WO2017125765A1

WO2017125765A1 - Immunotherapeutic treatment of cancer

Info

Publication number: WO2017125765A1
Application number: PCT/GB2017/050164
Authority: WO
Inventors: Charles AKLE; John Grange
Original assignee: Immodulon Therapeutics Limited
Priority date: 2016-01-22
Filing date: 2017-01-23
Publication date: 2017-07-27
Also published as: GB201601248D0

Abstract

The present invention resides in the preparation of a medicament to aid in the treatment of cancer. According to the invention, there is a non-viable whole cell Mycobacterium for use in the treatment of a cancer in combination with a tumour associated antigen (TAA), wherein the cancer is characterised by the presence of the TAA.

Description

IMMUNOTHERAPEUTIC TREATMENT OF CANCER

FIELD OF THE INVENTION The present invention relates to the field of cancer therapy. In particular, the present invention relates to a method of preventing, treating or inhibiting the development of tumours and/or metastases in a subject.

BACKGROUND OF THE INVENTION

In humans with advanced cancer, anti-tumour immunity becomes ineffective due to the tightly regulated interplay of pro- and anti-inflammatory, immune- stimulatory and immunosuppressive signals. For example, loss of the antiinflammatory signals leads to chronic inflammation and prolonged proliferative signalling. Interestingly, cytokines that both promote and suppress proliferation of the tumour cells are produced at the tumour site. It is the imbalance between the effects of these various processes that results in tumour promotion.

To date, a major barrier to attempts to develop effective immunotherapy for cancer has been an inability to break immunosuppression at the cancer site and restore normal networks of immune reactivity. The physiological approach of immunotherapy is to normalize the immune reactivity so that, for example, the endogenous tumour antigens would be recognized and effective cytolytic responses would be developed against tumour cells. Although it was once unclear if tumour immunosurveillance existed, it is now believed that the immune system constantly monitors and eliminates newly transformed cells. Accordingly, cancer cells may alter their phenotype in response to immune pressure in order to escape attack (immunoediting) and upregulate expression of inhibitory signals. Through immunoediting and other subversive processes, primary tumour and metastasis maintain their own survival.

Tumour associated antigens (TAAs) can be recognised by autologous antibodies and T cells and are capable of inducing tumour-directed immune responses. Many TAAs are now potential targets for immunotherapies, being prepared as part of a "cancer vaccine".

However, producing effective treatment vaccines has proven to be challenging. To be effective, cancer treatment vaccines must achieve two goals. First, they must stimulate specific immune responses against the correct target and, second, the immune responses must be powerful enough to overcome the barriers that cancer cells use to protect themselves from attack by immune cells. In the context of therapy based on administration of TAAs, there is a problem in that TAAs are often at the core self-antigens, so the immune system is geared towards not responding to them. Therefore, there can be a lack of effective targeting to dendritic cells and consequently a lack of induction of effective anti- tumour Type 1 responses.

There is therefore a need for improved cancer vaccine therapy aimed at TAA. SUMMARY OF THE INVENTION The present inventors have identified that there is significant genetic sequence homology between the sequences of a number of relevant and common TAAs and sequences present in the genome of mycobacteria, particularly M. obuense (NCTC13365) and M. vaccae (NCTC1 1695). This genetic similarity can be exploited to provide a therapy for patients suffering from a neoplastic disorder characterised by the presence of endogenous TAAs corresponding to those intended for administration.

The present invention provides an effective method for treating and/or preventing cancer and/or the establishment of metastases by administering selective tumour associated antigens together with a whole cell Mycobacterium.

In a first aspect of the invention, there is a non-viable whole cell Mycobacterium and a tumour associated antigen (TAA) as a combined preparation for simultaneous, separate, or sequential use in the treatment of a neoplastic disease.

In a second aspect of the invention, there is a method of treating, reducing, inhibiting or controlling a neoplastic disorder in a subject, wherein said method comprises simultaneously, separately or sequentially administering a method for treating a neoplastic disorder in a patient, comprising administering to the patient a non-viable whole cell Mycobacterium and one or more tumour associated antigens, wherein the disorder is characterised by the presence of said one or more antigens, and wherein the antigen(s) to be administered to the patient have genetic homology to exogenous sequences in said Mycobacterium.

In a third aspect of the invention, there is a non-viable Mycobacterium for therapeutic use in priming dendritic cells in a patient suffering a neoplastic disorder, wherein the Mycobacterium is M. obuense (IMM-101 ) and the disorder is characterised by the presence of one or more of the following tumour associate antigens: ERBB2, CDK4, RASK, WTIP, CDC27, MAGEA1 , MUC5AC, TP53, or CSAG2. In a fourth aspect of the invention, there is a non-viable Mycobacterium for therapeutic use in priming dendritic cells in a patient suffering a neoplastic disorder, wherein the Mycobacterium is M. vaccae (NCTC1 1695) and the disorder is characterised by the presence of one or more of the following tumour associated antigens: CDK4, ERBB2, RASK, PTPRC, GAGE7, MUC5A, GAGE2b, TP53, GAGE2a, CDC27, MSLN, MAGEA1 , MUC16, REC04, or SSX2.

The present invention therefore provides a combination therapy of specific tumour associated antigens together with a specific Mycobacterium. The inventors have found that the combination of both therapies has benefits over the administration of TAAs only. Description of the Drawings

The invention is described with reference to the following drawings, in which: Figure 1 illustrates overall survival Kaplan-Meier Curves for the Intention to Treat (ITT) population in an all patient (a) and a metastatic subgroup (b), shows significant effect of IMM-101 (M. obuense) treatment (0.1 mL intradermal injection of 10mg/ml_) in combination with gemcitabine (1000mg/m²) in the metastatic group (p= 0.01 1) compared to control (Gemcitabine alone) and a trend towards protection in all patients (p= 0.075). Survival Probability at 12, 18 and 24 months for ITT population ±SEM is shown for the all patient group (c) and metastatic subgroup (d).

Figure 2 illustrates (A) Flow cytometric analysis of the activation/maturation or (B) ELISA of cell culture supernatants from murine GMCSF bone marrow derived DCs following overnight stimulation with 10, 100 or 300pg/ml IMM-101 ,

PBS, 250g/ml LPS or 250pg/ml Pam3Cys (Data combined from 3 experiments).

(C) Flow cytometric analysis or of the activation/maturation or (D) CBA analysis of culture supernatants from human monocyte derived DCs following overnight culture with 10, 100 or 300 g/ml IMM-101 , PBS, or 250ng/ml LPS (one example donor from 2 repeats). (* p<0.05, ** p<0.01 , *** p<0.001 ). This shows the ability of M. obuense (IMM101 ) to prime dendritic cells.

Figure 3 illustrates CFSE-labeled OVA specific OTII CD4⁺ T cells were cultured for 72 hours alone (T cells'), with murine GMCSF bone marrow derived DCs that had been pre-exposed to IMM-101 (ΊΜΜ'), or with control, non-exposed DCs ('Media'), with the addition of OVA peptide (0.01 pg/ml) or OVA protein (5 pg/ml). (A) Flow cytometric histograms showing cell proliferation CFSE dilution in OTII T cells and (B) the percentage of T cells in each proliferation peak (±SEM). This shows the ability of M. obuense (IMM101) to effectively prime dendritic cells and the positive effect on presentation to CD4⁺ cells. Figure 4 illustrates (A) Mice were injected s.c. with IMM-101 -activated or control (media) GMCSF bone marrow derived DCs or Propionibacterium acnes (P.acnes)-activated GMGSF bone marrow-derived DCs. 7 days later, draining lymph nodes were removed, and lymph node (LN) cells cultured for 72 hours with media, 100pg/ml IMM-101 , 10pg/ml P. acnes or 16.67pg/ml plate bound anti-CD3. (B) Cytokine levels in culture supernatants were determined by ELISA (±SEM). (* p<0.05, ** p<0.01 , *** p<0.001).

Detailed Description of the Invention

The present invention provides an effective means to treat neoplastic disorders with immunotherapy. The realisation that mycobacteria share sequence homology with certain TAAs allows the mycobacteria to be utilised in therapies designed to treat neoplastic disorders using TAAs. The mycobacteria are shown to activate dendritic cells for effective antigen presentation and help provide a powerful immune response to overcome the barriers that cancer cells use to protect against attack by immune cells such as cytotoxic T cells, natural killer cells and macrophages. In order that the present invention may be more readily understood, certain terms are first defined. Additional definitions are set forth throughout the detailed description.

The terms "tumour," "cancer" and "neoplasia" are used interchangeably and refer to a cell or population of cells whose growth, proliferation or survival is greater than growth, proliferation or survival of a normal counterpart cell, e.g. a cell proliferative or differentiative disorder. Typically, the growth is uncontrolled. The term "malignancy" refers to invasion of nearby tissue. The term "metastasis" refers to spread or dissemination of a tumour, cancer or neoplasia to other sites, locations or regions within the subject, in which the sites, locations or regions are distinct from the primary tumour or cancer. The term "therapeutically effective amount" is defined as an amount of a TAA, in combination with a Mycobacterium, that preferably results in a decrease in severity of disease symptoms, an increase in frequency and duration of disease symptom-free periods, or a prevention of impairment or disability due to the disease affliction. The terms "effective amount" or "pharmaceutically effective amount" refer to a sufficient amount of an agent to provide the desired biological or therapeutic result. That result can be reduction, amelioration, palliation, lessening, delaying, and/or alleviation of one or more of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system. In reference to cancer, an effective amount may comprise an amount sufficient to cause a tumour to shrink and/or to decrease the growth rate of the tumour (such as to suppress tumour growth) or to prevent or delay other unwanted cell proliferation. In some embodiments, an effective amount is an amount sufficient to delay development, or induce stabilisation of the cancer or tumour. It may also prolong survival.

In some embodiments, a therapeutically effective amount is an amount sufficient to prevent or delay recurrence. A therapeutically effective amount can be administered in one or more administrations. The therapeutically effective amount of the therapeutic preparation or preparations may result in one or more of the following: (i) reduce the number of cancer cells; (ii) reduce tumour size; (iii) inhibit, retard, slow to some extent and preferably stop cancer cell infiltration into peripheral organs; (iv) inhibit (i.e., slow to some extent and preferably stop) tumour metastasis; (v) inhibit tumour growth; (vi) prevent or delay occurrence and/or recurrence of tumour; and/or (vii) relieve to some extent one or more of the symptoms associated with the cancer.

For example, for the treatment of tumours, a "therapeutically effective dosage" may induce tumour shrinkage by at least about 5 % relative to baseline measurement, such as at least about 10 %, or about 20 %, or about 60 % or more. The baseline measurement may be derived from untreated subjects.

A therapeutically effective amount of a therapeutic preparation or preparations can decrease tumour size, or otherwise ameliorate symptoms in a subject. One of ordinary skill in the art would be able to determine such amounts based on such factors as the subject's size, the severity of the subject's symptoms, and the particular composition or route of administration selected.

The term "immune response" refers to the action of, for example, lymphocytes, antigen presenting cells, phagocytic cells, granulocytes, and soluble macromolecules produced by the above cells or the liver (including antibodies, cytokines, and complement) that results in selective damage to, destruction of, or elimination from the human body of cancerous cells.

The term "treatment" or "therapy" refers to administering an active agent with the purpose to cure, heal, alleviate, relieve, alter, remedy, ameliorate, improve, or affect a condition (e.g., a disease), the symptoms of the condition, or to prevent or delay the onset of the symptoms, complications, biochemical indicia of a disease, or otherwise arrest or inhibit further development of the disease, condition, or disorder in a statistically significant manner.

As used herein, the term "subject" is intended to include human and non- human animals. Preferred subjects include human patients in need of enhancement of an immune response. The methods are particularly suitable for treating human patients having a neoplastic disorder. In a particular embodiment, the methods are particularly suitable for treatment of cancer cells in vivo. As used herein, the terms "concurrent administration" or "concurrently" or "simultaneous", "sequential" or "separate" mean that administration of the Mycobacterium and TAA occur as part of the same treatment regimen.

"Simultaneous" administration, as defined herein, includes the administration of the Mycobacterium and one or more TAAs within about 2 hours or about 1 hour or less of each other, even more preferably at the same time. "Separate" administration, as defined herein, includes the administration of the Mycobacterium and one or more TAAs, more than about 12 hours, or about 8 hours, or about 6 hours or about 4 hours or about 2 hours apart. "Sequential" administration, as defined herein, includes the administration of the Mycobacterium and one or more TAAs each in multiple aliquots and/or doses and/or on separate occasions. The Mycobacterium may be administered to the patient after before and/or after administration of the one or more TAAs. Alternatively, the Mycobacterium is continued to be applied to the patient after treatment with the one or more TAAs.

The use of the alternative (e.g., "or") should be understood to mean either one, both, or any combination thereof of the alternatives. As used herein, the indefinite articles "a" or "an" should be understood to refer to "one or more" of any recited or enumerated component.

As used herein, "about" means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, i.e., the limitations of the measurement system. For example, "about" can mean within 1 or more than 1 standard deviation per the practice in the art. Alternatively, "about" can mean a range of up to 20%. When particular values are provided in the application and claims, unless otherwise stated, the meaning of "about" should be assumed to be within an acceptable error range for that particular value.

The Mycobacterium is non-viable, e.g. is a heat-killed Mycobacterium, preferably a whole cell Mycobacterium. Examples of mycobacterial species for use in the present invention include M. vaccae, M. thermoresistibile, M. flavescens, M. duvalii, M. phlei, M. obuense, M. parafortuitum, M. sphagni, M. aichiense, M. rhodesiae, M. neoaurum, M. chubuense, M. tokaiense, M. komossense, M. aurum, M. w, M. tuberculosis, M. microti; M. africanum; M. kansasii, M. marinum; M. simiae; M. gastri; M. nonchromogenicum; M. terrae; M. triviale; M. gordonae; M. scrofulaceum; M. paraffinicum; M. intracellulare; M. avium; M. xenopi; M. ulcerans; M. diernhoferi, M. smegmatis; M. thamnopheos; M. flavescens; M. fortuitum; M. peregrinum; M. chelonei; M. paratuberculosis; M. leprae; M. lepraemurium and combinations thereof. Preferably, the heat-killed Mycobacterium is non-pathogenic. The nonpathogenic heat-killed Mycobacterium is preferably selected from M. vaccae, M. obuense, M. parafortuitum, M. aurum, M. indicus pranii, M. phlei and combinations thereof. More preferably the non-pathogenic heat-killed Mycobacterium is a rough variant. The amount of Mycobacterium administered to the patient is sufficient to elicit a protective immune response in the patient such that the patient's immune system is able to mount an effective immune response to the cancer or tumour. In certain embodiments of the invention, there is provided a containment means comprising the effective amount of heat-killed Mycobacterium or use in the present invention, which typically may be from 10³ to 10¹¹ organisms, preferably from 10⁴ to 10¹⁰ organisms, more preferably from 10⁶ to 10¹⁰ organisms, and even more preferably from 10⁶ to 10⁹ organisms. The effective amount of heat-killed Mycobacterium for use in the present invention may be from 10³ to 10¹¹ organisms, preferably from 10⁴ to 10¹⁰ organisms, more preferably from 10⁶ to 10¹⁰ organisms, and even more preferably from 10⁶ to 10⁹ organisms. Most preferably the amount of heat-killed Mycobacterium for use in the present invention is from 10⁷ to 10⁹ cells or organisms. Typically, the composition according to the present invention may be administered at a dose of from 10⁸ to 10⁹ cells for human and animal use. Alternatively the dose is from 0.01 mg to 1 mg or from 0.1 mg to 1 mg organisms presented as either a suspension or dry preparation.

M. vaccae and M. obuense are particularly preferred. M. obuense is sometimes referred to as IMM-101 and a suitable exemplary strain is deposited under the NCTC accession number, NCTC13365. A suitable exemplary strain of M.vaccae is deposited under the NCTC accession number NCTC1 1659.

The present invention may be used to treat a neoplastic disease, such as solid or non-solid cancers. As used herein, "treatment" encompasses the prevention, reduction, control and/or inhibition of a neoplastic disease. Such diseases include a sarcoma, carcinoma, adenocarcinoma, melanoma, myeloma, blastoma, glioma, lymphoma or leukemia. Exemplary cancers include, for example, carcinoma, sarcoma, adenocarcinoma, melanoma, neural (blastoma, glioma), mesothelioma and reticuloendothelial, lymphatic or haematopoietic neoplastic disorders (e.g., myeloma, lymphoma or leukemia). In particular aspects, a neoplasm, tumour or cancer includes a lung adenocarcinoma, lung carcinoma, diffuse or interstitial gastric carcinoma, colon adenocarcinoma, prostate adenocarcinoma, esophagus carcinoma, breast carcinoma, pancreas adenocarcinoma, ovarian adenocarcinoma, adenocarcinoma of the adrenal gland, adenocarcinoma of the endometrium or uterine adenocarcinoma.

Neoplasia, tumours and cancers include benign, malignant, metastatic and non- metastatic types, and include any stage (I, II, III, IV or V) or grade (G1 , G2, G3, etc.) of neoplasia, tumour, or cancer, or a neoplasia, tumour, cancer or metastasis that is progressing, worsening, stabilized or in remission. Cancers that may be treated according to the invention include but are not limited to cells or neoplasms of the bladder, blood, bone, bone marrow, brain, breast, colon, esophagus, gastrointestines, gum, head, kidney, liver, lung, nasopharynx, neck, ovary, prostate, skin, stomach, testis, tongue, or uterus. In addition, the cancer may specifically be of the following histological type, though it is not limited to the following: neoplasm, malignant; carcinoma; carcinoma, undifferentiated; giant and spindle cell carcinoma; small cell carcinoma; papillary carcinoma; squamous cell carcinoma; lymphoepithelial carcinoma; basal cell carcinoma; pilomatrix carcinoma; transitional cell carcinoma; papillary transitional cell carcinoma; adenocarcinoma; gastrinoma, malignant; cholangiocarcinoma; hepatocellular carcinoma; combined hepatocellular carcinoma and cholangiocarcinoma; trabecular adenocarcinoma; adenoid cystic carcinoma; adenocarcinoma in adenomatous polyp; adenocarcinoma, familial polyposis coli; solid carcinoma; carcinoid tumour, malignant; bronchiolo-alveolar adenocarcinoma; papillary adenocarcinoma; chromophobe carcinoma; acidophil carcinoma; oxyphilic adenocarcinoma; basophil carcinoma; clear cell adenocarcinoma; granular cell carcinoma; follicular adenocarcinoma; papillary and follicular adenocarcinoma; nonencapsulating sclerosing carcinoma; adrenal cortical carcinoma; endometroid carcinoma; skin appendage carcinoma; apocrine adenocarcinoma; sebaceous adenocarcinoma; ceruminous adenocarcinoma; mucoepidermoid carcinoma; cystadenocarcinoma; papillary cystadenocarcinoma; papillary serous cystadenocarcinoma; mucinous cystadenocarcinoma; mucinous adenocarcinoma; signet ring cell carcinoma; infiltrating duct carcinoma; medullary carcinoma; lobular carcinoma; inflammatory carcinoma; Paget's disease, mammary; acinar cell carcinoma; adenosquamous carcinoma; adenocarcinoma with squamous metaplasia; thymoma, malignant; ovarian stromal tumour, malignant; thecoma, malignant; granulosa cell tumour, malignant; androblastoma, malignant; Sertoli cell carcinoma; Leydig cell tumour, malignant; lipid cell tumour, malignant; paraganglioma, malignant; extra- mammary paraganglioma, malignant; pheochromocytoma; glomangiosarcoma; malignant melanoma; amelanotic melanoma; superficial spreading melanoma; malignant melanoma in giant pigmented nevus; epithelioid cell melanoma; blue nevus, malignant; sarcoma; fibrosarcoma; fibrous histiocytoma, malignant; myxosarcoma; liposarcoma; leiomyosarcoma; rhabdomyosarcoma; embryonal rhabdomyosarcoma; alveolar rhabdomyosarcoma; stromal sarcoma; mixed tumour; Mullerian mixed tumour; nephroblastoma; hepatoblastoma; carcinosarcoma; mesenchymoma, malignant; Brenner tumour, malignant; phyllodes tumour, malignant; synovial sarcoma; mesothelioma, malignant; dysgerminoma; embryonal carcinoma; teratoma, malignant; struma ovarii, malignant; choriocarcinoma; mesonephroma, malignant; hemangiosarcoma; hemangioendothelioma, malignant; Kaposi's sarcoma; hemangiopericytoma, malignant; lymphangiosarcoma; osteosarcoma; juxtacortical osteosarcoma; chondrosarcoma; chondroblastoma, malignant; mesenchymal chondrosarcoma; giant cell tumour of bone; Ewing's sarcoma; odontogenic tumour, malignant; ameloblastic odontosarcoma; ameloblastoma, malignant; ameloblastic fibrosarcoma; pinealoma, malignant; chordoma; glioma, malignant; ependymoma; astrocytoma; protoplasmic astrocytoma; fibrillary astrocytoma; astroblastoma; glioblastoma; oligodendroglioma; oligodendroblastoma; primitive neuroectodermal; cerebellar sarcoma; ganglioneuroblastoma; neuroblastoma; retinoblastoma; olfactory neurogenic tumour; meningioma, malignant; neurofibrosarcoma; neurilemmoma, malignant; granular cell tumour, malignant; malignant lymphoma; Hodgkin's disease; Hodgkin's; paragranuloma; malignant lymphoma, small lymphocytic; malignant lymphoma, large cell, diffuse; malignant lymphoma, follicular; mycosis fungoides; other specified non-Hodgkin's lymphomas; malignant histiocytosis; multiple myeloma; mast cell sarcoma; immunoproliferative small intestinal disease; leukemia; lymphoid leukemia; plasma cell leukemia; erythroleukemia; lymphosarcoma cell leukemia; myeloid leukemia; basophilic leukemia; eosinophilic leukemia; monocytic leukemia; mast cell leukemia; megakaryoblastic leukemia; myeloid sarcoma; and hairy cell leukemia. Preferably, the neoplastic disease may be tumours associated with a cancer selected from prostate cancer, liver cancer, renal cancer, lung cancer, breast cancer, colorectal cancer, pancreatic cancer, brain cancer, hepatocellular cancer, lymphoma, leukaemia, gastric cancer, cervical cancer, ovarian cancer, thyroid cancer, melanoma, head and neck cancer, skin cancer and soft tissue sarcoma and/or other forms of carcinoma. The tumour may be metastatic or a malignant tumour.

More preferably, the neoplastic disease to be treated is pancreatic cancer, breast cancer, lung cancer, ovarian cancer, colorectal cancer, prostate cancer and skin cancer. In a preferred embodiment the neoplastic disease to be treated is pancreatic cancer. In a further preferred embodiment, the neoplastic disease to be treated is lung cancer. In a further preferred embodiment, the neoplastic disease to be treated is colorectal cancer. In an embodiment of the invention, the therapy is used to reduce or inhibit metastasis of a primary tumour or cancer to other sites, or the formation or establishment of metastatic tumours or cancers at other sites distal from the primary tumour or cancer, thereby inhibiting or reducing tumour or cancer relapse or tumour or cancer progression.

In further embodiments, methods of the invention include, one or more of the following: 1) reducing or inhibiting growth, proliferation, mobility or invasiveness of tumour or cancer cells that potentially or do develop metastases, 2) reducing or inhibiting formation or establishment of metastases arising from a primary tumour or cancer to one or more other sites, locations or regions distinct from the primary tumour or cancer; 3) reducing or inhibiting growth or proliferation of a metastasis at one or more other sites, locations or regions distinct from the primary tumour or cancer after a metastasis has formed or has been established, 4) reducing or inhibiting formation or establishment of additional metastasis after the metastasis has been formed or established, 5) prolonged overall survival, 6) prolonged progression free survival, or 7) disease stabilisation.

The therapeutic effect may not take effect immediately. For example, treatment may be followed by an increase in the neoplasia, tumour or cancer cell numbers or mass, but over time eventual stabilization or reduction in tumour cell mass, size or numbers of cells in a given subject may subsequently occur.

Additional adverse symptoms and complications associated with neoplasia, tumour, cancer and metastasis that can be inhibited, reduced, decreased, delayed or prevented include, for example, nausea, lack of appetite, lethargy, pain and discomfort. Thus, a partial or complete decrease or reduction in the severity, duration or frequency of an adverse symptom or complication associated with or caused by a cellular hyperproliferative disorder, an improvement in the subjects quality of life and/or well-being, such as increased energy, appetite, psychological well-being, are all particular non-limiting examples of therapeutic benefit.

A therapeutic benefit or improvement therefore can also include a subjective improvement in the quality of life of a treated subject. In an additional embodiment, a method prolongs or extends lifespan (survival) of the subject. In a further embodiment, a method improves the quality of life of the subject.

The Mycobacterium for use according to the invention is administered in combination with one or more TAAs that share genetic sequence homology with the Mycobacterium. The term "genetic sequence homology" is intended to mean that the sequence of a TAA is significantly similar to a genetic sequence in the Mycobacterium. The sequence similarity can be derived by carrying out a BLAST (Basic Local Alignment Search Tool) alignment and analysis between a TAA and the mycobacterial generic sequence. The BLAST method, using the BLAST software version 2.2.28 (available at www.blast.ncbi.nlm.nih.gov/Blast.cqi), using the heuristic based algorithm identifies similar sequences by locating short matches between two sequences - known as seeding, allowing identification and scoring for the significance of each alignment according to the BLAST algorithm. The BLAST algorithm locates all common sequences of interest (cased on amino acid alignment) and aligns them to a preferred database or reference sequence, e.g. the genome sequences of the Mycobacterium. The sequences identified are then used to assemble aligned sequences and identify homologous regions and scored for significance according to key criteria including e-value scores.

The parameters used to identify homologues were "stringent" parameters. This required the "alignment length" to be at least 50 base pairs (bp) and an "e-val" score to be less than 0.5.

In a preferred embodiment, the therapy comprises administration of M. obuense in combination with one or more of the TAAs identified in Table 1. Table 1 TAA with homologies to sequences in M. obuense NCTC13365.

SUBSTITUTE SHEET RULE 26 RASK GTPase KRas httD://www.Droteinatlas.ora/ENSG00000133703-

KRAS/aene

WTIP Wilms tumour http://www.uniprot.org/uniprot/A6NIX2

protein 1 - interacting protein

CDC27 Cell division cycle httD://www.Droteinatlas.ora/ENSG00000004897- protein 27 CDC27/cancer

homolog

MAGEA1 Melanoma- http://www.uniprot.org/uniprot/P43355

associated

antigen 1

MUC5A Mucin-5AC http://www.uniprot.org/uniprot/P98088

TP53 Cellular tumour httD://www.Droteinatlas.ora/ENSG00000141510- antigen p53 TP53/aene

CSAG2 Chondrosarcoma- http://www.proteinatlas.orq/ENSG00000198930- associated gene CSAG1/aene

2/3 protein

To maximize success of TAAs used in immunotherapy, target TAAs with a restricted expression pattern in normal tissues need to be identified. Ideally target TAAs should be expressed in high frequency in tumour tissue and induce strong adaptive immune responses to confirm their immunogenic potential. Here we describe in some details whether the TAA showing homologies with M. obuense NCTC13365 may offer potential as suitable immunotherapeutic targets.

CDK4

Cyclin-dependent Kinase 4 (CDK4) is a member of the Ser/Thr kinase family. The human protein shares 94% and 95% aa sequence identity with the mouse and rat orthologs, respectively. CDK4 shuttles between the cytoplasm and nucleus as part of its role in cell cycle regulation. It promotes the transition from G1 to S phase by phosphorylating and inactivating RB1. Activation of CDK4 requires binding of a D-type Cyclin and phosphorylation of Thr172 by the CAK

SUBSTITUTE SHEET RULE 26 kinase complex. Negative regulators of CDK4 are Calcineurin, p21/CIP1/CDKN1A and p27/Kip1. CDK4 inhibition decreases homologous recombination and increases non-homologous end joining, suggesting that CDK4 may also promote error free DNA repair.

CDK4s might play a significant role in malignant disease. Amplification of the CDK4 gene, located at 12q13-q14, has been found as an alternative genetic alteration to CDKN2A inactivation in various human tumors including malignant gliomas and sarcomas (An et al, 1999). A somatic point mutation (R24C) of the CDK4 gene was identified in human melanomas, causing a tumor-specific antigen and disrupting the interaction between CDK4 and its inhibitor p16 and is recognized by CD8+ cells (Wolfel et al., 1995).

CDK4 has been suggested to be a prognostic marker for hepatocellular carcinoma and its kinase activity has been reported to promote the progression of T cell acute lymphoblastic leukemia; however, CDK4 failed to discriminate between healthy and malignant pancreatic tissue (Altirriba et al., 2012).

ERBB2 (Her2/neu)

ErbB2 or Her2/neu is a member of the epidermal growth factor (EGF) receptor family of receptor tyrosine kinases. This protein has no ligand binding domain of its own and therefore cannot bind growth factors. However, it does bind tightly to other ligand-bound EGF receptor family members to form a heterodimer, stabilizing ligand binding and enhancing kinase-mediated activation of downstream signalling pathways, such as those involving mitogen-activated protein kinase and phosphatidylinositol-3 kinase. ErbB2/Her2 is considered an oncogene; it is selectively over-expressed in a broad variety of human tumors including 25-40% of breast, ovarian, gastric, renal, esophageal and colorectal carcinomas and a small proportion of human melanomas (Selinger et al., 2000; Mimura et al., 2005; Al-kuraya et al., 2007). As a cell surface molecule it is accessible both to antibody- and T cell-based approaches. Moreover, ErbB2/Her2 can be regarded as an indispensable tumor antigen, since tumors over-expressing this protein are dependent on this oncogene for their survival and silencing consequently leads to growth arrest and/or apoptosis induction. Several groups have defined ErbB2/Her2 specific cytotoxic T lymphocytes epitopes and demonstrated that cytotoxic T lymphocytes can recognize and kill ErbB2/Her2 expressing tumors (Lollini et al., 1998; Anderson et al., 2000; Azuma et al., 2004; Kaplan et al., 2006).

Nepoletano and colleagues (2009) described the generation of an allogenic microvesicle cell factory in which the expression of a specific tumor antigen was combined to the expression of co-stimulatory and allogeneic molecules. The DG75 lymphoblastoid cell line was selected as microvesicle producer and transfected with ErbB2/Her2, as tumor antigen prototype. The shed microvesicles transferred antigenic components to recipient DCs, increasing their immunogenicity. DC pulsing resulted in cross-presentation of ErbB2/Her2 both in MHC class I and MHC class II compartments, and ErbB2/Her2-specific CD8+ T cells from cancer patients were activated by DCs pulsed with vesicle- bound ErbB2.

RASK

Mutant p21-ras proteins contain sequences that distinguish them from normal ras, and represent unique epitopes for T-cell recognition of antigen-bearing tumour cells. Gjertsen and colleagues (1997) examined the capacity of CD4+ and CD8+ T cells, generated simultaneously by mutant-ras-peptide vaccination of a pancreatic-adenocarcinoma patient, to recognize and lyse autologous tumour cells harbouring corresponding activated K-ras epitopes. The patient was vaccinated with a purified 17mer ras peptide (KLVWG AVG VG KS ALT I ) , containing the Gly12 -> Val substitution. Responding T cells were cloned following peptide stimulation, and CD4+ and CD8+ peptide-specific cytotoxic T lymphocytes were obtained. Transient pancreatic-adenocarcinoma cell lines were established in cell culture from malignant ascites of the patient, and were shown to harbour the same K-ras mutation as found in the primary tumour. These cells were efficiently killed by the T-cell clones and CD8+-mediated cytotoxicity was MHC-class-l-restricted, as demonstrated by inhibition of lysis by anti-class-l monoclonal antibodies. WTIP

WTIP (Wilms Tumor 1 Interacting Protein) is a protein coding gene. Diseases associated with WTIP include Wlms tumour. WTIP is an adapter or scaffold protein which participates in the assembly of numerous protein complexes and is involved in several cellular processes such as cell fate determination, cytoskeletal organization, repression of gene transcription, cell-cell adhesion, cell differentiation, proliferation and migration. It also positively regulates microRNA (miRNA)-mediated gene silencing and negatively regulates Hippo signaling pathway and antagonizes phosphorylation of YAP1. It acts as a transcriptional corepressor for S NAM and SNAI2/SLUG-dependent repression of E-cadherin transcription and as a hypoxic regulator by bridging an association between the prolyl hydroxylases and VHL enabling efficient degradation of HIF1A.

There is increasing clinical evidence to suggest that WTIP may be a promising immunotherapeutic target. For example, vaccine-induced immunological responses could be detected in patients with either haematological or solid cancers. Moreover, objective responses, such as stable disease were recorded in these patients (reviewed in van Driessche et al., 2012)

CDC27

The protein encoded by this gene shares strong similarity with Saccharomyces cerevisiae protein Cdc27, and the gene product of Schizosaccharomyces pombe nuc 2. This protein is a component of the anaphase-promoting complex (APC), which is composed of eight protein subunits and is highly conserved in eukaryotic cells. This complex catalyzes the formation of cyclin B-ubiquitin conjugate, which is responsible for the ubiquitin-mediated proteolysis of B-type cyclins. The protein encoded by this gene and three other members of the APC complex contain tetratricopeptide (TPR) repeats, which are important for protein- protein interactions. This protein was shown to interact with mitotic checkpoint proteins including Mad2, p55CDC and BUBR1 , and it may thus be involved in controlling the timing of mitosis. A mutation in CDC27 causing altered protein trafficking into the endosomal compartment was found in a melanoma. This allows for the presentation of an MHC class II epitope and recognition by CD4⁺ cells (Wang et al., 1999).

MAGE A1

The Melanoma Antigen Gene (MAGE) family, classified as cancer-testis antigens (CTA) is a large family of over 40 proteins usually expressed in the testis, but it can be found to be expressed in a number of tumours such as breast, ovary, lung, and bladder (Weon and Potts, 2015). This abnormal expression may be the result of the activation of a silent "gametogenic program", which is involved in tumour progression. In the case of MAGE-A, expression appears to be specifically related to a malignant phenotype, characterized by invasiveness and metastasis, and is often associated with poor prognosis in patients. Studies have suggested that these proteins may effect transcriptional repressor proteins, promoting tumour survival by supressing p53, which is involved in apoptosis and senescence (Meek and Marcar, 2012; Weon and Potts, 2015). However, MAGE-A are also broadly immunogenic and for this reason offer potential in cancer immunotherapy (Daudi et al., 2014). MAGE proteins have received increased attention in recent years as immunotherapeutic targets. Whereas a large Phase III trial in lung cancer (MAGRIT) has failed to show a therapeutic effect of targeting MAGE-A3 as measured by increase in disease-free survival vs placebo, the potential remains with alternative drug combinations and approaches (Ruiz et al., 2014).

MUC5AC

MUC5AC is a member of the mucin family, and as such expressed in mucotic tissue including the lung, the gastrointestinal tract and the pancreas. The mucin family consists of a heterogeneous group of 21 high molecular weight O- glycoproteins that can be either secreted or are membrane bound. Mucins, in particular MUC1 have been used in TAA cancer vaccines, more than 60 clinical trials are in progress and three have reached phase IIB/III; BLP25 a lyposomal vaccine, TG4010 which uses a recombinant modified vaccinia Ankara virus and an oxidized mannan MUC1 (reviewed in Roulois et al., 2013). MUC5AC could also become a relevant immunotherapeutic target. In the case of pancreatic cancer, MUC5A is not expressed in healthy tissue but is detected in precursor neoplastic lesions and in tumour tissue (Kim et al., 2002). Interestingly, it has been suggested that MUC5AC accelerates progression of pancreatic cancer adenocarcinoma and at least in vitro its inhibition reduces invasiveness (Yamazoe et al. 2010). In two phase I trial, treatment with mAbs targeting MUC5AC (NEO-101 ) showed therapeutic activity, with patients remaining stable and reaching greater than 12 months survival after having progressed on standard therapy (Morse et al., 2012; Patel et al., 2014). Based on these initial results, a phase II study of NEO-102 given in combination with gemcitabine is on-going in patients with refractory pancreatic cancer.

TP53

The TP53 is a tumour suppressor gene. The p53 protein binds DNA and induces production of p21 which when complexed to cdk2 prevents cells from undergoing cell division. Mutations in p53 interfere with the DNA binding step so that p21 is no longer produced and cells are allowed to divide uncontrollably. Approximately 50% of all tumours exhibit mutations and overexpression of p53, making this protein an interesting candidate target for immunotherapy of cancer. Early preclinical studies have shown that adoptive transfer of p53-specific cytotoxic T cells was able to eradicate tumours overexpressing p53 (Vierboom et al., 1997). Despite deletion of p53+ self-reactive T cells, responses to p53 have been detected in humans (Houbiers et al., 1997; Chikamatsu et al., 2003). A number of phase I and II clinical trials targeting p53 have been conducted between 2002 and 2010) using viral vector-based vaccines, dendritic cell-based vaccines and peptide-based vaccines, but with limited success to date (reviewed in Vermeij et al., 201 1). Despite the disappointing results, the rationale for targeting p53 is sound. Alternative approaches aimed at increasing immunogenicity, disrupting immunoregulatory process, providing additional TAA targets, may ultimately enhance therapeutic benefit of this strategy through the development of effective anti-tumour responses. CSAG2

Chondrosarcoma-associated gene 2/3 protein, also known as Taxol-resistant associated gene-3, belongs to the cancer testis antigen family. It appears to be associated with neoplastic phenotype and with resistance to chemotherapeutic agents. There is not as much known about this TAA compared to others listed in Table 1 , but studies investigating gene expression profiling in cancer patients and expression in cancer cell lines and biopsy specimens has identified CSAG2 in a variety of cancers including melanoma, ovarian, bladder and prostate cancer as worthy of consideration as potential immunotherapy target antigen (Karam et al., 201 1 ; Beard et al., 2013; Takahashi et al., 2015). Interestingly, spontaneous CD4⁺ T cell responses against CSAG2/TRAG-3 have been reported in patients with advanced melanoma and breast cancer. These patients developed IFN-g producing CD4+ T cell responses against a single immunodominant and promiscous epitope, suggesting this could be a good candidate for monitoring patients responses and for the development of immunotherapy to CTA expressing tumours (Janjic B et al., 2006).

In another preferred embodiment, the therapy comprises the administration of M. vaccae in combination with one or more of the TAAs identified in Table 2.

Table 2 TAA with homologies to sequences in M. vaccae NCTC11659.

SUBSTITUTE SHEET RULE 26

The term "combination" as used throughout the specification, is meant to encompass the administration of the Mycobacterium simultaneously, separately or sequentially with administration of the TAA. Accordingly, the TAA and the Mycobacterium may be present in the same or separate pharmaceutical formulations, and administered at the same time or at different times.

Thus, a Mycobacterium and the TAA may be provided as separate medicaments for administration at the same time or at different times.

Preferably, a Mycobacterium and TAA are provided as separate medicaments for administration at different times. When administered separately and at different times, either the Mycobacterium or TAA may be administered first; however, it is suitable to administer the Mycobacterium followed by the TAA. In addition, both can be administered on the same day or at different days, and they can be administered using the same schedule or at different schedules during the treatment cycle.

In an embodiment of the invention, a treatment cycle consists of the administration of a Mycobacterium daily, weekly, fortnightly or monthly, simultaneously with TAA weekly. Alternatively, the Mycobacterium is administered before and/or after the administration of the TAA.

SUBSTITUTE SHEET RULE 26 Dose delays and/ or dose reductions and schedule adjustments are performed as needed depending on individual patient tolerance to treatments.

Alternatively, the administration of TAA may be performed simultaneously with the administration of the effective amounts of the Mycobacterium.

The whole cell heat-killed Mycobacterium, may be administered to the patient via the parenteral, intratumoral, oral, sublingual, nasal or pulmonary route. In a preferred embodiment, it is administered via a parenteral route selected from subcutaneous, intradermal, subdermal, intraperitoneal, intravenous and intravesicular injection. More preferably, administration comprises intratumoural injection of the mycobacterial preparation.

In an aspect of the invention, the effective amount of the Mycobacterium may be administered as a single dose. Alternatively, the effective amount of the Mycobacterium may be administered in multiple (repeat) doses, for example two or more, three or more, four or more, five or more, ten or more, or twenty or more repeat doses. The Mycobacterium may be administered between about 4 weeks and about 1 day prior to TAA therapy, such as between about 4 weeks and 1 week, or about between 3 weeks and 1 week, or about between 3 weeks and 2 weeks. Administration may be presented in single or multiple doses.

In another preferred embodiment of the invention there is a non-viable Mycobacterium for therapeutic use in priming dendritic cells in a patient suffering a neoplastic disorder, wherein the Mycobacterium is M. obuense (I MM 1 -01 ) and the disorder is characterised by the presence of one or more of the following tumour associate antigens (TAAs): ERB2, CDK4, RASK, WTIP, CDC27, MAGEA1 , MUC5AC, TP53, or CSAG2. In another preferred embodiment of the invention there is a non-viable Mycobacterium for therapeutic use in priming dendritic cells in a patient suffering a neoplastic disorder, wherein the Mycobacterium is M. vaccae and the disorder is characterised by the presence of one or more of the following tumour associated antigens: CDK4, ERBB2, RASK, PTPRC, GAGE7, MUC5A, GAGE2b, TP53, GAGE2a, CDC27, MSLN, MAGEA1 , MUC16, REC04, or SSX2.

In another preferred embodiment of the invention there is a method of treating a neoplastic disorder in a patient, comprising administering to the patient a nonviable whole cell Mycobacterium and one or more tumour associated antigens (TAAs), wherein the disorder is characterised by the presence of said one or more antigens, and wherein the antigen(s) to be administered to the patient have genetic homology to exogenous sequences in said Mycobacterium.

Mycobacterial compositions according to the invention will comprise an effective amount of mycobacteria typically dispersed in a pharmaceutically acceptable carrier. The phrases "pharmaceutically or pharmacologically acceptable" refers to molecular entities and compositions that do not produce an adverse, allergic or other untoward reaction when administered to an animal, such as, for example, a human, as appropriate. The preparation of an pharmaceutical composition that contains mycobacteria will be known to those of skill in the art in light of the present disclosure, as exemplified by Remington's Pharmaceutical Sciences, 18th Ed. Mack Printing Company, 1990, Moreover, for animal (e.g., human) administration, it will be understood that preparations should meet sterility, pyrogenicity, general safety and purity standards. A specific example of a pharmacologically acceptable carrier as described herein is borate buffer or sterile saline solution (0.9% NaCI). As used herein, "pharmaceutically acceptable carrier" includes any and all solvents, dispersion media, coatings, surfactants, antioxidants, preservatives e.g., antibacterial agents, antifungal agents), isotonic agents, absorption delaying agents, salts, preservatives, drugs, drug stabilizers, gels, binders, excipients, disintegration agents, lubricants, sweetening agents, flavouring agents, dyes, such like materials and combinations thereof, as would be known to one of ordinary skill in the art (see, for example, Remington's Pharmaceutical Sciences, 18th Ed. Mack Printing Company, 1990, pp. 1289-1329). The invention is further illustrated by way of the following examples Example 1

Determination of sequence homology between M.obuense and TAAs

Data obtained from whole genome sequence analysis of the extracted and purified M. obuense NCTC 13365 DNA was subjected to Basic Local Alignment Search Tool (BLAST) alignment and analysis against the selected human TAA sequences. The BLAST method, using the heuristic based algorithm identifies similar sequences by locating short matches between the two sequences - known as seeding, allowing for the identification and scoring for the significance of each alignment according to the BLAST algorithm.

The BLAST algorithm locates all common sequences of interest (based on amino acid alignment) and aligns them to a preferred database or reference sequence - in this case the genome sequences of M. obuense NCTC13365. The sequences identified are then used to assemble aligned sequences and identify homologous regions and scored for significance according key criteria including e-value scores. Given the nature of human to Mycobacterium BLAST (amino acid based) alignment, key criteria were determined to improve the significance of the homologies identified. These included requiring an alignment length of at least 50bp and an "e-val" score as close as possible to 0, so only "e- val" score less than 0.5 were taken. A total of 218 sequences were blasted onto M. obuense NCTC13365. After applying the strict selection criteria outlined above, a total of nine TAA genes were identified showing homologies with sequences in M. obuense NCTC13365. These are listed in Table 1. The raw data resulting from the search is shown in Table 3. Table 3. TAAs with sequence homology to sequences in M.obuense NCTC13365.

Example 2

Determination of differential survival characteristics of cancer patients administered gemcitabine in combination with IMM-101 or in isolation

Patients were recruited to a multicentre (5 countries, 22 sites) randomised, open-label, proof-of-concept, Phase II Trial comparing gemcitabine (GEM) with and without M. obuense (referred to herein as IMM-101) in advanced pancreatic cancer. Patients with a WHO score of 0-2 were assigned randomly to receive IMM-101 (0.1 ml_ intradermal injection of 10 mg/mL) plus Gem (1000 mg/m2 for 3 consecutive weeks out of 4) or Gem alone. Per protocol, this regimen could be continued to a 12-cycle maximum. The primary efficacy endpoint was overall survival (OS). Safety, tolerability and progression free survival (PFS) were also assessed. A total of 1 10 patients were randomized, 75 to receive IMM-101 plus Gem and 35 Gem alone (ITT population) (Figure 1a and b). In the pre-defined sub-group of patients with metastatic disease (n=82), 64 patients received IMM- 101 plus Gem compared to 28 in the Gem group alone (Figure 1 c and d).

These studies show increased survival characteristics in both the all patent and metastatic subgroups who are co-administered IMM-101 alongside Gem.

The effect of IMM-101 on the immune system

Next the effects of IMM-101 on dendritic cell activation were assessed in order to determine whether IMM-101 enhances therapeutic efficacy by priming the immune system against recognition of tumour associated antigens (TAAs).

To assess the effects of IMM-101 on the immune system, mouse bone marrow- derived dendritic cells (BMDCs) were obtained from single cell suspensions of mouse femours and cultured in petri dishes with GM-CSF for 10 days, which included three regularly spaced media changes. Mouse BMDCs cells were then harvested and incubated overnight with 10 pg/ml, 100 pg/ml, or 300 pg/ml IMM- 101 , LPS, Pam3 or control (1 x phosphate buffered saline). Mouse peripheral blood mononuclear cells (PBMCs) were then further harvested and phenotypic activation was assessed by FACS analysis (Figure 2a - CD40, CD83 and CD86). Supernatants from mouse PBMCs were also removed and analysed for the cytokine secretion profile by FACS (Figure 2b— IL12 and IL6).

Similar experiments were repeated in human monocyte-derived DCs (HMDCs). HMDCs were obtained from 10ml apheresis cones of healthy patients, following CD14+ selection of peripheral blood mononuclear cells (PBMCs) and cultured in the presence of IL-4 and GM-CSF for 6 days. HMDCs were harvested and phenotypic activation in the presence of 10 pg/ml, 100 pg/ml, or 300 pg/ml IMM- 101 , LPS, or control (1 x phosphate buffered saline) were assessed by FACS (CD80 and CD86). Supernatants were removed and cytokine secretion levels were measured by ELISA (Figure 2d - IL-6 and IL-12p40). The results demonstrate that incubating either mouse or human DCs with IMM-101 causes De activation.

To determine whether IMM-101 activation of DCs enhances the humoural immune response, BMDCs were pre-pulsed with IMM-101 and added to cultures of CD4+ T cells isolated from the lymph nodes and spleens of transgenic OTII mice stimulated with ovalbumin (Ova) peptide or Ova protein. Ovalbumin is a mildly immunogenic glycoprotein that is often used as a key reference protein in vaccine-based experiments. The experiments were performed alongside a control with non-exposed DCs (Media), or T-cells cultured alone. The co- cultures were incubated for 72 hours. T cells in culture were stained with CFSE to assess proliferation via flow cytometry. (Figure 3).

The CD4+ T cells of OTII mice all express transgenic Ova-specific CD4⁺-T cell receptors. CFSE staining allows for the number of divisions of the T cell populations to be quantified as the dye dilutes with each division. The data suggest that IMM-101 influences bacterial uptake and/or processing, as evidenced by the increased number of divisions of CFSE-stained T-cells upon incubation with OVA protein in the presence of IMM-101 -activated DCs, versus control (Figure 3). This shows the ability of IMM-101 to effectively prime dendritic cells, with a positive effect on the presentation of antigens to CD4⁺ cells.

IMM-101 -primed DCs can activate the immune system against TAAs

Next, the inventors sought to determine whether IMM-101 could prime DCs to increase the recognition of TAAs. A pictorial representation of the protocol is presented in Figure 4A. Briefly, mice were injected subcutaneously in the footpad with IMM-101 -primed or control (Media) GMCSF bone marrow-derived DCs. Media DCs were not primed with IMM-101. As a control, the experiment was performed alongside P.acnes-stimulated DCs. Seven days later, popliteal draining lymph nodes were removed and lymph node (LN) cells cultured for 72 hours with media, 100pg/ml IMM-101 , 10pg/ml P. acnes or 16.67pg/ml plate bound anti-CD3. CD3 is a co-receptor that helps activate T-cells. Both P.acnes and IMM-101 during the challenge phase of the experiment (post-harvest in the experimental scheme presented in Figure 4a) act as surrogates for a number of TAAs, by virtue of the sequence homology shared between multiple TAAs and endogenous P.acnes and IMM-101 genes. Supernatants were collected and cytokine (Figure 4b - IFN-γ and IL-17) levels in culture supernatants were determined by ELISA (±SEM). (* p<0.05, ** p<0.01 , *** p<0.001).

The results show that IMM-101 -primed DCs show increased activation against both IMM-101 and P.acnes, compared to both media and P. acnes-activated DCs. REFERENCES

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Claims

1. A non-viable whole cell Mycobacterium and a tumour associated antigen (TAA) as a combined preparation for simultaneous, separate, or sequential use in the treatment of a neoplastic disease.

2. A preparation for use according to claim 1 , wherein the Mycobacterium is heat-inactivated M.obuense (IMM-101 ).

3. A preparation for use according to claim 1 or claim 2, wherein the tumour associated antigen (TAA) is a tumour antigen with genetic homology to M.obuense sequences.

4. A preparation for use according to claim 3, wherein the TAA is or is derived from one or more of ERBB2, CDK4, RASK, WTIP, CDC27, MAGEA1 ,

MUC5AC, TP53 or CSAG2.

5. A preparation according to any preceding claim, wherein the neoplastic disease is any which is characterised by the presence of any combination of the following TAAs:

ERB2, CDK4, RASK, WTIP, CDC27, MAGEA1 , MUC5AC, TP53, or CSAG2.

6. A preparation according to claim 1 , wherein the Mycobacterium is M. vaccae.

7. A preparation according to claim 6, wherein the TAA is, or is derived from, one or more of:

CDK4, ERBB2, RASK, PTPRC, GAGE7, MUC5A, GAGE2b, TP53, GAGE2a, CDC27, MSLN, MAGEA1 , MUC16, REC04, or SSX2.

8. A preparation according to claim 7 or claim 8, wherein the neoplastic disease is any which is characterised by the presence of any combination of the following TAAs:

9. A preparation for use according to any preceding claim, wherein the Mycobacterium is administered up to 14 days prior to the administration of the TAA.

10. A preparation for use according to any preceding claim, wherein the combined preparation is administered in repeat doses.

11. A preparation for use according to any preceding claim, wherein the Mycobacterium and TAA are administered simultaneously.

12. A preparation for use according to any preceding claim, wherein the Mycobacterium is present in a unit dose comprising an effective amount of from 10⁷ to 10⁹ cells.

13. A preparation for use according to any preceding claim, wherein the Mycobacterium is for administration via the parenteral, intratumoral oral, sublingual, nasal, or pulmonary route.

14. A preparation for use according to claim 13, wherein parenteral route is selected from subcutaneous, intradermal, subdermal, intraperitonal, intravenous, or intravesicular injection.

15. A preparation for use according to claim 14, wherein the Mycobacterium is for intradermal administration.

16. A non-viable Mycobacterium for therapeutic use in priming dendritic cells in a patient suffering a neoplastic disorder, wherein the Mycobacterium is M. obuense (IMM-101 ) and the disorder is characterised by the presence of one or more of the following tumour associate antigens:

ERB2, CDK4, RASK, WTIP, CDC27, MAGEA1 , MUC5AC, TP53, or CSAG2.

17. A non-viable Mycobacterium for therapeutic use in priming dendritic cells in a patient suffering a neoplastic disorder, wherein the Mycobacterium is M. vaccae and the disorder is characterised by the presence of one or more of the following tumour associated antigens:

CDK4, ERBB2, RASK, PTPRC, GAGE7, MUC5A, GAGE2b, TP53,

GAGE2a, CDC27, MSLN, MAGEA1 , MUC16, REC04, or SSX2.

18. A method for treating a neoplastic disorder in a patient, comprising administering to the patient a non-viable whole cell Mycobacterium and one or more tumour associated antigens (TAA), wherein the disorder is characterised by the presence of said one or more antigens, and wherein the antigen(s) to be administered to the patient have genetic homology to sequences in said Mycobacterium.

19. A method according to claim 18, wherein the Mycobacterium is M. obuense (IMM-101 ) and said antigen(s) is selected from:

ERB2, CDK4, RASK, WTIP, CDC27, MAGEA1 , MUC5AC, TP53, or CSAG2.

20. A method according to claim 18, wherein the Mycobacterium is M. vaccae and said antigen(s) is selected from: