JP7373991B2 - 免疫療法で使用するためのヒストン脱アセチル化酵素阻害剤 - Google Patents
免疫療法で使用するためのヒストン脱アセチル化酵素阻害剤 Download PDFInfo
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Description
本出願は、2016年7月15日に出願された米国仮特許出願第62/362,959号に対する優先権および利益を主張するものであり、当該文献はその全体として本明細書に組み込まれる。
本明細書で言及されるすべての公報、特許、および特許出願は、個々の公報、特許、特許出願が引用によって組み込まれるように具体的且つ個別に示される程度まで、引用によって本明細書に組み込まれる。
ヘルペスウイルスはヒトの疾患の原因となるDNAウイルスの大きな科である。この科のメンバーも、ヘルペスウイルスとして知られている。この科のウイルスとしては、単純ヘルペスウイルス(HSV)1および2;サイトメガロウイルス(CMV);エプスタイン-バーウイルス(EBV);ならびにヒトヘルペスウイルス(HHV)6、7、および8が挙げられる。HHV-8は、カポジ肉腫関連ヘルペスウイルスとしても知られる。
一態様では、癌、ウイルス誘導性癌、またはウイルス関連癌を処置および/または予防するための方法が、本明細書に提供される。いくつかの実施形態では、癌は潜伏ウイルス感染に関連する。ある実施形態では、方法は、HDAC阻害剤(HDACi)および免疫療法剤を投与する工程を含む。ある実施形態では、HDACiおよび免疫療法剤は、同時配合される。いくつかの実施形態では、方法は、追加のHDACiを投与する工程をさらに含む。他の実施形態では、方法は、追加の免疫療法剤を投与する工程をさらに含む。いくつかの実施形態では、方法は、追加の個体用量(individual doses)のHDACiを投与する工程を含む。ある態様では、方法は、HDACiおよび免疫療法剤を用いる癌の治療の前に、バルガンシクロビルまたはアシクロビルなどの、HDACiおよびチミジンキナーゼ阻害剤を投与する工程を含む。この前処置は、免疫療法剤の投与前に、腫瘍を縮小するか、または腫瘍を除去する役目を果たし得る。
「約」という用語は、明細書で使用されるように、規定の量の1%、5%、または10%以内の数を指す。
提供された発明の方法は、HDAC阻害剤(HDACi)を含む、本明細書において提供された1つ以上の医薬組成物の使用を含む。ある一実施形態では、HDACiは、ウイルス感染細胞における遺伝子産物の発現を誘導する。他の態様では、HDACiは、標的細胞または組織における遺伝子発現を改変し、結果として、標的細胞または組織が免疫療法により破壊される。発現させられた遺伝子産物は、ウイルス酵素もしくは細胞酵素、またはウイルス感染細胞において大規模に発現させられる活性になり得る。標的となり得る発現産物は、例えば、ゲノムの修復もしくは複製、完全なウイルス粒子の組立て、ウイルス膜もしくは壁の生成、RNA転写もしくはタンパク質翻訳、またはこれらの活性の組み合わせのための、DNA複製に関連する酵素を含む。これらのプロセスに対しする干渉は、酵素,好ましくはプロセスにおいて重要な酵素を誘導し、その後、それに作用することにより行われる。提供された発明の方法および組成物において使用できる誘導剤は、例えば、米国特許第6,197,743号、および米国特許第6,677,302号において記載されており、これらは全体として引用により本明細書に組み込まれる。
ある実施形態では、免疫療法剤は、個体の免疫システムの活性化をもたらす。ある実施形態では、免疫療法剤は、生物学的薬物である。ある実施形態では、免疫療法剤は、サイトカインである。ある実施形態では、免疫療法剤は、ケモカインである。ある実施形態では、免疫療法剤は、チェックポイント阻害剤と結合し拮抗する。ある実施形態では、免疫療法剤は、抗体である。ある実施形態では、免疫療法剤は、モノクローナル抗体である。ある実施形態では、免疫療法剤は、ヒト化モノクローナル抗体である。ある実施形態では、免疫療法剤は、抗体薬物コンジュゲートである。ある実施形態では、免疫療法剤は、二重特異性抗体である。ある実施形態では、免疫療法剤は、ワクチンである。ある実施形態では、免疫療法剤は、抗原提示細胞である。ある実施形態では、免疫療法剤は、樹状細胞である。ある実施形態では、免疫療法剤は、B細胞である。ある実施形態では、免疫療法剤は、マクロファージである。ある実施形態では、免疫療法剤は、T細胞である。ある実施形態では、免疫療法剤は、γδT細胞である。ある実施形態では、免疫療法剤は、CD8+T細胞である。ある実施形態では、免疫療法剤は、CD4+T細胞である。ある実施形態では、免疫療法剤は、自己T細胞である。ある実施形態では、免疫療法剤は、異種T細胞である。ある実施形態では、免疫療法剤は、遺伝子組換えされた抗原受容体を有するT細胞である。ある実施形態では、免疫療法剤は、キメラ抗原受容体である。ある実施形態では、免疫療法剤は、キメラ抗原受容体を有するT細胞である。ある実施形態では、免疫療法剤は、ウイルスにコードされたポリペプチドに特異的である。ある実施形態では、免疫療法剤は、EBVにコードされたポリペプチドに特異的である。ある実施形態では、免疫療法剤は、LMP-1に特異的である。ある実施形態では、免疫療法剤は、LMP-2に特異的である。ある実施形態では、免疫療法剤は、カルメット-ゲラン杆菌である。
ある実施形態では、本開示の方法は、癌の治療のためのものである。ある実施形態では、本開示の方法は、癌の治療を増強するためのものである。特定の実施形態では、癌は以下である:成人急性リンパ芽球性白血病;急性リンパ芽球性白血病、小児期;急性骨髄白血病、成人;急性骨髄白血病、小児期;副腎皮質癌;副腎皮質癌、小児期;青年期、癌;エイズ関連の癌;エイズ関連のリンパ腫;肛門癌;虫垂癌;星細胞腫、小児期;非定型奇形腫様/横紋筋肉腫様腫瘍、小児期、中枢神経系;基底細胞癌;肝外胆管癌;膀胱癌;膀胱癌、小児期;骨肉腫、骨肉腫、および悪性線維性組織球腫;脳幹神経膠腫、小児期;脳腫瘍、成人;脳腫瘍、脳幹神経膠腫、小児期;脳腫瘍、中枢神経系非定型奇形腫様/横紋筋肉腫様腫瘍、小児期;脳腫瘍、中枢神経系胚芽腫、小児期;脳腫瘍、星細胞腫、小児期;脳腫瘍、頭蓋咽頭腫、小児期;脳腫瘍、上衣芽細胞腫、小児期;脳腫瘍、上衣腫、小児期;脳腫瘍、髄芽腫、小児期;脳腫瘍、髄様上皮腫、小児期;脳腫瘍、中間分化型の松果体実質腫瘍、小児期;脳腫瘍、テント上原始神経外胚葉腫瘍および松果体芽腫、小児期;脳および脊髄の腫瘍、小児期(他の);乳癌;乳癌および妊娠;乳癌、小児期;乳癌、男性;気管支腫瘍、小児期;バーキットリンパ腫;カルチノイド腫瘍、小児期;カルチノイド腫瘍、消化器系;原発不明癌;中枢神経系非定型奇形腫様/横紋筋肉腫様腫瘍、小児期;中枢神経系胚芽腫、小児期;中枢神経系(CNS)リンパ腫、原発性;子宮頚癌;子宮頚癌、小児期;小児癌;脊索腫、小児期;慢性リンパ球性白血病;慢性骨髄性白血病;慢性骨髄増殖症候群;結腸癌;大腸癌、小児期;頭蓋咽頭腫、小児期;悪性皮膚T細胞リンパ腫;胚芽腫、中枢神経系、小児期;子宮内膜癌;上衣芽細胞腫、小児期;上衣腫、小児期;食道癌;食道癌、小児期;感覚神経芽腫、小児期;ユーイング肉腫ファミリー腫瘍;頭蓋外胚細胞腫瘍、小児期;性腺外胚細胞腫瘍;肝臓外胆管癌;眼癌、眼内黒色腫;眼癌、網膜芽細胞腫;胆嚢癌;胃(Gastric)(胃(Stomach))癌;胃(Gastric)(胃(Stomach))癌、小児期;消化管カルチノイド腫瘍;消化管間質腫瘍(GIST);消化器間質細胞腫瘍、小児期;胚細胞腫瘍、小児、小児期;性腺外胚細胞腫;卵巣胚細胞腫;妊娠性絨毛腫瘍;神経膠腫、成人;神経膠腫、小児脳幹;ヘアリーセル白血病;頭頸部癌;心臓癌、小児期;肝細胞(肝臓)癌、成人(原発性);肝細胞(肝臓)癌、小児期(原発性);組織球増殖症、ランゲルハンス細胞;成人ホジキンリンパ腫;小児期ホジキンリンパ腫;下咽頭癌;眼内黒色腫;島細胞腫(内分泌膵);カポジ肉腫;腎臓(腎細胞)癌;腎癌、小児期;ランゲルハンス細胞組織球症;喉頭癌;小児期喉頭癌;白血病、急性リンパ芽球性、成人;白血病、急性リンパ芽球性、小児期;白血病、急性骨髄性、成人;白血病、急性骨髄性、小児期;白血病、慢性リンパ球性;白血病、慢性骨髄性;白血病、毛様細胞;口唇および口腔の癌;肝臓癌、成人(原発性);肝臓癌、小児期(原発性);肺癌、非小細胞性;肺癌、小細胞性;リンパ腫、エイズ関連;リンパ腫、バーキット;リンパ腫、皮膚T細胞;リンパ腫、ホジキン、成人;リンパ腫、ホジキン、小児期;リンパ腫、非ホジキン、成人;リンパ腫、非ホジキン、小児期;リンパ腫、原発性中枢神経系(CNS);マクログロブリン血症、ワルデンシュトレーム;骨および骨肉腫の悪性線維性組織球腫;髄芽腫、小児期;髄様上皮腫、小児期;黒色腫;黒色腫、眼内(目);メルケル細胞癌;中皮腫、成人悪性腫瘍;中皮腫、小児期;原発不明の転移性頸部扁平上皮癌;口腔癌;多発性内分泌腫瘍症候群、小児期;多発性骨髄腫/形質細胞腫瘍;菌状息肉腫;骨髄異形成症候群;骨髄異形成/骨髄増殖性腫瘍;骨髄性白血病、慢性;骨髄性白血病、成人急性;骨髄性白血病、小児期急性;多発性骨髄腫;骨髄増殖症候群、慢性;鼻腔および副鼻腔の癌;上咽頭癌;上咽頭癌、小児期;神経芽細胞腫;非ホジキンリンパ腫、成人;非ホジキンリンパ腫、小児期;非小細胞肺癌;口腔癌、小児期;口腔癌;口唇および口腔咽頭癌;骨肉腫および骨の悪性線維性組織球腫;卵巣癌、小児期;卵巣上皮癌;卵巣胚細胞腫瘍;卵巣低悪性度腫瘍;膵臓癌;膵臓癌、小児期;膵臓癌、島細胞腫;乳頭腫、小児期;副鼻腔および鼻腔の癌;副甲状腺癌;陰茎癌;咽頭癌;中間分化型の松果体実質腫瘍、小児期;松果体芽腫およびテント上原始神経外胚葉腫瘍、小児期;下垂体腫瘍;形質細胞腫瘍/多発性骨髄腫;胸膜肺芽腫、小児期;妊娠および乳癌;原発性中枢神経系(CNS)リンパ腫;前立腺癌;直腸癌;腎細胞(腎臓)癌;腎盂および尿管、移行上皮癌;第15染色体の変化が伴う呼吸器癌(Respiratory Tract Cancer);網膜芽細胞腫;横紋筋肉腫、小児期;唾液腺癌;唾液腺癌、小児期;肉腫、ユーイング肉腫ファミリー腫瘍;肉腫、カポジ;肉腫、軟部組織、成人;肉腫、軟部組織、小児期;肉腫、子宮;セザリー症候群;皮膚癌(非黒色腫);皮膚癌、小児期;皮膚癌(黒色腫);皮膚癌、メルケル細胞;小細胞肺癌;小腸癌;軟部組織肉腫、成人;軟部組織肉腫、小児期;扁平上皮癌;原発不明の頸部扁平上皮癌、転移性;胃癌;テント上原始神経外胚葉腫瘍、小児期;T細胞性リンパ腫、皮膚;精巣癌;咽喉癌;胸腺腫および胸腺癌;甲状腺癌;甲状腺癌、小児期;腎盂および尿管の移行上皮癌;絨毛腫瘍、妊娠性;原発部位不明、細胞腫、成人;原発部位不明、癌、小児期;小児の珍しい癌;尿管および腎盂、移行性細胞癌;尿道癌;子宮癌、子宮内膜;子宮肉腫;膣癌;外陰癌;ワルデンストレーム高ガンマグロブリン血症;またはウィルムス腫瘍。
1つ以上の薬剤(例えばHDAC阻害剤または免疫療法剤)の投与は、断続的となり得る;例えば、投与は、2日ごと、3日ごと、5日ごと、週1回、月に1回または2回などであり得る。量、形態、及び/又は異なる形態の量は、投与の異なる時間に変更され得る。
CHR-39996は、特異的に、CD4+、CD25+、およびFoxP3+制御性細胞を減少させる。この減少は、他のHDAC阻害剤エンチノスタットと比較した場合に、とりわけ顕著である。
制御性T細胞に対して見られたVRx-3996の効果は、PD-1/PD-L1軸を標的とするものなどの免疫療法剤の有効性の増強をもたらすことができた。この例では、VRx-3996処置を、2つの異なる腫瘍異種移植片モデル4T1およびCT26において、抗PD-1抗体処置と組み合わせた。6つの異なる処置群(ビヒクル、10mg/kgの抗PD-1、25mg/kgのVRx-3996、10mg/kgのVRx-3996、25mg/kgのVRx-3996と10mg/kgの抗PD-1、10mg/kgのVRx-3996と10mg/kgの抗PD-1)で各モデルを試験し、各群は、8匹の動物で構成された。動物に、4T1またはCT26のいずれかで右ひ腹に接種処置し、投与を、腫瘍が65-90mm3になったときに開始し、21日間継続させた。動物に、VRx-3996を毎日、および抗PD-1を週2回投薬した。図2Aおよび図2Bは、CT26腫瘍を受けるマウスが、PD-1単独またはVRx-3996単独のいずれかと比較して、抗PD-1およびVRx-3996の組み合わせ(塗りつぶされたもの)で腫瘍成長のより高い減少を示したことを示す。これは、VRx-3995の両方の濃度(10mg/kg/日、図2A)および(25mg/kg/日、図2B)で見られた。図3Aおよび図3Bは、4T1腫瘍株がこの効果に耐性があったことを示す。実際には、この腫瘍は、抗PD1処置単独に耐性があり、結果として、VRx-3996を用いるHDAC処置が、抗PD-1、および場合によってはすべてのチェックポイント阻害剤などの免疫療法と、特異的に相乗作用を示すことができることが示された。
上咽頭癌、ホジキン病、バーキットリンパ腫、移植後のリンパ増殖性疾患、または胃癌などのエプスタイン-バーウイルス(EBV)-関連悪性病変と診断されたか、またはそれを有すると疑われているかのいずれかの患者を、処置できる。医療専門家が、JNJ 26481585を含む医薬組成物の1用量を投与し、続けて、CAR T細胞を5x106細胞/m2の用量で静脈に投与する処置を行う。CAR T細胞は自己由来であり、患者の血液から調製し、キメラ抗原受容体をコードするレトロウイルスを含む細胞を形質導入することにより、キメラ受容体を発現させる。患者に、錠剤状で1日1回用量を投与し、ここで、その錠剤は、5mgのJNJ 26481585を含む。JNJ-26481585を用いる処置の後に、CAR T細胞を2週間投与する。投与の期間中に、被験体はまた、悪性病変を処置するために、追加の化学療法剤を随意に投与され得る。
患者は、CMV陽性の粘液性類表皮癌と診断されたか、またはそれを有すると疑われている。医療専門家が、キダミドを含む医薬組成物の1用量を投与し、続けて、CAR T細胞を1x107細胞/m2の用量で静脈に投与する処置を行う。CAR T細胞は自己由来であり、患者の血液から調製し、CMVタンパク質に対して特異性がある、キメラ抗原受容体をコードするレトロウイルスを含む細胞を形質導入することにより、キメラ受容体を発現させる。患者に、2週間、週2回、20mgのキダミドを含む経口組成物を投与する。キダミドを用いる2週間の処置後に、CAR T細胞を投与する。投与の期間中に、被験体はまた、悪性病変を処置するために、追加の化学療法剤を随意に投与され得る。
Claims (6)
- 癌を処置する際の使用のための、HDAC阻害剤および免疫療法剤を含む組み合わせ製剤であって、ここで、前記HDAC阻害剤は、(2-(6-{[(6-フルオロキノリン-2-イル)メチル]アミノ}-3-アザビシクロ[3.1.0]ヘキサ-3-イル)-N-ヒドロキシピリミジン-5-カルボキサミド)を含み、前記免疫療法剤は、チェックポイント分子に結合する抗体またはその抗原結合性フラグメントであることを特徴とする、HDAC阻害剤および免疫療法剤を含む組み合わせ製剤。
- HDAC阻害剤は経口投与される、請求項1に記載のHDAC阻害剤および免疫療法剤を含む組み合わせ製剤。
- HDAC阻害剤は、1日当たり80mg以下の用量で投与される、請求項1または2に記載のHDAC阻害剤および免疫療法剤を含む組み合わせ製剤。
- 前記チェックポイント分子は、PD-L1、PDL-2、CTLA-4、PD-1、PD-2、TIM-3、VISTA、KIR、IDO、A2AR、B7-H3、B7-H4、BTLA、TIGIT、またはCD155のうちの1つ以上である、請求項1-3のいずれか1項に記載のHDAC阻害剤および免疫療法剤を含む組み合わせ製剤。
- 前記抗体またはその抗原結合性フラグメントは、ニボルマブ、ペンブロリズマブ、イピリムマブ、ピディリズマブ、アテゾリズマブ、またはそれらの組み合わせを含む、請求項4に記載のHDAC阻害剤および免疫療法剤を含む組み合わせ製剤。
- 癌は、白血病、リンパ腫、中枢神経系リンパ腫、ホジキンリンパ腫、バーキットリンパ腫、上咽頭癌、粘液性類表皮癌、多形神経膠芽腫、乳癌、カポジ肉腫、または胃癌である、請求項1-5のいずれか1項に記載のHDAC阻害剤および免疫療法剤を含む組み合わせ製剤。
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