WO2021213523A1 - 抗pd-1抗体和抗ctla-4抗体的组合在预防或治疗癌症中的用途 - Google Patents

抗pd-1抗体和抗ctla-4抗体的组合在预防或治疗癌症中的用途 Download PDF

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WO2021213523A1
WO2021213523A1 PCT/CN2021/089668 CN2021089668W WO2021213523A1 WO 2021213523 A1 WO2021213523 A1 WO 2021213523A1 CN 2021089668 W CN2021089668 W CN 2021089668W WO 2021213523 A1 WO2021213523 A1 WO 2021213523A1
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antibody
antigen
binding fragment
ctla
dose
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PCT/CN2021/089668
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English (en)
French (fr)
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周辉
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信达生物制药(苏州)有限公司
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents

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  • the present invention relates to the use of a combination of an anti-PD-1 antibody or an antigen-binding fragment thereof and an anti-CTLA-4 antibody in the preparation of the combination for preventing or treating cancer, especially hepatocellular carcinoma.
  • the present invention also relates to a drug combination of an anti-PD-1 antibody or an antigen-binding fragment thereof and an anti-CTLA-4 antibody, and a method of using the drug combination to prevent or treat cancer, especially hepatocellular carcinoma.
  • HCC hepatocellular carcinoma
  • HBV hepatitis B virus
  • HCV hepatitis C virus
  • alcohol alcohol
  • diet-related factors Most of the incidence of HCC in China is due to chronic HBV infection causing liver cirrhosis, which eventually develops into HCC.
  • Most HCC patients are already locally advanced or metastatic disease at the time of onset, and are not suitable for radical treatment.
  • HCC is highly resistant to conventional systemic chemotherapy.
  • FOLFOX4 fluorouracil, leucovorin and oxaliplatin
  • PFS overall survival
  • ORR objective response rate
  • the targets include VEGFR1, VEGFR2, VEGFR3, PDGFR- ⁇ , c-kit, FLT-3, RET
  • VEGFR1, VEGFR2, VEGFR3, PDGFR- ⁇ , c-kit, FLT-3, RET This is the first systemic drug or treatment program that has been proven to bring significant survival benefits to patients with advanced HCC, and it is also the current standard first-line treatment program.
  • the median OS of the sorafenib group was 10.7 months and the PFS was 5.5 months, and the effective rate was only 2%, but the incidence of adverse events (AE) was as high as 80%.
  • the second-line treatment for failure of sorafenib treatment currently mainly includes Regorafenib, Ramucirumab and Cabozantinib for Alpha-Fetal Protein (AFP)> 400ng/ml liver cancer patients.
  • the latest version of the 2019 CSCO liver cancer diagnosis and treatment guidelines on the treatment recommendations for advanced HCC pointed out that for patients with liver function Child-Pugh A or better B ( ⁇ 7 points), the first-line treatment recommends sorafenib and ol Saliplatin-based systemic chemotherapy or lenvatinib, and second-line treatment options, anti-PD-1 monoclonal antibodies (including nivolumab and pembrolizumab) are recommended as level I.
  • immune checkpoint inhibitors have also begun to show therapeutic value in advanced HCC.
  • the REACH-2 study compared the efficacy of ramucirumumab and placebo in HCC patients who were intolerant of sorafenib or had disease progression after use, and had AFP serum levels ⁇ 400ng/mL.
  • the results showed that the ramucirumumab group ORR 4.6%, DCR 59.9%, PFS is 2.8 months.
  • the domestic approved anti-PD1 monoclonal antibody (carrelizumab) for second-line hepatocellular carcinoma has an ORR of 13.8%, DCR of 44.7%, and mPFS of only 2.1 months. Therefore, although immune checkpoint inhibitor treatment improves the remission rate compared with chemotherapy treatment, it also sees the limitations of immunotherapy monotherapy, that is, it does not effectively prolong PFS, so combined treatment may further improve the efficacy.
  • CTLA-4 and CD28 molecules have a very similar relationship in gene structure, chromosomal location, sequence homology and gene expression. They are both receptors for the costimulatory molecule B7 and are mainly expressed on the surface of activated T cells. However, as a costimulatory signal for lymphocyte activation, the functions of CTLA-4 and CD28 molecules are opposite. Under normal circumstances, the activation of T cells depends on the first signal (formation of antigen-antibody complex) and the second signal (B7 Mediated activation signal) dual activation. The combination of CTLA-4 and B7 will generate inhibitory signals and inhibit T cell activation. Monoclonal antibody (CTLA-4mAb), as a CTLA-4 blocker, can specifically relieve the immune suppression of CTLA-4 on the body, activate T cells, and has a wide range of applications in gene therapy for anti-tumor and parasitic diseases prospect.
  • CTLA-4mAb Monoclonal antibody
  • Programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) axis is a powerful signaling pathway to inhibit immune activation, and it is also a tumor to achieve immune escape One of the important mechanisms.
  • Tumor infiltrating lymphocytes highly express PD-1. These PD-1 combine with PD-L1 on the surface of tumor cells or immune cells to inhibit the initial activation of T cells, and inhibit the production and function of effector T cells (including cytokine production and Cytotoxicity).
  • Many types of tumors including Hodgkin's lymphoma, diffuse large B-cell lymphoma, ENKTL, colorectal cancer, melanoma, etc., express PD-L1 and inhibit anti-tumor T cell responses through PD-L1. Blocking the PD-L1/PD-1 axis can restore the function of T cells to kill tumors and obtain a lasting clinical response.
  • the drug combination of the present application can have a preventive and/or therapeutic effect on cancer, especially hepatocellular carcinoma, in a way of synergistic effect and/or improving the incidence and/or severity of adverse events (AE) during treatment.
  • AE adverse events
  • the present invention provides the use of a combination comprising an anti-PD-1 antibody or an antigen-binding fragment thereof and an anti-CTLA-4 antibody in the preparation of a medicine for the prevention or treatment of cancer,
  • the anti-PD-1 antibody contains 6 CDRs, of which LCDR1, LCDR2 and LCDR3 are respectively composed of the amino acid sequences RASQGISSWLA (SEQ ID NO: 1), SAASSLQS (SEQ ID NO: 2) and QQANHLPFT (SEQ ID NO: 3), and Among them, HCDR1, HCDR2 and HCDR3 are respectively composed of amino acid sequences KASGGTFSSYAIS (SEQ ID NO: 4), LIIPMFDTAGYAQKFQG (SEQ ID NO: 5) and ARAEHSSTGTFDY (SEQ ID NO: 6), and the 6 CDRs are determined by North definition rules; where The anti-CTLA-4 antibody is ipilimumab or IBI310.
  • the anti-PD-1 antibody or antigen-binding fragment thereof comprises the heavy chain variable region sequence of SEQ ID NO: 7 and the light chain variable region sequence of SEQ ID NO: 8, preferably The anti-PD-1 antibody or antigen-binding fragment thereof includes the heavy chain sequence of SEQ ID NO: 9 and the light chain sequence of SEQ ID NO: 10.
  • the use is for the prevention or treatment of cancer, preferably hepatocellular carcinoma, wherein the hepatocellular carcinoma is more preferably advanced hepatocellular carcinoma that has failed or is intolerant to previous systemic at least first-line treatment.
  • the single administration dose of the anti-PD-1 antibody or antigen-binding fragment thereof in the pharmaceutical combination is 50-500 mg, preferably 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450mg or 500mg, more preferably 200mg, preferably once every two to four weeks; or the single administration dose of the anti-PD-1 antibody or antigen-binding fragment thereof in the pharmaceutical combination is 0.3-10mg/kg, preferably 0.3mg /kg, 1mg/kg, 3mg/kg or 10mg/kg, preferably parenteral, more preferably intravenous administration form; and
  • the single administration dose of the anti-CTLA-4 antibody in the pharmaceutical combination is 15-200mg, preferably 15mg, 60mg, 100mg, 120mg, 180mg or 200mg, more preferably 180mg, preferably once every two to four weeks; or
  • the single administration dose of the anti-CTLA-4 antibody is 0.3-3mg/kg, preferably 0.3mg/kg, 1mg/kg, 2mg/kg or 3mg/kg, preferably once every two to four weeks, preferably parenteral , More preferably, intravenous administration dosage form.
  • the anti-PD-1 antibody or antigen-binding fragment thereof and the anti-CTLA-4 antibody are administered separately, simultaneously or sequentially.
  • the single administration dose of the anti-PD-1 antibody or its antigen-binding fragment is 200 mg, and the single administration dose of the anti-CTLA-4 antibody or its antigen-binding fragment is 1 mg/kg; intravenous injection Every 3 weeks is a cycle, a total of 4 cycles, followed by a single-agent anti-PD-1 antibody or its antigen-binding fragment 200mg once every 3 weeks.
  • the single administration dose of the anti-PD-1 antibody or antigen-binding fragment thereof is 200 mg, and the single administration dose of the anti-CTLA-4 antibody or the antigen-binding fragment thereof is 2 mg/kg; intravenous injection Every 3 weeks is a cycle, a total of 4 cycles, followed by a single-agent anti-PD-1 antibody or its antigen-binding fragment 200mg once every 3 weeks.
  • the single administration dose of the anti-PD-1 antibody or its antigen-binding fragment is 200 mg, and the single administration dose of the anti-CTLA-4 antibody or its antigen-binding fragment is 3 mg/kg; intravenous injection Every 3 weeks is a cycle, a total of 4 cycles, followed by a single-agent anti-PD-1 antibody or its antigen-binding fragment 200mg once every 3 weeks.
  • the present invention provides a method for preventing or treating cancer, the method comprising administering to a patient in need a therapeutically effective amount of the anti-PD-1 antibody or antigen-binding fragment thereof defined in the first aspect and anti-CTLA -4 antibody drug combination, the cancer is preferably hepatocellular carcinoma, wherein the hepatocellular carcinoma is more preferably an advanced hepatocellular carcinoma that has failed or is intolerant to previous systemic at least first-line treatment.
  • the present invention also provides a pharmaceutical composition comprising a therapeutically effective amount of the anti-PD-1 antibody or antigen-binding fragment thereof, the anti-CTLA-4 antibody defined in the first aspect, and a pharmaceutically acceptable pharmaceutical composition a.
  • the present invention also provides a kit containing a therapeutically effective amount of the drug combination of the anti-PD-1 antibody or its antigen-binding fragment thereof and the anti-CTLA-4 antibody as defined in the first aspect.
  • the present invention also provides the use of the above-mentioned pharmaceutical composition or kit in the preparation of drugs for the prevention or treatment of cancer.
  • the cancer is preferably hepatocellular carcinoma, wherein the hepatocellular carcinoma is more preferably a systemic at least one line in the past. Advanced hepatocellular carcinoma with treatment failure or intolerance.
  • the term “comprising” or “including” means including the stated elements, integers or steps, but does not exclude any other elements, integers or steps.
  • the term “comprises” or “includes” when used, unless otherwise specified, it also encompasses the situation consisting of the stated elements, integers or steps.
  • an antibody variable region that "comprises” a specific sequence when referring to an antibody variable region that "comprises” a specific sequence, it is also intended to encompass the antibody variable region composed of the specific sequence.
  • antibody refers to a polypeptide comprising at least a light chain or heavy chain immunoglobulin variable region, which specifically recognizes and binds to an antigen.
  • the term encompasses various antibody structures, including, but not limited to, monoclonal antibodies, polyclonal antibodies, single-chain or multi-chain antibodies, monospecific or multispecific antibodies (such as bispecific antibodies), fully human antibodies, or Chimeric antibodies or humanized antibodies, full-length antibodies, and antibody fragments, as long as they exhibit the desired antigen-binding activity.
  • antigen-binding fragment of an antibody (which can be used interchangeably with “antibody fragment” and “antigen-binding portion” herein) refers to a molecule that is not an intact antibody, which includes the intact antibody used to bind the intact antibody. Part of the antigen. As understood by those skilled in the art, the antigen-binding portion of an antibody usually contains amino acid residues from the "complementarity determining region" or "CDR".
  • the antigen-binding fragment can be prepared by recombinant DNA technology, or by enzymatic or chemical cleavage of the intact antibody.
  • Antigen-binding fragments include but are not limited to Fab, scFab, Fab', F(ab')2, Fab'-SH, Fv, single-chain Fv, double-chain antibody (diabody), triabody (triabody), four-chain antibody ( tetrabody), minibody (minibody), single domain antibody (sdAb).
  • Fab fragment antigen-binding fragments
  • variable region refers to the domain of the heavy or light chain of an antibody that participates in the binding of an antibody to an antigen.
  • the variable domains of the heavy and light chains of natural antibodies usually have similar structures, where each domain contains four conserved framework regions (FR) and three complementarity determining regions (see, for example, Kindt et al. Kuby Immunology, 6th ed., WHFreeman and Co. 91 page (2007)).
  • a single VH or VL domain may be sufficient to give antigen binding specificity.
  • VH or VL domains from antibodies that bind to a specific antigen can be used to isolate antibodies that bind to the antigen to screen libraries of complementary VL or VH domains, respectively. See, for example, Portolano et al., J. Immunol. 150:880-887 (1993); Clarkson et al., Nature 352:624-628 (1991).
  • Variable regions generally exhibit the same general structure of relatively conserved framework regions (FR) connected by three hypervariable regions, which are also referred to as complementarity determining regions or CDRs.
  • the CDRs from the two chains of each pair are usually aligned by the framework regions, which allow the binding of specific epitopes.
  • the variable regions of the two light and heavy chains generally comprise the domains FR1, CDR1, FR2, CDR2, FR3, CDR3, and FR4 from N-terminus to C-terminus.
  • CDR region or “CDR” or “hypervariable region” (herein can be used interchangeably with hypervariable region “HVR”) is an antibody variable domain that is hypervariable in sequence and A structurally defined loop ("hypervariable loop") and/or a region containing antigen contact residues ("antigen contact point”) is formed.
  • CDR is mainly responsible for binding to antigen epitopes.
  • the CDRs of the heavy chain and light chain are usually referred to as CDR1, CDR2, and CDR3, and are numbered sequentially from the N-terminus.
  • the CDRs located in the variable domain of the antibody heavy chain are called HCDR1, HCDR2, and HCDR3, and the CDRs located in the variable domain of the antibody light chain are called LCDR1, LCDR2, and LCDR3.
  • the precise amino acid sequence boundaries of each CDR can be determined using any one or a combination of many well-known antibody CDR assignment systems, which include For example: Chothia based on the three-dimensional structure of antibodies and the topology of CDR loops (Chothia et al.
  • prevention includes the suppression or delay of the occurrence or frequency of the occurrence or occurrence of a disease or disorder or its symptoms, and it generally refers to the administration of a drug before the occurrence or occurrence of the symptoms or symptoms, especially before the occurrence of the symptoms or symptoms in individuals at risk.
  • treatment refers to the slowing, prevention or reversal of the progression of a subject's cancer (eg, colorectal cancer) as evidenced by the reduction or elimination of the clinical or diagnostic symptoms of the disease. Treatment may include, for example, reducing the severity of symptoms, the number of symptoms, or the frequency of recurrence, for example, tumor growth inhibition, tumor growth arrest, or regression of existing tumors.
  • drug combination refers to a non-fixed combination product or a fixed combination product, such as a kit.
  • non-fixed combination means that the active ingredients (for example, (i) anti-PD-1 antibody or antigen-binding fragment thereof, and (ii) anti-CTLA-4 antibody as separate entities are simultaneously, without a specific time limit, or with the same Or different time intervals, sequentially administered to the patient, wherein such administration provides a preventive or therapeutically effective level of the two active agents in the patient's body.
  • the anti-PD-1 antibody molecule used in the drug combination Anti-CTLA-4 antibody molecules and anti-CTLA-4 antibody molecules are administered at a level not exceeding when they are used alone.
  • the term "fixed combination" means that the two active agents are administered to the patient simultaneously in the form of a single entity.
  • the dosage and/or of the two active agents are preferred.
  • the time interval is selected so that the combined use of each part can produce an effect greater than that achieved by using any single component in the treatment of diseases or disorders.
  • Each component can be in the form of a separate preparation, and the preparation form can be the same or the same. Can be different.
  • an “effective amount” is generally sufficient to reduce the severity and/or frequency of symptoms, eliminate these symptoms and/or potential causes, prevent symptoms and/or their potential causes, and/or improve or ameliorate damage caused by or related to the disease state (Such as lung disease).
  • the effective amount is a therapeutically effective amount or a prophylactically effective amount.
  • a “therapeutically effective amount” is sufficient to treat a disease state or symptom, particularly a state or symptom related to the disease state, or to prevent, hinder, delay, or reverse the disease state or any other failure related to the disease in any way. The amount of progression of ideal symptoms.
  • a “prophylactically effective amount” is an amount that, when administered to a subject, will have a predetermined preventive effect, such as preventing or delaying the onset (or recurrence) of the disease state, or reducing the likelihood of the onset (or recurrence) of the disease state or related symptoms .
  • the complete therapeutic or preventive effect does not necessarily occur with a single dose, and may only occur after a series of doses. Therefore, the therapeutically or prophylactically effective amount can be administered in one or more administrations.
  • each treatment cycle refers to a specific period of time expressed in days or weeks that repeats on a regular schedule.
  • each treatment cycle is 15 to 30 days, such as 15 to 24 days, and preferably each treatment cycle is three weeks (ie, 21 days) or six weeks (ie, 42 days).
  • one treatment cycle is 4 times; in other embodiments, one treatment cycle is 1, 2, 3, or 5 times.
  • each active ingredient in the pharmaceutical combination of the present invention refers to the physical introduction of each active ingredient of the pharmaceutical combination of the present invention into an individual using any of a variety of methods and delivery systems known to those skilled in the art.
  • the administration route of each active ingredient in the pharmaceutical combination of the present invention is intravenous (for example, infusion (also called drip) or injection) or other parenteral administration routes.
  • parenteral administration refers to modes of administration other than gastrointestinal and topical administration, usually via intravenous.
  • each active ingredient in the pharmaceutical combination of the present invention can be formulated into capsules, tablets, injections (including infusions or injections), syrups, sprays, lozenges, liposomes or suppositories, etc.
  • dose is the amount of a drug that induces a therapeutic effect. Unless otherwise stated, the dosage is related to the amount of the free form of the drug. If the drug is in the form of a pharmaceutically acceptable salt, the amount of the drug is increased in proportion to the amount of the drug in the free form. For example, the dosage will be stated on the product packaging or product information sheet.
  • pharmaceutically acceptable refers to those compounds and materials that are suitable for use in contact with human and animal tissues without excessive toxicity, irritation, allergic reactions, or other problems or complications, and commensurate with a reasonable benefit/risk ratio , Composition and/or dosage form.
  • AE adverse event
  • an adverse event may be related to the activation of the immune system in response to treatment or the expansion of immune system cells (e.g., T cells) in response to treatment.
  • Medical treatments can have one or more related AEs, and each AE can have the same or different levels of severity.
  • anti-PD-1 antibody used herein includes the anti-PD-1 antibodies described in WO2017025016, CN108473977B and WO2017133540, the entire contents of which are incorporated herein by reference.
  • the anti-PD-1 antibody is preferably the anti-PD-1 antibody D-S228PIgG4 disclosed in WO2017025016A1, which is also referred to as sintilimab in this application.
  • the sequence of the anti-PD-1 antibody used herein is renumbered.
  • anti-CTLA-4 antibody includes the anti-CTLA-4 antibody described in the invention patent application with publication number CN106620691B, the entire content of which is incorporated herein by reference.
  • the present invention provides a pharmaceutical combination, wherein the anti-PD-1 antibody or antigen-binding fragment thereof in the pharmaceutical combination of the present invention can be administered to an individual in need in one or more doses, wherein in the case of administering multiple doses, The next dose is administered 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 weeks after the previous dose.
  • One dose of the anti-PD-1 antibody or antigen-binding fragment thereof can be selected from 0.3-10 mg/kg of the individual's body weight (for example, 0.3 mg/kg, 1 mg/kg, 3 mg/kg or 10 mg/kg).
  • each dose contains 50-500 mg of anti-PD-1 antibody or antigen-binding fragment thereof, such as 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, or 500 mg of anti-PD-1 Antibodies or antigen-binding fragments thereof.
  • the anti-CTLA-4 antibody in the pharmaceutical combination of the present invention can be administered to individuals in need in one or more doses, where in the case of administering multiple doses, after the previous dose, 1, 2, 3, 4, 5, The next dose is administered at 6, 7, 8, 9 or 10 weeks.
  • a dose of anti-CTLA-4 antibody can be selected from 0.3-3 mg/kg of the individual's body weight (e.g., 0.3 mg/kg, 1 mg/kg, 2 mg/kg or 3 mg/kg). In some other embodiments, each dose contains 1 mg/kg, 2 mg/kg, or 3 mg/kg of anti-CTLA-4 antibody. In some other embodiments, each dose contains 15-200 mg of anti-CTLA-4 antibody, such as 15 mg, 60 mg, 100 mg, 120 mg, 180 mg, or 200 mg of anti-CTLA-4 antibody.
  • the drug combination of the present invention is to administer the anti-PD-1 antibody or its antigen-binding fragment and anti-CTLA-4 antibody for 1, 2, 3, 4 or 5 cycles, and then administer the anti-PD-1 antibody or its antigen binding Fragment maintenance therapy.
  • the anti-PD-1 antibody or antigen-binding fragment thereof in the pharmaceutical combination of the present invention is an injection, and if it is administered by intravenous infusion, the administration time may be about 15-60 minutes.
  • the administration of at least one cycle of the drug combination of the present invention results in improved, preferably Synergistically improve the patient's ORR (objective response rate), CRR (complete response rate), progression-free survival (PFS) or overall survival (OS).
  • the administration of at least one cycle of the drug combination of the present invention results in PFS in the patient compared to a patient administered anti-PD-1 antibody or antigen-binding fragment thereof monotherapy or anti-CTLA-4 antibody monotherapy Increase at least about 1 month, about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, about 10 Months, about 11 months, about 1 year, about 2 years or more.
  • the administration of at least one cycle of the drug combination of the present invention results in the patient's OS compared to patients who are administered anti-PD-1 antibody or antigen-binding fragments of monotherapy or anti-CTLA-4 antibody monotherapy. Increase at least about 1 month, about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 7 months, about 8 months, about 9 months, about 10 Months, about 11 months, about 1 year, about 2 years or more.
  • the drug combination of the present invention results in an increase, preferably a synergistic increase in the inhibitory effect on tumor growth.
  • the drug combination of the invention results in tumor growth being inhibited by at least about 10%, compared to monotherapy with anti-PD-1 antibodies or antigen-binding fragments thereof or monotherapy with anti-CTLA-4 antibodies. 20%, about 30%, about 40%, about 50%, about 60%, about 70%, or about 80%.
  • administration of the drug combination of the invention results in increased tumor regression, tumor shrinkage and/or disappearance.
  • the drug combination of the present invention prevents tumor recurrence in an individual, compared with an untreated individual or with a monotherapy using an anti-PD-1 antibody or antigen-binding fragment thereof, or a monotherapy using an anti-CTLA-4 antibody And/or increase the duration of survival, for example, increase the duration of survival by more than 15 days, more than 1 month, more than 3 months, more than 6 months, more than 12 months, more than 18 months, More than 24 months, more than 36 months, or more than 48 months.
  • the drug combination of the present invention can increase progression-free survival or overall survival.
  • administration of the drug combination of the invention to an individual suffering from cancer results in the complete disappearance of the tumor ("complete response"). In some embodiments, administration of the drug combination of the invention to an individual suffering from cancer results in a reduction in tumor cells or tumor size by at least 30% or more (“partial response").
  • the tumor reduction can be measured by any method known in the art, such as X-ray, positron emission tomography (PET), computer tomography (CT), magnetic resonance imaging (MRI), cytology, histology, or molecular genetics analyze.
  • the present invention also provides a pharmaceutical composition
  • a pharmaceutical composition comprising a therapeutically effective amount of the anti-PD-1 antibody or antigen-binding fragment thereof, the pharmaceutical combination of the anti-CTLA-4 antibody as defined in the first aspect, and a pharmaceutically acceptable carrier.
  • An object of the present invention is to provide a kit comprising a therapeutically effective amount of an anti-PD-1 antibody or an antigen-binding fragment thereof and a drug combination of an anti-CTLA-4 antibody.
  • Another object of the present invention is to provide a kit of medicines comprising an effective amount of the pharmaceutical combination of the present invention and a pharmaceutically acceptable carrier.
  • the kit includes a therapeutically effective amount of an anti-PD-1 antibody or antigen-binding fragment thereof and an anti-CTLA-4 antibody, and the anti-PD-1 antibody or antigen-binding fragment thereof is about 0.3-10 mg/
  • the dose of kg body weight for example, 0.3 mg/kg, 1 mg/kg, 3 mg/kg or 10 mg/kg;
  • the anti-CTLA-4 antibody is a dose of 0.3-3 mg/kg body weight, for example, 0.3 mg/kg, 1 mg/kg , 2mg/kg or 3mg/kg.
  • the kit includes a therapeutically effective amount of an anti-PD-1 antibody or antigen-binding fragment thereof and an anti-CTLA-4 antibody, and the anti-PD-1 antibody or antigen-binding fragment thereof is about 50-500 mg.
  • Dose such as 50mg, 100mg, 150mg, 200mg, 250mg, 300mg, 350mg, 400mg, 450mg or 500mg;
  • the anti-CTLA-4 antibody is a dose of 0.3-3mg/kg body weight, such as 0.3mg/kg, 1mg/kg, 2mg/kg or 3mg/kg.
  • the kit includes a therapeutically effective amount of an anti-PD-1 antibody or antigen-binding fragment thereof and an anti-CTLA-4 antibody, and the anti-PD-1 antibody or antigen-binding fragment thereof is about 50-500 mg.
  • Dose such as 50mg, 100mg, 150mg, 200mg, 250mg, 300mg, 350mg, 400mg, 450mg or 500mg; the anti-CTLA-4 antibody is 15-200mg, for example 15mg, 60mg, 100mg, 120mg, 180mg or 200mg.
  • the kit includes a therapeutically effective amount of an anti-PD-1 antibody or antigen-binding fragment thereof and an anti-CTLA-4 antibody, and the anti-PD-1 antibody or antigen-binding fragment thereof is about 0.3-10 mg/
  • the dose per kg body weight for example, 0.3 mg/kg, 1 mg/kg, 3 mg/kg or 10 mg/kg; the anti-CTLA-4 antibody is a dose of 15-200 mg, such as 15 mg, 60 mg, 100 mg, 120 mg, 180 mg or 200 mg .
  • kit of the present invention contains in the same package:
  • -A second container containing a pharmaceutical composition for parenteral administration, said pharmaceutical composition comprising the anti-CTLA-4 antibody described above.
  • the present invention provides the aforementioned pharmaceutical combination of the present invention for preventing and/or treating the severity of at least one symptom or indication of cancer in an individual or inhibiting the growth of cancer cells.
  • the present invention provides the use of the aforementioned pharmaceutical combination of the present invention in the preparation of drugs for the prevention or treatment of cancer.
  • the cancer of the present invention includes hepatocellular carcinoma, and the hepatocellular carcinoma is preferably advanced hepatocellular carcinoma that has failed or is intolerant to previous systemic at least first-line treatment.
  • the drug combination of the present invention is administered to individuals with elevated levels of PD-L1 or CTLA-4 to administer a prophylactically effective amount or a therapeutically effective amount of the drug combination of the present invention.
  • the present invention provides a method of preventing or treating cancer, which comprises administering an effective amount of the pharmaceutical combination of the present invention to an individual in need.
  • the effective amount includes a preventive effective amount and a therapeutically effective amount.
  • the present invention also provides the use of the above kit in the preparation of drugs for the prevention or treatment of cancer.
  • the cancer is preferably hepatocellular carcinoma, wherein the hepatocellular carcinoma is more preferably an advanced stage that has failed or is intolerant to previous systemic at least first-line treatment. Hepatocellular carcinoma.
  • Figure 1 shows the progression-free survival curve after combined treatment with IBI310+ Sindili.
  • Sintilimab Injection Specification 10ml: 100mg, Xinda Biopharmaceutical (Suzhou) Co., Ltd.
  • IBI310 injection specification 10ml:50mg, Xinda Biopharmaceutical (Suzhou) Co., Ltd., for the preparation method, see Patent Publication No. CN106620691B.
  • AASLD American Society for the Study of Liver Diseases
  • Past systemic treatments include sorafenib, lenvatinib or platinum-based chemotherapy; 2) Past systems If the sexual treatment is not sorafenib, lenvatinib or platinum-based chemotherapy, the subject must be fully informed by the treating doctor that the current treatment options include sorafenib, lenvatinib targeted therapy or chemotherapy , Expressed rejection and recorded in writing by the research doctor.
  • stage IIb and stage III are Barcelona clinical liver cancer ( Barcelona Clinic Liver Cancer (BCLC) staging is stage B or stage C that is not suitable for radical surgery and/or local treatment.
  • BCLC Barcelona Clinic Liver Cancer
  • Female subjects of childbearing age or male subjects whose sexual partners are females of childbearing age must take effective contraceptive measures throughout the treatment period and 6 months after the treatment period.
  • -Blood routine absolute neutrophil count (ANC) ⁇ 1.5 ⁇ 109/L; platelet count (PLT) ⁇ 75 ⁇ 109/L; hemoglobin content (HGB) ⁇ 9g/dL.
  • TBIL serum total bilirubin
  • UPN upper limit of normal
  • ALT alanine aminotransferase
  • AST aspartate aminotransferase
  • serum albumin serum albumin ⁇ 28g/L
  • Alkaline Phosphatase Alkaline Phosphatase
  • Ipilimumab initial dose set up 3 dose groups (1mg/kg individual body weight, 2mg/kg individual body weight, 3mg/kg individual body weight)
  • DLT Dose-Limiting Toxicities
  • MTD Maximum Tolerated Dose
  • the stage Ib DLT is defined as: within 42 days (within 6 weeks) after the first dose of the study drug in the dose escalation phase or to 21 days after the second dose of the study drug is administered Any of the following adverse events (AEs) related to Ipilimumab and Sintilizumab that occurred within the day (whichever is the longest):
  • AEs adverse events
  • ALT/AST elevation is defined as 2.5 times the baseline value
  • grade 2 ALT/AST elevation is defined as 2.5 to 5 times the baseline value
  • grade 3 ALT/AST elevation is defined as 5 times the baseline value. ⁇ 20 times
  • DLT assessment situation Phase Ib has completed the IBI310 dose climbing experiment of 1mg/kg, 2mg/kg, and 3mg/kg, and no DLT has occurred.
  • Summary of adverse events A total of 13 cases (76.5%) of study drug-related adverse events (TRAE) occurred in stage Ib; only 4 cases (23.5%) of subjects had TEAEs above grade 3, and 1 case (5.9%) of subjects TRAE level 3 or higher occurred; only 1 case (5.9%) had an adverse event unrelated to the study drug that led to withdrawal from the trial; 6 cases (35.3%) had an adverse event that caused the suspension of the study drug but all were related to the study drug Irrelevant, no subjects had serious adverse events (SAEs) related to the study drug.
  • SAEs serious adverse events
  • phase Ib experiment concluded that there were no adverse events beyond expectations. Therefore, the overall safety of this study is relatively high, and there are no treatment-related deaths.
  • Adverse events related to IBI310 occurred in 22 subjects, with an incidence rate of 75.9%; 22 subjects experienced adverse events related to Sintilizumab, with an incidence rate of 75.9%; 12 subjects experienced grade ⁇ 3
  • the incidence of TEAE was 41.4%; 10 subjects had TRAE ⁇ grade 3, the incidence was 34.5%; 9 subjects had adverse events ⁇ Grade 3 and related to IBI310, the incidence was 31%; Ten subjects had adverse events ⁇ grade 3 and related to sintilimab, with an incidence rate of 34.5%.
  • the safety of the combination of IBI310+sintilimab in subjects with hepatocellular carcinoma is overall controllable.
  • the best overall response in 1 subject was partial response (PR), and the best in 3 subjects
  • the overall response was stable disease (SD); the best overall response of the 3 subjects was disease progression (PD), the objective response rate (ORR) was 14.3%, and the disease control rate (DCR) was 57.1%.
  • PR partial response
  • SD stable disease
  • PD disease progression
  • ORR objective response rate
  • DCR disease control rate
  • ORR For patients who have not used PD-1/PD-L1 monoclonal antibody before, ORR reached 18.2% and DCR reached 77.3%. In addition, for patients who have failed PD-1/PD-L1 therapy in the past, good results have also been achieved (ORR is 14.3%, DCR is 57.1%). It not only shows a better objective remission rate than traditional chemotherapy, but also has better progression-free survival than immunotherapy alone.

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Abstract

本发明公开了靶向程序性死亡蛋白-1(PD-1)的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的组合在制备用于治疗癌症尤其肝细胞癌的药物中的用途。本发明还公开了包含抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的药物组合物和成套药盒。

Description

抗PD-1抗体和抗CTLA-4抗体的组合在预防或治疗癌症中的用途
本申请要求申请日为2020/4/24的中国专利申请2020103334118的优先权。本申请引用上述中国专利申请的全文。
技术领域
本发明涉及抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的组合在制备其用于预防或治疗癌症尤其是肝细胞癌中的用途。本发明还涉及抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的药物组合以及应用所述药物组合预防或治疗癌症尤其肝细胞癌的方法。
背景技术
肝细胞癌(HCC)的病因主要是乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染、酒精、饮食相关因素等。我国的大部分HCC的发病是由于HBV的慢性感染引起肝硬化，最终发展成为HCC。多数HCC患者发病时已经是局部晚期或转移性疾病，不适于接受根治性治疗。
由于HCC的异质性及病因的多样性，HCC对常规全身性化疗具有较高的耐药性。目前仅有FOLFOX4(氟尿嘧啶、亚叶酸钙及奥沙利铂)化疗方案对比阿霉素化疗，有改善晚期HCC患者总生存期(overall Survival，OS)的趋势以及提高无进展生存期(Progression Free Survival，PFS)和客观缓解率(objective response rate，ORR)，该化疗方案或可为部分患者带来临床获益。2007年FDA批准了多靶点激酶抑制剂药索拉非尼(Sorafenib)用于不可手术的晚期HCC患者，靶点包括VEGFR1、VEGFR2、VEGFR3，PDGFR-β，c-kit、FLT-3、RET，这是第一个被证明可为晚期HCC患者带来明显生存获益的全身性药物或治疗方案，也是目前的标准一线治疗方案。但是，索拉非尼组的中位OS为10.7月，PFS为5.5个月，有效率仅为2％，但不良事件 (Adverse Event，AE)发生率高达80％。
索拉非尼治疗失败的二线治疗目前主要包括瑞戈非尼(Regorafenib)、雷莫卢单抗(Ramucirumab)和卡博替尼(cabozantinib)用于甲胎蛋白(Alpha-Fetal Protein，AFP)＞400ng/ml的肝癌患者。RESORCE研究对比了瑞戈非尼和安慰剂用于治疗索拉非尼治疗进展后的晚期HCC的疗效，结果显示瑞戈非尼改善了总生存期(10.6个月vs 7.8个月，HR 0.63，P＜0.0001)，PFS(3.1个月vs.1.5个月，HR 0.46，P＜0.0001)、ORR(11％vs.4％，单侧P＝0.0047)也均优于安慰剂组。2017年12月12日，瑞戈非尼经原国家食品药品监督管理总局(现国家药品监督管理局，NMPA)优先审评批准用于既往接受过索拉非尼治疗的肝细胞癌(HCC)患者。卡博替尼是一个c-MET和VEGFR2酪氨酸激酶抑制剂，III期CELESTIAL试验纳入707例应用索拉非尼过程中或应用后进展不可治愈的HCC患者，该试验中7.6％的患者已经接受超过1线的先前治疗。试验结果发现随机接受卡博替尼组中位OS和PFS率分别是10.2个月和5.2个月，明显高于安慰剂组8.0个月和1.9个月(POS＝0.005；PPFS＜0.001)。2019年1月14日，FDA批准了卡博替尼用于接受过索拉非尼治疗的HCC。虽然卡博替尼组的客观反应率对比安慰剂组较好(P＝0.009)，但这种价值还是很低，接受卡博替尼组ORR仅为4％(95％CI：2.3，6.0)，安慰剂组为0.4％(95％CI：0.0，2.3)。
最新版2019年的CSCO肝癌诊疗指南关于晚期HCC的治疗推荐中指出，对于肝功能Child-PughA级或较好的B级(≤7分)的患者，一线治疗I级推荐索拉非尼、奥沙利铂为主的系统化疗或仑伐替尼，而二线治疗选择上，抗PD-1单抗(包括纳武利尤单抗和帕博利珠单抗)作为I级推荐。目前，免疫检查点抑制剂也开始在晚期HCC中显示出治疗价值。REACH-2研究比较了雷莫芦单抗和安慰剂在索拉非尼不耐受或使用后疾病进展、AFP血清水平≥400ng/mL的HCC患者中的疗效，结果显示雷莫芦单抗组ORR 4.6％，DCR 59.9％，PFS为2.8个月。国内获批的用于二线肝细胞癌的抗PD1 单抗(卡瑞利珠单抗)，其ORR 13.8％，DCR44.7％，mPFS也仅为2.1个月。故免疫检查点抑制剂治疗虽然较化疗治疗提高了缓解率，但是也看到了免疫治疗单药治疗的的局限性，即在PFS上并没有有效延长，所以联合治疗或可进一步提高疗效。
CTLA-4与CD28分子在基因结构、染色体定位、序列的同源性及基因表达上具有十分相近的关系，都是共刺激分子B7的受体，主要表达于被激活的T细胞表面。但是作为淋巴细胞激活的共刺激信号，CTLA-4与CD28分子的功能是相反的，在正常情况下，T细胞的激活依赖于第一信号(抗原抗体复合物的形成)和第二信号(B7介导的活化信号)双活化。而CTLA-4与B7结合将产生抑制性信号并抑制T细胞活化。作为CTLA-4阻断剂的单克隆抗体(CTLA-4mAb)，可以特异地解除CTLA-4对机体的免疫抑制，激活T细胞，在抗肿瘤及寄生虫等疾病的基因治疗中有广泛的应用前景。
程序性死亡蛋白1(Programmed death-1，PD-1)/程序性死亡配体1(Programmed death ligand-1，PD-L1)轴是抑制免疫激活的强有力的信号途径，也是肿瘤实现免疫逃逸的重要机制之一。肿瘤浸润淋巴细胞高表达PD-1，这些PD-1与肿瘤细胞或免疫细胞表面的PD-L1相结合抑制起始活化的T细胞，并抑制效应T细胞的产生和功能(包括细胞因子生成和细胞毒性)。包括霍奇金淋巴瘤、弥漫大B细胞淋巴瘤、ENKTL、结直肠癌、黑色素瘤等在内的多种类型肿瘤会表达PD-L1，并通过PD-L1抑制抗肿瘤T细胞反应。阻断PD-L1/PD-1轴能恢复T细胞杀伤肿瘤功能并能获得持久的临床反应。
大部分肿瘤的生物学行为并非由单一信号传导通路所支配，而是多个信号传导通路共同起作用。在某些情况下，具有不同作用机制的药物可以联合使用。但是，具有不同作用机制但在类似领域起作用的药物的任何联合形式，并不必然能够产生具有有益效果的联合形式。因此，虽然现有技术中针对不同信号转导通路的联合用药方案和产品的确存在需求，但是鉴于肿瘤发生机制的复杂性、不同药物之间相互作用的不可预见性等因素，发现可行且能够 带来相比单药而言具有更优异效果(减少单药剂量、改善治疗中的不良事件(AE)发生率和/或严重程度，和/或以协同作用的方式起作用等)的联合用药的方案和产品，仍然是医药领域的一大挑战。
发明内容
本申请的药物组合能够以协同作用和/或改善治疗中的不良事件(AE)发生率和/或严重程度的方式对癌症、尤其是肝细胞癌起到预防和/或治疗的效果。
第一方面，本发明提供了包含抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的组合在制备用于预防或治疗癌症的药物中的用途，
其中抗PD-1抗体包含6个CDR，其中LCDR1、LCDR2和LCDR3分别由氨基酸序列RASQGISSWLA(SEQ ID NO：1)、SAASSLQS(SEQ ID NO：2)和QQANHLPFT(SEQ ID NO：3)组成，且其中HCDR1、HCDR2和HCDR3分别由氨基酸序列KASGGTFSSYAIS(SEQ ID NO：4)、LIIPMFDTAGYAQKFQG(SEQ ID NO：5)和ARAEHSSTGTFDY(SEQ ID NO：6)组成，所述6个CDR由North定义规则确定；其中抗CTLA-4抗体为伊匹单抗或IBI310。
在一个优选实施方案中，所述抗PD-1抗体或其抗原结合片段包含SEQ ID NO：7的重链可变区序列和包含SEQ ID NO：8的轻链可变区序列，优选地所述抗PD-1抗体或其抗原结合片段包含SEQ ID NO：9的重链序列和SEQ ID NO：10的轻链序列。
在一个优选实施方案中，所述用途用于预防或治疗癌症，优选肝细胞癌，其中所述肝癌更优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
在一个优选实施方案中，所述药物组合中抗PD-1抗体或其抗原结合片段的单次施用剂量为50-500mg、优选为50mg、100mg、150mg、200mg、 250mg、300mg、350mg、400mg、450mg或500mg，更优选地为200mg，优选每二至四周施用一次；或所述药物组合中抗PD-1抗体或其抗原结合片段的单次施用剂量为0.3-10mg/kg，优选为0.3mg/kg、1mg/kg、3mg/kg或10mg/kg，优选为胃肠外、更优选静脉内施用剂型；和
所述药物组合中抗CTLA-4抗体的单次施用剂量为15-200mg、优选为15mg、60mg、100mg、120mg、180mg或200mg、更优选地为180mg，优选每二至四周施用一次；或所述抗CTLA-4抗体的单次施用剂量为0.3-3mg/kg、优选为0.3mg/kg、1mg/kg、2mg/kg或3mg/kg，优选每二至四周施用一次，优选为胃肠外、更优选静脉内施用剂型。
在一个优选实施方案中，其中所述抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体分开、同时或依次施用。
在一个优选的实施方案中，所述抗PD-1抗体或其抗原结合片段单次施用剂量为200mg，所述抗CTLA-4抗体或其抗原结合片段单次施用剂量为1mg/kg；静脉注射每3周为一个周期，共4周期，随后予以单药抗PD-1抗体或其抗原结合片段200mg每3周一次。
在一个优选的实施方案中，所述抗PD-1抗体或其抗原结合片段单次施用剂量为200mg，所述抗CTLA-4抗体或其抗原结合片段单次施用剂量为2mg/kg；静脉注射每3周为一个周期，共4周期，随后予以单药抗PD-1抗体或其抗原结合片段200mg每3周一次。
在一个优选的实施方案中，所述抗PD-1抗体或其抗原结合片段单次施用剂量为200mg，所述抗CTLA-4抗体或其抗原结合片段单次施用剂量为3mg/kg；静脉注射每3周为一个周期，共4周期，随后予以单药抗PD-1抗体或其抗原结合片段200mg每3周一次。
第二方面，本发明提供用于预防或治疗癌症的方法，所述方法包括向有需要的患者施用治疗有效量的第一方面中所定义的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的药物组合，所述癌症优选肝细胞癌，其中所述肝 细胞癌更优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
第三方面，本发明还提供一种药物组合物，包含治疗有效量的第一方面中所定义的抗PD-1抗体或其抗原结合片段、抗CTLA-4抗体的药物组合和药学上可接受的载体。
第四方面，本发明还提供一种成套药盒，其包含治疗有效量的第一方面中所定义的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的药物组合。
第五方面，本发明还提供上述药物组合物或成套药盒在制备预防或治疗癌症的药物中的用途，所述癌症优选肝细胞癌，其中所述肝细胞癌更优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
定义
除非另有定义，否则本文中使用的所有技术和科学术语均具有与本领域一般技术人员通常所理解的含义相同的含义。为了本发明的目的，下文定义了以下术语。
术语“约”在与数字数值联合使用时意为涵盖具有比指定数字数值小5％的下限和比指定数字数值大5％的上限的范围内的数字数值。
术语“和/或”应理解为意指可选项中的任一项或可选项中的任意两项或多项的组合。
如本文中所用，术语“包含”或“包括”意指包括所述的要素、整数或步骤，但是不排除任意其他要素、整数或步骤。在本文中，当使用术语“包含”或“包括”时，除非另有指明，否则也涵盖由所述及的要素、整数或步骤组成的情形。例如，当提及“包含”某个具体序列的抗体可变区时，也旨在涵盖由该具体序列组成的抗体可变区。
在本文中，术语“抗体”是指至少包含轻链或重链免疫球蛋白可变区的多肽，所述免疫球蛋白可变区特异性识别并结合抗原。该术语涵盖各种抗体结构，包括、但不限于单克隆抗体、多克隆抗体、单链抗体或多链抗体、单 特异性或多特异性抗体(例如双特异性抗体)、全人源抗体或嵌合抗体或人源化抗体、全长抗体和抗体片段，只要它们呈现期望的抗原结合活性即可。
术语抗体的“抗原结合片段”(在本文中可与“抗体片段”和“抗原结合部分”互换使用)，是指并非完整抗体的分子，其包含完整抗体中用于结合该完整抗体所结合的抗原的部分。如本领域技术人员理解的，抗体的抗原结合部分通常包含来自“互补决定区”或“CDR”的氨基酸残基。可以通过重组DNA技术、或通过酶或化学切割完整的抗体制备抗原结合片段。抗原结合片段包括但不限于Fab、scFab、Fab’、F(ab’)2、Fab’-SH、Fv、单链Fv、双链抗体(diabody)、三链抗体(triabody)、四链抗体(tetrabody)、微抗体(minibody)、单结构域抗体(sdAb)。关于抗体片段的更详细的描述，可以参见：基础免疫学(Fundamental Immunology)，W.E.Paul编辑，Raven Press，N.Y.(1993)；邵荣光等人(编辑)，抗体药物研究与应用，人民卫生出版社(2013)；Hollinger等人，PNAS USA 90：6444-6448(1993)；Hudson等人，Nat.Med.9：129-134(2003)。
术语“可变区”或“可变结构域”是指参与抗体与抗原结合的抗体重或轻链的结构域。天然抗体的重链和轻链的可变结构域通常具有相似的结构，其中每个结构域包含四个保守的框架区(FR)和三个互补决定区(参见，例如，Kindt等Kuby Immunology，6th ed.，W.H.Freeman and Co.91页(2007))。单个VH或VL结构域可以足以给予抗原结合特异性。此外，可以使用来自与特定抗原结合的抗体的VH或VL结构域来分离结合所述抗原的抗体，以分别筛选互补VL或VH结构域的文库。参见，例如，Portolano等，J.Immunol.150：880-887(1993)；Clarkson等，Nature 352：624-628(1991)。
可变区通常表现出由三个高变区连接的相对保守的构架区(FR)的相同的一般结构，所述高变区也被称为互补决定区或CDR。通常通过构架区定位(align)来自每对的两条链的CDR，所述CDR使得可结合特异性表位。两条轻链和重链可变区从N-末端到C-末端通常包含结构域FR1、CDR1、FR2、 CDR2、FR3、CDR3和FR4。
“互补决定区”或“CDR区”或“CDR”或“高变区”(在本文中与超变区“HVR”可以互换使用)，是抗体可变结构域中在序列上高变并且形成在结构上确定的环(“超变环”)和/或含有抗原接触残基(“抗原接触点”)的区域。CDR主要负责与抗原表位结合。重链和轻链的CDR通常被称作CDR1、CDR2和CDR3，从N-端开始顺序编号。位于抗体重链可变结构域内的CDR被称作HCDR1、HCDR2和HCDR3，而位于抗体轻链可变结构域内的CDR被称作LCDR1、LCDR2和LCDR3。在一个给定的轻链可变区或重链可变区氨基酸序列中，各CDR的精确氨基酸序列边界可以使用许多公知的抗体CDR指派系统的任一种或其组合确定，所述指派系统包括例如：基于抗体的三维结构和CDR环的拓扑学的Chothia(Chothia等人.(1989)Nature 342：877-883，Al-Lazikani等人，“Standard conformations for the canonical structures of immunoglobulins”，Journal of Molecular Biology，273，927-948(1997))，基于抗体序列可变性的Kabat(Kabat等人，Sequences of Proteins of Immunological Interest，第4版，U.S.Department of Health and Human Services，National Institutes of Health(1987))，AbM(University of Bath)，Contact(University College London)，国际ImMunoGeneTics database(IMGT)(万维网imgt.cines.fr/)，除HCDR1和HCDR2以外，Chothia CDR定义与Kabat CDR定义相同。North CDR定义(North等人，“A New Clustering of Antibody CDR Loop Conformations”，Journal of Molecular Biology，406，228-256(2011))基于利用大量晶体结构的近邻传播聚类。
术语“预防”包括对疾病或病症或其症状的发生或发生频率的抑制或推迟，其通常是指在病征或症状发生前，特别是在具有风险个体的病征或症状发生前的药物施用。
本文所用术语“治疗”指通过疾病的临床或诊断症状的减轻或消除来证明的对象癌症(例如结直肠癌)进展的减缓、阻止或逆转。治疗可包括例如， 降低症状严重程度、症状数量或复发频率，例如，肿瘤生长抑制、肿瘤生长阻滞或已有肿瘤的消退。
术语“药物组合”是指非固定组合产品或固定组合产品，例如药盒。术语“非固定组合”意指活性成分(例如，(i)抗PD-1抗体或其抗原结合片段、和(ii)抗CTLA-4抗体以分开的实体被同时、无特定时间限制或以相同或不同的时间间隔、依次地施用于患者，其中这类施用在患者体内提供预防或治疗有效水平的所述两种活性剂。在一些实施方案中，药物组合中使用的抗PD-1抗体分子和抗CTLA-4抗体分子以不超过它们单独使用时的水平施用。术语“固定组合”意指两种活性剂以单个实体的形式被同时施用于患者。优选对两种活性剂的剂量和/或时间间隔进行选择，从而使各部分的联合使用能够在治疗疾病或病症时产生大于单独使用任何一种成分所能达到的效果。各成分可以各自呈单独的制剂形式，其制剂形式可以相同也可以不同。
“有效量”一般是足以降低症状的严重程度及/或频率、消除这些症状及/或潜在病因、预防症状及/或其潜在病因出现及/或改良或改善由疾病状态引起或与其相关的损伤(例如肺病)的量。在一些实施例中，有效量是治疗有效量或预防有效量。“治疗有效量”是足以治疗疾病状态或症状、尤其与该疾病状态相关的状态或症状，或者以其他方式预防、阻碍、延迟或逆转该疾病状态或以任何方式与该疾病相关的任何其他不理想症状的进展的量。“预防有效量”是当给予受试者时将具有预定预防效应，例如预防或延迟该疾病状态的发作(或复发)，或者降低该疾病状态或相关症状的发作(或复发)可能性的量。完全治疗或预防效应未必因给予一个剂量便发生，而且可能仅在给予一系列剂量之后发生。因而，治疗或预防有效量可以一次或多次给予的方式给予。
术语“周期”是指以常规时间表重复的以天或周表示的特定时间段。例如，每个治疗周期为15至30天、例如15至24天，优选每个治疗周期为三周(即，21天)或六周(即，42天)。在一个实施方案中，一个治疗周期是4 次；在另一些实施方案中，一个治疗周期是1、2、3或5次。
术语“施用”指用本领域技术人员已知的多种方法和递送系统中的任一种将本发明的药物组合中的各活性成分物理导入至个体。本发明的药物组合中的各活性成分的施用途径为静脉内(例如输注(又称滴注)或注射)或其他胃肠外施用途径。本文所用的短语“胃肠外施用”指胃肠和局部施用之外的施用方式，通常通过静脉内。相应地，本发明的药物组合中的各活性成分可以被配制成胶囊剂、片剂、注射剂(包括输液或注射液)、糖浆、喷雾剂、锭剂、脂质体或栓剂等。
术语“剂量”是引发治疗效果的药物的量。除非另有说明，否则剂量与游离形式的药物的量有关。如果药物是可药用盐形式，药物的量与游离形式的药物的量相比成比例地增加。例如，剂量将在产品包装或产品信息单中声明。
术语“可药用的”是指那些适合用于与人类和动物组织接触使用而没有过多的毒性、刺激、过敏反应或其他问题或并发症，与合理的益处/风险比相称的化合物、材料、组合物和/或剂型。
术语“不良事件”(AE)是与医学治疗的使用相关的任何不利且通常非预期或不想要的病征(包括异常实验室发现)、症状或疾病。例如，不良事件可以与免疫系统响应治疗而激活或免疫系统细胞(例如T细胞)响应治疗而扩增相关。医学治疗可以具有一种或多种相关AE，且各AE可以具有相同或不同水平的严重度。
本文所用的“抗PD-1抗体”包括描述于WO2017025016、CN108473977B和WO2017133540中的抗PD-1抗体，其全部内容被引入本文作为参考。其中，所述抗PD-1抗体优选是WO2017025016A1中公开的抗PD-1抗体D-S228PIgG4，在本申请中也称为信迪利单抗。本文中对所用的该抗PD-1抗体的序列进行重新编号。
本文所用的“抗CTLA-4抗体”包括描述于公开号为CN106620691B的 发明专利申请中的抗CTLA-4抗体，其全部内容被引入本文作为参考。
本发明的药物组合和药物组合物
本发明提供一种药物组合，其中本发明药物组合中的抗PD-1抗体或其抗原结合片段可以以一个或多个剂量施用于有需要的个体，其中在施用多个剂量的情况下，在前一剂量之后1、2、3、4、5、6、7、8、9或10周施用下一个剂量。抗PD-1抗体或其抗原结合片段的一个剂量可以选自0.3-10mg/kg个体体重(例如，0.3mg/kg、1mg/kg、3mg/kg或10mg/kg)。在一些其他实施方案中，每个剂量包含50-500mg的抗PD-1抗体或其抗原结合片段，例如50mg、100mg、150mg、200mg、250mg、300mg、350mg、400mg、450mg或500mg抗PD-1抗体或其抗原结合片段。
本发明药物组合中的抗CTLA-4抗体可以以一个或多个剂量施用于有需要的个体，其中在施用多个剂量的情况下，在前一剂量之后1、2、3、4、5、6、7、8、9或10周施用下一个剂量。抗CTLA-4抗体的一个剂量可以选自0.3-3mg/kg个体体重(例如0.3mg/kg、1mg/kg、2mg/kg或3mg/kg)。在一些其他实施方案中，每个剂量包含1mg/kg、2mg/kg或3mg/kg的抗CTLA-4抗体。在一些其他实施方案中，每个剂量包含15-200mg的抗CTLA-4抗体，例如15mg、60mg、100mg、120mg、180mg或200mg的抗CTLA-4抗体。
优选地，本发明的药物组合为施用抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体治疗1、2、3、4或5个周期之后，给予抗PD-1抗体或其抗原结合片段的维持治疗。
优选地，本发明的药物组合中的抗PD-1抗体或其抗原结合片段为注射剂，如果以静脉输注方式施用，则施用时间可以为约15-60分钟。
在一些实施方案中，与施用抗PD-1抗体或其抗原结合片段的单一疗法或施用抗CTLA-4抗体的单一疗法的患者相比，施用至少一个周期的本发明的药物组合导致提高、优选协同地提高患者的ORR(客观缓解率)、CRR(完全缓解率)、无进展生存(PFS)或总体生存(OS)。在一些实施方案中，与施用抗 PD-1抗体或其抗原结合片段的单一疗法或施用抗CTLA-4抗体的单一疗法的患者相比，施用至少一个周期的本发明的药物组合导致患者的PFS增加至少约1个月、约2个月、约3个月、约4个月、约5个月、约6个月、约7个月、约8个月、约9个月、约10个月、约11个月、约1年、约2年或更长时间。在一些实施方案中，与施用抗PD-1抗体或其抗原结合片段的单一疗法或施用抗CTLA-4抗体的单一疗法的患者相比，施用至少一个周期的本发明的药物组合导致患者的OS增加至少约1个月、约2个月、约3个月、约4个月、约5个月、约6个月、约7个月、约8个月、约9个月、约10个月、约11个月、约1年、约2年或更长时间。
与施用抗PD-1抗体或其抗原结合片段的单一疗法或施用抗CTLA-4抗体的单一疗法相比，本发明的药物组合导致增加、优选协同地增加对肿瘤生长的抑制作用。在一些实施方案中，与施用抗PD-1抗体或其抗原结合片段的单一疗法或施用抗CTLA-4抗体的单一疗法相比，本发明的药物组合导致肿瘤生长被抑制至少约10％、约20％、约30％、约40％、约50％、约60％、约70％或约80％。在一些实施方案中，本发明的药物组合的施用导致增加肿瘤消退、肿瘤缩小和/或消失。在一些实施方案中，与未治疗的个体或与使用抗PD-1抗体或其抗原结合片段的单一疗法或使用抗CTLA-4抗体的单一疗法相比，本发明的药物组合预防个体的肿瘤复发和/或增加生存持续时间，例如，将生存持续时间增加多于15天、多于1个月、多于3个月、多于6个月、多于12个月、多于18个月、多于24个月、多于36个月、或多于48个月。在一些实施方案中，本发明的药物组合可增加无进展生存或总体生存。
在一些实施方案中，向患有癌症的个体施用本发明的药物组合导致肿瘤的完全消失(“完全反应”)。在一些实施方案中，向患有癌症的个体施用本发明的药物组合导致肿瘤细胞或肿瘤大小减少至少30％或更多(“部分反应”)。可以通过本领域已知的任何方法测量肿瘤的减少，例如X-线、正电子发射断层扫描(PET)、计算机断层扫描(CT)、磁共振成像(MRI)、细胞学、组织学或 分子遗传分析。
本发明还提供一种药物组合物，包含治疗有效量的第一方面中所定义的抗PD-1抗体或其抗原结合片段、抗CTLA-4抗体的药物组合和药学上可接受的载体。
本发明的药盒
本发明的一个目的是提供一种包括治疗有效量的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体的药物组合的成套药盒。
本发明的另一个目的是提供一种成套药盒，其包含有效量的本发明的药物组合和药学上可接受的载体。
在一些实施方案中，所述药盒包括治疗有效量的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体，所述抗PD-1抗体或其抗原结合片段为约0.3-10mg/kg体重的剂量，例如，0.3mg/kg、1mg/kg、3mg/kg或10mg/kg；所述抗CTLA-4抗体为0.3-3mg/kg体重的剂量，例如0.3mg/kg、1mg/kg、2mg/kg或3mg/kg。
在一些实施方案中，所述药盒包括治疗有效量的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体，所述抗PD-1抗体或其抗原结合片段为约50-500mg的剂量，例如50mg、100mg、150mg、200mg、250mg、300mg、350mg、400mg、450mg或500mg；所述抗CTLA-4抗体为0.3-3mg/kg体重的剂量，例如0.3mg/kg、1mg/kg、2mg/kg或3mg/kg。
在一些实施方案中，所述药盒包括治疗有效量的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体，所述抗PD-1抗体或其抗原结合片段为约50-500mg的剂量，例如50mg、100mg、150mg、200mg、250mg、300mg、350mg、400mg、450mg或500mg；所述抗CTLA-4抗体为15-200mg的剂量，例如15mg、60mg、100mg、120mg、180mg或200mg。
在一些实施方案中，所述药盒包括治疗有效量的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体，所述抗PD-1抗体或其抗原结合片段为约0.3- 10mg/kg体重的剂量，例如，0.3mg/kg、1mg/kg、3mg/kg或10mg/kg；所述抗CTLA-4抗体为15-200mg的剂量，例如15mg、60mg、100mg、120mg、180mg或200mg。
在一个实施方案中，本发明的成套药盒在同一包装内包含：
-含有用于胃肠外施用的药物组合物的第一容器，所述药物组合物包含上面所述的抗PD-1抗体或其抗原结合片段；
-含有用于胃肠外施用的药物组合物的第二容器，所述药物组合物包含上面所述的抗CTLA-4抗体。
本发明的药物组合和药盒的用途
本发明提供了前述本发明的药物组合，其用于预防和/或治疗个体中癌症的至少一种症状或指征的严重性或抑制癌细胞生长。
本发明提供了前述本发明的药物组合在制备用于预防或治疗癌症的药物中的用途。
本发明所述癌症包括肝细胞癌，所述肝细胞癌优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
本发明的药物组合被施用于向PD-L1或CTLA-4水平升高的个体施用预防有效量或治疗有效量的本发明的药物组合。
本发明提供了预防或治疗癌症的方法，其包括向有需要的个体施用有效量的本发明的药物组合。所述有效量包括预防有效量和治疗有效量。
本发明还提供上述成套药盒在制备预防或治疗癌症的药物中的用途，所述癌症优选肝细胞癌，其中所述肝细胞癌更优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
本发明所述的各个实施方案/技术方案以及各个实施方案/技术方案中的特征应当被理解为可以任意进行相互组合，这些相互组合得到的各个方案均包括在本发明的范围内，就如同在本文中具体地且逐一地列出了这些相互组 合而得到的方案一样，除非上下文清楚地显示并非如此。
描述以下实施例以辅助对本发明的理解。不意在且不应当以任何方式将实施例解释成对本发明的保护范围的限制。
附图说明
图1为IBI310+信迪利联合治疗后的无进展生存期曲线。
具体实施方式
进一步通过以下非限制性实例来说明本发明，其不旨在限制本发明所涵盖的范围。
实施例1
1.受试药物
信迪利单抗注射液(Sintilimab Injection)：规格10ml∶100mg，信达生物制药(苏州)有限公司。
IBI310注射液：规格10ml∶50mg，信达生物制药(苏州)有限公司，制备方法参见专利公开号CN106620691B。
肝细胞癌入组受试者标准
入选标准：
1.签署书面知情同意书，而且能够遵守方案规定的访视及相关程序。
2.年龄≥18周岁。
3.局部晚期或转移性肝细胞癌，经组织学/细胞学确诊，或肝硬化者符合美国肝病研究学会(AASLD)肝细胞癌的临床诊断标准。
4.经过至少一种针对肝细胞癌的系统性治疗后失败或不耐受：1)既往系统性治疗包括索拉非尼、仑伐替尼或以铂类为主的化疗；2)既往系统性治疗如不是索拉非尼、仑伐替尼或以铂类为主的化疗，则受试者须经治疗医生充分告知当前治疗选择包括索拉非尼、仑伐替尼靶向治疗或化疗，表示拒绝 并经研究医生书面记录。
5.既往系统治疗为靶向治疗则要求治疗结束距本研究首次用药必须≥2周且治疗相关AE恢复至不良事件常用标准术语标准5.0版(CTCAE V5.0)≤1级(乏力、脱发除外)；如既往治疗为全身化疗则要求治疗结束距本研究首次用药必须≥4周且治疗相关AE恢复至不良事件常用标准术语标准5.0版(CTCAE V5.0)≤1级(乏力、脱发除外)。
6.根据实体瘤疗效评价标准1.1版(RECIST V1.1)，至少有1个未经局部治疗的或经过局部治疗后明确进展的可测量病灶。
7.Child-Pugh评分≤7分。
8.国家卫生和计划生育委员会颁布的原发性肝癌诊疗规范(2019年版)不适合根治性手术或局部治疗或经手术和/或局部治疗后疾病进展的IIb期，III期即巴塞罗那临床肝癌(Barcelona Clinic Liver Cancer，BCLC)分期为不适合根治性手术和/或局部治疗的B期或C期。
9.ECOG体力状态评分0或1分。
10.预期生存时间≥12周。
11.育龄期女性受试者或性伴侣为育龄期女性的男性受试者，需在整个治疗期及治疗期后6个月采取有效的避孕措施。
12.具有良好的器官和骨髓造血功能，入组前7天内实验室检查值符合下列要求(获得实验室检查的前14天内不允许给予任何血液成分、细胞生长因子、白蛋白及其他静脉或皮下给药的纠正治疗的药物)，具体如下：
-血常规：绝对中性粒细胞计数(ANC)≥1.5×109/L；血小板计数(PLT)≥75×109/L；血红蛋白含量(HGB)≥9g/dL。
-肝功能：血清总胆红素(TBIL)≤1.5×正常上限(ULN)；丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)≤5×ULN；血清白蛋白≥28g/L；碱性磷酸酶(ALP)≤5×ULN。
-肾功能：血清肌酐(Cr)≤1.5×ULN或肌酐清除率(CCr)≥50mL/min (Cockcroft-Gault公式)；尿常规结果显示尿蛋白＜2+或基线时尿常规检测显示尿蛋白≥2+的患者，进行24小时尿液采集且24小时尿蛋白定量＜1g。
2.-凝血功能：国际标准化比率(INR)≤2，且活化部分凝血活酶时间(APTT)≤1.5×ULN。给药方法及过程
肝癌治疗：在Ib期阶段，受试者接受伊匹单抗和信迪利单抗，该阶段主要进行伊匹单抗剂量探索。伊匹单抗初始剂量：设置3个剂量组(1mg/kg个体体重、2mg/kg个体体重、3mg/kg个体体重)
如果未出现DLT(Dose-LimitingToxicities，剂量限制性毒性)，按照既定的剂量递增方案，继续下一剂量水平试验。若出现1例DLT，在该剂量水平上增加3名受试者，当未再出现新的DLT，则继续下一剂量水平试验。如果出现≥2例DLT，该剂量水平的前一剂量水平定义为MTD(Maximum Tolerated Dose，最大耐受剂量)。信迪利单抗剂量：200mg/次(固定剂量)、1次/3周、静脉输注。
DLT定义：按照NCI CTCAE v5.0毒性评价标准，Ib期DLT定义为：剂量递增阶段的首剂研究药物给药后的42天内(6周内)或至第2剂研究药物给药后的21天内发生的(以最长时间为准)以下任何一项与伊匹单抗和信迪利单抗相关的所有不良事件(AE)：
·任何≥3级的免疫相关性不良事件(irAE)；
·任何≥3级运动神经毒性和任何≥3级治疗相关感觉神经毒性；
·任何≥2级眼痛或视敏度(视力)下降，对局部治疗无效，且在局部治疗开始后2周内不能改善至1级，或需要系统治疗；
·≥3级总胆红素升高，或者≥3级丙氨酸氨基转移酶(ALT)/天门冬氨酸氨基转移酶(AST)升高且伴随≥2级总胆红素升高(存在肝转移病灶时，1级ALT/AST升高定义为基线值的2.5倍，2级ALT/AST升高定义为基线值的2.5～5倍，3级ALT/AST升高定义为基线值的5～20倍)；
·任何5级不良事件。
给药方法：
Figure PCTCN2021089668-appb-000001
#应采用基线受试者体重计算给药剂量，除非体重变化较基线访视≥10％。则按计划给药当日的体重计算实际给药量。为了方便给药，允许±5％误差。
3.试验结果
1)Ib期IBI310研究：
DLT评估情况：Ib期已经完成了IBI310的1mg/kg、2mg/kg、3mg/kg的剂量爬坡实验，没有DLT的发生。不良事件总结：Ib期发生与研究药物相关的不良事件(TRAE)共13例(76.5％)；仅4例(23.5％)受试者发生3级以上TEAE、1例(5.9％)受试者发生3级以上TRAE；仅1例(5.9％)受试者发生与研究药物无关导致退出试验的不良事件；6例(35.3％)受试者发生导致研究药物暂停的不良事件但均与研究药物无关，没有受试者发生与研究药物相关的严重不良事件(SAE)。
Ib期实验得出，没有出现超出预期的不良事件。所以本研究总体安全性较高，未出现治疗相关死亡。
2)信迪利单抗联合IBI310联用用于治疗肝细胞癌的Ib期研究
下述实验中的病人满足入排标准。
一、安全性数据
从2020-07-02到2021-4-19，Ib期研究共入组29肝细胞癌患者。共计27例发生不良事件，不良事件发生率为93.1％；26例受试者发生治疗期不良事 件，发生率为89.7％；12例受试者发生免疫相关的不良事件，发生率为41.4％；未发生与输注相关的不良事件。
22例受试者发生与IBI310有关的不良事件，发生率为75.9％；22例受试者发生与信迪利单抗有关的不良事件，发生率为75.9％；12例受试者发生≥3级的TEAE，发生率为41.4％；10例受试者发生≥3级的TRAE，发生率为34.5％；9例受试者发生≥3级且与IBI310有关的不良事件，发生率为31％；10例受试者发生≥3级且与信迪利单抗有关的不良事件，发生率为34.5％。
5例受试者发生治疗期严重不良事件，发生率为17.2％；4例受试者发生与IBI310有关的治疗期严重不良事件，发生率为13.8％；4例受试者发生与信迪利单抗有关的治疗期间严重不良事件，发生率为13.8％。
2例受试者发生导致研究药物停用的不良事件，发生率为6.9％；16例受试者发生导致研究药物暂停的不良事件，发生率为55.2％；1例受试者发生导致死亡的不良事件，发生率为3.4％。
综上所述，IBI310+信迪利单抗的组合在肝细胞癌受试者中安全性整体可控。
二、疗效数据
从2020-07-02到2021-4-19，Ib期研究共入组29肝细胞癌患者，纳入分析29例。
截至2021-4-19，27例受试者完成了至少1次肿瘤评估，其中5例受试者最佳总缓解为部分缓解(PR)，16例受试者最佳总缓解疾病稳定(SD)；6例受试者最佳总缓解为疾病进展(PD)，客观缓解率(ORR)为17.2％，疾病控制率(DCR)为72.4％。中位无进展生存期(mPFS)为3.9个月(图1)。
7例受试者既往用过PD-1/PD-L1单抗且完成了至少1次肿瘤评估，其中1例受试者最佳总缓解为部分缓解(PR)，3例受试者最佳总缓解疾病稳定(SD)；3例受试者最佳总缓解为疾病进展(PD)，客观缓解率(ORR)为 14.3％，疾病控制率(DCR)为57.1％。
表2.基于研究者评估的证实的最佳总缓解(BOR)分析-RECIST 1.1
Figure PCTCN2021089668-appb-000002
结论：对既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌患者，对比目前国内已获批的恒瑞PD-1单抗卡瑞利珠单抗(ORR 13.8％，DCR 44.7％，mPFS 2.1个月)，在入组患者基线状态更差的情况下(均为BCLC C期患者，既往接受二线、三线及以上系统治疗患者比例更高，包含既往PD-1/PD-L1单抗治疗失败的患者)，采用IBI310+信迪利单抗进行二线及后线治疗取得了更好的疗效：ORR为17.2％，DCR为72.4％，尤其mPFS达到了3.9个月，这个指标对于二线及后线患者来说，具有重要的意义，可以为其 带来更好的生存获益。对于既往未用过PD-1/PD-L1单抗的患者，ORR达到了18.2％，DCR达到了77.3％。另外，对于既往经过PD-1/PD-L1治疗失败的患者，也取得了很好的疗效(ORR为14.3％，DCR为57.1％)。即显示出比传统化疗治疗更好的客观缓解率，又比免疫治疗单药更优的无进展生存期。
尽管已经出于说明本发明的目的显示了某些代表性实施方案和细节，但是本领域技术人员显而易见的是可以对它们进行多种变化和修改而不脱离主题发明的范围。在这个方面，本发明范围仅由以下权利要求限定。

Claims (12)

  1. 一种包含PD-1抗体或其抗原结合片段和抗CTLA-4抗体的组合在制备用于预防或治疗癌症的药物中的用途，
    其中抗PD-1抗体或其抗原结合片段包含6个CDR，其中LCDR1、LCDR2和LCDR3分别由氨基酸序列RASQGISSWLA(SEQ ID NO：1)、SAASSLQS(SEQ ID NO：2)和QQANHLPFT(SEQ ID NO：3)组成，且其中HCDR1、HCDR2和HCDR3分别由氨基酸序列KASGGTFSSYAIS(SEQ ID NO：4)、LIIPMFDTAGYAQKFQG(SEQ ID NO：5)和ARAEHSSTGTFDY(SEQ ID NO：6)组成，所述6个CDR由North定义规则确定；
    其中抗CTLA-4抗体是伊匹单抗或IBI310。
  2. 根据权利要求1所述的用途，其中所述抗PD-1抗体或其抗原结合片段包含重链可变区VH和轻链可变区VL，其中重链可变区包含SEQ ID NO：7的序列和轻链可变区包含SEQ ID NO：8的序列；优选地，所述抗PD-1抗体包含重链和轻链，其中所述重链包含SEQ ID NO：9的序列，所述轻链包含SEQ ID NO：10的序列。
  3. 根据权利要求1或2所述的用途，所述癌症为肝细胞癌，更优选地为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
  4. 根据权利要求1-3中任何一项所述的用途，所述抗PD-1抗体或其抗原结合片段单次施用剂量为约50-500mg、例如为约50mg、约100mg、约150mg、约200mg、约250mg、约300mg、约350mg、约400mg、约450mg或约500mg，更优选地为约200mg；或所述用途中抗PD-1抗体或其抗原结合片段单次施用剂量为约0.3-10mg/kg，例如为约0.3mg/kg、1mg/kg、3mg/kg或10mg/kg，更优选地为约3mg/kg，优选为胃肠外、更优选静脉内施用剂型；
    所述用途中抗CTLA-4抗体单次施用剂量为约15-200mg、例如为15mg、60mg、100mg、120mg、180mg或200mg、更优选地为180mg；或所述抗CTLA- 4抗体单次施用剂量为约0.3-3mg/kg、例如为约0.3mg/kg、约1mg/kg、约2mg/kg或约3mg/kg，优选为胃肠外、更优选静脉内施用剂型。
  5. 根据权利要求1-4中任何一项所述的用途，其中所述抗PD-1抗体或其抗原结合片段的单次施用剂量选自约100-300mg，例如约100mg、约150mg、约200mg、约250mg或约300mg，或所述用途中抗PD-1抗体或其抗原结合片段单次施用剂量为约0.3-10mg/kg、例如为约0.3mg/kg、1mg/kg、3mg/kg或10mg/kg，优选每二至四周施用一次，循环1、2、3、4或5个周期，优选通过静脉输注施用。
  6. 根据权利要求1-5中任何一项所述的用途，其中所述抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体分开、同时或依次施用。
  7. 根据权利要求1-6中任何一项所述的用途，其中所述抗PD-1抗体或其抗原结合片段单次施用剂量为200mg，所述抗CTLA-4抗体或其抗原结合片段单次施用剂量为1mg/kg；静脉注射每3周为一个周期，共4周期，随后予以单药抗PD-1抗体或其抗原结合片段200mg每3周一次；或
    其中所述抗PD-1抗体或其抗原结合片段单次施用剂量为200mg，所述抗CTLA-4抗体或其抗原结合片段单次施用剂量为2mg/kg；静脉注射每3周为一个周期，共4周期，随后予以单药抗PD-1抗体或其抗原结合片段200mg每3周一次；或
    其中所述抗PD-1抗体或其抗原结合片段单次施用剂量为200mg，所述抗CTLA-4抗体或其抗原结合片段单次施用剂量为3mg/kg；静脉注射每3周为一个周期，共4周期，随后予以单药抗PD-1抗体或其抗原结合片段200mg每3周一次。
  8. 根据权利要求7所述的用途，其中在抗PD-1抗体和抗CTLA-4抗体施用后，再单独给予抗PD-1抗体的维持治疗，优选给予抗PD-1抗体的维持治疗循环4个周期或不超过24个月。
  9. 用于预防或治疗癌症的方法，所述方法包括向有需要的患者施用有效 量的根据权利要求1-8中任何一项所述的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体，所述癌症优选肝细胞癌，其中所述肝细胞癌更优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
  10. 一种药物组合物，包含有效量的根据权利要求1-9中任何一项所述的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体和药学上可接受的载体。
  11. 一种成套药盒，其包含有效量的根据权利要求1-9中任何一项所述的抗PD-1抗体或其抗原结合片段和抗CTLA-4抗体。
  12. 根据权利要求10所述的药物组合物或根据权利要求11所述的成套药盒在制备预防或治疗癌症的药物中的用途，所述癌症优选肝细胞癌，其中所述肝细胞癌更优选为既往系统性至少一线治疗失败或不耐受的晚期肝细胞癌。
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