Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/2863—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against receptors for growth factors, growth regulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/30—Immunoglobulins specific features characterized by aspects of specificity or valency
  • C07K2317/31—Immunoglobulins specific features characterized by aspects of specificity or valency multispecific
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
  • C07K2317/73—Inducing cell death, e.g. apoptosis, necrosis or inhibition of cell proliferation
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
  • C07K2317/73—Inducing cell death, e.g. apoptosis, necrosis or inhibition of cell proliferation
  • C07K2317/732—Antibody-dependent cellular cytotoxicity [ADCC]

Definitions

• This application contains a sequence listing, which is submitted electronically via EFS- Web as an ASCII formatted sequence listing with a file name “JBI6371WOPCTlSEQLIST.txt”, creation date of August 2, 2021 and having a size of 19 KB.
• the sequence listing submitted via EFS-Web is part of the specification and is herein incorporated by reference in its entirety.
• the present invention relates to treatment of subjects having EGFR exon 20 insertion and other uncommon EGFR mutations.
• EGFR epidermal growth factor receptor
• c-Met receptor tyrosine kinase mesenchymal-epithelial transition factor
• NSCLC non-small cell lung cancer
• EGFR activating mutations have been reported in the first four exons (18 through 21) which result in changes to its tyrosine kinase domain.
• NSCLCs that harbor “classical” EGFR mutations in exons 18, 19 and 21, e.g. Exon 19 deletions orL858R, are sensitive to treatment with first-, second- and third-generation EGFR tyrosine kinase inhibitors (TKIs) such as erlotinib, afatinib and osimertinib (Gazdar AF.
• TKIs EGFR tyrosine kinase inhibitors
• TKIs EGFR tyrosine kinase inhibitors
• the EGFR exon 20 mutations encompass nucleotides that translate into amino acids at positions 762-823, and include a C-helix (762-766) followed by a loop (767-775) (Yasuda H, et al. Structural, biochemical, and clinical characterization of epidermal growth factor receptor (EGFR) exon 20 insertion mutations in lung cancer. Science translational medicine 2013;5(216):216ral77).
• the insertion mutations of one to seven amino acids in exon 20 form a wedge at the end of the C-helix in EGFR that promotes active kinase conformation.
• EGFR Exon20 insertion driver mutations (Exon20ins), a distinct and highly heterogeneous subset of NSCLCs, represent 4%-12% of all EGFR mutations (Y asuda H, et al. Sci Transl Med 2013 ;5(216); Russo A, et al. Heterogeneous Responses to Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) in Patients with Uncommon EGFR Mutations: New Insights and Future Perspectives in this Complex Clinical Scenario. Int J Mol Sci 2019;20(6); Riess JW, et al.
• the disclosure provides a method of treating a subject having cancer that is positive for an EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject having cancer that is positive for the EGFR exon 20 mutation.
• EGFR bispecific anti-epidermal growth factor receptor
• c-Met hepatocyte growth factor receptor
• the disclosure provides a method of treating a subject having cancer that is positive for an EGFR S768I, L861Q and/or G719X mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject having cancer that is positive for the mutation.
• EGFR bispecific anti-epidermal growth factor receptor
• c-Met hepatocyte growth factor receptor
• the disclosure also provides a method of treating a subject having cancer with a bispecific anti-EGFR/c-Met antibody, comprising: a) providing a biological sample from the subject; b) determining presence or absence of an EGFR exon 20 mutation in the sample; and c) administering or providing for administration the bispecific anti-EGFR/c-Met antibody to the subject determined to have the EGFR exon 20 mutation.
• the disclosure also provides a method of treating a subject having cancer with a bispecific anti-EGFR/c-Met antibody, comprising: a) providing a biological sample from the subject; b) determining presence or absence of an EGFR S768I, L861Q and/or G719X mutation mutation in the sample; and c) administering or providing for administration the bispecific anti-EGFR/c-Met antibody to the subject determined to have the mutation.
• the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a heavy chain complementarity determining region 1 (HCDR1) of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a light chain complementarity determining region 1 (LCDR1) of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6, and wherein the second domain that binds c-Met comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO: 11 and the LCDR3 of SEQ ID NO: 12.
• HCDR1 heavy chain complementarity determining region 1
• LCDR2 of SEQ ID NO: 2
• the first domain that specifically binds EGFR comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain that specifically binds c-Met comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the bispecific anti-EGFR/c-Met antibody is an IgGl isotype.
• the bispecific anti-EGFR/c-Met antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO: 20.
• the bispecific anti-EGFR/c-Met antibody comprises a biantennary glycan structure with a fucose content of between about 1% to about 15%.
• the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
• the one or more prior anti-cancer therapies comprises one or more chemotherapeutic agents, checkpoint inhibitors, targeted anti-cancer therapies or kinase inhibitors, or any combination thereof.
• the one or more prior anti-cancer therapies comprises carboplatin, paclitaxel, gemcitabine, cisplatin, vinorelbine, docetaxel, palbociclib, crizotinib, PD-(L)1 axis inhibitor, an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL, erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib, or any combination thereof.
• the subject is treatment naive.
• EGFR activating-mutations comprise L718Q, G719A, G719X (X being any amino acid), L861X (X being any amino acid), L858R, E746K, L747S, E749Q, A750P, A755V, V765M, C797S, L858P or T790M substitution, deletion of E746-A750, deletion of R748-P753, insertion of Ala (A) between M766 and A767, insertion of Ser, Vai and Ala (SVA) between S768 and V769, insertion of Asn and Ser (NS) between P772 and H773, insertion of one or more amino acids between D761 and E762, A763 and Y764, Y764 and Y765, M766 and A767, A767 and V768, S768 and V769, V769 and D770, D770 and N771, N771 and P772, P772 and H773, H773 and
• TKI EGFR tyrosine kinase inhibitors
• the cancer is lung cancer, gastric cancer, colorectal cancer, brain cancer, cancer derived from epithelial cells, breast cancer, ovarian cancer, colorectal cancer, anal cancer, prostate cancer, kidney cancer, bladder cancer, head and neck cancer, pharynx cancer, cancer of the nose, pancreatic cancer, skin cancer, oral cancer, cancer of the tongue, esophageal cancer, vaginal cancer, cervical cancer, cancer of the spleen, testicular cancer, gastric cancer, cancer of the thymus, colon cancer, thyroid cancer, liver cancer, hepatocellular carcinoma (HCC) or sporadic or hereditary papillary renal cell carcinoma (PRCC), or any combination thereof.
• HCC hepatocellular carcinoma
• PRCC hereditary papillary renal cell carcinoma
• the lung cancer is non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC) or lung adenocarcinoma, pulmonary sarcomatoid carcinoma or any combination thereof.
• NSCLC non-small cell lung cancer
• SCLC small cell lung cancer
• lung adenocarcinoma pulmonary sarcomatoid carcinoma or any combination thereof.
• the method of the disclosure comprises further administering one or more anti-cancer therapies to the subject.
• the one or more anti-cancer therapies comprises chemotherapy, radiation therapy, surgery, a targeted anti-cancer therapy, a kinase inhibitor, or any combination thereof.
• the kinase inhibitor is an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR or an inhibitor of AXL.
• the kinase inhibitor is erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib.
• the EGFR exon 20 mutation is a de novo mutation.
• the EGFR exon 20 mutation is an acquired mutation.
• the EGFR S768I, L861Q and/or G719X mutation is a de novo mutation. In one embodiment, the EGFR S768I, L861Q and/or G719X mutation is an acquired mutation. In one embodiment, the X is any amino acid other than G. In one embodiment, the G719X is G719A. In one embodiment, the G719X is G719S. In one embodiment, the G719X is G719C. In one embodiment, the G719X is G719D.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of between about 140 mg to about 1750 mg.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 700 mg, about 750 mg, about 800 mg, about 850 mg, 900 mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg or 1400 mg.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of 1050 mg.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of 1400 mg.
• the bispecific anti-EGFR/c-Met antibody is administered twice a week, once a week, once in two weeks, once in three weeks or once in four weeks.
• FIGs. 1A-1G show suppressesion of EGFR and c-Met signaling pathways in Ba/F3 cells with EGFR Exon20ins mutations by amivantamab.
• FIG 1A shows a schematic of the structure of amivantamab, an EGFR and cMet bispecific antibody
• FIG IB shows a schematic of EGFR Exon20 insertions in stable Ba/F3 cells, PDC, PDO, and PDX models
• FIG 1C shows the viability ofBa/F3 cells, stably expressing EGFR Exon20ins (V769_D770insASV, D770delinsGY, H773_V774insH, Y764_V765insHH and D770_N771insSVD), treated with either amivantamab, gefitinib, or osimertinib
• FIG ID shows protein levels inBa/F3 cells overexpressing the indicated EGFR Exon20ins mutations following treatment
• FIG. 2A-2E show the suppression of EGFR and cMet signaling pathways in Patient- Derived Cells (PDCs) and Organoids (PDOs) harboring EGFR Exon20ins mutations.
• FIG 2A shows protein levels in PDCs with the indicated EGFR Exon20ins mutantions treated with amivantamab for 72 hours at the indicated concentrations;
• FIG 2B shows cell viability of PDCs, determined via CellTiter-Glo, following amivantamab treatment for 72 hours;
• FIG 2C shows the effects of anuvantamab on the cell proliferation of PDCs, measured as % optical density (O.D.).
• FIG 2D shows a dose-response curves of YUO-036 (A767_V769dup) PDOs treated with IgGl control or amivantamab
• FIG 2E shows a doseresponse curves of YUO-029 (S768_D770dup) PDOs treated with IgGl control or amivantamab;
• FIG. 3A-3C show internalization of EGFR and cMet in Ba/F3 and PDC cells expressing EGFR Exon20ins mutations, following treatment with amivantamab.
• FIG 3A shows PE-EGFR and FITC-cMet expression on the plasma membrane detected in DFCI-127 (P772_H773insPNP) cells;
• FIG 3B shows PE-EGFR and FITC-cMet expression on the plasma membrane detected in DFCI-58 (H773_V774insNPH) cells;
• FIG 3C shows the protein levels in Ba/F3 cell lines overexpressing D770delinsGY or H773_V774insH, following pre-treatment with the autophagy inhibitor bafilomycin (100 nM) for 30 min and then amivantamab (1 mg/mL).
• FIG. 4A-4I show reduction of tumor burden in Ba/F3 cells and PDCs with EGFR Exon20ins xenograft models, following treatment with either IgGl control, or amivantamab twice per week i.p. injections dosing with 30 mg/kg; *P ⁇ 0.0001 vs. vehicle or IgGl control.
• FIG 4A shows tumor volums inBa/F3 cells overexpressing D770delinsGY- or H773_V774insH -bearing NOG mice
• FIG 4B shows % change in tumor volums in Ba/F3 cells overexpressing D770delinsGY- or H773_V774insH-bearing NOG mice, assessed on the last day of treatment in the xenograft mice
• FIG 4C shows protein levels in tumor lysates from Ba/F3 cells overexpressing D770delinsGY- or H773_V774insH-bearing NOG mice
• FIG 4D shows tumor volums DFCI-127— bearing NOG mice
• FIG 4E shows % change in tumor volums in DFCI-127 -bearing NOG mice, assessed on the last day of treatment
• FIG 4F shows protein levels in tumor lysates from vehicle- or amivantamab-treated DFCI-127-bearing NOG mice
• FIG 4G shows tumor volum
• FIG. 5A-5E show superior ADCC activity of amivantamab as compared to cetuximab.
• FIG. 5A shows amivantamab -mediated ADCC activity against NSCLC PDCs expressing EGFR Exon20ins mutations using PBMC, E : T (50 : 1) ratio;
• FIG. 5B shows quantitative analysis of amivantamab-mediated cytotoxicity against DFCI-127 and YU-1163 PDCs, treated with either IgGl, amivantamab (10 pg/ml) or cetuximab (10 pg/ml) for 24 hours in the presence or absence of PBMC, E : T (5 : 1) ratio;
• FIG. 5A shows amivantamab -mediated ADCC activity against NSCLC PDCs expressing EGFR Exon20ins mutations using PBMC, E : T (50 : 1) ratio
• FIG. 5B shows quantitative analysis of amivantamab-mediated cytotoxicity against DFCI-127 and
• FIG. 5D shows IFN-y (pg/ml) levels in the cell culture media of PDCs co-cultured with PBMCs in the presence of IgGl, amivantamab, or cetuximab, as detected by ELISA (*P ⁇ 0.0001 vs. cetuximab at the same concentration);
• FIG. 5E shows that PBMCs pretreated with Fc receptor blocker reduced the IFN-y level in the culture medium in the presence of amivantamab (10 pg/ml), *P ⁇ 0.0001, **P ⁇ 0.001.
• FIG. 6A-6D show the reduction of tumors in a PDX model with D770_N771insG EGFR mutantion by amivantamab.
• FIG. 6A shows Sanger sequencing data depicting the D770 N771 insG mutations of the EGFR gene in a PDX model;
• FIG. 6B shows group mean tumor volumes of patient-derived tumors implanted in B ALB/c nude mice treated with either vehicle, amivantamab (10 mg/kg), or cetuximab (10 mg/kg), twice per week, i.p. injections or poziotinib (1 mg/kg), Q.D. (*P ⁇ 0.0001);
• FIG. 6A shows Sanger sequencing data depicting the D770 N771 insG mutations of the EGFR gene in a PDX model
• FIG. 6B shows group mean tumor volumes of patient-derived tumors implanted in B ALB/c nude mice treated with either vehicle, amivantamab (10 mg/kg),
• FIG. 6C shows protein levels in tumors obtained from YHIM- 1029 PDX models treated with 10 mg/kg amivantamab
• FIG. 6D shows protein levels in tumors obtained from YHIM-1029 PDX models treated with 10 mg/kg cetuximab, or 1 mg/kg poziotinib.
• FIG. 7 shows the study design for two-part Phase 1 study of amivantamab in patients with advanced NSCLC (NCT02609776); Cohorts A (EGFR-dependent resistance) and B (EGFR- independent resistance) were closed.
• FIG. 9 shows best response; a - Partial response or better, b - Partial response or better or stable disease of at least 12 weeks (2 disease assessments).
• FIG. 10 shows change from baseline in sum of target lesion diameters over time; a - 2 patients treated with EGFR TKI, 1 patient with bevacizumab plus radiation therapy, 1 patient with adjuvant immuno-oncology chemotherapy.
• FIG. 11 shows progression-free survival.
• FIG. 12A-12C show the reduction of tumors in NSCLC patients with EGFR Exon20ins mutations following treatment with amivantamab.
• FIG. 12A shows radiologic response following amivantamab 1050 mg treatment in a 58-year old patient with the EGFR H773delinsNPY mutation;
• FIG. 12B shows radiologic response following amivantamab 1050 mg treatment in a 48-year old patient with the EGFR S768_D770dup mutation;
• FIG. 12C shows a proposed model of diverse antitumor mechanisms of amivantamab in NSCLC with EGFR Exon20ins.
• a first option refers to the applicability of the first element without the second.
• a second option refers to the applicability of the second element without the first.
• a third option refers to the applicability of the first and second elements together. Any one of these options is understood to fall within the meaning, and therefore satisfy the requirement of the term “and/or” as used herein. Concurrent applicability of more than one of the options is also understood to fall within the meaning, and therefore satisfy the requirement of the term “and/or.”
• transitional terms “comprising,” “consisting essentially of,” and “consisting of’ are intended to connote their generally accepted meanings in the patent vernacular; that is, (i) “comprising,” which is synonymous with “including,” “containing,” or “characterized by,” is inclusive or open-ended and does not exclude additional, unrecited elements or method steps; (ii) “consisting of’ excludes any element, step, or ingredient not specified in the claim; and (iii) consisting essentially of limits the scope of a claim to the specified matenals or steps and those that do not materially affect the basic and novel characteristic(s)” of the claimed invention.
• Embodiments described in terms of the phrase “comprising” (or its equivalents) also provide as embodiments those independently described in terms of “consisting of’ and “consisting essentially of.”
• “Co-administration,” “administration with,” “administration in combination with,” “in combination with” or the like, encompass administration of the selected therapeutics or drugs to a single patient, and are intended to include treatment regimens in which the therapeutics or drugs are administered by the same or different route of administration or at the same or different time.
• Isolated refers to a homogenous population of molecules (such as synthetic polynucleotides, polypeptides vectors or viruses) which have been substantially separated and/or purified away from other components of the system the molecules are produced in, such as a recombinant cell, as well as a protein that has been subjected to at least one purification or isolation step.
• molecules such as synthetic polynucleotides, polypeptides vectors or viruses
• isolated refers to a molecule that is substantially free of other cellular material and/or chemicals and encompasses molecules that are isolated to a higher purity, such as to 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% purity.
• Treat”, “treating” or “treatment” of a disease or disorder such as cancer refers to accomplishing one or more of the following: reducing the severity and/or duration of the disorder, inhibiting worsening of symptoms characteristic of the disorder being treated, limiting or preventing recurrence of the disorder in subjects that have previously had the disorder, or limiting or preventing recurrence of symptoms in subjects that were previously symptomatic for the disorder.
• Prevent”, “preventing”, “prevention”, or “prophylaxis” of a disease or disorder means preventing that a disorder occurs in subject.
• Diagnosing refers to methods to determine if a subject is suffering from a given disease or condition or may develop a given disease or condition in the future or is likely to respond to treatment for a prior diagnosed disease or condition, i.e., stratifying a patient population on likelihood to respond to treatment. Diagnosis is typically performed by a physician based on the general guidelines for the disease to be diagnosed or other criteria that indicate a subject is likely to respond to a particular treatment.
• “Responsive”, “responsiveness” or “likely to respond” refers to any kind of improvement or positive response, such as alleviation or amelioration of one or more symptoms, diminishment of extent of disease, stabilized (i.e., not worsening) state of disease, preventing spread of disease, delay or slowing of disease progression, amelioration or palliation of the disease state, and remission (whether partial or total), whether detectable or undetectable.
• Newly diagnosed refers to a subject who has been diagnosed with EGFR or c-Met expressing cancer but has not yet received treatment for multiple myeloma.
• “Therapeutically effective amount” refers to an amount effective, at doses and for periods of time necessary, to achieve a desired therapeutic result.
• a therapeutically effective amount may vary depending on factors such as the disease state, age, sex, and weight of the individual, and the ability of a therapeutic or a combination of therapeutics to elicit a desired response in the individual. Exemplary indicators of an effective therapeutic or combination of therapeutics that include, for example, improved well-being of the patient.
• Refractory refers to a disease that does not respond to a treatment.
• a refractory disease can be resistant to a treatment before or at the beginning of the treatment, or a refractory disease can become resistant during a treatment.
• Relapsed refers to the return of a disease or the signs and symptoms of a disease after a period of improvement after prior treatment with a therapeutic.
• Subject includes any human or nonhuman animal.
• Nonhuman animal includes all vertebrates, e.g., mammals and non-mammals, such as nonhuman primates, sheep, dogs, cats, horses, cows, chickens, amphibians, reptiles, etc.
• the terms “subject” and “patient” are used interchangeably herein.
• “About” means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, i.e., the limitations of the measurement system. Unless explicitly stated otherwise within the Examples or elsewhere in the Specification in the context of a particular assay, result or embodiment, “about” means within one standard deviation per the practice in the art, or a range of up to 5%, whichever is larger.
• Cancer refers to an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread) to other areas of a patient’s body.
• EGFR or c-Met expressing cancer refers to cancer that has detectable expression of EGFR or c-Met or has EGFR or c-Met mutation or amplification.
• EGFR or c-Met expression, amplification and mutation status can be detected using know methods, such as sequencing, fluorescent in situ hybridization, immunohistochemistry, flow cytometry or western blotting.
• EGFR epidermal growth factor receptor
• human EGFR also known as HER1 or ErbBl (Ullrich et al., Nature 309:418-425, 1984) having the amino acid sequence shown in GenBank accession number NP 005219, as well as naturally -occurring variants thereof.
• EGFR exon 20 mutations or EGFR Exon20ins or Exon20ins refer to the human EGFR gene encompassing at least one mutation in nucleotides that translate into amino acids at position 762-823, and include a C-helix (762-766) followed by a loop (767-775) (see Yasuda H et al., Science Translational Medicine 2013; 5(216):216ral77 doi 10.1126/scitranslmed.3007205).
• the insertion mutations of one to seven amino acids in exon 20 form a wedge at the end of the C-helix in EGFR that promotes active kinase conformation.
• Hepatocyte growth factor receptor or “c-Met” as used herein refers to the human c- Met having the amino acid sequence shown in GenBank Accession No: NP 001120972 and natural variants thereof.
• Bispecific anti-EGFR/c-Met antibody or “bispecific EGFR/c-Met antibody” refers to a bispecific antibody having a first domain that specifically binds EGFR and a second domain that specifically binds c-Met.
• the domains specifically binding EGFR and c-Met are typically VH/VL pairs, and the bispecific anti-EGFR/c-Met antibody is monovalent in terms of binding to EGFR and c-Met.
• Specific binding or “specifically binds” or “specifically binding” or “binds” refer to an antibody binding to an antigen or an epitope within the antigen with greater affinity than for other antigens.
• the antibody binds to the antigen or the epitope within the antigen with an equilibrium dissociation constant (KD) of about 5xl0' 8 M or less, for example about IxlO' 9 M or less, about IxlO' 10 M or less, about IxlO' 11 M or less, or about IxlO' 12 M or less, typically with the K D that is at least one hundred-fold less than its K D for binding to a non-specific antigen (e.g., BSA, casein).
• KD equilibrium dissociation constant
• the dissociation constant may be measured using known protocols.
• Antibodies that bind to the antigen or the epitope within the antigen may, however, have cross-reactivity to other related antigens, for example to the same antigen from other species (homologs), such as human or monkey, for example Macaca fascicularis (cynomolgus, cyno) or Pan troglodytes (chimpanzee, chimp). While a monospecific antibody binds one antigen or one epitope, a bispecific antibody binds two distinct antigens or two distinct epitopes.
• Antibodies is meant in a broad sense and includes immunoglobulin molecules including monoclonal antibodies including murine, human, humanized and chimeric monoclonal antibodies, antigen binding fragments, multispecific antibodies, such as bispecific, trispecific, tetraspecific etc., dimeric, tetrameric or multimeric antibodies, single chain antibodies, domain antibodies and any other modified configuration of the immunoglobulin molecule that comprises an antigen binding site of the required specificity.
• “Full length antibodies” are comprised of two heavy chains (HC) and two light chains (LC) inter-connected by disulfide bonds as well as multimers thereof (e.g. IgM).
• Each heavy chain is comprised of a heavy chain variable region (VH) and a heavy chain constant region (comprised of domains CHI, hinge, CH2 and CH3).
• Each light chain is compnsed of a light chain variable region (VL) and a light chain constant region (CL).
• the VH and the VL regions may be further subdivided into regions of hypervariability, termed complementarity determining regions (CDR), interspersed with framework regions (FR).
• CDR complementarity determining regions
• FR framework regions
• Each VH and VL is composed of three CDRs and four FR segments, arranged from amino-to-carboxy-terminus in the following order: FR1, CDR1, FR2, CDR2, FR3, CDR3 and FR4.
• CDR complementarity determining regions
• CDR CDR
• HCDR1 CDR1
• HCDR2 CDR3
• LCDR1 CDR2
• LCDR3 CDR3
• Immunoglobulins may be assigned to five major classes, IgA, IgD, IgE, IgG and IgM, depending on the heavy chain constant domain amino acid sequence.
• IgA and IgG are further sub-classified as the isotypes IgAl, IgA2, IgGl, IgG2, IgG3 and IgG4.
• Antibody light chains of any vertebrate species may be assigned to one of two clearly distinct types, namely kappa (K) and lambda (X), based on the amino acid sequences of their constant domains.
• Antigen binding fragment refers to a portion of an immunoglobulin molecule that binds an antigen.
• Antigen binding fragments may be synthetic, enzymatically obtainable or genetically engineered polypeptides and include the VH, the VL, the VH and the VL, Fab, F(ab')2, Fd and Fv fragments, domain antibodies (dAb) consisting of one VH domain or one VL domain, shark variable IgNAR domains, camelized VH domains, minimal recognition units consisting of the amino acid residues that mimic the CDRs of an antibody, such as FR3-CDR3- FR4 portions, the HCDR1, the HCDR2 and/or the HCDR3 and the LCDR1, the LCDR2 and/or the LCDR3.
• VH and VL domains may be linked together via a synthetic linker to form various types of single chain antibody designs where the VH/VL domains may pair intramolecularly, or intermolecularly in those cases when the VH and VL domains are expressed by separate single chain antibody constmcts, to form a monovalent antigen binding site, such as single chain Fv (scFv) or diabody; described for example in Int. Patent Publ. Nos. W01998/44001, WO1988/01649, WO1994/13804 and W01992/01047.
• scFv single chain Fv
• “Monoclonal antibody” refers to an antibody obtained from a substantially homogenous population of antibody molecules, i.e., the individual antibodies comprising the population are identical except for possible well-known alterations such as removal of C-terminal lysine from the antibody heavy chain or post-translational modifications such as amino acid isomerization or deamidation, methionine oxidation or asparagine or glutamine deamidation.
• Monoclonal antibodies typically bind one antigenic epitope.
• a bispecific monoclonal antibody binds two distinct antigenic epitopes.
• Monoclonal antibodies may have heterogeneous glycosylation within the antibody population.
• Monoclonal antibody may be monospecific or multispecific such as bispecific, monovalent, bivalent or multivalent.
• Recombinant refers to DNA, antibodies and other proteins that are prepared, expressed, created or isolated by recombinant means when segments from different sources are joined to produce recombinant DNA, antibodies or proteins.
• Bispecific refers to an antibody that specifically binds two distinct antigens or two distinct epitopes within the same antigen.
• the bispecific antibody may have cross-reactivity to other related antigens, for example to the same antigen from other species (homologs), such as human or monkey, for example Macaca cynomolgus (cynomolgus, cyno) or Pan troglodytes, or may bind an epitope that is shared between two or more distinct antigens.
• Antagonist refers to a molecule that, when bound to a cellular protein, suppresses at least one reaction or activity that is induced by a natural ligand of the protein.
• a molecule is an antagonist when the at least one reaction or activity is suppressed by at least about 20%, 30%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or 100% more than the at least one reaction or activity suppressed in the absence of the antagonist (e.g., negative control), or when the suppression is statistically significant when compared to the suppression in the absence of the antagonist.
• PD-(L)1 axis inhibitor refers to a molecule that inhibits PD-1 downstream signaling.
• PD-(L)1 axis inhibitor may be a molecule that binds PD-1, PD-L1 or PD-L2.
• Biological sample refers to a collection of similar fluids, cells, or tissues isolated from a subject, as well as fluids, cells, or tissues present within a subject.
• Exemplary samples are biological fluids such as blood, serum and serosal fluids, plasma, lymph, urine, saliva, cystic fluid, tear drops, feces, sputum, mucosal secretions of the secretory tissues and organs, vaginal secretions, ascites fluids, fluids of the pleural, pericardial, peritoneal, abdominal and other body cavities, fluids collected by bronchial lavage, synovial fluid, liquid solutions contacted with a subject or biological source, for example, cell and organ culture medium including cell or organ conditioned medium, lavage fluids and the like, tissue biopsies, tumor tissue biopsies, tumor tissue samples, fine needle aspirations, surgically resected tissue, organ cultures or cell cultures.
• Low fucose or “low fucose content” as used in the application refers to antibodies with fucose content of about between 1 %- 15%.
• Normal fucose or ‘normal fucose content” as used herein refers to antibodies with fucose content of about over 50%, typically about over 80% or over 85%.
• Amivantamab or JNJ-61186372 (JNJ-372) is an lgGl anti-EGFR/c-Met bispecific antibody described in U.S. Pat. No. 9,593,164.
• the disclosure is based, at least in part, on the finding that amivantamab is effective in treating subjects having EGFR exon 20 mutations.
• EGFR exon 20 mutations comprise insertion mutations of one to seven amino acids in exon 20.
• Exon 20 of EGFR encompasses nucleotides that translate into amino acid at position 762 to 823. It contains a C-helix (residues 762-766) and the loop following C-helix (residues 767-774), where the insertions could induce ligand-independent EGFR pathway activation and give rise to tumorigenesis.
• the EGFR exon 20 mutation is an insertion of one amino acid in exon 20.
• the EGFR exon 20 mutation is an insertion of two amino acids in exon 20.
• the EGFR exon 20 mutation is an insertion of three amino acids in exon 20. In one embodiment, the EGFR exon 20 mutation is an insertion of four amino acids in exon 20. In one embodiment, the EGFR exon 20 mutation is an insertion of five amino acids in exon 20. In one embodiment, the EGFR exon 20 mutation is an insertion of six amino acids in exon 20. In one embodiment, the EGFR exon 20 mutation is an insertion of seven amino acids in exon 20.
• the EGFR uncommon mutations comprise S768I, L861Q and/or G719X mutations.
• the X is any amino acid other than G.
• the G719X is G719A.
• the G719X is G719C.
• the G719X is G719S.
• the G719X is G719D.
• Certain embodiments of the present disclosure concern determining if a subject has one or more EGFR exon 20 mutations, such as an insertion mutation, or other uncommon mutations.
• Mutation detection methods are known the art, including PCR followed by nucleic acid sequencing, FISH, CGH, or next generation sequenceing (NGS).
• the exon 20 mutations or other uncommon mutations are detected by DNA sequencing, such as next generation sequenceing (NGS), by using a tumor tissue sample or circulating free DNA from plasma.
• the disclosure provides a method of treating a subject having cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject having cancer that is positive for a EGFR exon 20 mutation.
• EGFR bispecific anti-epidermal growth factor receptor
• c-Met hepatocyte growth factor receptor
• the disclosure also provides a method of treating a subject having lung cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung cancer that is positive for a EGFR exon 20 mutation.
• the disclosure also provides a method of treating a subject having non-small cell lung cancer (NSCLC) that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having NSCLC that is positive for a EGFR exon 20 mutation.
• NSCLC non-small cell lung cancer
• the disclosure also provides a method of treating a subject having small cell lung cancer (SCLC) that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having SCLC that is positive for a EGFR exon 20 mutation.
• SCLC small cell lung cancer
• the disclosure also provides a method of treating a subject having lung adenocarcinoma that is positive for EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung adenocarcinoma that is positive for EGFR exon 20 mutation.
• the disclosure also provides a method of treating a subject having cancer with a bispecific anti-EGFR/c-Met antibody, comprising: providing a biological sample from the subject; determining presence or absence of a EGFR exon 20 mutation in the sample; administering or providing for administration the bispecific anti-EGFR/c-Met antibody to the subject determined to have EGFR exon 20 mutation.
• the biological sample is a blood sample.
• the biological sample is a tumor tissue biopsy
• the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a heavy chain complementarity determining region 1 (HCDR1) of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a light chain complementarity determining region 1 (LCDR1) of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO: 11 and the LCDR3 of SEQ ID NO: 12.
• HCDR1 heavy chain complementarity determining region 1
• LCDR2 of SEQ ID NO: 2 a HCDR3 of SEQ
• the first domain that specifically binds EGFR comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14; and the second domain that specifically binds c-Met comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the bispecific anti-EGFR/c-Met antibody is an IgGl isotype.
• the bispecific anti-EGFR/c-Met antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO: 20.
• the bispecific anti-EGFR/c-Met antibody comprises a biantennary glycan structure with a fucose content of between about 1% to about 15%.
• Antibodies with reduced fucose content can be made using different methods reported to lead to the successful expression of relatively high defucosylated antibodies bearing the biantennary complex-type of Fc oligosaccharides such as control of culture osmolality (Konno et al., Cytotechnology 64(:249-65, 2012), application of a variant CHO line Lecl3 as the host cell line (Shields et al., J Biol Chem 277:26733-26740, 2002), application of a variant CHO line EB66 as the host cell line (Olivier et al., MAbs ;2(4), 2010; Epub ahead of print; PMID:20562582), application of a rat hybridoma cell line YB2/0 as the host cell line (Shinkawa et al., J Biol Chem 278:3466-3473, 2003), introduction of small interfering RNA specifically against the a 1,6-fucosyltrasferase
• the disclosure also provides a method of treating a subject having cancer that is positive for EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO:
• the disclosure also provides a method of treating a subject having lung cancer that is positive for EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID
• the disclosure also provides a method of treating a subject having NSCLC that is positive for EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having NSCLC that is positive for a EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2
• the disclosure also provides a method of treating a subject having SCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having SCLC that is positive for the EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of
• the disclosure also provides a method of treating a subject having lung adenocarcinoma that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung adenocarcinoma that is positive for EGFR exon 20 mutation, wherein the bispecific anti- EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCD
• the disclosure provides a method of treating a subject having cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having lung cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having NSCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having NSCLC that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having SCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having SCLC that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having lung adenocarcinoma that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung adenocarcinoma that is positive for EGFR exon 20 mutation, wherein the bispecific anti- EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure provides a method of treating a subject having cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody is an IgGl isotype and comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having lung cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody is an IgGl isotype and comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having NSCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having NSCLC that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody is an IgGl isotype and comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having SCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having SCLC that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody is an IgGl isotype and comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the disclosure also provides a method of treating a subject having lung adenocarcinoma that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung adenocarcinoma that is positive for EGFR exon 20 mutation, wherein the bispecific anti- EGFR/c-Met antibody is an IgGl isotype and comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the bispecific anti-EGFR/c-Met antibody is an IgGl isotype. Some variation exists within the IgGl constant domain (e.g. well-known allotypes), with variation at positions 214, 356, 358, 422, 431, 435 o 436 (residue numbering according to the EU numbering) (see e.g. IMGT Web resources; IMGT Repertoire (IG and TR); Proteins and alleles; allotypes).
• the bispecific anti-EGFR/c-Met antibody may be of any IgGl allotype, such as Glml7, Glm3, Glml, Glm2, Glm27 or Glm28.
• the disclosure also provides a method of treating a subject having cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
• the disclosure also provides a method of treating a subject having lung cancer that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung cancer that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
• the disclosure also provides a method of treating a subject having NSCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having NSCLC that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
• the disclosure also provides a method of treating a subject having SCLC that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having SCLC that is positive for EGFR exon 20 mutation, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
• the disclosure also provides a method of treating a subject having lung adenocarcinoma that is positive for a EGFR exon 20 mutation, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject having lung adenocarcinoma that is positive for EGFR exon 20 mutation, wherein the bispecific anti- EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
• the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
• the subject has acquired the EGFR exon 20 mutation as a result of treatment with one or more prior anti-cancer therapies.
• the subject has acquired the EGFR exon 20 mutation as a result of treatment with a kinase inhibitor.
• the subject has acquired the EGFR exon 20 mutation as a result of treatment with an EGFR kinase inhibitor.
• the subject has acquired the EGFR exon 20 mutation as a result of treatment with a c-Met kinase inhibitor.
• the one or more prior anti-cancer therapies comprises one or more chemotherapeutic agents, checkpoint inhibitors, targeted anti-cancer therapies or kinase inhibitors, or any combination thereof.
• the kinase inhibitor is an inhibitor of EGFR, an inhibitor of c- Met, an inhibitor of HER2, an inhibitor of HER3 , an inhibitor of HER4, an inhibitor of VEGFR or an inhibitor of AXL.
• the kinase inhibitor is erlotinib, gefitimb, lapatinib, vandetamb, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib.
• the one or more prior anti-cancer therapies comprises carboplatin, paclitaxel, gemcitabine, cisplatin, vinorelbine, docetaxel, palbociclib, crizotinib, PD-(L)1 axis inhibitor, an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL, erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib, or any combination thereof.
• the subject is resistant or has acquired resistance to an EGFR inhibitor.
• EGFR inhibitors for which cancer may acquire resistance are anti-EGFR antibodies cetuximab (ERBITUX®), pantinumumab (VECTIBIX®), matuzumab, nimotuzumab, small molecule EGFR inhibitors erlotinib (TARCEVA®), gefitinib (IRESSA®), EKB-569 (pelitinib, irreversible EGFR TKI), pan-ErbB and other receptor tyrosine kinase inhibitors, lapatinib (EGFR and HER2 inhibitor), pelitinib (EGFR and HER2 inhibitor), vandetanib (ZD6474, ZACTIMATM, EGFR, VEGFR2 and RET TKI), PF00299804 (dacomitinib, irreversible pan-ErbB TKI) , CI-1033 (irreversible pan-erbB TKI).
• Symptoms that may be associated with resistance to an anti-cancer therapy include a decline or plateau of the well-being of the patient, an increase in the size of a tumor, arrested or slowed decline in growth of a tumor, and/or the spread of cancerous cells in the body from one location to other organs, tissues or cells.
• Re-establishment or worsening of various symptoms associated with cancer may also be an indication that a subject has developed or is susceptible to developing resistance to an anti-cancer therapy, such as anorexia, cognitive dysfunction, depression, dyspnea, fatigue, hormonal disturbances, neutropenia, pain, peripheral neuropathy, and sexual dysfunction.
• the symptoms associated with cancer may vary according to the type of cancer.
• symptoms associated with cervical cancer may include abnormal bleeding, unusual heavy vaginal discharge, pelvic pain that is not related to the normal menstmal cycle, bladder pain or pain during urination, and bleeding between regular menstrual penods, after sexual intercourse, douching, or pelvic exam.
• Symptoms associated with lung cancer may include persistent cough, coughing up blood, shortness of breath, wheezing chest pain, loss of appetite, losing weight without trying and fatigue.
• Symptoms for liver cancer may include loss of appetite and weight, abdominal pain, especially in the upper right part of abdomen that may extend into the back and shoulder, nausea and vomiting, general weakness and fatigue, an enlarged liver, abdominal swelling (ascites), and a yellow discoloration of the skin and the whites of eyes (jaundice).
• One skilled in oncology may readily identify symptoms associated with a particular cancer type.
• Exemplary PD-(L)1 axis inhibitors are antibodies that bind PD-1 such as nivolumab (OPDIVO®), pembrolimumab (KEYTRUDA®), sintilimab, cemiplimab (LIBTAYO®), tripolibamab, tislelizumab, spartalizumab, camrelizumab, dostralimab, genolimzumab or cetrelimab, or antibodies that bind PD-L1, such as PD-L1 antibodies are envafolimab, atezolizumab (TECENTRIQ®), durvalumab (IMFINZI®) and avelumab (BAVENCIO®).
• OPDIVO® nivolumab
• KEYTRUDA® pembrolimumab
• sintilimab sintilimab
• cemiplimab LIBTAYO®
• Marketed antibodies may be purchased via authorized distributor or pharmacy.
• the amino acid sequences structures of the small molecules can be found from US AN and/or INN submissions by the companies of from CAS registry.
• the subject is treatment naive.
• the EGFR exon 20 mutation is a de novo mutation.
• EGFR activating mutations that may be associated with cancer include point mutations, deletion mutations, insertion mutations, inversions or gene amplifications that lead to an increase in at least one biological activity of EGFR, such as elevated tyrosine kinase activity, formation of receptor homodimers and heterodimers, enhanced ligand binding etc. Mutations can be located in any portion of an EGFR gene or regulatory region associated with an EGFR gene and include mutations in exon 18, 19, 20 or 21 or mutations in the kinase domain. Other examples of EGFR activating mutations are known in the art (see e.g., U.S. Pat. Publ. No. US2005/0272083).
• the EGFR activating mutation comprises L718Q, G719A, G719X (X being any amino acid), L861X (X being any amino acid), L858R, E746K, L747S, E749Q, A750P, A755V, V765M, C797S, L858P or T790M substitution, deletion of E746-A750, deletion of R748-P753, insertion of Ala (A) between M766 and A767, insertion of Ser, Vai and Ala (SVA) between S768 and V769, insertion of Asn and Ser (NS) between P772 and H773, insertion of one or more amino acids between D761 and E762, A763 and Y764, Y764 and Y765, M766 and A767, A767 and V768, S768 and V769, V769 and D770, D770 and N771, N771 and P772, P772 and H773, H
• Exemplary c-Met activating mutations include point mutations, deletion mutations, insertion mutations, inversions or gene amplifications that lead to an increase in at least one biological activity of a c-Met protein, such as elevated tyrosine kinase activity, formation of receptor homodimers and heterodimers, enhanced ligand binding etc. Mutations can be located in any portion of the c-Met gene or regulatory regions associated with the gene, such as mutations in the kinase domain of c-Met.
• Exemplary c-Met activating mutations are mutations at residue positions N375, V13, V923, R175, V136, L229, S323, R988, S1058/T1010 and E168. Methods for detecting EGFR and c-Met mutations or gene amplifications are well known.
• cancer that is positive for a EGFR exon 20 mutation comprises lung cancer, gastric cancer, colorectal cancer, brain cancer, derived from epithelial cell cancer, breast cancer, ovarian cancer, colorectal cancer, anal cancer, prostate cancer, kidney cancer, bladder cancer, head and neck cancer, pharynx cancer, cancer of the nose, pancreatic cancer, skin cancer, oral cancer, cancer of the tongue, esophageal cancer, vaginal cancer, cervical cancer, cancer of the spleen, testicular cancer, gastric cancer, cancer of the thymus, colon cancer, thyroid cancer, liver cancer, hepatocellular carcinoma (HCC) or sporadic or hereditary papillary renal cell carcinoma (PRCC), or any combination thereof.
• lung cancer gastric cancer, colorectal cancer, brain cancer, derived from epithelial cell cancer, breast cancer, ovarian cancer, colorectal cancer, anal cancer, prostate cancer, kidney cancer, bladder cancer, head and neck cancer, pharynx cancer, cancer of the
• cancer that is positive for a EGFR exon 20 mutation comprises lung cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises gastric cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises colorectal cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises brain cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises epithelial cell cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises breast cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises ovarian cancer.
• cancer that is positive for a EGFR exon 20 mutation comprises colorectal cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises anal cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises prostate cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises kidney cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises bladder cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises head and neck cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises pharynx cancer.
• cancer that is positive for a EGFR exon 20 mutation comprises cancer of the nose. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises pancreatic cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises skin cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises oral cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises cancer of the tongue. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises esophageal cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises vaginal cancer.
• cancer that is positive for a EGFR exon 20 mutation comprises cervical cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises cancer of the spleen. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises testicular cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises gastric cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises cancer of the thymus. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises colon cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises thyroid cancer.
• cancer that is positive for a EGFR exon 20 mutation comprises liver cancer. In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises hepatocellular carcinoma (HCC). In some embodiments, cancer that is positive for a EGFR exon 20 mutation comprises sporadic or hereditary papillary renal cell carcinoma (PRCC).
• HCC hepatocellular carcinoma
• PRCC hereditary papillary renal cell carcinoma
• NSCLC includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
• cells of the NSCLC have an epithelial phenotype.
• the NSCLC has acquired resistance to treatment with one or more EGFR inhibitors.
• EGFR-TKIs EGFR tyrosine kinase inhibitors
• EGFR gene amplification is also strongly correlated with response after EGFR-TKI treatment (Cappuzzo et al., J Natl Cancer Inst 97:643-55, 2005). EGFR exon 20 insertions have been associated with EGFR TKI resistance.
• the subject is further administering one or more anti-cancer therapies.
• the one or more anti-cancer therapies comprises chemotherapy, radiation therapy, surgery, a targeted anti-cancer therapy or a kinase inhibitor, or any combination thereof.
• the kinase inhibitor is an inhibitor of EGFR, an inhibitor of c- Met, an inhibitor of HER2, an inhibitor of HER3 , an inhibitor of HER4, an inhibitor of VEGFR or an inhibitor of AXL.
• the kinase inhibitor is an inhibitor of EGFR.
• the kinase inhibitor is an inhibitor of c-Met.
• the kinase inhibitor is an inhibitor of HER2.
• the kinase inhibitor is an inhibitor of HER3.
• the kinase inhibitor is an inhibitor of HER4.
• the kinase inhibitor is an inhibitor of VEGFR.
• the kinase inhibitor is an inhibitor of or AXL.
• the kinase inhibitor is erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib.
• the kinase inhibitor is erlotinib. In some embodiments, the kinase inhibitor is gefitinib. In some embodiments, the kinase inhibitor is lapatinib. In some embodiments, the kinase inhibitor is vandetanib. In some embodiments, the kinase inhibitor is afatinib. In some embodiments, the kinase inhibitor is osimertinib. In some embodiments, the kinase inhibitor is lazertinib. In some embodiments, the kinase inhibitor is poziotinib. In some embodiments, the kinase inhibitor is criotinib.
• the kinase inhibitor is cabozantinib. In some embodiments, the kinase inhibitor is capmatinib. In some embodiments, the kinase inhibitor is axitinib. In some embodiments, the kinase inhibitor is lenvatinib. In some embodiments, the kinase inhibitor is nintedanib. In some embodiments, the kinase inhibitor is regorafenib. In some embodiments, the kinase inhibitor is pazopanib. In some embodiments, the kinase inhibitor is sorafenib. In some embodiments, the kinase inhibitor is sunitinib.
• Anti-cancer therapies that may be administered in combination with the bispecific anti- EGFR/c-Met antibody in the methods of the disclosure include any one or more of the chemotherapeutic drugs or other anti-cancer therapeutics known to those of skill in the art.
• Chemotherapeutic agents are chemical compounds useful in the treatment of cancer and include growth inhibitory agents or other cytotoxic agents and include alkylating agents, anti- metabolites, anti-microtubule inhibitors, topoisomerase inhibitors, receptor tyrosine kinase inhibitors, angiogenesis inhibitors and the like.
• chemotherapeutic agents include alkylating agents such as thiotepa and cyclosphosphamide (CYTOXAN®); alkyl sulfonates such as busulfan, improsulfan and piposulfan; aziridines such as benzodopa, carboquone, meturedopa, and uredopa; ethylenimines and methylamelamines including altretamine, triethylenemelamine, trietylenephosphoramide, triethylenethiophosphaoramide and trimethylolomelamine; nitrogen mustards such as chlorambucil, chlomaphazine, cholophosphamide, estramustine, ifosfamide, mechlorethamine, mechlorethamine oxide hydrochloride, melphalan, novembichin, phenesterine, prednimustine, trofosfamide, uracil mustard; nitrosureas such as carmustine,
• anti-hormonal agents that act to regulate or inhibit hormone action on tumors
• anti-estrogens including for example tamoxifen, raloxifene, aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen, trioxifene, keoxifene, LY 117018, onapristone, and toremifene (FARESTON®); and antiandrogens such as fhitamide, nilutamide, bicalutamide, leuprolide, and goserelin; and pharmaceutically acceptable salts, acids or derivatives of any of the above.
• the bispecific anti-EGFR/c-Met antibody may be administered in a pharmaceutically acceptable carrier.
• Carrier refers to a diluent, adjuvant, excipient, or vehicle with which the antibody of the invention is administered.
• vehicles may be liquids, such as water and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like.
• 0.4% saline and 0.3% glycine may be used to formulate the bispecific anti-EGFR/c-Met antibody.
• These solutions are sterile and generally free of particulate matter. They may be sterilized by conventional, well-known sterilization techniques (e.g., filtration).
• the carrier may comprise sterile water and other excipients may be added to increase solubility or preservation.
• injectable suspensions or solutions may also be prepared utilizing aqueous carriers along with appropriate additives.
• Suitable vehicles and formulations, inclusive of other human proteins, e.g., human serum albumin, are described, for example, in e.g. Remington: The Science and Practice of Pharmacy, 21 st Edition, Troy, D.B. ed., Lipincott Williams and Wilkins, Philadelphia, PA 2006, Part 5, Pharmaceutical Manufacturing pp 691-1092, See especially pp. 958-989.
• the mode of administration may be any suitable route that delivers the bispecific anti- EGFR-c-Met antibody to the host, such as parenteral administration, e.g., intradermal, intramuscular, intraperitoneal, intravenous or subcutaneous, pulmonary, transmucosal (oral, intranasal, intravaginal, rectal), using a formulation in a tablet, capsule, solution, powder, gel, particle; and contained in a syringe, an implanted device, osmotic pump, cartridge, micropump; or other means appreciated by the skilled artisan, as well known in the art.
• parenteral administration e.g., intradermal, intramuscular, intraperitoneal, intravenous or subcutaneous, pulmonary, transmucosal (oral, intranasal, intravaginal, rectal), using a formulation in a tablet, capsule, solution, powder, gel, particle; and contained in a syringe, an implanted device, osmotic pump,
• Site specific administration may be achieved by for example intratumoral, intrarticular, intrabronchial, intraabdominal, intracapsular, intracartilaginous, intracavitary, intracelial, intracerebellar, intracerebroventricular, intracolic, intracervical, intragastric, intrahepatic, intracardial, intraosteal, intrapelvic, intrapericardiac, intraperitoneal, intrapleural, intrapro static, intrapulmonary, intrarectal, intrarenal, intraretinal, intraspinal, intrasynovial, intrathoracic, intrauterine, intravascular, intravesical, intralesional, vaginal, rectal, buccal, sublingual, intranasal, or transdermal delivery.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of between about 140 mg to about 1750 mg. In some embodiments, the bispecific anti- EGFR/c-Met antibody is administered at a dose of between about 140 mg to about 1750 mg.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 200 mg, about 210 mg, about 220 mg, about 230 mg, about 240 mg, about 250 mg, about 260 mg, about 270 mg, about 280 mg, about 290 mg, about 300 mg, about 310 mg, about 320 mg, about 330 mg, about 340 mg, about 350 mg, about 360 mg, about 370 mg, about 380 mg, about 390 mg, about 400 mg, about 410 mg, about 420 mg, about 430 mg, about 440 mg, about 450 mg, about 460 mg, about 470 mg, about 480 mg, about 490 mg, about 500 mg, about 510 mg, about 520 mg, about 530 mg, about 540 mg, about 550 mg, about 560 mg, about 570 mg, about 580 mg, about 590 mg, about 600 mg, about 610 mg, about 620 mg, about 630 mg, about 640 mg, about 650 mg, about 660 mg, about 670 mg
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 350 mg, about 700 mg, about 1050 mg or about 1400 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 350 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 700 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 750 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 800 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 850 mg.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 900 mg. In some embodiments, the bispecific anti- EGFR/c-Met antibody is administered at a dose of about 950 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1000 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1050 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1100 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1150 mg.
• the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1200 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1250 mg. In some embodiments, the bispecific anti- EGFR/c-Met antibody is administered at a dose of about 1300 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1350 mg. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered at a dose of about 1400 mg.
• the bispecific anti-EGFR/c-Met antibody is administered once a week. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered about 1050 mg once a week. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered about 1400 mg once a week.
• the bispecific anti-EGFR/c-Met antibody is administered once in two weeks. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered about 1050 mg once in two weeks. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered about 1400 mg once in two weeks.
• the bispecific anti-EGFR/c-Met antibody is administered twice a week. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered once a week. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered once in two weeks. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered once in three weeks. In some embodiments, the bispecific anti-EGFR/c-Met antibody is administered once in four weeks.
• the one or more anti-cancer agents may be administered using recommended doses and dosages of the anti-cancer agent.
• An exemplary bispecific anti-EGFR/c-Met antibody that can be used in the methods of the disclosures is amivantamab.
• Amivantamab is characterized by following amino acid sequences:
• bispecific anti-EGFR/c-Met antibodies publicly available may also be used in the methods of the disclosure as long as they demonstrate similar characteristics when compared to amivantamab as described in U.S. Pat. No. 9,593,164.
• Bispecific anti-EGFR/c-Met antibodies that may be used in the methods of the disclosure may also be generated by combining EGFR binding VH/VL domains and c-Met binding VH/VL domains that are publicly available and testing the resulting bispecific antibodies for their characteristics as described in U.S. Pat. No. 9,593,164.
• Bispecific anti-EGFR/c-Met antibodies used in the methods of the disclosure may be generated for example using Fab arm exchange (or half molecule exchange) between two monospecific bivalent antibodies by introducing substitutions at the heavy chain CH3 interface in each half molecule to favor heterodimer formation of two antibody half molecules having distinct specificity either in vitro in cell-free environment or using co-expression.
• the Fab arm exchange reaction is the result of a disulfide-bond isomerization reaction and dissociation-association of CH3 domains. The heavy chain disulfide bonds in the hinge regions of the parental monospecific antibodies are reduced.
• the resulting free cysteines of one of the parental monospecific antibodies form an inter heavy -chain disulfide bond with cysteine residues of a second parental monospecific antibody molecule and simultaneously CH3 domains of the parental antibodies release and reform by dissociation-association.
• the CH3 domains of the Fab arms may be engineered to favor heterodimerization over homodimerization.
• the resulting product is a bispecific antibody having two Fab arms or half molecules which each bind a distinct epitope, i.e. an epitope on EGFR and an epitope on c-Met.
• the bispecific antibodies of the invention may be generated using the technology described in Int.Pat. Publ. No. WO2011/131746.
• Mutations F405L in one heavy chain and K409R in the other heavy chain may be used in case of IgGl antibodies.
• IgG2 antibodies a wild-type IgG2 and a IgG2 antibody with F405L and R409K substitutions may be used.
• IgG4 antibodies a wild-type IgG4 and a IgG4 antibody with F405L and R409K substitutions may be used.
• first monospecific bivalent antibody and the second monospecific bivalent antibody are engineered to have the aforementioned mutation in the Fc region, the antibodies are incubated together under reducing conditions sufficient to allow the cysteines in the hinge region to undergo disulfide bond isomerization; thereby generating the bispecific antibody by Fab arm exchange.
• the incubation conditions may optimally be restored to non-reducing.
• Exemplary reducing agents that may be used are 2- mercaptoethylamine (2-MEA), dithiothreitol (DTT), dithioerythritol (DTE), glutathione, tris(2-carboxyethyl)phosphine (TCEP), L- cysteine and beta- mercaptoethanol.
• incubation for at least 90 min at a temperature of at least 20 C in the presence of at least 25 m 2-MEA or in the presence of at least 0.5 mM dithiothreitol at a pH of from 5-8, for example at pH of 7.0 or at pH of 7.4 may be used.
• Bispecific anti-EGFR/c-Met antibodies used in the methods of the disclosure may also be generated using designs such as the Knob-in-Hole (Genentech), CrossMAbs (Roche) and the electrostatically -matched (Chugai, Amgen, NovoNordisk, Oncomed), the LUZ-Y (Genentech), the Strand Exchange Engineered Domain body (SEEDbody)(EMD Serono), and the Biclonic (Menis).
• Exemplary CH3 substitution pairs forming a knob and a hole are (expressed as modified position in the first CH3 domain of the first heavy chain/ modified position in the second CH3 domain of the second heavy chain): T366Y/F405A, T366W/F405W, F405W/Y407A, T394W/Y407T, T394S/Y407A, T366W/T394S, F405W/T394S and T366W/T366S L368A Y407V.
• CrossMAb technology in addition to utilizing the “knob-in-hole” strategy to promoter Fab arm exchange utilizes CH1/CL domain swaps in one half arm to ensure correct light chain pairing of the resulting bispecific antibody (see e.g. U.S. Patent No. 8,242,247).
• heterodimerization may be promoted by following substitutions (expressed as modified positions in the first CH3 domain of the first heavy chain/ modified position in the second CH3 domain of the second heavy chain): L351Y F405A Y407V/T394W, T366I K392M T394W/F405A Y407V, T366L K392M T394W/F405A Y407V, L351 Y Y407A/T366A K409F, L351Y Y407A/T366V K409F, Y407A/T366A K409F, or T350V_L351Y_F405A_Y407V/T350V_T366L_K392L_T394W as described in U.S. Patent Publ. No. US2012/0149876 or U.S. Patent Publ. No. US2013/0195849.
• SEEDbody technology may be utilized to generate bispecific antibodies of the invention.
• SEEDbodies have, in their constant domains, select IgG residues substituted with IgA residues to promote heterodimerization as described in U.S. Patent No. US20070287170.
• Mutations are typically made at the DNA level to a molecule such as the constant domain of the antibody using standard methods.
• a method of treating a subject having cancer that is positive for an EGFR exon 20 mutation comprising administering a therapeutically effective amount of an isolated bispecific anti- epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject having cancer that is positive for the EGFR exon 20 mutation.
• EGFR epidermal growth factor receptor
• c-Met hepatocyte growth factor receptor
• a method of treating a subject having cancer that is positive for an EGFR S768I, L86 IQ and/or G719X mutation comprising administering a therapeutically effective amount of an isolated bispecific anti-epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody to the subject having cancer that is positive for the mutation.
• EGFRj/hepatocyte growth factor receptor (c-Met) antibody an isolated bispecific anti-epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody
• a method of treating a subject having cancer with a bispecific anti-EGFR/c-Met antibody comprising: a) providing a biological sample from the subject; b) determining presence or absence of an EGFR exon 20 mutation in the sample; and c) administering or providing for administration the bispecific anti-EGFR/c-Met antibody to the subject determined to have the EGFR exon 20 mutation.
• a method of treating a subject having cancer with a bispecific anti-EGFR/c-Met antibody comprising: a) providing a biological sample from the subject; b) determining presence or absence of an EGFR S768I, L861Q and/or G719X mutation in the sample; and c) administering or providing for administration the bispecific anti-EGFR/c-Met antibody to the subject determined to have the mutation.
• the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met
• the first domain comprises a heavy chain complementarity determining region 1 (HCDR1) of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a light chain complementarity determining region 1 (LCDR1) of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6,
• the second domain that binds c-Met comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO: 11 and the LCDR3 of SEQ ID NO: 12.
• the first domain that specifically binds EGFR comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain that specifically binds c-Met comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
• the bispecific anti-EGFR/c-Met antibody is an IgGl isotype.
• the bispecific anti-EGFR/c-Met antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO: 20.
• the bispecific anti-EGFR/c-Met antibody comprises a biantennary glycan structure with a fucose content of about between 1% to about 15%.
• the one or more prior anti-cancer therapies comprises one or more chemotherapeutic agents, checkpoint inhibitors, targeted anti-cancer therapies or kinase inhibitors, or any combination thereof.
• the one or more prior anti-cancer therapies comprises carboplatin, paclitaxel, gemcitabine, cisplatin, vinorelbine, docetaxel, palbociclib, crizotinib, PD-(L)1 axis inhibitor, an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL, erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib
• any one of embodiments 1-4 wherein the subject is treatment naive.
• the cancer is lung cancer, gastric cancer, colorectal cancer, brain cancer, cancer derived from epithelial cells, breast cancer, ovanan cancer, colorectal cancer, anal cancer, prostate cancer, kidney cancer, bladder cancer, head and neck cancer, pharynx cancer, cancer of the nose, pancreatic cancer, skin cancer, oral cancer, cancer of the tongue, esophageal cancer, vaginal cancer, cervical cancer, cancer of the spleen, testicular cancer, gastric cancer, cancer of the thymus, colon cancer, thyroid cancer, liver cancer, hepatocellular carcinoma (HCC) or sporadic or hereditary papillary renal cell carcinoma (PRCC), or any combination thereof.
• HCC hepatocellular carcinoma
• PRCC hereditary papillary renal cell carcinoma
• lung cancer is non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC) or lung adenocarcinoma, pulmonary sarcomatoid carcinoma or any combination thereof.
• NSCLC non-small cell lung cancer
• SCLC small cell lung cancer
• lung adenocarcinoma pulmonary sarcomatoid carcinoma or any combination thereof.
• the kinase inhibitor is an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR or an inhibitor of AXL.
• kinase inhibitor is erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib.
• All mutant Ba/F3 cell lines were purchased from the German Collection of Microorganisms and Cell Cultures and were obtained from the Dana-Farber Cancer Institute, Harvard University, USA. All cells were maintained in RPMI 1640 medium supplemented with 10% fetal bovine serum (FBS) and puromycin in a humidified incubator with 5% CO2. Amivantamab and IgGl controls were provided by Janssen. Gefitinib, osimertinib, cetuximab, and poziotinib were purchased from SelleckChem (Houston, TX, USA).
• YU-1163 (S768_D770dup) cell lines were derived from malignant effusions from patients with NSCLC and cultured on collagen-coated plates in ACL-4 medium supplemented with 5% FBS. The cells maintained the driver oncogenes that were observed in the patients. Cells were enriched in an epithelial cell adhesion molecule (EpCAM)-positive cell population with a purity of over 95% before they were subjected to further assays.
• EpCAM epithelial cell adhesion molecule
• DFCI-58 H773_V774insNPH
• DFCI-127 P772_H773insPNP
• YUO-029 and YUO-036) were established as previously described (54). Briefly, malignant effusions from two patients with NSCLC were collected, centrifuged, and the cell pellets were mixed with growth-factor reduced Matrigel (Coming) and seeded into 48-well plates.
• Coming growth-factor reduced Matrigel
• Solidified gels were overlaid with advanced DMEM/F12 (Invitrogen) containing IX Glutamax (Invitrogen), 10 mM HEPES (Invitrogen), IX antibiotic-antimycotic (Invitrogen), IX B-27 (Invitrogen), 20% R-spondin conditioned medium, 5 mM nicotinamide (Sigma), 1.25 m N-acetylcysteine (Sigma), 500 nM SB-202190 (Sigma), 500 nM A83-01 (Tocris), 100 ng/mL mouse noggin (Peprotech), 100 ng/mL human FGF10 (Peprotech), 25 ng/mL human FGF7 (Peprotech), 50 pg/mL primocin (Invivogen), and 10 pM Y-27632 (Enzo).
• IX Glutamax Invitrogen
• 10 mM HEPES Invitrogen
• IX antibiotic-antimycotic Invitrog
• R-spondin-conditioned medium was produced from HA-R-Spondinl-Fc 293T cells (Amsbio, Abingdon, United Kingdom).
• organoids were collected, mechanically sheared with a 25-gauge needle, and washed with cold PBS before the organoid pellets were resuspended in the Matrigel and seeded into 24-well plates at ratios of 1:2 to 1:4.
• the culture medium was replenished at least twice a week.
• Cell viability test were performed as previously described (55). Briefly, organoids were trypsinized into single cells and cultured for 5 to 10 days.
• organoids were collected, resuspended in the medium containing 5% matrigel, and plated in a 96- well plate (Coming) at a concentration of 2,000 organoids/pL.
• the medium with the IgGl control or Amivantamab at diverse concentrations were added and incubated for 72 h.
• Cell viability was measured using CellTiter-Glo 3D culture reagent (Promega) on a microplate luminometer according to the manufacturer’s instmctions.
• PDXs were created using 6-8-week old female severe combined immunodeficient (NOG) and nude (nu/nu) mice obtained from OrientBio (Seoul, Korea). All methods complied with the guidelines of our Institutional Animal Research Committee (Yonsei University College of Medicine) and were approved by the Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC). After removal of the necrotic and supporting tissues from core biopsy specimens, small specimens of the tumor tissue (3 mm x 3 mm x 3 mm) from each patient were implanted subcutaneously in 1-2 mice. After the tumor reached 1.5 cm in diameter, it was excised, dissected into small specimens (3 mm x 3 mm x 3 mm), and re-implanted into nude mice. In vivo xenograft studies
• Ba/F3 cells or PDCs expressing EGFR Exon20ins mutations were seeded onto 96-well plates in 100 pL. After treatment with IgGl control, amivantamab, gefitinib, or osimertinib for 72 hours, cell viability was measured by quantifying the total amount of ATP using the CellTiter- Glo® 2.0 assay kit (Promega) according to the manufacturer’s instructions.
• Cells were seeded onto 6-well culture plates and incubated for 12 days at 37°C with amivantamab (0, 0.1, or 1 mg/mL). Cells were washed with phosphate-buffered saline (PBS), fixed, and stained with 4% paraformaldehyde in 5% crystal violet for 10 mins. Colonies were eluted with 1% sodium dodecyl sulfate, and the optical density value was determined using ELISA at 470 nm.
• PBS phosphate-buffered saline
• the ADCC assay was conducted using the Lactase Dehydrogenase (LDH) Cytotoxicity Detection Kit (Roche) in accordance with manufacturer's instructions. Human PBMC obtained from healthy volunteers were used as the effector cells. ADCC was conducted using an effector : target (E:T) cell ratio ranging from 50:1 to 5:1 and incubated for 4 to 24 hours at 37 °C in 5% CO2. Amivantamab concentrations of 100 pg/mL to 0.01 pg/mL were tested. The lactate dehydrogenase activity of the cell culture supernatants was measured, and the percentage cytotoxicity was calculated as described in the manufacturer’s protocol. Immunofluorescence analysis
• PDCs were seeded on 0.01% poly-L-lysine (Sigma- Aldrich) coated coverslips. The following day, cells were treated with IgGl control or Amivantamab at 0.1 mg/mL. After 72 hours, the coverslips were fixed in 4% formaldehyde for 15 minutes, permeabilized with 0.5% Triton X-100 for 5 minutes and incubated with primary antibody for 1 hour at room temperature.
• the primary antibodies used in the study were rabbit monoclonal anti-EGFR and anti-cMet (Santa Cruz Biotechnology) and ab992 (Millipore) at a dilution of 1 : 100.
• the coverslips were rinsed twice with PBS, followed by incubation with the appropriate fluorophore-conjugated secondary antibody (Invitrogen) for 1 hour at room temperature.
• the cells were counterstained with 4',6-diamidino-2-phenylindole (DAPI; 300 nmol/L; Invitrogen), and the coverslips were mounted on slides using Paramount aqueous mounting medium (DAKO).
• DAPI 4',6-diamidino-2-phenylindole
• Immunohistochemistry was performed using the automated staining system (BOND Rx, Leica Biosystems). Briefly, 4-mm paraffin-embedded tumor sections were deparaffinized and rehydrated. Slides then underwent heat-induced epitope retrieval with citrate buffer at 100°C for 20 min. Antibodies were used at 1 : 100 dilution and hematoxylin solution was used for counterstaining. Stained slides were visualized with a Vectra Polaris and the Phenochart program.
• mice bearing tumor tissues were treated with vehicle, IgGl control, or Amivantamab (10 or 30 mg/kg) twice per week intraperitoneally (i.p), or cetuximab (10 mg/kg), poziotinib (1 mg/kg) once daily.
• the tumor samples were collected 48 hours after 15 days of treatment, and EGFR and cMet downstream signaling was evaluated by immunoblotting.
• amivantamab In tumor models driven by TKI-sensitive EGFR mutations such as L858R or Exon 19 deletions, amivantamab has several proposed mechanisms of action (MO As) including blocking ligand binding, receptor downmodulation, downstream signaling inhibition and triggering immune-directed antitumor activity (22). To determine if these MO As are also observed in the context of Exon20ins and contribute to the observed anti-proliferative activity in Fig. 1C, immunoblot analysis was performed in Ba/F3 cells overexpressing the D770delinsGY and H773_V774insH EGFR Exon20ins mutations. The total EGFR levels were reduced following treatment with amivantamab, compared to those of untreated cells (Fig.
• Example 3 Amivantamab displays antitumor activity in PDCs and organoids.
• amivantamab treatment resulted in decreased expression of total EGFR and cMet levels as well as inhibition of p-EGFR, p-cMet, p-AKT, p-ERK, and p-S6 (Fig. 2A), consistent with the results observed in Ba/F3 cell lines harboring EGFR Exon20ins mutations.
• Analysis of cell viability and colony formation revealed that amivantamab dose- dependently inhibited the cell growth and proliferation of PDCs, compared to IgGl controls (Fig. 2B and 2C).
• YU-1163 treated with amivantamab unexpectedly revealed an induction of p-ERK (Fig. 2A). Consistent with this result, the growth of YU-1163 was not inhibited after amivantamab treatment for 72 hours or following long term treatment (Fig. 2B and 2C). From the whole exome sequencing data of YU-1163, we observed a cooccurring mutation in the TP53 gene (R280T; 96% of mutant allele frequency). According to recent studies, mutations in TP53 commonly occurred with /i'G/T?
• TP53 mutations inNSCLC are mutations inNSCLC.
• TP53 mutations in exon 8 in NSCLC patients with EGFR mutations show lower responsiveness to EGFR-TKIs and worse prognosis than the patients with WT TP53 (30,31).
• accumulated studies have revealed that the R280T mutation in TP53 plays crucial roles in the proliferation and survival of cancer cells and knockdown of the mutant TP53 causes G2 arrest and apoptosis in bladder cancer cells (32,33).
• Depletion of mutant TP53 by three different TP53 -directed siRNAs significantly inhibited the cell proliferation with a reduction in activated ERK in YU-1163-pretreated with 1 mg/mL amivantamab (data not shown).
• mutant TP53 is associated with EGFR-TKI resistance (34) and the depleted mutant TP53 restored the sensitivity of amivantamab by downregulation of p-ERK
• induction of p-ERK following amivantamab treatment in YU-1163 cells might be a key regulator of cell survival potentially through the crosstalk between mutant TP53 and ERK signaling cascade (35-37).
• YUO-029 was derived from the same patient from whom YU-1163 PDC (S768_D770dup) was derived. As shown in Fig. 2D, YUO-036 was sensitive to amivantamab in a dose dependent manner, whereas YUO-029 derived from the same patient with YU-1163 showed no significant decrease in cell viability following amivantamab treatment compared to IgGl control (Fig. 2E). Taken together, these results indicate that amivantamab has potent antitumor activity in NSCLC patient-derived cancer cells with EGFR Exon20ins mutations by downmodulation of EGFR and cMet signaling pathways.
• Example 4 EGFR and cMet are internalized in response to amivantamab.
• amivantamab results in downmodulation of EGFR and cMet, as observed in Ba/F3 cells (Fig. 1A-1G) and PDCs (Fig. 2A-2E).
• anti-EGFR mAb induces internalization of EGFR leading to downregulation of its expression on the cell surface (38,39).
• Ba/F3 cells overexpressing D770delinsGY or H773_V774insH were incubated with 0.1 mg/mL IgGl control and 0.1 mg/mL amivantamab.
• Fluorescence-activated cell sorting was used to measure the level of plasma membrane-bound EGFR.
• EGFR expression on the plasma membrane began to dwindle by almost two-fold 30 min after amivantamab treatment.
• the % changes in median fluorescence intensity (MFI) of EGFR relative to IgGl control treated cells at 30 min were 56 % and 68 % in D770delinsGY and H773_V774insH, respectively, and subsequently remained at 40% EGFR expression relative to IgGl control-treated cells 72 hours after amivantamab treatment (Table 1).
• MFI median fluorescence intensity
• DFCI-127 and DFCI-58 PDCs were treated with 0.1 mg/mL amivantamab and the plasma membrane-bound cMet and EGFR were measured 72 hours after amivantamab treatment (Figs. 3 A and 3B).
• the results showed that amivantamab reduced EGFR and cMet on PDCs compared to IgGl control.
• Immunofluorescence (IF) staining was used to visualize the internalization of EGFR and cMet following amivantamab treatment.
• Example 5 Amivantamab inhibits EGFR Exon20ins mutation-driven growth of Ba/F3 and PDC models in vivo.
• xenograft models were generated using Ba/F3 cells harboring EGFR D770delinsGY and H773_V774insH Exon20ins mutations and PDCs (DFCI-127 and YU-1163) harboring EGFR P772insPNP and S768_D770dup Exon20ins mutations, respectively.
• Mice were treated with amivantamab, IgGl control, or vehicle at 30 mg/kg twice per week i.p.
• Amivantamab-treated mice showed reduced tumor volumes compared to vehicle or IgGl control-treated mice in the Ba/F3 cells-bearing NOG mice models (Figs. 4A-4B). Inhibition of tumor growth occurred early and was sustained 15 days following treatment. As shown in Ba/F3 and PDC cells in vitro, protein expression of EGFR, cMet, p-EGFR, and p-cMet were significantly reduced following amivantamab treatment (Fig. 4C) in the Ba/F3-bearing NOG mice models. Similarly, in the PDC xenograft models, amivantamab-treated mice showed a reduction in tumor volume compared to vehicle-treated mice (Figs.
• Example 6 Amivantamab induces antibody-dependent cell-mediated cytotoxicity (ADCC) in Exon20ins models.
• ADCC a process of ADCC is known to be initiated when both the target cell antigen and an activated Fey receptor (FcyR) are engaged respectively by the Fab and Fc portions of an antibody.
• the effector cells mainly natural killer (NK) cells, trigger degranulation and subsequent cytokine production, resulting in the elimination of the target cells (40).
• NK natural killer
• amivantamab Treatment with amivantamab resulted in cytotoxicity in both PDCs in a dose-dependent manner and to a greater extent than cetuximab, a monoclonal antibody targeting EGFR (Figs. 5A-5B).
• cetuximab treatment led to a less pronounced reduction in tumor volume in YU-1163- bearing BALB/c nude mice models relative to that observed with amivantamab (data not shown).
• FcR Fc receptor
• Induced inflammatory cytokines including IFN-y secreted from NK cells activated by amivantamab bound to EGFR and cMet on EGFR Exon20ins-driven tumors may lead to the recruitment and activation of adjacent immune cells to tumor cells in vivo.
• a PDX model (YHIM-1029)-, which was generated from a patient-derived tumor harboring the D770_N771insG Exon20ins mutation (Fig. 6A), and YU-1163-bearing BALB/c nude mice models treated with amivantamab at 10 mg/kg and 30 mg/kg dose, respectively.
• mF4/80 and mNKp46 markers of macrophages and NK cells in BALB/c nude mice, respectively, were elevated in tumors following treatment with amivantamab, suggesting that the mechanistic components of ADCC observed in vitro may translate to recruitment of key effector cells in tumors in vivo (data not shown). Additionally, these results suggest that amivantamab has greater ADCC and antitumor activity than cetuximab in the context of EGFR Exon20ins and that ADCC is an important mechanism in mediating the cytotoxic effects of amivantamab.
• Example 7 Amivantamab demonstrates antitumor activity in a PDX model harboring the D770_N771insG Exon20ins mutation.
• amivantamab treatment resulted in EGFR and cMet downmodulation, inhibition of the downstream signaling pathways p-AKT, p-ERK, and p- S6, and increased markers of apoptosis (Fig. 6C).
• tumors from mice treated with cetuximab or poziotinib maintained EGFR downstream signaling components p-ERK and p-S6 (Fig. 6D), which was consistent with the modest effects observed on tumor growth.
• Example 8 Antitumor activity of amivantamab in patients with EGFR Exon20ins disease.
• Fig. 7 shows the study design.
• the analysis presented here includes all enrolled patients with Exon20ins mutations who received the recommended phase 2 dose (RP2D) of 1050 mg (1400 mg for patients > 80 kg) amivantamab intravenously once weekly for the first cycle; biweekly thereafter.
• Adverse events (AEs) were graded as per Common Terminology Criteria for Adverse Events v4.03. Response was assessed by the investigator as per Response Criteria in Solid Tumors vl.1.
• Adverse Events (AE) in Patients Treated at the RP2D (Safety Population).
• a - Excludes infusion related reaction
• b Includes dermatitis acneiform, rash, rash generalized, rash maculo-papular, rash pustular, rash papular, erythema, generalized erythema, rash erythematous, macule, perineal rash, rash pruritic, dermatitis;
• AE adverse event;
• RP2D recommended phase 2 dose.
• Amivantamab has a manageable safety profile in patients with Exon20ins disease treated at the RP2D. Toxicities were mostly grade 1-2 and consistent with inhibition of EGFR activity. No grade >3 rash events were reported and only 1 grade 3 diarrhea was reported. Responses were observed in treatment-naive patients and post-platinum patients. The ORR was 36% for all patients and 41% for post-platinum patients. Responses were durable with mDOR of 10 months for all patients and 7 months for post-platinum patients. Amivantamab therapy resulted in mPFS of 8.3 months for all patients and 8.6 months for post-platinum patients. On the basis of these data, amivantamab received FDA Breakthrough Therapy Designation for the treatment of patients with EGFR Exon20ins NSCLC whose disease had progressed on or after platinum-based chemotherapy.
• amivantamab showed robust efficacy with ORR of 40% and median duration of response of 11.1 months.
• Median progression-free survival (mPFS) was 8.3 months.
• the safety profile was tolerable in these patients, with treatment-related adverse events being primarily grade 1-2 (16% grade >3).

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