Method for selecting personalized tri-therapy for cancer treatment

A method for treating a patient having a cancer comprising determining the classification of at least ten (10) selected intervention points for said patient, wherein each intervention point comprises a set of target genes which may be blocked by a drug and said classification of intervention points comprises:

• a) characterizing a tumor sample in comparison to a normal sample from the same patient, wherein the tumor sample and the normal sample are from the same type of tissue and are from the same patient, said characterizing comprising:
• (i) determining mRNA expression for each of the genes of each selected intervention point in the tumor sample and the normal sample and determining a fold change of mRNA expression of tumor vs normal (referred to as mRNA TvN fold change) for each of the genes of each intervention point;
• (ii) wholly or partially sequencing the genes of each selected intervention point and, optionally, the p53 gene to identify genes having an activating mutation in the tumor sample;
• (iii) optionally, for each selected intervention point, determining miRNA expression of each gene of each selected intervention point in the tumor sample and the normal sample, thereby determining a fold change of miRNA expression of tumor vs normal (referred to as miRNA TvN fold change) for each of the genes;
• and
• (iv) optionally, for each selected intervention point, determining copy number variation (CNV) of each of the genes in the tumor sample and the normal sample and determining a tumor vs normal fold change (CNV fold change) for each of the genes exhibiting CNV;
• b) determining a mutation score for each selected intervention point and an mRNA expression score from data of step a), wherein:
• (i) if, in the tumor sample, an activating mutation of a gene of a selected intervention point is detected, then a maximal mutation score is given to the intervention point;
• (ii) the mRNA expression score is calculated based on the mean of the mRNA TvN fold change of the genes for each selected intervention point, provided that the mRNA TvN fold change of a gene is taken into consideration only if its value is at least 1.3;
• and
• (iii) calculating a classification score for each selected intervention point that is either:
• A) the sum of the mutation score and the mRNA expression score when an activating mutation is present;
• or
• B) the mRNA expression score when an activating mutation is absent;
• c) classifying the selected intervention points according to the calculated scores;
• d) selecting the three intervention points having the highest calculated classification scores of the selected intervention points;
• e) selecting a combination of drugs targeting the three intervention points having the highest calculated classification scores;
• and
• f) administering to the patient the selected combination of drugs, wherein:
• the at least 10 intervention points are selected from the group consisting of HER, CDK4,6, PLK/AURK/kinesins, angiogenesis, angiopoietins, immune modulators, PI3K, MET, MEK, ERK, anti-apoptosis, FGF, mTOR, Ras/Raf, telomerase, IGF/glycolysis, Wnt, PARP, HDAC, JAK-STAT, Hedgehog, NOTCH pathway, DNA repair, RET, ROS1, ALK, and UB1, and
• wherein the intervention points comprise a set of target genes selected from:
• EGF, TGFA, AREG, EREG, HBEGF, BTC, NRG1, NRG2, NRG4, EGFR, ERBB2, ERBB3 and ERBB4 for the HER intervention point;
• CDK4, CDK6, CCND1, CCND2, CCND3, CDKN2A, CDKN2B, CCNE1, CCNE2, CCNE3 and RB1 for the CDK4,6, intervention point;
• PLK1, AURKA, BORA, ILK and KIF11 for the PLK/AURK/kinesins intervention point;
• VEGFA, VEGFB, VEGFC, VEGFD, VEGFR1, VEGFR2, VEGFR3, PDGFA, PDGFB, PDGFRA, PDGFRB and Kit for the angiogenesis intervention point;
• THBS1, TGFB1, ANGPT1, ANGPT2, ANGPTL1, ANGPT4, TIE1 and TEK for the angiopoietins intervention point;
• PD1L, PDCD1LG2, PDCD1, CTLA4 and LAG3 for the immune modulators' intervention point;
• PIK3CA, PIK3CB, PIK3CD, PIK3CG, PIK3C2B, PRKCB, PRKCA, PRKCB, PIK3R1, PIK3R2 and PIK3R3 for the PI3K intervention point;
• HGF, MET, AXL and MST1R for the MET intervention point;
• MAP2K1, MAP2K2, MAP2K3, MAP2K4, MAP3K1, MAP3K2, MAP3K3 and MAP3K4 for the MEK intervention point;
• MAPK3, MAPK1, KSR1 and MAPK11 for the ERK intervention point;
• BCL2, BCLXL, BIRCS, XIAP, BAK1 and TP53 for the anti-apoptosis intervention point;
• FGF1 to FGF18, FGFR1, FGFR2, FGFR3 and FGFR4 for the FGF intervention point;
• mTor, AKT1, AKT2, PTEN, TSC1, TSC2, STK11, PIM1, PIM2 and PIM3 for the mTor intervention point;
• KRAS, NRAS, HRAS, RAF1, BRAF and CRAF for the Ras/Raf intervention point;
• TERT, TERC, TEP1, HSP90AA1, DKC1 and PTGES3 for the telomerase intervention point;
• IGF1, IGF2, IGF1R, IGF2R, INSR, IRS1 and PKM for the IGF/glycolysis intervention point;
• CDH1, CTNNA1, CTNNB1, WNT 1, FZD1, WNTSA, B, FZDS, WIF1 and DKK1 for the Wnt intervention point;
• PARP1, BRCA1, XRCC1, RAD54L, RAD54B, ATM, ATR, CHEK1, CHEK2 and WEE1 for the PARP intervention point;
• HDAC1, HDAC2, HDAC3, HDAC4 and HDAC5 for the HDAC intervention point;
• JAK1, JAK2, STAT1, STAT2, STAT3 and SOCS1 for the JAK-STAT intervention point;
• SHH, PTCH1, SMO, STK36, PRKACA, SUFU and Gill for the Hedgehog intervention point;
• NOTCH1, Adam17, PSEN1, NCSTN, JAG1, SRRT and APH1A for the NOTCH intervention point;
• ERCC1, RAD52, XRCC4, RAD51, BRCA1, NEDD8 and NAE1 for the DNA repair intervention point;
• and
• RET, ROS1, ALK and UB1 for the set of other genes intervention point.