Therapeutic and diagnostic methods for cancer
The present invention provides therapeutic and diagnostic methods and compositions for cancer, for example, bladder cancer. The invention provides methods of treating bladder cancer, methods of determining whether a patient suffering from bladder cancer is likely to respond to treatment comprising a PD-L1 axis binding antagonist, methods of predicting responsiveness of a patient suffering from bladder cancer to treatment comprising a PD-L1 axis binding antagonist, and methods of selecting a therapy for a patient suffering from bladder cancer, based on somatic mutation levels of genes of the invention (e.g., somatic mutation levels in a tumor sample obtained from the patient).
1. A method of treating a patient suffering from a urothelial bladder cancer, the method comprising administering to the patient a therapeutically effective amount of a PD-L1 binding antagonist, wherein a tumor sample obtained from the patient has been determined to have an increased level of mutation load relative to a reference level of mutation load, wherein mutation load of the tumor sample reflects the level of somatic mutations in at least one-third of the genes set forth in Table 1, and wherein the PD-L1 binding antagonist is an anti-PD-L1 antibody comprising a heavy chain comprising the hypervariable region (HVR)-H1 sequence of SEQ ID NO: 19, the HVR-H2 sequence of SEQ ID NO: 20, and the HVR-H3 sequence of SEQ ID NO: 21; and a light chain comprising the HVR-L1 sequence of SEQ ID NO: 22, the HVR-L2 sequence of SEQ ID NO: 23, and the HVR-L3 sequence of SEQ ID NO: 24.
2. The method of claim 1 , wherein the mutation load of the tumor sample reflects the level of somatic mutations in at least one-half, two-thirds, three-fourths, or all of the genes set forth in Table 1.
3. The method of claim 1 , wherein:
(i) the somatic mutations are substitutions, deletions, and/or insertions;
(ii) the somatic mutations of the at least one gene set forth in Table 1 are protein-altering somatic mutations; or
(iii) the substitutions, deletions, and/or insertions of (i) are in coding regions.
4. The method of claim 1 , wherein the tumor sample obtained from the patient has a whole-genome mutation load that is higher than a reference level whole-genome mutation load.
5. The method of claim 4 , wherein the reference level whole-genome mutation load is at least about 10 mutations per megabase (Mb).
6. The method of claim 1 , wherein the antibody comprises a heavy chain variable region comprising the amino acid sequence of SEQ ID NO: 25 and a light chain variable region comprising the amino acid sequence of SEQ ID NO:4.
7. The method of claim 1 , further comprising administering to the patient an effective amount of a second therapeutic agent.
8. The method of claim 7 , wherein the second therapeutic agent is selected from the group consisting of a cytotoxic agent, a growth-inhibitory agent, a radiation therapy agent, an anti-angiogenic agent, and combinations thereof.
9. The method of claim 1 , wherein the urothelial bladder cancer is a locally advanced urothelial bladder cancer or a metastatic urothelial bladder cancer.
10. The method of claim 1 , wherein the patient is ineligible for treatment with a platinum-based chemotherapeutic agent and has not received prior treatment for locally advanced or metastatic urothelial bladder cancer.
11. The method of claim 1 , wherein the tumor sample is a formalin-fixed and paraffin-embedded (FFPE) tumor sample, an archival tumor sample, a fresh tumor sample, or a frozen tumor sample.
12. The method of claim 1 , wherein the antibody comprises a heavy chain comprising the amino acid sequence of SEQ ID NO:32 and a light chain comprising the amino acid sequence of SEQ ID NO: 33.
13. A method of treating a patient suffering from a locally advanced or metastatic urothelial carcinoma, the method comprising administering to the patient 1200 mg of an anti-PD-L1 antibody comprising a heavy chain comprising the hypervariable region (HVR)-H1 sequence of SEQ ID NO: 19, the HVR-H2 sequence of SEQ ID NO: 20, and the HVR-H3 sequence of SEQ ID NO: 21; and a light chain comprising the HVR-L1 sequence of SEQ ID NO: 22, the HVR-L2 sequence of SEQ ID NO: 23, and the HVR-L3 sequence of SEQ ID NO: 24 intravenously on Day 1 of each 21-day cycle, wherein the patient is ineligible for treatment with a platinum-based chemotherapeutic agent and has not received prior treatment for locally advanced or metastatic urothelial carcinoma, wherein a tumor sample obtained from the patient has been determined to have an increased level of mutation load relative to a reference level of mutation load, and wherein the mutation load of the tumor sample reflects the level of somatic mutations in at least one-third of the genes set forth in Table 1.