U.S. patent application number 17/311591 was filed with the patent office on 2022-03-10 for methods of using tumor infiltrating lymphocytes in double-refractory melanoma.
The applicant listed for this patent is Maria FARDIS, Iovance Biotherapeutics, Inc.. Invention is credited to Maria Fardis.
Application Number | 20220072039 17/311591 |
Document ID | / |
Family ID | 62791820 |
Filed Date | 2022-03-10 |
United States Patent
Application |
20220072039 |
Kind Code |
A1 |
Fardis; Maria |
March 10, 2022 |
METHODS OF USING TUMOR INFILTRATING LYMPHOCYTES IN
DOUBLE-REFRACTORY MELANOMA
Abstract
Methods of treating melanomas refractory to other therapies
using tumor infiltrating lymphocytes are disclosed. Also disclosed
is the use of IP-10 as a biomarker for predicting treatment
efficacy.
Inventors: |
Fardis; Maria; (San Carlos,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
FARDIS; Maria
Iovance Biotherapeutics, Inc. |
San Carlos
San Carlos |
CA
CA |
US
US |
|
|
Family ID: |
62791820 |
Appl. No.: |
17/311591 |
Filed: |
December 5, 2018 |
PCT Filed: |
December 5, 2018 |
PCT NO: |
PCT/US2018/064135 |
371 Date: |
June 7, 2021 |
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
C12N 2501/2321 20130101;
A61P 35/04 20180101; C12N 5/0638 20130101; C12N 2501/515 20130101;
C12N 2501/2302 20130101; C12N 2501/2304 20130101; C12N 2501/2307
20130101; A61K 35/00 20130101; C12N 2501/2315 20130101; C12N
2501/04 20130101; G01N 33/574 20130101; G01N 2333/522 20130101;
C12N 2502/30 20130101; A61K 35/17 20130101; C12N 5/0634
20130101 |
International
Class: |
A61K 35/17 20060101
A61K035/17; C12N 5/0783 20060101 C12N005/0783 |
Claims
1. A method of treating double-refractory metastatic melanoma in a
patient in need thereof, the method comprising administering a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs) to the patient.
2. The method of claim 1, wherein the double-refractory metastatic
melanoma is a cutaneous double-refractory metastatic melanoma.
3. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to at least two prior systemic treatment
courses, not including neo-adjuvant or adjuvant therapies.
4. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to aldesleukin or a biosimilar thereof.
5. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to pembrolizumab or a biosimilar
thereof.
6. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to nivolumab or a biosimilar thereof.
7. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to ipilimumab or a biosimilar thereof.
8. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to ipilimumab or a biosimilar thereof and
pembrolizumab or a biosimilar thereof.
9. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to ipilimumab or a biosimilar thereof and
nivolumab or a biosimilar thereof.
10. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to a BRAF inhibitor.
11. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to a PD-L1 inhibitor.
12. The method of claim 11, wherein the PD-L1 inhibitor is selected
from the group consisting of avelumab, atezolizumab, durvalumab,
and biosimilars thereof.
13. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to a combination of a PD-1 inhibitor and a
CTLA-4 inhibitor.
14. The method of claim 13, wherein the PD-1 inhibitor is nivolumab
or a biosimilar thereof and the CTLA-4 inhibitor is selected from
the group consisting of ipilumumab, tremelimumab, and biosimilars
thereof.
15. The method of claim 1, wherein the double-refractory metastatic
melanoma is refractory to a combination of a BRAF inhibitor and a
MEK inhibitor.
16. The method of claim 15, wherein the BRAF inhibitor is
dabrafenib or a pharmaceutically-acceptable salt thereof and the
MEK inhibitor is trametinib or a pharmaceutically-acceptable salt
or solvate thereof.
17. The method of claim 1, wherein the metastatic melanoma is
resistant to a PD-1 inhibitor or PD-L1 inhibitor.
18. The method of claim 17, wherein the PD-1 or PD-L1 inhibitor is
selected from the group consisting of nivolumab, pembrolizumab,
avelumab, atezolizumab, durvalumab, and biosimilars thereof.
19. The method of any one of claims 1-10, wherein the patient does
not possess a BRAF mutation.
20. The method of claim 1, wherein the patient has received at most
4 doses of nivolumab or a biosimilar thereof prior to receiving the
therapeutically effective population of TILs.
21. The method of claims 1-12, wherein the patient has progressed
or had no response to at least two prior systemic treatment
courses.
22. The method of claims 1-21, wherein the patient exhibits an
increase in the level of IP-10 after administration of the
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
23. The method of claim 22, wherein the increase in the level of
IP-10 is indicative of treatment response and/or treatment
efficacy.
24. The method of claims 22-23, wherein the patient is administered
one or more further dosages of a therapeutically effective
population of tumor infiltrating lymphocytes (TILs).
25. The method of claims 22-23, wherein the patient is not
administered a further dosage of a therapeutically effective
population of tumor infiltrating lymphocytes (TILs).
26. A method of treating double-refractory metastatic melanoma in a
patient in need thereof, the method comprising: (a) obtaining a
first population of TILs from a tumor resected from the patient by
processing a tumor sample obtained from the patient into multiple
tumor fragments; (b) adding the tumor fragments into a closed
system; (c) performing a first expansion by culturing the first
population of TILs in a cell culture medium comprising IL-2, and
optionally OKT-3, to produce a second population of TILs, wherein
the first expansion is performed in a closed container providing a
first gas-permeable surface area, wherein the first expansion is
performed for about 3-14 days to obtain the second population of
TILs, wherein the second population of TILs is at least 50-fold
greater in number than the first population of TILs, and wherein
the transition from step (b) to step (c) occurs without opening the
system; (d) performing a second expansion by supplementing the cell
culture medium of the second population of TILs with additional
IL-2, optionally OKT-3, and antigen presenting cells (APCs), to
produce a third population of TILs, wherein the second expansion is
performed for about 7-14 days to obtain the third population of
TILs, wherein the third population of TILs is a therapeutic
population of TILs, wherein the second expansion is performed in a
closed container providing a second gas-permeable surface area, and
wherein the transition from step (c) to step (d) occurs without
opening the system; (e) harvesting the therapeutic population of
TILs obtained from step (d) to provide a harvested TIL population,
wherein the transition from step (d) to step (e) occurs without
opening the system; (f) transferring the harvested TIL population
from step (e) to an infusion bag, wherein the transfer from step
(e) to (f) occurs without opening the system, and optionally
cryopreserving the harvested TIL population and (g) administering a
therapeutically effective amount of the harvested TIL population to
the patient with double-refractory metastatic melanoma.
27. The method of claim 26, wherein the patient has been previously
treated with a PD-1 inhibitor or a biosimilar thereof.
28. The method of claim 27, wherein the PD-1 inhibitor is selected
from the group consisting of nivolumab, pembrolizumab, and
biosimilars thereof.
29. The method of claim 26, wherein the patient has been previously
treated with a PD-L1 inhibitor or a biosimilar thereof.
30. The method of claim 29, wherein the PD-L1 inhibitor is selected
from the group consisting of avelumab, atezolizumab, durvalumab,
and biosimilars thereof.
31. The method of any one of claims 27-28, wherein the PD-1
inhibitor or a biosimilar thereof was co-administered with a CTLA-4
inhibitor or biosimilar thereof.
32. The method of any one of claims 29-30, wherein the PD-L1
inhibitor or a biosimilar thereof was co-administered with a CTLA-4
inhibitor or biosimilar thereof.
33. The method of any one of claims 26-32, wherein the patient has
been previously treated with one additional prior line of systemic
therapy.
34. The method of claim 33, wherein the one additional prior line
of systemic therapy is a BRAF inhibitor or a
pharmaceutically-acceptable salt thereof.
35. The method of claim 34, wherein the BRAF inhibitor is selected
from the group consisting of vemurafenib, dabrafenib, and
pharmaceutically-acceptable salts thereof.
36. The method of claim 33, wherein the one additional prior line
of systemic therapy is a MEK inhibitor or a
pharmaceutically-acceptable salt or solvate thereof.
37. The method of claim 36, wherein the MEK inhibitor is selected
from the group consisting of trametinib, cobimetinib, and
pharmaceutically-acceptable salts or solvates thereof.
38. The method of claim 33, wherein the one additional prior line
of systemic therapy is a combination of a BRAF inhibitor or a
pharmaceutically-acceptable salt thereof and a MEK inhibitor or a
pharmaceutically-acceptable salt or solvate thereof.
39. The method of claim 38, wherein the BRAF inhibitor is selected
from the group consisting of vemurafenib, dabrafenib, and
pharmaceutically-acceptable salts thereof, and the MEK inhibitor is
selected from the group consisting of trametinib, cobimetinib, and
pharmaceutically-acceptable salts or solvates thereof.
40. The method of claim 33, wherein the one additional prior line
of systemic therapy is a CTLA-4 inhibitor or a biosimilar
thereof.
41. The method of claim 40, wherein the CTLA-4 inhibitor is
selected from the group consisting of ipilumumab, tremelimumab, and
biosimilars thereof.
42. The method of claim 33, wherein the one additional prior line
of systemic therapy is chemotherapeutic regimen.
43. The method of claim 42, wherein the chemotherapeutic regimen
comprises dacarbazine or temozolimide.
44. The method of claim 26, wherein the first expansion is
performed over a period of about 11 days.
45. The method of any one of claims 26-44, wherein the IL-2 is
present at an initial concentration of between 1000 IU/mL and 6000
IU/mL in the cell culture medium in the first expansion step
(c).
46. The method of any one of claims 26-44, wherein in the second
expansion step (d), the IL-2 is present at an initial concentration
of between 1000 IU/mL and 6000 IU/mL and the OKT-3 antibody is
present at an initial concentration of about 30 ng/mL.
47. The method of any one of claims 26-46, wherein the first
expansion is performed using a gas permeable container.
48. The method of any one of claims 26-46, wherein the second
expansion is performed using a gas permeable container.
49. The method of any one of claims 26-48, wherein the cell culture
medium in the first expansion step (c) further comprises a cytokine
selected from the group consisting of TL-4, IL-7, IL-15, IL-21, and
combinations thereof.
50. The method of any one of claims 26-48, wherein the cell culture
medium in the second expansion step (d) further comprises a
cytokine selected from the group consisting of IL-4, IL-7, IL-15,
IL-21, and combinations thereof.
51. The method of any one of claims 26-50, further comprising the
step of treating the patient with a non-myeloablative
lymphodepletion regimen prior to administering the TILs to the
patient.
52. The method of claim 51, wherein the non-myeloablative
lymphodepletion regimen comprises the steps of administration of
cyclophosphamide at a dose of 60 mg/m.sup.2/day for two days
followed by administration of fludarabine at a dose of 25
mg/m.sup.2/day for five days.
53. The method of any one of claims 26-52, further comprising the
step of treating the patient with an IL-2 regimen starting on the
day after administration of the TILs to the patient.
54. The method of any one of claim 53, wherein the IL-2 regimen is
a high-dose IL-2 regimen comprising 600,000 or 720,000 IU/kg of
aldesleukin, or a biosimilar or variant thereof, administered as a
15-minute bolus intravenous infusion every eight hours until
tolerance.
55. The method of any one of claims 26-54, wherein the patient
exhibits an increase in the level of IP-10 after administration of
the therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
56. The method of claim 55, wherein the increase in the level of
IP-10 is indicative of treatment efficacy.
57. The method of any one of claims 26-56, wherein the increase in
the level of IP-10 is measured by calculating the difference in
IP-10 level in plasma seven days before TIL infusion and one day
after TIL infusion, and wherein said difference in IP-10 level in
plasma is at least 800 pg/mL, at least 900 pg/mL, at least 1000
pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at least 1300
pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at least 1600
pg/mL, at least 1650 pg/mL, at least 1656 pg/mL, at least 1700
pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at least 2000
pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
58. The method of any one of claims 55-57, wherein the patient is
administered one or more further dosages of a therapeutically
effective population of tumor infiltrating lymphocytes (TILs).
59. The method of any one of claims 55-57, wherein the patient is
not administered a further dosage of a therapeutically effective
population of tumor infiltrating lymphocytes (TILs).
60. The method according to any one of claims 1-59, wherein the
therapeutically effective population of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs.
61. A method of treating double-refractory metastatic melanoma in a
patient in need thereof, the method comprising: (a) obtaining a
first population of TILs from a tumor resected from the patient by
processing a tumor sample obtained from the patient into multiple
tumor fragments; (b) adding the tumor fragments into a closed
system; (c) performing a first expansion by culturing the first
population of TILs in a cell culture medium comprising IL-2, and
optionally OKT-3, to produce a second population of TILs, wherein
the first expansion is performed in a closed container providing a
first gas-permeable surface area, wherein the first expansion is
performed for about 3-14 days to obtain the second population of
TILs, wherein the second population of TILs is at least 50-fold
greater in number than the first population of TILs, and wherein
the transition from step (b) to step (c) occurs without opening the
system; (d) performing a second expansion by supplementing the cell
culture medium of the second population of TILs with additional
IL-2, optionally OKT-3, and antigen presenting cells (APCs), to
produce a third population of TILs, wherein the second expansion is
performed for about 7-14 days to obtain the third population of
TILs, wherein the third population of TILs is a therapeutic
population of TILs, wherein the second expansion is performed in a
closed container providing a second gas-permeable surface area, and
wherein the transition from step (c) to step (d) occurs without
opening the system; (e) harvesting the therapeutic population of
TILs obtained from step (d) to provide a harvested TIL population,
wherein the transition from step (d) to step (e) occurs without
opening the system; (f) transferring the harvested TIL population
from step (e) to an infusion bag, wherein the transfer from step
(e) to (f) occurs without opening the system, and optionally
cryopreserving the harvested TIL population; (g) administering a
therapeutically effective amount of the harvested TIL population to
the patient with double-refractory metastatic melanoma; and (h)
measuring the level of IP-10 in the patient after administering a
therapeutically effective amount of the TILs in step (g).
62. A method of treating cancer in a patient in need thereof, the
method comprising: (a) obtaining a first population of TILs from a
tumor resected from the patient by processing a tumor sample
obtained from the patient into multiple tumor fragments; (b) adding
the tumor fragments into a closed system; (c) performing a first
expansion by culturing the first population of TILs in a cell
culture medium comprising IL-2, and optionally OKT-3, to produce a
second population of TILs, wherein the first expansion is performed
in a closed container providing a first gas-permeable surface area,
wherein the first expansion is performed for about 3-14 days to
obtain the second population of TILs, wherein the second population
of TILs is at least 50-fold greater in number than the first
population of TILs, and wherein the transition from step (b) to
step (c) occurs without opening the system; (d) performing a second
expansion by supplementing the cell culture medium of the second
population of TILs with additional IL-2, optionally OKT-3, and
antigen presenting cells (APCs), to produce a third population of
TILs, wherein the second expansion is performed for about 7-14 days
to obtain the third population of TILs, wherein the third
population of TILs is a therapeutic population of TILs, wherein the
second expansion is performed in a closed container providing a
second gas-permeable surface area, and wherein the transition from
step (c) to step (d) occurs without opening the system; (e)
harvesting the therapeutic population of TILs obtained from step
(d) to provide a harvested TIL population, wherein the transition
from step (d) to step (e) occurs without opening the system; (f)
transferring the harvested TIL population from step (e) to an
infusion bag, wherein the transfer from step (e) to (f) occurs
without opening the system, and optionally cryopreserving the
harvested TIL population; (g) administering a therapeutically
effective amount of the harvested TIL population to the patient
with double-refractory metastatic melanoma; and (h) measuring the
level of IP-10 in the patient after administering a therapeutically
effective amount of the TILs in step (g).
63. The method of any one of claims 61-62, wherein an increase in
the level of IP-10 in step (h) is measured.
64. The method of claim 63, wherein the increase in the level of
IP-10 is measured by calculating the difference in IP-10 level in
plasma seven days before TIL infusion and one day after TIL
infusion, and wherein said difference in IP-10 level in plasma is
at least 800 pg/mL, at least 900 pg/mL, at least 1000 pg/mL, at
least 1100 pg/mL, at least 1200 pg/mL, at least 1300 pg/mL, at
least 1400 pg/mL, at least 1500 pg/mL, at least 1600 pg/mL, at
least 1650 pg/mL, at least 1656 pg/mL, at least 1700 pg/mL, or at
least 1800 pg/mL, at least 1900 pg/mL, at least 2000 pg/mL, at
least 2100 pg/mL, or at least 2200 pg/mL.
65. The method of any one of claims 63-64, wherein an increase in
the level of IP-10 in step (h) is indicative of treatment
efficacy.
66. The method of any one of claims 61-65, wherein the level of
IP-10 is measured about 1 day to 10 days post administering the
therapeutically effective amount of the TILs in step (g).
67. The method of any one of claims 61-66, wherein the level of
IP-10 is measured 1 day post administering a therapeutically
effective amount of the TILs in step (g).
68. The method of any one of claims 61-67, wherein the level of
IP-10 is measured about 6 hours to 24 hours post administering the
therapeutically effective amount of the TILs in step (g).
69. The method of any one of claims 61-68, wherein the method
further comprises a step of measuring the level of IP-10 in the
patient prior to administering a therapeutically effective amount
of the TILs in step (g).
70. The method of claim 69, wherein the increase is based on an
increase in the level of IP-10 after administering a
therapeutically effective amount of the TILs in step (g) as
compared to the level of IP-10 in the patient prior to
administering a therapeutically effective amount of the TILs in
step (g).
71. The method of any one of claims 61-70, wherein the method
further comprises step (i) predicting the patient will respond to
the therapeutically effective amount of the TILs administered in
step (g) based upon measuring an increase in the level of IP-10 in
step (h).
72. The method of claim 71, wherein the patient is administered one
or more further dosages of a therapeutically effective population
of tumor infiltrating lymphocytes (TILs).
73. The method of any one of claims 63-70, wherein the method
further comprises step (i) predicting the patient will not respond
to the therapeutically effective amount of the TILs administered in
step (g) based upon measuring no increase in the level of IP-10 in
step (h).
74. The method of any one of claims 63-70, wherein the method
further comprises step (i) predicting the patient will respond to
the therapeutically effective amount of the TILs administered in
step (g) based upon measuring an increase in the level of IP-10 in
step (h) or predicting the patient will not respond to the
therapeutically effective amount of the TILs administered in step
(g) based upon measuring no increase in the level of IP-10 in step
(h).
75. The method of any one of claims 63-74, wherein predicting the
probability that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(g) is based upon the presence or absence of an increase in the
level of IP-10 in step (h).
76. The method of claim 75, wherein the increase in the level of
IP-10 is an increase of at least one-fold, two-fold, three-fold,
four-fold, or five-fold or more.
77. The method of any one of claims 63-76, wherein predicting the
probability that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(g) comprises correlating the level of IP-10 measured in the
patient with a threshold value, wherein if the level of IP-10
measured is above the threshold value one or more further TIL
treatment dosages is indicated.
78. A method of predicting a treatment response and/or predicting
treatment efficacy for administration of a therapeutically
effective amount of tumor infiltrating lymphocytes (TILs) to a
patient, the method comprising: a) obtaining a biological sample
from a patient with cancer, including double-refractory metastatic
melanoma; b) measuring the level of IP-10 in the biological sample
from a); c) administering a therapeutically effective amount of
TILs; d) obtaining a biological sample from the patient after the
administration of the therapeutically effective amount of TILs in
step c) e) measuring the level of IP-10 in the biological sample
from d); f) predicting a treatment response to and/or predicting
treatment efficacy of the administration of the therapeutically
effective amount of the TILs based upon the level of IP-10 measured
after administration as compared to the level of IP-10 measured
prior to administration.
79. The method of claim 78, wherein an increase in the level of
IP-10 measured in step (e) as compared to the level of IP-10
measured step (b) is observed.
80. The method of any one of claims 78-79, wherein the increase in
the level of IP-10 is measured by calculating the difference in
IP-10 level in plasma seven days before TIL infusion and one day
after TIL infusion, and wherein said difference in IP-10 level in
plasma is at least 800 pg/mL, at least 900 pg/mL, at least 1000
pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at least 1300
pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at least 1600
pg/mL, at least 1650 pg/mL, at least 1656 pg/mL, at least 1700
pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at least 2000
pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
81. The method of any one of claim 78, wherein an increase in the
level of IP-10 in step (e) as compared to the level of IP-10
measured step (b) is indicative of treatment efficacy.
82. The method of any one of claims 78-81, wherein the level of
IP-10 is measured in step (e) about 1 day to 10 days post
administering a therapeutically effective amount of the TILs in
step (c).
83. The method of any one of claims 78-82, wherein the level of
IP-10 is measured in step (e) about 1 day post administering a
therapeutically effective amount of the TILs in step (c).
84. The method of any one of claims 78-83, wherein the level of
IP-10 is measured in step (e) about 6 hours to 24 hours post
administering a therapeutically effective amount of the TILs in
step (g).
85. The method of any one of claims 78-84, wherein predicting that
the patient will or will not respond to the therapeutically
effective amount of the TILs administered in step (c) is based upon
an increase in the level of IP-10 measured in step (f).
86. The method of any one of claims 78-85, wherein measuring an
increase in the level of IP-10 measured in step (e) as compared to
the level of IP-10 measured step (b) indicates that the patient
will respond to the therapeutically effective amount of the TILs
administered in step (d).
87. The method of any one of claims 78-86, wherein the patient is
administered one or more further dosages of a therapeutically
effective population of tumor infiltrating lymphocytes (TILs).
88. The method of any one of claims 78-85, wherein measuring no
increase in the level of IP-10 measured in step (e) as compared to
the level of IP-10 measured step (b) indicates that the patient
will not respond to the therapeutically effective amount of the
TILs administered in step (d).
89. The method of any one of claims 78-87, wherein the level of
IP-10 is increased one-fold, two-fold, three-fold, four-fold,
five-fold or more.
90. The method of any one of claims 78-89, wherein predicting that
the patient will or will not respond to the therapeutically
effective amount of the TILs administered in step (d) further
comprises correlating the level of IP-10 measured in the patient
with a threshold value, wherein if the level of IP-10 measured is
above the threshold value one or more further TIL treatment dosages
is indicated.
91. The method according to any one of claims 61-90, wherein the
therapeutically effective population of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application claims priority to U.S. patent application
Ser. No. 16/211,159, filed Dec. 5, 2018, which is incorporated by
reference in its entirety.
SEQUENCE LISTING
[0002] The instant application contains a Sequence Listing which
has been submitted electronically in ASCII format and is hereby
incorporated by reference in its entirety. Said ASCII copy, created
on Dec. 5, 2018, is named 116983-5047-WO_ST25.txt and is 122
kilobytes in size.
FIELD OF THE INVENTION
[0003] Methods of using tumor infiltrating lymphocytes (TILs) in
the treatment of double-refractory melanoma are disclosed herein,
as well as the use of IP-10 as a biomarker for predicting treatment
efficacy.
BACKGROUND OF THE INVENTION
[0004] Treatment of melanoma remains challenging, particularly for
patients that do not respond to commonly-used initial lines of
therapy, including nivolumab monotherapy, pembrolizumab
monotherapy, therapy using a combination of nivolumab and
ipilimumab, ipilimumab monotherapy, therapy using a combination of
dabrafenib and trametinib, vemurafenib monotherapy, and pegylated
interferon (preinterferon) alfa-2b. Approved first line treatments
for metastatic melanoma include immunotherapeutic strategies
blocking PD-1 (pembrolizumab, nivolumab), or combining nivolumab
with the anti-CTLA4 blocker ipilimumab, or chemotherapy with agents
targeting specific activating mutations in the BRAF pathway (e.g.,
vemurafenib, dabrafenib, trametinib). Following disease
progression, patients can receive additional treatment with
anti-PD-1 monotherapy; nivolumab/ipilimumab combination therapy;
ipilimumab monotherapy; targeted therapy if BRAF mutant; high-dose
aldesleukin (interleukin-2; IL-2); cytotoxic agents (e.g.,
dacarbazine, temozolomide, paclitaxel, cisplatin, carboplatin,
vinblastine); or imatinib for KIT-mutant melanoma. In 2015,
talimogene laherparepvec, a live oncolytic virus therapy, was
approved for the local treatment of unresectable cutaneous,
subcutaneous, and nodal lesions in patients with melanoma recurrent
after initial surgical excision. This product has not been shown to
improve overall survival or to have an effect on visceral
metastases.
[0005] Until recently, high-dose aldesleukin was the only
FDA-approved systemic therapy for metastatic melanoma capable of
inducing durable objective cancer responses, with an overall
objective response rate (ORR) of 16% and durable complete tumor
regressions (CRs) observed in up to 6% of treated patients
(Proleukin.RTM. (aldesleukin) Label, FDA, July 2012). Alva, et al.
Cancer Immunol. Immunother. 2016, 65, 1533-1544. The recently
approved PD-1 immune checkpoint inhibitors pembrolizumab and
nivolumab approximately double the rate of durable responses in
metastatic melanoma relative to aldesleukin treatment. Larkin, et
al., N. Engl. J. Med. 2015, 373, 23-34; Robert, et al., N. Engl. J.
Med. 2015, 372, 2521-32. In previously treated patients, the ORR
for nivolumab is 32%, with higher and more durable responses
correlated with higher levels of PD-1 ligand expression by tumors;
and the ORR for pembrolizumab following prior therapy with
ipilimumab is 21% (Table 2). In treatment naive patients, durable
objective responses are achieved in 50% of patients when nivolumab
and ipilimumab administered in combination, although the CR rate
remains low at 8.9% (Opdivo.RTM. (nivolumab) Label, FDA, October
2016).
[0006] Use of the checkpoint inhibitors is associated with a
spectrum of immune-related adverse events, including pneumonitis,
colitis, hepatitis, nephritis and renal dysfunction (Opdivo
(nivolumab) Label, FDA, October 2016). Hofmann, et al., Eur. J.
Cancer 2016, 60, 190-209. Increased toxicity is observed in
patients treated with nivolumab and ipilimumab combination therapy.
Treatment-related adverse events leading to discontinuation of
therapy occurred in 36.4%, 7.7% and 14.8% of patients receiving the
combination therapy, nivolumab alone or ipilimumab alone,
respectively. Larkin, et al., N. Engl. J. Med. 2015, 373, 23-34;
Johnson, et al., N. Engl. J. Med. 2016, 375, 1749-1755.
[0007] Although the targeted therapies and immune checkpoint
inhibitors can achieve dramatic responses in patients with
metastatic melanoma, death rates for this cancer are projected to
remain stable through 2030. The overall age-adjusted melanoma death
rate was 2.7 per 100000 in 2011 and remained at this level in 2015.
Guy, et al., Morbidity Mortality Weekly Rep. 2015, 64, 591-596.
[0008] Treatment of bulky, refractory cancers using adoptive
autologous transfer of tumor infiltrating lymphocytes (TILs)
represents a powerful approach to therapy for patients with poor
prognoses. Gattinoni, et al., Nat. Rev. Immunol. 2006, 6, 383-393.
TILs are dominated by T cells, and IL-2-based TIL expansion
followed by a "rapid expansion process" (REP) has become a
preferred method for TIL expansion because of its speed and
efficiency. Dudley, et al., Science 2002, 298, 850-54; Dudley, et
al., J. Clin. Oncol. 2005, 23, 2346-57; Dudley, et al., J. Clin.
Oncol. 2008, 26, 5233-39; Riddell, et al., Science 1992, 257,
238-41; Dudley, et al., J. Immunother. 2003, 26, 332-42. A number
of approaches to improve responses to TIL therapy in melanoma and
to expand TIL therapy to other tumor types have been explored with
limited success, and the field remains challenging. Goff, et al.,
J. Clin. Oncol. 2016, 34, 2389-97; Dudley, et al., J. Clin. Oncol.
2008, 26, 5233-39; Rosenberg, et al., Clin. Cancer Res. 2011, 17,
4550-57. There is an unmet need to standardize TIL production as
well as identify patient populations and specific types of cancers
that are most likely to benefit from TIL therapy.
[0009] The present invention provides the surprising finding that
TILs may be used in the treatment of a subpopulation of patients
suffering from melanoma that is refractory to at least two prior
therapies, which may include immune checkpoint inhibitors. Also
disclosed is the use of IP-10 as a biomarker for predicting
treatment efficacy.
SUMMARY OF THE INVENTION
[0010] In an embodiment, the present disclosure provides a method
of treating double-refractory metastatic melanoma in a patient in
need thereof, the method comprising administering a therapeutically
effective population of tumor infiltrating lymphocytes (TILs) to
the patient.
[0011] In an embodiment and in accordance with the above, wherein
the double-refractory metastatic melanoma is a cutaneous
double-refractory metastatic melanoma.
[0012] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to at least
two prior systemic treatment courses, not including neo-adjuvant or
adjuvant therapies.
[0013] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to
aldesleukin or a biosimilar thereof.
[0014] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to
pembrolizumab or a biosimilar thereof.
[0015] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to
nivolumab or a biosimilar thereof.
[0016] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to
ipilimumab or a biosimilar thereof.
[0017] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to
ipilimumab or a biosimilar thereof and pembrolizumab or a
biosimilar thereof.
[0018] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to
ipilimumab or a biosimilar thereof and nivolumab or a biosimilar
thereof.
[0019] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to a BRAF
inhibitor.
[0020] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to a PD-L1
inhibitor.
[0021] In an embodiment and in accordance with any of the above,
the PD-L1 inhibitor is selected from the group consisting of
avelumab, atezolizumab, durvalumab, and biosimilars thereof.
[0022] In an embodiment and in accordance with any of the above,
the double-refractory metastatic melanoma is refractory to a
combination of a PD-1 inhibitor and a CTLA-4 inhibitor.
[0023] In an embodiment and in accordance with any of the above,
the PD-1 inhibitor is nivolumab or a biosimilar thereof and the
CTLA-4 inhibitor is selected from the group consisting of
ipilumumab, tremelimumab, and biosimilars thereof.
[0024] The In an embodiment and in accordance with any of the
above, the double-refractory metastatic melanoma is refractory to a
combination of a BRAF inhibitor and a MEK inhibitor.
[0025] In an embodiment and in accordance with any of the above,
the BRAF inhibitor is dabrafenib or a pharmaceutically-acceptable
salt thereof and the MEK inhibitor is trametinib or a
pharmaceutically-acceptable salt or solvate thereof.
[0026] In an embodiment and in accordance with any of the above,
the metastatic melanoma is resistant to a PD-1 inhibitor or PD-L1
inhibitor.
[0027] In an embodiment and in accordance with any of the above,
the PD-1 or PD-L1 inhibitor is selected from the group consisting
of nivolumab, pembrolizumab, avelumab, atezolizumab, durvalumab,
and biosimilars thereof.
[0028] In an embodiment and in accordance with any of the above,
the patient does not possess a BRAF mutation.
[0029] In an embodiment and in accordance with any of the above,
the patient has received at most 4 doses of nivolumab or a
biosimilar thereof prior to receiving the therapeutically effective
population of TILs.
[0030] In an embodiment and in accordance with any of the above,
the patient has progressed or had no response to at least two prior
systemic treatment courses.
[0031] In an embodiment and in accordance with any of the above,
the patient exhibits an increase in the level of IP-10 after
administration of the therapeutically effective population of tumor
infiltrating lymphocytes (TILs).
[0032] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is indicative of treatment
response and/or treatment efficacy.
[0033] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is measured by calculating the
difference in IP-10 level in plasma seven days before TIL infusion
and one day after TIL infusion, and wherein said difference in
IP-10 level in plasma is at least 800 pg/mL, at least 900 pg/mL, at
least 1000 pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at
least 1300 pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at
least 1600 pg/mL, at least 1650 pg/mL, at least 1656 pg/mL, at
least 1700 pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at
least 2000 pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
[0034] In an embodiment and in accordance with any of the above,
the patient is administered one or more further dosages of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
[0035] In an embodiment and in accordance with any of the above,
the patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
[0036] In an embodiment, the present disclosure provides method of
treating double-refractory metastatic melanoma in a patient in need
thereof, the method comprising: [0037] (a) obtaining a first
population of TILs from a tumor resected from the patient by
processing a tumor sample obtained from the patient into multiple
tumor fragments; [0038] (b) adding the tumor fragments into a
closed system; [0039] (c) performing a first expansion by culturing
the first population of TILs in a cell culture medium comprising
IL-2, and optionally OKT-3, to produce a second population of TILs,
wherein the first expansion is performed in a closed container
providing a first gas-permeable surface area, wherein the first
expansion is performed for about 3-14 days to obtain the second
population of TILs, wherein the second population of TILs is at
least 50-fold greater in number than the first population of TILs,
and wherein the transition from step (b) to step (c) occurs without
opening the system; [0040] (d) performing a second expansion by
supplementing the cell culture medium of the second population of
TILs with additional IL-2, optionally OKT-3, and antigen presenting
cells (APCs), to produce a third population of TILs, wherein the
second expansion is performed for about 7-14 days to obtain the
third population of TILs, wherein the third population of TILs is a
therapeutic population of TILs, wherein the second expansion is
performed in a closed container providing a second gas-permeable
surface area, and wherein the transition from step (c) to step (d)
occurs without opening the system; [0041] (e) harvesting the
therapeutic population of TILs obtained from step (d) to provide a
harvested TIL population, wherein the transition from step (d) to
step (e) occurs without opening the system; [0042] (f) transferring
the harvested TIL population from step (e) to an infusion bag,
wherein the transfer from step (e) to (f) occurs without opening
the system, and optionally cryopreserving the harvested TIL
population and [0043] (g) administering a therapeutically effective
amount of the harvested TIL population to the patient with
double-refractory metastatic melanoma.
[0044] In an embodiment and in accordance with the above-described
method, wherein the patient has been previously treated with a PD-1
inhibitor or a biosimilar thereof.
[0045] In an embodiment and in accordance with any of the above,
wherein the PD-1 inhibitor is selected from the group consisting of
nivolumab, pembrolizumab, and biosimilars thereof.
[0046] In an embodiment and in accordance with any of the above,
wherein the patient has been previously treated with a PD-L1
inhibitor or a biosimilar thereof.
[0047] In an embodiment and in accordance with any of the above,
wherein the PD-L1 inhibitor is selected from the group consisting
of avelumab, atezolizumab, durvalumab, and biosimilars thereof.
[0048] In an embodiment and in accordance with any of the above,
wherein the PD-1 inhibitor or a biosimilar thereof was
co-administered with a CTLA-4 inhibitor or biosimilar thereof.
[0049] In an embodiment and in accordance with any of the above,
wherein the PD-L1 inhibitor or a biosimilar thereof was
co-administered with a CTLA-4 inhibitor or biosimilar thereof.
[0050] In an embodiment and in accordance with any of the above,
wherein the patient has been previously treated with one additional
prior line of systemic therapy.
[0051] In an embodiment and in accordance with any of the above,
wherein the one additional prior line of systemic therapy is a BRAF
inhibitor or a pharmaceutically-acceptable salt thereof.
[0052] In an embodiment and in accordance with any of the above,
wherein the BRAF inhibitor is selected from the group consisting of
vemurafenib, dabrafenib, and pharmaceutically-acceptable salts
thereof.
[0053] In an embodiment and in accordance with any of the above,
wherein the one additional prior line of systemic therapy is a MEK
inhibitor or a pharmaceutically-acceptable salt or solvate
thereof.
[0054] In an embodiment and in accordance with any of the above,
wherein the MEK inhibitor is selected from the group consisting of
trametinib, cobimetinib, and pharmaceutically-acceptable salts or
solvates thereof.
[0055] In an embodiment and in accordance with any of the above,
wherein the one additional prior line of systemic therapy is a
combination of a BRAF inhibitor or a pharmaceutically-acceptable
salt thereof and a MEK inhibitor or a pharmaceutically-acceptable
salt or solvate thereof.
[0056] In an embodiment and in accordance with any of the above,
wherein the BRAF inhibitor is selected from the group consisting of
vemurafenib, dabrafenib, and pharmaceutically-acceptable salts
thereof, and the MEK inhibitor is selected from the group
consisting of trametinib, cobimetinib, and
pharmaceutically-acceptable salts or solvates thereof.
[0057] In an embodiment and in accordance with any of the above,
wherein the one additional prior line of systemic therapy is a
CTLA-4 inhibitor or a biosimilar thereof.
[0058] In an embodiment and in accordance with any of the above,
wherein the CTLA-4 inhibitor is selected from the group consisting
of ipilumumab, tremelimumab, and biosimilars thereof.
[0059] In an embodiment and in accordance with any of the above,
wherein the one additional prior line of systemic therapy is
chemotherapeutic regimen.
[0060] In an embodiment and in accordance with any of the above,
wherein the chemotherapeutic regimen comprises dacarbazine or
temozolimide.
[0061] In an embodiment and in accordance with any of the above,
wherein the first expansion is performed over a period of about 11
days.
[0062] In an embodiment and in accordance with any of the above,
wherein the IL-2 is present at an initial concentration of between
1000 IU/mL and 6000 IU/mL in the cell culture medium in the first
expansion step (c).
[0063] In an embodiment and in accordance with any of the above,
wherein in the second expansion step (d), the IL-2 is present at an
initial concentration of between 1000 IU/mL and 6000 IU/mL and the
OKT-3 antibody is present at an initial concentration of about 30
ng/mL.
[0064] In an embodiment and in accordance with any of the above,
wherein the first expansion is performed using a gas permeable
container.
[0065] In an embodiment and in accordance with any of the above,
wherein the second expansion is performed using a gas permeable
container.
[0066] In an embodiment and in accordance with any of the above,
wherein the cell culture medium in the first expansion step (c)
further comprises a cytokine selected from the group consisting of
IL-4, IL-7, IL-15, IL-21, and combinations thereof.
[0067] In an embodiment and in accordance with any of the above,
wherein the cell culture medium in the second expansion step (d)
further comprises a cytokine selected from the group consisting of
IL-4, IL-7, IL-15, IL-21, and combinations thereof.
[0068] In an embodiment and in accordance with any of the above,
further comprising the step of treating the patient with a
non-myeloablative lymphodepletion regimen prior to administering
the TILs to the patient.
[0069] In an embodiment and in accordance with any of the above,
wherein the non-myeloablative lymphodepletion regimen comprises the
steps of administration of cyclophosphamide at a dose of 60
mg/m2/day for two days followed by administration of fludarabine at
a dose of 25 mg/m2/day for five days.
[0070] In an embodiment and in accordance with any of the above,
further comprising the step of treating the patient with an IL-2
regimen starting on the day after administration of the TILs to the
patient.
[0071] In an embodiment and in accordance with any of the above,
wherein the IL-2 regimen is a high-dose IL-2 regimen comprising
600,000 or 720,000 IU/kg of aldesleukin, or a biosimilar or variant
thereof, administered as a 15-minute bolus intravenous infusion
every eight hours until tolerance.
[0072] In an embodiment and in accordance with any of the above,
the patient exhibits an increase in the level of IP-10 after
administration of the therapeutically effective population of tumor
infiltrating lymphocytes (TILs).
[0073] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is measured by calculating the
difference in IP-10 level in plasma seven days before TIL infusion
and one day after TIL infusion, and wherein said difference in
IP-10 level in plasma is at least 800 pg/mL, 900 pg/mL, at least
1000 pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at least 1300
pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at least 1600
pg/mL, at least 1650 pg/mL, at least 1656 pg/mL, at least 1700
pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at least 2000
pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
[0074] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is indicative of treatment
efficacy.
[0075] In an embodiment and in accordance with any of the above,
the patient is administered one or more further dosages of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
[0076] In an embodiment and in accordance with any of the above,
the patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
[0077] In an embodiment and in accordance with any of the above,
wherein the therapeutically effective population of TILs comprises
from about 2.3.times.1010 to about 13.7.times.1010 TILs.
[0078] In an embodiment, the present disclosure provides a method
of treating double-refractory metastatic melanoma in a patient in
need thereof, the method comprising: [0079] (a) obtaining a first
population of TILs from a tumor resected from the patient by
processing a tumor sample obtained from the patient into multiple
tumor fragments; [0080] (b) adding the tumor fragments into a
closed system; [0081] (c) performing a first expansion by culturing
the first population of TILs in a cell culture medium comprising
IL-2, and optionally OKT-3, to produce a second population of TILs,
wherein the first expansion is performed in a closed container
providing a first gas-permeable surface area, wherein the first
expansion is performed for about 3-14 days to obtain the second
population of TILs, wherein the second population of TILs is at
least 50-fold greater in number than the first population of TILs,
and wherein the transition from step (b) to step (c) occurs without
opening the system; [0082] (d) performing a second expansion by
supplementing the cell culture medium of the second population of
TILs with additional IL-2, optionally OKT-3, and antigen presenting
cells (APCs), to produce a third population of TILs, wherein the
second expansion is performed for about 7-14 days to obtain the
third population of TILs, wherein the third population of TILs is a
therapeutic population of TILs, wherein the second expansion is
performed in a closed container providing a second gas-permeable
surface area, and wherein the transition from step (c) to step (d)
occurs without opening the system; [0083] (e) harvesting the
therapeutic population of TILs obtained from step (d) to provide a
harvested TIL population, wherein the transition from step (d) to
step (e) occurs without opening the system; [0084] (f) transferring
the harvested TIL population from step (e) to an infusion bag,
wherein the transfer from step (e) to (f) occurs without opening
the system, and optionally cryopreserving the harvested TIL
population; [0085] (g) administering a therapeutically effective
amount of the harvested TIL population to the patient with
double-refractory metastatic melanoma; and [0086] (h) measuring the
level of IP-10 in the patient after administering a therapeutically
effective amount of the TILs in step (g).
[0087] In an embodiment, the present disclosure provides a method
of treating cancer in a patient in need thereof, the method
comprising: [0088] (a) obtaining a first population of TILs from a
tumor resected from the patient by processing a tumor sample
obtained from the patient into multiple tumor fragments; [0089] (b)
adding the tumor fragments into a closed system; [0090] (c)
performing a first expansion by culturing the first population of
TILs in a cell culture medium comprising IL-2, and optionally
OKT-3, to produce a second population of TILs, wherein the first
expansion is performed in a closed container providing a first
gas-permeable surface area, wherein the first expansion is
performed for about 3-14 days to obtain the second population of
TILs, wherein the second population of TILs is at least 50-fold
greater in number than the first population of TILs, and wherein
the transition from step (b) to step (c) occurs without opening the
system; [0091] (d) performing a second expansion by supplementing
the cell culture medium of the second population of TILs with
additional IL-2, optionally OKT-3, and antigen presenting cells
(APCs), to produce a third population of TILs, wherein the second
expansion is performed for about 7-14 days to obtain the third
population of TILs, wherein the third population of TILs is a
therapeutic population of TILs, wherein the second expansion is
performed in a closed container providing a second gas-permeable
surface area, and wherein the transition from step (c) to step (d)
occurs without opening the system; [0092] (e) harvesting the
therapeutic population of TILs obtained from step (d) to provide a
harvested TIL population, wherein the transition from step (d) to
step (e) occurs without opening the system; [0093] (f) transferring
the harvested TIL population from step (e) to an infusion bag,
wherein the transfer from step (e) to (f) occurs without opening
the system, and optionally cryopreserving the harvested TIL
population; [0094] (g) administering a therapeutically effective
amount of the harvested TIL population to the patient with
double-refractory metastatic melanoma; and [0095] (h) measuring the
level of IP-10 in the patient after administering a therapeutically
effective amount of the TILs in step (g).
[0096] In an embodiment and in accordance with any of the above, an
increase in the level of IP-10 in step (h) is measured.
[0097] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is measured by calculating the
difference in IP-10 level in plasma seven days before TIL infusion
and one day after TIL infusion, and wherein said difference in
IP-10 level in plasma is at least 800 pg/mL, at least 900 pg/mL, at
least 1000 pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at
least 1300 pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at
least 1600 pg/mL, at least 1650 pg/mL, at least 1656 pg/mL, at
least 1700 pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at
least 2000 pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
[0098] In an embodiment and in accordance with any of the above, an
increase in the level of IP-10 in step (h) is indicative of
treatment efficacy.
[0099] In an embodiment and in accordance with any of the above,
the level of IP-10 is measured about 1 day to 10 days post
administering the therapeutically effective amount of the TILs in
step (g).
[0100] In an embodiment and in accordance with any of the above,
the level of IP-10 is measured 1 day post administering a
therapeutically effective amount of the TILs in step (g).
[0101] In an embodiment and in accordance with any of the above,
the level of IP-10 is measured about 6 hours to 24 hours post
administering the therapeutically effective amount of the TILs in
step (g).
[0102] In an embodiment and in accordance with any of the above,
the method further comprises a step of measuring the level of IP-10
in the patient prior to administering a therapeutically effective
amount of the TILs in step (g).
[0103] In an embodiment and in accordance with any of the above,
the increase is based on an increase in the level of IP-10 after
administering a therapeutically effective amount of the TILs in
step (g) as compared to the level of IP-10 in the patient prior to
administering a therapeutically effective amount of the TILs in
step (g).
[0104] In an embodiment and in accordance with any of the above,
the method further comprises step (i) predicting the patient will
respond to the therapeutically effective amount of the TILs
administered in step (g) based upon measuring an increase in the
level of IP-10 in step (h).
[0105] In an embodiment and in accordance with any of the above,
the patient is administered one or more further dosages of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
[0106] In an embodiment and in accordance with any of the above,
the method further comprises step (i) predicting the patient will
not respond to the therapeutically effective amount of the TILs
administered in step (g) based upon measuring no increase in the
level of IP-10 in step (h).
[0107] In an embodiment and in accordance with any of the above,
the method further comprises step (i) predicting the patient will
respond to the therapeutically effective amount of the TILs
administered in step (g) based upon measuring an increase in the
level of IP-10 in step (h) or predicting the patient will not
respond to the therapeutically effective amount of the TILs
administered in step (g) based upon measuring no increase in the
level of IP-10 in step (h).
[0108] In an embodiment and in accordance with any of the above,
predicting the probability that the patient will or will not
respond to the therapeutically effective amount of the TILs
administered in step (g) is based upon the presence or absence of
an increase in the level of IP-10 in step (h).
[0109] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is an increase of at least
one-fold, two-fold, three-fold, four-fold, or five-fold or
more.
[0110] In an embodiment and in accordance with any of the above,
predicting the probability that the patient will or will not
respond to the therapeutically effective amount of the TILs
administered in step (g) comprises correlating the level of IP-10
measured in the patient with a threshold value, wherein if the
level of IP-10 measured is above the threshold value one or more
further TIL treatment dosages is indicated.
[0111] In some embodiments, the invention provides a method of
predicting a treatment response and/or predicting treatment
efficacy for administration of a therapeutically effective amount
of tumor infiltrating lymphocytes (TILs) to a patient, the method
comprising: [0112] a) obtaining a biological sample from a patient
with cancer, including double-refractory metastatic melanoma;
[0113] b) measuring the level of IP-10 in the biological sample
from a); [0114] c) administering a therapeutically effective amount
of TILs; [0115] d) obtaining a biological sample from the patient
after the administration of the therapeutically effective amount of
TILs in step c) [0116] e) measuring the level of IP-10 in the
biological sample from d); [0117] f) predicting a treatment
response to and/or predicting treatment efficacy of the
administration of the therapeutically effective amount of the TILs
based upon the level of IP-10 measured after administration as
compared to the level of IP-10 measured prior to
administration.
[0118] In an embodiment and in accordance with any of the above, an
increase in the level of IP-10 measured in step (e) as compared to
the level of IP-10 measured step (b) is observed.
[0119] In an embodiment and in accordance with any of the above,
the increase in the level of IP-10 is measured by calculating the
difference in IP-10 level in plasma seven days before TIL infusion
and one day after TIL infusion, and wherein said difference in
IP-10 level in plasma is at least 800 pg/mL, at least 900 pg/mL, at
least 1000 pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at
least 1300 pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at
least 1600 pg/mL, at least 1650 pg/mL, at least 1656 pg/mL, at
least 1700 pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at
least 2000 pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
[0120] In an embodiment and in accordance with any of the above, an
increase in the level of IP-10 in step (e) as compared to the level
of IP-10 measured step (b) is indicative of treatment efficacy.
[0121] In an embodiment and in accordance with any of the above,
the level of IP-10 is measured in step (e) about 1 day to 10 days
post administering a therapeutically effective amount of the TILs
in step (c).
[0122] In an embodiment and in accordance with any of the above,
the level of IP-10 is measured in step (e) about 1 day post
administering a therapeutically effective amount of the TILs in
step (c).
[0123] In an embodiment and in accordance with any of the above,
the level of IP-10 is measured in step (e) about 6 hours to 24
hours post administering a therapeutically effective amount of the
TILs in step (g).
[0124] In an embodiment and in accordance with any of the above,
predicting that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(c) is based upon an increase in the level of IP-10 measured in
step (f).
[0125] In an embodiment and in accordance with any of the above,
measuring an increase in the level of IP-10 measured in step (e) as
compared to the level of IP-10 measured step (b) indicates that the
patient will respond to the therapeutically effective amount of the
TILs administered in step (d).
[0126] In an embodiment and in accordance with any of the above,
the patient is administered one or more further dosages of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs).
[0127] In an embodiment and in accordance with any of the above,
measuring no increase in the level of IP-10 measured in step (e) as
compared to the level of IP-10 measured step (b) indicates that the
patient will not respond to the therapeutically effective amount of
the TILs administered in step (d).
[0128] In an embodiment and in accordance with any of the above,
the level of IP-10 is increased one-fold, two-fold, three-fold,
four-fold, five-fold or more.
[0129] In an embodiment and in accordance with any of the above,
predicting that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(d) further comprises correlating the level of IP-10 measured in
the patient with a threshold value, wherein if the level of IP-10
measured is above the threshold value one or more further TIL
treatment dosages is indicated.
[0130] In an embodiment and in accordance with any of the above,
the therapeutically effective population of TILs comprises from
about 2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs.
BRIEF DESCRIPTION OF THE DRAWINGS
[0131] The foregoing summary, as well as the following detailed
description of the invention, will be better understood when read
in conjunction with the appended drawings.
[0132] FIG. 1 illustrates a TIL expansion and therapeutic treatment
process. Step 1 refers to the addition of 4 tumor fragments into 10
G-Rex 10 flasks. At step 2, approximately 40.times.10.sup.6 TILs or
greater are obtained. At step 3, a split occurs into 36 G-Rex 100
flasks for REP. TILs are harvested by centrifugation at step 4.
Fresh TIL product is obtained at step 5 after a total process time
of approximately 43 days, at which point TILs may be infused into a
patient.
[0133] FIG. 2 illustrates a treatment and manufacturing timeline
for use with TILs prepared according to the present disclosure and
the process of FIG. 1. Surgery (and tumor resection) occurs at the
start, and lymphodepletion chemo refers to non-myeloablative
lymphodepletion with chemotherapy as described elsewhere
herein.
[0134] FIG. 3 illustrates a TIL expansion and therapeutic treatment
process, including a "direct to REP" step wherein pre-REP TILs are
placed directly into a REP process. The total process time is
approximately 22 days, at which point TILs may be infused into a
patient.
[0135] FIG. 4 illustrates a treatment and manufacturing timeline
for use with TILs prepared according to the present disclosure and
the process of FIG. 3, when the cell count at day 6 is greater than
250.times.10.sup.6.
[0136] FIG. 5 illustrates a treatment and manufacturing timeline
for use with TILs prepared according to the present disclosure and
the process of FIG. 3, when the cell count at day 6 is less than
250.times.10.sup.6, and wherein lymphodepletion is begun later so
as to allow for an assessment of the viability of the TIL product
before lymphodepleting the patient.
[0137] FIG. 6 shows a detailed schematic of a TIL manufacturing
process according to FIG. 3.
[0138] FIG. 7 depicts the design of a clinical study using TIL
therapies prepared by different methods in double-refractory
melanoma.
[0139] FIG. 8 summarizes patient characteristics in the clinical
study.
[0140] FIG. 9 summarizes patient characteristics in the clinical
study.
[0141] FIG. 10 summarizes treatment emergent serious adverse events
in the clinical study. The "*" indicates a not related to therapy
event occurring six months after treatment.
[0142] FIG. 11 summarizes efficacy results in the clinical
study.
[0143] FIG. 12 illustrates a waterfall of response plot showing
efficacy in the clinical study. Responses are independent of BRAF
mutational status.
[0144] FIG. 13 illustrates time to best response and duration in
the clinical study.
[0145] FIG. 14 illustrates percentage change in sum of diameters in
the clinical study.
[0146] FIG. 15 illustrates scans from a patient in complete
remission.
[0147] FIG. 16 illustrates the design of a clinical study using TIL
therapies.
[0148] FIG. 17 illustrates the results of a second clinical study
performing using a TIL manufacturing process as described in
Radvanyi, et al., Clin. Cancer Res. 2012, 18, 6758-70. NT refers to
not tested, WT refers to wild type, and irRC refers to
immune-related response criteria. Site of TIL harvest is specified
as follows: 1: skin/SC; 2: lymph nodes; 3: lungs; and 4:
gastrointestinal/visceral.
[0149] FIG. 18: Exemplary Process 2A chart providing an overview of
Steps A through F.
[0150] FIG. 19A-19C: Process Flow Chart of Process 2A.
[0151] FIG. 20: Shows a diagram of an embodiment of a cryopreserved
TIL exemplary manufacturing process (.about.22 days).
[0152] FIG. 21: Shows a diagram of an embodiment of process 2A, a
22-day process for TIL manufacturing.
[0153] FIG. 22: Comparison table of Steps A through F from
exemplary embodiments of process 1C and process 2A.
[0154] FIG. 23: Detailed comparison of an embodiment of process 1C
and an embodiment of process 2A.
[0155] FIG. 24A-24B: Updated efficacy data for Cohort 1 from the
final data cut (N=23 patients). Abbreviations: PR, partial
response; SD, stable disease; PD, progressive disease.
[0156] FIG. 25: Scheme of Gen 2 cryopreserved LN-144 manufacturing
process.
[0157] FIG. 26: Scheme of study design of multicenter phase 2
clinical trial of novel cryopreserved TILs administered to patients
with metastatic melanoma.
[0158] FIG. 27: Table illustrating the Comparison Patient
Characteristics from Cohort 1 (ASCO 2017) vs Cohort 2.
[0159] FIG. 28: Table illustrating treatment emergent adverse
events (.gtoreq.30%).
[0160] FIG. 29: Efficacy of the infusion product and TIL
therapy.
[0161] FIG. 30: Clinical status of response evaluable patients with
SD or a better response.
[0162] FIG. 31: Percent change in sum of diameters.
[0163] FIG. 32: An increase of HMGB1 level was observed upon TIL
treatment.
[0164] FIG. 33: An increase in the biomarker IL-10 was observed
post-LN-144 infusion.
[0165] FIG. 34: Updated patient characteristics for Cohort 2 of the
phase 2 clinical trial in metastatic melanoma from the second data
cut (N=17 patients).
[0166] FIG. 35: Treatment emergent adverse events for Cohort 2
(.gtoreq.30%) from the second data cut (N=17 patients).
[0167] FIG. 36: Time to response for evaluable patients (stable
disease or better) in Cohort 2 from the second data cut (N=17
patients). Of the 10 patients in the efficacy set, one patient
(Patient 10) was not evaluable due to a melanoma-related death
prior to the first tumor assessment not represented on the
figure.
[0168] FIG. 37: Updated efficacy data for Cohort 2 from the second
data cut (N=17 patients). The mean number of TILs infused is
34.times.10.sup.1. The median number of prior therapies was 4.5.
Patients with a BRAF mutation responded as well as patients with
wild-type BRAF (a* refers to patients with a BRAF mutation). One
patient (Patient 10) was not evaluable due to a melanoma-related
death prior to the first tumor assessment but was still considered
in the efficacy set. Abbreviations: PR, partial response; SD,
stable disease; PD, progressive disease.
[0169] FIG. 38: Updated efficacy data for evaluable patients from
Cohort 2 from the second data cut (N=17 patients). The * indicates
a non-evaluable patient that did not reach the first assessment.
All efficacy-evaluable patients had received prior anti-PD-1 and
anti-CTLA-4 checkpoint inhibitor therapies.
[0170] FIG. 39: Representative computed tomography scan of a
patient (003-015) with a PR from Cohort 2, second data cut.
[0171] FIG. 40: Exemplary schematic of the process for
manufacturing of cryopreserved autologous TIL (LN-144, lifileucel),
22-day process.
[0172] FIG. 41: Schematic of the study design for example 14.
[0173] FIG. 42: Charts showing patient characteristics for Cohort
2. 3.3 mean prior therapies, ranging from 1-9. High tumor burden at
baseline 112 mm sum of diameters for the target lesions.
[0174] FIG. 43: Data showing efficacy of treatment response for
Example 14 study. Four patients who had no disease assessment
following autologous TIL (lifileucel, LN-144) due to cancer-related
death are not shown. Per RECIST 1.1, two patients (31, 33) had BOR
of SD: met PR criteria at Day 42 and PD at Day 84 due to new
lesions
[0175] FIG. 44: Data showing time to response for evaluable
patients (PR or Better). (1) BOR is best overall response on prior
anti-PD-1 immunotherapy. (2) U: unknown best overall response on
prior anti-PD-1 immunotherapy.
[0176] FIG. 45: Data showing percent change from baseline in sum of
target lesion diameters over time.
[0177] FIG. 46: Data showing treatment emergent adverse events
(.gtoreq.30%). *One death was due to intra-abdominal hemorrhage
considered possibly related to TIL and one was due to acute
respiratory failure assessed as not related to TIL per investigator
assessment. Patients with multiple events for a given preferred
term are counted only once using the maximum grade under each
preferred term. Treatment-Emergent Adverse Events refer to all AEs
starting on or after the first dose date of TIL up to 30 days.
[0178] FIG. 47: Chart showing treatment efficacy from the Example
14 study. *NE due to not reaching first assessment. 1 uPRs (4) were
all due to timing not having reached the second assessment.
[0179] FIG. 48: Data showing biomarker levels for IP-10. Change in
IP-10 (CXCL10) level in periphery may have a correlation with
response. Mean change in IP-10 levels from baseline to day 1 post
TIL infusion was higher among responders vs. nonresponders
(p=0.19). the Y-axis is in pg/mL. D-7 is seven days before TIL
infusion (administration) and D-1 is one day after TIL infusion
(administration).
BRIEF DESCRIPTION OF THE SEQUENCE LISTING
[0180] SEQ ID NO:1 is the amino acid sequence of the heavy chain of
muromonab.
[0181] SEQ ID NO:2 is the amino acid sequence of the light chain of
muromonab.
[0182] SEQ ID NO:3 is the amino acid sequence of a recombinant
human IL-2 protein.
[0183] SEQ ID NO:4 is the amino acid sequence of aldesleukin.
[0184] SEQ ID NO:5 is the amino acid sequence of a recombinant
human IL-4 protein.
[0185] SEQ ID NO:6 is the amino acid sequence of a recombinant
human IL-7 protein.
[0186] SEQ ID NO:7 is the amino acid sequence of a recombinant
human IL-15 protein.
[0187] SEQ ID NO:8 is the amino acid sequence of a recombinant
human IL-21 protein.
[0188] SEQ ID NO:9 is the amino acid sequence of human 4-1BB.
[0189] SEQ ID NO:10 is the amino acid sequence of murine 4-1BB.
[0190] SEQ ID NO:11 is the heavy chain for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0191] SEQ ID NO:12 is the light chain for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0192] SEQ ID NO:13 is the heavy chain variable region (VH) for the
4-1BB agonist monoclonal antibody utomilumab (PF-05082566).
[0193] SEQ ID NO: 14 is the light chain variable region (VL) for
the 4-1BB agonist monoclonal antibody utomilumab (PF-05082566).
[0194] SEQ ID NO: 15 is the heavy chain CDR1 for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0195] SEQ ID NO: 16 is the heavy chain CDR2 for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0196] SEQ ID NO: 17 is the heavy chain CDR3 for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0197] SEQ ID NO: 18 is the light chain CDR1 for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0198] SEQ ID NO:19 is the light chain CDR2 for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0199] SEQ ID NO:20 is the light chain CDR3 for the 4-1BB agonist
monoclonal antibody utomilumab (PF-05082566).
[0200] SEQ ID NO:21 is the heavy chain for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0201] SEQ ID NO:22 is the light chain for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0202] SEQ ID NO:23 is the heavy chain variable region (VH) for the
4-1BB agonist monoclonal antibody urelumab (BMS-663513).
[0203] SEQ ID NO:24 is the light chain variable region (VL) for the
4-1BB agonist monoclonal antibody urelumab (BMS-663513).
[0204] SEQ ID NO:25 is the heavy chain CDR1 for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0205] SEQ ID NO:26 is the heavy chain CDR2 for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0206] SEQ ID NO:27 is the heavy chain CDR3 for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0207] SEQ ID NO:28 is the light chain CDR1 for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0208] SEQ ID NO:29 is the light chain CDR2 for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0209] SEQ ID NO:30 is the light chain CDR3 for the 4-1BB agonist
monoclonal antibody urelumab (BMS-663513).
[0210] SEQ ID NO:31 is an Fe domain for a TNFRSF agonist fusion
protein.
[0211] SEQ ID NO:32 is a linker for a TNFRSF agonist fusion
protein.
[0212] SEQ ID NO:33 is a linker for a TNFRSF agonist fusion
protein.
[0213] SEQ ID NO:34 is a linker for a TNFRSF agonist fusion
protein.
[0214] SEQ ID NO:35 is a linker for a TNFRSF agonist fusion
protein.
[0215] SEQ ID NO:36 is a linker for a TNFRSF agonist fusion
protein.
[0216] SEQ ID NO:37 is a linker for a TNFRSF agonist fusion
protein.
[0217] SEQ ID NO:38 is a linker for a TNFRSF agonist fusion
protein.
[0218] SEQ ID NO:39 is a linker for a TNFRSF agonist fusion
protein.
[0219] SEQ ID NO:40 is a linker for a TNFRSF agonist fusion
protein.
[0220] SEQ ID NO:41 is a linker for a TNFRSF agonist fusion
protein.
[0221] SEQ ID NO:42 is an Fe domain for a TNFRSF agonist fusion
protein.
[0222] SEQ ID NO:43 is a linker for a TNFRSF agonist fusion
protein.
[0223] SEQ ID NO:44 is a linker for a TNFRSF agonist fusion
protein.
[0224] SEQ ID NO:45 is a linker for a TNFRSF agonist fusion
protein.
[0225] SEQ ID NO:46 is a 4-1BB ligand (4-1BBL) amino acid
sequence.
[0226] SEQ ID NO:47 is a soluble portion of 4-1BBL polypeptide.
[0227] SEQ ID NO:48 is a heavy chain variable region (VH) for the
4-1BB agonist antibody 4B4-1-1 version 1.
[0228] SEQ ID NO:49 is a light chain variable region (VL) for the
4-1BB agonist antibody 4B4-1-1 version 1.
[0229] SEQ ID NO:50 is a heavy chain variable region (VH) for the
4-1BB agonist antibody 4B4-1-1 version 2.
[0230] SEQ ID NO:51 is a light chain variable region (VL) for the
4-1BB agonist antibody 4B4-1-1 version 2.
[0231] SEQ ID NO:52 is a heavy chain variable region (VH) for the
4-1BB agonist antibody H39E3-2.
[0232] SEQ ID NO:53 is a light chain variable region (VL) for the
4-1BB agonist antibody H39E3-2.
[0233] SEQ ID NO:54 is the amino acid sequence of human OX40.
[0234] SEQ ID NO:55 is the amino acid sequence of murine OX40.
[0235] SEQ ID NO:56 is the heavy chain for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0236] SEQ ID NO:57 is the light chain for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0237] SEQ ID NO:58 is the heavy chain variable region (VH) for the
OX40 agonist monoclonal antibody tavolixizumab (MEDI-0562).
[0238] SEQ ID NO:59 is the light chain variable region (VL) for the
OX40 agonist monoclonal antibody tavolixizumab (MEDI-0562).
[0239] SEQ ID NO:60 is the heavy chain CDR1 for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0240] SEQ ID NO:61 is the heavy chain CDR2 for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0241] SEQ ID NO:62 is the heavy chain CDR3 for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0242] SEQ ID NO:63 is the light chain CDR1 for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0243] SEQ ID NO:64 is the light chain CDR2 for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0244] SEQ ID NO:65 is the light chain CDR3 for the OX40 agonist
monoclonal antibody tavolixizumab (MEDI-0562).
[0245] SEQ ID NO:66 is the heavy chain for the OX40 agonist
monoclonal antibody 11D4.
[0246] SEQ ID NO:67 is the light chain for the OX40 agonist
monoclonal antibody 11D4.
[0247] SEQ ID NO:68 is the heavy chain variable region (VH) for the
OX40 agonist monoclonal antibody 11D4.
[0248] SEQ ID NO:69 is the light chain variable region (VL) for the
OX40 agonist monoclonal antibody 11D4.
[0249] SEQ ID NO:70 is the heavy chain CDR1 for the OX40 agonist
monoclonal antibody 11D4.
[0250] SEQ ID NO:71 is the heavy chain CDR2 for the OX40 agonist
monoclonal antibody 11D4.
[0251] SEQ ID NO:72 is the heavy chain CDR3 for the OX40 agonist
monoclonal antibody 11D4.
[0252] SEQ ID NO:73 is the light chain CDR1 for the OX40 agonist
monoclonal antibody 11D4.
[0253] SEQ ID NO:74 is the light chain CDR2 for the OX40 agonist
monoclonal antibody 11D4.
[0254] SEQ ID NO:75 is the light chain CDR3 for the OX40 agonist
monoclonal antibody 11D4.
[0255] SEQ ID NO:76 is the heavy chain for the OX40 agonist
monoclonal antibody 18D8.
[0256] SEQ ID NO:77 is the light chain for the OX40 agonist
monoclonal antibody 18D8.
[0257] SEQ ID NO:78 is the heavy chain variable region (VH) for the
OX40 agonist monoclonal antibody 18D8.
[0258] SEQ ID NO:79 is the light chain variable region (VL) for the
OX40 agonist monoclonal antibody 18D8.
[0259] SEQ ID NO:80 is the heavy chain CDR1 for the OX40 agonist
monoclonal antibody 18D8.
[0260] SEQ ID NO:81 is the heavy chain CDR2 for the OX40 agonist
monoclonal antibody 18D8.
[0261] SEQ ID NO:82 is the heavy chain CDR3 for the OX40 agonist
monoclonal antibody 18D8.
[0262] SEQ ID NO:83 is the light chain CDR1 for the OX40 agonist
monoclonal antibody 18D8.
[0263] SEQ ID NO:84 is the light chain CDR2 for the OX40 agonist
monoclonal antibody 18D8.
[0264] SEQ ID NO:85 is the light chain CDR3 for the OX40 agonist
monoclonal antibody 18D8.
[0265] SEQ ID NO:86 is the heavy chain variable region (VH) for the
OX40 agonist monoclonal antibody Hu119-122.
[0266] SEQ ID NO:87 is the light chain variable region (VL) for the
OX40 agonist monoclonal antibody Hu119-122.
[0267] SEQ ID NO:88 is the heavy chain CDR1 for the OX40 agonist
monoclonal antibody Hu119-122.
[0268] SEQ ID NO:89 is the heavy chain CDR2 for the OX40 agonist
monoclonal antibody Hu119-122.
[0269] SEQ ID NO:90 is the heavy chain CDR3 for the OX40 agonist
monoclonal antibody Hu119-122.
[0270] SEQ ID NO:91 is the light chain CDR1 for the OX40 agonist
monoclonal antibody Hu119-122.
[0271] SEQ ID NO:92 is the light chain CDR2 for the OX40 agonist
monoclonal antibody Hu119-122.
[0272] SEQ ID NO:93 is the light chain CDR3 for the OX40 agonist
monoclonal antibody Hu119-122.
[0273] SEQ ID NO:94 is the heavy chain variable region (VH) for the
OX40 agonist monoclonal antibody Hu106-222.
[0274] SEQ ID NO:95 is the light chain variable region (VL) for the
OX40 agonist monoclonal antibody Hu106-222.
[0275] SEQ ID NO:96 is the heavy chain CDR1 for the OX40 agonist
monoclonal antibody Hu106-222.
[0276] SEQ ID NO:97 is the heavy chain CDR2 for the OX40 agonist
monoclonal antibody Hu106-222.
[0277] SEQ ID NO:98 is the heavy chain CDR3 for the OX40 agonist
monoclonal antibody Hu106-222.
[0278] SEQ ID NO:99 is the light chain CDR1 for the OX40 agonist
monoclonal antibody Hu106-222.
[0279] SEQ ID NO:100 is the light chain CDR2 for the OX40 agonist
monoclonal antibody Hu106-222.
[0280] SEQ ID NO:101 is the light chain CDR3 for the OX40 agonist
monoclonal antibody Hu106-222.
[0281] SEQ ID NO:102 is an OX40 ligand (OX40L) amino acid
sequence.
[0282] SEQ ID NO:103 is a soluble portion of OX40L polypeptide.
[0283] SEQ ID NO:104 is an alternative soluble portion of OX40L
polypeptide.
[0284] SEQ ID NO:105 is the heavy chain variable region (VH) for
the OX40 agonist monoclonal antibody 008.
[0285] SEQ ID NO:106 is the light chain variable region (VL) for
the OX40 agonist monoclonal antibody 008.
[0286] SEQ ID NO:107 is the heavy chain variable region (VH) for
the OX40 agonist monoclonal antibody 011.
[0287] SEQ ID NO:108 is the light chain variable region (VL) for
the OX40 agonist monoclonal antibody 011.
[0288] SEQ ID NO:109 is the heavy chain variable region (VH) for
the OX40 agonist monoclonal antibody 021.
[0289] SEQ ID NO:110 is the light chain variable region (VL) for
the OX40 agonist monoclonal antibody 021.
[0290] SEQ ID NO:111 is the heavy chain variable region (VH) for
the OX40 agonist monoclonal antibody 023.
[0291] SEQ ID NO:112 is the light chain variable region (VL) for
the OX40 agonist monoclonal antibody 023.
[0292] SEQ ID NO:113 is the heavy chain variable region (VH) for an
OX40 agonist monoclonal antibody.
[0293] SEQ ID NO:114 is the light chain variable region (VL) for an
OX40 agonist monoclonal antibody.
[0294] SEQ ID NO:115 is the heavy chain variable region (VH) for an
OX40 agonist monoclonal antibody.
[0295] SEQ ID NO:116 is the light chain variable region (VL) for an
OX40 agonist monoclonal antibody.
[0296] SEQ ID NO:117 is the heavy chain variable region (VH) for a
humanized OX40 agonist monoclonal antibody.
[0297] SEQ ID NO:118 is the heavy chain variable region (VH) for a
humanized OX40 agonist monoclonal antibody.
[0298] SEQ ID NO:119 is the light chain variable region (VL) for a
humanized OX40 agonist monoclonal antibody.
[0299] SEQ ID NO:120 is the light chain variable region (VL) for a
humanized OX40 agonist monoclonal antibody.
[0300] SEQ ID NO:121 is the heavy chain variable region (VH) for a
humanized OX40 agonist monoclonal antibody.
[0301] SEQ ID NO:122 is the heavy chain variable region (VH) for a
humanized OX40 agonist monoclonal antibody.
[0302] SEQ ID NO:123 is the light chain variable region (VL) for a
humanized OX40 agonist monoclonal antibody.
[0303] SEQ ID NO:124 is the light chain variable region (VL) for a
humanized OX40 agonist monoclonal antibody.
[0304] SEQ ID NO:125 is the heavy chain variable region (VH) for an
OX40 agonist monoclonal antibody.
[0305] SEQ ID NO:126 is the light chain variable region (VL) for an
OX40 agonist monoclonal antibody.
DETAILED DESCRIPTION OF THE INVENTION
[0306] 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 this invention belongs. All patents
and publications referred to herein are incorporated by reference
in their entireties.
Definitions
[0307] 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 this invention belongs. All patents
and publications referred to herein are incorporated by reference
in their entireties.
[0308] The term "in vivo" refers to an event that takes place in a
subject's body.
[0309] The term "in vitro" refers to an event that takes places
outside of a subject's body. In vitro assays encompass cell-based
assays in which cells alive or dead are employed and may also
encompass a cell-free assay in which no intact cells are
employed.
[0310] The term "ex vivo" refers to an event which involves
treating or performing a procedure on a cell, tissue and/or organ
which has been removed from a subject's body. Aptly, the cell,
tissue and/or organ may be returned to the subject's body in a
method of surgery or treatment.
[0311] The term "rapid expansion" means an increase in the number
of antigen-specific TILs of at least about 3-fold (or 4-, 5-, 6-,
7-, 8-, or 9-fold) over a period of a week, more preferably at
least about 10-fold (or 20-, 30-, 40-, 50-, 60-, 70-, 80-, or
90-fold) over a period of a week, or most preferably at least about
100-fold over a period of a week. A number of rapid expansion
protocols are outlined below.
[0312] By "tumor infiltrating lymphocytes" or "TILs" herein is
meant a population of cells originally obtained as white blood
cells that have left the bloodstream of a subject and migrated into
a tumor. TILs include, but are not limited to, CD8+ cytotoxic T
cells (lymphocytes), Th1 and Th17 CD4+ T cells, natural killer
cells, dendritic cells and M1 macrophages. TILs include both
primary and secondary TILs. "Primary TILs" are those that are
obtained from patient tissue samples as outlined herein (sometimes
referred to as "freshly harvested"), and "secondary TILs" are any
TIL cell populations that have been expanded or proliferated as
discussed herein, including, but not limited to bulk TILs and
expanded TILs ("REP TILs" or "post-REP TILs"). TIL cell populations
can include genetically modified TILs.
[0313] By "population of cells" (including TILs) herein is meant a
number of cells that share common traits. In general, populations
generally range from 1.times.10.sup.6 to 1.times.10.sup.10 in
number, with different TIL populations comprising different
numbers. For example, initial growth of primary TILs in the
presence of IL-2 results in a population of bulk TILs of roughly
1.times.10.sup.8 cells. REP expansion is generally done to provide
populations of 1.5.times.10.sup.9 to 1.5.times.10.sup.10 cells for
infusion.
[0314] By "cryopreserved TILs" herein is meant that TILs, either
primary, bulk, or expanded (REP TILs), are treated and stored in
the range of about -150.degree. C. to -60.degree. C. General
methods for cryopreservation are also described elsewhere herein,
including in the Examples. For clarity, "cryopreserved TILs" are
distinguishable from frozen tissue samples which may be used as a
source of primary TILs.
[0315] By "thawed cryopreserved TILs" herein is meant a population
of TILs that was previously cryopreserved and then treated to
return to room temperature or higher, including but not limited to
cell culture temperatures or temperatures wherein TILs may be
administered to a patient.
[0316] TILs can generally be defined either biochemically, using
cell surface markers, or functionally, by their ability to
infiltrate tumors and effect treatment. TILs can be generally
categorized by expressing one or more of the following biomarkers:
CD4, CD8, TCR .beta..beta., CD27, CD28, CD56, CCR7, CD45Ra, CD95,
PD-1, and CD25. Additionally and alternatively, TILs can be
functionally defined by their ability to infiltrate solid tumors
upon reintroduction into a patient.
[0317] The term "cryopreservation media" or "cryopreservation
medium" refers to any medium that can be used for cryopreservation
of cells. Such media can include media comprising 7% to 10% DMSO.
Exemplary media include CryoStor CS10, Hyperthermasol, as well as
combinations thereof. The term "CS10" refers to a cryopreservation
medium which is obtained from Stemcell Technologies or from Biolife
Solutions. The CS10 medium may be referred to by the trade name
"CryoStor.RTM. CS10". The CS10 medium is a serum-free, animal
component-free medium which comprises DMSO.
[0318] The term "central memory T cell" refers to a subset of T
cells that in the human are CD45R0+ and constitutively express CCR7
(CCR7hi) and CD62L (CD62hi). The surface phenotype of central
memory T cells also includes TCR, CD3, CD127 (IL-7R), and IL-15R.
Transcription factors for central memory T cells include BCL-6,
BCL-6B, MBD2, and BMI1. Central memory T cells primarily secret
IL-2 and CD40L as effector molecules after TCR triggering. Central
memory T cells are predominant in the CD4 compartment in blood, and
in the human are proportionally enriched in lymph nodes and
tonsils.
[0319] The term "effector memory T cell" refers to a subset of
human or mammalian T cells that, like central memory T cells, are
CD45R0+, but have lost the constitutive expression of CCR7 (CCR7lo)
and are heterogeneous or low for CD62L expression (CD62Llo). The
surface phenotype of central memory T cells also includes TCR, CD3,
CD127 (IL-7R), and IL-15R. Transcription factors for central memory
T cells include BLIMP1. Effector memory T cells rapidly secret high
levels of inflammatory cytokines following antigenic stimulation,
including interferon-.gamma., IL-4, and TL-5. Effector memory T
cells are predominant in the CD8 compartment in blood, and in the
human are proportionally enriched in the lung, liver, and gut. CD8+
effector memory T cells carry large amounts of perforin.
[0320] The term "closed system" refers to a system that is closed
to the outside environment. Any closed system appropriate for cell
culture methods can be employed with the methods of the present
invention. Closed systems include, for example, but are not limited
to closed G-containers. Once a tumor segment is added to the closed
system, the system is no opened to the outside environment until
the TILs are ready to be administered to the patient.
[0321] The terms "fragmenting," "fragment," and "fragmented," as
used herein to describe processes for disrupting a tumor, includes
mechanical fragmentation methods such as crushing, slicing,
dividing, and morcellating tumor tissue as well as any other method
for disrupting the physical structure of tumor tissue.
[0322] The terms "peripheral blood mononuclear cells" and "PBMCs"
refers to a peripheral blood cell having a round nucleus, including
lymphocytes (T cells, B cells, NK cells) and monocytes. Preferably,
the peripheral blood mononuclear cells are irradiated allogeneic
peripheral blood mononuclear cells. PBMCs are a type of
antigen-presenting cell.
[0323] The term "anti-CD3 antibody" refers to an antibody or
variant thereof, e.g., a monoclonal antibody and including human,
humanized, chimeric or murine antibodies which are directed against
the CD3 receptor in the T cell antigen receptor of mature T cells.
Anti-CD3 antibodies include OKT-3, also known as muromonab.
Anti-CD3 antibodies also include the UHCT1 clone, also known as T3
and CD3.epsilon.. Other anti-CD3 antibodies include, for example,
otelixizumab, teplizumab, and visilizumab.
[0324] The term "OKT-3" (also referred to herein as "OKT3") refers
to a monoclonal antibody or biosimilar or variant thereof,
including human, humanized, chimeric, or murine antibodies,
directed against the CD3 receptor in the T cell antigen receptor of
mature T cells, and includes commercially-available forms such as
OKT-3 (30 ng/mL, MACS GMP CD3 pure, Miltenyi Biotech, Inc., San
Diego, Calif., USA) and muromonab or variants, conservative amino
acid substitutions, glycoforms, or biosimilars thereof. The amino
acid sequences of the heavy and light chains of muromonab are given
in Table 1 (SEQ ID NO:1 and SEQ ID NO:2). A hybridoma capable of
producing OKT-3 is deposited with the American Type Culture
Collection and assigned the ATCC accession number CRL 8001. A
hybridoma capable of producing OKT-3 is also deposited with
European Collection of Authenticated Cell Cultures (ECACC) and
assigned Catalogue No. 86022706. A hybridoma capable of producing
OKT-3 is deposited with the American Type Culture Collection and
assigned the ATCC accession number CRL 8001. A hybridoma capable of
producing OKT-3 is also deposited with European Collection of
Authenticated Cell Cultures (ECACC) and assigned Catalogue No.
86022706. Anti-CD3 antibodies also include the UHCT1 clone
(commercially available from BioLegend, San Diego, Calif., USA),
also known as T3 and CD3.epsilon..
TABLE-US-00001 TABLE 1 Amino acid sequences of muromonab.
Identifier Sequence(One-Letter Amino Acid Symbols) SEQ ID NO: 1
QVQLQQSGAE LARPGASVKM SCKASGYTFT RYTMHWVKQR PGQGLEWIGY INPSRGYTNY
60 Muromonab NQHFKDKATL TTDKSSSTAY MQLSSLTSED SAVYYCARYY DDHYCLDYWG
QGTTLTVSSA 120 heavy KTTAPSVYPL APVCGGTTGS SVTLGCLVKG YFPEPVTLTW
NSGSLSSGVH TFPAVLQSDL 180 chain YTLSSSVTVT SSTWPSQSIT CNVAHPASST
KVDKKIEPRP KSCDKTHTCP PCPAPELLGG 240 PSVFLFPPKP KDTLMISRTP
EVTCVVVDVS HEDPEVKFNW YVDGVEVHNA KTKPREEQYN 300 STYRVVSVLT
VLHQDWLNGK EYKCKVSNKA LPAPIEKTIS KAKGQPREPQ VYTLPPSRDE 360
LTKNQVSLTC LVKGFYPSDI AVEWESNGQP ENNYKTTPPV LDSDGSFFLY SKLTVDKSRW
420 QQGNVFSCSV MHEALHNHYT QKSLSLSPGK 450 SEQ ID NO: 2 QIVLTQSPAI
MSASPGEKVT MTCSASSSVS YMNWYQQKSG TSPKRWIYDT SKLASGVPAH 60 Muromonab
FRGSGSGTSY SLTISGMEAE DAATYYCQQW SSNPFTFGSG TKLEINRADT APTVSIFPPS
120 light SEQLTSGGAS VVCFLNNFYP KDINVKWKID GSERQNGVLN SWTDQDSKDS
TYSMSSTLTL 180 chain TKDEYERHNS YTCEATHKTS TSPIVKSFNR NEC 213
[0325] The term "IL-2" (also referred to herein as "IL2") refers to
the T cell growth factor known as interleukin-2, and includes all
forms of IL-2 including human and mammalian forms, conservative
amino acid substitutions, glycoforms, biosimilars, and variants
thereof. IL-2 is described, e.g., in Nelson, J. Immunol. 2004, 172,
3983-88 and Malek, Annu. Rev. Immunol. 2008, 26, 453-79, the
disclosures of which are incorporated by reference herein. The
amino acid sequence of recombinant human IL-2 suitable for use in
the invention is given in Table 2 (SEQ ID NO:3). For example, the
term IL-2 encompasses human, recombinant forms of IL-2 such as
aldesleukin (PROLEUKIN, available commercially from multiple
suppliers in 22 million IU per single use vials), as well as the
form of recombinant IL-2 commercially supplied by CellGenix, Inc.,
Portsmouth, N.H., USA (CELLGRO GMP) or ProSpec-Tany TechnoGene
Ltd., East Brunswick, N.J., USA (Cat. No. CYT-209-b) and other
commercial equivalents from other vendors. Aldesleukin
(des-alanyl-1, serine-125 human IL-2) is a nonglycosylated human
recombinant form of IL-2 with a molecular weight of approximately
15 kDa. The amino acid sequence of aldesleukin suitable for use in
the invention is given in Table 2 (SEQ ID NO:4). The term IL-2 also
encompasses pegylated forms of IL-2, as described herein, including
the pegylated IL2 prodrug NKTR-214, available from Nektar
Therapeutics, South San Francisco, Calif., USA. NKTR-214 and
pegylated IL-2 suitable for use in the invention is described in
U.S. Patent Application Publication No. US 2014/0328791 A1 and
International Patent Application Publication No. WO 2012/065086 A1,
the disclosures of which are incorporated by reference herein.
Alternative forms of conjugated IL-2 suitable for use in the
invention are described in U.S. Pat. Nos. 4,766,106, 5,206,344,
5,089,261 and 4902,502, the disclosures of which are incorporated
by reference herein. Formulations of IL-2 suitable for use in the
invention are described in U.S. Pat. No. 6,706,289, the disclosure
of which is incorporated by reference herein.
TABLE-US-00002 TABLE 2 Amino acid sequences of interleukins.
Identifier Sequence (One-Letter Amino Acid Symbols) SEQ ID NO: 3
MAPTSSSTEK TQLQLEHLLL DLQMILNGIN NYENPELTRM LTFKEYMPEK ATELEHLQCL
60 recombinant EEELKPLEEV LNLAQSENFH LRPRDLISNI NVIVLELEGS
ETTFMCEYAD ETATIVEFLN 120 human IL-2 RWITFCQSII STLT 134 (rhIL-2)
SEQ ID NO: 4 PTSSSTKKTQ LQLEHLLLDL QMILNGINNY KNPKLTRMLT FKFYMPKKAT
ELKHLQCLEE 60 Aldesleukin ELKPLEEVLN LAQSKNFHLR PRDLISNINV
IVLELKGSET TFMCEYADET ATIVEFLNRW 120 ITFSQSIIST LT 132 SEQ ID NO: 5
MHKCDITLQE IIKTLNSLTE QKTLCTELTV TDIFAASKNT TEKETFCRAA TVLRQFYSHH
60 recombinant EKDTRCLGAT AQQFHRHKQL IRFLKRLDRN LWGLAGLNSC
PVKEANQSTL ENFLERLKTI 120 human IL-4 MREKYSKCSS 130 (rhIL-4) SEQ ID
NO: 6 MDCDIEGKDG KQYESVLMVS IDQLLDSMKE IGSNCLNNEF NFFKRHICDA
NKEGMFLFRA 60 recombinant ARKLRQFLKM NSTGDFDLHL LKVSEGTTIL
LNCTGQVKGR KPAALGEAQP TKSLEENKSL 120 human IL-7 KEQKKLNDLC
FLKRLLQEIK TCWNKILMGT KEH 153 (rhIL-7) SEQ ID NO: 7 MNWVNVISDL
KKIEDLIQSM HIDATLYTES DVHPSCKVTA MKCFLLELQV ISLESGDASI 60
recombinant HDTVENLIIL ANNSLSSNGN VTESGCKECE ELEEKNIKEF LQSFVHIVQM
FINTS 115 human IL-15 (rhIL-15) SEQ ID NO: 8 MQDRHMIRMR QLIDIVDQLX
NYVNDLVPEF LPAPEDVETN CEWSAFSCFQ KAQLKSANTG 60 recombinant
NNERIINVSI KKLKRKPPST NAGRRQKHRL TCPSCDSYEK KPPKEFLERF KSLLQKMIHQ
120 human IL-21 HLSSRTHGSE DS 132 (rhIL-21)
[0326] The term "IL-4" (also referred to herein as "IL4") refers to
the cytokine known as interleukin 4, which is produced by Th2 T
cells and by eosinophils, basophils, and mast cells. IL-4 regulates
the differentiation of naive helper T cells (Th0 cells) to Th2 T
cells. Steinke and Borish, Respir. Res. 2001, 2, 66-70. Upon
activation by IL-4, Th2 T cells subsequently produce additional
IL-4 in a positive feedback loop. IL-4 also stimulates B cell
proliferation and class II MHC expression, and induces class
switching to IgE and IgG1 expression from B cells. Recombinant
human IL-4 suitable for use in the invention is commercially
available from multiple suppliers, including ProSpec-Tany
TechnoGene Ltd., East Brunswick, N.J., USA (Cat. No. CYT-211) and
ThermoFisher Scientific, Inc., Waltham, Mass., USA (human IL-15
recombinant protein, Cat. No. Gibco CTP0043). The amino acid
sequence of recombinant human IL-4 suitable for use in the
invention is given in Table 2 (SEQ ID NO:5).
[0327] The term "IL-7" (also referred to herein as "IL7") refers to
a glycosylated tissue-derived cytokine known as interleukin 7,
which may be obtained from stromal and epithelial cells, as well as
from dendritic cells. Fry and Mackall, Blood 2002, 99, 3892-904.
IL-7 can stimulate the development of T cells. IL-7 binds to the
IL-7 receptor, a heterodimer consisting of IL-7 receptor alpha and
common gamma chain receptor, which in a series of signals important
for T cell development within the thymus and survival within the
periphery. Recombinant human IL-7 suitable for use in the invention
is commercially available from multiple suppliers, including
ProSpec-Tany TechnoGene Ltd., East Brunswick, N.J., USA (Cat. No.
CYT-254) and ThermoFisher Scientific, Inc., Waltham, Mass., USA
(human IL-15 recombinant protein, Cat. No. Gibco PHC0071). The
amino acid sequence of recombinant human IL-7 suitable for use in
the invention is given in Table 2 (SEQ ID NO:6).
[0328] The term "IL-15" (also referred to herein as "IL15") refers
to the T cell growth factor known as interleukin-15, and includes
all forms of IL-2 including human and mammalian forms, conservative
amino acid substitutions, glycoforms, biosimilars, and variants
thereof. IL-15 is described, e.g., in Fehniger and Caligiuri, Blood
2001, 97, 14-32, the disclosure of which is incorporated by
reference herein. IL-15 shares .beta. and .gamma. signaling
receptor subunits with IL-2. Recombinant human IL-15 is a single,
non-glycosylated polypeptide chain containing 114 amino acids (and
an N-terminal methionine) with a molecular mass of 12.8 kDa.
Recombinant human IL-15 is commercially available from multiple
suppliers, including ProSpec-Tany TechnoGene Ltd., East Brunswick,
N.J., USA (Cat. No. CYT-230-b) and ThermoFisher Scientific, Inc.,
Waltham, Mass., USA (human IL-15 recombinant protein, Cat. No.
34-8159-82). The amino acid sequence of recombinant human IL-15
suitable for use in the invention is given in Table 2 (SEQ ID
NO:7).
[0329] The term "IL-21" (also referred to herein as "IL21") refers
to the pleiotropic cytokine protein known as interleukin-21, and
includes all forms of IL-21 including human and mammalian forms,
conservative amino acid substitutions, glycoforms, biosimilars, and
variants thereof. IL-21 is described, e.g., in Spolski and Leonard,
Nat. Rev. Drug. Disc. 2014, 13, 379-95, the disclosure of which is
incorporated by reference herein. IL-21 is primarily produced by
natural killer T cells and activated human CD4+ T cells.
Recombinant human IL-21 is a single, non-glycosylated polypeptide
chain containing 132 amino acids with a molecular mass of 15.4 kDa.
Recombinant human IL-21 is commercially available from multiple
suppliers, including ProSpec-Tany TechnoGene Ltd., East Brunswick,
N.J., USA (Cat. No. CYT-408-b) and ThermoFisher Scientific, Inc.,
Waltham, Mass., USA (human IL-21 recombinant protein, Cat. No.
14-8219-80). The amino acid sequence of recombinant human IL-21
suitable for use in the invention is given in Table 2 (SEQ ID
NO:8).
[0330] When "an anti-tumor effective amount", "an tumor-inhibiting
effective amount", or "therapeutic amount" is indicated, the
precise amount of the compositions of the present invention to be
administered can be determined by a physician with consideration of
individual differences in age, weight, tumor size, extent of
infection or metastasis, and condition of the patient (subject). It
can generally be stated that a pharmaceutical composition
comprising the tumor infiltrating lymphocytes (e.g. secondary TILs
or genetically modified cytotoxic lymphocytes) described herein may
be administered at a dosage of 10.sup.4 to 10.sup.11 cells/kg body
weight (e.g., 10.sup.5 to 10.sup.6, 10.sup.5 to 10.sup.10, 10.sup.5
to 10.sup.11, 10.sup.6 to 10.sup.10, 106 to 10.sup.11, 10.sup.7 to
10.sup.11, 10.sup.7 to 10.sup.10, 10.sup.8 to 10.sup.11, 10.sup.8
to 10.sup.10, 10.sup.9 to 10.sup.11, or 10.sup.9 to 10.sup.10
cells/kg body weight), including all integer values within those
ranges. Tumor infiltrating lymphocytes (including in some cases,
genetically modified cytotoxic lymphocytes) compositions may also
be administered multiple times at these dosages. The tumor
infiltrating lymphocytes (including in some cases, genetically) can
be administered by using infusion techniques that are commonly
known in immunotherapy (see, e.g., Rosenberg et al., New Eng. J. of
Med. 319: 1676, 1988). The optimal dosage and treatment regime for
a particular patient can readily be determined by one skilled in
the art of medicine by monitoring the patient for signs of disease
and adjusting the treatment accordingly.
[0331] The term "hematological malignancy" refers to mammalian
cancers and tumors of the hematopoietic and lymphoid tissues,
including but not limited to tissues of the blood, bone marrow,
lymph nodes, and lymphatic system. Hematological malignancies are
also referred to as "liquid tumors." Hematological malignancies
include, but are not limited to, acute lymphoblastic leukemia
(ALL), chronic lymphocytic lymphoma (CLL), small lymphocytic
lymphoma (SLL), acute myelogenous leukemia (AML), chronic
myelogenous leukemia (CML), acute monocytic leukemia (AMoL),
Hodgkin's lymphoma, and non-Hodgkin's lymphomas. The term "B cell
hematological malignancy" refers to hematological malignancies that
affect B cells.
[0332] The term "solid tumor" refers to an abnormal mass of tissue
that usually does not contain cysts or liquid areas. Solid tumors
may be benign or malignant. The term "solid tumor cancer refers to
malignant, neoplastic, or cancerous solid tumors. Solid tumor
cancers include, but are not limited to, sarcomas, carcinomas, and
lymphomas, such as cancers of the lung, breast, prostate, colon,
rectum, and bladder. The tissue structure of solid tumors includes
interdependent tissue compartments including the parenchyma (cancer
cells) and the supporting stromal cells in which the cancer cells
are dispersed and which may provide a supporting
microenvironment.
[0333] The term "liquid tumor" refers to an abnormal mass of cells
that is fluid in nature. Liquid tumor cancers include, but are not
limited to, leukemias, myelomas, and lymphomas, as well as other
hematological malignancies. TILs obtained from liquid tumors may
also be referred to herein as marrow infiltrating lymphocytes
(MILs).
[0334] The term "microenvironment," as used herein, may refer to
the solid or hematological tumor microenvironment as a whole or to
an individual subset of cells within the microenvironment. The
tumor microenvironment, as used herein, refers to a complex mixture
of "cells, soluble factors, signaling molecules, extracellular
matrices, and mechanical cues that promote neoplastic
transformation, support tumor growth and invasion, protect the
tumor from host immunity, foster therapeutic resistance, and
provide niches for dominant metastases to thrive," as described in
Swartz, et al., Cancer Res., 2012, 72, 2473. Although tumors
express antigens that should be recognized by T cells, tumor
clearance by the immune system is rare because of immune
suppression by the microenvironment.
[0335] The terms "co-administration," "co-administering,"
"administered in combination with," "administering in combination
with," "simultaneous," and "concurrent," as used herein, encompass
administration of two or more active pharmaceutical ingredients (in
a preferred embodiment of the present invention, for example, at
least one potassium channel agonist in combination with a plurality
of TILs) to a subject so that both active pharmaceutical
ingredients and/or their metabolites are present in the subject at
the same time. Co-administration includes simultaneous
administration in separate compositions, administration at
different times in separate compositions, or administration in a
composition in which two or more active pharmaceutical ingredients
are present. Simultaneous administration in separate compositions
and administration in a composition in which both agents are
present are preferred.
[0336] The term "effective amount" or "therapeutically effective
amount" refers to that amount of a compound or combination of
compounds as described herein that is sufficient to effect the
intended application including, but not limited to, disease
treatment. A therapeutically effective amount may vary depending
upon the intended application (in vitro or in vivo), or the subject
and disease condition being treated (e.g., the weight, age and
gender of the subject), the severity of the disease condition, or
the manner of administration. The term also applies to a dose that
will induce a particular response in target cells (e.g., the
reduction of platelet adhesion and/or cell migration). The specific
dose will vary depending on the particular compounds chosen, the
dosing regimen to be followed, whether the compound is administered
in combination with other compounds, timing of administration, the
tissue to which it is administered, and the physical delivery
system in which the compound is carried.
[0337] The terms "treatment", "treating", "treat", and the like,
refer to obtaining a desired pharmacologic and/or physiologic
effect. The effect may be prophylactic in terms of completely or
partially preventing a disease or symptom thereof and/or may be
therapeutic in terms of a partial or complete cure for a disease
and/or adverse effect attributable to the disease. "Treatment" and
its grammatical equivalents, as used herein, covers any treatment
of a disease in a mammal, particularly in a human, and includes:
(a) preventing the disease from occurring in a subject which may be
predisposed to the disease but has not yet been diagnosed as having
it; (b) inhibiting the disease, i.e., arresting its development or
progression; and (c) relieving the disease, i.e., causing
regression of the disease and/or relieving one or more disease
symptoms. "Treatment" is also meant to encompass delivery of an
agent in order to provide for a pharmacologic effect, even in the
absence of a disease or condition. For example, "treatment"
encompasses delivery of a composition that can elicit an immune
response or confer immunity in the absence of a disease condition,
e.g., in the case of a vaccine.
[0338] The term "heterologous" when used with reference to portions
of a nucleic acid or protein indicates that the nucleic acid or
protein comprises two or more subsequences that are not found in
the same relationship to each other in nature. For instance, the
nucleic acid is typically recombinantly produced, having two or
more sequences from unrelated genes arranged to make a new
functional nucleic acid, e.g., a promoter from one source and a
coding region from another source, or coding regions from different
sources. Similarly, a heterologous protein indicates that the
protein comprises two or more subsequences that are not found in
the same relationship to each other in nature (e.g., a fusion
protein).
[0339] The terms "sequence identity," "percent identity," and
"sequence percent identity" (or synonyms thereof, e.g., "99%
identical") in the context of two or more nucleic acids or
polypeptides, refer to two or more sequences or subsequences that
are the same or have a specified percentage of nucleotides or amino
acid residues that are the same, when compared and aligned
(introducing gaps, if necessary) for maximum correspondence, not
considering any conservative amino acid substitutions as part of
the sequence identity. The percent identity can be measured using
sequence comparison software or algorithms or by visual inspection.
Various algorithms and software are known in the art that can be
used to obtain alignments of amino acid or nucleotide sequences.
Suitable programs to determine percent sequence identity include
for example the BLAST suite of programs available from the U.S.
Government's National Center for Biotechnology Information BLAST
web site. Comparisons between two sequences can be carried using
either the BLASTN or BLASTP algorithm. BLASTN is used to compare
nucleic acid sequences, while BLASTP is used to compare amino acid
sequences. ALIGN, ALIGN-2 (Genentech, South San Francisco, Calif.)
or MegAlign, available from DNASTAR, are additional publicly
available software programs that can be used to align sequences.
One skilled in the art can determine appropriate parameters for
maximal alignment by particular alignment software. In certain
embodiments, the default parameters of the alignment software are
used.
[0340] As used herein, the term "variant" encompasses but is not
limited to antibodies or fusion proteins which comprise an amino
acid sequence which differs from the amino acid sequence of a
reference antibody by way of one or more substitutions, deletions
and/or additions at certain positions within or adjacent to the
amino acid sequence of the reference antibody. The variant may
comprise one or more conservative substitutions in its amino acid
sequence as compared to the amino acid sequence of a reference
antibody. Conservative substitutions may involve, e.g., the
substitution of similarly charged or uncharged amino acids. The
variant retains the ability to specifically bind to the antigen of
the reference antibody. The term variant also includes pegylated
antibodies or proteins.
[0341] By "tumor infiltrating lymphocytes" or "TILs" herein is
meant a population of cells originally obtained as white blood
cells that have left the bloodstream of a subject and migrated into
a tumor. TILs include, but are not limited to, CD8+ cytotoxic T
cells (lymphocytes), Th1 and Th17 CD4+ T cells, natural killer
cells, dendritic cells and M1 macrophages. TILs include both
primary and secondary TILs. "Primary TILs" are those that are
obtained from patient tissue samples as outlined herein (sometimes
referred to as "freshly harvested"), and "secondary TILs" are any
TIL cell populations that have been expanded or proliferated as
discussed herein, including, but not limited to bulk TILs, expanded
TILs ("REP TILs") as well as "reREP TILs" as discussed herein.
reREP TILs can include for example second expansion TILs or second
additional expansion TILs (such as, for example, those described in
Step D of FIG. 27, including TILs referred to as reREP TILs).
[0342] TILs can generally be defined either biochemically, using
cell surface markers, or functionally, by their ability to
infiltrate tumors and effect treatment. TILs can be generally
categorized by expressing one or more of the following biomarkers:
CD4, CD8, TCR .alpha..beta., CD27, CD28, CD56, CCR7, CD45Ra, CD95,
PD-1, and CD25. Additionally, and alternatively, TILs can be
functionally defined by their ability to infiltrate solid tumors
upon reintroduction into a patient. TILS may further be
characterized by potency--for example, TILS may be considered
potent if, for example, interferon (IFN) release is greater than
about 50 pg/mL, greater than about 100 pg/mL, greater than about
150 pg/mL, or greater than about 200 pg/mL.
[0343] The terms "pharmaceutically acceptable carrier" or
"pharmaceutically acceptable excipient" are intended to include any
and all solvents, dispersion media, coatings, antibacterial and
antifungal agents, isotonic and absorption delaying agents, and
inert ingredients. The use of such pharmaceutically acceptable
carriers or pharmaceutically acceptable excipients for active
pharmaceutical ingredients is well known in the art. Except insofar
as any conventional pharmaceutically acceptable carrier or
pharmaceutically acceptable excipient is incompatible with the
active pharmaceutical ingredient, its use in the therapeutic
compositions of the invention is contemplated. Additional active
pharmaceutical ingredients, such as other drugs, can also be
incorporated into the described compositions and methods.
[0344] The terms "about" and "approximately" mean within a
statistically meaningful range of a value. Such a range can be
within an order of magnitude, preferably within 50%, more
preferably within 20%, more preferably still within 10%, and even
more preferably within 5% of a given value or range. The allowable
variation encompassed by the terms "about" or "approximately"
depends on the particular system under study, and can be readily
appreciated by one of ordinary skill in the art. Moreover, as used
herein, the terms "about" and "approximately" mean that dimensions,
sizes, formulations, parameters, shapes and other quantities and
characteristics are not and need not be exact, but may be
approximate and/or larger or smaller, as desired, reflecting
tolerances, conversion factors, rounding off, measurement error and
the like, and other factors known to those of skill in the art. In
general, a dimension, size, formulation, parameter, shape or other
quantity or characteristic is "about" or "approximate" whether or
not expressly stated to be such. It is noted that embodiments of
very different sizes, shapes and dimensions may employ the
described arrangements.
[0345] The transitional terms "comprising," "consisting essentially
of," and "consisting of," when used in the appended claims, in
original and amended form, define the claim scope with respect to
what unrecited additional claim elements or steps, if any, are
excluded from the scope of the claim(s). The term "comprising" is
intended to be inclusive or open-ended and does not exclude any
additional, unrecited element, method, step or material. The term
"consisting of" excludes any element, step or material other than
those specified in the claim and, in the latter instance,
impurities ordinary associated with the specified material(s). The
term "consisting essentially of" limits the scope of a claim to the
specified elements, steps or material(s) and those that do not
materially affect the basic and novel characteristic(s) of the
claimed invention. All compositions, methods, and kits described
herein that embody the present invention can, in alternate
embodiments, be more specifically defined by any of the
transitional terms "comprising," "consisting essentially of," and
"consisting of."
Methods of Treating Cancer
[0346] The compositions and methods involving TILs (and populations
thereof) described herein can be used in a method for treating
hyperproliferative disorders. In a preferred embodiment, they are
for use in treating cancers. In a preferred embodiment, the
invention provides a method of treating a cancer, wherein the
cancer is metastatic melanoma. In a preferred embodiment, the
invention provides a method of treating a cancer, wherein the
cancer is metastatic double-refractory melanoma.
[0347] Methods of treating metastatic double-refractory melanoma in
accordance with the present invention include administering to a
patient in need thereof a therapeutic population of TILS derived
from that patient's own tumor (autologous cell product). In certain
embodiments, the cell product is composed of .gtoreq.90%
CD45.sup.+CD3.sup.+ T cells. In some embodiments, the cell product
is composed of .gtoreq.80%, .gtoreq.85%, .gtoreq.90%, .gtoreq.96%,
.gtoreq.97%, .gtoreq.98%, or .gtoreq.99% CD45.sup.+CD3.sup.+ T
cells. Natural killer (NK) cells and B cells may be present in the
cell product, but generally represent less than 5%, less than 4%,
less than 3%, less than 2%, or less than 1% of the total cells in
the cell product.
[0348] For any of the treatment methods described herein, the route
of administration of TIL therapy is generally by intravenous
infusion. As described in further detail herein, this
administration of TILs follows two or more prior systemic
therapies. This administration of TIL therapy may also follow a
nonmyeloablative lymphodeletion therapy such as cyclophosphamide
and/or fludarabine. In further embodiments, IL-2 is administered to
the patient following the TIL therapy.
[0349] As will be appreciated, the TILs used in the treatment
methods described herein can be obtained and processed using
methods known in the art and described herein. In certain exemplary
embodiments, the therapeutic population TILs used in treatment
methods of the invention are expanded from tumors resected from the
patient with the metastatic double-refractory melanoma. Thus, the
therapeutic population of TILs is "derived from" TILs from a tumor
from the patient. The methods of expansion will in further
embodiments include expansions such as those described herein in
the section entitled "Methods of Expanding Tumor Infiltrating
Lymphocytes." Briefly, such methods include the steps of resecting
a tumor from a patient, the tumor comprising a first population of
TILs, fragmenting the tumor, contacting the tumor fragments with a
first cell culture medium to expand that first population of TILs
into a second population of TILs, contacting the second population
of TILs with a cell culture medium containing IL-2, OKT-3 (anti-CD3
antibody), and irradiated allogeneic peripheral blood mononuclear
cells (PBMCs) to perform an expansion of that second population of
TILs to obtain a third population of TILs, where a therapeutically
effective portion of that third population of TILs can be
administered to the patient. In general, the expansion of the
second population into the third (therapeutic) population of cells
is performed over a period of 14 days or less. In additional
embodiments, methods of expanding TILs include those exemplified in
co-pending applications WO2018/081473, filed Oct. 26, 2017;
PCT/US2018/012605, filed Jan. 5, 2018; and PCT/US18/12633, filed
Jan. 5, 2018, each of which is herein incorporated by reference in
its entirety for all purposes and in particular for all teachings
related to methods of expanding TILs from a tumor sample.
[0350] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory cutaneous melanoma.
[0351] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory uveal (ocular) melanoma.
[0352] As is discussed in further detail herein, the term
"double-refractory melanoma" encompasses melanoma refractory to two
or more prior systemic therapies. To be refractory to a prior
systemic therapy is meant that the patient either had no response
or progressed after receiving the prior systemic therapies.
[0353] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to at least two prior
systemic therapies, where those two prior system therapies are not
including neo-adjuvant or adjuvant therapies such as
interferon-.alpha.. As will be appreciated, neo-adjuvant therapies
encompass therapies given as a first step to reduce the size of a
tumor before the main treatment is given. As will further be
appreciated, adjuvant therapies include additional cancer treatment
given after the primary treatment to lower the risk that the cancer
will come back. The presently disclosed invention comprises TILs
treatments that are third, fourth or fifth-line therapies after the
melanoma has not responded to or has progressed after at least two
prior primary therapies. In further embodiments, the patient has
been previously treated with one additional prior line of systemic
therapy prior to receiving TILs treatments in accordance with the
methods described herein.
[0354] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to at least two prior
systemic therapies, not including neo-adjuvant or adjuvant
therapies such as interferon-.alpha., wherein prior systemic
therapies containing multiple agents, such as ipilimumab and
nivolumab, or concurrent administration of multiple approved or
experimental therapies, are counted as a single prior systemic
therapy. In other words, the two prior systemic therapies may
include primary therapies of combination treatments involving two
or more therapies that are considered to be a single therapy. As
will be appreciated, these combination therapies may include
combinations of the same type of therapies (such as two checkpoint
inhibitors), or they may include different types of therapies that
are often provided in conjunction as a single therapy (such as
radiation and chemotherapeutics).
[0355] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a checkpoint inhibitor
and (2) at least one other prior systemic therapy.
[0356] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a BRAF inhibitor and
(2) at least one other prior systemic therapy. In a further
embodiment, the at least one other prior systemic therapy is a
checkpoint inhibitor, and in a still further embodiment, the
checkpoint inhibitor is a PD-1 inhibitor.
[0357] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a checkpoint inhibitor
and (2) at least one other prior systemic therapy, wherein the one
other prior systemic therapy is a combination of therapies.
[0358] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a PD-1 inhibitor and
(2) at least one other prior systemic therapy. In a further
embodiment, the patient received no more than 4 doses of PD-1
inhibitor prior to receiving treatment by TILs in accordance with
the present invention. In a still further embodiment, the patient
received no more than 10, 9, 8, 7, 6, 5, 4, 3, or 2 doses of PD-1
inhibitor receiving treatment by TILs in accordance with the
present invention.
[0359] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a PD-L1 inhibitor and
(2) at least one other prior systemic therapy.
[0360] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a CTLA-4 inhibitor and
(2) at least one other prior systemic therapy.
[0361] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a PD-1 inhibitor and
(2) at least one other prior systemic therapy, wherein the one
other prior systemic therapy is a combination of therapies.
[0362] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a PD-L1 inhibitor and
(2) at least one other prior systemic therapy, wherein the one
other prior systemic therapy is a combination of therapies.
[0363] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a CTLA-4 inhibitor and
(2) at least one other prior systemic therapy, wherein the one
other prior systemic therapy is a combination of therapies.
[0364] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a checkpoint inhibitor
and (2) aldesleukin or a biosimilar or variant thereof, including
pegylated IL-2.
[0365] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to at least two checkpoint
inhibitors given as separate prior therapies.
[0366] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) pembrolizumab, or a
biosimilar or variant thereof, and (2) at least one other prior
systemic therapy.
[0367] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) nivolumab, or a
biosimilar or variant thereof, and (2) at least one other prior
systemic therapy.
[0368] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) ipilimumab, or a
biosimilar or variant thereof, and (2) at least one other prior
systemic therapy.
[0369] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a combination of
nivolumab and ipilimumab, or biosimilars or variants thereof, and
(2) at least one other prior systemic therapy.
[0370] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a checkpoint inhibitor
and (2) aldesleukin or a biosimilar or variant thereof, including
pegylated IL-2.
[0371] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) pembrolizumab, or a
biosimilar or variant thereof, and (2) at least one other prior
systemic therapy, wherein the one other prior systemic therapy is a
combination of therapies.
[0372] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) nivolumab, or a
biosimilar or variant thereof, and (2) at least one other prior
systemic therapy, wherein the one other prior systemic therapy is a
combination of therapies.
[0373] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) ipilimumab, or a
biosimilar or variant thereof, and (2) at least one other prior
systemic therapy, wherein the one other prior systemic therapy is a
combination of therapies.
[0374] In a preferred embodiment, the invention provides a method
of treating a cancer, wherein the cancer is metastatic
double-refractory melanoma refractory to (1) a combination of
nivolumab and ipilimumab, or biosimilars or variants thereof, and
(2) at least one other prior systemic therapy, wherein the one
other prior systemic therapy is a combination of therapies.
[0375] In any of the foregoing embodiments, the metastatic
double-refractory melanoma may be a cutaneous metastatic
double-refractory melanoma.
[0376] As is described in further detail herein, the therapeutic
population of TILs used in any of the treatment methods of the
invention may be cryopreserved or non-cryopreserved. Cryopreserved
TILs are produced according to methods known in the art or as
described in further detail herein.
[0377] In accordance with any of the above-described embodiments,
the double-refractory metastatic melanoma may be refractory to PD-1
inhibitors that can include for example antibodies that target
PD-1, e.g., but are not limited to nivolumab (BMS-936558,
Bristol-Myers Squibb; Opdivo.RTM.), pembrolizumab (lambrolizumab,
MK03475 or MK-3475, Merck; Keytruda.RTM.), humanized anti-PD-1
antibody JS001 (ShangHai JunShi), monoclonal anti-PD-1 antibody
TSR-042 (Tesaro, Inc.), Pidilizumab (anti-PD-1 mAb CT-011,
Medivation), anti-PD-1 monoclonal Antibody BGB-A317 (BeiGene),
and/or anti-PD-1 antibody SHR-1210 (ShangHai HengRui), human
monoclonal antibody REGN2810 (Regeneron), human monoclonal antibody
MDX-1106 (Bristol-Myers Squibb), and/or humanized anti-PD-1 IgG4
antibody PDR001 (Novartis). In some embodiments, the PD-1 antibody
is from clone: RMP1-14 (rat IgG)--BioXcell cat #BP0146. Other PD-1
antibodies include those disclosed in U.S. Pat. No. 8,008,449,
herein incorporated by reference. In some embodiments, the antibody
or antigen-binding portion thereof binds specifically to PD-L1 and
inhibits its interaction with PD-1, thereby increasing immune
activity. Any antibodies known in the art which bind to PD-L1 and
disrupt the interaction between the PD-1 and PD-L1, and stimulates
an anti-tumor immune response, may also be among the systemic
therapies to which the double-refractory melanoma is refractory.
For example, antibodies that target PD-L1 and are in clinical
trials or are approved and are commercially available include
avelumab (EMD Serono, Pfizer, Bavencio.RTM.), durvalumab (MEDI4736,
AstraZeneca, Imfinzi.RTM.), BMS-936559 (Bristol-Myers Squibb) and
atezolizumab (MPDL3280A, Genentech, Tecentriq.RTM.). Other suitable
antibodies that target PD-L1 are disclosed in U.S. Pat. No.
7,943,743, herein incorporated by reference. It will be understood
by one of ordinary skill that any antibody which binds to PD-1 or
PD-L1, disrupts the PD-1/PD-L1 interaction, and stimulates an
anti-tumor immune response may serve as therapies to which the
melanoma treated in accordance with methods of the present
invention are refractory.
[0378] Similarly, the melanoma treated in accordance with the
methods described herein may be refractory to BRAF inhibitors,
including without limitation inhibitors that affect the BRAF
protein directly or inhibitors that affect MEK. BRAF inhibitors
include without limitation Vemurafenib (Zelboraf.RTM.) and
dabrafenib (Tafinlar.RTM.), as well as GDC-0879, PLX-4720, or
sorafenib (Nexavar.RTM.). MEK inhibitors include without limitation
trametinib (Mekinist.RTM.) and cobimetinib (Cotellic.RTM.).
[0379] In certain embodiments and in accordance with any of the
embodiments described herein, patients treated in accordance with
the described invention may possess genetic makeups (or have tumors
that possess genetic makeups) that indicate susceptibility or
resistance to certain types of treatments. For example, patients
may show low PDL1 expression, or they may (or may not) possess
mutations in the BRAF gene. In specific embodiments, the treatments
for double-refractory melanoma described herein are
insensitive/agnostic to the BRAF status (e.g., the presence or
absence of mutations in the BRAF gene). In some embodiments,
patients may exhibit melanoma resistant to PD-1 or PD-L1
inhibitors. Mechanisms of resistance to PD-1 and PD-L1 inhibitors
are known in the art, including resistance based on mutations
within genes encoding Janus kinase 1 and Janus kinase 2 proteins
mutations and resistance based on mutations within genes encoding
beta-2-microglobulin, as well as other mutations, which are
described, e.g., in Zaretsky, et al., Mutations associated with
acquired resistance to PD-1 blockade in melanoma, N. Engl. J. Med.
2016, 375, 819-29, the disclosure of which is incorporated by
reference herein.
[0380] In accordance with any of the embodiments discussed above,
the TILs therapy provided to patients with double-refractory
melanoma may include treatment with therapeutic populations of TILs
alone or may include a combination treatment including TILs and one
or more other therapies. For example, in some embodiments, the TILs
produced as described herein can be administered in combination
with one or more immune checkpoint regulators, such as the
antibodies described below. For example, antibodies that target
PD-1 and which can be co-administered with the TILs of the present
invention include, e.g., but are not limited to nivolumab
(BMS-936558, Bristol-Myers Squibb; Opdivo.RTM.), pembrolizumab
(lambrolizumab, MK03475 or MK-3475, Merck; Keytruda.RTM.),
humanized anti-PD-1 antibody JS001 (ShangHai JunShi), monoclonal
anti-PD-1 antibody TSR-042 (Tesaro, Inc.), Pidilizumab (anti-PD-1
mAb CT-011, Medivation), anti-PD-1 monoclonal Antibody BGB-A317
(BeiGene), and/or anti-PD-1 antibody SHR-1210 (ShangHai HengRui),
human monoclonal antibody REGN2810 (Regeneron), human monoclonal
antibody MDX-1106 (Bristol-Myers Squibb), and/or humanized
anti-PD-1 IgG4 antibody PDR001 (Novartis). In some embodiments, the
PD-1 antibody is from clone: RMP1-14 (rat IgG)--BioXcell cat
#BP0146. Other suitable antibodies suitable for use in
co-administration methods with TILs produced according to Steps A
through F as described herein are anti-PD-1 antibodies disclosed in
U.S. Pat. No. 8,008,449, herein incorporated by reference. In some
embodiments, the antibody or antigen-binding portion thereof binds
specifically to PD-L1 and inhibits its interaction with PD-1,
thereby increasing immune activity. Any antibodies known in the art
which bind to PD-L1 and disrupt the interaction between the PD-1
and PD-L1, and stimulates an anti-tumor immune response, are
suitable for use in co-administration methods with TILs produced
according to Steps A through F as described herein. For example,
antibodies that target PD-L1 and are in clinical trials or are
approved and are commercially available include avelumab (EMD
Serono, Pfizer, Bavencio.RTM.), durvalumab (MEDI4736, AstraZeneca,
Imfinzi.RTM.), BMS-936559 (Bristol-Myers Squibb) and atezolizumab
(MPDL3280A, Genentech, Tecentriq.RTM.). Other suitable antibodies
that target PD-L1 are disclosed in U.S. Pat. No. 7,943,743, herein
incorporated by reference. It will be understood by one of ordinary
skill that any antibody which binds to PD-1 or PD-L1, disrupts the
PD-1/PD-L1 interaction, and stimulates an anti-tumor immune
response, are suitable for use in co-administration methods with
TILs. In some embodiments, the patient administered the combination
of TILs is co administered with an anti-PD-1 antibody when the
patient has progressed or had no response to treatment by anti-PD-1
antibody alone. Similarly, TILs therapy may be co-administered with
other therapies, such as CTLA-4 inhibitors, BRAF inhibitors, and
any other therapies known in the art to be useful for treatment of
melanoma.
[0381] As will be appreciated and in accordance with any of the
treatment methods described above, any of the additional treatment
modalities described herein, including BRAF inhibitors, MEK
inhibitors, PD-1 inhibitors, PD-L1 inhibitors, and CTLA-4
inhibitors, include any embodiments of such inhibitors as well as
any pharmaceutically acceptable salt thereof.
[0382] In an embodiment, a patient treated with TIL therapies
disclosed herein exhibits an improved response to the response
expected from a historical control, wherein the improved response
is determined as overall response rate. In an embodiment, a patient
treated with TIL therapies disclosed herein exhibits an improved
response to the response expected from a historical control,
wherein the improved response is determined as overall response
rate, wherein the improvement in overall response rate is at least
5%, at least 10%, at least 15%, at least 20%, at least 25%, or at
least 50%. In an embodiment, a patient treated with TIL therapies
disclosed herein exhibits an improved response to the response
expected from a historical control, wherein the improved response
is determined as duration of response. In an embodiment, a patient
treated with TIL therapies disclosed herein exhibits an improved
response to the response expected from a historical control,
wherein the improved response is determined as duration of
response, wherein the improvement in duration of response is at
least 5%, at least 10%, at least 15%, at least 20%, at least 25%,
or at least 50%.
Non-Myeloablative Lymphodepletion with Chemotherapy
[0383] Experimental findings indicate that lymphodepletion prior to
adoptive transfer of tumor-specific T lymphocytes plays a key role
in enhancing treatment efficacy by eliminating regulatory T cells
and competing elements of the immune system ("cytokine sinks").
Accordingly, some embodiments of the invention utilize a
lymphodepletion step (sometimes also referred to as
"immunosuppressive conditioning") on the patient prior to the
introduction of the TILs of the invention.
[0384] In an embodiment, the invention provides a method of
treating double-refractory melanoma with a population of TILs,
wherein a patient is pre-treated with non-myeloablative
chemotherapy prior to an infusion of TILs. In an embodiment, the
non-myeloablative chemotherapy includes one or more
chemotherapeutic agents. In an embodiment, the non-myeloablative
chemotherapy is cyclophosphamide 60 mg/kg/d for 2 days (days 27 and
26 prior to TIL infusion) and fludarabine 25 mg/m2/d for 5 days
(days 27 to 23 prior to TIL infusion). In an embodiment, after
non-myeloablative chemotherapy and TIL infusion (at day 0)
according to the present disclosure, the patient receives an
intravenous infusion of IL-2 intravenously at 720,000 IU/kg every 8
hours to physiologic tolerance. In further embodiments, the IL-2 is
administered between 3 and 24 hours following TIL infusion. In yet
further embodiments, the IL-2 is administered following 3-30, 5-25,
7-20, 9-15 hours following TIL infusion. In still further
embodiments, the IL-2 is administered at 500,000; 550,000; 600,000;
650,000; 700,000; 750,000; 800,000 IU/kg every 8-12 hours to
physiologic tolerance over 5 days following TIL infusion.
[0385] In general, lymphodepletion is achieved using administration
of fludarabine or cyclophosphamide (the active form being referred
to as mafosfamide) and combinations thereof. Such methods are
described in Gassner, et al., Cancer Immunol. Immunother. 2011, 60,
75-85, Muranski, et al., Nat. Clin. Pract. Oncol., 2006, 3,
668-681, Dudley, et al., J. Clin. Oncol. 2008, 26, 5233-5239, and
Dudley, et al., J. Clin. Oncol. 2005, 23, 2346-2357, all of which
are incorporated by reference herein in their entireties.
[0386] In some embodiments, the fludarabine is administered at a
concentration of 0.5 .mu.g/mL-10 .mu.g/mL fludarabine. In some
embodiments, the fludarabine is administered at a concentration of
1 .mu.g/mL fludarabine. In some embodiments, the fludarabine
treatment is administered for 1 day, 2 days, 3 days, 4 days, 5
days, 6 days, or 7 days or more. In some embodiments, the
fludarabine is administered at a dosage of 10 mg/kg/day, 15
mg/kg/day, 20 mg/kg/day, 25 mg/kg/day, 30 mg/kg/day, 35 mg/kg/day,
40 mg/kg/day, or 45 mg/kg/day. In some embodiments, the fludarabine
treatment is administered for 2-7 days at 35 mg/kg/day. In some
embodiments, the fludarabine treatment is administered for 4-5 days
at 35 mg/kg/day. In some embodiments, the fludarabine treatment is
administered for 4-5 days at 25 mg/kg/day.
[0387] In some embodiments, the mafosfamide, the active form of
cyclophosphamide, is obtained at a concentration of 0.5 .mu.g/mL-10
.mu.g/mL by administration of cyclophosphamide. In some
embodiments, mafosfamide, the active form of cyclophosphamide, is
obtained at a concentration of 1 .mu.g/mL by administration of
cyclophosphamide. In some embodiments, the cyclophosphamide
treatment is administered for 1 day, 2 days, 3 days, 4 days, 5
days, 6 days, or 7 days or more. In some embodiments, the
cyclophosphamide is administered at a dosage of 100 mg/m.sup.2/day,
150 mg/m.sup.2/day, 175 mg/m.sup.2/day, 200 mg/m.sup.2/day, 225
mg/m.sup.2/day, 250 mg/m.sup.2/day, 275 mg/m.sup.2/day, or 300
mg/m.sup.2/day. In some embodiments, the cyclophosphamide is
administered intravenously (i.e., i.v.) In some embodiments, the
cyclophosphamide treatment is administered for 2-7 days at 35
mg/kg/day. In some embodiments, the cyclophosphamide treatment is
administered for 4-5 days at 250 mg/m.sup.2/day i.v. In some
embodiments, the cyclophosphamide treatment is administered for 4
days at 250 mg/m.sup.2/day i.v.
[0388] In some embodiments, lymphodepletion is performed by
administering the fludarabine and the cyclophosphamide are together
to a patient. In some embodiments, fludarabine is administered at
25 mg/m.sup.2/day i.v. and cyclophosphamide is administered at 250
mg/m.sup.2/day i.v. over 4 days.
[0389] In an embodiment, the lymphodepletion is performed by
administration of cyclophosphamide at a dose of 60 mg/m.sup.2/day
for two days followed by administration of fludarabine at a dose of
25 mg/m.sup.2/day for five days.
Methods of Expanding Tumor Infiltrating Lymphocytes
[0390] An exemplary TIL process known as process 2A containing some
of these features is depicted in FIG. 19, and some of the
advantages of this embodiment of the present invention over process
1C are described in Figures F and G. An embodiment of process 2A is
shown FIG. 18.
[0391] As discussed herein, the present invention can include a
step relating to the restimulation of cryopreserved TILs to
increase their metabolic activity and thus relative health prior to
transplant into a patient, and methods of testing said metabolic
health. As generally outlined herein, TILs are generally taken from
a patient sample and manipulated to expand their number prior to
transplant into a patient. In some embodiments, the TILs may be
optionally genetically manipulated as discussed below.
[0392] In some embodiments, the TILs may be cryopreserved. Once
thawed, they may also be restimulated to increase their metabolism
prior to infusion into a patient.
[0393] In some embodiments, the first expansion (including
processes referred to as the preREP as well as processes shown in
FIG. 18 as Step A) is shortened to 3 to 14 days and the second
expansion (including processes referred to as the REP as well as
processes shown in FIG. 18 as Step B) is shorted to 7 to 14 days,
as discussed in detail below as well as in the examples and
figures. In some embodiments, the first expansion (for example, an
expansion described as Step B in FIG. 18) is shortened to 11 days
and the second expansion (for example, an expansion as described in
Step D in FIG. 18) is shortened to 11 days. In some embodiments,
the combination of the first expansion and second expansion (for
example, expansions described as Step B and Step D in FIG. 18) is
shortened to 22 days, as discussed in detail below and in the
examples and figures.
[0394] The "Step" Designations A, B, C, etc., below are in
reference to FIG. 18 and in reference to certain embodiments
described herein. The ordering of the Steps below and in FIG. 18 is
exemplary and any combination or order of steps, as well as
additional steps, repetition of steps, and/or omission of steps is
contemplated by the present application and the methods disclosed
herein.
Step A: Obtain Patient Tumor Sample
[0395] In general, TILs are initially obtained from a patient tumor
sample ("primary TILs") and then expanded into a larger population
for further manipulation as described herein, optionally
cryopreserved, restimulated as outlined herein and optionally
evaluated for phenotype and metabolic parameters as an indication
of TIL health.
[0396] A patient tumor sample may be obtained using methods known
in the art, generally via surgical resection, needle biopsy or
other means for obtaining a sample that contains a mixture of tumor
and TIL cells. In general, the tumor sample may be from any solid
tumor, including primary tumors, invasive tumors or metastatic
tumors. The tumor sample may also be a liquid tumor, such as a
tumor obtained from a hematological malignancy. The solid tumor may
be of any cancer type, including, but not limited to, breast,
pancreatic, prostate, colorectal, lung, brain, renal, stomach, and
skin (including but not limited to squamous cell carcinoma, basal
cell carcinoma, and melanoma). In some embodiments, useful TILs are
obtained from malignant melanoma tumors, as these have been
reported to have particularly high levels of TILs.
[0397] The term "solid tumor" refers to an abnormal mass of tissue
that usually does not contain cysts or liquid areas. Solid tumors
may be benign or malignant. The term "solid tumor cancer" refers to
malignant, neoplastic, or cancerous solid tumors. Solid tumor
cancers include, but are not limited to, sarcomas, carcinomas, and
lymphomas, such as cancers of the lung, breast, triple negative
breast cancer, prostate, colon, rectum, and bladder. In some
embodiments, the cancer is selected from cervical cancer, head and
neck cancer (including, for example, head and neck squamous cell
carcinoma (HNSCC)) glioblastoma, ovarian cancer, sarcoma,
pancreatic cancer, bladder cancer, breast cancer, triple negative
breast cancer, and non-small cell lung carcinoma. The tissue
structure of solid tumors includes interdependent tissue
compartments including the parenchyma (cancer cells) and the
supporting stromal cells in which the cancer cells are dispersed
and which may provide a supporting microenvironment.
[0398] The term "hematological malignancy" refers to mammalian
cancers and tumors of the hematopoietic and lymphoid tissues,
including but not limited to tissues of the blood, bone marrow,
lymph nodes, and lymphatic system. Hematological malignancies are
also referred to as "liquid tumors." Hematological malignancies
include, but are not limited to, acute lymphoblastic leukemia
(ALL), chronic lymphocytic lymphoma (CLL), small lymphocytic
lymphoma (SLL), acute myelogenous leukemia (AML), chronic
myelogenous leukemia (CML), acute monocytic leukemia (AMoL),
Hodgkin's lymphoma, and non-Hodgkin's lymphomas. The term "B cell
hematological malignancy" refers to hematological malignancies that
affect B cells.
[0399] Once obtained, the tumor sample is generally fragmented
using sharp dissection into small pieces of between 1 to about 8
mm.sup.3, with from about 2-3 mm.sup.3 being particularly useful.
The TILs are cultured from these fragments using enzymatic tumor
digests. Such tumor digests may be produced by incubation in
enzymatic media (e.g., Roswell Park Memorial Institute (RPMI) 1640
buffer, 2 mM glutamate, 10 mcg/mL gentamicine, 30 units/mL of DNase
and 1.0 mg/mL of collagenase) followed by mechanical dissociation
(e.g., using a tissue dissociator). Tumor digests may be produced
by placing the tumor in enzymatic media and mechanically
dissociating the tumor for approximately 1 minute, followed by
incubation for 30 minutes at 37.degree. C. in 5% CO.sub.2, followed
by repeated cycles of mechanical dissociation and incubation under
the foregoing conditions until only small tissue pieces are
present. At the end of this process, if the cell suspension
contains a large number of red blood cells or dead cells, a density
gradient separation using FICOLL branched hydrophilic
polysaccharide may be performed to remove these cells. Alternative
methods known in the art may be used, such as those described in
U.S. Patent Application Publication No. 2012/0244133 A1, the
disclosure of which is incorporated by reference herein. Any of the
foregoing methods may be used in any of the embodiments described
herein for methods of expanding TILs or methods treating a
cancer.
[0400] In general, the harvested cell suspension is called a
"primary cell population" or a "freshly harvested" cell
population.
[0401] In some embodiments, fragmentation includes physical
fragmentation, including for example, dissection as well as
digestion. In some embodiments, the fragmentation is physical
fragmentation. In some embodiments, the fragmentation is
dissection. In some embodiments, the fragmentation is by digestion.
In some embodiments, TILs can be initially cultured from enzymatic
tumor digests and tumor fragments obtained from patients. In an
embodiment, TILs can be initially cultured from enzymatic tumor
digests and tumor fragments obtained from patients.
[0402] In some embodiments, where the tumor is a solid tumor, the
tumor undergoes physical fragmentation after the tumor sample is
obtained in, for example, Step A (as provided in FIG. 18). In some
embodiments, the fragmentation occurs before cryopreservation. In
some embodiments, the fragmentation occurs after cryopreservation.
In some embodiments, the fragmentation occurs after obtaining the
tumor and in the absence of any cryopreservation. In some
embodiments, the tumor is fragmented and 10, 20, 30, 40 or more
fragments or pieces are placed in each container for the first
expansion. In some embodiments, the tumor is fragmented and 30 or
40 fragments or pieces are placed in each container for the first
expansion. In some embodiments, the tumor is fragmented and 40
fragments or pieces are placed in each container for the first
expansion. In some embodiments, the multiple fragments comprise
about 4 to about 50 fragments, wherein each fragment has a volume
of about 27 mm.sup.3. In some embodiments, the multiple fragments
comprise about 30 to about 60 fragments with a total volume of
about 1300 mm.sup.3 to about 1500 mm.sup.3. In some embodiments,
the multiple fragments comprise about 50 fragments with a total
volume of about 1350 mm.sup.3. In some embodiments, the multiple
fragments comprise about 50 fragments with a total mass of about 1
gram to about 1.5 grams. In some embodiments, the multiple
fragments comprise about 4 fragments.
[0403] In some embodiments, the TILs are obtained from tumor
fragments. In some embodiments, the tumor fragment is obtained by
sharp dissection. In some embodiments, the tumor fragment is
between about 1 mm.sup.3 and 10 mm.sup.3. In some embodiments, the
tumor fragment is between about 1 mm.sup.3 and 8 mm.sup.3. In some
embodiments, the tumor fragment is about 1 mm.sup.3. In some
embodiments, the tumor fragment is about 2 mm.sup.3. In some
embodiments, the tumor fragment is about 3 mm.sup.3. In some
embodiments, the tumor fragment is about 4 mm.sup.3. In some
embodiments, the tumor fragment is about 5 mm.sup.3. In some
embodiments, the tumor fragment is about 6 mm.sup.3. In some
embodiments, the tumor fragment is about 7 mm.sup.3. In some
embodiments, the tumor fragment is about 8 mm.sup.3. In some
embodiments, the tumor fragment is about 9 mm.sup.3. In some
embodiments, the tumor fragment is about 10 mm.sup.3. In some
embodiments, the tumors are 1-4 mm.times.1-4 mm.times.1-4 mm. In
some embodiments, the tumors are 1 mm.times.1 mm.times.1 mm. In
some embodiments, the tumors are 2 mm.times.2 mm.times.2 mm. In
some embodiments, the tumors are 3 mm.times.3 mm.times.3 mm. In
some embodiments, the tumors are 4 mm.times.4 mm.times.4 mm.
[0404] In some embodiments, the tumors are resected in order to
minimize the amount of hemorrhagic, necrotic, and/or fatty tissues
on each piece. In some embodiments, the tumors are resected in
order to minimize the amount of hemorrhagic tissue on each piece.
In some embodiments, the tumors are resected in order to minimize
the amount of necrotic tissue on each piece. In some embodiments,
the tumors are resected in order to minimize the amount of fatty
tissue on each piece.
[0405] In some embodiments, the tumor fragmentation is performed in
order to maintain the tumor internal structure. In some
embodiments, the tumor fragmentation is performed without
preforming a sawing motion with a scalpel. In some embodiments, the
TILs are obtained from tumor digests. In some embodiments, tumor
digests were generated by incubation in enzyme media, for example
but not limited to RPMI 1640, 2 mM GlutaMAX, 10 mg/mL gentamicin,
30 U/mL DNase, and 1.0 mg/mL collagenase, followed by mechanical
dissociation (GentleMACS, Miltenyi Biotec, Auburn, Calif.). After
placing the tumor in enzyme media, the tumor can be mechanically
dissociated for approximately 1 minute. The solution can then be
incubated for 30 minutes at 37.degree. C. in 5% CO.sub.2 and it
then mechanically disrupted again for approximately 1 minute. After
being incubated again for 30 minutes at 37.degree. C. in 5%
CO.sub.2, the tumor can be mechanically disrupted a third time for
approximately 1 minute. In some embodiments, after the third
mechanical disruption if large pieces of tissue were present, 1 or
2 additional mechanical dissociations were applied to the sample,
with or without 30 additional minutes of incubation at 37.degree.
C. in 5% CO.sub.2. In some embodiments, at the end of the final
incubation if the cell suspension contained a large number of red
blood cells or dead cells, a density gradient separation using
Ficoll can be performed to remove these cells.
[0406] In some embodiments, the harvested cell suspension prior to
the first expansion step is called a "primary cell population" or a
"freshly harvested" cell population.
[0407] In some embodiments, cells can be optionally frozen after
sample harvest and stored frozen prior to entry into the expansion
described in Step B, which is described in further detail below, as
well as exemplified in FIG. 18.
Step B: First Expansion
[0408] In some embodiments, the present methods provide for
obtaining young TILs, which are capable of increased replication
cycles upon administration to a subject/patient and as such may
provide additional therapeutic benefits over older TILs (i.e., TILs
which have further undergone more rounds of replication prior to
administration to a subject/patient). Features of young TILs have
been described in the literature, for example Donia, at al.,
Scandinavian Journal of Immunology, 75:157-167 (2012); Dudley et
al., Clin Cancer Res, 16:6122-6131 (2010); Huang et al., J
Immunother, 28(3):258-267 (2005); Besser et al., Clin Cancer Res,
19(17):OF1-OF9 (2013); Besser et al., J Immunother 32:415-423
(2009); Robbins, et al., J Immunol 2004; 173:7125-7130; Shen et
al., J Immunother, 30:123-129 (2007); Zhou, et al., J Immunother,
28:53-62 (2005); and Tran, et al., J Immunother, 31:742-751 (2008),
all of which are incorporated herein by reference in their
entireties.
[0409] The diverse antigen receptors of T and B lymphocytes are
produced by somatic recombination of a limited, but large number of
gene segments. These gene segments: V (variable), D (diversity), J
(joining), and C (constant), determine the binding specificity and
downstream applications of immunoglobulins and T-cell receptors
(TCRs). The present invention provides a method for generating TILs
which exhibit and increase the T-cell repertoire diversity. In some
embodiments, the TILs obtained by the present method exhibit an
increase in the T-cell repertoire diversity. In some embodiments,
the TILs obtained by the present method exhibit an increase in the
T-cell repertoire diversity as compared to freshly harvested TILs
and/or TILs prepared using other methods than those provide herein
including for example, methods other than those embodied in FIG.
18. In some embodiments, the TILs obtained by the present method
exhibit an increase in the T-cell repertoire diversity as compared
to freshly harvested TILs and/or TILs prepared using methods
referred to as process 1C, as exemplified in FIG. 22 and/or FIG.
23. In some embodiments, the TILs obtained in the first expansion
exhibit an increase in the T-cell repertoire diversity. In some
embodiments, the increase in diversity is an increase in the
immunoglobulin diversity and/or the T-cell receptor diversity. In
some embodiments, the diversity is in the immunoglobulin is in the
immunoglobulin heavy chain. In some embodiments, the diversity is
in the immunoglobulin is in the immunoglobulin light chain. In some
embodiments, the diversity is in the T-cell receptor. In some
embodiments, the diversity is in one of the T-cell receptors
selected from the group consisting of alpha, beta, gamma, and delta
receptors. In some embodiments, there is an increase in the
expression of T-cell receptor (TCR) alpha and/or beta. In some
embodiments, there is an increase in the expression of T-cell
receptor (TCR) alpha. In some embodiments, there is an increase in
the expression of T-cell receptor (TCR) beta. In some embodiments,
there is an increase in the expression of TCRab (i.e.,
TCR.alpha./.beta.).
[0410] After dissection or digestion of tumor fragments, for
example such as described in Step A of FIG. 18, the resulting cells
are cultured in serum containing IL-2 under conditions that favor
the growth of TILs over tumor and other cells. In some embodiments,
the tumor digests are incubated in 2 mL wells in media comprising
inactivated human AB serum with 6000 IU/mL of IL-2. This primary
cell population is cultured for a period of days, generally from 3
to 14 days, resulting in a bulk TIL population, generally about
1.times.10.sup.8 bulk TIL cells. In some embodiments, this primary
cell population is cultured for a period of 7 to 14 days, resulting
in a bulk TIL population, generally about 1.times.10.sup.8 bulk TIL
cells. In some embodiments, this primary cell population is
cultured for a period of 10 to 14 days, resulting in a bulk TIL
population, generally about 1.times.10.sup.8 bulk TIL cells. In
some embodiments, this primary cell population is cultured for a
period of about 11 days, resulting in a bulk TIL population,
generally about 1.times.10.sup.8 bulk TIL cells.
[0411] In a preferred embodiment, expansion of TILs may be
performed using an initial bulk TIL expansion step (for example
such as those described in Step B of FIG. 18, which can include
processes referred to as pre-REP) as described below and herein,
followed by a second expansion (Step D, including processes
referred to as rapid expansion protocol (REP) steps) as described
below under Step D and herein, followed by optional
cryopreservation, and followed by a second Step D (including
processes referred to as restimulation REP steps) as described
below and herein. The TILs obtained from this process may be
optionally characterized for phenotypic characteristics and
metabolic parameters as described herein.
[0412] In embodiments where TIL cultures are initiated in 24-well
plates, for example, using Costar 24-well cell culture cluster,
flat bottom (Corning Incorporated, Corning, N.Y., each well can be
seeded with 1.times.10.sup.6 tumor digest cells or one tumor
fragment in 2 mL of complete medium (CM) with IL-2 (6000 IU/mL;
Chiron Corp., Emeryville, Calif.). In some embodiments, the tumor
fragment is between about 1 mm.sup.3 and 10 mm.sup.3.
[0413] In some embodiments, the first expansion culture medium is
referred to as "CM", an abbreviation for culture media. In some
embodiments, CM for Step B consists of RPMI 1640 with GlutaMAX,
supplemented with 10% human AB serum, 25 mM Hepes, and 10 mg/mL
gentamicin. In embodiments where cultures are initiated in
gas-permeable flasks with a 40 mL capacity and a 10 cm.sup.2
gas-permeable silicon bottom (for example, G-Rex10; Wilson Wolf
Manufacturing, New Brighton, Minn.) (FIG. 1), each flask was loaded
with 10-40.times.10.sup.6 viable tumor digest cells or 5-30 tumor
fragments in 10-40 mL of CM with IL-2. Both the G-Rex10 and 24-well
plates were incubated in a humidified incubator at 37.degree. C. in
5% CO2 and 5 days after culture initiation, half the media was
removed and replaced with fresh CM and IL-2 and after day 5, half
the media was changed every 2-3 days.
[0414] After preparation of the tumor fragments, the resulting
cells (i.e., fragments) are cultured in serum containing IL-2 under
conditions that favor the growth of TILs over tumor and other
cells. In some embodiments, the tumor digests are incubated in 2 mL
wells in media comprising inactivated human AB serum (or, in some
cases, as outlined herein, in the presence of aAPC cell population)
with 6000 IU/mL of IL-2. This primary cell population is cultured
for a period of days, generally from 10 to 14 days, resulting in a
bulk TIL population, generally about 1.times.10.sup.8 bulk TIL
cells. In some embodiments, the growth media during the first
expansion comprises IL-2 or a variant thereof. In some embodiments,
the IL is recombinant human IL-2 (rhIL-2). In some embodiments the
IL-2 stock solution has a specific activity of 20-30.times.10.sup.6
IU/mg for a 1 mg vial. In some embodiments the IL-2 stock solution
has a specific activity of 20.times.10.sup.6 IU/mg for a 1 mg vial.
In some embodiments the IL-2 stock solution has a specific activity
of 25.times.10.sup.6 IU/mg for a 1 mg vial. In some embodiments the
IL-2 stock solution has a specific activity of 30.times.10.sup.6
IU/mg for a 1 mg vial. In some embodiments, the IL-2 stock solution
has a final concentration of 4-8.times.10.sup.6 IU/mg of IL-2. In
some embodiments, the IL-2 stock solution has a final concentration
of 5-7.times.10.sup.6 IU/mg of IL-2. In some embodiments, the IL-2
stock solution has a final concentration of 6.times.10.sup.6 IU/mg
of IL-2. In some embodiments, the IL-2 stock solution is prepare as
described in Example 9. In some embodiments, the first expansion
culture media comprises about 10,000 IU/mL of IL-2, about 9,000
IU/mL of IL-2, about 8,000 IU/mL of IL-2, about 7,000 IU/mL of
IL-2, about 6000 IU/mL of IL-2 or about 5,000 IU/mL of IL-2. In
some embodiments, the first expansion culture media comprises about
9,000 IU/mL of IL-2 to about 5,000 IU/mL of IL-2. In some
embodiments, the first expansion culture media comprises about
8,000 IU/mL of IL-2 to about 6,000 IU/mL of IL-2. In some
embodiments, the first expansion culture media comprises about
7,000 IU/mL of IL-2 to about 6,000 IU/mL of IL-2. In some
embodiments, the first expansion culture media comprises about
6,000 IU/mL of IL-2. In an embodiment, the cell culture medium
further comprises IL-2. In some embodiments, the cell culture
medium comprises about 3000 IU/mL of IL-2. In an embodiment, the
cell culture medium further comprises IL-2. In a preferred
embodiment, the cell culture medium comprises about 3000 IU/mL of
IL-2. In an embodiment, the cell culture medium comprises about
1000 IU/mL, about 1500 IU/mL, about 2000 IU/mL, about 2500 IU/mL,
about 3000 IU/mL, about 3500 IU/mL, about 4000 IU/mL, about 4500
IU/mL, about 5000 IU/mL, about 5500 IU/mL, about 6000 IU/mL, about
6500 IU/mL, about 7000 IU/mL, about 7500 IU/mL, or about 8000 IU/mL
of IL-2. In an embodiment, the cell culture medium comprises
between 1000 and 2000 IU/mL, between 2000 and 3000 IU/mL, between
3000 and 4000 IU/mL, between 4000 and 5000 IU/mL, between 5000 and
6000 IU/mL, between 6000 and 7000 IU/mL, between 7000 and 8000
IU/mL, or about 8000 IU/mL of IL-2.
[0415] In some embodiments, first expansion culture media comprises
about 500 IU/mL of IL-15, about 400 IU/mL of IL-15, about 300 IU/mL
of IL-15, about 200 IU/mL of IL-15, about 180 IU/mL of IL-15, about
160 IU/mL of IL-15, about 140 IU/mL of IL-15, about 120 IU/mL of
IL-15, or about 100 IU/mL of IL-15. In some embodiments, the first
expansion culture media comprises about 500 IU/mL of IL-15 to about
100 IU/mL of IL-15. In some embodiments, the first expansion
culture media comprises about 400 IU/mL of IL-15 to about 100 IU/mL
of IL-15. In some embodiments, the first expansion culture media
comprises about 300 IU/mL of IL-15 to about 100 IU/mL of IL-15. In
some embodiments, the first expansion culture media comprises about
200 IU/mL of IL-15. In some embodiments, the cell culture medium
comprises about 180 IU/mL of IL-15. In an embodiment, the cell
culture medium further comprises IL-15. In a preferred embodiment,
the cell culture medium comprises about 180 IU/mL of IL-15.
[0416] In some embodiments, first expansion culture media comprises
about 20 IU/mL of IL-21, about 15 IU/mL of IL-21, about 12 IU/mL of
IL-21, about 10 IU/mL of IL-21, about 5 IU/mL of IL-21, about 4
IU/mL of IL-21, about 3 IU/mL of IL-21, about 2 IU/mL of IL-21,
about 1 IU/mL of IL-21, or about 0.5 IU/mL of IL-21. In some
embodiments, the first expansion culture media comprises about 20
IU/mL of IL-21 to about 0.5 IU/mL of IL-21. In some embodiments,
the first expansion culture media comprises about 15 IU/mL of IL-21
to about 0.5 IU/mL of IL-21. In some embodiments, the first
expansion culture media comprises about 12 IU/mL of IL-21 to about
0.5 IU/mL of IL-21. In some embodiments, the first expansion
culture media comprises about 10 IU/mL of IL-21 to about 0.5 IU/mL
of IL-21. In some embodiments, the first expansion culture media
comprises about 5 IU/mL of IL-21 to about 1 IU/mL of IL-21. In some
embodiments, the first expansion culture media comprises about 2
IU/mL of IL-21. In some embodiments, the cell culture medium
comprises about 1 IU/mL of IL-21. In some embodiments, the cell
culture medium comprises about 0.5 IU/mL of IL-21. In an
embodiment, the cell culture medium further comprises IL-21. In a
preferred embodiment, the cell culture medium comprises about 1
IU/mL of IL-21.
[0417] In an embodiment, the cell culture medium comprises OKT-3
antibody. In some embodiments, the cell culture medium comprises
about 30 ng/mL of OKT-3 antibody. In some embodiments, the cell
culture medium comprises about 15 ng/mL of OKT-3 antibody. In an
embodiment, the cell culture medium comprises about 0.1 ng/mL,
about 0.5 ng/mL, about 1 ng/mL, about 2.5 ng/mL, about 5 ng/mL,
about 7.5 ng/mL, about 10 ng/mL, about 15 ng/mL, about 20 ng/mL,
about 25 ng/mL, about 30 ng/mL, about 35 ng/mL, about 40 ng/mL,
about 50 ng/mL, about 60 ng/mL, about 70 ng/mL, about 80 ng/mL,
about 90 ng/mL, about 100 ng/mL, about 200 ng/mL, about 500 ng/mL,
and about 1 .mu.g/mL of OKT-3 antibody. In an embodiment, the cell
culture medium comprises between 0.1 ng/mL and 1 ng/mL, between 1
ng/mL and 5 ng/mL, between 5 ng/mL and 10 ng/mL, between 10 ng/mL
and 20 ng/mL, between 20 ng/mL and 30 ng/mL, between 30 ng/mL and
40 ng/mL, between 40 ng/mL and 50 ng/mL, and between 50 ng/mL and
100 ng/mL of OKT-3 antibody. In some embodiments, the cell culture
medium does not comprise OKT-3 antibody. In some embodiments, the
OKT-3 antibody is muromonab.
TABLE-US-00003 TABLE 3 Amino acid sequences of muromonab (exemplary
OKT-3 antibody) Identifier Sequence (One-Letter Amino Acid Symbols)
SEQ ID NO: 1 QVQLQQSGAE LARPGASVKM SCHASGYTFT RYTMHWVKQR PGQGLEWIGY
INPSRGYTNY 60 Muromonab NQHFKDKATL TTDKSSSTAY MQLSSLTSED SAVYYCARYY
DDHYCLDYWG QGTTLTVSSA 120 heavy KTTAPSVYPL APVCGGTTGS SVTLGCLVKG
YFPEPVTLTW NSGSLSSGVH TFPAVLQSDL 180 chain YTLSSSVTVT SSTWPSQSIT
CNVAHPASST KVDKKIEPRP KSCDKTHTCP PCPAPELLGG 240 PSVFLFPPKP
KDTLMISRTP EVTCVVVDVS HEDPEVKFNW YVDGVEVHNA KTKPREEQYN 300
STYRVVSVLT VLHQDWLNGK EYKCKVSNKA LPAPIEKTIS KAKGQPREPQ VYTLPPSRDE
360 LTKNQVSLTC LVKGFYPSDI AVEWESNGQP ENNYKTTPPV LDSDGSFFLY
SKLTVDKSRW 420 QQGNVFSCSV MHEALHNHYT QKSLSLSPGK 450 SEQ ID NO: 2
QIVLTQSPAI MSASPGEKVT MTCSASSSVS YMNWYQQKSG TSPKRWIYDT SKLASGVPAH
60 Muromonab FRGSGSGTSY SLTISGMEAE DAATYYCQQW SSNPFTFGSG TKLEINRADT
APTVSIFPPS 120 light SEQLTSGGAS VVCFLNNFYP KDINVKWKID GSERQNGVLN
SWTDQDSKDS TYSMSSTLTL 180 chain TKDEYERHNS YTCEATHKTS TSPIVKSFNR
NEC 213
[0418] In some embodiments, the cell culture medium comprises one
or more TNFRSF agonists in a cell culture medium. In some
embodiments, the TNFRSF agonist comprises a 4-1BB agonist. In some
embodiments, the TNFRSF agonist is a 4-1BB agonist, and the 4-1BB
agonist is selected from the group consisting of urelumab,
utomilumab, EU-101, a fusion protein, and fragments, derivatives,
variants, biosimilars, and combinations thereof. In some
embodiments, the TNFRSF agonist is added at a concentration
sufficient to achieve a concentration in the cell culture medium of
between 0.1 .mu.g/mL and 100 .mu.g/mL. In some embodiments, the
TNFRSF agonist is added at a concentration sufficient to achieve a
concentration in the cell culture medium of between 20 .mu.g/mL and
40 .mu.g/mL.
[0419] In some embodiments, in addition to one or more TNFRSF
agonists, the cell culture medium further comprises IL-2 at an
initial concentration of about 3000 IU/mL and OKT-3 antibody at an
initial concentration of about 30 ng/mL, and wherein the one or
more TNFRSF agonists comprises a 4-1BB agonist.
[0420] In some embodiments, the first expansion culture medium is
referred to as "CM", an abbreviation for culture media. In some
embodiments, it is referred to as CM1 (culture medium 1). In some
embodiments, CM consists of RPMI 1640 with GlutaMAX, supplemented
with 10% human AB serum, 25 mM Hepes, and 10 mg/mL gentamicin. In
embodiments where cultures are initiated in gas-permeable flasks
with a 40 mL capacity and a 10 cm.sup.2 gas-permeable silicon
bottom (for example, G-Rex10; Wilson Wolf Manufacturing, New
Brighton, Minn.) (FIG. 1), each flask was loaded with
10-40.times.10.sup.6 viable tumor digest cells or 5-30 tumor
fragments in 10-40 mL of CM with IL-2. Both the G-Rex10 and 24-well
plates were incubated in a humidified incubator at 37.degree. C. in
5% CO.sub.2 and 5 days after culture initiation, half the media was
removed and replaced with fresh CM and IL-2 and after day 5, half
the media was changed every 2-3 days. In some embodiments, the CM
is the CM1 described in the Examples. In some embodiments, the
first expansion occurs in an initial cell culture medium or a first
cell culture medium. In some embodiments, the initial cell culture
medium or the first cell culture medium comprises IL-2.
[0421] In some embodiments, the first expansion (including
processes such as for example those described in Step B of FIG. 18,
which can include those sometimes referred to as the pre-REP)
process is shortened to 3-14 days, as discussed in the examples and
figures. In some embodiments, the first expansion (including
processes such as for example those described in Step B of FIG. 18,
which can include those sometimes referred to as the pre-REP) is
shortened to 7 to 14 days, as discussed in the Examples and shown
in FIGS. 4 and 5, as well as including for example, an expansion as
described in Step B of FIG. 18. In some embodiments, the first
expansion of Step B is shortened to 10-14 days. In some
embodiments, the first expansion is shortened to 11 days, as
discussed in, for example, an expansion as described in Step B of
FIG. 18.
[0422] In some embodiments, the first TIL expansion can proceed for
1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9
days, 10 days, 11 days, 12 days, 13 days, or 14 days. In some
embodiments, the first TIL expansion can proceed for 1 day to 14
days. In some embodiments, the first TIL expansion can proceed for
2 days to 14 days. In some embodiments, the first TIL expansion can
proceed for 3 days to 14 days. In some embodiments, the first TIL
expansion can proceed for 4 days to 14 days. In some embodiments,
the first TIL expansion can proceed for 5 days to 14 days. In some
embodiments, the first TIL expansion can proceed for 6 days to 14
days. In some embodiments, the first TIL expansion can proceed for
7 days to 14 days. In some embodiments, the first TIL expansion can
proceed for 8 days to 14 days. In some embodiments, the first TIL
expansion can proceed for 9 days to 14 days. In some embodiments,
the first TIL expansion can proceed for 10 days to 14 days. In some
embodiments, the first TIL expansion can proceed for 11 days to 14
days. In some embodiments, the first TIL expansion can proceed for
12 days to 14 days. In some embodiments, the first TIL expansion
can proceed for 13 days to 14 days. In some embodiments, the first
TIL expansion can proceed for 14 days. In some embodiments, the
first TIL expansion can proceed for 1 day to 11 days. In some
embodiments, the first TIL expansion can proceed for 2 days to 11
days. In some embodiments, the first TIL expansion can proceed for
3 days to 11 days. In some embodiments, the first TIL expansion can
proceed for 4 days to 11 days. In some embodiments, the first TIL
expansion can proceed for 5 days to 11 days. In some embodiments,
the first TIL expansion can proceed for 6 days to 11 days. In some
embodiments, the first TIL expansion can proceed for 7 days to 11
days. In some embodiments, the first TIL expansion can proceed for
8 days to 11 days. In some embodiments, the first TIL expansion can
proceed for 9 days to 11 days. In some embodiments, the first TIL
expansion can proceed for 10 days to 11 days. In some embodiments,
the first TIL expansion can proceed for 11 days.
[0423] In some embodiments, a combination of IL-2, IL-7, IL-15,
and/or IL-21 are employed as a combination during the first
expansion. In some embodiments, IL-2, IL-7, IL-15, and/or IL-21 as
well as any combinations thereof can be included during the first
expansion, including for example during a Step B processes
according to FIG. 18, as well as described herein. In some
embodiments, a combination of IL-2, IL-15, and IL-21 are employed
as a combination during the first expansion. In some embodiments,
IL-2, IL-15, and IL-21 as well as any combinations thereof can be
included during Step B processes according to FIG. 18 and as
described herein.
[0424] In some embodiments, the first expansion (including
processes referred to as the pre-REP; for example, Step B according
to FIG. 18) process is shortened to 3 to 14 days, as discussed in
the examples and figures. In some embodiments, the first expansion
of Step B is shortened to 7 to 14 days. In some embodiments, the
first expansion of Step B is shortened to 10 to 14 days. In some
embodiments, the first expansion is shortened to 11 days.
[0425] In some embodiments, the first expansion, for example, Step
B according to FIG. 18, is performed in a closed system bioreactor.
In some embodiments, a closed system is employed for the TIL
expansion, as described herein. In some embodiments, a single
bioreactor is employed. In some embodiments, the single bioreactor
employed is for example a G-REX-10 or a G-REX-100. In some
embodiments, the closed system bioreactor is a single
bioreactor.
Step C: First Expansion to Second Expansion Transition
[0426] In some cases, the bulk TIL population obtained from the
first expansion, including for example the TIL population obtained
from for example, Step B as indicated in FIG. 18, can be
cryopreserved immediately, using the protocols discussed herein
below. Alternatively, the TIL population obtained from the first
expansion, referred to as the second TIL population, can be
subjected to a second expansion (which can include expansions
sometimes referred to as REP) and then cryopreserved as discussed
below. Similarly, in the case where genetically modified TILs will
be used in therapy, the first TIL population (sometimes referred to
as the bulk TIL population) or the second TIL population (which can
in some embodiments include populations referred to as the REP TIL
populations) can be subjected to genetic modifications for suitable
treatments prior to expansion or after the first expansion and
prior to the second expansion.
[0427] In some embodiments, the TILs obtained from the first
expansion (for example, from Step B as indicated in FIG. 18) are
stored until phenotyped for selection. In some embodiments, the
TILs obtained from the first expansion (for example, from Step B as
indicated in FIG. 18) are not stored and proceed directly to the
second expansion. In some embodiments, the TILs obtained from the
first expansion are not cryopreserved after the first expansion and
prior to the second expansion. In some embodiments, the transition
from the first expansion to the second expansion occurs at about 3
days, 4, days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11
days, 12 days, 13 days, or 14 days from when fragmentation occurs.
In some embodiments, the transition from the first expansion to the
second expansion occurs at about 3 days to 14 days from when
fragmentation occurs. In some embodiments, the transition from the
first expansion to the second expansion occurs at about 4 days to
14 days from when fragmentation occurs. In some embodiments, the
transition from the first expansion to the second expansion occurs
at about 4 days to 10 days from when fragmentation occurs. In some
embodiments, the transition from the first expansion to the second
expansion occurs at about 7 days to 14 days from when fragmentation
occurs. In some embodiments, the transition from the first
expansion to the second expansion occurs at about 14 days from when
fragmentation occurs.
[0428] In some embodiments, the transition from the first expansion
to the second expansion occurs at 1 day, 2 days, 3 days, 4 days, 5
days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13
days, or 14 days from when fragmentation occurs. In some
embodiments, the transition from the first expansion to the second
expansion occurs 1 day to 14 days from when fragmentation occurs.
In some embodiments, the first TIL expansion can proceed for 2 days
to 14 days. In some embodiments, the transition from the first
expansion to the second expansion occurs 3 days to 14 days from
when fragmentation occurs. In some embodiments, the transition from
the first expansion to the second expansion occurs 4 days to 14
days from when fragmentation occurs. In some embodiments, the
transition from the first expansion to the second expansion occurs
5 days to 14 days from when fragmentation occurs. In some
embodiments, the transition from the first expansion to the second
expansion occurs 6 days to 14 days from when fragmentation occurs.
In some embodiments, the transition from the first expansion to the
second expansion occurs 7 days to 14 days from when fragmentation
occurs. In some embodiments, the transition from the first
expansion to the second expansion occurs 8 days to 14 days from
when fragmentation occurs. In some embodiments, the transition from
the first expansion to the second expansion occurs 9 days to 14
days from when fragmentation occurs. In some embodiments, the
transition from the first expansion to the second expansion occurs
10 days to 14 days from when fragmentation occurs. In some
embodiments, the transition from the first expansion to the second
expansion occurs 11 days to 14 days from when fragmentation occurs.
In some embodiments, the transition from the first expansion to the
second expansion occurs 12 days to 14 days from when fragmentation
occurs. In some embodiments, the transition from the first
expansion to the second expansion occurs 13 days to 14 days from
when fragmentation occurs. In some embodiments, the transition from
the first expansion to the second expansion occurs 14 days from
when fragmentation occurs. In some embodiments, the transition from
the first expansion to the second expansion occurs 1 day to 11 days
from when fragmentation occurs. In some embodiments, the transition
from the first expansion to the second expansion occurs 2 days to
11 days from when fragmentation occurs. In some embodiments, the
transition from the first expansion to the second expansion occurs
3 days to 11 days from when fragmentation occurs. In some
embodiments, the transition from the first expansion to the second
expansion occurs 4 days to 11 days from when fragmentation occurs.
In some embodiments, the transition from the first expansion to the
second expansion occurs 5 days to 11 days from when fragmentation
occurs. In some embodiments, the transition from the first
expansion to the second expansion occurs 6 days to 11 days from
when fragmentation occurs. In some embodiments, the transition from
the first expansion to the second expansion occurs 7 days to 11
days from when fragmentation occurs. In some embodiments, the
transition from the first expansion to the second expansion occurs
8 days to 11 days from when fragmentation occurs. In some
embodiments, the transition from the first expansion to the second
expansion occurs 9 days to 11 days from when fragmentation occurs.
In some embodiments, the transition from the first expansion to the
second expansion occurs 10 days to 11 days from when fragmentation
occurs. In some embodiments, the transition from the first
expansion to the second expansion occurs 11 days from when
fragmentation occurs.
[0429] In some embodiments, the TILs are not stored after the first
expansion and prior to the second expansion, and the TILs proceed
directly to the second expansion (for example, in some embodiments,
there is no storage during the transition from Step B to Step D as
shown in FIG. 18). In some embodiments, the transition occurs in
closed system, as described herein. In some embodiments, the TILs
from the first expansion, the second population of TILs, proceeds
directly into the second expansion with no transition period.
[0430] In some embodiments, the transition from the first expansion
to the second expansion, for example, Step C according to FIG. 18,
is performed in a closed system bioreactor. In some embodiments, a
closed system is employed for the TIL expansion, as described
herein. In some embodiments, a single bioreactor is employed. In
some embodiments, the single bioreactor employed is for example a
G-REX-10 or a G-REX-100. In some embodiments, the closed system
bioreactor is a single bioreactor.
[0431] Cytokines
[0432] The expansion methods described herein generally use culture
media with high doses of a cytokine, in particular IL-2, as is
known in the art.
[0433] Alternatively, using combinations of cytokines for the rapid
expansion and/or second expansion of TILS is additionally possible,
with combinations of two or more of IL-2, IL-15 and IL-21 as is
generally outlined in International Publication No. WO 2015/189356
and International Publication No. WO 2015/189357, hereby expressly
incorporated by reference in their entirety for all purposes and in
particular for all teachings related to use of cytokines in cell
expansion methods. Thus, possible combinations include IL-2 and
IL-15, IL-2 and IL-21, IL-15 and IL-21 and IL-2, IL-15 and IL-21,
with the latter finding particular use in many embodiments. The use
of combinations of cytokines specifically favors the generation of
lymphocytes, and in particular T-cells as described therein.
TABLE-US-00004 TABLE 4 Amino acid sequences of interleukins.
Identifier Sequence (One-Letter Amino Acid Symbols) SEQ ID NO: 3
MAPTSSSTEK TQLQLEHLLL DLQMILNGIN NYKNPKLTRM LTFKFYMPKK ATELKHLQCL
60 recombinant EEELKPLEEV LNLAQSKNFH LRPRDLISNI NVIVLELKGS
ETTFMCEYAD ETATIVEFLN 120 human IL-2 RWITFCQSII STLT 134 (rhIL-2)
SEQ ID NO: 4 PTSSSTKKTQ LQLEHLLLDL QMILNGINNY KNPKLTRMLT FKFYMPKKAT
ELKHLQCLEE 60 Aldesleukin ELKPLEEVLN LAQSKNFHLR PRDLISNINV
IVLELKGSET TFMCEYADET ATIVEFLNRW 120 ITFSQSIIST LT 132 SEQ ID NO: 5
MHKCDITLQE IIKTLNSLTE QKTLCTELTV TDIFAASKNT TEKETFCRAA TVLRQFYSHH
60 recombinant EXDTRCLGAT AQQFHRHKQL IRFLKRLDRN LWGLAGLNSC
PVKEANQSTL ENFLERLKTI 120 human IL-4 MREKYSKCSS 130 (rhIL-4) SEQ ID
NO: 6 MDCDIEGKDG KQYESVLMVS IDQLLDSMKE IGSNCLNNEF NFFKRHICDA
NKEGMFLFRA 60 recombinant ARKLRQFLKM NSTGDFDLHL LKVSEGTTIL
LNCTGQVKGR KPAALGEAQP TKSLEENKSL 120 human IL-7 KEQKKLNDLC
FLKRLLQEIK TCWNKILMGT KEH 153 (rhIL-7) SEQ ID NO: 7 MNWVNVISDL
KKIEDLIQSM HIDATLYTES DVHPSCKVTA MKCFLLELQV ISLESGDASI 60
recombinant HDTVENLIIL ANNSLSSNGN VTESGCKECE ELEEKNIKEF LQSFVHIVQM
FINTS 115 human IL-15 (rhIL-15) SEQ ID NO: 8 MQDRHMIRMR QLIDIVDQLK
NYVNDLVPEF LPAPEDVETN CEWSAFSCFQ KAQLKSANTG 60 recombinant
NNERIINVSI KKLKRKPPST NAGRRQKHRL TCPSCDSYEK KPPKEFLERF KSLLQKMIHQ
120 human IL-21 HLSSRTHGSE DS 132 (rhIL-21)
[0434] Step D: Second Expansion
[0435] In some embodiments, the TIL cell population is expanded in
number after harvest and initial bulk processing for example, after
Step A and Step B, and the transition referred to as Step C, as
indicated in FIG. 18). This further expansion is referred to herein
as the second expansion, which can include expansion processes
generally referred to in the art as a rapid expansion process (REP;
as well as processes as indicated in Step D of FIG. 18). The second
expansion is generally accomplished using a culture media
comprising a number of components, including feeder cells, a
cytokine source, and an anti-CD3 antibody, in a gas-permeable
container.
[0436] In some embodiments, the second expansion or second TIL
expansion (which can include expansions sometimes referred to as
REP; as well as processes as indicated in Step D of FIG. 18) of TIL
can be performed using any TIL flasks or containers known by those
of skill in the art. In some embodiments, the second TIL expansion
can proceed for 7 days, 8 days, 9 days, 10 days, 11 days, 12 days,
13 days, or 14 days. In some embodiments, the second TIL expansion
can proceed for about 7 days to about 14 days. In some embodiments,
the second TIL expansion can proceed for about 8 days to about 14
days. In some embodiments, the second TIL expansion can proceed for
about 9 days to about 14 days. In some embodiments, the second TIL
expansion can proceed for about 10 days to about 14 days. In some
embodiments, the second TIL expansion can proceed for about 11 days
to about 14 days. In some embodiments, the second TIL expansion can
proceed for about 12 days to about 14 days. In some embodiments,
the second TIL expansion can proceed for about 13 days to about 14
days. In some embodiments, the second TIL expansion can proceed for
about 14 days.
[0437] In an embodiment, the second expansion can be performed in a
gas permeable container using the methods of the present disclosure
(including for example, expansions referred to as REP; as well as
processes as indicated in Step D of FIG. 18). For example, TILs can
be rapidly expanded using non-specific T-cell receptor stimulation
in the presence of interleukin-2 (IL-2) or interleukin-15 (IL-15).
The non-specific T-cell receptor stimulus can include, for example,
an anti-CD3 antibody, such as about 30 ng/ml of OKT3, a mouse
monoclonal anti-CD3 antibody (commercially available from
Ortho-McNeil, Raritan, N.J. or Miltenyi Biotech, Auburn, Calif.) or
UHCT-1 (commercially available from BioLegend, San Diego, Calif.,
USA). TILs can be expanded to induce further stimulation of the
TILs in vitro by including one or more antigens during the second
expansion, including antigenic portions thereof, such as
epitope(s), of the cancer, which can be optionally expressed from a
vector, such as a human leukocyte antigen A2 (HLA-A2) binding
peptide, e.g., 0.3 .mu.M MART-1:26-35 (27 L) or gpl 00:209-217
(210M), optionally in the presence of a T-cell growth factor, such
as 300 IU/mL IL-2 or IL-15. Other suitable antigens may include,
e.g., NY-ESO-1, TRP-1, TRP-2, tyrosinase cancer antigen, MAGE-A3,
SSX-2, and VEGFR2, or antigenic portions thereof. TIL may also be
rapidly expanded by re-stimulation with the same antigen(s) of the
cancer pulsed onto HLA-A2-expressing antigen-presenting cells.
Alternatively, the TILs can be further restimulated with, e.g.,
example, irradiated, autologous lymphocytes or with irradiated
HLA-A2+ allogeneic lymphocytes and IL-2. In some embodiments, the
re-stimulation occurs as part of the second expansion. In some
embodiments, the second expansion occurs in the presence of
irradiated, autologous lymphocytes or with irradiated HLA-A2+
allogeneic lymphocytes and IL-2.
[0438] In an embodiment, the cell culture medium for the second
expansion step further comprises IL-2. In some embodiments, the
cell culture medium comprises about 3000 IU/mL of IL-2. In an
embodiment, the cell culture medium comprises about 1000 IU/mL,
about 1500 IU/mL, about 2000 IU/mL, about 2500 IU/mL, about 3000
IU/mL, about 3500 IU/mL, about 4000 IU/mL, about 4500 IU/mL, about
5000 IU/mL, about 5500 IU/mL, about 6000 IU/mL, about 6500 IU/mL,
about 7000 IU/mL, about 7500 IU/mL, or about 8000 IU/mL of IL-2. In
an embodiment, the cell culture medium comprises between 1000 and
2000 IU/mL, between 2000 and 3000 IU/mL, between 3000 and 4000
IU/mL, between 4000 and 5000 IU/mL, between 5000 and 6000 IU/mL,
between 6000 and 7000 IU/mL, between 7000 and 8000 IU/mL, or
between 8000 IU/mL of IL-2.
[0439] In an embodiment, the cell culture medium comprises OKT-3
antibody. In some embodiments, the cell culture medium comprises
about 30 ng/mL of OKT-3 antibody. In an embodiment, the cell
culture medium comprises about 0.1 ng/mL, about 0.5 ng/mL, about 1
ng/mL, about 2.5 ng/mL, about 5 ng/mL, about 7.5 ng/mL, about 10
ng/mL, about 15 ng/mL, about 20 ng/mL, about 25 ng/mL, about 30
ng/mL, about 35 ng/mL, about 40 ng/mL, about 50 ng/mL, about 60
ng/mL, about 70 ng/mL, about 80 ng/mL, about 90 ng/mL, about 100
ng/mL, about 200 ng/mL, about 500 ng/mL, and about 1 .mu.g/mL of
OKT-3 antibody. In an embodiment, the cell culture medium comprises
between 0.1 ng/mL and 1 ng/mL, between 1 ng/mL and 5 ng/mL, between
5 ng/mL and 10 ng/mL, between 10 ng/mL and 20 ng/mL, between 20
ng/mL and 30 ng/mL, between 30 ng/mL and 40 ng/mL, between 40 ng/mL
and 50 ng/mL, and between 50 ng/mL and 100 ng/mL of OKT-3 antibody.
In some embodiments, the cell culture medium does not comprise
OKT-3 antibody. In some embodiments, the OKT-3 antibody is
muromonab.
[0440] In some embodiments, the cell culture medium comprises one
or more TNFRSF agonists in a cell culture medium. In some
embodiments, the TNFRSF agonist comprises a 4-1BB agonist. In some
embodiments, the TNFRSF agonist is a 4-1BB agonist, and the 4-1BB
agonist is selected from the group consisting of urelumab,
utomilumab, EU-101, a fusion protein, and fragments, derivatives,
variants, biosimilars, and combinations thereof. In some
embodiments, the TNFRSF agonist is added at a concentration
sufficient to achieve a concentration in the cell culture medium of
between 0.1 .mu.g/mL and 100 .mu.g/mL. In some embodiments, the
TNFRSF agonist is added at a concentration sufficient to achieve a
concentration in the cell culture medium of between 20 .mu.g/mL and
40 .mu.g/mL.
[0441] In some embodiments, in addition to one or more TNFRSF
agonists, the cell culture medium further comprises IL-2 at an
initial concentration of about 3000 IU/mL and OKT-3 antibody at an
initial concentration of about 30 ng/mL, and wherein the one or
more TNFRSF agonists comprises a 4-1BB agonist.
[0442] In some embodiments, a combination of IL-2, IL-7, IL-15,
and/or IL-21 are employed as a combination during the second
expansion. In some embodiments, IL-2, IL-7, IL-15, and/or IL-21 as
well as any combinations thereof can be included during the second
expansion, including for example during a Step D processes
according to FIG. 18, as well as described herein. In some
embodiments, a combination of IL-2, IL-15, and IL-21 are employed
as a combination during the second expansion. In some embodiments,
IL-2, IL-15, and IL-21 as well as any combinations thereof can be
included during Step D processes according to FIG. 18 and as
described herein.
[0443] In some embodiments, the second expansion can be conducted
in a supplemented cell culture medium comprising IL-2, OKT-3,
antigen-presenting feeder cells, and optionally a TNFRSF agonist.
In some embodiments, the second expansion occurs in a supplemented
cell culture medium. In some embodiments, the supplemented cell
culture medium comprises IL-2, OKT-3, and antigen-presenting feeder
cells. In some embodiments, the second cell culture medium
comprises IL-2, OKT-3, and antigen-presenting cells (APCs; also
referred to as antigen-presenting feeder cells). In some
embodiments, the second expansion occurs in a cell culture medium
comprising IL-2, OKT-3, and antigen-presenting feeder cells (i.e.,
antigen presenting cells).
[0444] In some embodiments, the second expansion culture media
comprises about 500 IU/mL of IL-15, about 400 IU/mL of IL-15, about
300 IU/mL of IL-15, about 200 IU/mL of IL-15, about 180 IU/mL of
IL-15, about 160 IU/mL of IL-15, about 140 IU/mL of IL-15, about
120 IU/mL of IL-15, or about 100 IU/mL of IL-15. In some
embodiments, the second expansion culture media comprises about 500
IU/mL of IL-15 to about 100 IU/mL of IL-15. In some embodiments,
the second expansion culture media comprises about 400 IU/mL of
IL-15 to about 100 IU/mL of IL-15. In some embodiments, the second
expansion culture media comprises about 300 IU/mL of IL-15 to about
100 IU/mL of IL-15. In some embodiments, the second expansion
culture media comprises about 200 IU/mL of IL-15. In some
embodiments, the cell culture medium comprises about 180 IU/mL of
IL-15. In an embodiment, the cell culture medium further comprises
IL-15. In a preferred embodiment, the cell culture medium comprises
about 180 IU/mL of IL-15.
[0445] In some embodiments, the second expansion culture media
comprises about 20 IU/mL of IL-21, about 15 IU/mL of IL-21, about
12 IU/mL of IL-21, about 10 IU/mL of IL-21, about 5 IU/mL of IL-21,
about 4 IU/mL of IL-21, about 3 IU/mL of IL-21, about 2 IU/mL of
IL-21, about 1 IU/mL of IL-21, or about 0.5 IU/mL of IL-21. In some
embodiments, the second expansion culture media comprises about 20
IU/mL of IL-21 to about 0.5 IU/mL of IL-21. In some embodiments,
the second expansion culture media comprises about 15 IU/mL of
IL-21 to about 0.5 IU/mL of IL-21. In some embodiments, the second
expansion culture media comprises about 12 IU/mL of IL-21 to about
0.5 IU/mL of IL-21. In some embodiments, the second expansion
culture media comprises about 10 IU/mL of IL-21 to about 0.5 IU/mL
of IL-21. In some embodiments, the second expansion culture media
comprises about 5 IU/mL of IL-21 to about 1 IU/mL of IL-21. In some
embodiments, the second expansion culture media comprises about 2
IU/mL of IL-21. In some embodiments, the cell culture medium
comprises about 1 IU/mL of IL-21. In some embodiments, the cell
culture medium comprises about 0.5 IU/mL of IL-21. In an
embodiment, the cell culture medium further comprises IL-21. In a
preferred embodiment, the cell culture medium comprises about 1
IU/mL of IL-21.
[0446] In some embodiments the antigen-presenting feeder cells
(APCs) are PBMCs. In an embodiment, the ratio of TILs to PBMCs
and/or antigen-presenting cells in the rapid expansion and/or the
second expansion is about 1 to 25, about 1 to 50, about 1 to 100,
about 1 to 125, about 1 to 150, about 1 to 175, about 1 to 200,
about 1 to 225, about 1 to 250, about 1 to 275, about 1 to 300,
about 1 to 325, about 1 to 350, about 1 to 375, about 1 to 400, or
about 1 to 500. In an embodiment, the ratio of TILs to PBMCs in the
rapid expansion and/or the second expansion is between 1 to 50 and
1 to 300. In an embodiment, the ratio of TILs to PBMCs in the rapid
expansion and/or the second expansion is between 1 to 100 and 1 to
200.
[0447] In an embodiment, REP and/or the second expansion is
performed in flasks with the bulk TILs being mixed with a 100- or
200-fold excess of inactivated feeder cells, 30 mg/mL OKT3 anti-CD3
antibody and 3000 IU/mL IL-2 in 150 ml media. Media replacement is
done (generally 2/3 media replacement via respiration with fresh
media) until the cells are transferred to an alternative growth
chamber. Alternative growth chambers include G-REX flasks and gas
permeable containers as more fully discussed below.
[0448] In some embodiments, the second expansion (which can include
processes referred to as the REP process) is shortened to 7-14
days, as discussed in the examples and figures. In some
embodiments, the second expansion is shortened to 11 days.
[0449] In an embodiment, REP and/or the second expansion may be
performed using T-175 flasks and gas permeable bags as previously
described (Tran, et al., J Immunother. 2008, 31, 742-51; Dudley, et
al., J Immunother. 2003, 26, 332-42) or gas permeable cultureware
(G-Rex flasks). In some embodiments, the second expansion
(including expansions referred to as rapid expansions) is performed
in T-175 flasks, and about 1.times.10.sup.6 TILs suspended in 150
mL of media may be added to each T-175 flask. The TILs may be
cultured in a 1 to 1 mixture of CM and AIM-V medium, supplemented
with 3000 IU per mL of IL-2 and 30 ng per ml of anti-CD3. The T-175
flasks may be incubated at 37.degree. C. in 5% CO.sub.2. Half the
media may be exchanged on day 5 using 50/50 medium with 3000 IU per
mL of IL-2. In some embodiments, on day 7 cells from two T-175
flasks may be combined in a 3 L bag and 300 mL of AIM V with 5%
human AB serum and 3000 IU per mL of IL-2 was added to the 300 ml
of TIL suspension. The number of cells in each bag was counted
every day or two and fresh media was added to keep the cell count
between 0.5 and 2.0.times.10.sup.6 cells/mL.
[0450] In an embodiment, the second expansion (which can include
expansions referred to as REP, as well as those referred to in Step
D of FIG. 18) may be performed in 500 mL capacity gas permeable
flasks with 100 cm gas-permeable silicon bottoms (G-Rex 100,
commercially available from Wilson Wolf Manufacturing Corporation,
New Brighton, Minn., USA), 5.times.10.sup.6 or 10.times.10.sup.6
TIL may be cultured with PBMCs in 400 mL of 50/50 medium,
supplemented with 5% human AB serum, 3000 IU per mL of IL-2 and 30
ng per ml of anti-CD3 (OKT3). The G-Rex 100 flasks may be incubated
at 37.degree. C. in 5% CO.sub.2. On day 5, 250 mL of supernatant
may be removed and placed into centrifuge bottles and centrifuged
at 1500 rpm (491.times.g) for 10 minutes. The TIL pellets may be
re-suspended with 150 mL of fresh medium with 5% human AB serum,
3000 IU per mL of IL-2, and added back to the original G-Rex 100
flasks. When TIL are expanded serially in G-Rex 100 flasks, on day
7 the TIL in each G-Rex 100 may be suspended in the 300 mL of media
present in each flask and the cell suspension may be divided into 3
100 mL aliquots that may be used to seed 3 G-Rex 100 flasks. Then
150 mL of AIM-V with 5% human AB serum and 3000 IU per mL of IL-2
may be added to each flask. The G-Rex 100 flasks may be incubated
at 37.degree. C. in 5% CO.sub.2 and after 4 days 150 mL of AIM-V
with 3000 IU per mL of IL-2 may be added to each G-REX 100 flask.
The cells may be harvested on day 14 of culture.
[0451] In an embodiment, the second expansion (including expansions
referred to as REP) is performed in flasks with the bulk TILs being
mixed with a 100- or 200-fold excess of inactivated feeder cells,
30 mg/mL OKT3 anti-CD3 antibody and 3000 IU/mL IL-2 in 150 ml
media. In some embodiments, media replacement is done until the
cells are transferred to an alternative growth chamber. In some
embodiments, 2/3 of the media is replaced by respiration with fresh
media. In some embodiments, alternative growth chambers include
G-REX flasks and gas permeable containers as more fully discussed
below.
[0452] In an embodiment, the second expansion (including expansions
referred to as REP) is performed and further comprises a step
wherein TILs are selected for superior tumor reactivity. Any
selection method known in the art may be used. For example, the
methods described in U.S. Patent Application Publication No.
2016/0010058 A1, the disclosures of which are incorporated herein
by reference, may be used for selection of TILs for superior tumor
reactivity.
[0453] Optionally, a cell viability assay can be performed after
the second expansion (including expansions referred to as the REP
expansion), using standard assays known in the art. For example, a
trypan blue exclusion assay can be done on a sample of the bulk
TILs, which selectively labels dead cells and allows a viability
assessment. In some embodiments, TIL samples can be counted and
viability determined using a Cellometer K2 automated cell counter
(Nexcelom Bioscience, Lawrence, Mass.).
[0454] In some embodiments, the second expansion (including
expansions referred to as REP) of TIL can be performed using T-175
flasks and gas-permeable bags as previously described (Tran K Q,
Zhou J, Durflinger K H, et al., 2008, J Immunother., 31:742-751,
and Dudley M E, Wunderlich J R, Shelton T E, et al. 2003, J
Immunother., 26:332-342) or gas-permeable G-Rex flasks. In some
embodiments, the second expansion is performed using flasks. In
some embodiments, the second expansion is performed using
gas-permeable G-Rex flasks. In some embodiments, the second
expansion is performed in T-175 flasks, and about 1.times.10.sup.6
TIL are suspended in about 150 mL of media and this is added to
each T-175 flask. The TIL are cultured with irradiated (50 Gy)
allogeneic PBMC as "feeder" cells at a ratio of 1 to 100 and the
cells were cultured in a 1 to 1 mixture of CM and AIM-V medium
(50/50 medium), supplemented with 3000 IU/mL of IL-2 and 30 ng/mL
of anti-CD3. The T-175 flasks are incubated at 37.degree. C. in 5%
CO.sub.2. In some embodiments, half the media is changed on day 5
using 50/50 medium with 3000 IU/mL of IL-2. In some embodiments, on
day 7, cells from 2 T-175 flasks are combined in a 3 L bag and 300
mL of AIM-V with 5% human AB serum and 3000 IU/mL of IL-2 is added
to the 300 mL of TIL suspension. The number of cells in each bag
can be counted every day or two and fresh media can be added to
keep the cell count between about 0.5 and about 2.0.times.10.sup.6
cells/mL.
[0455] In some embodiments, the second expansion (including
expansions referred to as REP) are performed in 500 mL capacity
flasks with 100 cm.sup.2 gas-permeable silicon bottoms (G-Rex 100,
Wilson Wolf) (FIG. 1), about 5.times.10.sup.6 or 10.times.10.sup.6
TIL are cultured with irradiated allogeneic PBMC at a ratio of 1 to
100 in 400 mL of 50/50 medium, supplemented with 3000 IU/mL of IL-2
and 30 ng/mL of anti-CD3. The G-Rex 100 flasks are incubated at
37.degree. C. in 5% CO.sub.2. In some embodiments, on day 5, 250 mL
of supernatant is removed and placed into centrifuge bottles and
centrifuged at 1500 rpm (491 g) for 10 minutes. The TIL pellets can
then be resuspended with 150 mL of fresh 50/50 medium with 3000
IU/mL of IL-2 and added back to the original G-Rex 100 flasks. In
embodiments where TILs are expanded serially in G-Rex 100 flasks,
on day 7 the TIL in each G-Rex 100 are suspended in the 300 mL of
media present in each flask and the cell suspension was divided
into three 100 mL aliquots that are used to seed 3 G-Rex 100
flasks. Then 150 mL of AIM-V with 5% human AB serum and 3000 IU/mL
of IL-2 is added to each flask. The G-Rex 100 flasks are incubated
at 37.degree. C. in 5% CO.sub.2 and after 4 days 150 mL of AIM-V
with 3000 IU/mL of IL-2 is added to each G-Rex 100 flask. The cells
are harvested on day 14 of culture.
[0456] The diverse antigen receptors of T and B lymphocytes are
produced by somatic recombination of a limited, but large number of
gene segments. These gene segments: V (variable), D (diversity), J
(joining), and C (constant), determine the binding specificity and
downstream applications of immunoglobulins and T-cell receptors
(TCRs). The present invention provides a method for generating TILs
which exhibit and increase the T-cell repertoire diversity. In some
embodiments, the TILs obtained by the present method exhibit an
increase in the T-cell repertoire diversity. In some embodiments,
the TILs obtained in the second expansion exhibit an increase in
the T-cell repertoire diversity. In some embodiments, the increase
in diversity is an increase in the immunoglobulin diversity and/or
the T-cell receptor diversity. In some embodiments, the diversity
is in the immunoglobulin is in the immunoglobulin heavy chain. In
some embodiments, the diversity is in the immunoglobulin is in the
immunoglobulin light chain. In some embodiments, the diversity is
in the T-cell receptor. In some embodiments, the diversity is in
one of the T-cell receptors selected from the group consisting of
alpha, beta, gamma, and delta receptors. In some embodiments, there
is an increase in the expression of T-cell receptor (TCR) alpha
and/or beta. In some embodiments, there is an increase in the
expression of T-cell receptor (TCR) alpha. In some embodiments,
there is an increase in the expression of T-cell receptor (TCR)
beta. In some embodiments, there is an increase in the expression
of TCRab (i.e., TCR.alpha./.beta.).
[0457] In some embodiments, the second expansion culture medium
(e.g., sometimes referred to as CM2 or the second cell culture
medium), comprises IL-2, OKT-3, as well as the antigen-presenting
feeder cells (APCs), as discussed in more detail below.
[0458] In some embodiments, the second expansion, for example, Step
D according to FIG. 18, is performed in a closed system bioreactor.
In some embodiments, a closed system is employed for the TIL
expansion, as described herein. In some embodiments, a single
bioreactor is employed. In some embodiments, the single bioreactor
employed is for example a G-REX-10 or a G-REX-100. In some
embodiments, the closed system bioreactor is a single
bioreactor.
Feeder Cells and Antigen Presenting Cells
[0459] In an embodiment, the second expansion procedures described
herein (for example including expansion such as those described in
Step D from FIG. 18, as well as those referred to as REP) require
an excess of feeder cells during REP TIL expansion and/or during
the second expansion. In many embodiments, the feeder cells are
peripheral blood mononuclear cells (PBMCs) obtained from standard
whole blood units from healthy blood donors. The PBMCs are obtained
using standard methods such as Ficoll-Paque gradient
separation.
[0460] In general, the allogenic PBMCs are inactivated, either via
irradiation or heat treatment, and used in the REP procedures, as
described in the examples, which provides an exemplary protocol for
evaluating the replication incompetence of irradiate allogeneic
PBMCs.
[0461] In some embodiments, PBMCs are considered replication
incompetent and accepted for use in the TIL expansion procedures
described herein if the total number of viable cells on day 14 is
less than the initial viable cell number put into culture on day 0
of the REP and/or day 0 of the second expansion (i.e., the start
day of the second expansion).
[0462] In some embodiments, PBMCs are considered replication
incompetent and accepted for use in the TIL expansion procedures
described herein if the total number of viable cells, cultured in
the presence of OKT3 and IL-2, on day 7 and day 14 has not
increased from the initial viable cell number put into culture on
day 0 of the REP and/or day 0 of the second expansion (i.e., the
start day of the second expansion). In some embodiments, the PBMCs
are cultured in the presence of 30 ng/ml OKT3 antibody and 3000
IU/ml IL-2.
[0463] In some embodiments, PBMCs are considered replication
incompetent and accepted for use in the TIL expansion procedures
described herein if the total number of viable cells, cultured in
the presence of OKT3 and IL-2, on day 7 and day 14 has not
increased from the initial viable cell number put into culture on
day 0 of the REP and/or day 0 of the second expansion (i.e., the
start day of the second expansion). In some embodiments, the PBMCs
are cultured in the presence of 5-60 ng/ml OKT3 antibody and
1000-6000 IU/ml IL-2. In some embodiments, the PBMCs are cultured
in the presence of 10-50 ng/ml OKT3 antibody and 2000-5000 IU/ml
IL-2. In some embodiments, the PBMCs are cultured in the presence
of 20-40 ng/ml OKT3 antibody and 2000-4000 IU/ml IL-2. In some
embodiments, the PBMCs are cultured in the presence of 25-35 ng/ml
OKT3 antibody and 2500-3500 IU/ml IL-2.
[0464] In some embodiments, the antigen-presenting feeder cells are
PBMCs. In some embodiments, the antigen-presenting feeder cells are
artificial antigen-presenting feeder cells. In an embodiment, the
ratio of TILs to antigen-presenting feeder cells in the second
expansion is about 1 to 25, about 1 to 50, about 1 to 100, about 1
to 125, about 1 to 150, about 1 to 175, about 1 to 200, about 1 to
225, about 1 to 250, about 1 to 275, about 1 to 300, about 1 to
325, about 1 to 350, about 1 to 375, about 1 to 400, or about 1 to
500. In an embodiment, the ratio of TILs to antigen-presenting
feeder cells in the second expansion is between 1 to 50 and 1 to
300. In an embodiment, the ratio of TILs to antigen-presenting
feeder cells in the second expansion is between 1 to 100 and 1 to
200.
[0465] In an embodiment, the second expansion procedures described
herein require a ratio of about 2.5.times.10.sup.9 feeder cells to
about 100.times.10.sup.6 TILs. In another embodiment, the second
expansion procedures described herein require a ratio of about
2.5.times.10.sup.9 feeder cells to about 50.times.10.sup.6 TILs. In
yet another embodiment, the second expansion procedures described
herein require about 2.5.times.10.sup.9 feeder cells to about
25.times.10.sup.6 TILs.
[0466] In an embodiment, the second expansion procedures described
herein require an excess of feeder cells during the second
expansion. In many embodiments, the feeder cells are peripheral
blood mononuclear cells (PBMCs) obtained from standard whole blood
units from healthy blood donors. The PBMCs are obtained using
standard methods such as Ficoll-Paque gradient separation. In an
embodiment, artificial antigen-presenting (aAPC) cells are used in
place of PBMCs.
[0467] In general, the allogenic PBMCs are inactivated, either via
irradiation or heat treatment, and used in the TIL expansion
procedures described herein, including the exemplary procedures
described in the figures and examples.
[0468] In an embodiment, artificial antigen presenting cells are
used in the second expansion as a replacement for, or in
combination with, PBMCs.
[0469] Cytokines
[0470] The expansion methods described herein generally use culture
media with high doses of a cytokine, in particular IL-2, as is
known in the art.
[0471] Alternatively, using combinations of cytokines for the rapid
expansion and or second expansion of TILS is additionally possible,
with combinations of two or more of IL-2, IL-15 and IL-21 as is
generally outlined in International Publication No. WO 2015/189356
and W International Publication No. WO 2015/189357, hereby
expressly incorporated by reference in their entirety. Thus,
possible combinations include IL-2 and IL-15, IL-2 and IL-21, IL-15
and IL-21 and IL-2, IL-15 and IL-21, with the latter finding
particular use in many embodiments. The use of combinations of
cytokines specifically favors the generation of lymphocytes, and in
particular T-cells as described therein.
Step E: Harvest TILS
[0472] After the second expansion step, cells can be harvested. In
some embodiments the TILs are harvested after one, two, three, four
or more expansion steps, for example as provided in FIG. 18. In
some embodiments the TILs are harvested after two expansion steps,
for example as provided in FIG. 18.
[0473] TILs can be harvested in any appropriate and sterile manner,
including for example by centrifugation. Methods for TIL harvesting
are well known in the art and any such know methods can be employed
with the present process. In some embodiments, TILS are harvest
using an automated system.
[0474] Cell harvesters and/or cell processing systems are
commercially available from a variety of sources, including, for
example, Fresenius Kabi, Tomtec Life Science, Perkin Elmer, and
Inotech Biosystems International, Inc. Any cell based harvester can
be employed with the present methods. In some embodiments, the cell
harvester and/or cell processing systems is a membrane-based cell
harvester. In some embodiments, cell harvesting is via a cell
processing system, such as the LOVO system (manufactured by
Fresenius Kabi). The term "LOVO cell processing system" also refers
to any instrument or device manufactured by any vendor that can
pump a solution comprising cells through a membrane or filter such
as a spinning membrane or spinning filter in a sterile and/or
closed system environment, allowing for continuous flow and cell
processing to remove supernatant or cell culture media without
pelletization. In some embodiments, the cell harvester and/or cell
processing system can perform cell separation, washing,
fluid-exchange, concentration, and/or other cell processing steps
in a closed, sterile system.
[0475] In some embodiments, the harvest, for example, Step E
according to FIG. 18, is performed from a closed system bioreactor.
In some embodiments, a closed system is employed for the TIL
expansion, as described herein. In some embodiments, a single
bioreactor is employed. In some embodiments, the single bioreactor
employed is for example a G-REX-10 or a G-REX-100. In some
embodiments, the closed system bioreactor is a single
bioreactor.
[0476] In some embodiments, Step E according to FIG. 18, is
performed according to the processes described in Example 7. In
some embodiments, the closed system is accessed via syringes under
sterile conditions in order to maintain the sterility and closed
nature of the system. In some embodiments, a closed system as
described in Example 7 is employed.
[0477] In some embodiments, TILs are harvested according to the
methods described in the Examples.
Step F: Final Formulation/Transfer to Infusion Bag
[0478] After Steps A through E as provided in an exemplary order in
FIG. 18 and as outlined in detailed above and herein are complete,
cells are transferred to a container for use in administration to a
patient. In some embodiments, once a therapeutically sufficient
number of TILs are obtained using the expansion methods described
above, they are transferred to a container for use in
administration to a patient.
[0479] In an embodiment, TILs expanded using APCs of the present
disclosure are administered to a patient as a pharmaceutical
composition. In an embodiment, the pharmaceutical composition is a
suspension of TILs in a sterile buffer. TILs expanded using PBMCs
of the present disclosure may be administered by any suitable route
as known in the art. In some embodiments, the T-cells are
administered as a single intra-arterial or intravenous infusion,
which preferably lasts approximately 30 to 60 minutes. Other
suitable routes of administration include intraperitoneal,
intrathecal, and intralymphatic.
[0480] Optional Cell Medium Components
[0481] 1. Anti-CD3 Antibodies
[0482] In some embodiments, the culture media used in expansion
methods described herein (including those referred to as REP, see
for example, FIG. 18) also includes an anti-CD3 antibody. An
anti-CD3 antibody in combination with IL-2 induces T cell
activation and cell division in the TIL population. This effect can
be seen with full length antibodies as well as Fab and F(ab')2
fragments, with the former being generally preferred; see, e.g.,
Tsoukas et al., J. Immunol. 1985, 135, 1719, hereby incorporated by
reference in its entirety.
[0483] As will be appreciated by those in the art, there are a
number of suitable anti-human CD3 antibodies that find use in the
invention, including anti-human CD3 polyclonal and monoclonal
antibodies from various mammals, including, but not limited to,
murine, human, primate, rat, and canine antibodies. In particular
embodiments, the OKT3 anti-CD3 antibody is used (commercially
available from Ortho-McNeil, Raritan, N.J. or Miltenyi Biotech,
Auburn, Calif.).
TABLE-US-00005 TABLE 5 Amino acid sequences of muromonab (exemplary
OKT-3 antibody) Identifier Sequence (One-Letter Amino Acid Symbols)
SEQ ID NO: 1 QVQLQQSGAE LARPGASVKM SCKASGYTFT RYTMHWVKQR PGQGLEWIGY
INPSRGYTNY 60 Muromonab heavy NQKFKDKATL TTDKSSSTAY MQLSSLTSED
SAVYYCARYY DDHYCLDYWG QGTTLTVSSA 120 chain KTTAPSVYPL APVCGGTTGS
SVTLGCLVKG YFPEPVTLTW NSGSLSSGVH TFPAVLQSDL 180 YTLSSSVTVT
SSTWPSQSIT CNVAHPASST KVDKKIEPRP KSCDKTHTCP PCPAPELLGG 240
PSVFLFPPKP KDTLMISRTP EVTCVVVDVS HEDPEVKFNW YVDGVEVHNA KTKPREEQYN
300 STYRVVSVLT VLHQDWLNGK EYKCKVSNKA LPAPIEKTIS KAKGQPREPQ
VYTLPPSRDE 360 LTKNQVSLTC LVKGFYPSDI AVEWESNGQP ENNYKTTPPV
LDSDGSFFLY SKLTVDKSRW 420 QQGNVFSCSV MHEALHNHYT QKSLSLSPGK 450 SEQ
ID NO: 2 QIVLTQSPAI MSASPGEKVT MTCSASSSVS YMNWYQQKSG TSPKRWIYDT
SKLASGVPAH 60 Muromonab light FRGSGSGTSY SLTISGMEAE DAATYYCQQW
SSNPFTFGSG TKLEINRADT APTVSIFPPS 120 chain SEQLTSGGAS VVCFLNNFYP
KDINVKWKID GSERQNGVLN SWTDQDSKDS TYSMSSTLTL 180 TKDEYERHNS
YTCEATHKTS TSPIVKSFNR NEC 213
[0484] 2. 4-1BB (CD137) Agonists
[0485] In an embodiment, the TNFRSF agonist is a 4-1BB (CD137)
agonist. The 4-1BB agonist may be any 4-1BB binding molecule known
in the art. The 4-1BB binding molecule may be a monoclonal antibody
or fusion protein capable of binding to human or mammalian 4-1BB.
The 4-1BB agonists or 4-1BB binding molecules may comprise an
immunoglobulin heavy chain of any isotype (e.g., IgG, IgE, IgM,
IgD, IgA, and IgY), class (e.g., IgG1, IgG2, IgG3, IgG4, IgA1 and
IgA2) or subclass of immunoglobulin molecule. The 4-1BB agonist or
4-1BB binding molecule may have both a heavy and a light chain. As
used herein, the term binding molecule also includes antibodies
(including full length antibodies), monoclonal antibodies
(including full length monoclonal antibodies), polyclonal
antibodies, multispecific antibodies (e.g., bispecific antibodies),
human, humanized or chimeric antibodies, and antibody fragments,
e.g., Fab fragments, F(ab') fragments, fragments produced by a Fab
expression library, epitope-binding fragments of any of the above,
and engineered forms of antibodies, e.g., scFv molecules, that bind
to 4-1BB. In an embodiment, the 4-1BB agonist is an antigen binding
protein that is a fully human antibody. In an embodiment, the 4-1BB
agonist is an antigen binding protein that is a humanized antibody.
In some embodiments, 4-1BB agonists for use in the presently
disclosed methods and compositions include anti-4-1BB antibodies,
human anti-4-1BB antibodies, mouse anti-4-1BB antibodies, mammalian
anti-4-1BB antibodies, monoclonal anti-4-1BB antibodies, polyclonal
anti-4-1BB antibodies, chimeric anti-4-1BB antibodies, anti-4-1BB
adnectins, anti-4-1BB domain antibodies, single chain anti-4-1BB
fragments, heavy chain anti-4-1BB fragments, light chain anti-4-1BB
fragments, anti-4-1BB fusion proteins, and fragments, derivatives,
conjugates, variants, or biosimilars thereof. Agonistic anti-4-1BB
antibodies are known to induce strong immune responses. Lee, et
al., PLOS One 2013, 8, e69677. In a preferred embodiment, the 4-1BB
agonist is an agonistic, anti-4-1BB humanized or fully human
monoclonal antibody (i.e., an antibody derived from a single cell
line). In an embodiment, the 4-1BB agonist is EU-101 (Eutilex Co.
Ltd.), utomilumab, or urelumab, or a fragment, derivative,
conjugate, variant, or biosimilar thereof. In a preferred
embodiment, the 4-1BB agonist is utomilumab or urelumab, or a
fragment, derivative, conjugate, variant, or biosimilar
thereof.
[0486] In a preferred embodiment, the 4-1BB agonist or 4-1BB
binding molecule may also be a fusion protein. In a preferred
embodiment, a multimeric 4-1BB agonist, such as a trimeric or
hexameric 4-1BB agonist (with three or six ligand binding domains),
may induce superior receptor (4-1BBL) clustering and internal
cellular signaling complex formation compared to an agonistic
monoclonal antibody, which typically possesses two ligand binding
domains. Trimeric (trivalent) or hexameric (or hexavalent) or
greater fusion proteins comprising three TNFRSF binding domains and
IgG1-Fc and optionally further linking two or more of these fusion
proteins are described, e.g., in Gieffers, et al., Mol. Cancer
Therapeutics 2013, 12, 2735-47.
[0487] Agonistic 4-1BB antibodies and fusion proteins are known to
induce strong immune responses. In a preferred embodiment, the
4-1BB agonist is a monoclonal antibody or fusion protein that binds
specifically to 4-1BB antigen in a manner sufficient to reduce
toxicity. In some embodiments, the 4-1BB agonist is an agonistic
4-1BB monoclonal antibody or fusion protein that abrogates
antibody-dependent cellular toxicity (ADCC), for example NK cell
cytotoxicity. In some embodiments, the 4-1BB agonist is an
agonistic 4-1BB monoclonal antibody or fusion protein that
abrogates antibody-dependent cell phagocytosis (ADCP). In some
embodiments, the 4-1BB agonist is an agonistic 4-1BB monoclonal
antibody or fusion protein that abrogates complement-dependent
cytotoxicity (CDC). In some embodiments, the 4-1BB agonist is an
agonistic 4-1BB monoclonal antibody or fusion protein which
abrogates Fc region functionality.
[0488] In some embodiments, the 4-1BB agonists are characterized by
binding to human 4-1BB (SEQ ID NO:9) with high affinity and
agonistic activity. In an embodiment, the 4-1BB agonist is a
binding molecule that binds to human 4-1BB (SEQ ID NO:9). In an
embodiment, the 4-1BB agonist is a binding molecule that binds to
murine 4-1BB (SEQ ID NO:10). The amino acid sequences of 4-1BB
antigen to which a 4-1BB agonist or binding molecule binds are
summarized in TABLE 6.
TABLE-US-00006 TABLE 6 Amino acid sequences of 4-1BB antigens.
Identifier Sequence (One-Letter Amino Acid Symbols) SEQ ID NO: 9
MGNSCYNIVA TLLLVLNFER TRSLQDPCSN CPAGTFCDNN RNQICSPCPP NSFSSAGGQR
60 human 4-1BB, TCDICRQCKG VFRTRKECSS TSNAECDCTP GFHCLGAGCS
MCEQDCKQGQ ELTKKGCKDC 120 Tumor necrosis CFGTFNDQKR GICRPWTNCS
LDGKSVLVNG THERDVVCGP SPADLSPGAS SVTPPAPARE 180 factor receptor
PGHSPQIISF FLALTSTALL FLLFFLTLRF SVVKRGRKKL LYIFKQPFMR PVQTTQEEDG
240 superfamily, CSCRFPEEEE GGCEL 255 member 9 (Homo sapiens) SEQ
ID NO: 10 MGNNCYNVVV IVLLLVGCEK VGAVQNSCDN CQPGTFCRKY NPVCKSCPPS
TFSSIGGQPN 60 murine 4-1BB, CNICRVCAGY FRFKKFCSST HNAECECIEG
FHCLGPQCTR CEKDCRPGQE LTKQGCKTCS 120 Tumor necrosis LGTFNDQNGT
GVCRPWTNCS LDGRSVLKTG TTEKDVVCGP PVVSFSPSTT ISVTPEGGPG 180 factor
receptor GHSLQVLTLF LALTSALLLA LIFITLLFSV LKWIRKKFPH IFKQPFKKTT
GAAQEEDACS 240 superfamily, CRCPQEEEGG GGGYEL 256 member 9 (Mus
musculus)
[0489] In some embodiments, the compositions, processes and methods
described include a 4-1BB agonist that binds human or murine 4-1BB
with a K.sub.D of about 100 pM or lower, binds human or murine
4-1BB with a K.sub.D of about 90 pM or lower, binds human or murine
4-1BB with a K.sub.D of about 80 pM or lower, binds human or murine
4-1BB with a K.sub.D of about 70 pM or lower, binds human or murine
4-1BB with a K.sub.D of about 60 pM or lower, binds human or murine
4-1BB with a K.sub.D of about 50 pM or lower, binds human or murine
4-1BB with a K.sub.D of about 40 pM or lower, or binds human or
murine 4-1BB with a K.sub.D of about 30 pM or lower.
[0490] In some embodiments, the compositions, processes and methods
described include a 4-1BB agonist that binds to human or murine
4-1BB with a k.sub.assoc of about 7.5.times.10.sup.5 1/Ms or
faster, binds to human or murine 4-1BB with a k.sub.assoc of about
7.5.times.10.sup.5 1/Ms or faster, binds to human or murine 4-1BB
with a k.sub.assoc of about 8.times.10.sup.5 1/Ms or faster, binds
to human or murine 4-1BB with a k.sub.assoc of about
8.5.times.10.sup.5 1/Ms or faster, binds to human or murine 4-1BB
with a k.sub.assoc of about 9.times.10.sup.5 1/Ms or faster, binds
to human or murine 4-1BB with a k.sub.assoc of about
9.5.times.10.sup.5 1/Ms or faster, or binds to human or murine
4-1BB with a k.sub.assoc of about 1.times.10.sup.6 1/Ms or
faster.
[0491] In some embodiments, the compositions, processes and methods
described include a 4-1BB agonist that binds to human or murine
4-1BB with a k.sub.dissoc of about 2.times.10.sup.-5 1/s or slower,
binds to human or murine 4-1BB with a k.sub.dissoc of about
2.1.times.10.sup.-5 1/s or slower, binds to human or murine 4-1BB
with a k.sub.dissoc of about 2.2.times.10.sup.-5 1/s or slower,
binds to human or murine 4-1BB with a k.sub.dissoc of about
2.3.times.10.sup.-5 1/s or slower, binds to human or murine 4-1BB
with a k.sub.dissoc of about 2.4.times.10.sup.-5 1/s or slower,
binds to human or murine 4-1BB with a k.sub.dissoc of about
2.5.times.10.sup.-5 1/s or slower, binds to human or murine 4-1BB
with a k.sub.dissoc of about 2.6.times.10.sup.-5 1/s or slower or
binds to human or murine 4-1BB with a k.sub.dissoc of about
2.7.times.10.sup.-5 1/s or slower, binds to human or murine 4-1BB
with a k.sub.dissoc of about 2.8.times.10.sup.-5 1/s or slower,
binds to human or murine 4-1BB with a k.sub.dissoc of about
2.9.times.10.sup.-5 1/s or slower, or binds to human or murine
4-1BB with a k.sub.dissoc of about 3.times.10.sup.-5 1/s or
slower.
[0492] In some embodiments, the compositions, processes and methods
described include a 4-1BB agonist that binds to human or murine
4-1BB with an IC.sub.50 of about 10 nM or lower, binds to human or
murine 4-1BB with an IC.sub.50 of about 9 nM or lower, binds to
human or murine 4-1BB with an IC.sub.50 of about 8 nM or lower,
binds to human or murine 4-1BB with an IC.sub.50 of about 7 nM or
lower, binds to human or murine 4-1BB with an IC.sub.50 of about 6
nM or lower, binds to human or murine 4-1BB with an IC.sub.50 of
about 5 nM or lower, binds to human or murine 4-1BB with an
IC.sub.50 of about 4 nM or lower, binds to human or murine 4-1BB
with an IC.sub.50 of about 3 nM or lower, binds to human or murine
4-1BB with an IC.sub.50 of about 2 nM or lower, or binds to human
or murine 4-1BB with an IC.sub.50 of about 1 nM or lower.
[0493] In a preferred embodiment, the 4-1BB agonist is utomilumab,
also known as PF-05082566 or MOR-7480, or a fragment, derivative,
variant, or biosimilar thereof. Utomilumab is available from
Pfizer, Inc. Utomilumab is an immunoglobulin G2-lambda, anti-[Homo
sapiens TNFRSF9 (tumor necrosis factor receptor (TNFR) superfamily
member 9, 4-1BB, T cell antigen ILA, CD137)], Homo sapiens (fully
human) monoclonal antibody. The amino acid sequences of utomilumab
are set forth in Table 7. Utomilumab comprises glycosylation sites
at Asn59 and Asn292; heavy chain intrachain disulfide bridges at
positions 22-96 (V.sub.H-V.sub.L), 143-199 (C.sub.H1-C.sub.L),
256-316 (C.sub.H2) and 362-420 (C.sub.H3); light chain intrachain
disulfide bridges at positions 22'-87' (V.sub.H-V.sub.L) and
136'-195' (C.sub.H1-C.sub.L); interchain heavy chain-heavy chain
disulfide bridges at IgG2A isoform positions 218-218, 219-219,
222-222, and 225-225, at IgG2A/B isoform positions 218-130,
219-219, 222-222, and 225-225, and at IgG2B isoform positions
219-130 (2), 222-222, and 225-225; and interchain heavy chain-light
chain disulfide bridges at IgG2A isoform positions 130-213' (2),
IgG2A/B isoform positions 218-213' and 130-213', and at IgG2B
isoform positions 218-213' (2). The preparation and properties of
utomilumab and its variants and fragments are described in U.S.
Pat. Nos. 8,821,867; 8,337,850; and 9,468,678, and International
Patent Application Publication No. WO 2012/032433 A1, the
disclosures of each of which are incorporated by reference herein.
Preclinical characteristics of utomilumab are described in Fisher,
et al., Cancer Immunolog. & Immunother. 2012, 61, 1721-33.
Current clinical trials of utomilumab in a variety of hematological
and solid tumor indications include U.S. National Institutes of
Health clinicaltrials.gov identifiers NCT02444793, NCT01307267,
NCT02315066, and NCT02554812.
[0494] In an embodiment, a 4-1BB agonist comprises a heavy chain
given by SEQ ID NO:11 and a light chain given by SEQ ID NO: 12. In
an embodiment, a 4-1BB agonist comprises heavy and light chains
having the sequences shown in SEQ ID NO:11 and SEQ ID NO: 12,
respectively, or antigen binding fragments, Fab fragments,
single-chain variable fragments (scFv), variants, or conjugates
thereof. In an embodiment, a 4-1BB agonist comprises heavy and
light chains that are each at least 99% identical to the sequences
shown in SEQ ID NO:11 and SEQ ID NO: 12, respectively. In an
embodiment, a 4-1BB agonist comprises heavy and light chains that
are each at least 98% identical to the sequences shown in SEQ ID
NO:11 and SEQ ID NO:12, respectively. In an embodiment, a 4-1BB
agonist comprises heavy and light chains that are each at least 97%
identical to the sequences shown in SEQ ID NO:11 and SEQ ID NO:12,
respectively. In an embodiment, a 4-1BB agonist comprises heavy and
light chains that are each at least 96% identical to the sequences
shown in SEQ ID NO:11 and SEQ ID NO:12, respectively. In an
embodiment, a 4-1BB agonist comprises heavy and light chains that
are each at least 95% identical to the sequences shown in SEQ ID
NO:11 and SEQ ID NO:12, respectively.
[0495] In an embodiment, the 4-1BB agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of utomilumab. In an
embodiment, the 4-1BB agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:13, and the 4-1BB agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:14, and conservative amino acid substitutions thereof.
In an embodiment, a 4-1BB agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:13 and SEQ ID NO:14, respectively. In an embodiment, a
4-1BB agonist comprises V.sub.H and V.sub.L regions that are each
at least 98% identical to the sequences shown in SEQ ID NO:13 and
SEQ ID NO:14, respectively. In an embodiment, a 4-1BB agonist
comprises V.sub.H and V.sub.L regions that are each at least 97%
identical to the sequences shown in SEQ ID NO:13 and SEQ ID NO:14,
respectively. In an embodiment, a 4-1BB agonist comprises V.sub.H
and V.sub.L regions that are each at least 96% identical to the
sequences shown in SEQ ID NO:13 and SEQ ID NO:14, respectively. In
an embodiment, a 4-1BB agonist comprises V.sub.H and V.sub.L
regions that are each at least 95% identical to the sequences shown
in SEQ ID NO:13 and SEQ ID NO:14, respectively. In an embodiment, a
4-1BB agonist comprises an scFv antibody comprising V.sub.H and
V.sub.L regions that are each at least 99% identical to the
sequences shown in SEQ ID NO:13 and SEQ ID NO:14.
[0496] In an embodiment, a 4-1BB agonist comprises heavy chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:15, SEQ ID NO:16, and SEQ ID NO:17, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:18, SEQ ID NO:19, and SEQ ID NO:20, respectively, and
conservative amino acid substitutions thereof.
[0497] In an embodiment, the 4-1BB agonist is a 4-1BB agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to utomilumab. In an embodiment, the
biosimilar monoclonal antibody comprises an 4-1BB antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
utomilumab. In some embodiments, the one or more post-translational
modifications are selected from one or more of: glycosylation,
oxidation, deamidation, and truncation. In some embodiments, the
biosimilar is a 4-1BB agonist antibody authorized or submitted for
authorization, wherein the 4-1BB agonist antibody is provided in a
formulation which differs from the formulations of a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
utomilumab. The 4-1BB agonist antibody may be authorized by a drug
regulatory authority such as the U.S. FDA and/or the European
Union's EMA. In some embodiments, the biosimilar is provided as a
composition which further comprises one or more excipients, wherein
the one or more excipients are the same or different to the
excipients comprised in a reference medicinal product or reference
biological product, wherein the reference medicinal product or
reference biological product is utomilumab. In some embodiments,
the biosimilar is provided as a composition which further comprises
one or more excipients, wherein the one or more excipients are the
same or different to the excipients comprised in a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
utomilumab.
TABLE-US-00007 TABLE 7 Amino acid sequences for 4-1BB agonist
antibodies related to utomilumab. Identifier Sequence (One-Letter
Amino Acid Symbols) SEQ ID NO: 11 EVQLVQSGAE VKKPGESLRI SCKGSGYSFS
TYWISWVRQM PGKGLEWMGK IYPGDSYTNY 60 heavy chain for SPSFQGQVTI
SADKSISTAY LQWSSLKASD TAMYYCARGY GIFDYWGQGT LVTVSSASTK 120
utomilumab GPSVFPLAPC SRSTSESTAA LGCLVKDYFP EPVTVSWNSG ALTSGVHTFP
AVLQSSGLYS 180 LSSVVTVPSS NFGTQTYTCN VDHKPSNTKV DKTVERKCCV
ECPPCPAPPV AGPSVFLFPP 240 KPKDTLMISR TPEVTCVVVD VSHEDPEVQF
NWYVDGVEVH NAKTKPREEQ FNSTFRVVSV 300 LTVVHQDWLN GKEYECKVSN
KGLPAPIEKT ISKTKGQPRE PQVYTLPPSR EEMTKNQVSL 360 TCLVKGFYPS
DIAVEWESNG QPENNYKTTP PMLDSDGSFF LYSKLTVDKS RWQQGNVFSC 420
SVMHEALHNH YTQKSLSLSP G 441 SEQ ID NO: 12 SYELTQPPSV SVSPGQTASI
TCSGDNIGDQ YAHWYQQKPG QSPVLVIYQD KNRPSGIPER 60 light chain for
FSGSNSGNTA TLTISGTQAM DEADYYCATY TGFGSLAVFG GGTKLTVLGQ PKAAPSVTLF
120 utomilumab PPSSEELQAN KATLVCLISD FYPGAVTVAW KADSSPVKAG
VETTTPSKQS NNKYAASSYL 180 SLTPEQWKSH RSYSCQVTHE GSTVEKTVAP TECS 214
SEQ ID NO: 13 EVQLVQSGAE VKKPGESLRI SCKGSGYSFS TYWISWVRQM PGKGLEWMG
KIYPGDSYTN 60 heavy chain YSPSFQGQVT ISADKSISTA YLQWSSLKAS
DTAMYYCARG YGIFDYWGQ GTLVTVSS 118 variable region for utomilumab
SEQ ID NO: 14 SYELTQPPSV SVSPGQTASI TCSGDNIGDQ YAHWYQQKPG
QSPVLVIYQD KNRPSGIPER 60 light chain FSGSNSGNTA TLTISGTQAM
DEADYYCATY TGFGSLAVFG GGTKLTVL 108 variable region for utomilumab
SEQ ID NO: 15 STYWIS 6 heavy chain CDR1 for utomilumab SEQ ID NO:
16 KIYPGDSYTN YSPSFQG 17 heavy chain CDR2 for utomilumab SEQ ID NO:
17 RGYGIFDY 8 heavy chain CDR3 for utomilumab SEQ ID NO: 18
SGDNIGDQYA H 11 light chain CDR1 for utomilumab SEQ ID NO: 19
QDKNRPS 7 light chain CDR2 for utomilumab SEQ ID NO: 20 ATYTGFGSLA
V 11 light chain CDR3 for utomilumab
[0498] In a preferred embodiment, the 4-1BB agonist is the
monoclonal antibody urelumab, also known as BMS-663513 and
20H4.9.h4a, or a fragment, derivative, variant, or biosimilar
thereof. Urelumab is available from Bristol-Myers Squibb, Inc., and
Creative Biolabs, Inc. Urelumab is an immunoglobulin G4-kappa,
anti-[Homo sapiens TNFRSF9 (tumor necrosis factor receptor
superfamily member 9, 4-1BB, T cell antigen ILA, CD137)], Homo
sapiens (fully human) monoclonal antibody. The amino acid sequences
of urelumab are set forth in Table 7. Urelumab comprises
N-glycosylation sites at positions 298 (and 298''); heavy chain
intrachain disulfide bridges at positions 22-95 (V.sub.H-V.sub.L),
148-204 (C.sub.H1-C.sub.L), 262-322 (C.sub.H2) and 368-426
(C.sub.H3) (and at positions 22''-95'', 148''-204'', 262''-322'',
and 368''-426''); light chain intrachain disulfide bridges at
positions 23'-88' (V.sub.H-V.sub.L) and 136'-196'
(C.sub.H1-C.sub.L) (and at positions 23'''-88''' and
136'''-196'''); interchain heavy chain-heavy chain disulfide
bridges at positions 227-227'' and 230-230''; and interchain heavy
chain-light chain disulfide bridges at 135-216' and 135''-216'''.
The preparation and properties of urelumab and its variants and
fragments are described in U.S. Pat. Nos. 7,288,638 and 8,962,804,
the disclosures of which are incorporated by reference herein. The
preclinical and clinical characteristics of urelumab are described
in Segal, et al., Clin. Cancer Res. 2016, available at
http:/dx.doi.org/10.1158/1078-0432.CCR-16-1272. Current clinical
trials of urelumab in a variety of hematological and solid tumor
indications include U.S. National Institutes of Health
clinicaltrials.gov identifiers NCT01775631, NCT02110082,
NCT02253992, and NCT01471210.
[0499] In an embodiment, a 4-1BB agonist comprises a heavy chain
given by SEQ ID NO:21 and a light chain given by SEQ ID NO:22. In
an embodiment, a 4-1BB agonist comprises heavy and light chains
having the sequences shown in SEQ ID NO:21 and SEQ ID NO:22,
respectively, or antigen binding fragments, Fab fragments,
single-chain variable fragments (scFv), variants, or conjugates
thereof. In an embodiment, a 4-1BB agonist comprises heavy and
light chains that are each at least 99% identical to the sequences
shown in SEQ ID NO:21 and SEQ ID NO:22, respectively. In an
embodiment, a 4-1BB agonist comprises heavy and light chains that
are each at least 98% identical to the sequences shown in SEQ ID
NO:21 and SEQ ID NO:22, respectively. In an embodiment, a 4-1BB
agonist comprises heavy and light chains that are each at least 97%
identical to the sequences shown in SEQ ID NO:21 and SEQ ID NO:22,
respectively. In an embodiment, a 4-1BB agonist comprises heavy and
light chains that are each at least 96% identical to the sequences
shown in SEQ ID NO:21 and SEQ ID NO:22, respectively. In an
embodiment, a 4-1BB agonist comprises heavy and light chains that
are each at least 95% identical to the sequences shown in SEQ ID
NO:21 and SEQ ID NO:22, respectively.
[0500] In an embodiment, the 4-1BB agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of urelumab. In an
embodiment, the 4-1BB agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:23, and the 4-1BB agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:24, and conservative amino acid substitutions thereof.
In an embodiment, a 4-1BB agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:23 and SEQ ID NO:24, respectively. In an embodiment, a
4-1BB agonist comprises V.sub.H and V.sub.L regions that are each
at least 98% identical to the sequences shown in SEQ ID NO:23 and
SEQ ID NO:24, respectively. In an embodiment, a 4-1BB agonist
comprises V.sub.H and V.sub.L regions that are each at least 97%
identical to the sequences shown in SEQ ID NO:23 and SEQ ID NO:24,
respectively. In an embodiment, a 4-1BB agonist comprises V.sub.H
and V.sub.L regions that are each at least 96% identical to the
sequences shown in SEQ ID NO:23 and SEQ ID NO:24, respectively. In
an embodiment, a 4-1BB agonist comprises V.sub.H and V.sub.L
regions that are each at least 95% identical to the sequences shown
in SEQ ID NO:23 and SEQ ID NO:24, respectively. In an embodiment, a
4-1BB agonist comprises an scFv antibody comprising V.sub.H and
V.sub.L regions that are each at least 99% identical to the
sequences shown in SEQ ID NO:23 and SEQ ID NO:24.
[0501] In an embodiment, a 4-1BB agonist comprises heavy chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:25, SEQ ID NO:26, and SEQ ID NO:27, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:28, SEQ ID NO:29, and SEQ ID NO:30, respectively, and
conservative amino acid substitutions thereof.
[0502] In an embodiment, the 4-1BB agonist is a 4-1BB agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to urelumab. In an embodiment, the
biosimilar monoclonal antibody comprises an 4-1BB antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
urelumab. In some embodiments, the one or more post-translational
modifications are selected from one or more of: glycosylation,
oxidation, deamidation, and truncation. In some embodiments, the
biosimilar is a 4-1BB agonist antibody authorized or submitted for
authorization, wherein the 4-1BB agonist antibody is provided in a
formulation which differs from the formulations of a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
urelumab. The 4-1BB agonist antibody may be authorized by a drug
regulatory authority such as the U.S. FDA and/or the European
Union's EMA. In some embodiments, the biosimilar is provided as a
composition which further comprises one or more excipients, wherein
the one or more excipients are the same or different to the
excipients comprised in a reference medicinal product or reference
biological product, wherein the reference medicinal product or
reference biological product is urelumab. In some embodiments, the
biosimilar is provided as a composition which further comprises one
or more excipients, wherein the one or more excipients are the same
or different to the excipients comprised in a reference medicinal
product or reference biological product, wherein the reference
medicinal product or reference biological product is urelumab.
TABLE-US-00008 TABLE 8 Amino acid sequences for 4-1BB agonist
antibodies related to urelumab. Identifier Sequence (One-Letter
Amino Acid Symbols) SEQ ID NO: 21 QVQLQQWGAG LLKPSETLSL TCAVYGGSFS
GYYWSWIRQS PEKGLEWIGE INHGGYVTYN 60 heavy chain for PSLESRVTIS
VDTSENQFSL KLSSVTAADT AVYYCARDYG PGNYDWYFDL WGRGTLVTVS 120 urelumab
SASTKGPSVF PLAPCSRSTS ESTAALGCLV KDYFPEPVTV SWNSGALTSG VHTFPAVLQS
180 SGLYSLSSVV TVPSSSLGTK TYTCNVDHKP SNTKVDKRVE SKYGPPCPPC
PAPEFLGGPS 240 VFLFPPEPED TLMISRTPEV TCVVVDVSQE DPEVQFNWYV
DGVEVHNAKT KPREEQFNST 300 YRVVSVLTVL HQDWLNGKEY KCKVSNKGLP
SSIEKTISKA KGQPREPQVY TLPPSQEEMT 360 KNQVSLTCLV KGFYPSDIAV
EWESNGQPEN NYKTTPPVLD SDGSFFLYSR LTVDKSRWQE 420 GNVFSCSVMH
EALHNHYTQK SLSLSLGK 448 SEQ ID NO: 22 EIVLTQSPAT LSLSPGERAT
LSCRASQSVS SYLAWYQQKP GQAPRLLIYD ASNRATGIPA 60 light chain for
RFSGSGSGTD FTLTISSLEP EDFAVYYCQQ RSNWPPALTF CGGTKVEIKR TVAAPSVFIF
120 urelumab PPSDEQLKSG TASVVCLLNN FYPREAKVQW KVDNALQSGN SQESVTEQDS
KDSTYSLSST 180 LTLSKADYEK HKVYACEVTH QGLSSPVTKS FNRGEC 216 SEQ ID
NO: 23 MKHLWFFLLL VAAPRWVLSQ VQLQQWGAGL LKPSETLSLT CAVYGGSFSG
YYWSWIRQSP 60 variable heavy EKGLEWIGEI NHGGYVTYNP SLESRVTISV
DTSKNQFSLK LSSVTAADTA VYYCARDYGP 120 chain for urelumab SEQ ID NO:
24 MEAPAQLLFL LLLWLPDTTG EIVLTQSPAT LSLSPGERAT LSCRASQSVS
SYLAWYQQKP 60 variable light GQAPRLLIYD ASNRATGIPA RFSGSGSGTD
FTLTISSLEP EDFAVYYCQQ 110 chain for urelumab SEQ ID NO: 25 GYYWS 5
heavy chain CDR1 for urelumab SEQ ID NO: 26 EINHGGYVTY NPSLES 16
heavy chain CDR2 for urelumab SEQ ID NO: 27 DYGPGNYDWY FDL 13 heavy
chain CDR3 for urelumab SEQ ID NO: 28 RASQSVSSYL A 11 light chain
CDR1 for urelumab SEQ ID NO: 29 DASNRAT 7 light chain CDR2 for
urelumab SEQ ID NO: 30 QQRSDWPPAL T 11 light chain CDR3 for
urelumab
[0503] In an embodiment, the 4-1BB agonist is selected from the
group consisting of 1D8, 3Elor, 4B4 (BioLegend 309809), H4-1BB-M127
(BD Pharmingen 552532), BBK2 (Thermo Fisher MS621PABX), 145501
(Leinco Technologies B591), the antibody produced by cell line
deposited as ATCC No. HB-11248 and disclosed in U.S. Pat. No.
6,974,863, 5F4 (BioLegend 31 1503), C65-485 (BD Pharmingen 559446),
antibodies disclosed in U.S. Patent Application Publication No. US
2005/0095244, antibodies disclosed in U.S. Pat. No. 7,288,638 (such
as 20H4.9-IgGl (BMS-663031)), antibodies disclosed in U.S. Pat. No.
6,887,673 (such as 4E9 or BMS-554271), antibodies disclosed in U.S.
Pat. No. 7,214,493, antibodies disclosed in U.S. Pat. No.
6,303,121, antibodies disclosed in U.S. Pat. No. 6,569,997,
antibodies disclosed in U.S. Pat. No. 6,905,685 (such as 4E9 or
BMS-554271), antibodies disclosed in U.S. Pat. No. 6,362,325 (such
as 1D8 or BMS-469492; 3H3 or BMS-469497; or 3E1), antibodies
disclosed in U.S. Pat. No. 6,974,863 (such as 53A2); antibodies
disclosed in U.S. Pat. No. 6,210,669 (such as 1D8, 3B8, or 3E1),
antibodies described in U.S. Pat. No. 5,928,893, antibodies
disclosed in U.S. Pat. No. 6,303,121, antibodies disclosed in U.S.
Pat. No. 6,569,997, antibodies disclosed in International Patent
Application Publication Nos. WO 2012/177788, WO 2015/119923, and WO
2010/042433, and fragments, derivatives, conjugates, variants, or
biosimilars thereof, wherein the disclosure of each of the
foregoing patents or patent application publications is
incorporated by reference here.
[0504] In an embodiment, the 4-1BB agonist is a 4-1BB agonistic
fusion protein described in International Patent Application
Publication Nos. WO 2008/025516 A1, WO 2009/007120 A1, WO
2010/003766 A1, WO 2010/010051 A1, and WO 2010/078966 A1; U.S.
Patent Application Publication Nos. US 2011/0027218 A1, US
2015/0126709 A1, US 2011/0111494 A1, US 2015/0110734 A1, and US
2015/0126710 A1; and U.S. Pat. Nos. 9,359,420, 9,340,599,
8,921,519, and 8,450,460, the disclosures of which are incorporated
by reference herein.
[0505] In an embodiment, the 4-1BB agonist is a 4-1BB agonistic
fusion protein as depicted in Structure I-A (C-terminal Fc-antibody
fragment fusion protein) or Structure I-B (N-terminal Fc-antibody
fragment fusion protein), or a fragment, derivative, conjugate,
variant, or biosimilar thereof:
[0506] In structures I-A and I-B, the cylinders refer to individual
polypeptide binding domains. Structures I-A and I-B comprise three
linearly-linked TNFRSF binding domains derived from e.g., 4-1BBL or
an antibody that binds 4-1BB, which fold to form a trivalent
protein, which is then linked to a second trivalent protein through
IgG1-Fc (including C.sub.H3 and C.sub.H2 domains) is then used to
link two of the trivalent proteins together through disulfide bonds
(small elongated ovals), stabilizing the structure and providing an
agonists capable of bringing together the intracellular signaling
domains of the six receptors and signaling proteins to form a
signaling complex. The TNFRSF binding domains denoted as cylinders
may be scFv domains comprising, e.g., a V.sub.H and a V.sub.L chain
connected by a linker that may comprise hydrophilic residues and
Gly and Ser sequences for flexibility, as well as Glu and Lys for
solubility. Any scFv domain design may be used, such as those
described in de Marco, Microbial Cell Factories, 2011, 10, 44;
Ahmad, et al., Clin. & Dev. Immunol. 2012, 980250; Monnier, et
al., Antibodies, 2013, 2, 193-208; or in references incorporated
elsewhere herein. Fusion protein structures of this form are
described in U.S. Pat. Nos. 9,359,420, 9,340,599, 8,921,519, and
8,450,460, the disclosures of which are incorporated by reference
herein.
[0507] Amino acid sequences for the other polypeptide domains of
structure I-A are given in Table 9. The Fc domain preferably
comprises a complete constant domain (amino acids 17-230 of SEQ ID
NO:31) the complete hinge domain (amino acids 1-16 of SEQ ID NO:31)
or a portion of the hinge domain (e.g., amino acids 4-16 of SEQ ID
NO:31). Preferred linkers for connecting a C-terminal Fc-antibody
may be selected from the embodiments given in SEQ ID NO:32 to SEQ
ID NO:41, including linkers suitable for fusion of additional
polypeptides.
TABLE-US-00009 TABLE 9 Amino acid sequences for TNFRSF fusion
proteins, including 4-1BB fusion proteins, with C-terminal
Fc-antibody fragment fusion protein design (structure I-A).
Identifier Sequence (One-Letter Amino Acid Symbols) SEQ ID NO: 31
KSCDKTHTCP PCPAPELLGG PSVFLFPPKP KDTLMISRTP EVTCVVVDVS HEDPEVKFNW
60 Fc domain YVDGVEVHNA KTKPREEQYN STYRVVSVLT VLHQDWLNGK EYKCKVSNKA
LPAPIEKTIS 120 KAKGQPREPQ VYTLPPSREE MTKNQVSLTC LVKGFYPSDI
AVEWESNGQP ENNYKTTPPV 180 LDSDGSFFLY SKLTVDKSRW QQGNVFSCSV
MHEALHNHYT QKSLSLSPGK 230 SEQ ID NO: 32 GGPGSSKSCD KTHTCPPCPA PE 22
linker SEQ ID NO: 33 GGSGSSKSCD KTHTCPPCPA PE 22 linker SEQ ID NO:
34 GGPGSSSSSS SKSCDKTHTC PPCPAPE 27 linker SEQ ID NO: 35 GGSGSSSSSS
SKSCDKTHTC PPCPAPE 27 linker SEQ ID NO: 36 GGPGSSSSSS SSSKSCDKTH
TCPPCPAPE 29 linker SEQ ID NO: 37 GGSGSSSSSS SSSKSCDKTH TCPPCPAPE
29 linker SEQ ID NO: 38 GGPGSSGSGS SDKTHTCPPC PAPE 24 linker SEQ ID
NO: 39 GGPGSSGSGS DKTHTCPPCP APE 23 linker SEQ ID NO: 40 GGPSSSGSDK
THTCPPCPAP E 21 linker SEQ ID NO: 41 GGSSSSSSSS GSDKTHTCPP CPAPE 25
linker
[0508] Amino acid sequences for the other polypeptide domains of
structure I-B are given in Table 10. If an Fc antibody fragment is
fused to the N-terminus of an TNRFSF fusion protein as in structure
I-B, the sequence of the Fc module is preferably that shown in SEQ
ID NO:42, and the linker sequences are preferably selected from
those embodiments set forth in SEQ ID NO:43 to SEQ ID NO:45.
TABLE-US-00010 TABLE 10 Amino acid sequences for TNFRSF fusicN
proteins, including 4-1BB fusion proteins, with N-terminal
Fc-antibody fragment fusion protein design (structure I-B).
Identifier Sequence (One-Letter Amino Acid Symbols) SEQ ID NO: 42
METDTLLLWV LLLWVPAGNG DKTHTCPPCP APELLGGPSV FLFPPKPKDT LMISRTPEVT
60 Fc domain CVVVDVSHED PEVKFNWYVD GVEVHNAKTK PREEQYNSTY RVVSVLTVLH
QDWLNGKEYK 120 CKVSNKALPA PIEKTISKAK GQPREPQVYT LPPSREEMTK
NQVSLTCLVK GFYPSDIAVE 180 WESNGQPENN YKTTPPVLDS DGSFFLYSKL
TVDKSRWQQG NVFSCSVMHE ALHNHYTQKS 240 LSLSPG 246 SEQ ID NO: 43
SGSGSGSGSG S 11 linker SEQ ID NO: 44 SSSSSSGSGS GS 12 linker SEQ ID
NO: 45 SSSSSSGSGS GSGSGS 16 linker
[0509] In an embodiment, a 4-1BB agonist fusion protein according
to structures I-A or I-B comprises one or more 4-1BB binding
domains selected from the group consisting of a variable heavy
chain and variable light chain of utomilumab, a variable heavy
chain and variable light chain of urelumab, a variable heavy chain
and variable light chain of utomilumab, a variable heavy chain and
variable light chain selected from the variable heavy chains and
variable light chains described in Table 9, any combination of a
variable heavy chain and variable light chain of the foregoing, and
fragments, derivatives, conjugates, variants, and biosimilars
thereof.
[0510] In an embodiment, a 4-1BB agonist fusion protein according
to structures I-A or I-B comprises one or more 4-1BB binding
domains comprising a 4-1BBL sequence. In an embodiment, a 4-1BB
agonist fusion protein according to structures I-A or I-B comprises
one or more 4-1BB binding domains comprising a sequence according
to SEQ ID NO:46. In an embodiment, a 4-1BB agonist fusion protein
according to structures I-A or I-B comprises one or more 4-1BB
binding domains comprising a soluble 4-1BBL sequence. In an
embodiment, a 4-1BB agonist fusion protein according to structures
I-A or I-B comprises one or more 4-1BB binding domains comprising a
sequence according to SEQ ID NO:47.
[0511] In an embodiment, a 4-1BB agonist fusion protein according
to structures I-A or I-B comprises one or more 4-1BB binding
domains that is a scFv domain comprising V.sub.H and V.sub.L
regions that are each at least 95% identical to the sequences shown
in SEQ ID NO:13 and SEQ ID NO:14, respectively, wherein the V.sub.H
and V.sub.L domains are connected by a linker. In an embodiment, a
4-1BB agonist fusion protein according to structures I-A or I-B
comprises one or more 4-1BB binding domains that is a scFv domain
comprising V.sub.H and V.sub.L regions that are each at least 95%
identical to the sequences shown in SEQ ID NO:23 and SEQ ID NO:24,
respectively, wherein the V.sub.H and V.sub.L domains are connected
by a linker. In an embodiment, a 4-1BB agonist fusion protein
according to structures I-A or I-B comprises one or more 4-1BB
binding domains that is a scFv domain comprising V.sub.H and
V.sub.L regions that are each at least 95% identical to the V.sub.H
and V.sub.L sequences given in Table 11, wherein the V.sub.H and
V.sub.L domains are connected by a linker.
TABLE-US-00011 TABLE 11 Additional polypeptide domains useful as
4-1BB binding domains in fusion proteins or as scFv 4-1BB agonist
antibodies. Identifier Sequence (One-Letter Amino Acid Symbols) SEQ
ID NO: 46 MEYASDASLD PEAPWPPAPR ARACRVLPWA LVAGLLLLLL LAAACAVFLA
CPWAVSGARA 60 4-1BBL SPGSAASPRL REGPELSPDD PAGLLDLRQG MFAQLVAQNV
LLIDGPLSWY SDPGLAGVSL 120 TGGLSYKEDT KELVVAKAGV YYVFFQLELR
RVVAGEGSGS VSLALHLQPL RSAAGAAALA 180 LTVDLPPASS EARNSAFGFQ
GRLLHLSAGQ RLGVHLHTEA RARHAWQLTQ GATVLGLFRV 240 TPEIPAGLPS PRSE 254
SEQ ID NO: 47 LRQGMFAQLV AQNVLLIDGP LSWYSDPGLA GVSLTGGLSY
KEDTKELVVA KAGVYYVFFQ 60 4-1BBL soluble LELRRVVAGE GSGSVSLALH
LQPLRSAAGA AALALTVDLP PASSEARNSA FGFQGRLLHL 120 domain SAGQRLGVHL
HTEARARHAW QLTQGATVLG LFRVTPEIPA GLPSPRSE 168 SEQ ID NO: 48
QVQLQQPGAE LVKPGASVKL SCKASGYTFS SYWMHWVFQR PGQVLEWIGE INPGNGHTNY
60 variable heavy NEKFKSKATL TVDKSSSTAY MQLSSLTSED SAVYYCARSF
TTARGFAYWG QGTLVTVS 118 chain for 4B4-1- 1 version 1 SEQ ID NO: 49
DIVMTQSPAT QSVTPGDRVS LSCRASQTIS DYLHWYQQKS HESPRLLIKY ASQSISGIPS
60 variable light RFSGSGSGSD FTLSINSVEP EDVGVYYCQD GHSFPPTFGG
GTKLEIK 107 chain for 4B4-1- 1 version 1 SEQ ID NO: 50 QVQLQQPGAE
LVKPGASVKL SCKASGYTFS SYWMHWVFQR PGQVLEWIGE INPGNGHTNY 60 variable
heavy NEKFKSKATL TVDKSSSTAY MQLSSLTSED SAVYYCARSF TTARGFAYWG
QGTLVTVSA 119 chain for 4B4-1- 1 version 2 SEQ ID NO: 51 DIVMTQSPAT
QSVTPGDRVS LSCRASQTIS DYLHWYQQKS HESPRLLIKY ASQSISGIPS 60 variable
light RFSGSGSGSD FTLSINSVEP EDVGVYYCQD GHSFPPTFGG GTKLEIKR 108
chain for 4B4-1- 1 version 2 SEQ ID NO: 52 MDWTWRILFL VAAATGAHSE
VQLVESGGGL VQPGGSLRLS CAASGFTFSD YWMSWVRQAP 60 variable heavy
GKGLEWVADI KNDGSYTNYA PSLTNRFTIS RDNAKNSLYL QMNSLRAEDT AVYYCARELT
120 chain for H39E3- 2 SEQ ID NO: 53 MEAPAQLLFL LLLWLPDTTG
DIVMTQSPDS LAVSLGERAT INCKSSQSLL SSGNQKNYL 60 variable light
WYQQKPGQPP KLLIYYASTR QSGVPDRFSG SGSGTDFTLT ISSLQAEDVA 110 chain
for H39E3- 2
[0512] In an embodiment, the 4-1BB agonist is a 4-1BB agonistic
single-chain fusion polypeptide comprising (i) a first soluble
4-1BB binding domain, (ii) a first peptide linker, (iii) a second
soluble 4-1BB binding domain, (iv) a second peptide linker, and (v)
a third soluble 4-1BB binding domain, further comprising an
additional domain at the N-terminal and/or C-terminal end, and
wherein the additional domain is a Fab or Fc fragment domain. In an
embodiment, the 4-1BB agonist is a 4-1BB agonistic single-chain
fusion polypeptide comprising (i) a first soluble 4-1BB binding
domain, (ii) a first peptide linker, (iii) a second soluble 4-1BB
binding domain, (iv) a second peptide linker, and (v) a third
soluble 4-1BB binding domain, further comprising an additional
domain at the N-terminal and/or C-terminal end, wherein the
additional domain is a Fab or Fc fragment domain, wherein each of
the soluble 4-1BB domains lacks a stalk region (which contributes
to trimerisation and provides a certain distance to the cell
membrane, but is not part of the 4-1BB binding domain) and the
first and the second peptide linkers independently have a length of
3-8 amino acids.
[0513] In an embodiment, the 4-1BB agonist is a 4-1BB agonistic
single-chain fusion polypeptide comprising (i) a first soluble
tumor necrosis factor (TNF) superfamily cytokine domain, (ii) a
first peptide linker, (iii) a second soluble TNF superfamily
cytokine domain, (iv) a second peptide linker, and (v) a third
soluble TNF superfamily cytokine domain, wherein each of the
soluble TNF superfamily cytokine domains lacks a stalk region and
the first and the second peptide linkers independently have a
length of 3-8 amino acids, and wherein each TNF superfamily
cytokine domain is a 4-1BB binding domain.
[0514] In an embodiment, the 4-1BB agonist is a 4-1BB agonistic
scFv antibody comprising any of the foregoing V.sub.H domains
linked to any of the foregoing V.sub.L domains.
[0515] In an embodiment, the 4-1BB agonist is BPS Bioscience 4-1BB
agonist antibody catalog no. 79097-2, commercially available from
BPS Bioscience, San Diego, Calif., USA. In an embodiment, the 4-1BB
agonist is Creative Biolabs 4-1BB agonist antibody catalog no.
MOM-18179, commercially available from Creative Biolabs, Shirley,
N.Y., USA.
[0516] 3. OX40 (CD134) Agonists
[0517] In an embodiment, the TNFRSF agonist is an OX40 (CD134)
agonist. The OX40 agonist may be any OX40 binding molecule known in
the art. The OX40 binding molecule may be a monoclonal antibody or
fusion protein capable of binding to human or mammalian OX40. The
OX40 agonists or OX40 binding molecules may comprise an
immunoglobulin heavy chain of any isotype (e.g., IgG, IgE, IgM,
IgD, IgA, and IgY), class (e.g., IgG1, IgG2, IgG3, IgG4, IgA1 and
IgA2) or subclass of immunoglobulin molecule. The OX40 agonist or
OX40 binding molecule may have both a heavy and a light chain. As
used herein, the term binding molecule also includes antibodies
(including full length antibodies), monoclonal antibodies
(including full length monoclonal antibodies), polyclonal
antibodies, multispecific antibodies (e.g., bispecific antibodies),
human, humanized or chimeric antibodies, and antibody fragments,
e.g., Fab fragments, F(ab') fragments, fragments produced by a Fab
expression library, epitope-binding fragments of any of the above,
and engineered forms of antibodies, e.g., scFv molecules, that bind
to OX40. In an embodiment, the OX40 agonist is an antigen binding
protein that is a fully human antibody. In an embodiment, the OX40
agonist is an antigen binding protein that is a humanized antibody.
In some embodiments, OX40 agonists for use in the presently
disclosed methods and compositions include anti-OX40 antibodies,
human anti-OX40 antibodies, mouse anti-OX40 antibodies, mammalian
anti-OX40 antibodies, monoclonal anti-OX40 antibodies, polyclonal
anti-OX40 antibodies, chimeric anti-OX40 antibodies, anti-OX40
adnectins, anti-OX40 domain antibodies, single chain anti-OX40
fragments, heavy chain anti-OX40 fragments, light chain anti-OX40
fragments, anti-OX40 fusion proteins, and fragments, derivatives,
conjugates, variants, or biosimilars thereof. In a preferred
embodiment, the OX40 agonist is an agonistic, anti-OX40 humanized
or fully human monoclonal antibody (i.e., an antibody derived from
a single cell line).
[0518] In a preferred embodiment, the OX40 agonist or OX40 binding
molecule may also be a fusion protein. OX40 fusion proteins
comprising an Fc domain fused to OX40L are described, for example,
in Sadun, et al., J. Immunother. 2009, 182, 1481-89. In a preferred
embodiment, a multimeric OX40 agonist, such as a trimeric or
hexameric OX40 agonist (with three or six ligand binding domains),
may induce superior receptor (OX40L) clustering and internal
cellular signaling complex formation compared to an agonistic
monoclonal antibody, which typically possesses two ligand binding
domains. Trimeric (trivalent) or hexameric (or hexavalent) or
greater fusion proteins comprising three TNFRSF binding domains and
IgG1-Fc and optionally further linking two or more of these fusion
proteins are described, e.g., in Gieffers, et al., Mol. Cancer
Therapeutics 2013, 12, 2735-47.
[0519] Agonistic OX40 antibodies and fusion proteins are known to
induce strong immune responses. Curti, et al., Cancer Res. 2013,
73, 7189-98. In a preferred embodiment, the OX40 agonist is a
monoclonal antibody or fusion protein that binds specifically to
OX40 antigen in a manner sufficient to reduce toxicity. In some
embodiments, the OX40 agonist is an agonistic OX40 monoclonal
antibody or fusion protein that abrogates antibody-dependent
cellular toxicity (ADCC), for example NK cell cytotoxicity. In some
embodiments, the OX40 agonist is an agonistic OX40 monoclonal
antibody or fusion protein that abrogates antibody-dependent cell
phagocytosis (ADCP). In some embodiments, the OX40 agonist is an
agonistic OX40 monoclonal antibody or fusion protein that abrogates
complement-dependent cytotoxicity (CDC). In some embodiments, the
OX40 agonist is an agonistic OX40 monoclonal antibody or fusion
protein which abrogates Fc region functionality.
[0520] In some embodiments, the OX40 agonists are characterized by
binding to human OX40 (SEQ ID NO:54) with high affinity and
agonistic activity. In an embodiment, the OX40 agonist is a binding
molecule that binds to human OX40 (SEQ ID NO:54). In an embodiment,
the OX40 agonist is a binding molecule that binds to murine OX40
(SEQ ID NO:55). The amino acid sequences of OX40 antigen to which
an OX40 agonist or binding molecule binds are summarized in Table
12.
TABLE-US-00012 TABLE 12 Amino acid sequences of OX40 antigens.
Identifier Sequence (One-Letter Amino Acid Symbols) SEQ ID NO: 54
MCVGARRLGR GPCAALLLLG LGLSTVTGLH CVGDTYPSND RCCHECRPGN GMVSRCSRSQ
60 human OX40 NTVCRPCGPG FYNDVVSSXP CKPCTWCNLR SGSERKQLCT
ATQDTVCRCR AGTQPLDSYK 120 (Homo sapiens) PGVDCAPCPP GHFSPGDNQA
CKPWTNCTLA GKHTLQPASN SSDAICEDRD PPATQPQETQ 180 GPPARPITVQ
PTEAWPRTSQ GPSTRPVEVP GGRAVAAILG LGLVLGLLGP LAILLALYLL 240
RRDQRLPPDA HKPPGGGSFR TPIQEEQADA HSTLAKI 277 SEQ ID NO: 55
MYVWVQQPTA LLLLGLTLGV TARRLNCVKH TYPSGHKCCR ECQPGHGMVS RCDHTRDTLC
60 murine OX40 HPCETGFYNE AVNYDTCKQC TQCNHRSGSE LKQNCTPTQD
TVCRCRPGTQ PRQDSGYKLG 120 (Mus musculus) VDCVPCPPGH FSPGNNQACK
PWTNCTLSGK QTRHPASDSL DAVCEDRSLL ATLLWETQRP 180 TFRPTTVQST
TVWPRTSELP SPPTLVTPEG PAFAVLLGLG LGLLAPLTVL LALYLLRKAW 240
RLPNTPKPCW GNSFRTPIQE EHTDAHFTLA KI 272
[0521] In some embodiments, the compositions, processes and methods
described include a OX40 agonist that binds human or murine OX40
with a K.sub.D of about 100 pM or lower, binds human or murine OX40
with a K.sub.D of about 90 pM or lower, binds human or murine OX40
with a K.sub.D of about 80 pM or lower, binds human or murine OX40
with a K.sub.D of about 70 pM or lower, binds human or murine OX40
with a K.sub.D of about 60 pM or lower, binds human or murine OX40
with a K.sub.D of about 50 pM or lower, binds human or murine OX40
with a K.sub.D of about 40 pM or lower, or binds human or murine
OX40 with a K.sub.D of about 30 pM or lower.
[0522] In some embodiments, the compositions, processes and methods
described include a OX40 agonist that binds to human or murine OX40
with a k.sub.assoc of about 7.5.times.10.sup.5 1/Ms or faster,
binds to human or murine OX40 with a k.sub.assoc of about
7.5.times.10.sup.5 1/Ms or faster, binds to human or murine OX40
with a k.sub.assoc of about 8.times.10.sup.5 1/Ms or faster, binds
to human or murine OX40 with a k.sub.assoc of about
8.5.times.10.sup.5 1/Ms or faster, binds to human or murine OX40
with a k.sub.assoc of about 9.times.10.sup.5 1/Ms or faster, binds
to human or murine OX40 with a k.sub.assoc of about
9.5.times.10.sup.5 1/Ms or faster, or binds to human or murine OX40
with a k.sub.assoc of about 1.times.10.sup.6 1/Ms or faster.
[0523] In some embodiments, the compositions, processes and methods
described include a OX40 agonist that binds to human or murine OX40
with a k.sub.dissoc of about 2.times.10.sup.-5 1/s or slower, binds
to human or murine OX40 with a k.sub.dissoc of about
2.1.times.10.sup.-5 1/s or slower, binds to human or murine OX40
with a k.sub.dissoc of about 2.2.times.10.sup.-5 1/s or slower,
binds to human or murine OX40 with a k.sub.dissoc of about
2.3.times.10.sup.-5 1/s or slower, binds to human or murine OX40
with a k.sub.dissoc of about 2.4.times.10.sup.-5 1/s or slower,
binds to human or murine OX40 with a k.sub.dissoc of about
2.5.times.10.sup.-5 1/s or slower, binds to human or murine OX40
with a k.sub.dissoc of about 2.6.times.10.sup.-5 1/s or slower or
binds to human or murine OX40 with a k.sub.dissoc of about
2.7.times.10.sup.-5 1/s or slower, binds to human or murine OX40
with a k.sub.dissoc of about 2.8.times.10.sup.-5 1/s or slower,
binds to human or murine OX40 with a k.sub.dissoc of about
2.9.times.10.sup.-5 1/s or slower, or binds to human or murine OX40
with a k.sub.dissoc of about 3.times.10.sup.-5 1/s or slower.
[0524] In some embodiments, the compositions, processes and methods
described include OX40 agonist that binds to human or murine OX40
with an IC.sub.50 of about 10 nM or lower, binds to human or murine
OX40 with an IC.sub.50 of about 9 nM or lower, binds to human or
murine OX40 with an IC.sub.50 of about 8 nM or lower, binds to
human or murine OX40 with an IC.sub.50 of about 7 nM or lower,
binds to human or murine OX40 with an IC.sub.50 of about 6 nM or
lower, binds to human or murine OX40 with an IC.sub.50 of about 5
nM or lower, binds to human or murine OX40 with an IC.sub.50 of
about 4 nM or lower, binds to human or murine OX40 with an
IC.sub.50 of about 3 nM or lower, binds to human or murine OX40
with an IC.sub.50 of about 2 nM or lower, or binds to human or
murine OX40 with an IC.sub.50 of about 1 nM or lower.
[0525] In some embodiments, the OX40 agonist is tavolixizumab, also
known as MEDI0562 or MEDI-0562. Tavolixizumab is available from the
MedImmune subsidiary of AstraZeneca, Inc. Tavolixizumab is
immunoglobulin G1-kappa, anti-[Homo sapiens TNFRSF4 (tumor necrosis
factor receptor (TNFR) superfamily member 4, OX40, CD134)],
humanized and chimeric monoclonal antibody. The amino acid
sequences of tavolixizumab are set forth in Table 13. Tavolixizumab
comprises N-glycosylation sites at positions 301 and 301'', with
fucosylated complex bi-antennary CHO-type glycans; heavy chain
intrachain disulfide bridges at positions 22-95 (V.sub.H-V.sub.L),
148-204 (C.sub.H1-C.sub.L), 265-325 (C.sub.H2) and 371-429
(C.sub.H3) (and at positions 22''-95'', 148''-204'', 265''-325'',
and 371''-429''); light chain intrachain disulfide bridges at
positions 23'-88' (V.sub.H-V.sub.L) and 134'-194'
(C.sub.H1-C.sub.L) (and at positions 23'''-88''' and
134'''-194'''); interchain heavy chain-heavy chain disulfide
bridges at positions 230-230'' and 233-233''; and interchain heavy
chain-light chain disulfide bridges at 224-214' and 224''-214'''.
Current clinical trials of tavolixizumab in a variety of solid
tumor indications include U.S. National Institutes of Health
clinicaltrials.gov identifiers NCT02318394 and NCT02705482.
[0526] In an embodiment, a OX40 agonist comprises a heavy chain
given by SEQ ID NO:56 and a light chain given by SEQ ID NO:57. In
an embodiment, a OX40 agonist comprises heavy and light chains
having the sequences shown in SEQ ID NO:56 and SEQ ID NO:57,
respectively, or antigen binding fragments, Fab fragments,
single-chain variable fragments (scFv), variants, or conjugates
thereof. In an embodiment, a OX40 agonist comprises heavy and light
chains that are each at least 99% identical to the sequences shown
in SEQ ID NO:56 and SEQ ID NO:57, respectively. In an embodiment, a
OX40 agonist comprises heavy and light chains that are each at
least 98% identical to the sequences shown in SEQ ID NO:56 and SEQ
ID NO:57, respectively. In an embodiment, a OX40 agonist comprises
heavy and light chains that are each at least 97% identical to the
sequences shown in SEQ ID NO:56 and SEQ ID NO:57, respectively. In
an embodiment, a OX40 agonist comprises heavy and light chains that
are each at least 96% identical to the sequences shown in SEQ ID
NO:56 and SEQ ID NO:57, respectively. In an embodiment, a OX40
agonist comprises heavy and light chains that are each at least 95%
identical to the sequences shown in SEQ ID NO:56 and SEQ ID NO:57,
respectively.
[0527] In an embodiment, the OX40 agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of tavolixizumab. In an
embodiment, the OX40 agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:58, and the OX40 agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:59, and conservative amino acid substitutions thereof.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:58 and SEQ ID NO:59, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 98% identical to the sequences shown in SEQ ID NO:58 and SEQ
ID NO:59, respectively. In an embodiment, a OX40 agonist comprises
V.sub.H and V.sub.L regions that are each at least 97% identical to
the sequences shown in SEQ ID NO:58 and SEQ ID NO:59, respectively.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 96% identical to the sequences shown
in SEQ ID NO:58 and SEQ ID NO:59, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 95% identical to the sequences shown in SEQ ID NO:58 and SEQ
ID NO:59, respectively. In an embodiment, an OX40 agonist comprises
an scFv antibody comprising V.sub.H and V.sub.L regions that are
each at least 99% identical to the sequences shown in SEQ ID NO:58
and SEQ ID NO:59.
[0528] In an embodiment, a OX40 agonist comprises heavy chain CDR1,
CDR2 and CDR3 domains having the sequences set forth in SEQ ID
NO:60, SEQ ID NO:61, and SEQ ID NO:62, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:63, SEQ ID NO:64, and SEQ ID NO:65, respectively, and
conservative amino acid substitutions thereof.
[0529] In an embodiment, the OX40 agonist is a OX40 agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to tavolixizumab. In an embodiment, the
biosimilar monoclonal antibody comprises an OX40 antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
tavolixizumab. In some embodiments, the one or more
post-translational modifications are selected from one or more of:
glycosylation, oxidation, deamidation, and truncation. In some
embodiments, the biosimilar is a OX40 agonist antibody authorized
or submitted for authorization, wherein the OX40 agonist antibody
is provided in a formulation which differs from the formulations of
a reference medicinal product or reference biological product,
wherein the reference medicinal product or reference biological
product is tavolixizumab. The OX40 agonist antibody may be
authorized by a drug regulatory authority such as the U.S. FDA
and/or the European Union's EMA. In some embodiments, the
biosimilar is provided as a composition which further comprises one
or more excipients, wherein the one or more excipients are the same
or different to the excipients comprised in a reference medicinal
product or reference biological product, wherein the reference
medicinal product or reference biological product is tavolixizumab.
In some embodiments, the biosimilar is provided as a composition
which further comprises one or more excipients, wherein the one or
more excipients are the same or different to the excipients
comprised in a reference medicinal product or reference biological
product, wherein the reference medicinal product or reference
biological product is tavolixizumab.
TABLE-US-00013 TABLE 13 Amino acid sequences for OX40 agonist
antibodies related to tavolixizumab. Identifier Sequence
(One-Letter Amino Acid Symbols) SEQ ID NO: 56 QVQLQESGPG LVKPSQTLSL
TCAVYGGSFS SGYWNWIRKH PGKGLEYIGY ISYNGITYHN 60 heavy chain for
PSLKSRITIN RDTSKNQYSL QLNSVTPEDT AVYYCARYKY DYDGGHAMDY WGQGTLVTVS
120 tavolixizumab SASTKGPSVF PLAPSSKSTS GGTAALGCLV KDYFPEPVTV
SWNSGALTSG VHTFPAVLQS 180 SGLYSLSSVV TVPSSSLGTQ TYICNVNHKP
SNTKVDKRVE PKSCDKTHTC PPCPAPELLG 240 GPSVFLFPPK PKDTLMISRT
PEVTCVVVDV SHEDPEVKFN WYVDGVEVHN AKTKPREEQY 300 NSTYRVVSVL
TVLHQDWLNG KEYKCKVSNK ALPAPIEKTI SKAKGQPREP QVYTLPPSRE 360
EMTKNQVSLT CLVKGFYPSD IAVEWESNGQ PENNYKTTPP VLDSDGSFFL YSKLTVDKSR
420 WQQGNVFSCS VMHEALHNHY TQKSLSLSPG K 451 SEQ ID NO: 57 DIQMTQSPSS
LSASVGDRVT ITCRASQDIS NYLNWYQQKP GKAPKLLIYY TSKLHSGVPS 60 light
chain for RFSGSGSGTD YTLTISSLQP EDFATYYCQQ GSALPWTFGQ GTKVEIKRTV
AAPSVFIFPP 120 tavolixizumab SDEQLKSGTA SVVCLLNNFY PREAKVQWKV
DNALQSGNSQ ESVTEQDSKD STYSLSSTLT 180 LSKADYEKHK VYACEVTHQG
LSSPVTKSFN RGEC 214 SEQ ID NO: 58 QVQLQESGPG LVKPSQTLSL TCAVYGGSFS
SGYWNWIRKH PGKGLEYIGY ISYNGITYHN 60 heavy chain PSLKSRITIN
RDTSKNQYSL QLNSVTPEDT AVYYCARYKY DYDGGHAMDY WGQGTLVT 118 variable
region for tavolixizumab SEQ ID NO: 59 DIQMTQSPSS LSASVGDRVT
ITCRASQDIS NYLNWYQQKP GKAPELLIYY TSKLHSGVPS 60 light chain
RFSGSGSGTD YTLTISSLQP EDFATYYCQQ GSALPWTFGQ GTKVEIKR 108 variable
region for tavolixizumab SEQ ID NO: 60 GSFSSGYWN 9 heavy chain CDR1
for tavolixizumab SEQ ID NO: 61 YIGYISYNGI TYH 13 heavy chain CDR2
for tavolixizumab SEQ ID NO: 62 RYKYDYDGGH AMDY 14 heavy chain CDR3
for tavolixizumab SEQ ID NO: 63 QDISNYLN 8 light chain CDR1 for
tavolixizumab SEQ ID NO: 64 LLIYYTSKLH S 11 light chain CDR2 for
tavolixizumab SEQ ID NO: 65 QQGSALPW 8 light chain CDR3 for
tavolixizumab
[0530] In some embodiments, the OX40 agonist is 11D4, which is a
fully human antibody available from Pfizer, Inc. The preparation
and properties of 11D4 are described in U.S. Pat. Nos. 7,960,515;
8,236,930; and 9,028,824, the disclosures of which are incorporated
by reference herein. The amino acid sequences of 11D4 are set forth
in Table 14.
[0531] In an embodiment, a OX40 agonist comprises a heavy chain
given by SEQ ID NO:66 and a light chain given by SEQ ID NO:67. In
an embodiment, a OX40 agonist comprises heavy and light chains
having the sequences shown in SEQ ID NO:66 and SEQ ID NO:67,
respectively, or antigen binding fragments, Fab fragments,
single-chain variable fragments (scFv), variants, or conjugates
thereof. In an embodiment, a OX40 agonist comprises heavy and light
chains that are each at least 99% identical to the sequences shown
in SEQ ID NO:66 and SEQ ID NO:67, respectively. In an embodiment, a
OX40 agonist comprises heavy and light chains that are each at
least 98% identical to the sequences shown in SEQ ID NO:66 and SEQ
ID NO:67, respectively. In an embodiment, a OX40 agonist comprises
heavy and light chains that are each at least 97% identical to the
sequences shown in SEQ ID NO:66 and SEQ ID NO:67, respectively. In
an embodiment, a OX40 agonist comprises heavy and light chains that
are each at least 96% identical to the sequences shown in SEQ ID
NO:66 and SEQ ID NO:67, respectively. In an embodiment, a OX40
agonist comprises heavy and light chains that are each at least 95%
identical to the sequences shown in SEQ ID NO:66 and SEQ ID NO:67,
respectively.
[0532] In an embodiment, the OX40 agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of 11D4. In an
embodiment, the OX40 agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:68, and the OX40 agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:69, and conservative amino acid substitutions thereof.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:68 and SEQ ID NO:69, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 98% identical to the sequences shown in SEQ ID NO:68 and SEQ
ID NO:69, respectively. In an embodiment, a OX40 agonist comprises
V.sub.H and V.sub.L regions that are each at least 97% identical to
the sequences shown in SEQ ID NO:68 and SEQ ID NO:69, respectively.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 96% identical to the sequences shown
in SEQ ID NO:68 and SEQ ID NO:69, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 95% identical to the sequences shown in SEQ ID NO:68 and SEQ
ID NO:69, respectively.
[0533] In an embodiment, a OX40 agonist comprises heavy chain CDR1,
CDR2 and CDR3 domains having the sequences set forth in SEQ ID
NO:70, SEQ ID NO:71, and SEQ ID NO:72, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:73, SEQ ID NO:74, and SEQ ID NO:75, respectively, and
conservative amino acid substitutions thereof.
[0534] In an embodiment, the OX40 agonist is a OX40 agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to 11D4. In an embodiment, the
biosimilar monoclonal antibody comprises an OX40 antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
11D4. In some embodiments, the one or more post-translational
modifications are selected from one or more of: glycosylation,
oxidation, deamidation, and truncation. In some embodiments, the
biosimilar is a OX40 agonist antibody authorized or submitted for
authorization, wherein the OX40 agonist antibody is provided in a
formulation which differs from the formulations of a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
11D4. The OX40 agonist antibody may be authorized by a drug
regulatory authority such as the U.S. FDA and/or the European
Union's EMA. In some embodiments, the biosimilar is provided as a
composition which further comprises one or more excipients, wherein
the one or more excipients are the same or different to the
excipients comprised in a reference medicinal product or reference
biological product, wherein the reference medicinal product or
reference biological product is 11D4. In some embodiments, the
biosimilar is provided as a composition which further comprises one
or more excipients, wherein the one or more excipients are the same
or different to the excipients comprised in a reference medicinal
product or reference biological product, wherein the reference
medicinal product or reference biological product is 11D4.
TABLE-US-00014 TABLE 14 Amino acid sequences for OX40 agonist
antibodies related to 11D4. Identifier Sequence (One-Letter Amino
Acid Symbols) SEQ ID NO: 66 EVQLVESGGG LVQPGGSLRL SCAASGFTFS
SYSMNWVRQA PGKGLEWVSY ISSSSSTIDY 60 heavy chain for ADSVKGRFTI
SRDNAKNSLY LQMNSLRDED TAVYYCARES GWYLFDYWGQ GTLVTVSSAS 120 11D4
TKGPSVFPLA PCSRSTSEST AALGCLVKDY FPEPVTVSWN SGALTSGVHT FPAVLQSSGL
180 YSLSSVVTVP SSNFGTQTYT CNVDHKPSNT KVDKTVERKC CVECPPCPAP
PVAGPSVFLF 240 PPKPKDTLMI SRTPEVTCVV VDVSHEDPEV QFNWYVDGVE
VHNAKTKPRE EQFNSTFRVV 300 SVLTVVHQDW LNGKEYKCKV SNKGLPAPIE
KTISKTKGQP REPQVYTLPP SREEMTKNQV 360 SLTCLVKGFY PSDIAVEWES
NGQPENNYKT TPPMLDSDGS FFLYSKLTVD KSRWQQGNVF 420 SCSVMHEALH
NHYTQKSLSL SPGK 444 SEQ ID NO: 67 DIQMTQSPSS LSASVGDRVT ITCRASQGIS
SWLAWYQQKP EKAPKSLIYA ASSLQSGVPS 60 light chain for RFSGSGSGTD
FTLTISSLQP EDFATYYCQQ YNSYPPTFGG GTKVEIKRTV AAPSVFIFPP 120 11D4
SDEQLKSGTA SVVCLLNNFY PREAKVQWKV DNALQSGNSQ ESVTEQDSKD STYSLSSTLT
180 LSKADYEKHK VYACEVTHQG LSSPVTKSFN RGEC 214 SEQ ID NO: 68
EVQLVESGGG LVQPGGSLRL SCAASGFTFS SYSMNWVRQA PGKGLEWVSY ISSSSSTIDY
60 heavy chain ADSVKGRFTI SRDNAKNSLY LQMNSLRDED TAVYYCARES
GWYLFDYWGQ GTLVTVSS 118 variable region for 11D4 SEQ ID NO: 69
DIQMTQSPSS LSASVGDRVT ITCRASQGIS SWLAWYQQKP EKAPKSLIYA ASSLQSGVPS
60 light chain RFSGSGSGTD FTLTISSLQP EDFATYYCQQ YNSYPPTFGG GTKVEIK
107 variable region for 11D4 SEQ ID NO: 70 SYSMN 5 heavy chain CDR1
for 11D4 SEQ ID NO: 71 YISSSSSTID YADSVKG 17 heavy chain CDR2 for
11D4 SEQ ID NO: 72 ESGWYLFDY 9 heavy chain CDR3 for 11D4 SEQ ID NO:
73 RASQGISSWL A 11 light chain CDR1 for 11D4 SEQ ID NO: 74 AASSLQS
7 light chain CDR2 for 11D4 SEQ ID NO: 75 QQYNSYPPT 9 light chain
CDR3 for 11D4
[0535] In some embodiments, the OX40 agonist is 18D8, which is a
fully human antibody available from Pfizer, Inc. The preparation
and properties of 18D8 are described in U.S. Pat. Nos. 7,960,515;
8,236,930; and 9,028,824, the disclosures of which are incorporated
by reference herein. The amino acid sequences of 18D8 are set forth
in Table 15.
[0536] In an embodiment, a OX40 agonist comprises a heavy chain
given by SEQ ID NO:76 and a light chain given by SEQ ID NO:77. In
an embodiment, a OX40 agonist comprises heavy and light chains
having the sequences shown in SEQ ID NO:76 and SEQ ID NO:77,
respectively, or antigen binding fragments, Fab fragments,
single-chain variable fragments (scFv), variants, or conjugates
thereof. In an embodiment, a OX40 agonist comprises heavy and light
chains that are each at least 99% identical to the sequences shown
in SEQ ID NO:76 and SEQ ID NO:77, respectively. In an embodiment, a
OX40 agonist comprises heavy and light chains that are each at
least 98% identical to the sequences shown in SEQ ID NO:76 and SEQ
ID NO:77, respectively. In an embodiment, a OX40 agonist comprises
heavy and light chains that are each at least 97% identical to the
sequences shown in SEQ ID NO:76 and SEQ ID NO:77, respectively. In
an embodiment, a OX40 agonist comprises heavy and light chains that
are each at least 96% identical to the sequences shown in SEQ ID
NO:76 and SEQ ID NO:77, respectively. In an embodiment, a OX40
agonist comprises heavy and light chains that are each at least 95%
identical to the sequences shown in SEQ ID NO:76 and SEQ ID NO:77,
respectively.
[0537] In an embodiment, the OX40 agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of 18D8. In an
embodiment, the OX40 agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:78, and the OX40 agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:79, and conservative amino acid substitutions thereof.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:78 and SEQ ID NO:79, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 98% identical to the sequences shown in SEQ ID NO:78 and SEQ
ID NO:79, respectively. In an embodiment, a OX40 agonist comprises
V.sub.H and V.sub.L regions that are each at least 97% identical to
the sequences shown in SEQ ID NO:78 and SEQ ID NO:79, respectively.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 96% identical to the sequences shown
in SEQ ID NO:78 and SEQ ID NO:79, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 95% identical to the sequences shown in SEQ ID NO:78 and SEQ
ID NO:79, respectively.
[0538] In an embodiment, a OX40 agonist comprises heavy chain CDR1,
CDR2 and CDR3 domains having the sequences set forth in SEQ ID
NO:80, SEQ ID NO:81, and SEQ ID NO:82, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:83, SEQ ID NO:84, and SEQ ID NO:85, respectively, and
conservative amino acid substitutions thereof.
[0539] In an embodiment, the OX40 agonist is a OX40 agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to 18D8. In an embodiment, the
biosimilar monoclonal antibody comprises an OX40 antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
18D8. In some embodiments, the one or more post-translational
modifications are selected from one or more of glycosylation,
oxidation, deamidation, and truncation. In some embodiments, the
biosimilar is a OX40 agonist antibody authorized or submitted for
authorization, wherein the OX40 agonist antibody is provided in a
formulation which differs from the formulations of a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
18D8. The OX40 agonist antibody may be authorized by a drug
regulatory authority such as the U.S. FDA and/or the European
Union's EMA. In some embodiments, the biosimilar is provided as a
composition which further comprises one or more excipients, wherein
the one or more excipients are the same or different to the
excipients comprised in a reference medicinal product or reference
biological product, wherein the reference medicinal product or
reference biological product is 18D8. In some embodiments, the
biosimilar is provided as a composition which further comprises one
or more excipients, wherein the one or more excipients are the same
or different to the excipients comprised in a reference medicinal
product or reference biological product, wherein the reference
medicinal product or reference biological product is 18D8.
TABLE-US-00015 TABLE 15 Amino acid sequences for OX40 agonist
antibodies related to 18D8. Identifier Sequence (One-Letter Amino
Acid Symbols) SEQ ID NO: 76 EVQLVESGGG LVQPGRSLRL SCAASGFTFD
DYAMHWVRQA PGKGLEWVSG ISWNSGSIGY 60 heavy chain for ADSVKGRFTI
SRDNAKNSLY LQMNSLRAED TALYYCAKDQ STADYYFYYG MDVWGQGTTV 120 18D8
TVSSASTKGP SVFPLAPCSR STSESTAALG CLVKDYFPEP VTVSWNSGAL TSGVHTFPAV
180 LQSSGLYSLS SVVTVPSSNF GTQTYTCNVD HKPSNTKVDK TVERKCCVEC
PPCPAPPVAG 240 PSVFLFPPKP KDTLMISRTP EVTCVVVDVS HEDPEVQFNW
YVDGVEVHNA KTKPREEQFN 300 STFRVVSVLT VVHQDWLNGK EYKCKVSNKG
LPAPIEKTIS KTKGQPREPQ VYTLPPSREE 360 MTKNQVSLTC LVKGFYPSDI
AVEWESNGQP ENNYKTTPPM LDSDGSFFLY SKLTVDKSRW 420 QQGNVFSCSV
MHEALHNHYT QKSLSLSPGK 450 SEQ ID NO: 77 EIVVTQSPAT LSLSPGERAT
LSCRASQSVS SYLAWYQQKP GQAPRLLIYD ASNRATGIPA 60 light chain for
RFSGSGSGTD FTLTISSLEP EDFAVYYCQQ RSNWPTFGQG TKVEIKRTVA APSVFIFPPS
120 18D8 DEQLKSGTAS VVCLLNNFYP REAKVQWKVD NALQSGNSQE SVTEQDSKDS
TYSLSSTLTL 180 SKADYEKHKV YACEVTHQGL SSPVTKSFNR GEC 213 SEQ ID NO:
78 EVQLVESGGG LVQPGRSLRL SCAASGFTFD DYAMHWVRQA PGKGLEWVSG
ISWNSGSIGY 60 heavy chain ADSVKGRFTI SRDNAKNSLY LQMNSLRAED
TALTYCAKDQ STADYYFYYG MDVWGQGTTV 120 variable region TVSS 124 for
18D8 SEQ ID NO: 79 EIVVTQSPAT LSLSPGERAT LSCRASQSVS SYLAWYQQKP
GQAPRLLIYD ASNRATGIPA 60 light chain RFSGSGSGTD FTLTISSLEP
EDFAVYYCQQ RSNWPTFGQG YKVEIK 106 variable region for 18D8 SEQ ID
NO: 80 DYAMH 5 heavy chain CDR1 for 18D8 SEQ ID NO: 81 GISWNSGSIG
YADSVKG 17 heavy chain CDR2 for 18D8 SEQ ID NO: 82 DQSTADYYFY YGMDV
15 heavy chain CDR3 for 18D8 SEQ ID NO: 83 RASQSVSSYL A 11 light
chain CDR1 for 18D8 SEQ ID NO: 84 DASNRAT 7 light chain CDR2 for
18D8 SEQ ID NO: 85 QQRSNWPT 8 light chain CDR3 for 18D8
[0540] In some embodiments, the OX40 agonist is Hu119-122, which is
a humanized antibody available from GlaxoSmithKline plc. The
preparation and properties of Hu119-122 are described in U.S. Pat.
Nos. 9,006,399 and 9,163,085, and in International Patent
Publication No. WO 2012/027328, the disclosures of which are
incorporated by reference herein. The amino acid sequences of
Hu119-122 are set forth in Table 16.
[0541] In an embodiment, the OX40 agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of Hu119-122. In an
embodiment, the OX40 agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:86, and the OX40 agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:87, and conservative amino acid substitutions thereof.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:86 and SEQ ID NO:87, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 98% identical to the sequences shown in SEQ ID NO:86 and SEQ
ID NO:87, respectively. In an embodiment, a OX40 agonist comprises
V.sub.H and V.sub.L regions that are each at least 97% identical to
the sequences shown in SEQ ID NO:86 and SEQ ID NO:87, respectively.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 96% identical to the sequences shown
in SEQ ID NO:86 and SEQ ID NO:87, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 95% identical to the sequences shown in SEQ ID NO:86 and SEQ
ID NO:87, respectively.
[0542] In an embodiment, a OX40 agonist comprises heavy chain CDR1,
CDR2 and CDR3 domains having the sequences set forth in SEQ ID
NO:88, SEQ ID NO:89, and SEQ ID NO:90, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:91, SEQ ID NO:92, and SEQ ID NO:93, respectively, and
conservative amino acid substitutions thereof.
[0543] In an embodiment, the OX40 agonist is a OX40 agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to Hu119-122. In an embodiment, the
biosimilar monoclonal antibody comprises an OX40 antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
Hu119-122. In some embodiments, the one or more post-translational
modifications are selected from one or more of: glycosylation,
oxidation, deamidation, and truncation. In some embodiments, the
biosimilar is a OX40 agonist antibody authorized or submitted for
authorization, wherein the OX40 agonist antibody is provided in a
formulation which differs from the formulations of a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
Hu119-122. The OX40 agonist antibody may be authorized by a drug
regulatory authority such as the U.S. FDA and/or the European
Union's EMA. In some embodiments, the biosimilar is provided as a
composition which further comprises one or more excipients, wherein
the one or more excipients are the same or different to the
excipients comprised in a reference medicinal product or reference
biological product, wherein the reference medicinal product or
reference biological product is Hu119-122. In some embodiments, the
biosimilar is provided as a composition which further comprises one
or more excipients, wherein the one or more excipients are the same
or different to the excipients comprised in a reference medicinal
product or reference biological product, wherein the reference
medicinal product or reference biological product is Hu119-122.
TABLE-US-00016 TABLE 16 Amino acid sequences for OX40 agonist
antibodies related to Hu119-122. Identifier Sequence (One-Letter
Amino Acid Symbols) SEQ ID NO: 86 EVQLVESGGG LVQPGGSLRL SCAASEYEFP
SHDMSWVRQA PGKGLELVAA INSDGGSTYY 60 heavy chain PDTMERRFTI
SRDNAKNSLY LQMNSLRAED TAVYYCARHY DDYYAWFAYW GQGTMVTVSS 120 variable
region for Hu119-122 SEQ ID NO: 87 EIVLTQSPAT LSLSPGERAT LSCRASKSVS
TSGYSYMHWY QQKPGQAPRL LIYLASNLES 60 light chain GVPARFSGSG
SGTDFTLTIS SLEPEDFAVY YCQHSRELPL TFGGGTKVEI K 111 variable region
for Hu119-122 SEQ ID NO: 88 SHDMS 5 heavy chain CDR1 for Hu119-122
SEQ ID NO: 89 AINSDGGSTY YPDTMER 17 heavy chain CDR2 for Hu119-122
SEQ ID NO: 90 HYDDYYAWFA Y 11 heavy chain CDR3 for Hu119-122 SEQ ID
NO: 91 RASKSVSTSG YSYMH 15 light chain CDR1 for Hu119-122 SEQ ID
NO: 92 LASNLES 7 light chain CDR2 for Hu119-122 SEQ ID NO: 93
QHSRELPLT 9 light chain CDR3 for Hu119-122
[0544] In some embodiments, the OX40 agonist is Hu106-222, which is
a humanized antibody available from GlaxoSmithKline PLC. The
preparation and properties of Hu106-222 are described in U.S. Pat.
Nos. 9,006,399 and 9,163,085, and in International Patent
Publication No. WO 2012/027328, the disclosures of which are
incorporated by reference herein. The amino acid sequences of
Hu106-222 are set forth in Table 17.
[0545] In an embodiment, the OX40 agonist comprises the heavy and
light chain CDRs or variable regions (VRs) of Hu106-222. In an
embodiment, the OX40 agonist heavy chain variable region (V.sub.H)
comprises the sequence shown in SEQ ID NO:94, and the OX40 agonist
light chain variable region (V.sub.L) comprises the sequence shown
in SEQ ID NO:95, and conservative amino acid substitutions thereof.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 99% identical to the sequences shown
in SEQ ID NO:94 and SEQ ID NO:95, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 98% identical to the sequences shown in SEQ ID NO:94 and SEQ
ID NO:95, respectively. In an embodiment, a OX40 agonist comprises
V.sub.H and V.sub.L regions that are each at least 97% identical to
the sequences shown in SEQ ID NO:94 and SEQ ID NO:95, respectively.
In an embodiment, a OX40 agonist comprises V.sub.H and V.sub.L
regions that are each at least 96% identical to the sequences shown
in SEQ ID NO:94 and SEQ ID NO:95, respectively. In an embodiment, a
OX40 agonist comprises V.sub.H and V.sub.L regions that are each at
least 95% identical to the sequences shown in SEQ ID NO:94 and SEQ
ID NO:95, respectively.
[0546] In an embodiment, a OX40 agonist comprises heavy chain CDR1,
CDR2 and CDR3 domains having the sequences set forth in SEQ ID
NO:96, SEQ ID NO:97, and SEQ ID NO:98, respectively, and
conservative amino acid substitutions thereof, and light chain
CDR1, CDR2 and CDR3 domains having the sequences set forth in SEQ
ID NO:99, SEQ ID NO:100, and SEQ ID NO:101, respectively, and
conservative amino acid substitutions thereof.
[0547] In an embodiment, the OX40 agonist is a OX40 agonist
biosimilar monoclonal antibody approved by drug regulatory
authorities with reference to Hu106-222. In an embodiment, the
biosimilar monoclonal antibody comprises an OX40 antibody
comprising an amino acid sequence which has at least 97% sequence
identity, e.g., 97%, 98%, 99% or 100% sequence identity, to the
amino acid sequence of a reference medicinal product or reference
biological product and which comprises one or more
post-translational modifications as compared to the reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
Hu106-222. In some embodiments, the one or more post-translational
modifications are selected from one or more of: glycosylation,
oxidation, deamidation, and truncation. In some embodiments, the
biosimilar is a OX40 agonist antibody authorized or submitted for
authorization, wherein the OX40 agonist antibody is provided in a
formulation which differs from the formulations of a reference
medicinal product or reference biological product, wherein the
reference medicinal product or reference biological product is
Hu106-222. The OX40 agonist antibody may be authorized by a drug
regulatory authority such as the U.S. FDA and/or the European
Union's EMA. In some embodiments, the biosimilar is provided as a
composition which further comprises one or more excipients, wherein
the one or more excipients are the same or different to the
excipients comprised in a reference medicinal product or reference
biological product, wherein the reference medicinal product or
reference biological product is Hu106-222. In some embodiments, the
biosimilar is provided as a composition which further comprises one
or more excipients, wherein the one or more excipients are the same
or different to the excipients comprised in a reference medicinal
product or reference biological product, wherein the reference
medicinal product or reference biological product is Hu106-222.
TABLE-US-00017 TABLE 17 Amino acid sequences for OX40 agonist
antibodies related to Hu106-222. Identifier Sequence (One-Letter
Amino Acid Symbols) SEQ ID NO: 94 QVQLVQSGSE LKKPGASVKV SCKASGYTFT
DYSMHWVRQA PGQGLKWMGW INTETGEPTY 60 heavy chain ADDFKGRFVF
SLDTSVSTAY LQISSLKAED TAVYYCANPY YDYVSYYAMD YWGQGTTVTV 120 variable
region SS 122 for Hu106-222 SEQ ID NO: 95 DIQMTQSPSS LSASVGDRVT
ITCKASQDVS TAVAWYQQKP GKAPKLLIYS ASYLYTGVPS 60 light chain
RFSGSGSGTD FTFTISSLQP EDIATYYCQQ HYSTPRTFGQ GTKLEIK 107 variable
region for Hu106-222 SEQ ID NO: 96 DYSMH 5 heavy chain CDR1 for
Hu106-222 SEQ ID NO: 97 WINTETGEPT YADDFKG 17 heavy chain CDR2 for
Hu106-222 SEQ ID NO: 98 PYYDYVSYYA MDY 13 heavy chain CDR3 for
Hu106-222 SEQ ID NO: 99 KASQDVSTAV A 11 light chain CDR1 for
Hu106-222 SEQ ID NO: 100 SASYLYT 7 light chain CDR2 for Hu106-222
SEQ ID NO: 101 QQHYSTPRT 9 light chain CDR3 for Hu106-222
[0548] In some embodiments, the OX40 agonist antibody is MEDI6469
(also referred to as 9B12). MEDI6469 is a murine monoclonal
antibody. Weinberg, et al., J. Immunother. 2006, 29, 575-585. In
some embodiments the OX40 agonist is an antibody produced by the
9B12 hybridoma, deposited with Biovest Inc. (Malvern, Mass., USA),
as described in Weinberg, et al., J. Immunother. 2006, 29, 575-585,
the disclosure of which is hereby incorporated by reference in its
entirety. In some embodiments, the antibody comprises the CDR
sequences of MEDI6469. In some embodiments, the antibody comprises
a heavy chain variable region sequence and/or a light chain
variable region sequence of MEDI6469.
[0549] In an embodiment, the OX40 agonist is L106 BD (Pharmingen
Product #340420). In some embodiments, the OX40 agonist comprises
the CDRs of antibody L106 (BD Pharmingen Product #340420). In some
embodiments, the OX40 agonist comprises a heavy chain variable
region sequence and/or a light chain variable region sequence of
antibody L106 (BD Pharmingen Product #340420). In an embodiment,
the OX40 agonist is ACT35 (Santa Cruz Biotechnology, Catalog
#20073). In some embodiments, the OX40 agonist comprises the CDRs
of antibody ACT35 (Santa Cruz Biotechnology, Catalog #20073). In
some embodiments, the OX40 agonist comprises a heavy chain variable
region sequence and/or a light chain variable region sequence of
antibody ACT35 (Santa Cruz Biotechnology, Catalog #20073). In an
embodiment, the OX40 agonist is the murine monoclonal antibody
anti-mCD134/mOX40 (clone OX86), commercially available from
InVivoMAb, BioXcell Inc, West Lebanon, N.H.
[0550] In an embodiment, the OX40 agonist is selected from the OX40
agonists described in International Patent Application Publication
Nos. WO 95/12673, WO 95/21925, WO 2006/121810, WO 2012/027328, WO
2013/028231, WO 2013/038191, and WO 2014/148895; European Patent
Application EP 0672141; U.S. Patent Application Publication Nos. US
2010/136030, US 2014/377284, US 2015/190506, and US 2015/132288
(including clones 20E5 and 12H3); and U.S. Pat. Nos. 7,504,101,
7,550,140, 7,622,444, 7,696,175, 7,960,515, 7,961,515, 8,133,983,
9,006,399, and 9,163,085, the disclosure of each of which is
incorporated herein by reference in its entirety for all purposes
and in particular for all teachings related to OX40 agonists and
their use.
[0551] In an embodiment, the OX40 agonist is an OX40 agonistic
fusion protein as depicted in Structure I-A (C-terminal Fc-antibody
fragment fusion protein) or Structure I-B (N-terminal Fc-antibody
fragment fusion protein), or a fragment, derivative, conjugate,
variant, or biosimilar thereof. The properties of structures I-A
and I-B are described above and in U.S. Pat. Nos. 9,359,420,
9,340,599, 8,921,519, and 8,450,460, the disclosures of which are
incorporated by reference herein. Amino acid sequences for the
polypeptide domains of structure I-A are given in Table 9. The Fc
domain preferably comprises a complete constant domain (amino acids
17-230 of SEQ ID NO:31) the complete hinge domain (amino acids 1-16
of SEQ ID NO:31) or a portion of the hinge domain (e.g., amino
acids 4-16 of SEQ ID NO:31). Preferred linkers for connecting a
C-terminal Fc-antibody may be selected from the embodiments given
in SEQ ID NO:32 to SEQ ID NO:41, including linkers suitable for
fusion of additional polypeptides. Likewise, amino acid sequences
for the polypeptide domains of structure I-B are given in Table 10.
If an Fc antibody fragment is fused to the N-terminus of an TNRFSF
fusion protein as in structure I-B, the sequence of the Fc module
is preferably that shown in SEQ ID NO:42, and the linker sequences
are preferably selected from those embodiments set forth in SEQ ID
NO:43 to SEQ ID NO:45.
[0552] In an embodiment, an OX40 agonist fusion protein according
to structures I-A or I-B comprises one or more OX40 binding domains
selected from the group consisting of a variable heavy chain and
variable light chain of tavolixizumab, a variable heavy chain and
variable light chain of 11D4, a variable heavy chain and variable
light chain of 18D8, a variable heavy chain and variable light
chain of Hu119-122, a variable heavy chain and variable light chain
of Hu106-222, a variable heavy chain and variable light chain
selected from the variable heavy chains and variable light chains
described in Table 17, any combination of a variable heavy chain
and variable light chain of the foregoing, and fragments,
derivatives, conjugates, variants, and biosimilars thereof.
[0553] In an embodiment, an OX40 agonist fusion protein according
to structures I-A or I-B comprises one or more OX40 binding domains
comprising an OX40L sequence. In an embodiment, an OX40 agonist
fusion protein according to structures I-A or I-B comprises one or
more OX40 binding domains comprising a sequence according to SEQ ID
NO: 102. In an embodiment, an OX40 agonist fusion protein according
to structures I-A or I-B comprises one or more OX40 binding domains
comprising a soluble OX40L sequence. In an embodiment, a OX40
agonist fusion protein according to structures I-A or I-B comprises
one or more OX40 binding domains comprising a sequence according to
SEQ ID NO:103. In an embodiment, a OX40 agonist fusion protein
according to structures I-A or I-B comprises one or more OX40
binding domains comprising a sequence according to SEQ ID
NO:104.
[0554] In an embodiment, an OX40 agonist fusion protein according
to structures I-A or I-B comprises one or more OX40 binding domains
that is a scFv domain comprising V.sub.H and V.sub.L regions that
are each at least 95% identical to the sequences shown in SEQ ID
NO:58 and SEQ ID NO:59, respectively, wherein the V.sub.H and
V.sub.L domains are connected by a linker. In an embodiment, an
OX40 agonist fusion protein according to structures I-A or I-B
comprises one or more OX40 binding domains that is a scFv domain
comprising V.sub.H and V.sub.L regions that are each at least 95%
identical to the sequences shown in SEQ ID NO:68 and SEQ ID NO:69,
respectively, wherein the V.sub.H and V.sub.L domains are connected
by a linker. In an embodiment, an OX40 agonist fusion protein
according to structures I-A or I-B comprises one or more OX40
binding domains that is a scFv domain comprising V.sub.H and
V.sub.L regions that are each at least 95% identical to the
sequences shown in SEQ ID NO:78 and SEQ ID NO:79, respectively,
wherein the V.sub.H and V.sub.L domains are connected by a linker.
In an embodiment, an OX40 agonist fusion protein according to
structures I-A or I-B comprises one or more OX40 binding domains
that is a scFv domain comprising V.sub.H and V.sub.L regions that
are each at least 95% identical to the sequences shown in SEQ ID
NO:86 and SEQ ID NO:87, respectively, wherein the V.sub.H and
V.sub.L domains are connected by a linker. In an embodiment, an
OX40 agonist fusion protein according to structures I-A or I-B
comprises one or more OX40 binding domains that is a scFv domain
comprising V.sub.H and V.sub.L regions that are each at least 95%
identical to the sequences shown in SEQ ID NO:94 and SEQ ID NO:95,
respectively, wherein the V.sub.H and V.sub.L domains are connected
by a linker. In an embodiment, an OX40 agonist fusion protein
according to structures I-A or I-B comprises one or more OX40
binding domains that is a scFv domain comprising V.sub.H and
V.sub.L regions that are each at least 95% identical to the V.sub.H
and V.sub.L sequences given in Table 18, wherein the V.sub.H and
V.sub.L domains are connected by a linker.
TABLE-US-00018 TABLE 18 Additional polypeptide domains useful as
OX40 binding domains in fusion proteins (e.g., structures I-A and
I-B) or as scFv OX40 agonist antibodies. Identifier Sequence
(One-Letter Amino Acid Symbols) SEQ ID NO: 102 MFRVQPLEEN
VGNAARPRFE RNKLLLVASV IQGLGLLLCF TYICLHFSAL QVSHRYPRIQ 60 OX40L
SIKVQFTEYK KEKGFILTSQ KEDEIMKVQN NSVIINCDGF YLISLKGYFS QEVNISLHYQ
120 KDEEPLFQLK KVRSVNSLMV ASLTYKDKVY LNVTTDNTSL DDFHVNGGEL
ILIHQNPGEF 180 CVL 183 SEQ ID NO: 103 SHRYPRIQSI KVQFTEYKKE
KGFILTSQKE DEIMKVQNNS VIINCDGFYL ISLKGYFSQE 60 OX40L soluble
VNISLHYQKD EEPLFQLKKV RSVNSLMVAS LTYKDKVYLN VTTDNTSLDD FHVNGGELIL
120 domain IHQNPGEFCV L 131 SEQ ID NO: 104 YPRIQSIKVQ FTEYKKEKGF
ILTSQKEDEI MKVQNNSVII NCDGFYLISL KGYFSQEVNI 60 OX40L soluble
SLHYQKDEEP LFQLKKVRSV NSLMVASLTY KDKVYLNVTT DNTSLDDFHV NGGELILIHQ
120 domain NPGEFCVL 128 (alternative) SEQ ID NO: 105 EVQLVESGGG
LVQPGGSLRL SCAASGFTFS NYTMNWVRQA PGKGLEWVSA ISGSGGSTYY 60 variable
heavy ADSVKGRFTI SRDNSKNTLY LQMNSLRAED TAVYYCAKDR YSQVHYALDY
WGQGTLVTVS 120 chain for 008 SEQ ID NO: 106 DIVMTQSPDS LPVTPGEPAS
ISCRSSQSLL HSNGYNYLDW YLQKAGQSPQ LLIYLGSNRA 60 variable light
SGVPDRFSGS GSGTDFTLKI SRVEAEDVGV YYCQQYYNHP TTFGQGTK 108 chain for
008 SEQ ID NO: 107 EVQLVESGGG VVQPGRSLRL SCAASGFTFS DYTMNWVRQA
PGKGLEWVSS ISGGSTYYAD 60 variable heavy SRKGRFTISR DNSKNTLYLQ
MNNLRAEDTA VYYCARDRYF RQQNAFDYWG QGTLVTVSSA 120 chain for 011 SEQ
ID NO: 108 DIVMTQSPDS LPVTPGEPAS ISCRSSQSLL HSNGYNYLDW YLQKAGQSPQ
LLIYLGSNRA 60 variable light SGVPDRFSGS GSGTDFTLKI SRVEAEDVGV
YYCQQYYNHP TTFGQGTK 108 chain for 011 SEQ ID NO: 109 EVQLVESGGG
LVQPRGSLRL SCAASGFTFS SYAMNWVRQA PGKGLEWVAV ISYDGSNKYY 60 variable
heavy ADSVKGRFTI SRDNSKNTLY LQMNSLRAED TAVYYCAKDR YITLPNALDY
WGQGTLVTVS 120 chain for 021 SEQ ID NO: 110 DIQMTQSPVS LPVTPGEPAS
ISCRSSQSLL HSNGYNYLDW YLQKPGQSPQ LLIYLGSNRA 60 variable light
SGVPDRFSGS GSGTDFTLKI SRVEAEDVGV YYCQQYKSNP PTFGQGTK 108 chain for
021 SEQ ID NO: 111 EVQLVESGGG LVHPGGSLRL SCAGSGFTFS SYAMHWVRQA
PGKGLEWVSA IGTGGGTYYA 60 variable heavy DSVMGRFTIS RDNSKNTLYL
QMNSLRAEDT AVYYCARYDN VMGLYWFDYW GQGTLVTVSS 120 chain for 023 SEQ
ID NO: 112 EIVLTQSPAT LSLSPGERAT LSCRASQSVS SYLAWYQQKP GQAPRLLIYD
ASNRATGIPA 60 variable light RFSGSGSGTD FTLTISSLEP EDFAVYYCQQ
RSNWPPAFGG GTKVEIKR 108 chain for 023 SEQ ID NO: 113 EVQLQQSGPE
LVKPGASVKM SCKASGYTFT SYVMHWVKQK PGQGLEWIGY INPYNDGTKY 60 heavy
chain NEKFKGKATL TSDKSSSTAY MELSSLTSED SAVYYCANYY GSSLSMDYWG
QGTSVTVSS 119 variable region SEQ ID NO: 114 DIQMTQTTSS LSASLGDRVT
ISCRASQDIS NYLNWYQQKP DGTVKLLIYY TSRLHSGVPS 60 light chain
RFSGSGSGTD YSLTISNLEQ EDIATYFCQQ GNTLPWTFGG GTKLEIKR 108 variable
region SEQ ID NO: 115 EVQLQQSGPE LVKPGASVKI SCKTSGYTFK DYTMHWVKQS
HGKSLEWIGG IYPNNGGSTY 60 heavy chain NQNFKDKATL TVDKSSSTAY
MEFRSLTSED SAVYYCARMG YHGPHLDFDV WGAGTTVTVS 120 variable region P
121 SEQ ID NO: 116 DIVMTQSHKF MSTSLGDRVS ITCKASQDVG AAVAWYQQKP
GQSPKLLIYW ASTRHTGVPD 60 light chain RFTGGGSGTD FTLTISNVQS
EDLTDYFCQQ YINYPLTFGG GTKLEIKR 108 variable region SEQ ID NO: 117
QIQLVQSGPE LKKPGETVKI SCKASGYTFT DYSMHWVKQA PGKGLKWMGW INTETGEPTY
60 heavy chain ADDFKGRFAF SLETSASTAY LQINNLKNED TATYFCANPY
YDYVSYYAMD YWGHGTSVTV 120 variable region SS 122 of humanized
antibody SEQ ID NO: 118 QVQLVQSGSE LKKPGASVKV SCKASGYTFT DYSMHWVRQA
PGQGLKWMGW INTETGEPTY 60 heavy chain ADDFKGRFVF SLDTSVSTAY
LQISSLKAED TAVYYCANPY YDYVSYYAMD YWGQGTTVTV 120 variable region SS
122 of humanized antibody SEQ ID NO: 119 DIVMTQSHKF MSTSVRDRVS
ITCKASQDVS TAVAWYQQKP GQSPKLLIYS ASYLYTGVPD 60 light chain
RFTGSGSGTD FTFTISSVQA EDLAVYYCQQ HYSTPRTFGG GTKLEIK 107 variable
region of humanized antibody SEQ ID NO: 120 DIVMTQSHKF MSTSVRDRVS
ITCKASQDVS TAVAWYQQKP GQSPKLLIYS ASYLYTGVPD 60 light chain
RFTGSGSGTD FTFTISSVQA EDLAVYYCQQ HYSTPRTFGG GTKLEIK 107 variable
region of humanized antibody SEQ ID NO: 121 EVQLVESGGG LVQPGESLKL
SCESNEYEFP SHDMSWVRKT PEKRLELVAA INSDGGSTYY 60 heavy chain
PDTMERRFII SRDNTKKTLY LQMSSLRSED TALYYCARHY DDYYAWFAYW GQGTLVTVSA
120 variable region of humanized antibody SEQ ID NO: 122 EVQLVESGGG
LVQPGGSLRL SCAASEYEFP SHDMSWVRQA PGKGLELVAA INSDGGSTYY 60 heavy
chain PDTMERRFTI SRDNAKNSLY LQMNSLRAED TAVYYCARHY DDYYAWFAYW
GQGTMVTVSS 120 variable region of humanized antibody SEQ ID NO: 123
DIVLTQSPAS LAVSLGQRAT ISCRASKSVS TSGYSYMHWY QQKPGQPPKL LIYLASNLES
60 light chain GVPARFSGSG SGTDFTLNIH PVEEEDAATY YCQHSRELPL
TFGAGTKLEL K 111 variable region of humanized antibody SEQ ID NO:
124 EIVLTQSPAT LSLSPGERAT LSCRASKSVS TSGYSYMHWY QQKPGQAPRL
LIYLASNLES 60 light chain GVPARFSGSG SGTDFTLTIS SLEPEDFAVY
YCQHSRELPL TFGGGTKVEI K 111 variable region of humanized antibody
SEQ ID NO: 125 MYLGLNYVFI VFLLNGVQSE VKLEESGGGL VQPGGSMKLS
CAASGFTFSD AWMDWVRQSP 60 heavy chain EKGLEWVAEI RSKANNHATY
YAESVNGRFT ISRDDSKSSV YLQMNSLRAE DTGIYYCTWG 120 variable region
EVFYFDYWGQ GTTLTVSS 138 SEQ ID NO: 126 MRPSIQFLGL LLFWLHGAQC
DIQMTQSPSS LSASLGGKVT ITCKSSQDIN KYIAWYQHKP 60 light chain
GKGPRLLIHY TSTLQPGIPS RFSGSGSGRD YSFSISNLEP EDIATYYCLQ YDNLLTFGAG
120 variable region TKLELK 126
[0555] In an embodiment, the OX40 agonist is a OX40 agonistic
single-chain fusion polypeptide comprising (i) a first soluble OX40
binding domain, (ii) a first peptide linker, (iii) a second soluble
OX40 binding domain, (iv) a second peptide linker, and (v) a third
soluble OX40 binding domain, further comprising an additional
domain at the N-terminal and/or C-terminal end, and wherein the
additional domain is a Fab or Fc fragment domain. In an embodiment,
the OX40 agonist is a OX40 agonistic single-chain fusion
polypeptide comprising (i) a first soluble OX40 binding domain,
(ii) a first peptide linker, (iii) a second soluble OX40 binding
domain, (iv) a second peptide linker, and (v) a third soluble OX40
binding domain, further comprising an additional domain at the
N-terminal and/or C-terminal end, wherein the additional domain is
a Fab or Fc fragment domain wherein each of the soluble OX40
binding domains lacks a stalk region (which contributes to
trimerisation and provides a certain distance to the cell membrane,
but is not part of the OX40 binding domain) and the first and the
second peptide linkers independently have a length of 3-8 amino
acids.
[0556] In an embodiment, the OX40 agonist is an OX40 agonistic
single-chain fusion polypeptide comprising (i) a first soluble
tumor necrosis factor (TNF) superfamily cytokine domain, (ii) a
first peptide linker, (iii) a second soluble TNF superfamily
cytokine domain, (iv) a second peptide linker, and (v) a third
soluble TNF superfamily cytokine domain, wherein each of the
soluble TNF superfamily cytokine domains lacks a stalk region and
the first and the second peptide linkers independently have a
length of 3-8 amino acids, and wherein the TNF superfamily cytokine
domain is an OX40 binding domain.
[0557] In some embodiments, the OX40 agonist is MEDI6383. MEDI6383
is an OX40 agonistic fusion protein and can be prepared as
described in U.S. Pat. No. 6,312,700, the disclosure of which is
incorporated by reference herein.
[0558] In an embodiment, the OX40 agonist is an OX40 agonistic scFv
antibody comprising any of the foregoing V.sub.H domains linked to
any of the foregoing V.sub.L domains.
[0559] In an embodiment, the OX40 agonist is Creative Biolabs OX40
agonist monoclonal antibody MOM-18455, commercially available from
Creative Biolabs, Inc., Shirley, N.Y., USA.
[0560] In an embodiment, the OX40 agonist is OX40 agonistic
antibody clone Ber-ACT35 commercially available from BioLegend,
Inc., San Diego, Calif., USA.
[0561] Optional Cell Viability Analyses
[0562] Optionally, a cell viability assay can be performed after
the first expansion (sometimes referred to as the initial bulk
expansion), using standard assays known in the art. For example, a
trypan blue exclusion assay can be done on a sample of the bulk
TILs, which selectively labels dead cells and allows a viability
assessment. Other assays for use in testing viability can include
but are not limited to the Alamar blue assay; and the MTT
assay.
[0563] 1. Cell Counts, Viability, Flow Cytometry
[0564] In some embodiments, cell counts and/or viability are
measured. The expression of markers such as but not limited CD3,
CD4, CD8, and CD56, as well as any other disclosed or described
herein, can be measured by flow cytometry with antibodies, for
example but not limited to those commercially available from BD
Bio-sciences (BD Biosciences, San Jose, Calif.) using a
FACSCanto.TM. flow cytometer (BD Biosciences). The cells can be
counted manually using a disposable c-chip hemocytometer (VWR,
Batavia, Ill.) and viability can be assessed using any method known
in the art, including but not limited to trypan blue staining. The
cell viability can also be assayed based on U.S. Ser. No.
15/863,634, incorporated by reference herein in its entirety.
[0565] In some cases, the bulk TIL population can be cryopreserved
immediately, using the protocols discussed below. Alternatively,
the bulk TIL population can be subjected to REP and then
cryopreserved as discussed below. Similarly, in the case where
genetically modified TILs will be used in therapy, the bulk or REP
TIL populations can be subjected to genetic modifications for
suitable treatments.
[0566] According to the present disclosure, a method for assaying
TILs for viability and/or further use in administration to a
subject. In some embodiments, the method for assay tumor
infiltrating lymphocytes (TILs) comprises: [0567] (i) obtaining a
first population of TILs; [0568] (ii) performing a first expansion
by culturing the first population of TILs in a cell culture medium
comprising IL-2, and optionally OKT-3, to produce a second
population of TILs; and [0569] (iii) performing a second expansion
by supplementing the cell culture medium of the second population
of TILs with additional IL-2, OKT-3, and antigen presenting cells
(APCs), to produce a third population of TILs, wherein the third
population of TILs is at least 50-fold greater in number than the
second population of TILs; [0570] (iv) harvesting, washing, and
cryopreserving the third population of TILs; [0571] (v) storing the
cryopreserved TILs at a cryogenic temperature; [0572] (vi) thawing
the third population of TILs to provide a thawed third population
of TILs; and [0573] (vii) performing an additional second expansion
of a portion of the thawed third population of TILs by
supplementing the cell culture medium of the third population with
IL-2, OKT-3, and APCs for an additional expansion period (sometimes
referred to as a reREP period) of at least 3 days, wherein the
third expansion is performed to obtain a fourth population of TILs,
wherein the number of TILs in the fourth population of TILs is
compared to the number of TILs in the third population of TILs to
obtain a ratio; [0574] (viii) determining based on the ratio in
step (vii) whether the thawed population of TILs is suitable for
administration to a patient; [0575] (ix) administering a
therapeutically effective dosage of the thawed third population of
TILs to the patient when the ratio of the number of TILs in the
fourth population of TILs to the number of TILs in the third
population of TILs is determined to be greater than 5:1 in step
(viii).
[0576] In some embodiments, the TILs are assayed for viability
after step (vii).
[0577] The present disclosure also provides further methods for
assaying TILs. In some embodiments, the disclosure provides a
method for assaying TILs comprising: [0578] (i) obtaining a portion
of a first population of cryopreserved TILs; [0579] (ii) thawing
the portion of the first population of cryopreserved TILs; [0580]
(iii) performing a first expansion by culturing the portion of the
first population of TILs in a cell culture medium comprising IL-2,
OKT-3, and antigen presenting cells (APCs) for an additional
expansion period (sometimes referred to as a reREP period) of at
least 3 days, to produce a second population of TILs, wherein the
portion from the first population of TILs is compared to the second
population of TILs to obtain a ratio of the number of TILs, wherein
the ratio of the number of TILs in the second population of TILs to
the number of TILs in the portion of the first population of TILs
is greater than 5:1; [0581] (iv) determining based on the ratio in
step (iii) whether the first population of TILs is suitable for use
in therapeutic administration to a patient; [0582] (v) determining
the first population of TILs is suitable for use in therapeutic
administration when the ratio of the number of TILs in the second
population of TILs to the number of TILs in the first population of
TILs is determined to be greater than 5:1 in step (iv).
[0583] In some embodiments, the ratio of the number of TILs in the
second population of TILs to the number of TILs in the portion of
the first population of TILs is greater than 50:1.
[0584] In some embodiments, the method further comprises performing
expansion of the entire first population of cryopreserved TILs from
step (i) according to the methods as described in any of the
embodiments provided herein.
[0585] In some embodiments, the method further comprises
administering the entire first population of cryopreserved TILs
from step (i) to the patient.
[0586] 2. Cell Cultures
[0587] In an embodiment, a method for expanding TILs, including
those discussed above as well as exemplified in FIG. 18, may
include using about 5,000 mL to about 25,000 mL of cell medium,
about 5,000 mL to about 10,000 mL of cell medium, or about 5,800 mL
to about 8,700 mL of cell medium. In some embodiments, the media is
a serum free medium. In some embodiments, the media in the first
expansion is serum free. In some embodiments, the media in the
second expansion is serum free. In some embodiments, the media in
the first expansion and the second are both serum free. In an
embodiment, expanding the number of TILs uses no more than one type
of cell culture medium. Any suitable cell culture medium may be
used, e.g., AIM-V cell medium (L-glutamine, 50 .mu.M streptomycin
sulfate, and 10 .mu.M gentamicin sulfate) cell culture medium
(Invitrogen, Carlsbad Calif.). In this regard, the inventive
methods advantageously reduce the amount of medium and the number
of types of medium required to expand the number of TIL. In an
embodiment, expanding the number of TIL may comprise feeding the
cells no more frequently than every third or fourth day. Expanding
the number of cells in a gas permeable container simplifies the
procedures necessary to expand the number of cells by reducing the
feeding frequency necessary to expand the cells.
[0588] In an embodiment, the cell medium in the first and/or second
gas permeable container is unfiltered. The use of unfiltered cell
medium may simplify the procedures necessary to expand the number
of cells. In an embodiment, the cell medium in the first and/or
second gas permeable container lacks beta-mercaptoethanol
(BME).
[0589] In an embodiment, the duration of the method comprising
obtaining a tumor tissue sample from the mammal; culturing the
tumor tissue sample in a first gas permeable container containing
cell medium therein; obtaining TILs from the tumor tissue sample;
expanding the number of TILs in a second gas permeable container
containing cell medium for a duration of about 7 to 14 days, e.g.,
about 11 days. In some embodiments pre-REP is about 7 to 14 days,
e.g., about 11 days. In some embodiments, REP is about 7 to 14
days, e.g., about 11 days.
[0590] In an embodiment, TILs are expanded in gas-permeable
containers. Gas-permeable containers have been used to expand TILs
using PBMCs using methods, compositions, and devices known in the
art, including those described in U.S. Patent Application
Publication No. 2005/0106717 A1, the disclosures of which are
incorporated herein by reference. In an embodiment, TILs are
expanded in gas-permeable bags. In an embodiment, TILs are expanded
using a cell expansion system that expands TILs in gas permeable
bags, such as the Xuri Cell Expansion System W25 (GE Healthcare).
In an embodiment, TILs are expanded using a cell expansion system
that expands TILs in gas permeable bags, such as the WAVE
Bioreactor System, also known as the Xuri Cell Expansion System W5
(GE Healthcare). In an embodiment, the cell expansion system
includes a gas permeable cell bag with a volume selected from the
group consisting of about 100 mL, about 200 mL, about 300 mL, about
400 mL, about 500 mL, about 600 mL, about 700 mL, about 800 mL,
about 900 mL, about 1 L, about 2 L, about 3 L, about 4 L, about 5
L, about 6 L, about 7 L, about 8 L, about 9 L, and about 10 L.
[0591] In an embodiment, TILs can be expanded in G-Rex flasks
(commercially available from Wilson Wolf Manufacturing). Such
embodiments allow for cell populations to expand from about
5.times.10.sup.5 cells/cm.sup.2 to between 10.times.10.sup.6 and
30.times.10.sup.6 cells/cm.sup.2. In an embodiment this is without
feeding. In an embodiment, this is without feeding so long as
medium resides at a height of about 10 cm in the G-Rex flask. In an
embodiment this is without feeding but with the addition of one or
more cytokines. In an embodiment, the cytokine can be added as a
bolus without any need to mix the cytokine with the medium. Such
containers, devices, and methods are known in the art and have been
used to expand TILs, and include those described in U.S. Patent
Application Publication No. US 2014/0377739A1, International
Publication No. WO 2014/210036 A1, U.S. Patent Application
Publication No. us 2013/0115617 A1, International Publication No.
WO 2013/188427 A1, U.S. Patent Application Publication No. US
2011/0136228 A1, U.S. Pat. No. 8,809,050 B2, International
publication No. WO 2011/072088 A2, U.S. Patent Application
Publication No. US 2016/0208216 A1, U.S. Patent Application
Publication No. US 2012/0244133 A1, International Publication No.
WO 2012/129201 A1, U.S. Patent Application Publication No. US
2013/0102075 A1, U.S. Pat. No. 8,956,860 B2, International
Publication No. WO 2013/173835 A1, U.S. Patent Application
Publication No. US 2015/0175966 A1, the disclosures of which are
incorporated herein by reference. Such processes are also described
in Jin et al., J. Immunotherapy, 2012, 35:283-292.
[0592] Optional Genetic Engineering of TILs
[0593] In some embodiments, the TILs are optionally genetically
engineered to include additional functionalities, including, but
not limited to, a high-affinity T cell receptor (TCR), e.g., a TCR
targeted at a tumor-associated antigen such as MAGE-1, HER2, or
NY-ESO-1, or a chimeric antigen receptor (CAR) which binds to a
tumor-associated cell surface molecule (e.g., mesothelin) or
lineage-restricted cell surface molecule (e.g., CD19).
[0594] Optional Cryopreservation of TILs
[0595] As discussed above, and exemplified in Steps A through E as
provided in FIG. 18, cryopreservation can occur at numerous points
throughout the TIL expansion process. In some embodiments, the
expanded population of TILs after the second expansion (as provided
for example, according to Step D of FIG. 18) can be cryopreserved.
Cryopreservation can be generally accomplished by placing the TIL
population into a freezing solution, e.g., 85% complement
inactivated AB serum and 15% dimethyl sulfoxide (DMSO). The cells
in solution are placed into cryogenic vials and stored for 24 hours
at -80.degree. C., with optional transfer to gaseous nitrogen
freezers for cryopreservation. See Sadeghi, et al., Acta Oncologica
2013, 52, 978-986. In some embodiments, the TILs are cryopreserved
in 5% DMSO. In some embodiments, the TILs are cryopreserved in cell
culture media plus 5% DMSO. In some embodiments, the TILs are
cryopreserved according to the methods provided in Example 10.
[0596] When appropriate, the cells are removed from the freezer and
thawed in a 37.degree. C. water bath until approximately 4/5 of the
solution is thawed. The cells are generally resuspended in complete
media and optionally washed one or more times. In some embodiments,
the thawed TILs can be counted and assessed for viability as is
known in the art.
[0597] Closed Systems for TIL Manufacturing
[0598] The present invention provides for the use of closed systems
during the TIL culturing process. Such closed systems allow for
preventing and/or reducing microbial contamination, allow for the
use of fewer flasks, and allow for cost reductions. In some
embodiments, the closed system uses two containers.
[0599] Such closed systems are well-known in the art and can be
found, for example, at http://www.fda.gov/cber/guidelines.htm and
https.//www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryIn-
formation/Guidances/Blood/ucm076779.htm.
[0600] Sterile connecting devices (STCDs) produce sterile welds
between two pieces of compatible tubing. This procedure permits
sterile connection of a variety of containers and tube diameters.
In some embodiments, the closed systems include luer lock and heat
sealed systems. In some embodiments, the closed system is accessed
via syringes under sterile conditions in order to maintain the
sterility and closed nature of the system. In some embodiments, a
closed system as described in the Examples is employed. In some
embodiments, the TILs are formulated into a final product
formulation container according to the method described in the
Examples.
[0601] In some embodiments, the closed system uses one container
from the time the tumor fragments are obtained until the TILs are
ready for administration to the patient or cryopreserving. In some
embodiments when two containers are used, the first container is a
closed G-container and the population of TILs is centrifuged and
transferred to an infusion bag without opening the first closed
G-container. In some embodiments, when two containers are used, the
infusion bag is a HypoThermosol-containing infusion bag. A closed
system or closed TIL cell culture system is characterized in that
once the tumor sample and/or tumor fragments have been added, the
system is tightly sealed from the outside to form a closed
environment free from the invasion of bacteria, fungi, and/or any
other microbial contamination.
[0602] In some embodiments, the reduction in microbial
contamination is between about 5% and about 100%. In some
embodiments, the reduction in microbial contamination is between
about 5% and about 95%. In some embodiments, the reduction in
microbial contamination is between about 5% and about 90%. In some
embodiments, the reduction in microbial contamination is between
about 10% and about 90%. In some embodiments, the reduction in
microbial contamination is between about 15% and about 85%. In some
embodiments, the reduction in microbial contamination is about 5%,
about 10%, about 15%, about 20%, about 25%, about 30%, about 35%,
about 40%, about 45%, about 50%, about 55%, about 60%, about 65%,
about 70%, about 75%, about 80%, about 85%, about 90%, about 95%,
about 97%, about 98%, about 99%, or about 100%.
[0603] The closed system allows for TIL growth in the absence
and/or with a significant reduction in microbial contamination.
[0604] Moreover, pH, carbon dioxide partial pressure and oxygen
partial pressure of the TIL cell culture environment each vary as
the cells are cultured. Consequently, even though a medium
appropriate for cell culture is circulated, the closed environment
still needs to be constantly maintained as an optimal environment
for TIL proliferation. To this end, it is desirable that the
physical factors of pH, carbon dioxide partial pressure and oxygen
partial pressure within the culture liquid of the closed
environment be monitored by means of a sensor, the signal whereof
is used to control a gas exchanger installed at the inlet of the
culture environment, and the that gas partial pressure of the
closed environment be adjusted in real time according to changes in
the culture liquid so as to optimize the cell culture environment.
In some embodiments, the present invention provides a closed cell
culture system which incorporates at the inlet to the closed
environment a gas exchanger equipped with a monitoring device which
measures the pH, carbon dioxide partial pressure and oxygen partial
pressure of the closed environment, and optimizes the cell culture
environment by automatically adjusting gas concentrations based on
signals from the monitoring device.
[0605] In some embodiments, the pressure within the closed
environment is continuously or intermittently controlled. That is,
the pressure in the closed environment can be varied by means of a
pressure maintenance device for example, thus ensuring that the
space is suitable for growth of TILs in a positive pressure state,
or promoting exudation of fluid in a negative pressure state and
thus promoting cell proliferation. By applying negative pressure
intermittently, moreover, it is possible to uniformly and
efficiently replace the circulating liquid in the closed
environment by means of a temporary shrinkage in the volume of the
closed environment.
[0606] In some embodiments, optimal culture components for
proliferation of the TILs can be substituted or added, and
including factors such as IL-2 and/or OKT3, as well as combination,
can be added.
[0607] Optional Cryopreservation of TILs
[0608] Either the bulk TIL population or the expanded population of
TILs can be optionally cryopreserved. In some embodiments,
cryopreservation occurs on the therapeutic TIL population. In some
embodiments, cryopreservation occurs on the TILs harvested after
the second expansion. In some embodiments, cryopreservation occurs
on the TILs in exemplary Step F of FIG. 18. In some embodiments,
the TILs are cryopreserved in the infusion bag. In some
embodiments, the TILs are cryopreserved prior to placement in an
infusion bag. In some embodiments, the TILs are cryopreserved and
not placed in an infusion bag. In some embodiments,
cryopreservation is performed using a cryopreservation medium. In
some embodiments, the cryopreservation media contains
dimethylsulfoxide (DMSO). This is generally accomplished by putting
the TIL population into a freezing solution, e.g. 85% complement
inactivated AB serum and 15% dimethyl sulfoxide (DMSO). The cells
in solution are placed into cryogenic vials and stored for 24 hours
at -80.degree. C., with optional transfer to gaseous nitrogen
freezers for cryopreservation. See, Sadeghi, et al., Acta
Oncologica 2013, 52, 978-986.
[0609] When appropriate, the cells are removed from the freezer and
thawed in a 37.degree. C. water bath until approximately 4/5 of the
solution is thawed. The cells are generally resuspended in complete
media and optionally washed one or more times. In some embodiments,
the thawed TILs can be counted and assessed for viability as is
known in the art.
[0610] In a preferred embodiment, a population of TILs is
cryopreserved using CS10 cryopreservation media (CryoStor 10,
BioLife Solutions). In a preferred embodiment, a population of TILs
is cryopreserved using a cryopreservation media containing
dimethylsulfoxide (DMSO). In a preferred embodiment, a population
of TILs is cryopreserved using a 1:1 (vol:vol) ratio of CS10 and
cell culture media. In a preferred embodiment, a population of TILs
is cryopreserved using about a 1:1 (vol:vol) ratio of CS10 and cell
culture media, further comprising additional IL-2.
[0611] As discussed above in Steps A through E, cryopreservation
can occur at numerous points throughout the TIL expansion process.
In some embodiments, the bulk TIL population after the first
expansion according to Step B or the expanded population of TILs
after the one or more second expansions according to Step D can be
cryopreserved. Cryopreservation can be generally accomplished by
placing the TIL population into a freezing solution, e.g., 85%
complement inactivated AB serum and 15% dimethyl sulfoxide (DMSO).
The cells in solution are placed into cryogenic vials and stored
for 24 hours at -80.degree. C., with optional transfer to gaseous
nitrogen freezers for cryopreservation. See Sadeghi, et al., Acta
Oncologica 2013, 52, 978-986.
[0612] When appropriate, the cells are removed from the freezer and
thawed in a 37.degree. C. water bath until approximately 4/5 of the
solution is thawed. The cells are generally resuspended in complete
media and optionally washed one or more times. In some embodiments,
the thawed TILs can be counted and assessed for viability as is
known in the art.
[0613] In some cases, the Step B TIL population can be
cryopreserved immediately, using the protocols discussed below.
Alternatively, the bulk TIL population can be subjected to Step C
and Step D and then cryopreserved after Step D. Similarly, in the
case where genetically modified TILs will be used in therapy, the
Step B or Step D TIL populations can be subjected to genetic
modifications for suitable treatments.
Pharmaceutical Compositions, Dosages, and Dosing Regimens
[0614] In an embodiment, TILs expanded using the methods of the
present disclosure are administered to a patient as a
pharmaceutical composition. In an embodiment, the pharmaceutical
composition is a suspension of TILs in a sterile buffer. TILs
expanded using PBMCs of the present disclosure may be administered
by any suitable route as known in the art. In some embodiments, the
T-cells are administered as a single intra-arterial or intravenous
infusion, which preferably lasts approximately 30 to 60 minutes.
Other suitable routes of administration include intraperitoneal,
intrathecal, and intralymphatic administration.
[0615] Any suitable dose of TILs can be administered. In some
embodiments, from about 2.3.times.10.sup.10 to about
13.7.times.10.sup.10 TILs are administered, with an average of
around 7.8.times.10.sup.10 TILs, particularly if the cancer is
melanoma. In an embodiment, about 1.2.times.10.sup.10 to about
4.3.times.10.sup.10 of TILs are administered. In some embodiments,
about 3.times.10.sup.10 to about 12.times.10.sup.10 TILs are
administered. In some embodiments, about 4.times.10.sup.10 to about
10.times.10.sup.10 TILs are administered. In some embodiments,
about 5.times.10.sup.10 to about 8.times.10.sup.10 TILs are
administered. In some embodiments, about 6.times.10.sup.10 to about
8.times.10.sup.10 TILs are administered. In some embodiments, about
7.times.10.sup.10 to about 8.times.10.sup.10 TILs are administered.
In some embodiments, the therapeutically effective dosage is about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10. In some
embodiments, the therapeutically effective dosage is about
7.8.times.10.sup.10 TILs, particularly of the cancer is melanoma.
In some embodiments, the therapeutically effective dosage is about
1.2.times.10.sup.10 to about 4.3.times.10.sup.10 of TILs. In some
embodiments, the therapeutically effective dosage is about
3.times.10.sup.10 to about 12.times.10.sup.10 TILs. In some
embodiments, the therapeutically effective dosage is about
4.times.10.sup.10 to about 10.times.10.sup.10 TILs. In some
embodiments, the therapeutically effective dosage is about
5.times.10.sup.10 to about 8.times.10.sup.10 TILs. In some
embodiments, the therapeutically effective dosage is about
6.times.10.sup.10 to about 8.times.10.sup.10 TILs. In some
embodiments, the therapeutically effective dosage is about
7.times.10.sup.10 to about 8.times.10.sup.10 TILs.
[0616] In some embodiments, the number of the TILs provided in the
pharmaceutical compositions of the invention is about
1.times.10.sup.6, 2.times.10.sup.6, 3.times.10.sup.6,
4.times.10.sup.6, 5.times.10.sup.6, 6.times.10.sup.6,
7.times.10.sup.6, 8.times.10.sup.6, 9.times.10.sup.6,
1.times.10.sup.7, 2.times.10.sup.7, 3.times.10.sup.7,
4.times.10.sup.7, 5.times.10.sup.7, 6.times.10.sup.7,
7.times.10.sup.7, 8.times.10.sup.7, 9.times.10.sup.7,
1.times.10.sup.8, 2.times.10.sup.8, 3.times.10.sup.8,
4.times.10.sup.8, 5.times.10.sup.8, 6.times.10.sup.8,
7.times.10.sup.8, 8.times.10.sup.8, 9.times.10.sup.8,
1.times.10.sup.9, 2.times.10.sup.9, 3.times.10.sup.9,
4.times.10.sup.9, 5.times.10.sup.9, 6.times.10.sup.9,
7.times.10.sup.9, 8.times.10.sup.9, 9.times.10.sup.9,
1.times.10.sup.10, 2.times.10.sup.10, 3.times.10.sup.10,
4.times.10.sup.10, 5.times.10.sup.10, 6.times.10.sup.10,
7.times.10.sup.10, 8.times.10.sup.10, 9.times.10.sup.10,
1.times.10.sup.11, 2.times.10.sup.11, 3.times.10.sup.11,
4.times.10.sup.11, 5.times.10.sup.11, 6.times.10.sup.11,
7.times.10.sup.11, 8.times.10.sup.11, 9.times.10.sup.11,
1.times.10.sup.12, 2.times.10.sup.12, 3.times.10.sup.12,
4.times.10.sup.12, 5.times.10.sup.12, 6.times.10.sup.12,
7.times.10.sup.12, 8.times.10.sup.12, 9.times.10.sup.12,
1.times.10.sup.13, 2.times.10.sup.13, 3.times.10.sup.13,
4.times.10.sup.13, 5.times.10.sup.13, 6.times.10.sup.13,
7.times.10.sup.13, 8.times.10.sup.13, and 9.times.10.sup.13. In an
embodiment, the number of the TILs provided in the pharmaceutical
compositions of the invention is in the range of 1.times.10.sup.6
to 5.times.10.sup.6, 5.times.10.sup.6 to 1.times.10.sup.7,
1.times.10.sup.7 to 5.times.10.sup.7, 5.times.10.sup.7 to
1.times.10.sup.8, 1.times.10.sup.8 to 5.times.10.sup.8,
5.times.10.sup.8 to 1.times.10.sup.9, 1.times.10.sup.9 to
5.times.10.sup.9, 5.times.10.sup.9 to 1.times.10.sup.10,
1.times.10.sup.10 to 5.times.10.sup.10, 5.times.10.sup.10 to
1.times.10.sup.11, 5.times.10.sup.11 to 1.times.10.sup.12,
1.times.10.sup.12 to 5.times.10.sup.12, and 5.times.10.sup.12 to
1.times.10.sup.13.
[0617] In some embodiments, the concentration of the TILs provided
in the pharmaceutical compositions of the invention is less than,
for example, 100%, 90%, 80%, 70%, 60%, 50%0, 40%, 30%, 20%, 19%,
18%, 17%, 16%, 15%, 14%, 13%, 12%, 11%, 10%, 9%, 8%, 7%, 6%, 5%,
4%, 3%, 2%, 1%, 0.5%, 0.4%, 0.3%, 0.2%, 0.1%, 0.09%, 0.08%, 0.07%,
0.06%, 0.05%, 0.04%, 0.03%, 0.02%, 0.01%, 0.009%, 0.008%, 0.007%,
0.006%, 0.005%, 0.004%, 0.003%, 0.002%, 0.001%, 0.0009%, 0.0008%,
0.0007%, 0.0006%, 0.0005%, 0.0004%, 0.0003%, 0.0002% or 0.0001%
w/w, w/v or v/v of the pharmaceutical composition.
[0618] In some embodiments, the concentration of the TILs provided
in the pharmaceutical compositions of the invention is greater than
90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 19.75%, 19.50%, 19.25% 19%,
18.75%, 18.50%, 18.25% 18%, 17.75%, 17.50%, 17.25% 17%, 16.75%,
16.50%, 16.25% 16%, 15.75%, 15.50%, 15.25% 15%, 14.75%, 14.50%,
14.25% 14%, 13.75%, 13.50%, 13.25% 13%, 12.75%, 12.50%, 12.25% 12%,
11.75%, 11.50%, 11.25% 11%, 10.75%, 10.50%, 10.25% 10%, 9.75%,
9.50%, 9.25% 9%, 8.75%, 8.50%, 8.25% 8%, 7.75%, 7.50%, 7.25% 7%,
6.75%, 6.50%, 6.25% 6%, 5.75%, 5.50%, 5.25% 5%, 4.75%, 4.50%,
4.25%, 4%, 3.75%, 3.50%, 3.25%, 3%, 2.75%, 2.50%, 2.25%, 2%, 1.75%,
1.50%, 125%, 1%, 0.5%, 0.4%, 0.3%, 0.2%, 0.1%, 0.09%, 0.08%, 0.07%,
0.06%, 0.05%, 0.04%, 0.03%, 0.02%, 0.01%, 0.009%, 0.008%, 0.007%,
0.006%, 0.005%, 0.004%, 0.003%, 0.002%, 0.001%, 0.0009%, 0.0008%,
0.0007%, 0.0006%, 0.0005%, 0.0004%, 0.0003%, 0.0002% or 0.0001%
w/w, w/v, or v/v of the pharmaceutical composition.
[0619] In some embodiments, the concentration of the TILs provided
in the pharmaceutical compositions of the invention is in the range
from about 0.0001% to about 50%, about 0.001% to about 40%, about
0.01% to about 30%, about 0.02% to about 29%, about 0.03% to about
28%, about 0.04% to about 27%, about 0.05% to about 26%, about
0.06% to about 25%, about 0.07% to about 24%, about 0.08% to about
23%, about 0.09% to about 22%, about 0.1% to about 21%, about 0.2%
to about 20%, about 0.3% to about 19%, about 0.4% to about 18%,
about 0.5% to about 17%, about 0.6% to about 16%, about 0.7% to
about 15%, about 0.8% to about 14%, about 0.9% to about 12% or
about 1% to about 10% w/w, w/v or v/v of the pharmaceutical
composition.
[0620] In some embodiments, the concentration of the TILs provided
in the pharmaceutical compositions of the invention is in the range
from about 0.001% to about 10%, about 0.01% to about 5%, about
0.02% to about 4.5%, about 0.03% to about 4%, about 0.04% to about
3.5%, about 0.05% to about 3%, about 0.06% to about 2.5%, about
0.07% to about 2%, about 0.08% to about 1.5%, about 0.09% to about
1%, about 0.1% to about 0.9% w/w, w/v or v/v of the pharmaceutical
composition.
[0621] In some embodiments, the amount of the TILs provided in the
pharmaceutical compositions of the invention is equal to or less
than 10 g, 9.5 g, 9.0 g, 8.5 g, 8.0 g, 7.5 g, 7.0 g, 6.5 g, 6.0 g,
5.5 g, 5.0 g, 4.5 g, 4.0 g, 3.5 g, 3.0 g, 2.5 g, 2.0 g, 1.5 g, 1.0
g, 0.95 g, 0.9 g, 0.85 g, 0.8 g, 0.75 g, 0.7 g, 0.65 g, 0.6 g, 0.55
g, 0.5 g, 0.45 g, 0.4 g, 0.35 g, 0.3 g, 0.25 g, 0.2 g, 0.15 g, 0.1
g, 0.09 g, 0.08 g, 0.07 g, 0.06 g, 0.05 g, 0.04 g, 0.03 g, 0.02 g,
0.01 g, 0.009 g, 0.008 g, 0.007 g, 0.006 g, 0.005 g, 0.004 g, 0.003
g, 0.002 g, 0.001 g, 0.0009 g, 0.0008 g, 0.0007 g, 0.0006 g, 0.0005
g, 0.0004 g, 0.0003 g, 0.0002 g, or 0.0001 g.
[0622] In some embodiments, the amount of the TILs provided in the
pharmaceutical compositions of the invention is more than 0.0001 g,
0.0002 g, 0.0003 g, 0.0004 g, 0.0005 g, 0.0006 g, 0.0007 g, 0.0008
g, 0.0009 g, 0.001 g, 0.0015 g, 0.002 g, 0.0025 g, 0.003 g, 0.0035
g, 0.004 g, 0.0045 g, 0.005 g, 0.0055 g, 0.006 g, 0.0065 g, 0.007
g, 0.0075 g, 0.008 g, 0.0085 g, 0.009 g, 0.0095 g, 0.01 g, 0.015 g,
0.02 g, 0.025 g, 0.03 g, 0.035 g, 0.04 g, 0.045 g, 0.05 g, 0.055 g,
0.06 g, 0.065 g, 0.07 g, 0.075 g, 0.08 g, 0.085 g, 0.09 g, 0.095 g,
0.1 g, 0.15 g, 0.2 g, 0.25 g, 0.3 g, 0.35 g, 0.4 g, 0.45 g, 0.5 g,
0.55 g, 0.6 g, 0.65 g, 0.7 g, 0.75 g, 0.8 g, 0.85 g, 0.9 g, 0.95 g,
1 g, 1.5 g, 2 g, 2.5, 3 g, 3.5, 4 g, 4.5 g, 5 g, 5.5 g, 6 g, 6.5 g,
7 g, 7.5 g, 8 g, 8.5 g, 9 g, 9.5 g, or 10 g.
[0623] The TILs provided in the pharmaceutical compositions of the
invention are effective over a wide dosage range. The exact dosage
will depend upon the route of administration, the form in which the
compound is administered, the gender and age of the subject to be
treated, the body weight of the subject to be treated, and the
preference and experience of the attending physician. The
clinically-established dosages of the TILs may also be used if
appropriate. The amounts of the pharmaceutical compositions
administered using the methods herein, such as the dosages of TILs,
will be dependent on the human or mammal being treated, the
severity of the disorder or condition, the rate of administration,
the disposition of the active pharmaceutical ingredients and the
discretion of the prescribing physician.
[0624] In some embodiments, TILs may be administered in a single
dose. Such administration may be by injection, e.g., intravenous
injection. In some embodiments, TILs may be administered in
multiple doses. Dosing may be once, twice, three times, four times,
five times, six times, or more than six times per year. Dosing may
be once a month, once every two weeks, once a week, or once every
other day. Administration of TILs may continue as long as
necessary.
[0625] In some embodiments, an effective dosage of TILs is about
1.times.10.sup.6, 2.times.10.sup.6, 3.times.10.sup.6,
4.times.10.sup.6, 5.times.10.sup.66.times.10.sup.6,
7.times.10.sup.6, 8.times.10.sup.6, 9.times.10.sup.6,
1.times.10.sup.7, 2.times.10.sup.7, 3.times.10.sup.7,
4.times.10.sup.7, 5.times.10.sup.7, 6.times.10.sup.7,
7.times.10.sup.7, 8.times.10.sup.7, 9.times.10.sup.7,
1.times.10.sup.8, 2.times.10.sup.8, 3.times.10.sup.8,
4.times.10.sup.8, 5.times.10.sup.8, 6.times.10.sup.8,
7.times.10.sup.8, 8.times.10.sup.8, 9.times.10.sup.8,
1.times.10.sup.9, 2.times.10.sup.9, 3.times.10.sup.9,
4.times.10.sup.9, 5.times.10.sup.9, 6.times.10.sup.9,
7.times.10.sup.9, 8.times.10.sup.9, 9.times.10.sup.9,
1.times.10.sup.10, 2.times.10.sup.10,
3.times.10.sup.104.times.10.sup.10, 5.times.10.sup.10,
6.times.10.sup.10, 7.times.10.sup.10, 8.times.10.sup.10,
9.times.10.sup.10, 1.times.10.sup.11, 2.times.10.sup.11,
3.times.10.sup.11, 4.times.10.sup.11, 5.times.10.sup.11,
6.times.10.sup.11, 7.times.10.sup.11, 8.times.10.sup.11,
9.times.10.sup.11, 1.times.10.sup.12, 2.times.10.sup.12,
3.times.10.sup.12, 4.times.10.sup.12, 5.times.10.sup.12,
6.times.10.sup.12, 7.times.10.sup.12, 8.times.10.sup.12,
9.times.10.sup.12, 1.times.10.sup.13, 2.times.10.sup.13,
3.times.10.sup.13, 4.times.10.sup.13, 5.times.10.sup.13,
6.times.10.sup.13, 7.times.10.sup.13, 8.times.10.sup.13, and
9.times.10.sup.13. In some embodiments, an effective dosage of TILs
is in the range of 1.times.10.sup.6 to 5.times.10.sup.6,
5.times.10.sup.6 to 1.times.10.sup.7, 1.times.10.sup.7 to
5.times.10.sup.7, 5.times.10.sup.7 to 1.times.10.sup.8,
1.times.10.sup.8 to 5.times.10.sup.8, 5.times.10.sup.8 to
1.times.10.sup.9, 1.times.10.sup.9 to 5.times.10.sup.9,
5.times.10.sup.9 to 1.times.10.sup.10, 1.times.10.sup.10 to
5.times.10.sup.10, 5.times.10.sup.10 to 1.times.10.sup.11,
5.times.10.sup.11 to 1.times.10.sup.12, 1.times.10.sup.12 to
5.times.10.sup.12, and 5.times.10.sup.12 to 1.times.10.sup.13.
[0626] In some embodiments, an effective dosage of TILs is in the
range of about 0.01 mg/kg to about 4.3 mg/kg, about 0.15 mg/kg to
about 3.6 mg/kg, about 0.3 mg/kg to about 3.2 mg/kg, about 0.35
mg/kg to about 2.85 mg/kg, about 0.15 mg/kg to about 2.85 mg/kg,
about 0.3 mg to about 2.15 mg/kg, about 0.45 mg/kg to about 1.7
mg/kg, about 0.15 mg/kg to about 1.3 mg/kg, about 0.3 mg/kg to
about 1.15 mg/kg, about 0.45 mg/kg to about 1 mg/kg, about 0.55
mg/kg to about 0.85 mg/kg, about 0.65 mg/kg to about 0.8 mg/kg,
about 0.7 mg/kg to about 0.75 mg/kg, about 0.7 mg/kg to about 2.15
mg/kg, about 0.85 mg/kg to about 2 mg/kg, about 1 mg/kg to about
1.85 mg/kg, about 1.15 mg/kg to about 1.7 mg/kg, about 1.3 mg/kg mg
to about 1.6 mg/kg, about 1.35 mg/kg to about 1.5 mg/kg, about 2.15
mg/kg to about 3.6 mg/kg, about 2.3 mg/kg to about 3.4 mg/kg, about
2.4 mg/kg to about 3.3 mg/kg, about 2.6 mg/kg to about 3.15 mg/kg,
about 2.7 mg/kg to about 3 mg/kg, about 2.8 mg/kg to about 3 mg/kg,
or about 2.85 mg/kg to about 2.95 mg/kg.
[0627] In some embodiments, an effective dosage of TILs is in the
range of about 1 mg to about 500 mg, about 10 mg to about 300 mg,
about 20 mg to about 250 mg, about 25 mg to about 200 mg, about 1
mg to about 50 mg, about 5 mg to about 45 mg, about 10 mg to about
40 mg, about 15 mg to about 35 mg, about 20 mg to about 30 mg,
about 23 mg to about 28 mg, about 50 mg to about 150 mg, about 60
mg to about 140 mg, about 70 mg to about 130 mg, about 80 mg to
about 120 mg, about 90 mg to about 110 mg, or about 95 mg to about
10.sup.5 mg, about 98 mg to about 102 mg, about 150 mg to about 250
mg, about 160 mg to about 240 mg, about 170 mg to about 230 mg,
about 180 mg to about 220 mg, about 190 mg to about 210 mg, about
195 mg to about 205 mg, or about 198 to about 207 mg.
[0628] An effective amount of the TILs may be administered in
either single or multiple doses by any of the accepted modes of
administration of agents having similar utilities, including
intranasal and transdermal routes, by intra-arterial injection,
intravenously, intraperitoneally, parenterally, intramuscularly,
subcutaneously, topically, by transplantation, or by
inhalation.
Biomarker Correlation for Predicting Treatment Efficacy and/or
Response
[0629] Interferon gamma inducible protein 10 (IP-10) (also known as
CXCL10) is a 10 kDa chemokine that was originally identified based
on expression of the IP-10 gene in cells treated with interferon
gamma (IFN-gamma) (Luster, A. D et al. (1985) Nature 315:672-676).
The sequence for human IP-10 can be found in as Genbank Acc. No.
NP_001556. The present invention provides methods of predicting
treatment response and/or therapeutic efficacy of a TIL therapy
administered as described herein.
[0630] In some aspects of the invention, IP-10 is measured after
treatment of a patient with a therapeutic population of tumor
infiltrating lymphocytes (TILs). In some embodiments, any method
know in the art for detecting IP-10 can be employed. For example,
some methods for detection include the use of IP antibodies,
including for example, those described in U.S. Patent Publication
No. 2005/0191293. In some embodiments, the level of IP-10 is the
level of IP-10 protein in a sample. In some embodiments, measured
by a commercial Bio-Rad bead-based Bio-Plex immunoassay, which
measures multiple cytokines and chemokines, and which includes an
antibody specific for IP-10. In some embodiments, IP-10 is measured
by taking blood samples from the patient and is measured in the
plasma fraction obtained from the blood (i.e., after all blood
cells are removed) and is reported in units of picograms per
milliliter of plasma. In some embodiments, the level of IP-10 is
measured by calculating the difference between the level of IP-10
before administration of the therapeutic population of TILs and the
level of IP-10 after administration of the therapeutic population
of TILs. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 at Day -7
before administration of the therapeutic population of TILs and the
level of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration.
[0631] The present invention provides methods of treating cancer,
including treating double-refractory metastatic melanoma, in a
patient in need by administering a therapeutically effective
population of tumor infiltrating lymphocytes (TILs) to the patient,
where the patient is shown to exhibit an increase in IP-10 after
administration of the therapeutically effective population of tumor
infiltrating lymphocytes (TILs). In some embodiments, and the
increase in the level of IP-10 is indicative of treatment response
and/or treatment efficacy of the TIL administration. In some
embodiments, the increase in the level of IP-10 is at least
one-fold to at least five-fold, as compared to the level of IP-10
in the patient before the TIL administration. In some embodiments,
the IP-10 is measured before another treatment regimen, such as an
anti-PD-1 treatment regimen. In some embodiments, the IP-10 is
measured after another treatment regimen, such as an anti-PD-1
treatment regimen, but before administration of TILs. In some
embodiments, the level of IP-10 is measured before the TILs are
harvested for expansion. In some embodiments, the level of IP-10 is
measured after the TILs are harvested for expansion. In some
embodiments, the level IP-10 is measured 6 hours to 24 hours prior
to administration of the TILs to the patient. In some embodiments,
the level of IP-10 is measured 1 day, 2 days, 3 days, 4 days, 5
days or more before administration of the TILs to the patient. In
some embodiments, the level of IP-10 is measured by calculating the
difference between the level of IP-10 before administration of the
therapeutic population of TILs and the level of IP-10 after
administration of the therapeutic population of TILs. In some
embodiments, the level of IP-10 is measured by calculating the
difference between the level of IP-10 at Day -7 before
administration of the therapeutic population of TILs and the level
of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration. In some embodiments, the threshold value
for IP-10 level is about 500 pg/ml to about 3500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the level
of IP-10 is about 1000 pg/ml to about 3000 pg/mL, wherein an IP-10
level above the threshold value is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 1000 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the level of IP-10 is at least 1500 pg/mL and the IP-10 level is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is at least 2000 pg/mL and the
IP-10 level is indicative of treatment efficacy and/or treatment
response. In some embodiments, the level of IP-10 is at least 2500
pg/mL and the IP-10 level is indicative of treatment efficacy
and/or treatment response. In some embodiments, the increase in the
level of IP-10 is measured by calculating the difference in IP-10
level in plasma seven days before TIL infusion and one day after
TIL infusion, and wherein said difference in IP-10 level in plasma
is at least 800 pg/mL, at least 900 pg/mL, at least 1000 pg/mL, at
least 1100 pg/mL, at least 1200 pg/mL, at least 1300 pg/mL, at
least 1400 pg/mL, at least 1500 pg/mL, at least 1600 pg/mL, at
least 1700 pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at
least 2000 pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL. In
some embodiments, when there is an increase in the level of IP-10
after administration of a therapeutically effective population of
tumor infiltrating lymphocytes, the patient is administered one or
more further dosages of a therapeutically effective population of
tumor infiltrating lymphocytes (TILs). In some embodiments, when
there is an increase in the level of IP-10 after administration of
a therapeutically effective population of tumor infiltrating
lymphocytes, patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs). In some embodiments, the therapeutically
effective population that results in an increase in the level of
IP-10 after administration of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs. In some
embodiments, the one, two, three or more therapeutic TIL dosages
are administered after determining there is an increase in the
level of IP-10.
[0632] In some embodiments the invention provides methods of
treating cancer or double-refractory metastatic melanoma in a
patient where the method comprises: (a) obtaining a first
population of TILs from a tumor resected from the patient by
processing a tumor sample obtained from the patient into multiple
tumor fragments; (b) adding the tumor fragments into a closed
system; (c) performing a first expansion by culturing the first
population of TILs in a cell culture medium comprising IL-2, and
optionally OKT-3, to produce a second population of TILs, wherein
the first expansion is performed in a closed container providing a
first gas-permeable surface area, wherein the first expansion is
performed for about 3-14 days to obtain the second population of
TILs, wherein the second population of TILs is at least 50-fold
greater in number than the first population of TILs, and wherein
the transition from step (b) to step (c) occurs without opening the
system; (d) performing a second expansion by supplementing the cell
culture medium of the second population of TILs with additional
IL-2, optionally OKT-3, and antigen presenting cells (APCs), to
produce a third population of TILs, wherein the second expansion is
performed for about 7-14 days to obtain the third population of
TILs, wherein the third population of TILs is a therapeutic
population of TILs, wherein the second expansion is performed in a
closed container providing a second gas-permeable surface area, and
wherein the transition from step (c) to step (d) occurs without
opening the system; (e) harvesting the therapeutic population of
TILs obtained from step (d) to provide a harvested TIL population,
wherein the transition from step (d) to step (e) occurs without
opening the system; (f) transferring the harvested TIL population
from step (e) to an infusion bag, wherein the transfer from step
(e) to (f) occurs without opening the system, and optionally
cryopreserving the harvested TIL population and (g) administering a
therapeutically effective amount of the harvested TIL population to
the patient with cancer or double-refractory metastatic melanoma.
In some embodiments, the patient exhibits an increase in IP-10
after administration of the therapeutically effective population of
tumor infiltrating lymphocytes (TILs). In some embodiments, the
patient is shown to exhibit an increase in IP-10 after
administration of the therapeutically effective population of tumor
infiltrating lymphocytes (TILs). In some embodiments, and the
increase in the level of IP-10 is indicative of treatment response
and/or treatment efficacy of the TIL administration. In some
embodiments, the increase in the level of IP-10 is at least
one-fold to at least five-fold, as compared to the level of IP-10
in the patient before the TIL administration. In some embodiments,
the IP-10 is measured before another treatment regimen, such as an
anti-PD-1 treatment regimen. In some embodiments, the IP-10 is
measured after another treatment regimen, such as an anti-PD-1
treatment regimen, but before administration of TILs. In some
embodiments, the level of IP-10 is measured before the TILs are
harvested for expansion. In some embodiments, the level of IP-10 is
measured after the TILs are harvested for expansion. In some
embodiments, the level IP-10 is measured 6 hours to 24 hours prior
to administration of the TILs to the patient. In some embodiments,
the level of IP-10 is measured 1 day, 2 days, 3 days, 4 days, 5
days or more before administration of the TILs to the patient. In
some embodiments, when there is an increase in the level of IP-10
after administration of a therapeutically effective population of
tumor infiltrating lymphocytes, the patient is administered one or
more further dosages of a therapeutically effective population of
tumor infiltrating lymphocytes (TILs). In some embodiments, when
there is an increase in the level of IP-10 after administration of
a therapeutically effective population of tumor infiltrating
lymphocytes, patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs). In some embodiments, the therapeutically
effective population that results in an increase in the level of
IP-10 after administration of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs. In some
embodiments, the one, two, three or more therapeutic TIL dosages
are administered after determining there is an increase in the
level of IP-10. In some embodiments, the level of IP-10 is measured
by calculating the difference between the level of IP-10 before
administration of the therapeutic population of TILs and the level
of IP-10 after administration of the therapeutic population of
TILs. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 at Day -7
before administration of the therapeutic population of TILs and the
level of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration. In some embodiments, the threshold value
for IP-10 level is about 500 pg/ml to about 3500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the level
of IP-10 is about 1000 pg/ml to about 3000 pg/mL, wherein an IP-10
level above the threshold value is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 1000 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the level of IP-10 is at least 1500 pg/mL and the IP-10 level is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is at least 2000 pg/mL and the
IP-10 level is indicative of treatment efficacy and/or treatment
response. In some embodiments, the level of IP-10 is at least 2500
pg/mL and the IP-10 level is indicative of treatment efficacy
and/or treatment response. In some embodiments, the increase in the
level of IP-10 is measured by calculating the difference in IP-10
level in plasma seven days before TIL infusion and one day after
TIL infusion, and wherein said difference in IP-10 level in plasma
is at least 800 pg/mL, at least 900 pg/mL, at least 1000 pg/mL, at
least 1100 pg/mL, at least 1200 pg/mL, at least 1300 pg/mL, at
least 1400 pg/mL, at least 1500 pg/mL, at least 1600 pg/mL, at
least 1700 pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at
least 2000 pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL.
[0633] In some embodiments the invention provides methods of
treating cancer or double-refractory metastatic melanoma in a
patient in need thereof, the method comprising: (a) obtaining a
first population of TILs from a tumor resected from the patient by
processing a tumor sample obtained from the patient into multiple
tumor fragments; (b) adding the tumor fragments into a closed
system; (c) performing a first expansion by culturing the first
population of TILs in a cell culture medium comprising IL-2, and
optionally OKT-3, to produce a second population of TILs, wherein
the first expansion is performed in a closed container providing a
first gas-permeable surface area, wherein the first expansion is
performed for about 3-14 days to obtain the second population of
TILs, wherein the second population of TILs is at least 50-fold
greater in number than the first population of TILs, and wherein
the transition from step (b) to step (c) occurs without opening the
system; (d) performing a second expansion by supplementing the cell
culture medium of the second population of TILs with additional
IL-2, optionally OKT-3, and antigen presenting cells (APCs), to
produce a third population of TILs, wherein the second expansion is
performed for about 7-14 days to obtain the third population of
TILs, wherein the third population of TILs is a therapeutic
population of TILs, wherein the second expansion is performed in a
closed container providing a second gas-permeable surface area, and
wherein the transition from step (c) to step (d) occurs without
opening the system; (e) harvesting the therapeutic population of
TILs obtained from step (d) to provide a harvested TIL population,
wherein the transition from step (d) to step (e) occurs without
opening the system; (f) transferring the harvested TIL population
from step (e) to an infusion bag, wherein the transfer from step
(e) to (f) occurs without opening the system, and optionally
cryopreserving the harvested TIL population; (g) administering a
therapeutically effective amount of the harvested TIL population to
the patient with double-refractory metastatic melanoma; and (h)
measuring the level of IP-10 in the patient after administering a
therapeutically effective amount of the TILs in step (g). In some
embodiments, an increase in the level of IP-10 in step (h) is
measured. In some embodiments, the increase in the level of IP-10
is indicative of treatment response and/or treatment efficacy of
the TIL administration. In some embodiments, the increase in the
level of IP-10 in step (h) is indicative of treatment efficacy. In
some embodiments, the level of IP-10 is measured about 1 day to 10
days post administering the therapeutically effective amount of the
TILs in step (g). In some embodiments, the level of IP-10 is
measured 1 day post administering a therapeutically effective
amount of the TILs in step (g). In some embodiments, the level of
IP-10 is measured about 6 hours to 24 hours post administering the
therapeutically effective amount of the TILs in step (g). In some
embodiments, the method further comprises a step of measuring the
level of IP-10 in the patient prior to administering a
therapeutically effective amount of the TILs in step (g). In some
embodiments, the increase is based on an increase in the levels of
IP-10 in the patient prior to administering a therapeutically
effective amount of the TIL in step (g) as compared to the level of
IP-10 in the patient prior to administering a therapeutically
effective amount of the TILs in step (g). In some embodiments, the
method further comprises step (i) predicting the patient will
respond to the therapeutically effective amount of the TILs
administered in step (g) based upon measuring an increase in the
levels of IP-10 in step (h). In some embodiments, the method
further comprises step (i) predicting the patient will not respond
to the therapeutically effective amount of the TILs administered in
step (g) based upon measuring no increase in the levels of IP-10 in
step (h). In some embodiments, the method further comprises step
(i) predicting the patient will respond to the therapeutically
effective amount of the TILs administered in step (g) based upon
measuring an increase in the levels of IP-10 in step (h) or
predicting the patient will not respond to the therapeutically
effective amount of the TILs administered in step (g) based upon
measuring no increase in the levels of IP-10 in step (h). In some
embodiments, predicting the probability that the patient will or
will not respond to the therapeutically effective amount of the
TILs administered in step (g) is based upon the presence or absence
of an increase in the level of IP-10 in step (h). In some
embodiments, the increase in the level of IP-10 is an increase of
at least one-fold, two-fold, three-fold, four-fold, five-fold or
more. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 before
administration of the therapeutic population of TILs and the level
of IP-10 after administration of the therapeutic population of
TILs. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 at Day -7
before administration of the therapeutic population of TILs and the
level of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration. In some embodiments, predicting the
probability that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(g) comprises correlating the level of IP-10 measured in the
patient with a threshold value, wherein if the level of IP-10
measured is above the threshold value a further TIL treatment
regimen in indicated. In some embodiments, the threshold value for
IP-10 level is about 500 pg/ml to about 3500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the level
of IP-10 is about 1000 pg/ml to about 3000 pg/mL, wherein an IP-10
level above the threshold value is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 1000 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the level of IP-10 is at least 1500 pg/mL and the IP-10 level is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is at least 2000 pg/mL and the
IP-10 level is indicative of treatment efficacy and/or treatment
response. In some embodiments, the level of IP-10 is at least 2500
pg/mL and the IP-10 level is indicative of treatment efficacy
and/or treatment response. In some embodiments, the increase in the
level of IP-10 is measured by calculating the difference in IP-10
level in plasma seven days before TIL infusion and one day after
TIL infusion, and wherein said difference in IP-10 level in plasma
is at least 800 pg/mL, at least 900 pg/mL, at least 1000 pg/mL, at
least 1100 pg/mL, at least 1200 pg/mL, at least 1300 pg/mL, at
least 1400 pg/mL, at least 1500 pg/mL, at least 1600 pg/mL, at
least 1700 pg/mL, or at least 1800 pg/mL, at least 1900 pg/mL, at
least 2000 pg/mL, at least 2100 pg/mL, or at least 2200 pg/mL. In
some embodiments, the difference in IP-10 level in plasma is at
least 800 pg/mL. In some embodiments, the difference in IP-10 level
in plasma is at least 900 pg/mL. In some embodiments, the
difference in IP-10 level in plasma is at least 1000 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1100 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1200 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1300 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1400 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1500 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1600 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1700 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is or at least 1800 pg/mL. In some embodiments, the
difference in IP-10 level in plasma is at least 1900 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
2000 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 2100 pg/mL, or at least 2200 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1600 pg/ml. In some embodiments, the difference in IP-10 level in
plasma is at least 1650 pg/ml. In some embodiments, the difference
in IP-10 level in plasma is at least 1656 pg/ml. In some
embodiments, the increase in the level of IP-10 is at least
one-fold to at least five-fold, as compared to the level of IP-10
in the patient before the TIL administration. In some embodiments,
the IP-10 is measured before another treatment regimen, such as an
anti-PD-1 treatment regimen. In some embodiments, the IP-10 is
measured after another treatment regimen, such as an anti-PD-1
treatment regimen, but before administration of TILs. In some
embodiments, the level of IP-10 is measured before the TILs are
harvested for expansion. In some embodiments, the level of IP-10 is
measured after the TILs are harvested for expansion. In some
embodiments, the level IP-10 is measured 6 hours to 24 hours prior
to administration of the TILs to the patient. In some embodiments,
the level of IP-10 is measured 1 day, 2 days, 3 days, 4 days, 5
days or more before administration of the TILs to the patient. In
some embodiments, when there is an increase in the level of IP-10
after administration of a therapeutically effective population of
tumor infiltrating lymphocytes, the patient is administered a
further dosage of a therapeutically effective population of tumor
infiltrating lymphocytes (TILs). In some embodiments, when there is
an increase in the level of IP-10 after administration of a
therapeutically effective population of tumor infiltrating
lymphocytes, patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs). In some embodiments, the therapeutically
effective population that results in an increase in the level of
IP-10 after administration of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs. In some
embodiments, the one, two, three or more therapeutic TIL dosages
are administered after determining there is an increase in the
level of IP-10.
[0634] In some embodiments, the invention also provides a method of
treating cancer in a patient in need thereof, the method
comprising: (a) obtaining a first population of TILs from a tumor
resected from the patient by processing a tumor sample obtained
from the patient into multiple tumor fragments; (b) adding the
tumor fragments into a closed system; (c) performing a first
expansion by culturing the first population of TILs in a cell
culture medium comprising IL-2, and optionally OKT-3, to produce a
second population of TILs, wherein the first expansion is performed
in a closed container providing a first gas-permeable surface area,
wherein the first expansion is performed for about 3-14 days to
obtain the second population of TILs, wherein the second population
of TILs is at least 50-fold greater in number than the first
population of TILs, and wherein the transition from step (b) to
step (c) occurs without opening the system; (d) performing a second
expansion by supplementing the cell culture medium of the second
population of TILs with additional IL-2, optionally OKT-3, and
antigen presenting cells (APCs), to produce a third population of
TILs, wherein the second expansion is performed for about 7-14 days
to obtain the third population of TILs, wherein the third
population of TILs is a therapeutic population of TILs, wherein the
second expansion is performed in a closed container providing a
second gas-permeable surface area, and wherein the transition from
step (c) to step (d) occurs without opening the system; (e)
harvesting the therapeutic population of TILs obtained from step
(d) to provide a harvested TIL population, wherein the transition
from step (d) to step (e) occurs without opening the system; (f)
transferring the harvested TIL population from step (e) to an
infusion bag, wherein the transfer from step (e) to (f) occurs
without opening the system, and optionally cryopreserving the
harvested TIL population; (g) administering a therapeutically
effective amount of the harvested TIL population to the patient
with double-refractory metastatic melanoma; and (h) measuring the
level of IP-10 in the patient after administering a therapeutically
effective amount of the TILs in step (g). In some embodiments, an
increase in the level of IP-10 in step (h) is measured. In some
embodiments, an increase in the level of IP-10 in step (h) is
indicative of treatment efficacy. In some embodiments, the level of
IP-10 is measured about 1 day to 10 days post administering the
therapeutically effective amount of the TILs in step (g). In some
embodiments, the level of IP-10 is measured 1 day post
administering a therapeutically effective amount of the TILs in
step (g). In some embodiments, the level of IP-10 is measured about
6 hours to 24 hours post administering the therapeutically
effective amount of the TILs in step (g). In some embodiments, the
increase in the level of IP-10 is at least one-fold to at least
five-fold, as compared to the level of IP-10 in the patient before
the TIL administration. In some embodiments, the IP-10 is measured
before another treatment regimen, such as an anti-PD-1 treatment
regimen. In some embodiments, the IP-10 is measured after another
treatment regimen, such as an anti-PD-1 treatment regimen, but
before administration of TILs. In some embodiments, the level of
IP-10 is measured before the TILs are harvested for expansion. In
some embodiments, the level of IP-10 is measured after the TILs are
harvested for expansion. In some embodiments, the level IP-10 is
measured 6 hours to 24 hours prior to administration of the TILs to
the patient. In some embodiments, the level of IP-10 is measured 1
day, 2 days, 3 days, 4 days, 5 days or more before administration
of the TILs to the patient. In some embodiments, the method further
comprises a step of measuring the level of IP-10 in the patient
prior to administering a therapeutically effective amount of the
TILs in step (g). In some embodiments, the increase is based on an
increase in the levels of IP-10 in the patient after administering
a therapeutically effective amount of the TILs in step (g) as
compared to the level of IP-10 in the patient prior to
administering a therapeutically effective amount of the TILs in
step (g). In some embodiments, the method further comprises step
(i) predicting the patient will respond to the therapeutically
effective amount of the TILs administered in step (g) based upon
measuring an increase in the levels of IP-10 in step (h). In some
embodiments, the method further comprises step (i) predicting the
patient will not respond to the therapeutically effective amount of
the TILs administered in step (g) based upon measuring no increase
in the levels of IP-10 in step (h). In some embodiments, the level
of IP-10 is measured by calculating the difference between the
level of IP-10 before administration of the therapeutic population
of TILs and the level of IP-10 after administration of the
therapeutic population of TILs. In some embodiments, the level of
IP-10 is measured by calculating the difference between the level
of IP-10 at Day -7 before administration of the therapeutic
population of TILs and the level of IP-10 at Day 1 after
administration of the therapeutic population of TILs, wherein Day 0
is the Day of the TIL infusion/administration. In some embodiments,
the threshold value for IP-10 level is about 500 pg/ml to about
3500 pg/mL, wherein an IP-10 level above the threshold value is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the threshold value for IP-10 level is at least 1000
pg/mL, wherein an IP-10 level above the threshold value is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the threshold value for IP-10 level is at least 1500
pg/mL, wherein an IP-10 level above the threshold value is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the threshold value for IP-10 level is at least 2000
pg/mL, wherein an IP-10 level above the threshold value is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the threshold value for IP-10 level is at least 2500
pg/mL, wherein an IP-10 level above the threshold value is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is about 1000 pg/ml to about 3000
pg/mL, wherein an IP-10 level above the threshold value is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is at least 1000 pg/mL and the
IP-10 level is indicative of treatment efficacy and/or treatment
response. In some embodiments, the level of IP-10 is at least 1500
pg/mL and the IP-10 level is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 2000 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the level of IP-10 is at least 2500 pg/mL and the IP-10 level is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the increase in the level of IP-10 is measured by
calculating the difference in IP-10 level in plasma seven days
before TIL infusion and one day after TIL infusion, and wherein
said difference in IP-10 level in plasma is at least 800 pg/mL, at
least 900 pg/mL, at least 1000 pg/mL, at least 1100 pg/mL, at least
1200 pg/mL, at least 1300 pg/mL, at least 1400 pg/mL, at least 1500
pg/mL, at least 1600 pg/mL, at least 1700 pg/mL, or at least 1800
pg/mL, at least 1900 pg/mL, at least 2000 pg/mL, at least 2100
pg/mL, or at least 2200 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 800 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
900 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1000 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1100 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1200 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1300 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1400 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1500 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1600 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1700 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is or at least
1800 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1900 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 2000 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
2100 pg/mL, or at least 2200 pg/mL. In some embodiments, the
difference in IP-10 level in plasma is at least 1600 pg/ml. In some
embodiments, the difference in IP-10 level in plasma is at least
1650 pg/ml. In some embodiments, the difference in IP-10 level in
plasma is at least 1656 pg/ml.
[0635] In some embodiments, the method further comprises step (i)
predicting the patient will respond to the therapeutically
effective amount of the TILs administered in step (g) based upon
measuring an increase in the levels of IP-10 in step (h) or
predicting the patient will not respond to the therapeutically
effective amount of the TILs administered in step (g) based upon
measuring no increase in the levels of IP-10 in step (h). In some
embodiments, predicting the probability that the patient will or
will not respond to the therapeutically effective amount of the
TILs administered in step (g) is based upon the presence or absence
of an increase in the level of IP-10 in step (h). In some
embodiments, the increase in the level of IP-10 is an increase of
at least one-fold, two-fold, three-fold, four-fold, five-fold or
more. In some embodiments, the increase in the level of IP-10 is at
least one-fold to at least five-fold, as compared to the level of
IP-10 in the patient before the TIL administration. In some
embodiments, the IP-10 is measured before another treatment
regimen, such as an anti-PD-1 treatment regimen. In some
embodiments, the IP-10 is measured after another treatment regimen,
such as an anti-PD-1 treatment regimen, but before administration
of TILs. In some embodiments, the level of IP-10 is measured before
the TILs are harvested for expansion. In some embodiments, the
level of IP-10 is measured after the TILs are harvested for
expansion. In some embodiments, the level IP-10 is measured 6 hours
to 24 hours prior to administration of the TILs to the patient. In
some embodiments, the level of IP-10 is measured 1 day, 2 days, 3
days, 4 days, 5 days or more before administration of the TILs to
the patient. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 before
administration of the therapeutic population of TILs and the level
of IP-10 after administration of the therapeutic population of
TILs. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 at Day -7
before administration of the therapeutic population of TILs and the
level of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration. In some embodiments, predicting the
probability that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(g) comprises correlating the level of IP-10 measured in the
patient with a threshold value, wherein if the level of IP-10
measured is above the threshold value a further TIL treatment
regimen in indicated. In some embodiments, the threshold value for
IP-10 level is about 500 pg/ml to about 3500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 1500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2000 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the
threshold value for IP-10 level is at least 2500 pg/mL, wherein an
IP-10 level above the threshold value is indicative of treatment
efficacy and/or treatment response. In some embodiments, the level
of IP-10 is about 1000 pg/ml to about 3000 pg/mL, wherein an IP-10
level above the threshold value is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 1000 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the level of IP-10 is at least 1500 pg/mL and the IP-10 level is
indicative of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is at least 2000 pg/mL and the
IP-10 level is indicative of treatment efficacy and/or treatment
response. In some embodiments, the level of IP-10 is at least 2500
pg/mL and the IP-10 level is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 2500 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the increase in the level of IP-10 is measured by calculating the
difference in IP-10 level in plasma seven days before TIL infusion
and one day after TIL infusion, and wherein said difference in
IP-10 level in plasma is at least 800 pg/mL, at least 900 pg/mL, at
least 1000 pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at
least 1300 pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at
least 1600 pg/mL, at least 1700 pg/mL, or at least 1800 pg/mL, at
least 1900 pg/mL, at least 2000 pg/mL, at least 2100 pg/mL, or at
least 2200 pg/mL. In some embodiments, the difference in IP-10
level in plasma is at least 800 pg/mL. In some embodiments, the
difference in IP-10 level in plasma is at least 900 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1000 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1100 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1200 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1300 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1400 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1500 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1600 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1700 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is or at least 1800 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1900 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 2000 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 2100 pg/mL, or at least 2200
pg/mL. In some embodiments, the difference in IP-10 level in plasma
is at least 1600 pg/ml. In some embodiments, the difference in
IP-10 level in plasma is at least 1650 pg/ml. In some embodiments,
the difference in IP-10 level in plasma is at least 1656 pg/ml. In
some embodiments, when there is an increase in the level of IP-10
after administration of a therapeutically effective population of
tumor infiltrating lymphocytes, the patient is administered a
further dosage of a therapeutically effective population of tumor
infiltrating lymphocytes (TILs). In some embodiments, when there is
an increase in the level of IP-10 after administration of a
therapeutically effective population of tumor infiltrating
lymphocytes, patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs). In some embodiments, the therapeutically
effective population that results in an increase in the level of
IP-10 after administration of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs. In some
embodiments, the one, two, three or more therapeutic TIL dosages
are administered after determining there is an increase in the
level of IP-10.
[0636] In some embodiments, the invention provides methods of
predicting a treatment response and/or predicting treatment
efficacy for administration of a therapeutically effective amount
of tumor infiltrating lymphocytes (TILs) to a patient, the method
comprising: a) obtaining a biological sample from a patient with
cancer, including double-refractory metastatic melanoma; b)
measuring the level of IP-10 in the biological sample from a); c)
administering a therapeutically effective amount of TILs; d)
obtaining a biological sample from the patient after the
administration of the therapeutically effective amount of TILs in
step c); e) measuring the level of IP-10 in the biological sample
from d); f) predicting a treatment response to and/or predicting
treatment efficacy of the administration of the therapeutically
effective amount of the TILs based upon the level of IP-10 measured
after administration as compared to the level of IP-10 measured
prior to administration. In some embodiments, the increase in the
level of IP-10 measured in step (e) is determined as compared to
the level of IP-10 measured step (b) is observed. In some
embodiments, the increase in the level of IP-10 in step (e) is
determined as compared to the level of IP-10 measured step (b) is
indicative of treatment efficacy. In some embodiments, the increase
in the level of IP-10 is measured in step (e) about 1 day to 10
days post administering a therapeutically effective amount of the
TILs in step (c). In some embodiments, the increase in the level of
IP-10 is measured in step (e) about 1 day post administering a
therapeutically effective amount of the TILs in step (c). In some
embodiments, the increase in the level of IP-10 is measured in step
(e) about 6 hours to 24 hours post administering a therapeutically
effective amount of the TILs in step (g). In some embodiments,
predicting that the patient will or will not respond to the
therapeutically effective amount of the TILs administered in step
(c) is based upon an increase in the level of IP-10 measured in
step (f). In some embodiments, detecting an increase in the level
of IP-10 measured in step (e) as compared to the level of IP-10
measured step (b) indicates that the patient will respond to the
therapeutically effective amount of the TILs administered in step
(d). In some embodiments, detecting no increase in the level of
IP-10 measured in step (e) as compared to the level of IP-10
measured step (b) indicates that the patient will not respond to
the therapeutically effective amount of the TILs administered in
step (d). In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 before
administration of the therapeutic population of TILs and the level
of IP-10 after administration of the therapeutic population of
TILs. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 at Day -7
before administration of the therapeutic population of TILs and the
level of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration. In some embodiments, the level of IP-10 is
increased one-fold, two-fold, three-fold, four-fold, five-fold or
more. In some embodiments, the increase in the level of IP-10 is at
least one-fold to at least five-fold, as compared to the level of
IP-10 in the patient before the TIL administration. In some
embodiments, the IP-10 is measured before another treatment
regimen, such as an anti-PD-1 treatment regimen. In some
embodiments, the IP-10 is measured after another treatment regimen,
such as an anti-PD-1 treatment regimen, but before administration
of TILs. In some embodiments, the level of IP-10 is measured before
the TILs are harvested for expansion. In some embodiments, the
level of IP-10 is measured after the TILs are harvested for
expansion. In some embodiments, the level IP-10 is measured 6 hours
to 24 hours prior to administration of the TILs to the patient. In
some embodiments, the level of IP-10 is measured 1 day, 2 days, 3
days, 4 days, 5 days or more before administration of the TILs to
the patient. In some embodiments, predicting that the patient will
or will not respond to the therapeutically effective amount of the
TILs administered in step (d) further comprises correlating the
level of IP-10 measured in the patient with a threshold value. In
some embodiments, the threshold value for IP-10 level is about 500
pg/ml to about 3500 pg/mL, wherein an IP-10 level above the
threshold value is indicative of treatment efficacy and/or
treatment response. In some embodiments, the threshold value for
IP-10 level is at least 1000 pg/mL, wherein an IP-10 level above
the threshold value is indicative of treatment efficacy and/or
treatment response. In some embodiments, the threshold value for
IP-10 level is at least 1500 pg/mL, wherein an IP-10 level above
the threshold value is indicative of treatment efficacy and/or
treatment response. In some embodiments, the threshold value for
IP-10 level is at least 2000 pg/mL, wherein an IP-10 level above
the threshold value is indicative of treatment efficacy and/or
treatment response. In some embodiments, the threshold value for
IP-10 level is at least 2500 pg/mL, wherein an IP-10 level above
the threshold value is indicative of treatment efficacy and/or
treatment response. In some embodiments, the level of IP-10 is
about 1000 pg/ml to about 3000 pg/mL, wherein an IP-10 level above
the threshold value is indicative of treatment efficacy and/or
treatment response. In some embodiments, the level of IP-10 is at
least 1000 pg/mL and the IP-10 level is indicative of treatment
efficacy and/or treatment response. In some embodiments, the level
of IP-10 is at least 1500 pg/mL and the IP-10 level is indicative
of treatment efficacy and/or treatment response. In some
embodiments, the level of IP-10 is at least 2000 pg/mL and the
IP-10 level is indicative of treatment efficacy and/or treatment
response. In some embodiments, the level of IP-10 is at least 2500
pg/mL and the IP-10 level is indicative of treatment efficacy
and/or treatment response. In some embodiments, the level of IP-10
is at least 2500 pg/mL and the IP-10 level is indicative of
treatment efficacy and/or treatment response. In some embodiments,
the increase in the level of IP-10 is measured by calculating the
difference in IP-10 level in plasma seven days before TIL infusion
and one day after TIL infusion, and wherein said difference in
IP-10 level in plasma is at least 800 pg/mL, at least 900 pg/mL, at
least 1000 pg/mL, at least 1100 pg/mL, at least 1200 pg/mL, at
least 1300 pg/mL, at least 1400 pg/mL, at least 1500 pg/mL, at
least 1600 pg/mL, at least 1700 pg/mL, or at least 1800 pg/mL, at
least 1900 pg/mL, at least 2000 pg/mL, at least 2100 pg/mL, or at
least 2200 pg/mL. In some embodiments, the difference in IP-10
level in plasma is at least 800 pg/mL. In some embodiments, the
difference in IP-10 level in plasma is at least 900 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1000 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1100 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1200 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1300 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1400 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 1500 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1600 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 1700 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is or at least 1800 pg/mL. In some
embodiments, the difference in IP-10 level in plasma is at least
1900 pg/mL. In some embodiments, the difference in IP-10 level in
plasma is at least 2000 pg/mL. In some embodiments, the difference
in IP-10 level in plasma is at least 2100 pg/mL, or at least 2200
pg/mL. In some embodiments, the difference in IP-10 level in plasma
is at least 1600 pg/ml. In some embodiments, the difference in
IP-10 level in plasma is at least 1650 pg/ml. In some embodiments,
the difference in IP-10 level in plasma is at least 1656 pg/ml. In
some embodiments, when there is an increase in the level of IP-10
after administration of a therapeutically effective population of
tumor infiltrating lymphocytes, the patient is administered one or
more further dosages of a therapeutically effective population of
tumor infiltrating lymphocytes (TILs). In some embodiments, when
there is an increase in the level of IP-10 after administration of
a therapeutically effective population of tumor infiltrating
lymphocytes, patient is not administered a further dosage of a
therapeutically effective population of tumor infiltrating
lymphocytes (TILs). In some embodiments, the therapeutically
effective population that results in an increase in the level of
IP-10 after administration of TILs comprises from about
2.3.times.10.sup.10 to about 13.7.times.10.sup.10 TILs. In some
embodiments, the one, two, three or more therapeutic TIL dosages
are administered after determining there is an increase in the
level of IP-10.
[0637] According to the methods described herein, IP-10 production
can be measured by determining the levels of the IP-10 in the blood
of a subject treated with TILs prepared by the methods of the
present invention, including those as described for example in FIG.
18. In some embodiments, the level of IP-10 is the level of IP-10
protein in a sample. In some embodiments, IP-10 is measured by a
commercial Bio-Rad bead-based Bio-Plex immunoassay, which measures
multiple cytokines and chemokines, and which includes an antibody
specific for IP-10. In some embodiments, IP-10 is measured by
taking blood samples from the patient and is measured in the plasma
fraction obtained from the blood (i.e., after all blood cells are
removed) and is reported in units of picograms per milliliter of
plasma. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 before
administration of the therapeutic population of TILs and the level
of IP-10 after administration of the therapeutic population of
TILs. In some embodiments, the level of IP-10 is measured by
calculating the difference between the level of IP-10 at Day -7
before administration of the therapeutic population of TILs and the
level of IP-10 at Day 1 after administration of the therapeutic
population of TILs, wherein Day 0 is the Day of the TIL
infusion/administration. In some embodiments, higher IP-10 is
indicative of treatment efficacy and/or increased clinical
efficacy. In some embodiments, higher IP-10 in the blood of
subjects treated with TILs is indicative of active TILs. IP-10
production can be measured by determining the levels of the IP-10
in the blood of a subject treated with TILs prepared by the methods
of the present invention, including those as described for example
in FIG. 18. In some embodiments, higher IP-10 is indicative of
treatment efficacy in a patient treated with the TILs produced by
the methods of the present invention. In some embodiments, higher
IP-10 correlates to an increase of one-fold, two-fold, three-fold,
four-fold, or five-fold or more as compared to an untreated patient
and/or as compared to a patient treated with TILs prepared using
other methods than those provide herein including for example,
methods other than those embodied in FIG. 18. In some embodiments,
higher IP-10 correlates to an increase of one-fold as compared to
an untreated patient and/or as compared to a patient treated with
TILs prepared using other methods than those provide herein
including for example, methods other than those embodied in FIG.
18. In some embodiments, higher IP-10 correlates to an increase of
two-fold as compared to an untreated patient and/or as compared to
a patient treated with TILs prepared using other methods than those
provide herein including for example, methods other than those
embodied in FIG. 18. In some embodiments, higher IP-10 correlates
to an increase of three-fold as compared to an untreated patient
and/or as compared to a patient treated with TILs prepared using
other methods than those provide herein including for example,
methods other than those embodied in FIG. 18. In some embodiments,
higher IP-10 correlates to an increase of four-fold as compared to
an untreated patient and/or as compared to a patient treated with
TILs prepared using other methods than those provide herein
including for example, methods other than those embodied in FIG.
18. In some embodiments, higher IP-10 correlates to an increase of
five-fold as compared to an untreated patient and/or as compared to
a patient treated with TILs prepared using other methods than those
provide herein including for example, methods other than those
embodied in FIG. 18. In some embodiments, IP-10 is measured in
blood of a subject treated with TILs prepared by the methods of the
present invention, including those as described for example in FIG.
18. In some embodiments, IP-10 is measured in TILs serum of a
subject treated with TILs prepared by the methods of the present
invention, including those as described for example in FIG. 18.
Certain Exemplary Embodiments
[0638] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0639] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0640] (b) fragmenting the tumor into tumor fragments; [0641]
(c) contacting the tumor fragments with a first cell culture
medium; [0642] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0643]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0644] (f) harvesting the third population of TILs;
and [0645] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; wherein
the cancer is double-refractory metastatic melanoma.
[0646] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0647] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0648] (b) fragmenting the tumor into tumor fragments; [0649]
(c) contacting the tumor fragments with a first cell culture
medium; [0650] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0651]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0652] (f) harvesting the third population of TILs;
and [0653] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0654]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is a cutaneous
double-refractory metastatic melanoma.
[0655] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0656] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0657] (b) fragmenting the tumor into tumor fragments; [0658]
(c) contacting the tumor fragments with a first cell culture
medium; [0659] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0660]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0661] (f) harvesting the third population of TILs;
and [0662] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0663]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is refractory to
at least two prior systemic treatment courses, not including
neo-adjuvant or adjuvant therapies.
[0664] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0665] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0666] (b) fragmenting the tumor into tumor fragments; [0667]
(c) contacting the tumor fragments with a first cell culture
medium; [0668] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0669]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0670] (f) harvesting the third population of TILs;
and [0671] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0672]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is refractory to
aldesleukin or a biosimilar thereof.
[0673] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0674] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0675] (b) fragmenting the tumor into tumor fragments; [0676]
(c) contacting the tumor fragments with a first cell culture
medium; [0677] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0678]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0679] (f) harvesting the third population of TILs;
and [0680] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0681]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is refractory to
pembrolizumab or a biosimilar thereof.
[0682] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0683] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0684] (b) fragmenting the tumor into tumor fragments; [0685]
(c) contacting the tumor fragments with a first cell culture
medium; [0686] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0687]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0688] (f) harvesting the third population of TILs;
and [0689] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0690]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is refractory to
nivolumab or a biosimilar thereof. [0691] (a) resecting a tumor
from a patient, the tumor comprising a first population of TILs;
[0692] (b) fragmenting the tumor into tumor fragments; [0693] (c)
contacting the tumor fragments with a first cell culture medium;
[0694] (d) performing an initial expansion of the In an embodiment,
the invention provides a method of treating a cancer with a
population of tumor infiltrating lymphocytes (TILs) comprising the
steps of: [0695] first population of TILs in the first cell culture
medium to obtain a second population of TILs, wherein the second
population of TILs is at least 5-fold greater in number than the
first population of TILs, wherein the first cell culture medium
comprises IL-2; [0696] (e) performing a rapid expansion of the
second population of TILs in a second cell culture medium to obtain
a third population of TILs, wherein the third population of TILs is
at least 50-fold greater in number than the second population of
TILs after 7 days from the start of the rapid expansion; wherein
the second cell culture medium comprises IL-2, OKT-3 (anti-CD3
antibody), and irradiated allogeneic peripheral blood mononuclear
cells (PBMCs); and wherein the rapid expansion is performed over a
period of 14 days or less; [0697] (f) harvesting the third
population of TILs; and [0698] (g) administering a therapeutically
effective portion of the third population of TILs to a patient with
the cancer; [0699] wherein the cancer is double-refractory
metastatic melanoma, wherein the double-refractory metastatic
melanoma is refractory to ipilimumab or a biosimilar thereof.
[0700] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0701] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0702] (b) fragmenting the tumor into tumor fragments; [0703]
(c) contacting the tumor fragments with a first cell culture
medium; [0704] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0705]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0706] (f) harvesting the third population of TILs;
and [0707] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0708]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is refractory to
ipilimumab or a biosimilar thereof and pembrolizumab or a
biosimilar thereof.
[0709] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0710] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0711] (b) fragmenting the tumor into tumor fragments; [0712]
(c) contacting the tumor fragments with a first cell culture
medium; [0713] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0714]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0715] (f) harvesting the third population of TILs;
and [0716] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0717]
wherein the cancer is double-refractory metastatic melanoma,
wherein the double-refractory metastatic melanoma is refractory to
ipilimumab or a biosimilar thereof and nivolumab or a biosimilar
thereof.
[0718] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0719] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0720] (b) fragmenting the tumor into tumor fragments; [0721]
(c) contacting the tumor fragments with a first cell culture
medium; [0722] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0723]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0724] (f) harvesting the third population of TILs;
and [0725] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0726]
wherein the cancer is double-refractory metastatic melanoma,
wherein the initial expansion is performed over a period of 21 days
or less.
[0727] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0728] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0729] (b) fragmenting the tumor into tumor fragments; [0730]
(c) contacting the tumor fragments with a first cell culture
medium; [0731] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0732]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0733] (f) harvesting the third population of TILs;
and [0734] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0735]
wherein the cancer is double-refractory metastatic melanoma,
wherein the initial expansion is performed over a period of 11 days
or less.
[0736] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0737] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0738] (b) fragmenting the tumor into tumor fragments; [0739]
(c) contacting the tumor fragments with a first cell culture
medium; [0740] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0741]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0742] (f) harvesting the third population of TILs;
and [0743] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0744]
wherein the cancer is double-refractory metastatic melanoma,
wherein the IL-2 is present at an initial concentration of between
1000 IU/mL and 6000 IU/mL in the first cell culture medium.
[0745] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0746] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0747] (b) fragmenting the tumor into tumor fragments; [0748]
(c) contacting the tumor fragments with a first cell culture
medium; [0749] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0750]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0751] (f) harvesting the third population of TILs;
and [0752] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0753]
wherein the cancer is double-refractory metastatic melanoma,
wherein the IL-2 is present at an initial concentration of between
1000 IU/mL and 6000 IU/mL and the OKT-3 antibody is present at an
initial concentration of about 30 ng/mL in the second cell culture
medium.
[0754] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0755] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0756] (b) fragmenting the tumor into tumor fragments; [0757]
(c) contacting the tumor fragments with a first cell culture
medium; [0758] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0759]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0760] (f) harvesting the third population of TILs;
and [0761] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0762]
wherein the cancer is double-refractory metastatic melanoma,
wherein the initial expansion is performed using a gas permeable
container.
[0763] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0764] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0765] (b) fragmenting the tumor into tumor fragments; [0766]
(c) contacting the tumor fragments with a first cell culture
medium; [0767] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0768]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0769] (f) harvesting the third population of TILs;
and [0770] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0771]
wherein the cancer is double-refractory metastatic melanoma,
wherein the rapid expansion is performed using a gas permeable
container.
[0772] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0773] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0774] (b) fragmenting the tumor into tumor fragments; [0775]
(c) contacting the tumor fragments with a first cell culture
medium; [0776] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0777]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0778] (f) harvesting the third population of TILs;
and [0779] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0780]
wherein the cancer is double-refractory metastatic melanoma,
wherein the first cell culture medium further comprises a cytokine
selected from the group consisting of IL-4, IL-7, IL-15, IL-21, and
combinations thereof.
[0781] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0782] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0783] (b) fragmenting the tumor into tumor fragments; [0784]
(c) contacting the tumor fragments with a first cell culture
medium; [0785] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0786]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0787] (f) harvesting the third population of TILs;
and [0788] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0789]
wherein the cancer is double-refractory metastatic melanoma,
wherein the second cell culture medium further comprises a cytokine
selected from the group consisting of IL-4, IL-7, IL-15, IL-21, and
combinations thereof.
[0790] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0791] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0792] (b) fragmenting the tumor into tumor fragments; [0793]
(c) contacting the tumor fragments with a first cell culture
medium; [0794] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0795]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0796] (f) harvesting the third population of TILs;
and [0797] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0798]
wherein the cancer is double-refractory metastatic melanoma,
further comprising the step of treating the patient with a
non-myeloablative lymphodepletion regimen prior to administering
the third population of TILs to the patient.
[0799] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0800] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0801] (b) fragmenting the tumor into tumor fragments; [0802]
(c) contacting the tumor fragments with a first cell culture
medium; [0803] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0804]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0805] (f) harvesting the third population of TILs;
and [0806] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0807]
wherein the cancer is double-refractory metastatic melanoma,
wherein the non-myeloablative lymphodepletion regimen comprises the
steps of administration of cyclophosphamide at a dose of 60
mg/m.sup.2/day for two days followed by administration of
fludarabine at a dose of 25 mg/m.sup.2/day for five days.
[0808] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0809] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0810] (b) fragmenting the tumor into tumor fragments; [0811]
(c) contacting the tumor fragments with a first cell culture
medium; [0812] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0813]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0814] (f) harvesting the third population of TILs;
and [0815] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0816]
wherein the cancer is double-refractory metastatic melanoma,
further comprising the step of treating the patient with an IL-2
regimen starting on the day after administration of the third
population of TILs to the patient.
[0817] In an embodiment, the invention provides a method of
treating a cancer with a population of tumor infiltrating
lymphocytes (TILs) comprising the steps of: [0818] (a) resecting a
tumor from a patient, the tumor comprising a first population of
TILs; [0819] (b) fragmenting the tumor into tumor fragments; [0820]
(c) contacting the tumor fragments with a first cell culture
medium; [0821] (d) performing an initial expansion of the first
population of TILs in the first cell culture medium to obtain a
second population of TILs, wherein the second population of TILs is
at least 5-fold greater in number than the first population of
TILs, wherein the first cell culture medium comprises IL-2; [0822]
(e) performing a rapid expansion of the second population of TILs
in a second cell culture medium to obtain a third population of
TILs, wherein the third population of TILs is at least 50-fold
greater in number than the second population of TILs after 7 days
from the start of the rapid expansion; wherein the second cell
culture medium comprises IL-2, OKT-3 (anti-CD3 antibody), and
irradiated allogeneic peripheral blood mononuclear cells (PBMCs);
and wherein the rapid expansion is performed over a period of 14
days or less; [0823] (f) harvesting the third population of TILs;
and [0824] (g) administering a therapeutically effective portion of
the third population of TILs to a patient with the cancer; [0825]
wherein the cancer is double-refractory metastatic melanoma,
wherein the IL-2 regimen is a high-dose IL-2 regimen comprising
600,000 or 720,000 IU/kg of aldesleukin, or a biosimilar or variant
thereof, administered as a 15-minute bolus intravenous infusion
every eight hours until tolerance.
EXAMPLES
[0826] The embodiments encompassed herein are now described with
reference to the following examples. These examples are provided
for the purpose of illustration only and the disclosure encompassed
herein should in no way be construed as being limited to these
examples, but rather should be construed to encompass any and all
variations which become evident as a result of the teachings
provided herein.
Example 1: Processes for the Manufacture of TILs Suitable for
Therapy
[0827] TILs may be manufactured using methods known in the art and
any method described herein. For example, an exemplary method for
expanding TILs is depicted in FIG. 1. An exemplary timeline for
manufacturing TILs and treating a cancer patient with expanded TILs
according to the process of FIG. 1 is shown in FIG. 2. Surgery (and
tumor resection) occurs at the start, and lymphodepletion chemo
refers to non-myeloablative lymphodepletion with chemotherapy as
described elsewhere herein.
[0828] FIG. 3 illustrates a TIL expansion and therapeutic treatment
process, including a "direct to REP" step wherein pre-REP TILs are
placed directly into a REP process. The total process time is
approximately 22 days, at which point TILs may be infused into a
patient. FIG. 4 illustrates a treatment and manufacturing timeline
for use with TILs prepared according to the present disclosure and
the process of FIG. 3, when the cell count at day 6 is greater than
250.times.10.sup.6. In this situation, the TIL product is
considered to be very likely to succeed, and the risk of
lymphodepleting the patient in anticipation of obtaining suitable
final TIL product is warranted. FIG. 5 illustrates a treatment and
manufacturing timeline for use with TILs prepared according to the
present disclosure and the process of FIG. 3, when the cell count
at day 6 is less than 250.times.10.sup.6, and wherein
lymphodepletion is begun later so as to allow for an assessment of
the viability of the TIL product before the decision is made to
lymphodeplete the patient. FIG. 6 shows a detailed schematic of a
TIL manufacturing process according to FIG. 3.
Example 2: Clinical Study 1 of TIL Therapy in Double-Refractory
Melanoma
[0829] This Phase 2, multicenter, three-cohort study is designed to
assess the safety and efficacy of a TIL therapy manufactured
according to FIG. 1 for treatment of patients with metastatic
melanoma. Cohorts one and two will enroll up to 30 patients each
and cohort three is a re-treatment cohort for a second TIL infusion
in up to ten patients. The first two cohorts are evaluating two
different manufacturing processes for (FIG. 1 and FIG. 3,
respectively). Patients in cohort one receive fresh,
non-cryopreserved TIL (FIG. 1) and cohort two patients receive
product manufactured through a more streamlined and rapid
three-week procedure (FIG. 3) yielding a cryopreserved product. The
study design is shown in FIG. 7. The study is a Phase 2,
multicenter, three cohort study to assess the safety and efficacy
of autologous TILs for treatment of subpopulations of patients with
metastatic melanoma. Key inclusion criteria include: measurable
metastatic melanoma and .gtoreq.1 lesion resectable for TIL
generation; at least one prior line of systemic therapy;
age.gtoreq.18; and ECOG performance status of 0-1. Treatment
cohorts include non-cryopreserved TIL product (prepared using the
process of FIG. 1), cryopreserved TIL product (prepared using the
process of FIG. 3), and retreatment with TIL product for patients
without response or who progress after initial response. The
primary endpoint is safety and the secondary endpoint is efficacy,
defined as objective response rate (ORR), complete remission rate
(CRR), progression free survival (PFS), duration of response (DOR),
and overall survival (OS).
[0830] Data from 16 patients in cohort one is presented here. These
advanced metastatic melanoma patients were a median age of 55 and
were highly refractory to multiple prior lines of therapy with
significant tumor burden at baseline. All had prior anti-PD-1
therapy, 88% had anti-CTLA4 therapy and 64% had received three or
more prior therapies. The results showed that, of the evaluable
patients, a 29% objective response rate was reported including one
complete response (CR) continuing beyond 15 months
post-administration of a single TIL treatment. Furthermore, 77% of
patients had reduction in target tumor size. The mean time to first
response was 1.6 months, with the CR developing at 6 months.
Responses were observed in patients with tumors carrying wild type
or BRAF mutations. The protocol allows for administration of up to
6 doses of aldesleukin. The median number of aldesleukin
administrations was six.
[0831] Patient characteristics are shown in FIG. 8 and FIG. 9. The
median number of prior therapies was 3 (range: 1-6). The median sum
of diameter for target lesions at baseline was 10.2 cm. 81% of
patients had Stage IV disease. The patient population was highly
refractory to multiple prior lines of therapy, with significant
tumor burden at baseline, and had progressed after at least one
checkpoint inhibitor.
[0832] Treatment emergent serious adverse events are summarized in
FIG. 10, and efficacy results are summarized in FIG. 11. One of 14
patients was not evaluable due to melanoma-related death prior to
first tumor assessment. All patients entering the study had
received an anti-PD-1 checkpoint inhibitor. A waterfall of response
plot is shown in FIG. 12. The ORR is 29%. Tumor reduction was seen
in 77% of patients representing those who had tumor reduction in
the target lesions. Responses were noted regardless of BRAF
mutational status including one long lasting CR (15+ months). FIG.
13 illustrates time to best response and duration in the clinical
study. Mean time to first response was 1.6 months. Median follow up
for the data shown in FIG. 13 was 4.1 months. FIG. 14 illustrates
percentage change in sum of diameters in the clinical study. FIG.
15 illustrates scans from a patient in complete remission, showing
the reduction in tumor size.
[0833] Additionally, the protocol for this study was amended to
both increase the sample size for the study as well as further
define the patient population to patients with unresectable or
metastatic melanoma who have progressed after immune checkpoint
inhibition therapy (e.g., anti-PD-1), and if BRAF
mutation-positive, after BRAF targeted therapy.
[0834] Based on these results, which illustrate the ability of the
TIL therapies of the present disclosure to treat double-refractory
metastatic melanoma, the clinical study has been modified as shown
in FIG. 16, and furthermore, the primary endpoint has been changed
to ORR, with the secondary endpoints changed to CRR, DCR, PFS, DOR,
OR, OS, and safety.
Example 3: Clinical Study 2 of TIL Therapy in Double-Refractory
Melanoma
[0835] Alternative processes for TIL production may also be
employed in some embodiments, such as the process described in
Radvanyi, et al., Clin. Cancer Res. 2012, 18, 6758-70 (including
the supporting information), the disclosure of which is
incorporated by reference herein. The results from the use of TILs
produced by this method in the treatment of patients refractory to
both an anti-PD-1 (pembrolizumab or nivolumab) and ipilimumab are
shown in FIG. 17.
Example 4: Retrospective Clinical Study
[0836] A retrospective study is performed in unresectable,
metastatic melanoma patients assessing efficacy data following
.gtoreq.2 systemic therapies for their disease. This is a
retrospective chart review study. The study includes acquisition of
retrospective data on disease response in patients who are
relapsed/refractory unresectable metastatic melanoma who progressed
after receiving .gtoreq.2 lines of systemic therapies, where the
systemic therapies must include at least one line of PD-1 and BRAF
inhibitors for patients with confirmed BRAF mutation positive
disease. Selection of patient population is based on prospectively
determined inclusion criteria followed by retrospective chart
review.
[0837] The primary objective of this retrospective study is to
evaluate the objective response rate (ORR) assessed by the local
evaluation following Response Evaluation Criteria in Solid Tumors
(RECIST) 1.1. Secondary objectives of the study include (i)
evaluating the efficacy endpoints by the local evaluation for
duration of response (DOR), and disease control rate (DCR),
assessed by RECIST 1.1; (ii) to evaluate overall survival (OS)
based on retrospective data of the study population. An exploratory
objective further includes evaluating the treatment pattern of this
study population.
[0838] Dose and treatment are based on individual institutional
data, with the requirement to have been on a treatment in the
second or later line of treatment for the unresectable, metastatic
melanoma.
[0839] Retrospective data will be collected from up to 3 large
medical data bases (e.g., from hospitals, academic institutions,
oncological cooperative groups) in the United States.
[0840] No patients will be actively treated in this retrospective
data evaluation study. A minimum of about 100 patients will be
assessed for eligibility for the retrospective data review, based
on the available institutional data.
[0841] Patients will have relapsed/refractory unresectable,
metastatic melanoma following .gtoreq.2 lines of systemic that must
include at least one line of anti-PD-1 and BRAF inhibitors for
patients with confirmed BRAF mutation positive disease. Patients
will be .gtoreq.18 years of age at the time of consent, and will
have an Eastern Cooperative Oncology Group (ECOG) performance
status of 0 or 1.
[0842] Further criteria for inclusion include; patients must have
adequate hematopoietic and organ function; patients have provided
written authorization for use and disclosure of protected health
information, or there is institutional regulation allowing use of
clinical data, in compliance with GCP and local ethical
standards.
[0843] Patients meeting the following criteria will be excluded
from the study: patients with melanoma of uveal/ocular origin;
patients with symptomatic and/or untreated brain metastases (of any
size and any number); patients who have had another primary
malignancy within the previous 3 years (with the exception of
carcinoma in situ of the breast, cervix, or bladder, localized
prostate cancer and nonmelanoma skin cancer that has been
adequately treated); patients who have been shown to be BRAF
mutation positive (V600), but have not received prior systemic
therapy with a BRAF-directed kinase inhibitor.
[0844] Efficacy will be assessed based on the application of RECIST
1.1 to the data available in the medical charts of the patients
identified according to the inclusion/exclusion criteria. The
following parameters will be calculated: ORR, DOR, DCR. Data will
be reported by individual institutional data and as aggregate, if
feasible.
[0845] OS summary will be also assessed pending available
individual institutional data. If feasible, aggregate OS data will
be reported.
[0846] The primary statistical analysis is based on the efficacy
parameters obtained from the retrospective data from each
institution and it will be performed by individual set of
retrospective data per institution.
[0847] Statistical comparison among retrospective data sets may or
may not be performed.
[0848] Patients meeting RECIST 1.1 criteria for a confirmed
complete (CR) or partial (PR) response will be classified as
responders in the analysis of the ORR.
[0849] All time-to-event efficacy endpoints will use the
Kaplan-Meier method to summarize the data. The time origin for all
such analyses (except for response duration) will be the date on
which patients began treatment with the study therapy.
[0850] There may or may not be formal comparisons among individual
retrospective data sets.
Example 5: Preparation of Media for Pre-REP and REP Processes
[0851] This Example describes the procedure for the preparation of
tissue culture media for use in protocols involving the culture of
tumor infiltrating lymphocytes (TIL) derived from various tumor
types including, but not limited to, metastatic melanoma, head and
neck squamous cell carcinoma (HNSCC), ovarian carcinoma,
triple-negative breast carcinoma, and lung adenocarcinoma. This
media can be used for preparation of any of the TILs described in
the present application and Examples.
Preparation of CM1
[0852] Removed the following reagents from cold storage and warmed
them in a 37.degree. C. water bath: (RPMI1640, Human AB serum, 200
mM L-glutamine). Prepared CM1 medium according to Table 19 below by
adding each of the ingredients into the top section of a 0.2 .mu.m
filter unit appropriate to the volume to be filtered. Store at
4.degree. C.
TABLE-US-00019 TABLE 19 Preparation of CM1 Ingredient Final
concentration Final Volume 500 ml Final Volume IL RPMI1640 NA 450
ml 900 ml Human AB serum, 50 ml 100 ml heat-inactivated 10% 200 mM
L-glutamine 2 mM 5 ml 10 ml 55 mM BME 55 .mu.M 0.5 ml 1 ml 50 mg/ml
gentamicin sulfate 50 .mu.g/ml 0.5 ml 1 ml
[0853] On the day of use, prewarmed required amount of CM1 in
37.degree. C. water bath and add 6000 IU/ml IL-2.
[0854] Additional supplementation--as needed according to Table
20.
TABLE-US-00020 TABLE 20 Additional supplementation of CM1, as
needed. Supplement Stock concentration Dilution Final concentration
GlutaMAXTm 200 mM 1:100 2 mM Penicillin/streptomycin 10,000 U/ml
penicillin 1:100 100 U/ml penicillin 10,000 .mu.g/ml streptomycin
100 .mu.g/ml streptomycin Amphotericin B 250 .mu.g/ml 1:100 2.5
.mu.g/ml
Preparation of CM2
[0855] Removed prepared CM1 from refrigerator or prepare fresh CM1
as per Section 7.3 above. Removed AIM-V.RTM. from refrigerator and
prepared the amount of CM2 needed by mixing prepared CM1 with an
equal volume of AIM-V.RTM. in a sterile media bottle. Added 3000
IU/ml IL-2 to CM2 medium on the day of usage. Made sufficient
amount of CM2 with 3000 IU/ml IL-2 on the day of usage. Labeled the
CM2 media bottle with its name, the initials of the preparer, the
date it was filtered/prepared, the two-week expiration date and
store at 4.degree. C. until needed for tissue culture.
Preparation of CM3
[0856] Prepared CM3 on the day it was required for use. CM3 was the
same as AIM-V.RTM. medium, supplemented with 3000 IU/ml IL-2 on the
day of use. Prepared an amount of CM3 sufficient to experimental
needs by adding IL-2 stock solution directly to the bottle or bag
of AIM-V. Mixed well by gentle shaking. Label bottle with "3000
IU/ml IL-2" immediately after adding to the AIM-V. If there was
excess CM3, stored it in bottles at 4.degree. C. labeled with the
media name, the initials of the preparer, the date the media was
prepared, and its expiration date (7 days after preparation).
Discarded media supplemented with IL-2 after 7 days storage at
4.degree. C.
Preparation of CM4
[0857] CM4 was the same as CM3, with the additional supplement of 2
mM GlutaMAX.TM. (final concentration). For every 1 L of CM3, added
10 ml of 200 mM GlutaMAX.TM.. Prepared an amount of CM4 sufficient
to experimental needs by adding IL-2 stock solution and
GlutaMAX.TM. stock solution directly to the bottle or bag of AIM-V.
Mixed well by gentle shaking. Labeled bottle with "3000 IL/nil IL-2
and GlutaMAX" immediately after adding to the AIM-V. If there was
excess CM4, stored it in bottles at 4.degree. C. labeled with the
media name, "GlutaMAX", and its expiration date (7 days after
preparation). Discarded media supplemented with IL-2 after 7-days
storage at 4.degree. C.
Example 6: Use of IL-2, IL-15, and IL-21 Cytokine Cocktail
[0858] This example describes the use of IL-2, IL-15, and IL-21
cytokines, which serve as additional T cell growth factors, in
combination with the TIL process of Examples 1 to 10.
[0859] Using the process of Examples 1 to 10, TILs were grown from
colorectal, melanoma, cervical, triple negative breast, lung and
renal tumors in presence of IL-2 in one arm of the experiment and,
in place of IL-2, a combination of IL-2, IL-15, and IL-21 in
another arm at the initiation of culture. At the completion of the
pre-REP, cultures were assessed for expansion, phenotype, function
(CD107a+ and IFN-.gamma.) and TCR V.beta. repertoire. IL-15 and
IL-21 are described elsewhere herein and in Gruijl, et al., IL-21
promotes the expansion of CD27+CD28+ tumor infiltrating lymphocytes
with high cytotoxic potential and low collateral expansion of
regulatory T cells, Santegoets, S. J., J Transl Med., 2013, 11:37
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626797/).
[0860] The results showed that enhanced TIL expansion (>20%), in
both CD4.sup.+ and CD8.sup.+ cells in the IL-2, IL-15, and IL-21
treated conditions were observed in multiple histologies relative
to the IL-2 only conditions. There was a skewing towards a
predominantly CD8.sup.+ population with a skewed TCR V.beta.
repertoire in the TILs obtained from the IL-2, IL-15, and IL-21
treated cultures relative to the IL-2 only cultures. IFN-.gamma.
and CD107a were elevated in the IL-2, IL-15, and IL-21 treated
TILs, in comparison to TILs treated only IL-2.
Example 7: Qualifying Individual Lots of Gamma-Irradiated
Peripheral Mononuclear Cells
[0861] This Example describes a novel abbreviated procedure for
qualifying individual lots of gamma-irradiated peripheral
mononuclear cells (PBMCs, also known as MNC) for use as allogeneic
feeder cells in the exemplary methods described herein.
[0862] Each irradiated MNC feeder lot was prepared from an
individual donor. Each lot or donor was screened individually for
its ability to expand TIL in the REP in the presence of purified
anti-CD3 (clone OKT3) antibody and interleukin-2 (IL-2). In
addition, each lot of feeder cells was tested without the addition
of TIL. to verify that the received dose of gamma radiation was
sufficient to render them replication incompetent.
Background
[0863] Gamma-irradiated, growth-arrested MNC feeder cells were
required for REP of TIL. Membrane receptors on the feeder MNCs bind
to anti-CD3 (clone OKT3) antibody and crosslink to TIL in the REP
flask, stimulating the TIL to expand. Feeder lots were prepared
from the leukapheresis of whole blood taken from individual donors.
The leukapheresis product was subjected to centrifugation over
Ficoll-Hypaque, washed, irradiated, and cryopreserved under GMP
conditions.
[0864] It is important that patients who received TIL therapy not
be infused with viable feeder cells as this can result in
Graft-Versus-Host Disease (GVHD). Feeder cells are therefore
growth-arrested by dosing the cells with gamma-irradiation,
resulting in double strand DNA breaks and the loss of cell
viability of the MNC cells upon reculture.
Evaluation Criteria and Experimental Set-Up
[0865] Feeder lots were evaluated on two criteria: 1) their ability
to expand TIL in co-culture>100-fold and 2) their replication
incompetency.
[0866] Feeder lots were tested in mini-REP format utilizing two
primary pre-REP TIL lines grown in upright T25 tissue culture
flasks. Feeder lots were tested against two distinct TIL lines, as
each TIL line is unique in its ability to proliferate in response
to activation in a REP. As a control, a lot of irradiated MNC
feeder cells which has historically been shown to meet the criteria
above was run alongside the test lots.
[0867] To ensure that all lots tested in a single experiment
receive equivalent testing, sufficient stocks of the same pre-REP
TIL lines were available to test all conditions and all feeder
lots.
[0868] For each lot of feeder cells tested, there was a total of
six T25 flasks: Pre-REP TIL line #1 (2 flasks); Pre-REP TIL line #2
(2 flasks); and Feeder control (2 flasks). Flasks containing TIL
lines #1 and #2 evaluated the ability of the feeder lot to expand
TIL. The feeder control flasks evaluated the replication
incompetence of the feeder lot.
Experimental Protocol
Day -2/3, Thaw of TIL Lines
[0869] Prepared CM2 medium. Warmed CM2 in 37.degree. C. water bath.
Prepared 40 ml of CM2 supplemented with 3000 IU/ml IL-2. Keep warm
until use. Placed 20 ml of pre-warmed CM2 without TL-2 into each of
two 50 ml conical tubes labeled with names of the TIL lines used.
Removed the two designated pre-REP TIL lines from LN2 storage and
transferred the vials to the tissue culture room. Thawed vials by
placing them inside a sealed zipper storage bag in a 37.degree. C.
water bath until a small amount of ice remains.
[0870] Using a sterile transfer pipet, immediately transferred the
contents of vial into the 20 ml of CM2 in the prepared, labeled 50
ml conical tube. QS to 40 ml using CM2 without IL-2 to wash cells.
Centrifuged at 400.times.CF for 5 minutes. Aspirated the
supernatant and resuspend in 5 ml warm CM2 supplemented with 3000
IU/ml IL-2.
[0871] Removed small aliquot (20 .mu.l) in duplicate for cell
counting using an automated cell counter. Record the counts. While
counting, placed the 50 ml conical tube with TIL cells into a
humidified 37.degree. C., 5% CO.sub.2 incubator, with the cap
loosened to allow for gas exchange. Determined cell concentration
and diluted TIL to 1.times.10.sup.6 cells/ml in CM2 supplemented
with IL-2 at 3000 IU/ml.
[0872] Cultured in 2 ml/well of a 24-well tissue culture plate in
as many wells as needed in a humidified 37.degree. C. incubator
until Day 0 of the mini-REP. Cultured the different TIL lines in
separate 24-well tissue culture plates to avoid confusion and
potential cross-contamination.
Day 0, Initiate Mini-REP
[0873] Prepared enough CM2 medium for the number of feeder lots to
be tested. (e.g., for testing 4 feeder lots at one time, prepared
800 ml of CM2 medium). Aliquoted a portion of the CM2 prepared
above and supplemented it with 3000 IU/ml IL-2 for the culturing of
the cells. (e.g., for testing 4 feeder lots at one time, prepare
500 ml of CM2 medium with 3000 IU/ml IL-2).
[0874] Working with each TIL line separately to prevent
cross-contamination, removed the 24-well plate with TIL culture
from the incubator and transferred to the BSC.
[0875] Using a sterile transfer pipet or 100-1000 .mu.l Pipettor
and tip, removed about 1 ml of medium from each well of TIL to be
used and place in an unused well of the 24-well tissue culture
plate.
[0876] Using a fresh sterile transfer pipet or 100-1000 .mu.l
Pipettor and tip, mixed remaining medium with TIL in wells to
resuspend the cells and then transferred the cell suspension to a
50 ml conical tube labeled with the TIL name and recorded the
volume.
[0877] Washed the wells with the reserved media and transferred
that volume to the same 50 ml conical tube. Spun the cells at
400.times.CF to collect the cell pellet. Aspirated off the media
supernatant and resuspend the cell pellet in 2-5 ml of CM2 medium
containing 3000 IU/ml IL-2, volume to be used based on the number
of wells harvested and the size of the pellet-volume should be
sufficient to ensure a concentration of >1.3.times.10.sup.6
cells/ml.
[0878] Using a serological pipet, mixed the cell suspension
thoroughly and recorded the volume. Removed 200 .mu.l for a cell
count using an automated cell counter. While counting, placed the
50 ml conical tube with TIL cells into a humidified, 5% CO.sub.2,
37.degree. C. incubator, with the cap loosened to allow gas
exchange. Recorded the counts.
[0879] Removed the 50 ml conical tube containing the TIL cells from
the incubator and resuspend them cells at a concentration of
1.3.times.10.sup.6 cells/ml in warm CM2 supplemented with 30001
U/ml IL-2. Returned the 50 ml conical tube to the incubator with a
loosened cap.
[0880] Repeated steps above for the second TIL line.
[0881] Just prior to plating the TIL into the T25 flasks for the
experiment, TIL were diluted 1:10 for a final concentration of
1.3.times.10.sup.5 cells/ml as per below.
Prepare MACS GMP CD3 Pure (OKT3) Working Solution
[0882] Took out stock solution of OKT3 (1 mg/ml) from 4.degree. C.
refrigerator and placed in BSC. A final concentration of 30 ng/ml
OKT3 was used in the media of the mini-REP.
[0883] 600 ng of OKT3 were needed for 20 ml in each T25 flask of
the experiment; this was the equivalent of 60 .mu.l of a 10
.mu.g/ml solution for each 20 ml, or 360 .mu.l for all 6 flasks
tested for each feeder lot.
[0884] For each feeder lot tested, made 400 .mu.l of a 1:100
dilution of 1 mg/ml OKT3 for a working concentration of 10 .mu.g/ml
(e.g., for testing 4 feeder lots at one time, make 1600 .mu.l of a
1:100 dilution of 1 mg/ml OKT3: 16 .mu.l of 1 mg/ml OKT3+1.584 ml
of CM2 medium with 30001 U/ml IL-2.)
Prepare T25 Flasks
[0885] Labeled each flask and filled flask with the CM2 medium
prior to preparing the feeder cells. Placed flasks into 37.degree.
C. humidified 5% CO.sub.2 incubator to keep media warm while
waiting to add the remaining components. Once feeder cells were
prepared, the components will be added to the CM2 in each
flask.
TABLE-US-00021 TABLE 21 Solutions Volume in co-culture Volume in
control Component flasks (feeder only) flasks CM2 + 3000 IU/ml IL-2
18 ml 19 ml MNC: 1.3 .times. 10.sup.7/ml in CM2 + 3000 IU IL-2 1 ml
1 ml (final concentration 1/.3 .times. 10.sup.7/flask) OKT3: 10
.mu.g/ml in CM2 + 3000 IU of IL-2 60 .mu.l 60 .mu.l TIL: 1.3
.times. 10.sup.5/ml in CM2 with 3000 IU of IL-2 1 ml 0 (final
concentration 1.3 .times. 10.sup.5/flask)
Prepare Feeder Cells
[0886] A minimum of 78.times.10.sup.6 feeder cells were needed per
lot tested for this protocol. Each 1 ml vial frozen by SDBB had
100.times.10.sup.6 viable cells upon freezing. Assuming a 50%
recovery upon thaw from LN2 storage, it was recommended to thaw at
least two 1 ml vials of feeder cells per lot giving an estimated
100.times.10.sup.6 viable cells for each REP. Alternately, if
supplied in 1.8 ml vials, only one vial provided enough feeder
cells.
[0887] Before thawing feeder cells, pre-warmed approximately 50 ml
of CM2 without IL-2 for each feeder lot to be tested. Removed the
designated feeder lot vials from LN2 storage, placed in zipper
storage bag, and place on ice. Thawed vials inside closed zipper
storage bag by immersing in a 37.degree. C. water bath. Removed
vials from zipper bag, spray or wipe with 70% EtOH and transferred
vials to BSC.
[0888] Using a transfer pipet immediately transferred the contents
of feeder vials into 30 ml of warm CM2 in a 50 ml conical tube.
Washed vial with a small volume of CM2 to remove any residual cells
in the vial. Centrifuged at 400.times.CF for 5 minutes. Aspirated
the supernatant and resuspended in 4 ml warm CM2 plus 3000 IU/ml
IL-2. Removed 200 .mu.l for cell counting using the Automated Cell
Counter. Recorded the counts.
[0889] Resuspended cells at 1.3.times.10.sup.7 cells/ml in warm CM2
plus 3000 IU/ml IL-2. Diluted TIL cells from 1.3.times.10.sup.6
cells/ml to 1.3.times.10.sup.5 cells/ml.
Setup Co-Culture
[0890] Diluted TIL cells from 1.3.times.10.sup.6 cells/ml to
1.3.times.10.sup.5 cells/ml. Added 4.5 ml of CM2 medium to a 15 ml
conical tube. Removed TIL cells from incubator and resuspended well
using a 10 ml serological pipet. Removed 0.5 ml of cells from the
1.3.times.10.sup.6 cells/ml TIL suspension and added to the 4.5 ml
of medium in the 15 ml conical tube. Returned TIL stock vial to
incubator. Mixed well. Repeated for the second TIL line.
[0891] Transferred flasks with pre-warmed media for a single feeder
lot from the incubator to the BSC. Mixed feeder cells by pipetting
up and down several times with a 1 ml pipet tip and transferred 1
ml (1.3.times.10.sup.7 cells) to each flask for that feeder lot.
Added 60 .mu.l of OKT3 working stock (10 .mu.g/ml) to each flask.
Returned the two control flasks to the incubator.
[0892] Transferred 1 ml (1.3.times.10.sup.5) of each TIL lot to the
correspondingly labeled T25 flask. Returned flasks to the incubator
and incubate upright. Did not disturb until Day 5.
[0893] Repeated for all feeder lots tested.
Day 5, Media Change
[0894] Prepared CM2 with 3000 IU/ml IL-2. 10 ml is needed for each
flask. With a 10 ml pipette, transferred 10 ml warm CM2 with 3000
IU/ml IL-2 to each flask. Returned flasks to the incubator and
incubated upright until Day 7. Repeated for all feeder lots
tested.
Day 7, Harvest
[0895] Removed flasks from the incubator and transfer to the BSC,
care as taken not to disturb the cell layer on the bottom of the
flask. Without disturbing the cells growing on the bottom of the
flasks, removed 10 ml of medium from each test flask and 15 ml of
medium from each of the control flasks.
[0896] Using a 10 ml serological pipet, resuspended the cells in
the remaining medium and mix well to break up any clumps of cells.
After thoroughly mixing cell suspension by pipetting, removed 200
.mu.l for cell counting. Counted the TIL using the appropriate
standard operating procedure in conjunction with the automatic cell
counter equipment. Recorded counts in Day 7.
[0897] Repeated for all feeder lots tested.
[0898] Feeder control flasks were evaluated for replication
incompetence and flasks containing TIL were evaluated for fold
expansion from Day 0 according to Table 22 below.
Day 7, Continuation of Feeder Control Flasks to Day 14
[0899] After completing the Day 7 counts of the feeder control
flasks, added 15 ml of fresh CM2 medium containing 3000 IU/ml IL-2
to each of the control flasks. Returned the control flasks to the
incubator and incubated in an upright position until Day 14.
Day 14, Extended Non-Proliferation of Feeder Control Flasks
[0900] Removed flasks from the incubator and transfer to the BSC,
care was taken not to disturb the cell layer on the bottom of the
flask. Without disturbing the cells growing on the bottom of the
flasks, removed approximately 17 ml of medium from each control
flasks. Using a 5 ml serological pipet, resuspended the cells in
the remaining medium and mixed well to break up any clumps of
cells. Recorded the volumes for each flask.
[0901] After thoroughly mixing cell suspension by pipetting,
removed 200 .mu.l for cell counting. Counted the TIL using the
appropriate standard operating procedure in conjunction with the
automatic cell counter equipment. Recorded counts.
[0902] Repeated for all feeder lots tested.
Results and Acceptance Criteria
Results
[0903] The dose of gamma irradiation was sufficient to render the
feeder cells replication incompetent. All lots were expected to
meet the evaluation criteria and also demonstrated a reduction in
the total viable number of feeder cells remaining on Day 7 of the
REP culture compared to Day 0.
[0904] All feeder lots were expected to meet the evaluation
criteria of 100-fold expansion of TIL growth by Day 7 of the REP
culture.
[0905] Day 14 counts of Feeder Control flasks were expected to
continue the non-proliferative trend seen on Day 7.
Acceptance Criteria
[0906] The following acceptance criteria were met for each
replicate TIL line tested for each lot of feeder cells
[0907] Acceptance was two-fold, as follows (outlined in Table 22
below).
TABLE-US-00022 TABLE 22 Acceptance Criteria Test Acceptance
criteria Irradiation of MNC/ No growth observed at 7 and 14 days
Replication Incompetence TIL expansion At least a 100-fold
expansion of each TIL (minimum of 1.3 .times. 10.sup.7 viable
cells)
[0908] Evaluated whether the dose of radiation was sufficient to
render the MNC feeder cells replication incompetent when cultured
in the presence of 30 ng/ml OKT3 antibody and 3000 IU/ml IL-2.
Replication incompetence was evaluated by total viable cell count
(TVC) as determined by automated cell counting on Day 7 and Day 14
of the REP.
[0909] Acceptance criteria was "No Growth," meaning the total
viable cell number has not increased on Day 7 and Day 14 from the
initial viable cell number put into culture on Day 0 of the
REP.
[0910] Evaluated the ability of the feeder cells to support TIL
expansion. TIL growth was measured in terms of fold expansion of
viable cells from the onset of culture on Day 0 of the REP to Day 7
of the REP. On Day 7, TIL cultures achieved a minimum of 100-fold
expansion, (i.e., greater than 100 times the number of total viable
TIL cells put into culture on REP Day 0), as evaluated by automated
cell counting.
Contingency Testing of MNC Feeder Lots that do not Meet Acceptance
Criteria
[0911] In the event that an MNC feeder lot did not meet the either
of the acceptance criteria outlined above, the following steps will
be taken to retest the lot to rule out simple experimenter error as
its cause.
[0912] If there are two or more remaining satellite testing vials
of the lot, then the lot was retested. If there were one or no
remaining satellite testing vials of the lot, then the lot was
failed according to the acceptance criteria listed above.
[0913] In order to be qualified, the lot in question and the
control lot had to achieve the acceptance criteria above. Upon
meeting these criteria, the lot was then released for use.
Example 8: Qualifying Individual Lots of Gamma-Irradiated
Peripheral Blood Mononuclear Cells
[0914] This Example describes a novel abbreviated procedure for
qualifying individual lots of gamma-irradiated peripheral blood
mononuclear cells (PBMC) for use as allogeneic feeder cells in the
exemplary methods described herein. This example provides a
protocol for the evaluation of irradiated PBMC cell lots for use in
the production of clinical lots of TIL. Each irradiated PBMC lot
was prepared from an individual donor. Over the course of more than
100 qualification protocols, it was been shown that, in all cases,
irradiated PBMC lots from SDBB (San Diego Blood Bank) expand
TIL>100-fold on Day 7 of a REP. This modified qualification
protocol was intended to apply to irradiated donor PBMC lots from
SDBB which were then further tested to verify that the received
dose of gamma radiation was sufficient to render them replication
incompetent. Once demonstrated that they maintained replication
incompetence over the course of 14 days, donor PBMC lots were
considered "qualified" for usage to produce clinical lots of
TIL.
Background
[0915] Gamma-irradiated, growth-arrested PBMC were required for
current standard REP of TIL. Membrane receptors on the PBMCs bind
to anti-CD3 (clone OKT3) antibody and crosslink to TIL in culture,
stimulating the TIL to expand. PBMC lots were prepared from the
leukapheresis of whole blood taken from individual donors. The
leukapheresis product was subjected to centrifugation over
Ficoll-Hypaque, washed, irradiated, and cryopreserved under GMP
conditions.
[0916] It is important that patients who received TIL therapy not
be infused with viable PBMCs as this could result in
Graft-Versus-Host Disease (GVHD). Donor PBMCs are therefore
growth-arrested by dosing the cells with gamma-irradiation,
resulting in double strand DNA breaks and the loss of cell
viability of the PBMCs upon reculture.
Evaluation Criteria
[0917] 7.2.1 Evaluation criterion for irradiated PBMC lots was
their replication incompetency.
Experimental Set-Up
[0918] Feeder lots were tested in mini-REP format as if they were
to be co-cultured with TIL, using upright T25 tissue culture
flasks. Control lot: One lot of irradiated PBMCs, which had
historically been shown to meet the criterion of 7.2.1, was run
alongside the experimental lots as a control. For each lot of
irradiated donor PBMC tested, duplicate flasks were run.
Experimental Protocol
Day 0
[0919] Prepared .about.90 ml of CM2 medium for each lot of donor
PBMC to be tested. Kept CM2 warm in 37.degree. C. water bath.
Thawed an aliquot of 6.times.10.sup.6 IU/ml IL-2. Returned the CM2
medium to the BSC, wiping with 70% EtOH prior to placing in hood.
For each lot of PBMC tested, removed about 60 ml of CM2 to a
separate sterile bottle. Added IL-2 from the thawed
6.times.10.sup.6 IU/ml stock solution to this medium for a final
concentration of 3000 IU/ml. Labeled this bottle as "CM2/IL2" (or
similar) to distinguish it from the unsupplemented CM2.
Prepare OKT3
[0920] Took out the stock solution of anti-CD3 (OKT3) from the
4.degree. C. refrigerator and placed in the BSC. A final
concentration of 30 ng/ml OKT3 was used in the media of the
mini-REP. Prepared a 10 .mu.g/ml working solution of anti-CD3
(OKT3) from the 1 mg/ml stock solution. Placed in refrigerator
until needed.
[0921] For each PBMC lot tested, prepare 150 .mu.l of a 1:100
dilution of the anti-CD3 (OKT3) stock. For example, for testing 4
PBMC lots at one time, prepare 600 .mu.l of 10 .mu.g/ml anti-CD3
(OKT3) by adding 6 .mu.l of the 1 mg/ml stock solution to 594 .mu.l
of CM2 supplemented with 3000 IU/ml IL-2.
Prepare Flasks
[0922] 7.4.8 Added 19 ml per flask of CM2/IL-2 to the labeled T25
flasks and placed flasks into 37.degree. C., humidified, 5%
CO.sub.2 incubator while preparing cells.
Prepare Irradiate PBMC
[0923] Retrieved vials of PBMC lots to be tested from LN2 storage.
These were placed at -80.degree. C. or kept on dry ice prior to
thawing. Placed 30 ml of CM2 (without IL-2 supplement) into 50 ml
conical tubes for each lot to be thawed. Labeled each tube with the
different lot numbers of the PBMC to be thawed. Capped tubes
tightly and place in 37.degree. C. water bath prior to use. As
needed, returned 50 ml conical tubes to the BSC, wiping with 70%
EtOH prior to placing in the hood.
[0924] Removed a vial PBMC from cold storage and place in a
floating tube rack in a 37.degree. C. water bath to thaw. Allowed
thaw to proceed until a small amount of ice remains in the vial.
Using a sterile transfer pipet, immediately transferred the
contents of the vial into the 30 ml of CM2 in the 50 ml conical
tube. Removed about 1 ml of medium from the tube to rinse the vial;
returned rinse to the 50 ml conical tube. Capped tightly and swirl
gently to wash cells.
[0925] Centrifuged at 400.times.g for 5 min at room temperature.
Aspirated the supernatant and resuspend the cell pellet in 1 ml of
warm CM2/IL-2 using a 1000 .mu.l pipet tip. Alternately, prior to
adding medium, resuspended cell pellet by dragging capped tube
along an empty tube rack. After resuspending the cell pellet,
brought volume to 4 ml using CM2/IL-2 medium. Recorded volume.
[0926] Removed a small aliquot (e.g., 100 .mu.l) for cell counting
using an automated cell counter. Performed counts in duplicate
according to the particular automated cell counter SOP. It most
likely was necessary to perform a dilution of the PBMC prior to
performing the cell counts. A recommended starting dilution was
1:10, but this varied depending on the type of cell counter used.
Recorded the counts.
[0927] Adjusted concentration of PBMC to 1.3.times.10.sup.7
cells/ml using CM2/IL-2 medium. Mixed well by gentle swirling or by
gently aspirating up-and-down using a serological pipet.
Set Up Culture Flasks
[0928] Returned two labeled T25 flasks to the BSC from the tissue
culture incubator. Returned the 10 .mu.g/ml vial of anti-CD3/OKT3
to the BSC. Added 1 ml of the 1.3.times.10.sup.7 PBMC cell
suspension to each flask. Added 60 .mu.l of the 10 .mu.g/ml
anti-CD3/OKT3 to each flask. Returned capped flasks to the tissue
culture incubators for 14 days of growth without disturbance.
Placed anti-CD3/OKT3 vial back into the refrigerator until needed
for the next lot. Repeated for each lot of PBMC to be
evaluated.
Day 14, Measurement of Non-Proliferation of PBMC
[0929] Returned the duplicate T25 flasks to the BSC. For each
flask, using a fresh 10 ml serological pipet, removed .about.17 ml
from each of the flasks, then carefully pulled up the remaining
media to measure the volume remaining in the flasks. Recorded
volume.
[0930] Mixed sample well by pipetting up and down using the same
serological pipet.
[0931] Removed a 200 .mu.l sample from each flask for counting.
Counted cells using an automated cell counter. Repeated steps
7.4.26-7.4.31 for each lot of PBMC being evaluated.
Results and Acceptance Criterion
Results
[0932] The dose of gamma irradiation was expected to be sufficient
to render the feeder cells replication incompetent. All lots were
expected to meet the evaluation criterion, demonstrating a
reduction in the total viable number of feeder cells remaining on
Day 14 of the REP culture compared to Day 0.
[0933] Acceptance Criterion: The following acceptance criterion
were met for each irradiated donor PBMC lot tested: "No
growth"--meant that the total number of viable cells on Day 14 was
less than the initial viable cell number put into culture on Day 0
of the REP.
Contingency Testing of PBMC Lots which do not Meet Acceptance
Criterion.
[0934] In the event than an irradiated donor PBMC lot did not meet
the acceptance criterion above, the following steps were taken to
retest the lot to rule out simple experimenter error as the cause
of its failure. If there were two or more remaining satellite vials
of the lot, then the lot was retested. If there are one or no
remaining satellite vials of the lot, then the lot was failed
according to the acceptance criterion above.
[0935] To be qualified, a PBMC lot going through contingency
testing had both the control lot and both replicates of the lot in
question achieve the acceptance criterion. Upon meeting this
criterion, the lot was then released for use.
Example 9: Preparation of 11-2 Stock Solution (Cellgenix)
[0936] This Example describes the process of dissolving purified,
lyophilized recombinant human interleukin-2 into stock samples
suitable for use in further tissue culture protocols, including all
of those described in the present application and Examples,
including those that involve using rhIL-2.
Procedure
[0937] Prepared 0.2% Acetic Acid solution (HAc). Transferred 29 mL
sterile water to a 50 mL conical tube. Added 1 mL 1N acetic acid to
the 50 mL conical tube. Mixed well by inverting tube 2-3 times.
Sterilized the HAc solution by filtration using a Steriflip
filter
[0938] Prepare 1% HSA in PBS. Added 4 mL of 25% HSA stock solution
to 96 mL PBS in a 150 mL sterile filter unit. Filtered solution.
Stored at 4.degree. C. For each vial of rhIL-2 prepared, fill out
forms.
[0939] Prepared rhIL-2 stock solution (6.times.10.sup.6 IU/mL final
concentration). Each lot of rh1L-2 was different and required
information found in the manufacturer's Certificate of Analysis
(COA), such as: 1) Mass of rhIL-2 per vial (mg), 2) Specific
activity of rhIL-2 (IU/mg) and 3) Recommended 0.2% HAc
reconstitution volume (mL).
[0940] Calculated the volume of 1% HSA required for rhIL-2 lot by
using the equation below:
( Vial .times. .times. Mass .times. .times. ( mg ) .times.
Biological .times. .times. Activity .function. ( IU mg ) 6 .times.
10 6 .times. IU mL ) - HAc .times. .times. vol .times. .times. ( mL
) = 1 .times. % .times. .times. HSA .times. .times. vol .times.
.times. ( mL ) ##EQU00001## ( 1 .times. .times. mg .times. 25
.times. 10 6 .times. IU mg 6 .times. 10 6 .times. IU mL ) - 2
.times. .times. mL = 2.167 .times. .times. mL .times. .times. HSA
##EQU00001.2##
For example, according to CellGenix's rhIL-2 lot 10200121 COA, the
specific activity for the 1 mg vial is 25.times.10.sup.6 1 U/mg. It
recommends reconstituting the rhIL-2 in 2 mL 0.2% HAc.
[0941] Wiped rubber stopper of IL-2 vial with alcohol wipe. Using a
16 G needle attached to a 3 mL syringe, injected recommended volume
of 0.2% HAc into vial. Took care to not dislodge the stopper as the
needle is withdrawn. Inverted vial 3 times and swirled until all
powder is dissolved. Carefully removed the stopper and set aside on
an alcohol wipe. Added the calculated volume of 1% HSA to the
vial.
[0942] Storage of rhIL-2 solution. For short-term storage (<72
hrs), stored vial at 4.degree. C. For long-term storage (>72
hrs), aliquoted vial into smaller volumes and stored in cryovials
at -20.degree. C. until ready to use. Avoided freeze/thaw cycles.
Expired 6 months after date of preparation. Rh-IL-2 labels included
vendor and catalog number, lot number, expiration date, operator
initials, concentration and volume of aliquot.
Example 10: Cryopreservation Process
[0943] This example describes the cryopreservation process method
for TILs prepared with the abbreviated, closed procedure described
above in Example 8 using the CryoMed Controlled Rate Freezer, Model
7454 (Thermo Scientific).
[0944] The equipment used, in addition to that described in Example
9, is as follows: aluminum cassette holder rack (compatible with
CS750 freezer bags), cryostorage cassettes for 750 mL bags, low
pressure (22 psi) liquid nitrogen tank, refrigerator, thermocouple
sensor (ribbon type for bags), and CryoStore CS750 Freezing bags
(OriGen Scientific).
[0945] The freezing process provides for a 0.5.degree. C. rate from
nucleation to -20.degree. C. and 1.degree. C. per minute cooling
rate to -80.degree. C. end temperature. The program parameters are
as follows: Step 1--wait at 4.degree. C.; Step 2: 1.0.degree.
C./min (sample temperature) to -4.degree. C.; Step 3: 20.0.degree.
C./min (chamber temperature) to -45.degree. C.; Step 4:
10.0.degree. C./min (chamber temperature) to -10.0.degree. C.; Step
5: 0.5.degree. C./min (chamber temperature) to -20.degree. C.; and
Step 6: 1.0.degree. C./min (sample temperature) to -80.degree.
C.
Example 11: Production of a Cryopreserved TIL Cell Therapy Using a
Closed System
[0946] This examples describes the cGMP manufacture of Iovance
Biotherapeutics, Inc. TIL Cell Therapy Process in G-Rex Flasks
according to current Good Tissue Practices and current Good
Manufacturing Practices. This material will be manufactured under
US FDA Good Manufacturing Practices Regulations (21 CFR Part 210,
211, 1270, and 1271), and applicable ICH Q7 standards for Phase I
through Commercial Material.
[0947] The process summary is provided in Table 23 below.
TABLE-US-00023 TABLE 23 Process summary Estimated Estimated Total
Day Anticipated Volume (post-seed) Activity Target Criteria Vessels
(mL) 0 Tumor Dissection .ltoreq.50 desirable tumor fragments
G-Rex100MCS 1 flask .ltoreq.1000 per G-Rex100MCS 11 REP Seed 5 -
200 .times. 10.sup.6 viable cells G-Rex500MCS 1 flasks .ltoreq.5000
per G-Rex500MCS 16 REP Split 1 .times. 10.sup.9 viable cells
G-Rex500MCS .ltoreq.5 flasks .ltoreq.25000 per G-Rex500MCS 22
Harvest Total available cells 3-4 CS-750 bags .ltoreq.530
[0948] Throughout this Example, assume 1.0 mL/L=1.0 g/kg, unless
otherwise specified. Once opened, the following expiries apply at
2.degree. C.-8.degree. C.: Human Serum, type AB (HI) Gemini, 1
month; 2-mercaptoethanol, 1 month. Gentamicin Sulfate, 50 mg/ml
stock may be kept at room temperature for 1 month. Bags containing
10 L of AIM-V media may be warmed at room temperature once only for
up to 24 hours prior to use. During the Day 22 harvest two
Gatherex.TM. may be used to harvest the TIL from the G-Rex500MCS
flasks.
Day 0 CM1 Media Preparation
[0949] Prepared RPMI 1640 Media. In the BSC, using an appropriately
sized pipette, removed 100.0 mL from 1000 mL RPMI 1640 Media and
placed into an appropriately sized container labeled "Waste".
[0950] In the BSC added reagents to RPMI 1640 Media bottle. Added
the following reagents to the RPMI 1640 Media bottle as shown in
table. Recorded volumes added. Amount Added per bottle: Heat
Inactivated Human AB Serum (100.0 mL); GlutaMax (10.0 mL);
Gentamicin sulfate, 50 mg/mL (1.0 mL); 2-mercaptoethanol (1.0
mL)
[0951] Capped RPMI 1640 Media bottle and swirled bottle to ensure
reagents were mixed thoroughly. Filtered RPMI 1640 Media from Step
8.1.6 through 1 L 0.22-micron filter unit. Labeled filtered media.
Aseptically capped the filtered media and labeled with the
following information.
[0952] Thawed one 1.1 mL IL-2 aliquot (6.times.10.sup.6 IU/mL)
(BR71424) until all ice had melted. Recorded IL-2: Lot # and
Expiry. Transferred IL-2 stock solution to media. In the BSC,
transferred 1.0 mL of IL-2 stock solution to the CM1 Day 0 Media
Bottle prepared in Step 8.1.8. Added CM1 Day 0 Media 1 bottle and
IL-2 (6.times.10.sup.6 IU/mL) 1.0 mL. Capped and swirled the bottle
to mix media containing IL-2. Relabeled as "Complete CM1 Day 0
Media".
[0953] Removed 20.0 mL of media using an appropriately sized
pipette and dispensed into a 50 mL conical tube. In BSC,
transferred 25.0 mL of "Complete CM1 Day 0 Media" (prepared in Step
8.1.13) to a 50 mL conical tube. Labeled the tube as "Tissue
Pieces". Aseptically passed G-Rex100MCS (W3013130) into the BSC. In
the BSC, closed all clamps on the G-Rex100MCS, leaving vent filter
clamp open. Connected the red line of G-Rex100MCS flask to the
larger diameter end of the repeater pump fluid transfer set
(W3009497) via luer connection. Staged Baxa pump next to BSC.
Removed pump tubing section of repeater pump fluid transfer set
from BSC and installed in repeater pump. Within the BSC, removed
the syringe from Pumpmatic Liquid-Dispensing System (PLDS)
(W3012720) and discarded.
[0954] Connected PLDS pipette to the smaller diameter end of
repeater pump fluid transfer set via luer connection and placed
pipette tip in "Complete CM1 Day 0 Media" for aspiration. Opened
all clamps between media and G-Rex100MCS. Pumped Complete CM1 media
into G-Rex100MCS flask. Set the pump speed to "High" and "9" and
pumped all Complete CM1 Day 0 Media into G-Rex100MCS flask. Once
all media was transferred, cleared the line and stopped pump.
[0955] Disconnected pump from flask. Ensured all clamps were closed
on the flask, except vent filter. Removed the repeater pump fluid
transfer set from the red media line, and placed a red cap
(W3012845) on the red media line. Removed G-Rex100MCS flask from
BSC, heated seal off the red cap from the red line near the
terminal luer. Labeled G-Rex100MCS flask with QA provided
in-process "Day 0" label. Attached sample "Day 0" label below.
Incubator parameters: 37.0.+-.2.0.degree. C.; CO2 Percentage:
5.0.+-.1.5% CO.sub.2.
[0956] Placed the 50 mL conical tube" in incubator for .gtoreq.30
minutes of warming.
Day 0 Tumor Wash Media Preparation
[0957] Added Gentamicin to HBSS. In the BSC, added 5.0 mL
Gentamicin (W3009832 or W3012735) to 1.times.500 mL HBSS Media
(W3013128) bottle. Recorded volumes. Added per bottle: HBSS (500.0
mL); Gentamicin sulfate, 50 mg/ml (5.0 mL). Mixed reagents
thoroughly. Filtered HBSS containing gentamicin prepared in Step
8.2.1 through a 1 L 0.22-micron filter unit (W1218810). Aseptically
capped the filtered media and labeled with the following
information.
Day 0 Tumor Processing
[0958] Obtained tumor specimen and transferred into suite at
2-8.degree. C. immediately for processing and recorded tumor
information. Labeled three 50 ml conical tubes: the first as
"Forceps," the second as "Scalpel," and the third as "Fresh Tumor
Wash Media". Labeled 5.times.100 mm petri dishes as "Wash 1," "Wash
2," "Wash 3," "Holding," and "Unfavorable." Labeled one 6 well
plate as "Favorable Intermediate Fragments."
[0959] Using an appropriately sized pipette, transferred 5.0 mL of
"Tumor Wash Media" into each well of one 6-well plate for favorable
intermediate tumor fragments (30.0 mL total). Using an
appropriately sized pipette, transferred 50.0 mL of "Tumor Wash
Media" prepared in Step 8.2.4 into each 100 mm petri dish for "Wash
1," "Wash 2," "Wash 3," and "Holding" (200.0 mL total). Using an
appropriately sized pipette, transfer 20.0 mL of "Tumor Wash Media"
prepared in Step 8.2.4 into each 50 mL conical (60.0 mL total).
Aseptically removed lids from two 6-well plates. The lids were
utilized for selected tumor pieces. Aseptically passed the tumor
into the BSC. Recorded processing start time.
[0960] Tumor Wash 1: Using forceps, removed the tumor from the
specimen bottle and transferred to the "Wash 1". Using forceps,
gently washed tumor and record time. Transferred 20.0 mL (or
available volume) of solution from the tumor specimen bottle into a
50 mL conical per sample plan. Labeled and stored bioburden sample
collected at 2-8.degree. C. until submitted for testing.
[0961] Tumor Wash 2: Using a new set of forceps, removed the tumor
from the "Wash 1" dish and transferred to the "Wash 2" dish. Using
forceps, washed tumor specimen by gently agitating for .gtoreq.3
minutes and allowed it to sit. Recorded time.
[0962] Using a transfer pipette, placed 4 individual drops of Tumor
Wash Media from the conical into each of the 6 circles on the
upturned lids of the 6-well plates (2 lids). Placed an extra drop
on two circles for a total of 50 drops.
[0963] Tumor Wash 3: Using forceps, removed the tumor from the
"Wash 2" dish and transferred to the "Wash 3" dish. Using forceps,
washed tumor specimen by gently agitating and allowed it to sit for
.gtoreq.3 minutes. Recorded time.
[0964] Placed a ruler under 150 mm dish lid. Using forceps,
aseptically transferred tumor specimen to the 150 mm dissection
dish lid. Arranged all pieces of tumor specimen end to end and
recorded the approximate overall length and number of fragments.
Assessed the tumor for necrotic/fatty tissue. Assessed whether
>30% of entire tumor area observed to be necrotic and/or fatty
tissue; if yes, ensure tumor was of appropriate size if so
proceeded. Assessed whether <30% of entire tumor area were
observed to be necrotic or fatty tissue; if yes, proceeded.
[0965] Clean-Up Dissection. If tumor was large and >30% of
tissue exterior was observed to be necrotic/fatty, performed "clean
up dissection" by removing necrotic/fatty tissue while preserving
tumor inner structure using a combination of scalpel and/or
forceps. To maintain tumor internal structure, used only vertical
cutting pressure. Did not cut in a sawing motion with scalpel.
[0966] Using a combination of scalpel and/or forceps, cut the tumor
specimen into even, appropriately sized fragments (up to 6
intermediate fragments). To maintain tumor internal structure, use
only vertical cutting pressure. Did not cut in a sawing motion with
scalpel. Ensured to keep non-dissected intermediate fragments
completely submerged in "Tumor Wash Media". Transferred each
intermediate fragment to the "holding" dish
[0967] Manipulated one intermediate fragment at a time, dissected
the tumor intermediate fragment in the dissection dish into pieces
approximately 3.times.3.times.3 mm in size, minimizing the amount
of hemorrhagic, necrotic, and/or fatty tissues on each piece. To
maintain tumor internal structure, used only vertical cutting
pressure. Did not cut in a sawing motion with scalpel.
[0968] Selected up to eight (8) tumor pieces without hemorrhagic,
necrotic, and/or fatty tissue. Used the ruler for reference.
Continued dissection until 8 favorable pieces have been obtained,
or the entire intermediate fragment has been dissected. Transferred
each selected piece to one of the drops of "Tumor Wash Media".
[0969] After selecting up to eight (8) pieces from the intermediate
fragment, placed remnants of intermediate fragment into a new
single well of "Favorable Intermediate Fragments" 6-well plate.
[0970] If desirable tissue remains, selected additional Favorable
Tumor Pieces from the "favorable intermediate fragments" 6-well
plate to fill the drops for a maximum of 50 pieces. Recorded the
total number of dissected pieces created.
[0971] Removed the "Tissue Pieces" 50 mL conical tube from the
incubator. Ensured conical tube was warmed for .gtoreq.30 min.
Passed "Tissue Pieces" 50 mL conical into the BSC, ensuring not to
compromise the sterility of open processing surfaces.
[0972] Using a transfer pipette, scalpel, forceps or combination,
transferred the selected 50 best tumor fragments from favorable
dish lids to the "Tissue Pieces" 50 mL conical tube. If a tumor
piece was dropped during transfer and desirable tissue remains,
additional pieces from the favorable tumor intermediate fragment
wells were added. Recorded numbers of pieces.
[0973] Removed G-Rex100MCS containing media from incubator.
Aseptically passed G-Rex100MCS flask into the BSC. When
transferring the flask, did not hold from the lid or the bottom of
the vessel. Transferred the vessel by handling the sides. In the
BSC, lifted G-Rex100MCS flask cap, ensuring that sterility of
internal tubing was maintained. Swirled conical tube with tumor
pieces to suspend and quickly poured the contents into the
G-Rex100MCS flask. Ensured that the tumor pieces were evenly
distributed across the membrane of the flask. Gently tilted the
flask back and forth if necessary to evenly distribute the tumor
pieces. Recorded number of tumor fragments on bottom membrane of
vessel and number of observed to be floating in vessel. NOTE: If
the number of fragments seeded were NOT equivalent to number of
collected in Step 8.3.36H, contacted Area Management, and document
in Section 10.0.
[0974] Incubated G-Rex100MCS at the following parameters: Incubated
G-Rex flask: Temperature LED Display: 37.0.+-.2.0.degree. C.; CO2
Percentage: 5.0.+-.1.5% CO2. Performed calculations to determine
the proper time to remove G-Rex100MCS incubator on Day 11.
Calculations: Time of incubation; lower limit=time of
incubation+252 hours; upper limit=time of incubation+276 hours.
Day 11--Media Preparation
[0975] Monitored Incubator. Incubator parameters: Temperature LED
Display: 37.0.+-.2.0.degree. C.; CO2 Percentage: 5.0.+-.1.5% CO2.
Warmed 3.times.1000 mL RPMI 1640 Media (W3013112) bottles and
3.times.1000 mL AIM-V (W3009501) bottles in an incubator for
.gtoreq.30 minutes. Recorded time. Media: RPMI 1640 and AIM-V.
Placed an additional 1.times.1000 ml bottle of AIM-V Media
(W3009501) at room temperature for further use.
[0976] Removed the RPMI 1640 Media when time was reached. Record
end incubation time in Step 8.4.4. Ensure media was warmed for
.gtoreq.30 min. In the BSC, removed 100.0 mL from each of the three
pre-warmed 1000 mL RPMI 1640 Media bottles and placed into an
appropriately sized container labeled "Waste". In the BSC added the
following reagents to each of the three RPMI 1640 Media bottles and
recorded volumes added to each bottle. GemCell Human serum, Heat
Inactivated Type AB (100.0 mL), GlutaMax (10.0 mL), Gentamicin
sulfate, 50 mg/ml (1.0 mL), 2-mercaptoethanol (1.0 mL).
[0977] Caped bottles and swirled to ensure reagents were mixed
thoroughly. Filtered each bottle of media through a separate 1 L
0.22-micron filter unit. Aseptically capped the filtered media and
labeled each bottle with CM1 Day 11 Media. Thawed 3.times.1.1 mL
aliquots of IL-2 (6.times.10.sup.6 IU/mL) (BR71424) until all ice
had melted Recorded IL 2 lot # and Expiry.
[0978] Removed the three bottles of AIM-V Media from the incubator.
Recorded end incubation time. Ensured media had been warmed for
.gtoreq.30 minutes. Using a micropipette, added 3.0 mL of thawed
IL-2 into one 1 L bottle of pre-warmed AIM-V media. Rinse
micropipette tip with media after dispensing IL-2. Use a new
sterile micropipette tip for each aliquot. Recorded the total
volume added. Labeled bottle as "AIM-V Containing IL-2".
Aseptically transferred a 10 L Labtainer Bag and a repeater pump
transfer set into the BSC. Closed all lines on a 10 L Labtainer
bag. Attached the larger diameter tubing end of a repeater pump
transfer set to the middle female port of the 10 L Labtainer Bag
via luer lock connection.
[0979] Staged the Baxa pump next to the BSC. Fed the transfer set
tubing through the Baxa pump. Set the Baxa Pump to "High" and "9".
Removed syringe from Pumpmatic Liquid-Dispensing System (PLDS) and
discarded. Ensured to not compromise the sterility of the PLDS
pipette.
[0980] Connected PLDS pipette to smaller diameter end of repeater
pump fluid transfer set via luer connection and placed pipette tip
in AIM-V media containing IL-2 bottle (prepared in Step 8.4.13) for
aspiration. Opened all clamps between media bottle and 10 L
Labtainer.
[0981] Using the PLDS, transfer pre-warmed AIM-V media containing
IL-2 prepared in Step 8.4.13, as well as two additional AIM-V
bottles into the 10 L Labtainer bag. Added the three bottles of
filtered CM1 Day 11 Media from Step 8.4.10. After addition of final
bottle, cleared the line to the bag. NOTE: Stopped the pump between
addition of each bottle of media. Removed PLDS from the transfer
set and placed a red cap on the luer of the line in the BSC. Gently
massaged the bag to mix. Labeled the media bag with the following
information. Expiration date was 24 hours from the preparation
date.
[0982] Attached a 60 mL syringe to the available female port of the
"Complete CM2 Day 11 Media" bag. Removed 20.0 mL of media and place
in a 50 mL conical tube. Placed a red cap on the female port of the
"Complete CM2 Day 11 Media" Bag. Labeled and stored Media Retain
Sample at 2-8.degree. C. until submitted for testing. Heat sealed
off the red cap on the transfer set line, close to red cap. Kept
the transfer set on the bag.
[0983] In the BSC, added 4.5 mL of AIM-V Media that had been
labelled with "For Cell Count Dilutions" and lot number to four 15
mL conical tubes. Labeled the tubes with the lot number and tube
number (1-4). Labeled 4 cryovials "Feeder" and vial number (1-4).
Transferred any remaining 2-mercaptoethanol, GlutaMax, and human
serum from the BSC to 2-8.degree. C.
[0984] Outside of the BSC, weld a 1 L Transfer Pack to the transfer
set attached to the "Complete CM2 Day 11 Media" bag prepared.
Labeled transfer pack as "Feeder Cell CM2 Media" and lot number.
Made a mark on the tubing of the 1 L Transfer Pack tubing a few
inches away from the bag. Placed the empty Transfer Pack onto the
scale so that the tubing was on the scale to the point of the mark.
Tared the scale and left the empty Transfer Pack on the scale.
[0985] Set the Baxa pump to "Medium" and "4." Pumped 500.0.+-.5.0
mL of "Complete CM2 Day 11" media prepared in Step 8.4.22 into Cell
CM2 Media" transfer pack. Measured by weight and recorded the
volume of Complete CM2 media added to the Transfer Pack.
[0986] Once filled, heated seal the line. Separated CM2 Day 11
media bag with transfer set from feeder cell media transfer pack,
kept weld toward 1 L transfer pack. Placed "Complete CM2 Day 11
Media" prepared in incubator until use.
Day 11--TIL Harvest
[0987] Incubator parameters: Temperature LED Display:
37.0.+-.2.0.degree. C.; CO2 Percentage: 5.0.+-.1.5% CO2. Performed
check to ensure incubation parameters are met before removing
G-Rex100MCS from incubator. Lower limits the same as described
above.
[0988] Recorded Time of Removal from incubator. Carefully removed
G-Rex100MCS from incubator and ensured all clamps were closed
except large filter line. Recorded processing start time.
[0989] Labeled a 300 mL Transfer pack as "TIL Suspension". Sterile
welded the TIL Suspension transfer (single line) of a Gravity Blood
Filter. Placed the 300 mL Transfer Pack on a scale and record dry
weight. Labeled 1 L Transfer Pack as "Supernatant".
[0990] Sterile welded the red media removal line from the
G-Rex100MCS to the "Supernatant" transfer pack. Sterile welded the
clear cell removal line from the G-Rex100MCS to one of the two
spike lines on the top of the blood filter connected to the "TIL
Suspension" transfer pack. Placed G-Rex100MCS on the left side of
the GatheRex and the "Supernatant" and "TIL Suspension" transfer
packs to the right side.
[0991] Install the red media removal line from the G Rex100MCS to
the top clamp (marked with a red line) and tubing guides on the
GatheRex. Installed the clear harvest line from the G-Rex100MCS to
the bottom clamp (marked with a blue line) and tubing guides on the
GatheRex. Attached the gas line from the GatheRex to the sterile
filter of the G-Rex100MCS flask. Before removing the supernatant
from the G-Rex100MCS flask, ensured all clamps on the cell removal
lines were closed. Transferred .about.900 mL of culture supernatant
from the G-Rex100MCS to the 1 L Transfer Pack. Visually inspected
G-Rex100MCS flask to ensure flask is level and media has been
reduced to the end of the aspirating dip tube.
[0992] After removal of the supernatant, closed all clamps to the
red line.
[0993] Vigorously tapped flask and swirled media to release cells.
Performed an inspection of the flask to ensure all cells have
detached. NOTE: Contacted area management if cells did not detach.
Tilted flask away from collection tubing and allowed tumor pieces
to settle along edge. Slowly tipped flask toward collection tubing
so pieces remained on the opposite side of the flask. If the cell
collection straw is not at the junction of the wall and bottom
membrane, rapping the flask while tilted at a 450 angle is usually
sufficient to properly position the straw.
[0994] Released all clamps leading to the TIL Suspension transfer
pack. Using the GatheRex, transferred the cell suspension through
the blood filter into the 300 mL transfer pack. Maintained the
tilted edge until all cells and media are collected. Inspected
membrane for adherent cells. Rinsed the bottom of the G-Rex100MCS.
Cover .about.1/4 of gas exchange membrane with rinse media. Ensured
all clamps are closed. Heat sealed (per Process Note 5.12) the TIL
suspension transfer pack as close to the weld as possible so that
the overall tubing length remains approximately the same. Heat
sealed the "Supernatant" transfer pack. Maintained enough line to
weld. Recorded weight of TIL Suspension transfer pack and
calculated the volume of cell suspension.
[0995] Welded a 4'' plasma transfer set to "supernatant" transfer
pack, retaining the luer connection on the 4'' plasma transfer set,
and transferred into the BSC. Welded a 4'' plasma transfer set to
300 mL "TIL Suspension" transfer pack, retained the luer connection
on the 4'' plasma transfer set, and transferred into the BSC.
[0996] Drew up approximately 20.0 mL of supernatant from the 1 L
"Supernatant" transfer pack and dispense into a sterile 50 mL
conical tube labeled "Bac-T." Removed a 1.0 mL sample from the 50
mL conical labeled BacT using an appropriately sized syringe and
inoculated the anaerobic bottle.
[0997] Labeled 4 cryovials with vial number (1-4). Using separate 3
mL syringes, pulled 4.times.1.0 mL cell count samples from TIL
Suspension Transfer Pack using the luer connection, and placed in
respective cryovials. Placed a red cap (W3012845) on the line.
Placed TIL Transfer Pack in incubator until needed. Perform cell
counts and calculations. Perform initial cell counts undiluted. If
no dilution needed, "Sample [.mu.L]"=200, "Dilution [.mu.L]"=0.
[0998] Record cell counts and TIL numbers. If Total Viable TIL
Cells is <5.times.10.sup.6 cells, proceeded to "Day 11 G-Rex
Fill and Seed". If Total Viable TIL Cells is >5.times.10.sup.6,
proceed to "Calculation for flow cytometry".
Calculation for Flow Cytometry.
[0999] If the Total Viable TIL Cell count was
.gtoreq.4.0.times.10.sup.7, calculated the volume to obtain
1.0.times.10.sup.7 cells for the flow cytometry sample. Total
viable cells required for flow cytometry: 1.0.times.10.sup.7 cells.
Volume of cells required for flow cytometry: Viable cell
concentration divided by 1.0.times.10.sup.7 cells.
[1000] If Applicable: Recalculated Total Viable Cells and Volume
flow. Calculated the remaining Total Viable Cells and remaining
volume after the removal of cytometry sample below.
TIL Cryopreservation of Sample
[1001] If Applicable: Calculated Volume for Cryopreservation.
Calculated the volume of cells required to obtain 1.times.10.sup.7
cells for cryopreservation.
TABLE-US-00024 TABLE 24 Cryopreservation calculation Volume of
Cells Total Viable TIL required for required for Viable Cell
cryopreservation cryopreservation Concentration C = A / B A. 1
.times. 10.sup.7 cells B. cells/mL C. mL
[1002] If Applicable: Removed sample for Cryopreservation. Removed
the calculated volume from the TIL Suspension transfer pack. Placed
in appropriately sized conical tube and label as "Cryopreservation
Sample 1.times.10.sup.7 cells," dated, and lot number. Placed a red
cap (W3012845) on the TIL Suspension transfer pack.
[1003] Centrifuged the "Cryopreservation Sample 1.times.10.sup.7
cells" according to the following parameters: Speed: 350.times.g,
Time: 10:00 minutes, Temperature: Ambient, Brake: Full (9);
Acceleration: Full (9).
[1004] Added CS-10. In BSC, aseptically aspirate supernatant.
Gently tap bottom of tube to resuspend cells in remaining fluid.
Added CS-10. Slowly added 0.5 mL of CS10. Recorded volume added.
Cryopreservation Sample Vials Filled at .about.0.5 mL.
Day 11--Feeder Cells
[1005] Obtained 3 bags of feeder cells with at least two different
lot numbers from LN2 freezer. Kept cells on dry ice until ready to
thaw. Recorded feeder cell information. Confirmed that at least two
different lots of feeder cells were obtained. Placed the Feeder
Cell bags into individual zip top bags, based on Lot number, and
thawed 37.0.+-.2.0.degree. C. water bath or cytotherm for
.about.3-5 minutes or until ice has just disappeared.
[1006] Feeder cell harness preparation. Welded 4S-4M60 to a CC2
Cell Connect (W3012820), replacing a single spike of the Cell
Connect apparatus with the 4-spike end of the 4S-4M60 manifold.
Welded as needed.
[1007] Attached media transfer pack Weld the "Feeder Cell CM2
Media" transfer pack to a CC2 luer. The bag will be attached to the
side of the harness with the needless injection port. Transferred
the assembly containing the Complete CM2 Day 11 Media into the
BSC.
[1008] Pool thawed feeder cells. Within the BSC, pulled 10 mL of
air into a 100 mL syringe. Used this to replace the 60 mL syringe
on the CC2. Wiped each port on the feeder cell bags with an alcohol
pad prior to removing the cover. Spike the three feeder bags using
three of the spikes of the CC2. Maintained constant pressure while
turning the spike in one direction. Ensure to not puncture the side
of the port. Opened the stopcock so that the line from the feeder
cell bags is open and the line to the needless injection port is
closed. Drew up the contents of the feeder cell bags into the
syringe. All three bags drained at once. Once feeder cell bags had
been drained, while maintaining pressure on the syringe, clamped
off the line to the feeder cell bags. Did not detach syringe below.
the syringe from the harness. Recorded the total volume of feeder
cells in the syringe.
[1009] Added feeder cells to transfer pack. Turned the stopcock so
the line to the feeder cell bag was closed and the line to the
media Transfer Pack was open. Ensured the line to media transfer
pack is unclamped. Dispensed the feeder cells from the syringe into
the "Feeder Cell CM2 Media" transfer pack. Clamped off the line to
the transfer pack containing the feeder cells and leave the syringe
attached to the harness. Massaged bag to mix the pooled feeder
cells in the transfer pack. Labeled bag as "Feeder Cell
Suspension".
[1010] Calculated the total volume of feeder cell suspension.
Removed cell count samples. Using a separate 3 mL syringe for each
sample, pulled 4.times.1.0 mL cell count samples from Feeder Cell
Suspension Transfer Pack using the needless injection port.
Aliquoted each sample into labeled cryovials.
[1011] Performed cell counts and calculations utilizing NC-200 and
Process Note 5.14. Diluted cell count samples by adding 0.5 mL of
cell suspension into 4.5 mL of AIM-V media labelled with the lot
number and "For Cell Count Dilutions". This will give a 1:10
dilution.
[1012] Recorded Cell Count and Sample volumes. If Total Viable
Cells are <5.times.10.sup.9, proceed. If Total Viable Cells are
.gtoreq.5.times.10.sup.9, proceeded as above for higher cells
counts. Obtained additional Feeder Cells as needed and added to
transfer pack as discussed above. Calculated the volume of Feeder
Cell Suspension that was required to obtain 5.times.10.sup.9 viable
feeder cells. Calculated the volume of excess feeder cells to
remove. Round down to nearest whole number.
[1013] Removed excess feeder cells. In a new 100 mL syringe, pulled
up 10 mL of air and attached the syringe to the harness. Opened the
line to the "Feeder Cell Suspension" transfer pack. Using the
syringe drew up the volume of feeder cells calculated in Step
8.6.71C plus an additional 10.0 mL from the Transfer Pack into a
100 mL syringe. Closed the line to the Feeder Cell Suspension
transfer pack once the volume of feeder cells is removed. Did not
remove final syringe. Once a syringe has been filled, replaced it
with a new syringe. Multiple syringes could be used to remove total
volume. With each new syringe, pulled in 10 mL of air. Recorded the
total volume (including the additional 10 mL) of feeder cells
removed.
[1014] Added OKT3. In the BSC, using a 1.0 mL syringe and 16 G
needle, drew up 0.15 mL of OKT3. Aseptically removed the needle
from the syringe and attach the syringe to the needless injection
port. Injected the OKT3. Opened the stopcock to the "Feeder Cell
Suspension" transfer pack and added 10 mL of feeder cells removed
in Step 8.6.73 to flush OKT3 through the line. Turned the syringe
upside down and push air through to clear the line to the Feeder
Cell Suspension transfer pack. Left the remaining feeder cell
suspension in the syringe. Closed all clamps and remove the harness
from the BSC. Heat sealed the Feeder Cell Suspension transfer pack,
leaving enough tubing to weld.
Day 11 G-Rex Fill and Seed
[1015] Set up G-Rex500MCS. Removed a G-Rex500MCS from packaging and
inspected the flask for any cracks or kinks in the tubing. Ensured
all luer connections and closures were tight. Closed all clamps on
the G-Rex500MCS lines except for the vent filter line. Using a
marker drew a line at the 4.5 L gradation. Removed the "Complete
CM2 Day 11 Media", from the incubator.
[1016] Prepared to pump media. Welded the red line of the
G-Rex500MCS to the repeater pump transfer set attached to the
complete CM2 Day 11 Media. Hung the "Complete CM2 Day 11 Media" bag
on an IV pole. Fed the pump tubing through the Baxa pump. Pumped
media into G-Rex500MCS. Set the Baxa pump to "High" and "9". Pumped
4.5 L of media into the G-Rex500MCS, filling to the line marked on
the flask at the 4.5 L gradation. Heat sealed the red line of the
G-Rex500MCS near the weld. Labeled the flask with the "Day 11"
label. Welded the Feeder Cell: Suspension transfer pack to the
flask. Sterile welded the red line of the G-Rex500MCS to the
"Feeder Cell Suspension" transfer pack.
[1017] Added Feeder Cells to G-Rex500MCS. Opened all clamps between
Feeder Cell Suspension and G-Rex500MCS and added Feeder Cell
Suspension to flask by gravity feed. Heat sealed the red line near
the weld. Welded the TIL Suspension transfer pack to the flask.
Sterile weld the red line of the G-Rex500MCS to the "TIL
Suspension" transfer pack.
[1018] Added TIL to G-Rex500MCS. Opened all clamps between TIL
Suspension and G-Rex500MCS and added TIL Suspension to flask by
gravity feed. Heat sealed the red line near the weld to remove the
TIL suspension bag.
[1019] Incubated G-Rex500MCS. Checked that all clamps on the
G-Rex500MCS were closed except the large filter line and place in
the incubator. Incubator parameters: Temperature LED Display:
37.0.+-.2.0.degree. C., CO2 Percentage: 5.0.+-.1.5% CO2.
[1020] Calculated incubation window. Performed calculations to
determine the proper time to remove G-Rex500MCS from incubator on
Day 16. Lower limit: Time of incubation+108 hours. Upper limit:
Time of incubation+132 hours.
Day 11 Excess TIL Cryopreservation
[1021] Froze Excess TIL Vials. Recorded and verified the total
number of vials placed into the Control Rate Freezer (CRF). Upon
completion of freeze, transfer vials from CRF to the appropriate
storage container.
Day 16 Media Preparation
[1022] Pre-warmed AIM-V Media. Removed three CTS AIM V 10 L media
bags from 2-8.degree. C. at least 12 hours prior to use and place
at room temperature protected from light. Labeled each bag. Record
warming start time and date. Ensured all bags have been warmed for
a duration between 12 and 24 hours.
[1023] Attached the larger diameter end of a fluid pump transfer
set to one of the female ports of a 10 L Labtainer bag using the
Luer connectors. Setup 10 L Labtainer for Supernatant Label as
"Supernatant". Setup 10 L Labtainer for Supernatant. Ensure all
clamps were closed prior to removing from the BSC.
[1024] Thawed 5.times.1.1 mL aliquots of IL-2 (6.times.10.sup.6
IU/mL) (BR71424) per bag of CTS AIM V media until all ice had
melted. Aliquoted 100.0 mL of Glutamax into an appropriately sized
receiver. Recorded the volume added to each receiver and labeled
each receiver as "GlutaMax."
[1025] Added IL-2 to GlutaMax. Using a micropipette, added 5.0 mL
of IL-2 to each GlutaMax receiver. Ensured to rinse the tip per
process note 5.18 and used a new pipette tip for each mL added.
Recorded volume added to each Glutamax receiver and labeled each
receiver as "GlutaMax+IL-2" and receiver number.
[1026] Prepared CTS AIM V media bag for formulation. Ensured CTS
AIM V 10 L media bag (W3012717) was warmed at room temperature and
protected from light for 12-24 hours prior to use. Recorded end
incubation time. In the BSC, closed clamp on a 4'' plasma transfer
set, then connected to the bag using the spike ports. Maintained
constant pressure while turning the spike in one direction. Ensured
to not puncture the side of the port. Connected the larger diameter
end of a repeater pump fluid transfer set to the 4'' plasma
transfer set via luer.
[1027] Stage Baxa pump next to BSC. Removed pump tubing section of
repeater pump fluid transfer set from BSC and installed in repeater
pump.
[1028] Prepared to formulate media. In BSC, removed syringe from
Pumpmatic Liquid-Dispensing System (PLDS) and discarded. Ensured to
not compromise the sterility of the PLDS pipette. Connected PLDS
pipette to smaller diameter end of repeater pump fluid transfer set
via luer connection and placed pipette tip in "GlutaMax+IL-2"
prepared above for aspiration. Open all clamps between receiver and
10 L bag.
[1029] Pumped GlutaMax+IL-2 into bag. Set the pump speed to
"Medium" and "3" and pump all "GlutaMax+IL-2" into 10 L CTS AIM V
media bag. Once no solution remains, clear line and stop pump.
Recorded the volume of GlutaMax containing IL-2 added to each Aim V
bag below.
[1030] Removed PLDS. Ensured all clamps were closed, and removed
the PLDS pipette from the repeater pump fluid transfer set. Removed
repeater pump fluid transfer set and red cap the 4'' plasma
transfer set.
[1031] Labeled each bag of "Complete CM4 Day 16 media"
prepared.
[1032] Removed Media Retain per Sample Plan. Using a 30 mL syringe,
removed 20.0 mL of "Complete CM4 Day 16 media" by attaching syringe
to the 4'' plasma transfer set and dispensed sample into a 50 mL
conical tube. Ensure 4'' plasma transfer set was either clamped or
red capped after removal of syringe.
[1033] Attached new repeater pump fluid transfer set. Attached the
larger diameter end of a new fluid pump transfer set onto the 4''
plasma transfer set that was connected to the "Complete CM4 Day 16
media" bag. Labeled with sample plan inventory label and stored
media retain sample at 2-8.degree. C. until submitted for
testing.
[1034] Monitored Incubator. If applicable, monitor for additional
bags prepared. Incubator parameters: Temperature LED Display:
37.0.+-.2.0.degree. C., CO2 Percentage: 5.0.+-.1.5% CO2.
[1035] Warmed Complete CM4 Day 16 Media. Warmed the first bag of
Complete CM4 Day 16 Media in incubator for .gtoreq.30 minutes until
ready for use. If applicable, warmed additional bags.
[1036] Prepared Dilutions. In the BSC, added 4.5 mL of AIM-V Media
that had been labelled with "For Cell Count Dilutions" to each
4.times.15 mL conical tube. Labeled the conical tubes. Labeled 4
cryovials.
Day 16 REP Spilt
[1037] Monitored Incubator. Incubator parameters: Temperature LED
Display: 37.0.+-.2.0.degree. C., CO2 Percentage: 5.0.+-.1.5%
CO2
[1038] Removed G-Rex500MCS from Incubator. Performed check below to
ensure incubation parameters are met before removing G-Rex500MCS
from incubator: upper limit, lower limit, time of removal. Removed
G-Rex500MCS from the incubator.
[1039] Heat sealed a 1 L transfer pack (W3006645), leaving
.about.12'' of line. Labeled 1 L transfer pack as TIL Suspension.
Place 1 L transfer pack, including the entire line, on a scale and
record dry weight.
[1040] GatheRex Setup. Sterile welded the red media removal line
from the G-Rex500MCS to the repeater pump transfer set on the 10 L
labtainer bag "Supernatant" prepared above. Sterile welded the
clear cell removal line from the G-Rex500MCS to the TIL Suspension
transfer pack prepared above. Placed G-Rex500MCS flask on the left
side of the GatheRex. Placed the supernatant labtainer bag and TIL
suspension transfer pack to the right side. Installed the red media
removal line from the G-Rex500MCS to the top clamp (marked with a
red line) and tubing guides on the GatheRex. Installed the clear
harvest line from the G-Rex500MCS to the bottom clamp (marked with
a blue line) and tubing guides on the GatheRex. Attached the gas
line from the GatheRex to the sterile filter of the G-Rex500 MCS.
NOTE: Before removing the supernatant from the G-Rex500MCS, ensured
all clamps on the cell removal lines were closed.
[1041] Volume Reduction of G-Rex500MCS. Transferred .about.4.5 L of
culture supernatant from the G-Rex500MCS to the 10 L Labtainer per
SOP-01777. Visually inspect G-Rex500MCS to ensure flask as level
and media had been reduced to the end of the aspirating dip
tube.
[1042] Prepared flask for TIL Harvest. After removal of the
supernatant, closed all clamps to the red line.
[1043] Initiation of TIL Harvest. Recorded the start time of the
TIL harvest. Vigorously tap flask and swirl media to release cells.
Performed an inspection of the flask to ensure all cells have
detached. Tilted the flask to ensure hose is at the edge of the
flask. If the cell collection straw is not at the junction of the
wall and bottom membrane, rapping the flask while tilted at a 450
angle is usually sufficient to properly position the straw.
[1044] TIL Harvest. Released all clamps leading to the TIL
suspension transfer pack. Using the GatheRex transferred the cell
suspension into the TIL Suspension transfer pack. NOTE: Be sure to
maintain the tilted edge until all cells and media are collected.
Inspected membrane for adherent cells.
[1045] Rinsed flask membrane. Rinsed the bottom of the G-Rex500MCS.
Cover .about.1/4 of gas exchange membrane with rinse media. Closed
clamps on G-Rex500MCS. Ensured all clamps were closed on the
G-Rex500MCS.
[1046] Heat sealed. Heat sealed the Transfer Pack containing the
TIL as close to the weld as possible so that the overall tubing
length remained approximately the same. Heat sealed the 10 L
Labtainer containing the supernatant and passed into the BSC for
sample collection.
[1047] Recorded weight of Transfer Pack with cell suspension and
calculate the volume suspension. Prepared transfer pack for sample
removal. Welded a 4'' Plasma Transfer Set, to the TIL Suspension
transfer pack from above, leaving the female luer end attached as
close to the bag as possible.
[1048] Removed testing samples from cell supernatant. In the BSC,
remove 10.0 mL of supernatant from 10 L labtainer using female luer
port and appropriately sized syringe. Placed into a 15 mL conical
tube and label as "BacT" and Retain the tube for BacT sample. Using
a separate syringe, removed 10.0 mL of supernatant and placed into
a 15 mL conical tube. Retained the tube for mycoplasma sample for
testing. Labeled tube as "Mycoplasma diluent". Closed supernatant
bag. Placed a red cap on the luer port to close the bag, and pass
out of BSC.
[1049] Removed Cell Count Samples. In the BSC, using separate 3 mL
syringes for each sample, removed 4.times.1.0 mL cell count samples
from "TIL Suspension" transfer pack using the luer connection.
Placed samples in cryovials prepared above.
[1050] Removed Mycoplasma Samples. Using a 3 mL syringe, removed
1.0 mL from TIL Suspension transfer pack and place into 15 mL
conical labeled "Mycoplasma diluent" prepared above. Labeled and
stored Mycoplasma sample at 2-8.degree. C. until submitted for
testing.
[1051] Prepared Transfer Pack for Seeding. In the BSC, attached the
large diameter tubing end of a Repeater Pump Fluid Transfer Set to
the Luer adapter on the transfer pack containing the TIL. Clamped
the line close to the transfer pack using a hemostat. Placed a red
cap onto the end of the transfer set.
[1052] Placed TIL in Incubator. Removed cell suspension from the
BSC and place in incubator until needed. Recorded time.
[1053] Performed Cell Counts. Performed cell counts and
calculations utilizing NC-200. Diluted cell count samples initially
by adding 0.5 mL of cell suspension into 4.5 mL of AIM-V media
prepared above. This gave a 1:10 dilution.
[1054] Calculated flasks for subculture. Calculated the total
number of flasks to seed. NOTE: Rounded the number of G-Rex500MCS
flasks to see up to the neared whole number.
TABLE-US-00025 TABLE 25 Flask calculation Target Cells Number Total
Viable Required of G-Rex500MCS Cell Count per Flask Flasks to Seed
A B C = A / B cells 1.0 .times. 10.sup.9 cells/flask flasks
[1055] The maximum number of G-Rex500MCS flasks to seed was five.
If the calculated number of flasks to seed exceeded five, only five
were seeded USING THE ENTIRE VOLUME OF CELL SUSPENSION
AVAILABLE.
[1056] Determined number of additional media bags needed.
Calculated the number of media bags required in addition to the bag
prepared above. Round the number of media bags required up to the
next whole number.
TABLE-US-00026 TABLE 26 Media bag calculation Number of Number of
Number of Number of G-Rex500MCS Media Bag Bags Prepared Additional
Bags Flasks to Seed Required in above to Prepare A B = A / 2* C D =
B - C 1
[1057] Prepared additional media as needed. Prepared one 10 L bag
of "CM4 Day 16 Media" for every two G-Rex-500M flask needed
calculated in Step 8.10.59D. Proceeded to Step 8.10.62 and seeded
the first GREX-500M flask(s) while additional media is prepared and
warmed.
[1058] Prepared additional media bags as needed. Prepared and
warmed the calculated number of additional media bags determined
above.
[1059] Filled G-Rex500MCS. Opened a G-Rex500MCS on the benchtop and
inspected for cracks in the vessel or kinks in the tubing. Ensured
all luer connections and closures were tight. Made a mark at the
4500 mL line on the outside of the flask with a marker. Closed all
clamps on the G-Rex500MCS except the large filter line. Sterile
welded the red media line of a G-Rex500MCS to the fluid transfer
set on the media bag prepared above.
[1060] Prepared to pump media. Hung "CM4 Day 16 Media" on an IV
pole. Fed the pump tubing through the Baxa pump.
[1061] Pumped media into G-Rex500MCS. Set the Baxa pump on "High"
and "9" and pump 4500 mL of media into the flask. Pumped 4.5 L of
"CM4 Day 16 Media" into the G-Rex500MCS, filling to the line marked
on the flask as above. Once 4.5 L of media had been transferred,
stopped the pump.
[1062] Heat Sealed. Heat sealed the red media line of G-Rex500MCS,
near the weld created, removing the media bag.
[1063] Repeated Fill. Repeat filling and sealing steps for each
flask calculated in above as media is warmed and prepared for use.
Multiple flasks may be filled at the same time using gravity fill
or multiple pumps. Fill only two flasks per bag of media.
[1064] Recorded and labelled flask(s) filled. Labeled each flask
alphabetically and with "Day 16" labels.
[1065] As needed incubated flask. Held flask in incubator while
waiting to seed with TIL. Recorded the total number of flasks
filled.
[1066] Calculated volume of cell suspension to add. Calculated the
target volume of TIL suspension to add to the new G-Rex500MCS
flasks.
TABLE-US-00027 TABLE 27 Cell suspension volume Target Volume of
cell Total Volume of TIL suspension to transfer suspension Number
of to each flask A flask(s) filled C = A / B mL mL
[1067] If number of flasks exceeds five only five will be seeded,
USING THE ENTIRE VOLUME OF CELL SUSPENSION.
[1068] Prepared Flasks for Seeding. Removed G-Rex500MCS from Step
8.10.70 from the incubator.
[1069] Prepared for pumping. Closed all clamps on G-Rex500MCS
except large filter line. Fed the pump tubing through the Baxa
pump.
[1070] Removed TIL from incubator. Removed "TIL Suspension"
transfer pack from the incubator and record incubation end
time.
[1071] Prepared cell suspension for seeding. Sterile welded "TIL
Suspension" transfer pack from above to pump inlet line.
[1072] Placed TIL suspension bag on a scale. Primed the line from
the TIL suspension bag to the weld using the Baxa pump set to "Low"
and "2". Tared the scale.
[1073] Seeded flask with TIL Suspension. Set Baxa pump to "Medium"
and "5". Pump the volume of TIL suspension calculated above into
flask. Record the volume of TIL Suspension added to each flask.
[1074] Heat sealed. Heat sealed the "TIL Suspension" transfer pack,
leaving enough tubing to weld on the next flask.
[1075] Filled remaining flasks. Between each flask seeded, ensured
to mix "TIL Suspension" transfer pack and repeat filling and
sealing steps to seed all remaining flaks.
[1076] Monitored Incubator. If flasks must be split among two
incubators, ensure to monitor both. Incubator parameters:
Temperature LED Display: 37.0.+-.2.0.degree. C., CO2 Percentage:
5.0.+-.1.5% CO2. Recorded the time each flask is placed in the
incubator.
[1077] Calculated incubation window. Performed calculations below
to determine the time range to remove G-Rex500MCS from incubator on
Day 22. Lower limit: time+132 hours; upper limit: time+156
hours.
Day 22 Wash Buffer Preparation
[1078] Prepared 10 L Labtainer Bag. In BSC, attach a 4'' plasma
transfer set to a 10 L Labtainer Bag via luer connection. Prepared
10 L Labtainer Bag Label as "Supernatant", lot number, and
initial/date. Closed all clamps before transferring out of the BSC.
NOTE: Prepared one 10 L Labtainer Bag for every two G-Rex500MCS
flasks to be harvested.
[1079] Welded fluid transfer set. Outside the BSC, closed all
clamps on 4S-4M60. Welded repeater fluid transfer set to one of the
male luer ends of 4S-4M60.
[1080] Passed Plasmalyte-A and Human Albumin 25% into the BSC.
Passed the 4S-4M60 and repeater fluid transfer set assembly into
the BSC.
TABLE-US-00028 TABLE 28 Components Component Description Amount
Needed Plasmalyte-A 3000.0 mL Human Albumin 25% 120.0 mL 4S-4M60
with Repeater 1 Apparatus Fluid Transfer Set Step 8.11.7
TABLE-US-00029 TABLE 29 Plasmalyte-A Latex: Not Made with Natural
Rubber Latex Container Type: VIAFLEX PVC: Contains PVC DEHP:
Contains DEHP Volume: 500 ML Total Calories: 21 Kcal/L Sodium: 140
mEq/L Potassium: 5 mEq/L Magnesium: 3 mEq/L Acetate: 27 mEq/L
Chloride: 98 mEq/L Gluconate: 23 mEq/L Osmolarity (mOsmol/L): 294
Specific Gravity: 1.01 pH: 7.4 Fill Range Volume (mL): 530-565
Shelf Life from manufacture: 15 months Contains Preservative: No
Storage Recommendations: Store at room temperature (25.degree.
C./77.degree. F.); brief exposure up to 40.degree. C./104.degree.
F. does not adversely affect the product. Packaging: Single Pack Rx
Only: Yes **As commercially available from
http://ecatalog.baxter.com/ecatalog/loadproduct.html?cid=20016&lid=10001&-
hid=2000 1&pid=821874.
[1081] Pumped Plasmalyte into 3000 mL bag. Spiked three bags of
Plasmalyte-A to the 4S-4M60 Connector set. NOTE: Wipe the port
cover with an alcohol swab (W3009488) prior to removing. NOTE:
Maintain constant pressure while turning the spike in one
direction. Ensure to not puncture the side of the port. Connected
an Origen 3000 mL collection bag via luer connection to the larger
diameter end of the repeater pump transfer set. Closed clamps on
the unused lines of the 3000 mL Origen Bag. Staged the Baxa pump
next to the BSC. Fed the transfer set tubing through the Baxa pump
situated outside of the BSC. Set pump to "High" and "9". Opened all
clamps from the Plasmalyte-A to the 3000 mL Origen Bag. Pumped all
of the Plasmalyte-A into the 3000 mL Origen bag. Once all the
Plasmalyte-A had been transferred, stopped the pump. If necessary,
removed air from 3000 mL Origen bag by reversing the pump and
manipulating the position of the bag. Closed all clamps.
[1082] Remove the 3000 mL bag from the repeater pump fluid transfer
set via luer connection and placed a red cap (W3012845) on the line
to the bag.
[1083] Added Human Albumin 25% to 3000 mL Bag. Opened vented mini
spike. Without compromising sterility of spike, ensured blue cap is
securely fastened. Spiked the septum of a Human Albumin 25% bottle
with the vented mini spike. NOTE: Ensured to not compromise the
sterility of the spike. Repeated two times for a total of three (3)
spiked Human Albumin 25% bottles. Removed the blue cap from one
vented mini spike and attach a 60 mL syringe to the Human Serum
Albumin 25% bottle. Draw up 60 mL of Human Serum Albumin 25%. It
may be necessary to use more than one bottle of Human Serum Albumin
25%. If necessary, disconnect the syringe from the vented mini
spike and connect it to the next vented mini spike in a Human Serum
Albumin 25% bottle. Once 60 mL has been obtained, remove the
syringe from the vented mini spike. Attach syringe to needleless
injection port on 3000 mL Origen bag filled with Plasmalyte-A.
Dispensed all of the Human Albumin 25%. Repeated to obtain a final
volume of 120.0 mL of Human Albumin 25%. Gently mixed the bag after
all of the Human Albumin 25% had been added. Labeled as "LOVOWash
Buffer" and assign a 24 hour expiry.
[1084] Prepared IL-2 Diluent. Using a 10 mL syringe, removed 5.0 mL
of LOVO Wash Buffer using the needleless injection port on the LOVO
Wash Buffer bag. Dispensed LOVO wash buffer into a 50 mL conical
tube and label as "IL-2 Diluent".
[1085] CRF Blank Bag LOVO Wash Buffer Aliquotted. Using a 100 mL
syringe, drew up 70.0 mL of LOVO Wash Buffer from the needleless
injection port. NOTE: Wiped the needless injection port with an
alcohol pad before each use. Placed a red cap on the syringe and
label as "blank cryo bag" and lot number. NOTE: Held the syringe at
room temp until needed in Step 8.14.3
[1086] Completed Wash Buffer Prep. Closed all clamps on the LOVO
Wash Buffer bag.
[1087] Thawed IL-2. Thawed one 1.1 mL of IL-2 (6.times.10.sup.6
IU/mL), until all ice has melted. Record IL-2 Lot number and
Expiry. NOTE: Ensured IL-2 label is attached.
[1088] IL-2 Preparation. Added 50 .mu.L IL-2 stock
(6.times.10.sup.6 IU/mL) to the 50 mL conical tube labeled "IL-2
Diluent."
[1089] IL-2 Preparation. Relabeled conical as "IL-2 6.times.104",
the date, lot number, and 24 hour expiry. Cap and store at
2-8.degree. C.
[1090] Cryopreservation Prep. Placed 5 cryo-cassettes at
2-8.degree. C. to precondition them for final product
cryopreservation.
[1091] Prepared Cell Count Dilutions. In the BSC, added 4.5 mL of
AIM-V Media that has been labelled with lot number and "For Cell
Count Dilutions" to 4 separate 15 mL conical tubes and labeled the
tubes.
[1092] Prepared Cell Counts. Labeled 4 cryovials with vial number
(1-4).
Day 22 TIL Harvest
[1093] Monitored the incubator. Incubator Parameters Temperature
LED display: 37.+-.2.0.degree. C., CO2 Percentage: 5% 1.5%.
[1094] Removed G-Rex500MCS Flasks from Incubator. Check flasks and
confirm incubation parameters were met before removing G-Rex500MCS
from incubator (incubation time).
[1095] Prepared TIL collection bag Labeled a 3000 mL collection bag
as "TIL Suspension", lot number, and initial/date.
[1096] Sealed off extra connections. Heat sealed off two luer
connections on the collection bag near the end of each
connection.
[1097] GatheRex Setup. Sterile welded (per Process Note 5.11) the
red media removal line from the G-Rex500MCS to the 10 L labtainer
bag prepared above. NOTE: Referenced Process Note 5.16 for use of
multiple GatheRex devices. Sterile welded (per Process Note 5.11)
the clear cell removal line from the G-Rex500MCS to the TIL
Suspension collection bag prepared above. Placed the G-Rex500MCS
flask on the left side of the GatheRex. Placed the supernatant
Labtainer bag and pooled TIL suspension collection bag to the right
side. Installed the red media removal line from the G-Rex500MCS to
the top clamp (marked with a red line) and tubing guides on the
GatheRex. Installed the clear harvest line from the G-Rex500MCS to
the bottom clamp (marked with a blue line) and tubing guides on the
GatheRex. Attached the gas line from the GatheRex to the sterile
filter of the G-Rex500MCS. Before removing the supernatant from the
G-Rex500MCS, ensured all clamps on the cell removal lines were
closed.
[1098] Volume Reduction. Transferred .about.4.5 L of supernatant
from the G-Rex500MCS to the Supernatant bag. Visually inspected
G-Rex500MCS to ensure flask is level and media had been reduced to
the end of the aspirating dip tube. Repeat step if needed.
[1099] Prepared flask for TIL Harvest. After removal of the
supernatant, closed all clamps to the red line.
[1100] Initiated collection of TIL. Recorded the start time of the
TIL harvest. Vigorously tap flask and swirl media to release cells.
Performed an inspection of the flask to ensure all cells have
detached. Placed "TIL Suspension" 3000 mL collection bag on dry
wipes on a flat surface. Tilted the flask to ensure hose is at the
edge of the flask. NOTE: If the cell collection hose was not at the
junction of the wall and bottom membrane, rapping the flask while
tilted at a 450 angle is usually sufficient to properly position
the hose.
[1101] TIL Harvest. Released all clamps leading to the TIL
suspension collection bag. Using the GatheRex, transferred the TIL
suspension into the 3000 mL collection bag. NOTE: Maintained the
tilted edge until all cells and media were collected. Inspect
membrane for adherent cells.
[1102] Rinsed flask membrane. Rinsed the bottom of the G-Rex500MCS.
Covered .about.1/4 of gas exchange membrane with rinse media.
[1103] Closed clamps on G-Rex500MCS. Ensure all clamps are
closed.
[1104] Heat sealed. Heat seal the collection bag containing the TIL
as close to the weld as possible so that the overall tubing length
remained approximately the same. Heat sealed the Supernatant
bag.
[1105] Completed harvest of remaining G-Rex 500 MCS flasks. Repeat
steps above, pooling all TIL into the same collection bag. It was
necessary to replace the 10 l supernatant bag after every 2nd
flask.
[1106] Prepared LOVO source bag. Obtained a new 3000 mL collection
bag. Labeled as "LOVO Source Bag", lot number, and Initial/Date.
Heat sealed the tubing on the "LOVO Source bag", removing the
female luers, leaving enough line to weld.
[1107] Weighed LOVO Source Bag. Placed an appropriately sized
plastic bin on the scale and tare. Place the LOVO Source Bag,
including ports and lines, in the bin and record the dry
weight.
[1108] Transferred cell suspension into LOVO source bag. Closed all
clamps of a 170 .mu.m gravity blood filter.
[1109] Transferred cell suspension into LOVO source bag. Sterile
welded the long terminal end of the gravity blood filter to the
LOVO source bag. Sterile welded one of the two source lines of the
filter to "pooled TIL suspension" collection bag. Once weld was
complete, heat sealed the unused line on the filter to remove it.
Opened all necessary clamps and elevate the TIL suspension by
hanging the collection bag on an IV pole to initiate gravity-flow
transfer of TIL through the blood filter and into the LOVO source
bag. Gently rotated or knead the TIL Suspension bag while draining
in order to keep the TIL in even suspension.
[1110] Closed all clamps. Once all TIL were transferred to the LOVO
source bag, closed all clamps.
[1111] Heat Sealed. Heat sealed (per Process Note 5.12) as close to
weld as possible to remove gravity blood filter.
[1112] Removed Cell Counts Samples. In the BSC, using separate 3 mL
syringes for each sample, removed 4.times.1.0 mL cell count samples
from the LOVO source bag using the needless injection port. Placed
samples in the cryovials prepared in Step 8.11.36.
[1113] Performed Cell Counts. Performed cell counts and
calculations utilizing NC-200. Diluted cell count samples initially
by adding 0.5 mL of cell suspension into 4.5 mL of AIM-V media
prepared above. This gave a 1:10 dilution.
[1114] Recorded Cell Count and Sample Volumes. Calculated Total
Viable TIL Cells. If Total Viable cells.gtoreq.1.5.times.10.sup.9,
proceeded. Calculate Total Nucleated Cells.
[1115] Prepared Mycoplasma Diluent. In the BSC, removed 10.0 mL
from one supernatant bag via luer sample port and placed in a 15 mL
conical. Label 15 mL conical "Mycoplasma Diluent".
LOVO
[1116] Turned on the LOVO and started the "TIL G-Rex Harvest"
protocol and followed screen prompts. Buffer type was PlasmaLyte.
Followed the LOVO touch screen prompts.
[1117] Determined the final product target volume. Using the total
nucleated cells (TNC) value and the chart below, determined the
final product target volume and recorded (mL).
TABLE-US-00030 TABLE 30 Calculate final product volume Final
Product (Retentate) Volume to Cell Range Target (mL) 0 < Total
(Viable + Dead) Cells .ltoreq. 165 7.1 .times. 10.sup.10 7.1
.times. 10.sup.10 < Total (Viable + Dead) Cells .ltoreq. 215 1.1
.times. 10.sup.11 1.1 .times. 10.sup.11 < Total (Viable + Dead)
Cells .ltoreq. 265 1.5 .times. 10.sup.11
[1118] Followed the LOVO touch screen prompts.
[1119] Loaded disposable kit. Prior to loading the disposable kit,
wipe pressure sensor port with an alcohol wipe followed by a
lint-free wipe. Load the disposable kit. Follow screen directions
on loading the disposable kit.
[1120] Removed filtrate bag. When the standard LOVO disposable kit
had been loaded, touched the Next button. The Container Information
and Location Screen displayed. Removed filtrate bag from scale
[1121] Ensured Filtrate container was New and Off-Scale
[1122] Entered Filtrate capacity. Sterile welded a LOVO Ancillary
Bag onto the male luer line of the existing Filtrate Bag. Ensured
all clamps are open and fluid path is clear. Touch the Filtrate
Container Capacity entry field. A numeric keypad displays. Enter
the total new Filtrate capacity (5,000 mL). Touch the button to
accept the entry. NOTE: Estimated Filtrate Volume should not exceed
5000 mL.
[1123] Placed Filtrate container on benchtop. NOTE: If tubing was
removed from the F clamp during welding, placed the tubing back
into the clamp. Placed the new Filtrate container on the benchtop.
DID NOT hang the Filtrate bag on weigh scale #3. Weigh scale #3
will be empty during the procedure.
[1124] Followed the LOVO touch screen prompts after changes to the
filtrate container.
[1125] Ensured kit was loaded properly. The Disposable Kit Dry
Checks overlay displays. Checked that the kit was loaded properly
and all clamps were open. Checked all tubing for kinks or other
obstructions and correct if possible. Ensured kit was properly
installed and check all Robert's clamps. Pressed the Yes button.
All LOVO mechanical clamps closed automatically and the Checking
Disposable Kit Installation screen displays. The LOVO went through
a series of pressurizing steps to check the kit.
[1126] Kit Check Results. If the Kit check passed, proceeded to the
next step. *If No, a second Kit Check could be performed after
checks have been complete. *If No, Checked all tubing for kinks or
other obstructions and correct *If No, Ensured kit was properly
installed and check all Robert's clamps. If the 2nd kit check
failed: Contact area management and prepare to installation of new
kit in Section 10.0. Repeat Step 8.13.23-Step 8.13.30 needed.
[1127] Attached PlasmaLyte. The Connect Solutions screen displayed.
The wash value would always be 3000 mL. Entered this value on
screen.
[1128] Sterile welded the 3000 mL bag of PlasmaLyte to the tubing
passing through Clamp 1. Hung the PlasmaLyte bag on an IV pole
placing both corner bag loops on the hook.
[1129] Verified that the PlasmaLyte was attached. Opened any
plastic clamps. Verified that the Solution Volume entry was 3000
mL. Touched the "Next" button. The Disposable Kit Prime overlay
displayed. Verified that the PlasmaLyte was attached and any welds
and plastic clamps on the tubing leading to the PlasmaLyte bag were
open, then touched the Yes button
[1130] Observed that the PlasmaLyte is moving. Disposable kit prime
starts and the Priming Disposable Kit Screen displays. Visually
observed that PlasmaLyte moving through the tubing connected to the
bag of PlasmaLyte. If no fluid was moving, pressed the Pause Button
on the screen and determined if a clamp or weld was still closed.
Once the problem had been solved, pressed the Resume button on the
screen to resume the Disposable Kit Prime. Followed the LOVO touch
screen prompts.
[1131] Attached Source container to tubing. Sterile weld the LOVO
Source Bag prepared in Step 8.12.31 to the tubing passing through
Clamp S per Process Note 5.11. It could be necessary to remove the
tubing from the clamp. Note: Made sure to replace source tubing
into the S clamp if removed.
[1132] Hung Source container. Hung the Source container on the IV
pole placing both corner bag loops on the hook. DID NOT hang the
Source on weigh scale #1. Opened all clamps to the source bag.
[1133] Verified Source container was attached. Touched the Next
button. The Source Prime overlay displayed. Verified that the
Source was attached to the disposable kit, and that any welds and
plastic clamps on the tubing leading to the Source were open.
Touched the Yes button.
[1134] Confirm PlasmaLyte was moving. Source prime started and the
Priming Source Screen displayed. Visually observed that PlasmaLyte
is moving through the tubing attached to the Source bag. If no
fluid is moving, press the Pause Button on the screen and determine
if a clamp or weld is still closed. Once the problem was solved,
pressed the Resume button on the screen to resume the Source
Prime.
[1135] Started Procedure Screen. When the Source prime finishes
successfully, the Start Procedure Screen displays. Pressed Start,
the "Pre-Wash Cycle 1" pause screen appears immediately after
pressing start.
[1136] Inverted In Process Bag. Removed the In Process Bag from
weigh scale #2 (can also remove tubing from the In Process top port
tubing guide) and manually invert it to allow the wash buffer added
during the disposable kit prime step to coat all interior surfaces
of the bag. Re-hang the In Process Bag on weigh scale #2 (label on
the bag was facing to the left). Replace the top port tubing in the
tubing guide, if it was removed.
[1137] Inverted Source bag. Before pressing the Start button, mixed
the Source bag without removing it from the IV pole by massaging
the bag corners and gently agitating the cells to create a
homogeneous cell suspension. Pressed the Resume button. The LOVO
started processing fluid from the Source bag and the Wash Cycle 1
Screen displays.
[1138] Source Rinse Pause. The Rinse Source Pause screen displayed
once the source container was drained and the LOVO had added wash
buffer to the Source bag. Without removing the Source bag from IV
pole, massaged the corners and mixed well. Pressed Resume.
[1139] Mixed In Process Bag Pause. To prepare cells for another
pass through the spinner, the In Process Bag was diluted with wash
buffer. After adding the wash buffer to the In Process Bag, the
LOVO pauses automatically and displays the "Mix In Process Bag"
Pause Screen. Without removing the bag from the weigh scale, mixed
the product well by gently squeezing the bag. Press Resume.
[1140] Massaged In Process Corners Pause. When the In Process Bag
was empty, wash buffer was added to the bottom port of the In
Process Bag to rinse the bag. After adding the rinse fluid, the
LOVO paused automatically and displayed the "Massage IP corners"
Pause Screen. When the "Massage IP corners" Pause Screen displayed,
DO NOT remove the bag from weigh scale #2. With the In Process Bag
still hanging on weigh scale #2, massage the corners of the bag to
bring any residual cells into suspension. Ensured the bag was not
swinging on the weigh scale and pressed the Resume button.
[1141] Waited for Remove Products Screen. At the end of the LOVO
procedure, the Remove Products Screen displayed. When this Screen
displays, all bags on the LOVO kit could be manipulated. Note: Did
not touch any bags until the Remove Products displayed.
[1142] Removed retentate bag. Placed a hemostat on the tubing very
close to the port on the Retentate bag to keep the cell suspension
from settling into the tubing. Heat sealed (per Process Note 5.12)
below the hemostat, making sure to maintain enough line to weld in
Step 8.13.48. Removed the retentate bag.
[1143] Prepared retentate bag for formulation. Welded the female
luer lock end of a 4'' Plasma Transfer Set to the retentate bag.
Transferred the retentate bag.
[1144] Removed Products. Followed the instructions on the Remove
Products Screen. Closed all clamps on the LOVO kit to prevent fluid
movement.
[1145] Removed Products. Touched the Next button. All LOVO
mechanical clamps opened and the Remove Kit Screen displayed.
[1146] Recorded Data. Followed the instructions on the Remove Kit
screen. Touched the "Next" button. All LOVO mechanical clamps close
and the Results Summary Screen displays. Recorded the data from the
results summary screen. Closed all pumps and filter support.
Removed the kit when prompted to do so by the LOVO. All Times
recorded were recorded directly from the LOVO.
Final Formulation and Fill
[1147] Target volume/bag calculation. From Table 31 below, selected
the number of CS750 bags to be filled, target fill volume per bag,
volume removed for retain per bag, and final target volume per bag
that corresponded to the Volume of LOVO Retentate from above.
TABLE-US-00031 TABLE 31 Target volume/bag calculation Volume of
Volume of CS10 Final Predicted Volume Number of Target Fill Volume
removed Final Target LOVO product to add to product of formulated
product bags to be Volume per bag for retain per bag Volume per bag
165 mL 165 mL 330 mL 3 107 mL 7 mL 100 mL 215 mL 215 mL 430 mL 4
105 mL 5 mL 100 mL 265 mL 265 mL 530 mL 4 130 mL 5 mL 125 mL
[1148] Prepared CRF Blank. Calculated volume of CS-10 and LOVO wash
buffer to formulate blank bag.
TABLE-US-00032 TABLE 32 Calculated volumes. Final Target Blank LOVO
Wash Blank CS-10 Volume per Bag Buffer Volume Volume (mL) A B = A/2
C = B mL mL mL
[1149] Prepared CRY Blank. Outside of the BSC, using the syringe of
LOVO Wash Buffer prepared in above, added volume calculated to an
empty CS750 bag via luer connection. Note: Blank CS750 bag
formulation does not need to be done aseptically. Using an
appropriately sized syringe, added the volume of CS-10 calculated
to the same CS750 bag prepared above. Placed a red cap on the CS750
bag. Removed as much air as possible from the CS-750 bag as
possible. Heat sealed the CS750 bag as close to the bag as
possible, removing the tubing. Label CS750 bag with "CRF Blank",
lot number, and initial/date. Placed the CRF Blank on cold packs
until it was placed in the CRF.
[1150] Calculated required volume of IL-2. Calculated the volume of
IL-2 to add to the Final Product
TABLE-US-00033 TABLE 33 Calculated IL-2 volume Parameter Formula
Result Final Retentate Volume Step 8.13.51 A. mL Final Formulated
Volume B = A .times. 2 B. mL Final IL-2 Concentration 300 IU/mL C.
300 IU/mL desired (IU/mL) IU of IL-2 Required D = B .times. C D. IU
IL-2 Working Stock from 6 .times. 10.sup.4 IU/mL E. 6 .times.
10.sup.4 IU/mL Step 8.11.33 Volume of IL-2 to Add to F = D / E F.
mL Final Product
[1151] Assembled Connect apparatus. Sterile welded a 4S-4M60 to a
CC2 Cell Connect replacing a single spike of the Cell Connect
apparatus with the 4-spike end of the 4S-4M60 manifold.
[1152] Assembled Connected apparatus. Sterile welded the CS750
Cryobags to the harness prepared above, replacing one of the four
male luer ends (E) with each bag. Welded (per Process Note 5.11)
CS-10 bags to spikes of the 4S-4M60. Kept CS-10 cold by placing the
bags between two cold packs conditioned at 2-8.degree. C.
[1153] Prepared TIL with IL-2. Using an appropriately sized
syringe, removed amount of IL-2 determined above from the "IL-2
6.times.104" aliquot. Connect the syringe to the retentate bag
prepared above via the Luer connection and inject IL-2. Clear the
line by pushing air from the syringe through the line.
[1154] Labeled Formulated TIL Bag. Closed the clamp on the transfer
set and label bag as "Formulated TIL" and passed the bag out of the
BSC.
[1155] Added the Formulated TIL bag to the apparatus. Once TL-2 had
been added, welded the "Formulated TIL" bag to the remaining spike
on the apparatus.
[1156] Added CS10. Passed the assembled apparatus with attached
Formulated TIL, CS-750 bags, and CS-10 into the BSC. NOTE: The
CS-10 bag and all CS-750 bags were placed between two cold packs
preconditioned at 2-8.degree. C. Did not place Formulated TIL bag
on cold packs. Ensured all clamps were closed on the apparatus.
Turn the stopcock so the syringe was closed.
[1157] Switched Syringes. Drew .about.10 mL of air into a 100 mL
syringe and replaced the 60 mL syringe on the apparatus.
[1158] Added CS10. Turned stopcock so that the line to the CS750
bags is closed. Open clamps to the CS-10 bags and pull volume
calculated above into syringe. NOTE: Multiple syringes will be used
to add appropriate volume of CS-10. Closed clamps to CS-10 and open
clamps to the Formulated TIL bag and add the CS-10. Add first 10.0
mL of CS10 at approximately 10.0 mL/minute. Add remaining CS-10 at
approximate rate of 1.0 mL/sec. Note: Multiple syringes were used
to add appropriate volume of CS-10. Recorded time. NOTE: The target
time from first addition of CS-10 to beginning of freeze is 30
minutes. Recorded the volume of each CS10 addition and the total
volume added. Closed all clamps to the CS10 bags.
[1159] Prepared CS-750 bags. Turned the stopcock so that the
syringe was open. Opened clamps to the Formulated TIL bag and drew
up suspension stopping just before the suspension reaches the
stopcock. Closed clamps to the formulated TIL bag. Turned stopcock
so that it was open to the empty CS750 final product bags. Using a
new syringe, removed as much air as possible from the CS750 final
product bags by drawing the air out. While maintaining pressure on
the syringe plunger, clamped the bags shut. Draw .about.20 mL air
into a new 100 mL syringe and connect to the apparatus. NOTE: Each
CS-750 final product bag should be between two cold packs to keep
formulated TIL suspension cold.
[1160] Dispensed cells. Turned the stopcock so the line to the
final product bags was closed. Pulled the volume calculated above
from the Formulated TIL bag into the syringe. NOTE: Multiple
syringes could be used to obtain correct volume. Turned the
stopcock so the line to the formulated TIL bag is closed. Working
with one final product bag at a time, dispense cells into a final
product bag. Recorded volume of cells added to each CS750 bag
above. Cleared the line with air from the syringe so that the cells
are even with the top of the spike port. Closed the clamp on the
filled bag. Repeated steps for each final product bag, gently
mixing formulated TIL bag between each. Recorded volume of TIL
placed in each final product bag below.
[1161] Removed air from final product bags and take retain. Once
the last final product bag was filled, closed all clamps. Drew 10
mL of air into a new 100 mL syringe and replace the syringe on the
apparatus. Manipulating a single bag at a time, drew all of the air
from each product bag plus the volume of product for retain
determined above. NOTE: Upon removal of sample volume, inverted the
syringe and used air to clear the line to the top port of the
product bag. Clamped the line to the bag once the retain volume and
air was removed.
[1162] Recorded volume of retain removed from each bag.
[1163] Dispensed Retain. Dispensed retain into a 50 mL conical tube
and label tube as "Retain" and lot number. Repeat for each bag.
[1164] Prepared final product for cryopreservation. With a
hemostat, clamped the lines close to the bags. Removed syringe and
red cap luer connection on the apparatus that the syringe was on.
Passed apparatus out of the BSC. Heat sealed (per Process Note
5.12) at F, removing the empty retentate bag and the CS-10 bags.
NOTE: Retained luer connection for syringe on the apparatus.
Disposed of empty retentate and CS-10 Bags.
[1165] Labeled final product bags. Attached sample final product
label below.
[1166] Prepared final product for cryopreservation. Held the
cryobags on cold pack or at 2-8.degree. C. until
cryopreservation.
[1167] Removed Cell Count Sample. Using an appropriately sized
pipette, remove 2.0 mL of retain removed above and placed in a 15
mL conical tube to be used for cell counts.
[1168] Performed Cell Counts. Performed cell counts and
calculations utilizing the NC-200. NOTE: Diluted only one sample to
appropriate dilution to verify dilution is sufficient. Diluted
additional samples to appropriate dilution factor and proceed with
counts. Recorded Cell Count sample volumes. NOTE: If no dilution
needed, "Sample [.mu.L]"=200, "Dilution [.mu.L]"=0. Determined the
Average of Viable Cell Concentration and Viability of the cell
counts performed.
[1169] Calculated Flow Cytometry Sample. Performed calculation to
ensure sufficient cell concentration for flow cytometry
sampling.
TABLE-US-00034 TABLE 34 Calculate flow cytometry cell concentration
Viable Cell Target Volume Required Concentration for 6 .times.
10.sup.7 TVC Is B .ltoreq. 1.0 mL? A B = 6 .times. 10.sup.7 cells/A
(Yes/No**) mL
[1170] Calculated IFN-.gamma.. Sample Performed calculation to
ensure sufficient cell concentration for IFN-.gamma. sampling.
[1171] Heat Sealed. Once sample volumes had been determined, heat
sealed Final Product Bags as close to the bags as possible to
remove from the apparatus.
TABLE-US-00035 TABLE 35 Labeling and collection of samples Sample
Volume to Number of Add to Container Sample Containers Each Type
*Mycoplasma 1 1.0 mL 15 mL Conical Endotoxin 2 1.0 mL 2 mL Cryovial
Gram Stain 1 1.0 mL 2 mL Cryovial IFN-g 1 1.0 mL 2 mL Cryovial Flow
1 1.0 mL 2 mL Cryovial Cytometry **Bac-T 2 1.0 mL Bac-T Bottle
Sterility QC Retain 4 1.0 mL 2 mL Cryovial Satellite Vials 10 0.5
mL 2 mL Cryovial
[1172] For the Mycoplasma sample, add formulated cell suspension
volume to the 15 mL conical labelled "Mycoplasma Diluent" from
above. Sterility & BacT. Testing Sampling. In the BSC, remove a
1.0 mL sample from the retained cell suspension collected in above
using an appropriately sized syringe and inoculate the anaerobic
bottle. Repeat the above for the aerobic bottle.
[1173] Labeled and stored samples. Labeled all samples with sample
plan inventory labels and store appropriately until transfer.
Proceeded to next steps for cryopreservation of final product and
samples.
Final Product Cryopreservation
[1174] Prepared Controlled Rate Freezer. Verified the CRF had been
set up prior to freeze. Record CRF Equipment. Cryopreservation is
performed.
[1175] Set up CRF probes. Punctured the septum on the CRF blank
bag. Inserted the 6 mL vial temperature probe.
[1176] Placed final product and samples in CRF. Placed blank bag
into preconditioned cassette and transferred into the approximate
middle of the CRF rack. Transferred final product cassettes into
CRF rack and vials into CRF vial rack. Transferred product racks
and vial racks into the CRF. Recorded the time that the product is
transferred into the CRF and the chamber temperature.
[1177] Determined the time needed to reach 4.degree.
C..+-.1.5.degree. C. and proceed with the CRF run. Once the chamber
temperature reached 4.degree. C..+-.1.5.degree. C., started the
run. Recorded time.
[1178] Completed and Stored. Stopped the CRF after the completion
of the run. Remove cassettes and vials from CRF. Transferred
cassettes and vials to vapor phase LN2 for storage.
Example 12: Novel Cryopreserved Tumor Infiltrating Lymphocytes
(LN-144) Administered to Patients with Metastatic Melanoma
Demonstrated Efficacy and Tolerability in a Multicenter Phase 2
Clinical Trial
Background
[1179] The safety and efficacy of adoptive cell therapy (ACT)
utilizing tumor infiltrating lymphocytes (TIL) has been studied in
hundreds of patients with metastatic melanoma, and has demonstrated
meaningful and durable objective response rates (ORR)..sup.1 In an
ongoing Phase 2 trial, C-144-01 utilizing centralized GMP
manufacturing of TIL, both non-cryopreserved Generation 1 (Gen 1)
and cryopreserved Generation 2 (Gen 2) TIL manufacturing processes
were assessed.
[1180] Gen 1 is approximately 5-6 weeks in duration of
manufacturing (administered in Cohort 1 of C-144-01 study), while
Gen 2 is 22 days in duration of manufacturing (process 2A,
administered in Cohort 2 of C-144-01 study). Preliminary data from
Cohort 1 patients infused with the Gen 1 LN-144 manufactured
product, was encouraging in treating post-PD-1 metastatic melanoma
patients as the TIL therapy produced responses..sup.2 Benefits of
Gen 2 included: (A) reduction in the time patients and physicians
wait to infuse TIL to patient; (B) cryopreservation permits
flexibility in scheduling, distribution, and delivery; and (C)
reduction of manufacturing costs. Preliminary data from Cohort 2 is
presented herein. FIG. 25 shows an embodiment of the Gen 2
cryopreserved LN-144 manufacturing process (process 2A).
Study Design: C-144-01 Phase 2 Trial in Metastatic Melanoma
[1181] Phase 2, Multicenter, 3-Cohort Study to Assess the Efficacy
and Safety of Autologous Tumor Infiltrating Lymphocytes (LN-144)
for Treatment of Patients with Metastatic Melanoma.
[1182] Key Inclusion Criteria: (1) Measurable metastatic melanoma
and .gtoreq.1 lesion resectable for TIL generation; (2) Progression
on at least one prior line of systemic therapy; (3) Age.gtoreq.18;
and (4) ECOG PS 0-1.
[1183] Treatment Cohorts: (1) Non-Cryopreserved LN-144 product; (2)
Cryopreserved LN-144 product; and (3) Retreatment with LN-144 for
patients without response or who progress after initial response.
FIG. 26 shows the study design.
[1184] Endpoints: (1) Primary: Efficacy defined as ORR and (2)
Secondary: Safety and Efficacy.
Methods
[1185] Cohort 2 Safety Set: 13 patients who underwent resection for
the purpose of TIL generation and received any component of the
study treatment.
[1186] Cohort 2 Efficacy Set: 9 patients who received the NMA-LD
preconditioning, LN-144 infusion and at least one dose of IL-2, and
had at least one efficacy assessment. 4 patients did not have an
efficacy assessment at the time of the data cut.
[1187] Biomarker data has been shown for all available data read by
the date of the data cut.
Results
[1188] FIG. 27 provides a table illustrating the Comparison Patient
Characteristics from Cohort 1 (ASCO 2017) vs Cohort 2. Cohort 2
has: 4 median prior therapies; all patients have received prior
anti-PD-1 and anti-CTLA-4; and had higher tumor burden reflected by
greater sum of diameters (SOD) for target lesions and higher mean
LDH at Baseline. FIG. 28 provides a table showing treatment
emergent adverse events (.gtoreq.30%).
[1189] For Cohort 2 (cryopreserved LN-144), the infusion product
and TIL therapy characteristics were (1) mean number of TIL cells
infused: 37.times.10.sup.9, and (2) median number of IL-2 doses
administrations was 4.5. FIG. 29 shows the efficacy of the infusion
product and TIL therapy for Patients #1 to #8.
[1190] FIG. 30 shows the clinical status of response evaluable
patients with stable disease (SD) or a better response. A partial
response (PR) for Patient 6 was unconfirmed as the patient did not
reached the second efficacy assessment yet. One patient (Patient 9)
passed away prior to the first assessment (still considered in the
efficacy set).
[1191] Of the 9 patients in the efficacy set, one patient (Patient
9) was not evaluable (NE) due to melanoma-related death prior to
first tumor assessment not represented on FIG. 30. Responses were
seen in patients treated with Gen 2. The disease control rate (DCR)
was 78%. Time to response was similar to Cohort 1. One patient
(Patient 3) with progressive disease (PD) as best response was not
included in the swim lane plot.
[1192] FIG. 31 shows the percent change in sum of diameters.
Patient 9 had no post-LN-144 disease assessment due to
melanoma-related death prior to Day 42. Day -14: % change of Sum of
Diameters from Screening to Baseline (Day -14). Day -14 to Day 126:
% change of SOD from Baseline. Day -14=Baseline. Day 0=LN-144
infusion.
[1193] Upon TIL treatment, an increase of HMGB1 was observed (FIG.
32). Plasma HMGB1 levels were measured using HMGB1 ELISA kit (Tecan
US, Inc). Data shown represents fold change in HMGB1 levels pre
(Day -7) and post (Day 4 and Day 14) LN-144 infusion in Cohort 1
and Cohort 2 patients (p values were calculated using two-tailed
paired t-test based on log-transformed data). Sample size (bold and
italicized) and mean (italicized) values are shown in parentheses
for each time point. HMGB1 is secreted by activated immune cells
and released by damaged tumor cells. The increased HMGB1 levels
observed after treatment with LN-144 are therefore suggestive of an
immune-mediated mechanism of anti-tumor activity.
[1194] Plasma IP-10 levels were measured using Luminex assay. Data
shown in FIG. 33 represents fold change in IP-10 levels pre (Day
-7) and post (Day 4 and Day 14) LN-144 infusion in Cohort 1 and
Cohort 2 patients (p values were calculated using two-tailed paired
t-test based on log-transformed data). Sample size (bold and
italicized) and mean (italicized) values are shown in parentheses
for each time point. The post-LN-144 infusion increase in IP-10 is
being monitored to understand possible correlation with TIL
persistence.
[1195] Updated data from Cohort 2 (n=17 patients) is reported in
FIG. 34 to FIG. 39. In comparison to Cohort 1 and an embodiment of
the Gen 1 process, which showed a DCR of 64% and an overall
response rate (ORR) of 29% (N=14), Cohort 2 and an embodiment of
the Gen 2 process showed a DCR of 80% and an ORR of 40% (N=10).
Conclusions
[1196] Preliminary results from the existing data demonstrate
comparable safety between Gen 1 and Gen 2 LN-144 TIL products.
Administration of TILs manufactured with the Gen 2 process (process
2A, as described herein) leads to surprisingly increased clinical
responses seen in advanced disease metastatic melanoma patients,
all had progressed on anti-PD-1 and anti-CTLA-4 prior therapies.
The DCR for cohort 2 was 78%.
[1197] Preliminary biomarker data is supportive of the cytolytic
mechanism of action proposed for TIL therapy.
[1198] The embodiment of the Gen 2 manufacturing process described
herein takes 22 days. This process significantly shortens the
duration of time a patient has to wait to receive their TIL, offers
flexibility in the timing of dosing the patients, and leads to a
reduction of cost of manufacturing, while providing other
advantages over prior approaches that allow for commercialization
and registration with health regulatory agencies. Preliminary
clinical data in metastatic melanoma using an embodiment of the Gen
2 manufacturing process also indicates a surprising improvement in
clinical efficacy of the TILs, as measured by DCR, ORR, and other
clinical responses, with a similar time to response and safety
profile compared to TILs manufactured using the Gen 1 process.
REFERENCES
[1199] .sup.1Goff, et al. Randomized, Prospective Evaluation
Comparing Intensity of Lymphodepletion Before Adoptive Transfer of
Tumor-Infiltrating Lymphocytes for Patients With Metastatic
Melanoma. J Clin Oncol. 2016 Jul. 10; 34(20):2389-97. [1200]
.sup.2Sarnaik A, Kluger H, Chesney J, et al. Efficacy of single
administration of tumor-infiltrating lymphocytes (TIL) in heavily
pretreated patients with metastatic melanoma following checkpoint
therapy. J Clin Oncol. 2017; 35 [suppl; abstr 3045].
Example 13: Historical Control Study
[1201] A historical control study may be used for comparison of the
treatment outcomes in patients with double-refractory metastatic
melanoma to the outcomes of TIL therapies disclosed herein, such as
those therapies described in Example 2 and Example 3. In an
embodiment, a patient treated with TIL therapies disclosed herein
exhibits an improved response to the response expected from a
historical control. In an embodiment, a patient treated with TIL
therapies disclosed herein exhibits an improved response to the
response expected from a historical control, wherein the improved
response is determined as overall response rate. In an embodiment,
a patient treated with TIL therapies disclosed herein exhibits an
improved response to the response expected from a historical
control, wherein the improved response is determined as overall
response rate, wherein the improvement in overall response rate is
at least 5%, at least 10%, at least 15%, at least 20%, at least
25%, or at least 50%. In an embodiment, a patient treated with TIL
therapies disclosed herein exhibits an improved response to the
response expected from a historical control, wherein the improved
response is determined as duration of response. In an embodiment, a
patient treated with TIL therapies disclosed herein exhibits an
improved response to the response expected from a historical
control, wherein the improved response is determined as duration of
response, wherein the improvement in duration of response is at
least 5%, at least 10%, at least 15%, at least 20%, at least 25%,
or at least 50%.
[1202] The historical control study to determine the response of
double-refractory patients to other therapies may be performed
using data obtained from the treatment records of metastatic
melanoma patients. Patients must be exposed to 3 or more lines of
therapies for melanoma after the initial diagnosis of melanoma.
Lines of systemic therapies are counted per the following rules and
start and stop dates of each therapy are considered: [1203] All
agents received within 28 days of the first line (1 L) start
constituted the 1 L regimen, and could include a single agent or
combine multiple agents; 1 L end corresponded to either the first
gap of >90 days in the all 1 L agents or the initiation of a new
agent that was not part of 1 L (i.e., switch to a new line); [1204]
Subsequent lines of therapy are identified as the earliest of (a)
initiation of an agent not in the previous treatment regimen (after
the initial 28 day period to identify 1 L regimen), or (b)
initiation of any agent after a gap of >90 days in the previous
treatment. Regimens used in subsequent lines were identified based
on all agents received within 28 days of the start of the
respective line of therapy [1205] In general, ipilumimab and
nivolumab administered as a combination are considered to be one
therapy and BRAF and MEK inhibitors administered in combination
(e.g., dabrafenib and trametinib) considered to be one therapy.
[1206] All patients must have been treated with at least one
anti-PD-1 (or anti-PD-L1) therapy and failed (i.e., are refractory
or relapsed). Availability of the scan date that led to disease
progression if the line of therapy contains anti-PDi therapy is
preferred. For the last therapy on record (3rd or later), an
overall response per visit and date of either disease progression
or death (if applicable) are required. [1207] For the last line of
therapy on record, either i) target and non-target lesions measures
per each assessment, or ii) overall response per visit by RECIST is
required. [1208] Certain baseline disease status and baseline
characteristics before the initiation of the last therapy on record
are required, to allow for evaluation of whether these patients
meet the similar eligibility criteria for other studies described
herein (including in Example 2 and Example 3).
Example 14: Safety and Efficacy of Cryopreserved Autologous Tumor
Infiltrating Lymphocyte Therapy (LN-144, Lifileucel) in Advanced
Metastatic Melanoma Patients Following Progression on Checkpoint
Inhibitors
[1209] Adoptive cell therapy (ACT) utilizing tumor-infiltrating
lymphocytes (TIL) leverages and enhances the body's natural defense
against cancer. TIL has demonstrated antitumor efficacy. Durable
long-term responses in heavily pretreated patients (Rosenberg, S.
A., et al. Durable Complete Responses in Heavily Pretreated
Patients with Metastatic Melanoma Using T-Cell Transfer
Immunotherapy. Clinical Cancer Research, 17(13), 4550-4557).
[1210] C-144-01 (NCT02360579) is an ongoing Phase 2 multicenter
study, focusing on autologous TIL (lifileucel; LN-144). Patient
population being focused on is unresectable metastatic melanoma who
have progressed on checkpoint inhibitors and BRAF/MEK inhibitors
(if BRAF mutated). TIL manufacturing conditions: central
manufacturing of cryopreserved TIL, 22 day duration (based on the
processes described herein).
C-144-01 Phase 2 Trial in Metastatic Melanoma:
[1211] Phase 2, multicenter study to assess the efficacy and safety
of autologous Tumor Infiltrating Lymphocytes (LN-144) for treatment
of patients with metastatic melanoma (NCT02360579)
Endpoints of the Study:
[1212] Primary: Efficacy defined as investigator assessed ORR.
Secondary: Safety and efficacy
Study Details:
[1213] Cohort 2 fully enrolled. Cohort 2 preliminary efficacy,
safety and biomarker data provided in FIGS. 40-48 herein
(n=47).
[1214] Cohort 4 will initiate in the future with 80-100
patients.
Methods:
Data for Cohort 2.
[1215] Cohort 2 Safety & Efficacy Sets: 47 patients who
underwent resection for the purpose of TIL generation and received
lifileucel infusion. Biomarker data has been shown for all
available data read by the date of the data cut.
[1216] IP-10 is measured by a commercial Bio-Rad bead-based
Bio-Plex immunoassay, which measures multiple cytokines and
chemokines, and which includes an antibody specific for IP-10.
[1217] IP-10 is measured by taking blood samples from the patient
and is measured in the plasma fraction obtained from the blood
(i.e., after all blood cells are removed) and is reported in units
of picograms per milliliter of plasma (i.e., pg/mL).
Cohort 2 (lifileucel): Infusion Product and TIL Therapy
Characteristics
[1218] Mean number of TIL cells infused: 26.times.10.sup.9. Median
number of IL-2 doses administered was 6.0. Overall, 72% of patients
had a reduction in tumor burden. Median follow up is 6.0 months.
Median duration of response (DOR) is 6.4 months. Range of DOR was
from 1.3+ to 14+ months. Change in IP-10 levels in periphery may
have a correlation with response.
[1219] Mean change in IP-10 levels from baseline to day 1 post TIL
infusion was higher among responders vs. nonresponders (p=0.19)
[1220] In heavily pretreated metastatic melanoma patients, efficacy
to date is notable: [1221] Overall response rate (ORR): 38% [1222]
Median DOR: 6.4 months, range 1.3+ to 14+ [1223] Disease control
rate (DCR): 77% [1224] 16/17 had no response to prior anti-PD-1
[1225] The range of IP-10 in responders and non responders is
provided in Tables 1 and 2 below. These recite the actual numbers,
in pg/mL. Negative values mean decrease in IP-10 from day -7 to day
1 was observed.
[1226] Except the 4 patients in responders, remaining of responders
(7 responder patients) have change in IP-10 level value more than
1656 pg/ml.
TABLE-US-00036 TABLE 1 Change in levels of IP-10 from Day -7 to Day
1 (Range in pg/ml) Minimum Maximum Responders -264 9711.84
NonResponders -9808 4902.9
TABLE-US-00037 TABLE 2 Responders Non Responders 9711.84 932.23
2880.3 906.45 3105.92 -44.17 4923.37 4902.9 3960.7 1113.27 -65.99
2210.6 -264.25 263.81 313.38 166.41 2121.34 1236.29 1656.62 738.03
-72.48 -237.04 937.84 3109.53 308.36 3760.47 -9808.01 1082.79
868.95 -337.47 -27.29 287 1667.5 313.73 437.59
[1227] Biomarker analyses show that an increase in IP-10 levels may
correlate with anti-tumor response.
[1228] Preliminary data supports lifileucel (also known as LN-144)
autologous TIL as an efficacious and well-tolerated therapeutic
option for patients with metastatic melanoma.
Sequence CWU 1
1
1261450PRTArtificial SequenceMuromonab heavy chain 1Gln Val Gln Leu
Gln Gln Ser Gly Ala Glu Leu Ala Arg Pro Gly Ala1 5 10 15Ser Val Lys
Met Ser Cys Lys Ala Ser Gly Tyr Thr Phe Thr Arg Tyr 20 25 30Thr Met
His Trp Val Lys Gln Arg Pro Gly Gln Gly Leu Glu Trp Ile 35 40 45Gly
Tyr Ile Asn Pro Ser Arg Gly Tyr Thr Asn Tyr Asn Gln Lys Phe 50 55
60Lys Asp Lys Ala Thr Leu Thr Thr Asp Lys Ser Ser Ser Thr Ala Tyr65
70 75 80Met Gln Leu Ser Ser Leu Thr Ser Glu Asp Ser Ala Val Tyr Tyr
Cys 85 90 95Ala Arg Tyr Tyr Asp Asp His Tyr Cys Leu Asp Tyr Trp Gly
Gln Gly 100 105 110Thr Thr Leu Thr Val Ser Ser Ala Lys Thr Thr Ala
Pro Ser Val Tyr 115 120 125Pro Leu Ala Pro Val Cys Gly Gly Thr Thr
Gly Ser Ser Val Thr Leu 130 135 140Gly Cys Leu Val Lys Gly Tyr Phe
Pro Glu Pro Val Thr Leu Thr Trp145 150 155 160Asn Ser Gly Ser Leu
Ser Ser Gly Val His Thr Phe Pro Ala Val Leu 165 170 175Gln Ser Asp
Leu Tyr Thr Leu Ser Ser Ser Val Thr Val Thr Ser Ser 180 185 190Thr
Trp Pro Ser Gln Ser Ile Thr Cys Asn Val Ala His Pro Ala Ser 195 200
205Ser Thr Lys Val Asp Lys Lys Ile Glu Pro Arg Pro Lys Ser Cys Asp
210 215 220Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro Glu Leu Leu
Gly Gly225 230 235 240Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys
Asp Thr Leu Met Ile 245 250 255Ser Arg Thr Pro Glu Val Thr Cys Val
Val Val Asp Val Ser His Glu 260 265 270Asp Pro Glu Val Lys Phe Asn
Trp Tyr Val Asp Gly Val Glu Val His 275 280 285Asn Ala Lys Thr Lys
Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr Arg 290 295 300Val Val Ser
Val Leu Thr Val Leu His Gln Asp Trp Leu Asn Gly Lys305 310 315
320Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu Pro Ala Pro Ile Glu
325 330 335Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro Arg Glu Pro Gln
Val Tyr 340 345 350Thr Leu Pro Pro Ser Arg Asp Glu Leu Thr Lys Asn
Gln Val Ser Leu 355 360 365Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser
Asp Ile Ala Val Glu Trp 370 375 380Glu Ser Asn Gly Gln Pro Glu Asn
Asn Tyr Lys Thr Thr Pro Pro Val385 390 395 400Leu Asp Ser Asp Gly
Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp 405 410 415Lys Ser Arg
Trp Gln Gln Gly Asn Val Phe Ser Cys Ser Val Met His 420 425 430Glu
Ala Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro 435 440
445Gly Lys 4502213PRTArtificial SequenceMuromonab light chain 2Gln
Ile Val Leu Thr Gln Ser Pro Ala Ile Met Ser Ala Ser Pro Gly1 5 10
15Glu Lys Val Thr Met Thr Cys Ser Ala Ser Ser Ser Val Ser Tyr Met
20 25 30Asn Trp Tyr Gln Gln Lys Ser Gly Thr Ser Pro Lys Arg Trp Ile
Tyr 35 40 45Asp Thr Ser Lys Leu Ala Ser Gly Val Pro Ala His Phe Arg
Gly Ser 50 55 60Gly Ser Gly Thr Ser Tyr Ser Leu Thr Ile Ser Gly Met
Glu Ala Glu65 70 75 80Asp Ala Ala Thr Tyr Tyr Cys Gln Gln Trp Ser
Ser Asn Pro Phe Thr 85 90 95Phe Gly Ser Gly Thr Lys Leu Glu Ile Asn
Arg Ala Asp Thr Ala Pro 100 105 110Thr Val Ser Ile Phe Pro Pro Ser
Ser Glu Gln Leu Thr Ser Gly Gly 115 120 125Ala Ser Val Val Cys Phe
Leu Asn Asn Phe Tyr Pro Lys Asp Ile Asn 130 135 140Val Lys Trp Lys
Ile Asp Gly Ser Glu Arg Gln Asn Gly Val Leu Asn145 150 155 160Ser
Trp Thr Asp Gln Asp Ser Lys Asp Ser Thr Tyr Ser Met Ser Ser 165 170
175Thr Leu Thr Leu Thr Lys Asp Glu Tyr Glu Arg His Asn Ser Tyr Thr
180 185 190Cys Glu Ala Thr His Lys Thr Ser Thr Ser Pro Ile Val Lys
Ser Phe 195 200 205Asn Arg Asn Glu Cys 2103134PRTArtificial
Sequencerecombinant human IL-2 (rhIL-2) 3Met Ala Pro Thr Ser Ser
Ser Thr Lys Lys Thr Gln Leu Gln Leu Glu1 5 10 15His Leu Leu Leu Asp
Leu Gln Met Ile Leu Asn Gly Ile Asn Asn Tyr 20 25 30Lys Asn Pro Lys
Leu Thr Arg Met Leu Thr Phe Lys Phe Tyr Met Pro 35 40 45Lys Lys Ala
Thr Glu Leu Lys His Leu Gln Cys Leu Glu Glu Glu Leu 50 55 60Lys Pro
Leu Glu Glu Val Leu Asn Leu Ala Gln Ser Lys Asn Phe His65 70 75
80Leu Arg Pro Arg Asp Leu Ile Ser Asn Ile Asn Val Ile Val Leu Glu
85 90 95Leu Lys Gly Ser Glu Thr Thr Phe Met Cys Glu Tyr Ala Asp Glu
Thr 100 105 110Ala Thr Ile Val Glu Phe Leu Asn Arg Trp Ile Thr Phe
Cys Gln Ser 115 120 125Ile Ile Ser Thr Leu Thr 1304132PRTArtificial
SequenceAldesleukin 4Pro Thr Ser Ser Ser Thr Lys Lys Thr Gln Leu
Gln Leu Glu His Leu1 5 10 15Leu Leu Asp Leu Gln Met Ile Leu Asn Gly
Ile Asn Asn Tyr Lys Asn 20 25 30Pro Lys Leu Thr Arg Met Leu Thr Phe
Lys Phe Tyr Met Pro Lys Lys 35 40 45Ala Thr Glu Leu Lys His Leu Gln
Cys Leu Glu Glu Glu Leu Lys Pro 50 55 60Leu Glu Glu Val Leu Asn Leu
Ala Gln Ser Lys Asn Phe His Leu Arg65 70 75 80Pro Arg Asp Leu Ile
Ser Asn Ile Asn Val Ile Val Leu Glu Leu Lys 85 90 95Gly Ser Glu Thr
Thr Phe Met Cys Glu Tyr Ala Asp Glu Thr Ala Thr 100 105 110Ile Val
Glu Phe Leu Asn Arg Trp Ile Thr Phe Ser Gln Ser Ile Ile 115 120
125Ser Thr Leu Thr 1305130PRTArtificial Sequencerecombinant human
IL-4 (rhIL-4) 5Met His Lys Cys Asp Ile Thr Leu Gln Glu Ile Ile Lys
Thr Leu Asn1 5 10 15Ser Leu Thr Glu Gln Lys Thr Leu Cys Thr Glu Leu
Thr Val Thr Asp 20 25 30Ile Phe Ala Ala Ser Lys Asn Thr Thr Glu Lys
Glu Thr Phe Cys Arg 35 40 45Ala Ala Thr Val Leu Arg Gln Phe Tyr Ser
His His Glu Lys Asp Thr 50 55 60Arg Cys Leu Gly Ala Thr Ala Gln Gln
Phe His Arg His Lys Gln Leu65 70 75 80Ile Arg Phe Leu Lys Arg Leu
Asp Arg Asn Leu Trp Gly Leu Ala Gly 85 90 95Leu Asn Ser Cys Pro Val
Lys Glu Ala Asn Gln Ser Thr Leu Glu Asn 100 105 110Phe Leu Glu Arg
Leu Lys Thr Ile Met Arg Glu Lys Tyr Ser Lys Cys 115 120 125Ser Ser
1306153PRTArtificial Sequencerecombinant human IL-7 (rhIL-7) 6Met
Asp Cys Asp Ile Glu Gly Lys Asp Gly Lys Gln Tyr Glu Ser Val1 5 10
15Leu Met Val Ser Ile Asp Gln Leu Leu Asp Ser Met Lys Glu Ile Gly
20 25 30Ser Asn Cys Leu Asn Asn Glu Phe Asn Phe Phe Lys Arg His Ile
Cys 35 40 45Asp Ala Asn Lys Glu Gly Met Phe Leu Phe Arg Ala Ala Arg
Lys Leu 50 55 60Arg Gln Phe Leu Lys Met Asn Ser Thr Gly Asp Phe Asp
Leu His Leu65 70 75 80Leu Lys Val Ser Glu Gly Thr Thr Ile Leu Leu
Asn Cys Thr Gly Gln 85 90 95Val Lys Gly Arg Lys Pro Ala Ala Leu Gly
Glu Ala Gln Pro Thr Lys 100 105 110Ser Leu Glu Glu Asn Lys Ser Leu
Lys Glu Gln Lys Lys Leu Asn Asp 115 120 125Leu Cys Phe Leu Lys Arg
Leu Leu Gln Glu Ile Lys Thr Cys Trp Asn 130 135 140Lys Ile Leu Met
Gly Thr Lys Glu His145 1507115PRTArtificial Sequencerecombinant
human IL-15 (rhIL-15) 7Met Asn Trp Val Asn Val Ile Ser Asp Leu Lys
Lys Ile Glu Asp Leu1 5 10 15Ile Gln Ser Met His Ile Asp Ala Thr Leu
Tyr Thr Glu Ser Asp Val 20 25 30His Pro Ser Cys Lys Val Thr Ala Met
Lys Cys Phe Leu Leu Glu Leu 35 40 45Gln Val Ile Ser Leu Glu Ser Gly
Asp Ala Ser Ile His Asp Thr Val 50 55 60Glu Asn Leu Ile Ile Leu Ala
Asn Asn Ser Leu Ser Ser Asn Gly Asn65 70 75 80Val Thr Glu Ser Gly
Cys Lys Glu Cys Glu Glu Leu Glu Glu Lys Asn 85 90 95Ile Lys Glu Phe
Leu Gln Ser Phe Val His Ile Val Gln Met Phe Ile 100 105 110Asn Thr
Ser 1158132PRTArtificial Sequencerecombinant human IL-21 (rhIL-21)
8Met Gln Asp Arg His Met Ile Arg Met Arg Gln Leu Ile Asp Ile Val1 5
10 15Asp Gln Leu Lys Asn Tyr Val Asn Asp Leu Val Pro Glu Phe Leu
Pro 20 25 30Ala Pro Glu Asp Val Glu Thr Asn Cys Glu Trp Ser Ala Phe
Ser Cys 35 40 45Phe Gln Lys Ala Gln Leu Lys Ser Ala Asn Thr Gly Asn
Asn Glu Arg 50 55 60Ile Ile Asn Val Ser Ile Lys Lys Leu Lys Arg Lys
Pro Pro Ser Thr65 70 75 80Asn Ala Gly Arg Arg Gln Lys His Arg Leu
Thr Cys Pro Ser Cys Asp 85 90 95Ser Tyr Glu Lys Lys Pro Pro Lys Glu
Phe Leu Glu Arg Phe Lys Ser 100 105 110Leu Leu Gln Lys Met Ile His
Gln His Leu Ser Ser Arg Thr His Gly 115 120 125Ser Glu Asp Ser
1309255PRTArtificial Sequencehuman 4-1BB, Tumor necrosis factor
receptor superfamily, member 9 (Homo sapiens) 9Met Gly Asn Ser Cys
Tyr Asn Ile Val Ala Thr Leu Leu Leu Val Leu1 5 10 15Asn Phe Glu Arg
Thr Arg Ser Leu Gln Asp Pro Cys Ser Asn Cys Pro 20 25 30Ala Gly Thr
Phe Cys Asp Asn Asn Arg Asn Gln Ile Cys Ser Pro Cys 35 40 45Pro Pro
Asn Ser Phe Ser Ser Ala Gly Gly Gln Arg Thr Cys Asp Ile 50 55 60Cys
Arg Gln Cys Lys Gly Val Phe Arg Thr Arg Lys Glu Cys Ser Ser65 70 75
80Thr Ser Asn Ala Glu Cys Asp Cys Thr Pro Gly Phe His Cys Leu Gly
85 90 95Ala Gly Cys Ser Met Cys Glu Gln Asp Cys Lys Gln Gly Gln Glu
Leu 100 105 110Thr Lys Lys Gly Cys Lys Asp Cys Cys Phe Gly Thr Phe
Asn Asp Gln 115 120 125Lys Arg Gly Ile Cys Arg Pro Trp Thr Asn Cys
Ser Leu Asp Gly Lys 130 135 140Ser Val Leu Val Asn Gly Thr Lys Glu
Arg Asp Val Val Cys Gly Pro145 150 155 160Ser Pro Ala Asp Leu Ser
Pro Gly Ala Ser Ser Val Thr Pro Pro Ala 165 170 175Pro Ala Arg Glu
Pro Gly His Ser Pro Gln Ile Ile Ser Phe Phe Leu 180 185 190Ala Leu
Thr Ser Thr Ala Leu Leu Phe Leu Leu Phe Phe Leu Thr Leu 195 200
205Arg Phe Ser Val Val Lys Arg Gly Arg Lys Lys Leu Leu Tyr Ile Phe
210 215 220Lys Gln Pro Phe Met Arg Pro Val Gln Thr Thr Gln Glu Glu
Asp Gly225 230 235 240Cys Ser Cys Arg Phe Pro Glu Glu Glu Glu Gly
Gly Cys Glu Leu 245 250 25510256PRTArtificial Sequencemurine 4-1BB,
Tumor necrosis factor receptor superfamily, member 9 (Mus musculus)
10Met Gly Asn Asn Cys Tyr Asn Val Val Val Ile Val Leu Leu Leu Val1
5 10 15Gly Cys Glu Lys Val Gly Ala Val Gln Asn Ser Cys Asp Asn Cys
Gln 20 25 30Pro Gly Thr Phe Cys Arg Lys Tyr Asn Pro Val Cys Lys Ser
Cys Pro 35 40 45Pro Ser Thr Phe Ser Ser Ile Gly Gly Gln Pro Asn Cys
Asn Ile Cys 50 55 60Arg Val Cys Ala Gly Tyr Phe Arg Phe Lys Lys Phe
Cys Ser Ser Thr65 70 75 80His Asn Ala Glu Cys Glu Cys Ile Glu Gly
Phe His Cys Leu Gly Pro 85 90 95Gln Cys Thr Arg Cys Glu Lys Asp Cys
Arg Pro Gly Gln Glu Leu Thr 100 105 110Lys Gln Gly Cys Lys Thr Cys
Ser Leu Gly Thr Phe Asn Asp Gln Asn 115 120 125Gly Thr Gly Val Cys
Arg Pro Trp Thr Asn Cys Ser Leu Asp Gly Arg 130 135 140Ser Val Leu
Lys Thr Gly Thr Thr Glu Lys Asp Val Val Cys Gly Pro145 150 155
160Pro Val Val Ser Phe Ser Pro Ser Thr Thr Ile Ser Val Thr Pro Glu
165 170 175Gly Gly Pro Gly Gly His Ser Leu Gln Val Leu Thr Leu Phe
Leu Ala 180 185 190Leu Thr Ser Ala Leu Leu Leu Ala Leu Ile Phe Ile
Thr Leu Leu Phe 195 200 205Ser Val Leu Lys Trp Ile Arg Lys Lys Phe
Pro His Ile Phe Lys Gln 210 215 220Pro Phe Lys Lys Thr Thr Gly Ala
Ala Gln Glu Glu Asp Ala Cys Ser225 230 235 240Cys Arg Cys Pro Gln
Glu Glu Glu Gly Gly Gly Gly Gly Tyr Glu Leu 245 250
25511441PRTArtificial Sequenceheavy chain for utomilumab 11Glu Val
Gln Leu Val Gln Ser Gly Ala Glu Val Lys Lys Pro Gly Glu1 5 10 15Ser
Leu Arg Ile Ser Cys Lys Gly Ser Gly Tyr Ser Phe Ser Thr Tyr 20 25
30Trp Ile Ser Trp Val Arg Gln Met Pro Gly Lys Gly Leu Glu Trp Met
35 40 45Gly Lys Ile Tyr Pro Gly Asp Ser Tyr Thr Asn Tyr Ser Pro Ser
Phe 50 55 60Gln Gly Gln Val Thr Ile Ser Ala Asp Lys Ser Ile Ser Thr
Ala Tyr65 70 75 80Leu Gln Trp Ser Ser Leu Lys Ala Ser Asp Thr Ala
Met Tyr Tyr Cys 85 90 95Ala Arg Gly Tyr Gly Ile Phe Asp Tyr Trp Gly
Gln Gly Thr Leu Val 100 105 110Thr Val Ser Ser Ala Ser Thr Lys Gly
Pro Ser Val Phe Pro Leu Ala 115 120 125Pro Cys Ser Arg Ser Thr Ser
Glu Ser Thr Ala Ala Leu Gly Cys Leu 130 135 140Val Lys Asp Tyr Phe
Pro Glu Pro Val Thr Val Ser Trp Asn Ser Gly145 150 155 160Ala Leu
Thr Ser Gly Val His Thr Phe Pro Ala Val Leu Gln Ser Ser 165 170
175Gly Leu Tyr Ser Leu Ser Ser Val Val Thr Val Pro Ser Ser Asn Phe
180 185 190Gly Thr Gln Thr Tyr Thr Cys Asn Val Asp His Lys Pro Ser
Asn Thr 195 200 205Lys Val Asp Lys Thr Val Glu Arg Lys Cys Cys Val
Glu Cys Pro Pro 210 215 220Cys Pro Ala Pro Pro Val Ala Gly Pro Ser
Val Phe Leu Phe Pro Pro225 230 235 240Lys Pro Lys Asp Thr Leu Met
Ile Ser Arg Thr Pro Glu Val Thr Cys 245 250 255Val Val Val Asp Val
Ser His Glu Asp Pro Glu Val Gln Phe Asn Trp 260 265 270Tyr Val Asp
Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu 275 280 285Glu
Gln Phe Asn Ser Thr Phe Arg Val Val Ser Val Leu Thr Val Val 290 295
300His Gln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser
Asn305 310 315 320Lys Gly Leu Pro Ala Pro Ile Glu Lys Thr Ile Ser
Lys Thr Lys Gly 325 330 335Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu
Pro Pro Ser Arg Glu Glu 340 345 350Met Thr Lys Asn Gln Val Ser Leu
Thr Cys Leu Val Lys Gly Phe Tyr 355 360 365Pro Ser Asp Ile Ala Val
Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn 370 375 380Asn Tyr Lys Thr
Thr Pro Pro Met Leu Asp Ser Asp Gly Ser Phe Phe385 390 395 400Leu
Tyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn 405 410
415Val Phe Ser
Cys Ser Val Met His Glu Ala Leu His Asn His Tyr Thr 420 425 430Gln
Lys Ser Leu Ser Leu Ser Pro Gly 435 44012214PRTArtificial
Sequencelight chain for utomilumab 12Ser Tyr Glu Leu Thr Gln Pro
Pro Ser Val Ser Val Ser Pro Gly Gln1 5 10 15Thr Ala Ser Ile Thr Cys
Ser Gly Asp Asn Ile Gly Asp Gln Tyr Ala 20 25 30His Trp Tyr Gln Gln
Lys Pro Gly Gln Ser Pro Val Leu Val Ile Tyr 35 40 45Gln Asp Lys Asn
Arg Pro Ser Gly Ile Pro Glu Arg Phe Ser Gly Ser 50 55 60Asn Ser Gly
Asn Thr Ala Thr Leu Thr Ile Ser Gly Thr Gln Ala Met65 70 75 80Asp
Glu Ala Asp Tyr Tyr Cys Ala Thr Tyr Thr Gly Phe Gly Ser Leu 85 90
95Ala Val Phe Gly Gly Gly Thr Lys Leu Thr Val Leu Gly Gln Pro Lys
100 105 110Ala Ala Pro Ser Val Thr Leu Phe Pro Pro Ser Ser Glu Glu
Leu Gln 115 120 125Ala Asn Lys Ala Thr Leu Val Cys Leu Ile Ser Asp
Phe Tyr Pro Gly 130 135 140Ala Val Thr Val Ala Trp Lys Ala Asp Ser
Ser Pro Val Lys Ala Gly145 150 155 160Val Glu Thr Thr Thr Pro Ser
Lys Gln Ser Asn Asn Lys Tyr Ala Ala 165 170 175Ser Ser Tyr Leu Ser
Leu Thr Pro Glu Gln Trp Lys Ser His Arg Ser 180 185 190Tyr Ser Cys
Gln Val Thr His Glu Gly Ser Thr Val Glu Lys Thr Val 195 200 205Ala
Pro Thr Glu Cys Ser 21013116PRTArtificial Sequenceheavy chain
variable region for utomilumab 13Glu Val Gln Leu Val Gln Ser Gly
Ala Glu Val Lys Lys Pro Gly Glu1 5 10 15Ser Leu Arg Ile Ser Cys Lys
Gly Ser Gly Tyr Ser Phe Ser Thr Tyr 20 25 30Trp Ile Ser Trp Val Arg
Gln Met Pro Gly Lys Gly Leu Glu Trp Met 35 40 45Gly Lys Ile Tyr Pro
Gly Asp Ser Tyr Thr Asn Tyr Ser Pro Ser Phe 50 55 60Gln Gly Gln Val
Thr Ile Ser Ala Asp Lys Ser Ile Ser Thr Ala Tyr65 70 75 80Leu Gln
Trp Ser Ser Leu Lys Ala Ser Asp Thr Ala Met Tyr Tyr Cys 85 90 95Ala
Arg Gly Tyr Gly Ile Phe Asp Tyr Trp Gly Gln Gly Thr Leu Val 100 105
110Thr Val Ser Ser 11514108PRTArtificial Sequencelight chain
variable region for utomilumab 14Ser Tyr Glu Leu Thr Gln Pro Pro
Ser Val Ser Val Ser Pro Gly Gln1 5 10 15Thr Ala Ser Ile Thr Cys Ser
Gly Asp Asn Ile Gly Asp Gln Tyr Ala 20 25 30His Trp Tyr Gln Gln Lys
Pro Gly Gln Ser Pro Val Leu Val Ile Tyr 35 40 45Gln Asp Lys Asn Arg
Pro Ser Gly Ile Pro Glu Arg Phe Ser Gly Ser 50 55 60Asn Ser Gly Asn
Thr Ala Thr Leu Thr Ile Ser Gly Thr Gln Ala Met65 70 75 80Asp Glu
Ala Asp Tyr Tyr Cys Ala Thr Tyr Thr Gly Phe Gly Ser Leu 85 90 95Ala
Val Phe Gly Gly Gly Thr Lys Leu Thr Val Leu 100 105156PRTArtificial
Sequenceheavy chain CDR1 for utomilumab 15Ser Thr Tyr Trp Ile Ser1
51617PRTArtificial Sequenceheavy chain CDR2 for utomilumab 16Lys
Ile Tyr Pro Gly Asp Ser Tyr Thr Asn Tyr Ser Pro Ser Phe Gln1 5 10
15Gly178PRTArtificial Sequenceheavy chain CDR3 for utomilumab 17Arg
Gly Tyr Gly Ile Phe Asp Tyr1 51811PRTArtificial Sequencelight chain
CDR1 for utomilumab 18Ser Gly Asp Asn Ile Gly Asp Gln Tyr Ala His1
5 10197PRTArtificial Sequencelight chain CDR2 for utomilumab 19Gln
Asp Lys Asn Arg Pro Ser1 52011PRTArtificial Sequencelight chain
CDR3 for utomilumab 20Ala Thr Tyr Thr Gly Phe Gly Ser Leu Ala Val1
5 1021448PRTArtificial Sequenceheavy chain for urelumab 21Gln Val
Gln Leu Gln Gln Trp Gly Ala Gly Leu Leu Lys Pro Ser Glu1 5 10 15Thr
Leu Ser Leu Thr Cys Ala Val Tyr Gly Gly Ser Phe Ser Gly Tyr 20 25
30Tyr Trp Ser Trp Ile Arg Gln Ser Pro Glu Lys Gly Leu Glu Trp Ile
35 40 45Gly Glu Ile Asn His Gly Gly Tyr Val Thr Tyr Asn Pro Ser Leu
Glu 50 55 60Ser Arg Val Thr Ile Ser Val Asp Thr Ser Lys Asn Gln Phe
Ser Leu65 70 75 80Lys Leu Ser Ser Val Thr Ala Ala Asp Thr Ala Val
Tyr Tyr Cys Ala 85 90 95Arg Asp Tyr Gly Pro Gly Asn Tyr Asp Trp Tyr
Phe Asp Leu Trp Gly 100 105 110Arg Gly Thr Leu Val Thr Val Ser Ser
Ala Ser Thr Lys Gly Pro Ser 115 120 125Val Phe Pro Leu Ala Pro Cys
Ser Arg Ser Thr Ser Glu Ser Thr Ala 130 135 140Ala Leu Gly Cys Leu
Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val145 150 155 160Ser Trp
Asn Ser Gly Ala Leu Thr Ser Gly Val His Thr Phe Pro Ala 165 170
175Val Leu Gln Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val Val Thr Val
180 185 190Pro Ser Ser Ser Leu Gly Thr Lys Thr Tyr Thr Cys Asn Val
Asp His 195 200 205Lys Pro Ser Asn Thr Lys Val Asp Lys Arg Val Glu
Ser Lys Tyr Gly 210 215 220Pro Pro Cys Pro Pro Cys Pro Ala Pro Glu
Phe Leu Gly Gly Pro Ser225 230 235 240Val Phe Leu Phe Pro Pro Lys
Pro Lys Asp Thr Leu Met Ile Ser Arg 245 250 255Thr Pro Glu Val Thr
Cys Val Val Val Asp Val Ser Gln Glu Asp Pro 260 265 270Glu Val Gln
Phe Asn Trp Tyr Val Asp Gly Val Glu Val His Asn Ala 275 280 285Lys
Thr Lys Pro Arg Glu Glu Gln Phe Asn Ser Thr Tyr Arg Val Val 290 295
300Ser Val Leu Thr Val Leu His Gln Asp Trp Leu Asn Gly Lys Glu
Tyr305 310 315 320Lys Cys Lys Val Ser Asn Lys Gly Leu Pro Ser Ser
Ile Glu Lys Thr 325 330 335Ile Ser Lys Ala Lys Gly Gln Pro Arg Glu
Pro Gln Val Tyr Thr Leu 340 345 350Pro Pro Ser Gln Glu Glu Met Thr
Lys Asn Gln Val Ser Leu Thr Cys 355 360 365Leu Val Lys Gly Phe Tyr
Pro Ser Asp Ile Ala Val Glu Trp Glu Ser 370 375 380Asn Gly Gln Pro
Glu Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu Asp385 390 395 400Ser
Asp Gly Ser Phe Phe Leu Tyr Ser Arg Leu Thr Val Asp Lys Ser 405 410
415Arg Trp Gln Glu Gly Asn Val Phe Ser Cys Ser Val Met His Glu Ala
420 425 430Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Leu
Gly Lys 435 440 44522216PRTArtificial Sequencelight chain for
urelumab 22Glu Ile Val Leu Thr Gln Ser Pro Ala Thr Leu Ser Leu Ser
Pro Gly1 5 10 15Glu Arg Ala Thr Leu Ser Cys Arg Ala Ser Gln Ser Val
Ser Ser Tyr 20 25 30Leu Ala Trp Tyr Gln Gln Lys Pro Gly Gln Ala Pro
Arg Leu Leu Ile 35 40 45Tyr Asp Ala Ser Asn Arg Ala Thr Gly Ile Pro
Ala Arg Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr
Ile Ser Ser Leu Glu Pro65 70 75 80Glu Asp Phe Ala Val Tyr Tyr Cys
Gln Gln Arg Ser Asn Trp Pro Pro 85 90 95Ala Leu Thr Phe Cys Gly Gly
Thr Lys Val Glu Ile Lys Arg Thr Val 100 105 110Ala Ala Pro Ser Val
Phe Ile Phe Pro Pro Ser Asp Glu Gln Leu Lys 115 120 125Ser Gly Thr
Ala Ser Val Val Cys Leu Leu Asn Asn Phe Tyr Pro Arg 130 135 140Glu
Ala Lys Val Gln Trp Lys Val Asp Asn Ala Leu Gln Ser Gly Asn145 150
155 160Ser Gln Glu Ser Val Thr Glu Gln Asp Ser Lys Asp Ser Thr Tyr
Ser 165 170 175Leu Ser Ser Thr Leu Thr Leu Ser Lys Ala Asp Tyr Glu
Lys His Lys 180 185 190Val Tyr Ala Cys Glu Val Thr His Gln Gly Leu
Ser Ser Pro Val Thr 195 200 205Lys Ser Phe Asn Arg Gly Glu Cys 210
21523120PRTArtificial Sequencevariable heavy chain for urelumab
23Met Lys His Leu Trp Phe Phe Leu Leu Leu Val Ala Ala Pro Arg Trp1
5 10 15Val Leu Ser Gln Val Gln Leu Gln Gln Trp Gly Ala Gly Leu Leu
Lys 20 25 30Pro Ser Glu Thr Leu Ser Leu Thr Cys Ala Val Tyr Gly Gly
Ser Phe 35 40 45Ser Gly Tyr Tyr Trp Ser Trp Ile Arg Gln Ser Pro Glu
Lys Gly Leu 50 55 60Glu Trp Ile Gly Glu Ile Asn His Gly Gly Tyr Val
Thr Tyr Asn Pro65 70 75 80Ser Leu Glu Ser Arg Val Thr Ile Ser Val
Asp Thr Ser Lys Asn Gln 85 90 95Phe Ser Leu Lys Leu Ser Ser Val Thr
Ala Ala Asp Thr Ala Val Tyr 100 105 110Tyr Cys Ala Arg Asp Tyr Gly
Pro 115 12024110PRTArtificial Sequencevariable light chain for
urelumab 24Met Glu Ala Pro Ala Gln Leu Leu Phe Leu Leu Leu Leu Trp
Leu Pro1 5 10 15Asp Thr Thr Gly Glu Ile Val Leu Thr Gln Ser Pro Ala
Thr Leu Ser 20 25 30Leu Ser Pro Gly Glu Arg Ala Thr Leu Ser Cys Arg
Ala Ser Gln Ser 35 40 45Val Ser Ser Tyr Leu Ala Trp Tyr Gln Gln Lys
Pro Gly Gln Ala Pro 50 55 60Arg Leu Leu Ile Tyr Asp Ala Ser Asn Arg
Ala Thr Gly Ile Pro Ala65 70 75 80Arg Phe Ser Gly Ser Gly Ser Gly
Thr Asp Phe Thr Leu Thr Ile Ser 85 90 95Ser Leu Glu Pro Glu Asp Phe
Ala Val Tyr Tyr Cys Gln Gln 100 105 110255PRTArtificial
Sequenceheavy chain CDR1 for urelumab 25Gly Tyr Tyr Trp Ser1
52616PRTArtificial Sequenceheavy chain CDR2 for urelumab 26Glu Ile
Asn His Gly Gly Tyr Val Thr Tyr Asn Pro Ser Leu Glu Ser1 5 10
152713PRTArtificial Sequenceheavy chain CDR3 for urelumab 27Asp Tyr
Gly Pro Gly Asn Tyr Asp Trp Tyr Phe Asp Leu1 5 102811PRTArtificial
Sequencelight chain CDR1 for urelumab 28Arg Ala Ser Gln Ser Val Ser
Ser Tyr Leu Ala1 5 10297PRTArtificial Sequencelight chain CDR2 for
urelumab 29Asp Ala Ser Asn Arg Ala Thr1 53011PRTArtificial
Sequencelight chain CDR3 for urelumab 30Gln Gln Arg Ser Asp Trp Pro
Pro Ala Leu Thr1 5 1031230PRTArtificial SequenceFc domain 31Lys Ser
Cys Asp Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro Glu1 5 10 15Leu
Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys Asp 20 25
30Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val Asp
35 40 45Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp
Gly 50 55 60Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln
Tyr Asn65 70 75 80Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu
His Gln Asp Trp 85 90 95Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser
Asn Lys Ala Leu Pro 100 105 110Ala Pro Ile Glu Lys Thr Ile Ser Lys
Ala Lys Gly Gln Pro Arg Glu 115 120 125Pro Gln Val Tyr Thr Leu Pro
Pro Ser Arg Glu Glu Met Thr Lys Asn 130 135 140Gln Val Ser Leu Thr
Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp Ile145 150 155 160Ala Val
Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys Thr 165 170
175Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser Lys
180 185 190Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn Val Phe
Ser Cys 195 200 205Ser Val Met His Glu Ala Leu His Asn His Tyr Thr
Gln Lys Ser Leu 210 215 220Ser Leu Ser Pro Gly Lys225
2303222PRTArtificial Sequencelinker 32Gly Gly Pro Gly Ser Ser Lys
Ser Cys Asp Lys Thr His Thr Cys Pro1 5 10 15Pro Cys Pro Ala Pro Glu
203322PRTArtificial Sequencelinker 33Gly Gly Ser Gly Ser Ser Lys
Ser Cys Asp Lys Thr His Thr Cys Pro1 5 10 15Pro Cys Pro Ala Pro Glu
203427PRTArtificial Sequencelinker 34Gly Gly Pro Gly Ser Ser Ser
Ser Ser Ser Ser Lys Ser Cys Asp Lys1 5 10 15Thr His Thr Cys Pro Pro
Cys Pro Ala Pro Glu 20 253527PRTArtificial Sequencelinker 35Gly Gly
Ser Gly Ser Ser Ser Ser Ser Ser Ser Lys Ser Cys Asp Lys1 5 10 15Thr
His Thr Cys Pro Pro Cys Pro Ala Pro Glu 20 253629PRTArtificial
Sequencelinker 36Gly Gly Pro Gly Ser Ser Ser Ser Ser Ser Ser Ser
Ser Lys Ser Cys1 5 10 15Asp Lys Thr His Thr Cys Pro Pro Cys Pro Ala
Pro Glu 20 253729PRTArtificial Sequencelinker 37Gly Gly Ser Gly Ser
Ser Ser Ser Ser Ser Ser Ser Ser Lys Ser Cys1 5 10 15Asp Lys Thr His
Thr Cys Pro Pro Cys Pro Ala Pro Glu 20 253824PRTArtificial
Sequencelinker 38Gly Gly Pro Gly Ser Ser Gly Ser Gly Ser Ser Asp
Lys Thr His Thr1 5 10 15Cys Pro Pro Cys Pro Ala Pro Glu
203923PRTArtificial Sequencelinker 39Gly Gly Pro Gly Ser Ser Gly
Ser Gly Ser Asp Lys Thr His Thr Cys1 5 10 15Pro Pro Cys Pro Ala Pro
Glu 204021PRTArtificial Sequencelinker 40Gly Gly Pro Ser Ser Ser
Gly Ser Asp Lys Thr His Thr Cys Pro Pro1 5 10 15Cys Pro Ala Pro Glu
204125PRTArtificial Sequencelinker 41Gly Gly Ser Ser Ser Ser Ser
Ser Ser Ser Gly Ser Asp Lys Thr His1 5 10 15Thr Cys Pro Pro Cys Pro
Ala Pro Glu 20 2542246PRTArtificial SequenceFc domain 42Met Glu Thr
Asp Thr Leu Leu Leu Trp Val Leu Leu Leu Trp Val Pro1 5 10 15Ala Gly
Asn Gly Asp Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro 20 25 30Glu
Leu Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys 35 40
45Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val
50 55 60Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val
Asp65 70 75 80Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu
Glu Gln Tyr 85 90 95Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val
Leu His Gln Asp 100 105 110Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys
Val Ser Asn Lys Ala Leu 115 120 125Pro Ala Pro Ile Glu Lys Thr Ile
Ser Lys Ala Lys Gly Gln Pro Arg 130 135 140Glu Pro Gln Val Tyr Thr
Leu Pro Pro Ser Arg Glu Glu Met Thr Lys145 150 155 160Asn Gln Val
Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp 165 170 175Ile
Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys 180 185
190Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser
195 200 205Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn Val
Phe Ser 210 215 220Cys Ser Val Met His Glu Ala Leu His Asn His Tyr
Thr Gln Lys Ser225 230 235 240Leu Ser Leu Ser Pro Gly
2454311PRTArtificial Sequencelinker 43Ser Gly Ser Gly Ser Gly Ser
Gly Ser Gly Ser1 5 104412PRTArtificial Sequencelinker 44Ser Ser Ser
Ser Ser Ser Gly Ser Gly Ser Gly Ser1 5 104516PRTArtificial
Sequencelinker 45Ser Ser Ser Ser Ser Ser Gly Ser Gly Ser Gly Ser
Gly Ser Gly Ser1 5 10 1546254PRTArtificial Sequence4-1BBL 46Met Glu
Tyr Ala Ser Asp Ala Ser Leu
Asp Pro Glu Ala Pro Trp Pro1 5 10 15Pro Ala Pro Arg Ala Arg Ala Cys
Arg Val Leu Pro Trp Ala Leu Val 20 25 30Ala Gly Leu Leu Leu Leu Leu
Leu Leu Ala Ala Ala Cys Ala Val Phe 35 40 45Leu Ala Cys Pro Trp Ala
Val Ser Gly Ala Arg Ala Ser Pro Gly Ser 50 55 60Ala Ala Ser Pro Arg
Leu Arg Glu Gly Pro Glu Leu Ser Pro Asp Asp65 70 75 80Pro Ala Gly
Leu Leu Asp Leu Arg Gln Gly Met Phe Ala Gln Leu Val 85 90 95Ala Gln
Asn Val Leu Leu Ile Asp Gly Pro Leu Ser Trp Tyr Ser Asp 100 105
110Pro Gly Leu Ala Gly Val Ser Leu Thr Gly Gly Leu Ser Tyr Lys Glu
115 120 125Asp Thr Lys Glu Leu Val Val Ala Lys Ala Gly Val Tyr Tyr
Val Phe 130 135 140Phe Gln Leu Glu Leu Arg Arg Val Val Ala Gly Glu
Gly Ser Gly Ser145 150 155 160Val Ser Leu Ala Leu His Leu Gln Pro
Leu Arg Ser Ala Ala Gly Ala 165 170 175Ala Ala Leu Ala Leu Thr Val
Asp Leu Pro Pro Ala Ser Ser Glu Ala 180 185 190Arg Asn Ser Ala Phe
Gly Phe Gln Gly Arg Leu Leu His Leu Ser Ala 195 200 205Gly Gln Arg
Leu Gly Val His Leu His Thr Glu Ala Arg Ala Arg His 210 215 220Ala
Trp Gln Leu Thr Gln Gly Ala Thr Val Leu Gly Leu Phe Arg Val225 230
235 240Thr Pro Glu Ile Pro Ala Gly Leu Pro Ser Pro Arg Ser Glu 245
25047168PRTArtificial Sequence4-1BBL soluble domain 47Leu Arg Gln
Gly Met Phe Ala Gln Leu Val Ala Gln Asn Val Leu Leu1 5 10 15Ile Asp
Gly Pro Leu Ser Trp Tyr Ser Asp Pro Gly Leu Ala Gly Val 20 25 30Ser
Leu Thr Gly Gly Leu Ser Tyr Lys Glu Asp Thr Lys Glu Leu Val 35 40
45Val Ala Lys Ala Gly Val Tyr Tyr Val Phe Phe Gln Leu Glu Leu Arg
50 55 60Arg Val Val Ala Gly Glu Gly Ser Gly Ser Val Ser Leu Ala Leu
His65 70 75 80Leu Gln Pro Leu Arg Ser Ala Ala Gly Ala Ala Ala Leu
Ala Leu Thr 85 90 95Val Asp Leu Pro Pro Ala Ser Ser Glu Ala Arg Asn
Ser Ala Phe Gly 100 105 110Phe Gln Gly Arg Leu Leu His Leu Ser Ala
Gly Gln Arg Leu Gly Val 115 120 125His Leu His Thr Glu Ala Arg Ala
Arg His Ala Trp Gln Leu Thr Gln 130 135 140Gly Ala Thr Val Leu Gly
Leu Phe Arg Val Thr Pro Glu Ile Pro Ala145 150 155 160Gly Leu Pro
Ser Pro Arg Ser Glu 16548118PRTArtificial Sequencevariable heavy
chain for 4B4-1-1 version 1 48Gln Val Gln Leu Gln Gln Pro Gly Ala
Glu Leu Val Lys Pro Gly Ala1 5 10 15Ser Val Lys Leu Ser Cys Lys Ala
Ser Gly Tyr Thr Phe Ser Ser Tyr 20 25 30Trp Met His Trp Val Lys Gln
Arg Pro Gly Gln Val Leu Glu Trp Ile 35 40 45Gly Glu Ile Asn Pro Gly
Asn Gly His Thr Asn Tyr Asn Glu Lys Phe 50 55 60Lys Ser Lys Ala Thr
Leu Thr Val Asp Lys Ser Ser Ser Thr Ala Tyr65 70 75 80Met Gln Leu
Ser Ser Leu Thr Ser Glu Asp Ser Ala Val Tyr Tyr Cys 85 90 95Ala Arg
Ser Phe Thr Thr Ala Arg Gly Phe Ala Tyr Trp Gly Gln Gly 100 105
110Thr Leu Val Thr Val Ser 11549107PRTArtificial Sequencevariable
light chain for 4B4-1-1 version 1 49Asp Ile Val Met Thr Gln Ser Pro
Ala Thr Gln Ser Val Thr Pro Gly1 5 10 15Asp Arg Val Ser Leu Ser Cys
Arg Ala Ser Gln Thr Ile Ser Asp Tyr 20 25 30Leu His Trp Tyr Gln Gln
Lys Ser His Glu Ser Pro Arg Leu Leu Ile 35 40 45Lys Tyr Ala Ser Gln
Ser Ile Ser Gly Ile Pro Ser Arg Phe Ser Gly 50 55 60Ser Gly Ser Gly
Ser Asp Phe Thr Leu Ser Ile Asn Ser Val Glu Pro65 70 75 80Glu Asp
Val Gly Val Tyr Tyr Cys Gln Asp Gly His Ser Phe Pro Pro 85 90 95Thr
Phe Gly Gly Gly Thr Lys Leu Glu Ile Lys 100 10550119PRTArtificial
Sequencevariable heavy chain for 4B4-1-1 version 2 50Gln Val Gln
Leu Gln Gln Pro Gly Ala Glu Leu Val Lys Pro Gly Ala1 5 10 15Ser Val
Lys Leu Ser Cys Lys Ala Ser Gly Tyr Thr Phe Ser Ser Tyr 20 25 30Trp
Met His Trp Val Lys Gln Arg Pro Gly Gln Val Leu Glu Trp Ile 35 40
45Gly Glu Ile Asn Pro Gly Asn Gly His Thr Asn Tyr Asn Glu Lys Phe
50 55 60Lys Ser Lys Ala Thr Leu Thr Val Asp Lys Ser Ser Ser Thr Ala
Tyr65 70 75 80Met Gln Leu Ser Ser Leu Thr Ser Glu Asp Ser Ala Val
Tyr Tyr Cys 85 90 95Ala Arg Ser Phe Thr Thr Ala Arg Gly Phe Ala Tyr
Trp Gly Gln Gly 100 105 110Thr Leu Val Thr Val Ser Ala
11551108PRTArtificial Sequencevariable light chain for 4B4-1-1
version 2 51Asp Ile Val Met Thr Gln Ser Pro Ala Thr Gln Ser Val Thr
Pro Gly1 5 10 15Asp Arg Val Ser Leu Ser Cys Arg Ala Ser Gln Thr Ile
Ser Asp Tyr 20 25 30Leu His Trp Tyr Gln Gln Lys Ser His Glu Ser Pro
Arg Leu Leu Ile 35 40 45Lys Tyr Ala Ser Gln Ser Ile Ser Gly Ile Pro
Ser Arg Phe Ser Gly 50 55 60Ser Gly Ser Gly Ser Asp Phe Thr Leu Ser
Ile Asn Ser Val Glu Pro65 70 75 80Glu Asp Val Gly Val Tyr Tyr Cys
Gln Asp Gly His Ser Phe Pro Pro 85 90 95Thr Phe Gly Gly Gly Thr Lys
Leu Glu Ile Lys Arg 100 10552120PRTArtificial Sequencevariable
heavy chain for H39E3-2 52Met Asp Trp Thr Trp Arg Ile Leu Phe Leu
Val Ala Ala Ala Thr Gly1 5 10 15Ala His Ser Glu Val Gln Leu Val Glu
Ser Gly Gly Gly Leu Val Gln 20 25 30Pro Gly Gly Ser Leu Arg Leu Ser
Cys Ala Ala Ser Gly Phe Thr Phe 35 40 45Ser Asp Tyr Trp Met Ser Trp
Val Arg Gln Ala Pro Gly Lys Gly Leu 50 55 60Glu Trp Val Ala Asp Ile
Lys Asn Asp Gly Ser Tyr Thr Asn Tyr Ala65 70 75 80Pro Ser Leu Thr
Asn Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn 85 90 95Ser Leu Tyr
Leu Gln Met Asn Ser Leu Arg Ala Glu Asp Thr Ala Val 100 105 110Tyr
Tyr Cys Ala Arg Glu Leu Thr 115 12053109PRTArtificial
Sequencevariable light chain for H39E3-2 53Met Glu Ala Pro Ala Gln
Leu Leu Phe Leu Leu Leu Leu Trp Leu Pro1 5 10 15Asp Thr Thr Gly Asp
Ile Val Met Thr Gln Ser Pro Asp Ser Leu Ala 20 25 30Val Ser Leu Gly
Glu Arg Ala Thr Ile Asn Cys Lys Ser Ser Gln Ser 35 40 45Leu Leu Ser
Ser Gly Asn Gln Lys Asn Tyr Leu Trp Tyr Gln Gln Lys 50 55 60Pro Gly
Gln Pro Pro Lys Leu Leu Ile Tyr Tyr Ala Ser Thr Arg Gln65 70 75
80Ser Gly Val Pro Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr Asp Phe
85 90 95Thr Leu Thr Ile Ser Ser Leu Gln Ala Glu Asp Val Ala 100
10554277PRTArtificial Sequencehuman OX40 (Homo sapiens) 54Met Cys
Val Gly Ala Arg Arg Leu Gly Arg Gly Pro Cys Ala Ala Leu1 5 10 15Leu
Leu Leu Gly Leu Gly Leu Ser Thr Val Thr Gly Leu His Cys Val 20 25
30Gly Asp Thr Tyr Pro Ser Asn Asp Arg Cys Cys His Glu Cys Arg Pro
35 40 45Gly Asn Gly Met Val Ser Arg Cys Ser Arg Ser Gln Asn Thr Val
Cys 50 55 60Arg Pro Cys Gly Pro Gly Phe Tyr Asn Asp Val Val Ser Ser
Lys Pro65 70 75 80Cys Lys Pro Cys Thr Trp Cys Asn Leu Arg Ser Gly
Ser Glu Arg Lys 85 90 95Gln Leu Cys Thr Ala Thr Gln Asp Thr Val Cys
Arg Cys Arg Ala Gly 100 105 110Thr Gln Pro Leu Asp Ser Tyr Lys Pro
Gly Val Asp Cys Ala Pro Cys 115 120 125Pro Pro Gly His Phe Ser Pro
Gly Asp Asn Gln Ala Cys Lys Pro Trp 130 135 140Thr Asn Cys Thr Leu
Ala Gly Lys His Thr Leu Gln Pro Ala Ser Asn145 150 155 160Ser Ser
Asp Ala Ile Cys Glu Asp Arg Asp Pro Pro Ala Thr Gln Pro 165 170
175Gln Glu Thr Gln Gly Pro Pro Ala Arg Pro Ile Thr Val Gln Pro Thr
180 185 190Glu Ala Trp Pro Arg Thr Ser Gln Gly Pro Ser Thr Arg Pro
Val Glu 195 200 205Val Pro Gly Gly Arg Ala Val Ala Ala Ile Leu Gly
Leu Gly Leu Val 210 215 220Leu Gly Leu Leu Gly Pro Leu Ala Ile Leu
Leu Ala Leu Tyr Leu Leu225 230 235 240Arg Arg Asp Gln Arg Leu Pro
Pro Asp Ala His Lys Pro Pro Gly Gly 245 250 255Gly Ser Phe Arg Thr
Pro Ile Gln Glu Glu Gln Ala Asp Ala His Ser 260 265 270Thr Leu Ala
Lys Ile 27555272PRTArtificial Sequencemurine OX40 (Mus musculus)
55Met Tyr Val Trp Val Gln Gln Pro Thr Ala Leu Leu Leu Leu Gly Leu1
5 10 15Thr Leu Gly Val Thr Ala Arg Arg Leu Asn Cys Val Lys His Thr
Tyr 20 25 30Pro Ser Gly His Lys Cys Cys Arg Glu Cys Gln Pro Gly His
Gly Met 35 40 45Val Ser Arg Cys Asp His Thr Arg Asp Thr Leu Cys His
Pro Cys Glu 50 55 60Thr Gly Phe Tyr Asn Glu Ala Val Asn Tyr Asp Thr
Cys Lys Gln Cys65 70 75 80Thr Gln Cys Asn His Arg Ser Gly Ser Glu
Leu Lys Gln Asn Cys Thr 85 90 95Pro Thr Gln Asp Thr Val Cys Arg Cys
Arg Pro Gly Thr Gln Pro Arg 100 105 110Gln Asp Ser Gly Tyr Lys Leu
Gly Val Asp Cys Val Pro Cys Pro Pro 115 120 125Gly His Phe Ser Pro
Gly Asn Asn Gln Ala Cys Lys Pro Trp Thr Asn 130 135 140Cys Thr Leu
Ser Gly Lys Gln Thr Arg His Pro Ala Ser Asp Ser Leu145 150 155
160Asp Ala Val Cys Glu Asp Arg Ser Leu Leu Ala Thr Leu Leu Trp Glu
165 170 175Thr Gln Arg Pro Thr Phe Arg Pro Thr Thr Val Gln Ser Thr
Thr Val 180 185 190Trp Pro Arg Thr Ser Glu Leu Pro Ser Pro Pro Thr
Leu Val Thr Pro 195 200 205Glu Gly Pro Ala Phe Ala Val Leu Leu Gly
Leu Gly Leu Gly Leu Leu 210 215 220Ala Pro Leu Thr Val Leu Leu Ala
Leu Tyr Leu Leu Arg Lys Ala Trp225 230 235 240Arg Leu Pro Asn Thr
Pro Lys Pro Cys Trp Gly Asn Ser Phe Arg Thr 245 250 255Pro Ile Gln
Glu Glu His Thr Asp Ala His Phe Thr Leu Ala Lys Ile 260 265
27056451PRTArtificial Sequenceheavy chain for tavolixizumab 56Gln
Val Gln Leu Gln Glu Ser Gly Pro Gly Leu Val Lys Pro Ser Gln1 5 10
15Thr Leu Ser Leu Thr Cys Ala Val Tyr Gly Gly Ser Phe Ser Ser Gly
20 25 30Tyr Trp Asn Trp Ile Arg Lys His Pro Gly Lys Gly Leu Glu Tyr
Ile 35 40 45Gly Tyr Ile Ser Tyr Asn Gly Ile Thr Tyr His Asn Pro Ser
Leu Lys 50 55 60Ser Arg Ile Thr Ile Asn Arg Asp Thr Ser Lys Asn Gln
Tyr Ser Leu65 70 75 80Gln Leu Asn Ser Val Thr Pro Glu Asp Thr Ala
Val Tyr Tyr Cys Ala 85 90 95Arg Tyr Lys Tyr Asp Tyr Asp Gly Gly His
Ala Met Asp Tyr Trp Gly 100 105 110Gln Gly Thr Leu Val Thr Val Ser
Ser Ala Ser Thr Lys Gly Pro Ser 115 120 125Val Phe Pro Leu Ala Pro
Ser Ser Lys Ser Thr Ser Gly Gly Thr Ala 130 135 140Ala Leu Gly Cys
Leu Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val145 150 155 160Ser
Trp Asn Ser Gly Ala Leu Thr Ser Gly Val His Thr Phe Pro Ala 165 170
175Val Leu Gln Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val Val Thr Val
180 185 190Pro Ser Ser Ser Leu Gly Thr Gln Thr Tyr Ile Cys Asn Val
Asn His 195 200 205Lys Pro Ser Asn Thr Lys Val Asp Lys Arg Val Glu
Pro Lys Ser Cys 210 215 220Asp Lys Thr His Thr Cys Pro Pro Cys Pro
Ala Pro Glu Leu Leu Gly225 230 235 240Gly Pro Ser Val Phe Leu Phe
Pro Pro Lys Pro Lys Asp Thr Leu Met 245 250 255Ile Ser Arg Thr Pro
Glu Val Thr Cys Val Val Val Asp Val Ser His 260 265 270Glu Asp Pro
Glu Val Lys Phe Asn Trp Tyr Val Asp Gly Val Glu Val 275 280 285His
Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr 290 295
300Arg Val Val Ser Val Leu Thr Val Leu His Gln Asp Trp Leu Asn
Gly305 310 315 320Lys Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu
Pro Ala Pro Ile 325 330 335Glu Lys Thr Ile Ser Lys Ala Lys Gly Gln
Pro Arg Glu Pro Gln Val 340 345 350Tyr Thr Leu Pro Pro Ser Arg Glu
Glu Met Thr Lys Asn Gln Val Ser 355 360 365Leu Thr Cys Leu Val Lys
Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu 370 375 380Trp Glu Ser Asn
Gly Gln Pro Glu Asn Asn Tyr Lys Thr Thr Pro Pro385 390 395 400Val
Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val 405 410
415Asp Lys Ser Arg Trp Gln Gln Gly Asn Val Phe Ser Cys Ser Val Met
420 425 430His Glu Ala Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser
Leu Ser 435 440 445Pro Gly Lys 45057214PRTArtificial Sequencelight
chain for tavolixizumab 57Asp Ile Gln Met Thr Gln Ser Pro Ser Ser
Leu Ser Ala Ser Val Gly1 5 10 15Asp Arg Val Thr Ile Thr Cys Arg Ala
Ser Gln Asp Ile Ser Asn Tyr 20 25 30Leu Asn Trp Tyr Gln Gln Lys Pro
Gly Lys Ala Pro Lys Leu Leu Ile 35 40 45Tyr Tyr Thr Ser Lys Leu His
Ser Gly Val Pro Ser Arg Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp
Tyr Thr Leu Thr Ile Ser Ser Leu Gln Pro65 70 75 80Glu Asp Phe Ala
Thr Tyr Tyr Cys Gln Gln Gly Ser Ala Leu Pro Trp 85 90 95Thr Phe Gly
Gln Gly Thr Lys Val Glu Ile Lys Arg Thr Val Ala Ala 100 105 110Pro
Ser Val Phe Ile Phe Pro Pro Ser Asp Glu Gln Leu Lys Ser Gly 115 120
125Thr Ala Ser Val Val Cys Leu Leu Asn Asn Phe Tyr Pro Arg Glu Ala
130 135 140Lys Val Gln Trp Lys Val Asp Asn Ala Leu Gln Ser Gly Asn
Ser Gln145 150 155 160Glu Ser Val Thr Glu Gln Asp Ser Lys Asp Ser
Thr Tyr Ser Leu Ser 165 170 175Ser Thr Leu Thr Leu Ser Lys Ala Asp
Tyr Glu Lys His Lys Val Tyr 180 185 190Ala Cys Glu Val Thr His Gln
Gly Leu Ser Ser Pro Val Thr Lys Ser 195 200 205Phe Asn Arg Gly Glu
Cys 21058118PRTArtificial Sequenceheavy chain variable region for
tavolixizumab 58Gln Val Gln Leu Gln Glu Ser Gly Pro Gly Leu Val Lys
Pro Ser Gln1 5 10 15Thr Leu Ser Leu Thr Cys Ala Val Tyr Gly Gly Ser
Phe Ser Ser Gly 20 25 30Tyr Trp Asn Trp Ile Arg Lys His Pro Gly Lys
Gly Leu Glu Tyr Ile 35 40 45Gly Tyr Ile Ser Tyr Asn Gly Ile Thr Tyr
His Asn Pro Ser Leu Lys 50 55 60Ser Arg Ile Thr Ile Asn Arg Asp Thr
Ser Lys Asn Gln Tyr Ser Leu65
70 75 80Gln Leu Asn Ser Val Thr Pro Glu Asp Thr Ala Val Tyr Tyr Cys
Ala 85 90 95Arg Tyr Lys Tyr Asp Tyr Asp Gly Gly His Ala Met Asp Tyr
Trp Gly 100 105 110Gln Gly Thr Leu Val Thr 11559108PRTArtificial
Sequencelight chain variable region for tavolixizumab 59Asp Ile Gln
Met Thr Gln Ser Pro Ser Ser Leu Ser Ala Ser Val Gly1 5 10 15Asp Arg
Val Thr Ile Thr Cys Arg Ala Ser Gln Asp Ile Ser Asn Tyr 20 25 30Leu
Asn Trp Tyr Gln Gln Lys Pro Gly Lys Ala Pro Lys Leu Leu Ile 35 40
45Tyr Tyr Thr Ser Lys Leu His Ser Gly Val Pro Ser Arg Phe Ser Gly
50 55 60Ser Gly Ser Gly Thr Asp Tyr Thr Leu Thr Ile Ser Ser Leu Gln
Pro65 70 75 80Glu Asp Phe Ala Thr Tyr Tyr Cys Gln Gln Gly Ser Ala
Leu Pro Trp 85 90 95Thr Phe Gly Gln Gly Thr Lys Val Glu Ile Lys Arg
100 105609PRTArtificial Sequenceheavy chain CDR1 for tavolixizumab
60Gly Ser Phe Ser Ser Gly Tyr Trp Asn1 56113PRTArtificial
Sequenceheavy chain CDR2 for tavolixizumab 61Tyr Ile Gly Tyr Ile
Ser Tyr Asn Gly Ile Thr Tyr His1 5 106214PRTArtificial
Sequenceheavy chain CDR3 for tavolixizumab 62Arg Tyr Lys Tyr Asp
Tyr Asp Gly Gly His Ala Met Asp Tyr1 5 10638PRTArtificial
Sequencelight chain CDR1 for tavolixizumab 63Gln Asp Ile Ser Asn
Tyr Leu Asn1 56411PRTArtificial Sequencelight chain CDR2 for
tavolixizumab 64Leu Leu Ile Tyr Tyr Thr Ser Lys Leu His Ser1 5
10658PRTArtificial Sequencelight chain CDR3 for tavolixizumab 65Gln
Gln Gly Ser Ala Leu Pro Trp1 566444PRTArtificial Sequenceheavy
chain for 11D4 66Glu Val Gln Leu Val Glu Ser Gly Gly Gly Leu Val
Gln Pro Gly Gly1 5 10 15Ser Leu Arg Leu Ser Cys Ala Ala Ser Gly Phe
Thr Phe Ser Ser Tyr 20 25 30Ser Met Asn Trp Val Arg Gln Ala Pro Gly
Lys Gly Leu Glu Trp Val 35 40 45Ser Tyr Ile Ser Ser Ser Ser Ser Thr
Ile Asp Tyr Ala Asp Ser Val 50 55 60Lys Gly Arg Phe Thr Ile Ser Arg
Asp Asn Ala Lys Asn Ser Leu Tyr65 70 75 80Leu Gln Met Asn Ser Leu
Arg Asp Glu Asp Thr Ala Val Tyr Tyr Cys 85 90 95Ala Arg Glu Ser Gly
Trp Tyr Leu Phe Asp Tyr Trp Gly Gln Gly Thr 100 105 110Leu Val Thr
Val Ser Ser Ala Ser Thr Lys Gly Pro Ser Val Phe Pro 115 120 125Leu
Ala Pro Cys Ser Arg Ser Thr Ser Glu Ser Thr Ala Ala Leu Gly 130 135
140Cys Leu Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val Ser Trp
Asn145 150 155 160Ser Gly Ala Leu Thr Ser Gly Val His Thr Phe Pro
Ala Val Leu Gln 165 170 175Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val
Val Thr Val Pro Ser Ser 180 185 190Asn Phe Gly Thr Gln Thr Tyr Thr
Cys Asn Val Asp His Lys Pro Ser 195 200 205Asn Thr Lys Val Asp Lys
Thr Val Glu Arg Lys Cys Cys Val Glu Cys 210 215 220Pro Pro Cys Pro
Ala Pro Pro Val Ala Gly Pro Ser Val Phe Leu Phe225 230 235 240Pro
Pro Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val 245 250
255Thr Cys Val Val Val Asp Val Ser His Glu Asp Pro Glu Val Gln Phe
260 265 270Asn Trp Tyr Val Asp Gly Val Glu Val His Asn Ala Lys Thr
Lys Pro 275 280 285Arg Glu Glu Gln Phe Asn Ser Thr Phe Arg Val Val
Ser Val Leu Thr 290 295 300Val Val His Gln Asp Trp Leu Asn Gly Lys
Glu Tyr Lys Cys Lys Val305 310 315 320Ser Asn Lys Gly Leu Pro Ala
Pro Ile Glu Lys Thr Ile Ser Lys Thr 325 330 335Lys Gly Gln Pro Arg
Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg 340 345 350Glu Glu Met
Thr Lys Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly 355 360 365Phe
Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro 370 375
380Glu Asn Asn Tyr Lys Thr Thr Pro Pro Met Leu Asp Ser Asp Gly
Ser385 390 395 400Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp Lys Ser
Arg Trp Gln Gln 405 410 415Gly Asn Val Phe Ser Cys Ser Val Met His
Glu Ala Leu His Asn His 420 425 430Tyr Thr Gln Lys Ser Leu Ser Leu
Ser Pro Gly Lys 435 44067214PRTArtificial Sequencelight chain for
11D4 67Asp Ile Gln Met Thr Gln Ser Pro Ser Ser Leu Ser Ala Ser Val
Gly1 5 10 15Asp Arg Val Thr Ile Thr Cys Arg Ala Ser Gln Gly Ile Ser
Ser Trp 20 25 30Leu Ala Trp Tyr Gln Gln Lys Pro Glu Lys Ala Pro Lys
Ser Leu Ile 35 40 45Tyr Ala Ala Ser Ser Leu Gln Ser Gly Val Pro Ser
Arg Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr Ile
Ser Ser Leu Gln Pro65 70 75 80Glu Asp Phe Ala Thr Tyr Tyr Cys Gln
Gln Tyr Asn Ser Tyr Pro Pro 85 90 95Thr Phe Gly Gly Gly Thr Lys Val
Glu Ile Lys Arg Thr Val Ala Ala 100 105 110Pro Ser Val Phe Ile Phe
Pro Pro Ser Asp Glu Gln Leu Lys Ser Gly 115 120 125Thr Ala Ser Val
Val Cys Leu Leu Asn Asn Phe Tyr Pro Arg Glu Ala 130 135 140Lys Val
Gln Trp Lys Val Asp Asn Ala Leu Gln Ser Gly Asn Ser Gln145 150 155
160Glu Ser Val Thr Glu Gln Asp Ser Lys Asp Ser Thr Tyr Ser Leu Ser
165 170 175Ser Thr Leu Thr Leu Ser Lys Ala Asp Tyr Glu Lys His Lys
Val Tyr 180 185 190Ala Cys Glu Val Thr His Gln Gly Leu Ser Ser Pro
Val Thr Lys Ser 195 200 205Phe Asn Arg Gly Glu Cys
21068118PRTArtificial Sequenceheavy chain variable region for 11D4
68Glu Val Gln Leu Val Glu Ser Gly Gly Gly Leu Val Gln Pro Gly Gly1
5 10 15Ser Leu Arg Leu Ser Cys Ala Ala Ser Gly Phe Thr Phe Ser Ser
Tyr 20 25 30Ser Met Asn Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu
Trp Val 35 40 45Ser Tyr Ile Ser Ser Ser Ser Ser Thr Ile Asp Tyr Ala
Asp Ser Val 50 55 60Lys Gly Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys
Asn Ser Leu Tyr65 70 75 80Leu Gln Met Asn Ser Leu Arg Asp Glu Asp
Thr Ala Val Tyr Tyr Cys 85 90 95Ala Arg Glu Ser Gly Trp Tyr Leu Phe
Asp Tyr Trp Gly Gln Gly Thr 100 105 110Leu Val Thr Val Ser Ser
11569107PRTArtificial Sequencelight chain variable region for 11D4
69Asp Ile Gln Met Thr Gln Ser Pro Ser Ser Leu Ser Ala Ser Val Gly1
5 10 15Asp Arg Val Thr Ile Thr Cys Arg Ala Ser Gln Gly Ile Ser Ser
Trp 20 25 30Leu Ala Trp Tyr Gln Gln Lys Pro Glu Lys Ala Pro Lys Ser
Leu Ile 35 40 45Tyr Ala Ala Ser Ser Leu Gln Ser Gly Val Pro Ser Arg
Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr Ile Ser
Ser Leu Gln Pro65 70 75 80Glu Asp Phe Ala Thr Tyr Tyr Cys Gln Gln
Tyr Asn Ser Tyr Pro Pro 85 90 95Thr Phe Gly Gly Gly Thr Lys Val Glu
Ile Lys 100 105705PRTArtificial Sequenceheavy chain CDR1 for 11D4
70Ser Tyr Ser Met Asn1 57117PRTArtificial Sequenceheavy chain CDR2
for 11D4 71Tyr Ile Ser Ser Ser Ser Ser Thr Ile Asp Tyr Ala Asp Ser
Val Lys1 5 10 15Gly729PRTArtificial Sequenceheavy chain CDR3 for
11D4 72Glu Ser Gly Trp Tyr Leu Phe Asp Tyr1 57311PRTArtificial
Sequencelight chain CDR1 for 11D4 73Arg Ala Ser Gln Gly Ile Ser Ser
Trp Leu Ala1 5 10747PRTArtificial Sequencelight chain CDR2 for 11D4
74Ala Ala Ser Ser Leu Gln Ser1 5759PRTArtificial Sequencelight
chain CDR3 for 11D4 75Gln Gln Tyr Asn Ser Tyr Pro Pro Thr1
576450PRTArtificial Sequenceheavy chain for 18D8 76Glu Val Gln Leu
Val Glu Ser Gly Gly Gly Leu Val Gln Pro Gly Arg1 5 10 15Ser Leu Arg
Leu Ser Cys Ala Ala Ser Gly Phe Thr Phe Asp Asp Tyr 20 25 30Ala Met
His Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45Ser
Gly Ile Ser Trp Asn Ser Gly Ser Ile Gly Tyr Ala Asp Ser Val 50 55
60Lys Gly Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn Ser Leu Tyr65
70 75 80Leu Gln Met Asn Ser Leu Arg Ala Glu Asp Thr Ala Leu Tyr Tyr
Cys 85 90 95Ala Lys Asp Gln Ser Thr Ala Asp Tyr Tyr Phe Tyr Tyr Gly
Met Asp 100 105 110Val Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser
Ala Ser Thr Lys 115 120 125Gly Pro Ser Val Phe Pro Leu Ala Pro Cys
Ser Arg Ser Thr Ser Glu 130 135 140Ser Thr Ala Ala Leu Gly Cys Leu
Val Lys Asp Tyr Phe Pro Glu Pro145 150 155 160Val Thr Val Ser Trp
Asn Ser Gly Ala Leu Thr Ser Gly Val His Thr 165 170 175Phe Pro Ala
Val Leu Gln Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val 180 185 190Val
Thr Val Pro Ser Ser Asn Phe Gly Thr Gln Thr Tyr Thr Cys Asn 195 200
205Val Asp His Lys Pro Ser Asn Thr Lys Val Asp Lys Thr Val Glu Arg
210 215 220Lys Cys Cys Val Glu Cys Pro Pro Cys Pro Ala Pro Pro Val
Ala Gly225 230 235 240Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys
Asp Thr Leu Met Ile 245 250 255Ser Arg Thr Pro Glu Val Thr Cys Val
Val Val Asp Val Ser His Glu 260 265 270Asp Pro Glu Val Gln Phe Asn
Trp Tyr Val Asp Gly Val Glu Val His 275 280 285Asn Ala Lys Thr Lys
Pro Arg Glu Glu Gln Phe Asn Ser Thr Phe Arg 290 295 300Val Val Ser
Val Leu Thr Val Val His Gln Asp Trp Leu Asn Gly Lys305 310 315
320Glu Tyr Lys Cys Lys Val Ser Asn Lys Gly Leu Pro Ala Pro Ile Glu
325 330 335Lys Thr Ile Ser Lys Thr Lys Gly Gln Pro Arg Glu Pro Gln
Val Tyr 340 345 350Thr Leu Pro Pro Ser Arg Glu Glu Met Thr Lys Asn
Gln Val Ser Leu 355 360 365Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser
Asp Ile Ala Val Glu Trp 370 375 380Glu Ser Asn Gly Gln Pro Glu Asn
Asn Tyr Lys Thr Thr Pro Pro Met385 390 395 400Leu Asp Ser Asp Gly
Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp 405 410 415Lys Ser Arg
Trp Gln Gln Gly Asn Val Phe Ser Cys Ser Val Met His 420 425 430Glu
Ala Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro 435 440
445Gly Lys 45077213PRTArtificial Sequencelight chain for 18D8 77Glu
Ile Val Val Thr Gln Ser Pro Ala Thr Leu Ser Leu Ser Pro Gly1 5 10
15Glu Arg Ala Thr Leu Ser Cys Arg Ala Ser Gln Ser Val Ser Ser Tyr
20 25 30Leu Ala Trp Tyr Gln Gln Lys Pro Gly Gln Ala Pro Arg Leu Leu
Ile 35 40 45Tyr Asp Ala Ser Asn Arg Ala Thr Gly Ile Pro Ala Arg Phe
Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr Ile Ser Ser
Leu Glu Pro65 70 75 80Glu Asp Phe Ala Val Tyr Tyr Cys Gln Gln Arg
Ser Asn Trp Pro Thr 85 90 95Phe Gly Gln Gly Thr Lys Val Glu Ile Lys
Arg Thr Val Ala Ala Pro 100 105 110Ser Val Phe Ile Phe Pro Pro Ser
Asp Glu Gln Leu Lys Ser Gly Thr 115 120 125Ala Ser Val Val Cys Leu
Leu Asn Asn Phe Tyr Pro Arg Glu Ala Lys 130 135 140Val Gln Trp Lys
Val Asp Asn Ala Leu Gln Ser Gly Asn Ser Gln Glu145 150 155 160Ser
Val Thr Glu Gln Asp Ser Lys Asp Ser Thr Tyr Ser Leu Ser Ser 165 170
175Thr Leu Thr Leu Ser Lys Ala Asp Tyr Glu Lys His Lys Val Tyr Ala
180 185 190Cys Glu Val Thr His Gln Gly Leu Ser Ser Pro Val Thr Lys
Ser Phe 195 200 205Asn Arg Gly Glu Cys 21078124PRTArtificial
Sequenceheavy chain variable region for 18D8 78Glu Val Gln Leu Val
Glu Ser Gly Gly Gly Leu Val Gln Pro Gly Arg1 5 10 15Ser Leu Arg Leu
Ser Cys Ala Ala Ser Gly Phe Thr Phe Asp Asp Tyr 20 25 30Ala Met His
Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45Ser Gly
Ile Ser Trp Asn Ser Gly Ser Ile Gly Tyr Ala Asp Ser Val 50 55 60Lys
Gly Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn Ser Leu Tyr65 70 75
80Leu Gln Met Asn Ser Leu Arg Ala Glu Asp Thr Ala Leu Tyr Tyr Cys
85 90 95Ala Lys Asp Gln Ser Thr Ala Asp Tyr Tyr Phe Tyr Tyr Gly Met
Asp 100 105 110Val Trp Gly Gln Gly Thr Thr Val Thr Val Ser Ser 115
12079106PRTArtificial Sequencelight chain variable region for 18D8
79Glu Ile Val Val Thr Gln Ser Pro Ala Thr Leu Ser Leu Ser Pro Gly1
5 10 15Glu Arg Ala Thr Leu Ser Cys Arg Ala Ser Gln Ser Val Ser Ser
Tyr 20 25 30Leu Ala Trp Tyr Gln Gln Lys Pro Gly Gln Ala Pro Arg Leu
Leu Ile 35 40 45Tyr Asp Ala Ser Asn Arg Ala Thr Gly Ile Pro Ala Arg
Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr Ile Ser
Ser Leu Glu Pro65 70 75 80Glu Asp Phe Ala Val Tyr Tyr Cys Gln Gln
Arg Ser Asn Trp Pro Thr 85 90 95Phe Gly Gln Gly Thr Lys Val Glu Ile
Lys 100 105805PRTArtificial Sequenceheavy chain CDR1 for 18D8 80Asp
Tyr Ala Met His1 58117PRTArtificial Sequenceheavy chain CDR2 for
18D8 81Gly Ile Ser Trp Asn Ser Gly Ser Ile Gly Tyr Ala Asp Ser Val
Lys1 5 10 15Gly8215PRTArtificial Sequenceheavy chain CDR3 for 18D8
82Asp Gln Ser Thr Ala Asp Tyr Tyr Phe Tyr Tyr Gly Met Asp Val1 5 10
158311PRTArtificial Sequencelight chain CDR1 for 18D8 83Arg Ala Ser
Gln Ser Val Ser Ser Tyr Leu Ala1 5 10847PRTArtificial Sequencelight
chain CDR2 for 18D8 84Asp Ala Ser Asn Arg Ala Thr1
5858PRTArtificial Sequencelight chain CDR3 for 18D8 85Gln Gln Arg
Ser Asn Trp Pro Thr1 586120PRTArtificial Sequenceheavy chain
variable region for Hu119-122 86Glu Val Gln Leu Val Glu Ser Gly Gly
Gly Leu Val Gln Pro Gly Gly1 5 10 15Ser Leu Arg Leu Ser Cys Ala Ala
Ser Glu Tyr Glu Phe Pro Ser His 20 25 30Asp Met Ser Trp Val Arg Gln
Ala Pro Gly Lys Gly Leu Glu Leu Val 35 40 45Ala Ala Ile Asn Ser Asp
Gly Gly Ser Thr Tyr Tyr Pro Asp Thr Met 50 55 60Glu Arg Arg Phe Thr
Ile Ser Arg Asp Asn Ala Lys Asn Ser Leu Tyr65 70 75 80Leu Gln Met
Asn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr Tyr Cys 85 90 95Ala Arg
His Tyr Asp Asp Tyr Tyr Ala Trp Phe Ala Tyr Trp Gly Gln 100 105
110Gly Thr Met Val Thr Val Ser Ser 115 12087111PRTArtificial
Sequencelight chain variable region for Hu119-122 87Glu Ile Val Leu
Thr Gln Ser Pro Ala Thr Leu Ser Leu Ser Pro Gly1 5 10 15Glu Arg Ala
Thr Leu Ser Cys Arg Ala Ser Lys Ser Val Ser Thr Ser
20 25 30Gly Tyr Ser Tyr Met His Trp Tyr Gln Gln Lys Pro Gly Gln Ala
Pro 35 40 45Arg Leu Leu Ile Tyr Leu Ala Ser Asn Leu Glu Ser Gly Val
Pro Ala 50 55 60Arg Phe Ser Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu
Thr Ile Ser65 70 75 80Ser Leu Glu Pro Glu Asp Phe Ala Val Tyr Tyr
Cys Gln His Ser Arg 85 90 95Glu Leu Pro Leu Thr Phe Gly Gly Gly Thr
Lys Val Glu Ile Lys 100 105 110885PRTArtificial Sequenceheavy chain
CDRl for Hu119-122 88Ser His Asp Met Ser1 58917PRTArtificial
Sequenceheavy chain CDR2 for Hu119-122 89Ala Ile Asn Ser Asp Gly
Gly Ser Thr Tyr Tyr Pro Asp Thr Met Glu1 5 10
15Arg9011PRTArtificial Sequenceheavy chain CDR3 for Hu119-122 90His
Tyr Asp Asp Tyr Tyr Ala Trp Phe Ala Tyr1 5 109115PRTArtificial
Sequencelight chain CDR1 for Hu119-122 91Arg Ala Ser Lys Ser Val
Ser Thr Ser Gly Tyr Ser Tyr Met His1 5 10 15927PRTArtificial
Sequencelight chain CDR2 for Hu119-122 92Leu Ala Ser Asn Leu Glu
Ser1 5939PRTArtificial Sequencelight chain CDR3 for Hu119-122 93Gln
His Ser Arg Glu Leu Pro Leu Thr1 594122PRTArtificial Sequenceheavy
chain variable region for Hu106-222 94Gln Val Gln Leu Val Gln Ser
Gly Ser Glu Leu Lys Lys Pro Gly Ala1 5 10 15Ser Val Lys Val Ser Cys
Lys Ala Ser Gly Tyr Thr Phe Thr Asp Tyr 20 25 30Ser Met His Trp Val
Arg Gln Ala Pro Gly Gln Gly Leu Lys Trp Met 35 40 45Gly Trp Ile Asn
Thr Glu Thr Gly Glu Pro Thr Tyr Ala Asp Asp Phe 50 55 60Lys Gly Arg
Phe Val Phe Ser Leu Asp Thr Ser Val Ser Thr Ala Tyr65 70 75 80Leu
Gln Ile Ser Ser Leu Lys Ala Glu Asp Thr Ala Val Tyr Tyr Cys 85 90
95Ala Asn Pro Tyr Tyr Asp Tyr Val Ser Tyr Tyr Ala Met Asp Tyr Trp
100 105 110Gly Gln Gly Thr Thr Val Thr Val Ser Ser 115
12095107PRTArtificial Sequencelight chain variable region for
Hu106-222 95Asp Ile Gln Met Thr Gln Ser Pro Ser Ser Leu Ser Ala Ser
Val Gly1 5 10 15Asp Arg Val Thr Ile Thr Cys Lys Ala Ser Gln Asp Val
Ser Thr Ala 20 25 30Val Ala Trp Tyr Gln Gln Lys Pro Gly Lys Ala Pro
Lys Leu Leu Ile 35 40 45Tyr Ser Ala Ser Tyr Leu Tyr Thr Gly Val Pro
Ser Arg Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Phe Thr
Ile Ser Ser Leu Gln Pro65 70 75 80Glu Asp Ile Ala Thr Tyr Tyr Cys
Gln Gln His Tyr Ser Thr Pro Arg 85 90 95Thr Phe Gly Gln Gly Thr Lys
Leu Glu Ile Lys 100 105965PRTArtificial Sequenceheavy chain CDR1
for Hu106-222 96Asp Tyr Ser Met His1 59717PRTArtificial
Sequenceheavy chain CDR2 for Hu106-222 97Trp Ile Asn Thr Glu Thr
Gly Glu Pro Thr Tyr Ala Asp Asp Phe Lys1 5 10
15Gly9813PRTArtificial Sequenceheavy chain CDR3 for Hu106-222 98Pro
Tyr Tyr Asp Tyr Val Ser Tyr Tyr Ala Met Asp Tyr1 5
109911PRTArtificial Sequencelight chain CDR1 for Hu106-222 99Lys
Ala Ser Gln Asp Val Ser Thr Ala Val Ala1 5 101007PRTArtificial
Sequencelight chain CDR2 for Hu106-222 100Ser Ala Ser Tyr Leu Tyr
Thr1 51019PRTArtificial Sequencelight chain CDR3 for Hu106-222
101Gln Gln His Tyr Ser Thr Pro Arg Thr1 5102183PRTArtificial
SequenceOX40L 102Met Glu Arg Val Gln Pro Leu Glu Glu Asn Val Gly
Asn Ala Ala Arg1 5 10 15Pro Arg Phe Glu Arg Asn Lys Leu Leu Leu Val
Ala Ser Val Ile Gln 20 25 30Gly Leu Gly Leu Leu Leu Cys Phe Thr Tyr
Ile Cys Leu His Phe Ser 35 40 45Ala Leu Gln Val Ser His Arg Tyr Pro
Arg Ile Gln Ser Ile Lys Val 50 55 60Gln Phe Thr Glu Tyr Lys Lys Glu
Lys Gly Phe Ile Leu Thr Ser Gln65 70 75 80Lys Glu Asp Glu Ile Met
Lys Val Gln Asn Asn Ser Val Ile Ile Asn 85 90 95Cys Asp Gly Phe Tyr
Leu Ile Ser Leu Lys Gly Tyr Phe Ser Gln Glu 100 105 110Val Asn Ile
Ser Leu His Tyr Gln Lys Asp Glu Glu Pro Leu Phe Gln 115 120 125Leu
Lys Lys Val Arg Ser Val Asn Ser Leu Met Val Ala Ser Leu Thr 130 135
140Tyr Lys Asp Lys Val Tyr Leu Asn Val Thr Thr Asp Asn Thr Ser
Leu145 150 155 160Asp Asp Phe His Val Asn Gly Gly Glu Leu Ile Leu
Ile His Gln Asn 165 170 175Pro Gly Glu Phe Cys Val Leu
180103131PRTArtificial SequenceOX40L soluble domain 103Ser His Arg
Tyr Pro Arg Ile Gln Ser Ile Lys Val Gln Phe Thr Glu1 5 10 15Tyr Lys
Lys Glu Lys Gly Phe Ile Leu Thr Ser Gln Lys Glu Asp Glu 20 25 30Ile
Met Lys Val Gln Asn Asn Ser Val Ile Ile Asn Cys Asp Gly Phe 35 40
45Tyr Leu Ile Ser Leu Lys Gly Tyr Phe Ser Gln Glu Val Asn Ile Ser
50 55 60Leu His Tyr Gln Lys Asp Glu Glu Pro Leu Phe Gln Leu Lys Lys
Val65 70 75 80Arg Ser Val Asn Ser Leu Met Val Ala Ser Leu Thr Tyr
Lys Asp Lys 85 90 95Val Tyr Leu Asn Val Thr Thr Asp Asn Thr Ser Leu
Asp Asp Phe His 100 105 110Val Asn Gly Gly Glu Leu Ile Leu Ile His
Gln Asn Pro Gly Glu Phe 115 120 125Cys Val Leu
130104128PRTArtificial SequenceOX40L soluble domain (alternative)
104Tyr Pro Arg Ile Gln Ser Ile Lys Val Gln Phe Thr Glu Tyr Lys Lys1
5 10 15Glu Lys Gly Phe Ile Leu Thr Ser Gln Lys Glu Asp Glu Ile Met
Lys 20 25 30Val Gln Asn Asn Ser Val Ile Ile Asn Cys Asp Gly Phe Tyr
Leu Ile 35 40 45Ser Leu Lys Gly Tyr Phe Ser Gln Glu Val Asn Ile Ser
Leu His Tyr 50 55 60Gln Lys Asp Glu Glu Pro Leu Phe Gln Leu Lys Lys
Val Arg Ser Val65 70 75 80Asn Ser Leu Met Val Ala Ser Leu Thr Tyr
Lys Asp Lys Val Tyr Leu 85 90 95Asn Val Thr Thr Asp Asn Thr Ser Leu
Asp Asp Phe His Val Asn Gly 100 105 110Gly Glu Leu Ile Leu Ile His
Gln Asn Pro Gly Glu Phe Cys Val Leu 115 120 125105120PRTArtificial
Sequencevariable heavy chain for 008 105Glu Val Gln Leu Val Glu Ser
Gly Gly Gly Leu Val Gln Pro Gly Gly1 5 10 15Ser Leu Arg Leu Ser Cys
Ala Ala Ser Gly Phe Thr Phe Ser Asn Tyr 20 25 30Thr Met Asn Trp Val
Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45Ser Ala Ile Ser
Gly Ser Gly Gly Ser Thr Tyr Tyr Ala Asp Ser Val 50 55 60Lys Gly Arg
Phe Thr Ile Ser Arg Asp Asn Ser Lys Asn Thr Leu Tyr65 70 75 80Leu
Gln Met Asn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr Tyr Cys 85 90
95Ala Lys Asp Arg Tyr Ser Gln Val His Tyr Ala Leu Asp Tyr Trp Gly
100 105 110Gln Gly Thr Leu Val Thr Val Ser 115
120106108PRTArtificial Sequencevariable light chain for 008 106Asp
Ile Val Met Thr Gln Ser Pro Asp Ser Leu Pro Val Thr Pro Gly1 5 10
15Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser Gln Ser Leu Leu His Ser
20 25 30Asn Gly Tyr Asn Tyr Leu Asp Trp Tyr Leu Gln Lys Ala Gly Gln
Ser 35 40 45Pro Gln Leu Leu Ile Tyr Leu Gly Ser Asn Arg Ala Ser Gly
Val Pro 50 55 60Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr Asp Phe Thr
Leu Lys Ile65 70 75 80Ser Arg Val Glu Ala Glu Asp Val Gly Val Tyr
Tyr Cys Gln Gln Tyr 85 90 95Tyr Asn His Pro Thr Thr Phe Gly Gln Gly
Thr Lys 100 105107120PRTArtificial Sequencevariable heavy chain for
011 107Glu Val Gln Leu Val Glu Ser Gly Gly Gly Val Val Gln Pro Gly
Arg1 5 10 15Ser Leu Arg Leu Ser Cys Ala Ala Ser Gly Phe Thr Phe Ser
Asp Tyr 20 25 30Thr Met Asn Trp Val Arg Gln Ala Pro Gly Lys Gly Leu
Glu Trp Val 35 40 45Ser Ser Ile Ser Gly Gly Ser Thr Tyr Tyr Ala Asp
Ser Arg Lys Gly 50 55 60Arg Phe Thr Ile Ser Arg Asp Asn Ser Lys Asn
Thr Leu Tyr Leu Gln65 70 75 80Met Asn Asn Leu Arg Ala Glu Asp Thr
Ala Val Tyr Tyr Cys Ala Arg 85 90 95Asp Arg Tyr Phe Arg Gln Gln Asn
Ala Phe Asp Tyr Trp Gly Gln Gly 100 105 110Thr Leu Val Thr Val Ser
Ser Ala 115 120108108PRTArtificial Sequencevariable light chain for
011 108Asp Ile Val Met Thr Gln Ser Pro Asp Ser Leu Pro Val Thr Pro
Gly1 5 10 15Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser Gln Ser Leu Leu
His Ser 20 25 30Asn Gly Tyr Asn Tyr Leu Asp Trp Tyr Leu Gln Lys Ala
Gly Gln Ser 35 40 45Pro Gln Leu Leu Ile Tyr Leu Gly Ser Asn Arg Ala
Ser Gly Val Pro 50 55 60Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr Asp
Phe Thr Leu Lys Ile65 70 75 80Ser Arg Val Glu Ala Glu Asp Val Gly
Val Tyr Tyr Cys Gln Gln Tyr 85 90 95Tyr Asn His Pro Thr Thr Phe Gly
Gln Gly Thr Lys 100 105109120PRTArtificial Sequencevariable heavy
chain for 021 109Glu Val Gln Leu Val Glu Ser Gly Gly Gly Leu Val
Gln Pro Arg Gly1 5 10 15Ser Leu Arg Leu Ser Cys Ala Ala Ser Gly Phe
Thr Phe Ser Ser Tyr 20 25 30Ala Met Asn Trp Val Arg Gln Ala Pro Gly
Lys Gly Leu Glu Trp Val 35 40 45Ala Val Ile Ser Tyr Asp Gly Ser Asn
Lys Tyr Tyr Ala Asp Ser Val 50 55 60Lys Gly Arg Phe Thr Ile Ser Arg
Asp Asn Ser Lys Asn Thr Leu Tyr65 70 75 80Leu Gln Met Asn Ser Leu
Arg Ala Glu Asp Thr Ala Val Tyr Tyr Cys 85 90 95Ala Lys Asp Arg Tyr
Ile Thr Leu Pro Asn Ala Leu Asp Tyr Trp Gly 100 105 110Gln Gly Thr
Leu Val Thr Val Ser 115 120110108PRTArtificial Sequencevariable
light chain for 021 110Asp Ile Gln Met Thr Gln Ser Pro Val Ser Leu
Pro Val Thr Pro Gly1 5 10 15Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Gln Ser Leu Leu His Ser 20 25 30Asn Gly Tyr Asn Tyr Leu Asp Trp Tyr
Leu Gln Lys Pro Gly Gln Ser 35 40 45Pro Gln Leu Leu Ile Tyr Leu Gly
Ser Asn Arg Ala Ser Gly Val Pro 50 55 60Asp Arg Phe Ser Gly Ser Gly
Ser Gly Thr Asp Phe Thr Leu Lys Ile65 70 75 80Ser Arg Val Glu Ala
Glu Asp Val Gly Val Tyr Tyr Cys Gln Gln Tyr 85 90 95Lys Ser Asn Pro
Pro Thr Phe Gly Gln Gly Thr Lys 100 105111120PRTArtificial
Sequencevariable heavy chain for 023 111Glu Val Gln Leu Val Glu Ser
Gly Gly Gly Leu Val His Pro Gly Gly1 5 10 15Ser Leu Arg Leu Ser Cys
Ala Gly Ser Gly Phe Thr Phe Ser Ser Tyr 20 25 30Ala Met His Trp Val
Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45Ser Ala Ile Gly
Thr Gly Gly Gly Thr Tyr Tyr Ala Asp Ser Val Met 50 55 60Gly Arg Phe
Thr Ile Ser Arg Asp Asn Ser Lys Asn Thr Leu Tyr Leu65 70 75 80Gln
Met Asn Ser Leu Arg Ala Glu Asp Thr Ala Val Tyr Tyr Cys Ala 85 90
95Arg Tyr Asp Asn Val Met Gly Leu Tyr Trp Phe Asp Tyr Trp Gly Gln
100 105 110Gly Thr Leu Val Thr Val Ser Ser 115
120112108PRTArtificial Sequencevariable light chain for 023 112Glu
Ile Val Leu Thr Gln Ser Pro Ala Thr Leu Ser Leu Ser Pro Gly1 5 10
15Glu Arg Ala Thr Leu Ser Cys Arg Ala Ser Gln Ser Val Ser Ser Tyr
20 25 30Leu Ala Trp Tyr Gln Gln Lys Pro Gly Gln Ala Pro Arg Leu Leu
Ile 35 40 45Tyr Asp Ala Ser Asn Arg Ala Thr Gly Ile Pro Ala Arg Phe
Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr Ile Ser Ser
Leu Glu Pro65 70 75 80Glu Asp Phe Ala Val Tyr Tyr Cys Gln Gln Arg
Ser Asn Trp Pro Pro 85 90 95Ala Phe Gly Gly Gly Thr Lys Val Glu Ile
Lys Arg 100 105113119PRTArtificial Sequenceheavy chain variable
region 113Glu Val Gln Leu Gln Gln Ser Gly Pro Glu Leu Val Lys Pro
Gly Ala1 5 10 15Ser Val Lys Met Ser Cys Lys Ala Ser Gly Tyr Thr Phe
Thr Ser Tyr 20 25 30Val Met His Trp Val Lys Gln Lys Pro Gly Gln Gly
Leu Glu Trp Ile 35 40 45Gly Tyr Ile Asn Pro Tyr Asn Asp Gly Thr Lys
Tyr Asn Glu Lys Phe 50 55 60Lys Gly Lys Ala Thr Leu Thr Ser Asp Lys
Ser Ser Ser Thr Ala Tyr65 70 75 80Met Glu Leu Ser Ser Leu Thr Ser
Glu Asp Ser Ala Val Tyr Tyr Cys 85 90 95Ala Asn Tyr Tyr Gly Ser Ser
Leu Ser Met Asp Tyr Trp Gly Gln Gly 100 105 110Thr Ser Val Thr Val
Ser Ser 115114108PRTArtificial Sequencelight chain variable region
114Asp Ile Gln Met Thr Gln Thr Thr Ser Ser Leu Ser Ala Ser Leu Gly1
5 10 15Asp Arg Val Thr Ile Ser Cys Arg Ala Ser Gln Asp Ile Ser Asn
Tyr 20 25 30Leu Asn Trp Tyr Gln Gln Lys Pro Asp Gly Thr Val Lys Leu
Leu Ile 35 40 45Tyr Tyr Thr Ser Arg Leu His Ser Gly Val Pro Ser Arg
Phe Ser Gly 50 55 60Ser Gly Ser Gly Thr Asp Tyr Ser Leu Thr Ile Ser
Asn Leu Glu Gln65 70 75 80Glu Asp Ile Ala Thr Tyr Phe Cys Gln Gln
Gly Asn Thr Leu Pro Trp 85 90 95Thr Phe Gly Gly Gly Thr Lys Leu Glu
Ile Lys Arg 100 105115121PRTArtificial Sequenceheavy chain variable
region 115Glu Val Gln Leu Gln Gln Ser Gly Pro Glu Leu Val Lys Pro
Gly Ala1 5 10 15Ser Val Lys Ile Ser Cys Lys Thr Ser Gly Tyr Thr Phe
Lys Asp Tyr 20 25 30Thr Met His Trp Val Lys Gln Ser His Gly Lys Ser
Leu Glu Trp Ile 35 40 45Gly Gly Ile Tyr Pro Asn Asn Gly Gly Ser Thr
Tyr Asn Gln Asn Phe 50 55 60Lys Asp Lys Ala Thr Leu Thr Val Asp Lys
Ser Ser Ser Thr Ala Tyr65 70 75 80Met Glu Phe Arg Ser Leu Thr Ser
Glu Asp Ser Ala Val Tyr Tyr Cys 85 90 95Ala Arg Met Gly Tyr His Gly
Pro His Leu Asp Phe Asp Val Trp Gly 100 105 110Ala Gly Thr Thr Val
Thr Val Ser Pro 115 120116108PRTArtificial Sequencelight chain
variable region 116Asp Ile Val Met Thr Gln Ser His Lys Phe Met Ser
Thr Ser Leu Gly1 5 10 15Asp Arg Val Ser Ile Thr Cys Lys Ala Ser Gln
Asp Val Gly Ala Ala 20 25 30Val Ala Trp Tyr Gln Gln Lys Pro Gly Gln
Ser Pro Lys Leu Leu Ile 35 40 45Tyr Trp Ala Ser Thr Arg His Thr Gly
Val Pro Asp Arg Phe Thr Gly 50 55 60Gly Gly Ser Gly Thr Asp Phe Thr
Leu Thr Ile Ser Asn Val Gln Ser65 70 75 80Glu Asp Leu Thr Asp Tyr
Phe Cys Gln Gln Tyr Ile Asn Tyr Pro Leu 85 90 95Thr Phe Gly Gly Gly
Thr Lys Leu Glu Ile Lys Arg 100
105117122PRTArtificial Sequenceheavy chain variable region of
humanized antibody 117Gln Ile Gln Leu Val Gln Ser Gly Pro Glu Leu
Lys Lys Pro Gly Glu1 5 10 15Thr Val Lys Ile Ser Cys Lys Ala Ser Gly
Tyr Thr Phe Thr Asp Tyr 20 25 30Ser Met His Trp Val Lys Gln Ala Pro
Gly Lys Gly Leu Lys Trp Met 35 40 45Gly Trp Ile Asn Thr Glu Thr Gly
Glu Pro Thr Tyr Ala Asp Asp Phe 50 55 60Lys Gly Arg Phe Ala Phe Ser
Leu Glu Thr Ser Ala Ser Thr Ala Tyr65 70 75 80Leu Gln Ile Asn Asn
Leu Lys Asn Glu Asp Thr Ala Thr Tyr Phe Cys 85 90 95Ala Asn Pro Tyr
Tyr Asp Tyr Val Ser Tyr Tyr Ala Met Asp Tyr Trp 100 105 110Gly His
Gly Thr Ser Val Thr Val Ser Ser 115 120118122PRTArtificial
Sequenceheavy chain variable region of humanized antibody 118Gln
Val Gln Leu Val Gln Ser Gly Ser Glu Leu Lys Lys Pro Gly Ala1 5 10
15Ser Val Lys Val Ser Cys Lys Ala Ser Gly Tyr Thr Phe Thr Asp Tyr
20 25 30Ser Met His Trp Val Arg Gln Ala Pro Gly Gln Gly Leu Lys Trp
Met 35 40 45Gly Trp Ile Asn Thr Glu Thr Gly Glu Pro Thr Tyr Ala Asp
Asp Phe 50 55 60Lys Gly Arg Phe Val Phe Ser Leu Asp Thr Ser Val Ser
Thr Ala Tyr65 70 75 80Leu Gln Ile Ser Ser Leu Lys Ala Glu Asp Thr
Ala Val Tyr Tyr Cys 85 90 95Ala Asn Pro Tyr Tyr Asp Tyr Val Ser Tyr
Tyr Ala Met Asp Tyr Trp 100 105 110Gly Gln Gly Thr Thr Val Thr Val
Ser Ser 115 120119107PRTArtificial Sequencelight chain variable
region of humanized antibody 119Asp Ile Val Met Thr Gln Ser His Lys
Phe Met Ser Thr Ser Val Arg1 5 10 15Asp Arg Val Ser Ile Thr Cys Lys
Ala Ser Gln Asp Val Ser Thr Ala 20 25 30Val Ala Trp Tyr Gln Gln Lys
Pro Gly Gln Ser Pro Lys Leu Leu Ile 35 40 45Tyr Ser Ala Ser Tyr Leu
Tyr Thr Gly Val Pro Asp Arg Phe Thr Gly 50 55 60Ser Gly Ser Gly Thr
Asp Phe Thr Phe Thr Ile Ser Ser Val Gln Ala65 70 75 80Glu Asp Leu
Ala Val Tyr Tyr Cys Gln Gln His Tyr Ser Thr Pro Arg 85 90 95Thr Phe
Gly Gly Gly Thr Lys Leu Glu Ile Lys 100 105120107PRTArtificial
Sequencelight chain variable region of humanized antibody 120Asp
Ile Val Met Thr Gln Ser His Lys Phe Met Ser Thr Ser Val Arg1 5 10
15Asp Arg Val Ser Ile Thr Cys Lys Ala Ser Gln Asp Val Ser Thr Ala
20 25 30Val Ala Trp Tyr Gln Gln Lys Pro Gly Gln Ser Pro Lys Leu Leu
Ile 35 40 45Tyr Ser Ala Ser Tyr Leu Tyr Thr Gly Val Pro Asp Arg Phe
Thr Gly 50 55 60Ser Gly Ser Gly Thr Asp Phe Thr Phe Thr Ile Ser Ser
Val Gln Ala65 70 75 80Glu Asp Leu Ala Val Tyr Tyr Cys Gln Gln His
Tyr Ser Thr Pro Arg 85 90 95Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile
Lys 100 105121120PRTArtificial Sequenceheavy chain variable region
of humanized antibody 121Glu Val Gln Leu Val Glu Ser Gly Gly Gly
Leu Val Gln Pro Gly Glu1 5 10 15Ser Leu Lys Leu Ser Cys Glu Ser Asn
Glu Tyr Glu Phe Pro Ser His 20 25 30Asp Met Ser Trp Val Arg Lys Thr
Pro Glu Lys Arg Leu Glu Leu Val 35 40 45Ala Ala Ile Asn Ser Asp Gly
Gly Ser Thr Tyr Tyr Pro Asp Thr Met 50 55 60Glu Arg Arg Phe Ile Ile
Ser Arg Asp Asn Thr Lys Lys Thr Leu Tyr65 70 75 80Leu Gln Met Ser
Ser Leu Arg Ser Glu Asp Thr Ala Leu Tyr Tyr Cys 85 90 95Ala Arg His
Tyr Asp Asp Tyr Tyr Ala Trp Phe Ala Tyr Trp Gly Gln 100 105 110Gly
Thr Leu Val Thr Val Ser Ala 115 120122120PRTArtificial
Sequenceheavy chain variable region of humanized antibody 122Glu
Val Gln Leu Val Glu Ser Gly Gly Gly Leu Val Gln Pro Gly Gly1 5 10
15Ser Leu Arg Leu Ser Cys Ala Ala Ser Glu Tyr Glu Phe Pro Ser His
20 25 30Asp Met Ser Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu Leu
Val 35 40 45Ala Ala Ile Asn Ser Asp Gly Gly Ser Thr Tyr Tyr Pro Asp
Thr Met 50 55 60Glu Arg Arg Phe Thr Ile Ser Arg Asp Asn Ala Lys Asn
Ser Leu Tyr65 70 75 80Leu Gln Met Asn Ser Leu Arg Ala Glu Asp Thr
Ala Val Tyr Tyr Cys 85 90 95Ala Arg His Tyr Asp Asp Tyr Tyr Ala Trp
Phe Ala Tyr Trp Gly Gln 100 105 110Gly Thr Met Val Thr Val Ser Ser
115 120123111PRTArtificial Sequencelight chain variable region of
humanized antibody 123Asp Ile Val Leu Thr Gln Ser Pro Ala Ser Leu
Ala Val Ser Leu Gly1 5 10 15Gln Arg Ala Thr Ile Ser Cys Arg Ala Ser
Lys Ser Val Ser Thr Ser 20 25 30Gly Tyr Ser Tyr Met His Trp Tyr Gln
Gln Lys Pro Gly Gln Pro Pro 35 40 45Lys Leu Leu Ile Tyr Leu Ala Ser
Asn Leu Glu Ser Gly Val Pro Ala 50 55 60Arg Phe Ser Gly Ser Gly Ser
Gly Thr Asp Phe Thr Leu Asn Ile His65 70 75 80Pro Val Glu Glu Glu
Asp Ala Ala Thr Tyr Tyr Cys Gln His Ser Arg 85 90 95Glu Leu Pro Leu
Thr Phe Gly Ala Gly Thr Lys Leu Glu Leu Lys 100 105
110124111PRTArtificial Sequencelight chain variable region of
humanized antibody 124Glu Ile Val Leu Thr Gln Ser Pro Ala Thr Leu
Ser Leu Ser Pro Gly1 5 10 15Glu Arg Ala Thr Leu Ser Cys Arg Ala Ser
Lys Ser Val Ser Thr Ser 20 25 30Gly Tyr Ser Tyr Met His Trp Tyr Gln
Gln Lys Pro Gly Gln Ala Pro 35 40 45Arg Leu Leu Ile Tyr Leu Ala Ser
Asn Leu Glu Ser Gly Val Pro Ala 50 55 60Arg Phe Ser Gly Ser Gly Ser
Gly Thr Asp Phe Thr Leu Thr Ile Ser65 70 75 80Ser Leu Glu Pro Glu
Asp Phe Ala Val Tyr Tyr Cys Gln His Ser Arg 85 90 95Glu Leu Pro Leu
Thr Phe Gly Gly Gly Thr Lys Val Glu Ile Lys 100 105
110125138PRTArtificial Sequenceheavy chain variable region 125Met
Tyr Leu Gly Leu Asn Tyr Val Phe Ile Val Phe Leu Leu Asn Gly1 5 10
15Val Gln Ser Glu Val Lys Leu Glu Glu Ser Gly Gly Gly Leu Val Gln
20 25 30Pro Gly Gly Ser Met Lys Leu Ser Cys Ala Ala Ser Gly Phe Thr
Phe 35 40 45Ser Asp Ala Trp Met Asp Trp Val Arg Gln Ser Pro Glu Lys
Gly Leu 50 55 60Glu Trp Val Ala Glu Ile Arg Ser Lys Ala Asn Asn His
Ala Thr Tyr65 70 75 80Tyr Ala Glu Ser Val Asn Gly Arg Phe Thr Ile
Ser Arg Asp Asp Ser 85 90 95Lys Ser Ser Val Tyr Leu Gln Met Asn Ser
Leu Arg Ala Glu Asp Thr 100 105 110Gly Ile Tyr Tyr Cys Thr Trp Gly
Glu Val Phe Tyr Phe Asp Tyr Trp 115 120 125Gly Gln Gly Thr Thr Leu
Thr Val Ser Ser 130 135126126PRTArtificial Sequencelight chain
variable region 126Met Arg Pro Ser Ile Gln Phe Leu Gly Leu Leu Leu
Phe Trp Leu His1 5 10 15Gly Ala Gln Cys Asp Ile Gln Met Thr Gln Ser
Pro Ser Ser Leu Ser 20 25 30Ala Ser Leu Gly Gly Lys Val Thr Ile Thr
Cys Lys Ser Ser Gln Asp 35 40 45Ile Asn Lys Tyr Ile Ala Trp Tyr Gln
His Lys Pro Gly Lys Gly Pro 50 55 60Arg Leu Leu Ile His Tyr Thr Ser
Thr Leu Gln Pro Gly Ile Pro Ser65 70 75 80Arg Phe Ser Gly Ser Gly
Ser Gly Arg Asp Tyr Ser Phe Ser Ile Ser 85 90 95Asn Leu Glu Pro Glu
Asp Ile Ala Thr Tyr Tyr Cys Leu Gln Tyr Asp 100 105 110Asn Leu Leu
Thr Phe Gly Ala Gly Thr Lys Leu Glu Leu Lys 115 120 125
* * * * *
References