OA16773A - BCMA-based stratification and therapy for multiple myeloma patients. - Google Patents

BCMA-based stratification and therapy for multiple myeloma patients. Download PDF

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OA16773A
OA16773A OA1201300427 OA16773A OA 16773 A OA16773 A OA 16773A OA 1201300427 OA1201300427 OA 1201300427 OA 16773 A OA16773 A OA 16773A
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bcma
cells
antibody
patient
cell
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OA1201300427
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Eric Borges
Jasmin Barbara Hebeis
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Boehringer Ingelheim International Gmbh
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Abstract

The present invention relates to methods for the stratification of a multiple myeloma (MM) patient comprising determining whether or not Bcells, preferably malignant B-cells of said patient express BCMA protein on their surface. Also, methods for selecting an antibody-based multiple myeloma (MM) therapy is based on whether or not BCMA is expressed on the cell surface of Bcells, preferably malignant B-cells of a patient. Furthermore, antibody-based therapies for patients who have BCMA positive malignant B-cells are provided.

Description

[0001] The présent invention relates to methods for the stratification of a multiple myeloma (MM) patient comprising determining whether or not B-cells, preferably malignant B-cells of said patient express BCMA protein on their surface. Also, methods for selecting an antibody-based multiple myeloma (MM) therapy is based on whether or not BCMA is expressed on the cell surface of B-cells, preferably malignant B-cells of a patient. Furthermore, antibody-based thérapies for patients who hâve BCMA positive malignant B-cells are provided.
BACKGROUND OF THE INVENTION [0002]Multiple myeloma (MM), an incurable malignancy of the plasma B-cells, accounts for an estimated 14% of ail newly diagnosed hématologie malignancies (Colson et al., (2004) Clin J Oncol Nurs 8 (5): 473-480). MM is a heterogenous disease and caused by mostîy by chromosome translocations inter alia t(11 ;14), t(4;14)s t(8;14), del(13). del(17) (Drach et al., (1998) Blood 92(3):802-809; Gertz et al., (2005) Blood 106(8):2837-2840; Façon et al., (2001) Blood 97(6):15661571). MM- affected patients may expérience a variety of disease-related symptoms due to bony destruction, bone marrow infiltration, rénal failure, immunodeficiency, and the psychosocial burden of a cancer diagnosis. Exciting new thérapies such as chemotherapy and stem cell transplantation approaches are becoming available and hâve improved survival rates but often bring unwanted side effects, and thus MM remains still incurable (Lee et al., (2004) J Natl Compr Cane Netw 8 (4): 379-383).
[0003] MM is caused by malignancy of the plasma B-cells. In order to finally identify said malignant plasma B-cells, it was found that several proteins résidé on the surface of plasma B-cells (Harada et al., (1993) Blood 81(10): 2658-2663; Robillard N et al., Blood yy (2003) 102(3): 1070-1071). For instance, CD38 was found to express strongly on the surface of myeloma cells (malignant plasma B-cells), i.e. CD38*+ and therefore to distinguishing plasma B-cells from other hematopoietic cells in the bone marrow. In addition, Harada et al also found that normal plasma B-cells were VLA-4+ VLAS-5+ MPC-1+ CD44+ CD19* CD56' in the bone marrows from 7 healthy donors, on the other hand, mature myeloma cells (12 of 20 cases) were VLA-4+ VLAS-5+ MPC-1+ CD19' CD56+ and no myeloma cells were CD19+Cd56‘. In addition, it was reported that expression of CD20 is associated with small mature plasma B-cell morphology and MM patients with t(11 ;14).
[0004] BLyS (B Lymphocyte stimulator), also referred to as BAFF, TALL-1, or THANK, is a tumor necrosis factors (TNF) superfamily member. It is a type II transmembrane protein and plays a significant rôle in maintaîning the development and homeostasis of normal B-cell and promûtes the survival of malignant B cells. Three receptors for BLyS were identified, i.e. BCMA (B cell maturation antigen), BAFF receptor (BAFF-R), and TACI (transmembrane activator and calcium modulator cyclophilin ligand interactor). These three receptors are type I single membrane receptors and belong to the TNF receptors family. BCMA and BAFF-R are predominantly expressed on B lymphocytes, while TACI can be found on B cells and activâtes T cells. In addition, BCMA and TACI are capable of binding to APRIL (a proliferation-inducing ligand) which is the closest structural homologue of BLyS.
Novak et al found that three receptors for BLyS (BAFF) are expressed on the cell surface of B-cells of MM patients (Novak et al., (2004) Blood 103(2):689-694).
[0005]One of receptors for BLyS, BCMA, is known to be preferentially expressed in mature B cells (Gras et al., (1995) Int Immunol 7:1093-1106; Thompson et al., (2000) J Exp Med 192:129-135). Further, it was found that the expression of BCMA as BCMA mRNA was up-regulated during the late stages of normal B-cell différentiation and was highly expressed in MM cells (Tarte et al., (2002) Blood 100:1113-1122; Tarte et al., (2003) Blood 102:592-600; Claudio et al., (2002) Blood 100:2175-2186). Moreover, Bellucci et al confirmed that expression of BCMA, i.e. BCMA mRNA showed sélective expression in late stages of B-cell maturation (Belluci et al., (2005) Blood 105:39453950). However, Li et al found that expression of BCMA, i.e. BCMA mRNA was not always détectable in MM cells from patients (Li et al., (2010) Med Oncol 27:439-445). To this end, even though it has been reported that BCMA expression is limited only in the plasma cells and germinal center B cells, a BCMA+ population was also observed in naïve and memory B cells from peripheral blood (US2009/0325196). Average of BCMA+ B cells are 24% in naïve B cells and 20.8% in memory B cells, which is lower than that of plasmoblasts (37.9%). However, it seems that BCMA is mainly expressed in plasmablasts.
[0006] It has been reported that t(4;16)(q26;p13.1 ) chromosome translocation was found in tumor cells from a patient with a T cell lymphoma, resulting in the fusion of BCMA gene and interleukin 2 gene, and t(16;18)(p13;q21.3) chromosome translocation was found in a male patient with follicular lymphoma, resulting in the fusion of BCMA gene, HLA-D gene and several hematopoietic neoplasm-related genes such as MHC2TA with BCL2 gene (Laabi et al., (1992) J EMBO 11(11):3897-3904;Mahmoodi et al., (2004) Can Genet Cytogenet 154(2):160-162). Although these chromosomal translocations were not reported to cause MM, one of translocation is related to follicular lymphoma which is defined as a lymphoma of follicle center B cells.
[0007] Furthermore, Novak et al found that MM cell lines and freshly isolated MM cells express BCMA protein and TACI protein on their cell surfaces and hâve variable expression of BAFF-R protein on their cell surface (Novak et al., (2004) Blood 103(2):689-694).
[0008] It was also reported that BCMA protein is expressed on the cell surface of MM cells/cell lines although BCMA protein is originally reported as an intégral membrane protein in the Golgi apparatus of human mature B lymphocytes, i.e. as an intracellular protein (Gras et al., (1995) International Immunol 7(7):1093-1105), which shows that BCMA seems to hâve an important rôle during B-cell development and homeostasls. The findlng of Gras et al. might be associated with the fact that the BCMA protein that was described in Gras et al. is, because of a chromosomal translocation, a fusion protein between BCMA and IL-2. However, BCMA is meanwhile established to be a B-cell marker that is essential for B-cell development and homeostasis (Schliemann et al., (2001) Science 293 (5537):2111-2114) due to its presumably essential interaction with BAFF and APRIL.
[0009] Thus far, the two most promising treatment options for patients with multiple myeloma are tandem high-dose chemotherapy followed by autologous stem cell infusion or allogeneic hematopoietic stem cell transplantation after myelo-ablative therapy or reduced-intensity conditioning. However, cure is rarely achieved due to persistence of minimal residual disease. Thus, there is an urgent need for innovative treatment modalities to stabilize or even eradicate residual tumor cells.
With the discovery and molecular characterization of cancer target antigens, more focused approaches may become available to steer the patient’s immune system to recognize and eliminate residual cancer cells after conventional ablative thérapies. Antibody-based thérapies are thus an attractive option for the treatment of MM. Since MM cells have been B-cells prior to their “conversion”, commonly known and spécifie B-cell surface proteins are used as targets for antibodies such as CD20. Though normal B-cells will also be targeted by an anti-CD20 antibody, an anti-CD20 antibody therapy is applied to patients, since it was observed that normal B-cells will recover, while it is assumed (and has been observed) that malignant B-cells will not recover. Thus far, those of skill in the art, start from the assumption that once malignant B-cells express the target of interest on mRNA level such as BCMA, PIM2, MUM1/IRF4 or XBP1 (Claudio et al. (2002), Blood 100:2175-2186), such cells can be subject to an antibodybased therapy.
[0010] However, thus far it has not yet been reported as to whether or not there is a corrélation of BCMA mRNA and BCMA protein in MM patients as well as in MM cell lines to evaluate a possible therapy for MM using, in particular, an anti-BCMA antibody. Rather, in accordance with the commonly accepted concept that DNA makes RNA makes protein, it was rightly assumed that once BCMA mRNA is détectable in MM cells,
BCMA protein is présent on the cell surface of said cells to act as receptor. This would be in line with various reports that assign BCMA an important rôle in the development of
B-cell immunity and B-cell homeostasis (Mackay and Browning (2002) Nat Rev
Immunol. (2):465-475) as well as in prolifération of MM cells (Novak et al., cited above;
Bellucci et al., (2005) Blood 105:3945-3950).
[0011] Several recent studies have also documented the expression of BCMA in malignant as well as normal plasma cells and have shown that BAFF signaling through BCMA results in myeloma cell prolifération (Shu et al., (2000) Proc Natl Acad Sci USA 97:9156-9161; O’Connor et al., (2004) J Exp Med. 199:91-98; Novak et al., cited above; Avery et al., (2003) J Clin Invest. 112:286-297). Taken together, these studies suggested that BCMA is commonly expressed in myeloma and signaling through BCMA may also contribute to the expansion of myeloma cells in vivo (Bellucci et al., cited above).
[0012] Accordingly, based on the commonly accepted concept DNA makes RNA makes protein and given the fact that BCMA is assigned an important rôle in MM prolifération, thus implying its presence on the cell surface of MM B-cells, multiple myeloma treatment would automatically have been initiated (Ryan et al., (2007) Mol Cancer Ther 6: 3009-3018).
Consequently, no one has thus far questioned as to whether or not BCMA is indeed présent on the cell surface, if its mRNA is détectable, and therefore an antibody-based therapy would have been initiated, though it would not necessarily be bénéficiai for patients suffering from multiple myeloma, if BCMA is not présent on the cell surface.
[0013] The présent inventors, despite the knowledge that BCMA seems to be important both in normal B-cell development and malignant B-cell prolifération (in multiple myeloma), have nevertheless asked themselves the question as to whether or not and despite the important rôle of BCMA, also in MM, the dogma DNA makes RNA makes protein which is then presumably présent on the cell surface would hold true, if the dogma is only based on BCMA mRNA data. Put it dîfferently, it was not recognized in the art that BCMA, despite détectable mRNA, might not be présent on the cell surface of MM cells, thus being not available as target for an antibody-based therapy (Ryan et al., cited above). Accordingly, no one in the art has thought of personalizing an antiBCMA antibody based therapy for treating or ameliorating MM, since it was thought DNA makes RNA makes protein which Is présent on the surface of MM cells, bearing in mind the important rôle of BCMA in malignant B-cell development and prolifération. Therefore, a need exists for personalizing an anti-BCMA antibody therapy.
[0014]Hence, the technical problem underlying the présent invention is to comply with the needs described above.
DESCRIPTION OF THE FIGURES [0015] Figure 1: Binding of anti-BCMA antibodies to OPM-2 cells by FACS in OPM-2 cells [0016] Figure 2: BCMA Protein (A) and BCMA mRNA (B) expression levels of different MM cell lines.
[0017] Figure 3: Expression analysis of primary MM cells - exemplary results of positive and négative BCMA expressing patient samples
SUMMARY OF THE INVENTION [0018] The présent invention addresses these needs by providing a therapy using antiBCMA antibodies, preferably in combination with other antibodies or compounds used for the treatment or amelioration of MM, said therapy is based on the présent inventors’ récognition that the assumption that if BCMA mRNA is détectable BCMA protein is, so to say, automatically présent on the surface of MM cells not necessarily correct for each and every patient. Indeed, the présent inventors hâve found that it is of utmost importance to screen MM patient for the presence or absence, respectively, of the expression of BCMA on the protein level, i.e., for its presence or absence, respectively, on the cell surface of MM cells.
[0019] Accordingly, the présent invention provides a method for the stratification of a multiple myeloma (MM) patient disposed to respond favorably to an anti-BCMA antibody therapy, comprising determining whether B-cells of said patient, preferably malignant B-cells (MM cells or MM B-cells) expresses BCMA protein on the surface of said Bcells, wherein said patient is disposed to respond favorably to said anti-BCMA antibody therapy, if said B-cells express BCMA protein on their surface.
[0020] Furthermore, the présent invention provides a method for diagnosing a BCMA négative multiple myeloma (MM) patient, comprising determining whether B-cells, preferably malignant B-cells, of said patient express BCMA protein on their surface, wherein said patient suffers from BCMA négative MM, if no BCMA protein is détectable on the surface of said B-cells.
[0021] Also, the présent invention provides a method for selecting an antibody-based multiple myeloma (MM) therapy, comprising determining whether B-cells of a patient, preferably malignant B-cells, express BCMA protein on the surface of said B-cells, wherein, if said B-cells are BCMA positive, the patient may be subject to an anti-CD20 antibody therapy and/or an anti-CD38 antibody therapy and/or an anti-BCMA antibody therapy and/or an anti-CS1 antibody therapy, or, if said B-cells are BCMA-negative, the patient is subject to an anti-CD20 antibody therapy and/or an anti-CD38 antibody therapy and/or an anti-CS1 antibody therapy.
[0022] Further aspects of the présent invention relate to an anti-BCMA antibody therapy for use in the treatment or amelioration of a multiple myeloma (MM) patient whose B-cells are disposed to be BCMA positive, an anti-BCMA antibody for use in the treatment or amelioration of a multiple myeloma (MM) patient diagnosed in accordance with the method(s) of the présent invention, and an anti-CD20 antibody and/or an anti-CD38 antibody and/or an anti-CS1 antibody therapy for use in the treatment or amelioration of a multiple myeloma (MM) patient whose B-cells are BCMA négative. — *** [0023] It must be noted that as used herein, the singular forms “a, an, and the”, include plural references unless the context clearly indicates otherwise. Thus, for example, reference to “an expression cassette includes one or more of the expression cassettes disclosed herein and reference to the method” includes reference to équivalent steps and methods known to those of ordinary skill in the art that could be modified or substituted for the methods described herein.
[0024] Ali publications and patents cited in this disclosure are incorporated by reference in their entirety. To the extent the material incorporated by reference contradicts or is inconsistent with this spécification, the spécification will supersede any such material. Unless otherwise indicated, the term at least preceding a sériés of éléments is to be understood to refer to every element in the sériés. Those skilled in the art will recognize, or be able to ascertain using no more than routine expérimentation, many équivalents to the spécifie embodiments of the invention described herein. Such équivalents are intended to be encompassed by the present invention.
[0025] Throughout this spécification and the daims which follow, unless the context requires otherwise, the word comprise, and variations such as comprises and “comprising, will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integer or step. When used herein the term comprising can be substituted with the term “containing or sometimes when used herein with the term having”.
When used herein “consisting of excludes any element, step, or ingrédient not specified in the claim element. When used herein, consisting essentially of' does not exclude materials or steps that do not materially affect the basic and novel characteristics of the claim. In each instance herein any of the terms comprising, consisting essentially of' and consisting of' may be replaced with either of the other two terms. kiJ' [0026] As used herein, the conjunctive term “and/or between multiple recited éléments is understood as encompassing both îndividual and combined options. For instance, where two éléments are conjoined by and/or, a first option refers to the applicability of the first element without the second. A second option refers to the applicability of the second element without the first. A third option refers to the applicability of the first and second éléments together. Any one of these options is understood to fall within the meaning, and therefore satisfy the requirement of the term “and/or as used herein. Concurrent applicability of more than one of the options is also understood to fall within the meaning, and therefore satisfy the requirement of the term “and/or” as used herein.
[0027] Several documents are cited throughout the text of this spécification. Each of the documents cited herein (including all patents, patent applications, scientific publications, manufacturées spécifications, instructions, etc.), whether supra or infra, are hereby incorporated by reference in their entirety. Nothing herein is to be construed as an admission that the invention is not entitled to antedate such disclosure by virtue of prior invention.
AAA
DETAILED DESCRIPTION [0028] An object of the présent invention is to the provide a method for stratification of MM patients based on BMCA expression on the surface of the patients’ B-cells, preferably malignant B-cells and new therapy for MM patients using an anti-BCMA antibody, preferably combined with other antibodies such as anti-CD38, anti-CD20 and/or anti-CS1 antibodies based on the corrélation of expression of BCMA gene, i.e. BCMA mRNA and BCMA protein on the surface of B-cells, preferably malignant B-cells of MM patients.
Given the fact that BCMA is not or essentlally not expressed on each and every healthy B-cell of a patient, but on malignant B-cell of a patient, if said patient is diagnosed by the methods of the présent invention as BCMA positive, an anti-BCMA antibody therapy may be superior in comparison to, for example, an anti-CD20 antibody therapy, since CD20 is believed to be expressed on each and every B-cell. Accordingly, all B-cells t^/~ would be depleted, while, without being bound by theory, an anti-BCMA antibody therapy may not necessarily deplete ail healthy B-cells of a patient, since BCMA is not or essentially not expressed' on each and every healthy B-cell during development and/or homeostasis.
[0029] Thus, in a first aspect the preset invention provides a method for the stratification of a multiple myeloma (MM) patient disposed to respond favorably to an anti-BCMA antibody therapy, comprising determining whether B-cells, preferably malignant B-cells of said patient expresses BCMA protein on the surface of said B-cells, wherein said patient is disposed to respond favorably to said anti-BCMA antibody therapy, if said B-cells express BCMA protein on their surface.
[0030] In addition or in the alternative to the above described aspect, the présent invention provides a method for diagnosing a BCMA négative multiple myeloma (MM) patient, comprising determining whether B-cells, preferably malignant B-cells of said patient express BCMA protein on their surface, wherein said patient suffers from BCMA négative MM, if no BCMA protein is détectable on the surface of said B-cells.
[0031] The term stratification” as used herein includes the statistic division of a population of MM patients into subpopulation of MM patients with BCMA on the basis of expression of transcripts of BCMA gene, i.e. mRNA as well as of détection of said translated gene product, i.e. BCMA protein localized on the cell surface, for example, by an anti-BCMA antibody in order to consider whether or not a therapy using an antiBCMA antibody for MM patients may be bénéficiai. Détection of BCMA on the cell surface of B-cells, preferably malignant B-cells is preferred. However, nevertheless, BCMA expression on mRNA level can be additionally tested/determined. Also, said term refers to sorting patients into those who may or may not benefit from an anti-BCMA antibody based therapy for treating or ameliorating multiple myeloma. In particular, stratifying patients involves determining as to whether not BCMA is expressed on the surface of B-cells, preferably malignant B-cells of patients suffering from MM. Those patients whose B cells express BCMA on the cell surface of B cells may benefit from said therapy, while those whose B cells do not express BCMA on the cell surface may not benefit from said anti-BCMA antibody therapy. However, such BCMA négative patients may then benefit from, for example, an anti-CD20, anti-CD38 and/or anti-CS1 antibody therapy or any other antibody therapy applied for the treatment or amelioration of MM as described herein.
[0032] The term B-cells used herein means lymphocytes that play an important rôle in the humoral immune response (as opposed to the cell-mediated immune response, which is governed by T cells). The principal functions of B cells are to make antibodies against antigens, perform the rôle of antigen-presenting cells (APCs) and eventually develop into memory B cells after activation by antigen interaction. In that stage (antibody production) B-cells include “plasma cells”, sometimes also called herein plasma B-cells. These plasma cells or plasma B-cells are also encompassed by the term B cells when used herein. However, also precursor B-cells as well as B-cells in ail stages of their development and/or lineage commitment are encompassed by the term B cells”. B cells are an essential component of the adaptive immune system, While the term “B-cells also includes normal (i.e., healthy) B-cells, it preferably includes malignant B-cells, in partîcular malignant B-cells associated with MM (i.e., MM B-cells).
[0033] Thus, in the context of MM patient the term “B cells include both normal and malignant B-cells; with malignant B-cells being preferred (i.e., MM B-cells). “Malignant describes lymphocytes (in partîcular B cells) that contribute to a progressively worsening disease, in partîcular MM as described herein. The term is most familiar as a description of cancer, here MM. Malignant BCMA positive B cells are not self-limited in their growth, are capable of invading into adjacent tissues, and may be capable of spreading to distant tissues (metastasizing). Malignant when used herein is synonymous with cancerous. These malignant B-cells are of main interest in the context of the présent invention, since they should be targeted by antibodies, in partîcular by anti-BCMA antibodies, for which purpose these B-cells are analyzed for the expression of BCMA on their cell surface as described herein. MM patients that are subject to the methods and/or antibody-based thérapies of the présent invention hâve preferably malignant B-cells; said malignant B-cells are preferably Multiple myeloma cells. Of course, said patients also (or still hâve) hâve normal B-cells. Malignant B-cells can preferably be determined, detected and/or isolated by the means and methods described herein below. Briefly, malignant B-cells of a patient can be determined, detected and/or isolated by one or more of the spécifie (i.e., characteristic) B-cell surface marker(s) as described herein and, in particular as embodied in the claims (CD38 positive, CD56 positive or négative, CD 45 positive and/or CD19 positive).
[0034]The term, “Multiple Myeloma (MM)”, also known as plasma cell myeloma or Kahler's disease (after Otto Kahler), is an incurable clonal B-cell neoplasia characterized by the accumulation of malignant plasma B-cells within the bone marrow, in close contact with stromal cells. MM is a progressive disease inter alia, for example, caused by multiple genetic insults, i.e. chromosomal translocations mainly caused by translocations such as t(11;14), t(4;14)^ t(8;14), or délétions such as del(13), and del(17) to the precursor plasma B-cell that tumor cells proliferate drastically and become apoptosis résistance.
[0035] B lymphocytes start in the bone marrow and move to the lymph nodes. As they progress, they mature and display different proteins on their cell surface. When they are activated to secrete antibodies, they are known as plasma cells. Multiple myeloma develops in B lymphocytes after they hâve left the part of the lymph node known as the germinal center.
[0036] The immune System keeps the prolifération of B cells and the sécrétion of antibodies under tight control. When chromosomes and genes are damaged, often through rearrangement, this control is lost. Often, a promoter gene moves (or translocates) to a chromosome where it stimulâtes an antibody gene to overproduction.
[0037] As mentioned above, a chromosomal translocation between the immunoglobulin heavy chain gene (on the fourteenth chromosome, locus 14q32) and an oncogene (often 11q13, 4p16.3, 6p21, 16q23 and 20q11[10]) is frequently observed in patients with multiple myeloma. This mutation results in dysrégulation of the oncogene which is ~ thought to be an important initiating event in the pathogenesis of myeloma. The resuit is prolifération of a plasma cell clone and genomic instability that leads to further mutations and translocations. The chromosome 14 abnormality is observed in about
50% of ali cases of myeloma. Délétion of (parts of) the thirteenth chromosome is also observed in about 50% of cases.
[0038]Accordingly, MM patients that are subject to the methods and/or antibody-based thérapies of the présent invention hâve preferably any of the herein mentioned chromosomal translocation(s) and/or deletion(s).
Production of cytokines (especially IL-6) by the plasma cells causes much of their localized damage, such as osteoporosis, and créâtes a microenvironment in which the malignant cells thrive. Angiogenesis (the attraction of new blood vessels) is increased. The produced antibodies are deposited in various organs, leading to rénal failure, polyneuropathy and various other myeloma-associated symptoms.
In the context of the présent invention, MM is preferably staged in accordance with the International Staging System (Greipp et al. (2005), J. Clin. Oncol. 23 (15):3412-3420 and/or in accordance with the Durie-Salmon Staging System (Durie et al. (1975), Cancer 36 (3): 842-854.
Γ00391 International Staging System:
• Stage I: p2-microglobulin (β2Μ) < 3.5 mg/L, albumin >= 3.5 g/dL • Stage II: β2Μ < 3.5 mg/L and albumin < 3.5 g/dL; or β2Μ 3.5 mg/L - 5.5 mg/L irrespective of the sérum albumin • Stage lll: β2Μ >= 5.5 mg/L
Γ00401 Durie-Salmon staging system:
• stage I: ail of o Hb>10g/dL o normal calcium o Skeletal survey: normal or single plasmacytoma or osteoporosis o Sérum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
Urinary light chain excrétion < 4 g/24h • stage II: fulfilling the criteria of neither I nor III • stage III: one or more of o Hb < 8.5g/dL o high calcium > 12 mg/dL o Skeletal survey: Three or more lytic bone lésions o Sérum paraprotein > 7g/dL if IgG, > 5 g/dL if IgA o Urînary light chain excrétion > 12g/24h
Stages I, II, and III of the Durie-Salmon staging system can be divided into A or B depending on sérum créatinine:
• A: sérum créatinine < 2 mg/dL (< 177 umol/L) • B: sérum créatinine > 2 mg/dL (> 177 umol/L) [0041] Accordingly, MM patients that are subject to the methods and/or antibody-based thérapies of the présent invention are preferably staged in accordance with the International Staging System and/or in accordance with the Durie-Salmon Staging System.
[0042]Also, MM patients that are subject to the methods and/or antibody-based thérapies of the présent invention may hâve stage I, Il or III MM in accordance with the International Staging System and/or in accordance with the Durie-Salmon Staging System.
[0043]MM patients may expérience a variety of disease-related symptoms because of bony destruction, bone marrow infiltration, rénal failure, immunodeficiency, and the psychosocial burden of a cancer diagnosis. Excîting new thérapies and treatment approaches are becoming available but often bring unwanted side effects.
Most cases of myeloma also feature the production of a paraprotein, an abnormal antibody that can cause kidney problems and interfères with the production of normal antibodies leading to immunodeficiency. Hypercalcemia (high calcium levels) are often encountered. Myeloma is diagnosed with blood tests (such as protein electrophoresis, peripheral blood smear), microscopie examination of the bone marrow (bone marrow biopsy), and X-rays of commonly involved bones [0044] Because many organs can be affected by myeloma, the symptoms and signs vary greatly. A mnemonic sometimes used to remember the common tetrad of multiple myeloma is CRAB: C = Calcium (elevated), R = Rénal failure, A = Anémia, B = Bone lésions. Myeloma has many possible symptoms, and ail symptoms may be due to other causes. They are presented here in decreasing order of incidence, bone pain, infection, rénal failure, anémia, neurological symptoms.
[0045] The term BCMA when used herein encompass native sequence BCMA and BCMA variants (which are further defined herein). The BCMA may be isolated from a variety of sources, such as from murine or human tissue types or from another source, or prepared by recombinant or synthetic methods. BCMA” is the abbreviation of B cell 15 maturation antigen. BCMA was isolated as a receptor for BLyS (B Lymphocyte stimulator; trademark of Human Genome Science Rockville, MD), also referred to as BAFF, THANK, TALL-1, TNFSF13, zTNF4.
[0046] BCMA is type I single transmembrane receptors and belongs to the TNF family receptors, and is predominantly expressed on B lymphocytes. BCMA used herein also encompasses native sequence BCMA and BCMA variants (which are further defined herein), and may be isolated from a variety of sources, such as from murine or human tissue types or from another source, or prepared by recombinant or synthetic method.
[0047] A native sequence BCMA comprises a polypeptide having the same amino acid sequence as BCMA derived from nature. Such native sequence BCMA can be isolated from nature or can be produce by recombinant or synthetic means. The naturallyoccurring truncated or secreted forms of the BCMA (e.g. soluble forms containing for instance, an extracellular domain sequence), naturally-occurring variant forms (e.g., alternatively spliced forms) and naturally occurring allelic variants of the BCMA. In one embodiment of the invention, the native sequence BCMA is a mature or full-length yi/' native sequence BCMA polypeptide comprising amino acids 1 to 184 of SEQ ID NO:1 or fragment thereof. Such fragments are preferably biologically active.
Met Leu Gin Met Ala Gly Gin Cys Ser Gin Asn Glu Tyr Phe Asp Ser
1 5 10 15
Leu Leu His Ala Cys Ile Pro Cys Gin Leu Arg Cys Ser Ser Asn Thr
20 25 30
Pro Pro Leu Thr Cys Gin Arg Tyr Cys Asn Ala Ser Val Thr Asn Ser
35 40 45
Val Lys Gly Thr Asn Ala Ile Leu Trp Thr Cys Leu Gly Leu Ser Leu
50 55 60
Ile Ile Ser Leu Ala Val Phe Val Leu Met Phe Leu Leu Arg Lys Ile
65 70 75 80
Ser Ser Glu Pro Leu Lys Asp Glu Phe Lys Asn Thr Gly Ser Gly Leu
85 90 95
Leu Gly Met Ala Asn Ile Asp Leu Glu Lys Ser Arg Thr Gly Asp Glu
100 105 110
Ile Ile Leu Pro Arg Gly Leu Glu Tyr Thr Val Glu Glu Cys Thr Cys
115 120 125
Glu Asp Cys Ile Lys Ser Lys Pro Lys Val Asp Ser Asp His Cys Phe
130 135 140
Pro Leu Pro Ala Met Glu Glu Gly Ala Thr Ile Leu Val Thr Thr Lys
145 150 155 160
Thr Asn Asp Tyr Cys Lys Ser Leu Pro Ala Ala Leu Ser Ala Thr Glu
165 170 175
Ile Glu Lys Ser Ile Ser Ala Arg (SEQ ID NO: 1)
180 [0048] Biologically active as used herein, means having an in vivo or in vitro activity which may be performed directly or indirectly. Biologically active fragments of BCMA may hâve, for example, 70% amino acid homology with the active site of the receptor, more preferably at least 80%, and most preferably, at least 90% homology. Identity or^y— homology with respect to the receptor is defined herein as the percentage of amino acid residues in the candidate sequence which are identical to the BCMA residues in SEQ ID
NO:1, or which are identical to a defined portion of the amino acid residues in SEQ ID
NO:1. Biological activity can be tested by way of interaction with APRIL and/or BAFF.
[0049] The BCMA extracellular domain or BCMA ECD refers to a form of BCMA which is essentially free of transmembrane and cytoplasmic domains of BCMA. Ordinarily, BCMA extracellular domain will hâve less than 1% of such transmembrane and cytoplasmic domains and will preferably hâve less than 0.5% of such domains. Optionally, BCMA ECD will comprise amino acid residues 8 to 41 of SEQ ID NO:1, or amino acid residues 4 to 51 of SEQ ID NO: 1, or amino acid residues 1 to 53 of SEQ ID NO:1. In a preferred embodiment of the présent invention, the BCMA ECD comprises amino acid residues 1 to 51 of SEQ ID NO:1. It will be understood by the skilled artisan that the transmembrane domain identified for the BCMA polypeptide of the présent invention is identified pursuant to criteria routinely employed in the art for identifying that type of hydrophobie domain. The exact boundaries of a transmembrane domain may vary but most likely by no more than about 5 amino acids at either end of the domain specifically mentioned herein. Accordingly, the BCMA ECD may optionally comprise amino acids 8-41 (SEQ ID NO: 1).
[0050] BCMA-variant means an active BCMA as defined below having at least about 80% amino acid sequence identity with the BCMA having the deduced amino acid sequence shown in SEQ ID NO:1 for a full-length native sequence BCMA or with a BCMA sequence. Such BCMA variants include, for instance, BCMA polypeptides wherein one or more amino acid residues are added, or deleted, at the end or C-terminus of the sequence of SEQ ID NO:1. Ordinarily, a BCMA variant will hâve at least about 80% or 85% amino acid sequence identity, more preferably at least about 90% amino acid sequence identity, and even more preferably at least about 95% amino acid sequence identity with the amino acid sequence of SEQ ID NO:1.
[0051] Percent (%) amino acid sequence identity with respect BCMA sequences identified herein is defined as the percentage of amino acid residues in a candidate sequence that are identical with the amino acid residues in the BCMA sequence, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity, and not considering any conservative substitutions as part of the sequence identity. Alignment for purposes of determining percent amino acid sequence identity can be achieved in various ways that are within the skill in the art, for instance, using publically available computer software such as BLAST, ALIGN, or Megalign (DNASTAR) software. Those skilled in the art can détermine appropriate parameters for measuring alignment, including any algorithms needed to achieve maximum alignment over the full length of the sequences being compared.
[0052] The term disposed to respond favorably when used in the context of the present invention means that MM B-cells from a patient who is administered an antibody-based therapy, in particular an anti-BCMA antibody therapy are more likely to be susceptible to said antibody. The likelihood that MM B-cell (preferably obtained from a patient) may respond favorably is dépendent on the expression of BCMA on the cell surface of a MM B-cell as described herein. More specifically, the MM B-cell may respond favorably to said antibody if expression level of BCMA on the cell surface of a MM B-cell is higher than that of (a) reference cell(s) as described herein. The expression level of BCMA on the cell surface of a MM B-cell is determined as described herein.
[0053] Surface expression of BCMA can, for example, be done by Fluorescence Activated Cell Sorting (FACS) using an appropriate anti-BCMA antibody. Anti-BCMA antibody can either be generated by means and methods commonly known in the art or are commercially available.
[0054] In particular, the invention also includes antibodies specifically reactive with
BCMA. Antiprotein/anti-peptide antisera or monoclonal antibodies can be made by standard protocols (See, for example, Antibodies: A Laboratory Manual ed. by Harlow and Lane (Cold Spring Harbor Press: 1988)). A mammal such as a mouse, a hamster or rabbit can be immunized with an immunogenic form of the peptide. Techniques for^^z- conferring immunogenicity on a protein or peptide include conjugation to carriers, or other techniques, well known in the art. An immunogenic portion of BCMA can be administered in the presence of an adjuvant. The progress of immunization can be monitored by détection of antibody titers in plasma or sérum. Standard ELISA or other immunoassays can be used with the immunogen as antigen to assess the levels of antibodies.
[0055] In a preferred embodiment, the antibodies are immunospecific for antigenic déterminants of BCMA or its co-receptors, e.g. antigenic déterminants of a polypeptide of SEQ ID NO: 1, or a closely related human or non-human mammalian homolog (e.g. 70, 80 or 90 percent homologous, more preferably at least 95 percent homologous). In yet a further preferred embodiment of the présent invention, the anti-BCMA antibodies do not substantially cross react (i.e. react specifically) with a protein which is e.g., less than 80 percent homologous to SEQ ID NO:1; preferably less than 90 percent homologous with SEQ ID NO: 1; and, most preferably less than 95 percent homologous with SEQ ID NO:1. By not substantially cross react, it is meant that the antibody has a binding affinity for a non-homologous protein which is less than 10 percent, more preferably less than 5 percent, and even more preferably less than 1 percent, of the binding affinity for a protein of SEQ ID NO:1.
[0056] As mentioned above, BCMA contains an extracellular domain. Said extracellular domain is preferably targeted by an antibody applied in the methods and antibodybased thérapies of the présent invention. A preferred anti-BCMA antibody is an antihuman BCMA antibody such as a rat anti-human BCMA antibody, a mouse anti-human BCMA antibody, a camelid anti-human BCMA antibody, a sheep anti-human BCMA antibody. Of course, if BCMA from a mammal other than human is to be detected on the surface of a patient, for example, a cat or dog, an antibody from a species other than that to be diagnosed is applied. For example, if the patient is a dog or cat, a mouse, rat, sheep, camelid anti-dog or anti-cat BCMA antibody is applied.
[0057] In the alternative to an anti-BCMA antibody also an anticalin, i.e., a lipocalin mutein such as a tear lipocalin mutein, bacterial lipocalin mutein or an hNGAL lipocalin mutein directed against BCMA, preferably human BCMA, can be applied.
[0058] A particularly preferred antibody applied in the methods of the présent invention is the anti-human antibody Vicky-1 and/or MAB 193 (clone 335004). Vicky-1 is a rat lgG1 isotype and is available from GeneTex, Catalogue number #GTX17323. MAB193 is a rat lgG2a isotye and is available from R&D Systems, catalogue number #MAB193. Accordingly, in the methods of the présent invention it is preferred that BCMA, preferably BCMA expressed on the surface of MM B-cells is détectable with Vicky-1 or MAB 193.
Similarly, it is preferred that patients as described herein that may suffer from MM or are suspected to suffer therefrom hâve MM B-cells that are détectable with Vicky-1 or MAB 193. Put it differently, it is preferred that said patient (more specifically B-cells, in particular, MM B-cells of said patients) are, so to say, Vicky-1 and/or MAB193 positive.
[0059] Surface expression of BCMA can also be tested by a surface plasmon résonance (SPR) technique such as Biacore.
[0060] In the context of the methods of the présent invention, a MM B-cell is deemed to express BCMA on its surface (i.e., it is BCMA positive or has a certain BCMA expression level), if it shows a détectable signal that is above (or exceeds that of) a reference cell, preferably a BCMA négative cell, more preferably a BCMA négative Bcell, even more preferably a BCMA négative MM B-cell. A preferred BCMA négative MM B-cell is U266B1, JJN-3 or LP-1, with U266B1 and JJN-3 being preferred. Notably, such a BCMA négative cell line may nevertheless hâve détectable BCMA mRNA. The skilled person is readily in a position to détermine whether a détectable signal due to expression of BCMA on a B-cell of interest is above the détectable signal of a reference cell. Above in the context of a détectable signal means the détectable signal due to expression of BCMA on the surface of a B-cell of interest such as one or more B-cells from a patient, is 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95,
100% or higher than the signal from a BCMA négative reference cell. As mentioned above, the MAB193 or Vicky-1 antibody is preferably used for detecting/isolating/determining BCMA expression on the surface of B-cells, preferably malignant B-cells of a patient, preferably MM patient.
[0061] A “signar or “détectable signal reflects the resuit of an antibody-antigen reaction. In the context of the présent invention the antibody-antigen reaction is preferably the reaction of an anti-BCMA antibody with BCMA.
[0062] A signal can be determined by way of the signal provided by the signal generating group of an antibody, in particular an antibody against BCMA which is described herein. The signal can be any signal which is détectable by, for example, spectroscopic, photochemical, biochemical, immunochemical, or chemical means as described herein below. A signal can also be determined by way of the signal provided by the signal generating group of an antigen-specific receptor which is described herein below.
[0063] A signal generating group refers to a composition détectable by spectroscopic, photochemical, biochemical, immunochemical, or chemical means. For example, useful labels include radiolabels such as 32P, 35S, or 125l; fluorescent dyes (for example, Cy-3, Cy-5); chromophores, electron-dense reagents; enzymes that generate a détectable signal (e.g., as commonly used in an ELISA); or spin labels. The label or détectable moiety has or generates a measurable signal, such as a radioactive, chromogenic, or fluorescent signal, that can be used to quantify the amount of bound détectable moiety in a sample.
[0064] The détectable moiety can be incorporated in or attached to signal generating group either covalently, or through ionic, van der Waals or hydrogen bonds, e.g., incorporation of radioactive nucléotides, or biotinylated nucléotides that are recognized by streptavidin. The label or détectable moiety may be directly or indirectly détectable. Indirect détection can involve the binding of a second directly or indirectly détectable moiety to the détectable moiety. For example, the détectable moiety can be the ligand of a binding partner, such as biotin, which is a binding partner for streptavidin, or a nucléotide sequence, which is the binding partner for a complementary sequence, to which it can specifïcally hybridize. The binding partner may itself be directly détectable, for example, an antibody may be itself labelled with a fluorescent molécule. The binding partner also may be indirectly détectable.
[0065] When the antibody-specific receptor is “capable of binding to a signal generating group” this means that it can bind to a signal generating group. For example, the antibody-specific receptor may carry a functional group which is able to bind to a signal generating group. A functional group can be streptavidin/avidin which binds to biotin, an antigen such as a tag, for example, GST or histidine residues which binds to an antibody, a sugar which binds a lectin or the known Dig/Anti-Dig system. The moiety that binds to the functional group carries the signal generating group.
[0066] Any immunoassay known in the art can be used for immunologically detecting the binding of an antibody to an antigen or the binding of an antigen to an antibody. Immunoassays are well known to the skilled artisan. Methods for carrying out such assays as well as practical applications and procedures are summarized in related textbooks. Examples of related textbooks are Tijssen, P., In: Practice and theory of enzyme immunoassays, Burdon, R.H. and v. Knippenberg, P. H. (eds.), Elsevier, Amsterdam (1990), pp. 221-278, and various volumes of Colowick, S. P. and Caplan, N.O. (eds.), Methods in Enzymology, Academie Press, dealing with immunological détection methods, especially volumes 70, 73, 74, 84, 92 and 121.
[0067] Immunoassays, for example, include précipitation (particularly immunoprécipitation), electrochemiluminescence (electro-generated chemiluminescence), RIA (radioimmunoassay), ELISA (enzyme-linked immunosorbent assay), sandwich enzyme immune tests, electrochemiluminescence sandwich immunoassays (ECLIA), dissociation-enhanced lanthanide fluoro immuno assay (DELFIA), scintillation proximity assay (SPA), turbidimetry, nephelometry, latex- y/ enhanced turbidimetry or nephelometry, solid phase immune tests, and mass spectrometry such as SELDI-TOF, MALDI-TOF, or capillary electrophoresis-mass spectrometry (CE-MS).
Furthermore, suitable immunoassays include microplate ELISA-based methods, fullyautomated or robotic immunoassays and latex agglutination assays.
[0068] Typically, in the présent invention an immunoassay is an assay in which an antibody specifically binds an antigen to provide for the détection and/or quantification of an antibody or an assay in which an antigen binds to an antibody to provide for the détection and/or quantification of said antigen. In the context of the présent invention the antigen is preferably BCMA or a fragment thereof, said fragment being preferably immunologically détectable, and the antibody is preferably an anti-BCMA antibody. “Immunologically détectable when used herein preferably includes that a signal generated by the binding of an antibody to an antigen or by the binding of an antigen to an antibody as described herein is détectable by means and methods commonly known and applied in the art. In the context of the présent, “immunologically détectable preferably means that a signal generated by the reaction of an anti-BCMA antibody and BCMA or fragment thereof is above (or exceeds that of) a reference cell as described herein, i.e., a MM B-cell of interest is then BCMA positive.
[0069] Is not immunologically détectable when used herein preferably includes that a signal generated by the binding of an antibody to an antigen or by the binding of an antigen to an antibody as described herein is not détectable by means and methods commonly known and applied in the art. In the context of the présent, “not immunologically détectable preferably means that a signal generated by the reaction of an anti-BCMA antibody and BCMA or fragment thereof is equal to or below that of a reference cell as described herein, i.e., a MM B-cell of interest is then BCMA négative, [0070] “MM B-cell of interest’’ means B-cells, preferably malignant B-cells obtained from a patient suffering from MM or who is suspected to suffer from MM. Prior to analyzing said MM B-cell of interest in accordance with the methods of the présent invention, it cannot be said as to whether or not said B-cells are BCMA positive or négative, respectively.
[0071] In addition or as an the alternative to a comparison of the expression level of BCMA on the cell surface of a MM B-cell with a BCMA négative cell, also a BCMA positive cell line can serve as a reference cell. Suitable BCMA positive cell lines in the sense of the présent invention (i.e., as defined herein) are NCI-H929, MOLP-2, OPM-2, MOLP-8, RPMI8226, KMS-12-BM or L-363. Specifically, a MM B-cell of interest is deemed to be BCMA-positive if it has at least the equal expression level of BCMA as a reference cell line. The expression is preferably determined as described herein (i.e., by way of the signal generated by a cell).
[0072]Similarly, In the context of the methods of the présent invention, a MM B-cell is deemed to not express BCMA on its surface (i.e., it is BCMA négative), if it does essentially not show a détectable signal that is above a reference cell, preferably a BCMA négative cell, more preferably a BCMA négative B-cell, even more preferably a BCMA négative MM B-cell. A preferred BCMA négative MM B-cell is U266B1, JJN-3 or LP-1, with U266B1 and JJN-3 being preferred. Notably, such a BCMA négative cell line may nevertheless hâve détectable BCMA mRNA. The skilled person is readily in a position to détermine whether a détectable signal due to expression of BCMA on a Bcell of interest is not above (i.e., equal to or below) the signal of a reference cell.
Equal to” in the context of a détectable signal means the détectable signal due to expression of BCMA on the surface of a B-cell of interest such as one or more B-cells from a patient is the same as the signal of a BCMA négative reference cell.
“Below in the context of a détectable signal means that the B-cell of interest such as one or more B-cells from a patient shows a signal that is 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95 or even 100% lower than the signal from a BCMA négative reference cell.
[0073] The findings of the présent inventors also provide the skilled person with a method for selecting an antibody-based multiple myeloma (MM) therapy, comprising determining whether B-cells of a patient express BCMA protein on the surface of said plasma B-cells, wherein, if said plasma B-cells are BCMA positive, the patient may be subject to an anti-CD20 antibody therapy and/or an anti-CD38 antibody therapy and/or an anti-BCMA antibody therapy, or, if said B-cells are BCMA-negative, the patient is subject to an antî-CD20 antibody therapy and/or an anti-CD38 antibody therapy, [0074]lndeed, as described herein, if B-cells of a patient express BCMA protein, said patient will potentially respond favourably to an anti-BCMA antibody therapy. However, even if B-cells of a patient are négative for BCMA (BCMA-negative), said patient can be subject to an antibody-based therapy such as an anti-CD20 antibody-based therapy and/or anti-CD38 antibody based therapy. Thus, the présent invention provides methods and means for selecting one or more appropriate antibody-based thérapies for the treatment or prévention of MM.
[0075] The term “potentially’' when used in the context of a therapeutic effect means that an anti-BCMA antibody- though such an antibody is deemed to hâve a therapeutic effect based on the outcome of the methods of the présent invention - does not necessarily hâve to be therapeutically effective. This is so because - self-explanatory as it is - the methods of the présent invention cannot provide a 100% safe prédiction whether or not a patient may be susceptible to such an antibody, since, apart from the expression of BCMA on the surface of a MM B-celi, individual factors such as âge, body weight, general health, sex, diet, drug interaction and the like may hâve an influence as to whether or not a patient will be susceptible to such an antibody.
However, if a MM B-cell from a patient is BCMA positive as described herein, the likelihood that an anti-BCMA antibody has a therapeutic effect is more than 50% in comparison to a patient, whose MM B-cells does not show cell surface expression of
BCMA. Preferably the likelihood is more that 60%, 70%, 80% or 90%, more preferably more than 95%.
[0076]Of course, it is advisable to détermine as to whether a BCMA-negative MM patient may be CD20 and/or CD38-positive and/or CS1-positive before making him/her 10 subject to an anti-CD20 and/or anti-CD38 and/or CS1 antibody-based therapy.
Further antibody-based thérapies (i.e., one or more antibody-based thérapies) in addition (i.e., as combination) to an anti-BCMA antibody-based therapy (if a patient is BCMA positive) or as an alternative to an anti-BCMA antibody-based therapy (if a patient is BCMA négative), that are encompassed by the présent invention, may be 15 based on the target indicated in the outer left column of the table that follows below. If the antibody directed against the target as indicated in the outer left column îs conjugated to a toxin, then such a conjugate is also encompassed by said further antibody-based therapy.
'-J
Target Brand name Type of mAb (conjugate) Phase Remarks
CD138 B-B4-DM1 the maytansinoid immunoconjugate mouse IqGl mAb B-B4 predinical Tassone Blood 2004,104:3688-96
HM1.24 humanized HM1.24 humanized HM1.24 humanized Fc-engineered humanized IgGi preclincial preclincial Ozaki Blood 1999,93:3922-3930
IL-6 OP-R003-1, 1339 Elsilimomab, Azintrel human IgGl preclincial Fulciniti Clin Cancer Res 2009,15:7144- 52
HLA-DR 1D09C3 human IgGl preclincial Carlo-Stella Cancer Res 2007
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Sainz Cancer Immunol Immunother 2006 C11C1 mAb inhibits its own tumor growth in vivo, slows down B38-MM growth rate when both MM are implanted together
Kininogen C11C1 mouse preclincial and when mAb Cl ICI is injected intraperitoneally. MAb CllCl-treated-MM showed decreased MVD and kininogen binding in vivo without FGF-2, B1R, or B2R expression changes
HLA class I 2D7-DB converted from mouse IgG2b, single-chain Fv diabody preclincial Sekimoto Cancer Res 2007; 67:1184-92. a recombinant single-chain Fv diabody 2D7-DB specifically induces multiple myeloma cell death in the bone marrow environment
β2microglobulin anti-/ï2M mAbs mouse preclincial Yang Blood 2007; 110:3028-35. & Clin Cancer Res 2009; 15:951-9. Strong apoptotic effect on myeloma cells and low toxocity in the mice suppports potential use as therapeutic agents
Zhou Blood 2008; 111:549-557. humanized 2B6 MoAb may target in patients with systemic AL-amyloidosis. It
CD32B FGFR3 MGA321(2B6) PRO-OOl humanized IgGl human IgGl preclincial preclincial blocks Fc engagement of CD32B and may improve the performance of other cancer Mabs when combined with them durina administration Trudel Blood 2006; 2:4908-4915. The inhibitory anti-FGFR3 antibody, PRO-OOl, is cytotoxic to t(4; 14) MM cells and deserves further study for the treatment of FGFR3-expressing myeloma
ICAM-1 CUV3 chimeric IgGl preclincial Smallshaw J Immunother 2004; Coleman J Immunother 2006 cUV3 significantly prolongs the survival of SCID/ARH-77 mice
BLyS BLyS/rGel Fusion protein of an antibody tethered to a toxin preclincial Lyu et al. Mol Cancer Ther 2007; 6:46070
TACI Atacicept (TACI-Ig) fusion protein preclincial Yaccoby Leukemia 2008 22, 406-413
CD70 SGN-70 humanized IgGl preclincial McEarchern Clin Cancer Res 2008 14, 7763-72
TRAIL- R2(DR5) lexatumumab human preclincial Menoret et al. Blood 2006; 132: 1356-62
IL-6R NRI (engineered Tocilizumab) a single-chain fragment format dimerized by fusing to the Fc portion of human immunoqlobulin G1 preclincial Yoshio-Hoshino Cancer Res 2007; 67:871-5. the NRI gene introduction combined with adenovirus gene delivery inhibited the in vivo S6B45 cell growth significantly
BCMA SGI Auristatin-BCMA mAb preclincial Ryan et al. Mol Cancer Ther 2007; 6:3009-18
12-0333-pct matriptase M24-DOX
IL-lbeta XOMA 052
CD20 Rituxan
CD20
Zevalin (yttrium Y 90 ibritumomab tiuxetan)
CD40
SGN-40 (Dacetuzumab)
CD40
HCD122 (Lucatumumab) immunoconjugate with doxorubicin
Human Engineered
IgG2 chimeric with a human IgGl Fc mouse IgGl humanized IgGl human IgGl
Bertino et al. 2010 AACR abtract no. 2596. M24-DOX is as potent as free doxorubicin to inhibit the growth of MM
.. . . cells. But target delivery of doxorubicin prec incia the matrjptase antibody significantly reduced the toxicity toward cardiomyocytes that lack matriptase expression
Lust 2010 AACR abstract no. 2449. XOMA . 052 is highly effective at inhibiting IL-1 p induced IL-6 production in myeloma _____________patients in vitro____________________________
NCT00258206 (with cyclophosphamide): NCT00505895. High-dose cyclophosphamide in combination with II rituximab in patients with primary (ongoing) refractory, high-risk, or relapsed myeloma, also being studied for the treatment of peripheral neuropathy in patients with MGUS
NCT00477815: Zevalin
I radioimmunotherapy with high-dose (ongoing) melphalan and stem cell transplant for ________MM_________________________
NCT00664898: safety and pharmacology of SGN-40 administered in combination
I b with Bortezomib (Velcade, PS-341) in (ongoing) patients with relapsed or refractory MM.
NCT00525447 is the study of SGN40, lenalidomide, and dex in MM patients
I (ongoing)
M *
O
VJ
VJ
VJ i □ n
NCT00231166 Dose-finding trial of
HCD122 in MM patients that is relapsed or has not responded to prior therapy
CD20
Bexxar(131tositumomab) radioactive iodine 131 attaching to anti-CD20; mu!gG2a (131) humanized
CD56 BB-10901 (IMGN901) (maytansine DM1 conjugation)
RANKL Denosumab human IgG2
VEGF Avastin beuacizumab humanized
Campath-1H (alemtuzumab) humanized
NCT00135200: to see whether the
II treatment with Bexxar will decrease and (ongoing) possibly eliminate residual myeloma cells£ résistant to chemotherapy8
NCT00346255: given as an intravenousV infusion weekly for two consecutive
I weeks every three weeks to relapsed and (ongoing) relapsed refractory CD56-positive MM;
NCT00991562: IMGN901 in combination with lenalidomide and dexamethasone NCT00259740: to détermine if denosumab is effective in the treatment of relapsed or plateau-phase MM;
NCT00104650: to détermine the effectiveness of AMG 162 in reducing urinary N-telopeptide in advanced cancer subjects with bone métastasés;
NCT00330759: Phase III Study of Denosumab Compared With Zoledronic Acid (Zometa) in the Treatment of Bone Métastasés in Subjects With Advanced Cancer (Excluding Breast and Prostate Cancer) or MM
NCT00428545 (in combination with bortezomib); NCT00410605 (added with lenalidomide and dexamethasone)________
NCT00625144: studying the side effects of giving fludarabine and busulfan
II together with alemtuzumab followed by (ongoing) donor stem cell transplant and to see how well it works in treating patients with hematoloqical cancer or other disease
II/III (ongoing)
II (ongoing)
NCT00401843 (in combination with
IL-6 CNTO 328 chimerized IgGl Ι/Π (ongoing) bortezomib); NCT00911859 (added with Velcade-Melphalan-Prednisone); NCT00402181 (in combination with dexamethason)
IL-6 B-E8 (Elsilimomab) murine II Preliminary efficacy was seen but there is a limitation for the clinical use of a murine monoclonal antibody since it frequently induces human anti-mouse antîbodies (HAMA)
IL-6R MRA (Tocilizumab) humanized II
TRAIL- R1(DR4) Mapatumumab(TRM-l) human II (ongoing) NCT00315757 (in combination with bortezomib)
EGFR Erbitux(EMMA-l) chimerized II (ongoing) NCT00368121 (in combination with dexamethasone)
CS1 DKK e!otuzumab/HuLuc63 BHQ880 humanized human IgGl Ι/Π (ongoing) Ι/Π (ongoing) NCT00742560 & NCT00726869 (in combination with bortezomib) NCT00741377: in combination with Zoledronic Acid in relapsed/refractory myeloma
CD138 BT062 chimeric (B-B4maytansinoid DM4) I (ongoing) NCT00723359
the activin receptor type IIA (ActRIIA) ACE-011 human IgGl I/IIa (ongoing) NCT00747123 (in patients with osteolytic lésions with MM)
IGF-1R AVE1642 humanized Ι/Π (ongoing) Descamps et al. (B J Cancer 2009; 100:366) Anti-IGF-IR Monoclonal Antibody combined with bortezomib for patients with rel/ref MM
Ganglioside GM2 BIW-8962 humanized I/II (ongoing) Dosing study of anti-GM-2 ganglioside (expressed at high levels on the surface of MM cells) followed by efficacy study
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U-> K)
CD74 (variant milatuzumab (hLLl,
MHC II) IMMU-110)
Alpha-4 integrin
MHC II (HLADR)
IGF-1R humanized IgGl or humanized IgGl doxorubicin conjugale natalizumab (Tysabri) humanized IgG4
1D09C3 human IgG4
CP751,871/figitumumab human IgG2
NCT00421525: in patients with récurrent or refractory multiple myeloma who hâve failed at least two prior standard systemic—
I/II treatments. Its isotope, drug, and toxing (ongoing) conjugates hâve high antitumor activity£ in non-Hodgkin's lymphoma and multiplea myeloma in vitro and in tumor xenograft ____________models. Stein et al. 2007 & 2009_________ I/II NCT00675428: patients with relapsed or (ongoing) refractory multiple myeloma
Carlo-Stella et al. 2007 showed that IFNgamma-induced up-regulation of HLA-DR results in a potent enhancement of the in vivo antimyeloma activity of 1D09C3 in mice. Initial clinical testing with 1D09C3 has not raised any unexpected or unacceptable safety concerns and the maximum tolerated dose has not yet been reached. GPC Biotech has decîded to not put further internai resources into developing 1D09C3 due to potential swapping of IgG4 antibody one half of its Y-shaped structure with the half of a different antibody, thus resulting in a new molécule whose properties are unknown. However, the Company will seek a partner for the intellectual propertv relatinq to this program
Lacy et al. (J. Clin Onclo 26:3196) reported that CP-751,871 is well tolerated and may constitute a novel agent in the treatment of multiple myeloma
KIR
IPH 2101 human IgG4
NCT00552396 (ASCO May 30 2009 abstract 09-AB-3032) safety and tolerability study for patients with I/IIa relapsed/refractory MM. Preclinical (ongoing) characterization of 1-7F9, a novel human anti-KIR therapeutic antibody that augments NK-mediated killing of tumor cells (Romagne et al. 2009)
12-0333-pct
[0077] B-cells can be selected and/or identified by way of a B-cell surface marker. A B cell surface marker or B cell surface antigen herein is an antigen expressed on the surface of a B cell which can be targeted with an antagonist which binds thereto. Exemplary B cell surface markers include, but are not limited to CD19, CD20, CD21, CD22, CD23, CD24, CD37, CD40, CD52, D53, CD72, CD73, CD74, CDw75, CDw76, CD77, CDw78, CD79a, CD79b, CD80, CD81, CD82, CD83, CDw84, CD85, CD86, CDI 80 (RP105), FcRH2 (IRTA4), CD79A, C79B, CR2, CCR6, CD72, P2X5, HLA-DOB, CXCR5 (BLRI), FCER2, BR3 (aka BAFF-R), TACI, BTLA, NAG14 (aka LRRC4), SLGC16270 (aka LOC283663), FcRHI (IRTA5), FcRH5 (IRTA2), ATWD578 (aka MGC15619), FcRH3 (IRTA3), FcRH4 (IRTAI), FcRH6 (aka LOC343413) and, in particular BCMA.
[0078] MM B-cells may be detected, selected and/or identified by way of a B-cell surface marker as described above. However, preferably MM B-cells are selected and/or identified by way of the following markers: CD19, CD56, CD117, CD20, CD28, CD27, CD81 and/or CD200 (see also Table 2 of Rawston et al. (2008), Haematologica 93(3):431-438.
MM B-cells of the présent invention are preferably characterized to be at least CD38 positive, CD56 positive or négative, CD45 positive, and CD19 positive.
[0079] B-cells, preferably malignant B-cells that are subject to the methods of the présent invention are preferably obtained from a patient. A patient according to this invention is a mammal, preferably said patient or mammal suffers from MM or is suspected to sufferfrom MM. Mammal” for purposes of treatment refers to any animal classified as a mammal, including human, domestic and farm animais, nonhuman primates, and any other animal that has mammary tissue. A mammal includes human, rodents such as mouse, rat or rabbit, dog, cat, chimpanzee, horse, pig, etc,, with human being preferred. A patient also includes human and veterinary patients, with human patients being preferred. In each one of the above methods, the mammal may be one that suffers from multiple myeloma.
A mammal in need of treatment can include, but are not limited to, mammals that hâve multiple myeloma or are suspected to hâve multiple myeloma.
[0080] A “subject when used herein includes mammalian and non-mammalian subjects.
[0081]B-cells obtained from a patient are preferably contained in a sample. In accordance with the present invention by the term “sample” is intended any biological sample obtained from a subject, cell line, tissue culture, or other source containing at least B-cells. Biological samples include body fluids (such as blood, sérum, plasma, urine, saliva, synovial fluid and spinal fluid) and tissue sources found to contain B-cells. Methods for obtaining tissue biopsies and body fluids from subjects are well known in the art. Generally, a biological sample which includes peripheral blood mononuclear cells (PBMCs), in particular B cells and T cells is preferred as a source. A sample which includes peripheral blood mononuclear cells (PBMCs), in particular B cells and T cells is preferably taken from peripheral blood of a human patient. Other preferred samples are whole blood, sérum, plasma or synovial fluid, with plasma or sérum being most preferred. However, a sample from peripheral blood of a human patient is particularly preferred.
[0082] It is a preferred embodiment of the methods of the present invention that a patient is to be treated with an anti-BCMA antibody. The antibody applied for the treatment of a patient as well as the antibody applied in the methods for stratification, diagnosis or selecting an antibody-based MM therapy is preferably a monoclonal antibody, polyclonal antibody, chimeric antibody, humanized antibody, bispecific antibody, domain antibody (dAb) or nanobody.
[0083] The term antibody also includes but is not iimited to polyclonal, monoclonal, monospecific, polyspecific such as bispecific, non-specific, humanized, human, sînglechain, chimeric, synthetîc, recombinant, hybrid, mutated, grafted, domain (VHH) and in
V/- vitro generated antibodies as well as nanobodies including camelid antibodies and humanized camelid antibodies. Accordingly, the term antibody also relates to a purified sérum, i.e., a purified polyclonal sérum. Accordingly, said term preferably relates to a sérum, more preferably a polyclonal sérum and most preferably to a purified (polyclonal) sérum.
Furthermore, the term antibody as employed in the invention also relates to dérivatives or variants of the antibodies described herein which display the same specificity as the described antibodies. Examples of antibody variants include humanized variants of non- human antibodies, affinity matured antibodies (see, e.g. Hawkins et al. J. Mol. Biol. 254, 889-896 (1992) and Lowman et al., Biochemistry 30, 10832- 10837 (1991)) and antibody mutants with altered effector function (s) (see, e.g., US Patent 5, 648, 260).
The terms antigen-binding domain, antigen-binding fragment and “antibody binding région when used herein refer to a part of an antibody molécule that comprises amino acids responsible for the spécifie binding between antibody and antigen. The part of the antigen that is specifically recognized and bound by the antibody is referred to as the epitope as described herein above. As mentioned above, an antigen-binding domain may typically comprise an antibody light chain variable région (VL) and an antibody heavy chain variable région (VH); however, it does not have to comprise both. Fd fragments, for example, have two VH régions and often retain some antigen-binding function of the intact antigen-binding domain. Examples of antigen-binding fragments of an antibody include (1) a Fab fragment, a monovalent fragment having the VL, VH, CL and CH1 domains; (2) a F(ab')2 fragment, a bivalent fragment having two Fab fragments linked by a disulfide bridge at the hinge région; (3) a Fd fragment having the two VH and CH1 domains; (4) a Fv fragment having the VL and VH domains of a single arm of an antibody, (5) a dAb fragment (Ward et al., (1989) Nature 341 :544-546), which has a VH or VL domain; (6) an isolated complementarity determining région (CDR), and (7) a single chain Fv (scFv). Aithough the two domains of the Fv fragment, VL and VH> are coded for by separate genes, they can be joined, using recombinant methods, by a synthetic linker that enables them to be made as a single protein chain in which the VL and VH régions pair to form monovalent molécules (known as single chain Fv (scFv);
see e.g,, Bird et al. (1988) Science 242:423-426; and Huston et al. (1988) Proc. Natl.
Acad. Sci USA 85:5879-5883). These antibody fragments are obtained using conventional techniques known to those with skill in the art, and the fragments are evaluated for function in the same manner as are intact antibodies.
The term immunoglobulin (Ig) is used interchangeably with antibody herein.
[0084] A further aspect of the présent invention is an anti-BCMA antibody therapy for use in the treatment of a multiple myeloma (MM) patient whose plasma B-cells are disposed to be BCMA positive.
[0085] A still further aspect of the présent invention is an anti-BCMA antibody for use in the treatment of a multiple myeloma (MM) patient diagnosed with a method of the présent invention.
[0086] Also another aspect of the présent is an anti-CD20 antibody and/or an anti-CD38 antibody for use in the treatment of a multiple myeloma (MM) patient whose B-cells are BCMA négative.
[0087] In one embodiment of the présent invention, an anti-BCMA antibody is conjugated to a toxin including chemotherapeutic agent that is toxic against malignant plasma B-cells in MM patients. Suitable chemotherapeutic agents are disclosed in WO 2010/121093 such as Bortezomib (Velcade), Thalidomide (Thalomid), Lenalidomide (Revlimid).
[0088] The terms treat or treatment refer to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to prevent or slow down (lessen) an undesired physiological change or disorder, such as the development or spread of cancer, in particular MM. For purposes of this invention, bénéficiai or desired clinical results include, but are not limited to, alleviation of symptoms, diminishment of extent of disease, stabilized (i. e., not worsening) state of disease, delay or slowing of disease progression, amelioration or palliation of the disease state, and remission (whether partial or total), whether détectable or undetectable. Treatment can also mean prolonging survival as compared to expected survival if not receiving treatment. Those in need of treatment include those already with the condition or disorder as well as those prone to hâve the condition or disorder or those în which the condition or disorder is to be prevented.
[0089] The anti-BCMA antibody, anti-CD20 antibody, anti-CD38 antibody and/or antiCS1 antibody is preferably administered in an effective amount. An “effective amount” is an amount sufficient to carry out a specifically stated purpose. An effective amount can be determined empirically and by known methods relating to the stated purpose.
The term therapeutically effective amount refers to an amount of a therapeutic agent of this invention effective to treat or ameliorate MM in a mammal (aka patient). In one instance, the therapeutically effective amount may be a growth inhibitory amount or a cytotoxic amount In the case of MM, the therapeutically effective amount of the drug active for any one of the following: reducing the number of cancer cells; reducing the number of malignant MM B-cells, tumor size; inhibiting (i.e., slow to some extent and preferably stop) cancer cell infiltration into peripheral organs; inhibiting (i.e., slow to some extent and preferably stop) tumor metastasis; inhibiting, to some extent, tumor growth; and/or relieve to some extent one or more of the symptoms associated with the cancer. To the extent the drug can prevent growth and/or kill existing cancer cells, it can be cytostatic and/or cytotoxic. A treatment or a therapeutically effective amount refers to a course of administration of the therapeutic agent, which course may include several dosings spread over a period of time to achieve a desired effect.
[0090] The B cell depleting agents (i.e., the anti-BCMA antibody, anti-CD20 antibody, anti-CD38 antibody or any other antibody directed against a target expressed on the surface of a B cell such as CS1) can be administered to a patient by a variety of methods, such as by intravenous administration, e.g., as a bolus or by continuous infusion over a period of time, by subcutaneous, intramuscular, intraperitoneal, intracerobrospinal, intra-articular, intrasynovial, intrathecal, or inhalation routes.
[0091] These antibodies are preferably administered in the form of a pharmaceutical compositions. The dosage regimen will be determined by the attending physician and clinical factors. As is well known in the medical arts, dosages for any one patient dépends upon many factors, including the patient's size, body surface area, âge, the particular compound to be administered, sex, time and route of administration, general health, and other drugs being administered concurrently. Préparations for parentéral administration include stérile aqueous or non-aqueous solutions, suspensions, and émulsions. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and injectable organic esters such as ethyl oleate. Aqueous carriers include water, alcoholic/aqueous solutions, émulsions or suspensions, including saline and buffered media. Parentéral vehicles include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, lactated Ringer's, or fixed oils. Intravenous vehicles include fluid and nutrient replenishers, electrolyte replenishers (such as those based on Ringer's dextrose), and the like. Preservatives and other additives may also be présent such as, for example, antimicrobiais, antioxidants, chelating agents, and inert gases and the like. Furthermore, the pharmaceutical composition of the invention may comprise further agents such as additional anti-tumor agents as exemplified herein elsewhere.
[0092] Another embodiment of the invention is a kit comprising an anti-BCMA antibody and instructions for use, in particular instructions as how to perform the methods of the présent invention.
The kit comprises at least one container and a label or package insert on or associated with the container. Suitable containers include, for example, bottles, vials, syringes, etc. The containers may be formed from a variety of materials such as glass or plastic. The container can hâve a stérile access port for extracting a therapeutic agent (for example the container may be an intravenous solution bag or a vial having a stopper pierceable by a hypodermic injection needle). The label or package insert can indicate that the composition is used for treating MM. \k/” [0093] Additionally, the kit may further comprise a second container comprising a pharmaceutically-acceptable buffer, such as bacteriostatic water for injection (BWFI), phosphate-buffered saline, Ringer's solution and dextrose solution. It may further include other materials désirable from a commercial and user standpoint, including other buffers, diluents, filters, needles, and syringes
EXAMPLES [0094] ALEXA Fluor® 488 Labeling of antibodies
Anti-BCMA IgGs and appropriate isotype control IgGs were labeled with ALEXA Fluor® 488 using ALEXA Fluor® 488 Monoclonal Antibody Labeling Kit (Invitrogen, #A20181). Labeling and calculation of the degree of labeling was performed according to manufacturers’ instructions.
IgG Clone Isotype Cat. No.
Anti-BCMA Vicky-1 Rat lgG1 GeneTex, #GTX17323
Anti-BCMA 335004 Rat lgG2a R&D Systems, #MAB193
Rat lgG1 isotype ctrl. 43414 Rat lgG1 R&D Systems, #MAB005
Rat lgG2a isotype ctrl. 54447 Rat lgG2a R&D Systems, #MAB006
Table 1: anti-BCMA monoclonal antibodies used for ALEXA Fluor® 488 labeling [0095] Staining primary malignant plasma B-cells from bone marrow aspirâtes
Bone marrow aspirâtes from MM patients were filtered through a 70 pm cell strainer (BD, 352350). Plasma cell numbers have previously been determined and based on that, aspirate volumes for staining were calculated:
I- 10% plasma cells in the CD45 négative population 180 pl;
II- 20% plasma cells in the CD45 négative population 120 pl;
21-31% plasma cells in the CD45 négative population 60 pl; z—
An appropriate volume of the aspirâtes was incubated with 1.5 pl of each of the following antibodies: CD38-APC (BD, clone: HIT2, #555462), CD56-PE-Cy-7 (BD, clone: NCAM16.2, #335791), CD45-APC-Cy7 (BD, clone: 2D1; #557833) and 6μΙ of
CD19-PerCP-Cy5.5 (BD, clone: HIB19, #561295). For diagnostic staining cells were fixed and permeabilised using Fixation and Permeabilisation kit (Invitrogen, #GAS-003) followed by 6 μΙ each of anti-lg kappa-FITC (BD, clone: G20-193, # 555791) and anti-lg lambda-PE (BD, clone: JDC-12,#555797). For détection of BCMA, 10 μg/ml Vicky-1Alexa488 or MAB193-Alexa488 and of the isotype controls rat lgG1-Alexa488 and rat lgG2a-Alexa488 were used and samples were incubated for 15 min at 4 °C. Cells were washed and red blood cells lysed using a FACS Lyse/Wash Assistant, LWA (BD). Signais were analyzed using a FACSCanto flow cytometer (BD).
Plasma cells were identified by gating on the CD45 low, CD38 high, CD19 low population and, in case the patients expressed CD56 on their plasma cells, on CD56 high. As reference non plasma cells were gated on for CD45 high, CD38 low, CD56 low.
The fluorescence intensities of the Alexa488 were measured for both populations, e.g. for Vicky-1 and rat lgG1. Histogrammes derived from spécifie antibody and isotype control fluorescent signais were overlaid and the différence noted. Patients are considered BCMA positive if their non-plasma cells show no différence in fluorescence intensity for Vicky-1 and Mab193 and isotype controls as well as a clear increase in fluorescence on plasma cells for Vicky-1 and MAB193 as compared to the fluorescence measured for rat lgG1 or lgG2a respectively.
Raw data was analyzed using Flow Jo. Patients were given consecutive numbers for identification in addition to their sample number assigned on the date of data collection.
[0096] FA CS staining of OPM-2 cells with different anti-BCMA antibodies
In order to examine whether or not BCMA protein is expressed on cell surface of OPM-2 cell line which is a human, peripheral blood derived from multiple myeloma cells, Vicky30 1 as well as MAB193 were used for FACS analysis (Fig. 1). As a resuit, both showed sufficient staining efficacy for BCMA protein expressing in a surface of OPM-2 cells.
However, it was found that Vicky-1 showed a stronger FACS shift compared to MAB193 (Fig. 1), which mean fluorescence signais of Vicky-1 and MAB 193 also proved (Table
2).
Therefore, Vicky-1 as anti-BCMA antibody was used for further experiments conducted herein.
mAb Mean Fluorescence Signal
Vicky-1 609
MAB193 371
Table 2: Mean fluorescence signais [0097] Corrélation of protein and mRNA expression levels in MM cell lines
As a next step, the inventors examined the level of BCMA protein as well as BCMA mRNA by FACS and human exon gene chip (Affymetrix), respectîvely in 10 different MM cell lines (Fig. 2).
mRNA expression levels were analyzed in RT-PCR using Primers described in Li et al (Med Oncol (2010) 27:439-445). In detail, total cellular RNA was isolated from MM cell as is commonly done in the art. The isolated RNA was applied as a template for the first strand cDNA synthesis by reverse transcription (RT), and cDNA used as a template for polymerase chain reaction (PCR). The following primers were used: BCMA 5-TTA CTTGTCCTTCCAGGCTGTTCT-3' (sense) (SEQ ID NO:2) and 5'-CATAGAAACCAAGGAAGTTTCTACC-3' (antisense) (SEQ ID NO:3).
Fig. 2(A) shows the resuit of BCMA protein level by FACS using Vicky-1 in 10 MM cell lines. Intriguingly, BCMA protein level on the cell surface was varied in each cell line.
Especially, it was found that NCI-H929 (very strong indicated as +++ in Table 3),
MOLP-2, OPM-2 as well as KMS-12-BM (strong indicated as ++ in Table 3) showed very strong or strong expression on the cell surface of said cell lines. On the other hand,
U226B1, JJN-3 and LP-1 showed no BCMA protein expression on the cell surface of said cell lines.
Fig 2(B) indicates BCMA mRNA level of 10 different MM cell lines. The relative expression levels were resulted from the normalization by GAPDH mRNA level.
It was found that BCMA mRNA level was very high for example, in NCI-H929 cell line as it also showed high protein level. Although it was found that no expression of BCMA protein on the cell surface of U266B1, JJN-3 as well as LP-1 was détectable, BCMA mRNA in said cell lines were détectable, and it is noted that BCMA mRNA level of JJN3 and LP-1 cell lines rather showed higher. Thus, the inventor concluded that there is no solid corrélation between BCMA protein in the cell surface and BCMA mRNA in MM cell lines.
mRNA levels Protein levels
NCI-H929 +++ +++
MOLP-2 ++
OPM-2 + + ++
MOLP-8 +
RPMI8226 + +
KMS-12-BM + ++
L-363 ++ +
U266B1 + -
JJN-3 ++ -
LP-1 ++ -
Table 3: Summary of protein and mRNA expression levels in 10 different MM cell lines [0098] BCMA protein expression on bone marrow plasma cells ofMM patients
Further, the inventors examined as to whether or not BCMA protein was expressed on the cell surface of MM cells (malignant plasma B-cells) from 23 MM patients and detected by Vicky-1 or MAB193. Bone marrow aspirâtes of 23 patients were analyzed for BCMA expression in FACS. As a resuit, it was found that 52% (12/23) of MM patients showed BCMA positive on cell surface of MM cells, however, 48% (11/23) of MM patients showed BCMA négative (Table 4). In Fig. 3, the FACS signal shift was detected in primary plasma cells. On the other hand, no signal shift was observed in non-plasma cells (Fig. 3).
Patient # Plasma cell BCMA expression
1 +
2 10
3
4 ' +
5 -
6 +
7 +
8 15
9 -
10 +
11 -
12 - 70
13 +
14 -
15 +
16 -
17
18 +
19 +
20
21 +
22 +
23 -
Table 4
n.a. not applicable +positive staining -négative staining
4 jet 2013'
EKEMELY GHT Sari

Claims (13)

1. Use of B-cells in the formulation of a method for the stratification of a multiple myeloma (MM) patient disposed to respond favorably to an anti-BCMA antibody therapy, comprising determining whether said B-cells, preferably malignant Bcells of said patient express BCMA protein on the surface of said B-cells, wherein said patient is disposed to respond favorably to said anti-BCMA antibody therapy, if said B-cells express BCMA protein on their surface.
2. Use of B-cells in the formulation of a method for diagnosing a BCMA négative multiple myeloma (MM) patient, comprising determining whether said B-cells, preferably malignant B-cells of said patient express BCMA protein on their surface, wherein said patient suffers from BCMA négative MM, if no BCMA protein is détectable on the surface of said B-cells.
3. Use of B-cells in the formulation of a method for selecting an antibody-based multiple myeloma (MM) therapy, comprising determining whether said B-cells, preferably malignant B-cells of a patient express BCMA protein on the surface of said B-cells, wherein, if said B-cells are BCMA positive, the patient may be subject to an anti-CD20 antibody therapy and/or an anti-CD38 antibody therapy and/or an anti-BCMA antibody therapy and/or anti-CS1 antibody therapy, or, if said B-cells are BCMA-negative, the patient is subject to an anti-CD20 antibody therapy and/or an anti-CD38 antibody therapy and/or anti-CS1 antibody therapy.
4. The use of any one of the preceding claims, wherein said B-cells are obtained from said patient.
5. The use of any one of claims 1 to 4, wherein said B-cells are characterized to be CD38 positive, CD56 positive or négative, CD45 positive, and CD19 positive. —
6. The use of claim 1 or 2, wherein said patient is to be treated with an anti-BCMA antibody therapy.
7. The use of any one of the preceding daims, wherein said anti-BCMA antibody is a monoclonal antibody, a chimeric antibody a humanized antibody, or a bispecific antibody
8. The use of claim 6, wherein said anti-BCMA antibody is conjugated to a toxin.
9. An anti-BCMA antibody therapy for use in the treatment or amelioration of a multiple myeloma (MM) patient whose B-cells, preferably malignant B-cells are disposed to be BCMA positive.
10. An anti-BCMA antibody for use in the treatment or amelioration of a multiple myeloma (MM) patient diagnosed with the method of any one of the preceding daims.
11. An anti-CD20 antibody and/or an anti-CD38 antibody and/or anti-CS1 antibody for use in the treatment or amelioration of a multiple myeloma (MM) patient whose B-cells, preferably malignant B-cellsare BCMA négative.
12. Any of the preceding daims, wherein said BCMA protein is détectable with Vicky-1 or MAB 193.
13. A kit comprising an anti-BCMA antibody and instructions for carrying out the method of any one of daims 1 to 7. r/x/
OA1201300427 2011-04-21 2012-04-20 BCMA-based stratification and therapy for multiple myeloma patients. OA16773A (en)

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