US20180264094A1 - Personalised immunogenic peptide identification platform - Google Patents

Personalised immunogenic peptide identification platform Download PDF

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Publication number
US20180264094A1
US20180264094A1 US15/910,930 US201815910930A US2018264094A1 US 20180264094 A1 US20180264094 A1 US 20180264094A1 US 201815910930 A US201815910930 A US 201815910930A US 2018264094 A1 US2018264094 A1 US 2018264094A1
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Prior art keywords
subject
polypeptide
polypeptides
human subject
antigen
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Inventor
Julianna Lisziewicz
Levente Molnár
Enikö R. Töke
József Toth
Orsolya Lorincz
Zsolt Csiszovszki
Eszter Somogyi
Katalin Pántya
Mónika Megyesi
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Treos Bio Ltd
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Treos Bio Zrt
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Priority claimed from EP17159242.1A external-priority patent/EP3369431A1/en
Priority claimed from EP17159243.9A external-priority patent/EP3370065A1/en
Priority claimed from GBGB1703809.2A external-priority patent/GB201703809D0/en
Application filed by Treos Bio Zrt filed Critical Treos Bio Zrt
Assigned to TREOS BIO ZRT. reassignment TREOS BIO ZRT. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CSISZOVSZKI, ZSOLT, DR., LISZIEWICZ, JULIANNA, DR., LORINCZ, ORSOLYA, DR., MEGYESI, Mónika, MOLNÁR, Levente, PÁNTYA, Katalin, SOMOGYI, ESZTER, DR., TOKE, ENIKO R., DR., TOTH, József
Publication of US20180264094A1 publication Critical patent/US20180264094A1/en
Assigned to TREOS BIO LIMITED reassignment TREOS BIO LIMITED ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: TREOS BIO ZRT.
Priority to US17/448,020 priority Critical patent/US20220031823A1/en
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Definitions

  • the disclosure relates to methods of predicting whether a polypeptide is immunogenic for a specific human subject, methods of identifying fragments of a polypeptide that are immunogenic for a specific human subject, methods of preparing personalised or precision pharmaceutical compositions or kits comprising such polypeptide fragments, human subject-specific pharmaceutical compositions comprising such polypeptide fragments, and methods of treatment using such compositions.
  • peptides In antigen presenting cells (APC) protein antigens are processed into peptides. These peptides bind to human leukocyte antigen molecules (HLAs) and are presented on the cell surface as peptide-HLA complexes to T cells. Different individuals express different HLA molecules and different HLA molecules present different peptides. Therefore, according to the state of the art, a peptide, or a fragment of a larger polypeptide, is identified as immunogenic for a specific human subject if it is presented by a HLA molecule that is expressed by the subject. In other words, the state of the art describes immunogenic peptides as HLA-restricted epitopes.
  • HLA restricted epitopes induce T cell responses in only a fraction of individuals who express the HLA molecule. Peptides that activate a T cell response in one individual are inactive in others despite HLA allele matching. Therefore, it was unknown how an individual's HLA molecules present the antigen-derived epitopes that positively activate T cell responses.
  • the fragments of a polypeptide antigen that are immunogenic for a specific individual are those that can bind to multiple class I (activate cytotoxic T cells) or class II (activate helper T cells) HLAs expressed by that individual.
  • the disclosure provides methods of predicting whether a polypeptide or a fragment of a polypeptide is immunogenic for a specific human subject, the methods comprising the steps of
  • the disclosure also provides methods of identifying a fragment of a polypeptide as immunogenic for a specific human subject, the methods comprising the steps of
  • the methods of the disclosure comprise the step of determining or obtaining the HLA class I genotype and/or the HLA class II genotype of the specific human subject.
  • a specific polypeptide antigen may comprise more than one fragment that is a T cell epitope capable of binding to multiple HLA of a specific individual.
  • the combined group of all such fragments characterize the individual's antigen specific T cell response set, wherein the amino acid sequence of each fragment characterizes the specificity of each activated T cell clone.
  • the method is repeated until all of the fragments of the polypeptide that are a T cell epitope capable of binding to at least two HLA class I and/or at least two HLA class II of the subject have been identified.
  • This method characterises the immune response of the subject to the polypeptide.
  • the disclosure further provides methods of treatment of a human subject in need thereof, the method comprising administering to the subject a polypeptide, pharmaceutical composition or kit of the polypeptides of a panel of polypeptides that has been identified or selected by any of the methods above or comprising a fragment of a polypeptide that has been identified or selected by any of the methods above; their use in a method of treatment of a relevant human subject; and their use in the manufacture of a medicament for treating a relevant subject.
  • fragments of polypeptide that are determined to be immunogenic for a specific human subject in accordance with the methods above can be used to prepare human subject-specific immunogenic compositions.
  • the disclosure provides methods of designing or preparing a human subject-specific pharmaceutical composition or kit or panel of polypeptides for use in a method of treatment of a specific human subject, the methods comprising:
  • each peptide either consists of one of the selected amino acid sequences, or consists of two or more of the amino acid sequences arranged end to end or overlapping in a single peptide.
  • the disclosure further provides a human subject-specific pharmaceutical composition, kit or panel of polypeptides for use in a method of treatment of a specific human subject in need thereof, the composition, kit or panel comprising as active ingredients a first and a second peptide and optionally one of more additional peptides, wherein each peptide comprises an amino acid sequence that is a T cell epitope capable of binding to at least two HLA class I molecules and/or at least two HLA class II molecules of the subject, wherein the amino acid sequence of the T cell epitope of the first, second and optionally any additional peptides are different from each other, and wherein the pharmaceutical composition or kit optionally comprises at least one pharmaceutically acceptable diluent, carrier, or preservative.
  • the disclosure further provides a human subject-specific pharmaceutical composition, kit or panel of polypeptides for use in a method of treatment of a specific human subject in need thereof, the composition or kit comprising as an active ingredient a polypeptide comprising a first region and a second region and optionally one of more additional regions, wherein each region comprises an amino acid sequence that is a T cell epitope capable of binding to at least two HLA class I molecules and/or at least two HLA class II molecules of the subject, wherein the amino acid sequence of the T cell epitope of the first, second and optionally any additional regions are different from each other, and wherein the pharmaceutical composition or kit optionally comprises at least one pharmaceutically acceptable diluent, carrier, or preservative.
  • the disclosure further provides a method of designing or preparing a polypeptide for inducing an immune response in a specific human subject the method comprising selecting an amino acid sequence that is a T cell epitope capable of binding to at least three HLA class I molecules or at least three HLA class II molecules of the subject, and designing or preparing a polypeptide comprising the selected amino acid sequence.
  • the disclosure provides
  • the disclosure provides a system comprising
  • a storage module configured to store data comprising the class I and/or class II HLA genotype of a subject and the amino acid sequence of one or more test polypeptides; and (b) a computation module configured to identify and/or quantify amino acid sequences in the one or more test polypeptides that are capable of binding to multiple HLA class I molecules of the subject and/or that are capable of binding to multiple HLA class II molecules of the subject.
  • the disclosure provides a method of treatment of a human subject in need thereof, the method comprising administering to the subject a polypeptide, a panel of polypeptides, a pharmaceutical composition or the active ingredient polypeptides of a kit described above, wherein the subject has been determined to express at least three HLA class I molecules and/or at least three HLA class II molecules capable of binding to the polypeptide or to one or more of the active ingredient polypeptides of the pharmaceutical composition or kit.
  • compositions for treatment of a disease or disorder in a specific human subject comprising (a) at least two different polypeptides, each of the at least two different polypeptides being 10-50 amino acids in length and comprising a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, and wherein the T cell epitope of each of the at least two polypeptides are different from each other; and (b) a pharmaceutically-acceptable adjuvant.
  • the composition comprises at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, or at least 12 different polypeptides.
  • the composition comprises 3-40 different polypeptides.
  • the T cell epitope that binds at least three HLA class I molecules of the subject comprises 7 to 11 amino acids, and/or the T cell epitope that binds at least three HLA class II molecules comprises 13 to 17 amino acids.
  • the epitopes of the at least two different polypeptides are from a single antigen. In some embodiments, the epitopes of the at least two different polypeptides are from two or more different antigens.
  • the antigen is an antigen expressed by a cancer cell, a neoantigen expressed by a cancer cell, a cancer-associated antigen, a tumor-associated antigen, or an antigen expressed by a target pathogenic organism, an antigen expressed by a virus, an antigen expressed by a bacterium, an antigen expressed by a fungus, an antigen associated with an autoimmune disorder, or is an allergen.
  • the cancer cell is from the subject.
  • the antigen is selected from the antigens listed in Tables 2 to 7.
  • the at least two different polypeptides further comprise up to 10 amino acids flanking the T cell epitope that are part of a consecutive sequence flanking the epitope in a corresponding antigen. In some embodiments, the at least two different polypeptides further comprise up to 10 amino acids flanking the T cell epitope that are not part of a consecutive sequence flanking the epitope in a corresponding antigen. In some embodiments, two of the at least two polypeptides are arranged end to end or overlapping in a joined polypeptide. In some embodiments, the composition comprises two or more different joined polypeptides, wherein the two or more different joined polypeptides comprise different epitopes from each other.
  • the joined polypeptides have been screened to eliminate substantially all neoepitopes that span a junction between the two polypeptides and that (i) corresponds to a fragment of a human polypeptide expressed in healthy cells of the subject; (ii) is a T cell epitope capable of binding to at least two HLA class I molecules of the subject; or (iii) meets both requirements (i) and (ii).
  • the at least two polypeptides do not comprise any amino acid sequences that (i) correspond to a fragment of a human polypeptide expressed in healthy cells; or (ii) correspond to a fragment of a human polypeptide expressed in healthy cells and is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • the composition further comprises a pharmaceutically acceptable diluent, carrier, preservative, or combination thereof.
  • the adjuvant is selected from the group consisting of Montanide ISA-51, QS-21, GM-CSF, cyclophosamide, bacillus Calmette-Guerin (BCG), corynbacterium parvum, levamisole, azimezone, isoprinisone, dinitrochlorobenezene (DNCB), keyhole limpet hemocyanins (KLH), Freunds adjuvant (complete), Freunds adjuvant (incomplete), mineral gels, aluminum hydroxide (Alum), lysolecithin, pluronic polyols, polyanions, oil emulsions, dinitrophenol, diphtheria toxin (DT), and combinations thereof.
  • kits comprising, one or more separate containers each container comprising: (i) one or more polypeptides being 10-50 amino acids in length comprising an amino acid sequence that is a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject; and (ii) a pharmaceutically acceptable adjuvant, diluent, carrier, preservative, or combination thereof.
  • the kit comprises at least 2, at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, or at least 12 different polypeptides, wherein the amino acid sequence of the T cell epitope of each of the different polypeptides are different from each other.
  • the kit further comprises a package insert.
  • human subject-specific pharmaceutical compositions comprising: a nucleic acid molecule expressing two or more polypeptides, each polypeptide being 10-50 amino acids in length comprising a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, wherein each of the two or more polypeptides comprises a different T cell epitope, wherein the polypeptides do not comprise amino acid sequences that are adjacent to each other in a corresponding antigen.
  • the nucleic acid molecule expresses at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, or at least 12 different polypeptides, each being 10-50 amino acids in length comprising an amino acid sequence that is a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, wherein the amino acid sequence of the T cell epitope of each of the different polypeptides are different from each other.
  • compositions for treatment of a disease or disorder in a specific human subject comprising at least one different polypeptides, each of the at least one different polypeptides comprising at least a first region and a second region, (i) the first region of 10-50 amino acids in length comprising an amino acid sequence that is a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, (ii) the second region of 10-50 amino acids in length comprising an amino acid sequence that is a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least two HLA class II molecules of the subject, wherein the amino acid sequence of the T cell epitope of each of the first and second regions of each of the at least three different polypeptides comprise different sequences.
  • the composition comprises at least 2, at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, or at least 12 different polypeptides. In some embodiments, the composition comprises 2-40 different polypeptides.
  • the T cell epitope that binds at least three HLA class I molecules of the subject comprises 7 to 11 amino acids, and/or the T cell epitope that binds at least three HLA class II molecules comprises 13 to 17 amino acids.
  • the epitopes of the first and second regions are from a single antigen. In some embodiments, the epitopes of the first and second regions are from two or more different antigens.
  • the antigen is an antigen expressed by a cancer cell, a neoantigen expressed by a cancer cell, a cancer-associated antigen, a tumor-associated antigen, or an antigen expressed by a target pathogenic organism, an antigen expressed by a virus, an antigen expressed by a bacterium, an antigen expressed by a fungus, an antigen associated with an autoimmune disorder, or is an allergen.
  • the cancer cell is from the subject.
  • the antigen is selected from the antigens listed in Tables 2 to 7.
  • the polypeptides have been screened to eliminate substantially all neoepitopes that span a junction between the two regions and that (i) corresponds to a fragment of a human polypeptide expressed in healthy cells of the subject; (ii) is a T cell epitope capable of binding to at least two HLA class I molecules of the subject; or (iii) meets both requirements (i) and (ii).
  • the at least one polypeptides do not comprise any amino acid sequences that (i) correspond to a fragment of a human polypeptide expressed in healthy cells; or (ii) correspond to a fragment of a human polypeptide expressed in healthy cells and is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • the composition further comprises a pharmaceutically acceptable adjuvant, diluent, carrier, preservative, or combination thereof.
  • the adjuvant is selected from the group consisting of Montanide ISA-51, QS-21, GM-CSF, cyclophosamide, bacillus Calmette-Guerin (BCG), corynbacterium parvum, levamisole, azimezone, isoprinisone, dinitrochlorobenezene (DNCB), keyhole limpet hemocyanins (KLH), Freunds adjuvant (complete), Freunds adjuvant (incomplete), mineral gels, aluminum hydroxide (Alum), lysolecithin, pluronic polyols, polyanions, oil emulsions, dinitrophenol, diphtheria toxin (DT), and combinations thereof.
  • a human subject-specific pharmaceutical composition for use in a method of treatment of a specific human subject, the method comprising:
  • a pharmaceutical composition comprising at least one polypeptide, each of the at least one polypeptide being 10-50 amino acids in length comprising a first amino acid sequence that is a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, wherein the T cell epitope of each of the at least one polypeptide is from an antigen that is specific for the cancer.
  • the composition comprises at least 2, at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, or at least 12 different polypeptides, wherein the amino acid sequence of the T cell epitope of each of the different polypeptides are different from each other, and are from one or more antigens that are expressed by a cancer cell from the subject.
  • the composition comprises 2-40 different polypeptides.
  • the T cell epitope that binds at least three HLA class I molecules of the subject comprises 7 to 11 amino acids, and/or the T cell epitope that binds at least three HLA class II molecules comprises 13 to 17 amino acids.
  • the composition comprises at least two different polypeptides and the epitopes of the amino acid sequences of the at least two different polypeptides are from a single antigen. In some embodiments, the composition comprises at least two different polypeptides and the epitopes of the at least two different polypeptides are from two or more different antigens.
  • the one or more antigen is a neoantigen expressed by a cancer cell, a cancer-associated antigen, or a tumor-associated antigen. In some embodiments, the one or more antigen is selected from the antigens listed in Table 2.
  • the at least one different polypeptides further comprise up to 10 amino acids flanking the T cell epitope that are part of a consecutive sequence flanking the epitope in a corresponding antigen. In some embodiments, the at least one different polypeptides further comprise up to 10 amino acids flanking the T cell epitope that are not part of a consecutive sequence flanking the epitope in a corresponding antigen. In some embodiments, the composition comprises at least two different polypeptides and two of the polypeptides are arranged end to end or overlapping in a joined polypeptide. In some embodiments, the composition comprises two or more different joined polypeptides, wherein the two or more different joined polypeptides comprise different epitopes from each other.
  • the joined polypeptides have been screened to eliminate substantially all neoepitopes that span a junction between the two polypeptides and that (i) corresponds to a fragment of a human polypeptide expressed in healthy cells of the subject; (ii) is a T cell epitope capable of binding to at least two HLA class I molecules of the subject; or (iii) meets both requirements (i) and (ii).
  • the at least one polypeptide does not comprise any amino acid sequences that (i) correspond to a fragment of a human polypeptide expressed in healthy cells; or (ii) correspond to a fragment of a human polypeptide expressed in healthy cells and is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • the composition further comprises a pharmaceutically acceptable adjuvant, diluent, carrier, preservative, or combination thereof.
  • the adjuvant is selected from the group consisting of Montanide ISA-51, QS-21, GM-CSF, cyclophosamide, bacillus Calmette-Guerin (BCG), corynbacterium parvum, levamisole, azimezone, isoprinisone, dinitrochlorobenezene (DNCB), keyhole limpet hemocyanins (KLH), Freunds adjuvant (complete), Freunds adjuvant (incomplete), mineral gels, aluminum hydroxide (Alum), lysolecithin, pluronic polyols, polyanions, oil emulsions, dinitrophenol, diphtheria toxin (DT), and combinations thereof.
  • the method further comprises administering a chemotherapeutic agent, a targeted therapy, radiation therapy, a checkpoint inhibitor, another immunotherapy, or combination thereof.
  • human subject-specific pharmaceutical compositions for treatment of a disease or disorder in a specific human subject comprising (a) a polypeptide of 10-50 amino acids in length and comprising a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject; and (b) a pharmaceutically-acceptable adjuvant.
  • the composition comprises at least 2, at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, or at least 12 different polypeptides, each of the different polypeptides being 10-50 amino acids in length comprising a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, wherein the amino acid sequence of the T cell epitope of each of the different polypeptides are different from each other.
  • the composition comprises 2-40 different polypeptides.
  • the T cell epitope that binds at least three HLA class I molecules of the subject comprises 7 to 11 amino acids, and/or the T cell epitope that binds at least three HLA class II molecules comprises 13 to 17 amino acids.
  • the composition comprises at least two different polypeptides, wherein the epitopes of the at least two different polypeptides are from a single antigen. In some embodiments, the composition comprises at least two different polypeptides, wherein the epitopes of the at least two different polypeptides are from two or more different antigens.
  • the antigen is an antigen expressed by a cancer cell, a neoantigen expressed by a cancer cell, a cancer-associated antigen, a tumor-associated antigen, or an antigen expressed by a target pathogenic organism, an antigen expressed by a virus, an antigen expressed by a bacterium, an antigen expressed by a fungus, an antigen associated with an autoimmune disorder, or is an allergen.
  • the cancer cell is from the subject.
  • the antigen is selected from the antigens listed in Tables 2 to 7.
  • the composition comprises at least two different polypeptides, wherein two of the polypeptides are arranged end to end or overlapping in a joined polypeptide.
  • the adjuvant is selected from the group consisting of Montanide ISA-51, QS-21, GM-CSF, cyclophosamide, bacillus Calmette-Guerin (BCG), corynbacterium parvum, levamisole, azimezone, isoprinisone, dinitrochlorobenezene (DNCB), keyhole limpet hemocyanins (KLH), Freunds adjuvant (complete), Freunds adjuvant (incomplete), mineral gels, aluminum hydroxide (Alum), lysolecithin, pluronic polyols, polyanions, oil emulsions, dinitrophenol, diphtheria toxin (DT), and combinations thereof.
  • the composition comprises at least two different polypeptides, wherein two of the at least two polypeptides are arranged end to end or overlapping in a joined polypeptide. In some embodiments, the composition comprises two or more different joined polypeptides, wherein the two or more different joined polypeptides comprise different epitopes from each other.
  • the joined polypeptides have been screened to eliminate substantially all neoepitopes that span a junction between the two polypeptides and that (i) corresponds to a fragment of a human polypeptide expressed in healthy cells of the subject; (ii) is a T cell epitope capable of binding to at least two HLA class I molecules of the subject; or (iii) meets both requirements (i) and (ii).
  • the at least two polypeptides do not comprise any amino acid sequences that (i) correspond to a fragment of a human polypeptide expressed in healthy cells; or (ii) correspond to a fragment of a human polypeptide expressed in healthy cells and is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • kits comprising: a first human subject-specific pharmaceutical composition comprising (i) a first polypeptide of 10-50 amino acids in length and comprising a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject; and (ii) a pharmaceutically-acceptable adjuvant; and a second human subject-specific pharmaceutical composition comprising (i) a second polypeptide of 10-50 amino acids in length and comprising a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject; and (ii) a pharmaceutically-acceptable adjuvant, wherein the first and second polypeptides comprise different T cell epitopes.
  • the first composition and/or the second composition comprise one or more additional polypeptides, wherein each additional polypeptide being of 10-50 amino acids in length comprising an amino acid sequence that is a T cell epitope that binds at least three HLA class I molecules of the subject and/or at least three HLA class II molecules of the subject, wherein the amino acid sequences comprise different T cell epitopes.
  • FIG. 1 ROC curve of HLA restricted PEPI biomarkers.
  • FIG. 2 ROC curve of ⁇ 1 PEPI3+ Test for the determination of the diagnostic accuracy.
  • FIGS. 3A-B Distribution of HLA class I PEPI3+ compared to CD8+ T cell responses measured by a state of art assay among peptide pools used in the CD8+ T cell response assays.
  • FIG. 3A HLA class I restricted PEPI3+s. The 90% Overall Percent of Agreement (OPA) among the T cell responses and PEPI3+ peptides demonstrate the utility of the disclosed peptides for prediction of vaccine induced T cell response set of individuals.
  • FIG. 3B Class I HLA restricted epitopes (PEPI1+). The OPA between predicted epitopes and CD8+ T cell responses was 28% (not statistically significant).
  • FIGS. 4A-B Distribution of HLA class II PEPIs compared to CD4+ T cell responses measured by a state of art assay among peptide pools used in the assays.
  • FIG. 4B The class II HLA restricted epitopes. OPA between class II HLA restricted epitopes and CD4+ T cell responses was 66% (not statistically significant).
  • FIGS. 5A-D Multiple HLA binding peptides that define the HPV-16 LPV vaccine specific T cell response set of 18 VIN-3 and 5 cervical cancer patients.
  • HLA class I restricted PEPI3 counts FIGS. 5A and 5B
  • HLA class II restricted PEPI3 counts FIGS. 5C and 5D
  • Light grey immune responders measured after vaccination in the clinical trial
  • Dark grey Immune non-responders measured after vaccination in the clinical trial.
  • Results show that ⁇ 3 HLA class I binding peptides predict the CD8+ T cell reactivity and ⁇ 4 HLA class II binding peptides predict the CD4+ T cell reactivity.
  • FIG. 6 The multiple HLA class I binding peptides that define the HPV vaccine specific T cell response set of 2 patients.
  • Panel A Four HPV antigens in the HPV vaccine. Boxes represent the length of the amino acid sequences from the N terminus to the C terminus.
  • Panel B Process to identify the multiple HLA binding peptides of two patients: HLA sequences of the patients labelled as 4-digit HLA genotype right from the patient's ID. The location of the 1 st amino acid of the 54 and 91 epitopes that can bind to the patient 12-11 and patient 14-5 HLAs (PEPI1+) respectively are depicted with lines.
  • PEPI2 represents the peptides selected from PEPI1+s that can bind to multiple HLAs of a patient (PEPI2+).
  • PEPI3 represent peptides that can bind to ⁇ 3 HLAs of a patient (PEPI3+).
  • PEPI4 represent peptides that can bind to ⁇ 4 HLAs of a patient (PEPI4+).
  • PEPI5 represent peptides that can bind to ⁇ 5 HLAs of a patient (PEPI5+).
  • PEPI6 represent peptides that can bind to ⁇ 6 HLAs of a patient (PEPI6).
  • Panel C The DNA vaccine specific PEPI3+ set of two patients characterizes their vaccine specific T cell responses.
  • FIG. 7 Correlation between the ⁇ 1 PEPI3+ Score and CTL response rates of peptide targets determined in clinical trials.
  • FIG. 7 discloses SEQ ID NOS 1-4, 6, 5 and 7-13, respectively, in order of appearance.
  • FIG. 8 Correlation between the ⁇ 1 PEPI3+ Score and the clinical Immune Response Rate (IRR) of immunotherapy vaccines. Dashed lines: 95% confidence band.
  • FIG. 9 Correlation between the ⁇ 2 PEPI3+ Score and Disease Control Rate (DCR) of immunotherapy vaccines. Dashed lines: 95% confidence band.
  • FIGS. 10A-D The IPI-responder HLA Test. Overall Survival (OS) of melanoma patients treated with Ipilimumab. Data of 4 independent clinical trials: HLA responders (black line) and HLA non responders (gray line). Statistical analysis: Cox Proportional Hazards Survival Regression.
  • FIG. 10A Trial 1: 18 HLA responders and 30 HLA non responders;
  • FIG. 10B Trial 2: 24 HLA responders and 20 HLA non responders;
  • FIG. 10C Trial 3: 6 HLA responders and 11 HLA non responders;
  • FIG. 10D Trial 4: 13 HLA responders and 38 HLA non responders
  • FIGS. 11A-B Multiple HLA binding peptides in mutational neoantigens.
  • FIG. 11A Correlation of mutational load, neoantigen load (neoantigens are neoepitopes according to van Allen) and
  • FIG. 11B Correlation of PEPI3+ load and clinical benefit (min-Q1-median-Q3-max).
  • FIG. 12 HLA map of the Rindopepimut on the HLA alleles of the subjects in the Model Population.
  • FIG. 12 discloses SEQ ID NO: 87.
  • FIGS. 13A-B Provides of vaccine antigen expression in the XYZ patient's tumor cells.
  • FIG. 14 MRI findings of patient XYZ treated with personalised (PIT) vaccine. This late stage, heavily pretreated ovarian cancer patient had an unexpected objective response after the PIT vaccine treatment. These MRI findings suggest that PIT vaccine in combination with chemotherapy significantly reduced her tumor burden. The patient now continues the PIT vaccine treatment.
  • FIG. 16 Schot al. 16 —Schematic showing exemplary positions of amino acids in overlapping HLA class I- and HLA class-II binding epitopes in a 30-mer peptide.
  • SEQ ID Nos: 1 to 13 set forth the additional peptide sequences described in Table 17.
  • SEQ ID NOs: 14-26 set forth personalised vaccine peptides designed for patient XYZ described in Table 26.
  • SEQ ID NOs: 27-38 set forth personalised vaccine peptides designed for patient ABC described in Table 29.
  • SEQ ID NOs: 39-86 set forth further 9 mer T cell epitopes described in Table 33.
  • HLAs are encoded by the most polymorphic genes of the human genome. Each person has a maternal and a paternal allele for the three HLA class I molecules (HLA-A*, HLA-B*, HLA-C*) and four HLA class II molecules (HLA-DP*, HLA-DQ*, HLA-DRB1*, HLA-DRB3*/4*/5*). Practically, each person expresses a different combination of 6 HLA class I and 8 HLA class II molecules that present different epitopes from the same protein antigen. The function of HLA molecules is to regulate T cell responses. However up to date it was unknown how the HLAs of a person regulate T cell activation.
  • HLA-A*02:25 The nomenclature used to designate the amino acid sequence of the HLA molecule is as follows: gene name*allele:protein number, which, for instance, can look like: HLA-A*02:25.
  • “02” refers to the allele.
  • alleles are defined by serotypes—meaning that the proteins of a given allele will not react with each other in serological assays.
  • Protein numbers (“25” in the example above) are assigned consecutively as the protein is discovered. A new protein number is assigned for any protein with a different amino acid sequence (e.g. even a one amino acid change in sequence is considered a different protein number). Further information on the nucleic acid sequence of a given locus may be appended to the HLA nomenclature, but such information is not required for the methods described herein.
  • the HLA class I genotype or HLA class II genotype of an individual may refer to the actual amino acid sequence of each class I or class II HLA of an individual, or may refer to the nomenclature, as described above, that designates, minimally, the allele and protein number of each HLA gene.
  • the HLA genotype of an individual is obtained or determined by assaying a biological sample from the individual.
  • the biological sample typically contains subject DNA.
  • the biological sample may be, for example, a blood, serum, plasma, saliva, urine, expiration, cell or tissue sample.
  • the biological sample is a saliva sample.
  • the biological sample is a buccal swab sample.
  • An HLA genotype may be obtained or determined using any suitable method.
  • the sequence may be determined via sequencing the HLA gene loci using methods and protocols known in the art.
  • the HLA genotype is determined using sequence specific primer (SSP) technologies.
  • the HLA genotype is determined using sequence specific oligonucleotide (SSO) technologies.
  • the HLA genotype is determined using sequence based typing (SBT) technologies.
  • the HLA genotype is determined using next generation sequencing.
  • the HLA set of an individual may be stored in a database and accessed using methods known in the art.
  • a given HLA of a subject will only present to T cells a limited number of different peptides produced by the processing of protein antigens in an APC.
  • display or “present”, when used in relation to HLA, references the binding between a peptide (epitope) and an HLA.
  • to “display” or “present” a peptide is synonymous with “binding” a peptide.
  • epitope refers to a sequence of contiguous amino acids contained within a protein antigen that possess a binding affinity for (is capable of binding to) one or more HLAs.
  • An epitope is HLA- and antigen-specific (HLA-epitope pairs, predicted with known methods), but not subject specific.
  • An epitope, a T cell epitope, a polypeptide, a fragment of a polypeptide or a composition comprising a polypeptide or a fragment thereof is “immunogenic” for a specific human subject if it is capable of inducing a T cell response (a cytotoxic T cell response or a helper T cell response) in that subject.
  • the helper T cell response is a Th1-type helper T cell response.
  • an epitope, a T cell epitope, a polypeptide, a fragment of a polypeptide or a composition comprising a polypeptide or a fragment thereof is “immunogenic” for a specific human subject if it is more likely to induce a T cell response or immune response in the subject than a different T cell epitope (or in some cases two different T cell epitopes each) capable of binding to just one HLA molecule of the subject.
  • T cell response and “immune response” are used herein interchangeably, and refer to the activation of T cells and/or the induction of one or more effector functions following recognition of one or more HLA-epitope binding pairs.
  • an “immune response” includes an antibody response, because HLA class II molecules stimulate helper responses that are involved in inducing both long lasting CTL responses and antibody responses. Effector functions include cytotoxicity, cytokine production and proliferation.
  • an epitope, a T cell epitope, or a fragment of a polypeptide is immunogenic for a specific subject if it is capable of binding to at least two, or in some cases at least three, class I or at least two, or in some cases at least three or at least four class II HLAs of the subject.
  • PEPI personal epitope
  • a “PEPI” is a fragment of a polypeptide consisting of a sequence of contiguous amino acids of the polypeptide that is a T cell epitope capable of binding to one or more HLA class I molecules of a specific human subject.
  • a “PEPI” is a fragment of a polypeptide consisting of a sequence of contiguous amino acids of the polypeptide that is a T cell epitope capable of binding to one or more HLA class II molecules of a specific human subject.
  • PEPI is a T cell epitope that is recognised by the HLA set of a specific individual.
  • PEPIs are specific to an individual because different individuals have different HLA molecules which each bind to different T cell epitopes.
  • PEPI1 refers to a peptide, or a fragment of a polypeptide, that can bind to one HLA class I molecule (or, in specific contexts, HLA class II molecule) of an individual.
  • PEPI1+ refers to a peptide, or a fragment of a polypeptide, that can bind to one or more HLA class I molecule of an individual.
  • PEPI2 refers to a peptide, or a fragment of a polypeptide, that can bind to two HLA class I (or II) molecules of an individual.
  • PEPI2+ refers to a peptide, or a fragment of a polypeptide, that can bind to two or more HLA class I (or II) molecules of an individual, i.e. a fragment identified according to a method disclosed herein.
  • PEPI3 refers to a peptide, or a fragment of a polypeptide, that can bind to three HLA class I (or II) molecules of an individual.
  • PEPI3+ refers to a peptide, or a fragment of a polypeptide, that can bind to three or more HLA class I (or II) molecules of an individual.
  • PEPI4 refers to a peptide, or a fragment of a polypeptide, that can bind to four HLA class I (or II) molecules of an individual.
  • PEPI4+ refers to a peptide, or a fragment of a polypeptide, that can bind to four or more HLA class I (or II) molecules of an individual.
  • PEPI5 refers to a peptide, or a fragment of a polypeptide, that can bind to five HLA class I (or II) molecules of an individual.
  • PEPI5+ refers to a peptide, or a fragment of a polypeptide, that can bind to five or more HLA class I (or II) molecules of an individual.
  • PEPI6 refers to a peptide, or a fragment of a polypeptide, that can bind to all six HLA class I (or six HLA class II) molecules of an individual.
  • epitopes presented by HLA class I molecules are about nine amino acids long and epitopes presented by HLA class II molecules are about fifteen amino acids long.
  • an epitope may be more or less than nine (for HLA Class I) or more or less than fifteen (for HLA Class II) amino acids long, as long as the epitope is capable of binding HLA.
  • an epitope that is capable of binding to class I HLA may be between 7, or 8 or 9 and 9 or 10 or 11 amino acids long.
  • An epitope that is capable of binding to a class II HLA may be between 13, or 14 or 15 and 15 or 16 or 17 amino acids long.
  • the disclosure herein includes, for example, a method of predicting whether a polypeptide is immunogenic for a specific human subject or identifying a fragment of a polypeptide as immunogenic for a specific human subject, the method comprising the steps of
  • a T cell epitope is capable of binding to a given HLA if it has an IC50 or predicted IC50 of less than 5000 nM, less than 2000 nM, less than 1000 nM, or less than 500 nM.
  • T cell epitope presentation by multiple HLAs of an individual is generally needed to trigger a T cell response.
  • the methods of the invention comprise determining whether a polypeptide has a sequence that is a T cell epitope capable of binding to at least two HLA class I molecules or at least two HLA class II (PEPI2+) molecules of a specific human subject.
  • the best predictor of a cytotoxic T cell response to a given polypeptide is the presence of at least one T cell epitope that is presented by three or more HLA class I molecules of an individual ( ⁇ 1 PEPI3+). Accordingly, in some cases the method comprises determining whether a polypeptide has a sequence that is a T cell epitope capable of binding to at least three HLA class I molecules of a specific human subject. In some cases the method comprises determining whether a polypeptide has a sequence that is a T cell epitope capable of binding to just three HLA class I of a specific human subject.
  • a helper T cell response may be predicted by the presence of at least one T cell epitope that is presented by three or more ( ⁇ 1 PEPI3+) or 4 or more ( ⁇ 1 PEPI4+) HLA class II of an individual. Therefore in some cases, the method comprises determining whether a polypeptide has a sequence that is a T cell epitope capable of binding to at least three HLA class II of a specific human subject. In other cases, the method comprises determining whether a polypeptide has a sequence that is a T cell epitope capable of binding to at least four HLA class II of a specific human subject. In other cases, the method comprises determining whether a polypeptide has a sequence that is a T cell epitope capable of binding to at just three and/or just four HLA class II of a specific human subject.
  • the disclosure may be used to predict whether a polypeptide/fragment will induce both a cytotoxic T cell response and a helper T cell response in a specific human subject.
  • the polypeptide/fragment comprises both an amino acid sequence that is a T cell epitope capable of binding to multiple HLA class I molecules of the subject and an amino acid sequence that is a T cell epitope capable of binding to multiple HLA class II molecules of the subject.
  • the HLA class I-binding and HLA class II-binding epitopes may fully or partially overlap.
  • such fragments of a polypeptide may be identified by selecting an amino acid sequence that is a T cell epitope capable of binding to at multiple (e.g. at least two or at least three) HLA class I molecules of the subject, and then screening one or more longer fragments of the polypeptide that are extended at the N- and/or C-terminus for binding to one or more HLA class II molecules of the subject.
  • Some subjects may have two HLA alleles that encode the same HLA molecule (for example, two copies for HLA-A*02:25 in case of homozygosity).
  • the HLA molecules encoded by these alleles bind all of the same T cell epitopes.
  • binding to at least two HLA molecules of the subject includes binding to the HLA molecules encoded by two identical HLA alleles in a single subject. In other words, “binding to at least two HLA molecules of the subject” and the like could otherwise be expressed as “binding to the HLA molecules encoded by at least two HLA alleles of the subject”.
  • polypeptide refers to a full-length protein, a portion of a protein, or a peptide characterized as a string of amino acids.
  • peptide refers to a short polypeptide comprising between 2, or 3, or 4, or 5, or 6, or 7, or 8, or 9, or 10, or 11, or 12, or 13, or 14, or 15 and 10, or 11, or 12, or 13, or 14, or 15, or 20, or 25, or 30, or 35, or 40, or 45, or 50 amino acids.
  • fragment or “fragment of a polypeptide” as used herein refer to a string of amino acids or an amino acid sequence typically of reduced length relative to the or a reference polypeptide and comprising, over the common portion, an amino acid sequence identical to the reference polypeptide.
  • a fragment according to the disclosure may be, where appropriate, included in a larger polypeptide of which it is a constituent.
  • the fragment may comprise the full length of the polypeptide, for example where the whole polypeptide, such as a 9 amino acid peptide, is a single T cell epitope.
  • the polypeptide is, or the polypeptide consists of all or part of an antigen that is, expressed by a pathogenic organism (for example, a bacteria or a parasite), a virus, or a cancer cell, that is associated with an autoimmune disorder or response or a disease-associated cell, or that is an allergen, or an ingredient of a medicine or pharmaceutical composition such as a vaccine or immunotherapy composition.
  • a pathogenic organism for example, a bacteria or a parasite
  • virus for example, a virus, or a cancer cell, that is associated with an autoimmune disorder or response or a disease-associated cell, or that is an allergen, or an ingredient of a medicine or pharmaceutical composition such as a vaccine or immunotherapy composition.
  • the method of the disclosure comprises an initial step of identifying or selecting a suitable polypeptide, for example a polypeptide as further described below.
  • the polypeptide or antigen may be expressed in the cells or specifically in diseased cells of the subject (e.g. a tumor-associated antigen, a polypeptide expressed by a virus, intracellular bacteria or parasite, or the in vivo product of a vaccine or immunotherapy composition) or acquired from the environment (e.g. a food, an allergen or a drug).
  • the polypeptide or antigen may be present in a sample taken from the specific human subject. Both polypeptide antigens and HLAs can be exactly defined by amino acid or nucleotide sequences and sequenced using methods known in the art.
  • the polypeptide or antigen may be a cancer- or tumor-associated antigen (TAA).
  • TAAs are proteins expressed in cancer or tumor cells.
  • the cancer or tumour cell may be present in a sample obtained from the subject.
  • TAAs include new antigens (neoantigens) expressed during tumorigenesis, products of oncogenes and tumor suppressor genes, overexpressed or aberrantly expressed cellular proteins (e.g. HER2, MUC1), antigens produced by oncogenic viruses (e.g. EBV, HPV, HCV, HBV, HTLV), cancer testis antigens (CTA)(e.g. MAGE family, NY-ESO) and cell-type-specific differentiation antigens (e.g. MART-1).
  • TAA sequences may be found experimentally, or in published scientific papers, or through publicly available databases, such as the database of the Ludwig Institute for Cancer Research (www.cta.lncc.br/), Cancer Immunity database (cancerimmunity.org/peptide/) and the TANTIGEN Tumor T cell antigen database (cvc.dfci.harvard.edu/tadb/).
  • the polypeptide or antigen is not expressed or is minimally expressed in normal healthy cells or tissues, but is expressed (in those cells or tissues) in a high proportion of (with a high frequency in) subjects having a particular disease or condition, such as a type of cancer or a cancer derived from a particular cell type or tissue, for example breast cancer, ovarian cancer or melanoma.
  • a particular disease or condition such as a type of cancer or a cancer derived from a particular cell type or tissue, for example breast cancer, ovarian cancer or melanoma.
  • a further example is colorectal cancer.
  • non-limiting cancer examples include non-melanoma skin, lung, prostate, kidney, bladder, stomach, liver, cervix uteri, oesophagus, non-Hodgkin lymphoma, leukemia, pancreas, corpus uteri, lip, oral cavity, thyroid, brain, nervous system, gallbladder, larynx, pharynx, myeloma, nasopharynx, Hodgkin lymphoma, testis and Kaposi sarcoma.
  • the polypeptide may be expressed at low levels in normal healthy cells, but at high levels (overexpressed) in diseased (e.g. cancer) cells or in subjects having the disease or condition.
  • the polypeptide is expressed in, or expressed at a high level relative to normal healthy cells or subjects in, at least 2%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or more of such individuals, or of a subject-matched human subpopulation.
  • the subpopulation may be matched to the subject by ethnicity, geographical location, gender, age, disease, disease type or stage, genotype, or expression of one or more biomarkers.
  • the expression frequencies can be determined from published figures and scientific publications.
  • the method of the disclosure comprises a step of identifying or selecting such a polypeptide.
  • the polypeptide is associated with or highly (over-) expressed in cancer cells, or in solid tumors.
  • cancers include carcinomas, sarcomas, lymphomas, leukemias, germ cell tumors, or blastomas.
  • the cancer may or may not be a hormone related or dependent cancer (e.g., an estrogen or androgen related cancer).
  • the tumor may be malignant or benign.
  • the cancer may or may not be metastatic.
  • the polypeptide is a cancer testis antigens (CTA).
  • CTA cancer testis antigens
  • CTA are not typically expressed beyond embryonic development in healthy cells. In healthy adults, CTA expression is limited to male germ cells that do not express HLAs and cannot present antigens to T cells. Therefore, CTAs are considered expressional neoantigens when expressed in cancer cells.
  • CTA expression is (i) specific for tumor cells, (ii) more frequent in metastases than in primary tumors and (iii) conserved among metastases of the same patient (Gajewski ed. Targeted Therapeutics in Melanoma. Springer New York. 2012).
  • the polypeptide may be a mutational neoantigen, which is expressed by a cell, for example a cancer cell, of the individual, but altered from the analogous protein in a normal or healthy cell.
  • the methods of the disclosure comprise the step of identifying a polypeptide that is a mutational neoantigen, or that is a mutational neoantigen in the specific human subject, or of identifying a neoepitope.
  • the neoantigen may be present in a sample obtained from the subject.
  • Mutational neoantigens or neoepitopes can be used to target disease-associated cells, such as cancer cells, that express the neoantigen or a neoantigen comprising the neoepitope. Mutations in a polypeptide expressed by a cell, for example a cell in a sample taken from a subject, can be detected by, for example, sequencing, but the majority do not induce an immune response against the neoantigen-expressing cells.
  • the identification of mutational neoantigens that do induce an immune response is based on prediction of mutational HLA restricted epitopes and further in vitro testing of the immunogenicity of predicted epitopes in individual's blood specimen. This process is inaccurate, long and expensive.
  • the polypeptide is a mutational neoantigen
  • the immunogenic fragment of the polypeptide comprises a neoantigen specific mutation (or consists of a neoepitope).
  • the polypeptide may be a viral protein that is expressed intracellularly. Examples include HPV16 E6, E7; HIV Tat, Rev, Gag, Pol, Env; HTLV-Tax, Rex, Gag, Env, Human herpes virus proteins, Dengue virus proteins.
  • the polypeptide may be a parasite protein that is expressed intracellularly, for example malaria proteins.
  • the polypeptide may be an active ingredient of a pharmaceutical composition, such as a vaccine or immunotherapy composition, optionally a candidate active ingredient for a new pharmaceutical composition.
  • active ingredient refers to a polypeptide that is intended to induce an immune response and may include a polypeptide product of a vaccine or immunotherapy composition that is produced in vivo after administration to a subject.
  • the polypeptide may be produced in vivo by the cells of a subject to whom the composition is administered.
  • the polypeptide may be processed and/or presented by cells of the composition, for example autologous dendritic cells or antigen presenting cells pulsed with the polypeptide or comprising an expression construct encoding the polypeptide.
  • the pharmaceutical composition may comprise a polynucleotide or cell encoding one or more active ingredient polypeptides.
  • the polypeptide may be a target polypeptide antigen of a pharmaceutical, vaccine or immunotherapy composition.
  • a polypeptide is a target polypeptide antigen if the composition is intended or designed to induce an immune response (e.g. a cytotoxic T cell response) that targets or is directed at the polypeptide.
  • a target polypeptide antigen is typically a polypeptide that is expressed by a pathogenic organism, a virus or a diseased cell such as a cancer cell.
  • a target polypeptide antigens may be a TAA or a CTA.
  • the polypeptide may be an allergen that enters the body of an individual through, for example, the skin, lung or oral routes.
  • Non-limiting examples of suitable polypeptides include those listed in one or more of Tables 2 to 7.
  • Genetic sequences may be obtained from the sequencing of biological materials. Sequencing can be done by any suitable method that determines DNA and/or RNA and/or amino acid sequences.
  • the disclosure utilizes both the HLA genotypes and amino acid sequences. However, methods to identify HLA genotype from genetic sequences of an individual and methods of obtaining amino acid sequences derived from DNA or RNA sequence data are not the subject of the disclosure.
  • polypeptide antigens induce immune responses in only a fraction of human subjects.
  • diagnostic test that can predict whether a polypeptide antigen would likely induce an immune response in an individual.
  • a test that can predict whether a person is an immune responder to a vaccine or immunotherapy composition.
  • the polypeptide antigen-specific T cell response of an individual is defined by the presence within the polypeptide of one or more fragments that may be presented by multiple HLA class I or multiple HLA class II molecules of the individual.
  • the disclosure provides a method of predicting whether a subject will have an immune response to administration of a polypeptide, wherein an immune response is predicted if the polypeptide is immunogenic according to any method described herein.
  • a cytotoxic T cell response is predicted if the polypeptide comprises at least one amino acid sequence that is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • a helper T cell response is predicted if the polypeptide comprises at least one amino acid sequence that is a T cell epitope capable of binding to at least two HLA class II molecules of the subject.
  • No cytotoxic T cell response is predicted if the polypeptide does not comprise any amino acid sequence that is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • No helper T cell response is predicted if the polypeptide does not comprise any amino acid sequence that is a T cell epitope capable of binding to at least two HLA class II molecules of the subject.
  • the polypeptide is an active component of a pharmaceutical composition
  • the method comprises predicting the development or production of anti-drug antibodies (ADA) to the polypeptide.
  • the pharmaceutical composition may be a drug selected from those listed in Table 8.
  • ADA development will occur if, or to the extent that, an active component polypeptide is recognised by multiple HLA class II molecules of the subject, resulting in a helper T cell response to support an antibody response to the active component.
  • the presence of such epitopes (PEPIs) may predict the development of ADA in the subject.
  • the method may further comprise selecting or recommending for treatment of the specific human subject administration to the subject of a pharmaceutical composition that is predicted to induce low or no ADA, and optionally further administering the composition to the subject.
  • the method predicts that the pharmaceutical composition will induce unacceptable ADA and the method further comprises selecting or recommending or treating the subject with a different treatment or therapy.
  • the polypeptide may be a checkpoint inhibitor.
  • the method may comprise predicting whether the subject will respond to treatment with the checkpoint inhibitor.
  • Example drugs associated with ADA-related adverse events Drug ADA-related adverse event Abciximab anaphylaxis Adalimumab anti-drug antibodies and treatment failure Basiliximab anaphylaxis Cetuximab IgE, anaphlyaxis Epoetin Antibody-mediated pure red cell aplasia Erythropoietin pure red cell aplasia Etanercept no apparent effect on safety Factor-IX anaphylaxis Infliximab anaphylaxis OKT3 anaphylaxis Pegloticase anti-dug antibody, treatment failure rIFN-beta anaphylaxis recombinant factor VIII anaphylaxis Thrombopoietin thrombocitopenia Ustekinumab anti-ustekinumab antibodies, affected treatment efficacy
  • the inventors have discovered that the presence in a vaccine or immunotherapy composition of at least two polypeptide fragments (epitopes) that can bind to at least three HLA class I of an individual ( ⁇ 2 PEPI3+) is predictive for a clinical response. In other words, if ⁇ 2 PEPI3+ can be identified within the active ingredient polypeptide(s) of a vaccine or immunotherapy composition, then an individual is a likely clinical responder.
  • a “clinical response” or “clinical benefit” as used herein may be the prevention of or a delay in the onset of a disease or condition, the amelioration of one or more symptoms, the induction or prolonging of remission, or the delay of a relapse or recurrence or deterioration, or any other improvement or stabilisation in the disease status of a subject.
  • a “clinical response” may correlate to “disease control” or an “objective response” as defined by the Response Evaluation Criteria In Solid Tumors (RECIST) guidelines.
  • the disclosure provides a method of predicting whether the subject will have a clinical response to administration of a pharmaceutical composition such as a vaccine or immunotherapy composition comprising one or more polypeptides as active ingredients.
  • the method may comprise determining whether the one or more polypeptides together comprise at least two different sequences each of which is a T cell epitope capable of binding to at least two, or in some cases at least three HLA class I molecules of the subject; and predicting that the subject will have a clinical response to administration of the pharmaceutical composition if the one or more polypeptides together comprise at least two different sequences each of which is a T cell epitope capable of binding to at least two, or in some cases at least three HLA class I molecules of the subject; or that the subject will not have a clinical response to administration of the pharmaceutical composition if the one or more polypeptides together comprise no more that one sequence that is a T cell epitope capable of binding to at least two, or in some cases at least three HLA class I molecules of the subject.
  • two T cell epitopes are “different” from each other if they have different sequences, and in some cases also if they have the same sequence that is repeated in a target polypeptide antigen. In some cases the different T cell epitopes in a target polypeptide antigen do not overlap with one another.
  • all of the fragments of one or more polypeptides or active ingredient polypeptides that are immunogenic for a specific human subject are identified using the methods described herein.
  • the identification of at least one fragment of the polypeptide(s) that is a T cell epitope capable of binding to at least two, or at least three HLA class I molecules of the subject predicts that the polypeptide(s) will elicit or is likely to elicit a cytotoxic T cell response in the subject.
  • the identification of at least one fragment of the polypeptide(s) that is a T cell epitope capable of binding to at least two, or at least three, or at least four HLA class II molecules of the subject predicts that the polypeptide(s) will elicit or is likely to elicit a helper T cell response in the subject.
  • the identification of no fragments of the polypeptide(s) that are T cell epitopes capable of binding to at least two, or at least three HLA class I molecules of the subject predicts that the polypeptide(s) will not elicit or is not likely to elicit a cytotoxic T cell response in the subject.
  • the identification of no fragments of the polypeptide(s) that are T cell epitopes capable of binding to at least two, or at least three, or at least four HLA class II molecules of the subject predicts that the polypeptide(s) will not elicit or is not likely to elicit a helper T cell response in the subject.
  • the identification of at least two fragments of one or more active ingredient polypeptides of a vaccine or immunotherapy composition, wherein each fragment is a T cell epitope capable of binding to at least two, or at least three HLA class I molecules of the subject predicts that the subject is more likely to have, or will have a clinical response to the composition.
  • the identification of less than two fragments of the one or more polypeptides that are T cell epitopes capable of binding to at least two, or at least three HLA class I molecules of the subject predicts that the subject is less likely to have, or will not have, a clinical response to the composition.
  • one reason for the increased likelihood of deriving clinical benefit from a vaccine/immunotherapy comprising at least two multiple-HLA binding PEPIs is that diseased cell populations, such as cancer or tumor cells or cells infected by viruses or pathogens such as HIV, are often heterogenous both within and between effected subjects.
  • a specific cancer patient for example, may or may not express or overexpress a particular cancer associated target polypeptide antigen of a vaccine, or their cancer may comprise heterogeneous cell populations, some of which (over-)express the antigen and some of which do not.
  • the likelihood of developing resistance is decreased when more multiple HLA-binding PEPIs are included or targeted by a vaccine/immunotherapy because a patient is less likely to develop resistance to the composition through mutation of the target PEPI(s).
  • the likelihood that a subject will respond to treatment is therefore increased by (i) the presence of more multiple HLA-binding PEPIs in the active ingredient polypeptides; (ii) the presence of PEPIs in more target polypeptide antigens; and (iii) (over-)expression of the target polypeptide antigens in the subject or in diseased cells of the subject.
  • expression of the target polypeptide antigens in the subject may be known, for example if target polypeptide antigens are in a sample obtained from the subject.
  • the probability that a specific subject, or diseased cells of a specific subject, (over-)express a specific or any combination of target polypeptide antigens may be determined using population expression frequency data.
  • the population expression frequency data may relate to a subject- and/or disease-matched population or the intent-to-treat population.
  • the frequency or probability of expression of a particular cancer-associated antigen in a particular cancer or subject having a particular cancer, for example breast cancer can be determined by detecting the antigen in tumor, e.g. breast cancer tumor samples.
  • such expression frequencies may be determined from published figures and scientific publications.
  • a method of the invention comprises a step of determining the expression frequency of a relevant target polypeptide antigen in a relevant population.
  • biomarkers Disclosed is a range of pharmacodynamic biomarkers to predict the activity/effect of vaccines in individual human subjects as well as in populations of human subjects.
  • the biomarkers have been developed specifically for cancer vaccines, but similar biomarkers could be used for other vaccines or immunotherapy compositions. These biomarkers expedite more effective vaccine development and also decrease the development cost and may be used to assess and compare different compositions.
  • Exemplary biomarkers are as follows.
  • the results of a prediction as set out above may be used to inform a physician's decisions concerning treatment of the subject.
  • the polypeptide is an active ingredient, for example of a vaccine or immunotherapy composition
  • the method of the disclosure predicts that the subject will have, is likely to have, or has above a threshold minimum likelihood of having an immune response and/or a clinical response to a treatment comprising administering the active ingredient polypeptide to the subject, and the method further comprises selecting the treatment for or selecting the vaccine or immunotherapy composition for treatment of the specific human subject.
  • kits or panel of polypeptides comprising one or more polypeptides as active ingredients, wherein the pharmaceutical composition, kit or panel of polypeptides has been determined to have a threshold minimum likelihood of inducing a clinical response in the subject, wherein the likelihood of response has been determined using a method described herein.
  • a minimum PEPI3+ count for example 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 or more PEPI3+
  • a subject is selected for treatment if their likelihood of a response targeted at a predefined number of target polypeptide antigens, optionally wherein the target polypeptide antigens are (predicted to be) expressed, is above a predetermined threshold (e.g. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 or more).
  • a predetermined threshold e.g. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 or more.
  • the method may predict that the one or more polypeptide(s) of the composition will not elicit a T cell response and/or a clinical response in the subject and further comprise selecting a different treatment for the specific human subject.
  • the differences among HLAs may influence the probability of developing an autoimmune disease, condition or response.
  • the method of the disclosure may be used to identify a polypeptide or a fragment of a polypeptide that is immunogenic and/or associated with an auto-immune disorder or response.
  • the method comprises determining whether a polypeptide comprises an amino acid sequence that is a T cell epitope capable of binding to at least three, or at least four, or at least five HLA class I of a subject; or in other cases a sequence that is a T cell epitope capable of binding to at least four, or at least five, or at least six HLA class II of a subject; and identifying the polypeptide or said sequence as immunogenic or as being related to or associated with an auto-immune disorder or an auto-immune response in the subject.
  • the differences among HLAs may also influence the probability that a subject will experience immune-toxicity from a drug or polypeptide administered to the subject.
  • There may be a toxic immune response if a polypeptide administered to the subject comprises a fragment that corresponds to a fragment of an antigen expressed in normal healthy cells of the subject and that comprises an amino acid that is a T cell epitope capable of binding to multiple HLA class I molecules of the subject. Therefore, in some cases in accordance with the disclosure, the method is used to identify a toxic immunogenic region or fragment of a polypeptide or to identify subjects who are likely to experience immune-toxicity in response to administration of one or more polypeptides or a fragments thereof.
  • the polypeptide may be an active ingredient of a vaccine or immunotherapy composition.
  • the method may comprise determining whether the polypeptide(s) comprises a sequence that is a T cell epitope capable of binding to at least two, or in other cases to at least three HLA class I molecules of the subject. In some cases the method comprises determining that the polypeptide comprises a sequence that is a T cell epitope capable of binding to at least four, or at least five HLA class I molecules of the subject; or an amino acid sequence that is a T cell epitope capable of binding to at least four, or at least five, or at least six or at least seven HLA class II of the subject. The method may further comprise identifying said sequence as toxic immunogenic for the subject or predicting a toxic immune response in the subject.
  • the method further comprises predicting no toxic immune response in the subject.
  • the method may further comprise selecting or recommending for treatment of the subject administration of one or more polypeptides or a pharmaceutical composition that is predicted to induce no or low immune-toxicity, and optionally further treating the subject by administering the polypeptide.
  • the disclosure also provides a method of treating a subject in need thereof by administrating to the subject such a polypeptide or composition.
  • a method described herein further comprises mutating a polypeptide that is predicted to be immunogenic for a specific human subject, or that is predicted to be immunogenic in a proportion of subjects in a human population. Also provided is a method of reducing the immunogenicity of a polypeptide that has been identified as immunogenic in a specific human subject or in a proportion of a human population using any one of the methods described herein.
  • the polypeptide may be mutated to reduce the number of PEPIs in the polypeptide or to reduce the number of HLA class I or class II molecules of the subject or of said population that bind to the fragment of the polypeptide that is identified as immunogenic in the subject or in a proportion of said population.
  • the mutation may reduce or prevent a toxic immune response or may increase the efficacy by preventing the ADA development in the subject or in a proportion of said population.
  • the mutated polypeptide may be further selected or recommended for treatment of the subject or of a subject of said population.
  • the subject may further be treated by administration of the mutated polypeptide.
  • the disclosure also provides a method of treating a subject in need thereof by administrating to the subject such a mutated polypeptide.
  • the tumor specific T cell clones that are induced by a tumor are inactive or poorly functional in metastatic cancer patients.
  • Inactive tumor specific T cells cannot kill the tumor cells.
  • a fraction of these inactive T cells may be re-activated by checkpoint inhibitors (such as Ipilimumab), for example monoclonal antibodies that recognize checkpoint molecules (e.g. CTLA-4, PD-1, Lag-3, Tim-3, TIGIT, BTLA).
  • checkpoint inhibitors such as Ipilimumab
  • monoclonal antibodies that recognize checkpoint molecules e.g. CTLA-4, PD-1, Lag-3, Tim-3, TIGIT, BTLA.
  • the methods of the disclosure may be used to identify one or more or the subset of T cell clones that may be reactivated by a checkpoint inhibitor or to predict likely responders to checkpoint inhibitor (immuno)therapies.
  • the disclosure provides a method of predicting whether a subject will respond to of cancer with a checkpoint inhibitor.
  • the method comprises the step of identifying or selecting one or more polypeptides or polypeptide fragments that are associated with the disease or condition that is to be treated or that is associated with achieving an immune or clinical response to treatment with a checkpoint inhibitor.
  • the polypeptide is a tumor-associated and/or mutational antigen.
  • the polypeptide may be present in a sample obtained from the subject.
  • the polypeptide may be one that is frequently (over-) expressed in a subject- and/or disease-matched population.
  • the polypeptide may consist of or comprise a PEPI (or PEPI3+) identified in a subject that is known to have positively responded to a, or the, checkpoint inhibitor.
  • the polypeptide may comprise or consist of an amino acid sequence that is stored or recorded in or retrieved from a database.
  • the method comprises determining whether the polypeptide(s) comprise a sequence that is a T cell epitope capable of binding to multiple HLA class I molecules of the subject. In some cases the presence of at least two, or at least three, or four or five or six or seven or eight different such amino acid sequences is determined, and/or the presence of such an amino acid sequence in at least two, or at least three, or four or five different target polypeptide antigens. In some cases the method comprises determining whether the polypeptide(s) comprise a sequence that is a T cell epitope capable of binding to at least two, or in some cases at least three or at least four HLA class II molecules of the subject. A response to treatment with the or a checkpoint inhibitor may be predicted if the above requirement(s) is met. No response or no clinical response may be predicted if the above requirement(s) is not met.
  • the disclosure also provides a method of identifying a fragment of a polypeptide or a T cell epitope in a polypeptide that may be targeted by the subject's immune response following treatment with a checkpoint inhibitor, or that will be targeted by T cells that are re-activated by treatment with a checkpoint inhibitor.
  • the method may further comprise selecting, recommending and/or administering a checkpoint inhibitor to a subject who is predicted to respond, or selecting, recommending and/or administering a different treatment to a subject that is predicted not to respond to a checkpoint inhibitor.
  • the disclosure provides a method of treatment of a human subject in need thereof, the method comprising administering to the subject a checkpoint inhibitor, wherein the subject has been predicted to respond to administration of a checkpoint inhibitor by the method described herein.
  • Checkpoint inhibitors include, but are not limited to, PD-1 inhibitors, PD-L1 inhibitors, Lag-3 inhibitors, Tim-3 inhibitors, TIGIT inhibitors, BTLA inhibitors and CTLA-4 inhibitors, for example.
  • Co-stimulatory antibodies deliver positive signals through immune-regulatory receptors including but not limited to ICOS, CD137, CD27 OX-40 and GITR.
  • the checkpoint inhibitor is a CTLA-4 inhibitor.
  • the disclosure provides a method of designing or preparing a polypeptide, or a polynucleic acid that encodes a polypeptide, for inducing an immune response, a cytotoxic T cell response or a helper T cell response in a specific human subject.
  • the disclosure also provides a human subject-specific drug, immunogenic composition, or pharmaceutical composition, kit or panel of peptides, methods of designing or preparing the same, compositions that may be obtained by those methods, and their use in a method of inducing an immune response, a cytotoxic T cell response, or a helper T cell response in the subject, or a method of treating, vaccinating or providing immunotherapy to the subject.
  • the pharmaceutical composition, kit or panel of peptides has as active ingredients one or more polypeptides that together comprising two or more T cell epitopes (PEPIs) capable of binding to multiple HLA class I or multiple HLA class II molecules of the subject that are immunogenic for the subject as described herein or that have been identified as immunogenic for the subject by a method described herein.
  • PEPIs T cell epitopes
  • composition/kit may optionally further comprise at least one pharmaceutically acceptable diluent, carrier, or preservative and/or additional polypeptides that do not comprise any PEPIs.
  • the polypeptides may be engineered or non-naturally occurring.
  • the kit may comprise one or more separate containers each containing one or more of the active ingredient peptides.
  • the composition/kit may be a personalised medicine to prevent, diagnose, alleviate, treat, or cure a disease of an individual, such as a cancer.
  • each PEPI is a fragment of a target polypeptide antigen and polypeptides that comprise one or more of the PEPIs are the target polypeptide antigens for the treatment, vaccination or immunotherapy.
  • the method may comprise the step of identifying one or more suitable target polypeptide antigens.
  • each target polypeptide antigen will be associated with the same disease or condition, pathogenic organism or group of pathogenic organisms or virus, or type of cancer.
  • composition, kit or panel may comprise, or the method may comprise selecting, for each PEPI a sequence of up to 50, 45, 40, 35, 30, 25, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10 or 9 consecutive amino acids of the target polypeptide antigen, such as a polypeptide described herein, which consecutive amino acids comprise the amino acid sequence of the PEPI.
  • amino acid sequence is flanked at the N and/or C terminus by additional amino acids that are not part of the consecutive sequence of the target polypeptide antigen. In some cases the sequence is flanked by up to 41 or 35 or 30 or 25 or 20 or 15 or 10, or 9 or 8 or 7 or 6 or 5 or 4 or 3 or 2 or 1 additional amino acid at the N and/or C terminus or between target polypeptide fragments.
  • each polypeptide either consists of a fragment of a target polypeptide antigen, or consists of two or more such fragments arranged end to end (arranged sequentially in the peptide end to end) or overlapping in a single peptide (where two or more of the fragments comprise partially overlapping sequences, for example where two PEPIs in the same polypeptide are within 50 amino acids of each other).
  • neoepitopes When fragments of different polypeptides or from different regions of the same polypeptide are joined together in an engineered peptide there is the potential for neoepitopes to be generated around the join or junction.
  • Such neoepitopes encompass at least one amino acid from each fragment on either side of the join or junction, and may be referred to herein as junctional amino acid sequences.
  • the neoepitopes may induce undesired T cell responses against healthy cells (autoimmunity).
  • the peptides may be designed, or the peptides may be screened, to avoid or eliminate neoepitopes that correspond to a fragment of a protein expressed in normal healthy human cells and/or neoepitopes that are capable of binding to at least two, or in some cases at least three, or at least four HLA class I molecules of the subject, or in some cases at least two, or at least three or four or five HLA class II molecules of the subject.
  • the methods of the disclosure may be used to identify or screen for such neoepitopes as described herein. Alignment may be determined using known methods such as BLAST algorithms. Software for performing BLAST analyses is publicly available through the National Center for Biotechnology Information (http://www.ncbi.nlm.nih.gov/).
  • the at least two multiple HLA-binding PEPIs of the composition polypeptides may both target a single antigen (e.g a polypeptide vaccine comprising two multiple HLA-binding PEPIs derived from a single antigen, for example a tumor associated antigen, targeted by the vaccine/immunotherapy) or may target different antigens (e.g. a polypeptide vaccine comprising one multiple HLA-binding PEPI derived from one antigen, e.g. a tumor associated antigen, and a second multiple HLA-binding PEPI derived from a different antigen, e.g. a different tumor associated antigen, both targeted by the vaccine/immunotherapy).
  • a single antigen e.g a polypeptide vaccine comprising two multiple HLA-binding PEPIs derived from a single antigen, for example a tumor associated antigen, targeted by the vaccine/immunotherapy
  • different antigens e.g. a polypeptide vaccine comprising one multiple HLA-
  • the active ingredient polypeptide(s) together comprise, or the method comprises selecting, a total of or at least 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 or 40 or more different PEPIs.
  • the PEPIs may be fragments of one or more different target polypeptide antigens.
  • each target polypeptide antigen that are immunogenic for a specific subject it is possible to incorporate multiple such fragments, optionally from multiple different target polypeptide antigens, in a single active ingredient polypeptide or multiple active ingredient polypeptides intended for use in combination or to maximise the number of T cell clones that can be activated by one or more polypeptides of a certain length.
  • exemplary CTA expression probabilities in breast cancer are as follows: MAGE C2: 21%; MAGE A1: 37%; SPC1: 38%; MAGE A9: 44%.
  • Treatment of patient ABC with a vaccine comprising PEPIs in only MAGE C2: 21% and MAGE A1 has a mAGP probability of 7%.
  • Treatment of patient ABC with a vaccine comprising PEPIs in only SPC1: 38%; MAGE A9 has a mAGP probability of 11%.
  • Treatment of patient ABC with a vaccine comprising PEPIs in MAGE C2: 21%; MAGE A1: 37%; SPC1: 38%; MAGE A9 has a mAGP probability of 44% (44>7+11).
  • Patient ABC's PIT vaccine described in Example 18 contains a further 8 PEPIs, and thus, the probability of having a mAGP is over 99.93%.
  • the PEPIs of the active ingredient polypeptides are from two or more different target polypeptide antigens, for example different antigens associated with a specific disease or condition, for example different cancer- or tumor-associated antigens or antigens expressed by a target pathogen.
  • the PEPIs are from a total of or at least 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 or 40 or more different target polypeptide antigens.
  • the different target polypeptide antigens may be any different polypeptides that it is useful to target or that can be selectively targeted with different PEPI3+s.
  • different target polypeptide antigens are non-homologues or non-paralogues or have less than 95%, or 90%, or 85% or 80% or 75% or 70% or 60% or 50% sequence identity across the full length of each polypeptide.
  • different polypeptides are those that do not share any PEPI3+s
  • the PEPI3+s are from different target polypeptide antigens when they are not shared with other polypeptide antigens targeted by the active ingredient polypeptides.
  • one or more or each of the immunogenic polypeptide fragments is from a polypeptide that is present in a sample taken from the specific human subject. This indicates that the polypeptide is expressed in the subject, for example a cancer- or tumor-associated antigen or a cancer testis antigen expressed by cancer cells of the subject.
  • one or more or each of the polypeptides is a mutational neoantigen, or an expressional neoantigen of the subject.
  • One or more or each fragment may comprise a neoantigen specific mutation. Since mutational neoantigens are subject specific, a composition that targets one or more neoantigen specific mutations is personalised with regard to both their specific disease and their specific HLA set.
  • one or more or each of the immunogenic polypeptide fragments is from a target polypeptide antigen that is not generally expressed or is minimally expressed in normal healthy cells or tissue, but is expressed in a high proportion of (with a high frequency in) subjects or in the diseased cells of a subject having a particular disease or condition, as described above.
  • the method my comprise identifying or selecting such a target polypeptide antigen.
  • two or more or each of the immunogenic polypeptide fragments/PEPIs are from different cancer- or tumor-associated antigens that are each (over-)expressed with a high frequency in subjects having a type of cancer or a cancer derived from a particular cell type or tissue.
  • the immunogenic polypeptide fragments are from a total of or at least 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 or 40 different cancer- or tumor-associated polypeptides.
  • one or more or each or at least one, at least two, at least three, at least four, at least five or at least six or at least seven of the polypeptides are selected from the antigens listed in any one of Tables 2 to 7.
  • one or more or each of the target polypeptide antigens is a cancer testis antigen (CTA).
  • CTA cancer testis antigen
  • the immunogenic polypeptide fragments/PEPIs are from at least 1, or at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 or 25 CTAs, or from a total of 3 or more different target polypeptide antigens, optionally wherein 1, 2, or all three or at least three are CTAs, or from 4 or more different polypeptide antigens, optionally wherein 1, 2, 3 or all four or at least 1, 2, 3 or 4 are CTAs, or from 5 or more different polypeptide antigens, optionally wherein 1, 2, 3, 4 or all five or at least 1, 2, 3, 4, or 5 are CTAs, or from 6 or more different polypeptide antigens, optionally wherein 1, 2, 3, 4, 5 or all six or at least 1, 2, 3, 4, 5, or 6 are CTAs, or from 7 or more different polypeptide antigens, optionally wherein 1,
  • one or more of the polypeptide fragments comprises an amino acid sequence that is a T cell epitope capable of binding to at least two, or at least three HLA class I of the subject and one or more of the polypeptide fragments comprises an amino acid sequence that is a T cell epitope capable of binding to at least two, or at least three, or at least four HLA class II of the subject, wherein the HLA class I and HLA class II binding fragments may optionally overlap.
  • a composition prepared by such a method may elicit both a cytotoxic T cell response and a helper T cell response in the specific human subject.
  • the disclosure relates to a pharmaceutical composition, kit, or panels of polypeptides as described above having one or more polypeptides as active ingredient(s). These may be for use in a method of inducing an immune response, treating, vaccinating or providing immunotherapy to a subject, and the pharmaceutical composition may be a vaccine or immunotherapy composition.
  • a treatment comprises administering one or more polypeptides or pharmaceutical compositions that together comprise all of the active ingredient polypeptides of the treatment to the subject.
  • Multiple polypeptides or pharmaceutical compositions may be administered together or sequentially, for example all of the pharmaceutical compositions or polypeptides may be administered to the subject within a period of 1 year, or 6 months, or 3 months, or 60 or 50 or 40 or 30 days.
  • the immunogenic or pharmaceutical compositions or kits described herein may comprise, in addition to one or more immunogenic peptides, a pharmaceutically acceptable excipient, carrier, diluent, buffer, stabiliser, preservative, adjuvant or other materials well known to those skilled in the art. Such materials are preferably non-toxic and preferably do not interfere with the pharmaceutical activity of the active ingredient(s).
  • the pharmaceutical carrier or diluent may be, for example, water containing solutions. The precise nature of the carrier or other material may depend on the route of administration, e.g. oral, intravenous, cutaneous or subcutaneous, nasal, intramuscular, intradermal, and intraperitoneal routes.
  • the pharmaceutical compositions of the disclosure may comprise one or more “pharmaceutically acceptable carriers”. These are typically large, slowly metabolized macromolecules such as proteins, saccharides, polylactic acids, polyglycolic acids, polymeric amino acids, amino acid copolymers, sucrose (Paoletti et al., 2001, Vaccine, 19:2118), trehalose (WO 00/56365), lactose and lipid aggregates (such as oil droplets or liposomes). Such carriers are well known to those of ordinary skill in the art.
  • the pharmaceutical compositions may also contain diluents, such as water, saline, glycerol, etc.
  • auxiliary substances such as wetting or emulsifying agents, pH buffering substances, and the like, may be present.
  • Sterile pyrogen-free, phosphate buffered physiologic saline is a typical carrier (Gennaro, 2000, Remington: The Science and Practice of Pharmacy, 20th edition, ISBN:0683306472).
  • compositions of the disclosure may be lyophilized or in aqueous form, i.e. solutions or suspensions. Liquid formulations of this type allow the compositions to be administered direct from their packaged form, without the need for reconstitution in an aqueous medium, and are thus ideal for injection.
  • the pharmaceutical compositions may be presented in vials, or they may be presented in ready filled syringes. The syringes may be supplied with or without needles. A syringe will include a single dose, whereas a vial may include a single dose or multiple doses.
  • Liquid formulations of the disclosure are also suitable for reconstituting other medicaments from a lyophilized form.
  • the disclosure provides a kit, which may comprise two vials, or may comprise one ready-filled syringe and one vial, with the contents of the syringe being used to reconstitute the contents of the vial prior to injection.
  • compositions of the disclosure may include an antimicrobial, particularly when packaged in a multiple dose format.
  • Antimicrobials may be used, such as 2-phenoxyethanol or parabens (methyl, ethyl, propyl parabens).
  • Any preservative is preferably present at low levels.
  • Preservative may be added exogenously and/or may be a component of the bulk antigens which are mixed to form the composition (e.g. present as a preservative in pertussis antigens).
  • compositions of the disclosure may comprise detergent e.g. Tween (polysorbate), DMSO (dimethyl sulfoxide), DMF (dimethylformamide).
  • Detergents are generally present at low levels, e.g. ⁇ 0.01%, but may also be used at higher levels, e.g. 0.01-50%.
  • compositions of the disclosure may include sodium salts (e.g. sodium chloride) and free phosphate ions in solution (e.g. by the use of a phosphate buffer).
  • sodium salts e.g. sodium chloride
  • free phosphate ions e.g. by the use of a phosphate buffer.
  • the pharmaceutical composition may be encapsulated in a suitable vehicle either to deliver the peptides into antigen presenting cells or to increase the stability.
  • a suitable vehicle is suitable for delivering a pharmaceutical composition of the disclosure.
  • suitable structured fluid delivery systems may include nanoparticles, liposomes, microemulsions, micelles, dendrimers and other phospholipid-containing systems. Methods of incorporating pharmaceutical compositions into delivery vehicles are known in the art.
  • the pharmacological compositions may comprise one or more adjuvants and/or cytokines.
  • Suitable adjuvants include an aluminum salt such as aluminum hydroxide or aluminum phosphate, but may also be a salt of calcium, iron or zinc, or may be an insoluble suspension of acylated tyrosine, or acylated sugars, or may be cationically or anionically derivatised saccharides, polyphosphazenes, biodegradable microspheres, monophosphoryl lipid A (MPL), lipid A derivatives (e.g.
  • 3-O-deacylated MPL [3D-MPL], quil A, Saponin, QS21, Freund's Incomplete Adjuvant (Difco Laboratories, Detroit, Mich.), Merck Adjuvant 65 (Merck and Company, Inc., Rahway, N.J.), AS-2 (Smith-Kline Beecham, Philadelphia, Pa.), CpG oligonucleotides, bio adhesives and mucoadhesives, microparticles, liposomes, polyoxyethylene ether formulations, polyoxyethylene ester formulations, muramyl peptides or imidazoquinolone compounds (e.g. imiquamod and its homologues).
  • Human immunomodulators suitable for use as adjuvants in the disclosure include cytokines such as interleukins (e.g. IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-12, etc), macrophage colony stimulating factor (M-CSF), tumour necrosis factor (TNF), granulocyte, macrophage colony stimulating factor (GM-CSF) may also be used as adjuvants.
  • cytokines such as interleukins (e.g. IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-12, etc)
  • M-CSF macrophage colony stimulating factor
  • TNF tumour necrosis factor
  • GM-CSF macrophage colony stimulating factor
  • the compositions comprise an adjuvant selected from the group consisting of Montanide ISA-51 (Seppic, Inc., Fairfield, N.J., United States of America), QS-21 (Aquila Biopharmaceuticals, Inc., Lexington, Mass., United States of America), GM-CSF, cyclophosamide, bacillus Calmette-Guerin (BCG), corynbacterium parvum, levamisole, azimezone, isoprinisone, dinitrochlorobenezene (DNCB), keyhole limpet hemocyanins (KLH), Freunds adjuvant (complete and incomplete), mineral gels, aluminum hydroxide (Alum), lysolecithin, pluronic polyols, polyanions, peptides, oil emulsions, dinitrophenol, diphtheria toxin (DT).
  • Montanide ISA-51 Seppic, Inc., Fairfield, N.J., United States of America
  • QS-21 Amla Biopharmaceutic
  • the cytokine may be selected from the group consisting of a transforming growth factor (TGF) such as but not limited to TGF- ⁇ and TGF- ⁇ ; insulin-like growth factor-I and/or insulin-like growth factor-II; erythropoietin (EPO); an osteoinductive factor; an interferon such as but not limited to interferon-. ⁇ , - ⁇ , and - ⁇ ; a colony stimulating factor (CSF) such as but not limited to macrophage-CSF (M-CSF); granulocyte-macrophage-CSF (GM-CSF); and granulocyte-CSF (G-CSF).
  • TGF transforming growth factor
  • TGF- ⁇ and TGF- ⁇ insulin-like growth factor-I and/or insulin-like growth factor-II
  • EPO erythropoietin
  • an osteoinductive factor such as but not limited to interferon-. ⁇ , - ⁇ , and - ⁇
  • CSF colony stimulating factor
  • the cytokine is selected from the group consisting of nerve growth factors such as NGF- ⁇ ; platelet-growth factor; a transforming growth factor (TGF) such as but not limited to TGF- ⁇ . and TGF- ⁇ ; insulin-like growth factor-I and insulin-like growth factor-II; erythropoietin (EPO); an osteoinductive factor; an interferon (IFN) such as but not limited to IFN- ⁇ , IFN- ⁇ , and IFN- ⁇ ; a colony stimulating factor (CSF) such as macrophage-CSF (M-CSF); granulocyte-macrophage-CSF (GM-CSF); and granulocyte-CSF (G-CSF); an interleukin (I1) such as but not limited to IL-1, IL-1.alpha., IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-11, IL-12;
  • TGF
  • an adjuvant or cytokine can be added in an amount of about 0.01 mg to about 10 mg per dose, preferably in an amount of about 0.2 mg to about 5 mg per dose.
  • the adjuvant or cytokine may be at a concentration of about 0.01 to 50%, preferably at a concentration of about 2% to 30%.
  • compositions of the disclosure are prepared by physically mixing the adjuvant and/or cytokine with the PEPIs under appropriate sterile conditions in accordance with known techniques to produce the final product.
  • Vaccine and immunotherapy composition preparation is generally described in Vaccine Design (“The subunit and adjuvant approach” (eds Powell M. F. & Newman M. J. (1995) Plenum Press New York). Encapsulation within liposomes, which is also envisaged, is described by Fullerton, U.S. Pat. No. 4,235,877.
  • the compositions disclosed herein are prepared as a nucleic acid vaccine.
  • the nucleic acid vaccine is a DNA vaccine.
  • DNA vaccines, or gene vaccines comprise a plasmid with a promoter and appropriate transcription and translation control elements and a nucleic acid sequence encoding one or more polypeptides of the disclosure.
  • the plasmids also include sequences to enhance, for example, expression levels, intracellular targeting, or proteasomal processing.
  • DNA vaccines comprise a viral vector containing a nucleic acid sequence encoding one or more polypeptides of the disclosure.
  • compositions disclosed herein comprise one or more nucleic acids encoding peptides determined to have immunoreactivity with a biological sample.
  • the compositions comprise one or more nucleotide sequences encoding 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or more peptides comprising a fragment that is a T cell epitope capable of binding to at least three HLA class I molecules and/or at least three HLA class II molecules of a patient.
  • the peptides are derived from an antigen that is expressed in cancer.
  • the DNA or gene vaccine also encodes immunomodulatory molecules to manipulate the resulting immune responses, such as enhancing the potency of the vaccine, stimulating the immune system or reducing immunosuppression.
  • Immunomodulatory molecules to manipulate the resulting immune responses, such as enhancing the potency of the vaccine, stimulating the immune system or reducing immunosuppression.
  • Strategies for enhancing the immunogenicity of DNA or gene vaccines include encoding of xenogeneic versions of antigens, fusion of antigens to molecules that activate T cells or trigger associative recognition, priming with DNA vectors followed by boosting with viral vector, and utilization of immunomodulatory molecules.
  • the DNA vaccine is introduced by a needle, a gene gun, an aerosol injector, with patches, via microneedles, by abrasion, among other forms. In some forms the DNA vaccine is incorporated into liposomes or other forms of nanobodies.
  • the DNA vaccine includes a delivery system selected from the group consisting of a transfection agent; protamine; a protamine liposome; a polysaccharide particle; a cationic nanoemulsion; a cationic polymer; a cationic polymer liposome; a cationic nanoparticle; a cationic lipid and cholesterol nanoparticle; a cationic lipid, cholesterol, and PEG nanoparticle; a dendrimer nanoparticle.
  • the DNA vaccines is administered by inhalation or ingestion.
  • the DNA vaccine is introduced into the blood, the thymus, the pancreas, the skin, the muscle, a tumor, or other sites.
  • the compositions disclosed herein are prepared as an RNA vaccine.
  • the RNA is non-replicating mRNA or virally derived, self-amplifying RNA.
  • the non-replicating mRNA encodes the peptides disclosed herein and contains 5′ and 3′ untranslated regions (UTRs).
  • the virally derived, self-amplifying RNA encodes not only the peptides disclosed herein but also the viral replication machinery that enables intracellular RNA amplification and abundant protein expression.
  • the RNA is directly introduced into the individual.
  • the RNA is chemically synthesized or transcribed in vitro.
  • the mRNA is produced from a linear DNA template using a T7, a T3, or an Sp6 phage RNA polymerase, and the resulting product contains an open reading frame that encodes the peptides disclosed herein, flanking UTRs, a 5′ cap, and a poly(A) tail.
  • various versions of 5′ caps are added during or after the transcription reaction using a vaccinia virus capping enzyme or by incorporating synthetic cap or anti-reverse cap analogues.
  • an optimal length of the poly(A) tail is added to mRNA either directly from the encoding DNA template or by using poly(A) polymerase.
  • the RNA encodes one or more peptides comprising a fragment that is a T cell epitope capable of binding to at least three HLA class I and/or at least three HLA class II molecules of a patient.
  • the fragments are derived from an antigen that is expressed in cancer.
  • the RNA includes signals to enhance stability and translation.
  • the RNA also includes unnatural nucleotides to increase the half-life or modified nucleosides to change the immunostimulatory profile.
  • the RNAs is introduced by a needle, a gene gun, an aerosol injector, with patches, via microneedles, by abrasion, among other forms.
  • the RNA vaccine is incorporated into liposomes or other forms of nanobodies that facilitate cellular uptake of RNA and protect it from degradation.
  • the RNA vaccine includes a delivery system selected from the group consisting of a transfection agent; protamine; a protamine liposome; a polysaccharide particle; a cationic nanoemulsion; a cationic polymer; a cationic polymer liposome; a cationic nanoparticle; a cationic lipid and cholesterol nanoparticle; a cationic lipid, cholesterol, and PEG nanoparticle; a dendrimer nanoparticle; and/or naked mRNA; naked mRNA with in vivo electroporation; protamine-complexed mRNA; mRNA associated with a positively charged oil-in-water cationic nanoemulsion; mRNA associated with a chemically modified dendrimer and complexed with polyethylene glycol (PEG)-lipid; protamine-com
  • PEG poly
  • mRNA associated with a cationic polymer such as polyethylenimine (PEI); mRNA associated with a cationic polymer such as PEI and a lipid component; mRNA associated with a polysaccharide (for example, chitosan) particle or gel; mRNA in a cationic lipid nanoparticle (for example, 1,2-dioleoyloxy-3-trimethylammoniumpropane (DOTAP) or dioleoylphosphatidylethanolamine (DOPE) lipids); mRNA complexed with cationic lipids and cholesterol; or mRNA complexed with cationic lipids, cholesterol and PEG-lipid.
  • DOTAP 1,2-dioleoyloxy-3-trimethylammoniumpropane
  • DOPE dioleoylphosphatidylethanolamine
  • the RNA vaccine is administered by inhalation or ingestion.
  • the RNA is introduced into the blood, the thymus, the pancreas, the skin, the muscle, a tumor, or other sites, and/or by an intradermal, intramuscular, subcutaneous, intranasal, intranodal, intravenous, intrasplenic, intratumoral or other delivery route.
  • Polynucleotide or oligonucleotide components may be naked nucleotide sequences, or be in combination with cationic lipids, polymers or targeting systems. They may be delivered by any available technique.
  • the polynucleotide or oligonucleotide may be introduced by needle injection, preferably intradermally, subcutaneously or intramuscularly.
  • the polynucleotide or oligonucleotide may be delivered directly across the skin using a delivery device such as particle-mediated gene delivery.
  • the polynucleotide or oligonucleotide may be administered topically to the skin, or to mucosal surfaces for example by intranasal, oral, or intrarectal administration.
  • Uptake of polynucleotide or oligonucleotide constructs may be enhanced by several known transfection techniques, for example those including the use of transfection agents.
  • transfection agents include cationic agents, for example, calcium phosphate and DEAE-Dextran and lipofectants, for example, lipofectam and transfectam.
  • the dosage of the polynucleotide or oligonucleotide to be administered can be altered.
  • Administration is typically in a “prophylactically effective amount” or a “therapeutically effective amount” (as the case may be, although prophylaxis may be considered therapy), this being sufficient to result in a clinical response or to show clinical benefit to the individual, e.g. an effective amount to prevent or delay onset of the disease or condition, to ameliorate one or more symptoms, to induce or prolong remission, or to delay relapse or recurrence.
  • the dose may be determined according to various parameters, especially according to the substance used; the age, weight and condition of the individual to be treated; the route of administration; and the required regimen.
  • the amount of antigen in each dose is selected as an amount which induces an immune response.
  • a physician will be able to determine the required route of administration and dosage for any particular individual.
  • the dose may be provided as a single dose or may be provided as multiple doses, for example taken at regular intervals, for example 2, 3 or 4 doses administered hourly.
  • peptides, polynucleotides or oligonucleotides are typically administered in the range of 1 pg to 1 mg, more typically 1 pg to 10 ⁇ g for particle mediated delivery and 1 ⁇ g to 1 mg, more typically 1-100 ⁇ g, more typically 5-50 ⁇ g for other routes.
  • each dose will comprise 0.01-3 mg of antigen.
  • An optimal amount for a particular vaccine can be ascertained by studies involving observation of immune responses in subjects.
  • more than one peptide or composition of peptides is administered.
  • Two or more pharmaceutical compositions may be administered together/simultaneously and/or at different times or sequentially.
  • the disclosure includes sets of pharmaceutical compositions and uses thereof.
  • the use of combination of different peptides, optionally targeting different antigens, is important to overcome the challenges of genetic heterogeneity of tumors and HLA heterogeneity of individuals.
  • Multiple pharmaceutical compositions of PEPIs, manufactured for use in one regimen, may define a drug product.
  • Routes of administration include but are not limited to intranasal, oral, subcutaneous, intradermal, and intramuscular.
  • the subcutaneous administration is particularly preferred.
  • Subcutaneous administration may for example be by injection into the abdomen, lateral and anterior aspects of upper arm or thigh, scapular area of back, or upper ventrodorsal gluteal area.
  • compositions of the disclosure may also be administered in one, or more doses, as well as, by other routes of administration.
  • routes of administration include, intracutaneously, intravenously, intravascularly, intraarterially, intraperitnoeally, intrathecally, intratracheally, intracardially, intralobally, intramedullarly, intrapulmonarily, and intravaginally.
  • the compositions according to the disclosure may be administered once or several times, also intermittently, for instance on a monthly basis for several months or years and in different dosages.
  • Solid dosage forms for oral administration include capsules, tablets, caplets, pills, powders, pellets, and granules.
  • the active ingredient is ordinarily combined with one or more pharmaceutically acceptable excipients, examples of which are detailed above.
  • Oral preparations may also be administered as aqueous suspensions, elixirs, or syrups.
  • the active ingredient may be combined with various sweetening or flavoring agents, coloring agents, and, if so desired, emulsifying and/or suspending agents, as well as diluents such as water, ethanol, glycerin, and combinations thereof.
  • compositions of the disclosure may be administered, or the methods and uses for treatment according to the disclosure may be performed, alone or in combination with other pharmacological compositions or treatments, for example chemotherapy and/or immunotherapy and/or vaccine.
  • the other therapeutic compositions or treatments may for example be one or more of those discussed herein, and may be administered either simultaneously or sequentially with (before or after) the composition or treatment of the disclosure.
  • the treatment may be administered in combination with checkpoint blockade therapy/checkpopint inhibitors, co-stimulatory antibodies, cytotoxic or non-cytotoxic chemotherapy and/or radiotherapy, targeted therapy or monoclonal antibody therapy. It has been demonstrated that chemotherapy sensitizes tumors to be killed by tumor specific cytotoxic T cells induced by vaccination (Ramakrishnan et al. J Clin Invest. 2010; 120(4):1111-1124).
  • chemotherapy agents include alkylating agents including nitrogen mustards such as mechlorethamine (HN2), cyclophosphamide, ifosfamide, melphalan (L-sarcolysin) and chlorambucil; anthracyclines; epothilones; nitrosoureas such as carmustine (BCNU), lomustine (CCNU), semustine (methyl-CCNU) and streptozocin (streptozotocin); triazenes such as decarbazine (DTIC; dimethyltriazenoimidazole-carboxamide; ethylenimines/methylmelamines such as hexamethylmelamine, thiotepa; alkyl sulfonates such as busulfan; Antimetabolites including folic acid analogues such as methotrexate (amethopterin); alkylating agents, antimetabolites, pyrimidine analogs such as fluorouracil (5-fluor
  • the method of treatment is a method of vaccination or a method of providing immunotherapy.
  • immunotherapy is the treatment of a disease or condition by inducing or enhancing an immune response in an individual.
  • immunotherapy refers to a therapy that comprises the administration of one or more drugs to an individual to elicit T cell responses.
  • immunotherapy refers to a therapy that comprises the administration or expression of polypeptides that contain one or more PEPIs to an individual to elicit a T cell response to recognize and kill cells that display the one or more PEPIs on their cell surface in conjunction with a class I HLA.
  • immunotherapy comprises the administration of one or more PEPIs to an individual to elicit a cytotoxic T cell response against cells that display tumor associated antigens (TAAs) or cancer testis antigens (CTAs) comprising the one or more PEPIs on their cell surface.
  • TAAs tumor associated antigens
  • CTAs cancer testis antigens
  • immunotherapy refers to a therapy that comprises the administration or expression of polypeptides that contain one or more PEPIs presented by class II HLAs to an individual to elicit a T helper response to provide co-stimulation to cytotoxic T cells that recognize and kill diseased cells that display the one or more PEPIs on their cell surface in conjunction with a class I HLAs.
  • immunotherapy refers to a therapy that comprises administration of one or more drugs to an individual that re-activate existing T cells to kill target cells.
  • the theory is that the cytotoxic T cell response will eliminate the cells displaying the one or more PEPIs, thereby improving the clinical condition of the individual.
  • immunotherapy may be used to treat tumors. In other instances, immunotherapy may be used to treat intracellular pathogen-based diseases or disorders.
  • the disclosure relates to the treatment of cancer or the treatment of solid tumors.
  • the treatment may be of cancers or malignant or benign tumors of any cell, tissue, or organ type.
  • the cancer may or may not be metastatic.
  • Exemplary cancers include carcinomas, sarcomas, lymphomas, leukemias, germ cell tumors, or blastomas.
  • the cancer may or may not be a hormone related or dependent cancer (e.g., an estrogen or androgen related cancer).
  • the disclosure relates to the treatment of a viral, bacterial, fungal or parasitic infection, or any other disease or condition that may be treated by immunotherapy.
  • the disclosure provides a system comprising a storage module configured to store data comprising the class I and/or class II HLA genotype of a subject and the amino acid sequence of one or more test polypeptides; and a computation module configured to identify and/or quantify amino acid sequences in the one or more test polypeptides that are capable of binding to multiple HLA of the subject.
  • the system may be for obtaining data from at least one sample from at least one subject.
  • the system may comprise a an HLA genotyping module for determining the class I and/or class II HLA genotype of a subject.
  • the storage module may be configured to store the data output from the genotyping module.
  • the HLA genotyping module may receive a biological sample obtained from the subject and determines the subject's class I and/or class II HLA genotype.
  • the sample typically contains subject DNA.
  • the sample may be, for example, a blood, serum, plasma, saliva, urine, expiration, cell or tissue sample.
  • the system may further comprise an output module configured to display the sequence of one or more fragments of the one or more polypeptides that are predicted to be immunogenic for the subject, or any output prediction or treatment selection or recommendation described herein or the value of any pharmodynamic biomarker described herein.
  • a method of predicting whether a polypeptide or a fragment of a polypeptide is immunogenic for a specific human subject comprising the steps of
  • a method of identifying a fragment of a polypeptide as immunogenic for a specific human subject comprising the steps of
  • step (i) comprises determining that the polypeptide comprises an amino acid sequence that is a T cell epitope capable of binding to at least two HLA class I molecules of the subject.
  • step (i) comprises determining that the polypeptide comprises an amino acid sequence that is a T cell epitope capable of binding to at least three HLA class I molecules of the subject.
  • step (i) comprises determining that the polypeptide comprises an amino acid sequence that is a T cell epitope capable of binding to at least three HLA class II molecules of the subject.
  • the method of item 4 or item 5 further comprising identifying a fragment of the polypeptide that is a T cell epitope capable of binding to at least one HLA class II molecule of the subject, wherein the HLA class II-binding epitope comprises the amino acid sequence of the HLA class I-binding T cell epitope.
  • the polypeptide is an antigen or neoantigen expressed by a cancer cell, optionally wherein the cancer cell, the antigen or the neoantigen is in a sample taken from the subject.
  • polypeptide is a component of a pharmaceutical composition and the method comprises determining the likelihood that the subject will develop anti-drug antibodies (ADA) following administration of the polypeptide, wherein a predicted T helper cell response corresponds to a higher likelihood of ADA and no predicted T helper cell response corresponds to a lower likelihood of ADA.
  • ADA anti-drug antibodies
  • any one of items 1 to 14 further comprising predicting whether the subject will have a clinical response to administration of a pharmaceutical composition, kit or panel of polypeptides comprising one or more polypeptides as active ingredients, the method comprising determining whether the one or more active ingredient polypeptides together comprise at least two different amino acid sequences each of which is a T cell epitope capable of binding to at least three HLA class I molecules of the subject; and predicting
  • step (ii) comprises using population expression data for each antigen identified in step (i) to determine the probability that the subject expresses two or more of the antigens identified in step (i) that together comprise at least two different amino acid sequences of step (i).
  • any one of the preceding items further comprising selecting or recommending for treatment of the specific human subject administration to the subject of a polypeptide that comprises a polypeptide fragment that is identified as immunogenic for the subject, or of a polypeptide that is predicted to be immunogenic, or to induce a cytotoxic T cell or helper T cell response, or of a pharmaceutical composition, kit or panel of polypeptides that is predicted to induce a clinical response, or of a polypeptide or pharmaceutical composition that is predicted not to induce a toxic immune response or not to induce ADA in the subject.
  • a method of treatment of a human subject in need thereof comprising administering to the subject a polypeptide that comprises a polypeptide fragment that has been identified as immunogenic, or a polypeptide that has been predicted to be immunogenic, or a polypeptide or pharmaceutical composition that has been predicted to induce a cytotoxic T cell or helper T cell response, or a pharmaceutical composition, kit or panel of polypeptides that has been predicted to induce a clinical response, or a pharmaceutical composition, kit or panel of polypeptides that has been determined to have a threshold minimum likelihood of inducing a clinical response, or a polypeptide or pharmaceutical composition that is predicted not to induce a toxic immune response or ADA development in the subject using a method according to any one of items 1 to 23, or one or more polypeptides or pharmaceutical compositions that have been selected or recommended for treatment of the subject using a method according to item 26.
  • any one of items 1 to 12 further comprising predicting whether the subject will have a clinical response to administration of a checkpoint inhibitor to treat cancer, the method comprising determining whether one or more cancer associated antigens together comprise at least two different amino acid sequences each of which is a T cell epitope capable of binding to at least three HLA class I of the subject and predicting
  • a method of treatment of a human subject in need thereof comprising administering to the subject a checkpoint inhibitor, wherein the subject has been predicted to respond, or to be likely to respond, to administration of a checkpoint inhibitor by a method according to item 30 or item 31.
  • a method of designing or preparing a human subject-specific pharmaceutical composition or kit or panel of polypeptides for use in a method of treatment of a specific human subject comprising:
  • each polypeptide either consists of one of the selected amino acid sequences, or comprises or consists of two or more of the selected amino acid sequences arranged end to end or overlapping in a single peptide.
  • a human subject-specific pharmaceutical composition, kit or panel of polypeptides for use in a method of inducing an immune response in a specific human subject, and designed or prepared for the subject according to the method of any one of items 36 to 39, wherein the composition or kit optionally comprises at least one pharmaceutically acceptable diluent, carrier, or preservative.
  • a human subject-specific pharmaceutical composition, kit or panel of polypeptides for use in a method of treatment of a specific human subject in need thereof comprising as an active ingredient a polypeptide comprising a first region and a second region and optionally one of more additional regions, wherein each region comprises an amino acid sequence that is a T cell epitope capable of binding to at least two HLA class I molecules and/or at least two HLA class II molecules of the subject, wherein the amino acid sequence of the T cell epitope of the first, second and optionally any additional regions are different from each other, and wherein the pharmaceutical composition or kit optionally comprises at least one pharmaceutically acceptable diluent, carrier, or preservative.
  • a method of treatment comprising administering to a human subject in need thereof a human subject-specific pharmaceutical composition or the polypeptides of a kit or panel of polypeptides according to any one of items 41 to 55, wherein the pharmaceutical composition, kit or panel is specific for the subject, optionally wherein the method is for the treatment of cancer.
  • a method of designing or preparing a polypeptide for inducing an immune response in a specific human subject comprising selecting an amino acid sequence that is a T cell epitope capable of binding to at least three HLA class I molecules or at least three HLA class II molecules of the subject, and designing or preparing a polypeptide comprising the selected amino acid sequence.
  • a method of inducing an immune response in a subject comprising administering to the subject a polypeptide designed according to the method of item 58 or item 59.
  • a method of inducing an immune response in a specific human subject comprising designing or preparing a peptide according to the method of item 58 or item 59, and administering the peptide to the subject.
  • HLA I-epitope binding prediction process was validated by comparison with HLA I-epitope pairs determined by laboratory experiments. A dataset was compiled of HLA I-epitope pairs reported in peer reviewed publications or public immunological databases.
  • the probability of multiple HLA binding to an epitope shows the relationship between the number of HLAs binding an epitope and the expected minimum number of real binding. Per PEPI definition three is the expected minimum number of HLA to bind an epitope (bold).
  • the validated HLA-epitope binding prediction process was used to determine all HLA-epitope binding pairs described in the Examples below.
  • the presentation of one or more epitopes of a polypeptide antigen by one or more HLA I of an individual is predictive for a CTL response was determined.
  • All of these clinical trials measured antigen specific CD8+ CTL responses (immunogenicity) in the study subjects after vaccination. In some cases, correlation between CTL responses and clinical responses were reported.
  • the 157 patient datasets (Table 11) were randomized with a standard random number generator to create two independent cohorts for training and evaluation studies. In some cases the cohorts contained multiple datasets from the same patient, resulting in a training cohort of 76 datasets from 48 patients and a test/validation cohort of 81 datasets from 51 patients.
  • **Immunoassays are based on T cell stimulation with antigen-specific peptide pools and quantify the released cytokines by different techniques.
  • CT Clinical trial
  • SBT Sequence Based Typing
  • SSO Sequence-Specific Oligonucleotide
  • ICS Intracellular cytokine staining
  • SSP Sequence-specific priming
  • the reported CTL responses of the training dataset were compared with the HLA I restriction profile of epitopes (9 mers) of the vaccine antigens.
  • the antigen sequences and the HLA I genotype of each patient were obtained from publicly available protein sequence databases or peer reviewed publications and the HLA I-epitope binding prediction process was blinded to patients' clinical CTL response data.
  • the number of epitopes from each antigen predicted to bind to at least 1 (PEPI1+), or at least 2 (PEPI2+), or at least 3 (PEPI3+), or at least 4 (PEPI4+), or at least 5 (PEPI5+), or all 6 (PEPI6) HLA class I molecules of each patient was determined and the number of HLA bound were used as classifiers for the reported CTL responses.
  • the true positive rate (sensitivity) and true negative rate (specificity) were determined from the training dataset for each classifier (number of HLA bound) separately.
  • ROC analysis was performed for each classifier.
  • the true positive rate (Sensitivity) was plotted in function of the false positive rate (1-Specificity) for different cut-off points ( FIG. 1 ).
  • Each point on the ROC curve represents a sensitivity/specificity pair corresponding to a particular decision threshold (epitope (PEPI) count).
  • the area under the ROC curve (AUC) is a measure of how well the classifier can distinguish between two diagnostic groups (CTL responder or non-responder).
  • the threshold count of PEPI3+(number of antigen-specific epitopes presented by 3 or more HLA of an individual) that best predicted a positive CTL response was 1 (Table 13).
  • at least one antigen-derived epitope is presented by at least 3 HLA class I of a subject ( ⁇ 1 PEPI3+)
  • the antigen can trigger at least one CTL clone, and the subject is a likely CTL responder.
  • ⁇ 1 PEPI3+ Test to predict likely CTL responders (“ ⁇ 1 PEPI3+ Test”) provided 76% diagnostic sensitivity (Table 13).
  • the test cohort of 81 datasets from 51 patients was used to validate the ⁇ 1 PEPI3+ threshold to predict an antigen-specific CTL response. For each dataset in the test cohort it was determined whether the ⁇ 1 PEPI3+ threshold was met (at least one antigen-derived epitope presented by at least three class I HLA of the individual). This was compared with the experimentally determined CTL responses reported from the clinical trials (Table 14).
  • Performance characteristic Description Result Positive 100%[A/(A + B)] The likelihood that an individual that meets the ⁇ 1 84% predictive PEPI3+ threshold has antigen-specific CTL value (PPV) responses after treatment with immunotherapy.
  • Negative 100%[D/(C + D)] The likelihood that an individual who does not meet 42% predictive the ⁇ 1 PEPI3+ threshold does not have antigen- value (NPV) specific CTL responses after treatment with immunotherapy.
  • Overall 100%[(A + D)/N] The percentage of predictions based on the ⁇ 1 70% percent PEPI3+ threshold that match the experimentally agreement (OPA) determined result, whether positive or negative. Fisher's exact (p) 0.01
  • ROC analysis determined the diagnostic accuracy, using the PEPI3+ count as cut-off values ( FIG. 2 ).
  • the AUC value 0.73.
  • an AUC of 0.7 to 0.8 is generally considered as fair diagnostic.
  • the ⁇ 1 PEPI3+ Test was compared with a previously reported method for predicting a specific human subject's CTL response to peptide antigens.
  • the HLA genotypes of 28 cervical cancer and VIN-3 patients that received the HPV-16 synthetic long peptide vaccine (LPV) in two different clinical trials were determined from DNA samples 8 8 9 10 .
  • the LPV consists of long peptides covering the HPV-16 viral oncoproteins E6 and E7.
  • the amino acid sequence of the LPV was obtained from these publications.
  • the publications also report the T cell responses of each vaccinated patient to pools of overlapping peptides of the vaccine.
  • PEPI3+s patient class I HLA
  • Peptides that comprised at least one PEPI3+( ⁇ 1 PEPI3+) were predicted to induce a CTL response.
  • Peptides that comprised no PEPI3+ were predicted not to induce a CTL response.
  • the ⁇ 1 PEPI3+ Test correctly predicted 489 out of 512 negative CTL responses and 8 out of 40 positive CTL responses measured after vaccination ( FIG. 3A ). Overall, the agreement between the ⁇ 1 PEPI3+ Test and experimentally determined CD8+ T cell reactivity was 90% (p ⁇ 0.001).
  • the sensitivity of the prediction of HLA class II restricted epitopes was 78%, since the State of Art tool predicted 84 positive responses (positive CD4+ T cell reactivity to a peptide pool for a person's DP alleles) out of 107 (sensitivity 78%).
  • the specificity was 22% since it could rule out 7 negative responses out of 31.
  • Example 6 The ⁇ 1 PEPI3+ Test Predicts T Cell Responses to Full Length LPV Polypeptides
  • the ⁇ 1 PEPI3+ Test was used to predict patient CD8+ and CD4+ T cell responses to the full length E6 and E7 polypeptide antigens of the LPV vaccine. Results were compared to the experimentally determined responses were reported.
  • the Test correctly predicted the CD8+ T cell reactivity (PEPI3+) of 11 out of 15 VIN-3 patients with positive CD8+ T cell reactivity test results (sensitivity 73%, PPV 85%) and of 2 out of 5 cervical cancer patients (sensitivity 40%, PPV 100%).
  • the CD4+ T cell reactivities (PEPI4+) were correctly predicted 100% both of VIN-3 and cervical cancer patients ( FIG. 5 ).
  • pGX3001 is an HPV16 based DNA vaccine containing full length E6 and E7 antigens with a linker in between.
  • pGX3002 is an HPV18 based DNA vaccine containing full length E6 and E7 antigens with a linker in between.
  • a Phase II clinical trial investigated the T cell responses of 17 HPV-infected patients with cervical cancer who were vaccinated with both pGX3001 and pGX3002 (VGX-3100 vaccination) 1 .
  • FIGS. 5A-D and FIG. 6 shows for two illustrative patients (patient 12-11 and patient 14-5) the position of each epitope (9 mer) presented by at least 1 (PEPI1+), at least 2 (PEPI2+), at least 3 (PEPI3+), at least 4 (PEPI4+), at least 5 (PEPI5+), or all 6 (PEPI6) class I HLA of these patients within the full length sequence of the two HPV-16 and two HPV-18 antigens.
  • PEPI1+ PEPI1+
  • PEPI2+ at least 3
  • PEPI4+ at least 4
  • PEPI5+ at least 5
  • PEPI6 all 6
  • Patient 12-11 had an overall PEPI1+ count of 54 for the combined vaccines (54 epitopes presented by one or more class I HLA).
  • Patient 14-5 had a PEPI1+ count of 91. Therefore patient 14-5 has a higher PEPI1+ count than patient 12-11 with respect to the four HPV antigens.
  • the PEPI1+s represent the distinct vaccine antigen specific HLA restricted epitope sets of patients 12-11 and 14-5. Only 27 PEPI1+s were common between these two patients.
  • PEPI3+ counts (number of epitopes presented by three or more patient class I HLA)
  • the results for patients 12-11 and 14-5 were reversed.
  • Patient 12-11 had a PEPI3+ count of 8, including at least one PEPI3+ in each of the four HPV16/18 antigens.
  • Patient 14-5 had a PEPI3+ count of 0.
  • the diversity of the patient's PEPI3+ set resembled the diversity of T cell responses generally found in cancer vaccine trials.
  • Patients 12-3 and 12-6 similar to patient 14-5, did not have PEPI3+s predicting that the HPV vaccine could not trigger T cell immunity. All other patients had at least one PEPI3 predicting the likelihood that the HPV vaccine can trigger T cell immunity. 11 patients had multiple PEPI3+ predicting that the HPV vaccine likely triggers polyclonal T cell responses.
  • Patients 15-2 and 15-3 could mount high magnitude T cell immunity to E6 of both HPV, but poor immunity to E7.
  • Other patients 15-1 and 12-11 had the same magnitude response to E7 of HPV18 and HPV16, respectively.
  • Example 8 Design of a Model Population for Conducting in Silico Trials and Identifying Candidate Precision Vaccine Targets for Large Population
  • This Model Population has subjects with mixed ethnicity having a total of 152 different HLA alleles that are representative for >85% of presently known allele G-groups.
  • a database of a “Big Population” containing 7,189 subjects characterized with 4-digit HLA genotype and demographic information was also established.
  • the Big Population has 328 different HLA class I alleles.
  • the HLA allele distribution of the Model Population significantly correlated with the Big Population (Table 16) (Pearson p ⁇ 0.001). Therefore the 433 patient Model Population is representative for a 16 times larger population.
  • the Model Population is representative for 85% of the human race as given by HLA diversity as well as HLA frequency.
  • the objective of this study was to determine whether a model population, such as the one described in Example 8, may be used to predict CTL reactivity rates of vaccines, i.e. used in an in silico efficacy trials.
  • peptide vaccines derived from cancer antigens that induced T cell responses in a subpopulation of subjects were identified from peer reviewed publications. These peptides have been investigated in clinical trials enrolling a total of 172 patients (4 ethnicities). T cell responses induced by the vaccine peptides have been determined from blood specimens and reported. The immune response rate as the percentage of study subjects with positive T cell responses measured in the clinical trials was determined ( FIG. 7 ).
  • the 12 peptides were investigated with the ⁇ 1 PEPI3+ Test in each of the 433 subjects of the Model Population described in Example 8.
  • the “ ⁇ 1 PEPI3+ Score” for each peptide was calculated as the proportion of subjects in the Model Population having at least one vaccine derived epitope that could bind to at least three subject-specific HLA class I ( ⁇ 1 PEPI3+). If the corresponding clinical trial stratified patients for HLA allele selected population, the Model Population was also filtered for subjects with the respective allele(s) (Example: WT1, HLA-A*0201).
  • Each vaccine peptide of the 19 clinical trials was investigated with the ⁇ 1 PEPI3+ Test in each subject of the Model Population.
  • the ⁇ 1 PEPI3+ Score for each peptide was calculated as the proportion of subjects in the Model Population having at least one vaccine derived PEPI3+.
  • the experimentally determined response rates reported from the trials were compared with the PEPI Scores, as in Example 9 (Table 20).
  • Example 11 In Silico Trial Based on the Identification of Multiple HLA Binding Epitopes in a Multi-Peptide Vaccine Predict the Reported Clinical Trial Immune Response Rate
  • IMA901 is a therapeutic vaccine for renal cell cancer (RCC) comprising 9 peptides derived from tumor-associated peptides (TUMAPs) that are naturally presented in human cancer tissue.
  • RCC renal cell cancer
  • TUMAPs tumor-associated peptides
  • a total of 96 HLA-A*02+ subjects with advanced RCC were treated with IMA901 in two independent clinical studies (phase I and phase II).
  • Each of the 9 peptides of IMA901 have been identified in the prior art as HLA-A2-restricted epitopes. Based on currently accepted standards, they are all strong candidate peptides to boost T cell responses against renal cancer in the trial subjects, because their presence has been detected in renal cancer patients, and because the trial patients were specifically selected to have at least one HLA molecule capable of presenting each of the peptides.
  • phase I and phase II study results show the variability of the immune responses to the same vaccine in different trial cohorts. Overall, however, there was a good agreement between response rates predicted by the ⁇ 2 PEPI3+ Test and the reported clinical response rates.
  • Example 12 In Silico Trial Based on the Identification of Vaccine-Derived Multiple HLA Binding Epitopes Predict Reported Experimental Clinical Response Rates
  • DCRs Disease Control Rates
  • ORR objective response rate
  • MultiPEPI Score Overall Percentage of Immunotherapy DCR (Predicted DCR) Agreement IMA901 phase I 43% 27% 61% IMA901 phase II 22% 27% 81% Ipilimumab 60% 65% 92% HPV-SLP 60% 70% 86% HPV-SLP 62% 70% 89% gp100 - 2 peptides 15% 11% 73% Immucin 73% 59% 81% StimuVax 0% 0% 100% VGX-3100 50% 56% 89% TSPP peptide vaccine 48% 31% 65% KIF20A-66 peptide 26% 7% 27% vaccine Peptide vaccine 27% 10% 37% 7-peptide cocktail 10% 9% 90% vaccine GVX301 29% 7% 24% MAGE-A3 Trojan 35% 10% 29% PepCan 52% 26% 50% Melanoma peptide 12% 6% 50% vaccine
  • Example 13 The Set of Multiple HLA Binding Peptides from Tumor Antigens Predicts Responders to the Checkpoint Inhibitor Immunotherapy Ipilmumab
  • melanoma associated antigens were identified from which a panel of PEPI3+s (IPI-PEPI panel: 627 PEPIs) that are shared by Ipilimumab treated melanoma patients with a prolonged clinical benefit and are absent in those without a prolonged benefit was selected.
  • PEPI3+ define the specific T cells that are re-activated by Ipilimumab to attack the patient's tumor cells.
  • Patients with certain HLA sequences that can present more melanoma-specific PEPIs have more T cells re-activated by Ipilimumab and a higher chance to benefit from Ipilimumab immunotherapy.
  • the clinical benefit from Ipilimumab treatment for 160 patients from four independent clinical trial cohorts was determined. Two cohorts were from the trials CA184-007 (10 mg/kg Ipilimumab) and CA184-002 (3 mg/kg Ipilimumab) and two cohorts from published clinical trials 10 mg/kg and 3/mg/kg Ipilimumab datasets 5, 38, 39 .
  • Epitopes from 80 melanoma antigens restricted to all the 6 HLA class I of each patient were predicted and the number of melanoma-specific PEPI3+s restricted to at least 3 class I HLAs of each patient (4,668 PEPIs) was then computed. Each patient with at least one out of 627 PEPIs qualified as responder.
  • the IPI-PEPI panel predicts the overall survival of both 10 mg/kg and 3 mg/kg Ipilimumab. Results were highly significant and consistent in the four independent cohort ( FIGS. 10A-D ).
  • PEPI3+s of 110 melanoma patients treated with Ipilimumab was determined using published exome mutation data 39 . From the exome mutation data, mutations in 9,502 antigens from the 110 patients ( FIG. 11A ). Median nonsynonymous mutational load per sample was highly variable, 309 (29-4,738) in the clinical benefit cohort and 147 (7-5,854) in the minimal or no clinical benefit cohort. Due to their epitope prediction results these mutations had 211 (8-1950) and 56 (2-3444) neoepitopes in the clinical benefit cohort and the minimal or no clinical benefit cohorts, respectively.
  • Mutational PEPI3+ neoepitopes from the published mutations were determined ( FIG. 11B and Table 24). These mutations resulted in median 16 PEPIs and 6 PEPIs neoepitopes in clinical benefit cohort and the minimal or no clinical benefit cohorts, respectively.
  • PEPIs define the mutational neoantigens derived from genetically altered proteins expressed in an individual.
  • neoantigens are PEPI3+ peptides that capable to activate T cells in the patient's body. If a genetic alteration occurs in the tumor cell of the individual that creates a PEPI3+ then this PEPI3+ can induce T cell responses.
  • These PEPI3+ containing peptides could be included in a drug (e.g. vaccine, T cell therapy) to induce immune response against the individual tumor.
  • Example 15 In Silico Trials Based on the Identification of Multiple HLA Binding Epitopes Predict the Reported Cellular Immune Response Rates to a Vaccine Targeting a Mutational Antigen
  • the epidermal growth factor receptor variant III is a tumor-specific mutation broadly expressed in glioblastoma multiforme (GBM) and other neoplasms.
  • the mutation comprises an in-frame deletion of 801 bp from the extracellular domain of the EGFR that splits a codon and yields a novel glycine at the fusion junction.
  • 1, 2 This mutation encodes a constitutively active tyrosine kinase that increases tumor formation and tumor cell migration and enhances resistance against radiation and chemotherapy.
  • 3, 4, 5, 6, 7, 8, 9 This insertion results in a tumor-specific epitope which is not found in normal adult tissues making EGFRvIII a suitable target candidate for antitumor immunotherapy.
  • Rindopepimut is a 13-amino-acid peptide vaccine (LEEKKGNYVVTDHC (SEQ ID NO: 87)) spanning the EGFRvIII mutation with an additional C-terminal cysteine residue.
  • the peptide conjugated to keyhole limpet hemocyanin (KLH) was administered to newly diagnosed EGFRvIII-expressing GBM patients.
  • the first three vaccinations were given biweekly, starting 4 weeks after the completion of radiation.
  • Subsequent vaccines were given monthly until radiographic evidence of tumor progression or death. All vaccines were given intradermally in the inguinal region. Immunologic evaluation showed only 3 out of 18 patients developing cellular immune response assessed by DTH reaction test.
  • FIG. 12 An HLA map of the Rindopepimut on the HLA alleles of the subjects in the Model Population ( FIG. 12 ) illustrates that very few HLA-A and HLA-C alleles can bind the vaccine epitopes which explains the lack of PEPI3+ in the in silico cohort.
  • TPO Thrombopoietin
  • EpiVax/Genentech used State of Art technology to identify class II HLA restricted epitopes and found that the most immunogenic region of the TPO is located in the C-terminal end of TPO (US20040209324 A1).
  • PEPI3+s multiple class II HLA binding epitopes from TPO in 400 HLA class II genotyped US subjects were determined. Most of the PEPI3+ peptides of these individuals located within the N terminal region of the TPO between 1-165 amino acids. PEPI3+ were sporadically identified in some subjects also in the C terminal region. However, these results were different from the State of Art.
  • This example describes the treatment of an ovarian cancer patient with a personalised immunotherapy composition, wherein the composition was specifically designed for the patient based on her HLA genotype based on the disclosure described herein.
  • This Example and Example 19 below provide clinical data to support the principals regarding binding of epitopes by multiple HLA of a subject to induce a cytotoxic T cell response on which the present disclosure is based.
  • the HLA class I and class II genotype of metastatic ovarian adenocarcinoma cancer patient XYZ was determined from a saliva sample.
  • each peptide was selected, each of which met the following two criteria: (i) derived from an antigen that is expressed in ovarian cancers, as reported in peer reviewed scientific publications; and (ii) comprises a fragment that is a T cell epitope capable of binding to at least three HLA class I of patient XYZ (Table 26).
  • each peptide is optimized to bind the maximum number of HLA class II of the patient.
  • PEPI3 peptides in this immunotherapy composition can induce T cell responses in XYZ with 84% probability and the two PEPI4 peptides (POC01-P2 and POC01-P5) with 98% probability, according to the validation of the PEPI Test shown in Table 10.
  • T cell responses target 13 antigens expressed in ovarian cancers. Expression of these cancer antigens in patient XYZ was not tested. Instead the probability of successful killing of cancer cells was determined based on the probability of antigen expression in the patient's cancer cells and the positive predictive value of the ⁇ 1 PEPI3+ Test (AGP count).
  • AGP count predicts the effectiveness of a vaccine in a subject: Number of vaccine antigens expressed in the patient's tumor (ovarian adenocarcinoma) with PEPI.
  • the AGP count indicates the number of tumor antigens that vaccine recognizes and induces a T cell response against the patient's tumor (hit the target).
  • the AGP count depends on the vaccine-antigen expression rate in the subject's tumor and the HLA genotype of the subject. The correct value must be between 0 (no PEPI presented by expressed antigen) and maximum number of antigens (all antigens are expressed and present a PEPI).
  • FIGS. 13A-B The probability that patient XYZ will express one or more of the 12 antigens is shown in FIGS. 13A-B .
  • a pharmaceutical composition for patient XYZ may be comprised of at least 2 from the 13 peptides (Table 26), because the presence in a vaccine or immunotherapy composition of at least two polypeptide fragments (epitopes) that can bind to at least three HLA of an individual ( ⁇ 2 PEPI3+) was determined to be predictive for a clinical response.
  • the peptides are synthesized, solved in a pharmaceutically acceptable solvent and mixed with an adjuvant prior to injection. It is desirable for the patient to receive personalized immunotherapy with at least two peptide vaccines, but preferable more to increase the probability of killing cancer cells and decrease the chance of relapse.
  • the HLA class I and class II genotype of metastatic breast cancer patient ABC was determined from a saliva sample.
  • twelve peptides were selected, each of which met the following two criteria: (i) derived from an antigen that is expressed in breast cancers, as reported in peer reviewed scientific publications; and (ii) comprises a fragment that is a T cell epitope capable of binding to at least three HLA class I of patient ABC (Table 29).
  • each peptide is optimized to bind the maximum number of HLA class II of the patient.
  • the twelve peptides target twelve breast cancer antigens. The probability that patient ABC will express one or more of the 12 antigens is shown in FIG. 15 .
  • the 12 peptides were formulated as 4 ⁇ 3 peptide (PBR01/1, PBR01/2, PBR01/3, PBR01/4).
  • One treatment cycle is defined as administration of all 12 different peptide vaccines within 30 days.
  • Diagnosis bilateral metastatic breast carcinoma: Right breast is ER positive, PR negative, Her2 negative; Left Breast is ER, PR and Her2 negative.
  • BRC-09 was treated with 5 cycles of PIT vaccine. She was feeling very well and she refused a PET CT examination in September 2017. In November she had symptoms, PET CT scan showed progressive disease, but she refused all treatments. In addition, her oncologist found out that she did not take Palbocyclib since spring/summer. Patient ABC passed away in January 2018.
  • palbocyclib has been shown to improve the activity of immunotherapies by increases CTA presentation by HLAs and decreasing the proliferation of Tregs: (Goel et al. Nature. 2017:471-475).
  • the PIT vaccine may be used as add-on to the state-of-art therapy to obtain maximal efficacy.
  • Example 19 Personalised Immunotherapy Composition for Treatment of Patient with Late Stage Metastatic Breast Cancer
  • IBC Inflammatory breast cancer
  • inflammatory breast cancer is a rare, but aggressive form of locally advanced breast cancer. It's called inflammatory breast cancer because its main symptoms are swelling and redness (the breast often looks inflamed).
  • Most inflammatory breast cancers are invasive ductal carcinomas (begin in the milk ducts). This type of breast cancer is associated with the expression of oncoproteins of high risk Human Papilloma Virus. Indeed, HPV16 DNA was diagnosed in the tumor of this patient.
  • T4 Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules)
  • pN3a Metastases in ⁇ 10 axillary lymph nodes (at least 1 tumor deposit>2.0 mm); or metastases to the infraclavicular (level III axillary lymph) nodes.
  • T cell responses were measured cells in peripheral mononuclear cells 2 weeks after the 1 st vaccination with the mix of peptides PBRC05_P1, PBRC05_P2, PBRC05_P3, PBRC05_P4, PBRC05_P5, PBRC05_P6, PBRC05_P7.
  • Example 20 Personalised Immunotherapy Composition for Treatment of Patient with Early Stage Metastatic Breast Cancer
  • HISTORY In 2011 left breast sector excision due to neoplasm. Treatment: aromatase inhibitor and lumbar spine irradiation (osseal mets).
  • immunoBLAST A method was developed for performing on any antigen to determine its potential to induce toxic immune reaction, such as autoimmunity.
  • the method is referred to herein as immunoBLAST.
  • PolyPEPI1018 contains six 30-mer polypeptides. Each polypeptide consists of two 15-mer peptide fragments derived from antigens expressed in CRC. Neoepitopes might be generated in the joint region of the two 15-mer peptides and could induce undesired T cell responses against healthy cells (autoimmunity). This was assesses using the immunoBLAST methodology.
  • a 16-mer peptide for each of the 30-mer components of PolyPEP1018 was designed. Each 16-mer contains 8 amino acids from the end of the first 15 residues of the 30-mer and 8 amino acids from the beginning of the second 15 residues of the 30-mer—thus precisely spanning the joint region of the two 15-mers. These 16-mers are then analysed to identify cross-reactive regions of local similarity with human sequences using BLAST (https://blast.ncbi.nlm.nih.gov/Blast.cgi), which compares protein sequences to sequence databases and calculates the statistical significance of matches. 8-mers within the 16-mers were selected as the examination length since that length represents the minimum length needed for a peptide to form an epitope, and is the distance between the anchor points during HLA binding.
  • the positions of amino acids in a polypeptide are numbered.
  • the start positions of potential 9-mer peptides that can bind to HLAs and form neoepitopes are the 8 amino acids in positions 8-15.
  • the ratio of possible neoepitope generating peptides is 36.4% (8/22).
  • the PEPI3+ Test was used to identify neoepitopes and neoPEPI among the 9-mer epitopes in the joint region.
  • the risk of PolyPEPI1018 inducing unwanted T cell responses was assessed in the 433 subjects in the Model Population by determining the proportion of subjects with PEPI3+ among the 9-mers in the joint region.
  • the result of neoepitope/neoPEPI analysis is summarized in Table 33.
  • the average predicted epitope number that could be generated by intracellular processing was 40.12.
  • Neoepitopes were frequently generated; 11.61 out of 40.12 (28.9%) epitopes are neoepitopes.
  • Most of the peptides were able to be identified as a neoepitope, but the number of subjects that present neoepitopes varied.
  • Epitopes harbored by PolyPEPI1018 create an average of 5.21 PEPI3+. These PEPIs can activate T cells in a subject. The amount of potential neoPEPIs was much lower than neoepitopes (3.7%). There is a marginal possibility that these neoPEPIs compete on T cell activation with PEPIs in some subjects. Importantly, the activated neoPEPI specific T cells had no targets on healthy tissue.
  • NeoEPI NeoPEPI ID Neoepitope NO Sub# Sub % NeoEPI count Sub# Sub % NeoPEPI count CRC-P1 QFPVSEGKS 39 0 0.0% 0 0.0% 3 FPVSEGKSR 40 160 37.0% X 1 0.2% X PVSEGKSRY 41 150 34.6% X 0 0.0% VSEGKSRYR 42 194 44.8% X 7 1 0.2% X SEGKSRYRA 43 113 26.1% X 0 0.0% EGKSRYRAQ 44 77 17.8% X 0 0.0% GKSRYRAQR 45 37 8.5% X 0 0.0% KSRYRAQRF 46 337 77.8% X 33 7.6% X CRC-P2 I

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