USE OF INHIBITORS OF BRUTON'S TYROSINE KINASE (BTK)
Methods are provided for treating a hematologic cancer comprising administering an anticancer agent to a subject identified as having an increased mobilization of a subpopulation of lymphocytes from a malignancy following administration of an irreversible Btk inhibitor. Methods also are provided for identification of subjects for treatment and the analysis of cells mobilized from a hematologic malignancy following administration of an irreversible Btk inhibitor.
1 . A method for treating a hematological malignancy in an individual in need thereof, comprising administering to the individual an anti-cancer treatment, wherein the individual is identified as having an increased mobilization of a plurality of cells from the malignancy following administration of an irreversible Btk inhibitor to the individual.
2 . The method of claim 1 , wherein the irreversible Btk inhibitor covalently binds to Cys 481 of Btk.
3 . The method of claim 1 , wherein the irreversible Btk inhibitor is a compound of Formula (D).
4 . The method of claim 1 , wherein the irreversible Btk inhibitor is (R)-1-(3-(4-amino-3-(4-phenoxyphenyl)-1H-pyrazolo[3,4-d]pyrimidin-1-yl)piperidin-1-yl)prop-2-en-1-one (PCI-32765/ibrutinib).
5 . The method of claim 1 , wherein the hematological malignancy is a B-cell malignancy.
6 . The method of claim 1 , wherein the hematological malignancy is a leukemia, lymphoproliferative disorder, or myeloid disorder.
7 . The method of claim 1 wherein the hematological malignancy is a non-Hodgkin's lymphoma.
8 . The method of claim 1 , wherein the hematological malignancy is a chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), high risk CLL, non-CLL/SLL lymphoma, follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), Waldenstrom's macroglobulinemia, multiple myeloma (MM), marginal zone lymphoma, Burkitt's lymphoma, non-Burkitt high grade B cell lymphoma, extranodal marginal zone B cell lymphoma, acute or chronic myelogenous (or myeloid) leukemia, myelodysplastic syndrome, or acute lymphoblastic leukemia.
9 . The method of claim 1 , wherein the hematological malignancy is relapsed or refractory diffuse large B-cell lymphoma (DLBCL), relapsed or refractory mantle cell lymphoma, relapsed or refractory follicular lymphoma, relapsed or refractory CLL; relapsed or refractory SLL; relapsed or refractory multiple myeloma.
10 . The method of claim 1 , wherein the mobilized cells are myeloid cells or lymphoid cells.
11 . The method of claim 1 , wherein the individual has a higher peripheral blood concentration of mobilized cells following administration of the Btk inhibitor as compared to the concentration before administration of the Btk inhibitor.
12 . The method of claim 1 , where the second treatment is administered after the peripheral blood concentration of the mobilized plurality of cells has increased for a predetermined length of time.
13 . The method of claim 1 , wherein diagnosis is based on detection of the presence, expression or level of expression of one or more biomarkers.
14 . The method of claim 13 , wherein the biomarker is: ZAP70; t(14,18); β-2 microglobulin; p53 mutational status; ATM mutational status; del(17)p; del(11)q; del(6)q; CD5; CD11c; CD19; CD20; CD22; CD25; CD38; CD103; CD138; secreted, surface or cytoplasmic immunoglobulin expression; V H mutational status; or a combination thereof.
15 . The method of claim 1 , wherein the second treatment comprises lenalidomide, bortezomib, sorafenib, gemcitabine, dexamethasone, bendamustine, R-406, taxol, vincristine, doxorubicin, temsirolimus, carboplatin, ofatumumab, rituximab, GA101, R-ICE (ifosfamide, carboplatin, etoposide), R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone), BR (bendamustine and rituximab), FCR (fludarabine, cyclophosphamide, and rituximab) or any combination thereof.
16 . A method for treating a hematological malignancy in an individual in need thereof, comprising:
a. administering to the individual a first treatment comprising an amount of an irreversible Btk inhibitor sufficient to mobilize a plurality of cells from the malignancy;
b. analyzing the mobilized plurality of cells in a sample obtained from the individual; and
c. administering a second treatment to the individual.
17 . The method of claim 16 , wherein the amount of the irreversible Btk inhibitor is sufficient to induce lymphocytosis of a plurality of cells from the malignancy.
18 . The method of claim 16 , wherein the irreversible Btk inhibitor covalently binds to Cys 481 of Btk.
19 . The method of claim 16 , wherein the irreversible Btk inhibitor is a compound of Formula (D).
20 . The method of claim 16 , wherein the irreversible Btk inhibitor is (R)-1-(3-(4-amino-3-(4-phenoxyphenyl)-1H-pyrazolo[3,4-d]pyrimidin-1-yl)piperidin-1-yl)prop-2-en-1-one (PCI-32765).
21 . The method of claim 16 , wherein the hematological malignancy is a B-cell malignancy.
22 . The method of claim 16 , wherein the hematological malignancy is a leukemia, lymphoproliferative disorder, or myeloid disorder.
23 . The method of claim 16 , wherein the hematological malignancy is a non-Hodgkin's lymphoma.
24 . The method of claim 16 , wherein the hematological malignancy is a chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), high risk CLL, non-CLL/SLL lymphoma, follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), Waldenstrom's macroglobulinemia, multiple myeloma (MM), marginal zone lymphoma, Burkitt's lymphoma, non-Burkitt high grade B cell lymphoma, extranodal marginal zone B cell lymphoma, acute or chronic myelogenous (or myeloid) leukemia, myelodysplastic syndrome, or acute lymphoblastic leukemia.
25 . The method of claim 16 , wherein the hematological malignancy is relapsed or refractory diffuse large B-cell lymphoma (DLBCL), relapsed or refractory mantle cell lymphoma, relapsed or refractory follicular lymphoma, relapsed or refractory CLL; relapsed or refractory SLL; relapsed or refractory multiple myeloma.
26 . The method of claim 16 , wherein the mobilized cells are myeloid cells or lymphoid cells.
27 . The method of claim 16 , wherein analyzing the mobilized plurality of cells comprises measuring the peripheral blood concentration of the mobilized plurality of cells.
28 . The method of claim 27 , further comprising administering the second treatment after the peripheral blood concentration of the mobilized plurality of cells increases as compared to the concentration before administration of the Btk inhibitor.
29 . The method of claim 27 , wherein administering the second treatment occurs after a subsequent decrease in peripheral blood concentration of the mobilized plurality of cells.
30 . The method of claim 29 , wherein analyzing the mobilized plurality of cells comprises measuring the duration of an increase in the peripheral blood concentration of the mobilized plurality of cells as compared to the concentration before administration of the Btk inhibitor.
31 . The method of claim 27 , further comprising administering the second treatment after the peripheral blood concentration of the mobilized plurality of cells has increased for a predetermined length of time.
32 . The method of claim 16 , wherein analyzing the mobilized plurality of cells comprises preparing a biomarker profile for a population of cells isolated from the plurality of cells, wherein the biomarker profile indicates the expression of a biomarker, the expression level of a biomarker, mutations in a biomarker, or the presence of a biomarker.
33 . The method of claim 32 , wherein the biomarker is: ZAP70; t(14,18); β-2 microglobulin; p53 mutational status; ATM mutational status; del(17)p; del(11)q; del(6)q; CD5; CD11c; CD19; CD20; CD22; CD25; CD38; CD103; CD138; secreted, surface or cytoplasmic immunoglobulin expression; V H mutational status; or a combination thereof.
34 . The method of claim 33 , further comprising predicting the efficacy of the second treatment based on the biomarker profile.
35 . The method of claim 16 , wherein the second treatment comprises lenalidomide, bortezomib, sorafenib, gemcitabine, dexamethasone, bendamustine, R-406, taxol, vincristine, doxorubicin, temsirolimus, carboplatin, ofatumumab, rituximab, GA101, R-ICE (ifosfamide, carboplatin, etoposide), R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone), BR (bendamustine and rituximab), FCR (fludarabine, cyclophosphamide, and rituximab) or any combination thereof.
36 . A method for treating a hematological malignancy in an individual in need thereof, comprising:
a. administering to the individual a first treatment comprising an amount of an irreversible Btk inhibitor sufficient to mobilize a plurality of cells from the malignancy; and
b. preparing a biomarker profile for a population of cells isolated from the plurality of cells.
37 . The method of claim 36 , wherein the amount of the irreversible Btk inhibitor is sufficient to induce lymphocytosis of a plurality of cells from the malignancy.
38 . The method of claim 36 , wherein the biomarker expression profile is used to diagnose, determine a prognosis, or create a predictive profile of a hematological malignancy.
39 . The method of claim 36 , wherein the biomarker profile indicates the expression of a biomarker, the expression level of a biomarker, mutations in a biomarker, or the presence of a biomarker.
40 . The method of claim 36 , wherein the biomarker profile indicates:
(a) that the hematological malignancy or survival of the hematological malignancy involves Btk signaling;
(b) that the hematological malignancy or survival of the hematological malignancy does not involve Btk signaling;
if survival of a hematological malignancy involves Btk signaling;
(c) that the hematological malignancy or survival of the hematological malignancy involves BCR signaling; or
(d) that the hematological malignancy or survival of the hematological malignancy does not involve BCR signaling.
41 . The method of claim 36 , wherein the biomarker is ZAP70, t(14,18), β-2 microglobulin, p53 mutational status, ATM mutational status, del(17) p , del(11) q , del(6) q , CD5, CD11c, CD19, CD20, CD22, CD25, CD38, CD103, CD138, CXCR4, secreted, surface or cytoplasmic immunoglobulin expression, V H mutational status, or a combination thereof.
42 . The method of claim 36 , further comprising providing a second anti-cancer treatment based on the biomarker profile.
43 . The method of claim 36 , further comprising predicting the efficacy of a second anti-cancer treatment based on the biomarker profile.
44 . The method of any of claim 1 , 17 , or 36 wherein the hematological malignancy is mantle cell lymphoma (MCL), relapsed or refractory MCL, chronic lymphocytic leukemia (CLL), relapsed or refractory CLL, small lymphocytic lymphoma (SLL), relapsed or refractory SLL, diffuse large B-cell lymphoma (DLBCL), or relapsed or refractory DLBCL.
45 . The method of any of claim 1 , 17 or 36 , wherein the concentration of absolute lymphocyte count in the peripheral blood of the individual increases by at least about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 125% 150%, 175%, or 200% following administration of an irreversible Btk inhibitor to the individual.
46 . The method of any of claim 1 , 17 or 36 , wherein the mobilized cells are CD19+CD5+ cells.
47 . The method of any of claim 1 , 17 or 36 , wherein the mobilized cells have decreased expression of CD38 and CXCR4.
48 . The method of any of claim 1 , 17 or 36 , comprising using an analytical instrument to analyze the mobilized plurality of cells in a sample obtained from the individual.