NZ736368B2 - Methods and compositions for prediction of therapeutic efficacy of cancer treatments and cancer prognosis - Google Patents

Abstract

The invention generally relates to methods and compositions for the prediction of therapeutic efficacy of cancer treatments and the prognosis of cancer. The invention discloses markers that are associated with favorable and unfavorable outcomes, respectively, in certain cancer treatments and are useful as prognostic markers for cancer. Methods involving these markers are disclosed for predicting cancer therapy benefit and prognosing clinical outcome for cancer patients. In particular, the present invention relates to methods of assessing if a cancer patient having a CLDN18.2 positive tumor is a responder to treatment with an anti-CLDN18.2 antibody comprising determining the genotype for one or more single-nucleotide polymorphisms (SNPs) selected from MUC1 rs4072037, IL-10 rs1800896, DNMT3A rs1550117, SMAD4 rs12456284, EGF rs4444903, CDH1 rs16260 and ERCC1 rs11615. ful as prognostic markers for cancer. Methods involving these markers are disclosed for predicting cancer therapy benefit and prognosing clinical outcome for cancer patients. In particular, the present invention relates to methods of assessing if a cancer patient having a CLDN18.2 positive tumor is a responder to treatment with an anti-CLDN18.2 antibody comprising determining the genotype for one or more single-nucleotide polymorphisms (SNPs) selected from MUC1 rs4072037, IL-10 rs1800896, DNMT3A rs1550117, SMAD4 rs12456284, EGF rs4444903, CDH1 rs16260 and ERCC1 rs11615.

Description

METHODS AND COMPOSITIONS FOR PREDICTION OF THERAPEUTIC EFFICACY OF CANCER TREATMENTS AND CANCER PROGNOSIS TECHNICAL FIELD OF THE INVENTION The invention generally relates to methods and compositions for the prediction of therapeutic efficacy of cancer treatments and the prognosis of cancer. The invention discloses markers that are associated with favorable and unfavorable es, respectively, in certain cancer ents and are useful as prognostic markers for cancer. Methods involving these markers are disclosed for predicting cancer therapy benefit and prognosing al outcome for cancer BACKGROUND OF THE INVENTION Cancers of the stomach and the esophagus (gastroesophageal; GE) are among the malignancies with the highest unmet medical need. Gastric cancer is the second leading cause of death worldwide. The incidence of geal cancer has increased in recent decades and the l five-year survival rate for GE cancer is 20—25%, despite the aggressiveness of established standard treatment associated with substantial side effects. The medical need of patients suffering from this cancer type is high and tive drugs are required.

The tight junction molecule claudin 18 e 2 (CLDN18.2) is a cancer-associated splice variant of Claudin 18 [Niimi, T., et a1., Mol Cell Biol, 2001. 21(21): p. 7380—90; Tureci, 0., et a1., Gene, 2011. : p. 83—92]. CLDN18.2 is a 27.8 kDa transmembrane protein comprising four membrane spanning domains with two small extracellular loops (loopl embraced by hydrophobic region 1 and hydrophobic region 2; loop2 embraced by hydrophobic regions 3 and 4). CLDN18.2 is a highly ive gastric lineage antigen, exclusively expressed on lived differentiated gastric epithelial cells and not detectable in any other normal human tissue. The antigen is ectopically sed at significant levels in a diversity of human cancers including gastroesophageal and pancreatic cancer [Sahin, U., et a1., Clin Cancer Res, 2008. 14(23): p. 7624—34]. The CLDN18.2 protein is also frequently detected in lymph node metastases of gastric cancer and in distant metastases. CLDN18.2 seems to be involved in proliferation of CLDN18.2 positive tumor cells, since down tion of the target by siRNA technology results in tion of proliferation of gastric cancer cells.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN IMAB362 is a chimeric monoclonal antibody of IgG1 subtype directed against CLDN18.2.

IMAB362 recognizes the first extracellular domain of CLDN18.2 with high affinity and specificity and does not bind to any other claudin family member including the closely related splice variant 1 of Claudin 18 (CLDN18.l).

In human xenografts sing CLDN18.2 survival benefit and tumor regressions have been ed in mice after administration of IMAB362. When administered intravenously in relevant animal species, no toxicity in gastric tissue is observed as the target epitope is not accessible. However, the tumor target becomes accessible for IMAB362 during malignant ormation. 2 bundles four independent highly potent mechanisms of action: (i) antibody—dependent cellular cytotoxicity , (ii) complement-dependent cytotoxicity (CDC), (iii) induction of apoptosis induced by cross linking of the target at the tumor surface and (iv) direct inhibition of proliferation.

A previous phase I trial has evaluated IMAB362 as erapy in a single dose in patients with late-stage gastroesophageal cancer. In this trial five IMAB362 doses (33, 100, 300, 600 and 1000 mg/mz) were applied as monotherapy. This study shows that a single administration of this antibody is safe and well tolerated in a dosage of up to 1000 mg/mz, as no relevant differences in AB profile and other safety parameters between the dose groups could be seen (AB. = adverse event). Best results with regard to antitumora. activity were obtained for the 300 mg/m2 and 600 mg/m2 groups. In two patients of the 300 mg/m2 group the disease was controlled and as they had only non—target lesions they were rated as non-CR, non-PD (CD = complete response; PD = progressive disease). The duration of non-CR, non-PD was about two months and six weeks, respectively. Tumor marker levels of these three patients remained stable. One t in the 600 rug/m2 group presented with stable disease (SD). The duration of the SD was about 2 months.

On basis of the highly potent mechanisms of action for the induced cell killing of IMAB362, the al benefit of IMAB362-treated mice bearing a .2—positive tumor, the absence of any tion for IMAB362-related toxicity, and the ing results of the phase I trial a phase Ila study was initialized. This phase Ila clinical trial was conducted to determine safety, tolerability and antitumoral ty of repetitive doses of IMAB362 in [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN patients with metastatic, refractory or recurrent disease of advanced adenocarcinoma of the stomach or the lower esophagus proven by histology.

In this phase Ila trial the investigational drug was applied in three cohorts, which were ted sequentially. A first cohort of three patients received repeated doses of IMAB362 at a lower dose level (300 mg/m2 body surface area). The antibody was given as a 2 h intravenous infusion. Since no indication for 2-related toxicity was detected in the first cohort, the IMAB362 dose of the second cohort (three patients) was increased to 600 mg/m2 body surface area. In a third cohort 19 patients were allocated with the same dose (repetitive atio- of 600 trig/1112 body surface area). Patient samples from this cohort were analyzed for l accompanying analytics i.e. ADCC, CDC, immunophenotyping and genetic immune rphisms. All patients of all cohorts have received repeated doses of lMAB362 every two weeks on visits 2, 5, 6, 7 and 8 (5 ations).

The discrepancy of n positive tumors (overexpressing the target antigen to similar extent) with regard to responsiveness to intervention with therapeutic monoclonal antibodies such as IMAB362 suggests that there are additional factors which are associated with therapy outcome. This demands careful selection of patients who may have a benefit from antibody Therefore, there is a need to develop a test to measure the eligibility of patients for antibody therapy. The present invention addresses this need by providing markers which are associated with favorable and unfavorable outcomes, respectively, in antibody therapy. Furthermore, the present inve..tion demonstrates that these markers are useful as markers for prognosing clinical outcome for cancer patients.

The s presented herein may be used to select a suitable treatment for a cancer patient and, in particular, to decide whether antibody therapy should be administered to a cancer patient.

SUMMARY OF THE INVENTION The t ion provides methods of SNP (single-nucleotide polymorphism) genotpg, such as for use in evaluating an individual's likelihood of responding to a [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN therapeutic ent for cancer, in selecting a treatment or preventive regimen (e.g., in deciding Whether or not to administer a particular therapeutic agent to an individual having cancer, or Who is at increased risk for developing cancer in the future), or in evaluating an * individual's prognosis for e severity and ry.

The present invention is based on the finding that certain genotypes for SNPs are associated with sensitivity/insensitivity of cancer towards dy treatment such as treatment of CLDN18.2 positive cancer, in particular CLDN18.2 positive gastroesophageal cancer with IMAB362. The present invention is further based on the finding that certain genotypes for SNPs are associated with clinical outcome for cancer patients and thus are useful for prognosmg 33.11661.

In one aspect, the invention relates to a method of assessing (i) if a cancer patient having a tumor antigen—positive tumor is a der to ent with an antibody against the tumor antigen, and/or (ii) if a cancer patient, preferably a cancer patient having a tumor antigen-positive tumor, will experience ssion—free survival, said method comprising determining the genotype for one or more single—nucleotide polymorphisms ed from the group consisting of CGRZA rsl801274, MUCl rs4072037, IL-lO rsl800896, DNMTBA 117, SMAD4 rs12456284, EGF rs4444903, CDHl $16260, ERCCl rsll615, and FCGR3A rs396991 in a sample obtained from the patient.

In one embodiment, the presence of the heterozygous FCGRZA rsl801274 [CT] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the presence of the homozygous FCGRZA rs1801274 [TT] genotype and/or the homozygous FCGRZA rs1801274 [CC] genotype indicates an increased risk of a cancer patient not being a responder to ent with the antibody and/or an increased risk of a cancer patient not experiencing progression—free survival.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN ed set by MYN In one embodiment, the presence of the homozygous MUCl rs4072037 [AA] genotype indicates a d risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression—free survival.

In one ment, the presence of the homozygous MUCl rs4072037 [GG] genotype indicates an increased risk of a cancer patient not being a responder to treatment with the antibody and/or an increased risk of a cancer t not experiencing progression—free survival.

In one embodiment, the presence of the homozygous IL—IO rs1800896 [GG] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not encing progression-free survival.

In one embodiment, the ce of the heterozygous DNMT3A 117 [GA] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer t not experiencing progression-free survival.

In one embodiment, the presence of the heterozygous SMAD4 r512456284 [GA] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression—free survival.

In one embodiment, the presence of the homozygous EGF rs4444903 [AA] genotype tes a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression—free survival.

In one embodiment, the presence of the homozygous CDHl rs16260 [AA] genotype indicates a d risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the presence of the homozygous ERCCl rsl 1615 [TT] genotype tes a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In one embodiment, the presence of the heterozygous FCGR3A r3396991 [TG] genotype and/or the gous FCGR3A rs396991 [TT] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression—free survival.

In one embodiment, the presence of the homozygous FCGR3A rs396991 [GG] genotype indicates an increased risk of a cancer patient not being a responder to treatment with the antibody and/or an increased risk of a cancer patient not experiencing progression—free survival.

In one embodiment, the tumor antigen is the CLDN18.2 protein.

In one , the invention relates to a method of assessing (i) if a cancer patient having a .2-positive tumor is a responder to treatment with an dy against the CLDN18.2 protein, and/or (ii) if a cancer patient, preferably a cancer patient having a CLDN18.2-positive tumor, will ence progression-free survival, said method comprising determining the genotype for one or more single—nucleotide polymorphisms ed from the group consisting of FCGR2A rs1801274, MUCl rs4072037, IL-10 rsl800896, DNMT3A 131550117, SMAD4 1812456284, EGF rs4444903, CDHl rs16260, ERCCI rs11615, and FCGR3A rs396991 in a sample ed from the patient.

In one embodiment, the presence of the heterozygous FCGR2A. 131801274 {CT} genotype indicates a reduced risk of a cancer patient not being a responder to ent with the antibody and/or a reduced risk of a cancer patient not experiencing progression—free survival.

In one ment, the presence of the homozygous FCGR2A rs1801274 [TT] genotype and/or the homozygous FCGR2A r81801274 [CC] genotype indicates an increased risk of a cancer patient not being a responder to ent with the antibody and/or an increased risk of a cancer patient not experiencing ssion—free survival.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN ation] MYN Unmarked set by MYN In one embodiment, the presence of the homozygous MUCI rs4072037 [AA] genotype indicates a reduced risk of a cancer patient not being a responder to ent with the antibody and/or a reduced risk of a cancer patient not experiencing progression—free survival.

In one embodiment, the presence of the homozygous MUCl rs4072037 [GG] genotype indicates an increased risk of a cancer patient not being a responder to treatment with the antibody and/or an increased risk of a cancer t not experiencing progression-free survival.

In one embodiment, the presence of the homozygous IL-IO r51800896 [GG] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the ce of the heterozygous DNMT3A 117 [GA] pe indicates a d risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the presence of the heterozygous SMAD4 6284 [GA] genotype indicates a reduced risk of a cancer patient not being a der to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the presence of the homozygous EGF rs4444903 [AA] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progession—free survival.

In one embodiment, the presence of the homozygous CDHl rsl6260 [AA] genotype indicates a d risk of a cancer patient not being a responder to treatment with the dy and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the presence of the homozygous ERCCI r311615 [TT] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the dy and/or a reduced risk of a cancer patient not experiencing progression—free survival.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN In one embodiment, the presence of the heterozygous FCGR3A 91 [TG] genotype and/or the gous FCGR3A rs396991 [TT] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

In one embodiment, the presence of the gous FCGR3A rs396991 [GG] genotype indicates an increased risk of a cancer patient not being a der to treatment with the antibody and/or an increased risk of a cancer patient not experiencing progression—free survival.

In one embodiment of all aspects of the invention, the antibody acts through recruiting the patient’s immune system to destroy tumor cells. In one embodiment, the dy acts through antibody-dependent cell-mediated cytotoxicity (ADCC) and/or complement-dependent cytotoxicity (CDC). In one embodiment, the antibody is a monoclonal antibody. In one embodiment of all aspects of the invention, the antibody comprises a heavy chain comprising an amino acid ce represented by SEQ ID NO: 17 or 51 or a fragment thereof and a light chain comprising an amino acid sequence represented by SEQ ID NO: 24 or a nt thereof.

In one embodiment of all s of the invention, non-responsiveness to treatment with the antibody comprises a relative reduction in one or more of survival, progression-free survival, recurrence-free al, distant ence—free survival, and stable disease.

In one aspect, the invention relates to a method of treating a cancer patient, said method sing a. assessing if the cancer patient is a responder to treatment with an antibody bv them-..

”J LA method of the invention and b. (i) treating the cancer patient with an antibody if the patient has a reduced risk for not being a responder to treatment with the antibody or (ii) not treating the cancer patient with an antibody and/or treating the cancer patient with a treatment regimen which comprises a treatment which is ent from a treatment with an antibody if the patient has an increased risk for not being a responder to treatment with the antibody.

[Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In one embodiment, the treatment regimen comprises a treatment not being dependent on the immune system of the patient. In one embodiment, the treatment regimen does net comprise a treatment with an antibody acting through recruiting the patient's immune system to destroy tumor cells. In one embodiment, the treatment regimen comprises surgery, chemotherapy and/or radiation. In one embodiment, the treatment regimen comprises a treatment with a small le inhibitor of the tumor antigen and/or an antibody-drug conjugate wherein the antibody is directed against the tumor antigen. In one embodiment, the antibody-drug conjugate is an antibody coupled to a radioactive, chemotherapeutic or toxin moiety. In one embodiment, the antibody-drug conjugate is an antibody coupled to a cytostatic or xic compound.

In one aspect, the invention relates to a method of assessing the clinical outcome for a cancer patient, said method comprising determining the genotype for one or more -nucleotide polymorphisms selected from the group consisting of FCGRZA r51801274, MUCl rs4072037, IL—lO r51800896, DNMT3A r51550117, SMAD4 r312456284, EGF rs4444903, CDHI 0, ERCCI rsll615, and FCGR3A rs396991 in a sample obtained from the patient.

In one ment, the presence of the heterozygous FCGRZA 274 [CT] genotype indicates a reduced risk of poor clinical outcome.

In one embodiment, the presence of the gous FCGRZA r51801274 [TT] genotype and/or the homozygous FCGRZA r81801274 [CC] genotype tes an increased risk of poor clinical outcome.

In one embodiment, the presence of the gous MUCl rs4072037 [AA] genotype indicates a reduced risk of poor clinical outcome.

In one embodiment, the presence of the gous MUCl rs4072037 [GG] genotype indicates an increased risk of poor al outcome.

In one embodiment, the presence of the homozygous IL-lO r51800896 [GG] genotype indicates a d risk of poor clinical outcome.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In one embodiment, the presence of the heterozygous DNMT3A r51550117 [GA] genotype tes a reduced risk ofpoor clinical outcome.

In one embodiment, the presence of the heterozygous SMAD4 6284 [GA] genotype indicates a reduced risk ofpoor clinical outcome.

In one embodiment, the presence of the homozygous EGF rs4444903 [AA] genotype indicates a reduced risk of poor clinical outcome.

In one embodiment, the presence of the homozygous CDHl r516260 [AA] genotype indicates a reduced risk ofpoor al outcome.

In one embodiment, the presence of the homozygous ERCCl rs11615 [TT] genotype indicates a reduced risk of poor clinical outcome.

In one embodiment, the presence of the heterozygous FCGR3A rs396991 [TG] genotype and/or the homozygous FCGR3A 91 [TT] genotype indicates a reduced risk of poor clinical outcome.

In one ment, the presence of the homozygous FCGR3A rs396991 [GG] genotype indicates an increased risk of poor clinical outcome. irnent, assessing tuc clinical outcome tor a cancer patient comprises predicting the likelihood of one or more of survival, progression—free al, recurrence-free survival, distant recurrence-free al and stable disease. In one embodiment, poor clinical outcome comprises a relative reduction in one or more of survival, progression—free survival, recurrence—free survival, t recurrence—free survival and stable disease.

In one embodiment, the t has a tumor antigen-positive tumor and receives a treatment with an antibody against the tumor antigen.

In one embodiment of all aspects of the ion, the sample is a sample comprising DNA.

In one embodiment, the DNA has been extracted from a bodily sample of the patient. In one embognt, the DNA has been extracted from blood.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In one embodiment of all aspects of the invention, the tumor is a solid tumor. In one embodiment, the tumor is a gastroesophageal tumor. In one embodiment, the tumor is an advanced adenocarcinoma of the stomach or the lower esophagus. In one embodiment, the cancer is gastroesophageal cancer. In one embodiment, the cancer is an advanced ncinoma of the stomach or the lower esophagus.

In a further aspect, the present invention relates to a kit comprising means for ining the genotype for one or more single-nucleotide polymorphisms selected from the group ting of FCGRZA rs1801274, MUCl rs4072037, IL—lO rs1800896, DNMT3A rs1550117, SMAD4 rs12456284, EGF rs4444903, CDHl rsl6260, ERCCI rsl 1615, and FCGR3A 9l in a sample obtained from the patient. In one embodiment, said kit is useful for conducting the methods of all aspects of the present ion. In one ment, said kit further comprises a data carrier. In one preferred embodiment, said data carrier is an electronical or a non- electronical data carrier. In one embodiment, said data r comprises instructions on how to carry out the methods of all aspects of the invention.

Other objects, advantages and features of the present invention will become apparent from the following ed description when considered in conjunction with the accompanying figures.

BRIEF DESCRIPTION OF THE FIGURES rea”:Si'1('b p-t m1-Il“a(D lI:cleotide po.ymorphisms with a statistically sigmincant genotype frequency shift between patient and control population (xz—test, p<0.05).

Assignment of SNP-specific genotypes to bar sections is indicated. Pat. t population, Co. Control population.

Figure 2: Relative frequency of homozygous risk genotypes per patient in relation to the number of igated SNP risk factors per patient. Patients are sorted by sing frequency of accumulated homozygous risk factors.

Figure 3: Progression-free survival of PP patients entiated by 274 (FC ) genotype (Kaplan-Meier curve) [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN Figure 4: Progression-free survival of FAS patients differentiated by rs1801274 A) genetype (KaplamMeier curve) Figure 5: Progression—free survival of PP patients differentiated by rs1800896 (IL-10) pe (Kaplan—Meier curve) Figure 6: Progression-free survival of FAS patients differentiated by rs1800896 (IL-10) genotype (Kaplan-Meier curve) Figure 7: Progression-free survival of FAS patients differentiated by rs1550117 A) genotype (Kaplan-Meier curve) Figure 8: Progression—free survival of PP patients differentiated by rs12456284 (SMAD4) genotype (Kaplan-Meier curve) Figure 9: Progression-free survival of PP patients differentiated by rs4072037 (MUCl) genotype (Kaplan-Meier curve) Figure 10: Progression-free survival of FAS patients differentiated by rs4072037 {MUC1) genotype (Kaplan—Meier curve) Figure 11: ssion-free survival of FAS patients entiated by rs4444903 (EGF) genotype (Kaplan-Meier curve) Figure 12: Progression-free survi al of FAS patients differentiated by r316266 (CDHI) genotype (Kaplan-Meier curve) Figure 13: Progression-free survival of PP patients entiated by rsll615 (ERCCI) genotype (Kaplan-Meier curve) Figure 14: Progression-free al of PP patients differentiated by rs396991 (FCGE) genotype (Kaplan-Meier curve) [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ED DESCRIPTION OF THE INVENTION Although the present invention is described in detail below, it is to be understood that this invention is not limited to the particular methodologies, protocols and reagents described herein as these may vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not ed to limit the scope of the t invention which will be limited only by the appended claims. Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art.

In the following, the elements of the present invention will be described. These elements are listed with specific ments, however, it should be tood that they may be combined in any manner and in any number to create additional embodiments. The variously described es and red embodiments should not be construed to limit the present ion to only the explicitly described embodiments. This description should be understood, to support and encompass embodiments which combine the explicitly described embodiments with any number of the disclosed and/or preferred elements. Furthermore, permutations and combinations of all described elements in this application should be considered disclosed by the description of the present application unless the context indicates otherwise. ably, the terms used herein are defined as described in "A multilingual glossary of biotechnological terms: (IUPAC Recommendations)", H.G.W. Leuenberger, B. Nagel, and H.

Kolbl, Eds, Helvetica Chimica Acta, CH-4010 Basel, Switzerland, (1995).

The practice of the present invention will , unless otherwise indicated, conventional methods of chemistry, biochemistry, cell biology, immunology, and recombinant DNA ques which are ned in the literature in the field (cf., e.g., lar Cloning: A Laboratory Manual, 2nld Edition, J. Sambrook et al. eds, Cold Spring Harbor Laboratory Press, Cold Spring Harbor 1989).

Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be underst to imply the inclusion of a stated member, integer or step or group of members, [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN integers or steps but not the exclusion of any other member, integer or step or group of members, rs or steps llgh in some embodiments such other member, integer or step or group of members, integers or steps may be excluded, i.e. the subject-matter consists in the inclusion of a stated member, integer or step or group of members, integers or steps. The terms "a" and "an" and "the" and similar reference used in the context of bing the invention (especially in the context of the claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. tion of ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate value g within the range. Unless otherwise indicated herein, each individual value is incorporated into the cction as if it were individually recited herein. All methods described herein can be performed in any suitable order unless ise indicated herein or otherwise clearly contradicted by context. The of any and all es, or exemplary language (e.g., "such as"), provided herein is intended merely to better illustrate the invention and does not pose a limitation on the scope of the invention otherwise claimed. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the ion.

Several nts are cited throughout the text of this specification. Each of the documents cited herein ding all patents, patent applications, scientific publications, manufacturer's specifications, instructions, etc.), whether supra or infra, are hereby incorporated by reference in their entirety. Nothing herein is to be ued as an admission that the invention is ed to antedate such disclosure by virtue of prior invention.

The present inventors provide tests to measure the eligibility of patients for certain cancer treatments, in particular antibody therapy, and to draw conclusions on the prognosis of a cancer patient. The wsuits obtained using these tests en"bles the physician to decide on a suitable treatment for a cancer patient, and, in particular, to decide whether antibody therapy should be administered to a particular cancer patient.

The term "Single Nucleotide Polymorphism“ or "SNP" relates to a DNA sequence variation occurring commonly within a population in which a single nucleotide in the genome (or other shared sequence) differs between members of a biological species or paired somes.

SNPSfl occur in coding sequences of genes, non-coding regions of genes, or in intergenic region gions between genes). SNPs within a coding sequence may but do not necessarily [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN change the amino acid sequence of the protein that is produced, due to degeneracy of the genetic code. Thus, SNPs in the coding region are of two types, synonymous and nonsynonymous SNPS. Synonymous SNPs do not affect the protein sequence While nonsynonymous SNPs change the amino acid sequence of protein. The nonsynonymous SNPs are of two types: missense and nonsense. SNPs that are not in protein-coding regions may still affect gene splicing, transcription factor binding, messenger RNA degradation, or the sequence of ding RNA. Gene expression affected by this type of SNP is referred to as an eSNP (expression SNP) and may be upstream or downstream from the gene. s methods known in. the art can be used to ine the genotype for SNPs. Anelvtir‘ 111.14] lulva1 methods to discover novel SNPs and detect known SNPS include, for example, DNA sequencing, capillary electrophoresis, mass spectrometry, single-strand conformation rphism , electrochemical analysis, denaturating HPLC and gel electrophoresis, restriction fragment length polymorphism and ization analysis.

The process of ining which nucleotide is present at a particular SNP position described herein, for either or both alleles, can be referred to by such phrases as mining the genotype for a SNP" or "SNP genotyping". Thus, these phrases can refer to detecting a single allele otide) at a SNP on or can encompass detecting both alleles (nucleotides) at a SNP position (such as to determine the homozygous or heterozygous state of a SNP position).

Furthermore, these s may also refer to detecting an amino acid residue encoded by a SNP (such as alternative amino acid residues that are encoded by different codons created by alternative nucleotides at a SNP position).

A reagent that specifically detects a specific target SNP position disclosed herein, and that is preferably specific for a particular nucleotide (allele) of the target SNP position (i.e., the reagent preferably can differentiate between different alternative nucleotides at a target SNP position, thereby allowing the identity of the nucleotide t at the target SNP position to be ined) can be used for SNP detection. Typically, such detection reagent hybridizes to a target SNP—containing nucleic acid molecule by complementary base-pairing in a ce specific manner, and discriminates the target t sequence from other nucleic acid sequences such as an art-known form in a test sample. An example of a detection reagent is a non-nflglly occurring nucleic acid primer or probe that hybridizes to a target nucleic acidconta a SNP disclosed herein. In a preferred embodiment, such a primer or probe [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN differentiate between nucleic acids having a particular nucleotide (allele) at the target SNP position from other nucleic acids that have a different nucleotide at the same target SNP position. In addition, a detection reagent may hybridize to a c region 5' and/o. 3' to the SNP position. It will be apparent to one of skill in the art that such detections ts, such as such primers and probes are directly useful as reagents for genotyping one or more of the SNPs disclosed , and can be incorporated into any kit format.

For analyzing SNPs, it can be riate to use ucleotides specific for alternative SNP alleles. Such oligonucleotides that detect single tide variations in target sequences may be ed to by such terms as "allele—specific oligonucleotides", "allele-specific ", or "allele—specific primers“.

A SNP detection reagent may be labeled with a reporter such as a fluorogenic reporter dye that emits a detectable signal. While the preferred reporter dye is a fluorescent dye, any reporter dye that can be attached to a detection t such as an oligonucleotide probe or primer is suitable acco.ding to the invention. In yet another embodiment, the detection reagent may be further labeled with a quencher dye, especially when the reagent is used as a self— quenching probe such as a TaqMan probe. The SNP detection reagents disclosed herein may also contain other labels, including but not limited to, biotin for avidin binding, hapten for antibody binding, and oliconucleotide for bindin to another complementary oligonucleotide.

According to the present invention also reagents are contemplated that do not contain (or that are not complementary to) a SNP nucleotide to be identified but that are used to assay one or more SNPS disclosed herein. For example, primers that flank, but do not hybridize ly to a target SNP position are useful in primer extension reactions in which the primers hybridize to a region adjacent to the target SNP position (i.e., within one or more nucleotides from the target SNP site). During the primer extension reaction, a primer is typically not able to extend past a target SNP site if a particular nucleotide (allele) is present at that target SNP site, and the primer extension product can be detected in order to determine which SNP allele is present at the target SNP site. For example, particular ddNTPs are typically used in the primer extension reaction to terminate primer extension once a ddNTP is incorporated into the fiproduct. Thus, ts that bind to a nucleic acid molecule in a region adjacent to a [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN SNP site and that are used for assaying the SNP site, even though the bound sequences do not necessarily include the SNP site itself, are also plated according to the invention.

The term “FCGRZA” relates to the human FCGRZA gene. This gene encodes low affinity immunoglobulin gamma Fc region receptor II-a (CD32) and is one member of a family of immunoglobulin Fc receptor genes. The protein encoded by this gene is a cell surface receptor found on phagocytic cells such as macrophages and neutrophils, and is involved in the process of ytosis and clearing of immune complexes. Alternative splicing results in multiple transcript variants.

Preferably, the term "FCGRZAii relates to a nucleic acid comprising, preferably consisting of the nucleic acid sequence of SEQ ID NO: 61 of the sequence listing or a variant of said nucleic acid sequence and to a protein encoded by this nucleic acid, preferably to a protein comprising, ably consisting of the amino acid sequence of SEQ ID NO: 62 of the sequence listing or a variant of said amino acid ce. rs1801274 is a SNP in the FCGRZA gene. rs1801274 (C) encodes the arginine (R) allele, with the (T) allele encoding the variant histidine (H). This SNP is an intragenic transition tution with the following codon change: CAT,CGT and s in a missense mutation.

The SNP is known in the literature by many names, including A519C and R13lI-I. The t sequence is as follows: TGGGATGGAGAAGGTGGGATCCAAA[C/T]GGGAGAATTTCTGGGATTTTCCATT The term “MUCI “ relates to the human MUCI gene. This gene encodes Mucin 1, cell surface associated (MUCl) or polymorphic epithelial mucin (PEM) which is a member of the mucin family and is a membrane bound, ylated phosphoprotein. The protein is anchored to the apical surface of many epithelia by a embrane . Beyond the transmembrane domain is a SEA domain that contains a ge site for e of the large extracellular domain. The protein serves a protective function by binding to ens and also functions in a cell signaling capacity.

Preferably, the term "MUCl " relates to a nucleic acid comprising, preferably consisting of the nuclegcid sequence of SEQ ID NO: 63 of the sequence listing or a variant of said nucleicacid ence and to a protein encoded by this c acid, preferably to a protein [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN comprising, ably consisting of the amino acid sequence of SEQ ID NO: 64 of the sequence listing or a variant of said amino acid sequence. rs4072037 is a SNP in the MUCl gene. This SNP is an intragenic transition substitution with the following codon change: ACA,ACG and results in a silent mutation. The context ce is as follows: CCCCTAAACCCGCAACAGTTGTTAC[A/G]GGTTCTGGTCATGCAAGCTCTACCC The term "IL-10" relates to the human IL—lO gene. This gene encodes interleukin-10 (IL-10), also known as human cytokine synthesis inhibitory factor (CSIF), which is an anti— inflammatory cytokine.

Preferably, the term "IL—10" relates to a nucleic acid comprising, preferably consisting of the nucleic acid ce of SEQ ID NO: 65 of the sequence listing or a variant of said nucleic acid sequence and to a protein d by this nucleic acid, preferably to a protein comprising, preferably consisting of the amino acid sequence of SEQ ID NO: 66 of the sequence listing or a variant of said amino acid sequence. rsl800896 is a SNP in the IL-lO gene. This SNP is an intergenic /’ unknown intragenic transition substitution. The context sequence is as follows: CAACAC‘TACTAAGGCTTCTTTGGGA[A/G]GGGGAAGTAGGGATAGGTAAGAGGA The term A” relates to the human DNMT3A gene. This gene encodes DNA (cytosine—5)—methyltransferase 3A. The protein encoded by this gene is an enzyme that catalyzes the transfer of methyl groups to c CpG structures in DNA.

Preferably, the term "DNMT3A" s to a nucleic acid comprising, preferably ting of the nucleic acid ce of SEQ ID NO: 67 of the ce listing or a variant of said nucleic acid sequence and to a protein encoded by this nucleic acid, preferably to a protein comprising, preferably consisting of the amino acid sequence of SEQ ID NO: 68 of the sequence listing or a variant of said amino acid sequence. r3155g7 is a SNP in the DNMT3A gene. This SNP is an intragenic tion substitution inthe D T3A promoter region. The context sequence is as follows: [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN AATTCCACCAGCACAGCCACTCACT[A/G]TGTGCTCATCTCACTCCTCCAGCAG The term "SMAD4" relates to the human SMAD4 gene. This gene encodes Mothers against decapentaplegic homolog 4. The protein encoded by this gene is involved in cell signaling and belongs to the Darfwin family of proteins that modulate members of the TGFB protein superfamily. It binds receptor-regulated SMADs such as SMADI and SMADZ, and forms a complex that binds to DNA and serves as a transcription factor. It is the only known mammalian coSMAD.

Preferably, the term "SMAD4" s to a nucleic acid comprising, pretea‘(3'‘1.y censrsting of the nucleic acid sequence of SEQ ID NO: 69 of the sequence listing or a variant of said nucleic acid sequence and to a protein encoded by this nucleic acid, preferably to a protein comprising, preferably ting of the amino acid sequence of SEQ ID NO: 70 of the sequence listing or a valiant of said amino acid sequence. r312456284 is a SNP in the SMAD4 gene. This SNP is an intragenic transition substitution in the 3'-UTR. The t sequence is as follows: AGGTCCAGAGCCAGTGTTCTTGTTC[A/G]ACCTGAAAGTAATGGCTCTGGGTTG The term "EGF" relates to the human EGF gene. This gene encodes epidermal growth factor.

EGF is a growth factor that stimulates cell growth, eration, and differentiation by binding to its receptor EGFR.

Preferably, the term "EGF" relates to a c acid comprising, preferably ting of the nucleic acid sequence of SEQ ID NO: 71 of the sequence listing or a variant of said nucleic acid ce and to a protein encoded by this nucleic acid, preferably to a protein comprising, preferably ting of the amino acid sequence of SEQ ID NO: 72 of the sequence listing or a variant of said amino acid sequence. rs4444903 is a SNP in the EGF gene. This SNP is an intragenic transition substitution in the ’-UTR. The context sequence is as s: CTTTCAGCCCCAATCCAAGGGTTGT[A]G]GCTGGAACTTTCCATCAGTTCTTCC ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The term "CDHl" relates to the human CDHl gene. This gene encodes cadherin-l also known as CAM 120/80 or epithelial cadherin herin) or uvomorulin. The protein is classical member of the in superfamily. It is a calcium-dependent cell—cell adhesion glycoprotein composed of five extracellular cadherin repeats, a embrane region, and a highly conserved cytoplasmic tail. Loss of function is thought to contribute to progression in cancer by increasing proliferation, on, and/or metastasis.

Preferably, the term "CDHl " relates to a nucleic acid comprising, preferably consisting of the nucleic acid sequence of SEQ ID NO: 73 of the sequence listing or a t of said nucleic acid sequence and to a protein encoded by this nucleic acid, preferably to a protein comprising, preferably consisting of the amino acid sequence of SEQ 11) NO: 74 of the sequence g or a variant of said amino acid sequence. rsl6260 is a SNP in the CDHl gene. This SNP is an intragenic transversion substitution located in the promoter region of the CDHl gene. The context sequence is as follows: CTAGCAACTCCAGGCTAGAGGGTCA[A/C]CGCGTCTATGCGAGGCCGGGTGGGC The term " relates to the human ERCCl gene. This gene encodes DNA excision repair protein . The function of the ERCCl protein is predominantly in nucleotide excision repair of damaged DNA.

Preferably, the term "ERCCl" relates to a nucleic acid comprising, preferably consisting of the c acid sequence of SEQ {D N0: 75 of the sequence listing or a variant of said nucleic acid sequence and to a protein encoded by this nucleic acid, preferably to a protein comprising, preferably ting of the amino acid ce of SEQ ID NO: 76 of the sequence listing or a variant of said amino acid sequence. rsl 1615 is a SNP in the ERCCl gene. This SNP is a silent intragenic transition substitution.

The context sequence is as follows: ATCCCGTACTGAAGTTCGTGCGCAA[C/T]GTGCCCTGGGAATTTGGCGACGTAA The term "FCGR3A" relates to the human FCGR3A gene. This gene encodes low affinity immunoilobulin gamma Fc region receptor III-A. The protein encoded by this gene is part ofthe cl of differentiation cell surface molecules.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN Preferably, the term "FCGRSA" relates to a nucleic acid comprising, preferably consisting of the nucleic acid sequence of SEQ ID NO: 77 of the sequence listing or a variant of said nucleic acid sequence and to a protein encoded by this nucleic acid, preferably to a protein comprising, preferably consisting of the amino acid ce of SEQ ID NO: 78 of the sequence g or a variant of said amino acid sequence. 91 is a SNP in the FCGR3A gene. This SNP is an intragenic transversion substitution with the ing codon change: GTT,TTT and s in a missense mutation. rs396991 (T) encodes the phenylalanine (F) allele, with the (G) allele encoding the variant valine (V). The context sequence is as follows: CGGCTCCTACTTCTGCAGGGGGCTT[G/T]TTGGGAGTAAAAATGTGTCTTCAGA Claudins are a family of proteins that are the most important components of tight junctions, where they establish the paracellular barrier that controls the flow of molecules in the intercellular space between cells of an epithelium. Claudius are transmembrane proteins spanning the membrane 4 times with the inal and the C—terminal end both located in the cytoplasm. The first extracellular loop or domain consists on average of 53 amino acids, and the second extracellular loop or domain consists of around 24 amino acids. Cell surface proteins of the n family, such as CLDN182, are expressed in tumors of various origins, and are ularly suited as target structures in connection with antibody-mediated cancer immunotherapy due to their selective expression (no expression in a toxicity relevant normal tissue) and localization to the plasma membrane.

The term "CLDN" as used herein means claudin and includes CLDN18.2. Preferably, a claudin is a human n.

The term "CLDN18" relates to claudin 18 and includes any variants, including claudin 18 splice t 1 (claudin 18.1 8.1)) and claudin 18 splice variant 2 in 18.2 (CLDN18.2)).

The term "CLDN18.2" preferably relates to human .2, and, in particular, to a protein comprbg, preferably consisting of the amino acid sequence according to SEQ ID NO: 1 of the sequence listing or a variant of said amino acid sequence. The first extracellular loop or [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN domain of .2 preferably comprises amino acids 27 to 81, more preferably amino acids 29 to 78 of the amino acid sequence shown in SEQ ID NO: 1. The second extracellular loop or domain of CLuNlSZ preferably comprises amino acids l40 to l 80 of the amino acid1 ce shown in SEQ ID NO: 1. Said first and second extracellular loops or domains preferably form the extracellular n of CLDNl 8.2.

CLDNl8.2 is selectively expressed in normal tissues in differentiated epithelial cells of the gastric mucosa. CLDN18.2 is expressed in cancers of various origins such as pancreatic carcinoma, esophageal carcinoma, gastric carcinoma, bronchial carcinoma, breast carcinoma, and ENT . CLDN182 is a valuable target for the prevention and/or treatment of y , such as gastric cancer, esophageal cancer, pancreatic cancer, lung cancer such as non small cell lung cancer (NSCLC), ovarian cancer, colon cancer, hepatic cancer, head-neck cancer, and cancers of the gallbladder, and metastases f, in particular gastric cancer asis such as Krukenberg tumors, peritoneal metastasis, and lymph node metastasis.

The term "CLDN18.1" preferably relates to human CLDNl 8.1, and, in particular, to a protein sing, preferably consisting of the amino acid sequence according to SEQ ID NO: 2 of the sequence listing or a variant of said amino acid sequence.

"Prognosis" as used herein refers to a prediction of outcome and, in particular, the probability of progression-free survival (PFS) or disease-free survival (DFS). Survival is usually calculated as an average number of months (or years) that 50% of patients survive, or the percentage of patients that are alive after I, 5, l5, and 20 years. Prognosis is important for treatment decisions because patients with a good prognosis are usually offered less invasive treatments, while patients with poor prognosis are usually offered more sive treatments, such as more extensive chemotherapy drugs.

"Prediction" as used herein refers to providing information about the possible response of a e to a distinct eutic treatment.

The phrase "indicate a ris " refers to the indication of a certain degree of hood or proba ' ' . The phrase "indicate a reduced risk" refers to a low degree of likelihood or [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN probability. The phrase "indicate an increased risk" refers to a certain, higher or high degree of hood or probability.

If an event "indicates a d risk of a cancer patient not being a responder to treatment with an antibody" said event is indicative for a cancer patient being a responder to treatment with the antibody, i.e. it is likely that the patient is a responder to treatment with the antibody and optionally it is more likely that the patient is a responder to treatment with the antibody than the patient not being a responder to ent with the antibody. if an event "indicates an increased risk of a cancer patient not being a der to treatment with an antibody" said event is indicative for a cancer patient not being a responder to treatment with the antibody, i.e. it is likely that the patient is not a responder to treatment with the antibody and optionally it is more likely that the patient is not a responder to treatment with the antibody than the patient being a responder to treatment with the antibody.

If an event "indicates a d risk of poor clinical outcome" said event is indicative for a good clinical e, i.e. it is likely that there will be a good clinical outcome and optionally it is more likely that there will be a good clinical outcome than there being a poor clinical If an event "indicates an sed risk of poor clinical outcome" said event is indicative for a poor clinical outcome, i.e. it is likely that there will be a poor al outcome and optionally it is more likely that there will be a poor clinical outcome than there being a good clinical If an event "indicates a reduced risk of a cancer patient not experiencing progression—free survival" said event is indicative for a cancer patient experiencing progression-free survival, i.e. it is likely that the patient experiences progression—free survival and optionally it is more likely that the patient experiences progression-free survival than the patient not experiencing progression-free survival.

If an event "indicates an increased risk of a cancer patient not experiencing progression-free survival" said event is tive for a cancer patient not experiencing progression-free survixnie. it is likely that the patient does not experience progression-free survival and [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN optionally it is more likely that the patient does not experience progression—free survival than the patient experiencing progression-free survival.

The term "sample", as used herein, refers to any material which is obtained from a subject and which may be used for analytical purposes, in particular for the determination of the genotype for one or more single-nucleotide polymorphisms. In n embodiments, the samples described herein can be or can be derived from any tissues, cells and/or cells in biological fluids from, for example, a mammal or human to be tested. A sample may be isolated from a patient, e. g. from the human body. A sample can be a onated and/or purified sample. For example, samples encompassed by the present invention may be or may be derived from tissue (e.g. section or explant) s, single cell samples, cell colony samples, cell culture samples, blood (e.g. whole blood or blood on such as blood cell fraction, serum or plasma) samples, urine samples, or samples from other peripheral sources. In one particularly preferred embodiment, the sample is a tissue sample (e.g., a biopsy from a subject with or suspected of having cancerous tissue). For example, the sample may be a biopsy of a tumor.

The sample may be obtained from a patient prior to initiation of a therapeutic treatment, during the therapeutic treatment, and/or after the therapeutic treatment, e.g. prior to, during or following the stration of cancer therapy.

Sample als can be used to produce nucleic acid extracts (including DNA and/or RNA), proteins or membrane extracts from any bodily fluids (such as blood, serum, plasma, urine, saliva, phlegm, gastric , semen, tears, sweat, etc), skin, hair, cells (especially ted , biopsies, buccal swabs or tissue or tumor specimens.

The t ion fiirther relates to a kit comprising means such as reagents for determining the genotype for one or more single-nucleotide rphisms as described herein. In the context of the present invention, the term "kit of parts (in short: kit)" is understood to be any combination of at least some of the components identified herein, which are combined, coexisting lly, to a functional unit, and which can contain further components. For example, the kit may comprise pre—selected primers or probes specific for nucleic acid sequences comprising one or more single-nucleotide polymorphisms the genotype of which is to be determined. The kit may also comprise enzymes suitable for ying nucleic acids (e.g., polymerases such as Taq), and deoxynucleotides and buffers needear the reaction mixture for amplification. The kit may also comprise probes specific [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN for one or more single-nucleotide polymorphisms. In certain embodiments, said means are detectably labeled.

A kit of the invention may comprise (i) a container, and/or (ii) a data carrier. Said container may be filled with one or more of the above mentioned means or reagents. Said data carrier may be a non-electronical data carrier, e.g. a graphical data carrier such as an information , an ation sheet, a bar code or an access code, or an electronical data carrier such as a floppy disk, a compact disk (CD), a digital versatile disk (DVD), a microchip or another semiconductor—based electronical data carrier. The access code may allow the access to a database, e.g. an mternet datauase, a lized, or a decentralized datau'm-“DU. Said data carrier may comprise instructions for allowing the analysis of results obtained with said kit and, in particular, for the use of the kit in the methods of the invention.

Additionally or atively, said kit may comprise materials desirable from a commercial and user standpoint including buffer(s), reagent(s) and/or diluent(s).

Based on the s obtained (i.e. on the basis of the genotype for one or more single- nucleotide polymorphisms), the medical practitioner may choose a cancer therapy to which the patient is predicted as being sive, in particular antibody therapy. Preferably, a cancer therapy to which the t is predicted as being non-responsive is not administered to the patient.

Based on the result that the patient is ted as being non-responsive to antibody therapy, in particular antibody therapy acting through recruiting the patient’s immune system to destroy tumor cells, the medical practitioner may choose to administer cancer therapy which is ent from antibody y, in particular antibody therapy acting through recruiting the patient’s immune system to destroy tumor cells. In particular, the medical practitioner may choose to administer chemotherapy.

Based on the result that the patient is predicted as being responsive to antibody therapy, in particular antibody therapy acting through recruiting the patient’s immune system to destroy tumor cells, the medical practitioner may choose to ster dy y, in particular antibobtherapy acting through recruiting the patient’s immune system to destroy tumorcells, op ronally in combination with chemotherapy.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN The term "(therapeutic) treatment", in particular in connection with the treatment of cancer as used herein, relates to any treatment which aims at improving the health status and/or prolonging (increasing) the lifespan of a patient. Said treatment may ate , reduce the size or the number of tumors in a patient, arrest or slow the development of cancer in a patient, inhibit or slow the development of new cancer in a patient, decrease the frequency or severity of symptoms in a patient, and/or decrease recurrences in a t who currently has or who previously has had cancer. A (therapeutic) treatment of cancer may be ed from the group consisting of surgery, chemotherapy, radiation therapy and targeted therapy. One particularly preferred treatment according to the ion is the treatment of cancer involving therapeutic monoclonal antibodies against tumor antigens such as CLDN18.2 expressed on target cells.

Adjuvant therapy is a treatment that is given in addition to the primary, main or initial treatment. The surgeries and complex treatment regimens used in cancer therapy have led the term to be used mainly to describe adjuvant cancer treatments. An e of adjuvant y is the onal treatment usually given after surgery where all detectable disease has been removed, but where there remains a statistical risk of relapse due to occult disease.

Terms such as "responsive", or "responder" refer, in a therapeutic setting, to the fact that a patient has a therapeutic benefit from a given mode of treatment and, in particular, to the observation of an alleviation, prevention or elimination of a disease including shortening the duration of a e, arresting or slowing progression or worsening of a e, inhibiting or slowing the development of a new disease and/or recurrences, preventing or delaying the onset of a disease or the symptoms thereof, decreasing the frequency or severity of symptoms in a patient who tly has or who previously has had a disease and/or prolonging the lifespan of the patient. In particular, they refer to the observation of a reduction in tumor mass or of an increase in tumor free time, recurrence free time or overall al time.

Terms such as "non-responsive" or "non—responder" refer, in a therapeutic setting, to the fact that a patient has no therapeutic benefit from a given mode of treatment and, in ular, to no ation of an alleviation, prevention or elimination of a disease, i.e. the patient is resistfio treatment.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN ed set by MYN Complete response is defined as the absence of any residual disease such as cancer, and is usually assessed by pathological analysis of acquired tissue s. In this context, the term "pathological complete response" (pCR) is frequel tly used. In particular, pCR is defined as the absence of any residual invasive tumour cells in the original tumor bed. However, the definition of pCR may vary between ent grading systems. Pathological complete response has shown to be a prognostic factor for overall better survival, but also for disease- free survival and recurrence free survival.

Recurrence-free survival is defined as the time from randomization to the first of either recurrence or relapse, second , or death.

Progression-free survival (PFS) is a type of survival rate that measures the length of time during and after medication or treatment during which the disease being treated (usually ) does not get worse. It is sometimes used as a metric to study the health of a person with a disease to try to determine how well a new treatment is working and it is often used as a clinical nt in randomized controlled trials for cancer therapies.

According to the invention, the term "cancer patient experiencing progression-free surviva " relates to a cancer patient having a prolonged time period without progression of the disease, in particular when compared to the average of patients and/or when compared to patients which are non—responders to a given mode of ent. Preferably, said prolonged time period is at least 4, preferably at least 5, more preferably at least 6 months, such as at least 7 months or at least 8 months, said time period starting e.g. from the time of a first administration of a treatment.

The term "clinical outcome. . H . . . . . is defined as the cln 1c 1 result of a disease, eg. reduction or ration of symptoms, in ular following a treatment.

The term "recurrence" with respect to cancer includes occurrence of tumor cells at the same site and organ of the origin disease, distant metastasis that can appear even many years after the initial diagnosis and therapy of cancer, or to local events such as infiltration of tumor cells into regional lymph nodes.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The terms "individual" and "subject“ are used herein interchangeably. They refer to human , non-human primates or other mammals (e.g. mouse, rat, rabbit, dog, cat, cattle, swine, sheep, horse or primate) that can be afflicted with or are susceptible to a e or disorder (e.g., cancer) but may or may not have the disease or disorder. In many embodiments, the individual is a human being. Unless otherwise stated, the terms "individua " and "subject" do not denote a particular age, and thus encompass adults, elderlies, children, and newborns. In preferred embodiments of the present invention, the "individual" or "subject" is a "patient".

The term "patien " means according to the invention a subject for treatment, in particular a diseased t.

In one particularly preferred embodiment, a method of the invention is med on a patient which is already diagnosed as having . t cell" shall mean any undesirable cell such as a cancer cell. In preferred embodiments, the target cell expresses CLDN18.2.

In the context of the present invention, terms such as "protect", "prevent" or ylactic" relate to the prevention of the occurrence and/or the propagation of a disease in a subject and, in particular, to zing the chance that a subject will develop a e or to delaying the development of a disease. For example, a subject at risk for cancer would be a candidate for therapy to t cancer.

By "being at risk" is meant a subject that is identified as having a higher than normal chance of developing a disease, in particular cancer, compared to the general population. In addition, a t who has had, or who currently has, a disease, in particular cancer, is a subject who has an increased risk for developing a disease, as such a subject may continue to develop a disease. Subjects who currently have, or who have had, a cancer also have an increased risk for cancer metastases.

As used herein, the term "combination" in the context of the administration of a therapy refers to the use of more than one therapy or therapeutic agent. The use of the term "in combination" does not restrict the order in which the therapies or therapeutic agents are administered to a subjem therapy or eutic agent can be administered prior to, concomitantly with, or subse t to the administration of a second therapy or therapeutic agent to a subject.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN Preferably, the therapies or therapeutic agents are administered to a subject in a sequence, amount and/or within a time interval such that the therapies or therapeutic agents can act together. In a particular embodiment, the ies or eutic agents are administered to a subject in a sequence, amount and/or within a time interval such that they provide an increased benefit than if they were administered otherwise, in particular, independently from each other. Preferably, the increased benefit is a istic effect.

The term "disease" refers to an abnormal condition that affects the body of an individual. A e is often construed as a medical condition associated with specific symptoms and signs.

A disease may be caused by factors ally from an external source, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the individual afflicted, or similar problems for those in contact with the individual. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other ts and for other purposes these may be considered distinguishable categories. Diseases usually affect individuals not only physically, but also nally, as contracting and living with many diseases can alter one's perspective on life, and one's personality. ing to the invention, the term "disease" includes cancer, in particular those forms of cancer bed herein. Any reference herein to cancer or particular forms of cancer also includes cancer metastasis thereof. In a preferred embodiment, a disease to be treated ing to the present application involves cells expressing a tumor antigen such as CLDN18.2.

"Disease involving cells sing a tumor antigen" means according to the invention that a tumor antigen such as CLDN18.2 is expressed in cells of a diseased tissue or organ. In one embodiment, sion of a tumor antigen in cells of a diseased tissue or organ is increased compared to the state in a healthy tissue or organ. An increase refers to an increase by at least %, in ular at least 20%, at least 50%, at least 100%, at least 200%, at least 500%, at least 1000%, at least 10000% or even more. In one embodiment, expression is only found in a diseased tissue, while expression in a corresponding healthy tissue is sed. According to the invention, diseases involving cells expressing a tumor antigen include cancer diseases.

FurthDore, ing to the invention, cancer diseases preferably are those wherein the cancer cells s a tumor antigen.

[Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The terms "cancer disease" or "cancer" refer to or describe the physiological condition in an individual that is typically characterized by lated cell growth. Examples of cancers include, but are not limited to, carcinoma, lymphoma, ma, sarcoma, and leukemia. More particularly, es of such cancers include bone cancer, blood cancer, lung cancer, liver cancer, pancreatic , skin cancer, cancer of the head or neck, cutaneous or intraocular ma, uterine cancer, ovarian cancer, rectal cancer, cancer of the anal region, stomach cancer, colon cancer, breast cancer, prostate cancer, uterine cancer, carcinoma of the sexual and reproductive organs, Hodgkin's Disease, cancer of the esophagus, cancer of the small intestine, cancer of the endocrine system, cancer of the thyroid gland, cancer of the parathyroid gland, cancer of the l gland, sarcoma of soft tissue, cancer of the bladder, cancer of the kidney, renal cell carcinoma, carcinoma of the renal pelvis, neoplasms of the central nervous system (CNS), neuroectodermal cancer, spinal axis tumors, glioma, meningioma, and pituitary adenoma. The term "cancer" according to the invention also comprises cancer metastases. Preferably, a "cancer disease" is characterized by cells expressing a tumor antigen such as CLDN18.2 and a cancer cell expresses such tumor antigen. A cell expressing a tumor antigen such as CLDNl8.2 preferably is a cancer cell, preferably of the cancers described herein.

According to the invention, the term "tumor" or "tumor disease" refers to an abnormal growth of cells (called neoplastic cells, tumon'genous cells or tumor cells) preferably forming a swelling or lesion. By "tumor cell" is meant an al cell that grows by a rapid, uncontrolled cellular proliferation and continues to grow after the stimuli that initiated the new growth cease. Tumos show partial or complete lack of struc..1ral organization and functional coordination with the normal tissue, and usually form a distinct mass of tissue, which may be either benign, pre—malignant or malignant.

In one embodiment, a cancer according to the invention involves cancer cells expressing a tumor antigen such as .2. In one embodiment, the cancer is tumor antigen positive such as CLDNl8.2 positive. In one embodiment, sion of the tumor antigen such as CLDN18.2 is at the e of the cells. In one ment, at least 50%, ably 60%, 70%, 80% or 90% of the cancer cells are tumor antigen positive such as CLDN18.2 positive and/or at least 40%, preferably at least 50% of the cancer cells are ve for e exprerni of the tumor antigen such as CLDNl8.2. In one embodiment, at least 95% or at [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN least 98% of the cancer cells are tumor antigen ve such as CLDN18.2 positive. In one embodiment, at least 60%, at least 70%, at least 80% or at least 90% of the cancer cells are positive for sur ace expression of the ttnnor antigen such as CLDN l 8.2.

In one embodiment, a cancer involving cancer cells expressing .2 or a CLDN18.2 positive cancer is selected from the group ting of c cancer, esophageal cancer, pancreatic cancer, lung cancer such as non small cell lung cancer CNSCLC), ovarian cancer, colon cancer, hepatic cancer, head—neck , and cancer of the gallbladder and ases thereof, in particular gastric cancer metastasis such as Krukenberg tumors, peritoneal metastasis and lymph node metastasis. In one embodiment, the cancer is an adenocarcinoma, in particular an advanced adenocarcinoma. Particularly preferred cancer diseases are adenocarcinomas of the stomach, the esophagus, the pancreatic duct, the bile ducts, the lung and the ovary. In one embodiment, the cancer is selected from the group consisting of cance of the stomach, cancer of the esophagus, in particular the lower esophagus, cancer of the eso- c junction and gastroesophageal cancer. In a particularly red embodiment, the cancer is gastroesophagerl cancer such as metastfitic, refractory or recurrent advanced gastroesophageal cancer. In one embodiment, a CLDN18.2 positive tumor is a tumor of the above cancer types.

Embodiments involving a CLD “18.2 ve tumor or cancer cells expressing .2 preferably involve the use of an antibody having the ability of binding to CLDN18.2. In one embodiment, an antibody having the ability of binding to CLDN18.2 is a monoclonal, ic or humanized antibody, or a fragment of an antibody.

According to the ion, a "carcinoma" is a malignant tumor derived from epithelial cells.

This group represents the most common cancers, including the common forms of breast, prostate, lung and colon cancer.

"Adenocarcinoma" is a cancer that originates in glandular tissue. This tissue is also part of a larger tissue ry known as epithelial tissue. Epithelial tissue includes skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium is derived embryologically from ectoderm, endoderm and mesoderm. To be classified as adenoginoma, the cells do not necessarily need to be part of a gland, as long as they havesecret properties. This form of carcinoma can occur in some higher mammals, including [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN humans. Well entiated adenocarcinomas tend to resemble the glandular tissue that they are derived from, while poorly entiated may not. By staining the cells from a biopsy, a pathologist will determine whether the tui to is an adenocarcinoma or some other type of cancer. Adenocarcinomas can arise in many tissues of the body due to the ubiquitous nature of glands within the body. While each gland may not be secreting the same substance, as long as there is an exocrine fimction to the cell, it is considered glandular and its malignant form is therefore named adenocarcinoma. Malignant adenocarcinomas invade other tissues and ofien metastasize given enough time to do so. Ovarian adenocarcinoma is the most common type of ovarian carcinoma. It includes the serous and mucinous adenocarcinomas, the clear cell adenocarcinoma and the endometrioid adenocarcinoma.

By "metastasis" is meant the spread of cancer cells from its original site to r part of the body. The formation of metastasis is a very complex s and depends on detachment of malignant cells from the primary tumor, invasion of the extracellular matrix, penetration of the elial basement nes to enter the body cavity and vessels, and then, after being transported by the blood, infiltration of target organs. Finally, the growth of a new tumor at the target site depends on angiogenesis. Tumor metastasis ofien occurs even after the l of the primary tumor because tumor cells or ents may remain and p metastatic potential. In one embodiment, the term "metastasis" according to the invention relates to "distant metastasis" which relates to a metastasis which is remote from the primary tumor and the regional lymph node system. In one embodiment, the term "metastasis” according to the ion relates to lymph node metastasis. One particular form of metastasis which is treatable using the therapy of the invention is metastasis ating from gastric cancer as primary site. In preferred embodiments such gastric cancer asis is Krukenberg tumors, neal metastasis and/or lymph node metastasis.

A refractory cancer is a malignancy for which a particular ent is ineffective, which is either initially onsive to treatment, or which becomes unresponsive over time. The terms "refractoryH H , unresponsive" or "resistan " are used interchangeably herein.

Krukenberg tumor is an uncommon metastatic tumor of the ovary accounting for 1% to 2% of all ovarian tumors. Prognosis of Krukenberg tumor is still very poor and there is no establfivd treatment for Krukenberg tumors. Krukenberg tumor is a metastatic Signet ringcell a carcinoma of the ovary. Stomach is the primary site in most Krukenberg tumor [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN cases (70%). Carcinomas of colon, appendix, and breast (mainly invasive r oma) are the next most common primary sites. Rare cases of Krukenberg tumor originating from carcinomas of the gallbladder, biliary tract, pancreas, small ine, ampulla of Vater, cervix, and urinary r/urachus have been reported.

The term "surgery", as used herein, includes the removal of tumors in an operation. It is a common ent for cancer. A surgeon may remove the tumors using local excision.

The term "chemotherapy", as used herein, refers to the use of chemotherapeutic agents or COiuul r‘tions of chemotherapeutic , pref“? ly to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells hout the body mic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemotherapeutic agents according to the ion include cytostatic compounds and cytotoxic compounds. Traditional chemotherapeutic agents act by g cells that divide rapidly, one of the main properties of most cancer cells. This means that chemotherapy also harms cells that divide rapidly under normal circumstances such as cells in the bone marrow, digestive tract, and hair follicles. This results in the most common side-effects of chemotherapy. ing to the ion, the term "chemotherapy" preferably does not include antibodies that target proteins that are abnormally expressed in cancer cells (tumor antigens) and act through recruiting the patient's immune system to destroy tumor cells.

Antibodies that target ns that are abnormally expressed in cancer cells (tumor antigens) and act through a therapeutic moiety or agent conjugated to the antibody, however, can be viewed as a form of chemotherapy. r, in the strictest sense, the term "chemotherapy" according to the invention does not include targeted therapy.

According to the invention, the term "chemotherapeutic agent" includes taxanes, platinum compounds, nucleoside analogs, camptothecin analogs, anthracyclines, etoposide, bleomycin, vinorelbine, cyclophosphamide, and combinations thereof. According to the invention a reference to a chemotherapeutic agent is to include any prodrug such as ester, salt or derivan such as conjugate of said agent. Examples are conjugates of said agent With a [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN carrier substance, e.g. protein-bound paclitaxel such as albumin-bound paclitaxel. Preferably, salts of said agent are ceutically acceptable.

Taxanes are a class of ene compounds that were first derived from natural sources such as plants of the genus Taxus, but some have been synthesized ially. The principal mechanism of action of the taxane class of drugs is the disruption of microtubule function, thereby inhibiting the process of cell division. Taxanes include docetaxel (Taxotere) and axel ).

According to the invention? the term "docetaxel" refers to a compound having tLe following formula: In particular, the term "docetaxel" refers to the compound l,7B,lOB-trihydroxy—9—oxo—5 [3,20- epoxytax—l l—ene-Zu,4,l3a-triyl 4—acetate 2-benzoate 13-{(2R,3S)[(tert—butoxycarbonyl)- amino]hydroxy—3—phenylpropanoate} .

According to the invention, the term "paclitaxel" refers to a compound having the following formula: [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In ular, the term "paclitaxel" refers to the compound (2d,40t,5[3,7B,1OB,13d)—4,10-bis- (acetyloxy){[(2R,3 S)—3-(benzoylamino)hydroxy—3-pheny1propanoyl]oxy} -l ,7— dihydroxy—9-oxo-5,20—epoxytax-1 1—en—2-yl benzoate.

Accordin to the invention, the term " g latinum com ound" refers to com ounds containin platinum in their structure such as platinum xes and includes compounds such as cisplatin, carboplatin and oxaliplatin.

The term atin" or "cisplatinum" refers to the nd cis- diamminediclfloroplatinumfll) (CDDP) ofthe following formula: The term "carboplatin" refers to the compound cis—diammine(1,l- cyclobutanedicarboxylato)platinum(II) of the following formula: 1P1I/O_‘/<}\/\/ H3N \O—< \/ The term "oxaliplatin" refers to a compound which is a platinum compound that is complexed to a ocyclohexane carrier ligand of the following formula: H2 0 N\ /O """"""NlPt\0 H2 0 In particular, the term "oxaliplatin" refers to the compound [(1R,2R)-cyclohexane—l,2- diamine](ethanedioato—0,0')platinum(ll). Oxaliplatin for injection is also marketed under the tradefiie Eloxatine.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The term "nucleoside analog" refers to a structural analog of a nucleoside, a category that includes both purine s and pyrimidine analogs.

The term "gemcitabine" is a compound which is a a nucleoside analog of the following formula: oé‘N“3] HO3%90H In particular, the term refers to the compound o—l-(2-deoxy—2,2-difluoro-B—D—erythro- pentofuranosyl)pyrimidin—2(1H)-one or 4-amino—l-[(2R,4R,5R)—3,3—difluorohydroxy—5- xymethyl)oxolan—2-yl]-1 ydropyrimidin—2—one.

The term "nucleoside analog" includes fluoropyrimidine derivatives such as fluorouracil and prodrugs thereof. The term ouracil" or "5—fluorouracil" (S—FU or fSU) (sold under the brand names Adrucil, Carac, Efudix, Efudex and Fluoroplex) is a compound which is a pyrimidine analog of the following formula: In particular, the term refers to the compound S—fluoro-lH—pyrimidine-Z,4-dione.

The term "capecitabine" (Xeloda, Roche) refers to a herapeutic agent that is a prodrug that is converted into S—FU in the tissues. Capecitabine which may be orally administered has the following formula: [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN HO OH H30‘‘‘‘‘20§ ,,,,,,“XXL 1 W‘E 05V In particular, the term refers to the compound pentyl [l-(3,4-dihydroxy—5— methyltetrahydrofuran—2-yl)-5—fluoro-2—oxo— 1 H-pyrimidin—4-yl]carbamate.

The term ic acid" or "leucovorin" refers to a compound useful in synergistic combination with the chemotherapy agent S-fluorouracil. Thus, if reference is made herein to the administration of 5-fluorouracil or a g thereof, said administration in one embodiment may comprise an adminis.-..tion in conjunction with f. lini. acid. Folinic acid has the following formula: _ l ° V” 05‘“ hit/“:[Nj/m - o HZNXN O OH H H In particular, the term refers to the compound (ZS)—2—{[4-[(2-amino-5—formy1—4—oxo—5,6,7,8- tetrahydro—lH-pteridin—6-yl)methylamino]benzoyl]amino}pentanedioic acid.

According to the invention, the term "camptothecin analog" refers to derivatives of the compound camptothecin (CPT; ethylhydroxy—1H-pyrano[3',4':6,7]indolizino[l,2-b] quinoline-3,14—(4H,12H)—dione). Preferably, the term "camptothecin analog" refers to compounds comprising the ing structure: [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN According to the invention, preferred camptothecin analogs are inhibitors of DNA enzyme topoisomerase I (topo 1). Preferred camptothecin analogs according to the ion are irinotecan and topotecan.

Irinotecan is a drug preventing DNA from unwinding by inhibition of topoisomerase I. In chemical terms, it is a semisynthetic analogue of the natural alkaloid camptothecin having the following formula: ifi/K’AO/ CNC 912/M W0/ \ O H3C' In particular, the term "iiinotecan" refers to the compound (S)—4,1l-diethy1-3,4,12,l4— tetrahydro—4-hydroxy—3,14—dioxolH—pyrano[3 ’ ,4’ :6,7]—indolizino[ l ,2-b]quinolin—9-yl—[ 1 ,4’- bipiperidine1-1 ’—carboxylate.

Topotecan is a omerase inhibitor of the formula: H30.

H30 / HO N O In particular, the term "topotecan" refers to the compound (S)—l0—[(dimethylamino)methyl]—4- ethyl-4,9-dihydroxy-1H—pyrano[3',4':6,7]indolizino[1 uinoline—3,14(4H,12H)-dione drochloride.

Anthracyclines are a class of drugs commonly used in cancer chemotherapy that are also antibiotics. Structurally, all anthracyclines share a common four—ringed 7,8,9,10- tetrahydrotetracene-S,lZ—quinone structure and usually require glycosylation at specific sites.

Anthraeyclines preferably bring about one or more of the following mechanisms of action: 1.

InhibiD DNA and RNA synthesis by intercalating between base pairs of the A , thus preventing the replication of rapidly-growing cancer cells. 2. Inhibiting ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN topoisomerase II enzyme, preventing the relaxing of supercoiled DNA and thus blocking DNA transcription and replication. 3. Creating iron-mediated free oxygen radicals that damage the DNA and cell membranes.

According to the invention, the term "anthracycline" preferably relates to an agent, preferably an anticancer agent for inducing sis, preferably by inhibiting the rebinding of DNA in topoisomerase 11.

Examples of anthracyclines and anthracycline analogs e, but are not limited to, daunorubicin (daunomycin), doxorubicin (adriamycin), epirubicin, idarubicin, rhedomycin, pyrarubicin, valrubicin, N—trifluoro-acetyl doxorubicin—M-valerate, aclacinomycin, morpholinodoxorubicin (morpholino-DOX), cyanomorpholino—doxorubicin (cyano- morpholino-DOX), 2—pyrrolino—doxorubicin (2-PDOX), 5-iminodaunomycin, mitoxantrone and aelacinomycin A (aclarubicin). Mitoxantrone is a member of the anthracendione class of compounds, which are anthracycline analogs that lack the sugar moiety of the anthracyclines but retain the planar polycylic aromatic ring structure that permits intercalation into DNA.

Specifically plated as anthracycline in the context of the present ion is epirubicin. Epirubicin is an anthracycline drug which has the following a: ‘ ; H3C’O 0 OH 0,, 0 CH3 and is marketed under the trade name Ellence in the US and Pharmorubicin or Epirubicin Ebewe ere. In particular, the term "epirubicin" refers to the compound (8R,IOS) [(28,48,5R,6S)—4—amino—5-hydroxy—6-methyl—oxan—2-yl]oxy—6,1 l-dihydroxy—S—(z- hydroxyacetyl)— l -methoxy—8-methy1—9, 1 dro—7H—tetracen—5,12-dion. Epirubicin is favoured over doxorubicin, the most r anthracycline, in some chemotherapy ns as it appears to cause fewer side—effects.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The term side" refers to a semisynthetic derivative of podophyllotoxin that exhibits mor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex s breaks in double ed DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide has the following formula: H,c OCHG OWQ>IL.~O> In particular, the term refers to the compound 4'-demethyl—epipodophyllotoxin 9-[4,6-0—(R)- ethylidene-beta-D-glucopyranoside], 4' -(dihydrogen phosphate).

The term "bleomycin" refers to a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. When used as an anticancer agent, it works by causing breaks in DNA. Bleomycin preferably comprises a nd having the following formula: 8 HO \ / NH N CE?) NH , H// OH \‘N C’)’ N r O O n 8 CH3 um I nu I\ may I v]: UI| NH‘o 0 j} CH3NH o o H3C‘s+ O OH OH N/ \ / H30 ”N N: NH O OH H2? H0 H2N NH2 The term "vinorelbine" refers to an anti—mitotic chemotherapy drug that is a semi—synthetic vinca alkaloid and is given as a treatment for some types of cancer, including breast cancer and nDsmall cell lung cancer. Vinorelbine preferably comprises a compound having the following formula: [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Cyclophosphamide is a nitrogen mustard alkylating agent from the horines group. The main use of cyclophosphamide is with other chemotherapy agents in the treatment of some forms of cancer. Cyclophosphamide preferably comprises a compound having the ing formula: In the context of the present invention, the term "radiation therapy" refers to the use of high- energy x—rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the .

The way the radiation y is given depends on the type and stage of the cancer being treated.

According to the invention, the term "targeted therapy" relates to any therapy that can be used to target preferentially diseased cells such as cancer cells While non-diseased cells are not targeted or targeted to a lesser extent. Targeting of diseased cells preferably s in g and/or impairment of proliferation or viability of diseased cells. Such therapy includes i) antibodies, antibody fragments, and ns that are either naked or conjugated to a thera 'c moiety that target certain cell surface s on diseased cells, such as tumor antigens, for example, CLDN18.2, (e.g. antibodies or antibody conjugates against CLDN18.2 [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN as bed herein) or ii) small molecules which impair proliferation or viability of ed cells. In a specific embodiment, the agent binds to an antigen that is expressed at a greater level on diseased than on normal stem cells. In a specific embodiment, the agent binds specifically to a tumor antigen. Traditional chemotherapy or herapy is not considered a "targeted therapy" despite its often being aimed at the tumours. Furthermore, the term "antibody therapy" according to the invention preferably does not include therapy with antibodies, fragments or derivatives thereof that are conjugated to a therapeutic moiety but merely relates to therapy with dies, fragments or tives thereof acting through recruiting the patient's immune system to destroy tumor cells.

The term "antigen” relates to an agent comprising an e against which an immune se is to be generated and/or is directed. The term en“ includes in particular proteins, peptides, polysaccharides, nucleic acids, especially RNA and DNA, and nucleotides.

The term "antigen" also includes agents, which become antigenic — and sensitizing — only through transformation (e.g. intermediately in the molecule or by completion with body protein). An antigen or a processing product thereof is preferably recognizable by a T or B cell receptor, or by an immunoglobulin molecule such as an antibody. In a preferred embodiment, the antigen is a e-associated antigen, such as a tumor antigen, such as CLDN18.2.

In the context of the present invention, the term "tumor antigen" or "tumor-associated antigen" relates to an antigen which is present in tumor cells. Preferably the antigen is present on tumor cells, such as on the surface of tumor cells. Preferably, the "tumor antigen" is expressed by tumor cells. In one embodiment, the term "tumor antigen" relates to proteins which are aberrantly expressed in tumor cells when compared to the normal, i.e. non- tumorous, cells. For example, expression may be only found in tumor cells but not in th normal, i.e. non-tumorous, cells or the level of expression may be higher in tumor cells compared to the normal, i.e. non-tumorous, cells. In one embodiment, the term "tumor antigen" relates to proteins that are under normal conditions cally expressed in a limited number of tissues and/or organs or in specific developmental stages and are expressed or aberrantly expressed in one or more tumor or cancer tissues. In the context of the present ion, a tumor antigen is preferably ated with the cell surface of a cancer cell and is preferfi not, only rarely or at a lower level expressed in normal tissues and cells.

Prefer to the invention, a tumor n is not sed in a cell if the level of , according ation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN expression is below the detection limit and/or if the level of expression is too low to allow binding by tumor antigen-specific antibodies added to the cells. A particularly preferred tumor antigen according to the invention is CLDN18.2.

According to the invention, the term "tumor antigen-positive cancer" or "tumor antigen- positive tumor" or similar terms means a cancer or tumor involving cancer or tumor cells expressing a tumor antigen, preferably on the surface of said cancer cells or tumor cells. A tumor antigen is expressed on the surface of cells if it is located at the surface of said cells and is accessible to binding by tumor antigen—specific antibodies added to the cells. in one preferred embodiment of the ion, a "tumor n-positive cancer" or "tumor antigen-positive tumor" is a "CLDN18.2-positive cancer" or "CLDN18.2—positive tumor". ing to the invention, the term "CLDN18.2 positive cancer" or "CLDN18.2-positive tumor" means a cancer or tumor involving cancer or tumor cells sing CLDN18.2, preferably on the surface of said cancer cells or tumor cells.

"Cell e" is used in accordance with its normal meaning in the art, and thus es the outside of the cell which is accessible to binding by proteins and other molecules.

The term cellular portion" in the context of the present ion refers to a part of a molecule such as a protein that is facing the extracellular space of a cell and preferably is ible from the outside of said cell, e.g., by antigen-binding molecules such as antibodies located outside the cell. Preferably, the term refers to one or more extracellular loops or domains or a fragment thereof.

According to the invention, .2 is not substantially expressed in a cell if the level of expression is lower compared to expression in stomach cells or stomach tissue. Preferably, the level of expression is less than 10%, preferably less than 5%, 3%, 2%, 1%, 0.5%, 0.1% or 0.05% of the expression in stomach cells or stomach tissue or even lower. Preferably, CLDN18.2 is not substantially expressed in a cell if the level of expression exceeds the level of expression in non—cancerous tissue other than stomach by no more than 2-fold, ably 1,5-fold, and preferably does not exceed the level of expression in said non—cancerous tissue.

Preferfi, CLDN18.2 is not substantially expressed in a cell if the level of expression is [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN below the detection limit and/or if the level of expression is too low to allow binding by CLDN18.2-specific antibodies added to the cells.

According to the invention, CLDN18.2 is expressed in a cell if the level of sion exceeds the level of expression in non-cancerous tissue other than stomach preferably by more than 2- fold, preferably 10-fold, IOO—fold, lOOO—fold, or lOOOO-fold. ably, CLDN18.2 is expressed in a cell if the level of expression is above the detection limit and/or if the level of expression is high enough to allow binding by CLDN18.2—specific antibodies added to the cells. Preferably, CLDN18.2 expressed in a cell is expressed or exposed on the e of said cell.

The term "epitope" refers to an antigenic determinant in a molecule, i.e., to the part in a molecule that is recognized by the immune system, for example, that is recognized by an antibody. For example, es are the discrete, three—dimensional sites on an n, which are recognized by the immune system. Epitopes usually consist of chemically active surface groupings of molecules such as amino acids or sugar side chains and usually have specific three dimensional structural characteristics, as well as specific charge characteristics. mational and non-conformational epitopes are distinguished in that the binding to the former but not the latter is lost in the presence of denaturing solvents. An e of a protein preferably comprises a continuous or discontinuous portion of said protein and is preferably between 5 and 100, ably between 5 and 50, more preferably between 8 and 30, most preferably between 10 and 25 amino acids in length, for example, the epitope may be preferably 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, or 25 amino acids in length.

The term "antibody" includes a glyccprcteiu comprising at least two heavy (H) chains and two light (L) chains inter-connected by disulfide bonds, and any le comprising an antigen-binding portion of such glycoprotein. The term "antibody" includes monoclonal dies, recombinant antibodies, human antibodies, humanized antibodies, chimeric antibodies, fragments or derivatives of antibodies, ing, Without limitation, single chain antibodies, e.g., scFv's and antigen—binding antibody nts such as Fab and Fab' fragments and also includes all recombinant forms of antibodies, e.g., antibodies expressed in prokaxfies, unglycosylated antibodies, and any antigen—binding antibody fragments and deriva s as described herein. Each heavy chain is comprised of a heavy chain variable [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN region (abbreviated herein as VH) and a heavy chain constant . Each light chain is comprised of a light chain variable region (abbreviated herein as VL) and a light chain constant region. The VH and VL regions can be further subdivided into regions of hypervariability, termed complementarity determining regions (CDR), interspersed with regions that are more ved, termed framework regions (FR). Each VH and VL is composed of three ‘CDRS and four FRs, arranged from amino-terminus to carboxy—terminus in the following order: FRl, CDRl, FRZ, CDR2, FR3, CDR3, FR4. The variable regions of the heavy and light chains contain a binding domain that interacts with an antigen. The constant s of the antibodies may mediate the g of the immunoglobulin to host tissues or factors, including various cells of the immune system (e.g., effector cells) and the first component (Clq) of the classical complement .

The term "monoclonal antibody" as used herein refers to a preparation of antibody molecules of single molecular ition. A onal antibody displays a single binding specificity and affinity. In one embodiment, the monoclonal antibodies are produced by a hybridoma which includes a B cell obtained from a non-human animal, e.g., mouse, fused to an immortalized cell.

The term "recombinant antibody", as used herein, includes all antibodies that are prepared, expressed, d or isolated by recombinant means, such as (3) antibodies isolated from an animal (e.g., a mouse) that is transgenic or transchromosomal with respect to the globulin genes or a hybridoma prepared therefrom, (b) antibodies isolated from a host cell transformed to express the antibody, e.g., from a transfectoma, (c) antibodies isolated from a inant, combinatorial antibody library, and (d) antibodies prepared, expressed, created or isolated by any other means that involve splicing of globulin gene sequences to other DNA sequences.

The term "human antibody", as used herein, is intended to include antibodies having variable and constant regions derived from human germline immunoglobulin sequences. Human antibodies may include amino acid residues not encoded by human germline immunoglobulin sequences (e.g., ons introduced by random or site-specific mutagenesis in vitro or by c mutation in viva).

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The term "humanized antibody" refers to a molecule having an n g site that is substantially derived from an immunoglobulin from a non-human species, wherein the remaining immunoglobulin structure of the molecule is based upon the structure and/or sequence of a human oglobulin. The antigen binding site may either se complete variable domains fiised onto constant domains or only the complementarity determining regions {CDR} grafted ente- erpropriate framework regions in the le domains. Antigen binding sites may be wild—type or modified by one or more amino acid substitutions, e.g. modified to resemble human immunoglobulins more closely. Some forms of humanized antibodies preserve all CDR sequences (for e a humanized mouse antibody which contains all six CDRS from the mouse dy). Other forms have one or more CDRs which are altered with respect to the original antibody.

The term "chimeric antibody" refers to those antibodies wherein one portion of each of the amino acid sequences of heavy and light chains is homologous to corresponding sequences in antibodies derived from a particular species or belonging to a particular class, while the remaining segment of the chain is homologous to corresponding sequences in another. lly the variable region of both light and heavy chains mimics the variable regions of antibodies derived from one species of mammals, while the nt portions are homologous to sequences of antibodies derived from another. One clear age to such chimeric forms is that the variable region can iently be derived from presently known sources using readily available B-cells or hybridomas from non—human host organisms in combination with constant regions derived from, for example, human cell preparations. While the variable region has the advantage of ease of preparation and the specificity is not affected by the , the constant region being human, is less likely to elicit an immune response from a human subject when the antibodies are ed than would the constant region from a non human source. However the definition is not limited to this particular example.

Antibodies may be derived from different species, including but not limited to mouse, rat, rabbit, guinea pig and human.

Antibodies described herein include IgA such as IgAl or IgAZ, IgGl, IgGZ, IgG3, IgG4, IgE, IgM, and IgD antibodies. In various embodiments, the dy is an IgGl antibody, more particularly an IgGl, kappa or IgGl, lambda isotype (i.e. IgGl, K, 9»), an IgGZa antibody (e.g.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN IgGZa, 1c, 9»), an IgG2b antibody (e.g. IgGZb, K, it), an IgG3 antibody (e.g. IgG3, K, it) or an IgG4 antibody (e.g. IgG4, K, it).

As used herein, a "heterologous antibody" is defined in relation to a transgenic sm producing such an antibody. This term refers to an antibody having an amino acid sequence or an encoding c acid sequence corresponding to that found in an organism not consisting of the transgenic sm, and being lly derived from a species other than the transgenic organism.

As used herein, a "heterohybrid dy" refers to an antibody having light and heavy chains of different organismal origins. For example, an antibody having a human heavy chain associated with a murine light chain is a hybrid antibody.

The antibodies described herein are preferably isolated. An ted antibody" as used herein, is intended to refer to an antibody which is substantially free of other antibodies having different antigenic specificities (e.g., an isolated antibody that specifically binds to a tumor antigen is substantially free of antibodies that specifically bind antigens other than the tumor antigen). An isolated antibody that specifically binds to an epitope, isoform or variant of a human tumor antigen may, however, have cross—reactivity to other related antigens, e.g., from other species (e.g., tumor antigen species homologs). Moreover, an isolated antibody may be substantially free of other cellular material and/or chemicals. In one embodiment of the invention, a combination of "isolated" monoclonal antibodies relates to antibodies having different cities and being combined in a well-defined ition or mixture.

The terms "antigen-binding portion" of an antibody (or simply ng portion") or "antigen— binding fragment" of an antibody (or simply "binding fragment") or similar te r is refer to one or more fragments of an dy that retain the ability to specifically bind to an antigen. It has been shown that the antigen-binding function of an antibody can be performed by fragments of a full-length antibody. Examples of g fragments encompassed within the term "antigen-binding portion" of an antibody include (i) Fab nts, monovalent fragments ting of the VL, VH, CL and CH domains; (ii) F(ab')2 fragments, bivalent fragments comprising two Fab fragments linked by a disulfide bridge at the hinge region; (iii) Fd fr ents consisting of the VH and CH s; (iv) FV fragments consisting of the VL and omains of a single arm of an antibody, (v) dAb fragments (Ward et al., (1989) [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Nature 341: 6), which consist of a VH domain; (vi) isolated complementarity determining regions (CDR), and (vii) ations of two or more isolated CDRS which may optionally be joined by a synthetic linker. rmore, although the two domains of the Fv fragment, VL and VH, are coded for by separate genes, they can be , using recombinant methods, by a synthetic linker that enables them to be made as a single protein chain in which the VL and VH regions pair to form monovalent molecules (known as single chain Fv (scFv); see e.g., Bird et al. (1988) Science 242: 6; and Huston et a1. (1988) Proc. Natl. Acad.

Sci. USA 85: 5879—5883). Such single chain antibodies are also intended to be encompassed within the term "antigen-binding fragment" of an antibody. A further example is binding- domain immunoglobulin fusion ns comprising (i) a binding domain polypeptide that is fused to an immunoglobulin hinge region ptide, (ii) an immunoglobulin heavy chain CH2 constant region fused to the hinge region, and (iii) an immunoglobulin heavy chain CH3 constant region timed to the CH2 constant region. The binding domain ptide can be a heavy chain variable region or a light chain variable region. The binding—domain immunoglobulin fusion proteins are further disclosed in US 118592 and US 2003/0133939. These antibody fragments are obtained using conventional techniques known to those with skill in the art, and the fragments are screened for utility in the same manner as are intact antibodies.

The term "binding domain" characterizes in connection with the present invention a structure, eg. of an antibody, which binds to/interacts with a given target structure/antigen/epitope.

Thus, the binding domain according to the invention designates an "antigen-interaction—site".

All antibodies and derivatives of antibodies such as antibody fragments as described herein for the purposes of the invention are encompassed by the term "antibody". The term "antibody derivatives" refers to any modified form of an antibody, e.g, a conjugate of the dy andLU V1 Ll another agent or antibody, or an antibody nt.

Naturally occurring antibodies are generally monospecific, i.e. they bind to a single n.

The present invention comprises antibodies binding to a target cell (by engaging a tumor antigen) and a second entity such as a cytotoxic cell (e.g. by ng the CD3 receptor). The antibodies of the present invention may be bispecific or multispecific such as trispecific, tetrasrfi'frc and so on.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The term "bispecific molecule" is intended to include an agent which has two different binding specificities. For e, the molecule may bind to, or interact with (a) a cell surface antigen, and (b) a receptor such as an F0 receptor on the surface of an effector cell. The term "multispecific molecule" is intended to include an agent which has more than two different binding specificities. For example, the molecule may bind to, or interact with (a) a cell surface antigen, (b) a receptor such as an Fc receptor on the surface of an effector cell, and (c) at least one other component. Accordingly, the term "antibody against a tumor antigen" includes, but is not limited to, bispecific, trispecific, tetraspecific, and other multispecific molecules which are directed to a tumor n, and to other s, such as Fc receptors on effector cells. The term "bispecific antibodies” also includes diabodies. Diabodies are bivalent, iiic antibodies in which the VH and VL domains are sed on a single polypeptide chain, but using a linker that is too short to allow for pairing n the two domains on the same chain, thereby forcing the s to pair with complementary domains of another chain and creating two antigen binding sites (see cg. , Holliger, P., et a1. (1993) Proc. Natl. Acad. Sci.

USA 90: 6444-6448; Poljak, R. J., et a1. (1994) Structure 2: 1121-1123).

According to the invention, an antibody may exert its therapeutic effect h recruiting the t’s immune system to destroy tumor cells and/or through a therapeutic moiety or agent coupled to the antibody. For the purpose of the present invention, such antibody conjugates may be considered being encompassed by the term "chemotherapeutic agent" while antibodies exerting their therapeutic effect through recruiting the patient’s immune system to destroy tumor cells are not.

In the context of the present invention, an antibody preferably is capable of acting through recruiting the patient’s immune system to destroy tumor cells, i.e. the antibody, in particular when bound to its target such as a tuner andgen on a diseased cell, s immune effector functions as bed herein. Preferably, said immune effector ons are directed against cells such as cancer cells carrying a tumor n such as CLDN18.2 on their surface.

The term "immune effector functions" in the context of the present ion includes functions mediated by components of the immune system that result e.g. in the inhibition of tumor growth and/or inhibition of tumor development, including inhibition of tumor disserfiion and metastasis. Preferably, immune effector functions result in killing of cancercells. h functions se complement dependent cytotoxicity (CDC), antibody- [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN dependent cell—mediated xicity (ADCC), dy-dependent cell—mediated phagocytosis (ADCP), induction of apoptosis in the cells carrying the tumor antigen, cytolysis of the cells carrying the tumor antigen, and/or inhibition of eration of the cells carrying the tumor antigen. Binding agents may also exert an effect simply by g to tumor antigens on the surface of a cancer cell. For example, antibodies may block the function of the tumor antigen or induce apoptosis just by binding to the tumor antigen on the surface of a cancer cell.

Antibody—dependent ediated cytotoxicity ADCC describes the cell-killing ability cf effector cells, in particular lymphocytes, which preferably requires the target cell being marked by an antibody.

ADCC preferably occurs when antibodies bind to antigens on tumor cells and the antibody Fc domains engage Fc receptors (FcR) on the surface of immune effector cells. Several es of Fc receptors have been identified, and specific cell populations characteristically express defined Fc ors. ADCC can be viewed as a mechanism to directly induce a le degree of immediate tumor destruction that leads to antigen presentation and the ion of tumor-directed T—cell responses. ably, in viva induction of ADCC will lead to tumor— directed T-cell responses and host~derived dy responses. ment-dependent cytotoxicity CDC is another cell-killing method that can be directed by antibodies. IgM is the most effective isotype for complement activation. IgG1 and IgG3 are also both very effective at directing CDC Via the classical complement-activation pathway. Preferably, in this cascade, the formation of antigen-antibody complexes s in the uncloaking of multiple Clq binding sites in close proximity on the C32 domains of participating antibody molecules such as IgG molecules (Clq is one of three subcomponents of complement C1). Preferably these uncloaked Clq binding sites convert the previously low—affinity Clq—IgG interaction to one of high avidity, which triggers a cascade of events involving a series of other complement proteins and leads to the proteolytic release of the effector-cell chemotactic/activating agents C3a and C5a. Preferably, the complement cascade ends in the formation of a membrane attack complex, which creates pores in the cell membrane that facilitate free e of water and solutefito and out of the cell.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In order to inhibit tumor growth and/or tumor development, ing to the invention, an antibody may be conjugated to a therapeutic moiety or agent, such as a cytotoxin, a drug (e.g., an immunosuppressant) or a radioisotope. A xin or xic agent es any agent that is detrimental to and, in particular, kills cells. Examples include taxol, cytochalasin B, gramicidin D, ethidium bromide, emetine, mitomycin, etoposide, tenoposide, vincristine, vinblastine, colchicin, doxorubicin, ubicin, dihydroxy anthracin dione, mitoxantrone, mithramycin, actinomycin D, amanitin, 1-dehydrotestosterone, glucocorticoids, procaine, tetracaine, lidocaine, propranolol, and puromycin and analogs or homologs thereof. Suitable therapeutic agents for forming antibody conjugates include, but are not limited to, antimetabolites (e.g., methotrexate, 6—mercaptopurine, 6—thioguanine, cytarabine, fludarabin, S-fluorouracil decarbazine), alkylating agents (e.g., mechlorethamine, thioepa mbucil, melphalan, carmustine (BSNU) and ine (CCNU), cyclophosphamide, busulfan, dibromomannitol, streptozotocin, mitomycin C, and cis-dichlorodiamine platinum (ll) (DDP) cisplatin), anthracyclines (e.g., daunorubicin (formerly daunomycin) and doxorubicin), otics (e.g., dactinomycin rly actinomycin), cin, mithramycin, and mycin (AMC), and itotic agents (cg, vincristine and vinblastine). In a preferred embodiment, the therapeutic agent is a cytotoxic agent or a radiotoxic agent. In another embodiment, the therapeutic agent is an immunosuppressant. In yet another ment, the therapeutic agent is GM-CSF. In a preferred embodiment, the therapeutic agent is doxorubicin, cisplatin, bleomycin, sulfate, carmustine, chlorambucil, cyclophosphamide or ricin A.

Antibodies also can be conjugated to a sotope, e.g., iodine-131, yttrium—90 or indium- 111, to generate cytotoxic radiopharmaceuticals.

The antibody conjugates of the invention can be used to modify a given biological response, and the drug moiety is not to be construed as limited to classical chemical therapeutic agents.

For example, the drug moiety may be a protein or ptide possessing a desired biological activity. Such proteins may include, for example, an enzymatically active toxin, or active fragment thereof, such as abrin, Iicin A, pseudomonas exotoxin, 0r diphtheria toxin; a protein such as tumor necrosis factor or interferon-y; or, ical response modifiers such as, for example, lymphokines, interleukin—1 ("IL-1"), interleukin—2 ("IL-2"), interleukin-6 ("IL—6"), granume macrophage colony stimulating factor ("GM—CSF"), granulocyte colony stimu a mg factor ("G-CSF"), or other growth factors.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN Techniques for ating such therapeutic moiety to antibodies are well known, see, e.g., Arnon et al., "Monoclonal Antibodies For Immunotargeting Of D---gs In Cancer Therapy", in Monoclonal Antibodies And Cancer Therapy, Reisfeld et al. (eds. ), pp. 243—56 (Alan R. Liss, Inc. 1985); rom et al., "Antibodies For Drug Delivery", in Controlled Drug Delivery (2nd Ed), Robinson et al. (eds), pp. 623-53 (Marcel Dekker, Inc. 1987); Thorpe, "Antibody Carriers Of Cytotoxic Agents In Cancer y: A Review", in Monoclonal Antibodies '84: Biological And Clinical Applications, Pincheraet al. (eds. ), pp. 475—506 (1985); "Analysis, Results, And Future Prospective Of The eutic Use Of Radiolabeled Antibody In Cancer Therapy", in Monoclonal Antibodies For Cancer Detection And y, Baldwin et al. (eds), pp. 303-16 (Academic Press 1985), and Thorpe et al., "The Preparation And Cytotoxic Properties Of Antibody—Toxin Conjugates", Immunol. Rev., 62: 119—58 (1982).

The term "antibody against a tumor antigen" or similar terms relates to an dy directed to or having the ability of binding to the tumor antigen. The term "binding" according to the invention preferably relates to a specific binding.

According to the present invention, an antibody is e of binding to a predetermined target if it has a significant y for said predetermined target and binds to said predetermined target in standard assays. "Affinity" or "binding y" is often measured by equilibrium iation constant (Kn). Preferably, the term "significant affinity" refers to the binding to a predetermined target with a dissociation constant (Kn) of 10'5 M or lower, 10'6 M or lower, 10'7 M or lower, 10'8 M or lower, 10'9 M or lower, 10'10 M or lower, 10'11 M or lower, or 10'12 M or lower.

An antibody is not (substantially) capable of binding to a target if it has no significant affinity for said target and does not bind significantly, in particular does not bind detectably, to said target in standard assays. Preferably, the antibody does not detectably bind to said target if present in a concentration of up to 2, preferably 10, more preferably 20, in particular 50 or 100 itle or higher. Preferably, an antibody has no significant affinity for a target if it binds to said target with a K13 that is at least 10-fold, 100-fold, 103—fold, 104—f01d, lOs-fold, or 106- fold higher than the K1) for binding to the predetermined target to which the antibody is thecapafl g. For e, if the K); for binding of an antibody to the target to whichdy is capable of g is 10’7 M, the K13 for binding to a target for which the [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN antibody has no significant affinity would be is at least 10'6 M, 10'5 M, 104 M, 10'3 M, 10‘2 M, or 10-1 M.

An antibody is specific for a predetermined target if it is capable of binding to said ermined target while it is not capable of binding to other targets, i.e. has no significant affinity for other targets and does not significantly bind to other targets in standard assays.

According to the invention, an dy is specific for a tumor n if it is capable of binding to the tumor n but is not (substantially) capable of binding to other targets.

Preferably, an dy is specific for a tumor antigen if the affinity for and the binding to such other targets does not significantly exceed the affinity for or g to tumor antigen- unrelated proteins such as bovine serum albumin (BSA), casein, human serum albumin (HSA) or non-tumor antigen transmembrane proteins such as MHC molecules or transferrin receptor or any other specified polypeptide. Preferably, an antibody is specific for a predetermined target if it binds to said target with a K9 that is at least 10-fold, lOO-fold, 103=fold, 104efold, 105-fold, or 106-fold lower than the K]: for binding to a target for which it is not specific. For example, if the K9 for binding of an antibody to the target for which it is specific is 10'7 Mm. A» AVA, the Km for binding to a target for which it is not specific would be at least 10'6 M, 10'5 M, 104 M, 10—3 M, 10-2 M, or 10-1 M.

Binding of an antibody to a target can be determined experimentally using any suitable method; see, for e, Berzofsky et al., "Antibody-Antigen interactions" In Fundamental Immunology, Paul, W. E., Ed, Raven Press New York, N Y (1984), Kuby, Janis Immunology, W. H. Freeman and Company New York, N Y (1992), and methods described herein. Affinities may be readily determined using tional techniques, such as by equilibrium dialysis; by using the BlAcore 2000 ment, using general procedures ed by the manufacturer; by radioimmunoassay using radiolabeled target antigen; or by r method known to the skilled artisan. The affinity data may be analyzed, for example, by the method of Scatchard et al., Ann NY. Acad. ScL, 512660 (1949). The measured affinity of a particular antibody-antigen interaction can vary if measured under different conditions, e.g., salt concentration, pH. Thus, ements of y and other antigen—binding parameters, e.g., K1), ICso, are preferably made with standardized solutions of antibody and antigen, and a standardized buffer.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN As used herein, "isotype" refers to the antibody class (e.g., IgM or IgGl) that is encoded by heavy chain constant region genes.

As used herein, "isotype switching" refers to the phenomenon by which the class, or isotype, of an dy changes from one Ig class to one of the other 1g classes.

The term "naturally occurring" as used herein as applied to an object refers to the fact that an object can be found in nature. For example, a polypeptide or polynucleotide sequence that is present in an sm (including Viruses) that can be isolated from a source in nature and which has not been intentionally modified by man in the laboratory is naturally occurring.

The term "rearranged" as used herein refers to a configuration of a heavy chain or light chain immunoglobulin locus wherein a V t is positioned immediately adjacent to a D-J or J segment in a conformation ng essentially a complete VH or VL domain, respectively.

A rearranged immunoglobulin (antibody) gene locus can be identified by comparison to germline DNA; a rearranged locus will have at least one recombined er/nonamer gy element.

The term rranged" or ine configuration" as used herein in nce to a V segment refers to the configuration wherein the V segment is not recombined so as to be immediately adjacent to a D or J segment.

Preferably, binding of an antibody against a tumor antigen to cells expressing the tumor antigen induces or mediates killing of cells sing the tumor antigen. The cells expressing a tumor antigen are preferably cancer cells and are, in particular, cells of the cancer diseases described herein. Preferably, the antibody s or mediates killing of cellm (3" k< ,.I:ll3:r:5-;:30G 0:3(b or more of complement dependent cytotoxicity (CDC) mediated lysis, antibody dependent cellular cytotoxicity (ADCC) ed lysis, apoptosis, and inhibition of proliferation of cells expressing a tumor antigen. Preferably, ADCC mediated lysis of cells takes place in the presence of effector cells, which in particular embodiments are selected from the group ting of monocytes, mononuclear cells, NK cells and PMNS. Inhibiting proliferation of cells can be measured in Vitro by determining proliferation of cells in an assay using bromodeoxyuridine (5-bromo-2’-deoxyuridine, BrdU). BrdU is a synthetic nucleoside which is ue of thymidine and can be incorporated into the newly synthesized DNA of [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN replicating cells (during the S phase of the cell cycle), substituting for thymidine during DNA replication. ing the incorporated chemical using, for example, antibodies specific for BrdU indicates cells that were actively replicating their DNA.

In preferred embodiments, dies described herein can be characterized by one or more of the following properties: a) specificity for a tumor antigen; b) a binding affinity to a tumor antigen of about 100 nM or less, preferably, about 5—10 nM or less and, more preferably, about 1-3 nM or less, 0) the ability to induce or mediate CDC on tumor antigen positive cells; d) the ability to induce or mediate ADCC on tumor antigen positive cells; e) the ability to inhibit the growth of tumor antigen ve cells; f) the ability to induce apoptosis of tumor antigen positive cells.

In one embodiment, an antibody against a tumor antigen has the ability of binding to an e present in the tumor antigen, preferably an epitope located within the extracellular domains of the tumor antigen. Preferably, an dy against a tumor antigen is specific for the tumor antigen. Preferably, an antibody against a tumor antigen binds to the tumor antigen expressed on the cell surface. In particular red embodiments, an antibody against a tumor antigen binds to native epitopes of the tumor antigen present on the surface of living cells.

According to the invention ”‘1 antibody h-"vi'ig the “bility of binding to CLDN 18.2 or an d , against CLDN18.2 is an antibody capaule of binding to an ‘ present in.

CLDN18.2, preferably an epitope located within the extracellular domains of CLDN18.2, in particular the first extracellular domain, preferably amino acid positions 29 to 78 of CLDN18.2. In particular embodiments, an dy having the ability of binding to CLDN18.2 is an antibody capable of binding to (i) an epitope on CLDN18.2 which is not present on CLDN18.1, preferably SEQ ID NO: 3, 4, and 5, (ii) an epitope localized on the CLDN18.2-loopl, preferably SEQ ID NO: 8, (iii) an epitope localized on the CLDN18.2— loop2, preferably SEQ ID NO: 10, (iv) an epitope localized on the CLDN18.2—loopD3, preferably SEQ ID NO: ll, (v) an e, which ass CLDN18.2-loopl and prefeCLDi : i.2-loopD3, or (Vi) a non-glycosylated epitope localized on the CLDN18.2—loopD3,SEQ ID NO: 9.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN According to the invention an antibody having the y of binding to CLDN18.2 preferably is an antibody having the ability of binding to CLDN18.2 but not to CLDN 18,1. Preferably, an antibody having the ability of binding to .2 is specific for CLDN18.2. Preferably, an antibody having the ability of binding to CLDN18.2 is an antibody having the ability of binding to .2 expressed on the cell surface. In particular preferred embodiments, an antibody having the ability of binding to CLDN18.2 binds to native epitopes of CLDN18.2 present on the surface of living cells. Preferably, an antibody having the ability of binding to CLDN18.2 binds to one or more peptides ed from the group consisting of SEQ ID NOS: 1, 3—11, 44, 46, and 48—50. Preferably, an antibody having the ability of g to CLDN18.2 is specific for the afore mentioned proteins, peptides or immunogenic fragments or derivatives thereof. An antibody having the ability ofbinding to CLDN18.2 may be obtained by a method comprising the step of immunizing an animal with a n or peptide comprising an amino acid sequence selected from the group consisting of SEQ ID NOs: 1, 3-11, 44, 46, and 48-50, or a nucleic acid or host cell expressing said protein or peptide. ably, the antibody binds to cancer cells, in particular cells of the cancer types mentioned above and, preferably, does not bind substantially to non-cancerous cells.

Preferably, binding of an antibody having the ability of binding to CLDN18.2 to cells expressing CLDN182 induces or mediates g of cells expressing CLDN18.2. The cells expressing CLDN18.2 are preferably cancer cells and are, in particular, selected from the group consisting of tumorigenic gastric, esophageal, atic, lung, ovarian, colon, hepatic, head-neck, and gallbladder cancer cells. Preferably, the dy induces or mediates killing of cells by inducing one or more of complement dependent cytotoxicity (CDC) mediated lysis, antibody dependent cellular cytotoxicity (ADCC) ed lysis, sis, and inhibition of proliferation of cells expressing CLDN18.2. Preferably, ADCC mediated lysis of cells takes place in the ce of effector cells, which in ular embodiments are selected from the group consisting ofmonocytes, mononuclear cells, NK cells and PMNs.

In preferred ments, an antibody having the ability of binding to CLDN18.2 can be characterized by one or more of the following properties: a) specificity for CLDN18.2; b) ' a ing affinity to CLDN18.2 of about 100 nM or less, preferably, about 5-10 nM or less and, more preferably, about 1-3 nM or less, [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN c) the ability to induce or mediate CDC on CLDN18.2 positive cells; (1) the ability to induce or mediate ADCC on .2 positive cells; e) the ability to inhibit the growth of CLDN l 8.2 positive cells; If) the ability to induce apoptosis of CLDN18.2 positive cells.

In a particularly preferred ment, an dy having the ability of g to CLDN18.2 is produced by a hybridoma deposited at the DSMZ (Mascheroder Weg lb, 31824 Braunschweig, Germany; new address: Inhoffenstr. 7B, 31824 Braunschweig, Germany) and having the following designation and accession number: a. 182431106055, accession no. DSM ACC273’7, deposited on October l9, 2005 b. 182—D1106-056, ion no. DSM ACC2738, deposited on October 19, 2005 c. 182-D1106-057, accession no. DSM ACC2739, deposited on October 19, 2005 d. 182—D1106-058, accession no. DSM ACC2740, deposited on October 19, 2005 e. 182-D1106—059, accession no. DSM 1, deposited on October 19, 2005 f. 182-D1106-062, accession no. DSM ACC2742, deposited on October 19, 2005, g. 106=067, accession no. DSM ACC27 3, deposited onOctober 19, 2005 h. 182-D758-035, accession no. DSM ACC2745, deposited on Nov. 17, 2005 i. 58—036, ion no. DSM ACC2746, deposited on Nov. 17, 2005 j. 182—D758-040, accession no. DSM ACC2747, deposited on Nov. 17, 2005 k. 182—D1 106-061, accession no. DSM ACC2748, deposited on Nov. 17, 2005 l. l82—Dl l06-279, accession no. DSM ACC2808, deposited on Oct. 26, 2006 m. 182-D1106-294, accession no. DSM ACC2809, deposited on Oct. 26, 2006, n. 182-D1106-362, ion no. DSM ACC2810, deposited on Oct. 26, 2006.

Preferred antibodies according to the invention are those produced by and obtainable from the above-described omas; i.e. 37Gll in the case of 182—D1106-055, 37H8 in the case of 182—D1106—056, 38G5 in the case of 182-D1106-057, 38H3 in the case of 182-D1106-058, 39F11 in the case of 182—D1106—059, 43A11 in the case of 182-D1106-062, 61C2 in the case of 182-D1106-067, 26B5 in the case of 182-D758-035, 26D12 in the case of 182-D758-036, 28D10 in the case of 182-D758-040, 42E12 in the case of 182—D1106-061, 125E] in the case of 182-D1106-279, 163E12 in the case of 182-D1106-294, and 175D10 in the case of 182- D1106-362; and the chimerized and humanized forms thereof.

[Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN ation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN In one embodiment, an antibody having the ability of binding to CLDN18.2 is an antibody selected from the group consisting of (i) an antibody produced by and/or obtainable from a clone deposited under the accession no. DSM 7, DSM ACC2738, DSM ACC2739, DSM ACC2740, DSM ACC2741, DSM ACC2742, DSM ACC2743, DSM ACC2745, DSM ACCZ746, DSM ACC2747, DSM ACC2748, DSM ACC2808, DSM ACC2809, or DSM ACC2810, (ii) an antibody which is a chimerized or humanized form of the antibody under (i), (iii) an antibody having the specificity of the antibody under (i), and (iv) an antibody comprising the antigen binding portion or n g site, in particular the variable region, of the antibody under (i) and ably having the specificity of the antibody under Preferred chimerized antibodies and their sequences are shown in the following table. chimerized 1 clone mAb Isotype variable region antibody heavy ' chain ' 43AM 182-D1106—062 IgGZa SEQ ID N029 SEQ ID N0214 163E12 182-Dl 4 IgG3 SEQ ID NO:30 SEQ ID NO:15 125E1 182-D1 106-279 IgGZa SEQ ID NO:31 SEQ ID N0216 166132 182-D1106—308 IgG3 SEQ ID N033 SEQ ID NO:18 l75DlO 182-D1106-362 IgGl SEQ ID N0232 SEQ ID NO:17 45C1 182-D758-187 IgGZa SEQ ID N034 SEQ ID NO:19 chain 43All 182—Dl 106-062 SEQ ID N0236 SEQ ID N021 163E12 182-D1106-294 SEQ ID NO:35 SEQ ID N020 125E1 182—D1106-279 SEQ ID N0237 SEQ ID N022 166E2 l82—D1106—308 SEQ ID No:40 SEQ ID N025 175D10 l82—D1106-362 SEQ ID N039 SEQ ID N024 45C1 l82—D758—l 87 SEQ ID N0238 SEQ ID NO:23 45Cl l82—D758-l87 SEQ ID NO:41 SEQ ID N026 45Cl 182—D758—187 SEQ ID NO:42 SEQ ID N027 45C1 182-D758-187 SEQ ID NO:43 SEQ ID N028 In pre d embodiments, antibodies, in particular chimerised forms of antibodies according to the invention include antibodies comprising a heavy chain nt region (CH) comprising [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN an amino acid ce derived from a human heavy chain nt region such as the amino acid sequence represented by SEQ ID NO: 13 or a fragment thereof. In r preferred embodiments, antibodies, in particular chimerised forms of antibodies according to the invention include antibodies comprising a light chain constant region (CL) comprising an amino acid ce derived fiom a human light chain constant region such as the amino acid sequence represented by SEQ ID NO: 12 or a fragment thereof. In a particular preferred embodiment, antibodies, in particular ised forms of antibodies according to the invention include dies which comprise a CH comprising an amino acid sequence derived from a human CH such as the amino acid sequence represented by SEQ ID NO: 13 or a fragment f and which comprise a CL comprising an amino aci sequence derived from a human CL such as the amino acid sequence represented by SEQ ID NO: 12 or a fragment thereof.

In one embodiment, an antibody having the ability of binding to CLDN18.2 is a chimeric mouse/human IgGl monoclonal antibody comprising kappa, murine variable light chain, human kappa light chain constant region allotype Km(3), murine heavy chain le region, human IgG1 constant , allotype Glm(3).

In certain preferred embodiments, chimerised forms of antibodies include antibodies comprising a heavy chain comprising an amino acid sequence selected from the group consisting of SEQ ID NOS: 14, 15, 16, 17, 18, 19, 51, and a nt thereof and/0r comprising a light chain comprising an amino acid sequence selected from the group consisting of SEQ ID NOS: 20, 21, 22, 23, 24, 25, 26, 2'7, 28, and a fragment thereof.

In certain preferred embodiments, chimerised forms of antibodies e antibodies comprising a combination of heavy chains and light chains selected from the following possibilities (i) to (ix): (i) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 14 or a fragment thereof and the light chain comprises an amino acid sequence represented by SEQ ID NO: 21 or a nt thereof, (ii) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 15 or a fragment thereof and the light chain comprises an amino acid sequence represented by SEQ ID NCbO or a fragment thereof, [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN (iii) the heavy chain comprises an amino acid sequence ented by SEQ ID NO: 16 or a fragment thereof and the light chain comprises an amino acid sequence represented by SEQ ID NO: 22 or a fragment thereof, (iv) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 18 or a fragment thereof and the light chain comprises an amino acid ce represented by SEQ ID NO: 25 or a fragment thereof, (V) the heavy chain comprises an amino acid sequence ented by SEQ ID NO: 17 or a fragment thereof and the light chain comprises an amino acid ce represented by SEQ ID NO: 24 or a fragment thereof, (vi) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 19 or a fragment thereof and the light chain comprises an amino acid sequence represented by SEQ ID NO: 23 or a fragment thereof, (vii) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 19 or a nt thereof and the light chain comprises an amino acid sequence represented by SEQ ID NO: 26 or a nt thereof, (viii) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 19 or a fragment thereof and the light chain comprises an amino acid sequence represented by SEQ ID NO: 27 or a nt thereof, (ix) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 19 or a fragment f and the light chain comprises an amino acid sequence represented by SEQ ID NO: 28 or a fragment thereof, and (x) the heavy chain comprises an amino acid sequence represented by SEQ ID NO: 51 or a fragment thereof and the light chain comprises an amino acid sequence represented by SEQ ID NO: 24 or a fragment thereof.

The antibody according to (v) or (x) is particularly preferred.

"Fragment" or "fragment of an amino acid sequence" as used above s to a part of an antibody sequence, i.e. a sequence which represents the antibody sequence shortened at the N- and/or C-terminus, which when it es said antibody sequence in an antibody retains binding of said antibody to CLDN18.2 and preferably functions of said dy as bed herein, e.g. CDC mediated lysis or ADCC mediated lysis. Preferably, a fragment of an amino acid Sfince comprises at least 80%, preferably at least 90%, 95%, 96%, 97%, 98%, or 99% of the amino acid residues from said amino acid sequence. A fragment of an amino acid [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN sequence selected from the group consisting of SEQ ID NOs: 14, 15, 16, 17, 18, 19, 51, 20, 21, 22, 23, 24, 25, 26, 27, and 28 preferably relates to said sequence wherein 17, 18, 19, 20, 21, 22 or 23 amine acids at the N=terminus are remeved.

In a red embodiment, an antibody having the ability of binding to CLDN18.2 comprises a heavy chain variable region (VH) sing an amino acid sequence selected from the group ting of SEQ ID N03: 29, 30, 31, 32, 33, 34, and a fragment thereof.

In a preferred ment, an antibody having the ability of binding to CLDN18.2 comprises a light chain variable region (VL) comprising an amino acid sequence selected from the group consisting of SEQ ID NO: 35, 36, 37, 38, 39, 40, 41, 42, 43, 1d a fragment thereof.

In certain preferred embodiments, an antibedy having the abiliy of binding DN comprises a combination of heavy chain variable region (VH) and light chain variable region (VL) selected from the following possibilities (i) to (ix): 1)( the VH comprises an amine acid sequence ented by SE END:29 era fregment thereof and the VL comprises an amino acid sequence represented by SEQ ID NO. 360ra fragment thereof, (ii) the VH comprises an amino acid sequence represented by SEQ ID NO: 30 or a fragment thereof and the‘v’L comprises an amino acid sequence represented by SEQ ID NO: 35 or a fragment thereof, (iii) the VH ses an amino acid sequence represented by SEQ ID NO: 31 or a fragment thereof and the VL ses an amino acid sequence represented by SEQ ID NO: 37 or a fragment thereof, (iv) the VH comprises an amino acid sequence represented by SEQ ID NO: 33 or a fragment f and the VL comprises an amino acid sequence represented by SEQ ID NO: 40 or a nt thereof, (v) the VH comprises an amino acid sequence represented by SEQ ID NO: 32 or a fragment thereof and the VL comprises an amino acid sequence represented by SEQ ID NO: 39 or a fragment thereof, (vi) the VH comprises an amino acid sequence represented by SEQ ID NO: 34 or a fragment thereof and the VL comprises an amino acid sequence represented by SEQ ID NO: 38 or a fragrn hereof, [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN (vii) the VH comprises an amino acid sequence represented by SEQ ID NO: 34 or a fragment thereof and the VL comprises an amino acid sequence represented by SEQ ID NO: 41 or a fragment thereof, (viii) the VH comprises an amino acid ce represented by SEQ ID NO: 34 or a fragment f and the VL comprises an amino acid sequence represented by SEQ ID NO: 42 or a fragment f, (ix) the VH comprises an amino acid ce represented by SEQ ID NO: 34 or a fragment thereof and the VL comprises an amino acid sequence represented by SEQ ID NO: 43 or a fragment thereof.

The antibody according to (v) is particularly preferred.

According to the invention, the term "fragment" , in particular, to one or more of the complementarity-determining regions (CDRs), preferably at least the CDR3 variable region, of the heavy chain variable region (VH) and/or of the light chain variable region (VL). In one embodiment said one or more of the complementarity-determining regions (CDRS) are selected from a set of mentarity—determining s CDRl, CDR2 and CDR3. In a particularly preferred embodiment, the term "fragment" refers to the complementaritydetermining regions CDRl, CDR2 and CDR3 of the heavy chain le region (VH) and/or of the light chain variable region (VL).

In a preferred embodiment, an antibody having the ability of binding to CLDN18.2 comprises a VB comprising a set of mentarity-determining regions CDRI, CDR2 and CDR3 selected from the following embodiments (i) to (vi): (i) CDRl: positions 45-52 of SEQ ID NO: 14, CDR2: positions 70-77 of SEQ ID NO: 14, CDR3: positions 116-125 of SEQ ID NO: 14, (ii) CDRl: positions 45-52 of SEQ ID NO: 15, CDR2: positions 70—77 of SEQ ID NO: 15, CDR3: positions 116—126 of SEQ ID NO: 15, (iii) CDRI: positions 45—52 of SEQ ID NO: 16, CDR2: positions 70-77 of SEQ ID NO: 16, CDR3: positions 116—124 of SEQ ID NO: 16, (iv) CDRI: positions 45—52 of SEQ ID NO: 17, CDR2: positions 70-77 of SEQ ID NO: 17, CDR3: positions 116-126 of SEQ ID NO: 17, (v) CDRI: positions 44—51 of SEQ ID NO: 18, CDR2: positions 69—76 of SEQ ID NO: 18, CDR . s 115-125 of SEQ ID NO: 18, and [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN ed set by MYN (vi) CDRI: positions 45-53 of SEQ ID NO: 19, CDR2: positions 71-78 of SEQ ID NO: 19, CDR3: positions 117-128 of SEQ ID NO: 19.

In a preferred embodiment, an antibody having the ability of binding to CLDN18.2 comprises a VL comprising a set of complementarity-determining regions CDRl, CDR2 and CDR3 selected from the following embodiments (i) to (ix): (i) CDRI: positions 4758 of SEQ ID NO: 20, CDR2: positions 76—78 of SEQ ID NO: to5: CDR3: positions 115-123 of SEQ ID NO: 20, (ii) CDRl: ons 49—53 of SEQ ID NO: 21, CDR2: positions 71—73 of SEQ ID NO: 21, CDR3: positions 110-118 of SEQ ID NO: 21, (iii) CDRI: positions 47-52 of SEQ ID NO: 22, CDR2: positions 70-72 of SEQ ID NO: 22, CDR3: positions 109-117 of SEQ ID NO: 22, (iv) CDRI: positions 47—58 of SEQ ID NO: 23, CDR2: positions 76—78 of SEQ ID NO: 23, CDR3: positions 115-123 of SEQ ID NO: 23, (V) CDRI: positions 47—58 of SEQ ID NO: 24, CDR2: positions 76-78 of SEQ ID NO: 24, CDR3: positions 115—123 of SEQ ID NO: 24, (vi) CDRl: positions 47—58 of SEQ ID NO: 25, CDR2: positions 76-78 of SEQ ID NO: 25, CDR3: positions 115—122 of SEQ ID NO: 25, (vii) CDRl: ons 47—58 of SEQ ID NO: 26, CDR2: positions 76-78 of SEQ ID NO: 26, CDR3: positions 115-123 of SEQ ID NO: 26, (viii) CDRl: positions 47—58 of SEQ ID NO: 27, CDR2: positions 76-78 of SEQ ID NO: 27, CDR3: positions 115-123 of SEQ ID NO: 27, and (ix) CDRl: positions 47-52 of SEQ ID NO: 28, CDR2: positions 70-72 of SEQ ID NO: 28, CDR3: positions 109-117 of SEQ ID NO: 28.

In a preferred embodiment, an antibody having the ability of g to CLDN18.2 comprises a combination of VH and VL each comprising a set of complementarity—determining regions CDRI, CDR2 and CDR3 ed from the following embodiments (i) to (ix): (i) VH: CDRl: positions 45—52 of SEQ ID NO: 14, CDR2: positions 70-77 of SEQ ID NO: 14, CDR3: positions 116-125 of SEQ ID NO: 14, VL: CDRI: ons 49-53 of SEQ ID NO: 21, CDR2: positions 71—73 of SEQ ID NO: 21, CDR3: positions 8 of SEQ ID NO: 21, (ii) VH: CDRl: positions 45—52 of SEQ ID NO: 15, CDR2: positions 70-77 of SEQ ID NO: , CE: positions 116-126 of SEQ ID NO: 15, VL: CDRI: positions 47—58 of SEQ ID NO: , C : positions 76-78 of SEQ ID NO: 20, CDR3: positions 115-123 of SEQ ID NO: 20, [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN (iii) VH: CDRl: positions 45-52 of SEQ ID NO: 16, CDR2: positions 70-77 of SEQ ID NO: 16, CDR3: positions 116-124 of SEQ ID NO: 16, VL: CDRI: positions 47-52 of SEQ ID NO: 22, CDR2: positions 70—72 of SEQ ID NO: 22, CDR3: positions 109—117 of SEQ ID NO: 22, (iv) VH: CDRl: positions 44—51 of SEQ ID NO: 18, CDR2: positions 69-76 of SEQ ID NO: 18, CDR3: positions 115-125 of SEQ ID NO: 18, VL: CDRl: positions 47-58 of SEQ ID NO: , CDR2: positions 76-78 of SEQ ID NO: 25, CDR3: positions 115-122 of SEQ ID NO: 25, (V) VH: CDRl: ons 45-52 of SEQ ID NO: 17, CDR2: positions 70—77 of SEQ ID NO: 17, CDR3: positions 116-126 of SEQ ID NO: 17, VL: CDRI: positions 47-58 of SEQ ID NO: 24, CDR2: positions 76—78 of SEQ ID NO: 24, CDR3: positions 115-123 of SEQ ID NO: 24, (vi) VH: CDRI: positions 45—53 of SEQ ID NO: 19, CDR2: positions 71-78 of SEQ ID NO: 19, CDR3: positions 117-128 of SEQ ID NO: 19, VL: CDRI: positions 47-58 of SEQ ID NO: 23, CDR2: positions 76-78 of SEQ ID NO: 23, CDR3: positions 115-123 of SEQ ID NO: 23, (vii) VH: CDRI: positions 45—53 of SEQ ID NO: 19, CDR2: positions 71—78 of SEQ ID NO: 19, CDR3: positions 117-128 of SEQ ID NO: 19, VL: CDRl: positions 47-58 of SEQ ID NO: 26, CDR2: positions 76—78 of SEQ ID NO: 26, CDR3: positions 115—123 of SEQ ID NO: 26, (viii) VII: CDRI: positions 45-53 of SEQ ID NO: 19, CDR2: positions 71—78 of SEQ ID NO: 19, CDR3: ons 117-128 of SEQ ID NO: 19, VL: CDRl: ons 47-58 of SEQ ID NO: 27, CDR2: positions 76-78 of SEQ ID NO: 27, CDR3: positions 115—123 of SEQ ID NO: 27, (ix) VH: CDRI: positions 45-53 of SEQ ID NO: 19, CDR2: positions 71-78 of SEQ ID NO: 19, CDR3: positions 117-128 of SEQ ID NO: 19, VL: CDRl: positions 47—52 of SEQ ID NO: 28, CDR2: positions 70—72 of SEQ ID NO: 28, CDR3: ons 109-117 of SEQ ID NO: 28.

In further preferred ments, an antibody having the ability of binding to CLDN18.2 preferably comprises one or more of the complementarity-determining regions (CDRs), preferably at least the CDR3 variable region, of the heavy chain varir‘ole region (VH) and/or of the light chain variable region (VL) of a monoclonal antibody against CLDN18.2, preferably of a monoclonal antibody t CLDN18.2 described herein, and preferably comprises one or more of the complementarity—determining regions (CDRS), preferably at least the CDR3 variable , of the heavy chain variable regions (VH) and/or light chain le regions (VL) described herein. In one embodiment said one or more of the mentarity—determining regions (CDRs) are ed from a set of complementarity- png regions CDRl, CDR2 and CDR3 described herein. In a particularly preferredembo 1ment, an antibody having the ability of binding to CLDN18.2 preferably comprises the [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN complementarity-determining s CDRl, CDR2 and CDR3 of the heavy chain variable region (VH) and/or of the light chain le region (VL) of a monoclonal antibody against CLDN18.2, preferably of a monoclonal antibody against CLDN18.2 described herein, and preferably comprises the complementarity-determining regions CDRI, CDR2 and CDR3 of the heavy chain variable s (VH) and/or light chain variable regions (VL) described herein.

In one embodiment an antibody comprising one or more CDR3, a set of CDRs or a combination of sets of CDRs as described herein ses said CDRs together with their intervening framework regions. Preferably, the portion will also include at least about 50% of either or 0th of the first and fourth framework regions, the 50% being the C-terminal 50% 0f the first framework region and the N-terminal 50% of the fourth framework region.

Construction of dies made by inant DNA techniques may result in the introduction of residues N— or C—terrninal to the variable regions encoded by linkers introduced to facilitate cloning or other manipulation steps, including the introduction of linkers to join variable regions of the invention to r protein ces including immunoglobulin heavy chains, other variable domains (for example in the tion of diabodies) or protein labels.

In one embodiment an antibody comprising one or more CDRs, a set of CDRs or a combination of sets of CDRs as described herein comprises said CDRs in a human antibody framework.

Reference herein to an antibody comprising with respect to the heavy chain thereof a ular chain, or a particular region or sequence preferably relates to the ion wherein all heavy chains of said antibody comprise said particular chain, region or sequence. This applies correspondingly to the light chain of an antibody.

It is to be understood that the antibodies described herein may be delivered to a patient by administering a nucleic acid such as RNA encoding the antibody and/or by administering a host cell comprising a nucleic acid such as RNA encoding the antibody. Thus, a nucleic acid encoding an antibody when administered to a t may be present in naked form or in a suitabmelivery vehicle such as in the form of liposomes or viral particles, or within a hostcell. nucleic acid provided can produce the antibody over extended time periods in a ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN sustained manner mitigating the instability at least partially observed for therapeutic antibodies. Nucleic acids to be delivered to a patient can be produced by recombinant means. a nucleic acid is administered to a patient without being present within a host cell, it is preferably taken up by cells of the t for sion of the antibody encoded by the nucleic acid. If a nucleic acid is administered to a patient while being present within a host cell, it is preferably expressed by the host cell Within the patient so as to produce the antibody d by the nucleic acid.

The term "nucleic acid", as used herein, is intended to include DNA and RNA such as genomic DNA, CDNA, mRNA, recombinantly produced and chemically synthesized molecules. A nucleic acid may be -stranded or double-stranded. RNA includes in Vitro transcribed RNA (IVT RNA) or synthetic RNA. c acids may be comprised in a vector. The term "vector" as used herein includes vectors known to the skilled person including plasmid vectors, cosmid vectors, phage s such as lambda phage, viral vectors such as adenoviral or baculoviral vectors, or artificial chromosome vectors such as bacterial artificial chromosomes (BAC), yeast artificial chromosomes (YAC), or Pl artificial chromosomes (PAC). Said s include expression as well as cloning vectors. Expression vectors comprise plasmids as well as viral vectors and generally contain a d coding sequence and riate DNA sequences necessary for the expression of the operably linked coding sequence in a particular host organism (e.g., bacteria, yeast, plant, insect, or mammal) or in in vitro expression s. Cloning vectors are generally used to engineer and amplify a certain desired DNA fragment and may lack functional sequences needed for expression of the desired DNA fragments.

In the context of the present invention, the term "RNA" relates to a molecule which comprises ribonucleotide residues and preferably being entirely or substantially composed of ribonucleotide residues. "Ribonucleotide" relates to a nucleotide with a hydroxyl group at the ition of a B—D-ribofuranosyl group. The term includes double stranded RNA, single stranded RNA, ed RNA such as partially purified RNA, essentially pure RNA, synthetic RNA, recombinantly produced RNA, as well as modified RNA that differs from naturally ing RNA by the addition, deletion, substitution and/or alteration of one or more nuclefis. Such alterations can include addition of non-nucleotide material, such as to theend(s o a RNA or ally, for example at one or more nucleotides of the RNA.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Nucleotides in RNA molecules can also comprise non—standard nucleotides, such as non- naturally occurring nucleotides or chemically synthesized nucleotides or deoxynucleotides.

These altered RNAs can be referred to as analogs or analogs of naturally-occurring RNA. ing to the present invention, the term "RNA" includes and preferably relates to "mRNA" which means "messenger RNA" and relates to a "transcript" which may be produced using DNA as template and encodes a peptide or protein. mRNA typically comprises a 5‘ non ated region (5'-UTR), a protein or peptide coding region and a 3' non translated region (3'-UTR). mRNA has a limited halftime in cells and in Vitro. Preferably, mRNA is produced by in Vitro transcription using a DNA template. in one ment of the invention, the RNA is obtained by in Vitro transcription or chemical sis. The in Vitro transcription methodology is known to the skilled person. For example, there is a y of in Vitro transcription kits commercially available.

In order to increase expression and/or ity of the RNA used ing to the present invention, it may be modified, preferably withou. ng the sequence r\f the expressed peptide or protein.

The term "modification" in the context of RNA as used according to the present invention includes any modification ofRNA which is not naturally present in said RNA. Such d RNA is encompassed herein by the term "RNA".

For example, the RNA according to the ion may have modified naturally occurring or synthetic ribonucleotides in order to increase its stability and/or decrease cytotoxicity. For e, in one embodiment, in the RNA used according to the invention 5-methylcytidine is substituted partially or completely, preferably completely, for c .idine. Alternatively or additionally, in one embodiment, in the RNA used according to the invention pseudouridine is substituted lly or completely, preferably tely, for uridine.

In one embodiment, the term "modification" relates to ing an RNA with a 5’—cap or 5’- cap analog. The term "5’—cap" refers to a cap structure found on the 5'—end of an mRNA molecule and generally consists of a guanosine tide connected to the mRNA via an unusufi to 5' triphosphate linkage. In one embodiment, this guanosine is methylated at the7-pos . The term "conventional 5’-cap" refers to a naturally occurring RNA 5’-cap, ation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN preferably to the 7-methylguanosine cap (m7G). In the context of the present invention, the term "5’-cap" includes a 5’—cap analog that les the RNA cap structure and is modified to possess the ability to stabilize RNA if attached o, preferably in vivo and/or in a cell.

Preferably, RNA if delivered to, i.e. transfected into, a cell, in particular a cell present in vivo, expresses the protein or peptide it encodes.

The term fection" relates to the uction of nucleic acids, in particular RNA, into a cell. For purposes of the present invention, the term "transfection" also includes the introduction of a nucleic acid into a cell or the uptake of a nucleic acid by such cell, wherein the cell may be present in a subject, e.g., a patient. Thus, according to the t invention, a cell for transfection of a nucleic acid described herein can be present in vitro or in viva, e. g. the cell can form part of an organ, a tissue and/or an organism of a patient. According to the ion, transfection can be transient or stable. For some applications of transfection, it is sufficient if the transfected genetic material is only transiently expressed. Since the nucleic acid introduced in the transfection process is usually not ated into the nuclear genome, the foreign nucleic acid will be diluted through mitosis or degraded. Cells allowing episomal amplification of nucleic acids greatly reduce the rate of dilution. If it is desired that the transfected nucleic acid actually remains in the genome of the cell and its daughter cells, a stable transfection must occur. RNA can be transfected into cells to transiently express its coded protein.

The term "stability" of RNA relates to the "half-life" of RNA. "Half—life" relates to the period of time which is needed to eliminate half of the activity, amount, or number of molecules. In the context of the present invention, the half—life of an RNA is indicative for the stability of said RNA. The half-life of RA. may Lnflue. ce the "duration of ex ression" et‘ t“ U1 Like l\lVDNA. It can be expected that RNA having a long half—life will be expressed for an extended time period.

In the t of the present ion, the term "transcription" relates to a process, wherein the genetic code in a DNA sequence is transcribed into RNA. Subsequently, the RNA may be translated into protein. ing to the present invention, the term "transcription" comprises "in vifiranscription", wherein the term "in vitro ription" relates to a process wherein RNA, particular mRNA, is in vitro synthesized in a cell-free system, preferably using [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN appropriate cell extracts. Preferably, cloning vectors are applied for the generation of ripts. These cloning vectors are generally designated as transcription s and are according to the present invention encompassed by the term "vector".

The term "translation" according to the invention relates to the process in the ribosomes of a cell by which a strand of messenger RNA directs the assembly of a sequence of amino acids to make a peptide or n.

The term "expression" is used according to the invention in its most general meaning and comprises the production of RNA and/or peptides or proteins, e.g. by transcription and/or translation. With respect to RNA, the term "expression“ or "translation" relates in particular to the production of peptides or proteins. It also comprises partial expression of nucleic acids.

Moreover, expression can be transient or stable. According to the invention, the term expression also includes an "aberrant expression" or "abnormal expression".

"Aberrant expression" or "abnormal expression" means according to the invention that expression is altered, preferably increased, ed to a reference, e.g. a state in a t not having a disease associated with nt or abnormal expression of a certain protein, e.g., a tumor antigen. An increase in expression refers to an increase by at least 10%, in particular at least 20%, at least 50% or at least 100%, or more. In one embodiment, sion is only found in a diseased tissue, while expression in a healthy tissue is repressed.

The term "specifically sed" means that a protein is essentially only expressed in a specific tissue or organ. For e, a tumor antigen specifically expressed in c mucosa means that said protein is primarily expressed in gastric mucosa and is not expressed in other tissues or is not expressed to a significant extent in other tissue or organ types. Thus, a protein that is exclusively expressed in cells of the c mucosa and to a significantly lesser extent in any other tissue, such as testis, is cally expressed in cells of the gastric mucosa. In some embodiments, a tumor antigen may also be specifically expressed under normal conditions in more than one tissue type or organ, such as in 2 or 3 tissue types or organs, but ably in not more than 3 different tissue or organ types. In this case, the tumor n is then specifically expressed in these organs. For example, if a tumor antigen is ex ed under normal conditions preferably to an approximately equal extent in lung and stoma said tumor antigen is specifically expressed in lung and stomach.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN According to the invention, the term "RNA encoding" means that RNA, if present in the appropriate environment, preferably within a cell, can be expressed to produce a protein or peptide it encodes.

Some aspects of the invention rely on the adoptive er of host cells which are transfected in vitro with a nucleic acid such as RNA encoding an antibody described herein and transferred to recipients such as patients, preferably after ex vivo ion from low precursor frequencies to clinically relevant cell s. The host cells used for ent according to the invention may be autologous, allogeneic, or syngeneic to a treated recipient.

The term "autologous" is used to describe anything that is derived from the same subject. For example, "autologous transplan " refers to a transplant of tissue or organs derived from the same subject. Such procedures are advantageous because they overcome the immunological r which otherwise results in rejection.

The term "allogeneic" is used to describe anything that is derived from different individuals of the same s. Two or more individuals are said to be allogeneic to one another when the genes at one or more loci are not identical.

The term "syngeneic" is used to describe anything that is derived from individuals or tissues having identical genotypes, i.e., identical twins or animals of the same inbred , or their tissues.

The term ologous" is used to describe something consisting of multiple different elements. As an example, the transfer of one dual’s bone marrow into a different individual constitutes a heterologous transplant. A heterologous gene is a gene derived from a source other than the t.

The term "peptide" according to the invention comprises oligo- and polypeptides and refers to nces comprising two or more, preferably 3 or more, preferably 4 or more, preferably 6 or more, preferably 8 or more, preferably 9 or more, ably 10 or more, preferably 13 or more ferably 16 more, preferably 21 or more and up to preferably 8, 10, 20, 30, 40 or 50, in pa lar 100 amino acids joined covalently by e bonds. The term "protein" refers to [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN large peptides, preferably to es with more than 100 amino acid residues, but in l the terms "peptides" and "proteins" are synonyms and are used interchangeably .

The teaching given herein with respect to specific amino acid sequences, e.g. those shown in the sequence listing, is to be construed so as to also relate to variants of said specific sequences resulting in ces which are functionally equivalent to said specific ces, e.g. amino acid sequences exhibiting properties identical or similar to those of the specific amino acid sequences.

One important property is to retain binding of an dy to its target or to sustain effector functions of an antibody. Preferably, a sequence which is a variant with respect to a specific sequence, when it es the specific sequence in an antibody retains binding of said antibody to its target and preferably ons of said antibody as described , e.g. CDC mediated lysis or ADCC mediated lysis.

It will be appreciated by these skilled in the art that in particular the sequence" of the CDR, hypervariable and variable regions can be modified without losing the ability of an antibody to bind to its target. For example, CDR regions will be either identical or highly homologous to the regions of antibodies specified herein. By "highly homologous" it is contemplated that from 1 to 5, preferably from 1 to 4, such as 1 to 3 or 1 or 2 substitutions may be made in the CDRs. In addition, the hypervariable and variable regions may be modified so that they show substantial homology with the regions of antibodies cally disclosed herein.

The term "variant" according to the invention refers, in particular, to mutants, splice ts, conformations, ms, allelic variants, species variants and species homologs, in particular those which are lly present. An allelic variant relates to an alteration in the normal sequence of a gene, the significance of which is often unclear. Complete gene sequencing often identifies numerous allelic variants for a given gene. A species homolog is a nucleic acid or amino acid sequence with a different species of origin from that of a given nucleic acid or amino acid sequence. The term "varian " shall encompass any posttranslationally modified ts and conformation variants.

For t urposes of the present invention, "variants" of an amino acid sequence comprise amin id ion variants, amino acid addition variants, amino acid deletion variants [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN and/or amino acid substitution variants. Amino acid deletion variants that comprise the deletion at the N—terminal and/or C—terminal end of the protein are also called N-terminal and/or C—terminal tion variants.

Amino acid insertion variants comprise insertions of single or two or more amino acids in particular amino acid ce. In the case of amino acid sequence variants having an insertion, one or more amino acid residues are inserted into a particular site in an amino acid sequence, although random insertion with appropriate screening of the resulting product is also possible.

Alllino acid addition v-"i"iants comprise amino— and/or carhoxy—terminal fusions of one more amino acids such as 1, 2, ,10, 20, 30, 50, or more amino acids.

Amino acid on variants are characterized by the removal of one or more amino acids from the sequence, such as by removal of 1, 2, 3, 5, 10, 20, 30, 50, or more amino acids. The deletions may be in any position of the protein.

Amino acid substitution variants are characterized by at least one residue in the sequence being removed and another residue being inserted in its place. Preference is given to the modifications being in positions in the amino acid sequence which are not conserved between homologous proteins or peptides and/or to replacing amino acids with-other ones having similar properties. Preferably, amino acid changes in protein ts are conservative amino acid changes, i. e., substitutions of similarly d or uncharged amino acids. A conservative amino acid change involves substitutic ofcne of a f-“nily of amino acids which are related in their side chains. Naturally occurring amino acids are generally divided into four es: acidic (aspartate, glutamate), basic (lysine, arginine, histidine), non-polar (alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine, tryptophan), and uncharged polar (glycine, asparagine, ine, cysteine, , threonine, tyrosine) amino acids.

Phenylalanine, tryptophan, and ne are sometimes classified y as aromatic amino acids.

Preferably the degree of similarity, preferably identity n a given amino acid sequence and an amino acid sequence which is a variant of said given amino acid sequence will be at least t 60%, 65%, 70%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99%. The degree of similarity or identity is given preferably for an amino acid region which is at least about 10%, at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90% or about 100% of the entire length of the reference amino acid sequence. For example, if the reference amino acid sequence ts of 200 amino acids, the degree of rity or identity is given preferably for at least about 20, at least about 40, at least about 60, at least about 80, at least about 100, at least about 120, at least about 140, at least about 160, at least about 180, or about 200 amino acids, preferably uous amino acids. In preferred embodiments, the degree of similarity or identity is given for the entire length of the reference amino acid sequence. The ent for ining sequence similarity, preferably sequence ty can he done with art known tools, preferably using the best sequence alignment, for example, using Align, using standard gs, preferably EMBOSS::needle, Matrix: Blosum62, Gap Open 10.0, Gap Extend 0.5.

"Sequence similarity" indicates the tage of amino acids that either are identical or that represent conservative amino acid substitutions. "Sequence identity" between two amino acid sequences indicates the percentage of amino acids that are identical between the sequences.

The term "percentage identity" is intended to denote a percentage of amino acid residues which are identical between the two sequences to be compared, obtained afier the best alignment, this percentage being purely statistical and the differences between the two sequences being distributed randomly and over their entire length. Sequence comparisons between two amino acid sequences are conventionally carried out by comparing these sequences after having aligned them optimally, said comparison being carried out by segment or by "window of comparison" in order to identify and compare local regions of sequence rity. The optimal alignment of the sequences for comparison may be produced, besides manually, by means of the local homology algorithm of Smith and Waterman, 1981, Ads App. Math. 2, 482, by means of the local gy algorithm of Neddleman and Wunsch, 1970, J. Mol. Biol. 48, 443, by means of the similarity search method of Pearson and Lipman, 1988, Proc. Natl. Acad. Sci. USA 85, 2444, or by means of er ms which use these algorithms (GAP, BESTFIT, FASTA, BLAST P, BLAST N and TFASTA in Wisconsin Genetics Software Package, Genetics Computer Group, 575 Science Drive, Madison, Wis).

[Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN ation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The percentage identity is calculated by ining the number of identical positions between the two ces being compared, dividing this number by the number of positions compared and multiplying the result obtained by 100 so as to obtain the percentage identity between these two sequences.

The term "cell" or "host cell" preferably relates to an intact cell, i.e. a cell with an intact membrane that has not released its normal intracellular ents such as enzymes, lles, or genetic material. An intact cell preferably is a Viable cell, i.e. a living cell e of carrying out its normal metabolic functions. Preferably said term relates according to the invention to any cell which c n be transf cted with an exogenous rucleic acid.

Preferably, the cell when transfected with an exog‘nous nucleic acid and transferred to a recipient can express the nucleic acid in the recipient. The term "cell" includes bacterial cells; other useful cells are yeast cells, fungal cells or mammalian cells. Suitable bacterial cells include cells from gram—negative bacterial strains such as s of Escherichia coli, Proteus, and Pseudomonas, and gram—positive bacterial strains such as strains of Bacillus, Streptomyces, Staphylococcus, and occus. Suitable fungal cell include cells from species of Trichoderma, Neurospora, and Aspergillus. Suitable yeast cells include cells from species of Saccharomyces (Tor example Saccharomyces cerevisiae), Schizosaccharomyces (for example Schizo saccharomyces pombe), Pichia (for example Pichia pastoris and Pichia methanolicd), and Hansenula. Suitable mammalian cells include for example CHO cells, BHK cells, HeLa cells, COS cells, 293 HEK and the like. However, amphibian cells, insect cells, plant cells, and any other cells used in the art for the expression of heterologous proteins can he used as well. ian cells are particularly preferred for adoptive transfer, such as cells from humans, mice, hamsters, pigs, goats, and primates. The cells may be derived from a large number of tissue types and include primary cells and cell lines such as cells of the immune system, in particular antigen—presenting cells such as dendritic cells and T cells, stem cells such as poietic stem cells and mesenchymal stem cells and other cell types. An antigen-presenting cell is a cell that displays antigen in the context of major histocompatibility complex on its e. T cells may recognize this complex using their T cell receptor (TCR).

The term "transgenic animal" refers to an animal having a genome sing one or more transgenes, preferably heavy and/or light chain transgenes, or transchromosomes (either integrated or non-integrated into the animal's natural genomic DNA) and which is preferably capabgf expressing the enes. For example, a transgenic mouse can have a human light [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN chain transgene and either a human heavy chain ene or human heavy chain transchromosome, such that the mouse produces human anti-tumor antigen antibodies when immunized with a tumor antigen and/or cells expressing a tumor antigen. The human heavy Chain transgene can be ated into the chromosomal DNA of the mouse, as is the case for enic mice, e.g., HuMAb mice, such as HC07 or HC012 mice, or the human heavy chain transgete can be maintained extrachromescrnally, as is the case for transchromosomal (e.g., KM) mice as described in WO 02/43478. Such transgenic and transchromosomal mice may be capable of producing le isotypes of human monoclonal antibodies to a tumor antigen (e.g., IgG, lgA and/0r IgE) by undergoing V—D—J recombination and isotype switching.

"Reduce", "decrease" or "inhibit" as used herein means an overall decrease or the ability to cause an overall decrease, preferably of 5% or greater, 10% or greater, 20% or greater, more preferably of 50% or greater, and most preferably of 75% or greater, in the level, e.g. in the level of expression or in the level of proliferation of cells.

Terms such as "increase" or "enhance" preferably relate to an increase or enhancement by about at least 10%, ably at least 20%, preferably at least 30%, more preferably at least 40%, more preferably at least 50%, even more preferably at least 80%, and most preferably at least 100%, at least 200%, at least 500%, at least 1000%, at least 10000% or even more.

Antibodies described herein can be produced by a y of techniques, ing tional monoclonal antibody methodology, e.g., the standard somatic cell hybridization technique of Kohler and Milstein, Nature 256: 495 (1975). Although somatic cell hybridization procedures are preferred, in principle, other techniques for ing onal antibodies can be employed, e.g., Viral or oncogenic transformation of B- lymphocytes or phage display techniques using libraries of antibody genes.

The preferred animal system for preparing hybridomas that secrete monoclonal antibodies is the murine system. Hybridoma production in the mouse is a very well established procedure.

Immunization protocols and techniques for isolation of immunized splenocytes for fusion are known in the art. Fusion partners (e.g., murine myeloma cells) and fusion procedures are also known.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Other preferred animal systems for preparing hybridomas that secrete monoclonal antibodies are the rat and the rabbit system (e.g. described in Spieker—Polet et al., Proc. Natl. Acad. Sci.

USA. 92:9348 (1995), see also Rossi et al., Am. J. Clin. . 124: 295 (2005)), In yet another preferred embodiment, human monoclonal antibodies can be generated using transgenic or transchromosomal mice carrying parts of the human immune system rather than the mouse system. These transgenic and transchromosomic mice include mice known as HuMAb mice and KM mice, respectively, and are collectively referred to herein as "transgenic mice." The production of human dies in such transgenic mice can be med as described in detail for CD20 in W02004 035607.

Yet another strategy for ting monoclonal antibodies is to ly isolate genes encoding antibodies from lymphocytes producing antibodies of defined specificity e.g. see Babcock et al., 1996; A novel strategy for generating monoclonal antibodies from , isolated lymphocytes producing antibodies of defined specificities. For details of recombinant antibody engineering see also ‘v‘v’els‘hof and Kraus, Recombinant antibodes for cancer therapy ISBN896038 and Benny K.C. Lo Antibody Engineering ISBN 1—58829-092—1.

To generate antibodies, mice can be immunized with carrier—conjugated peptides derived from the antigen sequence, i.e. the sequence t which the antibodies are to be directed, an enriched ation of recombinantly expressed antigen or fragments thereof and/or cells expressing the antigen, as described. Alternatively, mice can be immunized with DNA encoding the antigen or fragments thereof. In the event that immunizations using a purified or enriched preparation of the antigen do not result in antibodies, mice can also be immunized with cells expressing the antigen, e.g., a cell line, to promote immune responses.

The immune response can be monitored over the course of the immunization protocol with plasma and serum samples being ed by tail vein or rbital bleeds. Mice with sufficient titers of immunoglobulin can be used for fusions. Mice can be boosted eritonealy or intravenously with antigen expressing cells 3 days before sacrifice and removal of the spleen to increase the rate of specific antibody secreting hybridomas.

To ge te hybridomas producing monoclonal antibodies, cytes and lymph node cells from immunized mice can be isolated and fused to an appropriate immortalized cell line, such [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN as a mouse myeloma cell line. The resulting hybridomas can then be screened for the production of antigen-specific antibodies. Individual wells can then be screened by ELISA for antibody secreting hybridomas. By Immunofluorescence and FACS analysis using antigen expressing cells, antibodies with specificity for the antigen can be identified. The antibody secreting hybridomas can be replated, screened again, and if still positive for monoclonal dies can be subcloned by limiting dilution. The stable subclones can then be cultured in Vitro to generate antibody in tissue culture medium for characterization.

Antibodies also can be produced in a host cell transfectoma using, for e, a combination of recombinant DNA techniques and gene transfection methods as are well known in the art (Morrison, S. (l/ 85) Science 229: 120{‘0\/ For example, in one embodiment, the gene(s) of interest, e.g., antibody genes, can be ligated into an sion vector such as a eukaryotic expression plasmid such as used by the GS gene expression system disclosed in WO 87/04462, WO 36 and EP 338 841 or other expression systems well known in the art. The purified plasmid with the cloned antibody genes can be introduced in eukaryotic host cells such as CHO cells, NS/O cells, HEK293T cells or HEK293 cells or alternatively other eukaryotic cells like plant derived cells, fungal yeast cells. The method used to introduce these genes can be methods described in the art such as electroporation, lipofectine, lipofectamine or others. After introduction of these antibody genes in the host cells, cells expressing the dy can be identified and selected.

These cells represent the transfectomas which can then be amplified for their expression level and upscaled to produce antibodies. inant antibodies can be ed and purified from these culture supernatants and/or cells.

Alternatively, the cloned dy genes can be expressed in other expression systems, including prokaryotic cells, such as microorganisms, e.g. E. coli. Furthermore, the antibodies can be produced in transgenic non-human animals, such as in milk from sheep and rabbits in eggs from hens, or in transgenic plants; see e.g. Verma, R., et a1. (1998) J. Immunol. Meth. 216: 165-181; Pollock, et al. (1999) J. Immunol. Meth. 231: 7; and r, R., et a1. (1999) Biol. Chem. 380: 825—839.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Chimerization Murine antibodies are highly immunogenic in man when repetitively applied g to ion of the therapeutic effect. The main immunogenicity is mediated by the heavy chain constant regions. The immunogenicity of murine antibodies in man can be reduced or tely avoided if respective antibodies are chimerized or humanized. Chimeric antibodies are dies, the different portions of which are derived from different animal species, such as those having a variable region derived from a murine antibody and a human immunoglobulin constant . Chimerisation of antibodies is achieved by joining of the variable s of the murine antibody heavy and light chain with the constant region of human heavy and light chain (cg. as described by Kraus et al., in Methods in Molecular Biology series, Recombinant antibodies for cancer therapy ISBN-0—89603—918-8). In a. red ment chimeric antibodies are generated by joining human kappa-light chain constant region to murine light chain le region. In an also preferred embodiment chimeric antibodies can be generated by joining human lambda—light chain constant region to murine light chain variable region. The preferred heavy chain constant regions for generation of chimeric antibodies are lgGl, lgG3 and lgG4. Other preferred heavy chain constant s for tion of chimeric antibodies are IgGZ, IgA, IgD and IgM.

Humanization Antibodies interact with target antigens predominantly through amino acid residues that are located in the six heavy and light chain mentarity ining regions (CDRs). For this reason, the amino acid sequences within CDRs are more diverse between individual antibodies than sequences outside of CDRs. Because CDR sequences are responsible for most dy-antigen interactions, it is possible to express recombinant antibodies that mimic the properties of specific naturally occurring antibodies by constructing expression vectors that include CDR sequences from the specific naturally occurring antibody grafted onto framework sequences from a different antibody with different properties (see, e.g., Riechmann, L. et a1. (1998) Nature 332: 323-327; Jones, P. et al. (1986) Nature 321: 522-525; and Queen, C. et a1. (1989) Proc. Natl. Acad. Sci. U. S. A. 86: 10029-10033). Such framework sequences can be obtained from public DNA databases that include germline dy gene sequences. These germline sequences will differ from mature dy gene sequences because they will not include completely assembled variable genes, which are formeu V (D) J joining during B cell maturation. Germline gene sequences will also differ ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN from the sequences of a high affinity secondary repertoire antibody at individual evenly ac.oss the variable region.

The ability of dies to bind an antigen can be determined using standard g assays (e. g., ELISA, Western Blot, Immunofluorescence and flow cytometric analysis).

To purify antibodies, ed hybridomas can be grown in two-liter spinner-flasks for monoclonal antibody purification. Alternatively, antibodies can be produced in dialysis based bioreactors. Supernatants can be filtered and, if ary, concentrated before affinity ciuumatography with protein u—seph"r“se or pretein A-se‘ harose. Eluted IgG can be d by gel electrophoresis and high performance liquid chromatography to ensure purity. The buffer solution can be exchanged into PBS, and the concentration can be determined by OD28O using 1.43 extinction coefficient. The monoclonal antibodies can be aliquoted and stored at 430°C.

To ine if the selected monoclonal antibodies bind to unique epitopes, site-directed or multi-site directed mutagenesis can be used.

To ine the isotype of antibodies, isotype ELISAs with various commercial kits (e.g.

Zymed, Roche stics) can be performed. Wells of microtiter plates can be coated with anti-mouse 1g. After blocking, the plates are reacted with onal antibodies or purified isotype controls, at ambient temperature for two hours. The wells can then be reacted with ither mouse IgGI, IgG2a, IgGZb or IgG3, IgA or mouse IgM—“pecific peroxidase—conjugated probes. After washing, the plates can be developed with ABTS substrate (1 mg/ml) and analyzed at OD of 405—650. Alternatively, the IsoStrip Mouse Monoclonal Antibody Isotyping Kit (Roche, Cat. No. 1493027) may be used as described by the manufacturer.

In order to demonstrate presence of antibodies in sera of immunized mice or binding of onal antibodies to living cells expressing antigen, flow cytometry can be used. Cell lines expressing naturally or after transfection antigen and negative controls lacking antigen expression (grown under standard growth conditions) can be mixed with various concentrations of monoclonal antibodies in oma supernatants or in PBS containing 1% FBS, and can be incubated at 4°C for 30 min. After g, the APC- or Alexa647-labeled anti I ntibody can bind to antigen—bound monoclonal antibody under the same conditions ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN as the y antibody staining. The samples can be analyzed by flow cytometry with a FACS instrument using light and side scatter properties to gate on single, living cells. In order to distinguish antigen—specific onal antibodies from non—specific binders in a single measurement, the method of co-transfection can be employed. Cells transiently transfected with plasmids encoding antigen and a fluorescent marker can be stained as described above.

Transfected cells can be detected in a different fluorescence channel than antibody-stained cells. As the majority of transfected cells express both transgenes, antigen-specific monoclonal antibodies bind preferentially to fluorescence marker expressing cells, Whereas non—specific antibodies bind in a comparable ratio to non-transfected cells. An alternative assay using fluorescence microscopy may be used in addition to or instead of the flow cytometry assay. Cells can be stained exactly as described above and examined by fluorescence microscopy.

In order to demonstrate presence of antibodies in sera of immunized mice or binding of monoclonal antibodies to living cells expressing antigen, immunofluorescence microscopy is can be used. For example, cell lines expressing either spontaneously or after transfection antigen and negative controls lacking antigen expression are grown in chamber slides under rd growth conditions in DMEM/FIZ medium, supplemented with 10 % fetal calf serum (FCS), 2 mM amine, 100 IU/ml penicillin and 100 ug/ml streptomycin.

Cells can then be fixed with methanol or paraformaldehyde or left untreated. Cells can then be reacted with monoclonal dies t the antigen for 30 min. at 25°C. Afier washing, cells can be reacted with an AleanSS-labelled anti—mouse IgG secondary antibody (Molecular ) under the same ions. Cells can then be ed by fluorescence microscopy.

Cell extracts from cells expressing antigen and riate negative controls can be prepared and subjected to sodium dodecyl sulfate (SDS) rylamide gel electrophoresis. After electrophoresis, the ted antigens will be transferred to nitrocellulose membranes, blocked, and probed with the monoclonal antibodies to be tested. IgG binding can be detected using anti—mouse IgG peroxidase and ped with ECL substrate.

Antibodies can be further tested for reactivity with antigen by Immunohistochemistry in a mannglell known to the skilled person, e.g. using paraformaldehyde or acetone fixed cryos ns or paraffin embedded tissue sections fixed with paraformaldehyde from non- [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN cancer tissue or cancer tissue samples obtained from patients during routine surgical procedures or from mice carrying xenografted tumors inoculated with cell lines expressing spontaneously or after transfection antigen. For immunostaining, antibodies reactive to antigen can be incubated followed by horseradish—peroxidase conjugated goat anti-mouse or goat abbit antibodies (DAKO) according to the vendor’s instructions. dies can be tested for their y to mediate phagocytosis and killing of cells expressing a tumor antigen. The testing of monoclonal antibody activity in Vitro will provide an initial screening prior to testing in Vivo models.

Antibody dependent ediated xicity (ADCC) Briefly, polymorphonuclear cells (PMNs), NK cells, monocytes, mononuclear cells or other effector cells, from healthy donors can be purified by Ficoll Hypaque density centrifugation, followed by lysis of contaminating ocytes. Washed effector cells can be suspended in RPMI supplemented with 10% heat-inactivated fetal calf serum or, alternatively with 5% heat-inactivated human serum and mixed with 51Cr labeled target cells expressing a tumor antigen, at various ratios of effector cells to target cells. Alternatively, the target cells may be labeled with a fluorescence ing ligand (BATDA). A highly fluorescent chelate 0f Europium with the ing ligand which is released from dead cells can be measured by a fluorometer. Another alternative technique may utilize the transfection of target cells with luciferase. Added lucifer yellow may then be oxidized by Viable cells only. Purified anti— tumor antigen IgGs can then be added at various concentrations. Irrelevant human lgG can be used as negative control. Assays can be carried out for 4 to 20 hours at 37°C depending on the or cell type used. Samples can be assayed for cytolysis by ing 51Cr release or the presence of the EuTDA e in the culture supernatant. Alternatively, luminescence resulting from the oxidation of lucifer yellow can be a measure of viable cells.

Anti—tumor antigen monoclonal antibodies can also be tested in various combinations to determine whether cytolysis is enhanced with multiple monoclonal antibodies.

Complement dependent cytotoxicity (CDC) Monoclonal umor antigen antibodies can be tested for their ability to mediate CDC using a varifl of known techniques. For example, serum for complement can be ed from blood in a manner known to the skilled person. To determine the CDC activity of mAbs, [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN different methods can be used. 51Cr release can for example be measured or elevated membrane permeability can be assessed using a propidium iodide (PI) ion assay.

Briefly, target cells can be washed and 5 x ids/ml can be incubated with various concentrations of mAb for 10-30 min. at room temperature or at 37°C. Serum or plasma can then be added to a final concentration of 20% (v/V) and the cells incubated at 37°C for 20-30 min. All cells from each sample can be added to the PI solution in a FACS tube. The mixture can then be analyzed immediately by flow cytometry is using ray.

In an alternative assay, induction of CDC can be determined on adherent cells. In one embodiment of this assay, cells are seeded 24 h before the assay with a y of 3 x 104/well in tissue—culture flat—bottom microtiter plates. The next day growth medium is removed and the cells are incubated in triplicates with antibodies. Control cells are incubated with growth medium or growth medium containing 0.2% saponin for the determination of background lysis and maximal lysis, respectively. After incubation for 20 min. at room temperature supernatant is removed and 20% (V/v) human plasma or serum in DMEM (prewarmed to 37°C) is added to the cells and incubated for another 20 min. at 37°C. All cells from each sample are added to propidium iodide solution (10 . Then, supematants are ed by PBS containing 2.5 ug/ml ethidium bromide and fluorescence on upon excitation at 520 nm is ed at 600 nm using a Tecan Satire. The percentage specific lysis is calculated as follows: % specific lysis = (fluorescence sample-fluorescence background)/ (fluorescence maximal lysis—fluorescence background) x 100.

Induction of apoptosis and inhibition of cell proliferation by monoclonal antibodies To test for the ability to initiate sis, monoclonal anti-tumor antigen antibodies can, for example, be incubated with tumor antigen positive tumor cells or tumor antigen transfected tumor cells at 37°C for about 20 hours. The cells can be harvested, washed in Annexin-V binding buffer (BD ences), and incubated with Annexin V conjugated with FITC or APC (BD biosciences) for 15 min. in the dark. All cells from each sample can be added to P1 solution (10 ug/ml in PBS) in a FACS tube and assessed immediately by flow cytometry (as above). Alternatively, a general inhibition of cell—proliferation by monoclonal dies can be detected with cially available kits. The DELFIA Cell Proliferation Kit (Perkin- Elmer, Cat. No. AD0200) is a non—isotopic immunoassay based on the measurement of 5- brom ’ deoxyuridine (BrdU) incorporation during DNA synthesis of proliferating cells in microp a es. orated BrdU is detected using europium labelled monoclonal antibody. To [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN allow antibody detection, cells are fixed and DNA denatured using Fix on. Unbound dy is washed away and DELFIA inducer is added to dissociate europium ions from the labelled antibody into solution, where they form highly fluorescent chelates with components of the DELFIA Inducer. The fluorescence measured - utilizing esolved etry in the detection - is proportional to the DNA synthesis in the cell of each well.

Preclinical s Antibodies described herein also can be tested in an in vivo model (e.g. in immune deficient mice carrying afted tumors inoculated with cell lines expressing a tumor antigen to determine their efficacy in controlling growth of tumor antigen-expressing tumor cells.

In Vivo studies after xenografiing tumor antigen expressing tumor cells into immunocompromised mice or other animals can be performed using antibodies described herein. Antibodies can be administered to tumor free mice followed by injection of tumor cells to measure the effects of the antibodies to prevent formation of tumors or tumor—related symptoms. Antibodies can be administere to tumor-bearing mice to determine the therapeutic efficacy of respective antibodies to reduce tumor growth, metastasis or tumor related symptoms. Antibody application can be ed with ation of other substances as tatic drugs, growth factor inhibitors, cell cycle blockers, angiogenesis inhibitors or other antibodies to determine synergistic efficacy and potential toxicity of combinations. To analyze toxic side effects mediated by antibodies animals can be inoculated with antibodies or control reagents and thoroughly igated for symptoms ly related to tumor antigen- antibody therapy. Possible side effects of in vivo ation of tumor antigen dies particularly include toxicity at tumor antigen expressing tissues. Antibodies recognizing a tumor antigen in human and in other species, e.g. mice, are particularly useful to predict ial side effects mediated by application of monoclonal tumor antigen—antibodies in humans.

Mapping of epitopes recognized by antibodies can be performed as bed in detail in "Epitope Mapping Protocols (Methods in Molecular Biology) by Glenn E. Morris ISBN- 089603—375-9 and in "Epitope Mapping: A Practical Approach" Practical Approach Series, 248 by Olwyn M. R. Westwood, Frank C. Hay.

[Annotation] MYN None set by MYN ation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The compounds and agents bed herein may be administered in the form of any suitable pharmaceutical composition.

Pharmaceutical compositions are ably sterile and contain an effective amount of the antibodies described herein and optionally of further agents as discussed herein to generate the desired reaction or the desired effect.

Pharmaceutical compositions are usually provided in a m dosage form and may be prepared in a manner known per se. A pharmaceutical composition may e.g. be in the form of a solution or suspension.

A pharmaceutical composition may comprise salts, buffer substances, preservatives, carriers, diluents and/or excipients all of which are preferably pharmaceutically acceptable. The term "pharmaceutically acceptable" refers to the non-toxicity of a material which does not interact with the action of the active ent of the pharmaceutical composition.

Salts which are not pharmaceutically acceptable may be used for ing pharmaceutically acceptable salts and are included in the invention. Pharmaceutically acceptable salts of this kind comprise in a non-limiting way those prepared from the following acids: hydrochloric, hydrobromic, sulfuric, nitric, oric, maleic, acetic, salicylic, citric, formic, malonic, succinic acids, and the like. Pharmaceutically acceptable salts may also be prepared as alkali metal salts or alkaline earth metal salts, such as sodium salts, potassium salts or calcium salts.

Suitable buffer substances for use in a pharmaceutical composition include acetic acid in salt, citric acid in a salt, boric acid in a salt and phosphoric acid in a salt.

Suitable preservatives for use in a pharmaceutical composition e benzalkonium chloride, chlorobutanol, paraben and thimerosal.

An injectible formulation may comprise a pharmaceutically acceptable excipient such as Ringer lactate.

The rrier" refers to an organic or inorganic component, of a natural or synthetic nature, in which the active component is combined in order to facilitate, enhance or enable [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN aPPlication. Accordin to the invention, the term er" also includes one or more compatible solid or liquid , diluents or encapsulating substances, which are suitable for administration to a patient.

Possible carrier substances for parenteral stration are e.g. sterile water, Ringer, Ringer lactate, sterile sodium chloride solution, polyalkylene s, hydrogenated naphthalenes and, in particular, biocompatible lactide polymers, lactide/glycolide copolymers or polyoxyethylene/polyoxy— propylene copolymers.

The term "excipien " when used herein is intended to indicate all substances which may be present in a pharmaceutical composition and which are not active ingredients such as, e.g., carriers, s, lubricants, thickeners, surface active agents, vatives, emulsifiers, buffers, flavoring agents, or colorants.

The agents and compositions described herein may be administered via any conventional route, such as by parenteral stration including by ion or infusion. Administration is preferably parenterally, e.g. intravenously, intraarterially, subcutaneously, intradermally or intramuscularly. itions suitable for parenteral administration usually comprise a sterile aqueous or nonaqueous preparation of the active compound, which is preferably isotonic to the blood of the recipient. Examples of compatible carriers and solvents are Ringer solution and ic sodium de solution. In addition, usually sterile, fixed oils are used as solution or suspension medium.

The agents and compositions described herein are administered in ive amounts. An "effective amount" refers to the amount which achieves a desired reaction or a desired effect alone or together with further doses. In the case of treatment of a particular disease or of a particular condition, the d reaction preferably relates to inhibition of the course of the disease. This comprises slowing down the ss of the disease and, in particular, interrupting or reversing the progress of the disease. The desired reaction in a treatment of a disease or of a condition may also be delay of the onset or a prevention of the onset of said diseasq said condition. In particular, the term "effective amount" refers to the amount of atherapyt at is sufficient to result in the prevention of the pment, recurrence, or onset of ation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN cancer and one or more symptoms thereof, reduce the severity, the duration of cancer, ameliorate one or more symptoms of cancer, prevent the advancement of cancer, cause regression of cancer, and/or prevent cancer metastases. in an embodiment of the invention, the amount of a therapy is effective to achieve a stabilization, reduction or elimination of the cancer stem cell population and/or eradication, removal, or control of primary cancer, metastatic cancer and/or recurrent cancer.

An ive amount of an agent or composition described herein will depend on the condition to be treated, the severeness of the disease, the individual parameters of the patient, including age, physiological condition, size and weight, the duration of treatment, the type of an anying therapy (if present), the specific route of administration and similar factors.

Accordingly, the doses administered of the agents described herein may depend on several of such parameters. In the case that a on in a patient is insufficient with an initial dose, higher doses (or effectively higher doses achieved by a different, more localized route of administration) may be used.

The agents and compositions provided herein may be used alone or in combination with conventional therapeutic regimens such as surgery, irradiation, chemotherapy and/or bone marrow transplantation (autologous, syngeneic, allogeneic or unrelated).

Treatment of cancer represents a field where combination strategies are especially desirable since frequently the combined action of two, three, four or even more cancer drugs/therapies generates synergistic effects which are erably er than the impact of a monotherapeutic approach. Thus, in another embodiment of the present invention, a cancer treatment may be effectively combined with s other drugs. Among those are e.g. combinations with conventional tumor therapies, multi-epitope strategies, additional immunotherapy, and treatment approaches targeting angiogenesis or apoptosis (for review see e.g. Andersen et al. 2008: Cancer treatment: the ation of vaccination with other therapies. Cancer Immunology therapy, : 1735—1743.) Sequential stration of different agents may inhibit cancer cell growth at different check , while other agents may e.g. inhibit giogenesis, survival of malignant cells or metastases, potentially converting cancer into a chronic disease.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN The present invention is further illustrated by the following examples which are not be construed as limiting the scope of the invention.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN EXAMPLES Example 1: Descriptive analysis of genetic immune polymorphisms The individual pattern of single nucleotide polymorphisms (SNP) in the patient genome could be tive for the response rate of the therapeutic antibody iMAB362. in order to investigate such SNP ns, all patients were ped for a number of SNPs with known or presumed role in immune response and gastric cancer susceptibility.

In detail, the following questions were addressed: a. The SNP pes of every patient with regard to studied polymorphisms. b. The frequency of SNP genotypes in the patient population. 0. Identification of patients with polymorphisms which may interfere directly with IMAB362 mode of action (Fc receptor and complement system polymorphisms). d. The accumulation of SNP genotypes per patient described as risk factors for gastric cancer susceptibility, cancer ssion, or cancer treatment. e. Correlation of SNP genotypes with clinical outcome. f. Correlation of SNP genotypes with Progression-Free Survival (PFS).

All patients of cohort 1, 2, and 3 were analyzed for c polymorphisms. Patient blood samples were collected on Day 1 (V2a, pre—infusion).

Whole blood samples (9 m1, onovette) were collected from all ts. EDTA blood was stored in 1 m1 ts immediately after sample collection at the study center at -20 °C.

EDTA blood samples were shipped on dry ice (-70 °C) and stored at -20 °C. Upon l, blood samples were stored immediately at ~20 °C until DNA isolation.

SNPs of interest were selected by a literature research focusing on SNPs which are known to affect functioning of the immune system and especially SNPs which have been described to affect the mode of action of therapeutic antibodies as Fe receptor and complement system polymorphisms. SNPs having been described to affect survival of gastric cancer patients, susceptibility to (gastric) cancer or progression of gastric cancer were selected and studied as well.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN Genetic polymorphisms were analyzed by SNP Genotyping TaqManTM assays (46 standard, 5 custom made; Life Technologies) on the Fluidigm BiomarkTM real time PCR is platform. DNA isolation was done according to standard protocols for the isolation of genomic DNA from whole blood. The Fluidigm BiomarkTM real time PCR analysis platform allows to genotype up to 96 t samples with 96 SNPs in one measurement, as patient s and specific SNP primers are applied to a lab chip with 96 channels for patient DNA samples and 96 orthogonal channels for the SNP assays. Genomic patient DNA is pre— amplified by Specific Target Amplification (STA). plified DNA is subjected to TaqManTM real time PCR analysis under rd conditions in the Fluidigm BiomarkTM real time PCR analysis plntfonn. Allelic ination of the SNPS was done for each pntient and each assay using the proprietary Fluidigm software and the statistical analysis re “R”.

A subset of SNPs was confirmed by classical Sanger sequencing as Fluidigm s were ambiguous.

Genetic polymorphisms of 51 single nucleotide polymorphisms (SNP) were determined for 53 patients. The blood sample from l patient did not allow DNA extraction in sufficient quantities to analyze SNPS. 6 SNP genotypes were determined for a subset of 20 patients only. The genotype for MDM2 SNP r52279744 was not ined in 9 patients due to technical problems. The PTGS2 rs20417 genotyping result for 1 patient was ambiguous and was not further investigated.

Determination of the matrix of SNP genotypes for tested patients allows tical testing of the patient population for ncy shifts of pes compared to genotype frequency in Caucasian control populations. SNP genotype frequencies in Caucasian control populations are based on data collected by international SNP genotyping projects (HapMap-CEU, PGA— EUROPEAN—PANEL, CAUCl, pilot_l_CEU_low_coverage_panel, CEU_GENO_PANEL, FDR—90) deposited into the public database dbSNP (National Center for hnology Information, da (MD, USA). The number of patients per genotype of a given SNP was compared with the number of patients per genotype in Caucasian control populations. The number of patients per genotype for control tions was calculated by lying the provided relative SNP genotype frequency in the population with the reported number of studied samples. This allowed a direct Chi square test to identify statistically significant differences between the patient population and the corresponding control population.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN The Chi square test was performed for 48 out of 51 studied SNPs. No data for SNP genotype frequencies has been deposited in public databases yet for SNPs ClQA (rle44378), FCGRZC (Q57X (C—>T)), and MDM2 (rs2279744). SNPs with a tically significant shift in genotype frequency between patient and l population (5 of 48 SNPs, p<0.05)- are shown in Figure l. 4 of these 5 SNPS have been shown t0 play a role in cmcer/gastric cancer susceptibility. All 4 cancer/gastric cancer susceptibility SNPS show indeed an overrepresentation of the respective cancer associated genotype in the patient population, as expected for gastric cancer ts (Table 1). l of these 5 SNPs has so far not been shown to be a risk/susceptibility factors in cancer or c cancer, rlel46727 ((318). This SNP has 50 far only been described as a putative risk factor for cardiovascular disease once.

Table 1: Gastric cancer susceptibility-associated SNPs with statistically significant differences in genotype frequency between patient and control population.

Major (gastric) overrepresented Gene SNP number cant“. . genotype susceptibility risk genotype n T A .MrvnFII-I | LTL er | 134.31 I [5 | GG | GG | 49 out of 51 studied SNPs in the patient population show a variant allele pattern in the studied patient population. This allows testing for frequency shifts of SNP alleles between patient subpopulations, which ideally could help in identification of a ve responder population.

Only 2 SNPs, ClQA (rle44378) and FCGRZC (AHNIME8) show an invariant SNP genotype in all patients, preventing any kind of differential is. For 5 SNPs, a tically significant allele frequency shift could be determined in this study compared to control populations, providing proof of principle that SNP allele frequency is dependent on the composition of a given population. The tested SNP selection is hence well suited for the future fication of SNP biomarker candidates.

Fc recgor and complement system polymorphisms may interfere directly with IMAB362 mode . Patients were genotyped for SNP alleles in genes which may affect the [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN efficacy of antibody-based therapies, as FCGR3A [T->G], r3396991), FCGRZA (H131R [T-9C], r31801274), and ClQA 9G], rsl72378) (Table 2).

Patients were further genotyped for published SNP alleles of the FCGR2C gene (Q57X [C—)T], no rs number) and of the complement system s CIS (R119H [09A], r512146727) and ClQA 001, rs1044378). These SNPs have not yet been demonstrated to affect antibody therapy but were included as interesting candidate SNPs.

Table 2: Patients with Fe receptor and complement system polymorphisms. The genotypes of patients with well-documented Fc receptor and complement system polymorphisms are listed. FCGR3A Val/Va1 polymorphisms with a putative positive impact on antibody therapy are depicted bold and underlined. Polymorphisms in FCGRZA (Arg/Arg) and ClQA [G/G] with a putative negative impact on antibody therapy are grey shaded and highlighted in bold. rs396991 rs1801274 {3172378 100124 GT 100605 _— Tc A total of 23 patients show at least one of the well-documented Fc receptor and complement system polymorphisms. 4 patients (100411, 101120, 200336, and 400109) were homozygous for the FCGR3A allele (F176V [T9G]), which has been reported to increase se rates and 1:gession free al in antibody therapy. 12 ts are homozygous for the FCG allele (H131R [T-)C]), further 10 patients are homozygous for the ClQA allele [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN ([276A-9G]). Both of these SNPs have been demonstrated to impact antibody therapy negatively. In total, 21 ts are homozygous for either the FCGRZA allele (H131R [TéCD or the ClQA allele {[276A9G} (Patient 100511 is homozygous for both SNP alleles).

A correlation of findings above with e progression of patients may yield insight into the role of Fe receptor and complement system polymorphisms for IMAB362 treatment.

Progression of disease and efficacy of antibody treatment in patients could be ed by the accumulation of SNPs described as risk factors for gastric cancer susceptibility, cancer progression, or cancer treatment. Among the investigated 51 SNPs, up to 43 SNPs allow categorization of the respective SNP genotypes as ‘risk’ versus ‘non—risk’ genotypes. The number of homozygous SNP risk factor genotypes per patient was counted as these are described in general as the most relevant risk alleles. The relative frequency of the number of homozygous risk pes per patient in relation to the number of investigated SNP risk factors per patient is depicted in Figure 2.

An accumulation of 14 to 46% of the investigated risk genotypes per patient is observed. This broad distribution allows investigating if the accumulation of SNP risk genotypes per patient ates with clinical outcome of the patient.

In summary, 53 of 54 patients were successfully genotyped for 51 SNPS. 49 out of 51 SNPs show a variant SNP allele pattern; allowing analysis of patient subpopulations for a significant shift in SNP genotype frequency. gous Fc receptor and ment system polymorphisms described as modulators of antibody therapy are discovereu in 23 out of 53 patients. An accumulation of 14 to 46% of the investigated risk genotypes per t is observed.

Example 2: Correlation of SNP genotyping with clinical results Objective of the correlation of clinical outcome with genotypes of genetic polymorphisms is the identification of putative SNP ker ates predicting clinical outcome of ts. Putative biomarker candidates identified in this analysis will be verified in nt Phase IIb and Phase III studies. Verification of putative biomarker candidates in [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Phase IIb will allow differentiation between putative prognostic and predictive SNP candidates.

Correlation analysis for each SNP with clinical outcome was done ndently for two defined phase Ila clinical trial patient populations: The ‘full analysis set’ population (FAS) with 40 ts and the ‘per protocol set’ tion with 21 patients.

Absolute frequencies of genotypes of the respective SNP for each al outcome group (‘responder’, ‘non-responder’) of the patient population were fied by SAS Enterprise Guide 6.1. Absolute genotype frequencies were organized in contingency tables (3X2 or 2x2) structured by clinical outcome and SNP genotype. The standard statistical test employed was Pearson’s Chi square test. Fisher’s exact test was applied in some cases for 2x2 contingency tables if numerical structure of the data set prohibited use of Pearson’s Chi square test. The level of statistical significance applied was p<0.05. ation analysis was realized with the statistical analysis software SAS rise Guide 6.1.

In order to investigate the effect of SNP genotypes on progression-free survival, Kaplan- Meier curves were ated for each group and then ly compared employing the statistical k test. The level of statistical significance applied was p<0.05. Logrank statistics were realized with the statistical analysis software SAS Enterprise Guide 6.1.

Correlation of clinical outcome with SNP genotyping is med to identify putative predictive or prognostic SNP ker candidates. Correlation was studied in two patient populations, the FAS population and the PP population.

The PAS population comprises 40 patients, 12 patients defined as ‘responder’ (clinical outcome ‘partial remission’ or e disease’) and 28 patients as ‘non-responder’ (clinical outcome ‘progression of disease’). One patient sample (100801, non—responder) of the FAS tion was not available for SNP analysis as bed above, maximum number of FAS patients analyzed for correlations was therefore reduced to 39. The PP population comprises 21 patients with 10 responder patients and 11 non-responder patients.

The number of patients investigated per SNP differ between 20 and 39 (in FAS population) and 2b 21 (in PP population).

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Correlation analysis was done as bed above. In total, out of the 51 SNPs studied, 2 show a statistically significant correlation with clinical outcome in FAS as well as in the PP population.

The 2 SNPs showing statistical ation between clinical outcome and respective SNP genotype in both tions are FCGRZA r51801274 (p=0.0004 [PP]; p=0.008 [FAS]), and IL-10 rs1800896 (p=0.042 [PP], p=0.022 [FAS]) (Table 3). Number of patients tested statistically per SNP were 21 (PP) and 39 (FAS) for each of these 2 SNPs.

Table 3: SNPs showing statistical correlation between clinical outcome and SNP g_en0_type in PP as well as in FAS populations Genotype overrepresented rs number Gene name , p-value (PP) p-value (FAS) In responder population r51801274 FCGRZA [CT] 0.0004 0.008 r51800896 lL10 [66] 0.042 0.022 (Chi square test, statistically significant: p<0.05) SNPs show a correlation with clinical outcome in one patient population (FAS or PP), can be shown for DNMT3A r81550117 [PP, p=0.035], SMAD4 rsl2456284 [FAS, p=0.02], MUCl rs4072037 (FAS, p=0.03), EGF rs4444903 [FASi p=0.049], and CDH1 rsl6260 {PAS p=0.049]) (Table 4).

Table 4: SNPs showing tical correlation between clinical outcome and SNP eno e in PP or FAS o ulation.

Genotype overrepresented rs number Gene name , p-value (PP) e (FAS) In responder population r51550117 DNMT3A [GA] 0.035 0.32 r512456284 SMAD4 [GA] 0.081 0.023 037 MUCl [AA] 0.11 0.03 rs4444903 EGF [AA] 0.32 0.049 rsl6260 CDH1 [AA] 0.72 0.049 (Chi square test, statistically cant: p<0.05) [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Inspection of over- or underrepresentation of SNP genotypes in responder/non—responder patients may allow to e scientific explanation for statistically significant frequency differences.

Genotypes of two SNPS, rs11615 (ERCCl) and rs396991 A), are correlated with ged progression—free survival (PFS) in the PP population (Ta‘o‘ze 5).

Table 5: SNPs showing statistical ation between prolonged PFS and SNP genotype in the PP population.

Genotype rs number Gene name correlated with p-value (PP) p-value (FAS) r511515 ERCCl [TT] 0.0001 0.13 r5396991 FCGR3A [TGl/[TI'] 0.0007 0.25 Number of patients tested statistically per SNP were 21 (PP) and 39 (FAS) for each of the 9 SNPs listed.

FCGRZA rs1801274 [CIT]: In PP, all patients harboring the heterozygous r31801274 [CT] genotype are indeed responder (8) which is reflected in the highly significant p—Value 4) of the statistical test. All PR patients (4 out of 4) display this genotype. Most non—responders (73%, 8 out of 11) show the homozygous [TT] genotype (Table 6). This genotype bution pattern can be found in the FAS population as well, although not as distinct as in the PP population (Table 7). A number of non—responder patients in the FAS population do a1so harbor the [CT] pe (30%) whic 1 leads to a less pronounced but still statistically highly cant p—Value.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Table 6: Listing of rs1801274 (FCGRZA) genotypes in PP patients and respective frequencies in der (PR and SD) and non-responder patients (PD). “1801274 PFS Abs freq. Rel freq.

Patient ID (FCGRZA) OUTCOME Best response [days] eno [CT] [CT] ‘5 e 100702 CT RESP PR 322 8 80% 200316 CT RESP PR 302 I i 100603 CT RESP PR 287 l I 200315 CT RESP PR 238 1 100108 CT RESP SD 330 100124 CC RESP SD 170 100709 CT RESP SD 146 101302 CT RESP SD 141 101 109 TT RESP SD 132 100534 CT RESP SD 78 101116 TT NONRESP PD 114 0 0% I 100510 TT P PD 112 200310 CC NONRESP PD 102 200319 CC NONRESP PD 73 I 101105 TT NONRESP PD 71 I I 10041 1 TT P PD 70 100513 TT NONRESP PD 70 100605 CC NONRESP PD 70 400109 TT NONRESP PD 67 400101 TT NONRESP PD 65 101 120 TT NONRESP PD 64 RESP: Responder, NONRESP: Non-responder, PFS: Progression—free survival, abs freq: absolute frequency, rel freq: relative frequency ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Table 7: Listing of rs1801274 (FCGRZA) genotypes in FAS patients and respective frequencies in responder (PR and SD) and sponder ts (PD). rs1801274 PatientID OUTCOME Best response Abereq‘ q' (FCGRZA) [days] [CT] [CT] em .6 100702 CT RESP PR 322 10 83% 200316 CT RESP PR 302 100603 CT RESP PR 28 I_200315 CT RESP PR 238 _I 200205 CT RESP SD 476 I 100108 CT RESP SD 330 400112 CT RESP SD 194 100124 CC RESP SD 170 100709 CT RESP SD 146 . 101302 CT mSP SD 141 1 I 101109 TT RESP SD 132 I I 100534 CT RESP SD 78 100715 CC NONRESP PD 141 8 30% I 100804 CT NONRESP PD 119 I I I 101116 TT NONRESP PD 114 100510 TT NONRESP PD 112 I I 100808 TT NONRESP PD 112 200310 CC NONRESP PD 102 200336 CC NONRESP PD 90 101201 CT NONRESP PD 79 200207 TT P PD 75 200319 CC NONRESP PD 73 101105 TT NONRESP PD 71 100411 TT NONRESP PD 70 100513 TT NONRESP PD 70 100605 CC NONRESP PD 70 400109 TT NONRESP PD 67 400101 TT NONRESP PD 65 101 120 TT NONRESP PD 64 400111 CT NONRESP PD 60 1 100901 CT NONRESP PD 55 100529 TT NONRESP PD 50 100127 CC P PD 47 100410 CT NONRESP PD 46 100518 CT NONRESP PD 35 100310 CC NONRESP PD 30 100607 CT NONRESP PD 27 100711 CC NONRESP PD 22 101007 CT NONRESP PD 1’1 RESP: Responder, NONRESP: Non-responder, PFS: Progression-free survival, abs freq; absolute frequency, rel freq.: relative frequency Survival analysis FCGRZA rs1801274 [C/T]: Highly significant overrepresentation of r51801274 genotype [CT] in the responder population is expected to be reflected in a correlation with prolonged progression-free survival (PFS) time, too. Indeed, in both populations, PP (Fig. 3) and FAS ), the [CT] genotype is correlated with prolonged PFS (PP p=0.0007, FAS p=0.03) highly Significant as well. It is of interest though, that during the first 6Gatment days FAS patients with the [TT] genotype Show a trend to a higher PFS rate than the patients with [CC] or [CT] genotype. Survival analysis thus confirms rS1801274 [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN (FCGRZA) as a highly interesting putative biomarker candidate of predictive or prognostic nature.

IL-10 r51800896 {A/G}: In PP, none of the “ion—responder patients harbors the homozygous r31800896 [GG] pe (Table 8). This genotype is found at elevated frequency (40%) in responder patients (4 out of 10). Only 1 out of 10 responder (10%) shows the [AA] genotype, the remaining responders Show the zygous [GA] genotype. In FAS, a comparable genotype frequency distribution can be observed (Table 9), although the [GG] genotype can be observed in the non-responder patients in this population at a low frequency (11%, 3 out of 27).

Table 8: Listing of 111800896 (IL-10) genotypes in PP ts and respective frequencies in responder (PR and SD) and non-responder patients (PD). . r51800896 (IL-10) PFS Patlent ID Abs freq. Rel freq.

OUTCOME Best response eno 1'9 [da 5] 100702 AA RESP PR 322 4 40% 200316 GG RESP PR 302 100603 GA RESP PR 287 200315 GA RESP PR 238 |_ J I 100108 GG RESP SD 330 100124 GA RESP SD 170 100709 GA RESP SD 146 101302 GA RESP SD 141 101109 GG RESP SD 132 100534 GG RESP SD 78 101116 AA P PD 114 O 0% 100510 AA NONRESP PD 112 200310 GA NONRESP PD 102 200319 GA NONRESP PD 73 101105 GA NONRESP PD 71 100411 AA NONRESP PD 70 100513 AA NONRESP PD 70 100605 GA NONRESP PD 70 400109 GA NONRESP PD 67 400101 AA NONRESP PD 65 101 120 GA NONRESP PD 64 RESP: der, NONRESP: Non—responder, PFS: Progression—free al, abs freq: te frequency, rel freq: relative frequency [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Table 9: Listing of rs1800896 (IL-10) genotypes in FAS patients and respective frequencies in responder (PR and SD) and non-responder patients (PD).

Patient 896 (IL-10) PFS Abs freq. Rel freq.

OUTCOME Best se ID ,eno ne [da 5] [GG] [GG] 100702 AA RESP PR 322 6 50% 200316 GG RESP PR 302 100603 GA RESP PR 287 200315 GA RESP PR 238 200205 GG RESP SD 476 100108 GG RESP SD 330 400112 GG RESP SD 194 100124 GA RESP SD 170 100709 GA RESP SD 146 101302 GA RESP SD 141 101109 GG RESP SD 132 100534 GG RESP SD 78 2,2 ,, ,, 100715 GA NONRESP PD 141 100804 AA NONRESP PD 119 101116 AA NONRESP PD 114 100510 AA P PD 112 100808 GG NONRESP PD 112 200310 GA NONRESP PD 102 200336 AA NONRESP PD 90 101201 GA NONRESP PD 79 200207 GA NONRESP PD 75 200319 GA NONRESP PD 73 ' 101105 GA NONRESP PD 71 100411 AA NONRESP PD 70 100513 AA NONRESP PD 70 100605 GA NONRESP PD 70 400109 GA NONRESP PD 67 400101 AA NOT‘IRESP PD 65 101120 GA NONRESP PD 64 400111 GA P PD 60 100901 GG P PD 55 100529 GA NONRESP PD 50 100127 AA NONRESP PD 47 100410 GG NONRESP PD 46 100518 GA NONRESP PD 35 100310 GA NONRESP PD 30 100607 GA NONRESP PD 27 100711 GA NONRESP 101007 P RESP: Responder, NONRESP: Non-responder, PFS: Progression-free survival, abs freq: absolute frequency, rel freq: ve frequency Survival analysis rs1800896 (IL-10) [A/G]: The 896 [GG] genotype is significantly overrepresented in responder patients. Statistical correlation of the [GG] genotype with PFS shows that in PP and FAS population, the [GG] genotype is not significantly correlated with PFS (PP p=0.27 (Fig. 5); FAS p=0.08, (Fig. 6)). However, the p-Value for the FAS survival correlation borders on significance, which may be an indication that in larger populations with reduced statistical noise significance may well be reached. Overall, rsl800896 (IL-10) is an intereng putative biomarker candidate.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN DNMT3A 117 [G/A]: In PP, 4 responder (40 %) show the [GA] genotype whereas all of the non-responder Show the [GG] pe (p=0.03, Table 10).

Table 10: Listing of r51550117 A) genotypes in PP raiivnntients and respective frequencies in responder (PR and SD) and non-responder patients (PD). ,_ Pattentm; :11 OUTCOME aestrespensa _ RelfrquGAI ' 1007-02 66 RESP PR 45 % 2003-16 66 RESP PR 1006-03 GA RESP PR GA RESP 1001—08 66 RESP 1001-24 66 RESP SD I 1007-09 GA RESP SD ' 2 GA RESP SD 1011-09 GG RESP SD 1005—34 66 RESP SD 1011-16 66 NONRESP PD 1005-10 66 NONRESP PD 2003-10 66 NON RESP PD 2003-19 66 NON RESP PD 1011—05 GG NON RESP PD 1004-11 GG NONRESP PD 1005-13 66 NONRESP PD 1006—05 66 NONRESP PD 9 66 NONRESP PD 4001—01 66 NONRESP PD 1011—20 GG NONRESP PD 64 RESP: Responder, NONRESP: Non—responder, PFS: Progression-free survival, abs freq.: te frequency, rel freq.: relative frequency Survival analysis rs1550117 (DNMT3A) [G/A]: The rsl550117 [GA] genotype is significantly overrepresented in der patients of the PP population. In the FAS population, the difference in PPS between [GA] and [GG] carriers is of borderline significance (FAS p=0.058) e 7).

In the FAS population, only one patient is a carrier of the [AA] genotype.

SMAD4 rs12456284 [G/A]: In FAS, a statistically cant overrepresentation of the [GA] genotype (7 of 12 patients, 58 %) over the [AA] and [GG] genotype can be found in the responder population (p=0.023, Table 11). In the FAS non-responder population the frequegof the [GA] genotype can be found at a frequency of 19 % (5 of 27 non—responder).In the population this association is indicated by trend significance (p=0.081, data not shown). 1 00 [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN ed set by MYN Table 11: Listing of 1012456284 (SMAD4) genotypes in FAS patients and respective frequencies in responder (PR and SD) and non-responder patients (PD).

W ‘rs12456284- , : , OWCOME _ _ MAM genotypes-r 1007-02 AA RESP 2003-16 GA RESP | 1006-03 GA RESP 2003-15 GA RESP GA RESP 1001—08 AA RESP 4001-12 AA RESP 1001-24 GA RESP | 1007-09 GA RESP 1013-02 AA RESP 1011-09 AA RESP 1005-34 GA RESP 1007-15 66 NONRESP 1008-04 AA NONRESP 1011-16 GA NONRESP 1005-10 AA NONRESP 1008-03 AA NONRESP 2003-10 GA NONRESP 2003-35 AA NONRESP 1012-01 AA NONRESP 2002-07 AA NONRESP 2003-19 AA P 1011-05 AA P 11004-11 AA NONRESP 1005-13 AA NONRESP 1006-05 AA NONRESP 4001-09 AA P 1 AA NONRESP 1011-20 AA P 4001-11 AA NONRESP 1009-01 GA NONRESP 1005-29 AA NONRESP 1001-27 AA NONRESP 1004-10 AA NONRESP 1005-13 AA NONRESP 1003-10 AA NONRESP 1006-07 AA NONRESP 1007-11 GA P 1010-07 GA NONRESP RESP: Responder, NONRESP: Non-responder, PFS: Progression-free survival, abs freq.: absolute frequency, rel freq.: relative frequency [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Survival analysis r512456284 (SMAD4) [G/A]: The r812456284 [GA] genotype is significantly overrepresented in PAS responder patients and shows the same trend in PP responders. tical correlation of rs12456284 genotypes with PFS shows that in the PP tion, the [GA] genotype is significantly correlated with PFS (PP p=0.048) using the Gehan—Brelow-Wilcoxon test (Figure 8) whereas significance using the logrank test is p=0.35.

The Gehan-Brelow-Wilcoxon test gives more weight to PFS events at early time points than the logrank test and indeed the difference n [GA] and [AA] carriers is most pronounced during the respective first 100 days of this phase Ila clinical trial. In the FAS population the [GA] genotype is not significantly correlated with PFS (p=0.20 (logrank), p=0.23 (Gehan—Brelow-Wilcoxon», although visual inspection suggests a trend of [GA] carriers to prolonged PFS.

MUCI rs4072037 [A/G]: In FAS, the rs4072037 genotype found with highest fiequency of 67% in the responder population is [AA] (8 out of 12), whereas non-responders display this pe in only 26% of ts (7 out of 27). None of the responder patients shows the homozygous [GG] genotype (Table 12) whereas non-responder Show the [GG] genotype at a rate of 22% (6 out of 27). This differential genotype distribution in responder and non— responder FAS patients is statistically significant (p=0.03). A comparable genotype distribution pattern is found in the PP tion (data not , where responder show nearly the same relative [AA] genotype ncy of 70% (7 out of 10) as in the FAS population (trend cance p=0.11).

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Table 12: Listing of rs4072037 (MUCl) genotypes in FAS patients and tive frequencies in responder (PR and SD) and non-responder patients (PD).

I rs4072037 Abs freq.

Patient 1]) OUTCOME Best response [AA] 100702 AA 67% 200316 AA RESP PR 302 100603 AA RESP PR 287 200315 AG RESP PR 238 200205 AA RESP SD 476 100108 AA RESP SD 330 400112 AG RESP SD 194 100124 AA RESP SD 170 100709 AG RESP SD 146 101302 AA RESP SD 141 101 1 9 AG ESP SD 1 7 2 100534 AA I 1007 1 5 NONRESP 100804 AG NONRESP PD 119 I 101116 AA NONRESP PD 114 100510 AA NONRESP PD 112 100808 AG NONRESP PD 112 200310 AG NONRESP PD 102 200336 GG NONRESP PD 90 101201 AG NONRESP PD 79 200207 AG NONRESP PD 75 I 200319 AA NONRESP PD 73 I | 101105 GG P PD 71 10041 1 AA NONRESP PD 70 100513 GG NONRESP PD 70 100605 AG NONRESP PD 70 400109 GG NONRESP PD 67 400101 GG NONRESP PD 65 101120 AG NONRESP PD 64 400111 GG NONRESP PD 60 100901 AG NONRESP PD 55 100529 AA NONRESP PD 50 100127 AG NONRESP PD 47 100410 AG NONRESP PD 46 100518 AA P PD 35 100310 AG NONRESP PD 30 100607 AG NONRESP PD 27 10071 1 AG NONRESP 101007 NONRESP RESP: Responder, NONRESP: Non-responder, PFS: Progression-free survival, abs freq: absolute ncy, rel freq; relative frequency Survival analysis rs4072037 (MUCl) [NC]: The significant overrepresentation of rs4072037 pe [AA] in responder ts may indicate correlation of this genotype with PFS. Statistical g reveals that in PP and FAS tion, the [AA] genotype is significantly correlated with PFS (PP p=0.001, (Fig. 9); FAS p=0.02, (Fig. 10)). This survival analysis confirms 037 (MUCl) as a very interesting putative predictive or prognostic biomarker candidate. ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN EGF rs4444903 [G/A]: In FAS, the rs4444903 pe [AA] is significantly overrepresented (p=0.049) in the responder population (5 out of 12; 42 %) compared to the non-responder population (3 out of 27; 11%) (Table 13). In the PP population this asymmetrical distribution is not statistically significant (p=0.32, data not shown).

Table 13: Listing of rs4444903 (EGF) genotypes in FAS patients and respective frequencies in responder (PR and SD) and non-responder patients (PD), Patient ID F) :1 L'L‘ ‘ ‘ : , _ genotype,» 2 GA 2003-16 AA 1 1006-03 AA I 200315 2002-05 21001-08 GA 4001-12 GA 10031-24 AA 1007—09 AA 1013-02 66 1011—09 GA 1005—34 NONRESP 4 GA NONRESP PD 119 1011-16 AA NONRESP PD 114 1005-10 GA NQNRESP .00 112 1008-08 GA NONRESP PD 112 2003-10 GA NONRESP PD 102 2003-36 66 NONRESP PD 90 1012-01 66 NONRESP PD 79 7 GA NONRESP PD 75 2003-19 66 NONRESP PD 73 101105 AA NONRESP PD 71 1004-11 GA P PD 70 1005-13 GA NON RESP PD 70 1006-05 GA NONRESP PD 70 4001-09 GG NONRESP PD 67 4001-01 66 NONRESP PD 65 1011-20 GA NONRESP PD 64 4001-11 GA NONRESP PD 60 1009-01 GA NONRESP PD 55 1005-29 GG NONRESP PD 50 7 66 NONRESP PD 47 1004-10 66 NON RESP PD 46 1005-18 66 NONRESP PD 35 101D0 GA NONRESP PD 30 1006-07 GA NONRESP PD 27 [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN 1007-11 AA NONRESP PD 22 1010-07 GA NONRESP PD 17 RESP: Responder, NONRESP: Non-responder, PFS: Progression-free survival, abs freq; absolute frequency, rel freq.: relative ncy Survival analysis rs4444903 (EGF) [G/A]: The correlation of the rs4444903 [AA] genotype with PFS in the PP or FAS population is not statistically significant (FAS p=0.1; PP p=0.16).

However, a trend towards prolonged PFS can be observed both in PP and FAS population (Figure 11).

CDHl 1316260 [CIA]: In FAS, the rsl6260 genotype [AA] is found at a significantly higher frequency in the responder (5 out of 12; 42 %) than the non-responder population (3 out of 27; 11 %) (p=0.049, Table 14). In PP, this asymmetrical distribution between both patient groups is not cant (p=0.72, data not shown).

Table 14: g of rsl6260 (CDHl) genotypes in FAS patients and respective frequencies in responder (PR and SD) and non-responder ts (PD). 1007—02 2003-15 CC RESP PR 302 1006-03 CC RESP PR 287 2003-15 RESP ' ' ’ 1001-03 CA RESP so 330 4001-12 AA RESP so 194 1001-24 CC RESP so 170 1007-09 AA RESP so 146 1013-02 CC RESP so 141 I i 9 cc RESP so 132 1005—34 CC RESP SD 78 1007-15 CC NONRESP PD 141 3 11 % 1008—04 cc NON RESP PD 119 1011-16 CA NONRESP PD 114 1005-10 AA NONRESP PD 112 1008-08 CC NONRESP PD 112 2003-10 cc NON RESP PD 102 6 CA NON RESP PD 90 1012-01 CA P PD 79 2002-07 cc NONRESP PD 75 2003-19 CC NONRESP PD 73 1011-05 AA P PD 71 100g AA NONRESP PD 70 100 - CC NONRESP PD 70 [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN 1006-05 CC NONRESP PD 70 4001-09 CA NON RESP PD 67 4001-01 CA NONRESP PD 65 1011-20 CC NONRESP I PD 64 4001-11 CC NONRESP PD 60 1009-01 CC NONRESP PD 55 1005-29 CA NON RESP PD 50 i 1001-27 CA NONRESP PD 47 1004-10 CA NONRESP PD 46 1005—18 C NONRESP PD 35 0 CC NON RESP PD 30 1006-07 CA P PD 27 1007-11 CC NONRESP PD 22 101007 CC NON RESP PD 17 RESP: Responder, NONRESP: Non-responder, PFS: Progression-free survival, abs freq: absolute frequency, rel freq; relative frequency Survival analysis 6 ) [CIA]: The $16260 (CDT-ll) genotype [AA] correlation with PFS borders on statistical significance in the FAS population (Logrank test p=0.065, Gehan—Brelow—Wilcoxon test p=0.032) (Figure 12).

ERCCl rs11615 [C/T]: In PP, a trend for higher frequency of the rsl 1615 genotype [TT] in the responder population (3 out of 10; 30%) is found (p=0_.068; non-responder population (0 %)). Inversely, the homozygous [CC] genotype is only found in the sponder population (2 patients) (Table 15).

Table 15: Listing of r311615 (ERCCl) genotypes in PP patients and respective frequencies in responder (PR and SD) and non-responder patients (PD). 1007-02 2003-16 CT RESP PR 302 1006-03 CT RESP PR 287 2003-15 1001-08 4 TT RESP SD 170 1007-09 CT RESP SD 146 1013-02 CT RESP SD 141 1011-09 CT RESP SD 132 6 NONRESP 1005 CT NONRESP PD 112 2003 CT NONRESP PD 102 2003—19 CT NONRESP PD 73 [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN 1011-05 CT NONRESP PD 71 1 CT NONRESP PD 70 1005-13 CT NON RESP PD 70 1006—05 CT NONRESP PD 70 4001-09 CC NONRESP PD 67 4001-01 CT NONRESP PD 65 1011-20 CC NONRESP PD 64 RESP: Responder, NONRESP: sponder, PFS: Progression-free survival, abs freq; absolute frequency rel freq: relative frequency Survival analysis rsl 1615 (ERCCI) [CIT]: The rs11615 [TT] genotype is found exclusively in the responder population in the PP population. Statistical correlation of 1511615 genotypes with PFS shows that the r311615 genotype in PP is highly significa lated with PPS, with [CTl and [TT1 Carri.rs showing prolon11gUed J J survive mpared to [CC] rs (PP “=0 0001‘ ‘1117' kl U- I \ re 13‘. Desl ite this strikin si ificance value, it should be noted that there are only 2 patients with the [CC] pe and 3 patients with the [TT] genotype in PP.

However, in the 11th population the same effect can be observed as a trend (PAS p=—0. 13, data not , suggesting that the effect1s also valid1n larger patient tions.

Survival analysis FCGR3A rs396991 [T/G]: Neither in PP or FAS, the genotype of SNP rs396991 is correlated with clinical outcome (FAS p=0.49; PP p=0.29, data not shown).

However, al analysis in the PP population tes with high statistical significance that patients with the genotypes [TG] and [TT] show improved PFS compared to [GG] (p=0.0007, Figure 14). This effect can also he observed in the FAS population (p=0.25; data not shown). Despite the significance value received for the PP tion, it should be noted that only 3 PP patients are [GG] carriers.

Example 3: Discussion of accompanying immune polymorphism analyses The prim1'11ary objective of this al phase 11a trial was the evaluation of safety and efficacy of the therapeutic LDN18.2 mononuclear antibody IMAB362 in patients with gastroesophageal adenocarcinomas. In addition, accompanying analyses on genetic immune response polymorphisms were performed to evaluate parameters that may serve as potential predictive or prognostic biomarkers in correlation with IMAB362 therapy.

Discussion of descriptive immune polymorphism analysis Genetnilymorphisms in the patient’s genome have been shown to alter the response rate of therapeutic antibodies. In order to investigate the impact of individual genetic variation on the [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN response rate, the genotypes of 51 single nucleotide polymorphisms (SNPs) with known or presumed role in immune response and gastric cancer susceptibility or progress were determined in patients.

In this study, 51 SNPs were successfully genotyped for 53 out of 54 patients studied. A statistically significant shift of genotype ncy in the patient population compared to l populations could be detected for 5 SNPs. 4 of these SNPS have been shown before to be associated with /gastric cancer susceptibility. The respective cancer/gastric cancer associated genotypes of these 4 SNPs are over-represented in the study population, as expected in a patient population with advanced GC. Over-representation of the respective homozygous pe may indicate a recessive mode of action implicating a compromised gene function as opposed to enhanced gene activity. This is underscored by published data, e.g. the gastric cancer associated AA genotype of SNP $16260 in CDHl has been reported to cause a down—regulation of CDHl expression due to its position in the promoter of CDHl at - 160.

Polymorphisms in genes being involved in immune signaling were igated even if these polymorphisms had not been described before as gastric cancer risk factors. Genetic polymorphisms in genes coding for immune ing s have been shown to modulate the risk of developing gastric cancer significantly. Response rate of an antibody-based cancer therapy might therefore be affected by these SNPS as well.

The over—represented IL-2 genotype GG (SNP rs2069762) in the patient population is associated with an increased risk of gastric atrophy induced by H. pylori infection and may predispose to gastric cancer. CTLA4 SNP r5231775 and rs2274223 (PLCEl) pes have been described as GC susceptibility risk factors. As published studies on rs231775 are contradictory on the sequence of the genotype, however, no conclusion will be drawn here.

Fey—receptor and complement system polymorphisms were investigated in this study. The possibly beneficial FCGR3A genotype coding for Val/Va1 [GG] is detected in 4 APT ts, the FCGRZA genotype with a ially negative impact rg) [CC] can be detected in 12 APT patients.

CDC as a second effector mechanism has been demonstrated to be affected by SNP polymorphisms as well: A allele carriers of a polymorphism in the complement ent ClqA —>G], rs172378) show prolonged response following Rituximab y of follicular lymphoma. The complement system polymorphism in ClQA with genotype ‘GG’ is detected in 10 ts, possibly affecting response vely. The SNP polymorphism [Annotation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN r512146727 in complement component CIS, however, has so far been described only in a screen not related to antibody therapies or came.

The identification of significant genotype ncy shifts between patient and control populations demonstrates that SNP genotype frequency shifts may serve as predictive and prognostic s in clinical studies.

Accumulation of SNP risk s may have an impact on a patients’ clinical outcome as well.

In order to allow such an analysis, the number of homozygous SNP risk genotypes was d per patient. ation of these numbers with therapy response may give insight into the role of SNP risk factor accumulation.

Discussion of correlation of SNP genotyping with clinical outcome FCGR2A 131801274: Inspection of FCGRZA genotypes over- or underrepresented reveals that in the PP population all patients with the heterozygous r31801274 genotype [CT] are responder patients and that patients with partial response (PR) exclusively harbor this genotype. The overrepresented homozygous genotype in the non—responder population is [TT]. The mere observation of these frequency distributions does not allow sion if the [CT] genotype is beneficial or if the [TT] is disadvantageous. In most studies igating the impact of SNP genotypes, the respective homozygous genotypes show the strongest biological effects, indicating often a ive mode of action reflecting compromised gene function of both alleles as opposed to enhanced gene activity. In case SNP alleles lead to increased genetic activity, a stepwise effect of ical effect can often be observed: One allele (i.e. heterozygous) increases gene activity, two alleles (i.e. homozygous) se gene activity even more. In both cases, gain of function or loss of fiinction, the strongest biological/clinical effects are usually observed in patients with homozygous genotypes. Under this assumption overrepresentation of the homozygous [TT] genotype in the non-responder population in the PP and FAS population would cause a disadvantageous effect.

This is unexpected, however, as the rs1801274 FCGRZA [TT] pe has been bed in a number of al studies as a factor having a prolonging effect on PFS. In our phase IIa clinical trial, closer inspection of the association between pe and PFS in FAS non- responder patients indicates that FAS PD patients with the [TT] genotype show during the first 60 days of therapy indeed a trend towards higher PFS times as opposed to FAS PD patienD/ith the [CT] genotype re Table 7 and Figure 4). An interpretation to bring this observation in line with the underrepresentation of [TT] in responders with prolonged [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN PFS could be an overlay of two different molecular mechanisms: First, the 274 [CT] genotype could be a marker for der patients. This is a new observation not described in the literature so far and may suggest that this genotype is a predictive marker for treatment with IMAB362. The molecular mechanism underlying this new observation has not been resolved yet.

The second observation, already described in the literature for other therapeutic anti—cancer antibodies, would be the prolonged PFS of patients harboring the FCGRZA [TT] genotype. In our phase IIa study this effect is due to overlay of the postulated first ism only observable as a trend in non—responder patients. Mechanistically, the second observation could be explained by increased binding affinity of the IgGl antibody to the FCGRZA 131 His/His or allele (encoded by [TT] genotype) as opposed to weaker binding y to the homozygous FCGRZA 131 Arg/Arg receptor allele (encoded by [CC] genotype): In studies investigating the impact of Fey-receptor polymorphisms systematically, it has recently been shown that antibodies of the IgGl e indeed bind with different affinities to the two allelic forms of the Fey receptor IIA, H131 with a higher affinity than R131. Differential affinity of IgG dies to the FCGRZA receptor alleles is generally assumed to affect the trigger rate of effector mechanisms and consequently prolonged PFS in patients harboring the high affinity receptor allele. Data ting this hypothesis has been ed by reports showing that Fey—receptor polymorphisms FCGRZA H131R and FCGR3A F176V (Phe > Val, rs396991) may have an impact on the clinical efficacy of Trastuzumab-based IgGl antibody therapy in metastatic breast cancer ts. Patients with the genotypes FCGR3A 176 Val/Va1 and FCGRZA 131 His/His showed significantly better se rate and progression- free survival. The same polymorphisms have also been associated with the response rate of rituximab (IgGl)—treated patients with B—cell lymphomas. In another study, prolonged PFS after Cetuximab (IgGl) y could be associated with the FCGR3A 176 1 genotype.

Controversially, there are recent well-powered studies ing no association between Fcy- receptor polymorphisms and survival, response rate, or progression—free survival for the antibodies discussed. In the BCIRG-006 trial of the Breast Cancer ational Research Group (BCIRG) 1218 patients were treated in a randomized study with two Trastuzumab— containing arms and a non—Trastuzumab control arm. The ations reported above between Fey—receptor polymorphisms and Trastuzumab efficacy could not be confirmed. A long term study with 460 ts employing rituximab combined with chemotherapy in follicular lymphoma reported no association of Fcy—receptor polymorphisms with progr n-free survival. In the REACH trial with 419 patients, where patients received [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN fludarabine and cyclophosphamide (FC) or rituximab plus FC, FCGRZA and FCGR3A polymorphisms did not significantly influence outcome. Recent Cetuximab trials also yielded inconsistent findings, not recommending Fey-receptor polymorphisms as useful biomarkers.

This may reflect differences in intrinsic population factors or concurrent chemotherapy regimens.

MUCI rs4072037: MUCl is a transmembrane glycoprotein of the mucin family. Mucins are high-molecular weight ns which are O-glycosylated in the N—terminal extracellular domain extensively with oligosaccharides and n—glycan chains. Mucins are expressed on the apical surface of epithelia lining respiratory and intestinal tracts and ducts in liver, pancreas, and kidneys. embrane mucins span the membrane with one (it—helix and provide with their sugar chains a protective lining to the extracellular space. Mucins secreted into the extracellular space build up a mucous gel layer serving as onal physical protection for the lium.

The transmembrane MUCl and the secreted mucins MUCSC and MUC6 are the main mucins sed in .he stomach. MUCl is translated as a single polypeptide chain which is subject to autocleavage. The N—terminal extracellular domain (MUCl—N) remains lly non- covalently connected to the transmembrane/intracytoplasmic domain (MUCl-C).' This intracytoplasmic domain serves as a signaling domain which can enter the nucleus and associate with a number of transcription factors to activate gene sion directly. Cell stress can lead to proteolytic cleavage of the MUCl—N and MUCl—C domain via a second proteolytic site. This can be observed in cancer cells, too, where MUCl is no longer expressed in an d fashion at the apical membrane of the cell but can be found overexpressed and localized throughout the cell. Shedding of the extracellular domain (also known as ) into the ellular space and intracellular localization ofMUCl -C is the consequence. The intracytoplasmic signaling domain acts as an oncogene e.g. by activation of Wnt/B-catenin signaling and blocking of apoptotic pathways.

The extracellular domain of MUCl, however, is not only a static structural component but plays important roles during signaling events at the cell membrane. The glycosylation and expression state of the MUCl extracellular domain has been demonstrated to regulate ctions of membrane signaling molecules and the extracellular matrix. Underglycosylated MUCl-N in tumor cells has been reported to increase signaling between membrane molecules as lCfi-l or ctin and the MUCl coreprotein. Furthermore, mucin expression and glyco tion state seems to mask membrane—associated molecules. In cancer cells, masking [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN ation] MYN None set by MYN [Annotation] MYN ionNone set by MYN [Annotation] MYN Unmarked set by MYN of HERZ proteins by mucin expression has been described as a possible resistance ism to Trastuzumab y.

The MUCl polymorphism rs4072037 ‘A’ allele has been described as a risk factor for gastric cancer susceptibility. This rphism is a G->A exchange in Exon 2, resulting in alternative ng of MUCl exactly in the predicted signal peptide cleavage site of MUCl.

Deficient cleavage of the signal peptide could lead to aberrant MUCl protein localization or glycosylation pattern and consequently deficient protein function.

In this phase 11a clinical trial, the rs4072037 [AA] genotype has been found to be statistically associated with the responder population. It could be speculated that the underglycosylated or underexpressed [AA] allelic form of MUCl allows better access of 2 to the rget molecule CLDN18.2 expressed on cencer cells, consequently “r"‘notmg treatment efficacy. This would render rs4072037 a tive biomarker.

IL-ll) ”1899896: IL—10 is a key regulator of the immune system with ropic functions. IL—10 is known to act as an anti—inflammatory, immunosuppressive cytokine by inhibiting macrophage- dependent antigen-specific T—cell proliferation and macrophage-dependent production of cytokines by T-cells. However, IL-lO has been described also as an immunostimulatory cytokine, enhancing B—cell, granulocyte and mast cell differentiation and growth as well as l and CD8+ T—cell activation. The ropic potential of IL-10 is also reflected by the widespread expression of IL-10 in many immune cell types including Th2 cells, Treg cells, Th3 cells, NK T cells, B cells, macrophages, and dendritic cells. This dual role of IL-10 is reflected in the tumor—promoting as well as tumor—inhibiting potential: IL-lO secreted by tumor cells or tumor infiltrating immune cells as macrophages allows tumor cells to escape from immune surveillance by isms which have been clarified only in part. One mechanism described involves Treg cells contributing to the induction of peripheral tolerance via sion of immunoregulatory cytokines like IL-10. Another mechanism reported is the inhibition of cross-presentation of associated antigens by dendritic cells and therefore prevention of T cells from starting an effective immune response against tumor cells. On the other hand, exposition of malignant tumor cells to IL-10 leads to a down regulation of HLA class I proteins resulting in sed sensitivity to NK cell cytotoxicity.

The IL-lO promoter polymorphism r31800896 at position (—1082) is of interest as the ‘G’ allele has been reported as gastric cancer risk factor and renal cancer risk factor. The ‘G’ allelenthis polymorphism has been reported to be associated in vitro with decreased IL—10 expression ed to the ‘A’ allele. In responder patients of this phase Ila clinical trial the ation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN ed set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN [GG] genotype of rs1800896 is over represented, possibly indicating a lower relative expression level of IL-10. It can be speculated that ts harboring the [GG] genotype have a lower IL-10 expression which in turn may render it more difficult for tumor cells to escape from immune surveillance by one of the mechanisms described above. Indeed, none of the 12 FAS responder patients shows elevated IL-lO serum level as opposed to 22% of the FAS non- responder ts (6 out of 27 measured). However, other authors state that the ‘A’ allele is associated with decreased lL—lO expression.

It should also be noted, that IL-10 signals through the intracellular mediator Stat3 and that Stat3 activation is dependent on MUCl-C. Therefore, the functional interaction of MUCl and IL-10 could be the reason why these molecules both proved to be tically significant biomarker candidates in this phase Ila clinical trial. y, FCGRZA is expressed on .M ,. n_...\...L nnt‘n n, 4,4. m.n A“n.A n n: A1n .-. n“.—m‘ A 4‘ 1’1 1n :V. «FLA « “:Mnnnnnuflm- r 11¢ rupuaECD, W 1 1 ‘11 lllbll an: ULLUu a luaJU1 DUUIUC u Lf'lU m Lin: L 11101 1111 1 11qu1 llUuL. 1 these putative biomarker candidates prevail in ongoing and future studies, an investigation of the functional interaction of these factors may be of considerable interest. rs1550117 (DNMT3A): rs1550117 is a SNP in the DNMT3A gene coding for the enzyme DNA (cytosine-5)- methyltransferase 3A zing the transfer of methyl groups to specific CpG structures in DNA inducing epigenetic ation. It has been shown that the genotype [AA] confers an increased risk for gastric cancer as compared to [GG] or [GA]. In this study [AA] could be found in only one patient in the FAS population and no t of the PP population. This may indicate that [AA] also confers a risk for survival, too, preventing third and fourth line treatment of [AA] carriers in this phase IIa al trial. The finding that [GA] is significantly correlated with clinical outcome in PP suggests that this marker holds potential as a predictive biomarker for IMAB362 treatment. 6284 (SMAD4): rs12456284 is a SNP in the SMAD4 gene coding for the intracellular TGFB/BMP-signaling co-transducer “Mothers against decapentaplegic homolog 4”. It has been published that the [GG] genotype significantly decreased the risk for gastric cancer. The statistically significant presentation of the heterozygous [GA] genotype over the [AA] genotype in the FAS responder population suggests that this genotype may serve as predictive biomarker.

Prolonged PFS ofpatients of the PP population carrying [GA] is a supporting fact.

[Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN rs4444903 (EGF): The functional polymorphism rs4444903 in the promoter region of the EGF gene was observed to modulate EGF protein levels, higher amounts of EGF factor were detected in the serum of [GG] carriers. The G allele and [GG] pe of this polymorphism showed significant correlations with increased risk of intestinal cancer in a meta—analysis.

In this phase Ila clinical trial the genotype [AA] is significantly overrepresented in FAS responders and patients with this genotype show a trend towards prolonged PFS in PAS 21 rd PP tion. This could indicate that the rs4444903 [AA] genotype is a predictive or prognostic biomarker. rs16260 (CDHI): The cell adhesion protein Cadherinl (E=cadherin) is a member of the calcium—dependent cadherin superfamily. Loss of function has been ed in progression of cancer. The r516260 [A] allele in the CDHl promoter has been demonstrated to reduce transcriptional efficiency of inl. Further the —160A allele of CDHl has been described as a susceptibility factor for the development of gastric cancer.

In this study, rsl6260 [AA] genotype carriers are statistically overrepresented in the FAS responder. This may suggest that the [AA] pe is a putative predictive biomarker. rs11615 (ERCCl) and rs396991 (FCGR3A): The two SNPs rsl 1615 (ERCClS DNA repair n “Excision repair cross—complementation group 1”) and 91 (FCGR3A, low affinity immunoglobulin gamma Fc region or III-A) both show a correlation of genotypes (ERCCl [TT], FCGRSA [TG] and [TT]) with prolonged PFS. This may suggest that these SNPs are predictive or prognostic biomarkers.

[Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN ation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Applicants m a ’t’s EWMQWMNQ. £3:ch 33:85 PCT MICATIONS RELATINGTODEPEJSITEB RECRWRGAWI ORGTBERBIOLOGICALfiiAIERIAL {E’C’TRHk 136m} A. mammemmmmmmmmflmmmMMmmmmsmm B. WCA’IIONQEBWH emmm him at“6241mmmm DSMZ—Deuische g van Womanmn and Zeilkuimzen GmbH Asians; nidqmsztmy 23331211191: {imiudbagmm: and:am“ mama} Maschem Weg 1b 381 24 Braunschwaig ‘ Ema mi@055: Momma anber 19,, 2985 [333M M36273? 1:. meNALINDIGXHONS flame bier»?{motuppikabia} Ibis infmmafim i5 cmfimmd an anWm D - Mouse Mus muscuius) myeiama PBXGBAQBUJ fused with muse {Mus us} spiemcy’tes - Hybsicioma severing mam againsi isms": mum-18A2 D. DESIGNATEDSTATES FORWHICH INDICATIONS AREMADE {5:579 maiicm are mafia«if:fzigmti’d.Mi 1:. 327mmHmfimGEmanozvsgm{amgm:qwfimfiia} m.mmmmwinheWmmakmazicmlBum“32m{Wfimgmmq‘hmagv ’iécwm mecdfingfltfinnsemly meimmm1}: E] mamsmmzmmwmmmappmm E] assumingmmagmmmm Pam:PC1389?I 34 (EWIWR; W Imam? 23384) [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN New International Patent Application Ganymed Pharmaceuticals AG, et a1.

,,METHODS AND ITIONS FOR PREDICTION OF THERAPEUTIC EFFICACY OF CANCER TREATMENTS AND CANCER SIS” Our Ref.: 342-85 PCT onal Sheq for Biological Material Identification of further deposits: 1) The Name and Address of depositary institution for the deposits (DSM ACC2738, DSM ACC2739, DSM 0, DSM ACC2741, DSM ACC2742, DSM ACC2743, DSM ACC2745, DSM ACC2746, DSM ACC2747, DSM ACC2748) are: DSMZ-Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH roder Weg 1b 3 8 124 Braunschweig 2) The Name and Address of depositary institution for the deposits (DSM ACC2808, DSM ACC2809, DSM ACC2810) are: DSMZ-Deutsche Sarnmlung von Mikroorganismen und Zellkulturen GmbH Inhoffenstr. 7 B 38124 Braunschweig Date of desposits Accession Numbers The indications made below ' | ‘ } relate to the deposited i - - - microorganism 1 in the ption on the following page<s> page 57, line 12 page 57, line 13 page 57, line 17 page 57, line 22 page 57, line 23 [Annotation] MYN None set by MYN [Annotation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN [Annotation] MYN None set by MYN ation] MYN MigrationNone set by MYN [Annotation] MYN Unmarked set by MYN Additional Indications for all above mentioned ts: - Mouse (Mus musculus) myeloma P3X63Ag8U.1 fused with mouse (Mus musculus) splenocytes - Hybridoma secreting dy against human c1audin-18A2 U0 \./ Depositor: All above mentioned depositions were made by: Ganymed Pharmaceuticals AG Freiligrathstrafie 12 5513 l Mainz

Claims (13)

1. A method of assessing (i) if a cancer patient having a tumor antigen-positive tumor is a responder to treatment with an antibody against the tumor antigen, and/or (ii) if a cancer patient having a tumor n-positive tumor will experience progressionfree survival, wherein the tumor antigen is the CLDN18.2 protein; said method comprising determining the genotype for one or more single-nucleotide polymorphisms selected from the group consisting of MUC1 rs4072037, IL-10 rs1800896, DNMT3A rs1550117, SMAD4 rs12456284, EGF rs4444903, CDH1 rs16260 and ERCC1 rs11615 in a sample ed from the patient, wherein (a) the presence of the homozygous MUC1 037 [AA] genotype indicates a reduced risk of a cancer patient not being a der to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival; (b) the presence of the homozygous MUC1 rs4072037 [GG] genotype indicates an increased risk of a cancer patient not being a responder to treatment with the antibody and/or an increased risk of a cancer patient not experiencing progression-free survival; (c) the presence of the homozygous IL-10 rs1800896 [GG] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a d risk of a cancer patient not experiencing progression-free survival; (d) the presence of the heterozygous DNMT3A rs1550117 [GA] genotype indicates a d risk of a cancer patient not being a responder to treatment with the antibody and/or a d risk of a cancer patient not encing progression-free survival; (e) the presence of the heterozygous SMAD4 rs12456284 [GA] genotype indicates a reduced risk of a cancer patient not being a responder to ent with the dy and/or a reduced risk of a cancer t not experiencing progression-free survival; (f) the presence of the homozygous EGF rs4444903 [AA] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a d risk of a cancer patient not experiencing progression-free al; (g) the presence of the homozygous CDH1 rs16260 [AA] genotype indicates a reduced risk of a cancer patient not being a responder to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival; and (h) the presence of the homozygous ERCC1 rs11615 [TT] genotype indicates a reduced risk of a cancer patient not being a der to treatment with the antibody and/or a reduced risk of a cancer patient not experiencing progression-free survival.

2. The method of claim 1 wherein the antibody acts through recruiting the patient's immune system to destroy tumor cells.

3. The method of claim 1 or 2 wherein the antibody acts through antibody-dependent cell-mediated cytotoxicity (ADCC) and/or complement-dependent xicity (CDC).

4. The method of any one of claims 1 to 3 wherein the antibody is a monoclonal antibody.

5. The method of any one of claims 1 to 4 wherein the dy comprises a heavy chain comprising an amino acid sequence represented by SEQ ID NO: 17 or 51 or a fragment f and a light chain comprising an amino acid sequence represented by SEQ ID NO: 24 or a fragment thereof.

6. Use of an antibody g to CLDN18.2 for the preparation of a medicament for treating a cancer t having a tumor which is positive for CLDN18.2, wherein the t is characterized by having a reduced risk for not being a responder to treatment with the antibody, wherein the d risk is assessed by ining the genotype for one or more singlenucleotide polymorphisms selected from the group consisting of MUC1 rs4072037, IL-10 rs1800896, DNMT3A 117, SMAD4 rs12456284, EGF rs4444903, CDH1 rs16260, and ERCC1 5 in a sample obtained from the patient, wherein the reduced risk is indicated in a tumor sample obtained from the patient by (a) the presence of the homozygous MUC1 rs4072037 [AA] genotype; (b) the presence of the homozygous IL-10 rs1800896 [GG] genotype; (c) the presence of the heterozygous DNMT3A rs1550117 [GA] genotype; (d) the presence of the heterozygous SMAD4 rs12456284 [GA] genotype; (e) the presence of the homozygous EGF rs4444903 [AA] genotype; (f) the presence of the homozygous CDH1 rs16260 [AA] genotype; and (g) the presence of the homozygous ERCC1 rs11615 [TT] genotype.

7. The use of claim 6, wherein treating comprises assessing if the cancer t is a responder to ent with an dy by the method of any one of claims 1 to 5 and treating the cancer patient with the antibody if the patient has a reduced risk for not being a responder to treatment with the antibody.

8. The use of claim 6 or 7 wherein the treatment regimen comprises a treatment with an antibody-drug conjugate and wherein the antibody is directed against the tumor n.

9. The use of claim 8 wherein the antibody-drug conjugate is an antibody coupled to a radioactive, chemotherapeutic or toxin moiety.

10. The use of claim 8 or 9 n the antibody-drug conjugate is an antibody coupled to a cytostatic or cytotoxic compound.

11. The method of any one of claims 1 to 5 or the use of any one of claims 6 to 10 wherein the tumor is a solid tumor.

12. The method of any one of claims 1 to 5 and 11 or the use of any one of claims 6 to 11 wherein the tumor is a gastroesophageal tumor.

13. The method of any one of claims 1 to 5, 11 and 12 or the use of any one of claims 6 to 12 wherein the tumor is an advanced adenocarcinoma of the stomach or the lower esophagus.