CN117677601A - 用于治疗肺癌和非小细胞肺癌的方法 - Google Patents
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Abstract
本发明公开了一种治疗个体中的NSCLC或肺癌的方法,该方法包括向该个体施用有效量的组合物,该组合物包括含有酰基富烯的纳摩尔效力颗粒。治疗可基于患有鳞状细胞癌的个体。另一方面包括用于本文所述方法的组合物(如药物组合物)、药物、试剂盒和单位剂量。
Description
相关专利申请的交叉引用
本申请要求于2021年4月12日提交的美国临时专利申请第63/173,968号的权益,该美国临时专利申请以引用的方式全文并入本文。
技术领域
本申请涉及癌症治疗,特别是涉及治疗肺癌的方法。本申请还涉及通过施用含有纳摩尔效力酰基富烯的组合物来治疗非小细胞肺癌(NSCLC)和肺癌的方法和组合物。
背景技术
肺癌仍然是癌症相关死亡的最常见原因。这对男女都是如此。2020年,在美国,肺癌导致的死亡人数超过了乳腺癌、前列腺癌、结肠癌和脑癌。
大多数由吸烟引起的肺癌是非小细胞肺癌(NSCLC),约占所有肺癌的90%。存在三种主要类型的NSCLC:鳞状细胞癌、大细胞癌和腺癌。腺癌是最常见的肺癌形式,并且是在吸烟者和非吸烟者两者中最常发现的肺癌。鳞状细胞癌通常发现于近端支气管。早期NSCLC趋向于局部化,并且如果早期发现,其通常可通过手术治疗,结果良好,并且存活率提高。其它治疗方案包括放射治疗、药物治疗以及这些方法的组合。
NSCLC根据肿瘤的大小及其在包括淋巴结的其它组织中的存在进行分期。在隐匿期,在痰样品或灌洗液样品中发现癌细胞,并且在肺中检测不到肿瘤。在0期,仅肺的最内层表现出癌细胞,并且肿瘤没有穿过内层生长。在IA期,癌症被认为是侵袭性的,并且已经生长到肺组织深处,但是肿瘤直径小于3cm。在该期,在支气管或淋巴结中没有发现肿瘤。在IB期,肿瘤或直径大于3cm,或已经生长到支气管或胸膜中,但是还没有生长到淋巴结中。在IIA期,肿瘤直径超过3cm,并且已经生长到淋巴结中。在IIB期,肿瘤或在已经淋巴结中发现并且直径大于3cm,或生长到支气管或胸膜中;或癌症不在淋巴结中,而是在胸壁、隔膜、胸膜、支气管或心脏周围的组织中发现。在IIIA期,在靠近肺和支气管的淋巴结中以及在肺之间但在肿瘤所位于的胸部一侧的淋巴结中发现癌细胞。IIIB期,癌细胞位于与肿瘤相对的胸部的一侧上和颈部中。肺附近的其它器官也可能有癌细胞,并且在肺的一个叶中可能发现多个肿瘤。在第四期,在同一个肺的一个以上的叶中发现肿瘤,或在身体的其它部位发现肺和癌细胞两者。在所有期,癌症都必须接受治疗。
因此,总是需要对非小细胞肺癌(NSCLC)和肺癌的治疗。
发明内容
本申请公开了在个体中治疗肺癌和NSCLC的方法。该方法包括向该个体施用有效量的组合物,该组合物包括含有酰基富烯的纳摩尔效力颗粒。
另一方面包括用于本文所述方法的组合物(诸如药物组合物)、药物、试剂盒和单位剂量。
本申请的另一方面包括治疗肺癌和NSCLC的方法,该方法使用有效量的羟基脲甲基-酰基富烯与有效量的一种或更多种附加治疗剂,该附加治疗剂选自由以下组成的组:替莫唑胺、贝伐单抗、依维莫司、卡莫司汀、洛莫司汀、丙卡巴肼、长春新碱、伊立替康、顺铂、卡铂、甲氨蝶呤、依托泊苷、长春碱、博来霉素、放线菌素、环磷酰胺和异环磷酰胺。
本申请的另一方面包括使用有效量的羟基脲甲基-酰基富烯与放射疗法一起治疗肺癌和NSCLC的方法。放射疗法可选自肺辐射疗法、分次放射疗法、放射外科手术及其组合。可在用有效量的羟基脲甲基-酰基富烯进行任何治疗之前、期间和之后进行放射。
本申请的另一方面包括患者是人类或动物的方法。
附图说明
图1显示了羟基脲甲基-酰基富烯在一系列NSCLC细胞系中表现出纳摩尔效力;
图2显示了X轴上的羟基脲甲基-酰基富烯敏感性和跨19种NSCLC细胞系的PTGR1转录水平;
图3显示了从GDSC数据库获得的奥沙利铂、顺铂、培美曲塞、紫杉醇和吉西他滨之间比较的以纳摩尔IC50表示的羟基脲甲基-酰基富烯效力;
图4显示了如与埃罗替尼、吉非替尼和奥希替尼相比,在源自原发性肺癌的脑转移模型LXFE 2478中,以纳摩尔IC50(Y轴)表示的羟基脲甲基-酰基富烯效力;
图5显示了H460裸鼠异种移植物模型的结果,其中羟基脲甲基-酰基富烯在X轴箭头所示的日期腹腔内施用(每组N=10)。
图6显示与高度突变基因相邻的值是驱动突变(黑色)和未突变(白色)样品之间PTGR1相对基因表达的排列测试p值。
序列
SEQ ID NO:1-PTGR1的氨基酸序列,
SEQ ID NO:2-KEAP1的氨基酸序列,
SEQ ID NO:3-KRAS的氨基酸序列,
SEQ ID NO:4-TP53的氨基酸序列,和
SEQ ID NO:5-STK11的氨基酸序列。
定义
除非另有定义,本文中使用的所有技术和科学术语与本主题所属技术领域的技术人员通常理解的含义相同。如本文所使用的,为了便于理解本发明,提供了以下定义。
与SEQ ID NO:X中列出的氨基酸序列比对的氨基酸序列(当指变体多肽时)是指变体氨基酸序列和SEQ ID NO:X中列出的氨基酸序列通过适当的方法比对,该方法允许相互比较序列并鉴定变体的氨基酸序列中的位置,其中如果与SEQ ID NO:X中列出的氨基酸序列相比,存在相同氨基酸(相同位置)或存在另一种氨基酸(取代)或存在一个或更多个额外的氨基酸(插入或延伸)或不存在氨基酸(缺失或截短)。
术语″基于″包括评估、确定或测量如本文所述的患者特征(并且优选地选择适合接受治疗的患者)。
术语″同时施用″是指在联合治疗中第一种治疗的施用和第二种治疗的施用相互重叠。
本文使用的术语″有效量″是指足以治疗特定症状、病症或疾病,诸如改善、减轻、减轻和/或延迟其一种或多种症状的化合物或组合物的量。关于NSCLC,有效量包括足以引起肿瘤缩小和/或降低肿瘤生长速率(诸如抑制肿瘤生长)或防止或延迟胰腺癌中其它不需要的细胞增殖的量。在一些实施方案中,有效量是足以延迟NSCLC发展的量。在一些实施方式中,有效量是足以防止或延迟复发的量。有效量可以一次或多次施用。在NSCLC的情况下,药物或组合物的有效量可:(i)减少NSCLC细胞的数量;(ii)减小肿瘤大小;(iii)在一定程度上抑制、阻滞、减缓并优选地停止NSCLC癌细胞向外周器官的浸润;(iv)抑制(即,在一定程度上减缓并优选地停止)肿瘤转移;(v)抑制肿瘤生长;(vi)防止或延迟肿瘤的发生和/或复发;和/或(vii)在一定程度上缓解与NSCLC相关的症状中的一种或多种症状。
术语″健康个体″应理解为已知未患癌症(例如肺癌或NSCLC)的个体,此类知识来源于个体的临床数据,包括但不限于与本文所述不同的诊断测定。
″参考水平″是指本发明的化合物或附加生物标志物的水平,其指示特定疾病状态、表型或其缺乏,以及疾病状态、表型或其缺乏的组合。
″参考样品″是指含有参考水平的生物标志物的样品。例如,可以从没有特定疾病、疾病状态或表型(例如癌症或急性损伤)的受试者获得参考样品。
如本文所使用的″可能有反应″或″反应性″是指任何种类的临床或非临床的改善或阳性应答,选自但不限于肿瘤大小的可测量的减少或疾病或疾病进展的证据、完全应答、部分应答、稳定疾病、无进展存活的增加或延长、或总体存活的增加或延长。
术语″肺组织″和″肺癌″分别是指肺本身的组织或癌,以及邻近和/或位于肺下层和支持结构,诸如胸膜、肋间肌、肋骨和呼吸系统的其它元素内的组织。在此上下文中,呼吸系统本身代表鼻腔、鼻窦、咽、喉、气管、支气管、肺、肺叶、肺泡、肺泡管、肺泡囊、肺泡毛细血管、细支气管、呼吸细支气管、内脏胸膜、壁层胸膜、胸膜腔、隔膜、会厌、腺样体、扁桃体、口和舌等。组织或癌症可来自哺乳动物,并且优选地来自人类,尽管猴、猿、猫、狗、牛、马和兔也在本发明的范围内。如本文所使用的术语″肺部病症″是指与肺有关的疾病、事件或健康状态的变化,包括例如肺癌和各种非癌病症。
当应用于多肽时,术语″基本相似性″或″基本上相似″是指如通过程序GAP或BESTFIT使用默认间隙权重最佳对齐时的两个肽序列在共享至少95%的序列同一性,甚至更优选地至少98%或99%的序列同一性。优选地,不相同的残基位置因保守氨基酸取代而不同。″保守氨基酸取代″是一个氨基酸残基被具有化学特性(例如,电荷或疏水性)类似的侧链(R基团)的另一个氨基酸残基取代的氨基酸取代。一般而言,保守氨基酸取代不会实质上改变蛋白质的功能特性。在两个或更多个氨基酸序列因保守取代而彼此不同的情况下,序列一致性百分比或相似性程度可向上调整以校正取代的保守质。作出此调整的方法是本领域技术人员所熟知的。参见,例如,Pearson(1994)Methods Mol,Biol.24:307-331。具有相似化学性质的侧链的氨基酸组的实施例包括(1)脂族侧链:甘氨酸、丙氨酸、缬氨酸、亮氨酸和异亮氨酸;(2)脂族-羟基侧链:丝氨酸和苏氨酸;(3)含酰胺侧链:天冬酰胺和谷氨酰胺;(4)芳族侧链:苯丙氨酸、酪氨酸和色氨酸;(5)碱性侧链:赖氨酸、精氨酸和组氨酸;(6)酸性侧链:天冬氨酸和谷氨酸,以及(7)含硫侧链为半胱氨酸和蛋氨酸。优选的保守氨基酸取代基团是:缬氨酸-亮氨酸-异亮氨酸、苯丙氨酸-酪氨酸、赖氨酸-精氨酸、丙氨酸-缬氨酸、谷氨酸-天冬氨酸和天冬酰胺-谷氨酰胺。或者,保守替代是在Gonnet等人,(1992)Science 256:1443-1445中公开的PAM250对数似然矩阵中具有正值的任何变化。″适度保守″替代是PAM250对数似然矩阵中具有非负值的任何变化。
术语″治疗(treatment或treating)″是获得有益的或期望的结果(包括临床结果)的方法。为了本发明的目的,有益的或期望的临床结果包括但不限于以下的一者或多者:减轻由疾病引起的一种或多种症状,减少疾病的程度,稳定疾病(例如,防止或延迟疾病的恶化),防止或延迟疾病的扩散(例如,转移),防止或延迟疾病的复发,延迟或减缓疾病的进展,改善疾病状态,缓解(部分或全部)疾病,减少治疗疾病所需的一种或多种其它药物的剂量,延缓疾病的进展,提高生活质量,和/或延长存活期。″治疗″还包括减少NSCLC或肺癌的病理后果。本发明的方法考虑了治疗的这些方面中的任何一个或多个方面。
术语″治疗作用″是指通过施用本发明的化合物或组合物而对动物,特别是哺乳动物,特别是对人类产生的有益的局部或全身作用。短语″治疗有效量″是指以合理的收益/风险比有效治疗由异常的生物活性引起的疾病或病症的本发明的化合物或组合物的量。在一些实施方案中,治疗有效量的羟基脲甲基-酰基富烯或其药学上可接受的盐选自由以下组成的组:0.5mg/天、1mg/天、2.5mg/天、5mg/天、10mg/天、20mg/天、30mg/天、60mg/天、90mg/天、120mg/天、150mg/天、180mg/天、210mg/天、240mg/天、270mg/天、300mg/天、360mg/天、400mg/天、440mg/天、480mg/天、520mg/天、580mg/天、600mg/天、620mg/天、640mg/天、680mg/天和720mg/天。
具体实施方式
本申请公开了在有需要的个体中治疗非小细胞肺癌(NSCLC)和肺癌的方法,该方法包括向该个体施用有效量的组合物,该组合物包括纳摩尔效力酰基富烯。
一个实施方案包括治疗患有肺癌和/或非小细胞肺癌或非小细胞肺癌患者的方法,其中将治疗有效量的羟基脲甲基酰基富烯或其盐施用于肺癌或非小细胞肺癌患者。
羟基脲甲基酰基富烯或羟基脲甲基-酰基富烯(目前由Lantern Pharma,Inc.将其称为LP-184)是一种衍生自蘑菇毒素illudin S的半合成或合成抗肿瘤剂。每种异构体的结构如下所示。
具体实施方案适用于多种组织学类型的NSCLC。NSCLC可为鳞状细胞癌(即表皮样癌)、大细胞癌、腺癌、腺鳞状细胞癌、具有多形性、肉瘤样或肉瘤样元素的癌、类癌或唾液腺癌。在一些实施方案中,NSCLC是鳞状细胞癌。在一些实施方案中,鳞状细胞癌是乳头状的、透明细胞的、小细胞的或基底样的。在一些实施方案中,NSCLC是腺癌。在一些实施方案中,腺癌是腺泡、乳头状、细支气管肺泡癌(例如,非粘液性、粘液性、混合粘液性和非粘液性或不确定细胞类型)、具有粘液性的实体腺癌、具有混合亚型的腺癌、高分化胎儿腺癌、粘液性(胶质)腺癌、粘液性囊腺癌、印戒腺癌或透明细胞腺癌。在一些实施方案中,大细胞癌是大细胞神经内分泌癌、组合大细胞神经内分泌癌、基底细胞样癌、淋巴上皮瘤样癌、透明细胞癌或具有横纹肌样表型的大细胞癌。在一些实施方案中,具有多形性、肉瘤样或肉瘤样元素的癌是具有梭形细胞和/或巨细胞的癌、梭形细胞癌、巨细胞癌、癌肉瘤或肺母细胞瘤。在一些实施方案中,唾液腺型癌是粘液表皮样癌或腺样囊性癌。在一个实施例中,可在施用一种或多种化疗剂之前、同时或之后施用羟基脲甲基酰基富烯或其盐。本文的方法中的任何方法的NSCLC可为隐匿性肿瘤、0期肿瘤、I期肿瘤(IA期(T1,N0,M0)或IB期(T2,N0,M0))、II期肿瘤(IIA期(T1,N1,M0)和IIB期(T2,N1,M0))、IIIA期肿瘤(T1,N2,M0,T2,N2,M0,T3,N1,M0或T3,N2,M0)、IIIB期肿瘤(任何T,N3,M0或T4、任何N、M0)、或IV期肿瘤(任何T、任何N、M1)。在本文所述的方法中的任何方法的一些实施方案中,NSCLC是早期NSCLC、非转移性NSCLC、原发性NSCLC、晚期NSCLC、局部晚期NSCLC、转移性NSCLC、缓解期NSCLC或复发性NSCLC。在一些实施方案中,NSCLC是局部可切除的、局部不可切除的或不可切除的。在一些实施方案中,NSCLC是不可切除的IV期NSCLC。在一些实施方案中,NSCLC是不可手术期IIIA和/或IIIBNSCLC,PS 0-1和FEV 1>800ml。
在另一个实施方案中,上述治疗方法中的任何治疗方法包括对患者共同施用一种或多种第二治疗剂的另外的步骤。可从已知可用于与羟基脲甲基酰基富烯或其盐共同施用的任何第二治疗剂中选择药剂组合或第二治疗剂。第二治疗剂的选择也取决于待治疗的特定疾病或病症。可在本申请的方法中采用的第二治疗剂的实施例是上面列出的用于包括本发明化合物和第二治疗剂的组合组合物中的那些。
在另一个实施方案中,第二治疗剂是一种或多种选自喜树碱衍生物、紫杉醇、多西他赛、埃博霉素B、5-FU、吉西他滨、奥沙利铂、顺铂、卡铂、美法仑、达卡巴嗪、替莫唑胺、阿霉素、伊马替尼、埃罗替尼、贝伐单抗、西妥昔单抗和Raf激酶抑制剂的化疗剂。
在另一个实施方案中,第二治疗剂是一种或多种选自紫杉醇或顺铂的化疗剂。
一些实施方案包括肺癌或NSCLC的治疗,其包括(I)对患者进行体检;(2)使用磁共振成像(″MRI″)来确认患者肺中肿瘤的存在;(3)进行肺活检以获得关于癌症的遗传信息,包括分子亚型和遗传标志物;和(4)向患有肺癌或NSCLC的受试者开具羟基脲甲基-酰基富烯的有效治疗处方。
另一个实施方案包括治疗肺癌或NSCLC的方法,该方法包括在人类受试者中检测某些遗传信息的存在;如果人类受试者过表达或低表达某些标志物,则向该受试者施用羟基脲甲基-酰基富烯或其药学上可接受的盐。该标志物可基本上类似于PTGR1(SEQ ID NO:1)、KEAP1(SEQ ID NO:2)、KRAS(SEQ ID NO:3)、TP53(SEQ ID NO:4)和STK11(SEQ ID NO:5)。
另一个实施方案包括在受试者中治疗肺癌或NSCLC的方法,该方法包括:(a)获得或已经获得来自受试者的样品中多个靶标的表达水平,其中多个靶标包括PTGR1(SEQ IDNO:1)以及一种或多种以下靶标:KEAP1、KRAS、TP53和STK11;(b)确定受试者对使用羟基脲甲基-酰基富烯的治疗敏感;和(c)施用包括羟基脲甲基-酰基富烯的癌症治疗。
只要肿瘤保持在控制之下并且该方案在临床上是耐受的,给药期可以是一个多周的治疗周期。在一些实施方案中,可每周一次施用单剂量的羟基脲甲基-酰基富烯或其它治疗剂,并且优选地在三周(21天)治疗周期的第1天和第8天各施用一次。在一些实施方式中,单剂量的羟基脲甲基-酰基富烯或其它治疗剂可每周一次、每周两次、每周三次、每周四次、每周五次、每周六次或在一周、两周、三周、四周或五周的治疗周期内每天施用。施用可以在治疗周期中每周的同一日或不同日进行。
本文鉴定的某些蛋白质的蛋白质序列包括PTGR1(SEQ ID NO:1)、KEAP1(SEQ IDNO:2)、KRAS(SEQ ID NO:3)、TP53(SEQ ID NO:4)和STK11(SEQ ID NO:5)。
如本领域技术人员所认识到的,治疗有效剂量可变化,这取决于所治疗的疾病、疾病的严重程度、施用途径、患者的年龄和总体健康状况、赋形剂的使用、与其它治疗性治疗共同使用的可能性(诸如使用其它药剂)以及治疗医师的判断。例如,选择有效剂量的指南可通过参考羟基脲甲基酰基富烯的处方信息或其期刊讨论来确定。
根据本发明使用的羟基脲甲基-酰基富烯可以主要通过肠胃外给药,具体包括皮下给药、肌肉内给药、静脉内给药、经皮给药、鞘内给药、硬膜外给药、联合给药和局部给药,或者可以还以各种剂型给药,例如如果可能通过口服给药。
用于施用的注射剂包括例如无菌、水性或非水性溶液剂、混悬剂和乳剂。水性溶液剂和混悬剂包含例如注射用蒸馏水和生理盐水。非水性溶液剂和混悬剂包含例如丙二醇、聚乙二醇、植物油(诸如橄榄油)、醇(诸如乙醇)和聚山梨醇酯80(商品名)。这种组合物可以含有辅助剂,诸如防腐剂、润湿剂、乳化剂、分散剂、稳定剂(例如,乳糖)和溶解辅助剂(例如,葡甲胺)。这些通过细菌截留过滤器过滤、混合灭菌剂或辐射进行灭菌。或者,在使用之前可以将这些辅助剂一次性制成无菌固体组合物,然后溶解或悬浮在注射用无菌水或无菌溶剂中。
根据本文所述方法施用药剂的剂量范围取决于例如药剂的形式、其效力以及本文所述病症的症状、标志物或指标需要降低的程度,例如肿瘤生长所需的百分比减少。剂量不应太大,以免引起不良副作用。通常,剂量将随着患者的年龄、病症和性别而变化,并且可由本领域技术人员确定。在出现任何并发症的情况下,剂量也可由个体医师调整。
熟练的临床医生可确定本文所述药剂在例如本文所述病症的治疗中的功效,或诱导如本文所述应答(例如肺癌)的功效。然而,治疗被认为是″有效的治疗″,如本文所使用的术语,如果本文所述病症的一种或多种体征或症状以有益的方式改变,其它临床上可接受的症状得到改善,或甚至减轻,或在根据本文所述方法治疗后,例如至少10%诱导了期望应答。例如,可通过测量根据本文所述方法治疗的病症的标志物、指标、症状和/或发生率,或任何其它合适的可测量参数,例如肿瘤大小和/或生长速率,来评估疗效。功效还可通过住院治疗或需要药物干预(即疾病的进展停止)来评估个体恶化的失败来测量功效。测量这些指标的方法是本领域技术人员已知的和/或在本文中有所描述。治疗包括对个体或动物(一些非限制性实施例包括人类或动物)疾病的任何治疗,并且包括:(1)抑制疾病,例如防止症状恶化(例如疼痛或炎症);或(2)减轻疾病的严重程度,例如,使症状好转。用于治疗疾病的有效量是指当施用有需要的受试者时,足以导致对所述疾病进行有效治疗的量,如所述术语在本文中所定义的。药剂的功效可通过评估病症或期望应答的物理指标来确定。本领域技术人员完全有能力通过测量此类参数中的任何一个参数或参数的任何组合来监测施用和/或治疗的功效。可在本文所述病症的动物模型中评估功效,例如在小鼠模型中治疗肺癌。当使用实验动物模型时,当观察到标志物(例如肿瘤大小和/或生长率)的统计学显著变化时,证明治疗的功效。在一些实施方案中,治疗有效量的羟基脲甲基-酰基富烯或其药学上可接受的盐选自由以下组成的组:0.5mg/天、1mg/天、2.5mg/天、5mg/天、10mg/天、20mg/天、30mg/天、60mg/天、90mg/天、120mg/天、150mg/天、180mg/天、210mg/天、240mg/天、270mg/天、300mg/天、360mg/天、400mg/天、440mg/天、480mg/天、520mg/天、580mg/天、600mg/天、620mg/天、640mg/天、680mg/天和720mg/天。
本文所述的方法可用于肺癌或NSCLC治疗的各个方面。在方法中的任何方法的一些实施方案中,该方法包括抑制个体中的NSCLC细胞增殖(诸如NSCLC肿瘤生长)的方法,该方法包括向个体施用a)有效量的组合物,该组合物包括含有羟基脲甲基-酰基富烯的颗粒。在一些实施方案中,至少约10%(包括例如至少约20%、30%、40%、60%、70%、80%、90%或100%中的任何一者)的细胞增殖被抑制。
在本文所述的方法中的任何方法的一些实施方案中,治疗方法导致客观应答(诸如部分应答或完全应答)。
在本文所述的方法中的任何方法的一些实施方案中,该治疗方法导致生活质量的改善。
还应理解,针对任何特定患者的具体剂量和治疗方案将取决于多种因素,包括所用特定化合物的活性、年龄、体重、总体健康状况、性别、饮食、施用时间、排泄率、药物组合以及治疗医师的判断以及所治疗特定疾病的严重性。本发明化合物在组合物中的量也将取决于组合物中的特定化合物。可能优选给出最大耐受剂量。
治疗可包括使用一种或多种生物标志物。该生物标志物可低于、高于或等于健康人中那些标志物的水平。在一个实施例中,下列基因的上调可能与羟基脲甲基-酰基富烯的敏感性增加有关:CD55、GLIS3、PRKCDBP、EGF、GLRX、SLC16A7、ABLIM3、DUSP4、ABCG2、HSPB8、TSPAN8、FKBP7、RGS2、CCPG1、DDIT4L、CTSL、PMP22、ACS33、HYAL1、KRT83、SLC16A14、AKR1B10、CA12、SDC2、HHIPL2、MCTP1。
在一些实施方案中,通过测量给定患者群体的感兴趣基因的表达水平,确定所述基因在该群体中的中值表达水平,并将单个患者的相同基因的表达水平与给定患者群体的中值表达水平进行比较,来确定表达水平。例如,如果确定单个患者的感兴趣基因的表达水平高于患者群体的中值表达水平,则确定该患者具有感兴趣基因的高表达。或者,如果确定单个患者的感兴趣基因的表达水平低于患者群体的中值表达水平,则确定该患者具有感兴趣基因的低表达。在一些实施方案中,单个患者患有NSCLC,并且患者群体不具有癌症(即,正常)。在一些实施方案中,单个患者具有一种组织学类型的NSCLC(例如,鳞状细胞癌),并且患者群体具有第二组织学类型的NSCLC(例如,腺癌)。在一些实施方案中,单个患者和患者群体具有相同组织学类型的NSCLC(例如,鳞状细胞癌)。
这些鉴定表达水平的方法不受用于鉴定感兴趣基因的表达水平的技术的限制。可测量感兴趣基因的核酸(例如RNA或DNA)或蛋白质水平。用于测量基因表达和/或确定序列以检测多态性的方法是本领域公知的,并且包括但不限于免疫学测定、核酸酶保护测定、northern印迹、原位杂交、ELISA、逆转录酶聚合酶链式反应(RT-PCR)、实时聚合酶链式反应、表达序列标签(EST)测序、cDNA微阵列杂交或基因芯片分析、消减克隆、基因表达系列分析(SAGE)、大规模平行测序技术(MPSS)和边合成边测序(SBS)。诊断程序也可直接在从活组织检查或切除获得的患者组织的组织切片(固定的和/或冷冻的)上原位执行。
实施例和结果
实施例1
表示不同分子、人口统计学和组织学特征的19个人类NSCLC细胞系用96孔格式的羟基脲甲基-酰基富烯处理,一式三份孔,浓度范围从14nM到10μM。治疗进行72小时,并使用Promega的CellTiter Fluor试剂分析细胞活力。如图1所示,根据GraphPad Prism中绘制的剂量应答曲线生成的IC50值来测量药物敏感性。未显示代表性的剂量应答曲线。总体而言,LP_184在大多数测试的NSCLC细胞系中表现出强纳摩尔效力,指示该组具有广泛的抗肿瘤细胞毒性。在这19个NSCLC细胞系中,IC50范围为45nM至1805nM,其中中值IC50为371nM,并且平均IC50为571nM。
实施例2
对原发性NSCLC细胞系中羟基脲甲基-酰基富烯应答的研究扩展到了原发性肺癌脑转移的体外模型。在2D培养系统和3D培养系统中测试了两个此类模型LXFA 983和LXFE2478对羟基脲甲基-酰基富烯的敏感性。对于2D培养物,CellTiter-测定提供了细胞活力读数,而对于3D培养物,3D克隆原测定提供了基于重要染色的菌落形成读数。如图4所示,羟基脲甲基-酰基富烯在这些模型中仍然有效,其IC50在88nM和3209nM之间。
羟基脲甲基-酰基富烯通过血脑屏障的特性强调了这些结果的翻译相关性。
如图2所示,在测试的NSCLC细胞系中发现了羟基脲甲基-酰基富烯敏感性,与PTGR1转录水平相关(皮尔逊相关系数,r=-0.603,p值6.076E-05)。571nM的平均羟基脲甲基-酰基富烯IC50值用于将NSCLC细胞系分成高敏感性组和低敏感性组。PTGR1的表达在两组受试的NSCLC细胞系中进行比较:11个细胞系的羟基脲甲基-酰基富烯IC50<571nM,并且8个细胞系的IC50>571nM。
为了研究KEAP1突变对测试的19个NSCLC细胞系中PTGR1转录水平的影响,比较了两组细胞系中PTGR1的表达:7个具有KEAP1突变的细胞系和12个没有KEAP1突变的细胞系。我们发现,在单尾t测试分析中,KEAP1突变体和野生型细胞系之间PTGR1表达的差异是显著的(p值0.0253)。相比之下,PTGR1的表达完全独立于KRAS、TP53和STK11的突变,这些突变在NSCLC中通常发生改变,但目前缺乏有效的靶向治疗方案。
实施例3
在所选择的NSCLC细胞系中,使用羟基脲甲基-酰基富烯应答与先前公布的从GDSC数据库获得的常用标准化疗药物的应答进行了广泛的比较。其中奥沙利铂和顺铂也作为DNA烷化剂,但可能经由被认为与羟基脲甲基-酰基富烯不重叠的机制。已知对抗代谢药物培美曲塞和吉西他滨有应答,目前也被认为是NSCLC的标准治疗选项。肺腺癌也可用紫杉烷治疗。公开可获得的奥沙利铂、顺铂、培美曲塞、紫杉醇和吉西他滨的IC50数据是从GDSC数据库获得的,这些数据是在用羟基脲甲基-酰基富烯治疗72小时后收集的,并且通常报道为无标准误差的平均值。如图3所示,在该跨所选择的NSCLC细胞系的相对细胞毒性的分析中,羟基脲甲基-酰基富烯被证明比这些被批准在NSCLC中医疗用途的化疗药物的效力高3800倍。
实施例4
脑转移模型LXFE 2478携带杂合的EGFR激活突变,即EGFR外显子20插入(M766_A767insASV)。据报道,衍生该模型的患者对放疗、顺铂/埃罗替尼/培美曲塞组合和PD-L1抗体治疗具有抗性。在该模型中,将已公布的各种EGFR抑制剂的体外2D功效与类似病症下的羟基脲甲基-酰基富烯进行了比较,并且发现羟基脲甲基-酰基富烯的功效是早期EGFR抑制剂埃罗替尼和吉非替尼的约6倍,而其功效是最新一代EGFR抑制剂奥希替尼的约2.4倍,从而将羟基脲甲基-酰基富烯置于该范围内(图4)。
实施例5
在作为裸鼠皮下异种移植物的NCI-H460肺肿瘤模型中体内评价羟基脲甲基-酰基富烯抗肿瘤应答。10只小鼠包括在媒剂对照组和治疗组中。如图5所示,使用在第1天、第3天、第6天、第9天和第12天腹膜内施用注射5次5mg/kg的方案进行羟基脲甲基-酰基富烯治疗。未显示取样日的单独的小鼠肿瘤体积和体重。该治疗在第8天、第12天和第15天产生了媒剂对照组和治疗组的平均肿瘤体积的统计学显著差异。因此,羟基脲甲基-酰基富烯在肺癌模型中显示了抗肿瘤功效。
实施例6
研究了NSCLC临床数据集中PTGR1表达状态与多个相关基因的突变状态相关。在对TCGA门户网站的533例NSCLC腺癌患者记录的分析中,发现PTGR1在KEAP1突变的样品中高度表达。在图6的图中,与高度突变基因相邻的值是驱动突变(黑色)和未突变(白色)样品之间PTGR1相对基因表达的排列测试p值。该结果对于KEAP1是最具统计学意义的(p值0.00126),其中PTGR1在KEAP1突变的样品中高度表达。在该PTGR1高亚群内,存在明显的富含KEAP1、KRAS、BRAF、EGFR、NRF2、MET和AKT1突变的括号。携带此类突变并伴有PTGR1水平升高的群体可能地代表从基于羟基脲甲基-酰基富烯的方案中受益的分子定义的NSCLC患者亚群。
SEQ ID NO:1(PTGR1)
MVRTKTWTLKKHFVGYPTNSDFELKTAELPPLKNGEVLLEALFLTVDPYMRVAAKRLKEGDTMMGQQVAKVVESKNVALPKGTIVLASPGWTTHSISDGKDLEKLLTEWPDTIPLSLALGTVGMPGLTAYFGLLEICGVKGGETVMVNAAAGAVGSVVGQIAKLKGCKVVGAVGSDEKVAYLQKLGFDVVFNYKTVESLEETLKKASPDGYDCYFDNVGGEFSNTVIGQMKKFGRIAICGAISTYNRTGPLPPGPPPEIVIYQELRMEAFVVYRWQGDARQKALKDLLKWVLEGKIQYKEYIIEGFENMPAAFMGMLKGDNLGKTIVKA
SEQ ID NO:2(KEAP1)
MQPDPRPSGAGACCRFLPLQSQCPEGAGDAVMYASTECKAEVTPSQHGNRTFSYTLEDHTKQAFGIMNELRLSQQLCDVTLQVKYQDAPAAQFMAHKVVLASSSPVFKAMFTNGLREQGMEVVSIEGIHPKVMERLIEFAYTASISMGEKCVLHVMNGAVMYQIDSVVRACSDFLVQQLDPSNAIGIANFAEQIGCVELHQRAREYIYMHFGEVAKQEEFFNLSHCQLVTLISRDDLNVRCESEVFHACINWVKYDCEQRRFYVQALLRAVRCHSLTPNFLQMQLQKCEILQSDSRCKDYLVKIFEELTLHKPTQVMPCRAPKVGRLIYTAGGYFRQSLSYLEAYNPSDGTWLRLADLQVPRSGLAGCVVGGLLYAVGGRNNSPDGNTDSSALDCYNPMTNQWSPCAPMSVPRNRIGVGVIDGHIYAVGGSHGCIHHNSVERYEPERDEWHLVAPMLTRRIGVGVAVLNRLLYAVGGFDGTNRLNSAECYYPERNEWRMITAMNTIRSGAGVCVLHNCIYAAGGYDGQDQLNSVERYDVETETWTFVAPMKHRRSALGITVHQGRIYVLGGYDGHTFLDSVECYDPDTDTWSEVTRMTSGRSGVGVAVTMEPCRKQIDQQNCTC
SEQ ID NO:3(KRAS)
MTEYKLVVVGAGGVGKSALTIQLIQNHFVDEYDPTIEDSYRKQVVIDGETCLLDILDTAGQEEYSAMRDQYMRTGEGFLCVFAINNTKSFEDIHHYREQIKRVKDSEDVPMVLVGNKCDLPSRTVDTKQAQDLARSYGIPFIETSAKTRQRVEDAFYTLVREIRQYRLKKISKEEKTPGCVKIKKCIM
SEQ ID NO:4(TP53)
MEEPQSDPSVEPPLSQETFSDLWKLLPENNVLSPLPSQAMDDLMLSPDDIEQWFTEDPGPDEAPRMPEAAPPVAPAPAAPTPAAPAPAPSWPLSSSVPSQKTYQGSYGFRLGFLHSGTAKSVTCTYSPALNKMFCQLAKTCPVQLWVDSTPPPGTRVRAMAIYKQSQHMTEVVRRCPHHERCSDSDGLAPPQHLIRVEGNLRVEYLDDRNTFRHSVVVPYEPPEVGSDCTTIHYNYMCNSSCMGGMNRRPILTIITLEDSSGNLLGRNSFEVRVCACPGRDRRTEEENLRKKGEPHHELPPGSTKRALPNNTSSSPQPKKKPLDGEYFTLQIRGRERFEMFRELNEALELKDAQAGKEPGGSRAHSSHLKSKKGQSTSRHKKLMFKTEGPD SD
SEQ ID NO:5(STK11)
MEVVDPQQLGMFTEGELMSVGMDTFIHRIDSTEVIYQPRRKRAKLIGKYLMGDLLGEGSYGKVKEVLDSETLCRRAVKILKKKKLRRIPNGEANVKKEIQLLRRLRHKNVIQLVDVLYNEEKQKMYMVMEYCVCGMQEMLDSVPEKRFPVCQAHGYFCQLIDGLEYLHSQGIVHKDIKPGNLLLTTGGTLKISDLGVAEALHPFAADDTCRTSQGSPAFQPPEIANGLDTFSGFKVDIWSAGVTLYNITTGLYPFEGDNIYKLFENIGKGSYAIPGDCGPPLSDLLKGMLEYEPAKRFSIRQIRQHSWFRKKHPPAEAPVPIPPSPDTKDRWRSMTVVPYLEDLHGADEDEDLFDIEDDIIYTQDFTVPGQVPEEEASHNGQRRGLPKAVCMNGTEAAQLSTKSRAEGRAPNPARKACSASSKIRRLSACKQQ
尽管为了清楚理解的目的已经通过图解和实施例的方式对前述发明进行了一些详细的描述,但是对于本领域的技术人员来说显而易见的是,将实施某些小的改变和修改。因此,描述和实施例不应被解释为限制本发明的范围。
Claims (9)
1.一种治疗个体中的NSCLC的方法,所述方法包括向所述个体施用有效量的组合物,所述组合物包括含有酰基富烯的纳摩尔效力颗粒,其中治疗基于患有鳞状细胞癌的所述个体。
2.根据权利要求1所述的方法,其中包括含有紫杉醇和白蛋白的纳米颗粒以及铂基剂的所述组合物是静脉内施用的。
3.根据权利要求1所述的方法,其中所述个体是人类。
4.根据权利要求1所述的方法,其中所述方法还包括进行放射。
5.根据权利要求1所述的方法,其中所述NSCLC是IIIB期NSCLC或IV期NSCLC。
6.根据权利要求所述的方法,其中附加治疗剂选自由以下组成的组:顺铂、紫杉醇和其它可用疗法。
7.根据权利要求1所述的方法,还包括测量脑癌遗传信息的表达以确定所述遗传信息的所述表达是大于还是小于所述遗传信息的参考水平。
8.根据权利要求7所述的方法,其中所述遗传信息是PTGR1、KEAP1、KRAS、TP53或STK11。
9.一种通过靶向药物疗法治疗人类受试者中的肺癌的方法,所述方法包括:
从所述人类受试者中提取生物样品;
测量所述生物样品中的PTGR1、KEAP1、KRAS、TP53和STK11或它们的组合的表达水平;
鉴定患有对使用基于隐陡头菌素的抗癌剂的治疗敏感的癌症的患者;
用具有以下结构的所述基于隐陡头菌素的抗癌剂治疗所述人类受试者:
其中PTGR1和一种或多种KEAP1、KRAS、TP53和STK11突变在所述人类受试者中的表达水平高于在未患有实体肿瘤癌症的人类中的水平。
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