi determinada usando a reação em cadeia da polimerase (PCR). 15
- 4Composição de acordo com a reivindicação 3, em que a PCR é uma reação em cadeia de polimerase quantitativa em tempo real (qRTPCR).
- 5Composição de acordo com qualquer uma das reivindicações precedentes, em que o inibidor da dimerização de HER é um inibidor da di20 merização de HER2.
- 6Composição de acordo com qualquer uma das reivindicações precedentes, em que o inibidor da dimerização de HER inibe a heterodimerização de HER.
- 7Composição de acordo com qualquer uma das reivindicações 25 precedentes, em que o inibidor da dimerização de HER é um anticorpo.
- 8Composição de acordo com a reivindicação 7, em que o anticorpo se liga a um receptor de HER selecionado do grupo que consiste em EGFR, HER2 e HER3.
- 9Composição de acordo com a reivindicação 8, em que o anti30 corpo se liga a HER2.
- 10Composição de acordo com a reivindicação 9, na qual o anticorpo HER2 se liqa ao Domínio II do domínio extracelular de HER2.
- 11Composição de acordo com a reivindicação 10, em que o anticorpo se liga a uma junção entre os domínios I, II e III do domínio extracelular de HER2.
- 12Composição de acordo com a reivindicação 10, em que o anticorpo HER2 compreende as sequências de aminoácido variáveis leves e variáveis pesadas das SEQ ID N° 3 e 4 , respectivamente.
- 13Composição de acordo com a reivindicação 12, em que o anticorpo HER2 é pertuzumab.
- 14Composição de acordo com qualquer uma das reivindicações 7 a 13, em que o anticorpo HER é um anticorpo nu, um anticorpo intacto ou um fragmento de anticorpo que compreende uma região de ligação ao antígeno.
- 15Composição de acordo com qualquer uma das reivindicações precedentes, em que o tipo de câncer é selecionado do grupo que consiste em câncer ovariano, câncer peritoneal, câncer da trompa falopiana, câncer de mama metastático (MBC), câncer de pulmão de célula nãopequena (NSCLC), câncer de próstata e câncer colorretal.
- 16Composição de acordo com a reivindicação 15, em que o tipo de câncer é ovariano, câncer peritoneal ou câncer da trompa falopiana.
- 17Composição de acordo com a reivindicação 16, em que o tipo de câncer é resistente à platina.
- 18Composição de acordo com a reivindicação 16, em que o tipo de câncer é câncer ovariano avançado, refratário ou recorrente.
- 19Composição de acordo com qualquer uma das reivindicações precedentes que prolonga a sobrevida livre de progressão (PFS) ou a sobrevida global (OS) do paciente.
- 20Composição de acordo com qualquer uma das reivindicações precedentes, em que o inibidor da dimerização de HER é administrado como o único agente antitumor.
- 21Composição de acordo com qualquer uma das reivindicações 1 a 19, em que o tratamento compreende a administração de um segundo agente terapêutico ao paciente.
- 22Composição de acordo com a reivindicação 21, em que o segundo agente terapêutico é selecionado do grupo que consiste em um agente quimioterápico, anticorpo HER, anticorpo direcionado contra um antígeno associado ao tumor, composto anti-hormonal, cardioprotetor, citocina, 5 fármaco direcionado para EGFR, agente antiangiogênico, inibidor da tirosina quinase, inibidor de COX, fármaco anti-inflamatório não esteroidal, inibidor da farnesil transferase, anticorpo que se liga à proteína oncofetal CA125, vacina para HER2, terapia direcionada a HER, inibidor de Raf ou ras, doxorrubicina lipossomal, topotecan, taxano, inibidor duplo de tirosina quinase, 10 TLK286, EMD-7200, um medicamento que trata náuseas, um medicamento que previne ou trate erupção cutânea ou terapia padronizada para acne, um medicamento que trata ou previne diarréia, um medicamento que reduz a temperatura corporal e um fator de crescimento hematopoiético.
- 23Composição de acordo com a reivindicação 22, em que o 15 segundo agente terapêutico é um agente quimioterápico.
- 24Composição de acordo com a reivindicação 23, em que o agente quimioterápico é selecionado do grupo que consiste em gencitabina, carboplatina, paclitaxel, docetaxel, topotecan e doxorrubicina lipossomal.
- 25Composição de acordo com a reivindicação 22, em que o 20 agente quimioterápico é um antimetabólito.
- 26Composição de acordo com a reivindicação 25, em que o agente quimioterápico antimetabólito é gencitabina.
- 27Composição de acordo com a reivindicação 21, em que o segundo agente terapêutico é trastuzumab, erlotinib ou bevacizumab. 25
- 28Composição de acordo com qualquer uma das reivindicações precedentes, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o 25° percentil da expressão de HER2:HER3 no tipo de câncer.
- 29Composição de acordo com a reivindicação 28, em que o
- 3030 câncer do paciente expressa HER2:HER3 em um nível que é maior do que o nível mediano da expressão de HER2;HER3 no tipo de câncer. 30. Composição de acordo com a reivindicação 29, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o 75° percentil da expressão de HER2:HER3 no tipo de câncer.
- 31Uso de pertuzumab na preparação de um medicamento para tratar um paciente com câncer ovariano, peritoneal ou da trompa falopiana, compreendendo administrar ao paciente uma quantidade terapeuticamente eficaz de pertuzumab, em que o câncer do paciente expressa HER3 em um nível menor do que o nível mediano da expressão de HER3 no câncer ovariano, peritoneal ou da trompa falopiana.
- 32Uso de acordo com a reivindicação 31, em que o câncer do paciente expressa HER3 em um nível menor do que o 25° percentil da expressão de HER3 no câncer ovariano, peritoneal ou da trompa falopiana.
- 33Uso de acordo com a reivindicação 31 ou 32, em que a expressão de HER3 foi determinada usando a reação em cadeia da polimerase (PCR).
- 34Uso de acordo com a reivindicação 33, em que a PCR é uma reação em cadeia da polimerase quantitativa em tempo real (qRTPCR).
- 35Uso de acordo com qualquer uma das reivindicações 31 a 34 que prolonga a sobrevida livre de progressão (PFS) ou sobrevida global (OS).
- 36Uso de acordo com qualquer uma das reivindicações 31 a 35, em que o paciente tem câncer ovariano.
- 37Uso de acordo com a reivindicação 36, em que o câncer ovariano é câncer ovariano resistente à platina.
- 38Uso de acordo com a reivindicação 36 ou reivindicação 37, em que o paciente tem câncer ovariano avançado, refratário ou recorrente.
- 39Uso de acordo com qualquer uma das reivindicações 31 a 38 compreendendo ainda administrar um agente quimioterápico ao paciente.
- 40Uso de acordo com a reivindicação 39, em que o agente quimioterápico é selecionado do grupo que consiste em gencitabina, carboplatina, paclitaxel, docetaxel, topotecan e doxorrubicina lipossomal.
- 41Uso de acordo com a reivindicação 40, em que o agente qui5 mioterápico é um agente quimioterápico antimetabólito.
- 42Uso de acordo com a reivindicação 41, em que o agente quimioterápico antimetabólito é gencitabina.
- 43Uso de acordo com qualquer uma das reivindicações 31 a 5 42, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o 25° percentil da expressão de HER2.HER3 no tipo de câncer.
- 44Uso de acordo com a reivindicação 43, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o nível me10 diano da expressão de HER2:HER3 no tipo de câncer.
- 45Uso de acordo com a reivindicação 44, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o 75° percentil da expressão de HER2:HER3 no câncer ovariano, peritoneal ou da trompa falopiana. 15
- 46Método in vitro para selecionar uma terapia para um paciente com um tipo de câncer que é capaz de responder a um inibidor da dimerização de HER compreendendo determinar a expressão de HER3 em uma amostra de câncer do paciente in vitro e selecionar um inibidor da dimerização de HER como a terapia se a amostra de câncer expressar HER3 em um 20 nível menor do que o nível médio da expressão de HER3 no tipo de câncer.
- 47Artigo de manufatura compreendendo, na mesma embalagem, uma composição farmacêutica compreendendo um inibidor da dimerização de HER em um veículo farmaceuticamente aceitável e um selo determinando que o inibidor ou a composição farmacêutica é indicado para tratar 25 um paciente com um tipo de câncer que é capaz de responder a um inibidor da dimerização de HER, em que o câncer do paciente expressa HER3 em um nível maior do que o nível mediano de expressão de HER3 no tipo de câncer.
- 48Método para fabricar um inibidor da dimerização de HER ou 30 uma composição farmacêutica do mesmo, compreendendo combinar em uma embalagem o inibidor ou a composição farmacêutica e um selo determinando que o inibidor ou a composição farmacêutica é indicado para tratar um paciente com um tipo de câncer que é capaz de responder a um inibidor da dimerização de HER, em que o câncer do paciente expressa HER3 em um nível menor do que o nível mediano de expressão de HER3 no tipo de câncer.
- 49Método para divulgar um inibidor da dimerização de HER ou uma composição farmaceuticamente aceitável do mesmo, compreendendo promover, para um público-alvo, o uso do inibidor da dimerização de HER ou uma composição farmacêutica do mesmo para tratar uma população de pacientes com um tipo de câncer, onde o câncer do paciente expressa HER3 em um nível menor do que o nível mediano de expressão de HER3 no tipo de câncer.
- 50Método in vitro para selecionar uma terapia para um paciente com um tipo de câncer que é capaz de responder a um agente quimioterápico, compreendendo determinar a expressão de HER3 na amostra de câncer do paciente in vitro e selecionar um agente quimioterápico como a terapia se a amostra de câncer expressar HER3 em um nível maior do que o nível mediano da expressão de HER3 no tipo de câncer.
- 51Método de acordo com a reivindicação 50, em que o tipo de câncer é câncer ovariano, peritoneal ou da trompa falopiana.
- 52Método de acordo com a reivindicação 51, em que o tipo de câncer é câncer ovariano, peritoneal ou da trompa falopiana resistente à platina.
- 53Método de acordo com a reivindicação 51, em que o tipo de câncer é câncer ovariano avançado, refratário ou recorrente.
- 54Método de acordo com qualquer uma das reivindicações 50 a 53, em que o agente quimioterápico é um agente quimioterápico antimetabólito.
- 55Método de acordo com a reivindicação 54, em que o agente quimioterápico antimetabólito é gencitabina.
- 56Uso de um inibidor de HER na preparação de um medicamento para tratar um paciente com um tipo de câncer que é capaz de responder a um inibidor de HER, compreendendo administrar uma quantidade terapeuticamente eficaz do inibidor de HER ao paciente, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o 25° percentil da expressão de HER2:HER3 no tipo de câncer.
- 57Uso de acordo com a reivindicação 57, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o nível mediano da expressão de HER2.HER3 no tipo de câncer.
- 58Uso de acordo com a reivindicação 57, em que o câncer do paciente expressa HER2:HER3 em um nível que é maior do que o 75° percentil da expressão de HER2:HER3 no tipo de câncer.
- 59Uso de acordo com qualquer uma das reivindicações 56 a 58, em que a expressão de HER2 e HER3 foi determinada usando a reação em cadeia da polimerase (PCR).
- 60Uso de acordo com a reivindicação 59, em que a PCR é uma reação em cadeia da polimerase quantitativa em tempo real (qRT-PCR).
- 61Uso de acordo com qualquer uma das reivindicações 56 a 60, em que o inibidor de HER é um inibidor da dimerização de HER.
- 62Uso de acordo com qualquer uma das reivindicações 56 a 61, em que o inibidor de HER é um inibidor de HER2.
- 63Uso de acordo com a reivindicação 61 ou reivindicação 62, em que o inibidor da dimerização de HER é um inibidor da dimerização de HER2.
- 64Uso de acordo com a reivindicação 61, em que o inibidor de HER inibe a heterodimerização de HER.
- 65Uso de acordo com qualquer uma das reivindicações 56 a 64, em que o inibidor de HER é um anticorpo.
- 66Uso de acordo com a reivindicação 65, em que o anticorpo se liga a um receptor de HER selecionado do grupo que consiste em EGFR, HER2 e HER3.
- 67Uso de acordo com a reivindicação 66, em que o anticorpo se liga a HER2.
- 68Uso de acordo com a reivindicação 67, em que o anticorpo HER2 se liga ao Domínio II do domínio extracelular de HER2.
- 69Uso de acordo com a reivindicação 67, em que o anticorpo se liga a uma junção entre os domínios I, II e lll do domínio extracelular de HER2.
- 70Uso de acordo com a reivindicação 69, em que o anticorpo HER2 compreenda as sequências de aminoácido variáveis leves e variáveis pesadas das SEQ ID N° 3 e 4 , respectivamente.
- 71Uso de acordo com a reivindicação 70, em que o anticorpo HER2 é pertuzumab.
- 72Uso de acordo com qualquer uma das reivindicações 65 a 71, em que o anticorpo HER é um anticorpo nu, um anticorpo intacto ou um fragmento de anticorpo que compreende uma região de ligação ao antígeno.
- 73Uso de acordo com qualquer uma das reivindicações 56 a 72, em que o tipo de câncer é selecionado do grupo que consiste em câncer ovariano, câncer peritoneal, câncer da trompa falopiana, câncer de mama metastático (MBC), câncer de pulmão de célula não-pequena (NSCLC), câncer de próstata e câncer colorretal.
- 74Uso de acordo com a reivindicação 73, em que o tipo de câncer é câncer ovariano, câncer peritoneal ou câncer da trompa falopiana.
- 75Uso de acordo com a reivindicação 74, em que o tipo de câncer é resistente à platina.
- 76Uso de acordo com a reivindicação 74, em que o tipo de câncer é câncer ovariano avançado, refratário ou recorrente.
- 77Uso de acordo com qualquer uma das reivindicações 56 a 76 que prolonga a sobrevida livre de progressão (PFS) ou sobrevida global (OS).
- 78Uso de acordo com qualquer uma das reivindicações 56 a 77, em que o inibidor de HER é administrado como o único agente antitumor.
- 79Uso de acordo com qualquer uma das reivindicações 56 a 77, compreendendo administrar um segundo agente terapêutico ao paciente.
- 80Uso de acordo com a reivindicação 79, em que o segundo agente terapêutico é selecionado do grupo que consiste em um agente quimioterápico, anticorpo HER, anticorpo direcionado contra um antígeno asso9 ciado ao tumor, composto anti-hormonal, cardioprotetor, citocina, fármaco direcionado a EGFR, agente antiangiogênico, inibidor da tirosina quinase, inibidor de COX, fármaco anti-inflamatório não esteroidal, inibidor da farnesil transferase, anticorpo que se liga a proteína oncofetal CA125, vacina para HER2, terapia direcionada a HER, inibidor de Raf ou ras, doxorrubicina lipossomal, topotecan, taxano, inibidor duplo de tirosina quinase, TLK286, EMD-7200, um medicamento que trata náuseas, um medicamento que previne ou trata erupção cutânea ou terapia padronizada para acne, um medicamento que trata ou previne diarréia, um medicamento que reduz a temperatura corporal e um fator de crescimento hematopoiético.
- 81Uso de acordo com a reivindicação 80, em que o segundo agente terapêutico é um agente quimioterápico.
- 82Uso de acordo com a reivindicação 81, em que o agente quimioterápico é selecionado do grupo que consiste em gencitabina, carboplatina, paclitaxel, docetaxel, topotecan e doxorrubicina lipossomal.
- 83Uso de acordo com a reivindicação 81, em que o agente quimioterápico é um antimetabólito.
- 84Uso de acordo com a reivindicação 83, em que o agente quimioterápico um antimetabólito é gencitabina.
- 85Uso de acordo com a reivindicação 80, em que o segundo agente terapêutico é trastuzumab, erlotinib ou bevacizumab.
- 86Uso de pertuzumab na preparação de um medicamento para tratar um paciente com câncer ovariano, peritoneal ou da trompa falopiana, compreendendo administrar uma quantidade terapeuticamente eficaz de pertuzumab ao paciente, em que o câncer do paciente expressa HER2:HER3 em um nível maior do que o 25° percentil da expressão de HER2:HER3 no câncer ovariano, peritoneal ou da trompa falopiana.
- 87Uso de acordo com a reivindicação 86, em que o câncer do paciente expressa HER2:HER3 em um nível maior do que o nívei mediano da expressão de HER2:HER3 no câncer ovariano, peritoneal ou da trompa falopiana.
- 88Uso de acordo com a reivindicação 87, em que o câncer do paciente expressa HER2:HER3 em um nível maior do que o 75° percentil da expressão de HER2:HER3 no câncer ovariano, peritoneal ou da trompa falopiana.
- 89Uso de acordo com qualquer uma das reivindicações 86 a 88, em que a expressão de HER2 e HER3 foi determinada pela reação em cadeia da polimerase (PCR).
- 90Uso de acordo com a reivindicação 89, em que a PCR é uma reação em cadeia de polimerase quantitativa em tempo real (qRT-PCR).
- 91Uso de acordo com qualquer uma das reivindicações 86 a 90, que prolonga a sobrevida livre de progressão (PFS) ou a sobrevida global (OS) do paciente.
- 92Uso de acordo com qualquer uma das reivindicações 86 a 91, em que o paciente tem câncer ovariano.
- 93Uso de acordo com a reivindicação 92, em que o câncer ovariano é câncer ovariano resistente à platina.
- 94Uso de acordo com a reivindicação 92 ou reivindicação 93, em que o paciente tem câncer ovariano avançado, refratário ou recorrente.
- 95Uso de acordo com qualquer uma das reivindicações 86 a 94, compreendendo ainda administrar um agente quimioterápico ao paciente.
- 96Uso de acordo com reivindicação 95, em que o agente quimioterápico é selecionado do grupo que consiste em gencitabina, carboplatina, paclitaxel, docetaxel, topotecan e doxorrubicina lipossomal.
- 97Uso de acordo com a reivindicação 95, em que o agente quimioterápico é um agente quimioterápico antimetabólito.
- 98Uso de acordo com a reivindicação 97, em que o agente quimioterápico antimetabólito é gencitabina.
- 99Método in vitro para selecionar uma terapia para um paciente com um tipo de câncer que é capaz de responder a um inibidor de HER, compreendendo determinar a expressão de HER2 e HER3 na amostra de câncer do paciente in vitro e selecionar um inibidor de HER como a terapia se a amostra de câncer expressar HER2.HER3 em um nível maior do que o 25° percentil da expressão de HER2:HER3 no tipo de câncer.
- 100Artigo de manufatura compreendendo, na mesma embalagem, uma composição farmacêutica compreendendo um inibidor de HER em um veículo farmaceuticamente aceitável e um selo determinando que o inibi5 dor ou a composição farmacêutica é indicado para tratar um paciente com um tipo de câncer que é capaz de responder a um inibidor de HER, em que o câncer do paciente expressa HER2:HER3 em um nível maior do que o 25° percentil de expressão de HER2;HER3 no tipo de câncer.
- 101Método para fabricar um inibidor de HER ou uma composi10 ção farmacêutica do mesmo, compreendendo combinar em uma embalagem o inibidor ou a composição farmacêutica e um selo determinando que o inibidor ou a composição farmacêutica são indicados para tratar um paciente com um tipo de câncer que é capaz de responder a um inibidor de HER, em que o câncer do paciente expressa HER2.HER3 em um nível maior do que o 15 25° percentil de expressão de HER2.HER3 no tipo de câncer.
- 102Método para divulgar um inibidor de HER ou uma composição farmaceuticamente aceitável do mesmo, compreendendo promover, para um público-alvo, o uso do inibidor de HER ou uma composição farmacêutica do mesmo para tratar uma população de pacientes com um tipo de cân20 cer, em que o câncer do paciente expressa HER2:HER3 em um nível maior do que o 25° percentil de expressão de HER2:HER3 no tipo de câncer.
- 103Uso de um inibidor de HER na preparação de um medicamento para tratar um paciente com um tipo de câncer que é capaz de responder a um inibidor de HER, compreendendo administrar uma quantidade 25 terapeuticamente eficaz do inibidor de HER ao paciente, em que o câncer do paciente expressa HER3 em um nível que é menor do que o nível mediano da expressão de HER3 no tipo de câncer.
- 104Método in vitro para selecionar uma terapia para um paciente com um tipo de câncer que é capaz de responder a um inibidor de HER 30 compreendendo determinar a expressão de HER3 em uma amostra de câncer do paciente in vitro e selecionar um inibidor de HER como a terapia, se a amostra de câncer expressar HER3 em um nível menor do que o nível me12 diano da expressão de HER3 no tipo de câncer.
- 105Método de acordo com a reivindicação 103 ou reivindicação 104, em que o inibidor de HER é um inibidor de HER2. 1/56 2/56 VARIÁVEL LEVE 10 20 30 40 2C4 DTVMTQSHKIMSTSVGDRVSITC (KASQDVSIGVAJ WYQQRP ** * * * 574 DIQMTQSPSSL5ASVG0RVTITC {KA5Q0VSIGVA1 WYQQKP ir * * <* * * hum Kl DIQMTQSPSSLSASVGDRVTITC [RASQSISNYLA] WYQQKP 2C4 50 GQSPKLLIY fSASYRYTJ 60 70 80 GVPDRFTGSGSGTDFTFTISSVQA * * * * * 574 GKAPKLLIY (SASYRYT) * * * * * * GVPSRFSGSGSGTDFTLTISSLQP hum Kl GKAPKLLIY [AASSLES] GVPSRFSGSGSGTDFTLTISSLQP 90 100 2C4 EDLAVYYC * * (QQYYIYPYTJ FGGGTKLEIK * * (SEQ ID NO:15 57 4 EDFATYYC (QQYYIYPYT) * * * * FGQGTKVEIK (SEQ ID NO: 3) hum κΐ EDFATYYC (QQYNSLPWT) FGQGTKVEIK (SEQ ID NO: 5) FIG. 2A VARIÁVEL PESADA 10 20 30 40 2C4 EVQLQQSGPELVKPGTSVKISCKAS [GFTFTDYTMO] WVKQS ********** * * 574 EVQLVESGGGLVQPGGSLRLSCAAS (GFTFTDYTMO) WVRQA ** * * hum III EVQLVESGGGLVQPGGSLRLSCAAS [GFTFSSYAMS] WVRQA 50 a 60 70 80 2C4 HGKSLEWIG [DVNPNSGGSIYNQRFKGJ KASLTVDRSSRIVYM . < * ★ ir * * * ir i O i i 574 PGKGLEWVA [DVNPNSGGSIYNQRFKGJ RFTLSVORSKNTLYL * i i ♦ * t *<* i t i t * A * hum III PGKGLEWVA [VISGDGGSTYYADSVKGJ RFTISRDNSKNTLYL 2C4 abc 90 ELRSLTFEDTAVYYCAR lOOab (NLGPSFYFDY) 110 WGQGTTLTVSS (SEQ ID »O:2) 574 fcii * * QMNSLRAEDTAVYYCAR [NLGPSFYFDY) * ir WGQGTLVTVSS (SEQ ID NO: 4) hum III QMNSLRAEDTAVYYCAR (GRVGYSLYDY) WGQGTLVTVSS (SEQ ID NO: 6)
Independent claims105
720 paragraphs in 5 sections, as filed
(54) Title: PREDICTION OF ANSWER TO ONE (57) Summary:
HER INHIBITOR (30) Unionist Priority: 02/03/2007 us 60 / 892,640,
04/16/2007 US 60 / 912,053, 02/19/2008 US 61 / 029,748 (73) Holder (s): f. Hoffmann-La Roche AG, Genentech, Inc (72) InventOr (s): Andreas Strauss, Chin-Yu Lin, Joachim Moecks, Lukas C. Amler, Merrill Birkner (74) Attorney (s): Dannemann .Siemsen, Bigler & Ipanema Moreira (86) International Order: pct US2008055502 of 29/02/2008 (87) International Publication: wo 2008 / i09440de 12/09/2008
Trastuzumab
Herceptin
<img file="BRPI0808418A2_D0001.tif" />
It is used in IV near JM
Protects against receiver exclusion
Moderately affects the negative regulation of the receptor
Discreet effect on the role of HER2 as a co-receptor
Pertuzumab
OmnKttg
<img file="BRPI0808418A2_D0002.tif" />
Connects to II on the dimming interface
Does not prevent the extrusion of the receiver
Moderately affects negative receptor modulation
Marked effect doubles the role of HER2 as a co-receptor
Invention Patent Descriptive Report for PREDICTING RESPONSE TO AN HER INHIBITOR.
Field of the Invention
The present invention relates to the use of low HER3 as a selection criterion to treat cancer patients, such as patients with ovarian cancer, with an HER inhibitor, such as pertuzumab.
The invention also relates to the use of a high HER2: HER3 ratio as a selection criterion for treating cancer patients, such as patients with ovarian cancer, with an HER inhibitor, such as pertuzumab.
In addition, the invention relates to the use of elevated HER3 as a selection criterion to treat cancer patients with a chemotherapeutic agent, for example, gemcitabine.
Background of the Invention
HER Receptors and Antibodies Against HER Receptors
The HER family of tyrosine kinase receptors are important mediators of cell growth, differentiation and survival. The family of receptors includes four distinct members, including the epidermal growth factor receptor (EGFR, ErbB1 or HER1), HER2 (ErbB2 or p185<sup>netJ</sup>), HER3 (ErbB3) and HER4 (ErbB4 or tyro2).
EGFR, encoded by the eróB1 gene, has been implicated as a cause of human malignancy. In particular, increased expression of EGFR has been observed in breast, bladder, lung, head, neck and stomach cancer as well as in glioblastomas. Increased expression25 of that of the EGFR receptor is generally associated with increased production of the EGFR ligand, which transforms the growth factor alpha (TGFa), by the same tumor cells that result in the activation of the receptor by an autocrine stimulatory pathway. Baselga and Mendelsohn Pharmac. The R. 64: 127-154 (1994). Monoclonal antibodies directed against EGFR or its ligands, TGF-α and EGF, have been evaluated as therapeutic agents in the treatment of such malignancies. See, for example, Baselga and Mendelsohn, supra; Masui et al. Cancer Research 44: 1002-1007 (1984): and Wu et al. J.
Clin. Invest. 95: 1897-1905 (1995).
The second member of the HER family, p185<sup>neu</sup>, was originally identified as the product of the transformed gene for neuroblastomas from chemically treated mice. The active form of the proto-oncogene neu results from a point mutation (valine to glutamic acid) in the transmembrane region of the encoded protein. Amplification of the human neu homologue is seen in breast and ovarian cancers and correlates with a bleak diagnosis (Slamon et al, Science, 235: 177-182 (1987); Slamon et al, Science, 244: 707-712 (1989); and US Patent No. 4,968,603). So far, no point mutations like that of the proto-oncogene neu have been described in human tumors. Overexpression of HER2 (often but not uniformly due to gene amplification) has also been seen in other carcinomas, including carcinomas of the stomach, endometrium, salivary glands, lung, kidney, colon, thyroid, pancreas and bladder. See, among others, King et al, Science, 229: 974 (1985); Yokota et al, Lancet. 1: 765-767 (1986); Fukushige et al, Mol Cell Biol., 6: 955-958 (1986); Guerin et al, Oncogene Res., 3: 21-31 (1988); Cohen et al, Oncogene, 4: 81-88 (1989); Yonemura et al. , Cancer Res., 51: 1034 (1991); Borst et al, Gynecol. Oncol., 38: 364 (1990); Weiner et al, Cancer Res., 50: 421-425 (1990); Kern et al, Cancer Res., 50: 5184 (1990); Park et al, Cancer Res., 49: 6605 (1989); Zhau et al, Mol. Carcinog, 3: 254-257 (1990); Aasland et al. Br. J. Cancer 57: 358-363 (1988); Williams et al. Pathobiology 59: 46-52 (1991); and McCann et al, Cancer, 65: 88-92 (1990). HER2 may be overexpressed in prostate cancer. (Gu et al. Cancer Lett. 99: 185-9 (1996); Ross et at. Hum. Pathol. 28: 82733 (1997); Ross et al. Cancer 79: 2162-70 (1997); and Sadasivan et al. J. Urol. 150: 126-31 (1993)).
Antibodies directed against p185<sup>neu</sup> rat and human HER2 protein products have been described.
Drebin and colleagues built antibodies against the mouse neu gene product, p185<sup>me</sup>. See, for example, Drebin et al., Cell 41: 695706 (1985); Myers et al., Meth. Enzym. 198: 277-290 (1991); and WO94 / 22478. Drebin et al., Oncoqene 2: 273-277 (1988) reported that mixtures of reactive antibodies with two distinct p185 regions<sup>neu</sup> result in synergistic antitumor effects on neu-transformed NIH-3T3 cells implanted in nude mice. See also US Patent 5,824,311, issued on October 20, 1998.
Hudziak et al., Mol. Cell. Biol. 9 (3): 1165-1172 (1989) describe the generation of a panel of antibodies against HER2 that were characterized using the human breast tumor SK-BR-3 lineage. The relative cell proliferation of SK-BR-3 cells after exposure to antibodies was determined by staining with crystal violet monolayers after 72 hours. Using this assay, maximum inhibition was achieved with the antibody called 4D5, which inhibited cell proliferation by 56%. Other antibodies in the panel reduced proliferation to a lesser extent in that assay. The 4D5 antibody was also observed to sensitize breast tumor cell lines that overexpress HER2 to the cytotoxic effects of TNF-a.
See also US Patent No. 5,677,171, issued October 14, 1997. The antibodies against HER2 discussed by Hudziak et al. were later characterized by Fendly et al. Cancer Research 50: 1550-1558 (1990); Kotts et al. In Vitro 26 (3): 59A (1990); Sarup et al. Growth Regulation 1: 72-82 (1991); Shepard et al. J. Clin. Immunol. 11 (3): 117-127 (1991); Ku20 mar et al. Mol. Cell. Biol. 11 (2): 979-986 (1991); Lewis et al. Immunol cancer. Immunother. 37: 255-263 (1993); Pietras et al Oncogene 9: 1829-1838 (1994); Vitetta et al. Cancer Research 54: 5301-5309 (1994); Sliwkowski et al J. Biol. Chem. 269 (20): 14661- 14665 (1994); Scott et al J. Biol. Chem. 266: 14300-5 (1991); D'souza et al. Proc. Natl. Acad. Sci 91: 7202-7206 (1994); Lewis et al. Cancer Research 56: 1457-1465 (1996); and Schaefer et al. Oncogene 15: 1385-1394 (1997).
A humanized recombinant version of the murine HER2 4D5 antibody (huMAb4D5-8, rhuMAb HER2, trastuzumab or HERCEPTIN®; US Patent No. 5,821,337) is clinically active in patients with metastatic breast cancers that overexpress HER2 who have received intense anti-cancer therapy previous (Baselga et al., J. Clin. Oncol. 14: 737-744 (1996)). Trastuzumab received approval for marketing from Food and
Drug Administration on September 25, 1998, for the treatment of patients with metastatic breast cancer whose tumors overexpress the HER2 protein.
Other antibodies against HER2 with various properties have been described in Tagliabue et al Int. J.
Cancer 47: 933-937 (1991); McKenzie et al Oncogene 4: 543-548 (1989); Maier et al. Cancer Res. 51: 5361-5369 (1991); Bacus et al. Molecular Carcinogenesis 3: 350-362 (1990); Stancovski et al. PNAS (USA) 88: 8691-8695 (1991); Bacus et al. Cancer Research 52: 2580-2589 (1992); Xu et al. Int. J. Cancer 53: 401-408 (1993); W094 / 00136; Kasprzyk et al. Cancer Research 52: 2771-2776 (1992); Hancock et al. Cancer Res. 51: 4575-4580 (1991); Shawver et al., Cancer Res. 54: 1367-1373 (1994); Arteaga et al. Cancer Res. 54: 3758-3765 (1994); Harwerth et al. J. Biol. Chem. 267: 15160-15167 (1992); US Patent No. 5,783,186; and Klapper et al Oncogene 14: 2099-2109 (1997).
Homology screening resulted in the identification of other members of the HER receptor family: HER3 (US Patent Nos. 5,183,884 and 5,480,968 as well as Kraus et al. PNAS (USA) 86: 9193-9197 (1989)) and HER4 (EP Patent Application No. 599,274; Plowman et al, Proc. Natl. Acad. Sci. USA, 90: 1746-1750 (1993); and Plowman et al, Nature, 366: 473-475 (1993)). Both receptors exhibit increased expression in at least some breast cancer strains.
HER receptors are generally found in cells in various combinations and heterodimerization is considered to increase the diversity of cellular responses to a variety of HER ligands (Earp et al., Breast Cancer Research and Treatment 35: 115-132 (1995)). EGFR is linked to six different ligands: epidermal growth factor (EGF), alpha growth transforming factor (TGF-α), amphirregulin. epidermal growth factor that binds to heparin (HB-EGF), betacellulin and epiregulin (Groenen et al., Growth Factors 11: 235-257 (1994)). A family of heregulin proteins, which result from the alternative splitting of a single qene, is HER3 and HER4 free. The herequina family includes alpha.
beta and gamma heregulins (Holmes et al., Science, 256: 1205-1210 (1992); US Patent No. 5,641,869; and Schaefer et al., Oncogene 15: 1385-1394 (1997)); neu differentiation factors (NDFs), glial growth factors (GGFs); inducer of acetylcholine receptor activity (ARIA); and factor derived from the sensory and motor neuron (SMDF). For a review, see Groenen et al. Growth Factors 11: 235-257 (1994); Lemke, G. Molec. & Cell. Neurosci. 7: 247-262 (1996) and Lee et al. Pharm. Rev. 47: 51-85 (1995). Recently, three additional HER ligands have been identified: neuregulin-2 (NRG-2) which has been described to bind to both HER3 and HER4 (Chang et al., Nature 387: 509-512 (1997); and Carraway et al. , Nature 387: 512-516 (1997)); neuregulin-3 that binds to HER4 (Zhang et al., PNAS (USA) 94 (18): 9562-7 (1997)); and neuregulin-4 that binds to HER4 (Harari et al., Oncogene 18: 2681-89 (1999)). HB-EGF, beta-cellulin and epiregulin also bind to HER4.
Although EGF and TGFa do not bind to HER2, EGF stimulates EGFR and HER2 to form a heterodimer, which activates EGFR and results in HER2 transfosphorylation in the heterodimer. Dimerization and / or transfosphorylation appear to activate HER2 tyrosine kinase. See Earp et al., Supra. Likewise, when HER3 is coexpressed with HER2, an active signaling complex is formed and antibodies directed against HER2 are able to disrupt that complex (Sliwkowski et al., J.Biol. Chem., 269 (20): 14661-14665 ( 1994)). In addition, HER3's affinity for heregulin (HRG) is increased to a state of greater affinity when coexpressed with HER2. See also Levi et al., Journal of Neuroscience 15: 1329-1340 (1995); Morrissey et al.,
Proc. Natl. Acad. Know. USA 92: 1431-1435 (1995); and Lewis et al, Cancer Res., 56: 1457-1465 (1996) with respect to the HER2-HER3 protein complex. HER4, like HER3, forms an active signaling complex with HER2 (Carraway and Cantley, Cell 78: 5-8 (1994)).
Patent publications related to HER antibodies include: US 5,677,171, US 5,720,937, US 5,720,954, US 5,725,856, US 5,770,195, US 5,772,997, US 6,165,464, US 6,387,371, US 6,399,063, US2002 / 019221 1A1. US 6,015,567, US 6,333,169, US 4,968,603, US
5,821,337, US 6,054,297, US 6,407,213, US 6,719,971, US 6,800,738, US2004 / 0236078A1, US 5,648,237, US 6,267,958, US 6,685,940, US 6,821,515, WO98 / 17797, US 6,127,526, US 6,333,398, US 6,797,814, US 6,339,142, US 6,417,335, US 6,489,447, WO99 / 31140, US2003 / 0147884A1, US2003 / 0170234A1, US2005 / 0002928A1, US 6,573 .043,
US2003 / 0152987A1, WO99 / 48527, US2002 / 0141993A1, W001 / 00245,
US2003 / 0086924, US2004 / 0013667A1, WO00 / 69460, WO01 / 00238,
W001 / 15730, US 6.627.196B1, US6.632.979B1, W001 / 00244,
US2002 / 0090662A1, WO01 / 89566, US2002 / 0064785, US2003 / 0134344, WO 04/24866, US2004 / 0082047, US2003 / 0175845A1, W003 / 087131,
US2003 / 0228663, W02004 / 008099A2, US2004 / 0106161, W02004 / 048525, US2004 / 0258685A1, US 5,985,553, US 5,747,261, US 4,935,341, US 5,401,638, US 5,604,107, WO 87/07646, WO 89/10412, WO 91/05264, EP
412,116 B1, EP 494,135 B1, US 5,824,311, EP 444,181 B1, EP 1,006,194 A2, US 2002 / 0155527A1, WO 91/02062, US 5,571,894, US 5,939,531, EP 502,812 B1, WO 93/03741 , EP 554,441 B1, EP 656,367 A1, US 5,288,477, US 5,514,554, US 5,587,458, WO 93/12220, WO 93/16185, US 5,877,305, WO 93/21319, WO 93/21232, US 5,856,089, WO 94/22478, US 5,910,486, US 6,028,059, WO 96/07321, US 5,804,396, US 5,846,749, EP 711,565, WO 96/16673, US 5,783,404, US 5,977. 322, US 6,512,097, WO 97/00271, US 6,270,765, US 6,395,272, US 5,837,243, WO 96/40789, US 5,783,186, US 6,458,356, WO 97/20858, WO 97/38731, US 6,214,388, US 5,925,519, WO 98/02463, US 5,922,845, WO 98/18489, WO 98/33914, US 5,994,071, WO 98/45479, US 6,358,682 B1, US 2003/0059790, WO 99/55367, WO 01/20033, US 2002/0076695 A1, WO 00/78347, WO 01/09187, WO 01/21192, WO 01/32155, WO 01/53354, WO 01/56604, WO 01/76630, W002 / 05791, WO 02/11677, US 6,582,919 , US2002 / 0192652A1, US 2003 / 0211530A1, WO 02/44413, US 2002/0142328, US 6,602,670 B2, WO 02/45653, WO 02/055106, US 2003/0152572, US 2003/0165840, WO 02/087619, WO 03/006509, W003 / 012072, WO 03/028638, US
2003/0068318, WO 03/041736, EP 1,357,132, US 2003/0202973, US 2004/0138160, US 5,705,157, US 6,123,939. EP 616,812 B1. US
2003/0103973, US 2003/0108545, US 6,403,630 BI, WO 00/61145, WO 00/61185, US 6,333,348 BI, WO 01/05425, WO 01/64246, US 2003/0022918, US 2002/0051785 Al, US 6,767,541, WO 01/76586, US 2003/0144252, WO 01/87336, US 2002/0031515 Al, WO 01/87334,
W002 / 05791, W002 / 09754, US 2003/0157097, US 2002/0076408, WO
02/055106, WO 02/070008, WO 02/089842 and WO 03/86467.
Diagnosis
Patients treated with the HER2 trastuzumab antibody are selected for therapy based on overexpression / amplification. See, for example, WO99 / 31140 (Paton eia /), US2003 / 0170234A1 (Hellmann, S.), and US2003 / 0147884 (Paton et al.); as well as WO01 / 89566,
US2002 / 0064785, and US2003 / 0134344 (Mass et al). See also US2003 / 0152987, Cohen et al, for immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) to detect HER2 overexpression and amplification.
W02004 / 053497 and US2004 / 024815A1 (Bacus et al), as well as US 2003/0190689 (Crosby and Smith), refer to the determined or predicted response to trastuzumab therapy. US2004 / 013297A1 (Bacus et al.) Refers to the response determined or predicted to therapy with the antibody ABX0303 EG20 FR. W02004 / 000094 (Bacus et al.) Targets the determined response to GW572016, a small molecule, EGFRHER2 tyrosine kinase inhibitor. W02004 / 063709, Amler et al, refers to biomarkers and methods for determining sensitivity to the EGFR inhibitor, erlotinib HCI. US2004 / 0209290, Cobleigh et al., Refers to gene expression markers for breast cancer prognosis.
Patients treated with pertuzumab can be selected for therapy based on HER2 activation or dimerization. Patent publications that refer to pertuzumab and the selection of patients for therapy with it include: WO01 / 00245 (Adams et al); US2003 / 0086924 (Sliwkowski, M.); US2004 / 0013667A1 (Sliwkowski, M.); as
W02004 / 008099A2, and US2004 / 0106161 (Bossenmaier et al).
Cronin et al., Am. J. Path. 164: (1): 35-42 (2004) describe the measurement of gene expression in archived tissues embedded in paraffin. Ma et al., Cancer Cell 5: 607-616 (2004) describe the definition of the gene profile for gene oligonucleotide microarrays using RNA isolated from sections of tumor tissue taken from archived primary biopsies.
Pertuzumab (also known as recombinant human monoclonal antibody 2C4; OMNITARG®, Genentech, Inc., South San Francisco) represents the first of a new class of agents known as HER dimerization inhibitors (HDI) and works by inhibiting HER2's ability to form active heterodimers with other HER receptors (such as EGFR / HER1, HER3 and HER4) and is active regardless of HER2 expression levels. See, for example, Harari and Yarden, Oncogene 19: 6102-14 (2000; Yarden and Sliwkowski Nat Rev Mol Cell Biol, 2: 127-37 (2001); Sliwkowski Nat Strcut Biol 10: 158-9 (2003); Cho , et al., Nature 421,756-60 (2003); and Malik, et al. Pro Am Soc Cancer Res 44: 176-7 (2003).
Pertuzumab blockade of HER2-HER3 heterodimer formation in tumor cells has been shown to inhibit critical cell signaling, resulting in reduced tumor proliferation and survival (Agus et al., Cancer Cell 2: 127-37 (2002)).
Pertuzumab has been tested as a single agent in the clinic with a phase Ia test in patients with advanced cancers and phase II tests in patients with ovarian cancer and breast cancer as well as lung and prostate cancer. In the Phase I study, patients with locally advanced, recurrent or metastatic incurable solid tumors that progressed during or after standard therapy were treated with pertuzumab administered intravenously every 3 weeks. Pertuzumab was generally well tolerated. Tumor regression was achieved in 3 of the 20 patients evaluable for the response. Two patients had confirmed partial responses. Stable disease lasting more than 2.5 months was observed in 6 out of 21 patients (Agus et al., Pro. Am. Soc. Clin. Oncol. 22: 192 (2003)). At doses of 2.0 to 15 mg / kg, the pharmacokinetics of pertuzumab were linear and the mean clearance varied between 2.69 to 3.74 ml / day / kg and the mean half-life of final elimination varied between 15.3 to 27.6 days. Antibodies to per9 tuzumab were not detected (Allison et al., Pro. Am. Soc. Clin. Oncol. 22: 197 (2003)).
Sergina et al. Reported that the biological marker used to evaluate the effectiveness of HER tyrosine kinase inhibitors (TKIs) could be transfosphorylation instead of HER3 autophosphorylation. Sergina et al., Nature 445 (7126): 437-441 (2007).
Jazaeri et al., Evaluated the gene expression profiles associated with the response to chemotherapy in cancers of the ovarian epithelium. Jazaeri et al., Clin. Cancer Res. 11 (17): 6300-6310 (2005).
Tanner et al. report that HER3 predicts survival in ovarian cancer. Tanner et al. J. Clin. Oncol. 24 (26): 4317-4323 (2006).
Summary of the Invention
This request refers, at least in part, to the surprising observation that cancer patients (eg, patients with ovarian cancer), whose cancer expresses HER3 at a low level, respond better to clinical trials in humans to an inhibitor of HER dimerization than those patients whose cancer expresses HER3 at a high level. Generally, such patients have a high HER2: HER3 ratio (due to the low level of HER3), thereby assessing that the relative levels of both HER2 and HER3 provide an additional or alternative means of selecting patients for therapy with an HER3 inhibitor. dimerization of HER.
Thus, the invention relates, in a first aspect, to a method for treating a patient with a type of cancer that is capable of responding to an HER inhibitor, comprising administering a therapeutically effective amount of an HER inhibitor to the patient, where the patient's cancer expresses HER3 at a lower level than the median level of HER3 expression in this type of cancer. Examples of contemplated HER inhibitors include antibodies to HER or small molecule inhibitors; antibodies to HER or small molecule inhibitors; tyrosine kinase inhibitors that include but are not limited to lapatinib, Tykerb, etc. Most preferably, the HER inhibitor is an inhibitor of dimerization of
HER. Accordingly, the invention provides a method for treating a patient with a type of cancer that is capable of responding to an HER dimerization inhibitor, comprising administering a therapeutically effective amount of an HER dimerization inhibitor to the patient, in which the cancer of the patient expresses HER3 at a lower level than the median level of HER expression in cancer.
According to this modality, preferably, the patient's cancer expresses HER3 at a level that is less than the 25th percentile of HER3 expression in the type of cancer. Optionally, such cancer of the patient expresses HER2.HER3 at a level greater than the 25th percentile, preferably greater than the median level and most preferably greater than the 75th percentile of HER2.HER3 expression in the type of cancer. The preferred assay for measuring HER3 (and HER2) expression comprises the polymerase chain reaction (PCR), more preferably the real-time quantitative polymerase chain reaction (qRT-PCR).
Preferably, the HER dimerization inhibitor is an antibody, more preferably an HER2 antibody, such as pertuzumab.
Preferably, the type of cancer to be treated or diagnosed here is selected from the group consisting of ovarian cancer, peritoneal cancer, fallopian tube cancer, metastatic breast cancer (MBC), non-small cell lung cancer (NSCLC), prostate cancer and colorectal cancer. Most preferably, the type of cancer treated or diagnosed here is ovarian cancer, peritoneal cancer or fallopian tube cancer. The type of cancer can be chemotherapy resistant, platinum resistant, advanced, refractory and / or recurrent. The method can prolong survival, including progression-free survival (PFS) and overall patient survival (OS).
The HER inhibitor can be administered as a single anti-tumor agent or can be combined with one or more other therapies. In one embodiment, the HER inhibitor is administered with one or more chemotherapeutic agents, such as gemcitabine, carboplatin, paclitaxel, topotecan and liposomal doxorubicin and preferably an antimetabolite. such as gemcitabine. The HER inhibitor can also be combined with trastuzumab, erlotinib or bevacizumab.
In a further aspect, the invention relates to a method for treating a patient with ovarian, peritoneal or fallopian tube cancer, comprising administering a therapeutically effective amount of pertuzumab to the patient, wherein the patient's cancer expresses HER3 at a lower level than the median level of HER expression in ovarian, peritoneal or fallopian tube cancer.
The invention further relates to a method for selecting a therapy for a patient with a type of cancer that is capable of responding to an HER inhibitor (for example, an HER dimerization inhibitor) comprising determining the expression of HER in a sample of the patient's cancer and select an HER inhibitor (for example, an HER dimerization inhibitor) as therapy if the cancer sample expresses HER3 at a lower level than the median level of HER3 expression in the cancer type.
In addition, the invention provides a manufacturing article comprising, in the same package, a pharmaceutical composition comprising an HER dimerization inhibitor in a pharmaceutically acceptable carrier and a seal determining that the inhibitor or pharmaceutical composition is indicated to treat a patient with a type of cancer that is able to respond to an inhibitor of HER dimerization, where the patient's cancer expresses HER3 at a lower level than the median level of HER3 expression in the type of cancer.
In another aspect, the invention relates to a method for the manufacture of an HER dimerization inhibitor or a pharmaceutical composition thereof comprising the combination, in a package, of the inhibitor or pharmaceutical composition and a seal indicating that the inhibitor or pharmaceutical composition is indicated (a) for the treatment of a patient with a type of cancer that is capable of responding to an HER dimerization inhibitor, where the patient's cancer expresses HER3 at a level below the average level of HER3 expression in the type of cancer.
In yet another embodiment, the invention provides a method for advertising an HER dimerization inhibitor or a pharmaceutically acceptable composition thereof, comprising offering, to a target audience, the use of the HER dimerization inhibitor or a pharmaceutical composition thereof to treat a population of patients with a type of cancer, where the patient's cancer expresses HER3 at a lower level than the median level of HER3 expression in the cancer type.
Apart from the inventions above, human clinical data provided here demonstrated that cancer patients (eg, patients with ovarian cancer) whose cancer expresses HER3 at a high level, have a better clinical response to a therapeutic agent, such as gemcitabine, than those patients whose cancer expresses HER3 at a low level.
With respect to this additional aspect of the invention, the invention provides a method for selecting a therapy for a patient with a type of cancer that is capable of responding to a chemotherapeutic agent comprising determining the expression of HER3 in the patient's cancer sample and selecting a chemotherapeutic agent such as therapy, if the cancer sample expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer. Preferably, the type of cancer is ovarian, peritoneal or fallopian tube cancer, including platinum-resistant ovarian, peritoneal or fallopian tube cancer, as well as advanced, refractory, or recurrent cancer. Preferably, the selected chemotherapeutic agent is an antimetabolite, such as gemcitabine.
The invention also relates to a method for treating a patient with a type of cancer that is capable of responding to a chemotherapeutic agent, comprising administering a therapeutically effective amount of a chemotherapeutic agent to the patient, wherein the patient's cancer expresses HER3 in a higher level than the median level of HER3 expression in the type of cancer. Preferably, the patient's cancer expresses HER3 at a level greater than the 25th percentile of HER3 expression in the type of cancer. The preferred assay for measuring HER3 expression comprises the polymerase chain reaction (PCR), more preferably the real-time quantitative polymerase chain reaction (qRT-PCR).
Preferably, the chemotherapeutic agent is an antimetabolite, more preferably gemcitabine.
Preferably, the type of cancer to be treated or diagnosed according to this additional aspect of the invention is ovarian cancer, peritoneal cancer or fallopian tube cancer. The type of cancer can be chemotherapy resistant, platinum resistant, advanced, refractory and / or recurrent. The method can extend survival, including progression-free survival (PFS) and overall patient survival (OS).
In a further aspect, the invention relates to a method for treating a patient with ovarian, peritoneal or fallopian tube cancer comprising administering a therapeutically effective amount of gemcitabine to the patient, wherein the patient's cancer expresses HER3 at a higher level than than the median level of HER3 expression in ovarian, peritoneal or fallopian tube cancer.
The invention also provides a manufacturing article comprising, in the same package, a pharmaceutical composition comprising a chemotherapeutic agent (such as gemcitabine) in a pharmaceutically acceptable carrier and a seal determining that the chemotherapeutic agent or pharmaceutical composition is indicated to treat a patient with a type of cancer, in which the patient's cancer expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer.
In a still further aspect, the invention relates to a method for producing a chemotherapeutic agent (such as gemcitabine) or a pharmaceutical composition thereof comprising combining in a package the chemotherapeutic agent or pharmaceutical composition and a seal determining that the chemotherapeutic agent or pharmaceutical composition are indicated to treat a patient with a type of cancer, in which the patient's cancer expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer.
In yet another embodiment, the invention provides a method for advertising a chemotherapeutic agent or its pharmaceutically acceptable composition, comprising promoting, to a target audience, the use of the chemotherapeutic agent or its pharmaceutical composition to treat a population of patients with a type of cancer, where the patient's cancer expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer.
The present application provides clinical data from humans demonstrating that patients with high HER2: HER3 expression respond more favorably to an HER inhibitor, such as pertuzumab. Thus, the invention provides, in another aspect, a means to select patients by assessing the levels of HER2 and HER3 expression and to exclude from therapy those patients whose cancer expresses HER2: HER3 at a low level.
Thus, the invention also relates to a method for treating a patient with a type of cancer that is capable of responding to an HER inhibitor, comprising administering a therapeutically effective amount of an HER inhibitor to a patient, in which the cancer of the patient expresses HER2.HER3 at a level that is greater than the 25th percentile of HER2: HER3 expression in the type of cancer. Preferably, the patient's cancer expresses HER2.HER3 at a level that is greater than average and, most preferably, greater than the 75th percentile of HER2: HER3 expression in the type of cancer.
In addition, a method is provided to treat a patient with ovarian, peritoneal or fallopian tube cancer, the method of which is to administer a therapeutically effective amount of pertuzumab to the patient, where the patient's cancer expresses HER2: HER3 at a level that is greater than the 25th percentile of HER2: HER3 expression in ovarian, peritoneal or fallopian tube cancer.
In another aspect, the invention relates to a method for selecting a therapy for a patient with a type of cancer that is capable of responding to an HER inhibitor, comprising determining the expression of HER2 and HER3 in the patient's cancer sample and select an HER inhibitor as therapy if the cancer sample expresses HER2.HER3 at a level that is greater than the 25th percentile of HER2: HER3 expression in the type of cancer.
The invention also relates to an article of manufacture comprising, in the same package, a pharmaceutical composition comprising an HER inhibitor in a pharmaceutically acceptable carrier and a seal determining that the inhibitor or pharmaceutical composition is indicated to treat a patient with a type of cancer that is able to respond to an HER inhibitor, in which the patient's cancer expresses HER2: HER3 at a level greater than the 25th percentile of HER2: HER3 expression in the type of cancer.
In addition, the invention provides a method for making an HER inhibitor or a pharmaceutical composition thereof, comprising combining the inhibitor or pharmaceutical composition in a package and a seal that determines that the inhibitor or pharmaceutical composition is indicated for treating a patient with a type of cancer that is able to respond to the HER inhibitor, where the patient's cancer expresses HER2: HER3 at a level that is greater than the 25th percentile of HER2.HER3 expression in the type of cancer.
In addition, the invention relates to a method for advertising an HER inhibitor or its pharmaceutically acceptable composition, comprising promoting, to a target audience, the use of the HER inhibitor or its pharmaceutical composition to treat a population of patients with a type of cancer, where the patient's cancer expresses HER2: HER3 at a level greater than the 25th percentile of HER2: HER3 expression in the type of cancer.
Brief Description of the Figures
Figure 1 provides a schematic of the structure of the HER2 protein and the amino acid sequences for Domains 1-IV (SEQ ID NO: 19-22, respectively) of its extracellular domain.
Figures 2A and 2B describe the amino acid sequence alignments of the light variable domains (V<sub>L</sub>) (Figure 2A) and heavy variable (V<sub>H</sub>) (Fiqura 2B) murine monoclonal antibody 2C4 (SEQ ID NO: 1 and 2, respectively); domains V<sub>L</sub>and V<sub>H</sub> variant 574 / pertuzumab (SEQ ID N ° 3 and 4, respectively) and V consensus structural regions<sub>L</sub> ev<sub>H</sub> human (hum k1, subgroup I of light kappa; humlll, subgroup lll heavy) (SEQ ID NO: 5 and 6, respectively). Asterisks identify the differences between the pertuzumab variable domains and the murine monoclonal antibody 2C4 or between the pertuzumab variable domains and the human structural region. The Complementarity Determining Regions (CDRs) are in parentheses.
Figure 3A and 3B show the light chain (Figure 3A; SEQ ID No. 13) and heavy chain (Figure 3B; SEQ ID No. 14) amino acid sequences of pertuzumab. CDRs are shown in bold. The calculated molecular mass of the light chain and the heavy chain are 23,526.22 Da and 49,216.56 DA (cysteines in reduced form). The carbohydrate portion is coupled to Asn 299 of the heavy chain.
Figure 4 schematically describes the binding of 2C4 to the heterodimeric binding site of HER2, thereby preventing heterodimerization with activated EGFR or HER3.
Figure 5 describes the coupling of HER2 / HER3 to the MAPK and Akt pathways.
Figure 6 compares the various activities of trastuzumab and pertuzumab.
Figure 7A and 7B show the amino acid sequences of the light chain (Figure 7A; SEQ ID NO: 15) and the heavy chain (Figure 7B; SEQ ID NO: 16) of trastuzumab, respectively.
Figures 8A and 8B depict a pertuzumab light chain sequence variant (Figure 8A; SEQ ID NO: 17) and a pertuzumab heavy chain variant (Figure 8B; SEQ ID No. 18), respectively.
Figure 9 describes the planning / scheme for the clinical test in Example 1 involving patients with platinum-resistant, primary peritoneal or fallopian tube carcinoma treated with both gemcitabine and placebo as well as gemcitabine and pertuzumab.
Figure 10A describes progression-free survival (PFS) for all patients in the Example 1 study.
Figure 10B is an updated version of Figure 10A. PFS was estimated using the stratified Cox model and the log-rank test stratified by stratification factors by randomization (ECOG PS, number of previous regions for platinum-resistant disease and disease measurability).
Figure 11A represents PFS by the predicted situation of pHER2. Figure 11B is an updated version of Figure 11 A.
Fig, 12A represents PFS by the cutoff points of qRT-PCR of
EGFR (HERI).
Figure 12B is another representation of the EGFR wRTPCR cutoff points (HER1), also indicating the number of individuals in the HER1 (High) and HER1 (Low) groups at various EGFR cutoff values.
Figure 13 A represents PFS by cut-off points of qRT-PCR of
HER2.
Figure 13 B is another representation of PFS by the cutoff points of HER2's qRT-PCR, also indicating the number of individuals in the HER1 (High) and HER1 (Low) groups at various cutoff values of
HER2.
Figure 14A represents PFS by the HER3 qRT-PCR cutoff points.
Figure 14B is another representation of PFS by the HER3 qRT-PCR cutoff points, also indicating the number of individuals in the HER3 (High) and HER3 (Low) groups at various HER3 cutoff values.
Figure 15A shows PFS for subgroups of HER3. Pertuzumab activity is much higher in patients with tumors that express low Her3 and tends to increase as the level of expression of the HER3 gene decreases.
Figure 15B is another representation of PFS by the HER3 qRTPCR levels.
Figure 16A demonstrates PFS by subgroups of HER3. The data show that there may be a negative interaction between pertuzumab and gemcitabine in patients with tumors that express high Her3.
Figure 16B is another representation of PFS by the HER3 qRTPCR levels. The data further confirm that there may be a negative interaction between pertuzumab and gemcitabine in patients with tumors that express high Her3.
Figure 17A summarizes PFS for subgroups of HER3; subgroup with high HER3 expression and subgroup with low HER3 expression.
Figure 17B is an updated version of PFS by the HER3 qRT-PCR levels shown in Figure 17A.
Figure 18A further demonstrates PFS for subgroups of HER3.
Figure 18B is an updated version of the PFS analysis by HER3 expression quartiles, shown in Figure 18A.
Figure 19A shows PFS by HER3 qRT-PCR with a 50/50 split; with low HER3 expression in less than the 50th percentile and high HER3 expression in more than or equal to the 50th percentile.
Figure 19B is an updated version of PFS by HER3 qRT-PCR with a 50/50 split, shown in Figure 9A.
Figure 20A shows PFS by HER3 qRT-PCR with a 25/75 split; with low expression of HER3 at less than the 25th percentile and high expression of HER3 at more than or equal to the 25th percentile.
Figure 20B is an updated version of PFS by HER3 qRT-PCR with a 25/75 split, shown in Figure 20A.
Figure 21A shows preliminary data on overall survival (OS) in all patients. Data based on 46/130 events.
Figure 21B is an updated graph of OS data, estimated stratified Cox model and log-rank test stratified by stratification factors by randomization (ECOG PS, number of previous regimens for platinum-resistant disease and disease measurability).
Figure 22A illustrates preliminary data for OS by HER3 qRT-PCR. Data based on 43/119 events.
Figure 22B is an updated graph of OS data per HER3 qRTPCR with a 50/50 split, with low HER3 expression at less than the 50th percentile and high HER3 expression at more than or equal to the 25th percentile .
Figure 23A demonstrates PFS by HER3 qRT-PCR comparing high versus low risk (HR) rates.
Figure 23B is an updated graph of PFS by HER3 qRT-PCR comparing high versus low risk (HR) rates.
Figure 24A shows the complete data set for platinum-resistant ovarian cancer pertuzumab in Example 1, with PFS by HER3 qRTPCR. Note: The p-values of HR and Log-rank were not adjusted for multiple comparison.
Figure 24B is another group of data for platinum-resistant ovarian cancer pertuzumab, with PFS by HER3 qRT-PCR. As in Figure 24A, the HR and Log-rank p values were not adjusted for multiple comparison.
Figure 25 shows PFS and OS by HER3 qRT-PCR for patients treated as in Example 2 with pertuzumab as a single agent. Patients with high Her3 were those with more than or equal to the 75th percentile; patients with low Her3 were those with less than the 75th percentile. The median survival for patients with low expression was 1.31 years (95% CI, 1.93-4.69); the median survival for patients expressing high Her3 was 1.80 years (95% CI, 0.83 to 2.78).
Figure 26A shows the calibrated normalized proportion of HER3; the expression range is about 20 to 80 times. CPs are between 23 and 30 for most samples.
Figure 26B is another figure showing the calibrated normalized proportion of HER3; the expression range is about 20 to 80 times. CPs are between 23 and 30 for most samples.
Figure 27 shows the process sequence of the in vitro diagnostic assay (IVD) by pertuzumab qRT-PCR in LIGHTCYCLER® 2.0.
Figure 28 shows the analysis and process sequence of the IVD exit of pertuzumab with a marker and reference.
Figure 29A provides PFS by the HER2.HER3 percentiles for patients treated in Example 1.
Figure 29B is another figure that shows PFS by the percentiles of
HER2.HER3 for patients treated in Example 1. Note: The p-values of HRs and Log-rank were not adjusted for multiple comparison.
Figure 30A evaluates PFS by the HER2: HER3 ratio for Example 1 using Kaplan Meyer plots specifically for patients with HER2 to HER3 ratios greater than average or greater than 75th percentile.
Figure 30B is an update showing PFS for the HER2: HER3 ratio for Example 1 using Kaplan Meyer plots specifically for patients with HER2 to HER3 ratios greater than average or greater than the 75th percentile.
Figure 31A evaluates PFS for the quartile subgroups of the HER2: HER3 ratio, again from Example 1.
Figure 31B is another summary of PFS analysis by HER2: HER3 quartiles of recurrent ovarian cancer.
Figure 32 shows Kaplan-Meier plots for PFS of individuals with ovarian cancer who have lower than average HER3 levels and equal to or greater than average, respectively, treated as described in Example 3.
Figure 33 shows a Kaplan-Meier plot for PFS of individuals with ovarian cancer, treated with chemotherapy or pertuzumab in a group of patients with HER3 levels below average or equal to or greater than average, respectively.
Figure 34 shows Kaplan-Meier graphs for individuals with ovarian cancer, treated with pertuzumab and chemotherapy or just pertuzumab, with proportions of HER2.HER3 below average and equal to or greater than average, respectively.
Figure 35 shows a Kaplan-Meier graph for individuals with ovarian cancer, treated with chemotherapy or pertuzumab, with portions of HER2: HER3 below average and equal to or greater than average, respectively.
Detailed Description of Preferred Modalities
I. Definitions
An HER receptor is a receptor for the protein tyrosine kinase that belongs to the HER receptor family and includes the EGFR, HER2, HER3 and HER4 receptors. The HER receptor will generally comprise an extracellular domain, which can bind to an HER ligand and / or dimerize with another HER receptor molecule; a lipophilic transmembrane domain; a conserved intracellular tyrosine kinase domain; and a terminal carboxyl signaling domain housing various tyrosine residues that can be phosphorylated. The HER receptor can be a native HER receptor sequence or a variant amino acid sequence thereof. Preferably, the HER receptor is a native sequence of the human HER receptor.
The expressions ErbB1 ”, HER1, epidermal growth factor receptor and EGFR are used here interchangeably and refer to EGFR as described, for example, in Carpenter et al. Ann. Rev. Biochem. 56: 881-914 (1987), including naturally occurring mutant forms of the same (for example, a mutant EGFR by deletion, as in Humphrey et al. PNAS (USA) 87: 4207-4211 (1990)). erbB1 refers to the gene that encodes the EGFR protein product.
The expressions ErbB2 and HER2 are used interchangeably here and refer to the human HER2 protein described, for example, in Semba et al., PNAS (USA) 82: 6497-6501 (1985) and Yamamoto et al. Nature 319: 230-234 (1986) (Genebank accession number X03363). The term erbB2 refers to the gene that encodes human ErbB2 and neu refers to the gene that encodes p185<sup>neu</sup> of rat. The preferred HER2 is the native human HER2 sequence.
Extracellular domains of HER2 or HER2 ECD refer here to an HER2 domain that is outside a cell, both anchored to a cell membrane and in circulation, including its fragments. In one embodiment, the HER2 extracellular domain can comprise four domains: Domain I (amino acid residues between about 1 to 195; SEQ ID NO: 19), Domain II (amino acid residues between about 320 to 488; SEQ ID N ° 20), Domain lll (amino acid residues between about 1 to 195; SEQ ID No. 21) and Domain IV (amino acid residues between about 489 to 630; SEQ ID No. 22) (residue numbering without peptide from signal). See Garrett et al. Mol. Cell. 11: 495-505 (2003), Cho et al. Nature 421: 756760 (2003), Franklin et al. Cancer Cell 5: 317-328 (2004), and Plowman et a! Proc. Natí. Acad. I know 90: 1746-1750 (1993) as well as Figure 1.
ErbB3 and HER3 refer to the receptor polypeptide as described, for example, in US Patent Nos. 5,183,884 and 5,480,968 as well as Kraus et al. PNAS (USA) 86: 9193-9197 (1989).
The expressions ErbB4 and HER4 refer here to the receptor polypeptide as described, for example, in Patent Application No. EP 599,274; Plowman et al, Proc. Natl. Acad. Sci USA, 90: 1746-1750 (1993); and Plowman et al, Nature, 366: 473-475 (1993), including their isoforms, for example, as described in WO99 / 19488, published on April 22, 1999.
By HER linker is meant a polypeptide that binds and / or activates an HER receptor. The HER ligand of particular interest here is a native sequence of human HER ligand such as epidermal growth factor (EGF) (Savage et al, J. Biol. Chem. 247: 7612-7621 (1972)); alpha growth transforming factor (TGF-α) (Marquardt et al, Science 223: 1079-1082 (1984)); amphirregulin also known as schwannoma or keratinocyte autocrine growth factor (Shoyab et al. Science 243: 1074-1076 (1989); Kimura et al Nature 348: 257-260 (1990); and Cook et al Mol Cell. Bi 11: 2547-2557 (1991)); beta-cellulin (Shing et al, Science 259: 1604-1607 (1993); and Sasada et al Biochem. Biophys. Res. Commun. 190: 1173 (1993)); heparin-binding epidermal growth factor (HB-EGF) (Higashiyama et al, Science 251: 936-939 (1991)); epiregulin (Toyoda et al, J. Biol. Chem. 270: 7495-7500 (1995); and Komurasaki et al Oncogene 15: 2841-2848 (1997)); a heregulin (see below); neuregulin-2 (NRG-2) (Carraway et al, Nature 387: 512-516 (1997)); neureklin-3 (NRG-3) (Zhang et al, Proc. Natl. Acad. Sci 94: 9562-9567 (1997)); neuregulin-4 (NRG-4) (Harari et al Oncogene 18: 2681-89 (1999)); and crypto (CR-I) (Kannan et al J. Biol. Chem. 272 (6): 3330-3335 (1997)). HER ligands that bind to EGFR include EGF, TGF-α amphirregulin, beta-cellulin, HB-EGF and epiregulin. HER ligands that bind to HER3 include heregulins. HER ligands capable of binding to HER4 include beta-cellulin, epiregulin, HB-EGF, NRG-2, NRG-3, NRG-4 and heregulins.
Heregulin (HRG) when used here refers to a polypeptide encoded by the heregulin gene product as described in US Patent No. 5,641,869, or Marchionni et al, Nature, 362: 312-318 (1993). Examples of heregulins include heregulin-a, heregulin-βΐ, heregulin-p2 and heregulin-p3 (Holmes et al, Science, 256: 1205-1210 (1992); and US Patent No. 5,641,869); neu differentiation factor (NDF) (Peles et al Cell 69: 205-216 (1992)); acetylcholine receptor (ARIA) activity inducer (Falis et al Cell 72: 801-815 (1993)); glial growth factors (GGFs) (Marchionni et al, Nature, 362: 312-318 (1993)); factors derived from sensory and motor neuron (SMDF) (Ho et al J. Biol. Chem. 270: 14523-14532 (1995)); γ-heregulin (Schaefer et al. Oncogene 15: 1385-1394 (1997)).
A HER dimer is a non-covalently associated dimer comprising at least two HER receptors. Such complexes can form when a cell that expresses two or more HER receptors is exposed to an HER ligand and can be isolated by immunoprecipitation and analyzed by SDS-PAGE as described in Sliwkowski et al, J. Biol. Chem., 269 (20): 14661-14665 (1994), for example. Other proteins, such as a cytokine receptor subunit (for example, gp130) can be associated with the dimer. Preferably, the HER dimer comprises HER2.
A HER heterodimer ”is a non-covalently associated heterodimer comprising at least two different HER receptors, such as the EGFR-HER2, HER2-HER3 or HER2HER4 heterodimers.
An HER inhibitor is an agent that interferes with HER activation or function. Examples of HER inhibitors include antiHER antibodies (for example, antibodies to EGFR, HER2, HER3 or HER4); drugs targeted to EGFR; small molecule HER antagonists; tyrosine kinase HER inhibitors; dual tyrosine kinase inhibitors
HER2 and EGFR such as lapatinib / GW572016; antisense molecules (see, for example, W02004 / 87207); and / or binding agents, interfere with the function of downstream signaling molecules, such as MAPK or Akt (see Figure 5). Preferably, the HER inhibitor is an antibody or small molecule that binds to the HER receptor.
An HER dimerization inhibitor is an agent that inhibits the formation of a HER dimer or a HER heterodimer. Preferably, the HER dimerization inhibitor is an HER2 dimerization inhibitor and / or HER heterodimerization inhibitor. Preferably, the HER dimerization inhibitor is an antibody, for example, an antibody that binds HER2 at its heterodimeric binding site. The most preferred HER dimerization inhibitor is pertuzumab or Mab 2C4. The binding of 2C4 to the HER2 heterodimeric binding site is illustrated in Figure 4. Other examples of HER dimerization inhibitors include antibodies that bind to EGFR and inhibit their dimerization with one or more other HER receptors (for example, monoclonal antibody 806 anti-EGFR, Mab806, which binds to activated or unbound EGFR, see Johns et al., J. Biol. Chem. 279 (29): 30375-30384 (2004)); antibodies that bind to HER3 and inhibit its dimerization with one or more other HER receptors; antibodies that bind to HER4 and inhibit its dimerization with one or more other HER receptors; peptide dimerization inhibitors (US Patent No. 6,417,168); antisense dimerization inhibitors, etc.
An HER2 dimerization inhibitor is an agent that inhibits the formation of a dimer or heterodimer that comprises HER2.
An HER antibody is an antibody that binds to a receptor for
HER. Optionally, the HER antibody also interferes with HER activation or function. Preferably, the HER antibody binds to the HER2 receptor. An HER2 antibody of particular interest here is pertuzumab. Another example of an HER2 antibody is trastuzumab. Examples of antibodies to EGFR include cetuximab and ABX0303.
HER activation refers to the activation or phosphorylation of any one or more HER receptors. Generally, activation of HER results in signal transduction (for example, that caused by an intracellular kinase domain of an HER receptor that phosphorylates tyrosine residues in the HER receptor or a polypeptide substrate). HER activation can be mediated by an HER ligand that binds to an HER dimer that comprises the HER receptor of interest. The HER ligand that binds to an HER dimer can activate a kinase domain of one or more of the HER receptors on the dimer and thereby result in the phosphorylation of tyrosine residues on one or more of the HER receptors and / or phosphorylation of tyrosine residues in additional substrate polypeptides, such as the Akt or MAPK intracellular kinases, for example; see Figure 5.
Phosphorylation refers to the addition of one or more phosphate groups to a protein, such as an HER receptor or its substrate.
An antibody that inhibits HER dimerization is an antibody that inhibits or interferes with the formation of a HER dimer. Preferably, such an antibody binds HER2 at its heterodimeric binding site. The most preferred antibody that inhibits dimerization here is pertuzumab or Mab 2C4.
The binding of 2C4 to the HER2 heterodimeric binding site is illustrated in Figure 4. Other examples of antibodies that inhibit HER dimerization include antibodies that bind to EGFR and inhibit its dimerization with one or more other HER receptors (for example, monoclonal antibody 806 to EGFR, Mab 806, which binds to activated or unbound EGFR, see Johns et al., J. Biol. Chem. 279 (29): 30375-30384 (2004)); antibodies that bind to HER3 and inhibit its dimerization with one or more other HER receptors; antibodies that bind to HER4 and inhibit its dimerization with one or more other HER receptors.
An antibody that blocks the activation of the HER receptor fluid more efficiently than trastuzumab is one that reduces or eliminates the HER ligand activation of the HER receptors or HER dimer (s) more efficiently (for example, at least about 2 times more efficiently) than trastuzumab. Preferably, such an antibody blocks the activation of the HER ligand from an HER receptor at least as efficiently as the murine monoclonal antibody 2C4 or its Fab fragment, or as pertuzumab or its Fab fragment. An antibody's ability to block activation of a HER receptor ligand can be assessed by studying HER dimers directly or by assessing HER activation or downstream signaling that results from HER dimerization and / or evaluation of the antibody-HER2 binding site, etc. Assays for screening antibodies with the ability to inhibit ligand activation of an HER receptor more efficiently than trastuzumab are described in Agus et al. Cancer Cell 2: 127-137 (2002) and W001 / 00245 (Adams et al.). Just as an example, one can test for: inhibition of HER dimer formation (see, for example, Figure IA-B by Agus et al. Cancer Cell 2: 127-137 (2002); and WO01 / 00245); reduction in HER ligand activation in cells that express HER dimers (W001 / 00245 and Figure 2A-B by Agus et al. Cancer Cell 2: 127-137 (2002), for example); blocking HER ligand that binds to cells that express HER dimers (WO 01/00245, and Figure 2E by Agus et al. Cancer Cell 2: 127-137 (2002), for example); inhibition of cell growth of cancer cells (eg MCF7, MDA-MD-134, ZR-75-1, MD-MB-175, T-47D cells) that express HER dimers in the presence (or in the absence) of ligand de HER (W001 / 00245 and Figures 3A-D by Agus et al. Cancer Cell 2: 127-137 (2002), for example); inhibition of downstream signaling (for example, inhibition of HRG-dependent AKT phosphorylation or inhibition of HRG-dependent MAPK phosphorylation or TGF-α) (see, W001 / 00245, and Figure 2C-D by Agus et al. Cancer Cell 2: 127-137 (2002), for example). One can also assess whether the antibody inhibits HER dimerization by studying the antibody-HER2 binding site, for example, by evaluating a structure or model, such as a crystalline structure, of the HER2-bound antibody (See, for example). example, Franklin et at. Cancer Cell 5: 317-328 (2004)).
A HER2 heterodimeric binding site refers to a region in the extracellular domain of HER2 that contacts or connects through an interface with a region in the extracellular domain of EGFR, HER3 or HER4 after the formation of a dimer with them. The region is found in Domain II of HER2. Franklin et al. Cancer Cell 5: 317-328 (2004).
The HER2 antibody can inhibit HRG-dependent AKT phosphorylation and / or inhibit TGF-α or HRG-dependent MAPK phosphorylation more efficiently (for example, at least 2 times more efficiently) than trastuzumab (see Agus et al. Cancer Cell 2: 127-137 (2002) and W001 / 00245, for example).
The HER2 antibody may be one that, as pertuzumab, does not inhibit HER2 ectodomain dividing (Molina et al. Cancer Res. 61: 4744-4749 (2001)). Trastuzumab, on the other hand, can inhibit HER2 ectodomain dividing.
An HER antibody that binds to a HER2 heterodimeric binding site, binds to residues in domain II (and optionally also binds to residues in another of the domains of the extracellular domain of HER2, such as domains I and 11) and can prevent sterically, at least at some level, the formation of a HER2-EGFR, HER2-HER3 or HER2-HER4 heterodimer. Franklin et al. Cancer Cell 5: 317-328 (2004) characterized the crystal structure of HER2-pertuzumab, deposited in the RCSB Protein Data Bank (ID Code IS78), illustrating an exemplary antibody that binds to the HER2 heterodimeric binding site.
An antibody that binds to domain II of HER2, binds to residues in the li domain and optionally to residues of other HER2 domain (s), such as domains I and 11. Preferably, the antibody that binds domain II binds at the junction between HER2 domains I, II and 11.
Protein expression refers to the conversion of information encoded into a gene into messenger RNA (mRNA) and then into the protein.
A sample or cell that expresses a protein of interest (such as HER3 and / or HER2) is one in which the mRNA encoding the protein, or the protein, including its fragments, is determined to be present in the sample or cell.
A sample, cell, tumor or cancer that expresses HER3 at a level lower than the median level of HER3 expression in a type of cancer is one in which the level of HER3 expression is considered a low level of HER3 for an experienced person in that type of cancer. Generally, this level will be in the range of about 0 to less than 50%, in relation to the levels of HER3 in a population of samples, cells, tumors or cancers of the same type of cancer. For example, the population that is used to reach the median level of expression may be samples of ovarian cancer, generally, or its subgroups, such as chemotherapy-resistant ovarian cancer, platinum-resistant ovarian cancer, as well as advanced ovarian cancer, refractory or recurrent. The examples here demonstrate how the average expression level is determined. This can be an absolute value of expression. Thus, with reference to Figure 17 of the same, the cut-off point for patients with platinum-resistant ovarian cancer considered to express HER3 at a low level may be about 2.8 or less (less than the 60th percentile); about 2.41 or less (less than the 55th percentile); about 2.28 or less (less than the 50th percentile); about 1.88 or less (less than the 45th percentile); about 1.71 or less (less than the 40th percentile); about 1.57 or less (less than the 35th percentile); about 1.4 or less (less than the 30th percentile); about 1.19 or less (less than the 25th percentile); about 0.99 or less (less than the 20th percentile), etc. Such absolute values will be quantified in an assay under specific assay conditions, such as qRT-PCR described herein and, more preferably, the qRT-PCR assay as in Example 1. Preferably, the level of HER3 expression is less than the 50th percentile and more preferably less than the 30th or 25th percentile.
The expressions HER2: HER3 or HER2 to HER3 refer here to the level of expression of HER2 in relation to the level of expression of HER3 in a sample, cell, tumor or cancer. Such level of expression can be quantified using a variety of different techniques such as those described here. Although this can be calculated as a ratio of HER2 expression to HER3 expression, the present invention contemplates several other ways to assess HER2 and HER3 levels in order to select a patient for therapy, including, but not limited to use of a decision tree where patients are selected if their HER2 and / or HER3 expressions are above or below certain cutoff points, etc. Such various other means of comparing HER2 to HER3 are covered by the phrases HER2: HER3 or Her2 for HER3.
A sample, cell, tumor or cancer that expresses HER2.HER3 at a level that is greater than the 25th percentile of HER2: HER3 expression in a type of cancer, is one in which the ratio of HER2 expression to HER3 expression is not a low level of HER2: HER3 for that type of cancer. Preferably, such a level will be in the range of greater than about 25% to about 100%, in relation to the levels of HER2: HER3 in a population of samples, cells, tumors or cancers of the same type of cancer. For example, the population that is used to reach such levels of expression may be samples of ovarian cancer, generally, or its subgroups, such as chemotherapy-resistant ovarian cancer, platinum-resistant ovarian cancer, as well as advanced ovarian cancer, refractory or recurrent. The examples here demonstrate how the percentile of expression levels can be determined. In one embodiment, the level of HER2: HER3 constitutes an absolute value of expression. Thus, with reference to Figure 29, the cut-off point for platinum-resistant ovarian cancer patients who express HER2: HER3 at this level can be about 0.82 or more (greater than the 25th percentile); about 0.90 or more (greater than 30th percentile); about 1.06 or more (greater than 35th percentile); about 1.13 or more (greater than 40th percentile); about 1.26 or more (greater than 45th percentile); about 1.53 or more (greater than 50th percentile): about 1.70 or more (greater than 55th percentile);
about 1.86 or more (greater than 60th percentile); about 2.15 or more (greater than 65th percentile); about 2.49 or more (greater than 70th percentile); about 2.62 or more (greater than 75th percentile); about 2.92 or more (greater than 80th percentile), etc. Such absolute values can be quantified in an assay under specified assay conditions, such as qRT-PCR described herein and most preferably, the qRT-PCR assay as in Example 1. In one embodiment, the level of expression of HER2: HER3 is greater than the 50th percentile, preferably greater than the 70th percentile and most preferably greater than the 75th percentile. Patients whose cancer expresses HER2: HER3 at levels as described herein may or may not overexpress HER2.
The polymerase chain reaction or PCR ”technique as used here generally refers to a procedure in which minimal amounts of a specific piece of nucleic acid, RNA and / or DNA, are amplified as described in US Patent No. 4,683. 195 issued on July 28, 1987. Generally, sequence information from the ends of the region of interest or beyond, needs to be evaluated, such that oligonucieotide primers can be designated; these initiators will be identical or similar in sequence to the opposite strands of the model to be amplified. The 5 'terminal nucleotides of the two primers can match the ends of the amplified material. PCR can be used to amplify specific RNA sequences, specific DNA sequences from total genomic DNA and cDNA transcribed from total cellular RNA, bacteriophage or plasmid sequences, etc. See, Mullis et al., Cold Spring Harbor Symp.
Quant. Biol., 51: 263 (1987); Erlich, ed., PCR Technology (Stockton Press, NY, 1989). As used here, PCR is considered to be one, but not the only example of a nucleic acid polymerase chain reaction method for amplifying a nucleic acid test sample, which comprises the use of a known nucleic acid (DNA or RNA) as an initiator and which uses a nucleic acid polymerase to amplify or generate a specific piece of a nucleic acid or to amplify or generate a specific piece of nucleic acid which is complement to a particular nucleic acid.
Real-time quantitative polymerase chain reaction or qRT-PCR refers to a form of PCR in which the amount of PCR product is measured at each step in a PCR reaction. This technique has been described in several publications including Cronin et al., Am. J. Pathol. 164 (1): 35-42 (2004); and Ma et al., Cancer Cell 5: 607-616 (2004).
The term "microarray" refers to an ordered array of hybridizable array elements, preferably polynucleotide probes, on a substrate.
The term polynucleotide, when used in the singular or in the plural, generally refers to any polyribonucleotide or polydeoxyribonucleotide, which can be unmodified RNA or DNA or modified RNA or DNA. So for example, polynucleotides as defined here include, without limitation, single and double stranded DNA, DNA that includes single and double stranded regions, hybrid molecules comprising DNA and RNA that can be single stranded or, more typically, stranded double or include single and double strand regions. In addition, the term polynucleotide as used here refers to triple strand regions that comprise RNA or DNA or both RNA and DNA. The tapes in such regions can be of the same or different molecules. The regions can include everything from one or more of the molecules, but more typically they involve only one region of some of the molecules. One of the molecules in a triple helix region is usually an oligonucleotide. The term polynucleotide specifically includes cDNAs. The term includes DNAs (including cDNAs) and RNAs that contain one or more modified bases. Thus, DNAs or RNAs with modified frameworks for stability or for other reasons are polynucleotides as this expression is designated here. In addition, DNAs and RNAs that comprise unusual bases, such as inosine, or modified bases, such as tritiated bases, are included in the expression 'polynucleotides' as defined herein. In general, the term polynucleotide covers all chemically, enzymatically and / or metabolically modified forms of unmodified polynucleotides, as well as the chemical forms of DNA and RNA characteristic of viruses and cells, including simple and complex cells.
The term oligonucleotide refers to a relatively short polynucleotide, including, without limitation, single stranded deoxyribonucleotides, single or double stranded ribonucleotides, RNA: DNA and double stranded DNA. Oligonucleotides, such as single-stranded DNA oligonucleotide probes, are generally synthesized by chemical methods, for example, using automated oligonucleotide synthesizers that are commercially available. However, oligonucleotides can be made by a variety of other methods, including techniques mediated by recombinant DNA in vitro and by expression of DNAs in cells and organisms.
The phrase gene amplification refers to a process by which multiple copies of a gene or gene fragment are formed in a particular cell or cell line. The duplicated region (a strand of amplified DNA) is generally referred to as amplicon. Generally, the amount of messenger RNA (mRNA) produced also increases in proportion to the number of copies made of a particular expressed gene.
The stringency of hybridization reactions is readily determinable by the person skilled in the art and is generally an empirical calculation dependent on the length of the probe, washing temperature and salt concentration. In general, longer probes require higher temperatures for the appropriate annealing, while shorter probes require lower temperatures. Hybridization generally depends on the ability of denatured DNA to reseal when complementary strands are present in an environment below their melting temperatures. The greater the degree of desired homology between the probe and the hybridizable sequence, the higher the relative temperature that can be used. As a result, it is observed that higher relative temperatures will tend to make the reaction conditions more stringent, while lower temperatures will tend to make the reaction conditions less stringent. For further details and explanations of the stringency of hybridization reactions, see Ausubel et al., Current Protocols in Molecular Biology, Wiley Interscience Publishers (1995).
Stringent conditions or high stringency conditions, as defined here, typically: (1) employ low ionic strength and high washing temperature, for example, 0.015M sodium chloride / 0.0015M sodium citrate / sodium dodecyl sulfate a 0.1% at 50 ° C; (2) employ a denaturing agent during hybridization, such as formamide, for example 50% formamide (v / v) with 0.1% bovine serum albumin / 0.1% Ficoll / 0.1% polyvinylpyrrolidone / 50 mM sodium phosphate buffer at pH 6.5 with 750 mM sodium chloride, 75 mM sodium citrate at 42 ° C; or (3) employ 50% formamide, 5 x SSC (0.75 M NaCI, 0.075 M sodium citrate), 50 mM sodium phosphate (pH 6.8), 0.1% sodium pyrophosphate, 5 x Denhardt's solution, sonicated salmon sperm DNA (50 mg / ml), 0.1% SDS and 10% dextran sulfate at 42 ° C, with washes at 42 ° C in 0.2 x SSC (chloride of sodium / sodium citrate) and 50% formamide at 55 ° C, followed by a high stringency wash consisting of 0.1 x SSC containing EDTA at 55 ° C.
Moderately stringent conditions can be identified as described in Sambrook et a /., Molecular Ctoning: A Laboratory Manual, New York: Cold Spring Harbor Press, 1989, and include the use of a washing solution and hybridization conditions (for example, temperature , ionic strength and% SDS) less stringent than those described above. An example of moderately stringent conditions is incubation overnight at 37 ° C in a solution comprising: 20% formamide, 5 x SSC (150 mM NaCI, 15 mM trisodium citrate), 50 mM sodium phosphate (pH 7.6), 5 x Denhardt's solution, 10% dextran sulfate and 20 mg / ml denatured salmon sperm DNA, followed by washing the filters in 1 x SSC at about 37 to 50 ° C. The experienced technician will recognize how to adjust the temperature, ionic strength, etc., as necessary to accommodate factors such as probe length and the like.
A native-sequence polypeptide is one that has the same amino acid sequence as the polypeptide (for example, HER receptor or HER linker) derived from nature, including naturally occurring or allelic variants. Such native sequence polypeptides can be isolated from nature or can be produced by recombinant or synthetic means. Thus a polypeptide with native sequence can have the same amino acid sequence as the human polypeptide, murine polypeptide or polypeptide of any other naturally occurring mammalian species.
The term antibody is used here in the broadest sense and specifically covers monoclonal antibodies, polyclonal antibodies, multispecific antibodies (for example, bispecific antibodies) formed by at least two intact antibodies, and antibody fragments as long as they exhibit the desired biological activity .
An isolated antibody is one that has been identified and separated and / or recovered from a component of its natural environment. The contaminating components of your natural environment are materials that can interfere with the research, diagnostic or therapeutic uses of the antibody and can include enzymes, hormones and other proteinaceous and non-proteinaceous solutes. In some embodiments, an antibody is purified (1) to more than 95% by weight of the antibody as determined, for example, by the Lowry method and, in some embodiments, to more than 99% by weight; (2) to a degree sufficient to obtain at least 15 residues of the N-terminal or internal amino acid sequence by using, for example, a rotating cup sequencer, or (3) until homogeneity by SDS-PAGE under reducing conditions or non-reducing agents using, for example, Coomassie dyes blue or silver. Isolated antibody includes the antibody in situ within recombinant cells as long as at least one component of the antibody's natural environment is not present. Commonly, however, an isolated antibody will be prepared for at least one purification step.
Native antibodies are generally heterotetrameric glycoproteins of about 150,000 daltons, composed of two identical light (L) chains and two identical heavy (H) chains. Each light chain is linked to a heavy chain by a covalent disulfide bond, although the number of disulfide bonds varies between heavy chains of different immunoglobulin isotypes. Each heavy and light chain also has regularly spaced intrachain disulfide bridges. Each heavy chain has, at one end, a variable domain (V<sub>H</sub>) followed by several constant domains. Each light chain has a variable domain at one end (V<sub>L</sub>) and a constant domain at the other end; the light chain constant domain is aligned with the first heavy chain constant domain and the light chain variable domain is aligned with the heavy chain variable domain. Particular amino acid residues are considered to form an interface between the variable domains of the light and heavy chain.
The variable region or variable domain of an antibody refers to the amino terminal domains of the heavy or light chain of the antibody. The heavy chain variable domain can be referred to as VH. The variable domain of the light chain can be referred to as VL. These domains are usually the most variable parts of an antibody and contain antigen-binding sites.
The variable expression refers to the fact that certain portions of the variable domains differ widely in sequence between antibodies and are used in the binding and specificity of each particular antibody by its particular antigen. However, the variability is not evenly distributed across the variable domains of antibodies. It is concentrated in three segments called hypervariable regions (HVRs) in both the light and heavy chain variable domains. The most highly conserved portions of the variable domains are called structural regions (FR). Each variable domain of the native heavy and light chains comprises four FR regions, which largely adopt a beta ribbon configuration, connected by three HVRs, which form loops that connect, and in some cases form part of the beta ribbon structure. The HVRs of each chain are organized in close proximity by the FR regions and, with the HVRs of the other chain, contribute to the formation of the binding site to the antibody antigen (see, Kabat et al., Sequences of Proteins of Immunological Interest, Fifth Edition, National Institute of Health, Bethesda, MD (1991)). The constant domains are not directly involved in the binding of an antibody to an antigen, but exhibit various effector functions, such as the participation of the antibody in antibody-dependent cellular toxicity.
The light chains of antibodies (immunoglobulins) of any species of vertebrate can be determined by one of two clearly distinct types, called kappa (k) and lambda (λ), based on the amino acid sequence of their constant domains.
Depending on the amino acid sequences of the domains in their chains, antibodies (immunoglobulins) can be divided into different classes. There are five main classes of immunoglobulins: IgA, IgD, IgE, IgG, and IgM, and several of these can be further divided into subclasses (isotypes), for example, IgG-ι, lgG<sub>2</sub>, lgG3, lgG<sub>4</sub>, IgA-ι, and lgA<sub>2</sub>. The heavy chain constant domains that correspond to different classes of immunoglobulins are called α, δ, ε, γ and μ, respectively. The subunit structures and three-dimensional configurations of different classes of immunoglobulins are well-known and described, generally in, for example Abbas et al. Cellular and Mol. Immunology, 4<sup>The</sup> Ed. (WB Saunders, Co., 2000). An antibody can be part of a large fusion molecule, formed by covalent and non-covalent association of the antibody with one or more proteins or peptides.
The terms full-length antibody, intact antibody and full antibody as used herein, interchangeably refer to an antibody in its substantially intact form, not to antibody fragments as defined below. The terms particularly refer to an antibody with heavy chains that contain an Fc region.
A naked antibody ”for its purposes, is an antibody that is not conjugated to a cytotoxic or radiolabel portion.
Antibody fragments comprise a portion of an intact antibody, preferably comprising its antigen-binding portion. Examples of antibody fragments include Fab, Fab ', F (ab') fragments<sub>2</sub> and FGV; dibodies; linear antibodies; single chain antibody molecules; and multispecific antibodies formed by antibody fragments.
The digestion of antibodies with papain produces two identical antigen-binding fragments, called Fab fragments, each with a unique antigen-binding site and a residual Fc fragment, whose name reflects its ability to crystallize quickly. Treatment with pepsin yields an F (ab ') 2 fragment that has two sites of combination with the antigen and is still capable of interconnecting with the antigen.
Fv is the minimum fragment of antibody that contains a complete antigen binding site. In one embodiment, a two-chain Fv species consists of a dimer from the variable domain of a light chain and a heavy chain in close association, not covalent. In a single chain Fv species (scFv), a heavy chain and a light chain variable domain can be covalently linked by a flexible peptide linker such that the light and heavy chains can associate in a dimeric structure analogous to that of the species of two-chain Fv. It is in this configuration that the three HVRs of each variable domain interact to define an antigen-binding site on the surface of the VH-VL dimer. Collectively, the six HVRs confer binding specificity to the antibody's antigen. However, even a single variable domain (or half of an Fv comprising only three antigen-specific HVRs) has the ability to recognize and bind to the antigen, albeit with less affinity than that of the entire binding site.
The Fab fragment contains the heavy and light chain variable domains and also contains the light chain constant domain and the first heavy chain constant domain (CH1). Fab 'fragments differ from Fab fragments by adding some residues at the carboxy terminus of the CH1 domain of the heavy chain, including one or more cysteines from the antibody hinge region. Fab'-SH is the designation for Fab 'in which the cysteine residue (s) in the constant domains embrace a free thiol group.
Fragments F (ab ')<sub>2</sub> of antibody were originally produced as pairs of Fab 'fragments that have cysteine hinges between them. Other chemical couplings of antibody fragments are also known.
Single chain Fv or scFv antibody fragments comprise the VH and VL domains of the antibody, where these domains are present in a single polypeptide chain. Generally, the scFv polypeptide further comprises a polypeptide linker between the VH and VL domains that enables scFv to form the desired structure for binding to the antigen. For a review of scFv, see, for example, Pluckthun, in The Pharmacology of Monoclonal Antibodies, vol. 113, Rosenburg and Moore eds., (Springer-Verlag, New York, 1994), pp. 269-315. The scFv fragments specifically include small modulating immunopharmaceuticals (SMIPs), as described in US2005 / 0180970 A1 and US2005 / 0186216 A1 designated for Trubion.
The term diabody refers to antibody fragments with two antigen binding sites, whose fragments comprise a heavy chain variable domain (VH) connected to a light chain variable domain (VL) on the same polypeptide chain (VH-VL ). Using a linker that is too short to allow pairing between the two domains on the same chain, the domains are forced to pair with the complementary domains of another chain and create two antigen-binding sites. Diabodies can be bivalent or bispecific. Diabodies are described more fully in, for example, EP 404,097; WO 1993/01161; Hudson et al, Nat. Med. 9: 129-134 (2003); and Hollinger et al., Proc. Natl. Acad. Sci USA 90: 6444-6448 (1993). Tribodies and tetrabodies are also described in Hudson et al, Nat. Med. 9: 129-134 (2003).
The term monoclonal antibody as used herein refers to an antibody obtained from a substantially homogeneous population of antibodies, that is, the individual antibodies that comprise the population are identical, except for possible mutations, for example, naturally occurring mutations, which may be present in small quantities. Thus, the monoclonal modifier indicates the character of the antibody as not being a mixture of distinct antibodies. In certain embodiments, such a monoclonal antibody typically includes an antibody comprising a sequence of polypeptides that binds to a target, wherein the sequence of polypeptides that binds to the target was obtained by a process that includes the selection of a single polypeptide sequence that binds to the target of a plurality of polypeptide sequences. For example, the selection process may be the selection of a single clone from a plurality of clones, such as a pool of hybridoma clones, phage clones or recombinant DNA clones. It should be understood that a sequence that binds to the selected target can be changed later, for example, to improve affinity with the target, to humanize the target binding sequence, to improve its production in cell culture, to reduce its immunogenicity in vivo, to create a multispecific antibody, etc., and that an antibody comprising the altered target binding sequence is also a monoclonal antibody of that invention. In contrast to polyclonal antibody preparations, which typically include different antibodies directed against different determinants (epitopes), each monoclonal antibody in a monoclonal antibody preparation is directed against a single determinant on an antigen. In addition to their specificity, monoclonal antibody preparations are advantageous since, typically, they are not contaminated by other tmunoglobulins.
The monoclonal modifier indicates the character of the antibody as being obtained from a substantially homogeneous population of antibodies and is not to be interpreted as requiring production of the antibody by any particular method. For example, the monoclonal antibodies to be used in accordance with the present invention can be made by a variety of techniques, including, for example, the hybridoma method (for example, Kohler and Milstein, Nature, 256: 495-97 (1975 ); Hongo et al, Hybridoma, 14 (3): 253-260 (1995), Harlow et al, Antibodies: A Laboratory Manual, (Cold Spring Harbor Laboratory Press, 2nd ed. 1988); Hammerling et al, in: Monocional Antibodies and T-Cell Hybridomas 563-681 (Elsevier, NY, 1981)), recombinant DNA methods (see, for example, Patent
US No. 4,816,567), phage display technologies (see, for example, Clackson et al, Nature, 352: 624-628 (1991); Marks et al., J. Mol. Biol. 222: 581-597 (1992); Sidhu et al., J. Mol. Biol. 338 (2): 299-310 (2004); Lee et al. J. Mol. Biol. 340 (5); 1073-1093 (2004); Fellouse, Proc. Natl. Acad. Sei USA 101 (34): 12467-12472 (2004); and Lee et al., J. Immunol. Methods 284 (1-2): 119-132 (2004), and technologies for producing human and human-like antibodies in animals that have parts or all human immunoglobulin loci or genes that encode human immunoglobulin sequences (see, for example, example, WO 1998/24893; WO 1996/34096; WO 1996/33735; WO 1991/10741; Jakobovits et al, Proc. Natl. Acad. Sei USA 90: 2551 (1993); Jakobovits et al, Nature 362: 255- 258 (1993); Bruggemann et al, Year in Immunol. 7:33 (1993); US Patent Nos. 5,545,807; 5,545,806; 5,569,825; 5,625,126; 5,633,425; and 5,661,016; Marks et al, Bio / Technology 10: 779-783 (1992); Lonberg et al., Nature 368: 856859 (1994); Morrison, Nature 368: 812-813 (1994); Fishwild et al, Nature Biotechnol 14; 845-851 (1996); Neuberger, Nature Biotechnol 14: 826 (1996); and Lonberg and Huszar, Intern. Rev. Immunol. 13: 65-93 (1995).
Monoclonal antibodies here specifically include chimeric antibodies in which a portion of the heavy and / or light chain is identical or homologous to corresponding sequences in antibodies derived from a particular species or belonging to another class or subclass of antibody, as well as fragments of such antibodies, as long as they exhibit the desired biological activity (see, for example, US Patent No. 4,816,567; and Morrison et al., Proc. Natl. Acad. Sei USA 81: 6851-6855 (1984)). Chimeric antibodies include PRIMATIZED® antibodies in which the antigen-binding region of the antibody is derived from an antibody produced, for example, by immunizing monkeys with the antigen of interest.
Humanized forms of non-human antibodies (for example, murine) are chimeric antibodies that contain a minimal sequence derived from a non-human immunoglobulin. In one embodiment, a humanized antibody is a human immunoglobulin (receptor antibody), in which residues from an HVR of the recipient are replaced by HVR residues from a non-human species (donor antibody) such as a mouse, rat, rabbit or non-primate. -human, who has the desired specificity, affinity and / or ability. In some examples, RF residues from human immunoglobulin are replaced by the corresponding non-human residues. In addition, humanized antibodies may comprise residues that are not found in the recipient antibody or the donor antibody. These modifications can be made to refine the performance of the antibody. In general, a humanized antibody will comprise substantially all or at least one, typically two, variable domains, in which all or substantially all hypervariable loops correspond to those of a non-human immunoglobulin and all or substantially all FRs are those of a sequence of human immunoglobulin. The humanized antibody will optionally comprise at least a portion of an immunoglobulin (Fc) constant region, typically that of a human immunoglobulin. For further details, see, for example, Jones et al, Nature 321: 522-525 (1986); Riechmann et al, Nature 332: 323- 329 (1988); and Presta, Curr. Op. Struct. Biol. 2: 593-596 (1992). See also, for example, Vaswani and Hamilton, Ann. Allergy, Asthma & Immunol. 1: 105-115 (1998); Harris, Biochem. Soc. Transactions 23: 1035-1038 (1995); Hurle and Gross, Curr. Op. Biotech. 5: 428-433 (1994); and Patents
US Nos. 6,982,321 and 7,087,409.
Antibodies to humanized HER2 include huMAb4D5-l, huMAb4D5-2, huMAb4D5-3, huMAb4D5-4, huMAb4D5-5, huMAb4D5-6, huMAb4D5-7 and huMAb4D5-8 or trastuzumab (as described) 5,821,337, expressly incorporated herein by reference; Humanized 520C9 (WO93 / 21319); and humanized 2C4 antibodies such as pertuzumab as described herein.
For the purposes of the same, trastuzumab, HERCEPTIN® '' and huMab4D5-8 refer to an antibody comprising the amino acid sequences of the light and heavy chain of SEQ ID NO: 15 and 16, respectively.
Pertuzumab and OMNITARG® refer to an antibody comprising the light and heavy chain amino acid sequences of SEQ ID NO: 13 and 14, respectively.
The differences between the functions of trastuzumab and pertuzumab are illustrated in Figure 6.
A human antibody is one that has an amino acid sequence that corresponds to that of an antibody produced by a human being and / or that has been made using any of the techniques for making human antibodies as described herein. This definition of a human antibody specifically excludes a humanized antibody that comprises residues that bind to a non-human antigen. Human antibodies can be produced using several known techniques, including phage display libraries. Hoogenboom and Winter, J. Mol. Biol, 227: 381 (1991); Marks et al., J. Mol. Biol., 222: 581 (1991). The methods described in Cole et al, Monoclonal Antibodies and Cancer Therapy, Alan R. Liss, p. 77 (1985); Boerner et al, J. Immunol, 147 (1): 86-95 (1991) are also available for the preparation of human monoclonal antibodies. See also van Dijk and van de Winkel, Curr. Opin. Pharmacol, 5: 368-74 (2001). Human antibodies can be prepared by administering the antigen to a transgenic animal that has been modified to produce such antibodies in response to an antigenic stimulus, but whose endogenous loci have been disabled, for example, immunized xeno-mice (see, for example, Patents US Nos. 6,075,181 and 6,150,584 with respect to XENOMOUSE® technology). See also, for example, Li et al, Proc. Natl. Acad. Know. USA, 103: 3557-3562 (2006) with respect to human antibodies generated through human B cell hybridoma technology.
Structural residues or RF are those variable domain residues other than HVR residues as defined herein.
The term variable domain residue numbering as in Kabat or numbering the amino acid position as in Kabat and its variations, refer to the numbering system used for heavy chain variable domains or light chain variable domains of the antibody composition of Kabat et al., Supra. Using this numbering system, the actual linear amino acid sequence can contain fewer or additional amino acids that correspond to shortening or insertion into an RF or HVR of the variable domain. For example, a heavy chain variable domain may include a single amino acid insert (residue 52a according to Kabat) after residue 52 of H2 and inserted residues (for example, residues 82a, 82b and 82c, etc., according to Kabat) after FR residue 82 of the heavy chain. The numbering of Kabat residues can be determined for a given antibody by aligning the regions of antibody sequence homology with a standardized numbered Kabat sequence.
Throughout the present application and claims, the Kabat numbering system is generally used when referring to a residue in the variable domain (approximately residues 1 to 107 of the light chain and residues 1 to 113 of the heavy chain) (for example, Kabat et al., Sequences of Immunological Interest. 5<sup>The</sup> Ed. Public Health Service, National Institutes of Health, Bethesda, Md (1991)).
The EU numbering system or EU index is generally used when referring to a residue in a constant region of an immunoglobulin heavy chain (for example, the EU index reported in Kabat et al., Sequences of Immunological Interest. 5<sup>The</sup> Ed. Public Health Service, National Institutes of Health, Bethesda, Md (1991), incorporated herein expressly by reference). Unless otherwise stated here, references to residue numbers in the antibody variable domain mean residue numbering by the Kabat numbering system. Unless otherwise stated here, references to the residue numbers in the antibody constant domain mean residue numbering by the EU numbering system (for example, see US Provisional Application No. 60 / 640.323, Numbers for EU numbering).
An affinity matured antibody is one with one or more changes in one or more of its HVRs that result in an improvement in the antibody's affinity for the antigen, compared to a parent antibody that does not have that change (s). In one embodiment, an affinity matured antibody has nanomolar or even picomolar affinities for the target antigen. Affinity-matured antibodies can be produced using certain procedures known in the art. For example, Marks et al., Bio / Technology 10: 779-783 (1992) describe affinity maturation by VH and VL domain shuffling. The random mutagenesis of HVR and / or structural residues is described in, for example, Barbas et al., Proc Nat. Acad Sei. USA 91: 3809-3813 (1994); Schier et al. Gene 169: 147-155 (1995); Yelton et al, J. Immunol. 155: 1994-2004 (1995);
Jackson et al, J. Immunol. 154 (7): 3310-9 (1995): and Hawkins et al, J. Mol. Biol. 226: 889-896 (1992).
Antibody effector functions refer to those biological activities attributable to the Fc region (a native region Fc region or an amino acid sequence variant Fc region) of an antibody and vary with the antibody's isotype. Examples of antibody effector functions include: binding to C1q and complement-dependent cytoxicity (CDC); binding to the Fc receptor; antibody dependent cell-mediated cytotoxicity (ADCC); phagocytosis; down regulation of cell surface receptors (eg, B cell receptor) and B cell activation.
The term Fc region is used here to define an end region of an immunoglobulin heavy chain, including the native sequence Fc regions and variant Fc regions. Although the boundaries of the Fc region of an immunoglobulin heavy chain may vary, the Fc region of the human IgG heavy chain is generally defined to extend from an amino acid residue at the Cys226, or Pro230 position, to the carboxyl termination thereof. The C-terminal lysine (residue 447 according to the EU numbering system) from the Fc region can be removed, for example, during the production or purification of the antibody or by recombinant manipulation of the nucleic acid encoding an antibody heavy chain. Consequently, an intact antibody composition can comprise antibody populations with all K447 residues removed, antibody populations without removal of K447 residues and antibody populations that have a mixture of antibodies with and without K447 residues.
Unless otherwise indicated, the numbering of residues in an immunoglobulin heavy chain is that of the EU index as in Kabat et /., Supra. The EU index as in Kabat refers to the residue numbering of the human EU lgG1 antibody.
A functional Fc region has an effector function of an Fc region of the native sequence. Exemplary effector functions include connection to C1q; binding to the Fc receptor; ADCC; phagocytosis; down regulation of cell surface receptors (eg B cell receptor; BCR), etc. Such effector functions generally require that the Fc region be combined with a binding domain (for example, an antibody variable domain) and can be evaluated using various assays as described, for example, in the definitions.
An Fc region of the native sequence comprises an amino acid sequence identical to the amino acid sequence of an Fc region found in nature. Fc regions of the native human sequence include an Fc region of the native human IgG1 sequence (non-A and A allotypes); Fc region of the native human IgG2 sequence; Fc region of the native human IgG3 sequence; and Fc region of the native human IgG4 sequence, as well as its naturally occurring variants.
A variant Fc region comprises an amino acid sequence that differs from that of a native sequence Fc region by virtue of at least one amino acid modification, preferably one or more amino acid substitutions. Preferably, the variant Fc region has at least one amino acid substitution compared to an Fc region of the native sequence or the Fc region of a parent polypeptide, for example, between about one to about ten amino acid substitutions, and preferably between about from one to about five amino acid substitutions in an Fc region of the native sequence or in the Fc region of the parent polypeptide. The variant Fc region will preferably have at least about 80% homology with the Fc region of the native sequence and / or with an Fc region of a parent polypeptide and most preferably at least about 90% homology to them, more preferably at least about 95% homology with them.
Fc or FcR receptor describes a receptor that binds to the Fc region of an antibody. In some embodiments, an FcR is a native human FcR. In some embodiments, an FcR is one that binds to an IgG antibody (a gamma receptor) and includes the receptors of the subclasses FcyRI, FcyRII and FcyRIII, including allelic variants and alternatively interlaced forms of those receptors. FcyRII receptors include FcyRIIA (an activation receptor) and FcyRIIB (an inhibitory receptor), which have similar amino acid sequences that differ primarily in their cytoplasmic domains. The FcyRIIA activation receptor contains an activation motif based on tyrosine immunoreceptor (ITAM) in its cytoplasmic domain. The inhibitory FcyRIIB receptor contains a tyrosine immunoreceptor (ITIM) -based inhibition motif in its cytoplasmic domain (see, for example, Daeron, Annu. Rev. Immunol. 15: 203-234 (1997)). FcRs are reviewed in, for example, Ravetch and Kinet, Annu. Rev. Immunol 9: 457-92 (1991); Capei et al, Immunomethods 4: 25-34 (1994); and de Haas et al, J. Lab. Clin. Med. 126: 330-41 (1995). Other FcRs, including those to be identified in the future, are covered here by the term FcR.
The expression FcR or FcR receptor also includes the neonatal receptor, FcRn, which is responsible for the transfer of maternal IgGs to the fetus (Guyer et al., J. Immunol. 117-587 (1976) and Kim et al., J. Immunol. 24: 249 (1994)) and by regulating immunoglobulin homeostasis. Methods for measuring binding to FcRn are known (see, for example, Ghetie and Ward, Immunol. Today 18 (12): 592-598 (1997); Ghetie etal, Nature Biotechnology, 15 (7): 637-640 (1997 ); Hinton et al, J. Biol. Chem. 279 (8): 6213-6216 (2004); WO 2004/92219 (Hinton etal).
Binding to human FcRn in vivo and the serum half-life of polypeptides that bind with high affinity to human FcRn can be assayed, for example, in transgenic mice or human cell lines transfected or expressing human FcRn, or in primates for which polypeptides with a variant Fc region are administered. WO 2000/42072 (Presta) describes antibody variants with improved or decreased binding to FcRs. See also, for example, Shields et al. J. Biol. Chem. 9 (2): 6591-6604 (2001).
Human effector cells are leukocytes that express one or more FcRns and perform effector functions. In certain embodiments, the cells express at least FcyRIII and perform ADCC effector functions. Examples of human leukocytes that mediate ADCC include peripheral blood mononuclear cells (PBMC), natural killer cells (NK). monocytes, cytotoxic T-cells and neutrophils. Effector cells can be isolated from a native source, for example, from blood.
Antibody-dependent cell-mediated cytoxicity or ADCC refers to a form of cytoxicity in which secreted IG bound over Fc receptors (FcRs) present in certain cytotoxic cells (eg, NK cells, neutrophils and macrophages) enables these cytotoxic effector cells specifically bind to a target cell that harbors an antigen and subsequently kill the target cell with cytotoxins. The primary cells that mediate ADCC, NK cells, express FcyRIII only, whereas monocytes express FcyRI, FcyRII and FcyRIII. FcR expression in hematopoietic cells is summarized in Table 3 on page 464 by Ravetech and Kinet, Annu. Rev. Immunol. 9: 457-92 (1991). To assess the ADCC activity of a molecule of interest, an in vitro ADCC assay, such as that described in US Patent No. 5,500,362 or 5,821,337 or US Patent No. 6,737,056 (Presta) can be performed. Effector cells useful for such assays include PBMC and NK cells. Alternatively, or in addition, the ADCC activity of the molecule of interest can be assessed in vivo, for example, in an animal model such as that described in Clynes etal., PNAS (USA) 95: 652-656 (1998).
Complement-dependent cytoxicity or CDC refers to the lysis of a target cell in the presence of complement. The activation of the classic complement pathway is initiated by binding the first component of the complement system (C1q) to antibodies (of the appropriate subclass), which are linked to its cognate antigens. To assess complement activation, a CDC assay, for example, as described in GazzanoSantoro et al., J. Immunol. Methods 202: 163 (1996), can be performed. Variant polypeptides with altered amino acid sequences in the Fc region (polypeptides with a variant Fc region) and increased or decreased C1q binding capacity are described, for example, in US Patent No. 6,194,551 B1 and WO 1999/51642. See also, for example, Idusogie et al., J. Immunol. 164: 4178-4184 (2000)
The term antibody comprising an Fc region refers to an antibody comprising an Fc region. The C-terminal lysine (residue 447 according to the EU numbering system) from the Fc region can be removed, for example, during antibody purification or by recombinant manipulation of the nucleic acid encoding the antibody. Consequently, a composition comprising an antibody that has an Fc region according to that invention can comprise an antibody with K447, with all K447 removed, or a mixture of antibodies with and without the K447 residue.
The term main antibody species refers here to the structure of the antibody in a composition that is the antibody molecule quantitatively predominant in the composition. In one embodiment, the primary antibody species is an HER2 antibody, such as an antibody that binds to Domain II of HER2, an antibody that inhibits HER dimerization more efficiently than trastuzumab and / or an antibody that binds to a site of heterodimeric binding of HER2. Here, the preferred embodiment of the main antibody species is that which comprises the amino acid sequences of the light variable and the heavy variable in SEQ ID NO: 3 and 4, and more preferably which comprises the amino acid sequences of the light chain and the heavy chain in SEQ ID NO: 13 and 14 (pertuzumab).
An antibody with a variant amino acid sequence is an antibody with an amino acid sequence that differs from a major antibody species. Commonly, amino acid sequence variants will have at least about 70% homology with the major antibody species, and preferably, they will be at least about 80%, more preferably at least about 90% homologous with the major antibody species. . Variant amino acid sequences have substitutions, deletions and / or additions at certain positions within or adjacent to the amino acid sequence of the main antibody species. Examples of variant amino acid sequences include an acidic variant (eg, wandering variant antibody), a basic variant, an antibody with an amino-terminal leader extension (eg HSV-) over one or two light chains of the same, an antibody with a C-terminal lysine residue on one or two heavy chains thereof, etc., and includes combinations of variations in amino acid sequences of the heavy and / or light chains. Here, the antibody variant of particular interest is the antibody that comprises a leading amino-terminal extension over one or two light chains, optionally further comprising another amino acid sequence and / or differences in glycosylation from the main antibody species.
A glycosylation variant antibody here is an antibody with one or more carbohydrate moieties attached to it that differ from one or more carbohydrate moieties attached to the main antibody species. Examples of glycosylation variants here include an antibody with G1 or G2 oligosaccharide structure, instead of G0 oligosaccharide structure, coupled to an Fc region of the same, antibody with one or more carbohydrate moieties attached to one or two light chains of the same , carbohydrate-free antibody coupled to one or two heavy antibody chains, etc., and combinations of glycosylation changes.
Where the antibody has an Fc region, an oligosaccharide structure can be attached to one or two heavy chains of the antibody, for example, at residue 299 (298, numbering residues Eu). For pertuzumab, G0 was the predominant oligosaccharide structure, with other oligosaccharide structures, such as G0-F, G-1, Man5, Man6, G1-1, G1 (16), G1 (1 -3) and G2 being found in smaller amounts in the pertuzumab composition.
Unless otherwise indicated, an oligosaccharide structure G1 includes structures G-1, G1-1, G1 (1-6) and G1 (1-3).
An amino-terminal leader extension refers here to one or more amino acid residues of the amino-terminal leader sequence that are present at the amino termination of any one or more heavy or light chains of an antibody. An exemplary amino-terminal leader extension comprises or consists of three amino acid residues, ESR, present on one or both light chains of an antibody variant.
A wandering antibody is one in which one or more of its asparagine residues have been derivatized, for example, to an aspartic acid, a succinimide or an isoaspartic acid.
The terms cancer and cancerous ”refer to or describe the physiological condition in mammals that is typically characterized by unregulated cell growth. A type of cancer here refers to a particular category or indication of cancer. Examples of such cancers include, but are not limited to, carcinoma, lymphoma, blastoma (including medulloblastoma and retinoblastoma), sarcoma (including liposarcoma and synovial cell sarcoma), neuroendocrine tumors (including carcinoid tumors, gastrinoma and cancer cell cancer islet), mesothelioma, schwannoma (including acoustic neuroma), meningioma, adenocarcinoma, melanoma, and leukemia or lymphoid malignancies. More particular examples of such cancers include squamous cell cancer (eg, epithelial squamous cell cancer), lung cancer including small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), adenocarcinoma of the lung and squamous lung carcinoma, peritoneum cancer, hepatocellular cancer, gastric or stomach cancer including gastrointestinal cancer, pancreatic cancer, glioblastoma, cervical cancer, ovarian cancer, liver cancer, bladder cancer, hepatoma, breast cancer (including metastatic breast cancer), colon cancer, rectal cancer, colorectal cancer, endometrial or uterine carcinoma, salivary gland carcinoma, kidney or kidney cancer, prostate cancer, vulvar cancer, thyroid cancer, liver carcinoma, anal carcinoma, penile carcinoma. testicular cancer, esophageal cancer, biliary tract tumors, as well as head and neck cancer, as well as subtypes of any such cancers, including, but not limited to, chemotherapy resistant, platinum resistant, advanced, refractory and / or applicants of the same.
One type of cancer that is able to respond to an HER inhibitor is one that when treated with an HER inhibitor, such as an HER2 antibody or a small molecule inhibitor, shows a therapeutically effective benefit to the patient according to any of the criteria for therapeutic efficacy known to the experienced oncologist, including those elaborated here, but particularly in terms of survival, including progression-free survival (PFS) and / or overall survival (OS). Preferably, such cancer is selected from ovarian cancer, peritoneal cancer, fallopian tube cancer, metastatic breast cancer (MBC), non-small cell lung cancer (NSCLC), prostate cancer and colorectal cancer. Most preferably, the cancer is ovarian, peritoneal or fallopian tube cancer, including platinum resistant forms of such cancers, as well as advanced, refractory or recurrent ovarian cancer.
One type of cancer that is able to respond to an HER dimerization inhibitor is one that when treated with an HER dimerization inhibitor, such as pertuzumab, shows a therapeutically effective benefit to the patient according to any of the criteria for therapeutic efficacy known to the experienced oncologist, including those elaborated here, but particularly in terms of survival, including progression-free survival (PFS) and / or overall survival (OS). Preferably, such cancer is selected from ovarian cancer, peritoneal cancer, fallopian tube cancer, metastatic breast cancer (MBC), non-small cell lung cancer (NSCLC), prostate cancer and colorectal cancer. Most preferably, the cancer is ovarian, peritoneal or fallopian tube cancer, including platinum resistant forms of such cancers, as well as advanced, refractory or recurrent ovarian cancer.
An effective response and similar words refer to a response to the HER dimerization inhibitor, HER inhibitor or chemotherapeutic agent that is significantly greater than the response of a patient who does not express HER3 at the designated level.
An advanced cancer is one that has spread outside the site or organ of origin, either by local invasion or by metastasis.
A refractory cancer is one that progresses even when an antitumor agent, such as a chemotherapeutic agent, is being administered to the cancer patient. An example of a refractory cancer is one that is refractory to platinum.
A recurrent cancer is one that relapses, both at the initial site and at a distance after a response to initial therapy.
Here, a patient is a human patient. The patient may be a cancer patient, that is, one who suffers or is at risk of suffering from one or more symptoms of cancer.
A tumor sample here is a sample derived from, or comprising cells from, a tumor of the patient. Examples of tumor samples include, but are not limited to, tumor biopsies, circulating tumor cells, circulating plasma proteins, ascites fluid, primary cell cultures or tumor derived cell lines or that exhibit tumor-like properties, as well as samples preserved tumor samples, such as formalin fixed tumor samples, paraffin embedded tumor samples or frozen tumor samples.
A fixed tumor sample is one that has been histologically preserved using a fixative.
A formalin-fixed tumor sample is one that was preserved using formaldehyde as the fixative.
An embedded tumor sample is one that is surrounded by a firm, usually hard medium, such as paraffin, wax, celloidine or a resin. Imbibition makes it possible to cut thin sections for microscopic examination or to generate tissue microarrays (TMAs).
A paraffin-embedded tumor sample is one that is surrounded by a purified mixture of solid petroleum-derived hydrocarbons.
Frozen refers to a tumor sample that is or has been frozen.
A cancer or biological sample that exhibits HER expression, amplification or activation ”is one that, in a diagnostic test, expresses (including overexpressed) an HER receptor, has an amplified HER gene and / or otherwise demonstrates activation or phosphorylation of an HER receptor.
A cancer cell with HER receptor overexpression or amplification is one that has significantly high levels of HER receptor protein or gene compared to a non-cancerous cell of the same type of tissue. Such overexpression can be caused by amplification or by increased transcription or translation of the gene. HER receptor overexpression or amplification can be determined in a diagnostic or prognostic assay by assessing the elevated levels of the HER protein present on the surface of a cell (for example, through an immunohistochemical assay; IHC). Alternatively, or in addition, the levels of nucleic acid encoding HER in the cell can be measured, for example, through fluorescent in situ hybridization (FISH; see WO98 / 45479 published in October 1998), Southern blot techniques or chain reaction polymerase (PCR), such as real-time quantitative PCR (qRTPCR). HER receptor overexpression or amplification can be studied by measuring the dispersion of the antigen (for example, HER extracellular domain) in a biological fluid such as serum (see, for example, US Patent No. 4,933,294 published in 12 June 1990; WO91 / 05264 published April 18, 1991; US Patent 5,401,638 published March 28, 1995; and Sias et al. J. Immunol. Methods 132: 73-80 (1990)). Along with the above tests, several in vivo tests are available for the experienced expert. For example, cells within the patient's body can be exposed to an antibody that is optionally labeled with a detectable marker, for example, a radioactive isotope, and the binding of the antibody to the patient's cells can be assessed, for example, by external radioactivity screening or by analyzing a biopsy taken from a patient previously exposed to the antibody.
In contrast, a cancer that does not overexpress or amplify an HER receptor is one that has no higher levels than normal levels of the HER receptor protein or gene compared to a non-cancerous cell of the same type of tissue. Antibodies that inhibit HER dimerization, such as pertuzumab, can be used to treat cancer that does not overexpress or amplify the HER2 receptor.
An antitumor agent refers here to a drug used to treat cancer. Non-limiting examples of antitumor agents here include chemotherapeutic agents, HER inhibitors, HER dimerization inhibitors, antibodies to HER, antibodies directed against tumor-associated antigens, anti-hormonal compounds, cytokines, drugs targeting EGFR, antiangiogenic agents, inhibitors tyrosine kinase, growth inhibitory agents and antibodies, cytotoxic agents, apoptosis-inducing antibodies, COX inhibitors, irnesyl transferase inhibitors, antibodies that bind to CA 125 oncofetal protein, HER2 vaccines, Rafou ras inhibitors, liposomal doxorubicin, topotecan, taxane, dual tyrosine kinase inhibitors, TLK286, EMD-7200, pertuzumab, trastuzumab, erlotinib and bevacizumab.
An approved antitumor agent is a drug used to treat cancer that has been approved for marketing by a regulatory authority such as the Food and Drug Administration (FDA) or its foreign equivalent.
Where an HER inhibitor or HER dimerization inhibitor is administered as a single anti-tumor agent, it is the only anti-tumor agent administered to treat cancer, that is, it is not administered in combination with another anti-tumor agent, such as chemotherapy.
By standard treatment is proposed here the antitumor agent or agents that are routinely used to treat a particular form of cancer. For example, for platinum-resistant ovarian cancer, the standard treatment is topotecan or liposomal doxorubicin.
A growth inhibitory agent when used herein refers to a compound or composition that inhibits cell growth, especially a cancer cell that expresses HER in vitro or in vivo. Thus, the growth inhibitory agent may be one that significantly reduces the percentage of cells that express HER in the S phase. Examples of growth inhibitory agents include those that block cell cycle progression (in a place other than the S phase), such as agents that induce G1 phase arrest and M phase arrest. Classic M phase blockers include creases (vincristine and vinblastine), taxanes, and top II inhibitors, such as doxorubicin, epirubicin, daunorubicin, etoposide and bleomycin. Those agents that interrupt G1 also interfere in stopping the S phase, for example, DNA alkylating agents such as tamoxifen, prednisone, dacarbazine, mecloretamine, cisplatin, methotrexate, 5-fluorouracil and ara-C. More information can be found in The Molecular Basis of Cancer, Mendelsohn and Israel, Eds., Chapter 1, with the title Cell cycle regulation, oncogenes and antineoplastic drugs by Murakami et al. (WB Saunders, Philadelphia, 1995), especially p. 13.
Examples of growth inhibitory antibodies are those that bind to HER2 and inhibit the growth of cancer cells that overexpress HER2. Preferred HER2 growth inhibitory antibodies inhibit the growth of SK-BR-3 breast tumor cells in cell culture by more than 20% and, preferably, by more than 50% (for example, between about 50% at about 100%) at an antibody concentration of about 0.5 to 30 pg / ml, where growth inhibition is determined six days after exposure of SK-BR-3 cells to the antibody (see US Patent No. 5,677,171 published October 14, 1997). The SK-BR-3 cell growth inhibition assay is described in more detail in that patent and here below. The preferred growth inhibitory antibody is a humanized variant of the murine monoclonal antibody 4D5, for example, trastuzumab.
An antibody that induces apoptosis is one that induces programmed cell death as determined by annexin V binding, DNA fragmentation, cell contraction, dilation of the endoplasmic reticulum, cell fragmentation and / or formation of membrane vesicles (called apoptotic bodies). The cell is one that usually overexpresses the HER2 receptor. Preferably, the cell is a tumor cell, for example, a breast, ovary, stomach, endometrial, salivary gland, lung, kidney, colon, thyroid, pancreas or bladder cell. In vitro, the cell can be an SK-BR-3, BT474, Fell 3, MDA-MB-453, MDA-MB-361 or SKOV3 cell. Several methods are available for the evaluation of cellular events associated with apoptosis. For example, phosphatidyl serine (PS) translocation can be measured by binding to annexin; DNA fragmentation can be assessed through DNA chaining; and nuclear / chromatin condensation along with DNA fragmentation can be assessed by any increase in hypodiploid cells. Preferably, the antibody that induces apoptosis is one that results in about 2 to 50 times, preferably about 5 to 50 times, and more preferably about 10 to 50 times, the induction of attachment to annexin in relation to a non- treated in an annexin binding assay using BT474 cells (see below). Examples of antibodies to HER2 that induce apoptosis are 7C2 and 7F3.
The 2C4 epitope is the region in the extracellular domain of HER2 to which the 2C4 antibody binds. In order to screen for antibodies that bind to the 2C4 epitope, a routine cross-blocking assay, such as that described in Antibodies, A Laboratorial Manual, Cold Spring Harbor Laboratory, Ed Harlow and David Lane (1988) can be performed. Preferably, the antibody blocks the binding of 2C4 to HER2 by about 50% or more. Alternatively, epitope mapping can be performed to assess whether the antibody binds to the HER2 2C4 epitope. The 2C4 epitope comprises residues from Domain II in the extracellular domain of HER2. 2C4 and pertuzumab bind to the extracellular domain of HER2 at the junction of domains I, II and III. Franklin et al. Cancer Cell 5: 317-328 (2004).
The 4D5 epitope is the region in the extracellular domain of HER2 to which the 4D5 antibody (ATCC CRL 10463) and trastuzumab bind. This epitope is close to the transmembrane domain of HER2 and within Domain IV of HER2. To screen for antibodies that bind to the 4D5 epitope, a routine cross-block assay, such as the one described in Antibodies, A
Laboratorial Manual, Cold Spring Harbor Laboratory, Ed Harlow and David Lane (1988) can be performed. Alternatively, epitope mapping can be performed to assess whether the antibody binds to the HD2 epitope 4D5 (for example, any one or more residues in the region between residue 529 to about residue 625, including HER2 ECD, residue numbering including signal peptide).
The 7C2 / 7F3 epitope is the N-terminated region, within Domain I, of the HER2 extracellular domain to which the 7C2 and / or 7F3 antibodies (each deposited with the ATCC, see below) bind. To screen for antibodies that bind to the 7C2 / 7F3 epitope, a routine cross-block assay, such as that described in Antibodies, A Laboratorial Manual, Cold Spring Harbor Laboratory, Ed Harlow and David Lane (1988) can be performed. Alternatively, epitope mapping can be performed to assess whether the antibody binds to the 7C2 / 7F3 epitope of HER2 (for example, any one or more residues in the region between residue 22 about residue 53 of HER2 ECD, numbering of residue including signal peptide).
Treatment refers to both therapeutic and prophylactic treatments or preventive measures. Those in need of treatment include those who already have cancer as well as those in which cancer must be prevented. Therefore, the patient to be treated here may have been diagnosed as having cancer or may be predisposed or susceptible to cancer.
The terms therapeutically effective amount or effective amount refer to an amount of a drug effective to treat cancer in a patient. The effective amount of the drug can reduce the number of cancer cells; reduce the size of the tumor; inhibit (i.e., slow down to some extent and preferably stop) cancer cell infiltration into peripheral organs; inhibit (that is, slow down to some extent and preferably stop) tumor metastases; inhibit, to some extent, tumor growth; and / or relieve to some extent one or more of the symptoms associated with cancer. As the drug prevents growth and / or kills existing cancer cells, it can be cytostatic and / or cytotoxic. The effective amount can prolong survival (for example, as measured by the Response Assessment Criteria for Solid Tumors, RECIST, or changes in CA-125), resulting in an objective response (including a partial response, PR, or complete response, CR), improve survival (including overall survival and progression-free survival) and / or improve one or more symptoms of cancer (for example, as assessed by FOSI). More preferably, the therapeutically effective amount of the drug is effective in improving progression-free survival (PFS) and / or overall survival (OS).
Survival refers to the patient who remains alive and includes overall survival as well as progression-free survival.
Global survival refers to the patient who remains alive for a defined period of time, such as 1 year, 5 years, etc. from the moment of diagnosis or treatment.
Progression-free survival refers to the patient who remains alive, with no cancer progression or getting worse.
Prolonged survival means the overall increase or progression-free survival in a patient treated with respect to an untreated patient (that is, with respect to the patient not treated with HER inhibitor, HER dimerization inhibitor, as as pertuzumab) or for a patient who does not express HER3 or HER2: HER3 at the designated level, and / or for the patient treated with an approved antitumor agent (such as topotecan or liposomal doxorubicin, where cancer is ovarian cancer).
An objective response refers to a measurable response, which includes either the complete response (CR) or a partial response (PR).
By complete response or CR the disappearance of all signs of cancer in response to treatment is intended. This does not always mean that the cancer has been cured.
Partial response or PR refers to a decrease in the size of one or more tumors or lesions or the extent of cancer in the body.
in response to treatment.
The term cytotoxic agent as used here refers to a substance that inhibits or prevents cell function and / or causes cell destruction. The term is intended to include radioactive isotopes (for example, At<sup>211</sup>, I<sup>131</sup>, I<sup>125</sup>, Y<sup>90</sup>, Re<sup>186</sup>, Re<sup>188</sup>, Sm<sup>153</sup>, Bi<sup>212</sup>, P<sup>32</sup> and radioactive isotopes of Lu), chemotherapeutic agents and toxins, such as small molecule toxins or enzymatically active toxins of bacterial, fungal, plant or animal origin, including fragments and / or variants.
A chemotherapeutic agent is a chemical compound useful in the treatment of cancer. Examples of chemotherapeutic agents include alkylating agents such as thiotepa and cyclophosphamide (CYTOXAN®); alkyl sulfonates such as busulfan, improssulfan and piposulfan; aziridines such as benzodopa, carboquone, meturedopa, and uredopa; ethylenimines and methylamelamines including altretamine, triethylene melamine, triethylene phosphoramide, triethylene thiophosphoramide and trimethylolomelamine; acetogenins (especially bullatacin and bullatacinone); delta-9-tetrahydrocannabinol (dronabinol, MARINOL®); beta-lapachone; lapachol; colchicines; betulinic acid; a camptothecin (including the synthetic analogue topotecan (HYCAMTIN®), CPT-11 (irinotecan, CAMPTOSAR®), acetylcamptothecin, scopolectin, and 9-aminocamptothecin); briostatin; calistatin; CC-1065 (including their synthetic analogues adozelesin, carzelesin and byzelesin); podophyllotoxin; podophyllinic acid; teniposide; cryptoficina (particularly cryptoficina 1 and criptoficina 8); dolastatin; duocarmycin (including synthetic analogs, KW-2189 and CB1-TM1); eleuterobin; pancratistatin; a sarcodictine; spongistatin; nitrogen mustard such as chlorambucil, chlornafazine, colophosphamide, estramustine, ifosfamide, meclorethamine, meclorethamine oxide hydrochloride, melphalan, novembicin, phenesterine, prednimustine, trophosphamide, uracil mustard; nitrosureas such as carmustine, chlorozotocin, photemustine, lomustine, nimustine, and ranimnustine; antibiotics such as enediin antibiotics (eg, calicheamicin, especially calicheamicin gamma 11 and calicheamicin omeqa 11 (see, for example, Nicolaou et al. Anqew. Chem Intl.
Ed. Engl., 33: 183-186 (1994)); CDP323, an oral alpha-4 integrin inhibitor; dinemicin, including dinemicin A; a speramycin; as well as chromophoric neocarzinostatin and chromophoric antibiotics related to enediin chromoprotein), aclacinomycins, actinomycin, autramycin, azasserine, bleomycins, cactinomycin, carabicin, carminomycin, carzinophylline, chromomycins, dactinicin, oxinorin-5-diaororubin, diaunorubin-5-diaororubin; doxorubicin (including ADRIAMYCIN®, morpholino-doxorubicin, cyanomorpholino-doxorubicin, 2-pyrroline-doxorubicin, liposomal HCl doxorubicin injection (DOXIL®), doxorubicin TLC D-99 liposomal (MYOCET®), pegylated liposomal doxorubicin (CAEL YX®), and deoxidoxorubicin), epirubicin, esorubicin, idarubicin, marcelomycin, mitomycins such as mitomycin C, mycophenolic acid, nogalamycin, puromycin, potassium, olomomycin, puromycin, puromycin, potomycin, puromycin, puromycin, potassium, purine , chelamycin, rhodorubicin, streptonigrin, streptozocin, tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such as methotrexate, gemcitabine (GEMZAR®), tegafur (UFTORAL®), capecitabine (XELODA®), an epothilone, and 5-fluorouracil (5-FU); folic acid analogs such as denopterin, methotrexate, pteropterin, trimetrexate; purine analogs such as fludarabine, 6-mercaptopurine, tiamiprine, thioguanine; pyrimidine analogs such as ancitabine, azacytidine, 6azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine, enocitabine, floxuridine; anti-adrenals such as aminoglutetimide, mitotane, trilostane; replenishing folic acid such as frolinic acid; aceglatone; aldophosphamide glycoside; aminolevulinic acid; eniluracil; amsacrine; bestrabucila: bisanthrene; edatraxate; defofamine; demecolcine; diaziquone; elfornitine; ellipinium acetate; etoglucide; gallium nitrate; hydroxyurea; ientinan; lonidainin; maytansinoids such as maytansine and ansamitocins; mitoguazone; mitoxantrone; mopidanmol; nitraerin; pentostatin; fenamet; pirarrubicin; losoxantrone; 2-ethyl hydrazide; procarbazine; PSK polysaccharide complex<sup>Ck</sup> (JHS Natural Products, Eugene, OR); razoxane; rhizoxin; sizofiran: spirogermanium; tenuazonic acid; triaziquone; 2,2 ', 2-trichlorotriethylamine. trichothecenes (especially T-2 toxin, verracurin A, roridin A and anguidine); urethane; dacarbazine; manomustine; mitobronitol; mitolactol; pipobro61 bro; gacytosine; arabinoside (Ara-C); thiotepa; taxoid, eg paclitaxel (TAXOL®), nanoparticulate formulation of paclitaxel manipulated in albumin (ABRAXANE<sup>Í;</sup>), and docetaxel (TAXOTERE®); chloranbucyl; 6thioguanine; mercaptopurine; methotrexate; platinum agents such as cisplatin, oxaliplatin, and carboplatin; creases, which prevent polymerization of tubulin to form microtubules, including vinblastine (VELBAN®), vincristine (ONCOVIN®), vindesine (ELDISINA®), FILDESIN®), and vinorelbine (NAVELBINA®); etoposide (VP-16); ifosfamide; mitoxantrone; leucovovin; new chair; edatrexate; daunomycin; aminopterin; ibandronate; topoisomerase RFS 2000 inhibitor; difluoromethylornithine (DMFO); retinoids such as retinoic acid, including bexarotene (TARGRETIN®); bisphosphonates such as clodronate (for example, BONEFOS® or OSTAC®), etidronate (DIDROCAL®), NE-58095, zoledronic acid / zoledronate (ZOMET A®), alendronate (FOSAMAX®), pamidronate (AREDIA®), tiludronate (SK ®), or risedronate (ACTONEL®); troxacitabine (a 1,3-dioxolane analog of the nucleoside cytosine); antisense oligonucleotides, particularly those that inhibit the expression of genes in signaling pathways implicated in aberrant cell proliferation, such as, for example, PKC-alpha, Raf, H-Ras, and epidermal growth factor (EGF-R); vaccines such as THERATOPE® vaccine and vaccines for gene therapy, for example, ALLOVECTIN® vaccine, LEUVECTIN® vaccine and VAXID® vaccine; topoisomerase 1 inhibitor (for example, LURTOTECAN®); rmRH (for example, ABARELIX®); BAY439006 (sorafenib; Bayer); SU-11248 (Pfizer); perifosine, COX-2 inhibitor (for example, celecoxib or etoricoxib), proteosome inhibitor (for example, PS341); bortezomib (VELC ADE®); CCI-779; tipifarnib (RI 1577); orafenib, ABT510; Bcl-2 inhibitor such as obiimersen sodium (GENASENSE®); pixantrone; EGFR inhibitors (see definition below); tyrosine kinase inhibitors (see definition below); and pharmaceutically acceptable salts, acids or derivatives of any of the above; as well as combinations of two or more of the above such as CHOP, an abbreviation for a combined therapy of cyclophosphamide, doxorubicin, vincristine and prednisolone and FOLFOX, an abbreviation for an oxaliplatin treatment regimen (ELOXATIN®) with 62 combined with 5-FU and leukovovine.
Chemotherapeutic agents here include anti-hormonal or endocrine therapeutic agents that act to regulate, reduce, biochemical or inhibit the effects of hormones that can promote the growth of cancer. They can be the hormones themselves, including, but not limited to, antiestrogens with a mixed agonist / antagonist profile, including tamoxifen (NOLVADEX®), 4-hydroxy tamoxifen, toremifene (FARESTON®), idoxifene, droloxifene, raloxifene (EVISTA®) , trioxifene, queoxifene and selective estrogen receptor modulators (SERMs) such as SERM3; pure antiestrogens without agonist properties, such as fulvestrant (FASLODEX®) and EM800 (such agents can block estrogen receptor (ER) dimerization, inhibit DNA binding, increase ER turnover and / or suppress ER levels) ; aromatase inhibitors, including steroidal aromatase inhibitors such as formestane and exemestane (AROMASIN®) and non-steroidal aromatase inhibitors such as anastrazole (ARIMIDEX®), letrozole (FEMARA®) and aminoglutetimide and other aromatase inhibitors include vorozole (RIVISOR®) , megestrol acetate (MEGASE®) fadrozole, and 4 (5) imidazois; hormone agonists that release luteinizing hormone, including leuprolide (LUPRON® and ELIGARD®), goserelin, buserelin and tripteretin; sex steroids, including progestins such as megestrol acetate and medroxyprogesterone acetate, estrogens such as diethylstilbestrol and premarine, and androgens / retinoids such as fluoxymesterone, transretionic acid and fenretinide; onapristone; anti-progesterones; negative estrogen receptor regulators (ERDs); anti-androgens such as flutamide, nilutamide and bicalutamide; and pharmaceutically acceptable salts, acids or derivatives of any of the above; as well as combinations of two or more of the above.
An antimetabolite chemotherapeutic agent is an agent that is structurally similar to a metabolite, but cannot be used by the body in a productive way. Various antimetabolite chemotherapeutic agents interfere with the production of nucleic acids, RNA and DNA. Examples of antimetabolite chemotherapeutic agents include qencitabine (GEMZAR®),
5-fluorouracil (5-FU), capecitabine (XELOD A®), 6-mercaptopurine, methotrexate, 6-thioguanine, pemetrexed, raltitrexed, arabinosilocytosine ARA-Cytarabine (CYTOSAR-U®), dacarbazine (DICarbazine) azocytosine, deoxycytosine, pyridmidene, fludarabine (FLUDARA®), cladrabine, 2-deoxy-D-glucose etc. The preferred antimetabolite chemotherapeutic agent is gemcitabine.
Gemcitabine or 2'-deoxy-2 'monohydrochloride, 2'difluorocytidine (isomer b) is a nucleoside analog that exhibits antitumor activity. The empirical formula for gemtabicin HCI is C9H11F2N3O4 HCI. Gemcitabine HCI is sold by Eli Lilly under the trademark GEMZAR®.
A platinum-based chemotherapeutic agent comprises an organic compound that contains platinum as an integral part of the molecule. Examples of platinum-based chemotherapeutic agents include carboplatin, cisplatin and oxaliplatin.
Platinum-based chemotherapy is intended for therapy with one or more platinum-based chemotherapeutic agents, optionally in combination with one or more chemotherapeutic agents.
Chemotherapy-resistant cancer means that the patient's cancer has progressed despite receiving a chemotherapy regimen (that is, the patient is refractory to chemotherapy) or the patient has progressed within 12 months (for example, within 6 months) after completed the chemotherapy regimen.
By platinum-resistant cancer it is understood that the patient's cancer has progressed despite receiving platinum-based chemotherapy (that is, the patient is refractory to platinum) or the patient has progressed within 12 months (for example, within 6 months) after completing the platinum-based chemotherapy regimen.
An antiangiogenic agent refers to a compound that blocks or interferes to some degree with the development of blood vessels. The antiangiogenic factor may, for example, be a small molecule or an antibody that binds to a growth factor or growth factor receptor involved in promoting angiogenesis. The preferred antiangiogenic factor here is an antibody that binds to vascular dothelial en64 growth factor (VEGF), such as bevacizumab (AVASTIN®).
The term cytokine is a generic term for proteins released by a cell population that acts on another cell as intercellular mediators. Examples of such cytokines are lymphokines, monokines and traditional polypeptide hormones. Included among cytokines are growth hormone such as human growth hormone, Nmetionyl human growth hormone and bovine growth hormone; parathyroid hormone; thyroxine; insulin; relaxin; pro-relaxin; glycoprotein hormones such as follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH) and luteinizing hormone (LH); liver growth factor; fibroblast growth factor; prolactin; placental lactogen; tumor necrosis factor β factor; Mullerian inhibitory substance; mouse gonadotropin-associated peptide; inhibin; activin; vascular endothelial growth factor; integrin; thrombopoietin (TPO); nerve growth factors such as NGF-β; platelet growth factor; transforming growth factors (TGFs) such as TGF-α and TGF-β; insulin-like growth factor I and II; erythropoietin (EPO); bone-inductive factors; interferons such as interferon-α, β and γ; colony stimulating factors (CSFs) such as macrophage-CSF (M-CSF); granulocyte-macrophage-CSF (GM-CSF); and granulocyte-CSF (G-CSF); interleukins (ILs) such as IL-1, IL-lct, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-1O, IL-11, IL-12; tumor necrosis factor such as TNF-α or TNF-β; and other polypeptide factors including LIF and the ligand kit (KL). As used herein, the term cytokine includes proteins from natural sources or recombinant cell culture and biologically active equivalents of native sequence cytokines.
As used herein, the term drug directed to EGFR refers to a therapeutic agent that binds to EGFR and optionally inhibits EGFR activation. Examples of such agents include antibodies and small molecules that bind to EGFR. Examples of antibodies that bind to EGFR include MAb 579 (ATCC CRL HB 8506), MAb 455 (ATCC CRL HB8507). MAb 225 (ATCC CRL 8508), MAb 528 (ATCC CRL 8509) (see, US Patent No. 4,943,533, Mendelsohn et al.) And variants thereof, such as chimeric 225 (C225 or Cetuximab; ERBUTIX®) and transformed human 225 (H225) (see, WO 96/40210, Imclone Systems Inc.); IMC-11F8, an antibody directed to fully human EGFR, antibody directed to EGFR (Imclone); antibodies that bind to type II mutant EGFR (US Patent No. 5,212,290); humanized and chimeric antibodies that bind to EGFR as described in US Patent No. 5,891,996; and human antibodies that bind to EGFR, such as ABX-EGF (see WO98 / 50433, Abgenix); EMD 55900 (Stragliotto et al. Eur. J. Cancer 32A: 636-640 (1996)); EMD7200 (matuzumab) a humanized antibody to EGFR directed against EGFR that competes with both EGF and TGF-alpha for binding to EGFR; and mAb 806 or humanized mAb 806 (Johns et al, J. Biol. Chem. 279 (29): 30375-30384 (2004)). The anti-EGFR antibody can be conjugated to a cytotoxic agent, thereby generating an immunoconjugate (see, for example, EP659.439 A2, Merck Patent GmbH). Examples of small molecules that bind to EGFR include ZDI839 or Gefitinib (IRESSA®; Astra Zeneca); CP-358774 or
Erlotinib (TARCEVA®, Genentech / OSI) and AG1478, AG1571 (SU 5271; Sugen); EMD-7200.
A tyrosine kinase inhibitor is a molecule that inhibits the tyrosine kinase activity of a tyrosine kinase such as an HER receptor. Examples of such inhibitors include drugs targeting EGFR listed in the previous paragraph; small molecule HER2 tyrosine kinase inhibitor such as TAK165 available from Takeda; CP724,714, an oral selective tyrosine kinase inhibitor of the ErbB2 receptor (Pfizer and OSI); dual HER inhibitors such as EKB-569 (available from Wyeth) that preferentially binds to EGFR, but inhibits cells that overexpress both HER2 and EGFR; Gw572016 (available from Glaxo), an oral HER2 and EGFR tyrosine kinase inhibitor; PKI-166 (available from Novartis); HER paninhibitors such as canertinib (CI-1033; Pharmacia); Raf-1 inhibitors such as the antisense agent ISIS-5132 provided by ISIS Pharmaceuticals which inhibits Raf-1 signaling; non-HER-directed TK inhibitors such as Imatinib mesylate (Glee66 vac®) provided by Glaxo; MAPK-regulated extracellular kinase I inhibitor CI-1040 (available from Pharmacia); quinazolines, such as PD 153035, 4- (3-chloroanilino) quinazoline; pyridopyrimidines; pyrimidopyrimidines; pyrrolopyrimidines, such as OGP 59326, CGP 60261 and CGP 62706; pyrazolopyrimidines, 4- (phenylamino) -7H-pyrrolo [2,3-d] pyrimidines; curcumin (diferuloyl methane, 4,5-bis (4-fluoroanilino) phthalimide); triphosphines containing portions of nitrothiophene; PD-OI 83805 (Warner-Lamber); antisense molecules (for example, those that bind to the nucleic acid encoding HER); quinoxalins (US Patent No. 5,804,396); triphosphines (US Patent No. 5,804,396); ZD6474 (Astra Zeneca); PTK-787 (Novartis / Schering AG); HER paninhibitors such as CI-1033 (Pfizer); Affinitac (ISIS 3521; Isis / Lilly); Imatinib mesylate (Gleevac; Novartis); PKI 166 (Novartis); GW2016 (Glaxo SmithKline); CI-1033 (Pfizer); EKB-569 (Wyeth); Semaxinib (Sugen);
ZD6474 (AstraZeneca); PTK-787 (Novartis / Schering AG); INC-ICI 1 (Imclone); or as described in any of the following patent applications: US Patent No. 5,804,396; W099 / 09016 (American Cyanimid); WO98 / 43960 (American Cyanamid); WO97 / 38983 (Warner Lambert); WO99 / 06378 (Warner Lambert); WO99 / 06396 (Warner Lambert); WO96 / 30347 (Pfizer, Inc); WO96 / 33978 (Zeneca); WO96 / 3397 (Zeneca); and WO96 / 33980 (Zeneca).
A fixed or invariable dose of a therapeutic agent refers to a dose that is administered to a human patient unrelated to the patient's weight (WT) or body surface area (BSA). The fixed or invariable dose is therefore not provided as a dose in mg / kg or mg / m<sup>2</sup>, but as an absolute amount of the therapeutic agent.
An attack dose generally comprises an initial dose of a therapeutic agent administered to a patient and is followed by one or more maintenance doses of the same. Generally, a single loading dose is administered, but multiple maintenance doses are contemplated here. Generally, the amount (s) of the loading dose exceeds the amount (s) of the maintenance dose (s) administered and / or the dose (s) of attack is (are) administered more frequently than the maintenance dose (s), in order to obtain the desired invariable concentration of the therapeutic agent earlier than can be obtained with the dose (s) ( s) maintenance.
A maintenance dose refers to one or more doses of a therapeutic agent administered to a patient during the treatment period. Generally, maintenance doses are administered at spaced treatment intervals, such as approximately every week, approximately every 2 weeks, approximately every 3 weeks, or approximately every 4 weeks.
A drug is an active drug to treat cancer, such as an HER inhibitor, an HER dimerization inhibitor (such as pertuzumab) or a chemotherapeutic agent (such as gemcitabine).
A target audience is a group of people or an institution to whom or for which a drug is being promoted or intended to be promoted, such as through marketing or advertising, especially for particular uses, treatments or indications, such as individual patients, patient populations , newspaper readers, medical literature, magazines, television or internet viewers, radio or internet listeners, doctors, pharmaceutical industries, etc.
A package insert is used to refer to instructions commonly included in commercial packaging of therapeutic products, which contain information about the indications, use, dosage, administration, contraindications, other products combined with the packaged product, and / or warnings regarding use of such therapeutic products, etc.
II. Antibody Production
In the preferred embodiment, since the HER inhibitor is an antibody, a description of the exemplary techniques for producing antibodies to HER used in accordance with the present invention follows. The HER antigen to be used for the production of antibodies can, for example, be a soluble form of the extracellular domain of a HER receptor or a portion thereof, containing the desired epitope. Alternatively, cells expressing HER on their cell surfaces (for example, NIH-3T3 cells transformed to overexpress HER2; or a carcinoma cell line68 such as SK-BR-3 cells, see Stancovski et al., PNAS (USA) 88: 8691-8695 (1991)) can be used to generate antibodies. Other forms of HER receptors useful for generating antibodies will become apparent to those skilled in the art.
(i) Polyclonal antibodies
Polyclonal antibodies are preferably originated in animals by multiple subcutaneous (sc) or intraperitoneal (ip) injections of the relevant antigen and an adjuvant. It may be useful to conjugate the relevant antigen to a protein that is immunogenic in the species to be immunized, for example, snail hemocyanin, serum albumin, bovine thyroglobulin or soybean trypsin inhibitor using a bifunctional or derivatizing agent, for example, maleimidobenzoyl ester sulfosuccinimide (conjugation via cysteine residues), N-hydroxysuccinimide (via lysine residues), glutaraldehyde, succinic anhydride, SOCI<sub>2</sub> or R<sup>1</sup>N = C = NR, where R and R<sup>1</sup> are different alkyl groups.
Animals are immunized against the antigen, immunogenic conjugates or derivatives by combining, for example, 100 pg or 5 pg of the protein or conjugate (for rabbits or mice, respectively) with 3 volumes of complete Freund's adjuvant by subcutaneous injection at multiple sites. Seven to 14 days later the animals are bled and the serum is assayed for antibody titration. The animals are stimulated up to the title plateau. Preferably, the animal is stimulated with the conjugate, but conjugated to a different protein and / or through a different cross-linking reagent. Conjugates can also be made in recombinant cell culture as fusion proteins. Aggregating agents such as alum can also be used appropriately to enhance the immune response.
(ii) Monoclonal antibodies
Various methods for making monoclonal antibodies are available in the art. For example, monoclonal antibodies can be made using the hybridoma method, first described by Kohler et al., Nature 256: 495 (1975), by recombinant DNA methods (US Patent No.<sup>ç</sup>
4.816.567).
In the hybridoma method, a mouse or other appropriate host animal, such as a hamster, is immunized as described above to generate lymphocytes that produce or are capable of producing antibodies that specifically bind to the protein used for immunization. Alternatively, lymphocytes can be immunized in vitro. Lymphocytes are then fused with myeloma cells using a suitable fusion agent, such as polyethylene glycol, to form a hybridoma cell (Goding, Monoclonal Antibodies: Principie and Practice, pp. 59-103 (Academic Press,
1986)).
The hybridoma cells thus prepared are seeded and grown in a suitable culture medium that preferably contains one or more substances that inhibit the growth or survival of unfused parental myeloma cells. For example, if parental myeloma cells lack the enzyme hypoxanthine guanine phosphoribosyl transferase (HGPRT or HPRT), the culture medium for hybridomas will typically include hypoxanthine, aminopterin and thymidine (HAT medium), whose substances prevent the growth of cells deficient in HGPRT.
Preferred myeloma cells are those that fuse efficiently, support the stable high level production of antibody by cells that produce antibody, and are sensitive to a medium such as the HAT medium. Among these, the preferred myeloma cell lines are murine myeloma lines, such as those derived from mouse MOPC-21 and MPC-11 tumors, available from the Salk Institute
Cell Distribution Center, San Diego, California, USA, and SP-2 or X63Ag8-653 cells, available from American Type Culture Collection, Rockville, Maryiand, USA. Human myeloma and mouse-human heteromyeloma cell lines have also been described for the production of human monoclonal antibodies (Kozbor, J.lununol., 133: 3001 (1984); and
Brodeur et al., Monoclonal Antibody Production Techniques and Applications, pp.51-63 (Marcei Dekker, Inc., New York, 1987)).
The culture medium in which hybridoma cells are cultured is tested for the production of monoclonal antibodies directed against the antigen. Preferably, the binding specificity of monoclonal antibodies produced by the hybridoma cells is determined by immunoprecipitation or by an in vitro binding assay, such as radioimmunoassay (RIA) or enzyme-linked immunosorbent assay (ELISA).
The binding affinity of the monoclonal antibody can, for example, be determined by the Scatchard analysis of Munson et al., Anal. Biochem., 107: 220 (1980).
After hybridoma cells are identified as those that produce antibodies of the desired specificity, affinity and / or activity, clones can be subcloned by limiting dilution procedures and cultured by standard methods (Goding, Monoclonal Antibodies: Principie and Practice, pp. 59 -103 (Academic Press, 1986)). Suitable culture media for this purpose include, for example, D-MEM or RPMI-1640 media. In addition, hybridoma cells can be cultured in vivo as ascites tumors in an animal.
Monoclonal antibodies secreted by the subclones are suitably separated from the culture medium, ascites fluid or serum by conventional antibody purification procedures such as, for example, protein A-Sepharose, hydroxyapatite chromatography, gel electrophoresis, dialysis or affinity chromatography .
The DNA encoding monoclonal antibodies is easily isolated and sequenced using conventional procedures (for example, by using oligonucleotide probes that are able to specifically bind to genes encoding murine antibody heavy and light chains). Hybridoma cells serve as the preferred source of such DNA. Once isolated, DNA can be placed into expression vectors, which are then transfected into host cells such as E cells. coli, Chinese hamster ovary (CHO) cells or myeloma cells that do not otherwise produce antibodies, to obtain the synthesis of monoclonal antibodies in recombinant host cells. Review articles on recombinant expression in bacteria of DNA encoding the antibody 71 include Skerra et al, Curr. Opinion in Immunol., 5: 256-262 (1993) and Pluckthun, Immunol. Revs., 130: 151-188 (1992).
In a further embodiment, monoclonal antibodies or antibody fragments can be isolated from antibody phage libraries generated using the techniques described in McCafferty et al., Nature, 348: 552-554 (1990). Clackson et al., Nature, 352: 624-628 (1991) and Marks et al., J. Mol. Biol, 222: 581-597 (1991) describe the isolation of murine and human antibodies, respectively, using libraries of phages. Subsequent publications describe the production of human antibodies with high affinity (mean nM) by shuffling chains (Marks et al., Bio / Technology, 10: 779-783 (1992)), as well as combinatorial infection and in vivo recombination as a strategy for building very large phage libraries (Waterhouse et al, Nuc. Acids. Res., 21: 2265-2266 (1993)). Thus, these techniques are viable alternatives to the traditional monoclonal antibody hybridoma techniques for isolating monoclonal antibodies.
DNA can also be modified, for example, by replacing the coding sequence of the heavy and light chain constant domains with homologous murine sequences (US Patent No.
4,816,567; and Morrison, et al, Proc. Natl Acad. Sci USA, 81: 6851 (1984)), or by covalently binding to the immunoglobulin coding sequence all or part of the coding sequence for a non-immunoglobulin polypeptide.
Typically, such non-immunoglobulin polypeptides are replaced by the constant domains of an antibody or they are replaced by the variable domains of an antigen binding site of an antibody to create a chimeric bivalent antibody comprising an antigen binding site that has specificity for an antigen and another antigen combination site that has specificity for a different antigen.
(iii) Humanized antibodies
Methods for humanizing non-human antibodies have been described in the art. Preferably, a humanized antibody has one or more amino acid residues introduced into it from a source that is non-human. Such non-human amino acid residues are generally referred to as imported residues, which are typically taken from an imported variable domain. Humanization can be essentially performed following the method of Winter et al. (Jones et al, Nature, 321: 522-525 (1986); Riechmann et al, Nature, 332: 323-327 (1988); Verhoeyen et al, Science, 239: 1534-1536 (1988)), by replacing sequences of hypervariable regions with the corresponding sequences of a human antibody. Consequently, such humanized antibodies are chimeric antibodies (US Patent No. 4,816,567), where substantially less than an intact human variable domain has been replaced by the corresponding sequence from a non-human species. In practice, humanized antibodies are typically human antibodies in which some residues from the hypervariable region and possibly some RF residues are replaced by residues from sites analogous to rodent antibodies.
The choice of human variable domains, both light and heavy, to be used in the production of humanized antibodies is very important to reduce antigenicity. According to the so-called Best-fit method, the variable domain sequence of a rodent antibody is screened against the complete library of known human variable domain sequences. The human sequence that is closest to that of the rodent is then accepted as the human framework region (FR) for the humanized antibody (Sims et al, J. Immunol., 151: 2296 (1993); Chothia et al, J. Mol Biol ., 196: 901 (1987)). Another method uses a particular framework region derived from the consensus sequence of all human antibodies in a particular subgroup of light or heavy chains. The same structure can be used for several different humanized antibodies (Carter et al, Proc. Natl. Acad. Know. USA, 89: 4285 (1992); Presta et al, J. Immunol, 151: 2623 (1993)).
It is also important that the antibodies are humanized with high affinity retention for the antigen and other favorable biological properties. To achieve this goal, according to a preferred method, humanized antibodies are prepared by a process of parental sequence analysis and various conceptual human products using three-dimensional models of the parental and humanized sequences. Three-dimensional immunoglobulin models are commonly available and are familiar to those skilled in the art. Computer programs that illustrate and display likely three-dimensional conformational structures of the selected candidate immunoglobulin sequences are available. The inspection of these presentations allows the analysis of the probable role of residues in the functioning of the candidate immunoglobulin sequence, that is, the analysis of residues that influence the ability of the candidate immunoglobulin to bind with its antigen. In this way, RF residues can be selected and combined from the recipient and the imported sequences such that the desired antibody characteristic, such as increased affinity for the target antigen (s), is obtained. In general, residues from the hypervariable region are directly and more substantially involved in the influence of antigen binding.
W001 / 00245 describes the production of exemplary humanized HER2 antibodies that bind and block the activation of a HER receptor ligand. The humanized antibody of particular interest here essentially blocks the activation of MAPK mediated by EGF, TGF-a and / or HRG as effectively as the murine monoclonal antibody 2C4 (or its Fab fragment) and / or binds to HER2 as effectively as the murine 2C4 monoclonal antibody (or its Fab fragment). The humanized antibody of the same can, for example, comprise residues from the non-human hypervariable region incorporated in a human heavy variable domain and can also comprise a substitution in the structural region (FR) at a position selected from the group consisting of 69H, 71H and 73H, using the variable domain numbering system described by Kabat et al, Sequences of Proteins of Immunological Interest, 5th Ed. Public Health Service, National Institutes of Health, Bethesda, MD (1991). In one embodiment, the humanized antibody comprises FR substitutions at two or all positions 69H, 71H and 73H.
An exemplary humanized antibody of interest here74 includes residues that determine GFTFTDYTMX variable heavy domain complementarity, where X is preferably D or S (SEQ ID NO: 7); DVNPNSGGSIYNQRFKG (SEQ ID NO: 8); and / or NLGPSFYFDY (SEQ ID NO: 9), optionally comprising amino acid modifications of those CDR residues, for example, where the modifications essentially maintain or improve the affinity of the antibody. For example, the variant antibody of interest can have between about one to about seven or about five amino acid substitutions in the heavy variable CDR sequences above. Such variant antibodies can be prepared by affinity maturation, for example, as described below. The most preferred humanized antibody comprises the variable heavy domain amino acid sequence of SEQ ID No. 4.
The humanized antibody may comprise KASQDVSIGVA variable light domain complementarity determining residues (SEQ ID NO: 10); SASYX<sup>1</sup>X<sup>2</sup>X<sup>3</sup>, where X<sup>1</sup> is preferably R or L, X<sup>2</sup> is preferably Y or E, and X<sup>3</sup> it is preferably T or S (SEQ ID NO: 11); and / or QQYYIYPYT (SEQ ID N ° 12), for example, in addition to those heavy domain variable CDR residues in the preceding paragraph. Such humanized antibodies may optionally comprise amino acid modifications in the above CDR residues, for example, where the modifications essentially maintain or improve the affinity of the antibody. For example, the variant antibody of interest can have between about one to about seven or about five amino acid substitutions in the above light variable CDR sequences. Such variant antibodies can be prepared by affinity maturation, for example, as described below. The most preferred humanized antibody comprises the amino acid sequence of the light variable domain of SEQ ID No. 3.
The present application also contemplates affinity matured antibodies that bind to HER2 and block the activation of an HER receptor ligand. The parental antibody can be a human antibody or a humanized antibody, for example, one comprising the sequences of the light variable and / or heavy variable region of SEQ ID NO: 3 and 4, respectively (i.e., comprising VL and / or Pertuzumab VH). Affinity-matured antibody binds, preferably to the HER2 receptor with an affinity greater than that of murine 2C4 or pertuzumab (e.g., improved affinity between about two to about four times, about 100 times, or about 1000 times, for example, as assessed using HER2 extracellular domain (ECD) ELISA). Exemplary heavy variable CDR residues for substitution include H28, H30, H34, H35, H64, H96, H99 or combinations of two or more (for example, two, three, four, five, six or seven of the same residues). Examples of light variable CDR residues for alteration include L28, L50, L53, L56, L91, L92, L93, L94, L96, L97 or combinations of two or more (for example, two to three, four, five or even about ten of the same waste).
Various forms of humanized antibody or affinity matured antibody are contemplated. For example, the humanized antibody or the affinity matured antibody can be an antibody fragment, such as Fab, which is optionally conjugated to one or more cytotoxic agents in order to generate an immunoconjugate. Alternatively, the humanized antibody or the affinity matured antibody can be an inlact antibody, such as an intact IgG1 antibody. The preferred intact IgG1 antibody comprises the sequence of the SEQ ID No. 13 light chain and the sequence of the SEQ ID No. 14 heavy chain.
(iv) Human antibodies
As an alternative to humanization, human antibodies can be generated. For example, it is now possible to produce transgenic animals (for example, mice) that are capable, after immunization, of producing a complete repertoire of human antibodies in the absence of endogenous immunoglobulin production. For example, it has been reported that the homozygous deletion of the junction region (Jh) gene of the antibody heavy chain in chimeric and germline mice results in complete inhibition of endogenous antibody production. The transfer of the immunoglobulin gene array from the human germline into such a mutant mouse germline will result in the production of human antibodies after stimulation with antigen. See, for example, Jakobovits et at, Proc. Natl. Acad. Know. USA, 90: 2551 (1993); Jakobovits et al., Nature, 362: 255-258 (1993); Bruggermann et al, Year in Immuno., 7:33 (1993); and US Patent No. 5,591,669, 5,589,369 and 5,545,807. Alternatively, phage display technology (McCafferty et al, Nature 348: 552-553 (1990)) can be used to produce human antibodies and antibody fragments in vitro from gene repertoires of the variable domain (V) of immunoglobulin from immunized donors. In accordance with this technique, genes in the V domain of the antibody are cloned in phase with both the main and secondary coat protein genes of a filamentous bacteriophage, such as M13 or fd, and presented as functional antibody fragments on the surface of the antibody. phage particle. Since the filamentous particle contains a single-stranded copy of the phage genome DNA, selections based on the antibody's functional properties also result in the selection of the gene encoding the antibody that exhibits these properties. Thus, the phage mimics some of the properties of cell Β. The phage presentation can be done in a variety of formats; for your review see, for example, Johnson, Kevin S. and Chiswell, David J., Current Opinion in Structural Biology 3: 564-571 (1993). Various sources of V gene segments can be used for phage display. Clackson et al, Nature, 352: 624-628 (1991) isolated a diverse array of antioxazolone antibodies from a small random combinatorial library of V genes derived from spleens of immunized mice. A repertoire of V genes from unimmunized human donors can be constructed and antibodies to a diverse array of antigens (including autoantigens) can be isolated, following essentially the techniques described by Marks et al, J. Mol Biol. 222: 581-597 (1991), or Griffith et al, EMBOJ.
12: 725-734 (1993). See also, US Patent No. 5,565,332 and 5,573,905.
As discussed above, human antibodies can also be generated by B cells activated in vitro (see US Patent Nos. 5,567,610 and 5,229,275).
Human antibodies against HER2 are described in the Patent
US No. 5,772,997, issued June 30, 1998 and WO 97/00271 published January 3, 1997.
(v) Antibody fragments
Several techniques have been developed for the production of 5 antibody fragments that comprise one or more antigen-binding regions. Traditionally, these fragments were derived from intact antibodies through proteolytic digestion (see, for example, Morimoto et a !, Journal of Biochemica! And Biophysical Methods 24: 107-117 (1992); and Brennan et al., Science, 229: 81 (1985)). However, these fragments can now be produced directly by recombinant host cells. For example, antibody fragments can be isolated from the antibody phage libraries discussed above. Alternatively, Fba'-SH fragments can be recovered directly from E. coli and chemically coupled to form F (ab ') fragments<sub>2</sub> (Carter et at., Bio / Technology 10: 163-167 (1992)). According to another approach, F (ab ') fragments<sub>2</sub> can be isolated directly from recombinant host cell culture. Other techniques for the production of antibody fragments will be clear to the skilled technician. In other embodiments, the antibody of choice is a single chain Fv fragment (scFv). See, WO
93/16185; US Patent No. 5,571,894; and US Patent No. 5,587,458. The antibody fragment can also be a linear antibody, for example, as described in US Patent No. 5,641,870, for example. Such linear antibody fragments can be monospecific or bispecific.
(vi) Bispecific antibodies
Bispecific antibodies are antibodies that have binding specificities by at least two different epitopes. Exemplary bispecific antibodies can bind to two different epitopes of the HER2 protein. Others of such antibodies can combine an HER2 binding site with EGFR, HER3 and / or HER4 binding site (s). Alternatively, an arm of HER2 can be combined with an arm that binds to a triggering molecule on a leukocyte such as a T cell receptor molecule (for example, CD2 or CD3), or Fc receptors for IqG (FcyR), such as FcyRI (CD64), FcyRII (CD32) and FcyRIII (CD16) in order to focus on cellular defense mechanisms for the cell that expresses HER2. Bispecific antibodies can also be used to locate cytotoxic agents for cells that express HER2. These antibodies have an HER2 binding arm and an arm that binds to the cytotoxic agent (for example, saporin, anti-interferon-α, vinca alkaloid, ricin A chain, methotrexate or hapten radioactive isotope). Bi-specific antibodies can be prepared as full-length antibodies or antibody fragments (e.g., F (ab ') 2 of bispecific antibodies).
WO 96/16673 describes a bispecific antibody for HER2 / FcyRIII and US Patent No. 5,837,234 describes a bispecific antibody for HER2 / FcyRI IDMI (Osidem). A bispecific antibody for HER2 / Fca is shown in WO98 / 02463. US Patent No. 5,821,337 describes a bispecific antibody to HER2 / CD3. MDX-210 is bispecific for Ab HER2FcyRIII.
Methods for producing bispecific antibodies are known in the art. The traditional production of bispecific antibodies of full extension is based on the coexpression of two pairs of light chain and heavy chain of immunoglobulin, where the two pairs have different specificities (Millstein et al., Nature, 305: 537-539 (1983)). Due to the random clustering of immunoglobulin light and heavy chains, these hybridomas (quadromas) produce a potential mixture of 10 different antibody molecules, of which only one has the correct bispecific structure. Purifying the correct molecule, which is usually done by affinity chromatography steps, is particularly laborious and the product yield is low. Similar procedures are described in WO 93/08829, and in Traunecker et al, EMBO J., 10: 3655-3659 (1991).
According to a different approach, the variable domains of the antibody with the desired binding specificities (sites that combine antibody-antigen) are fused to immunoglobulin constant domain sequences. The fusion is preferably with an immunoglobulin heavy chain constant domain, which comprises at least part of the hinge, CH2 and CH3 regions. It is preferred to have the first heavy chain constant region (CH1) containing the site necessary for light chain binding, present in at least one of the fusions. DNAs encoding immunoglobulin heavy chain fusions and, if desired, the immunoglobulin light chain, are inserted into separate expression vectors and are cotransfected to a suitable host organism. This provides great flexibility in adjusting the mutual proportions of the three polypeptide fragments in modalities when unequal proportions of the three polypeptide chains used in the construction provide optimal yields. However, it is possible to insert the coding sequences for two or all three polypeptide chains in an expression vector, when the expression of at least two polypeptide chains in equal proportions results in high yields or when the proportions are not of particular significance.
In a preferred embodiment of this approach, bispecific antibodies are composed of a hybrid immunoglobulin heavy chain with a first binding specificity in one arm and a hybrid immunoglobulin light-heavy chain pair (providing a second binding specificity) in another arm . This asymmetric structure has been found to facilitate separation of the desired bispecific compound from unwanted immunoglobulin chain combinations, since the presence of an immunoglobulin light chain in only one half of the bispecific molecule provides an easy way of separation. This approach is described in WO 94/04690. For more details on generation of bispecific antibodies see, for example, Suresh et al., Methods in Enzymology, 121: 210 (1986).
According to another approach described in US Patent No. 5,731,168, the interface between a pair of antibody molecules can be manipulated to maximize the percentage of heterodimers that are recovered from the recombinant cell culture. The preferred interface comprises at least part of the C domain<sub>H</sub>3 of an antibody constant domain. In this method, one or more small amino acids from the side chains at the interface of the first antibody molecule are replaced by larger side chains (for example, tyrosine or tryptophan). Compensatory cavities of the same or similar size, the larger side chains are created on the interface of the second antibody molecule by replacing large amino acids in the side chains with smaller ones (for example, alanine or threonine). This provides a mechanism to increase the yield of the heterodimer over other unwanted end products such as homodimers.
Bispecific antibodies include cross-linked or heteroconjugate antibodies. For example, one of the antibodies in the heteroconjugate can be coupled to avidin, the other to biotin. Such antibodies have, for example, been proposed to target cells of the immune system against unwanted cells (US Patent No. 4,676,980) and to treat HIV infection (WO 91/00360, WO 92/200373 and EP 03089). Heteroconjugate antibodies can be made using any convenient cross-linking method. Suitable crosslinking agents are well known in the art and are described in US Patent No. 4,676,980, along with various crosslinking techniques.
Techniques for generating bispecific antibodies from antibody fragments are also described in the literature. For example, bispecific antibodies can be prepared using chemical bonding.
Brennan et al., Science, 229: 81 (1985) describes a procedure in which intact antibodies are proteolytically cleaved to generate F (ab ') fragments<sub>2</sub>. These fragments are reduced in the presence of the dithiol agent complexed with sodium arsenite to stabilize vicinal dithiols and prevent the formation of intermolecular disulfide. The Fab 'fragments generated are then converted to thionitrobenzoate (TNB) derivatives. One of the Fab'-TNB derivatives is then re-converted to Fba-thiol by reduction with mercaptoethylamine and mixed with an equimolar amount of another Fab'-TNB derivative to form the bispecific antibody. The bispecific antibodies produced can be used for selective immobilization of enzymes.
Recent progress has facilitated the direct recovery of E. coli Fab'-SH fragments, which can be chemically coupled to form bispecific antibodies. Shalaby et a! .. J. Exp. Med., 175: 217-225 (1992) describe the production of an F (ab ') molecule<sub>2</sub> of fully humanized bispecific antibody. Each Fab 'fragment was secreted separately from E. coli and subjected to targeted chemical coupling in vitro to form the bispecific antibody. The bispecific antibody thus formed was able to bind to cells that overexpress the HER2 receptor and normal human T cells, as well as to trigger the lytic activity of human cytotoxic lymphocytes against human breast tumor targets.
Various techniques for making and isolating bispecific antibody fragments directly from recombinant cell culture have also been described. For example, bispecific antibodies have been produced using leucine zippers. Kostelny et al., J. Immunol., 148 (5): 1547-1553 (1992). The leucine zipper peptides from the Fos and Jun proteins were linked to the Fab 'portions of two different antibodies by gene fusion. The antibody homodimers were reduced in the hinge region to form monomers and then reoxidized to form antibody heterodimers. This method can also be used for the production of antibody homodimers. The dibody technology described by Hollinger et al., Proc. Natl. Acad. Know. USA, 90: 6444-6448 (1993) has provided an alternative mechanism for making bispecific antibody fragments. The fragments comprise a heavy chain variable domain (V<sub>H</sub>) connected to a light chain variable domain (V<sub>L</sub>) by a linker that is too short to allow pairing between the two domains on the same chain. Consequently, V domains<sub>H</sub> and V<sub>L</sub> of a fragment are forced to pair with complementary domains V<sub>H</sub> and V<sub>L</sub> from another fragment, thus forming two antigen-binding sites. Another strategy for making bispecific antibody fragments by using single chain Fv (sFv) dimers has also been described. See Gruber et al., J. Immunol., 152: 5368 (1994).
Antibodies with more than two valences are considered. For example, specific antibodies can be prepared. Tutt et al. J. Immunol. 147: 60 (1991).
(vii) Other amino acid sequence modifications
Amino acid sequence modifications of the antibodies described herein are considered. For example, it may be desirable to improve the binding affinity and / or other biological properties of the antibody. Amino acid sequence variants of the antibody are prepared by introducing appropriate nucleotide changes in the antibody's nucleic acid or by peptide synthesis. Such modifications include, for example, deletions of and / or insertions and / or substitutions of residues within the amino acid sequences of the antibody. Any combination of deletion, insertion and substitution is done to arrive at the final construct, as long as the final construct has the desired characteristics. Amino acid changes can also alter the post-translational processes of the antibody, such as changing the number or position of glycosylation sites.
A useful method for identifying certain residues or regions of the antibody that are the preferred locations for mutagenesis is called alanine screening mutagenesis as described by Cunningham and Wells Science, 244: 1081-1085 (1989). Here, a target residue or group of residues is identified (for example, charged residues such as arg, asp, his, lys and glu) and replaced with a neutral or negatively charged amino acid (more preferably alanine or polyalanine) to affect the interaction of the amino acids with the antigen. Those amino acid locations that demonstrate functional sensitivity to substitutions are then refined by adding additional or other variants to or at the substitution sites. Thus, although the site for introducing an amino acid variation is predetermined, the nature of the mutation per se does not need to be predetermined. For example, to analyze the performance of a mutation at a given site, wing screening or random mutagenesis is conducted at the target codon or region and the expressed antibody variants are screened for the desired activity.
Amino acid sequence inserts include amino and / or carboxy-terminal fusions varying in length from one residue to polypeptides that contain a hundred or more residues, as well as intra-sequence insertions of a single or multiple amino acid residues. E83 examples of terminal insertions include antibody with an N-terminal methionyl residue or the antibody fused to a cytotoxic polypeptide. Other variants of insertion of the antibody molecule include fusion at the N or C termination of the antibody of an enzyme (for example, for ADEPT) or a l5 peptide that increases the serum half-life of the antibody.
Another type of variant is an amino acid substitution variant. These variants have at least one amino acid residue in the antibody molecule replaced by a different residue. Sites of greatest interest for substitution mutagenesis include hypervariable10 regions, but changes in RF are also considered. Conservative substitutions are shown in Table 1 under the heading of preferred substitutions. If such substitutions result in a change in biological activity, then more substantial changes, called exemplary substitutions in Table 1, or as described below with respect to classes of amino acids, can be introduced and the products screened.
Table 1
<td>Original waste</td><td>Exemplary replacements</td><td>Preferred Substitutions</td>
<td>Wing (A)</td><td>Go. Read; Ile</td><td>Go</td>
<td>Arg (R)</td><td>Lys; Gin; Asn</td><td>Lys</td>
<td>Asn (N)</td><td>Gin; His; Asp; Lys; Arg</td><td>Gin</td>
<td>Asp (D)</td><td>Glu; Asn</td><td>Glu</td>
<td>Cys (C)</td><td>To be; Allah</td><td>To be</td>
<td>Gin (Q)</td><td>Asn; Glu</td><td>Asn</td>
<td>Glu (E)</td><td>Asp; Gin</td><td>Asp</td>
<td>Gly (G)</td><td>Aa</td><td>Allah</td>
<td>His (H)</td><td>Asn; Gin; Lys; Arg</td><td>Arg</td>
<td>Ile (I)</td><td>Read; Go; Met; Allah; Phe; Norleucine</td><td>Read</td>
<td>Leu (L)</td><td>Norleucine; Ile; Go; Met; Allah; Phe</td><td>Ile</td>
<td>Lys (K)</td><td>Arg; Gin; Asn</td><td>Arg</td>
<td>Met (M)</td><td>Read; Phe; Ile</td><td>Read</td>
<td>Phe (F) '</td><td>Trp; Read; Go; Ile. Allah; Tyr</td><td>Tyr</td>
<td>Pro (P)</td><td>Allah</td><td>Allah</td>
<td></td><td>YOU</td><td>YOU -</td>
<td></td><td>t 1 tl</td><td>1> II</td>
<td>Original waste</td><td>Exemplary replacements</td><td>Preferred Substitutions</td>
<td>Thr (T)</td><td>Go; To be</td><td>To be</td>
<td>Trp (W)</td><td>Tyr; Phe</td><td>Tyr</td>
<td>Tyr (Y)</td><td>Trp; Phe; Thr; To be</td><td>Phe</td>
<td>Go (V)</td><td>Ile; Read; Met; Phe; Allah; Norleucine</td><td>Read</td>
Substantial changes in the biological properties of the antibody are obtained by selective substitutions that differ significantly in their effects on maintaining (a) the structure of the polypeptide framework in the substitution area, for example, as a ribbon or helical conformation, (b) of the charge or hydrophobicity of the molecule at the target site or (c) the volume of the side chain. Amino acids can be grouped according to similarities in the properties of their side chains (in AL Lehninger, in Biochemistry, second ed., Pp. 73-75, Worth Publishers, New York (1975)):
(1) non-polar: Ala (A), Vai (V), Leu (L), Ile (I), Pro (P), Phe (F),
Uncharged polar Trp (W), Met (M) (2): Gly (G), Ser (S), Thr (T), Cys (C), Tyr (Y), Asn (N), Gin (Q) (3) acids: Asp (D), Glu (E) (4) basic: Lys (K), Arg (R), His (H)
Alternatively, naturally occurring residues can be divided into groups based on common side chain properties:
(1) hydrophobic: Norleucine, Met, Ala, Val, Leu, He;
(2) neutral hydrophilic: Cys, Ser, Thr, Asn, Gin;
(3) acids: Asp, Glu;
(4) basic: His, Lys, Arg;
(5) residues that influence the orientation of the chain: Gly, Pro;
(6) aromatics: Trp, Tyr, Phe.
Non-conservative substitutions will involve exchanging a member of one of these classes for another class.
Gucuquéi lesiuuu de cisieíuia not affected by the appropriate conformation of the antibody can also be substituted, usually by serine, to improve the oxidative stability of the molecule and prevent aberrant crosslinking. Conversely, cysteine bonds can be added to the antibody to improve its stability (particularly, when the antibody is an antibody fragment such as an Fv fragment).
A preferred type of substitution variant involves replacing one or more residues in the hypervariable region of a parent antibody (for example, a humanized or human antibody). Generally, the resulting variants, selected for further development, will have improved biological properties in relation to the parental antibody from which they were generated. A convenient way to generate such substitution variants involves affinity maturation using phage display. Briefly, several hypervariable region sites (for example, 6 to 7 sites) are mutated to generate all possible amino acid substitutions at each site. The antibody variants thus generated are presented in a monovalent aspect from filamentous phage particles as fusions of the M13 product of gene III packed within each particle. The phage-displayed variants are then screened for their biological activities (e.g., binding affinity) as described herein. In order to identify sites in the hypervariable region that are candidates for modification, mutation through alanine screening can be performed to identify residues in the hypervariable region that contribute significantly to antigen binding. Alternatively, or in addition, it may be beneficial to analyze the crystal structure of the antigen-antibody complex to identify points of contact between the antibody and human HER2. Such contact wastes and neighboring wastes are candidates for substitution according to the techniques developed here. Once the variants are generated, the panel of variants is screened as described here and antibodies with superior properties in one or more relevant assays can be selected for further development.
Another type of amino acid variant of the antibody alters the original glycosylation pattern of the antibody. By altering, it is meant to delete one or more portions of carbohydrate found in the antibody and / or to add one or more glycosylation sites that are not present in the antibody.
Antibody glycosylation is typically both N-linked and O-linked. N-linked refers to the coupling of the carbohydrate moiety to the side chain of an asparagine residue. The asparagine-X-serine and asparagine-X-threonine tripeptide sequences, where X is any amino acid except proline, are the recognition sequences for enzymatic coupling of the carbohydrate moiety to the asparagine side chain. Thus, the presence of any of these tripeptide sequences in a polypeptide creates a potential glycosylation site. O-linked glycosylation refers to the coupling of one of the sugars Nacetylgafactosamine, galactose or xylose to a hydroxyamino acid, more commonly serine or threonine, although 5-hydroxyproline or 5-hydroxylysine can also be used.
The addition of glycosylation sites to the antibody is conveniently achieved by altering the amino acid sequence such that it contains one or more of the tripeptide sequences described above (for N-linked glycosylation sites). The change can also be made by adding or replacing one or more serine or threonine residues from the original antibody sequence (for O-linked glycosylation sites).
Where the antibody comprises an Fc region, the carbohydrate attached to it can be changed. For example, antibodies with a mature carbohydrate structure that lacks fucose coupled to an antibody Fc region are described in US Patent Application No. US2003 / 0157108 A1, Presta, L. See also US2004 / 0093621 A1 (Kyowa Hakko Kogyo Co ., Ltd.). Antibodies with an N-acetylglycosamine divided in two (GlcNAc) in the carbohydrate coupled to an Fc region of the antibody are cited in WO03 / 011878, Jean-Marie et al. and US Patent No. 6,602,684, Umana et al. Antibodies with at least one galactose residue in the oligosaccharide coupled to an Fc region are reported in W097 / 30087, Patel et al. See also WO98 / 58964 (Raiu. S.) and WO99 / 22764 (Raju, S.) regarding antibodies with altered carbohydrate coupled to their Fc region.
It may be desirable to modify the antibody of the invention with respect to effector function, for example, in order to enhance the antigen-dependent cell-mediated cytotoxicity (ADCC) and / or the complement-dependent cytotoxicity (CDC) of the antibody. This can be achieved by introducing one or more amino acid substitutions into an Fc region of the antibody. Alternatively or additionally, cysteine residue (s) can be introduced into the Fc region, thereby allowing disulfide bond formation between the chains in that region. The homodimeric antibody thus generated may have improved internalization capacity and / or complement-mediated cell death and increased antibody-dependent cell cytotoxicity (ADCC). See Caron et al., J. Exp. Med. 176: 11911195 (1992) and Shopes, BJ Immunol. 148: 2918-2922 (1992). Homodimeric antibodies with increased antitumor activity can also be prepared using hetero-bifunctional crosslinkers as described in Wolff et al., Cancer Research 53: 2560-2565 (1993). Alternatively, an antibody that has double Fc regions can be engineered and may, therefore, have increased complement lysis and ADCC capabilities. See Stevenson et al., Anti-Cancer Drug Design 3: 219-230 (1989).
WO00 / 42072 (Presta, L) describes antibodies with improved ADCC function in the presence of human effector cells, where the antibodies comprise amino acid substitutions in their Fc region. Preferably, the antibody with improved ADCC comprises substitutions at positions 298, 333 and / or 334 of the Fc region (EU residue numbering). Preferably, the altered Fc region is a human IgG1 Fc region that comprises or consists of substitutions at one, two or three of these positions. Such substitutions are optionally combined with substitutions with increased C1q and / or CDC binding.
Antibodies with altered C1q binding and / or complement-dependent cytotoxicity (CDC) are described in WO99 / 51642, US Patent No. 6,194,551BI, US Patent No. 6,242,195BI, US Patent No. 6,528,624BI and US Patent N 6,538,124 (Idusoqte et al). The antibodies comprise an amino acid substitution at one or more amino acid positions 270, 322, 326, 327, 329, 313, 333 and / or 334 of their Fc region (EU number of residues).
To increase the serum half-life of the antibody, a rescue receptor binding epitope can be incorporated into the antibody (especially an antibody fragment) as described, for example, in US Patent No. 5,739,277. As used here, the term rescue receptor binding epitope refers to an epitope from the Fc region of an IgG molecule (eg, IgG-ι, lgG2, lgG3 or IgGzt) that is responsible for increasing the serum half-life of IgG molecule in vivo.
Antibodies with improved binding to the neonatal Fc receptor (FcRn) and increased half-lives are described in WO00 / 42072 (Presta, L.) and US2005 / 0014934A1 (Hinton et al). These antibodies comprise an Fc region with one or more substitutions in that place that increase the binding of the Fc region to FcRn. For example, the Fc region may have substitutions in one or more of positions 238, 250, 256, 265, 272, 286, 303, 305, 307, 311, 312, 314, 317, 340, 356, 360, 362, 376 , 378, 380, 382, 413, 424, 428 or 434 (Eu numbering of residues). The antibody variant comprising the preferred Fc region with increased FcRn binding, comprises amino acid substitutions at one, two or three of positions 307, 380 and 434 of its Fc region (numbering residues Eu).
Antibodies engineered with three or more (preferably four) functional antigen binding sites are also considered (US Application No. US2002 / 0004587 Al, Miller et al).
The nucleic acid molecules that encode the amino acid sequence variants of the antibody are prepared by a variety of methods known in the art. These methods include, but are not limited to, isolation from a natural source (in the case of naturally occurring amino acid sequence variants) or preparation by oligonucleotide-mediated (or site-directed) mutagenesis, PCR mutagenesis and cassette mutagenesis. a previously prepared version or a non-antibody variant.
(viii) Screening of antibodies with the desired properties
Techniques for generating antibodies have been described above. Antibodies with certain biological characteristics can also be selected, as desired.
To identify an antibody that blocks the activation of a HER receptor ligand, the ability of the antibody to block HER ligand binding in cells that express the HER receptor (for example, in conjunction with another HER receptor with the which the HER receptor of interest forms a HER hetero-oligomer) can be determined. For example, cells that express naturally or transfected to express the HER receptors of the Her hetero-oligomer can be incubated with the antibody and then exposed to the labeled HER ligand. The ability of the antibody to block ligand binding to the HER receptor on the HER hetero-oligomer can then be assessed.
For example, inhibition of the HRG ligand in breast tumor MCF7 cell lines by antibodies to HER2 can be performed using cultures of MCF7 monolayers on ice in a 24-well plate format, essentially as described in WO01 / 00245. Monoclonal antibodies to HER2 can be added to each well and incubated for 30 minutes. rHRGpi 177-224 tagged with<sup>125</sup>1 (25 pm) can then be added and the incubation can be continued for 4 to 16 hours. Dose-response curves can be prepared and an IC value<sub>50</sub> can be calculated for the antibody of interest. In one embodiment, the antibody that blocks the activation of an HER receptor ligand will have an IC 50 for inhibiting HRG binding in MCF7 cells in that assay of about 50 nM or less, more preferably 10 nM or less. Where the antibody is an antibody fragment, such as a Fab fragment, IC<sub>50</sub> for inhibiting HRG binding in MCF7 cells in that assay it can, for example, be about 100 nM or less, more preferably 50 nM or less.
Alternatively or in addition, the ability of an antibody to block tyrosine phosphorylation stimulated by the HER ligand of an HER receptor present in a HER hetero-oligomer can be assessed. For example, cells that express HER receptors endogenously or transfected to express them can be incubated with the antibody and then tested for HER ligand-dependent tyrosine phosphorylation activity using an anti-phosphotyrosine monoclonal antibody (which is optionally conjugated with detectable marker). The kinase receptor activation assay described in the US Patent No. 5,766,563 is also available to determine HER receptor activation and blocking this activity by an antibody.
In one embodiment, an antibody that inhibits HRG stimulation of tyrosine kinase p180 phosphorylation in MCF7 cells can essentially be screened essentially as described in W001 / 00245. For example, MCF7 cells can be plated on 24-well plates and monoclonal antibodies to HER2 can be added to each well and incubated for 30 minutes at room temperature; then, rHRGpi 177.224 can be added to a final concentration of 0.2 nM and the incubation can be continued for 8 minutes. The medium can be aspirated from each well and the reactions can be stopped by adding 100 μΙ of SDS sample buffer (5% SDS, 25 mM DTT and 25 mM Tris-HCI, pH 6.8). Each sample (25 μΙ) can be electrophoresed on a 4-12% gradient gel (No20 vex) and then transferred electrophoretically to a polyvinylidene difluoride membrane. Antiphosphotyrosine immunoblots (1 pg / ml) can be developed and the band intensity in M<sub>r</sub>~ 180,000 can be quantified by reflectance densitometry. The selected antibody will preferably significantly inhibit HRG stimulation of tyrosine phosphorylation25 sina p180 for about 0 to 35% of the control of the same assay. The dose-response curve for inhibiting HRG stimulation of tyrosine phosphorylation p180 as determined by reflectance densitometry can be prepared and an IC 50 for the antibody of interest can be calculated. In one embodiment, the antibody that blocks ligand activation of an HER receptor will have an IC 50 for inhibiting HRG stimulation of tyrosine phosphorylation p180 in that assay of about 50 nM or less, more preferably 10 nM or less. Where the antibody is an antibody fragment, such as a Fab fragment, IC<sub>50</sub> for inhibiting HRG stimulation of tyrosine p180 phosphorylation in that assay it can, for example, be about 100 nM or less, more preferably 50 nM or less.
One can evaluate the inhibitory effects of the antibody on the growth of MDA-MB-175 cells, for example, essentially as described by Schaefer et al., Oncogene 15: 1385-1394 (1997). According to this assay, MDA-MB-175 cells can be treated with monoclonal antibody to HER2 (10 pg / ml) for 4 days and stained with crystal violet. Incubation with an HER2 antibody may show an inhibitory effect on growth on this cell line similar to that presented by monoclonal antibody 2C4. In an additional embodiment, exogenous HRG will not significantly reverse this inhibition. Preferably, the antibody will be able to inhibit cell proliferation of MDA-MB-175 cells to a greater extent than the monoclonal antibody 4D5 (and optionally, to a greater extent than the 7F3 antibody), both in the presence and in the absence of Exogenous HRG.
In one embodiment, the HER2 antibody of interest can block the association of HER2 with heregulin-dependent HER3 in both MCF7 and SK-BR-3 cells as determined in a coimmunoprecipitation experiment such as that described in WO01 / 00245, substantially more effectively than the 4D5 monoclonal antibody and, substantially more effectively than the 7F3 monoclonal antibody.
To identify growth-inhibiting antibodies to HER2, antibodies that inhibit the growth of cancer cells that overexpress HER2 can be screened. In one embodiment, the growth inhibitory antibody of choice is capable of inhibiting the growth of SK-BR-3 cells in a cell culture by about 20 to 100% and preferably by about 50 to 100% at an antibody concentration of about 0.5 to 30 pg / ml. To identify such antibodies, the SK-BR-3 assay described in US Patent No. 5,677,171 can be performed. According to this assay, SK-BR-3 cells are cultured in a 1: 1 mixture of F12 and DMEM medium supplemented with 10% fetal bovine serum, qlutamine, penicillin and strep92 tomycin. SK-BR-3 cells are plated on 20,000 cells on a 35 mm cell culture plate (2 ml / 35 mm plate). 0.5 to 30 pg / ml of HER2 antibody is added to each plate. After six days, the number of cells, compared to untreated cells, is counted using a COULTER® electronic cell counter. Those antibodies that inhibit the growth of SK-BR-3 cells by about 20 to 100% or about 50 to 100% can be selected as growth inhibitory antibodies. See US Patent No. 5,677,171 for screening tests for growth inhibitory antibodies, such as 4D5 and 3E8.
In order to select antibodies that induce apoptosis, an annexin binding assay using B1474 cells is available. BT474 cells are cultured and plated as discussed in the preceding paragraph. The medium is then removed and replaced with fresh medium only or medium containing 10 pg / ml monoclonal antibody. After an incubation period of three days, the monolayers are washed with PBS and detached by trypsinization. The cells are then centrifuged, resuspended in Ca binding buffer<sup>2+</sup> and aliquoted in tubes as discussed above, for the cell death assay. The tubes then receive labeled annexin (for example, annexin V-FTIC) (1 gg / ml). The samples can be analyzed using a FACSCAN® flow cytometer and the FACSCONVERT® CelIQuest program (Becton Dickinson). Those antibodies that induce statistically significant levels of attachment to annexin compared to the control are selected as apoptosis-inducing antibodies. In addition to the annexin binding assay, a DNA staining assay using BT474 cells is available. In order to perform this assay, BT474 cells that have been treated with the antibody of interest as described in the preceding two paragraphs, are incubated with 9 μg / ml of HOECHST 33342® for 2 h at 37 ° C, then analyzed in a flow cytometer. EPICS ELITE® (Coulter Corporation) using the MODFIT LT® program (Verity Software House). Antibodies that induce a change in the percentage of apoptotic cells that is 2 times or more (and preferably 3 times or more) than untreated cells (up to 100% of apoptotic cells) can be selected as pro-apoptotic antibodies using this essay. See WO98 / 17797 for screening assays for antibodies that induce apoptosis, such as 7C2 and 7F3.
To screen for antibodies that bind to an epitope on HER2 bound by an antibody of interest, a routine cross-block assay, such as that described in Antibodies, A Laboratory Manual, Cold Spring Harbor Laboratory, Ed Harlow and David Lane (1988) , can be performed to assess whether the antibody blocks the binding of an antibody, such as 2C4 or pertuzumab, to HER2. Alternatively, or in addition, epitope mapping can be performed by methods known in the art and / or the structure of HER2 antibody (Franklin et al. Cancer Cell 5: 317-328 (2004)) can be seen to see which / which HER2 domain / domains is / are bound by the antibody.
(ix) Pertuzumab compositions
In one embodiment of an HER2 antibody composition, the composition comprises a mixture of a major species of pertuzumab and one or more of its variants. The preferred embodiment here of a major pertuzumab antibody species is one that comprises the light variable and heavy variable amino acid sequences in SEQ ID NO: 3 and 4 and, most preferably, which comprises a light chain amino acid sequence selected from among SEQ ID N ° 13 and 17 and a heavy chain amino acid sequence selected from SEQ ID N ° 14 and 18 (including deamidated and / or oxidized variants of these sequences) In one embodiment, the composition comprises a mixture of the main antibody species pertuzumab and a variant amino acid sequence thereof which comprises a leading amino-terminal extension. Preferably, the leading amino-terminal extension is on an antibody variant light chain (for example, on one or two antibody variant light chains). The main species of HER2 antibody or the variant antibody can be a full-length antibody or an antibody fragment (for example, Fab or F (ab ') fragments)<sub>2</sub>), but preferably both are full-length antibodies. The antibody variant can comprise a leading amino-terminal extension over any one or more of its heavy or light chains. Preferably, the leading amino-terminal extension is on one or two light chains of the antibody. The leading amino-terminal extension preferably comprises or consists of ESR. The presence of the leading amino-terminal extension in the composition can be detected by several analytical techniques including, but not limited to, Nterminal sequence analysis, assay for heterogeneity of charge (for example, cation exchange chromatography or capillary zone electrophoresis), mass spectrometry, etc. The amount of the antibody variant in the composition generally varies between an amount that constitutes the detection limit of any assay (preferably the analysis of the N-terminal sequence) used to detect the variant at an amount less than the amount of the main antibody species . Generally, about 20% or less (for example between about 1% to about 15%, for example, between about 5% to about 15%) of the antibody molecules in the composition comprise leading amino-terminal extension. Such percentage amounts are preferably determined using quantitative N-terminal sequence analysis or cation exchange analysis (preferably using a high resolution, weak cation exchange column, such as the PROPAC WCX-10 ™ cation exchange column) . Beside the leading amino-terminal variant extension, additional changes to the amino acid sequence of the main species of the antibody and / or variant are considered, including but not limited to an antibody comprising a C-terminal lysine residue in one or both heavy chains, a deamidated variant of antibody, etc.
In addition, the primary species of antibody or variant may further comprise variations in glycosylation, non-limiting examples of which include an antibody comprising an G1 or G2 oligosaccharide structure coupled to its Fc region, an antibody comprising a coupled carbohydrate portion your light chain (for example, one or two portions of carbohydrate, such as glucose or galactose, coupled with one or two light chains of the antibody, for example coupled to one or more lysine residues), antibody comprising one or two non-glycosylated heavy chains or antibody comprising a sialidated oligosaccharide coupled to one or more of its heavy chains, etc.
The composition can be recovered from a genetically engineered cell line, for example, a Chinese hamster ovary (CHO) cell line that expresses the HER2 antibody or can be prepared by peptide synthesis.
(x) Immunoconjugates
The invention also relates to immunoconjugates that comprise an antibody conjugated to a cytotoxic agent such as a chemotherapeutic agent, toxin (for example, small molecule toxin or an enzymatically active toxin of bacterial, fungal, plant or animal origin, including fragments and / or variants) or to a radioactive isotope (ie a radioconjugate).
Chemotherapeutic agents useful in the generation of such immunoconjugates have been described above. Conjugates of an antibody and one or more small molecule toxins, such as calicheamine, maytansine (US Patent No. 5,208,020), a trichotene and CC1065 are also considered here.
In a preferred embodiment of the invention, the antibody is conjugated to one or more maytansine molecules (for example, about 1 to about 10 maytansine molecules per antibody molecule). Maytansine can, for example, be converted to May-SS-Me which can be reduced to May-SH3 and reacted with modified antibody (Chari et al. Cancer Research 52: 127-131 (1992)) to generate a maytansinoid immunoconjugate. antibody.
Another immunoconjugate of interest comprises an antibody conjugated to one or more molecules of calicheamicin. The family of calicheamicin antibiotics are capable of producing double-stranded DNA breaks in subpicomolar concentrations. Structural analogs of calicheamicin that can be used include, but are not limited to γ-Λ 012<sup>1</sup>, α.3<sup>1</sup>, N-acetyl-γ-ι<sup>1</sup>, PSAG and θ / (Hinman et al. Cancer Research 53: 3336-3342 (1993) and Lode et al. Cancer Research 58: 2925-2928 (1998)). See also, US Patent Nos. 5,714,586; 5,712,374; 5,264,586; and 5,773,001 ex96 expressly incorporated herein by reference.
Enzymatically active toxins and fragments that may be used include diphtheria A chain, active non-binding diphtheria toxin fragments, exotoxin A chain (from Pseudomonas aeruginosa), ricin A chain, abrin A chain, modecin A chain, alpha-sarcina, Aieurites fordii proteins, diantin proteins, American Phytolaca proteins (PAPI, PAPII, and PAP-S), momordica charantia inhibitor, curcine, crotine, saponaria officinalis inhibitor, gelonin, mitogelin, restrictitocin, phenomycin, enomycin and trichothecenes. See, for example, WO 93/21232 published on October 28, 1993.
The present invention further contemplates an immunoconjugate formed between an antibody and a compound with nucleolytic activity (for example, a ribonuclease or a DNA endonuclease such as deoxyribonuclease; DNase).
A variety of radioactive isotopes are available for the production of HER2 antibody radioconjugates. Examples include At<sup>211</sup>, I<sup>131</sup>, I<sup>125</sup>, Y<sup>90</sup> Re<sup>188</sup>, Sm<sup>153</sup>, Bi<sup>212</sup>, P<sup>32</sup> and radioactive isotopes of Lu.
Antibody and cytotoxic agent conjugates can be made using a variety of bifunctional protein coupling agents such as N-succinimidyl-3- (2-pyridyldithiol) propionate (SPDP), succinimidyl-4 (N-maleimidomethyl) cyclohexane-1 -carboxylate, iminothiolane (IT), bifunctional derivatives of imidoesters (such as dimethyl adipimidate HCL), active esters (such as disuccinimidyl suberate), aldehydes (such as glutaraldehyde), bis-azido compounds (such as bis (p-azidobenzoyl) hexanediamine), bis-diazonium derivatives (such as bis- (p-diazoniobenzoyl) -ethylenediamine), diisocyanates (such as toliene 2,6-diisocyanate), and bisative fluorine compounds (such as 1,5-difluoro-2,4-dinitrobenzene). For example, a ricin immunotoxin can be prepared as described in Vitetta et al. Science 238: 1098 (1987). Carbon-14-labeled 1-isothiocyanatobenzyl-3-methylldiethylene triaminopentaacetic acid (MX-DTPA) is an exemplary chelating agent for the conjugation of radionucleotide to the antibody. See WO94 / 11026. The ligand can be a cleavable ligand that facilitates the release of the cytotoxic drug in the cell. For example, a labile acid ligand, a peptidase-sensitive ligand, a dimethyl ligand or disulfide-containing ligand (Chari et al. Cancer Research 52: 127-131 (1992)) can be used.
Alternatively, a fusion protein comprising the antibody and the cytotoxic agent can be made, for example, by recombinant techniques or peptide synthesis.
Other immunoconjugates are considered here. For example, the antibody can be linked to one of a variety of non-proteinaceous polymers, for example, polyethylene glycol, polypropylene glycol, polyoxyalkylene or copolymers of polyethylene glycol and polypropylene glycol. The antibody can be captured in microcapsules prepared, for example, by coacervation techniques or by inter-racial polymerization (for example, hydroxymethylcellulose or gelatin microcapsules and (methylmethacrylate) microcapsules, respectively), in colloidal drug delivery systems (for example, liposomes, albumin microspheres, microemulsions, nanoparticles and nanocapsules) or in other macroemulsions. Such techniques are described in Remington's Pharmaceutical Sciences, 16th edition, Oslo, A., Ed., (1980).
The antibodies described herein can also be formulated as immunoliposomes. Liposomes containing the antibody are prepared by methods known in the art, as described in Epstein et al, Proc. Natl. Acad. Sci USA, 82: 3688 (1985); Hwang et al, Proc. Natl Acad. Sci USA, 77: 4030 (1980); Pat. US Nos. 4,485,045 and 4,544,545; and WO97 / 38731 published on October 23, 1997. Liposomes with increased circulation time are described in U.S. Pat. US No. 5,013,556.
Particularly useful liposomes can be generated by the reverse phase evaporation method with a lipid composition comprising phosphatidylcholine, cholesterol and derivatized PEG-phosphatidylethanolamine (PEG-PE). Liposomes are expelled through filters of defined pore size to obtain liposomes with the desired diameter. Fab 'fragments of the antibody of the present invention can be conjugated to the liposomes as described in Martin et al. J. Biol. Chem. 257: 286-288 (1982) through a disulfide exchange reaction. A chemotherapeutic agent is optionally contained within the liposome. See, Gabizon et at. J. National Cancer /nsf.81(19)1484 (1989).
III. Diagnostic Methods
In a first aspect, the invention provides a method for selecting a therapy for a patient with a type of cancer (for example, ovarian cancer) that is capable of responding to an HER inhibitor or HER dimerization inhibitor (for example, pertuzumab ), which comprises determining HER3 expression in a patient's cancer sample and selecting an HER inhibitor or HER dimerization inhibitor as the therapy if the cancer sample expresses HER3 at a lower level than the median level of HER3 expression in type of cancer and / or if the cancer sample expresses HER2: HER3 at a level that is greater than the 25th percentile (or greater than the median level) of HER2: HER3 expression in the cancer type.
In a second aspect, the invention provides a method for selecting a therapy for a patient with a type of cancer (for example, ovarian cancer) that is capable of responding to a chemotherapeutic agent that comprises determining the expression of HER3 in a cancer sample. a patient and select a chemotherapeutic agent (eg gemcitabine) as the therapy, if the cancer sample expresses HER3 at a higher level than the median level of HER3 expression in the cancer type.
The median level or percentile of expression can be determined essentially at the same time as the measurement of HER3 expression (or expression of HER2 and HER3) or can be determined in advance.
Prior to the therapeutic methods described below, the level / levels of HER3 expression and, optionally, the level / levels of HER2 expression, in a cancer patient, are / are assessed. Generally, a biological sample is obtained from the patient who needs therapy, whose sample is subjected to one or more diagnostic tests, usually at least one in vitro diagnostic test (IVD). However, other ways to assess HER3 and / or HER2 expression, such as in vivo diagnosis, are expressly considered here. The biological sample is usually a tumor sample, preferably a tumor sample of ovarian cancer, peritoneal cancer, fallopian tube cancer, metastatic breast cancer (MBC), non-small cell lung cancer (NSCLC), prostate cancer or colorectal cancer.
The biological sample can be a fixed sample, for example, a sample fixed in formalin, a sample soaked in paraffin (FFPE) or a frozen sample.
Various methods for determining mRNA or protein expression include, but are not limited to, gene expression profiling, polymerase chain reaction (PCR) including real-time quantitative PCR (qRT-PCR), microarray analysis, serial analysis of gene expression (SAGE), MassARRAY, Gene Expression Analysis by Massively Parallel Signature Sequencing (MPSS), proteomics, immunohistochemistry (IHC), etc. Preferably the mRNA is quantified. Such mRNA analysis is preferably carried out using the polymerase chain reaction (PCR) technique or by microarray analysis. Where PCR is employed, a preferred form of PCR is real-time quantitative PCR (qRTPCR). The preferred qRT-PCR assay is described in Example 1 below.
The steps of a representative protocol for defining the gene expression profile using fixed tissues embedded in paraffin as a source of RNA, including isolation, purification, primer extension and mRNA amplification are given in several articles published in newspapers (for example, example: Godfrey et al J. Molec. Diagnostics 2: 84-91 (2000); Specht et al, Am. J. Pathol. 158: 419-29 (2001)). Briefly, a representative process starts with cutting thick sections with about 10 micrograms of tumor tissue samples embedded in paraffin. The RNA is then extracted and the protein and DNA are removed. After RNA concentration analysis, RNA repair and / or amplification steps may be included, if necessary, and the RNA is transcribed
100 using specific promoters for the gene followed by PCR. Finally, the data is analyzed to identify the best treatment option (s) available / available to the patient based on the expression pattern characteristic of the gene identified in the examined tumor sample.
Several exemplary methods for determining gene expression will now be described in more detail.
(i) Defining the gene expression profile
In general, gene expression profiling methods can be divided into two major groups: methods based on polynucleotide hybridization analysis and methods based on polynucleotide sequencing. The most commonly used methods known in the art for the quantification of mRNA expression in a sample include northern blotting and in situ hybridization (Parker & Barnes, Methods in Molecular Biology 106: 247-283 (1999)); RNAse protection assays (Hod, Biotechniques 13: 852- 854 (1992)); and polymerase chain reaction (PCR) (Weis et al, Trends in Genetics 8: 263-264 (1992)). Alternatively, antibodies can be employed that can recognize specific duplicates, including DNA duplicates, RNA duplicates, and hybrid DNA-RNA duplicates or protein-DNA duplicates. Representative methods for gene expression analysis based on sequencing include Serial Gene Expression Analysis (SAGE) and gene expression analysis by Massively Parallel Signature Sequencing (MPSS).
(ii) Polymerase chain reaction (PCR)
Of the techniques listed above, a sensitive and flexible quantitative method is PCR, which can be used to compare mRNA levels in different sample populations, in normal and tumor tissues, with or without drug treatment, to characterize gene expression patterns. , to discriminate between closely correlated mRNAs and to analyze the structure of RNA.
The first step is the isolation of mRNA from a target sample. The starting material is typically total RNA isolated from human tumors or
101 corresponding tumor and tissue cell lines and normal cell lines, respectively. Thus, RNA can be isolated from a variety of primary tumors, including tumors of the breast, lung, colon, prostate, brain, liver, kidney, pancreas, spleen, thymus, testis, ovary, uterus, etc., or from cell lines tumors, with grouped DNA from healthy donors. If the source of mRNA is a primary tumor, the mRNA can be extracted, for example, from frozen or archived tissue samples embedded in paraffin and fixed (for example, fixed in paraffin). Common methods for mRNA extraction are well known in the art and are described in standard textbooks on molecular biology, including Ausubel et al, Current Protocols of Molecular Biology, John Wiley and Sons (1997). Methods for extracting RNA from paraffin embedded tissues are described, for example in Rupp and Locker, Lab Invest. 56: A67 (1987), and De Andres et al, BioTechniques 18: 42044 (1995). In particular, RNA isolation can be performed using a purification kit, ready buffer and protease from commercial manufacturers, such as Qiagen, according to the manufacturer's instructions. For example, total RNA from cultured cells can be isolated using Qiagen RNeasy mini-columns. Other commercially available RNA isolation kits include MASTERPURE® Complete DNA and RNA Purification Kit (EPICENTRE®, Madison, Wis.), And Paraffin Block RNA Isolation Kit (Ambion, Inc.). Total RNA from tissue samples can be isolated using Stat-60 RNA (Tel-Test). RNA prepared from a tumor can be isolated, for example, by density gradient centrifugation with cesium chloride.
Since RNA does not serve as a model for PCR, the first step in defining the gene expression profile by PCR is the reverse transcription of the RNA model into cDNA, followed by its exponential amplification in a PCR reaction. The two most commonly used reverse transcriptases are avian myeloblastosis virus reverse transcriptase (AMV-RT) and murine Moloney leukemia virus reverse transcriptase (MMLV-RT). The reverse transcription step is typically initiated using specific primers, random hexamers or oli102 go-dT primers, depending on the circumstances and the expression profiling goal. For example, the extracted RNA can be reverse transcribed using a GENEAMP® RNA PCR kit (Perkin Elmer, California, USA), following the manufacturer's instructions. The derived cDNA can then be used as a template in the subsequent PCR reaction. Although the PCR step can use a variety of DNA polymerases dependent on thermostable DNA, it typically employs Taq DNA polymerase which has a 5'-3 'nuclease activity but lacks the error correction activity 3-5' endonuclease. Thus, TAQMAN® PCR typically uses the 5'-nuclease activity of Taq or Tth polymerase to hydrolyze a hybridization probe attached to its target amplicon, but any enzyme with equivalent 5 'nuclease activity can be used. Two oligonucleotide primers are used to generate an amplicon typical of a PCR reaction. A third oligonucleotide or probe is designed to detect the nucleotide sequence between the two PCR primers. The probe is not extensible by the enzyme Taq polymerase and is labeled with a reporter fluorescent dye and a repressor fluorescent dye. Any laser-induced emission of the reporter dye is suppressed by the repressor dye when the two dyes are located very close together as they are on the probe. During the amplification reaction, the Taq DNA polymerase enzyme cleaves the probe in a model-dependent manner. The resulting probe fragments dissociate in solution and the signal from the released reporter dye is free from the repressive effect of the second fluorophore. One molecule of the reporter dye is released for each new synthesized molecule and the detection of the unpressed reporter dye provides the basis for the quantitative interpretation of data.
TAQMAN®PCR can be performed using commercially available equipment, such as, for example, ABI PRISM 7700® Sequence Detection System® (Perkin-Elmer-Applied Biosystems, Foster City, California, USA) or Lightcycler (Roche Molecular Biochemicals, Mannheim, Germany). In a preferred embodiment, the 5'nuclease procedure is run on real-time quantitative PCR equipment such as
103
ABl PRISM 7700® Sequence Detection System. The system consists of a thermal cycler, laser, coupled charge device (CCD), camera and computer. The system amplifies samples in a 96-well format on the thermal cycler. During amplification, the laser-induced fluorescent signal is collected in real time via fiber optic cables for all 96 wells and detected on the CCD. The system includes a program to activate the instrument and for data analysis.
The data from the 5'-nuclease assay are expressed initially as Ct or the cyclolymer.
To minimize errors and the effect of variation from sample to sample, PCR is usually done using an internal standard. The ideal internal pattern is expressed at a constant level between different tissues and is not affected by the experimental treatment. RNAs most frequently used to normalize gene expression patterns are mRNAs for residing glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and P-actin genes.
A more recent variation of the PCR technique is quantitative real-time PCR (qRT-PCR), which measures the accumulation of PCR product through a double-labeled fluorescent probe (ie, TAQMAN® probe). Real-time PCR is compatible with both competitive quantitative PCR, where the internal competitor for each target sequence is used for normalization, and with comparative quantitative PCR using a standardization gene contained within the sample or a resident PCR gene. For further details see, for example, Held et al., Genome Research 6: 986-994 (1996).
The steps of a representative protocol for defining the gene expression profile using fixed tissues, embedded in paraffin as the source of RNA, including isolation, purification, primer extension and mRNA amplification are given in several articles published in newspapers ( for example, Godfrey et al., J. Molec. Diagnostics 2: 84-91 (2000); Specht et al., Am. J. Pathol. 158: 419-29 (2001)). Briefly, a representative process begins with the cutting of thick sections with about 10 microaramas of tumor tissue samples embedded in paraffin. RNA is
104 then extracted and the protein and DNA are removed. After RNA concentration analysis, RNA repair and / or amplification steps may be included, if necessary, and the RNA is reverse transcribed using specific promoters for the gene followed by PCR.
In accordance with an aspect of the present invention, PCR primers and probes are designed based on the intron sequences present in the gene to be amplified. In this modality, the first step in the planning of the primer / probe is the delineation of the intron sequences within the genes. This can be done with a publicly available program, such as the DNA BLAT program developed by Kent, W., Genome Res. 12 (4): 656-64 (2002) or the BLAST program including its variations. Subsequent steps follow well-established methods for PCR primer and probe design.
In order to avoid non-specific signals, it is important to mask repetitive sequences within the introns when designing primers and probes. This can be easily achieved by using the Repeat Masker program, available online through Baylor College of Medicine, which tracks DNA sequences against a library of repetitive elements and returns with a query sequence in which the repetitive elements are masked. Masked intron sequences can then be used to plan primer and probe sequences using any commercially or publicly available primer / probe planning packages, such as Primer Express (Applied Biosystems); MGB assay-by-design (Applied Biosystems); Primer 3 (Rozen and Skaletsky (2000) Primer3 on the internet for ordinary users and programmer biologists. In: Krawetz S, Misener S (eds) Bioinformatics Methods and Protocols: Methods in Molecular Biology. Humana Press, Totowa, NJ, pp 365-386).
Factors considered in PCR primer design include primer extension, melting temperature (Tm), and G / C content, specificity, complementary primer sequences and 3'-terminal sequence. In general, optimal PCR primers are generally 17-30
105 extension bases and contain about 20 to 80%, such as, for example, about 50 to 60% of G + C bases. Tm between 50 and 80 ° C, for example, about 50 to 70 ° C are typically preferred.
For additional instructions for planning the PCR primer and probe see, for example, Dieffenbach et al, General Concepts for PCR Primer Design in PCR Prímer, A Laboratory Manual, Cold Spring Harbor Laboratory Press, New York, 1995, pp. 133-155; Innis and Gelfand, Optimization of PCRs in PCR Protocols, A Guide to Methods and Applications, CRC Press, London, 1994, pp. 5-11; and Plasterer, TN Primerselect:
Primer and probe design. Methods Mol. Biol. 70: 520-527 (1997), the complete descriptions of which are expressly incorporated by reference.
Preferred conditions, primers, probes and internal reference (G6PDH) are as described in Example 1 below.
(iii) Microarray
Differential gene expression can also be identified or confirmed using the microarray technique. Thus, the expression profile of genes associated with breast cancer can be measured both in fresh tumor tissue and embedded in paraffin, using the microarray technique. In this method, sequences of polynucleotides of interest (including cDNAs and oligonucleotides) are plated or arranged on a microchip substrate. The arranged sequences are then hybridized with specific DNA probes for the cells or tissues of interest. As with the PCR method, the source of mRNA is typically total RNA isolated from tumors or cell lines from corresponding normal tumors and cell tissues or cell lines. If the source of mRNA is a primary tumor, mRNA can be extracted, for example, from frozen or archived tissue samples embedded in paraffin and fixed (for example, fixed with formalin), which are prepared and preserved routinely in daily clinical practice. .
In a specific embodiment of the microarray technique, inserts amplified by PCR from cDNA clones are applied to a substrate in a dense array. Preferably at least 10,000 strings
106 of nucleotide are applied to the substrate. The microarray genes, immobilized on the microchip in 10,000 elements each, are suitable for hybridization under stringent conditions. Fluorescently labeled cDNA probes can be generated by incorporating fluorescent nucleotides by reverse transcribing RNA extracted from the tissues of interest. Marked cDNA probes applied to the chip, hybridize with specificity to each DNA spot on the array. After stringent washing to remove probes not specifically attached, the chip is tracked by laser confocal microscopy or another detection method, such as a CCD camera. The quantification of the hybridization of each arranged element allows the evaluation of the corresponding mRNA abundance. With two-color fluorescence, separately labeled cDNA probes, generated from two RNA sources, are hybridized in pairs to the array. The relative abundance of transcripts from the two sources that correspond to each specified gene is thus determined simultaneously. The miniaturized scale of hybridization allows a convenient and quick assessment of the expression pattern of a large number of genes. Such methods have been shown to have the sensitivity needed to detect rare transcripts, which are expressed in a few copies per cell, and to reproducibly detect at least approximately duplicate differences in expression levels (Schena et al., Proc. Natl. Acad. Sei. USA 93 (2): 106-149 (1996)). The microarray analysis can be performed with commercially available equipment, according to the manufacturer's protocols, such as using Affimetrix GENCHIP® technology or Incyte microarray technology.
The development of microarray methods for large-scale analysis of gene expression makes it possible to systematically search for molecular markers for the classification of cancer and results in the prediction of a variety of tumor types.
(iv) Serial Analysis of Gene Expression (SAGE)
Serial gene expression analysis (SAGE) is a method that allows simultaneous and quantitative analysis of a large number of gene transcripts, without the need to provide an individual hybridization probe for each transcript. First, a short tag sequence (about 10 to 14 bp) is generated containing enough information to uniquely identify a transcript, as long as the tag is obtained from a single position within each transcript. Then, several transcripts are linked together to form a long series of molecules, which can be sequenced, revealing the identity of multiple tags simultaneously. The expression pattern of any population of transcripts can be quantitatively assessed by determining the abundance of individual tags and identifying the gene corresponding to each tag. For more details see, for example,
Velculescu et al, Science 270: 484-487 (1995); and Velculescu et al, Cell 88: 243-51 (1997).
(v) MassARRAY technology
MassARRAY technology (Sequenom, San Diego, California) is an automated, high-efficiency method of analyzing ge15 ne expression using mass spectrometry (MS) for detection. According to this method, after RNA isolation, reverse transcription and PCR amplification, cDNAs are subjected to primer extension. The products of the cDNA-derived primer extension are purified and distributed on an array chip that is preloaded with the necessary components for sample preparation for MALTI-TOF MS. The various cDNAS present in the reaction are quantified by analyzing peak areas in the obtained mass spectrum.
(vi) Analysis of Gene Expression by Massively Parallel Siqnature Sequencinq (MPSS)
This method, described by Brenner et al., Nature Biotechnology
18: 630-634 (2000), is a sequencing approach that combines non-gel-based signature sequencing with the in vitro cloning of millions of models on separate microspheres with 5 micrograms in diameter. First, a microsphere library of DNA models is built by in vitro cloning. This is followed by the assembly of a planar array of microspheres containing the model in a high density cell flow (typically greater than 3 x 10<sup>6</sup> microspheres / cm<sup>2</sup>). The free ends of the models cloned over each microsphere are analyzed simultaneously, using a fluorescence-based signature sequencing method that does not require DNA fragment separation. This method has been shown to simultaneously and precisely provide, in a single operation, hundreds of thousands of gene signature sequences from a yeast cDNA library.
(vii) Immunohistochemistry
Immunohistochemistry methods are also suitable for detecting levels of expression of the prognostic markers of the present invention. Thus, antibodies or antisera, preferably polyclonal antisera and, more preferably, specific monoclonal antibodies for each marker are used to detect expression. Antibodies can be detected by direct labeling of the antibodies themselves, for example, with radioactive labels, fluorescent labels, hapten labels such as biotin or an enzyme such as horseradish peroxidase or alkaline phosphatase. Alternatively, an unlabeled primary antibody is used in conjunction with a labeled secondary antibody, comprising antisera, polyclonal antisera, or monoclonal antibody specific for the primary antibody. Immunohistochemistry protocols and kits are well known in the art and are commercially available.
(viii) Proteomics
Proteome expression is defined as the totality of proteins present in a sample (for example, tissue, organism or cell culture) at any given time. Proteomics include, among other things, the study of global changes in protein expression in a sample (also referred to as expression proteomics). Proteomics typically include the following steps: (1) separation of individual proteins in a sample by 2-D gel electrophores (2-D PAGE); (2) identification of individual proteins recovered from the gel, for example, by mass spectrometry or N-terminal sequencing and (3) data analysis using bioinformatics. Proteomic methods are valuable complements to other methods of profiling gene expression and can be used,
109 alone or in combination with other methods, to detect the products of the prognostic markers of the present invention.
(ix) General Description of Isolation, Purification and Amplification of mRNA
The steps of a representative protocol for defining the gene expression profile using fixed tissues, embedded in paraffin as the source of RNA, including isolation, purification, primer extension and mRNA amplification are given in several articles published in newspapers ( for example, Godfrey et al., J. Molec. Diagnostics 2: 84-91 (2000); Specht et al., Am. J. Pathol. 158: 419-29 (2001)). Briefly, a representative process starts with cutting thick sections with about 10 micrograms of tumor tissue samples embedded in paraffin. The RNA is then extracted and the protein and DNA are removed. After RNA concentration analysis, RNA repair and / or amplification steps may be included, if necessary, and the RNA is reverse transcribed using specific promoters for the gene followed by PCR. Finally, the data is analyzed to identify the best treatment option (s) available / available to the patient based on the definition of the gene expression profile identified in the examined tumor sample.
In one embodiment, the patient treated here, in addition to expressing HER3 at a certain level and / or expressing HER2: HER3 at a certain level, does not overexpress HER2. Overexpression of HER2 can be analyzed by IHC, for example, using HERCEPTEST® (Dako). Tissue sections embedded in paraffin from the tumor biopsy can be subjected to the HCI assay and provide the criteria for staining intensity of the HER2 protein as follows;
Score 0 - no staining is observed or the staining of the membrane is observed in less than 10% of tumor cells.
Score 1+ - weak / barely perceptible staining of the membrane is detected in more than 10% of tumor cells. The cells are stained only in part of their membranes.
Score 2+ - weak to moderate complete staining of the membrane is seen in more than 10% of tumor cells.
110
Score 3+ - moderate to strong full staining of the membrane is seen in more than 10% of tumor cells.
Those tumors with scores 0 or 1+ in the assessment of overexpression of HER2 can be characterized as not overexpressing HER2, whereas those tumors with scores 2+ or 3+ can be characterized as overexpressing HER2.
Tumors that overexpress HER2 can be assessed by immunohistochemical scores that correspond to the number of copies of HER2 molecules expressed per cell and can be determined biochemically:
= 0 to 10,000 copies / cell,
1+ = at least about 200,000 copies / cell,
2+ = at least about 500,000 copies / cell,
3+ = at least about 2,000,000 copies / cell.
Overexpression of HER2 at level 3+, which leads to ligand-independent tyrosine kinase activation (Hudziak et al., Proc. Natl. Acad. Sci. USA, 84: 7159-7163 (1987)), occurs in approximately 30% of breast cancers and, in these patients, survival without recurrence and overall survival are decreased (Slamon et al, Science, 244: 707-712 (1989); Slamon et al., Science, 235: 177-182 (1987) ). Alternatively or in addition, FISH assays such as INFORM® (sold by Ventana, Arizona) or PATHVISION® (Vysis, Illinois) can be performed on formalin-fixed tumor tissue embedded in paraffin to determine the extent (if any) of amplification of HER2 in the tumor.
The expression of HER3 and / or HER2 can also be assessed using an in vivo diagnostic assay, for example, by administering a molecule (such as an antibody) that binds to the molecule to be detected and is marked with a detectable marker (for example, a radioactive isotope) and externally tracking the patient to the location of the marker.
IV. Pharmaceutical Formulations
The pharmaceutical formulations of the HER inhibitor, inhibitor of
111 dimerization of HER or chemotherapeutic agent used according to the present invention are prepared for storage by mixing an antibody that has the desired degree of purity with optional vehicles, excipients or stabilizers (Remington's Pharmaceutical Sciences 16th edition, Osol, A. Ed. (1980)), usually in the form of lyophilized formulations or aqueous solutions. Antibody crystals are also considered (see US Patent Application 2002/0136719). Acceptable vehicles, excipients or stabilizers are non-toxic to receptors at the dosages and concentrations employed and include buffers, such as phosphate, citrate and other organic acids; antioxidants including ascorbic acid and methionine; conservatives (such as octadecyldimethylbenzyl ammonium chloride; hexamethonium chloride; benzalkonium chloride, benzethonium chloride; phenol, butyl or benzyl alcohol; alkyl parabens such as methyl or propyl paraben; catechol; resorcinol; cyclohexanol; 3-pentanol; and m-cresol); low molecular weight polypeptides (less than about 10 residues); proteins, such as serum albumin, gelatin, or immunoglobulins; hydrophilic polymers such as polyvinylpyrrolidone; amino acids such as glycine, glutamine, asparagine, histidine, arginine, or lysine; monosaccharides, disaccharides and other carbohydrates including glucose, mannose, or dextrins; chelating agents such as EDTA; sugars such as sucrose, mannitol, trehalose or sorbitol; counterions that form salts such as sodium; metal complexes (for example, Zn-protein complexes); and / or non-ionic surfactants such as TWEEN®, PLURONICS® or polyethylene glycol (PEG). Lyophilized antibody formulations are described in WO 97/04801, expressly incorporated herein by reference.
The preferred formulation of pertuzumab for therapeutic use comprises 30 mg / ml pertuzumab in 20 mM histidine acetate, 120 mM sucrose, 0.02% polysorbate 20 at pH 6.0. An alternative formulation of pertuzumab comprises 25 mg / ml pertuzumab, 10 mM histidine-HCI buffer, 240 mM sucrose, 0.02% polysorbate 20, pH 6.0.
The formulation may also contain more than one active compound as necessary for the particular indication to be treated, preferably112 those with complementary activities that do not adversely affect each other. Various drugs that can be combined with the HER inhibitor or HER dimerization inhibitor are described in the Treatment Section below. Such molecules are suitably present in amounts that are effective for the intended purpose.
The active ingredients can also be contained in microcapsules prepared, for example, by coacervation techniques or by interfacial polymerization, hydroxymethylcellulose or gelatin microcapsules and microcapsules of poly (methylmethacrylate), respectively, in colloidal drug delivery systems (for example, liposomes, albumin microspheres, microemulsions, nanoparticles and nanocapsules) or in macroemulsions Such techniques are described in Remington's Pharmaceutical Sciences 16th edition, Osol, A. Ed. (1980).
Preparations for sustained release can be prepared, suitable examples of preparations for sustained release include semipermeable matrices of solid hydrophobic polymers containing the antibody, whose matrices are in the form of formed products, for example, films or microcapsules. Examples of sustained release matrices include polyesters, hydrogels (e.g., poly (2-hydroxyethylmethacrylate), or poly (vinyl alcohol)), polylactates (U.S. Pat. No. 3,773,919), copolymers of L-glutamic acid and γ ethyl-L-glutamate, non-degradable ethylene-vinyl acetate, degradable copolymers of lactic acid-glycolic acid such as LUPRON DEPOT (TM) (injectable microspheres composed of copolymer of lactic acid-glycolic acid and leuprolide acetate), and poly-D (-) - 3-hydroxybutyric acid.
The formulations to be used for in vivo administration must be sterile. This is easily achieved by filtration through sterile filtration membranes.
Accordingly, a method is provided for producing an HER inhibitor or HER dimerization inhibitor (such as pertuzumab) or a pharmaceutical composition thereof, the method of which comprises combining the inhibitor or pharmaceutical composition in a package and a
113 seal indicating that the inhibitor or pharmaceutical composition is indicated to treat a patient with a type of cancer (for example, ovarian cancer) that is capable of responding to the inhibitor, in which the patient's cancer expresses HER at a lower level than the level median HER expression in the cancer type and / or if the patient's cancer sample expresses HER2: HER3 at a level that is greater than the 25th percentile of HER2: HER3 expression in the cancer type.
In addition, a method is provided for producing a chemotherapeutic agent (such as gemcitabine) or a pharmaceutical composition thereof, wherein the method comprises combining the chemotherapeutic agent or pharmaceutical composition in a package and a seal indicating that the chemotherapeutic agent or pharmaceutical composition is indicated to treat a patient with a type of cancer (exemplified by ovarian cancer), where the patient's cancer expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer.
V. Treatment with HER inhibitors
The invention provides a method for treating a patient with a type of cancer that is capable of responding to an HER inhibitor or an HER dimerization inhibitor, comprising administering a therapeutically effective amount of the inhibitor to the patient, where the patient's cancer expresses HER3 at a lower level than the average level of HER3 expression in the type of cancer and / or if the cancer sample expresses HER2: HER3 at a level that is greater than the 25th percentile of expression of HER2: HER3 in the type of cancer and / or expresses HER2: HER3 at a level that is greater than the average level (more preferably greater than the 75th percentile of the expression of HER2: HER3) in the type of cancer.
In a particularly preferred embodiment, the invention provides a method for treating a patient with ovarian, peritoneal or fallopian tube cancer, comprising administering a therapeutically effective amount of pertuzumab to the patient, wherein the patient's cancer expresses HER3 at a lower level than the mean level of HER3 expression in ovarian, peritoneal or fallopian tube cancer and / or in which
114 cancer sample expresses HER2; HER3 at a level that is greater than the 25th percentile of HER2: HER3 expression in ovarian, peritoneal or fallopian tube cancer. In this embodiment, the patient's cancer preferably expresses HER2: HER3 at a level that is greater than the average level (more preferably greater than the 75th percentile of HER2: HER3 expression) in ovarian, peritoneal or fallopian tube cancer.
In another aspect, the invention provides a method for selecting a therapy for a patient with a type of cancer that is capable of responding to a chemotherapeutic agent, comprising determining the expression of hER3 in a patient's cancer sample and selecting a chemotherapeutic agent as therapy, if the cancer sample expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer. In this modality, the type of cancer is preferably ovarian, peritoneal or fallopian tube, including ovarian, peritoneal or platinum-resistant fallopian tube, as well as advanced, refractory and / or recurrent ovarian cancer. The chemotherapeutic agent is preferably an antimetabolite, such as gemcitabine. Thus, in this modality, elevated HER3 correlates with improved response to therapy with a chemotherapeutic agent, such as gemcitabine.
Examples of various cancers that can be treated with an HER inhibitor or HER dimerization inhibitor are listed in the definitions section above. Preferred types of cancer include ovarian cancer; peritoneal cancer; fallopian tube cancer; breast cancer including metastatic breast cancer (MBC); lung cancer, including non-small cell lung cancer (NSCLC); prostate cancer; and colorectal cancer. In one embodiment, the cancer to be treated is advanced, refractory, recurrent, resistant to chemotherapy and / or resistant to platinum.
Therapy with the HER inhibitor, HER dimerization inhibitor and / or chemotherapeutic agent preferably prolongs survival, including progression-free survival (PFS) and / or overall survival (OS). In one embodiment, therapy with an HER inhibitor or HER dimerization inhibitor prolongs survival by at least about 20% more than
115 survival achieved by administering an approved antitumor agent or treatment model for the cancer to be treated.
In a preferred embodiment, the method involves treating a patient with ovarian, peritoneal or fallopian tube cancer. The patient may have advanced, refractory, recurrent ovarian, peritoneal or fallopian tube cancer, resistant to chemotherapy and / or resistant to platinum. The administration of pertuzumab to the patient can, for example, prolong survival by at least about 20% more than the survival achieved by administering topotecan or liposomal doxorubicin to such a patient.
The HER inhibitor or HER dimerization inhibitor and / or chemotherapeutic agent are administered to a human patient according to known methods, such as intravenous administration, for example, in bolus or by continuous infusion over a period of time, intramuscularly. , intraperitoneal, intracerebrospinal, subcutaneous.intra-articular, intrasynovial, intrathecal, oral, topical or by inhalation. The intravenous route for administration of the antibody is preferred.
For cancer prevention or treatment, the dose of HER inhibitor or HER dimerization inhibitor and / or chemotherapeutic agent will depend on the type of cancer to be treated, as defined above, on the severity and course of the cancer, whether the antibody is administered for preventive or therapeutic purposes, prior therapy, the patient's clinical history and response to the drug and the knowledge of the attending physician.
In one embodiment, a fixed dose of inhibitor is administered. The fixed dose can be adequately administered to the patient at once or during a series of treatments. When the fixed dose is administered, it is preferably in the range of about 20 mg to about 2000 mg of inhibitor. For example, the fixed dose can be approximately 420 mg, approximately 525 mg, approximately 840 mg or approximately 1050 mg of the inhibitor, such as pertuzumab.
Where a series of doses are administered, these can, for example, be administered approximately every week, approximately every 2 weeks, approximately every 3 weeks, or approximately every 4 weeks, but preferably approximately every 3 weeks. Fixed doses may continue to be administered, for example, until disease progression, adverse effect or other time as determined by the doctor. For example, between about two, three or four to about 17 or more fixed doses can be administered.
In one embodiment, one or more loading doses of the antibody are administered, followed by one or more maintenance doses of the antibody. In another embodiment, a plurality of the same doses are administered to the patient.
According to a preferred embodiment of the invention, a fixed dose of HER dimerization inhibitor (e.g. pertuzumab) of approximately 840 mg (loading dose) is administered, followed by one or more doses of 420 mg (maintenance dose) of the antibody. Maintenance doses are preferably administered every 3 weeks, for a total of at least 2 doses up to 17 or more doses.
According to another preferred embodiment, one or more doses of 1050 mg of HER dimerization inhibitor (e.g., pertuzumab) are administered, for example, every 3 weeks. According to this modality, one, two or more of the fixed doses are administered, for example, for up to one year (17 cycles) or more if desired.
In another preferred embodiment, a fixed dose of approximately 1050 mg of HER dimerization inhibitor (e.g. pertuzumab) is administered as a loading dose, followed by one or more maintenance doses of approximately 525 mg. About one, two or more maintenance doses can be administered to the patient every 3 weeks according to this modality.
Although the HER inhibitor, HER dimerization inhibitor or chemotherapeutic agent can be administered as a single antitumor agent, the patient is optionally treated with a combination of the inhibitor (or chemotherapeutic agent) and one or more (additional) chemotherapeutic agents. Exemplary chemotherapeutic agents include: gemcitabine, carboplatin, paclitaxel, docetaxel, topotecan and / or liposomal doxorubicin. Preferably, at least one chemotherapeutic agent is an antimetabolite chemotherapeutic agent such as gemcitabine. Combined administration includes co-administration or concurrent administration, using separate formulations or a single pharmaceutical formulation, and consecutive administration in any order, where preferably there is a period of time while both (or all) of the active agents simultaneously perform their biological activities. Thus, the chemotherapeutic antimetabolite agent can be administered before or accompanying the administration of the inhibitor. In that embodiment, the period between at least one administration of the antimetabolite chemotherapeutic agent and at least one administration of the inhibitor is preferably approximately one month or less and, more preferably, approximately 2 weeks or less. Alternatively, the antimetabolite chemotherapeutic agent and inhibitor are administered concurrently to the patient, in a single formulation or in separate formulations. Treatment with a combination of chemotherapeutic agent (eg, antimetabolite chemotherapeutic agent such as gemcitabine) and inhibitor (eg pertuzumab) can result in a synergistic rather than additive therapeutic benefit for the patient.
Chemotherapeutic agents particularly desired for combination with the inhibitor, for example, for ovarian cancer therapy, include: an antimetabolite chemotherapeutic agent such as gemcitabine; a platinum compound such as carboplatin; a taxoid such as paclitaxel or docetaxel; topotecan; or liposomal doxorubicin.
An antimetabolite chemotherapeutic agent, if administered, is either administered at its known dosages, or optionally decreased due to the combined action of the drugs or negative side effects attributable to the administration of the antimetabolite chemotherapeutic agent. The preparation and dosage regimens for such chemotherapeutic agents can be used according to the manufacturer's instructions or as determined empirically by the experienced physician. Where the antimetabolite chemotherapeutic agent is gemcitabine, preferably it is administered at a dose between about 600 mg / m<sup>2</sup> at 1250 mg / m<sup>2</sup> (for example, approximately 118 mg 1000 m / m<sup>2</sup>), for example, on days 1 and 8 of a 3-week cycle.
In addition to the inhibitor and the antimetabolite chemotherapeutic agent, other therapeutic regimens can be combined with this. For example, a second (third, fourth, etc.) chemotherapeutic agent can be administered, wherein the second chemotherapeutic agent is another different antimetabolite chemotherapeutic agent or a chemotherapeutic agent that is not antimetabolite. For example, the second chemotherapeutic agent may be a taxane (such as paclitaxel or docetaxel), capecitabine or a platinum-based chemotherapeutic agent (such as carboplatin, cisplatin or oxaliplatin), anthracycline (such as doxorubicin, including liposomal doxorubicin), topotecan, pemetrexed, vinca alkaloid (such as vinorelbine) and TLK 286. Cocktails of different chemotherapeutic agents can be administered.
Other therapeutic agents that can be combined with the inhibitor and / or chemotherapeutic agent include any one or more of: a second different HER inhibitor, a HER dimerization inhibitor (for example, a growth inhibitory HER2 antibody, such as trastuzumab or an HER2 antibody that induces apoptosis of a cell that overexpresses HER2, such as 7C2, 7F3 or its humanized variants); an antibody directed against a different tumor-associated antigen, such as EGFR, HER3, HER4; anti-hormonal compound, for example, an anti-estrogen compound such as tamoxifen or an aromatase inhibitor; a cardioprotective (to prevent or reduce any myocardial dysfunction associated with the therapy); a cytokine; a drug targeting EGFR (such as TARCEVA®, IRESSA® or cetuximab); an antiangiogenic agent (especially bevacizumab sold by Genentech under the trade name AVASTIN ™); a tyrosine kinase inhibitor; a COX inhibitor (for example, a COX-I or COX-2 inhibitor); non-steroidal anti-inflammatory drug, celecoxib (CELEBREX®); farnesyl transferase inhibitor (for example, Tipifarnib / ZARNESTRA® RI15777 available from Johnson and Johnson or Lonafarnib SCH66336 available from Schering-Plow); antibody that binds to the oncofetal CA 125 protein such as Oregovomab (MoAb B43.13);
119 vaccine for HER2 (such as the HER2 Auto Vac vaccine from Pharmexia, or the APC8024 protein vaccine from Dendreon, or the HER2 peptide vaccine from GSK / Corixa); other HER-targeted therapy (e.g., trastuzumab, cetuximab, ABX-EGF, EMD7200, gefitinib, erlotinib, CP724714, CI1033, GW572016, IMC-11F8, TAK165, etc.); Raf and / or ras inhibitor (see, for example, WO 2003/86467); injection of liposomal doxorubicin HCI (DOXIL (R)); topoisomerase I inhibitor such as topotecan; taxane; dual HER2 and EGFR tyrosine kinase inhibitor such as lapatinib / GW572016; TLK286 (TELCYTA®); EMD-7200; a medicine that treats nausea such as a serotonin antagonist, steroid, or benzodiazepine; a medicine that prevents or treats skin rashes or standardized therapies for acne, including topical or oral antibiotics; a medication that prevents or treats diarrhea; a medicine that reduces body temperature such as acetaminophen, diphenhydramine, or meperidine ·, hematopoietic growth factor, etc.
The appropriate dosages for any of the co-administered agents above are those currently used and may be decreased due to the combined (synergistic) action of the agent and inhibitor.
In addition to the above therapeutic regimens, the patient may be subjected to surgical removal of cancer cells and / or radiation therapy.
Where the inhibitor is an antibody, preferably the antibody administered is a naked antibody. However, the administered inhibitor can be conjugated to a cytotoxic agent. Preferably, the conjugated inhibitor and / or antigen to which it binds is / are internalized by the cell resulting in increased effectiveness of the therapeutic conjugate in killing the cancer cell to which it binds. In a preferred embodiment, the cytotoxic agent targets or interferes with the nucleic acid in the cancer cell. Examples of such cytotoxic agents include maytansinoids, calicheamicins, ribonucleases and DNA endonucleases.
The present application considers the administration of the inhibitor by qene therapy. See, for example, WO96 / 07321. published on March 14, 1996, related to the use of gene therapy to generate intracellular antibodies.
There are two main approaches to introducing nucleic acid (optionally contained in a vector) into the patient's cells: in vivo and ex vivo. For in vivo release, nucleic acids are injected directly into the patient, usually where the antibody is needed. For ex vivo treatment, the patient's cells are removed, the nucleic acid is introduced into these isolated cells and the modified cells are administered to the patient either directly or, for example, encapsulated within porous membranes that are implanted in the patient (see, for example, US Patent Nos. 4,892,538 and 5,283,187). A variety of techniques are available for introducing nucleic acids into viable cells. The techniques vary depending on whether the nucleic acid is transferred to cells cultured in vitro or in vivo in the cells of the intended host. Suitable techniques for the transfer of nucleic acid to mammalian cells in vitro include the use of liposomes, electroporation, microinjection, cell fusion, DEAE-dextran, calcium phosphate precipitation method, etc. A commonly used vector for ex vivo gene release is a retrovirus.
Currently preferred in vivo nucleic acid transfer techniques include transfection with viral vectors (such as adenovirus, Herpes simplex virus I or adeno-associated viruses) and lipid-based systems (lipids useful for lipid-mediated gene transfer are DOTMA , DOPE and DC-Col, for example). In some situations it is desirable to provide the nucleic acid source with an agent that targets the target cells, such as an antibody specific for a cell membrane surface protein or the target cell, a ligand for a receptor on the target cell , etc. Where liposomes are employed, proteins that bind to a cell surface membrane protein associated with endocytosis can be used to target and / or facilitate absorption, for example, capsid proteins or their fragments in the tropics for a particular cell type , antibodies to proteins that undergo internalization in cycles and proteins that reach intracellular localization and increase intracellular half-life. The technique of receptor-mediated endocytosis is described, for example by Wu et al., J. Biol. Chem. 262: 4429-4432 (1987); and Wagner etal., Proc. Natl. Acad. Sci USA 87: 3410-3414 (1990). For a review of currently known gene labeling and gene therapy protocols, see Anderson et al., Science 256: 808-813 (1992). See also WO 93/25673 and the references cited here.
VI, Manufacturing Product
In another embodiment of the invention, a manufacturing article is provided containing materials useful for treating the diseases or conditions described above. The article of manufacture comprises a container and a seal or insert inserted or associated with the container. Suitable containers include, for example, glasses, vials, syringes, etc. Containers can be made from a variety of materials such as glass or plastic. The container holds or contains a composition that is effective to treat the disease or condition of choice and may have a sterile access (for example, the container may be a bag for intravenous solution or a bottle that has a cap that can be pierced by an injection needle hypodermic). At least one active agent in the composition is the HER dimerization inhibitor, such as pertuzumab or the chemotherapeutic agent, such as gemcitabine.
The manufacturing article may further contain a second container comprising a pharmaceutically acceptable diluent buffer, such as bacteriostatic water for injection (BWFI), phosphate buffered saline, Ringer's solution and dextrose solution. The manufacturing article may also include other materials desirable from a commercial and user point of view, including other buffers, thinners, filters, needles and syringes.
The kits and manufactured products of the present invention also include information, for example in the form of a package insert or a seal, indicating that the composition is used to treat cancer where the patient's cancer expresses HER3 and / or HER2: HER3 at a defined level depending on of the drug. The package insert or the seal can be of any form, such as paper or an electronic medium, such as a mechanically recorded medium (for example, floppy disk) or a CD-ROM. The breast or package insert may also include other information related to pharmaceutical compositions and dosage forms in the kit or article of manufacture.
Generally, such information helps, effectively and safely, patients and doctors in the use of pharmaceutical compositions and dosage forms. For example, the following information regarding the HER dimerization inhibitor or chemotherapeutic agent can be provided in the package insert: pharmacokinetics, pharmacodynamics, clinical studies, parameters of efficacy, indications and use, contraindications, care, precautions, adverse reactions, overdosing, appropriate dosage and administration, how to provide, appropriate storage conditions, references and patent information.
In a specific embodiment of the invention, a manufacturing article is provided comprising, in the same package, a pharmaceutical composition comprising an HER inhibitor or HER dimerization inhibitor in a pharmaceutically acceptable carrier and a seal determining that the inhibitor or the pharmaceutical composition are indicated to treat a patient with a type of cancer that is capable of responding to an HER inhibitor or HER dimerization inhibitor, where the patient's cancer expresses HER3 at a lower level than the median level of HER3 expression in the type of cancer and / or if the patient's cancer sample expresses HER2: HER3 at a level that is greater than 25 ° percentile of HER2.HER3 expression in the type of cancer.
In an optional embodiment of the same inventive aspect, the article of manufacture may further comprise a container comprising a second drug, in which the HER inhibitor or HER dimerization inhibitor is the first drug and whose product further comprises a package insert with instructions for treating the patient with the second drug, in an effective amount. The second drug can be any of those described above, with a second exemplary drug being another HER2 antibody or a chemotherapeutic agent.
In another aspect, a manufactured article comprising 123 comprising, in the same package, a pharmaceutical composition comprising a chemotherapeutic agent (such as gemcitabine) in a pharmaceutically acceptable carrier and a seal determining that the chemotherapeutic agent or pharmaceutical composition is indicated for treating a patient with a type of cancer, where the patient's cancer expresses HER3 at a higher level than the median level of HER3 expression in the cancer type.
The package insert is on or associated with the container. Suitable containers include, for example, glasses, vials, syringes, etc. Containers can be made from a variety of materials such as glass or plastic. The container holds or contains a composition that is effective for treating the type of cancer and may have a sterile access (for example, the container may be a bag for intravenous solution or a bottle that has a cap that can be pierced by a hypodermic injection needle) . At least one active agent in the composition is the HER inhibitor, HER dimerization inhibitor or the chemotherapeutic agent. The seal or package insert indicates that the composition is used to treat cancer in an individual eligible for treatment with specific guidelines regarding dosage amounts and ranges of the inhibitor or any other medication to be provided. The manufacturing article may further contain an additional container comprising a pharmaceutically acceptable diluent buffer, such as bacteriostatic water for injection (BWFI), phosphate buffered saline, Ringer's solution and dextrose solution. The manufacturing article may also include other materials desirable from a commercial and user point of view, including other buffers, thinners, filters, needles and syringes.
Various alternative experimental methods known in the art can be successfully replaced by those described herein in the practice of the invention, for example described in excellent textbooks and textbooks available in the technology areas relevant to that invention (for example, Using Antibodies, A Laboratory Manual , edited by Harlow, E. and Lane, D., 1999, Cold Spring Harbor Laboratory Press, (for example, ISBN 087969-544-7); Roe BA et. al. 1996, DNA Isolation and Sequencing (Essen124 tial Techniques Series), John Wiley & Sons. (For example, ISBN 0-47197324-0); Methods in Enzymology: Chimeríc Genes and Proteins, 2000, ed. J. Abelson, M. Simon, S. Emr, J. Thomer. Academic Press; Molecular Cloning: a Laboratory Manual, 2001, 3rd Edition, by Joseph Sambrook and Peter MacCalIum, (the former Maniatis Cloning manual) (for example, ISBN 087969-577-3); Current Protocols in Molecular Biology, Ed. Fred M. Ausubel, et. al. John Wiley & Sons (for example, ISBN 0-471- 50338-X); Current Protocols in Protein Science, Ed. John E. Coligan, John Wiley & Sons (for example, ISBN 0-471-11184-8); and Methods in Enzymology: Guide to protein Purification, 1990, Vol. 182, Ed. Deutscher, MP, Academic Press, Inc. (for example, ISBN 0-12-213585-7)), or as described on university and commercial websites focused on the description of experimental methods in molecular biology.
VII. Advertising Methods
The invention also encompasses a method for disclosing an HER inhibitor, an HER dimerization inhibitor (eg pertuzumab) or a pharmaceutically acceptable composition thereof which comprises promoting the use of the inhibitor or its pharmaceutical composition to a target audience. treating a population of patients with a type of cancer (such as ovarian cancer), where the patient's cancer expresses HER3 at a lower level than the median level of HER3 expression in the type of cancer and / or where the patient's cancer sample expresses HER2: HER3 at a level that is greater than the 25th percentile expression of HER2.HER3 in the type of cancer.
In another embodiment, the invention provides a method for disclosing a chemotherapeutic agent (such as gemcitabine) or a pharmaceutically acceptable composition thereof that comprises promoting to a target audience the use of the chemotherapeutic agent or a pharmaceutically acceptable composition thereof to treat a population of patients with a type of cancer (such as ovarian cancer), where the patient's cancer expresses HER3 at a higher level than the median level of HER3 expression in the type of cancer.
125
Advertising is generally paid communication through a non-personal medium in which the responsible person is identified and the message is controlled. Advertising for its purposes includes advertising, public relations, product placement, sponsorship, subscription and sales promotions. This term includes sponsored public information announcements that appear in any media in the press, designed to attract a massive audience to persuade, inform, promote, motivate or otherwise modify behavior toward a favorable pattern of acquisition, support or approval of that invention. .
Advertising and promotion of the diagnostic method can be obtained by any means. Examples of advertising media used to deliver these messages include television, radio, cinemas, magazines, newspapers, the internet and posters, including commercials that are messages that appear in the media. Commercials also include those on supermarket trolleys, on the walls of an airport corridor and on the sides of buses or heard on telephone waiting messages or on PA storage systems or anywhere where visual or auditory communication can be placed.
More specific examples of promotion or advertising means include television, radio, cinemas, the internet such as videos and teleconferences, interactive computer networks aimed at reaching simultaneous users, fixed or electronic posters or other public signs, traditional or electronic literature such as magazines and newspapers, presentations or individual contacts for example, by email, phone, instant message, postal, courier, direct mail, personal visits, etc.
The type of advertising used will depend on several factors, for example, the nature of the target audience to be reached, for example, hospitals, insurance companies, clinics, doctors, nurses and patients, as well as cost considerations and laws and relevant jurisdictional regulations governing drug advertising and diagnostics. Advertising can be individualized or personalized based on the characterizations of the user defined by the service interaction and / or
126 other data such as the user's demographic and geographic location.
VIII. Materials Deposit
The following hybridoma cell lines were deposited with the American Type Culture Collection, 10801 University Boulevard,
Manassas, VA 20110-2209, USA (ATCC):
<td>Antibody Designation</td><td>ATCC No.</td><td>Deposit Date</td>
<td>7C2</td><td>ATCC HB-12215</td><td>October 17, 1996</td>
<td>7F3</td><td>ATCC HB-12216</td><td>October 17, 1996</td>
<td>4D5</td><td>ATCC CRL 10463</td><td>May 24, 1990</td>
<td>2C4</td><td>ATCC HB-12697</td><td>April 8, 1999</td>
Additional details of the invention are illustrated by the following non-limiting examples. Descriptions of all citations in the application are expressly incorporated here by reference.
EXAMPLE 1
Pertuzumab and gemcitabine for therapy of ovarian cancer, primary peritoneal carcinoma or platinum-resistant fallopian tube carcinoma
This example provides the results for phase III of a clinical trial that assesses the safety, tolerability and efficacy of pertuzumab in combination with gemcitabine in patients with ovarian cancer, primary peritoneal carcinoma or platinum-resistant fallopian tube carcinoma. Pertuzumab represents a new class of targeted agents called HER dimerization inhibitors (HDIs) that inhibit HER2 dimerization with EGFR, HER3 and HER4 and which inhibit signaling through MAP and P13 kinase. Pertuzumab binds at the dimer20-dimer interaction site, has a major effect on the role of HER2 as a co-receptor, prevents the dimerization of EGFR / HER2 and HER3 / HER2 and inhibits multiple HER-mediated signaling pathways.
The effect of pertuzumab and gemcitabine on progression-free survival (PFS) and overall survival (OS) was assessed in all patients and in the subgroup of patients whose tumors contained markers that indicated HER2 activation. The study plan / scheme is shown in Figure 9.
127
Patients who had progressed while receiving, or within 6 months of receiving, a platinum-based chemotherapy regimen were chosen for this study. Patients were randomized to receive both gemtacibin in combination with pertuzumab and gemtacibin in combination with placebo. The patients treated here included those who had not received prior treatment in recovery for platinum-resistant disease before entering the study and those who had received a previous regimen for platinum-resistant disease.
Gemcitabine was administered at 1000 mg / m<sup>2</sup> on days 1 and 8 of each 21-day cycle. Gemcitabine was first infused for 30 minutes. Dose reductions were allowed due to toxicity. Placebo or pertuzumab were administered on day 1 of the 21-day cycle. Subjects randomized to receive pertuzumab were treated with an initial loading dose of 840 mg (Cycle 1) followed by 420 mg in Cycles 2 and subsequent. Subjects randomized to receive placebo were treated with placebo in the same volume as administered to the pertuzumab group for Cycle 1, Cycles 2 and subsequent. Individuals without progressive disease received treatment for up to 17 cycles or 1 year. Patients experienced a reduction in the standardized dose of gemcitabine and maintenance doses as a result of cytopenias. Pertuzumab was also maintained for any maintained doses of gemcitabine on Day 1. Subsequent doses were reduced doses and were not increased. If dose reduction or maintenance was necessary on more than 4 occasions or if doses were maintained for more than 3 weeks, then gemcitabine was discontinued and, with the approval of the attending physician and the medical supervisor, a placebo was continued until the disease progresses. If the doses of gemcitabine from Day 8 were maintained, then the dose from Day 8 was skipped and subsequent treatment was started with the next cycle (Day 22 of the previous cycle)
Gemcitabine was maintained and the dose reduced as recommended by the following table;
128
<td>Absolute Granulocyte Count (x 10<sup>6</sup>/ l)</td><td></td><td>Platelet Count (x 10<sup>6</sup>/ l)</td><td>% of total dose</td>
<td> >1000</td><td>and</td><td> >100.000</td><td> 100</td>
<td> 500-999</td><td>or</td><td> 50.000-99.000</td><td> 75</td>
<td> <500</td><td>or</td><td> <50.000</td><td>Maintained</td>
Subsequent doses for any patient requiring dose reduction were the reduced doses. If doses were maintained for more than 3 weeks as a result of cytopenias, patients were supposed to have unacceptable toxicity and gemcitabine was discontinued. If there were no other additional grade III or IV toxicities, the continuation of the placebo was the responsibility of the physician and the medical supervisor. The hematological toxicity of gemcitabine was related to the speed of dose administration. Gemcitabine was given for 30 minutes regardless of the total dose. The use of agents that stimulate colonies for NCI-CTC Grade 2 cytopenias was at the discretion of the attending physician.
The switch option for the isolated pertuzumab agent was offered. A loading dose of 840 mg was administered in the next appropriate cycle with a continuation of 420 mg in subsequent cycles every 21 days.
The response was assessed at the end of cycles 2, 4, 6, 8, 12 and 17. The measurable disease was assessed using the Response Assessment Criteria for Solid Tumors (RECIST), by clinical assessment and CT scan or equivalent. The response for individuals with assessable disease was estimated according to changes to CA-125 and clinical and radiological evidence of disease. Responses were confirmed 4 to 8 weeks after the initial response documentation. The following outcome measures were assessed. Primary Effectiveness Goal
Progression-free survival, as determined by the investigator's assessment using RECIST or CA-125 changes, after starting treatment assigned in the study for all subjects in each group.
Progression-free survival, as determined by the researcher's assessment using RECIST or CA-125 changes, after starting treatment designated in the study in each group in the following subgroups:
individuals with detectable HER2 activation markers.
Individuals without detectable HER2 activation markers.
Secondary Effectiveness Goals
Objective response (PR or CR)
Response duration Survival time
Absence of progression in 4 months
These goals were assessed on all individuals in each group and in the following subgroups:
Individuals with detectable HER2 activation markers. Individuals without detectable HER2 activation markers.
To prevent or treat possible nausea and vomiting, the patient was premedicated with serotonin antagonists, steroids and / or benzodiazepines. To prevent or treat possible rashes, conventional acne therapies were used, including topical and / or oral antibiotics. Other possible concomitant medications were any prescription medications or over-the-counter preparations used by an individual in an interval beginning 7 days before Day 1 and continuing until the last day of the follow-up period. Individuals who experienced elevations in temperature to> 38.5 ° C associated with infusion or other symptoms associated with infusion were treated symptomatically with acetaminophen, diphen25 hydramine or meperidine. Non-experimental hematopoietic growth factors were administered for NCI-CTC Grade 2 cytopenias.
Tissue specimens fixed in formalin, embedded in paraffin (FFPET) obtained from patients in this experimental study were analyzed for EGFR, HER2, HER3, two HER ligands (amphirregulin and beta30 cellulin), and G6PDH (a resident gene) by qRT-PCR . The qRT-PCR assay was performed by TARGOS Molecular Pathology GmbH (Kassel, Germany) using Roche Diaqnostic's laboratory kits. The workflow and analysis for performing the qRT-PCR assay on clinical samples are shown in Figures 27 and 28 of the same.
The mRNA analysis of EGFR, HER2, HER3, amphirregulin and beta-cellulin was performed in duplicate. To enable the analysis of quantitative data, G6PHD was also analyzed as an internal reference. Primers and probes were designed to amplify mRNA only, not DNA. qRT-PCR was conducted separately for each marker and G6PDH as a two-step procedure.
In the first step, cDNA was reverse transcribed from 5 10 μΙ of total RNA using AMV reverse transcriptase and specific preparation for each marker and G6PDH. The temperature profile was 10 min / 25 ° C for annealing, 60 min / 42 ° C for reverse transcription and 5 min / 49 ° C for enzymatic inactivation.
In the second step, a 100 to 120 bp fragment of marker 15 and G6PDH mRNA was amplified from 5 μΐ of cDNA, using the LIGHTCYCLER® instrument (Roche Applied Science, Mannheim, Germany). Amplicons were detected by fluorescence using specific pairs of labeled hybridization probes (principle of energy transfer by fluorescent resonance). All reagents used for qRT-PCR were from Roche Applied Science, Mannheim, Germany. The temperature profile was 10 min / 95 ° C for initial denaturation and 45 cycles (10 sec / 62 ° C for annealing, 9 sec / 72 ° C for elongation, 10 sec / 95 ° for denaturation). See the table below for used primer / probe.
<td>Name</td><td>Sequence</td>
<td>CDNA primer from G6PDH</td><td>5'-tgc gga tgt cag cca ctg tg-3 '(SEQ ID N ° 23)</td>
<td>Initiator ahead of G6PDH</td><td>5'-ggg tgc to ggg tga cct g-3 '(SEQ ID N ° 24)</td>
<td>Reverse initiator of G6PDH</td><td>5'-agc cac tgt gag gcg gga-3 '(SEQ ID N ° 25)</td>
<td>Fluos probe. from G6PDH</td><td>5'-ggt gtt ttc ggg cag aag gcc to c-Fluos-3 '(SEQ ID NO: 26)</td>
<td>LC Red G6PDH Probe</td><td>5-LCred 640-aac age cac cag atg gtg ggg tag ate tt-3 '(SEQ ÍD N ° 27)</td>
131
<td>Name</td><td>Sequence</td>
<td colspan="2"></td>
<td>CDNA primer from EGFR</td><td>5'-ccag tca atg tag tgg gca cac-3 '(SEQ ID N ° 28)</td>
<td>Initiator ahead of EGFR</td><td>5'-ggg tga gcc aag gga gtt tg-3 '(SEQ ID N ° 29)</td>
<td>Reverse EGFR initiator</td><td>5'-gca cac tgg ata cag ttg tct ggt c-3 '(SEQ, DN ° 30)</td>
<td>LC Fluos probe. from EGFR</td><td>5'-tgt gca ggt gat gtt cat ggc ctg agg-Fluos3 '(SEQ ID N ° 31)</td>
<td>EGFR LC Red Probe</td><td>5-LCred 640-cac tct ggg tgg cac tgt atg cac tc3 '(SEQ ID N ° 32)</td>
<td colspan="2"></td>
<td>CDNA primer from HER2</td><td>5'-gga cct gcc tca ctt ggt tg-3 '(SEQ ID N ° 33)</td>
<td>Initiator ahead of HER2</td><td>5'-cag gtg gtg cag gga aac ct-3 '(SEQ ID NO: 34)</td>
<td>Reverse initiator of HER2</td><td>5'-ctg cct ttg gtt gtg agc-3 '(SEQ ID N ° 35)</td>
<td>Fluos probe. from HER2</td><td>5'-caa tgc cag cct gtc ctt cct gca g-Fluos-3 '(SEQ ID N ° 36)</td>
<td>LC Red HER2 probe</td><td>5'-LCred 640-tat cca gga ggt gca ggg CTA CGT gc-3 '(SEQ ID N ° 37)</td>
<td colspan="2"></td>
<td>CDNA primer from HER3</td><td>5'-gtg tcc tga caa age tta tcg-3 '(SEQ ID N ° 38)</td>
<td>Initiator ahead of HER3</td><td>5'-gat ggg aag ttt gcc to ttc g-3 '(SEQ ID N ° 39)</td>
<td>Reverse initiator of HER3</td><td>5'-tct caa tat aaa cac ccc ctg aca g-3 '(SEQ ID N ° 40)</td>
<td>Fluos probe. from HER3</td><td>5'-aac acc aac tcc age cac gct ctg-Fluos-3 '(SEQ ID N ° 41)</td>
<td>LC Red HER3 probe</td><td>5'-LCred 640-agc tcc gct tga ctc age tca ccg3 '(SEQ ID N ° 42)</td>
<td colspan="2"></td>
<td>Amphirregulin cDNA primer</td><td>5'-ctt gtc gaa gtt tc-3 '(SEQ ID N ° 43)</td>
<td>initiator ahead of</td><td>5-cca tag ctg cct tta tgt ctg c-3 '(SEQ ID N ° 44)</td>
132
<td>Name</td><td>Sequence</td>
<td>firregulina</td><td></td>
<td>Reverse amphirregulin initiator</td><td>5'-ctt tgc ttc ctc age ttc tcc ttc-3 '(SEQ ID N ° 45)</td>
<td>Fluos amphirregulin probe</td><td>5'-tga tcc tea cag ctg ttg ctg tta-Fluos-3 '(SEQ ID N ° 46)</td>
<td>LC Red amphirregulin probe</td><td>5-LCred-tac agt cca cgt tag aag aça ata ata cgt cag gaa-3 '(SEQ «DN ° 47)</td>
<td colspan="2"></td>
<td>CDNA primer from beta-cellulin</td><td>5'-gtc aac tet ctc aca c-3 '(SEQ ID N ° 48)</td>
<td>Beta-cellulin starter</td><td>5'-tct agg tgc ccc aag c-3 '(SEQ ID N ° 49)</td>
<td>Beta-reverse primer cellulin</td><td>5'-tag cct tea tea cag aca cag-3 '(SEQ ID N ° 50)</td>
<td>Beta-Fluos probe cellulin</td><td>5'-gca tta ctg cat caa agg gag atg ccg-Fluos-3 '(SEQ ID N ° 51)</td>
<td>Beta Red LC probe cellulin</td><td>5-LCred 640-tcg tgg tgg ccg age agg cg-3 '(SEQ ID N ° 52)</td>
An RNA calibrator (purified RNA from the cell line
HT29) was included in each run to allow relative quantification, positive and negative controls were used to control workflow and reagents.
Data analysis was conducted using the LIGHTCYCLER® Relative Quantification Software (Roche Applied Science, Mannheim, Germany) according to the manufacturer's instructions. The result was a standardized calibrator rate for each marker for each patient sample.
The qRT-PCR values were accessible for 119/130 patients (92%). The dynamic mean was: EGFR - about 10 times, HER2 - about 10 times, HER3 - about 20 times. The principle of relative quantification was used. The gene expression (mRNA level) of a sample was relatively quantified by referring to the expression of a resident gene from the same sample (reference = G6PDH). This relative expression of gene i on + õn nnrmolHorlo ° ovnroooôn rpjptíVP Hp ΡΡΩΡ ΠΡ ΡΡΗΚγρΗρΓ
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133
For each marker, a standardized calibrator rate is calculated as follows:
<td rowspan="2">STANDARD RATE</td><td>Target concentration</td><td rowspan="2">(sample)</td>
<td>Reference concentration</td>
<td>OF THE CALIBRATOR =</td><td>Target concentration</td><td rowspan="2">(calibrator)</td>
<td></td><td>Reference concentration</td>
Target = gene of interest Reference = resident gene (G6PDH)
Calibrator = colorectal cancer cell line HT29 RNA
Efficacy results were assessed on average at 7.1 months of follow-up (mean 1.3-20.3). There were 101 progression-free survival (PFS) events at that time. Figures 10A and B represent PFS in all patients treated with both gemcitabine and placebo as well as gemcitabine and pertuzumab. P values were estimated using the stratified Cox model and the log-rank test stratified by stratification factor randomization (ECOG PS, number of previous regimens for platinum-resistant disease and disease measurability).
PFS by the predicted HER2 situation is shown in Figures 11A and B, which compares PFS in patients predicted to be negative for HER2 and those predicted to be positive for HER2. A predictive algorithm was developed using 80 commercially obtained ovarian cancer samples. A combination of HER2, HER3 and amphirregulin expression predicts 30% higher pHer samples with an accuracy of 80%. Patients were predicted to be positive for HER2 if amphirregulin, HER2 and HER3 were greater than and equal to the 70th percentile, others were considered negative for pHER2.
Figures 12A and B represent PFS based on the EGFR qRT-PCR cutoff points; Figures 13A and B, PFS based on the HER2 qRT-PCR cutoff points; and 14A and B, PFS by HER3 qRT-PCR cutoff points. Low Her3 patients have better results in
134 terms of PFS. These data are shown in more detail in Figures 15A and B. As shown in those figures, pertuzumab activity is higher in patients with tumors that express low Her3 and tends to increase as the level of HER3 gene expression decreases. These figures include the absolute value for HER3 expression as quantified in the qRT-PCR assay.
Figures 16A and B illustrate PFS for subgroups of HER3. These data show that there may be a negative interaction between pertuzumab and gemcitabine in patients with tumors that express high Her3.
Figures 17A and B are additional tables that summarize the PFS data for HER3 subgroups for both high HER3 expression and low HER3 expression. Figures 18A and B represent PFS for subgroups of HER3 based on four different percentiles. Patients in the 0th percentile less than the 50th, and particularly from the 0th to the 25th percentile for HER3 expression have an improved mean relapse time (HR) for PFS. (Lower HRs correlate with improved results as measured by PFS).
Figures 19A and B provide the data showing PFS for HER3 qRT-PCR with a 50/50 split. Patients who express low Her3 (less than the 50th percentile) have an increased duration of PFS as measured in months compared to patients who express high Her3 (greater than or equal to the 50th percentile). This correlation is most pronounced in Figures 20A and B where patients who express low Her3 were characterized as those in less than the 25th percentile and patients who express high Her3 were those in more than or equal to the 25th percentile. The P value for the difference in HR between the two diagnostic subgroups was 0.0007. The 25th percentile is equal to 1.19 CNR
Preliminary data are available for overall survival (OS). Such data for all patients are provided in Figures 21A and B. Figures 22A and B compare OS by HER3 qRT-PCR, comparing the low expression of HER3 (less than the 50th percentile) and the high expression of HER3 (greater than or equal to the 50th percentile).
135
Figures 23A and B illustrate PFS by HER3 qRT-PCR with 50/50 division, high versus low relapse time (HR). The complete picture of PFS data including the percentiles between 5% to 95% are shown in Figures 24A and B.
The average expression of the calibrated normalized rate of HER3 is shown in Figure 26. This average is about 20 to 80 times.
The PFS results were also evaluated in relation to the proportion of HER2: HER3. The results of these later analyzes are illustrated in Figs 29 to 31. As all of these figures show, pertuzumab activity is maximal in patients with a high HER2: HER3 ratio.
Conclusions
Pertuzumab activity is maximal in patients with cancer that expresses low Her3 and tends to increase as HER3 gene expression decreases. Pertuzumab activity is also maximal in patients with cancer that expresses high HER2: Her3 and tends to increase as the level of expression of the HER2: HER3 gene increases. Most patients with low HER3 expression who responded to pertuzumab therapy also had a high proportion of HER2.HER3.
There may be a negative interaction between pertuzumab and gemcitabine in patients with tumors that express high Her3.
The expression of HER3 may be predictive of the behavior of chemotherapy with tumors with high expression responding better.
The results were surprising and unexpected.
Example 2
Pertuzumab for therapy of advanced, refractory or recurrent ovarian cancer
This example concerns a multicentre, open phase II clinical trial of patients with ovarian cancer. Patients with advanced, refractory or recurrent ovarian cancer were treated with pertuzumab, a humanized antibody to HER2.
136
Patients with recurrent ovarian cancer were enrolled to receive therapy with the low-dose pertuzumab agent alone; pertuzumab was administered intravenously (IV) with a loading dose of 840 mg followed by 420 mg every 3 weeks.
A second patient cohort was treated with high dose pertuzumab; 1050 mg every 3 weeks, administered as a single agent.
Tumor evaluations were obtained after 2, 4, 6, 8, 12 and 16 cycles. The Response Rate (RR) PR RECIST was the first cutoff point. Safety and tolerability were further assessed. The secondary cutoff points were TTP, duration of response, duration of survival, pharmacokinetics (PK) and FOSI (cohort 2).
QRT-PCR assays were performed on archived tissues fixed in formalin embedded in paraffin. Trial data is available for 46/117 patients. PFS and OS by HER3 qRT-PCR with 25/75 selected as the best division are shown in Figure 25. Here, the high expressions of HER3 were greater than or equal to the 75th percentile, while low expressions of HER # were less than than the 75th percentile.
Again, patients with low HER3 expression showed better results in terms of PFS and OS.
Example 3
Pertuzumab for platinum-resistant ovarian cancer therapy
In this randomized clinical trial, opened in Phase II, the efficacy and safety of pertuzumab treatment in combination with standard carboplatin-based chemotherapy were investigated in patients with platinum-sensitive recurrent ovarian cancer. The target sample size is 100 to 500 individuals. The target sample size is 148. Inclusion criteria • ovarian, primary peritoneal or histologically confirmed fallopian tube cancer;
• only a previous regime, which should be based on platinum;
• platinum-sensitive disease that is defined by an interval without
137 progression greater than 6 months after the end of platinum-based chemotherapy.
Exclusion criteria:
• previous radiation therapy;
• previous treatment with an anticancer vaccine or any targeted therapy;
• major surgery or traumatic injury within 4 weeks of the study;
• history or evidence of metastasis to the central nervous system.
The results are shown in Figures 32-35. The results of the same experiment further confirm that pertuzumab activity is optimal in patients with cancer that expresses low Her3 and tends to increase as the level of expression of the HER3 gene decreases. Pertuzumab activity is also great in patients with cancer that expresses high HER2: Her3 and tends to increase as the level of HER2: HER3 expression increases. Most patients with low Her3 expression levels who responded to pertuzumab therapy also had a high HER2: Her3 ratio.
There may be a negative interaction between pertuzumab and gemcitabine in patients with tumors that express high Her3.
The expression of HER3 may be predictive of the behavior of chemotherapy with tumors with high expression responding better.
Example 4
Analysis of gene expression of the HER pathway in a Phase II study of pertuzumab + gemcitabine vs. gemcitabine + placebo in patients with platinum-resistant epithelial ovarian cancer
Background: A randomized experiment in phase II (N = 130) of pertuzumab + gemcitabine vs. gemcitabine + placebo in patients with platinum-resistant epithelial ovarian cancer (COC) (CCDP-R) suggested that pertuzumab could prolong PFS (HR 0.66, 95% Cl 0.43, 1.03) and that
138 PFS duration could be associated with HER3 gene expression (See Examples 2 and 3).
Methods: Patients with CDDP-R EOC were randomized to G + P or G + placebo. Treatment was given until progression or until unacceptable toxicity. The primary cutoff point was PFS. A secondary objective was to evaluate the effectiveness of the results in a patient with expression profiles related to HER2 activation. A qRT-PCR assay using archived tissue fixed in paraffin embedded formalin (FFPET), performed as described above, allowed the analysis of mRNA expression of genes from the HER pathway, including HER1, HER2, HER3, amphirregulin and betacellulin. The results were described by the low expression of the gene (<average) and the high expression of the gene (> average).
Results: Of the 5 biomarkers tested, only the expression of the HER3 gene suggested a subgroup of patients with a different PFS and OS result based on low vs. high results as follows:
<td></td><td>G + P</td><td>G + Placebo</td><td>Risk Rate (95% CI)</td>
<td>PFS (average in months)</td><td></td><td></td><td></td>
<td>All patients (n = 130)</td><td> 2,9</td><td> 2,6</td><td> 0,66* (0,43, 1,03)</td>
<td>Low Her3 (N = 61)</td><td> 5,3</td><td> 1,4</td><td> 0,34 (0,18, 0,63)</td>
<td>High Her3 (N = 61)</td><td> 2,8</td><td> 5,5</td><td> 1,48 (0,83, 2,63)</td>
<td>OS (average in months)</td><td></td><td></td><td></td>
<td>All patients (n = 130)</td><td> 13,0</td><td> 13,1</td><td> 0,91* (0,58, 1,41)</td>
<td>Low Her3 (N = 61)</td><td> 11,8</td><td> 8,4</td><td> 0,62 (0,35, 1,11)</td>
<td>High Her3 (N = 61)</td><td> 16,1</td><td> 18,2</td><td> 1,59 (0,8, 3,2)</td>
* All patient analyzes were stratified by ECOG status, measurability of the disease and No. of previous regimens for CDDP-R disease.
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Conclusions: This exploratory analysis suggests that low levels of HER3 gene expression in tumors can be used as prognostic indicators in patients with CDDP-R EOC. Pertuzumab treatment can add to the clinical activity of gemcitabine in patients whose tumors have low HER3 gene expression. These data suggest that the levels of HER3 mRNA expression can be used in r ~ »iim ΗιΪοπίογγόγΙογ r \ roHitnrr \ Ho Hioonocfioo
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Contents5
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| Document | Office | Kind | Date |
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| 60892640 | United States of America | – | |
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Numbers
- Publication
- PI0808418
- Application
- 8084181
Titles2
- Portuguese
- PREDIÇÃO DE RESPOSTA A UM INIBIDOR DE HER
- English
- PREDICTION OF RESPONSE TO AN HER INHIBITOR
Classification
- CPC, 19
- A61K39/39558
- C12Q1/6886
- C12Q2600/106
- C12Q2600/118
- C12Q2600/158
- G06Q99/00
- A61P15/00
- A61P35/00
- A61P43/00
- G01N33/5752
- G01N33/57555
- G01N33/57557
- G01N33/57515
- G01N33/57545
- A61K31/337
- A61K31/7068
- A61K45/06
- A61K2300/00
- B65B61/20
- IPC, 3
- G01N33 574
- C12Q1 68
- A61K39 395
