WO2018068691A1 - 一种抗pd-1抗体和vegfr抑制剂联合在制备治疗癌症的药物中的用途 - Google Patents

一种抗pd-1抗体和vegfr抑制剂联合在制备治疗癌症的药物中的用途 Download PDF

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WO2018068691A1
WO2018068691A1 PCT/CN2017/105410 CN2017105410W WO2018068691A1 WO 2018068691 A1 WO2018068691 A1 WO 2018068691A1 CN 2017105410 W CN2017105410 W CN 2017105410W WO 2018068691 A1 WO2018068691 A1 WO 2018068691A1
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antibody
cancer
seq
use according
vegfr
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PCT/CN2017/105410
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English (en)
French (fr)
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孙星
曹国庆
杨昌永
张连山
郭勇
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苏州盛迪亚生物医药有限公司
江苏恒瑞医药股份有限公司
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Priority to EP17860042.5A priority Critical patent/EP3524268A4/en
Application filed by 苏州盛迪亚生物医药有限公司, 江苏恒瑞医药股份有限公司 filed Critical 苏州盛迪亚生物医药有限公司
Priority to KR1020197009735A priority patent/KR102446673B1/ko
Priority to CN201780004768.8A priority patent/CN108601831B/zh
Priority to BR112019005908A priority patent/BR112019005908A2/pt
Priority to US16/339,819 priority patent/US11208484B2/en
Priority to JP2019540485A priority patent/JP7092775B2/ja
Priority to AU2017342880A priority patent/AU2017342880A1/en
Priority to MX2019003780A priority patent/MX2019003780A/es
Priority to RU2019112029A priority patent/RU2762746C2/ru
Priority to CA3038586A priority patent/CA3038586A1/en
Publication of WO2018068691A1 publication Critical patent/WO2018068691A1/zh
Priority to US17/454,634 priority patent/US11866500B2/en
Priority to US18/517,345 priority patent/US20240084013A1/en

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Definitions

  • the present invention relates to the use of an anti-PD-1 antibody in combination with a VEGFR inhibitor for the preparation of a medicament for the treatment of cancer.
  • PD-1 antibody specifically recognizes and binds to PD-1 on the surface of lymphocytes, blocks the PD-1/PD-L1 signaling pathway, and activates the immune killing effect of T cells on tumors, and modulates the immune system of the body to eliminate tumor cells in vivo.
  • WO201508584 discloses a novel anti-PD-1 antibody, which is currently in clinical trials and has shown a certain anti-tumor effect.
  • Apatinib is the world's first oral anti-angiogenic drug for advanced gastric cancer, highly selective for VEGFR-2, and potent anti-angiogenesis.
  • the results showed that apafitib can be compared with placebo.
  • CN101676267A discloses a series of salts of apatinib, such as mesylate, hydrochloride, and the like.
  • the pre-clinical animal experiments disclosed in CN101675930A also show that apatinib combined with cytotoxic drugs such as oxaliplatin, 5-Fu, docetaxel, and doxorubicin can significantly increase the therapeutic effect.
  • WO2015119930 discloses the use of a PD-1 antibody in combination with axitinib
  • WO2015088847 discloses the use of a PD-1 antibody in combination with pazopanib.
  • these VEGFR inhibitors including sorafenib, sunitinib, axitinib, and pazopanib, have different mechanisms of action than apatinib.
  • Apatinib has the strongest effect on VEGFR-2. Inhibition, but for other kinases, the inhibition is poor or not at all, that is, apatinib is highly selective for VEGFR-2, so the disease it treats is different from the aforementioned drugs, and it is different from PD.
  • the present invention provides the use of an anti-PD-1 antibody in combination with a VEGFR inhibitor for the preparation of a medicament for the treatment of cancer.
  • the VEGFR inhibitor is a VEGFR-2 inhibitor.
  • a preferred VEGFR inhibitor of the invention is an IC50 of less than 100 nM for VEGFR kinase according to the test method disclosed in CN101676267A, but no inhibitory activity against EGFR, HER2, FGFR (IC50 > 10000 nM), and particularly preferred VEGFR inhibitor is VEGFR-2 inhibition.
  • the VEGFR-2 inhibitor is apatinib or a pharmaceutically acceptable salt thereof.
  • a PD-1 antibody is known, and preferably the light chain variable region of the PD-1 antibody comprises LCDR1, LCDR2 and SEQ ID NO: 4, SEQ ID NO: 5 and SEQ ID NO: 6, respectively. LCDR3.
  • the heavy chain variable region of the PD-1 antibody comprises HCDR1, HCDR2 and HCDR3 as set forth in SEQ ID NO: 1, SEQ ID NO: 2 and SEQ ID NO: 3, respectively.
  • the PD-1 antibody is a humanized antibody.
  • a preferred humanized antibody light chain sequence is the sequence set forth in SEQ ID NO: 8 or a variant thereof; said variant preferably has a 0-10 amino acid change in the light chain variable region; more preferably A43S Amino acid changes.
  • the humanized antibody heavy chain sequence is the sequence set forth in SEQ ID NO: 7 or a variant thereof; the variant preferably has an amino acid change of 0-10 in the heavy chain variable region; more preferably an amino acid of G44R Variety.
  • the humanized antibody light chain sequence is the sequence set forth in SEQ ID NO: 8
  • the heavy chain sequence is the sequence set forth in SEQ ID NO: 7.
  • sequences of the aforementioned humanized antibody heavy and light chains are as follows:
  • the VEGFR inhibitor may also be selected from the group consisting of MP-0250, DE-120, ALN-VSP, Aflibercept, Anecortave, BI-695502, Bevacizumab, PF-06439535, Carboxyamidotriazole, Vanucizumab, RG.
  • the cancer is preferably a cancer expressing PD-L1; more preferably breast cancer, lung cancer, gastric cancer, intestinal cancer, renal cancer, liver cancer, melanoma, non-small cell lung cancer; most preferably non- Small cell lung cancer, melanoma and kidney cancer, intestinal cancer, and the intestinal cancer includes colorectal cancer, colorectal cancer, and the like.
  • apatinib is preferably administered in the form of a pharmaceutically acceptable salt, and the pharmaceutically acceptable salt of apatinib may be selected from the group consisting of mesylate and hydrochloride.
  • the PD-1 antibody when administered, may be used in an amount of 0.5 to 30 mg/kg, preferably 2 to 10 mg/kg, more preferably 2 to 6 mg/kg, and most preferably 3 mg/kg; It is administered once every 3 weeks, preferably once every 2 weeks.
  • a fixed dose can also be used, for example 100-1000 mg each time, preferably 200-600 mg.
  • the dose of the VEGFR inhibitor may be from 3 to 200 mg/kg, and for adults, a fixed dose, for example, 100-1000 mg, 250-1000 mg, preferably 400-850 mg, 100-500 mg may be administered once daily.
  • the term "combination” is a mode of administration which includes various conditions in which two drugs are administered sequentially or simultaneously.
  • simultaneous means that PD-1 antibody is administered and administered in the same administration cycle.
  • the VEGFR inhibitor for example, is administered two drugs within 2 days, or within 1 day.
  • the so-called “sequential” administration includes the administration of a PD-1 antibody and a VEGFR inhibitor, respectively, in different administration cycles.
  • the PD-1 antibody is administered by injection, for example subcutaneously or intravenously, and the PD-1 antibody is formulated in an injectable form prior to injection.
  • a particularly preferred injectable form of the PD-1 antibody is an injection or lyophilized powder comprising a PD-1 antibody, a buffer, a stabilizer, and optionally a surfactant.
  • the buffering agent may be selected from one or more of the group consisting of acetate, citrate, succinate, and phosphate.
  • the stabilizer may be selected from sugars or amino acids, preferably disaccharides such as sucrose, lactose, trehalose, maltose.
  • the surfactant is selected from the group consisting of polyoxyethylene hydrogenated castor oil, glycerin fatty acid ester, polyoxyethylene sorbitan fatty acid ester, preferably the polyoxyethylene sorbitan fatty acid ester is polysorbate 20, 40, 60 or 80. Most preferred is polysorbate 20.
  • injectable forms of the most preferred PD-1 antibodies comprise PD-1 antibody, acetate buffer, trehalose and polysorbate 20.
  • the present invention provides the above anti-PD-1 antibody in combination with the above VEGFR as a therapeutic preparation for treating tumors.
  • the present invention provides the above anti-PD-1 antibody in combination with the above VEGFR as a drug for reducing adverse drug reactions.
  • the adverse drug reaction is selected from an anti-PD-1 antibody or caused by a VEGFR inhibitor.
  • the present invention provides the above anti-PD-1 antibody in combination with the above VEGFR as a medicament for lowering the dose of the anti-PD-1 antibody alone and/or the dose of the VEGFR inhibitor alone.
  • a method of treating a tumor/cancer comprising administering to a patient an anti-PD-1 antibody as described above and the above-described VEGFR inhibitor.
  • a method of reducing the dose of an anti-PD-1 antibody administered alone and/or a dose of a VEGFR inhibitor alone comprising administering to the patient the above anti-PD-1 antibody in combination with the above VEGFR inhibitor.
  • the dose of the VEGFR inhibitor when administered in combination with PD-1, is administered alone.
  • the dose is from 10% to 100%, preferably from 10% to 75%, more preferably from 75%, 50%, 25%, 12.5%.
  • the anti-PD-1 antibody dose is from 10% to 100%, preferably from 10% to 50%, of the anti-PD-1 antibody administered alone.
  • the adverse drug reaction mediated by the anti-PD-1 antibody and/or immune can be reduced; preferably, the adverse reaction Selected from vascular-related adverse reactions, glandular dysfunction, skin adverse reactions, respiratory adverse reactions, liver-related adverse reactions, endocrine-related adverse reactions, digestive system adverse reactions, kidney-related adverse reactions, fatigue, fever;
  • the adverse reaction is selected from the group consisting of hemangioma, vasculitis, lymphangioma, the hypofunction of the gland is selected from hypothyroidism, hypoparathyroidism, pancreatic hypofunction, and hypofunction of the prostate;
  • the skin adverse reaction is selected from pruritus, Urticaria, rash, toxic epidermal necrosis;
  • said respiratory adverse reaction is selected from the group consisting of pneumonia, bronchitis, chronic obstructive pulmonary disease, pulmonary fibrosis;
  • said liver-related adverse reaction is selected from hepatitis, liver dysfunction; said en
  • the present invention also provides a pharmaceutical kit, or a pharmaceutical pack comprising the aforementioned VEGFR inhibitor and PD-1 antibody.
  • Figure 1 Effect of administration of antibodies and compounds on the relative volume of tumor-bearing mouse MC38 (PD-L1) xenografts;
  • FIG. 1 Effect of antibody and compound administration on body weight of MC38 (PD-L1) xenograft tumor-bearing mice, where * indicates p ⁇ 0.05, vs blank control group;
  • Example 1 PD-1 antibody, apacitrin mesylate alone or in combination with mouse colon cancer cell MC-38 (PD-L1) transplanted into PD-L1 gene C57 human PD- 1 The efficacy of transgenic mice
  • Human PD-1 transgenic mice were used as test animals. The combination of PD-1 antibody and apatinib was used to evaluate the colon cancer cell line MC-38 (PD-L1) transplanted into PD-L1 gene. Efficacy of human PD-1 transgenic mice.
  • the PD-1 antibody was prepared according to the method disclosed in WO2015085847, corresponding to the code number H005-1, and the sequences of the heavy and light chains thereof are SEQ ID NO: 7 and SEQ ID NO: 8 in the present invention.
  • Apatinib mesylate was prepared according to the method disclosed in CN101676267A, batch number: 668160401; molecular weight: 493.58; purity: 99.60%.
  • PD-1 antibody (3 mg/kg): PD-1 antibody stock solution (20 mg/ml) was dosed to a concentration of 0.3 mg/ml in PBS, and a volume of 0.2 ml/mouse was intraperitoneally injected.
  • Apatinib 400mg apatinib, dissolved in 20ml of 0.5% NaCMC, formulated into 20mg / ml, each administered 0.2ml.
  • the vehicle was HIgG (3 mpk): dissolved in 0.5% CMC, formulated into 0.3 mg/ml, and intraperitoneally injected into a volume of 0.2 ml/mouse.
  • mice were adapted to the laboratory environment for >5 days.
  • PD-1 transgenic C57 mice were pretreated one day in advance.
  • MC38 (PD-L1) cells (5 ⁇ 10 6 /only) were inoculated subcutaneously in the right flank.
  • the tumor grew for 8 days and grew to 142.17 ⁇ 13.30.
  • the animals were randomly divided into groups (d0), 8 rats/group (the first four in each group were male and the last four were female), a total of 4 groups.
  • PD-1 antibody was injected intraperitoneally, Q2D*7 (once every 2 days, 7 times), apatinib, oral gavage, QD*14 (once a day for 14 days).
  • the specific drug administration schedule is shown in Table 1.
  • Tumor volume and body weight were measured twice a week and data were recorded.
  • V 1/2 ⁇ L length ⁇ L short 2
  • Relative volume (RTV) V T /V 0
  • Tumor inhibition rate (%) (C RTV -T RTV ) / C RTV (%)
  • V 0 and V T are the tumor volume at the beginning of the experiment and at the end of the experiment, respectively.
  • C RTV and T RTV are the relative tumor volumes of the blank control group and the experimental group at the end of the experiment, respectively.
  • Example 2 Clinical study of anti-PD-1 antibody combined with apatinib mesylate in the treatment of advanced malignant tumors
  • Inclusion criteria (1) advanced malignancy; (2) failure of first- or second-line or second-line chemotherapy; (3) measurable lesions; (4) ECOG score 0-1.
  • Test drug commercially available apatinib mesylate tablet; PD-1 antibody of Example 1.
  • Method of administration A total of 31 subjects were screened as of September 20, 2017, and 30 subjects have been enrolled (14 of them have withdrawn from treatment, and 16 subjects are still re-administered) in).
  • 001-005 administration method is intravenous infusion of PD-1 antibody, 3mg/kg, 2 weeks/time; apatinib orally, 500mg once a day; 006-010 administration method is PD-1 antibody vein Infusion, 200mg, 2 weeks / time; apatinib orally, 125mg, once a day; 011-031 for PD-1 antibody intravenous infusion, 200mg, 2 weeks / time; apatinib orally, 250mg, Once a day.
  • the ORR was only 16.7%
  • the DCR was as high as 79%
  • the disease control rate was high
  • the PFS of some subjects reached 6
  • the dose of apafitini in the treatment of solid tumors is usually as high as 850 mg/day (apatinib specification), and in the embodiment of the present invention,
  • the combination of patinib with PD-1 antibody reduced the dose of apapitatin to 125 mg/day and was more effective and safer than apapitinib alone.
  • Example 3 Phase II clinical study of anti-PD-1 antibody combined with apatinicin mesylate in the treatment of advanced non-small cell lung cancer
  • Inclusion criteria (1) advanced non-small cell lung cancer; (2) failure of first- or second-line or second-line chemotherapy; (3) measurable lesions; (4) ECOG score 0-1.
  • Test drug commercially available apatinib mesylate tablet; PD-1 antibody of Example 1.
  • Administration method PD-1 antibody, once every 2 weeks, intravenous infusion, 200 mg each time; agingatin mesylate was orally administered once a day, 250 mg or 375 mg or 500 mg each time.
  • the incidence of pruritus was 19.0%.
  • the incidence of diarrhea was 10.3%. Therefore, the combination of apafitini mesylate and PD-1 antibody can not only alleviate or control the tumor proliferation of advanced non-small cell lung cancer with chemotherapy failure, and reduce PD-1 antibody-related or immune-mediated adverse reactions. Improve the quality of life of patients.

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Abstract

本发明公开一种抗PD-1抗体和VEGFR抑制剂联合在制备治疗癌症的药物中的用途。

Description

一种抗PD-1抗体和VEGFR抑制剂联合在制备治疗癌症的药物中的用途 技术领域
本发明涉及一种一种抗PD-1抗体和VEGFR抑制剂联合在制备治疗癌症的药物中的用途。
背景技术
PD-1抗体特异性识别并结合淋巴细胞表面PD-1，阻断PD-1/PD-L1信号通路，进而激活T细胞对肿瘤的免疫杀伤作用，调动机体免疫系统而清除体内肿瘤细胞。WO201508584公开了一种新的抗PD-1抗体，目前PD-1抗体正处于临床试验阶段，已经显示出一定的抗肿瘤作用。
阿帕替尼是全球首个晚期胃癌的口服抗血管生成药物，对VEGFR-2具有高度选择性，强效抗血管生成。在一项关于阿帕替尼二线以后治疗转移性胃/胃食管结合部癌患者的多中心随机双盲安慰剂对照Ⅲ期试验中，结果显示与安慰剂相比，阿帕替尼单药能将中位总生存延长1.8个月，中位无进展生存延长0.8个月，且不良事件可控(Randomized,Double-Blind,Placebo-Controlled Phase III Trial of阿帕替尼in Patients With Chemotherapy-Refractory Advanced or Metastatic Adenocarcinoma of the Stomach or Gastroesophageal Junction.J Clin Oncol,2016Feb 16)。阿帕替尼的结构式如式(I)所示。
Figure PCTCN2017105410-appb-000001
CN101676267A公开了阿帕替尼的一系列盐，例如甲磺酸盐、盐酸盐等。CN101675930A公开的临床前的动物实验也显示阿帕替尼联用细胞毒类药物如奥沙利铂、5-Fu、多西他赛、阿霉素，能明显增加其疗效。
目前尚无PD-1抗体和VEGFR抑制剂联用获批上市，但有多个PD-1抗体(其他公司的)与VEGFR抑制剂(如舒尼替尼，索拉菲尼等)正处于临床II/III期，适应症分别为恶性肝癌(索拉菲尼与PD-1抗体联用)和转移性肾细胞癌(舒尼替尼与PD-1抗体联用)，初步结果显示两种药物联用效果均优于单药。
WO2015119930公开了一种PD-1抗体与阿昔替尼联用的用途，WO2015088847公开了一种PD-1抗体与帕唑帕尼联用的用途。但是这些VEGFR抑制剂，包括索拉菲尼、舒尼替尼、阿昔替尼以及帕唑帕尼与阿帕替尼的作用机制有所不同，阿帕替尼对VEGFR-2具有最强的抑制作用，但对于其它激酶则抑制作用较差或完全不具有抑制作用，即阿帕替尼对于VEGFR-2具有高度的选择性，因此其治疗的疾病也与前述药物有所不同，其与PD-1联合能否产生协同作用，从而提高疗效值得进一步研究；另外，根据目前PD-1单独给药临床研究显示(Phase I study of the anti-PD-1antibody SHR-1210in patients with advanced solid tumors.(2017):e15572-e15572)，PD-1抗体在单独应用治疗时，毛细血管瘤发生率高达79.3％、甲状腺功能减退发生率为29.3％、瘙痒发生率为19.0％、腹泻发生率为10.3％，如此高发的不良反应无疑给肿瘤患者的精神健康和生存质量造成了负担；因此降低其用药时的不良反应非常重要
发明内容
本发明提供了一种抗PD-1抗体和VEGFR抑制剂联合在制备治疗癌症的药物中的用途。
优选的，其中所述VEGFR抑制剂是VEGFR-2抑制剂。
本发明优选的VEGFR抑制剂是按照CN101676267A中公开的测试方法对VEGFR激酶的IC50小于100nM，而对EGFR、HER2、FGFR无抑制活性(IC50>10000nM)，特别优选的VEGFR抑制剂是VEGFR-2抑制剂，其对VEGFR-2激酶的IC50小于50nM，优选小于20nM，更优选小于10nM，最优选小于5nM，而同时对VEGFR-1或VEGFR-3抑制效果较差，例如其IC50大于20nM，优选大于50nM。
在本发明优选的实施方案中，所述VEGFR-2抑制剂为阿帕替尼或其可药用盐。
PD-1抗体是已知的，优选所述的PD-1抗体的轻链可变区包含分别如SEQ ID NO:4、SEQ ID NO:5和SEQ ID NO:6所示的LCDR1、LCDR2和LCDR3。
所述的PD-1抗体的重链可变区包含分别如SEQ ID NO:1、SEQ ID NO:2和SEQ ID NO:3所示的HCDR1、HCDR2和HCDR3。
其中，前面所述的各CDR序列如下表所示：
名称 序列 编号
HCDR1 SYMMS SEQID NO：1
HCDR2 TISGGGANTYYPDSVKG SEQID NO：2
HCDR3 QLYYFDY SEQID NO：3
LCDR1 LASQTIGTWLT SEQID NO：4
LCDR2 TATSLAD SEQID NO：5
LCDR3 QQVYSIPWT SEQID NO：6
优选的，所述的PD-1抗体为人源化抗体。
优选的人源化抗体轻链序列为如SEQ ID NO:8所示的序列或其变体；所述的变体优选在轻链可变区有0-10的氨基酸变化；更优选为A43S的氨基酸变化。
所述人源化抗体重链序列为如SEQ ID NO:7所示的序列或其变体；所述变体优选在重链可变区有0-10的氨基酸变化；更优选为G44R的氨基酸变化。
特别优选的所述的人源化抗体轻链序列为如SEQ ID NO:8所示的序列，重链序列为如SEQ ID NO:7所示的序列。
前述的人源化抗体重、轻链的序列如下所示：
重链
Figure PCTCN2017105410-appb-000002
轻链
Figure PCTCN2017105410-appb-000003
在本发明优选的实施例方案中，所述VEGFR抑制剂还可选自MP-0250、DE-120、ALN-VSP、Aflibercept、Anecortave、BI-695502、Bevacizumab、PF-06439535、Carboxyamidotriazole、Vanucizumab、RG-7716、Bevacizumab类似物、Navicixizumab、Ranibizumab、Ranibizumab类似物、Conbercept、IBI-302、BI-836880、ARQ-736、RPI-4610、LMG-324、PTC-299、ABT-165、AG-13958、Brolucizumab、PAN-90806、Vatalanib、ODM-203、Altiratinib、TG-100572、OPT-302、TG-100801、CEP-7055、TAS-115、Ilorasertib、Foretinib、JNJ-26483327、Metatinib、R-1530、Tafetinib、Vorolanib、Donafenib、Subutinib、Regorafenib、VGX-100、ENMD-2076、Anlotinib、Ningetinib、Tesevatinib、Tanibirumab、Lucitanib、Cediranib、Chiauranib、IMC-3C5、Glesatinib、KRN-633、Icrucumab、PF-337210、RAF265、Puquitinib、SU-014813、Tivozanib、Fruquintinib、Sitravatinib、Pegaptanib、Pazopanib、Vandetanib、Axitinib、Sulfatinib、Ramucirumab、Plitidepsin、Orantinib、Alacizumab pegol、Telatinib、 Ponatinib、Cabozantinib、Lenvatinib、Brivanib Alaninate、Linifanib。
在本发明的用途中，所述癌症优选为表达PD-L1的癌症；更优选为乳腺癌、肺癌、胃癌、肠癌、肾癌、肝癌、黑素瘤、非小细胞肺癌；最优选为非小细胞肺癌、黑素瘤和肾癌、肠癌，所述的肠癌包括大肠癌、结直肠癌等。在给药时，阿帕替尼优选以可药用盐的形式给药，所述的阿帕替尼可药用盐可选自甲磺酸盐、盐酸盐。
具体地，在给药时，其中所述的PD-1抗体的用量可以为0.5－30mg/kg，优选2－10mg/kg，更优选2－6mg/kg，最优选3mg/kg；可以每1至3周给药一次，优选每2周给药一次。对于成年人类，也可以使用固定剂量，例如100－1000mg每次，优选200－600mg，。所述的VEGFR抑制剂的剂量可以为3－200mg/kg，对于成年人类，可以使用固定剂量，例如100-1000mg、250－1000mg、优选400-850mg，100-500mg,可以每天给药一次。
本发明中，所谓“联合”是一种给药方式，其包括两种药物先后，或同时给药的各种情况，此处所谓“同时”是指在同一给药周期给予PD-1抗体和VEGFR抑制剂，例如在2天内，或1天内给予两种药物。所谓“先后”给药，则包括在不同给药周期内分别给予PD-1抗体和VEGFR抑制剂的情况。这些给药方式，均属于本发明所述的联合给药。
在本发明优选的实施方案中，所述的PD-1抗体以注射的方式给药，例如皮下或静脉注射，注射前需将PD-1抗体配制成可注射的形式。特别优选的PD-1抗体的可注射形式是注射液或冻干粉针，其包含PD-1抗体、缓冲剂、稳定剂，任选地还含有表面活性剂。缓冲剂可选自醋酸盐、柠檬酸盐、琥珀酸盐、以及磷酸盐中的一种或几种。稳定剂可选自糖或氨基酸，优选二糖，例如蔗糖、乳糖、海藻糖、麦芽糖。表面活性剂选自聚氧乙烯氢化蓖麻油、甘油脂肪酸酯、聚氧乙烯山梨醇酐脂肪酸酯，优选所述聚氧乙烯山梨醇酐脂肪酸酯为聚山梨酯20、40、60或80，最优选聚山梨酯20。最为优选的PD-1抗体的可注射形式包含PD-1抗体、醋酸盐缓冲剂、海藻糖和聚山梨酯20。
本发明提供上述抗PD-1抗体联合上述VEGFR作为治疗制备治疗肿瘤的药物。
本发明提供上述抗PD-1抗体联合上述VEGFR作为减少药物不良反应的药物,优选的，所述的药物不良反应选自由抗PD-1抗体引起或由VEGFR抑制剂引起。
本发明提供上述抗PD-1抗体联合上述VEGFR作为降低抗PD-1抗体单独施用剂量和/或VEGFR抑制剂单独施用剂量的药物。
在本发明中，提供了一种治疗肿瘤/癌症的办法，包括向患者施用上述抗PD-1抗体和上述VEGFR抑制剂。
在本发明中，提供了一种降低抗PD-1抗体单独施用剂量和/或VEGFR抑制剂单独施用剂量的方法，包括向患者施用上述抗PD-1抗体联合上述VEGFR抑制剂。
优选的，与PD-1联合使用时，所述VEGFR抑制剂的给药剂量是其单独施用 剂量的10％-100％，优选10％-75％，更优选75％、50％、25％、12.5％。
优选的，与VEGFR联用时，抗PD-1抗体剂量是抗PD-1抗体单独施用剂量的10％-100％，优选10％-50％。
在本发明优选的实施例方案中，当PD-1抗体与VEGFR抑制剂联合使用时，可减少由抗PD-1抗体和/或免疫介导的药物不良反应；优选的，所述的不良反应选自血管相关不良反应、腺体机能减退、皮肤不良反应、呼吸系统不良反应、肝脏相关不良反应、内分泌相关不良反应、消化系统不良反应、肾脏相关不良反应、疲劳、发热；所述优选血管相关不良反应选自血管瘤、血管炎、淋巴管瘤、所述腺体功能减退选自甲状腺机能减退、甲状旁腺功能减退、胰腺功能减退、前列腺功能减退；所述皮肤不良反应选自瘙痒症、荨麻疹、皮疹、毒性表皮坏死症；所述呼吸系统不良反应选自肺炎、支气管炎、慢性阻塞性肺病、肺纤维化；所述肝脏相关不良反应选自肝炎、肝功能异常；所述内分泌相关不良反应选自I型糖尿病、II型糖尿病、低血糖症；肾脏相关不良反应选自肾炎、肾衰竭；所述消化系统不良反应选自腹泻、恶心、呕吐、肠炎、便秘；更优选的，所述药物不良反应选自血管瘤、甲状腺机能减退、甲状旁腺功能减退、瘙痒症、肺炎、肝炎、肝功能异常、I型糖尿病、肾炎、肾衰竭。
本发明还提供了一种药物套组，或者一种药物包装盒，其中含有前述的VEGFR抑制剂和PD-1抗体。
附图说明
图1.给药抗体和化合物对荷瘤小鼠MC38(PD-L1)移植瘤相对体积的影响；
图2.给药抗体和化合物对MC38(PD-L1)移植瘤荷瘤小鼠体重的影响，其中*表示p<0.05,vs空白对照组；
图3.给药抗体和化合物对荷瘤小鼠MC38(PD-L1)移植瘤的疗效-肿瘤重量。
具体实施方式
以下结合实施例用于进一步描述本发明，但这些实施例并非限制本发明的范围。
实施例1：PD-1抗体、甲磺酸阿帕替尼单用或二者联用对转入PD-L1基因的小鼠结肠癌细胞MC-38(PD-L1)移植瘤C57人PD-1转基因小鼠的疗效
1、研究目的
以人PD-1转基因小鼠为受试动物，评价PD-1抗体和阿帕替尼联用后对转入PD-L1基因的小鼠结肠癌细胞MC-38(PD-L1)移植瘤C57人PD-1转基因小鼠的疗效。
2、受试抗体和化合物
PD-1抗体按WO2015085847公开的方法制备，对应其代号为H005-1，其重、轻链的序列如本发明中SEQID NO：7和SEQID NO：8。批号：P1512，200mg/每瓶，配成20mg/ml备用。
甲磺酸阿帕替尼，按CN101676267A公开的方法制备，批号：668160401；分子量：493.58；纯度：99.60％。
3、实验动物
人PD-1转基因C57小鼠，SPF，体重不均等，雌雄各半。从英国IsisInnovation Limited公司购买。
4、药物配制
PD-1抗体(3mg/kg)：PD-1抗体原液(20mg/ml)用PBS配成0.3mg/ml浓度，腹腔注射体积0.2ml/小鼠。
阿帕替尼(200mpk)：400mg阿帕替尼，溶于20ml 0.5％NaCMC，配成20mg/ml,每只灌胃0.2ml。
溶媒为HIgG(3mpk)：溶于0.5％CMC，配制成0.3mg/ml,腹腔注射体积0.2ml/小鼠。
5、试验方法
5.1 C57小鼠与实验室环境适应性饲养>5天。
5.2肿瘤细胞移植
人PD-1转基因C57小鼠提前一天备皮，于6月12日在右肋部皮下接种MC38(PD-L1)细胞(5×106/只)，肿瘤生长8天，长至142.17±13.30mm3后将动物随机分组(d0)，8只/组(其中每组前四只为雄性，后四只为雌性)，共4组。
5.3给药剂量及方法
PD-1抗体腹腔注射，Q2D*7(2天一次，共7次)，阿帕替尼，口服灌胃，QD*14(每天一次，共14天)。具体药物给药方案见表1。
5.4移植瘤体积及小鼠体重测定
每周测量2次瘤体积和体重，记录数据。
5.5数据统计
使用Excel 2003统计软件：平均值以avg计算；SD值以STDEV计算；SEM值以STDEV/SQRT计算；组间差异P值以TTEST计算。
肿瘤体积(V)计算公式为：V＝1/2×L长×L短 2
相对体积(RTV)＝VT/V0
抑瘤率(％)＝(CRTV-TRTV)/CRTV(％)
其中V0、VT分别为实验开始时及实验结束时的肿瘤体积。CRTV、TRTV分别为实验结束时的空白对照组及实验组的相对肿瘤体积。
6、试验结果
本次实验结果显示，PD-1抗体腹腔注射，Q2D*7。化合物阿帕替尼，口服灌胃，QD*14。观察至21天时，PD-1抗体(3mpk)抑瘤率达到20.40％，阿帕替尼(200mpk)单用组抑瘤率达到35.67％；PD-1抗体(3mpk)+与阿帕替尼(200mpk)联用组抑瘤率达到63.07％(相对于HIgG对照组有显著差异)，其他单用组相对于HIgG对照组均无显著差异。从实验结果来看，PD-1抗体(3mpk)+阿帕替尼(200mpk)联用组的药效是优于PD-1抗体和阿帕替尼单用的药效。给药各组小鼠体重正常，显示药物无明显毒副作用。具体数据见表1及图1－3。
实施例2：抗PD-1抗体联合甲磺酸阿帕替尼治疗晚期恶性肿瘤的临床研究
入组标准：(1)晚期恶性肿瘤；(2)一线或二线或二线以上化疗失败；(3)具有可测量的病灶；(4)ECOG评分0-1分。
受试药物：市售甲磺酸阿帕替尼片；实施例1中的PD-1抗体。
给药方法：截止2017年9月20日共筛了31例受试者，已经入组30例受试者(其中14例受试者已经退出治疗，仍有16例受试者再组给药中)。
001-005例给药方法为PD-1抗体静脉滴注，3mg/kg，2周/次；阿帕替尼口服，500mg，一日一次；006-010例给药方法为PD-1抗体静脉滴注，200mg，2周/次；阿帕替尼口服，125mg，一日一次；011-031例为PD-1抗体静脉滴注，200mg，2周/次；阿帕替尼口服，250mg，一日一次。
临床结果：在有效性上，6周有24例可评价的疗效数据DCR为83.3％(20/24)，12周有19例可评价疗效数据DCR为63.2％(12/19)，18周有10例可评价疗效数据DCR为70％(7/10),24周5例可评价疗效数据DCR为80％(4/5)，目前有2例肝细胞癌受试者的24周疗效为PR，PFS长达6个月以上。24例可评价的数据中最佳疗效有4例PR，15例SD，5例PD，虽然ORR仅为16.7％，但DCR高达79％，疾病控制率很高且部分受试者的PFS达到6个月以上，具体结果见表2、表3、表4。此外，阿帕替尼在单药应用治疗实体瘤(如胃癌、胃食管结合部腺癌、肝癌等)剂量通常高达850mg/日(阿帕替尼说明书)，而在本发明实施例中，阿帕替尼与PD-1抗体联用，使阿帕替尼剂量降低至125mg/日，且与单独给予阿帕替尼相比有效性和安全性更佳。在安全性上，截止9月20日，8例受试者共报了11例次的严重不良反应(SAE)，SAE发生率为26.7％(8/30)。而大部分严重不良反应的发生由于001-005受试者(试验初期阿帕替尼的探索剂量较高，为500mg)出现7例次的SAE，后续修改方案调整剂量后发现不仅可以继续维持良好的抑瘤效果，并显著降低了由于高剂量阿帕替尼引发的药物不良反应；另外，在该次临床研究中，惊喜的发现，阿帕替尼与PD-1抗体在联合治疗恶性肿瘤的过程中发现，与PD-1抗体单独应用相比，几乎不发生血管瘤相关不良反应，仅有1例受试者发生血管瘤也是因为不耐受二者联用选择单独使用PD-1抗体所导致的。
实施例3：抗PD-1抗体联合甲磺酸阿帕替尼治疗晚期非小细胞肺癌的Ⅱ期临床研究
入组标准：(1)晚期非小细胞肺癌；(2)一线或二线或二线以上化疗失败；(3)具有可测量的病灶；(4)ECOG评分0-1分。
受试药物：市售甲磺酸阿帕替尼片；实施例1中的PD-1抗体。
给药方法：PD-1抗体，2周一次，静脉滴注，每次200mg；甲磺酸阿帕替尼口服每日一次，每次250mg或375mg或500mg。
临床结果：截至7月28日，共筛选15例受试者，其中已经入组12例。共12例受试者完成至少1周期用药观察，10名患者(10/12)疾病稳定，1名患者部分缓解。具体情况见表5。此外，在甲磺酸阿帕替尼和PD-1抗体联用过程中，我们惊奇的发现，二者联用在增强疗效的同时也减轻了PD-1抗体单独使用时的不良反应。在本研究中，常见不良反应通常为1～II级，与PD-1抗体或免疫相关不良反应如毛细血管瘤发生率仅为8％(1例)、甲状腺功能减退发生率仅为8％(1例)、无患者发生腹泻等消化道不良反应和瘙痒等皮肤不良反应；而在2017年ASCO公开的PD-1抗体单独用于治疗实体瘤的I期临床报道显示(Phase I study of the anti-PD-1antibody SHR-1210in patients with advanced solid tumors.(2017):e15572-e15572)，PD-1抗体在单独应用治疗时，毛细血管瘤发生率高达79.3％、甲状腺功能减退发生率为29.3％、瘙痒发生率为19.0％。腹泻发生率为10.3％。因此甲磺酸阿帕替尼与PD-1抗体联用不仅可以缓解或控制晚期经化疗失败的非小细胞肺癌的肿瘤增殖，同时降低PD-1抗体治疗相关或免疫介导相关的不良反应，提高患者生存质量。
Figure PCTCN2017105410-appb-000004
Figure PCTCN2017105410-appb-000005
Figure PCTCN2017105410-appb-000006
表5入组患者疗效评
Figure PCTCN2017105410-appb-000007

Claims (15)

  1. 一种抗PD-1抗体和VEGFR抑制剂联合在制备治疗癌症的药物中的用途。
  2. 根据权利要求1所述的用途，其中所述VEGFR抑制剂是VEGFR-2抑制剂。
  3. 根据权利要求1所述的用途，其中所述的VEGFR-2抑制剂为阿帕替尼或其可药用盐。
  4. 根据权利要求1所述的用途，其中所述的PD-1抗体的轻链可变区包含分别如SEQ ID NO:4、SEQ ID NO:5和SEQ ID NO:6所示的LCDR1、LCDR2和LCDR3所述的PD-1抗体的重链可变区包含分别如SEQ ID NO:1、SEQ ID NO:2和SEQ ID NO:3所示的HCDR1、HCDR2和HCDR3。
  5. 根据权利要求4所述的用途，其中所述的PD-1抗体为人源化抗体。
  6. 根据权利要求5所述的用途，其中所述人源化抗体轻链序列为如SEQ ID NO:8所示的序列或其变体；所述的变体优选在轻链可变区有0-10的氨基酸变化；更优选为A43S的氨基酸变化。
  7. 根据权利要求5所述的用途，其中所述人源化抗体重链序列为如SEQ ID NO:7所示的序列或其变体；所述变体优选在重链可变区有0-10的氨基酸变化；更优选为G44R的氨基酸变化。
  8. 根据权利要求5所述的用途，其中所述的人源化抗体轻链序列为如SEQ ID NO:8所示的序列，重链序列为如SEQ ID NO:7所示的序列。
  9. 根据权利要求1所述的用途，其中所述癌症为表达PD-L1的癌症；优选为乳腺癌、肺癌、肝癌、胃癌、肠癌、肾癌、黑素瘤、非小细胞肺癌；最优选为非小细胞肺癌、黑素瘤、肝癌和肾癌。
  10. 一种降低抗PD-1抗体或VEGFR抑制剂导致的不良反应的方法，包括向患者联合施用如权利要求1-3任意一项所述的VEGFR抑制剂和权利要求4-8任意一项所述的PD-1抗体。
  11. 一种减少PD-1抗体或VEGFR抑制剂单独施用剂量的方法，包括向患者联合施用如权利要求1-3任意一项所述的VEGFR抑制剂和权利要求4-9任意一项 所述的PD-1抗体。
  12. 根据权利要求3所述的用途，其中所述的阿帕替尼可药用盐选自甲磺酸盐、盐酸盐。
  13. 根据权利要求1所述的用途，其中所述的PD-1抗体的用量为100-1000mg每次，优选200-600mg。
  14. 根据权利要求1所述的用途，其中所述的VEGFR抑制剂的用量为250-1000mg，优选400至850mg。
  15. 一种药物包装盒，其中含有权利要求1-3任意一项所述的VEGFR抑制剂和权利要求4至8任意一项所述的PD-1抗体。
PCT/CN2017/105410 2016-10-10 2017-10-09 一种抗pd-1抗体和vegfr抑制剂联合在制备治疗癌症的药物中的用途 WO2018068691A1 (zh)

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