Method for permeabilizing tumor vasculature using a tumor vasculature permeabilizing molecule to improve access of a therapeutic or diagnostic agent to a tumor
The present invention provides a tumour vasculature permeabilising molecule for use in permeabilising vasculature of a tumour for treating, detecting or diagnosing said tumour wherein said tumour vasculature permeabilising molecule is formulated for systemic administration to said patient. A composition comprising a tumour vasculature permeabilising molecule and an appropriate anticancer agent or imaging agent, and a method of treatment or a method of detecting the presence or absence of a tumour are also provided.
1. A method of detecting a metastatic brain tumor behind an intact blood brain barrier in a patient who has a peripheral primary tumor, said method comprising
systemically administering to the patient a signal generating agent and a proinflammatory cytokine, wherein the proinflammatory cytokine binds specifically to TNF-receptor TNFR-1 or TNFR-2, and wherein the proinflammatory cytokine is administered at a sub-therapeutic dose for the treatment of tumors, wherein the sub-therapeutic dose of the proinflammatory cytokine is not cytotoxic to a brain tumor and/or does not cause tumor regression when administered systemically, wherein the sub-therapeutic dose of the proinflammatory cytokine permeabilizes pre-existing host vasculature adjacent to the metastatic brain tumor and disrupts the intact blood brain barrier of the metastatic brain tumor to improve access of the signal generating agent to the metastatic brain tumor, and
imaging the brain of the patient to detect the tumor, wherein the metastatic brain tumor is not detectable by imaging in the absence of the pro-inflammatory cytokine.
2. The method of claim 1 , wherein said permeabilization is specific to tumor vasculature and is transient.
3. The method of claim 1 , wherein said proinflammatory cytokine is selected from TNF and lymphotoxin α.
4. The method of claim 1 , wherein the proinflammatory cytokine comprises
(i) an amino acid sequence as set forth in SEQ ID NO:1 or 2, or
(ii) an amino acid sequence with at least 95% identity to said sequence in (i),
wherein the proinflammatory cytokine promotes an inflammatory response, which response is inhibited by IL-10.
5. The method of claim 1 , wherein said patient is a human.
6. The method of claim 1 , wherein said proinflammatory cytokine is administered parenterally, enterally or intravenously.
7. The method of claim 1 , wherein said proinflammatory cytokine is formulated with a carrier protein.
8. The method of claim 1 , wherein said signal generating agent is selected from a gadolinium-based compound and an iron oxide contrast agent.
9. The method of claim 1 , wherein said proinflammatory cytokine is administered to said patient in a single dose of 10-150 μg/m2.
10. The method of claim 1 , wherein said proinflammatory cytokine is administered to said patient at a dose which is less than the maximum tolerated dose (MTD).
11. A method of treating a human patient who has a metastasizing peripheral primary tumor capable of metastasizing to the brain, said method comprising
systemically administering to said human patient an anti-cancer agent and a proinflammatory cytokine, wherein the pro-inflammatory cytokine binds specifically to TNF-receptor TNFR-1 or TNFR-2, and wherein the pro-inflammatory cytokine is administered at a sub-therapeutic dose for the treatment of tumors, wherein the sub-therapeutic dose of the proinflammatory cytokine is not cytotoxic to a brain tumor and/or does not cause tumor regression when administered systemically and is less than the maximum tolerated dose (MTD), and wherein the sub-therapeutic dose of the proinflammatory cytokine transiently permeabilizes pre-existing host vasculature adjacent to any metastatic brain tumor present behind an intact blood brain barrier in said human patient and disrupts the intact blood brain barrier of the metastatic brain tumor to improve access of the anticancer agent to the metastatic brain tumor for treatment thereof, and wherein, in the absence of any metastatic brain tumor present behind an intact brain barrier, the sub-therapeutic dose of the proinflammatory cytokine does not permeabilize pre-existing non-tumor host vasculature.
12. The method of claim 11 , wherein said anticancer agent is selected from a chemotherapeutic agent, an oncolytic virus, a monoclonal antibody, and an exosome containing a therapeutic nucleic acid molecule.
13. The method of claim 12 , wherein said chemotherapeutic agent is selected from lapatinib, doxorubicin, melphalan, and paclitaxel.
14. The method of claim 11 , wherein the patient has not been diagnosed with a metastatic brain tumour.
15. The method of claim 11 , wherein the patient has been diagnosed with a metastatic brain tumour.
16. The method of claim 11 , wherein said proinflammatory cytokine is selected from TNF and lymphotoxin α.
17. The method of claim 11 , wherein the proinflammatory cytokine comprises
(i) an amino acid sequence as set forth in SEQ ID NO:1 or 2, or
(ii) an amino acid sequence with at least 95% identity to said sequence in (i),
wherein the proinflammatory cytokine promotes an inflammatory response, which response is inhibited by IL-10.
18. The method of claim 11 , wherein said proinflammatory cytokine is formulated with a carrier protein.
19. A method of treating a patient who has a metastasizing peripheral primary tumor capable of metastasizing to the brain, said method comprising
systemically administering to said patient an anti-cancer agent and a proinflammatory cytokine, wherein the pro-inflammatory cytokine binds specifically to TNF-receptor TNFR-1 or TNFR-2, and wherein the pro-inflammatory cytokine is administered in an amount of 0.5-200 μg/m2 wherein said amount is a sub-therapeutic dose for the treatment of tumors which is not cytotoxic to a brain tumor and/or does not cause tumor regression when administered systemically, and wherein the sub-therapeutic dose of the proinflammatory cytokine transiently permeabilizes pre-existing host vasculature adjacent to any metastatic brain tumor present behind an intact blood brain barrier in said patient and disrupts the intact blood brain barrier of the metastatic brain tumor to improve access of the anticancer agent to the metastatic brain tumor for treatment thereof, and wherein, in the absence of any metastatic brain tumor present behind an intact brain barrier, the sub-therapeutic dose of the proinflammatory cytokine does not permeabilize pre-existing non-tumor host vasculature.
20. The method of claim 19 , wherein said patient is a human.
21. The method of claim 19 , wherein said proinflammatory cytokine is administered parenterally, enterally or intravenously.
22. The method of claim 19 , wherein said proinflammatory cytokine is administered to said patient in an amount of 5-200 μg/m2.
23. The method of claim 19 , wherein said proinflammatory cytokine is administered to said patient in an amount of 10-150 μg/m2.
24. A method of imaging the brain of a patient who has a peripheral primary tumor, said method comprising
systemically administering to the patient a signal generating agent and a proinflammatory cytokine, wherein the proinflammatory cytokine binds specifically to TNF-receptor TNFR-1 or TNFR-2, and wherein the proinflammatory cytokine is administered at a sub-therapeutic dose for the treatment of tumors, wherein the sub-therapeutic dose of the proinflammatory cytokine is not cytotoxic to a brain tumor and/or does not cause tumor regression when administered systemically, wherein the sub-therapeutic dose of the proinflammatory cytokine improves access of the signal generating agent to the brain, and
imaging the brain of the patient, and optionally detecting a metastatic brain tumor that is not detectable by imaging in the absence of the pro-inflammatory cytokine.
25. The method of claim 24 , wherein said proinflammatory cytokine is administered to said patient in an amount of 0.5-200 μg/m2.
26. The method of claim 24 , wherein said proinflammatory cytokine is administered to said patient in an amount of 5-200 μg/m2.
27. A method of treating a human patient who has a metastasizing peripheral primary tumor, said method comprising
systemically administering to said human patient an anti-cancer agent and a proinflammatory cytokine, wherein the pro-inflammatory cytokine binds specifically to TNF-receptor TNFR-1 or TNFR-2, and wherein the pro-inflammatory cytokine is administered at a sub-therapeutic dose for the treatment of tumors, wherein the sub-therapeutic dose of the proinflammatory cytokine is not cytotoxic to a brain tumor and/or does not cause tumor regression when administered systemically and is less than the maximum tolerated dose (MTD), and wherein the sub-therapeutic dose of the proinflammatory cytokine transiently permeabilizes pre-existing host vasculature adjacent to any metastatic brain tumor present behind an intact blood brain barrier in said human patient and disrupts the intact blood brain barrier of the metastatic brain tumor to improve access of the anticancer agent to the metastatic brain tumor for treatment thereof, and wherein, in the absence of any metastatic brain tumor present behind an intact blood brain barrier, the sub-therapeutic dose of the proinflammatory cytokine does not permeabilize pre-existing non-tumor host vasculature.
28. A method of treating a patient who has a metastasizing peripheral primary tumor, said method comprising
systemically administering to said patient an anti-cancer agent and a proinflammatory cytokine, wherein the pro-inflammatory cytokine binds specifically to TNF-receptor TNFR-1 or TNFR-2, and wherein the pro-inflammatory cytokine is administered in an amount of 0.5-200 μg/m2 wherein said amount is a sub-therapeutic dose for the treatment of tumors which is not cytotoxic to a brain tumor and/or does not cause tumor regression when administered systemically, and wherein the sub-therapeutic dose of the proinflammatory cytokine transiently permeabilizes pre-existing host vasculature adjacent to any metastatic brain tumor present behind an intact blood brain barrier in said patient and disrupts the intact blood brain barrier of the metastatic brain tumor to improve access of the anticancer agent to the metastatic brain tumor for treatment thereof, and wherein, in the absence of any metastatic brain tumor present behind an intact brain barrier, the sub-therapeutic dose of the proinflammatory cytokine does not permeabilize non-tumor host vasculature.