WO2019230919A1 - 免疫チェックポイント阻害薬の有効性判定バイオマーカー - Google Patents
免疫チェックポイント阻害薬の有効性判定バイオマーカー Download PDFInfo
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- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
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- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
- C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
- C07K16/28—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
- C07K16/2803—Immunoglobulins [IGs], 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 [IGs], 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
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- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
- G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
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- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61P35/00—Antineoplastic agents
- A61P35/02—Antineoplastic agents specific for leukemia
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
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- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
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- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
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- G01N33/483—Physical analysis of biological material
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- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
- G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
- G01N33/5044—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics involving specific cell types
- G01N33/5047—Cells of the immune system
- G01N33/505—Cells of the immune system involving T-cells
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- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
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- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
- G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
- G01N33/57484—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumor, cancer, neoplasia, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides, metabolites
- G01N33/57492—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumor, cancer, neoplasia, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides, metabolites involving compounds localized on the membrane of tumor or cancer cells
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- A—HUMAN NECESSITIES
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- A61K2039/507—Comprising a combination of two or more separate antibodies
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- G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
- G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
- G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
- G01N2333/70503—Immunoglobulin superfamily, e.g. VCAMs, PECAM, LFA-3
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- G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
- G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
- G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
- G01N2333/70596—Molecules with a "CD"-designation not provided for elsewhere in G01N2333/705
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- G01N2800/00—Detection or diagnosis of diseases
- G01N2800/52—Predicting or monitoring the response to treatment, e.g. for selection of therapy based on assay results in personalised medicine; Prognosis
Definitions
- the present invention relates to a method for identifying a malignant tumor patient who can be more expected to have an effect of an immune checkpoint inhibitor, and a malignant tumor progression suppression, recurrence suppression and / or treatment method characterized by a prescription based thereon.
- cancer immunotherapy works on the immune surveillance mechanism that is inherent to the malignant tumor patient itself. Thus, it is a therapy for suppressing or treating the progression of malignant tumors by strengthening immunity against malignant tumors.
- Recent tumor immunity research has revealed that the development of malignant tumors involves an immunosuppressive environment centered on the local area of the tumor, and the tumor itself uses a system that bypasses the immune surveillance mechanism. It was. So-called immune checkpoint molecules such as PD-1 or its ligand PD-L1 are known as molecules used in such a circumvention system, and these inhibitors have already achieved certain results in clinical practice. ing.
- the present invention relates to an immune checkpoint inhibitor to which an evaluation item consisting of a combination of PD-1 expression intensity and PD-1 expression ratio in CD8 + T cells and Treg cells existing in a tumor tissue is administered. This is based on the knowledge that it can be used to predict effectiveness.
- Non-patent Document 1 suggesting that the ratio of the number of CD8 + T cells and the number of Treg cells in peripheral blood may correlate with the prognosis of malignant tumor patients.
- An object of the present invention is to provide a method for identifying a malignant tumor patient who can be more expected to have an effect of an immune checkpoint inhibitor, and a malignant tumor progression suppression, recurrence suppression and / or therapeutic agent characterized by a prescription based thereon. is there.
- the present invention was completed by finding that evaluation items comprising combinations of PD-1 expression intensity and PD-1 expression ratio in T cells can each be a biomarker that can predict the effectiveness of immune checkpoint inhibitors. did. That is, the present invention is as follows. [1] CD8 in the tissue or blood against the intensity of PD-1 expression in Treg cells in the tumor tissue or blood of patients with malignant tumors + Administered to a malignant tumor patient whose ratio to the PD-1 expression intensity in T cells (hereinafter, this ratio may be abbreviated as “biomarker 1” in this specification) is about 0.7 or more.
- a malignant tumor progression suppression, recurrence suppression and / or therapeutic agent comprising an immune checkpoint inhibitor as an active ingredient.
- the agent according to [1], wherein the ratio described in [1] is about 0.74 or more.
- the agent according to [1], wherein the ratio described in [1] is about 0.8 or more.
- the agent according to [1], wherein the ratio described in [1] is about 0.9 or more.
- the agent described in [1] above, wherein the ratio described in [1] is about 1.0 or more.
- the agent according to [1], wherein the ratio described in [1] is about 1.1 or more.
- the agent according to [1], wherein the ratio described in [1] is about 1.2 or more.
- the mean fluorescence intensity (hereinafter abbreviated as MFI) measured by flow cytometry is also referred to as “biomarker 2”.
- MFI mean fluorescence intensity measured by flow cytometry
- MFI mean fluorescence intensity measured by flow cytometry
- CD8 in tumor tissue or blood of patients with malignant tumors + Patients with malignant tumor whose percentage (%) of PD-1-expressing cells among T cells (hereinafter, this ratio may be abbreviated as “biomarker 3”) is about 35% or more.
- a malignant tumor progression inhibitory, recurrence inhibitory and / or therapeutic agent comprising an immune checkpoint inhibitor as an active ingredient.
- the agent described in [33] above, wherein the ratio described in [33] is about 40% or more.
- [53] The agent according to any one of [47] to [51], wherein the ratio described in (b) of [47] is about 45% or more.
- [54] (a1) CD8 in the same tissue against PD-1 expression intensity in Treg cells in the tumor tissue of a malignant tumor patient + The CD8 relative to the ratio of PD-1 expression intensity in T cells or (a2) the ratio (%) of the number of PD-1 expressing cells in the Treg cells + Any of the ratio of the number of PD-1-expressing cells in the T cells (%) is about 1.0 or more, and (b) the CD8 + Progression of a malignant tumor comprising an immune checkpoint inhibitor as an active ingredient, wherein the malignant tumor is administered to a malignant tumor patient whose percentage (%) of PD-1 expressing cells in T cells is about 40% or more Suppression, relapse suppression and / or therapeutic agent.
- biomarker 7 To be administered to a malignant tumor patient whose numerical value calculated by dividing by marker 4) (hereinafter, the same numerical value may be abbreviated as “biomarker 7” in this specification) is about 25 or more.
- a malignant tumor progression inhibitory, recurrence inhibitory and / or therapeutic agent comprising an immune checkpoint inhibitor as an active ingredient.
- Treg cells and CD8 in tumor tissue or blood + Each PD-1 expression intensity in T cells is MFI measured by flow cytometry, expression intensity or expression intensity score measured by multiple immunohistochemical staining, signal intensity measured by in situ hybridization Alternatively, expression intensity score, expression intensity or signal intensity measured by mass cytometry method, expression level or gene count value measured by single cell RNA sequencing method or expression intensity or expression intensity score measured by mass imaging method
- the agent according to any one of [1] to [18], [47] to [55] and [57] to [61] above.
- the immune checkpoint inhibitor is anti-PD-1 antibody, anti-PD-L1 antibody, PD-1 antagonist, PD-L1 / VISTA antagonist, PD-L1 / TIM3 antagonist, anti-PD-L2 antibody PD-L1 fusion protein, PD-L2 fusion protein, anti-CTLA-4 antibody, anti-LAG-3 antibody, LAG-3 fusion protein, anti-Tim3 antibody, anti-KIR antibody, anti-BTLA antibody, anti-TIGIT antibody, anti-VISTA antibody
- the agent according to any one of [1] to [64], which is an anti-CSF-1R antibody or a CSF-1R inhibitor.
- the anti-PD-1 antibody is Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388D4, ENUM 244C34, GL , CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, GB226, SSI-361, JY034, HX008, ISU106, ABBV181, BCD-100, PF-06801591, CX-188 or JNJ-
- the anti-PD-L1 antibody is Atezolizumab, Avelumab, Durvalumab, BMS-936559, STI-1014, KN035, LY3300054, HLX20, SHR-1316, CS1001, MSB2311, BGB-A333, KL-A167, CK-301
- the agent of the preceding item [65] which is AK106, AK104, ZKAB001, FAZ053, CBT-502, JS003 or CX-072.
- the agent described in [65] above, wherein the anti-CTLA-4 antibody is Ipilimumab, AGEN1884 or Tremelimumab.
- the agent according to any one of [1] to [68], wherein the malignant tumor is solid cancer or blood cancer.
- the solid cancer is malignant melanoma (for example, malignant melanoma in the skin, oral mucosal epithelium or orbit), non-small cell lung cancer (for example, squamous non-small cell lung cancer and non-squamous non-small cell lung cancer) Small cell lung cancer, head and neck cancer (eg oral cancer, nasopharyngeal cancer, oropharyngeal cancer, hypopharyngeal cancer, laryngeal cancer, salivary gland cancer and tongue cancer), renal cell cancer (eg clear cell renal cell carcinoma) Breast cancer, ovarian cancer (eg, serous ovarian cancer and clear cell adenocarcinoma), nasopharyngeal cancer, uterine cancer (eg, cervical cancer, endometrial cancer and endometrial cancer), anal cancer (eg, anal canal) Cancer), colon cancer (for
- the blood cancer is multiple myeloma, malignant lymphoma (eg, non-Hodgkin lymphoma (eg, follicular lymphoma, diffuse large B-cell lymphoma, MALT lymphoma, lymphoplasmacytoma, mycosis) Sarcoma, Sezary syndrome, chronic or acute lymphocytic leukemia, peripheral T-cell lymphoma, extranodal NK / T-cell lymphoma, adult T-cell leukemia, B-cell lymphoblastic leukemia, T-cell lymphoblastic leukemia and Lymphoid plasma cell lymphoma) and Hodgkin lymphoma (eg, classic Hodgkin lymphoma and nodular lymphocyte-dominated Hodgkin lymphoma)), leukemia (eg, acute myeloid leukemia and chronic myelogenous leukemia), central nervous system primary malignant lymphoma, [69] The preceding paragraph, which is one or
- the ratio described in [1] is 1.2 or more, wherein [1], [18], [62] and [64] to [70] Any one agent.
- any of the above [19], [32] and [65] to [70] wherein the PD-1 expression MFI described in [19] is 800 or more
- the agent according to any one of [56] and [63] to [70], wherein the numerical value described in [56] is about 40 or more when the malignant tumor is non-small cell lung cancer.
- Item agent If the malignant tumor is gastric cancer, the PD-1 expression MFI described in [19] above is 410 or more, and any one of [19], [32] and [65] to [70] above The agent described.
- the malignant tumor is a malignant tumor that has worsened after treatment with another antineoplastic agent.
- the agent according to any one of [1] to [81] above, wherein the malignant tumor is curative or unresectable, metastatic, recurrent, refractory and / or distant metastatic.
- TPS tumor cells that express PD-L1 in the tumor tissue
- CPS PD-L1 positive cells
- TMB tumor mutation load
- the other antineoplastic agents include alkylating agents, platinum preparations, antimetabolites (for example, folic acid antimetabolites, pyridine metabolism inhibitors, purine metabolism inhibitors), ribonucleotide reductase inhibitors, nucleotide analogs, The preceding paragraph, which is one or more drugs selected from topoisomerase inhibitors, microtubule polymerization inhibitors, microtubule depolymerization inhibitors, antitumor antibiotics, cytokine preparations, antihormonal drugs, molecular targeted drugs and cancer immunotherapeutic drugs [78] to [80] or [93] [95] The agent according to any one of [1] to [94], wherein the malignant tumor patient is a patient before administration of a drug containing the immune checkpoint inhibitor as an active ingredient.
- antimetabolites for example, folic acid antimetabolites, pyridine metabolism inhibitors, purine metabolism inhibitors
- ribonucleotide reductase inhibitors for example, folic acid antimetabol
- a malignant tumor progression inhibitory, recurrence inhibitory and / or therapeutic agent comprising, as an active ingredient, the anti-PD-1 antibody is Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, EN
- PD-1 expression intensity in Treg cells (Fr. II) in the tumor tissue of a malignant tumor patient before administration of a drug containing anti-PD-1 antibody or anti-PD-L1 antibody as an active ingredient For example, CD8 in the same organization for MFI
- any of the ratio of the number of PD-1-expressing cells in the T cells (%) is about 1.0 or more, and (b) the CD8 +
- the anti-PD-1 antibody or anti-PD-L1 antibody is effectively administered to a malignant tumor patient whose percentage (%) of PD-1 expressing cells in T cells is about 40% or more
- a malignant tumor progression inhibitory, recurrence inhibitory and / or therapeutic agent comprising a component, wherein the anti-PD-1 antibody is Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388D4, ENUM 244C8, GLS010, MGA012, AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZ
- the tumor tissue is a tissue containing at least the tumor mass itself, the infiltrating peripheral portion of the tumor, or a lymph node adjacent to the tumor.
- An effective amount of an immune checkpoint inhibitor is administered to a malignant tumor patient whose ratio to the PD-1 expression intensity in T cells is 0.7 or more (or the ratio is confirmed to be 0.7 or more).
- a method for suppressing progression, suppressing recurrence and / or treating malignant tumor comprising administering.
- a malignant tumor patient having an MFI measured by flow cytometry of about 400 or more (or that the MFI was confirmed to be about 400 or more) is treated with an effective amount of immunity
- a method for suppressing progression, suppressing recurrence and / or treating malignant tumor comprising administering an immune checkpoint inhibitor.
- the ratio (%) of the number of PD-1 expressing cells in Treg cells in the tumor tissue or blood of a malignant tumor patient is less than about 65% (or the ratio (%) is about 65%.
- the CD8 + A value calculated by multiplying the percentage (%) of the number of PD-1-expressing cells in T cells is about 25 or more (or confirmed to be about 25 or more)
- CD8 in tumor tissue or blood of malignant tumor patient + Calculated by dividing the square of the ratio (%) of PD-1 expressing cells in T cells by the ratio (%) of PD-1 expressing cells in Treg cells in the same tissue or blood.
- Inhibiting the progression or relapse of a malignant tumor comprising administering an effective amount of an immune checkpoint inhibitor to a malignant tumor patient having a numerical value of about 25 or more (or confirmed to be about 25 or more).
- Methods of suppression and / or treatment comprising administering an effective amount of an immune checkpoint inhibitor to a malignant tumor patient having a numerical value of about 25 or more (or confirmed to be about 25 or more).
- Methods of suppression and / or treatment means a treatment method in which an effective amount of an immune checkpoint inhibitor is administered only to a malignant tumor patient identified based on each biomarker. And may also include the process of identifying such patients.
- Progression of malignant tumor and / or progression of malignant tumor patient with a ratio (%) of PD-1-expressing cells out of Treg cells in the tumor tissue or blood of malignant tumor patients is less than about 65% Immune checkpoint inhibitors for use in the suppression of recurrence and / or treatment.
- CD8 in tumor tissue or blood of malignant tumor patients + Calculated by dividing the square of the ratio (%) of PD-1 expressing cells in T cells by the ratio (%) of PD-1 expressing cells in Treg cells in the same tissue or blood.
- Immune checkpoint inhibitor for use in the suppression and / or treatment of malignant tumor progression and / or recurrence for malignant tumor patients with numerical values greater than 25.
- a malignant tumor progression inhibitory, recurrence inhibitory and / or therapeutic agent characterized by being administered to a malignant tumor patient whose ratio of PD-1 expression intensity in T cells is about 0.7 or more Use of immune checkpoint inhibitors.
- CD8 in tumor tissue or blood of malignant tumor patients + Calculated by dividing the square of the ratio (%) of PD-1 expressing cells in T cells by the ratio (%) of PD-1 expressing cells in Treg cells in the same tissue or blood.
- an immune checkpoint inhibitor for producing a malignant tumor progression inhibitory, recurrence inhibitory and / or therapeutic agent, characterized by being administered to a malignant tumor patient having a numerical value of 25 or more.
- the Treg cell and the CD8 + Each of the PD-1 expression intensities in the T cells was measured, and the CD8 against the PD-1 expression intensities in the Treg cells +
- the ratio of PD-1 expression intensity in T cells is determined, and based on the ratio, a malignant tumor patient who can expect the effect of an immune checkpoint inhibitor or a malignant tumor that cannot expect an effect of an immune checkpoint inhibitor How to identify patients.
- [4-2] The method described in [4-1] above, wherein a patient whose ratio is about 0.7 or more is identified as a malignant tumor patient who can be more expected to have the effect of the immune checkpoint inhibitor.
- [4-3] The method described in [4-2] above, wherein the ratio described in [4-2] is about 0.74 or more.
- [4-4] The method described in [4-2] above, wherein the ratio described in [4-2] is about 0.8 or more.
- [4-5] The method described in [4-2] above, wherein the ratio described in [4-2] is about 0.9 or more.
- [4-6] The method described in [4-2] above, wherein the ratio described in [4-2] is about 1.0 or more.
- [4-7] The method described in [4-2] above, wherein the ratio described in [4-2] is about 1.1 or more.
- [4-8] The method described in [4-2] above, wherein the ratio described in [4-2] is about 1.2 or more.
- [4-9] The method described in [4-2] above, wherein the ratio described in [4-2] is about 1.25 or more.
- [4-22] The method described in [4-21] above, wherein the MFI described in [4-21] is about 410 or more.
- [4-23] The method described in [4-21] above, wherein the MFI described in [4-21] is about 450 or more.
- [4-24] The method described in [4-21] above, wherein the MFI described in [4-21] is about 500 or more.
- [4-25] The method described in [4-21] above, wherein the MFI described in [4-21] is about 550 or more.
- [4-26] The method described in [4-21] above, wherein the MFI described in [4-21] is about 600 or more.
- [4-27] The method described in [4-21] above, wherein the MFI described in [4-21] is about 650 or more.
- [4-28] The method described in [4-21] above, wherein the MFI described in [4-21] is about 700 or more.
- [4-29] The method described in [4-21] above, wherein the MFI described in [4-21] is about 750 or more.
- [4-30] The method described in [4-21] above, wherein the MFI described in [4-21] is about 800 or more.
- [4-31] The method described in [4-21] above, wherein the MFI described in [4-21] is about 810 or more.
- [4-32] The method described in [4-21] above, wherein the MFI described in [4-21] is about 850 or more.
- [4-33] The method described in [4-21] above, wherein the MFI described in [4-21] is not less than an arbitrary numerical value between about 400 and about 850.
- [4-34] Any one of [4-21] to [4-33] above, wherein the MFI of PD-1 expression described in [4-21] is not more than an arbitrary value between about 2050 and about 2810 The method according to one item.
- [4-35] CD8 from tumor tissue or blood of a malignant tumor patient + A cell population containing T cells is collected, purified as necessary, and subjected to CD8 by flow cytometry or immunostaining.
- [4-38] The agent according to [4-36], wherein the ratio described in [4-36] is about 45% or more.
- [4-39] The method described in [4-36] above, wherein the ratio described in [4-36] is about 49.7% or more.
- [4-40] The method described in [4-36] above, wherein the ratio described in [4-36] is about 50% or more.
- [4-41] The method described in [4-36] above, wherein the ratio described in [4-36] is about 50.7% or more.
- [4-42] The method described in [4-36] above, wherein the ratio described in [4-36] is about 60% or more.
- a cell population containing Treg cells is collected from the tumor tissue or blood of a malignant tumor patient, purified as necessary, and subjected to flow cytometry or immunostaining to determine the number of Treg cells and PD-1 among them.
- the ratio described in (a1) or (a2) in the above [4-51] is about 0.8 or more, and The method according to [4-51] above, wherein a patient whose ratio described in item (b) is about 35% or more is identified.
- [4-53] The method described in [4-52] above, wherein the ratio described in (a1) or (a2) described in [4-52] is about 0.9 or more.
- [4-54] The method described in [4-52] above, wherein the ratio described in (a1) or (a2) described in [4-52] is about 1.0 or more.
- [4-55] The method described in [4-52] above, wherein the ratio described in (a1) or (a2) described in [4-52] is about 1.1 or more.
- [4-56] The method described in [4-52] above, wherein the ratio described in (a1) or (a2) described in [4-52] is about 1.2 or more.
- [4-57] The method according to any one of [4-52] to [4-56] above, wherein the ratio of (b) described in [4-52] is about 40% or more.
- [4-58] The method according to any one of [4-52] to [4-56], wherein the ratio described in (b) in [4-52] is about 45% or more.
- a method for identifying a malignant tumor patient who can be more expected to have an effect of an immune checkpoint inhibitor comprising: (i) Treg cells and CD8 from tumor tissue or blood of a malignant tumor patient + A cell population containing T cells is collected and purified as necessary.
- the CD8 + In comparison with the PD-1 expression intensity in T cells, the CD8 + A numerical value calculated by multiplying the percentage (%) of the number of PD-1-expressing cells in T cells is determined, and based on the numerical value, a malignant tumor patient who can expect an effect of an immune checkpoint inhibitor, or immunity A method for identifying patients with malignant tumors who cannot expect the effects of checkpoint inhibitors.
- [4-62] The method according to [4-60] or [4-61] above, wherein a patient having the numerical value of about 25 or more is identified as a malignant tumor patient who can be more expected to be effective in the immune checkpoint inhibitor .
- [4-63] The method described in [4-62] above, wherein a patient whose numerical value described in [4-62] is about 40 or more or about 44.4 or more is identified.
- [4-64] The method described in [4-62] above, wherein a patient whose numerical value described in [4-62] is about 46.0 or more or about 50 or more is specified.
- [4-65] The method described in [4-62] above, wherein a patient whose numerical value described in [4-62] is about 60 or more is identified.
- the immune checkpoint inhibitor is an anti-PD-1 antibody, an anti-PD-L1 antibody, a PD-1 antagonist, a PD-L1 / VISTA antagonist, a PD-L1 / TIM3 antagonist, an anti-PD-L2 Antibody, PD-L1 fusion protein, PD-L2 fusion protein, anti-CTLA-4 antibody, anti-LAG-3 antibody, LAG-3 fusion protein, anti-Tim3 antibody, anti-KIR antibody, anti-BTLA antibody, anti-TIGIT antibody, anti-VISTA
- the method according to any one of [4-1] to [4-68] above, which is an antibody, an anti-CSF-1R antibody or a CSF-1R inhibitor.
- the anti-PD-1 antibody is Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388DGA, ENUM 010 , AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, GB226, SSI-361, JY034, HX008, ISU106, ABBV181, BCD-100, PF-06801591, CX-188 or The method according to [4-66] above, which is JNJ-63723283.
- the anti-PD-L1 antibody is Atezolizumab, Avelumab, Durvalumab, BMS-936559, STI-1014, KN035, LY3300054, HLX20, SHR-1316, CS1001, MSB2311, BGB-A333, KL-A167, CK
- the method described in [4-69] above, wherein the anti-CTLA-4 antibody is Ipilimumab, AGEN1884 or Tremelimumab.
- the solid cancer is malignant melanoma (for example, malignant melanoma in the skin, oral mucosal epithelium or orbit), non-small cell lung cancer (for example, squamous non-small cell lung cancer and non-squamous non-small cell) Lung cancer), small cell lung cancer, head and neck cancer (eg oral cancer, nasopharyngeal cancer, oropharyngeal cancer, hypopharyngeal cancer, laryngeal cancer, salivary gland cancer and tongue cancer), renal cell carcinoma (eg clear cell renal cell) Cancer), breast cancer, ovarian cancer (eg, serous ovarian cancer and ovarian clear cell adenocarcinoma), nasopharyngeal cancer, uterine cancer (eg, cervical cancer, endometrial cancer and endometrial cancer), anal
- the blood cancer is multiple myeloma, malignant lymphoma (eg, non-Hodgkin lymphoma (eg, follicular lymphoma, diffuse large B-cell lymphoma, MALT lymphoma, lymphoplasma cell lymphoma, Mycosis fungoides, Sezary syndrome, chronic or acute lymphocytic leukemia, peripheral T cell lymphoma, extranodal NK / T cell lymphoma, adult T cell leukemia, B cell lymphoblastic leukemia, T cell lymphoblastic Leukemia and lymphocytoplasmic lymphoma) and Hodgkin lymphoma (eg, classic Hodgkin lymphoma and nodular lymphocyte-dominated Hodgkin lymphoma)), leukemia (eg, acute myeloid leukemia and chronic myelogenous leukemia and chronic myelogenous leukemia.
- non-Hodgkin lymphoma eg, follicular lymph
- [4-82] The method according to any one of [4-1] to [4-81] above, wherein the malignant tumor is a cancer whose therapeutic effect by other antineoplastic agents is insufficient or insufficient. .
- [4-83] The method according to any one of [4-1] to [4-82] above, wherein the malignant tumor is a cancer exacerbated after treatment with another antineoplastic agent.
- [4-84] The method according to any one of [4-1] to [4-81] above, wherein the malignant tumor patient has no history of treatment with other antineoplastic agents.
- [4-85] The method according to any one of [4-1] to [4-84], which is prescribed in postoperative adjuvant therapy or preoperative adjuvant therapy.
- the malignant melanoma or non-small cell lung cancer is BRAF V600 wild type, [4-74], [4-76] to [4-78] and [4-81] to [4- 90].
- the non-small cell lung cancer is EGFR gene mutation-positive and / or ALK fusion gene-positive, [4-74], [4-76] to [4-78] and [4-81] to The method according to any one of [4-92].
- [4-94] The non-small cell lung cancer is EGFR gene mutation negative and / or ALK fusion gene negative, [4-74], [4-76] to [4-78] and [4-81] to The method according to any one of [4-92].
- a method for identifying a patient with a malignant tumor that can be more expected to have an effect of a drug containing an anti-PD-1 antibody or an anti-PD-L1 antibody as an active ingredient, and (i) a drug containing the antibody as an active ingredient Treg cells (Fr. II) and CD8 from tumor tissue or blood of malignant tumor patients before administration of + A cell population containing T cells is collected and purified as necessary.
- a patient whose ratio to the PD-1 expression intensity in T cells is about 0.7 or more is identified, and the anti-PD-1 antibody is expressed as Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab , Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388D4, ENUM 244C8, GLS010, MGA012, AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, 361, Sym021-361 JY034, HX008, ISU106, ABBV181, BCD-100, PF-06801591, CX-188 or JNJ-63723283, and the anti-PD-L1 antibody is Atezolizumab, Avelumab
- a method for identifying a patient with a malignant tumor that can be more expected to have an effect of a drug comprising an anti-PD-1 antibody or an anti-PD-L1 antibody as an active ingredient, and comprising: Treg cells (Fr. II) and CD8 from tumor tissue or blood of malignant tumor patients before administration of + A cell population containing T cells is collected and purified as necessary.
- Treg cells Fr. II
- CD8 Flow cytometry method, immunostaining method, multiple immunohistochemical staining method, in situ hybridization method, mass cytometry method, single cell RNA sequencing method Or by mass imaging method,
- the CD8 + The PD-1 expression intensity or (iib) CD8 in the T cell and the Treg cell Fr.
- any of the ratio of the number of PD-1-expressing cells in the T cells (%) is about 1.0 or more, and (b) the CD8 +
- the ratio of the number of PD-1 expressing cells among T cells is identified to be about 40% or more, and the anti-PD-1 antibody is used for Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388D4, ENUM 244C8, GLS010, MGA012, AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, SMI19 -361, JY034, HX008, ISU106, ABBV181, BCD-100, PF-06801591, CX-188 or JNJ
- PD-1 in Treg cells in the tumor tissue or blood of the patient of the malignant tumor for suppressing the progression of malignant tumor, suppression of the recurrence by the immune checkpoint inhibitor and / or predicting the effectiveness of the treatment CD8 in the same tissue or blood against expression intensity + Use as a biomarker of the ratio of PD-1 expression intensity in T cells.
- CD8 in tumor tissue or blood of the malignant tumor patient for suppressing the progression, relapse suppression and / or predicting the effectiveness of the malignant tumor by the immune checkpoint inhibitor + Use as a biomarker of PD-1 expression intensity in T cells.
- PD ⁇ of Treg cells in the tumor tissue or blood of the malignant tumor patient for suppressing progression of malignant tumor, suppression of recurrence and / or predicting the effectiveness of treatment by an immune checkpoint inhibitor Use of 1 percentage of expressed cells as a biomarker.
- the CD8 + Use as a biomarker of a numerical value calculated by multiplying the ratio (%) of the number of PD-1-expressing cells in T cells.
- CD8 in the tumor tissue or blood of the malignant tumor patient for suppressing progression of malignant tumor, suppressing recurrence and / or predicting the effectiveness of treatment by an immune checkpoint inhibitor + Calculated by dividing the square of the ratio (%) of PD-1 expressing cells in T cells by the ratio (%) of PD-1 expressing cells in Treg cells in the same tissue or blood. Use as a numerical biomarker.
- the PD-1 expression intensity is MFI measured by flow cytometry, expression intensity or expression intensity score measured by multiple immunohistochemical staining, signal intensity measured by in situ hybridization Or expressed by an expression intensity score, expression intensity or signal intensity measured by mass cytometry, expression level or gene count measured by single cell RNA sequencing, or expression intensity or expression intensity score measured by mass imaging
- [5-9] CD8 in tumor tissue or blood + Any of [5-3] to [5-7] above, wherein the number of T cells and the number of Treg cells and the number of PD-1 expressing cells of each of them are measured by flow cytometry or immunostaining. Use according to any one of the above.
- the immune checkpoint inhibitor is an anti-PD-1 antibody, anti-PD-L1 antibody, PD-1 antagonist, PD-L1 / VISTA antagonist, PD-L1 / TIM3 antagonist, anti-PD- L2 antibody, PD-L1 fusion protein, PD-L2 fusion protein, anti-CTLA-4 antibody, anti-LAG-3 antibody, LAG-3 fusion protein, anti-Tim3 antibody, anti-KIR antibody, anti-BTLA antibody, anti-TIGIT antibody, anti-antibody
- the anti-PD-1 antibody is Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388D4, ENUM 010 , AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, GB226, SSI-361, JY034, HX008, ISU106, ABBV181, BCD-100, PF-06801591, CX-188 or The use according to [5-11] above, which is JNJ-63723283.
- the anti-PD-L1 antibody is Atezolizumab, Avelumab, Durvalumab, BMS-936559, STI-1014, KN035, LY3300054, HLX20, SHR-1316, CS1001, MSB2311, BGB-A333, KL-A167, CK -301, AK106, AK104, ZKAB001, FAZ053, CBT-502, JS003 or CX-072
- [5-14] The use according to [5-11] above, wherein the anti-CTLA-4 antibody is Ipilimumab, AGEN1884 or Tremelimumab.
- the solid cancer is malignant melanoma (for example, malignant melanoma in the skin, oral mucosal epithelium or orbit), non-small cell lung cancer (for example, squamous non-small cell lung cancer and non-squamous non-small cell) Lung cancer), small cell lung cancer, head and neck cancer (eg oral cancer, nasopharyngeal cancer, oropharyngeal cancer, hypopharyngeal cancer, laryngeal cancer, salivary gland cancer and tongue cancer), renal cell carcinoma (eg clear cell renal cell) Cancer), breast cancer, ovarian cancer (eg, serous ovarian cancer and ovarian clear cell adenocarcinoma), nasopharyngeal cancer, uterine cancer (eg, cervical cancer, endometrial cancer and endometrial cancer), anal cancer (e
- the blood cancer is multiple myeloma, malignant lymphoma (eg, non-Hodgkin lymphoma (eg, follicular lymphoma, diffuse large B-cell lymphoma, MALT lymphoma, lymphoplasmacytoma, Mycosis fungoides, Sezary syndrome, chronic or acute lymphocytic leukemia, peripheral T cell lymphoma, extranodal NK / T cell lymphoma, adult T cell leukemia, B cell lymphoblastic leukemia, T cell lymphoblastic Leukemia and lymphocytoplasmic lymphoma) and Hodgkin lymphoma (eg, classic Hodgkin lymphoma and nodular lymphocyte-dominated Hodgkin lymphoma)), leukemia (eg, acute myeloid leukemia and chronic myelogenous leukemia), primary malignancy of the central nervous system
- malignant lymphoma eg, non-Hodgkin lymphoma (e
- the anti-PD-1 antibody is Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, AMP-514, Dostarlimab, Toripalimab, Camrelizumab, Genolimzumab, Sintilimab, STI-A1110, ENUM 388D4, ENUM 244C8, GLS010, MGA012, AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, GB226, SSI-361, X03 , ISU106, ABBV181, BCD-100, PF-06801591, CX-188 or JNJ-63723283, and the anti-PD-L1 antibody is Atez
- Nivolumab a group of patients with non-small cell lung cancer who showed complete response (CR) or partial response (PR) based on the RECIST guidelines (7 patients) and the same patients who showed stability (SD) or progression (PD) based on the guidelines
- CR complete response
- PR partial response
- PD progression
- the ratio of the PD-1-expressing MFI of CD8 + T cells to the PD-1-expressing MFI of Treg cells derived from tumor tissue before administration of Nivolumab is shown.
- tumor tissue-derived Treg cells Fr.
- CD8 against PD-1-expressing MFI of Treg cells derived from tumor tissue before administration of Nivolumab for the gastric cancer patient group (3 cases) where the effect of Nivolumab was PR and the same patient (14 cases) where it was SD or PD + Represents the ratio of PD-1 expressing MFI in T cells.
- the PD- 1 represents the ratio of CD1-expressing MFI of CD8 + T cells to 1-expressing MFI.
- the CD8 + T cells derived from the tumor tissue before administration of Nivolumab represents PD-1 expression MFI values.
- tumor tissue-derived CD8 + T cells before administration of Nivolumab PD-1 expression ratio (%).
- eTreg represents Treg cells (Fr. II).
- the PD-1 expression ratio (%) in the CD8 + T cells was plotted on the horizontal axis, and the PD-1 expression ratio (%) in the Treg cells (Fr. II) was plotted on the vertical axis.
- “Group R” has a CD-1 expression ratio (%) of CD8 + T cells of 40% or more and a CD8 + T cell relative to the PD-1 expression ratio (%) of Treg cells (Fr. II). Is defined as a group of patients who satisfy the condition that the PD-1 expression ratio (%) ratio is 1.0 or more.
- Group R group CD8 + T cell PD-1 expression ratio ⁇ 40% and Treg cell (Fr. II) PD-1 expression in cancer patients (12 non-small cell lung cancer patients and 23 gastric cancer patients)
- the ratio of CD8 + T cell to MFI to PD-1 expressing MFI ⁇ 1.0) and the other patient groups (“The other”) represent progression free survival (PFS) after administration of Nivolumab.
- PFS progression free survival
- the reference value positive group groups that are greater than or equal to each reference value: BM +
- the negative group each reference value Groups less than: BM-
- PFS progression-free survival
- a reference value positive group a group that is greater than each reference value: BM +
- a negative group below each reference value Group: BM-
- the reference value positive group group that is greater than each reference value: BM +
- the negative group lower each reference value Group: BM-
- a reference value positive group groups that are greater than or equal to each reference value: BM +
- a negative group groups that are less than each reference value: BM-
- the ratio of the biomarker 1 of the present invention (when it is Treg cells) before the administration of Nivolumab for each of the Responder group (2 persons) and the Non-Responder group (1 person) ( The left figure) and the ratio (right figure) of biomarker 1 (in the case of Treg cells (Fr. II)) are shown.
- the biomarker 3 left figure
- the biomarker 4 Teg cell ( Fr. II)
- the numerical value of the biomarker 6 of the present invention before administration of Nivolumab for each of the Responder group (2 persons) and the Non-Responder group (1 person) of the head and neck cancer patients to which Nivolumab was administered is shown.
- the biomarker 7 of the present invention (PD-1 in Treg cells (Fr. II)) before administration of Niivolumab. (Based on expression rate (%)).
- each patient group 1 represents the results of plotting the PD-1 expression ratio (%) in Treg cells (Fr. II) on the vertical axis.
- “Group R” represents a region including a patient group that satisfies the condition represented by the biomarker 5 of the present invention.
- the term “immune checkpoint inhibitor” refers to, for example, an anti-PD-1 antibody (eg, Nivolumab, Cemiplimab (REGN-2810), Pembrolizumab (MK-3475), Spartalizumab (PDR-001), Tislelizumab (BGB -A317), AMP-514 (MEDI0680), Dostarlimab (ANB011 / TSR-042), Toripalimab (JS001), Camrelizumab (SHR-1210), Genolimzumab (CBT-501), Sintilimab (IBI308), STI-A1110, ENUM 388D4 , ENUM 244C8, GLS010, MGA012, AGEN2034, CS1003, HLX10, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, GB226, SSI-361, JY03
- PD- L1 / VISTA antagonist for example, CA-170
- PD-L1 / TIM3 antagonist for example, CA-327
- anti-PD-L2 antibody for example, PD-L1 fusion protein, PD-L2 fusion protein (for example, AMP-224)
- anti-CTLA-4 antibody for example, Ipilimumab (MDX-010), AGEN1884 and Tremelimumab
- anti-LAG-3 antibody eg, Relatlimab (BMS-986016 / ONO-4482
- LAG-3 fusion protein eg, IMP321, etc.
- anti-Tim3 antibody Eg, MBG453 and TSR-022
- anti-KIR antibodies eg, Lirilumab (BMS-986015, ONO-4483), IPH2101, LY3321367, and MK-4280
- anti-BTLA antibodies for example,
- Nivolumab can be produced according to the method described in WO2006 / 121168
- Pembrolizumab can be produced according to the method described in WO2008 / 156712
- BMS-936559 is produced in WO2007 / 005874
- ipilimumab can be produced according to the method described in WO2001 / 014424.
- the “immune checkpoint inhibitor” in the present invention is preferably an anti-PD-1 antibody and an anti-PD-L1 antibody
- particularly preferred anti-PD-1 antibodies include Nivolumab, Cemiplimab, Pembrolizumab, Spartalizumab, Tislelizumab, Toripalimab Sintilimab and Camrelizumab
- anti-PD-L1 antibodies include Atezolizumab, Avelumab, Durvalumab and BMS-936559.
- CD8 + T cells mean cells that are positive for surface antigen CD8 among T cells, and can be identified as, for example, CD3 positive, CD4 negative and CD8 positive cells.
- “positive” means that a certain marker molecule is expressed on the cell surface and specific binding by an antibody against the marker molecule can be confirmed with a certain strength
- “negative” Means that specific binding by an antibody to the marker molecule cannot be confirmed with a certain intensity.
- a Treg cell or a regulatory T cell is a T cell exhibiting an inhibitory activity against an immune response, and can be identified as, for example, a CD3 positive, a CD4 positive, a CD8 negative and a FoxP3 positive cell.
- “Fraction II Treg cell”, “Treg cell (Fr. II)” or “eTreg cell” is an effector Treg cell that has a particularly strong immunosuppressive action among Treg cells and is responsible for immunosuppressive activity.
- the “tumor tissue” in the present invention includes, for example, a tissue containing at least the tumor mass itself, the infiltrating peripheral portion of the tumor, or a lymph node adjacent to the tumor, and a known method such as forceps biopsy, puncture aspiration Can be obtained by needle biopsy, surgical biopsy or surgical operation for tumor removal.
- the CD8 + T cells and Treg cells may be extracted after mechanically disrupting the tumor tissue by a known method, and further isolated and further purified as necessary.
- the tumor tissue may be destroyed by enzyme treatment.
- blood from which CD8 + T cells or Treg cells are collected includes, for example, peripheral blood, and the CD8 + T cells and Treg cells in the blood may be further subjected to specific gravity centrifugation as necessary. For example, it may be isolated or further purified.
- the number of CD8 + T cells, the number of PD-1 expressing CD8 + T cells, the number of Treg cells, the number of PD-1 expressing Treg cells, and the respective PD-1 expression intensities in CD8 + T cells and Treg cells are: For example, it can be calculated by measuring with flow cytometry or the like. Specifically, mononuclear cells isolated from tumor tissue and peripheral blood are stained with a fluorescent dye-labeled antibody.
- the fluorescent dye-labeled antibody includes staining with an unlabeled primary antibody and a secondary antibody labeled with the fluorescent dye. Mononuclear cells stained with the antibody are detected by flow cytometry.
- the number of CD8 + T cells and PD-1 expressing CD8 + T cells and the number of Treg cells and PD-1 expressing Treg cells can also be measured by immunostaining, while the PD-1 expression intensity is
- multiple immunohistochemical staining methods eg fluorescence or mass cytometry
- in situ hybridization methods eg FISH, CISH, SISH and DISH
- mass cytometry methods single cell RNA sequencing or mass imaging methods can also be measured and calculated.
- PD-1 expression intensity is MFI measured by flow cytometry, expression intensity or expression intensity score measured by multiple immunohistochemical staining, signal intensity or expression intensity measured by in situ hybridization method When expressed in terms of score, expression intensity or signal intensity measured by mass cytometry, expression level or gene count measured by single cell RNA sequencing, or expression intensity or expression intensity score measured by mass imaging There is.
- PD-1 expressing CD8 + T cells or PD-1 expressing Treg cells which are respectively measured in biomarkers 3 to 7, are cell populations that express PD-1 above a certain threshold, for example, flow cytometry measurement
- a certain threshold for example, flow cytometry measurement
- the ratio (%) of the number of PD-1 expressing cells among CD8 + T cells “the ratio (%) of the number of PD-1 expressing cells among Treg cells” and “Treg cells ( Fr.II) is the PD-1 expression ratio (%) in CD8 + T cells and PD-1 expression ratio (%) in Treg cells, respectively. And “PD-1 expression ratio (%) in Treg cells (Fr. II)”.
- “before administration of a drug containing an immune checkpoint inhibitor as an active ingredient” or “before administration of an immune checkpoint inhibitor” refers to a drug containing the immune checkpoint inhibitor as an active ingredient in the past.
- “before administration of a drug containing an immune checkpoint inhibitor as an active ingredient” or “before administration of an immune checkpoint inhibitor” refers to a drug containing the immune checkpoint inhibitor as an active ingredient in the past.
- the immune checkpoint inhibitor or other antineoplastic agents including immune checkpoint inhibitors other than the immune checkpoint inhibitor. This includes the case before the administration of the drug when there is a history of treatment.
- the reference value (cutoff value) of the biomarker of the present invention is to measure each biomarker of a malignant tumor patient before the immune checkpoint inhibitor is administered, and then administer the immune checkpoint inhibitor, It can be divided into a response group and a non-response group, and can be determined in advance based on the measured value of the biomarker before administration in each group. For example, if the cancer is solid cancer, the response is determined according to the RECIST guidelines (Response Evaluation Criteria Solid Tumor, 2000), complete response (Complete Response: CR), partial response (Partial Response: PR) ), Progress (Progressive Disease: PD), and stability (Stable Disease: SD).
- CR, PR, and SD patients are judged as responding (in this specification, sometimes referred to as “Responder”), and PD patients are considered as non-responding (in this specification, “non-responder”). May be described as “.”, Or each patient with CR and PR may be determined as a response, and each patient with SD and PD may be determined as a non-response.
- patients with CR and PR and patients with SD maintained for at least 6 months may be judged as responding, and patients with SD less than 6 months and those with PD may be judged as non-responding.
- Judgment based on the same criteria is, for example, from the start of treatment by administration of immune checkpoint inhibitor to 12 months, preferably to 10 months, more preferably to 8 months, and more preferably to 6 months. This can be done at In addition, whether the response is successful or non-responsive can also be determined by the overall response rate (ORR), progression-free survival (PFS), overall survival (OS), survival rate or median survival.
- ORR overall response rate
- PFS progression-free survival
- OS overall survival
- survival rate or median survival.
- the reference value (cut-off value) of the biomarker of the present invention can be determined by, for example, ROC (receiver operating characteristic curve) analysis.
- ROC analysis measures each biomarker of a malignant tumor patient before an immune checkpoint inhibitor is administered as a specimen, then administers the immune checkpoint inhibitor and divides it into a response group and a non-response group,
- Optimum values can be set by calculating sensitivity and specificity at each reference value, and plotting them on coordinates with the horizontal axis as specificity and the vertical axis as sensitivity.
- the reference value (cutoff value) of the biomarker of the present invention can be set, for example, by calculating a 95% confidence interval in each of the response group and the non-response group and based on the upper limit value or the lower limit value of the same interval. it can. When it is predicted that the same section of both groups is clearly deviated, it can be set in the deviation area of the same section of both groups. For example, in the case of biomarkers 1 to 3, 6 and 7, an arbitrary value between the lower limit of the 95% confidence interval of the response group and the upper limit of the same interval of the non-response group should be set as the reference value. Can do.
- the biomarkers 1 to 3 in the present invention are the ratios or ratios of reference values set in advance for each, or malignant tumor patients that are equal to or higher than the MFI value, and the biomarkers 4 are less than the ratio of reference values set in advance.
- Malignant tumor patients who satisfy the conditions relating to the combination of preset reference values for the biomarker 5, and those for the biomarkers 6 and 7 that are equal to or greater than the preset reference value. Is used to identify patients who are expected to be effective in immune checkpoint inhibitors, but conversely, the ratio or ratio of the reference value set in advance or less than the MFI value.
- Biomarkers 1 to 3 more than the ratio of the reference value (biomarkers 4) Patients whose malignant tumor patients who do not satisfy the conditions for the combination of the reference values (biomarker 5) or less than the numerical values of the reference values (biomarkers 6 and 7) cannot expect the effect of immune checkpoint inhibitors It can be used also when specifying as.
- the reference value (cutoff value) of the ratio that is the biomarker 1 in the present invention is an arbitrary ratio between about 0.7 and about 1.9, specifically, about 0.7, about 0.8. 74, about 0.8, about 0.9, about 0.95, about 1.0, about 1.1, about 1.2, about 1.25, about 1.27, about 1.3, about 1. 4, about 1.5, about 1.6, about 1.7, about 1.8, or about 1.9.
- the reference value of the ratio may have an upper limit of any ratio between about 2.6 and about 5.9, if necessary.
- the reference value of the same ratio is preferably about 1.2, while in the case of gastric cancer, it is preferably about 0.7.
- Treg cells may be limited to the fraction of Treg cells (Fr. II).
- the “PD-1 expression intensity” in the biomarker may be used for the calculation of the ratio instead of the number of PD-1 expression (expression amount) per cell.
- a known measurement method for example, BD ⁇ QuantiBRITE (registered trademark) PE Kit and Quantum using a fluorescently labeled bead used for preparing a calibration curve for antigen molecule quantification is used. (Registered trademark) FITCFIMESF Kit etc.) can be used as appropriate.
- FITCFIMESF Kit Registered trademark
- FITCFIMESF Kit FITCFIMESF Kit
- MEF Equivalent Soluble Fluorochrome
- the reference value (cutoff value) of MFI that is biomarker 2 in the present invention is any MFI between about 400 and about 850, specifically, about 400, about 410, about 450, about 500, About 550, about 600, about 650, about 700, about 750, about 800, about 810 or about 850.
- the MFI may have an upper limit of any MFI between about 2050 and about 2810 if necessary.
- the reference value of the MFI is preferably about 800, whereas in the case of gastric cancer, it is preferably about 410.
- the reference value (cutoff value) of the ratio (%) that is the biomarker 3 in the present invention is an arbitrary ratio between about 35% and about 70%, specifically, about 35% and about 36%. About 37%, about 38%, about 39%, about 40%, about 41%, about 42%, about 43%, about 44%, about 45%, about 49.7%, about 50%, about 50. 7%, about 51.8, about 56.8%, about 60% or about 70%.
- the reference value for the same ratio is preferably any ratio between about 49.7-51.8%, while for gastric cancer, it is about 50.7-56. Any proportion between 8% is preferred.
- the reference value (cut-off value) of the ratio (%) that is the biomarker 4 in the present invention is an arbitrary ratio between about 65% and about 55%, specifically, about 65% and about 64%. About 63%, about 62%, about 61%, about 60%, about 59%, about 58.4%, about 58%, about 57%, about 56% or about 55%. In particular, in the case of gastric cancer, the reference value of the same ratio is preferably about 58.4%. Similarly, in the measurement for calculating the reference value of the same ratio, the Treg cells may be limited to the fraction of Treg cells (Fr. II).
- Biomarker 5 in the present invention that is, (a1) PD-1 in CD8 + T cells in the same tissue or blood as compared to the PD-1 expression intensity in Treg cells in the tumor tissue or blood of patients with malignant tumors Ratio of expression intensity or (a2) Ratio of the number of PD-1 expressing cells in the CD8 + T cells (%) to the ratio (%) of the number of PD-1 expressing cells in the Treg cells And (b) the ratio of the number of PD-1-expressing cells among the CD8 + T cells (%) is a combination of patients satisfying a condition of a reference value (cutoff value) predetermined in the combination. Therefore, patients who can expect the effects of immune checkpoint inhibitors, or patients who do not meet the conditions, are more accurately characterized as patients who cannot expect the effects of immune checkpoint inhibitors. It can be used when.
- the ratio described in (a1) or (a2) is about 0.8 or more
- the ratio (%) described in (b) is about 35% or more, about 36% or more, about 37% or more, about 38% or more, about 39% or more, about 40% or more, about 41% or more, about 42% or more, about 43% or more, about 44% or more, or about 45% or more, the above (a1) or (a2)
- the described ratio is about 0.9 or more
- the ratio (%) described in (b) is about 35% or more, about 36% or more, about 37% or more, about 38% or more, about 39% or more, about
- the ratio described in the above (a1) or (a2) is about 1.0 or more.
- the proportion (%) described in (b) is about 35% or more, about 36% or more, about 37% or more When it is about 38% or more, about 39% or more, about 40% or more, about 41% or more, about 42% or more, about 43% or more, about 44% or more or about 45% or more, the above (a1) or (a2 ) And the ratio (%) described in (b) above is about 35% or more, about 36% or more, about 37% or more, about 38% or more, about 39% or more, About 40% or more, about 41% or more, about 42% or more, about 43% or more, about 44% or more, or about 45% or more, or the ratio described in (a1) or (a2) is about 1.2 And the proportion (%) described in (b) above is about 35% or more, about 36% or more, about 37% or more, about 38% or more, about 39% or more, about 40% or more, about 41% or more.
- the ratio described in (a1) or (a2) is about 0.9 or more, and the ratio (%) described in (b) is about 39% or more, about 40% or more, or about 41% or more.
- the ratio described in (a1) or (a2) is about 1.0 or more, and the ratio (%) described in (b) is about 39% or more, about 40% or more, or about 41% or more.
- the ratio described in (a1) or (a2) is about 1.1 or more, and the ratio (%) described in (b) is about 39% or more, about 40% or more, or about 41% or more.
- the ratio described in (a1) or (a2) is about 1.0 or more, and the ratio (%) described in (b) is about 40% or more. is there.
- the Treg cells may be limited to the fraction of Treg cells (Fr. II).
- the “PD-1 expression intensity” in the biomarker may be used for the calculation of the ratio instead of the number of PD-1 expression (expression amount) per cell.
- Biomarker 6 in the present invention that is, PD-1 expression intensity in CD8 + T cells in the same tissue or blood relative to PD-1 expression intensity in Treg cells in tumor tissue or blood of patients with malignant tumors Is calculated by multiplying the above ratio by the ratio (%) of the number of PD-1-expressing cells in the CD8 + T cells to satisfy the condition of a predetermined reference value (cutoff value). It can be used when a patient who can expect the effect of the checkpoint inhibitor or a patient who does not satisfy the condition is more accurately identified as a patient who cannot expect the effect of the immune checkpoint inhibitor.
- the same value is about 25 or more, about 40 or more, about 46.0 or more, about 50 or more, about 60 or more, about 90 or more, or about 100 or more
- a patient who can expect an effect of an immune checkpoint inhibitor More preferably, the number is about 46.0 or more, about 50 or more, about 60 or more, about 90 or more, or about 100 or more.
- the biomarker 7 in the present invention that is, the square of the percentage (%) of the number of PD-1-expressing cells in the CD8 + T cells in the tumor tissue or blood of a malignant tumor patient is expressed as Treg in the same tissue or blood.
- the effect of an immune checkpoint inhibitor can be expected for patients whose numerical value divided by the ratio (%) of PD-1-expressing cells out of the cells satisfies a predetermined reference value (cutoff value: CUT). It can be used to more accurately identify a patient or a patient who does not satisfy the condition as a patient who cannot expect the effect of an immune checkpoint inhibitor.
- the same value is about 25 or more, about 40 or more, about 44.4 or more, about 50 or more, about 60 or more, about 90 or more, or about 100 or more, as a patient who can expect the effect of an immune checkpoint inhibitor
- it is preferably about 40 or more, about 44.4 or more, about 50 or more, about 60 or more, about 90 or more, or about 100 or more.
- the same value is about 60 or more, about 90 or more, or about 100 or more.
- malignant tumors to which the drug or patient identification method of the present invention can be applied include solid malignant tumors such as malignant melanoma (for example, malignant melanoma in the skin, oral mucosal epithelium or orbit), non-small cell lung cancer (for example, squamous non-small cell lung cancer and non-squamous non-small cell lung cancer, small cell lung cancer, head and neck cancer (eg oral cancer, nasopharyngeal cancer, oropharyngeal cancer, hypopharyngeal cancer, laryngeal cancer, salivary gland cancer and tongue cancer) Renal cell carcinoma (eg clear cell renal cell carcinoma), breast cancer, ovarian cancer (eg serous ovarian cancer and ovarian clear cell adenocarcinoma), nasopharyngeal cancer, uterine cancer (eg cervical cancer, intrauterine) Membrane cancer and endometrial cancer), anal cancer (eg anal canal cancer), colon
- malignant melanoma
- malignant lymphoma eg, non-Hodgkin lymphoma (eg, follicular lymphoma, diffuse large B cell lymphoma, primary mediastinal B cell lymphoma, MALT lymphoma) Lymphatic plasma cell lymphoma, mycosis fungoides, Sezary syndrome, chronic or acute lymphocytic leukemia, peripheral T-cell lymphoma, extranodal NK / T-cell lymphoma, adult T-cell leukemia, B-cell lymphoblastic leukemia , T cell lymphoblastic leukemia and lymphoplasmic lymphoma) and Hodgkin lymphoma (eg, classic Hodgkin lymphoma and nodular lymphocyte-dominated Hodgkin lymphoma)), leukemia (eg, acute myeloid leukemia and chronic myelogenous leukemia) ), Selected from primary lymphoma (eg, non-Hodgkin lymphoma (eg,
- malignant tumor treatment means, for example, (i) reducing the proliferation of tumor cells, (ii) reducing symptoms caused by the malignant tumor, (iii) improving the quality of life of the malignant tumor patient. Including (iv) reducing the dose of other antineoplastic agents or cancer treatment adjuvants already administered, and / or (v) treatments performed to prolong the survival of patients with malignant tumors, “Suppression of malignant tumor progression” means delaying malignant tumor progression, stabilizing symptoms associated with malignant tumors, and slowing the progression of symptoms.
- suppression of recurrence of malignant tumors means prophylactic suppression of recurrence of malignant tumors in patients whose cancer lesions have been completely or substantially eliminated or removed by malignant tumor treatment or cancer resection surgery. .
- the immune checkpoint inhibitor is the following malignant tumor patient that satisfies the conditions of at least one biomarker of biomarkers 1 to 7 according to the present invention, that is, (a) another anti-malignant tumor drug Patients with malignant tumors that are inadequate or insufficient for treatment by or those who have exacerbated after treatment with other antineoplastic agents, (b) radical or unresectable, metastatic, relapsed, refractory and / or Patients with distant metastatic malignant tumors, (c) patients with malignant tumors with TPS or CPS of 50% or more, 25% or more, 10% or more, 5% or more, or 1% or more, (d) MSI-H or dMMR (E) BRAF V600E mutation-positive malignant melanoma or non-small cell lung cancer patient, (f) EGFR gene mutation-positive Others may be prescribed to the patient in malignant tumor patients of malignant tumors are ALK fusion gene-positive, or (g) TMB is frequent.
- another anti-malignant tumor drug Patients
- the immune checkpoint inhibitor is the following malignant tumor patient that satisfies the conditions of at least one biomarker of biomarkers 1 to 7 according to the present invention, that is, (a) other Patients with malignant tumors who have not been treated with any of the antineoplastic agents, (b) patients with malignant tumors with TPS or CPS less than 50%, less than 25%, less than 10%, less than 5% or less than 1%, (c) Patients with malignant tumors without MSI-H and / or dMMR, or with MSI-L, (d) BRAF V600 wild type malignant melanoma or non-small cell lung cancer, (e) EGFR gene mutation negative and When more prescriptions are required for patients with non-small cell lung cancer who are negative for ALK fusion gene or (f) malignant tumors with low TMB frequency There is also.
- it can also be prescribed as a postoperative adjuvant therapy that prophylactically suppresses recurrence or metastasis after surgical resection of a malignant tumor or a preoperative adjuvant therapy performed before surgical resection.
- antineoplastic agents the antineoplastic agents listed in the following section [Combination and combination drug], that is, alkylating agents, platinum preparations, antimetabolites (for example, folate metabolism) Antagonist, pyridine metabolism inhibitor, purine metabolism inhibitor), ribonucleotide reductase inhibitor, nucleotide analog, topoisomerase inhibitor, microtubule polymerization inhibitor, microtubule depolymerization inhibitor, antitumor antibiotic, cytokine preparation, anti Examples thereof include drugs exemplified as hormone drugs, molecular targeted drugs and cancer immunotherapy drugs.
- the therapeutic effect of an antineoplastic drug is insufficient or insufficient”, for example, in RECIST, a case where it is determined as stable (SD) or advanced (PD) by an anti-neoplastic drug treatment. It is done.
- the dose of the immune checkpoint inhibitor according to the present invention varies depending on age, weight, symptom, therapeutic effect, administration method, treatment time, etc., but it is usually one in the range of 1 ng to 1000 mg per adult. Orally administered once to several times daily, or parenterally administered once to several times daily in the range of 0.1 ng to 100 mg per adult, or 30 minutes to 24 hours per day Intravenous administration in the range of Of course, as described above, since the dosage varies depending on various conditions, an amount smaller than the above dosage may be sufficient, and administration may be necessary beyond the range.
- Nivolumab which is an anti-PD-1 antibody
- it is administered in the following dosage regimen.
- patients with malignant melanoma are given 3 mg / kg (body weight) once every 2 weeks or 2 mg / kg (body weight) as a drip infusion every 3 weeks as Nivolumab.
- Each patient with cancer, classic Hodgkin lymphoma, head and neck cancer, gastric cancer, and malignant pleural mesothelioma is given 3 mg / kg (body weight) as a single intravenous infusion every 2 weeks as Nivolumab.
- melanoma for example, malignant melanoma, non-small cell lung cancer, renal cell carcinoma, urothelial cancer, MSI-H or dMMR positive colon cancer (including pediatric patients over 12 years old)
- melanoma for example, non-small cell lung cancer, renal cell carcinoma, urothelial cancer, MSI-H or dMMR positive colon cancer (including pediatric patients over 12 years old)
- a gastric cancer for patients with gastric cancer, hepatocellular carcinoma, small cell lung cancer, and malignant pleural mesothelioma
- 480 mg is administered intravenously at an interval of 4 weeks.
- Nivolumab is infused intravenously 4 times at intervals of 3 weeks, and then Nivolumab
- 3 mg / kg (body weight) is infused intravenously at 2 week intervals, or as Nivolumab, once at 80 mg, at 4 weekly intervals, and then at 240 mg as 240 times at 2 week intervals. May be administered intravenously.
- Nivolumab in combination with ipilimumab, 240 mg of Nivolumab is infused 4 times at intervals of 3 weeks and then 240 mg of Nivolumab is infused at intervals of 2 weeks. Sometimes it is done. In the case of Pembrolizumab, which is the same anti-PD-1 antibody, it is administered in the following dosage regimen.
- Avelumab an anti-PD-L1 antibody
- Avelumab is intravenously administered as an Avelumab at a dose of 10 mg / kg (body weight) once every two weeks for patients with Merkel cell carcinoma and urothelial cancer.
- Atezolizumab the same PD-L1 antibody, is administered to each patient with non-small cell lung cancer and urothelial cancer as 1200 mg of Atezolizumab once every 3 weeks, and to patients with triple negative breast cancer with paclitaxel.
- 840 mg of Atezolizumab is administered by intravenous infusion every 2 weeks.
- Durvalumab which is the same PD-L1 antibody, is administered intravenously at a dose of 10 mg / kg (body weight) once every two weeks as Durvalumab to patients with non-small cell lung cancer and urothelial cancer.
- ipilimumab which is an anti-CTLA-4 antibody
- 3 mg / kg (body weight) of ipilimumab once a day 4 times at intervals of 3 weeks
- patients with malignant melanoma alone or in combination with Nivolumab for patients with renal cell carcinoma and MSI-H or dMMR-positive colorectal cancer that have been intravenously infused, in combination with Nivolumab, 1 mg / kg (body weight) of ipilimumab once daily is administered 4 times at intervals of 3 weeks. Noted.
- the immune checkpoint inhibitor according to the present invention comprises (1) a reduction in the dosage of other drugs used in combination for the purpose of (1) suppression of malignant tumor progression, suppression of recurrence, and / or enhancement of therapeutic effects. (3) In combination with one or more other drugs (mainly anti-neoplastic agents) used for the above malignant tumor treatment purposes in order to reduce the side effects of other drugs used in combination May be used.
- the dosage form in combination with other drugs may be a combination form in which both components are mixed in one preparation, or may be a separate preparation form. Good.
- the immune checkpoint inhibitor and other drugs are administered separately, the immune checkpoint inhibitor may be administered first, followed by other drugs, or other drugs first.
- the immune checkpoint inhibitor may be administered later, and there may be a period in which both drugs are administered simultaneously for a certain period in the above administration.
- the administration method of each medicine may be the same or different.
- it can also be provided as a kit containing an immune checkpoint inhibitor and other drugs.
- the dosage of the other drug can be appropriately selected based on the clinically used dose.
- you may administer 2 or more types of other chemical
- the other drugs include not only those found so far but also those found in the future.
- antineoplastic agents examples include alkylating drugs (for example, dacarbazine, Nimustine, Temozolomide, Fotemustine, bendamustine, Cyclophosphamide, Ifosfamide, Carmustine, Chlorambucil and Procarbazine, etc.), platinum preparations ( For example, Cisplatin, Carboplatin, Nedaplatin and Oxaliplatin), antimetabolites (eg, folic acid antimetabolites (eg, Pemetrexed, Leucovorin, and Methotrexate), pyridine metabolism inhibitors (eg, TS-1®, 5- fluorouracil, UFT, Carmofur, Doxifluridine, FdUrd, Cytarabine and Capecitabine, etc.), purine metabolism inhibitors (eg, Fludarabine, Cladribine and Nelarabine)), ribonucleotide reductase inhibitors, nucleotide analogs (
- examples of the molecular target drug include ALK inhibitors (for example, Crizotinib, Ceritinib, Ensartinib, Alectinib and Lorlatinib), BCR-ABL inhibitors (for example, Imatinib and Dasatinib), EGFR inhibitors (for example, Erlotinib, EGF816).
- ALK inhibitors for example, Crizotinib, Ceritinib, Ensartinib, Alectinib and Lorlatinib
- BCR-ABL inhibitors for example, Imatinib and Dasatinib
- EGFR inhibitors for example, Erlotinib, EGF816).
- cancer immunotherapeutic agents include anti-PD-1 antibodies (eg, Nivolumab, Cemiplimab (REGN-2810), Pembrolizumab (MK-3475), Spartalizumab (PDR-001), Tislelizumab (BGB-A317), AMP-514 (MEDI0680), Dostarlimab (ANB011 / TSR-042), Toripalimab (JS001), Camrelizumab (SHR-1210), Genolimzumab (CBT-501), Sintilimab (IBI308), STI-A1110, ENUM 388D4, ENUM 244C8, GLS010, MGA012, AGEN2034, CS1003, BAT-1306, AK105, AK103, BI 754091, LZM009, CMAB819, Sym021, GB226, SSI-361, JY034, HX008, ISU106, ABBV181, BCD-100, PF-06
- antibody drugs examples include anti-IL-1 ⁇ antibodies (eg, Canakinumab) and anti-CCR2 antibodies (eg, Plozalizumab).
- the immune checkpoint inhibitor or immune checkpoint inhibitor according to the present invention is administered alone or in combination with other drugs, it is a solid preparation or liquid for internal use for oral administration, or sustained release for oral administration. It is used as an injection, an external preparation, an inhalant, a suppository, etc.
- solid preparations for internal use for oral administration include tablets, pills, capsules, powders and granules.
- Capsules include hard capsules and soft capsules.
- one or more active substances are left as they are, or excipients (eg, lactose, mannitol, glucose, microcrystalline cellulose, starch, etc.), binders (eg, hydroxypropylcellulose) , Polyvinyl pyrrolidone, magnesium aluminate metasilicate, etc.), disintegrant (eg, calcium calcium glycolate), lubricant (eg, magnesium stearate), stabilizer, solubilizer (eg, glutamic acid, aspartic acid) Etc.) and the like, and formulated into a conventional method.
- excipients eg, lactose, mannitol, glucose, microcrystalline cellulose, starch, etc.
- binders eg, hydroxypropylcellulose
- Polyvinyl pyrrolidone e.g, magnesium aluminate metasilicate, etc.
- disintegrant eg, calcium calcium glycolate
- lubricant eg, magnesium stea
- cover may coat
- a coating agent for example, sucrose, gelatin, hydroxypropyl cellulose, hydroxypropyl methylcellulose phthalate etc.
- cover may be coated with two or more layers.
- capsules of absorbable materials such as gelatin.
- Oral liquids for oral administration include pharmaceutically acceptable solutions, suspensions, emulsions, syrups and elixirs.
- a solution one or more active substances are dissolved, suspended or emulsified in a commonly used diluent (for example, purified water, ethanol, or a mixture thereof).
- this liquid agent may contain a wetting agent, a suspending agent, an emulsifier, a sweetening agent, a flavoring agent, a fragrance, a preservative or a buffering agent.
- sustained-release preparations for oral administration are also effective.
- the gel-forming substance used in these sustained-release preparations is a substance that swells with a solvent, the colloidal particles are connected to each other, take a three-dimensional network structure, and can form a jelly-like object that loses fluidity It is. On the formulation, it is mainly used as a binder, thickener and sustained release base.
- gum arabic for example, gum arabic, agar, polyvinylpyrrolidone, sodium alginate, propylene glycol alginate, carboxyvinyl polymer, carboxymethylcellulose, sodium carboxymethylcellulose, guar gum, gelatin, hydroxypropylmethylcellulose, hydroxypropylcellulose, polyvinyl alcohol, methylcellulose or hydroxyethylmethylcellulose Can be used.
- the injection or infusion When formulated and used as an infusion for injection or infusion, the injection or infusion may be in the form of an aqueous solution, suspension or emulsion, and a solvent is added at the time of use. Thus, it may be formulated as a solid agent together with a pharmaceutically acceptable carrier so that it can be dissolved, suspended or emulsified.
- Solvents used in infusions for injections or infusions include, for example, distilled water for injection, saline, glucose solutions and isotonic solutions (eg, sodium chloride, potassium chloride, glycerin, mannitol, sorbitol, boric acid, Borax, a solution of propylene glycol, etc.) can be used.
- pharmaceutically acceptable carriers include, for example, stabilizers, solubilizers, suspending agents, emulsifiers, soothing agents, buffers, preservatives, preservatives, pH adjusters, antioxidants, and the like.
- stabilizers include various amino acids, albumin, globulin, gelatin, mannitol, glucose, dextran, ethylene glycol, propylene glycol, polyethylene glycol, ascorbic acid, sodium bisulfite, sodium thiosulfate, sodium edetate, sodium citrate, Dibutylhydroxytoluene or the like can be used.
- solubilizer examples include alcohols (eg, ethanol), polyalcohols (eg, propylene glycol, polyethylene glycol, etc.), nonionic surfactants (eg, polysorbate 20 (registered trademark), polysorbate 80 (registered trademark)). ), HCO-50, etc.) can be used.
- alcohols eg, ethanol
- polyalcohols eg, propylene glycol, polyethylene glycol, etc.
- nonionic surfactants eg, polysorbate 20 (registered trademark), polysorbate 80 (registered trademark)).
- HCO-50 etc.
- the suspending agent for example, glyceryl monostearate, aluminum monostearate, methyl cellulose, carboxymethyl cellulose, hydroxymethyl cellulose, sodium lauryl sulfate and the like can be used.
- emulsifier for example, gum arabic, sodium alginate, tragacanth and the like can be used.
- the soothing agent for example, benzyl alcohol, chlorobutanol, sorbitol and the like can be used.
- the buffer include phosphate buffer, acetate buffer, borate buffer, carbonate buffer, citrate buffer, Tris buffer, glutamate buffer, epsilon aminocaproate buffer, and the like.
- Preservatives include, for example, methyl paraoxybenzoate, ethyl paraoxybenzoate, propyl paraoxybenzoate, butyl paraoxybenzoate, chlorobutanol, benzyl alcohol, benzalkonium chloride, sodium dehydroacetate, sodium edetate, boric acid, boron Sand or the like can be used.
- preservative for example, benzalkonium chloride, paraoxybenzoic acid, chlorobutanol and the like can be used.
- pH adjuster for example, hydrochloric acid, sodium hydroxide, phosphoric acid, acetic acid and the like can be used.
- Antioxidants include, for example, (1) water-soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite, etc., (2) ascorbyl palmitate, butylated hydroxyanisole, Use oil-soluble antioxidants such as butylated hydroxytoluene, lecithin, propyl gallate, ⁇ -tocopherol, and (3) metal chelating agents such as citric acid, ethylenediaminetetraacetic acid, sorbitol, tartaric acid, phosphoric acid, etc. Can do.
- water-soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite, etc.
- ascorbyl palmitate butylated hydroxyanisole
- Use oil-soluble antioxidants such as butylated hydroxytoluene, lecithin, propyl gallate, ⁇ -tocopherol
- An infusion for injection or infusion can be produced by sterilizing in the final process or by sterilization by aseptic operation, for example, filtration with a filter or the like, and then filling an aseptic container.
- a sterile powder which may contain a pharmaceutically acceptable carrier powder
- vacuum drying and freeze-drying is used by dissolving in an appropriate solvent at the time of use.
- Examples of external dosage forms for parenteral administration include sprays, inhalants, sprays, aerosols, ointments, gels, creams, poultices, patches, liniments and nasal drops. Is included. These contain one or more active substances and are prepared by known methods or commonly used formulations.
- Sprays, inhalants, and sprays are commonly used diluents such as sodium bicarbonate, sodium citrate or citric acid buffers that provide isotonicity with stabilizers such as sodium bisulfite.
- Such an isotonic agent may be contained.
- a method for producing a spray is described in detail in, for example, US Pat. Nos. 2,869,691 and 3,095,355.
- Inhalants for parenteral administration include aerosols, inhalable powders or inhalable solutions, which are used by dissolving or suspending them in water or other suitable media at the time of use. It may be.
- inhalants are manufactured according to known methods. For example, in the case of inhalation solutions, preservatives (eg, benzalkonium chloride, parabens, etc.), colorants, buffering agents (eg, sodium phosphate, sodium acetate, etc.), isotonic agents (eg, chloride) Sodium, concentrated glycerin, etc.), thickeners (for example, carboxyvinyl polymer, etc.), absorption accelerators, and the like, as appropriate.
- preservatives eg, benzalkonium chloride, parabens, etc.
- colorants eg, sodium phosphate, sodium acetate, etc.
- isotonic agents eg, chloride
- thickeners for example, carboxyvinyl polymer, etc.
- absorption accelerators for example, carboxyvinyl polymer, etc.
- lubricants eg, stearic acid and its salts
- binders eg, starch, dextrin, etc.
- excipients eg, lactose, cellulose, etc.
- colorants eg, antiseptics
- an agent for example, benzalkonium chloride, paraben, etc. or an absorption accelerator is appropriately selected as necessary.
- a nebulizer for example, an atomizer, a nebulizer, etc.
- an inhalation administration device for a powder drug is usually used.
- the ointment is manufactured by a known or commonly used formulation. For example, it is prepared by mixing or melting one or more active substances in a base.
- the ointment base is selected from known or commonly used ones.
- higher fatty acid or higher fatty acid ester for example, adipic acid, myristic acid, palmitic acid, stearic acid, oleic acid, adipic acid ester, myristic acid ester, palmitic acid ester, stearic acid ester, oleic acid ester, etc.
- waxes E.g., beeswax, whale wax, ceresin, etc.
- surfactants e.g., polyoxyethylene alkyl ether phosphates, etc.
- higher alcohols e.g., cetanol, stearyl alcohol, cetostearyl alcohol, etc.
- silicone oils e.g., Dimethylpolysiloxane, etc.
- hydrocarbons eg, hydro
- Gel is manufactured by a known or commonly used formulation. For example, it is prepared by melting one or more active substances in a base.
- the gel base is selected from known or commonly used ones.
- lower alcohol eg, ethanol, isopropyl alcohol, etc.
- gelling agent eg, carboxymethylcellulose, hydroxyethylcellulose, hydroxypropylcellulose, ethylcellulose, etc.
- neutralizing agent eg, triethanolamine, diisopropanolamine, etc.
- surfactants for example, polyethylene glycol monostearate
- gums water
- absorption promoters and anti-rash agents are used alone or in admixture of two or more.
- a preservative, an antioxidant or a flavoring agent may be included.
- Creams are produced by known or commonly used formulations. For example, it is produced by melting or emulsifying one or more active substances in a base.
- the cream base is selected from known or commonly used ones. For example, higher fatty acid esters, lower alcohols, hydrocarbons, polyhydric alcohols (eg, propylene glycol, 1,3-butylene glycol, etc.), higher alcohols (eg, 2-hexyldecanol, cetanol, etc.), emulsifiers (eg, polyoxy (Ethylene alkyl ethers, fatty acid esters, etc.), water, absorption accelerators and anti-rash agents are used alone or in admixture of two or more. Furthermore, a preservative, an antioxidant or a flavoring agent may be included.
- the poultice is manufactured by a known or commonly used formulation. For example, it is produced by melting one or more active substances in a base material, and applying it as a kneaded product on a support.
- the poultice base is selected from known or commonly used ones.
- thickeners eg, polyacrylic acid, polyvinyl pyrrolidone, gum arabic, starch, gelatin, methyl cellulose, etc.
- wetting agents eg, urea, glycerin, propylene glycol, etc.
- fillers eg, kaolin, zinc oxide, Those selected from talc, calcium, magnesium, etc.
- solubilizers, tackifiers and anti-rash agents are used alone or in admixture of two or more.
- a preservative, an antioxidant or a flavoring agent may be included.
- the patch is manufactured by a known or commonly used formulation. For example, it is produced by melting one or more active substances in a base and spreading and coating them on a support.
- the base for patch is selected from known or commonly used ones. For example, those selected from polymer bases, fats and oils, higher fatty acids, tackifiers and anti-rash agents may be used alone or in admixture of two or more. Furthermore, a preservative, an antioxidant or a flavoring agent may be included.
- the liniment is produced by a known or commonly used formulation.
- one or more active substances may be selected from water, alcohol (eg, ethanol, polyethylene glycol, etc.), higher fatty acids, glycerin, soap, emulsifier, suspending agent, etc. alone or in two or more types It is prepared by suspending or emulsifying.
- a preservative, an antioxidant or a flavoring agent may be included.
- compositions for parenteral administration include suppositories for rectal administration and pessaries for intravaginal administration, which contain one or more active substances and are formulated by conventional methods.
- the present invention also includes a test or measurement kit for measuring the indicators constituting each of the biomarkers 1 to 7 according to the present invention.
- the test or measurement kit for example, when measuring PD-1 expression intensity, flow cytometry, multiple immunohistochemical staining (eg, fluorescence or mass cytometry), in situ hybridization (eg, FISH, CISH, SISH and DISH), mass cytometry method, single cell RNA sequencing method or mass imaging method, while CD8 + T cell number, PD-1 expressing CD8 + T cell number, Treg cell Or the number of PD-1 expressing Treg cells may be based on flow cytometry or immunostaining. In any case, a test or measurement kit based on flow cytometry is preferred.
- Example 1 Recovery of lymphocytes from tumor tissue and identification of each T cell by flow cytometry
- Tumor tissue was collected from a cancer patient before administration of Nivolumab, and tumor infiltrating lymph was obtained by tissue disruption with gentleMACS Dissociator (MiltenyiBiotec). Isolated sphere.
- Peripheral blood mononuclear cells were prepared from the peripheral blood of the patient before administration of the immune checkpoint inhibitor by density gradient centrifugation using Ficoll.
- the tumor-infiltrating lymphocytes and peripheral blood mononuclear cells after separation are suspended in PBS (hereinafter, FACSBuffer) to which fetal bovine serum is added to a final concentration of 2%, and then human Fc-Receptor Binding Inhibitor (ThermoFisher) ) was added and reacted at 4 ° C. for 10 minutes. Thereafter, fluorescent dye-labeled antibodies of various cell surface markers (CD3, CD8, CD4, CD45RA and PD-1) were added and reacted at 4 ° C. for 15 minutes.
- FACSBuffer fetal bovine serum
- human Fc-Receptor Binding Inhibitor ThermoFisher
- CD3 positive, CD4 positive, CD8 negative and FoxP3 positive cells were designated as Treg cells
- CD3 positive, CD4 positive, CD8 negative, CD45RA negative and FoxP3 strong positive cells were designated as Treg cells ( Fr.II)
- CD3 positive, CD4 negative and CD8 positive cells were CD8 + T cells.
- Example 2 Confirmation of Nivolumab efficacy determination biomarkers based on PD-1 expression intensities in Treg cells and CD8 + T cells (non-small cell lung cancer)
- the PD-1 expression intensity in each of Treg cells or Treg cells (Fr. II) and CD8 + T cells derived from tumor tissues of 15 non-small cell lung cancer patients before Nivolumab administration was measured by flow cytometry, The average fluorescence intensity (MFI) was calculated.
- non-small cell lung cancer patients 7 patients showed CR or PR effect by Nivolumab administration, and 7 patients were SD or PD. The remaining 1 case was not evaluated and was excluded from the following evaluation.
- CR / PR group the patient group showing CR or PR
- SD / PD group the patient group showing SD or PD
- FIGS. 1 and 2 The results of calculating the ratio of PD-1 expressing MFI in CD8 + T cells to PD-1 expressing MFI in cells (Fr. II) are shown in FIGS. 1 and 2, respectively. Furthermore, the upper and lower limits of the 95% confidence interval were calculated based on the average value and standard deviation of the same ratio in each group. The results are shown in Table 1.
- ratio A represents the ratio of PD-1-expressing MFI in CD8 + T cells to PD-1-expressing MFI in Treg cells
- ratio B represents PD ⁇ in Treg cells (Fr. II).
- 1 represents the ratio of PD-1 expressing MFI in CD8 + T cells to 1 expressing MFI.
- the upper limit value 1.27 of the SD / PD group is set as the reference value (cutoff value)
- the upper limit value 1.25 of the SD / PD group is set as the reference value.
- a non-small cell lung cancer patient showing a ratio equal to or higher than those values can be determined as a patient who can expect the effect of Nivolumab more.
- Example 3 Confirmation of Nivolumab efficacy determination biomarker based on PD-1 expression intensity in Treg cells and CD8 + T cells (gastric cancer)
- the PD-1 expression intensity in each of Treg cells or Treg cells (Fr. II) and CD8 + T cells derived from tumor tissues of 17 gastric cancer patients before Nivolumab administration was measured by flow cytometry, and the MFI was measured. Calculated.
- Nivolumab administration showed the effect of 3 cases becoming PR, and 14 cases were SD or PD.
- the ratio of PD-1-expressing MFI in CD8 + T cells to PD-1-expressing MFI in Treg cells and Treg cells was calculated for each of the patient group showing PR and the SD / PD group, respectively.
- the results are shown in FIGS.
- the upper and lower limits of the 95% confidence interval were calculated based on the average value and standard deviation of the same ratio in each group. The results are shown in Table 2.
- ratio A represents the ratio of PD-1-expressing MFI in CD8 + T cells to PD-1-expressing MFI in Treg cells
- ratio B represents PD ⁇ in Treg cells (Fr. II).
- 1 represents the ratio of PD-1 expressing MFI in CD8 + T cells to 1 expressing MFI.
- the ratio A when the upper limit value 0.74 of the SD / PD group is used as the reference value, while in the ratio B, the upper limit value 0.70 of the SD / PD group is used as the reference value, for example, A gastric cancer patient showing a ratio equal to or higher than the value can be determined as a patient who can expect the effect of Nivolumab more.
- Example 4 Confirmation of biomarker for determining Nivolumab efficacy based on PD-1 expression intensity in CD8 + T cells (non-small cell lung cancer)
- the PD-1 expression intensity in the tumor tissue-derived CD8 + T cells of 15 non-small cell lung cancer patients (same as the patient group in Example 2) before Nivolumab administration was measured by flow cytometry, and its MFI was calculated.
- FIG. 5 shows the results of calculating the MFI in the CR / PR group and SD / PD group. Furthermore, the upper and lower limits of the 95% confidence interval were calculated based on the average value and standard deviation of the same MFI for each group. The results are shown in Table 3.
- the upper limit value 807 of the SD / PD group is used as a reference value, for example, a non-small cell lung cancer patient showing an MFI equal to or higher than that value can be determined as a patient who can expect the effect of Nivolumab more.
- Example 5 Confirmation of Nivolumab efficacy determination biomarker based on PD-1 expression intensity in CD8 + T cells (gastric cancer) PD-1 expression intensity in CD8 + T cells derived from tumor tissues of 17 gastric cancer patients (same as the patient group in Example 3) before Nivolumab administration was measured by flow cytometry, and the MFI was calculated. .
- FIG. 6 shows the results of calculating the same MFI in the PR group and the SD / PD group. Furthermore, the upper and lower limits of the 95% confidence interval were calculated based on the average value and standard deviation of the same MFI for each group. The results are shown in Table 4.
- the upper limit value 410 of the SD / PD group when used as a reference value, for example, a stomach cancer patient showing an MFI equal to or higher than that value can be determined as a patient who can expect the effect of Nivolumab more.
- Example 6 Confirmation of biomarker for determining Nivolumab efficacy based on PD-1 expression ratio in CD8 + T cells (1) (Non-small cell lung cancer) The number of PD-1 expressing cells in CD8 + T cells derived from tumor tissues of 15 non-small cell lung cancer patients (same as the patient group in Example 2) before Nivolumab administration was measured by flow cytometry. + The PD-1 expression ratio (%) in T cells was calculated.
- FIG. 7 shows the results of calculating the same ratio in the CR / PR group and the SD / PD group. Furthermore, the upper limit and the lower limit of the 95% confidence interval were calculated based on the average value and standard deviation of the same ratio in each group. The results are shown in Table 5.
- Example 7 Confirmation of biomarker for determination of efficacy of Nivolumab based on PD-1 expression ratio in CD8 + T cells (1) (gastric cancer) The number of PD-1-expressing cells in the CD8 + T cells derived from tumor tissues of 17 gastric cancer patients (same as the patient group in Example 3) before Nivolumab administration was measured by flow cytometry, and the CD8 + T cells Of these, PD-1 expression ratio (%) was calculated.
- FIG. 8 shows the results of calculating the same ratio in the PR group and the SD / PD group. Furthermore, the upper limit and the lower limit of the 95% confidence interval were calculated based on the average value and standard deviation of the same ratio in each group. The results are shown in Table 6.
- the lower limit value 50.7 of the PR group when used as a reference value, for example, a gastric cancer patient showing a PD-1 expression ratio equal to or higher than that value can be determined as a patient who can expect the effect of Nivolumab more.
- Example 8 Confirmation of biomarker for determination of efficacy of Nivolumab based on PD-1 expression ratio in CD8 + T cells (2) (Non-small cell lung cancer: NSCLC) The number of PD-1 expressing cells in CD8 + T cells derived from tumor tissues of 12 non-small cell lung cancer patients before Nivolumab administration was measured by flow cytometry, and the PD-1 expression ratio in CD8 + T cells ( %) was calculated.
- the upper limit value 51.8 of the Non-Responder group when used as a reference value, for example, a non-small cell lung cancer patient exhibiting a PD-1 expression ratio equal to or higher than that value is considered as a patient who can expect more effects of Nivolumab. Can be judged.
- the upper non-small cell lung cancer patients were divided into two groups according to the median PD-1 expression ratio (52.9%), and the progression-free survival (PFS) of each group was calculated. .
- Example 9 Confirmation of Nivolumab efficacy determination biomarker based on PD-1 expression ratio in CD8 + T cells (2) (gastric cancer: GC) The number of PD-1 expressing cells in CD8 + T cells derived from tumor tissues of 23 gastric cancer patients before Nivolumab administration was measured by flow cytometry, and the PD-1 expression ratio (%) in CD8 + T cells was determined. Calculated.
- the lower limit value 56.8 of the Responder group when used as a reference value, for example, a gastric cancer patient showing a PD-1 expression ratio equal to or higher than that value can be determined as a patient who can expect the effect of Nivolumab more.
- the lower gastric cancer patients were divided into two groups according to the median PD-1 expression rate (55.8%), and the results of calculating progression-free survival (PFS) of each group are shown in the lower part of FIG.
- Example 10 Confirmation of Nivolumab efficacy determination biomarker based on PD-1 expression ratio in Treg cells (Fr. II) (gastric cancer: GC) The number of PD-1-expressing cells in Treg cells (Fr. II) derived from tumor tissues of 23 gastric cancer patients before administration of Nivolumab was measured by flow cytometry, and PD-1 in Treg cells (Fr. II) was measured. The expression rate (%) was calculated.
- the upper limit value 58.4 of the Responder group when used as a reference value, for example, a stomach cancer patient showing a ratio less than that value can be determined as a patient who can expect the effect of Nivolumab more.
- FIG. 12 shows the results of calculating the progression-free survival (PFS) of each group by dividing the stomach cancer patients into two groups based on the median PD-1 expression ratio (62.3%).
- Example 11 Confirmation of biomarkers for determining Nivolumab efficacy based on PD-1 expression intensities in Treg cells (Fr. II) and CD8 + T cells (non-small cell lung cancer)
- the PD-1 expression intensity in each of Treg cells (Fr. II) and CD8 + T cells derived from tumor tissues of 12 non-small cell lung cancer patients before Nivolumab administration was measured by flow cytometry, and the average fluorescence intensity (MFI) was calculated.
- the upper limit value 1.20 of the Non-Responder group when used as a reference value, for example, a non-small cell lung cancer patient showing a ratio higher than that value can be determined as a patient who can expect the effect of Nivolumab more.
- Example 12 Confirmation of biomarkers for determination of efficacy of Nivolumab based on PD-1 expression intensities in Treg cells (Fr. II) and CD8 + T cells (gastric cancer)
- the PD-1 expression intensity in each of Treg cells (Fr. II) and CD8 + T cells derived from tumor tissues of 23 gastric cancer patients before administration of Nivolumab was measured by flow cytometry, and the mean fluorescence intensity (MFI) was calculated.
- the upper limit value 0.95 of the Non-Responder group when used as a reference value, for example, a stomach cancer patient showing a ratio higher than that value can be determined as a patient who can expect the effect of Nivolumab more.
- Example 13 Confirmation of biomarkers for determining Nivolumab efficacy based on PD-1 expression ratio (%) in Treg cells (Fr. II) and CD8 + T cells
- the analysis and calculation in Examples 8 and 9 Analysis and calculation according to Example 10 with the horizontal axis representing PD-1 expression ratio (%) in CD8 + T cells derived from tumor tissues of non-small cell lung cancer patients (12 patients) and gastric cancer patients (23 patients).
- the PD-1 expression ratio (%) in Treg cells (Fr. II) derived from each tumor tissue of the same patient group was plotted on the vertical axis. The result is shown in FIG.
- the PD-1 expression ratio (%) in CD8 + T cells is 40% or more, and the CD8 + T ratio relative to the PD-1 expression ratio (%) in Treg cells (Fr. II). It was confirmed that the Responder group and the Non-Responder group can be selected by providing a condition where the PD-1 expression ratio (%) ratio in the cells is 1.0 or more. Therefore, it was confirmed that the patient who satisfy
- the PD-1 expression ratio (%) in CD8 + T cells is 40% or more, and the PD-1 expression MFI in Treg cells (Fr. II) It was also confirmed that a patient having a ratio of PD8-expressing MFI in CD8 + T cells of 1.0 or more can be determined as a patient who can expect the effect of Nivolumab more.
- the non-small cell lung cancer patients (12 patients) and gastric cancer patients (23 patients) are divided into two groups, a patient group “Group R” that satisfies the condition and a patient group “The others” that does not satisfy the condition.
- the results of calculating the progression-free survival (PFS) of the group are shown in FIG.
- Example 14 Confirmation of biomarkers for determining Nivolumab efficacy based on PD-1 expression intensity and PD-1 expression ratio (%) in Treg cells (Fr. II) and CD8 + T cells
- N-small before administration of Nivolumab PD-1 expression intensity in each of Treg cells (Fr. II) and CD8 + T cells derived from tumor tissues of 13 patients with cell lung cancer was measured by flow cytometry, and the average fluorescence intensity (MFI) was calculated.
- MFI average fluorescence intensity
- the number of PD-1 expressing cells in each of the tumor tissue-derived CD8 + T cells was measured by flow cytometry, and the PD-1 expression ratio (%) in the CD8 + T cells was calculated.
- the ratio of tumor volume change (%) on the horizontal axis to the ratio of PD-1 expression intensity in the same CD8 + T cells to PD-1 expression intensity in the same Treg cells, and the PD of the CD8 + T cells The numerical value calculated by multiplying the percentage of -1 expressing cells was plotted on the vertical axis. The result is shown in FIG. One of the 13 people was excluded from the results because it was missing data.
- the same value is 60 or more (shown by a broken line) or as shown in Table 12, the same value is 46.0 or more (upper limit of 95% confidence interval of the increased group). It was confirmed that by setting a certain condition, a group in which the tumor volume was unchanged or decreased and a group in which the tumor volume was increased could be selected. Therefore, it was confirmed that the patient who satisfy
- Example 15 Confirmation of biomarkers for determining Nivolumab efficacy based on PD-1 expression ratio (%) in Treg cells (Fr. II) and CD8 + T cells
- PD-1 expression ratio (%) was calculated.
- the tumor volume change rate (%) on the horizontal axis the square of the PD-1 expression ratio (%) in the CD8 + T cells was divided by the PD-1 expression ratio (%) in the Treg cells (Fr. II). Numerical values were plotted on the vertical axis. The result is shown in FIG.
- the same value is 60 or more (shown by a broken line) or as shown in Table 13, the same value is 44.4 or more (upper limit of 95% confidence interval of the increased group). It was confirmed that by setting a certain condition, a group in which the tumor volume was unchanged or decreased and a group in which the tumor volume increased could be selected. Therefore, it was confirmed that the patient who satisfy
- Example 16 Confirmation of biomarker for determining Nivolumab efficacy based on PD-1 expression ratio (%) in Treg cells (Fr. II) and CD8 + T cells
- PD-1 expression ratio (%) in Treg cells (Fr. II) and CD8 + T cells Non-small cells in the same manner as in Example 15.
- the CD8 + T cells A value obtained by dividing the square of the PD-1 expression ratio (%) by the PD-1 expression ratio (%) in the Treg cells (Fr. II) was calculated.
- a reference value positive group (a group that is greater than or equal to each reference value) when the reference values (CUT) based on the values are 25, 40, 60, 90, and 100, respectively.
- BM + and negative group (groups below BM: BM-)
- progression-free survival (PFS) after administration of Nivolumab is shown in FIGS.
- PFS progression-free survival
- a patient with a reference value of 40 or more can be determined as a patient who can expect the effect of Nivolumab more, whereas for a patient with stomach cancer, the reference value is 25. It was confirmed that the above patients can be determined as patients who can expect the effect of Nivolumab more.
- Example 17 Confirmation of biomarkers for determination of Nivolumab efficacy in head and neck cancer patients Regarding Treg cells and Treg cells (Fr. II) and CD8 + T cells derived from tumor tissues of 3 head and neck cancer patients before Nivolumab administration Their PD-1 expression intensity and PD-1 expression ratio (%) were each measured by flow cytometry.
- the ratio A represents the ratio of the biomarker 1 of the present invention (in the case of Treg cells), and the ratio B represents the ratio of the biomarker 1 (in the case of Treg cells (Fr. II)).
- the calculated value C represents the MFI value of the biomarker 2 of the present invention, and the calculated values D and E represent the PD-1 expression ratio (%) of the biomarkers 3 and 4 of the present invention, respectively.
- the Responder group (2 persons) and the Non-Responder group (1 person) both groups are the same as those defined in Example 8.
- the results of calculating the ratio of biomarker 1 are shown in the left figure of FIG. 23, and the ratio of biomarker 1 in Treg cells (Fr. II) is shown in the right figure.
- each PD- of the biomarker 3 of the present invention in the Responder group (2 persons) and the Non-Responder group (1 person) of the same head and neck cancer patient and the biomarker 4 in the Treg cells (Fr. II) respectively.
- the expression ratio (%) is shown in the left and right diagrams of FIG.
- the numerical value of the biomarker 6 of the present invention in the Responder group (2 persons) and Non-Responder group (1 person) of the head and neck cancer patients is shown in FIG. )
- the values of the biomarker 7 of the present invention are shown in FIG.
- FIG. 27 shows the result of plotting the PD-1 expression ratio (%) in Treg cells (Fr. II) on the vertical axis.
- Example 18 Calculation of ratio of biomarker 1 of the present invention based on MESF value Treg derived from tumor tissues of non-small cell lung cancer patients (2), head and neck cancer patients (1) and colon cancer patients (1)
- the PD-1 expression intensity in each of the cells, Treg cells (Fr. II) and CD8 + T cells was measured by flow cytometry, and the average fluorescence intensity (MFI) was calculated.
- MFI average fluorescence intensity
- a calibration curve for antigen molecule quantification was prepared by a known measurement method using fluorescently labeled beads, and the number of expression of cell surface antigen molecules (expression level) determined from “PD-1 expression intensity” in the biomarker Molecules of Equivalent Soluble Fluorochrome (MESF).
- Table 15 shows the ratio of the biomarker 1 of the present invention based on the MESF value and the MESF value.
- calculated value A indicates PD-1 expression intensity (MFI) in Treg cells (Fr. II)
- calculated value B indicates PD-1 expression intensity (MFI) in CD8 + T cells
- the calculated value C indicates the number of PD-1 expression (expression level) in Treg cells (Fr. II)
- the calculated value D indicates the number of PD-1 expression (expression level) in CD8 + T cells.
- the ratio A represents the ratio of the calculated value B to the calculated value A
- the ratio B represents the ratio of the calculated value D to the calculated value C. In calculating the ratio of biomarker 1, it was confirmed that the MESF value could be used instead of PD-1-expressing MFI.
- a malignant tumor patient who can be expected to be more effective as an immune checkpoint inhibitor can be identified.
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Abstract
Description
すなわち、本発明は、以下のとおりである。
[1] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率(以下、本明細書において、同比率を「バイオマーカー1」と略記することがある。)が約0.7以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[2] 前項[1]記載の比率が約0.74以上である前項[1]記載の剤。
[3] 前項[1]記載の比率が約0.8以上である前項[1]記載の剤。
[4] 前項[1]記載の比率が約0.9以上である前項[1]記載の剤。
[5] 前項[1]記載の比率が約1.0以上である前項[1]記載の剤。
[6] 前項[1]記載の比率が約1.1以上である前項[1]記載の剤。
[7] 前項[1]記載の比率が約1.2以上である前項[1]記載の剤。
[8] 前項[1]記載の比率が約1.25以上である前項[1]記載の剤。
[9] 前項[1]記載の比率が約1.27以上である前項[1]記載の剤。
[10] 前項[1]記載の比率が約1.3以上である前項[1]記載の剤。
[11] 前項[1]記載の比率が約1.4以上である前項[1]記載の剤。
[12] 前項[1]記載の比率が約1.5以上である前項[1]記載の剤。
[13] 前項[1]記載の比率が約1.6以上である前項[1]記載の剤。
[14] 前項[1]記載の比率が約1.7以上である前項[1]記載の剤。
[15] 前項[1]記載の比率が約1.8以上である前項[1]記載の剤。
[16] 前項[1]記載の比率が約1.9以上である前項[1]記載の剤。
[17] 前項[1]記載の比率が約0.7~約1.9の間の任意の比率以上である前項[1]記載の剤。
[18] 前項[1]記載の比率が、約2.6~約5.9の間の任意の比率以下である前項[1]~[17]の何れか一項記載の剤。
[19] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞でのPD-1発現強度について、フローサイトメトリー法により測定された平均蛍光強度(Mean Fluorescence Intensity(以下、MFIと略記する。また、本明細書において、同MFIを「バイオマーカー2」と略記することがある。))が約400以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[20] 前項[19]記載のPD-1発現のMFIが約410以上である前項[19]記載の剤。
[21] 前項[19]記載のPD-1発現のMFIが約450以上である前項[19]記載の剤。
[22] 前項[19]記載のPD-1発現のMFIが約500以上である前項[19]記載の剤。
[23] 前項[19]記載のPD-1発現のMFIが約550以上である前項[19]記載の剤。
[24] 前項[19]記載のPD-1発現のMFIが約600以上である前項[19]記載の剤。
[25] 前項[19]記載のPD-1発現のMFIが約650以上である前項[19]記載の剤。
[26] 前項[19]記載のPD-1発現のMFIが約700以上である前項[19]記載の剤。
[27] 前項[19]記載のPD-1発現のMFIが約750以上である前項[19]記載の剤。
[28] 前項[19]記載のPD-1発現のMFIが約800以上である前項[19]記載の剤。
[29] 前項[19]記載のPD-1発現のMFIが約810以上である前項[19]記載の剤。
[30] 前項[19]記載のPD-1発現のMFIが約850以上である前項[19]記載の剤。
[31] 前項[19]記載のPD-1発現のMFIが約400~約850の間の任意の数値以上である前項[19]記載の剤。
[32] 前項[19]記載のPD-1発現のMFIが、約2050~約2810の間の任意の数値以下である前項[19]~[31]の何れか一項記載の剤。
[33] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)(以下、本明細書において、同割合を「バイオマーカー3」と略記することがある。)が約35%以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[34] 前項[33]記載の割合が約40%以上である前項[33]記載の剤。
[35] 前項[33]記載の割合が約45%以上である前項[33]記載の剤。
[36] 前項[33]記載の割合が約49.7%以上である前項[33]記載の剤。
[37] 前項[33]記載の割合が約50%以上である前項[33]記載の剤。
[38] 前項[33]記載の割合が約50.7%以上である前項[33]記載の剤。
[39] 前項[33]記載の割合が約60%以上である前項[33]記載の剤。
[40] 前項[33]記載の割合が約70%以上である前項[33]記載の剤。
[41] 前項[33]記載の割合が約35~約70%の間の任意の割合以上である前項[33]記載の剤。
[42] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)(以下、本明細書において、同割合を「バイオマーカー4」と略記することがある。)が約65%未満である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[43] 前項[42]記載の割合が約60%未満である前項[42]記載の剤。
[44] 前項[42]記載の割合が約58.4%未満である前項[42]記載の剤。
[45] 前項[42]記載の割合が約55%未満である前項[42]記載の剤。
[46] 前項[42]記載の割合が約65~約55%の間の任意の割合未満である前項[42]記載の剤。
[47] (a1)悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率(バイオマーカー1)もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)(バイオマーカー4)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)(バイオマーカー3)との比率の何れかが約0.8以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)(バイオマーカー3)が約35%以上である(以下、本明細書において、当該(a1)もしくは(a2)の比率および当該(b)の割合の組合せを「バイオマーカー5」と略記することがある。)悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[48] 前項[47]の(a1)または(a2)記載の比率が約0.9以上である前項[47]記載の剤。
[49] 前項[47]の(a1)または(a2)記載の比率が約1.0以上である前項[47]記載の剤。
[50] 前項[47]の(a1)または(a2)記載の比率が約1.1以上である前項[47]記載の剤。
[51] 前項[47]の(a1)または(a2)記載の比率が約1.2以上である前項[47]記載の剤。
[52] 前項[47]の(b)記載の割合が約40%以上である前項[47]~[51]の何れか一項記載の剤。
[53] 前項[47]の(b)記載の割合が約45%以上である前項[47]~[51]の何れか一項記載の剤。
[54] (a1)悪性腫瘍患者の腫瘍組織内のTreg細胞でのPD-1発現強度に対する、同組織内のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約1.0以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約40%以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[55] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率(バイオマーカー1)に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)(バイオマーカー3)を乗じて算出される数値(以下、本明細書において、同数値を「バイオマーカー6」と略記することがある。)が約25以上である、悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[56] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)(バイオマーカー3)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)(バイオマーカー4)で除して算出される数値(以下、本明細書において、同数値を「バイオマーカー7」と略記することがある。)が約25以上である、悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
[57] 前項[55]または[56]記載の数値が約40以上または約44.4以上である、前項[55]または[56]記載の剤。
[58] 前項[55]または[56]記載の数値が約46.0以上または約50以上である、前項[55]または[56]記載の剤。
[59] 前項[55]または[56]記載の数値が約60以上である、前項[55]または[56]記載の剤。
[60] 前項[55]または[56]記載の数値が約90以上である、前項[55]または[56]記載の剤。
[61] 前項[55]または[56]記載の数値が約100以上である、前項[55]または[56]記載の剤。
[62] 腫瘍組織内または血液中のTreg細胞およびCD8+T細胞での各々のPD-1発現強度が、フローサイトメトリー法によって測定されるMFI、多重免疫組織染色法によって測定される発現強度もしくは発現強度スコア、in situ ハイブリダイゼーション法によって測定されるシグナル強度もしくは発現強度スコア、マスサイトメトリー法によって測定される発現強度もしくはシグナル強度、シングルセルRNAシーケンス法によって測定される発現レベルもしくは遺伝子カウント値またはマスイメージング法によって測定される発現強度もしくは発現強度スコアで表される前項[1]~[18]、[47]~[55]および[57]~[61]の何れか一項記載の剤。
[63] 腫瘍組織内または血液中のCD8+T細胞およびTreg細胞の各々の細胞数ならびにそれらのうちの各々のPD-1発現細胞数が、フローサイトメトリー法または免疫染色法にて測定される、前項[33]~[61]の何れか一項記載の剤。
[64] 当該Treg細胞が、Fraction II Treg細胞(以下、「Treg細胞(Fr.II)」または「eTreg細胞」と略記することがある。)である、前項[1]~[18]および[42]~[63]の何れか一項記載の剤。
[65] 当該免疫チェックポイント阻害物質が、抗PD-1抗体、抗PD-L1抗体、PD-1拮抗剤、PD-L1/VISTA拮抗剤、PD-L1/TIM3拮抗剤、抗PD-L2抗体、PD-L1融合タンパク質、PD-L2融合タンパク質、抗CTLA-4抗体、抗LAG-3抗体、LAG-3融合蛋白質、抗Tim3抗体、抗KIR抗体、抗BTLA抗体、抗TIGIT抗体、抗VISTA抗体、抗CSF-1R抗体またはCSF-1R阻害剤である、前項[1]~[64]の何れか一項記載の剤。
[66] 当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283である前項[65]記載の剤。
[67] 当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072である前項[65]記載の剤。
[68] 当該抗CTLA-4抗体が、Ipilimumab、AGEN1884またはTremelimumabである前項[65]記載の剤。
[69] 当該悪性腫瘍が、固形がんまたは血液がんである前項[1]~[68]の何れか一項記載の剤。
[70] 当該固形がんが、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、高頻度マイクロサテライト不安定性(以下、「MSI-H」と略記する。)および/またはミスマッチ修復欠損(以下、「dMMR」と略記する。)陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上のがんである前項[69]記載の剤。
[71] 当該血液がんが、多発性骨髄腫、悪性リンパ腫(例えば、非ホジキンリンパ腫(例えば、濾胞性リンパ腫、びまん性大細胞型B細胞性リンパ腫、MALTリンパ腫、リンパ形質細胞性リンパ腫、菌状息肉症、セザリー症候群、慢性または急性リンパ球性白血病、末梢性T細胞リンパ腫、節外性NK/T細胞リンパ腫、成人T細胞白血病、B細胞リンパ芽球性白血病、T細胞リンパ芽球性白血病およびリンパ形質細胞性リンパ腫)およびホジキンリンパ腫(例えば、古典的ホジキンリンパ腫および結節性リンパ球優位型ホジキンリンパ腫))、白血病(例えば、急性骨髄性白血病および慢性骨髄性白血病)、中枢神経系原発悪性リンパ腫、骨髄異形成症候群および骨髄増殖症候群から選択される一以上のがんである、前項[69]記載の剤。
[72] 当該悪性腫瘍が非小細胞肺癌の場合、前項[1]記載の比率が、1.2以上である前項[1]、[18]、[62]および[64]~[70]の何れか一項記載の剤。
[73] 当該悪性腫瘍が非小細胞肺癌の場合、前項[19]記載のPD-1発現のMFIが、800以上である前項[19]、[32]および[65]~[70]の何れか一項記載の剤。
[74] 当該悪性腫瘍が非小細胞肺癌の場合、前項[56]記載の数値が、約40以上である前項[56]および[63]~[70]の何れか一項記載の剤。
[75] 当該悪性腫瘍が胃癌の場合、前項[1]記載の比率が、0.7以上である前項[1]、[18]、[62]および[64]~[70]の何れか一項記載の剤。
[76] 当該悪性腫瘍が胃癌の場合、前項[19]記載のPD-1発現のMFIが、410以上である前項[19]、[32]および[65]~[70]の何れか一項記載の剤。
[77] 当該悪性腫瘍が、小児がんまたは原発不明がんである、前項[1]~[69]の何れか一項記載の剤。
[78] 当該悪性腫瘍が、他の抗悪性腫瘍薬による治療効果が不十分あるいは十分ではない悪性腫瘍である、前項[1]~[77]の何れか一項記載の剤。
[79] 当該悪性腫瘍が、他の抗悪性腫瘍薬による治療後に増悪した悪性腫瘍である、前項[1]~[77]の何れか一項記載の剤。
[80] 悪性腫瘍患者が、他の抗悪性腫瘍薬による治療歴のない、前項[1]~[77]の何れか一項記載の剤。
[81] 術後補助療法または術前補助療法において処方される前項[1]~[80]の何れか一項記載の剤。
[82] 当該悪性腫瘍が、根治もしくは切除不能、転移性、再発性、難治性および/または遠隔転移性である、前項[1]~[81]の何れか一項記載の剤。
[83] 腫瘍組織内の腫瘍細胞のうちPD-L1を発現した腫瘍細胞が占める割合(以下、「TPS」と略記する。)またはPD-L1陽性細胞数(腫瘍細胞、リンパ球およびマクロファージ)を総腫瘍細胞数で除し、100を乗じた数値(以下、「CPS」と略記する。)が、50%以上、25%以上、10%以上、5%以上または1%以上である、前項[1]~[82]の何れか一項記載の剤。
[84] TPSまたはCPSが50%未満、25%未満、10%未満、5%未満または1%未満である、前項[1]~[82]の何れか一項記載の剤。
[85] 当該悪性腫瘍が、MSI-Hおよび/またはdMMRを有する、前項[1]~[84]の何れか一項記載の剤。
[86] 当該悪性腫瘍が、MSI-Hおよび/またはdMMRを有しない、もしくは低頻度マイクロサテライト不安定性(以下、「MSI-L」と略記する。)を有する、前項[1]~[84]の何れか一項記載の剤。
[87] 悪性黒色腫または非小細胞肺癌が、BRAF V600E変異陽性である、前項[70]、[72]~[74]および[77]~[86]の何れか一項記載の剤。
[88] 悪性黒色腫または非小細胞肺癌が、BRAF V600野生型である、前項[70]、[72]~[74]および[77]~[86]の何れか一項記載の剤。
[89] 非小細胞肺癌が、EGFR遺伝子変異陽性および/またはALK融合遺伝子陽性である、前項[70]、[72]~[74]および[77]~[88]の何れか一項記載の剤。
[90] 非小細胞肺癌が、EGFR遺伝子変異陰性および/またはALK融合遺伝子陰性である、前項[70]、[72]~[74]および[77]~[88]の何れか一項記載の剤。
[91] 当該悪性腫瘍の腫瘍変異負荷(以下、「TMB」と略記する。)が高頻度(106塩基当たりの変異数が10個以上)である、前項[1]~[90]の何れか一項記載の剤。
[92] 当該悪性腫瘍のTMBが低頻度(106塩基当たりの変異数が10個未満)である、前項[1]~[90]の何れか一項記載の剤。
[93] さらに、他の抗悪性腫瘍薬と併用される前項[1]~[92]の何れか一項記載の剤。
[94] 当該他の抗悪性腫瘍薬が、アルキル化薬、白金製剤、代謝拮抗剤(例えば、葉酸代謝拮抗薬、ピリジン代謝阻害薬、プリン代謝阻害薬)、リボヌクレオチドリダクターゼ阻害薬、ヌクレオチドアナログ、トポイソメラーゼ阻害薬、微小管重合阻害薬、微小管脱重合阻害薬、抗腫瘍性抗生物質、サイトカイン製剤、抗ホルモン薬、分子標的薬およびがん免疫治療薬から選択される一以上の薬剤である前項[78]~[80]または[93]記載の剤。
[95] 当該悪性腫瘍患者が、当該免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における患者である前項[1]~[94]の何れか一項記載の剤。
[96] 抗PD-1抗体または抗PD-L1抗体を有効成分とする薬剤の投与前における、悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞(Fr.II)でのPD-1発現強度(例えば、MFI)に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度(例えば、MFI)との比率が約0.7以上である悪性腫瘍患者に投与されることを特徴とする、当該抗PD-1抗体または抗PD-L1抗体を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤であって、当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283であり、当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072であり、当該悪性腫瘍が、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の悪性腫瘍である、当該薬剤。
[97] (a1)抗PD-1抗体または抗PD-L1抗体を有効成分とする薬剤の投与前における悪性腫瘍患者の腫瘍組織内のTreg細胞(Fr.II)でのPD-1発現強度(例えば、MFI)に対する、同組織内のCD8+T細胞でのPD-1発現強度(例えば、MFI)との比率もしくは(a2)当該Treg細胞(Fr.II)のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約1.0以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約40%以上である悪性腫瘍患者に投与されることを特徴とする、当該抗PD-1抗体または抗PD-L1抗体を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤であって、当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283であり、当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072であり、当該悪性腫瘍が、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の悪性腫瘍である、当該薬剤。
[98] 当該腫瘍組織が、少なくとも腫瘍塊自体、腫瘍の浸潤性周辺部あるいは腫瘍に隣接するリンパ節を含む組織である前項[1]~[97]の何れか一項記載の剤。
[1-1] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率が0.7以上である(または当該比率が0.7以上であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
[1-2]悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞でのPD-1発現について、フローサイトメトリー法により測定されたMFIが約400以上である(または当該MFIが約400以上であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
[1-3] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)が約35%以上である(または当該割合(%)が約35%以上であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
[1-4] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)が約65%未満である(または当該割合(%)が約65%未満であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
[1-5] (a1)悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約0.8以上であり(または当該比率の何れかが約0.8以上であることが確認され)、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約35%以上である(または当該割合(%)が約35%以上であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
[1-6] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値が約25以上である(または当該数値が約25以上であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
[1-7] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値が約25以上である(または当該数値が約25以上であることが確認された)悪性腫瘍患者に、有効量の免疫チェックポイント阻害薬を投与することを含む、悪性腫瘍の進行抑制、再発抑制および/または治療方法。
なお、前記[1-1]~[1-7]における各方法は、各バイオマーカーに基づき特定された悪性腫瘍患者のみに有効量の免疫チェックポイント阻害薬を投与するという治療方法等を意味し、また、そのような患者を特定するプロセスを含む場合がある。
[2-1] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率が約0.7以上である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[2-2]悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞でのPD-1発現について、フローサイトメトリー法により測定されたMFIが約400以上である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[2-3] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)が約35%以上である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[2-4] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)が約65%未満である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[2-5] (a1)悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約0.8以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約35%以上である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[2-6] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値が約25以上である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[2-7] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値が25以上である悪性腫瘍患者に対する悪性腫瘍の進行および/もしくは再発の抑制ならびに/または治療における使用のための免疫チェックポイント阻害薬。
[3-1] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率が約0.7以上である悪性腫瘍患者に投与されることを特徴とする悪性腫瘍の進行抑制、再発抑制および/または治療剤を製造するための免疫チェックポイント阻害物質の使用。
[3-2] (a1)悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約0.8以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約35%以上である悪性腫瘍患者に投与されることを特徴とする悪性腫瘍の進行抑制、再発抑制および/または治療剤を製造するための免疫チェックポイント阻害物質の使用。
[3-3] 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値が約25以上である悪性腫瘍患者に投与されることを特徴とする悪性腫瘍の進行抑制、再発抑制および/または治療剤を製造するための免疫チェックポイント阻害物質の使用。
[3-4] 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値が25以上である悪性腫瘍患者に投与されることを特徴とする悪性腫瘍の進行抑制、再発抑制および/または治療剤を製造するための免疫チェックポイント阻害物質の使用。
[4-1] 悪性腫瘍患者の腫瘍組織または血液よりTreg細胞およびCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、フローサイトメトリー法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、当該Treg細胞および当該CD8+T細胞におけるPD-1発現強度を各々測定して、当該Treg細胞でのPD-1発現強度に対する、当該CD8+T細胞でのPD-1発現強度との比率を決定し、当該比率に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-2] 当該免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者として、当該比率が約0.7以上である患者を特定する、前項[4-1]記載の方法。
[4-3] 前項[4-2]記載の比率が約0.74以上である前項[4-2]記載の方法。
[4-4] 前項[4-2]記載の比率が約0.8以上である前項[4-2]記載の方法。
[4-5] 前項[4-2]記載の比率が約0.9以上である前項[4-2]記載の方法。
[4-6] 前項[4-2]記載の比率が約1.0以上である前項[4-2]記載の方法。
[4-7] 前項[4-2]記載の比率が約1.1以上である前項[4-2]記載の方法。
[4-8] 前項[4-2]記載の比率が約1.2以上である前項[4-2]記載の方法。
[4-9] 前項[4-2]記載の比率が約1.25以上である前項[4-2]記載の方法。
[4-10] 前項[4-2]記載の比率が約1.27以上である前項[4-2]記載の方法。
[4-11] 前項[4-2]記載の比率が約1.3以上である前項[4-2]記載の方法。
[4-12] 前項[4-2]記載の比率が約1.4以上である前項[4-2]記載の方法。
[4-13] 前項[4-2]記載の比率が約1.5以上である前項[4-2]記載の方法。
[4-14] 前項[4-2]記載の比率が約1.6以上である前項[4-2]記載の方法。
[4-15] 前項[4-2]記載の比率が約1.7以上である前項[4-2]記載の方法。
[4-16] 前項[4-2]記載の比率が約1.8以上である前項[4-2]記載の方法。
[4-17] 前項[4-2]記載の比率が約1.9以上である前項[4-2]記載の方法。
[4-18] 前項[4-2]記載の比率が約0.7~約1.9の間の任意の比率以上である前項[4-2]記載の方法。
[4-19] 前項[4-2]記載の比率が、約2.6~約5.9の間の任意の比率以下である前項[4-2]~[4-18]の何れか一項記載の方法。
[4-20] 悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、フローサイトメトリー法にて当該CD8+T細胞におけるPD-1発現のMFIを測定して、当該MFIに基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-21] 当該免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者として、当該MFIが約400以上である患者を特定する、前項[4-20]記載の方法。
[4-22] 前項[4-21]記載のMFIが約410以上である前項[4-21]記載の方法。
[4-23] 前項[4-21]記載のMFIが約450以上である前項[4-21]記載の方法。
[4-24] 前項[4-21]記載のMFIが約500以上である前項[4-21]記載の方法。
[4-25] 前項[4-21]記載のMFIが約550以上である前項[4-21]記載の方法。
[4-26] 前項[4-21]記載のMFIが約600以上である前項[4-21]記載の方法。
[4-27] 前項[4-21]記載のMFIが約650以上である前項[4-21]記載の方法。
[4-28] 前項[4-21]記載のMFIが約700以上である前項[4-21]記載の方法。
[4-29] 前項[4-21]記載のMFIが約750以上である前項[4-21]記載の方法。
[4-30] 前項[4-21]記載のMFIが約800以上である前項[4-21]記載の方法。
[4-31] 前項[4-21]記載のMFIが約810以上である前項[4-21]記載の方法。
[4-32] 前項[4-21]記載のMFIが約850以上である前項[4-21]記載の方法。
[4-33] 前項[4-21]記載のMFIが約400~約850の間の任意の数値以上である前項[4-21]記載の方法。
[4-34] 前項[4-21]記載のPD-1発現のMFIが、約2050~約2810の間の任意の数値以下である前項[4-21]~[4-33]の何れか一項記載の方法。
[4-35] 悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、フローサイトメトリー法または免疫染色法にて、CD8+T細胞数およびそのうちのPD-1発現細胞数を各々測定して、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を決定し、当該割合に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-36] 当該免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者として、当該割合が約35%以上である患者を特定する、前項[4-35]記載の方法。
[4-37] 前項[4-36]記載の割合が約40%以上である前項[4-36]記載の剤。
[4-38] 前項[4-36]記載の割合が約45%以上である前項[4-36]記載の剤。
[4-39] 前項[4-36]記載の割合が約49.7%以上である前項[4-36]記載の方法。
[4-40] 前項[4-36]記載の割合が約50%以上である前項[4-36]記載の方法。
[4-41] 前項[4-36]記載の割合が約50.7%以上である前項[4-36]記載の方法。
[4-42] 前項[4-36]記載の割合が約60%以上である前項[4-36]記載の方法。
[4-43] 前項[4-36]記載の割合が約70%以上である前項[4-36]記載の方法。
[4-44] 前項[4-36]記載の割合が約35~70%の間の任意の割合以上である前項[4-36]記載の方法。
[4-45] 悪性腫瘍患者の腫瘍組織または血液よりTreg細胞を含む細胞集団を採取、必要に応じて精製し、フローサイトメトリー法または免疫染色法にて、Treg細胞数およびそのうちのPD-1発現細胞数を各々測定して、当該Treg細胞のうちのPD-1発現細胞数の割合(%)を決定し、当該割合に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-46] 当該免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者として、当該割合が約65%未満である患者を特定する、前項[4-45]記載の方法。
[4-47] 前項[4-46]記載の割合が約60%未満である前項[4-46]記載の方法。
[4-48] 前項[4-46]記載の割合が約58.4%未満である前項[4-46]記載の方法。
[4-49] 前項[4-46]記載の割合が約55%未満である前項[4-46]記載の方法。
[4-50] 前項[4-46]記載の割合が約65~約55%の間の任意の割合未満である前項[4-46]記載の方法。
[4-51] (i)悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞およびTreg細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、(iia)当該CD8+T細胞および当該Treg細胞における各々のPD-1発現強度もしくは(iib)CD8+T細胞数およびTreg細胞数ならびにそれらのうちのPD-1発現細胞数を各々測定して、(iii)(a1)当該Treg細胞でのPD-1発現強度に対する、当該CD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率および(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を決定し、当該(a1)もしくは(a2)の比率および当該(b)の割合の組合せに基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-52] 当該免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者として、前項[4-51]の(a1)もしくは(a2)記載の比率が約0.8以上であり、かつ同項(b)記載の割合が約35%以上である患者を特定する、前項[4-51]記載の方法。
[4-53] 前項[4-52]記載の(a1)もしくは(a2)記載の比率が約0.9以上である前項[4-52]記載の方法。
[4-54] 前項[4-52]記載の(a1)もしくは(a2)記載の比率が約1.0以上である前項[4-52]記載の方法。
[4-55] 前項[4-52]記載の(a1)もしくは(a2)記載の比率が約1.1以上である前項[4-52]記載の方法。
[4-56] 前項[4-52]記載の(a1)もしくは(a2)記載の比率が約1.2以上である前項[4-52]記載の方法。
[4-57] 前項[4-52]記載の(b)記載の割合が約40%以上である前項[4-52]~[4-56]の何れか一項記載の方法。
[4-58] 前項[4-52]記載の(b)記載の割合が約45%以上である前項[4-52]~[4-56]の何れか一項記載の方法。
[4-59] 免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者を特定する方法であって、(i)悪性腫瘍患者の腫瘍組織または血液よりTreg細胞およびCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、(iia)当該CD8+T細胞および当該Treg細胞における各々のPD-1発現強度もしくは(iib)当該CD8+T細胞およびTreg細胞の各々の細胞数ならびにそれらのうちのPD-1発現細胞数を各々測定して、(iii)当該免疫チェックポイント阻害薬の効果がより期待できる患者として、(a1)当該Treg細胞でのPD-1発現強度に対する当該CD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約1.0以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約40%以上である患者を特定する方法。
[4-60] (i)悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞およびTreg細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、当該CD8+T細胞およびTreg細胞での各々のPD-1発現強度ならびに当該CD8+T細胞の細胞数およびそのうちのPD-1発現細胞数を各々測定して、(iii)当該Treg細胞でのPD-1発現強度に対する、当該CD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値を決定し、当該数値に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-61] (i)悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞およびTreg細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法または免疫染色法にて、当該CD8+T細胞およびTreg細胞の各々の細胞数ならびにそれらのうちのPD-1発現細胞数を各々測定して、(iii)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、Treg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値を決定し、当該数値に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者、あるいは免疫チェックポイント阻害薬の効果が期待できない悪性腫瘍患者を特定する方法。
[4-62] 当該免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者として、当該数値が約25以上である患者を特定する、前項[4-60]または[4-61]記載の方法。
[4-63] 前項[4-62]記載の数値が約40以上または約44.4以上である患者を特定する、前項[4-62]記載の方法。
[4-64] 前項[4-62]記載の数値が約46.0以上または約50以上である患者を特定する、前項[4-62]記載の方法。
[4-65] 前項[4-62]記載の数値が約60以上である患者を特定する、前項[4-62]記載の方法。
[4-66] 前項[4-62]記載の数値が約90以上である患者を特定する、前項[4-62]記載の方法。
[4-67] 前項[4-62]記載の数値が約100以上である患者を特定する、前項[4-62]記載の方法。
[4-68] 当該Treg細胞が、Treg細胞(Fr.II)である、前項[4-1]~[4-19]および[4-45]~[4-67]の何れか一項記載の剤。
[4-69] 免疫チェックポイント阻害薬が、抗PD-1抗体、抗PD-L1抗体、PD-1拮抗剤、PD-L1/VISTA拮抗剤、PD-L1/TIM3拮抗剤、抗PD-L2抗体、PD-L1融合タンパク質、PD-L2融合タンパク質、抗CTLA-4抗体、抗LAG-3抗体、LAG-3融合蛋白質、抗Tim3抗体、抗KIR抗体、抗BTLA抗体、抗TIGIT抗体、抗VISTA抗体、抗CSF-1R抗体またはCSF-1R阻害剤である、前項[4-1]~[4-68]の何れか一項記載の方法。
[4-70] 当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283である前項[4-66]記載の方法。
[4-71] 当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072である前項[4-69]記載の方法。
[4-72] 当該抗CTLA-4抗体が、Ipilimumab、AGEN1884またはTremelimumabである前項[4-69]記載の方法。
[4-73] 当該悪性腫瘍が、固形がんまたは血液がんである、前項[4-1]~[4-72]の何れか一項記載の方法。
[4-74] 当該固形がんが、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上のがんである前項[4-73]記載の方法。
[4-75] 当該血液がんが、多発性骨髄腫、悪性リンパ腫(例えば、非ホジキンリンパ腫(例えば、濾胞性リンパ腫、びまん性大細胞型B細胞性リンパ腫、MALTリンパ腫、リンパ形質細胞性リンパ腫、菌状息肉症、セザリー症候群、慢性または急性リンパ球性白血病、末梢性T細胞リンパ腫、節外性NK/T細胞リンパ腫、成人T細胞白血病、B細胞リンパ芽球性白血病、T細胞リンパ芽球性白血病およびリンパ形質細胞性リンパ腫)およびホジキンリンパ腫(例えば、古典的ホジキンリンパ腫および結節性リンパ球優位型ホジキンリンパ腫))、白血病(例えば、急性骨髄性白血病および慢性骨髄性白血病)、中枢神経系原発悪性リンパ腫、骨髄異形成症候群および骨髄増殖症候群から選択される一以上のがんである、前項[4-73]記載の剤。
[4-76] 当該悪性腫瘍が非小細胞肺癌の場合、前項[4-1]記載の比率が、1.2以上である前項[4-1]、[4-2]、[4-19]および[4-68]~[4-74]の何れか一項記載の方法。
[4-77] 当該悪性腫瘍が非小細胞肺癌の場合、前項[4-20]記載のPD-1発現のMFIが、800以上である前項[4-20]、[4-34]および[4-68]~[4-74]の何れか一項記載の方法。
[4-78] 当該悪性腫瘍が非小細胞肺癌の場合、前項[4-62]記載の数値が、約40以上である前項[4-62]および[4-68]~[4-74]の何れか一項記載の方法。
[4-79] 当該悪性腫瘍が胃癌の場合、前項[4-1]記載の比率が、0.7以上である前項[4-1]、[4-2]、[4-19]および[4-68]~[4-74]の何れか一項記載の方法。
[4-80] 当該悪性腫瘍が胃癌の場合、前項[4-20]記載のPD-1発現のMFIが、410以上である前項[4-20]、[4-34]および[4-68]~[4-74]の何れか一項記載の方法。
[4-81] 当該悪性腫瘍が、小児がんまたは原発不明がんである、前項[4-1]~[4-73]の何れか一項記載の方法。
[4-82] 当該悪性腫瘍が、他の抗悪性腫瘍薬による治療効果が不十分あるいは十分ではない癌である、前項[4-1]~[4-81]の何れか一項記載の方法。
[4-83] 当該悪性腫瘍が、他の抗悪性腫瘍薬による治療後に増悪した癌である、前項[4-1]~[4-82]の何れか一項記載の方法。
[4-84] 当該悪性腫瘍患者が、他の抗悪性腫瘍薬による治療歴のない、前項[4-1]~[4-81]の何れか一項記載の方法。
[4-85] 術後補助療法または術前補助療法において処方される前項[4-1]~[4-84]の何れか一項記載の方法。
[4-86] 当該悪性腫瘍が、根治もしくは切除不能、転移性、再発性、難治性および/または遠隔転移性である、前項[4-1]~[4-85]の何れか一項記載の方法。
[4-87] TPSまたはCPSが、50%以上、25%以上、5%以上または1%以上である、前項[4-1]~[4-86]の何れか一項記載の方法。
[4-88] TPSまたはCPSが、50%未満、25%未満、5%未満または1%未満である、前項[4-1]~[4-86]の何れか一項記載の方法。
[4-89] 当該悪性腫瘍が、MSI-Hおよび/またはdMMRを有する、前項[4-1]~[4-88]の何れか一項記載の方法。
[4-90] 当該悪性腫瘍が、MSI-Hおよび/またはdMMRを有しない、もしくはMSI-Lを有する、前項[4-1]~[4-88]の何れか一項記載の方法。
[4-91] 悪性黒色腫または非小細胞肺癌が、BRAF V600E変異陽性である、前項[4-74]、[4-76]~[4-78]および[4-81]~[4-90]の何れか一項記載の方法。
[4-92] 悪性黒色腫または非小細胞肺癌が、BRAF V600野生型である、前項[4-74]、[4-76]~[4-78]および[4-81]~[4-90]の何れか一項記載の方法。
[4-93] 非小細胞肺癌が、EGFR遺伝子変異陽性および/またはALK融合遺伝子陽性である、前項[4-74]、[4-76]~[4-78]および[4-81]~[4-92]の何れか一項記載の方法。
[4-94] 非小細胞肺癌が、EGFR遺伝子変異陰性および/またはALK融合遺伝子陰性である、前項[4-74]、[4-76]~[4-78]および[4-81]~[4-92]の何れか一項記載の方法。
[4-95] 当該悪性腫瘍のTMBが高頻度である、前項[4-1]~[4-94]の何れか一項記載の方法。
[4-96] 当該悪性腫瘍のTMBが低頻度である、前項[4-1]~[4-94]の何れか一項記載の方法。
[4-97] 当該悪性腫瘍患者が、当該免疫チェックポイント阻害薬の投与前における患者である前項[4-1]~[4-96]の何れか一項記載の方法。
[4-98] 抗PD-1抗体または抗PD-L1抗体を有効成分とする薬剤の効果がより期待できる悪性腫瘍患者を特定する方法であって、(i)当該抗体を有効成分とする薬剤の投与前における、悪性腫瘍患者の腫瘍組織または血液よりTreg細胞(Fr.II)およびCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、当該Treg細胞(Fr.II)および当該CD8+T細胞におけるPD-1発現強度を各々測定して、(iii)当該薬剤の効果がより期待できる患者として、当該Treg細胞(Fr.II)でのPD-1発現強度に対する当該CD8+T細胞でのPD-1発現強度との比率が約0.7以上である患者を特定し、当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283であり、当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072であり、当該悪性腫瘍が、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の悪性腫瘍である、当該方法。
[4-99] 抗PD-1抗体または抗PD-L1抗体を有効成分とする薬剤の効果がより期待できる悪性腫瘍患者を特定する方法であって、(i)当該抗体を有効成分とする薬剤の投与前における、悪性腫瘍患者の腫瘍組織または血液よりTreg細胞(Fr.II)およびCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、(iia)当該CD8+T細胞および当該Treg細胞(Fr.II)における各々のPD-1発現強度もしくは(iib)CD8+T細胞数およびTreg細胞(Fr.II)の各々の細胞数ならびにそれらのうちのPD-1発現細胞数を各々測定して、(iii)当該薬剤の効果がより期待できる患者として、(a1)当該Treg細胞(Fr.II)でのPD-1発現強度に対する当該CD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞(Fr.II)のうちのPD-1発現細胞数の割合(%)に対する当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率の何れかが約1.0以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)が約40%以上である患者を特定し、当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283であり、当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072であり、当該悪性腫瘍が、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の悪性腫瘍である、当該方法。
[4-100] 当該腫瘍組織が、少なくとも腫瘍塊自体、腫瘍の浸潤性周辺部あるいは腫瘍に隣接するリンパ節を含む組織である前項[4-1]~[4-99]の何れか一項記載の方法。
[4-101] 当該Treg細胞もしくはTreg細胞(Fr.II)および当該CD8+T細胞での各々のPD-1発現強度が、フローサイトメトリー法によって測定されるMFIで表わされる前項[4-1]~[4-19]および[4-51]~[4-100]の何れか一項記載の方法。
[5-1] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率のバイオマーカーとしての使用。
[5-2] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞におけるPD-1発現強度のバイオマーカーとしての使用。
[5-3] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)のバイオマーカーとしての使用。
[5-4] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)のバイオマーカーとしての使用。
[5-5] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、(a1)当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率、ならびに(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)の組合せのバイオマーカーとしての使用。
[5-6] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値のバイオマーカーとしての使用。
[5-7] 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値のバイオマーカーとしての使用。
[5-8] 当該PD-1発現強度が、フローサイトメトリー法によって測定されるMFI、多重免疫組織染色法によって測定される発現強度もしくは発現強度スコア、in situ ハイブリダイゼーション法によって測定されるシグナル強度もしくは発現強度スコア、マスサイトメトリー法によって測定される発現強度もしくはシグナル強度、シングルセルRNAシーケンス法によって測定される発現レベルもしくは遺伝子カウント値またはマスイメージング法によって測定される発現強度もしくは発現強度スコアで表わされる前項[5-1]、[5-2]、[5-5]および[5-6]の何れか一項記載の使用。
[5-9] 腫瘍組織内または血液中のCD8+T細胞数およびTreg細胞数ならびにそれらのうちの各々のPD-1発現細胞数が、フローサイトメトリー法または免疫染色法にて測定される、前項[5-3]~[5-7]の何れか一項記載の使用。
[5-10] 当該Treg細胞が、Treg細胞(Fr.II)である、前項[5-1]および[5-4]~[5-9]の何れか一項記載の使用。
[5-11] 当該免疫チェックポイント阻害薬が、抗PD-1抗体、抗PD-L1抗体、PD-1拮抗剤、PD-L1/VISTA拮抗剤、PD-L1/TIM3拮抗剤、抗PD-L2抗体、PD-L1融合タンパク質、PD-L2融合タンパク質、抗CTLA-4抗体、抗LAG-3抗体、LAG-3融合蛋白質、抗Tim3抗体、抗KIR抗体、抗BTLA抗体、抗TIGIT抗体、抗VISTA抗体、抗CSF-1R抗体またはCSF-1R阻害剤である、前項[5-1]~[5-10]の何れか一項記載の使用。
[5-12] 当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283である前項[5-11]記載の使用。
[5-13] 当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072である前項[5-11]記載の使用。
[5-14] 当該抗CTLA-4抗体が、Ipilimumab、AGEN1884またはTremelimumabである前項[5-11]記載の使用。
[5-15] 当該悪性腫瘍が、固形がんまたは血液がんである、前項[5-1]~[5-14]の何れか一項記載の使用。
[5-16] 当該固形がんが、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上のがんである前項[5-15]記載の使用。
[5-17] 当該血液がんが、多発性骨髄腫、悪性リンパ腫(例えば、非ホジキンリンパ腫(例えば、濾胞性リンパ腫、びまん性大細胞型B細胞性リンパ腫、MALTリンパ腫、リンパ形質細胞性リンパ腫、菌状息肉症、セザリー症候群、慢性または急性リンパ球性白血病、末梢性T細胞リンパ腫、節外性NK/T細胞リンパ腫、成人T細胞白血病、B細胞リンパ芽球性白血病、T細胞リンパ芽球性白血病およびリンパ形質細胞性リンパ腫)およびホジキンリンパ腫(例えば、古典的ホジキンリンパ腫および結節性リンパ球優位型ホジキンリンパ腫))、白血病(例えば、急性骨髄性白血病および慢性骨髄性白血病)、中枢神経系原発悪性リンパ腫、骨髄異形成症候群および骨髄増殖症候群から選択される1以上のがんである、前項[5-15]記載の使用。
[5-18] 当該悪性腫瘍が、小児がんまたは原発不明がんである、前項[5-1]~[5-15]の何れか一項記載の使用。
[5-19] 当該悪性腫瘍患者が、当該免疫チェックポイント阻害薬の投与前における患者である前項[5-1]~[5-18]の何れか一項記載の使用。
[5-20] 抗PD-1抗体または抗PD-L1抗体を有効成分とする薬剤による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該薬剤の投与前における当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞(Fr.II)でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率のバイオマーカーとしての使用であって、当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283であり、当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072であり、当該悪性腫瘍が、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の悪性腫瘍である、当該使用。
[5-21] 抗PD-1抗体または抗PD-L1抗体を有効成分とする薬剤による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、(a1)当該薬剤の投与前における当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞(Fr.II)でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞(Fr.II)のうちのPD-1発現細胞数の割合(%)に対する当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率、ならびに(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)の組合せのバイオマーカーとしての使用であって、当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283であり、当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072であり、当該悪性腫瘍が、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の悪性腫瘍である、当該使用。
[5-22] 当該腫瘍組織が、少なくとも腫瘍塊自体、腫瘍の浸潤性周辺部あるいは腫瘍に隣接するリンパ節を含む組織である前項[5-1]~[5-21]の何れか一項記載の使用。
本発明の薬剤あるいは患者特定方法が適用できる悪性腫瘍としては、固形がんの場合、例えば、悪性黒色腫(例えば、皮膚、口腔粘膜上皮または眼窩内などにおける悪性黒色腫)、非小細胞肺癌(例えば、扁平非小細胞肺癌および非扁平非小細胞肺癌)、小細胞肺癌、頭頸部癌(例えば、口腔癌、上咽頭癌、中咽頭癌、下咽頭癌、喉頭癌、唾液腺癌および舌癌)、腎細胞癌(例えば、淡明細胞型腎細胞癌)、乳癌、卵巣癌(例えば、漿液性卵巣癌および卵巣明細胞腺癌)、鼻咽頭癌、子宮癌(例えば、子宮頸癌、子宮内膜癌および子宮体癌)、肛門癌(例えば、肛門管癌)、大腸癌(例えば、MSI-Hおよび/またはdMMR陽性大腸癌)、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌(例えば、膀胱癌、上部尿路癌、尿管癌、腎盂癌および尿道癌)、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌(例えば、ブドウ膜悪性黒色腫およびメルケル細胞癌)、精巣癌(胚細胞腫瘍)、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍(例えば、神経膠腫(例えば、神経膠芽腫および神経膠肉腫)および髄膜腫)、扁平上皮癌、骨・軟部肉腫(例えば、ユーイング肉腫、小児横紋筋肉腫、子宮体部平滑筋肉腫、軟骨肉腫、肺肉腫、骨肉腫および先天性繊維肉腫)およびカポジ肉腫から選択される一以上の癌が挙げられる。
本発明にかかる免疫チェックポイント阻害物質の投与量は、年齢、体重、症状、治療効果、投与方法、処理時間等により異なるが、通常、成人一人当たり、一回につき、1ngから1000mgの範囲で一日一回から数回経口投与されるか、または成人一人当たり、一回につき、0.1ngから100mgの範囲で一日一回から数回非経口投与されるか、または一日30分から24時間の範囲で静脈内に持続投与される。もちろん前記したように、投与量は種々の条件により変動するので、上記投与量より少ない量で十分な場合もあるし、また範囲を越えて投与の必要な場合もある。
本発明にかかる免疫チェックポイント阻害薬は、(1)悪性腫瘍の進行抑制、再発抑制および/または治療効果の増強のために、(2)組み合わせて使用される他の薬剤の投与量の低減および/または(3)組み合わせて使用される他の薬剤の副作用の軽減のために、上記の悪性腫瘍の治療目的に使用される一種以上の他の薬剤(主に、抗悪性腫瘍薬)とともに組み合わせて使用してもよい。本発明において、他の薬剤とともに組み合わせて処方する場合の投与形態には、1つの製剤中に両成分を配合した配合剤の形態であっても、また別々の製剤としての投与形態であってもよい。免疫チェックポイント阻害薬と他の薬剤を別々に投与する場合には、免疫チェックポイント阻害薬を先に投与し、その投与の後に他の薬剤を投与してもよいし、他の薬剤を先に投与し、免疫チェックポイント阻害薬を後に投与してもよく、また、上記投与において、一定期間、両薬剤が同時に投与される期間があってもよい。また、各々の薬剤の投与方法は同じでも異なっていてもよい。薬剤の性質により、免疫チェックポイント阻害薬と他の薬剤を含むキットとして提供することもできる。ここで、他の薬剤の投与量は、臨床上用いられている用量を基準として適宜選択することができる。また、他の薬剤は任意の2種以上を適宜の割合で組み合わせて投与してもよい。また、前記他の薬剤には、現在までに見出されているものだけでなく今後見出されるものも含まれる。
本発明にかかる免疫チェックポイント阻害物質もしくは免疫チェックポイント阻害薬を単独であるいはそれらと他の薬剤を投与する際には、経口投与のための内服用固形剤若しくは内服用液剤、経口投与における徐放性製剤、放出制御製剤または非経口投与のための注射剤、外用剤、吸入剤若しくは坐剤等として用いられる。
本発明は、本発明にかかるバイオマーカー1~7を各々構成する指標を測定のための検査または測定キットをも含む。当該検査または測定キットは、例えば、PD-1発現強度を測定する場合には、フローサイトメトリー、多重免疫組織染色法(例えば、蛍光またはマスサイトメトリー)、in situ ハイブリダイゼーション法(例えば、FISH、CISH、SISHおよびDISH)、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法に基づくものであってもよく、一方、CD8+T細胞数、PD-1発現CD8+T細胞数、Treg細胞数またはPD-1発現Treg細胞数を測定する場合には、フローサイトメトリーまたは免疫染色法に基づくものであってもよい。何れにおいても、フローサイトメトリーに基づく検査または測定キットが好ましい。
本発明を以下の実施例によってさらに詳しく説明するが、本発明の範囲はこれに限定されない。本発明の記載に基づき種々の変更、修飾が当業者には可能であり、これらの変更、修飾も本発明に含まれる。
Nivolumab投与前の癌患者から腫瘍組織を採取し、gentleMACS Dissociator(MiltenyiBiotec社)による組織破砕にて腫瘍浸潤リンパ球を分離した。免疫チェックポイント阻害物質非投与前の同患者末梢血からFicollを用いた密度勾配遠心法にて末梢血単核細胞を調整した。分離後の腫瘍浸潤リンパ球及び末梢血単核細胞はウシ胎児血清が最終濃度2%になるように添加したPBS(以下、FACSBuffer)にて懸濁したのち、Human Fc-Receptor Binding Inhibitor(ThermoFisher社)を添加し4℃で10分間反応させた。その後各種細胞表面マーカー(CD3、CD8、CD4、CD45RAおよびPD-1)の蛍光色素標識抗体を添加して、4℃で15分間反応させた。FACS Bufferにて洗浄を行ったのち、Foxp3/Transcription Factor Staining Buffer Set(ThermoFisher社)を用いて細胞の固定及び膜透過処理を行い、細胞内タンパク質FoxP3の蛍光色素標識抗体を添加して、4℃で30分間反応させた。FACS Bufferにて洗浄を行ったのち、各タンパク質の発現をLSRFortessaX-20(ベクトン・ディッキンソン社製)にて解析した。
Nivolumab投与前における非小細胞肺癌患者15例の腫瘍組織由来のTreg細胞またはTreg細胞(Fr.II)ならびにCD8+T細胞の各々におけるPD-1発現強度を、フローサイトメトリー法にて測定し、その平均蛍光強度(MFI)を算出した。
Nivolumab投与前における胃癌患者17例の腫瘍組織由来のTreg細胞またはTreg細胞(Fr.II)ならびにCD8+T細胞の各々におけるPD-1発現強度を、フローサイトメトリー法にて測定し、そのMFIを算出した。
当該胃癌患者のうち、Nivolumab投与により、3例がPRとなる効果を示し、14例がSDまたはPDであった。
Nivolumab投与前における非小細胞肺癌患者15例(実施例2での患者群と同じ)の腫瘍組織由来のCD8+T細胞におけるPD-1発現強度を、フローサイトメトリー法にて測定し、そのMFIを算出した。
Nivolumab投与前における胃癌患者17例(実施例3での患者群と同じ)の腫瘍組織由来のCD8+T細胞におけるPD-1発現強度を、フローサイトメトリー法にて測定し、そのMFIを算出した。
Nivolumab投与前における非小細胞肺癌患者15例(実施例2での患者群と同じ)の腫瘍組織由来のCD8+T細胞におけるPD-1発現細胞数を、フローサイトメトリー法にて測定し、CD8+T細胞におけるそのうちのPD-1発現割合(%)を算出した。
Nivolumab投与前における胃癌患者17例(実施例3での患者群と同じ)の腫瘍組織由来のCD8+T細胞におけるPD-1発現細胞数をフローサイトメトリー法にて測定し、CD8+T細胞におけるそのうちのPD-1発現割合(%)を算出した。
Nivolumab投与前における非小細胞肺癌患者12例の腫瘍組織由来のCD8+T細胞におけるPD-1発現細胞数をフローサイトメトリー法にて測定し、CD8+T細胞におけるそのうちのPD-1発現割合(%)を算出した。
Nivolumab投与前における胃癌患者23例の腫瘍組織由来のCD8+T細胞におけるPD-1発現細胞数をフローサイトメトリー法にて測定し、CD8+T細胞におけるそのうちのPD-1発現割合(%)を算出した。
Nivolumab投与前における胃癌患者23名の腫瘍組織由来のTreg細胞(Fr.II)におけるPD-1発現細胞数をフローサイトメトリー法にて測定し、Treg細胞(Fr.II)におけるそのうちのPD-1発現割合(%)を算出した。
Nivolumab投与前における非小細胞肺癌患者12例の腫瘍組織由来のTreg細胞(Fr.II)ならびにCD8+T細胞の各々におけるPD-1発現強度をフローサイトメトリー法にて測定し、その平均蛍光強度(MFI)を算出した。
Nivolumab投与前における胃癌患者23例の腫瘍組織由来のTreg細胞(Fr.II)ならびにCD8+T細胞の各々におけるPD-1発現強度をフローサイトメトリー法にて測定し、その平均蛍光強度(MFI)を算出した。
実施例8および9において解析・算出された、非小細胞肺癌患者(12名)および胃癌患者(23名)の各々の腫瘍組織由来のCD8+T細胞におけるPD-1発現割合(%)を横軸に、実施例10に準じて解析・算出された、同患者群の各々の腫瘍組織由来のTreg細胞(Fr.II)におけるPD-1発現割合(%)を縦軸にプロットした。その結果を図14に示す。
Nivolumab投与前における非小細胞肺癌患者13名の腫瘍組織由来のTreg細胞(Fr.II)ならびにCD8+T細胞の各々におけるPD-1発現強度をフローサイトメトリー法にて測定し、その平均蛍光強度(MFI)を算出した。また、同腫瘍組織由来のCD8+T細胞の各々におけるPD-1発現細胞数をフローサイトメトリー法にて測定し、CD8+T細胞におけるそのうちのPD-1発現割合(%)を算出した。腫瘍容積変化率(%)を横軸に、同Treg細胞でのPD-1発現強度に対する、同CD8+T細胞でのPD-1発現強度との比率に、同CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値を縦軸にプロットした。その結果を図17に示す。なお、13名のうち1名は欠測データのため、結果から除いた。
Nivolumab投与前における非小細胞肺癌患者13名の腫瘍組織由来Treg細胞(Fr.II)およびCD8+T細胞の各々におけるPD-1発現細胞数をフローサイトメトリー法にて測定し、同Treg細胞(Fr.II)およびCD8+T細胞の各々におけるそのうちのPD-1発現割合(%)を算出した。腫瘍容積変化率(%)を横軸に、同CD8+T細胞におけるPD-1発現割合(%)の自乗を、同Treg細胞(Fr.II)におけるPD-1発現割合(%)で除した数値を縦軸にプロットした。その結果を図18に示す。
実施例15と同様の方法により、非小細胞肺癌患者(18名)および胃癌患者(29名)各々の腫瘍組織由来Treg細胞(Fr.II)およびCD8+T細胞の各々におけるPD-1発現割合(%)に基づき、同CD8+T細胞におけるPD-1発現割合(%)の自乗を、同Treg細胞(Fr.II)におけるPD-1発現割合(%)で除した数値を算出した。同非小細胞肺癌患者および胃癌患者の各々について、当該数値に基づく基準値(CUT)を各々25、40、60、90および100とした場合における、基準値陽性群(各基準値以上である群:BM+)および陰性群(各基準未満である群:BM-)各々のNivolumab投与後の無増悪生存期間(PFS)を図19~22に示す。無増悪生存期間での評価では、非小細胞肺癌患者については、例えば、基準値が40以上である患者をNivolumabの効果がより期待できる患者として判定でき、一方、胃癌患者では、基準値が25以上である患者をNivolumabの効果がより期待できる患者として判定できることが確認された。
Nivolumab投与前における頭頚部癌患者3例の腫瘍組織由来のTreg細胞およびTreg細胞(Fr.II)ならびにCD8+T細胞に関して、それらのPD-1発現強度およびPD-1発現割合(%)を、各々、フローサイトメトリー法にて測定した。
非小細胞肺癌患者(2名)、頭頚部癌患者(1名)および大腸癌患者(1名)の腫瘍組織由来のTreg細胞またはTreg細胞(Fr.II)ならびにCD8+T細胞の各々におけるPD-1発現強度を、フローサイトメトリー法にて測定し、その平均蛍光強度(MFI)を算出した。また、蛍光標識ビーズを用いた公知の測定法により、抗原分子定量のための検量線を作成し、同バイオマーカーにおける「PD-1発現強度」から決定した細胞表面抗原分子の発現数(発現量)であるMolecules of Equivalent Soluble Fluorochrome(MESF)を算出した。当該MESF値ならびに当該MESF値に基づく本発明のバイオマーカー1の比率を表15に示す。
バイオマーカー1の比率の算出において、PD-1発現MFIの代わりに、そのMESF値が使用できることが確認された。
Claims (52)
- 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率が約0.7以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 請求項1記載の比率が約1.2以上である請求項1記載の剤。
- 請求項1記載の比率が約1.5以上である請求項1記載の剤。
- (a1)悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合との比率の何れかが約0.8以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合が約35%以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 請求項4記載の(a1)または(a2)記載の比率が約0.9以上である請求項4記載の剤。
- 請求項4記載の(a1)または(a2)記載の比率が約1.0以上である請求項4記載の剤。
- 請求項4記載の(a1)または(a2)記載の比率が約1.1以上である請求項4記載の剤。
- 請求項4記載の(b)の比率が約40%以上である請求項4~7の何れか一項記載の剤。
- 悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値が約25以上である、悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値が約25以上である、悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 請求項9または10記載の当該数値が約60以上である、請求項9または10記載の剤。
- Treg細胞が、Treg細胞(Fr.II)である、請求項1~11の何れか一項記載の剤。
- 当該悪性腫瘍患者が、当該免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における患者である請求項1~12の何れか一項記載の剤。
- 免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞(Fr.II)でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率が約0.7以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- (a1)免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞(Fr.II)でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合との比率の何れかが約1.0以上であり、かつ(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合が約40%以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞(Fr.II)でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値が約60以上である、悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞(Fr.II)のうちのPD-1発現細胞数の割合(%)で除して算出される数値が約60以上である、悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 当該免疫チェックポイント阻害物質が、抗PD-1抗体、抗PD-L1抗体、PD-1拮抗剤、PD-L1/VISTA拮抗剤、PD-L1/TIM3拮抗剤、抗PD-L2抗体、PD-L1融合タンパク質、PD-L2融合タンパク質、抗CTLA-4抗体、抗LAG-3抗体、LAG-3融合蛋白質、抗Tim3抗体、抗KIR抗体、抗BTLA抗体、抗TIGIT抗体、抗VISTA抗体、抗CSF-1R抗体またはCSF-1R阻害剤である、請求項1~17の何れか一項記載の剤。
- 当該抗PD-1抗体が、Nivolumab、Cemiplimab、Pembrolizumab、Spartalizumab、Tislelizumab、AMP-514、Dostarlimab、Toripalimab、Camrelizumab、Genolimzumab、Sintilimab、STI-A1110、ENUM 388D4、ENUM 244C8、GLS010、MGA012、AGEN2034、CS1003、HLX10、BAT-1306、AK105、AK103、BI 754091、LZM009、CMAB819、Sym021、GB226、SSI-361、JY034、HX008、ISU106、ABBV181、BCD-100、PF-06801591、CX-188またはJNJ-63723283である請求項18記載の剤。
- 当該抗PD-L1抗体が、Atezolizumab、Avelumab、Durvalumab、BMS-936559、STI-1014、KN035、LY3300054、HLX20、SHR-1316、CS1001、MSB2311、BGB-A333、KL-A167、CK-301、AK106、AK104、ZKAB001、FAZ053、CBT-502、JS003またはCX-072である請求項18記載の剤。
- 当該抗CTLA-4抗体が、Ipilimumab、AGEN1884またはTremelimumabである請求項18記載の剤。
- 当該悪性腫瘍が、固形がんまたは血液がんである請求項1~21の何れか一項記載の剤。
- 当該固形がんが、悪性黒色腫、非小細胞肺癌、小細胞肺癌、頭頸部癌、腎細胞癌、淡明細胞型腎細胞癌、乳癌、卵巣癌、漿液性卵巣癌、卵巣明細胞腺癌、鼻咽頭癌、子宮癌、肛門癌、大腸癌、直腸癌、結腸癌、肝細胞癌、食道癌、食道腺癌、胃癌、食道胃接合部癌、小腸癌、膵癌、尿路上皮癌、前立腺癌、卵管癌、原発性腹膜癌、悪性胸膜中皮腫、胆嚢癌、胆管癌、胆道癌、皮膚癌、精巣癌、膣癌、外陰部癌、陰茎癌、小腸癌、内分泌系癌、甲状腺癌、副甲状腺癌、副腎癌、脊椎腫瘍、脳腫瘍、扁平上皮癌、骨・軟部肉腫およびカポジ肉腫から選択される一以上の癌である請求項22記載の剤。
- 当該悪性腫瘍患者が他の抗悪性腫瘍薬による治療歴のない、請求項1~23の何れか一項記載の剤。
- TPSまたはCPSが、50%未満、25%未満、10%未満、5%未満または1%未満である、請求項1~24の何れか一項記載の剤。
- 当該悪性腫瘍が、MSI-Hおよび/またはdMMRを有しない、請求項1~25の何れか一項記載の剤。
- 当該悪性腫瘍のTMBが低頻度である、請求項1~26の何れか一項記載の剤。
- 悪性腫瘍患者の腫瘍組織または血液よりTreg細胞およびCD8+T細胞を含む細胞集団を採取、必要に応じて精製し、フローサイトメトリー法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、当該Treg細胞および当該CD8+T細胞におけるPD-1発現強度を各々測定して、当該Treg細胞でのPD-1発現強度に対する当該CD8+T細胞でのPD-1発現強度との比率を決定し、当該比率に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者を特定する方法。
- 当該免疫チェックポイント阻害薬の効果がより期待できる患者が、当該比率が約0.7以上である、請求項28記載の方法。
- 当該免疫チェックポイント阻害薬の効果がより期待できる患者が、当該比率が約1.2以上である、請求項28記載の方法。
- 当該免疫チェックポイント阻害薬の効果がより期待できる患者が、当該比率が約1.5以上である、請求項28記載の方法。
- (i)悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞およびTreg細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、(iia)当該CD8+T細胞および当該Treg細胞における各々のPD-1発現強度もしくは(iib)CD8+T細胞数およびTreg細胞数ならびにそれらのうちのPD-1発現細胞数を各々測定して、(iii)(a1)当該Treg細胞でのPD-1発現強度に対する、当該CD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率、および(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を決定し、当該(a1)もしくは(a2)の比率および当該(b)の割合の組合せに基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者を特定する方法。
- 免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者が、請求項32の(a1)もしくは(a2)記載の比率が約0.8以上であり、かつ同項(b)記載の割合が約35%以上である患者である、請求項32記載の方法。
- 請求項32の(a1)または(a2)記載の比率が約0.9以上である請求項32または33記載の剤。
- 請求項32記載の(a1)または(a2)記載の比率が約1.0以上である請求項32または33記載の剤。
- 請求項32記載の(a1)または(a2)記載の比率が約1.1以上である請求項32または33記載の剤。
- 請求項32記載の(b)の比率が約40%以上である請求項33~36の何れか一項記載の剤。
- 免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者が、請求項32の(a1)もしくは(a2)記載の比率が約1.0以上であり、かつ同項(b)記載の割合が約40%以上である患者である、請求項32記載の方法。
- (i)悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞およびTreg細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法、免疫染色法、多重免疫組織染色法、in situ ハイブリダイゼーション法、マスサイトメトリー法、シングルセルRNAシーケンス法またはマスイメージング法にて、当該CD8+T細胞およびTreg細胞での各々のPD-1発現強度ならびに当該CD8+T細胞の細胞数およびそのうちのPD-1発現細胞数を各々測定して、(iii)当該Treg細胞でのPD-1発現強度に対する、当該CD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値を決定し、当該数値に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者を特定する方法。
- (i)悪性腫瘍患者の腫瘍組織または血液よりCD8+T細胞およびTreg細胞を含む細胞集団を採取、必要に応じて精製し、(ii)フローサイトメトリー法または免疫染色法にて、当該CD8+T細胞およびTreg細胞の各々の細胞数ならびにそれらのうちのPD-1発現細胞数を各々測定して、(iii)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、Treg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値を決定し、当該数値に基づいて、免疫チェックポイント阻害薬の効果がより期待できる悪性腫瘍患者を特定する方法。
- 請求項39または40記載の当該数値が約60以上である、請求項39または40記載の方法。
- Treg細胞が、Treg細胞(Fr.II)である、請求項28~41の何れか一項記載の方法。
- 当該悪性腫瘍患者が、当該免疫チェックポイント阻害薬の投与前における患者である請求項28~42の何れか一項記載の方法。
- 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率のバイオマーカーとしての使用。
- 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、(a1)当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率もしくは(a2)当該Treg細胞のうちのPD-1発現細胞数の割合(%)に対する当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)との比率、ならびに(b)当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)の組合せのバイオマーカーとしての使用。
- 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のTreg細胞でのPD-1発現強度に対する、同組織内または血液中のCD8+T細胞でのPD-1発現強度との比率に、当該CD8+T細胞のうちのPD-1発現細胞数の割合(%)を乗じて算出される数値のバイオマーカーとしての使用。
- 免疫チェックポイント阻害薬による悪性腫瘍の進行抑制、再発抑制および/または治療の有効性予測のための、当該悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞のうちのPD-1発現細胞数の割合(%)の自乗を、同組織内または血液中のTreg細胞のうちのPD-1発現細胞数の割合(%)で除して算出される数値のバイオマーカーとしての使用。
- Treg細胞が、Treg細胞(Fr.II)である、請求項44~47の何れか一項記載の使用。
- 当該悪性腫瘍患者が、当該免疫チェックポイント阻害薬の投与前における患者である請求項44~48の何れか一項記載の使用。
- 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞でのPD-1発現について、フローサイトメトリー法により測定されたMFIが約400以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 悪性腫瘍患者の腫瘍組織内または血液中のCD8+T細胞数のうちのPD-1発現細胞数の比率が約45%以上である悪性腫瘍患者に投与されることを特徴とする、免疫チェックポイント阻害物質を有効成分とする悪性腫瘍の進行抑制、再発抑制および/または治療剤。
- 当該悪性腫瘍患者が、当該免疫チェックポイント阻害物質を有効成分とする薬剤の投与前における患者である請求項50または51記載の剤。
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WO2022017435A1 (zh) * | 2020-07-22 | 2022-01-27 | 信达生物制药(苏州)有限公司 | 一系列TCR-β链的CDR3序列中共有序列的生物标志物及其应用 |
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IL278967A (en) | 2021-01-31 |
JPWO2019230919A1 (ja) | 2021-07-08 |
US20210198361A1 (en) | 2021-07-01 |
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