Classifications

• • A—HUMAN NECESSITIES
  • 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
  • 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
  • A61K31/336—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having three-membered rings, e.g. oxirane, fumagillin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/39—Medicinal preparations containing antigens or antibodies characterised by the immunostimulating additives, e.g. chemical adjuvants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/39558—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against tumor tissues, cells, antigens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/2803—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily
  • C07K16/2818—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily against CD28 or CD152
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • 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

Definitions

• the present invention relates to a combination therapy for tumours comprising the administration of an epoxytigliane compound and an immune checkpoint inhibitor.
• Pharmaceutical compositions and kits containing epoxytigliane compounds and immune checkpoint inhibitors are also described.
• Epoxytiglienone compounds have potent anti-tumour activity. When administered intra- tumourally, epoxytiglienone s initiate rapid haemorrhagic necrosis of the tumour mass by directly disrupting tumour vasculature (Boyle et al. 2014). To date, there is no evidence that localised administration of epoxytiglienone compounds has systemic effects on bystander or more distant tumours and it is considered that the
• intratumourally delivered epoxytiglienone compounds act primarily at the treatment site. As a consequence, each tumour must be treated individually.
• ICI immune checkpoint inhibitors
• CTL4 cytotoxic T-lymphocyte-associated antigen 4
• ICIs with small molecule chemotherapeutics (delivered either systemically or intratumourally) that may modulate immune responses by (1) reducing overall tumour burden, (2) potentiating the anti -tumour response by exposing neo-antigen during tumour necrosis and/or (3) directly affecting tumour stromal cells (Adams et al. 2015; Mahoney et al. 2015; O'Brien et al. 2014).
• the present invention is predicated, at least in part, on the discovery that some epoxytiglien-3-one compounds can stimulate an immune response that can work synergistically with immune checkpoint blockade to provide a therapy not only for the tumour being treated but also other tumours that may be present in the subject being treated.
• the present invention relates to a method of treating at least one tumour in a subject comprising administering to a subject, an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor.
• a method of treating or preventing a bystander tumour in a subject comprising administering to a subject in need thereof, an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor; wherein the epoxytigliane compound is administered locally to a tumour other than the bystander tumour.
• an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor in the manufacture of a medicament for treating a tumour.
• an immune checkpoint inhibitor in the manufacture of a medicament for treating a tumour, wherein the medicament is for administration in combination with an epoxytigliane compound or a pharmaceutically acceptable salt thereof.
• an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor in the manufacture of a medicament for treating or preventing a bystander tumour.
• medicament for treating or preventing a bystander tumour wherein the medicament is for administration in combination with an immune checkpoint inhibitor.
• an immune 5 checkpoint inhibitor in the manufacture of a medicament for treating or preventing a bystander tumour, wherein the medicament is for administration in combination with an epoxytigliane compound or a pharmaceutically acceptable salt thereof.
• an epoxytigliane compound or a o pharmaceutically acceptable salt thereof in combination with an immune checkpoint inhibitor for treating a tumour or treating or preventing a bystander tumour in another aspect of the present invention there is provided a pharmaceutical composition comprising an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor, optionally together with one or more pharmaceutically acceptable carriers.
• kits comprising an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor.
• an element means one element or more than one element.
• the term "about” refers to a quantity, level, value, dimension, size, or amount that varies by as much as 30%, 25%, 20%, 15% or 10% to a reference quantity, 5 level, value, dimension, size, or amount.
• alkyl refers to optionally substituted linear and branched hydrocarbon groups having 1 to 20 carbon atoms. Where appropriate, the alkyl group may have a specified number of carbon atoms, for example, -Ci-Ce alkyl which includes alkyl groups having 1, 2, 3, 4, 5 or 6 carbon atoms in linear or branched arrangements.
• Non-limiting examples of alkyl groups include methyl, ethyl, propyl, isopropyl, butyl, s- and /-butyl, pentyl, 2-methylbutyl, 3-methylbutyl, hexyl, 2-methylpentyl, 3-methylpentyl, 4-methylpentyl, 2-ethylbutyl, 3-ethylbutyl, heptyl, octyl, nonyl, decyl, undecyl, dodecyl, tridecyl, tetradecyl and pentadecyl.
• alkenyl refers to optionally substituted, unsaturated linear or branched hydrocarbons, having 2 to 20 carbon atoms and having at least one double bond. Where appropriate, the alkenyl group may have a specified number of carbon atoms, for example, C2-C5 alkenyl which includes alkenyl groups having 2, 3, 4, 5 or 6 carbon atoms in linear or branched arrangements.
• Non-limiting examples of alkenyl groups include, ethenyl, propenyl, isopropenyl, butenyl, s- and 7-butenyl, pentenyl, hexenyl, hept-l,3-diene, hex- l,3-diene, non-l,3,5-triene and the like.
• alkynyl refers to optionally substituted unsaturated linear or branched hydrocarbons, having 2 to 20 carbon atoms, having at least one triple bond.
• the alkynyl group may have a specified number of carbon atoms, for example, d-Ce alkynyl which includes alkynyl groups having 2, 3, 4, 5 or 6 carbon atoms in linear or branched arrangements. Non-limiting examples include ethynyl, propynyl, butynyl, pentynyl and hexynyl.
• cycloalkyl and “carbocyclic” refer to optionally substituted saturated or unsaturated mono-cyclic, bicyclic or tricyclic hydrocarbon groups.
• the cycloalkyl group may have a specified number of carbon atoms, for example, C3 -C6 cycloalkyl is a carbocyclic group having 3, 4, 5 or 6 carbon atoms.
• Non-limiting examples may include cyclopropyl, cyclobutyl, cyclopentyl, cyclopentenyl, cyclohexyl, cyclohexenyl, cyclohexadienyl and the like.
• “Aryl” means a C6-C14 membered monocyclic, bicyclic or tricyclic carbocyclic ring system having up to 7 atoms in each ring, wherein at least one ring is aromatic.
• aryl groups include, but are not limited to, phenyl, naphthyl, tetrahydronaphthyl, indanyl and biphenyl.
• the aryl may comprise 1-3 benzene rings. If two or more aromatic rings are present, then the rings may be fused together, so that adjacent rings share a common bond.
• substituents include, but are not limited to, methyl, ethyl, propyl, isopropyl, butyl, sec-butyl, fert-butyl, vinyl, methoxy, ethoxy, propoxy, isopropoxy, butoxy, methylthio, ethylthio, propylthio, isopropylthio, butylthio, hydroxy, hydroxymethyl, hydroxyethyl, hydroxypropyl, hydroxybutyl, fluoro, chloro, bromo, iodo, cyano, nitro, - CO2H, -CO2CH3, -C(0)CH3, trifluoromethyl, trifluoromethoxy, trifluoromethylthio, difluoromethyl, difluoromethoxy, difluoromethylthio, mo ⁇ holino, amino, methylamino, dimethylamino, phenyl, phenoxy, phenylcarbonyl, benz
• the epoxytigliane compounds may be in the form of pharmaceutically acceptable salts. It will be appreciated however that non-pharmaceutically acceptable salts also fall within the scope of the invention since these may be useful as intermediates in the preparation of pharmaceutically acceptable salts or may be useful during storage or transport.
• Suitable pharmaceutically acceptable salts include, but are not limited to, salts of pharmaceutically acceptable inorganic acids such as hydrochloric, sulphuric, phosphoric, nitric, carbonic, boric, sulfamic, and hydrobromic acids, or salts of pharmaceutically acceptable organic acids such as acetic, propionic, butyric, tartaric, maleic, hydroxymaleic, fumaric, maleic, citric, lactic, mucic, gluconic, benzoic, succinic, oxalic, phenylacetic, methane sulphonic, toluene sulphonic, benezenesulphonic, salicyclic sulphanilic, aspartic, glutamic, edetic, stearic, palmitic, oleic, lauric, pantothenic, tannic, ascorbic and valeric acids.
• pharmaceutically acceptable inorganic acids such as hydrochloric, sulphuric, phosphoric,
• Base salts include, but are not limited to, those formed with pharmaceutically acceptable cations, such as sodium, potassium, lithium, calcium, magnesium, ammonium and alkylammonium.
• Basic nitrogen-containing groups may be quarternised with such agents as lower alkyl halide, such as methyl, ethyl, propyl, and butyl chlorides, bromides and iodides; dialkyl sulfates like dimethyl and diethyl sulfate; and others.
• lower alkyl halide such as methyl, ethyl, propyl, and butyl chlorides, bromides and iodides
• dialkyl sulfates like dimethyl and diethyl sulfate; and others.
• the epoxytigliane compounds may possess asymmetric centres and are therefore capable of existing in more than one stereoisomeric form.
• the invention thus also relates to compounds in substantially pure isomeric form at one or more asymmetric centres e.g., greater than about 90% ee, such as about 95% or 97% ee or greater than 99% ee, as well as mixtures, including racemic mixtures, thereof.
• Such isomers may be obtained by isolation from natural sources, by asymmetric synthesis, for example using chiral intermediates, or by chiral resolution.
• the compounds of the invention may exist as geometrical isomers.
• the invention also relates to compounds in substantially pure cis (Z) or trans (E) forms or mixtures thereof.
• the compounds of the present invention may be obtained by isolation from a plant or plant part, or by derivatisation of the isolated compound, or by derivatisation of a related compound. Isolation procedures and derivatisation procedures may be found in WO 2007/070985 and WO2014/ 169356.
• epoxytigliane compound refers to a compound having the following basic carbon cyclic structure:
• the compounds have a tricyclo[9.3.0.0]tetradecane system with a fused cyclopropane ring appended to the six membered ring.
• the epoxide is fused to the seven membered ring in the 6,7-position.
• epoxytigliane compound is an epoxytiglien-3-one compound.
• epoxytiglien-3-one compound refers to a compound having an epoxy-tigliane structure defined above where the five membered ring has a l,2-ene-3-one structure:
• the term "bystander tumour” refers to a tumour other than the tumour which is treated with the epoxytigliane compound.
• the bystander tumour may be a primary tumour or a metastatic tumour.
• the term "in combination with” as used herein refers to the epoxytigliane compound and the ICI being administered in a single composition, or separately, either simultaneously or sequentially.
• the epoxytigliane compound and the ICI may be administered at different times and different frequencies but in combination they exert biological effects at the same time or at overlapping times.
• the ICI is administered so that it has an effect on immune response when the epoxytigliane compound is administered.
• the present invention relates to methods of treating tumours, including bystander tumours, the method comprising the administration of an epoxytigliane compound or a pharmaceutically acceptable salt thereof in combination with an immune checkpoint inhibitor (ICI).
• the invention also relates to methods of preventing bystander tumours comprising the administration of an epoxytigliane compound or a pharmaceutically acceptable salt thereof in combination with an ICI.
• the tumour being treated is a tumour to which the epoxytigliane compound may be delivered in a localised way directly to the tumour.
• the tumour is a cutaneous tumour or subcutaneous tumour or a tumour accessible from the outside of the body, for example, a tumour that is palpable.
• the tumour is an internal tumour.
• tumour is an internally located tumour, the localised delivery is achieved during surgery when the tumour is exposed and able to be injected with the epoxytigliane compound.
• the tumour is internally located and the epoxytigliane compound is delivered by injection guided by an imaging technique, for example, guided by o endoscopic ultrasound or by stereotactic imaging.
• the epoxytigliane compound is delivered to one or more tumours systemically. 5
• the tumour is a benign tumour. In other embodiments, the
• tumour is a malignant tumour.
• the tumour is a primary tumour and in other embodiments, the tumour is a metastatic tumour.
• cutaneous tumours include seborrheic keratosis, actinic keratosis, basal cell carcinoma (BCC) including nodular BCC, superficial BCC, infiltrative BCC and micronodular BCC, 0 squamous cell carcinoma, including in-situ squamous cell carcinoma and invasive squamous cell carcinoma, melanoma including superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, acral lentginous melanoma and desmoplastic/neutropic melanoma, cutaneous B cell lymphoma and cutaneous T cell lymphoma.
• BCC basal cell carcinoma
• melanoma including superficial spreading melanoma
• subcutaneous tumours include angiokeratoma, pyogenic 5 granuloma, cherry angioma, glomus tumour, angiosarcoma, karposi sarcoma, Ewings sarcoma, malignant fibrous histiocytoma, leiomyosarcoma, rhabdomyosarcoma, liposarcoma, synovial sarcoma, stromal sarcoma, gastrointestinal stromal sarcoma, malignant peripheral nerve sheath tumour, primitive neuroectodermal tumour, neurofibroma, Merkel cell carcinoma, dermatofibroma, fibrosarcoma, epithelioid o sarcoma and mastocytoma (mast cell tumour).
• angiokeratoma pyogenic 5 granuloma, cherry angioma, glomus tumour, angiosarcoma, karposi sarcoma, Ewings sarcoma, malignant fibrous hist
• the internal tumour may be any tumour that is accessible to injection during surgery or by guided injection or one that may be treated with systemically administered epoxytigliane and include tumours of the brain, lung, colon, epidermoid, squamous cell, bladder, stomach, pancreas, breast, head, neck, renal system, kidney, liver, ovary, prostate, uterus, oesophagus, testicles, cervix, vagina, thyroid or skin.
• the bystander tumour may be any tumour other than the tumour being treated with the epoxytigliane compound.
• the bystander tumour may be a second cutaneous or subcutaneous tumour or it may be a tumour in another organ or tissue.
• bystander tumours include tumours of the brain, lung, colon, epidermoid, squamous cell, bladder, stomach, pancreas, breast, head, neck, renal system, kidney, liver, ovary, prostate, uterus, oesophagus, testicles, cervix, vagina, thyroid or skin.
• the bystander tumour is an additional primary tumour and in other embodiments the bystander tumour is a metastatic tumour.
• the tumour being treated with the epoxytigliane compound is a primary tumour and the bystander tumour is a metastatic tumour.
• the tumour being treated with the epoxytigliane compound is a metastatic tumour and the bystander tumour is a primary tumour. In some embodiments, both the tumour being treated with the epoxytigliane compound and the bystander tumour are primary tumours. In some embodiments, both the tumour being treated with the epoxytigliane compound and the bystander tumour are metastatic tumours.
• the combination therapy prevents the bystander tumour occurring or delays the occurrence of the bystander tumour. In some embodiments, the combination therapy reduces the size of the bystander tumour.
• the epoxytigliane compound is a 6,7-epoxytigliane compound. In some embodiments, the epoxytigliane compound is an epoxytigli-l,2-en-3-one compound. In some embodiments, the epoxytigliane compound is a 6,7-epoxytigli-l,2- en-3-one compound. In some embodiments, the e oxytigliane compound is a compound of formula (I):
• Ri is hydrogen or Cusalkyl
• R 2 is -OH or -OR 9 ;
• R4 and R5 are independently selected from hydrogen and Cusalkyl
• Re is hydrogen or -Rio
• R7 is hydroxy or -OR10
• Rs is hydrogen or Cusalkyl
• R9 is -Ci- 2 oalkyl, -C 2 - 2 oalkenyl, -C 2 - 2 oalkynyl, -C(0)Ci- 2 oalkyl, -C(0)C 2 - 2 oalkenyl, -C(0)C 2 - 2 oalkynyl, -C(0)cycloalkyl, -C(0)Ci-ioalkylcycloalkyl;
• Rio is -Ci-6alkyl, -C 2 -6alkenyl, -C 2 -6alkynyl, -C(0)Ci-6alkyl, -C(0)C 2 -6alkenyl, -C(0)C 2 - 6alkynyl, -C(0)aryl, -C(0)Ci-6alkylaryl, -C(0)C2-6alkenylaryl, -C(0)C2-6alkynylaryl; and
• Rii is hydrogen, -Ci-ioalkyl, -C 2 -ioalkenyl, -C 2 -ioalkynyl, cycloalkyl or aryl;
• each alkyl, alkenyl, alkynyl, cycloalkyl or aryl group is optionally substituted.
• the epoxytigliane compound of formula (I) is a compound of
• Ri is -Ci-3alkyl, especially -Ct1 ⁇ 4;
• R 2 is -OC(0)Ci- 2 oalkyl, -OC(0)C 2-2 oalkenyl, -OC(0)C 2-2 oalkynyl, -OC(0)cycloalkyl, -OC(0)Ci-ioalkylcycloalkyl; -OC(0)C 2- ioalkenylcycloalkyl, -OC(0)C 2- loalkynylcycloalkyl, -OC(0)aryl, -OC(0)Ci-ioalkylaryl, -OC(0)C2-ioalkenylaryl, -OC(0)C 2- ioalkynylaryl, -OC(0)Ci-ioalkylC(0)Rn, -OC(0)C 2- ioalkenylC(0)Rn, -OC(0)C 2- ioalkynylC(0)Rii, -OC(0)C 2- ioalkenylC(0)Rn, -OC(0)C 2- ioalkynylC(0)Rii
• R 3 is -OC(O)Ci -20 alkyl, -OC(0)C 2-2 oalkenyl, -OC(O)C 2-20 alkynyl, -OC(0)cycloalkyl, -OC(0)Ci-ioalkylcycloalkyl; -OC(0)C 2- ioalkenylcycloalkyl, -OC(0)C 2- loalkynylcycloalkyl, -OC(0)aryl, -OC(0)Ci-ioalkylaryl, -OC(0)C 2- ioalkenylaryl, -OC(0)C 2- ioalkynylaryl, -OC(0)Ci-ioalkylC(0)Rn, -OC(0)C 2- ioalkenylC(0)Rn, -OC(0)C 2- ioalkynylC(0)Rn, -OC(0)C 2- ioalkenylC(0)Rn, -OC(0)C 2- ioalkynylC(0)Rii
• Rt and R5 are independently selected from -Ci ⁇ alkyl, especially -CH3;
• R5 is hydrogen, -C(0)Ci-6alkyl, -C(0)C 2- 6alkenyl, -C(0)C 2- 6alkynyl or -C(0)aryl; especially hydrogen, -C(0)Ci-3alkyl, -C(0)C 2- 3alkenyl or -C(0)C 2- 3alkynyl, more especially hydrogen or -C(0)CH3;
• R7 is hydroxyl, -OC(0)Ci-6alkyl, -OC(0)C 2- 6alkenyl or -OC(0)C 2- 6alkynyl, especially hydroxyl, -OC(0)Ci-3alkyl, -OC(0)C 2- 3alkenyl or -OC(0)C 2- 3alkynyl, more especially hydroxyl or -OC(0)CH3; and
• Re is -Ci-3alkyl, especially -CH3.
• the compounds of formulae (I) and/or (II) have stereochemistry as shown in formula (III) below:
• the epoxide in the 6,7-position is above the plane of the ring system. In other embodiments, the epoxide in the 6,7-position is below the plane of the ring system. In some embodiments, the R2 group in the 12 position is S and in other embodiments, the R2 group in the 12 position is R.
• the ICI may be any molecule that inhibits immune cell or cancer cell proteins that block immune responses in the immune cell, especially where the immune cell is a T cell or a natural killer cell (NK cell).
• immune cell and tumour cell proteins include Programmed Death 1 (PD-1) on T cells which binds PD-L1 of a tumour cell to block immune response of the T cell against the tumour cell and Cytotoxic T-Lymphocyte-Associated protein 4 (CTLA-4) protein on a T cell which binds B7-1/B7-2 protein on a cancer cell to block immune response of the T cell against the tumour cell. Therefore ICIs include molecules that bind to or block the interaction of PD-1 with PD-L1/PDL2 or CTLA-4 with B7-1/B7-2.
• PD-1 Programmed Death 1
• CTLA-4 Cytotoxic T-Lymphocyte-Associated protein 4
• IDO indoleamine 2,3-dioxygenase
• KIR Killer-cell Immunoglobulin like receptor
• LAG3 Lymphocyte Activation Gene-3
• T cell immunoreceptor with IG and ITIM domains T-cell immunoglobulin and mucin-domain containing-3
• VISTA V-domain Immunoglobulin Suppressor of T cell Activation
• ICIs include, but are not limited to antagonists of PD-1, PD-L1, PD-L2, CTLA-4, B7-1/B7-2 protein, Adenosine A2A receptor, B7-H3, B7-H4, IDO, KIR, LAG3, TIM-3, TIGIT, CD96 and VISTA, especially antagonists of PD-1, PD-L1, CTLA-4 or B7-1/B7-2 protein, more especially antagonists of PD-1 or CTLA-4.
• the antagonist is an antibody for the immune checkpoint protein, for example, Anti-PD-1 antibody or Anti-CTLA-4 antibody.
• a particular antagonist is an antagonist of IDO.
• epoxytigliane compounds or pharmaceutically acceptable salts thereof and ICIs may be administered neat, it may be more convenient to administer the epoxytigliane compounds and ICIs in the form of one or more pharmaceutical compositions, each together with a pharmaceutically acceptable carrier, diluent and/or excipient. Dosage form and rates for pharmaceutical use and compositions are readily determinable by a person of skill in the art.
• the epoxytigliane compound is formulated for administration directly onto or into the tumour being treated.
• the epoxytigliane compound is formulated for topical administration in the form of a gel, ointment, lotion, cream or transdermal patch that may be applied directly onto the tumour being treated.
• the epoxytigliane compound is formulated for injection, especially intratumoural injection where the compound is injected into one or more places in a tumour.
• the ICI may be administered in any means that is able to deliver the molecule systemically or locally.
• the ICI when the ICI is an antibody, the molecule is conveniently delivered by injection, for example, intravenous, intraarticular, intramuscular, intradermal, subcutaneous or intraperitoneal injection.
• the ICI may also be formulated for local delivery by injection, for example, intratumourally.
• Pharmaceutically acceptable carriers and acceptable carriers for systemic or local administration may also be incorporated into the compositions of ICIs.
• the epoxytigliane compound and the ICI are delivered separately, either simultaneously or sequentially.
• the epoxytigliane compound and the ICI are delivered in a single composition, for example, a single composition suitable for intratumoural delivery or a single composition formulated for systemic delivery.
• a pharmaceutical composition comprising an epoxytigliane compound or a pharmaceutically acceptable salt thereof and an immune checkpoint inhibitor, optionally together with one or more pharmaceutically acceptable carriers.
• the pharmaceutical composition(s) comprise a pharmaceutically acceptable excipient or an acceptable excipient.
• pharmaceutically acceptable excipient is meant a solid or liquid filler, diluent or encapsulating substance that may be safely used.
• a variety of carriers well known in the art may be used.
• These carriers or excipients may be selected from a group including sugars, starches, cellulose and its derivatives, cyclodextrins, malt, gelatine or other gelling agents, polymers, talc, calcium sulphate, vegetable oils, synthetic oils, alcohols and/or polyols, alginic acid, phosphate buffered solutions, emulsifiers, isotonic saline, and pyrogen-free water.
• Liquid form preparations include solutions, suspensions, and emulsions, for example, water or water-propylene glycol solutions.
• parenteral injection liquid preparations can be formulated as solutions in aqueous 1,2-propanediol, dimethylsulfoxide (DMSO), aqueous solutions of gamma cyclodextrin or 2- hydroxypropyl-beta-cyclodextrin, saline solution or polyethylene glycol solution, with or without buffer.
• DMSO dimethylsulfoxide
• a preferred range of pH is 3.0-4.5.
• Suitable buffers buffer the preparation at pH 3.5-4.5 and include, but are not limited to, acetate buffer and citrate buffer.
• compositions of epoxytigliane compound and/or ICI may thus be formulated for parenteral administration (e.g. by injection, for example bolus injection or continuous infusion) and may be presented in unit dose form in ampoules, pre-filled syringes, small volume infusion or in multi-dose containers with an added preservative.
• the compositions may take such forms as suspensions, solutions, gels or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilising and/or dispersing agents.
• the active ingredient may be in powder form, obtained by aseptic isolation of sterile solid or by lyophilisation from solution, for constitution with a suitable vehicle, e.g.
• compositions of epoxytigliane compound and/or ICI suitable for administration may be presented in discrete units such as syringes, vials, tubes or sachets each containing a predetermined amount of one or more pharmaceutically active compounds or extracts of the invention, as a powder or granules or as a solution or a suspension in an aqueous liquid, a cyclodextrin solution, a non-aqueous liquid, an oil-in-water emulsion or a water-in-oil emulsion or as a solution or suspension in a cream or gel or as a suspension of micro- or nano-particles incorporating an epoxytigliane compound, including but not limited to silica or polylactide micro- or nano-particles.
• compositions may be prepared by any of the method of pharmacy but all methods include the step of bringing into association one or more pharmaceutically active compounds of the invention with the carrier which constitutes one or more necessary ingredients.
• the compositions are prepared by uniformly and intimately admixing the agents of the invention with liquid carriers or finely divided solid carriers or both, and then, if necessary, shaping the product in to the desired presentation.
• the compounds according to the invention may be formulated as gels, ointments, emulsions, pastes, creams or lotions, or as a transdermal patch.
• Gels may be prepared using suitable thickening agents and adding them to aqueous/alcoholic compositions of compound. Suitable thickening or gelling agents are known in the art, such as the polyvinyl carboxy polymer Carbomer 940.
• Ointments and creams may, for example, be formulated with an aqueous or oily base with the addition of suitable thickening and/or gelling agents.
• Lotions may be formulated with an aqueous or oily base and will in general also contain one or more emulsifying agents, stabilising agents, dispersing agents, suspending agents, thickening agents, or colouring agents.
• Formulations suitable for topical administration also include solutions or suspensions that may be administered topically in the form of a bath or soak solution or a spray or may be absorbed into a dressing.
• the ICI When the ICI is a small molecule, it may be delivered by any suitable means including oral, topical, rectal, parenteral, sublingual, buccal, intravenous, intraarticular, intra-muscular, intra-dermal, subcutaneous, inhalational, intraocular, intraperitoneal, intracerebroventricular, transdermal and the like as known in the art of pharmacy.
• the epoxytigliane compound is delivered in the same composition as the ICI.
• the ICI is administered in a separate composition from the epoxytigliane compound.
• the epoxytigliane compound is administered directly to the tumour, for example by topical administration or by intra-tumoural injection.
• the epoxytigliane compound is administered to the tumour once.
• the treated tumour is monitored and further administration of epoxytigliane compound may be required if the tumour does not fully respond to the treatment.
• the epoxytigliane compound may be administered on a number of occasions over a period of time, for example, daily for a week, or once a week for 4 to 10 weeks. A person skilled in the art, monitoring the subject being treated would be able to determine an appropriate dosage schedule, which may vary depending on the response to the treatment.
• the ICI is administered at least once, prior to or simultaneously or sequentially with the epoxytigliane compound.
• multiple doses of ICI are administered over a period of time beginning before or together with administration of the epoxytigliane compound and then continuing after administration of the epoxytigliane compound.
• the ICI is administered more than once and on a regular basis before and after administration of the epoxytigliane compound.
• the ICI is administered before administration of the epoxytigliane compound, sequentially or simultaneously with the administration of the epoxytigliane compound and at least once subsequently to administration of the epoxytigliane compound.
• the ICI may be administered 1 week to 1 day prior to administration of the epoxytigliane compound, especially 1 to 3 days and more especially about 2 days before the administration of the epoxytigliane compound, the ICI is then administered sequentially or simultaneously with the epoxytigliane compound, either immediately before or immediately after the administration of the epoxytigliane compound, the ICI is then administered one or more times over the next month after administration of the epoxytigliane compound, for example, once a week, once every 5 days, once every 4 days, once every 3 days, every 2 days or every day, especially every 1 to 3 days, more especially every 2 days.
• Subsequent administration of the ICI may continue such that 1 to 10 doses of ICI are administered after the administration of the epoxytigliane compound, especially 1 to 8 doses, 1 to 6 doses, 1 to 4 doses, 1 to 3 doses or 1 to 2 doses.
• the ICI is administered 2 days before the administration of the epoxytigliane compound, sequentially (immediately before or immediately after) with the epoxytigliane compound and then every two days for 6 days following administration of the epoxytigliane compound.
• the epoxytigliane compound is administered in an effective amount.
• An "effective amount” means an amount necessary at least partly to attain the desired response, for example, to reduce the size of the tumour or to destroy the tumour in total. The amount varies depending upon the health and physical condition of the individual to be treated, the taxonomic group of individual to be treated, the formulation of the composition, the size of the tumour, the assessment of the medical situation, and other relevant factors. It is expected that the amount will fall in a relatively broad range that can be determined through routine trials.
• An effective amount for example, may lie in the range of about 0. 1 ng per kg of body weight to 1 g per kg of body weight per dosage.
• the dosage is preferably in the range of 1 ⁇ g to 0.5 g per kg of body weight per dosage, such as is in the range of 0.1 ⁇ g to 100 mg per kg of body weight per dosage.
• the dosage is in the range of 50 ng to 100 mg per kg of body weight, for example 0. 1 mg to 5 mg per kg of body weight, 0. 1 to 1 mg/kg of body weight, such as 0.25 mg/kg of body weight.
• the dosage is in the range of 0.001 mg to 20 mg per dosage, for example, 0.005 mg to 15 mg per dosage, especially 0.05 to 10 mg per dosage, more especially about 0.1 to about 5 mg per dosage. Dosage regimes may be adjusted to provide the optimum therapeutic response. For example, in some embodiments, where
• administration is intra-tumoural, the epoxytigliane compound is administered once and the progress of treatment monitored.
• a second dose may be administered.
• the topical compound formulation may be administered directly onto the site of the tumour in the form of a gel, cream, ointment or lotion. The frequency of treatment will depend on the tumour, its size, the subject being treated and the like.
• a topical formulation may be applied weekly until the tumour is resolved.
• the treatment may be a single treatment and a second treatment only administered if the tumour is not completely resolved.
• the ICI may also be administered in an effective amount.
• the amount of ICI considered to be effective will depend on the subject being treated, their health and physical condition, the number of bystander tumours present, the formulation of the composition and the assessment of the medical situation. It is expected that the amount of ICI will fall within a fairly broad range of amounts.
• An effective amount may lie in the range of about 0.1 ng/kg to about 500 mg/kg body weight, 100 ⁇ g/kg to 100 mg/kg body weight, 1 mg/kg to 50 mg/kg body weight, 1 mg/kg to 20 mg/kg body weight.
• the actual dosages may be in the range of from 1 ⁇ g to 1 g, for example, 100 ⁇ g to 750 mg per dose.
• the subject that may be treated with the combination therapy is a mammal, a bird, an aquatic animal such as a fish, or a reptile.
• the subject is a human, a laboratory animal such as a mouse, rat or rabbit, a companion animal such as a dog or cat, a working animal such as a horse, donkey and the like, a livestock animal such as a cow, bull, pig, sheep, goat, deer, llama, alpaca and the like, or a captive wild animal such as those in zoos or wildlife parks including lions, leopards, cheetah, elephant, zebra, antelope, giraffe, koala, kangaroo and reptiles such as crocodiles, lizards, snakes and the like, a bird, especially a captive bird, such as a budgerigar or canary, cockatoo, parakeet, macaw, parrot and the like, or a
• compositions of epoxytigliane compound and ICI may be formulated separately and sold together in a kit or package.
• Each kit may comprise dosages of each compound to achieve treatment of a tumour and treat or prevent one or more bystander tumours.
• the epoxytigliane composition is formulated for topical administration, such as in a gel, lotion, cream or ointment or is impregnated into a dressing.
• the epoxytigliane compound is formulated for injection such as intratumoural injection.
• the epoxytigliane formulation may be present in the kit as a liquid ready for uptake into a syringe, as a powder or solid formulation which may be solubilized in a carrier before injection or may be present in the kit in a pre-filled syringe.
• kits may comprise one or more doses of epoxytigliane compound.
• the kit will contain a single dose of epoxytigliane compound in a formulation suitable for intratumoural injection.
• the kit will contain a topical formulation of epoxytigliane compound containing multiple doses for application to the tumour.
• the ICI is formulated for parenteral administration in a single bolus dose or in a multiple dose form.
• the kit may contain the ICI in a pre-filled syringe, as a liquid in a vial ready for uptake into a syringe, or as a solid ready for dissolution before uptake into a syringe.
• the liquid or solid formulations may be single dose formulations or multiple dose formulations.
• the kit may contain multiple doses of ICI each formulated separately in a prefilled syringe, as a liquid in a vial ready for uptake into a syringe or as a solid ready for dissolution and uptake into a syringe.
• the kit may further comprise an insert with instruction for use of each formulation, including how to prepare each dose if required, how to administer each dosage and when to administer each dosage.
• Figure 1 provides A: images of PKC-a, - ⁇ , - ⁇ , - ⁇ and - ⁇ translocation after treatment with vehicle (Vehc.) or 500 nM Compound 1 (Comp 1), Compound 3 (Comp 3) and PMA. These images were also used for the quantitation shown in B.
• Figure 2 provides A: Schematic of the experimental design.
• cytokine s/chemokines are shown.
• IPA Ingenuity Pathway Analysis
• Figure 3 provides A. LDH release from cancer cell lines treated with Compound 1.
• A431, MM649 and B16-OVA were treated with Compound 1 at the indicated concentrations or vehicle only (Vehc.) and LDH released assayed over time using a Pierce LDH cytotoxicity assay kit.
• Figure 4 provides A. Determination of ATP release from cancer cell lines in response to treatment with Compound 1.
• HMGB 1 release from cancer cell lines treated with the Compound 1 and epoxytigliane analogues.
• HMGB 1 release also occurred in response to treatment with
• D Compound 1 promotes calreticulin extemalisation in a range of cancer cell lines.
• A431 (Di), MM649 (Dii) and B 16-OVA (Diii) were treated with Compound 1 or Vehicle (Vehc.) only for the indicated times and then stained with anti-Calreticulin/anti-rabbit Alexa 488 prior to flow cytometry.
• Mean fluorescence intensity values (Ex:488nm, Em: 530/530nm) +/- S.D. are indicated for each timepoint.
• Figure 6 provides A: Schematic of the experimental approach to Compound 1 and ICI combinations. All tumours were injected with either 15/30 ⁇ g Compound 1 or Vehicle (Vehc). Dosage regime of ICI treatment is also depicted. B and C. Kaplan-Meier plots indicating the % of tumours treated that remain below 100 mm 3 in size under the distinct treatment conditions with ICIs, with either anti-PD-1 ( Figure 6B) or anti- CTLA-4 ( Figure 6C). Mouse survival in response to the combination is also depicted.
• Figure 7 provides A: A schematic diagram of the combination therapy approach: index and bystander tumour are shown together with dosage regime; and B: Graphical representations of the combination therapy results (tumour volumes). Isotype antibody + Compound 1 (dot line), Anti-PD-1 antibody or Anti-CTLA-4 antibody + vehicle (dash line) and Anti-PD-1 antibody or Anti-CTLA-4 antibody + Compound 1 (solid line) in treated (white circles) and bystander (black circles) tumours.
• Figure 8 provides both volume (left panel) and Kaplan-Meier (right panel) based analyses of tumours (% tumours ⁇ 100 mm 3 ) injected with a sub-optimal dose of Compound 1 (15 ⁇ g) in wt and GCSF knockout backgrounds.
• the compounds of the present invention may be obtained by isolation from a plant or plant part, or by derivatisation of the isolated compound, or by derivatisation of a related compound. Isolation procedures and derivatisation procedures may be found in WO 2007/070985 and WO2014/ 169356.
• the 20-acetyl derivative of compound 1 may be produced from Compound 1 by acetylation with acetic anhydride (1 equiv) in the presence of triethylamine in dichloromethane. These conditions allow selective acetylation of the C-20 hydroxy group without acetylation of the secondary hydroxy groups.
• Compound 10 although not specifically synthesized in WO2014/169356, may be prepared using the general method for obtaining unsymmetrical esters set out in Example 1 of WO2014/169356, pages 64 to 70.
• Protein kinase C are a family of key enzymes involved in signalling pathways that specifically phosphorylate substrates at serine/threonine residues. Phosphorylation by PKC is important in regulation a variety of cellular events such as proliferation and regulation of gene expression.
• PKC isoforms (- ⁇ , - ⁇ , - ⁇ , - ⁇ , - ⁇ , - ⁇ , - ⁇ ) are directly implicated in immune cell responses and can also promote the expression of key immune genes. However, the expression pattern and levels of each of these PKC isoforms are cell-type and context specific (Lim et al. 2015; Anel et al. 2012; Pfeifliofer et al. 2006).
• PKC-a PKC- ⁇ , PKC- ⁇ , PKC- ⁇ , PKC- ⁇ , PK-C0, PKC- ⁇ , PKC- ⁇ - generated in house
• Lipofectamine 2000 Invitrogen
• a volume corresponding to 0.16 ⁇ g PKC-EGFP and 0.48 Lipofectamine was mixed with 25 ⁇ Opti-MEM medium (Invitrogen) and incubated for 5 min at RT.
• the percentage of cells showing plasma membrane translocation of Compounds 1 to 10 as well as positive control PMA were converted to a Heatmap depicting the PKC isoform translocation profile in response to 500, 50 and 5 nM of each compound.
• the Heatmap is shown in Figure IB.
• Example 2 Gene expression changes in mouse tumour stroma consistent with immune cell recruitment and the induction of a Th-l/Ml-like anti-tumour immune response
• Thl/M-1 like response in anti-tumour immunity has been associated with induction of anti-tumour cellular immunity through a range of mechanisms including direct tumouricidal activity, modification of anti-tumour cytokine responses and potentiation of long-term immunologic memory.
• Thl T helper type 1
• cytokines including interferon- ⁇ (IFN- ⁇ ), interleukin-2 (IL-2), and tumor necrosis factor-a (TNF-a) (Knutson et al. 2005; DeNardo et al.
• cytokines promote the activities of several cell types, including antigen presenting cells (APCs), cytotoxic T cells, NK cells, and various innate immune cell subtypes (e.g. Cohen et al. 2000; Bos & Sherman 2010).
• APCs antigen presenting cells
• cytotoxic T cells e.g. IL-1 and IL-6 (produced by Ml macrophages) have been associated with tumour development, more recent evidence suggests that they are in fact crucial components of acute anti -tumour immune responses (Haabeth et al. 2011; Gabrilovich et al.
• mice Mouse stroma in human tumour xenografts from mice.
• the SK-MEL-28 human melanoma cell line was injected subcutaneously (s.c) into 2 sites on the flanks of each BALB/c Foxnlnu mouse (2 million cells/site) and allowed to grow to approximately 7 mm diameter.
• Each tumour was then injected with 50 ⁇ of 20% propylene glycol containing 30 ⁇ g Compound 1 or with 50 ⁇ of 20% propylene glycol.
• a mouse was euthanased and the tumours harvested, the skin covering removed, and the intact tumours stored at -80 ° C
• RNA extraction was extracted from 30 mg of frozen tumour using the Qiagen RNeasy Plus Mini Kit, according to manufacturer's instructions, then quantitated with a NanoDrop instrument and integrity confirmed on denaturing agarose gels bearing a 1 kb DNA marker and stained with ethidium bromide. RNA amplification and labelling. Approximately 500 ng of total unlabelled RNA was adjusted to a final volume of 11 ⁇ with nuclease-free water.
• RNA was incubated with 9 ⁇ of the reverse transcriptase master mix (1 ⁇ of T7 Oligo (dT) Primer, 2 ⁇ of lOx first strand buffer, 4 ⁇ of dNTP mix, 1 ⁇ of RNase inhibitor and 1 ⁇ of ArrayScript) at 42 °C for 2 h.
• the cDNA was purified by filtering through a cDNA Filter Cartridge with 250 ⁇ of cDNA binding buffer and washing with 500 ⁇ of the wash buffer provided in the kit. Purified cDNA was eluted with 20 ⁇ of 55 °C nuclease-free water. Each cDNA sample was incubated with 7.5 ⁇ of the IVT master mix (2.5 ⁇ of T7 10X reaction buffer, 2.5 ⁇ of T7 enzyme mix and 2.5 ⁇ biotin-NTP mix) at 37 °C for 16 h. The reaction was stopped with the addition of 75 ⁇ of nuclease-free water to each cRNA sample.
• the IVT master mix 2.5 ⁇ of T7 10X reaction buffer, 2.5 ⁇ of T7 enzyme mix and 2.5 ⁇ biotin-NTP mix
• the biotinylated, amplified RNA was purified by filtering the cRNA samples through cRNA Filter Cartridges with 350 of cRNA binding buffer and 250 ⁇ of 100 % ethanol mixed together prior to loading onto the filters.
• the cRNA filter cartridges with attached RNA were then washed with 650 ⁇ of wash buffer before eluting purified cRNA with 200 ⁇ of 55 °C nuclease-free water.
• Illumina Expression BeadChip Hybridization The cRNA samples were heated at 65 ° C for 5 min and collected by pulse centrifugation. After heating at 65 °C for 5 min, approximately 750 ng of the cRNA sample was aliquoted into separate tubes to which were added ⁇ 5 ⁇ of RNase-free water and 10 ⁇ of Hyb Mix. Approximately 15 ⁇ of the prepared cRNA mix was loaded onto the Illumina Expression BeadChips. Subseqent steps of hybridisation and washing were carried out according to the Whole- Genome Gene Expression Direct Hybridization Assay Guide supplied by Illumina. The HumanHT-12 v4 Expression BeadChips cover more than 47,000 transcripts and known splice variants across the human transcriptome.
• the MouseRef-8 v2.0 Expression BeadChips cover approximately 25,600 well-annotated RefSeq (Reference Sequence) transcripts, comprising over 19,000 unique genes. Data analysis. BeadChips were read by the iScan System, and transferred via GenomeStudio into GeneSpring GX vl2.5 (Agilent Technologies, Santa Clara, CA, USA). The expression values were normalized using quantile normalization with default settings. The entities were filtered based on the detection score calculated by GenomeStudio where p ⁇ 0.05 was considered significant.
• Figure 2A shows that several host cytokine s/chemokines which are important for the recruitment/activation of immune cells are upregulated at the tumour site in response to Compound 1 treatment.
• Cxcll which is heavily upregulated by Compound 1 is known to promote neutrophil recruitment and subsequent killing of residual cancer cells (Garg et al. 2017).
• Figure 2B shows that Compound 1 induces gene expression changes in the host which are associated with the development of a Th-l/M-like response i.e.
• Oncosis is a form of necrotic cell death, characterised by the swelling and rupture of subcellular organelles and subsequent permeabilisation of the plasma membrane, due in part to loss of ATP -driven ion pump activity that maintains osmotic balance. Oncosis has been shown to be immunogenic in nature and is associated with the efficacy of some oncolytic viruses and small molecules developed as anti-cancer agents (e.g. Dyer et al. 2016).
• A431 human epidermoid carcinoma
• MM649 human melanoma
• B16-OVA B 16-F10 mouse melanoma cell line stably transfected with chicken ovalbumin
• MM415 human melanoma
• FaDu human hypopharyngeal carcinoma
• IncuCyte cytotoxicity assays Four cancer cell lines (A431, MM649 (human melanoma), FaDu (HNSCC) and MM415 (human melanoma) were assessed for their response to epoxytigliane treatment. Cells were plated at a density of 10,000 cells per well (100 ⁇ of complete media) into clear bottom black 96-well plates (Corning, #3603). Following 24 h incubation, the media within each well was aspirated and replaced with 50 ⁇ of fresh media containing 1 ⁇ g/ml propidium iodide (PI).
• PI propidium iodide
• Lactate dehydrogenase (LDH) release assays Measuring the release of LDH is a well- recognised assay to assess plasma membrane permeabilisation and detect cell death by necrosis (Chan et al. 2013). Three cell lines (A431, MM649 and B 16-OVA) were used in these assays. Cells were plated at a density of 10,000 cells per well into clear 96-well plates (Corning, #3595; 100 ⁇ of complete media) and the resultant plates incubated overnight as previously detailed. The following day, media was aspirated from each well and 50 ⁇ of fresh medium was inserted.
• LDH Lactate dehydrogenase
• Intracellular ATP assay Intracellular ATP assay.
• CellTiter-Glo® 2.0 assay kits Promega Corporation
• a luminescence based assay quantitating the amount of ATP present in cells were used to determine intracellular ATP levels in cultures of A431 and MM649 exposed to two concentrations (300 ⁇ and 500 ⁇ ) of Compound 1.
• cells were plated at a density of 10,000 cells per well into a clear bottomed black 96-well plates (in 100 ul of complete medium) and incubated at 37°C, 5% CO2 overnight.
• media was aspirated from each well and 50 ⁇ of fresh medium was inserted.
• Example 4 The Oncosis induced by Compound 1 and other Epoxytiglianes Displays Characteristics of Immunogenic Cell Death
• ICD Immunogenic cell death
• DAMPs damage associated molecular patterns
• A431 human epidermoid carcinoma
• MM649 human melanoma
• B16-OVA B 16-F10 mouse melanoma cell line stably transfected with chicken ovalbumin
• RPMI- 1640 10 % FCS (complete medium) at 37°C, 5 % C0 2 in a humidified incubator.
• BMDCs were cultured in R10 media (RPMI, 10 % FCS, 2 mM glutamine, 50 ⁇ beta-mercaptoethanol, Pen Strep). All cell lines used in this study were confirmed as mycoplasma negative using MycoAlert (Lonza). STR profiling was also performed to confirm the identity of the human cell lines used.
• ATP release assays Cell lines were plated at a density of 10, 000 cells per well into clear 96-well plates (Corning, #3595; 100 ⁇ of complete media) and the resultant plates incubated overnight as previously detailed. The following day, media was aspirated from each well and 50 ⁇ of fresh medium was inserted. Stock solutions of Compounds 1, 2, 3 and 4 were diluted to 2x final assay concentration (1 mM and 600 ⁇ ) and 50 ⁇ of these dilutions added to the required wells. Ethanol only control solutions were also compiled and administered.
• HMGB1 release assays were plated into T75 cm 2 flasks (Nunc) in 10 ml of complete media and cultured at 37°C, 5% CO2 until they reached 90% confluency. Compounds 1, 2, 3 and 4 were diluted in 5 ml of identical media to a final concentration of 500 and 300 ⁇ and then administered to the cells. Several flasks were prepared such that a kinetic curve of HMGB 1 release in response to drug treatment could be established. Ethanol only controls were also generated. At the required timepoint, media was removed from the flask into a 10 ml polypropylene tube that was placed on ice for 5 mins.
• Calreticulin externalization assays Calreticulin externalization was determined as previously detailed (Gomez-Cadena et al. 2016). Briefly, cells (A431, MM649, B 16- OVA) cultured in complete medium at 37°C, 5% CO2 were detached via trypsinisation, centrifuged at 1,200 rpm and washed x2 with fresh medium. After an additional round of centrifugation, the resultant cell pellet was resuspended at a concentration of 1 ⁇ 10 6 cells/ml, after which epoxytigliane was added to a final concentration of 500 or 300 ⁇ . Ethanol only controls were also performed.
• CD l lc is a well described marker of DC/macrophages (Merad et al. 2013).
• One way to investigate the potential of anti-cancer agents (and the associated death processes they induce) to promote the development of immunogenic responses is to determine whether they lead to the uptake of cellular components by CD l lc + dendritic cells/macrophages and their subsequent maturation into bone fide antigen presenting cells (APCs) (Guermonprez et al. 2002).
• APCs bone fide antigen presenting cells
• BMDC Bone Marrow Derived Cell
• B 16-OVA cells Prior to co-incubation with BMDCs, B 16-OVA cells were trypsinised, centrifuged at 1,200 rpm for 4 mins to pellet cells and washed x2 with complete medium. Cells were then stained with 2 ⁇ Cell Tracker Green in complete medium for 45 mins, after which they were pelleted and washed ⁇ 2 as above. Labelled B 16-OVA cells were subsequently treated with Compounds 1, 2, 3 and 4 at two concentrations (500 or 300 ⁇ ) in media at a density of l x 10 6 cells/ml for 30 and 60 mins, after which cells were pelleted via centrifugation, supernatant removed via aspiration and the cell pellet washed ⁇ 1 with complete media.
• the treated cells were resuspended in R10 media, inserted into the wells of a 6-well plate (Corning, #3471. Ultra low attachment surface) and BMDCs added. Co-cultures were incubated for 4 h after which cell suspensions were transferred to a microfuge tube and centrifuged at 1,500 rpm for 5 mins. Pellets were resuspended in 100 ⁇ FACs buffer containing anti-CD 1 lc-APC and incubated for 10 mins at 4°C. Cells were again pelleted, washed ⁇ 1 with FACs buffer and then fixed using PBS, 1 % formaldehyde for 10 mins. After centrifugation and removal of the supernatant, cells were resuspended in 500 ⁇ FACs buffer in preparation for flow cytometry.
• Figures 5A and 5B show that the oncosis induced by Compound 1 promotes the uptake (i.e. effective ingestion) of dying cancer cell fragments by CD1 lc + dendritic cells/macrophages. This ingestion appears to be dependent on both Compound 1 concentration and treatment time, such that at 500 ⁇ of Compound 1 antigen uptake occurs to a greater extent after a shorter treatment time compared to the use of 300 ⁇ . This is consistent with the kinetics of oncosis observed in Example 3.
• Figure 5C demonstrates that Compounds 2, 3 and 4 are also capable of inducing a cell death response that is immunogenic in vitro i.e. promotes uptake by CD1 lc + BMDCs.
• Example 6 Combination of Compound 1 with Immune Checkpoint Inhibitors
• Immune checkpoint inhibitor therapies especially those targeting receptors involved in T cell immunosuppression (e.g. cytotoxic T-lymphocyte -associated protein 4 (CTLA-4) or programmed death 1 (PD-1) and its ligand PD-Ll), have greatly improved patient outcomes in several types of late stage cancer, including melanoma, renal cell carcinoma, bladder cancer and head and neck squamous cell carcinoma (HNSCC) (Msaouel & Massarelli 2016; Sharma & Allison 2015).
• CTLA-4 cytotoxic T-lymphocyte -associated protein 4
• PD-1 programmed death 1
• HNSCC head and neck squamous cell carcinoma
• primary and de novo resistance to these ICI drugs is a significant clinical problem.
• extensive clinical follow-up has shown that some melanoma patients are developing resistance to treatment and are undergoing disease relapse (O'Donnell et al., 2017).
• FIG. 6A A schematic of the experimental approach can be seen in Figure 6A. Briefly, 6-7 week old C57BL/6 mice were injected subcutaneously (s.c.) on both flanks with B 16-F10- OVA mouse melanoma cells (2> 10 5 cells per site in 100 ⁇ ). Tumours were allowed to develop to approximately 5-50 mm 3 , after which 200 ⁇ g of anti-PD-1 (RMP1-14, BioXCell), anti-CTLA-4 (9H10, BioXCell) or isotype control antibody (2A3 and Syrian Hamster IgG, BioXCell) was injected i.p. per mouse (day -2). On day 0, both tumours were injected I.T.
• RMP1-14, BioXCell anti-CTLA-4 (9H10, BioXCell)
• isotype control antibody 2A3 and Syrian Hamster IgG, BioXCell
• Example 7 Observation of Abscopal Effects when using Compound 1 in combination with Immune Checkpoint Inhibitors
• FIG. 7A A schematic of the experimental approach can be seen in Figure 7A. Briefly, 6-7 week old C57BL/6 mice were injected s.c. on both flanks with B 16-F10-OVA mouse melanoma cells (2> 10 5 cells per site in 100 ⁇ ). Tumours were allowed to develop to approximately 5-50 mm 3 , after which 200 ⁇ g of anti-PD-1 (RMP1-14, BioXCell), anti- CTLA-4 (9H10, BioXCell) or isotype control antibody (2A3, BioXCell) was injected i.p. per mouse (day -2). On day 0, the largest of the two tumours (approx. 50-75 mm 3 ) was injected I.T.
• RMP1-14, BioXCell anti-CTLA-4 (9H10, BioXCell)
• isotype control antibody 2A3, BioXCell
• Myeloid derived suppressor cells are immature myeloid cells that can suppress host immune response to tumours via multiple pathways (Qu et al. 2016).
• MDSCs Myeloid derived suppressor cells
• GCSF granulocyte colony-stimulating factor
• IDO indoleamine 2,3-dioxygenase
• PKC0 Protein kinase C ⁇
• Oncolytic group B enadenotucirev mediates non-apoptotic cell death with membrane disruption and release of inflammatory mediators.
• G-CSF is a key modulator of MSC and could be a potential therapeutic target in colitis-associated colorectal cancers. Protein Cell 7: 130-140.

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