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WO2025153988A1 - Use of amivantamab to treat colorectal cancer - Google Patents

Use of amivantamab to treat colorectal cancer

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Publication number
WO2025153988A1
WO2025153988A1 PCT/IB2025/050476 IB2025050476W WO2025153988A1 WO 2025153988 A1 WO2025153988 A1 WO 2025153988A1 IB 2025050476 W IB2025050476 W IB 2025050476W WO 2025153988 A1 WO2025153988 A1 WO 2025153988A1
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WO
WIPO (PCT)
Prior art keywords
antibody
subject
seq
administered
egfr
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
PCT/IB2025/050476
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French (fr)
Inventor
Roland Knoblauch
Kiran Patel
Mahadi BAIG
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Janssen Biotech Inc
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Janssen Biotech Inc
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Publication of WO2025153988A1 publication Critical patent/WO2025153988A1/en
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
    • A61K39/39558—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against tumor tissues, cells, antigens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/4738—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems
    • A61K31/4745—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems condensed with ring systems having nitrogen as a ring hetero atom, e.g. phenantrolines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/555—Heterocyclic compounds containing heavy metals, e.g. hemin, hematin, melarsoprol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A61P35/04—Antineoplastic agents specific for metastasis
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/28—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
    • C07K16/2863—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against receptors for growth factors, growth regulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/30—Immunoglobulins specific features characterized by aspects of specificity or valency
    • C07K2317/31—Immunoglobulins specific features characterized by aspects of specificity or valency multispecific
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/73—Inducing cell death, e.g. apoptosis, necrosis or inhibition of cell proliferation
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding

Definitions

  • the present invention relates to methods of treating colorectal cancer (CRC), such as metastatic colorectal cancer (mCRC), in a subject in need thereof, comprising administering a therapeutically effective amount of an antibody (e.g. , a bispecific antibody) to the subject, wherein the antibody specifically binds epidermal growth factor receptor (EGFR) and hepatocyte growth factor receptor (c-Met).
  • CRC colorectal cancer
  • mCRC metastatic colorectal cancer
  • CRC Colorectal cancer
  • CRC colorectal cancer
  • mCRC metastatic CRC
  • the disclosure provides a method of treating CRC in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject.
  • EGFR anti-epidermal growth factor receptor
  • c-Met hepatocyte growth factor receptor
  • the antibody is a bispecific antibody.
  • the antibody (e.g. , bispecific antibody) comprises: a) a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
  • the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16.
  • the antibody (e.g. , bispecific antibody) comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO:20.
  • HC1 first heavy chain
  • LC1 first light chain
  • HC2 second heavy chain
  • LC2 second light chain
  • the antibody e.g. , bispecific antibody
  • the antibody is of the IgGl isotype.
  • the antibody e.g., bispecific antibody
  • the antibody e.g., bispecific antibody
  • the antibody (e.g., bispecific antibody) is Amivantamab.
  • the antibody e.g. , bispecific antibody
  • the antibody is administered at a dose of about 1,750 mg to about 2,100 mg.
  • the antibody e.g. , bispecific antibody
  • the antibody is administered once a week or once every two weeks.
  • the antibody e.g. , bispecific antibody
  • the antibody is administered once weekly for the first 4 weeks and then every 2 weeks.
  • the antibody is administered on a 28-day cycle.
  • the antibody e.g. , bispecific antibody
  • the method further comprises administering one or more chemotherapeutic agents to the subject.
  • the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
  • the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan.
  • the CRC is mCRC. In some embodiments, the CRC is unresectable. In certain embodiments, the subject has been diagnosed with left-sided CRC. In other embodiments, the subject has been diagnosed with right-sided mCRC.
  • the subject is anti-EGFR therapy naive. In other embodiments, the subject has received prior anti-EGFR therapy. In certain embodiments, the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies. In some embodiments, the subject is treatment naive. In some embodiments, the subject has not received oxaliplatin-based chemotherapy in a metastatic setting.
  • the subject is 18 years of age or older. In some embodiments, the subject has been characterized with wild-type KRAS, NRAS and BRAF. In some embodiments, the subject has been characterized with no amplification of ERBB2/HER2.
  • the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO: 11 and the LCDR3 of SEQ ID NO: 12.
  • the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
  • the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
  • the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody is amivantamab.
  • the disclosure provides a method of treating colorectal cancer in a subject in need thereof, comprising administering a therapeutically effective amount of an anti- epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody and one or more chemotherapeutic agents to the subject.
  • EGFRj/hepatocyte growth factor receptor (c-Met) antibody an anti- epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody and one or more chemotherapeutic agents
  • the antibody comprises: a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs: 1, 2, 3, 4, 5 and 6, respectively; and a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
  • HCDR1 heavy chain complementarity determining region 1
  • LCDR1 light chain complementarity determining region 1
  • LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs: 1, 2, 3, 4, 5 and 6, respectively respectively
  • a second domain that specifically binds c-Met comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8,
  • the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16.
  • the antibody is of the IgGl isotype.
  • the antibody comprises a first heavy chain (HC1) of SEQ ID NO: 1
  • the antibody is an isolated bispecific antibody.
  • the bispecific antibody is amivantamab.
  • the antibody is administered at a dose of about 1,400 mg.
  • the antibody is administered on a 28-day cycle.
  • FOLFOX is administered once every two weeks.
  • FOLFOX is administered on a 28-day cycle.
  • the oxaliplatin is administered at a dose of about 85 mg/m 2 .
  • the folinic acid is a racemic mixture of L- and D-folinic acid. In some embodiments, the folinic acid is administered at a dose of about 400 mg/m 2 .
  • FOLFIRI is administered once every two weeks.
  • the irinotecan is administered at a dose of about 180 mg/m 2 .
  • the folinic acid is L-folinic acid. In some embodiments, the folinic acid is administered at a dose of about 200 mg/m 2 .
  • the fluorouracil is administered at a dose of about 2,800 mg/m 2 .
  • the subject has been characterized with wild-type KRAS, NRAS and BRAF.
  • TP53 tumor protein 53
  • ctDNA circulating tumor DNA
  • the alteration in TP53 or APC is a somatic mutation that alters the function of TP53 or APC.
  • the alteration in TP53 or APC is a point mutation, insertion mutation, or deletion mutation.
  • the subject is anti-EGFR therapy naive.
  • the subject has received prior anti-EGFR therapy.
  • the subject is treatment naive.
  • the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
  • the subject is 18 years of age or older.
  • the method reduces the size of the at least one intrahepatic tumor.
  • the subject has one of more unresectable tumors, wherein the method renders the one or more unresectable tumors resectable.
  • FIG. 3(A-B) shows antitumor activity in Cohort A.
  • FIG. 6(A-B) shows antitumor activity in Cohort C.
  • FIG. 10 shows efficacy of amivantamab + chemotherapy.
  • FIG. 12 shows consistent efficacy of amivantamab + chemotherapy in patients with TP53 and APC alterations and difficult-to-treat PIK3CA alterations.
  • FIG. 13 shows OrigAMI-1 study design highlighting R-sided cohorts (Cohorts C, D, and E).
  • IL first-line
  • 2L second-line
  • 5-FU 5-fluorouracil
  • CRC colorectal cancer
  • ctDNA circulating tumor DNA
  • ECOG PS Eastern Cooperative Oncology Group performance status
  • EGFR epidermal growth factor receptor
  • EGFRi epidermal growth factor receptor inhibitor
  • IV intravenous
  • L-sided left-sided
  • WT wild-type.
  • FIG. 15 shows antitumor activity of amivantamab monotherapy or amivantamab + FOLFOX or FOLFIRI.
  • transitional terms “comprising,” “consisting essentially of,” and “consisting of’ are intended to connote their generally accepted meanings in the patent vernacular; that is, (i) “comprising,” which is synonymous with “including,” “containing,” or “characterized by,” is inclusive or open-ended and does not exclude additional, unrecited elements or method steps; (ii) “consisting of’ excludes any element, step, or ingredient not specified in the claim; and (iii) “consisting essentially of’ limits the scope of a claim to the specified materials or steps “and those that do not materially affect the basic and novel characteristic(s)” of the claimed invention.
  • Embodiments described in terms of the phrase “comprising” (or its equivalents) also provide as embodiments those independently described in terms of “consisting of’ and “consisting essentially of”
  • “About” means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, i.e., the limitations of the measurement system. Unless explicitly stated otherwise within the Examples or elsewhere in the Specification in the context of a particular assay, result or embodiment, “about” means within one standard deviation per the practice in the art, or a range of up to 5%, whichever is larger.
  • antibody or “antibodies” is meant in a broad sense and includes immunoglobulin molecules including monoclonal antibodies including murine, human, humanized and chimeric monoclonal antibodies, full-length antibodies, antigen binding fragments, multispecific antibodies, such as bispecific, trispecific, tetraspecific etc., dimeric, tetrameric or multimeric antibodies, single chain antibodies, domain antibodies and any other modified configuration of the immunoglobulin molecule that comprises an antigen binding site of the required specificity.
  • “Specific binding” or “specifically binds” or “specifically binding” or “binds” refer to an antibody binding to an antigen or an epitope within the antigen with greater affinity than for other antigens.
  • the antibody binds to the antigen or the epitope within the antigen with an equilibrium dissociation constant (K D ) of about 5xl0' 8 M or less, for example about IxlO' 9 M or less, about IxlO' 10 M or less, about IxlO' 11 M or less, or about IxlO' 12 M or less, typically with the K D that is at least one hundred-fold less than its K D for binding to a non-specific antigen (e.g., BSA, casein).
  • K D equilibrium dissociation constant
  • the dissociation constant may be measured using known protocols.
  • Antibodies that bind to the antigen or the epitope within the antigen may, however, have cross-reactivity to other related antigens, for example to the same antigen from other species (homologs), such as human or monkey, for example Macaca fascicularis (cynomolgus, cyno) or Pan troglodytes (chimpanzee, chimp). While a monospecific antibody binds one antigen or one epitope, a bispecific antibody binds two distinct antigens or two distinct epitopes.
  • CDR complementarity determining regions
  • CDR CDR
  • HCDR1 CDR1
  • HCDR2 CDR3
  • LCDR1 CDR2
  • LCDR3 CDR3
  • “Full-length antibodies” are comprised of two heavy chains (HC) and two light chains (LC) inter-connected by disulfide bonds as well as multimers thereof (e.g., IgM).
  • Each heavy chain is comprised of a heavy chain variable region (VH) and a heavy chain constant region (comprised of domains CHI, hinge, CH2 and CH3).
  • Each light chain is comprised of a light chain variable region (VL) and a light chain constant region (CL).
  • the VH and the VL regions may be further subdivided into regions of hypervariability, termed complementarity determining regions (CDR), interspersed with framework regions (FR).
  • CDR complementarity determining regions
  • FR framework regions
  • Each VH and VL is composed of three CDRs and four FR segments, arranged from amino-to-carboxy-terminus in the following order: FR1, CDR1, FR2, CDR2, FR3, CDR3 and FR4.
  • Antigen binding fragment refers to a portion of an immunoglobulin molecule that binds an antigen.
  • Antigen binding fragments may be synthetic, enzymatically obtainable or genetically engineered polypeptides and include the VH, the VL, the VH and the VL, Fab, F(ab')2, Fd and Fv fragments, domain antibodies (dAb) consisting of one VH domain or one VL domain, shark variable IgNAR domains, camelized VH domains, minimal recognition units consisting of the amino acid residues that mimic the CDRs of an antibody, such as FR3-CDR3-FR4 portions, the HCDR1, the HCDR2 and/or the HCDR3 and the LCDR1, the LCDR2 and/or the LCDR3.
  • VH and VL domains may be linked together via a synthetic linker to form various types of single chain antibody designs where the VH/VL domains may pair intramolecularly, or intermolecularly in those cases when the VH and VL domains are expressed by separate single chain antibody constructs, to form a monovalent antigen binding site, such as single chain Fv (scFv) or diabody ; described for example in Int. Patent Publ. Nos. W01998/44001, WO1988/01649, WO1994/13804 and W01992/01047.
  • scFv single chain Fv
  • “Monoclonal antibody” refers to an antibody obtained from a substantially homogenous population of antibody molecules, i.e., the individual antibodies comprising the population are identical except for possible well-known alterations such as removal of C-terminal lysine from the antibody heavy chain or post-translational modifications such as amino acid isomerization or deamidation, methionine oxidation or asparagine or glutamine deamidation.
  • Monoclonal antibodies typically bind one antigenic epitope.
  • a bispecific monoclonal antibody binds two distinct antigenic epitopes.
  • Monoclonal antibodies may have heterogeneous glycosylation within the antibody population.
  • Monoclonal antibody may be monospecific or multispecific such as bispecific, monovalent, bivalent or multivalent.
  • Humanized antibodies refers to antibodies in which the antigen binding sites are derived from non-human species and the variable region frameworks are derived from human immunoglobulin sequences. Humanized antibodies may include intentionally introduced mutations in the framework regions so that the framework may not be an exact copy of expressed human immunoglobulin or germline gene sequences.
  • Human antibodies refers to antibodies having heavy and light chain variable regions in which both the framework and the antigen binding site are derived from sequences of human origin. If the antibody contains a constant region or a portion of the constant region, the constant region is also derived from sequences of human origin. Antibodies in which antigen binding sites are derived from a non-human species are not included in the definition of “human antibody.”
  • a human antibody comprises heavy or light chain variable regions that are derived from sequences of human origin if the variable regions of the antibody are obtained from a system that uses human germline immunoglobulin or rearranged immunoglobulin genes.
  • Non-limiting example systems include human immunoglobulin gene libraries displayed on phage, and transgenic non-human animals such as mice or rats carrying human immunoglobulin loci.
  • a human antibody typically contains amino acid differences when compared to the human germline or rearranged immunoglobulin sequences due to, for example, naturally occurring somatic mutations, intentional substitutions in the framework or antigen binding site, and substitutions introduced during cloning or VDJ recombination in non-human animals.
  • a human antibody is at least 80% identical in amino acid sequence to an amino acid sequence encoded by a human germline or rearranged immunoglobulin gene. For example, about: 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% identical.
  • a human antibody may contain consensus framework sequences derived from human framework sequence analyses (see, e.g., Knappik et al., J. Mol. Biol.
  • Bispecific refers to an antibody that specifically binds two distinct antigens or two distinct epitopes within the same antigen.
  • the bispecific antibody may have cross-reactivity to other related antigens, for example to the same antigen from other species (homologs), such as human or monkey, for example Macaca cynomolgus (cynomolgus, cyno) or Pan troglodytes, or may bind an epitope that is shared between two or more distinct antigens.
  • Bispecific anti-EGFR/c-Met antibody or “bispecific EGFR/c-Met antibody” refers to a bispecific antibody having a first domain that specifically binds EGFR and a second domain that specifically binds c-Met.
  • the domains specifically binding EGFR and c-Met are typically VH/VL pairs, and the bispecific anti-EGFR/c-Met antibody is monovalent in terms of binding to EGFR and c- Met.
  • isolated refers to a homogenous population of molecules (such as synthetic polynucleotides, polypeptides vectors or viruses) which have been substantially separated and/or purified away from other components of the system the molecules are produced in, such as a recombinant cell, as well as a protein that has been subjected to at least one purification or isolation step.
  • molecules such as synthetic polynucleotides, polypeptides vectors or viruses
  • isolated refers to a molecule that is substantially free of other cellular material and/or chemicals and encompasses molecules that are isolated to a higher purity, such as to 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% purity.
  • Immunoglobulins may be assigned to five major classes, IgA, IgD, IgE, IgG and IgM, depending on the heavy chain constant domain amino acid sequence.
  • IgA and IgG are further subclassified as the isotypes IgAl, IgA2, IgGl, IgG2, IgG3 and IgG4.
  • Antibody light chains of any vertebrate species may be assigned to one of two clearly distinct types, namely kappa (K) and lambda (X), based on the amino acid sequences of their constant domains.
  • Dosage refers to the information of the amount of the therapeutic or the drug to be taken by the subject and the frequency of the number of times the therapeutic is to be taken by the subject. “Dose” refers to the amount or quantity of the therapeutic or the drug to be taken each time.
  • “Therapeutically effective amount” refers to an amount effective, at doses and for periods of time necessary, to achieve a desired therapeutic result. A therapeutically effective amount may vary depending on factors such as the disease state, age, sex, and weight of the individual, and the ability of a therapeutic or a combination of therapeutics to elicit a desired response in the individual. Exemplary indicators of an effective therapeutic or combination of therapeutics that include, for example, improved well-being of the patient.
  • “Co-administration,” “administration with,” “administration in combination with,” “in combination with” or the like, encompass administration of the selected therapeutics or drugs to a single patient, and are intended to include treatment regimens in which the therapeutics or drugs are administered by the same or different route of administration or at the same or different time.
  • “Fixed combination” refers to a single pharmaceutical composition comprising two or more compounds.
  • “Antagonist” or “inhibitor” refers to a molecule that, when bound to a cellular protein, suppresses at least one reaction or activity that is induced by a natural ligand of the protein.
  • a molecule is an antagonist when the at least one reaction or activity is suppressed by at least about 20%, 30%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or 100% more than the at least one reaction or activity suppressed in the absence of the antagonist (e.g., negative control), or when the suppression is statistically significant when compared to the suppression in the absence of the antagonist.
  • “Responsive”, “responsiveness” or “likely to respond” refers to any kind of improvement or positive response, such as alleviation or amelioration of one or more symptoms, diminishment of extent of disease, stabilized (i.e., not worsening) state of disease, preventing spread of disease, delay or slowing of disease progression, amelioration or palliation of the disease state, and remission (whether partial or total), whether detectable or undetectable.
  • EGFR or c-Met expressing cancer refers to cancer that has detectable expression of EGFR or c-Met or has EGFR or c-Met mutation or amplification.
  • EGFR or c-Met expression, amplification and mutation status can be detected using know methods, such as sequencing, next generation sequencing, fluorescent in situ hybridization, immunohistochemistry, flow cytometry or western blotting.
  • Epidermal growth factor receptor or “EGFR” refers to the human EGFR (also known as HER1 or ErbBl (Ullrich et al., Nature 309:418-425, 1984) having the amino acid sequence shown in GenBank accession number NP 005219, as well as naturally -occurring variants thereof.
  • Hepatocyte growth factor receptor or “c-Met” as used herein refers to the human c-Met having the amino acid sequence shown in GenBank Accession No: NP 001120972 and natural variants thereof.
  • mesenchymal-epithelial transition factor is highly expressed or amplified in mCRC subsets and plays a role in mediating resistance to anti-EGFR therapies; however, MET inhibitors are not currently used in mCRC treatment.
  • the disclosure provides a method of treating CRC in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject.
  • EGFR anti-epidermal growth factor receptor
  • c-Met hepatocyte growth factor receptor
  • the first domain that specifically binds EGFR comprises: a) heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3 amino acid sequences of SEQ ID NOs:l, 2 and 3, respectively; and/or b) light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:4, 5 and 6, respectively.
  • HCDR1 heavy chain complementarity determining region 1
  • HCDR2 HCDR3 amino acid sequences of SEQ ID NOs:l, 2 and 3, respectively
  • LCDR1 light chain complementarity determining region 1
  • LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:4, 5 and 6, respectively respectively.
  • HCDR2 VIWDDGSYKYYGDSVKG (SEQ ID NO:2)
  • HCDR3 DGITMVRGVMKDYFDY (SEQ ID NO:3)
  • HCDR1 RASQDISSALV (SEQ ID NO:4)
  • HCDR2 DASSLES (SEQ ID NO:5)
  • the first domain comprises a heavy chain variable region (VH) amino acid sequence that is at least 90% identical to SEQ ID NO:13, e.g., about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO:13.
  • VH heavy chain variable region
  • the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92-99.6%, 94-99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the first domain comprises a VH of SEQ ID NO: 13.
  • the first domain comprises a light chain variable region (VL) amino acid sequence that is at least 90% identical to SEQ ID NO:14, e.g., about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 14.
  • VL light chain variable region
  • the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92-99.6%, 94-99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the first domain comprises a VL of SEQ ID NO: 14.
  • the term “identical” or “has sequence identity,” refers to the extent to which two amino acid sequences have the same residues at the same positions when the sequences are aligned to achieve a maximal level of identity, expressed as a percentage.
  • the first domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; and b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14.
  • the first domain comprises: a) a VH of SEQ ID NO: 13; and b) a VL of SEQ ID NO: 14.
  • VH QVQLVESGGGWQPGRSLRLSCAASGFTFSTYGMHWVRQAPGKGLEWVAV
  • the first domain comprises a first heavy chain (HC1) amino acid sequence that is at least 80% identical to SEQ ID NO: 17, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99
  • the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the first domain comprises a HC1 amino acid sequence of SEQ ID NO: 17.
  • the first domain comprises a first light chain (LC1) amino acid sequence that is at least 80% identical to SEQ ID NO:18, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 18.
  • LC1 first light chain
  • the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the first domain comprises a LC1 amino acid sequence of SEQ ID NO: 18.
  • the first domain comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; and/or b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18.
  • the first domain comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; and b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18.
  • the first domain comprises: a) a HC1 of SEQ ID NO: 17; and/or b) a LC1 of SEQ ID NO: 18.
  • the first domain comprises: a) a HCl of SEQ ID NO: 17; and b) a LC1 of SEQ ID NO: 18.
  • HC1 QVQLVESGGGWQPGRSLRLSCAASGFTFSTYGMHWVRQAPGKGLEWVA VIWDDGSYKYYGDSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARDGITMVRGVMK DYFDYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGAL TSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTC PPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAK TKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYT LPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFLLYSKLTV
  • the second domain that specifically binds c-Met comprises: a) HCDR1, HCDR2, HCDR3 amino acid sequences of SEQ ID NOs:7, 8 and 9, respectively; and/or b) LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:10, 11 and 12, respectively.
  • the second domain that specifically binds c-Met comprises: a) HCDR1, HCDR2, HCDR3 amino acid sequences of SEQ ID NOs:7, 8 and 9, respectively; and b) LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:10, 11 and 12, respectively.
  • HCDR1 SYGIS (SEQ ID NO:7)
  • HCDR2 WISAYNGYTNYAQKLQG (SEQ ID NO:8)
  • HCDR3 DLRGTNYFDY (SEQ ID NO:9)
  • HCDR1 RASQGISNWLA (SEQ ID NO: 10)
  • HCDR2 AASSLLS (SEQ ID NO: 11)
  • HCDR3 QQANSFPIT (SEQ ID NO: 12)
  • the second domain comprises a VH amino acid sequence that is at least 90% identical to SEQ ID NO:15, e.g, about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 15.
  • the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92-99.6%, 94- 99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the second domain comprises a VH of SEQ ID NO: 15
  • the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92- 99.6%, 94-99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the second domain comprises a VL of SEQ ID NO: 16.
  • the second domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and/or b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16. [0170] In some embodiments, the second domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16.
  • the second domain comprises: a) a VH of SEQ ID NO: 15; and b) a VL of SEQ ID NO: 16.
  • VH QVQLVQSGAEVKKPGASVKVSCETSGYTFTSYGISWVRQAPGHGLEWMGW ISAYNGYTNYAQKLQGRVTMTTDTSTSTAYMELRSLRSDDTAVYYCARDLRGTNYFDYWG QGTLVTVSS (SEQ ID NO: 15)
  • VL DIQMTQSPSSVSASVGDRVTITCRASQGISNWLAWFQHKPGKAPKLLIYAAS SLLSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQANSFPITFGQGTRLEIK (SEQ ID NO: 16)
  • the second domain comprises a second heavy chain (HC2) amino acid sequence that is at least 80% identical to SEQ ID NO: 19, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO:19.
  • HC2 second heavy chain amino acid sequence that is at least 80% identical to SEQ ID NO: 19, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%
  • the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the second domain comprises a HC2 amino acid sequence of SEQ ID NO: 19.
  • the second domain comprises a second light chain (LC2) amino acid sequence that is at least 80% identical to SEQ ID NO:20, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO:20.
  • LC2 second light chain
  • the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%.
  • the second domain comprises a LC2 amino acid sequence of SEQ ID NO:20.
  • the second domain comprises: a) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and/or b) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
  • the second domain comprises: a) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and b) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
  • the second domain comprises: a) a HC2 of SEQ ID NO: 19; and/or b) a LC2 of SEQ ID NO:20.
  • the second domain comprises: a) a HC2 of SEQ ID NO: 19; and b) a LC2 of SEQ ID NO:20.
  • HC2 QVQLVQSGAEVKKPGASVKVSCETSGYTFTSYGISWVRQAPGHGLEWMG WISAYNGYTNYAQKLQGRVTMTTDTSTSTAYMELRSLRSDDTAVYYCARDLRGTNYFDYW GQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTF PAVLQSSGLYSLSSWTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPE
  • LC2 DIQMTQSPSSVSASVGDRVTITCRASQGISNWLAWFQHKPGKAPKLLIYAAS SLLSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQANSFPITFGQGTRLEIKRTVAAPSVFIF PPSDEQLKSGTASWCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLT LSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC (SEQ ID NO: 20)
  • the antibody (e.g. , bispecific antibody) comprises: a) a first domain that specifically binds EGFR, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and/or b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
  • the antibody (e.g., bispecific antibody) comprises: a) a first domain that specifically binds EGFR, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
  • the antibody (e.g. , bispecific antibody) comprises: a) a first domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; b) a first domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14; c) a second domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and/or d) a second domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16.
  • the antibody (e.g., bispecific antibody) comprises: a) a first domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; b) a first domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14; c) a second domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and d) a second domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16.
  • the antibody (e.g. , bispecific antibody) comprises: a) a first domain comprising a VH of SEQ ID NO : 13 ; b) a first domain comprising a VL of SEQ ID NO: 14; c) a second domain comprising a VH of SEQ ID NO: 15; and/or d) a second domain comprising a VL of SEQ ID NO: 16.
  • the antibody (e.g. , bispecific antibody) comprises: a) a first domain comprising a VH of SEQ ID NO : 13 ; b) a first domain comprising a VL of SEQ ID NO: 14; c) a second domain comprising a VH of SEQ ID NO: 15; and d) a second domain comprising a VL of SEQ ID NO: 16.
  • the antibody (e.g., bispecific antibody) comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18; c) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and/or d) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
  • the antibody (e.g., bispecific antibody) comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18; c) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and d) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
  • the antibody (e.g., bispecific antibody) comprises: a) a HC1 of SEQ ID NO: 17; b) a LC1 of SEQ ID NO: 18; c) a HC2 of SEQ ID NO: 19; and/or d) a LC2 of SEQ ID NO:20.
  • the antibody (e.g. , bispecific antibody) comprises: a) a HCl of SEQ ID N0:17; b) a LCl of SEQ ID NO:18; c) a HC2 of SEQ ID NO: 19; and d) a LC2 of SEQ ID NO:20.
  • the antibody e.g. , bispecific antibody
  • the antibody is of the IgG isotype.
  • the antibody e.g., bispecific antibody
  • the IgGl isotype Some variation exists within the IgGl constant domain (e.g., well-known allotypes), for example, with variation at positions 214, 356, 358, 422, 431, 435 and/or 436 (residue numbering according to the EU numbering) (see e.g., IMGT Web resources; IMGT Repertoire (IG and TR); Proteins and alleles; allotypes).
  • the bispecific anti-EGFR/c-Met antibody may be of any IgGl allotype, such as Glml7, Glm3, Glml, Glm2, Glm27 or Glm28.
  • the antibody is a human antibody.
  • the antibody is amivantamab.
  • Amivantamab or JNJ-61186372 (JNJ-372) is an IgGl anti-EGFR/c-Met bispecific antibody described in U.S. Pat. No. 9,593,164.
  • a schematic of the structure of amivantamab is shown in FIG. 2. The disclosure is based, at least in part, on the finding that amivantamab is effective in treating CRC such as mCRC.
  • anti-EGFR/c-Met antibodies may also be used in the methods of the disclosure, for example, by combining publicly available EGFR binding VH/VL domains and c-Met binding VH/VL domains.
  • the antibody (e.g. , bispecific antibody) comprises a biantennary glycan structure with a fucose content of between about 1% to about 15%. In some embodiments, the antibody (e.g., bispecific antibody) comprises a biantennary glycan structure with a fucose content of less than about 20%.
  • Antibodies with reduced fucose content can be made using different methods reported to lead to the successful expression of relatively high defucosylated antibodies bearing the biantennary complex-type of Fc oligosaccharides such as control of culture osmolality (Konno et al., Cytotechnology 64(:249-65, 2012), application of a variant CHO line Lecl3 as the host cell line (Shields et al., J Biol Chem 277:26733-26740, 2002), application of a variant CHO line EB66 as the host cell line (Olivier et al., MAbs ;2(4), 2010; Epub ahead of print; PMID:20562582), application of a rat hybridoma cell line YB2/0 as the host cell line (Shinkawa et al., J Biol Chem 278:3466-3473, 2003), introduction of small interfering RNA specifically against the a 1,6-fucosyltrasfer
  • Anti-EGFR/c-Met antibodies used in the methods of the disclosure may be generated, for example, using Fab arm exchange (or half molecule exchange) between two monospecific bivalent antibodies by introducing substitutions at the heavy chain CH3 interface in each half molecule to favor heterodimer formation of two antibody half molecules having distinct specificity either in vitro in cell-free environment or using co-expression.
  • the Fab arm exchange reaction is the result of a disulfide-bond isomerization reaction and dissociation-association of CH3 domains. The heavy chain disulfide bonds in the hinge regions of the parental monospecific antibodies are reduced.
  • Mutations F405L in one heavy chain and K409R in the other heavy chain may be used in case of IgGl antibodies.
  • IgG2 antibodies a wild-type IgG2 and a IgG2 antibody with F405L and R409K substitutions may be used.
  • IgG4 antibodies a wild-type IgG4 and a IgG4 antibody with F405L and R409K substitutions may be used.
  • the first monospecific bivalent antibody and the second monospecific bivalent antibody are engineered to have the aforementioned mutation in the Fc region, and the antibodies are incubated together under reducing conditions sufficient to allow the cysteines in the hinge region to undergo disulfide bond isomerization; thereby generating the bispecific antibody by Fab arm exchange.
  • the incubation conditions may optimally be restored to non-reducing.
  • Exemplary reducing agents that may be used are 2- mercaptoethylamine (2-MEA), dithiothreitol (DTT), dithioerythritol (DTE), glutathione, tris(2- carboxyethyl)phosphine (TCEP), L-cysteine and beta- mercaptoethanol.
  • incubation for at least 90 min at a temperature of at least 20°C in the presence of at least 25 mM 2-MEA or in the presence of at least 0.5 mM dithiothreitol at a pH of from 5-8, for example at pH of 7.0 or at pH of 7.4 may be used.
  • Bispecific anti-EGFR/c-Met antibodies used in the methods of the disclosure may also be generated using designs such as the Knob-in-Hole (Genentech), CrossMAbs (Roche) and the electrostatically -matched (Chugai, Amgen, NovoNordisk, Oncomed), the LUZ-Y (Genentech), the Strand Exchange Engineered Domain body (SEEDbody) (EMD Serono), and the Biclonic (Merus).
  • Knob-in-Hole Genentech
  • CrossMAbs Roche
  • electrostatically -matched Chougai, Amgen, NovoNordisk, Oncomed
  • the LUZ-Y Genentech
  • SEEDbody Strand Exchange Engineered Domain body
  • EMD Serono the Strand Exchange Engineered Domain body
  • Biclonic Biclonic
  • WO 2006/028936 select amino acids forming the interface of the CH3 domains in human IgG can be mutated at positions affecting CH3 domain interactions to promote heterodimer formation.
  • An amino acid with a small side chain (hole) is introduced into a heavy chain of an antibody specifically binding a first antigen and an amino acid with a large side chain (knob) is introduced into a heavy chain of an antibody specifically binding a second antigen.
  • a heterodimer is formed as a result of the preferential interaction of the heavy chain with a “hole” with the heavy chain with a “knob”.
  • Exemplary CH3 substitution pairs forming a knob and a hole are (expressed as modified position in the first CH3 domain of the first heavy chain/ modified position in the second CH3 domain of the second heavy chain): T366Y/F405A, T366W/F405W, F405W/Y407A, T394W/Y407T, T394S/Y407A, T366W/T394S, F405W/T394S and T366W/T366S_L368A_Y407V.
  • CrossMAb technology in addition to utilizing the “knob-in-hole” strategy to promote Fab arm exchange utilizes CH1/CL domain swaps in one half arm to ensure correct light chain pairing of the resulting bispecific antibody (see e.g., U.S. Patent No. 8,242,247).
  • SEEDbody technology may be utilized to generate bispecific antibodies of the invention.
  • SEEDbodies have, in their constant domains, select IgG residues substituted with IgA residues to promote heterodimerization as described in U.S. Patent No. US20070287170.
  • Mutations are typically made at the DNA level to a molecule such as the constant domain of the antibody using standard methods.
  • the anti-EGFR/c-Met antibody e.g. , bispecific antibody
  • additional therapeutic e.g. , chemotherapeutic
  • the pharmaceutical composition further comprises a pharmaceutically acceptable carrier.
  • the mode of administration may be any suitable route that delivers the antibody (e.g. , bispecific antibody) to the subject in need thereof, such as parenteral administration, e.g., intradermal, intramuscular, intraperitoneal, intravenous or subcutaneous, pulmonary, transmucosal (oral, intranasal, intravaginal, rectal), using a formulation in a tablet, capsule, solution, powder, gel, particle; and contained in a syringe, an implanted device, osmotic pump, cartridge, micropump; or other means appreciated by the skilled artisan, as well known in the art.
  • parenteral administration e.g., intradermal, intramuscular, intraperitoneal, intravenous or subcutaneous, pulmonary, transmucosal (oral, intranasal, intravaginal, rectal), using a formulation in a tablet, capsule, solution, powder, gel, particle; and contained in a syringe, an implanted device, osm
  • Site specific administration may be achieved by, for example intratumoral, intracolic, intraabdominal, intragastric, intracavitary, intrapelvic, intraperitoneal, intrarectal, intrathoracic, intravascular, intralesional, rectal, buccal, sublingual, intranasal, or transdermal delivery.
  • the pharmaceutical composition comprising the anti-EGFR/c-Met antibody (e.g., bispecific antibody) is administered via a subcutaneous injection.
  • the antibody e.g. , bispecific antibody
  • the antibody is administered at a dose of about 140 mg to about 2,100 mg, for example, about 700 mg to about 1,400 mg, about 700 mg to about 1,050 mg, about 1,050 mg to about 1,400 mg, or about 1,750 mg to about 2,100 mg.
  • the antibody e.g. , bispecific antibody
  • the antibody is administered at a dose of about: 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, 500, 510, 520, 530, 540, 550, 560, 570, 580,
  • the antibody is administered at a dose of about 1,000 mg.
  • the antibody is administered at a dose of about 1,100 mg.
  • the antibody is administered at a dose of about 1,150 mg.
  • the antibody is administered at a dose of about 1,250 mg.
  • the antibody is administered at a dose of about 1,350 mg.
  • the antibody is administered once a week.
  • the antibody is administered once every three weeks.
  • the antibody is administered once every four weeks.
  • the antibody is administered once a week or once every two weeks. In particular embodiments, the antibody is administered once weekly for the first 4 weeks and then every 2 weeks.
  • the subject has a body weight (B W) of ⁇ 80 kg, and the antibody
  • the subject is administered an IV infusion of amivantamab at a dose of 1,050 or 700 mg if the BW is ⁇ 80 kg, or 1,400 or 1,050 mg if BW is >80 kg, on Days -1, - 2, 8, and 22 of Cycle 1 and along with FOLFOX6 chemotherapy (e.g. , mFOLFOX6 SoC chemotherapy) on Days 1 and 15 of Cycle 1 and Days 1 and 15 of Cycle 2 (each cycle of 28 days).
  • FOLFOX6 chemotherapy e.g. , mFOLFOX6 SoC chemotherapy
  • the subject is administered an IV infusion of amivantamab along with FOLFIRI chemotherapy on Days -1, -2, and 8 of Cycle 1 and Days 1 and 15 of Cycle 2.
  • the subject has a body weight (B W) of >80 kg, and the antibody (e.g. , bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then every 2 weeks 28-day cycles.
  • the subject has a body weight of >80 kg, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,400 mg once weekly for the first 4 weeks and then every 2 weeks 28-day cycles.
  • the subject administered an IV infusion of amivantamab at a dose of 1,050 or 700 mg if the BW is ⁇ 80 kg, or 1,400 or 1,050 mg if BW is >80 kg, onDays -1, -2, 8, and 22 of Cycle 1 and along withFOLFOX6 chemotherapy (e.g., mFOLFOX6 SoC chemotherapy) onDays 1 and 15 of Cycle 1 and Days 1 and 15 of Cycle 2 (each cycle of 28 days).
  • the subject is administered an IV infusion of amivantamab along with FOLFIRI chemotherapy on days -1, -2, and 8 of Cycle 1 and Days 1 and 15 of Cycle 2.
  • the subject administered an IV infusion of amivantamab at a dose of 1,050 or 1,750 mg if the BW is ⁇ 80 kg, or 1,400 or 2,100 mg if BW is >80 kg, onDays -1, -2, 8, and 22 of Cycle 1 and along with FOLFOX6 chemotherapy (e.g., mFOLFOX6 SoC chemotherapy) onDays 1 and 15 of Cycle 1 and Days 1 and 15 of Cycle 2 (each cycle of 28 days).
  • FOLFOX6 chemotherapy e.g., mFOLFOX6 SoC chemotherapy
  • the subject is administered an IV infusion of amivantamab along with FOLFIRI chemotherapy on days -1, -2, and 8 of Cycle 1 and Days 1 and 15 of Cycle 2.
  • FOLFOX chemotherapy is administered to the subject on Days 1 and 15 of the 28-day cycles.
  • the chemotherapeutic agent is FOLFIRI chemotherapy.
  • FOLFIRI is administered to the subject on Days 1 and 15 of the 28-day cycles.
  • the subject has a body weight (BW) of 80 kg or more, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then every 2 weeks in 28-day cycles if a dose of 1,400 mg is found to not be tolerated.
  • the antibody is administered on Cycle 1 Days 1, 8, 15, and 22, and then Days 1 and 15 starting on Cycle 2 (in 28 day cycles).
  • the antibody (e.g. , bispecific antibody such as amivantamab) is administered intravenously.
  • the subject is further administered a chemotherapeutic agent.
  • the chemotherapeutic agent is FOLFOX chemotherapy. In some embodiments, FOLFOX chemotherapy is administered to the subject on Days 1 and 15 of the 28-day cycles. In some embodiments, the chemotherapeutic agent is FOLFIRI chemotherapy. In some embodiments, FOLFIRI is administered to the subject on Days 1 and 15 of the 28-day cycles.
  • Pharmaceutical compositions comprising 1,400 mg, 1,050 mg and 700 mg dose of the anti-EGFR/c-Met antibody can be administered in total volumes of about 28 mL, 21 mL and 14 mL, respectively, with 350 mg/7 mL (50 mg/mL) solution in a single-dose vial.
  • the method further comprises administering to the subject one or more additional therapeutic agents.
  • the one or more additional therapeutic agents include a T cell expressing chimeric antigen receptor (CAR) (CAR-T cell), a natural killer cell expressing CAR (CAR-NK cell), a macrophage expressing CAR (CAR-M cell), a chemotherapeutic agent, an immune checkpoint inhibitor, a T-cell redirector, radiation therapy, surgery and a standard of care drug.
  • the one or more additional therapeutic agents comprises chemotherapy, radiation therapy, surgery, a targeted anti-cancer therapy, a kinase inhibitor, or a combination thereof.
  • the one or more additional therapeutic agents are one or more anticancer therapies. In some embodiments, the one or more additional therapeutic agents comprise one or more chemotherapeutic agents.
  • a non-exhaustive list of chemotherapeutic agents considered for use in combination therapies include anastrozole (Arimidex®), bicalutamide (Casodex®), bleomycin sulfate (Blenoxane®), busulfan (Myleran®), leucovorin calcium, melphalan (Alkeran®), 6-mercaptopurine (Purinethol®), methotrexate (Folex®), mitoxantrone (Novantrone®), mylotarg, paclitaxel (Taxol®), phoenix (Yttrium90/MX-DTPA), pentostatin, polifeprosan 20 with carmustine implant (Gliadel®), dactinomycin (Actinomycin D, Cosmegan), daunorubicin hydrochloride (Cerubidine®), daunorubicin citrate liposome injection (DaunoXome®), dexamethasone, docet
  • alkylating agents include, without limitation, Oxaliplatin (Eloxatin®); Melphalan (also known as L-PAM, L-sarcolysin, and phenylalanine mustard, Alkeran®); Altretamine (also known as hexamethylmelamine (HMM), Hexylen®); Carmustine (BiCNU®); Bendamustine (Treanda®); Busulfan (Busulfex® and Myleran®); Carboplatin (Paraplatin®); Temozolomide (Temodar® and Temodal®); Dactinomycin (also known as actinomycin- D, Cosmegen®); Lomustine (also known as CCNU, CeeNU®); Cisplatin (also known as CDDP, Platinol® and Platinol®- AQ); Chlorambucil (Leukeran®); Cyclophosphamide (Cytoxan® and Neosar®); dacarbazine (also known
  • the one or more additional therapeutic agents comprise a kinase inhibitor.
  • the kinase inhibitor comprises an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL or a combination thereof.
  • the kinase inhibitor is an inhibitor of EGFR.
  • the kinase inhibitor is an inhibitor of c-Met.
  • the kinase inhibitor is an inhibitor of HER2.
  • the kinase inhibitor is an inhibitor of HER3.
  • the kinase inhibitor is an inhibitor of HER4.
  • the kinase inhibitor is an inhibitor of VEGFR.
  • the kinase inhibitor is an inhibitor of or AXL.
  • the one or more prior anti-cancer therapies comprises carboplatin, paclitaxel, gemcitabine, cisplatin, vinorelbine, docetaxel, palbociclib, crizotinib, PD-(L)1 axis inhibitor, an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL, erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib, or any
  • Anti-cancer therapies that may be administered in combination with the anti-EGFR/c-Met antibody (e.g., bispecific antibody) in the methods of the disclosure include any one or more of the chemotherapeutic drugs or other anti-cancer therapeutics known to those of skill in the art.
  • Chemotherapeutic agents are chemical compounds useful in the treatment of cancer and include growth inhibitory agents or other cytotoxic agents and include alkylating agents, anti-metabolites, anti-microtubule inhibitors, topoisomerase inhibitors, receptor tyrosine kinase inhibitors, angiogenesis inhibitors and the like.
  • chemotherapeutic agents include alkylating agents such as thiotepa and cyclosphosphamide (CYTOXAN®); alkyl sulfonates such as busulfan, improsulfan and piposulfan; aziridines such as benzodopa, carboquone, meturedopa, and uredopa; ethylenimines and methylamelamines including altretamine, triethylenemelamine, trietylenephosphoramide, triethylenethiophosphaoramide and trimethylolomelamine; nitrogen mustards such as chlorambucil, chlomaphazine, cholophosphamide, estramustine, ifosfamide, mechlorethamine, mechlorethamine oxide hydrochloride, melphalan, novembichin, phenesterine, prednimustine, trofosfamide, uracil mustard; nitrosureas such as carmustine,
  • anti-hormonal agents that act to regulate or inhibit hormone action on tumors
  • anti-estrogens including for example tamoxifen, raloxifene, aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen, trioxifene, keoxifene, LY 117018, onapristone, and toremifene (FARESTON®); and anti-androgens such as flutamide, nilutamide, bicalutamide, leuprolide, and goserelin; and pharmaceutically acceptable salts, acids or derivatives of any of the above.
  • the folinic acid is a racemic mixture of L- and D- folinic acid and the folinic acid is administered at a dose of about 400 mg/m 2 . In some embodiments, the folinic acid is L-folinic acid and the folinic acid is administered at a dose of about 200 mg/m 2 . In some embodiments, the fluorouracil is administered at a dose of about 2,800 mg/m 2 .
  • the one or more chemotherapeutic agents comprise folinic acid (leucovorin, FOL), fluorouracil (5-FU, F) and irinotecan (Camptosar, IRI).
  • FOLFIRI folinic acid
  • fluorouracil 5-FU
  • irinotecan Camptosar, IRI.
  • FOLFIRI a chemotherapy regimen for treatment of colorectal cancer, is known to those skilled in the art. Additional information regarding FOLFIRI can be found, for example, in Tournigand et al., J Clin Oncol. 22(2):229-37 (2004), Kamnerdsupaphon et al., J Med Assoc Thai.
  • the one or more chemotherapeutic agents comprise FOLFIRI.
  • FOLFIRI comprises folinic acid, fluorouracil, and irinotecan.
  • the irinotecan is administered at a dose of about 180 mg/m 2 .
  • the folinic acid is a racemic mixture of L- and D- folinic acid.
  • the folinic acid is L- folinic acid.
  • the folinic acid is administered at a dose between 200 mg/m 2 and 400 mg/m 2 .
  • the folinic acid is a racemic mixture of L- and D- folinic acid and the folinic acid is administered at a dose of about 400 mg/m 2 . In some embodiments, the folinic acid is L-folinic acid and the folinic acid is administered at a dose of about 200 mg/m 2 . In some embodiments, the fluorouracil is administered at a dose of about 2,800 mg/m 2 .
  • the one or more chemotherapeutic agents are administered once every two weeks. In some embodiments, the one or more chemotherapeutic agents (e.g., FOLFOX or FOLFIRI) are administered on a 28-day cycle. In some embodiments, the one or more chemotherapeutic agents (e.g., FOLFOX or FOLFIRI) are administered on Days 1 and 15 of the Cycle.
  • the anti-EGFR/c-Met antibody e.g., bispecific antibody
  • the one or more additional therapeutic agents e.g., chemotherapeutic agents
  • the antibody and the one or more additional therapeutic agents are administered separately (e.g., sequentially).
  • the one or more anti-cancer agents may be administered using recommended doses and dosages of the anti-cancer agent.
  • patient and “patient” can be used interchangeably herein.
  • “Patient in need thereof’ or “subject in need thereof’ refers to a mammalian subject, preferably human, diagnosed with or suspected of having a disease, to whom will be or has been administered a bi-specific anti-EGFR anti-MET antibody according to a method of the invention.
  • “Patient in need thereof’ or “subject in need thereof’ includes those subjects already with the undesired physiological change or disease well as those subjects prone to have the physiological change or disease.
  • the subject is 18 years of age or older, e.g., 18 to less than 40 years of age, 18 to less than 45 years of age, 18 to less than 50 years of age, 18 to less than 55 years of age, 18 to less than 60 years of age, 18 to less than 65 years of age, 18 to less than 70 years of age, 18 to less than 75 years of age, 40 to less than 75 years of age, 45 to less than 75 years of age, 50 to less than 75 years of age, 55 to less than 75 years of age, 60 to less than 75 years of age, 65 to less than 75 years of age, 60 to less than 75 years of age, 40 years of age or older, 45 years of age or older, 50 years of age or older, 55 years of age or older, 60 years of age or older, 65 years of age or older, 70 years of age or older or 75 years of age or older.
  • the subject is a child.
  • the subject is 18 years of age or younger, e.g., 0-18 years of age, 0-12 years of age, 0-16 years of age, 0-17 years of age, 2-12 years of age, 2-16 years of age, 2-17 years of age, 2-18 years of age, 3-12 years of age, 3-16 years of age, 3-17 years of age, 3-18 years of age, 4-12 years of age, 4-16 years of age, 4-17 years of age, 4-18 years of age, 6-12 years of age, 6-16 years of age, 6-17 years of age, 6-18 years of age, 9-12 years of age, 9-16 years of age, 9-17 years of age, 9-18 years of age, 12-16 years of age, 12-17 years of age or 12-18 years of age.
  • the subject has been diagnosed with CRC (e.g. , mCRC) for at least about 1 month, e.g. , at least about: 2 months, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 1 year, 18 months, 2 years, 30 months, 3 years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years or 10 years.
  • CRC e.g. mCRC
  • the subject is newly diagnosed with CRC (e.g., mCRC).
  • the CRC is adenocarcinoma.
  • the subject is treatment naive.
  • the subject has received one or more prior anti-cancer therapies.
  • the one or more prior anti-cancer therapies comprises one or more chemotherapeutic agents, checkpoint inhibitors, targeted anti-cancer therapies or kinase inhibitors, or any combination thereof.
  • the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
  • Various qualitative and/or quantitative methods may be used to determine if a subject is resistant, has developed or is susceptible to developing a resistance to treatment with an anti-cancer therapy.
  • Symptoms that may be associated with resistance to an anti-cancer therapy include a decline or plateau of the well-being of the patient, an increase in the size of a tumor, arrested or slowed decline in growth of a tumor, and/or the spread of cancerous cells in the body from one location to other organs, tissues or cells.
  • Symptoms associated with lung cancer may include persistent cough, coughing up blood, shortness of breath, wheezing chest pain, loss of appetite, losing weight without trying and fatigue.
  • Symptoms for liver cancer may include loss of appetite and weight, abdominal pain, especially in the upper right part of abdomen that may extend into the back and shoulder, nausea and vomiting, general weakness and fatigue, an enlarged liver, abdominal swelling (ascites), and a yellow discoloration of the skin and the whites of eyes (jaundice).
  • One skilled in oncology may readily identify symptoms associated with a particular cancer type.
  • Exemplary PD-(L)1 axis inhibitors are antibodies that bind PD-1 such as nivolumab (OPDIVO®), pembrolimumab (KEYTRUDA®), sintilimab, cemiplimab (LIBTAYO®), tripolibamab, tislelizumab, spartalizumab, camrelizumab, dostralimab, genolimzumab or cetrelimab, or antibodies that bind PD-L1, such as PD-L1 antibodies are envafolimab, atezolizumab (TECENTRIQ®), durvalumab (IMFINZI®) and avelumab (BAVENCIO®).
  • OPDIVO® nivolumab
  • KEYTRUDA® pembrolimumab
  • sintilimab sintilimab
  • cemiplimab LIBTAYO®
  • Marketed antibodies may be purchased via authorized distributor or pharmacy.
  • the amino acid sequences structures of the small molecules can be found from US AN and/or INN submissions by the companies of from CAS registry.
  • the subject has EGFR or c-Met expressing cancer.
  • Exemplary c-Met activating mutations include point mutations, deletion mutations, insertion mutations, inversions or gene amplifications that lead to an increase in at least one biological activity of a c-Met protein, such as elevated tyrosine kinase activity, formation of receptor homodimers and heterodimers, enhanced ligand binding etc. Mutations can be located in any portion of the c-Met gene or regulatory regions associated with the gene, such as mutations in the kinase domain of c-Met. Exemplary c-Met activating mutations are mutations at residue positions N375, V13, V923, R175, V136, L229, S323, R988, S1058/T1010 and E168. Methods for detecting EGFR and c-Met mutations or gene amplifications are well known.
  • the subject has been characterized with wild-type KRAS, NRAS and BRAF. In some embodiments, the subject has been characterized with wild-type EGFR. In some embodiments, the subject has at least one intrahepatic tumor that resulted from metastasis of the mCRC.
  • Certain embodiments of the present disclosure concern determining the presence of mutations in a KRAS, NRAS, BRAF, or EGFR gene, or ERBB2/HER2 amplification.
  • Mutation detection methods are known the art, including PCR followed by nucleic acid sequencing, FISH, CGH, or next generation sequencing (NGS).
  • the mutations are detected by DNA sequencing, such as next generation sequencing (NGS), by using a tumor tissue sample or circulating free tumor DNA (ctDNA) from plasma.
  • the method comprises: a) providing a biological sample from the subject; b) determining presence or absence of a mutation in KRAS, NRAS, BRAF, or EGFR gene or ERBB2/HER2 gene/fragment amplification in the sample; c) administering or providing for administration the anti-EGFR/c-Met antibody to the subject determined to have wild type KRAS, NRAS, BRAF, or EGFR gene or no ERBB2/HER2 gene/fragment amplification.
  • the biological sample is a blood sample.
  • the biological sample is a tumor tissue biopsy.
  • the method comprises: a) providing ctDNA from the subject; b) determining presence or absence of an alteration in TP53 or APC in the sample; c) administering or providing for administration the anti-EGFR/c-Met antibody to the subject determined to have an alteration in TP53 or APC.
  • the alteration in TP53 or APC is a somatic mutation, gene amplification, or fusion that alters the function of TP53 or APC.
  • the alteration in TP53 or APC is a point mutation, deletion mutation, or insertion mutation.
  • the alteration in TP53 or APC is a gene amplification, or fusion that alters the function of TP53 or APC.
  • the alteration in TP53 is a somatic mutation, gene amplification, or fusion that alters the function of TP53.
  • the alteration in TP53 is a point mutation.
  • the alteration in TP53 is a deletion mutation.
  • the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody and a therapeutically effective amount of one or more chemotherapeutic agents to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO:
  • the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16, and a therapeutically effective amount of one or more chemotherapeutic agents.
  • the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody and a therapeutically effective amount of one or more chemotherapeutic agents to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
  • the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody and a therapeutically effective amount of one or more chemotherapeutic agents to the subject, wherein the bispecific anti-EGFR/c-Met antibody is amivantamab.
  • the method further comprises administering one or more chemotherapeutic agents to the subject.
  • the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
  • the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan.
  • a method of treating colorectal cancer in a subject in need thereof comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject.
  • EGFR anti-epidermal growth factor receptor
  • c-Met hepatocyte growth factor receptor
  • the antibody comprises: a) a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
  • the antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO:20.
  • any one of embodiments 1-15 wherein the method further comprises administering one or more chemotherapeutic agents to the subject.
  • the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
  • the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan.
  • EGFRj/hepatocyte growth factor receptor (c-Met) antibody an anti-epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody and one or more chemotherapeutic agents
  • the antibody comprises: a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
  • HCDR1 heavy chain complementarity determining region 1
  • LCDR1 light chain complementarity determining region 1
  • LCDR1 light chain complementarity determining region 1
  • the method of any one of embodiments 30-34, wherein the antibody is an isolated bispecific antibody.
  • the method of embodiment 35, wherein the bispecific antibody is amivantamab.
  • the method of any one of embodiments 30-36, wherein the antibody comprises a biantennary glycan structure with a fucose content of about 1% to about 15% or of less than about 20%.
  • the method of any one of embodiments 30-37, wherein the antibody is administered at a dose of about 1,050 mg to about 2,100 mg.
  • the method of embodiment 38, wherein the antibody is administered at a dose of about 1,400 mg.
  • any one of embodiments 30-40 wherein the antibody is administered once a week or once every two weeks.
  • any one of embodiments 30-43 wherein the antibody is administered at a dose of 1,050 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of less than 80 kg, or at a dose of 1,400 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of 80 kg or more.
  • BW body weight
  • any one of embodiments 30-44 wherein the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
  • FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
  • the method of embodiment 45 wherein FOLFOX is administered once every two weeks.
  • the method of embodiment 49 wherein the folinic acid is administered at a dose of about 400 mg/m 2 .
  • the method of any one of embodiments 30-44 wherein the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil, and irinotecan.
  • any one of embodiments 54-61 wherein the fluorouracil is administered at a dose of about 2,800 mg/m 2 .
  • the method of any one of embodiments 30-62 wherein the subject has been characterized with wild-type KRAS, NRAS and BRAF.
  • the method of any one of embodiments 30-63 wherein the subject has been characterized with no amplification of ERBB2/HER2.
  • the method of any one of embodiments 30-64 wherein there is an alteration in the tumor protein 53 (TP53) gene or adenomatous polyposis coli (APC) gene in the circulating tumor DNA (ctDNA) of the subject.
  • TP53 tumor protein 53
  • APC adenomatous polyposis coli
  • the method of embodiment 65 wherein the alteration in TP53 or APC is a somatic mutation that alters the function of TP53 or APC.
  • the method of embodiment 66 wherein the alteration in TP53 or APC is a point mutation, insertion mutation, or deletion mutation.
  • the method of claim 65 wherein the alteration in TP53 or APC is a gene amplification or fusion that alters the function of TP53 or APC.
  • the method of any one of embodiments 30-68 wherein the subject is anti-EGFR therapy naive.
  • the method of any one of embodiments 30-68 wherein the subject has received prior anti- EGFR therapy.
  • the method of any one of embodiments 30-68 wherein the subject is treatment naive.
  • Example 1 Amivantamab in Patients with Advanced or Metastatic Colorectal Cancer.
  • This is an open-label, multicenter Phlb/2 study of amivantamab as a monotherapy and in combination with chemotherapy in patients with metastatic Colorectal Cancer (mCRC).
  • Part 1 Dose Confirmation will evaluate the safety and confirm the recommended Phase 2 dose (RP2D) of amivantamab either as a monotherapy or recommended Phase 2 combination dose (RP2CD) in combination with FOLFOX or FOLFIRI.
  • Part 2 expansion will evaluate the preliminary anti-tumor activity of amivantamab as monotherapy and in combination with FOLFOX or FOLFIRI in the respective populations. Details of the study are described in Table 1 and FIG. 1.
  • Example 3 Amivantamab monotherapy in relapsed/refractory metastatic colorectal cancer: OrigAMI-1, an open-label, phase lb/2 study.
  • OrigAMI-1 is a global, multicenter, open-label, phase lb/2 study (ClinicalTrials.gov Identifier: NCT05379595).
  • the primary objective of the OrigAMI-1 monotherapy cohorts is to assess the antitumor activity of amivantamab in patients with mCRC, and the secondary objective is to characterize the safety of amivantamab in this population.
  • FIGs. 3-6 show antitumor activity in Cohorts A, A2, B, and C. Data present response evaluable analysis set, which includes patients who received >1 dose of study drug and either had >1 postbaseline efficacy disease assessments, or discontinued treatment for any reason, or had disease progression/death prior to the first postbaseline disease assessment.
  • FIGs. 3-6 show antitumor activity in Cohorts A, A2, B, and C. Data present response evaluable analysis set, which includes patients who received >1 dose of study drug and either had >1 postbaseline efficacy disease assessments, or discontinued treatment for any reason, or had disease progression/death prior to the first postbaseline disease assessment.
  • amivantamab may enable improved clinical activity against mCRC and represents a new therapeutic option in this population.
  • Example 4 Amivantamab plus FOLFOX or FOLFIRI in metastatic colorectal cancer: results from OrigAMI-1, a phase lb/2 study
  • Treatment-related discontinuations of amivantamab were 10% for amivantamab + mFOLFOX6 and 9% for amivantamab + FOLFIRI. Median duration of treatment was 5.2 months for amivantamab + mFOLFOX6 and 5.7 months for amivantamab + FOLFIRI. Amivantamab + chemotherapy demonstrated a safety profile that was consistent with individual components and without evidence of additive toxicity. Treatment-related discontinuations of amivantamab were low. Safety outcomes are depicted in Table 8 below.
  • ORR is the proportion of patients achieving PR or CR by investigator assessment at >2 consecutive disease assessments.
  • ORR among patients receiving amivantamab + FOLFOX was 60% (95% CI, 36-81), and 39% (95% CI, 20-62) among patients receiving amivantamab + FOLFIRI.
  • c Among confirmed responders.
  • Amivantamab + chemotherapy demonstrated durable antitumor activity in patients with RAS/RAF WT mCRC without prior EGFR inhibitor therapy: Overall ORR, 49%; DCR, 88%; mDoR, 7.4 months; mPFS, 7.5 months, Clinically meaningful intrahepatic antitumor activity was seen (intrahepatic ORR of 53%; intrahepatic DCR of 93%). 7 (16%) patients proceeded to curative intent surgery (5 completed, 2 scheduled) due to robust antitumor activity.
  • the safety profile of amivantamab + FOLFOX or FOLFIRI was consistent with each individual component, without additive toxicity, including low rates of treatment-related discontinuations.
  • amivantamab plus chemotherapy showed promising, durable antitumor activity, and notable intrahepatic responses, with a manageable safety profile.
  • Example 5 Amivantamab with or without chemotherapy in right-sided metastatic colorectal cancer: Updated results from OrigAMI-1, an open-label, phase lb/2 study.
  • MET mesenchymal-epithelial transition
  • Amivantamab has shown promising antitumor activity in RAS/BRAF WT mCRC.
  • OrigAMI-1 (ClinicalTrials.gov Identifier: NCT05379595) is a global, multicenter, openlabel, phase lb/2 study of amivantamab monotherapy with or without standard-of-care chemotherapy in patients with advanced or metastatic CRC (FIG. 13).
  • ctDNA testing was performed at screening to identify KRAS/NRAS missense alterations (leading to G12X, G13X, Q61X, K117X, A59X, or A146X), BRAF missense alterations (leading to V600X change), or ERRB2/HER2 amplification, as detected by Guardant360 CDx.
  • R-sided disease was defined as a primary tumor arising from the cecum, ascending colon, or transverse colon.
  • Table 8 Baseline demographic and clinical characteristics a - Includes patients who identified as American Indian or Alaska Native, patients who identified as multiple races, and patients who did not report a race, b - Patients could have metastases at more than 1 location.
  • ECOG PS Eastern Cooperative Oncology Group performance status
  • EGFRi epidermal growth factor receptor inhibitor
  • ALT alanine aminotransferase
  • AST aspartate aminotransferase
  • EGFR epidermal growth factor receptor
  • IRR infusion-related reaction
  • MET mesenchymal-epithelial transition
  • TEAE treatment-emergent adverse event.
  • Kirstein MM Lange A, Prenzler A, Manns MP, Kubicka S, Vogel A. Targeted therapies in metastatic colorectal cancer: a systematic review and assessment of currently available data. Oncologist. 2014 Nov;19(ll):1156-68.

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Abstract

The present invention relates to methods of treating colorectal cancer (CRC), such as metastatic colorectal cancer (mCRC) or unresectable colorectal cancer, in a subject in need thereof, comprising administering a therapeutically effective amount of an antibody (e.g., a bispecific antibody) to the subject, wherein the antibody specifically binds epidermal growth factor receptor (EGFR) and hepatocyte growth factor receptor (c-Met).

Description

Use of Amivantamab to Treat Colorectal Cancer
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional Application No. 63/621,334, filed on 16 January 2024 and U.S. Provisional Application No. 63/691,612, filed on 6 September 2024, each of which is incorporated herein by reference in their entirety.
SEQUENCE LISTING
[0002] The instant application contains a Sequence Listing, which has been submitted electronically in XML format and is hereby incorporated by reference in its entirety. Said XML copy, created on January 15, 2025, is named JBI6868WOPCTl_SL.xml, and is 19,896 bytes in size.
FIELD OF THE INVENTION
[0003] The present invention relates to methods of treating colorectal cancer (CRC), such as metastatic colorectal cancer (mCRC), in a subject in need thereof, comprising administering a therapeutically effective amount of an antibody (e.g. , a bispecific antibody) to the subject, wherein the antibody specifically binds epidermal growth factor receptor (EGFR) and hepatocyte growth factor receptor (c-Met).
BACKGROUND
[0004] Colorectal cancer (CRC) is characterized by the unchecked division of abnormal cells in the colon or rectum. CRC is one of the most common malignant neoplasms, ranked 2nd to 4th in terms of incidence in the world, depending on the location, type or gender (Sawicki et al., Cancers (Basel) 13 (9) :2025 (2021)). CRC is the third most common cause of cancer mortality in the United States (Biller & Schrag, JAMA 325(7):669-85 (2021)). Among people diagnosed with metastatic colorectal cancer (mCRC), fewer than 20% of patients survive beyond 5 years from diagnosis, and the 5 -year survival rate for metastatic CRC is 14% (Id.).
SUMMARY
[0005] There is a need for improved therapeutics or combinations of therapeutics to develop more effective treatment of colorectal cancer (CRC), including metastatic CRC (mCRC).
[0006] The disclosure generally relates to methods that are useful for treating CRC (e.g. , metastatic colorectal cancer (mCRC)).
[0007] In one aspect, the disclosure provides a method of treating CRC in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject. [0008] In some embodiments, the antibody is a bispecific antibody.
[0009] In some embodiments, the antibody (e.g. , bispecific antibody) comprises: a) a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
[0010] In certain embodiments, the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16.
[0011] In particular embodiments, the antibody (e.g. , bispecific antibody) comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO:20.
[0012] In some embodiments, the antibody (e.g. , bispecific antibody) is of the IgGl isotype. In certain embodiments, the antibody (e.g., bispecific antibody) comprises a biantennary glycan structure with a fucose content of less than about 20%. In certain embodiments, the antibody (e.g., bispecific antibody) comprises a biantennary glycan structure with a fucose content of about 1% to about 15%. In particular embodiments, the antibody (e.g., bispecific antibody) is Amivantamab.
[0013] In some embodiments, the antibody (e.g. , bispecific antibody) is administered at a dose of about 1,750 mg to about 2,100 mg. In certain embodiments, the antibody (e.g. , bispecific antibody) is administered once a week or once every two weeks. In particular embodiments, the antibody (e.g. , bispecific antibody) is administered once weekly for the first 4 weeks and then every 2 weeks. In some embodiments, the antibody (e.g. , bispecific antibody) is administered on a 28-day cycle.
[0014] In some embodiments, the antibody (e.g. , bispecific antibody) is administered as a monotherapy. In other embodiments, the method further comprises administering one or more chemotherapeutic agents to the subject. In certain embodiments, the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin. In certain embodiments, the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan.
[0015] In some embodiments, the CRC is mCRC. In some embodiments, the CRC is unresectable. In certain embodiments, the subject has been diagnosed with left-sided CRC. In other embodiments, the subject has been diagnosed with right-sided mCRC.
[0016] In some embodiments, the subject is anti-EGFR therapy naive. In other embodiments, the subject has received prior anti-EGFR therapy. In certain embodiments, the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies. In some embodiments, the subject is treatment naive. In some embodiments, the subject has not received oxaliplatin-based chemotherapy in a metastatic setting.
[0017] In some embodiments, the subject is 18 years of age or older. In some embodiments, the subject has been characterized with wild-type KRAS, NRAS and BRAF. In some embodiments, the subject has been characterized with no amplification of ERBB2/HER2.
[0018] In another aspect, the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO: 11 and the LCDR3 of SEQ ID NO: 12.
[0019] In another aspect, the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16.
[0020] In another aspect, the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20. [0021] In another aspect, the disclosure provides a method of treating mCRC in a subject, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c- Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody is amivantamab.
[0022] In another aspect, the disclosure provides a method of treating colorectal cancer in a subject in need thereof, comprising administering a therapeutically effective amount of an anti- epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody and one or more chemotherapeutic agents to the subject.
[0023] In some embodiments, the antibody comprises: a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs: 1, 2, 3, 4, 5 and 6, respectively; and a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively. [0024] In some embodiments, the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16.
[0025] In some embodiments, the antibody is of the IgGl isotype.
[0026] In some embodiments, the antibody comprises a first heavy chain (HC1) of SEQ ID
NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO: 20.
[0027] In some embodiments, the antibody is an isolated bispecific antibody.
[0028] In some embodiments, the bispecific antibody is amivantamab.
[0029] In some embodiments, the antibody comprises a biantennary glycan structure with a fucose content of less than about 20%.
[0030] In some embodiments, the antibody comprises a biantennary glycan structure with a fucose content of about 1% to about 15%.
[0031] In some embodiments, the antibody is administered at a dose of about 1,050 mg to about 2,100 mg.
[0032] In some embodiments, the antibody is administered at a dose of about 1,050 mg.
[0033] In some embodiments, the antibody is administered at a dose of about 1,400 mg.
[0034] In some embodiments, the antibody is administered once a week or once every two weeks.
[0035] In some embodiments, the antibody is administered on a 28-day cycle.
[0036] In some embodiments, the antibody is administered once every week for the first 4 weeks
(Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15).
[0037] In some embodiments, the antibody is administered at a dose of 1,050 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of less than 80 kg, or at a dose of 1,400 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of 80 kg or more. [0038] In some embodiments, the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
[0039] In some embodiments, FOLFOX is administered once every two weeks.
[0040] In some embodiments, FOLFOX is administered on a 28-day cycle.
[0041] In some embodiments, the oxaliplatin is administered at a dose of about 85 mg/m2.
[0042] In some embodiments, the folinic acid is a racemic mixture of L- and D-folinic acid. In some embodiments, the folinic acid is administered at a dose of about 400 mg/m2.
[0043] In some embodiments, the folinic acid is L-folinic acid. In some embodiments, the folinic acid is administered at a dose of about 200 mg/m2.
[0044] In some embodiments, the fluorouracil is administered at a dose of about 2,800 mg/m2. [0045] In some embodiments, the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil, and irinotecan.
[0046] In some embodiments, FOLFIRI is administered once every two weeks.
[0047] In some embodiments, FOLFIRI is administered on a 28-day cycle.
[0048] In some embodiments, the irinotecan is administered at a dose of about 180 mg/m2.
[0049] In some embodiments, the folinic acid is a racemic mixture of L- and D-folinic acid. In some embodiments, the folinic acid is administered at a dose of about 400 mg/m2.
[0050] In some embodiments, the folinic acid is L-folinic acid. In some embodiments, the folinic acid is administered at a dose of about 200 mg/m2.
[0051] In some embodiments, the fluorouracil is administered at a dose of about 2,800 mg/m2.
[0052] In some embodiments, the subject has been characterized with wild-type KRAS, NRAS and BRAF.
[0053] In some embodiments, the subject has been characterized with no amplification of ERBB2/HER2.
[0054] In some embodiments, there is an alteration in the tumor protein 53 (TP53) gene in the circulating tumor DNA (ctDNA) of the subject.
[0055] In some embodiments, there is an alteration in the adenomatous polyposis coli (APC) gene in the ctDNA of the subject.
[0056] In some embodiments, the alteration in TP53 or APC is a somatic mutation that alters the function of TP53 or APC.
[0057] In some embodiments, the alteration in TP53 or APC is a point mutation, insertion mutation, or deletion mutation.
[0058] In some embodiments, the alteration in TP53 or APC is a gene amplification is a gene amplification or fusion that alters the function of TP53 or APC.
[0059] In some embodiments, the subject is anti-EGFR therapy naive.
[0060] In some embodiments, the subject has received prior anti-EGFR therapy.
[0061] In some embodiments, the subject is treatment naive.
[0062] In some embodiments, the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
[0063] In some embodiments, the subject is 18 years of age or older.
[0064] In some embodiments, the colorectal cancer is metastatic colorectal cancer (mCRC).
[0065] In some embodiments, the subject has been diagnosed with left-sided mCRC.
[0066] In some embodiments, the subject has been diagnosed with right-sided mCRC.
[0067] In some embodiments, the subject has at least one intrahepatic tumor that resulted from metastasis of the mCRC.
[0068] In some embodiments, the method reduces the size of the at least one intrahepatic tumor. [0069] In some embodiments, the subject has one of more unresectable tumors, wherein the method renders the one or more unresectable tumors resectable.
BRIEF DESCRIPTION OF THE DRAWINGS
[0070] The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
[0071] FIG. 1 shows a study design for Phase lb/2, open-label study of amivantamab in patients with advanced or metastatic colorectal cancer.
[0072] FIG. 2 shows a schematic of the structure of amivantamab, an EGFR and cMet bispecific antibody.
[0073] FIG. 3(A-B) shows antitumor activity in Cohort A.
[0074] FIG. 4(A-B) shows antitumor activity in Cohort A2.
[0075] FIG. 5(A-B) shows antitumor activity in Cohort B.
[0076] FIG. 6(A-B) shows antitumor activity in Cohort C.
[0077] FIG. 7(A-D) shows association between amivantamab treatment outcome and prior progression on EGFR mAb in Cohort B.
[0078] FIG. 8 shows genomic landscape of Cohort B.
[0079] FIG. 9 shows a schematic of the OrigAMI-1 study design.
[0080] FIG. 10 shows efficacy of amivantamab + chemotherapy.
[0081] FIG. 11 shows the results of treatment of a 65-year-old Asian female with no prior systemic treatment for colorectal cancer with amivantamab + FOLFIRI.
[0082] FIG. 12 shows consistent efficacy of amivantamab + chemotherapy in patients with TP53 and APC alterations and difficult-to-treat PIK3CA alterations.
[0083] FIG. 13 shows OrigAMI-1 study design highlighting R-sided cohorts (Cohorts C, D, and E). IL, first-line; 2L, second-line; 5-FU, 5-fluorouracil; CRC, colorectal cancer; ctDNA, circulating tumor DNA; ECOG PS, Eastern Cooperative Oncology Group performance status; EGFR, epidermal growth factor receptor; EGFRi, epidermal growth factor receptor inhibitor; IV, intravenous; L-sided, left-sided; R-sided, right-sided; WT, wild-type.
[0084] FIG. 14 shows response by baseline biomarker profde. c - Mutations included MAP2K1 K57T and K57N. d - Mutations included PIK3CA H1047R and R88Q. e - Patient had a KRAS V14I mutation, f - Patient had an EGFR amplification, g - Patient had a BRAF D594G mutation, h - Mutations included PIK3CA amplification and E542K. i - Mutations included MAP2K1 G128D and K57N. CR, complete response; ctDNA, circulating tumor DNA; EGFR, epidermal growth factor receptor; MET, mesenchymal-epithelial transition; PD, progressive disease; PR, partial response; SD, stable disease; SoD, sum of diameters. [0085] FIG. 15 shows antitumor activity of amivantamab monotherapy or amivantamab + FOLFOX or FOLFIRI.
DETAILED DESCRIPTION
Definitions
[0086] All publications, including but not limited to patents and patent applications, cited in this specification are herein incorporated by reference as though fully set forth.
[0087] It is to be understood that the terminology used herein is for describing particular embodiments only and is not intended to be limiting. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains.
[0088] Although any methods and materials similar or equivalent to those described herein may be used in the practice for testing of the present invention, exemplary materials and methods are described herein. In describing and claiming the present invention, the following terminology will be used.
[0089] When a list is presented, unless stated otherwise, it is to be understood that each individual element of that list, and every combination of that list, is a separate embodiment. For example, a list of embodiments presented as “A, B, or C” is to be interpreted as including the embodiments, “A,” “B,” “C,” “A or B,” “A or C,” “B or C,” or “A, B, or C.”
[0090] As used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the content clearly dictates otherwise. Thus, for example, reference to “a cell” includes a combination of two or more cells, and the like.
[0091] The conjunctive term “and/or” between multiple recited elements is understood as encompassing both individual and combined options. For instance, where two elements are conjoined by “and/or,” a first option refers to the applicability of the first element without the second. A second option refers to the applicability of the second element without the first. A third option refers to the applicability of the first and second elements together. Any one of these options is understood to fall within the meaning, and therefore satisfy the requirement of the term “and/or” as used herein.
Concurrent applicability of more than one of the options is also understood to fall within the meaning, and therefore satisfy the requirement of the term “and/or.”
[0092] The transitional terms “comprising,” “consisting essentially of,” and “consisting of’ are intended to connote their generally accepted meanings in the patent vernacular; that is, (i) “comprising,” which is synonymous with “including,” “containing,” or “characterized by,” is inclusive or open-ended and does not exclude additional, unrecited elements or method steps; (ii) “consisting of’ excludes any element, step, or ingredient not specified in the claim; and (iii) “consisting essentially of’ limits the scope of a claim to the specified materials or steps “and those that do not materially affect the basic and novel characteristic(s)” of the claimed invention. Embodiments described in terms of the phrase “comprising” (or its equivalents) also provide as embodiments those independently described in terms of “consisting of’ and “consisting essentially of”
[0093] “About” means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, i.e., the limitations of the measurement system. Unless explicitly stated otherwise within the Examples or elsewhere in the Specification in the context of a particular assay, result or embodiment, “about” means within one standard deviation per the practice in the art, or a range of up to 5%, whichever is larger.
[0094] The term “antibody” or “antibodies” is meant in a broad sense and includes immunoglobulin molecules including monoclonal antibodies including murine, human, humanized and chimeric monoclonal antibodies, full-length antibodies, antigen binding fragments, multispecific antibodies, such as bispecific, trispecific, tetraspecific etc., dimeric, tetrameric or multimeric antibodies, single chain antibodies, domain antibodies and any other modified configuration of the immunoglobulin molecule that comprises an antigen binding site of the required specificity.
[0095] “Specific binding” or “specifically binds” or “specifically binding” or “binds” refer to an antibody binding to an antigen or an epitope within the antigen with greater affinity than for other antigens. Typically, the antibody binds to the antigen or the epitope within the antigen with an equilibrium dissociation constant (KD) of about 5xl0'8 M or less, for example about IxlO'9 M or less, about IxlO'10 M or less, about IxlO'11 M or less, or about IxlO'12 M or less, typically with the KD that is at least one hundred-fold less than its KD for binding to a non-specific antigen (e.g., BSA, casein). The dissociation constant may be measured using known protocols. Antibodies that bind to the antigen or the epitope within the antigen may, however, have cross-reactivity to other related antigens, for example to the same antigen from other species (homologs), such as human or monkey, for example Macaca fascicularis (cynomolgus, cyno) or Pan troglodytes (chimpanzee, chimp). While a monospecific antibody binds one antigen or one epitope, a bispecific antibody binds two distinct antigens or two distinct epitopes.
[0096] “Complementarity determining regions” (CDR) are antibody regions that bind an antigen. CDRs may be defined using various delineations such as Kabat (Wu et al. (1970) J Exp Med 132: 211-50) (Kabat et al., Sequences of Proteins of Immunological Interest, 5th Ed. Public Health Service, National Institutes of Health, Bethesda, Md., 1991), Chothia (Chothia et al. (1987) J Mol Biol 196: 901-17), IMGT (Lefranc et al. (2003) Dev Comp Immunol 27: 55-77) and AbM (Martin and Thornton (1996) J Bmol Biol 263 : 800-15). The correspondence between the various delineations and variable region numbering are described see e.g., Lefranc et al. (2003) Dev Comp Immunol 27: 55-77; Honegger and Pluckthun, (2001) J Mol Biol 309:657-70; International ImMunoGeneTics (IMGT) database; Web resources, http://www_imgt_org). Available programs such as abYsis by UCL Business PLC may be used to delineate CDRs. The term “CDR”, “HCDR1”, “HCDR2”, “HCDR3”, “LCDR1”, “LCDR2” and “LCDR3” as used herein includes CDRs defined by any of the methods described supra, Kabat, Chothia, IMGT or AbM, unless otherwise explicitly stated in the specification.
[0097] “Full-length antibodies” are comprised of two heavy chains (HC) and two light chains (LC) inter-connected by disulfide bonds as well as multimers thereof (e.g., IgM). Each heavy chain is comprised of a heavy chain variable region (VH) and a heavy chain constant region (comprised of domains CHI, hinge, CH2 and CH3). Each light chain is comprised of a light chain variable region (VL) and a light chain constant region (CL). The VH and the VL regions may be further subdivided into regions of hypervariability, termed complementarity determining regions (CDR), interspersed with framework regions (FR). Each VH and VL is composed of three CDRs and four FR segments, arranged from amino-to-carboxy-terminus in the following order: FR1, CDR1, FR2, CDR2, FR3, CDR3 and FR4.
[0098] “Antigen binding fragment” refers to a portion of an immunoglobulin molecule that binds an antigen. Antigen binding fragments may be synthetic, enzymatically obtainable or genetically engineered polypeptides and include the VH, the VL, the VH and the VL, Fab, F(ab')2, Fd and Fv fragments, domain antibodies (dAb) consisting of one VH domain or one VL domain, shark variable IgNAR domains, camelized VH domains, minimal recognition units consisting of the amino acid residues that mimic the CDRs of an antibody, such as FR3-CDR3-FR4 portions, the HCDR1, the HCDR2 and/or the HCDR3 and the LCDR1, the LCDR2 and/or the LCDR3. VH and VL domains may be linked together via a synthetic linker to form various types of single chain antibody designs where the VH/VL domains may pair intramolecularly, or intermolecularly in those cases when the VH and VL domains are expressed by separate single chain antibody constructs, to form a monovalent antigen binding site, such as single chain Fv (scFv) or diabody ; described for example in Int. Patent Publ. Nos. W01998/44001, WO1988/01649, WO1994/13804 and W01992/01047.
[0099] “Monoclonal antibody” refers to an antibody obtained from a substantially homogenous population of antibody molecules, i.e., the individual antibodies comprising the population are identical except for possible well-known alterations such as removal of C-terminal lysine from the antibody heavy chain or post-translational modifications such as amino acid isomerization or deamidation, methionine oxidation or asparagine or glutamine deamidation. Monoclonal antibodies typically bind one antigenic epitope. A bispecific monoclonal antibody binds two distinct antigenic epitopes. Monoclonal antibodies may have heterogeneous glycosylation within the antibody population. Monoclonal antibody may be monospecific or multispecific such as bispecific, monovalent, bivalent or multivalent.
[0100] “Humanized antibodies” refers to antibodies in which the antigen binding sites are derived from non-human species and the variable region frameworks are derived from human immunoglobulin sequences. Humanized antibodies may include intentionally introduced mutations in the framework regions so that the framework may not be an exact copy of expressed human immunoglobulin or germline gene sequences.
[0101] “Human antibodies” refers to antibodies having heavy and light chain variable regions in which both the framework and the antigen binding site are derived from sequences of human origin. If the antibody contains a constant region or a portion of the constant region, the constant region is also derived from sequences of human origin. Antibodies in which antigen binding sites are derived from a non-human species are not included in the definition of “human antibody.”
[0102] A human antibody comprises heavy or light chain variable regions that are derived from sequences of human origin if the variable regions of the antibody are obtained from a system that uses human germline immunoglobulin or rearranged immunoglobulin genes. Non-limiting example systems include human immunoglobulin gene libraries displayed on phage, and transgenic non-human animals such as mice or rats carrying human immunoglobulin loci. A human antibody typically contains amino acid differences when compared to the human germline or rearranged immunoglobulin sequences due to, for example, naturally occurring somatic mutations, intentional substitutions in the framework or antigen binding site, and substitutions introduced during cloning or VDJ recombination in non-human animals. Typically, a human antibody is at least 80% identical in amino acid sequence to an amino acid sequence encoded by a human germline or rearranged immunoglobulin gene. For example, about: 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% identical. In some cases, a human antibody may contain consensus framework sequences derived from human framework sequence analyses (see, e.g., Knappik et al., J. Mol. Biol. 296:57-86 (2000)), or synthetic HCDR3 incorporated into human immune -globulin gene libraries displayed on phage (see, e.g. , Shi et al., J. Mol. Biol. 397:385-96 (2010) and Int. Pat. Publ. No. W02009/085462).
[0103] “Bispecific” refers to an antibody that specifically binds two distinct antigens or two distinct epitopes within the same antigen. The bispecific antibody may have cross-reactivity to other related antigens, for example to the same antigen from other species (homologs), such as human or monkey, for example Macaca cynomolgus (cynomolgus, cyno) or Pan troglodytes, or may bind an epitope that is shared between two or more distinct antigens.
[0104] “Bispecific anti-EGFR/c-Met antibody” or “bispecific EGFR/c-Met antibody” refers to a bispecific antibody having a first domain that specifically binds EGFR and a second domain that specifically binds c-Met. The domains specifically binding EGFR and c-Met are typically VH/VL pairs, and the bispecific anti-EGFR/c-Met antibody is monovalent in terms of binding to EGFR and c- Met.
[0105] “Isolated” refers to a homogenous population of molecules (such as synthetic polynucleotides, polypeptides vectors or viruses) which have been substantially separated and/or purified away from other components of the system the molecules are produced in, such as a recombinant cell, as well as a protein that has been subjected to at least one purification or isolation step. “Isolated” refers to a molecule that is substantially free of other cellular material and/or chemicals and encompasses molecules that are isolated to a higher purity, such as to 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% purity.
[0106] Immunoglobulins may be assigned to five major classes, IgA, IgD, IgE, IgG and IgM, depending on the heavy chain constant domain amino acid sequence. IgA and IgG are further subclassified as the isotypes IgAl, IgA2, IgGl, IgG2, IgG3 and IgG4. Antibody light chains of any vertebrate species may be assigned to one of two clearly distinct types, namely kappa (K) and lambda (X), based on the amino acid sequences of their constant domains.
[0107] “Low fucose” or “low fucose content” as used in the application refers to antibodies with fucose content of about between 1%-15%. In some embodiments, the low fucose content refers to antibodies with fucose content of less than about 20%.
[0108] “Normal fucose” or ‘normal fucose content” as used herein refers to antibodies with fucose content of about over 50%, typically about over 80% or over 85%.
[0109] “Recombinant” refers to DNA, antibodies and other proteins that are prepared, expressed, created or isolated by recombinant means when segments from different sources are joined to produce recombinant DNA, antibodies or proteins.
[0110] “Carrier” refers to a diluent, adjuvant, excipient, or vehicle with which the antibody of the invention is administered. Such vehicles may be liquids, such as water and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like. For example, 0.4% saline and 0.3% glycine may be used to formulate the bispecific anti-EGFR/c-Met antibody. These solutions are sterile and generally free of particulate matter. They may be sterilized by conventional, well-known sterilization techniques (e.g., filtration). For parenteral administration, the carrier may comprise sterile water and other excipients may be added to increase solubility or preservation. Injectable suspensions or solutions may also be prepared utilizing aqueous carriers along with appropriate additives. Suitable vehicles and formulations, inclusive of other human proteins, e.g., human serum albumin, are described, for example, in e.g., Remington: The Science and Practice of Pharmacy, 21st Edition, Troy, D.B. ed., Lipincott Williams and Wilkins, Philadelphia, PA 2006, Part 5, Pharmaceutical Manufacturing pp 691-1092, See especially pp. 958-989.
[0111] “Dosage” refers to the information of the amount of the therapeutic or the drug to be taken by the subject and the frequency of the number of times the therapeutic is to be taken by the subject. “Dose” refers to the amount or quantity of the therapeutic or the drug to be taken each time. [0112] “Therapeutically effective amount” refers to an amount effective, at doses and for periods of time necessary, to achieve a desired therapeutic result. A therapeutically effective amount may vary depending on factors such as the disease state, age, sex, and weight of the individual, and the ability of a therapeutic or a combination of therapeutics to elicit a desired response in the individual. Exemplary indicators of an effective therapeutic or combination of therapeutics that include, for example, improved well-being of the patient.
[0113] “Co-administration,” “administration with,” “administration in combination with,” “in combination with” or the like, encompass administration of the selected therapeutics or drugs to a single patient, and are intended to include treatment regimens in which the therapeutics or drugs are administered by the same or different route of administration or at the same or different time.
[0114] “Fixed combination” refers to a single pharmaceutical composition comprising two or more compounds.
[0115] “Non-fixed combination” refers to separate pharmaceutical compositions, wherein each comprises one or more compounds. The one or more compounds or unit dosage forms can be administered as separate entities either simultaneously, concurrently or sequentially with no specific intervening time limits, wherein such administration provides effective levels of the two compounds in the body of the subject.
[0116] “Antagonist” or “inhibitor” refers to a molecule that, when bound to a cellular protein, suppresses at least one reaction or activity that is induced by a natural ligand of the protein. A molecule is an antagonist when the at least one reaction or activity is suppressed by at least about 20%, 30%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or 100% more than the at least one reaction or activity suppressed in the absence of the antagonist (e.g., negative control), or when the suppression is statistically significant when compared to the suppression in the absence of the antagonist.
[0117] “Treat”, “treating” or “treatment” of a disease or disorder such as cancer refers to accomplishing one or more of the following: reducing the severity and/or duration of the disorder, inhibiting worsening of symptoms characteristic of the disorder being treated, limiting or preventing recurrence of the disorder in subjects that have previously had the disorder, or limiting or preventing recurrence of symptoms in subjects that were previously symptomatic for the disorder.
[0118] “Prevent”, “preventing”, “prevention”, or “prophylaxis” of a disease or disorder means preventing that a disorder occurs in subject.
[0119] “Responsive”, “responsiveness” or “likely to respond” refers to any kind of improvement or positive response, such as alleviation or amelioration of one or more symptoms, diminishment of extent of disease, stabilized (i.e., not worsening) state of disease, preventing spread of disease, delay or slowing of disease progression, amelioration or palliation of the disease state, and remission (whether partial or total), whether detectable or undetectable.
[0120] “Subject” includes any human or nonhuman animal. “Nonhuman animal” includes all vertebrates, e.g. , mammals and non-mammals, such as nonhuman primates, sheep, dogs, cats, horses, cows, chickens, amphibians, reptiles, etc. The terms “subject” and “patient” are used interchangeably herein. [0121] “Cancer” refers to an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread) to other areas of a patient’s body.
[0122] “EGFR or c-Met expressing cancer” refers to cancer that has detectable expression of EGFR or c-Met or has EGFR or c-Met mutation or amplification. EGFR or c-Met expression, amplification and mutation status can be detected using know methods, such as sequencing, next generation sequencing, fluorescent in situ hybridization, immunohistochemistry, flow cytometry or western blotting.
[0123] “Epidermal growth factor receptor” or “EGFR” refers to the human EGFR (also known as HER1 or ErbBl (Ullrich et al., Nature 309:418-425, 1984) having the amino acid sequence shown in GenBank accession number NP 005219, as well as naturally -occurring variants thereof.
[0124] “Hepatocyte growth factor receptor” or “c-Met” as used herein refers to the human c-Met having the amino acid sequence shown in GenBank Accession No: NP 001120972 and natural variants thereof.
[0125] “Newly diagnosed” refers to a subject who has been diagnosed with EGFR or c-Met expressing cancer but has not yet received treatment for CRC (e.g., mCRC).
[0126] “Refractory” refers to a disease that does not respond to a treatment. A refractory disease can be resistant to a treatment before or at the beginning of the treatment, or a refractory disease can become resistant during a treatment.
[0127] “Relapsed” refers to the return of a disease or the signs and symptoms of a disease after a period of improvement after prior treatment with a therapeutic.
[0128] “Diagnosing” or “diagnosis” refers to methods to determine if a subject is suffering from a given disease or condition or may develop a given disease or condition in the future or is likely to respond to treatment for a prior diagnosed disease or condition, i.e., stratifying a patient population on likelihood to respond to treatment. Diagnosis is typically performed by a physician based on the general guidelines for the disease to be diagnosed or other criteria that indicate a subject is likely to respond to a particular treatment.
[0129] “Biological sample” refers to a collection of similar fluids, cells, or tissues isolated from a subject, as well as fluids, cells, or tissues present within a subject. Exemplary samples are biological fluids such as blood, serum and serosal fluids, plasma, lymph, urine, saliva, cystic fluid, tear drops, feces, sputum, mucosal secretions of the secretory tissues and organs, vaginal secretions, ascites fluids, fluids of the pleural, pericardial, peritoneal, abdominal and other body cavities, fluids collected by bronchial lavage, synovial fluid, liquid solutions contacted with a subject or biological source, for example, cell and organ culture medium including cell or organ conditioned medium, lavage fluids and the like, tissue biopsies, tumor tissue biopsies, tumor tissue samples, fine needle aspirations, surgically resected tissue, organ cultures or cell cultures. Methods of the Disclosure
[0130] Anti-epidermal growth factor receptor (EGFR) antibodies combined with chemotherapy are standard-of-care (SoC) in first- or second-line metastatic colorectal cancer (mCRC), with anti- EGFR monotherapy used in later-line therapies. Colorectal cancer-driver mutations (eg, KRAS, NRAS, and BRAF) are implicated in de novo and acquired resistance to the EGFR-targeting monoclonal antibodies (mAbs) cetuximab and panitumumab. In addition, mesenchymal-epithelial transition factor (MET) is highly expressed or amplified in mCRC subsets and plays a role in mediating resistance to anti-EGFR therapies; however, MET inhibitors are not currently used in mCRC treatment.
[0131] In one aspect, the disclosure provides a method of treating CRC in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject.
Anti-EGFR/c-Met Antibodies
[0132] In some embodiments, the anti-EGFR/c-Met antibody is a bispecific antibody. In certain embodiments, the antibody is an isolated antibody. In particular embodiments, the antibody is an isolated bispecific antibody.
[0133] In some embodiments, the antibody (e.g. , bispecific antibody) comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met.
EGFR Binding Arm
[0134] In some embodiments, the first domain that specifically binds EGFR comprises: a) heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3 amino acid sequences of SEQ ID NOs:l, 2 and 3, respectively; and/or b) light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:4, 5 and 6, respectively.
[0135] In certain embodiments, the first domain that specifically binds EGFR comprises: a) HCDR1, HCDR2, HCDR3 amino acid sequences of SEQ ID NOs: 1, 2 and 3, respectively; and b) LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:4, 5 and 6, respectively.
[0136] HCDR1 : TYGMH (SEQ ID NO: 1)
[0137] HCDR2: VIWDDGSYKYYGDSVKG (SEQ ID NO:2)
[0138] HCDR3 : DGITMVRGVMKDYFDY (SEQ ID NO:3)
[0139] HCDR1: RASQDISSALV (SEQ ID NO:4)
[0140] HCDR2: DASSLES (SEQ ID NO:5)
[0141] HCDR3 : QQFNSYPLT (SEQ ID NO:6) [0142] In some embodiments, the first domain comprises a heavy chain variable region (VH) amino acid sequence that is at least 90% identical to SEQ ID NO:13, e.g., about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO:13. In some embodiments, the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92-99.6%, 94-99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the first domain comprises a VH of SEQ ID NO: 13. [0143] In certain embodiments, the first domain comprises a light chain variable region (VL) amino acid sequence that is at least 90% identical to SEQ ID NO:14, e.g., about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 14. In some embodiments, the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92-99.6%, 94-99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the first domain comprises a VL of SEQ ID NO: 14. [0144] As used herein, the term “identical” or “has sequence identity,” refers to the extent to which two amino acid sequences have the same residues at the same positions when the sequences are aligned to achieve a maximal level of identity, expressed as a percentage. For sequence alignment and comparison, typically one sequence is designated as a reference sequence, to which a test sequences are compared. The sequence identity between reference and test sequences is expressed as the percentage of positions across the entire length of the reference sequence where the reference and test sequences share the same amino acid upon alignment of the reference and test sequences to achieve a maximal level of identity. As an example, two sequences are considered to have 70% sequence identity when, upon alignment to achieve a maximal level of identity, the test sequence has the same amino acid residue at 70% of the same positions over the entire length of the reference sequence.
[0145] In some embodiments, the first domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; and/or b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14.
[0146] In some embodiments, the first domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; and b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14.
[0147] In some embodiments, the first domain comprises: a) a VH of SEQ ID NO:13; and/or b) a VL of SEQ ID NO: 14.
[0148] In particular embodiments, the first domain comprises: a) a VH of SEQ ID NO: 13; and b) a VL of SEQ ID NO: 14.
[0149] VH: QVQLVESGGGWQPGRSLRLSCAASGFTFSTYGMHWVRQAPGKGLEWVAV
IWDDGSYKYYGDSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARDGITMVRGVMKD YFDYWGQGTLVTVSS (SEQ ID NO: 13) [0150] VL: AIQLTQSPSSLSASVGDRVTITCRASQDISSALVWYQQKPGKAPKLLIYDASS LESGVPSRFSGSESGTDFTLTISSLQPEDFATYYCQQFNSYPLTFGGGTKVEIK (SEQ ID NO: 14) [0151] In some embodiments, the first domain comprises a first heavy chain (HC1) amino acid sequence that is at least 80% identical to SEQ ID NO: 17, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 17. In certain embodiments, the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the first domain comprises a HC1 amino acid sequence of SEQ ID NO: 17.
[0152] In some embodiments, the first domain comprises a first light chain (LC1) amino acid sequence that is at least 80% identical to SEQ ID NO:18, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 18. In certain embodiments, the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the first domain comprises a LC1 amino acid sequence of SEQ ID NO: 18.
[0153] In some embodiments, the first domain comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; and/or b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18.
[0154] In some embodiments, the first domain comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; and b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18.
[0155] In some embodiments, the first domain comprises: a) a HC1 of SEQ ID NO: 17; and/or b) a LC1 of SEQ ID NO: 18.
[0156] In some embodiments, the first domain comprises: a) a HCl of SEQ ID NO: 17; and b) a LC1 of SEQ ID NO: 18.
[0157] HC1: QVQLVESGGGWQPGRSLRLSCAASGFTFSTYGMHWVRQAPGKGLEWVA VIWDDGSYKYYGDSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCARDGITMVRGVMK DYFDYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGAL TSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTC PPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAK TKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYT LPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFLLYSKLTVD KSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK (SEQ ID NO: 17) [0158] LC1: AIQLTQSPSSLSASVGDRVTITCRASQDISSALVWYQQKPGKAPKLLIYDASS LESGVPSRFSGSESGTDFTLTISSLQPEDFATYYCQQFNSYPLTFGGGTKVEIKRTVAAPSVFIF PPSDEQLKSGTASWCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLT LSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC (SEQ ID NO: 18) c-Met binding arm
[0159] In certain embodiments, the second domain that specifically binds c-Met comprises: a) HCDR1, HCDR2, HCDR3 amino acid sequences of SEQ ID NOs:7, 8 and 9, respectively; and/or b) LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:10, 11 and 12, respectively.
[0160] In certain embodiments, the second domain that specifically binds c-Met comprises: a) HCDR1, HCDR2, HCDR3 amino acid sequences of SEQ ID NOs:7, 8 and 9, respectively; and b) LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:10, 11 and 12, respectively.
[0161] HCDR1 : SYGIS (SEQ ID NO:7)
[0162] HCDR2: WISAYNGYTNYAQKLQG (SEQ ID NO:8)
[0163] HCDR3 : DLRGTNYFDY (SEQ ID NO:9)
[0164] HCDR1 : RASQGISNWLA (SEQ ID NO: 10)
[0165] HCDR2: AASSLLS (SEQ ID NO: 11)
[0166] HCDR3 : QQANSFPIT (SEQ ID NO: 12)
[0167] In some embodiments, the second domain comprises a VH amino acid sequence that is at least 90% identical to SEQ ID NO:15, e.g, about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 15. In some embodiments, the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92-99.6%, 94- 99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the second domain comprises a VH of SEQ ID NO: 15
[0168] In certain embodiments, the second domain comprises a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16, e.g., about: 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO: 16. In some embodiments, the sequence identity is about: 90-99.9%, 90-99.8%, 92-99.8%, 92- 99.6%, 94-99.6%, 94-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the second domain comprises a VL of SEQ ID NO: 16.
[0169] In some embodiments, the second domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and/or b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16. [0170] In some embodiments, the second domain comprises: a) a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and b) a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16.
[0171] In some embodiments, the second domain comprises: a) a VH of SEQ ID NO: 15; and/or b) a VL of SEQ ID NO: 16.
[0172] In particular embodiments, the second domain comprises: a) a VH of SEQ ID NO: 15; and b) a VL of SEQ ID NO: 16.
[0173] VH: QVQLVQSGAEVKKPGASVKVSCETSGYTFTSYGISWVRQAPGHGLEWMGW ISAYNGYTNYAQKLQGRVTMTTDTSTSTAYMELRSLRSDDTAVYYCARDLRGTNYFDYWG QGTLVTVSS (SEQ ID NO: 15)
[0174] VL: DIQMTQSPSSVSASVGDRVTITCRASQGISNWLAWFQHKPGKAPKLLIYAAS SLLSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQANSFPITFGQGTRLEIK (SEQ ID NO: 16)
[0175] In some embodiments, the second domain comprises a second heavy chain (HC2) amino acid sequence that is at least 80% identical to SEQ ID NO: 19, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO:19. In certain embodiments, the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the second domain comprises a HC2 amino acid sequence of SEQ ID NO: 19.
[0176] In some embodiments, the second domain comprises a second light chain (LC2) amino acid sequence that is at least 80% identical to SEQ ID NO:20, e.g., about: 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, or 99.9% identical to SEQ ID NO:20. In certain embodiments, the sequence identity is about: 80-99.9%, 80-99.8%, 85-99.8%, 85-99.6%, 90-99.6%, 90-99.5%, 95-99.5%, 95-99.4%, 96-99.4%, 96-99.2%, 97-99.2% or 97-99%. In particular embodiments, the second domain comprises a LC2 amino acid sequence of SEQ ID NO:20.
[0177] In some embodiments, the second domain comprises: a) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and/or b) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
[0178] In some embodiments, the second domain comprises: a) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and b) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
[0179] In some embodiments, the second domain comprises: a) a HC2 of SEQ ID NO: 19; and/or b) a LC2 of SEQ ID NO:20.
[0180] In some embodiments, the second domain comprises: a) a HC2 of SEQ ID NO: 19; and b) a LC2 of SEQ ID NO:20.
[0181] HC2: QVQLVQSGAEVKKPGASVKVSCETSGYTFTSYGISWVRQAPGHGLEWMG WISAYNGYTNYAQKLQGRVTMTTDTSTSTAYMELRSLRSDDTAVYYCARDLRGTNYFDYW GQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTF PAVLQSSGLYSLSSWTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPE
LLGGPSVFLFPPKPKDTLMISRTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQ YNSTYRWSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREE MTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQ QGNVFSCSVMHEALHNHYTQKSLSLSPGK (SEQ ID NO: 19)
[0182] LC2: DIQMTQSPSSVSASVGDRVTITCRASQGISNWLAWFQHKPGKAPKLLIYAAS SLLSGVPSRFSGSGSGTDFTLTISSLQPEDFATYYCQQANSFPITFGQGTRLEIKRTVAAPSVFIF PPSDEQLKSGTASWCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLT LSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC (SEQ ID NO: 20)
[0183] In some embodiments, the antibody (e.g. , bispecific antibody) comprises: a) a first domain that specifically binds EGFR, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and/or b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
[0184] In certain embodiments, the antibody (e.g., bispecific antibody) comprises: a) a first domain that specifically binds EGFR, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
[0185] In some embodiments, the antibody (e.g. , bispecific antibody) comprises: a) a first domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; b) a first domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14; c) a second domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and/or d) a second domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16.
[0186] In certain embodiments, the antibody (e.g., bispecific antibody) comprises: a) a first domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 13; b) a first domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 14; c) a second domain comprising a VH amino acid sequence that is at least 90% identical to SEQ ID NO: 15; and d) a second domain comprising a VL amino acid sequence that is at least 90% identical to SEQ ID NO: 16.
[0187] In some embodiments, the antibody (e.g. , bispecific antibody) comprises: a) a first domain comprising a VH of SEQ ID NO : 13 ; b) a first domain comprising a VL of SEQ ID NO: 14; c) a second domain comprising a VH of SEQ ID NO: 15; and/or d) a second domain comprising a VL of SEQ ID NO: 16.
[0188] In some embodiments, the antibody (e.g. , bispecific antibody) comprises: a) a first domain comprising a VH of SEQ ID NO : 13 ; b) a first domain comprising a VL of SEQ ID NO: 14; c) a second domain comprising a VH of SEQ ID NO: 15; and d) a second domain comprising a VL of SEQ ID NO: 16.
[0189] In certain embodiments, the antibody (e.g., bispecific antibody) comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18; c) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and/or d) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
[0190] In certain embodiments, the antibody (e.g., bispecific antibody) comprises: a) a HC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 17; b) a LC1 amino acid sequence that is at least 80% identical to SEQ ID NO: 18; c) a HC2 amino acid sequence that is at least 80% identical to SEQ ID NO: 19; and d) a LC2 amino acid sequence that is at least 80% identical to SEQ ID NO:20.
[0191] In certain embodiments, the antibody (e.g., bispecific antibody) comprises: a) a HC1 of SEQ ID NO: 17; b) a LC1 of SEQ ID NO: 18; c) a HC2 of SEQ ID NO: 19; and/or d) a LC2 of SEQ ID NO:20.
[0192] In particular embodiments, the antibody (e.g. , bispecific antibody) comprises: a) a HCl of SEQ ID N0:17; b) a LCl of SEQ ID NO:18; c) a HC2 of SEQ ID NO: 19; and d) a LC2 of SEQ ID NO:20.
[0193] In some embodiments, the antibody (e.g. , bispecific antibody) is of the IgG isotype. In certain embodiments, the antibody (e.g., bispecific antibody) is of the IgGl isotype. Some variation exists within the IgGl constant domain (e.g., well-known allotypes), for example, with variation at positions 214, 356, 358, 422, 431, 435 and/or 436 (residue numbering according to the EU numbering) (see e.g., IMGT Web resources; IMGT Repertoire (IG and TR); Proteins and alleles; allotypes). The bispecific anti-EGFR/c-Met antibody may be of any IgGl allotype, such as Glml7, Glm3, Glml, Glm2, Glm27 or Glm28.
[0194] In some embodiments, the antibody is a human antibody.
[0195] In particular embodiments, the antibody is amivantamab. Amivantamab or JNJ-61186372 (JNJ-372) is an IgGl anti-EGFR/c-Met bispecific antibody described in U.S. Pat. No. 9,593,164. A schematic of the structure of amivantamab is shown in FIG. 2. The disclosure is based, at least in part, on the finding that amivantamab is effective in treating CRC such as mCRC.
[0196] Other anti-EGFR/c-Met antibodies (e.g., bispecific antibodies) may also be used in the methods of the disclosure, for example, by combining publicly available EGFR binding VH/VL domains and c-Met binding VH/VL domains.
[0197] In some embodiments, the antibody (e.g. , bispecific antibody) comprises a biantennary glycan structure with a fucose content of between about 1% to about 15%. In some embodiments, the antibody (e.g., bispecific antibody) comprises a biantennary glycan structure with a fucose content of less than about 20%.
[0198] Antibodies with reduced fucose content can be made using different methods reported to lead to the successful expression of relatively high defucosylated antibodies bearing the biantennary complex-type of Fc oligosaccharides such as control of culture osmolality (Konno et al., Cytotechnology 64(:249-65, 2012), application of a variant CHO line Lecl3 as the host cell line (Shields et al., J Biol Chem 277:26733-26740, 2002), application of a variant CHO line EB66 as the host cell line (Olivier et al., MAbs ;2(4), 2010; Epub ahead of print; PMID:20562582), application of a rat hybridoma cell line YB2/0 as the host cell line (Shinkawa et al., J Biol Chem 278:3466-3473, 2003), introduction of small interfering RNA specifically against the a 1,6-fucosyltrasferase ( FUT8) gene (Mori et al., Biotechnol Bioeng88:901-908, 2004), or coexpression of [3-1, 4-V- acetylglucosaminyltransferase III and Golgi a-mannosidase II or a potent alpha-mannosidase I inhibitor, kifunensine (Ferrara et al., J Biol Chem281:5032-5036, 2006, Ferrara et al., Biotechnol Bioeng 93:851-861, 2006; Zhou et al., Biotechnol Bioeng 99:652-65, 2008). In general, lowering fucose content in the glycan of the antibodies potentiates antibody -mediated cellular cytotoxicity (ADCC). Generating Anti-EGFR/c-Met Antibodies
[0199] Anti-EGFR/c-Met antibodies used in the methods of the disclosure may be generated, for example, using Fab arm exchange (or half molecule exchange) between two monospecific bivalent antibodies by introducing substitutions at the heavy chain CH3 interface in each half molecule to favor heterodimer formation of two antibody half molecules having distinct specificity either in vitro in cell-free environment or using co-expression. The Fab arm exchange reaction is the result of a disulfide-bond isomerization reaction and dissociation-association of CH3 domains. The heavy chain disulfide bonds in the hinge regions of the parental monospecific antibodies are reduced. The resulting free cysteines of one of the parental monospecific antibodies form an inter heavy -chain disulfide bond with cysteine residues of a second parental monospecific antibody molecule and simultaneously CH3 domains of the parental antibodies release and reform by dissociation-association. The CH3 domains of the Fab arms may be engineered to favor heterodimerization over homodimerization. The resulting product is a bispecific antibody having two Fab arms or half molecules which each bind a distinct epitope, i.e., an epitope on EGFR and an epitope on c-Met. For example, the bispecific antibodies of the invention may be generated using the technology described in Int. Pat. Publ. No.
WO2011/131746. Mutations F405L in one heavy chain and K409R in the other heavy chain may be used in case of IgGl antibodies. For IgG2 antibodies, a wild-type IgG2 and a IgG2 antibody with F405L and R409K substitutions may be used. For IgG4 antibodies, a wild-type IgG4 and a IgG4 antibody with F405L and R409K substitutions may be used. To generate bispecific antibodies, the first monospecific bivalent antibody and the second monospecific bivalent antibody are engineered to have the aforementioned mutation in the Fc region, and the antibodies are incubated together under reducing conditions sufficient to allow the cysteines in the hinge region to undergo disulfide bond isomerization; thereby generating the bispecific antibody by Fab arm exchange. The incubation conditions may optimally be restored to non-reducing. Exemplary reducing agents that may be used are 2- mercaptoethylamine (2-MEA), dithiothreitol (DTT), dithioerythritol (DTE), glutathione, tris(2- carboxyethyl)phosphine (TCEP), L-cysteine and beta- mercaptoethanol. For example, incubation for at least 90 min at a temperature of at least 20°C in the presence of at least 25 mM 2-MEA or in the presence of at least 0.5 mM dithiothreitol at a pH of from 5-8, for example at pH of 7.0 or at pH of 7.4 may be used.
[0200] Bispecific anti-EGFR/c-Met antibodies used in the methods of the disclosure may also be generated using designs such as the Knob-in-Hole (Genentech), CrossMAbs (Roche) and the electrostatically -matched (Chugai, Amgen, NovoNordisk, Oncomed), the LUZ-Y (Genentech), the Strand Exchange Engineered Domain body (SEEDbody) (EMD Serono), and the Biclonic (Merus). [0201] In the “knob-in-hole” strategy (see, e.g., Inti. Publ. No. WO 2006/028936) select amino acids forming the interface of the CH3 domains in human IgG can be mutated at positions affecting CH3 domain interactions to promote heterodimer formation. An amino acid with a small side chain (hole) is introduced into a heavy chain of an antibody specifically binding a first antigen and an amino acid with a large side chain (knob) is introduced into a heavy chain of an antibody specifically binding a second antigen. After co-expression of the two antibodies, a heterodimer is formed as a result of the preferential interaction of the heavy chain with a “hole” with the heavy chain with a “knob”.
Exemplary CH3 substitution pairs forming a knob and a hole are (expressed as modified position in the first CH3 domain of the first heavy chain/ modified position in the second CH3 domain of the second heavy chain): T366Y/F405A, T366W/F405W, F405W/Y407A, T394W/Y407T, T394S/Y407A, T366W/T394S, F405W/T394S and T366W/T366S_L368A_Y407V.
[0202] CrossMAb technology, in addition to utilizing the “knob-in-hole” strategy to promote Fab arm exchange utilizes CH1/CL domain swaps in one half arm to ensure correct light chain pairing of the resulting bispecific antibody (see e.g., U.S. Patent No. 8,242,247).
[0203] Other cross-over strategies may be used to generate full length bispecific antibodies of the invention by exchanging variable or constant, or both domains between the heavy chain and the light chain or within the heavy chain in the bispecific antibodies, either in one or both arms. These exchanges include for example VH-CH1 with VL-CL, VH with VL, CH3 with CL and CH3 with CHI as described in Int. Patent Publ. Nos. W02009/080254, W02009/080251, W02009/018386 and W02009/080252.
[0204] Other strategies such as promoting heavy chain heterodimerization using electrostatic interactions by substituting positively charged residues at one CH3 surface and negatively charged residues at a second CH3 surface may be used, as described in US Patent Publ. No. US2010/0015133; US Patent Publ. No. US2009/0182127; US Patent Publ. No. US2010/028637 or US Patent Publ. No. US2011/0123532. In other strategies, heterodimerization may be promoted by the following substitutions (expressed as modified positions in the first CH3 domain of the first heavy chain/ modified position in the second CH3 domain of the second heavy chain):
L351Y F405A Y407V/T394W, T366I K392M T394W/F405A Y407V, T366L K392M T394W/F405A Y407V, L351Y Y407A/T366A K409F, L351Y Y407A/T366V K409F, Y407A/T366A K409F, or T350V_L351Y_F405A_Y407V/T350V_T366L_K392L_T394W as described in U.S. Patent Publ.
No. US2012/0149876 or U.S. Patent Publ. No. US2013/0195849.
[0205] SEEDbody technology may be utilized to generate bispecific antibodies of the invention. SEEDbodies have, in their constant domains, select IgG residues substituted with IgA residues to promote heterodimerization as described in U.S. Patent No. US20070287170.
[0206] Mutations are typically made at the DNA level to a molecule such as the constant domain of the antibody using standard methods.
Administration
[0207] The anti-EGFR/c-Met antibody (e.g. , bispecific antibody) and/or additional therapeutic (e.g. , chemotherapeutic) agent may be administered in a pharmaceutical composition or compositions. In some embodiments, the pharmaceutical composition further comprises a pharmaceutically acceptable carrier.
[0208] The mode of administration may be any suitable route that delivers the antibody (e.g. , bispecific antibody) to the subject in need thereof, such as parenteral administration, e.g., intradermal, intramuscular, intraperitoneal, intravenous or subcutaneous, pulmonary, transmucosal (oral, intranasal, intravaginal, rectal), using a formulation in a tablet, capsule, solution, powder, gel, particle; and contained in a syringe, an implanted device, osmotic pump, cartridge, micropump; or other means appreciated by the skilled artisan, as well known in the art. Site specific administration may be achieved by, for example intratumoral, intracolic, intraabdominal, intragastric, intracavitary, intrapelvic, intraperitoneal, intrarectal, intrathoracic, intravascular, intralesional, rectal, buccal, sublingual, intranasal, or transdermal delivery.
[0209] In some embodiments, the pharmaceutical composition comprising the anti-EGFR/c-Met antibody (e.g., bispecific antibody) is administered via an intravenous infusion. In some embodiments, the additional therapeutic (e.g., chemotherapeutic) agent is administered via an intravenous infusion.
[0210] In some embodiments, the pharmaceutical composition comprising the anti-EGFR/c-Met antibody (e.g., bispecific antibody) is administered via a subcutaneous injection.
[0211] In some embodiments, the antibody (e.g. , bispecific antibody) is administered at a dose of about 140 mg to about 2,100 mg, for example, about 700 mg to about 1,400 mg, about 700 mg to about 1,050 mg, about 1,050 mg to about 1,400 mg, or about 1,750 mg to about 2,100 mg.
[0212] In some embodiments, the antibody (e.g. , bispecific antibody) is administered at a dose of about: 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, 500, 510, 520, 530, 540, 550, 560, 570, 580,
590, 600, 610, 620, 630, 640, 650, 660, 670, 680, 690, 700, 710, 720, 730, 740, 750, 760, 770, 780,
790, 800, 810, 820, 830, 840, 850, 860, 870, 880, 890, 900, 910, 920, 930, 940, 950, 960, 970, 980,
990, 1,000, 1,010, 1,020, 1,030, 1,040, 1,050, 1,060, 1,070, 1,080, 1,090, 1,100, 1,110, 1,120, 1,130,
1,140, 1,150, 1,160, 1,170, 1,180, 1,190, 1,200, 1,210, 1,220, 1,230, 1,240, 1,250, 1,260, 1,270, 1,280,
1,290, 1,300, 1,310, 1,320, 1,330, 1,340, 1,350, 1,360, 1,370, 1,380, 1,390, 1,400, 1,410, 1,420, 1,430,
1,440, 1,450, 1,460, 1,470, 1,480, 1,490, 1,500, 1,510, 1,520, 1,530, 1,540, 1,550, 1,560, 1,570, 1,580,
1,590, 1,600, 1,610, 1,620, 1,630, 1,640, 1,650, 1,660, 1,670, 1,680, 1,690, 1,700, 1,710, 1,720, 1,730,
1,740, 1,750, 1,760, 1,770, 1,780, 1,790, 1,800, 1,810, 1,820, 1,830, 1,840, 1,850, 1,860, 1,870, 1,880,
1,890, 1,900, 1,910, 1,920, 1,930, 1,940, 1,950, 1,960, 1,970, 1,980, 1,990, 2,000, 2,010, 2,020, 2,030,
2,040, 2,050, 2,060, 2,070, 2,080, 2,090, 2,100, 2,110, 2,120, 2,130, 2,140, or 2,150 mg.
[0213] In some embodiments, the antibody is administered at a dose of about 700 mg, about 1,050 mg, about 1,400 mg, about 1,750 mg, or about 2,100 mg. In some embodiments, the antibody is administered at a dose of about 1,050 mg. In certain embodiments, the antibody is administered at a dose of about 1,400 mg. In particular embodiments, the antibody is administered at a dose of about 700 mg. In some embodiments, the antibody is administered at a dose of about 1,750 mg. In some embodiments, the antibody is administered at a dose of about 2,100 mg.
[0214] In some embodiments, the antibody is administered at a dose of about 350 mg.
[0215] In some embodiments, the antibody is administered at a dose of about 750 mg.
[0216] In some embodiments, the antibody is administered at a dose of about 800 mg.
[0217] In some embodiments, the antibody is administered at a dose of about 850 mg.
[0218] In some embodiments, the antibody is administered at a dose of about 900 mg.
[0219] In some embodiments, the antibody is administered at a dose of about 950 mg.
[0220] In some embodiments, the antibody is administered at a dose of about 1,000 mg.
[0221] In some embodiments, the antibody is administered at a dose of about 1,100 mg.
[0222] In some embodiments, the antibody is administered at a dose of about 1,150 mg.
[0223] In some embodiments, the antibody is administered at a dose of about 1,200 mg.
[0224] In some embodiments, the antibody is administered at a dose of about 1,250 mg.
[0225] In some embodiments, the antibody is administered at a dose of about 1,300 mg.
[0226] In some embodiments, the antibody is administered at a dose of about 1,350 mg.
[0227] In some embodiments, the antibody is administered at a dose of about 1,750 mg.
[0228] In some embodiments, the antibody is administered at a dose of about 2,100 mg.
[0229] In certain embodiments, the antibody is administered at a dose of 1,050 mg for body weigh <80 kg and 1,400 mg for body weight > 80 kg.
[0230] In particular embodiments, the antibody is administered at a dose of 700 mg for body weigh <80 kg and 1,050 mg for body weight > 80 kg.
[0231] In particular embodiments, the antibody is administered at a dose of 1,750 mg for body weigh <80 kg and 2,100 mg for body weight > 80 kg.
[0232] In some embodiments, the antibody is administered twice a week.
[0233] In certain embodiments, the antibody is administered once a week.
[0234] In some embodiments, the antibody is administered once every two weeks.
[0235] In certain embodiments, the antibody is administered once every three weeks.
[0236] In some embodiments, the antibody is administered once every four weeks.
[0237] In certain embodiments, the antibody is administered once a week or once every two weeks. In particular embodiments, the antibody is administered once weekly for the first 4 weeks and then every 2 weeks.
[0238] In some embodiments, the antibody is administered on a 28-day cycle.
[0239] In some embodiments, the subject has a body weight (B W) of <80 kg, and the antibody
(e.g. , bispecific antibody such as amivantamab) is administered at a dose of 700 mg once weekly for the first 4 weeks and then every 2 weeks 28-day cycles. In other embodiments, the subject has a body weight of <80 kg, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then every 2 weeks 28-day cycles. In some embodiments, the antibody is administered once weekly for the first 4 weeks and then on Days 1 and 15 (28 days cycle). In other embodiments, the subject is administered an IV infusion of amivantamab at a dose of 1,050 or 700 mg if the BW is <80 kg, or 1,400 or 1,050 mg if BW is >80 kg, on Days -1, - 2, 8, and 22 of Cycle 1 and along with FOLFOX6 chemotherapy (e.g. , mFOLFOX6 SoC chemotherapy) on Days 1 and 15 of Cycle 1 and Days 1 and 15 of Cycle 2 (each cycle of 28 days). In other embodiments, the subject is administered an IV infusion of amivantamab along with FOLFIRI chemotherapy on Days -1, -2, and 8 of Cycle 1 and Days 1 and 15 of Cycle 2.
[0240] In certain embodiments, the subject has a body weight (B W) of >80 kg, and the antibody (e.g. , bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then every 2 weeks 28-day cycles. In other embodiments, the subject has a body weight of >80 kg, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,400 mg once weekly for the first 4 weeks and then every 2 weeks 28-day cycles. In other embodiments, the subject administered an IV infusion of amivantamab at a dose of 1,050 or 700 mg if the BW is <80 kg, or 1,400 or 1,050 mg if BW is >80 kg, onDays -1, -2, 8, and 22 of Cycle 1 and along withFOLFOX6 chemotherapy (e.g., mFOLFOX6 SoC chemotherapy) onDays 1 and 15 of Cycle 1 and Days 1 and 15 of Cycle 2 (each cycle of 28 days). In other embodiments, the subject is administered an IV infusion of amivantamab along with FOLFIRI chemotherapy on days -1, -2, and 8 of Cycle 1 and Days 1 and 15 of Cycle 2.
[0241] In certain embodiments, the subject has a body weight (B W) of >80 kg, and the antibody (e.g. , bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then at a dose of 1,750 mg every 2 weeks of the 28-day cycle. In other embodiments, the subject has a body weight of >80 kg, and the antibody (e.g. , bispecific antibody such as amivantamab) is administered at a dose of 1,400 mg once weekly for the first 4 weeks and then at a dose 2,100 mg every 2 weeks of a 28-day cycle. In other embodiments, the subject administered an IV infusion of amivantamab at a dose of 1,050 or 1,750 mg if the BW is <80 kg, or 1,400 or 2,100 mg if BW is >80 kg, onDays -1, -2, 8, and 22 of Cycle 1 and along with FOLFOX6 chemotherapy (e.g., mFOLFOX6 SoC chemotherapy) onDays 1 and 15 of Cycle 1 and Days 1 and 15 of Cycle 2 (each cycle of 28 days). In other embodiments, the subject is administered an IV infusion of amivantamab along with FOLFIRI chemotherapy on days -1, -2, and 8 of Cycle 1 and Days 1 and 15 of Cycle 2.
[0242] In some embodiments, the subject has a body weight (B W) of less than 80 kg, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then every 2 weeks in 28-day cycles. In some embodiments, the antibody is administered on Cycle 1 Days 1, 8, 15, and 22, and then Days 1 and 15 starting on Cycle 2 (in 28 day cycles). In some embodiments, the antibody (e.g., bispecific antibody such as amivantamab) is administered intravenously. In some embodiments, the subject is further administered a chemotherapeutic agent. In some embodiments, the chemotherapeutic agent is FOLFOX chemotherapy. In some embodiments, FOLFOX chemotherapy is administered to the subject on Days 1 and 15 of the 28-day cycles. In some embodiments, the chemotherapeutic agent is FOLFIRI chemotherapy. In some embodiments, FOLFIRI is administered to the subject on Days 1 and 15 of the 28-day cycles.
[0243] In some embodiments, the subject has a body weight (BW) of 80 kg or more, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,400 mg once weekly for the first 4 weeks and then every 2 weeks in 28-day cycles. In some embodiments, the antibody is administered on Cycle 1 Days 1, 8, 15, and 22, and then Days 1 and 15 starting on Cycle 2 (in 28 day cycles). In some embodiments, the antibody (e.g., bispecific antibody such as amivantamab) is administered intravenously. In some embodiments, the subject is further administered a chemotherapeutic agent. In some embodiments, the chemotherapeutic agent is FOLFOX chemotherapy. In some embodiments, FOLFOX chemotherapy is administered to the subject on Days 1 and 15 of the 28-day cycles. In some embodiments, the chemotherapeutic agent is FOLFIRI chemotherapy. In some embodiments, FOLFIRI is administered to the subject on Days 1 and 15 of the 28-day cycles.
[0244] In some embodiments, the subject has a body weight (BW) of less than 80 kg, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 700 mg once weekly for the first 4 weeks and then every 2 weeks in 28-day cycles if a dose of 1,050 mg is found to not be tolerated. In some embodiments, the antibody is administered on Cycle 1 Days 1, 8, 15, and 22, and then Days 1 and 15 starting on Cycle 2 (in 28 day cycles). In some embodiments, the antibody (e.g. , bispecific antibody such as amivantamab) is administered intravenously. In some embodiments, the subject is further administered a chemotherapeutic agent. In some embodiments, the chemotherapeutic agent is FOLFOX chemotherapy. In some embodiments, FOLFOX chemotherapy is administered to the subject on Days 1 and 15 of the 28-day cycles. In some embodiments, the chemotherapeutic agent is FOLFIRI chemotherapy. In some embodiments, FOLFIRI is administered to the subject on Days 1 and 15 of the 28-day cycles.
[0245] In some embodiments, the subject has a body weight (BW) of 80 kg or more, and the antibody (e.g., bispecific antibody such as amivantamab) is administered at a dose of 1,050 mg once weekly for the first 4 weeks and then every 2 weeks in 28-day cycles if a dose of 1,400 mg is found to not be tolerated. In some embodiments, the antibody is administered on Cycle 1 Days 1, 8, 15, and 22, and then Days 1 and 15 starting on Cycle 2 (in 28 day cycles). In some embodiments, the antibody (e.g. , bispecific antibody such as amivantamab) is administered intravenously. In some embodiments, the subject is further administered a chemotherapeutic agent. In some embodiments, the chemotherapeutic agent is FOLFOX chemotherapy. In some embodiments, FOLFOX chemotherapy is administered to the subject on Days 1 and 15 of the 28-day cycles. In some embodiments, the chemotherapeutic agent is FOLFIRI chemotherapy. In some embodiments, FOLFIRI is administered to the subject on Days 1 and 15 of the 28-day cycles. [0246] Pharmaceutical compositions comprising 1,400 mg, 1,050 mg and 700 mg dose of the anti-EGFR/c-Met antibody can be administered in total volumes of about 28 mL, 21 mL and 14 mL, respectively, with 350 mg/7 mL (50 mg/mL) solution in a single-dose vial.
[0247] Additional information regarding amivantamab can be found, for example, in the prescribing information product insert for RYBREVANT® (amivantamab-vmjw) (www.janssenlabels.com/package-insert/product-monograph/prescribing-information/RYBREVANT- pi.pdf), which is incorporated herein by reference.
[0248] Additional information regarding the use of amivantamab in patients can be found, for example, in Park K. et al., Amivantamab in EGFR Exon 20 Insertion-Mutated Non-Small-Cell Lung Cancer Progressing on Platinum Chemotherapy: Initial Results From the CHRYSALIS Phase I Study. J Clin Oncol. 2021 Oct 20;39(30):3391-3402; Vyse S, Huang PH. Amivantamab for the treatment of EGFR exon 20 insertion mutant non-small cell lung cancer. Expert Rev Anticancer Ther. 2021 Dec 16; and Cho BC et al., MARIPOSA: phase 3 study of first-line amivantamab + lazertinib versus osimertinib in EGFR-mutant non-small cell lung cancer. Future Oncol. 2021 Dec 16; which are incorporated herein by reference.
[0249] In some embodiments, the antibody is administered as a monotherapy.
Additional Therapeutic Agents
[0250] In certain embodiments, the method further comprises administering to the subject one or more additional therapeutic agents. Non-limiting examples of the one or more additional therapeutic agents include a T cell expressing chimeric antigen receptor (CAR) (CAR-T cell), a natural killer cell expressing CAR (CAR-NK cell), a macrophage expressing CAR (CAR-M cell), a chemotherapeutic agent, an immune checkpoint inhibitor, a T-cell redirector, radiation therapy, surgery and a standard of care drug. In certain embodiments, the one or more additional therapeutic agents comprises chemotherapy, radiation therapy, surgery, a targeted anti-cancer therapy, a kinase inhibitor, or a combination thereof.
[0251] In some embodiments, the one or more additional therapeutic agents are one or more anticancer therapies. In some embodiments, the one or more additional therapeutic agents comprise one or more chemotherapeutic agents.
[0252] A non-exhaustive list of chemotherapeutic agents considered for use in combination therapies include anastrozole (Arimidex®), bicalutamide (Casodex®), bleomycin sulfate (Blenoxane®), busulfan (Myleran®), leucovorin calcium, melphalan (Alkeran®), 6-mercaptopurine (Purinethol®), methotrexate (Folex®), mitoxantrone (Novantrone®), mylotarg, paclitaxel (Taxol®), phoenix (Yttrium90/MX-DTPA), pentostatin, polifeprosan 20 with carmustine implant (Gliadel®), dactinomycin (Actinomycin D, Cosmegan), daunorubicin hydrochloride (Cerubidine®), daunorubicin citrate liposome injection (DaunoXome®), dexamethasone, docetaxel (Taxotere®), doxorubicin hydrochloride (Adriamycin®, Rubex®), etoposide (Vepesid®), busulfan injection (Busulfex®), capecitabine (Xeloda®), N4-pentoxycarbonyl-5-deoxy-5-fluorocytidine, carboplatin (Paraplatin®), carmustine (BiCNU®), chlorambucil (Leukeran®), cisplatin (Platinol®), cladribine (Leustatin®), cyclophosphamide (Cytoxan® or Neosar®), cytarabine, cytosine arabinoside (Cytosar-U®), cytarabine liposome injection (DepoCyt®), dacarbazine (DTIC-Dome®), fludarabine phosphate (Fludara®), 5- fluorouracil (Adrucil®, Efudex®), flutamide (Eulexin®), tezacitibine, Gemcitabine (difluorodeoxycitidine), hydroxyurea (Hydrea®), Idarubicin (Idamycin®), ifosfamide (IFEX®), irinotecan (Camptosar®), L-asparaginase (ELSPAR®), tamoxifen citrate (Nolvadex®), teniposide (Vumon®), 6-thioguanine, thiotepa, tirapazamine (Tirazone®), topotecan hydrochloride for injection (Hycamptin®), vinblastine (Velban®), vincristine (Oncovin®), and vinorelbine (Navelbine®).
[0253] Example alkylating agents include, without limitation, nitrogen mustards, ethylenimine derivatives, alkyl sulfonates, nitrosoureas and triazenes): uracil mustard (Aminouracil Mustard®, Chlorethaminacil®, Haemanthamine®, Nordopan®, Uracil Nitrogen Mustard®, Uracillost®, Uracilmostaza®, Uramustin®, Uramustine®), chlormethine (Mustargen®), cyclophosphamide (Cytoxan®, Neosar®, Clafen®, Endoxan®, Procytox®, Revimmune™), ifosfamide (Mitoxana®), melphalan (Alkeran®), Chlorambucil (Leukeran®), pipobroman (Amedel®, Vercyte®), triethylenemelamine (Hemel®, Hexylen®, Hexastat®), Demethyldopan®, Desmethyldopan®, triethylenethiophosphoramine, Temozolomide (Temodar®), thiotepa (Thioplex®), busulfan (Busilvex®, Myleran®), carmustine (BiCNU®), lomustine (CeeNU®), streptozocin (Zanosar®), and Dacarbazine (DTIC-Dome®). Additional example alkylating agents include, without limitation, Oxaliplatin (Eloxatin®); Melphalan (also known as L-PAM, L-sarcolysin, and phenylalanine mustard, Alkeran®); Altretamine (also known as hexamethylmelamine (HMM), Hexylen®); Carmustine (BiCNU®); Bendamustine (Treanda®); Busulfan (Busulfex® and Myleran®); Carboplatin (Paraplatin®); Temozolomide (Temodar® and Temodal®); Dactinomycin (also known as actinomycin- D, Cosmegen®); Lomustine (also known as CCNU, CeeNU®); Cisplatin (also known as CDDP, Platinol® and Platinol®- AQ); Chlorambucil (Leukeran®); Cyclophosphamide (Cytoxan® and Neosar®); Dacarbazine (also known as DTIC, DIC and imidazole carboxamide, DTIC-Dome®); Altretamine (also known as hexamethylmelamine (HMM), Hexylen®); Ifosfamide (Ifex®); Prednumustine; Procarbazine (Matulane®); Mechlorethamine (also known as nitrogen mustard, mustine and mechloroethamine hydrochloride, Mustargen®); Streptozocin (Zanosar®); Thiotepa (also known as thiophosphoamide, TESPA and TSPA, Thioplex®); Cyclophosphamide (Endoxan®, Cytoxan®, Neosar®, Procytox®, Revimmune®); and Bendamustine HC1 (Treanda®).
[0254] In some embodiments, the one or more additional therapeutic agents comprise a kinase inhibitor. In some embodiments, the kinase inhibitor comprises an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL or a combination thereof. In certain embodiments, the kinase inhibitor is an inhibitor of EGFR. In particular embodiments, the kinase inhibitor is an inhibitor of c-Met. In some embodiments, the kinase inhibitor is an inhibitor of HER2. In certain embodiments, the kinase inhibitor is an inhibitor of HER3. In particular embodiments, the kinase inhibitor is an inhibitor of HER4. In some embodiments, the kinase inhibitor is an inhibitor of VEGFR. In certain embodiments, the kinase inhibitor is an inhibitor of or AXL.
[0255] In some embodiments, the kinase inhibitor comprises erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib, sunitinib or a combination thereof. In certain embodiments, the kinase inhibitor is erlotinib. In particular embodiments, the kinase inhibitor is gefitinib. In some embodiments, the kinase inhibitor is lapatinib. In certain embodiments, the kinase inhibitor is vandetanib. In some embodiments, the kinase inhibitor is afatinib. In some embodiments, the kinase inhibitor is osimertinib. In certain embodiments, the kinase inhibitor is lazertinib. In particular embodiments, the kinase inhibitor is poziotinib. In some embodiments, the kinase inhibitor is criotinib. In certain embodiments, the kinase inhibitor is cabozantinib. In some embodiments, the kinase inhibitor is capmatinib. In some embodiments, the kinase inhibitor is axitinib. In certain embodiments, the kinase inhibitor is lenvatinib. In some embodiments, the kinase inhibitor is nintedanib. In particular embodiments, the kinase inhibitor is regorafenib. In certain embodiments, the kinase inhibitor is pazopanib. In some embodiments, the kinase inhibitor is sorafenib. In particular embodiments, the kinase inhibitor is sunitinib.
[0256] In certain embodiments, the one or more prior anti-cancer therapies comprises carboplatin, paclitaxel, gemcitabine, cisplatin, vinorelbine, docetaxel, palbociclib, crizotinib, PD-(L)1 axis inhibitor, an inhibitor of EGFR, an inhibitor of c-Met, an inhibitor of HER2, an inhibitor of HER3, an inhibitor of HER4, an inhibitor of VEGFR, an inhibitor of AXL, erlotinib, gefitinib, lapatinib, vandetanib, afatinib, osimertinib, lazertinib, poziotinib, criotinib, cabozantinib, capmatinib, axitinib, lenvatinib, nintedanib, regorafenib, pazopanib, sorafenib or sunitinib, or any combination thereof.
[0257] Anti-cancer therapies that may be administered in combination with the anti-EGFR/c-Met antibody (e.g., bispecific antibody) in the methods of the disclosure include any one or more of the chemotherapeutic drugs or other anti-cancer therapeutics known to those of skill in the art. Chemotherapeutic agents are chemical compounds useful in the treatment of cancer and include growth inhibitory agents or other cytotoxic agents and include alkylating agents, anti-metabolites, anti-microtubule inhibitors, topoisomerase inhibitors, receptor tyrosine kinase inhibitors, angiogenesis inhibitors and the like. Examples of chemotherapeutic agents include alkylating agents such as thiotepa and cyclosphosphamide (CYTOXAN®); alkyl sulfonates such as busulfan, improsulfan and piposulfan; aziridines such as benzodopa, carboquone, meturedopa, and uredopa; ethylenimines and methylamelamines including altretamine, triethylenemelamine, trietylenephosphoramide, triethylenethiophosphaoramide and trimethylolomelamine; nitrogen mustards such as chlorambucil, chlomaphazine, cholophosphamide, estramustine, ifosfamide, mechlorethamine, mechlorethamine oxide hydrochloride, melphalan, novembichin, phenesterine, prednimustine, trofosfamide, uracil mustard; nitrosureas such as carmustine, chlorozotocin, fotemustine, lomustine, nimustine, ranimustine; antibiotics such as aclacinomysins, actinomycin, authramycin, azaserine, bleomycins, cactinomycin, calicheamicin, carabicin, carminomycin, carzinophilin, chromomycins, dactinomycin, daunorubicin, detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin, epirubicin, esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic acid, nogalamycin, olivomycins, peplomycin, potfiromycin, puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin, tubercidin, ubenimex, zinostatin, zorubicin; anti-metabolites such as methotrexate and 5-FU; folic acid analogues such as denopterin, methotrexate, pteropterin, trimetrexate; purine analogues such as fludarabine, 6- mercaptopurine, thiamiprine, thioguanine; pyrimidine analogues such as ancitabine, azacitidine, 6- azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine, enocitabine, floxuridine; androgens such as calusterone, dromostanolone propionate, epitiostanol, mepitiostane, testolactone; anti-adrenals such as aminoglutethimide, mitotane, trilostane; folic acid replenisher such as frolinic acid; aceglatone; aldophosphamide glycoside; aminolevulinic acid; amsacrine; bestrabucil; bisantrene; edatraxate; defofamine; demecolcine; diaziquone; elfomithine; elliptinium acetate; etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidamine; mitoguazone; mitoxantrone; mopidamol; nitracrine; pentostatin; phenamet; pirarubicin; podophyllinic acid; 2-ethylhydrazide; procarbazine; PSK®; razoxane; sizofiran; spirogermanium; tenuazonic acid; triaziquone; 2,2’,2”-trichlorotriethylamine; urethan; vindesine; dacarbazine; mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine; arabinoside (“Ara-C”); cyclophosphamide; thiotepa; members of taxoid or taxane family, such as paclitaxel (TAXOL®docetaxel (TAXOTERE®) and analogues thereof; chlorambucil; gemcitabine; 6- thioguanine; mercaptopurine; methotrexate; platinum analogues such as cisplatin and carboplatin; vinblastine; platinum; etoposide (VP-16); ifosfamide; mitomycin C; mitoxantrone; vincristine; vinorelbine; navelbine; novantrone; teniposide; daunomycin; aminopterin; xeloda; ibandronate; CPT- 11; topoisomerase inhibitor RFS 2000; difluoromethylomithine (DMFO); retinoic acid; esperamicins; capecitabine; inhibitors of receptor tyrosine kinases and/or angiogenesis, including sorafenib (NEXAVAR® ), sunitinib (SUTENT® ), pazopanib (VOTRIENT™), toceranib (PALLADIA™), vandetanib (ZACTIMA™), cediranib (RECENTIN®), regorafenib (BAY 73-4506), axitinib (AG013736), lestaurtinib (CEP-701), erlotinib (TARCEVA®), gefitinib (IRESSA®), afatinib (BIBW 2992), lapatinib (TYKERB®), neratinib (HKI-272), and the like, and pharmaceutically acceptable salts, acids or derivatives of any of the above. Also included in this definition are anti-hormonal agents that act to regulate or inhibit hormone action on tumors such as anti-estrogens including for example tamoxifen, raloxifene, aromatase inhibiting 4(5)-imidazoles, 4-hydroxytamoxifen, trioxifene, keoxifene, LY 117018, onapristone, and toremifene (FARESTON®); and anti-androgens such as flutamide, nilutamide, bicalutamide, leuprolide, and goserelin; and pharmaceutically acceptable salts, acids or derivatives of any of the above. Other conventional cytotoxic chemical compounds as those disclosed in Wiemann et al., 1985, inMedical Oncology (Calabresi et al, eds.), Chapter 10, McMillan Publishing, are also applicable to the methods of the present invention. [0258] In some embodiments, the one or more chemotherapeutic agents comprise folinic acid (leucovorin, FOL), fluorouracil (5-FU, F) and oxaliplatin (Eloxatin, OX). FOLFOX, e.g., FOLFOX6, for example, mFOLFOX6, a chemotherapy regimen for treatment of colorectal cancer, is known to those skilled in the art. Additional information regarding FOLFOX can be found, for example, in de Gramont et al., J Clin Oncol. 18(16):2938-47 (2000), Toumigand et al., J Clin Oncol. 22(2):229-37 (2004), Goldberg et al., J Clin Oncol. 22(l):23-30 (2004), Tsai etal., Springerplus. 5(1): 1318 (2016), Neugut et al., Clin Colorectal Cancer 18(2):133-40 (2019) and Sobrero et al., Journal of Clinical Oncology 36(15):1478-85 (2018), which are incorporated herein by reference.
[0259] In some embodiments, the one or more chemotherapeutic agents comprise FOLFOX. In some embodiments, FOLFOX comprises folinic acid, fluorouracil, and oxaliplatin. In some embodiments, the oxaliplatin is administered at a dose of about 85 mg/m2. In some embodiments, the folinic acid is a racemic mixture of L- and D- folinic acid. In some embodiments, the folinic acid in L- folinic acid. In some embodiments, the folinic acid is administered at a dose between 200 mg/m2 and 400 mg/m2. In some embodiments, the folinic acid is a racemic mixture of L- and D- folinic acid and the folinic acid is administered at a dose of about 400 mg/m2. In some embodiments, the folinic acid is L-folinic acid and the folinic acid is administered at a dose of about 200 mg/m2. In some embodiments, the fluorouracil is administered at a dose of about 2,800 mg/m2.
[0260] In certain embodiments, the one or more chemotherapeutic agents comprise folinic acid (leucovorin, FOL), fluorouracil (5-FU, F) and irinotecan (Camptosar, IRI). FOLFIRI, a chemotherapy regimen for treatment of colorectal cancer, is known to those skilled in the art. Additional information regarding FOLFIRI can be found, for example, in Tournigand et al., J Clin Oncol. 22(2):229-37 (2004), Kamnerdsupaphon et al., J Med Assoc Thai. 90(10):2121-7 (2007), Kirstein et al., Oncologist 19(11): 1156-68 (2014), Chen et al., Medicine (Baltimore) 95(46):e5221 (2016), which are incorporated herein by reference.
[0261] In some embodiments the one or more chemotherapeutic agents comprise FOLFIRI. In some embodiments, FOLFIRI comprises folinic acid, fluorouracil, and irinotecan. In some embodiments, the irinotecan is administered at a dose of about 180 mg/m2. In some embodiments, the folinic acid is a racemic mixture of L- and D- folinic acid. In some embodiments, the folinic acid is L- folinic acid. In some embodiments, the folinic acid is administered at a dose between 200 mg/m2 and 400 mg/m2. In some embodiments, the folinic acid is a racemic mixture of L- and D- folinic acid and the folinic acid is administered at a dose of about 400 mg/m2. In some embodiments, the folinic acid is L-folinic acid and the folinic acid is administered at a dose of about 200 mg/m2. In some embodiments, the fluorouracil is administered at a dose of about 2,800 mg/m2.
[0262] In some embodiments, the one or more chemotherapeutic agents (e.g., FOLFOX or FOLFIRI) are administered once every two weeks. In some embodiments, the one or more chemotherapeutic agents (e.g., FOLFOX or FOLFIRI) are administered on a 28-day cycle. In some embodiments, the one or more chemotherapeutic agents (e.g., FOLFOX or FOLFIRI) are administered on Days 1 and 15 of the Cycle.
[0263] In some embodiments, the anti-EGFR/c-Met antibody (e.g., bispecific antibody) and the one or more additional therapeutic agents (e.g., chemotherapeutic agents) are administered simultaneously. In other embodiments, the antibody and the one or more additional therapeutic agents are administered separately (e.g., sequentially).
[0264] For combination therapies, the one or more anti-cancer agents may be administered using recommended doses and dosages of the anti-cancer agent.
Subjects
[0265] The terms “subject” and “patient” can be used interchangeably herein. “Patient in need thereof’ or “subject in need thereof’ refers to a mammalian subject, preferably human, diagnosed with or suspected of having a disease, to whom will be or has been administered a bi-specific anti-EGFR anti-MET antibody according to a method of the invention. “Patient in need thereof’ or “subject in need thereof’ includes those subjects already with the undesired physiological change or disease well as those subjects prone to have the physiological change or disease.
[0266] In some embodiments, the subject is 18 years of age or older, e.g., 18 to less than 40 years of age, 18 to less than 45 years of age, 18 to less than 50 years of age, 18 to less than 55 years of age, 18 to less than 60 years of age, 18 to less than 65 years of age, 18 to less than 70 years of age, 18 to less than 75 years of age, 40 to less than 75 years of age, 45 to less than 75 years of age, 50 to less than 75 years of age, 55 to less than 75 years of age, 60 to less than 75 years of age, 65 to less than 75 years of age, 60 to less than 75 years of age, 40 years of age or older, 45 years of age or older, 50 years of age or older, 55 years of age or older, 60 years of age or older, 65 years of age or older, 70 years of age or older or 75 years of age or older.
[0267] In some embodiments, the subject is a child. In some embodiments, the subject is 18 years of age or younger, e.g., 0-18 years of age, 0-12 years of age, 0-16 years of age, 0-17 years of age, 2-12 years of age, 2-16 years of age, 2-17 years of age, 2-18 years of age, 3-12 years of age, 3-16 years of age, 3-17 years of age, 3-18 years of age, 4-12 years of age, 4-16 years of age, 4-17 years of age, 4-18 years of age, 6-12 years of age, 6-16 years of age, 6-17 years of age, 6-18 years of age, 9-12 years of age, 9-16 years of age, 9-17 years of age, 9-18 years of age, 12-16 years of age, 12-17 years of age or 12-18 years of age.
[0268] In some embodiments, the subject has been diagnosed with CRC (e.g. , mCRC) for at least about 1 month, e.g. , at least about: 2 months, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 1 year, 18 months, 2 years, 30 months, 3 years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years or 10 years. In particular embodiments, the subject is newly diagnosed with CRC (e.g., mCRC). In some embodiments, the CRC is adenocarcinoma.
[0269] In certain embodiments, the subject is treatment naive. [0270] In some embodiments, the subject has received one or more prior anti-cancer therapies. In certain embodiments, the one or more prior anti-cancer therapies comprises one or more chemotherapeutic agents, checkpoint inhibitors, targeted anti-cancer therapies or kinase inhibitors, or any combination thereof. In particular embodiments, the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
[0271] In some embodiments, the subject is resistant or has acquired resistance to an EGFR inhibitor. Exemplary EGFR inhibitors for which cancer may acquire resistance are anti-EGFR antibodies cetuximab (ERBITUX®), pantinumumab (VECTIBIX®), matuzumab, nimotuzumab, small molecule EGFR inhibitors erlotinib (TARCEVA®), gefitinib (IRESSA®), EKB-569 (pelitinib, irreversible EGFR TKI), pan-ErbB and other receptor tyrosine kinase inhibitors, lapatinib (EGFR and HER2 inhibitor), pelitinib (EGFR and HER2 inhibitor), vandetanib (ZD6474, ZACTIMA™, EGFR, VEGFR2 and RET TKI), PF00299804 (dacomitinib, irreversible pan-ErbB TKI) , CI-1033 (irreversible pan-erbB TKI), afatinib (BIBW2992, irreversible pan-ErbB TKI), AV-412 (dual EGFR and ErbB2 inhibitor), EXEL-7647 (EGFR, ErbB2, GEVGR and EphB4 inhibitor), CO-1686 (irreversible mutant-selective EGFR TKI), AZD9291 (irreversible mutant-selective EGFR TKI), and HKI-272 (neratinib, irreversible EGFR/ErbB2 inhibitor). In some embodiments, the subject is anti- EGFR therapy naive.
[0272] Various qualitative and/or quantitative methods may be used to determine if a subject is resistant, has developed or is susceptible to developing a resistance to treatment with an anti-cancer therapy. Symptoms that may be associated with resistance to an anti-cancer therapy include a decline or plateau of the well-being of the patient, an increase in the size of a tumor, arrested or slowed decline in growth of a tumor, and/or the spread of cancerous cells in the body from one location to other organs, tissues or cells. Re-establishment or worsening of various symptoms associated with cancer may also be an indication that a subject has developed or is susceptible to developing resistance to an anti-cancer therapy, such as anorexia, cognitive dysfunction, depression, dyspnea, fatigue, hormonal disturbances, neutropenia, pain, peripheral neuropathy, and sexual dysfunction. The symptoms associated with cancer may vary according to the type of cancer. For example, symptoms associated with cervical cancer may include abnormal bleeding, unusual heavy vaginal discharge, pelvic pain that is not related to the normal menstrual cycle, bladder pain or pain during urination, and bleeding between regular menstrual periods, after sexual intercourse, douching, or pelvic exam.
Symptoms associated with lung cancer may include persistent cough, coughing up blood, shortness of breath, wheezing chest pain, loss of appetite, losing weight without trying and fatigue. Symptoms for liver cancer may include loss of appetite and weight, abdominal pain, especially in the upper right part of abdomen that may extend into the back and shoulder, nausea and vomiting, general weakness and fatigue, an enlarged liver, abdominal swelling (ascites), and a yellow discoloration of the skin and the whites of eyes (jaundice). One skilled in oncology may readily identify symptoms associated with a particular cancer type. [0273] Exemplary PD-(L)1 axis inhibitors are antibodies that bind PD-1 such as nivolumab (OPDIVO®), pembrolimumab (KEYTRUDA®), sintilimab, cemiplimab (LIBTAYO®), tripolibamab, tislelizumab, spartalizumab, camrelizumab, dostralimab, genolimzumab or cetrelimab, or antibodies that bind PD-L1, such as PD-L1 antibodies are envafolimab, atezolizumab (TECENTRIQ®), durvalumab (IMFINZI®) and avelumab (BAVENCIO®).
[0274] Marketed antibodies may be purchased via authorized distributor or pharmacy. The amino acid sequences structures of the small molecules can be found from US AN and/or INN submissions by the companies of from CAS registry.
[0275] In some embodiments, the subject has EGFR or c-Met expressing cancer.
[0276] Exemplary c-Met activating mutations include point mutations, deletion mutations, insertion mutations, inversions or gene amplifications that lead to an increase in at least one biological activity of a c-Met protein, such as elevated tyrosine kinase activity, formation of receptor homodimers and heterodimers, enhanced ligand binding etc. Mutations can be located in any portion of the c-Met gene or regulatory regions associated with the gene, such as mutations in the kinase domain of c-Met. Exemplary c-Met activating mutations are mutations at residue positions N375, V13, V923, R175, V136, L229, S323, R988, S1058/T1010 and E168. Methods for detecting EGFR and c-Met mutations or gene amplifications are well known.
[0277] In some embodiments, the subject has been characterized with wild-type KRAS, NRAS and BRAF. In some embodiments, the subject has been characterized with wild-type EGFR. In some embodiments, the subject has at least one intrahepatic tumor that resulted from metastasis of the mCRC.
Diagnosis
[0278] Certain embodiments of the present disclosure concern determining the presence of mutations in a KRAS, NRAS, BRAF, or EGFR gene, or ERBB2/HER2 amplification. Mutation detection methods are known the art, including PCR followed by nucleic acid sequencing, FISH, CGH, or next generation sequencing (NGS). In some embodiments, the mutations are detected by DNA sequencing, such as next generation sequencing (NGS), by using a tumor tissue sample or circulating free tumor DNA (ctDNA) from plasma.
[0279] In some embodiments, the method comprises: a) providing a biological sample from the subject; b) determining presence or absence of a mutation in KRAS, NRAS, BRAF, or EGFR gene or ERBB2/HER2 gene/fragment amplification in the sample; c) administering or providing for administration the anti-EGFR/c-Met antibody to the subject determined to have wild type KRAS, NRAS, BRAF, or EGFR gene or no ERBB2/HER2 gene/fragment amplification. [0280] In certain embodiments, the biological sample is a blood sample. In particular embodiments, the biological sample is a tumor tissue biopsy.
[0281] Certain embodiments of the present disclosure concern determining the presence of alterations in tumor protein 53 (TP53) or adenomatous polyposis coli (APC). Mutation detection methods are known the art, including PCR followed by nucleic acid sequencing, FISH, CGH, or next generation sequencing (NGS). In some embodiments, the mutations are detected by DNA sequencing, such as next generation sequencing (NGS), by using a tumor tissue sample or circulating free tumor DNA (ctDNA) from plasma. In some embodiments, the mutations are detected by NGS by using circulating free tumor DNA (ctDNA) from plasma.
[0282] In some embodiments, the method comprises: a) providing ctDNA from the subject; b) determining presence or absence of an alteration in TP53 or APC in the sample; c) administering or providing for administration the anti-EGFR/c-Met antibody to the subject determined to have an alteration in TP53 or APC.
[0283] In some embodiments, the alteration in TP53 or APC is a somatic mutation, gene amplification, or fusion that alters the function of TP53 or APC. In some embodiments, the alteration in TP53 or APC is a point mutation, deletion mutation, or insertion mutation. In some embodiments, the alteration in TP53 or APC is a gene amplification, or fusion that alters the function of TP53 or APC. In some embodiments, the alteration in TP53 is a somatic mutation, gene amplification, or fusion that alters the function of TP53. In some embodiments, the alteration in TP53 is a point mutation. In some embodiments, the alteration in TP53 is a deletion mutation. In some embodiments, the alteration in TP53 is an insertion mutation. In some embodiments, the alteration in APC is a somatic mutation, gene amplification, or fusion that alters the function of APC. In some embodiments, the alteration in APC is a point mutation. In some embodiments, the alteration in APC is a deletion mutation. In some embodiments, the alteration in APC is an insertion mutation.
[0284] In another aspect, the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody and a therapeutically effective amount of one or more chemotherapeutic agents to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a HCDR1 of SEQ ID NO: 1, a HCDR2 of SEQ ID NO: 2, a HCDR3 of SEQ ID NO: 3, a LCDR1 of SEQ ID NO: 4, a LCDR2 of SEQ ID NO: 5 and a LCDR3 of SEQ ID NO: 6; and the second domain comprises the HCDR1 of SEQ ID NO: 7, the HCDR2 of SEQ ID NO: 8, the HCDR3 of SEQ ID NO: 9, the LCDR1 of SEQ ID NO: 10, the LCDR2 of SEQ ID NO: 11 and the LCDR3 of SEQ ID NO: 12. [0285] In another aspect, the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a first domain that specifically binds EGFR and a second domain that specifically binds c-Met, wherein the first domain comprises a VH of SEQ ID NO: 13 and a VL of SEQ ID NO: 14; and the second domain comprises the VH of SEQ ID NO: 15 and the VL of SEQ ID NO: 16, and a therapeutically effective amount of one or more chemotherapeutic agents.
[0286] In another aspect, the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody and a therapeutically effective amount of one or more chemotherapeutic agents to the subject, wherein the bispecific anti-EGFR/c-Met antibody comprises a HC1 of SEQ ID NO: 17, a LC1 of SEQ ID NO: 18, a HC2 of SEQ ID NO: 19 and a LC2 of SEQ ID NO: 20.
[0287] In another aspect, the disclosure provides a method of treating mCRC in a subject having wild type KRAS, NRAS, BRAF, or EGFR gene, or no ERBB2/HER2 gene/fragment amplification, and/or alteration in TP53 or APC, comprising administering a therapeutically effective amount of an isolated bispecific anti-EGFR/c-Met antibody and a therapeutically effective amount of one or more chemotherapeutic agents to the subject, wherein the bispecific anti-EGFR/c-Met antibody is amivantamab.
[0288] In some embodiments described herein are methods of treating colorectal cancer in a subject in need thereof harboring one of more unresectable tumors, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody to the subject wherein one or more of the one or more unresectable tumors is rendered resectable. In some embodiments, the method further comprises administering one or more chemotherapeutic agents to the subject. In some embodiments, the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin. In some embodiments, the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan.
[0289] In some embodiments described herein the one or more unresectable tumors are primary tumors and/or metastatic tumors. In some embodiments described herein the one or more unresectable tumors are formed as a results of mCRC spread.
[0290] In some embodiments described herein the one or more unresectable tumors are located outside of the colon. In some embodiments, the one or more unresectable tumors are located in the liver of lung. In some embodiments, the one or more unresectable tumors are located in the liver. In some embodiments, the one or more unresectable tumors are located in the lung. [0291]
Embodiments
1. A method of treating colorectal cancer in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject.
2. The method of embodiment 1, wherein the antibody comprises: a) a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
3. The method of embodiment 2, wherein the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16.
4. The method of any one of embodiments 1-3, wherein the antibody is of the IgGl isotype.
5. The method of any one of embodiments 1-4, wherein the antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO:20.
6. The method of any one of embodiments 1-5, wherein the antibody is an isolated bispecific antibody.
7. The method of embodiment 6, wherein the bispecific antibody is amivantamab.
8. The method of any one of embodiments 1-7, wherein the antibody comprises a biantennary glycan stmcture with a fucose content of about 1% to about 15% or less than about 20%.
9. The method of any one of embodiments 1-8, wherein the antibody is administered at a dose of about 1,750 mg to about 2,100 mg.
10. The method of embodiment 9, wherein the antibody is administered at a dose of about 1,750 mg or about 2, 100 mg. The method of embodiment 10, wherein the antibody is administered at a dose of about 1,750 mg. The method of embodiment 10, wherein the antibody is administered at a dose of about 2, 100 mg. The method of any one of embodiments 1-12, wherein the antibody is administered once a week or once every two weeks. The method of embodiment 13, wherein the antibody is administered once weekly for the first 4 weeks and then every 2 weeks. The method of any one of embodiments 1-14, wherein the antibody is administered on a 28- day cycle. The method of any one of embodiments 1-15, wherein the antibody is administered as a monotherapy. The method of any one of embodiments 1-15, wherein the method further comprises administering one or more chemotherapeutic agents to the subject. The method of embodiment 17, wherein the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin. The method of embodiment 17, wherein the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan. The method of any one of embodiments 1-19, wherein the colorectal cancer is metastatic colorectal cancer (mCRC). The method of any one of embodiments 1-20, wherein the subject has been characterized with wild-type KRAS, NRAS and BRAF. The method of any one of embodiments 1-21, wherein the subject has been characterized with no amplification of ERBB2/HER2. The method of any one of embodiments 1-22, wherein the subject has been diagnosed with left-sided mCRC. The method of any one of embodiments 1-22, wherein the subject has been diagnosed with right-sided mCRC. The method of any one of embodiments 1-24, wherein the subject is anti-EGFR therapy naive. The method of any one of embodiments 1-24, wherein the subject has received prior anti- EGFR therapy. The method of any one of embodiments 1-25, wherein the subject is treatment naive. The method of any one of embodiments 1-26, wherein the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies. The method of any one of embodiments 1-28, wherein the subject is 18 years of age or older. A method of treating colorectal cancer in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFRj/hepatocyte growth factor receptor (c-Met) antibody and one or more chemotherapeutic agents to the subject. The method of embodiment 30, wherein the antibody comprises: a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively. The method of embodiment 31, wherein the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16. The method of any one of embodiments 30-32, wherein the antibody is of the IgGl isotype. The method of any one of embodiments 30-33, wherein the antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO:20. The method of any one of embodiments 30-34, wherein the antibody is an isolated bispecific antibody. The method of embodiment 35, wherein the bispecific antibody is amivantamab. The method of any one of embodiments 30-36, wherein the antibody comprises a biantennary glycan structure with a fucose content of about 1% to about 15% or of less than about 20%. The method of any one of embodiments 30-37, wherein the antibody is administered at a dose of about 1,050 mg to about 2,100 mg. The method of embodiment 38, wherein the antibody is administered at a dose of about 1,050 mg. The method of embodiment 38, wherein the antibody is administered at a dose of about 1,400 mg. The method of any one of embodiments 30-40, wherein the antibody is administered once a week or once every two weeks. The method of any one of embodiments 30-41, wherein the antibody is administered on a 28- day cycle. The method of any one of embodiments 30-42, wherein the antibody is administered once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15). The method of any one of embodiments 30-43, wherein the antibody is administered at a dose of 1,050 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of less than 80 kg, or at a dose of 1,400 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of 80 kg or more. The method of any one of embodiments 30-44, wherein the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin. The method of embodiment 45, wherein FOLFOX is administered once every two weeks. The method of embodiment 45 or 46, wherein FOLFOX is administered on a 28-day cycle. The method of any one of embodiments 45-47, wherein the oxaliplatin is administered at a dose of about 85 mg/m2. The method of any one of embodiments 45-48, wherein the folinic acid is a racemic mixture of L- and D-folinic acid. The method of embodiment 49, wherein the folinic acid is administered at a dose of about 400 mg/m2. The method of any one of embodiments 47-50, wherein the folinic acid is L-folinic acid. The method of embodiment 51, wherein the folinic acid is administered at a dose of about 200 mg/m2. The method of any one of embodiments 45-52, wherein the fluorouracil is administered at a dose of about 2,800 mg/m2. The method of any one of embodiments 30-44 wherein the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil, and irinotecan. The method of embodiment 54, wherein the FOLFIRI is administered once every two weeks. The method of embodiment 54 or 55, wherein the FOLFIRI is administered on a 28-day cycle. The method of any one of embodiments 54-56, wherein the irinotecan is administered at a dose of about 180 mg/m2. The method of any one of embodiments 54-57, wherein the folinic acid is a racemic mixture of L- and D-folinic acid. The method of embodiment 58, wherein the folinic acid is administered at a dose of about 400 mg/m2. The method of any one of embodiments 54-57 wherein the folinic acid is L-folinic acid. The method of embodiment 60, wherein the folinic acid is administered at a dose of about 200 mg/m2. The method of any one of embodiments 54-61, wherein the fluorouracil is administered at a dose of about 2,800 mg/m2. The method of any one of embodiments 30-62, wherein the subject has been characterized with wild-type KRAS, NRAS and BRAF. The method of any one of embodiments 30-63, wherein the subject has been characterized with no amplification of ERBB2/HER2. The method of any one of embodiments 30-64, wherein there is an alteration in the tumor protein 53 (TP53) gene or adenomatous polyposis coli (APC) gene in the circulating tumor DNA (ctDNA) of the subject. The method of embodiment 65, wherein the alteration in TP53 or APC is a somatic mutation that alters the function of TP53 or APC. The method of embodiment 66, wherein the alteration in TP53 or APC is a point mutation, insertion mutation, or deletion mutation. The method of claim 65, wherein the alteration in TP53 or APC is a gene amplification or fusion that alters the function of TP53 or APC. The method of any one of embodiments 30-68, wherein the subject is anti-EGFR therapy naive. The method of any one of embodiments 30-68, wherein the subject has received prior anti- EGFR therapy. The method of any one of embodiments 30-68, wherein the subject is treatment naive. The method of any one of embodiments 30-68 and 70, wherein the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies. The method of any one of embodiments 30-72, wherein the subject is 18 years of age or older. The method of any one of embodiments 30-73, wherein the colorectal cancer is metastatic colorectal cancer (mCRC). The method of any one of embodiments 30-74, wherein the subject has been diagnosed with left-sided mCRC. The method of any one of embodiments 30-75, wherein the subject has been diagnosed with right-sided mCRC. The method of any one of embodiments 74-76, wherein the subject has at least one intrahepatic tumor that resulted from metastasis of the mCRC. 78. The method of embodiment 77, wherein the method reduces the size of the at least one intrahepatic tumor.
79. The method of any one of embodiments 1-78, wherein the subject has right sided KRAS, NRAS and BRAF wild type mCRC.
80. The method of any one of embodiments 1-79, wherein the subject has at least one intrahepatic tumor that resulted from metastasis of the mCRC
81. The method of embodiment 80, wherein the method reduces the size of the at least one intrahepatic tumor.
82. The method of any one of embodiments 1-81, wherein the subject has one of more unresectable tumors, wherein the method renders the one or more unresectable tumors resectable.
Example 1. Amivantamab in Patients with Advanced or Metastatic Colorectal Cancer. [0292] This is an open-label, multicenter Phlb/2 study of amivantamab as a monotherapy and in combination with chemotherapy in patients with metastatic Colorectal Cancer (mCRC). Part 1 Dose Confirmation will evaluate the safety and confirm the recommended Phase 2 dose (RP2D) of amivantamab either as a monotherapy or recommended Phase 2 combination dose (RP2CD) in combination with FOLFOX or FOLFIRI. Part 2 expansion will evaluate the preliminary anti-tumor activity of amivantamab as monotherapy and in combination with FOLFOX or FOLFIRI in the respective populations. Details of the study are described in Table 1 and FIG. 1.
Table 1. Amivantamab in Patients with Advanced or Metastatic Colorectal Cancer
Example 2. Amivantamab Monotherapy in Addition to Standard-of-Care Chemotherapy in Participants with Advanced or Metastatic Colorectal Cancer.
[0293] This is an open-label, multicenter Phase lb/2 study of amivantamab as a monotherapy and in combination with chemotherapy in patients with metastatic Colorectal Cancer (mCRC) as described in Table 2.
Table 2. Amivantamab Monotherapy and in Addition to Standard-of-Care Chemotherapy in Participants with Advanced or Metastatic Colorectal Cancer
Example 3. Amivantamab monotherapy in relapsed/refractory metastatic colorectal cancer: OrigAMI-1, an open-label, phase lb/2 study.
Abstract
[0294] Background: Amivantamab (ami), an EGFR-MET bispecific antibody with immune celldirecting activity, has shown preclinical activity in colorectal cancer (CRC) models. MET amplification is implicated in driving resistance to anti-EGFR therapies in metastatic CRC (mCRC). We hypothesize that dual, co-inhibition of EGFR and MET with ami could improve outcomes in relapsed/refractory mCRC.
[0295] Methods: OrigAMI-1 (NCT05379595) is assessing the safety and efficacy of ami as monotherapy in patients (pts) with refractory mCRC in 3 separate cohorts (Table 3). Eligible pts were wild-type for KRAS, NRAS, BRAF, and EGFR ectodomain by ctDNA testing, without ERBB2/HER2 amplification. Cohorts A and B included pts with left-sided mCRC without/with prior exposure to anti-EGFR monoclonal antibodies, respectively, and cohort C included pts with rightsided mCRC. Safety population included all pts receiving the recommended phase 2 dose (RP2D; 1050 mg [1400 mg, >80kg]). Investigator-assessed response per RECIST vl.l is reported for evaluable pts with post-baseline disease assessment(s) or who discontinued for any reason. Ami plus FOLFOX or FOLFIRI is being explored in additional cohorts.
[0296] Results: Ninety three pts were treated at RP2D; 89 were response evaluable (median follow-up: 4.4 mo). Median age was 60 years, 66% were male, and median prior lines of therapy were 2, with 94% receiving prior bevacizumab and 69% prior anti-EGFR therapy. Best timepoint responses were: Cohort A: 7/17, 41.2%; Cohort B: 13/54, 24.1%; Cohort C: 1/18, 5.6%. Disease control rates (DCR) were 88.2%, 72.2%, and 77.8% for Cohorts A, B, and C, respectively. Median duration of response (mDoR) for confirmed responders was 7.5 and 7.4 mo for Cohorts A and B, respectively. Treatment is ongoing for the responder in Cohort C. 10/13 responders (77%) remain on treatment. Preliminary biomarker data suggest ami may be active in alterations associated with anti-EGFR antibody resistance (eg, EML4-ALK fusion, PTEN). [0297] The most frequent treatment-emergent adverse events were rash (84%) and infusion- related reactions (53%). No new safety signals were observed. Updated results will be presented at the meeting.
[0298] Conclusions: Ami monotherapy demonstrated promising, durable antitumor activity in refractory mCRC, including pts treated with prior anti-EGFR therapy and pts with right-sided disease. The safety profile of ami in mCRC is manageable and consistent with prior NSCLC experience.
Table 3. Efficacy.
*In confirmed responders f 3 confirmed, 3 pending confirmation, 1 unconfirmed
J 9 confirmed, 1 pending confirmation, 3 unconfirmed
§ Confirmed
Objective
[0299] OrigAMI-1 is a global, multicenter, open-label, phase lb/2 study (ClinicalTrials.gov Identifier: NCT05379595). The primary objective of the OrigAMI-1 monotherapy cohorts is to assess the antitumor activity of amivantamab in patients with mCRC, and the secondary objective is to characterize the safety of amivantamab in this population.
Methods
[0300] OrigAMI-1 trial is assessing amivantamab (administered intravenously in 28-day cycles) as monotherapy and in combination with SoC chemotherapy (not reported here) in patients with advanced mCRC.
[0301] Patients must have received or been intolerant to SoC fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy and an anti-vascular endothelial growth factor (VEGF) treatment. Patient enrollment criteria require KRAS, NRAS, BRAF, and EGFR ectodomain wild-type status by central circulating-tumor DNA testing at screening without evidence of ERBB2/HER2 amplification. - Cohort A included patients with left-sided mCRC without prior exposure to anti-EGFR mAbs and evaluated 2 dose levels (Cohort A vs Cohort A2).
- Cohort B included patients with left-sided mCRC with prior exposure to anti-EGFR mAbs.
- Cohort C included patients with right-sided mCRC with or without prior exposure to anti-EGFR mAbs.
[0302] Investigator-assessed response is reported for patients with postbaseline disease assessment(s) and those who discontinued.
[0303] Patients in Cohorts A, B, and C received 1050 mg (1400 mg for >80 kg) every 2 weeks (Q2W); Cohort A2 patients received 1750 mg (2100 mg for >80 kg) Q2W.
[0304] A recent EGFR rechallenge study showed that the frequency of RAS and EGFR mutant clones declined after stopping prior anti-EGFR (ie, cetuximab or panitumumab) therapy; the mutational decay (MD) half life of these clones was found to be 4.4 months. We sought to determine whether response to amivantamab for Cohort B patients might be correlated with the time elapsed from withdrawal of previous anti-EGFR. We used the reference data of 1 MD half-life of RAS and EGFR clonal decay (4.4 months) to perform the retrospective analysis of Cohort B data. Months between anti-EGFR mAb withdrawal to amivantamab Cycle 1 Day 1 (C1D1) were used to generate 2 groups:
[0305] >2 MD half-lives (>8.8 months between anti-EGFR mAb withdrawal to amivantamab
C1D1)
[0306] and <2 MD half-lives (<8.8 months between anti-EGFR mAb withdrawal to amivantamab C1D1). These 2 groups are used to evaluate the effect of time elapsed from EGFR mAb progression to subsequent amivantamab treatment.
Results
[0307] One hundred ten (110) patients were dosed with amivantamab monotherapy; patient characteristics and efficacy are shown in Table 4 and FIGs. 3-6. The vast majority of patients (—92%) received intervening chemotherapy, with or without targeted agents, during the period between the prior anti-EGFR therapy regimen and the initiation of amivantamab. FIGs. 3-6 show antitumor activity in Cohorts A, A2, B, and C. Data present response evaluable analysis set, which includes patients who received >1 dose of study drug and either had >1 postbaseline efficacy disease assessments, or discontinued treatment for any reason, or had disease progression/death prior to the first postbaseline disease assessment. In FIGs. 3-6, * - response evaluable patient who does not have any evaluable target lesion measurements in any postbaseline disease assessment; DCR - disease control rate (partial response, PR + stable disease, SD); mDoR - median duration of response; mDoT - median duration of treatment; mPFS - median progression-free survival; NE - not estimable; ORR - overall response rate; PD - progressive disease; PR - partial response; SD - stable disease; SoD - sum of diameter; uPR - unconfirmed partial response.
Table 4. Patient characteristics
Other: Black/multiple/ American Indian/ Alaska Native/NR.
One patient who did receive amivantamab monotherapy is enrolled in a separate Cohort with a different dose and results are not presented here.
ECOG PS, Eastern Cooperative Oncology Group performance status; NR, not reported.
[0308] In Cohort B, improved efficacy (FIG. 7A) and progression-free survival (FIG. 7B) were observed in patients rechallenged with amivantamab >2 MD half-lives after prior anti-EGFR therapy. Spider plots comparing those with <2 and >2 MD half-lives are shown in FIG. 7C and FIG. 7D. Results shown in FIG. 7(A-D) demonstrate that longer interval between amivantamab treatment and prior progression on EGFR mAb is associated with improved outcomes (Cohort B). In FIG. 7(A-D), CBR - confirmed CR + confirmed PR + SD (duration of >11 weeks); >2 MD half-lives (>8.8 months between anti-EGFR mAb withdrawal to amivantamab C1D1); <2 MD half-lives (<8.8 months between anti-EGFR mAb withdrawal to amivantamab C1D1); CBR - clinical benefit rate; CI - confidence interval; EGFR - epidermal growth factor receptor; HR - hazard ratio; mAb - monoclonal antibody; MD - mutational decay; NE - not estimable; PD - progressive disease; PFS - progression- free survival; PR - partial response; SD - stable disease; SoD - sum of diameter; uPR - unconfirmed partial response.
[0309] Safety profiles are presented in Table 5. Table 5. Safety profile.
TEAE, treatment-emergent adverse event
[0310] Preliminary Cohort B data suggested that amivantamab may be active in patients harboring alterations associated with EGFR mAb resistance (eg, MAP2K1, EML4-ALK fusion; FIG. 8). FIG. 8 shows the genomic landscape of Cohort B. In FIG. 8, genomic landscape of efficacy evaluable cohort B patients was evaluated using detectable ctDNA from Guardant Health; * - evidence of activity observed in patients whose tumors harbor mutations reported to confer resistance to anti-EGFR therapy (eg, MAP2K1 [PR], EML4-ALK fusion [PR]); PD - progressive disease; PR - partial response; SD - stable disease; SoD - sum of diameters.
[0311] Clinical activity was improved in patients whose tumors harbored TP53+APC comutations (Cohort B; Table 6).
Table 6: Improved activity observed in patients whose tumor harbor TP53+APC comutations (Cohort B)
DCR, disease control rate (PR+SD); mPFS, median progression-free survival; ORR, overall response rate (PR);
PR, partial response; SD, stable disease.
Key takeaways
1. OrigAMI-1 is the first study to demonstrate amivantamab activity in mCRC.
2. The unique mechanism of action of amivantamab may enable improved clinical activity against mCRC and represents a new therapeutic option in this population.
3. The safety profile for amivantamab (at both dose levels) in mCRC is consistent with previously reported experience in NSCLC, and no new safety signals were identified. Conclusions
[0312] Amivantamab monotherapy showed substantial activity in Cohorts A and B:
- Cohort A: Overall response rate (ORR), 29.4%; with disease control rate (DCR), 88.2% and median progression-free survival (mPFS), 5.7 months;
- Cohort A2: ORR, 46.7%; with DCR, 93.3%;
- Cohort B: ORR, 20.4%; with DCR, 74.1% and mPFS, 4.6 months.
[0313] Amivantamab monotherapy showed favorable activity in Cohort C:
- Cohort C: ORR, 13.0%; with DCR, 78.3% and mPFS, 3.6 months
[0314] Clinical data obtained to date compare favorably with historical data (Price TJ, et al.
Lancet Oncol. 2014;15(6):569-579; Sartore-Bianchi A, et al. Nat Med. 2022;28(8):1612-1618. 7;
Moretto R, et al. Oncologist. 2016;21(8):988-994).
[0315] Longer interval between amivantamab treatment and prior progression on EGFR mAb was associated with improved outcomes.
[0316] Safety results are consistent with the previously reported profile, with no new safety signals.
Example 4: Amivantamab plus FOLFOX or FOLFIRI in metastatic colorectal cancer: results from OrigAMI-1, a phase lb/2 study
Study design
[0317] A schematic of the OrigAMI-1 study design is depicted in FIG 9.
Baseline characteristics
[0318] Baseline characteristics are depicted in Table 7 below.
Table 7:
Safety
[0319] Treatment-related discontinuations of amivantamab were 10% for amivantamab + mFOLFOX6 and 9% for amivantamab + FOLFIRI. Median duration of treatment was 5.2 months for amivantamab + mFOLFOX6 and 5.7 months for amivantamab + FOLFIRI. Amivantamab + chemotherapy demonstrated a safety profile that was consistent with individual components and without evidence of additive toxicity. Treatment-related discontinuations of amivantamab were low. Safety outcomes are depicted in Table 8 below.
Table 8 aAlso associated with irinotecan, a component of the FOLFIRI regimen.
ALT, alanine aminotransferase; IRR, infusion-related reaction; TEAE, treatment-emergent adverse event
Results
[0320] Amivantamab + chemotherapy demonstrated durable anti-tumor activity. FIG. 10 depicts the efficacy of amivantamab + chemotherapy. Median (range) follow-up was 7.3 months (1.1-14.4). 67% (29/43) of patients remain on treatment (one patient discontinued due to adverse event prior to first disease assessment and is not shown in the plot). ORR was 64% among patients on IL therapy and 44% among patients on 2L therapy. Results are further described in Table 9 below.
Table 9 aORR is the proportion of patients achieving PR or CR by investigator assessment at >2 consecutive disease assessments. bORR among patients receiving amivantamab + FOLFOX was 60% (95% CI, 36-81), and 39% (95% CI, 20-62) among patients receiving amivantamab + FOLFIRI. c Among confirmed responders. dOne patient discontinued due to an adverse event prior to first disease assessment and is not shown in the spider plot.
IL, first-line; 2L, second-line; CR, complete response; DCR, disease control rate (confirmed responders and patients with confirmed stable disease); DoR, duration of response; NE, not estimable; ORR, objective response rate; PD, progressive disease; PFS, median progression-free survival; PR, partial response; SD, stable disease; SoD, sum of diameter; uPR, unconfirmed partial response.
[0321] Liver produces human growth factor (HGF), and amivantamab blocks HGF ligand binding to MET; therefore, intrahepatic responses were examined:
70% (30 of 43) of patients had measurable target liver lesions
Intrahepatic outcomes: ORR: 53% (16 of 30); DCR: 93% (28 of 30)
[0322] FIG. 11 depicts the results from a 65 -year-old Asian female with no prior systemic treatment for colorectal cancer treated with amivantamab + FOLFIRI. Partial hepatectomy including segments 4/5/6Z8 performed at 30 weeks.
[0323] There is evidence of activity across a range of mutations, including those conferring resistance to anti-EGFR therapy (FIG. 12).
[0324] Amivantamab + chemotherapy (mFOLFOX6 or FOLFIRI) demonstrated durable antitumor activity in patients with RAS/RAF WT mCRC without prior EGFR inhibitor therapy: Overall ORR, 49%; DCR, 88%; mDoR, 7.4 months; mPFS, 7.5 months, Clinically meaningful intrahepatic antitumor activity was seen (intrahepatic ORR of 53%; intrahepatic DCR of 93%). 7 (16%) patients proceeded to curative intent surgery (5 completed, 2 scheduled) due to robust antitumor activity. The safety profile of amivantamab + FOLFOX or FOLFIRI was consistent with each individual component, without additive toxicity, including low rates of treatment-related discontinuations. Therefore, amivantamab plus chemotherapy showed promising, durable antitumor activity, and notable intrahepatic responses, with a manageable safety profile. Example 5. Amivantamab with or without chemotherapy in right-sided metastatic colorectal cancer: Updated results from OrigAMI-1, an open-label, phase lb/2 study.
Abstract
[0325] Background: Amivantamab (ami) is an EGFR-MET bispecific antibody with immune cell-directing activity and is FDA approved in EGFR-mutated advanced non-small cell lung cancer. High MET expression is observed in -68% of patients (pts) with metastatic colorectal cancer (mCRC). Additionally, MET amplification occurs in up to 23% of EGFR-resistant mCRC and is implicated in driving resistance to EGFR-targeting antibodies (EGFRi). Compared to left (L)-sided disease, right (R)-sided disease is less responsive to EGFRi and associated with poorer outcomes. We present longer follow-up data among pts with R-sided mCRC.
[0326] Methods: OrigAMI-1 (NCT05379595) was assessing ami as monotherapy and combined with chemotherapy in mCRC. All pts were wild-type for KRAS, NRAS, BRAF, and EGFR ectodomain by central ctDNA testing, without ERBB2/HER2 amplification. One ami monotherapy cohort (Cohort C) enrolled only pts with R-sided disease (all pts must have 2-3 prior lines; prior EGFRi allowed). The ami plus chemotherapy cohorts (Cohorts D [with FOLFOX] and E [with FOLFIRI) enrolled both L- and R-sided disease (1 prior line max; prior EGFRi use was exclusionary). Primary tumor locations of cecum, ascending colon, hepatic flexure, and transverse colon were considered R-sided. Response was assessed by the investigator per RECIST vl.l.
[0327] Results: 23 pts with R-sided mCRC received ami monotherapy (median follow-up of 8.1 months [mo]). Median number of prior lines was 2, and 43% had prior EGFRi. There were 7 pts with R-sided disease who received ami plus FOLFOX or FOLFIRI (median follow-up of 6.5 mo); all 7 had received 1 prior line.
[0328] Among pts receiving ami monotherapy, objective response rate (ORR) was 22% (5/23) and disease control rate (DCR) was 78% (18/23), with 1 achieving a complete response. Median duration of response (DoR) is 7.4 mo; response and treatment are ongoing for 3 of the 5 responders. [0329] In pts receiving ami plus FOLFOX or FOLFIRI, ORR was 43% (3/7) and DCR was 86% (6/7). Median DoR is 5.8 mo, with all 3 responders on treatment, of which 2 are ongoing response. Additional details are shown in Table 7.
[0330] Biomarker data will be presented at the meeting. Safety profile among R-sided disease was consistent with prior reports, with the most common ami-related grade 3+ AEs being rash and hypoalbuminemia (2 pts each).
[0331] Conclusions: Ami monotherapy or combined with FOLFOX or FOLFIRI demonstrated durable antitumor activity in R-sided mCRC. Table 7. Efficacy
Background
[0332] Anti-epidermal growth factor receptor (EGFR) antibodies (cetuximab and panitumumab) with chemotherapy (FOLFOX or FOLFIRI) are frequently used to treat left-sided (L-sided) but not right-sided (R-sided) RAS/BRAF wild-type (WT) metastatic colorectal cancer (mCRC).
[0333] While mesenchymal-epithelial transition (MET) inhibitors are not currently used in routine mCRC therapy, high MET expression is associated with poor prognosis in mCRC and, regardless of location, acquired MET alterations can lead to resistance to anti-EGFR therapies.
[0334] Amivantamab is an EGFR-MET bispecific antibody with immune cell-directing activity that is approved by the US Food and Drug Administration in 4 EGFR-mutant advanced non-small cell lung cancer indications.
[0335] Amivantamab has shown promising antitumor activity in RAS/BRAF WT mCRC. Here, we present updated activity data on amivantamab as a monotherapy and in combination with FOLFOX/FOLFIRI in R-sided RAS/BRAF WT mCRC, where there is an unmet need for more effective therapies.
Methods
[0336] OrigAMI-1 (ClinicalTrials.gov Identifier: NCT05379595) is a global, multicenter, openlabel, phase lb/2 study of amivantamab monotherapy with or without standard-of-care chemotherapy in patients with advanced or metastatic CRC (FIG. 13). ctDNA testing was performed at screening to identify KRAS/NRAS missense alterations (leading to G12X, G13X, Q61X, K117X, A59X, or A146X), BRAF missense alterations (leading to V600X change), or ERRB2/HER2 amplification, as detected by Guardant360 CDx. mFOLFOX6 comprises oxaliplatin (85 mg/m2) IV, leucovorin 400 mg/m2 (or 200 mg/m2 if levoleucovorin) IV, 5-FU bolus (400 mg/m2) IV, and 5-FU (2400 mg/m2 or 1200 mg/m2/day for 2 days). FOLFIRI comprises irinotecan (180 mg/m2) IV, leucovorin 400 mg/m2 (or 200 mg/m2 if levoleucovorin) IV, 5-FU bolus (400 mg/m2) IV, and 5-FU (2400 mg/m2 or 1200 mg/m2/day for 2 days).
[0337] The analyses assessed the efficacy and safety of:
- Amivantamab intravenous (IV) as a monotherapy in patients with R-sided disease who had 2 or 3 prior lines of therapy (prior EGFR inhibitor therapy allowed; Cohort C, prespecified analyses)
- Amivantamab IV in combination with chemotherapy (mFOLFOX6 or FOLFIRI) in patients with R-sided disease who had a maximum of 1 prior line of therapy and no prior EGFR inhibitor therapy (Cohorts D and E, post hoc analyses).
[0338] R-sided disease was defined as a primary tumor arising from the cecum, ascending colon, or transverse colon.
[0339] The association between biomarkers and clinical response was also assessed in an exploratory analysis.
Results.
Baseline demographic and clinical characteristics
[0340] A total of 30 patients were included in this analysis (Table 8). Patients in OrigAMI-1 were heavily pretreated, with up to 3 prior lines of therapy in the amivantamab monotherapy cohort.
Table 8. Baseline demographic and clinical characteristics a - Includes patients who identified as American Indian or Alaska Native, patients who identified as multiple races, and patients who did not report a race, b - Patients could have metastases at more than 1 location. ECOG PS, Eastern Cooperative Oncology Group performance status; EGFRi, epidermal growth factor receptor inhibitor
Safety
[0341] No discontinuations related to amivantamab were reported in any cohort among patients withR-sided disease in OrigAMI-1 (Table 9)
Table 9. Safety a - Also associated with 5FU, a component of the FOLFOX regimen, and with irinotecan, a component of the FOLFIRI regimen. ALT, alanine aminotransferase; AST, aspartate aminotransferase; EGFR, epidermal growth factor receptor; IRR, infusion-related reaction; MET, mesenchymal-epithelial transition; TEAE, treatment-emergent adverse event.
Efficacy
[0342] Objective response rate (ORR), median duration of response (mDoR), disease control rate (DCR), and median progression-free survival (mPFS) are shown in Table 10. [0343] There was evidence of activity across a range of mutations, including those conferring resistance to anti-EGFR therapy (FIG. 14). As shown on FIG14, no MET amplification was identified in this baseline assessment using ctDNA analyses.
[0344] Median (range) follow-up was 8.1 months (0.6-20.3) for the 23 patients receiving amivantamab monotherapy and 8.2 months (3.2-11.9) for the 7 patients receiving amivantamab + chemotherapy (FIG. 15).
Table 10. Efficacy endpoints a - ORR is the proportion of patients achieving PR or CR by investigator assessment at >2 consecutive disease assessments, b - Among confirmed responders, c - Of the 5 responders, 3 remain on treatment and have ongoing response, d - All 3 responders remain on treatment; 1 of 3 responders has ongoing response. 2L, second-line; 3L+, third-line or higher; CI, confidence interval; CR, complete response; DCR, disease control rate (confirmed responders and patients with confirmed stable disease); DoR, duration of response; mCRC, metastatic colorectal cancer; mo, months; NE, not estimable; ORR, objective response rate; PFS, progression-free survival; PR, partial response.
Conclusions
[0345] Amivantamab, an EGFR-MET bispecific antibody, as a monotherapy or combined with chemotherapy demonstrated durable antitumor activity in patients with R-sided RAS/BRAF WT mCRC, with a safety profile consistent with prior reports.
[0346] Amivantamab as a monotherapy or in combination with chemotherapy (FOLFOX or FOLFIRI) provided promising antitumor activity in patients with heavily pretreated R-sided RAS/BRAF WT mCRC:
- Amivantamab monotherapy in 3L+: ORR, 22%; DCR, 78%; mDoR, 9.8 months; one patient achieved a complete response; 3 patients had ongoing response
- Amivantamab + chemotherapy in 2L: ORR, 43%; DCR, 86%; mDoR, not estimable; one patient had ongoing response.
[0347] The safety profile of amivantamab among patients with R-sided mCRC was consistent with prior reports. [0348] Amivantamab showed activity in the R-sided setting across a range of mutations, including those conferring resistance to anti-EGFR therapy.
[0349] Other phase 3 studies are evaluating amivantamab in mCRC:
- Amivantamab versus cetuximab (both plus FOLFOX or FOLFIRI) as IL treatment in OrigAMI-2 (NCT06662786).
- Amivantamab versus cetuximab or bevacizumab (all plus FOLFIRI) as 2L treatment in OrigAMI-3 (NCT06750094).
References
Sawicki T, Ruszkowska M, Danielewicz A, Niedzwiedzka E, Arlukowicz T, Przybylowicz KE. A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis. Cancers (Basel). 2021 Apr 22;13(9):2025.
Biller LH, Schrag D. Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review. JAMA. 2021 Feb 16;325(7):669-685. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Frey er G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000 Aug;18(16):2938-47.
Toumigand C, Andre T, Achille E, Lledo G, Flesh M, Mery-Mignard D, Quinaux E, Couteau C, Buyse M, Ganem G, Landi B, Colin P, Louvet C, de Gramont A. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004 Jan 15;22(2):229-37.
Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, Findlay BP, Pitot HC, Alberts SR. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004 Jan l;22(l):23-30.
Tsai YJ, Lin JK, Chen WS, et al. Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough? Springerplus. 2016;5(l): 1318. Published 2016 Aug 11.
Neugut Al, Lin A, Raab GT, Hillyer GC, Keller D, O'Neil DS, Accordino MK, Kiran RP, Wright J, Hershman DL. FOLFOX and FOLFIRI Use in Stage IV Colon Cancer: Analysis of SEER-Medicare Data. Clin Colorectal Cancer. 2019 Jun;18(2): 133-140.
Alberto Sobrero, Sara Lonardi, Gerardo Rosati, Maria Di Bartolomeo, Monica Ronzoni, Nicoletta Pella, Mario Scartozzi, Maria Banzi, Maria Giulia Zampino, Felice Pasini, Paolo Marchetti, Maurizio Cantore, Alberto Zaniboni, Lorenza Rimassa, Libero Ciuffreda, Daris Ferrari, Vittorina Zagonel, Evaristo Maiello, Sandro Bami, Eliana Rulli, Roberto Labianca, and on behalf of the TOSCA Investigators Journal of Clinical Oncology 2018 36:15, 1478-1485.
Kamnerdsupaphon P, Lorvidhaya V, Chitapanarux I, Tonusin A, Sukthomya V. FOLFIRI chemotherapy for metastatic colorectal cancer patients. J Med Assoc Thai. 2007 Oct;90(10):2121-7.
Chen K, Gong Y, Zhang Q, Shen Y, Zhou T. Efficacy and safety of addition of bevacizumab to FOLFIRI or irinotecan/bolus 5-FU/LV (IFL) in patients with metastatic colorectal cancer: A metaanalysis. Medicine (Baltimore). 2016 Nov;95(46):e5221.
Kirstein MM, Lange A, Prenzler A, Manns MP, Kubicka S, Vogel A. Targeted therapies in metastatic colorectal cancer: a systematic review and assessment of currently available data. Oncologist. 2014 Nov;19(ll):1156-68.
Lawai B, Wang YC, Wu ATH, Huang HS. Pro-Oncogenic c-Met/EGFR, Biomarker Signatures of the Tumor Microenvironment are Clinical and Therapy Response Prognosticators in Colorectal Cancer, and Therapeutic Targets of 3-Phenyl-2H-benzo[e][l,3]-Oxazine-2,4(3H)-Dione Derivatives. Front Pharmacol. 2021 Aug 27;12:691234.

Claims

CLAIMS What is claimed is:
1. A method of treating colorectal cancer in a subject in need thereof, comprising administering a therapeutically effective amount of an anti-epidermal growth factor receptor (EGFR)/hepatocyte growth factor receptor (c-Met) antibody to the subject.
2. The method of claim 1, wherein the method further comprises administering one or more chemotherapeutic agents to the subject.
3. The method of claims 1 or 2, wherein the antibody comprises: a) a first domain that specifically binds EGFR, comprising heavy chain complementarity determining region 1 (HCDR1), HCDR2, HCDR3, light chain complementarity determining region 1 (LCDR1), LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:l, 2, 3, 4, 5 and 6, respectively; and b) a second domain that specifically binds c-Met, comprising HCDR1, HCDR2, HCDR3, LCDR1, LCDR2 and LCDR3 amino acid sequences of SEQ ID NOs:7, 8, 9, 10, 11 and 12, respectively.
4. The method of claim 2, wherein the first domain comprises a heavy chain variable region (VH) of SEQ ID NO: 13 and a light chain variable region (VL) of SEQ ID NO: 14, and the second domain comprises a VH of SEQ ID NO: 15 and a VL of SEQ ID NO: 16.
5. The method of any one of claims 1-3, wherein the antibody is of the IgGl isotype.
6. The method of any one of claims 1-4, wherein the antibody comprises a first heavy chain (HC1) of SEQ ID NO: 17, a first light chain (LC1) of SEQ ID NO: 18, a second heavy chain (HC2) of SEQ ID NO: 19 and a second light chain (LC2) of SEQ ID NO:20.
7. The method of any one of claims 1-6, wherein the antibody is administered at a dose of about 1,050 mg to about 2,100 mg.
8. The method of claim 7, wherein the antibody is administered at a dose of about 1,050 mg or about 1,400 mg.
9. The method of claim 7, wherein the antibody is administered at a dose of about 1,050 mg.
10. The method of claim 7, wherein the antibody is administered at a dose of about 1,400 mg.
11. The method of any one of claims 1-10, wherein the antibody is administered once a week or once every two weeks.
12. The method of any one of claims 1-11, wherein the antibody is administered once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15).
13. The method of any one of claims 1-12, wherein the antibody is administered at a dose of 1,050 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of less than 80 kg, or at a dose of 1,400 mg once every week for the first 4 weeks (Cycle 1 days 1, 8, 15, and 22), and then once every 2 weeks from Cycle 2 onwards (days 1 and 15) if the subject has a body weight (BW) of 80 kg or more.
14. The method of any one of claims 1-13, wherein the antibody is administered as a monotherapy.
15. The method of any one of claims 1-14, wherein the method further comprises administering one or more chemotherapeutic agents to the subject.
16. The method of claim 15, wherein the one or more chemotherapeutic agents comprise FOLFOX, wherein FOLFOX comprises folinic acid, fluorouracil and oxaliplatin.
17. The method of claim 15, wherein the one or more chemotherapeutic agents comprise FOLFIRI, wherein FOLFIRI comprises folinic acid, fluorouracil and irinotecan.
18. The method of any one of claims 1-16, wherein the colorectal cancer is metastatic colorectal cancer (mCRC) or unresectable colorectal cancer.
19. The method of any one of claims 1-18, wherein the subject has been characterized with wildtype KRAS, NRAS and BRAF.
20. The method of any one of claims 1-19, wherein the subject has been characterized with no amplification of ERBB2/HER2.
21. The method of any one of claims 1-20, wherein the subject has been diagnosed with left-sided colorectal cancer.
22. The method of any one of claims 1-20, wherein the subject has been diagnosed with rightsided colorectal cancer.
23. The method of any one of claims 1-22, wherein the subject is anti-EGFR therapy naive.
24. The method of any one of claims 1-22, wherein the subject has received prior anti-EGFR therapy.
25. The method of any one of claims 1-22, wherein the subject is treatment naive.
26. The method of any one of claims 1-22, wherein the subject is relapsed or resistant to treatment with one or more prior anti-cancer therapies.
27. The method of any one of claims 1-26, wherein the subject has right sided KRAS, NRAS and BRAF wild type mCRC.
28. The method of any one of claims 1-27, wherein the subject has at least one intrahepatic tumor that resulted from metastasis of the mCRC
29. The method of claim 27, wherein the method reduces the size of the at least one intrahepatic tumor.
30. The method of any one of claims 1-29, wherein the subject has one of more unresectable tumors, wherein the method renders the one or more unresectable tumors resectable.
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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2026022739A1 (en) * 2024-07-23 2026-01-29 Janssen Biotech, Inc. Combination therapies for the treatment of colorectal cancer

Citations (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1988001649A1 (en) 1986-09-02 1988-03-10 Genex Corporation Single polypeptide chain binding molecules
WO1992001047A1 (en) 1990-07-10 1992-01-23 Cambridge Antibody Technology Limited Methods for producing members of specific binding pairs
WO1994013804A1 (en) 1992-12-04 1994-06-23 Medical Research Council Multivalent and multispecific binding proteins, their manufacture and use
WO1998044001A1 (en) 1997-03-27 1998-10-08 Commonwealth Scientific And Industrial Research Organisation High avidity polyvalent and polyspecific reagents
WO2006028936A2 (en) 2004-09-02 2006-03-16 Genentech, Inc. Heteromultimeric molecules
US20070287170A1 (en) 2006-03-24 2007-12-13 Merck Patent Gmbh Engineered heterodimeric protein domains
WO2009018386A1 (en) 2007-07-31 2009-02-05 Medimmune, Llc Multispecific epitope binding proteins and uses thereof
WO2009080251A1 (en) 2007-12-21 2009-07-02 F. Hoffmann-La Roche Ag Bivalent, bispecific antibodies
WO2009080254A1 (en) 2007-12-21 2009-07-02 F. Hoffmann-La Roche Ag Bivalent, bispecific antibodies
WO2009080252A1 (en) 2007-12-21 2009-07-02 F. Hoffmann-La Roche Ag Bivalent, bispecific antibodies
WO2009085462A1 (en) 2007-12-19 2009-07-09 Centocor, Inc. Design and generation of human de novo pix phage display libraries via fusion to pix or pvii, vectors, antibodies and methods
US20090182127A1 (en) 2006-06-22 2009-07-16 Novo Nordisk A/S Production of Bispecific Antibodies
US20100015133A1 (en) 2005-03-31 2010-01-21 Chugai Seiyaku Kabushiki Kaisha Methods for Producing Polypeptides by Regulating Polypeptide Association
US20100028637A1 (en) 2005-06-22 2010-02-04 Sunjuet Deutschland Gmbh Multi-Layer Film Comprising a Barrier Layer and an Antistatic Layer
US20110123532A1 (en) 2009-04-27 2011-05-26 Oncomed Pharmaceuticals, Inc. Method for Making Heteromultimeric Molecules
WO2011131746A2 (en) 2010-04-20 2011-10-27 Genmab A/S Heterodimeric antibody fc-containing proteins and methods for production thereof
US20120149876A1 (en) 2010-11-05 2012-06-14 Zymeworks Inc. Stable Heterodimeric Antibody Design with Mutations in the Fc Domain
US8242247B2 (en) 2007-12-21 2012-08-14 Hoffmann-La Roche Inc. Bivalent, bispecific antibodies
US20130195849A1 (en) 2011-11-04 2013-08-01 Zymeworks Inc. Stable Heterodimeric Antibody Design with Mutations in the Fc Domain
US9593164B2 (en) 2012-11-21 2017-03-14 Janssen Biotech, Inc. Bispecific EGFR/c-Met antibodies
US20230183360A1 (en) * 2021-12-09 2023-06-15 Janssen Biotech, Inc. Use of Amivantamab to Treat Colorectal Cancer

Patent Citations (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1988001649A1 (en) 1986-09-02 1988-03-10 Genex Corporation Single polypeptide chain binding molecules
WO1992001047A1 (en) 1990-07-10 1992-01-23 Cambridge Antibody Technology Limited Methods for producing members of specific binding pairs
WO1994013804A1 (en) 1992-12-04 1994-06-23 Medical Research Council Multivalent and multispecific binding proteins, their manufacture and use
WO1998044001A1 (en) 1997-03-27 1998-10-08 Commonwealth Scientific And Industrial Research Organisation High avidity polyvalent and polyspecific reagents
WO2006028936A2 (en) 2004-09-02 2006-03-16 Genentech, Inc. Heteromultimeric molecules
US20100015133A1 (en) 2005-03-31 2010-01-21 Chugai Seiyaku Kabushiki Kaisha Methods for Producing Polypeptides by Regulating Polypeptide Association
US20100028637A1 (en) 2005-06-22 2010-02-04 Sunjuet Deutschland Gmbh Multi-Layer Film Comprising a Barrier Layer and an Antistatic Layer
US20070287170A1 (en) 2006-03-24 2007-12-13 Merck Patent Gmbh Engineered heterodimeric protein domains
US20090182127A1 (en) 2006-06-22 2009-07-16 Novo Nordisk A/S Production of Bispecific Antibodies
WO2009018386A1 (en) 2007-07-31 2009-02-05 Medimmune, Llc Multispecific epitope binding proteins and uses thereof
WO2009085462A1 (en) 2007-12-19 2009-07-09 Centocor, Inc. Design and generation of human de novo pix phage display libraries via fusion to pix or pvii, vectors, antibodies and methods
WO2009080252A1 (en) 2007-12-21 2009-07-02 F. Hoffmann-La Roche Ag Bivalent, bispecific antibodies
WO2009080254A1 (en) 2007-12-21 2009-07-02 F. Hoffmann-La Roche Ag Bivalent, bispecific antibodies
WO2009080251A1 (en) 2007-12-21 2009-07-02 F. Hoffmann-La Roche Ag Bivalent, bispecific antibodies
US8242247B2 (en) 2007-12-21 2012-08-14 Hoffmann-La Roche Inc. Bivalent, bispecific antibodies
US20110123532A1 (en) 2009-04-27 2011-05-26 Oncomed Pharmaceuticals, Inc. Method for Making Heteromultimeric Molecules
WO2011131746A2 (en) 2010-04-20 2011-10-27 Genmab A/S Heterodimeric antibody fc-containing proteins and methods for production thereof
US20120149876A1 (en) 2010-11-05 2012-06-14 Zymeworks Inc. Stable Heterodimeric Antibody Design with Mutations in the Fc Domain
US20130195849A1 (en) 2011-11-04 2013-08-01 Zymeworks Inc. Stable Heterodimeric Antibody Design with Mutations in the Fc Domain
US9593164B2 (en) 2012-11-21 2017-03-14 Janssen Biotech, Inc. Bispecific EGFR/c-Met antibodies
US20230183360A1 (en) * 2021-12-09 2023-06-15 Janssen Biotech, Inc. Use of Amivantamab to Treat Colorectal Cancer

Non-Patent Citations (50)

* Cited by examiner, † Cited by third party
Title
"GenBank", Database accession no. NP_001120972
ALBERTO SOBREROSARA LONARDIGERARDO ROSATIMARIA DI BARTOLOMEOMONICA RONZONINICOLETTA PELLAMARIO SCARTOZZIMARIA BANZIMARIA GIULIA ZA: "and on behalf of the TOSCA Investigators", JOURNAL OF CLINICAL ONCOLOGY, vol. 36, no. 15, 2018, pages 1478 - 1485
BILLER LHSCHRAG D: "Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review", JAMA, vol. 325, no. 7, 16 February 2021 (2021-02-16), pages 669 - 685
BILLERSCHRAG, JAMA, vol. 325, no. 7, 2021, pages 669 - 85
CHEN ET AL., MEDICINE (BALTIMORE, vol. 46, no. 95, 2016, pages 5221
CHEN KGONG YZHANG QSHEN YZHOU T: "Efficacy and safety of addition of bevacizumab to FOLFIRI or irinotecan/bolus 5-FU/LV (IFL) in patients with metastatic colorectal cancer: A meta-analysis", MEDICINE (BALTIMORE, vol. 95, no. 46, November 2016 (2016-11-01), pages 5221
CHO BC ET AL.: "MARIPOSA: phase 3 study of first-line amivantamab + lazertinib versus osimertinib in EGFR-mutant non-small cell lung cancer", FUTURE ONCOL, 16 December 2021 (2021-12-16)
CHOTHIA ET AL., J MOL BIOL, vol. 196, 1987, pages 901 - 17
DE GRAMONT AFIGER ASEYMOUR MHOMERIN MHMISSI ACASSIDY JBONI CCORTES-FUNES HCERVANTES AFREYER G: "Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer", J CLIN ONCOL, vol. 18, no. 16, August 2000 (2000-08-01), pages 2938 - 47, XP002302470
FERRARA ET AL., BIOTECHNOL BIOENG, vol. 93, 2006, pages 851 - 861
FERRARA ET AL., J BIOL CHEM, vol. 281, 2006, pages 5032 - 5036
GOLDBERG RMSARGENT DJMORTON RFFUCHS CSRAMANATHAN RKWILLIAMSON SKFINDLAY BPPITOT HCALBERTS SR: "A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer", J CLIN ONCOL, vol. 22, no. 1, 1 January 2004 (2004-01-01), pages 23 - 30, XP001203533, DOI: 10.1200/JCO.2004.09.046
GOV CLINICALTRIALS ET AL: "A Study of Amivantamab Monotherapy and in Addition to Standard-of-Care Chemotherapy in Participants With Advanced or Metastatic Colorectal Cancer (OrigAMI-1) NCT05379595", 1 January 2024 (2024-01-01), XP093269350, Retrieved from the Internet <URL:https://clinicaltrials.gov/study/NCT05379595?tab=history&a=24#version-content-panel> *
GRAMONT ET AL., J CLIN ONCOL, vol. 18, no. 16, 2000, pages 2938 - 47
HONEGGERPLUCKTHUN, J MOLBIOL, vol. 309, 2001, pages 657 - 70
KABAT ET AL.: "Sequences of Proteins of Immunological Interest", 1991, NATIONAL INSTITUTES OF HEALTH
KAMNERDSUPAPHON ET AL., J MED ASSOC THAI, vol. 90, no. 10, 2007, pages 2121 - 7
KANMERDSUPAPHON PLORVIDHAYA VCHITAPANARUX ITONUSIN ASUKTHOMYA V: "FOLFIRI chemotherapy for metastatic colorectal cancer patients", J MED ASSOC THAI, vol. 90, no. 10, October 2007 (2007-10-01), pages 2121 - 7
KIRSTEIN ET AL., ONCOLOGIST, vol. 19, no. 11, 2014, pages 1156 - 68
KIRSTEIN MMLANGE APRENZLER AMANNS MPKUBICKA SVOGEL A: "Targeted therapies in metastatic colorectal cancer: a systematic review and assessment of currently available data", ONCOLOGIST, vol. 19, no. 11, November 2014 (2014-11-01), pages 1156 - 68
KNAPPIK ET AL., J. MOL. BIOL., vol. 296, 2000, pages 57 - 86
KONNO ET AL., CYTOTECHNOLOGY, vol. 64, 2012, pages 249 - 65
LAWAL BWANG YCWU ATHHUANG HS: "Pro-Oncogenic c-Met/EGFR, Biomarker Signatures of the Tumor Microenvironment are Clinical and Therapy Response Prognosticators in Colorectal Cancer, and Therapeutic Targets of 3-Phenyl-2H-benzo[e][1,3]-Oxazine-2,4(3H)-Dione Derivatives", FRONT PHARMACOL, vol. 12, 27 August 2021 (2021-08-27), pages 691234
LEFRANC ET AL., DEV COMP IMMUNOL, vol. 27, 2003, pages 55 - 77
MARTINTHORNTON, J BMOL BIOL, vol. 263, 1996, pages 800 - 15
MORETTO R ET AL., ONCOLOGIST, vol. 21, no. 8, 2016, pages 988 - 994
MORI ET AL., BIOTECHNOL BIOENG, vol. 88, 2004, pages 901 - 908
NEUGUT AILIN ARAAB GTHILLYER GCKELLER DO'NEIL DSACCORDINO MKKIRAN RPWRIGHT JHERSHMAN DL: "FOLFOX and FOLFIRI Use in Stage IV Colon Cancer: Analysis of SEER-Medicare Data", CLIN COLORECTAL CANCER, vol. 18, no. 2, June 2019 (2019-06-01), pages 133 - 140
NEUGUT ET AL., CLIN COLORECTAL CANCER, vol. 18, no. 2, 2019, pages 133 - 40
OBERSTEIN PAUL ELIEZER ET AL: "Amivantamab monotherapy in relapsed/refractory metastatic colorectal cancer: OrigAMI-1, an open-label, phase 1b/2 study.", JOURNAL OF CLINICAL ONCOLOGY, 20 January 2024 (2024-01-20), pages 135 - 135, XP093268839, ISSN: 0732-183X, Retrieved from the Internet <URL:https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2024.42.3_suppl.135> DOI: 10.1200/JCO.2024.42.3_suppl.135 *
OLIVIER ET AL., MABS, vol. 2, no. 4, 2010
PARK K. ET AL.: "Amivantamab in EGFR Exon 20 Insertion-Mutated Non-Small-Cell Lung Cancer Progressing on Platinum Chemotherapy: Initial Results From the CHRYSALIS Phase I Study", J CLIN ONCOL, vol. 39, no. 30, 20 October 2021 (2021-10-20), pages 3391 - 3402, XP093038592, DOI: 10.1200/JCO.21
PATNAIK AMITA ET AL: "A phase I study of LY3164530, a bispecific antibody targeting MET and EGFR, in patients with advanced or metastatic cancer", CANCER CHEMOTHERAPY AND PHARMACOLOGY, SPRINGER VERLAG , BERLIN, DE, 20 June 2018 (2018-06-20), pages 407 - 418, XP036572985, ISSN: 0344-5704, Retrieved from the Internet <URL:https://pmc.ncbi.nlm.nih.gov/articles/PMC6105165/pdf/280_2018_Article_3623.pdf> [retrieved on 20180620], DOI: 10.1007/S00280-018-3623-7 *
PIETRANTONIO F ET AL: "Amivantamab plus FOLFOX or FOLFIRI in metastatic colorectal cancer: Results from OrigAMI-1, an open-label, phase Ib/II study", 17 September 2024 (2024-09-17), XP093268861, Retrieved from the Internet <URL:https://www.annalsofoncology.org/action/showPdf?pii=S0923-7534(24)02101-X> *
PRICE TJ ET AL., LANCET ONCOL, vol. 15, no. 6, 2014, pages 569 - 579
SARTORE-BIANCHI A ET AL., NAT MED., vol. 28, no. 8, 2022, pages 1612 - 1618
SAWICKI ET AL., CANCERS (BASEL, vol. 13, no. 9, 2021, pages 2025
SAWICKI TRUSZKOWSKA MDANIELEWICZ ANIEDZWIEDZKA EARLUKOWICZ TPRZYBYLOWICZ KE: "A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis", CANCERS (BASEL, vol. 13, no. 9, 22 April 2021 (2021-04-22), pages 2025
SHI ET AL., J. MOL. BIOL., vol. 397, 2010, pages 385 - 96
SHIELDS ET AL., J BIOL CHEM, vol. 277, 2002, pages 26733 - 26740
SHINKAWA ET AL., J BIOL CHEM, vol. 278, 2003, pages 3466 - 3473
TOURNIGAND CANDRÉ TACHILLE ELLEDO GFLESH MMERY-MIGNARD DQUINAUX ECOUTEAU CBUYSE MGANEM G: "FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study", J CLIN ONCOL, vol. 22, no. 2, 15 January 2004 (2004-01-15), pages 229 - 37
TOURNIGAND ET AL., J CLIN ONCOL, vol. 22, no. 1, 2004, pages 229 - 30
TSAI ET AL., SPRINGERPLUS, vol. 5, no. 1, 2016, pages 1318
TSAI YJLIN JKCHEN WS ET AL.: "Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough?", SPRINGERPLUS, vol. 5, no. 1, 11 August 2016 (2016-08-11), pages 1318, XP021268700, DOI: 10.1186/s40064-016-2976-9
ULLRICH ET AL., NATURE, vol. 309, 1984, pages 418 - 425
VYSE SHUANG PH: "Amivantamab for the treatment of EGFR exon 20 insertion mutant non-small cell lung cancer", EXPERT REV ANTICANCER THER, 16 December 2021 (2021-12-16)
WIEMANNMCMILLAN ET AL.: "Medical Oncology", 1985
WU ET AL., J EXP MED, vol. 132, 1970, pages 211 - 50
ZHOU ET AL., BIOTECHNOL BIOENG, vol. 99, 2008, pages 652 - 65

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2026022739A1 (en) * 2024-07-23 2026-01-29 Janssen Biotech, Inc. Combination therapies for the treatment of colorectal cancer

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