Biomarkers for response to rapamycin analogs
The present invention relates to the use of one or more biomarkers to evaluate the likelihood that a rapamycin analog would produce an anti-cancer effect in a subject. It is based, at least in part, on the results of experiments employing an integrated next-generation sequencing approach to interrogate spatially separated tumor specimens from the same individuals to decipher intra-tumor and intertumor heterogeneity and determine the oncogenomic basis of exceptional therapeutic benefit to rapalogs in kidney cancer patients. These experiments implicated loss of function mutations in TSC1 and/or TSC2 and/or gain-of-function of mTOR in therapeutic responsiveness to rapamycin analogs. Accordingly, in non-limiting embodiments, the present invention provides for assay methods and kits for determining the presence of loss of function mutations in TSC1 and/or TSC2 and/or gain-of-function of mTOR, and methods of using such determinations in selecting a therapeutic regimen for a cancer patient and in methods of treating cancer patients. In particular non-limiting embodiments, a plurality of tumor sites are evaluated and the composite effect of the genetic background on mTOR function is assessed.
1. A method of producing an anti-cancer effect in a cancer, comprising:
administering a therapeutically effective amount of a rapamycin analog to the cancer to produce an anti-cancer effect,
wherein cells of the cancer have been determined to contain a biomarker selected from the group consisting of:
a TSC1 biomarker, which is a TSC1 Q781* biomarker, TSC1 P311fs*4 biomarker, TSC1 I580fs*7 biomarker, TSC1 Q527* biomarker, TSC1 S334* biomarker or a combination thereof;
a TSC2 biomarker, which is a TSC2 Q794* biomarker, TSC2 R611W biomarker, TSC2 S1498N biomarker or a combination thereof;
a mTOR biomarker, which is:
a mTOR mutation selected from the group consisting of Q2223K, R2505P, L2431P, S2215F, V2406A, M2327I, L2230V, I2228T, L2220F, V2006L, T1977K, I1973F, F1888V, F1888I, F1888L, F1888L in combination with L2230V, C1483F, C1483Y, L1460P, A1459P, L1433S, A1105P, K860N and a combination thereof; and
a combination thereof,
wherein the cancer is renal cell carcinoma.
2. The method of claim 1 , where the presence of a TSC1 biomarker, a TSC2 biomarker, and/or a mTOR biomarker is determined by nucleic acid sequencing.
3. The method of claim 2 , where nucleic acid complementary to a TSC1 gene, a TSC2 gene, and/or a gene encoding a mTOR biomarker is amplified and the amplified nucleic acid is subjected to nucleic acid sequencing.
4. The method of claim 1 , where the biomarker is a mTOR biomarker.
5. The method of claim 4 , where the mTOR biomarker is Q2223K.
6. The method of claim 1 , where the biomarker is a TSC1 biomarker.
7. The method of claim 1 , where the biomarker is a TSC2 biomarker.
8. The method of claim 4 , where the mTOR biomarker is selected from the group of mutations consisting of Q2223K, R2505P, L2431P, S2215F, V2406A, M2327I, L2230V, I2228T, L2220F, V2006L, T1977K, I1973F, F1888V, F1888I, F1888L, F1888L in combination with L2230V, C1483F, C1483Y, L1460P, A1459P, L1433S, A1105P and K860N.
9. A method of treating a subject suffering from a cancer, comprising:
treating the subject with a therapeutically effective amount of a rapamycin analog,
wherein cells of the cancer have been determined to contain a biomarker selected from the group consisting of:
a TSC1 biomarker, which is a TSC1 Q781* biomarker, TSC1 P311fs*4 biomarker, TSC1 I580fs*7 biomarker, TSC1 Q527* biomarker, TSC1 S334* biomarker or a combination thereof;
a TSC2 biomarker, which is a TSC2 Q794* biomarker, TSC2 R611W biomarker, TSC2 S1498N biomarker or a combination thereof;
a mTOR biomarker, which is:
a mTOR mutation selected from the group consisting of Q2223K, R2505P, L2431P, S2215F, V2406A, M2327I, L2230V, I2228T, L2220F, V2006L, T1977K, I1973F, F1888V, F1888I, F1888L, F1888L in combination with L2230V, C1483F, C1483Y, L1460P, A1459P, L1433S, A1105P, K860N and a combination thereof; and
a combination thereof,
where the cancer is renal cell carcinoma.
10. The method of claim 9 , where the presence of a TSC1 biomarker, a TSC2 biomarker, and/or a mTOR biomarker is determined by nucleic acid sequencing.
11. The method of claim 10 , where nucleic acid complementary to a TSC1 gene, a TSC2 gene, and/or a gene encoding a mTOR biomarker is amplified and the amplified nucleic acid is subjected to nucleic acid sequencing.
12. The method of claim 9 , where the biomarker is a mTOR biomarker.
13. The method of claim 12 , where the mTOR biomarker is Q2223K.
14. The method of claim 9 , where the biomarker is a TSC1 biomarker.
15. The method of claim 9 , where the biomarker is a TSC2 biomarker.
16. The method of claim 12 , where the mTOR biomarker is selected from the group of mutations consisting of Q2223K, R2505P, L2431P, S2215F, V2406A, M2327I, L2230V, I2228T, L2220F, V2006L, T1977K, I1973F, F1888V, F1888I, F1888L, F1888L in combination with L2230V, C1483F, C1483Y, L1460P, A1459P, L1433S, A1105P and K860N.
17. A method of producing an anti-cancer effect in a renal cell carcinoma wherein cells of the renal cell carcinoma have been determined to contain cell a mTOR biomarker selected from the group consisting of Q2223K, R2505P, L2431P, S2215F, V2406A, M2327I, L2230V, I2228T, L2220F, V2006L, T1977K, I1973F, F1888V, F1888I, F1888L, F1888L in combination with L2230V, C1483F, C1483Y, L1460P, A1459P, L1433S, A1105P, K860N and a combination thereof, comprising:
administering, to a subject having the renal cell carcinoma an effective amount of a rapamycin analog.