Mycobacterium for use in cancer therapy
This invention provides an immunomodulator for use in the treatment, reduction, inhibition or control of cancer subject, wherein the subject is clinically classified as having a performance status of 1-, 2, 3 or 4 according to the ECOG Scale, or classified as not being of an age and/or not being sufficiently fit to tolerate two or more chemotherapy regimens. The invention also describes the use of one or more additional anticancer treatments or agents as well as protocols and dosage regimens for use.
1 . A method of treating, reducing, inhibiting or controlling cancer in a subject, wherein said subject is a human patient and wherein said method comprises simultaneously, separately or sequentially administering to the subject (i) one or more therapeutic agents and/or cancer treatments and (ii) a non-pathogenic non-viable Mycobacterium , wherein said method results in enhanced therapeutic efficacy relative to administration of one or more therapeutic agents and/or cancer treatments alone, wherein the human patient is clinically classified as having a performance status of 2, 3 or 4 according to the Eastern Cooperative Oncology Group (ECOG) Scale, wherein the human patient is classified as not being of an age and/or sufficiently fit to tolerate two or more chemotherapy regimens and, optionally, are considered eligible to receive gemcitabine and nab-paclitaxel.
2 . The method according to claim 1 , wherein said human patient is clinically classified as having a performance status of 2, 3 or 4 according to the ECOG Scale by at least two clinical observers, wherein in the event of conflicting evaluations, the highest (worst) assessment is used.
3 . The method according to claim 1 , wherein the non-pathogenic non-viable Mycobacterium is selected from M. vaccae; M. obuense, M. parafortuitum, M. paratuberculosis, M. brumae, M. aurum, M. indicus pranii, M. manresensis, M. kyogaense, M. phlei, M. smegmatis, M. tuberculosis Aoyama B, H37Rv, BCG, VPM1002BC, SMP-105, Z-100 and combinations thereof.
4 . The method according to claim 1 , wherein the non-pathogenic non-viable Mycobacterium is heat killed.
5 . The method according to claim 1 , wherein the non-pathogenic non-viable Mycobacterium is the rough variant and/or a presented as a fraction, fragment, sub-cellular component, lysate, homogenate, sonicate, or substantially in whole cell form.
6 . The method according to claim 5 , wherein the non-pathogenic non-viable Mycobacterium is administered to the human patient as a first line treatment simultaneously, separately or sequentially with the administration of one or more therapeutic agents or modalities that are selected from adoptive cell therapy, surgical therapy, chemotherapy, radiation therapy, hormonal therapy, checkpoint inhibitor therapy, small molecule therapy, receptor kinase inhibitor therapy, hyperthermia treatment, phototherapy, radiofrequency ablation therapy (RFA), anti-angiogenic therapy, cytokine therapy, cryotherapy, biological therapy, HDAC inhibitor therapy, BRAF inhibitor therapy, MEK inhibitor therapy, EGFR inhibitor therapy, VEGF inhibitor therapy, P13K delta inhibitor therapy, PARP inhibitor therapy, mTOR inhibitor therapy, hypomethylating agents, oncolytic virus, TLR agonists, STING agonists, mifamurtide, and cancer vaccines.
7 . The method according to claim 6 , wherein the human patient also receives one or more cytotoxic chemotherapeutic agents, optionally wherein the subject demonstrated a partial response or stable disease following FOLFIRINOX therapy.
8 . The method according to claim 7 , wherein the one or more cytotoxic chemotherapeutic agents comprise: a) gemcitabine; or b) nab-paclitaxel, optionally in combination with gemcitabine.
9 . The method according to claim 1 , wherein the human patient is also administered one or more checkpoint inhibitors.
10 . The method according to claim 9 , wherein the one or more checkpoint inhibitors is selected from ipilimumab, nivolumab, pembrolizumab, azetolizumab, BI 754091, bavituximab, bintrafusp alfa, dostarlimab, durvalumab, tremelimumab, spartalizumab, avelumab, sintilimab, toripalimab, prolgolimab, tislelizumab, camrelizumab, MGA012, MGD013, KN046, MGD019, enoblituzumab, MGD009, MGC018, MEDI0680, miptenalimab, nimotuzumab, PDR001, FAZ053, TSR022, MBG453, relatlimab, LAG525, IMP321, REGN2810, REGN3767, pexidartinib, LY3022855, FPA008, BLZ945, GDC0919, epacadostat, emactuzumab, FPA150, indoximid, BMS986205, CPI-444, MEDI9447, PBF509, FS118, lirilumab, Sym023, TSR-022, A2Ar inhibitors, NKG2A inhibitors, monalizumab, and combinations thereof, optionally administered in a sub-therapeutic amount and/or duration.
11 . The method according to claim 9 , wherein administration of said non-pathogenic non-viable Mycobacterium is prior to and/or after the administration of one or more checkpoint inhibitors.
12 . The method according to claim 1 , wherein the cancer is selected from bladder cancer, prostate cancer, liver cancer, renal cancer, lung cancer, breast cancer, colorectal cancer, colon cancer, rectal cancer, pancreatic cancer, brain cancer, hepatocellular cancer, lymphoma, leukaemia, gastric cancer, cervical cancer, ovarian cancer, thyroid cancer, melanoma, head and neck cancer, skin cancer, soft tissue sarcoma and/or osteosarcoma.
13 . The method according to claim 12 , wherein the cancer is pancreatic cancer selected from locally advanced pancreatic cancer with or without nodal lesions, resectable pancreatic cancer, borderline resectable pancreatic cancer, unresectable pancreatic cancer, checkpoint-refractory pancreatic cancer, chemotherapy-refractory pancreatic cancer, oligometastatic pancreatic cancer, pancreatic ductal adenocarcinoma (PDAC), and metastatic pancreatic ductal adenocarcinoma (mPDAC).
14 . The method according to claim 1 , wherein the non-pathogenic non-viable Mycobacterium is administered by intratumoral administration sequentially followed by intradermal administration.
15 . The method according to claim 1 , wherein:
a) the treatment, reduction, inhibition or control of said cancer results in a clinically relevant improvement in one or more markers of disease status and progression selected from one or more of the following: (i) overall survival; (ii) progression-free survival; (iii) disease free survival; (iv) overall response rate; (v) reduction in primary tumour size and/or metastatic disease; (vi) circulating levels of tumour antigens; (vii) nutritional status; (viii) pain control or analgesic use; (ix) CRP/albumin ratio; (x) improved Quality of Life; (xi) maintenance of lean body mass; (xii) reduced potential or incidence of cachexia; or (xiii) a reduction or elimination in ctDNA, as assessed following surgery and/or end of therapy and/or following administration of 1, 2, 3, 4, 5 or 6 or more doses of said non-pathogenic non-viable Mycobacterium;
b) the treatment, reduction, inhibition or control of said cancer, which comprises a primary tumour and/or non-target tumours, results in subtotal regression as demonstrated by less than 10% vital tumour cells present in tumour biopsy or resected primary tumour, stable disease (SD), a complete response (CR) or partial response (PR) of the primary tumour; and/or subtotal regression as demonstrated by less than 10% vital tumour cells present in tumour biopsy or resected metastatic tumour, stable disease (SD) or complete response (CR) of one or more non-target tumours, as assessed by Immune Related Response Criteria (irRC), iRECIST, or irRECIST, as assessed following surgery and/or end of therapy and/or following administration of 1, 2, 3, 4, 5 or 6 or more doses of said non-pathogenic non-viable Mycobacterium;
c) the treatment, reduction, inhibition or control of said cancer, which comprises a primary tumour and/or non-target tumours, results in prolonged progression free survival according to RECIST 1.1 or iRECIST; prolonged Duration of Response (DoR) according to RECIST 1.1 or iRECIST; or an accelerated Time to Response (TtR) according to RECIST 1.1 or iRECIST, as assessed following surgery and/or end of therapy and/or following administration of 1, 2, 3, 4, 5 or 6 or more doses of said non-pathogenic non-viable Mycobacterium ; or
d) the treatment, reduction, inhibition or control of said cancer, which comprises a primary tumour and/or non-target tumours, results in (1) reducing or inhibiting formation or establishment of metastases arising from a primary tumour or cancer to one or more other sites, locations or regions distinct from the primary tumour or cancer; (2) reducing or inhibiting growth or proliferation of a metastasis at one or more other sites, locations or regions distinct from the primary tumour or cancer after a metastasis has formed or has been established; (3) reducing or inhibiting formation or establishment of additional metastasis after the metastasis has been formed or established; (4) prolonged overall survival; (5) prolonged progression free survival; (6) disease stabilisation; (7) increased quality of life, and combinations thereof.
16 . The method according to claim 1 , wherein the subject is a human patient of at least 50 years old.
17 . The method according to claim 16 , wherein the human patient is 70 or more years old.
18 . The method according to claim 3 , wherein M. vaccae is the M. vaccae strain deposited under accession number NCTC 11659 and associated designations SRL172, SRP299, IMM-201, DAR-901, or the M. vaccae strain as deposited under ATCC 95051.
19 . Method according to claim 3 , wherein M. obuense is the strain of Mycobacterium obuense deposited under the Budapest Treaty under accession number NCTC 13365.
20 . The method according to claim 15 , wherein the nutritional status is weight, appetite, or serum albumin.