Combination therapies for treatment of BCMA-related cancers and autoimmune disorders
The present disclosure relates to methods for using BCMA-specific binding molecules (such as a BCMA-specific chimeric antigen receptor or antibody) in combination with γ-secretase inhibitors, which can be done concurrently or sequentially, to treat or prevent a B-cell related proliferative disease, such as a cancer or autoimmune disease, or the like. A BCMA-specific binding molecule in combination with γ-secretase inhibitor can be used in, for example, adoptive immunotherapy.
1. A method of treating
multiple myeloma in a subject, comprising administering to the subject (i) a therapeutically effective amount of a T cell expressing a BCMA-specific chimeric antigen receptor (CAR), wherein the CAR comprises a hydrophobic portion disposed between an extracellular component and an intracellular component, wherein the extracellular component comprises a BCMA-specific binding domain, and (ii) a therapeutically effective amount of a γ-secretase inhibitor.
2. The method of claim 1 , wherein the BCMA-specific binding domain comprises a BCMA-specific scFv, a BCMA-specific scTCR, a BCMA-specific domain antibody, or a BCMA ligand or binding portion thereof.
3. The method of claim 2 , wherein the BCMA-specific binding domain comprises a scFv comprising heavy chain and light chain variable regions based on BCMA antibody J6M0, J6M1, J6M2, J9M0, J9M1, J9M2, CA8, A7D12.2, C11 D5.3, C12A3.2, or C13F12.1.
4. The method of claim 1 , wherein the intracellular component of the CAR comprises an effector domain or functional portion thereof, a costimulatory domain or functional portion thereof, or any combination thereof.
5. The method of claim 1 , wherein:
(i) the intracellular component of the CAR comprises an effector domain from CD3ζ;
(ii) the intracellular component of the CAR comprises a costimulatory domain from 4-1BB;
(iii) the intracellular component of the CAR comprises a costimulatory domain from CD28;
(iv) the extracellular component of the CAR further comprises a hinge region comprising a cluster of differentiation molecule stalk region or a functional variant thereof;
(v) the extracellular component of the CAR further comprises a spacer region comprising a hinge, wherein the spacer region has a length of from about 15 to about 100 amino acids; or
(vi) any combination of (i)-(v).
6. The method of claim 1 , wherein the T cell is a CD4+ T cell, a CD8+ T cell, a CD4− CD8− double negative T cell, a γδ T cell, or any combination thereof.
7. The method of claim 6 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
8. The method of claim 1 , wherein the γ-secretase inhibitor comprises a small molecule, a peptidomimetic compound, LY411575, semagacestat, avagacestat, DAPT, BMS-906024, BMS-986115, MK-0752, PF-03084014, R04929097, or YO-01027.
9. The method of claim 1 , wherein the γ-secretase inhibitor is a nicastrin-specific binding protein.
10. The method of claim 1 , wherein the method further comprises pre-conditioning the subject with an immunosuppressive regimen prior to or concurrent with the T cell and the γ-secretase inhibitor.
11. The method of claim 10 , wherein the immunosuppressive regimen is a non-myeloablative treatment or a myeloablative treatment.
12. The method of claim 1 , wherein the T cell and the γ-secretase inhibitor are administered sequentially.
13. The method of claim 1 , wherein the T cell and the γ-secretase inhibitor are administered concurrently.
14. The method of claim 13 , wherein the T cell and the γ-secretase inhibitor are formulated together.
15. The method of claim 1 , wherein the intracellular component of the CAR comprises:
(i) an effector domain from CD3ζ; and
(ii) a costimulatory domain from 4-1BB, CD28, or both.
16. The method of claim 15 , wherein the extracellular component of the CAR further comprises:
(iii) a hinge region comprising a cluster of differentiation molecule stalk region or a functional variant thereof; and/or
(iv) a spacer region comprising a hinge, wherein the spacer region has a length of from about 15 to about 100 amino acids.
17. The method of claim 1 , wherein the γ-secretase inhibitor is administered to the subject at least once subsequent to a first administration of the T cell.
18. A method of treating
multiple myeloma in a subject, comprising administering to the subject a therapeutically effective amount of a T cell expressing a BCMA-specific chimeric antigen receptor (CAR), wherein the CAR comprises a hydrophobic portion disposed between an extracellular component and an intracellular component, wherein the extracellular component comprises a BCMA-specific binding domain,
wherein the subject has received a therapeutically effective amount of a γ-secretase inhibitor.
19. A method of treating
multiple myeloma in a subject, comprising administering to the subject a therapeutically effective amount of a γ-secretase inhibitor,
wherein the subject has received therapeutically effective amount of a T cell expressing a BCMA-specific chimeric antigen receptor (CAR), wherein the CAR comprises a hydrophobic portion disposed between an extracellular component and an intracellular component, wherein the extracellular component comprises a BCMA-specific binding domain.
20. The method of claim 1 , wherein:
(i) the CAR comprises (1) a BCMA-specific binding domain comprising a BCMA-specific scFv, a BCMA-specific scTCR, a BCMA-specific domain antibody, or a BCMA ligand or binding portion thereof, (2) an intracellular component comprising a costimulatory domain from 4-1BB and/or CD28, and an effector domain from CD3ζ, and/or (3) an extracellular spacer region comprising a hinge, wherein the spacer region has a length from about 15 to about 100 amino acids; and
(ii) the γ-secretase inhibitor comprises a small molecule.
21. The method of claim 18 , wherein the intracellular component of the CAR comprises:
(i) an effector domain from CD3ζ; and
(ii) a costimulatory domain from 4-1BB, CD28, or both.
22. The method of claim 18 , wherein:
(i) the CAR comprises (1) a BCMA-specific binding domain comprising a BCMA-specific scFv, a BCMA-specific scTCR, a BCMA-specific domain antibody, or a BCMA ligand or binding portion thereof, (2) an intracellular component comprising a costimulatory domain from 4-1BB and/or CD28, and an effector domain from CD3ζ, and/or (3) an extracellular spacer region comprising a hinge, wherein the spacer region has a length from about 15 to about 100 amino acids;
(ii) the γ-secretase inhibitor comprises a small molecule; or
(iii) (i) and (ii).
23. The method of claim 22 , wherein the CAR comprises (1) a BCMA-specific binding domain comprising a BCMA-specific scFv, a BCMA-specific scTCR, a BCMA-specific domain antibody, or a BCMA ligand or binding portion thereof, and (2) an intracellular component comprising a costimulatory domain from 4-1BB and/or CD28, and an effector domain from CD3ζ.
24. The method of claim 19 , wherein the intracellular component of the CAR comprises:
(i) an effector domain from CD3ζ; and
(ii) a costimulatory domain from 4-1BB, CD28, or both.
25. The method of claim 19 , wherein:
(i) the CAR comprises (1) a BCMA-specific binding domain comprising a BCMA-specific scFv, a BCMA-specific scTCR, a BCMA-specific domain antibody, or a BCMA ligand or binding portion thereof, (2) an intracellular component comprising a costimulatory domain from 4-1BB and/or CD28, and an effector domain from CD3ζ, and/or (3) an extracellular spacer region comprising a hinge, wherein the spacer region has a length from about 15 to about 100 amino acids;
(ii) the γ-secretase inhibitor comprises a small molecule; or
(iii) (i) and (ii).
26. The method of claim 25 , wherein the CAR comprises (1) a BCMA-specific binding domain comprising a BCMA-specific scFv, a BCMA-specific scTCR, a BCMA-specific domain antibody, or a BCMA ligand or binding portion thereof, and (2) an intracellular component comprising a costimulatory domain from 4-1BB and/or CD28, and an effector domain from CD3ζ.
27. The method of claim 18 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
28. The method of claim 19 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
29. The method of claim 5 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
30. The method of claim 20 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
31. The method of claim 21 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
32. The method of claim 23 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.
33. The method of claim 26 , wherein the T cell comprises a CD8+ T cell, a CD4+ T cell, or both.