TWI472339B - 包含結合至ｈｅｒ２結構域ii之抗體及其酸性變異體的組合物 - Google Patents
包含結合至ｈｅｒ２結構域ii之抗體及其酸性變異體的組合物 Download PDFInfo
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Description
本發明係關於一種組合物，其包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體。本發明亦係關於包含該組合物之醫藥調配物及該組合物之治療性用途。
本申請案主張2008年1月30日申請之美國臨時專利申請案第61/024825號之權益，該案之揭示內容係以引用的方式全部併入本文中用於所有目的。
受體酪胺酸激酶之HER家族為細胞生長、分化及存活之重要介體。該受體家族包括四個不同成員，包括表皮生長因子受體(EGFR、ErbB1或HER1)、HER2(ErbB2或p185 neu
)、HER3(ErbB3)及HER4(ErbB4或tyro2)。
由erb
B1基因編碼之EGFR與人類惡性腫瘤有因果關係。詳言之，已在乳癌、膀胱癌、肺癌、頭部癌症、頸部癌症及胃癌以及神經膠母細胞瘤中觀察到EGFR之表現增加。EGFR受體表現之增加通常係與由相同腫瘤細胞產生增加之EGFR配體轉型生長因子α(TGF-α)從而導致由自體分泌刺激路徑活化受體相關。Baselga及MendelsohnPharmac. Ther.
64:127-154(1994)。針對EGFR或其配體TGF-α及EGF之單株抗體已在該等惡性腫瘤之治療中作為治療劑而被評估。參見(例如)Baselga及Mendelsohn.，同上述；Masui等人，Cancer Research
44:1002-1007(1984)；及Wu等人，J
. Clin. Invest.
95:1897-1905(1995)。
HER家族之第二成員p185 neu
最初被鑑別為來自經化學處理之大鼠之神經母細胞瘤的轉型基因之產物。neu
原癌基因之活化形式係由編碼蛋白之跨膜區中的點突變(纈胺酸突變為麩胺酸)產生。在乳癌及卵巢癌中觀察到人類neu
同源物之擴增，且其與不良預後有關(Slamon等人，Science
,235:177-182(1987)；Slamon等人，Science
,244:707-712(1989)；及美國專利第4,968,603號)。迄今為止，對於人類腫瘤，未曾報導過類似於neu
原癌基因中點突變之點突變。在包括胃癌瘤、子宮內膜癌、唾液腺癌、肺癌、腎癌、結腸癌、甲狀腺癌、胰腺癌及膀胱癌之其他癌瘤中亦已觀察到HER2之過度表現(時常但並非一律係歸因於基因擴增)。尤其參見King等人，Science
,229:974(1985)；Yokota等人，Lancet
:1:765-767(1986)；Fukushige等人，Mol Cell Biol
.,6:955-958(1986)；Guerin等人，Oncogene Res
.,3:21-31(1988)；Cohen等人，Oncogene
,4:81-88(1989)；Yonemura等人，Cancer Res
.,51:1034(1991)；Borst等人，Gynecol
.Oncol
.,38:364(1990)；Weiner等人，Cancer Res
.,50:421-425(1990)；Kern等人，Cancer Res
.,50:5184(1990)；Park等人，Cancer Res
.,49:6605(1989)；Zhau等人，Mol
.Carcinog
.,3:254-257(1990)；Aasland等人，Br
.J. Cancer
57:358-363(1988)；Williams等人，Pathobiology
59:46-52(1991)；及McCann等人，Cancer
,65:88-92(1990)。HER2可能在前列腺癌中過度表現(Gu等人，Cancer Lett
. 99:185-9(1996)；Ross等人，Hum
.Pathol
. 28:827-33(1997)；Ross等人，Cancer
79:2162-70(1997)；及Sadasivan等人，J
.Urol
. 150:126-31(1993))。
已描述針對大鼠p185 neu
及人類HER2蛋白產物之抗體。Drebin及同事已製備針對大鼠neu
基因產物p185 neu
之抗體。參見(例如)Drebin等人，Cell
41:695-706(1985)；Myers等人，Meth
.Enzym
. 198:277-290(1991)；及WO 94/22478。Drebin等人，Oncogene
2:273-277(1988)報導可與p185 neu
之兩個不同區域起反應之抗體混合物對植入裸小鼠中之neu
轉型NIH-3T3細胞產生協同抗腫瘤作用。亦參見1998年10月20日頒布之美國專利5,824,311。
Hudziak等人，Mol
.Cell
.Biol
. 9(3):1165-1172(1989)描述已使用人類乳腺腫瘤細胞株SK-BR-3表徵之一組HER2抗體的產生。SK-BR-3細胞繼暴露於抗體之後的相對細胞增殖係在72小時後藉由單層結晶紫染色來測定。使用該檢定，由稱為4D5之抗體獲得最大抑制，其中該抗體將細胞增殖抑制56%。在該檢定中，該組抗體中之其他抗體在較小程度上減少細胞增殖。此外，發現抗體4D5可使過度表現HER2之乳腺腫瘤細胞株對TNF-α之細胞毒性作用敏感。亦參見1997年10月14日頒布之美國專利第5,677,171號。Hudziak等人所論述之HER2抗體在以下文獻中被進一步表徵：Fendly等人，Cancer Research
50:1550-1558(1990)；Kotts等人，In Vitro
26(3):59A(1990)；Sarup等人，Growth Regulation
1:72-82(1991)；Shepard等人，J
.Clin
.Immunol
. 11(3):117-127(1991)；Kumar等人，Mol
.Cell
.Biol
. 11(2):979-986(1991)；Lewis等人，Cancer Immunol
.Immunother
. 37:255-263(1993)；Pietras等人，Oncogene
9:1829-1838(1994)；Vitetta等人，Cancer Research
54:5301-5309(1994)；Sliwkowski等人，J
.Biol
.Chem
. 269(20):14661-14665(1994)；Scott等人，J
.Biol
.Chem
. 266:14300-5(1991)；D'souza等人，Proc
.Natl
.Acad
.Sci
. 91:7202-7206(1994)；Lewis等人，Cancer Research
56:1457-1465(1996)；及Schaefer等人，Oncogene
15:1385-1394(1997)。
鼠類HER2抗體4D5之重組人類化變型(huMAb4D5-8、rhuMAb HER2、曲妥珠單抗(Trastuzumab)或赫賽汀(HERCEPTIN)；美國專利第5,821,337號)在患有過度表現HER2之轉移性乳癌且已接受廣泛之先前抗癌療法的患者中具有臨床活性(Baselga等人，J
.Clin
.Oncol
. 14:737-744(1996))。曲妥珠單抗在1998年9月25日獲食品及藥物管理局(Food and Drug Administration)批准銷售以用於治療患有轉移性乳癌且腫瘤過度表現HER2蛋白之患者。
已在以下文獻中描述具有各種特性之其他HER2抗體：Tagliabue等人，Int
.J
.Cancer
47:933-937(1991)；McKenzie等人，Oncogene
4:543-548(1989)；Maier等人，Cancer Res
. 51:5361-5369(1991)；Bacus等人，Molecular Carcinogenesis
3:350-362(1990)；Stancovski等人，PNAS (USA)
88:8691-8695(1991)；Bacus等人，Cancer Research
52:2580-2589(1992)；Xu等人，Int. J. Cancer
53:401-408(1993)；WO 94/00136；Kasprzyk等人，Cancer Research
52:2771-2776(1992)；Hancock等人，Cancer Res.
51:4575-4580(1991)；Shawver等人，Cancer Res.
54:1367-1373(1994)；Arteaga等人，Cancer Res.
54:3758-3765(1994)；Harwerth等人，J. Biol. Chem.
267:15160-15167(1992)；美國專利第5,783,186號；及Klapper等人，Oncogene
14:2099-2109(1997)。
同源性篩選已使得可鑑別兩種其他HER受體家族成員：HER3(美國專利第5,183,884號及第5,480,968號，以及Kraus等人，PNAS(USA)
86:9193-9197(1989))及HER4(歐洲專利申請案第599,274號；Plowman等人，Proc. Natl. Acad. Sci. USA
,90:1746-1750(1993)；及Plowman等人，Nature
,366:473-475(1993))。該兩種受體均在至少一些乳癌細胞株上呈現表現增加。
通常在細胞中發現呈各種組合之HER受體，且認為雜二聚化使對各種HER配體之細胞反應之多樣性增加(Earp等人，Breast Cancer Research and Treatment
35:115-132(1995))。EGFR被以下六種不同之配體所結合：表皮生長因子(EGF)、轉型生長因子α(TGF-α)、雙調蛋白(amphiregulin)、肝素結合表皮生長因子(HB-EGF)、β細胞調節素(betacellulin)及表皮調節素(epiregulin)(Groenen等人，Growth Factors
11:235-257(1994))。由單一基因之替代性拼接產生的和瑞古林(heregulin)蛋白家族為HER3及HER4之配體。和瑞古林家族包括α、β及γ和瑞古林(Holmes等人，Science
,256:1205-1210(1992)；美國專利第5,641,869號；及Schaefer等人，Oncogene
15:1385-1394(1997))；neu
分化因子(NDF)；神經膠質生長因子(GGF)；乙醯膽鹼受體活性誘導蛋白(acetylcholine receptor inducing activity，ARIA)；以及感覺及運動神經元衍生因子(SMDF)。關於綜述，參見Groenen等人，Growth Factors
11:235-257(1994)；Lemke,G.Molec
.& Cell
.Neurosci
. 7:247-262(1996)及Lee等人，Pharm
.Rev
. 47:51-85(1995)。近來鑑別出三種其他HER配體：經報導結合HER3或HER4之神經調節蛋白-2(NRG-2)(Chang等人，Nature
387509-512(1997)；及Carraway等人，Nature
387:512-516(1997))、結合HER4之神經調節蛋白-3(Zhang等人，PNAS
(USA)94(18):9562-7(1997))及結合HER4之神經調節蛋白-4(Harari等人，Oncogene
18:2681-89(1999))，HB-EGF、β細胞調節素及表皮調節素亦與HER4結合。
雖然EGF及TGFα不結合HER2，但EGF刺激EGFR及HER2形成雜二聚體，此可活化EGFR且使雜二聚體中之HER2轉磷酸化。二聚化及/或轉磷酸化似乎活化HER2酪胺酸激酶。參見Earp等人，同上述。同樣，當HER3與HER2共表現時，形成活性信號傳導複合物，且針對HER2之抗體能夠破壞該複合物(Sliwkowski等人，J
.Biol
.Chem
.,269(20):14661-14665(1994))。此外，當與HER2共表現時，HER3對和瑞古林(HRG)之親和力增加至較高親和力狀態。關於HER2-HER3蛋白複合物，亦參見Levi等人，Journal of Neuroscience
15:1329-1340(1995)；Morrissey等人，Proc
.Natl
.Acad
.Sci
.USA
92:1431-1435(1995)；及Lewis等人，Cancer Res
.,56:1457-1465(1996)。HER4如同HER3與HER2形成活性信號傳導複合物(Carraway及Cantley,Cell
78:5-8(1994))。
為靶向HER信號傳導路徑，rhuMAb 2C4(帕妥珠單抗，Pertuzumab)已作為人類化抗體而被開發，其抑制HER2與其他HER受體之二聚化，從而抑制配體驅動之磷酸化及活化以及下游RAS及AKT路徑之活化。在帕妥珠單抗作為單一藥劑用於治療實體腫瘤之I期試驗中，以帕妥珠單抗治療3位患有晚期卵巢癌之個體。一位個體具有持久之部分反應，且另一個體在15週內病情穩定。Agus等人，Proc Am Soc Clin onc
ol
22:192，摘要771(2003)。
美國專利第6,339,142號描述一種HER2抗體組合物，其包含抗HER2抗體與其一或多種酸性變異體之混合物，其中酸性變異體之量小於約25%。曲妥珠單抗為例示性HER2抗體。
Reid等人於Well Characterized Biotech Pharmaceuticals Conference(2003年1月)上所呈現之海報：Effects of Cell Culture Process Changes on Humanized Antibody Characteristics描述一種未命名之人類化IgG1抗體組合物，其由於在其重鏈上存在VHS信號肽、N末端麩胺醯胺與焦麩胺酸之組合而具有N末端異質性。
Harris等人，於IBC Antibody Production Conference(2002年2月)上所呈現之The Ideal Chromatographic Antibody Characterization Method海報報導E25(一種人類化抗IgE抗體)重鏈上之VHS延伸。
Rouse等人，於WCBP上所呈現之海報："Top Down"Glycoprotein Characterization by High Resolution Mass Spectrometry and Its Application to Biopharmaceutical Development(2004年1月6日至9日)描述一種單株抗體組合物，其具有由其輕鏈上之-3
AHS或-2
HS信號肽殘基所產生的N末端異質性。
在IBC會議(2000年9月)上之呈文：Strategic Use of Comparability Studies and Assays for Well Characterized Biologicals中，Jill Porter論述一種遲溶離形式之ZENAPAX(於其重鏈上具有三個額外胺基酸殘基)。
US 2006/0018899描述一種組合物，其包含主要種類之帕妥珠單抗抗體及胺基末端前導序列延伸(leader extension)變異體以及帕妥珠單抗抗體之其他變異體形式。
根據第一態樣，本發明係關於一種組合物，其包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體，其中該等酸性變異體包括糖化變異體、二硫鍵還原變異體或非可還原變異體。酸性變異體較佳包括糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體。酸性變異體之量小於約25%較適宜。
在另一態樣中，本發明提供一種組合物，其包含包括分別示於SEQ ID No:3及4中之可變輕鏈及可變重鏈序列的主要種類之HER2抗體及該主要種類之抗體之酸性變異體，其中該等酸性變異體包括糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體。本發明亦係關於醫藥調配物，其在醫藥學上可接受之載劑中包含該等組合物。
此外，本發明係關於一種治療患者之HER2陽性癌症之方法，其包含向該患者投與可有效治療該癌症之量的醫藥調配物。關於如本文實例中所展示之該等方法，主要種類之抗體及酸性變異體較佳具有基本上相同之藥物動力學概況。
在另一態樣中，本發明係關於一種製備醫藥組合物之方法，其包含：(1)製備包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體的組合物，該等酸性變異體包括糖化變異體、二硫鍵還原變異體或非可還原變異體，及(2)評估該組合物中之該等酸性變異體，及確定其量小於約25%。在一實施例中，藉由選自由以下方法組成之群的方法來評估酸性變異體：離子交換層析法，其中以唾液酸酶處理組合物；利用十二烷基硫酸鈉之還原毛細管電泳(CE-SDS)；非還原CE-SDS；硼酸鹽層析法；及肽圖譜(peptide mapping)。
本文中之術語主要種類之抗體係指在一組合物中作為該組合物中數量佔優勢之抗體分子的抗體胺基酸序列結構。主要種類之抗體較佳為HER2抗體，諸如結合至HER2結構域II之抗體、與曲妥珠單抗相比更有效抑制HER二聚化之抗體及/或結合至HER2之雜二聚結合位點之抗體。在本文中，主要種類之抗體之較佳實施例為包含SEQ ID No:3及4中之可變輕鏈及可變重鏈胺基酸序列之抗體，且最佳為包含SEQ ID No:15及16中之輕鏈及重鏈胺基酸序列之抗體(帕妥珠單抗)。
本文中之胺基酸序列變異抗體為一種具有不同於主要種類之抗體之胺基酸序列的抗體。通常，胺基酸序列變異體將與主要種類之抗體具有至少約70%同源性，且較佳其將與主要種類之抗體至少約80%同源，且更佳為至少約90%同源。胺基酸序列變異體在主要種類之抗體之胺基酸序列內或鄰近於主要種類之抗體之胺基酸序列的某些位置處具有取代、缺失及/或添加。本文中之胺基酸序列變異體之實例包括酸性變異體(例如去醯胺化抗體變異體)、鹼性變異體、於一或兩條輕鏈上具有胺基末端前導序列延伸(例如VHS-)之抗體、於一或兩條重鏈上具有C末端離胺酸殘基之抗體、具有一或多個經氧化甲硫胺酸殘基之抗體等，且包括重鏈及/或輕鏈胺基酸序列之變異之組合。
酸性變異體為主要種類之抗體的比主要種類之抗體更具酸性的變異體。相對於主要種類之抗體，酸性變異體獲得負電荷或失去正電荷。可使用分離方法(諸如根據電荷分離蛋白質之離子交換層析法)來解析該等酸性變異體。在藉由陽離子交換層析法分離之後，主要種類之抗體之酸性變異體比主峰先溶離。
二硫鍵還原變異體具有一個以上以化學方式還原為游離硫醇形式之二硫鍵鍵結半胱胺酸。該變異體可藉由疏水相互作用層析法或藉由大小篩分法(諸如利用十二烷基硫酸鈉之毛細管電泳(CE-SDS))，例如如實例1中所述來監測。在本文中，非可還原變異體為主要種類之抗體不能藉由以諸如二硫蘇糖醇之還原劑處理而化學還原為重鏈及輕鏈的變異體。該等變異體可藉由以還原劑處理組合物且使用可評估蛋白質大小之方法(諸如利用十二烷基硫酸鈉之毛細管電泳(CE-SDS)，例如使用下文實例1中所述之技術)評估所得組合物來評估。
本文中之糖基化變異抗體為一種連接有一或多個碳水化合物部分且該(等)碳水化合物部分不同於一或多個與主要種類之抗體連接之碳水化合物部分的抗體。本文中之糖基化變異體之實例包括具有與Fc區連接之G1或G2寡醣結構替代G0寡醣結構的抗體、具有與一或兩條輕鏈連接之一或兩個碳水化合物部分的抗體、無碳水化合物與抗體之一或兩條重鏈連接的抗體、經唾液酸化之抗體等，以及該等糖基化變化之組合。
在抗體具有Fc區時，諸如本文中圖14所示之寡醣結構的寡醣結構可與抗體之一或兩條重鏈(例如)在殘基299處連接。對於帕妥珠單抗而言，G0為主要寡醣結構，而其他寡醣結構(諸如G0-F、G-1、Man5、Man6、G1-1、G1(1-6)、G1(1-3)及G2)在帕妥珠單抗組合物中以較小量存在。
除非另外指出，否則本文中之G1寡醣結構包括G1(1-6)及G1(1-3)結構。
出於本文之目的，唾液酸化變異體為主要種類之抗體的包含一或多個與其一或兩條重鏈連接之唾液酸化碳水化合物部分的變異體。唾液酸化變異體可藉由在有或無唾液酸酶處理之情況下評估組合物(例如藉由離子交換層析法)，例如如實例中所述來鑑別。
糖化變異體為已共價連接有糖(諸如葡萄糖)之抗體。可藉由使葡萄糖與蛋白質上之離胺酸殘基反應(例如在細胞培養基中)來進行該添加。糖化變異體可藉由以質譜術分析還原抗體從而評估重鏈或輕鏈質量之增加來鑑別。糖化變異體亦可藉由酸鹽層析法，如下文實例1所述來定量。糖化變異體不同於糖基化變異體。
去醯胺化抗體為一或多個天冬醯胺殘基已被衍生為(例如)天冬胺酸、丁二醯亞胺或異天冬胺酸之抗體。去醯胺化抗體之一實例為帕妥珠單抗變異體，其中帕妥珠單抗之一或兩條重鏈上之Asn-386及/或Asn-391被去醯胺化。
本文中之胺基末端前導序列延伸變異體係指一種如下主要種類之抗體，其在該主要種類之抗體之任何一或多條重鏈或輕鏈的胺基末端處具有胺基末端前導序列之一或多個胺基酸殘基。例示性胺基末端前導序列延伸包含存在於抗體變異體之一或兩條輕鏈上的三個胺基酸殘基VHS或由存在於抗體變異體之一或兩條輕鏈上的三個胺基酸殘基VHS組成。
同源性係定義為在比對序列及引入間隙(若必要時)以達成最大同源性百分比之後在胺基酸序列變異體中一致之殘基的百分比。用於比對之方法及電腦程式在此項技術中係熟知的。一種此類電腦程式為由Genentech,Inc.設計之"Align 2"，其於1991年12月10日與使用者文件一起備案於the United States Copyright Office,Washington,DC 20559中。
出於本文之目的，陽離子交換分析係指基於電荷差異使用陽離子交換劑來分離包含兩種或兩種以上化合物之組合物所用的任何方法。陽離子交換劑通常包含共價鍵結、帶負電之基團。本文中之陽離子交換劑較佳為弱陽離子交換劑，且/或包含羧酸鹽官能基，諸如PROPAC WCX-10TM
陽離子交換管柱(由Dionex出售)。
HER受體為屬於HER受體家族之受體蛋白酪胺酸激酶，且包括EGFR、HER2、HER3及HER4受體以及該家族中有待將來鑑別之其他成員。HER受體通常將包含可結合HER配體之胞外結構域；親脂性跨膜結構域；保守細胞內酪胺酸激酶結構域；及具有若干個可被磷酸化之酪胺酸殘基的羧基末端信號傳導結構域。HER受體較佳為天然序列人類HER受體。
HER2之胞外結構域包含四個結構域，亦即結構域I(約1-195之胺基酸殘基)、結構域II(約196-319之胺基酸殘基)、結構域III(約320-488之胺基酸殘基)及結構域IV(約489-630之胺基酸殘基)(在無信號肽之情況下的殘基編號)。參見Garrett等人，Mol. Cell.,
11:495-505(2003)；Cho等人，Nature
421:756-760(2003)；Franklin等人，Cancer Cell
5:317-328(2004)；或Plowman等人，Proc. Natl. Acad. Sci.
90:1746-1750(1993)。亦參見本文中之圖1。
術語ErbB1、"HER1"、表皮生長因子受體及EGFR在本文中可互換使用，且係指如(例如)Carpenter等人，Ann. Rev. Biochem.
56:881-914(1987)中所揭示之EGFR，包括其天然存在之突變體形式(例如Humphrey等人，PNAS(USA)
87:4207-4211(1990)中之缺失突變體EGFR)。erb
B1係指編碼EGFR蛋白產物之基因。
表述"ErbB2"及"HER2"在本文中可互換使用且係指(例如)Semba等人，PNAS(USA)
82:6497-6501(1985)及Yamamoto等人，Nature
319:230-234(1986)中所述之人類HER2蛋白(Genebank寄存編號X03363)。術語"erb
B2"係指編碼人類ErbB2之基因且neu
係指編碼大鼠p185 neu
之基因。較佳HER2為天然序列人類HER2。
"ErbB3"及"HER3"係指如(例如)美國專利第5,183,884號及第5,480,968號以及Kraus等人，PNAS(USA)
86:9193-9197(1989)中所揭示之受體多肽。
本文中之術語"ErbB4"及"HER4"係指如(例如)歐洲專利申請案第599,274號；Plowman等人，Proc. Natl. Acad. Sci. USA
,90:1746-1750(1993)；及Plowman等人，Nature,
366:473-475(1993)中所揭示之受體多肽，包括其同功異型物，例如1999年4月22日公開之WO 99/19488中所揭示。
HER配體意謂結合至HER受體且/或活化HER受體之多肽。本文中備受關注之HER配體為天然序列人類HER配體，諸如表皮生長因子(EGF)(Savage等人，J. Biol. Chem.
247:7612-7621(1972))；轉型生長因子α(TGF-α)(Marquardt等人，Science
223:1079-1082(1984))；雙調蛋白，亦稱為許旺氏瘤(schwanoma)或角質細胞自體分泌生長因子(Shoyab等人，Science
243:1074-1076(1989)；Kimura等人，Nature
348:257-260(1990)；及Cook等人，Mol. Cell. Biol.
11:2547-2557(1991))；β細胞調節素(Shing等人，Science
259:1604-1607(1993)；及Sasada等人，Biochem. Biophys. Res. Commun.
190:1173(1993))；肝素結合表皮生長因子(HB-EGF)(Higashiyama等人，Science
251:936-939(1991))；表皮調節素(Toyoda等人，J. Biol. Chem.
270:7495-7500(1995)；及Komurasaki等人，Oncogene
15:2841-2848(1997))；和瑞古林(參見下文)；神經調節蛋白-2(NRG-2)(Carraway等人，Nature
387:512-516(1997))；神經調節蛋白-3(NRG-3)(Zhang等人，Proc. Natl. Acad. Sci
. 94:9562-9567(1997))；神經調節蛋白-4(NRG-4)(Harari等人，Oncogene
18:2681-89(1999))或cripto(CR-1)(Kannan等人，J
.Biol
.Chem
. 272(6):3330-3335(1997))。結合EGFR之HER配體包括EGF、TGF-α、雙調蛋白、β細胞調節素、HB-EGF及表皮調節素。結合HER3之HER配體包括和瑞古林。能夠結合HER4之HER配體包括β細胞調節素、表皮調節素、HB-EGF、NRG-2、NRG-3、NRG-4及和瑞古林。
"和瑞古林"(HRG)在本文中使用時係指由和瑞古林基因產物編碼之多肽，如美國專利第5,641,869號或Marchionni等人，Nature
,362:312-318(1993)中所揭示。和瑞古林之實例包括和瑞古林-α、和瑞古林-β1、和瑞古林-β2及和瑞古林-β3(Holmes等人，Science
,256:1205-1210(1992)；及美國專利第5,641,869號)；neu
分化因子(NDF)(Peles等人，Cell
69:205-216(1992))；乙醯膽鹼受體活性誘導蛋白(acetylcholine receptor-inducing activity，ARIA)(Falls等人，Cell
72:801-815(1993))；神經膠質生長因子(GGF)(Marchionni等人，Nature
,362:312-318(1993))；感覺及運動神經元衍生因子(SMDF)(Ho等人，J
.Biol
.Chem
. 270:14523-14532(1995))；γ-和瑞古林(Schaefer等人，Oncogene
15:1385-1394(1997))。該術語包括天然序列HRG多肽之生物學活性片段及/或胺基酸序列變異體，諸如其EGF樣結構域片段(例如HRGβ1177-244
)。
本文中之"HER二聚體"為包含至少兩種不同HER受體之非共價結合的二聚體。該等複合物可在表現兩種或兩種以上HER受體之細胞暴露於HER配體時形成，且可藉由免疫沈澱法來分離並藉由SDS-PAGE加以分析，例如如Sliwkowski等人，J. Biol. Chem.
,269(20):14661-14665(1994)中所述。該等HER二聚體之實例包括EGFR-HER2、HER2-HER3及HER3-HER4雜二聚體。此外，HER二聚體可包含兩種或兩種以上與不同HER受體(諸如HER3、HER4或EGFR)組合之HER2受體。其他蛋白質(諸如細胞激素受體亞單位，例如gp130)可與該二聚體結合。
HER2上之雜二聚結合位點係指在EGFR、HER3或HER4與HER2形成二聚體之後，HER2胞外結構域中與EGFR、HER3或HER4之胞外結構域中之區域接觸或接合的區域。該區域見於HER2之結構域II中。Franklin等人，Cancer Cell
5:317-328(2004)。
HER活化或HER2活化係指任何一或多種HER受體或HER2受體之活化或磷酸化。一般而言，HER活化引起信號傳導(例如，由磷酸化HER受體或受質多肽中之酪胺酸殘基的HER受體之細胞內激酶結構域引起的信號傳導)。HER活化可由結合至包含所關注HER受體之HER二聚體的HER配體介導。結合至HER二聚體之HER配體可活化二聚體中之一或多種HER受體之激酶結構域，且由此引起一或多種HER受體中酪胺酸殘基之磷酸化及/或其他受質多肽(諸如Akt或MAPK細胞內激酶)中酪胺酸殘基之磷酸化。
本文中之術語"抗體"係在最廣泛意義上加以使用且具體涵蓋完整單株抗體、多株抗體、由至少兩個完整抗體形成之多特異性抗體(例如雙特異性抗體)及抗體片段，只要其展現所需生物學活性即可。
如本文中所使用之術語"單株抗體"係指自一群大體上均質之抗體獲得之抗體，亦即構成該群之個別抗體除可在產生單株抗體期間產生之可能變異體(諸如本文所述之彼等變異體)以外為相同的且/或結合相同抗原決定基。與通常包括針對不同決定子(抗原決定基)之不同抗體的多株抗體製劑對比，各單株抗體係針對抗原上之單一決定子。除其特異性以外，單株抗體之有利之處亦在於其未經其他免疫球蛋白污染。修飾語"單株"指示抗體係由一群大體上均質之抗體獲得之特徵，且不應被理解為需要藉由任何特定方法來產生抗體。舉例而言，根據本發明有待使用之單株抗體可藉由最先由Kohler等人，Nature
,256:495(1975)描述之融合瘤方法來製備，或可藉由重組DNA方法(參見(例如)美國專利第4,816,567號)來製備。"單株抗體"亦可使用(例如)Clackson等人，Nature
,352:624-628(1991)及Marks等人，J.Mol.Biol.,
222:581-597(1991)中所述之技術自噬菌體抗體庫分離得之。
本文中之單株抗體特定言之包括"嵌合"抗體，其中重鏈及/或輕鏈之一部分與源自特定物種或屬於特定抗體類別或亞類之抗體的相應序列一致或同源，而該(等)鏈之其餘部分與源自另一物種或屬於另一抗體類別或亞類之抗體的相應序列一致或同源；以及該等抗體之片段，只要其展現出所需生物學活性即可(美國專利第4,816,567號；及Morrison等人，Proc. Natl. Acad. Sci. USA
81:6851-6855(1984))。本文中所關注之嵌合抗體包括包含源自非人類靈長類動物(例如舊大陸猴(Old World Monkey)、猿(Ape)等)之可變結構域抗原結合序列及人類恆定區序列的靈長類化抗體。
"抗體片段"包含完整抗體之一部分，較佳包含其抗原結合或可變區。抗體片段之實例包括Fab、Fab'、F(ab')2
及Fv片段；雙功能抗體；線性抗體；單鏈抗體分子；及由抗體片段形成之多特異性抗體。
完整抗體為包含抗原結合可變區以及輕鏈恆定結構域(CL
)及重鏈恆定結構域(CH
1、CH
2及CH
3)之抗體。恆定結構域可為天然序列恆定結構域(例如人類天然序列恆定結構域)或其胺基酸序列變異體。完整抗體較佳具有一或多種效應功能，且包含與其一或兩條重鏈連接之寡醣結構。
抗體效應功能係指彼等可歸因於抗體之Fc區(天然序列Fc區或胺基酸序列變異Fc區)的生物學活性。抗體效應功能之實例包括：C1q結合；補體依賴性細胞毒性；Fc受體結合；抗體依賴性細胞介導細胞毒性(ADCC)；吞噬作用；細胞表面受體(諸如B細胞受體；BCR)之下調等。
在本文中術語Fc區係用於定義免疫球蛋白重鏈之C末端區，包括天然序列Fc區及變異Fc區。儘管免疫球蛋白重鏈Fc區之邊界可能變化，但人類IgG重鏈Fc區通常係定義為自位置Cys226處之胺基酸殘基或自Pro230延伸至其羧基末端。Fc區之C末端離胺酸(根據EU編號系統為殘基447)可(例如)在抗體產生或純化期間加以移除，或藉由重組工程化編碼抗體重鏈之核酸來移除。因此，完整抗體之組合物可包含所有K447殘基被移除之抗體群體、K447殘基未被移除之抗體群體及具有含有K447殘基之抗體與無K447殘基之抗體之混合物的抗體群體。
在本文中，除非另外指出，否則免疫球蛋白重鏈中殘基之編號為如Kabat等人，Sequences of Proteinsof Immunological Interest
，第5版，Public Health Service,National Institutes of Health,Bethesda,MD(1991)中之EU指數的編號。如Kabat中之EU指數係指人類IgG1 EU抗體之殘基編號。
視重鏈恆定結構域之胺基酸序列而定，完整抗體可被分為不同類別。存在有完整抗體之五種主要類別：IgA、IgD、IgE、IgG及IgM，且此等類別中有幾種可進一步被分成亞類(同型)，例如IgG1、IgG2、IgG3、IgG4、IgA及IgA2。對應於抗體之不同類別的重鏈恆定結構域分別被稱為α、δ、ε、γ及μ。免疫球蛋白之不同類別的亞單位結構及三維構型已為吾人所熟知。
抗體依賴性細胞介導細胞毒性及ADCC係指一種細胞介導之反應，其中表現Fc受體(FcR)之非特異性細胞毒性細胞(例如，自然殺手(NK)細胞、嗜中性白血球及巨噬細胞)識別標靶細胞上結合之抗體且隨後使標靶細胞溶解。介導ADCC之初級細胞(NK細胞)僅表現FcγRIII，而單核細胞表現FcγRI、FcγRII及 FcγRIII。FcR在造血細胞上之表現係概述於Ravetch及Kinet,Annu. Rev. Immunol
9:457-92(1991)之第464頁之表3中。為評估所關注分子之ADCC活性，可執行活體外ADCC檢定，諸如美國專利第5,500,362號或第5,821,337號中所述之檢定。適用於該等檢定之效應細胞包括周邊血液單核細胞(PBMC)及自然殺手(NK)細胞。或者或此外，可(例如)在動物模型(諸如Clynes等人，PNAS(USA)
95:652-656(1998)中所揭示之動物模型)中活體內評估所關注分子之ADCC活性。
人類效應細胞為表現一或多個FcR且執行效應功能之白血球。較佳地，該等細胞至少表現FcγRIII且執行ADCC效應功能。介導ADCC之人類白血球之實例包括周邊血液單核細胞(PBMC)、自然殺手(NK)細胞、單核細胞、細胞毒性T細胞及嗜中性白血球，其中PBMC及NK細胞為較佳。效應細胞可自天然來源分離，例如自如本文所述之血液或PBMC分離。
術語"Fc受體"或FcR係用於描述結合至抗體Fc區之受體。較佳FcR為天然序列人類FcR。此外，較佳FcR為結合IgG抗體(γ受體)且包括FcγRI、FcγRII及FcγRIII亞類之受體的FcR，包括此等受體之對偶基因變異體及替代性拼接形式。FcγRII受體包括FcγRIIA("活化受體")及FcγRIIB("抑制受體")，其具有類似胺基酸序列，但主要在其細胞質結構域方面存在不同。活化受體FcγRIIA在其細胞質結構域中含有基於免疫受體酪胺酸之活化基元(immunoreceptor tyrosine-based activation motif，ITAM)。抑制受體FcγRIIB在其細胞質結構域中含有基於免疫受體酪胺酸之抑制基元(ITIM)。(參見綜述M. in Daron,Annu. Reν. Immunol.
15:203-234(1997))。FcR係於Ravetch及Kinet,Annu. Reν. Immunol
9:457-92(1991)；Capel等人，Immunomethods
4:25-34(1994)；及de Haas等人，J. Lab. Clin. Med.
126:330-41(1995)中有評述。本文中之術語"FcR"涵蓋其他FcR，包括有待於將來鑑別之FcR。該術語亦包括新生兒受體FcRn，其負責將母IgG轉移至胎兒(Guyer等人，J. Immunol.
117:587(1976)及Kim等人，J. Immunol.
24:249(1994))。
補體依賴性細胞毒性或CDC係指在補體存在下分子溶解標靶之能力。補體活化路徑係由補體系統之第一組份(C1q)結合至與同源抗原複合之分子(例如抗體)而起始。為評估補體活化，可執行CDC檢定，例如Gazzano-Santoro等人，J. Immunol. Methods
202:163(1996)中所述。
"天然抗體"通常為由兩條相同輕鏈(L)及兩條相同重鏈(H)構成之約150,000道爾頓(dalton)的雜四聚醣蛋白。各輕鏈係藉由一個共價二硫鍵與重鏈連接，而在不同免疫球蛋白同型之重鏈之間，二硫鍵之數目不同。各重鏈及輕鏈亦具有規則間隔之鏈內二硫橋。各重鏈在一端具有可變結構域(VH
)，繼之以若干個恆定結構域。各輕鏈在一端具有可變結構域(VL
)且在另一端具有恆定結構域；輕鏈之恆定結構域係與重鏈之第一恆定結構域對準，且輕鏈可變結構域係與重鏈之可變結構域對準。咸信特定胺基酸殘基在輕鏈與重鏈可變結構域之間形成界面。
術語"可變"係指如下事實：在抗體之間可變結構域之某些部分在序列上廣泛不同且用於各特定抗體對其特定抗原的結合及特異性。然而，可變性在抗體整個可變結構域內並非均勻分布。其集中於輕鏈與重鏈可變結構域中三個稱作高變區之片段。可變結構域中較為高度保守之部分被稱為構架區(FR)。天然重鏈及輕鏈之可變結構域各包含四個主要採用β-摺疊構型且藉由三個高變區連接之FR，該等三個高變區形成連接β-摺疊結構之環，且在一些情況下形成β-摺疊結構之一部分。各鏈中之高變區藉由FR緊密地固持在一起，且與另一鏈之高變區一起促使形成抗體之抗原結合位點(參見Kabat等人，Sequences of Proteins of Immunological Interest
，第五版，Public Health Service,National Institute of Health,Bethesda,MD(1991))。恆定結構域並不直接涉及抗體與抗原之結合，但展現出各種效應功能，諸如抗體參與抗體依賴性細胞毒性(ADCC)。
術語高變區在本文中使用時係指抗體中負責抗原結合之胺基酸殘基。高變區通常包含互補決定區或CDR之胺基酸殘基(例如輕鏈可變結構域中之殘基24-34(L1)、50-56(L2)及89-97(L3)以及重鏈可變結構域中之殘基31-35(H1)、50-65(H2)及95-102(H3)；Kabat等人，Sequences of Proteins of Immunological Interest
，第5版，Public Health Service,National Institutes of Health,Bethesda,MD.(1991))及/或高變環之殘基(例如輕鏈可變結構域中之殘基26-32(L1)、50-52(L2)及91-96(L3)以及重鏈可變結構域中之殘基26-32(H1)、53-55(H2)及96-101(H3)；Chothia及Lesk,J. Mol. Biol.
196:901-917(1987))。"構架區"或"FR"殘基為除本文中所定義之高變區殘基以外的彼等可變結構域殘基。抗體之木瓜蛋白酶消化產生兩個稱為"Fab"片段之相同抗原結合片段，各具有單一抗原結合位點；及殘餘"Fc"片段，該名稱反映其易於結晶之能力。胃蛋白酶處理產生具有兩個抗原結合位點且仍能夠與抗原交聯之F(ab')2
片段。
"Fv"為含有完整抗原識別及抗原結合位點之最小抗體片段。該區域係由一個重鏈可變結構域與一個輕鏈可變結構域緊密、非共價結合之二聚體組成。在該構型中，各可變結構域之三個高變區相互作用而在VH
-VL
二聚體之表面上界定抗原結合位點。總體而言，六個高變區賦予抗體抗原結合特異性。然而，甚至單個可變結構域(或包含僅三個對抗原具特異性之高變區的Fv之一半)亦具有識別及結合抗原之能力，但親和力低於整個結合位點。
Fab片段亦含有輕鏈之恆定結構域及重鏈之第一恆定結構域(CH
1)。Fab'片段不同於Fab片段之處在於在重鏈CH
1結構域之羧基末端添加了幾個殘基(包括一或多個來自抗體鉸鏈區之半胱胺酸)。Fab'-SH為在本文中關於恆定結構域之半胱胺酸殘基具有至少一個游離硫醇基之Fab'的命名。最初F(ab')2
抗體片段係以彼此之間具有鉸鏈半胱胺酸之Fab'片段對形式產生。亦已知抗體片段之其他化學偶合。
來自任何脊椎動物物種之抗體的"輕鏈"可基於其恆定結構域之胺基酸序列而歸屬於兩種明顯不同之類型(稱作κ及λ)中之一者。
"單鏈Fv"或"scFv"抗體片段包含抗體之VH
及VL
結構域，其中該等結構域存在於單一多肽鏈中。Fv多肽較佳另外包含介於VH
與VL
結構域之間使scFv能夠形成抗原結合所需之結構的多肽連接子。關於scFv之綜述，參見Plckthun，The Pharmacology of Monoclonal Antibodies
，第113卷，Rosenburg及Moore編，Springer-Verlag,New York，第269-315頁(1994)。HER2抗體scFv片段描述於WO 93/16185；美國專利第5,571,894號及美國專利第5,587,458號中。
術語"雙功能抗體"係指具有兩個抗原結合位點之小抗體片段，該等片段包含在同一多肽鏈(VH
-VL
)中與可變輕鏈結構域(VL
)連接之可變重鏈結構域(VH
)。藉由使用過短而使得同一鏈上之兩個結構域間無法配對的連接子，迫使該等結構域與另一鏈上之互補結構域配對且產生兩個抗原結合位點。雙功能抗體更全面地描述於(例如)EP 404,097；WO 93/01161；及Hudson等人，Proc. Nat. Acad. Sci. USA
,90:6444-6448(1993)中。
"人類化"形式之非人類(例如齧齒動物)抗體為含有源自非人類免疫球蛋白之最小序列的嵌合抗體。一般而言，人類化抗體為如下人類免疫球蛋白(受體抗體)，其中來自受體高變區之殘基經具有所需特異性、親和力及能力的來自非人類物種(諸如小鼠、大鼠、兔或非人類靈長類動物)高變區(供體抗體)之殘基置換。在一些情況下，人類免疫球蛋白之構架區(FR)殘基係經相應非人類殘基置換。此外，人類化抗體可包含不存在於受體抗體或供體抗體中之殘基。進行此等修飾以進一步改進抗體之效能。一般而言，人類化抗體將包含至少一個且通常兩個可變結構域之大體上全部，其中所有或大體上所有高變環對應於非人類免疫球蛋白之彼等者，且所有或大體上所有FR為人類免疫球蛋白序列之彼等者。人類化抗體視情況亦將包含免疫球蛋白恆定區(Fc)之至少一部分，通常為人類免疫球蛋白之恆定區(Fc)之至少一部分。關於更多詳情，參見(例如)Jones等人，Nature
321：522-525(1986)；Riechmann等人，Nature
332：323-329(1988)；及Presta，Curr. Op
.Struct. Biol.
2：593-596(1992)。
人類化HER2抗體包括：如美國專利5,821,337表3中所描述之huMAb4D5-1、huMAb4D5-2、huMAb4D5-3、huMAb4D5-4、huMAb4D5-5、huMAb4D5-6、huMAb4D5-7及huMAb4D5-8或曲妥珠單抗(HERCEPTIN)，該專利係以引用的方式明確地併入本文中；人類化520C9(WO 93/21319)及如本文所述之人類化2C4抗體。
出於本文之目的，曲妥珠單抗、HERCEPTIN及"huMAb4D5-8"係指包含分別示於SEQ ID No：13及14中之輕鏈及重鏈胺基酸序列的抗體。
在本文中，帕妥珠單抗及"rhuMAb 2C4"係指包含分別示於SEQ ID No：3及4中之可變輕鏈及可變重鏈胺基酸序列之抗體。在帕妥珠單抗為完整抗體之情況下，其較佳包含分別示於SEQ ID No:15及16中之輕鏈及重鏈胺基酸序列。
"裸抗體"為未與異源分子(諸如細胞毒性部分或放射性標記)結合之抗體(如本文中所定義)。
"經分離之"抗體為一種已自自然環境之組份中鑑別出且分離及/或回收的抗體。其自然環境之污染物組份為將會干擾抗體之診斷或治療用途的物質，且可包括酶、激素及其他蛋白質性或非蛋白質性溶質。在較佳實施例中，抗體將被純化：(1)至如藉由勞立法(Lowry method)所測定之大於95重量%抗體，且最佳至大於99重量%；(2)至足以藉由使用旋杯式定序儀獲得N末端或內部胺基酸序列之至少15個殘基的程度；或(3)至藉由SDS-PAGE在還原或非還原條件下使用考馬斯藍(Coomassie blue)或較佳銀染色得知之均質性。經分離之抗體包括重組細胞內之原位抗體，此係因為抗體之自然環境中之至少一個組份將不會存在。然而，通常將藉由至少一個純化步驟來製備經分離之抗體。
比曲妥珠單抗更有效抑制HER二聚化之HER2抗體為一種比曲妥珠單抗更有效(例如更有效至少約2倍)減少或消除HER二聚體之抗體。該類抗體抑制HER2二聚化較佳至少與選自由以下組成之群之抗體大致同樣有效：完整鼠類單株抗體2C4、鼠類單株抗體2C4之Fab片段、完整帕妥珠單抗、及帕妥珠單抗之Fab片段。可藉由以下評估HER二聚化之抑制：直接研究HER二聚體；或評估HER活化，或下游信號傳導，其由HER二聚化產生；及/或評估抗體-HER2結合位點等。用於篩選抑制HER二聚化之能力比曲妥珠單抗有效之抗體的檢定描述於Agus等人，Cancer Cell
2:127-137(2002)及WO 01/00245(Adams等人)中。僅舉例而言，可藉由評估以下來檢定HER二聚化之抑制：例如HER二聚體形成之抑制(參見例如Agus等人，Cancer Cell
2:127-137(2002)之圖1A-B；及WO 01/00245)；表現HER二聚體之細胞之HER配體活化減少(例如WO 01/00245及Agus等人，Cancer Cell
2:127-137(2002)之圖2A-B)；HER配體與表現HER二聚體之細胞結合的阻斷(例如WO 01/00245及Agus等人，Cancer Cell
2:127-137(2002)之圖2E)；在有(或無)HER配體之情況下表現HER二聚體之癌細胞(例如MCF7、MDA-MD-134、ZR-75-1、MD-MB-175、T-47D細胞)的細胞生長抑制(例如WO 01/00245及Agus等人，Cancer Cell
2:127-137(2002)之圖3A-D)；下游信號傳導之抑制(例如HRG依賴性AKT磷酸化之抑制，或HRG或TGFα依賴性MAPK磷酸化之抑制)(參見例如WO 01/00245及Agus等人，Cancer Cell
2:127-137(2002)之圖2C-D)。亦可藉由研究抗體-HER2結合位點，例如藉由評估結合至HER2之抗體的結構或模型(諸如晶體結構)來評估抗體是否抑制HER二聚化(參見例如Franklin等人，Cancer Cell
5:317-328(2004))。
與曲妥珠單抗相比，HER2抗體可更有效(例如更有效至少2倍)抑制HRG依賴性AKT磷酸化及/或抑制HRG或TGFα依賴性MAPK磷酸化(參見例如Agus等人，Cancer Cell
2:127-137(2002)及WO 01/00245)。
HER2抗體可為不抑制HER2胞外結構域裂解之抗體(Molina等人，Cancer Res
.61:4744-4749(2001))。
結合至HER2之雜二聚結合位點的HER2抗體結合至結構域II中之殘基(且視情況亦結合至HER2胞外結構域之其他結構域(諸如結構域I及III)中之殘基)，且可至少在某種程度上於空間上阻礙HER2-EGFR、HER2-HER3或HER2-HER4雜二聚體之形成。Franklin等人，Cancer Cell
5:317-328(2004)表徵寄存於RCSB蛋白質資料庫(識別碼為IS78)之HER2-帕妥珠單抗晶體結構，其說明一種結合至HER2之雜二聚結合位點的例示性抗體。
結合至HER2結構域II之抗體結合至結構域II中之殘基且視情況結合至HER2其他結構域(諸如結構域I及III)中之殘基。
"生長抑制劑"在本文中使用時係指能在活體外或活體內抑制細胞(尤其表現HER之癌細胞)生長之化合物或組合物。因此，該生長抑制劑可為能顯著降低S期中表現HER之細胞的百分比之藥劑。生長抑制劑之實例包括能阻斷細胞週期進程(在除S期以外之階段)之藥劑，諸如誘導G1停滯及M期停滯之藥劑。典型M期阻斷劑包括長春鹼類(vincas)(長春新鹼(vincristine)及長春鹼(vinblastine))、紫杉烷(taxane)及topo II抑制劑(諸如多柔比星(doxorubicin)、表柔比星(epirubicin)、道諾黴素(daunorubicin)、依託泊苷(etoposide)及博萊黴素(bleomycin))。能使G1停滯之彼等藥劑亦擴溢為能使S期停滯，例如，DNA烷化劑，諸如他莫昔芬(tamoxifen)、潑尼松(prednisone)、達卡巴嗪(dacarbazine)、氮芥(mechlorethamine)、順鉑(cisplatin)、甲胺喋呤(methotrexate)、5-氟尿嘧啶及阿拉伯糖苷(ara-C)。其他資訊可見於The Molecular Basis of Cancer,
Mendelsohn及Israel編，第1章，標題為"Cell cycle regulation,oncogenes,and antineoplastic drugs"，M urakami等人(W.B. Saunders:Philadelphia,1995)，尤其第13頁中。
生長抑制性抗體之實例為彼等結合至HER2且抑制過度表現HER2之癌細胞生長之抗體。較佳生長抑制性HER2抗體在約0.5至30μg/ml之抗體濃度下將細胞培養物中SK-BR-3乳腺腫瘤細胞之生長抑制達20%以上，且較佳為達50%以上(例如約50%至約100%)，其中在SK-BR-3細胞暴露於抗體之後六日測定生長抑制(參見1997年10月14日頒布之美國專利第5,677,171號)。在該專利及下文中對SK-BR-3細胞生長抑制檢定有更詳細之描述。較佳生長抑制性抗體為鼠類單株抗體4D5之人類化變異體(例如曲妥珠單抗)。
"誘導細胞凋亡"之抗體為如藉由膜聯蛋白V之結合、DNA之斷裂、細胞收縮、內質網之膨脹、細胞斷裂及/或膜囊(稱作細胞凋亡體)之形成所確定誘導漸進式細胞死亡的抗體。該細胞通常為過度表現HER2受體之細胞。該細胞較佳為腫瘤細胞，例如乳腺、卵巢、胃、子宮內膜、唾液腺、肺、腎、結腸、甲狀腺、胰腺或膀胱腫瘤細胞。活體外，細胞可為SK-BR-3、BT474、Calu3細胞、MDA-MB-453、MDA-MB-361或SKOV3細胞。各種方法可用於評估與細胞凋亡相關之細胞事件。舉例而言，可藉由膜聯蛋白結合來量測磷脂醯絲胺酸(PS)易位；可經由DNA條帶(DNA laddering)來評估DNA斷裂；且可藉由亞二倍體細胞之任何增加來評估核/染色質凝聚以及DNA斷裂。較佳地，誘導細胞凋亡之抗體為在使用BT474細胞之膜聯蛋白結合檢定(參見下文)中導致膜聯蛋白結合之誘導相對於未經處理之細胞而言為約2至50倍、較佳為約5至50倍且最佳為約10至50倍的抗體。誘導細胞凋亡之HER2抗體之實例為7C2及7F3。
"抗原決定基2C4"為HER2胞外結構域中抗體2C4所結合之區域。為篩選結合至2C4抗原決定基之抗體，可執行常規交叉阻斷檢定，諸如Antibodies,A Laboratory Manual
,Cold Spring Harbor Laboratory,Harlow及David Lane編(1988)中所述之檢定。或者，可執行抗原決定基定位以使用此項技術中已知之方法來評估抗體是否結合至HER2之2C4抗原決定基，且/或可研究抗體-HER2結構(Franklin等人，Cancer Cell
5:317-328(2004))以發現HER2之何結構域為抗體所結合。抗原決定基2C4包含HER2胞外結構域中結構域II之殘基。2C4及帕妥珠單抗在結構域I、II及III之接合處結合至HER2胞外結構域。Franklin等人，Cancer Cell
5:317-328(2004)。
"抗原決定基4D5"為HER2胞外結構域中抗體4D5(ATCC CRL 10463)及曲妥珠單抗所結合之區域。該抗原決定基接近HER2之跨膜結構域，且在HER2之結構域IV內。為篩選結合至4D5抗原決定基之抗體，可執行常規交叉阻斷檢定，諸如Antibodies
,A Laboratory Manual
,Cold Spring Harbor Laboratory,Harlow及David Lane編(1988)中所述之檢定。或者，可執行抗原決定基定位以確定抗體是否結合至HER2之4D5抗原決定基(例如，在圖1中，約殘基529至約殘基625(包括端點)之區域中之任何一或多個殘基)。
"抗原決定基7C2/7F3"為HER2胞外結構域之結構域I內N末端處7C2及/或7F3抗體(各自寄存於ATCC，參見下文)所結合之區域。為篩選結合至7C2/7F3抗原決定基之抗體，可執行常規交叉阻斷檢定，諸如Antibodies,A Laboratory Manual
,Cold Spring Harbor Laboratory,Harlow及David Lane編(1988)中所述之檢定。或者，可執行抗原決定基定位以確定抗體是否結合至HER2上之7C2/7F3抗原決定基(例如在圖1中，HER2之約殘基22至約殘基53之區域中的任何一或多個殘基)。
"治療"係指治療性治療及預防性措施。需治療者包括已患有疾病之彼等者以及疾病有待被預防之彼等者。因此，在本文中待治療之患者可已診斷為患有疾病或可能易患疾病或對疾病敏感。
術語"癌症"及"癌性"係指或描述哺乳動物中通常特徵為不受調節之細胞生長的生理病狀。癌症之實例包括(但不限於)癌瘤、淋巴瘤、胚細胞瘤(包括神經管胚細胞瘤及視網膜胚細胞瘤)、肉瘤(包括脂肪肉瘤及滑膜細胞肉瘤)、神經內分泌腫瘤(包括類癌、胃泌素瘤及胰島細胞癌)、間皮瘤、神經鞘瘤(包括聽神經瘤)、脊膜瘤、腺癌、黑色素瘤及白血病或淋巴惡性腫瘤。該等癌症之更特定實例包括鱗狀細胞癌(例如上皮鱗狀細胞癌)、肺癌(包括小細胞肺癌、非小細胞肺癌、肺腺癌及肺鱗癌)、腹膜癌、肝細胞癌、胃癌(包括胃腸癌)、胰腺癌、神經膠母細胞瘤、子宮頸癌、卵巢癌、肝癌、膀胱癌、肝腫瘤、乳癌、結腸癌、直腸癌、結腸直腸癌、子宮內膜或子宮癌、唾液腺癌、腎癌、前列腺癌、陰門癌、甲狀腺癌、肝癌、肛門癌、陰莖癌、睪丸癌、食管癌、膽道腫瘤以及頭部及頸部癌症。
術語有效量係指可有效治療患者之疾病的藥物之量。在該疾病為癌症之情況下，有效量之藥物可減少癌細胞數目；減小腫瘤大小；抑制(亦即在某種程度上減緩且較佳為阻止)癌細胞浸潤至周邊器官中；抑制(亦即在某種程度上減緩且較佳為阻止)腫瘤轉移；在某種程度上抑制腫瘤生長；及/或在某種程度上減輕一或多個與癌症相關之症狀。就藥物可防止現有癌細胞生長及/或殺死現有癌細胞而言，其可具有細胞抑制性及/或細胞毒性。有效量可延長無進展存活期，產生目標反應(包括部分反應(PR)或完全反應(CR))，增加總存活時間及/或改良一或多個癌症症狀。
HER2陽性癌症為包含在細胞表面存在有HER2蛋白之細胞的癌症。
過度表現HER受體之癌症為與相同組織類型之非癌性細胞相比在細胞表面具有顯著較高含量之HER受體(諸如HER2)的癌症。該過度表現可能由基因擴增或由轉錄或轉譯增加引起。可在診斷性或預後性檢定中藉由評估細胞表面上所存在之HER蛋白所增加的含量(例如經由免疫組織化學檢定；IHC)來測定HER受體過度表現。或者或此外，可(例如)經由螢光原位雜交法(FISH；參見1998年10月公開之WO 98/45479)、南方墨點法或聚合酶鏈反應(PCR)技術(諸如即時定量PCR(RT-PCR))來量測細胞中編碼HER之核酸的含量。亦可藉由量測生物流體(諸如血清)中脫落之抗原(例如HER胞外結構域)來研究HER受體過度表現(參見(例如)1990年6月12日頒布之美國專利第4,933,294號；1991年4月18日公開之WO 91/05264；1995年3月28日頒布之美國專利5,401,638；及Sias等人，J. Immunol. Methods
132:73-80(1990))。除上述檢定以外，熟悉此項技術者可利用各種活體內檢定。舉例而言，可使患者體內之細胞暴露於視情況以可偵測標記(例如放射性同位素)標記之抗體，且可(例如)藉由外部掃描放射能或藉由分析取自先前暴露於抗體之患者之生檢組織來評估患者體內抗體與細胞之結合。
相反地，不過度表現HER2受體之癌症為與相同組織類型之非癌性細胞相比不表現高於正常含量之HER2受體的癌症。
過度表現HER配體之癌症為與相同組織類型之非癌性細胞相比產生顯著較高含量之彼配體的癌症。該過度表現可能由基因擴增或由轉錄或轉譯增加引起。可藉由評估患者體內(例如腫瘤生檢組織中)之配體(或編碼其之核酸)含量，或藉由各種診斷性檢定(諸如IHC、FISH、南方墨點法、PCR或上述活體內檢定)來診斷性測定HER配體之過度表現。
如本文中所用之術語"細胞毒性劑"係指一種能抑制或阻止細胞之功能且/或導致細胞破壞之物質。該術語意欲包括放射性同位素(例如，At211
、I131
、I125
、Y90
、Re186
、Re188
、Sm153
、Bi212
、P32
及Lu之放射性同位素)、化學治療劑及毒素(諸如細菌、真菌、植物或動物來源之小分子毒素或酶活性毒素，包括其片段及/或變異體)。
"化學治療劑"為適用於治療癌症之化合物。化學治療劑之實例包括：烷化劑，諸如塞替派(thiotepa)及環磷醯胺(CYTOXAN)；烷基磺酸鹽類，諸如白消安(busulfan)、英丙舒凡(improsulfan)及哌泊舒凡(piposulfan)；氮丙啶(aziridine)類，諸如苯佐多巴(benzodopa)、卡波醌(carboquone)、米特多巴(meturedopa)及尤利多巴(uredopa)；乙烯亞胺類及甲基三聚氰胺類，包括六甲密胺(altretamine)、三伸乙基三聚氰胺、三伸乙基磷醯胺、三伸乙基硫基磷醯胺及三羥甲基三聚氰胺；乙醯精寧(acetogenin)(尤其布拉他辛(bullatacin)及布拉他辛酮(bullatacinone))；δ-9-四氫大麻酚(屈大麻酚(dronabinol，MARINOL))；β-拉帕酮(beta-lapachone)；拉帕醇(lapachol)；秋水仙鹼(colchicine)；樺木酸(betulinic acid)；喜樹鹼(camptothecin)(包括合成類似物拓朴替康(topotecan，HYCAMTIN)、CPT-11(伊立替康(irinotecan)，CAMPTOSAR)、乙醯喜樹鹼、斯考普萊汀(scopolectin)及9-胺基喜樹鹼)；苔蘚蟲素(bryostatin)；卡利他汀(callystatin)；CC-1065(包括其阿多來新(adozelesin)、卡折來新(carzelesin)及比折來新(bizelesin)合成類似物)；鬼臼毒素(podophyllotoxin)；足葉草酸(podophyllinic acid)；替尼泊苷(teniposide)；自念珠藻環肽(cryptophycin)(尤其自念珠藻環肽1及自念珠藻環肽8)；海兔毒素(dolastatin)；多卡米辛(duocarmycin)(包括合成類似物KW-2189及CB1-TM1)；艾榴素(eleutherobin)；水鬼蕉鹼(pancratistatin)；沙考的汀(sarcodictyin)；海綿他汀(spongistatin)；氮芥類(nitrogen mustards)，諸如苯丁酸氮芥、萘氮芥(chlornaphazine)、氯磷醯胺、雌莫司汀(estramustine)、異環磷醯胺(ifosfamide)、氮芥(mechlorethamine)、氮芥氧化物鹽酸鹽、美法侖(melphalan)、新恩比興(novembichin)、膽甾醇對苯乙酸氮芥(phenesterine)、潑尼莫司汀(prednimustine)、曲洛磷胺(trofosfamide)、尿嘧啶氮芥(uracil mustard)；亞硝基脲(nitrosurea)，諸如卡莫司汀(carmustine)、氯脲黴素(chlorozotocin)、福莫司汀(fotemustine)、洛莫司汀(lomustine)、尼莫司汀(nimustine)及雷莫司汀(ranimnustine)；抗生素，諸如烯二炔抗生素(例如，卡奇黴素(calicheamicin)，尤其卡奇黴素γ1I及卡奇黴素ωI1(參見(例如)Angew.Chem Intl
.Ed
.Engl
.,33:183-186(1994))；達內黴素(dynemicin)，包括達內黴素A；埃斯培拉黴素(esperamicin)；以及新製癌菌素(neocarzinostatin)發色團及相關色蛋白烯二炔抗生素發色團)、阿克拉黴素(aclacinomysin)、放線菌素(actinomycin)、奧斯拉米辛(authramycin)、偶氮絲胺酸(azaserine)、博萊黴素、放線菌素C(cactinomycin)、卡拉比辛(carabicin)、洋紅黴素(carminomycin)、嗜癌黴素(carzinophilin)、色黴素(chromomycin)、放線菌素D(dactinomycin)、道諾黴素、地托比星(detorubicin)、6-重氮基-5-側氧基-L-正白胺酸、多柔比星(包括ADRIAMYCIN、嗎啉基-多柔比星、氰基嗎啉基-多柔比星、2-吡咯啉基-多柔比星、鹽酸多柔比星脂質體注射劑(DOXIL)、脂質體多柔比星TLC D-99(MYOCET)、聚乙二醇化脂質體多柔比星(CAELYX)及去氧多柔比星)、表柔比星(epirubicin)、依索比星(esorubicin)、黃膽素(idarubicin)、麻西羅黴素(marcellomycin)、絲裂黴素(mitomycin)(諸如絲裂黴素C)、黴酚酸(mycophenolicacid)、諾拉黴素(nogalamycin)、橄欖黴素(olivomycin)、培洛黴素(peplomycin)、泊非黴素(porfiromycin)、嘌呤黴素(puromycin)、三鐵阿黴素(quelamycin)、羅多比星(rodorubicin)、鏈黑黴素(streptonigrin)、鏈佐星(streptozocin)、殺結核菌素(tubercidin)、烏苯美司(ubenimex)、淨司他丁(zinostatin)、佐柔比星(zorubicin)；抗代謝物，諸如甲胺喋呤、吉西他濱(gemcitabine，GEMZAR)、喃氟啶(tegafur，UFToRAL)、卡培他濱(capecitabine，XELODA)、埃坡黴素(epothilone)及5-氟尿嘧啶(5-FU)；葉酸類似物，諸如迪諾特寧(denopterin)、甲胺喋呤、蝶羅呤(pteropterin)、三甲曲沙(trimetrexate)；嘌呤類似物，諸如氟達拉濱(fludarabine)、6-巰基嘌呤、噻咪嘌呤(thiamiprine)、硫鳥嘌呤(thioguanine)；嘧啶類似物，諸如安西他濱(ancitabine)、阿紮胞苷(azacitidine)、6-氮尿苷、卡莫氟(carmofur)、阿糖胞苷(cytarabine)、雙去氧尿苷(dideoxyuridine)、去氧氟尿苷(doxifluridine)、依諾他濱(enocitabine)、氟尿苷(floxuridine)；抗腎上腺類，諸如胺魯米特(aminoglutethimide)、米托坦(mitotane)、曲洛司坦(trilostane)；葉酸補充劑，諸如夫羅林酸(frolinic acid)；醋葡醛內酯(aceglatone)；醛磷醯胺糖苷(aldophosphamide glycoside)；胺基乙醯丙酸；恩尿嘧啶(eniluracil)；安吖啶(amsacrine)；貝司他布(bestrabucil)；比生群(bisantrene)；埃達曲卡(edatraxate)；得弗伐胺(defofamine)；秋水仙胺(demecolcine)；地吖醌(diaziquone)；艾弗尼辛(elfornithine)；依利醋銨(elliptinium acetate)；依託格魯(etoglucid)；硝酸鎵；羥基脲；香菇多糖(lentinan)；羅尼代寧(lonidainine)；美登素類(maytansinoids)，諸如美登素(maytansine)及美登木素(ansamitocin)；米托胍腙(mitoguazone)；米托蒽醌(mitoxantrone)；莫比達摩(mopidanmol)；硝爾靈(nitraerine)；噴司他丁(pentostatin)；蛋胺氮芥(phenamet)；吡柔比星(pirarubicin)；洛索蒽醌(losoxantrone)；2-乙基醯肼；丙卡巴肼(procarbazine)；PSK多醣複合物(JHS Natural Products,Eugene,OR)；雷佐生(razoxane)；根瘤菌素(rhizoxin)；西佐喃(sizofiran)；鍺螺胺(spirogermanium)；細交鏈孢菌酮酸(tenuazonic acid)；三亞胺醌(triaziquone)；2,2',2"-三氯三乙胺；單端孢黴烯族毒素(trichothecene)(尤其T-2毒素、韋拉庫林A(verracurin A)、桿孢菌素A(roridin A)及安奎定(anguidine))；烏拉坦(urethan)；達卡巴嗪(dacarbazine)；甘露莫司汀(mannomustine)；二溴甘露醇(mitobronitol)；二溴衛矛醇(mitolactol)；哌泊溴烷(pipobroman)；伽托辛(gacytosine)；阿拉伯糖苷("Ara-C")；塞替派；紫杉醇(taxoid)，例如太平洋紫杉醇(paclitaxel，TAXOL)、太平洋紫杉醇之白蛋白工程化奈米粒子調配物(ABRAXANETM
)及多西他賽(docetaxel，TAXOTERE)；苯丁酸氮芥；6-硫鳥嘌呤；巰基嘌呤；甲胺喋呤；鉑類試劑，諸如順鉑、奧賽力鉑(oxaliplatin)及卡鉑(carboplatin)；防止微管蛋白聚合形成微管之長春鹼類(vincas)，包括長春鹼(VELBAN)、長春新鹼(ONCOVIN)、長春地辛(vindesine)(ELDISINE，FILDESIN)及長春瑞賓(vinorelbine，NAVELBINE)；依託泊苷(VP-16)；異環磷醯胺；米托蒽醌；甲醯四氫葉酸(leucovorin)；諾凡特龍(novantrone)；依達曲沙(edatrexate)；道諾黴素(daunomycin)；胺基喋呤(aminopterin)；伊班膦酸鹽(ibandronate)；拓撲異構酶抑制劑RFS 2000；二氟甲基鳥胺酸(DMFO)；類視色素，諸如視黃酸，包括貝瑟羅汀(bexarotene，TARGRETIN)；雙膦酸鹽，諸如氯屈膦酸鹽(clodronate)(例如BONEFOS或OSTAC)、依替膦酸鹽(etidronate，DIDROCAL)、NE-58095、唑來膦酸(zoledronic acid)/唑來膦酸鹽(zoledronate)(ZOMETA)、阿侖膦酸鹽(alendronate，FOSAMAX)、帕米膦酸鹽(pamidronate，AREDIA)、替魯膦酸鹽(tiludronate，SKELID)或利塞膦酸鹽(risedronate，ACTONEL)；曲沙他濱(troxacitabine)(一種1,3-二氧戊環核苷胞嘧啶類似物)；反義寡核苷酸，尤其彼等能抑制與異常細胞增殖有關之信號傳導路徑中之基因表現的反義寡核苷酸，諸如PKC-α、Raf、H-Ras及表皮生長因子受體(EGF-R)；疫苗，諸如THERATOPE疫苗及基因療法疫苗，例如ALLOVECTIN疫苗、LEUVECTIN疫苗及VAXID疫苗；拓撲異構酶1抑制劑(例如LURTOTECAN)；rmRH(例如ABARELIX)；BAY439006(索拉非尼(sorafenib)；Bayer)；SU-11248(Pfizer)；哌立福新(perifosine)、COX-2抑制劑(例如賽利克西(celecoxib)或依託昔布(etoricoxib))、蛋白體抑制劑(例如PS341)；硼替佐米(bortezomib，VELCADE)；CCI-779；替吡法尼(tipifarnib，R11577)；索拉非尼(orafenib)、ABT510；Bcl-2抑制劑，諸如奧利默森鈉(oblimersen sodium)(GENASENSE)；匹杉瓊(pixantrone)；EGFR抑制劑(參見以下定義)；酪胺酸激酶抑制劑(參見以下定義)；及上述任一者之醫藥學上可接受之鹽、酸或衍生物；以及上述兩者或兩者以上之組合(諸如CHOP，其為環磷醯胺、多柔比星、長春新鹼及潑尼龍(prednisolone)之組合療法的縮寫；及FOLFOX，其為使用與5-FU及甲醯四氫葉酸組合之奧賽力鉑(ELOXATINTM
)之治療方案的縮寫)。
在該定義中亦包括發揮作用以調節或抑制激素對腫瘤之作用的抗激素劑，諸如具有混合之促效劑/拮抗劑概況的抗雌激素，包括他莫昔芬(NOLVADEX)、4-羥基他莫昔芬、托瑞米芬(toremifene，FARESTON)、艾多昔芬(idoxifene)、屈洛昔芬(droloxifene)、雷洛昔芬(raloxifene，EVISTA)、曲沃昔芬(trioxifene)、雷洛昔芬鹽酸鹽(keoxifene)及選擇性雌激素受體調節劑(SERM)(諸如SERM3)；無促效劑特性之純抗雌激素，諸如氟維司群(fulvestrant，FASLODEX)及EM800(該等試劑可阻斷雌激素受體(ER)二聚化，抑制DNA結合，增加ER轉換且/或抑制ER含量)；芳香酶抑制劑，包括類固醇芳香酶抑制劑(諸如福美司坦(formestane)及依西美坦(exemestane，AROMASIN))及非類固醇芳香酶抑制劑(諸如安美達錠(anastrozole，ARIMIDEX)、來曲唑(letrozole，FEMARA)及胺魯米特(aminoglutethimide))及其他芳香酶抑制劑(包括伏羅唑(vorozole，RIVISOR)、乙酸甲地孕酮(megestrol acetate，MEGASE)、法屈唑(fadrozole)、咪唑(imidazole))；黃體生成激素釋放激素促效劑，包括亮丙瑞林(leuprolide，LUPRON及ELIGARD)、戈舍瑞林(goserelin)、布舍瑞林(buserelin)及曲普瑞林(tripterelin)；性類固醇類，包括助孕素(progestine)(諸如乙酸甲地孕酮及乙酸甲羥孕酮(medroxyprogesterone acetate))、雌激素(諸如己烯雌酚(diethylstilbestrol)及普力馬林(premarin))及雄激素/類視色素(諸如氟甲睪酮(fluoxymesterone)、全反視黃酸及芬維A胺(fenretinide))；奧那司酮(onapristone)；抗孕酮；雌激素受體下調劑(ERD)；抗雄激素，諸如氟他胺(flutamide)、尼魯米特(nilutamide)及比卡魯胺(bicalutamide)；睪內酯酮(testolactone)；及上述任一者之醫藥學上可接受之鹽、酸或衍生物；以及上述兩者或兩者以上之組合。
如本文中所使用之術語EGFR靶向藥物係指結合至EGFR且視情況抑制EGFR活化之治療劑。該等藥劑之實例包括結合至EGFR之抗體及小分子。結合至EGFR之抗體之實例包括MAb 579(ATCC CRL HB 8506)、MAb 455(ATCC CRL HB8507)、MAb 225(ATCC CRL 8508)、MAb 528(ATCC CRL 8509)(參見美國專利第4,943,533號，Mendelsohn等人)及其變異體，諸如嵌合225(C225或西妥昔單抗(Cetuximab)；ERBUTIX)及改型人類225(H225)(參見WO 96/40210,Imclone Systems Inc.)；IMC-11F8，其為一種全人類EGFR靶向抗體(Imclone)；結合II型突變體EGFR之抗體(美國專利第5,212,290號)；如美國專利第5,891,996號中所述結合EGFR之人類化及嵌合抗體；及結合EGFR之人類抗體，諸如ABX-EGF或帕尼單抗(Panitumumab)(參見WO 98/50433，Abgenix/Amgen)；EMD 55900(Stragliotto等人，Eur. J. Cancer
32A:636-640(1996))；EMD7200(馬妥珠單抗(matuzumab))，其為一種針對EGFR且與EGF與TGF-α競爭EGFR結合之人類化EGFR抗體(EMD/Merck)；人類EGFR抗體HuMax-EGFR(GenMab)；稱為E1.1、E2.4、E2.5、E6.2、E6.4、E2.11、E6.3及E7.6.3且描述於US 6,235,883中之全人類抗體；MDX-447(Medarex Inc)；及mAb 806或人類化mAb 806(Johns等人，J. Biol. Chem
. 279(29):30375-30384(2004))。抗EGFR抗體可與細胞毒性劑結合，由此產生免疫結合物(參見(例如)EP659,439A2,Merck Patent GmbH)。EGFR拮抗劑包括小分子，諸如以下文獻中所述之化合物：美國專利第5,616,582號、第5,457,105號、第5,475,001號、第5,654,307號、第5,679,683號、第6,084,095號、第6,265,410號、第6,455,534號、第6,521,620號、第6,596,726號、第6,713,484號、第5,770,599號、第6,140,332號、第5,866,572號、第6,399,602號、第6,344,459號、第6,602,863號、第6,391,874號、第6,344,455號、第5,760,041號、第6,002,008號及第5,747,498號，以及以下PCT公開案：WO 98/14451、WO 98/50038、WO 99/09016及WO 99/24037。特定小分子EGFR拮抗劑包括OSI-774(CP-358774，埃羅替尼(erlotinib)，TARCEVA，Genentech/OSI Pharmaceuticals)；PD 183805(CI 1033，2-丙烯醯胺，N-[4-[(3-氯-4-氟苯基)胺基]-7-[3-(4-嗎啉基)丙氧基]-6-喹唑啉基]-二鹽酸鹽，Pfizer Inc.)；ZD1839(吉非替尼(gefitinib，IRESSA)，4-(3'-氯-4'-氟苯胺基)-7-甲氧基-6-(3-嗎啉基丙氧基)喹唑啉，AstraZeneca)；ZM 105180(6-胺基-4-(3-甲基苯基-胺基)-喹唑啉，Zeneca)；BIBX-1382(N8-(3-氯-4-氟-苯基)-N2-(1-甲基-哌啶-4-基)-嘧啶幷[5,4-d]嘧啶-2,8-二胺，Boehringer Ingelheim)；PKI-166((R)-4-[4-[(1-苯基乙基)胺基]-1H-吡咯幷[2,3-d]嘧啶-6-基]-苯酚；(R)-6-(4-羥基苯基)-4-[(1-苯基乙基)胺基]-7H-吡咯幷[2,3-d]嘧啶)；CL-387785(N-[4-[(3-溴苯基)胺基]-6-喹唑啉基]-2-丁炔醯胺)；EKB-569(N-[4-[(3-氯-4-氟苯基)胺基]-3-氰基-7-乙氧基-6-喹啉基]-4-(二甲基胺基)-2-丁烯醯胺)(Wyeth)；AG1478(Sugen)；AG1571(SU 5271；Sugen)；雙重EGFR/HER2酪胺酸激酶抑制劑，諸如拉帕替尼(lapatinib)(GW 572016或N-[3-氯-4-[(3氟苯基)甲氧基]苯基]6[5[[[2甲基磺醯基)乙基]胺基]甲基]-2-呋喃基]-4-喹唑啉胺；Glaxo-SmithKline)或氰基胍喹唑啉及氰基脒喹唑啉胺衍生物。
酪胺酸激酶抑制劑為抑制酪胺酸激酶(諸如HER受體)之酪胺酸激酶活性之分子。該等抑制劑之實例包括前一段中所述之EGFR靶向藥物；小分子HER2酪胺酸激酶抑制劑，諸如TAK165(可購自Takeda)；CP-724,714，其為ErbB2受體酪胺酸激酶之一種口服選擇性抑制劑(Pfizer及OSI)；雙重HER抑制劑，諸如EKB-569(可購自Wyeth)，其優先結合EGFR，但抑制過度表現HER2與EGFR之細胞；拉帕替尼(GW572016；可購自Glaxo-SmithKline)，其為一種口服HER2及EGFR酪胺酸激酶抑制劑；PKI-166(可購自Novartis)；pan-HER抑制劑，諸如卡奈替尼(canertinib，CI-1033；Pharmacia)；Raf-1抑制劑，諸如反義藥劑ISIS-5132(可購自ISIS Pharmaceuticals)，其抑制Raf-1信號傳導；非HER靶向TK抑制劑，諸如伊馬替尼甲磺酸鹽(GLEEVACTM
，可購自Glaxo)；MAPK細胞外調節激酶I抑制劑CI-1040(可購自Pharmacia)；喹唑啉類，諸如PD 153035，亦即4-(3-氯苯胺基)喹唑啉；吡啶幷嘧啶類；嘧啶幷嘧啶類；吡咯幷嘧啶類，諸如CGP 59326、CGP 60261及CGP 62706；吡唑幷嘧啶類；4-(苯基胺基)-7H-吡咯幷[2,3-d]嘧啶；薑黃素(二阿魏醯基甲烷(diferuloyl methane)，4,5-雙(4-氟苯胺基)酞醯亞胺)；含有硝基噻吩部分之泰伏汀(tyrphostine)類；PD-0183805(Warner-Lamber)；反義分子(例如彼等結合至編碼HER之核酸的反義分子)；喹喏啉類(美國專利第5,804,396號)；曲伏司汀(tryphostin)類(美國專利第5,804,396號)；ZD6474(Astra Zeneca)；PTK-787(Novartis/Schering AG)；pan-HER抑制劑，諸如CI-1033(Pfizer)；阿非尼他(Affinitac，ISIS 3521；Isis/Lilly)；伊馬替尼甲磺酸鹽(Gleevac；Novartis)；PKI 166(Novartis)；GW2016(Glaxo SmithKline)；CI-1033(Pfizer)；EKB-569(Wyeth)；塞馬西尼(Semaxinib，Sugen)；ZD6474(AstraZeneca)；PTK-787(Novartis/Schering AG)；INC-1C11(Imclone)；氰基胍喹唑啉及氰基脒喹唑啉胺衍生物；或以下專利公開案中之任一者中所述者：美國專利第5,804,396號；WO 99/09016(American Cyanamid)；WO 98/43960(American Cyanamid)；WO 97/38983(Warner Lambert)；WO 99/06378(Warner Lambert)；WO 99/06396(Warner Lambert)；WO 96/30347(Pfizer,Inc)；WO 96/33978(Zeneca)；WO 96/3397(Zeneca)；WO 96/33980(Zeneca)；及US 2005/0101617。
抗血管生成劑係指在某種程度上阻斷或干擾血管發育之化合物。抗血管生成因子可(例如)為結合至涉及促進血管生成之生長因子或生長因子受體之小分子或抗體。本文中之較佳抗血管生成因子為結合至血管內皮生長因子(VEGF)之抗體，諸如貝伐單抗(Bevacizumab，AVASTINTM
)。
術語"細胞激素"為由一個細胞群體釋放之作為細胞間介體作用於另一細胞的蛋白質之通用術語。該等細胞激素之實例為淋巴激素、單核球激素及傳統多肽激素。在細胞激素之中包括有生長激素，諸如人類生長激素、N-甲硫胺醯基人類生長激素及牛生長激素；甲狀旁腺激素；甲狀腺素；胰島素；前胰島素；鬆弛素；前鬆弛素；醣蛋白激素，諸如促濾泡激素(FSH)、促甲狀腺激素(TSH)及促黃體激素(LH)；肝生長因子；纖維母細胞生長因子；泌乳素；胎盤生乳素；腫瘤壞死因子-α及腫瘤壞死因子-β；苗勒抑制物質；小鼠促性腺激素相關肽；抑制素；活化素；血管內皮生長因子；整合素；血小板生成素(TPO)；神經生長因子，諸如NGF-β；血小板生長因子；轉型生長因子(TGF)，諸如TGF-α及TGF-β；胰島素樣生長因子-I及胰島素樣生長因子-II；紅血球生成素(EPO)；骨誘導因子；干擾素，諸如干擾素-α、干擾素-β及干擾素-γ；群落刺激因子(CSF)，諸如巨噬細胞-CSF(M-CSF)；顆粒球巨噬細胞-CSF(GM-CSF)；及顆粒球-CSF(G-CSF)；介白素(IL)，諸如IL-1、IL-1α、IL-2、IL-3、IL-4、IL-5、IL-6、IL-7、IL-8、IL-9、IL-10、IL-11、IL-12；腫瘤壞死因子，諸如TNF-α或TNF-β；及其他多肽因子(包括LIF及kit配體(KL))。如本文中所用之術語細胞激素包括來自天然來源或來自重組細胞培養物之蛋白質及天然序列細胞激素之生物學活性等效物。
本發明至少部分係關於某些HER2抗體組合物。HER2抗體(主要種類之HER2抗體及其抗體變異體中之任一者或兩者)較佳為結合至HER2結構域II、與曲妥珠單抗相比更有效抑制HER二聚化且/或結合至HER2之雜二聚結合位點的抗體。在本文中，主要種類之抗體之較佳實施例為包含SEQ ID No:3及4中之可變輕鏈及可變重鏈胺基酸序列之抗體，且最佳為包含SEQ ID No:15及16中之輕鏈及重鏈胺基酸序列之抗體(帕妥珠單抗)。
本文中之組合物包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體，其中該等酸性變異體包括糖化變異體、二硫鍵還原變異體及非可還原變異體中之一種、兩種或三種。該組合物中之酸性變異體可包括糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體中之一種、兩種、三種、四種或五種。組合物中所有酸性變異體之總量較佳小於約25%。在一實施例中，糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體構成組合物中酸性變異體之至少約75-80%。
本發明另外係關於一種如下組合物，其包含包括分別示於SEQ ID No:3及4中之可變輕鏈及可變重鏈序列的主要種類之HER2抗體及該主要種類之抗體之酸性變異體，其中該等酸性變異體包括糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體中之一種、兩種、三種、四種或五種。
本發明提供一種製備醫藥組合物之方法，其包含：(1)製備包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體的組合物，該等酸性變異體包括糖化變異體、二硫鍵還原變異體或非可還原變異體，及(2)評估該組合物中之該等酸性變異體，及確定其量小於約25%。該方法涵蓋在步驟(2)之前、期間或之後將該組合物與醫藥學上可接受之載劑組合。在一實施例中，步驟(2)中所評估之該組合物係在醫藥學上可接受之載劑中。
在一實施例中，至少約75-80%之酸性變異體(構成組合物之不及約25%)係選自：糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體。
可藉由各種方法來評估酸性變異體，但該等方法較佳包括以下方法中之一種、兩種、三種、四種或五種：離子交換層析法(IEC)，其中在IEC之前、之後及/或期間以唾液酸酶處理組合物(例如用於評估唾液酸化變異體)；還原CE-SDS(例如用於評估二硫鍵還原變異體)；非還原CE-SDS(例如用於評估非可還原變異體)；酸鹽層析法(例如用於評估糖化變異體)；及肽圖譜(例如用於評估去醯胺化變異體)。
在一實施例中，所有酸性變異體係藉由離子交換層析法，例如使用弱陽離子交換劑及/或具有羧酸鹽官能基之陽離子交換劑(例如使用DIONEX PROPACTM
WCX-10層析管柱))來評估。在該層析法之一實施例中，層析之條件包括緩衝液A：20mM BisTris(pH 6.0)；緩衝液B：20mM BisTris、200mM NaCl(pH 6.0)；及梯度：0.5%緩衝液B，1.0mL/min。
該組合物視情況包括胺基末端前導序列延伸變異體。胺基末端前導序列延伸較佳在抗體變異體之輕鏈上(例如在抗體變異體之一或兩條輕鏈上)。主要種類之HER2抗體或抗體變異體可為完整抗體或抗體片段(例如F(ab')2
片段之Fab)，但較佳為兩者均為完整抗體。本文中之抗體變異體可在其任何一或多條重鏈或輕鏈上包含胺基末端前導序列延伸。胺基末端前導序列延伸較佳在抗體之一或兩條輕鏈上。胺基末端前導序列延伸較佳包含VHS-或由VHS-組成。組合物中之胺基末端前導序列延伸之存在可藉由各種分析技術來偵測，該等分析技術包括(但不限於)N末端序列分析、電荷異質性檢定(例如陽離子交換層析法或毛細管區帶電泳)、質譜等。組合物中之抗體變異體之量通常介於構成用於偵測變異體之任何檢定(較佳為陽離子交換分析)的偵測下限之量至低於主要種類之抗體之量的量範圍內。一般而言，組合物中約20%或20%以下(例如約1%至約15%，例如5%至約15%，且較佳約8%至約12%)之抗體分子包含胺基末端前導序列延伸。該等百分比量較佳係使用陽離子交換分析來測定。
涵蓋主要種類之抗體之其他胺基酸序列變化及/或變異體，包括(但不限於)在一條或兩條重鏈上包含C末端離胺酸殘基之抗體(該類抗體變異體可以約1%至約20%之量存在)、具有一或多個經氧化甲硫胺酸殘基之抗體(例如包含經氧化met-254之帕妥珠單抗)等。
此外，除上述唾液酸化變異體以外，主要種類之抗體或變異體可包含其他糖基化變體，其非限制性實例包括：包含與Fc區連接之G1或G2寡醣結構的抗體、包含與輕鏈連接之碳水化合物部分(例如一或兩個與抗體之一或兩條輕鏈連接(例如與一或多個離胺酸殘基連接)之碳水化合物部分，諸如葡萄糖或半乳糖)的抗體、包含一或兩條未經糖基化之重鏈的抗體等。
視情況，該抗體包含一或兩條輕鏈，其中該等輕鏈中之任一者或兩者包含SEQ ID No:23中之胺基酸序列(包括其變異體，諸如本文中所揭示之彼等者)。該抗體另外包含一或兩條重鏈，其中該等重鏈中之任一者或兩者包含SEQ ID NO:16或SEQ ID NO:24中之胺基酸序列(包括其變異體，諸如本文中所揭示之彼等者)。
該組合物可自遺傳工程化細胞株(例如表現HER2抗體之中國倉鼠卵巢(CHO)細胞株)回收或可藉由肽合成來製備。
以下為關於用於產生根據本發明使用之抗體之例示性技術的描述。待用於產生抗體之HER2抗原可為(例如)可溶形式之HER2胞外結構域或其含有所需抗原決定基之部分。或者，可使用在細胞表面表現HER2之細胞(例如經轉型而過度表現HER2之NIH-3T3細胞；或癌細胞株，諸如SK-BR-3細胞，參見Stancovski等人，PNAS(USA)
88:8691-8695(1991))來產生抗體。適用於產生抗體之其他形式之HER2將為熟習此項技術者所顯而易見。
(i) 單株抗體
單株抗體係自一群大體上均質之抗體獲得，亦即構成該群之個別抗體除可在產生單株抗體期間產生之可能變異體(諸如本文所述之彼等變異體)以外為相同的且/或結合相同抗原決定基。因此，修飾語"單株"指示抗體不為離散抗體之混合物之特徵。
舉例而言，單株抗體可使用最先由Kohler等人，Nature,
256:495(1975)描述之融合瘤方法來製備，或可藉由重組DNA方法(美國專利第4,816,567號來製備)。
在融合瘤方法中，如上所述使小鼠或其他適當宿主動物(諸如倉鼠)免疫以激發產生或能夠產生將特異性結合至用於免疫之蛋白質之抗體的淋巴細胞。或者，可在活體外使淋巴細胞免疫。隨後使用合適融合劑(諸如聚乙二醇)使淋巴細胞與骨髓瘤細胞融合以形成融合瘤細胞(Goding,Monoclonal Antibodies:Principles and Practice
，第59-103頁(Academic Press,1986))。
將由此製備之融合瘤細胞接種且使之生長於合適培養基中，該培養基較佳含有一或多種可抑制未融合之親本骨髓瘤細胞之生長或存活的物質。舉例而言，若親本骨髓瘤細胞缺乏酶次黃嘌呤鳥嘌呤磷酸核糖基轉移酶(HGPRT或HPRT)，則用於融合瘤之培養基通常將包括次黃嘌呤、胺基喋呤及胸苷(HAT培養基)，該等物質阻止缺乏HGPRT之細胞生長。
較佳骨髓瘤細胞為彼等可有效融合、支持所選的產生抗體之細胞穩定高量產生抗體且對諸如HAT培養基之培養基敏感的骨髓瘤細胞。在該等骨髓瘤細胞中，較佳骨髓瘤細胞株為鼠類骨髓瘤株，諸如彼等源自MOPC-21及MPC-11小鼠腫瘤(可得自Salk Institute Cell Distribution Center,San Diego,California USA)以及SP-2或X63-Ag8-653細胞(可得自American Type Culture Collection,Rockville,Maryland USA)之骨髓瘤細胞株。亦已關於人類單株抗體之產生描述了人類骨髓瘤及小鼠-人類雜骨髓瘤細胞株(Kozbor,J. Immunol.，
133:3001(1984)；及Brodeur等人，Monoclonal Antibody Production Techniques and Applications
，第51-63頁(Marcel Dekker,Inc.,New York,1987))。
檢定融合瘤細胞所生長之培養基的針對抗原之單株抗體之產生。較佳地，藉由免疫沈澱或藉由活體外結合檢定(諸如放射免疫檢定(RIA)或酶聯免疫吸附檢定(ELISA))來測定由融合瘤細胞所產生之單株抗體之結合特異性。
單株抗體之結合親和力可(例如)藉由Munson等人，Anal. Biochem
.,107:220(1980)之斯卡查德(Scatchard)分析來測定。
在鑑別出產生具有所需特異性、親和力及/或活性之抗體的融合瘤細胞後，可藉由限制稀釋程序對純系進行次選殖且藉由標準方法使其生長(Goding,Monoclonal Antibodies：Principles and Practice
，第59-103頁(Academic Press,1986))。適用於此目的之培養基包括(例如)D-MEM或RPMI-1640培養基。此外，融合瘤細胞可作為腹水腫瘤生長於動物活體內。
藉由習知抗體純化程序將由次純系分泌之單株抗體自培養基、腹水流體或血清適當地分離，該等純化程序諸如蛋白A-瓊脂糖法、羥磷灰石層析法、凝膠電泳、透析或親和層析法。
使用習知程序(例如，藉由使用能夠特異性結合至編碼鼠類抗體重鏈及輕鏈之基因的寡核苷酸探針)來容易地將編碼單株抗體之DNA分離及定序。融合瘤細胞用作該DNA之較佳來源。一旦分離之後，可將DNA置於表現載體中，隨後將其轉染於不另外產生抗體蛋白之宿主細胞(諸如大腸桿菌(E. coli
)細胞、猿COS細胞、中國倉鼠卵巢(CHO)細胞或骨髓瘤細胞)中，以獲得單株抗體在重組宿主細胞中之合成。關於編碼抗體之DNA在細菌中之重組表現的評述文章包括Skerra等人，C u r r . O p i n i o n in Immunol
.,5:256-262(1993)及Plckthun,Immunol. Revs.,130:151-188(1992)。
在另一實施例中，單株抗體或抗體片段可自使用McCafferty等人，Nature
,348:552-554(1990)中所述之技術產生的抗體噬菌體庫分離。Clackson等人，Nature
,352:624-628(1991)及Marks等人，J. Mol. Biol
.,222:581-597(1991)分別描述使用噬菌體庫分離鼠類及人類抗體。後續公開案描述藉由鏈改組(Marks等人，Bio/Technology
,10:779-783(1992))以及組合感染及活體內再組合作為建構極大噬菌體庫之策略(Waterhouse等人，Nuc. Acids. Res
.,21:2265-2266(1993))來產生高親和力(nM範圍)人類抗體。因此，此等技術為對用於分離單株抗體之傳統單株抗體融合瘤技術的可行性替代方法。
DNA亦可(例如)藉由用人類重鏈及輕鏈恆定結構域之編碼序列取代同源鼠類序列(美國專利第4,816,567號；及Morrison等人，Proc. Netl Acad. Sci.
81:6851(1984))或藉由將非免疫球蛋白多肽之全部或部分編碼序列與免疫球蛋白編碼序列共價連接來修飾。
通常用該等非免疫球蛋白多肽取代抗體之恆定結構域，或用其取代抗體之一個抗原結合位點之可變結構域，以產生包含一個對某一抗原具有特異性之抗原結合位點及另一個對一不同抗原具有特異性之抗原結合位點的嵌合二價抗體。
(ii) 人類化抗體
此項技術中已描述人類化非人類抗體之方法。人類化抗體較佳具有一或多個自非人類來源引入之胺基酸殘基。該等非人類胺基酸殘基通常被稱為"輸入"殘基，其通常取自"輸入"可變結構域。人類化可基本上按照Winter及同事之方法(Jones等人，Nature
,321:522-525(1986)；Riechmann等人，Nature
,332:323-327(1988)；Verhoeyen等人，Science
,239:1534-1536(1988))，藉由用高變區序列取代人類抗體之相應序列來執行。因此，該等"人類化"抗體為嵌合抗體(美國專利第4,816,567號)，其中大體上不及完整人類可變結構域已由來自非人類物種之相應序列取代。實際上，人類化抗體通常為某些高變區殘基及可能之某些FR殘基由來自齧齒動物抗體中之類似位點之殘基取代的人類抗體。
對待用於製備人類化抗體之人類可變結構域(輕鏈與重鏈)之選擇對降低抗原性極其重要。根據所謂"最適合(best-fit)"方法，針對整個已知人類可變結構域序列庫篩選齧齒動物抗體之可變結構域序列。隨後將最接近於齧齒動物之序列的人類序列視作人類化抗體之人類構架區(FR)(Sims 等人，J. Im munol.
,151:2296(1993)；Chothia等人，J. Mol. Biol.
,196:901(1987))。另一方法使用源自輕鏈或重鏈之特定亞群的所有人類抗體之一致序列的特定構架區。相同構架可用於若干不同之人類化抗體(Carter等人，Proc. Natl
.Acad
.Sci. USA
,89:4285(1992)；Presta等人，J. Immunol.
,151:2623(1993))。
更為重要的是將抗體人類化但保留對抗原之高親和力及其他有利生物學特性。為達成該目標，根據一較佳方法，藉由使用親本及人類化序列之三維模型分析親本序列及各種概念性人類化產物的方法來製備人類化抗體。三維免疫球蛋白模型通常為可利用的且為熟習此項技術者所熟悉。可利用電腦程式，其例示且展現所選候選免疫球蛋白序列之可能的三維構形結構。對該等展現之檢查允許分析殘基在候選免疫球蛋白序列起作用時之可能作用，亦即分析影響候選免疫球蛋白結合其抗原之能力的殘基。以此方式，可自受體及輸入序列選擇FR殘基且加以組合以便獲得所需抗體特徵(諸如對標靶抗原之親和力增加)。一般而言，高變區殘基直接且在很大程度上涉及影響抗原結合。
美國專利第6,949,245號描述結合HER2且阻斷HER受體之配體活化的例示性人類化HER2抗體之產生。本文中備受關注之人類化抗體基本上與完整鼠類單株抗體2C4(或其Fab片段)同樣有效地阻斷EGF、TGF-a及/或HRG介導之MAPK活化，且/或基本上與完整鼠類單株抗體2C4(或其Fab片段)同樣有效地結合HER2。本文中之人類化抗體可(例如)包含併入人類可變重鏈結構域中之非人類高變區殘基，且可另外在選自由以下位置組成之群之位置處包含構架區(FR)取代：69H、71H及73H(利用Kabat等人，Sequences of Proteins of Immunological Interest
，第5版，Public Health Service,National Institutes of Health,Bethesda,MD(1991)中所述之可變結構域編號系統所編號)。在一實施例中，人類化抗體在位置69H、71H及73H中之兩者或所有位置處包含FR取代。
本文中所關注之例示性人類化抗體包含可變重鏈互補決定殘基GFTFTDYTMX，其中X較佳為D或S(SEQ ID NO:7)；DVNPNSGGSIYNQRFKG(SEQ ID NO:8)；及/或NLGPSFYFDY(SEQ ID NO:9)，視情況包含彼等CDR殘基之胺基酸修飾，(例如)在該等修飾基本上保持或改良抗體之親和力的情況下。舉例而言，所關注之抗體變異體可在以上可變重鏈CDR序列中具有約一個至約七個或約五個胺基酸取代。該等抗體變異體可藉由(例如)下述親和力成熟來製備。最佳人類化抗體包含SEQ ID NO:4中之可變重鏈胺基酸序列。
人類化抗體(例如)除前段中之彼等可變重鏈結構域CDR殘基以外可包含可變輕鏈互補決定殘基KASQDVSIGVA(SEQ ID NO:10)；SASYX1
X2
X3
，其中X1
較佳為R或L，X2
較佳為Y或E，且X3
較佳為T或S(SEQ ID NO:11)；及/或QQYYIYPYT(SEQ ID NO:12)。該等人類化抗體視情況包含上述CDR殘基之胺基酸修飾，(例如)在該等修飾基本上保持或改良抗體之親和力的情況下。舉例而言，所關注之抗體變異體可在以上可變輕鏈CDR序列中具有約一個至約七個或約五個胺基酸取代。該等抗體變異體可藉由(例如)下述親和力成熟來製備。最佳人類化抗體包含SEQ ID NO:3中之可變輕鏈胺基酸序列。
本申請案亦涵蓋結合HER2且阻斷HER受體之配體活化的親和力成熟抗體。親本抗體可為人類抗體或人類化抗體，例如包含分別為SEQ ID No:3及4之可變輕鏈及/或可變重鏈序列的抗體(亦即變異體574)。親和力成熟抗體較佳以優於完整鼠類2C4或完整變異體574之親和力的親和力結合至HER2受體(例如約2倍或約4倍至約100倍或約1000倍改良之親和力，(例如)如使用HER2胞外結構域(ECD)ELISA來評估)。適於取代之例示性可變重鏈CDR殘基包括H28、H30、H34、H35、H64、H96、H99或兩者或兩者以上之組合(例如該等殘基中之兩個、三個、四個、五個、六個或七個)。適於改變之可變輕鏈CDR殘基之實例包括L28、L50、L53、L56、L91、L92、L93、L94、L96、L97或兩者或兩者以上之組合(例如該等殘基中之兩個至三個、四個、五個或達約十個)。
涵蓋各種形式之人類化抗體或親和力成熟抗體。舉例而言，人類化抗體或親和力成熟抗體可為抗體片段，諸如Fab，其視情況與一或多種細胞毒性劑結合以產生免疫結合物。或者，人類化抗體或親和力成熟抗體可為完整抗體，諸如完整IgG1抗體。
(iii) 人類抗體
作為人類化之替代，可產生人類抗體。舉例而言，現在有可能產生轉殖基因動物(例如小鼠)，其在免疫後能夠在無內源性免疫球蛋白產生之情況下產生人類抗體之完整譜系。舉例而言，已描述嵌合及生殖系突變小鼠體內之抗體重鏈連接區域(JH
)基因之純合性缺失導致內源性抗體產生受到完全抑制。人類生殖系免疫球蛋白基因陣列轉移於該等生殖系突變小鼠中將在抗原激發後引起人類抗體之產生。參見例如Jakobovits等人，Proc. Natl. Acad. Sci. USA
,90:2551(1993)；Jakobovits等人，Nature
,362:255-258(1993)；Bruggermann等人，Year in Immuno.
,7:33(1993)；及美國專利第5,591,669號、第5,589,369號及第5,545,807號。
或者，可使用噬菌體呈現技術(McCafferty等人，Nature
348:552-553(1990))在活體外自未經免疫之供體之免疫球蛋白可變(V)結構域基因譜系產生人類抗體及抗體片段。根據該技術，將抗體V結構域基因同框選殖於絲狀噬菌體(諸如M13或fd)之主要或次要外殼蛋白基因中，且作為功能性抗體片段呈現於噬菌體粒子之表面上。由於絲狀粒子含有噬菌體基因組之單鏈DNA複本，故基於抗體之功能特性之選擇亦導致選擇編碼展現彼等特性之抗體的基因。因此，噬菌體模擬B細胞之一些特性。可以各種形式執行噬菌體呈現；關於其綜述，參見(例如)Johnson,Kevin S. 及Chiswell,David J.,Current Opinion in Structural Biology
3:564-571(1993)。V基因片段之若干來源可用於噬菌體呈現。Clackson等人，Nature
,352:624-628(1991)自源自經免疫小鼠之脾臟的V基因之小隨機組合庫分離出不同抗噁唑酮抗體陣列。可建構未經免疫之人類供體之V基因的譜系且不同抗原(包括自體抗原)陣列之抗體可基本上按照由Marks等人，J. Mol. Biol.
222:581-597(1991)或Griffith等人，EMBO J.
12:725-734(1993)所述之技術來分離。亦參見美國專利第5,565,332號及第5,573,905號。
人類抗體亦可由活體外活化B細胞產生(參見美國專利5,567,610及5,229,275)。
人類HER2抗體係描述於1998年6月30日頒布之美國專利第5,772,997號及1997年1月3日公開之WO 97/00271中。
(iv)抗體片段
已開發各種技術用於產生抗體片段。傳統上，該等片段係經由蛋白水解消化完整抗體而獲得(參見(例如)Morimoto等人，Journal of Biochemical and Biophysical Methods
24:107-117(1992)；及Brennan等人，Science
,229:81(1985))。然而，該等片段現在可直接由重組宿主細胞產生。舉例而言，抗體片段可自上述抗體噬菌體庫分離。或者，可直接自大腸桿菌回收Fab'-SH片段且使其化學偶合以形成F(ab')2
片段(Carter等人，Bio/Technology
10:163-167(1992))。根據另一方法，可直接自重組宿主細胞培養物分離F(ab')2
片段。用於產生抗體片段之其他技術將為熟習此項技術者顯而易見。在其他實施例中，所選抗體為單鏈Fv片段(scFv)。參見WO 93/16185；美國專利第5,571,894號；及美國專利第5,587,458號。抗體片段亦可(例如)如美國專利第5,641,870號中所述為"線性抗體"。該等線性抗體片段可為單特異性或雙特異性抗體。
(v)雙特異性抗體
雙特異性抗體為對至少兩個不同抗原決定基具有結合特異性之抗體。例示性雙特異性抗體可結合至HER2蛋白之兩個不同抗原決定基。其他該等抗體可組合HER2結合位點與EGFR、HER3及/或HER4之結合位點。或者，HER2臂可與結合至白血球上之觸發分子(諸如T細胞受體分子，例如CD2或CD3；或IgG之Fc受體(FcγR)，諸如FcγRI(CD64)、FcγRII(CD32)及FcγRIII(CD16))的臂組合，以便將細胞防禦機制集中於表現HER2之細胞。雙特異性抗體亦可用於針對表現HER2之細胞定位細胞毒性劑。此等抗體具有HER2結合臂及結合細胞毒性劑(例如，沙泊寧(saporin)、抗干擾素-α、長春花生物鹼、蓖麻毒素A鏈、甲胺喋呤或放射性同位素半抗原)之臂。雙特異性抗體可以全長抗體或抗體片段形式製備(例如F(ab')2
雙特異性抗體)。
WO 96/16673描述一種雙特異性HER2/FcγRIII抗體，且美國專利第5,837,234號揭示一種雙特異性HER2/FcγRI抗體IDM1(Osidem)。WO 98/02463中展示一種雙特異性HER2/Fcα抗體。美國專利第5,821,337號教示一種雙特異性HER2/CD3抗體。MDX-210為一種雙特異性HER2-FcγRIII Ab。
用於製備雙特異性抗體之方法在此項技術中已知。全長雙特異性抗體之傳統製備係基於兩對免疫球蛋白重鏈-輕鏈之共表現，其中該兩鏈具有不同特異性(Millstein等人，Nature
,305:537-539(1983))。由於免疫球蛋白重鏈與輕鏈之隨機分配，故該等融合瘤(四源雜交瘤(quadromas))產生10種不同抗體分子之可能混合物，其中僅一種具有正確雙特異性結構。通常藉由親和層析步驟進行之正確分子之純化相當繁瑣，且產物產率低。類似程序揭示於WO 93/08829及Traunecker等人，EMBO J.,
10:3655-3659(1991)中。
根據一種不同方法，使具有所需結合特異性之抗體可變結構域(抗體-抗原結合位點)與免疫球蛋白恆定結構域序列融合。較佳與一個包含鉸鏈區、CH
2及CH
3區域之至少一部分的免疫球蛋白重鏈恆定結構域融合。較佳使含有輕鏈結合所需位點的第一重鏈恆定區(CH
1)存在於融合物之至少一者中。將編碼免疫球蛋白重鏈融合物及(若需要)免疫球蛋白輕鏈之DNAs插入各別表現載體中，且共轉染至適合之宿主生物體中。當不等比率之用於建構之三個多肽鏈提供最佳產率時，此提供調節實施例中三個多肽片段之相互比例的極大彈性。然而，當等比率之至少兩個多肽鏈的表現產生高產率時或當比率並非特別重要時，可將兩個或所有三個多肽鏈之編碼序列插入一個表現載體中。
在該方法之一個較佳實施例中，雙特異性抗體係由一臂中具有第一結合特異性之雜合免疫球蛋白重鏈及另一臂中之雜合免疫球蛋白重鏈-輕鏈對(提供第二結合特異性)組成。已發現此不對稱結構有助於所需雙特異性化合物與非所要之免疫球蛋白鏈組合分離，因為免疫球蛋白輕鏈僅存在一半雙特異性分子中提供一種容易分離方式。該方法揭示於WO 94/04690中。產生雙特異性抗體之更多詳情參見例如Suresh等人，Methods in Enzymology
121:210(1986)。
根據美國專利第5,731,168號中所述之另一方法，可將抗體分子對之間的界面工程化以使自重組細胞培養物回收之雜二聚體之百分比最大化。較佳界面包含抗體恆定結構域之CH
3結構域之至少一部分。在此方法中，來自第一抗體分子界面之一或多個小胺基酸側鏈經較大側鏈(例如酪胺酸或色胺酸)置換。藉由以較小胺基酸側鏈(例如丙胺酸或蘇胺酸)置換較大胺基酸側鏈而於第二抗體分子之界面上產生具有與大側鏈相同或類似之尺寸的補償性"空穴"。此提供一種使雜二聚體之產率增加超過其他非所要之終產物(諸如均二聚體)的機制。
雙特異性抗體包括交聯抗體或"雜結合"抗體。舉例而言，雜結合物中之抗體中的一者可與抗生物素蛋白偶合，另一者可與生物素偶合。舉例而言，已提出該等抗體使免疫系統細胞靶向不需要之細胞(美國專利第4,676,980號)，且用於治療HIV感染(WO 91/00360、WO 92/200373及EP 03089)。雜結合抗體可使用任何適宜交聯方法來製備。合適之交聯劑在此項技術中係熟知的，且與許多交聯技術一起揭示於美國專利第4,676,980號中。
用於自抗體片段產生雙特異性抗體之技術亦已描述於文獻中。舉例而言，雙特異性抗體可使用化學鍵聯來製備。Brennan等人，Science
,229:81(1985)描述一種使完整抗體蛋白分解裂解以產生F(ab')2
片段之程序。在二硫醇錯合劑亞砷酸鈉存在下將此等片段還原以使鄰近二硫醇穩定且阻止形成分子間二硫鍵。隨後將所產生之Fab'片段轉化為硫代硝基苯甲酸酯(TNB)衍生物。隨後藉由以巰基乙胺還原將Fab'-TNB衍生物之一者再轉化為Fab'-硫醇，且將其與等莫耳量之另一Fab'-TNB衍生物混合以形成雙特異性抗體。所產生之雙特異性抗體可用作用於選擇性固定酶之試劑。
近期之發展有助於自大腸桿菌直接回收Fab'-SH片段，可以化學方法使該等片段偶合以形成雙特異性抗體。Shalaby等人，J. Exp. Med.
,175:217-225(1992)描述完全人類化雙特異性抗體F(ab')2
分子之產生。自大腸桿菌獨立地分泌各Fab'片段且使其經受活體外定向化學偶合以形成雙特異性抗體。由此形成之雙特異性抗體能夠與過度表現HER2受體之細胞及正常人類T細胞結合，且觸發人類細胞毒性淋巴細胞對人類乳腺腫瘤標靶之溶解活性。
亦已描述用於直接自重組細胞培養物製備且分離雙特異性抗體片段之各種技術。舉例而言，已使用白胺酸拉鏈產生雙特異性抗體。Kostelny等人，J. Immunol.
,148(5):1547-1553(1992)。藉由基因融合將來自Fos及Jun蛋白之白胺酸拉鏈肽與兩個不同抗體之Fab'部分連接。在鉸鏈區還原抗體均二聚體以形成單體，且隨後再氧化以形成抗體雜二聚體。該方法亦可用於產生抗體均二聚體。Hollinger等人，Proc. Natl. Acad. Sci. USA
,90:6444-6448(1993)所述之"雙功能抗體"技術為製備雙特異性抗體片段提供一種替代性機制。該等片段包含藉由過短而使得同一鏈上之兩個結構域間無法配對的連接子連接於輕鏈可變結構域(VL
)之重鏈可變結構域(VH
)。因此，迫使一個片段之VH
及VL
結構域與另一片段之互補VL
及VH
結構域配對，由此形成兩個抗原結合位點。亦已報導另一種藉由使用單鏈Fv(sFv)二聚體來製備雙特異性抗體片段之策略。參見Gruber等人，J. Immunol
.,152:5368(1994)。
涵蓋具有2以上之價數的抗體。舉例而言，可製備三特異性抗體。Tutt等人J. Immunol
. 147:60(1991)。
(vi)其他胺基酸序列修飾
涵蓋本文中所述之HER2抗體的胺基酸序列修飾。舉例而言，可希望改良抗體之結合親和力及/或其他生物學特性。HER2抗體之胺基酸序列變異體係藉由將適當核苷酸變化引入HER2抗體核酸中或藉由肽合成來製備。此等修飾包括(例如)HER2抗體胺基酸序列內之殘基的缺失及/或插入及/或取代。進行缺失、插入及取代之任何組合以獲得最終構築體，其限制條件為最終構築體具有所需特徵。胺基酸變化亦可改變HER2抗體之轉譯後加工，諸如改變糖基化位點之數目或位置。
適用於鑑別HER2抗體中為適於突變誘發之較佳位置之特定殘基或區域的方法被稱作"丙胺酸掃描突變誘發"，如Cunningham及Wells,Science
,244：1081-1085(1989)所述。此處，一個殘基或一組標靶殘基經鑑別(例如帶電殘基，諸如arg、asp、his、lys及glu)且經中性或帶負電之胺基酸(最佳為丙胺酸或聚丙胺酸)置換以影響胺基酸與抗原之相互作用。隨後，藉由在取代位點處或針對取代位點引入另外或其他變異體來改進彼等對取代顯示功能敏感性之胺基酸位置。因此，雖然預先確定用於引入胺基酸序列變異之位點，但突變之性質本身無需預定。舉例而言，為分析給定位點處之突變的效能，在標靶密碼子或區域處執行ala掃描或隨機突變誘發且針對所需活性篩選所表現之HER2抗體變異體。
胺基酸序列插入物包括長度為一個殘基至含有一百個或一百個以上殘基之多肽的胺基及/或羧基末端融合物以及具有單個或多個胺基酸殘基之序列內插入物。末端插入物之實例包括具有N末端甲硫胺醯基殘基之抗體或融合至細胞毒性多肽之抗體。HER2抗體分子之其他插入變異體包括HER2抗體之N末端或C末端與酶(例如，對於ADEPT而言)或增加抗體之血清半衰期之多肽的融合物。
另一類變異體為胺基酸取代變異體。該等變異體在HER2抗體分子中具有至少一個經不同殘基置換之胺基酸殘基。最受關注之適於取代突變之位點包括高變區或CDR，但亦涵蓋FR或Fc區變化。保守性取代係以標題"較佳取代"展示於表1中。若該等取代導致生物學活性變化，則可引入更多實質性改變(表1稱為"例示性取代"，或如下文關於胺基酸類別進一步描述)，且篩選產物。
對抗體生物學特性之實質性修飾係藉由選擇取代來達成，該等取代在其對保持以下特徵之效應方面顯著不同：(a)在取代區域中多肽骨架之結構，例如呈摺疊或螺旋構形；(b)標靶位點處之分子之電荷或疏水性；或(c)側鏈之堆積。可根據側鏈特性之類似性將胺基酸分類(在A. L. Lehninger，Biochemistry，第二版，第73-75頁，Worth Publishers，New York(1975)中)：
(1)非極性：Ala(A)、Val(V)、Leu(L)、Ile(I)、Pro(P)、Phe(F)、Trp(W)、Met(M)；
(2)不帶電極性：Gly(G)、Ser(S)、Thr(T)、Cys(C)、Tyr(Y)、Asn(N)、Gln(Q)；
(3)酸性：Asp(D)、Glu(E)；
(4)鹼性：Lys(K)、Arg(R)、His(H)。
或者，可基於共同的側鏈特性將天然存在之殘基分為下列各組：
(1)疏水性：正白胺酸、Met、Ala、Val、Leu、Ile；
(2)中性親水性：Cys、Ser、Thr、Asn、Gln；
(3)酸性：Asp、Glu；
(4)鹼性：His、Lys、Arg；
(5)影響鏈取向之殘基：Gly、Pro；
(6)芳族：Trp、Tyr、Phe。
非保守性取代將需要將該等類別中之一者的成員交換為另一類別。
亦可通常以絲胺酸取代不涉及維持HER2抗體之適當構形的任何半胱胺酸殘基以改良分子之氧化穩定性且防止異常交聯。相反地，可將半胱胺酸鍵添加至抗體中以改良其穩定性(尤其在抗體為抗體片段(諸如Fv片段)之情況下)。
尤其較佳之取代變異體類型包括取代親本抗體(例如人類化或人類抗體)之一或多個高變區殘基。一般而言，為進一步發展而選擇之所得變異體相對於產生其之親本抗體而言將具有改良之生物學特性。用於產生該等取代變異體之適宜方式包括使用噬菌體呈現進行之親和力成熟。簡言之，使若干高變區位點(例如，6-7個位點)突變以於各位點處產生所有可能之胺基取代。由此產生之抗體變異體係以單價方式自絲狀噬菌體粒子作為與封裝於各粒子內之M13之基因III產物的融合物呈現。隨後如本文中所揭示針對生物學活性(例如結合親和力)篩選噬菌體呈現之變異體。為鑑別修飾之候選高變區位點，可執行丙胺酸掃描突變誘發以鑑別顯著促成抗原結合之高變區殘基。或者或另外，分析抗原-抗體複合物之晶體結構以鑑別抗體與人類HER2之間的接觸點可為有益的。根據本文中詳述之技術，該等接觸殘基及相鄰殘基為進行取代之候選者。一旦產生該等變異體後，如本文所述使變異體組經受篩選，且可為進一步發展而選擇在一或多個相關檢定中具有優良特性之抗體。
抗體之另一類胺基酸變異體改變抗體之原始糖基化模式。改變意謂刪除抗體中所存在之一或多個碳水化合物部分及/或添加不存在於抗體中之一或多個糖基化位點。
抗體之糖基化通常為N連接或O連接。N連接係指碳水化合物部分與天冬醯胺殘基之側鏈連接。三肽序列天冬醯胺-X-絲胺酸及天冬醯胺-X-蘇胺酸(其中X為除脯胺酸外之任何胺基酸)為碳水化合物部分酶促連接於天冬醯胺側鏈之識別序列。因此，多肽中此等三肽序列中之任一者的存在產生潛在的糖基化位點。O連接之糖基化係指糖N-乙醯半乳糖胺、半乳糖或木糖中之一者與羥基胺基酸連接，該羥基胺基酸最通常為絲胺酸或蘇胺酸，但亦可使用5-羥基脯胺酸或5-羥基離胺酸。
向抗體中添加糖基化位點係藉由改變胺基酸序列以使其含有上述三肽序列中之一或多者來方便地達成(對於N連接糖基化位點而言)。亦可藉由將一或多個絲胺酸或蘇胺酸殘基添加至原始抗體之序列中或以該(等)絲胺酸或蘇胺酸殘基取代原始抗體之序列來進行改變(對於O連接糖基化位點而言)。
在抗體包含Fc區之情況下，可改變與其連接之任何寡醣結構。舉例而言，美國專利申請案第US 2003/0157108 A1號(Presta,L.)中描述具有缺乏連接於抗體Fc區之海藻糖的成熟碳水化合物結構之抗體。亦參見US 2004/0093621 A1(Kyowa Hakko Kogyo Co.,Ltd)。WO 03/011878(Jean-Mairet等人)及美國專利第6,602,684號(Umana等人)中提到在連接至抗體Fc區之寡醣結構中具有對分N-乙醯基葡萄胺糖(GlcNAc)之抗體。WO 97/30087(Patel等人)報導在連接至抗體Fc區之寡醣結構中具有至少一個半乳糖殘基的抗體。關於具有連接至Fc區之改變之碳水化合物的抗體，亦參見WO 98/58964(Raju,S.)及WO 99/22764(Raju,S.)。本文中涵蓋包含主要種類之抗體且該主要種類之抗體具有連接至Fc區一或兩條重鏈之該等碳水化合物結構的抗體組合物。
藉由此項技術中已知之各種方法來製備編碼HER2抗體之胺基酸序列變異體的核酸分子。該等方法包括(但不限於)：自天然來源分離(在天然存在之胺基酸序列變異體之情況下)，或藉由對早先製備之HER2抗體之變異體或非變異型式進行寡核苷酸介導(或定點)之突變誘發、PCR突變誘發及盒式突變誘發來製備。
(vii)篩選具有所需特性之抗體
上文已描述用於產生抗體之技術。可視需要進一步選擇具有特定生物學特性之抗體。
為鑑別阻斷HER受體之配體活化的抗體，可測定抗體阻斷HER配體結合至表現HER受體之細胞(例如與另一HER受體結合，所關注之HER受體與該另一HER受體形成HER雜寡聚物)的能力。舉例而言，可將天然表現或經轉染而表現HER雜寡聚物之HER受體的細胞與抗體一起培育且隨後暴露於經標記之HER配體。可隨後評估HER2抗體阻斷配體結合至HER雜寡聚物中之HER受體之能力。
舉例而言，可基本上如WO 01/00245中所述以24孔板形式在冰上使用單層MCF7培養物執行HER2抗體對HRG結合至MCF7乳腺腫瘤細胞株之抑制。可將HER2單株抗體添加至各孔中且培育30分鐘。可隨後添加125
I標記之rHRGβ1177-224
(25pm)，且可繼續培育4至16小時。可製作劑量反應曲線且可針對所關注之抗體計算IC50
值。在一實施例中，阻斷HER受體之配體活化的抗體在該檢定中對於抑制HRG結合至MCF7細胞而言將具有約50nM或50nM以下、更佳10nM或10nM以下之IC50
值。若抗體為抗體片段(諸如Fab片段)，則在該檢定中關於抑制HRG結合至MCF7細胞之IC50
值可(例如)為約100nM或100nM以下，更佳為50nM或50nM以下。
或者或另外，可評估HER2抗體阻斷存在於HER雜寡聚物中之HER受體的HER配體刺激之酪胺酸磷酸化之能力。舉例而言，可將內源表現HER受體或經轉染而表現該等受體之細胞與抗體一起培育，且隨後使用抗磷酸化酪胺酸單株(其視情況與可偵測標記結合)來檢定HER配體依賴性酪胺酸磷酸化活性。美國專利第5,766,863號中所述之激酶受體活化檢定亦可用於測定HER受體活化及抗體對該活性之阻斷。
在一實施例中，可基本上如WO 01/00245中所述篩選抑制MCF7細胞中p180酪胺酸磷酸化之HRG刺激的抗體。舉例而言，可將MCF7細胞塗佈於24孔板中，且可將HER2之單株抗體添加至各孔中且在室溫下培育30分鐘；隨後可將rHRGβl177-244
添加至各孔中至0.2nM之最終濃度，且可繼續培育8分鐘。可自各孔吸出培養基，且可藉由添加100μl SDS樣品緩衝液(5% SDS、25mM DTT及25mM Tris-HCl(pH 6.8))來中止反應。可使各樣品(25μl)在4-12%梯度之凝膠(Novex)上電泳且隨後電泳轉移至聚偏二氟乙烯膜上。可顯現抗磷酸化酪胺酸(1μg/ml)免疫印跡，且在Mr
-180,000處之主要反應條帶之強度可藉由反射密度測定法來定量。在該檢定中，所選抗體較佳為顯著地將p180酪胺酸磷酸化之HRG刺激抑制至對照組之約0-35%。可製作關於抑制p180酪胺酸磷酸化之HRG刺激(如由反射密度測定法所測定)的劑量-反應曲線，且可計算所關注抗體之IC50
值。在一實施例中，阻斷HER受體之配體活化的抗體在該檢定中對於抑制p180酪胺酸磷酸化之HRG刺激而言將具有約50nM或50nM以下、更佳10nM或10nM以下之IC50
值。若抗體為抗體片段(諸如Fab片段)，則在該檢定中關於抑制p180酪胺酸磷酸化之HRG刺激的IC50
值可(例如)為約100nM或100nM以下，更佳為50nM或50nM以下。
亦可基本上如Schaefer等人，Oncogene
15:1385-1394(1997)中所述評估抗體對MDA-MB-175細胞之生長抑制作用。根據該檢定，可將MDA-MB-175細胞以HER2單株抗體(10μg/mL)處理4日且用結晶紫染色。與HER2抗體一起培育可顯示對該細胞株有類似於單株抗體2C4所呈現之生長抑制作用。在另一實施例中，外源HRG不會顯著地逆轉該抑制作用。較佳地，在有外源HRG與無外源HRG之情況下，該抗體將能夠在比單株抗體4D5大之程度上(且視情況在比單株抗體7F3大之程度上)抑制MDA-MB-175細胞之細胞增殖。
在一實施例中，如諸如WO 01/00245中所述之共免疫沈澱實驗中所測定，所關注之HER2抗體可比單株抗體4D5且較佳比單株抗體7F3大體上更有效地阻斷MCF7與SK-BR-3細胞中HER2與HER3之和瑞古林依賴性結合。
為鑑別生長抑制性HER2抗體，可篩選抑制過度表現HER2之癌細胞生長的抗體。在一實施例中，所選生長抑制性抗體能夠在約0.5至30μg/ml之抗體濃度下將細胞培養物中SK-BR-3細胞之生長抑制約20-100%，且較佳抑制約50-100%。為鑑別該等抗體，可執行美國專利第5,677,171號中所述之SK-BR-3檢定。根據該檢定，使SK-BR-3細胞生長在補充有10%胎牛血清、麩胺醯胺及青黴素鏈黴素之F12與DMEM培養基之1:1混合物中。將SK-BR-3細胞以20,000個細胞塗佈於35mm細胞培養皿中(每35mm培養皿2ml)。每個培養皿添加0.5至30μg/ml HER2抗體。在六日之後，使用電子COULTERTM
細胞計數器，與未處理細胞對比來計數細胞數。彼等將SK-BR-3細胞之生長抑制約20-100%或約50-100%之抗體可被選為生長抑制性抗體。關於用於篩選生長抑制性抗體(諸如4D5及3E8)之檢定，參見美國專利第5,677,171號。
為選擇誘導細胞凋亡之抗體，可利用使用BT474細胞之膜聯蛋白結合檢定。如前段所述，培養BT474細胞且將其接種於培養皿中。隨後，移除培養基且置換為單獨的新鮮培養基或含有10μg/ml單株抗體之培養基。繼三日培育時段之後，將單層以PBS洗滌且藉由胰蛋白酶化分離。隨後將細胞離心，再懸浮於Ca2+
結合緩衝液中且等分至管中(如上所述)以進行細胞死亡檢定。隨後管接收經標記之膜聯蛋白(例如膜聯蛋白V-FTIC)(1μg/ml)。可使用FACSCANTM
流式細胞儀及FACSCONVERTTM
CellQuest軟體(Becton Dickinson)分析樣品。將相對於對照組誘導統計學上顯著之膜聯蛋白結合量的彼等抗體選為細胞凋亡誘導抗體。除膜聯蛋白結合檢定以外，可利用使用BT474細胞之DNA染色檢定。為執行該檢定，將已如前兩段中所述用所關注之抗體處理之BT474細胞在37℃下與9μg/ml HOECHST 33342TM
一起培育2h，隨後在EPICS ELITETM
流式細胞儀(Coulter Corporation)上使用MODFIT LTTM
軟體(Verity Software House)加以分析。與未處理細胞(達100%凋亡細胞)相比誘導2倍或2倍以上(且較佳為3倍或3倍以上)之凋亡細胞百分比變化的抗體可使用該檢定被選為促細胞凋亡抗體。關於用於篩選誘導細胞凋亡之抗體(諸如7C2及7F3)之檢定，參見WO 98/17797。
為篩選結合至由所關注抗體結合之HER2上的抗原決定基之抗體，可執行諸如Antibodies,A Laboratory Manual
,Cold Spring Harbor Laboratory,Harlow及David Lane編(1988)中所述之常規交叉阻斷檢定以評估抗體是否交叉阻斷諸如2C4或帕妥珠單抗之抗體與HER2之結合。或者或另外，可藉由此項技術中已知之方法執行抗原決定基定位，且/或可研究抗體-HER2結構(Franklin等人，Cancer Cell
5:317-328(2004))以發現HER2之何結構域為抗體所結合。
(viii)免疫結合物
本發明亦係關於包含結合至細胞毒性劑之抗體的免疫結合物，該細胞毒性劑諸如化學治療劑、毒素(例如小分子毒素或細菌、真菌、植物或動物來源之酶促活性毒素，包括其片段及/或變異體)或放射性同位素(亦即放射性結合物)。
上文已描述適用於產生該等免疫結合物之化學治療劑。本文中亦涵蓋抗體與一或多個小分子毒素(諸如卡奇黴素(calicheamicin)、美登素(maytansine)(美國專利第5,208,020號)、單端孢黴烯(trichothecene)及CC1065)之結合物。
在本發明之一較佳實施例中，抗體與一或多個美登素分子(例如每個抗體分子約1至約10個美登素分子)結合。美登素可(例如)轉化為May-SS-Me，其可還原為May-SH3且與經修飾抗體(Chari等人，Cancer Research
52:127-131(1992))反應以產生美登素類-抗體免疫結合物。
所關注之另一免疫結合物包含結合至一或多個卡奇黴素分子之HER2抗體。卡奇黴素抗生素家族能夠於亞皮莫耳濃度下產生雙鏈DNA斷裂。可使用之卡奇黴素之結構類似物包括(但不限於)γ1 I
、α2 I
、α3 I
、N-乙醯基-γ1 I
、PSAG及θI 1
(Hinman等人，Cancer Research
53:3336-3342 (1993)及Lode等人，Cancer Research
58:2925-2928 (1998))。亦參見美國專利第5,714,586號；第5,712,374號；第5,264,586號；及第5,773,001號，該等專利係以引用的方式明確地併入本文中。
可使用之酶促活性毒素及其片段包括：白喉A鏈、白喉毒素之非結合活性片段、外毒素A鏈(來自綠膿桿菌(Pseudomonas aeruginosa
))、蓖麻毒素A鏈、相思豆毒素A鏈、莫迪素(modeccin)A鏈、α-帚麴菌素(alpha-sarcin)、油桐(Aleurites fordii
)蛋白、康乃馨(dianthin)蛋白、美洲商陸(Phytolaca americana
)蛋白(PAPI、PAPII及PAP-S)、苦瓜(momordica charantia)抑制劑、麻瘋樹毒蛋白(curcin)、巴豆毒素(crotin)、肥皂草(sapaonaria officinalis)抑制劑、白樹素(gelonin)、有絲分裂素(mitogellin)、侷限麴菌素(restrictocin)、酚黴素(phenomycin)、伊諾黴素(enomycin)及黴菌毒素(tricothecene)。參見(例如)1993年10月28日公開之WO 93/21232。
本發明另外涵蓋抗體與具有核分解活性之化合物(例如核糖核酸酶或DNA核酸內切酶，諸如脫氧核糖核酸酶；DNase)之間所形成的免疫結合物。
各種放射性同位素可用於產生放射性結合HER2抗體。實例包括At211
、I131
、I125
、Y90
、Re186
、Re188
、Sm153
、Bi212
、P32
及Lu之放射性同位素。
抗體與細胞毒性劑之結合物可使用各種雙官能蛋白質偶合劑來製備，該等蛋白質偶合劑諸如N-丁二醯亞胺基-3-(2-吡啶基二硫醇)丙酸酯(SPDP)、丁二醯亞胺基-4-(N-順丁烯二醯亞胺基甲基)環己烷-1-甲酸酯、亞胺基硫雜環戊烷(IT)、亞胺基酯之雙官能衍生物(諸如己二亞胺二甲酯鹽酸鹽)、活性酯(諸如辛二酸二丁二醯亞胺酯)、醛類(諸如戊二醛)、雙疊氮基化合物(諸如雙(對疊氮基苄醯基)己二胺)、雙重氮鎓衍生物(諸如雙-(對重氮鎓苄醯基)-乙二胺)、二異氰酸酯(諸如甲苯2,6-二異氰酸酯)及雙活性氟化合物(諸如1,5-二氟-2,4-二硝基苯)。舉例而言，蓖麻毒素免疫毒素可如Vitetta等人，Science
238:1098(1987)中所述來製備。經碳14標記之1-異硫氰酸酯基苄基-3-甲基二伸乙三胺五乙酸(MX-DTPA)為一種用於使放射性核苷酸與抗體結合之例示性螯合劑。參見WO 94/11026。連接子可為有助於細胞毒性藥物在細胞中釋放之可裂解連接子。舉例而言，可使用酸不穩定性連接子、肽酶敏感性連接子、二甲基連接子或含二硫鍵之連接子(Chari等人，Cancer Research
52:127-131(1992))。
或者，可(例如)藉由重組技術或肽合成來製備包含HER2抗體及細胞毒性劑之融合蛋白。
在另一實施例中，抗體可與"受體"(諸如抗生蛋白鏈菌素)結合以用於腫瘤預靶向，其中向患者投與抗體-受體結合物，繼而使用清除劑將未結合之結合物自循環中移除，且隨後投與與細胞毒性劑(例如，放射性核苷酸)結合之"配體"(例如，抗生物素蛋白)。
(ix) 其他抗體修飾
本文中涵蓋抗體之其他修飾。舉例而言，抗體可與各種非蛋白質性聚合物(例如聚乙二醇、聚丙二醇、聚環氧烷或聚乙二醇與聚丙二醇之共聚物)中之一者連接。抗體亦可包埋於(例如)藉由凝聚技術或藉由界面聚合製備之微膠囊(分別例如為羥甲基纖維素或明膠-微膠囊及聚-(甲基丙烯酸甲酯)微膠囊)中；包埋於膠態藥物傳遞系統(例如，脂質體、白蛋白微球體、微乳液、奈米粒子及奈米膠囊)中；或包埋於巨乳液中。該等技術係揭示於Remington's Pharmaceutical Sciences
，第16版，Osol,A.編(1980)中。
可希望就效應功能而言修飾本發明之抗體，(例如)以便增強抗體之抗原依賴性細胞介導細胞毒性(ADCC)及/或補體依賴性細胞毒性(CDC)。此可藉由在抗體之Fc區中引入一或多個胺基酸取代來達成。或者或另外，可將半胱胺酸殘基引入Fc區域中，藉此允許在該區域內形成鏈間二硫鍵。由此產生之均二聚抗體可具有改良之內在化能力及/或增加之補體介導細胞殺死及抗體依賴性細胞細胞毒性(ADCC)。參見Caron等人，J. Exp. Med.
176:1191-1195(1992)及Shopes,B.J. Immunol.
148:2918-2922(1992)。具有增強之抗腫瘤活性的均二聚抗體亦可使用如Wolff等人，Cancer Research
53:2560-2565(1993)中所述之異型雙官能交聯劑來製備。或者，抗體可被工程化，其具有雙Fc區且進而可具有增強之補體溶解及ADCC能力。參見Stevenson等人，Anti-Cancer Drug Design
3:219-230(1989)。
WO 00/42072(Presta,L.)描述在人類效應細胞存在下具有改良之ADCC功能的抗體，其中該等抗體在其Fc區中包含胺基酸取代。較佳地，具有改良之ADCC的抗體在Fc區之位置298、333及/或334處包含取代。改變之Fc區域較佳為在該等位置中之一者、兩者或三者處包含取代或由取代組成之人類IgG1 Fc區。
WO 99/51642、美國專利第6,194,551B1號、美國專利第6,242,195B1號、美國專利第6,528,624B1號及美國專利第6,538,124號(Idusogie等人)中描述具有改變之C1q結合及/或補體依賴性細胞毒性(CDC)的抗體。該等抗體在其Fc區之胺基酸位置270、322、326、327、329、313、333及/或334中之一或多者處包含胺基酸取代。
為了增加抗體之血清半衰期，可將補救受體結合抗原決定基併入抗體(尤其抗體片段)中，例如，如美國專利5,739,277中所述。如本文中所用之術語"補救受體結合抗原決定基"係指負責增加IgG分子之活體內血清半衰期的IgG分子(例如IgG1
、IgG2
、IgG3
或IgG4
)之Fc區之抗原決定基。在Fc區具有取代且具有增加之血清半衰期的抗體亦描述於WO 00/4207(Presta,L.)中。
亦涵蓋具有三個或三個以上(較佳四個)功能性抗原結合位點之工程化抗體(美國申請案第US 2002/0004587 A1號，Miller等人)。
本文中所揭示之HER2抗體亦可被調配為免疫脂質體。含有抗體之脂質體係藉由此項技術中已知之方法來製備，諸如Epstein等人，Proc. Natl. Acad. Sci. USA,
82:3688(1985)；Hwang等人，Proc. Natl. Acad. Sci. USA,
77:4030(1980)；美國專利第4,485,045號及第4,544,545號；及1997年10月23日公開之WO 97/38731中所述之方法。美國專利第5,013,556號中揭示循環時間提高之脂質體。
尤其適用之脂質體可藉由使用包含磷脂醯膽鹼、膽固醇及PEG衍生之磷脂醯乙醇胺(PEG-PE)之脂質組合物的逆相蒸發法來產生。經由限定孔徑之過濾器擠出脂質體以得到具有所需直徑之脂質體。本發明之抗體之Fab'片段可經由二硫鍵互換反應而結合於脂質體(如Martin等人，J. Biol. Chem.
257:286-288(1982)中所述)。在脂質體內視情況含有化學治療劑。參見Gabizon等人，J. National Cancer Inst.
81(19)1484(1989)。
本發明組合物之治療性調配物係藉由以凍乾調配物或水溶液之形式將本發明之組合物與可選醫藥學上可接受之載劑、賦形劑或穩定劑(Remington's Pharmaceutical Sciences
第16版，Osol,A.編(1980))混合來製備以供儲存。可接受之載劑、賦形劑或穩定劑在所用劑量及濃度下對接受者係無毒的，且包括：緩衝劑，諸如磷酸鹽、檸檬酸鹽及其他有機酸；抗氧化劑，包括抗壞血酸及甲硫胺酸；防腐劑(諸如氯化十八烷基二甲基苄基銨；氯化六烴季銨；氯苄烷銨、苄索氯銨；苯酚、丁醇或苄醇；對羥基苯甲酸烷基酯，諸如對羥基苯甲酸甲酯或對羥基苯甲酸丙酯；兒茶酚；間苯二酚；環己醇；3-戊醇；及間甲酚)；低分子量(少於約10個殘基)多肽；蛋白質，諸如血清白蛋白、明膠或免疫球蛋白；親水性聚合物，諸如聚乙烯基吡咯啶酮；胺基酸，諸如甘胺酸、麩胺醯胺、天冬醯胺、組胺酸、精胺酸或離胺酸；單醣、雙醣及其他碳水化合物，包括葡萄糖、甘露糖或糊精；螯合劑，諸如EDTA；糖，諸如蔗糖、甘露糖醇、海藻糖或山梨糖醇；鹽形成抗衡離子，諸如鈉；金屬錯合物(例如，鋅-蛋白錯合物)；及/或非離子界面活性劑，諸如TWEEN、PLURONICS或聚乙二醇(PEG)。WO 97/04801中描述凍乾之HER2抗體調配物。US 20006/088523中描述本發明之組合物的尤佳調配物。
本文中之調配物亦可含有一種以上為所治療之特定適應症所必需之活性化合物，較佳為具有互補活性且彼此無不利影響之彼等活性化合物。舉例而言，可希望在一種調配物中另外提供結合至EGFR、HER2(例如結合HER2上之不同抗原決定基的抗體)、HER3、HER4或血管內皮因子(VEGF)之抗體。或者或另外，組合物可另外包含化學治療劑、細胞毒性劑、細胞激素、生長抑制劑、抗激素劑、EGFR靶向藥物、抗血管生成劑、酪胺酸激酶抑制劑及/或保心藥。該等分子適當地係以可有效達成預期目的之量組合存在。
活性成份亦可包埋於(例如)藉由凝聚技術或藉由界面聚合製備之微膠囊(分別例如為羥甲基纖維素或明膠-微膠囊及聚-(甲基丙烯酸甲酯)微膠囊)中；包埋於膠態藥物傳遞系統(例如，脂質體、白蛋白微球體、微乳液、奈米粒子及奈米膠囊)中；或包埋於巨乳液中。該等技術係揭示於Remington's Pharmaceutical Sciences
，第16版，Osol,A.編(1980)中。
可製備持續釋放製劑。持續釋放製劑之合適實例包括含有抗體之固體疏水性聚合物的半透性基質，該等基質呈成形物品(例如薄膜或微膠囊)之形式。持續釋放基質之實例包括聚酯、水凝膠(例如，聚(2-羥乙基-甲基丙烯酸酯)或聚(乙烯醇))、聚丙交酯(美國專利第3,773,919號)、L-麩胺酸與γ乙基-L-麩胺酸鹽之共聚物、不可降解之乙烯-乙酸乙烯酯、可降解之乳酸-乙醇酸共聚物(諸如LUPRON DEPOT(由乳酸-乙醇酸共聚物與乙酸亮丙瑞林組成之可注射微球體))及聚-D-(-)-3-羥基丁酸。
欲用於活體內投藥之調配物必須無菌。此易於藉由經由無菌過濾膜過濾來達成。
預期根據本發明，HER2抗體可用於治療癌症。該癌症通常為HER2陽性，以使本文中之HER2抗體能夠結合至癌細胞。在一實施例中，癌症表現低HER3(例如卵巢癌)或具有高HER2:HER3比率(例如卵巢癌)。可用該組合物治療之各種癌症係於以上定義部分中列出。
本文中欲治療之較佳癌症包括：乳癌，包括HER2陽性乳癌，視情況與曲妥珠單抗及紫杉醇(諸如多西他賽)組合，且包括乳癌之新輔助療法；卵巢癌(包括鉑耐受性及鉑敏感性卵巢癌)(參見(例如)US 2006/0013819)；肺癌(包括非小細胞肺癌，NSCLC)，視情況與EGFR抑制劑組合(參見(例如)US 2007/0020261)；結腸直腸癌等。
亦預期HER2抗體可用於治療各種非惡性疾病或病症，諸如自體免疫疾病(例如牛皮癬)；子宮內膜異位；硬皮病；再狹窄；息肉，諸如結腸息肉、鼻息肉或胃腸息肉；纖維腺瘤；呼吸道疾病；膽囊炎；多發性神經纖維瘤；多囊性腎病；發炎疾病；皮膚病，包括牛皮癬及皮膚炎；血管病；涉及血管上皮細胞異常增殖之病狀；胃腸潰瘍；蒙尼柴爾病(Menetrier's disease)、分泌型腺瘤或蛋白損失症候群；腎病；血管生成病；眼部疾病，諸如年齡相關黃斑退化、擬眼組織胞漿菌病症候群、增生性糖尿病性視網膜病之視網膜新血管生成、視網膜血管生成、糖尿病性視網膜病或年齡相關黃斑退化；骨相關病變，諸如骨關節炎、佝僂病及骨質疏鬆症；繼腦缺血事件後之損傷；纖維化或水腫疾病，諸如肝硬化、肺部纖維化、肉狀瘤病、甲狀腺炎、全身性高黏滯症候群(hyperviscosity syndrome systemic)、朗奧韋氏症(Osler Weber-Rendu disease)、慢性阻塞性肺病或繼灼傷、外傷、輻射、中風、低氧或缺血後之水腫；皮膚過敏性反應；糖尿病性視網膜病及糖尿病性腎病；古立安-白瑞症候群(Guillain-Barre syndrome)；移植物抗宿主疾病或移植排斥反應；佩吉特氏症(Paget's disease)；骨或關節發炎；光老化(例如由UV照射人類皮膚所致)；良性前列腺肥大；某些微生物感染，包括選自腺病毒、漢他病毒(hantaviruses)、伯氏疏螺旋體(Borrelia burgdorferi)、耶爾森氏菌屬(Yersinia spp.)及百日咳博德氏桿菌(Bordetella pertussis)之微生物病原體；由血小板凝集所致之血栓；生殖病狀，諸如子宮內膜異位、卵巢過度刺激症候群、先兆子癇、功能失調性子宮出血病或月經過多；滑膜炎；動脈粥樣化；急性及慢性腎病(包括增生性絲球體腎炎及糖尿病誘導性腎病)；濕疹；肥厚性瘢痕形成；內毒素性休克及真菌感染；家族性腺瘤病息肉病；神經退化性疾病(例如阿茲海默氏症(Alzheimer's disease)、AIDS相關性癡呆、帕金森氏症(Parkinson's disease)、肌萎縮性側索硬化、色素性視網膜炎、脊髓性肌萎縮及小腦退化)；骨髓發育不良症候群；再生障礙性貧血；缺血性損傷；肺、腎或肝纖維化；T細胞介導之過敏性疾病；嬰兒肥厚性幽門狹窄；尿阻塞性症候群；牛皮癬性關節炎；及橋本氏甲狀腺炎(Hasimoto's thyroiditis)。對於本文中之療法而言，較佳非惡性適應症包括牛皮癬、子宮內膜異位、硬皮病、血管病(例如再狹窄、動脈粥樣硬化、冠狀動脈病或高血壓)、結腸息肉、纖維腺瘤或呼吸道疾病(例如哮喘、慢性支氣管炎、支氣管擴張或囊腫性纖維化)。
以HER2抗體治療將使疾病之跡象或症狀改良。舉例而言，若所治療疾病為癌症，則該療法可使存活率(總存活率及/或無進展存活率)改良且/或可產生目標臨床反應(部分或完全)。
較佳地，所投與組合物中之HER2抗體為裸抗體。然而，所投與之HER2抗體可與細胞毒性劑結合。較佳地，免疫結合物及/或其所結合之HER2蛋白被細胞內在化，從而使免疫結合物殺死其所結合之癌細胞之治療功效增強。在一較佳實施例中，細胞毒性劑靶向或干擾癌細胞中之核酸。該等細胞毒性劑之實例包括美登素類、卡奇黴素、核糖核酸酶及DNA核酸內切酶。
根據已知方法，諸如靜脈內投藥(例如以大丸劑形式或藉由經一段時間連續輸注)、藉由肌肉內、腹膜內、腦脊髓內、皮下、關節內、滑膜內、鞘內、口服、局部或吸入途徑，向人類患者投與HER2抗體。靜脈內投與抗體組合物為較佳。
對於預防或治療疾病而言，HER2抗體之適當劑量將視待治療疾病之類型(如上所定義)、疾病之嚴重程度及病程、HER2抗體是否係出於預防性抑或治療性目的而投與、先前療法、患者之臨床病史及對HER2抗體之反應以及主治醫師之判斷而定。適宜一次性地或經一系列治療向患者投與HER2抗體。視疾病之類型及嚴重程度而定，無論(例如)藉由一或多次獨立投藥抑或藉由連續輸注，約1μg/kg至50mg/kg(例如，0.1-20mg/kg)HER2抗體皆為向患者投與之初始候選劑量。在一實施例中，HER2抗體之初始輸注時間可能比後續輸注時間長，例如初始輸注約90分鐘，且後續輸注約30分鐘(若初始輸注被完全耐受時)。HER2抗體之較佳劑量應處於約0.05mg/kg至約10mg/kg之範圍內。因此，可向患者投與約0.5mg/kg、2.0mg/kg、4.0mg/kg或10mg/kg中之一或多個劑量(或其任何組合)。該等劑量可間歇地投與，例如，每週或每隔三週投與(例如，以使患者接受約二至約二十個(例如約六個)劑量之HER2抗體)。可投與初始較高負荷劑量，繼而投與一或多個較低劑量。在一實施例中，以約840mg之負荷劑量投與HER2抗體，繼而約每隔3週投與約420mg。在另一實施例中，以約1050mg之負荷劑量投與HER2抗體，繼而約每隔3週投與約525mg。
可將其他治療劑與HER2抗體組合。該組合投藥包括使用獨立調配物或單一醫藥調配物共投藥或同時投藥及以任一次序連續投藥，其中較佳地為當兩種(或所有)活性劑同時發揮其生物學活性時存在一段時間。因此，可在投與HER2抗體之前或之後投與另一治療劑。在該實施例中，介於另一治療劑之至少一次投與與HER2抗體之至少一次投與之間的時間較佳為約1個月或1個月以下，且最佳為約2週或2週以下。或者，將另一治療劑與HER2抗體以單一調配物或獨立調配物之形式向患者同時投與。
可與HER2抗體組合之其他治療劑之實例包括以下各物中之任何一或多者：化學治療劑，諸如抗代謝物，例如吉西他濱；第二不同HER2抗體(例如生長抑制性HER2抗體(諸如曲妥珠單抗)或誘導過度表現HER2之細胞之細胞凋亡的HER2抗體(諸如7C2、7F3或其人類化變異體))；針對另一腫瘤相關抗原(諸如EGFR、HER3、HER4)之第二抗體；抗激素化合物，例如抗雌激素化合物(諸如他莫昔芬)，或芳香酶抑制劑；保心藥(旨在預防或減少與療法相關之任何心肌功能障礙)；細胞激素；EGFR靶向藥物(諸如埃羅替尼(Erlitonib)、吉非替尼或西妥昔單抗)；抗血管生成劑(尤其貝伐單抗(由Genentech以商標AVASTIN出售))；酪胺酸激酶抑制劑；COX抑制劑(例如COX-1或COX-2抑制劑)；非類固醇消炎藥賽利克西(CELEBREX)；法呢基轉移酶抑制劑(例如替吡法尼/ZARNESTRA7 R115777(可購自Johnson and Johnson)或洛那法尼(Lonafarnib)SCH66336(可購自Schering-Plough))；結合癌胚蛋白CA 125之抗體，諸如奧戈伏單抗(Oregovomab，MoAb B43.13)；HER2疫苗(諸如HER2 Auto Vac疫苗(來自Pharmexia)或APC8024蛋白疫苗(來自Dendreon)或HER2肽疫苗(來自GSK/Corixa))；另一HER靶向療法(例如曲妥珠單抗、西妥昔單抗、吉非替尼、埃羅替尼、CI1033、GW2016等)；Raf及/或ras抑制劑(參見(例如)WO 2003/86467)；多西呃(Doxil)；拓撲替康(Topetecan)；紫杉烷(taxane)；GW572016；TLK286；EMD-7200；治療噁心之藥劑，諸如血清素拮抗劑、類固醇或苯并二氮呯；預防或治療皮疹之藥劑或標準痤瘡療法，包括局部用抗生素或口服抗生素；降體溫藥，諸如乙醯胺苯酚、苯海拉明(diphenhydramine)或哌替啶(meperidine)；造血生長因子等。
以上兵投與之藥劑中之任一者的合適劑量為彼等目前所用之劑量且可由於該藥劑與HER2抗體之組合作用(協同作用)而降低。以HER2抗體組合物與另一治療劑之組合治療可對患者產生協同或大於加和之治療益處。
若投與化學治療劑，則通常係以關於其已知之劑量或視情況降低之劑量(由於該等藥物之組合作用或可歸因於投與該化學治療劑之負性副作用所致)來投與。可根據製造商之說明書或如由熟習此項技術者憑經驗所確定來使用該等化療劑之製劑及給藥方案。該化學療法之製劑及給藥方案亦描述於Chemotherapy Service,M.C. Perry編，Williams ＆ Wilkins,Baltimore,MD(1992)中。
除上述治療方案以外，患者亦可經受癌細胞之手術移除及/或放射療法。
以下融合瘤細胞株已寄存於美國菌種保存中心(American Type Culture Collection)，10801 University Boulevard,Manassas,VA 20110-2209,USA(ATCC)：
本發明之更多詳情係藉由以下非限制性實例來說明。在本說明書中所有引用之揭示內容係以引用的方式明確地併入本文中。
該實例描述對包含結合至HER2結構域II之主要種類之HER2抗體(帕妥珠單抗)及其酸性變異體的組合物之表徵。
帕妥珠單抗為一種基於人類IgG1(κ)構架產生之重組人類化單株抗體。其包含兩條重鏈(448個殘基)及兩條輕鏈(214個殘基)。兩條重鏈係藉由兩個鏈間二硫鍵來連接且各輕鏈係經由一個鏈間二硫鍵與重鏈連接。在帕妥珠單抗Fc區中於兩條重鏈之Asn-299處存在N連接之糖基化位點。帕妥珠單抗在輕鏈(12個胺基酸差異)及重鏈(30個胺基酸差異)之抗原決定基結合區中不同於赫賽汀(曲妥珠單抗)。由於該等差異，帕妥珠單抗結合至HER2受體上完全不同之抗原決定基。帕妥珠單抗與人類上皮細胞上之HER2受體之結合防止該HER2受體與HER受體家族之其他成員形成複合物(Agus等人，Cancer Cell
2:127-137(2002))。藉由阻斷複合物形成，帕妥珠單抗防止複合物配體(例如EGF及和瑞古林)之生長-刺激效應。活體外實驗展示帕妥珠單抗與帕妥珠單抗-Fab均抑制和瑞古林(HRG)與MCF7細胞之結合，且帕妥珠單抗與帕妥珠單抗-Fab均可抑制HRG刺激之HER2-HER3複合物之磷酸化(Agus等人，Cancer Cell
2:127-137(2002))。此外，發現在鼠類前列腺癌異種移植模型中帕妥珠單抗及帕妥珠單抗之聚乙二醇衍生化Fab對活體內腫瘤生長之抑制係相當的(Agus等人，Cancer Cell
2:127-137(2002))。該等資料表明抗體之Fc區並非抑制腫瘤生長所必需，且此外，二價及Fc介導之效應功能並非活體內或活體外生物學活性所必需。
在該實例中，自陽離子交換管柱收集帕妥珠單抗之主峰，且將其在細胞培養基中培育或使用標準抗體純化操作進行處理。在以細胞培養基組份培育主峰之後形成酸性變異體。單株抗體之酸性變異體為所需產物之改良形式，其在藉由陽離子交換層析法分離之後比主峰先溶離。通常在過程變化前後觀察到酸性變異體之量及/或分布的細微差異，且給展示產物可比性帶來挑戰。純化操作對形成酸性變異體具有極小影響。於酸性變異體溶離份中鑑別出之變異體包括糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體。總體而言，酸性變異體為完全有效的。
此研究之目的尤其在於：更好地瞭解細胞培養及回收過程對帕妥珠單抗酸性變異體形成之影響，表徵帕妥珠單抗之主要酸性變異體，且評估酸性變異體對藥物動力學(PK)之影響。
大鼠藥物動力學結果顯示酸性變異體溶離份及主峰溶離份之曲線下面積等於帕妥珠單抗起始物質(幾何平均值比率分別為0.96及0.95)。該等結果證明，儘管酸性變異體在化學上不同於主峰，但其具有相同之藥物動力學概況。
圖10展示關於陽離子交換MP(主峰)及AV(酸性變異體)之分離、細胞培養、回收以及PK(藥物動力學)評估及分析測試的實驗設計。新鮮培養基=標準培養基；經消耗培養基=在12日細胞培養之後的標準培養基，藉由離心移除細胞。未控制溶解氧、pH值及其他參數。
使用以下條件在4.0×250mm DIONEX PROPAC WCX-10TM
陽離子交換(CEX)管柱上分離帕妥珠單抗之電荷變異體：
緩衝液A：20mM BisTris(pH 6.0)；
緩衝液B：20mM BisTris，200mM NaCl(pH 6.0)；
梯度：0.5% B/min，以1.0mL/min輸送；
管柱溫度：35℃；
偵測：280nm。
圖11中展示典型層析圖。收集AV(酸性變異體)及MP(主峰)溶離份。
效能及單體含量在帕妥珠單抗起始物質、主峰及酸性變異體之間係類似的(圖12)。基於90%純度標準，利用CEX得知，主峰及酸性變異體CEX溶離份之純度對於藥物動力學研究而言係可接受的(圖12)。
如圖10所示，將藉由CEX分離之帕妥珠單抗主峰摻加至新鮮或經消耗細胞培養基(無細胞)中且在37℃下培育12日。將各時間點之樣品直接藉由CEX來分析或在以蛋白A分離之後加以分析。亦將主峰摻加至培養基+/-各種培養基組份(諸如葡萄糖及蛋白腖)中。此外，將主峰經由標準回收操作(諸如蛋白A層析(ProA)、低pH值處理及多循環SP瓊脂糖速流(SPFF))處理且藉由CEX加以分析。
在新鮮或經消耗培養基中培育12日之主峰的CEX概況係類似的(圖13及14)。與在經消耗培養基中相比，在新鮮培養基中培育之後，主峰減少更多。移除各種培養基組份確實影響主峰之減少。在進行蛋白A分離與不進行蛋白A分離之情況下經培育樣品中之主峰百分比係相同的。單獨在培養基緩衝液中培育導致主峰損失。
以蛋白A自培養基分離主峰並不影響CEX概況，此證明培育期間的變化並不影響蛋白A結合或溶離。回收操作對CEX主峰百分比幾乎無影響。
藉由CEX自帕妥珠單抗起始物質或培育在細胞培養基中之主峰分離帕妥珠單抗酸性變異體。將所分離之酸性變異體藉由圖15中所列之方法來分析。酸性變異體占總峰面積之21%，因此鑑別出約80%之酸性變異體(21%中之17%)。不能定量去醯胺化形式。
由以培養基培育之主峰所產生的酸性變異體中所鑑別之形式與在帕妥珠單抗起始物質中所鑑別之形式相同。偵測到以下形式：唾液酸化變異體、二硫鍵還原變異體、糖化變異體、非可還原變異體及去醯胺化變異體。在還原及PNGase處理之後，藉由電噴霧電離-質譜術(ESI-MS)來鑑別高級糖化形式。
10mg/kg之單次靜脈內(IV)劑量，每組12隻大鼠，3組(酸性變異體、主峰、帕妥珠單抗起始物質)。進行大量PK取樣歷時35日。酸性變異體、主峰及帕妥珠單抗起始物質之間的AUC之幾何平均值比率(第0-14日)。幾何平均值比率=GM樣品/GM IgG1起始物質。對於帕妥珠單抗起始物質、酸性變異體及主峰而言，帕妥珠單抗濃度與時間之關係曲線係類似的(圖16及17)。在酸性變異體、主峰及帕妥珠單抗起始物質之間未在暴露過程中觀察到顯著差異。GMR為約1.0，其中90%CI在0.80-1.25之間。
多重細胞培養因素促成酸性變異體形成，但未顯示回收影響酸性變異體形成。在酸性溶離份中鑑別出二硫鍵還原變異體、非可還原變異體、唾液酸化變異體、糖化變異體及去醯胺化變異體。自帕妥珠單抗起始物質分離之酸性溶離份及藉由培育CEX主峰產生之彼等者含有相同形式。酸性變異體、主峰及帕妥珠單抗起始物質具有相同藥物動力學概況。
圖1提供HER2蛋白質結構之示意圖及其胞外結構域之結構域I-IV的胺基酸序列(分別為SEQ ID No:19-22)。
圖2A及2B展示以下各者之胺基酸序列的比對：鼠類單株抗體2C4之可變輕鏈(VL
)(圖2A)及可變重鏈(VH
)(圖2B)結構域(分別為SEQ ID No:1及2)：人類化2C4變型574之VL
及VH
結構域(分別為SEQ ID No:3及4)；及人類VL
及VH
一致構架(humkI，輕鏈κ亞群I；humIII，重鏈亞群III)(分別為SEQ ID No:5及6)。星號標識人類化2C4變型574與鼠類單株抗體2C4之間或人類化2C4變型574與人類構架之間的差異。互補決定區(CDR)係以方括號表示。
圖3A及3B展示帕妥珠單抗輕鏈(SEQ ID No:15)及重鏈(SEQ ID No:16)之胺基酸序列。CDR係以粗體表示。碳水化合物部分與重鏈之Asn 299連接。
圖4A及4B展示帕妥珠單抗輕鏈(SEQ ID No:17)及重鏈(SEQ ID No:18)之胺基酸序列，其各自包括完整胺基末端信號肽序列。
圖5示意性展示2C4在HER2之雜二聚結合位點處結合，從而防止與活化EGFR或HER3之雜二聚化。
圖6展示HER2/HER3與MAPK及Akt路徑之偶合。
圖7比較曲妥珠單抗與帕妥珠單抗之活性。
圖8A及8B展示曲妥珠單抗輕鏈(SEQ ID No:13)及重鏈(SEQ ID No:14)之胺基酸序列。
圖9A及9B展示變異帕妥珠單抗輕鏈序列(SEQ ID No:23)及變異帕妥珠單抗重鏈序列(SEQ ID No:24)。
圖10展示關於陽離子交換MP(主峰)及AV(酸性變異體)之分離、細胞培養、回收以及PK(藥物動力學)評估及分析測試的實驗設計。新鮮培養基=標準培養基；經消耗培養基=在12日細胞培養之後的標準培養基，藉由離心移除細胞。未控制溶解氧、pH值及其他參數。
圖11展示實例1之典型DIONEX PROPACTM
陽離子交換(CEX)層析圖。
圖12展示對帕妥珠單抗起始物質及CEX溶離份之分析。AV=酸性變異體；MP=主峰；且BV=鹼性變異體。
圖13展示摻加至細胞培養基中且培育12日之主峰(MP)的CEX。
圖14描述主峰培育條件。
圖15總結表徵酸性變異體之方法。
圖16展示實例1中之PK研究中帕妥珠單抗濃度與時間之關係曲線。
圖17提供來自實例1中之PK研究的曲線下面積(AUC)及幾何平均值比率。
(無元件符號說明)
Claims (26)
- 一種組合物，其包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體，其中該酸性變異體包括該主要種類抗體之二硫鍵還原(disulfide reduced)變異體，其中該主要種類之HER2抗體包含分別示於SEQ ID NOs：3及4中之可變輕鏈及可變重鏈胺基酸序列。
- 如請求項1之組合物，其中該組合物進一步包含該主要種類抗體之糖化變異體。
- 如請求項1或請求項2之組合物，其中該組合物進一步包含該主要種類抗體之非可還原變異體。
- 如請求項1之組合物，其進一步包括該主要種類抗體之糖化變異體、該主要種類抗體之去醯胺化變異體、該主要種類抗體之唾液酸化變異體及該主要種類抗體之非可還原變異體。
- 如請求項1之組合物，其包含小於約25%之酸性變異體。
- 如請求項1之組合物，其中該主要種類之HER2抗體及該酸性變異體均為完整抗體。
- 如請求項1之組合物，其中該主要種類之HER2抗體包含分別示於SEQ ID NOs：15及16中之輕鏈及重鏈胺基酸序列。
- 如請求項1之組合物，其進一步包含該主要種類抗體之胺基端前導序列延伸變異體。
- 如請求項8之組合物，其中該胺基端前導序列延伸包含VHS-。
- 如請求項9之組合物，其中該胺基端前導序列延伸由VHS-組成。
- 如請求項1之組合物，其進一步包含該主要種類之HER2抗體之胺基酸序列變異體，該變異體係選自由以下組成之群：包含一個C端離胺酸殘基於一條或兩條重鏈上之抗體，及具有一或多個氧化甲硫胺酸殘基之抗體。
- 一種醫藥調配物，其包含如請求項1之組合物於醫藥學上可接受之載劑中。
- 如請求項12之醫藥調配物，其係滅菌的(sterile)。
- 一種組合物，其包含一種包含分別示於SEQ ID NOs：3及4中之可變輕鏈及可變重鏈序列的主要種類之HER2抗體及該主要種類之抗體之酸性變異體，其中該等酸性變異體包括糖化變異體、去醯胺化變異體、二硫鍵還原變異體、唾液酸化變異體及非可還原變異體。
- 一種醫藥調配物，其包含如請求項14之組合物於醫藥學上可接受之載劑中。
- 一種如請求項15之醫藥調配物之用途，其係用於製備用以治療患者之HER2陽性癌症之藥劑。
- 如請求項16之用途，其中該癌症係選自由乳癌、卵巢癌、肺癌及結腸直腸癌組成之群。
- 如請求項16之用途，其中該主要種類之抗體及該等酸性變異體具有基本上相同之藥物動力學。
- 一種製備醫藥組合物之方法，其包含：(1)製備一種包含結合至HER2結構域II之主要種類之HER2抗體及其酸性 變異體的組合物，該等酸性變異體包括糖化變異體、二硫鍵還原變異體或非可還原變異體，其中該主要種類之HER2抗體包含分別示於SEQ ID NOs：3及4中之可變輕鏈及可變重鏈胺基酸序列，及(2)評估該組合物中該等酸性變異體，及確定其量小於約25%。
- 如請求項19之方法，其中步驟(2)包含藉由一種選自由以下組成之群的方法來評估該等酸性變異體：離子交換層析法，其中以唾液酸酶處理該組合物；利用十二烷基硫酸鈉之還原毛細管電泳(CE-SDS)；非還原CE-SDS；酸鹽層析法；及肽圖譜(peptide mapping)。
- 如請求項19之方法，其中步驟(2)包含藉由離子交換層析法來評估該等酸性變異體。
- 如請求項21之方法，其包含使用具有羧酸鹽官能基之陽離子交換劑的陽離子交換層析法。
- 如請求項22之方法，其中該層析法之條件包括：緩衝液A：20mM BisTris(pH 6.0)；緩衝液B：20mM BisTris、200mM NaCl(pH 6.0)；及梯度：0.5%緩衝液B，1.0mL/min。
- 如請求項19之方法，其包含在步驟(2)之後將該組合物與醫藥學上可接受之載劑組合。
- 如請求項19之方法，其中步驟(2)中所評估之該組合物係在醫藥學上可接受之載劑中。
- 一種組合物，其包含結合至HER2結構域II之主要種類之HER2抗體及其酸性變異體，其中該酸性變異體包括該主 要種類抗體之非可還原變異體，其中該主要種類之HER2抗體包含分別示於SEQ ID NOs：3及4中之可變輕鏈及可變重鏈胺基酸序列。
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Patent Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2006033700A2 (en) * | 2004-07-22 | 2006-03-30 | Genentech, Inc. | Her2 antibody composition |
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