NZ795702A - Methods of treating cancer with anti-pd-1 antibodies - Google Patents
Methods of treating cancer with anti-pd-1 antibodiesInfo
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- NZ795702A NZ795702A NZ795702A NZ79570218A NZ795702A NZ 795702 A NZ795702 A NZ 795702A NZ 795702 A NZ795702 A NZ 795702A NZ 79570218 A NZ79570218 A NZ 79570218A NZ 795702 A NZ795702 A NZ 795702A
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- cancer
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- flat dose
- antibody
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Abstract
The present invention provides methods of administering certain PD-1 binding agents to patients having cancer. Dosage regimens for compositions comprising a PD-1 binding agent are also explicitly provided.
Description
The present invention provides methods of administering certain PD-1 g agents to patients
having cancer. Dosage regimens for compositions comprising a PD-1 binding agent are also
explicitly provided.
NZ 795702
METHODS OF TREATING CANCER WITH ANTI-PD-l ANTIBODIES
CROSS-REFERENCE TO RELATED APPLICATIONS
The present ation claims benefit of US Provisional Application No.
62/444,336, filed January 9, 2017, US Provisional Application No. ,423, filed March
27, 2017, US Provisional Application No. 62/491,220, filed April 27, 2017, and US
Provisional Application No. ,386, filed September 9, 2017, each of which is
incorporated by nce in its entirety.
SEQUENCE LISTING
The present specification makes reference to a Sequence g ed in
electronic form as an txt file named “TSR-006 SEQ LIST_ST25” that was generated
on y 8, 2018, and is 14,555 bytes in size.
BACKGROUND
Cancer is a serious public health problem, with about 600,920 people in the
United States of America expected to die of cancer in 2017 alone ing to the American
Cancer Society, Cancer Facts & Figures 2017 (https://www.cancer.org/research/cancer-facts-
statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html). Accordingly, there
continues to be a need for effective therapies to treat cancer patients.
SUMMARY
The present invention encompasses a recognition that certain dosage regimens for
agents that are capable of inhibiting anti-programmed death—1 protein (PD-1) (e.g., PD-1
binding agents) are useful for treating disorders such as cancer.
In embodiments, a PD-1 inhibitor is a PD—l binding agent. In embodiments, a
PD—1 binding agent is an antibody, an antibody conjugate, or an antigen-binding fragment
thereof. In embodiments, a PD-1 g agent is an antibody agent (i.e., an anti- PD-1
antibody agent).
In embodiments, a PD-1 binding agent is an anti-PD-l antibody. In embodiments,
a PD-1 binding agent comprises a heavy chain variable region with one or more CDR
sequences having at least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%,
98%, or 99% ce identity to SEQ ID NOs: 9, 10, or 11. In embodiments, a PD-1
binding agent comprises a heavy chain variable region with two or three CDR sequences
having at least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99%
sequence identity to SEQ ID NOs: 9, 10, or 11.
In embodiments, a PD-1 g agent comprises a light chain variable region
with one or more CDR sequences having at least about 80%, 85%, 90%, 91%, 92%, 93%,
94%, 95%, 96%, 97%, 98%, or 99% sequence identity to SEQ ID NOs: 12, 13, and 14. In
embodiments, a PD-l binding agent comprises a light chain variable region with two or three
CDR sequences having at least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%,
97%, 98%, or 99% sequence identity to SEQ ID NOs: 12, 13, and 14.
In some embodiments, a PD-l-binding agent ses a heavy chain variable
region with one or more CDR sequences selected from SEQ ID NOs: 9, 10, and 11 and/or a
light chain variable region with one or more CDR sequences selected from SEQ ID NOs: 12,
13, and 14. In some embodiments, a inding agent comprises a heavy chain variable
region with two or more CDR sequences selected from SEQ ID NOs: 9, 10, and 11 and/or a
light chain variable region with two or more CDR sequences selected from SEQ ID NOs: 12,
13, and 14. In some embodiments, a PDbinding agent comprises a heavy chain variable
region with three CDRs that have sequences of SEQ ID NOs: 9, 10, and 11 and/or a light
chain variable region with three CDRs that have sequences of SEQ ID NOs: 12, 13, and 14.
In some embodiments, a PD—l-binding agent comprises a heavy chain variable region with
three CDRs that have sequences of SEQ ID NOs: 9, 10, and 11 and a light chain le
region with three CDRs that have sequences of SEQ ID NOs: 12, 13, and 14.
In some embodiments, a PD-l-binding agent comprises an globulin heavy
chain variable domain comprising an amino acid sequence having at least about 80%, 85%,
90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to SEQ ID NO:
1 or SEQ ID NO:7. In some embodiments, a PD-l-binding agent comprises an
immunoglobulin heavy chain variable domain comprising an amino acid sequence having at
least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence
identity to SEQ ID NO: 1. In some embodiments, a inding agent comprises an
immunoglobulin heavy chain variable domain sing an amino acid sequence having at
least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence
identity to SEQ ID NO: 7.
In some embodiments, a PD-l-binding agent comprises an immunoglobulin light
chain variable domain comprising an amino acid sequence having at least about 80%, 85%,
WO 29559
90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to SEQ ID NO:
2 or SEQ ID NO: 8. In some embodiments, a PDbinding agent comprises an
immunoglobulin light chain le domain comprising an amino acid sequence having at
least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence
identity to SEQ ID NO: 2. In some embodiments, a PDbinding agent ses an
immunoglobulin light chain variable domain comprising an amino acid sequence having at
least about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence
identity to SEQ ID NO: 8.
In some embodiments, a PDbinding agent ses an immunoglobulin heavy
chain variable domain whose amino acid ce comprises SEQ ID NO: 1 or SEQ ID
N027 and an immunoglobulin light chain variable domain whose amino acid ce
comprises SEQ ID NO: 2 or SEQ ID NO: 8.
In some embodiments, a inding agent comprises an immunoglobulin heavy
chain comprising an amino acid sequence having at least about 80%, 85%, 90%, 91%, 92%,
93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to SEQ ID NO: 3.
In some embodiments, a PDbinding agent comprises an immunoglobulin light
chain comprising an amino acid sequence having at least about 80%, 85%, 90%, 91%, 92%,
93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity to SEQ ID NO: 4.
In some embodiments, a PDbinding agent comprises an immunoglobulin heavy
chain whose amino acid sequence comprises SEQ ID NO: 3 and an immunoglobulin light
chain whose amino acid sequence comprises SEQ ID NO: 4.
The PD-l binding agents can be any PD-l binding agent known in the art. In
some embodiments, a PD-l-binding agent is nivolumab, pembrolizumab, atezolizumab,
durvalumab, avelumab, 2, FDR-001, tislelizumab (BGB-A317), cemiplimab
(REGN2810), LY—3300054, JNJ-63723283, MGA012, BI-754091, IBI—308, camrelizumab
(HR—301210), BCD-100, JS—001, CX—072, BGB-A333, AMP—514 (MEDI-0680), AGEN-
2034, CS1001, Sym-021, SHR-1316, PF-06801591, LZM009, KN—035, AB122,
genolimzumab (CBT—501), FAZ-053, CK-301, AK 104, or 0, or any of the PD—1
antibodies disclosed in WO2014/179664.
In some embodiments, a PDbinding agent (e.g., anti-PD—l antibody agent)
binds an epitope of PD-1 which blocks the g of PD-1 to any one or more of its putative
ligands. In some ments, a PD—l—binding agent (e.g., anti—PD-l antibody agent) binds
an epitope of PD-1 which blocks the binding of PD-1 to two or more of its putative ligands.
In a some embodiments, a inding agent (e.g., anti-PD—l antibody agent) binds an
epitope of a PD-1 protein which blocks the binding of PD-1 to PD-Ll and/or PD—L2. PD—1-
binding agents (e.g., anti-PD-l dy agents) of the present sure may comprise a
heavy chain constant region (Fe) of any suitable class. In some embodiments, a PDbinding
agent (e.g., anti-PD-l antibody agent) comprises a heavy chain constant region that is based
upon wild—type IgGl, IgG2, or IgG4 dies, or variants thereof.
The t disclosure provides s of treating a disorder in a subject
comprising administering a therapeutically effective dose of an agent that is e of
inhibiting Programmed Death-1 Protein (PD-1) signaling. In embodiments, a therapeutically
effective dose is: about 1, 3 or 10 mg/kg. In embodiments, a therapeutically effective dose is
a flat dose of about 100 - 2000 mg (e.g., a flat dose about 100 mg; a flat dose about 200 mg; a
flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about
600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat
dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about
1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a
flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about 1900 mg; or a flat dose
about 2000 mg). In embodiments, a therapeutically effective dose is about 1 mg/kg. In
embodiments, a therapeutically effective dose is about 3 mg/kg. In embodiments, a
eutically effective dose is about 10 mg/kg. In embodiments, a therapeutically effective
dose is a flat dose about 500 mg. In embodiments, a therapeutically effective dose is about
800 mg. In embodiments, a therapeutically effective dose is about 1000 mg. In
embodiments, a PD—l inhibitor is any PD-1 binding agent bed herein (e.g., any anti-PD-
1 antibody described herein).
The present disclosure provides methods of increasing T cell activation or T cell
effector function in a t, which method comprises administering a therapeutically
effective dose of an agent that is capable of inhibiting Programmed Death-1 Protein (PD-1)
signaling. In embodiments, a therapeutically effective dose is: about 1, 3 or 10 mg/kg. In
embodiments, a therapeutically effective dose is a flat dose of about 100 - 2000 mg (e.g., a
flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about
400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat
dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about
1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a
flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose
about 1800 mg; a flat dose about 1900 mg; or a flat dose about 2000 mg). In embodiments, a
therapeutically effective dose is about 1 mg/kg. In embodiments, a therapeutically effective
dose is about 3 mg/kg. In embodiments, a therapeutically effective dose is about 10 mg/kg.
In embodiments, a therapeutically effective dose is a flat dose about 500 mg. In
ments, a therapeutically effective dose is about 800 mg. In embodiments, a
therapeutically effective dose is about 1000 mg. In embodiments, a PD-l inhibitor is any
PD—l binding agent described herein (e.g., any anti-PD—l antibody described herein).
The present sure provides methods of reducing tumors or inhibiting the
growth of tumor cells in a subject, which method comprises stering a therapeutically
ive dose of an agent that is capable of inhibiting Programmed 1 n (PD—1)
signaling. In embodiments, a therapeutically effective dose is: about 1, 3 or 10 mg/kg. In
embodiments, a therapeutically effective dose is a flat dose of about 100 - 2000 mg (e.g., a
flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about
400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat
dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about
1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a
flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose
about 1800 mg; a flat dose about 1900 mg; or a flat dose about 2000 mg). In embodiments, a
therapeutically effective dose is about 1 mg/kg. In embodiments, a therapeutically ive
dose is about 3 mg/kg. In embodiments, a therapeutically effective dose is about 10 mgfkg.
In embodiments, a therapeutically effective dose is a flat dose about 500 mg. In
embodiments, a therapeutically effective dose is about 800 mg. In embodiments, a
therapeutically effective dose is about 1000 mg. In embodiments, a PD-l inhibitor is any
PD—l binding agent described herein (e.g., any anti-PD-l antibody bed herein).
The present disclosure provides methods of inducing an immune response in a
subject, which method comprises administering a eutically effective dose of an agent
that is capable of inhibiting mmed Death-1 Protein (PD-1) signaling. In embodiments,
a therapeutically effective dose is: about 1, 3 or 10 mg/kg. In embodiments, a therapeutically
effective dose is a flat dose of about 100 - 2000 mg (e. g., a flat dose about 100 mg; a flat dose
about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg;
a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose
about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200
mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat
dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about
1900 mg; or a flat dose about 2000 mg). In embodiments, a therapeutically effective dose is
about 1 mg/kg. In embodiments, a therapeutically effective dose is about 3 mg/kg. In
embodiments, a therapeutically effective dose is about 10 mg/kg. In embodiments, a
therapeutically effective dose is a flat dose about 500 mg. In embodiments, a therapeutically
effective dose is about 800 mg. In embodiments, a eutically effective dose is about
1000 mg. In embodiments, a PD-l inhibitor is any PD-l binding agent described herein (e.g.,
any D—l antibody described herein).
The present disclosure provides s of enhancing an immune response or
increasing the activity of an immune cell in a t, which method comprises administering
a therapeutically effective dose of an agent that is capable of inhibiting Programmed Death-1
n (PD-1) signaling. In embodiments, an immune response is a humoral or cell
mediated immune response. In embodiments, an immune response is a CD4 or CD8 T cell
response. In embodiments, an immune response is a B cell response. In embodiments, a
therapeutically effective dose is: about 1, 3 or 10 mg/kg. In embodiments, a therapeutically
effective dose is a flat dose of about 100 - 2000 mg (e. g., a flat dose about 100 mg; a flat dose
about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg;
a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose
about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200
mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat
dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about
1900 mg; or a flat dose about 2000 mg). In embodiments, a therapeutically effective dose is
about 1 mg/kg. In embodiments, a therapeutically effective dose is about 3 mg/kg. In
embodiments, a therapeutically effective dose is about 10 mg/kg. In embodiments, a
therapeutically effective dose is a flat dose about 500 mg. In embodiments, a therapeutically
effective dose is about 800 mg. In embodiments, a therapeutically effective dose is about
1000 mg. In ments, a PD-l inhibitor is any PD-l binding agent described herein (e.g.,
any anti-PD—l antibody described herein).
The present disclosure provides methods of treating cancer that include
administering compositions that r particular inding agents. In embodiments, a
PD—l g agent in administered in an amount that is about 1, 3 or 10 mg/kg. In
embodiments, a PD-l binding agent in administered in an amount that is about 100 - 2000 mg
(e.g., about 100 mg; about 200 mg; about 300 mg; about 400 mg; about 500 mg; about 600
mg; about 700 mg about 800 mg; about 900 mg about 1000 mg; about 1100 mg; about 1200
mg; about 1300 mg; about 1400 mg; about 1500 mg; about 1600 mg; about 1700 mg; about
1800 mg; about 1900 mg; or about 2000 mg). In embodiments, a PD—l binding agent in
administered in an amount that is about 1 mgfkg. In embodiments, a PD—l binding agent in
administered in an amount that is about 3 mglkg. In embodiments, a PD-1 binding agent in
administered in an amount that is about 10 mg/kg. In embodiments, a PD-l binding agent in
administered in an amount that is about 500 mg. In embodiments, a therapeutically ive
dose is about 800 mg. In embodiments, a PD—l binding agent in administered in an amount
that is about 1000 mg. In ments, a PD-1 inhibitor is any PD-1 binding agent
described herein (e.g., any anti-PD-l antibody described herein).
The present disclosure provides methods of treating cancer comprising
administering to a patient in need of treatment an anti—programmed death-1 protein (PD—1)
antibody at a eutically ive dose at an administration interval for a period
sufficient to achieve clinical benefit. In embodiments, an anti—PD-l dy comprises a
heavy chain variable region comprising CDR sequences of SEQ ID NOS: 9, 10, and 11 and a
light chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13, and 14. In
embodiments, an anti-PD-l dy comprises an immunoglobulin heavy chain variable
domain whose amino acid ce comprises SEQ ID NO:1 or SEQ ID N017 and/or an
immunoglobulin light chain variable domain whose amino acid sequence comprises SEQ ID
NO:2 or SEQ ID NO:8. In ments, an anti-PD—l antibody comprises an
immunoglobulin heavy chain polypeptide whose amino acid sequence comprises SEQ ID
NO:3 and/or an immunoglobulin light chain polypeptide whose amino acid sequence
comprises SEQ ID NO:4. In embodiments, a therapeutically effective dose is: about 1, 3 or
mg/kg. In embodiments, a therapeutically effective dose is a flat dose of about 100 - 2000
mg (e.g., a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat
dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700
mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose
about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400
mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat
dose about 1800 mg; a flat dose about 1900 mg; or a flat dose about 2000 mg). In
embodiments, a therapeutically effective dose is about 1 mg/kg. In embodiments, a
therapeutically effective dose is about 3 mg/kg. In embodiments, a therapeutically effective
dose is about 10 mg/kg. In embodiments, a therapeutically ive dose is a flat dose about
500 mg. In embodiments, a therapeutically effective dose is about 800 mg. In embodiments,
a therapeutically effective dose is about 1000 mg.
The present disclosure provides methods of treating cancer comprising
administering to a patient in need of treatment an anti-programmed 1 protein (PD-1)
antibody at a first dose at a first interval for a first ; and administering to the patient the
anti-PD-l antibody at a second dose at a second interval for a second period. In
embodiments, an anti-PD-l antibody comprises a heavy chain variable region comprising
CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light chain variable region comprising
CDR sequences of SEQ ID N0s: 12, 13, and 14. In embodiments, an anti-PD—l antibody
comprises an immunoglobulin heavy chain variable domain whose amino acid sequence
comprises SEQ ID N0:1 or SEQ ID NO:7 and/or an immunoglobulin light chain variable
domain whose amino acid sequence comprises SEQ ID N022 or SEQ ID N028. In
embodiments, an anti-PD-l antibody comprises an immunoglobulin heavy chain ptide
whose amino acid sequence comprises SEQ ID N023 and/or an immunoglobulin light chain
polypeptide whose amino acid sequence comprises SEQ ID N0:4. In ments, a dose
is: about 1, 3 or 10 mg/kg. In embodiments, a dose is a flat dose of about 100 - 2000 mg
(e.g., a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose
about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg;
a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose
about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400
mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat
dose about 1800 mg; a flat dose about 1900 mg; or a flat dose about 2000 mg). In
embodiments, a therapeutically effective dose is about 1 mg/kg. In embodiments, a dose is
about 3 mg/kg. In embodiments, a dose is about 10 mg/kg. In embodiments, a
therapeutically effective dose is a flat dose about 500 mg. In embodiments, a therapeutically
effective dose is a flat dose about 800 mg. In embodiments, a therapeutically ive dose
is about 1000 mg. In embodiments, the first dose and second dose are different. In
embodiments, the first dose is about 500 mg and the second dose is about 1000 mg. In
embodiments, the first interval and the second al are different. In embodiments, the
first interval is once every three weeks and the second interval is once every six weeks. In
ments, anti-PD-l antibody is stered at the first dose of 500 mg once every three
weeks for the first period of 2-6 dosing cycles (e.g., the first 3, 4, or 5 dosing cycles), and at
the second dose of 1000 mg once every six weeks until therapy is discontinued (e.g., due to
disease progression, an adverse event, or as determined by a physician). In embodiments,
anti—PD-l antibody is administered at the first dose of 500 mg once every three weeks for the
first three dosing cycles, and at the second dose of 1000 mg once every six weeks or more
until therapy is discontinued (e.g., due to disease progression, an e event, or as
determined by a physician). In embodiments, anti-PD—l antibody is administered at the first
dose of 500 mg once every three weeks for the first four dosing cycles, and at the second
WO 29559 2018/013029
dose of 1000 mg once every six weeks or more until therapy is discontinued (e.g., due to
disease progression, an adverse event, or as determined by a physician). In embodiments,
anti-PD-1 antibody is administered at the first dose of 500 mg once every three weeks for the
first five dosing cycles, and at the second dose of 1000 mg once every six weeks or more
until therapy is discontinued (e.g., due to disease progression, an adverse event, or as
determined by a physician). In embodiments, the second dose is administered once every six
weeks.
In any of the methods described herein, a therapeutically effective dose is about 1
mglkg of a PD-1 binding agent. In any of the methods described herein, a therapeutically
effective dose is about 3 mg/kg of a PD-1 g agent. In any of the methods described
herein, a therapeutically effective dose is about 10 mg/kg of a PD—l binding agent. In
embodiments, a PD-1 binding agent is any anti—PD-l antibody described herein.
In any of the methods described herein, a therapeutically effective dose is about
100 mg of a PD-1 binding agent. In any of the methods described herein, a therapeutically
effective dose is about 200 mg of a PD-1 binding agent. In any of the methods described
herein, a therapeutically effective dose is about 300 mg of a PD-1 binding agent. In any of
the methods bed herein, a therapeutically ive dose is about 400 mg of a PD-1
binding agent. In any of the methods described herein, a therapeutically effective dose is
about 500 mg of a PD-l binding agent. In any of the methods described herein, a
eutically effective dose is about 600 mg of a PD-1 binding agent. In any of the
methods described herein, a therapeutically effective dose is about 700 mg of a PD-1 binding
agent. In any of the s described herein, a eutically ive dose is about 800
mg of a PD-1 binding agent. In any of the methods described herein, a therapeutically
effective dose is about 900 mg of a PD-1 binding agent. In any of the methods described
herein, a therapeutically effective dose is about 1000 mg of a PD-1 binding agent. In any of
the s described herein, a therapeutically effective dose is about 1100 mg of a PD—1
binding agent. In any of the methods described herein, a therapeutically effective dose is
about 1200 mg of a PD-l binding agent. In any of the methods described herein, a
therapeutically effective dose is about 1300 mg of a PD-1 binding agent. In any of the
methods described herein, a therapeutically effective dose is about 1400 mg of a PD—1
binding agent. In any of the methods described herein, a therapeutically ive dose is
about 1500 mg of a PD-l binding agent. In any of the methods described herein, a
therapeutically ive dose is about 1600 mg of a PD-1 binding agent. In any of the
methods described herein, a therapeutically effective dose is about 1700 mg of a PD—l
binding agent. In any of the methods described herein, a therapeutically effective dose is
about 1800 mg of a PD-l binding agent. In any of the methods described herein, a
therapeutically effective dose is about 1900 mg of a PD-l binding agent. In any of the
methods described herein, a therapeutically effective dose is about 2000 mg of a PD-l
g agent. In embodiments, a PD-l g agent is any anti-PD—l dy described
herein.
In embodiments, a PD-l binding agent is administered at an administration
interval (or treatment cycle) of once a week (QlW), once every 2 weeks (Q2W), once every 3
weeks (Q3W), once every 4 weeks (Q4W), once every 5 weeks (Q5W), or once every 6
weeks (Q6W). In embodiments, a PD-l binding agent is administered at an administration
interval (or treatment cycle) of once a week (QlW). In embodiments, a PD-l binding agent
is stered at an administration interval (or treatment cycle) of once every 2 weeks
(Q2W). In ments, a PD-l binding agent is administered at an administration interval
(or treatment cycle) of once every three weeks (Q3W). In embodiments, a PD-l binding
agent is administered at an administration al (or treatment cycle) of once every 4 weeks
(Q4W). In embodiments, a PD-l binding agent is administered at an administration interval
(or treatment cycle) of once every 5 weeks (Q5W). In embodiments, a PD-l binding agent is
administered at an administration interval (or treatment cycle) of once every 6 weeks (Q6W).
In embodiments, a PD-l g agent is administered for a period of at least about 2, 3, 4, 5,
6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 weeks, or more. In embodiments, a PD—l
binding agent is administered on the first day of a treatment cycle or within 1, 2, or 3 days of
the first day of a treatment cycle. In embodiments, a PD-l binding agent is any anti-PD—l
antibody described herein.
In embodiments, a PD-l binding agent described herein is administered according
to dosing regimens demonstrated to achieve a clinical benefit in some patients (for example,
according to a regimen as determined by a physician, including dosing modifications). In
ments, a PD-l binding agent described herein is administered until ent is
discontinued due to, e.g., disease progression or an adverse reaction or as determined by a
physician. In ments, a clinical benefit is stable disease (“SD”), a partial response
(“PR”) andfor a te se (“CR”). In embodiments, a clinical benefit is stable
disease (“SD”). In embodiments, a clinical benefit is a partial response (“PR”). In
ments, a clinical benefit is a complete response (“CR”). In embodiments, PR or CR is
ined in accordance with Response Evaluation Criteria in Solid Tumors (RECIST). In
embodiments, a PD—l binding agent is stered for a longer period to in clinical
benefit. In embodiments, a PD-l binding agent is any anti-PD-l antibody described .
In embodiments, a PD-l binding agent is administered periodically to a subject at
a dose of about 500 mg or about 1000 mg. In embodiments, a PD—l binding agent is
administered periodically to a subject at a dose of about 500 mg (e.g., once every three weeks
(Q3W) and/or for 2, 3, 4, 5, 6, or more cycles). In embodiments, a PD-l binding agent is
administered periodically to a subject at a dose of about 1000 mg (e.g., once every three
weeks (Q3W) and/or for 2, 3, 4, 5, 6, or more cycles). In embodiments, a PD-l binding agent
is administered to a subject at a dose of about 500 mg according once every three weeks
(Q3W) for 3 cycles. In embodiments, a PD-l binding agent is administered to a subject at a
dose of about 500 mg according once every three weeks (Q3W) for 4 cycles. In
embodiments, a PD—l binding agent is administered to a subject at a dose of about 500 mg
according once every three weeks (Q3W) for 5 cycles. In embodiments, a PD-l binding
agent is administered to a subject at a dose of about 1000 mg ing once every six weeks
or more (Q3W). In embodiments, a PD-l binding agent is administered to a subject at a dose
of about 1000 mg according once every six weeks (Q3W). In embodiments, a PD-l binding
agent is administered at a first dose of about 500 mg once every 3 weeks for 3 cycles
followed by a second dose of about 1000 mg once every 6 weeks or more (e.g., until
treatment is tinued). In embodiments, a PD-l binding agent is administered at a first
dose of about 500 mg once every 3 weeks for 4 cycles ed by a second dose of about
1000 mg once every 6 weeks (e.g., until treatment is discontinued). In embodiments, a PD-l
binding agent is administered at a first dose of about 500 mg once every 3 weeks for 5 cycles
followed by a second dose of about 1000 mg once every 6 weeks or more (e.g., until
treatment is discontinued). In embodiments, a second dose is of about 1000 mg once every
six weeks (e.g., until treatment is discontinued). In embodiments, a PD-l binding agent is
any anti-PD—l antibody bed .
In embodiments, a subject has been further administered or will be administered a
further therapeutic agent, such that the subject receives a PD-l binding agent and a further
therapeutic agent (e.g., one, two, three, four, or more r therapeutic agents). In
embodiments, a PD-1 binding agent is any anti—PD-l antibody described .
In embodiments, a subject has been further stered or will be administered
an immune checkpoint inhibitor, such that the subject receives a PD-l g agent and an
immune checkpoint inhibitor. That is, a subject can be administered a PD-l binding agent in
combination with at least one immune checkpoint inhibitor. In embodiments, a PD-1 binding
agent is any anti-PD—l antibody described herein.
In embodiments, an immune checkpoint inhibitor is an agent capable of inhibiting
any of the following: PD—1 (e.g., inhibition Via anti-PD-l, anti-PD—Ll, or anti-PD—L2
therapies), CTLA-4, TIM-3, TIGIT, LAGs (e.g., LAG-3), CEACAM (e.g., CEACAM-1, -3
and/or -5), VISTA, BTLA, LAIRl, CD160, 2B4, CD80, CD86, B7-H3 (CD276), B7-H4
(VTCNl), HVEM (TNFRSF14 or CD270), KIR, A2aR, MHC class I, MHC class II, GALS,
adenosine, TGFR (e.g., TGFR beta), B7-H1, B7-H4 ), OX-40, CD137, CD40, IDO,
or CSF-1R. In embodiments, a checkpoint inhibitor is a small molecule, a nucleic acid, a
polypeptide (e.g., an antibody), a carbohydrate, a lipid, a metal, or a toxin. In embodiments,
a checkpoint inhibitor is an antibody, an antibody conjugate, or an antigen-binding nt
thereof.
In embodiments, an immune checkpoint inhibitor is an agent that inhibits T cell
immunoglobulin and mucin protein 3 (TIM-3), cytotoxic hocyte—associated protein 4
(CTLA-4), lymphocyte activation gene-3 (LAG-3), T cell immunoglobulin and ITIM domain
(TIGIT), indoleamine 2,3-dioxygenase (IDO), or colony stimulating factor 1 or
(CSF1R).
In embodiments, an immune checkpoint inhibitor is a TIM-3 inhibitor. In
embodiments, a TIM-3 inhibitor is a small molecule, a nucleic acid, a ptide (e.g., an
antibody), a ydrate, a lipid, a metal, a toxin, or a g agent. In embodiments, a
TIM-3 inhibitor is a TIM-3 binding agent (e.g., an antibody, an antibody conjugate, or an
antigen-binding fragment thereof). In embodiments, a TIM-3 tor is a TIM—3 tor
described in
embodiments, a TIM—3 inhibitor is TSR-022. For example, a TIM-3 inhibitor (e.g., TSR-
022) can be administered in a dose of about 1, 3 or 10 mg/kg (e.g., about 1 mg/kg; about 3
mg/kg; or about 10 mg/kg) or a flat dose between about 100 - 1500 mg (e.g., a flat dose about
100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat
dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800
mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat
dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; or a flat dose
about 1500 mg).
In embodiments, an immune checkpoint inhibitor is a CTLA—4 inhibitor (e.g., an
antibody, an antibody ate, or an antigen—binding nt thereof). In embodiments, a
CTLA-4 inhibitor is a small molecule, a c acid, a polypeptide (e.g., an antibody), a
carbohydrate, a lipid, a metal, or a toxin. In embodiments, a CTLA—4 inhibitor is a small
molecule. In embodiments, a CTLA-4 inhibitor is a CTLA-4 binding agent. In
embodiments, a CTLA-4 inhibitor is an antibody, an antibody conjugate, or an antigen-
binding fragment thereof. In embodiments, a CTLA—4 inhibitor is ipilimumab (Yervoy),
AGEN1884, or tremelimumab.
In embodiments, an immune checkpoint inhibitor is a LAG—3 inhibitor (e.g., an
antibody, an antibody conjugate, or an antigen—binding fragment thereof). In ments, a
LAG-3 tor is a small molecule, a nucleic acid, a polypeptide (e.g., an antibody), a
carbohydrate, a lipid, a metal, or a toxin. In embodiments, a LAG-3 inhibitor is a small
le. In embodiments, a LAG-3 inhibitor is a LAG-3 binding agent. In embodiments, a
LAG-3 inhibitor is an dy, an antibody ate, or an antigen-binding fragment
thereof. In embodiments, a LAG-3 inhibitor is a IMP321, EMS-986016, GSK2831781,
Novartis LAG525, or a LAG-3 inhibitor described in WC 26858,
In embodiments, an immune oint inhibitor is a TIGIT inhibitor (e.g., an
antibody, an antibody conjugate, or an antigen—binding fragment thereof). In embodiments, a
TIGIT inhibitor is a small molecule, a nucleic acid, a polypeptide (e.g., an antibody), a
carbohydrate, a lipid, a metal, or a toxin. In embodiments, a TIGIT inhibitor is small
molecule. In embodiments, a TIGIT inhibitor is a TIGIT binding agent. In embodiments, a
TIGIT inhibitor is an antibody, an antibody conjugate, or an antigen-binding fragment
thereof. In embodiments, a TIGIT inhibitor is MTIG7 192A, EMS-986207, or OMP-3lM32.
In embodiments, an immune checkpoint inhibitor is an IDO inhibitor. In
embodiments, an IDO inhibitor is a small molecule, a nucleic acid, a polypeptide (e.g., an
antibody), a carbohydrate, a lipid, a metal, or a toxin. In embodiments, an IDO inhibitor is
small le. In embodiments, an IDO inhibitor is an IDO binding agent. In
embodiments, an IDO inhibitor is an antibody, an antibody conjugate, or an antigen-binding
fragment f.
In embodiments, an immune checkpoint inhibitor is a CSFlR inhibitor. In
embodiments, a CSFlR inhibitor is a small le, a nucleic acid, a polypeptide (e. g., an
antibody), a ydrate, a lipid, a metal, or a toxin. In embodiments, a CSFlR inhibitor is
small molecule. In embodiments, a CSFlR tor is a CSFlR binding agent. In
embodiments, a CSFlR inhibitor is an antibody, an dy conjugate, or an antigen-binding
fragment thereof.
In embodiments, a subject has been further administered or will be administered
an agent that inhibits poly (ADP-ribose) polymerase (PARP), such that the subject receives
treatment with a PD—l binding agent and a PARP inhibitor.
In embodiments, a PARP inhibitor is a small molecule, a nucleic acid, a
polypeptide (e.g., an antibody), a carbohydrate, a lipid, a metal, or a toxin. In embodiments,
a PARP inhibitor is ed from the group consisting of: ABT—767, AZD 2461, BGB-290,
BGP 15, CEP 8983, CEP 9722, DR 2313, E7016, E7449, fluzoparib, IMP 4297, INOlOOl,
JPI 289, JPI 547, monoclonal antibody B3-LysPE40 conjugate, MP 124, niraparib, NU 1025,
NU 1064, NU 1076, NU1085, olaparib, ONO2231, PD , R 503, R554, rucaparib, SBP
101, SC 101914, simmiparib, talazoparib, veliparib, WW 46, 2—(4-(trifluoromethyl)phenyl)-
7,8-dihydro-5H-thiopyrano[4,3-d]pyrimidin-4—ol, and salts or derivatives thereof. In
embodiments, a PARP inhibitor is niraparib, olaparib, rucaparib, talazoparib, or veliparib. In
embodiments, a PARP inhibitor is niraparib (e.g., niraparib free base, niraparib tosylate, or
niraparib tosylate monohydrate, or any combination thereof).
In embodiments, a subject is further administered or will be administered one or
more immune checkpoint tors (e.g., a TIM-3 inhibitor and/or a LAG-3 inhibitor) such
that the subject es ent with a PD-l binding agent, a PARP tor (e.g.,
niraparib), and the one or more immune checkpoint inhibitors. In embodiments, a subject is
administered a PD-l binding agent, a PARP inhibitor (e.g., niraparib), and a TIM-3 tor.
In embodiments, a subject is administered a PD-l binding agent, a PARP inhibitor (e.g.,
niraparib), and a LAG-3 tor. In ments, a subject is stered a PD-l binding
agent, a PARP inhibitor (e.g., niraparib), a TIM—3 inhibitor, and a LAG-3 inhibitor.
In embodiments, a therapeutic agent (e.g., a PD-l binding agent, an immune
checkpoint inhibitor, or a PARP inhibitor) described herein is administered ing to
closing regimens demonstrated to achieve a clinical benefit in some patients (for example,
according to a regimen as determined by a physician, including dosing modifications).
In some embodiments, a clinical benefit is a complete response (“CR”), a partial
se (“PR”) or a stable disease (“SD”). In some embodiments, a al benefit
corresponds to at least SD. In some embodiments, a clinical benefit corresponds to at least a
PR. In some embodiments, a clinical benefit corresponds to a CR. In some embodiments, at
least 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%,
55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of patients e a clinical benefit. In
some embodiments, at least 5% of patients achieve a clinical benefit. In some embodiments,
at least 5% of patients achieve SD. In some embodiments, at least 5% of patients achieve at
least a PR. In some embodiments, at least 5% of patients achieve CR. In some
embodiments, at least 10% of patients achieve a al benefit. In some embodiments, at
least 10% of patients e SD. In some embodiments, at least 10% of ts achieve at
least a PR. In some embodiments, at least 20% of patients achieve a clinical benefit. In some
ments, at least 20% of ts achieve SD.
In some embodiments, the al benefit (e.g., SD, PR and/or CR) is determined
in accordance with Response Evaluation Criteria in Solid Tumors (RECIST). In some
embodiments, the clinical benefit (e.g., SD, PR and/or CR) is determined in accordance
RECIST guidelines. In some embodiments, the clinical benefit (e.g., SD, PR and/or CR) is
determined in accordance RECIST ines (version 1.1). In some ments, the
clinical benefit (e.g., SD, PR and/or CR) is determined in accordance immune-related
RECIST (irRECIST) guidelines. In some embodiments, tumor response can be assessed by
either irRECIST or RECIST version 1.1. In some embodiments, tumor response can be
assessed by both irRECIST and RECIST version 1.1. When used herein, the term T
guidelines” can refer to RECIST 1.0, RECIST 1.1 or ir RECIST interchangeably.
In embodiments, a patient has a disorder that is a T-cell dysfunctional disorder.
In embodiments, a patient has a disorder that is cancer.
In embodiments, a cancer is ated with a high tumor mutation burden (TMB).
In embodiments, a cancer is microsatellite stable (MSS).
In embodiments a cancer is characterized by atellite instability.
In embodiments, a cancer has a high microsatellite instability status (MSI-H).
In embodiments, a cancer has a low microsatellite instability status (MSI—L).
In embodiments, a cancer is associated with high TMB and MSI-H.
In embodiments, a cancer is associated with high TMB and MSI-L or MSS. In
embodiments, a cancer is associated with high TMB and MSI—L. In embodiments, a cancer is
associated with high TMB and MSS.
In embodiments, a cancer has a defective DNA mismatch repair .
In embodiments, a cancer has a defect in a DNA mismatch repair gene.
In embodiments, a cancer is a hypermutated cancer.
In embodiments, a cancer has homologous recombination repair
deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer comprises a mutation in polymerase delta (POLD).
In embodiments, a cancer comprises a mutation in polymerase epsilon (POLE).
In embodiments, a cancer is endometrial cancer (e.g., MSI—H or MSS/MSI—L
endometrial cancer). In embodiments, a cancer is a MSI-H cancer comprising a mutation in
POLE or POLD (e.g., a MSI—H non—endometrial cancer comprising a mutation in POLE or
POLD). In embodiments, a cancer is breast cancer (e.g., triple negative breast cancer
(TNBC)). In embodiments, a cancer is lung cancer (e.g., non-small cell lung cancer). In
embodiments, a cancer is melanoma. In embodiments, a cancer is colorectal cancer. In
embodiments, a cancer is squamous cell carcinoma of the anus, squamous cell carcinoma of
the penis, squamous cell carcinoma of the , squamous cell carcinoma of the vagina, or
squamous cell carcinoma of the vulva.
In embodiments, a cancer is adenocarcinoma, endometrial cancer, breast cancer,
ovarian cancer, cervical cancer, fallopian tube , testicular cancer, primary peritoneal
cancer, colon , colorectal , stomach cancer, small intestine cancer, squamous cell
carcinoma of the anogenital region (e.g., squamous cell carcinoma of the anus, penis, cervix,
, or , soft tissue sarcoma (e.g., leiomyosarcoma), melanoma, renal cell
carcinoma, lung cancer, non-small cell lung cancer, adenocarcinoma of the lung, us
cell carcinoma of the lung, h cancer, bladder cancer, gall bladder cancer, liver cancer,
d cancer, laryngeal cancer, salivary gland cancer, esophageal cancer, head and neck
cancer, squamous cell carcinoma of the head and neck, te cancer, pancreatic cancer,
mesothelioma, Merkel cell carcinoma, sarcoma, astoma, a hematological cancer,
multiple myeloma, B-cell lymphoma, T-cell ma, Hodgkin’s lymphoma/primary
mediastinal B-cell lymphoma, chronic enous leukemia, acute myeloid leukemia, acute
lymphoblastic leukemia, non—Hodgkin’s lymphoma, neuroblastoma, a CNS tumor, diffuse
intrinsic pontine glioma (DIPG), Ewing’s sarcoma, embryonal rhabdomyosarcoma,
osteosarcoma, or Wilms tumor. In embodiments, a cancer is M85 or MSI—L, is characterized
by microsatellite instability, is MSI-H, has high TMB, has high TMB and is M88 or MSI-L,
has high TMB and is MSI—H, has a defective DNA mismatch repair system, has a defect in a
DNA mismatch repair gene, is a hypermutated cancer, is an HRD cancer, comprises a
mutation in polymerase delta (POLD) or comprises a mutation in polymerase epsilon
In embodiments, a cancer has homologous recombination repair
deficiency/homologous repair deficiency (“HRD”). In embodiments, a cancer is acute
d leukemia. In embodiments, a cancer is acute lymphoblastic leukemia. In
embodiments, a cancer is non-Hodgkin’s lymphoma. In embodiments, a cancer is Hodgkin’s
ma. In embodiments, a cancer is lastoma. In embodiments, a cancer is a CNS
tumor. In embodiments, a cancer is diffuse intrinsic pontine glioma . In
ments, a cancer is Ewing’s sarcoma. In ments, a cancer is embryonal
rhabdomyosarcoma. In embodiments, a cancer is osteosarcoma. In ments, a cancer is
Wilms tumor. In embodiments, a cancer is a soft tissue sarcoma (e.g., leiomyosarcoma).
In some embodiments, a patient has cancer, such as a head and neck cancer, a lung
cancer (e.g., a non-small cell lung cancer (NSCLC)), a renal cancer, a r cancer, a
melanoma, Merkel cell carcinoma, a cervical cancer, a vaginal cancer, a vulvar cancer, a
uterine cancer, a trial cancer, an ovarian cancer, a fallopian tube cancer, a breast
cancer, a prostate cancer, a salivary gland tumor, a thymoma, a adrenocortical carcinoma, a
esophageal cancer, a gastric cancer, a colorectal cancer, an appendiceal cancer, a urothelial
cell carcinoma, or a squamous cell carcinoma (e.g., of the lung; of the anogenital region
including anus, penis, cervix, vagina, or vulva; or of the esophagus). In some certain
embodiments, a patient has an anal , a fallopian tube cancer, an ovarian cancer, or a
lung cancer. In some certain embodiments, a patient has a cancer of the anus. In some certain
embodiments, a patient has a cancer of the fallopian tube(s). In some certain embodiments, a
patient has an ovarian cancer. In some n embodiments, a patient has a lung cancer.
In some embodiments, a patient has a cancer with microsatellite instability. In
some embodiments, the microsatellite instability is considered high, wherein the instability is
icantly higher than that observed in a control cell (e.g., MSI-H status). In some
embodiments, the microsatellite ility is MSI—Low. In some embodiments, the
microsatellite instability is microsatellite stable (e.g., MSS status). In some embodiments, a
cancer with microsatellite instability is a head and neck , a lung cancer (e.g., a non-
small cell lung cancer (NSCLC)), a renal cancer, a bladder cancer, a melanoma, Merkel cell
carcinoma, a cervical cancer, a vaginal cancer, a vulvar cancer, a uterine cancer, a
endometrial cancer, an ovarian , a fallopian tube cancer, a breast cancer, a te
cancer, a ry gland tumor, a thymoma, a adrenocortical carcinoma, a esophageal cancer,
a gastric cancer, a colorectal cancer, an appendiceal cancer, a lial cell carcinoma, or a
squamous cell carcinoma (e.g., of the lung; of the anogenital region including anus, penis,
cervix, vagina, or vulva; or of the esophagus). In some certain embodiments, a cancer with
microsatellite instability is an anal cancer, a fallopian tube cancer, an ovarian cancer, or a
lung cancer. In some certain embodiments, a patient has an endometrial cancer with
microsatellite instability. In some embodiments, a patient has an endometrial cancer that is
microsatellite stable (MSS).
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In some ments, a t has a cancer characterized by PD-l and/or PD—Ll
expression. In some embodiments, a cancer has high PD-l and/or PD-Ll expression (e.g., by
high PD-l and/or high PD—Ll expression). In some embodiment, a cancer characterized by
PD—l and/or PD—Ll expression is a head and neck cancer, a lung cancer (e.g., a non-small cell
lung cancer (NSCLC)), a renal cancer, a bladder cancer, a melanoma, Merkel cell carcinoma,
a cervical cancer, a vaginal cancer, a vulvar cancer, a uterine cancer, a endometrial cancer, an
ovarian cancer, a fallopian tube , a breast cancer, a prostate cancer, a salivary gland
tumor, a thymoma, a adrenocortical carcinoma, a esophageal cancer, a gastric cancer, a
colorectal cancer, an appendiceal cancer, a urothelial cell carcinoma, or a squamous cell
carcinoma (e.g., of the lung; of the anogenital region ing anus, penis, cervix, vagina, or
vulva; or of the esophagus). In some certain embodiments, a cancer characterized by PD-l
and/or PD-Ll expression is an anal cancer, a fallopian tube cancer, an ovarian cancer, or a
lung cancer.
In embodiments, a cancer is an advanced cancer. In embodiments, a cancer is a
metastatic . In ments, a cancer is a MSI—H cancer. In embodiments, a cancer is
a MSS cancer. In embodiments, a cancer is a POLE—mutant cancer. In embodiments, a
cancer is a POLD-mutant cancer. In embodiments, a cancer is a high TMB cancer. In
ments, a cancer is associated with homologous recombination repair
deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is a solid tumor. In embodiments, a solid tumor is
advanced. In embodiments, a solid tumor is a metastatic solid tumor. In embodiments, a
solid tumor is a MSI—H solid tumor. In ments, a solid tumor is a MSS solid tumor. In
embodiments, a solid tumor is a POLE-mutant solid tumor. In embodiments, a solid tumor is
a FOLD-mutant solid tumor. In embodiments, a solid tumor is a high TMB solid tumor. . In
embodiments, a solid tumor is associated with homologous recombination repair
deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is a non-endometrial cancer (e.g., a non—endometrial
solid tumor). In embodiments, a non-endometrial cancer is an advanced cancer. In
embodiments, a non-endometrial cancer is a metastatic cancer. In embodiments, a non-
endometrial cancer is a MSI—H cancer. In ments, a non—endometrial cancer is a MSS
cancer. In embodiments, a non-endometrial cancer is a utant cancer. In
embodiments, a non—endometrial cancer is a solid tumor (e.g., a MSS solid tumor, a MSI—H
solid tumor, a POLD mutant solid tumor, or a POLE-mutant solid tumor). In embodiments, a
non—endometrial cancer is a high TMB cancer. In embodiments, a non-endometrial cancer is
associated with homologous recombination repair deficiency/homologous repair deficiency
(“HRD”).
In embodiments, a cancer is endometrial cancer (e.g., a solid tumor). In
embodiments, an endometrial cancer is an advanced cancer. In embodiments, an endometrial
cancer is a metastatic cancer. In embodiments, an endometrial cancer is a MSI-H
trial cancer. In embodiments, an endometrial cancer is a MSS endometrial cancer. In
embodiments, an trial cancer is a POLE-mutant endometrial cancer. In embodiments,
an endometrial cancer is a FOLD—mutant endometrial cancer. In embodiments, an
endometrial cancer is a high TMB endometrial cancer. In embodiments, an endometrial
cancer is ated with homologous recombination repair deficiency/homologous repair
deficiency ).
In embodiments, a cancer is a lung cancer (e.g., a solid tumor). In embodiments, a
lung cancer is an advanced lung cancer. In embodiments, a lung cancer is a metastatic lung
cancer. In embodiments, a lung cancer is squamous cell carcinoma of the lung. In
embodiments, a lung cancer is small cell lung cancer (SCLC). In embodiments, a lung cancer
is all cell lung cancer (NSCLC). In embodiments, a lung cancer is an ALK-
translocated lung cancer (e.g., a lung cancer with a known ALK-translocation). In
embodiments, a lung cancer is an utant lung cancer (e.g., a lung cancer with a
known EGFR on). In embodiments, a lung cancer is a MSI—H lung cancer. In
embodiments, a lung cancer is a MSS lung cancer. In ments, a lung cancer is a
POLE-mutant lung cancer. In embodiments, a lung cancer is a FOLD-mutant lung cancer. In
embodiments, a lung cancer is a high TMB lung cancer. In embodiments, a lung cancer is
associated with homologous recombination repair deficiency/homologous repair deficiency
In embodiments, a cancer is a colorectal (CRC) cancer (e.g., a solid tumor). In
embodiments, a colorectal cancer is an advanced colorectal cancer. In embodiments, a
colorectal cancer is a metastatic colorectal cancer. In embodiments, a colorectal cancer is a
MSI—H colorectal cancer. In embodiments, a ctal cancer is a MSS colorectal cancer. In
embodiments, a colorectal cancer is a POLE—mutant colorectal cancer. In embodiments, a
colorectal cancer is a FOLD-mutant colorectal cancer. In embodiments, a ctal cancer is
a high TMB ctal cancer. In embodiments, a colorectal cancer is associated with
homologous recombination repair deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is a melanoma. In embodiments, a melanoma is an
advanced ma. In embodiments, a melanoma is a metastatic melanoma. In
embodiments, a melanoma is a MSI—H melanoma. In embodiments, a melanoma is a MSS
ma. In embodiments, a melanoma is a POLE-mutant melanoma. In embodiments, a
melanoma is a FOLD-mutant melanoma. In embodiments, a melanoma is a high TMB
melanoma. In embodiments, a melanoma is associated with homologous recombination
repair deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is squamous cell carcinoma of the anogenital region
(e.g., of the anus, penis, cervix, , or vulva). In embodiments, a squamous cell
oma of the anogenital region (e.g., of the anus, penis, cervix, vagina, or vulva) is an
advanced cancer. In embodiments, a squamous cell carcinoma of the anogenital region (e.g.,
of the anus, penis, , vagina, or vulva) is a metastatic cancer. In embodiments, a
squamous cell carcinoma of the anogenital region (e. g., of the anus, penis, , vagina, or
vulva) is MSI—H. In embodiments, a squamous cell carcinoma of the anogenital region (e.g.,
of the anus, penis, cervix, vagina, or vulva) is MSS. In embodiments, a lung cancer is a
POLE-mutant cancer. In embodiments, a squamous cell carcinoma of the anogenital region
(e.g., of the anus, penis, cervix, vagina, or vulva) is associated with homologous
recombination repair deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is an ovarian cancer. In embodiments, an ovarian
cancer is an advanced ovarian cancer. In embodiments, an ovarian cancer is a metastatic
ovarian . In embodiments, an ovarian cancer is a MSI—H ovarian cancer. In
ments, an ovarian cancer is a MSS ovarian cancer. In embodiments, an ovarian
cancer is a POLE-mutant ovarian cancer. In embodiments, an ovarian cancer is a POLD-
mutant ovarian cancer. In ments, an ovarian cancer is a high TMB ovarian . In
embodiments, an n cancer is associated with homologous recombination repair
deficiency/homologous repair deficiency (“HRD”). In embodiments, an ovarian cancer is a
serous cell ovarian cancer. In embodiments, an ovarian cancer is a clear cell ovarian cancer.
In ments, a cancer is a ian cancer. In embodiments, a fallopian
cancer is an advanced fallopian cancer. In embodiments, a fallopian cancer is a metastatic
fallopian cancer. In embodiments, a fallopian cancer is a MSI—H fallopian . In
embodiments, a fallopian cancer is a MSS fallopian cancer. In embodiments, a fallopian
cancer is a POLE-mutant fallopian cancer. In embodiments, a fallopian cancer is a POLD-
mutant fallopian cancer. In ments, a fallopian cancer is a high TMB fallopian cancer.
In embodiments, a fallopian cancer is associated with homologous ination repair
deficiency/homologous repair deficiency (“HRD”). In embodiments, a fallopian cancer is a
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serous cell fallopian cancer. In embodiments, a fallopian cancer is a clear cell fallopian
cancer.
In embodiments, a cancer is a y peritoneal cancer. In embodiments, a
primary peritoneal cancer is an ed primary peritoneal cancer. In embodiments, a
primary peritoneal cancer is a metastatic primary peritoneal cancer. In embodiments, a
primary peritoneal cancer is a MSI-H primary peritoneal cancer. In embodiments, a primary
peritoneal cancer is a MSS y peritoneal cancer. In embodiments, a primary peritoneal
cancer is a POLE-mutant primary peritoneal cancer. In embodiments, a primary neal
cancer is a POLD-mutant primary peritoneal cancer. In embodiments, a primary peritoneal
cancer is a high TMB primary peritoneal cancer. In embodiments, a primary peritoneal
cancer is associated with homologous recombination repair ency/homologous repair
deficiency (“HRD”). In embodiments, a y peritoneal cancer is a serous cell primary
peritoneal cancer. In embodiments, a primary peritoneal cancer is a clear cell primary
neal cancer.
In embodiments, a cancer is acute lymphoblastic leukemia (“ALL”). In
embodiments, acute lymphoblastic leukemia is advanced acute lymphoblastic ia. In
embodiments, acute lymphoblastic leukemia is metastatic acute blastic leukemia. In
embodiments, acute lymphoblastic leukemia is MSI-H acute lymphoblastic leukemia. In
embodiments, acute lymphoblastic leukemia is MSS acute lymphoblastic leukemia. In
embodiments, acute lymphoblastic leukemia is POLE-mutant acute lymphoblastic leukemia.
In embodiments, acute lymphoblastic leukemia is FOLD—mutant acute blastic
leukemia. In embodiments, an acute lymphoblastic leukemia is associated with homologous
recombination repair deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is acute myeloid leukemia (“AML”). In embodiments,
acute myeloid leukemia is advanced acute myeloid leukemia. In embodiments, acute
myeloid leukemia is metastatic acute myeloid ia. In embodiments, acute myeloid
ia is MSI-H acute myeloid ia. In embodiments, acute myeloid leukemia is
MSS acute myeloid leukemia. In embodiments, acute myeloid leukemia is POLE-mutant
acute myeloid ia. In embodiments, acute myeloid leukemia is POLD-mutant acute
myeloid ia. In embodiments, an acute d leukemia is associated With
homologous recombination repair deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is non-Hodgkin’s lymphoma (NHL). In embodiments,
non-Hodgkin’s lymphoma is advanced non-Hodgkin’s ma. In embodiments, non-
Hodgkin’s lymphoma is metastatic non-Hodgkin’s lymphoma. In embodiments, non—
Hodgkin’s lymphoma is MSI-H non—Hodgkin’s lymphoma. In embodiments, non-Hodgkin’s
lymphoma is MSS non-Hodgkin’s lymphoma In ments, non-Hodgkin’s ma is
POLE-mutant non—Hodgkin’s lymphoma. In embodiments, dgkin’s lymphoma is
FOLD-mutant non-Hodgkin’s lymphoma. In embodiments, non-Hodgkin’s lymphoma is
associated with homologous recombination repair deficiency/homologous repair deficiency
(“HRD”).
In embodiments, a cancer is Hodgkin’s lymphoma (HL). In embodiments,
n’s lymphoma is ed Hodgkin’s lymphoma. In embodiments, Hodgkin’s
lymphoma is metastatic Hodgkin’s lymphoma. In embodiments, Hodgkin’s lymphoma is
MSI-H n’s lymphoma. In embodiments, Hodgkin’s lymphoma is MSS Hodgkin’s
lymphoma In embodiments, Hodgkin’s lymphoma is POLE-mutant Hodgkin’s lymphoma.
In embodiments, Hodgkin’s lymphoma is FOLD-mutant Hodgkin’s lymphoma. In
embodiments, n’s lymphoma is associated with homologous recombination repair
deficiency/homologous repair ency (“HRD”).
In embodiments, a cancer is a neuroblastoma (NB). In embodiments, a
neuroblastoma is an advanced lastoma. In embodiments, a neuroblastoma is a
metastatic lastoma. In embodiments, neuroblastoma is a MSI—H neuroblastoma. In
embodiments, a neuroblastoma is a MSS neuroblastoma. In embodiments, a neuroblastoma
is a POLE—mutant neuroblastoma. In embodiments, a neuroblastoma is a FOLD-mutant
neuroblastoma. In embodiments, a neuroblastoma is a high TMB neuroblastoma. In
embodiments, a neuroblastoma is associated with homologous recombination repair
deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is a CNS tumor. In embodiments, a CNS tumor is
ed. In embodiments, a CNS tumor is a metastatic CNS tumor. In embodiments, a
CNS tumor is a MSI-H CNS tumor. In embodiments, a CNS tumor is a MSS CNS tumor. In
embodiments, a CNS tumor is a POLE—mutant CNS tumor. In ments, a CNS tumor is
a FOLD-mutant CNS tumor. In embodiments, a CNS tumor is a high TMB CNS tumor. . In
embodiments, a CNS tumor is associated with homologous recombination repair
deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is diffuse intrinsic pontine glioma (DIPG). In
embodiments, a DIPG is an advanced DIPG. In embodiments, a DIPG is a metastatic DIPG.
In embodiments, DIPG is a MSI-H DIPG. In embodiments, a DIPG is a MSS DIPG. In
embodiments, a DIPG is a POLE-mutant DIPG. In embodiments, a DIPG is a utant
DIPG. In embodiments, a DIPG is a high TMB DIPG. In embodiments, a DIPG is
associated with homologous ination repair deficiency/homologous repair deficiency
(“HRD”).
In embodiments, a cancer is Ewing’s sarcoma. In ments, Ewing’s sarcoma
is an advanced Ewing’s sarcoma. In embodiments, Ewing’s a is a metastatic Ewing’s
sarcoma. In embodiments, Ewing’s sarcoma is a MSI—H Ewing’s sarcoma. In embodiments,
Ewing’s sarcoma is a MSS Ewing’s sarcoma. In embodiments, Ewing’s sarcoma is a POLE-
mutant Ewing’s sarcoma. In embodiments, Ewing’s sarcoma is a utant Ewing’s
sarcoma. In embodiments, Ewing’s sarcoma is a high TMB Ewing’s sarcoma. In
embodiments, Ewing’s sarcoma is associated with homologous ination repair
ency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is an embryonal rhabdomyosarcoma (ERS). In
embodiments, an embryonal rhabdomyosarcoma is an advanced embryonal
rhabdomyosarcoma. In ments, an embryonal myosarcoma is a metastatic
embryonal rhabdomyosarcoma. In embodiments, an embryonal rhabdomyosarcoma is a
MSI-H embryonal rhabdomyosarcoma. In embodiments, an nal rhabdomyosarcoma
is a MSS embryonal rhabdomyosarcoma. In embodiments, an embryonal rhabdomyosarcoma
is a utant embryonal rhabdomyosarcoma. In embodiments, an embryonal
rhabdomyosarcoma is a FOLD-mutant embryonal rhabdomyosarcoma. In embodiments, an
embryonal rhabdomyosarcoma is a high TMB embryonal rhabdomyosarcoma. In
embodiments, an embryonal rhabdomyosarcoma is associated with homologous
recombination repair ency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is an osteosarcoma (OS). In ments, an
osteosarcoma is an advanced osteosarcoma. In embodiments, an osteosarcoma is a metastatic
osteosarcoma. In embodiments, an osteosarcoma is a MSI—H arcoma. In
embodiments, an osteosarcoma is a MSS osteosarcoma. In embodiments, an osteosarcoma is
a POLE-mutant osteosarcoma. In embodiments, an osteosarcoma is a utant
osteosarcoma. In embodiments, an arcoma is a high TMB osteosarcoma. In
embodiments, an osteosarcoma is associated with homologous recombination repair
deficiency/homologous repair deficiency (“HRD”).
In embodiments, a cancer is a soft tissue sarcoma. In embodiments, a soft tissue
sarcoma is an advanced soft tissue sarcoma. In embodiments, a soft tissue sarcoma is a
metastatic soft tissue sarcoma. In embodiments, a soft tissue sarcoma is a MSI-H soft tissue
sarcoma. In embodiments, a soft tissue sarcoma is a MSS soft tissue sarcoma. In
embodiments, a soft tissue sarcoma is a POLE—mutant soft tissue sarcoma. In embodiments,
a soft tissue sarcoma is a FOLD-mutant soft tissue sarcoma. In embodiments, a soft tissue
sarcoma is a high TMB soft tissue sarcoma. In embodiments, a soft tissue a is
associated with homologous ination repair deficiency/homologous repair deficiency
(“HRD”). In embodiments, a soft tissue a is leiomyosarcoma.
In embodiments, a cancer is Wilms tumor. In embodiments, Wilms tumor is an
advanced Wilms tumor. In ments, Wilms tumor is a metastatic Wilms tumor. In
embodiments, Wilms tumor is a MSI-H Wilms tumor. In embodiments, Wilms tumor is a
MSS Wilms tumor. In embodiments, Wilms tumor is a POLE-mutant Wilms tumor. In
embodiments, Wilms tumor is a FOLD-mutant Wilms tumor. In embodiments, Wilms tumor
is a high TMB Wilms tumor. In embodiments, Wilms tumor is associated with homologous
recombination repair deficiency/homologous repair deficiency (“HRD”).
In embodiments, a subject has previously been treated with one or more different
cancer treatment modalities (e.g., one or more of surgery, radiotherapy, chemotherapy, or
immunotherapy). In embodiments, a subject has previously been treated with one different
cancer treatment modalities (e.g., one or more of surgery, radiotherapy, chemotherapy, or
immunotherapy). In embodiments, a t has previously been treated with two or more
different cancer treatment modalities (e.g., one or more of surgery, radiotherapy,
chemotherapy, or immunotherapy). In embodiments, a subject has been previously treated
with a cytotoxic therapy. In ments, a subject has been previously treated with
chemotherapy. In embodiments, a subject has previously been d with two different
cancer treatment modalities (e.g., one or more of y, radiotherapy, chemotherapy, or
immunotherapy). In embodiments, a subject has previously been d with three different
cancer treatment modalities (e.g., one or more of surgery, radiotherapy, chemotherapy, or
immunotherapy).
In embodiments of methods described herein, a method further ses
administering one or more of surgery, a radiotherapy, a chemotherapy, an immunotherapy, an
anti-angiogenic agent, or an anti-inflammatory. In embodiments, a method further comprises
administering a chemotherapy.
In embodiments, a subject is resistant to ent with an agent that inhibits PD-
In embodiments, a subject is tory to treatment with an agent that inhibits
PD—l.
In ments, a method described herein sensitizes a subject to treatment with
an agent that inhibits PD-l.
In embodiments, a subject comprises an exhausted immune cell (e.g., an
exhausted immune cell that is an exhausted T cell).
In embodiments of methods described herein, a subject is an animal (e.g., a
mammal). In embodiments, a subject is a human. In embodiments, a subject is a non-human
mammal (e.g., mice, rats, rabbits, or non-human primates). Accordingly, methods described
herein can be useful in both treatment of humans and in veterinary medicine.
In embodiments, a PD—l binding agent (e.g., any anti-PD-l antibody) is
administered intravenously (e.g., by intravenous infusion).
The present disclosure also provides, in some embodiments, methods of treating
cancer that comprises administering to a patient in need of treatment an anti-programmed
1 n (PD-1) antibody at a eutically effective dose at an administration
interval for a period sufficient to e clinical benefit. In embodiments, the anti-PD-l
antibody comprises a heavy chain variable region comprising CDR ces of SEQ ID
NOS: 9, 10, and 11 and a light chain variable region comprising CDR sequences of SEQ ID
NOs: 12, 13, and 14. In embodiments, the heavy chain variable region comprises SEQ ID
NO: 1 and the light chain le domain comprises SEQ ID NO: 2. In embodiments, the
heavy chain le region comprises SEQ ID N027 and the light chain variable region
comprises SEQ ID NO:8. In embodiments, the heavy chain variable region comprises SEQ
ID NO: 3 and the light chain variable region comprises SEQ ID NO: 4.
The present disclosure provides, in some embodiments, methods of ng cancer
in a patient in need thereof, the method sing administering a composition that delivers
a PD-l-binding agent according to a regimen demonstrated to achieve a response rate in
relevant patient tion such that no more than 50% to 80% of patients show progressive
disease after 2, 4, 6, 8, 10, 12, 14, 16, 18, or 20 weeks following tion of treatment. In
some embodiments, no more than 80% of patients show progressive disease after at least 10
weeks ing initiation of treatment.
In some embodiments, a PDbinding agent comprises a heavy chain variable
region with one, two or three CDR ces selected from SEQ ID NOs: 9, 10, and 11
and/or a light chain variable region with one, two or three CDR sequences ed from SEQ
ID NOs: 12, 13, and 14. In some embodiments, a PD-l-binding agent comprises an
immunoglobulin heavy chain variable domain whose amino acid sequence comprises SEQ ID
NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain variable domain whose amino
acid sequence comprises SEQ ID NO: 2 or SEQ ID NO: 8. In some embodiments, a PD-l-
binding agent comprises an immunoglobulin heavy chain whose amino acid sequence
ses SEQ ID NO: 3 and an immunoglobulin light chain whose amino acid sequence
comprises SEQ ID NO: 4.
] The present disclosure provides, in some embodiments, s of treating cancer
in a patient in need thereof, the method sing administering a ition that delivers
a PDbinding agent ient to achieve an average PD-1 receptor occupancy of at least
about 50% to about 90% after 1, 2, 3, 4, or 5 days following a single dose of the composition.
In some embodiments, administration of a composition that delivers a PD-l-binding agent is
sufficient to achieve an average PD—1 receptor occupancy of at least 85% after 3 days
following a single dose of the composition. In some embodiments, a PDbinding agent
comprises a heavy chain variable region with one, two or three CDR sequences selected from
SEQ ID NOs: 9, 10, and 11 and/or a light chain variable region with one, two or three CDR
sequences selected from SEQ ID NOs: 12, 13, and 14. In some embodiments, a PD—l-
binding agent comprises an immunoglobulin heavy chain variable domain whose amino acid
sequence comprises SEQ ID NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain
variable domain whose amino acid sequence comprises SEQ ID NO: 2 or SEQ ID NO: 8. In
some embodiments, a PDbinding agent comprises an immunoglobulin heavy chain whose
amino acid sequence comprises SEQ ID NO: 3 and an immunoglobulin light chain whose
amino acid sequence comprises SEQ ID NO: 4.
] The present disclosure provides, in some embodiments, methods of ng cancer
in a patient in need thereof, the method comprising administering a composition that delivers
a PD-l-binding agent sufficient to achieve an e stimulation ratio of at least 1 in a
functional PD-1 receptor occupancy assay after 3 days ing a single dose of the PD—l-
binding agent. In some embodiments, a PDbinding agent comprises a heavy chain
variable region with one, two or three CDR sequences selected from SEQ ID NOs: 9, 10, and
11 and/or a light chain variable region with one, two or three CDR sequences selected from
SEQ ID NOs: 12, 13, and 14. In some embodiments, a PD-l—binding agent comprises an
immunoglobulin heavy chain variable domain whose amino acid sequence comprises SEQ ID
NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain variable domain whose amino
acid sequence comprises SEQ ID NO: 2 or SEQ ID NO: 8. In some embodiments, a PD
binding agent comprises an immunoglobulin heavy chain whose amino acid sequence
ses SEQ ID NO: 3 and an immunoglobulin light chain whose amino acid ce
comprises SEQ ID NO: 4.
The present disclosure provides, in some embodiments, methods of treating cancer
in a patient in need thereof, the method comprising administering a composition that delivers
a PDbinding agent sufficient to achieve an average PD-1 or occupancy of at least
75% over a first period of time (e.g., about 15 days to about 60 days; in some ments
about 29 days) following a single dose of the PDbinding agent. In some embodiments, a
PD—1-binding agent ses a heavy chain variable region with one, two or three CDR
sequences selected from SEQ ID NOs: 9, 10, and 11 and/or a light chain variable region with
one, two or three CDR sequences selected from SEQ ID NOS: 12, 13, and 14. In some
embodiments, a PDbinding agent comprises an immunoglobulin heavy chain variable
domain whose amino acid sequence comprises SEQ ID NO: 1 or SEQ ID NO: 7 and an
immunoglobulin light chain variable domain whose amino acid sequence comprises SEQ ID
NO: 2 or SEQ ID NO: 8. In some embodiments, a PD-1—binding agent comprises an
immunoglobulin heavy chain whose amino acid sequence comprises SEQ ID NO: 3 and an
immunoglobulin light chain whose amino acid sequence comprises SEQ ID NO: 4.
The present disclosure provides, in some embodiments, methods of ng cancer
in a patient in need thereof, the method comprising administering a composition that delivers
a PDbinding agent sufficient to achieve an average stimulation ratio of at least 1 in a
functional PD-1 or occupancy assay over a first period of time (e.g., about 15 days to
about 60 days; in some embodiments about 29 days) following a single dose of the PD
binding agent. In some embodiments, a PDbinding agent comprises a heavy chain
variable region with one, two or three CDR ces selected from SEQ ID NOS: 9, 10, and
11 and/or a light chain variable region with one, two or three CDR sequences selected from
SEQ ID NOs: 12, 13, and 14. In some embodiments, a PD-l-binding agent comprises an
immunoglobulin heavy chain variable domain whose amino acid sequence comprises SEQ ID
NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain variable domain whose amino
acid sequence comprises SEQ ID NO: 2 or SEQ ID NO: 8. In some embodiments, a PD—l-
binding agent comprises an immunoglobulin heavy chain whose amino acid sequence
comprises SEQ ID NO: 3 and an immunoglobulin light chain whose amino acid sequence
comprises SEQ ID NO: 4.
In some embodiments, a patient for treatment with a composition for delivering a
PD-1 g agent has a tumor. In some embodiments, the patient has a solid tumor. In
some embodiments, the t has an advanced stage solid tumor. In some embodiments, a
patient has a metastatic solid tumor.
In some embodiments, the patient has a head and neck , a lung cancer (e.g.,
a non-small cell lung cancer (NSCLC)), a renal cancer, a r cancer, a melanoma, Merkel
cell carcinoma, a cervical cancer, a vaginal cancer, a vulvar , a uterine cancer, an
endometrial cancer, an ovarian cancer, a fallopian tube cancer, a breast cancer, a prostate
cancer, a salivary gland tumor, a thymoma, an adrenocortical carcinoma, an esophageal
cancer, a c cancer, a ctal cancer, an appendiceal cancer, a urothelial cell
carcinoma, or a squamous cell carcinoma.
In some embodiments, the patient has an advanced stage cancer, including an
advanced stage head and neck cancer, lung cancer (e.g., non-small cell lung cancer
(NSCLC)), renal , r cancer, melanoma, Merkel cell carcinoma, cervical cancer,
vaginal cancer, vulvar cancer, uterine cancer, endometrial cancer, ovarian , fallopian
tube cancer, breast cancer, prostate cancer, salivary gland tumor, thymoma, adrenocortical
oma, esophageal cancer, gastric cancer, colorectal cancer, urothelial cell carcinoma, or
squamous cell carcinoma (e.g., of the lung; of the anogenital region including anus, penis,
cervix, vagina, or vulva; or of the esophagus). In some certain embodiments, a patient has an
advanced stage anal cancer, fallopian tube cancer, ovarian cancer, breast cancer, endometrial
cancer, or lung cancer. In some embodiments, the patient has an ed stage cancer such
as an advanced stage endometrial cancer, triple ve breast cancer, ovarian cancer, non-
small cell lung cancer, us cell carcinoma of the lung, or us cell carcinoma of
the anogenital region (e.g., us cell carcinoma of the anus, penis, , vagina, or
vulva).
In some embodiments, the patient has a cancer associated with a POLE (DNA
polymerase epsilon) or a POLD (DNA polymerase delta) mutation. In some ments,
the POLE or POLD mutation is in an exonuclease domain. In some embodiments, the POLE
or POLD on is a germline mutation. In some embodiments, the POLE or POLD
mutation is a sporadic on. In some embodiments, a method described herein further
comprises a step of first identifying the patient having the cancer with the POLE or POLD
mutation. In some embodiments, a POLE or POLD mutation is identified using sequencing.
In some embodiments, a patient has a cancer with microsatellite instability (e.g.,
MSI-H status). In some embodiments, the microsatellite instability is MSI-Low. In some
embodiments, the microsatellite instability is microsatellite stable (e.g., MSS status). In some
embodiments, the patient has endometrial cancer. In some embodiments, a patient has an
endometrial cancer with microsatellite instability. In some embodiments, a patient has an
advanced stage cancer with microsatellite instability. In some ments, an advanced
stage cancer with atellite instability is an endometrial cancer, a triple negative breast
cancer, an ovarian cancer, a non-small cell lung cancer, a squamous cell carcinoma of the
lung, or a squamous cell oma of the anogenital region (e.g., squamous cell carcinoma
of the anus, penis, cervix, , or vulva). In some embodiments, the patient has a solid
tumor (e.g., an advanced stage solid tumor or a metastatic solid . In some
embodiments, the patient has a MSI—H solid tumor.
In some ments, the patient has a hematological cancer. In some
embodiments, the patient has a hematological cancer such as Diffuse large B cell lymphoma
(“DLBCL”), Hodgkin’s lymphoma , Non-Hodgkin’s lymphoma (“NHL”), Follicular
lymphoma (“FL”), acute myeloid leukemia (“AML”), acute lymphoblastic leukemia
(“ALL”), or Multiple myeloma (“MM”). In some embodiments, a patient has a
hematological cancer with microsatellite instability.
] In some embodiments, the patient has not previously been treated with a cancer
treatment modality.
In some embodiments, the patient has previously been d with one or more
different cancer treatment modalities. In some embodiments, the patient has previously been
treated with one or more of surgery, herapy, chemotherapy or immunotherapy. In some
embodiments, the patient has previously been treated with surgery. In some embodiments,
the patient has previously been treated with chemotherapy (e.g., platinum-based
chemotherapy). In some such embodiments, the platinum agent is selected from cisplatin,
carboplatin, oxaliplatin, nedaplatin, triplatin tetranitrate, phenanthriplatin, picoplatin, or
satraplatin. In some embodiments, a patient has a cancer that has responded to platinum
induction therapy. In some embodiments, the cancer is platinum sensitive at the
commencement of treatment. In some embodiments, the cancer responded to the most recent
platinum-based chemotherapy regimen prior to cement of treatment. In some
embodiments, se to the most recent platinum-based chemotherapy regimen is a
complete response. In some embodiments, response to the most recent platinum-based
chemotherapy regimen is a partial response.
In some embodiments, a composition that delivers a PD-l-binding agent (e.g., an
anti-PD-l antibody) is administered in an amount that rs a dose of 1, 3 or 10 mg/kg PD-
ing agent. In some embodiments, a PD—l-binding agent (e.g., an anti-PD—l antibody)
is stered according to a regimen that delivers a dose of l, 3 or 10 mg/kg every two
weeks. In some embodiments, a PD-l-binding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that delivers a dose of l, 3 or 10 mg/kg every three
weeks. In some ments, a PD-l-binding agent (e.g., an anti—PD-l antibody) is
administered according to a n that delivers a dose of 1, 3 or 10 mg/kg every four
weeks.
] In some embodiments, a composition that delivers a PD-l-binding agent (e.g., an
anti-PD-l antibody) is administered in an amount that delivers a dose (e.g., a therapeutically
effective dose) within a range of about 100 mg to about 2,000 mg of PD—l-binding agent. In
some embodiments, a PD-l-binding agent (e.g., an anti-PD-l antibody) is administered at a
dose ranging from about 100 mg to about 1,200 mg, such as a therapeutically effective dose
that is about 100 mg, about 300 mg, about 500 mg, or about 1000 mg. In some embodiments,
a inding agent (e.g., an anti-PD-l antibody) is administered at a dose of about 400 mg,
about 500 mg, about 800 mg, and/or about 1000 mg of PD—l-binding agent. In some
embodiments, a dose of a particular PD-l binding agent is considered to be “a dose of about
[an indicated ]” if it achieves a relevant biological or pharmacological effect that is
able to that achieved with a dose of the indicated amount of a particular nce PD-
1 g agent (e.g., a particular anti-PD—l antibody, such as a particular anti-PD-l
monoclonal antibody or other anti-PD-l antibody agent including, for example, an anti-PD—l
antibody exemplified herein). In some embodiments, such a dose of the ular PD-l
g agent may be described as a dose “corresponding to” the indicated amount of the
reference PD-l binding agent.
In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that includes a plurality of individual doses (e.g., as set
forth above), separated from each other by a period of time. In some embodiments,
individual doses may be ted from each other by a period of two weeks, three weeks,
four weeks, five weeks, six weeks or more. In embodiments, the anti-PD-l antibody is
administered at the administration interval of once a week, once every 2 weeks, once every 3
weeks, once every 4 weeks, once every 5 weeks, or once every 6 weeks. In embodiments, the
administration interval is once every 3 weeks. In embodiments, the administration interval is
once every 6 weeks. In embodiments, the anti-PD-l antibody is administered for the period
of at least 2, 4, 6, 8, 10, 12, 14, 16, 18, or 20 weeks.
In some embodiments, a inding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 100 mg of PD-l-binding agent. In some embodiments, a PD—l-
binding agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a dose of 100 mg every two weeks. In some embodiments, a PD-l-binding agent
(e.g., an anti-PD-l antibody) is administered according to a regimen that delivers a dose of
100 mg every three weeks. In some embodiments, a PD—l-binding agent (e.g., an anti-PD—l
antibody) is administered ing to a n that delivers a dose of 100 mg every four
weeks. In some embodiments, a PD—l-binding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that delivers a dose of 100 mg every five weeks. In
some embodiments, a PD-l-binding agent (e.g., an anti-PD-l antibody) is administered at a
dose of 100 mg every six weeks.
] In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 300 mg of inding agent. In some embodiments, a PD—l-
binding agent (e.g., an anti—PD-l antibody) is administered according to a regimen that
delivers a dose of 300 mg every two weeks. In some ments, a PD-l-binding agent
(e.g., an anti-PD-l antibody) is administered according to a regimen that delivers a dose of
300 mg every three weeks. In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l
antibody) is stered according to a regimen that delivers a dose of 300 mg every four
weeks. In some embodiments, a PD-l-binding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that rs a dose of 300 mg every five weeks. In
some embodiments, a PD-l—binding agent (e.g., an anti-PD-l antibody) is administered at a
dose of 300 mg every six weeks.
In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 400 mg of PD-l-binding agent. In some embodiments, a PD—l-
g agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a dose of 400 mg every two weeks. In some embodiments, a PD-l-binding agent
(e.g., an anti-PD-l antibody) is administered according to a regimen that delivers a dose of
400 mg every three weeks. In some embodiments, a PD-l-binding agent (e.g., an anti-PD—l
antibody) is administered according to a regimen that delivers a dose of 400 mg every four
weeks. In some embodiments, a PD-l-binding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that delivers a dose of 400 mg every five weeks. In
some embodiments, a PD-l-binding agent (e.g., an anti—PD-l antibody) is administered at a
dose of 400 mg every six weeks.
In some embodiments, a PD-l-binding agent (e.g., an anti—PD-l dy) is
administered at a dose of 500 mg. In some embodiments, a PD-l-binding agent (e.g., an anti-
PD—l antibody) is administered according to a regimen that delivers a dose of 500 mg every
two weeks. In some embodiments, a PD-l-binding agent (e.g., an anti-PD—l antibody) is
stered according to a regimen that delivers a dose of 500 mg every three weeks. In
some embodiments, a PD-l-binding agent (e.g., an anti-PD—l antibody) is administered
according to a regimen that delivers a dose of 500 mg every four weeks. In some
ments, a inding agent (e.g., an anti-PD-l antibody) is stered according
to a regimen that rs a dose of 500 mg every five weeks. In some embodiments, a PD—l—
binding agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a dose of 500 mg every six weeks.
In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 600 mg. In some embodiments, a PD-l-binding agent (e.g., an
anti-PD-l antibody) is administered according to a regimen that delivers a dose of 600 mg
every two weeks. In some ments, a PD—l-binding agent (e.g., an anti-PD—l antibody)
is administered according to a regimen that delivers a dose of 600 mg every three weeks. In
some embodiments, a inding agent (e.g., an anti-PD-l antibody) is administered
according to a regimen that delivers a dose of 600 mg every four weeks. In some
embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is stered according
to a regimen that delivers a dose of 600 mg every five weeks. In some embodiments, a PD—l-
binding agent (e.g., an anti—PD-l antibody) is administered according to a regimen that
delivers a dose of 600 mg every six weeks.
In some embodiments, a PD-l-binding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 700 mg. In some embodiments, a PD—l-binding agent (e.g., an anti-
PD—l dy) is administered according to a regimen that delivers a dose of 700 mg every
four weeks. In some embodiments, a inding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that delivers a dose of 700 mg every five weeks. In
some ments, a PD-l-binding agent (e.g., an anti-PD—l antibody) is administered
according to a regimen that delivers a dose of 700 mg every six weeks. In some
embodiments, a PD-l-binding agent (e.g., an anti-PD—l antibody) is administered according
to a regimen that rs a dose of 700 mg every seven weeks. In some embodiments, a PD-
ing agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a dose of 700 mg every eight weeks.
In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 800 mg. In some embodiments, a inding agent (e.g., an anti-
PD—l antibody) is stered according to a regimen that delivers a dose of 800 mg every
four weeks. In some embodiments, a PD—l-binding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that delivers a dose of 800 mg every five weeks. In
some embodiments, a PD-l—binding agent (e.g., an anti-PD—l dy) is administered
according to a regimen that delivers a dose of 800 mg every six weeks. In some
embodiments, a PD—l—binding agent (e.g., an anti-PD-l antibody) is administered according
to a regimen that delivers a dose of 800 mg every eight weeks.
In some embodiments, a inding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 900 mg. In some embodiments, a PD-l-binding agent (e.g., an anti-
PD—l antibody) is stered according to a regimen that delivers a dose of 900 mg every
four weeks. In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered ing to a regimen that delivers a dose of 900 mg every five weeks. In
some embodiments, a PD-l—binding agent (e.g., an anti-PD-l antibody) is administered
according to a n that delivers a dose of 900 mg every six weeks. In some
embodiments, a PD—l-binding agent (e.g., an anti-PD-l dy) is administered according
to a regimen that delivers a dose of 900 mg every seven weeks. In some embodiments, a PD-
ing agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a dose of 900 mg every eight weeks.
In some embodiments, a PD-l-binding agent (e.g., an anti-PD-l antibody) is
administered at a dose of 1,000 mg. In some embodiments, a PD-l-binding agent (e.g., an
anti—PD-l antibody) is administered according to a regimen that delivers a dose of 1,000 mg
every four weeks. In some embodiments, a PD-l-binding agent (e.g., an anti-PD—l antibody)
is administered according to a regimen that delivers a dose of 1,000 mg every five weeks. In
some embodiments, a PD-l-binding agent (e.g., an anti-PD—l antibody) is administered
according to a regimen that delivers a dose of 1,000 mg every six weeks. In some
embodiments, a PD-l-binding agent (e.g., an anti-PD—l dy) is administered according
to a regimen that delivers a dose of 1,000 mg every seven weeks. In some embodiments, a
inding agent (e.g., an anti-PD—l antibody) is stered according to a regimen that
delivers a dose of 1,000 mg every eight weeks.
In some particular embodiments, a PD—l binding agent (e.g., an anti-PDl
antibody) is administered according to a regimen that comprises or consists of at least one
cycle of: a single dose (e.g., a single 400 mg dose or a single 500 mg dose) once every two
weeks, a single dose once every three weeks, a single dose once every four weeks, a single
dose once every five weeks, a single dose once every six weeks, etc. In some embodiments,
a cycle includes 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more single doses. In some embodiments, a
regimen includes a plurality of cycles. In some embodiments, individual cycles may be
separated from one another by a period of rest (i.e., no dosing).
] In embodiments, a PD-l inhibitor (e.g., any anti-PD-l antibody described )
is administered at a first dose of about 500 mg once every 3 weeks for 3, 4, or 5 cycles
followed by a second dose of about 1000 mg once every 6 weeks or more (e.g., a second dose
of about 1000 mg once every 6 . In embodiments, a PD-l inhibitor (e.g., any anti-PD—
1 antibody described herein) is administered at a first dose of about 500 mg once every 3
weeks for 3 cycles followed by a second dose of about 1000 mg once every 6 weeks or more
(e.g., a second dose of about 1000 mg once every 6 weeks). In embodiments, a PD-1
inhibitor (e.g., any anti-PD-l antibody described herein) is administered at a first dose of
about 500 mg once every 3 weeks for 4 cycles ed by a second dose of about 1000 mg
once every 6 weeks or more (e.g., a second dose of about 1000 mg once every 6 weeks). In
embodiments, a PD-1 inhibitor (e.g., any anti-PD-l antibody described herein) is
administered at a first dose of about 500 mg once every 3 weeks for 5 cycles followed by a
second dose of about 1000 mg once every 6 weeks or more (e.g., a second dose of about 1000
mg once every 6 weeks).
In some embodiments, stration of a dose may be achieved by
administration of a single unit dose composition (i.e., of a single composition that comprises
and/or delivers the nt dose amount). In some embodiments, administration of a dose
may be achieved by administration of a plurality of single unit dose compositions. In some
embodiments, administration of a dose may be achieved by administration of a portion of a
single unit dose composition.
In some embodiments, a PD—1-binding agent (e.g., an anti-PD-l antibody) is
stered according to a regimen that delivers a first dose of PD-l—binding agent once
every three weeks for the first 2-6 dosing cycles (e.g., the first 3, 4, or 5 dosing cycles), and
then delivers a second dose of a inding agent once every six weeks until disease
progression. In some embodiments, a inding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that delivers a first dose of a PD-l—binding agent once
every three weeks for the first 3, 4, or 5 dosing cycles, and then delivers a second dose of a
PD—l-binding agent once every six weeks or more until disease progression. In some
embodiments, a PDbinding agent (e.g., an anti-PD-l antibody) is administered according
to a n that rs a first dose of a PD-l—binding agent once every three weeks for the
first 3, 4, or 5 dosing cycles, and then delivers a second dose of a inding agent once
every six weeks or more until disease progression. In some embodiments the first andlor
second dose of a PD—l-binding agent (e.g., an anti-PD-l antibody) is about 100 mg to about
2,000 mg. In some embodiments the first dose and the second dose are the same. In some
embodiments, the first dose and the second dose are ent.
In some embodiments, a PD—l-binding agent (e.g., an anti—PD-l antibody) is
stered according to a regimen that comprises administering a 500 mg dose every 3
weeks for 3, 4, or 5 doses followed by administering at least one 1,000 mg dose every six
weeks after the third, fourth, or fifth 500 mg dose. In some ments, a PDbinding
agent (e.g., an D-1 dy) is administered according to a regimen that ses
administering a 500 mg dose every 3 weeks for 3 doses followed by administering at least
one 1,000 mg dose every six weeks or more after the third 500 mg dose. In some
embodiments, a PD—1-binding agent (e.g., an anti-PD—l antibody) is administered according
to a regimen that comprises administering a 500 mg dose every 3 weeks for 4 doses followed
by administering at least one 1,000 mg dose every six weeks or more after the fourth 500 mg
dose. In some embodiments, a PDbinding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that comprises administering a 500 mg dose every 3
weeks for 5 doses followed by administering at least one 1,000 mg dose every six weeks or
more after the fifth 500 mg dose. In some embodiments, additional 1,000 mg doses are
administered every six weeks or more after the first 1000 mg dose until no further clinical
benefit is achieved. In some ular embodiments, a PD-1 g agent (e.g., an anti-PDl
antibody) is administered according to a dosing regimen that includes 500 mg for 4 cycles
Q3W followed by 1000 mg Q6W.
In some embodiments, the a PD-l—binding agent (e.g., an anti-PD—l antibody) is
administered according to a regimen that comprises administering a 300 mg dose every 3
weeks for 3, 4, or 5 doses followed by administering at least one 800 mg or 1000 mg dose
every six weeks after the third, fourth, or fifth 300 mg dose. In some embodiments,
additional 800 mg or 1000 mg doses are administered every six weeks after the first 800 mg
or 1000 mg dose until no further clinical benefit is achieved. In some particular embodiments,
a PD-1 binding agent (e.g., an anti-PD1 dy) is administered according to a dosing
regimen that includes 300 mg for 4 cycles Q3W followed by 800 mg or 1000 mg Q6W.
In some embodiments, the a PD-l—binding agent (e.g., an D—l antibody) is
administered according to a regimen that comprises administering a 400 mg dose every 3
weeks for 3, 4, or 5 doses followed by administering at least one 800 mg or 1000 mg dose
every six weeks after the third, fourth, or fifth 400 mg dose. In some embodiments,
additional 800 mg or 1000 mg doses are administered every six weeks after the first 800 mg
or 1000 mg dose until no further clinical benefit is achieved. In some particular embodiments,
a PD-l g agent (e.g., an D1 antibody) is administered ing to a dosing
regimen that includes 400 mg for 4 cycles Q3W followed by 800 mg or 1000 mg Q6W.
] In some embodiments, the a PD-l—binding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that comprises administering a 600 mg dose every 3
weeks for 3, 4, or 5 doses followed by administering at least one 800 mg or 1000 mg dose
every six weeks after the third, fourth, or fifth 600 mg dose. In some embodiments,
additional 800 mg or 1000 mg doses are administered every six weeks after the first 800 mg
or 1000 mg dose until no further clinical benefit is achieved. In some particular embodiments,
a PD-l binding agent (e.g., an anti-PD1 dy) is administered according to a dosing
regimen that includes 600 mg for 4 cycles Q3W followed by 800 mg or 1000 mg Q6W.
In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that is demonstrated to achieve an average Cmax of PD-
1-binding agent in a patient population that is within 10 ug/mL to 500 ug/mL. In some
ments, the regimen is demonstrated to achieve an average Cmax of PD—1-binding agent
in a patient population that is about 20 ug/mL, about 65 ug/mL, or about 200 ug/mL. In
some ments, the regimen is demonstrated to achieve an average Cmax of inding
agent in a patient population that is about 140 ug/mL, about 180 ug/mL, about 200 ug/mL,
about 230 ug/mL, about 290 ug/mL. In ments, the administration of the anti-PD—l
antibody results in an average Cmax within 10 ug/mL to 500 ug/mL in the patient (e.g., an
average Cm of about 20 ug/mL, about 65 ug/mL, or about 200 ug/mL in the patient).
In some embodiments, a inding agent (e.g., an anti—PD-l antibody) is
administered according to a regimen that is demonstrated to achieve an average AUC0_336h of
PD—1-binding agent concentration-time curve in a patient tion that is within 2500
h*ug/mL to 50000 h*ug/mL. In some embodiments, the regimen is demonstrated to achieve
an average AUC0_336h of PD-l—binding agent concentration-time curve in a patient tion
that is about 3400 h*ug/mL, about 11000 h*ug/mL, or about 36800 h*ug/mL. In
ments, the administration of the anti-PD-l antibody results in an average AUC0_336h
within 2500 h*ug/mL to 50000 h*ug/mL in the patient (e.g., an average AUC0_336h is about
3400 h*ug/mL, about 11000 h*ug/mL, or about 36800 h*ug/mL).
In some embodiments, a PD—1-binding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that is demonstrated to achieve a peak serum
tration of a PDbinding agent within 0.5-3 hours after administration.
In some embodiments, a PD-l binding agent has a terminal half-life of
approximately 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, or 18 days. In some embodiments, a
PD—l binding agent has a terminal half—life of approximately 12 days.
In some embodiments, a inding agent (e.g., an anti-PD-l dy) is
administered intravenously. In some embodiments, a inding agent (e.g., an anti-PD—l
dy) is administered by intravenous infusion.
In some ments, a PD—1-binding agent (e.g., an D-l antibody) is
aseptically filled into a clear glass vial. In some ments, the glass vial is stoppered
with a chlorobutyl elastomer stopper laminated with fluoropolymer and sealed with an
aluminum overseal. In some embodiments, a PD-l-binding agent (e.g., an anti-PD—l
antibody) is stored at 2-8 °C. In some embodiments, a PD-l-binding agent (e.g., an anti-PD—l
dy) is free of preservatives.
In some embodiments, the patient is receiving or will receive an additional
therapy in combination with the inding agent. In some embodiments, the additional
therapy is surgery, radiotherapy, chemotherapy or immunotherapy. In some embodiments,
the additional therapy includes treatment with a composition that delivers a LAGbinding
agent (e.g., any bed in
of which is hereby incorporated by reference in its entirety) and/or a TIM-3 binding agent
(e.g., any described in
anti—TIM-3 antibody) can be administered at about 1, 3 or 10 mg/kg; a flat dose between
about 100 — 1500 mg; a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about
300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat
dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about
1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a
flat dose about 1400 mg; a flat dose about 1500 mg; about 1 mg/kg; about 3 mg/kg; or about
mg/kg. In some embodiments, the additional therapy is a PARP inhibitor. In some
embodiments, the PARP inhibitor is niraparib, olaparib, rucaparib, talazoparib, and veliparib.
In some ments, the present disclosure provides a method of administering
a PD-l-binding agent in combination with niraparib to a patient having a ent and/or
um sensitive cancer. In some embodiments, a recurrent and/or platinum sensitive
cancer is a head and neck , a lung cancer (e.g., a non-small cell lung cancer (NSCLC)),
a renal cancer, a r cancer, a melanoma, Merkel cell oma, a cervical cancer, a
vaginal cancer, a vulvar cancer, a uterine cancer, a endometrial cancer, an ovarian cancer, a
fallopian tube cancer, a breast cancer, a prostate cancer, a salivary gland tumor, a thymoma, a
cortical carcinoma, a esophageal cancer, a gastric cancer, a colorectal cancer, an
appendiceal cancer, a lial cell carcinoma, or a squamous cell carcinoma (e.g., of the
lung; of the anogenital region including anus, penis, cervix, vagina, or vulva; or of the
esophagus). In some certain embodiments, a recurrent and/or platinum sensitive cancer is an
anal cancer, a fallopian tube , an ovarian cancer, or a lung cancer. In some certain
embodiments, a recurrent and/or platinum sensitive cancer is an endometrial cancer, triple
negative breast cancer, ovarian cancer, non-small cell lung cancer ), squamous cell
carcinoma of the lung or squamous cell carcinoma of the ital region (e.g., squamous
cell carcinoma of the anus, penis, cervix, vagina, or vulva).
In some embodiments, niraparib is stered to a patient at a dose of 5 mg to
500 mg. In some embodiments, niraparib is administered according to a regimen that
comprises a once daily dose of 50 mg to 500 mg of niraparib. In some embodiments, a once
daily dose of niraparib comprises 100 mg to 300 mg. In some embodiments, a once daily
dose of niraparib comprises 100 mg, 200 mg, or 300 mg. In some embodiments, a once daily
dose of niraparib is administered .
In some embodiments, the method further comprises a step of reducing the
therapeutically effective dose of the anti-PD-l antibody and/or prolonging the administration
interval after achieving the clinical benefit.
The present disclosure provides, in some embodiments, s of ng cancer
comprising stering to a patient in need of treatment an anti-programmed death-l
protein (PD-l) antibody at a first dose at a first interval for a first period; administering to the
patient the anti-PD-l antibody at a second dose at a second interval for a second period;
wherein the anti-PD-l antibody comprises a heavy chain variable region comprising CDR
sequences of SEQ ID NOs: 9, 10, and 11 and a light chain variable region sing CDR
ces of SEQ ID NOs: l2, l3, and 14. In some embodiments, the first dose and the
second dose are different. In some embodiments, the first dose is 500 mg and the second
dose is 1000 mg. In embodiments, the first interval and the second interval are different. In
embodiments, the first interval is once every three weeks and the second interval is once
every six weeks. In embodiments, the anti-PD-l antibody is administered at the first dose
once every three weeks for the first period of 2—6 dosing cycles (e. g., the first 3, 4, or 5 dosing
cycles), and at the second dose once every six weeks until disease progression.
The present disclosure provides, in some embodiments, itions comprising
a PD-l-binding agent for use in treatment of cancer in a selected cancer patient population,
wherein the composition is administered according to a regimen demonstrated to achieve a
clinical benefit. In some embodiments, a PD-l-binding agent ses a heavy chain
variable region with one, two or three CDR sequences ed from SEQ ID NOs: 9, 10, and
11 and/or a light chain variable region with one, two or three CDR ces selected from
SEQ ID NOs: 12, 13, and 14. In some embodiments, a PD-l—binding agent comprises an
globulin heavy chain variable domain whose amino acid sequence comprises SEQ ID
NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain variable domain whose amino
acid sequence comprises SEQ ID NO: 2 or SEQ ID NO: 8. In some embodiments, a PD-l-
binding agent comprises an immunoglobulin heavy chain whose amino acid sequence
comprises SEQ ID NO: 3 and an immunoglobulin light chain whose amino acid sequence
comprises SEQ ID NO: 4.
In some ments, a clinical benefit is a complete se (“CR”), a partial
response (“PR”) or a stable disease (“SD”). In some embodiments, a clinical benefit
corresponds to at least SD. In some embodiments, a clinical benefit corresponds to at least a
PR. In some embodiments, a clinical benefit corresponds to a CR. In some embodiments, at
least 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%,
55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of patients achieve a clinical benefit. In
some embodiments, at least 5% of patients in a patient tion achieve a clinical benefit.
In some embodiments, at least 5% of patients in a patient population achieve SD. In some
embodiments, at least 5% of patients in a t population achieve at least a PR. In some
embodiments, at least 5% of patients achieve in a patient population CR. In some
embodiments, at least 20% of patients in a patient population e a clinical benefit. In
some embodiments, at least 20% of patients in a patient population achieve SD.
In some embodiments, the clinical benefit (e.g., SD, PR and/or CR) is determined
in accordance with Response Evaluation Criteria in Solid Tumors (RECIST). In some
embodiments, the clinical benefit (e.g., SD, PR and/or CR) is determined in accordance
RECIST guidelines. In some ments, the clinical benefit (e.g., SD, PR and/or CR) is
determined in accordance RECIST ines (version 1.1). In some embodiments, the
clinical benefit (e.g., SD, PR and/or CR) is determined in accordance immune-related
RECIST (irRECIST) guidelines.
The t disclosure es, in some ments, compositions sing
a PD-l-binding agent for use in treatment of cancer in a ed cancer patient population,
wherein the composition is administered according to a regimen demonstrated to achieve an
average PD-l receptor occupancy of at least 50% to 85% within 1 to 5 days of administration
of a single dose of the PD-l binding agent. In some embodiments, a PD-l-binding agent
comprises a heavy chain variable region with one, two or three CDR ces selected from
SEQ ID NOs: 9, 10, and 11 and/or a light chain variable region with one, two or three CDR
sequences ed from SEQ ID NOs: 12, 13, and 14. In some embodiments, a PD-l-
binding agent comprises an immunoglobulin heavy chain variable domain whose amino acid
sequence comprises SEQ ID NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain
variable domain whose amino acid ce comprises SEQ ID NO: 2 or SEQ ID NO: 8. In
some embodiments, a PD-l—binding agent comprises an immunoglobulin heavy chain whose
amino acid sequence comprises SEQ ID NO: 3 and an immunoglobulin light chain whose
amino acid sequence comprises SEQ ID NO: 4.
The present disclosure provides, in some embodiments, compositions comprising
a PD-l-binding agent for use in treatment of cancer in a selected cancer patient population,
wherein the ition is administered according to a regimen demonstrated to achieve an
average PD—l receptor occupancy of at least 75% over the first period of time (e.g., about 15
days to about 60 days; in some embodiments about 29 days). In some embodiments, a PD—l-
binding agent comprises an immunoglobulin heavy chain le domain whose amino acid
sequence comprises SEQ ID NO: 1 or SEQ ID NO: 7 and an immunoglobulin light chain
variable domain whose amino acid sequence comprises SEQ ID NO: 2 or SEQ ID NO: 8. In
some embodiments, a PD-l-binding agent comprises an immunoglobulin heavy chain whose
amino acid sequence comprises SEQ ID NO: 3 and an globulin light chain whose
amino acid sequence comprises SEQ ID NO: 4.
In some ments, the patients in the cancer patient population each have a
tumor. In some embodiments, the ts in the cancer patient tion each have a solid
tumor. In some embodiments, at least some of the patients in the cancer patient population
have an advanced stage solid tumor. In some embodiments, at least some of the patients in
the cancer patient population have a metastatic solid tumor. In some embodiments, the
t has a MSI—H solid tumor. In some embodiments, the patients in the cancer patient
population each have a cancer such as a head and neck cancer, a lung cancer (e.g., a non-
small cell lung cancer (NSCLC)), a renal cancer, a bladder cancer, a melanoma, Merkel cell
carcinoma, a cervical cancer, a vaginal , a vulvar cancer, a uterine cancer, a
trial cancer, an ovarian cancer, a fallopian tube cancer, a breast cancer, a prostate
, a salivary gland tumor, a thymoma, a adrenocortical carcinoma, a esophageal cancer,
a gastric cancer, a colorectal cancer, an appendiceal cancer, a lial cell carcinoma, or a
squamous cell carcinoma (e.g., of the lung; of the anogenital region including anus, penis,
cervix, vagina, or vulva; or of the esophagus). In some certain embodiments, the patients in
the cancer patient population each have a cancer such as an anal cancer, a fallopian tube
cancer, an ovarian cancer, or a lung cancer.. In some embodiments, the patients in the cancer
t population each have a cancer with microsatellite ility (e.g., MSI—H status). In
some embodiments, the microsatellite instability is MSI—Low. In some embodiments, the
microsatellite instability is microsatellite stable (e.g., MSS status). In some ments,
the patients in the cancer patient tion each have endometrial cancer. In some
embodiments, at least some of the patients in the cancer patient population have an
endometrial cancer with microsatellite instability or an endometrial cancer that is
microsatellite stable (MSS).
In some embodiments, the patients in the cancer t population each have a
hematological cancer. In some embodiments, the patients in the cancer patient population
each have a hematological cancer such as Diffuse large B cell ma (“DLBCL”),
Hodgkin’s lymphoma (“HL”), Non—Hodgkin’s lymphoma (“NHL”), Follicular lymphoma
(“FL”), acute myeloid leukemia (“AML”), acute lymphoblastic ia (“ALL”), or
Multiple myeloma (“MM”). In some embodiments, the patients in the cancer patient
population each have a hematological cancer with microsatellite instability.
In some embodiments, at least some of the patients in the cancer patient
population have previously been treated with one or more different cancer treatment
modalities. In some embodiments, at least some of the patients in the cancer patient
population have previously been d with one or more of surgery, radiotherapy,
chemotherapy or immunotherapy. In some embodiments, at least some of the patients in the
cancer t population have previously been treated with chemotherapy (e.g., platinum-
based chemotherapy).
In some embodiments, at least some of the patients in the cancer patient
population have not previously been treated with one or more ent cancer treatment
modalities.
BRIEF DESCRIPTION OF THE DRAWING
The Drawing included herein, which is composed of the following s, is for
ration purposes only not for limitation.
Figure 1 depicts a graphical representation of log-linear mean concentration
versus time profile following a single dose administration of an anti—PD-l antibody. Dots
represent a dose of 1 mg/kg, s represent a dose of 3 mg/kg and triangles represent a
dose of 10 mg/kg. The X-axis tes time from administration (in hours) and the y—axis
indicates the serum concentration of the anti-PD-l dy in ng/mL. Error bars ent i
standard deviation.
s 2A-2B depict graphical representations of near mean concentration
versus time profile following single dose administrations of an anti-PD-l antibody at
different dosages. (A) Dots represent a dose of 1 mg/kg, squares represent a dose of 3 mg/kg
and triangles represent a dose of 10 mg/kg. (B) Dots represent a dose of 500 mg and squares
represent a dose of 1000 mg. The x-axes indicates time from administration (in hours) and
the y-axes tes the serum concentration of the anti-PD-l antibody in ug/mL. Error bars
represent i standard deviation.
] Figure 3 depicts a graphical representation of dose and exposure relationship of
an exemplary anti-PD-l antibody. AUC0_336h1.(hr*ug/mL) was used as a model for exposure
and was observed to increase linearly with dosage of D-l antibody.
Figure 4 depicts a graphical representation of clearance and body weight
relationship. Body weight was not found to be a significant covariant for clearance of an
anti-PD-l antibody.
] Figures 5A-5B depicts results for receptor occupancy assays for 1, 3, and 10
mg/kg doses. Panel A depicts % PD—l receptor ncy in CD3+ cells. Panel B depicts
the IL-2 stimulation ratio.
Figures 6A-6D depicts results for receptor ncy assays for 500 mg Q3W
and 1000 mg Q6W doses. Panels A and C depict % PD-l receptor occupancy in CD3+ cells.
Panels B and D depict the IL—2 stimulation ratio.
Figures 7A-7B depict a summary of ent responses to an D-l
antibody. Panel A in Figure 7 depicts a Swimmer-Lane and panel B shows a Spider Plot of
treatment responses to the exemplary inding agent.
Figure 8 depicts the percent of PD-l receptor occupancy by an anti-PD—l
antibody as measured on circulating CD3+ T cells by flow cytometry prior to the first and
second 500 mg doses and again at the end of treatment.
DETAILED PTION OF CERTAIN EMBODIMENTS
Definitions
About: The term “about”, when used herein in reference to a value, refers to a
value that is similar, in context to the referenced value. In general, those skilled in the art,
familiar with the context, will appreciate the relevant degree of variance encompassed by
“about” in that context. For example, in some ments, the term “about” may
encompass a range of values that within 25%, 20%, 19%, 18%, 17%, 16%, 15%, 14%, 13%,
12%, 11%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, or less of the referred value.
Administration: As used herein, the term “administration” typically refers to the
administration of a composition to a subject or system to achieve delivery of an agent that is,
or is included in, the composition. Those of ordinary skill in the art will be aware of a variety
of routes that may, in appropriate circumstances, be utilized for administration to a subject,
for example a human. Examples of routes of administration include parenteral, e.g.,
enous, intradermal, subcutaneous, oral (e.g., inhalation), transdermal (i.e., topical),
transmucosal, and rectal administration. For example, in some embodiments, administration
may be ocular, oral, parenteral, topical, etc. In embodiments, administration is eral
(e.g., intravenous administration). In embodiments, intravenous administration is intravenous
infusion. In some particular embodiments, administration may be bronchial (e.g., by
bronchial instillation), , dermal (which may be or comprise, for example, one or more
of l to the , ermal, interdermal, transdermal, etc), l, intra-arterial,
intradermal, intragastric, intramedullary, intramuscular, intranasal, intraperitoneal,
intrathecal, intravenous, intraventricular, within a specific organ (e. g. intrahepatic), mucosal,
nasal, oral, rectal, subcutaneous, sublingual, topical, tracheal (e.g., by intratracheal
instillation), vaginal, vitreal, etc. In some embodiments, administration may involve only a
single dose. In some embodiments, administration may involve application of a fixed
number of doses. In some embodiments, administration may involve dosing that is
intermittent (e.g., a plurality of doses separated in time) and/or periodic (e.g., individual
doses separated by a common period of time) dosing. In some embodiments, administration
may involve continuous dosing (e.g., perfusion) for at least a selected period of time.
Solutions or suspensions used for parenteral, intradermal, or subcutaneous
application can include the following components: a sterile diluent such as water for
ion, saline solution, fixed oils, polyethylene glycols, glycerine, propylene glycol or
other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl parabens;
antioxidants such as ascorbic acid or sodium bisulfite; chelating agents such as
ethylenediaminetetraacetic acid (EDTA); s such as acetates, citrates or phosphates, and
agents for the adjustment of ty such as sodium chloride or dextrose. The pH can be
ed with acids or bases, such as hloric acid or sodium hydroxide. The parenteral
preparation can be enclosed in ampoules, disposable syringes or multiple dose vials made of
glass or plastic.
For administration by inhalation, the compounds are delivered in the form of an
l spray from pressured container or ser which contains a suitable propellant, e.g.,
a gas such as carbon dioxide, or a zer.
Systemic administration can also be by ucosal or transdermal means. For
transmucosal or transdermal administration, penetrants appropriate to the barrier to be
permeated are used in the formulation. Such penetrants are generally known in the art, and
e, for example, for transmucosal administration, detergents, bile salts, and fusidic acid
derivatives. Transmucosal stration can be accomplished through the use of nasal
sprays or suppositories. For ermal administration, the active compounds are
formulated into ointments, salves, gels, or creams as lly known in the art.
The nds can also be prepared in the form of suppositories (e.g., with
tional suppository bases such as cocoa butter and other glycerides) or retention
enemas for rectal delivery.
ty: As is known in the art, “affinity” is a measure of the ess with a
particular ligand binds to its partner. Affinities can be measured in different ways. In some
embodiments, affinity is measured by a quantitative assay. In some such embodiments,
binding partner concentration may be fixed to be in excess of ligand concentration so as to
mimic physiological conditions. Alternatively or additionally, in some embodiments, binding
partner concentration and/or ligand concentration may be varied. In some such embodiments,
affinity may be compared to a reference under comparable conditions (e.g., concentrations).
Antibody: As used , the term “antibody” refers to a polypeptide that
includes canonical immunoglobulin sequence elements ient to confer specific binding to
a particular target antigen. As is known in the art, intact antibodies as ed in nature are
approximately 150 kD tetrameric agents comprised of two identical heavy chain polypeptides
(about 50 kD each) and two cal light chain polypeptides (about 25 kD each) that
associate with each other into what is commonly referred to as a ped” structure. Each
heavy chain is comprised of at least four domains (each about 110 amino acids long)— an
amino-terminal variable (VH) domain (located at the tips of the Y structure), followed by
three constant s: CH1, CH2, and the carboxy-terminal CH3 (located at the base of the
Y’s stem). A short region, known as the “switch”, connects the heavy chain variable and
constant regions. The “hinge” connects CH2 and CH3 domains to the rest of the antibody.
Two disulfide bonds in this hinge region connect the two heavy chain polypeptides to one
another in an intact antibody. Each light chain is comprised of two domains — an amino-
terminal variable (VL) domain, followed by a carboxy-terminal constant (CL) domain,
separated from one another by another “switch”. Those skilled in the art are well familiar
with antibody structure and sequence elements, ize “variable” and “constant” regions
in provided sequences, and tand that there may be some flexibility in definition of a
“boundary” between such domains such that different presentations of the same antibody
chain sequence may, for example, indicate such a boundary at a location that is shifted one or
a few residues relative to a ent presentation of the same antibody chain sequence. Intact
antibody tetramers are comprised of two heavy chain-light chain dimers in which the heavy
and light chains are linked to one another by a single disulfide bond; two other disulfide
bonds connect the heavy chain hinge regions to one another, so that the dimers are connected
to one another and the tetramer is . Naturally-produced antibodies are also
ylated, typically on the CH2 domain. Each domain in a natural dy has a
structure characterized by an “immunoglobulin fold” formed from two beta sheets (e.g., 3—, 4-
or 5-stranded sheets) packed against each other in a compressed
, antiparallel beta .
Each variable domain contains three hypervariable loops known as “complement determining
regions” (CDRl, CDR2, and CDR3) and four somewhat invariant “framework” regions
(FRI, FR2, FR3, and FR4). When natural antibodies fold, the FR regions form the beta
sheets that provide the structural framework for the domains, and the CDR loop regions from
both the heavy and light chains are brought together in three-dimensional space so that they
create a single hypervariable antigen binding site located at the tip of the Y structure. The Fc
region of naturally—occurring antibodies binds to elements of the ment system, and
also to ors on effector cells, including for example effector cells that mediate
cytotoxicity. As is known in the art, affinity and/or other binding utes of Fc regions for
Fc receptors can be modulated through glycosylation or other modification. In some
embodiments, antibodies produced and/or utilized in accordance with the present invention
include glycosylated Fc domains, including Fc domains with modified or engineered such
glycosylation. For purposes of the present invention, in certain ments, any polypeptide
or complex of polypeptides that includes sufficient globulin domain sequences as
found in natural antibodies can be referred to and/or used as an “antibody”, r such
polypeptide is naturally produced (e.g., generated by an sm reacting to an antigen), or
produced by recombinant engineering, chemical synthesis, or other artificial system or
ology. In some ments, an antibody is polyclonal; in some embodiments, an
antibody is monoclonal. In some embodiments, an antibody has constant region sequences
that are characteristic of mouse, rabbit, primate, or human antibodies. In some embodiments,
antibody sequence elements are humanized, primatized, chimeric, etc, as is known in the art.
Moreover, the term “antibody” as used , can refer in appropriate embodiments (unless
otherwise stated or clear from context) to any of the art-known or developed constructs or
formats for utilizing antibody structural and functional features in alternative presentation.
For e, embodiments, an antibody utilized in accordance with the present invention is
in a format selected from, but not limited to, intact IgA, IgG, IgE or IgM antibodies; bi— or
multi- specific antibodies (e.g., Zybodies®, etc); antibody fragments such as Fab fragments,
Fab’ fragments, F(ab’)2 fragments, Fd’ fragments, Fd fragments, and isolated CDRs or sets
thereof; single chain Fvs; polypeptide-Fc fusions; single domain antibodies (e.g., shark
single domain antibodies such as IgNAR or nts thereof); cameloid antibodies; masked
antibodies (e.g., Probodies®); §mall Modular Immuntharmaceuticals (“SMIPsTM”); single
chain or Tandem diabodies b®); VHHs; Anticalins®; Nanobodies® minibodies;
BiTE®s; ankyrin repeat proteins or DARPINs®; Avimers®; DARTs; TCR-like antibodies;,
Adnectins®; Affilins®; Trans-bodies®; Affibodies®; TrimerX®; MicroProteins;
Fynomers®, Centyrins®; and KALBITOR®s. In some embodiments, an antibody may lack
a covalent modification (e.g., attachment of a glycan) that it would have if produced
lly. In some embodiments, an dy may contain a covalent modification (e.g.,
attachment of a glycan, a payload [e.g., a detectable moiety, a therapeutic moiety, a catalytic
moiety, etc], or other pendant group [e.g., poly-ethylene glycol, etc.].
Antibodies include antibody fragments. Antibodies also include, but are not
limited to, polyclonal monoclonal, chimeric dAb n antibody), single chain, Fab, Fab’,
Fwy fragments, scFvs, and Fab expression libraries. An antibody may be a whole antibody,
or immunoglobulin, or an antibody fragment.
Antibody agent: As used herein, the term “antibody agent” refers to an agent that
ically binds to a particular antigen. In some embodiments, the term encompasses any
polypeptide or polypeptide complex that es globulin structural elements
sufficient to confer specific binding. Exemplary antibody agents include, but are not limited
to monoclonal antibodies or polyclonal antibodies. In some embodiments, an antibody agent
may include one or more constant region sequences that are characteristic of mouse, rabbit,
primate, or human antibodies. In some embodiments, an antibody agent may e one or
more sequence elements are humanized, primatized, chimeric, etc, as is known in the art. In
many ments, the term “antibody agent” is used to refer to one or more of the art-
known or developed constructs or formats for utilizing antibody structural and functional
features in alternative presentation. For example, embodiments, an antibody agent ed in
accordance with the present invention is in a format selected from, but not limited to, intact
IgA, IgG, IgE or IgM antibodies; bi— or multi— ic antibodies (e.g., es®, etc);
antibody nts such as Fab fragments, Fab’ fragments, F(ab’)2 nts, Fd’
fragments, Fd fragments, and isolated CDRs or sets thereof; single chain Fvs; polypeptide—Fc
fusions; single domain antibodies (e.g., shark single domain antibodies such as IgNAR or
fragments thereof); id antibodies; masked dies (e.g., Probodies®); §mall
r Immuntharmaceuticals (“SMIPsTM”); single chain or Tandem diabodies
(TandAb®); VHHs; Anticalins®; Nanobodies® minibodies; BiTE®s; n repeat proteins
or DARPINs®; Avimers®; DARTs; TCR-like antibodies;, Adnectins®; Affilins®; Trans-
bodies®; Affibodies®; X®; MicroProteins; Fynomers®, Centyrins®; and
KALBITOR®s. In some embodiments, an antibody may lack a covalent modification (e.g.,
attachment of a ) that it would have if produced naturally. In some embodiments, an
antibody may contain a covalent modification (e.g., attachment of a glycan, a payload [e.g., a
detectable moiety, a therapeutic moiety, a tic moiety, etc], or other pendant group [e.g.,
poly-ethylene glycol, etc.]. In many embodiments, an antibody agent is or comprises a
polypeptide whose amino acid sequence includes one or more structural elements ized
by those skilled in the art as a complementarity determining region (CDR); in some
ments an antibody agent is or comprises a polypeptide whose amino acid sequence
includes at least one CDR (e.g., at least one heavy chain CDR and/or at least one light chain
CDR) that is ntially identical to one found in a reference antibody. In some
embodiments an included CDR is substantially identical to a reference CDR in that it is either
identical in sequence or ns between 1-5 amino acid substitutions as ed with the
reference CDR. In some embodiments an included CDR is substantially identical to a
reference CDR in that it shows at least 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%,
94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity with the reference CDR. In
some embodiments an included CDR is substantially identical to a reference CDR in that it
shows at least 96%, 96%, 97%, 98%, 99%, or 100% sequence identity with the reference
CDR. In some embodiments an included CDR is substantially identical to a reference CDR
in that at least one amino acid within the included CDR is deleted, added, or substituted as
compared with the reference CDR but the included CDR has an amino acid sequence that is
otherwise identical with that of the reference CDR. In some embodiments an included CDR
is substantially identical to a reference CDR in that 1-5 amino acids within the included CDR
are deleted, added, or substituted as compared with the reference CDR but the included CDR
has an amino acid sequence that is otherwise identical to the nce CDR. In some
embodiments an included CDR is substantially identical to a nce CDR in that at least
one amino acid within the included CDR is substituted as compared with the reference CDR
but the included CDR has an amino acid sequence that is otherwise identical with that of the
reference CDR. In some embodiments an included CDR is substantially identical to a
reference CDR in that 1-5 amino acids within the included CDR are deleted, added, or
substituted as ed with the reference CDR but the included CDR has an amino acid
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ce that is otherwise identical to the reference CDR. In some embodiments, an antibody
agent is or ses a polypeptide whose amino acid sequence includes structural ts
recognized by those d in the art as an immunoglobulin variable domain. In some
embodiments, an antibody agent is a polypeptide protein having a binding domain which is
homologous or largely homologous to an immunoglobulin-binding domain.
Binding: It will be tood that the term “binding”, as used herein, typically
refers to a non-covalent association between or among two or more entities. “Direct” binding
involves physical contact n entities or moieties; indirect binding involves physical
ction by way of physical contact with one or more intermediate entities. Binding
between two or more entities can typically be assessed in any of a variety of contexts —
including where interacting entities or es are d in isolation or in the context of
more complex s (e.g., while covalently or otherwise associated with a carrier entity
and/or in a biological system or cell). In some embodiments, “binding” refers to the non-
covalent interactions of the type which occur between an immunoglobulin molecule and an
antigen for which the immunoglobulin is specific. The strength, or affinity of immunological
binding interactions can be expressed in terms of the iation constant (Kd) of the
ction, wherein a smaller Kd represents a greater affinity. Immunological binding
properties of selected polypeptides can be quantified using methods well known in the art.
One such method entails measuring the rates of antigen-binding site/antigen complex
formation and dissociation, wherein those rates depend on the concentrations of the complex
partners, the affinity of the interaction, and geometric ters that equally influence the
rate in both directions. Thus, both the “on rate constant” (Ken) and the “off rate constant”
(Koff) can be determined by calculation of the concentrations and the actual rates of
association and dissociation. (See Nature 6-87 ). The ratio of Koff IKO,1 enables
the cancellation of all parameters not related to affinity, and is equal to the dissociation
constant Kd. (See, generally, Davies et al. (1990) Annual Rev Biochem 59:439-473).
Binding agent: In general, the term “binding agent” is used herein to refer to any
entity that binds to a target of interest as described herein. In many embodiments, a binding
agent of interest is one that binds specifically with its target in that it discriminates its target
from other potential binding partners in a particular interaction context. In general, a binding
agent may be or comprise an entity of any chemical class (e.g., polymer, non-polymer, small
molecule, polypeptide, carbohydrate, lipid, nucleic acid, etc). In some embodiments, a
binding agent is a single chemical entity. In some embodiments, a binding agent is a
complex of two or more discrete chemical es associated with one another under relevant
conditions by non—covalent interactions. For example, those skilled in the art will appreciate
that in some embodiments, a binding agent may se a ic” binding moiety (e.g.,
one of biotin/avidin/streptaviding and/or a class-specific antibody) and a “specific” binding
moiety (e.g., an dy or aptamers with a ular molecular target) that is linked to the
partner of the generic biding moiety. In some embodiments, such an approach can permit
modular assembly of multiple binding agents through linkage of different specific binding
moieties with the same generic binding moiety r. In some embodiments, binding
agents are or comprise polypeptides (including, e.g., antibodies or antibody fragments). In
some embodiments, g agents are or comprise small molecules. In some embodiments,
g agents are or comprise nucleic acids. In some embodiments, binding agents are
aptamers. In some embodiments, binding agents are polymers; in some embodiments,
binding agents are not polymers. In some embodiments, binding agents are non-polymeric in
that they lack polymeric moieties. In some embodiments, binding agents are or comprise
carbohydrates. In some embodiments, binding agents are or comprise lectins. In some
embodiments, binding agents are or comprise peptidomimetics. In some embodiments,
binding agents are or comprise scaffold proteins. In some embodiments, binding agents are
or comprise mimeotopes. In some embodiments, binding agents are or se nucleic
acids, such as DNA or RNA.
: The terms “cancer”, “malignancy”, “neoplasm”, “tumor”, and
“carcinoma”, are used herein to refer to cells that exhibit vely abnormal, uncontrolled,
and/or autonomous growth, so that they exhibit an aberrant growth phenotype characterized
by a significant loss of control of cell proliferation. In some embodiments, a tumor may be or
comprise cells that are cerous (e.g., benign), ant, pre-metastatic, metastatic,
and/or non-metastatic. The present disclosure specifically identifies certain cancers to which
its teachings may be particularly relevant. In some embodiments, a relevant cancer may be
characterized by a solid tumor (e.g., a metastatic solid tumor or an ed solid . In
some embodiments, a relevant cancer may be characterized by a hematologic tumor. In
general, examples of ent types of cancers known in the art include, for example,
hematopoietic cancers including leukemias, lymphomas (Hodgkin’s and dgkin’s),
myelomas and myeloproliferative disorders; sarcomas, melanomas, adenomas, carcinomas of
solid tissue, squamous cell carcinomas of the mouth, throat, larynx, and lung, liver cancer,
genitourinary cancers such as prostate, cervical, bladder, uterine, and endometrial cancer and
renal cell carcinomas, bone cancer, pancreatic cancer, skin cancer, cutaneous or intraocular
melanoma, cancer of the endocrine system, cancer of the thyroid gland, cancer of the
parathyroid gland, head and neck cancers, breast cancer, gastro—intestinal cancers and nervous
system cancers, benign lesions such as papillomas, and the like.
Carrier: as used herein, refers to a t, adjuvant, excipient, or vehicle with
which a composition is administered. In some exemplary embodiments, carriers can e
sterile liquids, such as, for example, water and oils, including oils of petroleum, animal,
vegetable or synthetic origin, such as, for example, peanut oil, n oil, mineral oil,
sesame oil and the like. In some embodiments, carriers are or include one or more solid
components. In some embodiments, the carrier can be a solvent or dispersion medium
containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and
liquid polyethylene glycol, and the like), and suitable es thereof. The proper fluidity
can be maintained, for example, by the use of a coating such as lecithin, by the maintenance
of the required particle size in the case of dispersion and by the use of surfactants. Prevention
of the action of microorganisms can be achieved by various cterial and antifungal
agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like.
In many cases, it will be preferable to include isotonic , for example, ,
polyalcohols such as manitol, sorbitol, sodium chloride in the composition. Prolonged
tion of the injectable compositions can be brought about by including in the
composition an agent which delays absorption, for example, um monostearate and
gelatin.
ation therapy: As used herein, the term “combination therapy” refers to a
clinical intervention in which a subject is simultaneously exposed to two or more therapeutic
regimens (e.g., two or more therapeutic agents). In some embodiments, the two or more
eutic regimens may be administered simultaneously. In some embodiments, the two or
more therapeutic ns may be stered sequentially (e. g., a first regimen
administered prior to administration of any doses of a second regimen). In some
embodiments, the two or more therapeutic regimens are administered in overlapping dosing
regimens. In some embodiments, administration of combination therapy may involve
administration of one or more therapeutic agents or modalities to a subject receiving the other
agent(s) or modality. In some embodiments, combination y does not necessarily
require that individual agents be administered together in a single composition (or even
necessarily at the same time). In some embodiments, two or more therapeutic agents or
modalities of a combination therapy are administered to a subject separately, e. g., in separate
compositions, via separate administration routes (e.g., one agent orally and another agent
intravenously), and/or at different time points. In some embodiments, two or more
therapeutic agents may be administered together in a combination composition, or even in a
combination compound (e.g., as part of a single chemical x or nt entity), via the
same administration route, and/or at the same time.
Complete Response: As used , the term “complete response” or “CR” is
used to mean the disappearance of all or substantially all target lesions. In some
embodiments, CR refers to an about 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%,
97%, 98%, 99% or 100% decrease in the sum of the diameters of the target lesions (i.e., loss
of lesions), taking as nce the baseline sum ers. In some embodiments, CR
indicates that less than about 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1% or less of the total
lesion diameter remains after treatment. Exemplary s for evaluating complete
response are identified by RECIST guidelines. See, e.g., E.A. Eisenhauer, et al., “New
response evaluation criteria in solid tumors: d RECIST guideline (version 1.1.),” Eur.
J. of Cancer, 45: 228-247 (2009).
Dosageform or unit dosage form: Those skilled in the art will appreciate that the
term “dosage form” may be used to refer to a physically discrete unit of an active agent (e.g.,
a therapeutic or diagnostic agent) for administration to a subject. Typically, each such unit
contains a ermined quantity of active agent. In some embodiments, such quantity is a
unit dosage amount (or a whole fraction f) appropriate for administration in accordance
with a dosing regimen that has been determined to correlate with a desired or beneficial
outcome when administered to a relevant population (i.e., with a therapeutic dosing regimen).
Those of ordinary skill in the art appreciate that the total amount of a therapeutic composition
or agent administered to a particular subject is determined by one or more attending
physicians and may involve administration of multiple dosage forms.
Dosing regimen or regimen: Those skilled in the art will appreciate that the term
“regimen” may be used to refer to a set of unit doses (typically more than one) that are
administered individually to a subject, typically separated by periods of time. In some
embodiments, a given therapeutic agent has a recommended dosing regimen, which may
involve one or more doses. In some ments, a dosing regimen comprises a plurality of
doses each of which is separated in time from other doses. In some embodiments, individual
doses are separated from one another by a time period of the same length; in some
ments, a dosing regimen comprises a plurality of doses and at least two ent time
s separating individual doses. In some embodiments, all doses within a dosing regimen
are of the same unit dose amount. In some embodiments, different doses within a dosing
regimen are of ent amounts. In some embodiments, a dosing regimen comprises a first
dose in a first dose amount, followed by one or more additional doses in a second dose
amount different from the first dose amount. In some embodiments, a dosing regimen
comprises a first dose in a first dose amount, followed by one or more additional doses in a
second dose amount same as the first dose amount In some embodiments, a dosing regimen is
correlated with a desired or beneficial outcome when administered across a relevant
population (i.e., is a eutic dosing regimen). In some embodiments, a regimen comprises
at least one dose, wherein the dose comprises one unit dose of a therapeutic agent (e.g., a PD-
l—binding agent). In some embodiments, a regimen comprises at least one dose, wherein the
dose comprises two or more unit doses of a therapeutic agent. For example, a dose of 500 mg
can be administered as a single 500 mg unit dose or as two 250 mg unit doses. In some
embodiments, a regimen is correlated with or result in a desired or beneficial outcome when
administered across a relevant population (i.e., is a therapeutic regimen).
Hazard Ratio: As used herein, a “hazard ratio” is the expression of the hazard or
chance of events occurring in the treatment arm as a ratio of the events occurring in the
control arm. Hazard ratios may be determined by the Cox model, a regression method for
survival data, which provides an estimate of the hazard ratio and its confidence interval. The
hazard ratio is an estimate of the ratio of the hazard rate in the treated versus the control
group. The hazard rate is the probability that if the event in question has not already occurred,
it will occur in the next time interval, divided by the length of that interval. An assumption of
proportional hazards regression is that the hazard ratio is constant over time.
Homology: As used , the term “homology” refers to the l relatedness
n polymeric les, e.g., n nucleic acid les (e.g., DNA molecules
and/or RNA molecules) and/or between ptide molecules. In some embodiments,
polymeric molecules are considered to be “homologous” to one another if their ces are
at least 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%,
95%, or 99% identical. In some embodiments, polymeric molecules are considered to be
“homologous” to one another if their ces are at least 25%, 30%, 35%, 40%, 45 %, 50%,
55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or 99% similar (e.g., containing residues
with related chemical properties at corresponding positions). For e, as is well known
by those of ordinary skill in the art, certain amino acids are typically classified as r to
one another as “hydrophobic” or “hydrophilic”amino acids, and/or as having “polar” or “non—
polar” side chains. Substitution of one amino acid for another of the same type may often be
considered a “homologous” substitution.
As will be understood by those skilled in the art, a y of algorithms are
available that permit comparison of sequences in order to determine their degree of
homology, including by permitting gaps of designated length in one ce relative to
another when considering which residues “correspond” to one another in different sequences.
Calculation of the percent homology between two nucleic acid sequences, for example, can
be performed by aligning the two sequences for optimal comparison purposes (e.g., gaps can
be introduced in one or both of a first and a second nucleic acid sequences for optimal
alignment and non-corresponding sequences can be arded for comparison purposes). In
certain embodiments, the length of a sequence aligned for comparison purposes is at least
%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least
95%, or substantially 100% of the length of the reference ce. The nucleotides at
corresponding nucleotide positions are then compared. When a position in the first sequence
is occupied by the same nucleotide as the corresponding position in the second sequence,
then the molecules are identical at that position; when a position in the first sequence is
occupied by a similar nucleotide as the corresponding position in the second sequence, then
the molecules are similar at that position. The percent homology between the two sequences
is a function of the number of identical and r positions shared by the sequences, taking
into account the number of gaps, and the length of each gap, which needs to be introduced for
l alignment of the two sequences. Representative algorithms and computer programs
useful in ining the percent homology n two nucleotide sequences include, for
example, the algorithm of Meyers and Miller (CABIOS, 1989, 4: 11-17), which has been
incorporated into the ALIGN m (version 2.0) using a PAM120 weight residue table, a
gap length penalty of 12 and a gap penalty of 4. The percent homology between two
nucleotide sequences can, alternatively, be determined for example using the GAP program
in the GCG software package using an NWSgapdna.CMP matrix
KB: as used , refers to the iation constant of a binding agent (e.g., an
antibody or binding component thereof) from a complex with its r (e.g., the e to
which the antibody or binding component thereof binds).
Kgf: as used herein, refers to the off rate constant for dissociation of a binding
agent (e.g., an antibody or binding component thereof) from a complex with its partner (e.g.,
the epitope to which the antibody or binding component thereof binds).
K0,... as used herein, refers to the on rate constant for association of a binding agent
(e.g., an antibody or binding component thereof) with its partner (e.g., the epitope to which
the dy or binding component thereof binds).
Niraparib: As used herein, the term “niraparib” includes any of the free base
compound ((3S)[4-{7-(aminocarbonyl)-2H—indazolyl}phenyl]piperidine), a salt form,
including pharmaceutically acceptable salts, of -[4-{7-(aminocarbonyl)-2H-indazol-2—
yl}phenyl]piperidine (e.g., (3S)[4-{7-(aminocarbonyl)-2H-indazolyl}phenyl]piperidine
tosylate), or a solvated or hydrated form thereof (e.g., (3S)—3-[4-{7—(aminocarbonyl)—2H-
indazolyl}phenyl]piperidine te drate). In some embodiments, such forms
may be individually referred to as arib free base”, “niraparib tosylate” and “niraparib
tosylate monohydrate”, respectively. Unless otherwise specified, the term “niraparib”
includes all forms of the compound (3S)[4-{7-(aminocarbonyl)-2H-indazol
yl } phenyl]piperidine.
Patient or subject: As used herein, the term nt” or “subject” refers to any
organism to which provided compound or nds described herein are administered in
accordance with the present invention e.g., for experimental, diagnostic, prophylactic, and/or
therapeutic purposes. Typical ts include animals. The term “animal” refers to any
member of the animal m. In some ments, “animal” refers to humans, at any stage
of development. In some embodiments, “animal” refers to non-human animals, at any stage of
development. In n embodiments, the non-human animal is a mammal (e.g., a rodent, a
mouse, a rat, a rabbit, a monkey, a dog, a cat, a sheep, , a primate, and/or a pig). In some
embodiments, animals include, but are not limited to, mammals, birds, reptiles, amphibians, fish,
insects, andj'or worms. In some embodiments, an animal may be a transgenic animal, genetically-
engineered animal, and/or a clone. In embodiments, animals are e.g., mammals such as mice,
rats, rabbits, non-human primates, and humans; insects; worms; etc. In some embodiments, a
subject is a human. In some embodiments, a subject may be suffering from, and/or
susceptible to a disease, disorder, andlor condition (e. g., cancer). As used herein, a “patient
population” or ation of subjects” refers to a ity of patients or subjects.
Partial se: As used herein, the term “partial se” (“PR”) refers to a
decrease in tumor progression in a subject as indicated by a decrease in the sum of the
diameters of the target lesions, taking as reference the baseline sum diameters. In some
embodiments, PR refers to at least a 30% decrease in the sum of diameters or target lesions,
taking as reference the baseline sum diameters. Exemplary methods for evaluating partial
response are identified by RECIST guidelines. See e.g, E.A. Eisenhauer, et al., “New
response evaluation criteria in solid : Revised RECIST guideline (version 11),” Eur.
J. of Cancer, 45: 228-247 (2009).
Pharmaceutical composition: As used , the term “pharmaceutical
composition” refers to a ition in which an active agent (e.g., a PD-l-binding agent) is
formulated together with one or more pharmaceutically acceptable rs. In some
embodiments, the active agent is present in unit dose amount appropriate for administration
in a therapeutic regimen that shows a statistically significant probability of achieving a
predetermined therapeutic effect when administered to a nt population. In some
embodiments, a pharmaceutical composition may be specially formulated for administration
in solid or liquid form, including those adapted for the following: oral administration, for
example, drenches us or non—aqueous solutions or suspensions), tablets, e.g., those
targeted for , sublingual, and systemic absorption, s, powders, granules, pastes
for application to the tongue; parenteral administration, for example, by subcutaneous,
intramuscular, enous or epidural injection as, for e, a sterile on or
suspension, or sustained-release formulation; topical application, for example, as a cream,
ointment, or a controlled-release patch or spray applied to the skin, lungs, or oral ;
intravaginally or intrarectally, for example, as a pessary, cream, or foam; sublingually;
ocularly; transdermally; or nasally, pulmonary, and to other mucosal surfaces. In some
embodiments, an active agent (e.g., a PD-l-binding agent) is ated for parenteral
administration.
Pharmaceutically acceptable: As used herein, the term “pharmaceutically
acceptable” applied to the carrier, diluent, or ent used to formulate a composition as
disclosed herein means that the r, diluent, or excipient must be compatible with the
other ingredients of the composition and not deleterious to the recipient thereof.
Progression Free Survival: As used herein, the term “progression free survival”
means the time period for which a subject having a disease (e. g., cancer) survives, without a
significant worsening of the disease state. Progression free survival may be assessed as a
period of time in which there is no progression of tumor growth and/or wherein the disease
status of a patient is not determined to be a progressive disease. In some embodiments,
progression free survival of a subject having cancer is assessed by evaluating tumor n)
size, tumor (lesion) number, and/or metastasis.
Progression or Progressive Disease: The term “progression” of tumor growth or
a “progressive disease” (“PD”) as used herein in reference to cancer status tes an
increase in the sum of the diameters of the target lesions (tumors). In some embodiments,
progression of tumor growth refers to at least a 20% increase in the sum of diameters of
target lesions, taking as reference the smallest sum on study (this includes the baseline sum if
that is the st on study). In some embodiments, in addition to a relative increase of 20%,
the sum of diameters of target lesions must also demonstrate an absolute increase of at least 5
mm. An appearance of one or more new lesions may also be factored into the determination
of progression of tumor growth. ssion for the purposes of determining progression free
survival may also be determined if at least one of the following criteria is met: 1) tumor
assessment by CT/MRI unequivocally shows progressive disease according to RECIST 1.1
or irRECIST criteria; or 2) additional diagnostic tests (e.g., histology/cytology, ultrasound
ques, endoscopy, positron on tomography) identify new lesions or determine
existing lesions qualify for vocal progressive disease AND CA-l25— progression
according to Gynecologic Cancer Intergroup (GCIG)-criteria (see Rustin et al., Int J Gynecol
Cancer 2011;21: 419-423 which is incorporated herein in its entirety); 3) definitive clinical
signs and symptoms of PD unrelated to non-malignant or iatrogenic causes ([i] intractable
cancer-related pain; [ii] ant bowel obstruction/worsening dysfunction; or [iii]
unequivocal symptomatic worsening of ascites or pleural effusion) AND CA-l25—progression
according to GCIG—criteria.
Solid Tumor: As used herein, the term “solid tumor” refers to an abnormal mass
of tissue that usually does not contain cysts or liquid areas. In some embodiments, a solid
tumor may be ; in some embodiments, a solid tumor may be malignant. Those skilled
in the art will appreciate that different types of solid tumors are typically named for the type
of cells that form them. Examples of solid tumors are carcinomas, lymphomas, and sarcomas.
In some embodiments, solid tumors may be or comprise adrenal, bile duct, bladder, bone,
brain, breast, , colon, endometrium, esophagum, eye, gall bladder, gastrointestinal tract,
kidney, larynx, liver, lung, nasal cavity, nasopharynx, oral cavity, ovary, penis, pituitary,
te, retina, salivary gland, skin, small intestine, stomach, testis, thymus, thyroid, uterine,
vaginal, and/or vulval tumors.
] Stabilization 0r Stable e: As used herein, lization” of tumor growth
or a “stable disease” (“SD”) refers to r sufficient age to qualify for PR nor
sufficient increase to qualify for PD. In some embodiments, stabilization refers to a less than
%, 25%, 20%, 15%, 10% or 5% change (increase or decrease) in the sum of the diameters
of the target lesions, taking as reference the baseline sum diameters. ary methods for
evaluating ization of tumor growth or a stable disease are identified by RECIST
guidelines. See e.g., E.A. Eisenhauer, et al., “New response evaluation criteria in solid
tumors: Revised RECIST guideline (version 1.1),” Eur. J. of Cancer, 45: 228-247 (2009).
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Therapeutically Effective Amount: As used herein, is meant an amount that
produces the desired effect for which it is administered. In some embodiments, the term
refers to an amount that is sufficient, when administered to a population suffering from or
susceptible to a disease, disorder, and/or condition in accordance with a therapeutic dosing
regimen, to treat the disease, disorder, and/or condition. In some embodiments, a
eutically effective amount is one that s the incidence and/or severity of, and/or
delays onset of, one or more symptoms of the disease, disorder, and/or condition. Those of
ordinary skill in the art will appreciate that the term “therapeutically eflective amount” does
not in fact require successful treatment be achieved in a particular individual. Rather, a
therapeutically ive amount may be that amount that provides a particular desired
cological response in a significant number of ts when administered to ts
in need of such treatment. In some ments, reference to a therapeutically effective
amount may be a reference to an amount as measured in one or more specific tissues (e. g., a
tissue affected by the disease, disorder or condition) or fluids (e.g., blood, saliva, serum,
sweat, tears, urine, etc.). Those of ordinary skill in the art will appreciate that, in some
embodiments, a therapeutically effective amount of a ular agent or therapy may be
formulated and/or administered in a single dose. In some embodiments, a therapeutically
ive agent may be formulated and/or administered in a plurality of doses, for example, as
part of a dosing regimen.
Treatment: As used herein, the term “treatment” (also “treat” or “treating”) refers
to any administration of a therapy that partially or completely alleviates, ameliorates, relives,
inhibits, delays onset of, reduces severity of, and/or reduces incidence of one or more
symptoms, features, and/or causes of a particular disease, disorder, and/or condition. In some
embodiments, such treatment may be of a subject who does not exhibit signs of the relevant
disease, disorder and/or ion and/or of a subject who exhibits only early signs of the
disease, disorder, and/or condition. Alternatively or additionally, such treatment may be of a
subject who exhibits one or more established signs of the relevant disease, er and/or
ion. In some embodiments, treatment may be of a subject who has been sed as
suffering from the relevant disease, disorder, and/or condition. In some embodiments,
ent may be of a subject known to have one or more susceptibility factors that are
statistically correlated with increased risk of development of the relevant disease, disorder,
and/or condition.
Methods of ent, Including Methods of Treating Cancer
Described herein are methods of treating disorders in a subject (e.g., disorders
that benefit from administration of an anti-PD—l therapy). For example, an anti—PD-l therapy
described herein can agent is administered e.g., as a monotherapy or in combination therapy,
for a period sufficient to achieve clinical benefit or according to a regimen as determined by a
physician (e.g., an anti-PD-l y is administered in dosage amounts and number of
treatment cycles as determined by a physician).
In embodiments, methods described herein are useful for ng T-cell
dysfunctional disorders (e.g., cancer). In ments, methods described herein are useful
for reducing tumors or inhibiting the growth of tumor cells in a subject.
In embodiments, s described herein are useful for increasing T cell
activation or T cell effector function in a subject.
] In ments, methods described herein are useful for inducing an immune
response in a subject.
In embodiments, s described herein are useful for enhancing an immune
response or increasing the activity of an immune cell in a subject.
The inventive methods can be used to treat any type of infectious disease (i.e., a
disease or disorder caused by a bacterium, a virus, a fungus, or a parasite). Examples of
infectious diseases that can be treated by the inventive method include, but are not limited to,
diseases caused by a human immunodeficiency virus (HIV), a respiratory syncytial Virus
(RSV), an influenza virus, a dengue virus, a tis B virus (HBV, or a hepatitis C virus
(HCV)). When the inventive method treats an infectious disease, an anti-TIM—3 antibody
agent can be administered in combination with at least one anti—bacterial agent or at least one
anti—viral agent. In this respect, the anti-bacterial agent can be any suitable antibiotic known
in the art. The iral agent can be any e of any suitable type that specifically targets
a particular virus (e.g., live—attenuated es, subunit vaccines, recombinant vector
vaccines, and small molecule anti-viral therapies (e.g., viral replication inhibitors and
nucleoside analogs).
The inventive methods can be used to treat any type of autoimmune disease (i.e.,
as e or disorder caused by immune system over-activity in which the body attacks and
damages its own tissues), such as those described in, for example, MacKay IR. and Rose
N.R., eds., The Autoimmune Diseases, Fifth Edition, Academic Press, Waltham, MA (2014).
es of autoimmune diseases that can be treated by the inventive method include, but
are not limited to, multiple sclerosis, type 1 diabetes mellitus, rheumatoid arthritis,
scleroderrna, Crohn’s disease, psoriasis, systemic lupus matosus (SLE), and ulcerative
colitis. When the inventive method treats an autoimmune disease, an anti-TIM—3 antibody
agent can be used in combination with an anti-inflammatory agent including, for example,
corticosteroids (e.g., prednisone and fluticasone) and non-steroidal anti—inflammatory drugs
s) (e.g., aspirin, ibuprofen, and naproxen).
PD-l is abnormally expressed in a variety of cancers (see, e.g., Brown et al, J.
Immunol., 170: 1257-1266 (2003); and Flies et. al, Yale Journal of Biology and ne,
84: 409-421 (2011)), and PD—Ll expression in some renal cell carcinoma patients correlates
with tumor aggressiveness. The ive methods can be used to treat any type of cancer
known in the art.
In embodiments, a cancer that is adenocarcinoma, adenocarcinoma of the lung,
acute myeloid leukemia (“AML”), acute lymphoblastic leukemia (“ALL”), adrenocortical
carcinoma, anal cancer, appendiceal cancer, B-cell derived leukemia, B-cell derived
lymphoma, r cancer, brain cancer, breast cancer (e.g., triple negative breast cancer
(TNBC)), cancer of the fallopian tube(s), cancer of the testes, cerebral cancer, cervical
cancer, choriocarcinoma, chronic myelogenous leukemia, a CNS tumor,
colon adenocarcinoma, colon cancer, colorectal , diffuse sic pontine glioma
(DIPG), diffuse large B cell lymphoma (“DLBCL”), embryonal rhabdomyosarcoma (ERMS),
endometrial cancer, epithelial cancer, esophageal cancer, Ewing’s sarcoma, ular
lymphoma (“FL”), gall bladder cancer, gastric cancer, intestinal cancer, , head
and neck , a hematological , hepatocellular cancer, n’s
ma/primary mediastinal B-cell lymphoma, kidney cancer, kidney clear cell cancer,
laryngeal cancer, leukemia, liver cancer, lung cancer, lymphoma, melanoma, Merkel cell
carcinoma, mesothelioma, monocytic leukemia, multiple myeloma, a, a neuroblastic-
derived CNS tumor, non-Hodgkin’s lymphoma (NHL), all cell lung cancer (NSCLC),
oral cancer, osteosarcoma, ovarian cancer, ovarian carcinoma, pancreatic cancer, peritoneal
cancer, primary peritoneal cancer, prostate cancer, relapsed or refractory classic Hodgkin’s
Lymphoma (cHL), renal cell carcinoma, rectal cancer, salivary gland cancer (e. g., a salivary
gland tumor), sarcoma, skin cancer, small cell lung cancer, small intestine , squamous
cell carcinoma of the anogenital region (e.g., squamous cell carcinoma of the anus, penis,
, vagina, or vulva), squamous cell carcinoma of the esophagus, squamous cell
carcinoma of the head and neck (SCHNC), squamous cell carcinoma of the lung, stomach
cancer, T-cell derived leukemia, T-cell derived lymphoma, thymic cancer, a thymoma,
thyroid cancer, uveal melanoma, urothelial cell carcinoma, uterine cancer, e
endometrial cancer, uterine sarcoma, vaginal cancer, vulvar cancer, or Wilms tumor.
] In other embodiments, a cancer is a head and neck cancer, a lung cancer (e.g., a
non-small cell lung cancer (NSCLC)), a renal cancer, a bladder cancer, a melanoma, Merkel
cell carcinoma (see, e.g., Bhatia et al., Curr. Oncol. Rep., 13(6): 488-497 (2011), a cervical
cancer, a vaginal cancer, a vulvar cancer, a uterine cancer, a endometrial cancer, an ovarian
cancer, a ian tube , a breast cancer, a prostate cancer, a salivary gland tumor, a
thymoma, a adrenocortical carcinoma, a esophageal cancer, a gastric cancer, a colorectal
cancer, an appendiceal , a urothelial cell carcinoma, or a squamous cell carcinoma
(e.g., of the lung; of the ital region including anus, penis, cervix, vagina, or vulva; or
of the gus). In some embodiments, a cancer for treatment in the context of the present
disclosure is a melanoma, renal cell carcinoma, lung cancer, bladder cancer, breast cancer,
cervical cancer, colon cancer, gall bladder cancer, laryngeal cancer, liver cancer, thyroid
cancer, stomach cancer, ry gland cancer, prostate cancer, pancreatic cancer, or Merkel
cell carcinoma.
In some embodiments, a patient or population of patients have a hematological
. In some embodiments, the t has a hematological cancer such as Diffuse large B
cell lymphoma (“DLBCL”), Hodgkin’s lymphoma (“HL”), Non-Hodgkin’s lymphoma
(“NHL”), Follicular lymphoma (“FL”), acute myeloid leukemia (“AML”), acute
lymphoblastic leukemia (“ALL”), or le a (“MM”). In embodiments, a cancer
is a blood-bome cancer such as acute lymphoblastic ia(“ALL”), acute lymphoblastic
B-cell leukemia, acute lymphoblastic T—cell leukemia, acute myeloblastic leukemia ),
acute promyelocytic leukemia(“APL”), acute monoblastic leukemia, acute erythroleukemic
leukemia, acute megakaryoblastic leukemia, acute myelomonocytic leukemia, acute
nonlymphocyctic leukemia, acute undifferentiated leukemia, chronic myelocytic
leukemia(“CML”), chronic lymphocytic leukemia(“CLL”), hairy cell leukemia and multiple
myeloma; acute and chronic leukemias such as lymphoblastic, myelogenous, lymphocytic,
and ytic leukemias.
In embodiments a cancer is a lymphoma such as Hodgkin’s disease, non-
n’s Lymphoma, Multiple myeloma, Waldenstrom’s macroglobulinemia, Heavy chain
disease and Polycythemia vera.
] In embodiments, a cancer is a squamous cell carcinoma. In ments, a
cancer is squamous cell carcinoma of the lung. In embodiments, a cancer is squamous cell
carcinoma of the esophagus. In embodiments, a cancer is head and neck us cell
oma (HNSCC).
In embodiments, a cancer is squamous cell oma of the anogenital region
(e.g., of the anus, penis, cervix, vagina, or .
In embodiments, a cancer is bladder cancer, breast cancer (e.g., triple negative
breast cancer (TNBC)), cancer of the fallopian tube(s), cholagiocarcinoma,
colon adenocarcinoma, trial cancer, esophageal cancer, Ewing’s sarcoma, gastric
, kidney clear cell cancer, lung cancer (e.g., lung adenocarcinoma or lung squamous
cell cancer), mesothelioma, ovarian cancer, pancreatic cancer, peritoneal cancer, prostate
cancer, uterine trial cancer, or uveal melanoma. In embodiments, a cancer is ovarian
cancer, cancer of the fallopian tube(s), or peritoneal cancer. In embodiments, a cancer is
breast cancer (e.g., TNBC). In embodiments, a cancer is lung cancer (e.g., non-small cell
lung cancer). In embodiments, a cancer is prostate cancer.
] In embodiments, a cancer is a CNS or brain cancer such as neuroblastoma (NB),
glioma, e intrinsic pontine glioma (DIPG), pilocytic astrocytoma, astrocytoma,
anaplastic astrocytoma, glioblastoma multiforme, medulloblastoma, craniopharyngioma,
ependymoma, pinealoma, ioblastoma, acoustic neuroma, oligodendroglioma,
meningioma, vestibular schwannoma, a, metastatic brain tumor, meningioma, spinal
tumor, or medulloblastoma. In embodiments, a cancer is a CNS tumor.
In some embodiments, a patient or population of ts have a solid tumor. In
embodiments, a cancer is a solid tumor such as fibrosarcoma, myxosarcoma, liposarcoma,
chondrosarcoma, osteogenic sarcoma, chordoma, angiosarcoma, endotheliosarcoma,
lymphangiosarcoma, lymphangioendotheliosarcoma, synovioma, mesothelioma, s
tumor, leiomyosarcoma, rhabdomyosarcoma, osteosarcoma, colon cancer, colorectal cancer,
kidney cancer, pancreatic cancer, bone cancer, breast cancer, ovarian cancer, prostate cancer,
esophageal cancer, stomach cancer, oral cancer, nasal cancer, throat cancer, squamous cell
carcinoma, basal cell carcinoma, adenocarcinoma, sweat gland carcinoma, sebaceous gland
carcinoma, papillary carcinoma, papillary adenocarcinomas, cystadenocarcinoma, medullary
carcinoma, bronchogenic carcinoma, renal cell carcinoma, hepatoma, bile duct carcinoma,
choriocarcinoma, seminoma, embryonal oma, Wilms tumor, cervical cancer, uterine
cancer, testicular cancer, non small cell lung cancer ), small cell lung carcinoma,
r carcinoma, lung cancer, epithelial carcinoma, skin cancer, melanoma, neuroblastoma
(NB), or retinoblastoma. In some embodiments, the tumor is an advanced stage solid tumor.
In some embodiments, the tumor is a atic solid tumor. In some embodiments, the
patient has a MSI—H solid tumor.
In some embodiments, a patient or population of patients to be treated by the
methods of the t invention have or are susceptible to cancer, such as a head and neck
cancer, a lung cancer (e.g., a non-small cell lung cancer (NSCLC)), a renal cancer, a r
cancer, a melanoma, Merkel cell carcinoma, a cervical cancer, a vaginal cancer, a vulvar
cancer, a uterine cancer, a endometrial cancer, an ovarian cancer, a fallopian tube cancer, a
breast , a prostate cancer, a salivary gland tumor, a thymoma, a adrenocortical
carcinoma, a esophageal cancer, a gastric cancer, a colorectal cancer, an iceal ,
a urothelial cell carcinoma, or a squamous cell carcinoma (e.g., of the lung; of the anogenital
region including anus, penis, cervix, vagina, or vulva; or of the esophagus). In some
embodiments, a patient or population of patients to be d by the methods of the present
invention have or are susceptible to lung cancer (e.g., NSCLC), renal cancer, melanoma,
cervical , colorectal cancer, or endometrial cancer (e.g., MSS endometrial cancer or
MSI-H endometrial cancer).
In some embodiments, a cancer is a logic cancer (Le, a cancer of the
female uctive system such as ovarian cancer, fallopian tube cancer, cervical cancer,
vaginal cancer, vulvar cancer, uterine cancer, or primary peritoneal cancer, or breast cancer).
In some ments, cancers of the female reproductive system include, but are not limited
to, ovarian cancer, cancer of the ian tube(s), peritoneal cancer, and breast cancer.
In embodiments, a cancer is ovarian cancer (e.g., serous or clear cell ovarian
cancer). In embodiments, a cancer is fallopian tube cancer (e.g., serous or clear cell fallopian
tube cancer). In embodiments, a cancer is primary peritoneal cancer (e.g., serous or clear cell
primary peritoneal cancer).
In some embodiments, an ovarian cancer is an epithelial carcinoma. lial
carcinomas make up 85% to 90% of ovarian cancers. While historically considered to start on
the surface of the ovary, new evidence suggests at least some ovarian cancer begins in special
cells in a part of the fallopian tube. The fallopian tubes are small ducts that link a s
s to her uterus that are a part of a woman’s reproductive system. In a normal female
reproductive system, there are two fallopian tubes, one located on each side of the uterus.
Cancer cells that begin in the fallopian tube may go to the surface of the ovary early on. The
term ‘ovarian cancer’ is often used to describe epithelial cancers that begin in the ovary, in
the fallopian tube, and from the lining of the abdominal cavity, call the peritoneum. In some
embodiments, the cancer is or comprises a germ cell tumor. Germ cell tumors are a type of
ovarian cancer develops in the egg—producing cells of the ovaries. In some embodiments, a
cancer is or ses a stromal tumor. Stromal tumors develop in the connective tissue cells
that hold the ovaries together, which sometimes is the tissue that makes female hormones
called estrogen. In some embodiments, a cancer is or ses a granulosa cell tumor.
Granulosa cell tumors may secrete estrogen resulting in unusual vaginal bleeding at the time
of diagnosis. In some embodiments, a gynecologic cancer is associated with homologous
recombination repair ency/homologous repair deficiency (“HRD”) and/or BRCA1/2
mutation(s). In some embodiments, a gynecologic cancer is platinum—sensitive. In some
embodiments, a gynecologic cancer has responded to a platinum-based therapy. In some
embodiments, a gynecologic cancer has developed resistance to a platinum-based therapy. In
some embodiments, a logic cancer has at one time shown a partial or complete
response to platinum—based therapy (e.g., a partial or complete response to the last platinum-
based therapy or to the penultimate platinum-based therapy). In some embodiments, a
logic cancer is now resistant to platinum—based therapy.
In embodiments, a cancer is a breast cancer. Usually breast cancer either begins
in the cells of the milk producing glands, known as the s, or in the ducts. Less
commonly breast cancer can begin in the l tissues. These include the fatty and fibrous
connective tissues of the breast. Over time the breast cancer cells can invade nearby tissues
such the rm lymph nodes or the lungs in a process known as metastasis. The stage of a
breast cancer, the size of the tumor and its rate of growth are all factors which determine the
type of treatment that is offered. Treatment options include surgery to remove the tumor, drug
ent which includes chemotherapy and hormonal therapy, radiation therapy and
immunotherapy. The prognosis and survival rate varies widely; the five year ve survival
rates vary from 98% to 23% depending on the type of breast cancer that occurs. Breast cancer
is the second most common cancer in the world with approximately 1.7 million new cases in
2012 and the fifth most common cause of death from cancer, with imately 521,000
. Of these cases, approximately 15% are triple-negative, which do not express the
estrogen receptor, progesterone receptor (PR) or HER2. In some embodiments, triple
negative breast cancer (TNBC) is characterized as breast cancer cells that are estrogen
receptor expression negative (<1% of cells), progesterone receptor expression ve (<1%
of cells), and HER2—negative.
In embodiments, a cancer is ER-positive breast cancer, ER-negative breast cancer,
PR-positive breast cancer, PR-negative breast cancer, HER2-positive breast cancer, HER2-
ve breast cancer, BRCA1/2-positive breast cancer, 2-negative cancer, or triple
ve breast cancer (TNBC). In embodiments, a cancer is triple negative breast cancer
(TNBC).
In some ments, a breast cancer is a metastatic breast . In some
embodiments, a breast cancer is an advanced breast cancer. In some embodiments, a cancer
is a stage II, stage III or stage IV breast cancer. In some embodiments, a cancer is a stage IV
breast cancer. In some ments, a breast cancer is a triple negative breast cancer.
In some embodiments, a patient or a population of patients to be d by the
s of the present disclosure have or are susceptible to endometrial cancer (“EC”).
Endometrial carcinoma is the most common cancer of the female genital, tract accounting for
—20 per 0 person-years. The annual number of new cases of endometrial cancer
(EC) is estimated at about 325 thousand worldwide. Further, EC is the most commonly
occurring cancer in post-menopausal women. About 53% of endometrial cancer cases occur
in developed countries. In 2015, approximately 55,000 cases of EC were diagnosed in the
US. and no ed therapies are currently approved for use in EC. There is a need for
agents and regimens that improve survival for advanced and recurrent EC in 1L and 2L
settings. Approximately 10,170 people are predicted to die from EC in the US. in 2016. The
most common histologic form is endometrioid adenocarcinoma, representing about 75-80%
of diagnosed cases. Other histologic forms include uterine papillary serous (less than 10%),
clear cell 4%, mucinous 1%, us less than 1% and mixed about 10%.
From the pathogenetic point of view, EC falls into two different types, so-called
types I and II. Type I tumors are low-grade and estrogen-related endometrioid carcinomas
(EEC) while type II are non-endometrioid (NEEC) (mainly serous and clear cell) carcinomas.
The World Health Organization has recently updated the pathologic classification of EC,
recognizing nine different subtypes of EC, but EEC and serous carcinoma (SC) account for
the vast majority of cases. EECs are en-related carcinomas, which occur in
perimenopausal patients, and are preceded by precursor lesions (endometrial
hyperplasia/endometrioid intraepithelial neoplasia). Microscopically, lowgrade EEC (EEC 1—
2) contains tubular glands, somewhat resembling the proliferative endometrium,with
architectural complexity with fusion of the glands and cribriform pattern. High-grade EEC
shows solid pattern of growth. In st, SC occurs in postmenopausal patients in e
of hyperestrogenism. At the microscope, SC shows thick, fibrotic or edematous papillae with
prominent stratification of tumor cells, cellular budding, and anaplastic cells with large,
eosinophilic cytoplasms. The vast majority of EEC are low grade tumors (grades 1 and 2),
and are ated with good prognosis when they are restricted to the uterus. Grade 3 EEC
(EEC3) is an aggressive tumor, with increased frequency of lymph node metastasis. SCs are
very aggressive, unrelated to estrogen stimulation, mainly occurring in older women. EEC 3
and SC are considered high-grade . SC and EEC3 have been compared using the
surveillance, epidemiology and End Results (SEER) program data from 1988 to 2001. They
represented 10% and 15% of EC respectively, but accounted for 39% and 27% of cancer
death respectively.
Endometrial cancers can also be classified into four molecular subgroups: (1)
ultramutated/POLE-mutant; (2) hypermutated MSI+ (e.g., MSI-H or MSI-L); (3) copy
number low/microsatellite stable (MSS); and (4) copy number erous-like.
Approximately 28% of cases are MSI-high. (Murali, Lancet Oncol. (2014). In some
embodiments, a t has a ch repair deficient subset of 2L endometrial cancer.
In embodiments, an endometrial cancer is metastatic endometrial cancer.
In embodiments, a patient has a MSS endometrial cancer.
In embodiments, a patient has a MSI-H endometrial cancer.
In embodiments, a cancer is a lung cancer. In embodiments, a lung cancer is a
squamous cell carcinoma of the lung. In embodiments, a lung cancer is small cell lung
cancer . In embodiments, a lung cancer is non—small cell lung cancer (NSCLC) such
as us NSCLC. In embodiments, a lung cancer is an ALK-translocated lung cancer
(e.g., ALK-translocated NSCLC). In embodiments, a lung cancer is an EGFR-mutant lung
cancer (e.g., EGFR-mutant NSCLC).
In embodiments, a cancer is a colorectal (CRC) cancer (e.g., a solid tumor). In
ments, a colorectal cancer is an advanced colorectal cancer. In embodiments, a
colorectal cancer is a metastatic colorectal . In embodiments, a colorectal cancer is a
MSI-H colorectal cancer. In embodiments, a colorectal cancer is a MSS colorectal cancer. In
embodiments, a colorectal cancer is a POLE—mutant colorectal cancer. In embodiments, a
colorectal cancer is a FOLD-mutant colorectal cancer. In embodiments, a ctal cancer is
a high TMB colorectal cancer.
In embodiments, a cancer is a melanoma. In embodiments, a melanoma is an
advanced melanoma. In embodiments, a melanoma is a atic melanoma. In
embodiments, a melanoma is a MSI-H melanoma. In embodiments, a melanoma is a MSS
melanoma. In embodiments, a ma is a POLE-mutant melanoma. In embodiments, a
melanoma is a utant ma. In embodiments, a melanoma is a high TMB
melanoma.
In embodiments, a cancer is an advanced cancer.
In embodiments, a cancer is a metastatic cancer.
] In embodiments, a cancer is a recurrent cancer (e.g., a recurrent gynecological
cancer such as recurrent epithelial ovarian cancer, recurrent fallopian tube cancer, recurrent
primary peritoneal cancer, or recurrent endometrial ).
Cancers that can be treated with methods described herein include s
associated with a high tumor mutation burden (TMB), cancers that microsatellite stable
(MSS), cancers that are characterized by atellite instability, cancers that have a high
microsatellite instability status (MSI—H), cancers that have low microsatellite instability status
(MSI-L), cancers associated with high TMB and MSI—H (e.g., cancers associated with high
TMB and MSI-L or MSS), cancers having a defective DNA mismatch repair system, s
having a defect in a DNA mismatch repair gene, hypermutated cancers, cancers having
homologous recombination repair deficiency/homologous repair deficiency (“HRD”), cancers
comprising a mutation in polymerase delta (POLD), and s comprising a mutation in
polymerase epsilon (POLE).
In some embodiments, a tumor to be d is characterized by microsatellite
instability. In some embodiments, a tumor is characterized by microsatellite instability high
status (MSI—H). Microsatellite instability (“MSI”) is or comprises a change that in the DNA
of certain cells (such as tumor cells) in which the number of repeats of microsatellites (short,
repeated sequences of DNA) is different than the number of repeats that was contained in the
DNA from which it was inherited. About 15% of sporadic colorectal s (CRC) harbor
widespread alterations in the length of microsatellite (MS) ces, known as
atellite instability (MSI) (Boland and Goel, 2010). Sporadic MSI CRC tumors display
unique clinicopathological features including near-diploid karyotype, higher frequency in
older populations and in females, and a better prognosis (de la Chapelle and Hampel, 2010;
Popat et al., 2005). MSI is also present in other tumors, such as in endometrial cancer (EC)
of the uterus, the most common logical malignancy (Duggan et al., 1994). The same
reference Bethesda panel originally developed to screen an inherited genetic disorder (Lynch
syndrome) (Umar et al., 2004) is currently d to test MSI for CRCs and ECs. r,
the genes frequently targeted by MSI in CRC genomes rarely harbor DNA slippage events in
EC s (Gurin et al., 1999).
Microsatellite instability arises from a e to repair replication—associated
errors due to a defective DNA mismatch repair (MMR) . This failure allows
persistence of mismatch mutations all over the genome, but especially in regions of repetitive
DNA known as microsatellites, leading to increased mutational load. It has been
demonstrated that at least some tumors characterized by MSI-H have improved responses to
n anti-PD-l agents (Le et al., (2015) N. Engl. J. Med. 372(26):2509-2520; Westdorp et
al., (2016) Cancer Immunol. Immunother. 65(10):1249-1259). In some embodiments, a
cancer has a microsatellite instability of high microsatellite instability (e.g., MSI—H status).
In some embodiments, a cancer has a microsatellite instability status of low microsatellite
instability (e.g., MSI-Low). In some embodiments, a cancer has a microsatellite instability
status of microsatellite stable (e.g., MSS status). In some embodiments microsatellite
instability status is ed by a next generation sequencing (NGS)-based assay, an
immunohistochemistry (IHC)-based assay, and/or a PCR—based assay. In some
embodiments, microsatellite instability is detected by NGS. In some embodiments,
microsatellite instability is detected by IHC. In some embodiments, microsatellite instability
is detected by PCR.
In embodiments, a patient has a MSI-L cancer.
In embodiments, a t has a MSI-H cancer. In some embodiments, a patient
has a MSI—H solid tumor. In embodiments, a MSI-H cancer is MSI—H endometrial cancer. In
embodiments, a MSI—H cancer is a solid tumor. In ments, a MSI—H cancer is a
metastatic tumor. In ments, a MSI-H cancer is endometrial cancer. In embodiments,
a MSI—H cancer is a non-endometrial cancer. In embodiments, a MSI-H cancer is colorectal
cancer.
In embodiments, a patient has a MSS cancer. In embodiments, a MSS cancer is
MSS trial cancer.
In embodiments, a cancer is associated with a POLE (DNA rase epsilon)
mutation (i.e., a cancer is a POLE-mutant cancer). In embodiments, a POLE mutation is a
on in the exonuclease domain. In embodiments, a POLE on is a germline
mutation. In ments, a POLE mutation is a sporadic mutation. In ments, a MSI
cancer also is associated with a POLE mutation. In embodiments, a MSS cancer also is
associated with a POLE mutation. In embodiments, a POLE mutation is identified using
sequencing. In embodiments, a POLE-mutant cancer is endometrial . In
embodiments, a POLE-mutant cancer is colon cancer. In embodiments, a POLE-mutant
cancer is pancreatic cancer, ovarian cancer, or cancer of the small intestine.
In embodiments, a cancer is associated with a POLD (DNA polymerase delta)
mutation (i.e., a cancer is a POLD-mutant cancer). In embodiments, a POLD mutation is a
mutation in the exonuclease . In embodiments, a POLD mutation is a somatic
mutation. In embodiments, a POLD mutation is a germline mutation. In embodiments, a
FOLD-mutant cancer is identified using sequencing. In ments, a FOLD-mutant
cancer is endometrial cancer. In embodiments, a FOLD-mutant cancer is colorectal .
In embodiments, a FOLD-mutant cancer is brain cancer.
] In some embodiments, a patient has a mismatch repair deficient (MMRd) cancer.
] In embodiments, a MMRd cancer is colorectal cancer.
Microsatellite instability may arise from a failure to repair replication-associated
errors due to a ive DNA mismatch repair (MMR) system. This failure allows
persistence of mismatch mutations all over the genome, but especially in regions of tive
DNA known as microsatellites, leading to increased mutational load that may e
responses to certain anti-PD—l agents. Id. In some embodiments MSI-H status is assess by a
NGS-based assay and/or a PCR-based MSI assay. In some embodiments, microsatellite
instability is detected by next generation sequencing. In embodiments, microsatellite
instability is detected using immunohistochemistry (IHC) testing.
In embodiments, a cancer (e.g., a MMRd cancer) is characterized by a high tumor
mutation burden (i.e., a cancer is a high TMB cancer). In some embodiments, the cancer is
associated with high TMB and MSI-H. In some embodiments, the cancer is ated with
high TMB and MSI—L or MSS. In some embodiments, the cancer is endometrial cancer
associated with high TMB. In some related embodiments, the endometrial cancer is
associated with high TMB and MSI-H. In some related embodiments, the endometrial cancer
is associated with high TMB and MSI-L or MSS. In embodiments, a high TMB cancer is
colorectal cancer. In ments, a high TMB cancer is lung cancer (e.g., small cell lung
cancer (SCLC) or non-small cell lung cancer (NSCLC) such as us NSCLC or non-
squamous NSCLC). In embodiments, a high TMB cancer is melanoma. In embodiments, a
high TMB cancer is urothelial cancer.
] In embodiments, a patient has a cancer with elevated expression of tumor-
infiltrating lymphocytes (TILs), i.e., a patient has a high-TIL cancer. In embodiments, a
high—TIL cancer is breast cancer (e.g., triple negative breast cancer (TNBC) or HERZ-
ve breast cancer). In embodiments, a high-TIL cancer is a metastatic cancer (e.g., a
metastatic breast cancer).
] In embodiments, immune-related gene expression signatures can be tive of
a response to an anti—PD-l therapy for cancer as described herein. For e, a gene panel
that includes genes associated with IFN-y signaling can be useful in identifying cancer
patients who would benefit from anti—PD—l therapy. Exemplary gene panels are described in
Ayers et al., J. Clin. Invest., 127(8):2930-2940, 2017. In embodiments, a cancer patient has a
cancer that is breast cancer (e.g., TNBC) or n cancer. In embodiments, a cancer patient
has a cancer that is bladder cancer, gastric cancer, bilary cancer, esophageal cancer, or head
and neck squamous cell carcinoma (HNSCC). In embodiments, a cancer patient has a cancer
that is anal cancer or colorectal cancer.
In some embodiments, a patient has a tumor that expresses PD—Ll. In some
ments, PD—Ll status is evaluated in a patient or patient population. In some
embodiments, mutational load and ne gene expression profiles in al or fresh pre-
treatment biopsies are evaluated before, during and/or after treatment with an anti-PD-l
antibody agent. In some ments, the status and/or expression of TIM-3 and/or LAG-3
are evaluated in patients.
In some embodiments, at least some of the patients in the cancer patient
population have not previously been treated with one or more different cancer treatment
modalities.
In some embodiments, a patient has previously been treated with one or more
different cancer treatment modalities (e.g., one or more of surgery, radiotherapy,
chemotherapy or immunotherapy). In embodiments, a subject has previously been treated
with two or more different cancer ent ties (e.g., one or more of surgery,
radiotherapy, chemotherapy, or immunotherapy). In embodiments, a subject has been
usly treated with a cytotoxic therapy. In ments, a subject has been previously
treated with chemotherapy. In embodiments, a subject has previously been treated with two
different cancer treatment modalities (e.g., one or more of surgery, radiotherapy,
herapy, or immunotherapy). In embodiments, a subject has previously been treated
with three different cancer treatment ties (e. g., one or more of surgery, radiotherapy,
chemotherapy, or immunotherapy).
In embodiments of s described , a method further comprises
administering one or more of surgery, a radiotherapy, a chemotherapy, an immunotherapy, an
ngiogenic agent, or an anti-inflammatory. In embodiments, a method further comprises
administering a chemotherapy.
In some embodiments, at least some of the patients in the cancer patient
population have previously been treated with chemotherapy (e.g., platinum-based
chemotherapy). For example, a patient who has received two lines of cancer treatment can be
fied as a 2L cancer patient (e.g., a 2L NSCLC patient). In embodiments, a patient has
received two lines or more lines of cancer treatment (e. g., a 2L+ cancer patient such as a 2L+
endometrial cancer patient). In embodiments, a patient has not been previously treated with
an anti-PD-l therapy. In embodiments, a patient previously received at least one line of
cancer ent (e.g., a patient previously received at least one line or at least two lines of
cancer treatment). In embodiments, a patient previously received at least one line of
treatment for metastatic cancer (e.g., a t previously received one or two lines of
treatment for metastatic cancer).
In embodiments, a subject is resistant to treatment with an agent that inhibits
PD—l.
In embodiments, a subject is tory to treatment with an agent that inhibits
PD—l.
In embodiments, a method described herein sensitizes the subject to treatment
with an agent that inhibits PD—l.
In embodiments, a subject ses an exhausted immune cell (e.g., an
exhausted immune cell that is an exhausted T cell).
In embodiments of methods described herein, a t is an animal (e.g., a
mammal). In embodiments, a subject is a human. In embodiments, a t is a non-human
mammal (e.g., mice, rats, rabbits, or non-human primates). Accordingly, methods described
herein can be useful in both treatment of humans and in veterinary ne.
] In embodiments, a PD-l inhibitor (e.g., an anti-PD-l antibody) is administered
intravenously (e.g., by intravenous infusion).
Programmed Death 1 (PD-1)
Programmed Death 1 (PD—l) (also known as Programmed Cell Death 1) is a type I
transmembrane protein of 268 amino acids originally identified by subtractive hybridization
of a mouse T cell line undergoing apoptosis a et al., Embo J 11: 3887-95 (1992)). PD-
1 is a member of the CD28/CTLA-4 family of T—cell tors, and is sed on activated
T-cells, B-cells, and myeloid lineage cells (Greenwald et al., Annu. Rev. Immunol, 23: 515-
548 (2005); and Sharpe et al., Nat. Immunol, 8: 239—245 (2007)). PD—l is an inhibitory
member of the CD28 family of receptors, that also includes CD28, CTLA-4, ICOS and
BTLA. PD-l is expressed on activated B cells, T cells, and myeloid cells (Agata et al., supra;
Okazaki et al. (2002) Curr. Opin. Immunol 142391779-82; Bennett et a1. (2003) J l
170:711-8).
Two ligands for PD-l have been identified, PD ligand 1 (PD-Ll) and PD ligand 2
(PD—L2), both of which belong to the B7 protein superfamily (Greenwald et al, supra). PD—Ll
is sed in a variety of cell types, including cells of the lung, heart, thymus, spleen, and
kidney (see, e.g., Freeman et al., J. Exp. Med., 192(7): 1027-1034 (2000); and Yamazaki et
al., J. Immunol, 169(10): 5538-5545 (2002)). PD-Ll expression is upregulated on
macrophages and dendritic cells (DCs) in response to lipopolysaccharide (LPS) and GM-CSF
treatment, and on T-cells and B-cells upon signaling via T-cell and B—cell receptors. PD—Ll
also is expressed in a variety of murine tumor cell lines (see, e.g., Iwai et al., Proc. Natl
Acad. Sci. USA, 99(9): 12293-12297 (2002); and Blank et al., Cancer Res, 64(3): 1140-1145
(2004)). In contrast, PD-L2 exhibits a more restricted expression pattern and is expressed
primarily by antigen presenting cells (e.g., dendritic cells and macrophages), and some tumor
cell lines (see, e.g., Latchman et al., Nat. l, 2(3): 261-238 (2001)). High PD—Ll
expression in tumors, whether on the tumor cell, stroma, or other cells within the tumor
microenvironment, correlates with poor clinical prognosis, presumably by inhibiting effector
T cells and upregulating regulatory T cells (Treg) in the tumor.
PD-l negatively regulates T-cell activation, and this inhibitory on is linked
to an immunoreceptor tyrosine-based switch motif (ITSM) in the cytoplasmic domain (see,
e.g., Greenwald et al., supra; and Parry et al., Mol. Cell. Biol, 25: 9543—9553 (2005)). PD-l
deficiency can lead to autoimmunity. For example, C57BL/6 PD-l knockout mice have been
shown to develop a lupus-like me (see, e.g., Nishimura et al., Immunity, 11: 141-1151
). In humans, a single nucleotide polymorphism in the PD-l gene is associated with
higher incidences of systemic lupus erythematosus, type 1 diabetes, toid arthritis, and
progression of multiple sclerosis (see, e.g., Nielsen et al., Tissue Antigens, 62(6): 492-497
(2003); Bertsias et al., Arthritis Rheum, 60(1): 207—218 (2009); Ni et al, Hum. Genet,
121(2): 223-232 (2007); Tahoori et al., Clin. Exp. Rheumatol., 29(5): 763-767 (2011); and
Kroner et al., Ann. , 58(1): 50—57 (2005)). Abnormal PD—l expression also has been
implicated in T-cell dysfunctions in several pathologies, such as tumor immune evasion and
chronic viral infections (see, e.g., Barber et al., , 439: 682-687 (2006); and Sharpe et
al., .
] Recent studies demonstrate that T-cell ssion induced by PD—l also plays a
role in the suppression of anti-tumor immunity. For example, PD—Ll is expressed on a y
of human and mouse tumors, and binding of PD-l to PD—Ll on tumors results in T-cell
suppression and tumor immune n and protection (Dong et al., Nat. Med., 8: 793-800
(2002)). Expression of PD—Ll by tumor cells has been ly associated with their
ance to lysis by anti-tumor T-cells in vitro (Dong et al., supra; and Blank et al., Cancer
Res., 64: 1140-1145 (2004)). PD-l knockout mice are resistant to tumor challenge (Iwai et
a1., Int. Immunol, 17: 133—144 (2005)), and T-cells from PD—1 knockout mice are highly
effective in tumor rejection when adoptively transferred to tumor-bearing mice (Blank et a1.,
supra). Blocking PD-1 inhibitory s using a monoclonal antibody can potentiate host
anti-tumor immunity in mice (Iwai et al., supra; and Hirano et al., Cancer Res., 65: 1089-
1096 (2005)), and high levels of PD-Ll sion in tumors are associated with poor
prognosis for many human cancer types (Hamanishi et al., Proc. Natl. Acad. Sci. USA, 104:
3360-335 (2007), Brown et al, J. Immunol, 170: 1257-1266 (2003); and Flies et a1., Yale
Journal ofBiology and Medicine, 84(4): 409-421 (2011)).
In view of the foregoing, strategies for inhibiting PD-1 activity to treat s
types of cancer and for immunopotentiation (e.g., to treat infectious diseases) have been
developed (see, e.g., Ascierto et a1., Clin. Cancer. Res, 19(5): 020 (2013)). In this
t, monoclonal antibodies targeting PD—l have been developed for the treatment of
cancer (see, e.g., Weber, Semin. Oncol, 37(5): 430-4309 (2010); and Tang et al., Current
Oncology Reports, 15(2): 98—104 (2013)). For example, nivolumab (also known as BMS-
936558) produced complete or partial responses in non-small-cell lung cancer, melanoma,
and renal-cell cancer in a Phase I clinical trial (see, e.g., Topalian, New England J. Meal, 366:
2443-2454 (2012)), and is tly in Phase III clinical trials. MK-3575 is a humanized
monoclonal antibody directed against PD-l that has shown evidence of mor activity in
Phase I clinical trials (see, e.g., Patnaik et a1., 2012 American Society of Clinical Oncology
(ASCO) Annual Meeting, Abstract # 2512). In on, recent evidence suggests that
therapies which target PD-l may enhance immune responses against pathogens, such as HIV
(see, e.g., Porichis et a1., Curr. HIV/AIDS Rep., 9(1): 81—90 (2012)). Despite these es,
however, the efficacy of these potential therapies in humans may be limited.
PD-l-binding agents
The present disclosure provides methods of ng cancer that include
administering compositions that deliver particular programmed death-1 protein (PD—1)-
g agents according to regimens that may achieve clinical benefit(s). The present
disclosure describes, at least in part, PD-l-binding agents (e.g., anti-PD-l antibody agents)
and various compositions and methods relating thereto. In some embodiments, a PD—l-
binding agent (e.g., anti-PD—l antibody agent) binds an epitope of PD-l which blocks the
g of PD-1 to any one or more of its putative s. In some embodiments, a PD—l—
binding agent (e.g., anti-PD—l antibody agent) binds an e of PD-l which blocks the
binding of PD—1 to two or more of its putative ligands. In some embodiments, a PD—l-binding
agent (e.g., anti-PD-1 antibody agent) binds an epitope of a PD-1 protein which blocks the
binding of PD-1 to PD-Ll and/or PD-L2. PD-l-binding agents (e.g., anti-PD—l antibody
agents) of the present disclosure may comprise a heavy chain constant region (F5) of any
suitable class. In some embodiments, a PD-l-binding agent (e.g., anti-PD-l antibody agent)
ses a heavy chain constant region that is based upon wild-type IgGl, IgG2, or IgG4
antibodies, or variants thereof. In some embodiments, a PDbinding agent is a monoclonal
In some embodiments, a PDbinding agent ses a heavy chain variable
region with one or more CDR sequences selected from SEQ ID NOs: 9, 10, and 11 and/or a
light chain variable region with one or more CDR sequences selected from SEQ ID NOs: 12,
13, and 14. In some embodiments, a PDbinding agent comprises a heavy chain variable
region with two or more CDR ces selected from SEQ ID NOs: 9, 10, and 11 and/or a
light chain variable region with two or more CDR sequences selected from SEQ ID NOs: 12,
13, and 14. In some embodiments, a PDbinding agent comprises a heavy chain variable
region with three CDRs that have sequences of SEQ ID NOs: 9, 10, and 11 and/or a light
chain variable region with three CDRs that have sequences of SEQ ID NOS: 12, 13, and 14.
SEQ ID NO: 9 (HCDRl) — SYDMS
SEQ ID NO: 10 (HCDR2) — SYTYYQDSVKG
SEQ ID NO: 11 (HCDR3) — PYYAMDY
SEQ ID NO: 12 (LCDRl) — GTAVA
SEQ ID NO: 13 (LCDR2) — WASTLHT
SEQ ID NO: 14 (LCDR3) — QHYSSYPWT
In some ments, a PDbinding agent comprises an immunoglobulin heavy
chain variable domain whose amino acid sequence comprises SEQ ID NO: 1 or
SEQ ID NO: 7.
SEQ ID NO: 1
EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYDMSWVRQAPGKGLEWVSTIS
GGGSYTYYQDSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCASPYYAM
DYWGQGTTVTVSSA
SEQ ID NO: 7
EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYDMSWVRQAPGKGLEWVSTIS
GGGSYTYYQDSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCASPYYAM
DYWGQGTTVTVSS
In some embodiments, a PD-l-binding agent comprises an globulin light
chain variable domain whose amino acid sequence comprises SEQ ID NO: 2 or
SEQ ID NO: 8.
SEQ ID NO: 2
DIQLTQSPSFLSAYVGDRVTITCKASQDVGTAVAWYQQKPGKAPKLLIYWAS
TLHTGVPSRFSGSGSGTEFTLTISSLQPEDFATYYCQHYSSYPWTFGQGTKLEI
SEQ ID NO: 8
DIQLTQSPSFLSAYVGDRVTITCKASQDVGTAVAWYQQKPGKAPKLLIYWAS
TLHTGVPSRFSGSGSGTEFTLTISSLQPEDFATYYCQHYSSYPWTFGQGTKLEI
In some embodiments, a PD-l-binding agent comprises an globulin heavy
chain variable domain whose amino acid ce comprises SEQ ID NO: 1 or SEQ ID NO:
7 and/or an immunoglobulin light chain variable domain whose amino acid sequence
comprises SEQ ID NO: 2 or SEQ ID NO: 8. In some embodiments a PD—l-binding agent is
or comprises an immunoglobulin G4 (IgG4) humanized monoclonal antibody (mAb). In
some embodiments, a PD-l—binding agent comprises a human IGHG4*01 polypeptide. In
some embodiments, a PD-l-binding agent comprises one or more mutations within the IgG
heavy chain region. In some embodiments, a PD-l-binding agent comprises an IgG4 heavy
chain constant region having one or more mutations in the heavy chain constant . In
some embodiments, a inding agent comprises an IgG4 heavy chain constant region
having one or more mutations in hinge region. It is envisioned that in some embodiments, a
mutation in the IgG4 hinge region may prevent half molecule exchange with other IgG4
molecules. In some embodiments, the one or more mutations in hinge region of IgG4 may
include a serine to proline stabilizing mutation that prevents half molecule exchange with
other IgG4 molecules. In some embodiments, the one or more mutations in hinge region of
IgG4 may include an $228P mutation. See, e. g., J. Biol. Chem. 2015; 290(9):5462-5469.
In some embodiments, a PD-l-binding agent comprises an globulin
heavy chain polypeptide whose amino acid sequence comprises SEQ ID NO: 3.
SEQ ID NO: 3 — An D-l antibody heavy chain polypeptide (CDR sequences!
EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYDMSWVRQAPGKGLEWVSE
YYS 2DSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCASPYYAM
D_YWGQGTTVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVS
WNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTKTYTCNVDHKPSNT
ESKYGPPCPPCPAPEFLGGPSVFLFPPKPKDTLMISRTPEVTCVVVD
VSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLN
GKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCL
SDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEG
NVFSCSVMHEALHNHYTQKSLSLSLGK
In some embodiments, a PD-l-binding agent comprises an immunoglobulin light
chain ptide whose amino acid sequence comprises SEQ ID NO: 4.
SEQ ID NO: 4 — An anti-PD-l antibody light chain polypeptide (CDR seguencesl
DIQLTQSPSFLSAYVGDRVTITCKASQ QDVGTAVAWYQQKPGKAPKLLIYWAS
PSRFSGSGSGTEFTLTISSLQPEDFATYYCS zHYSSYPWTFGQGTKLEI
PSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGN
SQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNR
SEQ ID NOs: 3 and 4 describe an exemplary humanized monoclonal anti-PD-l
antibody utilizing a human IGHG4*01 heavy chain gene, and a human IGKC*01 kappa light
chain gene, as scaffolds. There is a single Ser to Pro point mutation in the hinge region of the
IgG4 heavy chain. This mutation is at the canonical S228 position, corresponding to residue
224 in SEQ ID NO: 3. Without g to be bound by theory, it is envisioned that this point
mutation serves to stabilize the hinge of the antibody heavy chain.
Biophysical and biochemical terization of this exemplary humanized
monoclonal anti-PD—l antibody is consistent with the expected disulfide linkage pattern for
an IgG4 molecule. The residues involved in the expected inter— and intrachain disulfide
linkages are tabulated below (Tables 1 and 2).
Table 1 — Expected residues involved in disulfide linkages of an ary anti-PD-l
antibody agent heavy chain having an amino acid sequence as set forth in SEQ ID NO:3.
Cysteine residue anti-PD-l mAb HC
ID after Residue (position in
Edelman‘?l SEQ ID NO: 3)
I 22
II 96
III 130
IV 143
V 199
VI 222
VII 225
VIII 257
IX 3 17
X 363
XI 421
Table 2 — Expected residues involved in disulfide linkages of an ary anti—PD-l
antibody agent light chain having an amino acid sequence as set forth in SEQ ID NO: 4.
Cysteine residue anti-PD—l mAb LC
ID after Residue ion in
Edelmana SEQ ID NO: 4)
V 214
This exemplary anti-PD—l antibody exhibits an occupied N-glycosylation site at
asparagine residue 293 in the CH2 domain of each heavy chain in the mature protein
sequence (SEQ ID N023). The expressed N—glycosylation at this site is a mixture of
oligosaccharide species typically observed on IgGs expressed in ian cell culture, for
example, shown below is the relative abundance of glycan s from a ation of this
exemplary anti-PD-l antibody cultured in Chinese Hamster Ovary (CHO) cells (Table 3).
Table 3 — Glycan Analysis of an anti—PD-l antibody binding agent
Species Abundance (% of total Description of Glycan
oligosaccharide)
G0 <0. 1 % Nonfucosylated agalactobiantennary
complex-type oligosaccharide
GOF 19.5% Core fucosylated agalactobiantennary
complex type oligosaccharide
G1 0.1% Nonfucosylated monogalactosylated
biantennary x type oligosaccharide
GlF 45.6% Core fucosylated monogalactosylated
biantennary complex type oligosaccharide
G2F 27.4% Core fucosylated galactosylated biantennary
complex type oligosaccharide
M5 0.5% Oligomannosidic N—glycan, cNAcz
In some embodiments, the present disclosure provides an anti-PD-l antibody
agent comprising at least one immunoglobulin heavy chain having an amino acid sequence as
set forth in SEQ ID NO: 3 and at least one immunoglobulin light chain having an amino acid
sequence as set forth in SEQ ID NO: 4. In some embodiments an D-l antibody agent
comprises two immunoglobulin heavy chains, each having an amino acid sequence as set
forth in SEQ ID NO: 3. atively or additionally, in some ments an anti-PD-l
antibody agent comprises two immunoglobulin light chains, each having an amino acid
sequence as set forth in SEQ ID NO: 4. In some embodiments, an anti—PD-l antibody agent
has a canonical antibody format.
In some embodiments, a PD-l—binding agent is nivolumab, pembrolizumab,
atezolizumab, durvalumab, avelumab, or any of the antibodies disclosed in W02014/179664.
Pembrolizumab is an anti-PD-l monoclonal antibody (“mAb”) (also known as
MK-3475, SCH 9000475, da). Pembrolizumab is an immunoglobulin G4/kappa
isotype humanized mAb. The mechanism of lizumab consists of the mAb binding to
the PD-l receptor of lymphocytes to block the interaction of PD-l with PD-Ll and PD—L2
ligands produced by other cells in the body, including tumor cells of certain cancers.
Similarly to pembrolizumab, nivolumab (also known as 6558, Opdivo)
was first approved by the FDA in 2014 to treat melanoma that cannot be surgically removed
or has metastasized following ent with ipilimumab and a BRAF tor where
appropriate.
In some embodiments, a PD-l dy agent is as disclosed in International
Patent Application Publication W02014/179664, the entirety of which is orated herein.
In some embodiments, a provided heavy chain, light chain and/or antibody agent
has a structure that includes one or more disulfide bonds. In some embodiments, the one or
more disulfide bonds are or include a disulfide bond at the expected position for an IgG4
immunoglobulin.
In some embodiments, a PD-l-binding agent is glycosylated and one or more
sites. As used herein, n” is a sugar polymer y) component of a rotein.
The term “glycan” encompasses free glycans, including glycans that have been cleaved or
otherwise released from a glycoprotein. In some embodiments, present disclosure provides a
composition sing one or more glycoforms of a heavy chain, light chain, and/or
antibody agent as described . In some embodiments, a glycan is N-linked to an Fc
region. In some ments, a PD-l-binding agent is ylated at Asn297 (Kabat
numbering).
The term “glycoform” is used herein to refer to a particular form of a
glycoprotein. That is, when a glycoprotein includes a particular polypeptide that has the
potential to be linked to different glycans or sets of glycans, then each different version of the
glycoprotein (i.e., where the polypeptide is linked to a particular glycan or set of glycans) is
referred to as a “glycoform.” In some embodiments, a provided composition comprises a
plurality of glycoforms of one or more of an heavy chain, light chain, and/or antibody agent
as described herein.
WO 29559
In some embodiments a PD-l-binding agent binds with high affinity to human and
cynomolgus monkey PD-l. In some embodiments, binding of a inding agent can be
characterized by surface plasma resonance (SPR). In some embodiments, SPR measurements
may demonstrate or confirm binding of a PD-l binding agent a to human and/or a
cynomolgus monkey PD-l Fc . In some embodiments, a PD—l-binding agent binds
human and cynomolgus PD-l with a fast association rate, slow dissociation rate, and high
affinity (Table 4). For example, with an exemplary PD-l-binding agent, binding kinetics to
human and cynomolgus monkey PD—l were similar, with less than a 2-fold difference in KD
values. In addition, binding of an exemplary PD-l-binding agent to human or cynomolgus
monkey PD—l expressed on CHO-K1 cells was assessed by flow try. An exemplary
PD-l-binding agent was determined to bind to cell surface human and cynomolgus PD-l with
an EC50 of 2.0 and 3.4 nM, respectively.
Table 4: Binding of a PD-l-binding agent (comprising SEQ ID NOs: 1 and 2) to PD-l as
determined by Surface Plasma Resonance and bind to PD-l sing CHO cells
Kinetic Parameters (SPR) PD-l expressing
CHO cells
S Kassoc (MSI Kdissoc (S— ) KD ECSO (HM)
(11M)
HumanPD-l 5.7x10 1.7x10
CHO=Chinese hamster ovary; cyno=cynomolgus monkey, EC50= half-maximal effective concentration;
Kassoc=association rate constant; KD=dissociation constant; Kdissoc=dissociation rate constant;
PD—1=programmed cell death—1; SPR: e plasma resonance.
In some ments, antagonist activity of a PD-l-binding agent in blocking the
PD-l/PD-Ll or PD—L2 interaction may be confirmed or determined using a flow cytometry-
based assay that ed g of labeled PD-Ll and PD-L2 expressed as a mouse IgGl
Fc fusion proteins (PD-Ll ch or PD-L2 ch) to PD-l—expressing cells. In some
embodiments, a PD—l-binding agent can efficiently block PD—l/PD-Ll and PD-l/PD—L2
binding compared to an IgG4 isotype control.
In some embodiments, a PD-l-binding agent can effectively neutralize PD—l
activity (e.g., can inhibit binding of PD-l to PD-Ll and PD-L2). In some ments,
functional antagonist activity of a PD—l-binding agent may be confirmed or determined in a
mixed lymphocyte reaction (MLR) demonstrating ed interleukin (IL)—2 production
upon addition of a PD-l-binding agent. In some embodiments, a MLR assay may be carried
out using primary human CD4+ T cells as responders and human dendritic cells as
stimulators.
Expression and Formulation
In some embodiments, a PD-l—binding agent is expressed from a vector
comprising one or more nucleic acid sequences. In some embodiments, a PD-l-binding
agent comprises an immunoglobulin heavy chain polypeptide that is encoded by a tide
sequence which comprises SEQ ID NO: 5.
SEQ ID NO: 5 —
GAG GTG CAG CTG TTG GAG TCT GGG GGA GGC TTG GTA CAG CCT GGG
GGG TCC CTG AGA CTC TCC TGT GCA GCC TCT GGA TTC ACT TTC AGT
AGC TAT GAC ATG TCT TGG GTC CGC CAG GCT CCA GGG AAG GGG CTG
GAG TGG GTC TCA ACC ATT AGT GGT GGT GGT AGT TAC ACC TAC TAT
CAA GAC AGT GTG AAG GGG CGG TTC ACC ATC TCC AGA GAC AAT TCC
AAG AAC ACG CTG TAT CTG CAA ATG AAC AGC CTG AGA GCC GAG
GAC ACG GCC GTA TAT TAC TGT GCG TCC CCT TAC TAT GCT ATG GAC
TAC TGG GGG CAA GGG ACC ACG GTC ACC GTC TCC TCA GCA TCC ACC
AAG GGC CCA TCG GTC TTC CCG CTA GCA CCC TGC TCC AGG AGC ACC
TCC GAG AGC ACA GCC GCC CTG GGC TGC CTG GTC AAG GAC TAC TTC
CCC GAA CCA GTG ACG GTG TCG TGG AAC TCA GGC GCC CTG ACC AGC
GGC GTG CAC ACC TTC CCG GCT GTC CTA CAG TCC TCA GGA CTC TAC
TCC CTC AGC AGC GTG GTG ACC GTG CCC TCC AGC AGC TTG GGC ACG
AAG ACC TAC ACC TGC AAC GTA GAT CAC AAG CCC AGC AAC ACC
AAG GTG GAC AAG AGA GTT GAG TCC AAA TAT GGT CCC CCA TGC CCA
CCA TGC CCA GCA CCT GAG TTC CTG GGG GGA CCA TCA GTC TTC CTG
TTC CCC CCA AAA CCC AAG GAC ACT CTC ATG ATC TCC CGG ACC CCT
GAG GTC ACG TGC GTG GTG GTG GAC GTG AGC CAG GAA GAC CCC
GAG GTC CAG TTC AAC TGG TAC GTG GAT GGC GTG GAG GTG CAT AAT
GCC AAG ACA AAG CCG CGG GAG GAG CAG TTC AAC AGC ACG TAC
CGT GTG GTC AGC GTC CTC ACC GTC CTG CAC CAG GAC TGG CTG AAC
GGC AAG GAG TAC AAG TGC AAG GTC TCC AAC AAA GGC CTC CCG TCC
TCC ATC GAG AAA ACC ATC TCC AAA GCC AAA GGG CAG CCC CGA
GAG CCA CAG GTG TAC ACC CTG CCC CCA TCC CAG GAG GAG ATG ACC
AAG AAC CAG GTC AGC CTG ACC TGC CTG GTC AAA GGC TTC TAC CCC
AGC GAC ATC GCC GTG GAG TGG GAG AGC AAT GGG CAG CCG GAG
AAC AAC TAC AAG ACC ACG CCT CCC GTG CTG GAC TCC GAC GGC TCC
TTC TTC CTC TAC AGC AGG CTA ACC GTG GAC AAG AGC AGG TGG CAG
GAG GGG AAT GTC TTC TCA TGC TCC GTG ATG CAT GAG GCT CTG CAC
AAC CAC TAC ACA CAG AAG AGC CTC TCC CTG TCT CTG GGT AAA
WO 29559
In some embodiments, a PD-l-binding agent comprises an immunoglobulin light
chain polypeptide that is encoded by a nucleotide sequence which ses SEQ ID NO: 6.
SEQ ID NO: 6 —
GAC ATC CAG TTG ACC CAG TCT CCA TCC TTC CTG TCT GCA TAT GTA
GGA GAC AGA GTC ACC ATC ACT TGC AAG GCC AGT CAG GAT GTG GGT
ACT GCT GTA GCC TGG TAT CAG CAA AAA CCA GGG AAA GCC CCT AAG
CTC CTG ATC TAT TGG GCA TCC ACC CTG CAC ACT GGG GTC CCA TCA
AGG TTC AGC GGC AGT GGA TCT GGG ACA GAA TTC ACT CTC ACA ATC
AGC AGC CTG CAG CCT GAA GAT TTT GCA ACT TAT TAC TGT CAG CAT
TAT AGC AGC TAT CCG TGG ACG TTT GGC CAG GGG ACC AAG CTG GAG
ATC AAA CGG ACT GTG GCT GCA CCA TCT GTC TTC ATC TTC CCG CCA
TCT GAT GAG CAA TTG AAA TCT GGA ACT GCC TCT GTT GTG TGC CTG
CTG AAT AAC TTC TAT CCC AGA GAG GCC AAA GTA CAG TGG AAG GTG
GAT AAC GCC CTC CAA TCG GGT AAC TCC CAG GAG AGT GTC ACA GAG
CAG GAC AGC AAG GAC AGC ACC TAC AGC CTC AGC AGC ACC CTG
ACG CTG AGC AAA GCA GAC TAC GAG AAA CAC AAA GTC TAC GCC
TGC GAA GTC ACC CAT CAG GGC CTC AGC TCG CCC GTC ACA AAG AGC
TTC AAC AGG GGA GAG TGT
In some embodiments, a PD-l binding agent is sed from a vector
comprising one or more nucleic acid sequences encoding a PD—1-binding immunoglobulin
heavy chain variable domain polypeptide and/or a PD-l-binding immunoglobulin light chain
variable domain polypeptide. In some embodiments, a PD-1 binding agent is expressed from
a vector sing one or more nucleic acid sequences encoding a inding
immunoglobulin heavy chain polypeptide andfor a PD-l—binding immunoglobulin light chain
polypeptide. The vector can be, for example, a plasmid, episome, , viral vector (e.g.,
retroviral or adenoviral), or phage. Suitable vectors and methods of vector preparation are
well known in the art (see, e.g., Sambrook et al., Molecular Cloning, a Laboratory Manual,
3rd edition, Cold Spring Harbor Press, Cold Spring Harbor, NY. (2001), and Ausubel et a1,
Current ols in Molecular Biology, Greene Publishing ates and John Wiley &
Sons, New York, NY. (1994)).
In some embodiment, vector(s) for expression of PDbinding agents further
comprises expression control sequences, such as promoters, enhancers, polyadenylation
s, transcription terminators, internal ribosome entry sites (IRES), and the like, that
provide for the expression of the coding sequence in a host cell. Exemplary expression
control ces are known in the art and described in, for example, Goeddel, Gene
Expression Technology: Methods in Enzymology, Vol. 185, Academic Press, San Diego,
Calif. (1990).
The vector(s) comprising the nucleic ) encoding PD-l—binding agents of the
present disclosure can be introduced into a host cell that is capable of expressing the
polypeptides encoded y, including any suitable prokaryotic or eukaryotic cell. Some
preferable qualities of host cells include easy and reliable growth, a reasonably fast growth
rate, having well-characterized expression systems, and/or ease/efficient transformation or
transfection.
In some embodiments, mammalian cells are utilized. A number of suitable
mammalian host cells are known in the art, and many are ble from the American Type
Culture Collection (ATCC, Manassas, VA). Examples of suitable mammalian cells include,
but are not limited to, Chinese hamster ovary cells (CHO) (ATCC No. CCL61), CHO DHFR-
cells b et al, Proc. Natl. Acad. Sci. USA, 97: 4216-4220 (1980)), human embryonic
kidney (HEK) 293 or 293T cells (ATCC No. 3), and 3T3 cells (ATCC No. .
Other suitable mammalian cell lines are the monkey COS-1 (ATCC No. CRL1650) and COS-
7 cell lines (ATCC No. CRL1651), as well as the CV-l cell line (ATCC No. CCL70).
Further exemplary ian host cells include primate cell lines and rodent cell
lines, including transformed cell lines. Normal diploid cells, cell strains derived from in Vitro
culture of primary tissue, as well as primary explants, are also suitable. Other le
ian cell lines include, but are not limited to, mouse neuroblastoma N2A cells, HeLa,
mouse L-929 cells, and BHK or HaK hamster cell lines, all of which are available from the
ATCC. Methods for selecting le mammalian host cells and methods for transformation,
culture, amplification, ing, and purification of cells are known in the art.
In some embodiments, the mammalian cell is a human cell. For example, the
mammalian cell can be a human lymphoid or id derived cell line, such as a cell line of
pre—B lymphocyte origin. Examples of human lymphoid cells lines e, without
limitation, RAMOS (CRL-1596), Daudi (CCL—213), EB-3 (CCL—85), DT40 (CRL—2111), 18-
81 (Jack et al, Proc. Natl. Acad. Sci. USA, 85: 1581-1585 (1988)), Raji cells (CCL-86), and
derivatives thereof.
In some embodiments, a PD-l-binding agent is formulated as a pharmaceutical
composition, ning one or a combination of monoclonal antibodies, or antigen-binding
portion(s) thereof, formulated with a pharmaceutically acceptable carrier. An anti-PD—l
antibody agent may be formulated alone or in combination with other drugs (e.g., as an
adjuvant). For example, a PD—l—binding agent can be administered in combination with other
agents for the treatment or prevention of the es disclosed herein (e.g., cancer).
Therapeutic compositions typically must be sterile and stable under the
conditions of manufacture and storage. The composition can be formulated as a solution,
microemulsion, liposome, or other ordered structure suitable to high drug concentration. The
carrier can be a solvent or dispersion medium containing, for e, water, ethanol, polyol
(for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and
le es thereof. The proper fluidity can be maintained, for example, by the use of a
coating such as lecithin, by the maintenance of the ed particle size in the case of
dispersion and by the use of surfactants. In many cases, it may be useful to include isotonic
agents, for example, sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride in the
composition. Prolonged absorption of the inj ectable compositions can be brought about by
including in the composition an agent that delays absorption, for example, monostearate salts
and gelatin.
] Sterile injectable solutions can be prepared by incorporating the active
compound in the required amount in an appropriate solvent with one or a combination of
ingredients enumerated above, as required, followed by ization microfiltration.
Generally, dispersions are prepared by incorporating the active compound into a sterile
vehicle that contains a basic dispersion medium and the required other ingredients from those
enumerated above. In the ease of sterile powders is the preparation of e injectable
ons, such methods of preparation may include vacuum drying and freeze-drying
(lyophilization) to yield a powder of the active ient plus any additional desired
ingredient from a previously sterile-filtered solution thereof.
In some embodiments, a therapeutic composition is ated as a sterile liquid.
In some embodiments, the composition is free from visible particles. In some embodiments,
the composition is formulated in a buffer (e.g., a citrate buffer). In some embodiments, the
composition comprises a inding agent and two or more of the following: citrate,
arginine, sodium chloride and rbate 80.
In some embodiments, a therapeutic composition of the present disclosure (e.g., a
PD—l binding agent) is aseptically filled into a clear glass vial. In some embodiments, such a
glass vial is stoppered with a chlorobutyl elastomer stopper laminated with fluoropolymer
and sealed with an aluminum oversea].
In some ments, a PD-l binding agent is stored at 2-8 °C. In some
ments, a drug product of the present disclosure is free of preservatives.
General Protocol
As described herein, provided methods comprise administering a PD—l g
agent to a patient, a subject, or a population of subjects according to a regimen that achieves
clinical benefit.
ed methods can e various benefits (e.g., a al benefit). In
embodiments, a method described herein achieves a clinical benefit. In embodiments, a
clinical benefit is stable disease (SD). In embodiments, a clinical benefit is a partial response
(PR). IN embodiments, a clinical benefit is a complete se (CR).
In embodiments, a combination therapy achieves a clinical benefit for each
therapy administered to a patient. For example, a combination therapy may improve a
clinical benefit obtained with a PD—l inhibitor (e. g., any anti-PD-l antibody described
herein).
In embodiments, a patient or subject is an animal. In embodiments, a patient or
subject is a human.
In some embodiments, the regimen comprises at least one parental dose of a PD-l
binding agent. In some embodiments, the regimen comprises a plurality of parental doses.
In some embodiments, the al dose is an amount of a PD-l binding agent is
within a range of about 5 to about 5000 mg (e.g., about 5 mg, about 10 mg, about 50 mg,
about 100 mg, about 200 mg, about 300 mg, about 400 mg, about 500 mg, about 600 mg,
about 700 mg, about 800 mg, about 900 mg, about 1000 mg, about 1100 mg, about 1200 mg,
about 1300 mg, about 1400 mg, about 1500 mg, about 2000 mg, about 3000 mg, about 4000
mg, about 5000 mg, or a range defined by any two of the ing values). In some
embodiments, the parental dose of a PD-l g agent is 500 mg or 1000 mg.
In some embodiments, the dose is in an amount relative to body weight. In some
ments, the parental dose of a PD-l binding agent is within a range of about 0.01
mgikg to 100 mg/kg of animal or human body weight; however, doses below or above this
exemplary range are within the scope of the invention. The daily parenteral dose can be about
0.01 mg/kg to about 50 mg/kg of total body weight (e.g., about 0.1 mg/kg, about 0.5 mgikg,
about 1 mg/kg, about 2 mg/kg, about 3 mg/kg, about 4 mg/kg, about 5 mg/kg, about 6 mg/kg,
about 7 mgfkg, about 8 mg/kg, about 9 mg/kg, about 10 mg/kg, about 12 mg/kg, about 15
mg/kg, about 20 mg/kg, or a range defined by any two of the foregoing values).
] In some ments, a composition that delivers a PD-1—binding agent (e.g., an
anti-PD-l antibody) is administered to a patient at a dose of about 1, 3 or 10 mg/kg. In some
embodiments, a PD—l-binding agent (e.g., an anti-PD—l antibody) is administered according
to a regimen that delivers a dose of about 1, 3 or 10 mg/kg every two weeks. In some
embodiments, a PD—l-binding agent (e.g., an anti-PD—l antibody) is stered according
to a regimen that delivers a dose of about 1, 3 or 10 mg/kg every three weeks. In some
embodiments, a inding agent (e.g., an anti-PD—l antibody) is administered according
to a n that delivers a dose of about 1, 3 or 10 mg/kg every four weeks. In some
ments, a PD-l-binding agent (e.g., an anti-PD—l antibody) is administered ing
to a regimen that delivers a dose of about 1 mg/kg every three weeks. In some embodiments,
a PD-l-binding agent (e.g., an anti-PD-l antibody) is administered according to a regimen
that rs a dose of about 3 mg/kg every three weeks. In some embodiments, a PD—l-
binding agent (e.g., an anti-PD-l antibody) is administered ing to a regimen that
delivers a dose of about 10 mg/kg every three weeks.
In some embodiments, a composition that delivers a PD-l-binding agent (e.g., an
anti—PD-l antibody) is administered to a patient at a dose of about 400 mg. In some
embodiments, a PD-l-binding agent (e.g., an D—l antibody) is administered according
to a regimen that delivers a dose of about 400 mg every two weeks. In some embodiments, a
PD-l-binding agent (e.g., an anti-PD—l antibody) is administered according to a regimen that
delivers a dose of about 400 mg every three weeks. In some embodiments, a PD-l-binding
agent (e.g., an anti—PD-l antibody) is administered according to a regimen that delivers a
dose of about 400 mg every four weeks.
In some embodiments, a composition that delivers a PD-l-binding agent (e.g., an
anti—PD-l antibody) is stered to a t at a dose of about 500 mg. In some
embodiments, a PD-l-binding agent (e.g., an anti-PD-l antibody) is administered according
to a regimen that delivers a dose of about 500 mg every two weeks. In some embodiments, a
PD-l-binding agent (e.g., an anti-PD—l antibody) is administered according to a regimen that
delivers a dose of about 500 mg every three weeks. In some embodiments, a PD—l-binding
agent (e.g., an D-l antibody) is administered according to a regimen that delivers a
dose of about 500 mg every four weeks.
In some embodiments, a composition that delivers a PD-l-binding agent (e.g., an
anti—PD-l antibody) is administered to a patient at a dose of about 800 mg. In some
embodiments, a PD—l-binding agent (e.g., an anti-PD-l dy) is administered according
to a regimen that delivers a dose of about 800 mg every three weeks. In some embodiments,
a inding agent (e.g., an anti-PD-l antibody) is stered according to a regimen
that delivers a dose of about 800 mg every four weeks. In some embodiments, a PD—l—
binding agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a dose of about 800 mg every six weeks. In some embodiments, a PDbinding
agent (e.g., an anti—PD-l antibody) is stered according to a n that delivers a
dose of about 800 mg every eight weeks.
In some embodiments, a composition that delivers a PDbinding agent (e.g., an
anti-PD-l antibody) is administered to a patient at a dose of about 1,000 mg. In some
embodiments, a PDbinding agent (e.g., an anti-PD—l antibody) is administered according
to a regimen that delivers a dose of about 1,000 mg every three weeks. In some
embodiments, a PDbinding agent (e.g., an anti-PD—l antibody) is administered according
to a regimen that delivers a dose of about 1,000 mg every four weeks. In some embodiments,
a PD-l-binding agent (e.g., an anti-PD-l antibody) is administered according to a regimen
that delivers a dose of about 1,000 mg every five weeks. In some embodiments, a PD—1-
binding agent (e.g., an anti-PD-1 antibody) is administered according to a regimen that
rs a dose of about 1,000 mg every six weeks. In some ments, a PDbinding
agent (e.g., an anti—PD-1 antibody) is administered according to a regimen that delivers a
dose of about 1,000 mg every seven weeks. In some embodiments, a PDbinding agent
(e.g., an anti-PD-l dy) is administered according to a regimen that delivers a dose of
about 1,000 mg every eight weeks. In some embodiments, a inding agent (e.g., an
anti-PD-l antibody) is administered according to a regimen that delivers a dose of about
1,000 mg every nine weeks.
In some embodiments, a PD—1-binding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that delivers a dose of about 500 mg every three weeks.
In some embodiments, a PDbinding agent (e.g., an anti-PD—l antibody) is administered
according to a regimen that rs a dose of about 1000 mg every six weeks.
In some embodiments, a PD—1-binding agent (e.g., an anti-PD-l antibody) is
administered according to a regimen that delivers a first dose of inding agent for the
first 2-6 dosing cycles (e.g., the first 3, 4, or 5 dosing cycles), and then delivers a second dose
of a PD-l-binding agent for the subsequent dosing cycles until y is discontinued (e.g.,
due to disease ssion or an e effect or as directed by a physician). In some
embodiments, the duration of the first set of 2—6 dosing cycles (e. g., the first 3, 4, or 5 dosing
cycles) is different from the duration of the subsequent dosing . In embodiments, a
PD—1—binding agent (e.g., an anti-PD-l antibody) is administered according to a regimen that
delivers a first dose of PD—l—binding agent once every three weeks for the first three dosing
cycles, and then delivers a second dose of a PD-l-binding agent once every six weeks or
more for the remaining dosing cycles (e. g., a second dose of a PD-l-binding agent once every
six weeks for the remaining dosing cycles). In embodiments, a PD-l-binding agent (e.g., an
anti-PD-l antibody) is administered according to a regimen that delivers a first dose of PD—1-
binding agent once every three weeks for the first four dosing cycles, and then delivers a
second dose of a PDbinding agent once every six weeks or more for the remaining dosing
cycles (e.g., a second dose of a PD-l—binding agent once every six weeks for the remaining
dosing cycles). In embodiments, a PDbinding agent (e.g., an anti-PD—l antibody) is
administered ing to a regimen that delivers a first dose of PD-l—binding agent once
every three weeks for the first five dosing cycles, and then delivers a second dose of a PD—1-
binding agent once every six weeks or for the remaining dosing cycles (e.g., a second dose of
a PD-l-binding agent once every six weeks for the remaining dosing ). In some
ments, a inding agent (e.g., an anti-PD-l antibody) is administered according
to a regimen that delivers a first dose of PDbinding agent once every three weeks for the
first 2-6 dosing cycles (e.g., the first 3, 4, or 5 dosing cycles), and then delivers a second dose
of a PD-l-binding agent once every six weeks or until therapy is discontinued (e.g., due to
e progression or an adverse effect or as ed by a physician). In some
embodiments, a PD-l-binding agent (e.g., an D—l antibody) is administered according
to a regimen that delivers a first dose of a PD-l—binding agent once every three weeks for the
first 3, 4, or 5 dosing cycles (e.g., the first 4 dosing cycles), and then delivers a second dose
of a PD-l-binding agent once every six weeks or more until therapy is discontinued (e.g., due
to disease progression or an e effect or as directed by a physician). In embodiments,
the method comprises delivering a second dose of PD-1 binding agent once every six weeks
until therapy is discontinued.
In some embodiments the first and/or second dose of a inding agent (e.g.,
an anti-PD—l antibody) is about 100 mg to about 2,000 mg (e.g., about 100 mg, about 200
mg, about 300 mg, about 400 mg, about 500 mg, about 600 mg, about 700 mg, about 800 mg,
about 900 mg, about 1000 mg, about 1100 mg, about 1200 mg, about 1300 mg, about 1400
mg, about 1500 mg, about 1600 mg, about 1700 mg, about 1800 mg, about 1900 mg, or about
2000 mg). In some embodiments the first dose and the second dose are the same. In some
embodiments, the first dose and the second dose are different. In embodiments, the first dose
is about 500 mg of a PD—1-binding agent (e.g., an anti-PD-l antibody). In embodiments, the
first dose is about 1000 mg of a PD-l—binding agent (e.g., an anti—PD—l antibody).
In some embodiments, a PD—l-binding agent (e.g., an anti-PD-l antibody) is
stered according to a regimen that comprises administering an about 500 mg dose
every 3 weeks for four doses followed by administering at least one about 1,000 mg dose
every six weeks after the fourth dose of about 500 mg. In some embodiments, onal
about 1,000 mg doses are administered every six weeks after the first about 1000 mg dose
until no r al t is achieved. In some particular ments, a PD-1 binding
agent (e.g., an anti—PD1 antibody) is administered according to a dosing regimen that includes
500 mg for 4 cycles Q3W followed by 1000 mg Q6W.
In some embodiments, a PD—1-binding agent (e.g., an anti-PD-1 antibody) is
administered according to a regimen that comprises administering a 400 mg dose every 3
weeks for four doses followed by administering at least one 800 mg dose every six weeks
after the fourth 400 mg dose. In some embodiments, additional 800 mg doses are
administered every six weeks after the first 800 mg dose until no further clinical benefit is
achieved. In some particular embodiments, a PD-1 binding agent (e.g., an anti-PD1
antibody) is administered according to a g regimen that includes 400 mg for 4 cycles
Q3W followed by 800 mg Q6W.
Therapeutic or prophylactic efficacy can be monitored by periodic assessment of
treated patients. For ed administrations over several days or longer, depending on the
condition, the treatment can be repeated until a desired suppression of disease symptoms
occurs. However, other dosage regimens may be useful and are within the scope of the
invention.
The desired dosage can be delivered by a single bolus stration of the
composition, by multiple bolus administrations of the composition, or by continuous infusion
stration of the composition.
In some embodiments, a PD-1 binding agent is administered to a patient or
tion of subjects who has exhibited response to prior therapy. In some embodiments,
the patient or population of subjects has exhibited response to a prior cancer therapy.
In some embodiments, a PD-1 binding agent is administered to a patient or
population of subjects who has not exhibited response to prior therapy. In some
ments, the patient or population of subjects has not received or exhibited response to a
prior cancer therapy.
In embodiments, a subject is resistant to ent with an agent that inhibits PD-
1. In embodiments, a subject is is tory to ent with an agent that inhibits PD-l. In
embodiments, a method described herein sensitizes the subject to treatment with an agent that
inhibits PD—l.
In embodiments, an anti—PD-l therapy as described herein is administered in
combination with one or more additional therapies (e. g., therapies as described herein). That
is, a subject is treated with an anti—PD-l therapy and one or more additional therapies is
administered to a subject such that the subject receives each therapy.
In ments, an additional therapy is surgery. In embodiments, an additional
therapy is radiotherapy. In embodiments, an additional therapy is chemotherapy. In
ments, an additional therapy is immunotherapy.
In some embodiments, a PD-l binding agent is administered aneously or
sequentially with an additional therapeutic agent, such as, for example, another antibody
agent (e. g., an antibody agent that binds to lymphocyte—activation gene 3 (LAG-3) or T-cell
immunoglobulin domain and mucin domain 3 protein (TIM-3)) and/or a herapeutic
agent (e. g., niraparib). In some embodiments, a PD-l binding agent is administered before,
, or after administration of an additional therapeutic agent. In some embodiments, a
PD—l binding agent is stered before, during, or after administration of a
chemotherapeutic agent (e.g., niraparib).
] An anti-PD-l antibody agent may be administered alone or in combination with
other drugs (e.g., as an adjuvant). For example, the PD—l binding agent can be administered in
combination with other agents for the treatment or tion of the diseases disclosed herein
(e.g., cancer). In this respect, the PD—l binding agent can be used in combination with at least
one other anticancer agent including, for example, any chemotherapeutic agent known in the
art, ionization radiation, small molecule anticancer agents, cancer vaccines, biological
ies (e.g., other monoclonal antibodies, —killing viruses, gene therapy, and
adoptive T—cell transfer), and/or surgery.
Administration of a PD-1 binding agent simultaneously or tially with an
additional therapeutic agent is ed to herein as “combination therapy.” In combination
therapy, a PD-l g agent can be administered prior to (e.g., 5 minutes, 15 minutes, 30
minutes, 45 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, 24 hours, 48, hours, 72
hours, 96 hours, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 8 weeks, or 12 weeks
before), concurrently with, or subsequent to (e.g., 5 minutes, 15 s, 30 minutes, 45
minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours, 96 hours, 1
week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 8 weeks, or 12 weeks after) the
administration of the additional therapeutic agent to a subject in need thereof. In some
embodiments a PD-l binding agent and an additional therapeutic agent are administered 1
minute apart, 10 minutes apart, 30 minutes apart, less than 1 hour apart, 1 hour to 2 hours
apart, 2 hours to 3 hours apart, 3 hours to 4 hours apart, 4 hours to 5 hours apart, 5 hours to 6
hours apart, 6 hours to 7 hours apart, 7 hours to 8 hours apart, 8 hours to 9 hours apart, 9
hours to 10 hours apart, 10 hours to 11 hours apart, 11 hours to 12 hours apart, no more than
24 hours apart, or no more than 48 hours apart.
PARP tors
In embodiments, an additional therapy is a poly (ADP-ribose) polymerase (PARP)
In embodiments, a PARP inhibitor inhibits PARP-1 and/or PARP-2. In some
embodiments, the agent is a small le, a nucleic acid, a polypeptide (e. g., an antibody),
a carbohydrate, a lipid, a metal, or a toxin. In d embodiments, the agent is ABT-767,
AZD 2461, BGB-290, BGP 15, CEP 8983, CEP 9722, DR 2313, E7016, E7449, fluzoparib
(SHR 3162), IMP 4297, IN01001, JPI 289, JPI 547, monoclonal antibody B3-LysPE40
conjugate, MP 124, niraparib (ZEJULA) 27), NU 1025, NU 1064, NU 1076,
NU1085, olaparib (AZD2281), ONO2231, PD 128763, R 503, R554, rucaparib (RUBRACA)
(AG-014699, PF-01367338), SBP 101, SC 101914, simmiparib, talazoparib (BMN-673),
veliparib (ABT-888), W 46, 2-(4-(trifluoromethyl)phenyl)-7,8—dihydro—5H-thiopyrano[4,3-
d]pyrimidinol, and salts or derivatives thereof. In some related embodiments, an agent is
niraparib, olaparib, rucaparib, talazoparib, veliparib, or salts or derivatives thereof. In certain
embodiments, an agent is niraparib or a salt or derivative thereof. In n embodiments, an
agent is ib or a salt or derivative thereof. In certain embodiments, an agent is rucaparib
or a salt or derivative thereof. In certain ments, an agent is talazoparib or a salt or
derivative thereof. In certain embodiments, an agent is veliparib or a salt or derivative
thereof.
Niraparib, (3S)[4-{7-(aminocarbonyl)-2H—indazol—2-yl}phenyl]piperidine, is an
orally available, potent, poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP)-1
and —2 inhibitor. See
(published July 16, 2009), and PCT/US17/40039 (filed June 29, 2017), the ty of each of
which is hereby orated by reference. Niraparib can be ed according to Scheme 1
In some embodiments, niraparib can be prepared as a pharmaceutically acceptable
salt. One of skill in the art will appreciate that such salt forms can exist as solvated or
hydrated polymorphic forms. In some embodiments, niraparib is prepared in the form of a
hydrate.
In n embodiments, niraparib is prepared in the form of a tosylate salt. In
some embodiments, niraparib is prepared in the form of a tosylate monohydrate. The
molecular structure of the tosylate monohydrate salt of niraparib is shown below:
O NH2 O§E¢O
/N\ NH2 ' H20
CH3 (1)
] Niraparib is a potent and selective PARP-1 and PARP-2 inhibitor with inhibitory
tration at 50% of control (IC50) = 3.8 and 2.1 nM, respectively, and is at least 100—fold
selective over other PARP-family members. Niraparib inhibits PARP activity, stimulated as a
result of DNA damage caused by addition of hydrogen peroxide, in various cell lines with an
IC50 and an inhibitory concentration at 90% of control (ICgO) of about 4 and 50 nM,
respectively.
In embodiments, niraparib is administered at a dose equivalent to about 100 mg of
niraparib free base (e.g., a pharmaceutically acceptable salt of niraparib such as niraparib
tosylate monohydrate is administered at a dose lent to about 100 mg of niraparib free
base). In embodiments, niraparib is administered at a dose lent to about 200 mg of
niraparib free base (e.g., a pharmaceutically acceptable salt of niraparib such as niraparib
tosylate monohydrate is administered at a dose equivalent to about 200 mg of niraparib free
base In embodiments, niraparib is administered at a dose equivalent to about 300 mg of
niraparib free base (e.g., a ceutically acceptable salt of niraparib such as niraparib
tosylate monohydrate is administered at a dose equivalent to about 300 mg of niraparib free
base).
Checkpoint tors
In embodiments, an additional therapy is an immunotherapy. In embodiments, an
immunotherapy comprises stration of one or more further immune checkpoint
inhibitors (e.g., administration of one, two, three, four, or more further immune checkpoint
inhibitors).
Exemplary immune checkpoint targets for inhibition include: PD-l (e.g.,
inhibition via D-l, anti-PD-Ll, or D-L2 therapies), CTLA-4, TIM-3, TIGIT,
LAGs (e.g., LAG-3), CEACAM (e.g., CEACAM-1, -3 and/or —5), VISTA, BTLA, LAIRl,
CD160, 2B4, CD80, CD86, B7-H3 (CD276), B7-H4 (VTCN1), HVEM (TNFRSF14 or
, KIR, A2aR, MHC class I, MHC class II, GALS, adenosine, TGFR (e.g., TGFR
beta), B7—H1, B7-H4 (VTCNl), OX-40, CD137, CD40, IDO, and CSF—lR. Accordingly,
agents that inhibit of any of these molecules can be used in combination with an anti-PD-l
therapy described herein.
In embodiments, a checkpoint inhibitor is a small molecule, a c acid, a
polypeptide (e.g., an antibody), a carbohydrate, a lipid, a metal, a toxin, or a binding agent.
In embodiments, a oint inhibitor is an antibody, an antibody conjugate, or an antigen-
binding fragment thereof.
In embodiments, an immune checkpoint inhibitor is an agent that inhibits TIM—3,
, LAG-3, TIGIT, IDO or CSF1R.
In embodiments, an immune checkpoint inhibitor is a TIM-3 inhibitor. In
embodiments, a TIM-3 inhibitor is a TIM-3 binding agent (e.g., an antibody, an antibody
conjugate, or an antigen-binding fragment f). In embodiments, a TIM-3 inhibitor is a
TIM-3 inhibitor described in WO 2016/ , which is hereby incorporated by reference in
its entirety. In embodiments, a TIM-3 inhibitor is TSR—022. For example, a TIM—3 inhibitor
(e.g., TSR-022) can be administered in a dose of about 1, 3 or 10 mg/kg (e.g., about 1 mg/kg;
about 3 mg/kg; or about 10 mg/kg) or a flat dose between about 100 - 1500 mg (e.g., a flat
dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400
mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose
about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100
mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; or a flat
dose about 1500 mg).
In embodiments, an immune checkpoint tor is a CTLA—4 inhibitor (e.g., an
antibody, an antibody conjugate, or an antigen—binding fragment thereof). In ments, a
CTLA-4 tor is a small molecule, a nucleic acid, a polypeptide (e.g., an antibody), a
carbohydrate, a lipid, a metal, or a toxin. In embodiments, a CTLA-4 inhibitor is a small
molecule. In embodiments, a CTLA-4 inhibitor is a CTLA-4 g agent. In
embodiments, a CTLA-4 tor is an antibody, an antibody conjugate, or an antigen-
binding fragment thereof. In embodiments, a CTLA—4 inhibitor is ipilimumab (Yervoy),
AGEN1884, or tremelimumab.
In embodiments, an immune checkpoint inhibitor is a LAG—3 inhibitor (e.g., an
antibody, an antibody ate, or an antigen—binding fragment thereof). In embodiments, a
LAG—3 inhibitor is a small molecule, a nucleic acid, a polypeptide (e.g., an antibody), a
carbohydrate, a lipid, a metal, or a toxin. In embodiments, a LAG—3 inhibitor is a small
molecule. In embodiments, a LAG-3 inhibitor is a LAG-3 binding agent. In embodiments, a
LAG-3 inhibitor is an antibody, an antibody conjugate, or an antigen-binding fragment
thereof. In embodiments, a LAG-3 inhibitor is a IMP321, EMS-986016, GSK2831781,
Novartis LAG525, or a LAG-3 inhibitor described in
In embodiments, an immune checkpoint inhibitor is a TIGIT inhibitor (e.g., an
antibody, an antibody conjugate, or an n—binding fragment thereof). In embodiments, a
TIGIT inhibitor is a small le, a nucleic acid, a polypeptide (e.g., an dy), a
carbohydrate, a lipid, a metal, or a toxin. In ments, a TIGIT inhibitor is small
molecule. In embodiments, a TIGIT inhibitor is a TIGIT binding agent. In ments, a
TIGIT inhibitor is an antibody, an antibody conjugate, or an antigen-binding fragment
thereof. In embodiments, a TIGIT inhibitor is MTIG7192A, 6207, or OMP-31M32.
In embodiments, an immune checkpoint inhibitor is an IDO inhibitor. In
embodiments, an IDO inhibitor is a small molecule, a nucleic acid, a polypeptide (e.g., an
antibody), a carbohydrate, a lipid, a metal, or a toxin. In embodiments, an IDO inhibitor is
small le. In embodiments, an IDO inhibitor is an IDO binding agent. In
embodiments, an IDO inhibitor is an antibody, an antibody conjugate, or an antigen-binding
fragment thereof.
In embodiments, an immune checkpoint inhibitor is a CSFlR inhibitor. In
ments, a CSFlR tor is a small molecule, a nucleic acid, a polypeptide (e. g., an
antibody), a ydrate, a lipid, a metal, or a toxin. In embodiments, a CSFlR inhibitor is
small molecule. In embodiments, a CSFlR inhibitor is a CSFlR binding agent. In
embodiments, a CSFlR inhibitor is an antibody, an antibody conjugate, or an n-binding
fragment thereof.
In ments, a checkpoint inhibitor (e. g., a TIM—3 inhibitor such as TSR-022)
can be administered in a dose of about 1, 3 or 10 mg/kg (e.g., about 1 mg/kg; about 3 mg/kg;
or about 10 mg/kg) or a flat dose between about 100 — 1500 mg (e.g., a flat dose about 100
mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose
about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg;
a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose
about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; or a flat dose about
1500 mg).
In embodiments, an anti—PD-l agent is administered in combination with at least
one additional immune checkpoint inhibitor or at least two or at least three additional
checkpoint inhibitors. In embodiments, a PARP inhibitor is further administered.
In embodiments, an anti-PD-l agent is administered in combination with a TIM-3
inhibitor, and a LAG-3 inhibitor. In embodiments, an anti-PD-l agent is administered in
combination with a TIM-3 tor, a LAG-3 inhibitor, and a CTLA-4 inhibitor.
In embodiments, an anti-PD-l agent is stered in combination with a LAG-3
inhibitor and a PARP inhibitor (e.g., rib). In embodiments, an anti-PD—l agent is
administered in combination with a TIM-3 inhibitor, a LAG-3 inhibitor and a PARP inhibitor
(e.g., niraparib).
For female patients of childbearing potential, it is preferable that the patient have
a negative serum pregnancy test within 72 hours prior to the date of administration of the first
dose of an anti-PD-l binding agent. It is also preferable that female patients of childbearing
potential and male patients agree to use 2 adequate methods of contraception with their
partner. In some embodiments, a t agrees to use 2 methods of contraception starting
with the screening visit through 150 days after the last dose of study therapy.
Measuring Tumor Response
] In some embodiments, a clinical benefit is a te response (“CR”), a partial
response (“PR”) or a stable e (“SD”). In some embodiments, a clinical benefit
corresponds to at least SD. In some embodiments, a clinical benefit corresponds to at least a
PR. In some ments, a clinical benefit corresponds to a CR. In some embodiments, at
least 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%,
55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 95% of patients achieve a al benefit. In
some ments, at least 5% of patients achieve a clinical benefit. In some embodiments,
at least 5% of patients achieve SD. In some embodiments, at least 5% of patients achieve at
least a PR. In some ments, at least 5% of patients achieve CR. In some
embodiments, at least 20% of patients achieve a al benefit. In some embodiments, at
least 20% of patients e SD.
In some embodiments, the clinical benefit (e.g., SD, PR and/or CR) is determined
in accordance with Response Evaluation Criteria in Solid Tumors (RECIST). In some
embodiments, the clinical benefit (e.g., SD, PR and/or CR) is determined in ance
RECIST guidelines.
In some embodiments, tumor response can be measured by, for e, the
RECIST V 1.1 guidelines. The guidelines are provided by EA. Eisenhauer, et al., “New
response evaluation criteria in solid tumors: Revised RECIST guideline (version 1.1),” Eur.
J. of Cancer, 45: 228-247 (2009), which is incorporated by reference in its entirety. In some
embodiments, RECIST guidelines may serve as a basis for all protocol guidelines related to
disease status. In some embodiments, RECIST guidelines are used to assess tumor response
to treatment and/or date of disease progression.
RECIST guidelines require, first, estimation of the overall tumor burden at
baseline, which is used as a comparator for subsequent measurements. Tumors can be
measured via use of any imaging system known in the art, for example, by a CT scan, or an
X—ray. able disease is defined by the presence of at least one able lesion. In
studies where the primary endpoint is tumor progression (either time to progression or
proportion with progression at a fixed date), the protocol must specify if entry is cted to
those with measurable disease or whether patients having non—measurable disease only are
also eligible.
] When more than one measurable lesion is present at baseline, all lesions up to a
maximum of five lesions total (and a maximum of two lesions per organ) representative of all
involved organs should be identified as target lesions and will be recorded and measured at
baseline (this means in instances where patients have only one or two organ sites involved a
maximum of two and four lesions respectively will be recorded).
Target s should be ed on the basis of their size (lesions with the
longest diameter), be entative of all involved organs, but in addition should be those
that lend themselves to reproducible repeated measurements.
Lymph nodes merit special mention since they are normal ical structures
which may be visible by imaging even if not involved by tumor. Pathological nodes which
are defined as measurable and may be identified as target s must meet the criterion of a
short axis of P15 mm by CT scan. Only the short axis of these nodes will contribute to the
baseline sum. The short axis of the node is the diameter normally used by radiologists to
judge if a node is involved by solid tumor. Nodal size is normally ed as two dimensions
in the plane in which the image is ed (for CT scan this is almost always the axial plane;
for MRI the plane of acquisition may be axial, saggital or coronal). The smaller of these
measures is the short axis.
] For example, an abdominal node which is ed as being 20mm. 30mm has a
short axis of 20mm and qualifies as a malignant, measurable node. In this example, 20mm
should be recorded as the node measurement. All other pathological nodes (those with short
axis P10mm but <15 m) should be considered non-target lesions. Nodes that have a short
axis <10mm are considered non-pathological and should not be recorded or followed.
A sum of the diameters (longest for dal lesions, short axis for nodal
lesions) for all target lesions will be calculated and reported as the baseline sum ers. If
lymph nodes are to be included in the sum, then as noted above, only the short axis is added
into the sum. The baseline sum diameters will be used as reference to further characterize any
objective tumor regression in the measurable dimension of the disease.
All other lesions (or sites of disease) including pathological lymph nodes should
be identified as non-target lesions and should also be recorded at baseline. Measurements are
not ed and these lesions should be followed as ‘present’, ‘absent’, or in rare cases
‘unequivocal progression.’ In addition, it is possible to record multiple nontarget lesions
involving the same organ as a single item on the case record form (e.g., ple enlarged
pelvic lymph nodes’ or ‘multiple liver metastases’).
In some embodiments, tumor se can be measured by, for example, the
immune-related RECIST (irRECIST) ines, which include immune related Response
Criteria (irRC). In irRC, measurable lesions are measured that have at least one dimension
with a m size of 10 mm (in the longest diameter by CT or MRI scan) for nonnodal
lesions and greater than or equal to 15 mm for nodal lesions, or at least 20 mm by chest X-
In some embodiments, Immune Related Response ia include CR (complete
disappearance of all lesions (measurable or not, and no new lesions)); PR (decrease in tumor
burden by 50% or more ve to baseline); SD (not meeting criteria for CR or PR in the
absence of PD); or PD (an se in tumor burden of at 25% or more relative to nadir).
Detailed description of irRECIST can be found at Bohnsack et al., (2014) ESMO,
ABSTRACT 4958 and Nishino et al., (2013) Clin. Cancer Res. 19(14): 3936-43.
In some embodiments, tumor response can be assessed by either irRECIST or
RECIST version 1.1. In some ments, tumor response can be ed by both
irRECIST and RECIST version 1.1.
Pharmacokinetics
Pharmacokinetic data can be obtained by known techniques in the art. Due to
the inherent ion in pharmacokinetic and pharmacodynamic parameters of drug
metabolism in human subjects, appropriate cokinetic and pharmacodynamic e
components describing a particular ition can vary. Typically, pharmacokinetic and
pharmacodynamic es are based on the determination of the mean parameters of a group
of ts. The group of subjects includes any reasonable number of subjects suitable for
determining a representative mean, for example, 5 subjects, 10 subjects, 16 subjects, 20
subjects, 25 subjects, 30 subjects, 35 subjects, or more. The mean is determined by
calculating the average of all subject’s measurements for each parameter measured.
In some embodiments, a patient population includes one or more ts (“a
population of subjects”) suffering from metastatic disease.
In some embodiments, a patient population includes one or more subjects that
is suffering from or susceptible to cancer. In some embodiments, the cancer is a head and
neck , a lung cancer (e.g., a non-small cell lung cancer (NSCLC)), a renal cancer, a
bladder cancer, a melanoma, Merkel cell carcinoma, a cervical cancer, a vaginal cancer, a
vulvar cancer, a uterine cancer, a endometrial cancer, an ovarian cancer, a fallopian tube
cancer, a breast cancer, a prostate cancer, a salivary gland tumor, a thymoma, a
adrenocortical carcinoma, a esophageal , a gastric cancer, a colorectal cancer, an
appendiceal cancer, a urothelial cell carcinoma, or a squamous cell carcinoma (e.g., of the
lung; of the anogenital region including anus, penis, cervix, vagina, or vulva; or of the
gus). In some certain embodiments, the cancer is endometrial cancer, NSCLC, renal
, melanoma, cervical , squamous cell carcinoma (e.g., of the lung) or colorectal
cancer. In some embodiments, a patient population includes one or more subjects (e.g.,
comprises or consists of subjects) suffering from cancer. For example, in some
embodiments, a patient population suffering from cancer may have previously been treated
with a prior therapy, for example, radiation and/or chemotherapy.
In some ments, the pharmacokinetic ter(s) can be any
parameters suitable for describing the present composition. For example, in some
embodiments, the Cmax is about 1 rig/ml; about 5 ug/ml, about 10 ug/ml, about 15 ug/ml,
about 20 ug/ml, about 25 ugfml, about 30 ugi'ml, about 35 ug/ml, about 40 ug/ml, about 45
ug/ml, about 50 ug/ml, about 55 ug/ml, about 60 ug/ml, about 65 ug/ml, about 70 ug/ml,
about 75 ug/ml, about 80 rig/ml, about 85 ug/ml, about 90 ug/ml, about 95 ug/ml, about 100
ug/ml, about 150 ug/ml, about 200 ug/ml, about 250 ug/ml, about 300 ug/ml, or any other
Cmax appropriate for describing a pharmacokinetic profile of a PD—l g agent.
] In some embodiments, the Tmx is, for example, not greater than about 0.5
hours, not greater than about 1.0 hours, not greater than about 1.5 hours, not greater than
about 2.0 hours, not greater than about 2.5 hours, or not greater than about 3.0 hours, or any
other Tmax appropriate for describing a pharmacokinetic profile of a PD-l binding agent.
In general, AUC as described herein is the measure of the area under the curve
that corresponds to the concentration of an analyte over a selected time period following
administration of a dose of a therapeutic agent. In some embodiments, such time period
begins at the dose administration (i.e., 0 hours after dose administration) and extends for
about 2, about 6, about 12, about 36, about 48, about 72, about 168, about 336, about 514,
about 682, or more hours after the dose administration. In some embodiments, AUC is that
achieved from 0 hours to 336 hours following administration of a dose described herein.
The AUC(0_336h) can be, for example, about 500 ug-hr/mL, about 1000 ugOhr/mL,
about 1500 ugOhr/mL, about 2000 ug-hr/mL, about 2500 ugOhr/mL, about 3000 ugOhr/mL,
about 3500 ugOhr/mL, about 4000 ugOhr/mL, about 4500 ug-hr/mL, about 5000 mL,
about 7500 ugOhr/mL, about 10,000 ugOhr/mL, about 15,000 ugOhr/mL, about 20,000
ugOhr/mL, about 25,000 ug-hr/mL, about 30,000 ug-hr/mL, about 35,000 ugOhr/mL, about
40,000 ug-hr/mL, about 45,000 ugOhr/mL, about 50,000 ugOhr/mL, about 65,000 ugOhr/mL,
about 75,000 ug-hr/mL, about 90,000 ug-hr/mL, or any other AUC(0_336h) appropriate for
describing a pharmacokinetic profile of a therapeutic agent (e.g., a PD—1 binding agent). In
some embodiments, a PD-l—binding agent (e.g., an anti-PD—l antibody) is administered
according to a regimen that is demonstrated to achieve an average AUC0_336h of PD-l-binding
agent concentration-time curve in a patient tion that is within 2500 h*ug/mL to 50000
h*ug/mL. In some embodiments, the regimen is trated to achieve an average AUC0_
33611 of inding agent concentration-time curve in a patient population that is about 3400
h*ug/mL, about 11000 h*ug/mL, or about 36800 h*ug/mL.
In some embodiments, the AUC from 0 hours to the end of the dosing period is
determined (AUC(0_Tau)). In some embodiments, the dosing period is one week, two weeks,
three weeks, four weeks, five weeks, six weeks, seven weeks, eight weeks, nine weeks or ten
weeks. In some ments, the dosing period is 3 weeks. In some embodiments, the
dosing period is six weeks.
] In some embodiments, a PD-l-binding agent is administered according to a
regimen trated to achieve a response rate in relevant patient population such that no
more than 50% to 80% of ts show progressive disease after 2, 4, 6, 8, 10, 12, 14, 16, 18,
or 20 weeks following initiation of ent. In some embodiments, no more than 80% of
patients show progressive disease after at least 10 weeks following initiation of treatment.
In some embodiments, a PD-1—binding agent is administered according to a
regimen that is sufficient to e an average PD—l receptor occupancy of at least 50% to
90% after 1, 2, 3, 4, or 5 days following a single dose of the composition. In some
embodiments, administration of a composition that delivers a inding agent sufficient
to achieve an average PD—l receptor occupancy of at least 85% after 3 days following a
single dose of the composition.
In some ments, a PD—1-binding agent is administered according to a
regimen sufficient to achieve an average stimulation ratio of at least 1 in a functional PD-1
receptor ncy assay after 3 days following a single dose of the PD—l-binding agent.
In some embodiments, a PD—l-binding agent is administered ing to a
regimen sufficient to achieve an average PD-l receptor occupancy of at least 75% over a first
period of time, e.g., about 14 days to about 60 days following a single dose of the PD—lbinding
agent. In some embodiments, a PD—l-binding agent is administered according to a
regimen sufficient to achieve an average PD-l receptor occupancy of at least 75% over the
first period of time (e.g., about 15 days to about 60 days; in some embodiments about 29
days) following a single dose of the PD-l-binding agent.
In some ments, a PD—1-binding agent is administered according to a
regimen sufficient to achieve an average stimulation ratio of at least 1 in a functional PD—1
receptor occupancy assay over a first period of time, e.g., about 14 days to about 60 days
ing a single dose of the PD-l-binding agent. In some embodiments, a PD-l-binding
agent is administered ing to a regimen sufficient to e an average stimulation
ratio of at least 1 in a functional PD-l receptor occupancy assay over the first period of time
(e.g., about 15 days to about 60 days; in some embodiments about 29 days) following a single
dose of the PD-l-binding agent.
EXAMPLES
The following examples are ed to illustrate, but not limit the claimed
invention.
Example 1. Dosing Regimens for an Exemplary PD-l-binding agent
This example describes a multicenter, abel, first-in-human Phase 1 study
evaluating a PD—l binding agent (an anti-PD-l dy), in patients with tumors.
Specifically, this example describes dosage effects of treatment with a particular PD-1
binding agent in ts, and in particular patients with advanced solid tumors or metastatic
solid tumors. A PD—l g agent as described in the present study comprises a humanized
monoclonal anti-PD-l dy. Specifically, a particular PD—l g agent that comprises
a heavy chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10, and 11 and
a light chain variable region comprising CDR sequences of SEQ ID NOs: l2, l3, and 14.
This exemplary anti—PD-l antibody utilizes a human IGHG4*01 heavy chain gene, and a
human IGKC*01 kappa light chain gene, as lds. Further, there is a single Ser to Pro
point mutation in the hinge region of the IgG4 heavy chain at the canonical S228 position.
Patients were included with ogically or cytologically proven advanced
(unresectable) or metastatic solid tumor and who had disease progression after treatment with
available therapies that are known to confer clinical benefit or who are intolerant to other
known treatment(s).
This study comprises 2 parts: dose escalation and cohort expansion. Part 1 of the
study (dose escalation) is ed, inter alia, to te the safety, PK, and PDy e,
tolerability and anti-cancer effect of the anti-PD-l antibody. A modified 3+3 design was
used for dose escalation at 1 mg/kg, 3 mg/kg, and 10 mg/kg every 2 weeks (Q2W). Dose
escalation continued to a maximally administered dose of 10 mg/kg Q2W and a MTD was
not identified. No DLTs were observed. Preliminary safety findings indicate that the
exemplary PD-l-binding agent is safe and well tolerated.
Part 2 of the study is intended, inter alia, are to evaluate safety and tolerability,
PK, and PDy profile of the anti-PD-l antibody at fixed doses of 400 mg or 500 mg
administered every 3 weeks (Q3W) and 800 mg or 1000 mg administered every 6 weeks
(Q6W) by using a modified 6+6 design. Part 2 of this study assesses the effects in patients
who have certain tumor types, such as: endometrial cancer in separate cohorts consisting of
MSS tumors and MSI-H tumors, triple negative breast cancer, ovarian cancer, NSCLC, and
squamous cell carcinoma of the anogenital region (e.g., squamous cell carcinoma of the anus,
penis, , vagina, or vulva).
Pharmacokinetic parameters of a PD-l-binding agent in patients administered
ent doses were determined. As described herein, a least 18 patients were enrolled in the
study, with at least 12 subjected in the dose-limiting toxicity (DLT) tion cohorts and at
least 6 subjects in the PK/PDy cohorts. The clearance of a inding agent was
determined in patients following single IV infusion. Administration was done through a 30
minute IV on. The log-linear mean serum concentration versus time following a single
WO 29559
dose of the anti-PD—l antibody at concentrations of 1 mg/kg, 3 mg/kg and 10 mg/kg are each
shown in Figure 1 and Figure 2, panel A.
This anti-PD-l antibody treatment exhibited dose proportional PK across all dose
groups tested, see Table 5. The mean Cmax was approximately 21, 66, and 224 ug/mL and
the mean AUC0_336h was approximately 3378, 10999, and 39303 h*ug/mL for dose levels 1, 3
and 10 mg/kg, respectively. The time of peak serum concentration ranged from 0.5-3 hours
for all three treatment groups with median at 1.5 hours. The mean clearances were 0.201,
0.117 and 0.152 mL/h/kg for 1, 3, and 10 mg/kg dose groups, respectively. Terminal half-life
ranged from approximately 201 to 438 hours. er, as shown in Figure 3, an exemplary
anti-PD-l antibody exhibited exposure, as assessed by Cmax and AUC, that was linearly
proportional to dose.
Table 5: Mean Pharmacokinetic Parameters for Treatment Groups of PD—l-binding agent
(with a heavy chain variable region sing CDR sequences of SEQ ID NOs: 9, 10, and
11 and a light chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13, and
14) after intravenous infusion to patients.
(mg/kg) (Hg/mL) (lug/HID (h) (h) (h X Hg/mL) (mL/kg) (mL/h/kg)
1 mg/kg 21.4i4.43 5.99i2.38 1.5 311i149 3378i1141 74.2i23.7 0.201i0.121
(n = 6) (0.5-3.0)
-3mg/kg66.4i6.25 23.4i1.52 1.5 438i114 10,999i841 71.7i11.4 0.117i0.010
-------10 mg/kg244i52.7 76.6i25.1 1.5 317i155 39,303i10,301 60.7i16.6 0.152i0.052
iations: AUC0_336h = area under the concentration—time curve from 0 to 336 hours; C336}, = concentration at
336 hours; CL = nce; Cmax = maximum concentration; n=number; PD—1= programmed cell death-1;
SD=standard ion; tm = half—life; tmax = time to reach maximum concentration; VSS = volume of distribution at
steady state. Note: Data are presented as mean i SD for Cm“, C336h’ t“; AUC0_336h7 VSS and CL values and median
(range) for tmax values.
After repeat doses of a inding agent in two week cycles (Q2W), PK
profiles of 2 patients in 1 mg/kg group and 2 patients in 3 mg/kg group reached the steady
state after 3 doses. The accumulation ratio based on tration at the end of the dosage
interval (Cuough) ranged from 1.45 to 2.93.
For selection of fixed doses, a two compartmental model was used to describe the
observed PK data and predict the appropriate dose and regimen. The effect of body weight
on nce of a PD-l-binding agent was also explored. Body weight over a range of 45 kg
to 146 kg was found not to be a significant ant for clearance (See, Figure 4). Full
receptor occupancy was achieved at serum concentrations of anti-PD-l antibody of 2.43
ug/ml and above. The model predicted Cgough at steady state for the 500 mg Q3W and 1000
mg Q6W are 51.1 and 29.2 ug/mL with 90% ence interval of (13.4, 111.1) and (4.1,
78.5), respectively. The projected mean and 90% lower bound of Cgough at 500 mg Q3W and
1000 mg Q6W are about 21.0 and 12.0; 5.5 and 1.7 fold higher than the level required for full
receptor occupancy of peripheral blood cells. Data assessing the dose and regimes at steady
start are provided in Table 6 below.
Table 6: Pharmacokinetic parameters for different treatment regimens with a PD-l-binding
agent (with a heavy chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10,
and 11 and a light chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13,
and 14).
400 mg Q3W (10.7, 88.9)
500 mg Q3W . (13.4,111.1)
800 mg 06W . (3.3, 62.8)
1000 mg Q6W . (4.1, 78.5)
These data t flat dosing, including at 400mg, 500 mg, 800 mg and/or 1000
Clearance of a PD—l-binding agent after single dose administration of 500 mg and
1000 mg was determined. near mean serum concentration versus time following a
single dose of the anti-PD-l antibody at trations of 500 mg and 1000 mg are shown in
Figure 2, panel B, and single-dose cokinetic summaries are provided in Table 7
below. Mean maximum concentration was approximately 174 and 322 ug/mL for 500 mg
Q3W and 1000 mg Q6W, respectively; mean area under the concentration-time curve from 0
to 504 hours (AUCg_504h) and AUCO_1008h were approximately 36,424 and 91,376 hxug/mL,
respectively. The time of peak serum concentration ranged from 0.5 to 3.0 hours for both
treatment groups, with the median at 1.0 and 1.5 hours, respectively. Serum trations
of the exemplary PD-l-binding agent observed 3 weeks after the 500 mg dose were
comparable to those observed 6 weeks after the 1000 mg dose.
Table 7: Mean Pharmacokinetic Parameters for Fixed Dose Treatment Groups of PD
binding agent (with a heavy chain variable region comprising CDR sequences of SEQ ID
NOs: 9, 10, and 11 and a light chain variable region comprising CDR sequences of SEQ ID
NOS: 12, 13, and 14) after enous infusion to patients.
(mg/kg) (lug/mL) (Mg/mL) (h) (h K ug/mL)
_____500 mg 174:35.2 40.21931 1.0 36,424i6674
(n = 7) (0.5-3.0)
AUC0_1asl = area under the concentration—time curve from 0 to 504 hours (500 mg cohort) or with/without
extrapolated 1008 hours (1000 mg cohort); CW: last measurable plasma concentration; Cmax = maximum
concentration; n=number; Q3W = every 2 weeks; Q6W = every 6 weeks; SD=standard deviation; tmax = time to
reach maximum concentration; Data are ted as mean i SD for Cmax, Clash AUCOJaSL values and median )
for tmax . Cmax was measured at 504 hours for 500 mg Q3W group and 1008 hours for 1000 mg Q6W gropu.
Example 2. PD-l Target Engagement of an exemplary inding agent
This example describes the y of an ary PD-l-binding agent that is a
humanized monoclonal anti-PD-l antibody to engage with its target (e.g., the PD—1 receptor).
Specifically, an exemplary anti-PD-l antibody that comprises a heavy chain variable region
comprising CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light chain variable region
comprising CDR sequences of SEQ ID NOs: 12, 13, and 14. Target engagement of an anti-
PD-1 antibody agent was determined by measuring PD-1 receptor occupancy in peripheral
blood from patients following a first dose with an anti-PD-l antibody agent. Two assays are
being employed: the first assay, termed conventional receptor occupancy (cRO), provides a
measure of direct anti-PD-l antibody agent binding to CD3+ cells and the second assay,
termed onal or occupancy (fRO), measures IL-2 production by ex vivo stimulated
T cells following administration of anti-PD-l dy agent.
0R0 Assay Results
To measure direct binding in the cRO assay, PBMCs were isolated from patients
at baseline as well as on Days 3 and 15 following administration of a first dose of anti—PD-1
antibody agent. Additionally, certain patients additional samples were collected on Days 22
and 29 following the first dose. PD—l—receptor occupancy by an anti-PD-1 dy agent on
circulating CD3+ T cells was measured by flow cytometry.
Following a single dose of the anti—PD-l antibody agent at 1 mg/kg, 3 mg/kg or 10
mg/kg, the mean percent occupancy on Day 3 across all dose levels is about 90%. Consistent
with published data for nivolumab (Brahmer et (11., 2010), a mean ncy of
approximately 80% is maintained throughout the first 29 days following a single dose at
1 mg/kg (Table 8; data cut-off 30 Sep 2016)
Table 8: Mean Percent PD-l Occupancy for anti-PD-l antibody agent in CD3+ cells at 1, 3
and 10 mg/kg Dose Levels
Dose Percent PD-l Occupancy
Mean i SD (N)
1 mg/kg 3.23 i 3.12 95.6 i 17.1 84.3 i 4.27 82.8 i 3.67 77.8 i
(6) (6) (6) (3) 0.514
3 mg/kg 5.75 i 1.72 88.0 i 5.42 85.9 i 2.49
(3) (3) (3)
mg/kg 2.42 i 86.9 i 4.08 85.8 i 7.45 ND ND
0.898 (5) (3)
Abbreviations: CD=cluster of entiation; n=number; ND=no data available; PD—l: programmed
cell death-1; SD=standard deviation.
Results for receptor occupancy assessed for dosing at 1, 3, and 10 mg/kg dose
levels of the ary PD—l-binding agent is also shown in Figure 5, panel A.
Additionally, PD-l receptor occupancy as assessed above, was maintained over
three and six weeks for fixed dosing levels of 500 mg at Q3W (n=6) and 1000 mg at Q6W
(n=7), respectively. Results for receptor occupancy of the exemplary inding agent at
500 mg and 1000 mg dose levels are shown in Figure 6, panels A and C, respectively.
fRO Assay s
To obtain a functional readout of or occupancy in the fRO assay, whole
blood was collected at baseline as well as on Days 3 and 15 following the first dose.
Additionally, in certain patients, samples were onally collected on Days 22 and 29
following the first dose. eceptor occupancy by anti-PD-l antibody agent on
circulating T cells was measured as a function of IL-2 production following ex Vivo
stimulation with the superantigen staphylococcal enterotoxin B (SEB) in the presence of
saturating concentrations of anti-PD-l dy agent or isotype control (Patnaik et al.,
2015). In this assay an IL—2 ratio of 1 reflects stimulation close to the maximal ation
and is reflective of maximal receptor occupancy.
] Following a single dose of anti-PD-l antibody agent, a mean IL-2 stimulation
ratio of 1 is achieved on Day 3 across all dose levels. A mean IL-2 ratio of approximately 1
is maintained at 29 days following a single dose at 1 mg/kg (Table 9).
Table 9: Mean IL-2 Stimulation Ratio in fRO Assay at 1, 3 and 10 mg/kg Dose Levels of
anti-PD-1 antibody agent
Dose t PD-1 Occupancy
Mean i SD (n=)
Day 15 Day 22 Day 29
1 mg/kg 1.69 i 1.01 i 0.073 1.00 i 0.0513 1.32 i 1.08 i
0.241 (6) (6) 0.276 0.064
(6) (2) (2)
3 mg/kg 1.62 i 0.927 i 0.0473 0.977 i 0.0702 ND ND
0.236 (3) (3)
-10 mg/kg 1.86 4.- 1.05 i 0.0603---0.860 ND ND
Results for IL—2 stimulation for dosing at 1, 3, and 10 mg/kg dose levels of the
exemplary PD-l-binding agent is also shown in Figure 5, panel B. Additionally, IL-2
stimulation of the exemplary PDbinding agent at 500 mg at Q3W (n=6) and 1000 mg at
Q6W (n=7) are shown in Figure 6, panels B and D, respectively.
The receptor occupancy and IL-2 stimulation ments demonstrate that the
PD-1 antibody agent fully binds PD-1 on T cells in the periphery of patients treated at all
dose levels tested. The lowest anti-PD-l antibody agent concentration that resulted in full
receptor occupancy was calculated to be 2.43 ug/mL. Moreover, the data demonstrate that
the anti-PD-l antibody agent binding to PD-1 is maintained for at least 29 days following a
single dose at 1 mg/kg. These results demonstrate the efficacy and ity of a single dose
of an anti-PD-l antibody agent.
Moreover, for the fixed dosing regimens (500 mg Q3W and 1000 Q6W) the
mean Cmin at which full receptor occupancy was observed was ~2 ug/ml. Taking the or
occupancy studies in view of the pharmacokinetic data reveals advantageous properties of a
dosing schedule for a PDbinding agent of 500 mg Q3W ed by 1000 mg Q6W. One
benefit of this dosing schedule is that it es trough concentrations which are at least 20-
fold above the lowest concentration at which full peripheral receptor occupancy is achieved
(40.2 ug/ml) for 500 mg Q3W and 43.7 ng/mL for 1000 mg Q6W).
The or occupancy (R0) for this 500 mg Q3W/1000 mg Q6W fixed dose
regimen of the anti-PD-l dy also has been d in ts having MSS endometrial
cancer, MSI-H endometrial , and NSCLC.
] To e direct binding in the RO assay, PBMCs were isolated from
patients at baseline (Day 1 predose) as well as prior to the second dose (Day 22 predose) on a
500 mg Q3W schedule. PD-l-receptor occupancy by the anti-PD-l antibody on circulating
CD3+ T cells was measured by flow cytometry using a method similar to that previously
reported for nivolumab (Brahmer, JCO 2010). PBMCs from treated patients were
preincubated ex vivo with a saturating concentration of either led human IgG4 (isotype
control) or the anti-PD-l antibody. Following washing and staining with anti-CD3 and anti-
human IgG4, PD-l occupancy by the infused D-l antibody was estimated as the ratio
of CD3+ cells stained with anti-human IgG4 after ex vivo saturation with isotype l
antibody (indicating in vivo binding) to that after anti-PD-l antibody saturation (indicating
total available binding sites).
Data from the RO assay are shown in Figure 8, with the number of patients
indicated in parentheses. In this plot, the line in the center of the box plot indicates the
median, with the box extending to indicate the 25th and 75th percentiles. The bars represent
the minimum and maximum values and show that high occupancy of the anti-PD-l antibody
is achieved.
Example 3. ent of patients with an exemplary PD-l-binding agent
This example describes clinical efficacy of an exemplary PD-l-binding agent
in cancer patients, e.g., patients with advanced solid tumors. It was found that administration
of a PD-l binding agent by a closing regimen of the present disclosure conferred Clinical
benefits to patients. An exemplary PD-l binding agent as described in the present study is a
humanized monoclonal anti-PD-l antibody. For example, a particular PD-l binding agent
with a heavy chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10, and 11
and a light chain le region comprising CDR sequences of SEQ ID NOs: 12, 13, and 14
is evaluated. This anti-PD-l antibody utilizes a human IGHG4*01 heavy chain gene, and a
human IGKC*01 kappa light chain gene, as scaffolds. Further, there is a single Ser to Pro
point on in the hinge region of the IgG4 heavy chain at the canonical S228 position.
Moreover, it was found that administration of a composition comprising the anti-
PD-l antibody after intravenous on conferred clinical benefits to patients, at each of the
doses tested. The tumor se in patients that were evaluated as of September 2016 are
described in Table 10.
Table 10: Tumor Response in patient administered different dosing regimens of a PD-l-
binding agent.
Intra-Patient Dose
Tumor Type Cohort
Escalation Y
Ovarian adenocarcmoma 3 mg/kg PR
Anal Cancer 1 mg/kg PK/PDy SD Y
Small Cell Lung Cancer 10 mg/kg PR —
Ovarian adenocarcinoma 10 mg/kg PK/de
Cervical cancer 10 mgfkg PK/de
“PD” = Progressive e; “SD” = Stable Disease; “PR” = Partial Response;
“ND” = not determined at time of assessment
A wide y of tumor types have been tested thus far including tumors of
the anus, rectum, parotid gland, ovaries, breast, fallopian tube, endometrial, uterine,
appendix, prostate, lung, cervix, esophagus, peritoneum, kidney, and colon. As of July 2017,
19 patients had a follow-up scan in part 1, and 2 of the 19 patients were categorized as
responsive. Both of these 2 patients achieved a PR: one patient with ovarian cancer had a
duration of response of 26 weeks and ended treatment at week 36 without progression, and
one patient with small cell lung cancer for whom treatment was ongoing, with duration of
response 231 weeks. Five patients had stable disease, two of whom were continuing
treatment pian tube cancer, n=l; ovarian cancer, n=l). Treatment ses are
summarized in Figure 7. Panel A in Figure 7 depicts a Swimmer—Lane and panel B shows a
Spider Plot of treatment responses to the exemplary PD—l-binding agent.
Patients can also receive 500 mg anti-PD—l antibody every three weeks (Q3W)
for the first four cycles followed by 1000 mg every 6 weeks (Q6W) for all subsequent cycles.
The effect of a composition this anti-PD-l antibody administered according to this regimen
was d in ts having MSS endometrial cancer (Table 11). ts may also
receive 500 mg anti-PD-l antibody every three weeks (Q3W) for the first three cycles
followed by 1000 mg every 6 weeks (Q6W) for all subsequent cycles, or patients may receive
500 mg anti—PD-l antibody every three weeks (Q3W) for the first five cycles followed by
1000 mg every 6 weeks (Q6W) for all subsequent cycles.
Table 11. Tumor Assessments in MSS Endometrial Cohort A2
Best l Response by ST Cohort A2 (N=25) [n (%)]
irCR 0
irPR 6 (24)
irSD 7 (28)
irPD ll (44)
Not ble 0
Not Done 1 (4)
] Twenty five patients with advanced/recurrent MSS endometrial cancer were
treated with the anti-PD-l antibody and have had at least one CT scan for tumor assessment.
These patients are ts who have progress on or after platinum doublet therapy and
patients who have received no more than two lines of anti-cancer therapy for recurrent or
advanced disease. Of the six patients that achieved irPR, one response has been confirmed.
Five patients remain on treatment and one patient has discontinued treatment due to disease
progression. These clinical outcomes with the anti-PD-l antibody are surprising in contrast
with previous results using agents such as atezolizumab and pembrolizumab.
The dosing regimen of 500 mg D-l antibody every three weeks (Q3W)
for the first four cycles ed by 1000 mg every 6 weeks (Q6W) for all subsequent cycles
can also be useful for patients with non-small cell lung cancer ) and ts with
MSI-H cancers (e.g., MSI-H endometrial ). Other dosing regimens include 500 mg
anti-PD-l antibody every three weeks (Q3W) for the first three cycles followed by 1000 mg
every 6 weeks (Q6W) for all uent cycles or 500 mg anti—PD-l antibody every three
weeks (Q3W) for the first five cycles followed by 1000 mg every 6 weeks (Q6W) for all
subsequent cycles.
Accordingly, this e demonstrates that the exemplary PD-l-binding
agent with a heavy chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10,
and 11 and a light chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13,
and 14 shows aging clinical benefits in patients with diverse cancer types.
Example 4. Treatment of Ovarian Cancer with exemplary PD-l-binding agent in
combination with niraparib
This e describes a clinical trial of niraparib in combination with an anti-
PD—l antibody in first—line maintenance treatment of patients with advanced ovarian cancer
who have responded to platinum induction therapy. An exemplary PD-l binding agent may
be a humanized monoclonal anti-PD-l antibody. For example, a particular a PD-1 binding
agent with a heavy chain le region sing CDR sequences of SEQ ID NOs: 9, 10,
and 11 and a light chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13,
and 14 as described in Example 1 may be ted.
Patients with histologically or cytologically proven advanced (unresectable) or
metastatic solid gynecological tumor (e.g., an ovarian cancer) and who responded to platinum
chemotherapy may be included.
Specifically, this study will assess efficacy of treatment of patients with advanced
recurrent ovarian cancer with an ary PD-1 binding agent in combination with
niraparib. The exemplary PD-l binding agent may comprise a heavy chain variable region
with CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light chain variable region with
CDR sequences of SEQ ID NOs: 12, 13, and 14 in combination with niraparib. Combination
treatment may include 0 mg once daily oral administration of niraparib (e.g., one to
three capsules of 100 mg strength may be taken at each dose administration). It is envisioned
that the PD-1 binding agent may be administered at a dose of 00 mg of a PD-1
antibody agent (e. g., intravenous administration). The exemplary anti-PD-1 dy may be
administered at fixed doses, for example, of 400 mg or 500 mg administered every 3 weeks
(Q3W), followed by administration and 800 mg or 1000 mg administered every 6 weeks
(Q6W). In some embodiments, a PD—1 antibody agent is administered at a dose of 1, 3, and
mg/kg. Treatment cycles may be 14-42 days, e.g., 21 days, 28 days, etc.
Response evaluation ia in solid tumors T) tumor assessment via
clinically validated imaging methods may be performed at the end of every 1 to 3 cycles until
progression.
] Patients will continue to e their assigned treatment until disease progression,
unacceptable toxicity, death, withdrawal of consent, and/or lost to follow-up.
Example 5. Treatment of Lung Cancer with niraparib
This example describes a clinical trial of niraparib alone and/or in combination
with an exemplary PD-1 antibody agent for treatment of lung cancer (e.g., NSCLC and/or
squamous cell carcinoma). An exemplary PD-1 binding agent may be a humanized
monoclonal anti-PD—l antibody. For example, a particular a PD—1 binding agent with a heavy
chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light
chain variable region comprising CDR ces of SEQ ID NOs: 12, 13, and 14 as
described in Example 1 may be ted.
Patients with histologically or cytologically proven advanced (unresectable) or
metastatic solid lung cancer (e.g., NSCLS and/or squamous cell carcinoma) may be included.
In some embodiments, a patient will have had disease progression after treatment with
available therapies that are known to confer clinical benefit or who are intolerant to other
known treatment(s).
This study will assess cy of treatment of patients with advanced lung cancer
with niraparib and/or the exemplary PD-1 binding agent. Patients with advanced lung
cancers, for example, us cell carcinoma or NSCLC may be treated with niraparib
alone and/or in combination with the exemplary PD-1 binding agent. Niraparib treatment
may include 0 mg once daily oral administration of niraparib (e.g., one to three
capsules of 100 mg strength may be taken at each dose administration). It is envisioned that
the PD-1 binding agent may be administered at a dose of 200—1000 mg of a PD—1 antibody
agent (e.g., intravenous administration). The exemplary anti-PD-l antibody may be
stered at fixed doses of 400 mg or 500 mg administered every 3 weeks (Q3W),
ed by administration and 800 mg or 1000 mg administered every 6 weeks (Q6W). In
some embodiments, a PD-1 antibody agent is administered at a dose of 1, 3, and 10 mg/kg.
ent cycles may be 14-42 days, e. g., 21 days, 28 days, etc.
Response evaluation criteria in solid tumors (RECIST) tumor assessment via
clinically validated imaging methods may be performed at the end of every 1 to 3 cycles until
progression.
Patients will continue to receive their assigned ent until disease
progression, unacceptable toxicity, death, withdrawal of consent, and/or lost to follow-up.
Example 6. Treatment of PD-l expressing Lung Cancer with exemplary PD-l-binding
agent in ation with niraparib
This example bes a clinical trial of an exemplary PD—l antibody agent in
combination with niraparib for treatment of lung cancer (e.g., NSCLS and/or squamous cell
carcinoma) that expresses PD-l and/or PD-Ll, including subjects whose PD-l or PDL-l
levels are considered high. An exemplary PD—l g agent may be a zed
monoclonal D—l antibody. For example, a particular a PD—l binding agent with a heavy
chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light
chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13, and 14 as
described in Example 1 may be evaluated. Efficacy of combination treatment of PD-l/PD-Ll
expressing lung cancer with the exemplary PD—l binding agent in combination with niraparib
may be compared with efficacy of treatment with the PD-l binding agent alone.
Patients with ogically or cytologically proven advanced ectable) or
metastatic solid lung cancer (e.g., NSCLS andlor us cell carcinoma) may be included.
In some embodiments, a patient will have had disease progression after treatment with
available therapies that are known to confer clinical benefit or who are intolerant to other
known treatment(s). In some embodiments the lung cancer is characterized by a high level of
expression of PD-1 and/or PD-Ll.
This study will assess efficacy of treatment of patients with advanced lung cancer
with the exemplary PD-1 binding agent in combination with niraparib compared to treatment
with the PD-l binding agent alone in patients with PD-l/PD—Ll expressing lung cancer.
WO 29559
ts will include those with advanced lung cancers, for example, squamous cell
carcinoma or NSCLC. It is envisioned that the PD-1 binding agent may be administered at a
dose of 200-1000 mg of a PD—1 antibody agent (e.g., intravenous administration). rib
treatment may include 100-300 mg once daily oral administration of niraparib (e.g., one to
three capsules of 100 mg strength may be taken at each dose administration). The exemplary
anti-PD-l antibody may be administered at fixed doses of 400 mg or 500 mg administered
every 3 weeks (Q3W), followed by administration and 800 mg or 1000 mg administered
every 6 weeks (Q6W). In some embodiments, a PD-1 antibody agent is administered at a
dose of 1, 3, and 10 mg/kg. Treatment cycles may be 14-42 days, e.g., 21 days, 28 days, etc.
Response evaluation criteria in solid tumors (RECIST) tumor ment via
clinically validated imaging methods may be performed at the end of every 1 to 3 cycles until
progression.
Patients will ue to receive their assigned treatment until disease
progression, unacceptable toxicity, death, withdrawal of consent, and/or lost to follow-up.
Having thus described at least several aspects and embodiments of this
invention, it is to be appreciated that various alterations, modifications, and improvements
will readily be apparent to those skilled in the art. Such tions, cations, and
improvements are intended to be part of this disclosure, and are intended to be within the
spirit and scope of the invention. Accordingly, the foregoing description and drawing are by
way of example only and the invention is described in further detail by the claims that follow.
LENTS
The articles “a” and “an” as used herein in the specification and in the claims,
unless clearly indicated to the contrary, should be understood to include the plural referents.
Claims or descriptions that include “or” between one or more members of a group are
ered satisfied if one, more than one, or all of the group members are present in,
employed in, or otherwise nt to a given product or process unless ted to the
contrary or otherwise evident from the context. The invention includes embodiments in
which exactly one member of the group is present in, employed in, or otherwise relevant to a
given product or process. The invention also includes ments in which more than one,
or the entire group members are present in, ed in, or otherwise relevant to a given
t or process. Furthermore, it is to be understood that the invention asses all
variations, combinations, and permutations in which one or more limitations, elements,
clauses, descriptive terms, etc., from one or more of the listed claims is introduced into
another claim dependent on the same base claim (or, as relevant, any other claim) unless
otherwise indicated or unless it would be evident to one of ordinary skill in the art that a
contradiction or istency would arise. Where elements are presented as lists, (e.g., in
Markush group or similar format) it is to be understood that each subgroup of the elements is
also disclosed, and any element(s) can be removed from the group. It should be understood
that, in general, where the ion, or aspects of the invention, is/are referred to as
comprising particular elements, features, etc., certain embodiments of the invention or
aspects of the invention consist, or consist essentially of, such elements, features, etc. For
purposes of simplicity those embodiments have not in every case been specifically set forth in
so many words herein. It should also be understood that any embodiment or aspect of the
ion can be itly excluded from the claims, regardless of r the specific
exclusion is recited in the specification. The publications, websites and other reference
materials referenced herein to describe the background of the invention and to provide
additional detail regarding its practice are hereby incorporated by reference.
Claims (9)
1. A method of treating a disorder in a subject, which method comprises administering a therapeutically effective dose of an agent that is capable of inhibiting mmed Death-1 Protein (PD-1) signaling, wherein the therapeutically effective dose is: about 1, 3 or 10 mg/kg; a flat dose between about 100 - 2000 mg; a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about 1900 mg; a flat dose about 2000 mg; about 1 mg/kg; about 3 mg/kg; or about 10 mg/kg.
2. A method of increasing T cell activation or T cell effector function in a subject, which method comprises administering a therapeutically effective dose of an agent that is capable of inhibiting Programmed Death-1 Protein (PD-1) signaling, n the therapeutically effective dose is: about 1, 3 or 10 mg/kg; a flat dose between about 100 - 2000 mg; a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about 1900 mg; a flat dose about 2000 mg; about 1 mg/kg; about 3 mg/kg; or about 10 mg/kg.
3. A method of reducing tumors or inhibiting the growth of tumor cells in a t, which method comprises administering a therapeutically ive dose of an agent that is capable of inhibiting Programmed 1 Protein (PD-1) signaling, wherein the therapeutically effective dose is: about 1, 3 or 10 mg/kg; a flat dose between about 100 - 2000 mg; a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about 1900 mg; a flat dose about 2000 mg; about 1 mg/kg; about 3 mg/kg; or about 10 mg/kg.
4. A method of inducing an immune response in a subject, which method comprises administering a therapeutically effective dose of an agent that is capable of ting Programmed Death-1 Protein (PD-1) signaling, wherein the therapeutically effective dose is: about 1, 3 or 10 mg/kg; a flat dose between about 100 - 2000 mg; a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about 1900 mg; a flat dose about 2000 mg; about 1 mg/kg; about 3 mg/kg; or about 10 mg/kg.
5. A method of ing an immune response or increasing the activity of an immune cell in a subject, which method comprises administering a therapeutically effective dose of an agent that is capable of inhibiting Programmed Death-1 Protein (PD-1) signaling, n the therapeutically effective dose is: about 1, 3 or 10 mg/kg; a flat dose between about 100 - 2000 mg; a flat dose about 100 mg; a flat dose about 200 mg; a flat dose about 300 mg; a flat dose about 400 mg; a flat dose about 500 mg; a flat dose about 600 mg; a flat dose about 700 mg; a flat dose about 800 mg; a flat dose about 900 mg; a flat dose about 1000 mg; a flat dose about 1100 mg; a flat dose about 1200 mg; a flat dose about 1300 mg; a flat dose about 1400 mg; a flat dose about 1500 mg; a flat dose about 1600 mg; a flat dose about 1700 mg; a flat dose about 1800 mg; a flat dose about 1900 mg; a flat dose about 2000 mg; about 1 mg/kg; about 3 mg/kg; or about 10 mg/kg.
6. A method of treating cancer, the method comprising: administering to a patient in need of treatment an anti-programmed death-1 protein (PD- 1) dy at a therapeutically effective dose at an administration interval for a period sufficient to achieve clinical benefit, wherein the anti-PD-1 antibody comprises a heavy chain le region comprising CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light chain variable region sing CDR sequences of SEQ ID NOs: 12, 13, and 14.
7. A method of treating cancer, the method comprising administering to a t in need of treatment an anti-programmed death-1 protein (PD- 1) antibody at a first dose at a first interval for a first period; administering to the patient the anti-PD-1 antibody at a second dose at a second interval for a second period; wherein the anti-PD-1 antibody comprises a heavy chain variable region comprising CDR sequences of SEQ ID NOs: 9, 10, and 11 and a light chain variable region comprising CDR sequences of SEQ ID NOs: 12, 13, and 14.
8. A method of treating n cancer, ian cancer, or primary peritoneal cancer the method sing: stering a patient in need of treatment an anti-programmed death-1 protein (PD-1) antibody, and administering niraparib.
9. A method of treating lung cancer, the method comprising: administering a patient in need of treatment an anti-programmed death-1 protein (PD-1) antibody, and administering niraparib.
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US62/444,336 | 2017-01-09 | ||
US62/477,423 | 2017-03-27 | ||
US62/491,220 | 2017-04-27 | ||
US62/556,386 | 2017-09-09 |
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NZ795702A true NZ795702A (en) | 2022-12-23 |
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