COMBINATION INCLUDING A CPG-C TYPE OLIGONUCLEOTIDE AND A PD-1 ANTAGONIST FOR TREATING BREAST CANCER
The present disclosure describes combination therapies for breast cancer comprising an oligonucleotide toll-like receptor 9 agonist and a PD-1 antagonist. In particular, the present disclosure describes combinations of a CpG-C type oligonucleotide and an anti-PD-1 antibody for the treatment of breast cancer. The combination may further comprise a taxane chemotherapeutic agent, in the presence or absence of a corticosteroid.
1 . A method of treating breast cancer in a mammalian subject in need thereof, the method comprising administering to the subject a CpG-C type oligonucleotide in combination with a PD-1 antagonist and a taxane chemotherapeutic agent in a neoadjuvant regimen, wherein
the CpG-C type oligonucleotide comprises the sequence 5′-TCNDyAACGTTCGAACGTTCGAANz-3′ (SEQ ID NO:2), each N is an independently selected nucleoside, D is G, A or T, y=0 or 1, z=0 to 19, and two or more internucleotide linkages are phosphorothioate ester linkages, and
the PD-1 antagonist is an anti-human PD-1 monoclonal antibody or an antigen-binding fragment thereof, or an anti-human PD-L1 monoclonal antibody or antigen-binding fragment thereof.
2 . The method according to claim 1 , wherein the CpG-C type oligonucleotide comprises a sequence selected from the group consisting of:
(SEQ ID NO: 4)
5′-TCGAACGTTCGAACGTTCGAACGTTCGAAT-3′;
(SEQ ID NO: 5)
5′-TCGAACGTTCGAACGTTCGAACGTT-3′;
(SEQ ID NO: 6)
5′-TCGAACGTTCGAACGTTCGAATTTT-3′;
(SEQ ID NO: 7)
5′-TCGTAACGTTCGAACGTTCGAACGTTA-3′;
(SEQ ID NO: 8)
5′-TCGTAACGTTCGAACGTTCGAACGTT-3′;
(SEQ ID NO: 9)
5′-TCGTAACGTTCGAACGTTCGAACGT-3′;
(SEQ ID NO: 10)
5′-TCGTAACGTTCGAACGTTCGAACG-3′;
(SEQ ID NO: 11)
5′-TCGTAACGTTCGAACGTTCGAAC-3′;
and
(SEQ ID NO: 12)
5′-TCGTAACGTTCGAACGTTCGAA-3′.
3 . The method according to claim 2 , wherein the CpG-C type oligonucleotide comprises:
(SEQ ID NO: 4)
5′-TCGAACGTTCGAACGTTCGAACGTTCGAAT-3′.
4 . The method according to claim 2 , wherein all of the internucleotide linkages of the CpG-C type oligonucleotide are phosphorothioate ester linkages.
5 . The method according to claim 1 , wherein the PD-1 antagonist is an anti-human PD-1 monoclonal antibody or an antigen-binding fragment thereof.
6 . The method according to claim 5 , wherein the anti-human PD-1 monoclonal antibody is selected from the group consisting of pembrolizumab, nivolumab, and cemiplimab.
7 . The method according to claim 5 , wherein the anti-human PD-1 monoclonal antibody or antigen-binding fragment comprises light chain complementarity determining regions (CDRs) of SEQ ID NOs:13, 14 and 15, and heavy chain CDRs of SEQ ID NOs:16, 17 and 18.
8 . The method according to claim 5 , wherein:
(i) the anti-human PD-1 monoclonal antibody or antigen-binding fragment comprises a light chain variable region comprising SEQ ID NO:19, and a heavy chain comprising SEQ ID NO:20; or
(ii) the anti-human PD-1 monoclonal antibody comprises a light chain comprising SEQ ID NO:21, and a heavy chain comprising SEQ ID NO:22.
9 . The method according to claim 1 , wherein the PD-1 antagonist is an anti-human PD-L1 monoclonal antibody or antigen-binding fragment thereof.
10 . The method according to claim 9 , wherein the anti-human PD-L1 monoclonal antibody is selected from the group consisting of atezolizumab, durvalumab, and avelumab.
11 . The method according to claim 1 , wherein the taxane chemotherapeutic agent is selected from the group consisting of paclitaxel, docetaxel, cabazitaxel, and albumin-bound paclitaxel.
12 . The method according to claim 11 , wherein the taxane chemotherapeutic agent is paclitaxel.
13 . The method according to claim 1 , wherein the breast cancer is:
(i) Stage II, Stage III, or Regional Stage IV, as staged according to the TNM system, or is T4, any N, and M0; or (ii) Stage II or Stage III.
14 . The method according to claim 13 , wherein the breast cancer is estrogen receptor and/or progesterone receptor negative.
15 . The method according to claim 13 , wherein the breast cancer is HER2-negative.
16 . The method according to claim 13 , wherein the breast cancer is triple-negative.
17 . The method according to claim 1 , wherein:
the CpG-C type oligonucleotide is administered by intratumoral injection at a dose of 2 mg;
the PD-1 antagonist is administered intravenously at a dose of 200 mg; and
the taxane chemotherapeutic agent is administered intravenously at a dose of 80 mg/m 2 , optionally after steroid premedication.
18 . The method according to claim 17 , wherein:
the CpG-C type oligonucleotide is administered once a week (q1w) for three weeks and then once every three weeks (q3w);
the PD-1 antagonist is administered once every three weeks (q3w); and
the taxane chemotherapeutic agent is administered once a week (q1w).
19 . The method of claim 18 , further comprising administering doxorubicin and cyclophosphamide after the neoadjuvant regimen with the combination of the CpG-C type oligonucleotide, the PD-1 antagonist and the taxane chemotherapeutic agent has been completed, wherein;
the doxorubicin is administered intravenously at a dose of 60 mg/m 2 once every two or three weeks (q2w or q3w); and
the cyclophosphamide is administered intravenously at a dose of 600 mg/m 2 once every two or three weeks (q2w or q3w).
20 . The method according to claim 1 , wherein the mammalian subject is a human.
21 . The method according to claim 1 , wherein the CpG-C type oligonucleotide is not associated with a multimerization agent by one or more covalent linkages, or by adsorption.
22 . The method according to claim 1 , wherein the CpG-C type oligonucleotide is not administered together with an antigen, optionally wherein the antigen is a tumor antigen.
23 . The method according to claim 1 , wherein treating cancer results in a favorable outcome according to:
(i) response evaluation criteria in solid tumors version 1.1 (RECIST 1.1), and the favorable outcome comprises one or more of the following:
(a) a complete response of target lesion(s);
(b) a partial response of target lesion(s);
(c) a stable disease of target lesion(s);
(d) a complete response of non-target lesion(s); and
(e) a stable disease of non-target lesion(s); or
(ii) immunotherapy response evaluation criteria in solid tumors version (iRECIST), and the favorable outcome comprises one of the following:
(a) an immune complete response (iCR);
(b) an immune partial response (iPR);
(c) an immune stable disease (iSD); or
(d) an immune unconfirmed progression (iUPD).
24 . The method according to claim 1 , wherein treating cancer results in a pathologic complete response (pCR) defined as an absence of invasive tumor in breast or lymph nodes of the subject at the completion of the neoadjuvant regimen.
25 . The method according to claim 1 , wherein treating cancer comprises reducing size of target lesion(s) as measured using magnetic resonance imaging (MRI).
26 . The method according to claim 1 , wherein treating cancer comprises lengthening time before breast cancer recurrence in the subject after surgical resection following completion of the neoadjuvant regimen, as compared to what was expected in the absence of administration of the CpG-C type oligonucleotide and the PD-1 antagonist.
27 . A method of treating HER2-negative breast cancer in a mammalian subject in need thereof, the method comprising administering to the subject a CpG-C type oligonucleotide in combination with a PD-1 antagonist and a taxane chemotherapeutic agent in a neoadjuvant regimen, wherein
(i) the CpG-C type oligonucleotide is administered by intratumoral injection at a dose of 2 mg once a week (q1w) for three weeks and then once every three weeks (q3w),
the CpG-C type oligonucleotide comprises the sequence 5′-TCNDyAACGTTCGAACGTTCGAANz-3′ (SEQ ID NO:2), in which each N is an independently selected nucleoside, D is G, A or T, y=0 or 1, z=0 to 19, and two or more internucleotide linkages are phosphorothioate ester linkages;
(ii) the PD-1 antagonist is administered intravenously at a dose of 200 mg once every three weeks (q3w), and the PD-1 antagonist is an anti-human PD-1 monoclonal antibody or an antigen-binding fragment thereof, or an anti-human PD-L1 monoclonal antibody or antigen-binding fragment thereof; and
(iii) the taxane chemotherapeutic agent is administered intravenously at a dose of 80 mg/m 2 once a week (q1w), optionally after steroid premedication.
28 . A composition comprising a CpG-C type oligonucleotide for use in a method of treating breast cancer in a mammalian subject in need thereof, the method comprising administering to the subject the CpG-C type oligonucleotide in combination with a PD-1 antagonist and a taxane chemotherapeutic agent in a neoadjuvant regimen, wherein
the CpG-C type oligonucleotide comprises of the sequence 5′-TCNDyAACGTTCGAACGTTCGAANz-3′ (SEQ ID NO:2), in which each N is an independently selected nucleoside, D is G, A or T, y=0 or 1, z=0 to 19, and two or more internucleotide linkages are phosphorothioate ester linkages, and
the PD-1 antagonist is an anti-human PD-1 monoclonal antibody or an antigen-binding fragment thereof, or an anti-human PD-L1 monoclonal antibody or antigen-binding fragment thereof.
29 . Use of a CpG-C type oligonucleotide in the manufacture of a medicament for use in a method of treating a mammalian subject diagnosed with breast cancer with the CpG-C type oligonucleotide in combination with a PD-1 antagonist and a taxane chemotherapeutic agent in a neoadjuvant regimen, wherein
the CpG-C type oligonucleotide comprises the sequence 5′-TCNDyAACGTTCGAACGTTCGAANz-3′ (SEQ ID NO:2), in which each N is an independently selected nucleoside, D is G, A or T, y=0 or 1, z=0 to 19, and two or more internucleotide linkages are phosphorothioate ester linkages, and
the PD-1 antagonist is an anti-human PD-1 monoclonal antibody or an antigen-binding fragment thereof, or an anti-human PD-L1 monoclonal antibody or antigen-binding fragment thereof.
30 . Use of a CpG-C type oligonucleotide, a PD-1 antagonist and a taxane chemotherapeutic agent in the manufacture of medicaments for use in a method of treating a mammalian subject diagnosed with breast cancer, wherein
the CpG-C type oligonucleotide comprises the sequence: 5′-TCNDyAACGTTCGAACGTTCGAANz-3′ (SEQ ID NO:2), in which each N is an independently selected nucleoside, D is G, A or T, y=0 or 1, z=0 to 19, and two or more internucleotide linkages are phosphorothioate ester linkages, and
the PD-1 antagonist is an anti-human PD-1 monoclonal antibody or an antigen-binding fragment thereof, or an anti-human PD-L1 monoclonal antibody or antigen-binding fragment thereof.
31 . The method of claim 27 , the composition of claim 28 , the use of claim 29 , or the use of claim 30 , wherein
the CpG-C type oligonucleotide comprises the sequence of SEQ ID NO:4;
the PD-1 antagonist is:
(i) an anti-human PD-1 monoclonal antibody or antigen-binding fragment comprising light chain complementarity determining regions (CDRs) of SEQ ID NOs:13, 14 and 15, and heavy chain CDRs of SEQ ID NOs:16, 17 and 18;
(ii) an anti-human PD-1 monoclonal antibody or antigen-binding fragment comprising a light chain variable region comprising SEQ ID NO:19, and a heavy chain comprising SEQ ID NO:20; or
(iii) an anti-human PD-1 monoclonal antibody comprising a light chain comprising SEQ ID NO:21, and a heavy chain comprising SEQ ID NO:22; and
the taxane chemotherapeutic agent is paclitaxel.