Combination therapy

文档序号：788171 发布日期：2021-04-09 浏览：35次中文

阅读说明：本技术 组合疗法 (Combination therapy ) 是由 F·扎马尔基 F·贝尔托尼于 2019-08-30 设计创作，主要内容包括：本公开涉及用于治疗诸如癌症的病理疾患的组合疗法。具体而言,本公开涉及组合疗法,所述组合疗法包括使用抗CD19抗体药物缀合物(抗CD19ADC)和抗BCL-2剂治疗。(The present disclosure relates to combination therapies for treating pathological conditions such as cancer. In particular, the disclosure relates to combination therapies comprising treatment with an anti-CD 19 antibody drug conjugate (anti-CD 19ADC) and an anti-BCL-2 agent.)

1. ADCx19 for use in a method of treating a disorder in an individual, the method comprising administering to the individual an effective amount of ADCx19 and an anti-BCL-2 agent;

wherein ADCx19 has the following chemical structure:

wherein Ab represents an antibody comprising a VH domain having the sequence of SEQ ID NO. 2 and a VL domain having the sequence of SEQ ID NO. 8.

2. The ADCx19 for use of claim 6, wherein the method comprises administering ADCT-402 prior to the anti-BCL-2 agent, simultaneously with the anti-BCL-2 agent, or after the anti-BCL-2 agent.

3. ADCx19 for use according to any of claims 1 and 2, wherein the method further comprises administering a chemotherapeutic agent.

4.ADCx19 for use according to any one of claims 1 to 3, wherein the subject is a human.

5. ADCx19 for use according to any one of claims 1 to 4, wherein the individual has or has been determined to have a disorder.

6. ADCx19 for use according to claim 5, wherein the individual has or has been determined to have a cancer expressing CD19 or CD19+ tumor associated non-tumor cells, such as CD19+ infiltrating cells.

7. The ADCx19 for use of any preceding claim, wherein the individual is receiving treatment with an anti-BCL-2 agent.

8. The ADCx19 for use of any preceding claim, wherein the individual has been treated with an anti-BCL-2 agent.

9. The ADCx19 for use of any preceding claim, wherein the individual is refractory to or further treated with an anti-BCL-2 agent.

10. The ADCx19 for use of any of the preceding claims, wherein the treatment has increased efficacy compared to monotherapy using either ADCx19 or an anti-BCL-2 agent alone.

11. The ADCx19 for use of any preceding claim, wherein the disorder is a proliferative disease.

12. The ADCx19 for use of claim 11, wherein the disorder is cancer.

13. The disease of claim 18 using ADCx19, wherein the disorder is selected from the group comprising: non-hodgkin lymphomas including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL), and marginal zone B-cell lymphoma (MZBL); and leukemias, such as Hairy Cell Leukemia (HCL), hairy cell leukemia variants (HCL-v), and acute lymphoblastic leukemia (ALL, such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL).

14. A method of selecting an individual suitable for treatment with ADCx19, wherein the individual is selected for ADCx19 treatment if the individual has been treated with an anti-BCL-2 agent;

wherein ADCx19 has the following chemical structure:

wherein Ab represents an antibody comprising a VH domain having the sequence of SEQ ID NO. 2 and a VL domain having the sequence of SEQ ID NO. 8.

15. A method of selecting an individual eligible for treatment with ADCx19, wherein the individual is selected for ADCx19 treatment if the individual is being treated with an anti-BCL-2 agent;

wherein ADCx19 has the following chemical structure:

wherein Ab represents an antibody comprising a VH domain having the sequence of SEQ ID NO. 2 and a VL domain having the sequence of SEQ ID NO. 8.

16. The method of any one of claims 14 or 15, wherein the individual is selected for treatment if the individual is refractory to treatment or further treatment with an anti-BCL-2 agent.

17. ADCx19 for use according to any one of claims 1 to 13, wherein the individual is selected for treatment according to the method of any one of claims 14 to 16.

18. ADCx19 for use in a method of treating a disorder in a subject, the method comprising:

(i) selecting an individual suitable for treatment by the method of any one of claims 14 to 16; and

(ii) administering an effective amount of ADCx19 to the individual;

wherein ADCx19 has the following chemical structure:

wherein Ab represents an antibody comprising a VH domain having the sequence of SEQ ID NO. 2 and a VL domain having the sequence of SEQ ID NO. 8.

19. The ADCx19 for use of claim 18, further comprising administering an anti-BCL-2 agent in combination with ADCx 19.

20. The ADCx19 for use of any preceding claim or the method of any preceding claim, wherein the ADCx19 is comprised in a composition, optionally in combination with a pharmaceutically acceptable excipient.

21. An anti-BCL-2 agent for use in the method of treatment of any one of claims 1-13 or 17-20.

22. The ADCx19 for use of any preceding claim, the anti-BCL-2 agent for use of any preceding claim, or the method of any preceding claim, wherein the anti-BCL-2 agent is venetiana.

Technical Field

The present disclosure relates to combination therapies for treating pathological conditions such as cancer. In particular, the disclosure relates to combination therapies comprising treatment with an anti-CD 19 antibody drug conjugate (anti-CD 19ADC) and an anti-BCL-2 agent.

Background

Antibody therapy

Antibody therapy for targeted therapy of subjects with cancer, immune and angiogenic disorders has been established (Carter, P. (2006) Nature Reviews Immunology 6: 343-. Local delivery of cytotoxic or cytostatic agents (i.e., drugs that kill or inhibit tumor cells in Cancer therapy) using antibody-drug conjugates (ADCs), i.e., immunoconjugates, to target the drug moiety to the tumor and accumulate it within the tumor cells, whereas systemic administration of these unconjugated agents may result in unacceptable levels of toxicity to normal cells (Xie et al (2006) Expert. Opin. biol. The.6 (3): 281-291; Kovtun et al (2006) Cancer Res.66(6): 3214-3121; Law et al (2006) Cancer Res.66(4): 2328-2337; Wu et al (2005) Nature Biotech.23(9): 1137-1145; LambertJ. 2005) Current Opin. Immunol.5: 543; Hamann P. 2005) Ex. Op. No. 1089; 2003-19; 2003-52; 2003-67; 2003-52) Cancer cells No. 12; 2003-1089; 2003-201, No. 12; 2003-201, No. 11; 2003-201, 11; III, No. 11; No. 7.

CD19

CD19 is a 95kDa membrane receptor that is expressed early in B cell differentiation and continues to be expressed until it triggers terminal differentiation of B cells (Pezzutto et al (1987), J.Immunol 138: 2793; Tedder et al (1994) lmmunol Today15: 437). The CD19 extracellular domain contains two Immunoglobulin (IG) -like domains of the C2 type separated by a smaller, potentially disulfide-linked domain. The CD19 cytoplasmic domain is structurally unique, but highly conserved among humans, mice and guinea pigs (Fujimoto et al, (1998) Semin Immunol.10: 267). CD19 is part of a protein complex that is present on the cell surface of B lymphocytes. Protein complexes include CD19, CD21 (complement receptor, type 2), CD81(TAPA-1) and CD225(Leu-13) (Fujimoto, supra).

CD19 is an important regulator of transmembrane signaling in B cells. An increase or decrease in the cell surface density of CD19 can affect B cell development and function, resulting in diseases (such as autoimmune diseases or hypogammaglobulinemia). The CD19 complex enhances the B cell response to antigens in vivo by cross-linking two separate signaling complexes present on the B cell membrane. The two signal transduction complexes associated with membrane IgM and CD19 activate phospholipase c (plc) by different mechanisms. Cross-linking of CD19 and B cell receptors reduces the number of IgM molecules required to activate PLC. CD19 also serves as a specialized adapter for the amplification of Arc family kinases (Hasegawa et al, (2001) J Immunol 167: 3190).

CD19 binding has been shown to enhance and inhibit both B cell activation and proliferation depending on the amount of cross-linking that occurs (Tedder,1994, immunol. today15: 437). CD19 is expressed on more than 90% of B cell lymphomas and is predicted to affect lymphoma growth in vitro and in vivo.

Therapeutic use of anti-CD 19ADC

The efficacy of antibody drug conjugates comprising anti-CD 19 antibodies (anti-CD 19-ADC) has been established, for example, in the treatment of cancer-see, for example, WO2014/057117 and WO 2016/166298.

Studies were continued to further improve the efficacy, tolerability and clinical utility of anti-CD 19 ADCs. To this end, the inventors have identified clinically advantageous combination therapies in which anti-CD 19ADC is administered in combination with at least one anti-BCL-2 agent.

Disclosure of Invention

The present authors have determined that administration of a combination of an anti-CD 19ADC and an anti-BCL-2 agent to an individual results in unexpected clinical advantages. The inventors have also determined that administration of anti-CD 19ADC to an individual who has been or is being treated with an anti-BCL-2 agent results in a synergistic increase in therapeutic efficacy.

Accordingly, in a first aspect, the present disclosure provides a method of selecting an individual eligible for treatment with an anti-CD 19ADC, wherein the individual is selected for anti-CD 19ADC treatment if the individual has been or is being treated with an anti-BCL-2 agent. If the individual is refractory to treatment or further treatment with an anti-BCL-2 agent, the individual may be selected for treatment.

In another aspect, the present disclosure provides a method for treating a disorder in an individual, the method comprising selecting an individual suitable for treatment by the method of the first aspect, and then administering to the individual an effective amount of an anti-CD 19 ADC. The method of treatment may further comprise administering an anti-BCL-2 agent in combination with the anti-CD 19 ADC.

In another aspect, the present disclosure provides a method for treating a disorder in an individual, comprising administering to the individual an effective amount of an anti-CD 19ADC and an anti-BCL-2 agent. The individual may be selected for treatment according to the method of the first aspect.

The condition may be a proliferative disease, for example a cancer, such as non-hodgkin's lymphoma (including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL) and marginal zone B-cell lymphoma (MZBL)) and leukaemia (such as Hairy Cell Leukaemia (HCL), hairy cell leukaemia variant (HCL-v) and Acute Lymphoblastic Leukaemia (ALL) (such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL))).

The anti-CD 19-ADC may be ADCX19 as described herein.

The anti-BCL-2 agent can be Venetosela (Venetoselx) (ABT-199), Navitoxix (Navitoclax) (ABT-263), ABT-737, S55746/BCL201, and Olimersen (oblimersen) (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

The subject may be a human. The individual may have cancer, or may have been determined to have cancer. The individual may have or have been identified as having CD19+ cancer or CD19+ tumor-associated non-tumor cells, such as CD19+ infiltrating B cells.

In the disclosed methods, the anti-CD 19ADC may be administered prior to the anti-BCL-2 agent, simultaneously with the anti-BCL-2 agent, or after the anti-BCL-2 agent. The disclosed methods can include administering an additional chemotherapeutic agent to the subject.

In another aspect, the present disclosure provides an anti-CD 19ADC or a composition comprising an anti-CD 19ADC for use in a method of treatment as described herein.

In one aspect, the present disclosure provides an anti-BCL-2 agent or a composition comprising an anti-BCL-2 agent for use in a method of treatment as described herein.

In another aspect, the present disclosure provides the use of an anti-CD 19ADC or an anti-BCL-2 ADC in the manufacture of a medicament for treating a disorder in a subject, wherein the treatment comprises a method of treatment as described herein.

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In another aspect, the present disclosure provides a first composition comprising an anti-CD 19ADC for use in a method of treating a disorder in an individual, wherein the treatment comprises administering the first composition in combination with a second composition comprising an anti-BCL-2 agent.

This aspect also provides a first composition comprising an anti-BCL-2 agent for use in a method of treating a disorder in an individual, wherein the treatment comprises administering the first composition in combination with a second composition comprising an anti-CD 19 ADC.

The anti-CD 19-ADC may be ADCX19 as described herein.

The first composition may be administered before, simultaneously with, or after the second composition. Treatment may include administering another chemotherapeutic agent to the subject.

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In another aspect, the present disclosure provides a use of an anti-CD 19ADC in the manufacture of a medicament for treating a disorder in an individual, wherein the medicament comprises an anti-CD 19ADC, and wherein the treatment comprises administering the medicament in combination with a composition comprising an anti-BCL-2 agent.

This aspect also provides for the use of an anti-BCL-2 agent in the manufacture of a medicament for treating a disorder in an individual, wherein the medicament comprises the anti-BCL-2 agent, and wherein the treatment comprises administering the medicament in combination with a composition comprising an anti-CD 19 ADC.

The anti-CD 19ADC may be ADCX19 as described herein.

The anti-BCL-2 agent may be Venetolara (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimeson (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

The drug may be administered prior to the composition, simultaneously with the composition, or after the composition. Treatment may include administering another chemotherapeutic agent to the subject.

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Another aspect of the disclosure provides a kit comprising:

a first drug comprising an anti-CD 19 ADC;

a package insert comprising instructions for administration of a first medicament according to a method of treatment as disclosed herein. The kit may additionally include a second agent comprising an anti-BCL-2 agent.

Another aspect of the disclosure provides a kit comprising:

a first drug comprising an anti-CD 19 ADC;

a second agent comprising an anti-BCL-2 agent; and optionally also (c) a second set of one or more of,

a package insert comprising instructions for administering a first medicament in combination with a second medicament to an individual to treat a disorder.

This aspect also provides a kit comprising a medicament comprising an anti-CD 19ADC and a package insert comprising instructions for administering the medicament to an individual in combination with a composition comprising an anti-BCL-2 agent to treat a disorder.

This aspect also provides a kit comprising a medicament comprising an anti-BCL-2 agent and a package insert comprising instructions for administering the medicament to an individual in combination with a composition comprising an anti-CD 19ADC to treat a disorder.

The anti-CD 19ADC may be ADCX19 as described herein.

The anti-BCL-2 agent may be Venetolara (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimeson (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

The drug or composition comprising the anti-CD 19ADC may be administered prior to, concurrently with, or after the drug or composition comprising the anti-BCL-2 agent. Treatment may include administering another chemotherapeutic agent to the subject.

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In yet another aspect, the present disclosure provides a composition comprising an anti-CD 19ADC and an anti-BCL-2 agent.

This aspect of the disclosure also provides a method of treating a disorder in an individual, comprising administering to the individual an effective amount of a composition comprising an anti-CD 19ADC and an anti-BCL-2 agent.

This aspect of the disclosure also provides a composition comprising an anti-CD 19ADC and an anti-BCL-2 agent for use in a method of treating a disorder in an individual.

This aspect of the disclosure also provides for the use of a composition comprising an anti-CD 19ADC and an anti-BCL-2 agent in the manufacture of a medicament for treating a disorder in a subject.

This aspect of the disclosure also provides a kit comprising a composition comprising an anti-CD 19ADC and an anti-BCL-2 agent, and a set of instructions for administering the drug to an individual to treat a disorder.

The anti-CD 19-ADC may be ADCX19 as described herein.

The anti-BCL-2 agent may be Venetolara (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimeson (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

Treatment may include administering another chemotherapeutic agent to the subject.

Drawings

Embodiments and experiments demonstrating the principles of the present disclosure will now be discussed with reference to the accompanying drawings, in which:

FIG. 1 sequence

The present disclosure includes combinations of the described aspects and preferred features unless such combinations are clearly not allowed or explicitly avoided.

The section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described.

Aspects and embodiments of the present disclosure will now be presented, by way of example, with reference to the accompanying drawings. Other aspects and embodiments will be apparent to those skilled in the art. All documents mentioned herein are incorporated by reference.

Throughout the specification, including the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.

It must be noted that, as used in the specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Ranges can be expressed herein as from "about" one particular value, and/or to "about" another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment.

Some embodiments

The following paragraphs describe some specific embodiments of the present disclosure:

1. a method of selecting an individual suitable for treatment with ADCx19 or ADCT-402, wherein if the individual has been treated with venetall, the individual is selected for ADCx19 or ADCT-402 treatment.

2. A method of selecting an individual suitable for treatment with ADCx19 or ADCT-402, wherein if the individual is being treated with venestaela, the individual is selected for ADCx19 or ADCT-402 treatment.

3. The method of any one of the preceding paragraphs, wherein the individual is selected for treatment if the individual is refractory to treatment or further treatment with vernetorale.

4.A method for treating a disorder in an individual, the method comprising:

(i) selecting an individual suitable for treatment by the method according to any one of paragraphs 1 to 3; and

(ii) administering to the individual an effective amount of ADCx19 or ADCT-402.

5. The method of paragraph 4, further comprising administering Venetular in combination with ADCx19 or ADCT-402.

6. A method for treating a disorder in an individual, the method comprising administering to the individual an effective amount of ADCx19 or ADCT-402 and venetall.

7. The method of paragraph 6, wherein the individual is selected for treatment according to the method of any one of paragraphs 1 to 3.

8. The method of any of paragraphs 5 to 7, wherein the treatment comprises administration of ADCx19 or ADCT-402 prior to, simultaneously with, or after venetolela.

9. The method of any one of the preceding paragraphs, wherein the treatment further comprises administering a chemotherapeutic agent.

10. The method of any one of the preceding paragraphs, wherein the subject is a human.

11. The method of any one of the preceding paragraphs, wherein the individual has or has been determined to have a disorder.

12. The method of paragraph 11, wherein the individual has or has been determined to have a cancer that expresses CD19 or CD19+ tumor-associated non-tumor cells, such as CD19+ infiltrating cells.

13. The method of any one of the preceding paragraphs, wherein the individual is receiving von Willebrand therapy.

14. The method of any one of the preceding paragraphs, wherein the subject has received vernetralan therapy.

15. The method of any one of the preceding paragraphs, wherein the subject is refractory to treatment or further treatment with venereal.

16. The method of any of the preceding paragraphs, wherein the treatment has increased efficacy compared to monotherapy with any of ADCx19 or ADCT-402 or venetall alone.

17. The method of any one of the preceding paragraphs, wherein the disorder is a proliferative disease.

18. The method of paragraph 17, wherein the disorder is cancer.

19. The method of paragraph 18, wherein the disorder is selected from the group comprising: non-hodgkin lymphomas (including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL) and marginal zone B-cell lymphoma (MZBL)) and leukemias (such as Hairy Cell Leukemia (HCL), hairy cell leukemia variants (HCL-v) and Acute Lymphoblastic Leukemia (ALL) (such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL))).

20. ADCx19 or ADCT-402 for use in a method of treatment according to any one of paragraphs 4 to 19.

21. A composition comprising ADCx19 or ADCT-402 for use in a method of treatment according to any one of paragraphs 4 to 19.

22. Venetular for use in a method of treatment according to any one of paragraphs 5 to 19.

23. A composition comprising vernetulara for use in a method of treatment according to any one of paragraphs 5 to 19.

Use of ADCx19 or ADCT-402 in the manufacture of a medicament for treating a disorder in a subject, wherein the treatment comprises the method according to any one of paragraphs 4 to 19.

25. Use of vernetorale in the manufacture of a medicament for treating a disorder in a subject, wherein the treatment comprises a method according to any one of paragraphs 5 to 19.

26. A kit, comprising:

a first drug comprising ADCx19 or ADCT-402;

a package insert comprising instructions for administration of the first medicament according to the method of any one of paragraphs 4 to 19.

27. The kit of paragraph 26, further comprising:

a second drug comprising vernetulara.

Statement of the invention

1. A method of selecting an individual suitable for treatment with an anti-CD 19ADC, wherein if the individual has been treated with an anti-BCL-2 agent, the individual is selected for the anti-CD 19ADC treatment.

2. A method of selecting an individual eligible for treatment with an anti-CD 19ADC, wherein if the individual is being treated with an anti-BCL-2 agent, the individual is selected for the anti-CD 19ADC treatment.

3. The method of any one of the preceding paragraphs, wherein the individual is selected for treatment if the individual is refractory to treatment or further treatment with the anti-BCL-2 agent.

4.A method for treating a disorder in an individual, the method comprising:

(i) selecting an individual suitable for treatment by the method according to any one of paragraphs 1 to 3; and

(ii) administering an effective amount of the anti-CD 19ADC to the individual.

5. The method of paragraph 4, further comprising administering an anti-BCL-2 agent in combination with the anti-CD 19 ADC.

6. A method for treating a disorder in an individual, comprising administering to the individual an effective amount of an anti-CD 19ADC and an anti-BCL-2 agent.

7. The method of paragraph 6, wherein the individual is selected for treatment according to the method of any one of paragraphs 1 to 3.

8. The method of any one of paragraphs 5 to 7, wherein the treatment comprises administration of the anti-CD 19ADC prior to the anti-BCL-2 agent, simultaneously with the anti-BCL-2 agent, or after the anti-BCL-2 agent.

9. The method of any one of the preceding paragraphs, wherein the treatment further comprises administering a chemotherapeutic agent.

10. The method of any one of the preceding paragraphs, wherein the subject is a human.

11. The method of any one of the preceding paragraphs, wherein the individual has or has been determined to have a disorder.

12. The method of paragraph 11, wherein the individual has or has been determined to have a cancer that expresses CD19 or CD19+ tumor-associated non-tumor cells, such as CD19+ infiltrating cells.

13. The method of any one of the preceding paragraphs, wherein the individual is receiving treatment with an anti-BCL-2 agent.

14. The method of any one of the preceding paragraphs, wherein the individual has been treated with an anti-BCL-2 agent.

15. The method of any one of the preceding paragraphs, wherein the subject is refractory to treatment or further treatment with the anti-BCL-2 agent.

16. The method of any one of the preceding paragraphs, wherein the treatment has increased efficacy compared to monotherapy with either the anti-CD 19ADC or anti-BCL-2 agent alone.

17. The method of any one of the preceding paragraphs, wherein the anti-CD 19ADC is ADCx 19.

The method of any one of the preceding paragraphs, wherein the anti-CD 19ADC is ADCT-402.

18. The method of any one of the preceding paragraphs, wherein the disorder is a proliferative disease.

19. The method of paragraph 18, wherein the disorder is cancer.

20. The method according to paragraph 19, wherein the disorder is selected from the group comprising: non-hodgkin lymphomas (including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL) and marginal zone B-cell lymphoma (MZBL)) and leukemias (such as Hairy Cell Leukemia (HCL), hairy cell leukemia variants (HCL-v) and Acute Lymphoblastic Leukemia (ALL) (such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL))).

21. The method of any one of the preceding paragraphs, wherein the anti-BCL-2 agent is selected from the group consisting of: venetulant (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimerson (G3139).

22. The method of any one of the preceding paragraphs, wherein the anti-BCL-2 agent is venestaela.

23. An anti-CD 19ADC for use in a method of treatment according to any one of paragraphs 4 to 22.

24.A composition comprising an anti-CD 19ADC for use in a method of treatment according to any one of paragraphs 4 to 22.

25. An anti-BCL-2 agent for use in the method of treatment according to any one of paragraphs 5 to 22.

26. A composition comprising an anti-BCL-2 agent for use in a method of treatment according to any one of paragraphs 5 to 22.

27. Use of an anti-CD 19ADC in the manufacture of a medicament for treating a disorder in an individual, wherein the treatment comprises a method according to any one of paragraphs 4 to 22.

28. Use of an anti-BCL-2 agent in the manufacture of a medicament for treating a disorder in a subject, wherein the treatment comprises a method according to any one of paragraphs 5 to 22.

29. A kit, comprising:

a first drug comprising an anti-CD 19 ADC;

a package insert comprising instructions for administration of the first medicament according to the method of any one of paragraphs 4 to 22.

30. The kit of paragraph 29, further comprising:

a second agent comprising an anti-BCL-2 agent.

Examples

In the following examples:

cell lines expressing CD19 suitable for use in the examples include Ramos, Daudi, Raji, WSU-DLCL and NALM-6 cells.

Disease a-diffuse large B-cell lymphoma/DLBC is an aggressive type of non-hodgkin's lymphoma, which develops from B-cells of the lymphatic system. It constitutes the largest subgroup of non-hodgkin lymphomas.

Disease B-mantle cell lymphoma/MCL is a rare B-cell NHL, most frequently affecting men over 60 years of age. The disease may be aggressive (rapid growth), but may also appear more indolent (slow growth) in some patients. MCL accounts for about five percent of all NHLs.

The disease C-follicular lymphoma/FL is a rather indolent NHL with a long survival time but is difficult to cure; it can also be converted into a more aggressive form of lymphoma.

Example 1

In a separate experiment, cell lines expressing CD19 were incubated with etoposide (negative control) and oxaliplatin (positive control), 1 μ g/mL anti-CD 19ADC (CD 19-targeted ADC with PBD dimer warhead), 1 μ g/mL anti-CD 19 (antibody in ADC), and 1 μ g/mL B12-SG3249 (non-binding control ADC, whose PBD payload was the same as anti-CD 19ADC) for 0, 6, 24, and 48 hours.

After incubation, the cells were washed, added to human Dendritic Cells (DCs), and left for an additional 24 hours. Activation of DCs was then measured by an increase in surface expression of CD86 on DC populations (determined by flow cytometry) and by measuring DC-mediated release of IL-8 and MIP 2.

Example 2

The aim of this study was to pre-evaluate the safety, tolerability, pharmacological and clinical activity of this combination

The following cancer types have been selected for study: disease A, disease B and disease C

Evidence that both drugs have efficacy as single agents:

anti-CD 19ADC (see, e.g., WO2014/057117, WO2016/166298, WO2014/057122 and WO2016/166307)

anti-BCL-2 agents (see KS Peggs et al 2009, Clinical and Experimental Immunology,157: 9-19 [ doi:10.1111/j.1365-2249.2009.03912.x ])

The primary purpose of this study is to investigate whether these agents can be safely combined and, if so, to identify one or more administrations and regimens suitable for further study. The study will also evaluate whether each combination induces a pharmacological change in the tumor that would indicate a potential clinical benefit.

Furthermore, this will provide preliminary evidence that the combination can increase response rate and response persistence compared to published data for single agent anti-CD 19ADC or anti-BCL-2 agent treatments.

Each disease group may include a subset of patients previously treated with an anti-BCL-2 agent to study whether combination therapy can overcome resistance to BCL-2 drug therapy. For each disease, no specific molecular selection was applied, as currently available data generally does not support exclusion of patients based on approved molecular diagnostic tests.

anti-CD 19 Rationale for starting dose of ADC

The established RDE for ADC (administered once every three weeks in ug/kg) will be used for all patients in the study. To ensure patient safety, a starting dose lower than RDE will be used; the starting dose level will be one at which patient benefit can still be demonstrated in study ADC1, indicating that patients enrolled at such dose levels will participate in achieving at least some benefit.

Rationale for anti-BCL-2 agent initial dose

An established RDE (in ug/kg, administered once every three weeks) against the BCL-2 agent will be used for all patients in this study. To ensure patient safety, a starting dose lower than RDE will be used; the starting dosage level will be one at which the beneficial effects of the patient can still be demonstrated in study SA1, indicating that patients enrolled at such dosage levels will participate in achieving at least some beneficial effects.

Targets and associated endpoints

Design of research

This phase Ib, multicenter, open label study was aimed at characterizing the safety, tolerability, Pharmacokinetics (PK), Pharmacodynamics (PD), and anti-tumor activity of ADC in combination with anti-BCL-2 agents in patients with disease a, disease B, and disease C.

The study included a dose escalation portion and a dose escalation portion.

For ADC and anti-BCL-2 agents, dose escalation will begin with a reduced initial dose (compared to their respective recommended phase 2 or approved dose levels) to ensure patient safety. The starting dose of each compound will be 33% (or 50%) of the RDE. Subsequently, the dose of the anti-BCL-2 agent will first be escalated until the RDE or approved dose is reached; if for tolerability reasons, the dose is reduced if necessary. The dose of ADC was then escalated until the RDE for the combination therapy was reached. As shown in the following figures:

if the dose combination is determined to be safe, tests can be performed in other patients to confirm the safety and tolerability of the dose level. The dosage of each compound can be further adjusted and/or the regimen can be varied.

The Bayesian Logistic Regression Model (BLRM) will guide the dose escalation of the combination according to any dose-limiting toxicity (DLT) observed in the first (or first two, TBC) cycles of treatment. The use of BLRM is an effective method to estimate the Maximum Tolerated Dose (MTD)/recommended increased dose (RDE) in cancer patients. Adaptive BLRM will be guided by the principle of excess control over Escalation (EWOC) to control the risk of DLT in future patients in the study. FDA and EMEA ("small-scale population clinical trial guideline", 2.1.2007) have accepted the use of bayesian response adaptation models for small data sets and received approval from many publications (Babb et al 1998, Neuenschwander et al 2008).

The decision on a new dose combination is made by the investigator and the sponsoring investigator in a Dose Escalation Safety Call (DESC) based on patient tolerability and safety information (including BLRM summary of DLT risk, if applicable) as well as PK, PD and preliminary activity information obtained at the time of decision.

Once the MTD/RDE for the combination is determined, an expanded portion of the study can be initiated to further evaluate safety, tolerability, and primary efficacy.

■ for IO combinations, changes in immune infiltration in the tumor will also be characterized after combination treatment for the disease indication of interest.

Given the prior clinical experience of the agents in this study, it is expected that in most cases, the combined dose can be determined without testing the majority of the dose levels or schedules. To assess the pharmacodynamic activity of the combination, the patient will be required to receive a tumor biopsy at baseline and again after approximately two treatment cycles.

■ for IO combinations: the varying degree of tumor infiltration by immune cells (including lymphocytes and macrophages) will help determine any potential beneficial effects.

Dose escalation section

During the dose escalation portion of the study, patients will be treated by i.v. administration of a fixed dose of ADC and increasing the dose of the anti-BCL-2 agent until the RDE of the anti-BCL-2 agent is reached. Subsequently, the dose of ADC was increased (in different cohorts) while the dose of anti-BCL-2 agent remained constant.

Two to about 3 or 4 patients with disease a, disease B or disease C will be treated in each ascending cohort until the MTD/RDE is determined.

A 24 hour observation will be made before the second patient is admitted at dose level 1. The DLT observation period for each dose level is 1 cycle (3 weeks) or 2 cycles (6 weeks) depending on the requirements of the appropriate institution for IO treatment, after which it will be determined whether to increment to the next dose level and either remain at the current dose level or decrement to the previous dose level for the next cohort. And not decreasing from dose level 1. Dose escalation in patients is not allowed.

Dose escalation is not allowed unless 2 or more patients have complete DLT information in the first cycle of any given dose level. Dose escalation will be determined by using a mCRM with a target DLT rate of 30%, equally spaced 20% to 35% and dose Escalation (EWOC) and no dose jump to control overdose.

The patient will be assigned to the active admission queue. After completion of one cycle of treatment, dose escalation will be performed for each combination. Safety assessments including Adverse Events (AEs) and laboratory values will be closely monitored for all enrolled patients to identify any DLTs. A single MTD/RDE will be defined; disease-specific MTD/RDE will not be established.

mCRM will be administered for DE under the supervision of the dose escalation guide committee (DESC). After reviewing all available safety data, the DESC will confirm each incremental dose level. PK data from patients at this and previous dose levels may also provide a basis for decision making. Depending on emerging PK, PD, toxicity or response data, DESC may stop dose escalation before determining MTD.

If at least 1 patient in the study achieved partial response or better results, or if the DESC deems it necessary to make further assessments of PK or PD data to determine RDE, then additional patients may be included at any dose to further assess safety and tolerability.

Dose escalation will be stopped after the same dose level is consecutively assigned to 3 cohorts (or at least 6 patients). If the MTD is not reached, a recommended escalation dose (RDE) will be determined. A minimum of 6 patients must be treated with the combination before MTD/RDE can be determined.

It is expected that paired tumor biopsies will be obtained from patients during dose escalation. Analysis of these living tissues will help to better understand the relationship between dose and combined pharmacodynamic activity.

Safety supervision of the dose escalation guidance committee

DESC, including ADC Therapeutics and researchers, will continuously review patient safety during DE to determine if the dose escalation schedule specified by mCRM needs to be modified. In addition to security observations, PK and/or PD data may also provide basis for decisions. Intermediate doses may be dispensed after agreement between ADC Therapeutics and the investigator. In section 2, the DESC may continue to provide supervision. The formal data security monitoring committee (DSMB) is not used.

Dose enlarging portion

Once the MTD/RDE is published, the dose enlargement can be initiated. The main purpose of the expanded section is to further evaluate the safety and tolerability of the study treatment at MTD/RDE and to initially understand the efficacy of this combination compared to historical single agent efficacy data.

An important exploratory goal is to assess changes in tumor immune infiltration in response to treatment. This will be evaluated in paired tumor biopsies collected from patients, with at least ten evaluable biopsies (biopsy samples must contain enough tumor for analysis) for patients receiving treatment at MTD/RDE. If this is not feasible, collection of these biopsies may be stopped. At least 10 to 20 patients were planned to be treated in each study group,

several different study groups will be opened, one for each disease. A total of nine study groups can be run in dose escalation. If inclusion of any of these groups is not feasible, inclusion of the group may be turned off before reaching the 10 to 20 patient goal.

In each treatment group, up to about six patients receiving prior single administration (i.e., no combined administration) of anti-BCL-2 agent therapy and progressing are allowed to be treated. This number can be increased if the combination shows promise to overcome resistance to prior treatments with a single administration of an anti-BCL-2 agent.

Patient population

The study will be performed in adult patients with advanced disease a, disease B or disease C as described above. The investigator or prescribing personnel must ensure that only patients who meet all of the inclusion criteria below and who do not meet any exclusion criteria are treated in the study.

Inclusion criteria

Patients eligible for inclusion in the study must meet all of the following criteria:

1. written informed consent must be obtained before any procedure can be performed

2. The age was 18 years.

3. Patients with advanced/metastatic cancer with measurable disease as defined by RECIST version 1.1 have progressed or are intolerant to standard therapy despite receiving standard therapy or have no standard therapy for the patient. The patient must belong to one of the following groups:

disease A

Disease B

Disease C

ECOG physical Performance status 0-1 (or 2TBC)

TBC: according to the guidelines of the treatment institution, the patient must have a disease site suitable for biopsy and be a candidate for tumor biopsy. The patient must be willing to receive a new tumor biopsy at baseline and again during the treatment period of the study.

6. Allowing prior treatment with an anti-BCL-2 agent or related compound (i.e., the same MOA)

Exclusion criteria

Patients eligible for this study should not meet any of the following criteria:

1. there was a history of severe hypersensitivity to other mAbs (either the same backbone mAb as in ADC or to the same IO mAb if applicable)

2. It is known that there is a history of serum human ADA positive for mAb backbone in ADC

3. Central Nervous System (CNS) diseases only (if applicable)

4. Evidence of symptomatic CNS metastasis or leptomeningeal disease (brain MRI or previously recorded cerebrospinal fluid (CSF) cytology)

Allowing asymptomatic CNS metastasis of previous treatments, provided that the last treatment (systemic anti-cancer treatment and/or local radiotherapy) is prior to day1 of administration>Completed 8 weeks, except where a decreasing low dose of steroid was allowed)

Patients with discrete dural metastases were eligible.

5. The patient's laboratory values were out of range, defined as:

serum creatinine 1.5 × ULN. If serum creatinine is >1.5, creatinine clearance (calculated or measured using the Cockcroft-Gault equation) must be >60mL/min/1.73m2 for a qualified patient

Total bilirubin >1.5 × ULN, except for Gilbert's syndrome patients (Gilbert's syndrome) with total bilirubin >3.0 × ULN or direct bilirubin >1.5 × ULN

Alanine Aminotransferase (ALT) >3 × ULN, except for patients with liver tumor involvement, and if ALT >5 × ULN, it is excluded

Aspartate Aminotransferase (AST) >3 × ULN, except for patients with liver tumor involvement, which is excluded if AST >5 × ULN

Absolute neutrophil count <1.0 × 10e9/L

Platelet count <75 × 10e9/L

Hemoglobin (Hgb) <8g/dL

Although appropriate replacement therapy was performed, potassium, magnesium, calcium or phosphate abnormalities > CTCAE grade 1

6. Cardiac function with impaired or clinically significant heart disease, including any of the following:

clinically significant and/or uncontrolled cardiac disease in need of treatment such as congestive heart failure (NYHA grade III or IV) or uncontrolled hypertension defined by Systolic Blood Pressure (SBP)160mmHg and/or Diastolic Blood Pressure (DBP)100mmHg with or without the use of antihypertensive agents.

When ECG is screened for congenital long QT syndrome using Friedrich (Fridericia) correction, female QTcF >470 ms or male QTcF >450 ms

Acute myocardial infarction or unstable angina at <3 months (months prior to study entry)

Clinically significant valvular disease and documented impaired cardiac function

Symptomatic pericarditis

Cardiomyopathy with a history or ongoing recording

Left Ventricular Ejection Fraction (LVEF) determined by Echocardiography (ECHO) or multi-gate acquisition (MUGA) scans < 40%

History of or presence of any clinically significant arrhythmia, e.g. ventricular, supraventricular, lymph node arrhythmia or conduction abnormalities (TBC qualifier: … … requires pacemaker or is not controlled by drug)

The presence of unstable atrial fibrillation (ventricular response rate >100 bpm).

Note: stable atrial fibrillation patients may be included if they do not meet other cardiac exclusion criteria.

Complete Left Bundle Branch Block (LBBB), double bundle block

Any clinically significant ST-segment and/or T-wave abnormalities

7. Toxicity due to previous IO therapy led to discontinuation of therapy. Patients who are adequately treated with alternative therapies for drug-related rashes or for endocrinopathies are not excluded, provided that these toxicities do not lead to cessation of prior treatment.

8. The patient has an active, known or suspected autoimmune disease. Subjects with the following diseases were allowed to enroll: vitiligo, type I diabetes, residual hypothyroidism resulting from autoimmune disease requiring only hormone replacement, psoriasis without the need for systemic treatment or disease that does not recur without external triggers, provided that the triggers can be avoided.

9. Infection with Human Immunodeficiency Virus (HIV) or active Hepatitis B (HBV) or Hepatitis C (HCV)

The test is not mandatory to be qualified. If a patient is at risk for undiagnosed HCV (e.g., a history of drug injections), then HCV testing should be considered.

10. Malignant diseases other than the malignant diseases being treated in this study. Excluded exceptions include the following: malignant tumors that were treated with efficacy and did not recur within 2 years prior to study treatment; complete removal of basal cell and squamous cell skin cancer; any malignancy that is considered inert and never requires treatment; and any type of carcinoma in situ that is completely resected.

11. Systemic anti-cancer treatment was performed within 2 weeks after the first dose of study treatment. For cytotoxic agents with significant delayed toxicity, such as mitomycin C and nitrosoureas, a clearance period of 4 weeks is indicated. For patients receiving anti-cancer immunotherapy, such as CTLA-4 antagonists, the washout period is 6 weeks.

12. Active diarrhea CTCAE grade 2 or medical conditions associated with chronic diarrhea (such as irritable bowel syndrome, inflammatory bowel disease)

13. There are 2: CTCAE grade 2 toxicity (except alopecia, peripheral neuropathy and ototoxicity, if > ═ CTCAE grade 3, then excluded) due to previous cancer treatments.

14. Active infections require systemic antibiotic treatment.

15. Active ulcer of upper digestive tract or gastrointestinal hemorrhage

16. Active hemorrhagic diathesis or oral anti-vitamin K medicine (except low dose warfarin and aspirin or equivalent medicine, as long as INR < 2.0)

17. Active autoimmune diseases, motor neuropathies and other CNS immune diseases considered to be of autoimmune origin

18. The patient is in need of concurrent treatment with an immunosuppressive agent or chronic treatment with a corticosteroid, except for the following:

alternative doses of steroids in case of adrenal insufficiency

Allowing topical, inhalation, nasal and ophthalmic steroids

19. Any live vaccine against infectious diseases (e.g. influenza, chicken pox, pneumococcus) was used within 4 weeks after initiation of study treatment (NB was not allowed to use live vaccine throughout the study)

20. Hematopoietic cell colony stimulating growth factors (e.g., G-CSF, GMCSF, M-CSF) were used <2 weeks prior to the start of the study drug. The red blood cell stimulating agent may be used as long as it begins at least 2 weeks prior to the first dose of study treatment.

21. Major surgery was performed within 2 weeks after the first dose of study treatment (NB mediastinoscopy, insertion of central venous access device, or insertion of feeding tube were not considered major surgery).

22. Radiation therapy was performed within 2 weeks after the first study drug administration, except palliative radiation therapy to a limited area, such as for the treatment of bone pain or a localized painful mass. To allow assessment of the response to treatment, the patient must have the remaining measurable disease not yet irradiated

23. One interventional study was enrolled within 2 weeks of the first dose of study treatment.

24. Researchers believe that patients are unable to attend any medical condition of a clinical study due to safety concerns, adherence to clinical study procedures or interpretation of study results.

25. Sexually active men, except that they used condoms during the dosing period at intercourse and 90 days after discontinuation of study treatment, and should not gestate their children during this period. Men undergoing vasectomy also need to use condoms to prevent drug delivery through the semen.

26. A pregnant or lactating woman is confirmed by positive laboratory testing for hCG, wherein pregnancy is defined as the state of the woman after conception until termination of pregnancy. In the rare case of endocrine gland-secreting tumors, hCG levels may be above normal limits, but the patient is not pregnant. In these cases, serum hCG testing (no elevated results) and vaginal/pelvic ultrasound examinations should be repeated to rule out pregnancy. After confirming the results and discussing with a medical representative, these patients may be entered into the study.

27. Women with fertility, defined as all women with physiological capacity to get pregnant, unless they have used an efficient contraceptive method during the study treatment and within 90 days after the last dose of the study treatment. The high-efficiency contraceptive method comprises the following steps:

complete abstinence (when this is consistent with the patient's preferred and usual lifestyle). Regular abstinence (e.g., calendar, ovulation, symptomatic body temperature, post-ovulation) and withdrawal are unacceptable methods of contraception

Female sterilization surgery (bilateral ovariectomy with or without hysterectomy in the past), total hysterectomy, or tubal ligation is performed at least 6 weeks prior to receiving study treatment. In the case of ovariectomy only, the reproductive status of the woman is determined only by follow-up hormone level assessment

Male sterilization (at least 6 months prior to screening). For a female patient in the study, the male partner undergoing vasectomy should be the only partner for that patient.

Combined contraceptive methods using oral (estrogen and progesterone), injection or implantation of hormones or placement of intrauterine devices (IUDs) or intrauterine systems (IUS) or other hormonal contraceptive methods with comparable efficacy (failure rate < 1%), such as hormonal vaginal rings or transdermal hormonal contraception.

If an oral contraceptive is used, the woman should be stable on the same pill for at least 3 months prior to receiving study treatment.

A woman is considered postmenopausal and non-fertile if he has a natural (spontaneous) amenorrhea of 12 months and has the appropriate clinical characteristics (e.g. appropriate age, history of vasomotor symptoms) or has had a bilateral ovariectomy (with or without hysterectomy) or tubal ligation (at least 6 weeks ago). Only in the case of ovariectomy was she considered to be infertile only when her reproductive status was confirmed by follow-up hormone level assessment.

Dose limiting toxicity and dose modification guidelines

Dose-limiting toxicity (DLT) is defined as any of the following events: what was considered at least likely to be related to ADC at the investigator's discretion to occur during the 21-day DLT assessment. Toxicity that is clearly and directly related to the primary disease or another etiology is not included in this definition.

DLT definition

Blood DLT is defined as:

■ 3 grade 3 or 4 febrile neutropenia or neutropenic infection

■ 4 grade neutropenia persists for >7 days

■ 4 grade thrombocytopenia

■ grade 3 thrombocytopenia with clinically significant bleeding or requiring platelet infusion

■ grade 3 anemia requiring transfusion

Grade ■ 4 anemia

Non-blood DLT is defined as:

■ 4 grade non-hematologic toxicity

■ grade 3 non-hematologic toxicity persists for >3 days, although optimal supportive treatment or medical intervention is achieved

■ example of Hai's Law (AST and/or ALT)>3×ULN，And isBilirubin>2×ULN，And isInitial discovery of serum alkaline phosphatase (ALP) Activity without cholestasis<2×ULN)，And isOther reasons cannot explain the combination of increased transaminase and serum total bilirubin, such as viral hepatitis A, B or C, previous or acute liver disease or other drugs that can cause the observed damage

■ 3 grade 3 or higher hypersensitivity/infusion related reactions (whether or not preoperative). Grade 3 hypersensitivity/infusion related reactions resolved by appropriate clinical management within 8 hours after onset do not qualify as DLT.

■ LVEF decreased from baseline to < 40% or > 20%

■ 4 grade oncolytic syndrome (grade 3 TLS does not constitute DLT unless irreversible end organ damage is caused)

The following cases are not considered non-blood DLT:

3 grade fatigue lasting 7 days or less

Grade 3 diarrhea, nausea or vomiting that occurs without prior administration, which responds to treatment and improves at least grade 1 within 3 days for grade 3 events, or falls to grade ≦ 1 within 7 days.

AST or ALT increase by 5 × ULN or more but 8 × ULN or less, while bilirubin does not increase at the same time and degrades to grade 2 or less within 5 days after the onset.

(iii) a grade 3 serum lipase or serum amylase for ≤ 7 days without clinical signs or symptoms of pancreatitis

Patients experiencing a DLT that can resolve or stabilize under appropriate medical management, the researcher may decide to continue treatment as appropriate, with negotiations with the sponsor.

Dose modification

The following table details the regulatory guidelines for a particular toxicity. To manage events not specified in the table, the following may be used as a researcher guide:

example 3

Method

MTT proliferation assays and IC50 calculations were performed on cell lines exposed to increased ADCx19 concentrations (96 hours). Pearson correlation coefficient (r): IC50 was calculated versus cell surface CD19 expression levels (absolute fluorescence quantification using Quantum simple Cellular microspheres; non-absolute data from PMID 29298756) and RNA levels (Illumina HT-12 array and HTG EdgeSeq tumor biomarker panel, data from PMID 29066507). 2 activated B-cell-like (ABC) DLBCL (OCI-LY-3, TMD8) and 2 Germinal Center (GCB) DLBCL (VAL, WSU-DLCL2) were evaluated for synergy at 96 hours by Chou-Talalay combination index (CI <0.9 for synergy CI, 0.9-1.1 for additive CI, and antagonism/no benefit CI > 1.1).

Results

The median of ADCx19 IC50 was 4pM (95% C.I, 2-10pM) in 48B-cell lymphoma cell lines and was over 800-fold in 9T-cell lymphoma cell lines (3.5 nM; 95% CI, 0.8-11nM) as expected from the CD19 expression pattern. Focusing on B-cell lymphomas, ADCx19 in vitro activity was correlated with its target expression measured at cell surface protein levels [ (absolute quantification, n-40, r-0.37P 0.02; non-absolute quantification, n-42, -0.48, P0.001 ] and RNA levels [ (array, n-39, -0.69P < 0.001; HTG, n-31, -0.73P 0.001 ]. in DLBCL, the presence of BCL2 and MYC translocation or TP53 inactivation did not affect sensitivity to ADCx 19.

ADCx19 was then combined with the BCL2 inhibitor Venetolara in GCB-and ABC-DLBCL cell lines

The combined use of ADCx19 and Venetulara can achieve synergistic effects in all cell lines

Cell line: OCI-LY3

RRID cell entry identifier: CVCL _8800

Cell line: TMD8

RRID cell entry identifier: CVCL _ A442

Reference documents: tohda et al, Leuk.Res.30:1385-1390(2006)

Cell line: VAL

RRID cell entry identifier: CVCL _1819

Cell line: WSU-DLCL2

RRID cell entry identifier: CVCL _1902

Conclusion

The potent single agent in vitro anti-lymphoma activity of ADCx19 correlates with its target expression and supports the ongoing clinical study of relapsed/refractory DLBCL. The novel vernetorale combination data indicate clinical synergy.

SEQUENCE LISTING

<110> ADC treatment Co., Ltd

MEDIMMUNE Ltd.

<120> combination therapy

<130> P21111550WP

<150> GB 1814207.5

<151> 2018-08-31

<150> GB 1908225.4

<151> 2019-06-10

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<223> anti-CD 19-ADC antibody RB4v1.0 VH

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Gln Val Gln Leu Val Gln Pro Gly Ala Glu Val Val Lys Pro Gly Ala

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Ser Val Lys Leu Ser Cys Lys Thr Ser Gly Tyr Thr Phe Thr Ser Asn

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Trp Met His Trp Val Lys Gln Arg Pro Gly Gln Gly Leu Glu Trp Ile

35 40 45

Gly Glu Ile Asp Pro Ser Asp Ser Tyr Thr Asn Tyr Asn Gln Asn Phe

50 55 60

Lys Gly Lys Ala Lys Leu Thr Val Asp Lys Ser Thr Ser Thr Ala Tyr

65 70 75 80

Met Glu Val Ser Ser Leu Arg Ser Asp Asp Thr Ala Val Tyr Tyr Cys

85 90 95

Ala Arg Gly Ser Asn Pro Tyr Tyr Tyr Ala Met Asp Tyr Trp Gly Gln

100 105 110

Gly Thr Ser Val Thr Val Ser

115

<210> 2

<211> 119

<212> PRT

<213> Artificial Sequence

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<223> anti-CD 19-ADC antibody RB4v1.2 VH

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Gln Val Gln Leu Val Gln Pro Gly Ala Glu Val Val Lys Pro Gly Ala

1 5 10 15

Ser Val Lys Leu Ser Cys Lys Thr Ser Gly Tyr Thr Phe Thr Ser Asn

20 25 30

Trp Met His Trp Val Lys Gln Ala Pro Gly Gln Gly Leu Glu Trp Ile

35 40 45

Gly Glu Ile Asp Pro Ser Asp Ser Tyr Thr Asn Tyr Asn Gln Asn Phe

50 55 60

Gln Gly Lys Ala Lys Leu Thr Val Asp Lys Ser Thr Ser Thr Ala Tyr

65 70 75 80

Met Glu Val Ser Ser Leu Arg Ser Asp Asp Thr Ala Val Tyr Tyr Cys

85 90 95

Ala Arg Gly Ser Asn Pro Tyr Tyr Tyr Ala Met Asp Tyr Trp Gly Gln

100 105 110

Gly Thr Ser Val Thr Val Ser

115

<210> 3

<211> 121

<212> PRT

<213> Artificial Sequence

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<223> anti-CD 19-ADC antibody B43 VH

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Gln Val Gln Leu Leu Glu Ser Gly Ala Glu Leu Val Arg Pro Gly Ser

1 5 10 15

Ser Val Lys Ile Ser Cys Lys Ala Ser Gly Tyr Ala Phe Ser Ser Tyr

20 25 30

Trp Met Asn Trp Val Lys Gln Arg Pro Gly Gln Gly Leu Glu Trp Ile

35 40 45

Gly Gln Ile Trp Pro Gly Asp Gly Asp Thr Asn Tyr Asn Gly Lys Phe

50 55 60

Lys Gly Lys Ala Thr Leu Thr Ala Asp Glu Ser Ser Ser Thr Ala Tyr

65 70 75 80

Met Gln Leu Ser Ser Leu Arg Ser Glu Asp Ser Ala Val Tyr Ser Cys

85 90 95

Ala Arg Arg Glu Thr Thr Thr Val Gly Arg Tyr Tyr Tyr Ala Met Asp

100 105 110

Tyr Trp Gly Gln Gly Thr Thr Val Thr

115 120

<210> 4

<211> 123

<212> PRT

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<223> anti-CD 19-ADC antibody HD37 VH

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Gln Val Gln Leu Gln Gln Ser Gly Ala Glu Leu Val Arg Pro Gly Ser

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Ser Val Lys Ile Ser Cys Lys Ala Ser Gly Tyr Ala Phe Ser Ser Tyr

20 25 30

Trp Met Asn Trp Val Lys Gln Arg Pro Gly Gln Gly Leu Glu Trp Ile

35 40 45

Gly Gln Ile Trp Pro Gly Asp Gly Asp Thr Asn Tyr Asn Gly Lys Phe

50 55 60

Lys Gly Lys Ala Thr Leu Thr Ala Asp Glu Ser Ser Ser Thr Ala Tyr

65 70 75 80

Met Gln Leu Ser Ser Leu Ala Ser Glu Asp Ser Ala Val Tyr Phe Cys

85 90 95

Ala Arg Arg Glu Thr Thr Thr Val Gly Arg Tyr Tyr Tyr Ala Met Asp

100 105 110

Tyr Trp Gly Gln Gly Thr Ser Val Thr Val Ser

115 120

<210> 5

<211> 120

<212> PRT

<213> Artificial Sequence

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<223> anti-CD 19-ADC antibody 4G7 VH

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Glu Val Gln Leu Gln Gln Ser Gly Pro Glu Leu Ile Lys Pro Gly Ala

1 5 10 15

Ser Val Lys Met Ser Cys Lys Ala Ser Gly Tyr Thr Phe Thr Ser Tyr

20 25 30

Val Met His Trp Val Lys Gln Lys Pro Gly Gln Gly Leu Glu Trp Ile

35 40 45

Gly Tyr Ile Asn Pro Tyr Asn Asp Gly Thr Lys Tyr Asn Glu Lys Phe

50 55 60

Lys Gly Lys Ala Thr Leu Thr Ser Asp Lys Ser Ser Ser Thr Ala Tyr

65 70 75 80

Met Glu Leu Ser Ser Leu Thr Ser Glu Asp Ser Ala Val Tyr Tyr Cys

85 90 95

Ala Arg Gly Thr Tyr Tyr Tyr Gly Ser Arg Val Phe Asp Tyr Trp Gly

100 105 110

Gln Gly Thr Thr Leu Thr Val Ser

115 120

<210> 6

<211> 119

<212> PRT

<213> Artificial Sequence

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<223> anti-CD 19-ADC antibody FMC63 VH

<400> 6

Glu Val Lys Leu Gln Glu Ser Gly Pro Gly Leu Val Ala Pro Ser Gln

1 5 10 15

Ser Leu Ser Val Thr Cys Thr Val Ser Gly Val Ser Leu Pro Asp Tyr

20 25 30

Gly Val Ser Trp Ile Arg Gln Pro Pro Arg Lys Gly Leu Glu Trp Leu

35 40 45

Gly Val Ile Trp Gly Ser Glu Thr Thr Tyr Tyr Asn Ser Ala Leu Lys

50 55 60

Ser Arg Leu Thr Ile Ile Lys Asp Asn Ser Lys Ser Gln Val Phe Leu

65 70 75 80

Lys Met Asn Ser Leu Gln Thr Asp Asp Thr Ala Ile Tyr Tyr Cys Ala

85 90 95

Lys His Tyr Tyr Tyr Gly Gly Ser Tyr Ala Met Asp Tyr Trp Gly Gln

100 105 110

Gly Thr Ser Val Thr Val Ser

115

<210> 7

<211> 104

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody RB4v1.0 VK

<400> 7

Glu Ile Val Leu Thr Gln Ser Pro Ala Ile Met Ser Ala Ser Pro Gly

1 5 10 15

Glu Arg Val Thr Met Thr Cys Ser Ala Ser Ser Gly Val Asn Tyr Met

20 25 30

His Trp Tyr Gln Gln Lys Pro Gly Thr Ser Pro Arg Arg Trp Ile Tyr

35 40 45

Asp Thr Ser Lys Leu Ala Ser Gly Val Pro Ala Arg Phe Ser Gly Ser

50 55 60

Gly Ser Gly Thr Ser Tyr Ser Leu Thr Ile Ser Ser Met Glu Pro Glu

65 70 75 80

Asp Ala Ala Thr Tyr Tyr Cys His Gln Arg Gly Ser Tyr Thr Phe Gly

85 90 95

Gly Gly Thr Lys Leu Glu Ile Lys

100

<210> 8

<211> 104

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody RB4v1.2 VK

<400> 8

Glu Ile Val Leu Thr Gln Ser Pro Ala Ile Met Ser Ala Ser Pro Gly

1 5 10 15

Glu Arg Val Thr Met Thr Cys Ser Ala Ser Ser Gly Val Asn Tyr Met

20 25 30

His Trp Tyr Gln Gln Lys Pro Gly Thr Ser Pro Arg Arg Trp Ile Tyr

35 40 45

Asp Thr Ser Lys Leu Ala Ser Gly Val Pro Ala Arg Phe Ser Gly Ser

50 55 60

Gly Ser Gly Thr Ser Tyr Ser Leu Thr Ile Ser Ser Met Glu Pro Glu

65 70 75 80

Asp Ala Ala Thr Tyr Tyr Cys His Gln Arg Gly Ser Tyr Thr Phe Gly

85 90 95

Gly Gly Thr Lys Leu Glu Ile Lys

100

<210> 9

<211> 111

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody B43 VK

<400> 9

Glu Leu Val Leu Thr Gln Ser Pro Ala Ser Leu Ala Val Ser Leu Gly

1 5 10 15

Gln Arg Ala Thr Ile Ser Cys Lys Ala Ser Gln Ser Val Asp Tyr Asp

20 25 30

Gly Asp Ser Tyr Leu Asn Trp Tyr Gln Gln Ile Pro Gly Gln Pro Pro

35 40 45

Lys Leu Leu Ile Tyr Asp Ala Ser Asn Leu Val Ser Gly Ile Pro Pro

50 55 60

Arg Phe Ser Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Asn Ile His

65 70 75 80

Pro Val Glu Lys Val Asp Ala Ala Thr Tyr His Cys Gln Gln Ser Thr

85 90 95

Glu Asp Pro Trp Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile Lys

100 105 110

<210> 10

<211> 111

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody HD37 VK

<400> 10

Asp Ile Leu Leu Thr Gln Thr Pro Ala Ser Leu Ala Val Ser Leu Gly

1 5 10 15

Gln Arg Ala Thr Ile Ser Cys Lys Ala Ser Gln Ser Val Asp Tyr Asp

20 25 30

Gly Asp Ser Tyr Leu Asn Trp Tyr Gln Gln Ile Pro Gly Gln Pro Pro

35 40 45

Lys Leu Leu Ile Tyr Asp Ala Ser Asn Leu Val Ser Gly Ile Pro Pro

50 55 60

Arg Phe Ser Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Asn Ile His

65 70 75 80

Pro Val Glu Lys Val Asp Ala Ala Thr Tyr His Cys Gln Gln Ser Thr

85 90 95

Glu Asp Pro Trp Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile Lys

100 105 110

<210> 11

<211> 112

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody 4G7 VK

<400> 11

Asp Ile Val Met Thr Gln Ala Ala Pro Ser Ile Pro Val Thr Pro Gly

1 5 10 15

Glu Ser Val Ser Ile Ser Cys Arg Ser Ser Lys Ser Leu Leu Asn Ser

20 25 30

Asn Gly Asn Thr Tyr Leu Tyr Trp Phe Leu Gln Arg Pro Gly Gln Ser

35 40 45

Pro Gln Leu Leu Ile Tyr Arg Met Ser Asn Leu Ala Ser Gly Val Pro

50 55 60

Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr Ala Phe Thr Leu Arg Ile

65 70 75 80

Ser Arg Val Glu Ala Glu Asp Val Gly Val Tyr Tyr Cys Met Gln His

85 90 95

Leu Glu Tyr Pro Phe Thr Phe Gly Ala Gly Thr Lys Leu Glu Leu Lys

100 105 110

<210> 12

<211> 107

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody FMC63 VK

<400> 12

Asp Ile Gln Met Thr Gln Thr Thr Ser Ser Leu Ser Ala Ser Leu Gly

1 5 10 15

Asp Arg Val Thr Ile Ser Cys Arg Ala Ser Gln Asp Ile Ser Lys Tyr

20 25 30

Leu Asn Trp Tyr Gln Gln Lys Pro Asp Gly Thr Val Lys Leu Leu Ile

35 40 45

Tyr His Thr Ser Arg Leu His Ser Gly Val Pro Ser Arg Phe Ser Gly

50 55 60

Ser Gly Ser Gly Thr Asp Tyr Ser Leu Thr Ile Ser Asn Leu Glu Gln

65 70 75 80

Glu Asp Ile Ala Thr Tyr Phe Cys Gln Gln Gly Asn Thr Leu Pro Tyr

85 90 95

Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile Thr

100 105

<210> 13

<211> 449

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody RB4v1.2-HC

<400> 13

Gln Val Gln Leu Val Gln Pro Gly Ala Glu Val Val Lys Pro Gly Ala

1 5 10 15

Ser Val Lys Leu Ser Cys Lys Thr Ser Gly Tyr Thr Phe Thr Ser Asn

20 25 30

Trp Met His Trp Val Lys Gln Ala Pro Gly Gln Gly Leu Glu Trp Ile

35 40 45

Gly Glu Ile Asp Pro Ser Asp Ser Tyr Thr Asn Tyr Asn Gln Asn Phe

50 55 60

Gln Gly Lys Ala Lys Leu Thr Val Asp Lys Ser Thr Ser Thr Ala Tyr

65 70 75 80

Met Glu Val Ser Ser Leu Arg Ser Asp Asp Thr Ala Val Tyr Tyr Cys

85 90 95

Ala Arg Gly Ser Asn Pro Tyr Tyr Tyr Ala Met Asp Tyr Trp Gly Gln

100 105 110

Gly Thr Ser Val Thr Val Ser Ser Ala Ser Thr Lys Gly Pro Ser Val

115 120 125

Phe Pro Leu Ala Pro Ser Ser Lys Ser Thr Ser Gly Gly Thr Ala Ala

130 135 140

Leu Gly Cys Leu Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val Ser

145 150 155 160

Trp Asn Ser Gly Ala Leu Thr Ser Gly Val His Thr Phe Pro Ala Val

165 170 175

Leu Gln Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val Val Thr Val Pro

180 185 190

Ser Ser Ser Leu Gly Thr Gln Thr Tyr Ile Cys Asn Val Asn His Lys

195 200 205

Pro Ser Asn Thr Lys Val Asp Lys Lys Val Glu Pro Lys Ser Cys Asp

210 215 220

Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro Glu Leu Leu Gly Gly

225 230 235 240

Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys Asp Thr Leu Met Ile

245 250 255

Ser Arg Thr Pro Glu Val Thr Cys Val Val Val Asp Val Ser His Glu

260 265 270

Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp Gly Val Glu Val His

275 280 285

Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr Arg

290 295 300

Val Val Ser Val Leu Thr Val Leu His Gln Asp Trp Leu Asn Gly Lys

305 310 315 320

Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu Pro Ala Pro Ile Glu

325 330 335

Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro Arg Glu Pro Gln Val Tyr

340 345 350

Thr Leu Pro Pro Ser Arg Glu Glu Met Thr Lys Asn Gln Val Ser Leu

355 360 365

Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp

370 375 380

Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys Thr Thr Pro Pro Val

385 390 395 400

Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp

405 410 415

Lys Ser Arg Trp Gln Gln Gly Asn Val Phe Ser Cys Ser Val Met His

420 425 430

Glu Ala Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro

435 440 445

Gly

<210> 14

<211> 211

<212> PRT

<213> Artificial Sequence

<220>

<223> anti-CD 19-ADC antibody RB4v1.2-LC

<400> 14

Glu Ile Val Leu Thr Gln Ser Pro Ala Ile Met Ser Ala Ser Pro Gly

1 5 10 15

Glu Arg Val Thr Met Thr Cys Ser Ala Ser Ser Gly Val Asn Tyr Met

20 25 30

His Trp Tyr Gln Gln Lys Pro Gly Thr Ser Pro Arg Arg Trp Ile Tyr

35 40 45

Asp Thr Ser Lys Leu Ala Ser Gly Val Pro Ala Arg Phe Ser Gly Ser

50 55 60

Gly Ser Gly Thr Ser Tyr Ser Leu Thr Ile Ser Ser Met Glu Pro Glu

65 70 75 80

Asp Ala Ala Thr Tyr Tyr Cys His Gln Arg Gly Ser Tyr Thr Phe Gly

85 90 95

Gly Gly Thr Lys Leu Glu Ile Lys Arg Thr Val Ala Ala Pro Ser Val

100 105 110

Phe Ile Phe Pro Pro Ser Asp Glu Gln Leu Lys Ser Gly Thr Ala Ser

115 120 125

Val Val Cys Leu Leu Asn Asn Phe Tyr Pro Arg Glu Ala Lys Val Gln

130 135 140

Trp Lys Val Asp Asn Ala Leu Gln Ser Gly Asn Ser Gln Glu Ser Val

145 150 155 160

Thr Glu Gln Asp Ser Lys Asp Ser Thr Tyr Ser Leu Ser Ser Thr Leu

165 170 175

Thr Leu Ser Lys Ala Asp Tyr Glu Lys His Lys Val Tyr Ala Cys Glu

180 185 190

Val Thr His Gln Gly Leu Ser Ser Pro Val Thr Lys Ser Phe Asn Arg

195 200 205

Gly Glu Cys

210

<210> 15

<211> 18

<212> DNA

<213> Artificial Sequence

<220>

<223> Olimoeson (G3139) oligonucleotide Structure

<400> 15

tctcccagcg tgcgccat 18

Detailed Description

Antibody Drug Conjugates (ADC)

The present disclosure relates to improved efficacy of a combination of ADC and an anti-BCL-2 agent.

The ADC may deliver the drug to the target site. The target site is preferably a proliferative cell population. Antibodies are antibodies to antigens present on a proliferative cell population. In one aspect, no antigen or a low level of antigen is present in the non-proliferative cell population as compared to the amount of antigen present in the proliferative cell population (e.g., tumor cell population).

The ADC may include a linker that can be cleaved to release the drug at the target site. The drug may be a compound selected from RelA, RelB, RelC, RelD or RelE. Thus, the conjugates can be used to selectively provide compounds RelA, RelB, RelC, RelD, or RelE to a target location.

The linker may be cleaved by an enzyme present at the target site.

The present disclosure is particularly directed to treatment with an anti-CD 19ADC disclosed in WO2014/057117 and as described herein.

anti-CD 19ADC

As used herein, the term "anti-CD 19 ADC" or "CD 19-ADC" refers to an ADC in which the antibody component is an anti-CD 19 antibody. The term "PBD-ADC" refers to a compound in which the drug component is a pyrrolobenzodiazepine(PBD) ADC of warheads. The term "anti-CD 19-ADC" refers to an ADC in which the antibody component is an anti-CD 19 antibody and the drug component is a PBD warhead.

The ADC may comprise the formula L- (D)^L)_pThe conjugate of (1), wherein D^LIs of formula I or II:

wherein:

l is an antibody (Ab), i.e. an antibody that binds to CD 19;

when there is a double bond between C2 'and C3', R¹²Selected from the group consisting of:

(ia)C_5-10an aryl group optionally substituted with one or more substituents selected from the group comprising: halogen, nitro, cyano, ether, carboxyl, ester, C_1-7Alkyl radical, C_3-7Heterocyclyl and bis-oxy-C_1-3An alkylene group;

(ib)C_1-5a saturated aliphatic alkyl group;

(ic)C_3-6a saturated cycloalkyl group;

(id)wherein R is²¹、R²²And R²³Is independently selected from H, C_1-3Saturated alkyl radical, C_2-3Alkenyl radical, C_2-3Alkynyl and cyclopropyl, wherein R¹²Radical (I)The total number of carbon atoms in (A) does not exceed 5;

(ie)wherein R is^25aAnd R^25bOne of which is H and the other is selected from: phenyl, optionally substituted with a group selected from halo, methyl, methoxy; a pyridyl group; and thienyl; and

(if)wherein R is²⁴Selected from: h; c_1-3A saturated alkyl group; c_2-3An alkenyl group; c_2-3An alkynyl group; a cyclopropyl group; phenyl, optionally substituted with a group selected from halo, methyl, methoxy; a pyridyl group; and thienyl;

when there is a single bond between C2' and C3

R¹²Is thatWherein R is^26aAnd R^26bIndependently selected from H, F, C_1-4Saturated alkyl radical, C_2-3Alkenyl, said alkyl and alkenyl groups optionally being selected from C_1-4Alkylamino radical and C_1-4Alkyl ester group substitution; or, when R is^26aAnd R^26bWhen one of them is H, the other is selected from the group consisting of nitrile and C_1-4An alkyl ester;

R⁶and R⁹Independently selected from H, R, OH, OR, SH, SR, NH₂NHR, NRR', nitro, Me₃Sn and a halogen group;

wherein R and R' are independently selected from optionally substituted C_1-12Alkyl radical, C_3-20Heterocyclyl and C_5-20An aryl group;

R⁷selected from H, R, OH, OR, SH, SR, NH₂NHR, NHRR', nitro, Me₃Sn and a halogen group;

r' is C_3-12Alkylene groups, the chain of which may be interrupted by one or more hetero atomsE.g. O, S, NR^N2(wherein R is^N2Is H or C_1-4Alkyl), and/or aromatic rings (e.g., benzene or pyridine);

y and Y' are selected from O, S or NH;

R^6’、R^7’、R^9’is selected from the group consisting of⁶、R⁷And R⁹The same groups.

[ formula I ]

R^L1’Is a linker for attachment to an antibody (Ab);

R^11aselected from OH, OR^AWherein R is^AIs C_1-4Alkyl, and SO_zM, wherein z is 2 or 3, and M is a monovalent pharmaceutically acceptable cation;

R²⁰and R²¹Either of which together form a double bond between the nitrogen and carbon atoms to which they are bound, or;

R²⁰selected from H and R^CWherein R is^CIs a capping group;

R²¹selected from OH, OR^AAnd SO_zM；

When there is a double bond between C2 and C3, R²Selected from the group consisting of:

(ib)C_1-5a saturated aliphatic alkyl group;

(ic)C_3-6a saturated cycloalkyl group;

(id)wherein R is¹¹、R¹²And R¹³Each of which is independently selected from H, C_1-3Saturated alkyl radical, C_2-3Alkenyl radical, C_2-3Alkynyl and cyclopropyl, wherein R²The total number of carbon atoms in the group is not more than 5;

(ie)wherein R is^15aAnd R^15bOne of which is H and the other is selected from: phenyl, optionally substituted with a group selected from halo, methyl, methoxy; a pyridyl group; and thienyl; and

(if)wherein R is¹⁴Selected from: h; c_1-3A saturated alkyl group; c_2-3An alkenyl group; c_2-3An alkynyl group; a cyclopropyl group; phenyl, optionally substituted with a group selected from halo, methyl, methoxy; a pyridyl group; and thienyl;

when a single bond is present between C2 and C3,

R²is thatWherein R is^16aAnd R^16bIndependently selected from H, F, C_1-4Saturated alkyl radical, C_2-3Alkenyl, wherein alkyl and alkenyl groups are optionally selected from C_1-4Alkylamino radical and C_1-4Alkyl ester group substitution; or, when R is^16aAnd R^16bWhen one of them is H, the other is selected from the group consisting of nitrile and C_1-4An alkyl ester;

[ formula II ]

R²²Having formula IIIa, formula IIIb, or formula IIIc:

(a)

wherein A is C_5-7An aryl radical, and

(i)Q¹is a single bond, and Q²Selected from the group consisting of single bonds and-Z- (CH)₂)_n-, wherein Z is selected from the group consisting of a single bond, O, S and NH, and n is 1 to 3; or

(ii)Q¹is-CH ═ CH-, and Q²Is a single bond;

(b)

wherein;

R^C1、R^C2and R^C3Independently selected from H and unsubstituted C_1-2An alkyl group;

(c)

wherein Q is selected from O-R^L2'、S-R^L2' and NR^N-R^L2', and R^NSelected from H, methyl and ethyl

X is selected from the group comprising: O-R^L2’、SR^L2’、CO₂-R^L2’、CO-R^L2’、NH-C(＝O)-R^L2’、NHNH-R^L2’、CONHNH-R^L2’、NR^NR^L2’Wherein R is^NSelected from the group comprising: h and C_1-4An alkyl group;

R^L2' is a linker for attachment to an antibody (Ab);

R¹⁰and R¹¹Either of which together form a double bond between the nitrogen and carbon atoms to which they are bound, or;

R¹⁰is H, and R¹¹Selected from OH, OR^AAnd SO_zM；

R³⁰And R³¹Either of which together form a double bond between the nitrogen and carbon atoms to which they are bound, or;

R³⁰is H, and R³¹Selected from OH, OR^AAnd SO_zM。

In some embodiments, L-R^L1’Or L-R^L2’Is the group:

wherein the asterisk indicates the point of attachment to PBD, Ab is an antibody, L¹Is a cleavable linker, A is¹Linking group to an antibody, L²Is a covalent bond or forms a self-immolative linker together with-OC (═ O) -.

In some of these embodiments, L¹Is enzymatically cleavable.

It has been previously shown that such ADCs can be used to treat cancers that express CD19 (see, e.g., WO2014/057117, which is incorporated herein by reference in its entirety).

The term anti-CD 19-ADC may include any of the embodiments described in WO 2014/057117. Specifically, in a preferred embodiment, the ADC may have the following chemical structure:

wherein Ab is CD19 antibody and DAR is between 1 and 8.

The antibody may comprise a VH domain having a sequence according to any one of SEQ ID NOs 1,2, 3,4, 5 or 6, optionally further comprising a VL domain having a sequence according to any one of SEQ ID NOs 7, 8, 9, 10, 11 or 12.

In some aspects, the antibody component of the anti-CD 19-ADC is an antibody comprising the following domains: VH and VL domains having the following sequences, respectively: 1 and 7, 2 and 8, 3 and 9, 4 and 10, 5 and 11, or 6 and 12.

In a preferred embodiment, the antibody comprises a VH domain having a sequence according to SEQ ID NO 2. In a preferred embodiment, the antibody comprises a VL domain having a sequence according to SEQ ID NO 8.

In a preferred embodiment, the antibody comprises a VH domain having the sequence of SEQ ID NO. 2 and a VL domain having the sequence of SEQ ID NO. 8.

One or more of the VH and VL domains may be paired to form an antibody antigen-binding site that binds CD 19.

In some embodiments, the antibody is a complete antibody comprising a VH domain and a VL domain having the sequences of SEQ ID NO. 2 and SEQ ID NO. 8.

In some embodiments, the antibody is an antibody comprising a heavy chain having the sequence of SEQ ID NO. 13 and a light chain having the sequence of SEQ ID NO. 14.

In some embodiments, the antibody is a fully human monoclonal IgG1 antibody, preferably IgG1, κ.

In some embodiments, the antibody is the rb4v1.2 antibody described in WO 2014/057117.

In one aspect, the antibody is an antibody as described herein that has been modified (or further modified) as described below. In some embodiments, the antibody is a humanized, deimmunized, or resurfaced version of an antibody disclosed herein.

The most preferred anti-CD 19-ADC used in aspects of the present disclosure is ADCx19, as described herein below.

A less preferred anti-CD 19-ADC for use with aspects of the present disclosure is ADCT-402.

ADCx19

ADCx19 is an antibody drug conjugate consisting of a humanized antibody against human CD19 attached to a pyrrolobenzodiazepine via a cleavable linker(PBD) warhead. The mechanism of action of ADCX19 is dependent on CD19 binding. The CD 19-specific antibody targets the Antibody Drug Conjugate (ADC) to cells expressing CD 19. Upon binding, the ADC is internalized and transported to lysosomes where the protease-sensitive linker is cleaved and the free PBD dimer is released within the target cell. Due to direct inhibition of RNA polymerase or inhibition of interaction of related transcription factors, the released PBD dimers are selected by sequenceInhibiting transcription in a selective manner. The PBD dimer creates covalent crosslinks that do not distort the DNA double helix and are not recognized by nucleotide excision repair factors, allowing for extended lifetimes (Hartley 2011).

ADCX19 has the following chemical structure:

ab denotes antibody RB4v1.2 (antibody with VH and VL sequences of SEQ ID NO:2 and SEQ ID NO:8, respectively). It can be synthesized as described in WO2014/057117(rb4v1.2-E) and typically has a DAR (ratio of drug to antibody) of 2 +/-0.3.

CD19 binding

As used herein, "bind CD 19" is used to refer to antibodies that bind CD19 with higher affinity than non-specific partners such as bovine serum albumin (BSA, Genbank accession number CAA76847, version number CAA76847.1 GI:3336842, record update date: 2011 1/7 days, 2:30 pm). In some embodiments, the antibody binds CD19, the association constant (K) when measured under physiological conditions_a) At least 2,3,4, 5, 10, 20, 50, 100, 200, 500, 1000, 2000, 5000, 10 of the association constant of an antibody to BSA⁴、10⁵Or 10⁶And (4) doubling. The antibodies of the invention can bind CD19 with high affinity. For example, in some embodiments, the antibody may bind to CD19, where K is_DEqual to or less than about 10^-6M, such as 1X 10^-6、10^-7、10^-8、10^-9、10^-10、10^-11、10^-12、10^-13Or 10^-14。

In some embodiments, the CD19 polypeptide corresponds to Genbank accession No. NP _001171569, version number NP _001171569.1GI:296010921, record update date: 9/10/2012, 12:43 am. In one embodiment, the nucleic acid encoding a CD19 polypeptide corresponds to Genbank accession No. NM _001178098, version No. NM _001178098.1GI:296010920, record update date: 9/10/2012, 12:43 am. In some embodiments, the CD19 polypeptide corresponds to Uniprot/Swiss-Prot accession number P15391.

anti-BCL-2 agents

Suitable anti-BCL-2 agents include Venetulan (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimeson (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

BCL-2 is localized to the outer membrane of mitochondria, where it plays an important role in promoting cell survival and inhibiting the action of pro-apoptotic proteins. Pro-apoptotic proteins in the BCL-2 family (including Bax and Bak) typically act on the mitochondrial membrane to promote the permeabilization and release of cytochrome C and ROS, which are important signals in the apoptotic cascade. These pro-apoptotic proteins are in turn activated by the BH 3-only protein and inhibited by the function of BCL-2 and its counterpart BCL-Xl. The kinetic effects of pro-apoptotic and anti-apoptotic proteins, among other proteins, may alter the importance of increased BCL-2 expression in human diseases. However, the multiple cancer types (both hematologic and non-hematologic solid tumors) associated with aberrant expression of BCL-2 are consistent with its role as a regulator of apoptosis (see Hanada M. et al, blood.1993; 82: 1820-.

An "anti-BCL-2 agent" is used herein to refer to any agent that specifically binds to BCL-2 and/or inhibits the biological activity of BCL-2.

As used herein, "specifically binds BCL-2" is used to refer to an agent that binds BCL-2 with a higher affinity than a non-specific partner, such as bovine serum albumin (BSA, Genbank accession number CAA76847, version number CAA76847.1 GI:3336842, record update date: 2011 1/7 days, 2:30 pm). In some embodiments, the agent binds BCL-2, the association constant (K) when measured under physiological conditions_a) Is at least 2,3,4, 5, 10, 20, 50, 100, 200, 500, 1000, 2000, 5000, 10 of the association constant of the agent for BSA⁴、10⁵Or 10⁶And (4) doubling. The agent can bind BCL-2 with high affinity. For example, inIn some embodiments, the agent may bind to BCL-2, where K_DEqual to or less than about 10^-6M, such as 1X 10^-6、10^-7、10^-8、10^-9、10^-10、10^-11、10^-12、10^-13Or 10^-14。

In some embodiments, the BCL-2 polypeptide corresponds to Genbank accession No. AAB72092, version number AAB72092.1, record update date: 24/7/2016 at 2:22 pm. In one embodiment, the nucleic acid encoding a BCL-2 polypeptide corresponds to Genbank accession No. AF021792, version number AF021792.1, record update date: 24/7/2016 at 2:22 pm. In some embodiments, the BCL-2 polypeptide corresponds to Uniprot/Swiss-Prot accession number Q92934.

To show that the CD19ADC synergizes with the anti-BCL-2 agent, a panel of CD19(+) cell lines were co-treated with both the anti-CD 19ADC and the anti-BCL-2 agent at a range of concentrations. As negative controls, the same set of cell lines were treated with a range of concentrations of anti-BCL-2 agent or a range of concentrations of anti-CD 19ADC and vehicle. After incubation, two parameters were measured: the amount of surface CD19 (determined by flow cytometry) and the combined in vitro cytotoxicity (determined by MTS assay). To determine cytotoxicity, cell viability was measured by adding MTS per well and incubating for 4 hours at 37 ℃. The percent cell viability was calculated relative to untreated controls. The cytotoxic synergy was calculated by the following method: cell viability data was converted to affected scores and the CalcuSyn analysis program was used to calculate the combination index.

anti-CBCL-2 agents suitable for use in the present disclosure include:

a) venetulara (ABT-199)

CAS number → 1257044-40-8

(see http:// www.cas.org/content/chemical-substances/faqs)

Drug bank reference → DB11581

(see https:// www.drugbank.ca /)

Unique identification code (UNII) → N54AIC43PW

(see http:// www.fda.gov/ForIndustry/DataStandards/Presence registration System-uniqueIngredientIdentifier UNII/default. htm)

Formula I: venetolara

b) Navitoxsi (ABT-263)

CAS number → 923564-51-6

(see http:// www.cas.org/content/chemical-substances/faqs)

Unique identification code (UNII) → XKJ5VVK2WD

(see http:// www.fda.gov/ForIndustry/DataStandards/Presence registration System-uniqueIngredientIdentifier UNII/default. htm)

Formula II: navitoxci

c)ABT-737

CAS number → 852808-04-9

(see http:// www.cas.org/content/chemical-substances/faqs)

Unique identification code (UNII) → Z5NFR173NV

(see http:// www.fda.gov/ForIndustry/DataStandards/Presence registration System-uniqueIngredientIdentifier UNII/default. htm)

Formula III: ABT-737

d)S55746/BCL201

CAS number → 1448584-12-0

(seehttp://www.cas.org/content/chemical-substances/faqs)

Formula IV: SS55746

e) Olimoesen (G3139)

CAS number → 190977-41-4

(seehttp://www.cas.org/content/chemical-substances/faqs)

Drug bank reference → DB06650

(see https:// www.drugbank.ca /)

Unique identification code (UNII) → 85J5ZP6YSL

(seehttp://www.fda.gov/ForIndustry/DataStandards/ SubstanceRegistrationSystem-UniqueIngredientIdentifierUNII/default.htm)

Oligonucleotide structure: d (P-thio) (T-C-T-C-C-A-G-C-G-T-G-C-G-C-C-A-T)

------------------------------------------

Advantageous properties of the combination

When both anti-CD 19ADC and anti-BCL-2 agents are used as separate single agents, they have demonstrated clinical utility, for example, in the treatment of cancer. However, as described herein, it is contemplated that the combination of anti-CD 19ADC and anti-BCL-2 agent may provide one or more of the following advantages over treatment with either of the anti-CD 19ADC or anti-BCL-2 agent:

1) effective in treating a wider range of cancers;

2) resistant or refractory forms effective in treating a disorder, such as cancer, and individuals with a disorder that recurs after remission (such as cancer);

3) increasing the response rate to treatment; and/or

4) Improving the durability of the treatment.

Effective treatment of cancer as used herein more broadly means that, after use of combination therapy, a complete response is observed in a wider range of recognized cancer types. That is, a complete response was observed from a cancer type that did not previously report a complete response to either anti-CD 19ADC or anti-BCL-2 agent alone.

Effective treatment in a resistant, refractory, or relapsed form as used herein means that, after treatment with the combination therapy, a complete response is observed in individuals who are partially or completely resistant or refractory to treatment with either of the anti-CD 19ADC or anti-BCL-2 agents alone (e.g., individuals who do not respond or show only a partial response after treatment with either agent alone, or those with relapsed disease). In some embodiments, at least 10% of individuals who are partially or completely resistant or refractory to treatment with either of the anti-CD 19ADC or anti-BCL-2 agent alone are observed to develop a complete response following treatment with the anti-CD 19 ADC/anti-BCL-2 agent combination. In some embodiments, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 98%, or at least 99% of individuals who are partially or fully resistant or refractory to treatment with either of the anti-CD 19ADC or anti-BCL-2 agent alone are observed to develop a complete response following treatment with the anti-CD 19 ADC/anti-BCL-2 agent combination.

An increased response rate to treatment as used herein means that a complete response is observed in a greater proportion of individuals following treatment with the combination therapy than is observed following treatment with either of the anti-CD 19ADC or anti-BCL-2 agent alone. In some embodiments, at least 10% of treated individuals are observed to produce a complete response following treatment with the anti-CD 19 ADC/anti-BCL-2 agent combination. In some embodiments, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 98%, or at least 99% of treated individuals are observed to produce a complete response following treatment with the anti-CD 19 ADC/anti-BCL-2 agent combination.

As used herein, increased persistence of treatment means that the average duration of a complete response in an individual using combination therapy is longer than the duration of an individual achieving a complete response following treatment with either of the anti-CD 19ADC or anti-BCL-2 agent alone. In some embodiments, the average duration of a complete response is at least 6 months following treatment with the anti-CD 19 ADC/anti-BCL-2 agent combination. In some embodiments, the average duration of a complete response after treatment with the anti-CD 19 ADC/anti-BCL-2 agent combination is at least 12 months, at least 18 months, at least 24 months, at least 3 years, at least 4 years, at least 5 years, at least 6 years, at least 7 years, at least 8 years, at least 9 years, at least 10 years, at least 15 years, or at least 20 years.

"complete response" is used herein to refer to any clinical evidence of the absence of disease in an individual. Evidence can be assessed using appropriate methods in the art, such as CT or PET scans, or appropriate biopsies. The number of doses required to achieve a complete response may be one, two, three, four, five, ten or more doses. In some embodiments, the subject achieves a complete response no more than one year after administration of the first dose, such as no more than 6 months, no more than 3 months, no more than one month, no more than two weeks, or no more than one week after administration of the first dose.

The disorder treated

The combination therapies described herein include those useful for anti-cancer activity. In particular, in certain aspects, the therapy includes an antibody conjugated (i.e., covalently linked through a linker) to a PBD drug moiety (i.e., a toxin). PBD drugs have cytotoxic effects when the drug is not conjugated to an antibody. Thus, the biological activity of the PBD drug moiety is modulated by conjugation to an antibody. The antibody-drug conjugates (ADCs) of the present disclosure selectively deliver an effective dose of cytotoxic agent to tumor tissue, such that higher selectivity (i.e., lower effective dose) can be achieved.

Accordingly, in one aspect, the present disclosure provides a combination therapy comprising administering an anti-CD 19ADC that binds CD19 for treatment, wherein the method comprises selecting a subject according to the expression of a target protein.

In one aspect, the present disclosure provides a combination therapy using markers that indicate that the therapy is suitable for use with a subject determined to be suitable for such use. The marker may indicate that the therapy is applicable to a subject with expression of CD19 (such as overexpression of CD 19). The indicia can indicate that the subject has a particular type of cancer.

The cancer may be a lymphoma, such as non-hodgkin's lymphoma. The marker may indicate that the subject has CD19+ lymphoma.

In another aspect, there is also provided a combination therapy as described herein for the treatment of a proliferative disease. Another aspect of the disclosure provides the use of a conjugate compound in the manufacture of a medicament for the treatment of a proliferative disease.

One of ordinary skill in the art can readily determine whether a candidate combination therapy is capable of treating a proliferative disease of any particular cell type. For example, the following describes assays that may be conveniently used to assess the activity provided by a particular compound.

The combination therapies described herein can be used to treat proliferative diseases. The term "proliferative disease" relates to unwanted or uncontrolled cellular proliferation of excess or abnormal cells, which is undesirable, such as neoplastic or proliferative growth in vitro or in vivo.

Examples of proliferative disorders include, but are not limited to, benign, pre-malignant, and malignant cell proliferation, including, but not limited to, neoplasms and tumors (e.g., histiocytoma, glioma, astrocytoma, osteoma), cancer (e.g., lung cancer, small cell lung cancer, gastrointestinal cancer, intestinal cancer, colon cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, liver cancer, kidney cancer, bladder cancer, pancreatic cancer, brain cancer, sarcoma, osteosarcoma, kaposi's sarcoma, melanoma), lymphoma, leukemia, psoriasis, bone disease, fibroproliferative disorders (e.g., fibroproliferative disorders of connective tissue), and atherosclerosis. Cancers of interest include, but are not limited to, leukemia and ovarian cancer.

Any type of cell can be treated, including but not limited to lung, gastrointestinal tract (including, e.g., intestine, colon), breast (breast), ovary, prostate, liver (liver), kidney (kidney), bladder, pancreas, brain, and skin.

Proliferative diseases of particular interest include, but are not limited to, non-hodgkin's lymphoma (including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL), and marginal zone B-cell lymphoma (MZBL)) and leukemias (such as Hairy Cell Leukemia (HCL), hairy cell leukemia variants (HCL-v), and Acute Lymphoblastic Leukemia (ALL) (such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL))). [ Fielding A., 1 month of Haematologica.2010; 95(1):8-12].

It is contemplated that the combination therapies of the present disclosure may be used to treat a variety of diseases or disorders, for example, diseases or disorders characterized by overexpression of a tumor antigen. Exemplary conditions or hyperproliferative disorders include benign or malignant tumors; leukemia, hematologic and lymphoid malignancies. Other diseases include neuronal diseases, glial cell diseases, astrocytic diseases, hypothalamic diseases, glandular diseases, macrophage diseases, epithelial diseases, stromal diseases, blastocoel diseases, inflammatory diseases, angiogenic diseases, and immune diseases, including autoimmune disorders and graft-versus-host disease (GVHD).

Typically, the disease or disorder to be treated is a hyperproliferative disease (such as cancer). Examples of cancers to be treated herein include, but are not limited to, carcinomas, lymphomas, blastomas, sarcomas, and leukemias or lymphoid malignancies. More specific examples of such cancers include squamous cell cancer (e.g., epithelial squamous cell cancer), lung cancer (including small-cell lung cancer, non-small cell lung cancer, adenocarcinoma of the lung, and squamous carcinoma of the lung), cancer of the peritoneum, hepatocellular cancer, gastric cancer (including cancer of the gastrointestinal tract), pancreatic cancer, glioblastoma, cervical cancer, ovarian cancer, liver cancer, bladder cancer, hepatoma, breast cancer, colon cancer, rectal cancer, colorectal cancer, endometrial or uterine carcinoma, salivary gland carcinoma, kidney or renal cancer, prostate cancer, vulval cancer, thyroid cancer, hepatic carcinoma, anal carcinoma, penile carcinoma, and head and neck cancer.

Autoimmune diseases that can be treated using combination therapy include rheumatic diseases (e.g., rheumatoid arthritis, sjogren's syndrome, scleroderma, lupus (such as SLE and lupus nephritis), polymyositis/dermatomyositis, cryoglobulinemia, antiphospholipid antibody syndrome, and psoriatic arthritis), osteoarthritis, autoimmune gastrointestinal and liver disorders (e.g., inflammatory bowel diseases (e.g., ulcerative colitis and Crohn's disease)), autoimmune gastritis and pernicious anemia, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, and celiac disease), vasculitis (e.g., ANCA-associated vasculitis, including charg-schetter's vasculitis (Churg-straussivasculitis), Wegener's granulomatosis, and polyarteritis), autoimmune neurological disorders (e.g., multiple sclerosis, ocular-myoclonus syndrome, myasthenia gravis, neuromyelitis optica, Parkinson's disease, Alzheimer's disease, and autoimmune polyneuropathy, nephropathy (e.g., glomerulonephritis, Goodpasture's syndrome, and Berger's disease), autoimmune skin disorders (e.g., psoriasis, urticaria, measles, pemphigus vulgaris, bullous pemphigoid, and cutaneous lupus erythematosus), blood disorders (e.g., thrombocytopenic purpura, thrombopoietic thrombocytopenic purpura, post-transfusion purpura, and auto-hemolytic anemia), atherosclerosis, uveitis, autoimmune diseases (e.g., otopathy and hearing loss), Behcet's disease, Raynaud's syndrome, organ transplantation, Graft Versus Host Disease (GVHD), and autoimmune endocrine disorders (e.g., diabetes-related immune diseases such as insulin-dependent diabetes mellitus (IDDM), Addison's disease, and autoimmune thyroid diseases such as Graves ' disease and thyroiditis). More preferred such diseases include, for example, rheumatoid arthritis, ulcerative colitis, ANCA-associated vasculitis, lupus, multiple sclerosis, sjogren's syndrome, graves' disease, IDDM, pernicious anemia, thyroiditis and glomerulonephritis.

In some aspects, the subject has a proliferative disease selected from non-hodgkin's lymphoma, including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL), and marginal zone B-cell lymphoma (MZBL), and leukemias, such as Hairy Cell Leukemia (HCL), hairy cell leukemia variant (HCL-v), and Acute Lymphoblastic Leukemia (ALL), such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL)). [ Fielding A., 1 month of Haematologica.2010; 95(1):8-12].

In certain aspects, the subject has diffuse large B-cell lymphoma.

Patient selection

In certain aspects, prior to administration of the treatment, an individual is selected that is suitable for treatment using combination therapy.

As used herein, an individual considered suitable for treatment is an individual who is expected to benefit from or respond to treatment. The individual may have, or be suspected of having, or be at risk of having cancer. The individual may have already received a cancer diagnosis. In particular, the individual may have, or be suspected of having, or be at risk of having, a lymphoma. In some cases, an individual may have, or be suspected of having, or be at risk of having, a solid cancer with tumor-associated non-tumor cells that express CD19, such as infiltrating cells that express CD 19.

In some aspects, the individual is selected for the amount or pattern of expression of CD 19. In some aspects, the selection is based on CD19 expression on the cell surface.

In certain aspects, the target is BCL-2. In some aspects, the selection is based on expression of BCL-2.

In some aspects, the selection is based on the level of both CD19 and BCL-2 on the cell surface.

In some cases, the expression of the target in a particular tissue of interest is determined. For example, in samples of lymphoid tissue or tumor tissue. In some cases, systemic expression of the target is assayed. For example in a sample of circulating fluid such as blood, plasma, serum or lymph.

In some aspects, the individual is selected for treatment based on the presence of target expression in the sample. In those cases, individuals without target expression may be considered unsuitable for treatment.

In other aspects, the target expression level is used to select an individual suitable for treatment. If the target expression level is above a threshold level, the individual is determined to be suitable for treatment.

In some aspects, the presence of CD19 and/or CD in the sample cells indicates that the individual is eligible for treatment with a combination comprising an anti-CD 19ADC and an anti-BCL-2 agent. In other aspects, the amount of CD19 and/or expression must be above a threshold level to indicate that the individual is eligible for treatment. In some aspects, the observation of altered CD19 and/or localization in the sample as compared to the control indicates that the individual is eligible for treatment.

In some aspects, if cells obtained from a lymph node or site outside a node react with an antibody against CD19 and/or as determined by IHC, then the individual is indicated as suitable for treatment.

In some aspects, a patient is determined to be suitable for treatment if at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or more of all cells in the sample express CD 19. In some aspects disclosed herein, a patient is determined to be suitable for treatment if at least 10% of the cells in the sample express CD 19.

In some aspects, a patient is determined to be suitable for treatment if at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or more of all cells in the sample are expressed. In some aspects disclosed herein, a patient is determined to be suitable for treatment if at least 10% of the cells in the sample are expressed.

In some aspects, the selection of an individual suitable for treatment is based on current or previous treatment regimens. In some embodiments, if an individual has been treated with an anti-BCL-2 agent, the individual is selected for anti-CD 19ADC treatment. In some embodiments, if the individual is being treated with an anti-BCL-2 agent, the individual is selected for anti-CD 19ADC treatment. In some cases, if an individual is refractory to treatment (or further treatment) with an anti-BCL-2 agent, the individual is selected for treatment. In some cases, the anti-BCL-2 agent can be venetola. In embodiments where the individual is receiving or has received treatment with an anti-BCL-2 agent, the anti-CD 19ADC may be administered in combination with the anti-BCL-2 agent, or in the case of discontinuous administration of the anti-BCL-2 agent.

In some embodiments, the anti-CD 19ADC is administered to the selected individual in combination with an anti-BCL-2 agent. In some embodiments, the anti-CD 19ADC is administered to the selected individual without the discrete administration of the anti-BCL-2 agent. The anti-BCL-2 agent is preferably Venetular.

The term "refractory to treatment (or further treatment) with an anti-BCL-2 agent" is used herein to mean that a disorder, such as cancer, is unresponsive or has ceased to respond to administration of the anti-BCL-2 agent when administered as monotherapy. In some embodiments, individuals with refractory NHL are identified using the reaction criteria disclosed by Cheson et al, 2014(South Asian J cancer. 2014.1-3 months; 3(1): 66-70). In this document, a non-responder is defined as an individual who satisfies any one of the following: (i) the diameter and volume of any previously identified abnormal lymph nodes increased > 50% above nadir, or (ii) any new lesions appeared during or at the end of treatment. In some embodiments, an individual with refractory leukemia is identified as an individual with stable or progressive disease who has completed one complete treatment cycle, or who achieves a partial response after two or more complete treatment cycles.

The term "being treated with … …" is used herein to refer to an individual who has received the agent in question within the preceding 3 weeks, or who is scheduled to receive the agent in question within the following 3 weeks. In some embodiments, the term "being treated with … …" is used herein to refer to an individual who is receiving the agent in question during the same treatment cycle.

The term "has been treated with … …" is used herein to mean that an individual has received an agent at any previous point in time. In some embodiments, the term "has been treated with … …" is used herein to refer to an individual that has received the agent in question within the previous 12 months, for example within the previous 3 months. In some embodiments, the term "has been treated with … …" is used herein to refer to an individual who has received an agent during a treatment cycle that has been immediately previously performed.

Sample (I)

The sample may comprise or may be derived from: a quantity of blood; a quantity of serum derived from the blood of the individual, which may include a fluid portion of the blood obtained after removal of fibrin clots and blood cells; a quantity of pancreatic juice; a tissue sample or biopsy; or a cell isolated from the individual.

The sample may be taken from any tissue or body fluid. In certain aspects, the sample may comprise or may be derived from a tissue sample, biopsy, resection, or isolated cell of the individual.

In certain aspects, the sample is a tissue sample. The sample may be a sample of tumor tissue (such as cancerous tumor tissue). The sample may have been obtained by tumor biopsy. In some aspects, the sample is a lymphatic tissue sample, such as a lymphatic lesion sample or lymph node biopsy. In some cases, the sample is a skin biopsy.

In some aspects, the sample is taken from a bodily fluid (more preferably a bodily fluid that circulates throughout the body). Thus, the sample may be a blood sample or a lymph sample. In some cases, the sample is a urine sample or a saliva sample.

In some cases, the sample is a blood sample or a blood-derived sample. The blood-derived sample may be a selected blood fraction of the individual, such as a selected cell-containing fraction or a plasma or serum fraction.

The selected cell-containing fraction may contain cell types of interest, which may include White Blood Cells (WBCs), particularly peripheral blood mononuclear cells (PBC) and/or granulocytes, and/or Red Blood Cells (RBCs). Thus, methods according to the present disclosure may involve detection of a first target polypeptide or nucleic acid in blood, leukocytes, peripheral blood mononuclear cells, granulocytes, and/or erythrocytes.

The sample may be fresh or archived. For example, the archived tissue may be from the first diagnosis of the individual, or a biopsy at the time of relapse. In certain aspects, the sample is a fresh biopsy.

The first target polypeptide may be CD 19.

Status of an individual

The subject can be an animal, a mammal, a placental mammal, a marsupial (e.g., kangaroo, satchel), a monocellular animal (e.g., duckbill), a rodent (e.g., guinea pig, hamster, rat, mouse), a murine (e.g., mouse), a lagomorpha (e.g., rabbit), an avian (e.g., bird), a canine (e.g., dog), a feline (e.g., cat), an equine (e.g., horse), a porcine (e.g., pig), a ovine (e.g., sheep), a bovine (e.g., cow), a primate, an simian (e.g., monkey or ape), a monkey (e.g., marmoset, baboon), an ape (e.g., gorilla, chimpanzee, orangutan, gibbon), or a human.

Furthermore, the individual may be in any form of development, such as a fetus. In a preferred embodiment, the subject is a human. The terms "subject", "patient" and "individual" are used interchangeably herein.

In some aspects disclosed herein, the individual has cancer, or is suspected of having cancer, or has been identified as being at risk for developing cancer. In some aspects disclosed herein, the individual has received a cancer diagnosis. Individuals may have received a diagnosis of non-hodgkin's lymphoma, including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL), and marginal zone B-cell lymphoma (MZBL), and leukemias, such as Hairy Cell Leukemia (HCL), hairy cell leukemia variants (HCL-v), and Acute Lymphoblastic Leukemia (ALL), such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL). [ Fielding A., 1 month of Haematologica.2010; 95(1):8-12].

In some cases, individuals have received a diagnosis of non-hodgkin's lymphoma, including diffuse large B-cell lymphoma (DLBCL), Follicular Lymphoma (FL), Mantle Cell Lymphoma (MCL), Chronic Lymphocytic Lymphoma (CLL), and marginal zone B-cell lymphoma (MZBL), and leukemias, such as Hairy Cell Leukemia (HCL), hairy cell leukemia variants (HCL-v), and Acute Lymphoblastic Leukemia (ALL), such as philadelphia chromosome positive ALL (Ph + ALL) or philadelphia chromosome negative ALL (Ph-ALL)). [ Fielding A., 1 month of Haematologica.2010; 95(1):8-12].

In some cases, the individual has received a diagnosis of a solid cancer containing infiltrating cells that express CD19 +.

The individual may be receiving or have received therapeutic treatment for the cancer. The subject may or may not have previously received ADCX 19. In some cases, the cancer is lymphoma, including non-hodgkin's lymphoma.

The subject may be undergoing or have undergone treatment with an anti-BCL-2 agent. In some cases, the subject may be refractory to (or further treated with) an anti-BCL-2 agent. In some cases, the anti-BCL-2 agent can be venetola. In embodiments where the individual is receiving or has received treatment with an anti-BCL-2 agent, the anti-CD 19ADC may be administered in combination with the anti-BCL-2 agent, or in the case of discontinuous administration of the anti-BCL-2 agent.

Control

In some aspects, target expression in an individual is compared to target expression in a control. Controls can be used to support the effectiveness of staining and to identify experimental artifacts.

In some cases, the control may be a reference sample or reference dataset. The reference may be a sample that has been previously obtained from an individual to a known degree of appropriateness. The reference may be a data set obtained by analyzing a reference sample.

The control may be a positive control in which the target molecule is known to be present or expressed at a high level, or a negative control in which the target molecule is known to be absent or expressed at a low level.

The control may be a tissue sample from an individual known to benefit from treatment. The tissue may be the same type of tissue as the sample being tested. For example, a sample of tumor tissue from an individual may be compared to a control sample of tumor tissue from an individual known to be suitable for treatment, such as an individual that has previously responded to treatment.

In some cases, the control may be a sample obtained from the same individual as the test sample, but from a tissue that is known to be healthy. Thus, a cancerous tissue sample from an individual may be compared to a non-cancerous tissue sample.

In some cases, the control is a cell culture sample.

In some cases, the test sample is analyzed prior to incubation with the antibody to determine the background staining level inherent to the sample.

In some cases, an isotype control was used. Isotype controls used antibodies of the same class as the target-specific antibodies, but were not immunoreactive with the sample. Such controls can be used to distinguish between non-specific interactions of target-specific antibodies.

The method may include morphological and immunohistochemical interpretation by a hematopathologist to ensure accurate interpretation of the test results. The method may involve confirming that the expression pattern is associated with an expected pattern. For example, where the amount of CD19 and/or BCL-2 expression is analyzed, the method may involve confirming that expression in the test sample is observed by membrane staining by cytoplasmic components. The method may involve confirming that the target signal-to-noise ratio is above a threshold level, allowing clear discrimination between specific and non-specific background signals.

Method of treatment

As used herein, the term "treatment" in the context of treating a condition refers generally to treatment and therapy (e.g., in veterinary applications) of a human or animal in which some desired therapeutic effect is achieved, such as inhibition of progression of the condition, and includes reduction in the rate of progression, cessation of the rate of progression, regression of the condition, amelioration of the condition, and cure of the condition. Treatment as a prophylactic measure (i.e., prevention, prophylaxis) is also included.

As used herein, the term "therapeutically effective amount" or "effective amount" refers to an amount of an active compound or a material, composition or dosage form containing the active compound that, when administered in accordance with a desired treatment regimen, is effective to produce some desired therapeutic effect commensurate with a reasonable benefit/risk ratio.

Similarly, as used herein, the term "prophylactically effective amount" refers to an amount of an active compound, or a material, composition, or dosage form containing the active compound, that is effective, when administered according to a desired treatment regimen, to produce some desired prophylactic effect commensurate with a reasonable benefit/risk ratio.

Methods of treatment are disclosed herein. Also provided are methods of treatment comprising administering therapeutically effective amounts of an anti-CD 19ADC and an anti-BCL-2 agent to a subject in need of treatment. The term "therapeutically effective amount" is an amount sufficient to exhibit a beneficial effect in a subject. The beneficial effect may be at least an improvement in at least one symptom. The actual amount administered, as well as the rate and time course of administration, will depend on the nature and severity of the disease being treated. Prescription of treatment (e.g., determination of dosage) is the responsibility of general practitioners and other physicians. The subject may be tested to determine eligibility for treatment according to the methods disclosed herein. A method of treatment may comprise the step of determining whether a subject qualifies for treatment using the methods disclosed herein.

anti-CD 19 ADCs include anti-CD 19 antibodies. The anti-CD 19 antibody may be an rb4v1.2 antibody. The ADC may include the drug as a PBD dimer. The ADC may be ADCx 19. The ADC may be the ADC disclosed in WO 2014/057117.

The anti-BCL-2 agent may be Venetolara (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimeson (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

Treatment may involve the administration of the anti-CD 19 ADC/anti-BCL-2 agent combination alone or in further combination with other treatments, either simultaneously or sequentially depending on the condition to be treated.

One exemplary method of treatment involves:

(1) identifying an individual has been or is being treated with an anti-BCL-2 agent (such as vernetorale);

(2) administering an anti-CD 19ADC (such as ADCx19) to an individual; and optionally

(3) An anti-BCL-2 agent (such as vernetorale) is administered to an individual in combination with an anti-CD 19ADC (e.g., simultaneously with or after the ADC).

Examples of treatments and therapies include, but are not limited to, chemotherapy (administration of active agents, including, for example, drugs, such as chemotherapeutic agents); performing surgery; and radiation therapy.

A "chemotherapeutic agent" is a compound useful in the treatment of cancer, regardless of its mechanism of action. Classes of chemotherapeutic agents include, but are not limited to: alkylating agents, antimetabolites, spindle poison plant alkaloids, cytotoxic/antitumor antibiotics, topoisomerase inhibitors, antibodies, photosensitizers, and kinase inhibitors. Chemotherapeutic agents include compounds used for "targeted therapy" and conventional chemotherapy.

Examples of chemotherapeutic agents include: lenalidomide (Lenalidomide) ((Lenalidomide))Celgene), Vorinostat (Vorinostat), (Merck), panobinostat (panobinostat) ((panobinostat)Novartis), moxidestatin (Mocetinostat) (MGCD0103), Everolimus (Everolimus) ((r)Novartis), Bendamustine (Bendamustine), (B), (C Mundicharma International), erlotinib (erlotinib), (III)Genentech/OSI Pharm.), docetaxel (docetaxel)Sanofi-Aventis), 5-FU (fluorouracil, 5-fluorouracil, CAS number 51-21-8), gemcitabine (gemcitabine) (Lilly), PD-0325901(CAS number 391210-10-9, Pfizer), cisplatin (cisclin) (cis-diaminedichloroplatin (II), CAS number 15663-27-1), carboplatin (CAS number 41575-94-4), paclitaxel (paclitaxel) ((CAS number)Bristol-Myers Squibb Oncology, Princeton, N.J.), trastuzumab (trastuzumab)Genentech), temozolomide (temozolomide) (4-methyl-5-oxo-2, 3,4,6, 8-pentaazabicyclo [4.3.0 ]]Nonane-2, 7, 9-triene-9-carboxamide, CAS number 85622-93-1,schering Plough), tamoxifen ((Z) -2- [4- (1, 2-diphenylbut-1-enyl) phenoxy]-N, N-dimethylethylamine, ) And doxorubicin (doxorubicin)Akti-1/2, HPPD and rapamycin (rapamycin).

Further examples of chemotherapeutic agents include: oxaliplatin (oxaliplatin) ((oxaliplatin))Sanofi), bortezomib (bortezomib), (b), (d), (Millennium Pharm, sulam (patent) ((R))SU11248, Pfizer), letrozole (letrozole), (L-Toxole)Novartis), imatinib mesylate (imatinib mesylate), (I) and (II) a pharmaceutically acceptable salt thereofNovartis), XL-518(Mek inhibitor, Exelixis, WO 2007/044515), ARRY-886(Mek inhibitor, AZD6244, Array BioPharma, Astra Zeneca), SF-1126(PI3K inhibitor, Semafore Pharmaceuticals), BEZ-235(PI3K inhibitor, Novartis), XL-147(PI3K inhibitor, Exelixis), PTK787/ZK 222584(Novartis), fulvestrant (fulvestrant) ((fulvestrant)AstraZeneca), leucovorin (leucovorin), rapamycin (sirolimus,wyeth), lapatinib (lapatinib)GSK572016 (Glaxo Smith Kline), Lonafanib (Lonafarnib) (SARASAR)^TMSCH 66336, Schering Plough), Sorafenib (sorafenib) ((Schering Plough)BAY43-9006, Bayer Labs), gefitinib (gefitinib) ((B)AstraZeneca), irinotecan (irinotecan), (CPT-11, Pfizer), tipifarnib (ZARNESTRA)^TM,Johnson&Johnson)、ABRAXANE^TMAlbumin engineered nanoparticle formulations of paclitaxel (without cremophor), paclitaxel (American Pharmaceutical Partners, Schaumberg, Il), vandetanib (rINN, ZD6474,AstraZeneca), chlorambucil, AG1478, AG1571(SU 5271; sugen), temsirolimus (temsirolimus) (Wyeth), pazopanib (pazopanib) (GlaxoSmithKline), Kanfamamide (canfosfamide) ((canfosfamide)Telik), thiotepa (thiotepa) and cyclophosphamide Alkyl sulfonates such as busulfan, improsulfan, and piposulfan; aziridines such as benzotepa (benzodopa), carboquone (carboquone), metotepipa (meturedpa), and uredepa (uredpa); ethyleneimine and methylmelamine, including hexamethylmelamine, triethylenemelamine, triethylenephosphoramide, triethylenethiophosphoramide, and trimethylolmelamine; polyacetogenin (especially bullatacin and bullatacin); camptothecin (including the synthetic analog topotecan); bryostatins; kelitin (callystatin); CC-1065 (including its synthetic analogs of adozelesin, carzelesin, and bizelesin); cryptophycin (especially cryptophycin 1 and cryptophycin 8); dolastatin (dolastatin); duocarmycin (duo)carmycins) (including the synthetic analogs KW-2189 and CB1-TM 1); eiscosahol (eleutherobin); coprinus atrata base (pancratistatin); sarcandra glabra alcohol (sarcodictyin); spongistatin (spongistatin); nitrogen mustards such as chlorambucil, chlorambucil (chlorenaphazine), chlorophosphamide (chlorophosphamide), estramustine (estramustine), ifosfamide (ifosfamide), mechlorethamine (mechlorethamine), mechlorethamine hydrochloride, melphalan (melphalan), neomustard (novembichin), benzene mustard cholesterol (pherenesterone), prednimustine (prednimustine), trofosfamide (trofosfamide), uracil mustard; nitrosoureas such as carmustine (carmustine), chlorouretocin (chlorozotocin), fotemustine (fotemustine), lomustine (lomustine), nimustine (nimustine) and ramustine (ranirnustine); antibiotics such as enediyne antibiotics (e.g., calicheamicin gamma 1I, calicheamicin omega I1(Angew chem. Intl. Ed. Engl. (1994)33:183-186), daptomycin (dynemicin), daptomycin A (dynemicin A), bisphosphonates such as clodronate, epothilones (peramicin), and neocarzinostatin (neocarzinostatin) chromophores and related chromoprotein enediyne antibiotic chromophores), aclacinomycin (aclacinomycin), actinomycin (actinomycin), antromycin (aurramycin), azalysin, bleomycin (ubromycin), actinomycin C (cactinomycin), carrubicin (carzinomycin), carminomycin (carminomycin), pheochromomycin (carzinomycin), rhodomycin (monocrotamycin), monocrotamycin-5-6-oxo-5-norubicin, monocrotamycin (monocrotamycin-5), monocrotamycin-5-D, monocrotamycin, and a, Morpholino-doxorubicin, cyanomorpholino-doxorubicin, 2-pyrrolinyl-doxorubicin and deoxydoxorubicin), epirubicin (epirubicin), esorubicin (esorubicin), idarubicin (idarubicin), nemorubicin (nemorubicin), mariomycin (marcellomycin), mitomycin (such as mitomycin C), mycophenolic acid, nogaxomycin (nogalamycin), olivomycin (olivomycin), pelomycin (peplomycin), pofiomycin (porfiromycin), puromycin, triforimycin (quelomycin), rodobicin (rodorubicin), streptonigrin (streptonigrogrin), streptozotocin (streptozotocin), tuberculocideHormone (tubercidin), ubenimex (ubenimex), zinostatin (zinostatin), zorubicin (zorubicin); antimetabolites such as methotrexate and 5-fluorouracil (5-FU); folic acid analogs such as denopterin, methotrexate, pteropterin, trimetrexate; purine analogs such as fludarabine (fludarabine), 6-mercaptopurine, thiamiprine (thiamiprine), thioguanine; pyrimidine analogs such as cyclocytidine (ancitabine), azacitidine (azacitidine), 6-azauridine (6-azauridine), carmofur (carmofur), cytarabine (cytarabine), dideoxyuridine (dideoxyuridine), deoxyfluorouridine (doxifluridine), enocitabine (enocitabine), floxuridine (floxuridine); androgens such as carposterone (calusterone), dromostanolone propionate (dromostanolone propionate), epitioandrostanol (epitiostanol), mepiquitane (mepiquitazone), testolactone (testolactone); anti-adrenal agents such as aminoglutethimide (aminoglutethimide), mitotane (mitotane), trostane (trilostane); folic acid replenisher such as folinic acid; acetoglucuronolactone (acegultone); (ii) an aldophosphamide glycoside; aminolevulinic acid (aminolevulinic acid); eniluracil (eniluracil); amsacrine (amsacrine); doubly-branched betuzucil; bisantrene; edatrexate (edatraxate); desphosphamide (defofamine); dimecorsine (demecolcine); iminoquinone urethane (diaziquone); edenisol (elfornitine); ammonium etitanium acetate; epothilone (epothilone); etoglut (etoglucid); gallium nitrate; hydroxyurea (hydroxyurea); lentinan (lentinan); lonidamine (lonidainine); maytansinoids such as maytansinoid (maytansine) and ansamitocins (ansamitocin); mitoguazone (mitoguzone); mitoxantrone (mitoxantrone); mopidanol (mopidanmol); diamine nitracridine (nitrarine); pentostatin (pentostatin); methionine mustard (phenamett); pirarubicin (pirarubicin); losoxantrone (losoxantrone); podophyllinic acid; 2-ethyl hydrazide; (ii) procarbazine;polysaccharide complex (JHS Natural Products, Eugene, OR)(ii) a Razoxane (rizoxane); rhizomycin (rhizoxin); sizofuran (sizofiran); helical germanium (spirogermanium); tenuazonic acid (tenuazonic acid); a tri-imine quinone; 2, 2' -trichlorotriethylamine; trichothecenes (trichothecenes) (in particular T-2 toxin, verrucin a (verrucin a), tuberculin a (roridin a) and serpentin (anguidine)); ethyl carbamate (urethan); vindesine (vindesine); dacarbazine (dacarbazine); mannitol mustard (mannomustine); dibromomannitol (mitobronitol); dibromodulcitol (mitolactol); pipobromane (pipobroman); gatifloxacin (gacytosine); arabinoside ("Ara-C"); cyclophosphamide; thiotepa; 6-thioguanine; mercaptopurine; methotrexate; platinum analogs such as cisplatin and carboplatin; vinblastine; etoposide (VP-16); ifosfamide (ifosfamide); mitoxantrone (mitoxantrone); vincristine (vincristine); vinorelbineNorfloxacin (novantrone); teniposide (teniposide); edatrexate (edatrexate); daunomycin (daunomycin); aminopterin (aminopterin); capecitabine (capecitabine) (capecitabine)Roche); ibandronate (ibandronate); CPT-11; topoisomerase inhibitor RFS 2000; difluoromethyl ornithine (DMFO); retinoids (retinoids), such as retinoic acid; and pharmaceutically acceptable salts, acids and derivatives of any of the foregoing chemotherapeutic agents. Combinations of agents may be used, such as CHP (doxorubicin, prednisone, cyclophosphamide) or CHOP (doxorubicin, prednisone, cyclophosphamide, vincristine).

Also included in the definition of "chemotherapeutic agent" are: (i) anti-hormonal agents that exert a modulating or inhibiting hormonal effect against tumors, such as anti-estrogens and Selective Estrogen Receptor Modulators (SERMs), including for example tamoxifen (tamoxifen) (includingTamoxifen citrate), raloxifene (raloxifene), droloxifene (droloxifene), 4-hydroxytamoxifene, troloxifene (trioxifene), naloxifene (keoxifene), LY117018, onapristone (onapristone), and(toremifene citrate); (ii) aromatase inhibitors which inhibit the enzyme which regulates estrogen production in the adrenal gland (aromatase), e.g. 4(5) -imidazole, aminoglutethimide,(megestrol acetate)) (a salt of megestrol acetate),(exemestane (Pfizer);, formestane (formestanie)), fadrozole (fadrozole),(vorozole) and (C) a salt thereof,(letrozole; Novartis) and(anastrozole; AstraZeneca); (iii) antiandrogens such as flutamide (flutamide), nilutamide (nilutamide), bicalutamide (bicalutamide), leuprolide (leuprolide) and goserelin (goserelin); and troxacitabine (a 1, 3-dioxolane nucleoside cytosine analogue); (iv) protein kinase inhibitors such as MEK inhibitors (WO 2007/044515); (v) a lipid kinase inhibitor; (vi) antisense oligonucleotides, particularly those that inhibit gene expression in signaling pathways associated with abnormal cell proliferation, e.g., PKC- α, Raf, and H-Ras, such as Orimeson: (A)Genta Inc.); (vii) ribozymes, such as VEGF expression inhibitors (e.g.,) And inhibitors of HER2 expression; (viii) vaccines, such as gene therapy vaccines, e.g.AndrIL-2; topoisomerase 1 inhibitors, such asrmRH; (ix) anti-angiogenic agents, such as bevacizumab (bevacizumab) ((r))Genentech); and pharmaceutically acceptable salts, acids and derivatives of any of the foregoing chemotherapeutic agents.

Also included in the definition of "chemotherapeutic agent" are therapeutic antibodies such as alemtuzumab (Campath), bevacizumab (r) ((r))Genentech); cetuximab (cetuximab) (C)Imclone); panitumumab (panitumumab)Amgen), pertuzumab (pertuzumab) (PERJETA)^TM,OMNITARG^TM2C4, Genentech), trastuzumab (Genentech), MDX-060(Medarex) and antibody drug conjugates, gemtuzumab ozolomide(gemtuzumab ozogamicin)(Wyeth)。

Humanized monoclonal antibodies with therapeutic potential as chemotherapeutic agents in combination with the conjugates of the present disclosure include: alemtuzumab, aprezumab (apiolizumab), aselizumab (aselizumab), atitizumab (atlizumab), palivizumab (bapineuzumab), bevacizumab, mabuzumab (bivatuzumab mertansine), mortatuzumab (cantuzumab mertansine), cetilizumab (cedezumab), certolizumab (certolizumab pegol), cefurozumab (certolizumab pegol), sibutruzumab (cidufuzumab), siduzumab (ciduzumab), daclizumab (daclizumab), eculizumab (eculizumab), efuzumab (efalizumab), epratuzumab (epratuzumab), epratuzumab (ertuzumab), epratuzumab (rituzumab), epratuzumab (eprezuzumab), epratuzumab (epratuzumab), epratuzumab (erbuzumab), zetuzumab (rituzumab), epratuzumab (zetuzumab (rituzumab), irtuzumab (zetuzumab), irtuzumab (zetuzumab), zetuzumab (zetuzumab), zetuzumab (zetimuzumab), zetuzumab (zetuzumab), zetimuzumab), zetuzumab (zetimuzumab), ze, Natalizumab (natalizumab), nimotuzumab (nimotuzumab), nolvazumab (nolovizumab), noumazumab (numavizumab), omalizumab (omab), palivizumab (omlizumab), palivizumab (palivizumab), paclobuzumab (paclobuzumab), pertuzumab (pecluzumab), pertuzumab (pexelizumab), ravizumab (raluzumab), ranibizumab (ranibizumab), revzumab (resivizumab), resilizumab (resvizumab), rexizumab (resvizumab), rovizumab (rovizumab), rutilzumab (ruplizumab), rallizumab (sibuzumab), rituzumab (resvizumab), rituximab (rituzumab), rituzumab (ritulizumab), rituzumab (rituzumab), rituzumab (rituzimab (rituzumab), rituzumab (rituqilib), rituzumab (rituzumab), ritujivub (rituzumab), ritu, Tustuzumab (tucustuzumab), umavivizumab (umavivumab), urazumab (urotxazumab), and vislizumab (visilizumab).

The composition according to the present disclosure is preferably a pharmaceutical composition. In accordance with the present disclosure and the pharmaceutical compositions used in accordance with the present disclosure, in addition to the active ingredient (i.e., conjugate compound), may contain pharmaceutically acceptable excipients, carriers, buffers, stabilizers, or other materials well known to those skilled in the art. These materials should be non-toxic and should not interfere with the efficacy of the active ingredient. The exact nature of the carrier or other material will depend on the route of administration, which may be oral or by injection, for example cutaneous, subcutaneous or intravenous injection.

Pharmaceutical compositions for oral administration may be in the form of tablets, capsules, powders or liquids. Tablets may include solid carriers or adjuvants. Liquid pharmaceutical compositions typically comprise a liquid carrier, such as water, petroleum, animal or vegetable oil, mineral oil or synthetic oil. Saline solution, dextrose or other sugar solutions or glycols (such as ethylene glycol, propylene glycol or polyethylene glycol) may also be included. Capsules can include solid carriers such as gelatin.

For intravenous, cutaneous or subcutaneous injection, or injection at the site of affliction, the active ingredient will be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability. Those skilled in the art will be able to prepare suitable solutions using, for example, isotonic vehicles such as sodium chloride injection, ringer's injection, lactated ringer's injection. Preservatives, stabilizers, buffers, antioxidants and/or other additives may also be included as desired.

Dosage form

One skilled in the art will appreciate that the appropriate dosage of the anti-CD 19ADC and/or anti-BCL-2 agent, and compositions comprising these active elements, may vary from subject to subject. Determining the optimal dosage will generally involve balancing the level of therapeutic benefit with any risk or deleterious side effects. The selected dosage level will depend upon a variety of factors including, but not limited to, the activity of the particular compound, the route of administration, the time of administration, the rate of excretion of the compound, the duration of the treatment, the other drugs, compounds and/or materials used in the combination, the severity of the disease, and the species, sex, age, weight, condition, general health and prior medical history of the subject. The amount of the compound and the route of administration will ultimately be at the discretion of the physician, veterinarian, or clinician, but the dosage will generally be selected to achieve local concentrations at the site of action so as to achieve the desired effect without causing substantial deleterious or toxic side effects.

In certain aspects, the dose of anti-CD 19ADC is determined by the expression of CD19 observed in a sample obtained from the subject. Thus, the expression level or location of CD19 in a sample may indicate that a higher or lower dose of anti-CD 19ADC is required. For example, a high expression level of CD19 may indicate that a higher dose of anti-CD 19ADC would be suitable. In some cases, a high expression level of CD19 may indicate that another agent needs to be administered in addition to the anti-CD 19 ADC. For example, anti-CD 19ADC is administered in combination with a chemotherapeutic agent. High expression levels of CD19 may indicate a more aggressive therapy.

In certain aspects, the dose of the anti-BCL-2 agent is determined from expression observed in a sample obtained from the subject. Thus, expression levels or localization in a sample may indicate a need for higher or lower doses of anti-BCL-2 agent. For example, a high expression level of BCL-2 may indicate that higher doses of anti-BCL-2 agent would be appropriate. In some cases, a high expression level of BCL-2 may indicate that another agent needs to be administered in addition to the anti-BCL-2 agent. For example, an anti-BCL-2 agent is administered in combination with a chemotherapeutic agent. High expression levels of BCL-2 may indicate a more aggressive therapy.

A dose may be administered continuously or intermittently (e.g., in divided portions at appropriate intervals) throughout the course of treatment. Methods of determining the most effective mode of administration and dosage are well known to those skilled in the art and will vary depending upon the formulation used for treatment, the purpose of the treatment, the target cell or cells being treated, and the subject being treated. Single or multiple administrations may be carried out with dose levels and regimes as selected by the attending physician, veterinarian or clinician.

Typically, a suitable dose of each active compound is in the range of about 100ng to about 25mg (more typically about 1 μ g to about 10mg) per kilogram subject body weight per day. In the case where the active compound is a salt, ester, amide, prodrug, or the like, the amount administered is calculated based on the parent compound and, therefore, the actual weight to be used increases proportionally.

In one embodiment, each active compound is administered to a human subject according to the following dosage regimen: about 100mg, 3 times daily.

In one embodiment, each active compound is administered to a human subject according to the following dosage regimen: about 150mg, 2 times daily.

In one embodiment, each active compound is administered to a human subject according to the following dosage regimen: about 200mg, 2 times daily.

However, in one embodiment, each conjugate compound is administered to a human subject according to the following dosage regimen: about 50 or about 75mg, 3 or 4 times daily.

In one embodiment, each conjugate compound is administered to a human subject according to the following dosage regimen: about 100 or about 125mg, 2 times daily.

For anti-CD 19ADC, if it is a PBD with ADC, the dose described above can be administered to the conjugate (including the linker of the PBD moiety and antibody) or to the PBD compound provided in an effective amount, e.g., the amount of the compound that is releasable upon cleavage of the linker.

anti-CD 19 ADCs include anti-CD 19 antibodies. The anti-CD 19 antibody may be an rb4v1.2 antibody. The ADC may include the drug as a PBD dimer. The anti-CD 19-ADC may be ADCx 19. The ADC may be the ADC disclosed in WO 2014/057117.

The anti-BCL-2 agent may be Venetolara (ABT-199), Navitoxx (ABT-263), ABT-737, S55746/BCL201, and Orimeson (G3139). Preferably, the anti-BCL-2 agent is Venetulara (ABT-199).

Antibodies

The term "antibody" is used herein in the broadest sense and specifically covers monoclonal antibodies, polyclonal antibodies, dimers, multimers, multispecific antibodies (e.g., bispecific antibodies), intact antibodies (also referred to as "full length" antibodies), and antibody fragments so long as they exhibit the desired biological activity, e.g., the ability to bind CD19 (Miller et al (2003) journal. of Immunology 170: 4854-. The antibody may be murine, human, humanized, chimeric, or derived from other species, such as rabbit, goat, sheep, horse, or camel.

Antibodies are proteins produced by the immune system that are capable of recognizing and binding to a particular antigen. (Janeway, C., Travers, P., Walport, M., Shlomchik (2001) Immuno Biology, 5 th edition, Garland Publishing, New York). The target antigen typically has multiple binding sites, also referred to as epitopes, that are recognized by Complementarity Determining Regions (CDRs) on multiple antibodies. Each antibody that specifically binds to a different epitope has a different structure. Thus, an antigen may have more than one corresponding antibody. The antibody may comprise a full-length immunoglobulin molecule or an immunologically active portion of a full-length immunoglobulin molecule, i.e., a molecule that contains an antigen binding site that immunospecifically binds to an antigen of a target of interest, or a portion thereof, including, but not limited to, cancer cells or cells that produce autoimmune antibodies associated with autoimmune diseases. The immunoglobulin may belong to any class (e.g., IgG, IgE, IgM, IgD, and IgA), class (e.g., IgG1, IgG2, IgG3, IgG4, IgA1, and IgA2) or subclass, or allotype (e.g., human G1m1, non-G1 m1[ i.e., any allotype other than G1m 1], G1m1, G2m 1, G3m1, A2m1, k 1, and k 1) of immunoglobulin molecules. The immunoglobulin may be derived from any species, including human, murine or rabbit origin.

"antibody fragments" comprise a portion of a full-length antibody, typically their antigen-binding or variable regions. Examples of antibody fragments include Fab, Fab ', F (ab')₂And a scFv fragment; a double body; a linear antibody; produced from Fab expression librariesFragments, anti-idiotypic (anti-Id) antibodies, CDRs (complementarity determining regions), and epitope-binding fragments of any of the foregoing, which fragments immunospecifically bind to a cancer cell antigen, a viral antigen, or a microbial antigen, a single chain antibody molecule; and multispecific antibodies formed from antibody fragments.

As used herein, the term "monoclonal antibody" refers to an antibody obtained from a substantially homogeneous population of antibodies, i.e., the individual antibodies comprising the population are identical except for possible naturally occurring mutations that may be present in minor amounts. Monoclonal antibodies are highly specific (to a single antigenic site). Furthermore, each monoclonal antibody is directed against a single determinant on the antigen, as compared to a polyclonal antibody preparation comprising different antibodies directed against different determinants (epitopes). In addition to specificity, monoclonal antibodies have the advantage that they can be synthesized without contamination by other antibodies. The modifier "monoclonal" indicates the character of the antibody as obtained from a substantially homogeneous population of antibodies, and is not to be construed as requiring production of the antibody by any particular method. For example, monoclonal antibodies for use according to the present disclosure can be prepared by the hybridoma method first described by Kohler et al (1975) Nature 256:495, or can be prepared by recombinant DNA methods (see US 4816567). Monoclonal antibodies can also be used as described by Clackson et al (1991) Nature,352: 624-; marks et al (1991) J.mol.biol.,222: 581-.

Monoclonal antibodies herein expressly include "chimeric" antibodies: wherein a portion of the heavy and/or light chains are identical or homologous to corresponding sequences in antibodies derived from a particular species or belonging to a particular antibody class or subclass, and the remainder of one or more chains are identical or homologous to corresponding sequences in antibodies derived from another species or belonging to another antibody class or subclass; as well as fragments of these antibodies, so long as they exhibit the desired biological activity (US 4816567; and Morrison et al (1984) Proc. Natl. Acad. Sci. USA,81: 6851-. Chimeric antibodies include "primatized" antibodies comprising variable domain antigen binding sequences derived from a non-human primate (e.g., old world monkey or ape) and human constant region sequences.

An "intact antibody" herein is an antibody comprising a VL domain and a VH domain, as well as a light chain constant domain (CL) and heavy chain constant domains CH1, CH2, and CH 3. The constant domains may be native sequence constant domains (e.g., human native sequence constant domains) or amino acid sequence variants thereof. An intact antibody may have one or more "effector functions," which refer to those biological activities attributable to the Fc region of the antibody (either the native sequence Fc region or the amino acid sequence variant Fc region). Examples of antibody effector functions include C1q binding; complement-dependent cytotoxicity; fc receptor binding; antibody-dependent cell-mediated cytotoxicity (ADCC); phagocytosis; and down-regulation of cell surface receptors such as B cell receptors and BCR.

Depending on the amino acid sequence of the heavy chain constant domain, whole antibodies can be classified into different "classes". There are five major classes of intact antibodies: IgA, IgD, IgE, IgG and IgM, and several of these classes can be further divided into "subclasses" (isotypes), such as IgG1, IgG2, IgG3, IgG4, IgA and IgA 2. The heavy chain constant domains corresponding to different antibody classes are called α, δ, ε, γ and μ, respectively. The subunit structures and three-dimensional configurations of different classes of immunoglobulins are well known.

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