Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/4965—Non-condensed pyrazines
  • A61K31/497—Non-condensed pyrazines containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/58—Medicinal preparations containing antigens or antibodies raising an immune response against a target which is not the antigen used for immunisation
  • A61K2039/585—Medicinal preparations containing antigens or antibodies raising an immune response against a target which is not the antigen used for immunisation wherein the target is cancer
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
  • C07K2317/24—Immunoglobulins specific features characterized by taxonomic origin containing regions, domains or residues from different species, e.g. chimeric, humanized or veneered

Definitions

• the present invention relates to a pharmaceutical combination comprising
• TN0155 and a PD-1 inhibitor are examples of TN0155 and a PD-1 inhibitor
• pharmaceutical compositions comprising the same; and methods of using such combinations and compositions in the treatment or prevention of conditions in which SHP2 inhibition combined with PD-1 inhibition is beneficial, for example, in the treatment of cancers.
• TN0155 is an orally bioavailable, allosteric inhibitor of Src homology-2 domain containing protein tyrosine phsophatase-2 (SHP2, encoded by the PTPN11 gene), which transduces signals from activated receptor tyrosine kinases (RTKs) to downstream pathways, including the mitogen-activated protein kinase (MAPK) pathway.
• RTKs activated receptor tyrosine kinases
• MPK mitogen-activated protein kinase pathway.
• SHP2 has also been implicated in immune checkpoint and cytokine receptor signaling.
• TN0155 has demonstrated efficacy in a wide range of RTK-dependent human cancer cell lines and in vivo tumor xenografts.
• the Programmed Death 1 (PD-1) protein is an inhibitory member of the extended
• CD28/CTLA-4 family of T cell regulators Two ligands for PD-1 have been identified, PD-L1 (B7-H1) and PD-L2 (B7-DC), that have been shown to downregulate T cell activation upon binding to PD-1.
• PD-L1 is abundant in a variety of human cancers.
• PD-1 is known as an immunoinhibitory protein that negatively regulates TCR signals.
• the interaction between PD-1 and PD-L1 can act as an immune checkpoint, which can lead to, for example, a decrease in tumor infiltrating lymphocytes, a decrease in T-cell receptor mediated proliferation, and/or immune evasion by cancerous cells.
• Immune suppression can be reversed by inhibiting the local interaction of PD-1 with PD-L1 or PD-L2; the effect is additive when the interaction of PD-1 with PD-L2 is blocked as well.
• the present invention provides for a pharmaceutical combination comprising:
• the PD-1 inhibitor is chosen from PDR001 (spartalizumab;
• the PD-1 inhibitor is PDR001 (spartalizumab).
• the PD-1 inhibitor is administered at a dose of about 300-
• the PD-1 inhibitor is administered once every 3 weeks or once every 4 weeks.
• the PD-1 inhibitor is administered at a dose of about 300 mg once every 3 weeks. [0015] In another embodiment, the PD-1 inhibitor is administered at a dose of about 400 mg once every 4 weeks.
• a pharmaceutical combination comprising:
• PD-1 inhibitor will also be referred to herein as a“combination of the invention”.
• TN0155 or a pharmaceutically acceptable salt thereof and a PD-1 inhibitor are in separate formulations.
• the combination of the invention is for simultaneous or sequential (in any order) administration.
• in another embodiment is a method for treating or preventing cancer in a subject in need thereof comprising administering to the subject a therapeutically effective amount of the combination of the invention.
• the cancer is selected from: esophageal or head and neck squamous cell carcinoma; colorectal, ovarian, pancreatic or non-small cell lung cancer; and renal cell carcinoma.
• the cancer is colorectal cancer.
• the cancer is non-small cell lung cancer.
• the cancer is head and neck squamous cell carcinoma.
• the combination of the invention provides for a use in the manufacture of a medicament for treating a cancer selected from: esophageal or head and neck squamous cell carcinoma; colorectal, ovarian, pancreatic or non-small cell lung cancer; and renal cell carcinoma.
• composition comprising the combination of the invention.
• the pharmaceutical composition further comprises one or more pharmaceutically acceptable excipients as described herein.
• Figure 1 Anti-tumor activity of TN0155 as a single agent and in combination with mouse anti-PDl antibody in a syngeneic immune-competent mouse xenograft model
• Figure 2 Immunophenotyping by flow cytometry of MC38 xenograft tumors 7 days post-treatment with TN0155 and combination of TN0155 and mouse anti-PDl antibody.
• subject or“patient” as used herein is intended to include animals, which are capable of suffering from or afflicted with a cancer or any disorder involving, directly or indirectly, a cancer.
• subjects include mammals, e.g., humans, apes, monkeys, dogs, cows, horses, pigs, sheep, goats, cats, mice, rabbits, rats, and transgenic non-human animals.
• the subject is a human, e.g., a human suffering from, at risk of suffering from, or potentially capable of suffering from cancers.
• the term“treating” or“treatment” as used herein comprises a treatment relieving, reducing or alleviating at least one symptom in a subject or effecting a delay of progression of a disease.
• treatment can be the diminishment of one or several symptoms of a disorder or partial or complete eradication of a disorder, such as cancer.
• the term“treat” also denotes to arrest, delay the onset (i.e., the period prior to clinical manifestation of a disease) and/or reduce the risk of developing or worsening a disease.
• the term“combination therapy” or“in combination with” refers to the administration of two or more therapeutic agents to treat a condition or disorder described in the present disclosure (e.g., cancer). Such administration encompasses co -administration of these therapeutic agents in a substantially simultaneous manner, such as in a single capsule having a fixed ratio of active ingredients. Alternatively, such administration encompasses co- administration in multiple, or in separate containers (e.g., capsules, powders, and liquids) for each active ingredient. Powders and/or liquids may be reconstituted or diluted to a desired dose prior to administration. In addition, such administration also encompasses use of each type of therapeutic agent in a sequential manner, either at approximately the same time or at different times. In either case, the treatment regimen will provide beneficial effects of the drug combination in treating the conditions or disorders described herein.
• the combination therapy can provide“synergy” and prove“synergistic”, i.e., the effect achieved when the active ingredients used together is greater than the sum of the effects that results from using the compounds separately.
• a synergistic effect can be attained when the active ingredients are: (1) co-formulated and administered or delivered simultaneously in a combined, unit dosage formulation; (2) delivered by alternation or in parallel as separate formulations; or (3) by some other regimen.
• alternation therapy a synergistic effect can be attained when the compounds are administered or delivered sequentially, e.g., by different injections in separate syringes.
• synergistic effect refers to action of two therapeutic agents such as, for example, a compound TN0155 as a SHP2 inhibitor and a PD-1 inhibitor, producing an effect, for example, slowing the symptomatic progression of a proliferative disease, particularly cancer, or symptoms thereof, which is greater than the simple addition of the effects of each drug administered by themselves.
• a synergistic effect can be calculated, for example, using suitable methods such as the Sigmoid-Emax equation (Holford, N. H. G. and Scheiner, L. B., Clin.
• pharmaceutical combination refers to either a fixed combination in one dosage unit form, or non-fixed combination or a kit of parts for the combined administration where two or more therapeutic agents may be administered independently at the same time or separately within time intervals, especially where these time intervals allow that the combination partners show a cooperative, e.g. synergistic effect.
• PD-1 inhibitors include PDR001.
• PDR001 is also known as spartalizumab, an anti-PD-1 antibody molecule described in US 2015/0210769, published on July 30, 2015, entitled “Antibody Molecules to PD-1 and Uses Thereof,” incorporated by reference in its entirety.
• Further anti-PD-1 antibody molecules include the following: [0044] Nivolumab (Bristol-Myers Squibb), also known as MDX-1106, MDX-1106-04,
• Nivolumab clone 5C4
• other anti-PD-1 antibodies are disclosed in US 8,008,449 and WO 2006/121168, incorporated by reference in their entirety;
• Pembrolizumab (Merck & Co), also known as Lambrolizumab, MK-3475, MK03475,
• Pembrolizumab and other anti-PD-1 antibodies are disclosed in Hamid, O. et al. (2013) New England Journal of Medicine 369 (2): 134-44, US 8,354,509, and WO 2009/114335, incorporated by reference in their entirety;
• Pidilizumab (CureTech), also known as CT-011.
• Pidilizumab and other anti-PD-1 antibodies are disclosed in Rosenblatt, J. et al. (2011) J Immunotherapy 34(5): 409-18, US 7,695,715, US 7,332,582, and US 8,686,119, incorporated by reference in their entirety;
• MEDI0680 Medimmune
• AMP-514 also known as AMP-514.
• MEDI0680 and other anti-PD-1 antibodies are disclosed in US 9,205,148 and WO 2012/145493, incorporated by reference in their entirety;
• AMP-224 B7-DCIg (Amplimmune), e.g., disclosed in WO 2010/027827 and WO
• REGN2810 (Regeneron); PF-06801591 (Pfizer); BGB-A317 or BGB-108 (Beigene);
• INCSHR1210 (Incyte), also known as INCSHR01210 or SHR-1210; TSR-042 (Tesaro), also known as ANB011; and further known anti-PD-1 antibodies including those described, e.g., in WO
• the combination of the invention, TN0155 and a PD-1 inhibitor is also intended to represent unlabeled forms as well as isotopically labeled forms of the compounds.
• Isotopically labeled compounds have one or more atoms replaced by an atom having a selected atomic mass or mass number.
• isotopes that can be incorporated into TN0155 and a PD-1 inhibitor include isotopes, where possible, of hydrogen, carbon, nitrogen, oxygen, and chlorine, for example, 2 H, 3 H, 11 C, 13 C, 14 C, 15 N, 35 S, 36 C1.
• the invention includes isotopically labeled TN0155 and a PD-1 inhibitor, for example into which radioactive isotopes, such as 3 H and 14 C, or non- radioactive isotopes, such as 2 H and 13 C, are present.
• Isotopically labelled TN0155 and a PD-1 inhibitor are useful in metabolic studies (with 14 C), reaction kinetic studies (with, for example 2 H or 3 H), detection or imaging techniques, such as positron emission tomography (PET) or single- photon emission computed tomography (SPECT) including drug or substrate tissue distribution assays, or in radioactive treatment of patients.
• Isotopically-labeled compounds of the invention can generally be prepared by conventional techniques known to those skilled in the art or by processes analogous to those described in the accompanying Examples using appropriate isotopically-labeled reagents.
• substitution with heavier isotopes may afford certain therapeutic advantages resulting from greater metabolic stability, for example increased in vivo half-life or reduced dosage requirements or an improvement in therapeutic index.
• deuterium in this context is regarded as a substituent of either TN0155 or a PD-1 inhibitor.
• concentration of such a heavier isotope, specifically deuterium may be defined by the isotopic enrichment factor.
• isotopic enrichment factor as used herein means the ratio between the isotopic abundance and the natural abundance of a specified isotope.
• a substituent in TN0155 or a PD-1 inhibitor is denoted deuterium
• such compound has an isotopic enrichment factor for each designated deuterium atom of at least 3500 (52.5% deuterium incorporation at each designated deuterium atom), at least 4000 (60% deuterium incorporation), at least 4500 (67.5% deuterium incorporation), at least 5000 (75% deuterium incorporation), at least 5500 (82.5% deuterium incorporation), at least 6000 (90% deuterium incorporation), at least 6333.3 (95% deuterium incorporation), at least 6466.7 (97% deuterium incorporation), at least 6600 (99% deuterium incorporation), or at least 6633.3 (99.5% deuterium incorporation).
• TN0155 is an orally bioavailable small molecule inhibitor of SHP2 activity.
• SHP2 transduces signaling downstream of activated RTKs, as well as of PD-1 and other immunoreceptors, for example, CTLA4, SCF1R and LILRB4.
• PD-1 for example, CTLA4, SCF1R and LILRB4.
• SHP2 inhibition can enhance the anti-tumor activity of immune checkpoint inhibitors.
• the pharmaceutical combination of the invention is a pharmaceutical combination comprising (3S,4S)-8-(6-amino-5-((2-amino-3- chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and a PD-1 inhibitor, or a pharmaceutically acceptable salt thereof.
• (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or a pharmaceutically acceptable salt thereof, and a PD-1 inhibitor, or a pharmaceutically acceptable salt thereof, are administered separately, simultaneously or sequentially, in any order.
• (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine is in an oral dose form.
• composition comprising a pharmaceutical combination of (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and a PD-1 inhibitor and at least one pharmaceutically acceptable carrier.
• the PD-1 inhibitor is an anti-PD-1 antibody molecule.
• the PD-1 inhibitor is an anti-PD-1 antibody molecule as described in US 2015/0210769, published on July 30, 2015, entitled“Antibody Molecules to PD-1 and Uses Thereof,” incorporated by reference in its entirety.
• the anti-PD-1 antibody molecule is BAP049-Clone E or BAP049-Clone B.
• the anti-PD-1 antibody molecule is Spartalizumab
• the anti-PD-1 antibody molecule comprises at least one, two, three, four, five or six complementarity determining regions (CDRs) (or collectively all of the CDRs) from a heavy and light chain variable region comprising an amino acid sequence shown in Table 1 (e.g., from the heavy and light chain variable region sequences of BAP049-Clone-E or BAP049-Clone-B disclosed in Table 1), or encoded by a nucleotide sequence shown in Table 1.
• CDRs complementarity determining regions
• the CDRs are according to the Kabat definition (e.g., as set out in Table 1). In some embodiments, the CDRs are according to the Chothia definition (e.g., as set out in Table 1). In some embodiments, the CDRs are according to the combined CDR definitions of both Rabat and Chothia (e.g., as set out in Table 1). In one embodiment, the combination of Rabat and Chothia CDR of VH CDR1 comprises the amino acid sequence GYTFTTYWMH (SEQ ID NO: 541).
• one or more of the CDRs (or collectively all of the CDRs) have one, two, three, four, five, six or more changes, e.g., amino acid substitutions (e.g., conservative amino acid substitutions) or deletions, relative to an amino acid sequence shown in Table 1, or encoded by a nucleotide sequence shown in Table 1.
• the anti-PD-1 antibody molecule comprises a heavy chain variable region (VH) comprising a VHCDR1 amino acid sequence of SEQ ID NO: 501, a VHCDR2 amino acid sequence of SEQ ID NO: 502, and a VHCDR3 amino acid sequence of SEQ ID NO: 503; and a light chain variable region (VL) comprising a VLCDR1 amino acid sequence of SEQ ID NO: 510, a VLCDR2 amino acid sequence of SEQ ID NO: 511, and a VLCDR3 amino acid sequence of SEQ ID NO: 512, each disclosed in Table 1.
• VH heavy chain variable region
• VL light chain variable region
• the antibody molecule comprises a VH comprising a
• the anti-PD-1 antibody molecule comprises a VH comprising the amino acid sequence of SEQ ID NO: 506, or an amino acid sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 506. In one embodiment, the anti-PD-1 antibody molecule comprises a VL comprising the amino acid sequence of SEQ ID NO: 520, or an amino acid sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 520. In one embodiment, the anti-PD-1 antibody molecule comprises a VL comprising the amino acid sequence of SEQ ID NO: 516, or an amino acid sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 516.
• the anti-PD-1 antibody molecule comprises a VH comprising the amino acid sequence of SEQ ID NO: 506 and a VL comprising the amino acid sequence of SEQ ID NO: 520. In one embodiment, the anti-PD-1 antibody molecule comprises a VH comprising the amino acid sequence of SEQ ID NO: 506 and a VL comprising the amino acid sequence of SEQ ID NO: 516.
• the antibody molecule comprises a VH encoded by the nucleotide sequence of SEQ ID NO: 507, or a nucleotide sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 507.
• the antibody molecule comprises a VL encoded by the nucleotide sequence of SEQ ID NO: 521 or 517, or a nucleotide sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 521 or 517.
• the antibody molecule comprises a VH encoded by the nucleotide sequence of SEQ ID NO: 507 and a VL encoded by the nucleotide sequence of SEQ ID NO: 521 or 517.
• the anti-PD-1 antibody molecule comprises a heavy chain comprising the amino acid sequence of SEQ ID NO: 508, or an amino acid sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 508.
• the anti-PD-1 antibody molecule comprises a light chain comprising the amino acid sequence of SEQ ID NO: 522, or an amino acid sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 522.
• the anti-PD-1 antibody molecule comprises a light chain comprising the amino acid sequence of SEQ ID NO: 518, or an amino acid sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 518.
• the anti-PD-1 antibody molecule comprises a heavy chain comprising the amino acid sequence of SEQ ID NO: 508 and a light chain comprising the amino acid sequence of SEQ ID NO: 522. In one embodiment, the anti-PD-1 antibody molecule comprises a heavy chain comprising the amino acid sequence of SEQ ID NO: 508 and a light chain comprising the amino acid sequence of SEQ ID NO: 518.
• the antibody molecule comprises a heavy chain encoded by the nucleotide sequence of SEQ ID NO: 509, or a nucleotide sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 509.
• the antibody molecule comprises a light chain encoded by the nucleotide sequence of SEQ ID NO: 523 or 519, or a nucleotide sequence at least 85%, 90%, 95%, or 99% identical or higher to SEQ ID NO: 523 or 519.
• the antibody molecule comprises a heavy chain encoded by the nucleotide sequence of SEQ ID NO: 509 and a light chain encoded by the nucleotide sequence of SEQ ID NO: 523 or 519.
• the antibody molecules described herein can be made by vectors, host cells, and methods described in US 2015/0210769, incorporated by reference in its entirety.
• [0068] in another embodiment is method of treating cancer comprising adminstering to a subject in need thereof a pharmaceutical composition comprising (3S,4S)-8-(6-amino-5-((2- amino-3-chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, in combination with a second therapeutic agent.
• the cancer is selected from esophageal squamous cell carcinoma, head and neck squamous cell carcinoma, colorectal cancer, ovarian cancer, pancreatic cancer, non-small cell lung cancer and renal cell carcinoma.
• the cancer is selected from esophageal squamous cell carcinoma and pharyngeal squamous cell carcinoma.
• the cancer is colorectal cancer.
• the cancer is non-small cell lung cancer.
• the cancer is head and neck squamous cell carcinoma.
• (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and the second therapeutic agent are administered simultaneously, separately or over a period of time.
• the amount of (3S,4S)-8-(6-amino-5-((2-amino-3- chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, administered to the subject in need therof is effective to treat the cancer.
• the amounts of (3S,4S)-8-(6-amino-5-((2-amino-3- chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and the second therapeutic agent, administered to the subject in need thereof is effective to treat the cancer.
• the second therapeutic agent is an immunomodulator.
• the second therapeutic agent is an immune checkpoint inhibitor.
• the second therapeutic agent is a PD-1 inhibitor.
• the PD-1 inhibitor is selected from PDR001, Nivolumab,
• Pembrolizumab Pembrolizumab, Pidilizumab, MEDI0680, REGN2810, TSR-042, PF-06801591, BGB-A317, BGB-108, INCSHR1210, or AMP-224.
• the PD-1 inhibitor is PDR001.
• (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof is administered orally at a dose of about 1.5 mg per day, or 3 mg per day, or 6 mg per day, or 10 mg per day, or 20 mg per day, or 30 mg per day, or 40 mg per day, or 50 mg per day, or 60 mg per day, or 70 mg per day, or 80 mg per day, or 90 mg per day, or 100 mg per day.
• the dose per day of (3S,4S)-8-(6-amino-5-((2-amino-3- chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof is on a 21 day cycle of 2 weeks on drug followed by 1 week off drug.
• the_dose is 20 mg QD per day of (3S,4S)-8-(6-amino-5-
• PDR001 is administered at a dose of about 300 mg once every 3 weeks.
• PDR001 is administered at a dose of about 400 mg once every 4 weeks.
• [0087] in another embodiment is a method of treating cancer comprising adminstering, to a patient in need thereof, (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4-yl)thio)pyrazin-2- yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, orally at a dose of about 1.5 mg per day, or 3 mg per day, or 6 mg per day, or 10 mg per day, or 20 mg per day, or 30 mg per day, or 40 mg per day, or 50 mg per day, or 60 mg per day, or 70 mg per day, or 80 mg per day, or 90 mg per day, or 100 mg per day.
• the dose per day of (3S,4S)-8-(6-amino-5-((2-amino-3- chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof is on a 21 day cycle of 2 weeks on drug followed by 1 week off drug.
• the dose is 20 mg QD per day of (3S,4S)-8-(6-amino-5-
• the cancer is selected from esophageal squamous cell carcinoma, head and neck squamous cell carcinoma, colorectal cancer, ovarian cancer, pancreatic cancer, non-small cell lung cancer and renal cell carcinoma.
• the cancer is colorectal cancer.
• the cancer is non-small cell lung cancer.
• the cancer is head and neck squamous cell carcinoma.
• the method further comprises a second therapeutic agent.
• (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and the second therapeutic agent are administered simultaneously, separately, or over a period of time.
• the second therapeutic agent is an immunomodulator.
• the second therapeutic agent is an immune checkpoint inhibitor.
• the second therapeutic agent is a PD-1 inhibitor.
• the PD-1 inhibitor is selected from PDR001, Nivolumab,
• Pembrolizumab Pembrolizumab, Pidilizumab, MEDI0680, REGN2810, TSR-042, PF-06801591, BGB-A317, BGB-108, INCSHR1210, or AMP-224.
• the PD-1 inhibitor is PDR001.
• PDR001 is administered at a dose of about 300 mg once every 3 weeks.
• PDR001 is administered at a dose of about 400 mg once every 4 weeks.
• the second therapeutic agent is administered intravenously.
• the cancer is colorectal cancer.
• the cancer is non-small cell lung cancer.
• the cancer is head and neck squamous cell carcinoma.
• a medicament for the treatment of a cancer selected from: esophageal or head and neck squamous cell carcinoma; colorectal, ovarian, pancreatic or non-small cell lung cancer; and renal cell carcinoma.
• a method of treating a cancer selected from: esophageal or head and neck squamous cell carcinoma; colorectal, ovarian, pancreatic or non-small cell lung cancer; and renal cell carcinoma; comprising administrating to a patient in need thereof a pharmaceutical combination of (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and PDR001, or a pharmaceutical composition comprising a pharmaceutical combination of (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and PDR001, or a pharmaceutical composition comprising
• a method of treating a cancer selected from: esophageal or head and neck squamous cell carcinoma; colorectal, ovarian, pancreatic or non-small cell lung cancer; and renal cell carcinoma; comprising administrating to a patient in need thereof a pharmaceutical combination of (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and PDR001, or a pharmaceutical composition comprising a pharmaceutical combination of (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4- yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine, or pharmaceutically acceptable salt thereof, and PDR001, or a pharmaceutical composition comprising
• Non-small cell lung cancer In 2012, approximately 1.8 million people worldwide were diagnosed with lung cancer, and an estimated 1.6 million people died from the disease.
• Non-small cell lung cancer comprises approximately 85% of lung cancers, with adenocarcinomas and squamous cell carcinomas being the most common subtypes.
• Standard of care treatment for advanced stage non-small cell lung carcinomas (NSCLCs) that do not harbor genetic alterations in draggable driver oncogenes such as EGFR, ALK, or ROS includes chemotherapy and immunotherapy, administered concurrently or sequentially. While these treatments provide clinical benefit, the majority of patients experience disease progression within a year, and the prognosis for patients with advanced NSCLC remains poor.
• Head and neck squamous cell cancer - Squamous cell cancers are the most common cancers occurring in the head and neck, with an estimated worldwide incidence of approximately 686,000 for oropharyngeal and laryngeal cancers combined. Alcohol and tobacco use are the most common risk factors for head and neck squamous cell cancers (HNSCCs), with human papilloma virus (HPV) infection likely also playing a causative role. More than 90% of HNSCCs have overexpression of EGFR or its ligands. For patients with metastatic disease, standard systemic treatment includes platinum-based chemotherapy with or without cetuximab. Historically, median survival with systemic chemotherapy is approximately six months, with only approximately 20% of patients surviving one year.
• nivolumab an anti-programmed death- 1 (PD-1) antibody
• standard second-line single agent therapy docetaxel, methotrexate, or cetuximab
• CRC Colorectal cancer - Colorectal cancer
• Chromosomal instability is found in approximately 85% of sporadic colorectal cancers and is characterized by mutations in the Wnt pathway genes, APC and CTNNB1. KRAS mutations, occurring most commonly in codon 12 or 13, are present in approximately 45% of these cases and render anti-EGFR therapies ineffective.
• MSI Microsatellite instability
• Systemic therapy for metastatic CRC includes various agents used alone or in combination, including chemotherapies such as 5-Fluorouracil/leucovorin, capecitabine, oxaliplatin, and irinotecan; anti-angiogenic agents such as bevacizumab and ramucirumab; anti-EGFR agents including cetuximab and panitumumab for KRAS/NRAS wild-type cancers; and immunotherapies including nivolumab and pembrolizumab.
• chemotherapies such as 5-Fluorouracil/leucovorin, capecitabine, oxaliplatin, and irinotecan
• anti-angiogenic agents such as bevacizumab and ramucirumab
• anti-EGFR agents including cetuximab and panitumumab for KRAS/NRAS wild-type cancers
• immunotherapies including nivolumab and pembrolizumab.
• TN0155 is a first-in-class allosteric inhibitor of wild-type SHP2.
• SHP2 is a ubiquitously expressed non-receptor protein tyrosine phosphatase (PTP) composed of two N- terminal SH2 domains, a classic PTP domain, and a C-terminal tail. The phosphatase activity is auto-inhibited by the two SHP2 domains that bind to the PTP domain (closed conformation).
• PTP non-receptor protein tyrosine phosphatase
• RTKs receptor tyrosine kinases
• SHP2 Upon activation of receptor tyrosine kinases (RTKs), SHP2 is recruited to the plasma membrane where it associates with activated RTKs and a number of adaptor proteins to relay signaling by activating the RAS/MAPK pathway.
• TN0155 binds the inactive, or“closed” conformation of SHP2, thereby preventing its opening into the active conformation. This prevents the transduction of signaling from activated RTKs to the downstream RAS/MAPK pathway.
• TN0155 has demonstrated efficacy in a wide range of RTK-dependent human cancer cell lines and in vivo xenografts. Preclinical in vitro and in vivo evaluation of TN0155 demonstrate selective and potent inhibition of the SHP2 phosphatase, in RTK-dependent human cancer models, for example, esophageal, HNSCC and NSCLC. SHP2 inhibition can be measured by assessing biomarkers within the MAPK signaling pathway, such as decreased levels of phosphorylated ERKl/2 (pERK) and downregulation of dual specificity phosphatase 6 (DUSP6) mRNA transcript.
• pERK phosphorylated ERKl/2
• DUSP6 dual specificity phosphatase 6
• the in vitro pERK IC50’s were 8 nM (3.4 ng/mL) and 35 nM (14.8 ng/mL) and the antiproliferation IC50’s were 100 nM (42.2 ng/mL) and 470 nM (198.3 ng/mL), respectively.
• the antiproliferative effect of TN0155 was revealed to be most effective in cancer cell lines that are dependent on RTK signaling.
• SHP2 inhibition by orally-administered TN0155 (20 mg kg) achieved approximately 95% decrease in DUSP6 mRNA transcript in an EGFR-dependent DETROIT-562 cancer cell line and 47% regression when dosed on a twice-daily schedule.
• Dose fractionation studies, coupled with modulation of the tumor DUSP6 biomarker show that maximal efficacy is achieved when 50% PD inhibition is attained for at least 80% of the dosing interval.
• SHP2 is implicated in immune checkpoint and cytokine receptor signaling.
• SHP2 was shown to be recruited by Programmed cell death- 1 (PD-1) to dephosphorylate and inactivate the co-stimulatory receptor CD28, which suppresses T cell activation.
• PD-1 Programmed cell death- 1
• SHP2 ablation in myeloid cells inhibited melanoma growth by potentiating production of the T-cell chemoattractant CXCL9 by macrophages in response to IFN-g and tumor cell -derived cytokines, thereby facilitating tumor infiltration of IFN-g-producing T cells.
• SHP2 may achieve anti-tumor efficacy through multiple mechanisms including direct inhibition of cancer cell growth, activation of tumor targeting T cells, and promotion of T cell tumor infiltration.
• SHP2 is implicated in PD-1 suppression of T-cell activation and the immune signaling in other immune- suppressive cells such as type 2 tumor associated macrophages (TAM).
• TAM tumor associated macrophages
• the immune system is tightly controlled by a network of costimulatory and co- inhibitory ligands and receptors. These molecules provide the second signal for T cell activation and provide a balanced network of positive and negative signals to maximize immune responses against infection, while limiting immunity to self.
• costimulatory signals include the binding between the B7.1 (CD80) and B7.2 (CD86) ligands of the APC and the CD28 and CTLA- 4 receptors of the CD4 + T-lymphocyte. Binding of B7.1 or B7.2 to CD28 stimulates T cell activation, whereas binding of B7.1 or B7.2 to CTLA-4 inhibits such activation.
• CD28 is constitutively expressed on the surface of T cells, whereas CTLA4 expression is rapidly up- regulated following T-cell activation.
• Other ligands of the CD28 receptor include a group of related B7 molecules, also known as the“B7 Superfamily”.
• Superfamily are known, including B7.1 (CD80), B7.2 (CD86), the inducible co-stimulator ligand (ICOS-L), the programmed death-1 ligand (PD-L1; B7-H1), the programmed death-2 ligand (PD- L2; B7-DC), B7-H3, B7-H4 and B7-H6.
• the Programmed Death 1 (PD-1) protein is an inhibitory member of the extended
• CD28/CTLA-4 family of T cell regulators Two ligands for PD-1 have been identified, PD-L1 (B7-H1) and PD-L2 (B7-DC), that have been shown to downregulate T cell activation upon binding to PD-1.
• PD-L1 is abundant in a variety of human cancers.
• PD-1 is known as an immunoinhibitory protein that negatively regulates TCR signals.
• the interaction between PD-1 and PD-L1 can act as an immune checkpoint, which can lead to, e.g., a decrease in tumor infiltrating lymphocytes, a decrease in T-cell receptor mediated proliferation, and/or immune evasion by cancerous cells.
• Immune suppression can be reversed by inhibiting the local interaction of PD-1 with PD-L1 or PD-L2; the effect is additive when the interaction of PD-1 with PD-L2 is blocked as well.
• PDR001 spartalizumab
• the constant of dissociation (KD) of spartalizumab on human PD-1 is 0.827 nM.
• spartalizumab enhances IL-2 production by approximately 2-fold in response to super antigen stimulation with Staphylococcal enterotoxin B (SEB).
• SEB Staphylococcal enterotoxin B
• Spartalizumab does not cross-react with rodent PD-1 and cannot be evaluated in murine tumor models.
• a mouse antibody surrogate was developed (Clone 1D2) that demonstrates binding affinities to mouse PD1 antigen comparable to that of spartalizumab to human PD1 antigen.
• PRD001 Investigator Combination efficacy and immune modulation by TN0155 with mouse anti-PDl antibody in a syngeneic mouse tumor model
• MC38 demonstrated a robust anti-tumor effect and significant inhibition of immune suppressive myeloid cells (gMDSC, TAMII) and lymphocytes (Treg cells) with an increase in activated CD8+ T-cells within the tumor.
• gMDSC immune suppressive myeloid cells
• TAMII immune suppressive myeloid cells
• Treg cells lymphocytes
• SHP2 transduces signaling downstream of activated RTKs, as well as of PD-1 and
• TN0155 is a potent inhibitor of wild-type SHP2, which enhances the anti-tumor activity of immune checkpoint inhibitors.
• Preclinical mouse syngeneic tumor model studies have demonstrated enhanced anti -tumor activity of an anti -PD-1 antibody when combined with TN0155.
• TN0155 has demonstrated single agent activity in preclinical NSCLC and HNSCC models, and anti-PD-1 agents have demonstrated clinical efficacy in subsets of NSCLC and HNSCC patients.
• the combination of the present invention shows improved efficacy compared to either single agent alone in the treatment of a syngeneic MC38 CRC tumor-bearing immune-competent mouse model.
• the combinations disclosed herein can result in one or more of: an increase in antigen presentation, an increase in effector cell function (e.g., one or more of T cell proliferation, IFN-g secretion or cytolytic function), inhibition of regulatory T cell function, an effect on the activity of multiple cell types (e.g., regulatory T cell, effector T cells and NK cells), an increase in tumor infiltrating lymphocytes, an increase in T-cell receptor mediated proliferation, a decrease in immune evasion by cancerous cells, and a decrease in oncogenic activity (e.g., overexpression of an oncogene).
• an increase in antigen presentation an increase in effector cell function (e.g., one or more of T cell proliferation, IFN-g secretion or cytolytic function), inhibition of regulatory T cell function, an effect on the activity of multiple cell
• the use of a PD-1 inhibitor in the combinations inhibits, reduces or neutralizes one or more activities of PD-1, resulting in blockade or reduction of an immune checkpoint.
• a PD-1 inhibitor in the combinations inhibits, reduces or neutralizes one or more activities of PD-1, resulting in blockade or reduction of an immune checkpoint.
• a method of modulating an immune response in a subject comprises administering to the subject a combination disclosed herein (e.g., a combination comprising a therapeutically effective amount of a PD-1 inhibitor described herein), in combination with a SHP2 inhibitor, such that the immune response in the subject is modulated.
• the antibody molecule enhances, stimulates, restores, or increases the immune response in the subject.
• the subject can be a mammal, e.g., a primate, preferably a higher primate, e.g., a human (e.g., a patient having, or at risk of having, a disorder described herein).
• the subject is in need of enhancing an immune response.
• the subject has, or is at risk of, having a disorder described herein, e.g., a cancer or an infectious disorder as described herein.
• the subject is, or is at risk of being, immunocompromised.
• the subject is undergoing or has undergone a chemotherapeutic treatment and/or radiation therapy.
• the subject is, or is at risk of being, immunocompromised as a result of an infection.
• a method of treating e.g., one or more of reducing, inhibiting, or delaying progression
• the method comprises administering to the subject a combination disclosed herein (e.g., e.g., a combination comprising a therapeutically effective amount of a PD-1 inhibitor described herein).
• the cancer treated with the combination includes but is not limited to, a solid tumor, a hematological cancer (e.g., leukemia, lymphoma, myeloma, e.g., multiple myeloma), and a metastatic lesion.
• a solid tumor e.g., leukemia, lymphoma, myeloma, e.g., multiple myeloma
• a metastatic lesion e.g., the cancer is a solid tumor.
• solid tumors include malignancies, e.g., sarcomas and carcinomas, e.g.,
• adenocarcinomas of the various organ systems such as those affecting the lung, breast, ovarian, lymphoid, gastrointestinal (e.g., colon), anal, genitals and genitourinary tract (e.g., renal, urothelial, bladder cells, prostate), pharynx, CNS (e.g., brain, neural or glial cells), head and neck, skin (e.g., melanoma), and pancreas, as well as adenocarcinomas which include malignancies such as colon cancers, rectal cancer, renal cancer (e.g., renal-cell carcinoma (clear cell or non- clear cell renal cell carcinoma), liver cancer, lung cancer (e.g., non-small cell lung cancer (squamous or non-squamous non-small cell lung cancer)), cancer of the small intestine and cancer of the esophagus.
• the cancer may be at an early, intermediate, late stage or metastatic cancer.
• the cancer is an advanced cancer. In some embodiments, the cancer is a metastatic cancer. In some embodiments, the cancer is a relapsed cancer. In some embodiments, the cancer is a refractory cancer. In some embodiments, the cancer is a recurrent cancer. In some embodiments, the cancer is an unresectable cancer.
• the cancer is a microsatellite instability -high (MSI-H) cancer. In some embodiments, the cancer is a mismatch repair deficient (dMMR) cancer.
• MSI-H microsatellite instability -high
• dMMR mismatch repair deficient
• the cancer e.g., cancer cells, cancer microenvironment, or both
• the cancer has an elevated level of PD-L1 expression.
• the cancer e.g., cancer cells, cancer microenvironment, or both
• the subject has, or is identified as having, a cancer that has one or more of high PD-L1 level or expression, or as being tumor infiltrating lymphocyte (TIL)+ (e.g., as having an increased number of TILs), or both.
• TIL tumor infiltrating lymphocyte
• the subject has, or is identified as having, a cancer that has high PD-L1 level or expression and that is TIL+.
• the method described herein further includes identifying a subject based on having a cancer that has one or more of high PD-L1 level or expression, or as being TIL+, or both.
• the method described herein further includes identifying a subject based on having a cancer that has high PD-L1 level or expression and as being TIL+.
• a cancer that is TIL+ is positive for CD8 and IFNg.
• the subject has, or is identified as having, a high percentage of cells that are positive for one, two or more of PD-L1, CD8, or IFNg.
• the subject has, or is identified as having, a high percentage of cells that are positive for all of PD-L1, CD8, and IFNg.
• the methods described herein further includes identifying a subject based on having a high percentage of cells that are positive for one, two or more of PD- Ll, CD8, and/or IFNg. In certain embodiments, the methods described herein further includes identifying a subject based on having a high percentage of cells that are positive for all of PD-L1, CD8, and IFNg.
• the subject has, or is identified as having, one, two or more of PD-L1, CD8, and/or IFNg, and one or more of , esophageal cancer, an ovarian cancer, a breast cancer, a pancreatic cancer, a colorectal cancer, a skin cancer, a gastric cancer, an ER+ cancer, a head and neck squamous cell carcinoma, or a renal cell carcinoma.
• PD-L1, CD8, and/or IFNg one or more of , esophageal cancer, an ovarian cancer, a breast cancer, a pancreatic cancer, a colorectal cancer, a skin cancer, a gastric cancer, an ER+ cancer, a head and neck squamous cell carcinoma, or a renal cell carcinoma.
• the method described herein further includes identifying a subject based on having one, two or more of PD-L1, CD8, and/or IFNg, and one or more of a breast cancer, a pancreatic cancer, a colorectal cancer, a skin cancer, a gastric cancer, or an ER+ cancer).
• the invention provides a method of treating an infectious disease in a subject, comprising administering to a subject a combination as described herein, e.g., a combination comprising a therapeutically effective amount of a PD-1 inhibitor described herein.
• the infection disease is chosen from hepatitis (e.g., hepatitis C infection), or sepsis.
• the invention provides a method of enhancing an immune response to an antigen in a subject, comprising administering to the subject: (i) the antigen; and (ii) a combination as described herein, e.g., a combination comprising a therapeutically effective amount of a PD-1 inhibitor described herein, such that an immune response to the antigen in the subject is enhanced.
• the antigen can be, for example, a tumor antigen, a viral antigen, a bacterial antigen or an antigen from a pathogen.
• the combinations as described herein can be administered to the subject systemically (e.g., orally, parenterally, subcutaneously, intravenously, rectally, intramuscularly, intraperitoneally, intranasally, transdermally, or by inhalation or intracavitary installation), topically, or by application to mucous membranes, such as the nose, throat and bronchial tubes.
• the PD-1 inhibitor is administered by injection (e.g., subcutaneously or intravenously) at a dose (e.g., a flat dose) of about 100 mg to 600 mg, e.g., about 200 mg to 500 mg, e.g., about 250 mg to 450 mg, about 300 mg to 400 mg, about 250 mg to 350 mg, about 350 mg to 450 mg, or about 100 mg, about 200 mg, about 300 mg, or about 400 mg.
• the dosing schedule (e.g., flat dosing schedule) can vary from e.g., once a week to once every 2, 3, 4, 5, or 6 weeks.
• the PD-1 inhibitor is administered at a dose from about 300 mg to 400 mg once every three weeks or once every four weeks. In one embodiment, the PD-1 inhibitor is administered at a dose from about 300 mg once every three weeks. In one embodiment, the PD-1 inhibitor is administered at a dose from about 400 mg once every four weeks. In one embodiment, the PD-1 inhibitor is administered at a dose from about 300 mg once every four weeks. In one embodiment, the PD-1 inhibitor is administered at a dose from about 400 mg once every three weeks.
• the epidermal growth factor receptor (EGFR) is an established critical therapeutic target in NSCLCs harboring activating EGFR mutations. Numerous trials with first (e.g.
• erlotinib, gefitinib) and second (e.g. afatinib, dacomitinib) generation EGFR inhibitors have been conducted in the EGFR-mutant advanced/unresectable NSCLC population, and have consistently demonstrated superior efficacy of EGFR tyrosine kinase inhibitors (TKIs) over chemotherapy in this population.
• TKIs EGFR tyrosine kinase inhibitors
• Resistance to 1 st generation EGFR TKIs has been shown to arise through the development of an EGFR“gatekeeper” T790M mutation that impairs binding of the TKI, as well as by activation of alternative RTK pathways, including MET and ERBB2 amplification.
• TN0155 is predicted to provide clinical benefit in these cancers whether resistance is driven by signaling from EGFR or another RTK.
• More than 90% of head and neck cancers are characterized by overexpression or amplification of EGFR, amplification/overexpression of other RTKs, particularly FGFRs, and their ligands is also common. Inhibition of EGFR with cetuximab in advanced HNSCCs has also demonstrated clinical benefit, though disease control is not durable.
• the modest efficacy of EGFR inhibition in HNSCC may be related to compensatory signaling through other RTKs, which would be predicted to be abrogated by SHP2 inhibition with TN0155 treatment.
• preclinical testing identified head and neck cancer cells as the lineage with the highest frequency of sensitivity to SHP2 inhibition.
• RTK-driven cancers such as anaplastic lymphoma kinase (ALK) -rearranged NSCLC or stem cell factor receptor (KIT)-mutant gastrointestinal stromal tumor (GIST) derive benefit from molecules directly targeting these RTKs, but resistance to these agents invariably occurs.
• Mechanisms of resistance frequently include drug -resistant mutations in the targeted RTK and/or activation of bypass RTK pathways; in most cases, further treatment options are limited.
• Targeting SHP2 with TN0155 is a rational approach in such RTK-dependent cancers.
• MTD dose of 20 mg/kg BID achieves anti-tumor efficacy as a single agent with significant combination benefit observed for TN0155 and anti-PDl therapy.
• This combination also resulted in a decrease in subsets of suppressive immune populations such as T-regs, TAMII and gMDSCs.
• the present invention provides pharmaceutically acceptable compositions which comprise a therapeutically -effective amount TN0155 and a PD-1 inhibitor, formulated together with one or more pharmaceutically acceptable carriers (additives) and/or diluents.
• the pharmaceutical compositions of the present invention may be specially formulated for administration in solid or liquid form, including those adapted for oral administration, for example, drenches (aqueous or non-aqueous solutions or suspensions), tablets, e.g., those targeted for buccal, sublingual, and systemic absorption, boluses, powders, granules, pastes for application to the tongue.
• terapéuticaally-effective amount means that amount of a compound, material, or composition comprising a compound of the present invention which is effective for producing some desired therapeutic effect in at least a sub-population of cells in an animal at a reasonable benefit/risk ratio applicable to any medical treatment.
• phrases "pharmaceutically acceptable” is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
• pharmaceutically-acceptable carrier means a pharmaceutically-acceptable material, composition or vehicle, such as a liquid or solid filler, diluent, excipient, manufacturing aid (e.g., lubricant, talc magnesium, calcium or zinc stearate, or steric acid), or solvent encapsulating material, involved in carrying or transporting the subject compound from one organ, or portion of the body, to another organ, or portion of the body.
• manufacturing aid e.g., lubricant, talc magnesium, calcium or zinc stearate, or steric acid
• solvent encapsulating material involved in carrying or transporting the subject compound from one organ, or portion of the body, to another organ, or portion of the body.
• Each carrier must be “acceptable” in the sense of being compatible with the other ingredients of the formulation and not injurious to the patient.
• materials which can serve as pharmaceutically-acceptable carriers include: (1) sugars, such as lactose, glucose and sucrose; (2) starches, such as com starch and potato starch; (3) cellulose, and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7) talc; (8) excipients, such as cocoa butter and suppository waxes; (9) oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, com oil and soybean oil; (10) glycols, such as propylene glycol; (11) polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol; (12) esters, such as ethyl oleate and ethyl laurate; (13) agar; (14) buffering agents, such as magnesium hydroxide and aluminum, such
• certain embodiments of the present compounds may contain a basic functional group, such as amino or alkylamino, and are, thus, capable of forming pharmaceutically-acceptable salts with pharmaceutically-acceptable acids.
• a basic functional group such as amino or alkylamino
• “pharmaceutically-acceptable salts” in this respect, refers to the relatively non-toxic, inorganic and organic acid addition salts of compounds of the present invention. These salts can be prepared in situ in the administration vehicle or the dosage form manufacturing process, or by separately reacting a purified compound of the invention in its free base form with a suitable organic or inorganic acid, and isolating the salt thus formed during subsequent purification.
• Representative salts include the hydrobromide, hydrochloride, sulfate, bisulfate, phosphate, nitrate, acetate, valerate, oleate, palmitate, stearate, laurate, benzoate, lactate, phosphate, tosylate, citrate, maleate, fumarate, succinate, tartrate, napthylate, mesylate, glucoheptonate, lactobionate, and
• the pharmaceutically acceptable salts of the subject compounds include the conventional nontoxic salts or quaternary ammonium salts of the compounds, e.g., from non-toxic organic or inorganic acids.
• such conventional nontoxic salts include those derived from inorganic acids such as hydrochloride, hydrobromic, sulfuric, sulfamic, phosphoric, nitric, and the like; and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, palmitic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicyclic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, isothionic, and the like.
• the pharmaceutically acceptable salt of TN0155 is succinate.
• the compounds of the present invention may contain one or more acidic functional groups and, thus, are capable of forming pharmaceutically-acceptable salts with pharmaceutically-acceptable bases.
• pharmaceutically-acceptable salts in these instances refers to the relatively non-toxic, inorganic and organic base addition salts of compounds of the present invention. These salts can likewise be prepared in situ in the administration vehicle or the dosage form manufacturing process, or by separately reacting the purified compound in its free acid form with a suitable base, such as the hydroxide, carbonate or bicarbonate of a pharmaceutically-acceptable metal cation, with ammonia, or with a
• Representative alkali or alkaline earth salts include the lithium, sodium, potassium, calcium, magnesium, and aluminum salts and the like.
• Representative organic amines useful for the formation of base addition salts include ethylamine, diethylamine, ethylenediamine, ethanolamine, diethanolamine, piperazine and the like. (See, for example, Berge et al, supra )
• wetting agents such as sodium lauryl sulfate and magnesium stearate, as well as coloring agents, release agents, coating agents, sweetening, flavoring and perfuming agents, preservatives and antioxidants can also be present in the compositions.
• antioxidants examples include: (1) water soluble antioxidants, such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium
• antioxidants such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, alpha- tocopherol, and the like
• metal chelating agents such as citric acid, ethylenediamine tetraacetic acid (EDTA), sorbitol, tartaric acid, phosphoric acid, and the like.
• Formulations of the present invention include those suitable for oral, nasal, topical
• the formulations may conveniently be presented in unit dosage form and may be prepared by any methods well known in the art of pharmacy.
• the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will vary depending upon the host being treated, the particular mode of administration.
• the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will generally be that amount of the compound which produces a therapeutic effect. Generally, out of one hundred per cent, this amount will range from about 0.1 per cent to about ninety-nine percent of active ingredient, preferably from about 5 per cent to about 70 per cent, most preferably from about 10 percent to about 30 percent.
• a formulation of the present invention comprises an excipient selected from the group consisting of cyclodextrins, celluloses, liposomes, micelle forming agents, e.g., bile acids, and polymeric carriers, e.g., polyesters and poly anhydrides; and a compound of the present invention.
• an aforementioned formulation renders orally bioavailable a compound of the present invention.
• Methods of preparing these formulations or compositions include the step of bringing into association a compound of the present invention with the carrier and, optionally, one or more accessory ingredients.
• the formulations are prepared by uniformly and intimately bringing into association a compound of the present invention with liquid carriers, or finely divided solid carriers, or both, and then, if necessary, shaping the product.
• Formulations of the invention suitable for oral administration may be in the form of capsules, cachets, pills, tablets, lozenges (using a flavored basis, usually sucrose and acacia or tragacanth), powders, granules, or as a solution, suspension or solid dispersion in an aqueous or non-aqueous liquid, or as an oil-in-water or water-in-oil liquid emulsion, or as an elixir or syrup, or as pastilles (using an inert base, such as gelatin and glycerin, or sucrose and acacia) and/or as mouth washes and the like, each containing a predetermined amount of a compound of the present invention as an active ingredient.
• a compound of the present invention may also be administered as a bolus, electuary or paste.
• the active ingredient is mixed with one or more pharmaceutically-acceptable carriers, such as sodium citrate or dicalcium phosphate, and/or any of the following: (1) fdlers or extenders, such as starches, lactose, sucrose, glucose, mannitol, and/or silicic acid; (2) binders, such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinyl pyrrolidone, sucrose and/or acacia; (3) humectants, such as glycerol; (4) disintegrating agents, such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; (5) solution retarding agents, such as paraffin; (6) absorption accelerators, such as quaternary ammonium compounds and surfactants,
• pharmaceutically-acceptable carriers such as sodium citrate or dicalcium phosphate, and/or any of the following: (1) fdlers or extenders, such as star
• compositions may also comprise buffering agents.
• Solid compositions of a similar type may also be employed as fdlers in soft and hard-shelled gelatin capsules using such excipients as lactose or milk sugars, as well as high molecular weight polyethylene glycols and the like.
• a tablet may be made by compression or molding, optionally with one or more accessory ingredients.
• Compressed tablets may be prepared using binder (for example, gelatin or hydroxypropylmethyl cellulose), lubricant, inert diluent, preservative, disintegrant (for example, sodium starch glycolate or cross-linked sodium carboxymethyl cellulose), surface-active or dispersing agent.
• Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
• the tablets, and other solid dosage forms of the pharmaceutical compositions of the present invention may optionally be scored or prepared with coatings and shells, such as enteric coatings and other coatings well known in the pharmaceutical-formulating art. They may also be formulated so as to provide slow or controlled release of the active ingredient therein using, for example, hydroxypropylmethyl cellulose in varying proportions to provide the desired release profde, other polymer matrices, liposomes and/or microspheres. They may be formulated for rapid release, e.g., freeze-dried.
• compositions may be sterilized by, for example, filtration through a bacteria-retaining fdter, or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved in sterile water, or some other sterile injectable medium immediately before use.
• These compositions may also optionally contain opacifying agents and may be of a composition that they release the active ingredient(s) only, or preferentially, in a certain portion of the gastrointestinal tract, optionally, in a delayed manner.
• embedding compositions which can be used include polymeric substances and waxes.
• the active ingredient can also be in micro-encapsulated form, if appropriate, with one or more of the above-described excipients.
• Liquid dosage forms for oral administration of the compounds of the invention include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs.
• the liquid dosage forms may contain inert diluents commonly used in the art, such as, for example, water or other solvents, solubilizing agents and emulsifiers, such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3 -butylene glycol, oils (in particular, cottonseed, groundnut, com, germ, olive, castor and sesame oils), glycerol, tetrahydrofuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
• inert diluents commonly used in the art, such as, for example, water or other solvents, solubilizing
• the oral compositions can also include adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, coloring, perfuming and preservative agents.
• adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, coloring, perfuming and preservative agents.
• Suspensions in addition to the active compounds, may contain suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, and mixtures thereof.
• suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, and mixtures thereof.
• aqueous and nonaqueous carriers examples include water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), and suitable mixtures thereof, vegetable oils, such as olive oil, and injectable organic esters, such as ethyl oleate.
• polyols such as glycerol, propylene glycol, polyethylene glycol, and the like
• vegetable oils such as olive oil
• injectable organic esters such as ethyl oleate.
• Proper fluidity can be maintained, for example, by the use of coating materials, such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
• compositions may also contain adjuvants such as preservatives, wetting agents, emulsifying agents and dispersing agents. Prevention of the action of microorganisms upon the subject compounds may be ensured by the inclusion of various antibacterial and antifungal agents, for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents, such as sugars, sodium chloride, and the like into the compositions.
• compositions containing, for example, 0.1 to 99% (more preferably, 10 to 30%) of active ingredient in combination with a pharmaceutically acceptable carrier.
• the selected dosage level will depend upon a variety of factors including the activity of the particular compound of the present invention employed, or the ester, salt or amide thereof, the route of administration, the time of administration, the rate of excretion or metabolism of the particular compound being employed, the rate and extent of absorption, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular compound employed, the age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well known in the medical arts.
• a physician or veterinarian having ordinary skill in the art can readily determine and prescribe the effective amount of the pharmaceutical composition required.
• the physician or veterinarian could start doses of the compounds of the invention employed in the pharmaceutical composition at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved.
• a suitable daily dose of the combination of the invention will be that amount of each compound which is the lowest dose effective to produce a therapeutic effect.
• compositions which comprise a therapeutically -effective amount of one or more of the subject compounds, as described above, formulated together with one or more pharmaceutically acceptable carriers (additives) and/or diluents.
• TN0155 was evaluated for single agent and combination anti-tumor activity with a mouse anti-PDl antibody, Clone 1D2, in a syngeneic colorectal mouse model, MC38, implanted into immunocompromised NOD scid gamma (NSG) or immune-intact (C57BL/6) mice.
• MC38 cells harbor a PTPN11 G503V mutation that prevents inhibition of SHP2 by TN0155, thus allowing for direct interrogation of TN0155 immunomodulatory effects on tumors.
• TN0155 was evaluated in vitro in the MC38 cell line, in the absence of any immune cells, and demonstrated no effect on cell proliferation or viability. Similarly, a lack of anti-tumor activity was observed with TN0155, at 20 mg/kg twice a day (BID), on MC38 xenografts implanted into
• TN0155 had no impact on downstream MAPK-signaling markers in tumor cells, such as phospho-ERK and phospho-RSK.
• Phenotypic markers are shown (see Figure 2) for two suppressive myeloid populations, granulocytic MDSCs and tumor associated macrophage type II in addition to the lymphoid populations of cytotoxic CD8+ T-cells and the suppressive regulator T-cells (Tregs). Shown is the percentage of the total CD45+ cells for the population ⁇ SEM. One-way ANOVA pairwise comparison (p ⁇ 0.05). [00174] See figure 2.
• gMDSCs Ly6G+, Ly6C+, C11b+, F4/80+
• TAMIL Ly6G-, Ly6C+, CD11b+, F4/80+, MHCII- tumor associated macrophages type II
• CD8+ CD45+, CD3+, CD8+
• TN0155 and anti-PDl therapy exerts anti-tumor activity as a consequence of decreased immunosuppressive myeloid cells and T-cells, and an increase in activated T-cells.
• CD14+ monocytes Peripheral blood mononuclear cells (PBMC) were isolated from the whole blood of two donors (donor 1670 and E423) by CPT tubes and spinning at 1800 rpm for 20 minutes. CD14 positive monocytes were then isolated from PBMC using human Pan Monocyte Isolation Kit (Miltenyi Biotec # 130-096-537). 5000 monocytes suspended in 100 mL RPMI media were seeded in 96 well plates with 50 ng/mL recombinant M-CSF. 24 hours later, TN0155 was added at the indicated final concentrations.
• PBMC Peripheral blood mononuclear cells
• a CellTiter-Glo ® (CTG) cell viability assay was performed according to manufacturer’s instructions using a separate plate with identically seeded cells and also performed for all plates after 6 days of incubation with TN0155.
• the Day 6 measurements were normalized with DMSO treated groups as 100% to evaluate the TN0155 effects on the M-CSF stimulated proliferation of monocytes and the Day 0 cell seeding measurement was indicated by the light dotted line.
• TN0155 can block the conversion of monocytes in the tumor microenvironment to immune-suppressive macrophages after being exposed to the M-CSF ligands in the tumors and synergizes with PD1 targeting agents that reinvigorate the exhausted T cells in the tumors.
• TN0155 is dosed daily (QD) 2 weeks on/1 week off on a 21 -day cycle (starting at 20 mg QD).
• Spartalizumab is dosed at 300 mg every 3 weeks on a 21-day cycle.
• CTNO155B12101 patients with advanced EGFR WT, ALK WT, KRAS G12C and KRAS WT NSCLC are studied along with patients with advanced HNSCC (+/- naive to prior immuno-oncologic therapy).
• Patients are treated with advanced solid tumors (with evaluable disease) fitting into one of the following groups: i). advanced EGFR WT, ALK WT NSCLC, after progression on or intolerance to platinum-containing combination chemotherapy; ii). Advanced HNSCC or esophageal SCC, after progression on or intolerance to platinum-containing combination therapy; iii). Advanced CRC, after progression on or intolerance to standard-of-care (SOC) therapy per local guidelines.
• SOC standard-of-care

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