JP2018070629A - Method for improving efficacy of survivin vaccine in treatment of cancer - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide methods for improving an efficacy of a survivin vaccine in a treatment of cancer.SOLUTION: The methods comprise the administration of at least two doses of an agent interfering with DNA replication, which is an alkylating agent, preferably a nitrogen mustard alkylating agent, further preferably cyclophosphamide, at least two days, preferably at least four days, prior to vaccination with a therapeutically effective amount of a survivin vaccine, which includes a survivin antigen being a peptide antigen or a nucleic acid encoding an antigen.SELECTED DRAWING: None

Description

The present invention relates generally to methods for treating cancer, and in particular to methods for improving the effectiveness of survivin vaccines in the treatment of cancer by pre-treatment with agents that interfere with DNA replication. .

The immune response induced by vaccination can be broadly classified into humoral or cellular types. Humoral responses are usually desirable for protection against viral or bacterial invaders, while immunity against virus-infected cells and cancer cells is usually accompanied by cell-mediated responses. Humoral immunity is characterized by high levels of antibody production by B cells, while cellular immunity is
Characterized by increased activation of cytotoxic CD8 + T lymphocytes.

Many vaccines that looked promising in preclinical development eventually failed to show clinical utility when tested in humans. For cancer vaccines, therapeutic intervention is a complex issue, and many aspects of the disease, such as the relative timing of treatment, the stage and type of cancer, compared to the standard of care, all contribute to the outcome of the treatment. Affect. However, if combined strictly,
There are three features of immunotherapy that may lead to better outcomes: (1) vaccine immunogenicity (ie, adjuvant); (2) appropriate selection of tumor-associated antigens; and (3) induced by tumors Ability to overcome immune suppression (Weir et al., Cancer 3: 3114-3142, 2011
Berzofsky et al., Semin Oncol 39 (3): 348-357, 2012).

Applicants have finally discovered that the efficacy of cancer vaccines (ie, survivin vaccines) can be improved by administering at least twice in advance an agent that interferes with DNA replication.

Accordingly, in one aspect, the present invention is a method for improving the effectiveness of a vaccine in treating a subject's cancer, comprising: (i) providing the subject with an agent that interferes with DNA replication that provides an immunomodulatory effect. Administering at least twice in an amount sufficient for, and (ii) subsequently subject
Administering a therapeutically effective amount of a vaccine comprising at least one survivin antigen.

In one embodiment of the methods of the invention, an agent that interferes with DNA replication is administered to a subject every 14 days for 7 consecutive days daily (ie, alternating weekly treatment). In one embodiment, this weekly alternating treatment with an agent that interferes with DNA replication begins about one week before the first dose of survivin vaccine.

In one embodiment of the method of the invention, the survivin vaccine is administered to the subject once every three weeks.

In one embodiment of the method of the invention, the agent that interferes with DNA replication is an alkylating agent, such as cyclophosphamide.

In one embodiment of the method of the present invention, the survivin vaccine has the amino acid sequence: FEELTLGEF (
FTELTLGEF (SEQ ID NO: 2); LTLGEFLKL (SEQ ID NO: 3); LMLGEFLKL (SEQ ID NO: 4); RISTFKNWPF (SEQ ID NO: 5); RISTFKNWPK (SEQ ID NO: 6); STFKNWPFL (SEQ ID NO: 7); A vaccine comprising one or more survivin peptide antigens having SEQ ID NO: 8).

In one embodiment of the method of the present invention, the survivin vaccine is an Immunovaccine.
, Inc., DPX-Survivac, an anti-cancer immunotherapy vaccine candidate. DPX-S
urvivac is an amino acid sequence: FTELTLGEF (SEQ ID NO: 2), LMLGEFLKL (SEQ ID NO: 4)
, RISTFKNWPK (SEQ ID NO: 6), STFKNWPFL (SEQ ID NO: 7), and LPPAWQPFL (SEQ ID NO: 8)
Synthetic survivin peptide antigens having); universal T from tetanus toxoid
Helper epitope (universal T-helper epitope) (AQYIKANSKFIGITEL; SEQ ID NO: 9)
A poly I: C polynucleotide adjuvant; a liposome consisting of DOPC and cholesterol; and a hydrophobic carrier Montanide® ISA51VG.

In another aspect, the invention provides for improving the effectiveness of a vaccine in treating cancer,
The use of an agent that interferes with DNA replication in combination with a vaccine comprising at least one survivin antigen, wherein the agent is administered at least twice prior to the vaccine.

  In another aspect, the present invention relates to a composition for use in the methods described herein.

Other aspects and features of the present invention should become apparent to those skilled in the art upon review of the following description of specific embodiments of the invention in conjunction with the accompanying figures.

  In the drawings, embodiments of the invention are described by way of example only.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 illustrates a Phase I clinical trial design for evaluating the safety and immunogenicity of DPX-Survivac. Test-Between days 7 and +49, with or without low-dose cyclophosphamide (50 mg twice daily, Baxter) with vaccines every 3 weeks (approximately 21 days apart) 3 times vaccination). Low dose cyclophosphamide was given daily for 14 consecutive days every 14 days. Cyclophosphamide was started one week before the first vaccination. Patients were (1) 3 doses of DPX-Survivac 0.5 mL (Cohort A), (2) 3 doses of DPX-Survivac 0.1 mL in combination with low dose oral cyclophosphamide as shown ( Cohort B) or (3) received either 3 doses of DPX-Survivac 0.5 mL (Cohort C) in combination with low dose cyclophosphamide as indicated. Blood samples were taken before the first vaccination (baseline) and approximately 3-4 weeks after each vaccination to isolate and cryopreserve peripheral blood mononuclear cells (PBMC). Blood samples were taken at a later time when possible. PBMC were used for immunoassays including ELISPOT and for assays based on flow cytometry such as tetramer staining and intracellular cytokine staining (ICS). FIG. 5 provides an increase in interferon gamma production induced by DPX-Survivac in peripheral blood mononuclear cells (PBMC) from vaccinated ovarian cancer patients, providing ELISPOT detection results. Subject PBMCs were stimulated overnight with survivin peptide in the IFN-γ ELISPOT assay. The data presented represents the number of spot forming units (SFU) per million PBMC from individual subjects, the line is the average at baseline and after 1, 2, and 3 doses of vaccine administration Represents a value. FIG. 5 provides a summary of stimulation factors showing the fold increase in IFN-gamma secreting cells of these patients compared to their baseline immune response. Stimulation factors were calculated using valid ELISPOT results. In the absence of peptide stimulation, samples with unknown high background were excluded from the analysis in ELISPOT. Considering a patient as an immune responder at a given time point required a 2x minimal stimulation factor. FIG. 6 provides ELISPOT detection results and shows DPX-Survivac-induced increase in IFN-gamma production in PBMC derived from vaccinated ovarian cancer patients. Subject PBMCs were stimulated overnight with survivin peptide in the IFN-γ ELISPOT assay. The presented data represents the number of spot forming units (SFU) per million PBMC derived from individual subjects. It is a figure explaining the MHC multimer dyeing | staining result derived from the typical object 02-04. The ability of peptide-specific CD8 + T cells to bind peripheral blood mononuclear cells to MHC multimeric reagents (tetramers) designed using DPX-Survivac peptide and the corresponding MHC molecules allows for peptide-specific CD8 + T cells. Was tested for the presence of. Assays were performed either with unstimulated PBMC (ex vivo) or with PBMC stimulated in vitro for 10 days in the presence of HLA-matched survivin peptide (s). Non-related MHC-multimers based on HIV peptides served as negative controls. The figure shown represents the percentage of CD8 + T cells that are specifically bound to the MHC-multimer reagent in the post-vaccination PBMC sample. Specific T cells were detected using flow cytometry, which gates PBMC on live CD3 + cells to show cells that are double positive for CD8 + and tetramer binding. Detection of DPX-Survivac-induced increase in CD8 + T cells in peripheral blood mononuclear cells (PBMC) from vaccinated ovarian cancer patients. Due to the ability of peptide-specific CD8 + T cells to bind subject PBMCs to MHC multimeric reagents (tetramers) designed using DPX-Survivac peptide and the corresponding MHC molecules, the presence of peptide-specific CD8 + T cells Tested. Assays were performed either with unstimulated PBMC (ex vivo) or with PBMC stimulated in vitro for 10 days in the presence of HLA-matched survivin peptide (s). The data presented is the percentage of CD8 + T cells in the peripheral blood of individual subjects after baseline (circle), 1 dose (triangle), 2 doses (diamonds) and 3 doses (squares). Represent. Illustrates immune response and reactivity ELISPOT and tetramer-based analysis against single amino acid modified or unmodified natural survivin peptide sequences and of vaccine-induced immune responses that recognize both modified and unmodified survivin peptides It is a figure demonstrating ability.

Advanced cancer utilizes several mechanisms that escape immune-mediated detection and destruction, thereby reducing the effectiveness of cancer therapy at multiple levels.

Tumor-induced immunosuppression is a characteristic of cancer and is a significant obstacle for any immunotherapy against cancer, including peptide vaccines (Hanahan and Weinberg
, Cell, 144 (5): 646-674, 2011). As it develops, the tumor is
Adapt to avoid immune detection and escape. For example, the tumor microenvironment is CD4 ⁺ FoxP3 ⁺
Regulatory T cells (Treg) (Curiel et al., Nat Med 10 (9): 942-949, 2004) and bone marrow-derived suppressor cells (MDSC) (Nagaraj and Gabrilovich, Cancer Res 68 (8):
2561-3, 2008) and upregulate many factors that promote the development of suppressive immune cells.
The tumor microenvironment also contributes to direct suppression of activated CD8 + T cells by releasing immunosuppressive cytokines such as TNF-β (Yang et al., Trends Immunol 31
(6): 220-227, 2010). Other tumor escape mechanisms that respond to immune pressure include immune editing, MHC
There are class I down-regulations and alterations in antigen processing and presentation. Therefore,
It is absolutely necessary that CD8 + T cells induced by the vaccine have an opportunity to quickly recognize and destroy them before the tumor cells have a chance to adapt. The use of immunomodulators to combat tumor-induced immunosuppression may improve the efficacy of cancer vaccines (Yong et al., J Biomed Biotechnol 2012: 605045).

The methods of the invention relate to the treatment of a subject's cancer by administering a combination of an agent that interferes with DNA replication and a survivin vaccine.

Survivin, a protein involved in the negative regulation of apoptosis, is highly expressed in many tumor types and its prognostic importance has been reported. As used herein, “survivin vaccine” is intended to encompass any vaccine or antigen delivery means for administering one or more of the survivin antigens described herein to a subject. While exemplary embodiments of such “survivin vaccines” are described herein, one skilled in the art will appreciate that any vaccine or means for delivering an antigen to a subject is encompassed. It should be.

Embodiments of the methods of the invention relate to improving the effectiveness of a vaccine (ie, survivin vaccine) in treating cancer by administering at least twice in advance an agent that interferes with DNA replication.

Accordingly, in certain embodiments, the present invention is a method for improving the effectiveness of a vaccine in the treatment of cancer in a subject, comprising: Administering at least twice in an amount sufficient to effect; and (ii) subsequently administering to the subject a therapeutically effective amount of a vaccine comprising at least one survivin antigen.

As used herein, “improving vaccine efficacy” or “improving vaccine efficacy” and the like are any changes or alterations in a subject's immune response, and in the treatment of cancer, the invention Refers to changes or modifications that can make survivin vaccines more effective. In some embodiments, this may involve promoting the emergence of an immune response and / or improving the persistence or strength of the immune response to a survivin vaccine. The immune response can be either a cell-mediated immune response or a humoral immune response.

In the methods of the present invention, agents that interfere with DNA replication can “improve the effectiveness of the vaccine” by enhancing either directly or indirectly the immune response to the survivin antigen in the vaccine. This can be achieved, for example, by reducing the number and / or activity of suppressor immune cells. For example, the tumor microenvironment includes CD4 ⁺ FoxP3 ⁺ regulatory T cells (Treg) (Curiel et al., Nat Med 10 (9): 942-949, 2004), bone marrow derived suppressor cells (MDSC) (Nagaraj and Gabrilovich , Cancer Res 68 (8): 2561-3, 2
008) and CD19 ⁺ CD5 ⁺ CD1d ^hi IL-10 ⁺ B cells (Breg) (Balkwil
l et al., Trends Immunol, 03 December 2012, 10.1016 / j.it.2012.10.007 (Epub ahead
have been reported to up-regulate many factors that promote the development of suppressive immune cells, such as of print)). Thus, the ability to reduce the number or activity of these suppressor immune cells represents an embodiment for improving vaccine efficacy.

“Improving vaccine efficacy” can also be achieved, for example, by increasing the number and / or activity of antigen-specific CD8 + T cells. In this regard, for example, the tumor microenvironment has also been reported to contribute to direct suppression of activated CD8 + T cells by releasing immunosuppressive cytokines such as TNF-β (Yang et al. ., T
rends Immunol 31 (6): 220-227, 2010). Thus, the ability to increase the activity of antigen-specific CD8 + T cells represents a potential mechanism to improve vaccine efficacy. Antigen-specific CD8
The increase in + T cells is due to an increase in the number of such cells, an increase in the activity of such cells, and / or a relative decrease in the total CD8 + T cell number, etc.
It may be the result of the generation of an enriched population of antigen-specific CD8 + T cells versus T cell count.

More generally, “improving vaccine efficacy” is induced by the vaccine,
Enhance the immunogenicity of the vaccine by enhancing either the cell-mediated immune response or the humoral immune response; increase the number of immune cells at the vaccinated or tumor site; or for example cancer Enhancing the preventive and / or therapeutic treatment of
And / or refers to the ability of the method of the invention to improve the therapeutic effect provided by the vaccine of the invention, such as by reducing, delaying or inhibiting the progression of disease symptoms.
Improving vaccine efficacy may also be associated with improved quality of life or reduced morbidity compared to monotherapy treatment.

“Improving the effectiveness of a vaccine” may mean that the dose of active ingredients of the combination of the invention required to obtain the desired result is lowered. This includes both embodiments where the dosage itself is lower, as well as embodiments that utilize vaccines and / or agents that interfere with DNA replication less frequently.

Several chemotherapeutic drugs showed immunomodulatory activity when used at low cytotoxic doses (Zitvogel et al., Nat Rev Immunol 8 (1): 59-73, 2008; Liu and Dalgleish, Semin O
ncol 39 (3): 340-347, 2012). Cyclophosphamide is one of the first immunomodulators described and has multiple effects on the immune system when used at a fraction of the dose normally used for its cytotoxic effects. Yes (Sistigu et al., Semin Immunopathol 33 (4): 369-383, 2
011). Low-dose cyclophosphamide selectively reduces and prevents Treg functionality (L
utsiak et al., Blood 105 (7): 2862-2868, 2005) and inhibits tumor angiogenesis (Browder et
al., Cancer Res 60 (7): 1878-1886, 2000) and increased dendritic cell activation (Radojcic et
al., Cancer Immunol Immunother 59 (1): 137-148, 2009) and distorting the immune response towards Th1 (Schiavoni et al., Blood 95 (6): 2024-2030, 2000) ing. In mice, the effect of a single bolus at a low dose of cyclophosphamide is transient,
Usually the lowest point is reached within 4 days after dosing and returns to normal by 7-10 days (Lutsiak et al.
, Blood 105 (7): 2862-2868, 2005).

When used in combination with a cancer vaccine, low dose cyclophosphamide is usually about 100-300 mg / m ² (1-5 g / m ² of chemotherapy, 1 to 3 days before vaccination in humans. Administered as a single bolus IV injection (in contrast to the dose at
a et al., Clin Exp Immunol 150 (3): 523-530, 2007; Vermeij et al., Int J Cancer 13
1 (5): E670-680, 2012). Although this regimen has shown promise in preclinical models,
In clinical trial applications, the same uncertain results were not obtained (Audia et al., Clin Exp I
mmunol 150 (3): 523-530, 2007; Vermeij et al., Int J Cancer 131 (5): E670-680, 2012
). However, Walter et al. Recently published data showing that a single dose of cyclophosphamide before peptide vaccine was associated with increased patient survival in a phase II study in patients with renal cell carcinoma (RCC). (Walter et al., Nat Med 18: 1254-1261, 2012). However, sbCPA treatment had no measurable effect on the immunogenicity of the vaccine.

An alternative to single bolus administration of cyclophosphamide is to deliver cyclophosphamide on a regular schedule by administering very low doses of cyclophosphamide daily. Regular cyclophosphamide administration has been reported to have an immunomodulatory effect similar to a single dose of low-dose cyclophosphamide (Ghiringhelli et al., Can
cer Immunol Immunother 56 (5): 641-648, 2007; Le and Jaffee, Cancer Res 72 (14): 3
439-3444, 2012).

Surprisingly and unexpectedly, survivin vaccines (eg DP
It has now been found that the effectiveness of the vaccine can be improved by administering cyclophosphamide to the subject at least twice prior to administration of X-Survivac). This is a very important finding because the results disclosed herein relate to clinical phase studies in humans compared to preclinical animal studies.

DPX-Survivac, a survivin vaccine according to the present invention, is a candidate anti-cancer immunotherapy vaccine for the treatment of cancer. The DPX-Survivac vaccine is designed to target survivin. As described herein, DPX-Survi
vac has one decapeptide (SEQ ID NO: 6) and 4 derived from the survivin protein sequence with different HLA restriction (HLA-A1, A2, A3, A24 and B7).
Contains one nonapeptide (SEQ ID NO: 2, 4, 7 and 8).

Treatment of subjects with DPX-Survivac in Cohort A, Cohort B and Cohort C (see FIG. 1) as described herein first produces a strong antigen-specific immune response and is persistent over time The objective was to investigate an optimal treatment schedule that maintains an immune response to the tumor. This antigen-specific T cell response is expected to continually put pressure on developing or new tumors and prolong patient remission.

Extensive immunoassays on subjects treated with DPX-Survivac according to the method of the present invention have yielded several important findings in the Phase I portion of the clinical study. All subjects who were receiving DPX-Survivac combination therapy (cohorts B and C, n = 12) including a low-dose cyclophosphamide treatment period prior to administration of the vaccine were:
The antigen-specific immune response measured by at least one of the three immune monitoring assays of this study (ELISPOT, tetramer analysis and multiparametric intracellular staining; Table 1) was shown.

Table 1 shows ELISPOT results (SFU / 10 ⁶ PBMC) examined at post-treatment time points, low (L) for SFU <128, medium (MFU for SFU in the range 128-512)
), When the SFU is> 512, it is represented as high (H). The tetrameric analysis of PBMC is e
Performed either x vivo (no stimulation) or in vitro (with peptide stimulation). A case where antigen-specific CD8 + T cells increased 2-fold from pre-vaccination levels was indicated as a positive responder; N / A, not applicable (no appropriate test reagent). Multifunctional antigen-specific CD8 + T cells are defined as cells that simultaneously secrete IFN-γ and at least one or both of TNF-α and IL-2.

All of the high responders in this study were found in cohorts B and C that had received combination therapy according to the method of the present invention. In 11 of the 12 subjects in Cohorts B and C, the immune response was confirmed by 2 assays (5 subjects) or 3 assays (6 subjects). The immune response was generally established by one or two vaccinations and increased or maintained by a booster. A dose response was observed in cohort C patients with a significantly greater response (cohort C vs. cohort B, P = 0.013). Low-dose cyclophosphamide started before vaccine administration significantly enhanced the 0.5 ml dose of vaccine (Cohort C vs Cohort A, P = 0.015). Notably, the most frequent antigen-specific CD8 + T cells have been used in cohort C patients using tetramers ex vi
It has been further characterized by multiparametric ICS that these antigen-specific CD8 + T cells are detected in vivo in PBL's (in PBL's) and this indicates that low dose cyclophosphamide It was shown that the combination with the survivin vaccine produced the strongest anti-survivin immune response.

  The ELISPOT data for Cohorts A and C of FIG.

From the table above (Table 2), the highest ELISPOT immune response achieved after a single vaccination with Cohort A (Vaccine only; n = 6) is 130 SFU / 10 ⁶ PBMC
It can be seen that it was (PBMC's) (range 55-130). In contrast, Cohort C
The highest ELISPOT response achieved after a single vaccination (previously cyclophosphamide plus vaccine; n = 6) was 2309 SFU / 10 ⁶ PBMC (2
Range of ˜2309). This corresponds to a 17.7-fold improvement in the highest immune response achieved, and the method of the present invention comprising the step of pre-administration of an agent that interferes with DNA replication can significantly improve the effectiveness of survivin vaccines. It shows that it brings.

Similarly, it has been found that the effectiveness of the DPX-Survivac vaccine is enhanced by the method of the invention when the vaccine is administered two or three times. As shown in Table 2, the highest EL achieved after two vaccinations with Cohort A (Vaccine alone; n = 5)
The immune response by ISPOT was 137SFU / 10 ⁶ PBMC (range 22-137), while achieved in Cohort C after 2 vaccinations (previously cyclophosphamide plus vaccine; n = 6) The highest response by ELISPOT is 1911SF
U / 10 ⁶ PBMC (range 25-1911). This corresponds to a 13.9-fold improvement in the highest immune response achieved.

After 3 vaccinations, the highest achieved in Cohort A (Vaccine alone; n = 6),
The immune response by ELISPOT was 284 SFU / 10 ⁶ PBMC (range 12-284). In contrast, Cohort C (previously cyclophosphamide, plus vaccine; n
= 6) The highest immune response by ELISPOT achieved in 2517 SFU / 10
⁶ PBMC (range 38-2517). This corresponds to an 8.9-fold improvement in the highest immune response achieved.

Furthermore, as shown in FIG. 4, after 3 vaccinations, 4/6 of cohort C (previously cyclophosphamide plus vaccine) patients had an ELISPOT response greater than 512 spots / 10 ⁶ PBMC. This was contrasted with 0/6 of the patients in Cohort A (survivin vaccine alone) (see FIG. 4). These results indicate that low dose cyclophosphamide significantly enhanced the immune response provided by the 0.5 ml dose of survivin vaccine. In Cohort A, even after three vaccinations, no Cohort A patient was able to achieve a response that was considered a high immune response in this study (ie, SFU> 512).

The ability of the method of the invention to improve the effectiveness of the DPX-Survivac vaccine is presented in FIG. 3, which shows the stimulation index when the vaccine is administered once, twice and three times in cohorts A, B and C. It is further evident from the data. The stimulation index represents how many times the patient's number of IFN-gamma secreting cells has increased relative to their baseline immune response. As shown in FIG. 3, in cohort A (vaccine alone; n = 6), the stimulation index achieved after 3 vaccinations was 0.4-8.9x, whereas cohort C (pre-cyclo For phosphamide plus vaccine; n = 6), the stimulation index achieved after 3 vaccinations is 1
. 2 to 79x. This corresponds to an 8.9-fold improvement in the highest immune response achieved at this time, and the method of the present invention comprising the step of pre-administration of an agent that interferes with DNA replication is a significant efficacy of the survivin vaccine. It shows that it brings about improvement.

Furthermore, in cohort A (vaccine alone; n = 4), the highest stimulation index achieved in at least one patient after two doses was 3.5x, whereas cohort C (previously cyclophosphamide) In addition, the vaccine; n = 6), the highest stimulation index achieved in at least one patient after 2 doses was 59.7x. This corresponds to a 17.1 fold improvement in the highest immune response achieved at that time by the method of the present invention comprising the step of administering an agent that interferes with DNA replication prior to vaccination with survivin vaccine. .

Larger immune responses (eg, cohorts B and C) generated by the methods of the present invention and detected by ELISPOLT are the detection of circulating antigen-specific T cell responses (by tetramer staining) and multifunctionality in the blood It was also characterized by sex T cell response profile (by ICS staining).

In vitro tetramer: 10 out of 12 subjects in cohorts B and C were evaluable by tetramer staining (Table 1). With all 10 people, DPX-Survivac
There was strong evidence that survivin-specific CD8 + T cells were induced after one or two vaccinations. It is important that these specific immune cells are activated and maintained. This is because CD8 + T cells have been suggested to be involved in identifying cancer cells, invading tumors and killing cancer targets. All evaluable patients in Cohort C are positive for more than 1% of total CD8 + T cell counts (with in vitro stimulation)
It was found that as much as 34% of the total number of CD8 + T cells was reached. In contrast, the strongest SD70 tetramer positive recorded in Cohort A was 1% of the total CD8 + T cell count.
Was less than 0.7%.

Ex vivo tetramer: 1/6 out of cohort A patients as shown in Table 1 above
Had detectable tetramer positive CD8 + T cells in rested / unstimulated PBMC at least once after vaccination. Importantly, however, in this patient, antigen-specific CD8 + T cells were not multifunctional as determined by ICS staining. In contrast, 4/6 of patients in Cohort C had tetramer-positive CD8 + T in resting / unstimulated PBMC at least once after vaccination.
Had cells. In these patients, ICS confirmed that antigen-specific CD8 + T cells are multifunctional.

Multifunctionality with ICS: In addition, 5/6 of cohort C patients had detectable antigen-specific multifunctional CD8 + T cells, which is 2/6 of patients in cohort A
(Table 1). These results indicate that cohort C patients developed antigen-specific multifunctional CD8 + T cells significantly larger and more frequently than cohort A patients.

The results obtained by tetramer and ICS staining were found to correlate with a strong immune response by ELISPOT. Had tetramer positive cells in resting / unstimulated PBMC or had multifunctional antigen specific CD8 + cells by ICS (ie at least one but not both assays) Cohort A patients were found to have a low / moderate ELISPOT response (positive by)
Ie, between 12-284 SFU / 10 ⁶ PBMC after 3 vaccinations). In contrast, cohort C patients who were tetramer positive and had confirmed multifunctional antigen-specific CD8 + cells had a moderate / high ELISPOT immune response (ie 3 Between 773-2517 SFU / 10 ⁶ PBMC after two vaccinations).

The results disclosed herein indicate that the methods of the invention comprising the step of pre-administering an agent that interferes with DNA replication have the ability to improve the effectiveness of survivin vaccines. The methods of the invention may therefore be suitable for the treatment of cancer, particularly cancers that express survivin antigen on the cell surface. Furthermore, the immune response generated by the vaccines of the present invention may have the potential to target not only tumor cells that express the particular survivin antigen contained in the vaccine. As shown in FIG. 7, the immune response generated by the modified survivin peptide in DPX-Survivac was also cross-reactive with the natural peptide.

The level of immunity induction observed by the method of the present invention comprising the steps of pre-administering cyclophosphamide followed by survivin vaccine was highly striking. This is a level rarely seen with other approaches of vaccines targeting self antigens. These strong immune responses are generally understood to be very difficult to achieve in cancer patients and are likely to underlie a clinically meaningful anti-tumor immune response . Given the strength of the response in Cohort C, giving low-dose cyclophosphamide in advance as an immunomodulator is an important factor in improving vaccine efficacy and producing a recorded strong immune response. It is proved to be.

The clinical results disclosed herein are exemplary embodiments of the methods of the invention having broader applications for any agent that interferes with DNA replication and any survivin vaccine, as described herein. I will provide a.

Agents that Prevent DNA Replication The methods of the present invention involve administering an agent that prevents DNA replication prior to administering the vaccines described herein.

As used herein, the phrase “preventing DNA replication” includes any action that interferes with, inhibits, or delays a biological process that copies (ie, replicates) a cell's DNA. Intended. One skilled in the art will appreciate that there are various mechanisms that interfere with, inhibit or delay DNA replication, such as DNA cross-linking, DNA methylation, base substitution, and the like. The method according to the present invention encompasses the use of any agent that interferes with DNA replication, by any means known in the art. In an exemplary embodiment, the agent that prevents DNA replication is, but is not limited to, a drug.

In one embodiment, agents that interfere with DNA replication, when used at non-chemotherapeutic doses, selectively affect DNA replication of immune system cells with the intention of modulating the immune system to enhance the vaccine response. It is a drug that can be given. “Non-chemotherapeutic” means that the dose of the drug is lower than that which would have been used to directly and selectively destroy malignant or cancerous cells and tissues.

Other embodiments of agents that interfere with DNA replication include agents that interfere with DNA replication and cause programmed cell death by the ability to selectively target rapidly dividing immune system cells. The purpose of such agents is to regulate immune system cells to enhance vaccine response. Such agents are usually used at doses that are not expected to be chemotherapeutic and are considered acceptable for human use. The purpose of selectively targeting immune cells is to reduce the number of immunosuppressive cells and / or to remove rapid drugs that target DNA replication to induce rapid proliferation, It may be depletion of useful immune cells involved in mediating the immune response.

Factors that prevent DNA replication in the form of cell death include, but are not limited to, formation of DNA crosslinks (eg, by alkylating agents, platinum compounds, etc.), DNA methylation (ie, by methylating agents), base substitution There can be many mechanisms, including (ie, by nucleoside analogs). Exemplary drugs and their mechanisms are Cancer Chemotherapy an
d Biotherapy: Principles and Practice (Cabner BA, 5 ^th edition, Lippincott Will
iams & Wilkins, PA, USA, 2011).

In one embodiment, the agent that interferes with DNA replication is an alkylating agent. Alkylating agents include
Cyclophosphamide, temozolomide, ifosfamide, maphosphamide, melphalan, busulfan, bendamustine, uramustine, carmustine or bis-chloroethylnitrosourea (BCNU), chlorambucil, mitomycin C, and derivatives thereof, but not limited thereto Metabolite or metabolite intermediate
e) is included. A suitable derivative may be, for example, but not limited to, parifosfamide (eg, a derivative of ifosfamide).

In another embodiment, the agent that interferes with DNA replication is a platinum compound. Platinum compounds include, but are not limited to carboplatin, cisplatin, oxaliplatin and derivatives thereof.

In another embodiment, the agent that interferes with DNA replication is a methylating agent. Methylating agents include, but are not limited to, temzolomide, procarbazine and dacarbazine and their derivatives.

In another embodiment, the agent that interferes with DNA replication is a nucleoside analog. Non-limiting examples of nucleoside analogs include gemcitabine, 5-fluorouracil, cytosine arabinoside (Ara-C) and derivatives thereof.

In another embodiment, any drug that indirectly inhibits DNA replication by inhibiting an enzyme essential for DNA replication, such as topoisomerase I, topoisomerase II or DNA polymerase, may be used. Such drugs include, but are not limited to, doxorubicin, daunorubicin, mitoxantrone, etoposide, teniposide,
Topotecan, camptothecin, irinotecan, acyclovir and gancyclovir are included.

Exemplary agents that interfere with DNA replication that can be used in the methods of the present invention include:
Examples include, but are not limited to, the drugs listed in Table 3 below. Those skilled in the art will appreciate that these are examples of drugs that can be used. Other agents include, for example, any drug or compound that prevents DNA replication by a similar mechanism and / or has a similar functional group.

In certain embodiments, the agent that interferes with DNA replication is a nitrogen mustard alkylating agent, or any intermediate or active metabolite thereof. Nitrogen mustard is a non-specific DNA alkylating agent. The nitrogen mustard forms a cyclic aminium ion (aziridinium ring) by intramolecular substitution of chloride with an amine nitrogen. This azidirium group can then alkylate DNA by attacking the N-7 nucleophilic center of the guanine base. When the second chlorine is replaced, a second alkylation step occurs, resulting in the formation of interchain bridges (ICL). These damages are caused by DN
It is extremely cytotoxic to block basic metabolic processes such as A replication and transcription.

The methods of the invention include the use of any such non-specific nitrogen mustard DNA alkylating agent. Particularly suitable nitrogen mustard alkylating agents may include, but are not limited to, for example, cyclophosphamide, parifosfamide, bendamustine and ifosfamide.

Ifosfamide is a nitrogen mustard alkylating agent. Ifosfamide I
The UPAC name is N-3-bis (2-chloroethyl) -1,3,2-oxazaphosphinan-2-amide-2-oxide. Ifosfamide is commonly known as Ifex®. The chemical structure of ifosfamide is as follows:

Palyphosphamide is an active metabolite of ifosfamide that is covalently linked to the amino acid lysine for stability. Palyphosphamide irreversibly alkylates DNA and crosslinks through GC base pairs. This results in irreparable interstrand crosslinks with 7 atoms, leading to inhibition of DNA replication and / or cell death. Palyphosphamide is also known as Zymafos®.

Bendamustine is another nitrogen mustard alkylating agent. The IUPAC name for bendamustine is 4- [5- [bis (2-chloroethyl) amino] -1-methylbenzimidazol-2-yl] butanoic acid, commonly Treakisym®, R
They are referred to as ibomustin®, Levact® and Treanda®. The chemical structure of bendamustine is as follows:

The methods of the present invention also include the use of intermediate and / or active metabolites of DNA alkylating agents, particularly the intermediate and / or active metabolites of the nitrogen mustard DNA alkylating agents described herein. Is included. Such metabolites include, but are not limited to, aldophosphamide, 4-hydroxycyclophosphamide, 4-hydroxyifosfamide, chloracetaldehyde and phosphamide mustard.

In a further embodiment, the agent that interferes with DNA replication is any suitable pharmaceutically acceptable salt, ester, tautomer of an alkylating agent, platinum compound, methylating agent or nucleoside analog described herein. , Stereoisomers, racemic mixtures, solvates, hydrates or prodrugs.

In certain embodiments, the agent that interferes with DNA replication for use in the methods of the invention is cyclophosphamide.

Cyclophosphamide (CPA)
Cyclophosphamide (N, N-bis (2-chloroethyl) -1,3,2-oxazaphosphinan-2-amine 2-oxide), also known as cytophosphane
Is a nitrogen mustard alkylating agent. The chemical structure of cyclophosphamide is as follows:

Cyclophosphamide is an Endoxan®, Cytoxan®,
Neosar (R), Procytox (R) and Revimmune (
It is also known and referred to under the registered trademark. Other nitrogen mustard alkylating agents in the same class as cyclophosphamide include, but are not limited to, parifosfamide, bendamustine and ifosfamide.

Cyclophosphamide (CPA) is usually administered by intravenous infusion, but can also be administered parenterally and orally with little change in bioavailability (Juma, Rogers et al. 1979) (de Jonge, Huitema et al. 2005) Prodrug. CPA is converted to its active metabolites, 4-hydroxy-CPA and aldophosphamide, to liver P4.
It is converted by oxidation with 50 enzymes (Emmenegger, Shaked et al. 2007; 2011). C
The active metabolite of PA is fat soluble and enters the cell by passive diffusion. Intracellular 4-OH-
CPA spontaneously degrades to phosphoramide mustard, the final active metabolite. Phosphoramide mustard catalyzes intrastrand and interstrand DNA crosslinks as well as DNA-protein crosslinks, which inhibit DNA replication leading to cell death (de Jonge, Huitema et al. 200
Five). Phosphoramide mustard is lost by enzymatic conversion to carboxyphoshphamide by cytosolic aldehyde dehydrogenase (ALDH) (Emmeneg
ger, Shaked et al. 2007; 2011). Cells with low levels of ALDH tend to accumulate CPA metabolites and are more sensitive to their effects. Indeed, upregulation of ALDH by tumors is one of the mechanisms of CPA resistance (Zhang, Tian et al. 2005). Apart from ALDH, low intracellular ATP levels have also been associated with the selectivity of CPA for certain cell types (Zhao, Cao et al. 2010). For high doses, typically in the range of 1-5 g / m ² , CPA
The effect of is most cytotoxic to rapidly dividing cells, without distinction of cell types.
CPA is myelosuppressive because most hematogenic cells are dividing rapidly (Bruce, Meeker et al. 1966; Smith and Sladek 1985).

Systemic clearance of CPA and its metabolites varies between 5-9 hours, and the parental peak plasma levels also vary considerably from patient to patient (3-11 hours). This reflects the genetic differences between humans (Cohen, Jao et al. 1971; Mouridsen, Faber et
al. 1974). Repeated administration of CPA has been reported to shorten the elimination half-life by increasing the activity of enzymes involved in metabolism (D'Incalci, Bolis et al. 1979), which increases the metabolism of active metabolites. Whether or not it is connected, especially at low doses (Emmenegger, Shaked et al
2007) not known (de Jonge, Huitema et al. 2005).

  Dose conversion from human to mouse studies is calculated using the following formula:

In the formula, the constant Km value in mice is 3, and the Km value in humans is 37 (Reagan-Shaw,
Nihal et al. 2008). Using this calculation, a daily regular treatment in humans consisting of orally administering 50 mg twice daily is equivalent to 20.56 mg / kg in mice. An oral dose of 20 mg / kg has been evaluated in preclinical models and determined to be bioequivalent to the dose in humans (Voelcker, Wagner et al. 1984; Man, Bocci e
t al. 2002).

In the last 20 years, low-dose CPA has been recognized for its immunomodulatory and anti-angiogenic effects.
In contrast to high-dose CPA, low-dose CPA, typically 100-300 mg / m ² , lacks extensive cytotoxic activity, but by selectively modulating immune system cells and further in the tumor microenvironment It appears to promote immune-mediated tumor disappearance by reducing internal angiogenesis. Low dose CPA treatment alone has been shown to delay tumor growth in animal models but is ineffective in completely eradicating tumors. The tumor delay mechanism induced by CPA is complementary to combinations with other forms of immunotherapy, such as cancer vaccines. Low dose CPA, typically <300 mg / m ² , is given as a single bolus injection (s
bCPA) or orally over several days as a regular treatment (mCPA). It was first shown by Robert Nor that CPA selectively depleted immunosuppressive cells that were responsible for suppressing the active immune response to the tumor.
It was a pioneering study by th in the 1980s (North 1982; Awwad and North 1988).
Since then, CPA selectively reduces and impairs CD4 + CD25hiFoxP3 + regulatory T cell functionality (Lutsiak, Semnani et al. 2005) and inhibits tumor angiogenesis (Browde
r, Butterfield et al. 2000) and increased dendritic cell activation (Radojcic, Bezak et al.
2009), distort the immune response towards Th1 (Schiavoni, Mattei et al. 2000), and T
And have been reported to restore NK effector function (Ghiringhelli, Menard et al. 2007). In mice, the effect of a single bolus administration at a low dose of CPA is transient, usually reaching the lowest point within 4 days after administration and returning to normal by 7-10 days (Lutsiak, Semnani e
t al. 2005; Salem, Al-Khami et al. 2012).

Low-dose CPA has been combined with cancer vaccines in preclinical models and clinical trials. Hermans et al. Examined the effectiveness of low-dose CPA treatment in tumor-bearing mice that had been prophylactically immunized with a DNA / MVA prime / boost strategy. Briefly, mice were immunized with plasmid DNA encoding the tumor antigen mel3 and then boosted with MVA encoding the same antigen after 14 days. Seven days after MVA boost, mice were exposed to B16-F10 tumors and then treated with low dose CPA (175 mg / kg, ip) every 6 days (Hermans, Chong et al. 2003). They are pre-immunized and then low dose C
In mice treated with PA, tumor growth was significantly delayed, but either treatment alone was found to have no effect. They did not detect an increase in the number of antigen-specific CD8 + T cells. From the study of Barbon et al. In tumor-free mice, low dose CPA (20 mg / kg / day, ip) 3 times daily before DNA vaccine encoding CYP1B1 antigen
The low or high dose (20 or 200 mg / kg) 2 days before the vaccine
It has been shown to produce a better immune response than a single dose of CPA (Barbon, Yang
et al. 2010). CPA was administered daily and the last dose was 2 days prior to vaccination. In this study, daily CPA treatment was more effective in reducing the total number of Tregs while leaving effector CD8 + T cells. Wada et al. Studied various regimens of low-dose CPA with GVAX vaccine (50 mg / kg, intravenous) in an autologous TRAMP-C2 / HA prostate tumor model (Wada, Yoshimura et al. 2009). These tumors develop naturally in mice and express the HA antigen. To establish the best regimen, CPA was given once before vaccination or once after vaccination. A low dose single pre-bolus administration was most effective in generating CD8 + T cells. The immunogenicity of a vaccine
Mice were vaccinated twice at 7-day intervals (Day 0 and Day 7), which were administered low-dose cyclophosphamide before each vaccine (CPA was administered on Days -1 and 6). Was further enhanced by combining with a single dose. They are circulating total CDs
4 and an increase in the number of CD8, specifically an increase in antigen-specific CD8 + T cells. Sal
In a study by em et al., various doses of CPA were evaluated in a single bolus dose at a low dose 3 days prior to vaccination (Salem, Kadima et al. 2007). This study is OT-
2 days before adoptive transfer of one transgenic T cell and ovalbumin peptide (10
A transgenic model was used in which wild type mice were treated by a single intraperitoneal injection of CPA 3 days before vaccination of mice by delivering 0 ug; SIINFEKL, 257-264) subcutaneously in PBS. . The ability of the vaccine to increase the number of circulating antigen-specific T cells was measured after pretreatment with PBS, 1 mg CPA or 4 mg CPA. They found that 1 mg CPA (corresponding to a dose of 50 mg / kg) did not increase antigen-specific OT-IT cells more than PBS sham treatment, but 4 mg CPA (
(Corresponding to a dose of 200 mg / kg) was found to increase these cells. Although any dose is considered a “low dose”, a single dose did not result in a consistent enhancement of the immune response induced by the vaccine. Most recently, Peng et al. Compared daily CPA (10 mg / kg / day) to sbCPA (50 mg / kg) in combination with a DNA vaccine encoding HPV16 E7 protein in a TC-1 HPV16 tumor model (Peng, Lyford-Pike et al. 2012). In this model, mice were therapeutically vaccinated starting 9 days after transplantation, which was repeated once a week for the following 2 weeks. mCPA was administered continuously for 4 weeks or at a single, low dose before each vaccination. All CPA treatments started on day 8, one day before the first vaccination. They found that both sbCPA and mCPA combined with vaccines resulted in increased tumor protection and that a single dose of CPA prior to each vaccine resulted in the strongest CD8 response and best antitumor activity. I found it. Finally, Taieb et al. Tested low-dose CPA with a Mart-1 exosome vaccine in a melanoma model (Taieb, Chaput et al.
2006). Briefly, on day 0, HLA-A2 transgenic mice were treated with B16. A
Two tumors were implanted and then treated on day 6 with low dose CPA (100 mg / kg, ip) and vaccinated on day 12. Mice treated with the combination showed significantly better tumor control and significant increase in antigen-specific CD8 + T cells and IFN-γ release than either treatment alone.

Low dose CPA is also being tested in clinical trials. Ghiringhelli et al., MC
Delivery of PA (without vaccination) at 50 mg twice a day for 1 month to patients with stage IV cancer resulted in a marked decrease in circulating Treg, but circulating CD4, C
It was first reported that total levels of D8 and NK cells were not affected (Ghiringhelli
, Menard et al. 2007). In addition, they reported that the T and NK cells of the treated patients had increased proliferative capacity, suggesting that mCPA treatment could be successfully combined with the vaccine. Phase I / II study (n = 14) showed the efficacy of a dendritic cell vaccine (monocyte-derived dendritic cells loaded with Her2 / neu, hTERT and PADRE peptides) in 14 ovarian cancer patients With or without a single bolus at a low dose of CPA (sbCPA
(Delivered intravenously at 300 mg / m ² 2 days before vaccine) (Chu, Boyer et
al. 2012). Patients who received the combination treatment reported possible improvements in progression-free survival and overall survival, but the results were not statistically significant in this study due to the small patient population. They did not detect a decrease in circulating Treg in patients treated with CPA. Moreover, the enhancement of T cell response measured by IFN-γ ELISPOT was not shown between the CPA group and the non-CPA group. In another single group phase II study in melanoma patients (n = 28), a dendritic cell vaccine (autologous dendritic cells loaded with peptides from KLH, survivin, hTERT, p53 and PADRE, vaccinated intradermally In combination with mCPA (50 mg twice daily, 1 week use-1 week rest) started after vaccination (Engell-Noerregaard et al. 2012). In the evaluation of the immune response induced by the vaccine in this single group study (in this study a DC-based vaccine was combined with IL-2 and Cox-2 inhibitors and CPA), IFN-γ E
LISPOT has shown that there is a moderate immune response from baseline to the fourth vaccination, and that the response occurs in a slowly decaying manner over time. Importantly, these responses are infrequent, as is usually seen with peptide vaccine therapy alone,
Or it could not be detected directly ex vivo. Because these patients' responses were not directly compared to patients who had been vaccinated without treatment with CPA,
It is unclear whether CPA alone or in combination with IL-2 and Cox-2 inhibitors contributed to any vaccine efficacy.

In a single group phase II study in ovarian cancer patients (n = 10), a vaccine containing p53-SLP (long synthetic peptide) consisting of 10 overlapping synthetic peptides emulsified in Montanide Vaccines delivered subcutaneously to patients (at 3 week intervals) were combined with a single bolus with a low dose of CPA (sbCPA, 300 mg / m ² , 2 days before vaccine). This study, when compared to a still study that tested a single vaccine,
We reported an increase in IFN-γ ELISPOT response in patients receiving combination therapy (Vermeij, Leffers et al. 2011). Comparison of treatment outcomes across different trials, however, is subject to selection bias that can distort results. A more systematic study on melanoma has shown that two special multipeptide vaccines (tyrosinase, MAGE-A1) delivered as a water-in-oil emulsion, half subcutaneously and half intradermally with a T helper peptide.
Use of peptides corresponding to MAGE-A3, gp100, MAGE-A10 and / or NY-ESO1, sbCPA (300 mg / m ² ,
Comparison before and after vaccination. This study shows that CD4 + and C after vaccination
The D8 + T cell response was carefully examined by ELISPOT and found that sbCPA also did not produce a detectable improvement when combined with vaccination. Finally, a phase I / II study on renal cell carcinoma by Walter et al.
A combination of MA901) with sbCPA (300 mg / m ² , 3 days before vaccine) was tested (Walter, Weinschenk et al. 2012). Group 2 Phase II study (n = 68) compared vaccines with and without sbCPA treatment. They reported that the immune responders within the group treated with the sbCPA / vaccine combination had improved survival over the non-responders in the same group and also over the group treated with the vaccine alone. Nevertheless, sbCPA treatment had no measurable effect on the immunogenicity of the vaccine.

In summary, CPA has been tested in clinical trials in combination with vaccines, both as a single intravenous infusion at a low dose before vaccination and as a regular oral therapy at a low dose started after vaccination. These studies yielded inconsistent results and did not show the definitive and widely applicable benefit of using low dose CPA for the purpose of enhancing vaccine activity.

To date, to the best of Applicants' knowledge, the benefits of direct administration of low dose CPA or multiple doses of low dose CPA before vaccination have been directly compared in clinical trials. There is nothing. We repeatedly administer CPA before vaccinating cancer patients with our multipeptide-based survivin vaccine (tested against a CPA-free vaccine in the same study). The results obtained by the method of the present invention comprising: vaccination with two different vaccines based on multiple peptides, MELITAC12.1 and MELITAC12.6 (both tested in the same test against a CPA-free vaccine) By administering a single dose of low dose CPA prior to
Compared to the results achieved in cancer patients by gluff et al. (2011).

Based on the ELISPOT results, without CPA pretreatment, the survivin peptide vaccine and the melanoma vaccines MELITAC12.1 and MELITAC12.6 all had about the same immunogenic strength. MELITAC12.1 alone and MEL
The immune response generated by up to 3 vaccinations with ITAC 12.6 alone is 100
Per 1,000 CD8 + T cells ranged from 0 to 1095 spots for MELITAC12.1 and 0 to 700 spots for MELITAC12.6. Compared to this, DPX
-ELISPOT values for patients who had been vaccinated with Survivac alone up to 3 times were calculated from the number of spots per 1,000,000 PBMCs to 100,000 CD8 +
Converting the value to the number of spots per T cell, it was in the range of 0-291 spots per 100,000 CD8 + T cells. The number of T cell counts in the patient's PBMC was determined by flow cytometry, and the data presented here are spots per 100,000 CD8 + T cells for direct comparison with the results obtained with the MELITAC vaccine. Converted to a number.

In comparison, when MELITAC12.1 and MELITAC12.6 are combined with a single dose of low dose CPA prior to the vaccine, 0-1095 and 0-700 respectively for MELITAC12.1 and MELITAC12.6. A range of immune responses occurred. Thus, the immune response generated by a single dose of low dose CPA prior to MELITAC12.1 and MELITAC12.6 was essentially unchanged compared to the vaccine alone.

In contrast, in patients who received multiple doses of CPA prior to vaccination with DPX-Survivac, E ranging from 0-8467 spots per 100,000 CD8 + T cells.
A LISPOT response occurred. CPA before vaccination with DPX-Survivac
Thus repeatedly increased the immune response (0-8467 vs. 0-291).
Thus, repeated treatment with a low dose of cyclophosphamide prior to vaccination enhances the immune response with the vaccine rather than a single dose of low dose cyclophosphamide prior to vaccination Is shown to be advantageous.

Vaccine Composition As used herein, the terms “vaccine”, “vaccine composition” or “composition” may be used interchangeably.

The vaccine composition of the invention for use with an agent that interferes with DNA replication may be in any form suitable for delivering survivin antigen to a subject. The vaccine composition according to the invention mixes one or more survivin antigens with one or more pharmaceutically acceptable excipients or carriers, preferably those that are acceptable for administration to humans. And can be formulated by known methods. Examples of such additives, carriers and formulation methods are for example
It can be found in Remington's Pharmaceutical Sciences (Maack Publishing Co, Easton, PA). In order to formulate a pharmaceutically acceptable vaccine composition suitable for effective administration, such a composition typically comprises a survivin polypeptide as described herein,
It should contain a therapeutically effective amount of a survivin antigen, such as a survivin peptide or survivin peptide variant, or a nucleic acid molecule or vector encoding such a survivin antigen.

A vaccine composition according to the present invention can be administered to a subject in a therapeutically effective amount. A “therapeutically effective amount” as used herein treats, prevents, reduces or ameliorates cancer or symptoms of cancer; prolongs the survival time of the subject being treated; and / or is cytotoxic. By an amount of a vaccine or active ingredient (eg, one or more survivin antigens) effective to stimulate, induce or enhance a subject's immune response, such as a T cell response. In some embodiments, a therapeutically effective amount of a vaccine is an amount that can induce a subject's clinical response in the treatment of cancer. The determination of a therapeutically effective amount of a vaccine can be sufficiently accomplished by those skilled in the art, especially in view of the disclosure provided herein. The therapeutically effective amount may vary depending on factors such as the subject's condition, weight, sex and age.

Once one or more suitable survivin antigens have been selected for inclusion in a vaccine composition according to the present invention, the antigens can be delivered by a variety of suitable means known in the art. Vaccine compositions for use in the methods described herein include, but are not limited to, for example, lipopeptides (eg, Vitiello, A. et al., J. Clin. Invest.
95: 341, 1995), peptide compositions encapsulated in poly (DL-lactide-co-glycolide) (“PLG”) microspheres (eg, Eldridge, et al., Molec. Immunol. 28: 287-294, 199
1: Alonso et al., Vaccine 12: 299-306, 1994; Jones et al., Vaccine 13: 675-681, 19
95), peptide compositions contained in immunostimulatory complexes (ISCOMS) (eg Takahashi et al., Nature 344: 873-875, 1990; Hu et al., Clin Exp Immunol. 11).
3: 235-243, 1998), multiple antigen peptide systems (MAPs: multi
ple antigen peptide systems) (eg Tam, JP, Pr
oc. Natl. Acad. Sci. USA 85: 5409-5413, 1988; Tam, JP, J. Immunol. Methods
196: 17-32, 1996), peptides formulated as multivalent peptides; peptides for use in ballistic delivery systems, typically crystallized peptides, viral delivery vectors (Perkus , ME et al., In: Concepts in vaccine de
velopment, Kaufmann, SHE, ed., p. 379, 1996; Chakrabarti, S. et al., Nature
320: 535, 1986; Hu, SL et al., Nature 320: 537, 1986; Kieny, M.-P. et al., AID
S Bio / Technology 4: 790, 1986; Top, FH et al., J. Infect. Dis. 124: 148, 1971;
Chanda, PK et al., Virology 175: 535, 1990), particles of viral or synthetic origin (
For example, Kofler, N. et al., J. Immunol. Methods. 192: 25, 1996; Eldridge, JH et
al., Sem. Hematol. 30:16, 1993; Falo, LD, Jr. et al., Nature Med. 7: 649, 199
5) Adjuvant (Warren, HS, Vogel, FR, and Chedid, LA Annu. Rev. Imm
unol. 4: 369,1986; Gupta, RK et al., Vaccine 11: 293, 1993), liposomes (Reddy
, R. et al, J. Immunol. 148: 1585, 1992; Rock, KL, Immunol. Today 17: 131, 1996
), Or naked or adsorbed cDNA (Ulmer, JB et al., Science 259
: 1745, 1993; Robinson, HL, Hunt, LA, and Webster, RG, Vaccine 11: 957, 1
993; Shiver, JW et al., In: Concepts in vaccine development, Kaufmann, SH
E., ed., P. 423, 1996; Cease, KB, and Berzofsky, JA, Annu. Rev. Immunol. 1
2: 923, 1994 and Eldridge, JH et al., Sem. Hematol. 30:16, 1993).

The vaccine composition of the present invention also encompasses nucleic acid mediated therapy. For example, DNA or RNA encoding one or more survivin antigens described herein may be administered to a subject. Such an approach is described, for example, by Wolff et al., Science 247: 1465 (19
90) and U.S. Pat. Nos. 5,580,859; 5,589,466; 5,804.
No. 5,639; No. 5,739,118; No. 5,736,524; No. 5,679,647
No .; and WO 98/04720. Examples of DNA-based delivery techniques include “naked DNA”, facilitated (bupivicaine, polymer, peptide mediated) delivery, cationic lipid complexes, and particle mediated (“gene” Guns)) or pressure mediated delivery (see, eg, US Pat. No. 5,922,687).

In further embodiments of the vaccine composition, the survivin antigen (eg, survivin peptide) can be expressed by a viral or bacterial vector. Examples of expression vectors include attenuated virus hosts such as vaccinia or fowlpox. This approach involves the use of vaccinia virus, for example, as a vector that expresses a nucleotide sequence encoding a survivin peptide as described herein. When introduced into an acute or chronically infected or non-infected host, the recombinant vaccinia virus expresses the antigenic peptide, thereby inducing a host immune response. Vaccinia vectors and methods useful for immunization protocols are described, for example, in US Pat. No. 4,722,848. Another vector is BCG (Bacille Calmette Guerin). BC
The G vector is described in Stover et al., Nature 351: 456-460 (1991). A wide variety of other vectors useful for therapeutic administration or immunization with the peptides of the invention, such as adenoviral vectors and adeno-associated viral vectors, retroviral vectors,
Salmonella typhi vectors, detoxified anthrax toxin vectors, and the like should be apparent to those skilled in the art and are encompassed by the vaccine compositions described herein.

Vaccines according to the invention also include compositions containing one or more survivin antigens, wherein the antigens are presented individually or presented as a construct containing multiple copies of the same or different survivin antigens. It's okay. For example, survivin antigens can be presented as a single nucleic acid molecule (eg, a vector) that encodes several same or different survivin antigens. Alternatively, in other embodiments, homopolymers containing multiple copies of the same survivin antigen, or heteropolymers of different different survivin antigens may be used. Such polymers may have the advantage of providing an increased immunological response. This is because the polymer contains multiple copies of the survivin antigen so that the resulting effect may be an enhanced ability to induce an immune response against one or more of the survivin's antigenic determinants. Said composition may comprise a naturally occurring region of one or more survivin antigens or may comprise an antigen prepared, for example, by recombinant or chemical synthesis.

Vaccines of the invention can also include antigen presenting cells (APC) such as dendritic cells (DC) as a vehicle for presenting one or more survivin antigens (eg, survivin peptides). Such vaccine compositions can be used after dendritic cell mobilization and recovery.
n dendritic cells can be prepared in vitro, and dendritic cells are loaded in vitro. For example, a dendritic cell may have DNA or RNA encoding one or more survivin antigens
Or survivin peptide antigen is added in pulses.
Dendritic cells can then be administered to the subject to elicit an immune response in vivo.

The vaccines of the present invention may be obtained by any suitable means, such as injection (eg, intramuscular, intradermal, subcutaneous,
Intravenously or intraperitoneally), aerosol, oral, nasal, topical, intravaginal, transdermal, transmucosal, or any other suitable route. The vaccine can be formulated for systemic or local distribution within the subject's body. Systemic formulations include systemic formulations designed for administration by injection and systemic formulations designed for transdermal, transmucosal or oral administration.

For injection, the vaccine may be formulated in a carrier comprising a continuous phase of the hydrophobic material described herein, such as a water-in-oil emulsion or an oil-based carrier. In some embodiments, liposomes may be used with a carrier. The vaccine may also be formulated as an aqueous solution such as Hank's solution, Ringer's solution, or physiological saline buffer.

As will be apparent from the above, the vaccine compositions of the present invention comprise cancer compositions, including compositions that, when administered, can stimulate a subject's immune response, such as a specific cytotoxic T cell response. It is intended to encompass any composition or antigen delivery means (eg, viral vector) useful for treatment.

In order to obtain the vaccine composition of the present invention, various substances such as adjuvants, additives, surfactants, immunostimulatory components and / or carriers and survivin antigens, which are relatively small survivin peptides, It may be appropriate to combine them. An adjuvant may be included in the vaccine composition to enhance the specific immune response. The desired route of administration, or the desired distribution in the subject, e.g. systemic or local,
Depending on the case, different carriers may be used.

In certain embodiments, a vaccine for use in the methods of the invention is a composition comprising at least one survivin antigen, a liposome, and a carrier comprising a continuous phase of a hydrophobic substance.
In further embodiments, the composition may additionally comprise an adjuvant. In further embodiments, the composition may additionally comprise a T helper epitope or antigen.

Thus, in one embodiment, the vaccine composition comprises one or more survivin antigens; T
A carrier comprising a helper epitope; an adjuvant; a liposome; and a continuous phase of a hydrophobic substance. The T helper epitope is, for example, the amino acid sequence AQYIKANSKFIGITEL (SEQ ID NO: 9).
It may be a peptide containing. The adjuvant may be, for example, a poly I: C polynucleotide.

In a further embodiment, the vaccine for use in the method of the invention comprises at least one survivin antigen, liposome-based and / or amphiphilic compound-based Imm.
unovaccine, Inc. vaccine adjuvant application platform (vaccine
adjuvanting platform), including VacciMax (R) and DepoVax
Compositions including, but not limited to, (trademark) platform technology (eg, US Pat. Nos. 6,793,923 and 7,824,686; WO2
002/038175; WO2007 / 041832; WO2009 / 039628; W
O2009 / 043165 and WO2009 / 146523). Dep
The oVax ™ platform is a vaccine delivery formulation that provides for controlled and long-term exposure to the immune system of antigens and adjuvants. This platform allows for a strong, specific and persistent immune response and allows single dose efficacy.

In a further embodiment, the vaccine of the invention comprises the amino acid sequence: FEELTLGEF (SEQ ID NO: 1)
FTELTLGEF (SEQ ID NO: 2); LTLGEFLKL (SEQ ID NO: 3); LMLGEFLKL (SEQ ID NO: 4); R
One or more survivin peptide antigens having ISTFKNWPF (SEQ ID NO: 5); RISTFKNWPK (SEQ ID NO: 6); STFKNWPFL (SEQ ID NO: 7); and LPPAWQPFL (SEQ ID NO: 8),
Any suitable composition as described above.

In a further embodiment, the vaccine composition comprises the amino acid sequence: FTELTLGEF (SEQ ID NO: 2)
5 peptide antigens, including LMLGEFLKL (SEQ ID NO: 4), RISTFKNWPK (SEQ ID NO: 6), STFKNWPFL (SEQ ID NO: 7), and LPPAWQPFL (SEQ ID NO: 8); T helper epitope; adjuvant; liposome; A carrier containing a phase is included. The T helper epitope may be, for example, a peptide comprising the amino acid sequence AQYIKANSKFIGITEL (SEQ ID NO: 9). The adjuvant can be, for example, a poly I: C polynucleotide. Liposomes may be composed of, for example, 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC; synthetic phospholipid) and cholesterol. Hydrophobic carriers are for example Monta
NIDE (registered trademark) ISA51VG may be used.

In a specific embodiment, the vaccine of the present invention may be DPX-Survivac, an immunocancer immunotherapy vaccine candidate from Immunovaccine, Inc. DPX-Surv
ivac consists of amino acid sequences: FTELTLGEF (SEQ ID NO: 2), LMLGEFLKL (SEQ ID NO: 4), RIST
Five synthetic survivin peptide antigens with FKNWPK (SEQ ID NO: 6), STFKNWPFL (SEQ ID NO: 7), and LPPAWQPFL (SEQ ID NO: 8); a universal T helper epitope derived from tetanus toxoid (AQYIKANSKFIGITEL; SEQ ID NO: 9); poly I: C Polynucleotide adjuvant; liposome consisting of DOPC and cholesterol; and hydrophobic carrier Mont
anide® ISA51VG. Exemplary amounts of each component (per ml of vaccine) include, but are not limited to, 1.0 mg of each survivin antigen; 0.5 mg of T helper epitope (eg, SEQ ID NO: 9); adjuvant (eg, poly I: C polynucleotide) 0.4 mg; synthetic DOPC phospholipid 120.0 mg; cholesterol 12.0 mg; and a hydrophobic carrier (eg Montanide® ISA5
1 VG) 0.7 ml.

The vaccine may optionally further comprise additional components such as emulsifiers. A more detailed disclosure of exemplary embodiments of the vaccine and its components is described below.

(I) Survivin antigen The vaccine composition of the present invention comprises at least one survivin antigen. “At least one
The expression “one” is used interchangeably herein with the expression “one or more”.
These expressions refer to the number of different survivin antigens in the vaccine, and not to the amount of any particular survivin antigen, unless explicitly stated otherwise herein.
As the ordinary meaning of “at least one” or “one or more”, the vaccine composition of the present invention contains at least one survivin antigen.

Baculovirus Apoptosis Inhibitor 5 (BIRC5: baculov)
iral inhibitor of apoptosis repeat-conta
Survivin, also called ining 5), is a protein involved in the negative regulation of apoptosis. Survivin is classified as a member of the apoptosis inhibitor protein (IAP) family. Survivin is a 16.5 kDa cytoplasmic protein that contains a single BIR motif and, instead of ring fingers, contains a strongly charged carboxy-terminal coil region. The gene encoding survivin is nearly identical to the sequence of effector cell protease receptor-1 (EPR-1) but in the opposite orientation. The coding sequence of survivin (homo sapiens) is 429 nucleotides long including the stop codon (SEQ ID NO: 10). The encoded protein survivin (homo sapiens) is 142 amino acids long (SEQ ID NO: 11).

Survivin protein is hypothesized to function by inhibiting caspase activation, thereby resulting in negative regulation of apoptosis or programmed cell death. Consistent with this function, survivin has been identified as one of the top genes that is upregulated without exception in many types of cancer, but is not upregulated in normal tissues (eg,
Altieri et al., Lab Invest, 79: 1327-1333, 1999; and US Pat. No. 6,245,5
(See 23). Therefore, survivin is an ideal target for cancer therapy because cancer cells are targeted because of this fact, whereas normal cells are not. Indeed, survivin is highly expressed in many tumor types, including most human cancers, and its prognostic importance has been reported.

The vaccine of the present invention comprises one or more survivin antigens. As used herein, the term “survivin antigen” encompasses any peptide, polypeptide or variant thereof (eg, survivin peptide variant) derived from a survivin protein or fragment thereof. The term “survivin antigen” also encompasses a polynucleotide that encodes a survivin peptide, survivin peptide variant, or functional equivalent of a survivin peptide as described herein. The polynucleotide may be DNA (eg, genomic DNA or cDNA) or RNA (eg, mRNA) or a combination thereof. A polynucleotide can be naturally occurring or synthetic (eg, chemically synthesized). The possibility of including a modification of one or more nitrogen bases, pentose sugars or phosphate groups in the nucleotide chain is also contemplated. Such modifications are well known in the art and may be aimed, for example, to improve the stability of the polynucleotide.

In one embodiment, the survivin antigen may comprise a full length survivin polypeptide or a nucleic acid encoding a full length survivin polypeptide. Alternatively, the survivin antigen may be a survivin peptide comprising a fragment of any length of survivin protein. Exemplary embodiments include at least 5, 6, 7, 8, 9, 10, 11, 12, 13, 14
, 15, 16, 17, 18, 19 or 20 survivin peptides comprising amino acid residues. In certain embodiments, the survivin peptide is a heptapeptide, octapeptide, nonapeptide, decapeptide, or undeca consisting of 7, 8, 9, 10, 11 amino acid residues in sequence of a survivin protein (eg, SEQ ID NO: 11), respectively. It consists of peptides. Particular embodiments of survivin antigens include survivin peptides of about 9 or 10 amino acids.

Survivin antigens of the present invention also include survivin peptide variants and functional equivalents. A survivin peptide variant or functional equivalent exhibits an amino acid sequence that differs from a sequence unique to survivin protein, such as one or more amino acid substitutions, deletions or additions, or any combination thereof. Includes peptides. The difference can be measured as a decrease in identity between the survivin protein sequence and the functional equivalent of the survivin peptide variant or survivin peptide.

Identity between amino acid sequences can be calculated using algorithms well known in the art. The survivin peptide variant or functional equivalent is preferably at least 70% identical to the peptide sequence of the survivin protein over its entire length, eg, at least 7
5% identical, at least 80% identical, at least 85% identical, at least 90% identical, or at least 95% identical, including 96% of the peptide sequence of survivin protein, 97
%, 98% or 99% identical, should be considered within the meaning of the “survivin antigen” of the present invention. In certain embodiments, the survivin peptide variant is at least 85%, 90%, 95%, contiguous amino acid sequence of SEQ ID NO: 11,
It has 96%, 97%, 98% or 99% sequence identity.

A survivin protein that can be the source of a survivin antigen is a survivin protein from any animal species in which the protein is expressed. One particular embodiment is a survivin protein from human (SEQ ID NO: 11). The survivin antigen can be derived by subjecting the survivin protein or encoding nucleic acid to any suitable chemical or enzymatic treatment based on the sequence of the selected survivin protein. Alternatively, survivin antigens may be synthesized by any conventional peptide or nucleic acid synthesis method familiar to those skilled in the art.

The survivin antigen (peptide or nucleic acid) of the present invention has a sequence that is the natural sequence of survivin. Alternatively, the survivin antigen may be a peptide or nucleic acid sequence that has been modified by one or more substitutions, deletions or additions, such as the survivin peptide variants or functional equivalents described herein. Exemplary techniques and modifications of survivin peptides that increase the immunogenicity of peptides include, for example, WO 2004/0, with amino acid substitutions introduced at anchor sites that increase the binding of peptides to HLA class I molecules.
Examples include the methods and modifications described in 67023.

In one embodiment, the survivin antigen is any peptide derived from survivin protein or any survivin peptide variant thereof that can bind to an MHC class I HLA molecule. In these policies, the survivin antigen may be any survivin peptide or survivin peptide variant thereof that can induce or stimulate a subject's immune response.

In one embodiment, the survivin antigen is a peptide antigen comprising an amino acid sequence derived from a survivin protein (SEQ ID NO: 11) capable of inducing a cytotoxic T lymphocyte (CTL) response in a subject, or said peptide A nucleic acid molecule that encodes.

In one embodiment, the vaccine comprises one or more synthetic survivin peptides or variants thereof based on the amino acid sequence of the survivin protein, such as the amino acid sequence set forth in SEQ ID NO: 11.

Survivin peptides, survivin peptide variants and functional equivalents of survivin, and their use for diagnostic and therapeutic purposes, in particular their use in cancer, for example WO
2004/067023 and WO 2006/081826. The novel peptides disclosed in these publications have been used to treat cytotoxic T lymphocytes (CTLs) in cancer patients.
It has been found that a response can be elicited. In particular, in WO2004 / 067023, MHC class I restricted peptides that can bind to MHC class I HLA molecules, thereby eliciting both ex vivo and in situ CTL immune responses in patients with a wide range of cancer diseases, It has been found that it can be derived from survivin protein.

In one embodiment, the vaccine of the present invention comprises WO2004 / 067023 and WO200.
It may include any one or more survivin peptides, survivin peptide variants or functional equivalents of survivin peptides disclosed in 6/081826.

In another embodiment, the vaccine of the present invention has one or more survivin peptides, survivin, having the ability to bind to any MHC class I molecule selected from HLA-A, HLA-B or HLA-C molecules. It may include peptide variants or functional equivalents of survivin peptides.

Exemplary MHC class I HLA-A molecules to which survivin peptides, survivin peptide variants, or functional equivalents of survivin peptides can bind include, but are not limited to, HLA-A1, HLA-A2, HLA-A3, HLA-A9, HLA-A10,
HLA-A11, HLA-A19, HLA-A23, HLA-A24, HLA-A25,
HLA-A26, HLA-A28, HLA-A29, HLA-A30, HLA-A31,
HLA-A32, HLA-A33, HLA-A34, HLA-A36, HLA-A43,
HLA-A66, HLA-A68, and HLA-A69.

Exemplary MHC class I HLA-B molecules to which a survivin peptide, survivin peptide variant or functional equivalent of survivin peptide can bind include, but are not limited to, HLA-B5, HLA-B7, HLA-B8, HLA-B12, HLA-B13
HLA-B14, HLA-B15, HLA-B16, HLA-B17, HLA-B18
, HLA-B21, HLA-B22, HLA-B27, HLA-B35, HLA-B37
HLA-B38, HLA-B39, HLA-B40, HLA-B41, HLA-B42
, HLA-B44, HLA-B45, HLA-B46 and HLA-B47.

Exemplary MHC class I HLA-C molecules to which survivin peptides, survivin peptide variants, or functional equivalents of survivin peptides can bind include, but are not limited to, HLA-C1, HLA-C2, HLA-C3, HLA-C4, HLA-C5, H
LA-C6, HLA-C7 and HLA-C16 are mentioned.

In certain embodiments, the vaccines of the invention may comprise one or more survivin peptide antigens selected from:
i) FEELTLGEF (SEQ ID NO: 1) [HLA-A1]
ii) FTELTLGEF (SEQ ID NO: 2) [HLA-A1]
iii) LTLGEFLKL (SEQ ID NO: 3) [HLA-A2]
iv) LMLGEFLKL (SEQ ID NO: 4) [HLA-A2]
v) RISTFKNWPF (SEQ ID NO: 5) [HLA-A3]
vi) RISTFKNWPK (SEQ ID NO: 6) [HLA-A3]
vii) STFKNWPFL (SEQ ID NO: 7) [HLA-A24]
viii) LPPAWQPFL (SEQ ID NO: 8) [HLA-B7]

Although not limited thereto, the survivin peptides listed above are exemplary MHC class I limited peptides encompassed by the present invention. The particular MHC class I HLA molecule that each survivin peptide is thought to bind is shown in the right square brackets. The vaccine of the present invention may comprise one or more of these survivin peptides in any suitable combination.

In a further embodiment, the vaccine of the present invention comprises any one or more of the five survivin peptides listed below in any suitable combination:
i) FTELTLGEF (SEQ ID NO: 2) [HLA-A1]
ii) LMLGEFLKL (SEQ ID NO: 4) [HLA-A2]
iii) RISTFKNWPK (SEQ ID NO: 6) [HLA-A3]
iv) STFKNWPFL (SEQ ID NO: 7) [HLA-A24]
v) LPPAWQPFL (SEQ ID NO: 8) [HLA-B7]

In certain embodiments, the composition of the present invention comprises all five survivin peptide antigens listed above, or any combination of peptide antigens, or one as found in the composition of Immunovaccine Inc. Or include more than one. In a preferred embodiment, the composition comprises all five survivin peptide antigens that are anti-cancer immunotherapy vaccine candidates DPX-Survivac.

In addition to at least one survivin antigen, further embodiments of the vaccines of the invention include:
Useful for the treatment of cancer or useful for inducing or stimulating an immune response against cancer 1
One or more additional antigens may be included. Exemplary embodiments of such additional antigens are described below.

(Ii) Additional antigens Other antigens that may be useful in the compositions of the invention include, but are not limited to, inducing an immune response in a subject that is beneficial in the treatment of cancer, eg, a cell-mediated immune response, or Antigens that are capable of strengthening are included.

Cell-mediated immunity is not related to antibodies, but rather to activation of macrophages and natural killer cells, production of antigen-specific cytotoxic T lymphocytes and the release of various cytokines in response to antigen. Is an immune response. Cytotoxic T lymphocytes are a subgroup of T lymphocytes (a type of white blood cell) that can induce the death of infected cells or tumor cells, ie, cytotoxic T lymphocytes are viruses (or others). Cells that are infected with, or otherwise, damaged or otherwise dysfunctional cells.

Most cytotoxic T cells express a T cell receptor capable of recognizing specific peptide antigens that bind to class IMHC molecules. Such CTL is CD8 (CD8 + T
Cell) and this CD8 is attracted to a portion of class IMHC molecules. This affinity maintains close binding of the CTL and target cells to each other during antigen-specific activation.

Cellular immunity is antigen-specific, for example, capable of lysing somatic cells that present epitopes of foreign antigens on their surface, such as virus-infected cells, cells with intracellular bacteria, and cancer cells that present tumor antigens. Activates cytotoxic T lymphocytes; activates macrophages and natural killer cells to allow them to destroy intracellular pathogens; and stimulates cells to adapt and innate immune responses It protects the body by secreting a variety of cytokines that affect the function of other cells involved.

Thus, in a further embodiment, the vaccine composition of the invention may comprise additional antigens in addition to one or more survivin antigens. For example, additional antigens include, but are not limited to, peptides, suitable natural, non-natural, recombinant or denatured proteins or polypeptides, or fragments thereof, or the ability to induce or enhance a CTL immune response in a subject. There may be an epitope.

The further antigen may also be a polynucleotide encoding a polypeptide that functions as an antigen. Nucleic acid based vaccination strategies are known and a vaccine composition containing a polynucleotide is administered to a subject. The antigenic polypeptide encoded by the polynucleotide is expressed in the subject as if the vaccine composition itself contained the polypeptide, as the antigenic polypeptide was ultimately present in the subject. For the purposes of the present invention, additional antigens include such polynucleotides that encode a polypeptide that functions as an antigen, as indicated by context.

The term “polypeptide” refers to a length (eg, at least 6, 8, 10, 12, 14, 16
, 18 or 20 amino acids) or post-translational modifications (eg glycosylation or phosphorylation)
Regardless of any chain of amino acids, including, for example, natural proteins, synthetic or recombinant polypeptides and peptides, epitopes, hybrid molecules, variants, homologues, analogs, peptoids, peptide-like substances, and the like. Thus, variants or derivatives include deletions including truncations and fragments; insertions and additions, such as conservative substitutions, site-specific mutants and allelic variants; and one or more covalently linked to the peptide Modifications are included, including peptoids with multiple non-aminoacyl groups (eg, sugars, lipids, etc.) and post-translational modifications. As used herein, the term “conserved amino acid substitution” or “conservative substitution” refers to a substitution of one amino acid for another at a given position in a peptide, where the substitution It can be performed without substantial loss of related functions. In making such changes, substitution of similar amino acid residues can be made based on the relative similarity of side chain substituents, such as their size, charge, hydrophobicity, hydrophilicity, etc. Such substitutions can be assayed by routine testing for their effect on peptide function. Specific non-limiting examples of conservative substitutions include the following examples.
Original residue Conservative substitution Ala Ser
Arg Lys
Asn Gln, His
Asp Glu
Cys Ser
Gln Asn
Glu Asp
His Asn; Gln
Ile Leu, Val
Leu Ile; Val
Lys Arg; Gln; Glu
Met Leu; Ile
Phe Met; Leu; Tyr
Ser Thr
Thr Ser
Trp Tyr
Tyr Trp; Phe
Val Ile; Leu

Polypeptides or peptides having substantial identity with the preferred antigen sequence can be used. When optimally aligned (allowing gaps) they are at least about 5
Two sequences are considered to have substantial identity if they share 0% sequence identity or if they share a defined functional motif. In an alternative embodiment, optimally aligned sequences are at least 60%, 70%, 75%, 80% where they are in a particular region
, 85%, 90%, 95%, 96%, 97%, 98%, 99% identity, and therefore considered substantially identical (ie, having substantial identity) Can do. The term “identity” refers to sequence similarity between two polypeptide molecules. Identity can be determined by comparing each position in the aligned sequences. The degree of identity between amino acid sequences is a function of the number of amino acids that are identical or identical, for example in specific regions, at positions shared by the sequences. The optimal alignment of sequences for comparing identities is the ClustalW program available at http://clustalw.genome.ad.jp, Smith and
Waterman, 1981, Adv. Appl. Math 2: 482 local homology algorithm, Needlema
n and Wunsch, 1970, J. Mol. Biol. 48: 443, homology alignment algorithm,
Various algorithms known in the art, including the similarity search method of Pearson and Lipman, 1988, Proc. Natl. Acad. Sci. USA 85: 2444, and computer implementations of these algorithms (eg, Wisconsin Genetics Software Pa
package GAP, BESTFIT, FASTA and TFASTA, Genetic
s Computer Group, Madison, WI, U.S. S. A. ) Can be performed using. Sequence identity is determined by Altschul et al., 1990, J. Mol. Biol. 215: 403.
-10 (use published default settings) can also be used to determine. For example, National Center for B
Through iotechnology Information (Internet site ht
tp: //www.ncbi.nlm.nih.gov/BLAST/bl2seq/wblast2.cgi)
The “ST2 Array” tool can be used with the following default settings selecting the “blastp” program: expected threshold 10; word size 3; matrix BLOSUM62
There are 11 gap costs and 1 extension. In another embodiment, one of skill in the art can easily and properly align any given sequence, and sequence identity and / or by simple visual inspection.
Or homology can be inferred.

Polypeptides and peptides used as additional antigens in the vaccines of the present invention may be isolated from natural sources, synthesized, or recombinantly produced It may be a polypeptide. Peptides and proteins can be expressed recombinantly in vitro or in vivo.
Peptides and polypeptides used to practice the invention may be made and isolated using any method known in the art. Polypeptides and peptides used to practice the invention may also be synthesized in whole or in part using chemical methods well known in the art. For example, Caruthers (1980) Nucleic Acids Res. Symp. Ser. 215-223;
Hom (1980) Nucleic Acids Res. Symp. Ser. 225-232; Banga, A. K, Therapeutic Peptid
es and Proteins, Formulation, Processing and Delivery Systems (1995) Technomic P
See ublishing Co., Lancaster, Pa. For example, peptide synthesis can be performed using various solid phase techniques (eg, Roberge (1995) Science 269: 202; Merrifield (19
97) Methods Enzymol. 289: 3-13), automated synthesis can be achieved, for example, using an ABI 431A peptide synthesizer (Perkin Elmer) according to the instructions provided by the manufacturer.

In some embodiments, the additional antigen is, for example, about 25% to 50% pure, about 50%
About 75% pure, about 75% to about 85% pure, about 85% to about 90% pure, about 9%
0% to about 95% pure, about 95% to about 98% pure, about 98% to about 99% pure,
Alternatively, it may be a purified antigen that is more than 99% pure.

As noted above, further antigens include polynucleotides that encode polypeptides that function as antigens. As used herein, the term “polynucleotide” can be of any length (eg, 9, 12, 18, 24, 30, 60, 150, 300, 600
1500 or more nucleotides) or a number of strands (eg single or double stranded). The polynucleotide may be DNA (eg, genomic DNA or cDNA) or RNA (eg, mRNA) or combinations thereof. They may exist naturally or may be synthesized (for example, chemically synthesized). It is believed that a polynucleotide may contain modifications of one or more nitrogen bases, pentose sugars or phosphate groups in the nucleotide chain. Such modifications are well known in the art and can be for example to improve the stability of the polynucleotide.

The polynucleotide may be delivered in various forms. In some embodiments, naked polynucleotides that are in linear form or inserted into a plasmid, such as an expression plasmid, can be used. In other embodiments, live vectors such as viral or bacterial vectors can be used.

There may be one or more regulatory sequences that assist in transcription of DNA into RNA and / or translation of RNA into polypeptide. In some cases, regulatory sequences (eg, promoters) associated with the transcription process are not required, such as when the polynucleotide is a messenger RNA (mRNA) molecule, and protein expression can be achieved in the absence of a promoter.
One skilled in the art can include appropriate regulatory sequences depending on the situation.

In some embodiments, the polynucleotide is present in an expression cassette, wherein the polynucleotide is operably linked to regulatory sequences that cause the polynucleotide to be expressed in the subject to which the composition of the invention is administered. The choice of expression cassette depends on the subject to which the composition is administered as well as the characteristics desired for the expressed polypeptide.

In general, an expression cassette includes a promoter that may be functional in a subject and may be constitutive or inducible; a ribosome binding site; an initiation codon (ATG) if necessary; a polynucleotide encoding a polypeptide of interest; a stop A codon; and optionally a 3 ′ terminal region (translational and / or transcriptional terminator). Additional sequences such as regions encoding signal peptides may be included. The polynucleotide encoding the polypeptide of interest may be homologous or heterologous to any of the other regulatory sequences in the expression cassette. Sequences expressed with the polypeptide of interest, such as the signal peptide coding region,
In general, it is located adjacent to a polynucleotide encoding the protein to be expressed and placed in a suitable reading frame. An open reading frame composed solely by a polynucleotide encoding the protein to be expressed or together with any other sequence to be expressed (eg, a signal peptide) is a promoter so that transcription and translation occur in the subject to which the composition is administered. Placed under the control of

The amount of additional antigen used in a single treatment with the vaccine composition described herein may vary depending on the type of antigen and the size of the subject. One skilled in the art will be able to determine an effective amount of additional antigens to be used in a particular application without undue experimentation. The term “effective amount” as used herein means an amount that is effective at the dosage and for the period of time necessary to achieve the desired result.

In some embodiments, the additional antigen may be at least one CTL epitope that can induce a CTL response. For example, the additional antigen may be a CTL epitope derived from a protein identified as being upregulated in cancer cells.

In certain embodiments, the CTL epitope may be an epitope of a tumor associated protein, such as, for example, a melanoma associated protein. In some embodiments, the melanoma-related protein is tyrosine-related protein 2 (TRP-2) or p53, which can be obtained in various ways, including recombinant techniques or chemical synthesis.

The following genes encode, but are not limited to, tumor associated proteins with peptide sequences that can be incorporated into the vaccines of the invention as further antigens: p53, HPV E6
And E7, ART-4, CAMEL, CEA, Cyp-B, HER2 / neu, hTE
RT, hTRT, iCE, MUC1, MUC2, PRAME, P15, RUI, RU2,
SART-1, SART-3, WT1, PSA, tyrosinase, TRP-1, TRP-2
, Gp100, MART-1 / Melan A, MAGE-A1, MAGE-A2, MA
GE-A3, MAGE-A6, MAGE-A10, MAGE-A12, BAGE, DAM
-6, DAM-10, GAGE-1, GAGE-2, GAGE-3, GAGE-4, GA
GE-5, GAGE-6, GAGE-7B, GAGE-8, NA88-A, NY-ESO
-1, NY-ESO-1a (CAG-3), AFP, β-catenin / m, caspase-8
/ M, CDK-4 / m, ELF2M, GnT-V, G250, Ras, HSP70-2M
, HST-2, KIAA0205, MUM-1, MUM-2, MUM-3, myosin / m
, RAGE, SART-2, Survivin, TRP-2 / INT2, and 707-AP
.

In certain embodiments, the vaccine may be a C associated with cancer as an antigen that induces a CTL response.
It may contain a mixture of TL epitopes. For example, the antigen may be combined with at least one additional antigen of a tumor associated protein, for example, but not limited to the following amino acid sequence: FE
ELTLGEF (SEQ ID NO: 1); FTELTLGEF (SEQ ID NO: 2); LTLGEFLKL (SEQ ID NO: 3); LMLGEFL
KL (SEQ ID NO: 4); RISTFKNWPF (SEQ ID NO: 5); RISTFKNWPK (SEQ ID NO: 6); STFKNWPFL
(SEQ ID NO: 7); and may include at least one or more of the survivin antigens described herein, such as a survivin peptide antigen having LPPAWQPFL (SEQ ID NO: 8).

(Iii) T helper epitope In some embodiments, a vaccine of the invention comprises at least one T helper epitope or T helper antigen.

A T helper epitope is a sequence of amino acids (natural or non-natural amino acids) having T helper activity. T helper epitopes are recognized by T helper lymphocytes that play an important role in establishing and maximizing the immune system's ability to activate and direct other immune cells, such as cytotoxic T lymphocytes. Involved in.

T helper epitopes can consist of continuous or discontinuous epitopes. Thus, every amino acid of T helper is not necessarily part of the epitope. Thus, T helper epitopes, including analogs and segments of T helper epitopes, can enhance or stimulate an immune response. Immunodominant T helper epitopes are widely reactive in animal and human populations with a wide variety of MHC types (Celi
s et al. (1988) J. Immunol. 140: 1808-1815; Demotz et al. (1989) J. Immunol. 142:
394-402; Chong et al. (1992) Infect. Immun. 60: 4640-4647). The T helper domain of the subject peptide has from about 10 to about 50 amino acids, preferably from about 10 to about 30 amino acids. When multiple T helper epitopes are present, each T helper epitope acts independently.

In some embodiments, T helper epitopes can form part of the antigens described herein. Specifically, if the antigen is of sufficient size, it can contain an epitope that functions as a T helper epitope. In other embodiments, the T helper epitope is a separate molecule from the antigen.

In another embodiment, T helper epitope analogs may comprise substitutions, deletions and insertions of 1 to about 10 amino acid residues in the T helper epitope. A T helper segment is a contiguous portion of a T helper epitope that is sufficient to enhance or stimulate an immune response. An example of a T helper segment is a series of overlapping peptides derived from a single longer peptide.

In certain embodiments, the compositions of the invention comprise a modified tetanus toxin peptide A16L (830-844, AQYIKANSKFIGITEL) that has an alanine residue added to its amino terminus as a T helper epitope or antigen to enhance stability. (SEQ ID NO: 9)) (Slingluff et al., Clin Cancer Res., 7: 3012-3024, 2001).

Other sources of T helper epitopes that can be used in the present compositions include, for example, B
Hepatitis B surface antigen helper T cell epitope, pertussis toxin helper T cell epitope, measles virus F protein helper T cell epitope, Chlamydia trachomitis (Chla
mydia trachomitis) main outer membrane protein helper T cell epitope, diphtheria toxin helper T cell epitope, Plasmodium falciparum sporozoite helper T cell epitope, Schistosoma mansoni triose phosphate isomerase helper T cell epitope, E. coli (Escherichia coli) TraT helper T cell epitopes, and immunopotentiating analogs and segments of any of these T helper epitopes are included.

In some embodiments, the T helper epitope is a universal T helper epitope.
A universal T helper epitope as used herein is a peptide or other immunogenic molecule that binds to multiple MHC class II molecules in a manner that activates T cell function in a class II (CD4 + T cell) restricted manner. , Or a fragment thereof. An example of a universal T helper epitope is PADRE (pan-DR epitope) comprising the peptide sequence AKXVAAWTLKAAA (SEQ ID NO: 12), where X may be cyclohexylalanyl. PADRE is CD4 +
Specifically has a T helper epitope, ie it stimulates the induction of a PADRE-specific CD4 + T helper response.

In addition to the modified tetanus toxin peptide A16L, tetanus toxoid has other T helper epitopes that work in a manner similar to PADRE. Tetanus and diphtheria toxins have universal epitopes on human CD4 + cells (Diethelm-Okita, BM et al.,
J. Infect. Diseases, 181: 1001-1009, 2000). In another embodiment, the T helper epitope is the peptide sequence FNNFTVSFWLRVPKVSASHLE (amino acids 947-967, SEQ ID NO: 13
Tetanus toxoid peptide such as F21E.

In certain embodiments, the T helper epitope is fused to at least one of one or more survivin antigens in a vaccine of the invention, or to a further antigen that can be included in the vaccine (eg, a fusion peptide). .

(Iv) Adjuvants In some embodiments, the vaccines of the invention include one or more pharmaceutically acceptable adjuvants. A number of adjuvants have been described and are known to those skilled in the art. For example, Re
mington's Pharmaceutical Sciences (Remington's Pharmaceutical Sciences, Mack Pub
lishing Company, Easton, Pa., USA 1985) and US Pharmacopoeia issued in 1999:
The United States Pharmacopoeia: The National Formulary (USP 24 N
See F19)).

Exemplary adjuvants include, but are not limited to, alum, other compounds of aluminum, Bacillus Calmette-Guerin (BCG), TiterMax ™, Ribi (
Brand), Freund's complete adjuvant (FCA), CpG-containing oligodeoxynucleotides (CpG ODN), lipopeptides and poly I: C polynucleotides.
An exemplary CpG ODN is 5'-TCCATGACGTTCCTGACGTT-3 '(SEQ ID NO: 14). One skilled in the art can readily select other suitable CpG ODNs based on the target species and effectiveness. Exemplary lipopeptides include, but are not limited to, Pam3Cys-SKK
(EMC Microcollections, Germany) or variants, homologues, and analogs thereof. The Pam2 family of lipopeptides has been shown to be an effective alternative to the Pam3 family of lipopeptides.

In certain embodiments, the vaccine is used as an adjuvant, for example but not limited to 2
Includes poly I: C polynucleotides, such as 6mer deoxyinosine / cytosine synthetic polynucleotides.

As used herein, “poly I: C” or “poly I: C polynucleotide” is a double-stranded polynucleotide molecule (RNA or DNA or a combination of DNA and RNA) Each strand contains at least 6 adjacent inosinic acid or cytidylic acid residues, or 6 adjacent residues selected from inosinic acid and cytidylic acid in any order (eg, IICIIC, ICICIC or IIICCC); There is the ability to induce or enhance the production of at least one inflammatory cytokine, such as interferon, in a mammalian subject. Poly I: C polynucleotides are about 8, 10
, 12, 14, 16, 18, 20, 22, 24, 25, 28, 30, 35, 40, 45,
50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 150, 20
It generally has a length of 0, 250, 300, 500, 1000 or more residues. The upper limit is not considered important. The minimum length of a preferred poly I: C polynucleotide is
About 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, or 30
May be nucleotides, with a maximum length of about 1000, 500, 300, 200, 100,
It may be 90, 80, 70, 60, 50, 45 or 40 nucleotides.

Each strand of the poly I: C polynucleotide may be a homopolymer of inosinic acid or cytidylic acid residues, or each strand is a heteropolymer containing both inosine and cytidylic acid residues. There may be. In any case, the polymer may contain one or more non-inosines if there is at least one contiguous region of 6 I, 6 C or 6 I / C residues, as described above. It may be interrupted by acid or non-cytidylic acid residues (eg uridine). In general, each strand of a poly I: C polynucleotide has no more than 1 non-I / C residue, more preferably 8, 10 per 6 I / C residues.
, 12, 14, 16, 18, 20, 22, 24, 26, 28 or 30 I / C residues contain no more than one non-I / C residue.

An inosinic acid or cytidylic acid (or other) residue in a poly I: C polynucleotide can be used if the ability of the poly I: C polynucleotide to promote production of inflammatory cytokines such as interferon is retained. It may be derivatized or modified as is known in the art. Non-limiting examples of derivatives or modifications include, for example, azide modification, fluoro modification,
Alternatively, the use of a thioester (or similar) linkage in place of the natural phosphodiester linkage to enhance stability in vivo. Poly I: C polynucleotides can also be used to enhance the molecule's resistance to degradation in vivo, for example, with positively charged poly-lysine and carboxymethyl cellulose, or with positively charged synthetic peptides. It may be modified by complexing.

The poly I: C polynucleotide is about 0.0 per unit dose of the composition in the composition of the invention.
Generally included in an amount of 01 mg to 1 mg. In certain embodiments, the amount of poly I: C polynucleotide will be about 0.04 mg / mL of vaccine composition.

Other suitable adjuvants for vaccines are adjuvants that activate or increase the activity of TLR2. As used herein, adjuvants that “activate” or “increase their activity” include any adjuvant, and in some embodiments are based on lipids that act as TLR agonists. Adjuvants are included. Furthermore, activating or increasing the activity of TLR2 includes its activation in any monomeric, homodimeric or heterodimeric form, ie a heterodimer with TLR1 or TLR6 (ie TLR1 / 2 or TLR2 / 6). In particular, the activation of TLR2 as

An exemplary embodiment of an adjuvant that activates or increases the activity of TLR2 is:
A lipid-based adjuvant comprising at least one lipid moiety or lipid component.

As used herein, the expression “lipid moiety” or “lipid component” refers to any fatty acid (eg, fatty acyl) or derivatives thereof, including, for example, triglycerides, diglycerides and monoglycerides. Exemplary fatty acids include, but are not limited to, palmitoyl, myristoyl, stearoyl and decanoyl groups, or any C2-C30 saturated or unsaturated fatty acyl group, preferably any C14-C22 saturated or unsaturated fatty acyl group, More preferably, a C16 saturated or unsaturated fatty acyl group is contained. Thus, as referred to herein, the expression “lipid-based adjuvant” encompasses any adjuvant that contains a fatty acyl group or derivative thereof.

Lipid-based adjuvants contain at least one lipid moiety, or a synthetic / semi-synthetic lipid moiety analog, which contains amino acids, oligopeptides or other molecules (
For example, carbohydrates, glycans, polysaccharides, biotin, rhodamine, etc.). Thus, but not limited to, lipid-based adjuvants may be, for example, lipoamino acids, lipopeptides, lipoglycans, lipopolysaccharides or lipoteichoic acids. further,
In order to create antigenic compounds having the properties of built-in adjuvants, lipid moieties or structures containing lipid moieties can be covalently or non-covalently bound to an antigen. For example, without limitation, the lipid-based moiety may include a cation (eg, nickel) to provide a positive charge for non-covalent bonding.

In some embodiments, the lipid moiety or lipid component is naturally occurring, such as a cell wall component (eg, lipoprotein) from, for example, Gram positive or Gram negative bacteria, Rhodopseudomonas viridis, or Mycoplasma. What to do. In other embodiments, the lipid moiety or lipid component may be synthetic or semi-synthetic.

The lipid based adjuvant may include palmitic acid (PAM) as at least one of the lipid portion or components of the adjuvant. Such lipid-based adjuvants are referred to herein as “palmitic acid adjuvants”. Palmitic acid is a low molecular weight lipid found in the immunologically reactive brown lipoprotein of Escherichia coli. Other common chemical names for palmitic acid include, for example, IU
Hexadecanoic acid and 1-pentadecanecarboxylic acid in the PAC nomenclature are included. The molecular formula of palmitic acid is CH ₃ (CH ₂ ) ₁₄ CO ₂ H. As will be appreciated by those skilled in the art, the lipid chain of palmitic acid may be altered. Exemplary compounds that can be used herein as palmitic acid adjuvants and methods for their synthesis are described, for example, in US Patent Publications US2008 / 0233143; US2010 / 0129385; and US2
01/01/0200632.

Generally, as described above for the lipid moiety, a palmitic acid adjuvant contains at least one palmitic acid moiety, which may be bound to amino acids, oligopeptides or other molecules. In order to create an antigenic compound having the properties of a built-in adjuvant, a palmitic acid moiety or a structure containing palmitic acid can be covalently or non-covalently bound to the antigen. Chemical structures containing palmitic acid moieties or palmitic acid can be conjugated to cysteine peptides (Cys) to allow various structural configurations of adjuvants, including linear and branched structures. it can. To create adjuvant compounds with improved solubility, cysteine residues are generally extended at the C-terminus by polar residues such as serine (Ser) and / or lysine (Lys). To elicit an enhanced immune response, palmitate-containing adjuvant compounds can be mixed with the antigen, associated with the antigen through non-covalent interactions, or directly or using a linker / spacer It can be covalently attached to an antigen. Most commonly, dipalmitoyl-S-glyceryl-cysteine (PAM ₂ Cys) or tripalmitoyl-S can also be used in multiple configurations as described above.
-To create glyceryl-cysteine (PAM ₃ Cys), two palmitic acid moieties are attached to the glyceryl backbone and cysteine residues.

Thus, in certain embodiments, the adjuvant of the composition may include a palmitic acid moiety or component. Palmitic acid moieties can be generated in vitro or in vivo
can be modified or manipulated to improve its stability at o, enhance its binding to a receptor (such as the toll-like receptor described below), or enhance its biological activity .

In certain embodiments, the palmitic acid adjuvant is PAM ₂ Cys or PAM ₃ C.
ys may be included. In another specific embodiment, the palmitic acid adjuvant is Pam-
It may be 2-Cys-Ser- (Lys) 4 or Pam-3-Cys-Ser- (Lys) 4. Such palmitic acid adjuvants are used, for example, as research reagents in EMC.
Microcollections GmbH (Germany) and InvivoG
en (San Diego, California, USA). Also, including labeled analogs, Pam-2-Cys-Ser- (Lys) 4 and Pam-3-Cy
Various analogs of s-Ser- (Lys) 4 are also available on EMC Microcollection.
s.

The composition of the present invention may comprise an adjuvant as described above in combination with at least one other suitable adjuvant. Exemplary embodiments of at least one other adjuvant are:
Organic and inorganic compounds, polymers derived from synthetic, non-living, or biological sources (including but not limited to bacteria, virus-like particles, viruses and their constituents), but in no way limited to them , Protein, peptide, sugar.

Additional examples of suitable adjuvants include, but are not limited to, chemokines, Toll-like receptor agonists, colony stimulating factors, cytokines, 1018 ISS, aluminum salts, Amplivax, AS04, AS15, ABM2, Adjumer, argamulin, AS01B, AS02 (SBASA ), ASO2A, BCG, calcitriol, chitosan, cholera toxin, CP-870,893, CpG, poly IC, CyaA, dimethyl dioctadecyl ammonium bromide (DDA), dibutyl phthalate (DBP), dSLIM, gamma inulin, GM -CSF, GMDP, glycerol, IC30, IC31, imiquimod, ImuFact IMP321, IS Patch, ISCOM, ISCOMATR
IX, JuvImmune, LipoVac, LPS, lipid core protein, MF59,
Monophosphoryl lipid A, Montanide® IMS 1312, Monta
Nide® based adjuvant, OK-432, OM-174, OM
-197-MP-EC, ONTAK, PepTel vector system, other palmitoyl-based molecules, PLG microparticles, resiquimod, squalene, SLR172, YF-17DB
CG, QS21, QuilA, P1005, poloxamer, saponin, synthetic polynucleotide, zymosan, pertussis toxin can be included.

Thus, the composition can include one or more pharmaceutically acceptable adjuvants. In some embodiments, at least one or additional antigens of one or more survivin antigens may be bound to at least one of the adjuvants.

The amount of adjuvant used depends on the amount of antigen and the type of adjuvant. One skilled in the art can readily determine the amount of adjuvant needed for a particular application by empirical testing.

(V) Liposomes In some embodiments, the vaccine of the present invention comprises liposomes. In certain embodiments, liposomes are included when the vaccine composition comprises a carrier comprising a continuous phase of a hydrophobic material described herein.

Liposomes are a specific embodiment of the adjuvant system encompassed by the present invention. But,
The vaccine of the present invention may not contain liposomes. Rather, in other embodiments of the vaccine, one or more survivin antigens may be combined with any suitable adjuvant for delivery of the survivin antigen to the subject.

Liposomes are fully closed lipid bilayer membranes that contain an encapsulated aqueous volume.
Liposomes may be unilamellar vesicles (having a single bilayer membrane) or multilamellar vesicles characterized by a multilamellar bilayer, each bilayer having two adjacent bilayers. It may or may not be separated by a multilayer and an aqueous layer. A general discussion of liposomes is Gregoriadis G. Immunol. Today, 1
1: 89-97, 1990; and Frezard, F., Braz. J. Med. Bio. Res., 32: 181-189, 1999. As used herein and in the claims, the term “liposome” is intended to encompass all such vesicular structures as described above, but is not limited to “niosomes” in the art. ”,“ Transfersome ”and“ Virosome ”
Is included.

In the present invention, any liposome may be used, including liposomes made from archaeal lipids, but particularly useful liposomes use phospholipids and non-esterified cholesterol in the liposome formulation. Cholesterol is used to stabilize liposomes, and any other compound that stabilizes liposomes can replace cholesterol. Other liposome stabilizing compounds are known to those skilled in the art. For example, saturated phospholipids give rise to liposomes with high transition temperatures that exhibit increased stability.

The phospholipid preferably used in the preparation of the liposome is selected from the group consisting of phosphoglycerol, phosphoethanolamine, phosphoserine, phosphocholine (eg DOPC, 1,2-dioleoyl-sn-glycero-3-phosphocholine) and phosphoinositol. A phospholipid having at least one head group. More preferred are liposomes comprising a lipid that is 94-100% phosphatidylcholine. Such lipids are lecithin Pho.
It is marketed by spholipon (registered trademark) 90G. If non-esterified cholesterol is also used in the liposomal formulation, the cholesterol is used in an amount equal to about 10% of the weight of the phospholipid. If compounds other than cholesterol are used to stabilize the liposomes, one skilled in the art can easily determine the amount required in the composition.

Liposome compositions include, for example, natural lipids, synthetic lipids, sphingolipids, ether lipids,
It can be obtained using sterols, cardiolipins, cationic lipids, and lipids modified with poly (ethylene glycol) and other polymers. Synthetic lipids may include the following fatty acid components: lauroyl, myristoyl, palmitoyl, stearoyl,
Arachidyl, oleoyl, linoleic oil, elcoil, or a combination of these fatty acids.

(Vi) Carrier In some embodiments, the vaccines of the invention comprise a pharmaceutically acceptable carrier, excipient or diluent. As used herein, a pharmaceutically acceptable carrier refers to any substance suitable for delivery of the vaccine composition of the invention and is useful in the methods of the invention.

Carriers that can be used in the vaccines of the present invention are well known in the art and are not limited in any way, for example, water, phosphate buffered saline, Ringer's solution, dextrose solution, serum-containing solution, Hank's solution, etc. Aqueous physiological equilibrium solution, oil-in-water emulsion, oil, water-in-oil emulsion, ester, poly (ethylene vinyl acetate), copolymer of lactic acid and glycolic acid, poly (lactic acid), gelatin, collagen matrix, Polysaccharides, poly (D, L-lactide),
Poly (malic acid), poly (caprolactone), cellulose, albumin, starch, casein, dextran, polyester, ethanol, methacrylate, polyurethane, polyethylene, vinyl polymer, glycol, thyroglobulin, albumin such as human serum albumin, tetanus toxoid, poly Including polyamino acids such as L-lysine and poly L-glutamic acid, influenza, hepatitis B virus core protein, and combinations thereof. For example, Remington: The Science and Practice of Pharmacy, 2000, Gennaro, AR
ed., Eaton, Pa .: See Mack Publishing Co.

In certain embodiments, the carrier of the vaccine composition is a carrier comprising a continuous phase of a hydrophobic material, preferably a liquid hydrophobic material. The continuous phase may be an essentially pure hydrophobic material or a mixture of hydrophobic materials. Further, if the hydrophobic material constitutes a continuous phase, the carrier may be an emulsion of water in the hydrophobic material or an emulsion of water in the mixture of hydrophobic materials. Furthermore, in another embodiment, the carrier can function as an adjuvant.

Hydrophobic substances useful in the compositions described herein are pharmaceutically and / or immunologically acceptable hydrophobic substances. Although the carrier is preferably a liquid, certain hydrophobic materials that are not liquid at ambient temperature may be liquefied, for example by warming, which is also useful in the present invention. In one embodiment, the hydrophobic carrier may be a phosphate buffered saline / Freund's incomplete adjuvant (PBS / FIA) emulsion.

Oil or water-in-oil emulsions are particularly suitable carriers for use in the vaccine compositions of the present invention. The oil should be pharmaceutically and / or immunologically acceptable. Suitable oils include
For example, mineral oils (especially light or low viscosity mineral oils such as Drakeol® 6VR), vegetable oils (eg soybean oil), nut oils (eg peanut oil) or mixtures thereof are included. Thus, in certain embodiments, the carrier is vegetable oil, nut oil,
Or a hydrophobic substance such as mineral oil. Animal fats and artificial hydrophobic polymer materials, particularly those that are liquid at ambient temperature, or that can be liquefied relatively easily can also be used.

To enhance the immunogenicity of cancer vaccines, Immunovaccine Inc. Has developed an adjuvant vaccine platform designed to promote a strong and robust immune response against peptide antigens. DepoVax ™ (DPX) is a TL
Liposome formulation in oil containing R-adjuvant and generic T helper peptide, which is immune response mediated by cytotoxic T lymphocytes (Karkada et al., J Immunother 3
3 (3): 250-261, 2010) and / or can be formulated with any epitope or mixture of epitopes to induce a humoral immune response. DPX forms a strong depot at the immune site, which prolongs antigen exposure to the immune system.

Montanide ISA51 by single vaccination with DPX peptide
An immune response equal to or better than multiple vaccinations with peptides of other conventional formulations such as VG emulsion is similar to VacciMax, which was a first generation emulsion based vaccine platform It has been shown to produce an immune response (Daftarian et a
l., J Transl Med 5: 26, 2007; Mansour et al., J Transl Med 5: 20, 2007). DPX
Phase I clinical trials for breast, ovarian and prostate cancer patients with a DepoVax ™ -based peptide vaccine named -0907 was recently completed and safety and immunogenicity in these advanced patients Proven (Berinstein et al., J Transl Med 10
(1): 156, 2012).

Thus, in a particular embodiment, the vaccine carrier of the invention is an Immunovaccc
in Inc. It may be a liposome-based adjuvant system. Unlike vaccines based on water-in-oil emulsions, which rely on oil encapsulating water droplets containing antigen and adjuvant, formulations based on DepoVax ™ do not need to be emulsified, Rely on liposomes to help antigens and adjuvants be taken directly into the oil. The advantages of this approach include (1) increasing the solubility in oily diluents of hydrophilic antigens / adjuvants that normally have maximum solubility in inherently aqueous based diluents, and (2) It includes that there is no trouble of the emulsification procedure before vaccine administration.

In a preferred embodiment, the carrier is a mineral oil or mannide oleate in a mineral oil solution, such as mannide oleate commercially available as Montanide® ISA51 (SEPPIC, France).

In certain embodiments, the composition may be substantially free of water (eg, “anhydrous”).
). If water is present in the discontinuous phase of the carrier, the hydrophobic carrier of these “anhydrous” compositions may still contain small amounts of water. For example, the individual components of the composition can have bound water that cannot be completely removed by processes such as vacuum lyophilization or evaporation, and certain hydrophobic carriers can have small amounts dissolved in them. It can contain water. In general, compositions of the present invention that are “anhydrous” are about 10%, 9%, 8%, 7%, 6%, 5%, for example, on a weight / weight basis of the total weight of the carrier components of the composition. 4%, 3%, 2%,
Contains less than 1%, 0.5%, 0.1%, 0.05% or 0.01% water.

Exemplary Methods for Preparing Vaccine Compositions In certain embodiments, a vaccine composition of the invention is a composition comprising at least one survivin antigen and a carrier comprising a liposome and a continuous phase of a hydrophobic substance.

Methods for making liposomes are well known in the art. For example, both are quoted before
See Gregoriadis (1990) and Frezard (1999). Any suitable method for making liposomes can be used in the practice of the invention, or liposomes can be obtained from commercial sources. Liposomes are generally prepared by hydrating liposome components (eg, phospholipids and cholesterol) that form a lipid bilayer with an aqueous solution, which is either pure water, or one dissolved in water or It may be a solution of multiple components, such as phosphate buffered saline (PBS), phosphate free saline or any other physiologically compatible aqueous solution.

In certain embodiments, phospholipids (eg, Phospholipon® 90G)
Or a liposome component or mixture of liposome components, such as DOPC and cholesterol, is solubilized in an organic solvent, such as a mixture of chloroform and methanol, followed by filtration (eg, PTFE 0.2 μm filter) and removing the solvent. For example, it can be dried by rotary evaporation.

Hydration of the resulting lipid mixture can be performed, for example, by injecting the mixed lipid into an aqueous solution or sonicating the mixed lipid and aqueous solution. During the formation of liposomes, the liposome component forms a single bilayer (monolayer) or multiple bilayers (multilayer) surrounding a certain volume of aqueous solution that hydrates the liposome component.

In some embodiments, the liposomes are then dehydrated, such as by lyophilization or vacuum lyophilization.

Liposomes are combined with a suitable carrier, such as a carrier comprising a continuous hydrophobic phase. This can be done in various ways.

If the carrier is composed solely of a hydrophobic substance or a mixture of hydrophobic substances (eg, using 100% mineral oil carrier), the liposome can be simply mixed with the hydrophobic substance or a plurality of hydrophobic substances Can be mixed with any one or combination thereof.

Alternatively, if the carrier containing a continuous phase of hydrophobic material contains a discontinuous aqueous phase, the carrier generally represents the form of an aqueous phase emulsion in a hydrophobic phase, such as a water-in-oil emulsion. Take it. Such compositions can contain emulsifiers to stabilize the emulsion and promote uniform distribution of the liposomes. In this regard, an emulsifier may be useful even when an anhydrous carrier is used to facilitate uniform distribution of liposomes in the carrier. Common emulsifiers include mannide oleate (Arlacel ™ A), lecithin (eg S100 lecithin), phospholipids, Tween ™ 80 and Spans ™ 20, 80, 83 and 85. Generally, the volume ratio (v / v) between the hydrophobic material and the emulsifier is in the range of about 5: 1 to about 15: 1, with a ratio of about 10: 1 being preferred.

Liposomes can be added to the finished emulsion, or the liposomes may be present in the aqueous or hydrophobic phase prior to emulsification.

Survivin antigen or additional antigens described herein can be introduced at various different stages of the formulation process. Multiple types of antigens can be incorporated into the composition. As used in this section, the term “antigen” is commonly used and refers to a survivin antigen as described herein, one or more survivin antigens, a further antigen as described herein, or one or more. Of additional antigens, or any combination thereof. The terminology is generally used to describe how any antigen can be formulated in the vaccine composition of the invention. The term “antigen” is the singular “antigen”.
en) "and the plural form" antigens ". Likewise, not all antigens need be introduced into the vaccine composition.

In some embodiments, the antigen is present in an aqueous solution used to hydrate the components used to form the lipid bilayer of the liposome, such as phospholipid (s) and cholesterol. In this case, the antigen is encapsulated in liposomes present in the aqueous interior. If the resulting liposomes are not washed or dried so that there is a residual aqueous solution that is ultimately mixed with a carrier containing a continuous phase of hydrophobic material, there is additional antigen outside the final product liposomes. It is possible to obtain. In the related art, the antigen may be mixed with the components used to form the lipid bilayer of the liposome prior to hydration with an aqueous solution. The antigen may be added to the preformed liposomes, in which case the antigen may be actively carried in the liposome, bound to the surface of the liposome, or the antigen may remain external to the liposome. It may be allowed. In such embodiments, prior to the addition of antigen,
The pre-formed liposome may be an empty liposome (eg, containing no encapsulated antigen or lipid-based adjuvant), or the pre-formed liposome is incorporated into or associated with the liposome. Lipid based adjuvants can be included. Preferably, these steps may be performed prior to mixing with a carrier comprising a continuous phase of hydrophobic material.

In an alternative approach, the antigen may instead be mixed with a carrier comprising a continuous phase of hydrophobic material before, during or after the carrier is combined with the liposomes. If the carrier is an emulsion, the antigen may be mixed with one or both of the aqueous or hydrophobic phase prior to emulsification. Alternatively, the antigen may be mixed with a carrier after emulsification.

The technique of combining an antigen with a carrier so that the antigen is present both in the liposome and in a carrier containing a continuous phase of hydrophobic material should be used in conjunction with encapsulation of the antigen in the liposome as described above. Can do.

In embodiments in which the above procedures for introducing an antigen into a composition are incorporated, the above procedures also apply to T-helper epitopes and / or adjuvants of the compositions described herein. That is, the T-helper epitope and / or adjuvant can be introduced before, during or after the carrier is combined with the liposome, for example, in one or more of the following: (1) forming the lipid bilayer of the liposome Aqueous solution used to hydrate the components used to form, (2) aqueous solution after formation of the lipid bilayer of the liposome, (3) configuration used to form the lipid bilayer of the liposome Ingredient, or (4
) A carrier comprising a continuous phase of hydrophobic material. If the carrier is an emulsion, the T-helper epitope and / or adjuvant may be mixed with one or both of the aqueous or hydrophobic phase before, during or after emulsification.

T on the inside and / or outside of liposomes and on a carrier containing a continuous phase of a hydrophobic substance
The technique of combining the T-helper epitope and / or adjuvant with the carrier so that the helper epitope and / or adjuvant is present, together with the encapsulation of these components in the liposome or the addition of these components to the liposome Can be used.

The T-helper epitope and / or adjuvant can be incorporated into the composition together with the antigen at the same processing step or separately at different processing steps. For example, the antigen, T-helper epitope and the aqueous solution used to hydrate the lipid bilayer-forming liposome component so that all three components of the antigen, T-helper epitope and adjuvant are encapsulated in the liposome. All of the adjuvant may be present. Alternatively, the antigen and T-helper epitope may be encapsulated in liposomes, and the adjuvant may be mixed with a carrier comprising a continuous phase of hydrophobic material. In a further embodiment, the liposome-antigen preparation is passed through a manual mini-extruder and the resulting liposome-antigen preparation is then mixed with a lipid-based adjuvant, eg, in phosphate buffer, to encapsulate the antigen. After the step, T-helper epitopes and / or adjuvants can be incorporated into the composition. After forming the liposomes so that the T-helper epitope and adjuvant can associate with or remain outside of the liposomes,
T-helper epitopes and / or adjuvants can also be incorporated into the composition alone or together with the antigen. T-helper epitopes and / or adjuvants can also be incorporated into or associated with the liposome prior to the addition of the antigen, where the antigen remains outside the preformed liposome or is added to the liposome by further processing / association. To do. In such embodiments, the resulting preparation can be lyophilized in vacuo and then reconstituted with a carrier comprising a continuous phase of hydrophobic material. It will be appreciated that many such combinations are possible.

In a particular embodiment, the vaccine of the invention is DPX-Survivac. DPX-
An exemplary method for preparing Survivac is as follows. However, antigens, adjuvants and T-helper epitopes can be introduced at any stage of the vaccine formulation, in any order, and can ultimately be found inside the liposome, outside or both inside and outside the liposome. It is understood that alternative embodiments, such as those described above, are also encompassed herein.

In an exemplary method, to prepare DPX-Survivac, five survivin antigens (SEQ ID NOs: 2, 4 and 4) are prepared in aqueous buffer by a process of mixing and hydrating lipid components in the presence of survivin antigen and adjuvant. , 6, 7 and 8), adjuvant (poly I
: C polynucleotide) and liposomes (DOPC and cholesterol), and this complex is extruded to obtain a particle size that can be sterile filtered, then filled into vials and dried into a dry cake Freeze-dry in vacuum. Prior to injection, the dry cake is then resuspended in the hydrophobic carrier Montanide ISA51 VG. This exemplary method of preparation involves survivin antigen, any suitable adjuvant and any suitable T
Any combination of helper epitopes can be used.

Where the composition contains one or more additional adjuvants, such additional adjuvants may be suitable in a manner similar to that described above for the adjuvant or for additional adjuvant (s). Can be incorporated into the composition.

Such compositions include stabilizers such as sugars, antioxidants or preservatives, adjuvants, liposomes or continuous hydrophobic carriers that maintain biological activity or improve chemical stability to extend the lifetime of the antigen. Can be added to the product.

In some embodiments, an antigen / adjuvant mixture can be used, in which case the antigen and adjuvant are simultaneously incorporated into the composition. An “antigen / adjuvant mixture” refers to an embodiment in which the antigen and adjuvant are in the same diluent, at least before being incorporated into the composition. The antigen and adjuvant in the antigen / adjuvant mixture are not necessarily required, but may be chemically linked, such as by covalent bonds.

In some embodiments, a carrier comprising a continuous phase of hydrophobic material can itself have adjuvant activity. Incomplete Freund's adjuvant and Montanide® ISA51 VG are examples of hydrophobic carriers with adjuvant effects. As used herein and in the claims, when the term “adjuvant” is used, this means that in addition to any adjuvant activity provided by the carrier comprising a continuous phase of hydrophobic material, the adjuvant The existence of

Mode of Administration The methods of the present invention comprise the combined administration of an agent that interferes with DNA replication and a vaccine comprising at least one survivin antigen.

In order to improve the effectiveness of the vaccine, embodiments of the methods of the present invention include the administration of at least two doses of an agent that interferes with DNA replication prior to the first administration of the vaccine. In conjunction with such embodiments, as long as at least two doses are administered prior to the initial administration of the vaccine, the drug may be added to the subject either before, during or after the course of treatment with the vaccine. Can be administered.

As used herein, the term “combination”, “simultaneous administration”, or “combination administration”.
Is meant to encompass administration of a drug and a vaccine that interferes with DNA replication to a single patient, and includes the case where the drug and vaccine are not necessarily administered by the same route of administration or simultaneously Intended. For example, the agent that interferes with DNA replication and the vaccine may be administered separately, sequentially, or alternately.

As used herein, the expression “at least two doses” is intended to encompass any number of doses greater than a single dose. In certain embodiments, at least two doses are 2
Between -50 doses, more particularly between 2-28 doses, more particularly between 2-14 doses. In certain embodiments, at least two doses are 2, 3, 4, 5, 6, 7, 8,
9, 10, 11, 12, 13 or 14 doses. At least two doses may be separated by any suitable amount of time. In certain embodiments, the at least two doses comprise two daily doses for a period of one week, for a total of 14 doses.

Agents that interfere with DNA replication are generally administered in an amount sufficient to produce an immunomodulatory effect. As used herein, the expression “immunomodulatory effect” refers to the ability of an agent that interferes with DNA replication to modify (modulate) one or more aspects of the immune system and / or cells of the immune system. Point to. In certain embodiments, “an amount sufficient to provide an immunomodulatory effect” is an amount of an agent capable of selectively affecting DNA replication in immune system cells. For example, the amount of drug is
An amount sufficient to selectively target rapidly dividing cells of the immune system to cause programmed cell death. Such an amount can also be described as a “non-chemotherapeutic” dose, as defined herein.

“An amount sufficient to provide an immunomodulatory effect” can be interchangeably referred to herein as a “low dose” amount. Accordingly, the method of the present invention preferably includes the use of a low dose of an agent that interferes with DNA replication in combination with a vaccine. In relation to a particular embodiment of the invention, wherein the agent that interferes with DNA replication is the alkylating agent cyclophosphamide, the expression “low dose” refers to 300 mg / m ² , for example 100-300 mg / m 2. A cyclophosphamide dose of less than ² is generally referred to. For daily administration, the “low dose” of cyclophosphamide is
Generally between about 25-300 mg / day, preferably between 50-150 mg / day. A daily dose amount of 100 mg for cyclophosphamide is particularly suitable. It is also particularly appropriate to administer about 50 mg of cyclophosphamide per dose. The amount of “low dose” with respect to other agents that interfere with DNA replication, as encompassed herein, will be known to those skilled in the art or can be determined routinely.

The method of the invention comprises the steps of administering at least two doses of an agent that interferes with DNA replication, followed by administering the vaccine of the invention. “Subsequent administration” means starting administration of an agent that interferes with DNA replication prior to the initial administration of the vaccine (eg, subjecting the subject to at least two doses of the agent prior to vaccine). However, as described herein, after initiation of vaccine administration, agents that interfere with DNA replication can continue to be administered to the subject. In an alternative embodiment, administration of the agent that interferes with DNA replication is stopped prior to the first administration of the vaccine.

In the methods of the invention, the initial administration of an agent that interferes with DNA replication precedes any treatment of the subject with the vaccine. In certain embodiments, the minimum amount of time separating the initial administration of an agent that interferes with DNA replication and the initial administration of the vaccine can be any amount of time sufficient to produce an immunomodulatory effect. As those skilled in the art will appreciate, the amount of time sufficient to produce an immunomodulatory effect may depend on many variables and may not be the same for an individual patient.

In some embodiments, the initial dose of the agent that interferes with DNA replication is administered at least 12 hours prior to the first dose of vaccine, preferably at least 2, 4 or 6 days prior to the first vaccination. In further embodiments, the initial dose of the agent that interferes with DNA replication is about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14 days prior to the first administration of the vaccine. Or may be provided before. In certain embodiments, the first administration of the agent that interferes with DNA replication occurs 1-4 days prior to the first administration of the vaccine. The first administration of an agent that interferes with DNA replication is particularly suitable about one week before the first administration of the vaccine.

Subsequent doses can be administered at any desired time interval between doses, as long as at least two doses of drug are administered after the first dose with an agent that interferes with DNA replication and before the first dose of vaccine. Dosing of agents that interfere with DNA replication can be stopped before, during or after the course of treatment with the vaccine.

In certain embodiments, the initial dose is followed by one or more maintenance doses. As used herein, the term “maintenance dose” refers to maintaining a sufficient amount of a drug and / or its active metabolite in a subject's body (eg, for the drug and / or its active metabolite, Avoiding systemic clearance of the subject body), given such intervals and / or amounts, D
It is meant to encompass a dose of an agent that prevents NA replication. By providing a maintenance dose, it may be possible to prolong and / or maintain the immunomodulatory effect of an agent that prevents DNA replication before, during and / or after the course of vaccine administration. .

In certain embodiments, in order to maintain an immunomodulatory effect as long as low dose administration is maintained,
Agents that interfere with DNA replication can be administered 1, 2, 3, 4 or 5 times or more daily (eg, multiple smaller doses, for a total of the desired lower daily dose). A single dose (ie, administration) of an agent that interferes with DNA replication, such as a swallowed pill, may be given at a single time point. Alternatively, a single dose of an agent that interferes with DNA replication, such as by intravenous infusion, may be given over a short continuous period of time.

For embodiments of the invention in which the agent that interferes with DNA replication is cyclophosphamide, it may be appropriate to provide a maintenance dose, for example, every 6-18 hours. The person skilled in the art
Appropriate intervals for the maintenance dose will be known or could be determined for cyclophosphamide, as well as other agents that interfere with DNA replication encompassed herein.

In certain embodiments, the agent that interferes with DNA replication is administered for a period of at least 2 consecutive days prior to the first administration of the vaccine. During these days, an agent that interferes with DNA replication is administered to the subject at least 1, 2, 3, or 4 times daily, or any desired number of times to provide a low daily dose of the agent Can do.

In another embodiment, the agent that interferes with DNA replication is administered for a period of about 1 week prior to the first administration of the vaccine. Multiple doses may be given during this one week period. In an exemplary embodiment, D
Agents that interfere with NA replication can be administered daily, every two days, or at any interval suitable to provide the stated maintenance dose. For example, certain embodiments of the methods of the invention comprise administering the agent twice daily for a period of about one week prior to administration of the vaccine.

In the methods of the invention, there may be an interruption in treatment with an agent that interferes with DNA replication prior to the first administration of the vaccine. In such embodiments, administration of an agent that interferes with DNA replication may be stopped permanently or temporarily before the first dose of vaccine. The period between the final dose of the drug that interferes with DNA replication and the initial dose of the vaccine can be any suitable period as long as the subject still benefits from the drug with immunomodulation. For example, without limitation, administration of an agent that interferes with DNA replication can be stopped at the same time as the initial dose of vaccine is administered, or at any time up to about one week before the initial dose of vaccine. For example, but not limited to, administration of an agent that interferes with DNA replication may be stopped about 6, 12, 18, 24, 36, 48, 60, or 72 hours before or more than the initial dose of the vaccine. In certain embodiments,
Administration of agents that interfere with DNA replication is stopped approximately 2, 4 or 7 days before the first dose of vaccine.

In an alternative embodiment, treatment of a subject with an agent that interferes with DNA replication is continued through the course of treatment with the vaccine, with or without intermittent interruption during administration of the agent. In a further embodiment, treatment with an agent that interferes with DNA replication can continue after cessation of vaccination.

Thus, in certain embodiments, agents that interfere with DNA replication can be administered during the period prior to each administration of the vaccine. Alternatively, agents that interfere with DNA replication can only be administered during the period prior to the first dose of vaccine.

As described herein, treatment with an agent that interferes with DNA replication may continue after the initial administration of the vaccine. In certain embodiments, administration of an agent that interferes with DNA replication is continued on a daily basis throughout the course of treatment with the vaccine, with or without intermittent interruption. Thus, in some embodiments, the agent will be administered before and during treatment with the vaccine. In such cases, once vaccine administration is initiated, agents that interfere with DNA replication can be administered simultaneously with the vaccine, immediately sequentially, or at different times of the day. When an agent that interferes with DNA replication is administered at the same time as the vaccine, the agent can be included in the vaccine composition of the invention as a single composition or can be administered in separate compositions.

Alternatively, administration of an agent that interferes with DNA replication may be suspended for the day on which the vaccine is administered. Accordingly, the regimen of the present invention may include the step of interrupting administration of an agent that interferes with DNA replication during the course of vaccine administration.

Embodiments described herein for administering an agent that interferes with DNA replication prior to the first administration of the vaccine also apply to drug administration after the initial administration of the vaccine (eg, prior to each subsequent administration of the vaccine). .

As a particularly suitable embodiment, the methods of the present invention comprise the regular treatment of a subject with an agent that interferes with DNA replication. For the purposes of the present invention, “regular treatment”, “regular regimen” or “regular dosing” etc. are meant to refer to frequent administrations below the amount of the normal dose of an agent that prevents DNA replication. As used herein, the term “amount of normal dose” includes, for example, but is not limited to: (i) an established maximum tolerated dose (MTD) or standard dose via a conventional dosing schedule, or (ii) ) It can refer to any where a single bolus amount of a low dose has been established for a particular agent that prevents DNA replication more than the low dose amount.

Regular dosing may result in a cumulative dose that is the same, lower, or higher than that administered via a conventional dosing schedule over a particular period of time. In particularly suitable embodiments, this is achieved by extending the time frame during which the medication is performed and / or increasing the frequency of administration but reducing the dosage compared to the normal dosage. The For example, when administering a drug that interferes with DNA replication in a low dose amount of 300 mg / m ² in general (eg, by a single bolus injection), regular regimens can be administered over a period of several days by administering frequent low doses. It is possible to include administering the same amount. This approach allows regular dosing to be used to provide, for example, the maintenance doses described herein.

In certain embodiments of the methods of the invention, regular treatment with an agent that interferes with DNA replication is over a certain period of time, such as a period of consecutive days, such as 2, 3, 4, 5, 6 or 7 or more. It is intended to encompass daily low dose administration of the drug. During these days of regular dosing, agents that interfere with DNA replication may be provided at frequent, regular intervals, or at various intervals. For example, in certain embodiments, the dose of an agent that prevents DNA replication is 1, 2
It may be administered every 3, 4, 6, 8, 12 or 24 hours. In another embodiment, DN
A dose of an agent that prevents A replication may be administered every 2, 3, or 4 days.

In some embodiments of the methods of the invention, there may be interruptions or gaps during regular treatment with agents that interfere with DNA replication. In such a method, regular treatment with an agent that interferes with DNA replication can be carried out periodically in alternating periods of administration and periods of no administration. Agents that interfere with DNA replication are particularly suitable for administration to subjects daily at alternating weekly intervals. For example, an agent that interferes with DNA replication is administered for one week, then the treatment is suspended for one week and the cycle is repeated.

Accordingly, in certain embodiments, the methods of the invention may be applied to a subject daily for a period of one week every other week.
Administering an agent that interferes with NA replication. In certain aspects of such embodiments, administration of the agent that interferes with DNA replication is initiated about one week prior to the first dose of vaccine.

In connection with the vaccines of the present invention, in some embodiments, the vaccine is targeted at 1 per week.
Once, every 2 weeks, or once every 3 weeks may be particularly appropriate, 1 every 3 weeks
Times are preferred. However, the frequency and duration of vaccine administration can be adjusted as desired for any given subject, and once every week, once every two weeks, or once every three weeks.
It can be more or less frequent. The interval between doses may also not be constant during the course of treatment with the vaccine. In the method of the present invention, the vaccine is 1, 2, 3, 4, 5, 6, 7
, 8, 9, 10 or more times. Vaccine treatment can continue for an unspecified period, depending on how far the subject's cancer treatment is progressing.

In certain embodiments of the methods of the invention, the agent that interferes with DNA replication may be administered as a priming agent during an intermittent period prior to each administration of the vaccine.

In certain embodiments, the methods of the invention comprising a combination of an agent that interferes with DNA replication and a survivin vaccine, wherein the vaccine is once every 3 weeks (eg, days 0, 21, 42, 63, 84, etc.). Initial administration of an agent that interferes with DNA replication, beginning about 1 week before the first vaccine administration (eg, day -7) and continues at alternating weekly intervals And every day (eg regular). Such a treatment regime is shown in FIG.

As will be appreciated by those skilled in the art, the frequency and duration of administration of an agent that interferes with DNA replication and the vaccine can be adjusted as desired for any given subject. Factors that can be considered are
For example, the nature of one or more survivin antigens in the vaccine, the type of cancer, the subject's age, physical condition, weight, sex and diet, and other clinical factors.

Agents that interfere with DNA replication can be administered by any suitable delivery means and any suitable route of administration. In certain embodiments, the agent that interferes with DNA replication is administered orally, such as in the form of a pill, tablet, or capsule. In an alternative embodiment, the agent is administered by injection (eg intravenously). In certain embodiments of the methods of the invention, the agent is cyclophosphamide, which is administered orally.

The vaccines of the invention described herein can be formulated in a form suitable for oral, nasal, rectal or parenteral administration. Parenteral administration includes intravenous, intraperitoneal, intradermal, subcutaneous, intramuscular, transepithelial, intrapulmonary, intrathecal, and topical modes of administration. In embodiments where the vaccine is formulated as a composition comprising one or more survivin antigens, liposomes, and a carrier comprising a continuous phase of a hydrophobic substance, a particularly suitable route of administration is a depot at the site of injection. Injection (eg, intradermal, intramuscular or subcutaneous) may be used to achieve the effect. Vaccines and agents that interfere with DNA replication are not necessarily administered by the same route of administration or simultaneously.

In certain embodiments of the methods of the invention, the agent that interferes with DNA replication is an alkylating agent, such as, for example, cyclophosphamide.

Treatment Indications As described herein, the methods of the invention relate to the treatment of cancer. Cancers that can be treated and / or prevented with the methods of the present invention can include, for example, any cancer that expresses survivin or overexpresses survivin compared to normal cells.

In certain embodiments, cancers that can be treated by the methods of the invention include, but are not limited to, carcinomas, adenocarcinomas, lymphomas, leukemias, sarcomas, blastomas, myeloma and germ cell tumors. In certain embodiments, the cancer is in the form of a solid tumor. Although not limited, particularly suitable embodiments include glioblastoma, multiple myeloma, ovarian cancer, fallopian tube cancer, or peritoneal cancer.

In some embodiments, the subject may have undergone surgery to remove a large bulk of the tumor, and the methods of the invention may be applied before and / or after tumor bulk resection. In other embodiments, the subject may have undergone radiation therapy, chemotherapy, or some other non-surgical procedure that controls or kills cancerous or malignant cells, and the method of the invention comprises Can be applied prior to or following such therapy. In certain embodiments, the cancer is in an advanced stage.

As used herein, the terms “tumor”, “tumor cell”, “cancer” and “cancer cell” (used interchangeably) refer to a significant loss of control of cell proliferation or immortality. Refers to a cell that exhibits an abnormal growth characterized by an activated cell. The term "cancer" or "tumor"
Includes metastatic as well as non-metastatic cancers or tumors. Cancer can be diagnosed using criteria generally accepted in the art, including the presence of malignant tumors.

“Treating” or “treatment” or “preventing” as referred to herein.
Alternatively, “prevention” refers to an approach for obtaining beneficial or desired results, including clinical results. Beneficial or desired clinical outcome includes, but is not limited to, alleviation or amelioration of one or more symptoms or conditions, reduction of the degree of disease, stabilization of disease state, prevention of disease development, disease Prevention of spreading, delaying or slowing disease progression, delaying or slowing disease onset, conferring protective immunity against pathogenic factors, and ameliorating or alleviating disease states. “Treating” or “preventing” can also mean prolonging the patient's survival beyond what would be expected in the absence of treatment, temporarily blocking disease progression. More preferably, it includes preventing the occurrence of a disease, such as by preventing infection of a subject. “Treating” or “preventing” can also refer to a reduction in the size of a tumor mass.

In the treatment and / or prevention of cancer, the methods of the invention can be used to “enhance the efficacy of a vaccine” as this expression is described herein. This can include improving the effectiveness of the vaccine in inducing either or both a cell-mediated immune response or a humoral immune response. This can also include reducing tumor-induced immunosuppression.

As used herein, “inducing” or “inducing” an immune response means
To elicit, enhance and / or enhance an immune response. Inducing an immune response means that the immune response is enhanced, increased, improved or enhanced for the benefit of the subject as compared to a previous immune response state, for example, prior to application of the method of the invention. It includes cases where

As used herein, the term “cell-mediated immune response” refers to a subject's body in response to introduction of an antigen into the subject's body, antigen-specific cytotoxic T lymphocytes, macrophages, macrophages, It refers to an increase in the amount of natural killer cells or cytokines.

Cell-mediated immunity is not associated with antibodies, but rather with activation of macrophages and natural killer cells, production of antigen-specific cytotoxic T lymphocytes and release of various cytokines in response to antigen It is an immune response. Cytotoxic T lymphocytes are a subgroup of T lymphocytes (a type of white blood cell) that can induce the death of infectious cells or tumor cells, and cytotoxic T lymphocytes are viruses (or others). Cells that are infected with, or otherwise, damaged or otherwise dysfunctional cells.

Most cytotoxic T cells express T cell receptors that can recognize specific peptide antigens that bind to class IMHC molecules. Such CTLs also express CD8 (CD8 + T cells), which is attracted to a portion of class IMHC molecules. Such affinity maintains close binding of CTL and target cells to each other during antigen-specific activation.

Cellular immunity is antigen-specific, for example, capable of lysing somatic cells that present epitopes of foreign antigens on their surface such as virus-infected cells, cells with intracellular bacteria, and cancer cells that present tumor antigens. By activating cytotoxic T lymphocytes (eg, antigen-specific CD8 + T cells); activating macrophages and natural killer cells so that they can destroy intracellular pathogens; and stimulating cells It protects the body by secreting a variety of cytokines that affect the function of other cells involved in adaptive and innate immune responses.

Cellular immunity is an important component of the adaptive immune response, including dendritic cells, B lymphocytes, and
To a lesser extent, it receives antigen recognition by cells through interaction with antigen-presenting cells such as macrophages,
1. Antigen-specific cytotoxicity T capable of inducing apoptosis in somatic cells presenting an epitope of a foreign antigen on its surface, such as virus-infected cells, cells with intracellular bacteria, and cancer cells presenting tumor antigens Activating lymphocytes;
2. 2. Activate macrophages and natural killer cells so that they can destroy intracellular pathogens; Stimulating cells to secrete various cytokines that affect the function of other cells involved in adaptive and innate immune responses,
The body is protected by various mechanisms.

Cell-mediated immunity is most effective at removing virus-infected cells, but is also involved in protection against fungi, protozoa, cancer, and intracellular bacteria. It also plays an important role in transplant rejection.

Because cell-mediated immunity involves the involvement of various cell types and is mediated by different mechanisms,
Several methods can be used to demonstrate induction of immunity and improved efficacy after application of the methods of the invention. These can be broadly classified into i) specific antigen presenting cells, ii) specific effector cells and their functions, and iii) detection of the release of soluble mediators such as cytokines.

i) Antigen presenting cells: Dendritic cells and B cells (and to a lesser extent macrophages) are equipped with special immunostimulatory receptors that allow for enhanced T cell activation, and professional antigen presenting cells ( APC). These immunostimulatory molecules (also called costimulatory molecules) are up-regulated in these cells during the process of antigen presentation to effector cells such as CD4 + and CD8 + cytotoxic T cells after infection or vaccination. The Such costimulatory molecules (such as CD80, CD86, MHC class I or MHC class II), together with antibodies that specifically identify APC (such as CD11c against dendritic cells),
It can be detected by using flow cytometry with fluorescent dye-conjugated antibodies against these molecules.

ii) Cytotoxic T cells: (Tc, killer T cells, or cytotoxic T lymphocytes (CT
L), also known as L), is a subgroup of T cells that induces the death of cells infected with viruses (and other pathogens) or expressing tumor antigens. Such a CTL is
It directly attacks other cells with specific foreign or abnormal molecules on its surface. Such cytotoxic ability can be detected using an in vitro cytolysis assay (chromium release assay). Thus, induction of adaptive cellular immunity can be demonstrated by the presence of such cytotoxic T cells, where target cells are produced in vivo after vaccination or infection when loaded with antigen. Lysed by specific CTL.

Naive cytotoxic T cells are activated when their T cell receptor (TCR) interacts strongly with MHC class I molecules bound to the peptide. This affinity depends on the type and orientation of the antigen / MHC complex and keeps the CTL and infected cells tied together.
Once activated, CTL undergoes a process called clonal expansion, where CTL
Gains functionality and divides rapidly to produce an army of “armed” effector cells. The activated CTL then migrates throughout the body looking for cells with its unique MHC class I + peptide. This is used to determine peptide-M in flow cytometry assays.
Such CTLs can be identified in vitro by using HC class I tetramers.

When exposed to such infected or dysfunctional somatic cells, effector CTLs form perforin and granulysin, i.e. pores in the cell membrane of the target cell, allowing ions and water to flow into the infected cell, Releases cytotoxins that burst or lyse. CTL releases granzyme, a serine protease that enters cells via pores and induces apoptosis (cell death). Release of these molecules from CTL can be used as a measure of the success of inducing a cellular immune response after vaccination. this is,
It can be performed by enzyme immunosorbent assay (ELISA) or enzyme immunospot assay (ELISPOT), which can quantitatively measure CTL. CTL is IFN-γ
Quantitative measurement of IFN-γ producing CD8 cells should be achieved by ELISPOT and by flow cytometric measurement of intracellular IFN-γ in such cells. Can do.

CD4 + “helper” T cells: CD4 + lymphocytes, or helper T cells, are immune response mediators and play an important role in establishing and maximizing the capacity of an adaptive immune response. These cells have neither cytotoxic or phagocytic activity, nor can they kill infected cells or remove pathogens, but are essentially immune by directing other cells to perform these tasks. “Manage” responses. Named Th1 and Th2,
Two types of effector CD4 + T helper cell responses can be induced by professional APC, each designed to eliminate different types of pathogens.

Helper T cells are T cell receptors that recognize antigens bound to class II MHC molecules (T
CR) is expressed. Activation of naive helper T cells causes naive helper T cells to release cytokines, which affects the activity of many cell types, including APCs that have activated naive helper T cells. Helper T cells require a much milder activation stimulus than cytotoxic T cells. Helper T cells can provide special signals that “help” activate cytotoxic cells. Two types of effector CD4 + T helper cell responses, named Th1 and Th2, are professional APCs
Each of which is designed to eliminate different types of pathogens.
These two Th cell populations differ in the pattern of effector proteins (cytokines) they produce. In general, Th1 cells assist the cellular immune response by activating macrophages and cytotoxic T cells, while Th2 cells are B for conversion to plasma cells.
Promotes the humoral immune response by stimulating cells and by forming antibodies. For example, responses regulated by Th1 cells can induce IgG2a and IgG2b in mice (IgG1 and IgG3 in humans) and can favor cell-mediated immune responses to antigens. If the IgG response to the antigen is modulated by Th2-type cells, it can primarily enhance the production of IgG1 in mice (IgG2 in humans). T
Measurement of cytokines associated with the h1 or Th2 response will provide a measure of successful vaccination. This is because TFN such as IFN-γ, IL-2, IL-12, and TNF-α.
It can be achieved by a specific ELISA designed for h1 cytokines or Th2 cytokines such as IL-4, IL-5, IL10, among others.

iii) Measurement of cytokines released from regional lymph nodes is a good indicator of successful immunization. As a result of antigen presentation and maturation of immune effector cells such as APC and CD4 + and CD8 + T cells, several types of cytokines are released by lymph node cells.
By culturing these LNCs in vitro in the presence of the antigen, IFN-γ,
For certain important cytokines, such as IL-2, IL-12, TNF-α and GM-CSF, an antigen-specific immune response can be detected by measuring release. This can be done by ELISA using recombinant cytokine as culture supernatant and standard.

Successful immunization can be determined by several methods known to those of skill in the art including, but not limited to, hemagglutination inhibition (HAI) and serum neutralization inhibition assays to detect functional antibodies; vaccination A challenge test in which the subject is challenged with the relevant pathogen to determine the effectiveness of vaccination; and a population of cells that express a specific cell surface marker, eg, in the identification of activated or memory lymphocytes Use of a fluorescence activated cell sorter (FACS). One skilled in the art can also determine whether the effectiveness of the cell-mediated immune response has been improved by the methods of the invention using other known methods. For example, Current Protocols in Immunology Coligan et al., Ed.
iley Interscience, 2007).

In some embodiments, the methods of the invention are used to treat cancer by inducing a humoral immune response or by improving the effectiveness of a vaccine in inducing a humoral immune response. Is also possible. Such an embodiment may have particular use when the vaccine of the invention comprises additional antigens as described herein other than the survivin antigen. Such methods may include treating cancer by inducing both cell-mediated and humoral immune responses.

A humoral immune response is mediated by secretory antibodies produced in cells of the B lymphocyte lineage (B cells), as opposed to cell-mediated immunity. Such secreted antibodies flag these substances and pathogens for binding and destroying antigens, such as antigens on the surface of foreign substances and / or pathogens (eg viruses, bacteria, etc.).

An “antibody” is a protein comprising one or more polypeptides substantially or partially encoded by immunoglobulin genes or fragments of immunoglobulin genes.
The recognized immunoglobulin genes include the kappa, lambda, alpha, gamma, delta, epsilon and mu constant region genes, as well as the myriad immunoglobulin variable region genes. Light chains are classified as kappa or lambda. Heavy chains are classified as γ, μ, α, δ, or ε, which
The immunoglobulin classes, IgG, IgM, IgA, IgD and IgE, respectively, are defined. A typical immunoglobulin (antibody) structural unit comprises a protein containing four polypeptides. Each antibody structural unit is composed of two identical pairs of polypeptide chains, each having one “light” chain and one “heavy” chain. The N-terminus of each chain defines a variable region that is primarily responsible for antigen recognition. Antibody structural units (eg, those of the IgA and IgM classes) can also assemble together with each other and with additional polypeptide chains to form oligomeric forms, eg, IgM pentamers associated with J chain polypeptides. it can.

Antibodies are the antigen-specific glycoprotein products of a subset of leukocytes called B lymphocytes (B cells). Binding of the antigen to the antibody expressed on the surface of the B cell induces and activates an antibody response, including stimulation of the B cell, which can undergo terminal differentiation through mitosis,
This plasma cell is specialized in the synthesis and secretion of antigen-specific antibodies.

B cells are the only producers of antibodies during the immune response and are therefore a key element of effective humoral immunity. In addition to mass production of antibodies, B cells also serve as antigen presenting cells and can present antigens to T cells such as T helper CD4 or cytotoxic CD8, thus spreading the immune response. B cells, as well as T cells, are part of the adaptive immune response that can promote vaccine efficacy. During an active immune response induced by either vaccination or natural infection, antigen-specific B cells are activated and proliferated clonally. During proliferation, B cells evolve to have a higher affinity for the epitope. B cell proliferation can be induced indirectly by activated T helper cells, and toll-like receptors (
It can also be induced directly through stimulation of receptors such as (TLR).

Antigen presenting cells such as dendritic cells and B cells can be attracted to the vaccination site and interact with antigens and adjuvants contained in the vaccine. The adjuvant stimulates and activates the cells, and the antigen provides a blueprint of the target. Different types of adjuvants send different stimulation signals to the cells. For example, poly I: C polynucleotide (TLR3
Agonists) can activate dendritic cells, but not B cells. Adjuvants such as Pam3Cys, Pam2Cys and FSL-1 are particularly good at activating B cells to initiate their proliferation, which is expected to promote the generation of antibody responses (Moyle et al., Curr Med Chem, 2008; So., J Immunol, 2012).

As used herein, the term “antibody response” refers to an increase in the amount of antigen-specific antibodies in a subject's body in response to introduction of an antigen into the subject's body.

One way to assess antibody response is to measure the titer of antibodies that are reactive with a particular antigen. This is an enzyme immunosorbent assay (ELISA) of antibody-containing substances obtained from animals.
) And other methods known in the art. For example, the titer of serum antibodies that bind to a particular antigen can be determined in the subject both before and after exposure to the antigen. A statistically significant increase in the titer of antigen-specific antibody after exposure to the antigen will indicate that the subject has initiated an antibody response to the antigen.

Other assays that can be used to detect the presence of antigen-specific antibodies include, but are not limited to, immunological assays (eg, radioimmunoassay (RIA)), immunoprecipitation assays and protein blot (eg, Western blot) assays, and Neutralization assay (
For example, neutralization of viral infectivity in in vitro or in vivo assays).

The methods of the invention can treat and / or prevent cancer by improving the effectiveness of the vaccine in inducing a humoral immune response.

The humoral immune response is the main mechanism of effective infectious disease vaccines. However, the humoral immune response can also be useful to fight cancer. While complementing cancer vaccines designed to generate cytotoxic CD8 + T cell responses that can recognize and destroy cancer cells, responses mediated by B cells are in some cases the most beneficial Thus, cancer cells can be targeted through other mechanisms that can cooperate with cytotoxic CD8 + T cells. Examples of mechanisms of anti-tumor responses mediated by B cells (eg mediated by a humoral immune response) include:
These include, but are not limited to: 1) Antibodies produced by B cells that bind to surface antigens found on tumor cells or other cells that affect tumor formation. For example, such antibodies induce target cell death through antibody-dependent cell-mediated cytotoxicity (ADCC) or complement binding, potentially leading to the release of additional antigens that the immune system can recognize. 2) binds to receptors on tumor cells and blocks their stimulation,
Antibodies that effectively neutralize their action, 3) antibodies that bind to factors released by or associated with tumors or tumor-associated cells, and regulate signal transduction or cellular pathways that support cancer, and 4) cells Antibodies that bind to internal targets and mediate anti-tumor activity through a currently unknown mechanism.

The subject to be treated by the methods of the present invention can be any vertebrate, preferably a mammal, more preferably a human.

Kits and Reagents For carrying out the methods of the invention, the compositions described herein can optionally be provided to the user as a kit. For example, the kit of the present invention contains one or more components of the composition of the present invention. The kit can further include one or more additional reagents, packaging materials, containers for holding the kit components, and an instruction set or user manual detailing the preferred method of using the kit components. .

In certain embodiments, the vaccine of the invention (eg, DPX-Survivac) is supplied as a kit containing two containers. The container 1 may contain, for example, a vacuum lyophilized adjuvant system (eg liposome), survivin antigen and adjuvant. The container 2 may contain, for example, only an oil component (Montanide (registered trademark) ISA51 VG). An appropriate volume (0.1 or 0.5 mL) of the reconstituted vaccine can be injected subcutaneously.

In certain embodiments, the kit may further contain an agent that prevents DNA replication. D
An agent that prevents NA replication can be included in the kit in a third container, or the agent can be included in container 1 or container 2 above. In certain embodiments, the agent that prevents DNA replication included in the kit is an alkylating agent, such as, for example, cyclophosphamide.

Embodiments of the Invention Specific embodiments of the invention include, but are not limited to:

(1) A method for improving the effectiveness of a vaccine in the treatment of cancer in a subject,
(I) administering to the subject at least twice an agent that interferes with DNA replication in an amount sufficient to produce an immunomodulatory effect;
(Ii) subsequently administering, consisting of, or consisting essentially of administering to the subject a therapeutically effective amount of a vaccine comprising at least one survivin antigen.

(2) The method of paragraph (1), comprising administering to the subject an initial dose of the drug at least 2 days prior to administering the vaccine, preferably at least 4 days prior to administering the vaccine.

(3) The method of paragraph (1), comprising administering to the subject an initial dose of the drug about one week before administering the vaccine.

(4) The method according to any one of paragraphs (1) to (3), comprising the step of administering the drug for a period of at least 2 consecutive days.

(5) The method of any one of paragraphs (1) to (4), comprising administering to the subject an initial dose of drug followed by administration of a maintenance dose of drug one or more times.

(6) The method according to any one of paragraphs (1) to (5), comprising administering the drug to the subject at least once, twice, three times, or four times daily before administering the vaccine.

(7) The method according to any one of paragraphs (1) to (6), comprising administering the drug twice daily for a period of about 1 week before administering the vaccine.

(8) Stop administering the drug to the subject before administering the vaccine, paragraph (1
) To (7).

(9) Continue administering the drug to the subject while administering the vaccine, paragraph (1)
To the method according to any one of paragraphs (7).

(10) The method according to any one of paragraphs (1) to (9), comprising a step of administering the vaccine to the subject about once every three weeks.

(11) The method according to any one of paragraphs (1) to (10), comprising the step of administering the vaccine to the subject two times, three times, four times or more times.

(12) The method of any one of paragraphs (1) to (11), comprising administering an agent that interferes with DNA replication to a subject in a regular regimen.

(13) The method of paragraph (12), wherein the regular regimen comprises administering the drug daily to the subject for a period of about one week every other week.

(14) Paragraph (13) comprising the step of administering the drug to the subject from about one week before administering the initial dose of vaccine, and the step of administering the vaccine to the subject about once every three weeks.
) Method.

(15) The method according to any one of paragraphs (1) to (14), wherein the survivin antigen is a peptide antigen or a nucleic acid encoding the antigen.

(16) A peptide wherein the survivin antigen comprises, consists of, or consists essentially of an amino acid sequence derived from survivin protein (SEQ ID NO: 11) capable of inducing a cytotoxic T lymphocyte (CTL) response in a subject The method according to any one of paragraphs (1) to (15), wherein the method is an antigen or a nucleic acid molecule encoding the peptide antigen.

(17) Survivin antigen is an amino acid sequence, FEELTLGEF (SEQ ID NO: 1); FTELTLGEF (SEQ ID NO: 2); LTLGEFLKL (SEQ ID NO: 3); LMLGEFLKL (SEQ ID NO: 4); RISTFKNWPF (SEQ ID NO: 5); ); STFKNWPFL (SEQ ID NO: 7); and LPPAWQPFL (SEQ ID NO: 8) or any combination thereof, a peptide antigen consisting of, consisting essentially of, or a nucleic acid molecule encoding said peptide antigen Is a paragraph (
The method according to any one of paragraphs 1) to (16).

(18) The at least one survivin antigen has an amino acid sequence FTELTLGEF (SEQ ID NO: 2
); LMLGEFLKL (SEQ ID NO: 4); RISTFKNWPK (SEQ ID NO: 6); comprising, consisting of, or consisting essentially of a mixture of five peptide antigens including STFKNWPFL (SEQ ID NO: 7) or LPPAWQPFL (SEQ ID NO: 8) The method according to any one of paragraphs (1) to (14).

(19) The agent according to any one of paragraphs (1) to (18), wherein the agent that prevents DNA replication can selectively target rapidly dividing immune system cells and cause programmed cell death. Method.

(20) The method according to any one of paragraphs (1) to (19), wherein the agent that prevents DNA replication is an alkylating agent.

(21) Paragraph (20), wherein the alkylating agent is a nitrogen mustard alkylating agent
The method described in 1.

(22) The nitrogen mustard alkylating agent is cyclophosphamide, paragraph (
21).

(23) In paragraph (22), the amount sufficient to produce an immunomodulatory effect is about 25-300 mg / day, preferably about 50-100 mg / day, more preferably about 100 mg / day of cyclophosphamide. The method described.

(24) The method of paragraph (22) or (23), wherein the amount sufficient to produce an immunomodulatory effect is about 50 mg of cyclophosphamide per dose.

(25) The method according to any one of paragraphs (22) to (24), comprising a step of orally administering cyclophosphamide to a subject.

(26) administering the vaccine to the subject by injection, such as subcutaneous injection, the paragraph (
The method according to any one of paragraphs 1) to (25).

(27) The vaccine is a composition comprising, consisting of, or consisting essentially of at least one survivin antigen, a liposome, and a carrier comprising a continuous phase of a hydrophobic substance.
The method according to any one of paragraphs (1) to (26).

  (28) The method of paragraph (27), wherein the composition further comprises a T helper epitope.

(29) The method of paragraph (28), wherein the T helper epitope is a peptide comprising, consisting of, or consisting essentially of the amino acid sequence AQYIKANSKFIGITEL (SEQ ID NO: 9).

(30) The method according to any one of paragraphs (27) to (29), wherein the composition further comprises an adjuvant.

(31) The method of paragraph (30), wherein the adjuvant is a poly I: C polynucleotide.

(32) Paragraph (where the carrier is a hydrophobic material such as vegetable oil, nut oil or mineral oil)
27) The method according to any one of paragraphs (31).

(33) the carrier is mineral oil or mannide oleate in mineral oil solution, eg M
The method according to any one of paragraphs (27) to (31), which is ontanide (registered trademark) ISA51.

(34) The agent improves the efficacy of the vaccine by directly enhancing the immune response to the antigen, such as increasing the activity or number of antigen-specific CD8 + T cells, paragraph (1
) To (33).

(35) Increasing the activity or number of antigen-specific CD8 + T cells comprises total CD8
Paragraph (34), with enrichment of antigen-specific CD8 + T cells by a relative decrease in the number of + T cells
The method described in 1.

(36) The drug is eg CD4 ⁺ FoxP3 ⁺ regulatory T cells (Treg), bone marrow derived suppressor cells (MDSC) and / or CD19 ⁺ CD1d ⁺ CD5 ⁺ B cells (B
The method of any one of paragraphs (1) to (33), wherein the effectiveness of the vaccine is improved by reducing the number or activity of suppressive immune cells such as reg).

(37) The method according to any one of paragraphs (1) to (36), wherein the cancer is a subcutaneous solid tumor.

(38) The method according to any one of paragraphs (1) to (36), wherein the cancer is ovarian cancer, fallopian tube cancer or peritoneal cancer.

  (39) The method according to any one of paragraphs (1) to (38), wherein the subject is a human.

(40) The use of an agent that interferes with DNA replication in combination with a vaccine comprising, consisting of, or consisting essentially of at least one survivin antigen to improve the effectiveness of the vaccine in the treatment of cancer. The drug is for administration at least twice prior to the vaccine.

(41) D for use in the method according to any one of paragraphs (1) to (39)
Contains or consists of an agent that interferes with NA replication and at least one survivin antigen,
Or a combination with a vaccine that consists essentially of.

(42) A composition as described herein for use in a method according to any one of paragraphs (1) to (39).

  The invention is further illustrated by the following non-limiting examples.

[Example 1]
A phase I study conducted in the United States (IND # 14731) and Canada (CTA-A # 155301) confirmed that DPX- combined with cyclophosphamide in ovarian cancer patients.
Survivac was examined for safety and immune efficacy.

DPX-Survivac has various HLA-restricted properties (HLA-A1, A2, A3, A2
4 and B7), a candidate vaccine for anti-cancer immunotherapy containing one decapeptide and four nonapeptides derived from survivin protein sequences. In detail, D
PX-Survivac has five synthetic survivin peptides having amino acid sequences, FTELTLGEF (SEQ ID NO: 2), LMLGEFLKL (SEQ ID NO: 4), RISTFKNWPK (SEQ ID NO: 6), STFKNWPFL (SEQ ID NO: 7), and LPPAWQPFL (SEQ ID NO: 8). An antigen, a generic T helper epitope from tetanus toxoid (AQYIKANSKFIGITEL, SEQ ID NO: 9), a poly I: C polynucleotide adjuvant, a liposome composed of DOPC and cholesterol, and a hydrophobic carrier M
ontanide (registered trademark) ISA51 VG. The DPX-Survivac vaccine is designed to target survivin.

In clinical trials, patients with advanced ovarian cancer treated with platinum chemotherapy and showing no disease progression1
Eighteen of nine completed vaccine therapy. Cohort A (6 patients) received 3 0.5 mL vaccine injections at 3 week intervals, and Cohort B and Cohort C (6 patients each) were combined with regular low dose oral cyclophosphamide. Three 0.1 mL or 0.5 mL vaccine injections were received, respectively. The clinical trial was conducted according to the schedule shown in FIG.

CTCAEv4.0 was used to evaluate adverse events. Blood was collected to examine immune function and vaccine-induced T cell immunity (analysis was performed by (i) ELISPOT, (ii) tetramer analysis and (iii) multiparametric intracellular cytokine staining)
. Repeated measures of immunity by ELISPOT at baseline and after 1, 2 and 3 injections were analyzed statistically using a general linear model.

(I) IFN-γ ELISPOT assay to detect functional antigen-specific PBMC Frozen PBMC samples taken from clinical trial subjects were tested in the IFN-γ ELISPOT assay for recall responses to specific test antigens. Pooled thawed PBMC 5
Stimulated with a species survivin peptide and with the corresponding peptide (s) depending on the HLA type of interest. Response to antigen, negative control (cells in medium only) and positive control (PHA) were tested in duplicate wells. In addition to antigen specificity, dose dependence was also tested by testing the antigen at concentrations of 50 and 5 μg / ml. PBMC clinical samples were collected in a 96-well ELSPOT plate with sex-matched PBMC from a healthy control subject.
Seeded at well concentration.

On day 1, the plate is coated with 80 μl / well of primary antibody diluted in PBS and the plate is cooled overnight in a humid box. On day 2, the plate was washed 3 times with 200 μl PBS / well and the plate was flicked to remove excess PBS. Add desired 100 μl / well antigen (s) to T cell activation followed by 10 test or control PBMCs.
0 μl / well was added. For IFN-γ secretion, the cells are incubated at 37 ° C. in a humidified incubator.
And incubated for 24 hours. Until this step, all steps were performed under aseptic conditions. On day 3, wash the plate 3 times with PBS, 3 times with PBS-TWEEN, followed by PB
80 μl / well of biotinylated secondary antibody of S-TWEEN-BSA was added and incubated overnight in a humidified box in a refrigerator. On the 4th day, the plate was PBS-TWEEN200.
The plate was washed 3 times with μl / well, and then 100 μl / well of a third detection reagent of PBS-BSA was added and incubated at room temperature for 2 hours. Plate 3 times with PBS-TWEEN, PB
Wash 3 times with S and 200 μl / well of freshly prepared developer solution will be added. Spot development was monitored at room temperature, typically 10-60 minutes, carefully checking for the absence of color in the control well medium and the appearance of spots in the antigen-containing wells. The reaction was stopped by rinsing the plate with tap water while flicking the plate. Plates were air dried overnight and stored at room temperature in the dark. The ELISPOT plate was then scanned using an automated plate analyzer. The raw counts of SFU were processed and summarized to obtain data on antigen-induced IFN-γ secretion by PBMC.

ELISPOT material:
solution:
1. PBS: Sterile tissue culture tested 2.0.05% PBS-TWEEN: eg 500 μl Tween-2 in 1 L PBS
0
3.1% PBS-BSA: eg 10 g BSA-Fraction V in 1 L PBS (1
%)
4.1% PBS-TWEEN-BSA: for example 1 L PBS-TWEEN with 10 g BS
A-Fraction V added Medium:
Serum-free test medium supplemented with 1% L-glutamine.
Test cells:
Human PBMC (frozen and thawed with liquid nitrogen)
3 × 10 ⁵ cells per well of test sample Incubator: 37 ° C., humidified, 7% CO ₂
AEC solution:
100 mg AEC (3-amino-9-ethylcarbazole) in 10 ml DMF (N, N, dimethylformamide)
Prepared in a glass tube in a fume hood AEC buffer (0.1M acetate)
0.2M acetate _(H 2 O1L per glacial acetic 11.55Ml) 0.2M sodium acetate 148ml added _(H 2 27.2 g per O1L) 352 ml.
Bring to 1 L with H ₂ O. Adjust to pH 5.0 Developing solution (immediate use):
Add 24 ml of AEC buffer to 800 μl of AEC solution. Filter at 0.45 μm. H ₂ O
₂ Add 12 μl (30%)

(Ii) Antigen-specific CD8 + T cells using MHC multimers (tetramers) MHC multimer reagents help to identify antigen-specific CD8 + T cells that occur in vaccinated subjects. Such specific T cells express TCR, which (when conjugated to an MHC molecule) can recognize and bind to the peptide (s) used in the vaccine. The immune response to the vaccine peptide is reflected by the proliferation of antigen-specific T cells. Such CD8 + T cells were in vivo immediately after PBMC thawing and in the presence of survivin peptide antigen contained in DPX-Survivac.
Direct measurements were made after in vitro stimulation and cytokine-induced proliferation.

MHC multimeric reagents, such as tetramers (Beckman Coulter or TC Metric for HLA-A1, A2 and A3, TC Metric for HLA-A24 and B7) were used for the specific detection of vaccine-induced CD8 + T cells. . The assay included ex vivo PBMC and in vitro activated PBMC.
Both used control PBMC and control MHC multimeric reagents. CMV + known healthy donor PBMC along with CMV-specific MHC multimers were used as positive controls. HIV-
Specific reagents are used as negative controls for intra- and inter-assay validity and quality assurance.

A. Ex vivo detection of antigen-specific CD8 + T cells Ex vivo staining of specific T cells in blood was performed with a regulatory T cell (Treg) phenotype by 10-color flow cytometry. Staining cocktails include life / death, CD3, CD4,
CD8, CD45RA, CD27, CD25, Ki67, Foxp3 and subject HLA
A tetrameric reagent compatible with the mold was included. The assay qualification test that verifies that the cell permeability of intracellular Foxp3 staining Treg cells does not interfere with cell surface staining was successfully completed. Ex vivo tetramer analysis consisted of staining PBMCs that had been thawed and aged overnight using an antibody cocktail (shown above) and tetramer reagents for flow cytometry. In brief, thawed PBMC are first stained with tetramer reagent at 4 ° C. for 30 minutes,
Washed in IMF buffer (PBS + 0.5% BSA + 0.01% sodium azide).
Cells were then stained for 30 minutes at 4 ° C. with antibody mixtures containing various fluorochrome conjugate antibodies as phenotypic markers. Cells were then washed, fixed with 1% paraformaldehyde and used for flow cytometry. Since cell permeability to Foxp3 adversely affects CD19 antibody binding, cells were stained with CD19 antibody using separate tubes to detect B cell levels.

B. In vitro activation of PBMC to detect specific CD8 + T cells Thaw and ex viv for in vitro activation and proliferation of antigen specific T cells
o PBMCs derived from the same cells used for analysis were cultured for 10 days in the presence of survivin peptide antigen and cytokines (IL-2 and IL-15). Briefly, viability of cells that were thawed and aged overnight was performed and PBMCs were treated with 10% heat-inactivated FCS, 2 mM.
L glutamine, 50 μM β-mercaptoethanol, 100 U / ml penicillin and 1
00 μg / ml streptomycin, 10 IU / ml human recombinant IL-2 and 10 ng
1 × 10 ⁶ cells in RPMI-1640 complete medium supplemented with / ml human recombinant IL-15 /
Suspended in ml. In a 24 well plate, 1 × 10 ⁶ cells / well were placed in 1.0 ml medium and cells were left untreated or stimulated at a final concentration of 5 μg / ml of HLA-compatible appropriate survivin peptide. Cells were incubated at 37 ° C. in a humidified incubator supplied with 5% CO ₂ . On days 3, 6 and 8, the medium was carefully aspirated without disturbing the cells, leaving a portion of the medium carefully so that the cells did not dry out. Preheated RPMI complete medium with cytokines (10 IU / ml IL-2 and 10 ng / ml IL-15) was added in an appropriate volume (1.0 ml). On day 10, all cells are harvested and washed once with plain RPMI medium and once with IMF buffer, protocol: live / dead, CD3, CD8, CD45RA and depending on the HLA type of the subject, one or Used for tetramer staining (5 colors) according to two MHC multimer reagents. Since the HLA-A2 tetramer can be cross-reactive with PBMC from either A1 or A3 subjects, cells from subjects with the latter two HLA types are also designed for HLA-A2 Tested. In parallel with patient PBMC, CMV + known healthy control PBMCs were also activated with the CEF peptide pool, creating a positive control sample that could be used for intra- and inter-assay comparisons. Following staining, cells were fixed with 1% paraformaldehyde for flow cytometry.

(Iii) Multiparametric flow cytometry (ICS)
Multi-parametric flow cytometry assay allows multiple cytokines / chemokines (IFN-γ, TNF-α, IL-2, IL-4, IL-17, etc.) and phenotypic and / or functional markers (CD3, CD4, CD8) , CD19, CD27, CD
45RA, CD107a, Granzyme-B, CCR7, etc.) can be detected simultaneously, so the multiparametric flow cytometry assay is considered very informative. Also, multifunctional T cells (secreting multiple cytokines) are associated with a protective type 1 immune response, and detecting such cells in participating subjects reflects the immune efficacy of the administered vaccine It was shown that there is a possibility to do.

ICS assays were performed using IFN-γ, TNF-γ, IL-2, IL-17, Granzym
with e-B and CD107a (for cytokines and other functional markers)
Performed as 12-color flow cytometry including death markers, CD3, CD4, CD8, CD45RA, CD27 (as subset and memory differentiation markers). Selecting the phenotypic marker used in the assay allows the identification of specific effector / central memory T cells that may respond to the vaccine antigen of the assay. Cell stimulation conditions included no stimulation, PMA / ronomycin positive control, pooled survivin peptide included in the vaccine, HLA-matched peptide for a given subject, and control PBM
C CEF (CMV / EBV / FLU) peptide pool stimulation was included. Patient's PB
In addition to MC, known HLA-A2 healthy donor PBMC were used as an internal control for quality assurance. Briefly, 10 ⁶ PBMC were allowed to sleep overnight and then stimulated with individual peptides and peptide pools for 1 hour in the presence of anti-CD107a antibody. The final peptide pool or individual peptide concentration used for stimulation was 1 μg / mL. Protein secretion inhibitors (GolgiPlug ™ / GolgiStop ™, BD Bioscience
ce) was added 1 hour after stimulation and the cells were incubated separately for 5 hours at 37 ° C. and 5% CO ₂ . Following in vitro stimulation, the cells are washed and the surface is stained at 4 ° C. for 30 minutes (CD8, CD27, CD3, CD4 and CD45RA and viability markers)
Followed by intracellular staining of fixed / permeabilized cells (IFN-γ, TNF-α for 30 minutes at 4 ° C).
, IL-17, IL-2). Labeled cells were prepared using FACS DiVa software (B
Obtained with an LSRII flow cytometer using D Bioscience)
Analyzed using owJo software. Multifunctional cytokine analysis is performed after each cytokine positive population has been rigorously gated. In addition, a large Fl from multicolor flow cytometry using SPICE, a data mining software application.
The owJo data set was analyzed and normalized data summarized in a chart.

Results Antigen-specific immune responses assessed by production of IFN-γ in ELISPOT analysis were usually established with 1 or 2 vaccinations and were elevated or maintained with boosters (Figure 2).
4). A dose response was observed, resulting in a significantly higher response in cohort C patients (
Cohort C vs. Cohort B, P =. 013). Low dose cyclophosphamide significantly enhanced the 0.5 ml dose (Cohort C vs Cohort A, P = .015). These results show that DPX
-Demonstrating that the combination of immunomodulation with low dose cyclophosphamide in combination with Survivac produced the strongest immune response. Cohort C patients were able to initiate an immune response with only one week of pre-administration of low dose cyclophosphamide, followed by a single dose of vaccine. Responses achieved in Cohort C after 1, 2 or 3 doses (about 2309, 1911 and 2517 spots per 10 ⁶ PBMC) can only be achieved with the combination of survivin vaccine and low dose cyclophosphamide. did it.

The greater degree of immune response generated by survivin vaccines in cohorts B and C was characterized by the detection of circulating antigen-specific T cell responses and the profile of multifunctional T cell responses in blood (FIGS. 5 and 6). . In some subjects, such circulating antigen-specific CD8 + T cells can be detected ex vivo by tetramer staining and such specific T cells can be detected in vitro by HLA-matched peptide antigen (s). It can be further proliferated by stimulation with. Of the 12 subjects receiving DPX-Survivac combination therapy, 10 can be evaluated by tetramer staining and all 10 can be evaluated with DPX-Su.
There was strong evidence of survivin-specific CD8 + T cell induction following 1 or 2 vaccination with rvivac. Importantly, a CD8 + T cell response was maintained with booster vaccination. Since CD8 + T cells are involved in identifying cancer cells, penetrating tumors and killing cancer targets, the activation and maintenance of such specific immune cells is particularly interesting in immunotherapy. The strongest response was observed in Cohort C by tetramer analysis, confirming the results obtained by ELISPOT. Most patients in Cohort C have (in
> 1% of total CD8 + T cells (with vitro stimulation) and 22% of total CD8 + T cells
It had tetramer positivity that reached about. In contrast, the highest tetramer positive recorded in Cohort A was less than 1% (0.7%) of total CD8 + T cells. This demonstrates that the combination of low dose cyclophosphamide and vaccine produced a significantly higher antigen-specific immune response.

Some subjects treated with DPX-Survivac also showed the induction of multifunctional CD8 + T cells that exhibited a protective immune response. 2 of 6 subjects in each of cohorts A and B
Each subject, as well as 5 out of 6 subjects in Cohort C, were positive for multiple cytokine secreting CD8 + T cells. Most of these CD8 cells had a central memory phenotype that showed previous antigen exposure and induction of a sustained immune response to survivin in treated subjects. Table 4 shows the results from a representative subject who was positive for multicytokine positivity after treatment.

The above table (Table 4) provides ICS staining results from representative responders, subjects 09-08, 10-09, 11-10 and 02-16, and shows multicytokine secreting central memory CD8 T cells. Peripheral blood mononuclear cells, intracellular cytokine staining (ICS)
Were tested for the presence of multifunctional CD8 + T cells. After a short period (5 hours) stimulation with survivin peptide, the cells are surface stained for phenotypic markers such as CD3, CD4, CD8, CD27, CD45RA, fixed, permeabilized, INF-γ, TNF-
Further staining for the presence of intracellular cytokines such as α and IL-2. Flow-
Single / multiple cytokine secretion central memory (CD27 + C) at baseline and post vaccination using flow cytometry analysis using Jo software.
D45RA−) CD8 + T cells were detected and delayed differentiated CD8 + T cells (CD3 + CD8 +
Subjects 09-08 with CD45RA + CD27-) were excluded. (+) Indicates that multifunctional T cells were detected in post-treatment blood samples in the frequency range of> 0.05% to> 3.0% for the analyzed memory CD8 + T cell subsets. (-) Indicates a detectable multi-function CD
Indicates that 8T cells are absent. ( ^* ) Was not judged because the quality of PBMC was poor.

[Example 2]
Peripheral blood mononuclear cells (PBMC) from patients 02-04, 11-10, 02-16, 03-07, 09-08, 10-09, and 01-12, as described on day 70 of the study 4 weeks after the third vaccination with DPX-Survivac, given in combination with regular cyclophosphamide. Patient 09-08 was an exception, and the sample analyzed was on study day 126, 12 weeks after the third vaccination. The HLA haplotype of all patients was determined and is shown in parentheses along with the patient ID number (see FIG. 7). Following stimulation with the pooled survivin peptide, the immune response of these patients is
Analyzed ex vivo using the OT assay (FIG. 7, left panel) or by in vitro tetramer analysis by flow cytometry (FIG. 7, right panel). In the ELISPOT assay, patient PBMC were stimulated with pooled peptides, which were modified peptides contained in the vaccine DPX-Survivac (black bars, SurA1.T (
SEQ ID NO: 2), SurA2. M (SEQ ID NO: 4), SurA3. K (SEQ ID NO: 6), and unmodified SurA24 (SEQ ID NO: 7) and SurB7 (SEQ ID NO: 8) peptides), or modified peptides from survivin proteins (white bars, SurA1 (SEQ ID NO: 1), SurA2 (sequence) No. 3), SurA3 (SEQ ID NO: 5)) and any of the alternative peptide pools.

  Table 5 shows the modified peptides contained in DPX-Survivac.

For tetramer analysis, a single peptide (natural or modified) is used to convert PBMC to IL-2.
Stimulated for 10 days in the presence of / IL-15 cytokine, the frequency of antigen-specific T cells was detected using a tetramer reagent designed based on the modified peptide and the corresponding HLA molecule.
Patients have their HLA type (ie, SurA1, HLA-A against HLA-A1)
It is expected that an immune response to peptides corresponding to SurA2 against 2 and SurA3 against HLA-A3) will occur. As shown in FIG. 7, DPX-Survivac
The immune response generated to the modified survivin peptide contained in is shown to be significantly cross-reactive with the native peptide as seen in both ELISPOT and tetramer analysis of blood samples after vaccination. Thus, DPX-Survivac vaccine derived CD8 + T cells are expected to target tumor cells that express the natural peptide in combination with the corresponding HLA molecule on the cell surface. Since immune cross-reactivity to the native survivin peptide sequence is observed, inclusion of the natural peptide in the vaccine allows the native sequence to be recognized if the natural sequence is present on the cell targeted by the vaccine. It is expected that an immune response will occur.

All publications and patent applications cited herein are hereby incorporated by reference as if each individual publication or patent application was clearly and individually indicated to be incorporated by reference. It is. Citation of any publication is with respect to its disclosure prior to the filing date and should not be construed as an admission that the invention is not entitled to antedate such publication by any prior invention.

Although the foregoing invention has been described in some detail for purposes of explanation and illustration for purposes of clarity of understanding, certain changes and modifications may be made without departing from the spirit or scope of the appended claims. Additions to the present invention will be readily apparent to those skilled in the art in light of the teachings of the present invention.

As used herein and in the appended claims, the singular forms “a”, “a
It should be noted that “n” and “the” encompass multiple references unless the context clearly dictates otherwise. 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 this invention belongs.

Here, the phrase “and / or” used in the specification and claims is present in the elements so conjoined, that is, together in some cases and apart in other cases. It should be understood to mean “one or both” of the elements to be. Multiple elements listed with “and / or” should be construed in the same manner, ie, “one or more” of the elements so conjoined. In addition to the elements specifically identified by the “and / or” clause, other elements may optionally be present, whether related to or unrelated to those elements specifically identified. Therefore, as a non-limiting example,
When used in conjunction with a non-limiting language such as “comprising”, references to “A and / or B” are in one embodiment only A (optionally including elements other than B); In embodiments, only B (optionally including elements other than A); in still other embodiments, both A and B (optionally including other elements);

As used herein in the specification and in the claims, “or” should be understood to include the same meaning as “and / or” as defined above. For example, when extracting items in a list, “or” or “and / or” is inclusive, ie includes at least one of several elements or lists of elements, but more than one Including, and optionally, items that are not on the list.

As used herein, whether in the specification or the appended claims, the transition terms “comprising”, “including”, “carryi”
ng) "," having "," containing "," involving ", etc. means inclusive or non-limiting (ie including but not limited to) They do not exclude uncited elements, materials or method steps. Only the transitional phrases “consisting of” and “consisting essentially of” are exclusive or semi-exclusive transitional phrases, respectively, with respect to the claims and paragraphs of the exemplary embodiments herein. The transitional phrase “consisting of” excludes any element, step, or ingredient not specifically recited. Transition phrase “consists essentially of”
Limits its scope to the specified elements, materials or steps and to those that do not substantially affect the basic characteristic (s) of the invention disclosed and / or claimed herein.

As used herein, whether in the specification or the appended claims, the transition terms “comprising”, “including”, “carrying”, “having” , “Containing”, “including”, etc. should be understood to be inclusive or non-limiting (ie, including but not limited to) They do not exclude uncited elements, materials or method steps. Only the transitional phrases “consisting of” and “consisting essentially of” are exclusive or semi-exclusive transitional phrases, respectively, with respect to the claims and paragraphs of the exemplary embodiments herein. The transitional phrase “consisting of” excludes any element, step, or ingredient not specifically recited. The transitional phrase “consisting essentially of” substantially covers its scope to the specified element, material or step, and to the basic characteristic (s) of the invention disclosed and / or claimed herein. Limit to things that have no effect.

The present invention includes the following aspects.
[1]
A method for improving the effectiveness of a vaccine in treating a subject's cancer, comprising:
(I) administering to the subject at least twice an agent that interferes with DNA replication in an amount sufficient to produce an immunomodulatory effect;
(Ii) subsequently administering to said subject a therapeutically effective amount of a vaccine comprising at least one survivin antigen;
Including methods.
[2]
The method of [1], comprising administering an initial dose of the agent to the subject at least 2 days prior to administering the vaccine, preferably at least 4 days prior to administering the vaccine.
[3]
The method of [1], comprising administering an initial dose of the agent to the subject about 1 week before administering the vaccine.
[4]
The method according to any of [1] to [3], comprising a step of administering the drug for a period of at least 2 consecutive days.
[5]
The method of any of [1]-[4], comprising administering to the subject an initial dose of the drug followed by administering a maintenance dose of the drug one or more times.
[6]
The method according to any one of [1] to [5], comprising the step of administering the drug to the subject at least once, twice, three times or four times daily before administering the vaccine.
[7]
The method according to any one of [1] to [6], comprising the step of administering the drug twice a day for a period of about one week before administering the vaccine.
[8]
The method according to any one of [1] to [7], wherein the step of administering the drug to the subject is stopped before administering the vaccine.
[9]
The method according to any one of [1] to [7], wherein the step of administering the drug to the subject is continued during the administration of the vaccine.
[10]
The method according to any one of [1] to [9], comprising the step of administering the vaccine to the subject about once every 3 weeks.
[11]
The method of [10], comprising administering the vaccine to the subject twice, three times, four times or more.
[12]
The method according to any one of [1] to [11], comprising the step of administering the agent that prevents DNA replication to the subject in a regular regimen.
[13]
The method of [12], wherein the regular regimen comprises administering the drug daily to the subject every other week for a period of about one week.
[14]
Including administering the agent to the subject about one week before administering the initial dose of the vaccine, and administering the vaccine to the subject about once every three weeks [13]. The method described in 1.
[15]
The method according to any one of [1] to [14], wherein the survivin antigen is a peptide antigen or a nucleic acid encoding the antigen.
[16]
The survivin antigen is a peptide antigen comprising an amino acid sequence derived from a survivin protein (SEQ ID NO: 11) capable of inducing a cytotoxic T lymphocyte (CTL) response in the subject, or encodes the peptide antigen The method according to any one of [1] to [15], which is a nucleic acid molecule.
[17]
The survivin antigen has the amino acid sequence FEELTLGEF (SEQ ID NO: 1); FTELTLGEF (SEQ ID NO: 2); LTLGEFLKL (SEQ ID NO: 3); LMLGEFLKL (SEQ ID NO: 4); RISTFKNWPF (SEQ ID NO: 5); (SEQ ID NO: 7); and LPPAWQPFL (SEQ ID NO: 8), or a peptide antigen comprising any combination thereof; or any one of [1] to [16], which is a nucleic acid molecule encoding the peptide antigen The method described in 1.
[18]
5 peptide antigens wherein the at least one survivin antigen comprises the amino acid sequences FTELTLGEF (SEQ ID NO: 2); LMLGEFLKL (SEQ ID NO: 4); RISTFKNWPK (SEQ ID NO: 6); STFKNWPFL (SEQ ID NO: 7) or LPPAWQPFL (SEQ ID NO: 8) The method in any one of [1]-[14] containing the mixture of these.
[19]
The method according to any one of [1] to [18], wherein the agent that interferes with DNA replication can selectively target rapidly dividing immune system cells and cause programmed cell death.
[20]
The method according to any one of [1] to [19], wherein the agent that prevents DNA replication is an alkylating agent.
[21]
The method according to [20], wherein the alkylating agent is a nitrogen mustard alkylating agent.
[22]
The method according to [21], wherein the nitrogen mustard alkylating agent is cyclophosphamide.
[23]
The method of [22], wherein the amount sufficient to produce an immunomodulatory effect is about 25-300 mg / day, preferably about 50-100 mg / day, more preferably about 100 mg / day of cyclophosphamide.
[24]
The method of [22] or [23], wherein the amount sufficient to produce an immunomodulatory effect is about 50 mg of cyclophosphamide per dose.
[25]
The method according to any one of [22] to [24], comprising a step of orally administering the cyclophosphamide to the subject.
[26]
The method according to any one of [1] to [25], comprising a step of administering the vaccine to the subject by injection such as subcutaneous injection.
[27]
The method according to any one of [1] to [26], wherein the vaccine is a composition comprising the at least one survivin antigen, a liposome, and a carrier containing a continuous phase of a hydrophobic substance.
[28]
The method of [27], wherein the composition further comprises a T helper epitope.
[29]
The method according to [28], wherein the T helper epitope is a peptide comprising the amino acid sequence AQYIKANSKFIGITEL (SEQ ID NO: 9).
[30]
The method according to any of [27] to [29], wherein the composition further comprises an adjuvant.
[31]
The method according to [30], wherein the adjuvant is a poly I: C polynucleotide.
[32]
The method according to any one of [27] to [31], wherein the carrier is a hydrophobic substance such as vegetable oil, nut oil or mineral oil.
[33]
The method according to any of [27] to [31], wherein the carrier is mineral oil or mannide oleate in a mineral oil solution, such as Montanide® ISA51.
[34]
The agent according to any one of [1] to [33], wherein the agent improves the effectiveness of the vaccine by directly enhancing an immune response to the antigen, such as increasing the activity or number of antigen-specific CD8 + T cells. the method of.
[35]
The method of [34], wherein increasing the activity or number of antigen-specific CD8 + T cells involves enrichment of antigen-specific CD8 + T cells by a relative decrease in the total number of CD8 + T cells.
[36]
Said agent reduces the number or activity of suppressive immune cells such as CD4 ⁺ FoxP3 ⁺ regulatory T cells (Treg), bone marrow derived suppressor cells (MDSC) and / or CD19 ⁺ CD1d ⁺ CD5 ⁺ B cells (Breg). The method according to any one of [1] to [33], wherein the effectiveness of the vaccine is improved by reducing the vaccine.
[37]
The method according to any one of [1] to [36], wherein the cancer is a subcutaneous solid tumor.
[38]
The method according to any one of [1] to [36], wherein the cancer is ovarian cancer, fallopian tube cancer, or peritoneal cancer.
[39]
The method according to any one of [1] to [38], wherein the subject is a human.
[40]
Use of an agent that interferes with DNA replication in combination with a vaccine comprising at least one survivin antigen to improve the effectiveness of the vaccine in the treatment of cancer, said agent being at least twice prior to said vaccine Administered, use.
[41]
A combination of an agent that prevents DNA replication and a vaccine comprising at least one survivin antigen for use in the method according to any one of [1] to [39].

Claims (41)

A method for improving the effectiveness of a vaccine in treating a subject's cancer, comprising:
(I) administering to the subject at least twice an agent that interferes with DNA replication in an amount sufficient to produce an immunomodulatory effect;
(Ii) subsequently administering to said subject a therapeutically effective amount of a vaccine comprising at least one survivin antigen. 2. The method comprising administering an initial dose of the agent to the subject at least 2 days prior to administering the vaccine, preferably at least 4 days prior to administering the vaccine.
The method described in 1. 2. The method of claim 1, comprising administering an initial dose of the agent to the subject about one week prior to administering the vaccine. 4. The method of any one of claims 1 to 3, comprising administering the agent for a period of at least 2 consecutive days. 5. The method of any one of claims 1-4, comprising administering an initial dose of the drug to the subject followed by administration of a maintenance dose of the drug one or more times. 6. The method of any one of claims 1-5, comprising administering the agent to the subject at least once, twice, three times, or four times daily prior to administering the vaccine. 7. The method of any one of claims 1-6, comprising administering the agent twice daily for a period of about 1 week prior to administering the vaccine. 8. The method of any one of claims 1-7, wherein the step of administering the agent to the subject is stopped before administering the vaccine. Continuing the step of administering the drug to the subject while administering the vaccine;
The method according to any one of claims 1 to 7. 10. The method of any one of claims 1-9, comprising administering the vaccine to the subject about once every 3 weeks. 11. The method of claim 10, comprising administering the vaccine to the subject twice, three times, four times or more. 12. The method of any one of claims 1-11, comprising administering the agent that interferes with DNA replication to the subject in a regular regimen. 14. The method of claim 12, wherein the regular regimen comprises administering the drug to the subject every other week for a period of about 1 week. 14. The method includes administering the agent to the subject about one week before administering the initial dose of the vaccine, and administering the vaccine to the subject about once every three weeks. The method described in 1. The method according to any one of claims 1 to 14, wherein the survivin antigen is a peptide antigen or a nucleic acid encoding the antigen. The survivin antigen is a peptide antigen comprising an amino acid sequence derived from a survivin protein (SEQ ID NO: 11) capable of inducing a cytotoxic T lymphocyte (CTL) response in the subject, or encodes the peptide antigen The method according to any one of claims 1 to 15, which is a nucleic acid molecule. The survivin antigen has the amino acid sequence FEELTLGEF (SEQ ID NO: 1); FTELTLGEF (SEQ ID NO: 2); LTLGEFLKL (SEQ ID NO: 3); LMLGEFLKL (SEQ ID NO: 4); RISTFKNWPF (SEQ ID NO: 5)
RISTFKNWPK (SEQ ID NO: 6); STFKNWPFL (SEQ ID NO: 7); and LPPAWQPFL (SEQ ID NO: 8);
), Or a peptide antigen comprising any combination thereof; or a nucleic acid molecule encoding said peptide antigen. The at least one survivin antigen comprises the amino acid sequence FTELTLGEF (SEQ ID NO: 2); LML
GEFLKL (SEQ ID NO: 4); RISTFKNWPK (SEQ ID NO: 6); STFKNWPFL (SEQ ID NO: 7) or LPP
15. A method according to any one of claims 1 to 14, comprising a mixture of five peptide antigens comprising AWQPFL (SEQ ID NO: 8). The agent that interferes with DNA replication selectively targets rapidly dividing immune system cells;
19. A method according to any one of claims 1 to 18 capable of causing programmed cell death. 20. The method of any one of claims 1-19, wherein the agent that interferes with DNA replication is an alkylating agent. 21. The method of claim 20, wherein the alkylating agent is a nitrogen mustard alkylating agent. 24. The nitrogen mustard alkylating agent is cyclophosphamide.
The method described in 1. An amount sufficient to provide an immunomodulatory effect is about 25-300 mg / day, preferably about 50-
24. The method of claim 22, wherein the method is 100 mg / day, more preferably about 100 mg / day cyclophosphamide. 24. The method of claim 22 or 23, wherein the amount sufficient to produce an immunomodulatory effect is about 50 mg of cyclophosphamide per dose. 25. The method includes orally administering the cyclophosphamide to the subject.
The method as described in any one of. 26. The method of any one of claims 1-25, comprising administering the vaccine to the subject by injection, such as subcutaneous injection. 27. The method according to any one of claims 1 to 26, wherein the vaccine is a composition comprising the at least one survivin antigen, a liposome, and a carrier comprising a continuous phase of a hydrophobic substance.   28. The method of claim 27, wherein the composition further comprises a T helper epitope. 29. The method of claim 28, wherein the T helper epitope is a peptide comprising the amino acid sequence AQYIKANSKFIGITEL (SEQ ID NO: 9). 30. A method according to any one of claims 27 to 29, wherein the composition further comprises an adjuvant.   32. The method of claim 30, wherein the adjuvant is a poly I: C polynucleotide. 28. The carrier is a hydrophobic material such as vegetable oil, nut oil or mineral oil.
32. The method according to any one of -31. The carrier is mineral oil or oleic mannide in a mineral oil solution, such as Mon
32. A method according to any one of claims 27 to 31 which is tanide (R) ISA51. 2. The agent improves the efficacy of the vaccine by directly enhancing the immune response to the antigen, such as increasing the activity or number of antigen-specific CD8 + T cells.
34. The method according to any one of -33. 35. The method of claim 34, wherein increasing the activity or number of antigen-specific CD8 + T cells involves enrichment of antigen-specific CD8 + T cells by a relative decrease in the total CD8 + T cell number. The agent may be, for example, CD4 ⁺ FoxP3 ⁺ regulatory T cells (Treg), bone marrow derived suppressor cells (MDSC) and / or CD19 ⁺ CD1d ⁺ CD5 ⁺ B cells (Bre
34. The method of any one of claims 1-33, wherein the vaccine efficacy is improved by reducing the number or activity of suppressive immune cells such as g).   The method according to any one of claims 1 to 36, wherein the cancer is a subcutaneous solid tumor. The method according to any one of claims 1 to 36, wherein the cancer is ovarian cancer, fallopian tube cancer or peritoneal cancer.   40. The method of any one of claims 1-38, wherein the subject is a human. Use of an agent that interferes with DNA replication in combination with a vaccine comprising at least one survivin antigen to improve the effectiveness of the vaccine in the treatment of cancer, said agent being at least twice prior to said vaccine Administered, use. 40. A combination of an agent that interferes with DNA replication and a vaccine comprising at least one survivin antigen for use in the method of any one of claims 1-39.