JP2021073203A - Her2陽性転移性乳癌の治療方法 - Google Patents
Her2陽性転移性乳癌の治療方法 Download PDFInfo
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Abstract
Description
本出願は、その開示の全体が参照により本明細書に組み込まれる、2015年5月30日に出願された米国特許仮出願第62/168,809号の利益を、米国特許法119条の下で主張する。
本出願は、ASCII形式で配列表を含み、参照によりその全体が本明細書に組み込まれる。ASCIIテキストファイルは、2016年5月20日に作成され、GNE−0423R1−WO Sequence_Listing.txtという名称であり、30,476バイトのサイズである。
乳癌は、世界中で罹患率及び死亡率の非常に大きな原因となっている。毎年、世界中で130万症例を超える乳癌が診断され、その疾患に関連する死亡は450,000件を超える(Jemal A,Bray F,Center M,et al.Global cancer statistics.CA Cancer J Clin,2011;61(2):69−90)。
用語「comprise、comprising、include、including及びincludes(含む)」は、本明細書及び特許請求の範囲で使用されるとき、述べられた特徴、整数、成分、または工程の存在を特定することを意図しているが、その他の特徴、整数、成分、工程またはそのグループの1つ以上の存在または追加を排除しない。
ロリジン(roridin)A及びアンギジン(anguidine));ウレタン(urethan);ビンデシン(vindesine);デカルバジン(dacarbazine);マンノムスチン(mannomustine);ミトブロニトール(mitobronitol);ミトラクトール(mitolactol);ピポブロマン(pipobroman);ガシトシン(gacytosine);アラビノシド(arabinoside)(「Ara−C」);シクロホスファミド;チオテパ(thiotepa);6−チオグアニン;メルカプトプリン;メトトレキセート(methotrexate);白金類似体、例えばシスプラチン(cisplatin)及びカルボプラチン(carboplatin);ビンブラスチン(vinblastine);エトポシド(etoposide)(VP−16);イホスファミド(ifosfamide);ミトキサントロン(mitoxantrone);ビンクリスチン(vincristine);ビノレルビン(vinorelbine)(NAVELBINE(登録商標));ノバントロン(novantrone);テニポシド(teniposide);エダトレキセート(edatrexate);ダウノマイシン(daunomycin);アミノプテリン(aminopterin);カペシタビン(capecitabine)(XELODA(登録商標)、Roche)イバンドロネート(ibandronate);CPT−11;トポイソメラーゼ阻害薬RFS 2000;ジフルオロメチルオルニチン(DMFO);レチノイド類、例えばレチノイン酸;ならびに上記のいずれかの医薬的に許容できる塩類、酸、及び誘導体が挙げられる。
本発明は、構造:
を有する抗体−薬物複合体(Cas Reg.No.139504−50−0)であるトラスツズマブ−MCC−DM1(T−DM1)による治療的処置を含み、式中、Trは、リンカー部分MCCを介してメイタンシノイド薬物部分DM1に結合されたトラスツズマブである(US5208020、US6441163)。薬物対抗体の比または薬物負荷は、トラスツズマブ−MCC−DM1の上記構造においてpによって表され、1〜約8の整数値の範囲である。トラスツズマブ−MCC−DM1は、様々に負荷されかつ結合された抗体−薬物複合体の全ての混合物を含むが、この場合1、2、3、4、5、6、7、及び8つの薬物部分が、抗体トラスツズマブに共有結合される(US7097840、US2005/0276812、US2005/0166993)。平均薬物負荷は、約3.5である。
トラスツズマブ−MCC−DM1等の抗HER2−メイタンシノイド複合体は、治療用の組み合わせで使用するための標準医薬品基準に従って製剤化され得る。医薬組成物は、1つ以上の医薬的に許容される担体、流動促進剤、希釈剤、または賦形剤を伴って、トラスツズマブ−MCC−DM1を含む。
ペルツズマブの市販の製剤(PERJETA(登録商標))は、IV点滴用の保存剤を含まない溶液の形態のペルツズマブ420mg/14mL(30mg/mL)を含有する。
本明細書に記載される医薬組成物は、治療すべき病態に適切な任意の経路によって投与されてもよい。好適な経路としては、経口、非経口(皮下、筋肉内、静脈内、動脈内、吸入、皮内、髄腔内、硬膜外、及び注入技術を含む)、経皮、直腸、経鼻、局所(頬側及び舌下を含む)、膣内、腹腔内、肺内、及び鼻腔内が挙げられる。局所投与はまた、経皮パッチまたはイオン導入装置等の経皮投与の使用を伴うことができる。局所免疫抑制治療については、化合物は、移植前に移植片を潅流するさもなければ移植片を阻害薬と接触させることを含む、病巣内投与によって投与されてもよい。好ましい経路は、例えば、レシピエントの病態により異なり得ることが理解されるであろう。化合物は、経口投与される場合、薬学的に許容される担体、流動促進剤、または賦形剤と共に丸薬、カプセル、錠剤等として製剤化されてもよい。化合物は、非経口投与される場合、下記に詳述される通り、薬学的に許容される非経口ビヒクルまたは希釈剤と共に注射用単位剤形で製剤化されてもよい。
トラスツズマブ−MCC−DM1等の抗HER2−メイタンシノイド複合体を含有する製造物品、または「キット」は、本明細書の治療方法に有用であり、提供される。一実施形態において、このキットは、トラスツズマブ−MCC−DM1を含む容器を含む。このキットは、容器上の、または容器と関連したラベルまたは添付文書をさらに含んでもよい。「添付文書」という用語は、かかる治療薬の適応症、使用法、投薬量、投与、禁忌症についての情報、及び/またはその使用に関する警告を含む、治療薬の商用のパッケージに通例含まれる説明書を指すように使用される。適切な容器には、例えば、ボトル、バイアル、注射器、ブリスターパック等が含まれる。容器は、ガラスまたはプラスチック等の様々な材料から形成されてもよい。容器は、トラスツズマブ−MCC−DM1等の抗HER2メイタンシノイド複合体、または本明細書における治療方法での使用に有効なその製剤を保有し得、また無菌アクセスポートを有し得る(例えば容器は、静脈注射用溶液バッグまたは皮下注射針によって貫通可能な栓を有するバイアルであり得る)。ラベルまたは添付文書は、組成物が本明細書に記載されて特許請求される治療方法で使用されることを表示する。製品は、薬学的に許容される緩衝剤、例えば、注入用静菌水(BWFI)、リン酸緩衝生理食塩水、リンガー溶液、及びデキストロース溶液を含む容器をさらに含んでもよい。これは、他の緩衝液、希釈剤、フィルター、針、及びシリンジを含む、商業的及びユーザの立場から望ましい他の材料をさらに含んでもよい。
第III相臨床試験
本試験(clinicaltrials.gov識別子番号NCT01120184;試験番号BO22589)は、HER2陽性の進行性もしくは再発性の局所進行性の、または未治療の転移性乳癌を有する患者における、トラスツズマブエムタンシン(T−DM1)とペルツズマブとの併用、またはトラスツズマブエムタンシン(T−DM1)単独(すなわち、ペルツズマブのプラセボとの併用)対トラスツズマブ(ハーセプチン)+タキサン(ドセタキセルまたはパクリタキセル)の併用の有効性及び安全性を評価した無作為化、3群間、多施設の第III相試験である(図6を参照)。
組み入れ基準は、以下の通りである:1)18歳以上の成人患者であること;2)HER2陽性乳癌であること;3)局所的再発性または転移性疾患を有する乳房の組織学的もしくは細胞学的に確認された腺癌、ならびに化学療法の候補者であること。(局所的進行疾患を有する患者は、再発性または進行性疾患を有する必要があり、治癒目的で切除を受けてはならない);4)患者はRECIST1.1により評価可能であるべき測定可能な疾患及び/または測定不可能な疾患を有さねばならない;5)ECOGパフォーマンスステータスが0または1であること;6)検査結果によって決定される適切な臓器機能があること。
主要転帰を、以下の尺度を使用して評価した:1)独立審査機関(IRF)により実施された腫瘍評価に基づく無進行生存(PFS);及び2)有害事象(AE)発生率。
Claims (44)
- HER2陽性の局所進行性のまたは未治療の転移性乳癌の治療方法であって、抗HER2−メイタンシノイド(maytansinoid)複合体の治療有効量を、前記乳癌を有する患者に投与することを含み、前記患者が、タキサンによる前治療を受けている、前記方法。
- 前記投与が、前記タキサンによる前治療から6ヶ月以上経過した後に行われる、請求項1に記載の方法。
- 前記患者が、タキサンによる前治療及び少なくとも1つのHER2標的療法を受けている、請求項1または2に記載の方法。
- 前記患者が、タキサン及びトラスツズマブによる前治療を受けている、請求項3に記載の方法。
- 前記患者が、タキサン、トラスツズマブ、及びペルツズマブによる前治療を受けている、請求項4に記載の方法。
- 前記前治療が、アジュバント療法で施されている、請求項1〜5のいずれかに記載の方法。
- 前記前治療が、非アジュバント療法で施されている、請求項1〜5のいずれかに記載の方法。
- 前記タキサンがパクリタキセルである、先行請求項のいずれか一項に記載の方法。
- 前記パクリタキセルが、80mg/m2にて毎週静脈内投与されていた、請求項8に記載の方法。
- 前記パクリタキセルが、最短で18週間投与されていた、請求項9に記載の方法。
- 前記タキサンが、ドセタキセルである、請求項1〜7のいずれか一項に記載の方法。
- 前記ドセタキセルが、75mg/m2または100mg/m2にて3週間毎に静脈内投与されていた、請求項11に記載の方法。
- 前記ドセタキセルが、最短で6サイクルの間投与されていた、請求項12に記載の方法。
- 前記トラスツズマブが、サイクル1で8mg/kgにて、続いてその後のサイクルで6mg/kgにて3週間毎に静脈内投与されていた、請求項4〜13のいずれか一項に記載の方法。
- 前記トラスツズマブが、サイクル1の1日目に4mg/kgにて、続いてサイクル1の8日目から毎週2mg/kgにて静脈内投与されていた、請求項4〜13のいずれか一項に記載の方法。
- 前記トラスツズマブが、サイクル1の1日目に840mgにて静脈内投与され、続いてその後のサイクルで420mgにて3週間毎に静脈内投与されていた、請求項5〜15のいずれか一項に記載の方法。
- 前記抗HER2−メイタンシノイド複合体が、トラスツズマブ−メイタンシノイド複合体である、先行請求項のいずれか一項に記載の方法。
- 前記トラスツズマブ−メイタンシノイド複合体が、トラスツズマブ−DM1複合体である、請求項17に記載の方法。
- 前記トラスツズマブ−DM1複合体が、トラスツズマブ−MCC−DM1である、請求項18に記載の方法。
- 前記トラスツズマブ−MCC−DM1が、3.6mg/kgで3週間毎に投与される、請求項19に記載の方法。
- 前記トラスツズマブ−MCC−DM1が、2.4mg/kgで毎週投与される、請求項19に記載の方法。
- 前記乳癌が、未治療の転移性乳癌である、先行請求項のいずれか一項に記載の方法。
- HER2陽性の局所進行性のまたは未治療の転移性乳癌の治療方法であって、(1)患者が、タキサンによる前治療を受けているかどうかを判定することと、(2)前記患者タキサンによる前治療を受けている場合には、抗HER2−メイタンシノイド複合体の治療有効量を、前記乳癌を有する患者に投与することとを含む、前記方法。
- 前記投与が、前記タキサンによる前治療から6ヶ月以上経過した後に行われる、請求項23に記載の方法。
- 前記患者が、タキサンによる前治療及び少なくとも1つのHER2標的療法を受けている、請求項23または24に記載の方法。
- 前記患者が、タキサン及びトラスツズマブによる前治療を受けている、請求項25に記載の方法。
- 前記患者が、タキサン、トラスツズマブ、及びペルツズマブによる前治療を受けている、請求項26に記載の方法。
- 前記前治療が、アジュバント療法で施されている、請求項23〜27のいずれかに記載の方法。
- 前記前治療が、非アジュバント療法で施されている、請求項23〜27のいずれかに記載の方法。
- 前記タキサンが、パクリタキセルである、請求項23〜29のいずれか一項に記載の方法。
- 前記パクリタキセルが、80mg/m2にて毎週静脈内投与されていた、請求項30に記載の方法。
- 前記パクリタキセルが、最短で18週間投与されていた、請求項31に記載の方法。
- 前記タキサンが、ドセタキセルである、請求項23〜30のいずれか一項に記載の方法。
- 前記ドセタキセルが、75mg/m2または100mg/m2にて3週間毎に静脈内投与されていた、請求項33に記載の方法。
- 前記ドセタキセルが、最短で6サイクルの間投与されていた、請求項34に記載の方法。
- 前記トラスツズマブが、サイクル1で8mg/kgにて、続いてその後のサイクルで6mg/kgにて3週間毎に静脈内投与されていた、請求項26〜35のいずれか一項に記載の方法。
- 前記トラスツズマブが、サイクル1の1日目に4mg/kgにて、続いてサイクル1の8日目から毎週2mg/kgにて静脈内投与されていた、請求項26〜35のいずれか一項に記載の方法。
- 前記トラスツズマブが、サイクル1の1日目に840mgにて静脈内投与され、続いてその後のサイクルで420mgにて3週間毎に静脈内投与されていた、請求項27〜37のいずれか一項に記載の方法。
- 前記抗HER2−メイタンシノイド複合体が、トラスツズマブ−メイタンシノイド複合体である、請求項23〜38のいずれか一項に記載の方法。
- 前記トラスツズマブ−メイタンシノイド複合体が、トラスツズマブ−DM1複合体である、請求項39に記載の方法。
- 前記トラスツズマブ−DM1複合体が、トラスツズマブ−MCC−DM1である、請求項40に記載の方法。
- 前記トラスツズマブ−MCC−DM1が、3.6mg/kgで3週間毎に投与される、請求項41に記載の方法。
- 前記トラスツズマブ−MCC−DM1が、2.4mg/kgで毎週投与される、請求項41に記載の方法。
- 前記乳癌が、未治療の転移性乳癌である、請求項23〜43のいずれか一項に記載の方法。
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