U.S. patent application number 15/650830 was filed with the patent office on 2018-03-15 for tec family kinase inhibitor adjuvant therapy.
The applicant listed for this patent is Pharmacyclics LLC. Invention is credited to Joseph J. Buggy, John C. Byrd, Betty Y. Chang, Jason A. Dubovsky, Amy J. Johnson, Richard B. Love, Tarak D. Mody, Natarajan Muthusamy.
Application Number | 20180071293 15/650830 |
Document ID | / |
Family ID | 50628113 |
Filed Date | 2018-03-15 |
United States Patent
Application |
20180071293 |
Kind Code |
A1 |
Buggy; Joseph J. ; et
al. |
March 15, 2018 |
TEC FAMILY KINASE INHIBITOR ADJUVANT THERAPY
Abstract
Described herein are methods and compositions comprising a
covalent TEC family kinase inhibitor for use in adjuvant therapy,
including adjuvant cancer therapy, vaccination and treatment of
immune disorders and pathogenic infections.
Inventors: |
Buggy; Joseph J.; (Mountain
View, CA) ; Mody; Tarak D.; (Sunnyvale, CA) ;
Love; Richard B.; (Montara, CA) ; Byrd; John C.;
(Columbus, OH) ; Chang; Betty Y.; (Cupertino,
CA) ; Dubovsky; Jason A.; (Columbus, OH) ;
Muthusamy; Natarajan; (Columbus, OH) ; Johnson; Amy
J.; (Columbus, OH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Pharmacyclics LLC |
Sunnyvale |
CA |
US |
|
|
Family ID: |
50628113 |
Appl. No.: |
15/650830 |
Filed: |
July 14, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14198559 |
Mar 5, 2014 |
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15650830 |
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14070420 |
Nov 1, 2013 |
9717731 |
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14198559 |
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61785868 |
Mar 14, 2013 |
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61722107 |
Nov 2, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 31/519 20130101;
A61P 37/00 20180101; A61P 37/02 20180101; A61P 35/02 20180101; A61P
35/00 20180101; A61K 45/06 20130101; A61P 29/00 20180101; A61P
31/00 20180101; A61P 43/00 20180101; A61K 31/519 20130101; A61K
2300/00 20130101 |
International
Class: |
A61K 31/519 20060101
A61K031/519; A61K 45/06 20060101 A61K045/06 |
Claims
1-34. (canceled)
35. A method of treating a myeloma or lymphoma in a subject in need
thereof comprising co-administering: a. a first amount of
ibrutinib; and b. a second amount of bortezomib, wherein, together,
the first amount of ibrutinib and the second amount of bortezomib
are therapeutically effective.
36. The method of claim 35, wherein the myeloma or lymphoma is a
relapsed or refractory myeloma or lymphoma.
37. The method of claim 35, wherein the lymphoma is non-Hodgkin's
lymphoma.
38. The method of claim 35, wherein the myeloma is multiple
myeloma.
39. The method of claim 35, wherein the lymphoma is mantle cell
lymphoma.
40. The method of claim 35, wherein the myeloma is relapsed or
refractory multiple myeloma.
41. The method of claim 35, wherein the lymphoma is relapsed or
refractory mantle cell lymphoma.
42. The method of claim 35, wherein, following co-administration of
ibrutinib and bortezomib, the subject achieves a longer disease
free survival (DFS) than a control subject who was administered
bortezomib alone.
43. The method of claim 35, wherein, following co-administration of
ibrutinib and bortezomib, the subject achieves a longer overall
survival (OS) than a control subject who was administered
bortezomib alone.
44. The method of claim 35, wherein, following co-administration of
ibrutinib and bortezomib, the subject does not experience a relapse
of the myeloma or lymphoma for about 6 months, about 1 year, about
2 years, about 3 years, about 4 years, about 5 years, about 6
years, about 7 years, about 8 years, about 9 years, or about 10
years.
45. The method of claim 35, wherein, following co-administration of
ibrutinib and bortezomib, the subject experiences a reduced risk of
relapsed or refractory myeloma or lymphoma as compared to a control
subject who was administered bortezomib alone.
46. The method of claim 42, wherein the risk of relapsed or
refractory myeloma or lymphoma is reduced by about 10%, about 20%,
about 30%, about 40%, about 50%, about 60%, about 70%, about 80%,
or about 90% as compared to the control subject.
47. The method of claim 35, wherein the subject experiences a
decreased risk of developing a secondary tumor as compared to a
control subject who was administered bortezomib alone.
48. The method of claim 35, wherein, prior to co-administration of
ibrutinib and bortezomib, the subject exhibits abnormal B-cell
function, abnormal B-cell size, abnormal B-cell shape, abnormal
B-cell count, fatigue, fever, night sweats, frequent infection,
enlarged lymph nodes, paleness, anemia, loss of appetite, weight
loss, bone or joint pain, headaches, or petechie.
49. The method of claim 35, wherein the first amount of ibrutinib
is about 300 mg per day to about 600 mg per day.
50. The method of claim 35, wherein the first amount of ibrutinib
is about 420 mg per day.
51. The method of claim 35, wherein ibrutinib is administered once
per day.
52. The method of claim 35, wherein ibrutinib is administered
orally.
53. The method of claim 35, wherein ibrutinib is administered
orally once per day.
54. The method of claim 35, wherein about 420 mg of ibrutinib is
administered orally once per day.
55. The method of claim 35, wherein bortezomib is administered
intravenously.
56. A method of treating a myeloma or lymphoma in a subject in need
thereof comprising co-administering: a. a first amount of
ibrutinib; b. a second amount of bortezomib; and c. a third amount
of a corticosteroid, wherein, together, the first amount of
ibrutinib, the second amount of bortezomib, and the third amount of
the corticosteroid are therapeutically effective.
57. The method of claim 56, wherein the corticosteroid is
dexamethasone.
58. The method of claim 57, wherein the myeloma or lymphoma is a
relapsed or refractory myeloma or lymphoma.
59. The method of claim 57, wherein the lymphoma is non-Hodgkin's
lymphoma.
60. The method of claim 57, wherein the myeloma is multiple
myeloma.
61. The method of claim 57, wherein the lymphoma is mantle cell
lymphoma.
62. The method of claim 57, wherein the myeloma is relapsed or
refractory multiple myeloma.
63. The method of claim 57, wherein the lymphoma is relapsed or
refractory mantle cell lymphoma.
64. The method of claim 57, wherein, following co-administration of
ibrutinib, bortezomib, and dexamethasone, the subject achieves a
longer disease free survival (DFS) than a control subject who was
co-administered bortezomib and dexamethasone.
65. The method of claim 57, wherein, following co-administration of
ibrutinib, bortezomib, and dexamethasone, the subject achieves a
longer overall survival (OS) than a control subject who was
co-administered bortezomib and dexamethasone.
66. The method of claim 57, wherein, following co-administration of
ibrutinib, bortezomib, and dexamethasone, the subject does not
experience a relapse of the myeloma for about 6 months, about 1
year, about 2 years, about 3 years, about 4 years, about 5 years,
about 6 years, about 7 years, about 8 years, about 9 years, or
about 10 years.
67. The method of claim 57, wherein, following co-administration of
ibrutinib, bortezomib, and dexamethasone, the subject experiences a
reduced risk of relapsed or refractory myeloma or lymphoma as
compared to a control subject who was co-administered bortezomib
and dexamethasone.
68. The method of claim 67, wherein the risk of relapsed or
refractory myeloma is reduced by about 10%, about 20%, about 30%,
about 40%, about 50%, about 60%, about 70%, about 80%, or about 90%
as compared to the control subject.
69. The method of claim 57, wherein the subject experiences a
decreased risk of developing a secondary tumor as compared to a
control subject who was co-administered bortezomib and
dexamethasone.
70. The method of claim 57, wherein, prior to co-administration of
ibrutinib, bortezomib, and dexamethasone, the subject exhibits
abnormal B-cell function, abnormal B-cell size, abnormal B-cell
shape, abnormal B-cell count, fatigue, fever, night sweats,
frequent infection, enlarged lymph nodes, paleness, anemia, loss of
appetite, weight loss, bone or joint pain, headaches, or
petechie.
71. The method of claim 57, wherein the first amount of ibrutinib
is about 300 mg per day to about 600 mg per day.
72. The method of claim 57, wherein the first amount of ibrutinib
is about 420 mg per day.
73. The method of claim 57, wherein ibrutinib is administered once
per day.
74. The method of claim 57, wherein ibrutinib is administered
orally.
75. The method of claim 57, wherein ibrutinib is administered
orally once per day.
76. The method of claim 57, wherein about 420 mg of ibrutinib is
administered orally once per day.
77. The method of claim 57, wherein bortezomib is administered
intravenously.
78. The method of claim 57, wherein dexamethasone is administered
orally.
79. A method of treating a myeloma or lymphoma in a subject in need
thereof comprising co-administering: a. a first amount of
ibrutinib, wherein the first amount is 300 mg to 600 mg; and b. a
second amount of bortezomib, wherein ibrutinib is administered
orally and bortezomib is administered intravenously; and wherein,
together, the first amount of ibrutinib and the second amount of
bortezomib are therapeutically effective.
80. The method of claim 79, wherein ibrutinib is administered once
per day.
81. The method of claim 79, wherein the myeloma or lymphoma is a
relapsed or refractory myeloma or lymphoma.
82. The method of claim 79, wherein the lymphoma is non-Hodgkin's
lymphoma.
83. The method of claim 79, wherein the myeloma is multiple
myeloma.
84. The method of claim 79, wherein the lymphoma is mantle cell
lymphoma.
85. The method of claim 79, wherein the myeloma is relapsed or
refractory multiple myeloma.
86. The method of claim 79, wherein the lymphoma is relapsed or
refractory mantle cell lymphoma.
87. The method of claim 79, wherein the treatment further comprises
co-administering: c. a third amount of dexamethasone, wherein,
together, the first amount of ibrutinib, the second amount of
bortezomib, and the third amount of dexamethasone are
therapeutically effective.
Description
RELATED APPLICATIONS
[0001] The present application is a continuation of U.S. patent
application Ser. No. 14/198,559, filed Mar. 5, 2014, which is a
continuation of U.S. patent application Ser. No. 14/070,420, filed
Nov. 1, 2013, which claims the benefit of priority from U.S.
Provisional Patent Application Nos. 61/722,107, filed Nov. 2, 2012,
and 61/785,868, filed Mar. 14, 2013, each of which is herein
incorporated by reference in its entirety.
SEQUENCE LISTING
[0002] The instant application contains a Sequence Listing which
has been submitted in ASCII format via EFS-Web and is hereby
incorporated by reference in its entirety. Said ASCII copy, created
on Jan. 21, 2014, is named 25922-869-201SEQ.txt and is 2,319 bytes
in size.
BACKGROUND
[0003] T-lymphocytes comprise an indispensable component of the
adaptive immune response, yet certain autoimmune, infectious,
parasitic, and neoplastic diseases subvert adaptive immunity by
specifically misdirecting T-helper cell polarity. A common
mechanism of immune subversion is the aberrant recruitment of a Th2
dominant response that directly promotes B-cell antibody production
and interferes with direct effector cell cytotoxicity. In contrast,
a Th1 dominant response evokes cytotoxic effects with the
production of IFN.gamma. and IL2, which contribute to effector
cell-based immune surveillance. Clearance of certain intracellular
bacterial pathogens such as Listeria and parasites such as
Leishmania, as well as tumor immune surveillance, hinge upon the
capacity to elicit robust Th1 and CD8 T-cell responses.
[0004] Interleukin-2 Inducible Kinase (ITK) is a T-cell dominant
member of the TEC-kinase family that drives proximal T-cell
receptor (TCR) signaling. Upon TCR ligation in Th1 and CD8 T-cells,
ITK and redundant resting lymphocyte kinase (RLK or TXK) activate
PLC.gamma., launching a signaling cascade that includes the NFAT,
NF.kappa.B, and MAPK pathways resulting in cellular activation,
cytokine release, and rapid proliferation. ITK plays a supportive
yet dispensable role to RLK in Th1 polarized and CD8 effector
cells, but is indispensable for signaling in Th2 polarized
T-cells.
SUMMARY OF THE INVENTION
[0005] Described herein, in certain embodiments, are methods of
adjuvant therapy for cancer and for the treatment of immune
disorders and pathogenic infections comprising administration of a
TEC family kinase inhibitor. In some embodiments, the TEC family
kinase inhibitor is a covalent TEC family kinase inhibitor. In some
embodiments, the covalent TEC family kinase inhibitor is
ibrutinib.
[0006] Described herein, in certain embodiments, are methods of
treating a subject having a cancer characterized by a cytokine
profile in which Th1 response is suppressed and Th2 response is
enhanced, comprising administering a covalent TEC family kinase
inhibitor to promote the Th1 response and suppress the Th2
response. In some embodiments, the methods further comprise
measuring the level one or more Th1 or Th2 cytokines in the subject
prior to administering a covalent TEC family kinase. In some
embodiments, the covalent TEC family kinase inhibitor is
administered following treatment of the cancer with a first
anticancer therapy, wherein the first anticancer therapy does not
comprise administration of a covalent TEC family kinase inhibitor.
In some embodiments, administration of the covalent TEC family
kinase inhibitor decreases the number of Th2 polarized T cells in
the subject compared to no administration with the covalent TEC
family kinase inhibitor. In some embodiments, administration of the
covalent TEC family kinase inhibitor increases the number of Th1
polarized T cells in the subject compared to no administration with
the covalent TEC family kinase inhibitor. In some embodiments,
administration of the covalent TEC family kinase inhibitor
increases the number of activated CD8+ cytotoxic T cells in the
subject compared to no administration with the covalent TEC family
kinase inhibitor. In some embodiments, administration of the
covalent TEC family kinase inhibitor increases the ratio of Th1
polarized T cells to Th2 polarized T cells in the subject compared
to no administration with the covalent TEC family kinase inhibitor.
In some embodiments, administration of the covalent TEC family
kinase inhibitor decreases IL-10, IL-4 or IL-13 expression in the
subject compared to no administration with the covalent TEC family
kinase inhibitor. In some embodiments, administration of the
covalent TEC family kinase inhibitor increases IFN-.gamma.
expression in the subject compared to no administration with the
covalent TEC family kinase inhibitor. In some embodiments,
administration of the covalent TEC family kinase inhibitor
increases IL-2 expression in the subject compared to no
administration with the covalent TEC family kinase inhibitor. In
some embodiments, administration of the covalent TEC family kinase
inhibitor increases IL-12 expression in the subject compared to no
administration with the covalent TEC family kinase inhibitor. In
some embodiments, the first anticancer therapy comprises
administration of a chemotherapeutic agent, a biologic agent,
radiation therapy, bone marrow transplant, surgery,
photosensitizing agents, toxins, or a combination thereof. In some
embodiments, treatment with the chemotherapeutic agent or a
biologic agent is discontinued prior to initiation of treatment
with the covalent TEC family kinase inhibitor. In some embodiments,
treatment with a chemotherapeutic agent or a biologic agent is
continued prior to initiation of treatment with the covalent TEC
family kinase inhibitor. In some embodiments, the chemotherapeutic
agent or biologic agent is selected from among an antibody, a B
cell receptor pathway inhibitor, a T cell receptor inhibitor, a
PI3K inhibitor, an IAP inhibitor, an mTOR inhibitor, a
radioimmunotherapeutic, a DNA damaging agent, a histone deacetylase
inhibitor, a protein kinase inhibitor, a hedgehog inhibitor, an
Hsp90 inhibitor, a telomerase inhibitor, a Jak1/2 inhibitor, a
protease inhibitor, an IRAK inhibitor, a PKC inhibitor, a PARP
inhibitor, a CYP3A4 inhibitor, an AKT inhibitor, an Erk inhibitor,
a proteosome inhibitor, an alkylating agent, an anti metabolite, a
plant alkaloid, a terpenoid, a cytotoxin, a topoisomerase
inhibitor, or a combination thereof. In some embodiments, the B
cell receptor pathway inhibitor is a CD79A inhibitor, a CD79B
inhibitor, a CD19 inhibitor, a Lyn inhibitor, a Syk inhibitor, a
PI3K inhibitor, a Blnk inhibitor, a PLC.gamma. inhibitor, a
PKC.beta. inhibitor, a CD22 inhibitor, a Bcl-2 inhibitor, an IRAK
1/4 inhibitor, a JAK inhibitor (e.g., ruxolitinib, baricitinib,
CYT387, lestauritinib, pacritinib, TG101348, SAR302503, tofacitinib
(Xeljanz), etanercept (Enbrel), GLPG0634, R256), a microtubule
inhibitor, a Topo II inhibitor, anti TWEAK antibody, anti-IL17
bispecific antibody, a CK2 inhibitor, anaplastic lymphoma kinase
(ALK) and c-Met inhibitors, demethylase enzyme inhibitors such as
demethylase, HDM, LSDI and KDM, fatty acid synthase inhibitors such
as spirocyclic piperidine derivatives, glucocorticosteriod receptor
agonist, fusion anti-CD 19-cytotoxic agent conjugate,
antimetabolite, p70S6K inhibitor, immune modulators, AKT/PKB
inhibitor, procaspase-3 activator PAC-1, BRAF inhibitor, lactate
dehydrogenase A (LDH-A) inhibitor, CCR2 inhibitor, CXCR4 inhibitor,
chemokine receptor antagonists, DNA double stranded break repair
inhibitors, NOR202, GA-101, TLR2 inhibitor, or a combination
thereof. In some embodiments, the T cell receptor inhibitor is
Muromonab-CD3. In some embodiments, the chemotherapeutic agent is
selected from among rituximab (rituxan), carfilzomib, fludarabine,
cyclophosphamide, vincristine, prednisalone. chlorambucil,
ifosphamide, doxorubicin, mesalazine, thalidomide, revlimid,
lenalidomide, temsirolimus, everolimus, fostamatinib, paclitaxel,
docetaxel, ofatumumab, dexamethasone, bendamustine, prednisone,
CAL-101, ibritumomab, tositumomab, bortezomib, pentostatin,
endostatin, ritonavir, ketoconazole, an anti-VEGF antibody,
herceptin, cetuximab, cisplatin, carboplatin, docetaxel, erlotinib,
etopiside, 5-fluorouracil, gemcitabine, ifosphamide, imatinib
mesylate (Gleevec), gefitinib, erlotinib, procarbazine, prednisone,
irinotecan, leucovorin, mechlorethamine, methotrexate, oxaliplatin,
paclitaxel, sorafenib, sunitinib, topotecan, vinblastine, GA-1101,
dasatinib, Sipuleucel-T, disulfiram, epigallocatechin-3-gallate,
salinosporamide A, ONX0912, CEP-18770, MLN9708, R-406,
lenalinomide, spirocyclic piperidine derivatives, quinazoline
carboxamide azetidine compounds, thiotepa, DWA2114R, NK121, IS 3
295, 254-S, alkyl sulfonates such as busulfan, improsulfan and
piposulfan; aziridines such as benzodepa, carboquone, meturedepa
and uredepa; ethylenimine, methylmelamines such as altretamine,
triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of; anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; ACK inhibitors such as
AVL-263 (Avila Therapeutics/Celgene Corporation), AVL-292 (Avila
Therapeutics/Celgene Corporation), AVL-291 (Avila
Therapeutics/Celgene Corporation), BMS-488516 (Bristol-Myers
Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746 (CGI
Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech), HY-11066
(also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21, HMS3265H22,
439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical Co., Ltd.),
ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123 (Peking
University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof. In some
embodiments, the patient has a tumor. In some embodiments,
administering the covalent TEC family kinase inhibitor thereby
decreases the size of a tumor, prevents or delays progression of
the tumor, promotes further regression of the tumor, or eliminates
the tumor. In some embodiments, the tumor is a sarcoma, carcinoma,
lymphoma, or a melanoma. In some embodiments, the subject has a
brain, breast, bladder, bone, colon, kidney, liver, lung, ovarian,
pancreatic, prostate, skin or proximal or distal bile duct
carcinoma. In some embodiments, the lymphoma is an enlarged lymph
node or an extranodal lymphoma. In some embodiments, the cancer is
a leukemia, a lymphoma, or a myeloma. In some embodiments, the
cancer is non-Hodgkin's lymphoma. In some embodiments, wherein the
non-Hodgkin's lymphoma is chronic lymphocytic leukemia/small
lymphocytic lymphoma (CLL/SLL), follicular lymphoma (FL), diffuse
large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL),
Waldenstrom's macroglobulinemia, multiple myeloma, marginal zone
lymphoma, Burkitt's lymphoma, non-Burkitt high grade B cell
lymphoma, or extranodal marginal zone B cell lymphoma. In some
embodiments, the non-Hodgkin's lymphoma is a relapsed or refractory
non-Hodgkin's lymphoma. In some embodiments, the cancer is a T-cell
malignancy. In some embodiments, the T-cell malignancy is
peripheral T-cell lymphoma not otherwise specified (PTCL-NOS),
anaplastic large cell lymphoma, angioimmunoblastic lymphoma,
cutaneous T-cell lymphoma, adult T-cell leukemia/lymphoma (ATLL),
blastic NK-cell lymphoma, enteropathy-type T-cell lymphoma,
hematosplenic gamma-delta T-cell lymphoma, lymphoblastic lymphoma,
nasal NK/T-cell lymphomas, or treatment-related T-cell lymphomas.
In some embodiments, the T-cell malignancy is a relapsed or
refractory T-cell malignancy. In some embodiments, treatment with
the covalent TEC family kinase inhibitor extends disease free
survival (DFS) or overall survival (OS) in the subject. In some
embodiments, the covalent TEC family kinase inhibitor inhibits one
or more TEC family kinases selected from among ITK, BTK, TEC,
RLK/TXK and BMX. In some embodiments, the covalent TEC family
kinase inhibitor is an IL2-inducible T-cell kinase (ITK) inhibitor.
In some embodiments, the covalent TEC family kinase inhibitor is a
Bruton's tyrosine kinase (BTK) inhibitor. In some embodiments, the
subject is a mammal. In some embodiments, the mammal is a human. In
some embodiments, the covalent TEC family kinase inhibitor is
administered daily. In some embodiments, the covalent TEC family
kinase inhibitor is administered 1, 2, 3, 4, 5 times or more per
day. In some embodiments, the covalent TEC family kinase inhibitor
is administered once per day. In some embodiments, the covalent TEC
family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, the covalent TEC
family kinase inhibitor is administered at a dosage of about 40
mg/day to about 1000 mg/day. In some embodiments, covalent TEC
family kinase inhibitor is administered for about 1 week to 5
years. In some embodiments, covalent TEC family kinase inhibitor is
administered orally. In some embodiments, the risk of relapsed or
refractory disease is reduced by about 10%, 20%, 30%, 40%, 50%,
60%, 70%, 80%, 90% or greater compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
subject is disease free for about 6 months, 1 year, 2 years, 3
years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years, 10
years or longer following last administration of the covalent TEC
family kinase inhibitor. In some embodiments, the subject has a
high risk of cancer recurrence prior to administration of the
covalent TEC family kinase inhibitor. In some embodiments, the
methods further comprise administration of an additional
chemotherapeutic agent or biologic agent.
[0007] Described herein, in certain embodiments are methods of
adjuvant therapy comprising administering to a subject having
cancer, following treatment of a tumor with a first anticancer
therapy to decrease the size of a tumor or eliminate the tumor, an
effective amount of a covalent TEC family kinase inhibitor to
prevent or delay progression of the tumor, promote further
regression of the tumor, or eliminate the tumor, wherein the first
anticancer therapy does not comprise administration of a covalent
TEC family kinase inhibitor. In some embodiments, the first
anticancer therapy comprises administration of a chemotherapeutic
agent, a biologic agent, radiation therapy, bone marrow transplant,
surgery, photosensitizing agents, toxins, or a combination thereof.
In some embodiments, the covalent TEC family kinase inhibitor
extends disease free survival (DFS) or overall survival (OS) in the
subject. In some embodiments, disease free survival (DFS) or
overall survival (OS) is assessed one or more years following
initiation of covalent TEC family kinase inhibitor administration.
In some embodiments, the covalent TEC family kinase inhibitor
therapy is initiated following a decrease in size of the tumor
following administration of the anticancer therapy. In some
embodiments, treatment with a chemotherapeutic agent or a biologic
agent is discontinued prior to initiation of treatment with the
covalent TEC family kinase inhibitor. In some embodiments,
treatment with a chemotherapeutic agent or a biologic agent is
continued prior to initiation of treatment with the covalent TEC
family kinase inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor inhibits one or more TEC family kinases
selected from among ITK, BTK, TEC, RLK/TXK and BMX. In some
embodiments, the covalent TEC family kinase inhibitor is an
IL2-inducible T-cell kinase (ITK) inhibitor. In some embodiments,
the covalent TEC family kinase inhibitor is a Bruton's tyrosine
kinase (BTK) inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, the chemotherapeutic
agent is selected from among an antibody, a B cell receptor pathway
inhibitor, a T cell receptor inhibitor, a PI3K inhibitor, an IAP
inhibitor, an mTOR inhibitor, a radioimmunotherapeutic, a DNA
damaging agent, a histone deacetylase inhibitor, a protein kinase
inhibitor, a hedgehog inhibitor, an Hsp90 inhibitor, a telomerase
inhibitor, a Jak1/2 inhibitor, a protease inhibitor, an IRAK
inhibitor, a proteosome inhibitor, a PKC inhibitor, a PARP
inhibitor, a CYP3A4 inhibitor, an AKT inhibitor, an Erk inhibitor,
an alkylating agent, an anti metabolite, a plant alkaloid, a
terpenoid, a cytotoxin, a topoisomerase inhibitor, or a combination
thereof. In some embodiments, the B cell receptor pathway inhibitor
is a CD79A inhibitor, a CD79B inhibitor, a CD19 inhibitor, a Lyn
inhibitor, a Syk inhibitor, a PI3K inhibitor, a Blnk inhibitor, a
PLC.gamma. inhibitor, a PKC.beta. inhibitor, a CD22 inhibitor, a
Bcl-2 inhibitor, an IRAK 1/4 inhibitor, a JAK inhibitor (e.g.,
ruxolitinib, baricitinib, CYT387, lestauritinib, pacritinib,
TG101348, SAR302503, tofacitinib (Xeljanz), etanercept (Enbrel),
GLPG0634, R256), a microtubule inhibitor, a Topo II inhibitor, anti
TWEAK, anti-IL17 bispecific antibody, a CK2 inhibitor, anaplastic
lymphoma kinase (ALK) and c-Met inhibitors, demethylase enzyme
inhibitors such as demethylase, HDM, LSDI and KDM, fatty acid
synthase inhibitors such as spirocyclic piperidine derivatives,
glucocorticosteriod receptor agonist, fusion anti-CD 19-cytotoxic
agent conjugate, antimetabolite, p70S6K inhibitor, immune
modulators, AKT/PKB inhibitor, procaspase-3 activator PAC-1, BRAF
inhibitor, lactate dehydrogenase A (LDH-A) inhibitor, CCR2
inhibitor, CXCR4 inhibitor, chemokine receptor antagonists, DNA
double stranded break repair inhibitors, NOR202, GA-101, TLR2
inhibitor, or a combination thereof. In some embodiments, the T
cell receptor inhibitor is Muromonab-CD3. In some embodiments, the
chemotherapeutic agent is selected from among rituximab (rituxan),
carfilzomib, fludarabine, cyclophosphamide, vincristine,
prednisalone. chlorambucil, ifosphamide, doxorubicin, mesalazine,
thalidomide, revlimid, lenalidomide, temsirolimus, everolimus,
fostamatinib, paclitaxel, docetaxel, ofatumumab, dexamethasone,
bendamustine, prednisone, CAL-101, ibritumomab, tositumomab,
bortezomib, pentostatin, endostatin, ritonavir, ketoconazole, an
anti-VEGF antibody, herceptin, cetuximab, cisplatin, carboplatin,
docetaxel, erlotinib, etopiside, 5-fluorouracil, gemcitabine,
ifosphamide, imatinib mesylate (Gleevec), gefitinib, erlotinib,
procarbazine, prednisone, irinotecan, leucovorin, mechlorethamine,
methotrexate, oxaliplatin, paclitaxel, sorafenib, sunitinib,
topotecan, vinblastine, GA-1101, dasatinib, Sipuleucel-T,
disulfiram, epigallocatechin-3-gallate, salinosporamide A, ONX0912,
CEP-18770, MLN9708, R-406, lenalinomide, spirocyclic piperidine
derivatives, quinazoline carboxamide azetidine compounds, thiotepa,
DWA2114R, NK121, IS 3 295, 254-S, alkyl sulfonates such as
busulfan, improsulfan and piposulfan; aziridines such as benzodepa,
carboquone, meturedepa and uredepa; ethylenimine, methylmelamines
such as altretamine, triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of; anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; ACK inhibitors such as
AVL-263 (Avila Therapeutics/Celgene Corporation), AVL-292 (Avila
Therapeutics/Celgene Corporation), AVL-291 (Avila
Therapeutics/Celgene Corporation), BMS-488516 (Bristol-Myers
Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746 (CGI
Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech), HY-11066
(also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21, HMS3265H22,
439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical Co., Ltd.),
ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123 (Peking
University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof. In some
embodiments, the subject has no detectable tumors following
treatment with the first anticancer therapy, prior to initiation of
covalent TEC family kinase inhibitor administration. In some
embodiments, the subject has no detectable circulating tumor cells
following treatment with the first anticancer therapy, prior to
initiation of covalent TEC family kinase inhibitor administration.
In some embodiments, the subject is a mammal. In some embodiments,
the mammal is a human. In some embodiments, the covalent TEC family
kinase inhibitor is administered daily. In some embodiments, the
covalent TEC family kinase inhibitor is administered 1, 2, 3, 4, 5
times or more per day. In some embodiments, the covalent TEC family
kinase inhibitor is administered once per day. In some embodiments,
the covalent TEC family kinase inhibitor is administered at a
dosage of about 40 mg/day to about 1000 mg/day. In some
embodiments, covalent TEC family kinase inhibitor is administered
for about 1 week to 5 years. In some embodiments, covalent TEC
family kinase inhibitor is administered orally. In some
embodiments, the risk of relapsed or refractory disease is reduced
by about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or greater
compared to no treatment with the covalent TEC family kinase
inhibitor. In some embodiments, the subject is disease free for
about 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, 6
years, 7 years, 8 years, 9 years, 10 years or longer following last
administration of the covalent TEC family kinase inhibitor. In some
embodiments, the subject has a high risk of cancer recurrence prior
to administration of the covalent TEC family kinase inhibitor. In
some embodiments, the tumor is a sarcoma, carcinoma, lymphoma, or a
melanoma. In some embodiments, the lymphoma is an enlarged lymph
node or an extranodal lymphoma. In some embodiments, the subject
has a brain, breast, bladder, bone, colon, kidney, liver, lung,
ovarian, pancreatic, prostate, skin or proximal or distal bile duct
carcinoma. In some embodiments, the subject has a hematologic
cancer. In some embodiments, the cancer is a leukemia, a lymphoma,
or a myeloma. In some embodiments, the subject has a non-Hodgkin's
lymphoma. In some embodiments, the non-Hodgkin's lymphoma is
chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL),
follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL),
mantle cell lymphoma (MCL), Waldenstrom's macroglobulinemia,
multiple myeloma, marginal zone lymphoma, Burkitt's lymphoma,
non-Burkitt high grade B cell lymphoma, or extranodal marginal zone
B cell lymphoma. In some embodiments, the non-Hodgkin's lymphoma is
a relapsed or refractory non-Hodgkin's lymphoma. In some
embodiments, the subject has a T-cell malignancy. In some
embodiments, the T-cell malignancy is peripheral T-cell lymphoma
not otherwise specified (PTCL-NOS), anaplastic large cell lymphoma,
angioimmunoblastic lymphoma, cutaneous T-cell lymphoma, adult
T-cell leukemia/lymphoma (ATLL), blastic NK-cell lymphoma,
enteropathy-type T-cell lymphoma, hematosplenic gamma-delta T-cell
lymphoma, lymphoblastic lymphoma, nasal NK/T-cell lymphomas, or
treatment-related T-cell lymphomas. In some embodiments, the T-cell
malignancy is a relapsed or refractory T-cell malignancy. In some
embodiments, the risk of a secondary tumor is decreased compared to
no treatment with the covalent TEC family kinase inhibitor. In some
embodiments, DFS or OS is evaluated about 1, 2, 3, 4, 5, 6, 7, 8,
9, 10 years or longer after initiation of the covalent TEC family
kinase inhibitor treatment. In some embodiments, the covalent TEC
family kinase inhibitor is administered in combination with an
additional chemotherapeutic agent or biologic agent. In some
embodiments, the additional chemotherapeutic agent or biologic
agent is selected from among an antibody, a B cell receptor pathway
inhibitor, a T cell receptor inhibitor, a PI3K inhibitor, an IAP
inhibitor, an mTOR inhibitor, a radioimmunotherapeutic, a DNA
damaging agent, a histone deacetylase inhibitor, a protein kinase
inhibitor, a hedgehog inhibitor, an Hsp90 inhibitor, a telomerase
inhibitor, a Jak1/2 inhibitor, a protease inhibitor, an IRAK
inhibitor, a PKC inhibitor, a PARP inhibitor, a CYP3A4 inhibitor, a
proteosome inhibitor, an alkylating agent, an anti metabolite, a
plant alkaloid, a terpenoid, a cytotoxin, a topoisomerase
inhibitor, or a combination thereof. In some embodiments, the B
cell receptor pathway inhibitor is a CD79A inhibitor, a CD79B
inhibitor, a CD19 inhibitor, a Lyn inhibitor, a Syk inhibitor, a
PI3K inhibitor, a Blnk inhibitor, a PLC.gamma. inhibitor, a
PKC.beta. inhibitor, a JAK inhibitor (e.g., ruxolitinib,
baricitinib, CYT387, lestauritinib, pacritinib, TG101348,
SAR302503, tofacitinib (Xeljanz), etanercept (Enbrel), GLPG0634,
R256), or a combination thereof. In some embodiments, the
additional chemotherapeutic agent or biologic agent is selected
from among rituximab (rituxan), carfilzomib, fludarabine,
cyclophosphamide, vincristine, prednisalone. chlorambucil,
ifosphamide, doxorubicin, mesalazine, thalidomide, lenalidomide,
temsirolimus, everolimus, fostamatinib, paclitaxel, docetaxel,
ofatumumab, dexamethasone, prednisone, CAL-101, ibritumomab,
tositumomab, bortezomib, pentostatin, endostatin, ritonavir,
ketoconazole, an anti-VEGF antibody, herceptin, cetuximab,
cisplatin, carboplatin, docetaxel, erlotinib, etopiside,
5-fluorouracil, gemcitabine, ifosphamide, imatinib mesylate
(Gleevec), gefitinib, procarbazine, prednisone, irinotecan,
leucovorin, mechlorethamine, methotrexate, oxaliplatin, paclitaxel,
sorafenib, sunitinib, topotecan, vinblastine, GA-1101, dasatinib,
Sipuleucel-T, disulfiram, epigallocatechin-3-gallate,
salinosporamide A, ONX0912, CEP-18770, MLN9708, R-406,
lenalinomide, spirocyclic piperidine derivatives, quinazoline
carboxamide azetidine compounds, thiotepa, DWA2114R, NK121, IS 3
295, 254-S, alkyl sulfonates such as busulfan, improsulfan and
piposulfan; aziridines such as benzodepa, carboquone, meturedepa
and uredepa; ethylenimine, methylmelamines such as altretamine,
triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda;
ibandronate; CPT1 1; topoisomerase inhibitor RFS 2000;
difluoromethylornithine (DMFO); retinoic acid; esperamycins;
capecitabine; and pharmaceutically acceptable salts, acids or
derivatives of; anti-hormonal agents such as anti-estrogens
including for example tamoxifen, raloxifene, aromatase inhibiting
4(5)-imidazoles, 4-hydroxytamoxifen, trioxifene, keoxifene,
LY117018, onapristone and toremifene (Fareston); antiandrogens such
as flutamide, nilutamide, bicalutamide, leuprolide and goserelin;
ACK inhibitors such as AVL-263 (Avila Therapeutics/Celgene
Corporation), AVL-292 (Avila Therapeutics/Celgene Corporation),
AVL-291 (Avila Therapeutics/Celgene Corporation), BMS-488516
(Bristol-Myers Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746
(CGI Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech),
HY-11066 (also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21,
HMS3265H22, 439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical
Co., Ltd.), ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123
(Peking University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof.
[0008] Described herein, in certain embodiments, are methods of
adjuvant therapy comprising administering to a subject,
characterized as disease free or having minimal residual disease
(MRD) following treatment of a cancer with a first anticancer
therapy, an effective amount of the covalent TEC family kinase
inhibitor to prevent, reduce the risk of, or delay relapsed or
refractory disease, wherein the first anticancer therapy does not
comprise administration a covalent TEC family kinase inhibitor. In
some embodiments, the anticancer therapy comprises administration
of a chemotherapeutic agent, a biologic agent, radiation therapy,
bone marrow transplant, surgery, photosensitizing agents, toxins,
or a combination thereof. In some embodiments, treatment covalent
TEC family kinase inhibitor extends disease free survival (DFS) or
overall survival (OS) in the subject. In some embodiments, disease
free survival (DFS) or overall survival (OS) is assessed 1, 2, 3,
4, 5, 6, 7, 8, 9, 10 years or longer following initiation of TEC
family kinase inhibitor administration. In some embodiments,
treatment with a chemotherapeutic agent or a biologic agent is
discontinued prior to initiation of treatment with the covalent TEC
family kinase inhibitor. In some embodiments, treatment with a
chemotherapeutic agent or a biologic agent is continued prior to
initiation of treatment with the covalent TEC family kinase
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor inhibits one or more TEC family kinases selected from
among ITK, BTK, TEC, RLK/TXK and BMX. In some embodiments, the
covalent TEC family kinase inhibitor is an IL2-inducible T-cell
kinase (ITK) inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is a Bruton's tyrosine kinase (BTK)
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor is selected from among ibrutinib (PCI-32765), PCI-45292,
PCI-45466, AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, the chemotherapeutic agent or biologic agent
is selected from among an antibody, a B cell receptor pathway
inhibitor, a T cell receptor inhibitor, a PI3K inhibitor, an IAP
inhibitor, an mTOR inhibitor, a radioimmunotherapeutic, a DNA
damaging agent, a histone deacetylase inhibitor, a protein kinase
inhibitor, a hedgehog inhibitor, an Hsp90 inhibitor, a telomerase
inhibitor, a Jak1/2 inhibitor, a protease inhibitor, an IRAK
inhibitor, a PKC inhibitor, a PARP inhibitor, a CYP3A4 inhibitor,
an AKT inhibitor, an Erk inhibitor, a proteosome inhibitor, an
alkylating agent, an anti metabolite, a plant alkaloid, a
terpenoid, a cytotoxin, a topoisomerase inhibitor, or a combination
thereof. In some embodiments, the B cell receptor pathway inhibitor
is a CD79A inhibitor, a CD79B inhibitor, a CD19 inhibitor, a Lyn
inhibitor, a Syk inhibitor, a PI3K inhibitor, a Blnk inhibitor, a
PLC.gamma. inhibitor, a PKC.beta. inhibitor, a CD22 inhibitor, a
Bcl-2 inhibitor, an IRAK 1/4 inhibitor, a microtubule inhibitor, a
Topo II inhibitor, anti TWEAK, anti-IL17 bispecific antibody, a CK2
inhibitor, anaplastic lymphoma kinase (ALK) and c-Met inhibitors,
demethylase enzyme inhibitors such as demethylase, HDM, LSDI and
KDM, fatty acid synthase inhibitors such as spirocyclic piperidine
derivatives, glucocorticosteriod receptor agonist, fusion anti-CD
19-cytotoxic agent conjugate, antimetabolite, p70S6K inhibitor,
immune modulators, AKT/PKB inhibitor, procaspase-3 activator PAC-1,
BRAF inhibitor, lactate dehydrogenase A (LDH-A) inhibitor, CCR2
inhibitor, CXCR4 inhibitor, chemokine receptor antagonists, DNA
double stranded break repair inhibitors, NOR202, GA-101, TLR2
inhibitor, a JAK inhibitor (e.g., ruxolitinib, baricitinib, CYT387,
lestauritinib, pacritinib, TG101348, SAR302503, tofacitinib
(Xeljanz), etanercept (Enbrel), GLPG0634, R256), or a combination
thereof. In some embodiments, the T cell receptor inhibitor is
Muromonab-CD3. In some embodiments, the chemotherapeutic agent or
biologic agent is selected from among rituximab (rituxan),
carfilzomib, fludarabine, cyclophosphamide, vincristine,
prednisalone. chlorambucil, ifosphamide, doxorubicin, mesalazine,
thalidomide, lenalidomide, temsirolimus, everolimus, fostamatinib,
paclitaxel, docetaxel, ofatumumab, dexamethasone, prednisone,
CAL-101, ibritumomab, tositumomab, bortezomib, pentostatin,
endostatin, ritonavir, ketoconazole, an anti-VEGF antibody,
herceptin, cetuximab, cisplatin, carboplatin, docetaxel, erlotinib,
etopiside, 5-fluorouracil, gemcitabine, ifosphamide, imatinib
mesylate (Gleevec), gefitinib, procarbazine, prednisone,
irinotecan, leucovorin, mechlorethamine, methotrexate, oxaliplatin,
paclitaxel, sorafenib, sunitinib, topotecan, vinblastine, GA-1101,
dasatinib, Sipuleucel-T, disulfiram, epigallocatechin-3-gallate,
salinosporamide A, ONX0912, CEP-18770, MLN9708, R-406,
lenalinomide, spirocyclic piperidine derivatives, quinazoline
carboxamide azetidine compounds, thiotepa, DWA2114R, NK121, IS 3
295, 254-S, alkyl sulfonates such as busulfan, improsulfan and
piposulfan; aziridines such as benzodepa, carboquone, meturedepa
and uredepa; ethylenimine, methylmelamines such as altretamine,
triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of, anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; ACK inhibitors such as
AVL-263 (Avila Therapeutics/Celgene Corporation), AVL-292 (Avila
Therapeutics/Celgene Corporation), AVL-291 (Avila
Therapeutics/Celgene Corporation), BMS-488516 (Bristol-Myers
Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746 (CGI
Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech), HY-11066
(also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21, HMS3265H22,
439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical Co., Ltd.),
ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123 (Peking
University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof. In some
embodiments, the subject has no detectable cancer following
treatment of the cancer with the first anticancer therapy and prior
to administration of the covalent TEC family kinase inhibitor. In
some embodiments, the subject has no detectable primary or
metastatic tumors following treatment of the cancer with the first
anticancer therapy and prior to administration of the covalent TEC
family kinase inhibitor. In some embodiments, the first anticancer
therapy decreases the size of a primary or metastatic tumor. In
some embodiments, the subject has no detectable circulating tumor
cells following treatment of the cancer with the first anticancer
therapy and prior to administration of the covalent TEC family
kinase inhibitor. In some embodiments, the subject is a mammal. In
some embodiments, the mammal is a human. In some embodiments, the
covalent TEC family kinase inhibitor is administered daily. In some
embodiments, the covalent TEC family kinase inhibitor is
administered 1, 2, 3, 4, 5 times or more per day. In some
embodiments, the covalent TEC family kinase inhibitor is
administered once per day. In some embodiments, the covalent TEC
family kinase inhibitor is administered at a dosage of about 40
mg/day to about 1000 mg/day. In some embodiments, the covalent TEC
family kinase inhibitor is administered for about 1 week to 5
years. In some embodiments, the covalent TEC family kinase
inhibitor is administered orally. In some embodiments, the risk of
relapsed or refractory disease is reduced by about 10%, 20%, 30%,
40%, 50%, 60%, 70%, 80%, 90% or greater compared to no treatment
with TEC family kinase inhibitor. In some embodiments, the subject
is disease free for about 6 months, 1 year, 2 years, 3 years, 4
years, 5 years, 6 years, 7 years, 8 years, 9 years, or 10 years
following last administration of TEC family kinase inhibitor. In
some embodiments, the risk of a secondary tumor is decreased
compared to no treatment with the covalent TEC family kinase
inhibitor. In some embodiments, the subject has a high risk of
cancer recurrence prior to administration of the covalent TEC
family kinase inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is administered with an additional
chemotherapeutic agent or biologic agent. In some embodiments, the
additional chemotherapeutic agent or biologic agent is selected
from among an antibody, a B cell receptor pathway inhibitor, a T
cell receptor inhibitor, a PI3K inhibitor, an IAP inhibitor, an
mTOR inhibitor, a radioimmunotherapeutic, a DNA damaging agent, a
histone deacetylase inhibitor, a protein kinase inhibitor, a
hedgehog inhibitor, an Hsp90 inhibitor, a telomerase inhibitor, a
Jak1/2 inhibitor, a protease inhibitor, an IRAK inhibitor, a PKC
inhibitor, a PARP inhibitor, a CYP3A4 inhibitor, an AKT inhibitor,
an Erk inhibitor, an alkylating agent, an anti metabolite, a plant
alkaloid, a terpenoid, a cytotoxin, a topoisomerase inhibitor, a
CD22 inhibitor, a Bcl-2 inhibitor, an IRAK 1/4 inhibitor, a
microtubule inhibitor, a Topo II inhibitor, anti TWEAK, anti-IL17
bispecific antibody, a CK2 inhibitor, anaplastic lymphoma kinase
(ALK) and c-Met inhibitors, demethylase enzyme inhibitors such as
demethylase, HDM, LSDI and KDM, fatty acid synthase inhibitors such
as spirocyclic piperidine derivatives, glucocorticosteriod receptor
agonist, fusion anti-CD 19-cytotoxic agent conjugate,
antimetabolite, p70S6K inhibitor, immune modulators, AKT/PKB
inhibitor, procaspase-3 activator PAC-1, BRAF inhibitor, lactate
dehydrogenase A (LDH-A) inhibitor, CCR2 inhibitor, CXCR4 inhibitor,
chemokine receptor antagonists, DNA double stranded break repair
inhibitors, NOR202, GA-101, TLR2 inhibitor, or a combination
thereof. In some embodiments, the B cell receptor pathway inhibitor
is a CD79A inhibitor, a CD79B inhibitor, a CD19 inhibitor, a Lyn
inhibitor, a Syk inhibitor, a PI3K inhibitor, a Blnk inhibitor, a
PLC.gamma. inhibitor, a PKC.beta. inhibitor, a JAK inhibitor (e.g.,
ruxolitinib, baricitinib, CYT387, lestauritinib, pacritinib,
TG101348, SAR302503, tofacitinib (Xeljanz), etanercept (Enbrel),
GLPG0634, R256), or a combination thereof. In some embodiments, the
additional chemotherapeutic agent or biologic agent is selected
from among rituximab (rituxan), carfilzomib, fludarabine,
cyclophosphamide, vincristine, prednisalone. chlorambucil,
ifosphamide, doxorubicin, mesalazine, thalidomide, lenalidomide,
temsirolimus, everolimus, fostamatinib, paclitaxel, docetaxel,
ofatumumab, dexamethasone, prednisone, CAL-101, ibritumomab,
tositumomab, bortezomib, pentostatin, endostatin, ritonavir,
ketoconazole, an anti-VEGF antibody, herceptin, cetuximab,
cisplatin, carboplatin, docetaxel, erlotinib, etopiside,
5-fluorouracil, gemcitabine, ifosphamide, imatinib mesylate
(Gleevec), gefitinib, procarbazine, prednisone, irinotecan,
leucovorin, mechlorethamine, methotrexate, oxaliplatin, paclitaxel,
sorafenib, sunitinib, topotecan, vinblastine, GA-1101, dasatinib,
Sipuleucel-T, disulfiram, epigallocatechin-3-gallate,
salinosporamide A, ONX0912, CEP-18770, MLN9708, R-406,
lenalinomide, spirocyclic piperidine derivatives, quinazoline
carboxamide azetidine compounds, thiotepa, DWA2114R, NK121, IS 3
295, 254-S, alkyl sulfonates such as busulfan, improsulfan and
piposulfan; aziridines such as benzodepa, carboquone, meturedepa
and uredepa; ethylenimine, methylmelamines such as altretamine,
triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of; anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; ACK inhibitors such as
AVL-263 (Avila Therapeutics/Celgene Corporation), AVL-292 (Avila
Therapeutics/Celgene Corporation), AVL-291 (Avila
Therapeutics/Celgene Corporation), BMS-488516 (Bristol-Myers
Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746 (CGI
Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech), HY-11066
(also, CTK4I7891, HMS3265G21, HMS3265G22,
HMS3265H21, HMS3265H22, 439574-61-5, AG-F-54930), ONO-4059 (Ono
Pharmaceutical Co., Ltd.), ONO-WG37 (Ono Pharmaceutical Co., Ltd.),
PLS-123 (Peking University), RN486 (Hoffmann-La Roche), HM71224
(Hanmi Pharmaceutical Company Limited) or a combination
thereof.
[0009] Described herein, in certain embodiments, are methods of
adjuvant therapy comprising administering to a subject with cancer,
following surgery for removal of a tumor, an effective amount of a
covalent TEC family kinase inhibitor to prevent, reduce the risk
of, or delay relapsed or refractory disease. In some embodiments,
the covalent TEC family kinase inhibitor inhibits one or more TEC
family kinases selected from among ITK, BTK, TEC, RLK/TXK and BMX.
In some embodiments, the covalent TEC family kinase inhibitor is an
IL2-inducible T-cell kinase (ITK) inhibitor. In some embodiments,
the covalent TEC family kinase inhibitor is a Bruton's tyrosine
kinase (BTK) inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, disease free survival
(DFS) or overall survival (OS) is assessed 1, 2, 3, 4, 5, 6, 7, 8,
9, 10 years or longer following initiation of covalent TEC family
kinase inhibitor administration. In some embodiments, the surgery
for removal of a tumor is a definitive surgery. In some
embodiments, the subject has no detectable tumors following
surgery. In some embodiments, the subject has no detectable
circulating tumor cells following surgery. In some embodiments, the
surgery for removal of a tumor is a partial removal of the tumor.
In some embodiments, the subject has not been administered
chemotherapy for treatment of the cancer. In some embodiments, the
subject has been administered a chemotherapeutic agent or biologic
agent for treatment of the cancer. In some embodiments, the subject
is a mammal. In some embodiments, the mammal is a human. In some
embodiments, the covalent TEC family kinase inhibitor is
administered daily. In some embodiments, the covalent TEC family
kinase inhibitor is administered 1, 2, 3, 4, 5 times or more per
day. In some embodiments, the covalent TEC family kinase inhibitor
is administered once per day. In some embodiments, the covalent TEC
family kinase inhibitor is administered at a dosage of about 40
mg/day to about 1000 mg/day. In some embodiments, the covalent TEC
family kinase inhibitor is administered for about 1 week to 5
years. In some embodiments, the covalent TEC family kinase
inhibitor is administered orally. In some embodiments, the risk of
relapsed or refractory disease is reduced by about 10%, 20%, 30%,
40%, 50%, 60%, 70%, 80%, 90% or greater compared to no treatment
with the covalent TEC family kinase inhibitor. In some embodiments,
the subject is disease free for about 6 months, 1 year, 2 years, 3
years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years, 10
years or longer following last administration of the covalent TEC
family kinase inhibitor. In some embodiments, the risk of a
secondary tumor is decreased compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
subject has a high risk of cancer recurrence prior to treatment
with the covalent TEC family kinase inhibitor. In some embodiments,
the tumor is a sarcoma, carcinoma, neurofibromatoma or a lymphoma.
In some embodiments, the lymphoma is an enlarged lymph node or an
extranodal lymphoma. In some embodiments, the subject has a brain,
breast, bladder, bone, colon, kidney, liver, lung, ovarian,
pancreatic, prostate, skin or proximal or distal bile duct
carcinoma. In some embodiments, the subject has a hematologic
cancer. In some embodiments, the cancer is a lymphoma. In some
embodiments, the subject has a non-Hodgkin's lymphoma. In some
embodiments, the non-Hodgkin's lymphoma is chronic lymphocytic
leukemia/small lymphocytic lymphoma (CLL/SLL), follicular lymphoma
(FL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma
(MCL), Waldenstrom's macroglobulinemia, multiple myeloma, marginal
zone lymphoma, Burkitt's lymphoma, non-Burkitt high grade B cell
lymphoma, or extranodal marginal zone B cell lymphoma. In some
embodiments, the non-Hodgkin's lymphoma is a relapsed or refractory
non-Hodgkin's lymphoma. In some embodiments, the subject has a
T-cell malignancy. In some embodiments, the T-cell malignancy is
peripheral T-cell lymphoma not otherwise specified (PTCL-NOS),
anaplastic large cell lymphoma, angioimmunoblastic lymphoma,
cutaneous T-cell lymphoma, adult T-cell leukemia/lymphoma (ATLL),
blastic NK-cell lymphoma, enteropathy-type T-cell lymphoma,
hematosplenic gamma-delta T-cell lymphoma, lymphoblastic lymphoma,
nasal NK/T-cell lymphomas, or treatment-related T-cell lymphomas.
In some embodiments, the T-cell malignancy is a relapsed or
refractory T-cell malignancy. In some embodiments, DFS or OS is
evaluated about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 years after
initiation of the covalent TEC family kinase inhibitor treatment.
In some embodiments, the covalent TEC family kinase inhibitor is
administered in combination with an additional chemotherapeutic
agent or biologic agent. In some embodiments, the additional
chemotherapeutic agent or biologic agent is selected from among an
antibody, a B cell receptor pathway inhibitor, a T cell receptor
inhibitor, a PI3K inhibitor, an IAP inhibitor, a proteosome
inhibitor, an mTOR inhibitor, a radioimmunotherapeutic, a DNA
damaging agent, a histone deacetylase inhibitor, a protein kinase
inhibitor, a hedgehog inhibitor, an Hsp90 inhibitor, a telomerase
inhibitor, a Jak1/2 inhibitor, a protease inhibitor, an IRAK
inhibitor, a PKC inhibitor, a PARP inhibitor, a CYP3A4 inhibitor,
an AKT inhibitor, an Erk inhibitor, an alkylating agent, an anti
metabolite, a plant alkaloid, a terpenoid, a cytotoxin, a
topoisomerase inhibitor, a CD22 inhibitor, a Bcl-2 inhibitor, an
IRAK 1/4 inhibitor, a microtubule inhibitor, a Topo II inhibitor,
anti TWEAK, anti-IL17 bispecific antibody, a CK2 inhibitor,
anaplastic lymphoma kinase (ALK) and c-Met inhibitors, demethylase
enzyme inhibitors such as demethylase, HDM, LSDI and KDM, fatty
acid synthase inhibitors such as spirocyclic piperidine
derivatives, glucocorticosteriod receptor agonist, fusion anti-CD
19-cytotoxic agent conjugate, antimetabolite, p70S6K inhibitor,
immune modulators, AKT/PKB inhibitor, procaspase-3 activator PAC-1,
BRAF inhibitor, lactate dehydrogenase A (LDH-A) inhibitor, CCR2
inhibitor, CXCR4 inhibitor, chemokine receptor antagonists, DNA
double stranded break repair inhibitors, NOR202, GA-101, TLR2
inhibitor, or a combination thereof. In some embodiments, the B
cell receptor pathway inhibitor is a CD79A inhibitor, a CD79B
inhibitor, a CD19 inhibitor, a Lyn inhibitor, a Syk inhibitor, a
PI3K inhibitor, a Blnk inhibitor, a PLC.gamma. inhibitor, a
PKC.beta. inhibitor, a JAK inhibitor (e.g., ruxolitinib,
baricitinib, CYT387, lestauritinib, pacritinib, TG101348,
SAR302503, tofacitinib (Xeljanz), etanercept (Enbrel), GLPG0634,
R256), or a combination thereof. In some embodiments, the T cell
receptor inhibitor is Muromonab-CD3. In some embodiments, the
additional chemotherapeutic agent or biologic agent is selected
from among rituximab (rituxan), carfilzomib, fludarabine,
cyclophosphamide, vincristine, prednisalone. chlorambucil,
ifosphamide, doxorubicin, mesalazine, thalidomide, lenalidomide,
temsirolimus, everolimus, fostamatinib, paclitaxel, docetaxel,
ofatumumab, dexamethasone, prednisone, CAL-101, ibritumomab,
tositumomab, bortezomib, pentostatin, endostatin, ritonavir,
ketoconazole, an anti-VEGF antibody, herceptin, cetuximab,
cisplatin, carboplatin, docetaxel, erlotinib, etopiside,
5-fluorouracil, gemcitabine, ifosphamide, imatinib mesylate
(Gleevec), gefitinib, procarbazine, prednisone, irinotecan,
leucovorin, mechlorethamine, methotrexate, oxaliplatin, paclitaxel,
sorafenib, sunitinib, topotecan, vinblastine, GA-1101, dasatinib,
Sipuleucel-T, disulfiram, epigallocatechin-3-gallate,
salinosporamide A, ONX0912, CEP-18770, MLN9708, R-406,
lenalinomide, spirocyclic piperidine derivatives, quinazoline
carboxamide azetidine compounds, thiotepa, DWA2114R, NK121, IS 3
295, 254-S, alkyl sulfonates such as busulfan, improsulfan and
piposulfan; aziridines such as benzodepa, carboquone, meturedepa
and uredepa; ethylenimine, methylmelamines such as altretamine,
triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of; anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; ACK inhibitors such as
AVL-263 (Avila Therapeutics/Celgene Corporation), AVL-292 (Avila
Therapeutics/Celgene Corporation), AVL-291 (Avila
Therapeutics/Celgene Corporation), BMS-488516 (Bristol-Myers
Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746 (CGI
Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech), HY-11066
(also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21, HMS3265H22,
439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical Co., Ltd.),
ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123 (Peking
University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof.
[0010] Described herein, in certain embodiments, are methods
adjuvant therapy comprising administering to a subject with cancer,
following surgery for removal of a tumor, an effective amount of a
covalent TEC family kinase inhibitor so as to extend disease free
survival (DFS) or overall survival (OS) in the subject. In some
embodiments, the covalent TEC family kinase inhibitor inhibits one
or more TEC family kinases selected from among ITK, BTK, TEC,
RLK/TXK and BMX. In some embodiments, the covalent TEC family
kinase inhibitor is an IL2-inducible T-cell kinase (ITK) inhibitor.
In some embodiments, the covalent TEC family kinase inhibitor is a
Bruton's tyrosine kinase (BTK) inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor is selected from among
ibrutinib (PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291,
AVL-292, or ONO-WG-37. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib. In some embodiments, disease free
survival (DFS) or overall survival (OS) is assessed 1, 2, 3, 4, 5,
6, 7, 8, 9, 10 years or longer following initiation of covalent TEC
family kinase inhibitor administration. In some embodiments, the
surgery for removal of a tumor is a definitive surgery. In some
embodiments, the subject has no detectable tumors following
surgery. In some embodiments, the subject has no detectable
circulating tumor cells following surgery. In some embodiments, the
surgery for removal of a tumor is a partial removal of the tumor.
In some embodiments, the subject has not been administered
chemotherapy for treatment of the cancer. In some embodiments, the
subject has been administered a chemotherapeutic agent or biologic
agent for treatment of the cancer. In some embodiments, the subject
is a mammal. In some embodiments, the mammal is a human. In some
embodiments, the covalent TEC family kinase inhibitor is
administered daily. In some embodiments, the covalent TEC family
kinase inhibitor is administered 1, 2, 3, 4, 5 times or more per
day. In some embodiments, the covalent TEC family kinase inhibitor
is administered once per day. In some embodiments, the covalent TEC
family kinase inhibitor is administered at a dosage of about 40
mg/day to about 1000 mg/day. In some embodiments, the covalent TEC
family kinase inhibitor is administered for about 1 week to 5
years. In some embodiments, the covalent TEC family kinase
inhibitor is administered orally. In some embodiments, the risk of
relapsed or refractory disease is reduced by about 10%, 20%, 30%,
40%, 50%, 60%, 70%, 80%, 90% or greater compared to no treatment
with the covalent TEC family kinase inhibitor. In some embodiments,
the subject is disease free for about 6 months, 1 year, 2 years, 3
years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years, 10
years or longer following last administration of the covalent TEC
family kinase inhibitor. In some embodiments, the risk of a
secondary tumor is decreased compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
subject has a high risk of cancer recurrence prior to treatment
with the covalent TEC family kinase inhibitor. In some embodiments,
the tumor is a sarcoma, carcinoma, neurofibromatoma or a lymphoma.
In some embodiments, the lymphoma is an enlarged lymph node or an
extranodal lymphoma. In some embodiments, the subject has a brain,
breast, bladder, bone, colon, kidney, liver, lung, ovarian,
pancreatic, prostate, skin or proximal or distal bile duct
carcinoma. In some embodiments, the subject has a hematologic
cancer. In some embodiments, the cancer is a lymphoma. In some
embodiments, the subject has a non-Hodgkin's lymphoma. In some
embodiments, the non-Hodgkin's lymphoma is chronic lymphocytic
leukemia/small lymphocytic lymphoma (CLL/SLL), follicular lymphoma
(FL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma
(MCL), Waldenstrom's macroglobulinemia, multiple myeloma, marginal
zone lymphoma, Burkitt's lymphoma, non-Burkitt high grade B cell
lymphoma, or extranodal marginal zone B cell lymphoma. In some
embodiments, the non-Hodgkin's lymphoma is a relapsed or refractory
non-Hodgkin's lymphoma. In some embodiments, the subject has a
T-cell malignancy. In some embodiments, the T-cell malignancy is
peripheral T-cell lymphoma not otherwise specified (PTCL-NOS),
anaplastic large cell lymphoma, angioimmunoblastic lymphoma,
cutaneous T-cell lymphoma, adult T-cell leukemia/lymphoma (ATLL),
blastic NK-cell lymphoma, enteropathy-type T-cell lymphoma,
hematosplenic gamma-delta T-cell lymphoma, lymphoblastic lymphoma,
nasal NK/T-cell lymphomas, or treatment-related T-cell lymphomas.
In some embodiments, the T-cell malignancy is a relapsed or
refractory T-cell malignancy. In some embodiments, DFS or OS is
evaluated about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 years after
initiation of the covalent TEC family kinase inhibitor treatment.
In some embodiments, the covalent TEC family kinase inhibitor is
administered in combination with an additional chemotherapeutic
agent or biologic agent. In some embodiments, the additional
chemotherapeutic agent or biologic agent is selected from among an
antibody, a B cell receptor pathway inhibitor, a T cell receptor
inhibitor, a PI3K inhibitor, an IAP inhibitor, an mTOR inhibitor, a
radioimmunotherapeutic, a DNA damaging agent, a histone deacetylase
inhibitor, a protein kinase inhibitor, a hedgehog inhibitor, an
Hsp90 inhibitor, a telomerase inhibitor, a Jak1/2 inhibitor, a
protease inhibitor, an IRAK inhibitor, a PKC inhibitor, a PARP
inhibitor, a proteomsome inhibitor, a CYP3A4 inhibitor, an AKT
inhibitor, an Erk inhibitor, an alkylating agent, an anti
metabolite, a plant alkaloid, a terpenoid, a cytotoxin, a
topoisomerase inhibitor, or a combination thereof. In some
embodiments, the B cell receptor pathway inhibitor is a CD79A
inhibitor, a CD79B inhibitor, a CD19 inhibitor, a Lyn inhibitor, a
Syk inhibitor, a PI3K inhibitor, a Blnk inhibitor, a PLC.gamma.
inhibitor, a PKC.beta. inhibitor, a CD22 inhibitor, a Bcl-2
inhibitor, an IRAK 1/4 inhibitor, a microtubule inhibitor, a Topo
II inhibitor, anti TWEAK, anti-IL17 bispecific antibody, a CK2
inhibitor, anaplastic lymphoma kinase (ALK) and c-Met inhibitors,
demethylase enzyme inhibitors such as demethylase, HDM, LSDI and
KDM, fatty acid synthase inhibitors such as spirocyclic piperidine
derivatives, glucocorticosteriod receptor agonist, fusion anti-CD
19-cytotoxic agent conjugate, antimetabolite, p70S6K inhibitor,
immune modulators, AKT/PKB inhibitor, procaspase-3 activator PAC-1,
BRAF inhibitor, lactate dehydrogenase A (LDH-A) inhibitor, CCR2
inhibitor, CXCR4 inhibitor, chemokine receptor antagonists, DNA
double stranded break repair inhibitors, NOR202, GA-101, TLR2
inhibitor, a JAK inhibitor (e.g., ruxolitinib, baricitinib, CYT387,
lestauritinib, pacritinib, TG101348, SAR302503, tofacitinib
(Xeljanz), etanercept (Enbrel), GLPG0634, R256), or a combination
thereof. In some embodiments, the T cell receptor inhibitor is
Muromonab-CD3. In some embodiments, the additional chemotherapeutic
agent or biologic agent is selected from among rituximab,
carfilzomib, fludarabine, cyclophosphamide, vincristine,
prednisalone. chlorambucil, ifosphamide, doxorubicin, mesalazine,
thalidomide, lenalidomide, temsirolimus, everolimus, fostamatinib,
paclitaxel, docetaxel, ofatumumab, dexamethasone, prednisone,
CAL-101, ibritumomab, tositumomab, bortezomib, pentostatin,
endostatin, ritonavir, ketoconazole, an anti-VEGF antibody,
herceptin, cetuximab, cisplatin, carboplatin, docetaxel, erlotinib,
etopiside, 5-fluorouracil, gemcitabine, ifosphamide, imatinib
mesylate (Gleevec), gefitinib, procarbazine, prednisone,
irinotecan, leucovorin, mechlorethamine, methotrexate, oxaliplatin,
paclitaxel, sorafenib, sunitinib, topotecan, vinblastine, GA-1101,
dasatinib, Sipuleucel-T, disulfiram, epigallocatechin-3-gallate,
salinosporamide A, ONX0912, CEP-18770, MLN9708, R-406,
lenalinomide, spirocyclic piperidine derivatives, quinazoline
carboxamide azetidine compounds, thiotepa, DWA2114R, NK121, IS 3
295, 254-S, alkyl sulfonates such as busulfan, improsulfan and
piposulfan; aziridines such as benzodepa, carboquone, meturedepa
and uredepa; ethylenimine, methylmelamines such as altretamine,
triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of; anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; ACK inhibitors such as
AVL-263 (Avila Therapeutics/Celgene Corporation), AVL-292 (Avila
Therapeutics/Celgene Corporation), AVL-291 (Avila
Therapeutics/Celgene Corporation), BMS-488516 (Bristol-Myers
Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746 (CGI
Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech), HY-11066
(also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21, HMS3265H22,
439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical Co., Ltd.),
ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123 (Peking
University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof.
[0011] Described herein, in certain embodiments, are methods of
treating T-cell malignancy in the subject comprising administering
to the subject an effective amount of a covalent TEC family kinase
inhibitor thereby treating the T-cell malignancy. In some
embodiments, the covalent TEC family kinase inhibitor inhibits one
or more TEC family kinases selected from among ITK, BTK, TEC,
RLK/TXK and BMX. In some embodiments, the covalent TEC family
kinase inhibitor inhibits ITK. In some embodiments, the covalent
TEC family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, the T-cell malignancy
is selected from among peripheral T-cell lymphoma not otherwise
specified (PTCL-NOS), anaplastic large cell lymphoma,
angioimmunoblastic lymphoma, cutaneous T-cell lymphoma, adult
T-cell leukemia/lymphoma (ATLL), blastic NK-cell lymphoma,
enteropathy-type T-cell lymphoma, hematosplenic gamma-delta T-cell
lymphoma, lymphoblastic lymphoma, nasal NK/T-cell lymphomas, or
treatment-related T-cell lymphomas. In some embodiments, the T-cell
malignancy is a relapsed or refractory T-cell malignancy.
[0012] Described herein, in certain embodiments, are methods of
treating a subject having an immune disorder characterized by an
impaired Th1 immune response or an overactive Th2 response
comprising administering to the subject an effective amount of a
covalent TEC family kinase inhibitor to increase the Th1 immune
response or decrease the Th2 response in the subject, whereby the
immune disorder is treated. In some embodiments, the subject has a
pathogenic infection. In some embodiments, the pathogenic infection
is a viral, a bacterial, a fungal, a parasitic or a protozoal
infection. In some embodiments, the pathogenic infection is a viral
or a bacterial infection. In some embodiments, the immune disorder
is associated with a hematologic cancer. In some embodiments, the
immune disorder is associated with a leukemia, a lymphoma, or a
myeloma. In some embodiments, the immune disorder is associated
with non-Hodgkin's lymphoma. In some embodiments, the immune
disorder is associated with chronic lymphocytic leukemia (CLL),
small lymphocytic lymphoma (SLL), high risk CLL, follicular
lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), mantle cell
lymphoma (MCL), Waldenstrom's macroglobulinemia, multiple myeloma,
marginal zone lymphoma, Burkitt's lymphoma, non-Burkitt high grade
B cell lymphoma, extranodal marginal zone B cell lymphoma or Sezary
syndrome. In some embodiments, the subject has an autoimmune
disease characterized by an impaired Th1 immune response or an
overactive Th2 response. In some embodiments, the autoimmune
disease is associated with a viral infection. In some embodiments,
wherein the subject has a human immunodeficiency virus (HIV)
infection. In some embodiments, the subject has a hepatitis
infection. In some embodiments, the hepatitis infection is an A, B
or C type hepatitis infection. In some embodiments, the subject has
an influenza infection. In some embodiments, the subject has
measles virus infection. In some embodiments, the subject has a
Human papilloma virus infection. In some embodiments, the subject
has a Human herpesvirus 6A, Human herpesvirus 6B, or Human
herpesvirus 7. In some embodiments, the subject has a Herpes
Simplex virus. In some embodiments, the subject has an Epstein-Bar
virus. In some embodiments, the subject has a Human
cytomegalovirus. In some embodiments, the subject has a Rous
sarcoma virus. In some embodiments, the subject has a chronic
granulomatous disease. In some embodiments, the autoimmune disease
is autoimmune arthritis. In some embodiments, the immune disorder
is atopic dermatitis, inflammatory bowel disease, an unspecified
T-cell lymphoma (U-PTCLs), rheumatoid arthritis, bronchial asthma,
allergic airway inflammatory disease or aplastic anemia. In some
embodiments, the pathogenic infection is a Listeria monocytogenes
infection. In some embodiments, the pathogenic infection is a
Leishmania major infection. In some embodiments, the covalent TEC
family kinase inhibitor inhibits one or more TEC family kinases
selected from among ITK, BTK, TEC, RLK/TXK and BMX. In some
embodiments, the covalent TEC family kinase inhibitor inhibits ITK.
In some embodiments, the covalent TEC family kinase inhibitor is
selected from among ibrutinib (PCI-32765), PCI-45292, PCI-45466,
AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some embodiments, the
covalent TEC family kinase inhibitor is ibrutinib. In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with a T-cell immunotherapy. In some
embodiments, the T-cell immunotherapy is selected from among
adoptive T cell transfer, a vaccine, a cytokine, an interleukin, a
chemokine, a cytokine inducer, an interleukin inducer, a chemokine
inducer, or an immunomodulatory antibody.
[0013] Described herein, in certain embodiments, is a method for
treating a Th2 cell-mediated disease or condition by increasing the
Th1:Th2 ratio in the subject comprising administering to the
subject an effective amount of a covalent TEC family kinase
inhibitor thereby treating the Th2 cell-mediated disease or
condition. In some embodiments, the covalent TEC family kinase
inhibitor inhibits one or more TEC family kinases selected from
among ITK, BTK, TEC, RLK/TXK and BMX. In some embodiments, the
covalent TEC family kinase inhibitor inhibits ITK. In some
embodiments, the covalent TEC family kinase inhibitor is selected
from among ibrutinib (PCI-32765), PCI-45292, PCI-45466, AVL-101,
AVL-291, AVL-292, or ONO-WG-37. In some embodiments, the covalent
TEC family kinase inhibitor is ibrutinib. In some embodiments, the
Th2 cell-mediated disease or condition is selected from among
cancer (e.g., hematologic malignancies and solid tumors),
exacerbation of infection with infectious diseases (e.g.,
Leishmania major, Listeria monocytogenes, Mycobacterium leprae,
Candida albicans, Toxoplasma gondi, Hepatitis C virus (HCV),
Respiratory Syncytial virus (RSV), human immunodeficiency virus
(HIV), influenzavirus A) and allergic disorders, such as
anaphylactic hypersensitivity, asthma, allergic rhinitis, atopic
dermatitis, vernal conjunctivitis, eczema, urticaria and food
allergies, autoimmune diseases, inflammatory diseases, inflammatory
bowel disease, ulcerative colitis, systemic lupus erythematodes,
myasthenia gravis, systemic progressive scleroderma, rheumatoid
arthritis, interstitial cystitis, Hashimoto's diseases, Basedow's
diseases, autoimmune hemolytic anemia, idiopathic thrombocytopenic
purpura, Goodpasture's syndrome, atrophic gastritis, pernicious
anemia, Addison diseases, pemphigus, pemphigoid, lenticular
uveitis, sympathetic ophthalmia, primary biliary cirrhosis, active
chronic hepatitis, Sjogren's syndrome, multiple myositis,
dermatomyositis, polyarteritis nodosa, rheumatic fever, glomerular
nephritis (lupus nephritis, IgA nephropathy, and the like),
allergic encephalitis, atopic allergic diseases (for example,
bronchial asthma, allergic rhinitis, allergic dermatitis, allergic
conjunctivitis, pollinosis, urticaria, food allergy and the like),
Omenn's syndrome, vernal conjunctivitis and hypereosinophilic
syndrome.
[0014] Described herein, in certain embodiments, are methods of
treating a pathogenic infection in a subject having an immune
disorder characterized by an impaired Th1 immune response or an
overactive Th2 response comprising administering to the subject an
effective amount of a covalent TEC family kinase inhibitor, whereby
the pathogenic infection is treated. In some embodiments, the
pathogenic infection is a viral, a bacterial, a fungal, a parasitic
or a protozoal infection. In some embodiments, the pathogenic
infection is a viral or a bacterial infection. In some embodiments,
the immune disorder is associated with a hematologic cancer. In
some embodiments, the immune disorder is associated with a
leukemia, a lymphoma, or a myeloma. In some embodiments, the immune
disorder is associated with non-Hodgkin's lymphoma. In some
embodiments, the immune disorder is associated with chronic
lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), high
risk CLL, follicular lymphoma (FL), diffuse large B-cell lymphoma
(DLBCL), mantle cell lymphoma (MCL), Waldenstrom's
macroglobulinemia, multiple myeloma, marginal zone lymphoma,
Burkitt's lymphoma, non-Burkitt high grade B cell lymphoma, or
extranodal marginal zone B cell lymphoma. In some embodiments, the
subject has an autoimmune disease characterized by an impaired Th1
immune response or an overactive Th2 response. In some embodiments,
the autoimmune disease is associated with a viral infection. In
some embodiments, wherein the subject has a human immunodeficiency
virus (HIV) infection. In some embodiments, the subject has a
hepatitis infection. In some embodiments, the hepatitis infection
is an A, B or C type hepatitis infection. In some embodiments, the
subject has an influenza infection. In some embodiments, the
subject has measles virus infection. In some embodiments, the
subject has a Human papilloma virus infection. In some embodiments,
the subject has a Human herpesvirus 6A, Human herpesvirus 6B, or
Human herpesvirus 7. In some embodiments, the subject has a Herpes
Simplex virus. In some embodiments, the subject has an Epstein-Bar
virus. In some embodiments, the subject has a Human
cytomegalovirus. In some embodiments, the subject has a Rous
sarcoma virus. In some embodiments, the subject has a chronic
granulomatous disease. In some embodiments, the autoimmune disease
is autoimmune arthritis. In some embodiments, the immune disorder
is atopic dermatitis, inflammatory bowel disease, an unspecified
T-cell lymphoma (U-PTCLs), rheumatoid arthritis, bronchial asthma,
allergic airway inflammatory disease or aplastic anemia. In some
embodiments, the pathogenic infection is a Listeria monocytogenes
infection. In some embodiments, the pathogenic infection is a
Leishmania major infection. In some embodiments, the covalent TEC
family kinase inhibitor inhibits one or more TEC family kinases
selected from among ITK, BTK, TEC, RLK/TXK and BMX. In some
embodiments, the covalent TEC family kinase inhibitor inhibits ITK.
In some embodiments, the covalent TEC family kinase inhibitor is
selected from among ibrutinib (PCI-32765), PCI-45292, PCI-45466,
AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some embodiments, the
covalent TEC family kinase inhibitor is ibrutinib. In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with a T-cell immunotherapy. In some
embodiments, the T-cell immunotherapy is selected from among
adoptive T cell transfer, a vaccine, a cytokine, an interleukin, a
chemokine, a cytokine inducer, an interleukin inducer, a chemokine
inducer, or an immunomodulatory antibody.
[0015] Described herein, in certain embodiments, are methods of
treating a pathogenic infection in a subject comprising
administering to the subject an effective amount of a covalent TEC
family kinase inhibitor whereby the pathogenic infection is
treated. In some embodiments, the pathogenic infection is
associated with an impaired Th1 immune response or an overactive
Th2 response in the individual. In some embodiments, the pathogenic
infection is a chronic viral infection. In some embodiments, the
chronic viral infection is a chronic HCV infection. In some
embodiments, the pathogenic infection is an HIV infection. In some
embodiments, the pathogenic infection is an influenza infection. In
some embodiments, the methods further comprise administering an
antiviral agent. In some embodiments, the antiviral agent is
acyclovir, famciclovir, ganciclovir, penciclovir, valacyclovir,
valganciclovir, idoxuridine, trifluridine, brivudine, cidofovir,
docosanol, fomivirsen, foscarnet, tromantadine, imiquimod,
podophyllotoxin, entecavir, lamivudine, telbivudine, clevudine,
adefovir, tenofovir, boceprevir, telaprevir, pleconaril, arbidol,
amantadine, rimantadine, oseltamivir, zanamivir, peramivir,
inosine, interferon (e.g., Interferon alfa-2b, Peginterferon
alfa-2a), ribavirin/taribavirin, abacavir, emtricitabine,
lamivudine, didanosine, zidovudine, apricitabine, stampidine,
elvucitabine, racivir, amdoxovir, stavudine, zalcitabine,
tenofovir, efavirenz, nevirapine, etravirine, rilpivirine,
loviride, delavirdine, atazanavir, fosamprenavir, lopinavir,
darunavir, nelfinavir, ritonavir, saquinavir, tipranavir,
amprenavir, indinavir, enfuvirtide, maraviroc, vicriviroc, PRO 140,
ibalizumab, raltegravir, elvitegravir, bevirimat, or vivecon. In
some embodiments, the antiviral agent is ribavirin. In some
embodiments, the antiviral agent is IFN-.alpha.. In some
embodiments, the methods further comprise administering ribavirin
and IFN-.alpha. in combination with the covalent TEC family kinase
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor inhibits one or more TEC family kinases selected from
among ITK, BTK, TEC, RLK/TXK and BMX. In some embodiments, the
covalent TEC family kinase inhibitor is an IL2-inducible T-cell
kinase (ITK) inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is a Bruton's tyrosine kinase (BTK)
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor is selected from among ibrutinib (PCI-32765), PCI-45292,
PCI-45466, AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, the subject is a mammal. In some embodiments,
the mammal is a human. In some embodiments, the covalent TEC family
kinase inhibitor is administered daily. In some embodiments, the
covalent TEC family kinase inhibitor is administered 1, 2, 3, 4, 5
times or more per day. In some embodiments, the covalent TEC family
kinase inhibitor is administered once per day. In some embodiments,
the covalent TEC family kinase inhibitor is administered at a
dosage of about 40 mg/day to about 1000 mg/day. In some
embodiments, the covalent TEC family kinase inhibitor is
administered for about 1 week to 5 years. In some embodiments, the
covalent TEC family kinase inhibitor is administered orally. In
some embodiments, administration of a covalent TEC family kinase
inhibitor decreases the number of Th2 polarized T cells in the
subject. In some embodiments, administration of a covalent TEC
family kinase inhibitor increases the number of Th1 polarized T
cells in the subject. In some embodiments, administration of a
covalent TEC family kinase inhibitor increases the number of
activated CD8+ cytotoxic T cells in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor increases the ratio of Th1 polarized T cells to Th2
polarized T cells in the subject. In some embodiments,
administration of a covalent TEC family kinase inhibitor decreases
the expression of one or more Th2 cytokines in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-10, IL-4 or IL-13 expression in the subject.
In some embodiments, administration of a covalent TEC family kinase
inhibitor increases the expression of one or more Th1 cytokines in
the subject. In some embodiments, administration of a covalent TEC
family kinase inhibitor increases IL-2, GM-CSF, IFN-.gamma.,
IL-12(p70) and TNF-.alpha. expression in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor increase the number of cytotoxic CD8+ T cells in the
subject. In some embodiments, a covalent TEC family kinase
inhibitor inhibits the kinase activity of IL2-inducible T-cell
kinase (ITK). In some embodiments, a covalent TEC family kinase
inhibitor covalently binds to Cysteine 442 of ITK. In some
embodiments, the covalent TEC family kinase inhibitor covalently
binds to Cysteine 481 of BTK. In some embodiments, the covalent TEC
family kinase inhibitor covalently inhibits the kinase activity of
BTK and ITK. In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with an immune cell
modulator. In some embodiments, the immune modulator is a T cell
immune modulator. In some embodiments, the immune modulator is a
recombinant T cell, a vaccine, a cytokine, an interleukin, a
chemokine, a cytokine inducer, an interleukin inducer, a chemokine
inducer, or an immunomodulatory antibody. In some embodiments, the
immune modulator is Sipuleucel-T.
[0016] Described herein, in certain embodiments, are methods of
vaccination of a subject comprising administering to the subject an
effective amount of a covalent TEC family kinase inhibitor in
combination with a vaccine. In some embodiments, the covalent TEC
family kinase inhibitor and the vaccine are administered
simultaneously, sequentially, or intermittently. In some
embodiments, the vaccine comprises a tumor antigen. In some
embodiments, the vaccine comprises an antigen from a virus,
bacterium, or a parasite. In some embodiments, the vaccine
comprises an attenuated virus or inactivated virus. In some
embodiments, the vaccine comprises attenuated bacteria or killed
bacteria. In some embodiments, the covalent TEC family kinase
inhibitor inhibits one or more TEC family kinases selected from
among ITK, BTK, TEC, RLK/TXK and BMX. In some embodiments, the
covalent TEC family kinase inhibitor is an IL2-inducible T-cell
kinase (ITK) inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is a Bruton's tyrosine kinase (BTK)
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor is selected from among ibrutinib (PCI-32765), PCI-45292,
PCI-45466, AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some
embodiments, the covalent TEC family kinase inhibitor is
ibrutinib.
[0017] Described herein, in certain embodiments, are compositions
comprising: a covalent TEC family kinase inhibitor; and an
antiviral agent. In some embodiments, the antiviral agent comprises
a cytokine, a protease inhibitor or a nucleoside analog. In some
embodiments, the antiviral agent comprises ribavirin. In some
embodiments, the antiviral agent comprises IFN-.alpha.. In some
embodiments, the antiviral agent comprises ribavirin and
IFN-.alpha.. In some embodiments, the covalent TEC family kinase
inhibitor inhibits one or more TEC family kinases selected from
among ITK, BTK, TEC, RLK/TXK and BMX. In some embodiments, the
covalent TEC family kinase inhibitor is an IL2-inducible T-cell
kinase (ITK) inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor is a Bruton's tyrosine kinase (BTK)
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor is selected from among ibrutinib (PCI-32765), PCI-45292,
PCI-45466, AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some
embodiments, the covalent TEC family kinase inhibitor is
ibrutinib.
[0018] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors for treating a subject having
a cancer characterized by a cytokine profile in which Th1 response
is suppressed and Th2 response is enhanced. In some embodiments,
the covalent TEC family kinase inhibitor suppresses the Th2
response in the subject. In some embodiments, the covalent TEC
family kinase inhibitor inhibits one or more TEC family kinases
selected from among ITK, BTK, TEC, RLK/TXK and BMX. In some
embodiments, the covalent TEC family kinase inhibitor inhibits ITK.
In some embodiments, the covalent TEC family kinase inhibitor is
selected from among ibrutinib (PCI-32765), PCI-45292, PCI-45466,
AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some embodiments, the
covalent TEC family kinase inhibitor is ibrutinib.
[0019] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors for the manufacture of a
medicament for treating a subject having a cancer characterized by
a cytokine profile in which Th1 response is suppressed and Th2
response is enhanced. In some embodiments, the covalent TEC family
kinase inhibitor suppresses the Th2 response in the subject. In
some embodiments, the covalent TEC family kinase inhibitor inhibits
one or more TEC family kinases selected from among ITK, BTK, TEC,
RLK/TXK and BMX. In some embodiments, the covalent TEC family
kinase inhibitor inhibits ITK. In some embodiments, the covalent
TEC family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib.
[0020] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors for increasing the Th1:Th2
biomarker ratio in a subject having cancer. In some embodiments,
the covalent TEC family kinase inhibitor suppresses the Th2
response in the subject. In some embodiments, the covalent TEC
family kinase inhibitor inhibits one or more TEC family kinases
selected from among ITK, BTK, TEC, RLK/TXK and BMX. In some
embodiments, the covalent TEC family kinase inhibitor inhibits ITK.
In some embodiments, the covalent TEC family kinase inhibitor is
selected from among ibrutinib (PCI-32765), PCI-45292, PCI-45466,
AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some embodiments, the
covalent TEC family kinase inhibitor is ibrutinib.
[0021] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors for the manufacture of a
medicament for increasing the Th1:Th2 biomarker ratio in a subject
having cancer. In some embodiments, the covalent TEC family kinase
inhibitor suppresses the Th2 response in the subject. In some
embodiments, the covalent TEC family kinase inhibitor inhibits one
or more TEC family kinases selected from among ITK, BTK, TEC,
RLK/TXK and BMX. In some embodiments, the covalent TEC family
kinase inhibitor inhibits ITK. In some embodiments, the covalent
TEC family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib.
[0022] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors (e.g. ibrutinib) for treating
a subject having a T-cell malignancy following treatment with a
first anticancer therapy, to prevent, reduce the risk of, or delay
relapsed or refractory disease, wherein the first anticancer
therapy does not comprise the covalent TEC family kinase inhibitor.
In some embodiments, the covalent TEC family kinase inhibitor
suppresses the Th2 response in the subject. In some embodiments,
the covalent TEC family kinase inhibitor inhibits one or more TEC
family kinases selected from among ITK, BTK, TEC, RLK/TXK and BMX.
In some embodiments, the covalent TEC family kinase inhibitor
inhibits ITK. In some embodiments, the covalent TEC family kinase
inhibitor is selected from among ibrutinib (PCI-32765), PCI-45292,
PCI-45466, AVL-101, AVL-291, AVL-292, or ONO-WG-37. In some
embodiments, the covalent TEC family kinase inhibitor is
ibrutinib.
[0023] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors (e.g. ibrutinib) for the
manufacture of a medicament for treating a subject having a T-cell
malignancy following treatment with a first anticancer therapy, to
prevent, reduce the risk of, or delay relapsed or refractory
disease, wherein the first anticancer therapy does not comprise the
covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor suppresses the Th2 response in
the subject. In some embodiments, the covalent TEC family kinase
inhibitor inhibits ITK. In some embodiments, the covalent TEC
family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib.
[0024] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors for treating a Th2-mediated
disease or disorder. In some embodiments, Th2-mediated disease or
disorder is cancer, an inflammatory disease, an autoimmune disease
or an pathogenic infection. In some embodiments, the covalent TEC
family kinase inhibitor suppresses the Th2 response in the subject.
In some embodiments, the covalent TEC family kinase inhibitor
inhibits one or more TEC family kinases selected from among ITK,
BTK, TEC, RLK/TXK and BMX. In some embodiments, the covalent TEC
family kinase inhibitor inhibits ITK. In some embodiments, the
covalent TEC family kinase inhibitor is selected from among
ibrutinib (PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291,
AVL-292, or ONO-WG-37. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib.
[0025] Described herein, in certain embodiments, are uses of
covalent TEC family kinase inhibitors (e.g. ibrutinib) for the
manufacture of a medicament for treating a Th2-mediated disease or
disorder. In some embodiments, Th2-mediated disease or disorder is
cancer, an inflammatory disease, an autoimmune disease or an
pathogenic infection. In some embodiments, the covalent TEC family
kinase inhibitor suppresses the Th2 response in the subject. In
some embodiments, the covalent TEC family kinase inhibitor inhibits
one or more TEC family kinases selected from among ITK, BTK, TEC,
RLK/TXK and BMX. In some embodiments, the covalent TEC family
kinase inhibitor inhibits ITK. In some embodiments, the covalent
TEC family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib.
BRIEF DESCRIPTION OF THE DRAWINGS
[0026] FIG. 1A-FIG. 1J illustrate ibrutinib as an irreversible
molecular inhibitor of ITK, displaying BTK-independent antileukemic
potential and inhibiting ITK as well as distal markers of T-cell
activation and components of Th2 signaling. FIG. 1A illustrates in
vitro kinase assay IC.sub.50 data for ibrutinib. Targets considered
irreversible all contain a Cys residue homologous to Cys481 in BTK
which is covalently bound by ibrutinib. FIG. 1B illustrates a
graphical depiction of the sequence and domain homology between ITK
and BTK. The relevant phosphorylation sites as well as ibrutinib
irreversible covalent binding sites are labeled. FIG. 1C
illustrates in silico representation of docked ibrutinib within the
active site of crystallized ITK (PDB databank code: (3QGW) showing
close approximation of Cys442 to reactive moiety of ibrutinib
(bottom panel). Shape and chemical complementarity of ibrutinib
shown in surface representation (top panel). FIG. 1D illustrates
fluorescent probe assay was used to calculate the percent
irreversible occupancy of total ITK in Jurkat whole cell lysates
irreversibly bound by ibrutinib. Error bars=s.e.m. FIG. 1E
illustrates qRT-PCR analysis of relative ITK and BTK mRNA levels in
CD8 T-cell leukemia derived from E.mu.TCL1 mice. Fold change is
calculated by Pfaffl method using splenocytes from a healthy
C57BL/6 mouse as a control. Error bars=s.e.m. FIG. 1F illustrates
annexin V/PI viability assay conducted on 72 hr in vitro CD8 T-cell
leukemia splenocyte cultures. Data were averaged across 5
replicates and normalized to untreated samples; cells from 3
independent donor mice were examined. Error bars, s.e.m. FIG. 1G
illustrates fluorescent probe assay was used to calculate the
percent irreversible occupancy of ITK by ibrutinib in cryopreserved
PBMCs obtained immediately prior to (predose) and 8 days into
(ibrutinib) daily oral ibrutinib therapy for CLL (n=8). Error
bars=s.e.m. FIG. 1H illustrates immunoblot analysis of ibrutinib
pretreated, 2 hr anti-CD3/anti-CD28 stimulated (or unstimulated),
Jurkat whole cell lysates. Blot probed for pITK-Y180, Total ITK,
pIkB.alpha.-S.sub.32/36, Total IkB.alpha., and Actin. FIG. 1I
illustrates immunoblot analysis of ibrutinib pretreated, 2 hr
anti-CD3/anti-CD28 stimulated (or unstimulated), Jurkat whole cell
lysates. Blot probed for pSTAT6-Y641, Total STAT6,
pIkB.alpha.-S32/36, Total IkB.alpha., JunB, and Actin. FIG. 1J
illustrates immunoblot analysis of ibrutinib pretreated, 45 minute
anti-CD3/anti-CD28 stimulated (or unstimulated), Jurkat cytoplasmic
and nuclear lysates. Blots probed for NFAT (and activated
hyper-dephosphorlyated NFAT), Brg1 (nuclear loading control), and
Actin (cytoplasmic loading control). In FIG. 1H-FIG. 1J, each blot
was repeated in a minimum of 3 independent experiments.
[0027] FIG. 2A-FIG. 2F illustrate ibrutinib inhibiting ITK derived
TCR signaling, specific Th2 signaling pathways, but not overall
proliferative capacity in primary CD4 T-cells. FIG. 2A illustrates
immunoblot analysis of freshly isolated ibrutinib pretreated
primary CD4+ cells from a healthy donor, 2 hr anti-CD3/anti-CD28
stimulated (or unstimulated), whole cell lysates. Blot probed for
pITK-Y180, Total ITK, pSTAT1-Y701, Total STAT1, pSTAT6-Y641, Total
STAT6, pIkB.alpha.-S32/36, Total IkB.alpha., JunB, and Actin. FIG.
2B illustrates immunoblot analysis of freshly isolated ibrutinib
pretreated primary CD4+ cells from a healthy donor, 45 minute
anti-CD3/anti-CD28 stimulated (or unstimulated), cytoplasmic and
nuclear lysates. Blots probed for NFAT (and activated
hyper-dephosphorlyated NFAT), Brg1, and Actin. In FIGS. 2A-2B, each
blot was repeated in a minimum of 3 independent experiments. FIG.
2C illustrates immunofluorescence microscopy of ibrutinib
pretreated, freshly isolated, primary CD4+ cells from healthy
donors (Panels A and B) were stimulated for 45 minutes with
anti-CD3/anti-CD28 (or unstimulated), fixed, and stained for NFAT
and nuclei (DAPI). Activated cells are characterized by influx of
NFAT into nuclear region and are denoted by white arrows. FIG. 2D
illustrates percent relative NFAT1/DAPI colocalization derived from
Pearson correlation analysis of 10 independent immunofluorescence
microscopy fields (different donors than pictured in FIG. 2C) and
normalized to the average unstimulated value. CSA, cyclosporin A
treatment was used as an additional negative control. Error bars,
s.e.m. FIG. 2E illustrates phosflow analysis of pPLC.gamma.1-Tyr783
in 1 hr anti-CD3/anti-CD28 stimulated cryopreserved PBMCs obtained
immediately predose or after 8 days of receiving ibrutinib therapy
for CLL (n=11). A minimum of 400,000 events were collected, graph
displays the overall percent of live CD3+CD4+pPLC.gamma.1-Tyr783+
events in each sample. Error bars, s.e.m. In FIG. 2F, Top panel:
CFSE stained, freshly isolated, ibrutinib pretreated, and
anti-CD3/anti-CD28 stimulated (or unstimulated) CD4+ cells from a
healthy donor were assayed by flow cytometry after 7 days of in
vitro culture. Bottom panel: cells from first week were re-stained
with PKH26 and restimulated for an additional 7 days of in vitro
culture. Flow cytometric analysis was conducted at the end of each
week. Gated cells represent at least 1 cellular division.
[0028] FIG. 3A-FIG. 3H illustrate ibrutinib irreversibly binding to
ITK-C442 and RLK expression provides compensatory kinase activity
in Th1 and CD8 T-cells. FIG. 3A illustrates immunoblot analysis of
45 minute nuclear and 2 hr whole cell extracts from ibrutinib or
alternate BTK inhibitor pretreated, freshly purified healthy donor
primary CD4+ cells stimulated with anti-CD3/anti-CD28. Nuclear
extracts were probed for NFAT1 and Brg1; whole cell extracts were
probed for pSTAT1-Y701, Total STAT1, pSTAT6-Y641, Total STAT6,
pIkB.alpha.-S32/36, Total IkB.alpha., JunB, and Actin. FIG. 3B
illustrates fluorescent probe assay was used to calculate the
percent occupancy of total ITK in Jurkat whole cell lysates
irreversibly bound by ibrutinib (dark bars) or Alt. BTK inhibitor
(open bars). Error bars, s.e.m. FIG. 3C illustrates Sanger
sequencing reaction chromatograms conducted on amplified mRNA from
Jurkat-ITKC442A, Jurkat-ITKwt, and Jurkat parental cell lines.
Highlighted base pairs are the first two nucleotides in ITK codon
442 which code for a wt-Cys (TGC) or a mutant-Ala (GCC). FIG. 3D
illustrates immunoblot analysis of Jurkat parental, Jurkat-ITKwt,
and Jurkat-ITKC442A nuclear lysates after ibrutinib pretreatment
and 45 minute anti-CD3/anti-CD28 stimulation. Blots were probed for
NFAT1 and Brg1. FIG. 3E illustrates cytokine analysis of IL4 (black
bars and right Y-axis) and IFN.gamma. (open bars and left Y-axis)
media levels in anti-CD3/anti-CD28 stimulated Th1 and Th2 polarized
cell cultures. These are the same cell cultures utilized in FIG.
3F. FIG. 3F illustrates Th1, Th2, and CD8 purified primary cells
were stimulated for 45 minutes (nuclear) and 2 hr (whole cell) with
anti-CD3/anti-CD28 after pretreatment with ibrutinib. Immunoblot
analysis was conducted probing for NFAT and Brg1 as well as
pIkB.alpha.-S32/36, Total IkB.alpha., and Actin. FIG. 3G
illustrates average qRT-PCR cycle of transmittance (Ct) values are
depicted for GAPDH (control gene) and RLK in the stable clones of
Jurkat parental, Jurkat-EV (Empty Vector), and Jurkat-RLK. FIG. 3H
illustrates immunoblot analysis of Jurkat parental, Jurkat-RLK, and
Jurkat-EV (empty vector) nuclear lysates after ibrutinib
pretreatment and 45 minute anti-CD3/anti-CD28 stimulation. Blots
were probed for NFAT1 and Brg1.
[0029] FIG. 4A-FIG. 4E illustrate ibrutinib which limits Th2
activation, thus selectively promoting Th1 expansion in a mixed
population of CD4 T-cells. FIG. 4A illustrates intracellular
staining analysis of IFN.gamma. (left) and IL4 (right) in bulk 5
day anti-CD3/anti-CD28 stimulated CD4+ T-cell cultures pretreated
with Ibrutinib or vehicle. Experiment was repeated 5 times, isotype
staining control is provided. FIG. 4B illustrates immunoblot
analysis of JunB (top) and Tbet (bottom) levels in bulk CD4+
cultures pretreated with ibrutinib and anti-CD3/anti-CD28
stimulated (or unstimulated) for 3 days in-vitro, Actin is used as
loading control. FIG. 4C illustrates intracellular staining of
IFN.gamma. (top) and IL4 (bottom) in CD4+ cells freshly isolated
from a CLL donor, pretreated with ibrutinib, and stimulated with
anti-CD3/anti-CD28. FIG. 4D illustrates normalized intracellular
staining analysis of IL4 (open bars) and IFN.gamma. (closed bars)
in healthy donor CD4+ cells pretreated with ibrutinib and
stimulated with anti-CD3/anti-CD28 (n=3). Error bars, s.e.m. FIG.
4E illustrates normalized intracellular staining analysis of IL4
(open bars n=6) and IFN.gamma. (closed bars n=9) CD4+ cells derived
from CLL patients pretreated with ibrutinib and stimulated with
anti-CD3/anti-CD28. Error bars, s.e.m.
[0030] FIG. 5A-FIG. 5F illustrate ibrutinib driving Th1 mediated L.
major immunity in an in vivo model of Th2 dominant cutaneous
leishmaniasis. FIG. 5A illustrates a schematic representation of L.
major mouse experiment timecourse. Mice were initiated on ibrutinib
or vehicle 2 days prior to being infected with 2E6 stationary phase
L. major promastigotes. Lesion size was tracked for 9 weeks and
immune correlates were collected upon sacrifice at week 9. FIG. 5B
illustrates Lymphocytes isolated from draining lymph nodes were
stimulated with L. major antigens for 72 hr and culture supernatant
was analyzed by ELISA for IL4 and IL10. Error bars, s.e.m. FIG. 5C
illustrates Lymphocytes isolated from draining lymph nodes were
stimulated with L. major antigens for 72 hr and culture supernatant
was analyzed by ELISA for IFN.gamma.. IFN.gamma. responses are
displayed as a ratio with IL4 (left panel) or IL10 (right panel) to
compare relative Th1 and Th2 immunity in ibrutinib or vehicle
treated groups. FIG. 5D illustrates whole mount gross histological
preparations of vehicle and ibrutinib treated L. major infected
footpads are depicted along with a centimeter ruler for size
comparison. Cutaneous lesions are visible on the underside of the
footpad. FIG. 5E illustrates log dilution of parasites obtained
from footpad lesions are displayed. Error bars, s.e.m. FIG. 5F
illustrates timecourse analysis of cutaneous lesion size over the 9
week period of L. major infection. Measurements were taken at
weekly intervals. Error bars, s.e.m.
[0031] FIG. 6A-FIG. 6I illustrate ibrutinib skewed Th1/Th2 plasma
cytokines and IgG subisotypes in human CLL patients as well as TCL1
leukemic mice and functionally restores immunity in a
leukemia/listeriosis mouse model. FIG. 6A illustrates percent
relative alteration in plasma cytokine levels from pre-treatment to
day 28 of therapy in relapsed refractory CLL patients enrolled in a
phase I trial of oral ibrutinib. FIG. 6B illustrates plasma IgG1
(Th2) and IgG2c (Th1) subisotype analysis of C57BL/6 E.mu.TCL1 mice
at 8 months of age after 7 consecutive months of ibrutinib (n=12)
or vehicle (n=13) administration via drinking water. FIG. 6C
illustrates a schematic representation of the leukemia/listeriosis
mouse experiment timecourse. Mice were engrafted via I.V. injection
with leukemic cells purified from the spleen of a E.mu.TCL1
transgenic animal. I.V. L. monocytogenes inoculation (5000 CFU) was
conducted 14 days after engraftment. FIG. 6D illustrates plasma
cytokine analysis of IFN.gamma. 2 days after Listeria inoculation
FIG. 6E illustrates plasma cytokine analysis of TNF.alpha. 2 days
after Listeria inoculation. FIG. 6F illustrates plasma cytokine
analysis of IL6 2 days after Listeria inoculation. FIG. 6G
illustrates OVA-MHC I tetramer analysis of peripheral CD8+ T-cells
8 days after Listeria m. infection. Percent tetramer positive is
displayed along with total number. FIG. 6H illustrates a time
course analysis of OVA-MHC I tetramer positive peripheral CD8
T-cells from leukemia/listeriosis mouse study. 5000CFU of OVA
expressing-Listeria m. was injected at day 0. Error bars, s.e.m.
FIG. 6I illustrates Listeria m. cultures derived from mouse livers
diluted 1:3 (grams:milliliters) at interim analysis points on day 2
(top row) and day 8 (bottom row) post infection. Colony forming
units (CFU) are displayed as calculated from each plate. A 1:1000
dilution of Listeria m. innoculum confirms the viability of
pre-injected Listeria m.
[0032] FIG. 7A-FIG. 7L illustrate flow cytometric analysis of
T-cell leukemia arising in C57BL/6 E.mu.TCL1 mice. Flow cytometric
analysis of peripheral blood (PBMC) (FIGS. 7A-7C), splenocytes
(Spleen) (FIGS. 7D-7F), bone marrow (FIGS. 7G-7I), and mesenteric
lymph nodes (FIGS. 7J-7L) from animals presenting with enlarged
spleen, elevated lymphocyte count, and apparent CD8+ T-cell
leukemia. Cells were gated on CD45+ and subsequently analyzed by
CD5 and CD19 (left panels), CD3 and CD4 (middle panels), and CD3
and CD8 (right panels). CD5+CD19+ B-cell leukemias were often
concomitant with CD3+CD5+CD8+ T-cell leukemias in these
animals.
[0033] FIG. 8 illustrates immunoblot analysis of TCL1 oncoprotein
expression in CD8 selected T-cell leukemias. Immunoblot analysis of
TCL1 protein levels (and Actin control) in purified CD8+ T-cells
and CD 19+ B-cells isolated from a C57BL/6 E.mu.TCL1 mouse spleen
presenting with a CD3+CD5+CD8+ T-cell leukemia.
[0034] FIG. 9A-FIG. 9G illustrates immunohistochemical analysis of
spleen and thymus from C57BL/6 E.mu.TCL1 mice presenting with
T-cell leukemia. IHC revealed that the secondary lymphoid organs,
spleen (FIGS. 9A-9B) and thymus (FIGS. 9C-9D) were expanded by
neoplastic round cells expressing the CD3 cell surface marker of
the T-lymphocyte lineage (100.times.). The splenic pulp contained
numerous pale basophilic, CD3+ neoplastic T-lymphocytes with
scattered clusters of dark basophilic erythrocytic precursors
(arrows)(400.times.)(FIG. 9E). FIG. 9F illustrates large numbers of
intermediate-sized, round, neoplastic lymphocytes with moderate
amounts of pale basophilic cytoplasm fill the cortex and medullary
cords of the lymph nodes, expand the pulp of the spleen, and are
scattered in the thymic cortex, in contrast to B220 (B-Cells)(FIG.
9G). These cells in FIG. 9F are widely dispersed in the white fat
associated with the lymph nodes and thymus. The cells seem fairly
well differentiated as indicated by their regular features and low
mitotic rate. The immunohistochemical analysis confirms that the
tumor cells arose from the T-cell lineage.
[0035] FIG. 10 illustrates immunoblot analysis of JAK3 inhibitory
effects of ibrutinib in primary T-cells. Primary T cells were
isolated using RosetteSep Human T cell enrichment kit, and treated
with either PCI-32765 or CP-690, 550 (JAK1/3 inhibitor) at 0, 0.01,
0.1 or 1 .mu.M for 1 hr and stimulated with 100 nM rhIL-2 for 10
minutes. Blots were probed for STAT5 (Cell Signaling 9358), pSTAT5
(Cell signaling 9359) and JAK3 (Cell signaling 3775).
[0036] FIG. 11 illustrates immunoblot analysis of primary CD4
T-cells pretreated with ibrutinib and stimulated via anti-CD28 and
anti-CD3. Immunoblot analysis of freshly isolated ibrutinib
pretreated primary CD4+ cells from a healthy donor, 2 hr
anti-CD3/anti-CD28 stimulated (or unstimulated), whole cell
lysates. Blot probed for pITK-Y.sub.180, Total ITK,
pSTAT1-Y.sub.701, Total STAT1, pSTAT6-Y.sub.641, Total STAT6,
pIkB.alpha.-S.sub.32/36, Total IkB.alpha., JunB, and Actin.
[0037] FIG. 12A-FIG. 12E illustrates gating strategy for
pPLC.gamma.-Tyr783 analysis in CD3+CD4+ cells. A minimum of 400,000
cellular events were collected and gated on forward and side
scatter to isolate lymphocytes (FIG. 12A-FIG. 12B). Size selected
cells were subgated using a fixable live dead marker and live cells
were gated on CD3 and CD4 to isolate double positive cells (FIG.
12C). Living CD3+CD4+ were gated on pPLC.gamma.1-Tyr783 and
relative positive and negative gates were generated based upon
unstimulated and stimulated control samples (FIG. 12D-FIG.
12E).
[0038] FIG. 13 illustrates flow cytometry analysis of naive,
terminal, central, and effector memory CD4+ T-cells before and
after ibrutinib treatment. Flow cytometric analysis of naive
(N)(CD62L+CD45RA+), central memory (CM)(CD62L+CD45RA-), effector
memory (EM)(CD62L-CD45RA-), and terminal Memory.TM. (CD62L-CD45RA+)
CD4+ selected T-cells isolated from a healthy donor. Cells were
pretreated with the indicated concentration of ibrutinib and
stimulated (or unstimulated) with anti-CD3/anti-CD28 for 24 hours
prior to analysis. Percentages are represented in each quadrant and
each row represents a different healthy donor of varying age
(between 30 and 56 years of age).
[0039] FIG. 14 illustrates in vitro kinase screening data from
ibrutinib, alternate BTK inhibitor, and PCI-45292. In-vitro kinase
assay IC50 data for ibrutinib, Alternate BTK inhibitor, and
PCI-45292. Targets considered irreversible all contain a cysteine
residue homologous to Cys488 in BTK which is covalently bound by
ibrutinib.
[0040] FIG. 15 illustrates a chemical structure of an alternate BTK
inhibitor.
[0041] FIG. 16 illustrates immunoblot analysis of constitutive
downstream BTK signaling in leukemic B-cells treated in vitro with
three irreversible BTK inhibitors. Immunoblot analysis of whole
cell lysates from freshly isolated 1 .mu.M ibrutinib, PCI45292,
Alt. BTK inhibitor, or vehicle (DMSO) treated primary CD19+ B-cells
from a CLL donor. Blot was probed for pERK, Total ERK, and
Actin.
[0042] FIG. 17 illustrates ITK binding probe assay conducted on
Jurkat lysates pretreated with ibrutinib or PCI-45292. Fluorescent
probe assay was used to calculate the percent occupancy of total
ITK in Jurkat whole cell lysates irreversibly bound by ibrutinib
(dark bars) or PCI-45292 (open bars). Error bars, s.e.m.
[0043] FIG. 18A-FIG. 18D illustrate ITK specific downstream
signaling is attenuated by ibrutinib but not a structurally similar
ITK non-targeting BTK inhibitor. Immunoblot analysis of 45 minute
nuclear and 2 hr whole cell extracts from ibrutinib or PCI-45292
pretreated, freshly purified healthy donor primary CD4+ cells
stimulated with anti-CD3/anti-CD28. Nuclear extracts were probed
for NFAT1 and Brg1 (FIGS. 18A-18B); whole cell extracts were probed
for pSTAT1-Y701, Total STAT1, JunB, and Actin (FIGS. 18C-18D).
[0044] FIG. 19 illustrates B and CLL cell cytokine mRNA analysis
reveals no ibrutinib-induced modulation of IL10, IL13, IL4, or
IFN.gamma.. CD19+ B-cells and CLL cells were isolated from
peripheral blood at pre-dose and after 28 days on ibrutinib.
Transcript-specific qRT-PCR analysis of IL10, IL13, IL4, and
IFN.gamma. mRNA levels were compared to GAPDH and subsequently to
day 28 levels using the Pfaffl fold-change calculation.
[0045] FIG. 20 illustrates gating strategy for OVA-Tetramer
positive CD8 T-cells. (1) FS/SS gate for T and B lymphocytes.
Backgating verified this gate included all CD19/CD4/CD8 positive
events. (2) Gated on singlet events using FS-Peak vs. FS-Area plot.
(3) Excluded CD19+ B-cells (4) Gated on CD4+ and CD8+ T-cells (5)
Refined gate on CD8+ T-cells for tetramer analysis. The gate for
tetramer positive CD8 T-cells was generating on an individual basis
using the baseline tetramer staining 7 days prior to Listeria
injection. The tetramer positive gate was set such that less than
0.04% CD8+ events would appear tetramer positive at day -7.
[0046] FIG. 21A-FIG. 21B illustrate ibrutinib PCYC-04753 phase I
clinical trial which demonstrates Th1/Th2 skewing due to an
elevated level of IFN.gamma.. FIG. 21A illustrates cytokine and
chemokine responses at the end of phase I PCYC-04753 study in CLL
patients. Th2-type markers IL10, IL4, IL13, MIP1.alpha., MIP1.beta.
and MDC exhibited a decrease from pre-treatment to day 28 of
ibrutinib therapy. In contrast, Th1-type marker IFN.gamma.
exhibited an increase during the phase I study. Soluble CD40L
(sCD40L), a Th1-type cytokine, showed a decrease in patients
receiving ibrutinib as part of the phase I study. FIG. 21B
illustrates Th1 and Th2 responses at the end of phase I PCYC-04753
study in CLL patients. The data demonstrated a decrease in serum
markers IL4, IL13 and sCD40L and an increase in IFN.gamma..
[0047] FIG. 22 illustrates ibrutinib effect on cytokine/chemokine
response in high risk RR CLL patients as part of a cohort 4 study.
The data demonstrated a decrease in the level of serum Th2-type
cytokines including IL10, IL8, MCP-1, MDC, MIP1.alpha., and
MIP1.beta. from pre-treatment to day 28 of ibrutinib therapy. The
level of the Th2-type cytokine IL6 remained constant during the
course of the ibrutinib therapy. The level of the Th1-type cytokine
TNF-.alpha. also decreased during the course of the ibrutinib
therapy.
[0048] FIG. 23A-FIG. 23F illustrates ibrutinib effect on Th1/Th2
skewing in mentel cell lymphoma patients. Levels of cytokines and
chemokine including IL10 (FIG. 23A), MIP1.beta. (FIG. 23B), sCD40L
(FIG. 23C), IL13 (FIG. 23D), IL4 (FIG. 23E) and IFN.gamma. (FIG.
23F) were measured on day 0, day 1 at 4 hours, day 1 at 24 hours,
day 15 and day 29. Reduction in the levels of IL10, IL13 and IL4
were observed following ibrutinib treatment. This was in sharp
contrast to an increase in the IFN.gamma. level.
DETAILED DESCRIPTION OF THE INVENTION
Certain Terminology
[0049] Unless defined otherwise, all technical and scientific terms
used herein have the same meaning as is commonly understood by one
of skill in the art to which the claimed subject matter belongs.
All patents, patent applications, published applications and
publications, GENBANK sequences, websites and other published
materials referred to throughout the entire disclosure herein,
unless noted otherwise, are incorporated by reference in their
entirety. In the event that there is a plurality of definitions for
terms herein, those in this section prevail. Where reference is
made to a URL or other such identifier or address, it is understood
that such identifiers can change and particular information on the
internet can come and go, but equivalent information is known and
can be readily accessed, such as by searching the internet and/or
appropriate databases. Reference thereto evidences the availability
and public dissemination of such information. Generally, the
procedures for cell culture, cell infection, antibody production
and molecular biology methods are methods commonly used in the art.
Such standard techniques can be found, for example, in reference
manual, such as, for example, Sambrook et al. (2000) and Ausubel et
al. (1994).
[0050] As used herein, the singular forms "a," "an" and "the"
include plural referents unless the context clearly dictates
otherwise. In this application, the use of the singular includes
the plural unless specifically stated otherwise. As used herein,
the use of "or" means "and/or" unless stated otherwise.
Furthermore, use of the term "including" as well as other forms
(e.g., "include", "includes", and "included") is not limiting.
[0051] As used herein, ranges and amounts can be expressed as
"about" a particular value or range. About also includes the exact
amount. Hence "about 40 mg" means "about 40 mg" and also "40 mg."
Generally, the term "about" includes an amount that would be
expected to be within experimental error.
[0052] The term "irreversible inhibitor," as used herein, refers to
a compound that, upon contact with a target protein (e.g., a
kinase) causes the formation of a new covalent bond with or within
the protein, whereby one or more of the target protein's biological
activities (e.g., phosphotransferase activity) is diminished or
abolished notwithstanding the subsequent presence or absence of the
irreversible inhibitor.
[0053] As used herein, "ACK" and "Accessible Cysteine Kinase" are
synonyms. They mean a kinase with an accessible cysteine residue.
ACKs include, but are not limited to, BTK, ITK, Bmx/ETK, TEC, EFGR,
HER4, HER4, LCK, BLK, C-src, FGR, Fyn, HCK, Lyn, YES, ABL, Brk,
CSK, FER, JAK3, SYK.
[0054] As used herein, a "covalent TEC family kinase inhibitor"
refers to any irreversible inhibitor that reduces or inhibits one
more activities of a kinase protein of the covalent Tec kinase
family. Exemplary members of the covalent Tec kinase family include
ITK (IL-2-Inducible T-cell Kinase), BTK (Bruton's tyrosine kinase),
TEC, RLK/TXK (Resting Lymphocyte Kinase) and BMX (Bone Marrow
Kinase). In some embodiments, the covalent TEC family kinase
inhibitor inhibits two or more members of the covalent Tec kinase
family. In some embodiments, the covalent TEC family kinase
inhibitor inhibits ITK and BTK. In some embodiments, the covalent
TEC family kinase inhibitor inhibits ITK by covalent binding to
Cysteine 442 of ITK. In some embodiments, the covalent TEC family
kinase inhibitor inhibits BTK by covalent binding to Cysteine 481
of BTK.
[0055] As used herein, inhibition of kinase activity refers any
decrease in kinase activity in the presence of an inhibitor
compared to the same activity in the absence of the inhibitor.
[0056] The terms "cancer" and "cancerous" refer to or describe the
physiological condition in mammals that is typically characterized
by unregulated cell growth. Examples of cancer include, but are not
limited to, B-cell lymphoproliferative disorders (BCLDs), such as
lymphoma and leukemia, and solid tumors.
[0057] By "refractory" in the context of a cancer is intended the
particular cancer is resistant to, or non-responsive to, therapy
with a particular therapeutic agent. A cancer is refractory to
therapy with a particular therapeutic agent either from the onset
of treatment with the particular therapeutic agent (i.e.,
non-responsive to initial exposure to the therapeutic agent), or as
a result of developing resistance to the therapeutic agent, either
over the course of a first treatment period with the therapeutic
agent or during a subsequent treatment period with the therapeutic
agent.
[0058] As used herein, the IC.sub.50 refers to an amount,
concentration or dosage of a particular test compound that achieves
a 50% inhibition of a maximal response, such as inhibition of a TEC
kinase, in an assay that measures such response.
[0059] As used herein, EC.sub.50 refers to a dosage, concentration
or amount of a particular test compound that elicits a
dose-dependent response at 50% of maximal expression of a
particular response that is induced, provoked or potentiated by the
particular test compound.
[0060] As used herein, the terms "treat," "treating" or
"treatment," and other grammatical equivalents, include
alleviating, abating or ameliorating one or more symptoms of a
disease or condition, ameliorating, preventing or reducing the
appearance, severity or frequency of one or more additional
symptoms of a disease or condition, ameliorating or preventing the
underlying metabolic causes of one or more symptoms of a disease or
condition, inhibiting the disease or condition, such as, for
example, arresting the development of the disease or condition,
relieving the disease or condition, causing regression of the
disease or condition, relieving a condition caused by the disease
or condition, or inhibiting the symptoms of the disease or
condition either prophylactically and/or therapeutically.
[0061] As used herein, prevention or prophylaxis refers to the
reduction in the risk of developing a disease or condition.
[0062] The terms "effective amount", "therapeutically effective
amount" or "pharmaceutically effective amount" as used herein,
refer to an amount of a BTK inhibitor compound that is sufficient
to treat a disorder. In some embodiments, the result is a reduction
in and/or alleviation of the signs, symptoms, or causes of a
disorder, or any other desired alteration of a biological system.
For example, an "effective amount" for therapeutic uses is the
amount of the composition comprising a BTK inhibitor compound
disclosed herein required to provide a clinically significant
decrease in a disorder. An appropriate "effective" amount in any
individual case is determined using any suitable technique, (e.g.,
a dose escalation study).
[0063] The term "pharmaceutically acceptable" as used herein,
refers to a material, (e.g., a carrier or diluent), which does not
abrogate the biological activity or properties of a BTK inhibitor
compound described herein, and is relatively nontoxic (i.e., the
material is administered to an individual without causing
undesirable biological effects or interacting in a deleterious
manner with any of the components of the composition in which it is
contained).
[0064] As used herein, "minimal residual disease (MRD)" refers to
small numbers of cancer cells that remain in the patient during
treatment, or after treatment when the patient is in remission
(i.e. no symptoms or signs of disease).
[0065] As used herein, "survival" refers to the patient remaining
alive, and includes disease free survival (DFS) and overall
survival (OS). Survival is estimated by the Kaplan-Meier method,
and any differences in survival are computed using the stratified
log-rank test.
[0066] As used herein, "disease free survival (DFS)" refers to the
patient remaining alive, without return of the cancer, for a
defined period of time such as about 1 year, about 2 years, about 3
years, about 4 years, about 5 years, about 10 years, or more from
initiation of treatment or from initial diagnosis. In one
embodiment, DFS is analyzed according to the intent-to-treat
principle, i.e., patients are evaluated on the basis of their
assigned therapy. The events used in the analysis of DFS include
local, regional and distant recurrence of cancer, occurrence of
secondary cancer, and death from any cause in patients without a
prior event (e.g., cancer recurrence or second primary cancer).
[0067] As used herein, "overall survival" refers to the patient
remaining alive for a defined period of time, such as about 1 year,
about 2 years, about 3 years, about 4 years, about 5 years, about
10 years, or more from initiation of treatment or from initial
diagnosis.
[0068] As used herein, "extending survival" or "increasing the
likelihood of survival" refers to increasing DFS and/or OS or
increasing the probability of remaining alive and/or disease-free
at a given point in time in a treated patient relative to an
untreated patient (i.e. relative to a patient not treated with a
covalent TEC family kinase inhibitor), or relative to a control
treatment protocol, such as treatment only with the
chemotherapeutic agent or biologic agent, such as those use in the
standard of care for a particular cancer). Survival is monitored
for at least about two months, four months, six months, nine
months, or at least about 1 year, or at least about 2 years, or at
least about 3 years, or at least about 4 years, or at least about 5
years, or at least about 10 years, etc., following the initiation
of treatment or following the initial diagnosis.
[0069] As used herein, the term "concurrently" is used herein to
refer to administration of two or more therapeutic agents, where at
least part of the administration overlaps in time. Accordingly,
concurrent administration includes a dosing regimen when the
administration of one or more agent(s) continues after
discontinuing the administration of one or more other agent(s).
[0070] As used herein, "monotherapy" refers to a therapeutic
regimen that includes only a single therapeutic agent for the
treatment of the cancer or tumor during the course of the treatment
period. Monotherapy using a covalent TEC family kinase inhibitor
means that the covalent TEC family kinase inhibitor is administered
in the absence of an additional anticancer therapy during treatment
period.
[0071] As used herein, "adjuvant therapy" refers to a therapy
administered in combination with or following a primary therapy in
order to enhance or modify the effect of the first therapy. In some
embodiments, an adjuvant for cancer therapy is administered
following an anticancer therapy, so as to reduce the risk of
disease recurrence of the cancer, either local or metastatic. In
some embodiments, an adjuvant for vaccine therapy, such as an
anticancer vaccine or a antiviral vaccine therapy, is administered
in combination with a vaccine in order to enhance the efficacy of
the vaccine. In some embodiments, an adjuvant for viral therapy is
administered in combination with one or more antiviral agents in or
to enhance the efficacy of the antiviral therapy. In some
embodiments, an adjuvant therapy administered to an individual
enhances the Th1 or cytotoxic immune response in the
individual.
[0072] As used herein, "standard of care" therapy refers to a
therapy routinely used to treat a particular disease or disorder.
As used herein, "standard of care" chemotherapy refers to the
chemotherapeutic agents routinely used to treat a particular
cancer. As used herein, "standard of care" antiviral therapy refers
to the antiviral agents routinely used to treat a particular virus
infection. As used herein, "standard of care" antibacterial therapy
refers to the antibacterial agents routinely used to treat a
particular bacterial infection.
[0073] As used herein, "definitive surgery" is used as that term is
used within the medical community, and typically refers to surgery
where the outcome is potentially curative. Definitive surgery
includes, for example, procedures, surgical or otherwise, that
result in removal or resection of the tumor, including those that
result in the removal or resection of all grossly visible tumor.
Definitive surgery includes, for example, complete or curative
resection or complete gross resection of the tumor. Definitive
surgery includes procedures that occurs in one or more stages, and
includes, for example, multi-stage surgical procedures where one or
more surgical or other procedures are performed prior to resection
of the tumor. Definitive surgery includes procedures to remove or
resect the tumor including involved organs, parts of organs and
tissues, as well as surrounding organs, such as lymph nodes, parts
of organs, or tissues.
[0074] As used herein, the terms "cancer" and "cancerous" refer to
or describe the physiological condition in mammals that is
typically characterized by unregulated cell growth. Included in
this definition are benign and malignant cancers as well as dormant
tumors or micrometastatses. The term cancer includes solid tumors
and hematologic cancers. Examples of cancer include but are not
limited to, carcinoma, lymphoma, blastoma, sarcoma, and leukemia.
More particular examples of such cancers include 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 or stomach cancer (including gastrointestinal
cancer), pancreatic cancer, glioblastoma, cervical cancer, ovarian
cancer, liver cancer, bladder cancer, hepatoma, breast cancer,
colon cancer, colorectal cancer, endometrial or uterine carcinoma,
salivary gland carcinoma, kidney or renal cancer, liver cancer,
prostate cancer, vulval cancer, ovarian cancer, thyroid cancer,
proximal or distal bile duct carcinoma, hepatic carcinoma and
various types of head and neck cancer, T-cell lymphoma, as well as
B-cell lymphoma, including low grade/follicular non-Hodgkin's
lymphoma (NHL); small lymphocytic (SL) NHL; intermediate
grade/follicular NHL; intermediate grade diffuse NHL; high grade
immunoblastic NHL; high grade lymphoblastic NHL; high grade small
non-cleaved cell NHL; bulky disease NHL; mantle cell lymphoma;
AIDS-related lymphoma; and Waldenstrom's Macroglobulinemia; chronic
lymphocytic leukemia (CLL); acute lymphoblastic leukemia (ALL);
Hairy cell leukemia; chronic myeloblastic leukemia; and
post-transplant lymphoproliferative disorder (PTLD), as well as
abnormal vascular proliferation associated with phakomatoses, edema
(such as that associated with brain tumors), and Meigs'
syndrome.
[0075] As used herein the term "T-helper type 2 (Th2)-mediated
disease" means a disease which is characterized by the
overproduction of Th2 cytokines, including those that result from
an overproduction or bias in the differentiation of T-cells into
the Th2 subtype. Such diseases include, for example, cancer (e.g.,
hematologic malignancies and solid tumors), exacerbation of
infection with infectious diseases (e.g., Leishmania major,
Listeria monocytogenes, Mycobacterium leprae, Candida albicans,
Toxoplasma gondi, Hepatitis C virus (HCV), Respiratory Syncytial
virus (RSV), human immunodeficiency virus (HIV)) and allergic
disorders, such as anaphylactic hypersensitivity, asthma, allergic
rhinitis, atopic dermatitis, vernal conjunctivitis, eczema,
urticaria and food allergies, autoimmune diseases, inflammatory
diseases, inflammatory bowel disease, ulcerative colitis, systemic
lupus erythematodes, myasthenia gravis, systemic progressive
scleroderma, rheumatoid arthritis, interstitial cystitis,
Hashimoto's diseases, Basedow's diseases, autoimmune hemolytic
anemia, idiopathic thrombocytopenic purpura, Goodpasture's
syndrome, atrophic gastritis, pernicious anemia, Addison diseases,
pemphigus, pemphigoid, lenticular uveitis, sympathetic ophthalmia,
primary biliary cirrhosis, active chronic hepatitis, Sjogren's
syndrome, multiple myositis, dermatomyositis, polyarteritis nodosa,
rheumatic fever, glomerular nephritis (lupus nephritis, IgA
nephropathy, and the like), allergic encephalitis, atopic allergic
diseases (for example, bronchial asthma, allergic rhinitis,
allergic dermatitis, allergic conjunctivitis, pollinosis,
urticaria, food allergy and the like), Omenn's syndrome, vernal
conjunctivitis and hypereosinophilic syndrome.
[0076] As used herein, "metastasis" refers to the spread of cancer
from its primary site to other places in the body. In certain
embodiments, cancer cells break away from a primary tumor,
penetrate into lymphatic and blood vessels, circulate through the
bloodstream, and grow in a distant focus (metastasize) in normal
tissues elsewhere in the body. In certain embodiments, metastasis
is either local or distant. Metastasis is believed to be a
sequential process, contingent on tumor cells breaking off from the
primary tumor, traveling through the bloodstream, and stopping at a
distant site. At the new site, the cells establish a blood supply
and grow to form a life-threatening mass. Both stimulatory and
inhibitory molecular pathways within the tumor cell regulate this
behavior, and interactions between the tumor cell and host cells in
the distant site are also significant.
[0077] As used herein, "cancer recurrence", "cancer relapse",
"relapsed or refractory disease" are used interchangeably herein to
refer to a return of cancer following treatment, and includes
return of cancer in the primary organ, as well as distant
recurrence, where the cancer returns outside of the primary
organ.
[0078] As used herein, a subject at "high risk of cancer recurrence
or relapse" is one who has a greater chance of experiencing
recurrence of cancer. A subject's risk level can be determined by a
skilled physician.
[0079] "Decrease in risk of cancer recurrence or relapse" is meant
reducing the likelihood of experiencing recurrence of cancer
relative to an untreated patient (i.e., relative to a patient not
treated with a covalent TEC family kinase inhibitor), or relative
to a control treatment protocol, such as treatment only with the
chemotherapeutic agent, such as those used in the standard of care
for the particular cancer. Cancer recurrence is monitored for at
least about two months, four months, six months, nine months, or at
least about 1 year, or at least about 2 years, or at least about 3
years, or at least about 4 years, or at least about 5 years, or at
least about 10 years, etc., following the initiation of treatment
or following the initial diagnosis.
[0080] As used herein, "anticancer therapy" refers to a therapy
useful in treating cancer. Examples of anticancer therapeutic
agents include, but are limited to, e.g., surgery, chemotherapeutic
agents, biologic agents, growth inhibitory agents, cytotoxic
agents, nanoparticle agents, agents used in radiation therapy,
agents used in photodynamic therapy, agents used in hyperthermia
therapy (e.g., radiofrequency ablation), anti-angiogenesis agents,
apoptotic agents, anti-tubulin agents, siRNA agents,
enzyme/pro-drug agents, nucleic acid agents, oliopeptide agents,
and other agents to treat cancer, such as anti-HER-2 antibodies,
anti-CD20 antibodies, an epidermal growth factor receptor (EGFR)
antagonist (e.g., a tyrosine kinase inhibitor), HER1/EGFR inhibitor
(e.g., erlotinib (Tarceva.RTM.), platelet derived growth factor
inhibitors (e.g., Gleevec.RTM. (Imatinib Mesylate)), a COX-2
inhibitor (e.g., celecoxib), interferons, cytokines, antagonists
(e.g., neutralizing antibodies) that bind to one or more of the
following targets ErbB2, ErbB3, ErbB4, PDGFR-beta, BlyS, APRIL,
BCMA or VEGF receptor(s), TRAIL/Apo2, and other bioactive and
organic chemical agents, or combination thereof.
[0081] As used herein, "cytotoxic agent" as used herein refers to a
substance that inhibits or prevents the function of cells and/or
causes destruction of cells. The term is intended to include
radioactive isotopes, chemotherapeutic agents, and toxins such as
small molecule toxins or enzymatically active toxins of bacterial,
fungal, plant or animal origin, including fragments and/or variants
thereof.
[0082] As used herein, a "chemotherapeutic agent" is a chemical
compound useful in the treatment of cancer. Examples of
chemotherapeutic agents include is a chemical compound useful in
the treatment of cancer. Examples of chemotherapeutic agents
include alkylating agents such as rituximab, carfilzomib,
fludarabine, cyclophosphamide, vincristine, prednisalone.
chlorambucil, ifosphamide, doxorubicin, mesalazine, thalidomide,
revlimid, lenalidomide, temsirolimus, everolimus, fostamatinib,
paclitaxel, docetaxel, ofatumumab, dexamethasone, prednisone,
CAL-101, ibritumomab, tositumomab, bortezomib, pentostatin,
endostatin, ritonavir, ketoconazole, thiotepa and CYTOXAN.RTM.
cyclosphosphamide; alkyl sulfonates such as busulfan, improsulfan
and piposulfan; aziridines such as benzodopa, carboquone,
meturedopa, and uredopa; ethylenimines and methylamelamines
including altretamine, triethylenemelamine,
trietylenephosphoramide, triethiylenethiophosphoramide and
trimethylolomelamine; acetogenins (especially bullatacin and
bullatacinone); a camptothecin (including the synthetic analogue
topotecan); bryostatin; callystatin; CC-1065 (including its
adozelesin, carzelesin and bizelesin synthetic analogues);
cryptophycins (particularly cryptophycin 1 and cryptophycin 8);
dolastatin; duocarmycin (including the synthetic analogues, KW-2189
and CB 1-TM1); eleutherobin; pancratistatin; a sarcodictyin;
spongistatin; nitrogen mustards such as bendamustine, chlorambucil,
chlornaphazine, cholophosphamide, estramustine, ifosfamide,
mechlorethamine, mechlorethamine oxide hydrochloride, melphalan,
novembichin, phenesterine, prednimustine, trofosfamide, uracil
mustard; nitrosureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, and ranimnustine; antibiotics
such as the enediyne antibiotics (e.g., calicheamicin, especially
calicheamicin gammall and calicheamicin omegaI1 (see, e.g., Agnew,
Chem Intl. Ed. Engl., 33: 183-186 (1994)); dynemicin, including
dynemicin A; bisphosphonates, such as clodronate; an esperamicin;
as well as neocarzinostatin chromophore and related chromoprotein
enediyne antiobiotic chromophores), aclacinomysins, actinomycin,
authramycin, azaserine, bleomycins, cactinomycin, carabicin,
carminomycin, carzinophilin, chromomycinis, dactinomycin,
daunorubicin, detorubicin, 6-diazo-5-oxo-L-norleucine,
ADRIAMYCIN.RTM. doxorubicin (including morpholino-doxorubicin,
cyanomorpholino-doxorubicin, 2-pyrrolino-doxorubicin and
deoxydoxorubicin), epirubicin, esorubicin, idarubicin,
marcellomycin, mitomycins such as mitomycin C, mycophenolic acid,
nogalamycin, olivomycins, peplomycin, potfiromycin, puromycin,
quelamycin, rodorubicin, streptonigrin, streptozocin, tubercidin,
ubenimex, zinostatin, zorubicin; anti-metabolites such as
methotrexate and 5-fluorouracil (5-FU); folic acid analogues such
as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as frolinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
eniluracil; amsacrine; bestrabucil; bisantrene; edatraxate;
defofamine; demecolcine; diaziquone; elfornithine; elliptinium
acetate; an epothilone; etoglucid; gallium nitrate; hydroxyurea;
lentinan; lonidainine; maytansinoids such as maytansine and
ansamitocins; mitoguazone; mitoxantrone; mopidanmol; nitraerine;
pentostatin; phenamet; pirarubicin; losoxantrone; podophyllinic
acid; 2-ethylhydrazide; procarbazine; PSK.RTM. polysaccharide
complex (JHS Natural Products, Eugene, Oreg.); gefitinib;
erlotinib; procarbazine; prednisone; razoxane; rhizoxin; sizofiran;
spirogermanium; tenuazonic acid; triaziquone;
2,2',2''-trichlorotriethylamine; trichothecenes (especially T-2
toxin, verracurin A, roridin A and anguidine); urethan; vindesine;
dacarbazine; mannomustine; mitobronitol; mitolactol; pipobroman;
gacytosine; arabinoside ("Ara-C"); cyclophosphamide; thiotepa;
taxoids, e.g., TAXOL.RTM. paclitaxel (Bristol-Myers Squibb
Oncology, Princeton, N.J.), ABRAXANE.RTM. Cremophor-free,
albumin-engineered nanoparticle formulation of paclitaxel (American
Pharmaceutical Partners, Schaumberg, Ill.), and TAXOTERE.RTM.
doxetaxel (Rhone-Poulenc Rorer, Antony, France); chloranbucil;
GEMZAR.RTM. gemcitabine; 6-thioguanine; mercaptopurine;
methotrexate; platinum analogs such as cisplatin, oxaliplatin and
carboplatin; vinblastine; platinum; etoposide (VP-16); ifosfamide;
mitoxantrone; vincristine; NAVELBINE.RTM. vinorelbine; novantrone;
teniposide; edatrexate; daunomycin; aminopterin; xeloda;
ibandronate; irinotecan (Camptosar, CPT-11) (including the
treatment regimen of irinotecan with 5-FU and leucovorin);
topoisomerase inhibitor RFS 2000; difluorometlhylornithine (DMFO);
retinoids such as retinoic acid; capecitabine; combretastatin;
leucovorin (LV); oxaliplatin, including the oxaliplatin treatment
regimen (FOLFOX); a CD22 inhibitor, a Bcl-2 inhibitor, an IRAK 1/4
inhibitor, a microtubule inhibitor, a Topo II inhibitor, anti
TWEAK, anti-IL17 bispecific antibody, a CK2 inhibitor, anaplastic
lymphoma kinase (ALK) and c-Met inhibitors, demethylase enzyme
inhibitors such as demethylase, HDM, LSDI and KDM, fatty acid
synthase inhibitors such as spirocyclic piperidine derivatives,
glucocorticosteriod receptor agonist, fusion anti-CD 19-cytotoxic
agent conjugate, antimetabolite, p70S6K inhibitor, immune
modulators, AKT/PKB inhibitor, procaspase-3 activator PAC-1, BRAF
inhibitor, lactate dehydrogenase A (LDH-A) inhibitor, CCR2
inhibitor, CXCR4 inhibitor, chemokine receptor antagonists, DNA
double stranded break repair inhibitors, NOR202, GA-101, TLR2
inhibitor; inhibitors of PKC-alpha, Raf, H-Ras, HDAC, Cyp3A4, IRAK,
protease, AKT, Erk, JAK (e.g., ruxolitinib, baricitinib, CYT387,
lestauritinib, pacritinib, TG101348, SAR302503, tofacitinib
(Xeljanz), etanercept (Enbrel), GLPG0634, R256), EGFR (e.g.,
erlotinib (Tarceva.RTM.)) and VEGF-A that reduce cell proliferation
and pharmaceutically acceptable salts, acids or derivatives of any
of the above; GA-1101; proteosome inhibitors such as disulfiram,
epigallocatechin-3-gallate, salinosporamide A, ONX0912, CEP-18770,
or MLN9708; R-406; lenalinomide; spirocyclic piperidine
derivatives; quinazoline carboxamide azetidine compounds; ACK
inhibitors such as AVL-263 (Avila Therapeutics/Celgene
Corporation), AVL-292 (Avila Therapeutics/Celgene Corporation),
AVL-291 (Avila Therapeutics/Celgene Corporation), BMS-488516
(Bristol-Myers Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746
(CGI Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech),
HY-11066 (also, CTK417891, HMS3265G21, HMS3265G22, HMS3265H21,
HMS3265H22, 439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical
Co., Ltd.), ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123
(Peking University), RN486 (Hoffmann-La Roche), or HM71224 (Hanmi
Pharmaceutical Company Limited).
[0083] Also included in this definition are anti-hormonal agents
that act to regulate or inhibit hormone action on tumors such as
anti-estrogens and selective estrogen receptor modulators (SERMs),
including, for example, tamoxifen (including NOLVADEX.RTM.
tamoxifen), raloxifene, droloxifene, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone, and FARESTON.RTM.
toremifene; aromatase inhibitors that inhibit the enzyme aromatase,
which regulates estrogen production in the adrenal glands, such as,
for example, 4(5)-imidazoles, aminoglutethimide, MEGASE.RTM.
megestrol acetate, AROMASIN.RTM. exemestane, formestanie,
fadrozole, RIVISOR.RTM. vorozole, FEMARA.RTM. letrozole, and
ARIMIDEX.RTM. anastrozole; and anti-androgens such as flutamide,
nilutamide, bicalutamide, leuprolide, and goserelin; as well as
troxacitabine (a 1,3-dioxolane nucleoside cytosine analog);
antisense oligonucleotides, particularly those which inhibit
expression of genes in signaling pathways implicated in abherant
cell proliferation, such as, for example, PKC-alpha, Ralf and
H-Ras; ribozymes such as a VEGF expression inhibitor (e.g.,
ANGIOZYME.RTM. ribozyme) and a HER2 expression inhibitor; vaccines
such as gene therapy vaccines, for example, ALLOVECTIN.RTM.
vaccine, LEUVECTIN.RTM. vaccine, and VAXID.RTM. vaccine;
PROLEUKIN.RTM. rIL-2; LURTOTECAN.RTM. topoisomerase 1 inhibitor;
ABARELIX.RTM. rmRH; and pharmaceutically acceptable salts, acids or
derivatives of any of the above.
[0084] As used herein, the term "biologic agent" is a generic term
referring to any biological molecules derived from protein,
carbohydrate, lipid or nucleic acid and is useful in the treatment
of a disease. A non-exhaustive list of biologic agents include: TNF
blockers (e.g., etanercept, infliximab, adalinumab, certolizumab
pegol, and golimumab); interleukin 1 (IL-1) blockers such as
anakinra; mnonoconal antibodies (e.g., Trastuzumnab (Herceptin),
Bevacizurnab (Avastin), Cetuximab (Erbitux), Panitumnunab
(Vectibix), Ipilimumnab (Yervoy), Rituximab (Rituxan and Mabthera),
Alemtuzulmab (Campath), Ofatumumab (Arzerra), Gemrtuzumab
ozogamicin (Mylotarg), Brentuximab vedotin (Adcetris),
.sup.90Y-Ibritumomab Tiuxetan (Zevalin) and .sup.131I-Tositumomab
(Bexxar)); T-cell costimulation blockers such as abatacept;
Interleukin 6 (IL-6) blockers such as tocilizumab and antibodies
against oxidized phospholipids and/or oxidized lipoproteins and/or
fragments or derivatives thereof.
[0085] As used herein, the terms "biomarkers" and "markers" are
used interchangeably and are generic terms referring to any
biological molecules found either in blood, other body fluids, or
tissues. A non-exhaustive list of biomarkers and markers include:
ZAP70, t(14,18), 13-2 microglobulin, p53 mutational status, ATM
mutational status, del(17)p, del(11)q, del(6)q, CD3, CD4, CD5,
CD11c, CD19, CD20, CD22, CD25, CD26, CD28, CD30, CD33, CD38, CD45,
CD52, CD62, CD81, CD94, CD103, CD119, CD152, CD138, CD183, CD184,
CD191 (CCR1), CD195, CD197 (CCR7), CD212, CD278, CCR3, CCR4, CCR8,
TBX21, NKG7, XCL1 (lymphotactin), TXK, GZMB (granzyme B), S100P,
LIR9, KIR3DL2, VAV3, DLG5, MMP-9, MS4A4A, lymphotoxin, perforin,
t-bet, Tim-1, Tim-3, TRANCE, GATA-3, c-maf, CRTH2, ST2L/T1,
secreted, surface or cytoplasmic immunoglobulin expression, V.sub.H
mutation status; chemokines such as GCP-2 (granulocyte chemotactic
protein 2), Gro-a (growth related oncogene a), Gro-.beta. (growth
related oncogene .beta.), Gro-.gamma. (growth related oncogene
.gamma.), NAP-2 (neutrophil activating protein), ENA-78
(epithelial-cell-derived neutrophil-activating chemokine), IP-10
(Interferon-inducible protein-10), Mig (monokine induced by
interferone .gamma.), 1-TAC (Interferon-inducible T-cell alpha
chemoattractant), SDF-1 (stromal cell-derived factor-1), PBSF
(pre-B-cell growth stimulating factor), BCA-1 (B-lymphocyte
chemoattractant 1), MIP-1 (macrophage inflammatory protein 1),
RANTES (regulated upon activation, normal T-cell expressed and
secreted), MIP-5 (macrophage inflammatory protein 5), MCP-1
(monocyte chemoattractant protein 1), MCP-2 (monocyte
chemoattractant protein 2), MCP-3 (monocyte chemoattractant protein
3), MCP-4 (monocyte chemoattractant protein 4), Eotaxin, TARC
(thymus- and activation-regulated chemokine), MIP-1 a (macrophage
inflammatory protein 1a), MIP-1 .beta. (macrophage inflammatory
protein 1 .beta.), Exodus-1, ELC (Ebl1 ligand chemokine); cytokines
such as lymphokines, monokines, traditional polypeptide hormones,
growth hormone (e.g., human growth hormone, N-methionyl human
growth hormone, bovine growth hormone); parathyroid hormone;
thyroxine; insulin; proinsulin; relaxin; prorelaxin; glycoprotein
hormones (e.g., follicle stimulating hormone (FSH), thyroid
stimulating hormone (TSH) and luteinizing hormone (LH)); epidermal
growth factor; hepatic growth factor; fibroblast growth factor;
prolactin; placental lactogen; tumor necrosis factor-alpha and
-beta; mullerian-inhibiting substance; mouse
gonadotropin-associated peptide; inhibin; activin; vascular
endothelial growth factor; integrin; thrombopoietin (TPO); nerve
growth factors such as NGF-alpha; platelet-growth factor;
transforming growth factors (TGFs) (e.g., TGF-alpha and TGF-beta);
insulin-like growth factor-I and -II; erythropoietin (EPO);
osteoinductive factors; interferons (e.g., interferon-alpha, -beta
and -gamma); colony stimulating factors (CSFs) (e.g.,
macrophage-CSF (M-CSF), granulocyte-macrophage-CSF (GM-CSF) and
granulocyte-CSF (G-CSF)); interleukins (ILs) (e.g., IL-1,
IL-1.alpha., IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10,
IL-11, IL-12, IL-13, IL-14, IL-15, IL-16, IL-17, IL-18, IL-19,
IL-20, IL-21, IL-22, IL-23, IL-24, IL-25, IL-26, IL-27, IL-28,
IL-29, II-32, IL-33, IL-35 and IL-36); a tumor necrosis factor
(e.g., TNF-alpha and TNF-beta) and other polypeptide factors
including LIF and kit ligand (KL). As used herein, the terms
biomarker and marker include proteins from natural sources or from
recombinant cell culture and biologically active equivalents of the
native sequence biomarkers/markers.
[0086] As used herein, the term "radiation therapy" includes, but
is not limited to, x-rays or gamma rays that are delivered form
either an externally applied source such as a beam, or by
implantation of small radioactive sources. Radionuclides, which
depending up the radionuclide, amount and application can be used
for diagnosis and/or for treatment. They include, but are not
limited to, for example, a compound or molecule containing
32Phosphorus, 60Cobalt, 90Yttrium, 99Technitium, 103Palladium,
106Ruthenium, 111indium, 117Lutetium, 125Iodine, 131Iodine,
137Cesium, 153Samarium, 186Rhenium, 188Rhenium, 192Iridium,
198Gold, 211Astatine, 212Bismuth or 213Bismuth.
[0087] As used herein, the term "photosensitizing agents" includes,
but is not limited to, indocyanine green, toluidine blue,
aminolevulinic acid, texaphyrins, benzoporphyrins, phenothiazines,
phthalocyanines, porphyrins such as sodium porfimer, chlorins such
as tetra(m-hydroxyphenyl)chlorin or tin(IV) chlorin e6, purpurins
such as tin ethyl etiopurpurin, purpurinimides, bacteriochlorins,
pheophorbides, pyropheophorbides or cationic dyes.
[0088] As used herein, the term "pathogenic infection" is a generic
term for infection due to a virus or a bacterium. Examples of
infectious virus include: Retroviridae (e.g., human
immunodeficiency viruses, such as HIV-1 (also referred to as
HTLV-III, LAV or HTLV-III/LAV, or HIV-III: and other isolates, such
as HIV-LP; Picornaviridae (e.g., polio viruses, hepatitis A virus:
enteroviruses, human coxsackie viruses, rhinoviruses,
echovircases); Calciviridae (e.g., strains that cause
gastroenteritis); Togaviridae (e.g., equine encephalitis viruses,
rubella viruses); Flaviridae (e.g., dengue viruses, encephalitis
viruses, yellow fever viruses); Coronaviridae (e.g.,
coronaviruses); Rhabdoviridae (e.g., vesicular stomatitis viruses,
rabies viruses): Filoviridae (e.g., ebola viruses);
Pararmyxoviridae (e.g., parainfluenza viruses, mumps virus, measles
virus, respiratory syncytial virus); Orthomyxoviridae (e.g.,
influenza viruses): Bunyaviridae (e.g., Hantaan viruses, bunya
viruses, phleboviruses and Nairo viruses); Arena viridae
(hemorrhagic fever viruses); Reoviridae (e.g., reoviruses,
orbiviurses and rotaviruses); Birnaviridae; Hepadnaviridae
(Hepatitis B virus); Parvoviridae (parvoviruses); Papovaviridae
(papilloma viruses, polyoma viruses); Adenoviridae (most
adenoviruses); Herpesviridae (herpes simplex virus (HSV) 1 and 2,
varicella zoster virus, cytomegalovirus (CMV), herpes viruses');
Poxyiridae (variola viruses, vaccinia viruses, pox viruses); and
Iridoviridae (e.g., African swine fever virus); and unclassified
viruses (e.g., the etiological agents of Spongiform
encephalopathies, the agent of delta hepatitis (thought to be a
defective satellite of hepatitis B virus), the agents of non-A,
non-B hepatitis (class 1=internally transmitted; class
2=parenterally transmitted (i.e., Hepatitis C); Norwalk and related
viruses, and astroviruses).
[0089] Examples of infectious bacteria include: Helicobacter
pyloris, Borelia burgdorferi, Legionella pneumophilia, Mycobacteria
spp. (e.g., M. tuberculosis, M. avium, M. intracellulare, M.
kansasi, M. gordonae), Staphylococcus aureus, Neisseria
gonorrhoeae, Neisseria meningitidis, Listeria monocytogenes,
Streptococcus pyogenes (Group A Streptococcus), Streptococcus
agalactiae (Group B Streptococcus), Streptococcus (viridans group),
Streptococcus faecalis, Streptococcus bovis, Streptococcus
(anaerobic spp.), Streptococcus pneumoniae, pathogenic
Campylobacter sp., Enterococcus sp., Haemophilus influenzae,
Bacillus anthracis, Corynebacterium diphtheriae, Corynebacterium
sp., Erysipelothrix rhusiopathiae, Clostridium perfringens,
Clostridium tetani, Enterobacter aerogenes, Klebsiella pneumoniae,
Pasteurella multocida, Bacteroides sp., Fusobacterium nucleatum,
Streptobacillus moniliformis, Treponema pallidum, Treponema
pertenue, Leptospira, and Actinomyces israelli.
[0090] Examples of infectious fungi include: Cryptococcus
neoformans, Histoplasma capsulatum, Coccidioides immitis,
Blastomyces dermatitidis, Chlamydia trachomatis, Candida albicans.
Other infectious organisms (i.e., protists) include: Plasmodium
falciparum and Toxoplasma gondii.
[0091] As used herein, the term "antibody" is used in the broadest
sense and covers fully assembled antibodies, antibody fragments
that bind antigen (e.g., Fab, F(ab').sub.2, Fv, single chain
antibodies, diabodies, antibody chimeras, hybrid antibodies,
bispecific antibodies, humanized antibodies, and the like), and
recombinant peptides comprising the forgoing.
[0092] As used herein, the terms "monoclonal antibody" and "mAb" as
used herein refer 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 are present in minor
amounts.
[0093] Native antibodies" and "native immunoglobulins" are usually
heterotetrameric glycoproteins of about 150,000 daltons, composed
of two identical light (L) chains and two identical heavy (H)
chains. Each light chain is linked to a heavy chain by one covalent
disulfide bond, while the number of disulfide linkages varies among
the heavy chains of different immunoglobulin isotypes. Each heavy
and light chain also has regularly spaced intrachain disulfide
bridges. Each heavy chain has at one end a variable domain
(V.sub.H) followed by a number of constant domains. Each light
chain has a variable domain at one end (V.sub.L) and a constant
domain at its other end; the constant domain of the light chain is
aligned with the first constant domain of the heavy chain, and the
light chain variable domain is aligned with the variable domain of
the heavy chain. Particular amino acid residues are believed to
form an interface between the light and heavy-chain variable
domains.
[0094] As used herein, the term "variable" refers to the fact that
certain portions of the variable domains differ extensively in
sequence among antibodies. Variable regions confer antigen-binding
specificity. However, the variability is not evenly distributed
throughout the variable domains of antibodies. It is concentrated
in three segments called complementarity determining regions (CDRs)
or hypervariable regions, both in the light chain and the
heavy-chain variable domains. The more highly conserved portions of
variable domains are celled in the framework (FR) regions. The
variable domains of native heavy and light chains each comprise
four FR regions, largely adopting a 13-pleated-sheet configuration,
connected by three CDRs, which form loops connecting, and in some
cases forming part of, the f3-pleated-sheet structure. The CDRs in
each chain are held together in close proximity by the FR regions
and, with the CDRs from the other chain, contribute to the
formation of the antigen-binding site of antibodies (see, Kabat et
al. (1991) NIH PubL. No. 91-3242, Vol. I, pages 647-669). The
constant domains are not involved directly in binding an antibody
to an antigen, but exhibit various effector functions, such as Fc
receptor (FcR) binding, participation of the antibody in
antibody-dependent cellular toxicity, initiation of complement
dependent cytotoxicity, and mast cell degranulation.
[0095] As used herein, the term "hypervariable region," when used
herein, refers to the amino acid residues of an antibody that are
responsible for antigen-binding. The hypervariable region comprises
amino acid residues from a "complementarily determining region" or
"CDR" (i.e., residues 24-34 (L1), 5056 (L2), and 89-97 (L3) in the
light-chain variable domain and 31-35 (H1), 50-65 (H2), and 95-102
(H3) in the heavy-chain variable domain; Kabat et al. (1991)
Sequences of Proteins of Immunological Interest, 5th Ed. Public
Health Service, National Institute of Health, Bethesda, Md.) and/or
those residues from a "hypervariable loop" (i.e., residues 26-32
(L1), 50-52 (L2), and 91-96 (L3) in the light-chain variable domain
and (H1), 53-55 (H2), and 96-101 (13) in the heavy chain variable
domain; Clothia and Lesk, (1987) J. Mol. Biol., 196:901-917).
"Framework" or "FR" residues are those variable domain residues
other than the hypervariable region residues, as herein deemed.
[0096] "Antibody fragments" comprise a portion of an intact
antibody. In some embodiments, the portion of an intact antibody is
an antigen-binding or variable region of the intact antibody.
Examples of antibody fragments include Fab, Fab, F(ab')2, and Fv
fragments; diabodies; linear antibodies (Zapata et al. (1995)
Protein Eng. 10:1057-1062); single-chain antibody molecules; and
multispecific antibodies formed from antibody fragments. Papain
digestion of antibodies produces two identical antigen-binding
fragments, called "Fab" fragments, each with a single
antigen-binding site, and a residual "Fc" fragment, whose name
reflects its ability to crystallize readily. Pepsin treatment
yields an F(ab')2 fragment that has two antigen-combining sites and
is still capable of cross-linking antigen.
[0097] "Fv" is the minimum antibody fragment that contains a
complete antigen recognition and binding site. This region consists
of a dimer of one heavy- and one light-chain variable domain in
tight, non-covalent association. It is in this configuration that
the three CDRs of each variable domain interact to define an
antigen-binding site on the surface of the V.sub.H-V.sub.L dimer.
Collectively, the six CDRs confer antigen-binding specificity to
the antibody. However, even a single variable domain (or half of an
Fv comprising only three CDRs specific for an antigen) has the
ability to recognize and bind antigen, although at a lower affinity
than the entire binding site.
[0098] The Fab fragment also contains the constant domain of the
light chain and the first constant domain (CH1) of the heavy chain.
Fab fragments differ from Fab' fragments by the addition of a few
residues at the carboxy terminus of the heavy chain CH1 domain
including one or more cysteines from the antibody hinge region.
Fab'-SH is the designation herein for Fab' in which the cysteine
residue(s) of the constant domains bear a free thiol group. Fab'
fragments are produced by reducing the F(ab')2 fragment's heavy
chain disulfide bridge. Other chemical couplings of antibody
fragments are also known.
[0099] The "light chains" of antibodies (immunoglobulins) from any
vertebrate species assigned to one of two clearly distinct types,
called kappa (x) and lambda (.lamda.), based on the amino acid
sequences of their constant domains.
[0100] Depending on the amino acid sequence of the constant domain
of their heavy chains, immunoglobulins are assigned to different
classes. There are five major classes of human immunoglobulins:
IgA, IgD, IgE, IgG, and IgM, and several of these are further
divided into subclasses (isotypes), e.g., IgG1, IgG2, IgG3, IgG4,
IgA1, and IgA2. The heavy-chain constant domains that correspond to
the different classes of immunoglobulins are called alpha, delta,
epsilon, gamma, and mu, respectively. The subunit structures and
three-dimensional configurations of different classes of
immunoglobulins are well known. Different isotypes have different
effector functions. For example, human IgG1 and IgG3 isotypes have
ADCC (antibody dependent cell-mediated cytotoxicity) activity.
[0101] As used herein, the term "viral load" refers to the amount
of viral particles or toxic fragments thereof in a biological
fluid, such as blood or plasma. "Viral load" encompasses all viral
particles, infectious, replicative and non-infective, and fragments
thereof. Therefore, viral load represents the total number of viral
particles and/or fragments thereof circulating in the biological
fluid. Viral load can therefore be a measure of any of a variety of
indicators of the presence of a virus, such as viral copy number
per unit of blood or plasma or units of viral proteins or fragments
thereof per unit of blood or plasma. Viral load can be determined
by techniques known by one of skill in the art, e.g.,
polymerase-chain reaction (PCR) test and plaque-forming unit test.
For example, viral load values can be determined by measuring the
quantity of viral nucleic acid at the beginning of a treatment as
well as at each of the virus measurement time points before,
during, or after the treatment. A reduction in viral load during
the course of treatment can be determined by comparing the viral
load values obtained at different virus measurement time points.
The rate at which the viral load of a patient is reduced can be
determined by plotting the reduction in viral load value against
time.
[0102] As used herein, the terms "subject", "individual" and
"patient" are used interchangeably. None of the terms are to be
interpreted as requiring the supervision of a medical professional
(e.g., a doctor, nurse, physician's assistant, orderly, hospice
worker). As used herein, the subject can be any animal, including
mammals (e.g., a human or non-human animal) and non-mammals. In one
embodiment of the methods and compositions provided herein, the
mammal is a human.
Ibrutinib and Modulation of the Immune Response
[0103] In chronic lymphocytic leukemia (CLL), mounting evidence
points to an aberrant tumor associated Th2 bias that drives
leukemic cell immune evasion, promotes formation of a supportive
niche microenvironment, and functionally cripples innate and
adaptive immunity. The end result is a high incidence of infections
which is the primary cause of mortality in CLL. This same Th2 bias
is induced by many other types of cancer. Th2 CD4 T-cells are
singularly dependent upon IL-2-inducible T-cell kinase (ITK) for
activation whereas Th1 CD4 and CD8 T-cells have compensatory
resting lymphocyte kinase (RLK) which conducts T-cell receptor
activation even in the absence of ITK. In some embodiments, a
clinically viable ITK inhibitor would be suitable for targeting
immune suppression associated with CLL and other types of
cancer.
[0104] Ibrutinib, a confirmed inhibitor of the Bruton's tyrosine
kinase (BTK) that irreversibly blocks downstream B-cell receptor
activation, has demonstrated clinical activity in phase I/II
clinical trials resulting in durable remissions in CLL. Similarly,
combination therapy with ibrutinib has advanced into phase III
clinical trials. Recently, studies have unveiled a previously
uncharacterized Th1 cytokine switch in ibrutinib-treated CLL
patients, which was not attributed to B-lymphocytes. As described
herein, this ibrutinib-induced Th1 T-cell skewing was confirmed
using the E.mu.TCL1 mouse model of leukemia. Such alterations in
cytokine patterns were similar to mouse studies in which genetic
ablation of ITK subverted Th2 immunity, thereby potentiating
Th1-based adaptive immunity. The striking homology between BTK and
ITK combined with in silico docking studies and in vitro kinase
inhibition profiles with ibrutinib suggest that ibrutinib is a
clinically viable irreversible ITK inhibitor.
[0105] Cellular probe assays described herein confirmed that the
active site of ITK was covalently blocked by ibrutinib at
pharmacologically relevant doses. Comprehensive molecular analyses
of T-cell signaling confirmed this in the Jurkat cell line. It was
further confirmed both molecular and functional outcomes in primary
and in vitro polarized Th1 and Th2 CD4 T-cells. In addition, it was
found that mutation of the ITK-Cys442 covalent binding residue for
ibrutinib alleviated molecular inhibition. It was also demonstrated
that Th1 and CD8 T-cell restricted expression of RLK provides a
compensatory platform for T-cell activation offering a molecular
explanation for the selective outgrowth of cytotoxic Th1 biased
immunity. This effect was further confirmed using T-cells directly
derived from CLL patients.
[0106] To demonstrate that ibrutinib-induced ITK inhibition had
direct clinical relevance in the setting of CLL a novel
listeriosis/leukemia mouse model was utilized. In this model,
complete recovery of functional immunity was demonstrated, and all
ibrutinib treated mice survived a potentially lethal Listeria
monocytogenes infection. In certain embodiments, ibrutinib's
irreversible ITK inhibitory effects are applicable for use as an
adjuvant for cancer therapy and for the treatment of a number of
other autoimmune, inflammatory, and viral diseases, including
Hepatitis C virus, influenza A and human immunodeficiency virus
(HIV) infection.
Anticancer Therapy Adjuvant
[0107] Described herein, in certain embodiments, are methods of
adjuvant therapy for cancer comprising administering to a subject
with cancer an effective amount of a covalent TEC family kinase
inhibitor. In some embodiments, the covalent TEC family kinase
inhibitor inhibits the kinase activity of one or more members of
the TEC family of kinases (e.g. ITK, BTK, TEC, RLK and BMX). In
some embodiments, the covalent TEC family kinase inhibitor inhibits
the kinase activity of ITK. In some embodiments, the covalent TEC
family kinase inhibitor covalently binds to Cysteine 442 of ITK. In
some embodiments, the covalent TEC family kinase inhibitor
covalently binds to Cysteine 481 of BTK. In some embodiments, the
covalent TEC family kinase inhibitor is selected from among
ibrutinib (PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-263,
AVL-291, AVL-292, ONO-WG-37, BMS-488516, BMS-509744, CGI-1746,
CTA-056, GDC-0834, HY-11066 (also, CTK417891, HMS3265G21,
HMS3265G22, HMS3265H21, HMS3265H22, 439574-61-5, AG-F-54930),
ONO-4059, ONO-WG37, PLS-123, RN486, HM71224, or a combination
thereof. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. Additional covalent TEC family kinase
inhibitors for use in any of the methods provided herein are found,
for example, in U.S. Pat. Nos. 7,547,689, 7,960,396 and U.S. Patent
Publication Nos. US 2009-0197853 A1 and US 2012-0065201 A1, all of
which are incorporated by reference in their entirety.
[0108] In some embodiments, the methods of adjuvant therapy for
cancer comprise administering to a subject with cancer an effective
amount of a covalent TEC family kinase inhibitor to treat the
cancer by modulation of an immune response. In some embodiments,
the covalent TEC family kinase inhibitor increases a Th1 immune
response against the cancer compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor decreases a Th2 immune
response against the cancer compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor alters the ratio of Th1-Th2
immune response against the cancer compared to no treatment with
the covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor increases the ratio of Th1-Th2
immune response against the cancer compared to no treatment with
the covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor increases the population of
Th1 cells by about 1%, 2%, 3%, 4%, 5%, 10%, 20%, 30%, 40%, 50%,
60%, 70%, 80%, 90% or greater compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor decreases the population of
Th2 cells by about 1%, 2%, 3%, 4%, 5%, 10%, 20%, 30%, 40%, 50%,
60%, 70%, 80%, 90% or greater compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
covalent TEC family kinase inhibitor increases the expression of
one or more Th1 related markers. In some embodiments, the covalent
TEC family kinase inhibitor increases the expression of one or more
Th1 related markers by about 1%, 2%, 3%, 4%, 5%, 10%, 20%, 30%,
40%, 50%, 60%, 70%, 80%, 90% or greater compared to no treatment
with the covalent TEC family kinase inhibitor. In some embodiments,
the one or more Th1 related marker includes CCR1, CD4, CD26, CD94,
CD119, CD183, CD195, CD212, GM-CSF, Granzyme B, IFN-.alpha.,
IFN-.gamma., IL-2, IL-12, IL-15, IL-18R, IL-23, IL-27, IL-27R,
Lymphotoxin, perforin, t-bet, Tim-3, TNF-.alpha., TRANCE, sCD40L,
or any combination thereof. In some embodiments, the one or more
Th1 related markers includes IFN-.gamma., IL-2, IL-12 or any
combination thereof. In some embodiments, the covalent TEC family
kinase inhibitor decreases the expression of Th2 related markers.
In some embodiments, the covalent TEC family kinase inhibitor
decreases the expression of Th2 related markers by about 1%, 2%,
3%, 4%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or greater
compared to no treatment with the covalent TEC family kinase
inhibitor. In some embodiments, the one or more Th2 related markers
includes CCR3, CCR4, CCR7, CCR8, CD4, CD30, CD81, CD184, CD278,
c-maf, CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD, IL-1R, IL-4, IL-5,
IL-6, IL-9, IL-10, IL-13, IL-15, ST2L/T1, Tim-1, or any combination
thereof. In some embodiments, the one or more Th1 related markers
includes IL-4, IL-10, IL-13, or any combination thereof.
[0109] In certain embodiments, Th1 and Th2 related markers are
analyzed from a solid or a fluid sample from a subject. In some
embodiments, a solid sample comprises peripheral blood mononuclear
cells (PBMC). In some embodiments, a fluid sample comprises blood,
urine or spinal fluid.
[0110] Described herein, in certain embodiments, are methods of
adjuvant therapy for cancer comprising administering to a subject
with cancer an effective amount of a covalent TEC family kinase
inhibitor to prevent, reduce the risk of, or delay relapsed or
refractory disease. In some embodiments, the risk of relapsed or
refractory disease is reduced by about 10%, 20%, 30%, 40%, 50%,
60%, 70%, 80%, 90% or greater compared to no treatment with the
covalent TEC family kinase inhibitor.
[0111] In some embodiments, the covalent TEC family kinase
inhibitor is administered so as to extend disease free survival
(DFS) in the subject. In some embodiments, DFS is assessed 1, 2, 3,
4, 5, 6, 7, 8, 9, 10, 15, 20, 25 years or later following
initiation of covalent TEC family kinase inhibitor administration.
In some embodiments, DFS is improved by about 5 years, 10 years, 15
years, 20 years, 25 years or longer compared to no treatment with
the covalent TEC family kinase inhibitor. In some embodiments, the
subject is disease free for about 6 months, 1 year, 2 years, 3
years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years, 10
years, 15 years, 20 years, 25 years or longer following last
administration of the covalent TEC family kinase inhibitor.
[0112] In some embodiments, the covalent TEC family kinase
inhibitor is administered so as to extend overall survival (OS) in
the subject. In some embodiments, OS is assessed 1, 2, 3, 4, 5, 6,
7, 8, 9, 10, 15, 20, 25 years or later following initiation of
covalent TEC family kinase inhibitor administration. In some
embodiments, OS is improved by about 5 years, 10 years, 15 years,
20 years, 25 years or longer compared to no treatment with the
covalent TEC family kinase inhibitor. In some embodiments, the
subject is disease free for about 6 months, 1 year, 2 years, 3
years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years, 10
years, 15 years, 20 years, 25 years or longer following last
administration of the covalent TEC family kinase inhibitor.
[0113] In some embodiments, the methods of adjuvant therapy
comprise administering to a subject, characterized as disease free
or having minimal residual disease (MRD) following treatment of a
cancer with a first anticancer therapy, an effective amount of the
covalent TEC family kinase inhibitor to prevent, reduce the risk
of, or delay relapsed or refractory disease, wherein the first
anticancer therapy is not a covalent TEC family kinase inhibitor.
In some embodiments, the risk of relapsed or refractory disease is
reduced by about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or
greater compared to no treatment with the covalent TEC family
kinase inhibitor. In some embodiments, the anticancer therapy is
selected from among administration of a chemotherapeutic agent, a
biologic agent, radiation therapy, bone marrow transplant or
surgery. In some embodiments, the subject has no detectable cancer
following treatment of the cancer with the first anticancer therapy
and prior to administration of the covalent TEC family kinase
inhibitor. In some embodiments, the subject has no detectable
primary or metastatic tumors following treatment of the cancer with
the first anticancer therapy and prior to administration of the
covalent TEC family kinase inhibitor. In some embodiments, the
subject has no detectable circulating tumor cells in a fluid sample
following treatment of the cancer with the first anticancer therapy
and prior to administration of the covalent TEC family kinase
inhibitor. In some embodiments, the fluid sample is a blood, spinal
fluid or urine sample.
[0114] In some embodiments, the methods of adjuvant therapy
comprise administering to a subject having a tumor an effective
amount of a covalent TEC family kinase inhibitor to prevent or
delay progression of the tumor, wherein the subject is administered
a first anticancer therapy prior to administration of the covalent
TEC family kinase inhibitor, wherein the first anticancer therapy
does not comprise a covalent TEC family kinase inhibitor. In some
embodiments, the methods of adjuvant therapy comprise administering
to a subject having a tumor an effective amount of a covalent TEC
family kinase inhibitor to promote further regression of the tumor,
wherein the subject is administered a first anticancer therapy
prior to administration of the covalent TEC family kinase
inhibitor, wherein the first anticancer therapy does not comprise a
covalent TEC family kinase inhibitor. In some embodiments, the
methods of adjuvant therapy comprise administering to a subject
having a tumor an effective amount of a covalent TEC family kinase
inhibitor to eliminate the tumor, wherein the subject is
administered a first anticancer therapy prior to administration of
the covalent TEC family kinase inhibitor, wherein the first
anticancer therapy does not comprise a covalent TEC family kinase
inhibitor. In some embodiments, the first anticancer therapy is
selected from among administration of a chemotherapeutic agent, a
biologic agent, radiation therapy, bone marrow transplant or
surgery. In some embodiments, the subject has no detectable
circulating tumor cells following treatment with the anticancer
therapy, prior to initiation of covalent TEC family kinase
inhibitor administration. In some embodiments, the subject, prior
to initiation of covalent TEC family kinase inhibitor
administration, has a decreased amount of detectable circulating
tumor cells following treatment with the anticancer therapy
compared to before treatment with the anticancer therapy. In some
embodiments, the subject has no detectable cancer following
treatment of the cancer with the first anticancer therapy and prior
to administration of the covalent TEC family kinase inhibitor. In
some embodiments, the subject has no detectable primary or
metastatic tumors following treatment of the cancer with the first
anticancer therapy and prior to administration of the covalent TEC
family kinase inhibitor.
[0115] In some embodiments, the covalent TEC family kinase
inhibitor is administered following surgery for removal of a tumor.
In some embodiments, the surgery for removal of a tumor is a
definitive surgery. In some embodiments, the subject has no
detectable tumors following surgery. In some embodiments, the
surgery for removal of a tumor is a partial removal of the tumor.
In some embodiments, the subject has not been administered
chemotherapy for treatment of the cancer. In some embodiments, the
subject has been administered a chemotherapeutic agent or a
biologic agent for treatment of the cancer. In some embodiments,
the tumor is a sarcoma, carcinoma, lymphoma, or a melanoma. In some
embodiments, the lymphoma is an enlarged lymph node or an
extranodal lymphoma. In some embodiments, the subject has no
detectable cancer following surgery and prior to administration of
the covalent TEC family kinase inhibitor. In some embodiments, the
subject has no detectable primary or metastatic tumors following
surgery and prior to administration of the covalent TEC family
kinase inhibitor. In some embodiments, the subject has no
detectable circulating tumor cells following surgery. In some
embodiments, the subject has detectable circulating tumor cells in
a fluid sample following surgery. In some embodiments, the fluid
sample is a blood, spinal fluid or urine sample.
[0116] In some embodiments, administration of a covalent TEC family
kinase inhibitor to an individual decreases the risk of metastasis
of a primary tumor compared to the absence of the covalent TEC
family kinase inhibitor. In some embodiments, administration of a
covalent TEC family kinase inhibitor to an individual decreases the
risk of a secondary tumor compared to the absence of the covalent
TEC family kinase inhibitor.
[0117] In some embodiments, the subject has a bladder, brain,
breast, bladder, bone, cervical, colon, esophageal, kidney, liver,
lung, ovarian, pancreatic, proximal or distal bile duct, prostate,
skin, stomach, thyroid, or uterine cancer. In some embodiments, the
subject has a metastatic cancer. In some embodiments, the subject
has a cancer that is acute lymphoblastic leukemia, acute
lymphoblastic leukemia, acute myeloid leukemia, acute promyelocytic
leukemia, adenocarcinoma, adenoma, adrenal cancer, adrenocortical
carcinoma, AIDS-related cancer, AIDS-related lymphoma, anal cancer,
appendix cancer, astrocytoma, basal cell carcinoma, bile duct
cancer, bladder cancer, bone cancer, osteosarcoma/malignant fibrous
histiocytoma, brainstem glioma, brain cancer, carcinoma, cerebellar
astrocytoma, cerebral astrocytoma/malignant glioma, ependymoma,
medulloblastoma, supratentorial primitive neuroectodermal tumor,
visual pathway or hypothalamic glioma, breast cancer, bronchial
adenoma/carcinoid, Burkitt lymphoma, carcinoid tumor, carcinoma,
central nervous system lymphoma, cervical cancer, chronic
lymphocytic leukemia, chronic myelogenous leukemia, chronic
myeloproliferative disorder, colon cancer, cutaneous T-cell
lymphoma, desmoplastic small round cell tumor, endometrial cancer,
ependymoma. epidermoid carcinoma, esophageal cancer, Ewing's
sarcoma, extracranial germ cell tumor, extragonadal germ cell
tumor, extrahepatic bile duct cancer, eye cancer/intraocular
melanoma, eye cancer/retinoblastoma, gallbladder cancer, gallstone
tumor, gastric/stomach cancer, gastrointestinal carcinoid tumor,
gastrointestinal stromal tumor, giant cell tumor, glioblastoma
multiforme, glioma, hairy-cell tumor, head and neck cancer, heart
cancer, hepatocellular/liver cancer, Hodgkin lymphoma, hyperplasia,
hyperplastic corneal nerve tumor, in situ carcinoma, hypopharyngeal
cancer, intestinal ganglioneuroma, islet cell tumor, Kaposi's
sarcoma, kidney/renal cell cancer, laryngeal cancer, leiomyoma
tumor, lip and oral cavity cancer, liposarcoma, liver cancer,
non-small cell lung cancer, small cell lung cancer, lymphomas,
macroglobulinemia, malignant carcinoid, malignant fibrous
histiocytoma of bone, malignant hypercalcemia, malignant melanomas,
marfanoid habitus tumor, medullary carcinoma, melanoma, merkel cell
carcinoma, mesothelioma, metastatic skin carcinoma, metastatic
squamous neck cancer, mouth cancer, mucosal neuromas, multiple
myeloma, mycosis fungoides, myelodysplastic syndrome, myeloma,
myeloproliferative disorder, nasal cavity and paranasal sinus
cancer, nasopharyngeal carcinoma, neck cancer, neural tissue
cancer, neuroblastoma, oral cancer, oropharyngeal cancer,
osteosarcoma, ovarian cancer, ovarian epithelial tumor, ovarian
germ cell tumor, pancreatic cancer, parathyroid cancer, penile
cancer, pharyngeal cancer, pheochromocytoma, pineal astrocytoma,
pineal germinoma, pineoblastoma, pituitary adenoma, pleuropulmonary
blastoma, polycythemia vera, primary brain tumor, prostate cancer,
rectal cancer, renal cell tumor, reticulum cell sarcoma,
retinoblastoma, rhabdomyosarcoma, salivary gland cancer, seminoma,
Sezary syndrome, skin cancer, small intestine cancer, soft tissue
sarcoma, squamous cell carcinoma, squamous neck carcinoma, stomach
cancer, supratentorial primitive neuroectodermal tumor, testicular
cancer, throat cancer, thymoma, thyroid cancer, topical skin
lesion, trophoblastic tumor, urethral cancer, uterine/endometrial
cancer, uterine sarcoma, vaginal cancer, vulvar cancer,
Waldenstrom's macroglobulinemia or Wilm's tumor.
[0118] In some embodiments, the subject has a solid tumor. In some
embodiments, the subject has a sarcoma, carcinoma, a
neurofibromatoma or a lymphoma. In some embodiments, the subject
has a colon cancer. In some embodiments, the subject has a lung
cancer. In some embodiments, the subject has an ovarian cancer. In
some embodiments, the subject has a pancreatic cancer. In some
embodiments, the subject has a prostate cancer. In some
embodiments, the subject has a proximal or distal bile duct
carcinoma. In some embodiments, the subject has a breast cancer. In
some embodiments, the subject has a HER2-positive breast cancer. In
some embodiments, the subject has a HER2-negative breast
cancer.
[0119] In some embodiments, the cancer is a hematologic cancer. In
some embodiments, cancer is a leukemia, a lymphoma, or a myeloma.
In some embodiments, cancer is a non-Hodgkin lymphoma. In some
embodiments, cancer is a Hodgkin lymphoma. In some embodiments,
cancer is a B-cell malignancy. In some embodiments, the B-cell
malignancy is chronic lymphocytic leukemia (CLL), small lymphocytic
lymphoma (SLL), diffuse large B-cell lymphoma (DLBCL), follicular
lymphoma (FL), activated B-cell diffuse large B-cell lymphoma
(ABC-DLBCL), germinal center diffuse large B-cell lymphoma (GCB
DLBCL), primary mediastinal B-cell lymphoma (PMBL), Burkitt's
lymphoma, immunoblastic large cell lymphoma, precursor
B-lymphoblastic lymphoma, mantle cell lymphoma (MCL), B cell
prolymphocytic leukemia, lymphoplasmacytic lymphoma, Waldenstrom
macroglobulinemia, splenic marginal zone lymphoma, plasma cell
myeloma, plasmacytoma, extranodal marginal zone B cell lymphoma,
nodal marginal zone B cell lymphoma, mediastinal (thymic) large B
cell lymphoma, intravascular large B cell lymphoma, primary
effusion lymphoma, or lymphomatoid granulomatosis. In some
embodiments, cancer is a T-cell malignancy. In some embodiments,
the T-cell malignancy is peripheral T-cell lymphoma not otherwise
specified (PTCL-NOS), anaplastic large cell lymphoma,
angioimmunoblastic lymphoma, cutaneous T-cell lymphoma, adult
T-cell leukemia/lymphoma (ATLL), blastic NK-cell lymphoma,
enteropathy-type T-cell lymphoma, hematosplenic gamma-delta T-cell
lymphoma, lymphoblastic lymphoma, nasal NK/T-cell lymphomas, or
treatment-related T-cell lymphomas. In some embodiments, the
subject has multiple myeloma. In some embodiments, the regression
of a cancer ceases.
[0120] In some embodiments, the subject has a relapsed or
refractory cancer. In some embodiments, the relapsed or refractory
cancer is a bladder cancer. In some embodiments, the relapsed or
refractory cancer is a colon cancer. In some embodiments, the
relapsed or refractory cancer is a lung cancer. In some
embodiments, the relapsed or refractory cancer is an ovarian
cancer. In some embodiments, the relapsed or refractory cancer is a
pancreatic cancer. In some embodiments, the relapsed or refractory
cancer is a prostate cancer. In some embodiments, the relapsed or
refractory cancer is a proximal or distal bile duct carcinoma. In
some embodiments, the relapsed or refractory cancer is a breast
cancer.
[0121] In some embodiments, the subject has a relapsed or
refractory hematologic cancer. In some embodiments, the relapsed or
refractory hematologic cancer is a leukemia, a lymphoma, or a
myeloma. In some embodiments, the relapsed or refractory
hematologic cancer is a non-Hodgkin lymphoma. In some embodiments,
the relapsed or refractory hematologic cancer is a Hodgkin
lymphoma. In some embodiments, the relapsed or refractory
hematologic cancer is a B-cell malignancy. In some embodiments, the
B-cell malignancy is chronic lymphocytic leukemia (CLL), small
lymphocytic lymphoma (SLL), diffuse large B-cell lymphoma (DLBCL),
follicular lymphoma (FL), activated B-cell diffuse large B-cell
lymphoma (ABC-DLBCL), germinal center diffuse large B-cell lymphoma
(GCB DLBCL), primary mediastinal B-cell lymphoma (PMBL), Burkitt's
lymphoma, immunoblastic large cell lymphoma, precursor
B-lymphoblastic lymphoma, mantle cell lymphoma (MCL), B cell
prolymphocytic leukemia, lymphoplasmacytic lymphoma, Waldenstrom
macroglobulinemia, splenic marginal zone lymphoma, plasma cell
myeloma, plasmacytoma, extranodal marginal zone B cell lymphoma,
nodal marginal zone B cell lymphoma, mediastinal (thymic) large B
cell lymphoma, intravascular large B cell lymphoma, primary
effusion lymphoma, or lymphomatoid granulomatosis. In some
embodiments, the relapsed or refractory hematologic cancer is a
T-cell malignancy. In some embodiments, the T-cell malignancy is
peripheral T-cell lymphoma not otherwise specified (PTCL-NOS),
anaplastic large cell lymphoma, angioimmunoblastic lymphoma,
cutaneous T-cell lymphoma, adult T-cell leukemia/lymphoma (ATLL),
blastic NK-cell lymphoma, enteropathy-type T-cell lymphoma,
hematosplenic gamma-delta T-cell lymphoma, lymphoblastic lymphoma,
nasal NK/T-cell lymphomas, or treatment-related T-cell lymphomas.
In some embodiments, the subject has a relapsed or refractory
multiple myeloma. In some embodiments, the regression of a relapsed
or refractory cancer ceases.
[0122] In some embodiments, the subject exhibits one or more
symptoms of a hematologic cancer. In some embodiments, the subject
exhibits one or more symptoms of a B-cell malignancy. In some
embodiments, the subject exhibits one or more symptoms of a T-cell
malignancy. In some embodiments, the subject exhibits one or more
symptoms of a leukemia, a lymphoma, or a myeloma. In some
embodiments, the subject exhibits one or more symptoms such as, but
not limited to, abnormal B-cell function, abnormal B-cell size or
shape, abnormal B-cell count, fatigue, fever, night sweats,
frequent infection, enlarged lymph nodes, paleness, anemia, easy
bleeding or bruising, loss of appetite, weight loss, bone or joint
pain, headaches, and petechie.
[0123] In some embodiments, the subject has a high risk of cancer
recurrence. In some embodiments, the subject is a mammal, such as,
but not limited to a human, a non-human primate, mouse, rat,
rabbit, goat, dog, cat, or cow. In some embodiments, the mammal is
a human. In some embodiments, a high risk of cancer recurrence is
determined based on the expression or presence of a biomarker. In
some embodiments, the biomarker includes PMSB1 P11A G/C
heterozygote, CD68, suppressor of cytokine signaling 1 (SOCS1), LIM
domain only 2 (LMO2), CD137, or a combination thereof.
[0124] In some embodiments, a high risk cancer includes bladder,
colon, lung, ovarian, pancreatic, prostate, proximal or distal bile
duct and breast cancer. In some embodiments, a high risk of
bladder, colon, lung, ovarian, pancreatic, prostate and proximal or
distal bile duct cancer recurrence is determined based on the
expression or presence of a biomarker. In some embodiments,
biomarkers for bladder cancer include BTA Stat, BTA Track, NMP 22,
Bladder Chek, immunocyt, UroVysion, cytokeratins 8, 18 and 19,
telomerase TRAP, hTert and hTR, BLCA-4, survivn, hyaluronic
acid/hyaluronidase, DD23 monoclonal antibody, fibronectin and HCG.
In some embodiments, biomarkers for colon cancer include CEA, CA
19-9, CYFRA 21-1, ferritin, osteopontin, p53, seprase and EGFR. In
some embodiments, biomarkers for lung cancer include ERCC-1, NSE,
ProGRP, SCC, beta-tubulin, RRM1, EGFR, VEGF, CYFRA-21-1, CEA, CRP,
LDH, CA125, CgA, NCAM and TPA. In some embodiments, biomarkers for
ovarian cancer include CA125, Her-2/neu, Akt-2, inhibin, HLA-G,
TATI, CASA, TPA, CEA, LPA, PAI-1, IL-6, kallikreins 5, 6, 7, 8,
9,10, 11, 13, 14, 15, hCGpcf, prostasin, osteopontin, HE4,
mitogen-activated protein kinase, IGFBP-2, RSF-1 and NAC-1. In some
embodiments, biomarkers for pancreatic cancer include CA19-9, CEA,
TIMP-1, CA50, CA242, MUC1, MUC5AC, Claudin 18 and annexin A8. In
some embodiments, biomarkers for prostate cancer include PSA, human
kallikrein 2, IGF-1, IGFBP-3, PCA3, AMACR, GSTPi, CDKN1B, Ki-67,
PTEN, and PSCA. In some embodiments, biomarkers for proximal or
distal bile duct carcinoma include CA125, CA19-9, CEA, CgA, MUC1,
MUC5AC, PML, p53, DPC4, Ki67, matrix metalloproteinases,
alpha-fetoprotein, N-cadherin, VEGF-C, claudins, thrombospondin-1,
cytokeratins and CYFRA 21-1. In some embodiments, biomarkers for
breast cancer include HER-1, -2, -3, -4; EGFR and HER-2/neu.
[0125] In some embodiments, the covalent TEC family kinase
inhibitor inhibits the kinase activity of one or more members of
the TEC family of kinases (e.g. ITK, BTK, TEC, RLK and BMX). In
some embodiments, the covalent TEC family kinase inhibitor inhibits
the kinase activity of ITK. In some embodiments, the covalent TEC
family kinase inhibitor covalently binds to Cysteine 442 of ITK. In
some embodiments, the covalent TEC family kinase inhibitor
covalently binds to Cysteine 481 of BTK. In some embodiments, the
covalent TEC family kinase inhibitor is selected from among
ibrutinib (PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-263,
AVL-291, AVL-292, ONO-WG-37, BMS-488516, BMS-509744, CGI-1746,
CTA-056, GDC-0834, HY-11066 (also, CTK4I7891, HMS3265G21,
HMS3265G22, HMS3265H21, HMS3265H22, 439574-61-5, AG-F-54930),
ONO-4059, ONO-WG37, PLS-123, RN486, HM71224, or a combination
thereof. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. Additional covalent TEC family kinase
inhibitors for use in any of the methods provided herein are found,
for example, in U.S. Pat. Nos. 7,547,689, 7,960,396 and U.S. Patent
Publication Nos. US 2009-0197853 A1 and US 2012-0065201 A1, all of
which are incorporated by reference in their entirety.
[0126] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a bladder cancer. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
bladder cancer. Exemplary therapies for the treatment of bladder
cancer include, but are not limited to, doxorubicin hydrochloride
(Adriamycin PFS/RDF), cisplatin, mitomycin, fluorouracil,
gemcitabine, methotrexate, vinblastine, carboplatin, paclitaxel,
docetaxel, thiotepa (Thioplex, Tepadina), immunotherapeutic agents
(e.g. Bacille Calmette-Guerin, interferon alfa-2b), and radiation
therapeutic agents. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with doxorubicin
hydrochloride (Adriamycin PFS/RDF), cisplatin, mitomycin,
fluorouracil, gemcitabine, methotrexate, vinblastine, carboplatin,
paclitaxel, docetaxel, thiotepa (Thioplex, Tepadina),
immunotherapeutic agents (e.g. Bacille Calmette-Guerin, interferon
alfa-2b), and radiation therapeutic agents. In some embodiments,
the covalent TEC family kinase inhibitor is ibrutinib. In some
embodiments, ibrutinib is administered in combination with
doxorubicin hydrochloride (Adriamycin PFS/RDF), cisplatin,
mitomycin, fluorouracil, gemcitabine, methotrexate, vinblastine,
carboplatin, paclitaxel, docetaxel, thiotepa (Thioplex, Tepadina),
immunotherapeutic agents (e.g. Bacille Calmette-Guerin, interferon
alfa-2b), and radiation therapeutic agents for the treatment of a
bladder cancer. In some embodiments, the covalent TEC family kinase
inhibitor (e.g., ibrutinib) is administered sequentially,
simultaneously, or intermittently with the one or more therapies
for the treatment of a bladder cancer.
[0127] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a colon cancer. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
colon cancer. Exemplary therapies for the treatment of colon cancer
include, but are not limited to, fluorouracil (Adrucil),
bevacizumab (Avastin), irinotecan hydrochloride (Camptosar),
capecitabine, cetuximab, Efudex, oxaliplatin (Eloxatin), Erbutix,
Fluoroplex, leucovorin calcium (Wellcovorin), panitumamab
(Vectibix), regorafenib (Stivarga), ziv-aflibercept, CAPOX,
FOLFIRI, FOLFOX, and XELOX. In some embodiments, the covalent TEC
family kinase inhibitor is administered in combination with
fluorouracil (Adrucil), bevacizumab (Avastin), irinotecan
hydrochloride (Camptosar), capecitabine, cetuximab, Efudex,
oxaliplatin (Eloxatin), Erbutix, Fluoroplex, leucovorin calcium
(Wellcovorin), panitumamab (Vectibix), regorafenib (Stivarga),
ziv-aflibercept, CAPOX, FOLFIRI, FOLFOX, and XELOX. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, ibrutinib is administered in combination with
fluorouracil (Adrucil), bevacizumab (Avastin), irinotecan
hydrochloride (Camptosar), capecitabine, cetuximab, Efudex,
oxaliplatin (Eloxatin), Erbutix, Fluoroplex, leucovorin calcium
(Wellcovorin), panitumamab (Vectibix), regorafenib (Stivarga),
ziv-aflibercept, CAPOX, FOLFIRI, FOLFOX, and XELOX for the
treatment of a colon cancer. In some embodiments, the covalent TEC
family kinase inhibitor (e.g., ibrutinib) is administered
sequentially, simultaneously, or intermittently with the one or
more therapies for the treatment of a colon cancer.
[0128] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a lung cancer. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
lung cancer. Exemplary therapies for the treatment of lung cancer
include, but are not limited to, Adriamycin IV, Rheumatrex,
Mustargen, methotrexate (Abitrexate), Abraxane, afatinib dimaleate
(Gilotrif), pemetrexed disodium (Alimta), bevacixumab, carboplatin,
cisplatin, crizotinib, erlotinib hydrochloride, Etopophos
(etoposide phosphate), Folex, Folex PFS, gefitinib (Iressa),
gemcitabine hydrochloride (Gemzar), topotecan hydrochloride
(Hycamtin), Methotrexate LPF, Mexate, Mexate-AQ, paclitaxel,
Paraplat, Paraplatin, Platinol, Platinol-AQ, Tarceva, Taxol,
Xalkori, Toposar, VePesid and MPDL3280A. In some embodiments, the
covalent TEC family kinase inhibitor is administered in combination
with Adriamycin IV, Rheumatrex, Mustargen, methotrexate
(Abitrexate), Abraxane, afatinib dimaleate (Gilotrif), pemetrexed
disodium (Alimta), bevacixumab, carboplatin, cisplatin, crizotinib,
erlotinib hydrochloride, Etopophos (etoposide phosphate), Folex,
Folex PFS, gefitinib (Iressa), gemcitabine hydrochloride (Gemzar),
topotecan hydrochloride (Hycamtin), Methotrexate LPF, Mexate,
Mexate-AQ, paclitaxel, Paraplat, Paraplatin, Platinol, Platinol-AQ,
Tarceva, Taxol, Xalkori, Toposar, VePesid and MPDL3280A. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, ibrutinib is administered in combination with
Adriamycin IV, Rheumatrex, Mustargen, methotrexate (Abitrexate),
Abraxane, afatinib dimaleate (Gilotrif), pemetrexed disodium
(Alimta), bevacixumab, carboplatin, cisplatin, crizotinib,
erlotinib hydrochloride, Etopophos (etoposide phosphate), Folex,
Folex PFS, gefitinib (Iressa), gemcitabine hydrochloride (Gemzar),
topotecan hydrochloride (Hycamtin), Methotrexate LPF, Mexate,
Mexate-AQ, paclitaxel, Paraplat, Paraplatin, Platinol, Platinol-AQ,
Tarceva, Taxol, Xalkori, Toposar, VePesid and MPDL3280A for the
treatment of a lung cancer. In some embodiments, the covalent TEC
family kinase inhibitor (e.g., ibrutinib) is administered
sequentially, simultaneously, or intermittently with the one or
more therapies for the treatment of a lung cancer.
[0129] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of an ovarian cancer. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
ovarian cancer. Exemplary therapies for the treatment of ovarian
cancer include, but are not limited to, doxorubicin hydrochloride
(Adriamycin PFS/RDF), carboplatin, cyclophosphamide (Clafen),
cisplatin, Cytoxan, Dox-SL, DOXIL, doxorubicin hydrochloride
liposome (Evacet), gemcitabine hydrochloride (Gemzar), topotecan
hydrochloride (Hycamtin), Neosar, Paclitaxel, Paraplat, Paraplatin,
Platinol, Platinol-AQ, Taxol and BEP. In some embodiments, the
covalent TEC family kinase inhibitor is administered in combination
with doxorubicin hydrochloride (Adriamycin PFS/RDF), carboplatin,
cyclophosphamide (Clafen), cisplatin, Cytoxan, Dox-SL, DOXIL,
doxorubicin hydrochloride liposome (Evacet), gemcitabine
hydrochloride (Gemzar), topotecan hydrochloride (Hycamtin), Neosar,
Paclitaxel, Paraplat, Paraplatin, Platinol, Platinol-AQ, Taxol and
BEP. In some embodiments, the covalent TEC family kinase inhibitor
is ibrutinib. In some embodiments, ibrutinib is administered in
combination with doxorubicin hydrochloride (Adriamycin PFS/RDF),
carboplatin, cyclophosphamide (Clafen), cisplatin, Cytoxan, Dox-SL,
DOXIL, doxorubicin hydrochloride liposome (Evacet), gemcitabine
hydrochloride (Gemzar), topotecan hydrochloride (Hycamtin), Neosar,
Paclitaxel, Paraplat, Paraplatin, Platinol, Platinol-AQ, Taxol and
BEP for the treatment of an ovarian cancer. In some embodiments,
the covalent TEC family kinase inhibitor (e.g., ibrutinib) is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of an ovarian
cancer.
[0130] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a pancreatic cancer. In
some embodiments, a covalent TEC family kinase inhibitor is
administered in combination with one or more therapies for the
treatment of the pancreatic cancer. Exemplary therapies for the
treatment of pancreatic cancer include, but are not limited to,
Adriamycin PFS IV, Adrucil, Efudex, erlotinib hydrochloride,
Fluoroplex, fluorouracil, gemcitabine hydrochloride (Gemzar),
mitomycin C, Tarceva, Oxaliplatin paclitaxel-protein bound IV, anc
capecitabine. In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with Adriamycin PFS IV,
Adrucil, Efudex, erlotinib hydrochloride, Fluoroplex, fluorouracil,
gemcitabine hydrochloride (Gemzar), mitomycin C, Tarceva,
Oxaliplatin paclitaxel-protein bound IV, anc capecitabine. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, ibrutinib is administered in combination with
Adriamycin PFS IV, Adrucil, Efudex, erlotinib hydrochloride,
Fluoroplex, fluorouracil, gemcitabine hydrochloride (Gemzar),
mitomycin C, Tarceva, Oxaliplatin paclitaxel-protein bound IV, anc
capecitabine for the treatment of a pancreatic cancer. In some
embodiments, the covalent TEC family kinase inhibitor (e.g.,
ibrutinib) is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
a pancreatic cancer.
[0131] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a prostate cancer. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
prostate cancer. Exemplary therapies for the treatment of prostate
cancer include, but are not limited to, abiraterone acetate,
cabazitaxel, degarelix, docetaxel, enzalutamide, leuprolide
acetate, prednisone, denosumab, sipuleucel-T, and radium 223
dichloride. In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with abiraterone acetate,
cabazitaxel, degarelix, docetaxel, enzalutamide, leuprolide
acetate, prednisone, denosumab, sipuleucel-T, or radium 223
dichloride. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with abiraterone acetate, cabazitaxel,
degarelix, docetaxel, enzalutamide, leuprolide acetate, prednisone,
denosumab, sipuleucel-T, or radium 223 dichloride for the treatment
of prostate cancer. In some embodiments, the covalent TEC family
kinase inhibitor (e.g., ibrutinib) is administered sequentially,
simultaneously, or intermittently with the one or more therapies
for the treatment of prostate cancer.
[0132] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a proximal or distal bile
duct cancer. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the proximal or distal bile duct cancer.
Exemplary therapies for the treatment of proximal or distal bile
duct cancer include, but are not limited to, cisplatin,
gemcitabine, fluorouracil, and doxorubicin. In some embodiments,
the covalent TEC family kinase inhibitor is administered in
combination with cisplatin, gemcitabine, fluorouracil, or
doxorubicin. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with cisplatin, gemcitabine,
fluorouracil, or doxorubicin for the treatment of a proximal or
distal bile duct cancer. In some embodiments, the covalent TEC
family kinase inhibitor (e.g., ibrutinib) is administered
sequentially, simultaneously, or intermittently with the one or
more therapies for the treatment of a proximal or distal bile duct
cancer.
[0133] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a breast cancer. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
breast cancer. Exemplary therapies for the treatment of breast
cancer include, but are not limited to, ado-trastuzumab emtansine,
anastrozole, capecitabine, cyclophosphamide, docetaxel, doxorubicin
hydrochloride, epirubicin hydrochloride, everolimus, exemestane,
fluorouracil, fulvestrant, gemcitabine hydrochloride, ixabepilone,
lapatinib ditosylate, letrozole, megestrol acetate, methotrexate,
paclitaxel, paclitaxel albumin-stabilized nanoparticle formulation,
pamidronate disodium, tamoxifen citrate, toremifene, and
trastuzumab. In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with ado-trastuzumab
emtansine, anastrozole, capecitabine, cyclophosphamide, docetaxel,
doxorubicin hydrochloride, epirubicin hydrochloride, everolimus,
exemestane, fluorouracil, fulvestrant, gemcitabine hydrochloride,
ixabepilone, lapatinib ditosylate, letrozole, megestrol acetate,
methotrexate, paclitaxel, paclitaxel albumin-stabilized
nanoparticle formulation, pamidronate disodium, tamoxifen citrate,
toremifene, or trastuzumab. In some embodiments, the covalent TEC
family kinase inhibitor is ibrutinib. In some embodiments,
ibrutinib is administered in combination with ado-trastuzumab
emtansine, anastrozole, capecitabine, cyclophosphamide, docetaxel,
doxorubicin hydrochloride, epirubicin hydrochloride, everolimus,
exemestane, fluorouracil, fulvestrant, gemcitabine hydrochloride,
ixabepilone, lapatinib ditosylate, letrozole, megestrol acetate,
methotrexate, paclitaxel, paclitaxel albumin-stabilized
nanoparticle formulation, pamidronate disodium, tamoxifen citrate,
toremifene, or trastuzumab for the treatment of a breast cancer. In
some embodiments, the covalent TEC family kinase inhibitor (e.g.,
ibrutinib) is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
a breast cancer.
[0134] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a T-cell or NK cell
malignancy. In some embodiments, a covalent TEC family kinase
inhibitor is administered for adjuvant therapy of an aggressive
T-cell or NK cell malignancy. In some embodiments, a covalent TEC
family kinase inhibitor is administered for adjuvant therapy of an
indolent T-cell or NK cell malignancy. In some embodiments, the
T-cell or NK cell malignancy is a cutaneous malignancy. In some
embodiments, the cutaneous malignancy is Mycosis Fungoides (MF),
transformed MF, Sezary syndrome, a primary cutaneous CD30+ T-cell
disorder, or a primary cutaneous gamma/delta T-cell lymphoma. In
some embodiments, the T-cell or NK cell malignancy is an extranodal
T-cell or NK cell malignancy. In some embodiments, the extranodal
malignancy is a nasal NK/T-cell lymphoma, an enteropathy-type
T-cell lymphoma, hepatosplenic T-cell lymphoma. In some
embodiments, the T-cell or NK cell malignancy is an nodal T-cell or
NK cell malignancy. In some embodiments, the nodal malignancy is
peripheral T-cell lymphoma not otherwise specified (PTCL-NOS),
anaplastic large cell lymphoma, angioimmunoblastic lymphoma,
blastic NK-cell lymphoma, lymphoblastic lymphoma. In some
embodiments, the T-cell or NK cell malignancy is a leukemic cell or
NK cell malignancy. In some embodiments, the leukemic malignancy is
adult T-cell leukemia/lymphoma (ATLL), aggressive NK-cell leukemia,
T-cell prolymphocytic leukemia, or T-cell large granular
lymphocytic leukemia. In some embodiments, the T-cell or NK cell
malignancy is a treatment-related T-cell lymphoma.
[0135] In some embodiments, a covalent TEC family kinase inhibitor
is administered in combination with one or more therapies for the
treatment of a T-cell or NK cell malignancy. Exemplary therapies
for the treatment of a T-cell or NK cell malignancies include, but
are not limited to, CHOP (cyclophosphamide, hydroxydoxorubicin,
vincristine, and prednisone), EPOCH (etoposide, prednisone,
vincristine, cyclophosphamide, hydroxydoxorubicin), Hyper-CVAD
(cyclophosphamide, vincristine, hydroxydoxorubicin, dexamethasone),
ICE (ifosfamide, carboplatin, etoposide), DHAP (high-dose
cytarabine [ara-C], dexamethasone, cisplatin), ESHAP (etoposide,
methylprednisolone, cytarabine [ara-C], cisplatin),
anthracycline-based chemotherapy, histone deacetylase (HDAC)
inhibitors, such as abexinostat, resminostat, vorinostat,
belinostat and panobinostat, proteasome inhibitors such as
bortezomib, immunomodulatory drugs, such as lenalidomide,
monoclonal antibodies, such as alemtuzumab and brentuximab vedotin,
and nucleoside analogs, such as gemcitabine, nelarabine. In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with CHOP (cyclophosphamide,
hydroxydoxorubicin, vincristine, and prednisone), EPOCH (etoposide,
prednisone, vincristine, cyclophosphamide, hydroxydoxorubicin),
Hyper-CVAD (cyclophosphamide, vincristine, hydroxydoxorubicin,
dexamethasone), ICE (ifosfamide, carboplatin, etoposide), DHAP
(high-dose cytarabine [ara-C], dexamethasone, cisplatin), and ESHAP
(etoposide, methylprednisolone, cytarabine [ara-C], cisplatin) for
the treatment of a T-cell or NK cell malignancy. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, ibrutinib is administered in combination with
CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine, and
prednisone), EPOCH (etoposide, prednisone, vincristine,
cyclophosphamide, hydroxydoxorubicin), Hyper-CVAD
(cyclophosphamide, vincristine, hydroxydoxorubicin, dexamethasone),
ICE (ifosfamide, carboplatin, etoposide), DHAP (high-dose
cytarabine [ara-C], dexamethasone, cisplatin), or ESHAP (etoposide,
methylprednisolone, cytarabine [ara-C], cisplatin) for the
treatment of a T-cell or NK cell malignancy. In some embodiments,
ibrutinib is administered in combination with bortezomib for the
treatment of a T-cell or NK cell malignancy. In some embodiments,
ibrutinib is administered in combination with an HDAC inhibitor,
such as abexinostat, resminostat, vorinostat, belinostat and
panobinostat for the treatment of a T-cell or NK cell malignancy.
In some embodiments, the covalent TEC family kinase inhibitor
(e.g., ibrutinib) is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
a T-cell or NK cell malignancy.
[0136] In some embodiments, a covalent TEC family kinase inhibitor
is administered in combination with one or more therapies for the
treatment of a relapsed or refractory T-cell or NK cell malignancy.
Exemplary therapies for the treatment of a relapsed or refractory
T-cell or NK cell malignancies include, but are not limited to,
CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine, and
prednisone), EPOCH (etoposide, prednisone, vincristine,
cyclophosphamide, hydroxydoxorubicin), Hyper-CVAD
(cyclophosphamide, vincristine, hydroxydoxorubicin, dexamethasone),
ICE (ifosfamide, carboplatin, etoposide), DHAP (high-dose
cytarabine [ara-C], dexamethasone, cisplatin), ESHAP (etoposide,
methylprednisolone, cytarabine [ara-C], cisplatin),
anthracycline-based chemotherapy, histone deacetylase (HDAC)
inhibitors, such as abexinostat, resminostat, vorinostat,
belinostat and panobinostat, proteasome inhibitors such as
bortezomib, immunomodulatory drugs, such as lenalidomide,
monoclonal antibodies, such as alemtuzumab and brentuximab vedotin,
and nucleoside analogs, such as gemcitabine, nelarabine. In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with CHOP (cyclophosphamide,
hydroxydoxorubicin, vincristine, and prednisone), EPOCH (etoposide,
prednisone, vincristine, cyclophosphamide, hydroxydoxorubicin),
Hyper-CVAD (cyclophosphamide, vincristine, hydroxydoxorubicin,
dexamethasone), ICE (ifosfamide, carboplatin, etoposide), DHAP
(high-dose cytarabine [ara-C], dexamethasone, cisplatin), and ESHAP
(etoposide, methylprednisolone, cytarabine [ara-C], cisplatin) for
the treatment of a relapsed or refractory T-cell or NK cell
malignancy. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with CHOP (cyclophosphamide,
hydroxydoxorubicin, vincristine, and prednisone), EPOCH (etoposide,
prednisone, vincristine, cyclophosphamide, hydroxydoxorubicin),
Hyper-CVAD (cyclophosphamide, vincristine, hydroxydoxorubicin,
dexamethasone), ICE (ifosfamide, carboplatin, etoposide), DHAP
(high-dose cytarabine [ara-C], dexamethasone, cisplatin), or ESHAP
(etoposide, methylprednisolone, cytarabine [ara-C], cisplatin) for
the treatment of a relapsed or refractory T-cell or NK cell
malignancy. In some embodiments, ibrutinib is administered in
combination with bortezomib for the treatment of a T-cell or NK
cell malignancy. In some embodiments, ibrutinib is administered in
combination with an HDAC inhibitor, such as abexinostat,
resminostat, vorinostat, belinostat and panobinostat for the
treatment of a T-cell or NK cell malignancy. In some embodiments,
the covalent TEC family kinase inhibitor (e.g., ibrutinib) is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of a relapsed or
refractory T-cell or NK cell malignancy.
[0137] Described herein, in certain embodiments, are methods of
selecting a patient having cancer for adjuvant therapy with a
covalent TEC Family kinase inhibitor comprising measuring the the
expressing of one more Th1 and/or Th2 cytokines and characterizing
the patient as a candidate for therapy with a covalent TEC Family
kinase inhibitor if the level of the one or more Th1 cytokines is
decreased and/or the level of the one or more Th2 cytokines is
increased compared to a normal control. In some embodiments, a
patient having an defective Th1 response is selected as a candidate
for therapy with a covalent TEC Family kinase inhibitor. In some
embodiments, a patient having an overactive Th2 response is
selected as a candidate for therapy with a covalent TEC Family
kinase inhibitor. In some embodiments, a patient having a low
Th1:Th2 ratio is selected as a candidate for therapy with a
covalent Tec Family kinase inhibitor.
Adjuvant for Treatment of Cancer Associated Immune Disorders
[0138] Described herein, in certain embodiments, are methods of
adjuvant therapy for the treatment of an immune disorder comprising
administration of a covalent TEC Family kinase inhibitor. In some
embodiments, the immune disorder is a cancer associated immune
disorder. Described herein, in certain embodiments, are methods of
adjuvant therapy for the treatment of a immune disorder
characterized by an impaired Th1 immune response or an overactive
Th2 response. In some embodiments, the methods of adjuvant therapy
comprise administering to a subject having an immune disorder
characterized by an impaired Th1 immune response or an overactive
Th2 response an effective amount of a covalent TEC family kinase
inhibitor to increase the Th1 immune response or decrease the Th2
response in the subject. In some embodiments, the disease or
condition is associated with increased Th2 activity, such as an
allergic or asthmatic disorder. In some embodiments, the autoimmune
disease is autoimmune arthritis. In some embodiments, the immune
disorder is atopic dermatitis, inflammatory bowel disease, an
unspecified T-cell lymphoma (U-PTCLs), rheumatoid arthritis,
bronchial asthma, allergic airway inflammatory disease or aplastic
anemia.
[0139] In some embodiments, the immune disorder is associated with
a hematologic cancer. In some embodiments, the immune disorder is
associated with a leukemia, a lymphoma, or a myeloma. In some
embodiments, immune disorder is associated with non-Hodgkin's
lymphoma. In some embodiments, the immune disorder is associated
with Hodgkin's lymphoma. In some embodiments, the immune disorder
is associated with chronic lymphocytic leukemia (CLL), small
lymphocytic lymphoma (SLL), high risk CLL, follicular lymphoma
(FL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma
(MCL), Waldenstrom's macroglobulinemia, multiple myeloma, marginal
zone lymphoma, Burkitt's lymphoma, non-Burkitt high grade B cell
lymphoma, or extranodal marginal zone B cell lymphoma. In some
embodiments, the subject has an autoimmune disease.
[0140] In some embodiments, the subject is a mammal, such as, but
not limited to a human, a non-human primate, mouse, rat, rabbit,
goat, dog, cat, or cow. In some embodiments, the mammal is a
human.
[0141] In some embodiments, the covalent TEC family kinase
inhibitor inhibits the kinase activity of one or more members of
the TEC family of kinases (e.g. ITK, BTK, TEC, RLK and BMX). In
some embodiments, the covalent TEC family kinase inhibitor inhibits
the kinase activity of ITK. In some embodiments, the covalent TEC
family kinase inhibitor covalently binds to Cysteine 442 of ITK. In
some embodiments, the covalent TEC family kinase inhibitor
covalently binds to Cysteine 481 of BTK. In some embodiments, the
covalent TEC family kinase inhibitor is selected from among
ibrutinib (PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-263,
AVL-291, AVL-292, ONO-WG-37, BMS-488516, BMS-509744, CGI-1746,
CTA-056, GDC-0834, HY-11066 (also, CTK4I7891, HMS3265G21,
HMS3265G22, HMS3265H21, HMS3265H22, 439574-61-5, AG-F-54930),
ONO-4059, ONO-WG37, PLS-123, RN486, HM71224, or a combination
thereof. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. Additional covalent TEC family kinase
inhibitors for use in any of the methods provided herein are found,
for example, in U.S. Pat. Nos. 7,547,689, 7,960,396 and U.S. Patent
Publication Nos. US 2009-0197853 A1 and US 2012-0065201 A1, all of
which are incorporated by reference in their entirety.
Treatment Assessment Utilizing Biomarker Profiles
[0142] Disclosed herein, in certain embodiments, is a method for
assessing a cancer therapy in an individual following treatment of
a tumor with a first anticancer therapy to decrease the size of a
tumor or eliminate the tumor in need thereof. In some embodiments,
the method comprises of creating a biomarker profile. In some
embodiments, the biomarker profile is a Th2 polarized T cell
biomarker profile. In some embodiments, the biomarker profile is a
Th1 polarized T cell biomarker profile. In some embodiments, the
biomarker profile shows a decrease in Th2 polarized T cell
population following treatment with the covalent Tec family kinase
inhibitor. In some embodiments, the biomarker profile shows an
increase in Th1 polarized T cell population following treatment
with the covalent Tec family kinase inhibitor.
[0143] In some embodiments, the biomarker profile indicates the
expression of a biomarker, the expression level of a biomarker,
mutations in a biomarker, or the presence of a biomarker. In some
embodiments, the biomarker is any cytogenetic, cell surface
molecular or protein or RNA expression marker. In some embodiments,
the biomarker is: CCR1, CCR3, CCR4, CCR7, CCR8, CD4, CD26, CD28,
CD30, CD81, CD94, CD119, CD183, CD184, CD195, CD212, CD278, c-maf,
CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD, IL-1R, IL-4, IL-5, IL-6,
IL-9, IL-10, IL-1231, IL-13, IL-15, IL-2, IL-12, IL-15, IL-18R,
IL-23, IL-27, IL-27R, ST2L/T1, Tim-1, Tim-3, GM-CSF, Granzyme B,
IFN-.alpha., IFN-.gamma., Lymphotoxin, perforin, t-bet,
TNF-.alpha., TRANCE, sCD40L, or a combination thereof.
[0144] In some embodiments, administration of a covalent TEC family
kinase inhibitor decreases the biomarker profile of one population
of cells. In some embodiments, the population of cells is Th2
polarized T cells. In some embodiments, administration of a
covalent TEC family kinase inhibitor decreases the biomarker
profile of Th2 polarized T cell population. In some embodiments,
administration of a covalent TEC family kinase inhibitor decreases
the biomarker profile of Th2 polarized T cell population in a
subject.
[0145] In some embodiments, administration of a covalent TEC family
kinase inhibitor increases the biomarker profile of a second
population of cells. In some embodiments, the second population of
cells is Th1 polarized T cells. In some embodiments, administration
of a covalent TEC family kinase inhibitor increases the biomarker
profile of Th1 polarized T cells populations. In some embodiments,
administration of a covalent TEC family kinase inhibitor increases
the biomarker profile of Th1 polarized T cells populations in a
subject.
[0146] In some embodiments, administration of a covalent TEC family
kinase inhibitor increases the ratio of Th1 polarized T cells to
Th2 polarized T cells in the subject. In some embodiments,
administration of a covalent TEC family kinase inhibitor increases
the ratio of Th1 polarized T cells to Th2 polarized T cells in the
subject by about 5 fold, 10 fold, 20 fold, 30 fold, 40 fold, 50
fold, 60 fold, 70 fold, 80 fold, 90 fold, 100 fold, 200 fold, 300
fold, 400 fold, 500 fold, 600 fold, 700 fold, 800 fold, 900 fold,
1000 fold or greater. In some embodiments, administration of a
covalent TEC family kinase inhibitor increase the number of
cytotoxic CD8+ T cells in the subject.
[0147] In some embodiments, administration of a covalent TEC family
kinase inhibitor decreases the expression of one or more biomarkers
in a subject. In some embodiments, the biomarker is a Th2 related
marker in the subject. In some embodiments, administration of a
covalent TEC family kinase inhibitor decreases the expression of
one or more Th2 related markers selected from among CCR3, CCR4,
CCR7, CCR8, CD4, CD30, CD81, CD184, CD278, c-maf, CRTH2, Gata-3,
GM-CSF, IFN .gamma.R, IgD, IL-1R, IL-4, IL-5, IL-6, IL-9, IL-10,
IL-13, IL-15, ST2L/T1 and Tim-1. In some embodiments,
administration of a covalent TEC family kinase inhibitor decreases
IL-4, IL-5, IL-6, IL-10, IL-13, or IL-15 expression in the subject.
In some embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-4 expression in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-5 expression in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-6 expression in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-10 expression in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-13 expression in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases IL-15 expression in the subject.
[0148] In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, administration of
ibrutinib decreases the expression of one or more biomarkers in a
subject. In some embodiments, the biomarker is a Th2 related marker
in the subject. In some embodiments, administration of ibrutinib
decreases the expression of one or more Th2 related markers
selected from among CCR3, CCR4, CCR7, CCR8, CD4, CD30, CD81, CD184,
CD278, c-maf, CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD, IL-1R,
IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-15, ST2L/T1 and Tim-1. In
some embodiments, administration of ibrutinib decreases IL-4, IL-5,
IL-6, IL-10, IL-13, or IL-15 expression in the subject. In some
embodiments, administration of ibrutinib decreases IL-4 expression
in the subject. In some embodiments, administration of ibrutinib
decreases IL-5 expression in the subject. In some embodiments,
administration of ibrutinib decreases IL-6 expression in the
subject. In some embodiments, administration of ibrutinib decreases
IL-10 expression in the subject. In some embodiments,
administration of ibrutinib decreases IL-13 expression in the
subject. In some embodiments, administration of ibrutinib decreases
IL-15 expression in the subject.
[0149] In some embodiments, administration of a covalent TEC family
kinase inhibitor increases the expression of one or more biomarkers
in a subject. In some embodiments, the biomarker is a Th1 related
marker in the subject. In some embodiments, administration of a
covalent TEC family kinase inhibitor increases the expression of
one or more Th1 related markers selected from among CCR1, CD4,
CD26, CD94, CD119, CD183, CD195, CD212, GM-CSF, Granzyme B,
IFN-.alpha., IFN-.gamma., IL-2, IL-12, IL-15, IL-18R, IL-23, IL-27,
IL-27R, Lymphotoxin, perforin, t-bet, Tim-3, TNF-.alpha., TRANCE,
and sCD40L. In some embodiments, administration of a covalent TEC
family kinase inhibitor increases IFN-.gamma., GM-CSF, IL-2,
IL-12(p70) expression in the subject. In some embodiments,
administration of a covalent TEC family kinase inhibitor increases
IFN-.gamma. expression in the subject. In some embodiments,
administration of a covalent TEC family kinase inhibitor increases
GM-CSF expression in the subject. In some embodiments,
administration of a covalent TEC family kinase inhibitor increases
IL-2 expression in the subject. In some embodiments, administration
of a covalent TEC family kinase inhibitor increases IL-12(p70)
expression in the subject.
[0150] In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, administration of
ibrutinib increases the expression of one or more biomarkers in a
subject. In some embodiments, the biomarker is a Th1 related marker
in the subject. In some embodiments, administration of ibrutinib
increases the expression of one or more Th1 related markers
selected from among CCR1, CD4, CD26, CD94, CD119, CD183, CD195,
CD212, GM-CSF, Granzyme B, IFN-.alpha., IFN-.gamma., IL-2, IL-12,
IL-15, IL-18R, IL-23, IL-27, IL-27R, Lymphotoxin, perforin, t-bet,
Tim-3, TNF-.alpha., TRANCE and sCD40L. In some embodiments,
administration of ibrutinib increases IFN-.gamma., GM-CSF, IL-2,
IL-12(p70) expression in the subject. In some embodiments,
administration of ibrutinib increases IFN-.gamma. expression in the
subject. In some embodiments, administration of ibrutinib increases
GM-CSF expression in the subject. In some embodiments,
administration of ibrutinib increases IL-2 expression in the
subject. In some embodiments, administration of ibrutinib increases
IL-12(p70) expression in the subject.
[0151] In some embodiments, the method further comprises providing
a continuation of a first cancer therapy or an initiation of a
second cancer treatment regimen based on the biomarker profile
after the discontinuation of a first anticancer therapy. In some
embodiments, the method further comprises not administering based
on the biomarker profile. In some embodiments, the method further
comprises assessing the efficacy of a treatment regimen based on
the biomarker profile. In some embodiments, the biomarkers include:
IL-4, IL-5, IL-6, IL-10, IL-13, IL-15, IFN-.gamma., GM-CSF,
TNF-.alpha., IL-2, or IL-12. In some embodiments, the biomarker is
IFN-.gamma.. In some embodiments, the biomarker is IL-4. In some
embodiments, the biomarker is IL-10. In some embodiments, the
biomarker is IL-13. In some embodiments, the biomarker is IL-2. In
some embodiments, the biomarker is IL-12.
[0152] Methods for determining the expression or presence of
biomarkers are well known in the art. Circulating levels of
biomarkers in a blood sample obtained from a candidate subject are
measured, for example, by ELISA, radioimmunoassay (RIA),
electrochemiluminescence (ECL), Western blot, multiplexing
technologies, or other similar methods. Cell surface expression of
biomarkers are measured, for example, by flow cytometry,
immunohistochemistry, Western Blot, immunoprecipitation, magnetic
bead selection, and quantification of cells expressing either of
these cell surface markers. Biomarker RNA expression levels could
be measured by RT-PCR, Qt-PCR, microarray, Northern blot, or other
similar technologies.
[0153] As previously noted, determining the expression or presence
of the biomarker of interest at the protein or nucleotide level are
accomplished using any detection method known to those of skill in
the art. By "detecting expression" or "detecting the level of is
intended determining the expression level or presence of a
biomarker protein or gene in the biological sample. Thus,
"detecting expression" encompasses instances where a biomarker is
determined not to be expressed, not to be detectably expressed,
expressed at a low level, expressed at a normal level, or
overexpressed.
[0154] In certain aspects of the method provided herein, the one or
more subpopulation of lymphocytes are isolated, detected or
measured. In certain embodiments, the one or more subpopulation of
lymphocytes are isolated, detected or measured using
immunophenotyping techniques. In other embodiments, the one or more
subpopulation of lymphocytes are isolated, detected or measured
using fluorescence activated cell sorting (FACS) techniques.
[0155] In certain embodiments of the methods provided herein, the
one or more biomarkers comprises IL-4, IL-5, IL-6, IL-10, IL-13,
IL-15, IFN-.gamma., GM-CSF, TNF-.alpha., IL-2 or IL-12.
[0156] In certain aspects, the methods described herein, the
determining step requires determining the expression or presence of
a combination of biomarkers. In certain embodiment, the combination
of biomarkers is CD3 and CD28.
[0157] In certain aspects, the expression or presence of these
various biomarkers and any clinically useful prognostic markers in
a biological sample are detected at the protein or nucleic acid
level, using, for example, immunohistochemistry techniques or
nucleic acid-based techniques such as in situ hybridization and
RT-PCR. In one embodiments, the expression or presence of one or
more biomarkers is carried out by a means for nucleic acid
amplification, a means for nucleic acid sequencing, a means
utilizing a nucleic acid microarray (DNA and RNA), or a means for
in situ hybridization using specifically labeled probes.
[0158] In other embodiments, the determining the expression or
presence of one or more biomarkers is carried out through gel
electrophoresis. In one embodiment, the determination is carried
out through transfer to a membrane and hybridization with a
specific probe.
[0159] In other embodiments, the determining the expression or
presence of one or more biomarkers carried out by a diagnostic
imaging technique.
[0160] In still other embodiments, the determining the expression
or presence of one or more biomarkers carried out by a detectable
solid substrate. In one embodiment, the detectable solid substrate
is paramagnetic nanoparticles functionalized with antibodies.
[0161] In another aspect, provided herein are methods for detecting
or measuring residual lymphoma following a course of treatment in
order to guide continuing or discontinuing treatment or changing
from one therapeutic regimen to another comprising determining the
expression or presence of one or more biomarkers from one or more
subpopulation of lymphocytes in a subject wherein the course of
treatment is treatment with a covalent TEC family kinase
inhibitor.
[0162] Methods for detecting expression of the biomarkers described
herein, within the test and control biological samples comprise any
methods that determine the quantity or the presence of these
markers either at the nucleic acid or protein level. Such methods
are well known in the art and include but are not limited to
western blots, northern blots, ELISA, immunoprecipitation,
immunofluorescence, flow cytometry, immunohistochemistry, nucleic
acid hybridization techniques, nucleic acid reverse transcription
methods, and nucleic acid amplification methods. In particular
embodiments, expression of a biomarker is detected on a protein
level using, for example, antibodies that are directed against
specific biomarker proteins. These antibodies are used in various
methods such as Western blot, ELISA, multiplexing technologies,
immunoprecipitation, or immunohistochemistry techniques. In some
embodiments, detection of biomarkers is accomplished by ELISA. In
some embodiments, detection of biomarkers is accomplished by
electrochemiluminescence (ECL).
[0163] Any means for specifically identifying and quantifying a
biomarker (for example, biomarker, a biomarker of cell survival or
proliferation, a biomarker of apoptosis, a biomarker of a
Btk-mediated signaling pathway) in the biological sample of a
candidate subject is contemplated. Thus, in some embodiments,
expression level of a biomarker protein of interest in a biological
sample is detected by means of a binding protein capable of
interacting specifically with that biomarker protein or a
biologically active variant thereof. In some embodiments, labeled
antibodies, binding portions thereof, or other binding partners are
used. The word "label" when used herein refers to a detectable
compound or composition that is conjugated directly or indirectly
to the antibody so as to generate a "labeled" antibody. In some
embodiments, the label is detectable by itself (e.g., radioisotope
labels or fluorescent labels) or, in the case of an enzymatic
label, catalyzes chemical alteration of a substrate compound or
composition that is detectable.
[0164] The antibodies for detection of a biomarker protein are
either monoclonal or polyclonal in origin, or are synthetically or
recombinantly produced. The amount of complexed protein, for
example, the amount of biomarker protein associated with the
binding protein, for example, an antibody that specifically binds
to the biomarker protein, is determined using standard protein
detection methodologies known to those of skill in the art. A
detailed review of immunological assay design, theory and protocols
are found in numerous texts in the art (see, for example, Ausubel
et al., eds. (1995) Current Protocols in Molecular Biology) (Greene
Publishing and Wiley-Interscience, NY)); Coligan et al., eds.
(1994) Current Protocols in Immunology (John Wiley & Sons,
Inc., New York, N.Y.).
[0165] The choice of marker used to label the antibodies will vary
depending upon the application. However, the choice of the marker
is readily determinable to one skilled in the art. These labeled
antibodies are used in immunoassays as well as in histological
applications to detect the presence of any biomarker or protein of
interest. The labeled antibodies are either polyclonal or
monoclonal. Further, the antibodies for use in detecting a protein
of interest are labeled with a radioactive atom, an enzyme, a
chromophoric or fluorescent moiety, or a colorimetric tag as
described elsewhere herein. The choice of tagging label also will
depend on the detection limitations desired. Enzyme assays (ELISAs)
typically allow detection of a colored product formed by
interaction of the enzyme-tagged complex with an enzyme substrate.
Radionuclides that serve as detectable labels include, for example,
1-131, 1-123, 1-125, Y-90, Re-188, Re-186, At-211, Cu-67, Bi-212,
and Pd-109. Examples of enzymes that serve as detectable labels
include, but are not limited to, horseradish peroxidase, alkaline
phosphatase, beta-galactosidase, and glucose-6-phosphate
dehydrogenase. Chromophoric moieties include, but are not limited
to, fluorescein and rhodamine. The antibodies are conjugated to
these labels by methods known in the art. For example, enzymes and
chromophoric molecules are conjugated to the antibodies by means of
coupling agents, such as dialdehydes, carbodiimides, dimaleimides,
and the like. Alternatively, conjugation occurs through a
ligand-receptor pair. Examples of suitable ligand-receptor pairs
are biotin-avidin or biotin-streptavidin, and antibody-antigen.
[0166] In certain embodiments, expression or presence of one or
more biomarkers or other proteins of interest within a biological
sample, for example, a sample of bodily fluid, is determined by
radioimmunoassays or enzyme-linked immunoassays (ELISAs),
competitive binding enzyme-linked immunoassays, dot blot (see, for
example, Promega Protocols and Applications Guide, Promega
Corporation (1991), Western blot (see, for example, Sambrook et al.
(1989) Molecular Cloning, A Laboratory Manual, Vol. 3, Chapter 18
(Cold Spring Harbor Laboratory Press, Plainview, N.Y.),
chromatography such as high performance liquid chromatography
(HPLC), or other assays known in the art. Thus, the detection
assays involve steps such as, but not limited to, immunoblotting,
immunodiffusion, immunoelectrophoresis, or immunoprecipitation.
[0167] In certain other embodiments, the methods of the invention
are useful for identifying and treating cancer, including those
listed above, that are refractory to (i.e., resistant to, or have
become resistant to) first-line oncotherapeutic treatments.
[0168] In some embodiments, the expression or presence of one or
more of the biomarkers described herein are also determined at the
nucleic acid level. Nucleic acid-based techniques for assessing
expression are well known in the art and include, for example,
determining the level of biomarker mRNA in a biological sample.
Many expression detection methods use isolated RNA. Any RNA
isolation technique that does not select against the isolation of
mRNA is utilized for the purification of RNA (see, e.g., Ausubel et
al., ed. (1987-1999) Current Protocols in Molecular Biology (John
Wiley & Sons, New York). Additionally, large numbers of tissue
samples are readily processed using techniques well known to those
of skill in the art, such as, for example, the single-step RNA
isolation process disclosed in U.S. Pat. No. 4,843,155.
[0169] Thus, in some embodiments, the detection of a biomarker or
other protein of interest is assayed at the nucleic acid level
using nucleic acid probes. The term "nucleic acid probe" refers to
any molecule that is capable of selectively binding to a
specifically intended target nucleic acid molecule, for example, a
nucleotide transcript. Probes are synthesized by one of skill in
the art, or derived from appropriate biological preparations.
Probes are specifically designed to be labeled, for example, with a
radioactive label, a fluorescent label, an enzyme, a
chemiluminescent tag, a colorimetric tag, or other labels or tags
that are discussed above or that are known in the art. Examples of
molecules that are utilized as probes include, but are not limited
to, RNA and DNA.
[0170] For example, isolated mRNA are used in hybridization or
amplification assays that include, but are not limited to, Southern
or Northern analyses, polymerase chain reaction analyses and probe
arrays. One method for the detection of mRNA levels involves
contacting the isolated mRNA with a nucleic acid molecule (probe)
that hybridize to the mRNA encoded by the gene being detected. The
nucleic acid probe comprises of, for example, a full-length cDNA,
or a portion thereof, such as an oligonucleotide of at least 7, 15,
30, 50, 100, 250 or 500 nucleotides in length and sufficient to
specifically hybridize under stringent conditions to an mRNA or
genomic DNA encoding a biomarker, biomarker described herein above.
Hybridization of an mRNA with the probe indicates that the
biomarker or other target protein of interest is being
expressed.
[0171] In one embodiment, the mRNA is immobilized on a solid
surface and contacted with a probe, for example by running the
isolated mRNA on an agarose gel and transferring the mRNA from the
gel to a membrane, such as nitrocellulose. In an alternative
embodiment, the probe(s) are immobilized on a solid surface and the
mRNA is contacted with the probe(s), for example, in a gene chip
array. A skilled artisan readily adapts known mRNA detection
methods for use in detecting the level of mRNA encoding the
biomarkers or other proteins of interest.
[0172] An alternative method for determining the level of an mRNA
of interest in a sample involves the process of nucleic acid
amplification, e.g., by RT-PCR (see, for example, U.S. Pat. No.
4,683,202), ligase chain reaction (Barany (1991) Proc. Natl. Acad.
Sci. USA 88:189 193), self-sustained sequence replication (Guatelli
et al. (1990) Proc. Natl. Acad. Sci. USA 87:1874-1878),
transcriptional amplification system (Kwoh et al. (1989) Proc.
Natl. Acad. Sci. USA 86:1173-1177), Q-Beta Replicase (Lizardi et
al. (1988) Bio/Technology 6:1197), rolling circle replication (U.S.
Pat. No. 5,854,033) or any other nucleic acid amplification method,
followed by the detection of the amplified molecules using
techniques well known to those of skill in the art. These detection
schemes are especially useful for the detection of nucleic acid
molecules if such molecules are present in very low numbers. In
particular aspects of the invention, biomarker expression is
assessed by quantitative fluorogenic RT-PCR (i.e., the TaqManO
System).
[0173] Expression levels of an RNA of interest are monitored using
a membrane blot (such as used in hybridization analysis such as
Northern, dot, and the like), or microwells, sample tubes, gels,
beads or fibers (or any solid support comprising bound nucleic
acids). See U.S. Pat. Nos. 5,770,722, 5,874,219, 5,744,305,
5,677,195 and 5,445,934, which are incorporated herein by
reference. The detection of expression also comprises using nucleic
acid probes in solution.
[0174] In one embodiment of the invention, microarrays are used to
determine expression or presence of one or more biomarkers.
Microarrays are particularly well suited for this purpose because
of the reproducibility between different experiments. DNA
microarrays provide one method for the simultaneous measurement of
the expression levels of large numbers of genes. Each array
consists of a reproducible pattern of capture probes attached to a
solid support. Labeled RNA or DNA is hybridized to complementary
probes on the array and then detected by laser scanning
Hybridization intensities for each probe on the array are
determined and converted to a quantitative value representing
relative gene expression levels. See, U.S. Pat. Nos. 6,040,138,
5,800,992 and 6,020,135, 6,033,860, and 6,344,316, which are
incorporated herein by reference. High-density oligonucleotide
arrays are particularly useful for determining the gene expression
profile for a large number of RNA's in a sample.
[0175] Techniques for the synthesis of these arrays using
mechanical synthesis methods are described in, e.g., U.S. Pat. No.
5,384,261, incorporated herein by reference in its entirety. In
some embodiments, an array is fabricated on a surface of virtually
any shape or even a multiplicity of surfaces. In some embodiments,
an array is a planar array surface. In some embodiments, arrays
include peptides or nucleic acids on beads, gels, polymeric
surfaces, fibers such as fiber optics, glass or any other
appropriate substrate, see U.S. Pat. Nos. 5,770,358, 5,789,162,
5,708,153, 6,040,193 and 5,800,992, each of which is hereby
incorporated in its entirety for all purposes. In some embodiments,
arrays are packaged in such a manner as to allow for diagnostics or
other manipulation of an all-inclusive device. See, for example,
U.S. Pat. Nos. 5,856,174 and 5,922,591, herein incorporated by
reference.
Dosages, Routes of Administration and Therapeutic Regimens
[0176] Described herein methods of administration of a covalent TEC
family kinase inhibitor via any conventional means including oral,
buccal, rectal, parenteral, intraperitoneal, intradermal,
intravenous, subcutaneous, intramuscular, intratumoral,
transdermal, intratracheal, intracerobrospinal, intra-articular,
intrasynovial, systemic, mucosal, topical, inhalation, etc.,
administration. In some embodiments, two different routes of
administration are used. For example, in some embodiments, the
first anticancer therapy is administered by a route such as
intramuscular, subcutaneous, or intravenous, and the covalent TEC
family kinase inhibitor is administered orally.
[0177] Subcutaneous administration of the covalent TEC family
kinase inhibitor is accomplished using standard methods and
devices, e.g., needle and syringe, a subcutaneous injection port
delivery system, and the like. See, e.g., U.S. Pat. Nos. 3,547,119;
4,755,173; 4,531,937; 4,311,137; and 6,017,328. In some
embodiments, subcutaneous administration is achieved by a
combination of devices, e.g., bolus delivery by needle and syringe,
followed by delivery using a continuous delivery system. The term
"continuous delivery system" encompasses continuous (e.g.,
controlled) delivery devices (e.g., pumps) in combination with
catheters, injection devices, and the like, a wide variety of which
are known in the art. In some embodiments, the covalent TEC family
kinase inhibitor is delivered by a continuous delivery system.
[0178] Mechanical or electromechanical infusion pumps are also
suitable for use with the present invention. Examples of such
devices include those described in, for example, U.S. Pat. Nos.
4,692,147; 4,360,019; 4,487,603; 4,360,019; 4,725,852; 5,820,589;
5,643,207; 6,198,966; and the like. In general, the present methods
of drug delivery are accomplished using any of a variety of
refillable, pump systems. Pumps provide consistent, controlled
release over time. Typically, the covalent TEC family kinase
inhibitor is in a liquid formulation in a drug-impermeable
reservoir, and is delivered in a continuous fashion to the
individual.
[0179] A drug delivery system is at least partially an implantable
device. The implantable device is implanted at any suitable
implantation site using methods and devices well known in the art.
An implantation site is a site within the body of a subject at
which a drug delivery device is introduced and positioned.
Implantation sites include, but are not necessarily limited to a
subdermal, subcutaneous, intramuscular, or other suitable site
within a subject's body.
[0180] Drug release devices suitable for use in the invention are
based on any of a variety of modes of operation. For example, the
drug release device is based upon a diffusive system, a convective
system, or an erodible system (e.g., an erosion-based system). For
example, the drug release device is an electrochemical pump,
osmotic pump, an electroosmotic pump, a vapor pressure pump, or
osmotic bursting matrix, e.g., where the drug is incorporated into
a polymer and the polymer provides for release of drug formulation
concomitant with degradation of a drug-impregnated polymeric
material (e.g., a biodegradable, drug-impregnated polymeric
material). In other embodiments, the drug release device is based
upon an electrodiffusion system, an electrolytic pump, an
effervescent pump, a piezoelectric pump, a hydrolytic system,
etc.
[0181] In some embodiments, in pharmaceutical dosage forms, a
covalent TEC family kinase inhibitor is administered in the form of
its pharmaceutically acceptable salts. The following methods and
excipients are merely exemplary and are in no way limiting.
[0182] In some embodiments, as oral preparations, the covalent TEC
family kinase inhibitor is used alone or in combination with
appropriate additives to make tablets, powders, granules or
capsules, for example, with conventional additives, such as
lactose, mannitol, corn starch or potato starch; with binders, such
as crystalline cellulose, cellulose derivatives, acacia, corn
starch or gelatins; with disintegrators, such as corn starch,
potato starch or sodium carboxymethylcellulose; with lubricants,
such as talc or magnesium stearate; and if desired, with diluents,
buffering agents, moistening agents, preservatives and flavoring
agents.
[0183] The covalent TEC family kinase inhibitor is formulated into
preparations for injection by dissolving, suspending or emulsifying
them in an aqueous or nonaqueous solvent, such as vegetable or
other similar oils, synthetic aliphatic acid glycerides, esters of
higher aliphatic acids or propylene glycol; and if desired, with
conventional additives such as solubilizers, isotonic agents,
suspending agents, emulsifying agents, stabilizers and
preservatives.
[0184] Furthermore, the covalent TEC family kinase inhibitor is
made into suppositories by mixing with a variety of bases such as
emulsifying bases or water-soluble bases. The suppository includes
vehicles such as cocoa butter, carbowaxes and polyethylene glycols,
which melt at body temperature, yet are solidified at room
temperature.
[0185] Described herein methods of treatment with a covalent TEC
family kinase inhibitor following administration of a first
anticancer therapy. In some embodiments, treatment with the
covalent TEC family kinase inhibitor is initiated following a
decrease in size of the tumor following administration of a first
anticancer therapy. In some embodiments, treatment with the
covalent TEC family kinase inhibitor is initiated following an
elimination of the tumor following administration of a first
anticancer therapy. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib. In some embodiments, treatment with
ibrutinib is initiated following a decrease in size of the tumor
following administration of a first anticancer therapy. In some
embodiments, treatment with ibrutinib is initiated following an
elimination of the tumor following administration of a first
anticancer therapy.
[0186] In some embodiments, treatment with the covalent TEC family
kinase inhibitor is initiated after the discontinuation of a first
anticancer therapy. In some embodiments, the covalent TEC family
kinase inhibitor is initiated in less than 1 hour, 1 hour, 2 hour,
3 hour, 4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1
day, 2 days, 3 days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or
longer after the discontinuation of a first anticancer therapy. In
some embodiments, treatment with the covalent TEC family kinase
inhibitor is initiated after a continuation of a first anticancer
therapy. In some embodiments, the covalent TEC family kinase
inhibitor is initiated in less than 1 hour, 1 hour, 2 hour, 3 hour,
4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1 day, 2
days, 3 days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or longer
after a continuation of a first anticancer therapy. In some
embodiments, treatment with the covalent TEC family kinase
inhibitor is initiated after the continuation of a first anticancer
therapy and after an initiation of a second anticancer therapy. In
some embodiments, the covalent TEC family kinase inhibitor is
initiated in less than 1 hour, 1 hour, 2 hour, 3 hour, 4 hour, 5
hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1 day, 2 days, 3
days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or longer after the
continuation of a first anticancer therapy and after an initiation
of a second anticancer therapy. In some embodiments, treatment with
the covalent TEC family kinase inhibitor is initiated after the
continuation of a first anticancer therapy but simultaneously or
intermittently with an initiation of a second anticancer therapy.
In some embodiments, the covalent TEC family kinase inhibitor is
initiated in less than 1 hour, 1 hour, 2 hour, 3 hour, 4 hour, 5
hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1 day, 2 days, 3
days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or longer after the
continuation of a first anticancer therapy but simultaneously or
intermittently with an initiation of a second anticancer therapy.
In some embodiments, treatment with the covalent TEC family kinase
inhibitor is initiated after the discontinuation of a first
anticancer therapy and after an initiation of a second anticancer
therapy. In some embodiments, the covalent TEC family kinase
inhibitor is initiated in less than 1 hour, 1 hour, 2 hour, 3 hour,
4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1 day, 2
days, 3 days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or longer
after the discontinuation of a first anticancer therapy and after
an initiation of a second anticancer therapy. In some embodiments,
treatment with the covalent TEC family kinase inhibitor is
initiated after the discontinuation of a first anticancer therapy
but simultaneously or intermittently with an initiation of a second
anticancer therapy. In some embodiments, the covalent TEC family
kinase inhibitor is initiated in less than 1 hour, 1 hour, 2 hour,
3 hour, 4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1
day, 2 days, 3 days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or
longer after the discontinuation of a first anticancer therapy but
simultaneously or intermittently with an initiation of a second
anticancer therapy.
[0187] In some embodiment, the covalent TEC family kinase inhibitor
is ibrutinib. In some embodiments, treatment with ibrutinib is
initiated after the discontinuation of a first anticancer therapy.
In some embodiments, ibrutinib is initiated in less than 1 hour, 1
hour, 2 hour, 3 hour, 4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9
hour, 10 hour, 1 day, 2 days, 3 days, 4 days, 5 days, 1 week, 2
weeks, 3 weeks or longer after the discontinuation of a first
anticancer therapy. In some embodiments, treatment with ibrutinib
is initiated after a continuation of a first anticancer therapy. In
some embodiments, ibrutinib is initiated in less than 1 hour, 1
hour, 2 hour, 3 hour, 4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9
hour, 10 hour, 1 day, 2 days, 3 days, 4 days, 5 days, 1 week, 2
weeks, 3 weeks or longer after a continuation of a first anticancer
therapy. In some embodiments, treatment with ibrutinib is initiated
after the continuation of a first anticancer therapy and after an
initiation of a second anticancer therapy. In some embodiments,
ibrutinib is initiated in less than 1 hour, 1 hour, 2 hour, 3 hour,
4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1 day, 2
days, 3 days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or longer
after the continuation of a first anticancer therapy and after an
initiation of a second anticancer therapy. In some embodiments,
treatment with ibrutinib is initiated after the continuation of a
first anticancer therapy but simultaneously or intermittently with
an initiation of a second anticancer therapy. In some embodiments,
ibrutinib is initiated in less than 1 hour, 1 hour, 2 hour, 3 hour,
4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9 hour, 10 hour, 1 day, 2
days, 3 days, 4 days, 5 days, 1 week, 2 weeks, 3 weeks or longer
after the continuation of a first anticancer therapy but
simultaneously or intermittently with an initiation of a second
anticancer therapy. In some embodiments, treatment with ibrutinib
is initiated after the discontinuation of a first anticancer
therapy and after an initiation of a second anticancer therapy. In
some embodiments, ibrutinib is initiated in less than 1 hour, 1
hour, 2 hour, 3 hour, 4 hour, 5 hour, 6 hour, 7 hour, 8 hour, 9
hour, 10 hour, 1 day, 2 days, 3 days, 4 days, 5 days, 1 week, 2
weeks, 3 weeks or longer after the discontinuation of a first
anticancer therapy and after an initiation of a second anticancer
therapy. In some embodiments, treatment with ibrutinib is initiated
after the discontinuation of a first anticancer therapy but
simultaneously or intermittently with an initiation of a second
anticancer therapy. In some embodiments, ibrutinib is initiated in
less than 1 hour, 1 hour, 2 hour, 3 hour, 4 hour, 5 hour, 6 hour, 7
hour, 8 hour, 9 hour, 10 hour, 1 day, 2 days, 3 days, 4 days, 5
days, 1 week, 2 weeks, 3 weeks or longer after the discontinuation
of a first anticancer therapy but simultaneously or intermittently
with an initiation of a second anticancer therapy.
[0188] In some embodiments, the covalent TEC family kinase
inhibitor is administered during the entire course of the continued
first anticancer therapy treatment. In some embodiments, the
covalent TEC family kinase inhibitor is administered during the
entire course of the continued first anticancer therapy and the
second anticancer therapy treatments. In some embodiments, the
covalent TEC family kinase inhibitor is administered for a period
of time that is overlapping with the treatments of the continued
first anticancer therapy and the second anticancer therapy, e.g.
the covalent TEC family kinase inhibitor treatment ends before the
treatments of the continued first anticancer therapy and the second
anticancer therapy end; the covalent TEC family kinase inhibitor
treatment ends after the treatments of the continued first
anticancer therapy and the second anticancer therapy end.
[0189] In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered during the entire course of the continued first
anticancer therapy treatment. In some embodiments, ibrutinib is
administered during the entire course of the continued first
anticancer therapy and the second anticancer therapy treatments. In
some embodiments, ibrutinib is administered for a period of time
that is overlapping with the treatments of the continued first
anticancer therapy and the second anticancer therapy, e.g.
ibrutinib treatment ends before the treatments of the continued
first anticancer therapy and the second anticancer therapy end;
ibrutinib treatment ends after the treatments of the continued
first anticancer therapy and the second anticancer therapy end.
[0190] In some embodiments, a biomarker profile is measured to
assess or evaluate a therapeutic regimen after the administration
of the covalent TEC family kinase inhibitor. In some embodiments,
the biomarker profile is measured daily, once per week, two times
per week, three times per week, once every two weeks, once a month,
twice a month, three times a month, once, twice, three times, four
times, five times, six times, seven times, eight times, nine times,
ten times or more during the entire course of the treatment. In
some embodiments, the biomarker is: CCR1, CCR3, CCR4, CCR7, CCR8,
CD4, CD26, CD28, CD30, CD81, CD94, CD119, CD183, CD184, CD195,
CD212, CD278, c-maf, CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD,
IL-1R, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-15, IL-2, IL-12,
IL-15, IL-18R, IL-23, IL-27, IL-27R, ST2L/T1, Tim-1, Tim-3, GM-CSF,
Granzyme B, IFN-.alpha., IFN-.gamma., Lymphotoxin, perforin, t-bet,
TNF-.alpha., TRANCE, sCD40L, or a combination thereof. In some
embodiments, the biomarker is a Th1 related marker. In some
embodiments, Th1 related markers include CCR1, CD4, CD26, CD94,
CD119, CD183, CD195, CD212, GM-CSF, Granzyme B, IFN-.alpha.,
IFN-.gamma., IL-2, IL-12, IL-15, IL-18R, IL-23, IL-27, IL-27R,
Lymphotoxin, perforin, t-bet, Tim-3, TNF-.alpha., TRANCE and
sCD40L. In some embodiments, the Th1 biomarker is IFN-.gamma.. In
some embodiments, the Th1 biomarker is IL-2. In some embodiments,
the Th1 biomarker is L-12. In some embodiments, the biomarker is a
Th2 related marker. In some embodiments, Th2 related markers
include CCR3, CCR4, CCR7, CCR8, CD4, CD30, CD81, CD184, CD278,
c-maf, CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD, IL-1R, L-4, IL-5,
IL-6, IL-9, IL-10, L-13, L-15, ST2L/T1 and Tim-1. In some
embodiments, the Th2 biomarker is 11-4. In some embodiments, the
Th2 biomarker is IL-10. In some embodiments, the Th2 biomarker is
IL-13. In some embodiments, the treatment with the covalent TEC
family kinase inhibitor is modified based on the biomarker profile.
In some embodiments, the amount of the covalent TEC family kinase
inhibitor administered to the patient is increased, decreased or
not altered based on the biomarker profile. In some embodiments,
the frequency of administration of the covalent TEC family kinase
inhibitor to the patient is increased, decreased or not altered
based on the biomarker profile. In some embodiments, the cytokine
biomarker profile is used to calculate a Th1:Th2 ratio in the
patient. In some embodiments, the treatment with the covalent TEC
family kinase inhibitor is modified based on the Th1:Th2 ratio. In
some embodiments, the amount of the covalent TEC family kinase
inhibitor administered to the patient is increased, decreased or
not altered based on the Th1:Th2 ratio. In some embodiments, the
frequency of administration of the covalent TEC family kinase
inhibitor to the patient is increased, decreased or not altered
based on the Th1:Th2 ratio. In some embodiments, the number of
cells expressing a Th1 biomarker is measured in a patient sample.
In some embodiments, the number of cells expressing a Th2 biomarker
is measured in a patient sample. In some embodiments, the ratio of
Th1:Th2 ratio is calculated based on the the number of cells
expressing a Th1 biomarker versus the number of cells expressing a
Th2 biomarker measured in a patient sample. In some embodiments,
the ratio of Th1:Th2 ratio is calculated based on the total
expression of a Th1 biomarker versus a Th2 biomarker in a patient
sample.
[0191] In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, a biomarker profile is
measured to assess or evaluate a therapic course after the
administration of ibrutinib. In some embodiments, the biomarker
profile is measured daily, once per week, two times per week, three
times per week, once every two weeks, once a month, twice a month,
three times a month, once, twice, three times, four times, five
times, six times, seven times, eight times, nine times, ten times
or more during the entire course of the treatment. In some
embodiments, the biomarker is: CCR1, CCR3, CCR4, CCR7, CCR8, CD4,
CD26, CD28, CD30, CD81, CD94, CD119, CD183, CD184, CD195, CD212,
CD278, c-maf, CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD, IL-1R,
IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-15, IL-2, IL-12, IL-15,
IL-18R, IL-23, IL-27, IL-27R, ST2L/T1, Tim-1, Tim-3, GM-CSF,
Granzyme B, IFN-.alpha., IFN-.gamma., Lymphotoxin, perforin, t-bet,
TNF-.alpha., TRANCE, sCD40L, or a combination thereof. In some
embodiments, the biomarker is a Th1 related marker. In some
embodiments, Th1 related markers include CCR1, CD4, CD26, CD94,
CD119, CD183, CD195, CD212, GM-CSF, Granzyme B, IFN-.alpha.,
IFN-.gamma., IL-2, IL-12, IL-15, IL-18R, IL-23, IL-27, IL-27R,
Lymphotoxin, perforin, t-bet, Tim-3, TNF-.alpha., TRANCE and
sCD40L. In some embodiments, the Th1 biomarker is IFN-.gamma.. In
some embodiments, the Th1 biomarker is IL-2. In some embodiments,
the Th1 biomarker is IL-12. In some embodiments, the biomarker is a
Th2 related marker. In some embodiments, Th2 related markers
include CCR3, CCR4, CCR7, CCR8, CD4, CD30, CD81, CD184, CD278,
c-maf, CRTH2, Gata-3, GM-CSF, IFN .gamma.R, IgD, IL-1R, IL-4, IL-5,
IL-6, IL-9, IL-10, IL-13, IL-15, ST2L/T1 and Tim-1. In some
embodiments, the Th2 biomarker is 11-4. In some embodiments, the
Th2 biomarker is IL-10. In some embodiments, the Th2 biomarker is
IL-13. In some embodiments, the treatment with ibrutinib is
modified based on the biomarker profile. In some embodiments, the
amount of ibrutinib administered to the patient is increased,
decreased or not altered based on the biomarker profile. In some
embodiments, the frequency of administration of ibrutinib to the
patient is increased, decreased or not altered based on the
biomarker profile. In some embodiments, the cytokine biomarker
profile is used to calculate a Th1:Th2 ratio in the patient. In
some embodiments, the treatment with ibrutinib is modified based on
the Th1:Th2 ratio. In some embodiments, the amount of ibrutinib
administered to the patient is increased, decreased or not altered
based on the Th1:Th2 ratio. In some embodiments, the frequency of
administration of ibrutinib to the patient is increased, decreased
or not altered based on the Th1:Th2 ratio. In some embodiments, the
number of cells expressing a Th1 biomarker is measured in a patient
sample. In some embodiments, the number of cells expressing a Th2
biomarker is measured in a patient sample. In some embodiments, the
ratio of Th1:Th2 ratio is calculated based on the the number of
cells expressing a Th1 biomarker versus the number of cells
expressing a Th2 biomarker measured in a patient sample. In some
embodiments, the ratio of Th1:Th2 ratio is calculated based on the
total expression of a Th1 biomarker versus a Th2 biomarker in a
patient sample.
[0192] In some embodiments, adjuvant therapy comprises a single
administration. In some embodiments, adjuvant therapy comprises
multiple cycles of administration. In some embodiments, a cycle of
administration is one month, 2 months, 3 months, 4 months, 5
months, 6 months, 7 months, 8 months, 9 months, 10 months, 11
months, 12 months or longer. In some embodiments, a cycle of
administration comprises administration of a single therapeutic
dosage of the covalent TEC family kinase inhibitor over the cycle.
In some embodiments, a cycle of administration comprises two or
more different dosages of the covalent TEC family kinase inhibitor
over the cycle. In some embodiments, the dosage of the covalent TEC
family kinase inhibitor differs over consecutive cycles. In some
embodiments, the dosage of the covalent TEC family kinase inhibitor
increases over consecutive cycles. In some embodiments, the dosage
of the covalent TEC family kinase inhibitor is the same over
consecutive cycles. In some embodiments, the covalent TEC family
kinase inhibitor is administered for about 1 week to 5 years.
[0193] In some embodiments, adjuvant therapy comprises
administration of a daily dosage of the covalent TEC family kinase
inhibitor. In some embodiments, the daily dosage of the covalent
TEC family kinase inhibitor administered is at or about 10 mg per
day to about 2000 mg per day, such as for example, about 40 mg per
day to about 1500 mg per day, such as for example, about 40 mg per
day to about 1000 mg per day, such as for example about 100 mg per
day to about 1000 mg per day, such as for example about 250 mg per
day to about 850 mg per day, such as for example about 300 mg per
day to about 600 mg per day. In a particular embodiment, daily
dosage of the covalent TEC family kinase inhibitor is about 420 mg
per day. In a particular embodiment, the covalent TEC family kinase
inhibitor is ibrutinib and the daily dosage is about 420 mg per
day. In a particular embodiment, daily dosage of the covalent TEC
family kinase inhibitor is about 140 mg per day. In a particular
embodiment, the covalent TEC family kinase inhibitor is ibrutinib
and the daily dosage is about 140 mg ibrutinib per day.
[0194] In some embodiments, the covalent TEC family kinase
inhibitor is administered once per month, twice per month, three
times per month, every other week, once per week, twice per week,
three times per week, four times per week, five times per week, six
times per week, every other day, daily, twice a day, three times a
day or more frequent, continuously over a period of time ranging
from about one day to about one week, from about two weeks to about
four weeks, from about one month to about two months, from about
two months to about four months, from about four months to about
six months, from about six months to about eight months, from about
eight months to about 1 year, from about 1 year to about 2 years,
or from about 2 years to about 4 years, or more. In a particular
embodiment, the covalent TEC family kinase inhibitor is
administered once per day. In some embodiments, the covalent TEC
family kinase inhibitor that is ibrutinib is administered once per
month, twice per month, three times per month, every other week,
once per week, twice per week, three times per week, four times per
week, five times per week, six times per week, every other day,
daily, twice a day, three times a day or more frequent,
continuously over a period of time ranging from about one day to
about one week, from about two weeks to about four weeks, from
about one month to about two months, from about two months to about
four months, from about four months to about six months, from about
six months to about eight months, from about eight months to about
1 year, from about 1 year to about 2 years, or from about 2 years
to about 4 years, or more. In a particular embodiment, the covalent
TEC family kinase inhibitor that is ibrutinib is administered once
per day.
[0195] In some embodiments, the covalent TEC family kinase
inhibitor is administered by any suitable route of administration.
In some embodiments, the covalent TEC family kinase inhibitor is
administered orally.
[0196] In some embodiments, DFS or OS is evaluated following
administration of the covalent TEC family kinase inhibitor. In some
embodiments, DFS or OS is evaluated about 1, 2, 3, 4, 5, 6, 7, 8,
9, 10 years or longer after initiation of the covalent TEC family
kinase inhibitor.
[0197] In some embodiments, a cycle of administration comprises
administration of the covalent TEC family kinase inhibitor in
combination with an additional therapeutic agent. In some
embodiments the additional therapeutic agent is administered
simultaneously, sequentially, or intermittently with the covalent
TEC family kinase inhibitor. In some embodiments, the covalent TEC
family kinase inhibitor and the additional therapeutic agent are
administered as a single composition. In some embodiments, the
covalent TEC family kinase inhibitor and the additional therapeutic
agent are administered as separate compositions.
[0198] In some embodiments the additional therapeutic agent or
biologic agent is an anticancer agent. In some embodiments the
additional therapeutic agent is an anticancer agent for the
treatment of a solid tumor. In some embodiments the additional
therapeutic agent is an anticancer agent for the treatment of a
hematologic cancer. In some embodiments, the additional therapeutic
agent is an anticancer agent for the treatment of a leukemia,
lymphoma or a myeloma. In some embodiments, the additional
therapeutic agent is an anticancer agent for the treatment of
bladder, breast, colon, pancreatic, lung, prostate, ovarian and
proximal or distal bile duct cancer. Exemplary anticancer agents
for administration in a combination with a covalent TEC family
kinase inhibitor are provided elsewhere herein and include, but are
not limited to chemotherapeutic agents, biologic agents, radiation
therapy, thermal therapy, or surgery. In a particular embodiment,
the anticancer agent is an anti-CD 20 antibody (e.g. Rituxan). In a
particular embodiment, the anticancer agent bendamustine. In some
embodiments, the additional anticancer agent is a reversible TEC
family kinase inhibitor. In some embodiments, the additional
anticancer agent is a reversible ITK inhibitor. In some
embodiments, the additional anticancer agent is a reversible BTK
inhibitor that does not depend on cysteine 442 for binding to ITK.
In some embodiments, the additional anticancer agent is a
reversible BTK inhibitor. In some embodiments, the additional
anticancer agent is a reversible BTK inhibitor that does not depend
on cysteine 481 for binding to BTK.
[0199] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy). In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with an additional chemotherapeutic
agent or biologic agent. In some embodiments, the additional
chemotherapeutic agent or biologic agent is selected from among an
antibody, a B cell receptor pathway inhibitor, a T cell receptor
inhibitor, a PI3K inhibitor, an IAP inhibitor, an mTOR inhibitor, a
radioimmunotherapeutic, a DNA damaging agent, a proteasome
inhibitor, a histone deacetylase (HDCA) inhibitor, a protein kinase
inhibitor, an IRAK inhibitor, a hedgehog inhibitor, an Hsp90
inhibitor, a telomerase inhibitor, a Jak1/2 inhibitor (e.g.,
ruxolitinib, baricitinib, CYT387, lestauritinib, pacritinib,
TG101348, SAR302503, tofacitinib (Xeljanz), etanercept (Enbrel),
GLPG0634, R256), a protease inhibitor, a PKC inhibitor, a PARP
inhibitor, a proteosome inhibitor, a CYP3A4 inhibitor, an AKT
inhibitor, an Erk inhibitor, an alkylating agent, an anti
metabolite, a plant alkaloid, a terpenoid, a cytotoxin, a
topoisomerase inhibitor, or a combination thereof. In some
embodiments, the B cell receptor pathway inhibitor is a CD79A
inhibitor, a CD79B inhibitor, a CD19 inhibitor, a Lyn inhibitor, a
Syk inhibitor, a PI3K inhibitor, a Blnk inhibitor, a PLC.gamma.
inhibitor, a PKC.beta. inhibitor, a CD22 inhibitor, a Bcl-2
inhibitor, an IRAK 1/4 inhibitor, a microtubule inhibitor, a Topo
II inhibitor, anti TWEAK, anti-IL17 bispecific antibody, a CK2
inhibitor, anaplastic lymphoma kinase (ALK) and c-Met inhibitors, a
T cell receptor inhibitor is Muromonab-CD3, demethylase enzyme
inhibitors such as demethylase, HDM, LSDI and KDM, fatty acid
synthase inhibitors such as spirocyclic piperidine derivatives,
glucocorticosteriod receptor agonist, fusion anti-CD 19-cytotoxic
agent conjugate, antimetabolite, p70S6K inhibitor, immune
modulators, AKT/PKB inhibitor, procaspase-3 activator PAC-1, BRAF
inhibitor, lactate dehydrogenase A (LDH-A) inhibitor, CCR2
inhibitor, CXCR4 inhibitor, chemokine receptor antagonists, DNA
double stranded break repair inhibitors, NOR202, GA-101, TLR2
inhibitor, or a combination thereof. In some embodiments, the
chemotherapeutic agent or biologic agent is selected from among
rituximab, carfilzomib, fludarabine, cyclophosphamide, vincristine,
prednisalone. chlorambucil, ifosphamide, doxorubicin, mesalazine,
thalidomide, lenalidomide, temsirolimus, everolimus, fostamatinib,
paclitaxel, docetaxel, ofatumumab, dexamethasone, prednisone,
CAL-101, ibritumomab, tositumomab, bortezomib, pentostatin,
endostatin, ritonavir, ketoconazole, an anti-VEGF antibody,
herceptin, cetuximab, cisplatin, carboplatin, docetaxel, erlotinib,
etopiside, 5-fluorouracil, gemcitabine, ifosphamide, imatinib
mesylate (Gleevec), gefitinib, procarbazine, prednisone,
irinotecan, leucovorin, mechlorethamine, methotrexate, oxaliplatin,
paclitaxel, sorafenib, sunitinib, topotecan, vinblastine,
disulfiram, epigallocatechin-3-gallate, salinosporamide A, ONX0912,
CEP-18770, MLN9708, R-406, lenalinomide, spirocyclic piperidine
derivatives, quinazoline carboxamide azetidine compounds, thiotepa,
DWA2114R, NK121, IS 3 295, 254-S, alkyl sulfonates such as
busulfan, improsulfan and piposulfan; aziridines such as benzodepa,
carboquone, meturedepa and uredepa; ethylenimine, methylmelamines
such as altretamine, triethylenemelamine, triethylenephosphoramide,
triethylenethiophosphoramide and trimethylmelamine; chlornaphazine;
estramustine; ifosfamide; mechlorethamine; oxide hydrochloride;
novobiocin; phenesterine; prednimustine; trofosfamide; uracil
mustard; nitrosoureas such as carmustine, chlorozotocin,
fotemustine, lomustine, nimustine, ranimustine; antibiotics such as
aclacinomycins, actinomycin, anthramycin, azaserine, bleomycins,
cactinomycin, calicheamicin, carubicin, carminomycin,
carzinophilin, chromomycins, dactinomycin, daunorubicin,
detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin,
esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic
acid, nogalamycin, olivomycins, peplomycin, porfiromycin,
puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin,
tubercidin, ubenimex, zinostatin, zorubicin; antimetabolites such
as methotrexate and 5-fluorouracil (5-FU); folic acid analogues
such as denopterin, methotrexate, pteropterin, trimetrexate; purine
analogs such as fludarabine, 6-mercaptopurine, thiamiprine,
thioguanine; pyrimidine analogs such as ancitabine, azacitidine,
6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine,
enocitabine, floxuridine; androgens such as calusterone,
dromostanolone propionate, epitiostanol, mepitiostane,
testolactone; anti-adrenals such as aminoglutethimide, mitotane,
trilostane; folic acid replenisher such as folinic acid;
aceglatone; aldophosphamide glycoside; aminolevulinic acid;
amsacrine; bestrabucil; bisantrene; edatrexate; defosfamide;
demecolcine; diaziquone; eflornithine; elliptinium acetate;
etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine;
mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin;
phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide;
procarbazine; polysaccharide-K; razoxane; sizofiran;
spirogermanium; tenuazonic acid; triaziquone; 2,
2',2''-trichlorotriethylamine; urethan; vindesine; dacarbazine;
mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine;
cytosine arabinoside; taxoids, e.g., paclitaxel and docetaxel;
6-thioguanine; mercaptopurine; methotrexate; platinum analogs;
platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone;
vincristine; vinorelbine; Navelbine; Novantrone; teniposide;
daunomycin; aminopterin; Xeloda; ibandronate; CPT1 1; topoisomerase
inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoic acid;
esperamycins; capecitabine; and pharmaceutically acceptable salts,
acids or derivatives of; anti-hormonal agents such as
anti-estrogens including for example tamoxifen, raloxifene,
aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen,
trioxifene, keoxifene, LY117018, onapristone and toremifene
(Fareston); antiandrogens such as flutamide, nilutamide,
bicalutamide, leuprolide and goserelin; or a combination thereof.
In some embodiments, the chemotherapeutic agent or biologic agent
is selected from among AVL-263 (Avila Therapeutics/Celgene
Corporation), AVL-292 (Avila Therapeutics/Celgene Corporation),
AVL-291 (Avila Therapeutics/Celgene Corporation), BMS-488516
(Bristol-Myers Squibb), BMS-509744 (Bristol-Myers Squibb), CGI-1746
(CGI Pharma/Gilead Sciences), CTA-056, GDC-0834 (Genentech),
HY-11066 (also, CTK4I7891, HMS3265G21, HMS3265G22, HMS3265H21,
HMS3265H22, 439574-61-5, AG-F-54930), ONO-4059 (Ono Pharmaceutical
Co., Ltd.), ONO-WG37 (Ono Pharmaceutical Co., Ltd.), PLS-123
(Peking University), RN486 (Hoffmann-La Roche), HM71224 (Hanmi
Pharmaceutical Company Limited) or a combination thereof.
[0200] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with an additional
chemotherapeutic agent or biologic agent for the treatment of a
leukemia, lymphoma or a myeloma. Exemplary chemotherapeutic agents
for the treatment of a leukemia, lymphoma or a myeloma include but
are not limited to adriamycin (doxorubicin), bexxar, bendamustine,
bleomycin, blenoxane, bortezomib, dacarbazine, deltasone,
cisplatin, cyclophosphamide, cytoxan, DTIC daca rbazine, dasatinib,
doxorubicin, etoposide, fludarabine, granisetron, kytril,
lenalidomide, matulane, mechlorethamine, mustargen, mustine,
natulan, Rituxan (rituximab, anti-CD20 antibody), VCR, neosar,
nitrogen mustard, oncovin, ondansetron, orasone, prednisone,
procarbazine, thalidomide, VP-16, velban, velbe, velsar, VePesid,
vinblastine, vincristine, Zevalin.RTM., zofran, stem cell
transplantation, radiation therapy or combination therapies, such
as, for example, ABVD (adriamycin, bleomycin, vinblastine and
dacarbazine), ChlvPP (chlorambucil, vinblastine, procarbazine and
prednisolone), Stanford V (mustine, doxorubicin, vinblastine,
vincristine, bleomycin, etoposide and steroids), BEACOPP
(bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine,
procarbazine and prednisolone), BEAM (carmustine (BiCNU) etoposide,
cytarabine (Ara-C, cytosine arabinoside), and melphalan), CHOP
(cyclophosphamide, doxorubicin, vincristine, and prednisone),
R-CHOP (rituximab, doxorubicin, cyclophosphamide, vincristine, and
prednisone), EPOCH (etoposide, vincristine, doxorubicin,
cyclophosphamide, and prednisone), CVP (cyclophosphamide,
vincristine, and prednisone), ICE
(ifosfamide-carboplatin-etoposide), R-ACVBP (rituximab,
doxorubicin, cyclophosphamide, vindesine, bleomycin, and
prednisone), DHAP (dexamethasone, high-dose cytarabine, (Ara C),
cisplatin), R-DHAP(rituximab, dexamethasone, high-dose cytarabine,
(Ara C), cisplatin), ESHAP (etoposide (VP-16), methyl-prednisolone,
and high-dose cytarabine (Ara-C), cisplatin), CDE
(cyclophosphamide, doxorubicin and etoposide), Velcade.RTM.
(bortezomib) plus Doxil.RTM. (liposomal doxorubicin), Revlimid.RTM.
(lenalidomide) plus dexamethasone, and bortezomib plus
dexamethasone.
[0201] In some embodiments, anticancer agent is fludarabine. In
some embodiments, anticancer agent is bendamustine. In some
embodiments, the anticancer agent is Rituxan. In some embodiments,
the anticancer agent is dasatinib. In some embodiments, anticancer
agent is a HDAC inhibitor. In some embodiments, anticancer agent is
a Cyp3A4 inhibitor. In some embodiments, anticancer agent is
carfilzomib. In some embodiments, anticancer agent is bortezomib
(Veload). In some embodiments, anticancer agent is an IRAK
inhibitor. In some embodiments, anticancer agent is revlimid. In
some embodiments, anticancer agent is lenalidomide. In some
embodiments, anticancer agent is dexamethasone. In some
embodiments, anticancer agent is a protease inhibitor. In some
embodiments, anticancer agent is a JAK inhibitor. In some
embodiments, anticancer agent is an AKT inhibitor. In some
embodiments, anticancer agent is an Erk inhibitor.
[0202] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy). In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with an additional therapeutic agent.
In some embodiments, the covalent TEC family kinase inhibitor is
administered in combination with an immunotherapy. In some
embodiments, the T-cell immunotherapy is selected from among
adoptive T cell transfer, a vaccine, a cytokine, an interleukin, a
chemokine, a cytokine inducer, an interleukin inducer, a chemokine
inducer, or an immunomodulatory antibody. In some embodiments, the
vaccine is an anti cancer vaccine, such as for example,
Sipuleucel-T. In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with an anticancer,
antiviral or antibacterial agent.
Adjuvant for Treatment of a Pathogenic Infection
[0203] Described herein, in certain embodiments, are methods of
adjuvant therapy for the treatment of an immune disorder. In some
embodiments, the methods of adjuvant therapy comprise administering
to a subject having an immune disorder an effective amount of a
covalent TEC family kinase to treat the immune disorder. In some
embodiments, the methods of adjuvant therapy comprise administering
to a subject having an immune disorder an effective amount of a
covalent TEC family kinase to treat a pathogenic infection
associated with the immune disorder. In some embodiments, the
methods of adjuvant therapy comprise administering to a subject
having an a pathogenic infection an effective amount of a covalent
TEC family kinase to treat the pathogenic infection.
[0204] Described herein, in certain embodiments, are methods of
adjuvant therapy for the treatment of an immune disorder
characterized by an impaired Th1 immune response or an overactive
Th2 response. In some embodiments, the methods of adjuvant therapy
comprise administering to a subject having an immune disorder
characterized by an impaired Th1 immune response or an overactive
Th2 response an effective amount of a covalent TEC family kinase
inhibitor to increase the Th1 immune response or decrease the Th2
response in the subject. In some embodiments, the subject has a
pathogenic infection. In some embodiments, the disease or condition
is associated with increased Th2 activity, such an allergic or
asthmatic disorder. In some embodiments, the pathogenic infection
is a viral, bacterial, fungal or parasitic infection. In some
embodiments, the autoimmune disease is autoimmune arthritis. In
some embodiments, the immune disorder is atopic dermatitis,
inflammatory bowel disease, an unspecified T-cell lymphoma
(U-PTCLs), rheumatoid arthritis, bronchial asthma, allergic airway
inflammatory disease or aplastic anemia.
[0205] In some embodiments, methods of adjuvant therapy are for the
treatment of a pathogenic infection in an individual. In some
embodiments, methods of adjuvant therapy are for the treatment of a
pathogenic infection in an individual, wherein the pathogenic
infection is characterized by an impaired Th1 immune response or an
overactive Th2 response. In some embodiments, methods of adjuvant
therapy comprise administering to a subject an effective amount of
a covalent TEC family kinase inhibitor to treat the pathogenic
infection. In some embodiments, methods of adjuvant therapy
comprise administering to a subject an effective amount of a
covalent TEC family kinase inhibitor in combination with one or
more therapeutic agents to treat the pathogenic infection.
[0206] In some embodiments, methods of adjuvant therapy are for the
treatment of a viral infection. In some embodiments, the subject
has a chronic viral infection. In some embodiments, the subject has
an acute viral infection.
[0207] In some embodiments, the virus infection is a DNA virus
infection. In some embodiments, the virus is an adenovirus, a
papilloma virus, a parvovirus, a herpes viruses, a pox virus, a
hepatitis virus. In some embodiments, the virus infection is a RNA
virus infection. In some embodiments, the virus is a reovirus, a
picorna viruse, a calicivirus, a togavirus, an arenavirus, a
flavivirus, a orthmyxoviurs, a paramyxovirus, a bunyavirus, a
rhabdovirus, a filovirus, a coronavirus, an astrovirus, a
bornavirus, an arterivirus, or a hepevirus. In some embodiments,
the virus infection is a retrovirus infection. In some embodiments,
the virus infection is a hepatitis B infection. In some
embodiments, the virus infection is a cytoplasmic virus infection.
In some embodiments, the virus infection is a nuclear virus
infection. In some embodiments, the virus is a hepatitis virus
(e.g., HCV), an influenza virus, a human immunodeficiency virus
infection, a measles virus, a human papilloma virus (HPV), a human
herpes virus (HHV-6A, -6B, 7), an herpes simplex virus (HSV), an
epstein bar virus (EBV), a cytomegalovirus, a respiratory syncytial
virus or chronic granulomatous disease.
[0208] In certain embodiments, the progression of a viral infection
from an acute viral infection into a chronic viral infection is
characterized by and increased Th2 immune profile and a decreased
Th1 immune profile. In some embodiments, administration of a
covalent TEC family kinase inhibitor inhibits or delays the
progression of a viral infection from an acute viral infection into
a chronic viral infection. In some embodiments, administration of a
covalent TEC family kinase inhibitor increases the Th1 immune
response in a subject having a chronic viral infection.
[0209] In some embodiments, the subject has a hepatitis infection.
In some embodiments, the hepatitis infection is an A type hepatitis
infection. In some embodiments, the hepatitis infection is a B type
hepatitis infection. In some embodiments, the hepatitis infection
is a C type hepatitis infection. In some embodiments, the hepatitis
infection is a D type hepatitis infection. In some embodiments, the
hepatitis infection is an E type hepatitis infection. In some
embodiments, the hepatitis infection is an HCV infection. In some
embodiments, the subject having an HCV infection is infected with
multiple HCV genotypes. In some embodiments, multiple HCV genotypes
include type 1, 2, 3, 4, 5 or 6 or any combination thereof.
Genotype 1 is further defined as 1a or 1b. Genotype 2 is further
defined as 2a, 2b, 2c or 2d. Genotype 3 is further defined as 3a,
3b, 3c, 3d, 3e or 3f. Genotype 4 is further defined as 4a, 4b, 4c,
4d, 4e, 4f, 4g, 4h, 4i or 4j. Genotype 5 is further defined as 5a.
Genotype 6 is further defined as 6a. In some embodiments, multiple
HCV genotypes include type 1 and 2 or any combination thereof. In
some embodiments, multiple HCV genotypes include type 1 and 3 or
any combination thereof. In some embodiments, multiple HCV
genotypes include type 1, 2 and 3 or any combination thereof. In
some embodiments, the subject has a chronic HCV infection. In some
embodiments, a chronic HCV infection is characterized by the
presence of anti-HCV and HCV RNA in the serum for more than six
months. In some embodiments, the subject has an acute HCV
infection. In some embodiments, an acute HCV infection is
characterized by the presence of anti-HCV and HCV RNA in the serum
within six months of initial HCV exposure. In some embodiments, the
subject has an occult HCV infection. In some embodiments, an occult
HCV infection is characterized by the presence of HCV-RNA in liver
cells with undetectable anti-HCV and serum viral RNA.
[0210] In certain embodiments, the progression of HCV infection
from an acute viral infection into a chronic viral infection is
characterized by and increased Th2 immune profile and a decreased
Th1 immune profile. In some embodiments, administration of a
covalent TEC family kinase inhibitor inhibits or delays the
progression of a HCV infection from an acute HCV infection into a
chronic HCV infection. In some embodiments, administration of a
covalent TEC family kinase inhibitor increases the Th1 immune
response in a subject having a chronic HCV infection.
[0211] In some embodiments, the subject has an influenza infection.
In some embodiments, the subject having an influenza infection is
infected with influenza A virus. In some embodiments, influenza A
virus include all subtypes-H1N1, H2N2, H3N2, H5N1, H7N7, H1N2,
H9N2, H7N2, H7N3, H10N7 and H7N9.
[0212] In some embodiments, the subject has AIDS. In some
embodiments, the subject having AIDS is infected with human
immunodeficiency virus (HIV). In some embodiments, HIV includes
HIV-1 and HIV-2.
[0213] In some embodiments, the subject has a bacterial infection.
In some embodiments, the subject has a chronic bacterial infection.
In some embodiments, the bacterium is an intracellular bacterium.
In some embodiments, the subject has a Listeria monocytogenes
infection.
[0214] In some embodiments, the subject has a fungal infection. In
some embodiment, the subject has a chronic fungal infection. In
some embodiments, the subject has a parasitic infection.
[0215] In some embodiments, the subject is a mammal, such as, but
not limited to a human, a non-human primate, mouse, rat, rabbit,
goat, dog, cat, or cow. In some embodiments, the mammal is a human.
In some embodiments, the human is a patient having an HCV
infection. In some embodiments, the patient has a chronic HCV
infection. In some embodiments, the patient having chronic HCV
infection means any patient having chronic HCV and includes
treatment naive patients, relapsers and non-responders. In some
embodiments, the patient has infections caused by multiple viruses.
In some embodiments, the patient has a primary infection followed
by a secondary infection. In some embodiments, the patient has
infections caused by HCV and HIV. In some embodiments, the primary
infection is an HIV infection and the secondary infection is a
viral, bacterial, fungal or parasitic infection. In some
embodiments, the primary infection is an HIV infection and the
secondary infection is a HCV infection.
[0216] Adjuvant Treatment Regimens
[0217] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with a T-cell
immunotherapy. In some embodiments, the T-cell immunotherapy is
selected from among adoptive T cell transfer, a vaccine, a
cytokine, an interleukin, a chemokine, a cytokine inducer, an
interleukin inducer, a chemokine inducer, or an immunomodulatory
antibody. In some embodiments, the vaccine is an anti cancer
vaccine, such as for example, Sipuleucel-T.
[0218] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy) for treatment of
a viral infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with an antiviral
agent. Exemplary antiviral agents for use in combination with a
covalent TEC family kinase inhibitor for adjuvant therapy include,
but are not limited to, immunostimulants such as interferon (e.g.,
alpha interferons, beta interferons, gamma interferons, pegylated
alpha interferons, pegylated beta interferons, pegylated gamma
interferons and mixtures of any two or more thereof), granulocyte
macrophage colony-stimulating factor, echinacin, isoprinosine,
adjuvants, biodegradable microspheres (e.g., polylactic galactide)
and liposomes (into which the compound is incorporated), and thymus
factors; immunosuppressants such as cyclosporin, azatioprin,
methotrexate, cyclophsphamide, FK 506, Cortisol, betametasone,
cortisone, desametasone, flunisolide, prednisolone,
methylprednisolone, prednisone, triamcinolone, alclometasone,
amcinonide desonide, desoxymetasone, prednisone, cyclosporine,
mycophenolate mofetil, and tacrolimus; nucleoside and nucleotide
antiviral agents such as abacavir, acyclovir (ACV), adefovir,
zidovudine (ZDV), ribavirin, lamivudine, adefovir and entecavir,
tenofovir, emtricitabine, telbuvidine, clevudine, valtorcitabine,
cidofovir, and derivatives thereof; protease inhibitors such as
saquinavir, ritonavir, indinavir, nelfinavir, amprenavir,
atazanavir, boceprevir, and HCV NS3 protease inhibitors; inosine
5'-monophosphate dehydrogenase (IMPDH) inhibitors such as
merimepodib (VX-497); viral entry inhibitors; viral maturation
inhibitors; viral uncoating inhibitors such as amantadine,
rimantadine, pleconaril, and derivatives thereof; integrase
inhibitors; viral enzyme inhibitors; antisense antiviral molecules;
ribozyme antiviral agents such as RNase P ribozyme; nanoviricides,
antisense antiviral molecules include, but are not limited to,
oligonucleotides designed to recognize and inactivate viral genes
and antibodies.
[0219] Antibodies for use in combination with the covalent TEC
family kinase inhibitor provided herein include, but are not
limited to, monoclonal antibodies, multispecific antibodies,
synthetic antibodies, human antibodies, humanized antibodies,
chimeric antibodies, intrabodies, single-chain Fvs (scFv), single
chain antibodies, Fab fragments, F(ab') fragments, disulfide-linked
Fvs (sdFv), and anti-idiotypic (anti-Id) antibodies (including,
e.g., anti-Id antibodies to antibodies provided herein), and
epitope-binding fragments of any of the above. The antibodies for
use in combination with the covalent TEC family kinase inhibitor
provided herein can be of any type (e.g., IgG, IgE, IgM, IgD, IgA
and IgY), class (e.g., IgGi, IgG2, IgG3, IgG4, IgAi and IgA2) or
subclass of immunoglobulin molecule.
[0220] Antibodies for use in combination with the covalent TEC
family kinase inhibitor provided herein can be from any animal
origin, including birds and mammals (e.g., human, murine, donkey,
sheep, rabbit, goat, guinea pig, camel, horse, shark, llama, or
chicken). Typically, the antibodies for use in combination with
covalent TEC family kinase inhibitor provided herein are human or
humanized antibodies. The antibodies for use in combination with
covalent TEC family kinase inhibitor provided herein can be
monospecific, bispecific, trispecific or of greater
multispecificity.
[0221] The antibodies for use in combination with covalent TEC
family kinase inhibitor provided herein can include derivative
antibodies that are modified, for example, by the attachment of any
type of molecule to the antibody or antigen-binding fragment
thereof such as by covalent attachment. Exemplary antibody or
antigen-binding fragment thereof derivatives include antibodies
that have been modified, for example, by glycosylation,
acetylation, pegylation, phosphorylation, amidation, derivatization
by known protecting/blocking groups, proteolytic cleavage, linkage
to a cellular ligand or other protein, or contain heterologous Fc
domain with higher affinities for the FcRN receptor (see, e.g. U.S.
Pat. No. 7,083,784). Any of numerous chemical modifications can be
carried out by known techniques, including, but not limited to,
specific chemical cleavage, acetylation, formylation, or synthesis
in the presence of tunicamycin. Additionally, the derivative can
contain one or more non-classical amino acids.
[0222] In some embodiments, antibodies include actoxumab,
bezlotoxumab, afelimomab, bavituximab, CR6261, edobacomab,
efungumab, felvizumab, ibalizumab, libivirumab, motavizumab,
nebacumab, pagibaximab, palivizumab, panobacumab, pidilizumab, PRO
140, rafivirumab, regavirumab, sevirumab, suvizumab and
tefibazumab.
[0223] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with one or more agents
capable of stimulating cellular immunity, such as cellular mucosal
immunity. Any agent capable of stimulatory cellular immunity can be
used. Exemplary immunostimulatory agents include, cytokines, such
as, but not limited to, interferons (e.g., IFN-a, .beta., .gamma.,
.omega.), lymphokines and hematopoietic growth factors, such as,
for example, GM-CSF, (granulocyte macrophage colony stimulating
factor), Interleukin-2 (IL-2), Interleukin-3 (IL-3), Interleukin-4
(IL-4), Interleukin-7 (IL-7), Interleukin-10 (IL-10),
Interleukin-12 (IL-12), Interleukin-14 (IL-14), and Tumor Necrosis
Factor (TNF).
[0224] In some embodiments, the covalent TEC family kinase
inhibitor improves the efficacy of an antiviral agent. In some
embodiments, the covalent TEC family kinase inhibitor improves the
efficacy of an antiviral agent by promoting a Th1 response against
the virus (e.g. a Th1 response against a virus infected cell) in
the infected patient. In some embodiments, the covalent TEC family
kinase inhibitor improves clearance of virus from the subject when
administered in combination with the antiviral agent. In some
embodiments, the subject having a viral infection has an overactive
Th2 response. In some embodiments, the subject having a viral
infection has a defective Th1 response against the virus.
[0225] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy) for treatment of
a bacterial infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with an
antibacterial agent. Exemplary antibacterial agents for use in
combination with a covalent TEC family kinase inhibitor for
adjuvant therapy include, but are not limited to aminoglycosides
such as amikacin, arbekacin, bekanamycin, dibekacin,
framycetin,
gentamicin, kanamycin, neomycin, netilmicin, paromomycin,
ribostamycin, rhodostreptomycin, spectinomycin, hygromycin B,
paromomycin sulfate, sisomicin, isepamicin, verdamicin, astromicin,
streptomycin, tobramycin, and apramycin; ansamycins such as
geldanamycin, herbimycin, rifaximin or streptomycin; carbapenem
(beta-lactam) such as Imipenem, meropenem, ertapenem, doripenem,
panipenem/betamipron, biapenem, razupenem, tebipenem, lenapenem or
tomopenem; cephalosporin such as Cefacetrile (cephacetrile),
Cefadroxil (cefadroxyl; Duricef), Cephalexin (cefalexin; Keflex),
Cefaloglycin (cephaloglycin), Cefalonium (cephalonium),
Cefaloridine(cephaloradine), Cefalotin (cephalothin; Keflin),
Cefapirin (cephapirin; Cefadryl), Cefatrizine, Cefazaflur,
Cefazedone, Cefazolin (cephazolin; Ancef, Kefzol), Cefradine
(cephradine; Velosef), Cefroxadine, Ceftezole Cefaclor (Ceclor,
Distaclor, Keflor, Raniclor), Cefonicid (Monocid), Cefprozil
(cefproxil; Cefzil), Cefuroxime (Zefu, Zinnat, Zinacef, Ceftin,
Biofuroksym, Xorimax), Cefoperazone (Cefobid), Ceftazidime (Meezat,
Fortum, Fortaz), Ceftobiprole, Ceftaroline; glycopeptide
antibiotics such as vancomycin, teicoplanin, telavancin, bleomycin,
ramoplanin, and decaplanin; lincosamides such as clindamycin or
lincomycin; lipopeptide such as daptomycin; macrolides such as
azithromycin, clarithromycin, dirithromycin, erythromycin,
roxithromycin, telithromycin, j osamycin, kitasamycin, midecamycin,
oleandomycin, solithromycin, spiramycin, troleandomycin, or
tylosin; ketolides such as telithromycin, cethromycin,
solithromycin, spiramycin, ansamycin, oleandomycin, or carbomycin;
monobactam such as aztreonam; nitrofurans such as furazolidone,
furylfuramide, nitrofurantoin, nitrofurazone, nifuratel,
nifurquinazol, nifurtoinol, nifuroxazide or ranbezolid;
oxazolidinones such as linezolid, posizolid, torezolid, radezolid,
cycloserine, rivaroxaban or oxazolidinone and derivatives of;
penicillins such as all natural penicillins (e.g. penicillins that
are naturally produced by P. chrysogenum--e.g., penicillin G),
biosynthetic penicillin (e.g. penicillins that are produced by P.
chrysogenumthrough directed biosynthesis when a side chain acid is
added to the medium--e.g., penicillin V), semi-synthetic penicillin
(penicillin that are made by chemical means from natural or
biosynthetic penicillin--e.g., ampicillin), synthetic penicillin
(e.g. penicillin that are made wholly synthetically), adipyl-6-APA,
amoxicillin, ampicillin, butyryl-6-APA, decanoyl-6-APA,
heptanoyl-6-APA, hexanoyl-6-APA, nonanoyl-6-APA, octanoyl-6-APA,
penicillin F, penicillin G, penicillin V, penicillin mX, penicillin
X, 2-thiopheynlacetyl-6-APA, or valeryl-6-APA, azlocillin,
flucloxacillin, amoxicillin/clavulanate, ampicillin/sulbactam,
piperacillin/tazobactam, ticarcillin/clavulanate; polypeptides such
as bacitracin, colistin or polymyxin B; quinolones such as
cinoxacin, nalidixic acid, oxolinic acid, piromidic acid, pipemidic
acid, rosoxacin, ciprofloxacin, enoxacin, fleroxacin, iomefloxacin,
nadifloxacin, norfloxacin, ofloxacin, pefloxacin, rufloxacin,
balofloxacin, grepafloxacin, levofloxacin, pazufloxacin,
sparfloxacin, temafloxacin, tosufloxacin, clinafloxacin,
gatifloxacin, gemifloxacin, moxifloxacin, sitafloxacin,
trovafloxacin, prulifloxacin, delafloxacin, JNJ-Q2 or nemonoxacin;
sulfonamides such as mafenide, sulfacetamide, sulfadiazine, silver
sulfadiazine, sulfadimethoxine, sulfamethizole, sulfamethoxazole,
sulfasalazine, sulfisoxazole, TMP-SMX, or sulfonamidochrysoidine;
tetracycline such as naturally occurring tetracycline,
chlortetracycline, oxytetracycline, demeclocycline, doxycycline,
lymecycline, meclocycline, methacycline, minocycline or
rolitetracycline; anti-mycobacteria agents such as clofazimine,
dapsone, capreomycin, cycloserine, ethambutol, ethionamide,
isoniazid, pyrazinamide, rifampin (rifampicin), rifabutin,
rifapentine or streptomycin.
[0226] In some embodiments, the covalent TEC family kinase
inhibitor improves the efficacy of an antibacterial agent. In some
embodiments, the covalent TEC family kinase inhibitor improves the
efficacy of an antibacterial agent by promoting a Th1 response
against the bacteria in the infected subject (e.g. a Th1 response
against a cell infected with an intracellular bacterium). In some
embodiments, the covalent TEC family kinase inhibitor improves the
efficacy of an antibacterial agent by promoting a Th17 response
against the bacteria in the infected subject. In some embodiments,
the bacteria is an intracellular bacteria (e.g., Mycobacterium
tuberculosis, Listeria monocytogenes, Shigella flexneri, Yersinia
pestis). In some embodiments, the bacteria is an extracellular
bacteria (e.g. Staphylococcus aureus, Neisseria gonorrhoea,
Chlamydia trachomatis, Streptococcus pyogenes, Streptococcus
pneimoniae, Haemophilus influenza, Escherichia coli, Salmonella,
Clostridium). In some embodiments, the covalent TEC family kinase
inhibitor improves clearance of bacteria from the subject when
administered in combination with the antibacterial agent. In some
embodiments, the subject having a bacterial infection has an
overactive Th2 response. In some embodiments, the subject having a
bacterial infection has a defective Th1 or Th17 response against
the bacteria.
[0227] In some embodiments, the patient has listeriosis (i.e. a
Listeria monocytogenes infection). In some embodiments, the patient
having listeriosis is administered a covalent TEC family kinase
inhibitor for adjuvant therapy of listeriosis. In some embodiments,
the patient having listeriosis is administered a covalent family
kinase inhibitor in combination with one or more therapies for the
treatment of listeriosis. Exemplary therapies for the treatment of
listeriosis include, but are not limited to, antibiotics, such as
ampicillin and gentamicin, trimethoprim/sulfamethoxazole,
erythromycin, vancomycin, and fluoroquinolones. In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with ampicillin and gentamicin for the
treatment of listeriosis. In some embodiments, the covalent TEC
family kinase inhibitor is ibrutinib. In some embodiments,
ibrutinib is administered in combination with ampicillin and
gentamicin for the treatment of listeriosis. In some embodiments,
the covalent TEC family kinase inhibitor (e.g., ibrutinib) is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of listeriosis.
[0228] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy) for treatment of
a fungal infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with an antifungal
agent. Exemplary antifungal agents for use in combination with a
covalent TEC family kinase inhibitor for adjuvant therapy include,
but are not limited to polyene antifungals such as amphotericin B,
candicidin, filipin, hamycin, natamycin, nystatin or rimocidin;
imidazoles such as bifonazole, butoconazole, clotrimazole,
econazole, fenticonazole, isoconazole, ketoconazole, miconazole,
omoconazole, oxiconazole, sertaconazole, sulconazole or
tioconazole; triazoles such as albaconazole, fluconazole,
isavuconazole, itraconazole, posaconazole, ravuconazole,
terconazole or voriconazole; thiazoles such as abafungin;
allylamines such as amorolfin, butenafine, naftifine or
terbinafine; echinocandins include anidulafungin, caspofungin or
micafungin; antifungal macrolides such as polyene antimycotics
(e.g., amphotericin B, nystatin benzoic acid); ciclopirox;
flucytosine; griseofulvin; haloprogin; polygodial; tolnaftate;
undecylenic acid; or crystal violet; and natural alternatives such
as oregano, allicin, citronella oil, cocnut oil, iodine, lemon
myrtle, neem seed oil, olife leaf, orange oil, palmarosa oil,
patchouli, selenium, tea tree oil, zinc, horopito, turnip, chives,
radish and garlic.
[0229] In some embodiments, the covalent TEC family kinase
inhibitor improves the efficacy of an antifungal agent. In some
embodiments, the covalent TEC family kinase inhibitor improves the
efficacy of an antifungal agent by promoting a Th17 response
against the fungi in the infected subject. In some embodiments, the
covalent TEC family kinase inhibitor improves the efficacy of an
antibacterial agent by promoting a Th1 response against the
bacteria in the infected subject (e.g. a Th1 response against a
cell infected with an intracellular fungus). In some embodiments,
the fungi is an intracellular fungi (e.g., Cryptococcus
neoformans). In some embodiments, the bacteria is an extracellular
fungi (e.g. Candida albicans, Coccidiodes, Aspergillus). In some
embodiments, the subject having a fungal infection has an
overactive Th2 response. In some embodiments, the subject having a
fungal infection has a defective Th17 response against the fungi.
In some embodiments, the subject having a fungal infection has a
defective Th1 response against the fungi.
[0230] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy) for treatment of
a parasitic infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with an
antiparasitic agent. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib. Exemplary antiparasitic agents for
use in combination with a covalent TEC family kinase inhibitor for
adjuvant therapy include, but are not limited to antinematodes such
as mebendazole, pyrantel pamoate, thiabendazole, diethylcarbamazine
or ivermectin; anticestodes such as niclosamide, praziquantel or
albendazole; antitrematodes such as praziquantel, antiamoebics such
as rafampin or amphotericin B; antiprotozoals such as melarsoprol,
eflornithine, metronidazole, tinidazole or miltefosine.
[0231] In some embodiments, the covalent TEC family kinase
inhibitor improves the efficacy of an antiparasitic agent. In some
embodiments, the covalent TEC family kinase inhibitor improves the
efficacy of an antiparasitic agent by promoting a Th1 response
against the parasite in the infected subject. In some embodiments,
the covalent TEC family kinase inhibitor improves the efficacy of
an antiparasitic agent by promoting a Th17 response against the
parasite in the infected subject. In some embodiments, the covalent
TEC family kinase inhibitor improves the efficacy of an
antiparasitic agent by promoting a Th1 response against the
parasite in the infected subject (e.g. a Th1 response against a
cell infected with an intracellular parasite). In some embodiments,
the parasite is an intracellular parasite (e.g. Leishmania). In
some embodiments, the parasite is an extracellular parasite. In
some embodiments, the subject having a parasitic infection has an
overactive Th2 response. In some embodiments, the subject having a
parasitic infection has a defective Th17 response against the
parasite. In some embodiments, the subject having a parasitic
infection has a defective Th1 response against the parasite.
[0232] In some embodiments, the patient has leishmaniasis In some
embodiments, the patient having leishmaniasis is administered a
covalent TEC family kinase inhibitor for adjuvant therapy of
leishmaniasis (e.g. infection by a Leishmania parasite). In some
embodiments, the patient having leishmaniasis is administered a
covalent TEC family kinase inhibitor in combination with one or
more therapies for the treatment of leishmaniasis. Exemplary
therapies for the treatment of leishmaniasis include, but are not
limited to, antimony-containing compounds, such as meglumine
antimoniate and sodium stibogluconate, amphotericin B,
ketoconazole, itraconazole, fluconazole, miltefosine, paromomycin,
and pentamidine. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with an
antimony-containing compound, such as meglumine antimoniate and
sodium stibogluconate, amphotericin B, ketoconazole, itraconazole,
fluconazole, miltefosine, paromomycin, pentamidine, or any
combination thereof for the treatment of leishmaniasis. In some
embodiments, the covalent family kinase inhibitor is ibrutinib. In
some embodiments, ibrutinib is administered in combination with an
antimony-containing compound, such as meglumine antimoniate and
sodium stibogluconate, amphotericin B, ketoconazole, itraconazole,
fluconazole, miltefosine, paromomycin, pentamidine, or any
combination thereof for the treatment of leishmaniasis. In some
embodiments, the covalent TEC family kinase inhibitor (e.g.,
ibrutinib) is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
leishmaniasis.
[0233] In some embodiments, the covalent TEC family kinase
inhibitor is administered alone (e.g. monotherapy) for treatment of
a protozoal infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered in combination with an
antiprotozoal agent. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib. Exemplary antiprotozoal agents for
use in combination with a covalent TEC family kinase inhibitor for
adjuvant therapy include, but are not limited to, Acetarsol,
Azanidazole, Chloroquine, Metronidazole, Nifuratel, Nimorazole,
Omidazole, Propenidazole, Secnidazole, Sineflngin, Tenonitrozole,
Temidazole, Tinidazole, and pharmaceutically acceptable salts or
esters thereof.
[0234] In certain instances, the covalent TEC family kinase
inhibitor permits the antiviral or antibacterial agent to be
administered at a lower dosage to achieve the same therapeutic
effect compared to standard dosage for administration of the
antiviral or antibacterial agent in the absence of the covalent TEC
family kinase inhibitor. In some embodiments, administration of a
covalent TEC family kinase inhibitor for the treatment of HCV in
combination with ribavirin or peginterferon alfa-2a and allows
ribavirin or peginterferon alfa-2a to be administered at a lower
dosage compared to standard therapy. In certain instances, the
standard therapy for the treatment of chronic HCV in an individual
is 100-200 .mu.g peginterferon alfa-2a and 500-2000 mg ribavirin
per day. In some embodiments, the dosage of peginterferon alfa-2a
is about or at 135 .mu.g peginterferon alfa-2a per day. In some
embodiments, the dosage of peginterferon alfa-2a is about or at 180
.mu.g peginterferon alfa-2a per day. In some embodiments, the
dosage of ribavirin is about or at 500 mg ribavirin per day. In
some embodiments, the dosage of ribavirin is about or at 600 mg
ribavirin per day. In some embodiments, the dosage of ribavirin is
about or at 700 mg ribavirin per day. In some embodiments, the
dosage of ribavirin is about or at 800 mg ribavirin per day. In
some embodiments, the dosage of ribavirin is about or at 900 mg
ribavirin per day. In some embodiments, the dosage of ribavirin is
about or at 1000 mg ribavirin per day. In some embodiments, the
dosage of ribavirin is about or at 1100 mg ribavirin per day. In
some embodiments, the dosage of ribavirin is about or at 1200 mg
ribavirin per day. In some embodiments, the dosage of ribavirin is
about or at 1300 mg ribavirin per day. In some embodiments, the
dosage of ribavirin is about or at 1400 mg ribavirin per day. In
some embodiments, the dosage of ribavirin is about or at 1500 mg
ribavirin per day. In some embodiments, the dosage of ribavirin is
about or at 1600 mg ribavirin per day. In some embodiments, the
dosage of ribavirin is about or at 1700 mg ribavirin per day. In
some embodiments, the dosage of ribavirin is about or at 1800 mg
ribavirin per day. In some embodiments, the dosage of ribavirin is
about or at 1900 mg ribavirin per day. In some embodiments, the
dosage of ribavirin is about or at 2000 mg ribavirin per day.
[0235] In some embodiments, the antiviral agent inhibits one or
more steps of the viral life cycle. For example, in some
embodiments, the antiviral agent inhibits attachment to a host
cell, release of viral nucleic acid or enzymes into the host cell,
replication of viral component using the host-cell machinery,
assembly of viral component into complete viral particles, or
release of viral particles from the host cell. In some embodiments,
the antiviral agent includes, but is not limited to a receptor, a
ligand, an antibody, a protease inhibitor, a cytokine, a ribozyme,
a reverse transcriptase inhibitor, a polymerase inhibitor, an
integrase inhibitor, a HDAC inhibitor, a Cyp3A4 inhibitor, an IRAK
inhibitor, a JAK inhibitor, an antisense nucleic acid, or a purine
nucleoside analog. In some embodiments, the antiviral agent
includes, but is not limited to acyclovir, famciclovir,
ganciclovir, penciclovir, valacyclovir, valganciclovir,
idoxuridine, trifluridine, brivudine, cidofovir, docosanol,
fomivirsen, foscarnet, tromantadine, imiquimod, podophyllotoxin,
entecavir, lamivudine, telbivudine, clevudine, adefovir, tenofovir,
an antiviral nucleoside inhibitor of NS5B polymerase (e.g.,
4-amino-7-(2-C-methyl-D-ribofuranosyl)-pyrrolo[2,
1-f][1,2,4]triazine; PSI-7977; PSI-938; mericitabine; IDX-184;
INX-189), a non-nucleoside inhibitor of NS5B polymerase (e.g.,
tegobuvir; filibuvir; VX-222; IDX-375; ABT-072; ABT-333; VX-135;
setrobuvir; BI207127; JTK-853; GS-9669), a NS3/4A protease
inhibitor (e.g., boceprevir; telaprevir; B1-201335; TMC-435;
danoprevir; vaniprevir; GS-9451; GS-9256; BMS-650032; ACH-1625;
ACH-2684; MK-5172; ABT-450; IDX-320; SCH-900518), an NS5A inhibitor
(e.g., daclatasvir; GS-5885; ABT-267; PPI-461; ACH-2928;
GSK2336805), carfilzomib, bortezomib, revlimid, lenalidomide,
dexamethasone, Bendamustine, pleconaril, arbidol, amantadine,
rimantadine, oseltamivir, zanamivir, peramivir, inosine, interferon
or interferon derivative (e.g., Interferon alfa-2a, Interferon
alfa-2b, Peginterferon alfa-2a, Peginterferon alfa-2b), consensus
interferon (e.g., interferon alphacon-1), recombinant interferon
alpha 2A, lymphoblastoid interferon tau, pegylated interferon
lambda, an inhibitor of inosine-5'-monophosphate dehydrogenase
(IMPDH), ribavirin/taribavirin, D-ribavirin, L-ribavirin, abacavir,
emtricitabine, lamivudine, didanosine, asunaprevir, daclatasvir,
sofosbuvir, zidovudine, apricitabine, stampidine, elvucitabine,
racivir, amdoxovir, stavudine, zalcitabine, tenofovir, efavirenz,
nevirapine, etravirine, rilpivirine, loviride, delavirdine,
atazanavir, fosamprenavir, lopinavir, darunavir, nelfinavir,
ritonavir, saquinavir, tipranavir, amprenavir, indinavir,
enfuvirtide, maraviroc, vicriviroc, PRO 140, ibalizumab,
raltegravir, elvitegravir, bevirimat, vivecon, including tautomeric
forms, analogs, isomers, polymorphs, solvates, derivatives, or
salts thereof. In a particular embodiment, the antiviral agent is
ribavirin
(1-.beta.-D-ribofuranosyl-1,2,4-triazole-3-carboximide).
[0236] In some embodiments, the antibacterial agent includes, but
is not limited to, antibacterial agents that target the bacterial
cell wall (e.g. penicillins and cephalosporins) or the cell
membrane (e.g., polymixins), antibacterial agents that interfere
with essential bacterial enzymes (e.g., rifamycins, lipiarmycins,
quinolones, and sulfonamides), and antibacterial agents that target
bacterial protein synthesis (e.g., aminoglycosides, macrolides, and
tetracyclines). In some embodiments, the antibacterial agent
includes, but is not limited to penicillins, cephalosporins,
polymixins, carbapenems, sulfonamides, rifamycins, quinolones,
oxaolidinones (e.g., linezolid), cyclic lipopeptides (e.g.,
daptomycin), glycylcyclines (e.g., tigecycline) and lipiarmycins
(e.g., fidaxomicin).
[0237] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of an HCV infection. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
HCV infection. Exemplary therapies for the treatment of HCV
infection include, but are not limited to, interferon or interferon
derivatives such as Interferon alfa-2a, Interferon alfa-2b,
Peginterferon alfa-2a, Peginterferon alfa-2b, recombinant
interferon alfa-2a, Sumiferon (a purified blend of natural alpha
interferons), ALFERON.RTM. (a mixture of natural alpha
interferons), consensus alpha interferon, pegylated interferon
lambda; nucleoside analogs such as ribavirin or its derivatives,
D-ribavirin, L-ribavirin, or taribavirin; nucleoside and nucleotide
NS5B polymerase inhibitors such as sofosbuvir; NS5A inhibitors such
as daclatasvir, ledipasvir, ABT-267, ACH-3102, GS-5816, GS-5885,
IDX719, MK-8742 or PPI-668; non-nucleoside NS5B polymerase
inhibitors such as deleobuvir, ABT-072, ABT-333, BMS-791325,
VX-222, or tegobuvir; protease inhibitors such as boceprevir,
danoprevir, faldaprevir, incivek, telaprevir, simeprevir,
victrelis, ACH-1625, ACH-2684, ABT-450/r or VX-950; polymerase
inhibitors such as deleobuvir, sofosbuvir or VX-135; NS3/4A
protease inhibitors such as asunaprevir, danoprevir, MK-5172 or
VX-950; ALN-VSP; PV-10; HDAC inhibitor such as abexinostat,
resminostat, vorinostat, belinostat and panobinostat; thiazolides
such as alinia (nitazoxanide); A3AR agonist such as CF102; GI-5005
(Tarmogen); MBL-HCV1; microRNA such as miravirsen; oral interferon;
cyclophilin inhibitor such as SCY-635; TG4040; doxorubicin,
livatag; immunomodulatory agents, such as Cc-, .beta.-, and
.gamma.-interferons or thymosin, pegylated derivatized
interferon-.alpha. compounds, and thymosin; other anti-viral
agents, such as ribavirin, amantadine, and telbivudine; other
inhibitors of hepatitis C proteases (NS2-NS3 inhibitors and
NS3-NS4A inhibitors); inhibitors of other targets in the HCV life
cycle, including helicase, polymerase, and metalloprotease
inhibitors; inhibitors of internal ribosome entry; broad-spectrum
viral inhibitors, such as IMPDH inhibitors (e.g., compounds
described in U.S. Pat. Nos. 5,807,876, 6,498,178, 6,344,465, and
6,054,472; and PCT publications WO 97/40028, WO 98/40381, and WO
00/56331; and mycophenolic acid and derivatives thereof, and
including, but not limited to, VX-497, VX-148, and VX-944);
cytochrome P-450 inhibitor such as ritonavir (WO 94/14436),
ketoconazole, troleandomycin, 4-methyl pyrazole, cyclosporin,
clomethiazole, cimetidine, itraconazole, fluconazole, miconazole,
fluvoxamine, fluoxetine, nefazodone, sertraline, indinavir,
nelfinavir, amprenavir, fosamprenavir, saquinavir, lopinavir,
delavirdine, erythromycin, VX-944, and VX-497; kinase inhibitors
such as methyl 2-cyano-3,12-dioxoolean-1,9-dien-28-oate (for the
inhibition of CHUK); cetuximab (for the inhibition of EGFR), AEE
788, panitumumab, BMS-599626, ARRY-334543, XL647, canertinib,
gefitinib, HKI-272, PD 153035, lapatinib, vandetanib, and erlotinib
(for the inhibition of EGFR); BMS-387032 and fiavopiridol (for the
inhibition of CDK2, CDK3, CDK4, and CDK8); XL647 (for the
inhibition of EPHB4); dasatinib and AZM-475271 (for the inhibition
of SRC); imatinib (for the inhibition of BCR); dasatinib (for the
inhibition of EPHA2); and AZD-1152 (for the inhibition of AURKB).
Other examples of known kinase inhibitors include, but are not
limited to, sorafenib (for the inhibition of BRAF); BMS-599626 (for
the inhibition of ERBB4); PD-0332991 and flavopiridol (for the
inhibition of CDK4).
[0238] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with interferon or
interferon derivatives such as Interferon alfa-2a, Interferon
alfa-2b, Peginterferon alfa-2a, Peginterferon alfa-2b, recombinant
interferon alfa-2a, Sumiferon (a purified blend of natural alpha
interferons), ALFERON.RTM. (a mixture of natural alpha
interferons), consensus alpha interferon, pegylated interferon
lambda; nucleoside analogs such as ribavirin or its derivatives,
D-ribavirin, L-ribavirin, or taribavirin; nucleoside and nucleotide
NS5B polymerase inhibitors such as sofosbuvir; NS5A inhibitors such
as daclatasvir, ledipasvir, ABT-267, ACH-3102, GS-5816, GS-5885,
IDX719, MK-8742 or PPI-668; non-nucleoside NS5B polymerase
inhibitors such as deleobuvir, ABT-072, ABT-333, BMS-791325,
VX-222, or tegobuvir; protease inhibitors such as boceprevir,
danoprevir, faldaprevir, incivek, telaprevir, simeprevir,
victrelis, ACH-1625, ACH-2684, ABT-450/r or VX-950; polymerase
inhibitors such as deleobuvir, sofosbuvir or VX-135; NS3/4A
protease inhibitors such as asunaprevir, danoprevir, MK-5172 or
VX-950; ALN-VSP; PV-10; HDAC inhibitor such as abexinostat,
resminostat, vorinostat, belinostat and panobinostat; thiazolides
such as alinia (nitazoxanide); A3AR agonist such as CF102; GI-5005
(Tarmogen); MBL-HCV1; microRNA such as miravirsen; oral interferon;
cyclophilin inhibitor such as SCY-635; TG4040; doxorubicin,
livatag; immunomodulatory agents, such as Cc-, .beta.-, and
.gamma.-interferons or thymosin, pegylated derivatized interferon-t
compounds, and thymosin; other anti-viral agents, such as
ribavirin, amantadine, and telbivudine; other inhibitors of
hepatitis C proteases (NS2-NS3 inhibitors and NS3-NS4A inhibitors);
inhibitors of other targets in the HCV life cycle, including
helicase, polymerase, and metalloprotease inhibitors; inhibitors of
internal ribosome entry; broad-spectrum viral inhibitors, such as
IMPDH inhibitors (e.g., compounds described in U.S. Pat. Nos.
5,807,876, 6,498,178, 6,344,465, and 6,054,472; and PCT
publications WO 97/40028, WO 98/40381, and WO 00/56331; and
mycophenolic acid and derivatives thereof, and including, but not
limited to, VX-497, VX-148, and VX-944); cytochrome P-450 inhibitor
such as ritonavir (WO 94/14436), ketoconazole, troleandomycin,
4-methyl pyrazole, cyclosporin, clomethiazole, cimetidine,
itraconazole, fluconazole, miconazole, fluvoxamine, fluoxetine,
nefazodone, sertraline, indinavir, nelfinavir, amprenavir,
fosamprenavir, saquinavir, lopinavir, delavirdine, erythromycin,
VX-944, and VX-497; kinase inhibitors such as methyl
2-cyano-3,12-dioxoolean-1,9-dien-28-oate (for the inhibition of
CHUK); cetuximab (for the inhibition of EGFR), AEE 788,
panitumumab, BMS-599626, ARRY-334543, XL647, canertinib, gefitinib,
HKI-272, PD 153035, lapatinib, vandetanib, and erlotinib (for the
inhibition of EGFR); BMS-387032 and fiavopiridol (for the
inhibition of CDK2, CDK3, CDK4, and CDK8); XL647 (for the
inhibition of EPHB4); dasatinib and AZM-475271 (for the inhibition
of SRC); imatinib (for the inhibition of BCR); dasatinib (for the
inhibition of EPHA2); and AZD-1 152 (for the inhibition of AURKB).
Other examples of known kinase inhibitors include, but are not
limited to, sorafenib (for the inhibition of BRAF); BMS-599626 (for
the inhibition of ERBB4); PD-0332991 and flavopiridol (for the
inhibition of CDK4).
[0239] In some embodiments, a covalent TEC family kinase inhibitor
is administered in combination with ribavirin for the treatment of
an HCV infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with IFN-.alpha. for the
treatment of an HCV infection. In some embodiments, a covalent TEC
family kinase inhibitor is administered in combination with
ribavirin and IFN-.alpha. for the treatment of an HCV
infection.
[0240] In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with interferon or interferon
derivatives such as Interferon alfa-2a, Interferon alfa-2b,
Peginterferon alfa-2a, Peginterferon alfa-2b, recombinant
interferon alfa-2a, Sumiferon (a purified blend of natural alpha
interferons), ALFERON.RTM. (a mixture of natural alpha
interferons), consensus alpha interferon, pegylated interferon
lambda; nucleoside analogs such as ribavirin or its derivatives,
D-ribavirin, L-ribavirin, or taribavirin; nucleoside and nucleotide
NS5B polymerase inhibitors such as sofosbuvir; NS5A inhibitors such
as daclatasvir, ledipasvir, ABT-267, ACH-3102, GS-5816, GS-5885,
IDX719, MK-8742 or PPI-668; non-nucleoside NS5B polymerase
inhibitors such as deleobuvir, ABT-072, ABT-333, BMS-791325,
VX-222, or tegobuvir; protease inhibitors such as boceprevir,
danoprevir, faldaprevir, incivek, telaprevir, simeprevir,
victrelis, ACH-1625, ACH-2684, ABT-450/r or VX-950; polymerase
inhibitors such as deleobuvir, sofosbuvir or VX-135; NS3/4A
protease inhibitors such as asunaprevir, danoprevir, MK-5172 or
VX-950; ALN-VSP; PV-10; HDAC inhibitor such as abexinostat,
resminostat, vorinostat, belinostat and panobinostat; thiazolides
such as alinia (nitazoxanide); A3AR agonist such as CF102; GI-5005
(Tarmogen); MBL-HCV1; microRNA such as miravirsen; oral interferon;
cyclophilin inhibitor such as SCY-635; TG4040; doxorubicin,
livatag; immunomodulatory agents, such as Cc-, .beta.-, and
.gamma.-interferons or thymosin, pegylated derivatized
interferon-.alpha. compounds, and thymosin; other anti-viral
agents, such as ribavirin, amantadine, and telbivudine; other
inhibitors of hepatitis C proteases (NS2-NS3 inhibitors and
NS3-NS4A inhibitors); inhibitors of other targets in the HCV life
cycle, including helicase, polymerase, and metalloprotease
inhibitors; inhibitors of internal ribosome entry; broad-spectrum
viral inhibitors, such as IMPDH inhibitors (e.g., compounds
described in U.S. Pat. Nos. 5,807,876, 6,498,178, 6,344,465, and
6,054,472; and PCT publications WO 97/40028, WO 98/40381, and WO
00/56331; and mycophenolic acid and derivatives thereof, and
including, but not limited to, VX-497, VX-148, and VX-944);
cytochrome P-450 inhibitor such as ritonavir (WO 94/14436),
ketoconazole, troleandomycin, 4-methyl pyrazole, cyclosporin,
clomethiazole, cimetidine, itraconazole, fluconazole, miconazole,
fluvoxamine, fluoxetine, nefazodone, sertraline, indinavir,
nelfinavir, amprenavir, fosamprenavir, saquinavir, lopinavir,
delavirdine, erythromycin, VX-944, and VX-497; kinase inhibitors
such as methyl 2-cyano-3,12-dioxoolean-1,9-dien-28-oate (for the
inhibition of CHUK); cetuximab (for the inhibition of EGFR), AEE
788, panitumumab, BMS-599626, ARRY-334543, XL647, canertinib,
gefitinib, HKI-272, PD 153035, lapatinib, vandetanib, and erlotinib
(for the inhibition of EGFR); BMS-387032 and fiavopiridol (for the
inhibition of CDK2, CDK3, CDK4, and CDK8); XL647 (for the
inhibition of EPHB4); dasatinib and AZM-475271 (for the inhibition
of SRC); imatinib (for the inhibition of BCR); dasatinib (for the
inhibition of EPHA2); and AZD-1 152 (for the inhibition of AURKB).
Other examples of known kinase inhibitors include, but are not
limited to, sorafenib (for the inhibition of BRAF); BMS-599626 (for
the inhibition of ERBB4); PD-0332991 and flavopiridol (for the
inhibition of CDK4) for the treatment of a HCV infection. In some
embodiments, the covalent TEC family kinase inhibitor is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of a HCV infection.
[0241] In some embodiments, ibrutinib is administered in
combination with ribavirin for the treatment of an HCV infection.
In some embodiments, ibrutinib is administered in combination with
IFN-.alpha. for the treatment of an HCV infection. In some
embodiments, ibrutinib is administered in combination with
ribavirin and IFN-.alpha. for the treatment of an HCV
infection.
[0242] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of an HBV infection. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
HBV infection. Exemplary therapies for the treatment of HBV
infection include, but are not limited to, interferons or
interferon derivatives such as interferon alfa-2b and peginterferon
alfa-2a; nucleoside analogues such as lamivudine (Epivir-HBV),
adfovir dipivoxil (Hepsera), entecavir (Baraclude), telbivudine
(Tyzeka/Sebivo), tenofovir (Viread), L-FMAU (Clevudine), LB80380
(Besifovir) and AGX-1009; non-nucleoside antivirals such as BAM 205
(NOV-205), Myrcludex B, HAP compound Bay 41-4109, REP 9AC,
nitazoxanide (Alinia), dd-RNAi compound, ARC-520, NVR-1221 and
IHVR-25; non-interferon immune enhancers such as thymosin alpha-1
(zadaxin), interleukin-7 (CYT107), DV-601, HBV core antigen
vaccine, GS-9620 and GI13000; post-exposure and/or post-liver
transplant treatment such as hyperHEP S/D, Nabi-HB and Hepa Gam B;
and alternative natural agents such as milk thistle.
[0243] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with interferons or
interferon derivatives such as interferon alfa-2b and peginterferon
alfa-2a; nucleoside analogues such as lamivudine (Epivir-HBV),
adfovir dipivoxil (Hepsera), entecavir (Baraclude), telbivudine
(Tyzeka/Sebivo), tenofovir (Viread), L-FMAU (Clevudine), LB80380
(Besifovir) and AGX-1009; non-nucleoside antivirals such as BAM 205
(NOV-205), Myrcludex B, HAP compound Bay 41-4109, REP 9AC,
nitazoxanide (Alinia), dd-RNAi compound, ARC-520, NVR-1221 and
IHVR-25; non-interferon immune enhancers such as thymosin alpha-1
(zadaxin), interleukin-7 (CYT107), DV-601, HBV core antigen
vaccine, GS-9620 and GI13000; post-exposure and/or post-liver
transplant treatment such as hyperHEP S/D, Nabi-HB and Hepa Gam B;
or alternative natural agents such as milk thistle. In some
embodiments, the covalent TEC family kinase inhibitor is ibrutinib.
In some embodiments, ibrutinib is administered in combination with
interferons or interferon derivatives such as interferon alfa-2b
and peginterferon alfa-2a; nucleoside analogues such as lamivudine
(Epivir-HBV), adfovir dipivoxil (Hepsera), entecavir (Baraclude),
telbivudine (Tyzeka/Sebivo), tenofovir (Viread), L-FMAU
(Clevudine), LB80380 (Besifovir) and AGX-1009; non-nucleoside
antivirals such as BAM 205 (NOV-205), Myrcludex B, HAP compound Bay
41-4109, REP 9AC, nitazoxanide (Alinia), dd-RNAi compound, ARC-520,
NVR-1221 and IHVR-25; non-interferon immune enhancers such as
thymosin alpha-1 (zadaxin), interleukin-7 (CYT107), DV-601, HBV
core antigen vaccine, GS-9620 and GI13000; post-exposure and/or
post-liver transplant treatment such as hyperHEP S/D, Nabi-HB and
Hepa Gam B; or alternative natural agents such as milk thistle for
the treatment of HBV infection. In some embodiments, the covalent
TEC family kinase inhibitor is administered sequentially,
simultaneously, or intermittently with the one or more therapies
for the treatment of a HBV infection.
[0244] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of an HIV infection. In some
embodiments, a covalent TEC family kinase inhibitor is administered
in combination with one or more therapies for the treatment of the
HIV infection. Exemplary therapies for the treatment of HIV
infection include, but are not limited to, multi-class combination
drugs such as atripla (efavirenz+tenofovir+emtricitabine); complera
(eviplera, rilpivirine+tenofovir+emtricitabine); stribild
(elvitegravir+cobicistat+tenofovir+emtricitabine); "572-Trii"
(dolutegravir+abacavir+lamivudine or DTG+ABC+3TC);
nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
include combivir (zidovudine+lamivudine, AZT+3TC); emtriva
(emtricitabine, FTC); epivir (lamivudine, 3TC); epzicom (Livexa,
abacavir+lamivudine, ABC+3TC); retrovir (zidovudine, AZT, ZDV);
trizivir (abacavir+zidovudine+lamivudine, ABC+AZT+3TC); truvada
(tenofovir DF+emtricitabine, TDF+FTC); videx and videx EC
(didanosine, ddl); viread (tenofovir disoproxil fumarate, TDF);
zerit (stavudine, d4T); ziagen (abacavir, ABC); amadoxovir (AMDX,
DAPD); tenofovir alafenamide fumarate (TAF); non-nucleoside reverse
transcriptase inhibitors (NNRTIs) include edurant (rilpivirine,
RPV, TMC-278); intelence (etravirine, ETR, TMC-125); rescriptor
(delavirdine, DLV); sustiva (Stocrin, efavirenz, EFV); viramune and
viramune XR (nevirapine, NVP), lersivirine (UK-453061);
immune-based therapies include aralen (chloroquine phosphate),
dermaVir, interleukin-7, lexgenleucel-T (VRX-496), plaquenil
(hydroxychloroquine), proleukin (aldesleukin, IL-2), SB-782-T and
Vacc-4x; protease inhibitors such as aptivus (tipranavir, TPV),
crixivan (indinavir, IDV), invirase (saquinavir, SQV), kaletra
(Aluvia, lopinavir/ritonavir, LPV/r), lexiva (Telzir,
fosamprenavir, FPV), norvir (ritonavir, RTV), prezista (darunavir,
DRV), reyataz (atazanavir, ATV) and viracept (nelfinavir, NFV);
entry inhibitors (including fusion inhibitors) such as fuzeon
(enfuvirtide, ENF, T-20), selzentry (Celsentri, maraviroc, UK-427,
857), cenicriviroc (TBR-652, TAK-652), ibalizumab (TNX-355) and
PRO140; integrase inhibitors such as isentress (raltegravir,
MK-0518), tivicay (dolutegravir, S/GSK-572) and elvitegravir
(GS-9137); pharmacokinetic enhancers such as norvir (ritonavir,
RTV), cobicistat (GS-9350) and SPI-452; HIV vaccines such as
peptide vaccine, recombinant subunit protein vaccine, live vector
vaccine, DNA vaccine, viruls-like particle vaccine (pseudovirion
vaccine), vaccine combinations, rgp120 (AIDSVAX) (VAX003 and
VAX004), ALVAC HIV (vCP1521)/AIDSVAX B/E (gpl20) (RV144),
Adenovirus type 5 (Ad5)/gag/pol/nef (HVTN 502/Merck 023), Ad5
gag/pol/nef (HVTB 503) and DNA-Ad5 gag/pol/nef/nev (HVTN505);
combination therapy to elicit an immune response such as pegylated
interferon alfa, hydroxyurea, mycophenolate mofetil (MPA) and its
ester derivative mycophenolate mofetil (MMF); ribavirin, IL-2,
IL-12, polymer polyethyleneimine (PEI), or a combination thereof;
HIV-related opportunistic infection treatments such as
Co-trimoxazole; and alternative life-style combination therapy such
as acupuncture and exercise.
[0245] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with multi-class
combination drugs such as atripla
(efavirenz+tenofovir+emtricitabine); complera (eviplera,
rilpivirine+tenofovir+emtricitabine); stribild
(elvitegravir+cobicistat+tenofovir+emtricitabine); "572-Trii"
(dolutegravir+abacavir+lamivudine or DTG+ABC+3TC);
nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
include combivir (zidovudine+lamivudine, AZT+3TC); emtriva
(emtricitabine, FTC); epivir (lamivudine, 3TC); epzicom (Livexa,
abacavir+lamivudine, ABC+3TC); retrovir (zidovudine, AZT, ZDV);
trizivir (abacavir+zidovudine+lamivudine, ABC+AZT+3TC); truvada
(tenofovir DF+emtricitabine, TDF+FTC); videx and videx EC
(didanosine, ddl); viread (tenofovir disoproxil fumarate, TDF);
zerit (stavudine, d4T); ziagen (abacavir, ABC); amadoxovir (AMDX,
DAPD); tenofovir alafenamide fumarate (TAF); non-nucleoside reverse
transcriptase inhibitors (NNRTIs) include edurant (rilpivirine,
RPV, TMC-278); intelence (etravirine, ETR, TMC-125); rescriptor
(delavirdine, DLV); sustiva (Stocrin, efavirenz, EFV); viramune and
viramune XR (nevirapine, NVP), lersivirine (UK-453061);
immune-based therapies include aralen (chloroquine phosphate),
dermaVir, interleukin-7, lexgenleucel-T (VRX-496), plaquenil
(hydroxychloroquine), proleukin (aldesleukin, IL-2), SB-782-T and
Vacc-4x; protease inhibitors such as aptivus (tipranavir, TPV),
crixivan (indinavir, IDV), invirase (saquinavir, SQV), kaletra
(Aluvia, lopinavir/ritonavir, LPV/r), lexiva (Telzir,
fosamprenavir, FPV), norvir (ritonavir, RTV), prezista (darunavir,
DRV), reyataz (atazanavir, ATV) and viracept (nelfinavir, NFV);
entry inhibitors (including fusion inhibitors) such as fuzeon
(enfuvirtide, ENF, T-20), selzentry (Celsentri, maraviroc, UK-427,
857), cenicriviroc (TBR-652, TAK-652), ibalizumab (TNX-355) and
PRO140; integrase inhibitors such as isentress (raltegravir,
MK-0518), tivicay (dolutegravir, S/GSK-572) and elvitegravir
(GS-9137); pharmacokinetic enhancers such as norvir (ritonavir,
RTV), cobicistat (GS-9350) and SPI-452; HIV vaccines such as
peptide vaccine, recombinant subunit protein vaccine, live vector
vaccine, DNA vaccine, viruls-like particle vaccine (pseudovirion
vaccine), vaccine combinations, rgp120 (AIDSVAX) (VAX003 and
VAX004), ALVAC HIV (vCP1521)/AIDSVAX B/E (gpl20) (RV144),
Adenovirus type 5 (Ad5)/gag/pol/nef (HVTN 502/Merck 023), Ad5
gag/pol/nef (HVTB 503) and DNA-Ad5 gag/pol/nef/nev (HVTN505);
combination therapy to elicit an immune response such as pegylated
interferon alfa, hydroxyurea, mycophenolate mofetil (MPA) and its
ester derivative mycophenolate mofetil (MMF); ribavirin, IL-2,
IL-12, polymer polyethyleneimine (PEI), or a combination thereof;
HIV-related opportunistic infection treatments such as
Co-trimoxazole; or alternative life-style combination therapy such
as acupuncture and exercise.
[0246] In some embodiments, a covalent TEC family kinase inhibitor
is ibrutinib. In some embodiments, ibrutinib is administered in
combination with multi-class combination drugs such as atripla
(efavirenz+tenofovir+emtricitabine); complera (eviplera,
rilpivirine+tenofovir+emtricitabine); stribild
(elvitegravir+cobicistat+tenofovir+emtricitabine); "572-Trii"
(dolutegravir+abacavir+lamivudine or DTG+ABC+3TC);
nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
include combivir (zidovudine+lamivudine, AZT+3TC); emtriva
(emtricitabine, FTC); epivir (lamivudine, 3TC); epzicom (Livexa,
abacavir+lamivudine, ABC+3TC); retrovir (zidovudine, AZT, ZDV);
trizivir (abacavir+zidovudine+lamivudine, ABC+AZT+3TC); truvada
(tenofovir DF+emtricitabine, TDF+FTC); videx and videx EC
(didanosine, ddl); viread (tenofovir disoproxil fumarate, TDF);
zerit (stavudine, d4T); ziagen (abacavir, ABC); amadoxovir (AMDX,
DAPD); tenofovir alafenamide fumarate (TAF); non-nucleoside reverse
transcriptase inhibitors (NNRTIs) include edurant (rilpivirine,
RPV, TMC-278); intelence (etravirine, ETR, TMC-125); rescriptor
(delavirdine, DLV); sustiva (Stocrin, efavirenz, EFV); viramune and
viramune XR (nevirapine, NVP), lersivirine (UK-453061);
immune-based therapies include aralen (chloroquine phosphate),
dermaVir, interleukin-7, lexgenleucel-T (VRX-496), plaquenil
(hydroxychloroquine), proleukin (aldesleukin, IL-2), SB-782-T and
Vacc-4x; protease inhibitors such as aptivus (tipranavir, TPV),
crixivan (indinavir, IDV), invirase (saquinavir, SQV), kaletra
(Aluvia, lopinavir/ritonavir, LPV/r), lexiva (Telzir,
fosamprenavir, FPV), norvir (ritonavir, RTV), prezista (darunavir,
DRV), reyataz (atazanavir, ATV) and viracept (nelfinavir, NFV);
entry inhibitors (including fusion inhibitors) such as fuzeon
(enfuvirtide, ENF, T-20), selzentry (Celsentri, maraviroc, UK-427,
857), cenicriviroc (TBR-652, TAK-652), ibalizumab (TNX-355) and PRO
140; integrase inhibitors such as isentress (raltegravir, MK-0518),
tivicay (dolutegravir, S/GSK-572) and elvitegravir (GS-9137);
pharmacokinetic enhancers such as norvir (ritonavir, RTV),
cobicistat (GS-9350) and SPI-452; HIV vaccines such as peptide
vaccine, recombinant subunit protein vaccine, live vector vaccine,
DNA vaccine, viruls-like particle vaccine (pseudovirion vaccine),
vaccine combinations, rgp120 (AIDSVAX) (VAX003 and VAX004), ALVAC
HIV (vCP1521)/AIDSVAX B/E (gp120) (RV144), Adenovirus type 5
(Ad5)/gag/pol/nef (HVTN 502/Merck 023), Ad5 gag/pol/nef (HVTB 503)
and DNA-Ad5 gag/pol/nef/nev (HVTN505); combination therapy to
elicit an immune response such as pegylated interferon alfa,
hydroxyurea, mycophenolate mofetil (MPA) and its ester derivative
mycophenolate mofetil (MMF); ribavirin, IL-2, IL-12, polymer
polyethyleneimine (PEI), or a combination thereof; HIV-related
opportunistic infection treatments such as Co-trimoxazole; or
alternative life-style combination therapy such as acupuncture and
exercise for the treatment of an HIV infection. In some
embodiments, the covalent TEC family kinase inhibitor is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of an HIV
infection.
[0247] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of an influenza virus
infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the influenza virus infection. Exemplary
therapies for the treatment of an influenza virus infection
include, but are not limited to, antiviral drugs such as
neuraminidase inhibitors (e.g. oseltamivir, peramivir and
zanamivir) and admantanes (e.g. amantadine and rimantadine);
seasonal flu vaccines (antigens representing three (trivalent) or
four (quadrivalent) influenza virus strains) such as Flumist
Quadrivalent (MedImmune, Gaithersburg, Md.), Fluarix Quadrivalent
(Glaxo Smith Kline, Research Triangle Park, N.C.), Fluzone
Quadrivalent (Sanofi Pasteur, Swiftwater, Pa.), Flulaval
Quadrivalent, (ID Biomedical Corportation of Quebec/GlaxoSmith
Kline, Research Triangle Park, N.C.), Flucelvax (Novartis Vaccines
and Diagnostics, Cambridge, Mass.), and FluBlok (Protein Sciences,
Meriden, Conn.); and combination drugs for the treatment of
influenza including one or more immunomodulators such as immune
suppressors or enhancers and anti-inflammatory agents.
[0248] In certain embodiments, the anti-inflammatory agent can be
non-steroidal, steroidal, or a combination thereof. Representative
examples of non-steroidal anti-inflammatory agents include, but are
not limited to, oxicams, such as piroxicam, isoxicam, tenoxicam,
sudoxicam; salicylates, such as aspirin, disalcid, benorylate,
trilisate, safapryn, solprin, diflunisal, and fendosal; acetic acid
derivatives, such as diclofenac, fenclofenac, indomethacin,
sulindac, tolmetin, isoxepac, furofenac, tiopinac, zidometacin,
acematacin, fentiazac, zomepirac, clindanac, oxepinac, felbinac,
and ketorolac; fenamates, such as mefenamic, meclofenamic,
flufenamic, nifiumic, and tolfenamic acids; propionic acid
derivatives, such as ibuprofen, naproxen, benoxaprofen,
flurbiprofen, ketoprofen, fenoprofen, fenbufen, indopropfen,
pirprofen, carprofen, oxaprozin, pranoprofen, miroprofen,
tioxaprofen, suprofen, alminoprofen, and tiaprofenic; pyrazoles,
such as phenylbutazone, oxyphenbutazone, feprazone, azapropazone,
and trimethazone. Representative examples of steroidal
anti-inflammatory drugs include, without limitation,
corticosteroids such as hydrocortisone, hydroxyl-triamcinolone,
alpha-methyl dexamethasone, dexamethasone-phosphate, beclomethasone
dipropionates, clobetasol valerate, desonide, desoxymethasone,
desoxycorticosterone acetate, dexamethasone, dichlorisone,
diflorasone diacetate, diflucortolone valerate, fluadrenolone,
fluclorolone acetonide, fludrocortisone, flumethasone pivalate,
fluosinolone acetonide, fluocinonide, flucortine butylesters,
fluocortolone, fluprednidene (fluprednylidene) acetate,
flurandrenolone, halcinonide, hydrocortisone acetate,
hydrocortisone butyrate, methylprednisolone, triamcinolone
acetonide, cortisone, cortodoxone, flucetonide, fludrocortisone,
difluorosone diacetate, fluradrenolone, fludrocortisone,
diflurosone diacetate, fluradrenolone acetonide, medrysone,
amcinafel, amcinafide, betamethasone and the balance of its esters,
chloroprednisone, chlorprednisone acetate, clocortelone,
clescinolone, dichlorisone, diflurprednate, flucloronide,
flunisolide, fluoromethalone, fluperolone, fluprednisolone,
hydrocortisone valerate, hydrocortisone cyclopentylpropionate,
hydrocortamate, meprednisone, paramethasone, prednisolone,
prednisone, beclomethasone dipropionate, triamcinolone, and
mixtures thereof.
[0249] In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with antiviral drugs such
as neuraminidase inhibitors (e.g. oseltamivir, peramivir and
zanamivir) and admantanes (e.g. amantadine and rimantadine);
seasonal flu vaccines (antigens representing three (trivalent) or
four (quadrivalent) influenza virus strains) such as Flumist
Quadrivalent (MedImmune, Gaithersburg, Md.), Fluarix Quadrivalent
(Glaxo Smith Kline, Research Triangle Park, N.C.), Fluzone
Quadrivalent (Sanofi Pasteur, Swiftwater, Pa.), Flulaval
Quadrivalent, (ID Biomedical Corportation of Quebec/GlaxoSmith
Kline, Research Triangle Park, N.C.), Flucelvax (Novartis Vaccines
and Diagnostics, Cambridge, Mass.), and FluBlok (Protein Sciences,
Meriden, Conn.); or combination drugs for the treatment of
influenza including one or more immunomodulators such as immune
suppressors or enhancers and anti-inflammatory agents.
[0250] In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with antiviral drugs such as
neuraminidase inhibitors (e.g. oseltamivir, peramivir and
zanamivir) and admantanes (e.g. amantadine and rimantadine);
seasonal flu vaccines (antigens representing three (trivalent) or
four (quadrivalent) influenza virus strains) such as Flumist
Quadrivalent (MedImmune, Gaithersburg, Md.), Fluarix Quadrivalent
(Glaxo Smith Kline, Research Triangle Park, N.C.), Fluzone
Quadrivalent (Sanofi Pasteur, Swiftwater, Pa.), Flulaval
Quadrivalent, (ID Biomedical Corportation of Quebec/GlaxoSmith
Kline, Research Triangle Park, N.C.), Flucelvax (Novartis Vaccines
and Diagnostics, Cambridge, Mass.), and FluBlok (Protein Sciences,
Meriden, Conn.); or combination drugs for the treatment of
influenza including one or more immunomodulators such as immune
suppressors or enhancers and anti-inflammatory agents for the
treatment of an influenza infection. In some embodiments, the
covalent TEC family kinase inhibitor is administered sequentially,
simultaneously, or intermittently with the one or more therapies
for the treatment of an influenza infection.
[0251] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a measles virus infection.
In some embodiments, a covalent TEC family kinase inhibitor is
administered in combination with one or more therapies for the
treatment of the measles virus infection. Exemplary therapies for
the treatment of a measles virus infection include, but are not
limited to the measles vaccination and immune serum globulin. In
some embodiments, the covalent TEC family kinase inhibitor is
administered in combination with the measles vaccination and immune
serum globulin for the treatment of a measles virus infection. In
some embodiments, the covalent TEC family kinase inhibitor is
ibrutinib. In some embodiments, ibrutinib is administered in
combination with the measles vaccination and immune serum globulin
for the treatment of a measles virus infection. In some
embodiments, the covalent TEC family kinase inhibitor is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of a measles virus
infection.
[0252] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a Human papilloma virus
(HPV) infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the HPV infection. Exemplary therapies for the
treatment of a HPV infection include, but are not limited to,
podofilox or imiquimod. In some embodiments, the covalent TEC
family kinase inhibitor is administered in combination with
podofilox or imiquimod for the treatment of a HPV infection. In
some embodiments, the covalent TEC family kinase inhibitor is
ibrutinib. In some embodiments, ibrutinib is administered in
combination with podofilox or imiquimod for the treatment of a HPV
infection. In some embodiments, the covalent TEC family kinase
inhibitor is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
a HPV infection.
[0253] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a Human herpesvirus 6A
(HHV-6A), Human herpesvirus 6B (HHV-6B), or Human herpesvirus 7
(HHV-7) infection. In some embodiments, a covalent TEC family
kinase inhibitor is administered in combination with one or more
therapies for the treatment of the HHV-6A, HHV-6B, or HHV-7
infection. Exemplary therapies for the treatment of a HHV-6A,
HHV-6B, or HHV-7 infection include, but are not limited to,
valganciclovir, ganciclovir, cidofovir, and foscarnet. In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with valganciclovir, ganciclovir,
cidofovir, or foscarnet for the treatment of a HHV-6A, HHV-6B, or
HHV-7 infection. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with valganciclovir, ganciclovir,
cidofovir, or foscarnet for the treatment of a HHV-6A, HHV-6B, or
HHV-7 infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
a HHV-6A, HHV-6B, or HHV-7 infection.
[0254] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a Herpes Simplex virus
(HSV) infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the HSV infection. Exemplary therapies for the
treatment of a HSV infection include, but are not limited to,
acyclovir, famciclovir, and valacyclovir. In some embodiments, the
covalent TEC family kinase inhibitor is administered in combination
with acyclovir, famciclovir, and valacyclovir for the treatment of
a HSV infection. In some embodiments, the covalent TEC family
kinase inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with acyclovir, famciclovir, or
valacyclovir for the treatment of a HSV infection. In some
embodiments, the covalent TEC family kinase inhibitor is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of a HSV infection.
[0255] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of an Epstein-Bar virus (EBV)
infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the EBV infection. Exemplary therapies for the
treatment of an EBV infection include, but are not limited to
acyclovir, ganciclovir, and foscarnet. In some embodiments, the
covalent TEC family kinase inhibitor is administered in combination
with acyclovir, ganciclovir, or foscarnet for the treatment of an
EBV infection. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. In some embodiments, ibrutinib is
administered in combination with acyclovir, ganciclovir, and
foscarnet for the treatment of an EBV infection. In some
embodiments, the covalent TEC family kinase inhibitor is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of an EBV
infection.
[0256] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a Human cytomegalovirus
(HCMV) infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the HCMV infection. Exemplary therapies for
the treatment of a HCMV infection include, but are not limited to
ganciclovir, valganciclovir, foscarnet, cidofovir, maribavir, and
leflunomide. In some embodiments, the covalent TEC family kinase
inhibitor is administered in combination with ganciclovir for the
treatment of a HCMV infection. In some embodiments, the covalent
TEC family kinase inhibitor is ibrutinib. In some embodiments,
ibrutinib is administered in combination with ganciclovir,
foscarnet, cidofovir, maribavir, or leflunomide for the treatment
of a HCMV infection. In some embodiments, the covalent TEC family
kinase inhibitor is administered sequentially, simultaneously, or
intermittently with the one or more therapies for the treatment of
HCMV.
[0257] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a Rous sarcoma virus (RSV)
infection. In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of the RSV infection. Exemplary therapies for the
treatment of an RSV infection include, but are not limited to, a
nucleoside analog, such as ribavirin, administration of intravenous
infusion of immunoglobulin, administration of supplemental oxygen
and fluids or assisted breathing, anti-RSV antibodies (e.g.
palivizumab), antisense nucleic acids, one or more agents that
regulate lung maturation and surfactant protein expression, such
as, but not limited to, glucocorticoids, PPARy ligands, and
vascular endothelial cell growth factor (VEGF). In some
embodiments, the covalent TEC family kinase inhibitor is
administered in combination with ribavirin or an anti-RSV antibody
for the treatment of an RSV infection. In some embodiments, the
covalent TEC family kinase inhibitor is ibrutinib. In some
embodiments, ibrutinib is administered in combination with
ribavirin or an anti-RSV antibody for the treatment of RSV. In some
embodiments, the covalent TEC family kinase inhibitor is
administered sequentially, simultaneously, or intermittently with
the one or more therapies for the treatment of RSV.
[0258] In some embodiments, a covalent TEC family kinase inhibitor
is administered for adjuvant therapy of a chronic granulomatous
disease (CGD). In some embodiments, a covalent TEC family kinase
inhibitor is administered in combination with one or more therapies
for the treatment of CGD, such as for example, one or more
therapies for the prophylaxis or treatment of pathogenic infections
associated with CGD. Exemplary therapies for the treatment of CGD
include, but are not limited to, administration of an antiviral,
antibacterial, antifungal, or antiparasitic agent for the
prophylaxis or treatment of pathogenic infections associated with
CGD. Exemplary antiviral, antibacterial, antifungal, or
antiparasitic agents are provided elsewhere herein and can be used
in combination with a TEC family kinase inhibitor for the
prophylaxis or treatment of pathogenic infections associated with
CGD. In some embodiments, the covalent TEC family kinase inhibitor
is administered in combination with gamma-interferon for the
prophylaxis or treatment of pathogenic infections associated with
CGD. In some embodiments, the covalent TEC family kinase inhibitor
is ibrutinib. In some embodiments, ibrutinib is administered in
combination with gamma-interferon for the prophylaxis or treatment
of pathogenic infections associated with CGD. In some embodiments,
the covalent TEC family kinase inhibitor is administered
sequentially, simultaneously, or intermittently with the one or
more therapies for the treatment of CGD.
[0259] In some embodiments, the patient has disease or condition
characterized by a defective Th1 response. In some embodiments, the
patient having disease or condition characterized by a defective
Th1 response is administered a TEC family kinase inhibitor for
adjuvant therapy of the disease or disorder. In some embodiments,
the patient having disease or condition characterized by a
defective Th1 response is administered a TEC family kinase
inhibitor in combination with one or more therapies for the
treatment of the disease or disorder, such as for example, one or
more therapies for the prophylaxis or treatment of pathogenic
infections associated with a disease or condition characterized by
a defective Th1 response. Exemplary therapies for the treatment of
disease or condition characterized by a defective Th1 response
include, but are not limited to, administration of an antiviral,
antibacterial, antifungal, or antiparasitic agent for the
prophylaxis or treatment of pathogenic infections associated with
the disease or condition characterized by a defective Th1 response.
Exemplary antiviral, antibacterial, antifungal, or antiparasitic
agents are provided elsewhere herein and can be used in combination
with a TEC family kinase inhibitor for the prophylaxis or treatment
of pathogenic infections associated with a disease or condition
characterized by a defective Th1 response. In some embodiments, the
covalent TEC family kinase inhibitor is administered in combination
with gamma-interferon for the prophylaxis or treatment of
pathogenic infections associated with a disease or condition
characterized by a defective Th1 response. In some embodiments, the
covalent TEC family kinase inhibitor is ibrutinib. In some
embodiments, ibrutinib is administered in combination with
gamma-interferon for the prophylaxis or treatment of pathogenic
infections associated with a disease or condition characterized by
a defective Th1 response. In some embodiments, the covalent TEC
family kinase inhibitor is administered sequentially,
simultaneously, or intermittently with the one or more therapies
for the treatment of a disease or condition characterized by a
defective Th1 response. In some embodiments, the patient having a
disease or condition characterized by a defective Th1 response has
a defect in Th1 cytokine production or a Th1 cytokine receptor,
such as, for example, a defect in IFN-.gamma., IL-12 or IL-12
receptor. In some embodiments, disease or condition characterized
by a defective Th1 response is secondary to a cancer in the patient
(e.g. leukemia, lymphoma or a myeloma).
[0260] In some embodiments, the patient has disease or condition
characterized by an overactive Th2 response. In some embodiments,
the patient having disease or condition characterized by a an
overactive Th2 response is administered a TEC family kinase
inhibitor for adjuvant therapy of the disease or disorder. In some
embodiments, the patient having disease or condition characterized
by an overactive Th2 response is administered a TEC family kinase
inhibitor in combination with one or more therapies for the
treatment of the disease or disorder, such as for example, one or
more therapies for the prophylaxis or treatment of pathogenic
infections associated with a disease or condition characterized by
an overactive Th2 response. Exemplary therapies for the treatment
of disease or condition characterized by an overactive Th2 response
include, but are not limited to, administration of an antiviral,
antibacterial, antifungal, or antiparasitic agent for the
prophylaxis or treatment of pathogenic infections associated with
the disease or condition characterized by an overactive Th2
response. Exemplary antiviral, antibacterial, antifungal, or
antiparasitic agents are provided elsewhere herein and can be used
in combination with a TEC family kinase inhibitor for the
prophylaxis or treatment of pathogenic infections associated with a
disease or condition characterized by an overactive Th2 response.
In some embodiments, the covalent TEC family kinase inhibitor is
administered in combination with gamma-interferon for the
prophylaxis or treatment of pathogenic infections associated with a
disease or condition characterized by an overactive Th2 response.
In some embodiments, the covalent TEC family kinase inhibitor is
ibrutinib. In some embodiments, ibrutinib is administered in
combination with gamma-interferon for the prophylaxis or treatment
of pathogenic infections associated with a disease or condition
characterized by an overactive Th2 response. In some embodiments,
the covalent TEC family kinase inhibitor is administered
sequentially, simultaneously, or intermittently with the one or
more therapies for the treatment of a disease or condition
characterized by an overactive Th2 response. In some embodiments,
disease or condition characterized by an overactive Th2 response is
secondary to a cancer in the patient (e.g. leukemia, lymphoma or a
myeloma). In some embodiments, disease or condition characterized
by an overactive Th2 response is an inflammatory or autoimmune
disease.
[0261] In some embodiments, the covalent TEC family kinase
inhibitor inhibits the kinase activity of one or more members of
the TEC family of kinases (e.g. ITK, BTK, TEC, RLK and BMX). In
some embodiments, the covalent TEC family kinase inhibitor inhibits
the kinase activity of IL2-inducible T-cell kinase (ITK). In some
embodiments, the covalent TEC family kinase inhibitor covalently
binds to Cysteine 442 of ITK. In some embodiments, the covalent TEC
family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-263, AVL-291,
AVL-292, ONO-WG-37, BMS-488516, BMS-509744, CGI-1746, CTA-056,
GDC-0834, HY-11066 (also, CTK417891, HMS3265G21, HMS3265G22,
HMS3265H21, HMS3265H22, 439574-61-5, AG-F-54930), ONO-4059,
ONO-WG37, PLS-123, RN486, HM71224, or a combination thereof. In
some embodiments, the covalent TEC family kinase inhibitor is
ibrutinib. Additional covalent TEC family kinase inhibitors for use
in any of the methods provided herein are found, for example, in
U.S. Pat. Nos. 7,547,689, 7,960,396 and U.S. Patent Publication
Nos. US 2009-0197853 A1 and US 2012-0065201 A1, all of which are
incorporated by reference in their entirety.
[0262] In some embodiments, administration of a covalent TEC family
kinase inhibitor decreases the number of Th2 polarized T cells in
the subject. In some embodiments, administration of a covalent TEC
family kinase inhibitor increases the number of Th1 polarized T
cells in the subject. In some embodiments, administration of a
covalent TEC family kinase inhibitor increases the ratio of Th1
polarized T cells to Th2 polarized T cells in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor increase the number of cytotoxic CD8+ T cells in the
subject. In some embodiments, administration of a covalent TEC
family kinase inhibitor decreases the expression of one or more Th2
cytokines in the subject. In some embodiments, administration of a
covalent TEC family kinase inhibitor decreases IL-4, IL-5, IL-6,
L-9, IL-10 or IL-13 expression in the subject. In some embodiments,
administration of a covalent TEC family kinase inhibitor increases
the expression of one or more Th1 cytokines in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor increases L-2, GM-CSF, IFN-.gamma., IL-12(p70), IL-18 and
TNF-.alpha. expression in the subject.
[0263] Adjuvant for Vaccination
[0264] Described herein, in certain embodiments, are methods of
adjuvant therapy to improve vaccine efficacy by administering to a
subject an effective amount of a covalent TEC family kinase
inhibitor in combination with a vaccine.
[0265] In some embodiments, the enhancing the efficacy of said
adjuvant therapy comprises increasing the rate at which the viral
load of a patient reduced measured during the administration of the
course of adjuvant therapy as compared to the viral reduction rate
achieved by administering either of said vaccine or said course of
adjuvant therapy alone. In some embodiments, the increase in a rate
at which the viral load of a patient is reduced during the
administration of the course of adjuvant therapy as compared to the
viral reduction rate achieved by administering of either vaccine or
the course of adjuvant therapy alone is at least about 1%, 5%, 10%,
15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%,
80%, 85%, 90%, 95%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%,
180%, 190%, 200%. In some embodiments, the rate at which the viral
load of a patient is reduced during the administration of the
course of adjuvant therapy is higher than the viral reduction rate
achieved by administering of lectin affinity hemodialysis treatment
alone combined with the viral load reduction rate achieved by
administering the course of adjuvant therapy alone by a percentage
of at least about 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%,
50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 100%, 110%, 120%,
130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%. In some
embodiments, the rate at which the viral load of a patient is
reduced during the administration of the course of adjuvant therapy
is at least about 99%, 98%, 97%, 96%, 95%, 90%, 85%, 80%, 75%, 70%,
65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%, 25%, 20%, 15%, 10%, 9%, 8%,
7%, 6%, 5%, 4%, 3%, 2%, or 1% per hour, per 8 hours, per 12 hours,
or per day.
[0266] In some embodiments, enhancing the efficacy of said adjuvant
therapy is achieved by reducing the amount of time required to
achieve a clinically relevant viral load in the patient during the
administration of the course of adjuvant therapy as compared to
administering of either said vaccine treatment or said course of
adjuvant therapy alone. In some embodiments, the clinically
relevant viral load is less than about 100000, 90000, 80000, 70000,
60000, 50000, 40000, 30000, 20000, 10000, 9000, 8000, 7000, 6000,
5000, 4000, 3000, 2000, 1000, 900, 800, 700, 600, 500, 400, 300,
200, 100, 90, 80, 70, 60, 50, 40, 30, 20, 10, 9, 8, 7, 6, 5, 4, 3,
2, or 1 copies/ml. In some embodiments, the amount of time required
to achieve the clinically relevant viral load compared to
administration of either vaccine or the course of adjuvant therapy
alone is reduced by at least about 99%, 98%, 97%, 96%, 95%, 90%,
85%, 80%, 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%, 25%,
20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, or 1%. In some
embodiments, the amount of time required to achieve the clinically
relevant viral load is less than about 36, 35, 34, 32, 31, 30, 29,
28, 27, 26, 25, 24, 23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, or
12 months, or 56, 55, 50, 45, 40, 35, 30, 29, 28, 27, 26, 25, 24,
23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6,
5, or 4 weeks, or 28, 27, 26, 25, 24, 23, 22, 21, 20, 19, 18, 17,
16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2 or 1 days.
[0267] In some embodiments, the covalent TEC family kinase
inhibitor is administered sequentially, simultaneously or
intermittently with the vaccine. In some embodiments, the covalent
TEC family kinase inhibitor is administered prior to or following
administration of the vaccine. In some embodiments, the covalent
TEC family kinase inhibitor and the vaccine are administered as a
single composition. In some embodiments, the covalent TEC family
kinase inhibitor and the vaccine are administered as separate
compositions. In some embodiments, the covalent TEC family kinase
inhibitor and the vaccine are administered by the same route of
administration. In some embodiments, the covalent TEC family kinase
inhibitor and the vaccine are administered by the different routes
of administration. In some embodiments, the vaccine is administered
by any suitable method, such as, but not limited to, intramuscular,
subcutaneous, intranasal, oral, intradermal, transcutaneous, or
transdermal administration.
[0268] In some embodiments, the covalent TEC family kinase
inhibitor and the vaccine are administered simultaneously,
sequentially, or intermittently.
[0269] In some embodiments, the vaccine is an anticancer vaccine.
In some embodiments, the cancer vaccine comprises one or more
cancer or tumor antigens for immunization. In some embodiments, the
cancer antigen is, but is not limited to, acute lymphoblastic
leukemia (etv6, amll, cyclophilin b), B cell lymphoma
(Ig-idiotype), glioma (E-cadherin, a-catenin, P-catenin, y-catenin,
pl20ctn), bladder cancer (p21ras), biliary cancer (p21ras), breast
cancer (MUC family, HER2/neu, c-erbB-2), cervical carcinoma (p53,
p21ras), colon carcinoma (p21ras, HER2/neu, c-erbB-2, MUC family),
colorectal cancer (Colorectal associated antigen
(CRC)-C017-1A/GA733, APC), choriocarcinoma (CEA), epithelial cell
cancer (cyclophilin b), gastric cancer (HER2/neu, c-erbB-2, ga733
glycoprotein), hepatocellular cancer (a-fetoprotein), Hodgkins
lymphoma (lmp-1, EBNA-1), lung cancer (CEA, MAGE-3, NY-ESO-1),
lymphoid cell-derived leukemia (cyclophilin b), melanoma (p15
protein, gp75, oncofetal antigen, GM2 and GD2 gangliosides,
Melan-A/MART-1, cdc27, MAGE-3, p21ras, gplOO"), myeloma (MUC
family, p21ras), non-small cell lung carcinoma (HER2/neu,
c-erbB-2), nasopharyngeal cancer (lmp-1, EBNA-1), ovarian cancer
(MUC family, HER2/neu, c-erbB-2), prostate cancer (Prostate
Specific Antigen (PSA) and its antigenic epitopes PSA-1, PSA-2, and
PSA-3, PSMA, HER2/neu, c-erbB-2, ga733 glycoprotein), renal cancer
(HER2/neu, c-erbB-2), squamous cell cancers of the cervix and
esophagus (viral products such as human papilloma virus proteins),
testicular cancer (NY-ESO-1), and T cell leukemia (HTLV-1
epitopes).
[0270] In some embodiments, the vaccine is an antivirus vaccine. In
some embodiments, the cancer vaccine comprises one or more viral
antigens for immunization. In some embodiments, the vaccine
comprises an attenuated virus or inactivated virus. In some
embodiments, the vaccine is an adenovirus, measles, mump, rabies,
rotavirus, yellow fever virus, varicella virus, rubella, polio,
hepatitis A virus, hepatitis B virus, hepatitis C virus, human
papilloma virus, human immunodeficiency virus, human herpesvirus,
herpes simplex virus, Epstein-Bar virus, human cytomegalovirus,
Rous sarcoma virus, smallpox virus or influenza virus vaccine.
[0271] In some embodiments, the vaccine is an antibacterial
vaccine. In some embodiments, the cancer vaccine comprises one or
more bacterial antigens for immunization. In some embodiments, the
vaccine comprises attenuated bacteria or killed bacteria. In some
embodiments, the vaccine comprises a toxin produced by the
bacterium. In some embodiments, the vaccine comprises diphtheria,
anthrax, pertussis, meningococcal, typhoid, pneonocaccal or tetanus
vaccine.
[0272] In some embodiments, administration of a covalent TEC family
kinase inhibitor decreases the number of Th2 polarized T cells in
the subject. In some embodiments, administration of a covalent TEC
family kinase inhibitor increases the number of Th1 polarized T
cells in the subject. In some embodiments, administration of a
covalent TEC family kinase inhibitor increases the ratio of Th1
polarized T cells to Th2 polarized T cells in the subject. In some
embodiments, administration of a covalent TEC family kinase
inhibitor decreases the expression of one or more Th2 cytokines in
the subject. In some embodiments, administration of a covalent TEC
family kinase inhibitor decreases IL-10, IL-2 or IL-13 expression
in the subject. In some embodiments, administration of a covalent
TEC family kinase inhibitor increases the expression of one or more
Th1 cytokines in the subject. In some embodiments, administration
of a covalent TEC family kinase inhibitor increases IL-2, GM-CSF,
IFN-.gamma., IL-12(p70) and TNF-.alpha. expression in the subject.
In some embodiments, administration of a covalent TEC family kinase
inhibitor increase the number of cytotoxic CD8+ T cells in the
subject.
[0273] In some embodiments, after administration of a covalent TEC
family kinase inhibitor the profiles of Th1 and Th2 polarized T
cells are examined. In some embodiments, the profiles of Th1 and
Th2 polarized T cells are examined along with a third subset of T
helper cells, Th17 polarized T cells. In some embodiments, after
administration of a covalent TEC family kinase inhibitor Th1 and
Th2 related markers are examined. In some embodiments, after
administration of a covalent TEC family kinase inhibitor Th1, Th2
and Th17 related markers are examined. In some embodiments, Th1
related markers include IL-2, GM-CSF, IFN-.gamma., IL-12(p70) and
TNF-.alpha.. In some embodiments, Th2 related markers include
IL-10, IL-4 or IL-13. In some embodiments, Th17 related markers
include IL17.
[0274] In some embodiments, the covalent TEC family kinase
inhibitor inhibits the kinase activity of one or more members of
the TEC family of kinases (e.g. ITK, BTK, TEC, RLK and BMX). In
some embodiments, the covalent TEC family kinase inhibitor inhibits
the kinase activity of IL2-inducible T-cell kinase (ITK). In some
embodiments, the covalent TEC family kinase inhibitor covalently
binds to Cysteine 442 of ITK. In some embodiments, the covalent TEC
family kinase inhibitor is selected from among ibrutinib
(PCI-32765), PCI-45292, PCI-45466, AVL-101, AVL-291, AVL-292, or
ONO-WG-37. In some embodiments, the covalent TEC family kinase
inhibitor is ibrutinib. Additional covalent TEC family kinase
inhibitors for use in any of the methods provided herein are found,
for example, in U.S. Pat. Nos. 7,547,689, 7,960,396 and U.S. Patent
Publication Nos. US 2009-0197853 A1 and US 2012-0065201 A1, all of
which are incorporated by reference in their entirety.
[0275] In some embodiments, the vaccine is administered in
combination with a covalent TEC family kinase inhibitor and one or
more additional adjuvants. In some embodiments, the one or more
additional adjuvants improve the efficacy of the vaccine compared
to the absence of the additional adjuvant. In some embodiments, the
one or more additional adjuvants induces a Th1 polarized response,
decreases a Th2 polarized response, improves antigen presentation
on effector cells, induces CD8+ cytotoxic T cells, improves
delivery of antigen to immune effector cells, and/or provide short
term or long term depot delivery. In some embodiments, the one or
more additional adjuvants include, but are not limited to, aluminum
salts (e.g. aluminum hydroxide, aluminum phosphate or alum), water
in oil emulsions (e.g. microdroplets of water stabilized by a
surfactant (e.g. mannide monooleate, Freund's Incomplete Adjuvant
(IFA), and MF59) in a continuous oil phase (e.g. mineral oil,
squalene or squalane), oil in water emulsions, immune stimulating
conlexes (e.g. ISCOM adjuvant-Iscotec AB), liposomes, nano- or
microparticles, calcium salts, proteases, virosomes, stearyl
tyrosine, .gamma.-inulin, algammulin, muramyl dipeptides (MDP)
(e.g. N-acetyle muramyl-L-alanyl-D-isoglutamine) and derivatives
thereof (e.g. threonyl MDP, murabutide, N-acetylglucosaminyl-MDP,
GMDP, merametide, and nor-MDP), non-ionic block copolymers (e.g.
hydrophobic polyoxypropylene (POP)), saponins (e.g. QuilA,
Spikoside, QS21 (Stimulon) and ISCOPREP703), lipid A (MPL),
cytokines (e.g. IL-1, IFN-.gamma., IL-2, and IL-12), carbohydrate
polymers (e.g. mannose polymers (e.g. mannan), glucan, acemannan
and lentinan), derivatized polysaccharides (e.g. dectrins,
diethylaminoethyl dextran), pattern recognition receptor (PRR)
ligands, Toll-like receptor ligands (TLRs) (e.g. double stranded
RNAs, poly (I:C), lipopolysacharides, monophosphoryl lipid A,
bacterial flagellin, imadazoquinolines, imiquimod, gardiquimod,
R848, CpG oligodepxynucleotides, such as ODN1826 and ODB2006),
Nod-like receptor (NLR) ligands (e.g. MDP), RIG-I-like receptor
(RLR) ligands), and C-type lectin recptor (CLR) ligands.
[0276] In some embodiments, the subject for immunization is a
mammal, such as, but not limited to a human, a non-human primate,
mouse, rat, rabbit, goat, dog, cat, or cow. In some embodiments,
the mammal is a human.
Kits and Articles of Manufacture
[0277] For use in the diagnostic and therapeutic applications
described herein, kits and articles of manufacture are also
described herein. Such kits comprise a carrier, package, or
container that is compartmentalized to receive one or more
containers such as vials, tubes, and the like, each of the
container(s) comprising one of the separate elements to be used in
a method described herein. Suitable containers include, for
example, bottles, vials, syringes, and test tubes. The containers
are formed from any acceptable material including, e.g., glass or
plastic.
[0278] In some embodiments, the container(s) comprise one or more
covalent TEC family kinase inhibitors in a composition or in
combination with another therapeutic agent as disclosed herein. The
container(s) optionally have materials, such as syringes, needles,
dosing cups or vials, for administration. Such kits optionally
comprise a compound with an identifying description or label or
instructions relating to its use in the methods described
herein.
EXAMPLES
[0279] These examples are provided for illustrative purposes only
and not to limit the scope of the claims provided herein.
Example 1
[0280] T-lymphocytes comprise an indispensable component of the
adaptive immune response, yet certain autoimmune, infectious,
parasitic, and neoplastic diseases subvert adaptive immunity by
specifically misdirecting T-helper cell polarity. A common
mechanism of immune subversion is the aberrant recruitment of a Th2
dominant response that directly promotes B-cell antibody production
and interferes with direct effector cell cytotoxicity. In contrast,
a Th1 dominant response evokes cytotoxic effects with the
production of IFN.gamma. and IL2, which contribute to effector
cell-based immune surveillance. Clearance of certain intracellular
bacterial pathogens such as Listeria and parasites such as
Leishmania, as well as tumor immune surveillance, hinge upon the
capacity to elicit robust Th1 and CD8 T-cell responses.
[0281] Interleukin-2 Inducible Kinase (ITK) is a T-cell dominant
member of the covalent Tec-kinase family that drives proximal
T-cell receptor (TCR) signaling. Upon TCR ligation in Th1 and CD8
T-cells, ITK and redundant resting lymphocyte kinase (RLK or TXK)
activate PLC.gamma., launching a signaling cascade that includes
the NFAT, NF.kappa.B, and MAPK pathways resulting in cellular
activation, cytokine release, and rapid proliferation. Importantly
ITK plays a supportive yet dispensable role to RLK in Th1 polarized
and CD8 effector cells. However, the epigenetic evolution of Th2
cells conserves a singular dominant role for ITK, pinning it as the
Achilles heel of Th2 T-cells. Clinically applicable ITK-specific
inhibitors are sought by the medical community, given the potential
to specifically inhibit a number of Th2 dominant autoimmune,
inflammatory, and infectious diseases ranging from atopic
dermatitis to inflammatory bowel disease to cancer
immunosuppression and even HIV/AIDS. Although multiple chemical
analogs have been reported, none have successfully transitioned
into clinical trials. Ibrutinib is an irreversible inhibitor of
Bruton's tyrosine kinase (BTK) that blocks downstream B-cell
receptor (BCR) activation. Numerous in vitro and in vivo studies
confirm the specific activity of ibrutinib against BTK restricted
targets. Ibrutinib has demonstrated clinical activity in phase I/II
clinical trials, with durable remissions against a variety of
B-cell malignancies including mantle cell lymphoma, follicular
lymphoma, and chronic lymphocytic leukemia (CLL). Intriguingly, ITK
shares significant sequence and functional homology with BTK and
both contain an ibrutinib inhibition motif consisting of an SH3
autophosphorylatable Tyrosine (Tyr) and a covalent binding Cysteine
(Cys) residue within the hinge region connecting the C and N lobes
of the active site. ITK had previously been discounted as a
relevant target of ibrutinib given a subdued in vitro kinase
inhibition profile and a lack of sufficient in vitro evidence. The
striking homology between BTK and ITK combined with intriguing in
silico docking studies and promising in vitro kinase inhibition
profiles led to the hypothesis that ibrutinib is the first
clinically viable irreversible ITK inhibitor. This was explored
using healthy human T-cells and human and murine CLL as a model
system of dysregulated Th2-biased immunosuppression. In CLL, an
increasingly defective immune synapse enables malignant B-cells to
evade immune detection by inducing T-cell anergy as well as
improper Th2 polarization. In addition to being incapable of
responding to environmental pathogens, these improperly polarized
T-cells contribute both cytokine and direct signaling support to
malignant B-cells. The end result of this immunosuppression is a
high incidence of severe infections which often leads to patient
mortality.
[0282] Here, detailed molecular analysis confirms that ibrutinib
irreversibly binds ITK at Cys442 and inhibits downstream activation
of Th2 cells after TCR stimulation. This inhibition is specific to
Th2 polarized CD4 T-cells, as RLK remains uninhibited by ibrutinib
thus providing a compensatory platform for activation and
proliferation of Th1 and CD8 T-cells. These data demonstrate that
CD4 T-cell populations isolated from CLL patients are skewed at a
molecular and phenotypic level towards a Th1 profile after brief
exposure to ibrutinib. Findings were validated using mouse models
of leukemia, cutaneous leishmaniasis, and Listeria monocytogenes
infection. ITK inhibition in humans was confirmed using
irreversible ITK binding, cytokine, and T-cell signaling analysis
from CLL patients treated with ibrutinib in a phase I clinical
trial. Together, these results demonstrate that ibrutinib is the
first potent and selective irreversible inhibitor of ITK to achieve
clinical viability, potentially repurposing the drug for a
multitude of novel therapeutic applications.
[0283] Methods:
[0284] Subject Populations
[0285] Sera and peripheral blood mononuclear cells (PBMCs) were
obtained from normal donors or patients with CLL in accordance with
the Declaration of Helsinki. All subjects gave written, informed
consent for their blood products to be used for research under an
institutional review board (IRB)-approved protocol. Blood was
collected at The Ohio State University Wexner Medical Center
(Columbus, Ohio). PBMCs were used fresh or stored in 1 ml aliquots
at -140.degree. C. and sera were stored in aliquots at -80.degree.
C. until used.
[0286] Cell Culture, Drug Treatments, and T Cell Polarization
[0287] Primary T-cells were isolated using RosetteSep untouched CD3
or CD4 selection, EasySep Naive CD4+ T cell enrichment kits
(STEMCELL Technologies, Vancouver, BC, Canada) or magnetic
separation (MACS Human CD8+ microbeads, Miltenyi, Auburn, Calif.)
according to the manufacturer's protocol. Cells were cultured in
vitro at 37.degree. C. and 5% CO2 using RPMI1640/10% fetal calf
serum. Cells were pretreated for 30 minutes with Ibrutinib, washed
2.times., then stimulated with plate-bound anti-CD3 and soluble
anti-CD28 (eBiosciences, San Diego, Calif.). Nuclear and
cytoplasmic lysates (NEN-PER kit, Thermo, Rockford, Ill.) were
collected after 45 minutes and whole cell lysates were collected at
2 hours. Th1 and Th2 polarized primary CD4 T-cells were generated
according to our previously published methodology. In brief,
T-cells were obtained from magnetically purified naive human CD4 T
cells. Cells were stimulated weekly with plate-bound anti-CD3,
soluble anti-CD28, and IL-2 (20 U/ml) in the presence of IL-12 (10
ng/ml) and anti-IL-4 (1:100) for Th1 or IL-4 (5 ng/ml) and
anti-IL-12 (1:100).
[0288] Reverse Transcriptase-PCR (RT-PCR)
[0289] Total RNA was prepared from pelleted cells (RNeasy mini
columns and RNAse free DNAse, Qiagen, Valencia, Calif.). RT-PCR and
qRT-PCR reactions were conducted using the Qiagen one-step RT-PCR
kit (Qiagen) or the iScript SYBR green RT-PCR kit (BioRad,
Hercules, Calif.) with transcript-specific primers (mITK: 5'
GGTCATCAAGGTGTCCGACT (SEQ ID NO: 1), 3' TCGTATGGGATTTTGCCTTC (SEQ
ID NO: 2)) (mBTK:5'AAAGGTTCCCGTACCCATTC (SEQ ID NO: 3),
3'CCCATAGCATTCTTGGCTGT (SEQ ID NO: 4)) (mGAPDH:
5'CTCATGACCACAGTCCATGC (SEQ ID NO: 5), 3'CACATTGGGGGTAGGAACAC (SEQ
ID NO: 6)) (hGAPDH: 5'AGAAGGCTGGGGCTCATTTG (SEQ ID NO: 7),
3'AGGGGCCATCCACAGTCTTC (SEQ ID NO: 8)) (hRLK: GTACGGAGGCTGCCATAAAA
(SEQ ID NO: 9), 3'CAGCTGTGGCTGGTAAACAA (SEQ ID NO: 10)) and 200 ng
of total RNA. RT-PCR amplification reactions were resolved on 2%
agarose gels and the size of the amplified transcript confirmed by
comparison with a standard DNA ladder (GelPilot 1 Kb Plus Ladder,
Qiagen). qRT-PCR experiments were analyzed using the MyiQ software
package. After confirming a single melt curve peak CT values for
GAPDH were compared to CT values for the transcript of interest
using the Pfaffl method 42.
[0290] Calcium Flux Analysis
[0291] Jurkat cells were stained with Fluo4-AM (Invitrogen), washed
twice, and resuspended in phenol-red free RPMI. Fluo4 fluorescence
was measured using a plate reader at 535 nm.
[0292] Ibrutinib Probe Assay
[0293] Protein lysates were labeled with a biotinylated derivative
of ibrutinib and added to a Streptavidin coated plate, washed
3.times., and incubated with mouse anti-ITK. After washing with
SULFO-TAG conjugated anti-mouse antibody (MSD, cat#R32AC-5),
washed, and read on a S12400.
[0294] Flow Cytometry and Cytokine Bead Array (CBA)
[0295] Flow cytometric analysis was performed using
fluorochrome-labeled monoclonal antibodies (mAbs; anti-CD3, -CD4,
-CD5, -CD8, -CD19, -CD62L, -CD45RA, -IL-4, -IFN.gamma., Annexin V,
PI, Becton Dickinson, San Jose, Calif.). Intracellular staining was
conducted according the appropriate manufacturer protocol (Becton
Dickinson). For intracellular staining of IL-4 and IFN.gamma., PMA
and ionomycin stimulation was utilized. For phoflow analysis of
PLC.gamma.1 cells were fixed with 4% paraformaldehyde/PBS after
surface staining and permeablized in cold 90% methanol.
Intracellular staining used anti-pPLC.gamma.1-Tyr783 (Cell
Signaling Technologies, cat#2821S) followed by anti-rabbit Alexa488
(Invitrogen, cat#A11008). CBA (Becton Dickinson) was conducted
according to the manufacturers published protocol using cellular
supernatant from three replicate experiments or mouse plasma. CFSE
and PKH26-based cell proliferation assays were performed as
previously described (Dubovsky, J. A., et al. Leukemia research 35,
1193-1199 (2011) and Dubovsky, J. A., et al. Leukemia research 35,
394-404 (2011)). Flow cytometric data was analyzed with FlowJo or
Kaluza software (Tree Star, Ashland, Oreg.) or what software
(Beckman Coulter, Indianapolis, Ind.) on a minimum of 30,000
collected events. Flow cytometry-based tetramer staining was
conducted on 50 .mu.l of whole blood for 1 hour on ice in PBS (+5%
FBS, +0.02% NaN3) with anti-CD4, CD8, CD19 (Becton Dickinson) and 2
.mu.g/ml Alexa647-H-2K(b) SIINFEKL tetramer (NIH Tetramer
Facility). Afterwards, RBCs were lysed according to the
manufacturer's protocol (eBiosciences) and samples were washed once
prior to analysis. Gates for tetramer positive CD8 T-cells were
verified using the baseline samples obtained 7 days prior to
Listeria infection and confirmed using FMO controls.
[0296] Immunoblot Analysis
[0297] Experiments were conducted using conventional methodology
previously described in Lapalombella, R., et al. Cancer Cell 21,
694-708 (2012). Blotting was conducted using pSTAT1 #9177S, STAT1
#9176, NFAT1 #4389S, pITK #3531S, ITK #2380S, JUNB #3746S,
pIKB.alpha. #9246L, pSTAT6 #9361S, and STAT6 #9362S (Cell Signaling
Technologies, Danvers, Mass.), T-bet #14-5825-82 (eBiosciences),
IkB.alpha. #sc-371, BRG1 #sc-17796, TCL1 #sc-32331, and
.beta.-Actin #sc-1616 (Santa Cruz Biotechnology, Santa Cruz,
Calif.) specific antibodies.
[0298] Confocal Immunofluorescence Microscopy of Fixed Cells
[0299] Cells were centrifugally concentrated on microscope slides
using a Cytospin3 (Thermo) centrifuge and stained as previously
described (Dubovsky, J. A., et al. Leukemia research 35, 394-404
(2011)). Cells were then fixed in PBS/2% paraformaldehyde. Slides
were incubated in blocking solution (4% bovine serum albumin in
PBS) and stained for NFAT1 (Cell Signaling, Boston, Mass.) by
incubating with the primary antibodies overnight at 4.degree. C.,
followed by incubation with fluorescent secondary antibody Alexa
fluor 488 (Invitrogen, Carlsbad, Calif.). Nuclei were stained blue
with DAPI (Vector Laboratories, Burlingame, Calif.). Images were
taken using a 60.times. objective and 4.times. digital zoom with
Olympus Fluoview 1000 Laser Scanning Confocal microscope at the
Ohio State University Campus Microscopy and Imaging Facility.
[0300] Mouse Models
[0301] C57BL/6 mice and E.mu.tTCL1 transgenic (Tg) mice on a
C57BL/6 background were housed in microisolator cages under
controlled temperature and humidity. All animal procedures were
performed in accordance with Federal and Institutional Animal Care
and Use Committee requirements. For longitudinal analysis of
Th1/Th2 skewing 4 week old E.mu.TCL1 transgenic animals were given
drinking water containing sterile control vehicle (1% HP-.beta.-CD)
or ibrutinib in 1% HP-.beta.-CD, at 0.16 mg/mL. The volume of water
consumed and the body weight of mice were recorded. On average,
mice took 0, 2.5, or 25 mg/kg/d ibrutinib for a total of 16 days.
For leukemia/listeriosis studies adoptive transfer of 1.times.107
freshly isolated splenocytes from E.mu.TCL1 animals was performed.
In this model, mice usually succumb from tumor in 8-10 weeks.
[0302] One week after injection mice were given drinking water
containing sterile control vehicle (1% HP-.beta.-CD) or ibrutinib
in 1% HP-.beta.-CD, at 0.16 mg/mL. On average, mice took 25 mg/kg/d
ibrutinib for a total of 16 days. 14 days after engraftment mice
were challenged with a sub-lethal I.V. dose (5000CFU) of
recombinant Listeria monocytogenes (rLM-OVA, a kind gift from Dr.
Michael J. Bevan, University of Washington, Seattle, Wash.). During
treatment, blood was drawn regularly to track disease progression.
Individual mice were euthanized and assessed for Listeria growing
in the liver compartment at days 2, 8 and 13. Two days prior to
infection 6-8 week old BALB/c mice (Jackson labs, Bar Harbor, Me.)
were randomly assigned to vehicle or ibrutinib treatment groups.
Ibrutinib was administered via drinking water as previously
described for L. monocytogenes experiments. At day zero 2E6
stationary phase Leishmania major promastigotes were injected into
the rear left footpad and lesions were monitored weekly for
development of cutaneous leishmaniasis. Popletial lymph nodes were
collected for Interim analysis of T-cell cytokines at weeks 6 and
9. Footpad lesions were mashed and parasite load calculations were
determined using standard methodology (Fowell, D. J., et al.
Immunity 11, 399-409 (1999)).
[0303] Enzyme Linked Immunoabsorbent Assay (ELISA)
[0304] Submandibular blood was collected and plasma was
centrifugally separated. An ELISA assay was performed for each IgG
subisotype using a clonotyping system (B6/C57J-AP-5300-04B,
Southern Biotech, Birmingham, Ala.) according to manufacturer's
instructions on EIA/RIA high binding 96 well plates (Costar 3590,
Corning, N.Y.). Plasma dilutions were made in 1.times.BBS as
follows: IgG1-1:10,000, IgG2c-1:10,000. A standard curve was
utilized for each isotype on each individual plate (B6/C57J Mouse
Immunoglobulin Panel-5300-01B, Southern Biotech) and the sample
triplicate averages were read from the curve at 405 nm using a
spectrophotometer (Labsystem Multiskan MCC/340, Fisher Scientific).
IL4, IL10, IL13, and IFN.gamma. analysis of popletial lymph node
cells derived from L. major infected mice was conducted as
previously described (Cummings, H. E., et al. PNAS USA 109,
1251-1256 (2012)). In brief, cells were stimulated with soluble L.
major antigen for 72 hr. Culture supernatants were collected for
ELISA based analysis.
[0305] Kinase Screening
[0306] In vitro kinase inhibition assays were conducted as
previously described by Honigberg et al. in PNAS USA 107,
13075-13080 (2010).
[0307] Statistics
[0308] Unless otherwise noted, a two-tailed student's T-test was
used for normal data at equal variance. Significance was considered
for p<0.05. Comparisons of IL4 and IFN.gamma. expression in CD4
T-cells were performed using mixed effects models to allow for
dependencies among observations from the same patient. From the
model, estimated differences in expression at each of the five dose
levels were estimated, with 95% CI, with an adjusted significance
level of .alpha.=0.01. Similarly, for Listeria/leukemia mouse
models a mixed effects model was applied to log-transformed data,
and the interaction between condition and time was assessed. From
the model, the change in percentage tetramer positive from baseline
(day -7) to the peak (day +8) between the ibrutinib and vehicle
groups, as well as healthy Listeria and control groups, were
estimated with 95% CI. All analyses were performed using SAS/STAT
software, v 9.2 (SAS Institute Inc., Cary, N.C.).
[0309] Ibrutinib is an Irreversible Inhibitor of ITK and Displays
Cytotoxic Potential Against an ITK Expressing, BTK-Null T-Cell
Leukemia.
[0310] In vitro kinase screening of Ibrutinib revealed a small
number of unvalidated targets that include the T-cell dominant ITK
(FIG. 1a). Potential irreversible targets were identified by the
presence of a cysteine residue homologous to Cys481 in BTK. ITK
retains significant structural and functional homology to BTK,
including a Cys442 covalent binding site located within the hinge
region of the active site and an autophosphorylatable Tyr180 in the
SH3 domain (FIG. 1b). In silico docking studies showed potential
covalent binding of ITK at Cys442 and occupancy of the active site
(FIG. 1c). In vitro probe binding assays confirmed that ibrutinib
was capable of irreversibly binding a significant percentage of
endogenous ITK in the Jurkat T cell leukemia cell line at
physiologically relevant concentrations (FIG. 1d). qRT-PCR analysis
of a novel CD8+ T-cell leukemia which rarely develops in the
E.mu.TCL1 mouse model due to leaky expression of the E.mu. promoter
in T-cells revealed elevated transcript levels of ITK compared to
healthy C57BL/6 mouse spleen lymphocytes (FIGS. 1e, 7-9). Our prior
studies identified an in vitro, LD50 (dose lethal to 50% of cells)
for Ibrutinib in BTK relevant leukemia targets between 1 and 10
.mu.M with 72 hr continuous exposure. Using these same conditions,
similar cytotoxicity levels were identified in BTK-null E.mu.TCL1
T-cell leukemia cells (Figure if).
[0311] To confirm that ibrutinib irreversibly binds ITK in vivo we
conducted an ITK probe assay on PBMC samples obtained from CLL
patients on a phase I clinical trial of ibrutinib. Samples were
tested immediately prior to receiving ibrutinib and after eight
days of daily oral administration. The data revealed that a
significant percentage (40 to 80%) of ITK is irreversibly bound by
ibrutinib (FIG. 1g).
[0312] The Jurkat T-cell line is a well accepted transformed tumor
model of Th2-like CD4 T-cells. Immunoblots conducted on
ibrutinib-pretreated, CD3/CD28 stimulated Jurkat cells confirmed
functional inhibition of the Tyr180 autophosphorylation site of ITK
(FIG. 1h). Downstream T-cell activation is predicated upon robust
NF.kappa.B, MAPK, and NFAT signaling; therefore, components of each
pathway were examined to determine the T-cell specific effects of
ibrutinib. As expected, ibrutinib treatment resulted a
dose-dependent inhibition of IkB.alpha., JunB, and NFAT signaling,
supporting ibrutinib's role in inhibiting ITK and thus the proximal
TCR signalosome (FIGS. 1i and j). Notably, an inhibition of both
JunB and pSTAT6 signaling was observed, indicating that the Th2
dominant IL4/STAT6 autocrine axis had been disrupted by brief
exposure to ibrutinib. While JAK3 inhibition could explain some of
our in vitro data, our initial target validation studies
demonstrated that ibrutinib does not directly influence this kinase
in cell-based assays (FIG. 10).
[0313] Ibrutinib Disproportionately Inhibits Th2 Signaling Pathways
Yet does not Inhibit Proliferative Capacity of a Mixed Population
T-Cell Culture.
[0314] To translate these findings into primary human CD4 T-cells,
ITK and downstream TCR inhibition was assessed following ibrutinib
treatment. Consistent with prior work in Jurkat cells, potent
irreversible inhibition of TCR-induced ITK phosphorylation was
identified (FIG. 2a). Moreover, inhibition of NFAT, JunB, and
IkB.alpha. downstream signaling was confirmed in primary CD4
T-cells (FIGS. 2a and b). Again the JunB-IL4/pSTAT6 Th2 signaling
axis was disrupted, although the IFN.gamma./pSTAT1 Th1 molecular
axis remained intact at approximately 10-fold higher concentrations
of ibrutinib, as evidenced by immunoblot (FIGS. 2a and 11). NFAT
nuclear localization was inhibited in a proportion of CD4 T-cells
(FIGS. 2c and d), further confirming the inhibition of CD4 T-cell
activation. However, remnant populations of activated CD4 T-cells
were present even at ibrutinib pretreatment doses exceeding 1
.mu.M.
[0315] To confirm that TCR-induced activation events preceding ITK
autophosphorylation were not altered, the proximal pathway
components were examined using both primary CD4 and Jurkat T-cells.
Immunoblot data revealed that upstream phosphorylation of LCK,
ZAP70 and LAT remain unchanged. Furthermore, the PKC activator,
phorbol 12-myristate 13-acetate (PMA), and the calcium ionophore,
ionomycin, were utilized to confirm that distal elements of TCR
activation including NFAT activity and ikBa phosphorylation were
engaged regardless of ibrutinib treatment in Jurkat cells.
[0316] Given that PLC.gamma.1 is directly phosphorylated at Tyr783
by active ITK, pPLC.gamma.1-Tyr783 phosflow analysis were conducted
on CD3/CD28 stimulated CD4 T-cells from predose and day eight
cryopreserved PBMCs. This was to confirm functional ITK inhibition
in CLL patients receiving oral ibrutinib. Results reveal a
significant decrease in TCR-induced pPLC.gamma.1 activation
confirming inhibition of CD4 T-cell ITK signaling in these patients
(FIGS. 2e and 12).
[0317] Prior work in mice has demonstrated that loss of ITK
attenuates but does not ablate intracellular calcium flux in
response to TCR signaling. Ibrutinib treatment of Jurkat cells
yielded similar results. This demonstrates that ibrutinib-based ITK
inhibition significantly reduces intracellular calcium flux in
response to TCR stimulation.
[0318] Rapid proliferation is a hallmark of TCR-induced
stimulation. To study the effects of ibrutinib pretreatment on
repeated CD3/CD28 induced proliferation, 7 day cultures of
CFSE-stained CD4 T cells were analyzed. Very minor inhibition of
overall CD4 T-cell proliferative capacity was observed in the
initial 7 days following ibrutinib treatment (FIG. 2f). To ensure
that recall response proliferation was also unaffected, the culture
was re-stimulated via CD3/CD28 and cells were re-stained with the
PKH26 proliferative tracker dye. Ibrutinib treated CD4 T-cell
cultures proliferated more upon recall stimulation than untreated
cultures, with the exception of the supra-pharmacologic dose of
10M. Furthermore, the naive, central memory, effector memory, and
terminal memory subsets were unaffected by ibrutinib (FIG. 13).
Collectively, these data indicate that a remnant population of
Th1-biased T-cells is resistant to ibrutinib inhibition and retain
the functional capacity to activate via TCR stimulation, achieving
a proliferative advantage in an otherwise inhibited polyclonal
population of CD4 T-cells.
[0319] Ibrutinib-Induced ITK-C442 Irreversible Inhibition Provides
a Selective Advantage to RLK-Expressing Th1 and CD8 T Cells.
[0320] To confirm that the primary irreversible molecular target of
ibrutinib in CD4 T-cells was ITK, TCR-induced activation of NFAT,
pSTAT1, pSTAT6, pIkB.alpha., and JunB was evaluated in primary CD4
T cells pretreated with Ibrutinib or one of two alternative BTK
inhibitors that do not target ITK (IC50>22.5 nM) (FIGS. 3a,b and
14-18). Only ibrutinib (ITK IC50=2.2 nM) was capable of inhibiting
TCR downstream molecular activation ex vivo when compared to these
two ITK non-targeting alternative BTK inhibitors.
[0321] As molecular confirmation that ITK was the primary
irreversible target in CD4 T-cells, a stably transduced Jurkat line
was generated with ITK-C442A, a version of ITK that lacks the
covalent irreversible binding site for ibrutinib (FIG. 3c). The
ITK-C442A Jurkat line maintained NFAT activation to drug
concentrations exceeding 8 .mu.M, whereas the wild-type and
parental lines were inhibited at 2-4 .mu.M (FIG. 3d).
[0322] Ibrutinib skews ex vivo Th1/Th2 responses and attenuates
certain Th2-critical signaling pathways such as JunB and STAT6
while preserving Th1 related signaling pathways like STAT1 at
physiologically relevant doses between 0.1 and 1 .mu.M. This
molecular inhibition pattern occurs alongside an outgrowth
uninhibited CD4 T-cells. To elucidate the differential inhibition
of Th2 polarized T-cells in relation to Th1, naive CD4 T-cells were
polarized in vitro using a previously described strategy to obtain
enriched cultures of IFN.gamma.-producing Th1 cells and
IL4-producing Th2 cells (FIG. 3e). Only Th2 cultures were sensitive
to physiologically relevant levels of ibrutinib as demonstrated by
reduced IL4 production. Additionally, ibrutinib inhibited NFAT and
IkB.alpha. activation in Th2 T-cells, whereas both Th1 polarized
CD4 T-cells as well as purified CD8 T-cells were resistant to
ibrutinib pretreatment levels sub-10M (FIG. 3f).
[0323] In Th1 CD4 and conventional CD8 T-cells, RLK plays a
redundant role to ITK; however, both Th2 polarized CD4 T-cells and
the Th2-like Jurkat cell line do not express RLK31. To test the
hypothesis that RLK expression protects Th1 T-cells from ibrutinib
inhibition, Jurkat cells stably transduced to express RLK were
tested (FIG. 3g). TCR downstream activation of NFAT was protected
in the Jurkat-RLK cell line at ibrutinib doses exceeding 8 .mu.M,
whereas both the parental and empty vector stable transfectants
were susceptible to ibrutinib inhibition at in-vitro concentrations
of 2-4 .mu.M (FIG. 3h). Confirmatory intracellular calcium release
experiments demonstrate a significant restoration of calcium flux
in Jurkat cells stably expressing RLK. This result demonstrates
that RLK compensate for ibrutinib-inhibited ITK, thereby providing
an alternate activation platform for specific RLK-expressing
subsets of T-cells.
[0324] Ibrutinib Limits Th2 Activation Thereby Selectively
Promoting Th1 Expansion in a Mixed Population of CD4 T-Cells from
Healthy Donors and Chronic Lymphocytic Leukemia Patients.
[0325] To evaluate the effects of ibrutinib on the Th1/Th2
polarization of a CD4 T-cell population over time, CD4 T-cells
isolated from healthy donors were cultured for three days following
ibrutinib pretreatment. Outgrowth of IFN.gamma. positive T-cells
was confirmed by intracellular staining analysis (FIG. 4a). This
outgrowth correlated with a decrease in JunB protein levels and a
sharp increase in T-bet expression (FIG. 4b). These data indicate
that Th1 cells form a rapidly expanding dominant subpopulation in
ibrutinib-treated CD4 T-cell cultures.
[0326] To confirm the functional relevance of these results in the
setting of CLL, intracellular staining was performed for IFN.gamma.
and IL4 in ibrutinib-pretreated, CD3/CD28 stimulated bulk CD4
T-cell cultures purified from CLL patients not treated with
ibrutinib. The data revealed a decrease in IL4+ Th2 CD4 T-cells
while IFN.gamma.+Th1 CD4 T-cells were unaffected (FIG. 4c). To
confirm that ibrutinib induced Th2 suppression was relevant in a
larger cohort of patients, CD4 T-cells isolated from healthy donors
and CLL patients were pre-treated with ibrutinib. Following
stimulation, a significant decrease was identified in the
IL4-producing Th2 population of CD4 T-cells; whereas
IFN.gamma.-producing Th1 cells were largely unaffected in ibrutinib
pre-treatment doses less than 1 .mu.M (FIGS. 4d and e). A
significant divergence of the two populations was observed at
ibrutinib doses of 0.1-1 .mu.M, which is consistent with the
attainable concentrations in patients from in vivo pharmacokinetics
of administration of this agent in both mouse and human trials.
[0327] Ibrutinib Drives Th1 Mediated L. major Immunity in an In
Vivo Model of Th2 Dominant Cutaneous Leishmaniasis.
[0328] Studies conducted in ITK knockout mice revealed Th1 biased
immunity which was specifically capable of mounting effective
responses against cutaneous L. major parasitic infection 8. Using
this archetypal model of Th1/Th2 immunity we sought to demonstrate
comparable results using ibrutinib as an ITK inhibitor (FIG. 5a).
T-cell cytokine analysis demonstrated a significant decrease in Th2
cytokines IL10, IL4, and IL13 relative the Th1 cytokine IFN.gamma.
(FIGS. 5b and c). Enhanced Th1 immunity was correlated with
improved parasite clearance in ibrutinib treated mice as evidenced
by smaller cutaneous lesions and lower parasitic burden (FIG. 5d,
e, and f).
[0329] Ibrutinib Phase I Clinical Trials Along with the E.mu.TCL1
Leukemia Model Confirm Th1/Th2 Skewing and a Direct Functional
Relevance in the Setting of Infection.
[0330] To validate these biochemical findings in human patients,
serial serum cytokine levels were investigated in relapsed or
refractory CLL patients receiving ibrutinib as part of a phase I
study. The data demonstrated a decrease in serum Th2-type cytokines
including IL10, IL4, and IL13 from pre-treatment to day 28 of
ibrutinib therapy (FIG. 6a). This was in sharp contrast to a
simultaneous increase in the Th1-type cytokine IFN.gamma.. These
augmented cytokine levels could not readily be attributed to the
inhibition of B-cells or BTK driven targets since the majority of
plasma IFN.gamma., IL4, and IL13 is derived from activated effector
T-cells. To further rule out any potential contribution of B-cells
to the observed Th1 cytokine skewing we analyzed peripheral CD19+
B-cell and CLL mRNA levels at identical timepoints and found no
such alteration in B-cell cytokine expression (FIG. 19).
[0331] To assess the long-term functional implications of this
ibrutinib-induced Th1 cytokine skewing IgG subisotype analyses were
conducted in a cohort of 8 month old C57BL/6 E.mu.TCL1 mice. These
mice were treated continuously for 7 months with ibrutinib or
vehicle. This analysis revealed a significant (p=0.002) inversion
of the Th1/Th2 ratio as measured by the relative levels of IgG1
(Th2) and IgG2c (Th1), confirming an in vivo ibrutinib related Th1
skewing (FIG. 6b).
[0332] Infection linked to immunosuppression is the primary cause
of death in CLL patients. Therefore, the therapeutic relevance of
ibrutinib immunomodulation in a concurrent leukemia/listeriosis
mouse model was investigated. In this model, E.mu.TCL1
leukemia-engrafted mice were treated with ibrutinib or vehicle.
After 7 days of therapy, mice (along with non-leukemic control
cohorts) were challenged with a sub-lethal intravenous dose (5000
CFU) of L. monocytogenes (Listeria) expressing the immunodominant
chicken ovalbumin (OVA) protein (FIG. 6c). As Listeria is an
intracellular pathogen, a robust Th1 and CD8 T-cell response is
required to achieve sterilizing immunity. Listeria-responsive
Th1-biased immunity is indicated by elevated plasma IFN.gamma. and
TNF.alpha., along with robust monocyte L6 production. Plasma
cytokine analysis at day 2 post infection revealed that
ibrutinib-treated mice had significantly elevated (p=0.0198)
IFN.gamma., TNF.alpha., and IL6 in comparison to vehicle-treated
leukemic animals (FIG. 6d-f). Tetramer analysis revealed a
depression in the OVA-specific CD8 T-cell response in the vehicle
treated leukemic group; however, this immunosuppression was
reversed by ibrutinib therapy (FIGS. 6g and 20). Longitudinal
analysis confirmed that the overall magnitude of Listeria response
was significantly attenuated in leukemic mice (p=0.025 for day 6).
However, ibrutinib significantly restored the veracity of response
(p=0.028) to that approximating a healthy non-leukemic mouse (FIG.
6h). Interim analyses revealed that all healthy and
ibrutinib-treated leukemic mice cleared the infection by day 8, yet
half of vehicle treated mice analyzed at day 8 displayed
uncontrolled Listeria infections within the liver which would
likely have resulted in mortality (FIG. 6i).
Example 2: Ibrutinib PCYC-04753 Phase I Clinical Trial Demonstrates
Th1/Th2 Skewing Due to an Elevated Level of IFN.gamma.
[0333] A serial serum cytokine and chemokine levels were
investigated in CLL patients receiving ibrutinib as part of a phase
I study. The data demonstrated a decrease in serum Th2-type
cytokines including IL10, IL4, and IL13 from pre-treatment to day
28 of ibrutinib therapy (FIG. 21a). Th2-type chemokines including
MIP1.alpha., MIP1.beta. and MDC also exhibited a decrease from
pre-treatment to day 28. These Th2-type cytokine/chemokine levels
were in sharp contrast to a simultaneous increase in the Th1-type
cytokine IFN.gamma.. Soluble CD40L (sCD40L), a Th1-type cytokine,
showed a decrease in patients receiving ibrutinib as part of the
phase I study. Th1/Th2 ratio was also investigated in CLL patients
receiving ibrutinib as part of the phase I study (FIG. 21b). The
data demonstrated a decrease in serum cytokines IL4, IL13 and
sCD40L and an increase in IFN.gamma..
Example 3: Ibrutinib Effect on Cytokine/Chemokine Response in High
Risk RR CLL Patients
[0334] A serial serum cytokine and chemokine levels were
investigated in high risk RR CLL patients receiving ibrutinib as
part of a cohort 4 study. The data demonstrated a decrease in the
level of serum Th2-type cytokines including IL10, IL8, MCP-1, MDC,
MIP1.alpha., and MIP11 from pre-treatment to day 28 of ibrutinib
therapy (FIG. 22). The level of the Th2-type cytokine IL6 remained
constant during the course of the ibrutinib therapy. The level of
the Th1-type cytokine TNF-.alpha. also decreased during the course
of the ibrutinib therapy.
Example 4: Ibrutinib Clinical Trial Demonstrates Th1/Th2 Skewing in
Mantel Cell Lymphoma Patients
[0335] A serial serum cytokine and chemokine levels were
investigated in MCL patients receiving ibrutinib as part of a
clinical study. Levels of cytokines and chemokine including IL10,
IL13, IL4, sCD40L, IFN.gamma. and MIP1.beta. were measured on day
0, day 1 at 4 hours, day 1 at 24 hours, day 15 and day 29 (FIG.
23). Reduction in the levels of IL10, IL13 and IL4 were observed
following ibrutinib treatment. This was in sharp contrast to an
increase in the IFN.gamma. level.
[0336] The examples and embodiments described herein are for
illustrative purposes only and various modifications or changes
suggested to persons skilled in the art are to be included within
the spirit and purview of this application and scope of the
appended claims.
Sequence CWU 1
1
10120DNAArtificial Sequence5' Synthetic primer 1ggtcatcaag
gtgtccgact 20220DNAArtificial Sequence3' Synthetic primer
2tcgtatggga ttttgccttc 20320DNAArtificial Sequence5' Synthetic
primer 3aaaggttccc gtacccattc 20420DNAArtificial Sequence3'
Synthetic primer 4cccatagcat tcttggctgt 20520DNAArtificial
Sequence5' Synthetic primer 5ctcatgacca cagtccatgc
20620DNAArtificial Sequence3' Synthetic primer 6cacattgggg
gtaggaacac 20720DNAArtificial Sequence5' Synthetic primer
7agaaggctgg ggctcatttg 20820DNAArtificial Sequence3' Synthetic
primer 8aggggccatc cacagtcttc 20920DNAArtificial Sequence5'
Synthetic primer 9gtacggaggc tgccataaaa 201020DNAArtificial
Sequence3' Synthetic primer 10cagctgtggc tggtaaacaa 20
* * * * *