WO2017138924A1 - Compositions et méthodes de traitement du cancer du pancréas - Google Patents

Compositions et méthodes de traitement du cancer du pancréas Download PDF

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WO2017138924A1
WO2017138924A1 PCT/US2016/017176 US2016017176W WO2017138924A1 WO 2017138924 A1 WO2017138924 A1 WO 2017138924A1 US 2016017176 W US2016017176 W US 2016017176W WO 2017138924 A1 WO2017138924 A1 WO 2017138924A1
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day
composition
tgfp2
days
antisense oligonucleotide
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PCT/US2016/017176
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English (en)
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Vuong Trieu
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Autotelic Llc
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Priority to KR1020187008495A priority Critical patent/KR20180103816A/ko
Priority to KR1020167010327A priority patent/KR101843984B1/ko
Priority to PCT/US2016/017176 priority patent/WO2017138924A1/fr
Publication of WO2017138924A1 publication Critical patent/WO2017138924A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/407—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with other heterocyclic ring systems, e.g. ketorolac, physostigmine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
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    • A61K31/33—Heterocyclic compounds
    • A61K31/555—Heterocyclic compounds containing heavy metals, e.g. hemin, hematin, melarsoprol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
    • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
    • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
    • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
    • A61K31/7068—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines having oxo groups directly attached to the pyrimidine ring, e.g. cytidine, cytidylic acid
    • A—HUMAN NECESSITIES
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    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7088—Compounds having three or more nucleosides or nucleotides
    • A61K31/711—Natural deoxyribonucleic acids, i.e. containing only 2'-deoxyriboses attached to adenine, guanine, cytosine or thymine and having 3'-5' phosphodiester links
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    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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    • A—HUMAN NECESSITIES
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    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N2005/1092—Details
    • A61N2005/1098—Enhancing the effect of the particle by an injected agent or implanted device

Definitions

  • the invention relates to medicine and oncology.
  • compositions and methods for treating cancers including pancreatic cancer.
  • Pancreatic cancer is a devastating disease. It represents one of the worst solid tumors and has a diagnosis to mortality ratio approaching one. There are approximately 40,000 diagnoses per year in the US, and 350,000 diagnoses worldwide. Combinations of radiotherapy (RT), chemotherapy and surgery have been used to treat resectable, locally advanced unresectable, and metastatic cancer patients. However, the doses of treatments (e.g., RT and chemotherapy) are dictated by their associated toxicities. This in turn impacts the clinical efficacy of these treatments. There is an unmet need in the art for pancreatic cancer therapies and methods for treating same.
  • the methods comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to sensitize the tumor.
  • kits for treating, inhibiting, reducing the severity of and/or preventing metastasis of cancer in a subject in need thereof comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to treat, inhibit, reduce the severity of and/or prevent metastasis of cancer in the subject.
  • the tumor is a pancreatic tumor.
  • TGF signaling inhibitors include but are not limited to small molecules, antibodies or antigen-binding antibody fragments, intrabodies, aptamers, antisense oligonucleotides, RNA interference agents, and ribozymes.
  • antibodies that may be used for TGF signaling inhibition for use in the methods described herein or in the compositions described herein include but are not limited to any one or more of Fresolimumad (GC-1008), Lerderlimumab (CAT- 152), Metelimumab (CAT- 162), or combinations thereof.
  • TGF signaling inhibitors for use in the methods described herein or in the compositions described herein include but are not limited to any one or more of PF-03446962 antibody (a fully-human monoclonal antibody against transforming growth-factor ⁇ (TGFP) receptor ALKl), Galunisertib (LY2157299, a small molecule inhibitor of TGF signaling), Lucanix (an allogenic tumor vaccine comprising a mixture of four allogeneic human non-small cell lung cancer cell lines modified to express an antisense oligonucleotide targeting TGF 2) or TGF 2 antisense oligonucleotide in combination with GM-CSF, or combinations thereof. It is contemplated that any of these TGF signaling inhibitors set forth herein may be used in the methods described herein to treat pancreatic cancer alone or in combination with chemotherapeutic agents and/or radiation therapy as set forth herein.
  • PF-03446962 antibody a fully-human monoclonal antibody against transforming growth-factor ⁇ (
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • methods for treating, inhibiting, reducing the severity of or preventing metastasis of cancer in a subject in need thereof include first sensitizing the tumor using the TGF signaling inhibitor as set forth herein and subsequently administering exogenous therapeutic agents including chemotherapeutic agents, radiation therapy or a combination thereof.
  • the inhibitor of ⁇ signaling sensitizes the tumor to subsequence therapies but does not or is not required to decrease the IC 50 of chemotherapeutic agents.
  • trabedersen or a variant, derivative or analog thereof is administered prior to administration of cancer therapies such as chemotherapies or radiation therapy or a combination thereof.
  • FIG. 1 depicts in accordance with various embodiments of the invention, the dose dependent increase in overall survival (OS) rate in pancreatic cancer patients when trabedersen is used as a second line treatment.
  • OS and PFS of patients treated with trabedersen were compared to reported median OS and PFS. While PFS was not significantly different, the OS was higher than reported in the literature.
  • Figure 2 depicts in accordance with various embodiments of the invention, that there is an increase in response to chemotherapy following trabedersen therapy as indicated by an increase in overall survival rate. This suggests that trabedersen sensitizes the tumor to chemotherapy.
  • Figure 3 depicts in accordance with various embodiments of the invention, that trabedersen alone does not have a significant effect on the tumor as indicated by a low overall survival rate but when trabedersen therapy is followed by chemotherapy, there is a significant increase in the overall survival rate. This suggests that trabedersen sensitizes the tumor to chemotherapy.
  • the term “comprising” or “comprises” is used in reference to compositions, methods, and respective component(s) thereof, that are useful to an embodiment, yet open to the inclusion of unspecified elements, whether useful or not. It will be understood by those within the art that, in general, terms used herein are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.).
  • the terms “treat,” “treatment,” “treating,” or “amelioration” when used in reference to a disease, disorder or medical condition refer to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to prevent, reverse, alleviate, ameliorate, inhibit, lessen, slow down or stop the progression or severity of a symptom or condition.
  • the term “treating” includes reducing or alleviating at least one adverse effect or symptom of a condition. Treatment is generally “effective” if one or more symptoms or clinical markers are reduced. Alternatively, treatment is “effective” if the progression of a disease, disorder or medical condition is reduced or halted.
  • treatment includes not just the improvement of symptoms or markers, but also a cessation or at least slowing of progress or worsening of symptoms that would be expected in the absence of treatment. Also, “treatment” may mean to pursue or obtain beneficial results, or lower the chances of the individual developing the condition even if the treatment is ultimately unsuccessful. Those in need of treatment include those already with the condition as well as those prone to have the condition or those in whom the condition is to be prevented.
  • “Beneficial results” or “desired results” may include, but are in no way limited to, lessening or alleviating the severity of the disease condition, preventing the disease condition from worsening, curing the disease condition, preventing the disease condition from developing, lowering the chances of a patient developing the disease condition, decreasing morbidity and mortality, and prolonging a patient's life or life expectancy.
  • "beneficial results” or “desired results” may be alleviation of one or more symptom(s), diminishment of extent of the deficit, stabilized (i.e., not worsening) state of pancreatic cancer, delay or slowing of pancreatic cancer, and amelioration or palliation of symptoms associated with pancreatic cancer.
  • Diseases may include, but are in no way limited to any form of malignant neoplastic cell proliferative disorders or diseases. Examples of such disorders include but are not limited to cancer and tumor.
  • a "cancer” or “tumor” as used herein refers to an uncontrolled growth of cells which interferes with the normal functioning of the bodily organs and systems, and/or all neoplastic cell growth and proliferation, whether malignant or benign, and all pre-cancerous and cancerous cells and tissues.
  • a subject that has a cancer or a tumor is a subject having objectively measurable cancer cells present in the subject's body. Included in this definition are benign and malignant tumors, as well as dormant tumors or micrometastasis. Cancers which migrate from their original location and seed vital organs can eventually lead to the death of the subject through the functional deterioration of the affected organs.
  • the term “invasive” refers to the ability to infiltrate and destroy surrounding tissue. Melanoma is an invasive form of skin tumor. As used herein, the term “carcinoma” refers to a cancer arising from epithelial cells.
  • cancer examples include, but are not limited to, nervous system tumor, brain tumor, nerve sheath tumor, breast cancer, colorectal cancer, colon cancer, rectal cancer, bowel cancer, carcinoma, lung cancer, hepatocellular cancer, gastric cancer, pancreatic cancer, cervical cancer, ovarian cancer, liver cancer, bladder cancer, cancer of the urinary tract, thyroid cancer, renal cancer, renal cell carcinoma, carcinoma, melanoma, head and neck cancer, brain cancer, and prostate cancer, including but not limited to androgen-dependent prostate cancer and androgen-independent prostate cancer.
  • brain tumor examples include, but are not limited to, benign brain tumor, malignant brain tumor, primary brain tumor, secondary brain tumor, metastatic brain tumor, glioma, glioblastoma, glioblastoma multiforme (GBM), medulloblastoma, ependymoma, astrocytoma, pilocytic astrocytoma, oligodendroglioma, brainstem glioma, optic nerve glioma, mixed glioma such as oligoastrocytoma, low-grade glioma, high-grade glioma, supratentorial glioma, infratentorial glioma, pontine glioma, meningioma, pituitary adenoma, and nerve sheath tumor.
  • GBM glioblastoma multiforme
  • medulloblastoma medulloblastoma
  • Nervous system tumor or nervous system neoplasm refers to any tumor affecting the nervous system.
  • a nervous system tumor can be a tumor in the central nervous system (CNS), in the peripheral nervous system (PNS), or in both CNS and PNS.
  • Examples of nervous system tumor include but are not limited to brain tumor, nerve sheath tumor, and optic nerve glioma.
  • administering refers to the placement of an agent or a composition as disclosed herein into a subject by a method or route which results in at least partial localization of the agents or composition at a desired site.
  • Route of administration may refer to any administration pathway known in the art, including but not limited to oral, topical, aerosol, nasal, via inhalation, anal, intra-anal, peri-anal, transmucosal, transdermal, parenteral, enteral, or local.
  • Parenteral refers to a route of administration that is generally associated with injection, including intratumoral, intracranial, intraventricular, intrathecal, epidural, intradural, intraorbital, infusion, intracapsular, intracardiac, intradermal, intramuscular, intraperitoneal, intrapulmonary, intraspinal, intrasternal, intrathecal, intrauterine, intravascular, intravenous, intraarterial, subarachnoid, subcapsular, subcutaneous, transmucosal, or transtracheal.
  • the agent or composition may be in the form of solutions or suspensions for infusion or for injection, or as lyophilized powders.
  • the agent or composition can be in the form of capsules, gel capsules, tablets, sugar-coated tablets, syrups, suspensions, solutions, powders, granules, emulsions, microspheres or nanospheres or lipid vesicles or polymer vesicles allowing controlled release.
  • the agent or composition can be in the form of aerosol, lotion, cream, gel, ointment, suspensions, solutions or emulsions.
  • agent or composition may be provided in a powder form and mixed with a liquid, such as water, to form a beverage.
  • “administering” can be self-administering. For example, it is considered as “administering" that a subject consumes a composition as disclosed herein.
  • a "subject” means a human or animal. Usually the animal is a vertebrate such as a primate, rodent, domestic animal or game animal. Primates include chimpanzees, cynomologous monkeys, spider monkeys, and macaques, e.g., Rhesus. Rodents include mice, rats, woodchucks, ferrets, rabbits and hamsters. Domestic and game animals include cows, horses, pigs, deer, bison, buffalo, feline species, e.g., domestic cat, and canine species, e.g., dog, fox, wolf. The terms, "patient”, “individual” and “subject” are used interchangeably herein.
  • the subject is mammal.
  • the mammal can be a human, non-human primate, mouse, rat, dog, cat, horse, or cow, but are not limited to these examples.
  • the methods described herein can be used to treat domesticated animals and/or pets.
  • mammal refers to any member of the class Mammalia, including, without limitation, humans and nonhuman primates such as chimpanzees and other apes and monkey species; farm animals such as cattle, sheep, pigs, goats and horses; domestic mammals such as dogs and cats; laboratory animals including rodents such as mice, rats and guinea pigs, and the like.
  • the term does not denote a particular age or sex. Thus, adult and newborn subjects, as well as fetuses, whether male or female, are intended to be included within the scope of this term.
  • a "subject” can be one who has been previously diagnosed with or identified as suffering from or having a condition in need of treatment (e.g., pancreatic cancer) or one or more complications related to the condition, and optionally, have already undergone treatment for the condition or the one or more complications related to the condition.
  • a subject can also be one who has not been previously diagnosed as having a condition or one or more complications related to the condition.
  • a subject can be one who exhibits one or more risk factors for a condition or one or more complications related to the condition or a subject who does not exhibit risk factors.
  • a subject can be one who exhibits one or more symptoms for a condition or one or more complications related to the condition or a subject who does not exhibit symptoms.
  • a "subject in need" of diagnosis or treatment for a particular condition can be a subject suspected of having that condition, diagnosed as having that condition, already treated or being treated for that condition, not treated for that condition, or at risk of developing that condition.
  • small molecule refers to a chemical agent including, but not limited to, peptides, peptidomimetics, amino acids, amino acid analogs, polynucleotides, polynucleotide analogs, aptamers, nucleotides, nucleotide analogs, organic or inorganic compounds (i.e., including heteroorganic and organometallic compounds) having a molecular weight less than about 10,000 grams per mole, organic or inorganic compounds having a molecular weight less than about 5,000 grams per mole, organic or inorganic compounds having a molecular weight less than about 1,000 grams per mole, organic or inorganic compounds having a molecular weight less than about 500 grams per mole, and salts, esters, and other pharmaceutically acceptable forms of such compounds.
  • organic or inorganic compounds i.e., including heteroorganic and organometallic compounds
  • a "nucleic acid”, as described herein, can be RNA or DNA, and can be single or double stranded, and can be selected, for example, from a group including: nucleic acid encoding a protein of interest, oligonucleotides, nucleic acid analogues, for example peptide- nucleic acid (PNA), pseudo-complementary PNA (pc-PNA), locked nucleic acid (LNA) etc.
  • PNA peptide- nucleic acid
  • pc-PNA pseudo-complementary PNA
  • LNA locked nucleic acid
  • nucleic acid sequences include, for example, but are not limited to, nucleic acid sequence encoding proteins, for example that act as transcriptional repressors, antisense molecules, ribozymes, small inhibitory nucleic acid sequences, for example but are not limited to RNAi, shRNAi, siRNA, micro RNAi (mRNAi), antisense oligonucleotides etc.
  • an "inhibitor" of TGFP can function in a competitive or non-competitive manner, and can function, in one embodiment, by interfering with the expression of the TGFP protein.
  • the TGFP protein is TGFP2, having the sequence set forth in SEQ ID NO: 2 (NM_003238.3). Any of a number of different approaches can be taken to inhibit TGFp (for example, TGFP2) expression or activity.
  • a TGFP (for example, TGFP2) inhibitor includes any chemical or biological entity that, upon treatment of a cell, results in inhibition of the biological activity caused by activation of TGFp (for example, TGFP2) in response to cellular signals.
  • TGFp for example, TGFP2
  • TGFp include, but are not limited to, small molecules, antibodies or antigen-binding antibody fragments, intrabodies, aptamers, antisense constructs, RNA interference agents, and ribozymes.
  • a small molecule inhibitor of TGF is a small molecule inhibitor of ' ⁇ receptor type I kinase (ALK5, an inhibitor is an ALK5 inhibitor).
  • an antibody inhibitor of ⁇ ' ⁇ is a neutralizing anti-TGF- beta-I , ⁇ 2, -3 antibody or TGF-beta binding fragments thereof or a neutralizing anti-TGF-beta receptor type L- type II or type III antibody or TGF-beta receptors binding fragments thereof or a TGF trap.
  • an inhibitor of ⁇ is an antisense oligonucleotide specific for mRNA encoding TGF-beta 1, -2, and -3 isotypes or other components of TGF-beta signaling assembly optionally comprising a modified nucleoside such as 2 -0, 4 -C-methylene linked bicyclic ribonucleotides, known as locked nucleic acids LNA (e.g., oxy-LNA, amino-LNA, thio-LNA), phosphorodiamidate morpholino oligomers (PMO), phosphorothioate (PS), 2 -0-metbyl (2 -Ome), 2 -fluoro (2 -fiuoro (2 -F), or 2 - methoxyethyl (2 -MOE) derivatives.
  • LNA locked nucleic acids
  • PMO phosphorodiamidate morpholino oligomers
  • PS phosphorothioate
  • an inhibitor of TGFp includes an antisense RNA molecule specific for TGF-beta2 ⁇ mRNA like belagenpumatucel-L and/or TGF-betal-mR A. or TGF-beta3-mRNA or other components of mRNA encoding TGF-beta signaling assembly.
  • an inhibitor of TGFP includes a silencing RNA molecule (siRNA) specific for mRNA encoding TGF-betal, -2, and/or -3 isotypes or other components of TGF-beta signaling assembly.
  • an inhibitor of ⁇ includes a short hairpin RNA (shRNA) specific for mRNA encoding TGF-betal, -2, and/or -3 isotypes or other components of TGF-beta signaling assembly.
  • an inhibitor of TGFP includes a miRNA molecule specific for mRNA encoding TGF-betal, -2, and/or -3 isotypes or other components of TGF-beta signaling assembly.
  • an inhibitor of TGF$ includes an aptamer and/or aptmer molecule specific for TGF-betal, -2, and/or -3 isotypes or other components of the TGF-beta signaling assembly.
  • an inhibitor of ⁇ includes a ribozyme molecule specific for mRNA encoding TGF-betal, -2, and/or -3 isotypes or other components of the TGF-beta signaling assembly.
  • Antisense oligonucleotides are single-stranded polynucleotide molecules comprising 13-25 nucleotides, preferably 15-20 nucleotides, more preferred 15, 16, 17, 8, 19, 20, 21, 22 or 23 nucleotides, that hybridize to complementary RNA, inhibiting mRNA function, and preventing protein synthesis for example through accelerated niRNA degradation by RNase H or steric blockade.
  • 32 inhibitor is an antisesnse oligonucleotide ASPH 0047 (from Isarna Therapeutics as described in WO2014/154835) which is a selective LNA-modified ASO gapmer targeting ⁇ - ⁇ 2.
  • ASPH 0047 (ISTH0047) has the sequence 5 '-CAAAGTATTTGGTCTCC- 3', as set forth in SEQ ID NO: 3.
  • TGF signaling inhibitors for use with the methods described herein include but are not limited to antisense oligonucleotides from Isarna Therapeutics as described in WO2014/154835 having the sequence CAAAGTATTTGGTCTCC (ASPH47; SEQ ID NO: 3), ACCTCCTTGGCGTAGTA (ASPH01; SEQ ID NO: 4), ACCTCCTTGGCGTAGTA (ASPH02; SEQ ID NO: 5), CCTCCTTGGCGTAGTA (ASPH03; SEQ ID NO: 6), CCTCCTTGGCGTAGTA (ASPH04; SEQ ID NO: 7), CTCCTTGGCGTAGTA (ASPH05; SEQ ID NO: 8), CTCCTTGGCGTAGTA (ASPH06; SEQ ID NO: 9), CTCCTTGGCGTAGTA (ASPH07; SEQ ID NO: 10), TCCTTGGCGTAGTA (ASPH08; SEQ ID NO: 11), CAGAAGTTGGCAT (ASPH09; SEQ
  • one or more nucleotide(s) of the oligonucleotide set forth herein is/are a LNA modified, wherein the modified nucleotide is a LNA, and/or an ENA, polyalkylene oxide-, 2'-fluoro-, 2'- 0-methoxy-, and/or 2'0-methyl-modified nucleotide.
  • cycle refers to the number of days when the inhibitor of TGF is administered and number of days when the inhibitor of TGF is not administered.
  • one cycle is defined as administering the inhibitor for 7 days at a specific dosage per day and then not administering the inhibitor for 7 days. This is referred to as “7 days on and 7 days off cycle.
  • one cycle is defined as administering the inhibitor for 4 days at a specific dosage per day and then not administering the inhibitor for 10 days. This is referred to as "4 days on and 10 days off cycle”.
  • PFS progression free survival and is a measure of the activity of a treatment on a disease.
  • OS refers to overall survival and is a measure of the activity of the treatment and subsequent treatments, on a disease.
  • PFS is not improved upon administration of trabedersen or a variant, derivative or analog thereof but OS is improved upon administration of trabedersen or a variant, derivative or analog thereof, it is indicative of sensitization of the tumors by trabedersen or a variant, derivative or analog thereof to subsequent treatments.
  • trabedersen or a variant, derivative or analog thereof sensitizes tumors to subsequent exogenously administered therapies such as chemotherapy, radiation therapy, hormonal therapy or combination thereof.
  • trabedersen or a variant, derivative or analog thereof sensitizes tumors to the patient's own endogenous immune system.
  • chemotherapeutic agents when a tumor is sensitized with trabedersen or a variant, derivative or analog thereof prior to chemotherapy, administration of one or more chemotherapeutic agents following treatment with trabedersen or a variant, derivative or analog thereof results in at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or 100%) improved response to the chemotherapeutic agents compared to treatment with the chemotherapeutic agents without sensitization with trabedersen or a variant, derivative or analog thereof.
  • Trabedersen or “trabedersen” as used herein refers to a transforming growth factor (TGF)-beta2 (TGFP2) specific phosphorothioate antisense oligodeoxynucleotide with the sequence 5'-CGGCATGTCTATTTTGTA-3', as shown in SEQ ID No: 1.
  • TGF transforming growth factor
  • TGFP2 transforming growth factor-beta2
  • inhibitors of TGF including inhibitors of TGFP2 (such as trabedersen) are described in W094/25588, WO95/17507, WO95/02051, WO98/33904, W099/63975, WO01/68146, WO01/68122, WO03/064457, WO2005/014812, WO2004/093945, WO2005/059133, WO2005/084712, WO2006/11740, WO2008/077956A2, WO2010/055148, WO2011/012713A1, WO2011/154542, EP application no.
  • trabedersen is LNA modified.
  • a LNA is a modified RNA nucleotide, wherein the ribose moiety is modified with an extra bridge connecting the 2' oxygen and 4' carbon (2'- 4 'ribonucleoside). The bridge "locks" the ribose in the 3'-endo (North) conformation, which is often found in the A- form duplexes.
  • LNA nucleosides and nucleotides comprise for example the forms of thio-LNA, oxy- LNA, or amino-LNA, in alpha-D- or beta-L-configuration, and are mixable and combineable, respectively, with DNA or RNA residues in the oligonucleotide.
  • compositions and methods for treating pancreatic cancer in a subject in need thereof, using trabedersen or a variant, derivative or analog thereof first, followed by other agents to treat pancreatic agents are provided herein.
  • compositions comprising a TGF signaling inhibitors and a pharmaceutically acceptable carrier.
  • a “TGFP signaling inhibitor”, “TGFP signaling antagonist”, “TGFP signaling blocker”, or “TGFP signaling reducer” is any reagent that inhibits/blocks/reduces the TGFP signaling, including inhibition/blockade/reduction of any molecular signaling step from the TGFP ligand through its receptor to various downstream target molecules.
  • TGFP includes but is not limited to TGFpi, TGFP2, or TGFP3, or a combination thereof.
  • the TGF signaling inhibitor inhibits TGF i, TGF 2 or TGF 3.
  • the TGF signaling inhibitor inhibits TGF i and TGF 2 or TGF i and TGF 3 or TGF 2 and TGF 3. In a further embodiment, the TGF signaling inhibitor inhibits TGF i, TGF 2 and TGF 3.
  • the TGF signaling inhibitor is a direct inhibitor of TGF or an indirect inhibitor of TGF .
  • An indirect inhibitor of TGF may be an inhibitor of TGF receptor.
  • TGF signaling inhibitors include but are not limited to small molecules, antibodies or antigen-binding antibody fragments, intrabodies, aptamers, antisense oligonucleotides, RNA interference agents, and ribozymes.
  • Antibodies that specifically bind TGFp can be used for the inhibition of the TGFP (for example, TGFP2) in vivo.
  • protein ligands for construction of TGF trap are also encompassed by the compositions and methods described herein.
  • Antibodies to TGFp are commercially available and can be raised by one of skill in the art using well known methods.
  • the TGFP (for example, TGFP2) inhibitory activity of a given antibody, or, for that matter, any TGFP (for example, TGFP2) inhibitor can be assessed using methods known in the art or described herein.
  • Antibody inhibitors of TGFP can include polyclonal and monoclonal antibodies and antigen-binding derivatives or fragments thereof.
  • Well known antigen binding fragments include, for example, single domain antibodies (dAbs; which consist essentially of single VL or VH antibody domains), Fv fragment, including single chain Fv fragment (scFv), Fab fragment, and F(ab')2 fragment. Methods for the construction of such antibody molecules are well known in the art.
  • antibodies that may be used for TGF signaling inhibition for use in the methods described herein or in the compositions described herein include but are not limited to any one or more of Fresolimumad (GC-1008), Lerderlimumab (CAT- 152), Metelimumab (CAT- 162), or combinations thereof.
  • TGF signaling inhibitors for use in the methods described herein or in the compositions described herein include but are not limited to any one or more of PF-03446962 antibody (a fully-human monoclonal antibody against transforming growth-factor ⁇ (TGFP) receptor ALKl), Galunisertib (LY2157299, a small molecule inhibitor of TGF signaling), Lucanix (an allogenic tumor vaccine comprising a mixture of four allogeneic human non-small cell lung cancer cell lines modified to express an antisense oligonucleotide targeting TGFP2) or TGFP2 antisense oligonucleotide in combination with GM-CSF, or combinations thereof. It is contemplated that any of these TGF signaling inhibitors set forth herein may be used in the methods described herein to treat pancreatic cancer alone or in combination with chemotherapeutic agents and/or radiation therapy as set forth herein.
  • the TGFP signaling inhibitor is an antisense molecule that specifically targets a TGFp.
  • the antisense molecule is an antisense nucleic acid, antisense polynucleotide, antisense polydeoxynucleotide, antisense oligonucleotide, or antisense oligodeoxynucleotide.
  • the inhibition/blockade/reduction/decrease will be of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%), 80%), 90%), 95% or 99% or more as compared to the expression of TGFP gene or the activity or level of the TGFP encoded by a TGFP gene which has not been targeted by an antisense oligonucleotide.
  • the TGFP signaling inhibitor is a phosphorothioate antisense oligodeoxynucleotide specific for human TGFP2 mRNA.
  • the TGFP signaling inhibitor is trabedersen (AP12009) or a variant, derivative or analog thereof.
  • the TGFP signaling inhibitor comprises, consists of or consists essentially of the sequence 5'-CGGC ATGTCTATTTTGTA-3 ' as set forth in SEQ ID NO: 1.
  • trabedersen or a variant, derivative or analog thereof to reduce the IC50 of chemotherapeutic agents and/or trabedersen or a variant, derivative or analog thereof does not reduce the IC 50 of chemotherapeutic agents.
  • a trabedersen with temozolomide in glioma cells or in combining trabedersen in with 5- fluorouracil in pancreatic cancer cells or colon cancer cells.
  • Antisense oligodeoxynucleotide molecules need not be limited to those molecules containing only RNA, but, for example, further encompasses chemically modified nucleotides and non-nucleotides, and also include molecules wherein a ribose sugar molecule is substituted for another sugar molecule or a molecule which performs a similar function. Moreover, a non-natural linkage between nucleotide residues can be used, such as a phosphorothioate (sulfur group) linkage, methyl phosphonate linkage (methyl group) or phosphoramidate (amine group) linkage.
  • the antisense oligonucleotide strand can be derivatized with a reactive functional group of a reporter group, such as a fluorophore.
  • a reporter group such as a fluorophore.
  • Particularly useful derivatives are modified at a terminus or termini of an antisense oligonucleotide strand, typically the 3' terminus of the sense strand.
  • the 2'- hydroxyl at the 3 ' terminus can be readily and selectively derivatizes with a variety of groups.
  • RNA bases may also be modified. Any modified base useful for inhibiting or interfering with the expression of a target sequence may be used. For example, halogenated bases, such as 5-bromouracil and 5-iodouracil can be incorporated.
  • the bases may also be alkylated, for example, 7- methylguanosine can be incorporated in place of a guanosine residue.
  • antisense oligonucleotide modifications include 2'-deoxy-2'-fluorouridine or locked nucleic acid (LNA) nucleotides, peptide nucleic acid (PNA) nucleotides, morpholino phosphoroamidates (MF) nucleotides, or RNA duplexes containing either phosphodiester or varying numbers of phosphorothioate linkages.
  • LNA locked nucleic acid
  • PNA peptide nucleic acid
  • MF morpholino phosphoroamidates
  • RNA duplexes containing either phosphodiester or varying numbers of phosphorothioate linkages.
  • the TGF signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) inhibits TGF 2 and may be used to treat subjects with disease-states that overexpress TGF 2.
  • the disease- state is pancreatic cancer.
  • the TGF 2-specific antisense oligonucleotide (for example, trabedersen or a variant, derivative or analog thereof) is administered sequentially with a chemotherapeutic agent.
  • the TGF 2-specific antisense oligonucleotide is administered prior to administration of the chemotherapeutic agent.
  • trabedersen or a variant, derivative or analog thereof is administered prior to administration of one or more chemotherapeutic agents and/or prior to administration of radiation therapy so as to sensitize the tumor to the chemotherapeutic agent and/or radiation therapy.
  • the TGF 2-specific antisense oligonucleotide (such as trabedersen or a variant, derivative or analog thereof) sensitizes the tumor to the chemotherapeutic agent.
  • the TGFP signaling inhibitor comprises, consists of or consists essentially of the sequence 5'-CGGC ATGTCTATTTTGTA-3 ' as set forth in SEQ ID NO: l .
  • there is no requirement for trabedersen or a variant, derivative or analog thereof to reduce the IC50 of chemotherapeutic agents and/or trabedersen or a variant, derivative or analog thereof does not reduce the IC 50 of chemotherapeutic agents.
  • Typical dosages of an effective amount of the TGFP signaling inhibitor can be in the ranges recommended by the manufacturer where known molecules or compounds are used, and also as indicated to the skilled artisan by the in vitro responses in cells or in vivo responses in animal models. Such dosages typically can be reduced by up to about an order of magnitude in concentration or amount without losing relevant biological activity.
  • the actual dosage can depend upon the judgment of the physician, the condition of the patient, and the effectiveness of the therapeutic method based, for example, on the in vitro responsiveness of relevant cultured cells or histocultured tissue sample, or the responses observed in the appropriate animal models.
  • the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) is administered at about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg inhibitor/kg body weight, or a combination thereof.
  • the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) is administered at about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5- 10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg inhibitor/m 2 body surface area, or a combination thereof.
  • mg inhibitor/kg body weight refers to mg inhibitor per kg body weight of the subject
  • mg inhibitor/m 2 body surface area refers to mg inhibitor per m 2 body surface area of the subject.
  • the effective amount of the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) is any one or more of about 0.001- 0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400- 500, 500-600, 600-700, 700-800, 800-900, or 900-1000 ⁇ g/kg/day, or a combination thereof.
  • the effective amount of the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 ⁇ / ⁇ 2 / , or a combination thereof.
  • the effective amount of the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg/kg/day, or a combination thereof.
  • the effective amount of the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg/m 2 /day, or a combination thereof.
  • ' ⁇ g/kg/day or “mg/kg/day” refers to ⁇ g or mg inhibitor per kg body weight of the subject per day
  • ' ⁇ g/m 2 /day or “mg/m 2 /day” refers to ⁇ g or mg inhibitor per m 2 body surface area of the subject per day.
  • the TGFP signaling inhibitor is trabedersen (AP12009) or a variant, derivative or analog thereof and is administered at about 50-100, 100-150, 150-200, 200-250, 250-300, 300-350, 350-400, 400-450, or 450-500 mg/m 2 /day.
  • trabedersen or a variant, derivative or analog thereof is administered at about 140, 150, 160, 170, or 180mg/m 2 /day.
  • trabedersen or a variant, derivative or analog thereof is administered at about 310, 320, 330, 340, 350 mg/m 2 /day or a combination thereof.
  • the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) may be administered once, twice, three or more times. In various embodiments, the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) may be administered 1-3 times per day, 1-7 times per week, 1-9 times per month, or 1-12 times per year.
  • the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) may be administered for about 1-10 days, 10-20 days, 20-30 days, 30-40 days, 40-50 days, 50-60 days, 60-70 days, 70-80 days, 80-90 days, 90-100 days, 1-6 months, 6-12 months, or 1-5 years.
  • the TGFP signaling inhibitor (such as trabedersen or a variant, derivative or analog thereof) may be administered once a day (SID/QD), twice a day (BID), three times a day (TID), four times a day (QID), or more, so as to deliver an effective amount of the TGFP signaling inhibitor to the subject, where the effective amount is any one or more of the doses described herein.
  • trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion for one, two, three, four, five or more cycles of 7 days and on 7 days off, prior to administration of a chemotherapeutic agent, radiation therapy or a combination thereof.
  • trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion for one, two, three, four, five or more cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent, radiation therapy or a combination thereof. In one embodiment, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion for one cycle of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent or radiation therapy. In one embodiment, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion two cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent, radiation therapy or a combination thereof.
  • trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion three cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent, radiation therapy or a combination thereof. In one embodiment, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion four cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent, radiation therapy or a combination thereof.
  • examples of the chemotherapeutic agent include but are not limited to Temozolomide, Actinomycin, Alitretinoin, All-trans retinoic acid, Azacitidine, Azathioprine, Bevacizumab, Bexatotene, Bleomycin, Bortezomib, Carboplatin, Capecitabine, Cetuximab, Cisplatin, Chlorambucil, Cyclophosphamide, Cytarabine, Daunorubicin, Docetaxel, Doxifluridine, Doxorubicin, liposome-encapsulated Doxorubicin such as as Doxil (pegylated form), Myocet (nonpegylated form) and Caelyx, Epirubicin, Epothilone, Erlotinib, Etoposide, Fluorouracil, Folinic acid, Gefitinib, Gemcitabine, Hydroxyurea, Idarubi
  • the chemotherapeutic agent is a platinum-based antineoplastic agent.
  • platinum-based antineoplastic agent include but are not limited to oxaliplatin, cisplatin, lipoplatin (a liposomal version of cisplatin), carboplatin, satraplatin, picoplatin, nedaplatin, and triplatin, and their functional equivalents, analogs, derivatives, variants or salts.
  • the chemotherapeutic agent is a taxane.
  • the taxane include but are not limited to paclitaxel, docetaxel, and cabazitaxel, and their functional equivalents, analogs, derivatives, variants or salts, or formulations such as Abraxane, Taxol, Genexol.
  • the chemotherapeutic agent is an anthracycline.
  • anthracycline examples include but are not limited to doxorubicin, daunorubicin, epirubicin, idarubicin, pirarubicin, aclarubicin, valrubicin, and mitoxantrone, and their functional equivalents, analogs, derivatives, variants or salts.
  • Typical dosages of an effective amount of the chemotherapeutic agent can be in the ranges recommended by the manufacturer where known molecules or compounds are used, and also as indicated to the skilled artisan by the in vitro responses in cells or in vivo responses in animal models. Such dosages typically can be reduced by up to about an order of magnitude in concentration or amount without losing relevant biological activity.
  • the actual dosage can depend upon the judgment of the physician, the condition of the patient, and the effectiveness of the therapeutic method based, for example, on the in vitro responsiveness of relevant cultured cells or histocultured tissue sample, or the responses observed in the appropriate animal models.
  • the chemotherapeutic agent is administered at about 0.001- 0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400- 500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg agent/kg body weight, or a combination thereof.
  • the chemotherapeutic agent is administered at about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg agent/ m 2 body surface area, or a combination thereof.
  • mg agent/kg body weight refers to mg agent per kg body weight of the subject
  • mg agent/m 2 body surface area refers to mg agent per m 2 body surface area of the subject.
  • the effective amount of the chemotherapeutic agent is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100- 200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 ⁇ g/kg/day, or a combination thereof.
  • the effective amount of the chemotherapeutic agent is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5- 10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 ⁇ g/m 2 /day, or a combination thereof.
  • the effective amount of the chemotherapeutic agent is any one or more of about 0.001-0.01, 0.01- 0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500- 600, 600-700, 700-800, 800-900, or 900-1000 mg/kg/day, or a combination thereof.
  • the effective amount of the chemotherapeutic agent is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg/m 2 /day, or a combination thereof.
  • ' ⁇ g/kg/day" or “mg/kg/day” refers to ⁇ g or mg agent per kg body weight of the subject per day
  • ' ⁇ g/m 2 /day" or “mg/m 2 /day” refers to ⁇ g or mg agent per m 2 body surface area of the subject per day.
  • the chemotherapeutic agent may be administered once, twice, three or more times. In various embodiments, the chemotherapeutic agent may be administered 1-3 times per day, 1-7 times per week, 1-9 times per month, or 1-12 times per year. In various embodiments, the chemotherapeutic agent may be administered for about 1- 10 days, 10-20 days, 20-30 days, 30-40 days, 40-50 days, 50-60 days, 60-70 days, 70-80 days, 80-90 days, 90-100 days, 1-6 months, 6-12 months, or 1-5 years.
  • the chemotherapeutic agent may be administered once a day (SID/QD), twice a day (BID), three times a day (TID), four times a day (QID), or more, so as to deliver an effective amount of the chemotherapeutic agent to the subject, where the effective amount is any one or more of the doses described herein.
  • the TGFP signaling inhibitor and/or the chemotherapeutic agent may be administered using the appropriate modes of administration, for instance, the modes of administration recommended by the manufacturer where known molecules or compounds are used.
  • the TGF signaling inhibitor for example, trabedersen or a variant, derivative or analog thereof
  • chemotherapeutic agent are administered sequentially, wherein the TGF signaling inhibitor (for example, trabedersen or a variant, derivative or analog thereof) is administered prior to administration of chemotherapy or radiation therapy.
  • various routes may be utilized to administer the TGFP signaling inhibitor and the chemotherapeutic agent of the claimed composition and methods, including but not limited to intratumoral, intravascular, intravenous, intraarterial, intramuscular, subcutaneous, intraperitoneal, aerosol, nasal, via inhalation, oral, transmucosal, transdermal, parenteral, implantable pump or reservoir, continuous infusion, enteral application, topical application, local application, capsules and/or injections.
  • the TGFP signaling inhibitor can be administered intracranially, intraventricularly, intrathecally, epidurally, intradurally, topically, intratumorally, intravascularly, intravenously, intraarterially, intramuscularly, subcutaneously, intraperitoneally, intranasally, or orally.
  • the chemotherapeutic agent can be administered intracranially, intraventricularly, intrathecally, epidurally, intradurally, topically, intratumorally, intravascularly, intravenously, intraarterially, intramuscularly, subcutaneously, intraperitoneally, intranasally, or orally.
  • the TGFP signaling inhibitor for example, trabedersen or a variant, derivative or analog thereof
  • the chemotherapeutic agent are administered using the same route.
  • the TGFP signaling inhibitor and the chemotherapeutic agent are administered using different routes.
  • the compositions according to the invention can contain any pharmaceutically acceptable excipient.
  • an "excipient” is a natural or synthetic substance formulated alongside the active ingredient of a composition or formula, included for the purpose of bulking-up the composition or formula.
  • excipient is often referred to as “bulking agent", “filler”, or “diluent”.
  • one or more excipients may be added to a composition described herein and increase the composition's volume or size so that one serving of the composition fits into one capsule or tablet.
  • an “excipient” may confer an enhancement on the active ingredients in the final dosage form, such as facilitating absorption or solubility of the active ingredients.
  • “Pharmaceutically acceptable excipient” means an excipient that is useful in preparing a pharmaceutical composition that is generally safe, non-toxic, and desirable, and includes excipients that are acceptable for veterinary use as well as for human pharmaceutical use. Such excipients may be solid, liquid, semisolid, or, in the case of an aerosol composition, gaseous.
  • excipients include but are not limited to starches, sugars, microcrystalline cellulose, diluents, granulating agents, lubricants, binders, disintegrating agents, wetting agents, emulsifiers, coloring agents, release agents, coating agents, sweetening agents, flavoring agents, perfuming agents, preservatives, antioxidants, plasticizers, gelling agents, thickeners, hardeners, setting agents, suspending agents, surfactants, humectants, carriers, stabilizers, and combinations thereof.
  • the compositions according to the invention can contain any pharmaceutically acceptable carrier.
  • “Pharmaceutically acceptable carrier” as used herein refers to a pharmaceutically acceptable material, composition, or vehicle that is involved in carrying or transporting a compound of interest from one tissue, organ, or portion of the body to another tissue, organ, or portion of the body.
  • the carrier may be a liquid or solid filler, diluent, excipient, solvent, or encapsulating material, or a combination thereof.
  • Each component of the carrier must be “pharmaceutically acceptable” in that it must be compatible with the other ingredients of the formulation. It must also be suitable for use in contact with any tissues or organs with which it may come in contact, meaning that it must not carry a risk of toxicity, irritation, allergic response, immunogenicity, or any other complication that excessively outweighs its therapeutic benefits.
  • compositions according to the invention can also be in liposomes, encapsulated, tableted or prepared in an emulsion or syrup for oral administration.
  • liposomes comprising trabedersen or a variant, derivative or analog thereof are coated with tissue specific antibodies.
  • the composition comprising trabedersen or a variant, derivative or analog thereof is prepared for administration by injection (e.g., intravenous, subcutaneous, intramuscular, etc.).
  • a pharmaceutical composition comprises a carrier and is formulated in aqueous solution, such as water or physiologically compatible buffers such as Hanks's solution, Ringer's solution, or physiological saline buffer.
  • injectable suspensions are prepared using appropriate liquid carriers, suspending agents and the like.
  • Certain pharmaceutical compositions for injection are presented in unit dosage form, e.g., in ampoules or in multi-dose containers.
  • Certain pharmaceutical compositions for injection are suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
  • solvents suitable for use in pharmaceutical compositions for injection include, but are not limited to, lipophilic solvents and fatty oils, such as sesame oil, synthetic fatty acid esters, such as ethyl oleate or triglycerides, and liposomes.
  • Aqueous injection suspensions may contain substances that increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran.
  • such suspensions may also contain suitable stabilizers or agents that increase the solubility of the pharmaceutical agents to allow for the preparation of highly concentrated solutions.
  • Solid or liquid carriers may be added to enhance or stabilize the composition, or to facilitate preparation of the composition.
  • Liquid carriers include syrup, peanut oil, olive oil, glycerin, saline, alcohols and water.
  • Solid carriers include starch, lactose, calcium sulfate, dihydrate, terra alba, magnesium stearate or stearic acid, talc, pectin, acacia, agar or gelatin.
  • the carrier may also include a sustained release material such as glyceryl monostearate or glyceryl distearate, alone or with a wax.
  • compositions are made following the conventional techniques of pharmacy involving dry milling, mixing, and blending for powder forms; milling, mixing, granulation, and compressing, when necessary, for tablet forms; or milling, mixing and filling for hard gelatin capsule forms.
  • a liquid carrier When a liquid carrier is used, the preparation will be in the form of a syrup, elixir, emulsion or an aqueous or non-aqueous suspension.
  • Such a liquid formulation may be administered directly p.o. or filled into a soft gelatin capsule.
  • compositions according to the invention may be delivered in a therapeutically effective amount.
  • the precise therapeutically effective amount is that amount of the composition that will yield the most effective results in terms of efficacy of treatment in a given subject. This amount will vary depending upon a variety of factors, including but not limited to the characteristics of the therapeutic compound (including activity, pharmacokinetics, pharmacodynamics, and bioavailability), the physiological condition of the subject (including age, sex, disease type and stage, general physical condition, responsiveness to a given dosage, and type of medication), the nature of the pharmaceutically acceptable carrier or carriers in the formulation, and the route of administration.
  • formulants may be added to the composition.
  • a liquid formulation may be preferred.
  • these formulants may include oils, polymers, vitamins, carbohydrates, amino acids, salts, buffers, albumin, surfactants, bulking agents or combinations thereof.
  • Carbohydrate formulants include sugar or sugar alcohols such as monosaccharides, di saccharides, or polysaccharides, or water soluble glucans.
  • the saccharides or glucans can include fructose, dextrose, lactose, glucose, mannose, sorbose, xylose, maltose, sucrose, dextran, pullulan, dextrin, alpha and beta cyclodextrin, soluble starch, hydroxethyl starch and carboxymethylcellulose, or mixtures thereof.
  • “Sugar alcohol” is defined as a C4 to C8 hydrocarbon having an -OH group and includes galactitol, inositol, mannitol, xylitol, sorbitol, glycerol, and arabitol. These sugars or sugar alcohols mentioned above may be used individually or in combination. There is no fixed limit to amount used as long as the sugar or sugar alcohol is soluble in the aqueous preparation. In one embodiment, the sugar or sugar alcohol concentration is between 1.0 w/v % and 7.0 w/v %, more preferable between 2.0 and 6.0 w/v %.
  • Amino acids formulants include levorotary (L) forms of carnitine, arginine, and betaine; however, other amino acids may be added.
  • Polymers formulants include polyvinylpyrrolidone (PVP) with an average molecular weight between 2,000 and 3,000, or polyethylene glycol (PEG) with an average molecular weight between 3,000 and 5,000.
  • PVP polyvinylpyrrolidone
  • PEG polyethylene glycol
  • a buffer in the composition it is also preferred to use a buffer in the composition to minimize pH changes in the solution before lyophilization or after reconstitution.
  • Most any physiological buffer may be used including but not limited to citrate, phosphate, succinate, and glutamate buffers or mixtures thereof.
  • the concentration is from 0.01 to 0.3 molar.
  • Surfactants that can be added to the formulation are shown in EP Nos. 270,799 and 268, 110.
  • liposome Another drug delivery system for increasing circulatory half-life is the liposome.
  • Methods of preparing liposome delivery systems are discussed in Gabizon et al., Cancer Research (1982) 42:4734; Cafiso, Biochem Biophys Acta (1981) 649: 129; and Szoka, Ann Rev Biophys Eng (1980) 9:467.
  • Other drug delivery systems are known in the art and are described in, e.g., Poznansky et al., DRUG DELIVERY SYSTEMS (R. L. Juliano, ed., Oxford, N.Y. 1980), pp. 253-315; M. L. Poznansky, Pharm Revs (1984) 36:277.
  • the liquid composition may be lyophilized to prevent degradation and to preserve sterility.
  • Methods for lyophilizing liquid compositions are known to those of ordinary skill in the art.
  • the composition may be reconstituted with a sterile diluent (Ringer's solution, distilled water, or sterile saline, for example) which may include additional ingredients.
  • a sterile diluent Finger's solution, distilled water, or sterile saline, for example
  • the composition is administered to subjects using those methods that are known to those skilled in the art.
  • compositions of the invention may be sterilized by conventional, well-known sterilization techniques.
  • the resulting solutions may be packaged for use or filtered under aseptic conditions and lyophilized, the lyophilized preparation being combined with a sterile solution prior to administration.
  • the compositions may contain pharmaceutically-acceptable auxiliary substances as required to approximate physiological conditions, such as pH adjusting and buffering agents, tonicity adjusting agents and the like, for example, sodium acetate, sodium lactate, sodium chloride, potassium chloride, calcium chloride, and stabilizers (e.g., 1-20% maltose, etc.).
  • the numbers expressing quantities of ingredients, properties such as concentration, reaction conditions, and so forth, used to describe and claim certain embodiments of the invention are to be understood as being modified in some instances by the term "about.” Accordingly, in some embodiments, the numerical parameters set forth in the written description and attached claims are approximations that can vary depending upon the desired properties sought to be obtained by a particular embodiment. In some embodiments, the numerical parameters should be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of some embodiments of the invention are approximations, the numerical values set forth in the specific examples are reported as precisely as practicable. The numerical values presented in some embodiments of the invention may contain certain errors necessarily resulting from the standard deviation found in their respective testing measurements.
  • the subject is a human.
  • the subject is a mammalian subject including but not limited to human, monkey, ape, dog, cat, cow, horse, goat, pig, rabbit, mouse and rat.
  • the subject is an animal model of a cancer.
  • the methods comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to sensitize the tumor.
  • the tumor is a pancreatic tumor.
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • methods for treating, inhibiting, reducing the severity of or preventing metastasis of cancer in a subject in need thereof include first sensitizing the tumor using the TGF signaling inhibitor as set forth herein and subsequently administering exogenous therapeutic agents including chemotherapeutic agents, radiation therapy or a combination thereof.
  • methods for treating cancer in a subject in need thereof comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to treat cancer in the subject.
  • the cancer is pancreatic cancer.
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • the methods further comprise administering exogenous therapies including chemotherapy, radiation therapy, hormonal therapy or a combination thereof.
  • trabedersen or a variant, derivative or analog thereof is administered prior to administration of chemotherapeutic agents, radiation therapy or a combination thereof as described herein.
  • the methods comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to inhibit cancer in the subject.
  • the cancer is pancreatic cancer.
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • the methods further comprise administering exogenous therapies including chemotherapy, radiation therapy, hormonal therapy or a combination thereof.
  • trabedersen or a variant, derivative or analog thereof is administered prior to administration of chemotherapeutic agents, radiation therapy or a combination thereof as described herein
  • the methods comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to reduce the severity of cancer in the subject.
  • the cancer is pancreatic cancer.
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • the methods further comprise administering exogenous therapies including chemotherapy, radiation therapy, hormonal therapy or a combination thereof. In some embodiments, trabedersen or a variant, derivative or analog thereof is administered prior to administration of chemotherapeutic agents, radiation therapy or a combination thereof as described herein.
  • the methods comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to prevent metastasis of cancer in the subject.
  • the cancer is pancreatic cancer.
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • the methods further comprise administering exogenous therapies including chemotherapy, radiation therapy, hormonal therapy or a combination thereof. In some embodiments, trabedersen or a variant, derivative or analog thereof is administered prior to administration of chemotherapeutic agents, radiation therapy or a combination thereof as described herein.
  • the methods comprise, consist of or consist essentially of providing a composition comprising an inhibitor of TGF signaling and administering an effective amount of the composition to the subject so as to reduce the pancreatic tumor load in the subject.
  • the inhibitor of TGF signaling is an antisense oligonucleotide specific for TGF 2.
  • the antisense oligonucleotide specific for TGF 2 is trabedersen or a variant, derivative or analog thereof.
  • the methods further comprise administering exogenous therapies including chemotherapy, radiation therapy, hormonal therapy or a combination thereof. In some embodiments, trabedersen or a variant, derivative or analog thereof is administered prior to administration of chemotherapeutic agents, radiation therapy or a combination thereof, as described herein.
  • the TGFP signaling inhibitor is an antisense molecule that specifically targets a TGFp.
  • the antisense molecule is an antisense nucleic acid, antisense polynucleotide, antisense polydeoxynucleotide, antisense oligonucleotide, or antisense oligodeoxynucleotide.
  • the inhibition/blockade/reduction/decrease will be of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%), 80%), 90%), 95% or 99% or more as compared to the expression of TGF gene or the activity or level of the TGF encoded by a TGF gene which has not been targeted by an antisense oligonucleotide.
  • the TGFP signaling inhibitor is a phosphorothioate antisense oligodeoxynucleotide specific for human TGFP2 mRNA.
  • the TGFP signaling inhibitor is trabedersen (API 2009), or a variant, derivative or analog thereof.
  • the TGFP signaling inhibitor comprises, consists of or consists essentially of the sequence 5'-CGGC ATGTCTATTTTGTA-3 ' as set forth in SEQ ID NO: 1.
  • trabedersen or a variant, derivative or analog thereof to reduce the IC50 of chemotherapeutic agents and/or trabedersen or a variant, derivative or analog thereof does not reduce the IC 50 of chemotherapeutic agents.
  • a trabedersen with temozolomide in glioma cells or in combining trabedersen in with 5- fluorouracil in pancreatic cancer cells or colon cancer cells.
  • trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion for one, two, three, four, five or more cycles of 7 days and on 7 days off, prior to administration of a chemotherapeutic agent or radiation therapy. In some embodiments, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion for one, two, three, four, five or more cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent or radiation therapy.
  • trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion for one cycle of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent or radiation therapy. In one embodiment, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion two cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent or radiation therapy. In one embodiment, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion three cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent or radiation therapy. In one embodiment, trabedersen or a variant, derivative or analog thereof is administered intravenously via continuous infusion four cycles of 4 days on and 10 days off, prior to administration of a chemotherapeutic agent or radiation therapy.
  • the chemotherapeutic agent for use with the methods described herein include but are not limited to Temozolomide, Actinomycin, Alitretinoin, All-trans retinoic acid, Azacitidine, Azathioprine, Bevacizumab, Bexatotene, Bleomycin, Bortezomib, Carboplatin, Capecitabine, Cetuximab, Cisplatin, Chlorambucil, Cyclophosphamide, Cytarabine, dacarbazine, Daunorubicin, Docetaxel, Doxiflundine, Doxorubicin, liposome-encapsulated Doxorubicin such as as Doxil (pegylated form), Myocet (nonpegylated form) and Caelyx, Epirubicin, Epothilone, Erlotinib, Etoposide, Fluorouracil, Folinic acid, Ge
  • exogenous therapies for use with the methods described herein include radiation therapy.
  • the radiation used in radiation therapy can be ionizing radiation.
  • Radiation therapy can also be gamma rays, X-rays, or proton beams.
  • Examples of radiation therapy include, but are not limited to, external-beam radiation therapy, interstitial implantation of radioisotopes (1-125, palladium, iridium), radioisotopes such as strontium-89, thoracic radiation therapy, intraperitoneal P-32 radiation therapy, and/or total abdominal and pelvic radiation therapy.
  • the radiation therapy can be administered as external beam radiation or tele-therapy wherein the radiation is directed from a remote source.
  • the radiation treatment can also be administered as internal therapy or brachytherapy wherein a radioactive source is placed inside the body close to cancer cells or a tumor mass.
  • photodynamic therapy comprising the administration of photosensitizers, such as hematoporphyrin and its derivatives, Vertoporfin (BPD-MA), phthalocyanine, photosensitizer Pc4, demethoxy- hypocrellin A; and 2BA-2-DMHA.
  • photosensitizers such as hematoporphyrin and its derivatives, Vertoporfin (BPD-MA), phthalocyanine, photosensitizer Pc4, demethoxy- hypocrellin A; and 2BA-2-DMHA.
  • exogenous therapies for use with the methods described herein include hormonal therapy.
  • Hormonal therapeutic treatments can comprise, for example, hormonal agonists, hormonal antagonists (e.g., flutamide, bicalutamide, tamoxifen, raloxifene, leuprolide acetate (LUPRON), LH-RH antagonists), inhibitors of hormone biosynthesis and processing, and steroids (e.g., dexamethasone, retinoids, deltoids, betamethasone, Cortisol, cortisone, prednisone, dehydrotestosterone, glucocorticoids, mineralocorticoids, estrogen, testosterone, progestins), vitamin A derivatives (e.g., all-trans retinoic acid (ATRA)); vitamin D3 analogs; antigestagens (e.g., mifepristone, onapristone), or antiandrogens (e.g., cyproterone
  • hormonal antagonists e.g., flu
  • typical dosages of an effective amount of the TGF inhibitor can be in the ranges recommended by the manufacturer where known therapeutic compounds are used, and also as indicated to the skilled artisan by the in vitro responses or responses in animal models. Such dosages typically can be reduced by up to about an order of magnitude in concentration or amount without losing relevant biological activity.
  • the actual dosage can depend upon the judgment of the physician, the condition of the patient, and the effectiveness of the therapeutic method based, for example, on the in vitro responsiveness of relevant cultured cells or histocultured tissue sample, such as biopsied malignant tumors, or the responses observed in the appropriate animal models.
  • compositions of the invention comprising the TGF inhibitor may be administered once a day (SID/QD), twice a day (BID), three times a day (TID), four times a day (QID), or more, so as to administer an effective amount of the TGF inhibitor (for example, TGF 2 inhibitor) to the subject, where the effective amount is any one or more of the doses described herein.
  • TGF inhibitor for example, TGF 2 inhibitor
  • the subject is selected from the group consisting of human, non-human primate, monkey, ape, dog, cat, cow, horse, rabbit, mouse and rat.
  • Typical dosages of an effective amount of the TGFP signaling inhibitor for example, TGF 2 inhibitor or a composition comprising TGF 2 inhibitor
  • these dosages can be in the ranges recommended by the manufacturer where known molecules or compounds are used, and also as indicated to the skilled artisan by the in vitro responses in cells or in vivo responses in animal models.
  • Such dosages typically can be reduced by up to about an order of magnitude in concentration or amount without losing relevant biological activity.
  • the actual dosage can depend upon the judgment of the physician, the condition of the patient, and the effectiveness of the therapeutic method based, for example, on the in vitro responsiveness of relevant cultured cells or histocultured tissue sample, or the responses observed in the appropriate animal models.
  • the TGFP signaling inhibitor is administered at about 0.001- 0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400- 500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg inhibitor/kg body weight, or a combination thereof.
  • the TGFP signaling inhibitor is administered at about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg inhibitor/m 2 body surface area, or a combination thereof.
  • mg inhibitor/kg body weight refers to mg inhibitor per kg body weight of the subject
  • mg inhibitor/m 2 body surface area refers to mg inhibitor per m 2 body surface area of the subject.
  • the effective amount of the TGFP signaling inhibitor is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100- 200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 ⁇ g/kg/day, or a combination thereof.
  • the effective amount of the TGFP signaling inhibitor is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5- 10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 ⁇ g/m 2 /day, or a combination thereof.
  • the effective amount of the TGFP signaling inhibitor is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200-300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg/kg/day, or a combination thereof.
  • the effective amount of the TGFP signaling inhibitor is any one or more of about 0.001-0.01, 0.01-0.1, 0.1-0.5, 0.5-5, 5-10, 10-20, 20-50, 50-100, 100-200, 200- 300, 300-400, 400-500, 500-600, 600-700, 700-800, 800-900, or 900-1000 mg/m 2 /day, or a combination thereof.
  • ' ⁇ g/kg/day" or “mg/kg/day” refers to ⁇ g or mg inhibitor per kg body weight of the subject per day
  • ' ⁇ g/m 2 /day" or “mg/m 2 /day” refers to ⁇ g or mg inhibitor per m 2 body surface area of the subject per day.
  • the TGFP signaling inhibitor is trabedersen (AP12009) or a variant, derivative or analog thereof, and it is administered at about 50-100, 100-150, 150- 200, 200-250, 250-300, 300-350, 350-400, 400-450, or 450-500 mg/m 2 /day. In some embodiments, trabedersen or a variant, derivative or analog thereof is administered at about 140, 150, 160, 170, or 180mg/m 2 /day. In some embodiments, trabedersen or a variant, derivative or analog thereof is administered at about 310, 320, 330, 340, or 350mg/m 2 /day.
  • the TGFP signaling inhibitor may be administered once, twice, three or more times. In various embodiments, the TGFP signaling inhibitor may be administered 1-3 times per day, 1-7 times per week, 1-9 times per month, or 1-12 times per year. In various embodiments, the TGFP signaling inhibitor may be administered for about 1-10 days, 10-20 days, 20-30 days, 30-40 days, 40-50 days, 50-60 days, 60-70 days, 70-80 days, 80-90 days, 90-100 days, 1-6 months, 6-12 months, or 1-5 years.
  • the TGFP signaling inhibitor may be administered once a day (SID/QD), twice a day (BID), three times a day (TID), four times a day (QID), or more, so as to deliver an effective amount of the TGFp signaling inhibitor to the subject, where the effective amount is any one or more of the doses described herein.
  • TGF 2 is overexpressed in many advanced tumors where it generates a microenvironment that cloaks the tumor and promotes immune evasion in patients. This makes it challenging for therapeutic agents such as chemotherapies to reach the tumor cells.
  • the inventor shows for the first time that inhibition of TGF 2 using trabedersen un-cloaks the tumor, thus sensitizing it to subsequent chemotherapies, showing the importance of the order in which the therapeutic agents are administered.
  • the instant invention provides an unexpected advantage, namely, that treatment of pancreatic cancer patients with trabedersen (for an effective number of cycles as described herein) prior to treatment with a chemotherapeutic agent significantly increases the overall survival rate in patients with pancreatic cancer patients.
  • the aim of the study was to determine the effect of AP12009 (trabedersen) treatment in combination with 5-Fluorouracil (5-FU) on TGFP2 secretion and on cellular proliferation of HUP-T3 pancreatic cancer cells and WiDr colon cancer cells in vitro.
  • AP12009 trabedersen
  • 5-Fluorouracil 5-Fluorouracil
  • A- 172 glioma cells were treated with a combination of AP12009 (trabedersen) 0 to ⁇ ) and different concentrations of TMZ (temozolomide) for 7 days (treatment schedule 2*2/1 *3 d).
  • a pre-treatment (1 *2/1 *3d) of A- 172 glioma cells with AP12009, before combined treatment with AP12009 and TMZ (2*2/1 *3d) did not show any benefit.
  • a single treatment (day 0) with TMZ for one day combined with a 7 day AP12009 treatment (2* l/l *2/l *3d) did not show any benefit or disadvantage.
  • High TMZ concentrations (64/160/400 ⁇ ) dose- dependently reduced migration of A- 172 cells as monotherapy.
  • AP12009 (10 ⁇ ) as monotherapy did not affect migration compared with untreated control. In combination, AP12009 did not influence the effects of TMZ on migration.
  • TMZ dose dependently reduced proliferation and TGF- 2 in parallel.
  • AP12009 strongly reduced TGF 2 and slightly reduced cell proliferation.
  • an additive effect on inhibition of TGFP2 secretion was observed, while no reproducible beneficial effect on cell proliferation could be detected.
  • Lactase dehydrogensa (LDH) release assay for quantification of cytotoxity did not show reproducible results.
  • LDH Lactase dehydrogensa
  • TGF- 2 transforming growth factor-beta 2
  • the primary objective was to determine the Maximum Tolerated Dose (MTD) and the Dose Limited Toxicity (DLT) of two cycles of trabedersen administered intravenously (i.v.) for either 7 days every other week (i.e. 7 days on/ 7 days off) or for 4 days every other week (4 days on/10 days off).
  • the secondary objective included assessment of antitumor activity of trabedersen administered intravenously for either 7 days every other week (i.e. 7 days on/ 7 days off) or for 4 days every other week (4 days on/ 10 days off).
  • the escalation scheme of this study aimed to determinate the MTD of two cycles of trabedersen (so called 'core study period') administered as a continuous i.v. infusion for 7 days every other week (7-day s-on/7-day s-off) or for 4 days every other week (4-day s-on/10- days-off).
  • the MTD was determined according to the following procedure: If 2 out of 3 patients of 1 cohort experienced a DLT, 3 more patients were enrolled in the same treatment group. If at least 1 of these additional 3 patients also met the toxicity criteria for a DLT, the MTD for two cycles was determined; otherwise the dose escalation was continued upon agreement with the DSMB. MTD for two cycles was then defined as the dose at which no more than 2 out of 3, or 2 out of 6 patients of the same treatment group experienced a DLT. This procedure was followed until the MTD was reached.
  • the end of the study was defined as the point at which one of the following criteria had been met for all patients of the last cohort: (1) a time-point of twelve months after enrollment of the last patient had been reached, or (2) Median overall survival (OS) was reached for the last cohort (i.e. more than half of the patients had died during follow-up).
  • OS Median overall survival
  • FAS safety population/ full analysis set
  • pancreatic cancer patients After the core study period, 25 pancreatic cancer patients, 16 melanoma patients, and 1 colorectal patient continued treatment in the extension study period during which most of these patients discontinued prematurely before receiving a total of 10 treatment cycles. 3 patients with pancreatic cancer and 1 with melanoma completed the full extension study period. Of note, investigators were asked to discontinue the treatment of patients after the 4th treatment cycle if signs of progressive disease were observed at that time point.
  • the inclusion criteria for this study were as follows: (1) The patient provided written informed consent prior to any study -related procedure; (2) The patient was at least 18 years of age and not older than 75 years; (3) The patient was a male or a non-pregnant, non- lactating female.
  • the exclusion criteria for this study were as follows: (1) The patient was unable to comply with the protocol regulations; (2) The patient was a pregnant or lactating female; (3) The patient had received antitumor radiation therapy within 12 weeks, tumor surgery within 4 weeks or any other therapy with established antitumor effects within 2 weeks prior to study entry; (4) The patient was taking or was likely to need other prohibited concomitant medication; administration of corticosteroids was strictly avoided during the course of the study; (5) The patient had participated in another clinical trial with investigational medication within 30 days prior to study entry; (6) The patient had a history of brain metastases. If brain metastases were suspected, a computed tomography (CT) scan of the skull was performed.
  • CT computed tomography
  • the patient showed clinically significant cardiovascular abnormalities such as refractory hypertension, congestive heart failure, unstable angina pectoris, or poorly controlled arrhythmia, or had a myocardial infarction within 6 months prior to treatment; (8) The patient had gastric or duodenal ulcers within 6 months before study entry or was at risk of gastrointestinal ulceration due to high consumption of non-steroidal anti-inflammatory (NSAIDs); (9) The patient had an active infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV); (10) The patient had a clinically significant acute viral, bacterial, or fungal infection; (11) The patient had acute medical problems that may have been considered to become an unacceptable risk, or any conditions that might have been contraindications for starting study treatment; (12) The patient had a history of allergies to reagents used in this study; (13) The patient was known for drug abuse or extensive use of alcohol; (14) The patient showed
  • the clinical starting dose for the 7-days-on and 7-days-off schedule was based on the Lowest-Observed-Adverse-Effect-Level (LOAEL) devoid of severe toxicity in Cynomolgus monkeys as the most relevant species.
  • LOAEL Lowest-Observed-Adverse-Effect-Level
  • This LOAEL of 4 mg/kg body weight (b.w.)/day is equivalent to approximately 1.3 mg/kg b.w./day or 48 mg/m 2 /day on a body surface area basis in human adults. These numbers were rounded down and the safe starting dose was defined at 40 mg/m 2 /day, equivalent to approximately 1 mg/kg b.w./day in humans.
  • the daily dose of the proposed 4-days-on and 10-day s-off schedule (140 mg/m 2 /day or 560 mg/m 2 /cycle or approx. 3.5 mg/kg/day) still remained slightly below the daily dose of MTD of the initial 7-days-on and 7-days-off schedule (approx. 4 mg/kg/day).
  • the dose was administered only for 4 instead of 7 days. Therefore, the starting dose of 140 mg/m 2 /day for the 4-days-on, 10-days-off schedule was assessed as safe by the DSMB as well as by the Coordinating Investigator. Based upon the adverse events observed for the various doses of the 7-days-on and 7-days-off schedule, it was decided to explore doses of up to 330 mg/m 2 /day for the 4-days-on and 10-days-off schedule.
  • the safety population comprised of 61 patients, representing all patients for whom at least once a trabedersen infusion was started.
  • the MTD was determined according to the following procedure: if 2 out of 3 patients of one cohort experience dose-limiting toxicity, 3 more patients were enrolled in the same treatment group. If at least 1 more patient of this second cohort met the toxicity criteria, MTD for two cycles has been determined (otherwise escalation was continued). MTD for two cycles was then defined as the dose at which no more than 2 out of 3 or 2 out of 6 patients of the same treatment group experienced DLT. Consistently, if 3 patients of the first cohort showed DLT, the second cohort was left out. In the case that 2 patients of the first cohort experienced DLTs that clearly indicated attainment of the MTD, the second cohort could also be omitted. The described procedure was pursued until the MTD is reached.
  • the number of patients per cohort of the 7-days-on and 7-days-off and 4-days-on and 10-days-off dose escalation schedules varied between 3 and 6 patients.
  • the last cohort treated with 140 mg/m 2 /day with the 4-days-on and 10-day s-off schedule contained 28 patients (14 each with pancreatic cancer and melanoma).
  • the median number of cycles per cohort varied between 1.5 and 5.0.
  • the median trabedersen dose per day during the core study period reflected the respective dose cohort, with the highest median dose per day seen for cohort 4 of the 7-days-on and 7-days-off schedule (167.9 mg/m 2 /day).
  • the fourth patient experienced a dose-limiting Grade 3 upper gastrointestinal hemorrhage after he had been infused with 140 mg/m 2 /day in the 4-days-on and 10-days-off schedule. No other DLTs were observed in the 4-days-on and 10-days-off schedule and therefore no MTD was established for that schedule (highest dose test 330 mg/m 2 /day).
  • SAE Serious Adverse Events
  • measurable lesions i.e. lesions that could be accurately measured in at least 1 dimension with a longest diameter of 2 cm
  • target lesions i.e. lesions that could be accurately measured in at least 1 dimension with a longest diameter of 2 cm
  • All other lesions were defined and recorded as "non-target lesions”.
  • Tumor response was determined by the local investigator every 8 weeks after start of the first trabedersen cycle during follow-up visits, irrespective of whether the patient was still on treatment or off treatment. The tumor assessment was based on Response Evaluation Criteria in Solid Tumors (RECIST 1.0) criteria.
  • the categories of overall tumor response are as follows: (1) Complete response (CR): disappearance of all target and non-target lesions and normalization of tumor marker level; (2) Partial response (PR): at least 30% decrease in the sum of the longest diameter (LD) of target lesions (baseline sum LD as reference) and/or persistence of one or more non-target lesions and/or maintenance of tumor marker level above normal limits; (3) Stable disease (SD): less than 30% decrease or less than 20% increase in sum LD target lesions (smallest sum LD since treatment start as reference) and/or persistence of one or more non-target lesions and/or maintenance of tumor marker level above normal limits; (4) Progressive disease (PD) At least 20% increase in sum LD target lesions (smallest sum LD since treatment start as reference) and/or unequivocal progression of existing nontarget lesions and/or appearance of one or more new lesions; and (5) Unknown.
  • CR Complete response
  • PR Partial response
  • SD Stable disease
  • SD less than 30% decrease or less than 20% increase in sum LD target lesions
  • PFS Progression-free survival
  • OS Overall survival
  • Trabedersen treatment was characterized by outstanding OS which was not supported by PFS. The effect was seen primarily when chemotherapies were used as third line after trabedersen treatment; OS benefit was not observed for the converse- chemotherapies used first followed by trabedersen. The data support the enhancement of subsequent chemotherapies following trabedersen treatment.

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Abstract

L'invention concerne une composition de sensibilisation de tumeurs à des thérapies antitumorales. Les compositions comprennent des oligonucléotides antisens contre le TGFβ2, les compositions sensibilisant des tumeurs à des thérapies antitumorales. L'invention concerne également une méthode de traitement du cancer à l'aide des compositions de l'invention.
PCT/US2016/017176 2016-02-09 2016-02-09 Compositions et méthodes de traitement du cancer du pancréas WO2017138924A1 (fr)

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US9963703B2 (en) 2016-02-09 2018-05-08 Autotelic Llc Compositions and methods for treating pancreatic cancer
WO2022251102A3 (fr) * 2021-05-24 2022-12-29 Gmp Biotechnology Limited Agents thérapeutiques ciblant le tgf-bêta contre une maladie associée au vieillissement

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KR102680316B1 (ko) * 2021-11-01 2024-07-01 오토텔릭바이오 주식회사 안티센스 올리고뉴클레오타이드

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US9963703B2 (en) 2016-02-09 2018-05-08 Autotelic Llc Compositions and methods for treating pancreatic cancer
WO2022251102A3 (fr) * 2021-05-24 2022-12-29 Gmp Biotechnology Limited Agents thérapeutiques ciblant le tgf-bêta contre une maladie associée au vieillissement

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