Methods of stratifying patients for treatment with retinoic acid receptor-alpha agonists
The invention provides methods that define cellular populations that are sensitive to RARA agonists and identify patient subgroups that will benefit from treatment with RARA agonists. The invention also provides packaged pharmaceutical compositions that comprise a RARA agonist and instructions for determining if such agonist is suitable for use in treatment.
1. A method of treating non-acute promyelocytic leukemia acute myelogenous leukemia (non-APL AML) in a subject, the method comprising administering a therapeutically effective amount of tamibarotene to the subject, wherein, prior to administration, a sample of diseased cells from the subject is determined to have
(a) a super enhancer associated with a retinoic acid receptor alpha (RARA) gene, wherein the super enhancer has a strength or ordinal rank that is equal to or above a pre-determined threshold level, or
(b) a level of primary RNA transcripts from the RARA gene and/or a portion of the super enhancer associated therewith, wherein the level of the RNA transcripts is equal to or above a pre-determined threshold, and wherein the RNA transcripts are transcribed from a RARA gene that encodes a functional RARA and specifically excludes gene fusions that comprise all or a portion of the RARA gene.
2. The method of claim 1 , wherein the pre-determined threshold is a cutoff value.
3. The method of claim 2 , wherein the cutoff value is set at a value that is equal to or up to 5% above the level of primary RNA transcripts from the RARA gene in the lowest responder in a population of non-APL AML test samples.
4. The method of claim 3 , wherein the population of test samples comprises samples obtained from human subjects, cell lines, or patient-derived xenografts.
5. The method of claim 4 , wherein the cutoff value is the level of primary RNA transcripts in xenograft AM5512.
6. The method of claim 1 , wherein the level of the primary RNA transcripts from the RARA gene, in the sample, is determined using qPCR, fluorescent hybridization, RNA sequencing, RNA hybridization and signal amplification, or northern blot.
7. The method of claim 1 , wherein the subject is a human subject.
8. The method of claim 7 , wherein the human subject is an elderly unfit subject.
9. The method of claim 1 , wherein the subject has a relapsed or refractory form of the non-APL AML.
10. The method of claim 1 , wherein the sample of diseased cells from the subject has been determined to have a super enhancer associated with the RARA gene, wherein the super enhancer has a strength or ordinal rank that is equal to or above a pre-determined threshold level.
11. The method of claim 10 , wherein the super enhancer has (i) a strength corresponding to a prevalence rank that is equal to or above a pre-determined prevalence cutoff for RARA gene super enhancer strength; (ii) a strength that is equal to or above a pre-determined RARA gene strength cutoff; (iii) an ordinal of strength corresponding to a prevalence rank that is equal to or above a pre-determined RARA gene strength ordinal prevalence cutoff; and/or (iv) an ordinal of strength that is equal to or above a pre-determined RARA gene strength ordinal cutoff.
12. The method of claim 11 , wherein the cutoff value is set at a value that is (i) equal to or up to 5% above the RARA enhancer strength in the lowest responder in a population of cell samples; (ii) equal to or up to 5% above the RARA enhancer strength in the highest non-responder in the population; or (iii) a value in between the RARA enhancer strength of the lowest responder and the highest non-responder in the population.
13. The method of claim 12 , wherein the population of cell samples comprises samples obtained from human subjects, cell lines, or patient-derived xenografts.
14. The method of claim 11 , wherein the cutoff value is the super enhancer strength or ordinal rank in xenograft AM5512.
15. The method of claim 10 , wherein the subject is a human subject.
16. The method of claim 15 , wherein the human subject is an elderly unfit subject.
17. The method of claim 10 , wherein the subject has a relapsed or refractory form of the non-APL AML.
18. The method of claim 1 , wherein the sample of diseased cells from the subject has been determined to have a level of the RNA transcripts from the RARA gene and/or a portion of the super enhancer associated therewith, wherein the level of RNA transcripts is equal to or above a pre-determined threshold.
19. The method of claim 18 , wherein the RNA transcripts from the RARA gene are mRNA transcripts.
20. The method of claim 19 , wherein the mRNA transcripts are expressed at a level that (i) is equal to or above a pre-determined mRNA level cutoff; and/or (ii) corresponds to a prevalence rank that is equal to or above a pre-determined RARA mRNA prevalence cutoff.
21. The method of claim 20 , wherein the cutoff value is set at a value that is equal to or up to 5% above the level of mRNA transcripts from the RARA gene in the lowest responder in a population of non-APL AML test samples.
22. The method of claim 21 , wherein the population of cell samples comprises samples obtained from human subjects, cell lines, or patient-derived xenografts.
23. The method of claim 22 , wherein the cutoff value is the level of mRNA transcripts from the RARA gene in xenograft AM5512.
24. The method of claim 19 , wherein the level of mRNA transcripts from the RARA gene, in the sample, is determined using qPCR, fluorescent hybridization, RNA sequencing, RNA hybridization and signal amplification, or northern blot.
25. The method of claim 19 , wherein the subject is a human subject.
26. The method of claim 25 , wherein the human subject is an elderly unfit subject.
27. The method of claim 19 , wherein the subject has a relapsed or refractory form of the non-APL AML.