TW202322828A - 利用腫瘤微環境之特性之嵌合受體t細胞治療 - Google Patents
利用腫瘤微環境之特性之嵌合受體t細胞治療 Download PDFInfo
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Abstract
本發明提供治療惡性腫瘤之方法,其包含投與有效劑量之經嵌合受體(例如CAR或TCR)基因改造之T細胞免疫療法。本發明之一些態樣係關於表徵預輸注腫瘤微環境及測定T細胞免疫療法之有效劑量的方法。
Description
人類癌症根據其性質係由已進行遺傳或表觀遺傳轉化變成異常癌細胞之正常細胞構成。藉此,癌細胞開始表現不同於正常細胞表現之蛋白質及其他抗原。此等異常腫瘤抗原可由身體的先天性免疫系統用於特異性靶向及殺癌細胞。然而,癌細胞採用各種機制來阻止免疫細胞(諸如T及B淋巴球)成功地靶向癌細胞。
人類T細胞治療依賴於經富集或經修飾人類T細胞靶向及殺患者之癌細胞。為了增強T細胞靶向及殺特定癌細胞之能力,已研發出方法來工程改造T細胞以表現構築體,該等構築體將T細胞導向特定靶標癌細胞。包含能夠與特定腫瘤抗原相互作用之結合域的嵌合抗原受體(CAR)及經工程改造之T細胞受體(TCR)允許T細胞靶向及殺表現特定腫瘤抗原之癌細胞。
腫瘤微環境(TME)特徵在CAR T細胞輸注之前可影響臨床結果。本發明提供使用TME之免疫相關基因表現標記及/或瘤內T細胞密度評定TME與結果相關聯之方法。
除非上下文另外明確指示,否則可合併下文所描述之態樣及實施例中之各者。
在一個態樣中,本發明提供一種治療患者之惡性腫瘤之方法,其包含:(a)分析來自患者之腫瘤活體組織切片以表徵腫瘤微環境;及(b)向患者投與有效劑量之包含一或多種嵌合受體之T細胞,其中使用腫瘤微環境之特徵測定有效劑量。
在一些實施例中,使用基因表現圖譜表徵腫瘤微環境。在一些實施例中,基於瘤內T細胞密度表徵腫瘤微環境。在一些實施例中,使用基因表現圖譜及瘤內T細胞密度表徵腫瘤微環境。
在一些實施例中,基因表現圖譜包含測定特定基因組之表現量。在一些實施例中,該組包含CD3G、STAT4、CD3E、CD3D、GZMK、GZMM、PRF1、CD8A、ICOS、CXCL10、STAT1、IL15、CCR2、CCL2、IRF1、TBX21、GZMA、CXCR3、GZMB、CD69、CXCL11及其組合。在一些實施例中,該組包含CTLA4、GZMH、CD8A、PDCD1、CD3G、IRF1、CX3CL1、TNFRSF9、CD3E、GZMA、CXCL10、TSLP、REN、GZMB、TNFRSF18、CCL2、GZMK、CXCL11、CD69、CD247、CCL5、STAT4、CD274、GNLY、ITGAE、LAG3、IL15、LTK、PRF1、CD3D、PF4、TBX21、ICOS、CXCL9、IFNG、VEGFA、STAT1、GZMM、CXCL13、CXCR3、CCR2、IL17A、PROM1及其組合。在一些實施例中,該組包含PanCancer免疫圖譜組(Immune Profiling Panel)。
在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:CD3G、STAT4、CD3E、CD3D、GZMK、GZMM、PRF1、CD8A、ICOS、CXCL10、STAT1、IL15、CCR2、CCL2、IRF1、TBX21、GZMA、CXCR3、GZMB、CD69、CXCL11及其組合。
在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:CTLA4、GZMH、CD8A、PDCD1、CD3G、IRF1、CX3CL1、TNFRSF9、CD3E、GZMA、CXCL10、TSLP、REN、GZMB、TNFRSF18、CCL2、GZMK、CXCL11、CD69、CD247、CCL5、STAT4、CD274、GNLY、ITGAE、LAG3、IL15、LTK、PRF1、CD3D、PF4、TBX21、ICOS、CXCL9、IFNG、VEGFA、STAT1、GZMM、CXCL13、CXCR3、CCR2、IL17A、PROM1及其組合。
在一些實施例中,方法包含測定選自PanCancer免疫圖譜組之基因之表現量。
在一些實施例中,方法包含測定B細胞標記之表現量。在一些實施例中,B細胞標記選自BLK、CD19、CR2、MS4A1、TNFRSF17及其組合。
在一些實施例中,方法包含測定T細胞標記之表現量。在一些實施例中,T細胞標記選自CD2、CD2E、CD3G、CD6及其組合。
在一些實施例中,方法包含測定包含與先天性免疫反應相關之基因的特定基因組之表現量。在一些實施例中,特定基因組包含細胞毒性細胞、樹突狀細胞、巨噬細胞、粒細胞及其組合之標記。
在一些實施例中,特定基因組包含選自CD8、BLC2及其組合之基因。
在一些實施例中,特定基因組包含選自CCL12、CCL17及其組合之基因。
在一些實施例中,特定基因組包含選自APOE、CCL7及其組合之基因。
在一些實施例中,特定基因組包含選自CMA1、CSF3R及其組合之基因。
在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:CTLA4、CD3g、CD3e、CD27、SH2B2、ICOSL及其組合。
在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:CD27、SH2B2、ICOSLG、HLA-DQA1、HLA-DQB1、MAGEB2、PRAME、MAGEA1、IL22RA1、SSX1、CCL20、NEFL、C9、GZMM、KIR作用子群(Act Subgroup) 2、HLA-DOB及其組合。
在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:CD27、SH2B2、ICOSLG及其組合。
在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:HLA-DQA1、HLA-DQB1、MAGEB2、PRAME、MAGEA1、IL22RA1、SSX1、CCL20、NEFL、C9、GZMM、KIR作用子群2、HLA-DOB及其組合。
在一些實施例中,方法包含測定組織微環境中之T細胞密度(亦即,瘤內T細胞密度),諸如藉由對腫瘤活體組織切片進行免疫組織化學染色測定。在一些實施例中,方法包含測定組織微環境中之CD3+及/或CD8+ T細胞的密度。
在一些實施例中,方法包含基於基因表現圖譜測定免疫分數。在一些實施例中,方法包含基於瘤內T細胞密度測定免疫分數。在一些實施例中,方法包含使用免疫分數調節CAR-T細胞之總劑量。在一些實施例中,方法包含在CAR-T細胞投與之前提供免疫調節化合物或干預以增加免疫分數。
在一些實施例中,有效劑量包含至少1 × 10
6個CAR陽性活T細胞/公斤體重。
在一些實施例中,嵌合受體靶向腫瘤抗原。在一些實施例中,嵌合受體靶向選自以下之腫瘤抗原:腫瘤相關表面抗原(諸如5T4)、α胎蛋白(AFP)、B7-1 (CD80)、B7-2 (CD86)、BCMA、B-人類絨毛膜促性腺激素、CA-125、癌胚抗原(CEA)、CD123、CD133、CD138、CD19、CD20、CD22、CD23、CD24、CD25、CD30、CD33、CD34、CD4、CD40、CD44、CD56、CD8、CLL-1、c-Met、CMV特異性抗原、CS-1、CSPG4、CTLA-4、DLL3、雙唾液酸神經節苷脂GD2、乳腺管上皮黏蛋白、EBV特異性抗原、EGFR變異體III (EGFRvIII)、ELF2M、內皮因子、肝配蛋白B2、表皮生長因子受體(EGFR)、上皮細胞黏附分子(EpCAM)、上皮腫瘤抗原、ErbB2 (HER2/neu)、纖維母細胞相關蛋白(fap)、FLT3、葉酸結合蛋白、GD2、GD3、神經膠質瘤相關抗原、醣神經鞘脂質、gp36、HBV特異性抗原、HCV特異性抗原、HER1-HER2、HER2-HER3組合、HERV-K、高分子量黑素瘤相關抗原(HMW-MAA)、HIV-1包膜醣蛋白gp41、HPV特異性抗原、人類端粒酶逆轉錄酶、IGFI受體、IGF-II、IL-11Rα、IL-13R-a2、流感病毒特異性抗原、CD38胰島素生長因子(IGFl)-l、腸道羧基酯酵素、κ鏈、LAGA-la、λ鏈、拉沙病毒特異性抗原、凝集素反應性AFP、譜系特異性或組織特異性抗原(諸如CD3)、MAGE、MAGE-A1、主要組織相容複合物(MHC)分子、呈現腫瘤特異性肽抗原決定基之主要組織相容複合物(MHC)分子、M-CSF、黑素瘤相關抗原、間皮素、MN-CA IX、MUC-1、mut hsp70-2、突變p53、突變p53、突變ras、嗜中性白血球彈性蛋白酶、NKG2D、Nkp30、NY-ESO-1、p53、PAP、前列腺酶、前列腺特異性抗原(PSA)、前列腺癌腫瘤抗原-1 (PCTA-1)、前列腺特異性抗原蛋白、STEAP1、STEAP2、PSMA、RAGE-1、ROR1、RU1、RU2 (AS)、表面黏附分子、存活及端粒酶、TAG-72、纖維結合蛋白之額外結構域A (EDA)及額外結構域B (EDB)以及肌腱蛋白-C之Al結構域 (TnC Al)、甲狀球蛋白、腫瘤基質抗原、血管內皮生長因子受體-2 (VEGFR2)、病毒特異性表面抗原(諸如HIV特異性抗原(諸如HIV gpl20)以及此等表面標記之任何衍生物或變異體。
在一些實施例中,嵌合受體特異性地靶向CD19。
在一些實施例中,嵌合受體為嵌合抗原受體(CAR)。在一些實施例中,嵌合受體為T細胞受體(TCR)。
在一些實施例中,惡性腫瘤為實體腫瘤、肉瘤、癌瘤、淋巴瘤、多發性骨髓瘤、霍奇金氏病(Hodgkin's Disease)、非霍奇金氏淋巴瘤(NHL)、原發性縱隔大B細胞淋巴瘤(PMBC)、瀰漫性大B細胞淋巴瘤(DLBCL)、濾泡性淋巴瘤(FL)、轉化型濾泡性淋巴瘤、脾邊緣區淋巴瘤(SMZL)、慢性或急性白血病、急性骨髓性白血病、慢性骨髓性白血病、急性淋巴母細胞白血病(acute lymphoblastic leukemia,ALL) (包括非T細胞ALL)、慢性淋巴細胞白血病(CLL)、T細胞淋巴瘤、B細胞急性淋巴球性白血病(「BALL」)中之一或多者、T細胞急性淋巴球性白血病(「TALL」)、急性淋巴球性白血病(acute lymphoid leukemiaALL)、慢性骨髓性白血病(CML)、B細胞前淋巴球性白血病、母細胞性漿細胞樣樹突狀細胞贅瘤、伯基特氏淋巴瘤(Burkitt's lymphoma)、濾泡性淋巴瘤、毛細胞白血病、小細胞濾泡性淋巴瘤或大細胞濾泡性淋巴瘤、惡性淋巴增生病況、MALT淋巴瘤、套細胞淋巴瘤、邊緣區淋巴瘤、骨髓發育不良及骨髓發育不良症候群、漿母細胞淋巴瘤、漿細胞樣樹突狀細胞贅瘤、華氏巨球蛋白血症(Waldenstrom macroglobulinemia)、漿細胞增生性病症(例如,無症狀骨髓瘤(冒煙型多發性骨髓瘤或無痛性骨髓瘤))、意義不明單株伽瑪球蛋白症(monoclonal gammapathy of undetermined significance,MGUS)、漿細胞瘤(例如,漿細胞惡液質、孤立性骨髓瘤、孤立性漿細胞瘤、髓外漿細胞瘤及多發性漿細胞瘤)、全身性澱粉樣輕鏈澱粉樣變性病、POEMS症候群(亦稱為克羅-富克斯症候群(Crow-Fukase syndrome)、高槻病(Takatsuki disease)及PEP症候群)或其組合。
在一些實施例中,惡性腫瘤為瀰漫性大B細胞淋巴瘤(DLBCL)、原發性縱隔大B細胞淋巴瘤、高級B細胞淋巴瘤、非霍奇金淋巴瘤、轉移性黑素瘤、轉化型濾泡性淋巴瘤、濾泡性淋巴瘤、套細胞淋巴瘤及多發性骨髓瘤。
在一些實施例中,有效劑量經最適化以增加患者對治療有反應之可能性。
在一些實施例中,在用嵌合受體療法治療之前自患者獲取腫瘤活體組織切片。
在一個態樣中,本發明包含一種測定患者是否將對嵌合受體治療有反應的方法,其包含:(a)分析來自患者之腫瘤活體組織切片以使用基因表現圖譜表徵腫瘤微環境;(b)基於基因表現圖譜測定免疫分數;及(c)基於免疫分數測定患者是否將對嵌合受體治療有反應。
在一個態樣中,本發明包含一種測定患者是否將對嵌合受體治療有反應的方法,其包含:(a)分析來自患者之腫瘤活體組織切片以藉由量化T細胞(例如,CD3+及/或CD8+ T細胞)之瘤內密度來表徵腫瘤微環境;(b)基於瘤內T細胞密度測定免疫分數;及(c)基於免疫分數測定患者是否將對嵌合受體治療有反應。
在一個態樣中,本發明提供一種治療患者之惡性腫瘤的方法,其包含:(a)在嵌合受體治療之前分析來自患者之腫瘤活體組織切片以表徵腫瘤微環境;(b)基於腫瘤微環境之特徵測定患者是否將對嵌合受體治療有反應;及(c)向患者投與有效劑量之包含一或多種嵌合受體之T細胞,其中使用腫瘤微環境之特徵測定有效劑量。
在一些實施例中,方法進一步包含使用腫瘤微環境之特徵測定額外療法是否將改善臨床療效。在一些實施例中,嵌合受體療法與額外療法一起投與。在一些實施例中,額外療法與嵌合受體療法組合投與。在一些實施例中,額外療法在嵌合受體療法之前或之後投與。
在一些實施例中,方法進一步包含投與細胞介素療法。在一些實施例中,細胞介素療法為IL-2或IL-15。
在一些實施例中,方法進一步包含投與刺激抗體。在一些實施例中,刺激抗體為抗41BB或OX-40。
在一些實施例中,方法進一步包含投與檢查點阻斷療法。在一些實施例中,檢查點阻斷療法包含CTLA4或PD-1。
在一些實施例中,方法進一步包含投與先天性免疫刺激劑。在一些實施例中,先天性免疫刺激劑包含TLR或STING促效劑。
在一些實施例中,基因表現圖譜包含測定增殖性標記、發炎標記、免疫調節標記、效應子及/或趨化介素之表現量。在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:IL-6、CRP、SAA、IL-5、鐵蛋白、IL-1Ra、IL-2Rα及其組合。在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:GM-CSF、IFN-γ、IL-10及其組合。在一些實施例中,方法包含測定選自以下之一或多個基因之表現量:IL-8、IP-10、MCP-1及其組合。在一些實施例中,方法包含測定顆粒酶B之表現量。在一些實施例中,方法包含測定CD3ε、CD28及CTLA4之表現量。在一些實施例中,方法包含測定MX1、ISG15及MYD88之表現量。在一些實施例中,方法包含測定CD19、CD79B及PAX5之表現量。在一些實施例中,方法包含測定PD-L1及/或CD19之表現量。在一些實施例中,在用CAR T細胞療法治療之前獲取腫瘤活體組織切片。在一些實施例中,在用CAR T細胞療法治療之後獲取腫瘤活體組織切片。在一些實施例中,方法包含在用CAR T細胞療法治療之前獲取腫瘤活體組織切片及在用CAR T細胞療法治療之後獲取腫瘤活體組織切片。在一些實施例中,在用CAR T細胞療法治療之後7天、14天、21天或28天獲取腫瘤活體組織切片。
本發明係關於使用患者活體組織切片之腫瘤微環境之特徵治療患者之惡性腫瘤的方法。本發明部分地基於以下出人意料的發現:在嵌合受體治療之前獲取的患者活體組織切片之腫瘤微環境之特徵可用於預測臨床結果。如本文中所描述,在嵌合受體治療之前的腫瘤微環境圖譜可用於測定有效劑量以影響嵌合受體(例如CAR或TCR) T細胞療法之臨床結果。
定義
為了使本發明可更易於理解,首先在下文對某些術語進行定義。以下術語及其他術語之額外定義貫穿本說明書闡述。
除非上下文另外明確指示,否則如本說明書及所附申請專利範圍中所用,單數形式「一(a/an)」及「該」包括複數個指示物。
除非明確陳述或自上下文顯而易見,否則如本文所用,術語「或」應理解為包括性的且涵蓋「或」與「及」兩者。
本文所用之術語「及/或」應視為兩種指定特徵或組分中之每一者具有或不具有另一者之特定揭示內容。因此,諸如本文中之「A及/或B」之片語中所用之術語「及/或」意欲包括A及B;A或B;A (單獨);及B (單獨)。同樣,諸如「A、B及/或C」之片語中所用之術語「及/或」意欲涵蓋以下態樣中之各者:A、B及C;A、B或C;A或C;A或B;B或C;A及C;A及B;B及C;A (單獨);B (單獨);及C (單獨)。
如本文所用之術語「例如」及「亦即」僅作為舉例使用,但不意欲限制,且不應視為僅提及本說明書中明確列舉之彼等條目。
術語「或更多」、「至少」、「大於」及其類似者,例如「至少一個」應理解為包括(但不限於)至少1、2、3、4、5、6、7、8、9、10、11、12、13、14、15、16、17、18、19、20、21、22、23、24、25、26、27、28、29、30、31、32、33、34、35、36、37、38、39、40、41、42、43、44、45、46、47、48、49、50、51、52、53、54、55、56、57、58、59、60、61、62、63、64、65、66、67、68、69、70、71、72、73、74、75、76、77、78、79、80、81、82、83、84、85、86、87、88、89、90、91、92、93、94、95、96、97、98、99、100、101、102、103、104、105、106、107、108、109、110、111、112、113、114、115、116、117、118、119、120、121、122、123、124、125、126、127、128、129、130、131、132、133、134、135、136、137、138、139、140、141、142、143、144、145、146、147、148、149或150、200、300、400、500、600、700、800、900、1000、2000、3000、4000、5000或大於所述值。亦包括任何更大的數值或其間的分數。
相反,術語「不大於」包括小於所述值之各值。舉例而言,「不大於100個核苷酸」包括100、99、98、97、96、95、94、93、92、91、90、89、88、87、86、85、84、83、82、81、80、79、78、77、76、75、74、73、72、71、70、69、68、67、66、65、64、63、62、61、60、59、58、57、56、55、54、53、52、51、50、49、48、47、46、45、44、43、42、41、40、39、38、37、36、35、34、33、32、31、30、29、28、27、26、25、24、23、22、21、20、19、18、17、16、15、14、13、12、11、10、9、8、7、6、5、4、3、2、1及0個核苷酸。亦包括任何更小的數值或其間的分數。
術語「複數個」、「至少兩個」、「兩個或更多個」、「至少第二個」及其類似者應理解為包括(但不限於)至少2、3、4、5、6、7、8、9、10、11、12、13、14、15、16、17、18、19、20、21、22、23、24、25、26、27、28、29、30、31、32、33、34、35、36、37、38、39、40、41、42、43、44、45、46、47、48、49、50、51、52、53、54、55、56、57、58、59、60、61、62、63、64、65、66、67、68、69、70、71、72、73、74、75、76、77、78、79、80、81、82、83、84、85、86、87、88、89、90、91、92、93、94、95、96、97、98、99、100、101、102、103、104、105、106、107、108、109、110、111、112、113、114、115、116、117、118、119、120、121、122、123、124、125、126、127、128、129、130、131、132、133、134、135、136、137、138、139、140、141、142、143、144、145、146、147、148、149或150、200、300、400、500、600、700、800、900、1000、2000、3000、4000、5000個或更多個。亦包括任何更大的數值或其間的分數。
貫穿本說明書,詞語「包含(comprising)」或諸如「包含(comprises/comprising)」之變型應理解為暗示包括所陳述之要素、整數或步驟、或要素、整數或步驟之群組,但不排除任何其他要素、整數或步驟、或要素、整數或步驟之群組。應瞭解,每當本文中用措辭「包含」描述態樣時,亦提供用術語「由……組成」及/或「基本上由……組成」所描述之另外類似態樣。
除非特定陳述或自上下文顯而易見,否則如本文所用,術語「約」係指如一般熟習此項技術者所測定之特定值或組成之可接受誤差範圍內的值或組成,其將部分取決於值或組成之量測或測定方式,亦即量測系統之限制。舉例而言,「約」或「大致」可意謂根據此項技術中之實踐在一個或大於一個標準差內。「約」或「大致」可意謂至多10% (亦即,± 10%)之範圍。因此,「約」可理解為在大於或小於所述值之10%、9%、8%、7%、6%、5%、4%、3%、2%、1%、0.5%、0.1%、0.05%、0.01%或0.001%內。舉例而言,約5 mg可包括4.5 mg與5.5 mg之間的任何量。此外,尤其就生物系統或方法而言,該等術語可意謂值之至多一個數量級或至多5倍。當特定值或組成提供於本發明中時,除非另外說明,否則「約」或「大致」之含義應假定為在特定值或組成之可接受誤差範圍內。
如本文中所描述,除非另外指明,否則任何濃度範圍、百分比範圍、比率範圍或整數範圍應理解為包括在所述範圍內之任何整數值及(在適當時)其分數(諸如整數之十分之一及百分之一)。
本文中所用之單位、前綴及符號使用其國際單位系統(SI)公認的形式來提供。數值範圍包括界定該範圍之數字。
除非另外規定,否則本文中所用之所有技術及科學術語均具有與本發明所屬領域之一般技術者通常所理解相同之含義。舉例而言,Juo, 「The Concise Dictionary of Biomedicine and Molecular Biology」, 第2版, (2001), CRC Press;「The Dictionary of Cell & Molecular Biology」第5版, (2013), Academic Press;及「The Oxford Dictionary Of Biochemistry And Molecular Biology」, Cammack等人編, 第2版, (2006), Oxford University Press為熟習此項技術者提供本發明中所用之許多術語之通用辭典。
「投與」係指使用熟習此項技術者已知之各種方法及遞送系統中之任一者將藥劑物理引入至個體中。本文中所揭示之調配物的例示性投與途徑包括靜脈內、肌肉內、皮下、腹膜內、脊椎或其他非經腸投與途徑,例如藉由注射或輸注。如本文中所用之片語「非經腸投與」意謂通常藉由注射之除腸及局部投與之外的投與模式,且包括(但不限於)靜脈內、腹膜內、肌肉內、動脈內、鞘內、淋巴管內、病灶內、囊內、眶內、心內、皮內、經氣管、皮下、表皮下、關節內、囊下、蛛膜下、脊柱內、硬膜外及胸骨內注射及輸注,以及活體內電穿孔。在一些實施例中,調配物經由非腸胃外途徑,較佳經口投與。其他非腸胃外途徑包括局部、表皮或經黏膜投與途徑,例如鼻內、經陰道、經直腸、舌下或局部。投與亦可執行例如一次、複數次及/或經一或多個延長之週期。
術語「抗體」(Ab)包括(但不限於)特異性結合至抗原之醣蛋白免疫球蛋白。一般而言,抗體可包含藉由二硫鍵互連之至少兩個重(H)鏈及兩個輕(L)鏈,或其抗原結合分子。各H鏈包含重鏈可變區(本文中縮寫為VH)及重鏈恆定區。重鏈恆定區包含三個恆定結構域CH1、CH2及CH3。各輕鏈包含輕鏈可變區(本文中縮寫為VL)及輕鏈恆定區。輕鏈恆定區包含一個恆定域CL。VH及VL區可進一步再分成稱為互補決定區(CDR)之高變區,其穿插有稱為構架區(FR)之更保守的區。各VH及VL包含三個CDR及四個FR,其自胺基端至羧基端按以下次序排列:FR1、CDR1、FR2、CDR2、FR3、CDR3及FR4。重鏈及輕鏈之可變區含有與抗原相互作用之結合域。Ab之恆定區可介導免疫球蛋白與宿主組織或因子,包括免疫系統之各種細胞(例如效應細胞)及典型補體系統之第一組分(C1q)的結合。
抗體可包括例如單株抗體、以重組方式產生之抗體、單特異性抗體、多特異性抗體(包括雙特異性抗體)、人類抗體、經工程改造之抗體、人類化抗體、嵌合抗體、免疫球蛋白、合成抗體、包含兩個重鏈及兩個輕鏈分子之四聚抗體、抗體輕鏈單體、抗體重鏈單體、抗體輕鏈二聚體、抗體重鏈二聚體、抗體輕鏈-抗體重鏈對、胞內抗體、抗體融合物(在本文中有時稱為「抗體結合物」)、異結合抗體、單結構域抗體、單價抗體、單鏈抗體或單鏈Fvs (scFv)、駱駝化抗體、親和抗體、Fab片段、F(ab')2片段、二硫鍵連接之Fvs (sdFv)、抗個體基因型(抗Id)抗體(包括例如抗抗Id抗體)、微型抗體、結構域抗體、合成抗體(在本文中有時稱為「抗體模擬物」)及以上任一者之抗原結合片段。在一些實施例中,本文中所描述之抗體係指多株抗體群體。
「抗原結合分子」、「抗原結合部分」或「抗體片段」係指包含自其中衍生分子之抗體之抗原結合部分(例如,CDR)的任何分子。抗原結合分子可包括抗原互補決定區(CDR)。抗體片段之實例包括(但不限於) Fab、Fab'、F(ab')2及Fv片段、dAb、直鏈抗體、scFv抗體以及由抗原結合分子形成之多特異性抗體。肽體(亦即,包含肽結合域之Fc融合分子)為適合抗原結合分子之另一實例。在一些實施例中,抗原結合分子結合至腫瘤細胞上之抗原。在一些實施例中,抗原結合分子結合至與過度增殖性疾病有關之細胞上之抗原或結合至病毒性或細菌性抗原。在一些實施例中,抗原結合分子結合至CD19。在其他實施例中,抗原結合分子為特異性結合至抗原之抗體片段,包括其互補決定區(CDR)中之一或多者。在其他實施例中,抗原結合分子為單鏈可變片段(scFv)。在一些實施例中,抗原結合分子包含高親和性多聚體或由高親和性多聚體組成。
「抗原」係指引起免疫反應或能夠由抗體或抗原結合分子結合之任何分子。免疫反應可涉及抗體產生或特異性免疫勝任細胞之活化或兩者。熟習此項技術者將容易瞭解,任何大分子(包括幾乎所有蛋白質或肽)均可充當抗原。抗原可內源性表現,亦即由基因組DNA表現,或可以重組方式表現。抗原可對某一組織,諸如癌細胞具有特異性,或其可廣泛表現。另外,較大分子之片段可充當抗原。在一個實施例中,抗原為腫瘤抗原。
術語「中和」係指抗原結合分子、scFv、抗體或其片段結合至配位體且阻止或降低彼配位體之生物效應的。在一些實施例中,直接阻斷或以其他方式阻斷配位體上之結合位點的抗原結合分子、scFv、抗體或其片段改變配位體經由間接手段(諸如在配位體中進行結構性或高能改變)結合之能力。在一些實施例中,抗原結合分子、scFv、抗體或其片段阻止其所結合之蛋白質執行生物功能。
術語「自體性」意謂源自個體之任何物質,該個體與物質隨後重新引入至相同個體。舉例而言,本文中所描述之經工程改造之自體細胞療法(eACT™)方法涉及收集患者之淋巴球,該等淋巴球接著經工程改造以表現例如CAR構築體,且接著投與回至相同患者。
術語「同種異體」係指源自一個個體之接著引入至相同物種之另一個體中的任何物質,例如同種異體T細胞移植。
術語「轉導」及「經轉導」係指經由病毒載體將外源DNA引入至細胞中所藉由之方法(參見Jones等人, 「Genetics: principles and analysis,」 Boston: Jones & Bartlett Publ. (1998))。在一些實施例中,載體為反轉錄病毒載體、DNA載體、RNA載體、腺病毒載體、桿狀病毒載體、艾伯斯坦巴爾病毒載體(Epstein Barr viral vector)、乳多泡病毒載體、牛痘病毒載體、單純疱疹病毒載體、腺病毒相關載體、慢病毒載體或其任何組合。
「癌症」係指表徵為異常細胞在體內不受控生長之廣泛各種疾病群。不受調控細胞分裂及生長導致形成形成侵入鄰近組織且亦可經由淋巴系統或血流轉移至身體之遠端部分的惡性腫瘤。「癌症」或「癌症組織」可包括腫瘤。可藉由本文中所揭示之方法治療之癌症的實例包括(但不限於)免疫系統之癌症,包括淋巴瘤、白血病、骨髓瘤及其他白血球惡性腫瘤。在一些實施例中,本文中所揭示之方法可用於減小源自例如以下之腫瘤的腫瘤大小:骨癌、胰臟癌、皮膚癌、頭或頸部之癌症、皮膚或眼內惡性黑素瘤、子宮癌、卵巢癌、直腸癌、肛門區癌、胃癌睾丸癌、子宮癌、輸卵管癌、子宮內膜癌、子宮頸癌、陰道癌、外陰癌、多發性骨髓瘤、霍奇金氏病、非霍奇金氏淋巴瘤(NHL)、原發性縱隔大B細胞淋巴瘤(PMBC)、瀰漫性大B細胞淋巴瘤(DLBCL)、濾泡性淋巴瘤(FL)、轉化型濾泡性淋巴瘤、脾邊緣區淋巴瘤(SMZL)、食道癌、小腸癌、內分泌系統癌、甲狀腺癌、副甲狀腺癌、腎上腺癌、軟組織肉瘤、尿道癌、陰莖癌、慢性或急性白血病、急性骨髓性白血病、慢性骨髓性白血病、急性淋巴母細胞白血病(ALL) (包括非T細胞ALL)、慢性淋巴細胞白血病(CLL)、兒童實體腫瘤、淋巴球性淋巴瘤、膀胱癌、腎臟或尿管之癌症、腎盂之癌瘤、中樞神經系統(CNS)之贅瘤、原發性CNS淋巴瘤、腫瘤血管生成、脊軸腫瘤、腦幹神經膠質瘤、垂體腺瘤、卡波西氏肉瘤(Kaposi's sarcoma)、表皮樣癌、鱗狀細胞癌、T細胞淋巴瘤、包括由石棉誘發之癌症的環境誘發之癌症、其他B細胞惡性腫瘤及該等癌症之組合。在一些實施例中,癌症為多發性骨髓瘤。特定癌症可對化學或輻射療法有反應,或癌症可為難治癒的。難治癒之癌症係指手術干預不可改善之癌症,且癌症起初對化學或輻射療法無反應抑或癌症隨時間推移變得無反應。
如本文中所用,「抗腫瘤效應」係指可呈現為腫瘤體積減小、腫瘤細胞數目減少、腫瘤細胞增殖降低、轉移數目減少、總體或無進行存活增加、預期壽命增加或與腫瘤相關之各種生理學症狀改善之生物學效應。抗腫瘤效應亦可指預防腫瘤發生,例如疫苗。
如本文中所用,「細胞介素」係指由一種細胞對與特定抗原接觸反應而釋放之非抗體蛋白質,其中細胞介素與第二細胞相互作用以介導第二細胞中之反應。本文中所用之「細胞介素」意指由一種細胞群體釋放作為細胞間介體作用於另一細胞之蛋白質。細胞介素可由細胞內源性表現或向個體投與。細胞介素可由包括巨噬細胞、B細胞、T細胞及肥大細胞之免疫細胞釋放以傳播免疫反應。細胞介素可在接受體細胞中誘導各種反應。細胞介素可包括體內恆定細胞介素、趨化介素、促發炎細胞介素、效應子及急性期蛋白質。舉例而言,包括介白素(IL)7及IL-15之體內恆定細胞介素促進免疫細胞存活及增殖,且促發炎細胞介素可促進發炎反應。體內恆定細胞介素之實例包括(但不限於)IL-2、IL-4、IL-5、IL-7、IL-10、IL-12p40、IL-12p70、IL-15及干擾素(IFN) γ。促發炎細胞介素之實例包括(但不限於)IL-1a、IL-1b、IL-6、IL-13、IL-17a、腫瘤壞死因子(TNF)-α、TNF-β、纖維母細胞生長因子(FGF) 2、粒細胞巨噬細胞群落刺激因子(GM-CSF)、可溶性細胞間黏附分子1 (sICAM-1)、可溶性血管黏附分子1 (sVCAM-1)、血管內皮生長因子(VEGF)、VEGF-C、VEGF-D及胎盤生長因子(PLGF)。效應子之實例包括(但不限於)顆粒酶A、顆粒酶B、可溶性Fas配位體(sFasL)及穿孔蛋白。急性期蛋白質之實例包括(但不限於)C反應蛋白(CRP)及血清澱粉樣蛋白A (SAA)。
「趨化介素」為細胞介素之一種類型,其介導細胞趨化性或方向性移動。趨化介素之實例包括(但不限於)IL-8、IL-16、伊紅趨素、伊紅趨素-3、巨噬細胞來源之趨化介素(MDC或CCL22)、單核球趨化性蛋白質1 (MCP-1或CCL2)、MCP-4、巨噬細胞發炎性蛋白質1α (MIP-1α、MIP-1a)、MIP-1β (MIP-1b)、γ誘導性蛋白質10 (IP-10),及胸腺及活化調節之趨化介素(TARC或CCL17)。
如本文中所用,「嵌合受體」係指能夠識別特定分子之經工程改造之表面表現分子。包含能夠與特定腫瘤抗原相互作用之結合域的嵌合抗原受體(CAR)及經工程改造之T細胞受體(TCR)允許T細胞靶向及殺表現特定腫瘤抗原之癌細胞。
治療劑(例如經工程改造之CAR T細胞)之「治療有效量」、「有效劑量」、「有效量」或「治療有效劑量」為在單獨或與另一治療劑組合使用時保護個體免於疾病發作或促進疾病消退之任何量,疾病消退由疾病症狀之嚴重強度降低、無疾病症狀週期之頻率及持續時間增長或預防歸因於疾病病痛之損傷或功能障礙證明。治療劑促進疾病消退之能力可使用熟習此項技術者已知的多種方法評估,諸如在臨床試驗期間在人類個體中評估、在預測人類中之功效的動物模型系統中評估或藉由在活體外分析法中分析試劑活性評估。
如本文中所用之術語「淋巴球」包括自然殺手(NK)細胞、T細胞或B細胞。NK細胞為表示固有免疫系統之主要組分的一種類型之細胞毒性(cytotoxic/cell toxic)淋巴球。NK細胞抑制腫瘤及感染病毒之細胞。其經由細胞凋亡或計劃性細胞死亡之過程起作用。其稱為「自然殺手」,此係因為其並不需要活化以殺細胞。T細胞在細胞介導之免疫性中起主要作用(無抗體參與)。其T細胞受體(TCR)將自身與其他淋巴球類型進行區分。胸腺(一種免疫系統之特定器官)主要負責T細胞之成熟。存在六個類型之T細胞,亦即:輔助T細胞(例如CD4+細胞)、細胞毒性T細胞(亦稱為TC、細胞毒性T淋巴球、CTL、T殺手細胞、溶胞T細胞、CD8+ T細胞或殺手T細胞)、記憶T細胞((i)幹細胞記憶TSCM細胞(如原始細胞)為CD45RO-、CCR7+、CD45RA+、CD62L+ (L-選擇素)、CD27+、CD28+及 IL-7Rα+,但其亦表現大量CD95、IL-2Rβ、CXCR3及LFA-1,且展示記憶細胞特有之許多功能屬性);(ii)中樞記憶TCM細胞表現L-選擇素及CCR7,其分泌IL-2,但不分泌IFNγ或IL-4,且(iii)然而,效應子記憶TEM細胞並不表現L-選擇素或CCR7,但產生效應子細胞介素,如IFNγ及IL-4)、調節性T細胞(Treg、抑制因子T細胞或CD4+CD25+調節性T細胞)、自然殺手T細胞(NKT)及γ δ T細胞。另一方面,B細胞在體液免疫中起主要作用(有抗體參與)。其製得抗體及抗原且執行抗原呈現細胞(APC)之作用且在藉由抗原相互作用活化之後轉變成記憶B細胞。在哺乳動物中,未成熟B細胞在其名稱來源之骨髓中形成。
術語「經基因工程改造」或「經工程改造」係指修飾細胞基因組之方法,包括(但不限於)刪除編碼或非編碼區或其一部分或插入編碼區或其一部分。在一些實施例中,經修飾細胞為淋巴球,例如T細胞,其可獲自患者抑或供體。細胞可經修飾以表現併入至細胞之基因組中的外源性構築體,諸如(例如)嵌合抗原受體(CAR)或T細胞受體(TCR)。
「免疫反應」係指免疫系統之細胞(例如,T淋巴球、B淋巴球、自然殺手(NK)細胞、巨噬細胞、嗜酸性球、肥大細胞、樹突狀細胞及嗜中性球)及藉由此等細胞中之任一者或肝臟產生之可溶性大分子(包括Ab、細胞介素及補體)的作用,該作用導致選擇性靶向、結合至、損傷、破壞及/或消除脊椎動物體中之入侵病原體、感染病原體之細胞或組織、癌或其他異常細胞或在自體免疫或病理性發炎的情況下的正常人類細胞或組織。
術語「免疫療法」係指藉由包含誘導、增強、抑制或以其他方式修飾免疫反應之方法治療罹患疾病或處於感染或遭受疾病復發之風險中的個體。免疫療法之實例包括(但不限於) T細胞療法。T細胞療法可包括授受性T細胞療法、腫瘤浸潤性淋巴球(TIL)免疫療法、自體細胞療法、經工程改造之自體細胞療法(eACT™)及同種異體T細胞移植。然而,熟習此項技術者將認識到,本文中所揭示之處理方法將增強任何移植T細胞療法之效力。T細胞療法之實例描述於美國專利公開案第2014/0154228號及第2002/0006409號、美國專利第7,741,465號、美國專利第6,319,494號、美國專利第5,728,388號及國際公開案第WO 2008/081035號中。
免疫療法之T細胞可來自此項技術中已知之任何來源。舉例而言,T細胞可在活體外自造血幹細胞群體分化,或T細胞可獲自個體。T細胞可獲自例如外周血液單核細胞(PBMC)、骨髓、淋巴結組織、臍帶血、胸腺組織、來自感染部位之組織、腹水、肋膜積液、脾組織及腫瘤。另外,T細胞可源自此項技術中可獲得之一或多個T細胞株。T細胞亦可使用熟習此項技術者已知之多種技術,諸如FICOLL™分離及/或血球分離術自個體收集之血液單元獲得。用於T細胞療法之分離T細胞之額外方法揭示於美國專利公開案第2013/0287748號中,該公開案以全文引用之方式併入本文中。
術語「經工程改造之自體細胞療法」(其可縮寫為「eACT™」,亦稱為授受性細胞轉移)為一種收集患者自身之T細胞且隨後對其進行基因改變以識別及靶向在一或多種特異性腫瘤細胞或惡性腫瘤之細胞表面上表現的一或多種抗原所藉由之方法。T細胞可經工程改造以表現例如嵌合抗原受體(CAR)。CAR陽性(+) T細胞經工程改造以表現對特定腫瘤抗原具有特異性之連接至包含至少一個共刺激結構域及至少一個活化結構域之細胞內信號傳導部分的細胞外單鏈可變片段(scFv)。CAR scFv可經設計以靶向例如由B細胞譜系中之細胞表現的跨膜蛋白CD19,該B細胞譜系包括所有正常B細胞及B細胞惡性腫瘤,包括(但不限於)未另列出之瀰漫性大B細胞淋巴瘤(DLBCL)、原發性縱隔大B細胞淋巴瘤、高級B細胞淋巴瘤以及由濾泡性淋巴瘤、NHL、CLL及非T細胞ALL引起之DLBCL。實例CAR T細胞療法及構築體描述於美國專利公開案第2013/0287748號、第2014/0227237號、第2014/0099309號及第2014/0050708號中,且此等參考案以全文引用之方式併入。
如本文中所用之「患者」包括罹患癌症(例如淋巴瘤或白血病)之任何人類。術語「個體」及「患者」在本文中可互換使用。
如本文中所用,術語「活體外細胞」係指離體培養之任何細胞。特定言之,活體外細胞可包括T細胞。
術語「肽」、「多肽」及「蛋白質」可互換使用,且係指由藉由肽鍵共價連接之胺基酸殘基組成之化合物。蛋白質或肽含有至少兩個胺基酸,且不對可包含蛋白質或肽的序列之胺基酸之最大數目加以限制。多肽包括包含藉由肽鍵彼此接合之兩個或更多個胺基酸的任何肽或蛋白質。如本文中所用,該術語係指短鏈(其在此項技術中通常亦稱為例如肽、寡肽及寡聚物)及長鏈(其在此項技術中一般稱為蛋白質,其存在多種類型)兩者。「多肽」包括例如生物學上地活性片段、實質上同源多肽、寡肽、均二聚體、雜二聚體、多肽變異體、經修飾多肽、衍生物、類似物、融合蛋白以及其他物質。多肽包括天然肽、重組型肽、合成肽或其組合。
如本文中所用,「刺激」係指藉由刺激分子與其同源配位體之結合所誘導之主要反應,其中該結合介導信號轉導事件。「刺激分子」為T細胞上之分子,例如與在抗原呈現細胞上呈現之同源刺激配位體特異性結合之T細胞受體(TCR)/CD3複合物。「刺激配位體」為若呈現於抗原呈現細胞(例如,APC、樹突狀細胞、B細胞及其類似者)上可與T細胞上之刺激分子特異性結合,從而藉由T細胞介導主要反應(包括(但不限於)活化、引發免疫反應、增殖及其類似者)之配位體。刺激配位體包括但不限於抗CD3抗體、負載有肽之MHC I類分子、超促效劑抗CD2抗體及超促效劑抗CD28抗體。
如本文中所用,「共刺激信號」係指與諸如TCR/CD3接合之初級信號組合引起T細胞反應之信號,該T細胞反應諸如(但不限於)關鍵分子之增殖及/或上調或下調。
如本文中所用,「共刺激配位體」包括特異性結合T細胞上之同源共刺激分子之抗原呈現細胞上之分子。共刺激配位體之結合提供介導T細胞反應之信號,該T細胞反應包括(但不限於)增殖、活化、分化及其類似反應。共刺激配位體誘導除初級信號以外的藉由刺激分子,例如藉由T細胞受體(TCR)/CD3複合物與負載有肽之主要組織相容複合物(MHC)分子結合提供的信號。共刺激配位體可包括(但不限於) 3/TR6、4-1BB配位體、結合鐸配位受體之促效劑或抗體、B7-1 (CD80)、B7-2 (CD86)、CD30配位體、CD40、CD7、CD70、CD83、疱疹病毒進入介體(HVEM)、人類白血球抗原G (HLA-G)、ILT4、免疫球蛋白樣轉錄物(ILT) 3、誘導性共刺激配位體(ICOS-L)、細胞間黏附分子(ICAM)、與B7-H3特異性結合之配位體、淋巴毒素β受體、MHC I類鏈相關之蛋白質A (MICA)、MHC I類鏈相關之蛋白質B (MICB)、OX40配位體、PD-L2或計劃性死亡(PD) L1。共刺激配位體包括(但不限於)與存在於T細胞上之共刺激分子特異性結合之抗體,諸如(但不限於) 4-1BB、B7-H3、CD2、CD27、CD28、CD30、CD40、CD7、ICOS、與CD83特異性結合之配位體、淋巴球功能相關之抗原-1 (LFA-1)、自然殺手細胞受體C (NKG2C)、OX40、PD-1或腫瘤壞死因子超家族成員14 (TNFSF14或LIGHT)。
「共刺激分子」為T細胞上之同源結合搭配物,其與共刺激配位體特異性結合,由此藉由T細胞介導共刺激反應,諸如(但不限於)增殖。共刺激分子包括(但不限於) 4-1BB/CD137、B7-H3、BAFFR、BLAME (SLAMF8)、BTLA、CD 33、CD 45、CD100 (SEMA4D)、CD103、CD134、CD137、CD154、CD16、CD160 (BY55)、CD18、CD19、CD19a、CD2、CD22、CD247、CD27、CD276 (B7-H3)、CD28、CD29、CD3 (α;β;δ;ε;γ;ζ)、CD30、CD37、CD4、CD4、CD40、CD49a CD49D、CD49f、CD5、CD64、CD69、CD7、CD80、CD83配位體、CD84、CD86、CD8α、CD8β、CD9、CD96 (Tactile)、CDl-la、CDl-lb、CDl-lc、CDl-ld、CDS、CEACAM1、CRT AM、DAP-10、DNAM1 (CD226)、Fc γ受體、GADS、GITR、HVEM (LIGHTR)、IA4、ICAM-1、ICAM-1、ICOS、Ig α (CD79a)、IL2R β、IL2R γ、IL7R α、整合素、ITGA4、ITGA4、ITGA6、ITGAD、ITGAE、ITGAL、ITGAM、ITGAX、ITGB2、ITGB7、ITGBl、KIRDS2、LAT、LFA-1、LFA-1、LIGHT、LIGHT (腫瘤壞死因子超家族成員14;TNFSF14)、LTBR、Ly9 (CD229)、淋巴球功能相關之抗原-1 (LFA-1 (CDl la/CD18))、MHC I類分子、NKG2C、NKG2D、NKp30、NKp44、NKp46、NKp80 (KLRF1)、OX40、PAG/Cbp、PD-1、PSGL1、SELPLG (CD162)、信號傳導淋巴球性活化分子、SLAM (SLAMF1;CD150;IPO-3)、SLAMF4 (CD244;2B4)、SLAMF6 (NTB-A;Lyl08)、SLAMF7、SLP-76、TNF、TNFr、TNFR2、鐸配位受體、TRANCE/RANKL、VLA1或VLA-6,或其片段、截斷或組合。
術語「減少(reducing)」及「降低(decreasing)」在本文中可互換使用且指示小於原始之任何變化。「減少」及「降低」為相對術語,需要在量測前與量測後之間進行比較。「減少」及「降低」包括完全耗盡。
個體之「治療(treatment/treating)」係指對個體進行之任何類型之干預或處理,或向個體投與活性劑,目標為逆轉、緩解、改善、抑制、減緩或防止症狀、併發症或病狀之發作、進展、發展、嚴重程度或復發,或與疾病相關聯之生物化學標誌。在一些實施例中,「治療(treatment/treating)」包括部分緩解。在另一實施例中,「治療(treatment/treating)」包括完全緩解。
在以下分章節中更詳細地描述本發明之各種態樣。
腫瘤微環境(TME)之表徵
本發明提供在用嵌合受體療法(例如,西卡思羅(axi-cel))治療之前使用基因表現圖譜及/或瘤內T細胞密度量測表徵TME之方法。如本文中所描述,利用預先指定之基因組(例如Immunosign®21、Pan Cancer)及免疫分數(例如,Immunosign®21)及/或瘤內T細胞密度量測或指數(例如,Immunoscore®)之TME特徵與嵌合受體療法(例如,西卡思羅(axi-cel))之臨床結果相關聯。
患者活體組織切片可作為起始材料用於使用基因表現圖譜(例如,使用NanoString
TM之數位基因表現)分析腫瘤微環境。在一些實施例中,在用嵌合受體療法(例如,西卡思羅(axi-cel))治療之前獲取患者活體組織切片。
生物資訊方法可用於產生一或多個免疫分數以表徵TME。在一些實施例中,免疫分數為提供關於包括T細胞細胞毒性、T細胞分化、T細胞吸引力、T細胞黏附性之適應性免疫及包括免疫定向、血管生成抑制、免疫共抑制之免疫抑制以及癌症幹細胞之資訊的免疫相關基因之量測值。生物資訊方法亦可包括T細胞特異性(效應T細胞,Th1)基因、干擾素路徑相關基因、趨化介素及免疫檢查點。
表現圖譜分析(例如,Immunosign®臨床研究分析利用nCounter
®技術(NanoString))可用於以多工格式量測多個免疫基因之基因表現量。在一些實施例中,高/低免疫分數(例如,Immunosign®21分數)截止值可定義為在樣本中所觀測到的分數之第25個百分位。在一些實施例中,高分數指示可能與腫瘤反應相關聯之免疫相關基因表現。
在一些實施例中,免疫分數為瘤內T細胞密度之量測值。瘤內T細胞密度可藉由例如偵測及量化腫瘤微環境中之T細胞(諸如CD3+ T細胞及/或CD8+ T細胞)來測定。舉例而言,針對諸如CD3及/或CD8之T細胞標記可將腫瘤活體組織切片切開且染色或標記,且T細胞之相對或絕對豐度可由病理學家量化或使用專用數位病理學軟體測定。在一些實施例中,基於瘤內T細胞密度分配高/低免疫分數(例如,Immunoscore®)。高/低免疫分數臨界值可定義為例如在樣本中所觀測到的中位值分數。在一些實施例中,使用流式細胞量測術及/或諸如西方墨點法及ELISA之基於蛋白質之分析來測定瘤內T細胞密度。
表現及腫瘤浸潤性T淋巴球分析及計分可用於檢查TME特徵與反應之間的關聯。在一些實施例中,目標反應(OR)根據經修訂之惡性淋巴瘤之IWG反應標準(IWG Response Criteria for Malignant Lymphoma) (Cheson, 2007)測定且藉由惡性淋巴瘤之IWG反應標準(Cheson等人,
Journal of Clinical Oncology32, 第27期(2014年9月) 3059-3067)測定。在一些實施例中,評定反應持續時間。在一些實施例中,根據盧加諾反應分類標準(Lugano Response Classification Criteria)藉由研究者評定來評估無進展存活期(PFS)。
嵌合抗原受體及T細胞受體
嵌合抗原受體(CAR或CAR-T)為經基因工程改造之受體。此等經工程改造之受體可根據此項技術中已知之技術易於插入至包括之T細胞之免疫細胞中且由其表現。在CAR之情況下,單個受體可經程式化以識別特異性抗原並在結合至彼抗原時活化免疫細胞以攻擊且破壞帶有彼抗原之細胞。當此等抗原存在於腫瘤細胞上時,表現CAR之免疫細胞可靶向且殺腫瘤細胞。嵌合抗原受體併入有共刺激(信號傳導)結構域以增加其效力。參見美國專利第7,741,465號及第6,319,494號,以及Krause等人及Finney等人(同前文獻), Song等人, Blood 119:696-706 (2012);Kalos等人, Sci. Transl. Med. 3:95 (2011);Porter等人, N. Engl. J. Med. 365:725-33 (2011)及Gross等人, Annu. Rev. Pharmacol. Toxicol. 56:59-83 (2016)。
在一些實施例中,包括經截斷鉸鏈結構域(「THD」)之共刺激結構域進一步包含免疫球蛋白家族成員中之一些或全部,諸如IgG1、IgG2、IgG3、IgG4、IgA、IgD、IgE、IgM或其片段。
在一些實施例中,THD源自人類完全鉸鏈結構域(「CHD」)。在其他實施例中,THD源自共刺激蛋白質之嚙齒動物、鼠類或靈長類(例如,非人類靈長類) CHD。在一些實施例中,THD源自共刺激蛋白質之嵌合CHD。
本發明之CAR或TCR之共刺激結構域可進一步包含跨膜結構域及/或細胞內信號傳導結構域。跨膜結構域可經設計以融合至CAR之細胞外結構域。其可類似地融合至CAR之細胞內結構域。在一些實施例中,使用與CAR中之結構域中之一者天然地締合的跨膜結構域。在一些情況下,跨膜結構域可經胺基酸取代選擇或修飾以避免此類結構域與相同或不同表面膜蛋白之跨膜結構域結合,從而使與受體複合物之其他成員的相互作用降至最低。跨膜結構域可來源於天然來源或合成來源。在來源為天然來源時,結構域可來源於任何膜結合蛋白或跨膜蛋白。在本發明中特別適用的跨膜區可來源於(亦即,包含) 4-1BB/CD137、活化NK細胞受體、免疫球蛋白蛋白質、B7-H3、BAFFR、BLAME (SLAMF8)、BTLA、CD100 (SEMA4D)、CD103、CD160 (BY55)、CD18、CD19、CD19a、CD2、CD247、CD27、CD276 (B7-H3)、CD28、CD29、CD3 δ、CD3 ε、CD3 γ、CD3 ζ、CD30、CD4、CD40、CD49a、CD49D、CD49f、CD69、CD7、CD84、CD8、CD8α、CD8β、CD96 (Tactile)、CDl la、CDl lb、CDl lc、CDl ld、CDS、CEACAM1、CRT AM、細胞介素受體、DAP-10、DNAM1 (CD226)、Fc γ受體、GADS、GITR、HVEM (LIGHTR)、IA4、ICAM-1、ICAM-1、Ig α (CD79a)、IL-2R β、IL-2R γ、IL-7R α、誘導性T細胞共刺激分子(ICOS)、整合素、ITGA4、ITGA4、ITGA6、ITGAD、ITGAE、ITGAL、ITGAM、ITGAX、ITGB2、ITGB7、ITGBl、KIRDS2、LAT、LFA-1、LFA-1、與CD83特異性結合之配位體、LIGHT、LTBR、Ly9 (CD229)、淋巴球功能相關抗原-1 (LFA-1;CDl-la/CD18)、MHC 1類分子、NKG2C、NKG2D、NKp30、NKp44、NKp46、NKp80 (KLRF1)、OX-40、PAG/Cbp、計劃性死亡-1 (PD-1)、PSGL1、SELPLG (CD162)、信號傳導淋巴球性活化分子(SLAM蛋白質)、SLAM (SLAMF1;CD150;IPO-3)、SLAMF4 (CD244;2B4)、SLAMF6 (NTB-A;Lyl08)、SLAMF7、SLP-76、TNF受體蛋白質、TNFR2、TNFSF14、鐸配位受體、TRANCE/RANKL、VLA1或VLA-6,或其片段、截斷或組合。
視情況,短連接子可在CAR之細胞外、跨膜及細胞內結構域中之任何或一些之間形成鍵聯。在一些實施例中,連接子可來源於甘胺酸-甘胺酸-甘胺酸-甘胺酸-絲胺酸(G4S)n或GSTSGSGKPGSGEGSTKG (SEQ ID NO: 1)之重複序列。在一些實施例中,連接子包含3-20個胺基酸及與GSTSGSGKPGSGEGSTKG (SEQ ID NO:1)具有至少80%、81%、82%、83%、84%、85%、86%、87%、88%、89%、90%、91%、92%、93%、94%、95%、96%、97%、98%、99%或100%一致性之胺基酸序列。
本文中所描述之連接子亦可用作肽標記。連接子肽序列可具有任何適當長度以連接一或多種相關蛋白質,且較佳經設計以具有足夠柔韌性以便允許其連接之肽中之一者或兩者的適當摺疊及/或功能及/或活性。因此,連接子肽的長度可不超過10個、不超過11個、不超過12個、不超過13個、不超過14個、不超過15個、不超過16個、不超過17個、不超過18個、不超過19個或不超過20個胺基酸。在一些實施例中,連接子肽的長度可為至少3個、至少4個、至少5個、至少6個、至少7個、至少8個、至少9個、至少10個、至少11個、至少12個、至少13個、至少14個、至少15個、至少16個、至少17個、至少18個、至少19個或至少20個胺基酸。在一些實施例中,連接子包含至少7個且不超過20個胺基酸、至少7個且不超過19個胺基酸、至少7個且不超過18個胺基酸、至少7個且不超過17個胺基酸、至少7個且不超過16個胺基酸、至少7個且不超過15個胺基酸、至少7個且不超過14個胺基酸、至少7個且不超過13個胺基酸、至少7個且不超過12個胺基酸或至少7個且不超過11個胺基酸。在某些實施例中,連接子包含15-17個胺基酸,且在特定實施例中,包含16個胺基酸。在一些實施例中,連接子包含10-20個胺基酸。在一些實施例中,連接子包含14-19個胺基酸。在一些實施例中,連接子包含15-17個胺基酸。在一些實施例中,連接子包含15-16個胺基酸。在一些實施例中,連接子包含16個胺基酸。在一些實施例中,連接子包含3、4、5、6、7、8、9、10、11、12、13、14、15、16、17、18、19或20個胺基酸。
在一些實施例中,使用間隔結構域。在一些實施例中,間隔結構域來源於CD4、CD8a、CD8b、CD28、CD28T、4-1BB或本文中所描述之其他分子。在一些實施例中,間隔結構域可包括化學誘導性二聚物以控制在添加小分子之後的表現。在一些實施例中,不使用間隔子。
本發明之經工程改造之T細胞之細胞內(信號傳導)域可向活化結構域提供信號傳導,其接著活化免疫細胞之正常效應功能中之至少一者。舉例而言,T細胞之效應功能可為細胞溶解活性或輔助活性,包括分泌細胞介素。
在某些實施例中,適合的細胞內信號傳導結構域包括(亦即,包含) (但不限於) 4-1BB/CD137、活化NK細胞受體、免疫球蛋白蛋白質、B7-H3、BAFFR、BLAME (SLAMF8)、BTLA、CD100 (SEMA4D)、CD103、CD160 (BY55)、CD18、CD19、CD19a、CD2、CD247、CD27、CD276 (B7-H3)、CD28、CD29、CD3 δ、CD3 ε、CD3 γ、CD30、CD4、CD40、CD49a、CD49D、CD49f、CD69、CD7、CD84、CD8、CD8α、CD8β、CD96 (Tactile)、CDl la、CDl lb、CDl lc、CDl ld、CDS、CEACAM1、CRT AM細胞介素受體、DAP-10、DNAM1 (CD226)、FC γ受體、GADS、GITR、HVEM (LIGHTR)、IA4、ICAM-1、ICAM-1、Ig α (CD79a)、IL-2R β、IL-2R γ、IL-7R α、誘導性T細胞共刺激分子(ICOS)、整合素、ITGA4、ITGA4、ITGA6、ITGAD、ITGAE、ITGAL、ITGAM、ITGAX、ITGB2、ITGB7、ITGBl、KIRDS2、LAT、LFA-1、LFA-1、與CD83特異性結合之配位體、LIGHT、LTBR、Ly9 (CD229)、Lyl08、淋巴球功能相關抗原-1 (LFA-1;CDl-la/CD18)、MHC 1類分子、NKG2C、NKG2D、NKp30、NKp44、NKp46、NKp80 (KLRF1)、OX-40、PAG/Cbp、計劃性死亡-1 (PD-1)、PSGL1、SELPLG (CD162)、信號傳導淋巴球性活化分子(SLAM蛋白質)、SLAM (SLAMF1;CD150;IPO-3)、SLAMF4 (CD244;2B4)、SLAMF6 (NTB-A)、SLAMF7、SLP-76、TNF受體蛋白質、TNFR2、TNFSF14、鐸配位受體、TRANCE/RANKL、VLA1或VLA-6,或其片段、截斷或組合。
在一些實施例中,嵌合抗原受體(CAR)為西卡思羅(axi-cel)。西卡思羅(axi-cel)為自體性抗CD19嵌合抗原受體(CAR) T細胞療法(圖1)。西卡思羅(axi-cel) (YESCARTA
TM)由美國食品及藥物管理局(US Food and Drug Administration)審批通過,用於以≥ 2種先前全身性療法治療患有復發性或難治癒大B細胞淋巴瘤之患者。(Yescarta (西卡思羅)[藥品說明書]. Santa Monica, CA: Kite Pharma; 2017)。
可引入TCR以傳遞抗原反應性。在一些實施例中,抗原反應性受肽之MHC呈現限制。TCR可為α/β TCR、γ/δ TCR或其他。在一些實施例中,TCR為具有鼠類恆定鏈(2A連接)之HPV-16 E7 TCR。在一些實施例中,該等鏈可藉由IRES或任何2A家族成員之序列(例如,P2A、T2A、E2A、F2A等)連接。在一些實施例中,TCR為HPV識別TCR或其他病毒反應性TCR (例如,EBV、流感病毒等)。在一些實施例中,可使用癌症或癌症相關抗原反應性TCR (例如,NYESO、MART1、gp100等)。
在一些實施例中,TCR為正常/健康肽反應性或其他抗原反應性/限制性之TCR。在一些實施例中,TCR為反應性抗鼠類或其他非人類MHC。在一些實施例中,TCR為I級或II級限制性TCR。
抗原結合分子
適合的CAR可經工程改造以藉由併入與彼靶向抗原相互作用之抗原結合分子結合至抗原(諸如細胞表面抗原)。在一些實施例中,抗原結合分子為其抗體片段,例如一或多個單鏈抗體片段(「scFv」)。scFv為具有連接在一起的抗體之重鏈及輕鏈之可變區之單鏈抗體片段。參見美國專利第7,741,465號及第6,319,494號,以及Eshhar等人, Cancer Immunol Immunotherapy (1997) 45: 131-136。scFv保留親本抗體與標靶抗原特異性相互作用之能力。scFv適用於嵌合抗原受體,此係由於其可經工程改造以連同其他CAR組分一起表現為單鏈之部分。同上,亦參見Krause等人, J. Exp. Med., 第188卷, 第4期, 1998 (619-626);Finney等人,
Journal of Immunology, 1998, 161: 2791-2797。應瞭解,抗原結合分子通常包含於CAR之細胞外部分內以使得其能夠識別且結合至相關抗原。對多於一個相關標靶具有特異性之雙特異性及多特異性CAR涵蓋在本發明之範疇內。
在一些實施例中,多核苷酸編碼CAR或TCR,其包含本發明之THD及特異性結合至標靶抗原之抗原結合分子。在一些實施例中,靶標抗原為腫瘤抗原。在一些實施例中,抗原選自腫瘤相關表面抗原(諸如5T4)、α胎蛋白(AFP)、B7-1 (CD80)、B7-2 (CD86)、BCMA、B-人類絨毛膜促性腺激素、CA-125、癌胚抗原(CEA)、CD123、CD133、CD138、CD19、CD20、CD22、CD23、CD24、CD25、CD30、CD33、CD34、CD4、CD40、CD44、CD56、CD8、CLL-1、c-Met、CMV特異性抗原、CS-1、CSPG4、CTLA-4、DLL3、雙唾液酸神經節苷脂GD2、乳腺管上皮黏蛋白、EBV特異性抗原、EGFR變異體III (EGFRvIII)、ELF2M、內皮因子、肝配蛋白B2、表皮生長因子受體(EGFR)、上皮細胞黏附分子(EpCAM)、上皮腫瘤抗原、ErbB2 (HER2/neu)、纖維母細胞相關蛋白(fap)、FLT3、葉酸結合蛋白、GD2、GD3、神經膠質瘤相關抗原、醣神經鞘脂質、gp36、HBV特異性抗原、HCV特異性抗原、HER1-HER2、HER2-HER3組合、HERV-K、高分子量黑素瘤相關抗原(HMW-MAA)、HIV-1包膜醣蛋白gp41、HPV特異性抗原、人類端粒酶逆轉錄酶、IGFI受體、IGF-II、IL-11Rα、IL-13R-a2、流感病毒特異性抗原、CD38胰島素生長因子(IGFl)-l、腸道羧基酯酵素、κ鏈、LAGA-la、λ鏈、拉沙病毒特異性抗原、凝集素反應性AFP、譜系特異性或組織特異性抗原(諸如CD3)、MAGE、MAGE-A1、主要組織相容複合物(MHC)分子、呈現腫瘤特異性肽抗原決定基之主要組織相容複合物(MHC)分子、M-CSF、黑素瘤相關抗原、間皮素、MN-CA IX、MUC-1、mut hsp70-2、突變p53、突變p53、突變ras、嗜中性白血球彈性蛋白酶、NKG2D、Nkp30、NY-ESO-1、p53、PAP、前列腺酶、前列腺特異性抗原(PSA)、前列腺癌腫瘤抗原-1 (PCTA-1)、前列腺特異性抗原蛋白、STEAP1、STEAP2、PSMA、RAGE-1、ROR1、RU1、RU2 (AS)、表面黏附分子、存活及端粒酶、TAG-72、纖維結合蛋白之額外結構域A (EDA)及額外結構域B (EDB)以及肌腱蛋白-C之Al結構域 (TnC Al)、甲狀球蛋白、腫瘤基質抗原、血管內皮生長因子受體-2 (VEGFR2)、病毒特異性表面抗原(諸如HIV特異性抗原(諸如HIV gpl20))以及此等表面標記之任何衍生物或變異體。
經工程改造之T細胞及用途
本發明之細胞可經由獲自個體之T細胞獲取。T細胞可獲自例如外周血液單核細胞、骨髓、淋巴結組織、臍帶血、胸腺組織、來自感染部位之組織、腹水、肋膜積液、脾組織及腫瘤。另外,T細胞可源自此項技術中可獲得之一或多個T細胞株。T細胞亦可使用熟習此項技術者已知之多種技術,諸如FICOLL™分離及/或血球分離術自個體收集之血液單元獲得。在一些實施例中,藉由血球分離術收集之細胞可經洗滌以移除血漿部分,且置於適當緩衝液或培養基中用於後續處理。在一些實施例中,細胞用PBS洗滌。如將瞭解,可使用洗滌步驟,諸如藉由使用半自動流通式離心機,例如Cobe
TM2991細胞處理器、Baxter CytoMate
TM或其類似者。在一些實施例中,使經洗滌細胞再懸浮於一或多種生物相容緩衝液或具有或不具有緩衝液之其他生理鹽水溶液中。在一些實施例中,移除血球分離樣品之非所要組分。用於T細胞療法之分離T細胞之額外方法揭示於美國專利公開案第2013/0287748號中,該公開案以全文引用之方式併入本文中。
在一些實施例中,T細胞藉由裂解紅血球及耗減單核球,例如藉由使用經由PERCOLL
TM梯度之離心而自PBMC分離。在一些實施例中,特定T細胞亞群(諸如CD4+、CD8+、CD28+、CD45RA+及CD45RO+T細胞)藉由此項技術中已知之陽性或陰性選擇技術進一步分離。舉例而言,藉由陰性選擇富集T細胞群體可使用針對陰性選擇之細胞所特有之表面標記的抗體組合來實現。在一些實施例中,可使用經由陰性磁性免疫黏附或流式細胞量測術進行的細胞分選及/或選擇,其使用針對存在於經陰性選擇之細胞上之細胞表面標記的單株抗體混合液。舉例而言,為藉由陰性選擇富集CD4+細胞,單株抗體混合液通常包括針對CD8、CD11b、CD14、CD16、CD20及HLA-DR之抗體。在一些實施例中,使用流式細胞量測術及細胞分選分離用於本發明中之相關細胞群體。
在一些實施例中,PBMC直接用於使用如本文中所述之方法利用免疫細胞(諸如CAR)進行基因改造。在一些實施例中,在分離PBMC之後,進一步分離T淋巴球,且在基因改造及/或擴增之前或之後,將細胞毒性與輔助T淋巴球兩者分選為原始、記憶及效應T細胞亞群。
在一些實施例中,CD8+細胞係藉由識別此等類型之CD8+細胞之各者相關之細胞表面抗原而進一步分選為原始、中樞記憶及效應細胞。在一些實施例中,中樞記憶T細胞之表現型標記之表現包括CCR7、CD3、CD28、CD45RO、CD62L及CD127之表現且對於顆粒酶B為陰性的。在一些實施例中,中樞記憶T細胞為CD8+、CD45RO+及CD62L+ T細胞。在一些實施例中,效應T細胞對於CCR7、CD28、CD62L及CD127為陰性的且對於顆粒酶B及穿孔蛋白為陽性的。在一些實施例中,CD4+ T細胞進一步分選成亞群。舉例而言,CD4+ T輔助細胞可藉由識別具有細胞表面抗原之細胞群體而分選成原始、中樞記憶及效應細胞。
在一些實施例中,免疫細胞(例如T細胞)在使用已知方法分離之後經基因改造,或免疫細胞在基因改造之前活體外活化及擴增(或在祖細胞的情況下分化)。在另一實施例中,免疫細胞(例如T細胞)經本文中所描述之嵌合抗原受體基因改造(例如經包含一或多種編碼CAR或TCR之核苷酸序列之病毒載體轉導)且接著活體外活化及/或擴增。用於活化及擴增T細胞之方法在此項技術中為已知且描述於例如美國專利第6,905,874號;第6,867,041號;及第6,797,514號;及PCT公開案第WO 2012/079000號中,其內容以全文引用之方式併入本文中。一般而言,此類方法包括使PBMC或經分離T細胞與刺激劑及共刺激劑(諸如抗CD3及抗CD28抗體,通常附著於珠粒或其他表面)在具有適當細胞介素(諸如IL-2)之培養基中接觸。附著於相同珠粒之抗CD3及抗CD28抗體充當「替代性」抗原呈現細胞(APC)。一個實施例為Dynabeads
®系統,一種用於人類T細胞之生理學活化之CD3/CD28活化劑/刺激劑系統。在其他實施例中,使用諸如美國專利第6,040,177號及第5,827,642號及PCT公開案第2012/129514號中所描述之彼等方法的方法利用飼養細胞及適當抗體及細胞介素活化並刺激T細胞以增殖,該等專利之內容以全文引用的方式併入本文中。
在一些實施例中,T細胞獲自供體個體。在一些實施例中,供體個體為罹患癌症或腫瘤之人類患者。在一些實施例中,供體個體為未罹患癌症或腫瘤之人類患者。
在一些實施例中,組合物包含醫藥學上可接受之載劑、稀釋劑、增溶劑、乳化劑、防腐劑及/或佐劑。在一些實施例中,組合物包含賦形劑。
在一些實施例中,組合物經選擇以用於非經腸遞送、吸入或經由消化道(諸如經口)遞送。此類醫藥學上可接受之組合物之製備在熟習此項技術者的能力範圍內。在一些實施例中,緩衝劑用於將組合物維持在生理pH或略低之pH,通常在約5至約8之pH範圍內。在一些實施例中,當涵蓋非經腸投與時,組合物呈無熱原非經腸可接受之水溶液形式,包含在醫藥學上可接受之媒劑中具有或不具有額外治療劑的本文中所描述之組合物。在一些實施例中,用於非經腸注射之媒劑為無菌蒸餾水,其中具有或不具有至少一種額外治療劑之本文中所描述之組合物經調配為恰當保藏之無菌等張溶液。在一些實施例中,製備涉及所要分子與聚合化合物(諸如聚乳酸或聚乙醇酸)、珠粒或脂質體一起調配,該等聚合化合物、珠粒或脂質體可提供隨後經由積存注射遞送之產物的受控或持續釋放。在一些實施例中,可植入藥物遞送裝置用於引入所要分子。
在一些實施例中,治療有需要個體之癌症的方法包含T細胞療法。在一些實施例中,本文中所揭示之T細胞療法為經工程改造之自體細胞療法(eACT™)。根據此實施例,該方法可包括自患者收集血球。經分離之血球(例如T細胞)接著可經工程改造以表現本文中所揭示之CAR或TCR。在一個特定實施例中,向該患者投與CAR T細胞或TCR T細胞。在一些實施例中,CAR T細胞或TCR T細胞治療患者之腫瘤或癌症。在一些實施例中,CAR T細胞或TCR T細胞減小腫瘤或癌症之大小。
在一些實施例中,用於T細胞療法中之供體T細胞獲自患者(例如用於自體T細胞療法)。在其他實施例中,用於T細胞療法中之供體T細胞獲自並非患者之個體。
在一些實施例中,T細胞可以治療有效量投與。舉例而言,T細胞之治療有效量可為至少約10
4個細胞、至少約10
5個細胞、至少約10
6個細胞、至少約10
7個細胞、至少約10
8個細胞、至少約10
9個細胞或至少約10
10個細胞。在另一實施例中,T細胞之治療有效量為約10
4個細胞、約10
5個細胞、約10
6個細胞、約10
7個細胞或約10
8個細胞。在一些實施例中,CAR T細胞之治療有效量為約2 × 10
6個細胞/公斤、約3 × 10
6個細胞/公斤、約4 × 10
6個細胞/公斤、約5 × 10
6個細胞/公斤、約6 ×10
6個細胞/公斤、約7 × 10
6個細胞/公斤、約8 × 10
6個細胞/公斤、約9 × 10
6個細胞/公斤、約1 × 10
7個細胞/公斤、約2 × 10
7個細胞/公斤、約3 × 10
7個細胞/公斤、約4 × 10
7個細胞/公斤、約5 × 10
7個細胞/公斤、約6 × 10
7個細胞/公斤、約7 × 10
7個細胞/公斤、約8 × 10
7個細胞/公斤或約9 × 10
7個細胞/公斤。
在一些實施例中,CAR陽性活T細胞之治療有效量在約1 × 10
6個與約2 × 10
6個CAR陽性活T細胞/公斤體重之間至最大劑量約1 × 10
8個CAR陽性活T細胞。
治療方法
本文中所揭示之方法可用於治療個體之癌症,減小腫瘤大小,殺腫瘤細胞,阻止腫瘤細胞增殖,阻止腫瘤生長,消除患者之腫瘤,阻止腫瘤復發,阻止腫瘤轉移,誘導患者之緩解,或其任何組合。在一些實施例中,該等方法誘導完全反應。在其他實施例中,該等方法誘導部分反應。
在一些實施例中,藉由在治療之前分析腫瘤微環境,本發明提供用於T細胞療法之臨床療效的預測性工具。
本發明方法亦可伴隨測試用於告知關於組合或依次使用之額外療法是否將對具有某些腫瘤微環境特徵之個體更有效。在一些實施例中,額外治療可為細胞介素(例如,IL-2、IL-15)、刺激抗體(例如,抗41BB、OX-40)、檢查點阻斷(例如,CTLA4、PD-1)或先天性免疫刺激劑(例如,TLR、STING促效劑)。在一些實施例中,額外治療可為T細胞募集趨化介素(例如,CCL2、CCL1、CCL22、CCL17及其組合)及/或T細胞。在一些實施例中,全身性或瘤內投與一或多種額外療法。
可治療之癌症包括並未血管化、尚未實質上血管化或血管化之腫瘤。癌症亦可包括實體或非實體腫瘤。在一些實施例中,癌症為血液癌。在一些實施例中,癌症具有白血球。在其他實施例中,癌症具有漿細胞。在一些實施例中,癌症為白血病、淋巴瘤或骨髓瘤。在一些實施例中,癌症為急性淋巴母細胞白血病(ALL) (包括非T細胞ALL)、急性淋巴球性白血病(ALL)、及噬血細胞性淋巴組織細胞增生症(HLH)、B細胞前淋巴球性白血病、B細胞急性淋巴球性白血病(「BALL」)、母細胞性漿細胞樣樹突狀細胞贅瘤、伯基特氏淋巴瘤、慢性淋巴細胞白血病(CLL)、慢性骨髓性白血病(CML)、慢性骨髓性白血病(CML)、慢性或急性肉芽腫性疾病、慢性或急性白血病、瀰漫性大B細胞淋巴瘤(DLBCL)、濾泡性淋巴瘤(FL)、毛細胞白血病、噬血細胞性症候群、巨噬細胞活化症候群(MAS)、霍奇金氏病、大細胞肉芽腫、白血球黏著缺乏症、惡性淋巴增生病、MALT淋巴瘤、套細胞淋巴瘤邊緣區淋巴瘤、意義不明單株伽瑪球蛋白症(MGUS)、多發性骨髓瘤、骨髓發育不良及骨髓發育不良症候群(MDS)、包括(但不限於)急性骨髓性白血病(AML)之骨髓疾病、非霍奇金氏淋巴瘤(NHL)、漿細胞增生性病症(例如,無症狀骨髓瘤(冒煙型多發性骨髓瘤或無痛性骨髓瘤)、漿母細胞淋巴瘤、漿細胞樣樹突狀細胞贅瘤、漿細胞瘤(例如,漿細胞惡液質;孤立性骨髓瘤;孤立性漿細胞瘤;髓外漿細胞瘤;及多發性漿細胞瘤)、POEMS症候群(克羅-富克斯症候群;高槻病;PEP症候群)、原發性縱隔大B細胞淋巴瘤(PMBC)、小細胞濾泡性淋巴瘤或大細胞濾泡性淋巴瘤、脾邊緣區淋巴瘤(SMZL)、全身性澱粉樣輕鏈澱粉樣變性病、T細胞急性淋巴球性白血病(「TALL」)、T細胞淋巴瘤、轉化型濾泡性淋巴瘤、華氏巨球蛋白血症或其組合。
在一些實施例中,癌症為骨髓瘤。在一些實施例中,癌症為多發性骨髓瘤。在一些實施例中,癌症為白血病。在一些實施例中,癌症為急性骨髓性白血病。
在一些實施例中,方法進一步包含投與化學治療劑。在一些實施例中,所選化學治療劑為淋巴球耗乏(預處理)化學治療劑。有利預處理治療方案連同相關的有利生物標記描述於美國臨時專利申請案62/262,143及62/167,750中,其特此以引用之方式併入本文中。此等描述例如處理需要T細胞療法之患者之方法,其包含向該患者投與環磷醯胺之指定有利劑量(在200毫克/平方公尺/天與2000毫克/平方公尺/天之間)及氟達拉賓(fludarabine)之指定劑量(在20毫克/平方公尺/天與900毫克/平方公尺/天之間)。一個此類給藥方案涉及治療患者,包含在向患者投與治療有效量之經工程改造T細胞之前每天向患者投與約500毫克/平方公尺/天之環磷醯胺及約60毫克/平方公尺/天之氟達拉賓持續三天。
在一些實施例中,以可有效地治療個體之疾病或病況的量投與抗原結合分子、經轉導(或以其他方式工程改造)細胞(諸如CAR或TCR)及化學治療劑。
在一些實施例中,本文中所揭示之包含表現CAR之免疫效應細胞之組合物可與多種化學治療劑一起投與。化學治療劑之實例包括烷基化劑,諸如噻替派(thiotepa)及環磷醯胺(CYTOXAN
TM);磺酸烷基酯,諸如白消安(busulfan)、英丙舒凡(improsulfan)及哌泊舒凡(piposulfan);氮丙啶(aziridine),諸如苯唑多巴(benzodopa)、卡波醌(carboquone)、米特多巴(meturedopa)及尤利多巴(uredopa);伸乙亞胺及甲基三聚氰胺,包括六甲蜜胺、三伸乙基蜜胺、三伸乙基磷醯胺、三伸乙基硫代磷醯胺及三羥甲基密胺(trimethylolomelamine resume);氮芥類,諸如苯丁酸氮芥、萘氮芥、氯磷醯胺、雌氮芥、異環磷醯胺、氮芥、鹽酸氧氮芥(mechlorethamine oxide hydrochloride)、美法侖(melphalan)、新氮芥、苯芥膽甾醇、潑尼氮芥(prednimustine)、曲洛磷胺(trofosfamide)、尿嘧啶氮芥;亞硝基脲,諸如卡莫司汀(carmustine)、氯脲黴素、福莫司汀(fotemustine)、洛莫司汀(lomustine)、尼莫司汀(nimustine)、雷莫司汀(ranimustine);抗生素,諸如阿克拉黴素(aclacinomysins)、放線菌素(actinomycin)、安麯黴素(authramycin)、偶氮絲胺酸(azaserine)、博萊黴素(bleomycin)、放線菌素(cactinomycin)、卡奇黴素(calicheamicin)、卡柔比星(carabicin)、洋紅黴素(carminomycin)、嗜癌菌素(carzinophilin)、色黴素(chromomycin)、放線菌素(dactinomycin)、道諾黴素(daunorubicin)、地托比星(detorubicin)、6-重氮-5-側氧基-L-正白胺酸、小紅莓(doxorubicin)、表柔比星(epirubicin)、依索比星(esorubicin)、伊達比星(idarubicin)、麻西羅黴素(marcellomycin)、絲裂黴素(mitomycin)、黴酚酸、諾加黴素(nogalamycin)、橄欖黴素(olivomycins)、培洛黴素(peplomycin)、潑非黴素(potfiromycin)、嘌呤黴素(puromycin)、奎那黴素(quelamycin)、羅多比星(rodorubicin)、鏈黑菌素(streptonigrin)、鏈脲佐菌素(streptozocin)、殺結核菌素(tubercidin)、烏苯美司(ubenimex)、淨司他丁(zinostatin)、佐柔比星(zorubicin);抗代謝物,諸如甲胺喋呤(methotrexate)及5-氟尿嘧啶(5-FU);葉酸類似物,諸如迪諾特寧(denopterin)、甲胺喋呤、蝶羅呤(pteropterin)、曲美沙特(trimetrexate);嘌呤類似物,諸如氟達拉賓、6-巰基嘌呤、硫咪嘌呤(thiamiprine)、硫鳥嘌呤(thioguanine);嘧啶類似物,諸如安西他濱(ancitabine)、阿紮胞苷(azacitidine)、6-氮尿苷(6-azauridine)、卡莫氟(carmofur)、阿糖胞苷(cytarabine)、二去氧尿苷(dideoxyuridine)、去氧氟尿苷(doxifluridine)、依諾他濱(enocitabine)、氟尿苷(floxuridine)、5-FU;雄激素,諸如卡魯睾酮(calusterone)、丙酸屈他雄酮(dromostanolone propionate)、環硫雄醇、美雄烷(mepitiostane)、睾內酯;抗腎上腺類,諸如胺格魯米特(aminoglutethimide)、米托坦(mitotane)、曲洛司坦(trilostane);葉酸補充劑,諸如亞葉酸;乙醯葡醛酯;醛磷醯胺糖苷;胺基乙醯丙酸;安吖啶(amsacrine);貝斯布西(bestrabucil);比生群(bisantrene);依達曲沙(edatraxate);得弗伐胺(defofamine);地美可辛(demecolcine);地吖醌(diaziquone);艾福米辛(elformithine);依利醋銨(elliptinium acetate);依託格魯(etoglucid);硝酸鎵(gallium nitrate);羥基尿素;蘑菇多醣(lentinan);氯尼達明(lonidamine);米托胍腙(mitoguazone);米托蒽醌(mitoxantrone);莫哌達醇(mopidamol);尼曲吖啶(nitracrine);噴司他丁(pentostatin);苯來美特(phenamet);吡柔比星(pirarubicin);鬼臼酸(podophyllinic acid);2-乙基醯肼;丙卡巴肼(procarbazine);PSK®;雷佐生(razoxane);西索菲蘭(sizofiran);鍺螺胺(spirogermanium);細交鏈孢菌酮酸(tenuazonic acid);三亞胺醌(triaziquone);2,2',2''-三氯三乙胺;尿烷(urethan);長春地辛(vindesine);達卡巴嗪(dacarbazine);甘露醇氮芥(mannomustine);二溴甘露醇;二溴衛矛醇;哌泊溴烷(pipobroman);加西托星(gacytosine);阿拉伯糖苷(arabinoside,「Ara-C」);環磷醯胺;噻替派;類紫杉醇(taxoid),例如太平洋紫杉醇(paclitaxel,TAXOL
TM, Bristol-Myers Squibb)及多西他賽(doxetaxel,TAXOTERE®, Rhone-Poulenc Rorer);氯芥苯丁酸;吉西他濱(gemcitabine);6-硫代鳥嘌呤;巰基嘌呤;甲胺喋呤;鉑類似物,諸如順鉑(cisplatin)及卡鉑(carboplatin);長春鹼(vinblastine);鉑;依託泊苷(etoposide,VP-16);異環磷醯胺;絲裂黴素C;米托蒽醌;長春新鹼(vincristine);長春瑞賓(vinorelbine);溫諾平(navelbine);諾凡特龍(novantrone);替尼泊苷(teniposide);柔紅黴素(daunomycin);胺基喋呤(aminopterin);希羅達(xeloda);伊班膦酸鹽(ibandronate);CPT-11;拓樸異構酶(topoisomerase)抑制劑RFS2000;二氟甲基鳥胺酸(DMFO);視黃酸衍生物,諸如Targretin
TM(貝瑟羅汀(bexarotene))、Panretin
TM(亞利崔托寧(alitretinoin));ONTAK
TM(地尼白介素(denileukin diftitox);埃斯波黴素(esperamicin);卡培他濱(capecitabine);及以上各者中之任一者之醫藥學上可接受之鹽、酸或衍生物。在一些實施例中,本文中所揭示之包含表現CAR及/或TCR之免疫效應細胞之組合物可與用以調節或抑制對腫瘤的激素作用之抗激素劑一起投與,該抗-激素劑為諸如抗雌激素,包括例如他莫昔芬(tamoxifen)、雷洛昔芬(raloxifene)、芳香酶抑制4(5)-咪唑、4-羥基他莫昔芬、曲沃昔芬(trioxifene)、那洛昔芬(keoxifene)、LY117018、奧那司酮(onapristone)及托瑞米芬(toremifene,Fareston);及抗雄激素,諸如氟他胺(flutamide)、尼魯胺(nilutamide)、比卡魯胺(bicalutamide)、亮丙立德(leuprolide)及戈舍瑞林(goserelin);及以上各者中之任一者之醫藥學上可接受之鹽、酸或衍生物。在適當時亦投與化學治療劑之組合,包括(但不限於) CHOP,亦即環磷醯胺(Cytoxan
®)、小紅莓(羥基小紅莓)、長春新鹼(Oncovin
®)及潑尼松(Prednisone)。
在一些實施例中,化學治療劑在投與經工程改造之細胞或核酸的同時或之後一週內投與。在其他實施例中,化學治療劑在投與經工程改造之細胞或核酸之後1至4週或1週至1個月、1週至2個月、1週至3個月、1週至6個月、1週至9個月或1週至12個月投與。在一些實施例中,化學治療劑在投與細胞或核酸之前至少1個月投與。在一些實施例中,方法進一步包含投與兩種或更多種化學治療劑。
各種額外治療劑可與本文中所描述之組合物一起使用。舉例而言,可能適用之額外治療劑包括PD-1抑制劑,諸如納武單抗(nivolumab,OPDIVO®)、派立珠單抗(pembrolizumab,KEYTRUDA®)、派立珠單抗、皮立珠單抗(pidilizumab,CureTech)及阿特珠單抗(atezolizumab,Roche)。
適用於與本發明之組合物及方法組合使用之額外治療劑包括(但不限於)依魯替尼(ibrutinib,Imbruvica®)、奧伐木單抗(ofatumumab,Arzerra®)、利妥昔單抗(rituximab,Rituxan®)、貝伐單抗(bevacizumab,Avastin®)、曲妥珠單抗(trastuzumab,Herceptin®)、曲妥珠單抗恩他新(trastuzumab emtansine,KADCYLA®)、伊馬替尼(imatinib,Gleevec®)、西妥昔單抗(cetuximab,Erbitux®)、帕尼單抗(panitumumab,Vectibix®)、卡托莫西單抗(catumaxomab)、異貝莫單抗(ibritumomab)、奧伐木單抗(ofatumumab)、托西莫單抗(tositumomab)、貝倫妥單抗(brentuximab)、阿侖妥珠單抗(alemtuzumab)、吉妥珠單抗(gemtuzumab)、埃羅替尼(erlotinib)、吉非替尼(gefitinib)、凡德他尼(vandetanib)、阿法替尼(afatinib)、拉帕替尼(lapatinib)、來那替尼(neratinib)、阿西替尼(axitinib)、馬賽替尼(masitinib)、帕佐泮尼(pazopanib)、舒尼替尼(sunitinib)、索拉非尼(sorafenib)、妥賽蘭尼(toceranib)、來他替尼(lestaurtinib)、西地蘭尼(cediranib)、樂伐替尼(lenvatinib)、尼達尼布(nintedanib)、瑞戈非尼(regorafenib)、司馬沙尼(semaxanib)、替沃紮尼(tivozanib)、恩曲替尼(entrectinib)、卡博替尼(cabozantinib)、達沙替尼(dasatinib)、尼羅替尼(nilotinib)、普納替尼(ponatinib)、拉多替尼(radotinib)、伯舒替尼(bosutinib)、盧佐替尼(ruxolitinib)、帕瑞替尼(pacritinib)、考比替尼(cobimetinib)、司美替尼(selumetinib)、曲美替尼(trametinib)、畢尼替尼(binimetinib)、艾樂替尼(alectinib)、色瑞替尼(ceritinib)、克卓替尼(crizotinib)、阿柏西普(aflibercept)、脂肪肽(adipotide)、地尼白介素、mTOR抑制劑(諸如依維莫司(Everolimus)及替西羅莫司(Temsirolimus))、刺蝟抑制劑(諸如索尼蒂吉伯(sonidegib)及維莫德吉(vismodegib))、CDK抑制劑(諸如CDK抑制劑(帕泊昔布(palbociclib)))。
在一些實施例中,包含CAR免疫細胞之組合物與消炎劑一起投與。消炎劑或藥物可包括(但不限於)類固醇及糖皮質激素(包括倍他米松(betamethasone)、布地奈德(budesonide)、地塞米松(dexamethasone)、乙酸氫化可體松(hydrocortisone acetate)、氫化可體松、甲基潑尼龍(methylprednisolone)、潑尼龍(prednisolone)、潑尼松(prednisone)、曲安西龍(triamcinolone));非類固醇消炎藥(NSAIDS),包括阿司匹林(aspirin)、布洛芬(ibuprofen)、萘普生(naproxen)、甲胺喋呤、柳氮磺胺吡啶(sulfasalazine)、來氟米特(leflunomide)、抗TNF藥物、環磷醯胺及黴酚酸酯(mycophenolate)。例示性NSAID包括布洛芬、萘普生、萘普生鈉、Cox-2抑制劑及唾液酸化物(sialylate)。例示性鎮痛劑包括乙醯胺苯酚、羥考酮(oxycodone)、曲馬多(tramadol)或鹽酸丙氧芬(proporxyphene hydrochloride)。例示性糖皮質激素包括可體松(cortisone)、地塞米松、氫化可體松、甲基潑尼龍、潑尼龍或潑尼松。例示性生物反應修飾劑包括針對細胞表面標記之分子(例如CD4、CD5等)、諸如TNF拮抗劑之細胞介素抑制劑(例如依那西普(etanercept,ENBREL
®)、阿達木單抗(adalimumab,HUMIRA
®)及英利昔單抗(infliximab,REMICADE
®))、趨化介素抑制劑及黏附分子抑制劑。生物反應修飾劑包括單株抗體以及分子之重組形式。例示性DMARD包括硫唑嘌呤(azathioprine)、環磷醯胺、環孢靈、甲胺喋呤、青黴胺(penicillamine)、來氟米特、柳氮磺胺吡啶、羥基氯奎(hydroxychloroquine)、金製劑(經口(金諾芬(auranofin))及肌肉內)及二甲胺四環素(minocycline)。
在一些實施例中,本文中所描述之組合物與細胞介素一起投與。細胞介素之實例為淋巴介質、單核球激素及傳統多肽激素。細胞介素中包括生長激素,諸如人類生長激素、N-甲硫胺醯基人類生長激素及牛類生長激素;副甲狀腺激素;甲狀腺素;胰島素;胰島素原;鬆弛素;鬆弛素原;醣蛋白激素,諸如濾泡刺激激素(FSH)、促甲狀腺激素(TSH)及黃體生成激素(LH);肝生長因子(HGF);纖維母細胞生長因子(FGF);促乳素;胎盤催乳激素;苗勒氏管抑制物質(mullerian-inhibiting substance);小鼠促性腺激素相關肽;抑制素;活化素;血管內皮生長因子;整合素;血小板生成素(TPO);神經生長因子(NGF),諸如NGF-β;血小板生長因子;轉型生長因子(TGF),諸如TGF-α及TGF-β;類胰島素生長因子-I及類胰島素生長因子-II;紅血球生成素(EPO,Epogen
®,Procrit
®);骨性誘導因子;干擾素,諸如干擾素-α、干擾素-β及干擾素-γ;群落刺激因子(CSF),諸如巨噬細胞-CSF (M-CSF);粒細胞-巨噬細胞-CSF (GM-CSF);及粒細胞-CSF (G-CSF);介白素(IL),諸如IL-1、IL-1α、IL-2、IL-3、IL-4、IL-5、IL-6、IL-7、IL-8、IL-9、IL-10、IL-11、IL-12;IL-15,一種腫瘤壞死因子,諸如TNF-α或TNF-β;及其他多肽因子,包括LIF及套組配位體(KL)。如本文中所用,術語細胞介素包括來自天然來源或來自重組細胞培養基之蛋白質及天然序列細胞介素之生物學活性等效物。
投藥
在一些實施例中,本文中所描述之經工程改造之T細胞用於以包含以下的方法治療患者之惡性腫瘤:(a)獲取包含一或多種嵌合受體之複數個T細胞;及(b)向患者投與有效劑量之T細胞。
在一些實施例中,T細胞可以治療有效量投與。舉例而言,T細胞之治療有效量可為至少約10
4個細胞、至少約10
5個細胞、至少約10
6個細胞、至少約10
7個細胞、至少約10
8個細胞、至少約10
9個細胞或至少約10
10個細胞。在另一實施例中,T細胞之治療有效量為約10
4個細胞、約10
5個細胞、約10
6個細胞、約10
7個細胞或約10
8個細胞。在一些實施例中,CAR T細胞之治療有效量為約2 × 10
6個細胞/公斤、約3 × 10
6個細胞/公斤、約4 × 10
6個細胞/公斤、約5 × 10
6個細胞/公斤、約6 ×10
6個細胞/公斤、約7 × 10
6個細胞/公斤、約8 × 10
6個細胞/公斤、約9 × 10
6個細胞/公斤、約1 × 10
7個細胞/公斤、約2 × 10
7個細胞/公斤、約3 × 10
7個細胞/公斤、約4 × 10
7個細胞/公斤、約5 × 10
7個細胞/公斤、約6 × 10
7個細胞/公斤、約7 × 10
7個細胞/公斤、約8 × 10
7個細胞/公斤或約9 × 10
7個細胞/公斤。
在一些實施例中,CAR陽性活T細胞之治療有效量在約1 × 10
6個CAR陽性活T細胞/公斤體重與約2 × 10
6個CAR陽性活T細胞/公斤體重之間,至多約1 × 10
8個CAR陽性活T細胞之最大劑量。
監測
在一些實施例中,投與嵌合受體T細胞免疫療法在經認證之醫療保健機構進行。
在一些實施例中,本文中所揭示之方法包含在輸注之後在經認證之醫療保健機構至少每天一次監測投與嵌合受體T細胞免疫療法(例如,西卡思羅(axi-cel))之後的患者之CRS及神經毒性之病徵及症狀持續7天。在一些實施例中,至少每天一次監測患者持續3、4、5、6、7、8、9、10、11、12、13或14天。
在一些實施例中,患者在輸注之後受指示留在經認證之醫療保健機構附近維持至少4週。在一些實施例中,患者在輸注之後受指示留在經認證之醫療保健機構附近持續至少1、2、3、4、5、6、7、8、9或10週。
臨床試驗
ZUMA-1 (NCT02348216)為患有難治癒侵蝕性大B細胞淋巴瘤之患者中對西卡思羅(axi-cel)的1/2期多中心關鍵研究(圖2) (Neelapu SN, Locke LF等人,N Engl J Med. 2017;377:2531-2544)。西卡思羅(axi-cel)在15.4個月的中間隨訪時維持持續反應。在ZUMA-1中用西卡思羅(axi-cel)治療患有難治癒大B細胞淋巴瘤的108個患者之中,在15.4個月的中間隨訪下,82%呈現客觀反應率(ORR),58%呈現完全反應(CR)且持續反應為42%,包括40% CR。細胞介素釋放症候群(CRS)及神經事件(NE)為可逆的(13%等級≥ 3 CRS,28%等級≥ 3 NE:3個5級不良事件)。
嚴重不良反應之管理
在一些實施例中,方法包含管理不良反應。在一些實施例中,不良反應選自由以下組成之群:細胞介素釋放症候群(CRS)、神經毒性、過敏反應、嚴重感染、細胞減少症及低伽瑪球蛋白血症。
在一些實施例中,不良反應之病徵及症狀選自由以下組成之群:發燒、低血壓、心搏過速、低氧及發冷,包括心律不整(包括心房震顫及心室心搏過速)、心跳驟停、心臟衰竭、腎功能衰竭、毛細管滲漏症候群、低血壓、低氧、器官毒性、噬血細胞性淋巴組織細胞增殖症/巨噬細胞活化症候群(HLH/MAS)、癲癇、腦病、頭痛、痙攣症、眩暈、失語症、譫妄、失眠焦慮症、全身性過敏反應、發熱性嗜中性球減少症、血小板減少症、嗜中性白血球減少症及貧血症。
細胞介素釋放症候群
在一些實施例中,方法包含基於臨床表現識別CRS。在一些實施例中,方法包含評估並治療發燒、低氧及低血壓之其他病因。應利用連續心臟遙測術及脈動式測氧法監測經受≥ 2級CRS (例如,低血壓、對流體無反應或需要補充氧合作用之低氧)之患者。在一些實施例中,對於經受嚴重CRS之患者,考慮執行心動回聲圖以評估心臟功能。對於嚴重或危及生命的CRS,可考慮加護支持療法。
在一些實施例中,方法包含在輸注之後在經認證之醫療保健機構至少每天一次監測患者之CRS之病徵及症狀持續7天。在一些實施例中,方法包含在輸注之後監測患者之CRS之病徵或症狀持續4週。在一些實施例中,方法包含建議患者在任何時候出現CRS之病徵或症狀時立即尋求醫療照顧。在一些實施例中,方法包含如CRS之第一病徵處所指示用支持護理、托西利單抗(tocilizumab)或托西利單抗與皮質類固醇進行治療。
神經毒性
在一些實施例中,方法包含監測患者之神經毒性之病徵或症狀。在一些實施例中,方法包含排除神經症狀之其他病因。應利用連續心臟遙測術及脈動式測氧法監測經受≥ 2級神經毒性之患者。對於嚴重或危及生命的神經毒性,提供加護支持療法。
在一些實施例中,方法包含在輸注之後在經認證之醫療保健機構至少每天一次監測患者之神經毒性之病徵及症狀持續7天。在一些實施例中,方法包含在輸注之後監測患者之神經毒性之病徵及症狀持續4週。
繼發性惡性腫瘤
在一些實施例中,用針對CD19之經基因改造之自體性T細胞免疫療法治療之患者可能罹患繼發性惡性腫瘤。在一些實施例中,方法包含長期監測繼發性惡性腫瘤。
本說明書中所提及之所有公開案、專利及專利申請案均以引用的方式併入本文中,其引用的程度如各單獨的公開案、專利或專利申請案經特定及單獨地指示以引用的方式併入一般。然而,本文中參考文獻之引用不應視為承認此類參考文獻為本發明之先前技術。若以引用的方式併入之參考文獻中提供之定義或術語中之任一者與本文中所提供之術語及論述有一定程度不同,則以本發明術語及定義為準。
額外實施例
本發明之一個態樣係關於治療惡性腫瘤之方法,其包含在投與(例如,至少一次輸注)表現外源性TCR之CAR-T細胞或T細胞之前量測惡性腫瘤(亦即,腫瘤微環境)的一或多個位點處之免疫相關基因表現及/或T細胞密度。在一些實施例中,在化學治療劑處理及經工程改造T細胞(例如,CAR-T細胞)投與之前執行該量測。
在一些實施例中,該量測包含基於免疫相關基因表現(諸如ImmunoSign®21或Immunosign®15分數)測定組合物免疫分數。在一些實施例中,該量測包含基於T細胞(包括CD3+及/或CD8+ T細胞)之瘤內密度測定免疫分數,諸如Immunoscore®。在一些實施例中,該量測進一步包含基於個體之免疫分數與預定臨限值之比較測定並分配相對分數,諸如高或低分數。在一些實施例中,此類預定臨限值經測定或已測定具有根據用經工程改造T細胞對惡性腫瘤進行治療的預後值。
在一些實施例中,所揭示之方法進一步包含基於該(等)量測進行治療最適化之步驟。舉例而言,在一些實施例中,基於腫瘤微環境之免疫分數最適化經工程改造T細胞(例如,CAR-T細胞)投與之劑量及/或方案。在例示性實施例中,具有低免疫分數(諸如低ImmunoSign®21分數)之個體投與比具有高免疫分數之個體更高劑量的CAR-T細胞。在一些實施例中,具有低免疫分數之個體投與比具有高免疫分數之個體高約25%或高約50%或高約100%的劑量。
在額外及替代例示性實施例中,具有低免疫分數之個體接受一或多此額外CAR-T細胞輸注。在一些實施例中,具有低預處理免疫分數之個體投與第一劑量之CAR-T細胞,評定治療反應,且若觀測到不完全反應,則實施額外TME免疫分數量測步驟。在一些實施例中,若在第一次投與之後個體之免疫分數較高,則執行CAR-T細胞之額外投與。
在一些實施例中,所揭示之方法另外或替代地包含「預處理」步驟,其中具有低免疫分數之個體在CAR-T投與之前以改良其免疫分數之目標治療。舉例而言,在一些實施例中,具有低免疫分數之患者經投與一或多種免疫刺激劑,諸如細胞介素、趨化介素或免疫檢查點抑制劑。在一些實施例中,在治療之前執行免疫分數之額外量測。
在一些實施例中,在評估治療選項時考慮根據基於CAR-T療法之完全反應之高免疫分數的預後值。舉例而言,在一些實施例中,具有高免疫分數之個體接受作為比具有低免疫分數之個體更前線之療法的CAR-T投藥與。
藉由以下實例進一步說明本發明,該等實例不應理解為進一步限制性的。本申請案整篇中所引用之所有參考文獻之內容以引用的方式明確併入本文中。
實例
實例 1 : 如 axi-cel 反應之預後之基線 TME 免疫基因表現
西卡思羅(axi-cel;YESCARTA
®)為一種當前由US FDA及EMA審批通過用於利用2種或更多種先前全身性療法治療患有復發性或難治癒大B細胞淋巴瘤之患者的自體性抗CD19嵌合抗原受體(CAR) T細胞療法。axi-cel CAR之結構示意性地描繪於圖1中。
ZUMA-1 (NCT02348216)為患有難治癒侵蝕性大B細胞淋巴瘤之患者中對西卡思羅(axi-cel)的1/2期多中心關鍵研究(Neelapu SN, Locke LF等人,
N Engl J Med.2017;377:2531-2544)。各ZUMA-1期及同期組群大小示意性地描繪於圖2中。患者在兩期中接受2.0 × 10
6個CAR T細胞/公斤。
在ZUMA-1中用西卡思羅(axi-cel)治療的患有難治癒大B細胞淋巴瘤的108個患者之中,整體反應率為82%且完全反應(CR)率為58%。細胞介素釋放症候群(CRS)及神經事件(NE)大部分可逆(11%等級≥ 3 CRS;32%等級≥ 3 NE;4個5級不良事件(包括2個非axi-cel相關事件))。在15.4個月之中間隨訪時,持續反應率為42%,包括40% CR。在27.1個月之中間隨訪時,持續反應率為39%,包括37% CR。
設計對ZUMA-1之2期之事後分析以探索腫瘤免疫微環境(TME)之關鍵預治療特徵之關聯。分析來自用西卡思羅(axi-cel)治療隨訪最少9個月之25個患者的基線活體組織切片。表1展示患者及腫瘤基線特徵及治療結果。
表 1 . 患者及腫瘤基線特徵及治療
當前基因表現研究 (n = 25) | ZUMA-1 整體 (N = 101) | |
基線特徵 | ||
腫瘤組織學,n (%) DLBCL PMBCL/TFL | 21 (84) 4 (16) | 77 (76) 24 (24) |
IPI分數3-4, n (%) | 11 (44) | 48 (48) |
≥3個前線療法,n (%) | 18 (72) | 70 (69) |
治療結果 | ||
中位CAR峰值含量 個細胞/微升(範圍) | 36 (1-1514) | 38 (1-1514) |
CAR:嵌合抗原受體;DLBCL:瀰漫性大B細胞淋巴瘤;IPI:國際預後指數;ORR:客觀反應率;PMBCL:原發性縱隔B細胞淋巴瘤;TFL:轉化型濾泡性淋巴瘤。 |
此等25個患者之客觀反應率為80%,其中20個為反應者且5個為無反應者。在後續資料截止值(隨訪最少12個月)中,一個患者隨後在第1個月自「非反應者」轉變成「反應者」。
如圖3中所展示,在基線處及在西卡思羅(axi-cel)投與後三週內採集腫瘤活體組織切片。使用nCounter®技術(NanoString)利用Immunosign®臨床研究分析來分析基線新鮮冷凍核心活體組織切片,從而以多工格式量測多發性免疫基因之基因表現量。利用極少量之來自新鮮冷凍或福馬林固定之腫瘤組織的RNA進一步研發分析。預先規定之生物資訊方法及截止值應用於免疫介導性腫瘤消退基因以評估包括T細胞細胞毒性、T細胞分化、T細胞吸引力、T細胞黏附性之適應性免疫及包括免疫定向、血管生成抑制、免疫共抑制之免疫抑制以及癌症幹細胞。(Immunosign®;圖4;Galon J等人,Immunity. 2013;39:11-26; www.haliodx.com/clinical-research-services/immunosignr/)。生物資訊方法包括T細胞特異性(效應T細胞,Th1)基因、干擾素路徑相關基因、趨化介素及免疫檢查點。高/低Immunosign®21分數截止值定義為在樣本中所觀測到的分數之第25個百分位。高分數指示可能與腫瘤反應相關聯之免疫相關基因之表現。
表現分析及計分用於檢查TME特徵與反應之間的關聯。使用預先規定之基因組之更廣泛分析亦如表2中所示般應用。包括由Immusign®15、Immunosign®21及其他基因組成之預先規定之43基因組以及來自PanCancer免疫圖譜組之所有763個基因。(nCounter PanCancer免疫圖譜組。https://www.nanostring.com/products/gene-expression-panels/ hallmarks-cancer-gene-expression-panel-collection/pancancer-immune-profiling-panel)。使用利用由假發現率進行之多重測試修正(Benjamini-Hochberg)之費雪精確測試(Fisher's exact test)及威爾科克森(Wilcoxon)標誌之排序測試。
表 2 . 預先規定之基因組
Immunosign®21 | 擴增之43 免疫基因組 | PanCancer 免疫圖譜組 (763 個基因) | |||||
CD3G | STAT4 | CTLA4 | GZMH | CD8A | PDCD1 | B細胞 | T細胞 |
CD3E | CD3D | CD3G | IRF1 | CX3CL1 | TNFRSF9 | 例如,BLK、CD19、CR2、MS4A1、TNFRSF17 | 例如,CD2、CD2E、CD3G、CD6 |
GZMK | GZMM | CD3E | GZMA | CXCL10 | TSLP | ||
PRF1 | CD8A | REN | GZMB | TNFRSF18 | CCL2 | ||
ICOS | CXCL10 | GZMK | CXCL11 | CD69 | CD247 | ||
STAT1 | IL15 | CCL5 | STAT4 | CD274 | GNLY | 先天性免疫反應 | |
CCR2 | CCL2 | ITGAE | LAG3 | IL15 | LTK | 細胞毒性細胞 | 樹突狀細胞 |
IRF1 | TBX21 | PRF1 | CD3D | PF4 | TBX21 | 例如,CD8、BLC2 | 例如,CCL12、CCL17 |
GZMA | CXCR3 | ICOS | CXCL9 | IFNG | VEGFA | 巨噬細胞 | 粒細胞 |
GZMB | CD69 | STAT1 | GZMM | CXCL13 | CXCR3 | 例如,APOE、CCL7 | 例如,CMA1、CSF3R |
CXCL11 | CCR2 | IL17A | PROM1 |
腫瘤微環境(TME)之預存在免疫特徵與對西卡思羅(axi-cel)之反應相關聯。如圖5A中所展示,與無反應者相比,基線處之TME Immunosign®21分數在反應者中升高,其中臨床隨訪≥ 9個月(
P= .012)。85% (17/20)之反應者具有高Immunosign®21分數且80% (4/5)之無反應者具有低Immunosign®21分數(圖5B及5C)。在包括在12個月時具有延遲反應之患者的敏感性分析中,Immunosign®21與反應之間的關聯具有
P= .053。
相對於無反應者,在反應者中基線處在TME中上調的前幾個免疫相關基因包括CTLA4、CD3g、CD3e、CD27、SH2B2及ICOSL。與無反應者相比,在反應者中基線處在TME中相對降低的其他基因之表現包括MHC II級基因及癌症睾丸抗原PRAME、MAGE、SSX。依據瀰漫性大B細胞淋巴瘤中之MHC II級表現之陽性預後值,與MHC II級基因之關聯係出人意料的(Rimsza LM等人,
Blood.2004;103:4251-4258)。與無反應者相比,來自擴增之763個基因PanCancer免疫圖譜組之在反應者中之TME中區別表現的額外基因展示於表3中。
表 3 . 相對於無反應者在反應者中之 TME 中區別表現之基因
實例 2 : 如 Axi-cel 反應之預後之基線瘤內 T 細胞 密度
相對於無反應者在反應者中上調 | ||||
基因 | Log2 倍數變化 | P 值 | 假發現率 | 基因組 |
CD27 | 2.46 | .039 | 1 | 免疫輔受體 |
SH2B2 | 1.84 | < .001 | 1 | 調節 |
ICOSLG | 1.54 | .035 | 1 | 免疫輔受體 |
相對於無反應者在反應者中下調 | ||||
基因 | Log2 倍數變化 | P 值 | 假發現率 | 基因組 |
HLA-DQA1 | -7.85 | .038 | 1 | 適應性,抗原處理 |
HLA-DQB1 | -7.05 | .017 | 1 | 適應性,抗原處理 |
MAGEB2 | -6.26 | .007 | 1 | 癌症睾丸 |
PRAME | -5.11 | .015 | 1 | 癌症睾丸 |
MAGEA1 | -3.89 | .028 | 1 | 癌症睾丸 |
IL22RA1 | -3.48 | .002 | 1 | 趨化介素 |
SSX1 | -3.18 | .001 | 1 | 癌症睾丸 |
CCL20 | -3.13 | .044 | 1 | 趨化介素 |
NEFL | -3.1 | .002 | 1 | 細胞功能 |
C9 | -2.87 | .028 | 1 | 先天性,補體 |
GZMM | -2.83 | .040 | 1 | 先天性,ImmunoSign®21 |
KIR作用子群2 | -2.66 | .004 | 1 | 先天性免疫 |
HLA-DOB | -2.12 | .043 | 1 | 適應性,抗原處理 |
設計對ZUMA-1之2期之額外事後分析以探索腫瘤免疫微環境(TME)之關鍵預治療特徵(特定言之,CD3+及CD8+ T細胞密度及Immunoscore®)與對axi-cel及免疫基因表現(包括Immunosign®21)之反應的關聯。
預處理組織活體組織切片經福馬林固定及鏈烷烴嵌入(FFPE),用於藉由免疫組織化學分析CD3+及CD8+ T細胞密度(個細胞/平方毫米)。使用Benchmark® XT工作台對2個相連FFPE切片(4 µm)進行CD3及CD8染色。利用專用數位病理學軟體測定陽性細胞染色密度。
Immunoscore®分析量測經切除或經活組織檢查之癌症樣本之CD8+細胞毒性T細胞及CD3+ T細胞的密度,且在福馬林固定之鏈烷烴嵌入式組織載玻片上執行。藉由免疫組織化學分析預處理(在化學治療劑處理之前)腫瘤組織活體組織切片之T細胞亞群(CD3+、CD8+)的密度(個細胞/平方毫米)。使用Benchmark® XT工作台對2個相連FFPE切片(4 µm)進行CD3及CD8染色。使用專用數位病理學軟體實施對陽性細胞區域之量測。對於各個體,對25個基線活體組織切片樣本之CD3及CD8免疫組織化學染色進行評分且使用如Galon等人, J Pathol. 232:199-209 (2014)中所描述之HalioDx演算法及分析截止值將其轉變成ImmunoScore® (T細胞密度之數值指數)。所觀測到的分數之中位值定義為高及低Immunoscore®之臨界值,其中高免疫分數表示相對增加之瘤內T細胞浸潤。威爾奇t測試(Welch's t-test)用於比較具有CR之個體相對於具有部分反應、穩定疾病及進展性疾病之個體的Immunoscore®、CD3及CD8水準。
結果:均測定預治療的具有腫瘤內CD3+及CD8+ T細胞之更高密度及高Immunoscore®的大多數患者達成CR (圖8A至8C)。總體而言,更高預處理Immunoscore®與CR之達成相關聯(
P= .048;圖8A及8B)。CD3+及CD8+ T細胞之預處理瘤內密度與CR之達成正性相關(
P= .025及.049;分別圖9A及圖9B)。並未達成CR之患者顯示腫瘤內CD3+及CD8+ T細胞之顯著低密度及低Immunoscore®。(圖8A及圖8C)。
Immunoscore®及Immunosign®21評估顯示82%一致率(95% CI,65-93;r
2= 0.451;圖10)之相同腫瘤活體組織切片中之預治療,表明更高的T細胞浸潤密度與容許基因標籤之間的潛在關係。
來自實例1及實例2之發現指出預處理TME在對CAR T細胞療法之反應中之關鍵作用。抗CD19 CAR T療法可解決與低Immunosign®21分數或Immunoscore®相關聯之不良預後。
實例 3 :腫瘤免疫微環境
對患者樣本之進一步分析顯示,CAR T細胞擴增在治療2週內出現且在免疫程序中伴有細胞介素升高。藥效動力學圖譜顯示增殖性標記(IL-15及IL-2)、發炎標記(IL-6、CRP、SAA、IL-5、鐵蛋白、IL-1Ra、IL-2Rα)、免疫調節標記(GM-CSF、IFN-γ、IL-10)、趨化介素(IL-8、IP-10、MCP-1)及效應標記(顆粒酶B)中大於基線之快速增加。基因表現分析表明,預治療T細胞相關基因(CD3ε、CD28及CTLA4)、先天性免疫相關基因(MX1、ISG15及MYD88)及B細胞相關基因(CD19、CD79B及PAX5)可與臨床結果相關(圖11)。
使用針對CAR T RNA之原位雜交(ISH)及利用WO2018/013563A1及WO2018/053790A1中所描述之識別單獨CAR抗原決定基之抗體的免疫組織化學(IHC)在Zuma-1患者(治療後7-21天)中之TME中偵測CAR T細胞。在1年後在具有減輕之預治療腫瘤負荷之患者中觀測到增加的持續反應速率。此等資料表明與腫瘤負荷相稱之CAR T細胞移植可克服大型腫瘤。CAR T細胞治療與TME中之變化相關聯。對來自預先指定之43免疫基因組的轉錄本之分析顯示在治療之後7-21天在腫瘤中上調。回應於治療觀測到免疫抑制檢查點(PD-L1、CTLA4、LAG3、TNFRSF18、ICOS)、IFN相關基因(IRF1、STAT1、STAT4、IFNγ)及趨化介素(CXCL9、CCL2、CCL5)、效應子(CD8A、GNLY、GZMA、GZMM、GZMB、GZMH)及增殖性標記IL-15之增加(圖12)。Nanostring分析顯示IL-15及PD-L1基因表現在具有完全或部分反應之個體中升高(圖13A及13B)。
針對CD19及PD-L1表現,評估患有大細胞淋巴瘤及B細胞急性淋巴母細胞白血病(B-ALL)之患者的活體組織切片。至少三分之一的在Axi-cel後復發之個體具有針對CD19表現為陰性之腫瘤。在進展下對B細胞及免疫相關分子之分析識別CD19+或CD19-腫瘤細胞之復發。在基線處,94% (16/17)之可評估患者為CD19+。來自21個可評估患者之進展後腫瘤活體組織切片顯示33%為CD19-且62%為PD-L1+。
圖式僅出於說明的目的,而非限制。
圖1展示嵌合抗原受體(CAR)構築體組態之示意性圖示。
圖2展示接受西卡思羅(axicabtagene ciloleucel)之患者之ZUMA-1臨床試驗的示意性圖示。AE:不良事件;axi-cel:西卡思羅;CAR:嵌合抗原受體;CR:完全反應;CRS:細胞介素釋放症候群;DLBCL:瀰漫性大B細胞淋巴瘤;NE:神經事件;ORR:客觀反應率;PMBCL:原發性縱隔B細胞淋巴瘤;TFL:轉化型濾泡性淋巴瘤。
圖3展示成對活體組織切片之ZUMA-1臨床試驗方法及時序的示意性圖示。
圖4展示用於評估腫瘤微環境內之關鍵免疫路徑之Immunosign®臨床研究分析組。
圖5A展示對來自用西卡思羅(axi-cel)治療隨訪最少9個月之25個患者之樣本執行的Immunosign®21分數與臨床結果之間的關聯。一個患者隨後在12個月隨訪後自「非反應者」轉變成「反應者」。圖5B展示以高及低基線Immunosign®21分數對axi-cel治療有反應之患者的比例。圖5C展示以高及低基線Immunosign®21分數對axi-cel治療無反應之患者的比例。高/低Immunosign®21分數截止值定義為在樣本中所觀測到的分數之第25個百分位。圖5B及5C中之斑點指示低Immunosign®21分數。
圖6展示對來自用西卡思羅(axi-cel)治療隨訪最少9個月之25個患者之樣本執行的與無反應者相比Immunosign®21基因在反應者中之表現的差值。
圖7A至7C展示前三個免疫環境基因CTLA4 (圖7A)、CD3γ (圖7B)及CD3ε (圖7C)之關聯,根據對來自用西卡思羅(axi-cel)治療隨訪最少9個月之25個患者之樣本執行的預先規定之43個免疫基因組,該等基因在來自反應者之腫瘤中升高。
圖8A展示對來自經治療患者之樣本執行的平均百分位Immunoscore®與臨床結果之間的關聯。圖8B展示在具有高基線Immunoscore®之患者中觀測到的臨床結果之比例。圖8C展示在具有低基線Immunoscore®之患者中觀測到的臨床結果之比例。高/低Immunosign®21分數截止值定義為在樣本中所觀測到的分數之中位值。CR:完全反應;PR:部分反應;SD:穩定疾病;PD:進展性疾病。
圖9A及9B分別展示在完全反應者以及在經治療患者之基線活體組織切片中呈現除完全反應以外的患者中之CD3+細胞及CD8+細胞之密度。
圖10標繪如自經治療患者之基線活體組織切片評估的Immunosign®21分數與Immunoscore®之間的相關性。
圖11展示T細胞相關基因(CD3ε、CD28及CTLA4)、先天性免疫相關基因(MX1、ISG15及MYD88)及B細胞相關基因(CD19、CD79B及PAX5)之TME中之預治療基因表現分析以及在axi-cel治療隨訪1年後的臨床結果。CR:完全反應;PR:部分反應;SD:穩定疾病;PD:進展性疾病。
圖12展示在CAR-T治療之後7-21天的TME基因表現之倍數變化,其指示與免疫抑制檢查點(PD-L1、CTLA4、LAG3、TNFRSF18、ICOS)、IFN相關基因(IRF1、STAT1、STAT4、IFNγ)及趨化介素(CXCL9、CCL2、CCL5)、效應子(CD8A、GNLY、GZMA、GZMM、GZMB、GZMH)以及增殖性標記IL-15中之基線相比較的相對變化。
圖13A及13B展示對IL-15 (圖13A)及PD-L1 (圖13B)之差異變化之奈米串(nanostring)分析。Pre-TX:預治療;W1-2:第1-2週;W4:第4週。
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Claims (20)
- 一種治療患者之惡性腫瘤的方法,其包含: (a) 分析來自該患者之腫瘤活體組織切片以表徵腫瘤微環境;及 (b) 向該患者投與有效劑量之包含一或多種嵌合受體之T細胞,其中使用腫瘤微環境之特徵測定該有效劑量。
- 如請求項1之方法,其中使用基因表現圖譜(profiling)、瘤內T細胞密度量測或其組合表徵腫瘤微環境。
- 如請求項2之方法,其中該基因表現圖譜包含測定特定基因組之表現量。
- 如前述請求項中任一項之方法,其包含測定選自以下之一或多個基因之表現量:CD3G、STAT4、CD3E、CD3D、GZMK、GZMM、PRF1、CD8A、ICOS、CXCL10、STAT1、IL15、CCR2、CCL2、IRF1、TBX21、GZMA、CXCR3、GZMB、CD69、CXCL11及其組合。
- 如前述請求項中任一項之方法,其包含測定選自以下之一或多個基因之表現量:CTLA4、GZMH、CD8A、PDCD1、CD3G、IRF1、CX3CL1、TNFRSF9、CD3E、GZMA、CXCL10、TSLP、REN、GZMB、TNFRSF18、CCL2、GZMK、CXCL11、CD69、CD247、CCL5、STAT4、CD274、GNLY、ITGAE、LAG3、IL15、LTK、PRF1、CD3D、PF4、TBX21、ICOS、CXCL9、IFNG、VEGFA、STAT1、GZMM、CXCL13、CXCR3、CCR2、IL17A、PROM1及其組合。
- 如前述請求項中任一項之方法,其包含測定選自PanCancer免疫圖譜組(Immune Profiling Panel)之基因之表現量。
- 如前述請求項中任一項之方法,其包含測定B細胞標記之表現量。
- 如前述請求項中任一項之方法,其包含測定T細胞標記之表現量。
- 如前述請求項中任一項之方法,其包含測定包含與先天性免疫反應相關之基因的特定基因組之表現量。
- 如請求項9之方法,其中該特定基因組包含細胞毒性細胞、樹突狀細胞、巨噬細胞或粒細胞之標記。
- 如前述請求項中任一項之方法,其進一步包含基於該基因表現圖譜及/或該瘤內T細胞密度測定免疫分數。
- 如請求項11之方法,其進一步包含使用該免疫分數調節總劑量。
- 如前述請求項中任一項之方法,其中該有效劑量包含至少1 × 10 6個CAR陽性活T細胞/公斤體重。
- 如前述請求項中任一項之方法,其中該嵌合受體為嵌合抗原受體(CAR)。
- 如前述請求項中任一項之方法,其中該嵌合受體為T細胞受體(TCR)。
- 如前述請求項中任一項之方法,其中該惡性腫瘤為實體腫瘤、肉瘤、癌、淋巴瘤、多發性骨髓瘤、霍奇金氏病(Hodgkin's Disease)、非霍奇金氏淋巴瘤(NHL)、原發性縱隔大B細胞淋巴瘤(PMBC)、瀰漫性大B細胞淋巴瘤(DLBCL)、濾泡性淋巴瘤(FL)、經轉化濾泡性淋巴瘤、脾邊緣區淋巴瘤(SMZL)、慢性或急性白血病、急性骨髓性白血病、慢性骨髓性白血病、急性淋巴母細胞白血病(ALL) (包括非T細胞ALL)、慢性淋巴細胞白血病(CLL)、T細胞淋巴瘤、一或多種B細胞急性淋巴球性白血病(「BALL」)、T細胞急性淋巴球性白血病(「TALL」)、急性淋巴球性白血病(ALL)、慢性骨髓性白血病(CML)、B細胞前淋巴球性白血病、母細胞性漿細胞樣樹突狀細胞贅瘤、伯基特氏淋巴瘤(Burkitt's lymphoma)、瀰漫性大B細胞淋巴瘤、濾泡性淋巴瘤、毛細胞白血病、小細胞或大細胞濾泡性淋巴瘤、惡性淋巴增生病況、MALT淋巴瘤、套細胞淋巴瘤、邊緣區淋巴瘤、骨髓發育不良及骨髓發育不良症候群、漿母細胞淋巴瘤、漿細胞樣樹突狀細胞贅瘤、華氏巨球蛋白血症(Waldenstrom macroglobulinemia)、漿細胞增生性病症(例如無症狀骨髓瘤(冒煙型(smoldering)多發性骨髓瘤或無痛性(indolent)骨髓瘤))、意義不明單株伽瑪球蛋白症(monoclonal gammapathy of undetermined significance,MGUS)、漿細胞瘤(例如漿細胞惡液質(dyscrasia)、孤立性骨髓瘤、孤立性漿細胞瘤、髓外漿細胞瘤及多發性漿細胞瘤)、全身性澱粉樣輕鏈澱粉樣變性病、POEMS症候群(亦稱為克羅-富克斯症候群(Crow-Fukase syndrome)、高槻病(Takatsuki disease)及PEP症候群)或其組合。
- 如前述請求項中任一項之方法,其中該有效劑量經最適化以增加該患者對嵌合受體治療有反應的可能性。
- 一種測定患者是否將對嵌合受體治療有反應的方法,其包含: (a) 分析來自該患者之腫瘤活體組織切片以使用基因表現圖譜表徵腫瘤微環境; (b) 基於該基因表現圖譜測定免疫分數;及 (c) 基於該免疫分數測定該患者是否將對嵌合受體治療有反應。
- 一種測定患者是否將對嵌合受體治療有反應的方法,其包含: (a) 在治療之前獲取來自患者之腫瘤活體組織切片; (b) 分析該腫瘤活體組織切片以表徵腫瘤微環境;及 (c) 基於腫瘤微環境之特徵測定該患者是否將對嵌合受體治療有反應。
- 一種治療患者之惡性腫瘤的方法,其包含: (a) 在嵌合受體治療之前分析來自該患者之腫瘤活體組織切片以表徵腫瘤微環境; (b) 基於腫瘤微環境之特徵測定該患者是否將對嵌合受體治療有反應;及 (c) 向該患者投與有效劑量之包含一或多種嵌合受體之T細胞,其中使用腫瘤微環境之特徵測定該有效劑量。
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