Combination therapies of egfrviii chimeric antigen receptors and pd-1 inhibitors
OwnerDonald M. O'Rourke, Stephen Joseph Bagley +2inventors
InventorsDonald M. O'Rourke, Stephen Joseph Bagley, Randi Isaacs, Arati Suvas Desai
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Abstract
Provided are compositions and methods for treating diseases, e.g., cancers, e.g., diseases associated with expression of an antigen, e.g., EGFRvIII, comprising administering a cell that expresses a chimeric antigen receptor (CAR) specific to the antigen, e.g., EGFRvIII, in combination with a PD-1 inhibitor.
Claims94
A CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR) for use in combination with a PD-1 inhibitor, wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain and an intracellular signaling domain, and wherein the dose of the PD-1 inhibitor, e.g., anti-PD-1 antibody molecule, is about 200 mg to about 450 mg, e.g., about 300 mg to about 400 mg, e.g., administered every 2 weeks, 3 weeks, 4 weeks, or 5 weeks.
A method of treating a subject having a cancer, comprising administering to the subject:
- (i) a CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR), wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain, and an intracellular signaling domain;
- and
- (ii) a PD-1 inhibitor,
- wherein the dose of the PD-1 inhibitor, e.g., anti-PD-1 antibody molecule, is about 200 mg to about 450 mg, e.g., about 300 mg to about 400 mg, e.g., administered every 2 weeks, 3 weeks, 4 weeks, or 5 weeks.
A CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR) for use in combination with a PD-1 inhibitor, wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain and an intracellular signaling domain, and wherein administration of the PD-1 inhibitor is initiated 20 days or less after administration of the CAR therapy.
A method of treating a subject having a cancer, comprising administering to the subject:
- (i) a CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR), wherein the CAR comprises an antigen (e.g., EGFRvIII) binding domain, a transmembrane domain, and an intracellular signaling domain;
- and
- (ii) a PD-1 inhibitor,
- wherein administration of the PD-1 inhibitor is initiated 20 days or less after administration of the CAR therapy.
A CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR) for use in combination with a PD-1 inhibitor, wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain and an intracellular signaling domain, and wherein administration of the PD-1 inhibitor is initiated after the subject has, or is identified as having, one or more of the following:
- (a) a partial or no detectable response to the CAR therapy,
- (b) a relapsed cancer after the CAR therapy,
- (c) a cancer refractory to the CAR therapy;
- or
- (d) a progressive form of the cancer after the CAR therapy.
A method of treating a subject having a cancer, comprising administering to the subject:
- (i) a CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR), wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain, and an intracellular signaling domain;
- and
- (ii) a PD-1 inhibitor,
- wherein administration of the PD-1 inhibitor is initiated after the subject has, or is identified as having, one or more of the following:
- (a) a partial or no detectable response to the CAR therapy,
- (b) a relapsed cancer after the CAR therapy,
- (c) a cancer refractory to the CAR therapy;
- or
- (d) a progressive form of the cancer after the CAR therapy.
A CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR) for use in combination with a PD-1 inhibitor, wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain and an intracellular signaling domain, and wherein administration of the PD-1 inhibitor is initiated after administration of the CAR therapy, and the subject does not have, or has not been identified as having, one or more of the following:
- (a) a partial or no detectable response to the CAR therapy,
- (b) a relapsed cancer after the CAR therapy,
- (c) a cancer refractory to the CAR therapy, or
- (d) a progressive form of the cancer.
A method of treating a subject having a cancer, comprising administering to the subject:
- (i) a CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR), wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain, and an intracellular signaling domain;
- and
- (ii) a PD-1 inhibitor,
- wherein administration of the PD-1 inhibitor is initiated after administration of the CAR therapy, and the subject does not have, or has not been identified as having, one or more of the following:
- (a) a partial or no detectable response to the CAR therapy,
- (b) a relapsed cancer after the CAR therapy,
- (c) a cancer refractory to the CAR therapy, or
- (d) a progressive form of the cancer.
The CAR therapy for use or the method of any of the preceding claims, further comprising administering one or more, e.g., 1, 2, 3, 4, or more, subsequent doses of the PD-1 inhibitor.
The CAR therapy for use or the method of any of the preceding claims, wherein the CAR therapy and the PD-1 inhibitor are administered for a treatment interval, and wherein the treatment interval comprises a single dose of the PD-1 inhibitor and a single dose of the CAR-expressing cell.
The CAR therapy for use or the method of any of the preceding claims, wherein the CAR therapy comprises a dose of CAR-expressing cells comprising about 1.75-5×108 cells.
The CAR therapy for use or the method of any of the preceding claims, wherein the PD-1 inhibitor comprises an antibody molecule, a small molecule, a polypeptide, e.g., a fusion protein, or an inhibitory nucleic acid, e.g., a siRNA or shRNA.
The CAR therapy for use or the method of any of the preceding claims, wherein the PD-1 inhibitor is characterized by one or more of the following:
- a. inhibits or reduces PD-1 expression, e.g., transcription or translation of PD-1;
- b. inhibits or reduces PD-1 activity, e.g., inhibits or reduces binding of PD-1 to its cognate ligand, e.g., PD-L1 or PD-L2;
- or
- c. binds to PD-1 or its ligand(s), e.g., PD-L1 or PD-L2.
The CAR therapy for use or the method of any of the preceding claims, wherein the PD-1 inhibitor is an antibody molecule.
The CAR therapy for use or the method of any of the preceding claims, wherein the PD-1 inhibitor is selected from the group consisting of Nivolumab, Pembrolizumab, PDR001, Pidilizumab, AMP 514, AMP-224, and any anti-PD-1 antibody molecule provided in Table 6.
The CAR therapy for use or the method of any of the preceding claims, wherein the PD-1 inhibitor comprises an anti-PD-1 antibody molecule comprising
- d. a heavy chain complementary determining region 1 (HC CDR1), a heavy chain complementary determining region 2 (HC CDR2), and a heavy chain complementary determining region 3 (HC CDR3) of any PD-1 antibody molecule amino acid sequence listed in Table 6;
- and
- e. a light chain complementary determining region 1 (LC CDR1), a light chain complementary determining region 2 (LC CDR2), and a light chain complementary determining region 3 (LC CDR3) of any PD-1 antibody molecule amino acid sequence listed in Table 6.
The CAR therapy for use or the method of any of the preceding claims, wherein the CAR comprises an anti-EGFRvIII binding domain, a transmembrane domain, and an intracellular signaling domain comprising a stimulatory domain, and wherein said anti-EGFRvIII binding domain comprises one or more of light chain complementary determining region 1 (LC CDR1), light chain complementary determining region 2 (LC CDR2), and light chain complementary determining region 3 (LC CDR3) of any anti-EGFRvIII light chain binding domain amino acid sequence listed in Table 2 or SEQ ID NO:11, and one or more of heavy chain complementary determining region 1 (HC CDR1), heavy chain complementary determining region 2 (HC CDR2), and heavy chain complementary determining region 3 (HC CDR3) of any anti-EGFRvIII heavy chain binding domain amino acid sequence listed in Table 2 or SEQ ID NO:11.
The CAR therapy for use or the method of any of the preceding claims, wherein the anti-EGFRvIII binding domain comprises a LC CDR1, LC CDR2 and LC CDR3 of any anti-EGFRvIII light chain binding domain amino acid sequence listed in Table 2 or SEQ ID NO:11.
The CAR therapy for use or the method of any of the preceding claims, wherein the anti-EGFRvIII binding domain comprises an LC CDR1, LC CDR2 and LC CDR3 of any anti-EGFRvIII light chain binding domain amino acid sequence listed in Table 2 or SEQ ID NO:11 and/or an HC CDR1, HC CDR2, and HC CDR3 of any anti-EGFRvIII heavy chain binding domain amino acid sequence listed in Table 2 or SEQ ID NO:11.
The CAR therapy for use or the method of any of the preceding claims, wherein the anti-EGFRvIII binding domain comprises any light chain variable region listed in Table 2 or SEQ ID NO:11 and/or any heavy chain variable region listed in Table 2 or SEQ ID NO:11.
The CAR therapy for use or the method of any of the preceding claims, wherein the anti-EGFRvIII binding domain is an scFv.
The CAR therapy for use or the method of any of the preceding claims, wherein the anti-EGFRvIII binding domain is comprises a light chain variable region comprising an amino acid sequence having at least one, two, or three modifications but not more than 30, 20, or 10 modifications of an amino acid sequence of a light chain variable region provided in Table 2 or SEQ ID NO:11, or a sequence with 95-99% identity with an amino acid sequence provided in Table 2 or SEQ ID NO:11 and/or a heavy chain variable region comprising an amino acid sequence having at least one, two or three modifications but not more than 30, 20 or 10 modifications of an amino acid sequence of a heavy chain variable region provided in Table 2 or SEQ ID NO:11, or a sequence with 95-99% identity to an amino acid sequence provided in Table 2 or SEQ ID NO:11.
The CAR therapy for use or the method of any of the preceding claims, wherein the anti-EGFRvIII binding domain comprises a sequence selected from a group consisting of SEQ ID NO:38, SEQ ID NO:44, SEQ ID NO:50, SEQ ID NO:56, SEQ ID NO:62, SEQ ID NO:68, SEQ ID NO:74, SEQ ID NO:80, and SEQ ID NO:86, or a sequence with 95-99% identify thereof.
The CAR therapy for use or the method of any of the preceding claims wherein the transmembrane domain comprises a transmembrane domain from a protein selected from the group consisting of the alpha, beta or zeta chain of the T-cell receptor, CD28, CD3 epsilon, CD45, CD4, CD5, CD8, CD9, CD16, CD22, CD33, CD37, CD64, CD80, CD86, CD134, CD137 and CD154.
The CAR therapy for use or the method of any of the preceding claims, wherein the transmembrane domain comprises
- (i) the amino acid sequence of SEQ ID NO:
- 15,
- (ii) an amino acid sequence comprises at least one, two or three modifications but not more than 20, 10 or 5 modifications of the amino acid sequence of SEQ ID NO:15, or
- (iii) a sequence at least 95% identical, e.g., with 95-99% identity, to the amino acid sequence of SEQ ID NO:15.
The CAR therapy for use or the method of any of the preceding claims, wherein
- the CD19 binding domain is connected to the transmembrane domain by a hinge region.
The CAR therapy for use or the method of any of the preceding claims, wherein the hinge region comprises SEQ ID NO:14, or a sequence at least 95% identical, e.g., with 95-99%, identity thereof.
The CAR therapy for use or the method of any of the preceding claims, wherein the intracellular signaling domain comprises a costimulatory signaling domain, optionally further comprising a functional signaling domain obtained from a protein selected from the group consisting of a MHC class I molecule, a TNF receptor protein, an Immunoglobulin-like protein, a cytokine receptor, an integrin, a signaling lymphocytic activation molecule (SLAM protein), an activating NK cell receptor, BTLA, a Toll ligand receptor, OX40, CD2, CD7, CD27, CD28, CD30, CD40, CDS, ICAM-1, LFA-1 (CD11a/CD18), 4-1BB (CD137), B7-H3, CDS, ICAM-1, ICOS (CD278), GITR, BAFFR, LIGHT, HVEM (LIGHTR), KIRDS2, SLAMF7, NKp80 (KLRF1), NKp44, NKp30, NKp46, CD19, CD4, CD8alpha, CD8beta, IL2R beta, IL2R gamma, IL7R alpha, ITGA4, VLA1, CD49a, ITGA4, IA4, CD49D, ITGA6, VLA-6, CD49f, ITGAD, CD11d, ITGAE, CD103, ITGAL, CD11a, LFA-1, ITGAM, CD11b, ITGAX, CD11c, ITGB1, CD29, ITGB2, CD18, LFA-1, ITGB7, NKG2D, NKG2C, TNFR2, TRANCE/RANKL, DNAM1 (CD226), SLAMF4 (CD244, 2B4), CD84, CD96 (Tactile), CEACAM1, CRTAM, Ly9 (CD229), CD160 (BY55), PSGL1, CD100 (SEMA4D), CD69, SLAMF6 (NTB-A, Ly108), SLAM (SLAMF1, CD150, IPO-3), BLAME (SLAMF8), SELPLG (CD162), LTBR, LAT, GADS, SLP-76, PAG/Cbp, CD19a, and a ligand that specifically binds with CD83.
The CAR therapy for use or the method of any of the preceding claims, wherein the intracellular signaling domain comprises a functional signaling domain of 4-1BB and/or a functional signaling domain of CD3 zeta.
The CAR therapy for use or the method of any of the preceding claims, wherein the intracellular signaling domain comprises the amino acid sequence of SEQ ID NO:
- 16 and/or the amino acid sequence of SEQ ID NO:17 or SEQ ID NO:
- 99;
- or an amino acid sequence having at least one, two, or three modifications but not more than 20, 10, or 5 modifications of the amino acid sequence of SEQ ID NO:16 and/or the amino acid sequence of SEQ ID NO:17 or SEQ ID NO:
- 99;
- or an amino acid sequence at least 95% identical to the amino acid sequence of SEQ ID NO:16 and/or the amino acid sequence of SEQ ID NO:17 or SEQ ID NO:99.
The CAR therapy for use or the method of any of the preceding claims, wherein the intracellular signaling domain comprises the amino acid sequence of SEQ ID NO:16 and the amino acid sequence of SEQ ID NO:17 or SEQ ID NO:99, wherein the amino acid sequences comprising the intracellular signaling domain are expressed in the same frame and as a single polypeptide chain.
The CAR therapy for use or the method of any of the preceding claims, wherein the CAR further comprises a leader sequence, optionally further comprising the amino acid sequence of SEQ ID NO:13 or a sequence with 95-99% identity to an amino acid sequence of SEQ ID NO:13.
The CAR therapy for use or the method of any of the preceding claims, wherein the CAR comprises:
- (i) the amino acid sequence of any of SEQ ID NO:38, 44, 50, 56, 62, 68, 74, or 80;
- (ii) an amino acid sequence having at least one, two or three modifications but not more than 30, 20 or 10 modifications to any of SEQ ID NO:38, 44, 50, 56, 62, 68, 74, or 80;
- or
- (iii) an amino acid sequence at least 95 identical to any of SEQ ID NO:38, 44, 50, 56, 62, 68, 74, or 80.
The CAR therapy for use or the method of any of the preceding claims, wherein the cell comprising a CAR comprises a nucleic acid encoding the CAR.
The CAR therapy for use or the method of any of the preceding claims, wherein the cell is a T cell or an NK cell.
The CAR therapy for use or the method of any of the preceding claims, further comprising administering an additional anti-cancer agent.
The CAR therapy for use or the method of any of the preceding claims, wherein the cancer is glioblastoma.
The CAR therapy for use or the method of any of the preceding claims, wherein the cancer is MGMT-unmethylated glioblastoma.
The CAR therapy for use or the method of any of the preceding claims, wherein radiation is administered to the subject prior to the CAR therapy.
The CAR therapy for use or the method of any of the preceding claims, wherein the subject is a mammal, e.g., a human.
The CAR therapy for use or the method of any of the preceding claims, wherein the subject is an adult.
The CAR therapy for use or the method of any of the preceding claims, wherein the subject expresses PD-1, PD-L1, and/or PD-L2.
The CAR therapy for use or the method of any of the preceding claims, wherein the subject has, or is identified as having, a higher number or percentage of immune effector cells, e.g., CD4+ and/or CD8+ T cells, expressing one, two, three, or all of PD-1, LAG-3 or TIM-3, compared to a reference value, e.g., a complete responder to the CAR therapy.
The CAR therapy for use or the method of 80, wherein the subject has, or is identified as having, a higher number of:
- PD-1 expressing immune effector cells, e.g., CD4+ and/or CD8+ T cells;
- PD-1 and LAG-3-expressing immune effector cells, e.g., CD4+ and/or CD8+ T cells;
- PD-1 and TIM-3 expressing immune effector cells, e.g., CD4+ and/or CD8+ T cells;
- or PD-1, TIM-3 and LAG-3 expressing immune effector cells, e.g., CD4+ and/or CD8+ T cells.
The CAR therapy for use or the method of 80 or 81, wherein the immune effector cells, e.g., CD4+ and/or CD8+ T cells, coexpress a CAR, e.g., a EGFRvIII CAR.
A combination comprising:
- a cell, e.g., a population of immune effector cells, comprising a CAR, wherein the CAR comprises an antigen binding domain, a transmembrane domain, and an intracellular signaling domain;
- and
- a PD-1 inhibitor chosen pembrolizumab, nivolumab, or any of the antibody molecules from Table 6, e.g., comprising the variable light chain and the variable heavy chain amino acid sequences of SEQ ID NO:
- 204 and SEQ ID NO:
- 172,
- for use in treating a cancer, in a subject.
A composition (e.g., one or more compositions or dosage forms), comprising:
- a cell, e.g., a population of immune effector cells, comprising a CAR, wherein the CAR comprises an antigen binding domain, a transmembrane domain, and an intracellular signaling domain, and
- a PD-1 inhibitor chosen from Table 6, e.g., comprising the variable light chain and the variable heavy chain amino acid sequences of SEQ ID NO:
- 204 and SEQ ID NO:
- 172.
The method, combination, or composition of any of the preceding claims, wherein the anti-EGFRvIII binding domain comprises SEQ ID NO:
- 68.
A method of treating MGMT-unmethylated glioblastoma in a subject in need thereof, comprising administering to the subject:
- (i) low dose radiation;
- and
- (ii) a combination comprising an effective amount of a CAR therapy comprising a population of immune effector cells expressing a chimeric antigen receptor (CAR), wherein the CAR comprises an antigen (e.g., a EGFRvIII) binding domain, a transmembrane domain, and an intracellular signaling domain;
- and an effective amount of a PD-1 inhibitor.
Dependencies are inferred from the claim text.