Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/24—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against cytokines, lymphokines or interferons
  • C07K16/244—Interleukins [IL]
  • C07K16/245—IL-1
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/02—Nasal agents, e.g. decongestants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/04—Drugs for disorders of the respiratory system for throat disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/02—Antineoplastic agents specific for leukemia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/04—Antineoplastic agents specific for metastasis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/10—Antioedematous agents; Diuretics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
  • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/90—Immunoglobulins specific features characterized by (pharmaco)kinetic aspects or by stability of the immunoglobulin
  • C07K2317/92—Affinity (KD), association rate (Ka), dissociation rate (Kd) or EC50 value

Definitions

• the invention relates generally to the fields of medicine, oncology, and immunology. More particularly, the invention relates to the use of antibodies (Abs) which specifically bind interleukin-la (IL-la) to treat a tumor-associated disease and other tumor-associated pathologies.
• Abs antibodies which specifically bind interleukin-la (IL-la) to treat a tumor-associated disease and other tumor-associated pathologies.
• tumor-associated diseases such as cancer remain one of the leading causes of death and morbidity in developed countries.
• standard treatment of most aggressive tumors continues to be surgical resection, chemotherapy, and radiotherapy. While increasingly successful, each of these treatments still causes numerous undesired side effects. For example, surgery results in pain, traumatic injury to healthy tissue, and scarring. Radiotherapy and chemotherapy cause nausea, immune suppression, gastric ulceration, and secondary tumorigenesis.
• Abs can directly target specific types of tumor cells to harness a patient's immune response to kill the tumor. Alternatively, they can target cell growth factors to interfere with the growth of tumor cells. As with conventional chemotherapeutic agents, not all anti-tumor Abs are useful for treating all types of neoplasms, and many initially effective antibodies later lose potency. Thus new anti-tumor Abs are needed.
• the invention is based on the discovery that a mAb that specifically binds IL- la is useful for treating various tumor-associated diseases.
• the invention features a medicament and method for treating neoplastic diseases (e.g., a colorectal cancer such as one having a KRAS mutation, an EBV-associated cancer such as nasopharygeal carcinoma or Burkitt's lymphoma, non-small cell lung cancer (NSCLC) or non-cancerous conditions associated with tumors such as Castleman's disease) in a human subject.
• neoplastic diseases e.g., a colorectal cancer such as one having a KRAS mutation, an EBV-associated cancer such as nasopharygeal carcinoma or Burkitt's lymphoma, non-small cell lung cancer (NSCLC) or non-cancerous conditions associated with tumors such as Castleman's disease
• the method can be performed by administering to the subject a pharmaceutical composition including a pharmaceutically acceptable carrier and an amount of an anti-IL- 1 a Ab effective to ameliorate a symptom of a tumor-associated pathology and/or to reduce the size of a tumor in the subject by at least about 10% (e.g., at least 8, 9, 10, 15, 17, 20, 30, 40, 50, 60, 70, 80, 90, or 100%).
• the medicament can include an anti-IL- 1 a Ab.
• the anti-IL- la Ab can be a mAb such as an IgGl .
• the anti-IL- la Ab can be the mAb designated as MABpl or a mAb that includes one or more complementarity determining regions (CDRs) of MABpl .
• the pharmaceutical composition can be administered to the subject by injection, subcutaneous ly, intravenously, intramuscularly, or directly into a tumor.
• the dose can be at least 0.25 (e.g., at least 0.2, 0.5, 0.75., 1, 2, 3, 4, or 5) mg/ml.
• an “Ab” or “Ab” is an immunoglobulin (Ig), a solution of identical or heterogeneous Igs, or a mixture of Igs.
• An “Ab” can also refer to fragments and engineered versions of Igs such as Fab, Fab', and F(ab')2 fragments; and scFv's, heteroconjugate Abs, and similar artificial molecules that employ Ig- derived CDRs to impart antigen specificity.
• a “mAb” or “mAb” is an Ab expressed by one clonal B cell line or a population of Ab molecules that contains only one species of an antigen binding site capable of immunoreacting with a particular epitope of a particular antigen.
• a “polyclonal Ab” or “polyclonal Ab” is a mixture of heterogeneous Abs.
• a polyclonal Ab will include myriad different Ab molecules which bind a particular antigen with at least some of the different Abs immunoreacting with a different epitope of the antigen.
• a polyclonal Ab can be a mixture of two or more mAbs.
• an "antigen-binding portion" of an Ab is contained within the variable region of the Fab portion of an Ab and is the portion of the Ab that confers antigen specificity to the Ab (i.e., typically the three-dimensional pocket formed by the CDRs of the heavy and light chains of the Ab).
• a "Fab portion” or “Fab region” is the proteolytic fragment of a papain-digested Ig that contains the antigen-binding portion of that Ig.
• a "non-Fab portion” is that portion of an Ab not within the Fab portion, e.g., an "Fc portion” or “Fc region.”
• a "constant region" of an Ab is that portion of the Ab outside of the variable region.
• effector portion of an Ab is the portion of an Ab that is responsible for binding other immune system components that facilitate the immune response.
• the site on an Ab that binds complement components or Fc receptors is an effector portion of that Ab.
• purified means separated from components that naturally accompany such molecules.
• an Ab or protein is purified when it is at least about 10% (e.g., 9%, 10%, 20%, 30% 40%, 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99%, 99.9%, and 100%), by weight, free from the non-Ab proteins or other naturally-occurring organic molecules with which it is naturally associated. Purity can be measured by any appropriate method, e.g., column chromatography, polyacrylamide gel electrophoresis, or HPLC analysis. A chemically-synthesized protein or other recombinant protein produced in a cell type other than the cell type in which it naturally occurs is "purified.”
• bind By “bind”, “binds”, or “reacts with” is meant that one molecule recognizes and adheres to a particular second molecule in a sample, but does not substantially recognize or adhere to other molecules in the sample.
• an Ab that "specifically binds" another molecule has a K d greater than about 10 5 , 10 6 , 10 7 , 10 8 , 10 9 , 10 10 , 10 11 , or 10 12 liters/mole for that other molecule.
• a “therapeutically effective amount” is an amount which is capable of producing a medically desirable effect in a treated animal or human (e.g., amelioration or prevention of a disease or symptom of a disease).
• the invention encompasses compositions and methods for ameliorating one or more symptoms of a tumor-associated pathology in a subject.
• the below described preferred embodiments illustrate adaptation of these compositions and methods. Nonetheless, from the description of these embodiments, other aspects of the invention can be made and/or practiced based on the description provided below.
• compositions and methods described herein are useful for treating a tumor-associated disease in a mammalian subject by administering to the subject a pharmaceutical composition including an amount of an anti-IL- 1 a Ab effective to improve at least one characteristic of the tumor-associated disease in the subject.
• the mammalian subject might be any that suffers from a tumor-associated disease including, human beings, dogs, cats, horses, cattle, sheep, goats, and pigs.
• Human subjects might be male, female, adults, children, seniors (65 and older), and those with other diseases.
• Particularly preferred subjects are those whose disease has progressed after treatment with chemotherapy, radiotherapy, surgery, and/or biologic agents. Any type of a tumor-associated disease susceptible to treatment with an anti- IL-la Ab might be targeted.
• Anti-IL-la Ab administration is thought to be particularly effective for treating colorectal tumors (e.g., colorectal cancers with a KRAS mutation), EBV-associated neoplasms such as nasopharyngeal cancer or Burkitt's lymphoma, NSCLC, and blood cell neoplasms such as in Castleman's disease.
• colorectal tumors e.g., colorectal cancers with a KRAS mutation
• EBV-associated neoplasms such as nasopharyngeal cancer or Burkitt's lymphoma, NSCLC
• blood cell neoplasms such as in Castleman's disease.
• a disease with tumors expressing IL-la or tumors infiltrated with IL- la inflammatory cells might also be targeted.
• the particular characteristic of a tumor-associated disease to be improved can be tumor size (e.g., TO, Tis, or Tl-4), state of metastasis (e.g., MO, Ml), number of observable tumors, node involvement (e.g., NO, l-4, Nx), grade (i.e., grades 1, 2, 3, or 4), stage (e.g., 0, I, II, III, or IV), presence or concentration of certain markers on the cells or in bodily fluids (e.g., AFP, B2M, beta-HCG, BTA, CA 15-3, CA 27.29, CA 125, CA 72.4, CA 19-9, calcitonin, CEA, chromgrainin A, EGFR, hormone receptors, HER2, HCG, immunoglobulins, NSE, NMP22, PSA, PAP, PSMA, S-100, TA-90, and thyroglobulin), and/or associated pathologies (e.g., ascites or e
• any suitable type of Ab or other biologic agent e.g., a fusion protein including an IL- la-binding component such as an IL-1 receptor
• a fusion protein including an IL- la-binding component such as an IL-1 receptor that specifically binds IL-la and reduces a characteristic of a tumor-associated disease in a subject
• the anti-IL-la Ab used might be mAb, a polyclonal Ab, a mixture of mAbs, or an Ab fragment or engineered Ab-like molecule such as an scFv.
• the Ka of the Ab is preferably at least 1 xlO 9 M “1 or greater (e.g., greater than 9 xlO 10 M “1 , 8 xlO 10 M “1 , 7 xlO 10 M “1 , 6 xlO 10 M “1 , 5 xlO 10 M “1 , 4 xlO 10 M “1 , 3 xlO 10 M “1 , 2 xlO 10 M “1 , or 1 xlO 10 M “1 ).
• the invention utilizes a fully human mAb that includes (i) an antigen- binding variable region that exhibits very high binding affinity (e.g., at least nano or picomolar) for human IL- 1 a and (ii) a constant region.
• the human Ab is preferably an IgGl, although it might be of a different isotype such as IgM, IgA, or IgE, or subclass such as IgG2, IgG3, or IgG4.
• a particularly useful mAb is MABpl, an IL-la-specific IgGl mAb described in U.S. patent application serial number 12/455,458 filed on June 1, 2009.
• Other useful mAbs are those that include at least one but preferably all the CDRs of MABpl .
• B lymphocytes which express Ig specific for human IL-la occur naturally in human beings
• a presently preferred method for raising mAbs is to first isolate such a B lymphocyte from a subject and then immortalize it so that it can be continuously replicated in culture.
• Subjects lacking large numbers of naturally occurring B lymphocytes which express Ig specific for human IL-la may be immunized with one or more human IL-la antigens to increase the number of such B lymphocytes.
• Human mAbs are prepared by immortalizing a human Ab secreting cell (e.g., a human plasma cell). See, e.g., U.S. patent no. 4,634,664.
• one or more human subjects are screened for the presence of such human IL-la-specific Ab in their blood.
• Those subjects that express the desired Ab can then be used as B lymphocyte donors.
• peripheral blood is obtained from a human donor that possesses B lymphocytes that express human IL-la-specific Ab.
• B lymphocytes are then isolated from the blood sample, e.g., by cells sorting (e.g., fluorescence activated cell sorting, "FACS"; or magnetic bead cell sorting) to select B lymphocytes expressing human IL-la-specific Ig.
• cells sorting e.g., fluorescence activated cell sorting, "FACS"; or magnetic bead cell sorting
• the B lymphocytes within this population that express Ig specific for human IL- 1 a can then be isolated by limiting dilution methods (e.g., cells in wells of a microtiter plate that are positive for Ig specific for human IL-la are selected and subcultured, and the process repeated until a desired clonal line can be isolated). See, e.g., Goding, MAbs: Principles and Practice, pp. 59-103, Academic Press, 1986.
• Those clonal cell lines that express Ig having at least nanomolar or picomolar binding affinities for human IL-la are preferred.
• MAbs secreted by these clonal cell lines can be purified from the culture medium or a bodily fluid (e.g., ascites) by conventional Ig purification procedures such as salt cuts, size exclusion, ion exchange separation, and affinity chromatography.
• Ig purification procedures such as salt cuts, size exclusion, ion exchange separation, and affinity chromatography.
• immortalized B lymphocytes might be used in in vitro cultures to directly produce mAbs, in certain cases it might be desirable to use heterologous expression systems to produce mAbs. See, e.g., the methods described in U.S. patent application number 1 1/754,899.
• the genes encoding an mAb specific for human IL-la might be cloned and introduced into an expression vector (e.g., a plasmid-based expression vector) for expression in a heterologous host cell (e.g., CHO cells, COS cells, myeloma cells, and E. coli cells).
• an expression vector e.g., a plasmid-based expression vector
• a heterologous host cell e.g., CHO cells, COS cells, myeloma cells, and E. coli cells.
• Igs include heavy (H) and light (L) chains in an H2L2 configuration
• the genes encoding each may be separately isolated and expressed in different vectors.
• chimeric mAbs e.g., "humanized” mAbs
• Such chimeric Abs can be prepared by methods known in the art. See, e.g., Morrison et al, Proc. Nat'l. Acad. Sci. USA, 81 :6851, 1984; Neuberger et al., Nature, 312:604, 1984; Takeda et al, Nature, 314:452, 1984.
• Abs can be humanized by methods known in the art.
• mAbs with a desired binding specificity can be humanized by various vendors or as described in U.S. Pat. Nos. 5,693,762; 5,530, 101 ; or 5,585,089.
• the mAbs described herein might be affinity matured to enhance or otherwise alter their binding specificity by known methods such as VH and VL domain shuffling (Marks et al. Bio/Technology 10:779-783, 1992), random mutagenesis of the hypervariable regions (HVRs) and/or framework residues (Barbas et al. Proc Nat. Acad. Sci. USA 91 :3809-3813, 1994; Schier et al. Gene 169: 147-155, 1995; Yelton et al. J. Immunol. 155: 1994-2004, 1995; Jackson et al, J. Immunol. 154(7):3310-9, 1995; and Hawkins et al, J. Mol.
• Amino acid sequence variants of an Ab may be prepared by introducing appropriate changes into the nucleotide sequence encoding the Ab.
• modifications to nucleic acid sequences encoding mAbs might be altered (e.g., without changing the amino acid sequence of the mAb) for enhancing production of the mAb in certain expression systems (e.g., intron elimination and/or codon optimization for a given expression system).
• the mAbs described herein can also be modified by conjugation to another protein (e.g., another mAb) or non-protein molecule.
• a mAb might be conjugated to a water soluble polymer such as polyethylene glycol or a carbon nanotube (See, e.g., Kam et al, Proc. Natl. Acad. Sci. USA 102: 1 1600-1 1605, 2005). See, U.S. patent application number 1 1/754,899.
• a water soluble polymer such as polyethylene glycol or a carbon nanotube
• the mAb compositions of the invention are at least 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 95, 96, 97, 98, 99, 99.9 or more percent by weight pure (excluding any excipients).
• the mAb compositions of the invention might include only a single type of mAb (i.e., one produced from a single clonal B lymphocyte line) or might include a mixture of two or more (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10 or more) different types of mAbs.
• the human IL-la mAbs might be conjugated with another molecule such as a cytotoxin.
• a human IL-la specific mAb might be conjugated with one or more cytotoxins to more effectively kill cells expressing IL-la.
• Cytotoxins for use in the invention can be any cytotoxic agent (e.g., molecule that can kill a cell after contacting the cell) that can be conjugated to a human IL-la specific mAb.
• cytotoxins include, without limitation, radionuclides (e.g., 35 S, 14 C, 32 P, 125 I, 131 I, 90 Y, 89 Zr, 201 T1, 186 Re, 188 Re, 57 Cu, 213 Bi, and 211 At), conjugated radionuclides, and chemotherapeutic agents.
• radionuclides e.g., 35 S, 14 C, 32 P, 125 I, 131 I, 90 Y, 89 Zr, 201 T1, 186 Re, 188 Re, 57 Cu, 213 Bi, and 211 At
• conjugated radionuclides e.g., chemotherapeutic agents.
• cytotoxins include, but are not limited to, antimetabolites (e.g., 5-fluorouricil (5- FU), methotrexate (MTX), fludarabine, etc.), anti-microtubule agents (e.g., vincristine, vinblastine, colchicine, taxanes (such as paclitaxel and docetaxel), etc.), alkylating agents (e.g., cyclophasphamide, melphalan, bischloroethylnitrosurea (BCNU), etc.), platinum agents (e.g., cisplatin (also termed cDDP), carboplatin, oxaliplatin, JM-216, CI-973, etc.), anthracyclines (e.g., doxorubicin, daunorubicin, etc.), antibiotic agents (e.g., mitomycin-C), topoisomerase inhibitors (e.g., etoposide, tenoposide,
• IL-la specific Abs described above are preferred for use in the invention, in some cases, other agents that specifically target IL-la might be used so long as their administration leads to improvement of a characteristic of a tumor- associated disease. These other agents might include small organic molecules, aptamers, peptides, and proteins that specifically bind IL-la (e.g., anakinra or rilonacept).
• the anti-IL-la Ab compositions may be administered to animals or humans in pharmaceutically acceptable carriers (e.g., sterile saline), that are selected on the basis of mode and route of administration and standard pharmaceutical practice.
• pharmaceutically acceptable carriers e.g., sterile saline
• a list of pharmaceutically acceptable carriers, as well as pharmaceutical formulations, can be found in Remington's Pharmaceutical Sciences, a standard text in this field, and in USP/NF.
• Other substances may be added to the compositions and other steps taken to stabilize and/or preserve the compositions, and/or to facilitate their administration to a subject.
• the Ab compositions might be lyophilized (see Draber et al, J. Immunol. Methods. 181 :37, 1995; and PCT/US90/01383); dissolved in a solution including sodium and chloride ions; dissolved in a solution including one or more stabilizing agents such as albumin, glucose, maltose, sucrose, sorbitol, polyethylene glycol, and glycine; filtered (e.g., using a 0.45 and/or 0.2 micron filter); contacted with beta-propiolactone; and/or dissolved in a solution including a microbicide (e.g., a detergent, an organic solvent, and a mixture of a detergent and organic solvent.
• a microbicide e.g., a detergent, an organic solvent, and a mixture of a detergent and organic solvent.
• the Ab compositions may be administered to animals or humans by any suitable technique. Typically, such administration will be parenteral (e.g., intravenous, subcutaneous, intramuscular, or intraperitoneal introduction).
• the compositions may also be administered directly to the target site (e.g., intratumorally) by, for example, injection.
• Other methods of delivery e.g., liposomal delivery or diffusion from a device impregnated with the composition, are known in the art.
• the composition may be administered in a single bolus, multiple injections, or by continuous infusion (e.g., intravenously or by peritoneal dialysis).
• a therapeutically effective amount is an amount which is capable of producing a medically desirable result in a treated animal or human.
• An effective amount of anti-IL- 1 a Ab compositions is an amount which shows clinical efficacy in patients as measured by the improvement in one or more a tumor-associated disease characteristics described above.
• dosage for any one animal or human depends on many factors, including the subject's size, body surface area, age, the particular composition to be administered, sex, time and route of administration, general health, and other drugs being administered concurrently.
• Preferred doses range from about 0.2 to 20 (e.g., 0.15, 0.2, 0.3, 0.4, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 50, or 100) mg/kg body weight.
• the dose may be given repeatedly, e.g., hourly, daily, semi -weekly, weekly, bi-weekly, tri-weekly, or monthly.
• XilonixTM is a sterile injectable liquid formulation of 15 mg/mL MABpl in a stabilizing isotonic buffer (pH 6.4).
• a stabilizing isotonic buffer pH 6.4.
• Each 10-mL Type I borosilicate glass serum vial contains 5 mL of the formulation, and is sealed with a 20-mm Daikyo Flurotec butyl rubber stopper and flip-off aluminum seal.
• the product is stored at 5 ⁇ 3°C, with excursions to room temperature permitted.
• the exact composition of the drug product is shown below:
• the calculated volume is withdrawn from the drug (mAb)-containing vial(s) using a suitable syringe.
• the drug is then injected into a small IV bag containing 100 mL of normal saline (0.9% NaCl) and mixed by inversion.
• the diluted drug product can be stored at room temperature for 3 hours prior to administration and is infused over a 1-hour period, with the subject being monitored for signs of an infusion reaction.
• the infusion is chased with a minimum of 30 mLs of normal saline to deliver any product that may be held up in the infusion set.
• Example 2 Treatment of Colorectal Cancer with an IL- la-specific MAb (XilonixTM).
• the human subject was a 63 year-old female diagnosed with metastatic colorectal cancer (KRAS mutation positive). Prior to treatment with XilonixTM, the subject underwent right hemicolectomy and was reportedly staged T3N1MX. She thereafter received adjuvant chemotherapy with FOLFOX for a total of 12 cycles over about six months. A PET CT scan performed about two months after completion of FOLFOX revealed a mass in her pelvis. The subject was hospitalized at the time for placement of ureteral stent due to obstructive hydronephrosis apparently from the tumor. She started FOLFIRI and Avastin shortly thereafter and received 8 cycles of therapy.
• the subject then underwent re-staging PET CT scan which confirmed disease in the pelvis, and also revealed small pulmonary nodules consistent with metastatic disease.
• a CT scan of the chest, abdomen and pelvis revealed a 12 cm pelvic mass, a 2 cm omental mass, and the hydronephrosis on the right side with associated ureteral stent. She received 2 extra cycles of FOLFIRI and Avastin.
• a subsequent PET CT scan showed progression of the bilateral pulmonary nodules.
• the subject then started irinotecan and Erbitux ® (Cetuximab) therapy.
• a follow up PET CT scan demonstrated disease progression in the lungs.
• a left lung metastasis decreased from 2.2 cm to 1.9 cm, and an implant from the left rectus muscle decreased from 3.2 cm to 2.7 cm.
• the CEA tumor marker at baseline was 81, decreased to 69.2 at the end of cycle 3, and was 27.9 as of Cycle 7 Dayl . This patient has continued on therapy for over 71 weeks and the disease has remained stable.
• Example 3 Treatment of Nasopharygeal Cancer with an IL- la-specific MAb (XilonixTM).
• the subject was a 47 year old Chinese male having EBV+ (Epstein-Barr virus) nasopharyngeal carcinoma with the histological subtype lymphoepithelioma (old terminology) or non-keratinizing carcinoma.
• the subject was previously treated with cisplatin, 5-FU, radiotherapy, Taxotere ® (Docetaxel), Gemzar® (Gemcitabine) , Xeloda ® (Capecitabine), adoptive EBV-directed T cell transfer, and Cymevene ® ⁇ Ganciclovir) in combination with Gemzar® (Gemcitabine) .
• the patient Prior to starting therapy, the patient had fatigue, fevers and sweats, and was receiving frequent therapeutic paracentesis for ascites.
• the subject began MABpl treatment on day 0 at 1.25 mg/kg IV every two weeks. By days 3 and 4, a marked decrease in the subjects fatigue, fevers, and sweats was noted. The ascites also resolved. Abdominal CT abdomen scans showed a reduction in the size of a metastatic liver tumor from 50.4mm on day 1 to 35.8mm by day 36 (almost 30%) of one of the masses. Multiple other liver lesions decreased in size, and bone lesions appeared to be stable.
• Example 4 Treatment of Castleman's Syndrome with an IL-la-specific MAb (XilonixTM).
• the subject was a 55-year-old woman suffering from Castleman's disease (the variant known as POEMS syndrome). Her symptoms included fatigue, edema, and nerve pain. Prior treatment with Rituxan ® (Rituximab) and an investigational anti-IL-6 therapy failed. The subject was administered a total of four infusions of MABpl (0.75 mg/kg) every 21 days. The subject's dose was increased to 1.25 mg/kg in the next cycle. [0040] This subject had stable disease through 2 re-stagings, and has been treated for over 4 months. For approximately 2 weeks after each injection, her symptoms of fatigue, edema, and nerve pain improved significantly, and then gradually recurred until the next injection. Her RECIST staging criteria showed 2% increase of lymph node size from baseline at the first restage, and 4% increase of lymph node size from baseline at the second restage.
• the subject After completing 7 cycles, the subject withdrew consent for therapy in order to try another experimental treatment. After being off study for 8 weeks, the subject physician requested that she be allowed to resume therapy with MABpl due to "rapid disease progression". Since resuming treatment, the subject's disease is stable and she has been on study for over 58 weeks.
• Example 5 Treatment of NSCLC with an IL- la-specific MAb (XilonixTM).
• the subject was an 84 year old female with a history of metastatic non-small cell lung cancer diagnosed by fine needle aspiration. Three months after diagnosis, the subject began treatment with Tarceva® (Erlotinib) for 8 months at which point disease progression was noted. The subject was then treated with 1 1 cycles of Alimta ® (Permetrexed) over 8 months, at which time treatment was halted due to the development of renal failure of undetermined etiology. Six months later, progressive disease was noted and the patient was again treated with Tarceva® (Erlotinib) for 3 months. At that point, her CAT scan showed further progressive disease in the lungs with an increase in size of a right upper-lobe mass, pulmonary nodules consistent with metastases, and increasing intra-thoracic adenopathy.
• Example 6 Treatment of Non-small Cell Lung Cancer with an IL- la- specific MAb (XilonixTM).
• the subject was a 52 yr old female diagnosed with KRAS-positive non-small cell (adenocarcinoma) cancer of the lung on day 0.
• a PET/CT scan from day 14 revealed a 4 x 3.5 cm left upper lobe mass, with disease metastasis to the lungs, hilar nodes, right inguinal nodes, right adrenal, 4th right rib, and sacroiliac joint.
• the subject began treatment with Carboplatin, Paclitaxel, and Bevacizumab a few weeks after the scan. The subject had a good initial response and completed five cycles before progressing at about 5 months from the first treatment. Over the next six months, the subject was treated with 3 cycles of Docetaxel and one cycle of Carboplatin plus Pemetrexed. Despite this therapy, she continued to progress.
• the subject subsequently began treatment with MABpl . After only 4 days the subject began experiencing a worsening of her headaches. These were initially attributed to sinusitis, but MRI revealed brain metastases. The investigator believed that these were likely present prior to beginning therapy, however, the subject came off of study after only one dose of MABpl to receive gamma-knife radiotherapy. The subject was seen in follow up twenty days after the initial MABpl dose, and reported a subjective improvement in symptoms with a decrease in her chest pain. Because of this, the investigator checked a chest x-ray, which showed "an obvious decrease in the size of her lung lesions" after only one dose. A waiver was issued, and the subject resumed therapy. Forty-six days after the initial MABpl dose, the subject underwent restaging, and had a 6% decrease in the sum total diameter of lesions as graded by RECIST criteria.

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