WO2019001417A1 - IMMUNOTHERAPY FOR HEPATOCELLULAR CARCINOMA - Google Patents

IMMUNOTHERAPY FOR HEPATOCELLULAR CARCINOMA Download PDF

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WO2019001417A1
WO2019001417A1 PCT/CN2018/092827 CN2018092827W WO2019001417A1 WO 2019001417 A1 WO2019001417 A1 WO 2019001417A1 CN 2018092827 W CN2018092827 W CN 2018092827W WO 2019001417 A1 WO2019001417 A1 WO 2019001417A1
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cdr
seq
antibody
hcc
nos
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English (en)
French (fr)
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Lai Wang
Kang Li
Qinzhou QI
Jeannie Hou
Zhong Wu
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BeOne Medicines Ltd
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Beigene Ltd
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Priority to CA3066518A priority Critical patent/CA3066518C/en
Priority to JP2019566957A priority patent/JP2020525411A/ja
Priority to CN201880042740.8A priority patent/CN110799543A/zh
Priority to AU2018290532A priority patent/AU2018290532A1/en
Priority to KR1020207002309A priority patent/KR102757960B1/ko
Priority to US16/621,342 priority patent/US11597768B2/en
Priority to EP18823691.3A priority patent/EP3645569A4/en
Publication of WO2019001417A1 publication Critical patent/WO2019001417A1/en
Anticipated expiration legal-status Critical
Priority to JP2023064789A priority patent/JP2023080215A/ja
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • 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
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/55—Medicinal preparations containing antigens or antibodies characterised by the host/recipient, e.g. newborn with maternal antibodies
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/71—Decreased effector function due to an Fc-modification
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding

Definitions

  • HCC hepatocellular carcinoma
  • Hepatocellular carcinoma is one of most common cancers in the world and the third highest cause of cancer-related mortality globally due to its malignancy. HCC develops in patients with chronic hepatitis, either due to chronic hepatitis B or C viral infection or due to inflammation following aflatoxin ingestion, or excessive alcohol consumption.
  • HCC patients are first diagnosed with the disease at an advanced stage or present with poor liver function, thereby preventing the use of potentially curative therapies.
  • Treatment options for patients with advanced stage disease are limited to either chemoembolization or systemic therapies, which include sorafenib, which is the only approved first-line treatment, with modest efficacy and considerable toxicity [Samonakis DN, Kouroumalis EA. Systemic treatment for hepatocellular carcinoma: Still unmet expectations. World J Hepatol. 2017; 9 (2) : 80–90. ]
  • systemic therapies which include sorafenib, which is the only approved first-line treatment, with modest efficacy and considerable toxicity
  • Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040) : an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017; 389 (10088) : 2492–2502] .
  • the response rate in the HBV-infected group is relatively low (7%) as reported for Nivolumab [M. Kudo, Immune Checkpoint Blockade in Hepatocellular Carcinoma: 2017 Update, Liver Cancer 2017; 6: 1-12] . So far, HBV-infected HCC is associated with poor prognosis. Therefore, there is a need for a new immunotherapy for advanced HCC, in particular, with high response rate to infected HCC.
  • HCC hepatocellular carcinoma
  • the anti-PD-1antibody or antigen binding fragment thereof was specifically engineered to minimize Fc ⁇ R binding on macrophages to abrogate antibody-dependent phagocytosis.
  • the HCC is advanced HCC and/or a metastatic HCC.
  • the advanced HCC is HBV-infected HCC, or HCV-infected HCC, or HBV/HCV co-infected HCC.
  • the advanced HCC is advanced HBV-infected HCC, metastatic HBV-infected HCC, HCV-infected HCC, or metastatic HCV-infected HCC.
  • the anti-PD-1 antibody is the one disclosed in WO2015/035606A1 or US Patent No. 8,735,553, the entire contents of which are incorporated by reference herein.
  • the antibodies disclosed in WO2015/035606A1 and US Patent No. 8,735,553 specifically bind to Programmed Death-1 (PD-1) and inhibit PD-1-mediated cellular signaling and activities in immune cells.
  • the antibodies bind to a set of amino acid residues required for its ligand (Programmed death-ligand 1, PD-L1) binding.
  • the anti-PD-1 antibody is a humanized monoclonal antibody comprising a heavy chain variable region (Vh) and a light chain variable region (Vk) (comprising SEQ ID No 24 and SEQ ID No 26, respectively) and a IgG4 heavy chain effector or constant domain (comprising SEQ ID NO: 88) , hereinafter Mab-1, which specifically binds to PD-1.
  • the antibody binds to PD-1 residues including K45 and I93; or, I93, L95 and P97, and inhibits PD-1-medidated cellular signaling and activities in immune cells, the antibodies binding to a set of amino acid residues required for its ligand binding.
  • the method for immunotherapy disclosed herein has been proved to prevent, delay progression, alleviate, and therefore treat HCC, or even advanced HCC, in particular infected advanced HCC, and the toxicity profile of the anti-PD-1 antibodies disclosed herein demonstrate that adverse events (AEs) are generally low severity, manageable and reversible. Accordingly, the present disclosure provides PD-1 antibodies with a superior effect in HCC relative to other PD-1 antibodies.
  • the inventors of the present application have found that treatment with Mab-1 was generally well tolerated in pretreated patients with advanced HCC.
  • Figure 1 shows the potential mechanism of T-cell clearance of the anti-PD-1 antibody used in the present application, i.e., lacking or reduced Fc ⁇ R binding prevents macrophage-mediated T-cell clearance.
  • Figure 2 shows a schematic of the study design of the phase 1a/1b study.
  • Figure 3 shows best change in tumor size by hepatitis virus infection status in the phase 1a/1b study.
  • Figure 4 shows duration of treatment and response in the phase 1a/1b study.
  • Figure 5 shows baseline and most recent CT assessment in the three patients with partial response in the phase 1a/1b study.
  • Figure 6 shows change in tumor burden over time in the phase 1a/1b study.
  • FIG. 7 shows change in Alpha-Fetoprotein (AFP) from baseline in the phase 1a/1b study.
  • Figure 8 shows the study design of the phase 3 study.
  • antibody herein is used in the broadest sense and specifically covers antibodies (including full length monoclonal antibodies) and antibody fragments so long as they recognize PD-1.
  • An antibody molecule is usually monospecific, but may also be described as idiospecific, heterospecific, or polyspecific.
  • Antibody molecules bind by means of specific binding sites to specific antigenic determinants or epitopes on antigens.
  • Antibody fragments or “antigen binding fragments” comprise a portion of a full length antibody, generally the antigen binding or variable region thereof. Examples of antibody fragments include Fab, Fab', F (ab') 2 , and Fv fragments; diabodies; linear antibodies; single-chain antibody molecules; and multispecific antibodies formed from antibody fragments.
  • monoclonal antibody or “ mAb ” or “ Mab ” herein means a population of substantially homogeneous antibodies, i.e., the antibody molecules comprised in the population are identical in amino acid sequence except for possible naturally occurring mutations that may be present in minor amounts.
  • conventional (polyclonal) antibody preparations typically include a multitude of different antibodies having different amino acid sequences in their variable domains, particularly their CDRs, which are often specific for different epitopes.
  • the modifier “monoclonal” indicates the character of the antibody as being obtained from a substantially homogeneous population of antibodies, and is not to be construed as requiring production of the antibody by any particular method.
  • Monoclonal antibodies may be obtained by methods known to those skilled in the art. See, for example Kohler et al (1975) ; U.S. Pat. No. 4,376,110; Ausubel et al (1987-1999) ; Harlow et al (1988) ; and Colligan et al (1993) .
  • the mAbs disclosed herein may be of any immunoglobulin class including IgG, IgM, IgD, IgE, IgA, and any subclass thereof.
  • a hybridoma producing a mAb may be cultivated in vitro or in vivo.
  • High titers of mAbs can be obtained in in vivo production where cells from the individual hybridomas are injected intraperitoneally into mice, such as pristine-primed Balb/c mice to produce ascites fluid containing high concentrations of the desired mAbs.
  • MAbs of isotype IgM or IgG may be purified from such ascites fluids, or from culture supernatants, using column chromatography methods well known to those of skill in the art.
  • the basic antibody structural unit comprises a tetramer.
  • Each tetramer includes two identical pairs of polypeptide chains, each pair having one “light chain” (about 25 kDa) and one “heavy chain” (about 50-70 kDa) .
  • the amino-terminal portion of each chain includes a variable region of about 100 to 110 or more amino acids primarily responsible for antigen recognition.
  • the carboxy-terminal portion of the heavy chain may define a constant region primarily responsible for effector function.
  • human light chains are classified as kappa and lambda light chains.
  • human heavy chains are typically classified as ⁇ , ⁇ , ⁇ , ⁇ , or ⁇ , and define the antibody's isotypes as IgA, IgD, IgE, IgG, and IgM, respectively.
  • the variable and constant regions are joined by a “J” region of about 12 or more amino acids, with the heavy chain also including a “D” region of about 10 more amino acids.
  • variable regions of each light/heavy chain (Vk/Vh) pair form the antibody binding site.
  • an intact antibody has two binding sites.
  • the two binding sites are, in general, the same.
  • variable domains of both the heavy and light chains comprise three hypervariable regions, also called “ complementarity determining regions (CDRs) ” , which are located within relatively conserved framework regions (FR) .
  • CDRs complementarity determining regions
  • FR framework regions
  • the CDRs are usually aligned by the framework regions, enabling binding to a specific epitope.
  • both light and heavy chains variable domains comprise FR-1, CDR-1, FR-2, CDR-2, FR-3, CDR-3, and FR-4.
  • the assignment of amino acids to each domain is, generally, in accordance with the definitions of Sequences of Proteins of Immunological Interest, Kabat, et al. National Institutes of Health, Bethesda, Md.
  • hypervariable region means the amino acid residues of an antibody that are responsible for antigen-binding.
  • the hypervariable region comprises amino acid residues from a “complementarity determining region” or “CDR” (i.e., CDR-L1, CDR-L2 and CDR-L3 in the light chain variable domain and CDR-H1, CDR-H2 and CDR-H3 in the heavy chain variable domain) .
  • CDR complementarity determining region
  • antibody fragment or “ antigen binding fragment ” means antigen binding fragments of antibodies, i.e. antibody fragments that retain the ability to bind specifically to the antigen bound by the full-length antibody, e.g. fragments that retain one or more CDR regions.
  • antibody binding fragments include, but not limited to, Fab, Fab', F (ab') 2, and Fv fragments; diabodies; linear antibodies; single-chain antibody molecules, e.g., sc-Fv; nanobodies and multispecific antibodies formed from antibody fragments.
  • An antibody that “ specifically binds to ” a specified target protein is an antibody that exhibits preferential binding to that target as compared to other proteins, but this specificity does not require absolute binding specificity.
  • An antibody is considered “specific” for its intended target if its binding is determinative of the presence of the target protein in a sample, e.g. without producing undesired results such as false positives.
  • Antibodies, or binding fragments thereof, useful in the present invention will bind to the target protein with an affinity that is at least two fold greater, preferably at least ten times greater, more preferably at least 20-times greater, and most preferably at least 100-times greater than the affinity with non-target proteins.
  • An antibody herein is said to bind specifically to a polypeptide comprising a given amino acid sequence, e.g. the amino acid sequence of a mature human PD-1 molecule, if it binds to polypeptides comprising that sequence but does not bind to proteins lacking that sequence.
  • human antibody herein means an antibody that comprises human immunoglobulin protein sequences only.
  • a human antibody may contain murine carbohydrate chains if produced in a mouse, in a mouse cell, or in a hybridoma derived from a mouse cell.
  • mouse antibody or “rat antibody” mean an antibody that comprises only mouse or rat immunoglobulin sequences, respectively.
  • humanized antibody means forms of antibodies that contain sequences from non-human (e.g., murine) antibodies as well as human antibodies. Such antibodies contain minimal sequence derived from non-human immunoglobulin.
  • the humanized antibody will comprise substantially all of at least one, and typically two, variable domains, in which all or substantially all of the hypervariable loops correspond to those of a non-human immunoglobulin and all or substantially all of the FR regions are those of a human immunoglobulin sequence.
  • the humanized antibody optionally also will comprise at least a portion of an immunoglobulin constant region (Fc) , typically that of a human immunoglobulin.
  • Fc immunoglobulin constant region
  • the prefix “ hum ” , “ hu ” or “ h ” is added to antibody clone designations when necessary to distinguish humanized antibodies from parental rodent antibodies.
  • the humanized forms of rodent antibodies will generally comprise the same CDR sequences of the parental rodent antibodies, although certain amino acid substitutions may be included to increase affinity, increase stability of the humanized antibody, or for other reasons.
  • HCC hepatocellular carcinoma
  • liver cancer indicates hepatocellular carcinoma.
  • HCC may result from excessive alcohol consumption (alcoholic steatohepatitis) or from inflammation following aflatoxin ingestion (non-alcoholic steatohepatitis, sometimes referred to as NASH) .
  • HCC may be caused by infection, such as hepatitis B virus (sometimes referred to as HBV-infected HCC) or hepatitis C virus (sometimes referred to as HCV-infected HCC) or by infection of HBV and HCV together (sometimes referred to as HBV/HCV co-infected HCC) .
  • HCC is developed from chronic hepatitis B, chronic hepatitis C, aflatoxin, alcoholism, cirrhosis of the liver, nonalcoholic steatohepatitis, hemochromatosis, alpha 1-antitrypsin deficiency Wilson's disease, Type 2 diabetes, hemophilia, etc.
  • the HCC is early stage HCC, non-metastatic HCC, primary HCC, advanced HCC, locally advanced HCC, metastatic HCC, HCC in remission, or recurrent HCC.
  • treatment is an approach for obtaining beneficial or desired clinical results, including, but not limited to, one or more of the following: alleviating one or more symptoms resulting from the disease, diminishing the extent of the disease, stabilizing the disease (e.g., preventing or delaying the worsening of the disease) , preventing or delaying the spread (e.g., metastasis) of the disease, preventing or delaying the recurrence of the disease, delay or slowing the progression of the disease, ameliorating the disease state, providing a remission (partial or total) of the disease, decreasing the dose of one or more other medications required to treat the disease, delaying the progression of the disease, increasing the quality of life, and/or prolonging survival. Therefore, a reduction of pathological consequence of HCC is also included by the term “treatment” .
  • the methods disclosed herein encompass any one or more of these aspects of treatment.
  • the term “patient” is used interchangeably herein with the term “subject” and the like.
  • the patient is a human patient.
  • the patient is a human patient who has been diagnosed with, is in need of treatment for, and/or is at risk of HCC.
  • CDRs means complementarity determining region (s) in an immunoglobulin variable region, defined using the Kabat numbering system, unless otherwise indicated.
  • the anti-PD-1 antibody is an antibody or a fragment antigen binding thereof, which specifically binds to human PD-1.
  • the anti-PD-1 antibody is an antibody which comprises a heavy chain variable region (Vh) and a light chain variable region (Vk) that contain complement determinant regions (CDRs) provided in Table 2:
  • the anti-PD-1 antibody in some embodiments, is an antibody which comprises a heavy chain variable region (Vh) and a light chain variable region (Vk) that contain any combinations of CDRs provided in Table 3:
  • the anti-PD-1 antibody is an antibody which comprises a heavy chain variable region (Vh) and a light chain variable region (Vk) comprising sequences selected from those provided in Table 4:
  • the anti-PD-1 antibody provided herein comprises a heavy chain effector or constant domain that includes amino acid mutations that reduce binding to Fc ⁇ R.
  • the antibody may further comprise one or more mutations in the effector or constant domain that provide enhanced stability.
  • the antibody comprises an IgG4 Fc region.
  • the antibody comprises an IgG4 Fc region comprising one or more amino acid mutations that reduce binding to Fc ⁇ R.
  • the antibody comprises an IgG4 Fc region comprising mutations that reduce or eliminate binding to Fc ⁇ RI, Fc ⁇ RIIA, Fc ⁇ RIIB, Fc ⁇ RIIIA, and/or Fc ⁇ RIIIB.
  • the antibody comprises an IgG4 Fc region having a serine to proline mutation at position 228 (EU numbering system) . In some embodiments, this mutation is referred to as the S228P mutation. In some embodiments, the antibody comprises an IgG4 Fc region having a mutation at one or more of positions 233, 234, 235, 265, 309, and 409 (EU numbering system) . For example, in some embodiments, the antibody comprises an IgG4 region having a mutation at 228 and at least one other position, wherein the at least one other mutation results in reduced binding to one or more Fc ⁇ R.
  • the antibody comprises an IgG4 region having a mutation at position 228 and at least two, at least 3, at least 4, at least 5, or at least 6 additional positions, wherein one or more of the additional mutations results in reduced binding to one or more Fc ⁇ R.
  • the antibody comprises an IgG4 region having mutations at positions 234 and 235.
  • the antibody comprises an IgG4 region having mutations at positions 233, 235, and 235.
  • the antibody comprises an IgG4 region having mutations at positions 234, 235, and 265.
  • the antibody comprises an IgG4 region having mutations at positions 233, 234, 235, and 265.
  • the antibody comprises an IgG4 region having mutations at positions 234, 235, 265, and 409. In some embodiments, the antibody comprises an IgG4 region having mutations at positions 233, 234, 235, 265, and 409. In some embodiments, the antibody comprises an IgG4 region having mutations at positions 234, 235, 265, 309, and 409. In some embodiments, the antibody comprises an IgG4 region having mutations at positions 233, 234, 235, 265, 309, and 409.
  • the mutation at position 234 may be a phenylalanine to valine substitution or a phenylalanine to alanine substitution.
  • the mutation at position 235 may be a leucine to alanine substitution.
  • the mutation at position 233 may be a glutamic acid to proline substitution.
  • the mutation at position 265 may be a aspartic acid to valine substitution or an aspartic acid to threonine substitution.
  • the mutation at position 309 may be a leucine to valine substitution.
  • the mutation at position 409 may be an arginine to a lysine, threonine, or methionine substitution.
  • Exemplary IgG4 Fc regions are provided in Table 5 below.
  • the anti-PD-1 antibody is an antibody which comprises a IgG4 heavy chain effector or constant domain comprising any of SEQ ID NOs: 83-88.
  • the anti-PD-1 antibody is an antibody which contains a F (ab) or F (ab) 2 comprising a domain said above, including a heavy chain variable region (Vh) , a light chain variable region (Vk) and a IgG4 heavy chain effector or constant domain.
  • the anti-PD-1 antibody is an antibody which comprises a heavy chain variable region (Vh) and a light chain variable region (Vk) , and a IgG4 heavy chain effector or constant domain comprising a sequence selected from SEQ ID NOs: 83-88 and 91-106, wherein the heavy chain variable region (Vh) and the light chain variable region (Vk) comprise sequences selected from those provided in Table 6:
  • the anti-PD-1 antibody is an antibody which comprises a heavy chain CDR-H1, CDR-H2, and CDR-H3 according to SEQ ID NOs: 11, 32, and 13, respectively; a light chain CDR-L1, CDR-L2, and CDR-L3 according to SEQ ID NOs: 61, 15, and 16, respectively; and an IgG4 heavy chain effector or constant domain comprising SEQ ID NO: 88.
  • the anti-PD-1 antibody is an antibody which comprises a heavy chain variable region (Vh) and a light chain variable region (Vk) , and an IgG4 heavy chain effector or constant domain comprising SEQ ID NO: 88, wherein the heavy chain variable region (Vh) and the light chain variable region (Vk) comprises SEQ ID NO: 24 and SEQ ID NO: 26, respectively.
  • the anti-PD-1 antibody is a uniquely engineered humanized IgG4 monoclonal antibody with high affinity and binding specificity against PD-1, specifically engineered to minimize Fc ⁇ R binding on macrophages to abrogate antibody-dependent phagocytosis, a potential mechanism of T-cell clearance.
  • anti-PD1 antibodies and antibody fragments thereof disclosed herein may be prepared in accordance with the disclosure of WO2015/035606A1 or US Patent No. 8,735,553, the entire disclosure of which is expressly incorporated herein by reference.
  • the anti-PD-1 antibody at a certain dose was administered to the patients with HCC intravenously.
  • the patient with HCC was not previously treated with a PD-1 or PD-L1 targeting therapy.
  • the patient with HCC was previously treated with another therapeutic agent (e.g., sorafenib) .
  • the present disclosure provides methods for treating HCC in a subject in need thereof, the method comprising administering to the subject an anti-PD-1 antibody or antigen binding fragment thereof, wherein the antibody is engineered to reduce, minimize, or eliminate Fc ⁇ R binding on macrophages or other antigen presenting cells.
  • the antibody comprises an engineered IgG4 region provided herein.
  • the antibody comprises an engineered IgG4 region having an amino acid sequence selected from the group consisting of SEQ ID NOs: 83-88 and 91-106.
  • the antibody comprises heavy chain CDR1, CDR2, and CDR3 sequences according to SEQ ID NOs: 11, 32, and 13, respectively; light chain CDR1, CDR2, and CDR3 sequences according to SEQ ID NOs: 61, 15, and 16, respectively; and an IgG4 region that has been engineered to have reduced Fc ⁇ R.
  • the antibody comprises heavy chain CDR1, CDR2, and CDR3 sequences according to SEQ ID NOs: 11, 32, and 13, respectively; light chain CDR1, CDR2, and CDR3 sequences according to SEQ ID NOs: 61, 15, and 16, respectively; and an IgG4 region having an amino acid sequence selected from the group consisting of SEQ ID NOs: 83-88 and 91-106.
  • the antibody comprises heavy and light chain variable region sequences according to SEQ ID NOs: 24 and 26, respectively, and an IgG4 region that has been engineered to have reduced Fc ⁇ R. In some embodiments, the antibody comprises heavy and light chain variable region sequences according to SEQ ID NOs: 24 and 26, respectively, and comprises an IgG4 region having an amino acid sequence selected from the group consisting of SEQ ID NOs: 83-88 and 91-106. In some embodiments, the anti-PD-1 antibody is Mab-1.
  • the present disclosure provides an antibody provided herein for use in the treatment of HCC in a patient. In some embodiments, the present disclosure provides an antibody provided herein for use in immunotherapy in a HCC patient. In some embodiments, the present disclosure provides an antibody provided herein for use in the manufacture of a medicament for the treatment of HCC. In some embodiments, the present disclosure provides an antibody provided herein for use in the manufacture of a medicament for immunotherapy in a HCC patient.
  • the present disclosure provides methods for treating HCC in a patient comprising administering an antibody provided herein, wherein the administration of the antibody provides improvement in: overall survival (OS) , objective response rate (ORR) , complete response rate (CR) , partial response rate (PR) , stable disease (SD) , progression free survival (PFS) , disease free survival (DFS) , event-free survival (EFS) , duration of response (DoR) , time to progression (TTP) , disease control rate (DCR) , clinical benefit rate (CBR) , or any combination thereof, relative to a patient that did not receive the antibody.
  • OS overall survival
  • ORR objective response rate
  • CR complete response rate
  • PR partial response rate
  • SD stable disease
  • PFS progression free survival
  • DFS disease free survival
  • EFS event-free survival
  • DoR duration of response
  • TTP time to progression
  • DCR disease control rate
  • CBR clinical benefit rate
  • OS is defined as the time from clinical trial randomization until death from any cause.
  • ORR is defined as the percentage of patients with a tumor size reduction of a predefined amount and for a minimum period of time.
  • CR is defined as the disappearance of all signs of cancer in response to treatment.
  • PR is defined as at least 30%reduction in detectable disease (e.g., size of tumors) .
  • SD is defined as neither sufficient reduction in disease to qualify as PR nor sufficient increase in disease to qualify as progressive disease (e.g., less than 25%increase to a 30%reduction in detectable disease (e.g., size of tumors) ) .
  • the TTP is defined as the time from randomization until tumor progression.
  • PFS is defined as the time from randomization until tumor progression or until death occurs.
  • DFS is defined as the time from randomization until recurrence of tumor or death from any cause.
  • EFS is defined as the time from randomization to disease progression, death, or discontinuation of treatment for any reason.
  • the DoR is defined as the period of time from documentation of tumor response to disease progression.
  • both DCR and CBR are defined as the percentage of patients who have achieved a complete response, partial response, or stable disease.
  • RECIST v. 1.1 (Response Evaluation Criterial in Solid Tumors) , a set of published rules that define disease response, progression, or stability in cancer patients during or following treatment, is used to evaluate patients treated with an antibody provided herein.
  • the present disclosure provides methods for treating a patient with HCC comprising administering an antibody provided herein to the patient, wherein the method achieves ORR and/or CR and/or PR and/or DCR and/or CBR (or any other known rate-based measure of outcome for tumor patients) of at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, or more.
  • ORR and/or CR and/or PR and/or DCR and/or CBR or any other known rate-based measure of outcome for tumor patients
  • the present disclosure provides methods for treating HCC in a patient comprising administering an antibody provided herein, wherein the administration of the antibody provides a statistically significant therapeutic effect relative to a placebo treatment, or relative to another anti-tumor or anti-cancer therapy.
  • the statistically significant effect includes therapeutic efficacy in combination with a statistically significant effect on toxicity or tolerability parameters.
  • the statistically significant effect further comprises improved OS, ORR, CR, PR, SD, PFS, DFS, EFS, DoR, TTP, DCR, CBR, or any combination thereof.
  • the methods provided herein provide a statistically significant effect compared to sorafenib.
  • the method provided herein comprise administration of about 200 mg IV Q3W of an antibody provided herein (e.g., Mab-1) , wherein the method provides a statistically significant effect compared to administration of about 400 mg sorafenib orally BID. In some embodiments, the method provided herein provides a statistically significant effect compared to another PD-1 or PD-L1 targeting therapy.
  • the term “statistically significant therapeutic effect” and the like refers to an outcome of a treatment that results in a clinical or medical improvement in a subject. By “statistically significant” it is meant that the result was unlikely to have occurred by chance. Statistical significance can be determined by any method known in the art.
  • p-value which is the frequency or probability with which the observed event would occur, if the null hypothesis were true. If the obtained p-value is smaller than the significance level, then the null hypothesis is rejected. In simple cases, the significance level is defined at a p-value of 0.05 or less.
  • the anti-PD-1 antibody is administered at a dose of 0.5-10 mg/kg QW, or Q2W, or Q3W, or Q4W.
  • the anti-PD-1 antibody is Mab-1, and the Mab-1 is administrated at a dose of 0.5-10 mg/kg QW or Q2W or Q3W.
  • Mab-1 is administrated at a dose of 0.5-5 mg/kg Q2W, 5-10 mg/kg Q2W, or 2-5 mg/kg Q3W.
  • Mab-1 is administrated parenterally at a dose of 0.5 mg/kg Q2W, 5 mg/kg Q2W, 10 mg/kg Q2W, 2 mg/kg Q3W or 5 mg/kg Q3W.
  • the present disclosure provides methods for treating HCC comprising administering an anti-PD-1 antibody provided herein at a dose of about 50 mg, about 75 mg, about 100 mg, about 125 mg, about 150 mg, about 175 mg, about 200 mg, about 225 mg, about 250 mg, about 300 mg, about 325 mg, about 350 mg, about 375 mg, about 400 mg, about 425 mg, about 450 mg, about 475 mg, or about 500 mg.
  • the antibody is administered daily, every other day, every 3 days, every 4 days, every 5 days, every 6 days, or every seven days.
  • the antibody is administered weekly, every 10 days, every 2 weeks, every 3 weeks, every 4 weeks, every 5 weeks, every 6 weeks, every 7 weeks, or every 8 weeks. In some embodiments, the antibody is administered monthly or every other month. In some embodiments, the antibody is administered one or more times to a subject, and/or at increasing or decreasing doses of the antibody, depending on the clinical stage of the patient, the therapeutic effect achieved, and other patient characteristics. In particular embodiments, the antibody is administered to a subject QW, Q2W, Q3W, or Q4W.
  • the route of administration of the pharmaceutical composition is according to known methods, e.g. through injection by intravenous, intraperitoneal, intracerebral (intra-parenchymal) , intracerebroventricular, intramuscular, subcutaneously, intra-ocular, intraarterial, intraportal, or intralesional routes; by sustained release systems or by implantation devices.
  • the compositions can be administered by bolus injection or continuously by infusion, or by implantation device.
  • the present disclosure provides methods for treating HCC comprising administering to a subject in need thereof an anti-PD-1 antibody provided herein at a dose of about 200 mg intravenously (IV) , every 3 weeks (Q3W) .
  • Example 1 A Phase 1A/1B study of Mab-1 in patients with advanced hepatocellular carcinoma (HCC)
  • the purpose of the study design is to enroll HCC patients by selecting tumors for recommended phase 2 dose (RP2D) determination and preliminary differentiation, consisting of phase 1A and phase 1B.
  • R2D phase 2 dose
  • preliminary differentiation consisting of phase 1A and phase 1B.
  • the study design is detailed in Figure 2.
  • HBV hepatitis B virus
  • HCV hepatitis C virus
  • Table 7 Patient demographics and disease characteristics
  • Figure 6 also shows that change in tumor burden over time in patients with HBV-infected HCC is promising.
  • Figure 7 shows the best overall response by radiographic evidence in the HCC patients in which one patient shown to have a controlled, stable disease for over 60 weeks.
  • AEs Adverse events associated with administration of Mab-1 disclosed herein was also studied.
  • Example 2 A Phase 2 study of Mab-1 in patients with unresectable hepatocellular carcinoma (HCC)
  • a Phase 2 study is designed to evaluate the efficacy, safety/tolerability, and pharmacokinetics (PK) of Mab-1 in patients with previously treated HCC.
  • Safety/tolerability assessments will include monitoring of adverse events (AEs) , including immune-related AEs.
  • AEs adverse events
  • BCLC Barcelona Clinic Liver Cancer
  • Example 3 A phase 3 study to compare the efficacy and safety of Mab-1 versus sorafenib as first-line treatment in patients with unresectable hepatocellular carcinoma (HCC)
  • a phase 3 study is designed to evaluate the efficacy and safety of Mab-1 compared with sorafenib as a first-line treatment of advanced HCC ( Figure 8) .
  • the primary object will be to compare overall survival (OS) between the two treatment groups.
  • Objective response rate (ORR) is a key secondary objective.
  • Other secondary objectives will include a comparison of Mab-1 and sorafenib in terms of various efficacy assessments (progression free survival [PFS] , duration of response [DoR] , time to progression [TTP] , disease control rate [DCR] , and clinical benefit rate [CBR] ) , measures of health-related quality of life, and safety and tolerability.
  • Patients will be randomized 1: 1 to receive Mab-1 200 mg IV Q3W or sorafenib 400 mg orally twice daily (BID) , with randomization stratified by the presence of macrovascular invasion, the presence of extrahepatic spread, ECOG performance status, etiology, and geography. Treatment will be administered until disease progression, intolerable toxicity, or treatment discontinuation for other reasons.
  • BID twice daily
  • Tumor response will be evaluated every 9 weeks during Year 1 and every 12 weeks from Year 2 onwards, in accordance with RECIST v1.1.
  • Safety and tolerability (a secondary endpoint) will be assessed by monitoring adverse events (AEs) , including immune-related AEs, and through physical examinations, vital signs, and electrocardiograms.
  • AEs adverse events

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CA3066518A CA3066518C (en) 2017-06-26 2018-06-26 Immunotherapy for hepatocellular carcinoma
JP2019566957A JP2020525411A (ja) 2017-06-26 2018-06-26 肝細胞癌のための免疫療法
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AU2018290532A AU2018290532A1 (en) 2017-06-26 2018-06-26 Immunotherapy for hepatocellular carcinoma
KR1020207002309A KR102757960B1 (ko) 2017-06-26 2018-06-26 간세포암(hepatocellular carcinoma: HCC)에 대한 면역 치료
US16/621,342 US11597768B2 (en) 2017-06-26 2018-06-26 Immunotherapy for hepatocellular carcinoma
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