U.S. patent application number 17/668125 was filed with the patent office on 2022-07-14 for dosing regimen of avelumab for the treatment of cancer.
The applicant listed for this patent is MERCK PATENT GMBH, PFIZER INC.. Invention is credited to Glen Ian Andrews, Carlo Leonel BELLO, Satjit Singh BRAR, Pascal GIRARD, Shaonan WANG.
Application Number | 20220220205 17/668125 |
Document ID | / |
Family ID | |
Filed Date | 2022-07-14 |
United States Patent
Application |
20220220205 |
Kind Code |
A1 |
Andrews; Glen Ian ; et
al. |
July 14, 2022 |
DOSING REGIMEN OF AVELUMAB FOR THE TREATMENT OF CANCER
Abstract
The present invention relates to dosing regimen of avelumab for
the treatment of cancer. In particular, the invention relates to
improved dosing regimen of avelumab for the treatment of
cancer.
Inventors: |
Andrews; Glen Ian; (San
Diego, CA) ; BELLO; Carlo Leonel; (San Francisco,
CA) ; BRAR; Satjit Singh; (San Diego, CA) ;
WANG; Shaonan; (Muehltal Traisa, DE) ; GIRARD;
Pascal; (Renens, CH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
PFIZER INC.
MERCK PATENT GMBH |
New York
Darmstadt |
NY |
US
DE |
|
|
Appl. No.: |
17/668125 |
Filed: |
February 9, 2022 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16339779 |
Apr 5, 2019 |
11274154 |
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PCT/IB2017/056160 |
Oct 5, 2017 |
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17668125 |
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62405188 |
Oct 6, 2016 |
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62565728 |
Sep 29, 2017 |
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International
Class: |
C07K 16/28 20060101
C07K016/28; A61P 35/00 20060101 A61P035/00 |
Claims
1-45. (canceled)
46. A method of treating a cancer in a patient, comprising
administering avelumab to the patient according to a dosing regimen
of 1200-2400 mg flat dose Q3W.
47. The method of claim 46, wherein the dosing regimen is 1200 mg
flat dose Q3W.
48. The method of claim 46, wherein the cancer is selected from the
group consisting of MCC, NSCLC, RCC, bladder cancer, ovarian
cancer, head and neck cancer and gastric cancer.
49. The method of claim 48, wherein the cancer is NSCLC.
50. The method of claim 48, wherein the cancer is MCC.
51-69. (canceled)
70. The method of claim 47, wherein the cancer is selected from the
group consisting of MCC, NSCLC, RCC, bladder cancer, ovarian
cancer, head and neck cancer and gastric cancer.
71. The method of claim 70, wherein the cancer is NSCLC.
72. The method of claim 70, wherein the cancer is MCC.
Description
FIELD
[0001] The present invention relates to dosing regimens of avelumab
for the treatment of cancer. In particular, the invention relates
to improved dosing regimens of avelumab for the treatment of
cancer.
BACKGROUND
[0002] The programmed death 1 (PD-1) receptor and PD-1 ligands 1
and 2 (PD-L1 and PD-L2, respectively) play integral roles in immune
regulation. Expressed on activated T25 cells, PD-1 is activated by
PD-L1 (also known as B7-H1) and PD-L2 expressed by stromal cells,
tumor cells, or both, initiating T-cell death and localized immune
suppression (Dong et al., Nat Med 1999; 5:1365-69; Freeman et al. J
Exp Med 2000; 192:1027-34), potentially providing an
immune-tolerant environment for tumor development and growth.
Conversely, inhibition of this interaction can enhance local T30
cell responses and mediate antitumor activity in nonclinical animal
models (Iwai Y, et al. Proc Natl Acad Sci USA 2002;
99:12293-97).
[0003] Avelumab is a fully human mAb of the IgG1 isotype that
specifically targets and blocks PD-L1. Avelumab is the
International Nonproprietary Name (INN) for the anti-PD-L1
monoclonal antibody MSB0010718C and has been described by its full
length heavy and light chain sequences in WO2013079174, where it is
referred to as A09-246-2. The glycosylation and truncation of the
C-terminal Lysine in its heavy chain is described in WO2017097407.
Avelumab has been in clinical development for the treatment of
Merkel Cell Carcinoma (MCC), non-small cell lung cancer (NSCLC),
urothelial carcinoma (UC), renal cell carcinoma (RCC) and a number
of other cancer conditions of a dosing regimen of 10 mg/kg Q2W.
SUMMARY OF THE INVENTION
[0004] This invention relates to dosing regimens of avelumab for
the treatment of cancer. More specifically, the invention relates
method of treating cancer in a patient, comprising administering to
the patient a dosing regimen that provides a higher mean exposure,
as measured by C.sub.trough or other suitable PK parameters, of
avelumab in the patient, than the current dosing regimen of 10
mg/kg Q2W that are used in the clinical trials.
[0005] In one embodiment, the invention relates to a method of
treating a cancer in a patient, comprising administering avelumab
to the patient in a dosing regimen of 5-10 mg/Kg Q1W. In one aspect
of this embodiment, the dosing regimen is 5 mg/kg Q1W, 6 mg/kg Q1W,
7 mg/kg Q1W, 8 mg/kg Q1W, 9 mg/kg Q1W or 10 mg/kg Q1W. More
preferably, the dosing regimen is 5 mg/kg Q1W, 8 mg/kg Q1W or 10
mg/kg Q1W. Even more preferably, the dosing regimen is 10 mg/kg
Q1W. In another aspect of this embodiment, and in combination with
any other aspects of this embodiment, the cancer is selected from
the group consisting of MCC, NSCLC, RCC, bladder cancer, ovarian
cancer, head and neck cancer, gastric cancer, mesothelioma,
urothelial carcinoma, breast cancer, adenocarcinoma of the stomach
and thymoma. Preferably, the cancer is MCC, NSCLC, RCC, bladder
cancer, ovarian cancer, head and neck cancer and gastric cancer.
More preferably, the cancer is MSCLC or MCC. In another embodiment,
the invention relates to a method of treating a cancer in a
patient, comprising administering avelumab to the patient in a
dosing regimen of 11-20 mg/kg Q2W. In one aspect of this
embodiment, the dosing regimen is 11, 12, 13, 14, 15, 16, 17, 18,
19 or 20 mg/kg Q2W. Preferably, the dosing regimen is 13, 15, 17 or
20 mg/kg Q2W. More preferably, the dosing regimen is 15 or 20 mg/kg
Q2W. Even more preferably, the dosing regimen is 20 mg/kg Q2W. In
another aspect of this embodiment, and in combination with any
other aspects of this embodiment, the cancer is selected from the
group consisting of MCC, NSCLC, RCC, bladder cancer, ovarian
cancer, head and neck cancer gastric cancer, mesothelioma,
urothelial carcinoma, breast cancer, adenocarcinoma of the stomach
and thymoma. Preferably, the cancer is MCC, NSCLC, RCC, bladder
cancer, ovarian cancer, head and neck cancer gastric cancer. More
preferably, the cancer is MSCLC or MCC.
[0006] In another embodiment, the invention relates to a method of
treating a cancer in a patient, comprising administering avelumab
to the patient in a dosing regimen of 15-30 mg/kg Q3W. In one
aspect of this embodiment, the dosing regimen is, 15, 16, 17, 18,
19, 20, 21, 22, 23, 24, 25, 26, 27, 28 29 or 30 mg/kg Q3W.
Preferably, the dosing regimen is 15, 20, 25 or 30 mg/kg Q3W. More
preferably, the dosing regimen is 15, 20 or 25 mg/kg Q3W. Even more
preferably, the dosing regimen is 20 mg/kg Q3W. In another aspect
of this embodiment, and in combination with any other aspects of
this embodiment, the cancer is selected from the group consisting
of MCC, NSCLC, RCC, bladder cancer, ovarian cancer, head and neck
cancer gastric cancer, mesothelioma, urothelial carcinoma, breast
cancer, adenocarcinoma of the stomach and thymoma. Preferably, the
cancer is MCC, NSCLC, RCC, bladder cancer, ovarian cancer, head and
neck cancer gastric cancer. More preferably, the cancer is MSCLC or
MCC.
[0007] In another embodiment, the invention relates to a method of
treating a cancer in a patient, comprising administering avelumab
to the patient in a dosing regimen of X mg/kg Q1W for n weeks
followed by Y mg/kg Q2W, wherein X is 5-20, Y is 10-20, n is 6, 12
or 18. In one aspect of this embodiment, n is 12. In another aspect
of the embodiment, n is 6. In another aspect of the embodiment, and
in combination with any other aspect of this embodiment, X is 5, 6,
7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 19, 18, 19 or 20. Preferably,
X is 5, 10, 15 or 20. More preferably, X is 5, 10, or 15. Even more
preferably, X is 10. In another aspect of the embodiment, and in
combination with any other aspect of this embodiment, Y is 10, 11,
12, 13, 14, 15, 16, 17, 18, 19 or 20. Preferably, Y is 10, 15 or
20. More preferably, Y is 10. In another aspect of this embodiment,
and in combination with any other aspects of this embodiment, the
cancer is selected from the group consisting of MCC, NSCLC, RCC,
bladder cancer, ovarian cancer, head and neck cancer gastric
cancer, mesothelioma, urothelial carcinoma, breast cancer,
adenocarcinoma of the stomach and thymoma. Preferably, the cancer
is MCC, NSCLC, RCC, bladder cancer, ovarian cancer, head and neck
cancer gastric cancer. More preferably, the cancer is MSCLC or
MCC.
[0008] In some embodiments, a flat dose can be used in place of the
mg/kg dose mentioned above. Correlation between mg/kg dose and the
flat dose can be made, e.g., as follows: 5 mg/kg is about 500 mg
flat dose; 10 mg/kg is about 800 mg; 11mg/mg is about 900 mg; 15
mg/kg is about 1240 mg flat dose; 20 mg is about 1600 mg flat dose
and 30 mg/kg is about 2400 mg flat dose. Therefore, in another
embodiment of the invention, the aforementioned embodiments based
on a mg/kg dosing regimen of avelumab can be replaced with the
corresponding flat dosing regimen as described herein.
[0009] In other embodiments, the invention relates to a method of
treating a cancer in a patient, comprising administering avelumab
to the patient a flat dosing regimen of avelumab. In one aspect of
the embodiment, the flat dosing regimen is 400-800 mg flat dose
Q1W. Preferably, the flat dosing regimen is 400 mg, 450 mg, 500 mg,
550 mg, 600 mg, 650 mg, 700 mg, 750 mg or 800 mg flat dose Q1W.
Preferably, the flat dosing regimen is 800 mg flat dose Q1W. In
another aspect of this embodiment, the flat dosing regimen is
880-1600 mg flat dose Q2W. Preferably the flat dosing regimen is
880 mg, 900 mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200
mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg
or 1600 mg flat dose Q2W. More preferably, the flat dosing regimen
is 1200 mg or 1600 mg flat dose Q2W. In another aspect of this
embodiment, the flat dosing regimen is 1200-2400 mg flat dose Q3W,
preferably 1200 mg Q3W. Preferably, the flat dosing regimen is 1200
mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg 1500 mg, 1550 mg,
1600 mg, 1650 mg, 1700 mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950
mg, 2000 mg, 2050 mg, 2100 mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg,
2350 mg or 2400 mg flat dose Q3W. More preferably, the dosing
regimen is 1200 mg flat dose Q3W. In another aspect of the
embodiment, the flat dosing regimen is 400-1600 mg Q1W for n weeks
followed by 800-1600 mg Q2W, wherein n is 6, 12 or 18. Preferably,
the flat dosing regimen is 400 mg, 450 mg, 500 mg, 550 mg, 600 mg,
650 mg, 700 mg, 725 mg, 750 mg, 775 mg, 800 mg, 825 mg, 850 mg, 875
mg, 900 mg, 925 mg, 950 mg, 975 mg, 1000 mg, 1050 mg, 1100 mg, 1150
mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg,
1550 mg or 1600 mg Q1W for n weeks followed by 800 mg, 850 mg, 900
mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg,
1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg or 1600 mg
Q2W. More preferably, the dosing regimen is 800 mg flat dose Q1W
for n weeks followed by 800 mg flat dose Q2W. Even more preferably,
n is 12. In another aspect of this embodiment, the flat dosing
regimen is 400-800 mg flat dose Q2W. Preferably, the flat dosing
regimen is 400 mg, 450 mg, 500 mg, 550 mg, 600 mg, 650 mg, 700 mg
750 mg or 800 mg flat dose Q2W. More preferably, the flat dosing
regimen is 800 mg flat dose Q2W. In another aspect of this
embodiment, and in combination with any other aspects of this
embodiment not inconsistent, the cancer is selected from the group
consisting of MCC, NSCLC, RCC, bladder cancer, ovarian cancer, head
and neck cancer, gastric cancer, mesothelioma, urothelial
carcinoma, breast cancer, adenocarcinoma of the stomach and
thymoma. Preferably, the cancer is MCC, NSCLC, RCC, bladder cancer,
ovarian cancer, head and neck cancer gastric cancer. More
preferably, the cancer is NSCLC or MCC.
[0010] In another embodiment, the invention is directed to a method
of treating a cancer comprising administering to the patient
avelumab in a dosing regimen as described in any of the proceeding
embodiments, wherein the patient has a TPS of PD-L1 expression of
1% and above, 5% and above, 10% and above, 20% and above, 30% and
above, 40% and above, 50% and above, 60% and above, 70% and above,
80% and above 95% and above, or 95% and above. Preferably, the TPS
of PD-L1 expression is 20% and above. More preferably, the TPS of
PD-L1 expression is 50% and above.
[0011] In another embodiment, the invention is directed to a method
of treating a cancer in a patient, comprising administering
avelumab to the patient in a dosing regimen selected from the group
consisting of 800 mg Q1W for 12 weeks followed by 800 mg Q2W, 10
mg/kg Q1W for 12 weeks followed by 10 mg/kg Q2W and 1200 mg Q3W,
and wherein the tumor proportion score of PD-L1 expression is 5%
and above, 20% and above, 50% and above or 80% and above.
Preferably, tumor proportion score of PD-L1 expression is 20% and
above. More preferably, the TPS of PD-L1 expression is 50% and
above. In one aspect of this embodiment and the cancer is selected
from NSCLC, urothelial cancer, RCC, ovarian cancer, head and neck
cancer gastric cancer. More preferably, the cancer is NSCLC.
[0012] In another embodiment, the invention is directed to a method
of treating a cancer comprising administering to the patient
avelumab in a dosing regimen as described in any of the proceeding
embodiments, further comprising administering to the patient at
least one of a second anti-cancer treatment. In an aspect of this
embodiment, the method further comprising administering one or two
of a second anti-cancer treatment. Preferably, the second
anti-cancer treatment is selected from the group consisting of a
VEGFR antagonist, an anti-4-1BB antibody an anti-OX-40 antibody, an
anti-MCSF antibody, an anti-PTK-7 antibody based antibody drug
conjugate (ADC) wherein the drug payload is an antineoplastic
agent, an IDO1 antagonist, an ALK antagonist, an anti-cancer
vaccine, a radio therapy and a standard of care treatment of
cancers of the relevant tumor type. Preferably, the VEGFR
antagonist is axitinib, the anti-4-1BB antibody is PF0582566, the
antiOX-40 antibody is PF4518600, the anti-MCSF antibody is
PF-0360324, the ALK antagonist is crizotinib or lorlatinib
(PF-06463922) and the anti-PTK7 antibody based ADC is
PF-06647020.
BRIEF DESCRIPTION OF THE FIGURES AND DRAWINGS
[0013] FIG. 1 depicts the C.sub.trough v. ORR curve of 88 patients
in phase III MCC trial.
[0014] FIG. 2. depicts the C.sub.trough v. ORR curve of 156
patients in phase III first line NSCLC patients
[0015] FIG. 3 depicts the C.sub.trough v. ORR curve of 184 patients
in phase I, 2.sup.nd line NSCLC patients.
[0016] FIG. 4A and FIG. 4B depict the density plots showing the
distribution of AUC.sub.0-336 h (.mu.gh/mL) after 10 mg/kg Q2W and
flat 800 mg Q2W dosing using the PK SS model for the entire
population (FIG. 4A) and split by quartiles of weight (FIG. 4B)
[0017] FIG. 5A and FIG. 5B depict the box and whisker plots showing
the AUC.sub.0-336 h (.mu.gh/mL) after 10 mg/kg Q2W and 800 mg Q2W
dosing using the PK SS model for the entire population (FIG. 5A)
and split by quartiles of weight (FIG. 5B)
[0018] FIG. 6 depicts the density plot of mean probability of best
overall response (BOR) in simulated studies with metastatic MCC
(mMCC) based on the PK CYCLE model, for the 10 mg/kg Q2W and the
800 mg Q2W dose.
[0019] FIG. 7 depicts the box and whisker plot of mean probability
of BOR in simulated studies with UC for the 10 mg/kg Q2W and 800 mg
Q2W.
[0020] FIG. 8A and FIG. 8B depict the density plot (FIG. 8A) and
box and whisker plot (FIG. 8B), using the PK CYCLE model, showing
the probably of experiencing an immune-related adverse event (irAE)
after 10 mg/kg Q2W and 800 mg Q2W dose.
[0021] FIG. 9A and FIG. 9B depict the density plot (FIG. 9A) and
box and whisker plot (FIG. 9B), using the PK SS model, showing the
probably of experiencing an irAE after 10 mg/kg Q2W and 800 mg Q2W
dose.
DETAILED DESCRIPTION OF THE INVENTION
[0022] As used herein, the terms such as "area under curve" (AUC),
C.sub.trough, C.sub.max, "best overall response" (BOR), "overall
response rate" (ORR), Q1W, Q2W, Q3W have the meaning as they are
generally known by one of the ordinary skill in the art.
[0023] As used herein, the term "anti-cancer treatment" refers to
any standard of care treatment of cancers in any relevant tumor
types, or the administration of any single pharmaceutical agent,
any fixed dose combinations of two or more single pharmaceutical
agents, other than the standard of care treatment of cancer,
documented in the state of the art as having or potentially having
an effect toward the treatment of cancer or in the relevant tumor
types.
[0024] As used herein the term "standard of care treatment of
cancers" refers to any non-surgical treatment of any particular
tumor type that is suggested in the NCCN Guidelines Version 1 2017.
For clarity, such standard of care treatment of cancers may be
radiation or, the administration of a single pharmaceutical agent,
a fixed dose combinations of two or more single pharmaceutical
agents or the combination of two or more single pharmaceutical
agents, provided that standard of care treatment of cancers does
not already contain any PD-1 or PD-L1 antagonist.
[0025] As used herein the term "single pharmaceutical agent" means
any composition that comprising a single substance as the only
active pharmaceutical ingredient in the composition.
[0026] As used herein, the term "tumor proportion score" or "TPS"
as used herein refers to the percentage of viable tumor cells
showing partial or complete membrane staining in an
immunohistochemistry test of a sample. "Tumor proportion score of
PD-L1 expression" used here in refers to the percentage of viable
tumor cells showing partial or complete membrane staining in a
PD-L1 expression immunohistochemistry test of a sample. Exemplary
samples include, without limitation, a biological sample, a tissue
sample, a formalin-fixed paraffin-embedded (FFPE) human tissue
sample and a formalin-fixed paraffin-embedded (FFPE) human tumor
tissue sample. Exemplary PD-L1 expression immunohistochemistry
tests include, without limitation, the PD-L1 IHC 22C3 PharmDx (FDA
approved, Daco), Ventana PD-L1 SP263 assay, and the tests described
in PCT/EP2017/073712.
[0027] "Administration" and "treatment," as it applies to an
animal, human, experimental subject, cell, tissue, organ, or
biological fluid, refers to contact of an exogenous pharmaceutical,
therapeutic, diagnostic agent, or composition to the animal, human,
subject, cell, tissue, organ, or biological fluid. Treatment of a
cell encompasses contact of a reagent to the cell, as well as
contact of a reagent to a fluid, where the fluid is in contact with
the cell. "Administration" and "treatment" also means in vitro and
ex vivo treatments, e.g., of a cell, by a reagent, diagnostic,
binding compound, or by another cell. The term "subject" includes
any organism, preferably an animal, more preferably a mammal (e.g.,
rat, mouse, dog, cat, and rabbit) and most preferably a human.
"Treatment", as used in a clinical setting, is intended for
obtaining beneficial or desired clinical results. For purposes of
this invention, beneficial or desired clinical results include, but
are not limited to, one or more of the following: reducing the
proliferation of (or destroying) neoplastic or cancerous cells,
inhibiting metastasis of neoplastic cells, shrinking or decreasing
the size of tumor, remission of a disease (e.g., cancer),
decreasing symptoms resulting from a disease (e.g., cancer),
increasing the quality of life of those suffering from a disease
(e.g., cancer), decreasing the dose of other medications required
to treat a disease (e.g., cancer), delaying the progression of a
disease (e.g., cancer), curing a disease (e.g., cancer), and/or
prolong survival of patients having a disease (e.g., cancer).
[0028] An "antibody" is an immunoglobulin molecule capable of
specific binding to a target, such as a carbohydrate,
polynucleotide, lipid, polypeptide, etc., through at least one
antigen recognition site, located in the variable region of the
immunoglobulin molecule. As used herein, the term encompasses not
only intact polyclonal or monoclonal antibodies, but also antigen
binding fragments thereof (such as Fab, Fab', F(ab')2, Fv), single
chain (scFv) and domain antibodies (including, for example, shark
and camelid antibodies), and fusion proteins comprising an
antibody, and any other modified configuration of the
immunoglobulin molecule that comprises an antigen recognition site.
An antibody includes an antibody of any class, such as IgG, IgA, or
IgM (or sub-class thereof), and the antibody need not be of any
particular class. Depending on the antibody amino acid sequence of
the constant region of its heavy chains, immunoglobulins can be
assigned to different classes. There are five major classes of
immunoglobulins: IgA, IgD, IgE, IgG, and IgM, and several of these
may be further divided into subclasses (isotypes), e.g., IgG1,
IgG2, IgG3, IgG4, IgA1 and IgA2. The heavy-chain constant regions
that correspond to the different classes of immunoglobulins are
called alpha, delta, epsilon, gamma, and mu, respectively. The
subunit structures and three-dimensional configurations of
different classes of immunoglobulins are well known.
[0029] The term "antigen binding fragment" or "antigen binding
portion" of an antibody, as used herein, refers to one or more
fragments of an intact antibody that retain the ability to
specifically bind to a given antigen (e.g., PD-L1). Antigen binding
functions of an antibody can be performed by fragments of an intact
antibody. Examples of binding fragments encompassed within the term
"antigen binding fragment" of an antibody include Fab; Fab';
F(ab')2; an Fd fragment consisting of the VH and CH1 domains; an Fv
fragment consisting of the VL and VH domains of a single arm of an
antibody; a single domain antibody (dAb) fragment (Ward et al.,
Nature 341:544-546, 1989), and an isolated complementarity
determining region (CDR).
[0030] An antibody, an antibody conjugate, or a polypeptide that
"preferentially binds" or "specifically binds" (used
interchangeably herein) to a target (e.g., PD-L1 protein) is a term
well understood in the art, and methods to determine such specific
or preferential binding are also well known in the art. A molecule
is said to exhibit "specific binding" or "preferential binding" if
it reacts or associates more frequently, more rapidly, with greater
duration and/or with greater affinity with a particular cell or
substance than it does with alternative cells or substances. An
antibody "specifically binds" or "preferentially binds" to a target
if it binds with greater affinity, avidity, more readily, and/or
with greater duration than it binds to other substances. For
example, an antibody that specifically or preferentially binds to a
PD-L1 epitope is an antibody that binds this epitope with greater
affinity, avidity, more readily, and/or with greater duration than
it binds to other PD-L1 epitopes or non-PD-L1 epitopes. It is also
understood that by reading this definition, for example, an
antibody (or moiety or epitope) that specifically or preferentially
binds to a first target may or may not specifically or
preferentially bind to a second target. As such, "specific binding"
or "preferential binding" does not necessarily require (although it
can include) exclusive binding. Generally, but not necessarily,
reference to binding means preferential binding.
[0031] A "variable region" of an antibody refers to the variable
region of the antibody light chain or the variable region of the
antibody heavy chain, either alone or in combination. As known in
the art, the variable regions of the heavy and light chain each
consist of four framework regions (FR) connected by three
complementarity determining regions (CDRs) also known as
hypervariable regions. The CDRs in each chain are held together in
close proximity by the FRs and, with the CDRs from the other chain,
contribute to the formation of the antigen binding site of
antibodies. There are at least two techniques for determining CDRs:
(1) an approach based on cross-species sequence variability (i.e.,
Kabat et al. Sequences of Proteins of Immunological Interest, (5th
ed., 1991, National Institutes of Health, Bethesda Md.)); and (2)
an approach based on crystallographic studies of antigen-antibody
complexes (Al-lazikani et al., 1997, J. Molec. Biol. 273:927-948).
As used herein, a CDR may refer to CDRs defined by either approach
or by a combination of both approaches.
[0032] A "CDR" of a variable domain are amino acid residues within
the variable region that are identified in accordance with the
definitions of the Kabat, Chothia, the accumulation of both Kabat
and Chothia, AbM, contact, and/or conformational definitions or any
method of CDR determination well known in the art. Antibody CDRs
may be identified as the hypervariable regions originally defined
by Kabat et al. See, e.g., Kabat et al., 1992, Sequences of
Proteins of Immunological Interest, 5th ed., Public Health Service,
NIH, Washington D.C. The positions of the CDRs may also be
identified as the structural loop structures originally described
by Chothia and others. See, e.g., Chothia et al., Nature
342:877-883, 1989. Other approaches to CDR identification include
the "AbM definition," which is a compromise between Kabat and
Chothia and is derived using Oxford Molecular's AbM antibody
modeling software (now Accelrys.RTM.), or the "contact definition"
of CDRs based on observed antigen contacts, set forth in MacCallum
et al., J. Mol. Biol., 262:732-745, 1996. In another approach,
referred to herein as the "conformational definition" of CDRs, the
positions of the CDRs may be identified as the residues that make
enthalpic contributions to antigen binding. See, e.g., Makabe et
al., Journal of Biological Chemistry, 283:1156-1166, 2008. Still
other CDR boundary definitions may not strictly follow one of the
above approaches, but will nonetheless overlap with at least a
portion of the Kabat CDRs, although they may be shortened or
lengthened in light of prediction or experimental findings that
particular residues or groups of residues or even entire CDRs do
not significantly impact antigen binding. As used herein, a CDR may
refer to CDRs defined by any approach known in the art, including
combinations of approaches. The methods used herein may utilize
CDRs defined according to any of these approaches. For any given
embodiment containing more than one CDR, the CDRs may be defined in
accordance with any of Kabat, Chothia, extended, AbM, contact,
and/or conformational definitions.
[0033] "Isolated antibody" and "isolated antibody fragment" refers
to the purification status and in such context means the named
molecule is substantially free of other biological molecules such
as nucleic acids, proteins, lipids, carbohydrates, or other
material such as cellular debris and growth media. Generally, the
term "isolated" is not intended to refer to a complete absence of
such material or to an absence of water, buffers, or salts, unless
they are present in amounts that substantially interfere with
experimental or therapeutic use of the binding compound as
described herein.
[0034] "Monoclonal antibody" or "mAb" or "Mab", as used herein,
refers to a population of substantially homogeneous antibodies,
i.e., the antibody molecules comprising the population are
identical in amino acid sequence except for possible naturally
occurring mutations that may be present in minor amounts. In
contrast, conventional (polyclonal) antibody preparations typically
include a multitude of different antibodies having different amino
acid sequences in their variable domains, particularly their CDRs,
which are often specific for different epitopes. The modifier
"monoclonal" indicates the character of the antibody as being
obtained from a substantially homogeneous population of antibodies,
and is not to be construed as requiring production of the antibody
by any particular method. For example, the monoclonal antibodies to
be used in accordance with the present invention may be made by the
hybridoma method first described by Kohler et al. (1975) Nature
256: 495, or may be made by recombinant DNA methods (see, e.g.,
U.S. Pat. No. 4,816,567). The "monoclonal antibodies" may also be
isolated from phage antibody libraries using the techniques
described in Clackson et al. (1991) Nature 352: 624-628 and Marks
et al. (1991) J. Mol. Biol. 222: 581-597, for example. See also
Presta (2005) J. Allergy Clin. Immunol. 116:731.
[0035] "Chimeric antibody" refers to an antibody in which a portion
of the heavy and/or light chain is identical with or homologous to
corresponding sequences in an antibody derived from a particular
species (e.g., human) or belonging to a particular antibody class
or subclass, while the remainder of the chain(s) is identical with
or homologous to corresponding sequences in an antibody derived
from another species (e.g., mouse) or belonging to another antibody
class or subclass, as well as fragments of such antibodies, so long
as they exhibit the desired biological activity.
[0036] "Human antibody" refers to an antibody that comprises human
immunoglobulin protein sequences only. A human antibody may contain
murine carbohydrate chains if produced in a mouse, in a mouse cell,
or in a hybridoma derived from a mouse cell. Similarly, "mouse
antibody" or "rat antibody" refer to an antibody that comprises
only mouse or rat immunoglobulin sequences, respectively.
[0037] "Humanized antibody" refers to forms of antibodies that
contain sequences from non-human (e.g., murine) antibodies as well
as human antibodies. Such antibodies contain minimal sequence
derived from non-human immunoglobulin. In general, the humanized
antibody will comprise substantially all of at least one, and
typically two, variable domains, in which all or substantially all
of the hypervariable loops correspond to those of a non-human
immunoglobulin and all or substantially all of the FR regions are
those of a human immunoglobulin sequence. The humanized antibody
optionally also will comprise at least a portion of an
immunoglobulin constant region (Fc), typically that of a human
immunoglobulin. The prefix "hum", "hu" or "h" is added to antibody
clone designations when necessary to distinguish humanized
antibodies from parental rodent antibodies. The humanized forms of
rodent antibodies will generally comprise the same CDR sequences of
the parental rodent antibodies, although certain amino acid
substitutions may be included to increase affinity, increase
stability of the humanized antibody, or for other reasons.
[0038] Avelumab entered phase 1 clinical trial in early 2013 and
has since then advanced to phase 3 trials in several different
tumor types such as MCC, NSCLC, RCC, gastric cancer, ovarian cancer
and bladder cancer. The dosing regimen in these trials was 10 mg/kg
Q2W. Provided herein are improved dosing regimens for avelumab
which could achieve a better overall response rate than the current
10 mg/kg Q2W dosing regimen.
[0039] Table 1 below provides the sequences of the anti-PD-L1
antibody avelumab for use in the treatment method, medicaments and
uses of the present invention. Avelumab is described in
International Patent Publication No. WO2013/079174, the disclosure
of which is hereby incorporated by references in its entirety.
TABLE-US-00001 TABLE 1 Anti-human-PD-L1 antibody Avelumab Sequences
Heavy chain SYIMM CDR1 (CDRH1) (SEQ ID NO: 1) Heavy chain
SIYPSGGITFY CDR2 (CDRH2) (SEQ ID NO: 2) Heavy chain IKLGTVTTVDY
CDR3 (CDRH3) (SEQ ID NO: 3) Light chain TGTSSDVGGYNYVS CDR1 (CDRL1)
(SEQ ID NO: 4) Light chain DVSNRPS CDR2 (CDRL2) (SEQ ID NO: 5)
Light chain SSYTSSSTRV CDR3 (CDRL3) (SEQ ID NO: 6) Heavy chain
EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYIMMW variable
VRQAPGKGLEWVSSIYPSGGITFYADKGRFTISRDN region
SKNTLYLQMNSLRAEDTAVYYCARIKLGTVTTVDYW (VR) GQGTLVTVSS (SEQ ID NO: 7)
Light chain QSALTQPASVSGSPGQSITISCTGTSSDVGGYNYVS VR
WYQQHPGKAPKLMIYDVSNRPSGVSNRFSGSKSGNT
ASLTISGLQAEDEADYYCSSYTSSSTRVFGTGTKVT VL (SEQ ID NO: 8) Heavy chain
EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYIMMW
VRQAPGKGLEWVSSIYPSGGITFYADTVKGRFTISR
DNSKNTLYLQMNSLRAEDTAVYYCARIKLGTVTTVD
YWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAA
LGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSS
GLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDK
KVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKD
TLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVH
NAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKC
KVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDE
LTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKT
TPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMH EALHNHYTQKSLSLSPGK (SEQ ID NO:
9) Light chain QSALTQPASVSGSPGQSITISCTGTSSDVGGYNYVS
WYQQHPGKAPKLMIYDVSNRPSGVSNRFSGSKSGNT
ASLTISGLQAEDEADYYCSSYTSSSTRVFGTGTKVT
VLGQPKANPTVTLFPPSSEELQANKATLVCLISDFY
PGAVTVAWKADGSPVKAGVETTKPSKQSNNKYAASS
YLSLTPEQWKSHRSYSCQVTHEGSTVEKTVAPTECS (SEQ ID NO: 10)
EXAMPLES
[0040] General methods for Examples 1-3: a population
pharmacokinetic (PK) model was used to estimate individual exposure
metrics using individual pharmacokinetic parameters for patients
with MCC and NSCLC. The influence of exposure metrics
(C.sub.trough,) on response was explored via logistic regression
and was applied to model the relationships between exposure and the
overall response rate (ORR). In the figures for each example, the
heavy dot on each vertical bar represents a summary statistic of
the observed data, divided into quartiles. The X axis for each
quartile represents the mean C.sub.trough of the patients in each
of the quartiles and the Y axis represents the probability of
response for the individual quartile and it is corresponding 95%
confidence interval. The curved thin line represents the logistic
regression model fit, about all the observed data along with the
95% prediction interval about the regression (shaded red area).
Example 1
C.sub.trough and ORR Correlation of 88 Patients in a Phase 3 MCC
Trial
[0041] 88 patients participated in a phase 3 MCC trial with the
avelumab dosing of 10 mg/kg Q2W over one hour of IV infusion.
Patients were divided into four quartiles based on the
C.sub.through value of patients, with 22 patients in each quartile.
The C.sub.trough value of each patient was calculated based on the
existing model and the actual serum concentration of avelumab
tested for each patient at various points during the trial. As
shown in FIG. 1, the four quartiles of patients were represented by
the four vertical bars in the figure. The C.sub.trough value of
each quartile is represented by the mean C.sub.trough value of the
quartile. The heavy dot on each vertical bar represents the
probability of overall response rate for the group.
[0042] A positive correlation between C.sub.trough and ORR was
observed (FIG. 1). Patients of the upper 4.sup.th quartile have a
probability of ORR of about 60% (FIG.1). A mean C.sub.trough of
around 44-50 ug/mL correlates to a probability of ORR of 50-60%
(FIG. 1).
Example 2
C.sub.trough and ORR Correlation of 156 Patients in Phase 3 First
Line NSCLC Trial
[0043] 156 patients participated in a phase 3 first line NSCLC
trial with the avelumab dosing of 10 mg/kg Q2W over one hour of IV
infusion. Patients were divided into four quartiles based on the
C.sub.through value of patients, with 39 patients in each quartile.
The C.sub.trough number of each patient was calculated based on the
existing model and the actual serum concentration of avelumab
tested for each patient at various points during the trial. As
shown in FIG. 2, the four quartiles of patients were represented by
the four vertical bars in the figure. The C.sub.trough value of
each quartile is represented by the mean C.sub.trough value of the
quartile. The heavy dot on each vertical bar represents the
probability of overall response rate for the group.
[0044] A positive correlation between C.sub.trough and ORR was
observed (FIG. 2). Patients of the upper 4.sup.th quartile have a
probability of ORR of about 35% (FIG. 2). A mean C.sub.trough of
around 44-54 ug/mL correlates to a probability of ORR of 35-50%
(FIG. 2).
Example 3
C.sub.trough and ORR Correlation of 184 Patients in Phase 1b Second
Line NSCLC Trial
[0045] 184 patients participated in a phase 1b second line NSCLC
trial with the avelumab dosing of 10 mg/kg Q2W over one hour of IV
infusion. Patients were divided into four quartiles based on the
C.sub.through value of patients, with 46 patients in each quartile.
The C.sub.trough number of each patient was calculated based on the
existing model and the actual serum concentration of avelumab
tested for each patient at various points during the trial. As
shown in FIG. 3, the four quartiles of patients were represented by
the four vertical bars in the figure. The C.sub.trough value of
each quartile is represented by the mean C.sub.trough value of the
quartile. The heavy dot on each vertical bar represents the
probability of overall response rate for the group.
[0046] A positive correlation between C.sub.trough and ORR was
observed. Patients of the upper 4.sup.th quartile have a
probability of ORR of about 31% (FIG. 3). A mean C.sub.trough of
around 60-85 ug/mL correlates to a probability of ORR of 35-50%
(FIG. 3).
[0047] Tumor proportion score (TPS) of PD-L1 expression was tested
of the tumor tissues collected during the clinical trial. TPS of
PD-L1 expression was analyzed together with C.sub.through and
response rate. Surprising ORRs were observed among the subset of
patients with both high exposure any increased PD-L1 expression in
the tumor cells. Among the 184 patients, 142 patients evaluated for
C.sub.trough exposure, and 71 patients were in the upper half (top
two quartiles). For patients in the upper half (top two quartiles)
of the C.sub.trough exposure, TPS PD-L1 expression cutoff values of
.gtoreq.1%, .gtoreq.5%, .gtoreq.50%, and .gtoreq.80% yielded ORRs
of 25.4%, 25.6%, 33.3%, and 42.9%, respectively (Table 2).
TABLE-US-00002 TABLE 2 Avelumab response in 2L NSCLC patients with
high exposure and high TPS of PD-L1 PD-L1 TPS Patient number ORR
Non selected 184 14.1% 1% and above 59 25.4% 5% and above 39 25.6%
50% and above 21 33.3% 80% and above 14 42.9%
[0048] A consistent positive correlation between mean C.sub.trough
and the probability of ORR was observed (Examples 1-3). Taking into
consideration of the best probability of the ORR in each Example,
which occurs generally in the 4.sup.th quartile (Examples 1-3), the
correlation of the C.sub.trough and ORR is expected to continue
within reasonable range above the 4.sup.th quartile. These data
indicate that a mean C.sub.trough of 44-85 ug/mL correlates with a
probability of ORR of 50% in various tumor types.
Example 4
Simulation of C.sub.trough of Various Avelumab Dosing Regimens
[0049] Table 3 provides a number of dosing regimens for avelumab.
The population PK model generated for avelumab based on previous
work, was used to simulate the C.sub.trough of selected dosing
regimens, in MCC, SCCLC and in solid tumor types.
TABLE-US-00003 TABLE 3 Avelumab dosing regimens Proposed dosing
regimen Notes 5-10 mg/kg Q1W Dosing range 10 mg/kg Q1W Preferred
specific dose 5 mg/kg Q1W additional Preferred specific 8 mg/kg Q1W
dose within the range 11-20 mg/kg Q2W Dosing range 11 mg Q2W
Preferred specific dose 20 mg/kg Q2W Preferred specific dose 13,
15, 17 mg/kg Q2W Additional preferred specific dose 15-30 mg/kg Q3W
Range 20 mg/kg Q3W Preferred specific doses 15, 20, 25, 30 mg/kg
Q3W Additional Preferred specific dose within the range 5-20 mg/kg
Q1W for n weeks Dosing range followed by 10 mg/kg Q2W n is 6 or 12
10 mg/kg Q1W for 12 weeks Preferred specific dose followed by 10
mg/kg Q2W 5, 15, 20 mg/kg Q1W for 6 or Additional Preferred
specific 12 weeks followed by 10 mg/kg dose within the range Q2W
500-800 mg Q1W Correspond to 5-10 mg/kg Q1W 900-1600 mg Q2W
Correspond to 11-20 mg/kg Q2W 1250-2400 mg Q3W Correspond to 15-30
mg/kg Q2W 500-1600 mg Q1W for n weeks Correspond to 5-20 mg/kg
followed by 800 mg Q2W Q1W for n weeks followed by 10 mg/kg Q2W
[0050] General methods: Pharmacokinetic simulations of the avelumab
dosing regimens were performed using the NONMEM version 7.3
software (ICON Development Solutions, Hanover, Md.). Two
compartment IV model with linear elimination was used as the
population PK model. This model is based on over three thousand PK
observations from over seven hundred patients who participated in
the avelumab clinical trials thus far. To conduct the simulations
of the dosing regimen described in above Table 3, a dataset was
created with dosing events, dosing amounts, a 1 hour rate of
infusion, and covariates included in the population PK model. The
steady-state C.sub.trough concentrations were calculated by
removing the first 3 doses and then computing the average
C.sub.trough from the remaining dosing event for the given dose
amount. For loading dose schedules, the C.sub.trough was calculated
for the loading portion of the regimen as well as for the continued
dosing after the loading period.
[0051] Results of the above simulation are shown in the below
Tables 4-6.
TABLE-US-00004 TABLE 4 Summary of median C.sub.trough for MCC under
various dosing regimen 95% C.sub.trough Median C.sub.trough
prediction interval No. Dosing regimen (ug/mL) (ug/mL) 1 5 mg/kg
Q1W 59 29.0-109.8 2 10 mg/kg Q1W 116.5 56.3-208.5 3 10 mg/kg/Q2W
38.9 14.7-83.0 4 11 mg/kg Q2W 43.4 17.6-91.5 5 20 mg/kg Q2W 77.1
31.1-160.3 6 10 mg/kg Q3W 18.1 4.5-45.5 7 15 mg/kg Q3W 27.3
9.5-67.4 8 20 mg/kg Q3W 36.6 12.3-86.7 9 25 mg/kg Q3W 10 30 mg/kg
Q3W 53.7 18.4-127.2 11 5 mg/kg Q1W for During Loading: During
loading: 12 weeks followed 59.0 29.0-109.8 by 10 mg/kg Q2W After
loading: After loading: 40.6 15.7-90.2 12 10 mg/kg Q1W for During
loading: During loading: 12 weeks followed 116.5 56.3-208.5 by 10
mg/kg Q2W After loading: After loading: 45.3 17.4-100.4 13 20 mg/kg
Q1W for During loading During loading: 12 weeks followed 225.8
115.4-430.3 by 10 mg/kg Q2W After loading: After loading: 55.3
17.4-100.4 14 5 mg/kg Q1W for During loading: During loading: 6
weeks followed 55.0 27.6-105.4 by 10 mg/kg Q2W After loading: After
loading: 39.4 16.2-88.3 15 10 mg Q1W for During loading: During
loading: 6 weeks followed 110.1 53.6-206.0 by 10 mg/kg Q2W After
loading: After loading: 41.9 17.1-88.3 16 20 mg Q1W for During
loading: During loading: 6 weeks followed 215.7 107.7-382.6 by 10
mg/kg Q2W After loading: After loading: 46.2 17.9-105.2
[0052] The dosing regimens Nos. 1-2, 4-5, 8-16 of Table 4, and
ranges within these regimens such as 5-10 mg/kg Q1W, 11-20 mg/kg
Q2W, 20-30 mg/kg Q3W, 5-20 mg/kg Q1W for 6-12 weeks followed by 10
mg/kg Q2W, provide an expected median C.sub.trough higher than the
current 10 mg/kg Q2W dosing regimen (Table 4). From Example 1, a
dosing regimen that provides a mean C.sub.trough of over 50 ug/mL
correlates with a higher probability of ORR in MCC. The data shown
in Table 4 for the avelumab dosing regimens 1-2, 10 and 11-16
indicate that these regimens could advantageously provide a higher
expected probability of ORR for MCC.
TABLE-US-00005 TABLE 5 Summary of Median C.sub.trough under various
dosing regimen for NSCLC. Median 95% C.sub.trough Ctrough
prediction interval No. Dosing regimen (ug/mL) (ug/mL) 1 5 mg/kg
Q1W 42.8 19.4-79.6 2 10 mg/kg Q1W 83.9 39.9-160.2 3 10 mg/kg/Q2W
20.6 4.8-51.2 4 11 mg/kg Q2W 22.2 5.8-56.6 5 20 mg/kg Q2W 39.9
11.5-96.3 6 10 mg/kg Q3W 6.3 0.0-20.1 7 15 mg/kg Q3W 9.1 0.2-34.1 8
20 mg/kg Q3W 12.8 0.5-46.7 9 25 mg/kg Q3W 14.2 0.9-54.6 10 30 mg/kg
Q3W 17.6 1.8-66.7 11 5 mg/kg Q1W for During Loading: During
loading: 12 weeks followed 42.8 19.4-79.6 by 10 mg/kg Q2W After
loading: After loading: 20.2 5.2-47.5 12 10 mg/kg Q1W for During
loading: During loading: 12 weeks followed 83.9 39.9-160 by 10
mg/kg Q2W After loading: After loading: 20.2 4.8-51.5 13 20 mg/kg
Q1W for During loading During loading: 12 weeks followed 172.9
74.6-342.6 by 10 mg/kg Q2W After loading: After loading: 20.5
4.6-63.9 14 5 mg/kg Q1W for During loading: During loading: 6 weeks
followed 42.9 19.5-82.1 by 10 mg/kg Q2W After loading: After
loading: 20.9 5.2-51.7 15 10 mg Q1W for 6 During loading: During
loading: weeks followed by 86.7 39.0-163 10 mg/kg Q2W After
loading: After loading: 20.5 5.0-52.6 16 20 mg Q1W for 6 During
loading: During loading: weeks followed by 163.4 79.3-332.5 10
mg/kg Q2W After loading: After loading: 19.6 4.9-56.4
[0053] The dosing regimens Nos. 1-2, 4-5, 10, 11-16 of Table 5, and
ranges within these regimens, such as 5-10 mg/kg Q1W, 11-20 mg/kg
Q2W, 5-20 mg/kg Q1W for 6-12 weeks followed by 10 mg/kg Q2W,
provide an expected median C.sub.trough above the current 10 mg/kg
Q2W dosing regimen (Table 5). Examples 1-3 above demonstrate that
the mean C.sub.trough has a positive correlation with the
probability of ORR. In Examples 2 and 3, a mean C.sub.trough of 44
ug/mL to 85 ug/mL corresponds to about 35% to about 50% probability
of ORR, wherein the 4.sup.th quartile probability of ORR in
Examples 2 and 3 was 35% and 31% respectively. The data from Table
5 demonstrate that regimens Nos. 1-2, 5 and 11-16 provide an
expected mean C.sub.trough of about or over 44 ug/mL and thus could
advantageously provide better probability of ORR in NSCLC patients.
Other advantageous dosing regimens include, for example, regimens
Nos. 2, 12-13 and 15-16, and the ranges within these regimens such
as 10 mg-20 mg/kg Q1W for 6 or 12 weeks followed by 10 mg/kg Q2W,
all of which correspond to a median C.sub.trough of about or more
than 85 ug/mL. Other advantageous regimens for NSCLC are those
providing a mean C.sub.trough between 44 ug/mL and 85 ug/ml, i.e.
dosing regimen Nos. 1, 2, 5, 11, 12, 14, 15 of Table 5, and ranges
within these regimens such as 5-10 mg/kg Q1W, 5-10 mg/kg Q1W for
6-12 weeks followed by 10 mg/kg Q2W.
TABLE-US-00006 TABLE 6 Summary of Median C.sub.trough under various
avelumab dosing regimen for all solid tumor types. 95% C.sub.trough
Median C.sub.trough prediction interval No. Dosing regimen (ug/mL)
(ug/mL) 1 5 mg/kg Q1W 43 19.5-84 2 10 mg/kg Q1W 83.6 36.6-160 3 10
mg/kg/Q2W 19.9 4.7-53.3 4 11 mg/kg Q2W 22.9 6.4-57.9 5 20 mg/kg Q2W
40.2 11.1-100.5 6 10 mg/kg Q3W 6.3 0.0-33.5 7 15 mg/kg Q3W 9.2
0.0-33.5 8 20 mg/kg Q3W 11.6 0.4-41.9 9 25 mg/kg Q3W 10 30 mg/kg
Q3W 16.7 1.7-58.2 11 5 mg/kg Q1W for During Loading: During
loading: 12 weeks followed 43.0 19.5-84.5 by 10 mg/kg Q2W After
loading: After loading: 20.2 4.7-53.2 12 10 mg/kg Q1W for During
loading: During loading: 12 weeks followed 83.6 36.6-160 by 10
mg/kg Q2W After loading: After loading: 19.7 4.3-51.6 13 20 mg/kg
Q1W for During loading During loading: 12 weeks followed 160.7
73.8-319 by 10 mg/kg Q2W After loading: After loading: 19.3
4.2-54.9 14 5 mg/kg Q1W for During loading: During loading: 6 weeks
followed 42.2 19.6-83.7 by 10 mg/kg Q2W After loading: After
loading: 20.9 5.1-51.1 15 10 mg Q1W for During loading: During
loading: 6 weeks followed by 83.9 39.6-158 10 mg/kg Q2W After
loading: After loading: 19.9 5.5-48.6 16 20 mg Q1W for During
loading: During loading: 6 weeks followed by 163.8 78.0-314 10
mg/kg Q2W After loading: After loading: 19.9 5.3-52.0
[0054] Avelumab dosing regimen Nos. 1-2, 4-5, 11-16 in Table 6, and
ranges within these regimens such as 5-10 mg/kg Q1W, 11-20 mg/kg
Q2W, 5-20 mg/kg Q1W for 6-12 weeks followed by 10 mg/kg Q2W,
provide an expected median C.sub.trough above the current 10 mg/kg
Q2W dosing regimen, and could advantageously provide a better
probability of ORR (see, Examples 1-3). From Examples 1-3, a mean
C.sub.trough of 44-85 ug/mL corresponds to about 50% of ORR
respectively. Thus, dosing regimens that provide a mean
C.sub.trough of over 44 ug/mL could advantageously provide a higher
probability of ORR in patients with solid tumors. As such, dosing
regimen 1-2, 5 and 11-16 shown in Table 6, or ranges therein, such
as 5-10 mg/kg Q1W, 5-20 mg/kg Q1W for 6 or 12 weeks followed by 10
mg/kg Q2W, are advantageous for treatment of solid tumor types.
Other advantageous dosing regimens to treat solid tumor include
avelumab dosing regimen Nos. 2, 12-13 and 15-16 and the ranges
within these regimens such as 10 mg-20 mg/kg Q1W for 6 or 12 weeks
followed by 10 mg/kg Q2W, all of which corresponding to a median
C.sub.trough of about or more than 85 ug/mL. Other advantageous
avelumab dosing regimens include dosing regimen Nos. 1-2, 5, 11-12
and 14-15 shown in Table 6, and ranges within these regimens such
as, for example, 5-10 mg/kg Q1W, 5-10 mg/kg Q1W for 6 or 12 weeks
followed by 10 mg/kg Q2W, all of which correspond to a median
C.sub.trough between about 44 ug/mL and about 85 ug/mL in solid
tumors. Exemplary solid tumor types suitable for treatment with the
avelumab dosing regimens provided herein include, without
limitation, MCC, NSCLC, RCC, bladder cancer, ovarian cancer, head
and neck cancer, gastric cancer, mesothelioma, urothelial
carcinoma, breast cancer, adenocarcinoma of the stomach and
thymoma.
Example 5
Modeling of Safety and Efficacy for the 800 mg Q2W Dosing in
Comparison with the 10 mg/kg Q2W Dosing
[0055] The clinical profile of avelumab has been evaluated from
data in more than 1800 subjects in ongoing Phase I, II, and III
trials in adult subjects with various solid tumors. The clinical
pharmacology results are obtained from 1827 subjects from three
studies with PK information available as of Jun. 9, 2016 (studies
EMR100070-001 and EMR100070-003) and Nov. 20, 2015 (study
EMR100070-002).
[0056] Exposure Metrics.
[0057] Based on the clinical pharmacology results of these more
than 1800 subjects mentioned above, 10000 and 4000 simulated
subjects were generated using the PK CYCLE model and PK SS model
respectively to project the avelumab exposure metrics of AUC,
C.sub.though and C.sub.max for both the 10 mg/kg Q2W dosing and the
800 mg Q2W dosing. Where PK CYCLE model represents the PK model
generated using PK data from the first dose of avelumab and PK SS
model represents the PK model generated using PK data after
repeated dosing of avelumab. Such projected exposure metrics were
then used in the below Exposure-efficacy correlation and
Exposure-safety correlation simulation. The distribution plot of
such projected avelumab AUC.sub.0-336 are shown in FIG. 4A, FIG.
4B, FIG. 5A and FIG. 5B. The plots depicted in FIG. 4A and FIG. 4B
show that the simulated values of AUC.sub.0-336 have a close
correspondence between the two dosing regimens. The graphs in FIG.
5A and FIG. 5B show that the total variability of avelumab
AUC.sub.0-336 is lower in the 800 mg Q2W regimen than the 10 mg/kg
Q2W regimen.
[0058] Exposure--Efficacy Correlation and Exposure--Safety
Correlation.
[0059] A univariate logistic regression model has been developed to
describe the exposure--best overall response (BOR) relationship for
the n=88 observed subjects with mMCC. The exposure values that were
used for developing the logistic regression model were simulated
from the PK CYCLE and PK SS models. Four hundred sets of parameter
estimates were sampled from the uncertainty distribution of the
exposure-BOR logistic regression model. For each of these 400
parameter sets, 2500 subjects were sampled from the mMCC population
of the n=10000 subjects simulated based on the PK CYCLE and PK SS
models. The mean predicted probability of response (across the
n=2500 simulated subjects) was then obtained for each of the 400
sets of logistic model parameter estimates.
[0060] The same procedure was followed for the UC indication, with
n=153 observed subjects with UC.
[0061] The results are summarized in the graphs shown in FIG. 6 and
FIG. 7. The graph in FIG. 6 shows the probability of BOR in
individual simulated patients with mMCC have large overlap between,
and are similar for the 10 mg/kg Q2W and the 800 mg Q2W dosing
regimens. The graph in FIG. 7 shows that the mean probability of
BOR is very similar between the 10 mg/kg Q2W and 800 mg Q2W dosing
regimens for the UC with a lower variability for the 800 mg Q2W
dosing.
[0062] Exposure--safety correlation was modelled similarly using
the safety variables immune related AE of any grade (irAE) and
infusion related reactions (IRR). The results are shown in FIG. 8A,
FIG. 8B, FIG. 9A and FIG. 9B. The graphs depicted in FIG. 8A and
FIG. 8B show very similar probability of experiencing an irAE
between the two dosing regimens. The graphs depicted in FIG. 9A and
FIG. 9B show that the 800 mg Q2W dosing regimen tends to have a
lower variability comparing to the 10 mg/kg Q2W dosing.
Sequence CWU 1
1
1015PRTArtificial SequenceSynthetic Consruct 1Ser Tyr Ile Met Met1
5211PRTArtificial SequenceSynthetic Construct 2Ser Ile Tyr Pro Ser
Gly Gly Ile Thr Phe Tyr1 5 10311PRTArtificial SequenceSynthetic
Construct 3Ile Lys Leu Gly Thr Val Thr Thr Val Asp Tyr1 5
10414PRTArtificial SequenceSynthetic Construct 4Thr Gly Thr Ser Ser
Asp Val Gly Gly Tyr Asn Tyr Val Ser1 5 1057PRTArtificial
SequenceSynthetic Construct 5Asp Val Ser Asn Arg Pro Ser1
5610PRTArtificial SequenceSynthetic Construct 6Ser Ser Tyr Thr Ser
Ser Ser Thr Arg Val1 5 107118PRTArtificial SequenceSynthetic
Construct 7Glu Val Gln Leu Leu 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 30Ile Met Met Trp Val Arg Gln Ala Pro Gly Lys Gly
Leu Glu Trp Val 35 40 45Ser Ser Ile Tyr Pro Ser Gly Gly Ile Thr Phe
Tyr Ala Asp Lys Gly 50 55 60Arg Phe Thr Ile Ser Arg Asp Asn Ser Lys
Asn Thr Leu Tyr Leu Gln65 70 75 80Met Asn Ser Leu Arg Ala Glu Asp
Thr Ala Val Tyr Tyr Cys Ala Arg 85 90 95Ile Lys Leu Gly Thr Val Thr
Thr Val Asp Tyr Trp Gly Gln Gly Thr 100 105 110Leu Val Thr Val Ser
Ser 1158110PRTArtificial SequenceSynthetic Construct 8Gln Ser Ala
Leu Thr Gln Pro Ala Ser Val Ser Gly Ser Pro Gly Gln1 5 10 15Ser Ile
Thr Ile Ser Cys Thr Gly Thr Ser Ser Asp Val Gly Gly Tyr 20 25 30Asn
Tyr Val Ser Trp Tyr Gln Gln His Pro Gly Lys Ala Pro Lys Leu 35 40
45Met Ile Tyr Asp Val Ser Asn Arg Pro Ser Gly Val Ser Asn Arg Phe
50 55 60Ser Gly Ser Lys Ser Gly Asn Thr Ala Ser Leu Thr Ile Ser Gly
Leu65 70 75 80Gln Ala Glu Asp Glu Ala Asp Tyr Tyr Cys Ser Ser Tyr
Thr Ser Ser 85 90 95Ser Thr Arg Val Phe Gly Thr Gly Thr Lys Val Thr
Val Leu 100 105 1109450PRTArtificial SequenceSynthetic Construct
9Glu Val Gln Leu Leu 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 30Ile Met Met Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu
Trp Val 35 40 45Ser Ser Ile Tyr Pro Ser Gly Gly Ile Thr Phe Tyr Ala
Asp Thr 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 Arg Ile Lys Leu Gly Thr Val Thr
Thr Val Asp Tyr Trp Gly Gln 100 105 110Gly Thr Leu Val Thr Val Ser
Ser Ala Ser Thr Lys Gly Pro Ser Val 115 120 125Phe Pro Leu Ala Pro
Ser Ser Lys Ser Thr Ser Gly Gly Thr Ala Ala 130 135 140Leu Gly Cys
Leu Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val Ser145 150 155
160Trp Asn Ser Gly Ala Leu Thr Ser Gly Val His Thr Phe Pro Ala Val
165 170 175Leu Gln Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val Val Thr
Val Pro 180 185 190Ser Ser Ser Leu Gly Thr Gln Thr Tyr Ile Cys Asn
Val Asn His Lys 195 200 205Pro Ser Asn Thr Lys Val Asp Lys Lys Val
Glu 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 45010216PRTArtificial
SequenceSynthetic Construct 10Gln Ser Ala Leu Thr Gln Pro Ala Ser
Val Ser Gly Ser Pro Gly Gln1 5 10 15Ser Ile Thr Ile Ser Cys Thr Gly
Thr Ser Ser Asp Val Gly Gly Tyr 20 25 30Asn Tyr Val Ser Trp Tyr Gln
Gln His Pro Gly Lys Ala Pro Lys Leu 35 40 45Met Ile Tyr Asp Val Ser
Asn Arg Pro Ser Gly Val Ser Asn Arg Phe 50 55 60Ser Gly Ser Lys Ser
Gly Asn Thr Ala Ser Leu Thr Ile Ser Gly Leu65 70 75 80Gln Ala Glu
Asp Glu Ala Asp Tyr Tyr Cys Ser Ser Tyr Thr Ser Ser 85 90 95Ser Thr
Arg Val Phe Gly Thr Gly Thr Lys Val Thr Val Leu Gly Gln 100 105
110Pro Lys Ala Asn Pro Thr Val Thr Leu Phe Pro Pro Ser Ser Glu Glu
115 120 125Leu Gln Ala Asn Lys Ala Thr Leu Val Cys Leu Ile Ser Asp
Phe Tyr 130 135 140Pro Gly Ala Val Thr Val Ala Trp Lys Ala Asp Gly
Ser Pro Val Lys145 150 155 160Ala Gly Val Glu Thr Thr Lys Pro Ser
Lys Gln Ser Asn Asn Lys Tyr 165 170 175Ala Ala Ser Ser Tyr Leu Ser
Leu Thr Pro Glu Gln Trp Lys Ser His 180 185 190Arg Ser Tyr Ser Cys
Gln Val Thr His Glu Gly Ser Thr Val Glu Lys 195 200 205Thr Val Ala
Pro Thr Glu Cys Ser 210 215
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