JPWO2020014333A5 - - Google Patents
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- JPWO2020014333A5 JPWO2020014333A5 JP2021500521A JP2021500521A JPWO2020014333A5 JP WO2020014333 A5 JPWO2020014333 A5 JP WO2020014333A5 JP 2021500521 A JP2021500521 A JP 2021500521A JP 2021500521 A JP2021500521 A JP 2021500521A JP WO2020014333 A5 JPWO2020014333 A5 JP WO2020014333A5
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- UREBDLICKHMUKA-CXSFZGCWSA-N Dexamethasone Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@@H](C)[C@@](C(=O)CO)(O)[C@@]1(C)C[C@@H]2O UREBDLICKHMUKA-CXSFZGCWSA-N 0.000 claims 64
- 229960003957 Dexamethasone Drugs 0.000 claims 62
- 239000008194 pharmaceutical composition Substances 0.000 claims 42
- 239000000203 mixture Substances 0.000 claims 41
- GOTYRUGSSMKFNF-UHFFFAOYSA-N Lenalidomide Chemical compound C1C=2C(N)=CC=CC=2C(=O)N1C1CCC(=O)NC1=O GOTYRUGSSMKFNF-UHFFFAOYSA-N 0.000 claims 29
- 229960004942 lenalidomide Drugs 0.000 claims 29
- GXJABQQUPOEUTA-RDJZCZTQSA-N Bortezomib Chemical compound C([C@@H](C(=O)N[C@@H](CC(C)C)B(O)O)NC(=O)C=1N=CC=NC=1)C1=CC=CC=C1 GXJABQQUPOEUTA-RDJZCZTQSA-N 0.000 claims 28
- 229960001467 bortezomib Drugs 0.000 claims 28
- 210000004027 cells Anatomy 0.000 claims 21
- 108090001123 antibodies Proteins 0.000 claims 20
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- AOJJSUZBOXZQNB-TZSSRYMLSA-N ADRIAMYCIN Chemical compound O([C@H]1C[C@@](O)(CC=2C(O)=C3C(=O)C=4C=CC=C(C=4C(=O)C3=C(O)C=21)OC)C(=O)CO)[C@H]1C[C@H](N)[C@H](O)[C@H](C)O1 AOJJSUZBOXZQNB-TZSSRYMLSA-N 0.000 claims 18
- 108010019670 Chimeric Antigen Receptors Proteins 0.000 claims 18
- 229960004679 Doxorubicin Drugs 0.000 claims 18
- 230000011664 signaling Effects 0.000 claims 18
- CMSMOCZEIVJLDB-UHFFFAOYSA-N Cyclophosphamide Chemical compound ClCCN(CCCl)P1(=O)NCCCO1 CMSMOCZEIVJLDB-UHFFFAOYSA-N 0.000 claims 16
- 229960004397 Cyclophosphamide Drugs 0.000 claims 16
- 206010035226 Plasma cell myeloma Diseases 0.000 claims 16
- 125000003275 alpha amino acid group Chemical group 0.000 claims 14
- UVSMNLNDYGZFPF-UHFFFAOYSA-N Pomalidomide Chemical compound O=C1C=2C(N)=CC=CC=2C(=O)N1C1CCC(=O)NC1=O UVSMNLNDYGZFPF-UHFFFAOYSA-N 0.000 claims 13
- 229960000688 pomalidomide Drugs 0.000 claims 13
- 201000009251 multiple myeloma Diseases 0.000 claims 12
- 210000002865 immune cell Anatomy 0.000 claims 11
- 229960003648 Ixazomib Drugs 0.000 claims 10
- FWZRWHZDXBDTFK-ZHACJKMWSA-N Panobinostat Chemical compound CC1=NC2=CC=C[CH]C2=C1CCNCC1=CC=C(\C=C\C(=O)NO)C=C1 FWZRWHZDXBDTFK-ZHACJKMWSA-N 0.000 claims 10
- 210000002966 Serum Anatomy 0.000 claims 10
- MXAYKZJJDUDWDS-LBPRGKRZSA-N [(1R)-1-[[2-[(2,5-dichlorobenzoyl)amino]acetyl]amino]-3-methylbutyl]boronic acid Chemical compound CC(C)C[C@@H](B(O)O)NC(=O)CNC(=O)C1=CC(Cl)=CC=C1Cl MXAYKZJJDUDWDS-LBPRGKRZSA-N 0.000 claims 10
- 229960005184 panobinostat Drugs 0.000 claims 10
- 239000003207 proteasome inhibitor Substances 0.000 claims 10
- 229960004137 Elotuzumab Drugs 0.000 claims 9
- 108010061937 elotuzumab Proteins 0.000 claims 9
- BLMPQMFVWMYDKT-NZTKNTHTSA-N Carfilzomib Chemical compound C([C@@H](C(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CC=1C=CC=CC=1)C(=O)N[C@@H](CC(C)C)C(=O)[C@]1(C)OC1)NC(=O)CN1CCOCC1)CC1=CC=CC=C1 BLMPQMFVWMYDKT-NZTKNTHTSA-N 0.000 claims 8
- -1 calfilzomib Chemical compound 0.000 claims 8
- 201000011510 cancer Diseases 0.000 claims 8
- 229960002438 carfilzomib Drugs 0.000 claims 8
- 108010021331 carfilzomib Proteins 0.000 claims 8
- 229960004316 cisplatin Drugs 0.000 claims 8
- 108010031324 daratumumab Proteins 0.000 claims 8
- 229960002204 daratumumab Drugs 0.000 claims 8
- LXZZYRPGZAFOLE-UHFFFAOYSA-L transplatin Chemical compound [H][N]([H])([H])[Pt](Cl)(Cl)[N]([H])([H])[H] LXZZYRPGZAFOLE-UHFFFAOYSA-L 0.000 claims 8
- UEJJHQNACJXSKW-UHFFFAOYSA-N Thalidomide Chemical compound O=C1C2=CC=CC=C2C(=O)N1C1CCC(=O)NC1=O UEJJHQNACJXSKW-UHFFFAOYSA-N 0.000 claims 6
- 229960003433 Thalidomide Drugs 0.000 claims 6
- 108010008014 B-Cell Maturation Antigen Proteins 0.000 claims 5
- 102000006942 B-Cell Maturation Antigen Human genes 0.000 claims 5
- YTKUWDBFDASYHO-UHFFFAOYSA-N Bendamustine Chemical compound ClCCN(CCCl)C1=CC=C2N(C)C(CCCC(O)=O)=NC2=C1 YTKUWDBFDASYHO-UHFFFAOYSA-N 0.000 claims 4
- 102100008191 CD8A Human genes 0.000 claims 4
- 101700054655 CD8A Proteins 0.000 claims 4
- 201000004085 CLL/SLL Diseases 0.000 claims 4
- 102000018358 Immunoglobulins Human genes 0.000 claims 4
- 108060003951 Immunoglobulins Proteins 0.000 claims 4
- 210000002700 Urine Anatomy 0.000 claims 4
- 101700055524 VME1 Proteins 0.000 claims 4
- 229960002707 bendamustine Drugs 0.000 claims 4
- 201000010099 disease Diseases 0.000 claims 4
- 230000000694 effects Effects 0.000 claims 4
- 238000001962 electrophoresis Methods 0.000 claims 4
- 239000002955 immunomodulating agent Substances 0.000 claims 4
- 230000002584 immunomodulator Effects 0.000 claims 4
- 229940121354 immunomodulators Drugs 0.000 claims 4
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- 101700045377 mvp1 Proteins 0.000 claims 4
- 201000000050 myeloid neoplasm Diseases 0.000 claims 4
- 102000004169 proteins and genes Human genes 0.000 claims 4
- 108090000623 proteins and genes Proteins 0.000 claims 4
- 230000004083 survival Effects 0.000 claims 4
- 238000002054 transplantation Methods 0.000 claims 4
- 206010025323 Lymphomas Diseases 0.000 claims 3
- 206010025310 Other lymphomas Diseases 0.000 claims 3
- 239000003814 drug Substances 0.000 claims 3
- 238000004519 manufacturing process Methods 0.000 claims 3
- 208000003950 B-Cell Lymphoma Diseases 0.000 claims 2
- 102100019461 CD28 Human genes 0.000 claims 2
- 101700033362 CD28 Proteins 0.000 claims 2
- 206010008958 Chronic lymphocytic leukaemia Diseases 0.000 claims 2
- VJJPUSNTGOMMGY-MRVIYFEKSA-N Etoposide Chemical compound COC1=C(O)C(OC)=CC([C@@H]2C3=CC=4OCOC=4C=C3[C@@H](O[C@H]3[C@@H]([C@@H](O)[C@@H]4O[C@H](C)OC[C@H]4O3)O)[C@@H]3[C@@H]2C(OC3)=O)=C1 VJJPUSNTGOMMGY-MRVIYFEKSA-N 0.000 claims 2
- 229960005420 Etoposide Drugs 0.000 claims 2
- 208000000429 Leukemia, Lymphocytic, Chronic, B-Cell Diseases 0.000 claims 2
- 206010026798 Mantle cell lymphomas Diseases 0.000 claims 2
- 206010029592 Non-Hodgkin's lymphomas Diseases 0.000 claims 2
- 206010036524 Precursor B-lymphoblastic lymphomas Diseases 0.000 claims 2
- 108010070144 Single-Chain Antibodies Proteins 0.000 claims 2
- 102000005632 Single-Chain Antibodies Human genes 0.000 claims 2
- 230000002159 abnormal effect Effects 0.000 claims 2
- 201000003444 follicular lymphoma Diseases 0.000 claims 2
- 230000031146 intracellular signal transduction Effects 0.000 claims 2
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- 229920000023 polynucleotide Polymers 0.000 claims 2
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- 230000002485 urinary Effects 0.000 claims 2
- 210000003719 B-Lymphocytes Anatomy 0.000 claims 1
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Description
3.図面の簡単な説明3. Brief description of the drawing
「抗原(Ag)」とは、動物において抗体の産生またはT細胞応答を刺激することができる、化合物、組成物、または物質を指し、これらには、動物に注射または吸収される組成物(がん特異的タンパク質を含む組成物など)が含まれる。抗原は、本開示の抗原などの異種抗原によって誘発される免疫を含む、特定の体液性免疫または細胞性免疫の産物と反応する。特定の実施形態において、標的抗原は、BCMAポリペプチドのエピトープである。 "Antigen (Ag)" refers to a compound, composition, or substance capable of stimulating the production of antibodies or a T -cell response in an animal, including compositions injected or absorbed into the animal ( compositions comprising cancer-specific proteins, etc.). Antigens react with the products of specific humoral or cellular immunity, including immunity induced by heterologous antigens such as the antigens of the present disclosure. In certain embodiments, the target antigen is an epitope of a BCMA polypeptide.
一実施形態において、CARは、BCMAポリペプチドに結合するマウス抗BCMA scFv;IgG1ヒンジ/CH2/CH3、IgG4ヒンジ/CH2/CH3、及びCD8αヒンジからなる群から選択されるヒンジドメイン;T細胞受容体のアルファ鎖、ベータ鎖またはゼータ鎖、CD3ε、CD3ζ、CD4、CD5、CD8α、CD9、CD16、CD22、CD27、CD28、CD33、CD37、CD45、CD64、CD80、CD86、CD134、CD137、CD152、CD154、及びPD1からなる群から選択されるポリペプチドに由来する膜貫通ドメイン;ならびにCARD11、CD2、CD7、CD27、CD28、CD30、CD40、CD54(ICAM)、CD83、CD134(OX40)、CD137(4-1BB)、CD150(SLAMF1)、CD152(CTLA4)、CD223(LAG3)、CD270(HVEM)、CD273(PD-L2)、CD274(PD-L1)、CD278(ICOS)、DAP10、LAT、NKD2CSLP76、TRIM、及びZAP701からなる群から選択される共刺激分子由来の1つ以上の細胞内共刺激シグナル伝達ドメイン;ならびにTCRζ、FcRγ、FcRβ、CD3γ、CD3δ、CD3ε、CD3ζ、CD22、CD79a、CD79b、及びCD66dからなる群から選択されるポリペプチド由来の1つ以上の一次シグナル伝達ドメインを含む。 In one embodiment, the CAR is a murine anti-BCMA scFv that binds to a BCMA polypeptide; a hinge domain selected from the group consisting of IgG1 hinge/CH2/CH3, IgG4 hinge/CH2/CH3, and CD8α hinge; T-cell receptor alpha, beta or zeta chain, CD3ε, CD3ζ, CD4, CD5, CD8α, CD9, CD16, CD22, CD27, CD28, CD33, CD37, CD45, CD64, CD80, CD86, CD134, CD137, CD152, CD154, and PD1; and CARD11, CD2, CD7, CD27, CD28, CD30, CD40, CD54 (ICAM), CD83, CD134 (OX40), CD137 (4-1BB) ), CD150 (SLAMF1), CD152 (CTLA4), CD223 (LAG3), CD270 (HVEM), CD273 (PD-L2), CD274 (PD-L1), CD278 (ICOS), DAP10, LAT, NKD2CSLP76, TRIM, and one or more intracellular co-stimulatory signaling domains from a co-stimulatory molecule selected from the group consisting of ZAP701; It comprises one or more primary signaling domains from a polypeptide selected from the group.
認識配列の他の例は、リコンビナーゼ酵素λインテグラーゼ、例えば、phi-c31によって認識されるattB、attP、attL、及びattR配列である。φC31 SSRは、異型部位attB(長さ34bp)とattP(長さ39bp)との間の組み換えのみを媒介する(Groth et al.,2000)。attB及びattPは、それぞれ細菌及びファージゲノム上のファージインテグラーゼ結合部位にちなんで名付けられており、どちらもφC31ホモ二量体によって結合される可能性のある不完全な逆方向反復を含有する(Groth et al.,2000)。生成部位であるattL及びattRは、更なるφC31媒介組み換えに対して効果的に不活性であり(Belteki et al.,2003)、これにより、反応は不可逆となる。挿入を触媒するには、attB含有DNAをゲノムattP部位に挿入するほうが、attP部位をゲノムattB部位に挿入するよりも容易であることが分かっている(Thyagarajan et al.,2001;Belteki et al.,2003)。したがって、典型的な戦略は、相同組み換えによって、attP含有「ドッキング部位」を、定義した遺伝子座に配置し、次いで、それを挿入のためにattB含有移入配列と合わせることである。 Other examples of recognition sequences are the attB, attP, attL, and attR sequences recognized by the recombinase enzyme λ integrase, eg, phi-c31. The φC31 SSR mediates only recombination between the heterologous sites attB (34 bp in length) and attP (39 bp in length) (Groth et al., 2000). attB and attP, named after phage integrase binding sites on the bacterial and phage genomes, respectively, both contain imperfect inverted repeats that can be bound by φC31 homodimers ( Groth et al., 2000). The production sites, attL and attR, are effectively inert to further φC31-mediated recombination (Belteki et al., 2003), making the reaction irreversible. It has been found that inserting an attB-containing DNA into a genomic attP site is easier than inserting an attP site into a genomic attB site to catalyze insertion (Thyagarajan et al., 2001; Belteki et al. , 2003). Thus, a typical strategy is to place an attP-containing "docking site" at a defined locus by homologous recombination and then align it with the attB-containing import sequence for insertion.
6. 実施例
6.1.実施例1:BCMA CARの構築
マウス抗BCMA scFv抗体を含有するCARは、抗BMCA scFvに作動可能に連結されたMNDプロモーター、CD8α由来のヒンジ及び膜貫通ドメイン、ならびにCD137共刺激ドメイン、続いてCD3ζ鎖の細胞内シグナル伝達ドメインを含有するように設計した。例えば、図1を参照されたい。図1に示されるBCMA CARは、免疫エフェクター細胞上での表面発現のためのCD8αシグナルペプチド(SP)配列を含む。例示的なBCMA CARのポリヌクレオチド配列は、配列番号10に記載され(抗BCMA02 CARのポリヌクレオチド配列)、BCMA CARの例示的なポリペプチド配列は、配列番号9に記載され(抗BCMA02 CARのポリペプチド配列)、例示的なCARコンストラクトのベクターマップは、図1に示される。表5は、BCMA CARレンチウイルスベクターの様々なヌクレオチドセグメントの識別情報、Genbank参照、供給源名及び引用文献を示す。
表5.
Table 5.
除外基準。以下のいずれかに該当する場合、被験者は登録から除外される:
(1)被験者は、試験参加を妨げるような何らかの重大な医学的状態、検査所見の異常、または精神疾患を有する;
(2)被験者は、検査所見の異常の存在を含め、試験に参加した場合に被験者が許容できないリスクにさらされると考えられる何らかの状態を有している;
(3)被験者は、試験データの解釈力に混乱をもたらす何らかの状態を有する;
(4)被験者は、非分泌型MMを有する;
(5)被験者は、以下の検査所見異常のいずれかを有する:
(a)絶対好中球数(ANC)<1,000/Μl;
(b)骨髄有核細胞の50%未満が形質細胞である被験者の場合、血小板数:<75,000/μL及び骨髄有核細胞の50%以上が形質細胞である被験者の場合、血小板数<50,000/μL(このレベルに達するための被験者への輸血は認められない);
(c)ヘモグロビン<8g/dL(<4.9mmol/L)(このレベルに達するための被験者への輸血は認められない);
(d)血清クレアチニンクリアランス(CrCl)<45mL/分;
(e)補正血清カルシウム>13.5mg/dL(>3.4mmol/L);
(f)血清アスパラギン酸アミノトランスフェラーゼ(AST)またはアラニンアミノトランスフェラーゼ(ALT)>2.5×正常値上限(ULN);
(g)血清総ビリルビン>1.5×ULNまたはジルベール症候群が記録されている被験者の場合>3.0mg/dL;及び
(h)国際標準比(INR)もしくは活性化部分トロンボプラスチン時間(aPTT)>1.5×ULN、または30日以内にグレード2以上の出血の既往歴、または抗凝固薬(例えば、ワルファリン、低分子量ヘパリン、第Xa因子阻害薬)の長期的な治療的投与を継続する必要がある被験者;
(6)被験者は、酸素飽和度(SaO2)<92%室内気として定義される十分な肺機能を有していない;
(7)被験者は、MM以外の悪性腫瘍の既往歴がある。ただし、以下の非侵襲性悪性腫瘍を例外とし、被験者は、5年以上罹患していない場合は除く:
(a)皮膚基底細胞癌;
(b)皮膚扁平上皮癌;
(c)子宮頸部上皮内癌;
(d)乳房上皮内癌;及び
(e)前立腺癌の偶発的組織学的所見(腫瘍、リンパ節、転移[TNM]臨床的病期分類を使用した場合T1aまたはT1b)または治癒目的で治療可能な前立腺癌;
(8)被験者は、形質細胞白血病、ワルデンストレームマクログロブリン血症、POEMS症候群(多発性神経障害、臓器巨大症、内分泌障害、モノクローナルタンパク質、及び皮膚変化)、またはアミロイド症を有するまたは既往歴がある;
(9)中枢神経系(CNS)に骨髄腫の病変が認められる被験者;
(10)被験者は、肺白血球停滞及び播種性血管内凝固の臨床エビデンスを有する;
(11)被験者は、慢性閉塞性肺疾患(COPD)を認め、1秒間努力呼気肺活量(FEV1)の予想正常値が50%である。COPDの疑いがある被験者には努力呼気検査(FEV1)が求められ、予測正常値が50%未満である場合は、被験者を除外しなければならない。
(12)被験者は、てんかん、痙攣発作、不全麻痺、失語症、脳卒中、くも膜下出血またはその他のCNS出血、重度の脳損傷、認知症、パーキンソン病、小脳疾患、器質性脳症候群、精神病などの臨床的に重大なCNS病態の既往歴または現病歴を有する;
(13)被験者は、直近の抗骨髄腫治療レジメンの一部として、デキサメタゾンの有無にかかわらないポマリドミド(POM)と組み合わせたダラツムマブ(DARA)(DP±d)で治療されていると、ブリッジング療法としてDPd(すなわち、ダラツムマブ、ポマリドミド及びデキサメタゾン)を受けることはできないが、治療群Aに無作為化された場合は、試験責任医師の判断に従って、ブリッジングとして、DVd(すなわち、ダラツムマブ、ボルテゾミブ及びデキサメタゾン)またはIRd(すなわち、イキサゾミブ、レナリドミド及びデキサメタゾン)を受けることができる;
(14)被験者は、直近の抗骨髄腫治療レジメンの一部として、DP±dで治療されていると、DPdを受けることはできないが、治療群Bに無作為化された場合、試験責任医師の判断に従って、DVdまたはIRdを受けることができる;
(15)被験者は、直近の抗骨髄腫治療レジメンの一部として、デキサメタゾン(dex)の有無にかかわらないボルテゾミブ(BTZ)と組み合わせたDARA(DV±d)で治療されていると、ブリッジング療法としてDVdを受けることはできないが、治療群Aに無作為化された場合、試験責任医師の判断に従って、ブリッジングとしてDPdまたはIRdを受けることができる;
(16)被験者は、直近の抗骨髄腫治療レジメンの一部として、DV±dで治療されていると、DVdを受けることはできないが、治療群Bに無作為化された場合、試験責任医師の判断に従って、DPdまたはIRdを受けることができる;
(17)被験者は、直近の抗骨髄腫治療レジメンの一部として、dexの有無にかかわらないレナリドミド(LEN)と組み合わせたイキサゾミブ(IXA)(IR±d)で治療されていると、ブリッジング療法としてIRdを受けることはできないが、治療群Aに無作為化された場合、試験責任医師の判断に従って、ブリッジングとしてDPdまたはDVdを受けることができる;
(18)被験者は、直近の抗骨髄腫治療レジメンの一部として、IR±dで治療されていると、IRdを受けることはできないが、治療群Bに無作為化された場合、試験責任医師の判断に従って、DPdまたはDVdを受けることができる;
(19)同種造血幹細胞移植、がんに対する任意の遺伝子療法に基づく治療法、がんの試験的細胞療法またはBCMA標的療法による治療の前治療歴;
(20)被験者は、無作為化前12週間以内に自己由来幹細胞移植(ASCT)を受けている;
(21)無作為化前28日以内に任意の試験薬を使用した被験者。
(22)被験者は、無作為化前の14日以内に以下のいずれかを受けている:
(a)血漿アフェレーシス;
(b)大手術(試験責任医師による定義);
(c)骨髄腫関連骨病変に対する局所療法以外の放射線療法;及び
(d)任意の全身性抗骨髄腫薬物療法の使用;
(23)心エコー図(ECHO)またはマルチゲートスキャン(MUGA)による左室駆出率(LVEF)<45%;
(24)長期的な免疫抑制薬(例えば、あらゆる用量のシクロスポリンまたは全身ステロイド)の治療継続。コルチコステロイドの間欠的な局所、吸入、鼻腔内投与は許容される;
(25)被験者は、ヒト免疫不全ウイルス(HIV-1)陽性、慢性もしくは活動性B型肝炎または活動性A型もしくはC型肝炎である;
(26)被験者は、コントロール不良の全身性の真菌、細菌、ウイルス、または他の感染症(適切な抗菌治療にもかかわらず、感染に伴う徴候/症状が改善なく持続するものとして定義される)、またはIV抗菌薬による管理を要する。
(27)被験者は、クラスIIIまたはIVのうっ血性心不全(CHF)または重度の非虚血性心筋症、無作為化前6ヶ月以内の不安定またはコントロール不良の狭心症、心筋梗塞または心室性不整脈の既往歴がある;
(28)DARA、サリドマイド、レナリドミド、POM、BTZ、IXAまたはdexに対する過敏症。これには、先のサリドマイド、POMまたはレナリドミド療法中のグレード3以上の発疹が含まれる;
(29)bb2121製品の任意の構成成分:シクロホスファミド、フルダラビン、及び/またはトシリズマブに対する過敏症、またはDARA、POM、LEN、IXA、BTZもしくはdexの製剤中に含有される賦形剤に対する過敏症があることが認められる被験者;
(30)被験者は、妊娠中、授乳中、もしくは母乳養育中の女性、または本試験参加中に妊娠する意志のある女性である;
(31)治療群Bに無作為化され、POMまたはLENを含むレジメンに割り当てられる被験者の場合、プロトコルで規定された血栓塞栓症予防を受けることができない、または受ける意志がない;及び
(32)被験者は、ボルテゾミブに忍容性がなければ、治療群Aに無作為化された場合、ブリッジング療法としてDVdを受けることができず、または治療群Bに無作為化された場合、DVdを受けることができない。
Exclusion Criteria . Subjects will be excluded from enrollment if any of the following apply:
(1) Subject has any significant medical condition, abnormal laboratory findings, or psychiatric illness that would preclude study participation;
(2) the subject has any condition, including the presence of an abnormal laboratory finding, that would place the subject at unacceptable risk if entered into the study;
(3) the subject has any condition that confounds the interpretability of the test data;
(4) the subject has non-secretory MM;
(5) Subject has any of the following laboratory abnormalities:
(a) absolute neutrophil count (ANC) <1,000/Ml;
(b) Platelet count: <75,000/μL for subjects with less than 50% plasma cells of bone marrow nucleated cells and platelet count <75,000/μL for subjects with 50% or more of bone marrow nucleated cells plasma cells 50,000/μL (subjects will not be transfused to reach this level);
(c) hemoglobin <8 g/dL (<4.9 mmol/L) (subjects are not transfused to reach this level);
(d) serum creatinine clearance (CrCl) <45 mL/min;
(e) corrected serum calcium >13.5 mg/dL (>3.4 mmol/L);
(f) serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2.5 x upper limit of normal (ULN);
(g) serum total bilirubin >1.5 x ULN or >3.0 mg/dL in subjects with documented Gilbert's syndrome; and (h) international normalized ratio (INR) or activated partial thromboplastin time (aPTT) > 1.5 x ULN, or history of grade 2 or greater bleeding within 30 days, or need to continue long-term therapeutic anticoagulants (e.g., warfarin, low-molecular-weight heparin, factor Xa inhibitors) subject with;
(6) Subject does not have adequate pulmonary function defined as oxygen saturation (SaO 2 ) <92% room air;
(7) The subject has a history of malignant tumors other than MM. Exceptions are the following non-invasive malignancies, unless the subject is disease free for 5 years or more:
(a) cutaneous basal cell carcinoma;
(b) cutaneous squamous cell carcinoma;
(c) cervical carcinoma in situ;
(d) carcinoma in situ of the breast; and (e) an incidental histologic finding of prostate cancer (T1a or T1b using tumor, node, metastasis [TNM] clinical staging) or treatable with curative intent. prostate cancer;
(8) Subject has or has a history of plasma cell leukemia, Waldenström's macroglobulinemia, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes), or amyloidosis there is;
(9) Subjects with myeloma lesions in the central nervous system (CNS);
(10) Subject has clinical evidence of pulmonary leukostasis and disseminated intravascular coagulation;
(11) The subject has chronic obstructive pulmonary disease (COPD) and a predicted normal value of forced expiratory volume in one second (FEV1) of 50%. Subjects with suspected COPD are required to have a forced breath test (FEV1) and must be excluded if the predicted normal value is less than 50%.
(12) The subject has clinical symptoms such as epilepsy, seizures, paresis, aphasia, stroke, subarachnoid hemorrhage or other CNS hemorrhage, severe brain injury, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, psychosis, etc. have a history or current history of significantly significant CNS pathology;
(13) subject has been treated with daratumumab (DARA) (DP±d) in combination with pomalidomide (POM) with or without dexamethasone as part of the most recent anti-myeloma treatment regimen, bridging therapy DPd (i.e., daratumumab, pomalidomide and dexamethasone) as a bridging DVd (i.e., daratumumab, bortezomib and dexamethasone), if randomized to Arm A, per investigator's discretion ) or IRd (i.e. ixazomib, lenalidomide and dexamethasone);
(14) Subject cannot receive DPd if treated with DP±d as part of the most recent anti-myeloma treatment regimen, but if randomized to Arm B, the investigator may receive DVd or IRd, as determined by
(15) subject has been treated with DARA (DV±d) in combination with bortezomib (BTZ) with or without dexamethasone (dex) as part of a most recent anti-myeloma treatment regimen, bridging therapy not receive DVd as a bridging agent, but if randomized to Arm A, may receive DPd or IRd as bridging, according to the investigator's discretion;
(16) Subject cannot receive DVd if treated with DV±d as part of the most recent anti-myeloma treatment regimen, but if randomized to Arm B, the investigator may receive DPd or IRd, as determined by
(17) subject has been treated with ixazomib (IXA) (IR±d) in combination with lenalidomide (LEN) with or without dex as part of a most recent anti-myeloma treatment regimen, bridging therapy cannot receive IRd as bridging, but if randomized to Arm A, may receive DPd or DVd as bridging, according to investigator's discretion;
(18) Subjects cannot receive IRd if they have been treated with IR±d as part of their most recent anti-myeloma treatment regimen, but if randomized to Arm B, the investigator may receive DPd or DVd, as determined by
(19) prior treatment with allogeneic hematopoietic stem cell transplantation, any gene therapy-based therapy for cancer, experimental cell therapy for cancer, or BCMA-targeted therapy;
(20) subject has undergone autologous stem cell transplantation (ASCT) within 12 weeks prior to randomization;
(21) Subjects who have used any study drug within 28 days prior to randomization.
(22) Subject has received any of the following within 14 days prior to randomization:
(a) plasmapheresis;
(b) major surgery (as defined by the investigator);
(c) radiation therapy other than local therapy for myeloma-related bone lesions; and (d) use of any systemic anti-myeloma drug therapy;
(23) left ventricular ejection fraction (LVEF) <45% by echocardiogram (ECHO) or multigated scan (MUGA);
(24) Continuation of long-term immunosuppressive drugs (eg, cyclosporine or systemic steroids at any dose). Intermittent topical, inhaled, or intranasal corticosteroids are permissible;
(25) the subject is human immunodeficiency virus (HIV-1) positive, chronic or active hepatitis B or active hepatitis A or C;
(26) Subject has an uncontrolled systemic fungal, bacterial, viral, or other infection (defined as signs/symptoms associated with the infection persisting without improvement despite appropriate antimicrobial therapy) , or require management with IV antibiotics.
(27) Subject has class III or IV congestive heart failure (CHF) or severe nonischemic cardiomyopathy, unstable or poorly controlled angina, myocardial infarction or ventricular arrhythmia within 6 months prior to randomization have a history of
(28) Hypersensitivity to DARA, thalidomide, lenalidomide, POM, BTZ, IXA or dex. This includes grade 3 or greater rash during prior thalidomide, POM or lenalidomide therapy;
(29) Hypersensitivity to any component of the bb2121 product: cyclophosphamide, fludarabine, and/or tocilizumab, or to excipients contained in formulations of DARA, POM, LEN, IXA, BTZ, or dex. a subject who is found to have a disease;
(30) Subjects are pregnant, lactating, or breast-feeding women, or intend to become pregnant while participating in this study;
(31) For subjects randomized to treatment arm B and assigned to regimens containing POM or LEN, unable or unwilling to receive protocol-specified thromboembolic prophylaxis; and (32) Subjects cannot receive DVd as bridging therapy if randomized to arm A unless bortezomib is tolerated, or receive DVd if randomized to arm B I can't.
Claims (66)
a.ダラツムマブ、ポマリドミド、及びデキサメタゾン(DPd);
b.ダラツムマブ、ボルテゾミブ、及びデキサメタゾン(DVd);
c.イキサゾミブ、レナリドミド、及びデキサメタゾン(IRd);
d.ダラツムマブ、レナリドミド及びデキサメタゾン;
e.ボルテゾミブ、レナリドミド及びデキサメタゾン(RVd);
f.ボルテゾミブ、シクロホスファミド及びデキサメタゾン(BCd);
g.ボルテゾミブ、ドキソルビシン及びデキサメタゾン;
h.カルフィルゾミブ、レナリドミド及びデキサメタゾン(CRd);
i.ボルテゾミブ及びデキサメタゾン;
j.ボルテゾミブ、サリドマイド及びデキサメタゾン;
k.レナリドミド及びデキサメタゾン;
l.デキサメタゾン、サリドマイド、シスプラチン、ドキソルビシン、シクロホスファミド、エトポシド及びボルテゾミブ(VTD-PACE);
m.レナリドミド及び低用量デキサメタゾン;
n.ボルテゾミブ、シクロホスファミド及びデキサメタゾン;
o.カルフィルゾミブ及びデキサメタゾン;
p.レナリドミド単独;
q.ボルテゾミブ単独;
r.ダラツムマブ単独;
s.エロツズマブ、レナリドミド、及びデキサメタゾン;
t.エロツズマブ、レナリドミド及びデキサメタゾン;
u.ベンダムスチン、ボルテゾミブ及びデキサメタゾン;
v.ベンダムスチン、レナリドミド、及びデキサメタゾン;
w.ポマリドミド及びデキサメタゾン;
x.ポマリドミド、ボルテゾミブ及びデキサメタゾン;
y.ポマリドミド、カルフィルゾミブ及びデキサメタゾン;
z.ボルテゾミブ及びリポソーム化ドキソルビシン;
aa.シクロホスファミド、レナリドミド、及びデキサメタゾン;
bb.エロツズマブ、ボルテゾミブ及びデキサメタゾン;
cc.イキサゾミブ及びデキサメタゾン;
dd.パノビノスタット、ボルテゾミブ及びデキサメタゾン;
ee.パノビノスタット及びカルフィルゾミブ;または
ff.ポマリドミド、シクロホスファミド及びデキサメタゾンを含む前治療ラインを1つ以上受けたことがある、請求項1~6のいずれか1項に記載の組成物の使用。 Prior to the administration, the subject
a. Daratumumab, pomalidomide, and dexamethasone (DPd);
b. Daratumumab, bortezomib, and dexamethasone (DVd);
c. Ixazomib, lenalidomide, and dexamethasone (IRd);
d. Daratumumab, lenalidomide and dexamethasone;
e. Bortezomib, lenalidomide and dexamethasone (RVd);
f. Bortezomib, cyclophosphamide and dexamethasone (BCd);
g. Bortezomib, doxorubicin and dexamethasone;
h. Carfilzomib, lenalidomide and dexamethasone (CRd);
i. Bortezomib and dexamethasone;
j. Bortezomib, thalidomide and dexamethasone;
k. Lenalidomide and dexamethasone;
l. Dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, etoposide and bortezomib (VTD-PACE);
m. Lenalidomide and low-dose dexamethasone;
n. Bortezomib, cyclophosphamide and dexamethasone;
o. Carfilzomib and dexamethasone;
p. Lenalidomide alone;
q. Bortezomib alone;
r. Daratumumab alone;
s. Elotuzumab, lenalidomide, and dexamethasone;
t. Elotuzumab, lenalidomide and dexamethasone;
u. Bendamustine, bortezomib and dexamethasone;
v. Bendamustine, lenalidomide, and dexamethasone;
w. Pomalidomide and dexamethasone;
x. Pomalidomide, bortezomib and dexamethasone;
y. Pomalidomide, carfilzomib and dexamethasone;
z. Bortezomib and liposomal doxorubicin;
aa. Cyclophosphamide, lenalidomide, and dexamethasone;
bb. Elotuzumab, bortezomib and dexamethasone;
cc. Ixazomib and dexamethasone;
dd. Panobinostat, bortezomib and dexamethasone;
ee. Panobinostat and carfilzomib; or ff. Use of the composition according to any one of claims 1 to 6, which has received one or more pretreatment lines containing pomalidomide, cyclophosphamide and dexamethasone.
a.血清Mタンパク質レベル(血清タンパク質電気泳動[sPEP])が約0.5g/dL以上、もしくは尿Mタンパク質レベル(尿タンパク質電気泳動[uPEP])が約200mg/24時間以上、及び/または
b.血清中もしくは尿中に測定可能な疾患がなく、血清免疫グロブリン遊離軽鎖が約10mg/dL以上であり、血清免疫グロブリンカッパラムダ遊離軽鎖比が異常である軽鎖多発性骨髄腫(MM);及び/または
c.米国東海岸がん臨床試験グループ(ECOG)パフォーマンスステータスが約1以下を示す、請求項1~16のいずれか1項に記載の組成物の使用。 At the time of the administration, the subject
a. Serum M protein levels (serum protein electrophoresis [sPEP]) are about 0.5 g / dL or higher, or urinary M protein levels (urine protein electrophoresis [upEP]) are about 200 mg / 24 hours or higher, and / or b. Light chain multiple myeloma (MM) with no measurable disease in serum or urine, serum immunoglobulin free light chain of about 10 mg / dL or higher, and abnormal serum immunoglobulin kappa lambda free light chain ratio. ; And / or c. Use of the composition according to any one of claims 1-16, which has a US East Coast Cancer Clinical Trials Group (ECOG) performance status of about 1 or less.
a.プロテアソーム阻害薬、免疫調節薬(レナリドミドまたはポマリドミド)及び抗CD38抗体による前治療を含む、前記前治療ラインのうちの少なくとも3つを受けたことがあり;
b.前記前治療ラインのうちの少なくとも3つのそれぞれについて、進行(PD)が治療ラインに対する最良効果でない限り、少なくとも連続2サイクルの治療を受けたことがあり;
c.直近の前治療ラインの60日目もしくは60日以内の進行(PD)のエビデンスがあり;及び/または
d.前記前治療ラインのうちの少なくとも1つに対する効果(最小奏効以上)が得られている、請求項17に記載の組成物の使用。 The subject is further
a. Have received at least three of the above pretreatment lines, including pretreatment with proteasome inhibitors, immunomodulators (lenalidomide or pomalidomide) and anti-CD38 antibodies;
b. For each of at least three of the pretreatment lines, at least two consecutive cycles of treatment have been received unless progression (PD) has the best effect on the treatment line;
c. There is evidence of progression (PD) on day 60 or within 60 days of the most recent pretreatment line; and / or d. The use of the composition according to claim 17, wherein an effect (or more than a minimum response) on at least one of the pretreatment lines has been obtained.
a.先に受けた抗骨髄腫治療が1レジメンのみであり;及び/または
b.以下のハイリスク因子:R-ISSステージIII及び早期再発を有し、前記早期再発は、(i)前記対象が導入法と幹細胞移植を受けている場合、最初の移植日から12ヶ月未満での進行;もしくは(ii)前記対象が導入法のみを受けている場合、少なくともプロテアソーム阻害薬、免疫調節薬及びデキサメタゾンを含有していなければならない最後の治療レジメン日から12ヶ月未満での進行(PD)として定義される、請求項17に記載の組成物の使用。 The subject is further
a. Only one regimen was previously treated for myeloma; and / or b. The following high risk factors: R-ISS stage III and early recurrence, said early recurrence: (i) less than 12 months from the date of initial transplantation if the subject has undergone induction and stem cell transplantation. Progression; or (ii) Progression less than 12 months from the date of the last treatment regimen, which must contain at least proteasome inhibitors, immunomodulators and dexamethasone if the subject is undergoing induction only (PD) Use of the composition according to claim 17, defined as.
a.ダラツムマブ、ポマリドミド、及びデキサメタゾン(DPd);
b.ダラツムマブ、ボルテゾミブ、及びデキサメタゾン(DVd);
c.イキサゾミブ、レナリドミド、及びデキサメタゾン(IRd);
d.ダラツムマブ、レナリドミド及びデキサメタゾン;
e.ボルテゾミブ、レナリドミド及びデキサメタゾン(RVd);
f.ボルテゾミブ、シクロホスファミド及びデキサメタゾン(BCd);
g.ボルテゾミブ、ドキソルビシン及びデキサメタゾン;
h.カルフィルゾミブ、レナリドミド及びデキサメタゾン(CRd);
i.ボルテゾミブ及びデキサメタゾン;
j.ボルテゾミブ、サリドマイド及びデキサメタゾン;
k.レナリドミド及びデキサメタゾン;
l.デキサメタゾン、サリドマイド、シスプラチン、ドキソルビシン、シクロホスファミド、エトポシド及びボルテゾミブ(VTD-PACE);
m.レナリドミド及び低用量デキサメタゾン;
n.ボルテゾミブ、シクロホスファミド及びデキサメタゾン;
o.カルフィルゾミブ及びデキサメタゾン;
p.レナリドミド単独;
q.ボルテゾミブ単独;
r.ダラツムマブ単独;
s.エロツズマブ、レナリドミド、及びデキサメタゾン;
t.エロツズマブ、レナリドミド及びデキサメタゾン;
u.ベンダムスチン、ボルテゾミブ及びデキサメタゾン;
v.ベンダムスチン、レナリドミド、及びデキサメタゾン;
w.ポマリドミド及びデキサメタゾン;
x.ポマリドミド、ボルテゾミブ及びデキサメタゾン;
y.ポマリドミド、カルフィルゾミブ及びデキサメタゾン;
z.ボルテゾミブ及びリポソーム化ドキソルビシン;
aa.シクロホスファミド、レナリドミド、及びデキサメタゾン;
bb.エロツズマブ、ボルテゾミブ及びデキサメタゾン;
cc.イキサゾミブ及びデキサメタゾン;
dd.パノビノスタット、ボルテゾミブ及びデキサメタゾン;
ee.パノビノスタット及びカルフィルゾミブ;または
ff.ポマリドミド、シクロホスファミド及びデキサメタゾンを含む前治療ラインを1つ以上受けたことがある、請求項34~39のいずれか1項に記載の医薬組成物。 Prior to the administration, the subject
a. Daratumumab, pomalidomide, and dexamethasone (DPd);
b. Daratumumab, bortezomib, and dexamethasone (DVd);
c. Ixazomib, lenalidomide, and dexamethasone (IRd);
d. Daratumumab, lenalidomide and dexamethasone;
e. Bortezomib, lenalidomide and dexamethasone (RVd);
f. Bortezomib, cyclophosphamide and dexamethasone (BCd);
g. Bortezomib, doxorubicin and dexamethasone;
h. Carfilzomib, lenalidomide and dexamethasone (CRd);
i. Bortezomib and dexamethasone;
j. Bortezomib, thalidomide and dexamethasone;
k. Lenalidomide and dexamethasone;
l. Dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, etoposide and bortezomib (VTD-PACE);
m. Lenalidomide and low-dose dexamethasone;
n. Bortezomib, cyclophosphamide and dexamethasone;
o. Carfilzomib and dexamethasone;
p. Lenalidomide alone;
q. Bortezomib alone;
r. Daratumumab alone;
s. Elotuzumab, lenalidomide, and dexamethasone;
t. Elotuzumab, lenalidomide and dexamethasone;
u. Bendamustine, bortezomib and dexamethasone;
v. Bendamustine, lenalidomide, and dexamethasone;
w. Pomalidomide and dexamethasone;
x. Pomalidomide, bortezomib and dexamethasone;
y. Pomalidomide, carfilzomib and dexamethasone;
z. Bortezomib and liposomal doxorubicin;
aa. Cyclophosphamide, lenalidomide, and dexamethasone;
bb. Elotuzumab, bortezomib and dexamethasone;
cc. Ixazomib and dexamethasone;
dd. Panobinostat, bortezomib and dexamethasone;
ee. Panobinostat and carfilzomib; or ff. The pharmaceutical composition according to any one of claims 34 to 39, which has received one or more pretreatment lines containing pomalidomide, cyclophosphamide and dexamethasone.
a.血清Mタンパク質レベル(血清タンパク質電気泳動[sPEP])が約0.5g/dL以上、もしくは尿Mタンパク質レベル(尿タンパク質電気泳動[uPEP])が約200mg/24時間以上、及び/または
b.血清中もしくは尿中に測定可能な疾患がなく、血清免疫グロブリン遊離軽鎖が約10mg/dL以上であり、血清免疫グロブリンカッパラムダ遊離軽鎖比が異常である軽鎖多発性骨髄腫(MM);及び/または
c.米国東海岸がん臨床試験グループ(ECOG)パフォーマンスステータスが約1以下を示す、請求項34~49のいずれか1項に記載の医薬組成物。 At the time of the administration, the subject
a. Serum M protein levels (serum protein electrophoresis [sPEP]) are about 0.5 g / dL or higher, or urinary M protein levels (urine protein electrophoresis [upEP]) are about 200 mg / 24 hours or higher, and / or b. Light chain multiple myeloma (MM) with no measurable disease in serum or urine, serum immunoglobulin free light chain of about 10 mg / dL or higher, and abnormal serum immunoglobulin kappa lambda free light chain ratio. ; And / or c. The pharmaceutical composition according to any one of claims 34 to 49, wherein the US East Coast Cancer Clinical Trials Group (ECOG) performance status is about 1 or less.
a.プロテアソーム阻害薬、免疫調節薬(レナリドミドまたはポマリドミド)及び抗CD38抗体による前治療を含む、前記前治療ラインのうちの少なくとも3つを受けたことがあり;
b.前記前治療ラインのうちの少なくとも3つのそれぞれについて、進行(PD)が治療ラインに対する最良効果でない限り、少なくとも連続2サイクルの治療を受けたことがあり;
c.直近の前治療ラインの60日目もしくは60日以内の進行(PD)のエビデンスがあり;及び/または
d.前記前治療ラインのうちの少なくとも1つに対する効果(最小奏効以上)が得られている、請求項50に記載の医薬組成物。 The subject is further
a. Have received at least three of the above pretreatment lines, including pretreatment with proteasome inhibitors, immunomodulators (lenalidomide or pomalidomide) and anti-CD38 antibodies;
b. For each of at least three of the pretreatment lines, at least two consecutive cycles of treatment have been received unless progression (PD) has the best effect on the treatment line;
c. There is evidence of progression (PD) on day 60 or within 60 days of the most recent pretreatment line; and / or d. The pharmaceutical composition according to claim 50, wherein an effect (minimum response or more) on at least one of the pretreatment lines has been obtained.
a.先に受けた抗骨髄腫治療が1レジメンのみであり;及び/または
b.以下のハイリスク因子:R-ISSステージIII及び早期再発を有し、前記早期再発は、(i)前記対象が導入法と幹細胞移植を受けている場合、最初の移植日から12ヶ月未満での進行;もしくは(ii)前記対象が導入法のみを受けている場合、少なくともプロテアソーム阻害薬、免疫調節薬及びデキサメタゾンを含有していなければならない最後の治療レジメン日から12ヶ月未満での進行(PD)として定義される、請求項50に記載の医薬組成物。 The subject is further
a. Only one regimen was previously treated for myeloma; and / or b. The following high risk factors: R-ISS stage III and early recurrence, said early recurrence: (i) less than 12 months from the date of initial transplantation if the subject has undergone induction and stem cell transplantation. Progression; or (ii) Progression less than 12 months from the date of the last treatment regimen, which must contain at least proteasome inhibitors, immunomodulators and dexamethasone if the subject is undergoing induction only (PD) The pharmaceutical composition according to claim 50, which is defined as.
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PCT/US2019/041165 WO2020014333A1 (en) | 2018-07-11 | 2019-07-10 | Uses of anti-bcma chimeric antigen receptors |
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EP (2) | EP4223269A3 (en) |
JP (1) | JP2021530483A (en) |
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CN (1) | CN112689516A (en) |
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BR112022015968A2 (en) * | 2020-02-12 | 2022-10-11 | Juno Therapeutics Inc | BCMA-Targeted ANTIGEN RECEPTOR T-CELL COMPOSITIONS AND METHODS AND USES THEREOF |
JP2023550309A (en) * | 2020-11-04 | 2023-12-01 | セルジーン コーポレーション | CAR T cell therapy in patients who previously received anticancer alkylating agent therapy |
US20220193134A1 (en) * | 2020-12-23 | 2022-06-23 | Crispr Therapeutics Ag | Co-use of lenalidomide with car-t cells |
CA3214683A1 (en) * | 2021-04-16 | 2022-10-20 | Julie Ann RYTLEWSKI | Combination therapies with bcma-directed t cell therapy |
WO2023081735A1 (en) * | 2021-11-03 | 2023-05-11 | Celgene Corporation | Chimeric antigen receptors specific for b-cell maturation antigen for use in treating myeloma |
WO2023077343A1 (en) * | 2021-11-04 | 2023-05-11 | Janssen Biotech, Inc. | Bcma-targeted car-t cell therapy for multiple myeloma |
WO2023230548A1 (en) * | 2022-05-25 | 2023-11-30 | Celgene Corporation | Method for predicting response to a t cell therapy |
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2019
- 2019-07-10 WO PCT/US2019/041165 patent/WO2020014333A1/en unknown
- 2019-07-10 BR BR112021000249-9A patent/BR112021000249A2/en unknown
- 2019-07-10 CN CN201980059605.9A patent/CN112689516A/en active Pending
- 2019-07-10 US US17/258,971 patent/US20210330788A1/en active Pending
- 2019-07-10 JP JP2021500521A patent/JP2021530483A/en active Pending
- 2019-07-10 SG SG11202100160SA patent/SG11202100160SA/en unknown
- 2019-07-10 MX MX2021000283A patent/MX2021000283A/en unknown
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- 2019-07-10 EP EP23156042.6A patent/EP4223269A3/en active Pending
- 2019-07-10 EP EP19755454.6A patent/EP3820515A1/en not_active Withdrawn
- 2019-07-10 KR KR1020217003369A patent/KR20210045985A/en unknown
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- 2019-07-10 AU AU2019301126A patent/AU2019301126A1/en active Pending
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