Use of the therapeutic composition for the treatment of patients with tumors of epithelial origin - Patents.com

Abstract

The present invention relates to the field of biotechnology and medicine. The use of a therapeutic composition comprising a compound that blocks epidermal growth factor and an antibody that blocks the PD-1 / PD-1 ligand signaling pathway in the treatment of tumors of epithelial origin, particularly tumors expressing the native form of the human KRAS protein, is described. Patients with cancers of epithelial origin expressing native KRAS treated with the therapeutic composition have been observed to have increased survival rates.

Description

[Technical field]

[0001] The present invention relates to the fields of biotechnology and medicine. In particular, the use of a therapeutic composition for the treatment of patients with tumors of epithelial origin by simultaneous blocking of the epidermal growth factor and PD1 / PD1 ligand signaling pathways is described. [Background technology]

[0002] Molecules called "checkpoints," prominent among which are the PD1 receptor and its PDL1 ligand, negatively regulate the antitumor responses generated by the immune system. Monoclonal antibodies (mAbs) (anti-CPIs) that block the transmission of inhibitory signals at these checkpoints induce more efficient antitumor responses. As of December 2020, seven anti-CPI mAbs have been approved for the treatment of a number of "immune-sensitive" malignancies, such as melanoma, lung cancer, head and neck squamous cell tumors, hepatocellular carcinoma, urothelial carcinoma, gastric cancer, breast and colorectal tumors (Ravindranathan D et al. (2021) Biology, 10: 325).

[0003] Among the most successful anti-CPI mAbs are PD1-specific (anti-PD1) nivolumab and pembrolizumab, and atezolizumab and durvalumab against PDL1. These treatments have been shown to be more effective in tumors that express the PDL1 molecule, have a high frequency of mutations, and have an infiltration of immune cells that can potentially attack the tumor if the inhibitory signal is blocked (Gibney GT y cols. (2016) Lancet Oncol. 17(12): e542-e551). Small molecular weight inhibitors have also been developed against PD1 / PDL1, with promising results in terms of blocking this signaling pathway without showing adverse effects related to the immune system (Liu Ch y cols. (2021) Cancer Cell Int. 21: e1-e17).

[0004] The epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor and a known oncogene activated by seven natural ligands (Yarden Y. (2001) European Journal of Cancer. 37: S3-S8). Several studies have reported differential activation of the EGFR signaling cascade depending on the ligand that binds to EGFR. Ligands such as EGF induce signaling that favors tumor growth, while low affinity ligands such as amphiregulin promote differentiation (Freed DM y cols. (2017) Cell 171: 1-13). Differential activation of ligand-dependent signaling cascades may be important in targeted therapy against these molecules, as opposed to direct receptor blockade, for example, by anti-EGFR mAbs or inhibitors of the TKI signaling cascade. Such differences may affect the tolerability / safety of the treatment, as well as greater or less clinical efficacy in different therapeutic settings. In this sense, a therapeutic modality targeting the EGFR ligand is the use of a vaccine composition that induces specific antibodies (Ab) against the ligand and, consequently, blocks its interaction with EGFR. An example of this therapeutic strategy is the CIMAvax-EGF vaccine, which generates specific mAbs against human epidermal growth factor (EGF) and deprives tumors of this important ligand. Numerous clinical trials in non-small cell lung cancer (NSCLC) patients immunized with CIMAvax-EGF have shown that the vaccine is safe and immunogenic. In terms of clinical response, the administration of the vaccine significantly increased patient survival (Rodriguez PC y cols. (2016) Clin Cancer Res. 22 (15): 3782-90).

[0005] One of the most important molecules involved in EGFR signaling is the GTPase KRAS. This molecule also activates multiple signaling cascades involved in tumorigenesis. Approximately 30% of all human tumors have mutations in the gene encoding KRAS, which induce some constitutive activation of the EGF-R cascade, independent of classical membrane receptor activation (Fernandez-Medarde, A y cols. (2011) Genes and Cancer. 2: 344-358).

[0006] Mutations in this gene are predominant in some of these neoplasms, such as pancreatic adenocarcinoma, which shows mutations in 90% of tumors. In other adenocarcinomas, such as colon, it is present in 40% of them. In the case of the lung, KRAS mutations are present in 30% of all non-small cell lung tumors, mainly in adenocarcinoma histology (Moore AR y cols. (2020) Nat Rev Drug Discov. 19 (8): 533-552).

[0007] In tumors such as pancreas and colon, the presence of KRAS mutations favors tumor growth and resistance to therapy (Haigis KM et al. (2008) Nat Genet. 40: 600-8.; Bournet B et al. (2016) Clin Transl Gastroenterol. 7: e157). However, in others, such as lung adenocarcinoma, there are controversial data on the prognostic value of mutations in this gene (Shepherd FA et al. (2013) J Clin. Oncol. 31 (17): 2173-81; Zer A et al. (2016) J Thoracic. Oncol. 11 (13): 312-23). ​​In advanced colon tumors, the presence of native KRAS is a predictor of clinical benefit of treatment with the EGFR-specific mAbs panitumumab and cetuximab. Furthermore, the use of nimotuzumab (another anti-EGFR) in combination with genicitabine provides clinical benefit in patients with advanced pancreatic cancer whose tumors are native to KRAS (Schultheis B et al. (2017) Ann. Oncol. 28:2429-35). However, the use of cetuximab for the treatment of NSCLC has not shown clinical benefit in any of the subgroups of patients with mutations in the EGFR signaling cascade, particularly those involving KRAS. On the other hand, the mutation or non-mutation of KRAS in tumors does not, by itself, affect or modulate the clinical response of patients to anti-PD1 / PDL1 mAbs. In phase III clinical trials with anti-PD1 / PDL1 mAbs in lung cancer, significant clinical benefit was observed for patients with mutant KRAS tumors (Borghaei, H et al. (2015) N Engl J Med. 373 (17): 1627-1639; Socinski May cols. (2018) N Engl J Med. 378 (24): 2288-2301). In line with this finding, recent clinical trials have shown that the presence of other mutations in combination with KRAS mutations (co-mutations) may modulate better or worse responses in patients treated with anti-PD1 / PDL1 mAbs.In particular, lung adenocarcinomas in which KRAS is co-mutated with the TP53 gene result in immunogenic tumors that are more sensitive to CPIs. In contrast, co-mutations in STK11 result in tumors that are not inflamed and are more resistant to this type of treatment (Dong ZY et al. (2017) Clin Cancer Res 23:3012-3024; Skoulidis Fy cols. (2018) Cancer Discov;8:822-835).

[0008] Given the success of EGFR signaling blockade therapy and CPIs, several studies have evaluated the benefits of combined treatment of both approaches in different treatment niches, with mixed results. Some authors have investigated the feasibility of combining anti-PD1 / PDL1 mAbs with TKI therapy to block aberrant signaling by mutated EGFR variants in patients with lung cancer. These studies showed no benefit of the combination and significantly increased toxicity (Yang JC et al.(2019)J Thorac Oncol.;14(3):553-9;Schoenfeld AJ et al.(2019)Ann Oncol.30(5):839-44). Other authors have evaluated the combination with necitumumab (another anti-EGFR mAb) in patients with lung cancer. In this study, toxicity was manageable, but there was no evidence of a clinically relevant effect (Besse B et al.(2020)Lung Cancer.142:63-69). No association with KRAS molecular status was reported in any of these studies. Summary of the Invention [Means for solving the problem]

[0009] The present invention reports for the first time the use of a therapeutic composition combining a mAb blocking the interaction between PD1 and PDL1 with a vaccine composition inducing Abs against autologous human EGF in patients with native KRAS. The results obtained show that the treatment is well tolerated and specifically benefits patients with tumors that display native KRAS. Furthermore, this treatment method benefits patients with tumors with low PD-L1 expression, which are less sensitive to anti-PD1 / PDL1 mAb treatment.

[0010] In one embodiment, the present invention relates to the use of therapeutic compositions for treating tumors of epithelial origin. These compositions are characterized by the use of vaccine compositions that induce the production of specific Abs against EGF and compounds that block PD1 / PD1 ligand signaling pathway. In particular, the use of the above-mentioned therapeutic compositions is described in tumors of epithelial origin that express the native form of KRAS protein, preferably tumors with the sequences described in SEQ ID NO:1 and SEQ ID NO:2.

[0011] In particular, the vaccine composition inducing the production of Abs against EGF comprises as an active ingredient a conjugate between recombinant human EGF and a carrier protein, said carrier protein being selected from the group comprising cholera toxin B, tetanus toxoid, KLH and Neisseria meningitidis p64k protein.

[0012] Further, the vaccine composition inducing the production of Abs against EGF has an adjuvant selected from the group including incomplete Freund's adjuvant, squalene-based, synthetic, mineral, plant, animal, particulate proteins and liposomes.

[0013] The compound that blocks the PD1 / PD1 ligand signaling pathway is selected from the group including anti-PD1 Ab, which are nivolumab, pembrolizumab, MEDI0608 and pidilizumab, and anti-PDL1 Ab, which may be atezolizumab, durvalumab, avelumab and MDX-1105, among others.

[0014] In one embodiment of the invention, patients are screened for the presence or absence of native KRAS in a sample of their tumor cells. Those with native KRAS are selected for treatment. Tumor types that may be treated include non-small cell lung cancer, head and neck squamous cell carcinoma, urothelial carcinoma, colorectal cancer, gastric cancer, esophageal cancer, cervical cancer, hepatocellular carcinoma, Merkel cell carcinoma, renal cell carcinoma, endometrial carcinoma, breast cancer, and skin cancer.

[0015] In a further embodiment, the present invention relates to a method for stratifying patients into responders or non-responders to treatment with the therapeutic compositions described herein. Patients are stratified by determining the presence or absence of native KRAS in a sample of tumor cells, and patients in which the presence of native KRAS is detected are considered to be responders to treatment.Preferably, patients whose tumor sample has a PDL1 level of less than 1% are considered to be responders.

[0016] Detailed Description of the Invention KRAS The methods and uses of the present invention are envisaged for the treatment and / or stratification of patients whose epithelial tumors express the wild-type protein KRAS. The term "wild-type" KRAS refers to the naturally occurring KRAS isoform (Uniprot Acc. No. P01116, version 246 of April 7, 2021). It is envisaged that wild-type KRAS comprises a sequence corresponding to SEQ ID NO: 1 or SEQ ID NO: 2. In particular, wild-type KRAS may consist of a sequence corresponding to SEQ ID NO: 1 or SEQ ID NO: 2.

[0017] The term "wild-type KRAS" generally encompasses KRAS polypeptides having mutations relative to the reference sequence shown in SEQ ID NO:1 (KRAS4A) or SEQ ID NO:2 (KRAS4B), and also encompasses polypeptides having an amino acid sequence that shares a degree of identity with the amino acid sequence shown in SEQ ID NO:1 (KRAS4A, Uniprot Acc. No. P01116-1) or SEQ ID NO:2 (KRAS4B, Uniprot Acc. No. P01116-2) described herein. More specifically, "wild-type KRAS" includes KRAS polypeptides having at least 80%, 85%, 90%, 95% or 100% identity with SEQ ID NO:1 (KRAS4A) or SEQ ID NO:2 (KRAS4B). In particular, KRAS isoforms 4A and 4B are encompassed by the term "wild-type KRAS". Preferably, "wild-type KRAS" does not include mutations in its amino acid sequence compared to SEQ ID NO:1 or SEQ ID NO:2, respectively.

[0018] therapeutic composition The present invention relates to a therapeutic composition for treating cancer, which is aimed in particular at blocking the target EGF and the signaling pathway PD1 / PD1 ligand.The present invention describes the effective use of a combination of compounds against PD1 or its ligand PDL1 with agents that reduce the concentration of EGF in a subpopulation of patients with tumors of epithelial origin, especially those tumors that typically respond to immunotherapy.

[0019] Among the compounds against PD1 or its ligands are the MAbs anti-PD1 used in the present invention. All such compounds specifically bind to the cell surface receptor PD1 and block the inhibitory pathway PD1 / PDL1. Among these anti-PD1 MAbs are nivolumab, described in US Patent No. 8,008,449, pembrolizumab, described in US Patent No. 8,354,509 and US Patent No. 8,900,587, MEDI0608 (US Patent No. 8,609,089), pidilizumab (US Patent No. 8,686,119) and cemiplimab.

[0020] All of the anti-PDL1 MAbs used in the present invention specifically bind to PDL1 and block the inhibitory pathway PD1 / PDL1. Among these anti-PDL1 MAbs are atezolizumab, described in US Patent No. 8,217,149, durvalumab (US Patent No. 8,779,108), avelumab, described in US Patent No. 9,624,298, and MDX-1105 (US Patent No. 7,943,743).

[0021] Furthermore, low molecular weight inhibitors that inhibit the interaction PD1 / PDL1 can be combined with agents that reduce EGF concentrations according to the present invention. Among these inhibitors are BMS1166, BMS202 and CA-170.

[0022] All of the agents that reduce the concentration of EGF provided in the present invention are vaccine compositions that induce the production of specific Abs against autologous human EGF. Such Abs block the interaction of EGF with EGF receptor, which contributes to the reduction and / or elimination of serum EGF levels. Examples of these vaccine compositions are all those that contain a conjugate between recombinant human EGF (EGFhr) and a transporter protein as an active ingredient. The transport protein can be, but is not limited to, cholera toxin B, tetanus toxoid, KLH, and P64k from Neisseria meningitidis. In addition, these vaccine compositions contain an adjuvant selected from Freund's incomplete adjuvant, squalene-based adjuvant, synthetic origin, mineral origin, plant origin, animal origin, particulate protein adjuvant, and liposome.

[0023] Methods of patient identification and / or selection Whether a particular patient belongs to the group of patients treated by the method of the present invention can be evaluated using routine experiments known in the art.For example, to determine whether epithelial tumor expresses wild-type KRAS, tumor samples are typically obtained from the patient to be evaluated, and KRAS nucleic acid sequences are obtained from each sample, amplified, and subjected to sequencing.Alternatively, polymerase chain reaction can detect the presence of KRAS gene.

[0024] Another method involves plasma or serum samples in which circulating tumor cells carrying the KRAS oncogene can be detected using membrane microarrays. In this regard, a positive KRAS mutation in plasma or serum suggests a KRAS mutation in the tumor, but the absence of a KRAS mutation in plasma or serum does not necessarily prove the absence of a similar mutation in pancreatic tumor tissue.

[0025] Additionally or alternatively, expression of wild-type KRAS can be determined by detecting mutant and / or wild-type KRAS polypeptides in tumor samples, for example, by using specific antibodies that bind to epitopes specific for wild-type or mutant KRAS, respectively. It is envisioned that patients with epithelial tumors that express wild-type KRAS will be selected for treatment, whereas patients expressing mutant KRAS will not be selected for treatment.

[0026] As described elsewhere herein, patients with epithelial tumors expressing mutant KRAS, particularly KRAS with one or more mutations, are considered to be less responsive or non-responsive to treatment with the therapeutic composition used in the method of the present invention. Thus, the present invention also provides a method for stratifying patients with epithelial tumors. "Stratification" as used herein means classifying patients with epithelial tumors into those who may benefit from treatment with the therapeutic composition of the present invention and those who may not benefit. It is assumed that patients whose epithelial tumors do not express wild-type KRAS, particularly those whose epithelial tumors express mutant KRAS, are less likely to benefit (respond) from treatment with the therapeutic composition described herein.

[0027] Otherwise, patients whose PDAC tumors express wild-type KRAS, HRAS or NRAS as defined elsewhere herein are likely to benefit (be responsive) to the treatments described herein, wherein the "wild-type" KRAS preferably has a sequence corresponding to SEQ ID NO:1 or SEQ ID NO:2.

[0028] The term "responsive" in the context of the treatment methods provided herein means that the patient or tumor shows a complete response, partial response, or disease stabilization after administration of a therapeutic composition as defined herein according to the iRECIST (iRECIST) standard. The term "non-responsive" as used herein means that the patient or tumor shows stable disease or progressive disease after administration of a therapeutic composition as defined herein according to iRECIST. iRECIST is described in Seymour Ly cols. RECIST working group (2017) Lancet Oncol. 18(3): e143-e152.

[0029] Therefore, a method for selecting a patient or a group of patients to be treated is also provided herein. This is achieved by determining the presence or absence of mutant and / or wild-type KRAS in each patient's epithelial tumor sample. Patients with mutant KRAS and / or with no wild-type KRAS detected in tumor samples are not considered eligible for treatment, whereas patients with wild-type KRAS and / or with no mutant KRAS detected in tumor samples are considered eligible for treatment according to the invention and are therefore selected for treatment according to the invention.

[0030] Furthermore, as mentioned above, the present invention allows to provide a method for prognostic diagnosis of whether a patient suffering from PDAC or epithelial tumor is responsive or non-responsive to treatment with the therapeutic composition described herein. As mentioned above, the absence or presence of mutant and / or wild-type KRAS in a patient tumor sample can be evaluated using routine methods known in the art and described elsewhere herein. Expression of mutant KRAS in an epithelial tumor indicates that the patient or epithelial tumor will not respond to treatment, whereas expression of wild-type KRAS in an epithelial tumor indicates that the patient will respond to treatment with the therapeutic composition described herein.

[0031] In a further preferred embodiment of the invention, patients who respond to treatment are those who express native KRAS and have PDL1 levels of less than 1% measured by immunohistochemical techniques in tumor samples.

[0032] Treatment Among the types of cancer that may be treated with the therapeutic compositions described herein are, but are not limited to, NSCLC, squamous cell carcinoma of the head and neck, urothelial carcinoma, colorectal cancer, gastric cancer, esophageal cancer, cervical cancer, hepatocellular carcinoma, Merkel cell carcinoma, renal cell carcinoma, endometrial carcinoma, breast cancer, and squamous cell skin carcinoma. Additionally, the present invention includes refractory or recurrent neoplasms whose growth can be inhibited using the combinations of the present invention.

[0033] The administration of the vaccine composition containing EGF as active ingredient is preferably performed intramuscularly; the first four administrations are performed every 14 days, the remaining every 28 days, with a 3-day acceptable time range. The dose range in which these compositions are used includes 20-70 μL / kg of body weight or 20-70 μg of total protein per kilogram of body weight, or up to 5 mg of total protein, more recommended being 30-60 μg / kg. The treatment phase has a minimum duration of 6 months, followed by a maintenance phase whose frequency and dosage can vary depending on the results obtained. This maintenance period can be optimized taking into account the produced Abs titers as well as the improvement and / or stabilization of clinical signs, provided that a reduction in serum EGF concentration is warranted. Such serum EGF concentration can be measured by any of the diagnostic sets commercially available for this purpose.

[0034] Anti-PD1 and anti-PDL1 MAbs are administered at the doses and schedules recommended for each case. For anti-PD1 MAbs, a dose range of 100-500 mg total protein is administered intravenously at a frequency of 2-6 weeks. Anti-PDL1 MAbs are administered intravenously at a dose range of 600-1800 mg total protein at a frequency of 2-5 weeks. The administration of vaccines and MAbs is adjusted to coincide with the blocking effect of PD1 / PD1L signaling and inhibition of EGF-mediated signaling. According to this principle, administration can be concomitant or sequential. In particular, administration of the vaccine composition can overlap with the administration scheme of MAbs.

[0035] The present invention will be further described with the aid of the following examples and figures, which should not, however, be construed as limiting the scope of the invention. [Brief description of the drawings]

[0036] [Figure 1] Anti-EGF antibody (Ab) titers in the sera of patients treated with CIMAvax-EGF and nivolumab mAb. [Diagram 2] EGF levels in serum of patients treated with CIMAvax-EGF and mAb Nivolumab. [Diagram 3] Cumulative survival over time in patients with native KRAS and mutated KRAS tumors treated with CIMAvax-EGF and nivolumab. [Figure 4] For patients with <1% PD-L1 tumors that are native KRAS or mutated KRAS, cumulative survival over time for patients treated with CIMAvax-EGF and nivolumab. EXAMPLES

[0037] Example 1. Coadministration of CIMAvax-EGF with the anti-PD1 mAb nivolumab is safe and induces potent anti-human EGF antibody responses. In a Phase I / II clinical trial (NCT02955290) at Roswell Park Comprehensive Cancer Center in Buffalo, New York, a therapeutic composition containing the vaccine composition CIMAvax-EGF, along with the anti-PD1 mAb nivolumab, was used to treat patients with advanced NSCLC.

[0038] The study included a phase I dose escalation and a phase II efficacy evaluation. A total of 29 patients with metastatic NSCLC were included. Nivolumab was used intravenously at a dose of 240 mg every 2 weeks. The CIMAvax-EGF vaccine composition was used intramuscularly at a dose of 2.4 mg every 2 weeks (4 doses) during the induction phase, followed by monthly injections during the maintenance phase. The first 6 patients received a half dose of CIMAvax-EGF (1.2 mg).

[0039] The safety profile was favorable, with no serious adverse reactions related to the applied treatment. CIMAvax-EGF induced a good response in all patients, as defined by anti-EGF antibody (Ab) titers of ≥ 1:4000 (serum dilution (Figure 1)).

[0040] A rapid decrease in EGF concentrations in patient serum, measured by ELISA (Human EGF Quantikine ELISA kit, R&D Systems), was also observed in patients treated with CIMAvax-EGF and mAb nivolumab (Figure 2).

[0041] The median overall survival for the 29 patients treated was 10.36 months. The 1-year overall survival rate was 44%.

[0042] Example 2. Combined administration of CIMAvax-EGF and the anti-PD1 mAb Nivolumab significantly benefits patients with native KRAS. In the study described in Example 1, the analysis was performed by stratifying patients according to the presence or absence of KRAS gene mutation in the tumor. The presence or absence of mutation and the copy number of KRAS gene were verified using a new generation sequencing assay using multiparametric PCR-based DNA sequencing. Surprisingly, the survival rate of patients with native KRAS was significantly higher than that of patients with mutant KRAS (Figure 3).

[0043] Median survival was 22.06 months in patients with native KRAS and 10.26 months in patients with mutant KRAS. One-year survival rates were 69% in patients with native KRAS and 37% in patients with mutant KRAS.

[0044] Furthermore, after combination therapy, patients with native KRAS had a significantly improved disease control rate (patients with at least stable disease by irRECIST criteria (Seymour L et al. RECIST working group (2017) Lancet Oncol. 18(3):e143-e152)). In patients with native KRAS, the disease control rate after the combination of CIMAvax-EGF and nivolumab was 56.3%, compared to 12.5% ​​in patients whose tumors contained KRAS mutations.

[0045] According to the literature, stratification by KRAS mutations does not affect the survival of patients treated with nivolumab mAb alone, so the survival observed with combination therapy in patients with native KRAS is clinically relevant. In these patients with advanced NSCLC, monotherapy with nivolumab resulted in a median survival of 11.2 months and 10 months in patients with mutated or native KRAS, respectively (Passiglia F et al. (2019) Br J Cancer 120(1):57-62).

[0046] Example 3. Combined administration of CIMAvax-EGF with anti-PD1 Ab Nivolumab significantly benefits patients with native KRAS tumors and PDL1<1%. Given known reports in the literature of lower response to monotherapy with anti-PD1 mAbs in patients with low expression of PDL1 in their tumors, the analysis of Example 2 was repeated in patients whose tumors did not express PDL1 (PDL1<1%). PDL1 expression was determined using pharmDx assay 28-8 for PDL1 determination.

[0047] Surprisingly, we observed that stratification of patients according to KRAS mutations again differentiated patient survival: median survival was 22.06 months in patients with native KRAS and 10.26 months in patients with mutated KRAS. The 1-year survival rate was very high, 80% in patients with native KRAS (Figure 4).

Claims

1. A therapeutic composition for treating tumors of epithelial origin, comprising a vaccine composition that induces the production of specific antibodies (Abs) against epidermal growth factor (EGF) and a compound that blocks the PD1 / PD1 ligand (PD-1L) signaling pathway.

2. The therapeutic composition of claim 1, wherein the tumor of epithelial origin expresses a wild-type form of the human KRAS protein.

3. The therapeutic composition of claim 2, wherein the wild-type KRAS has a sequence selected from the group consisting of SEQ ID NO:1 and SEQ ID NO:

2.

4. The therapeutic composition according to claim 1, wherein the vaccine composition inducing Ab production against EGF comprises, as an active ingredient, a conjugate between human recombinant EGF and a carrier protein.

5. The carrier protein is cholera toxin B subunit, tetanus toxoid, KLH and P64k of Neisseria meningitidis The therapeutic composition of claim 4, selected from the group consisting of:

6. The vaccine composition comprises: incomplete Freund's adjuvant, Squalene-based adjuvants, Adjuvants of synthetic origin, Adjuvants of mineral origin, Adjuvants of plant origin, Adjuvants of animal origin, Particulate protein adjuvants and Liposomes 6. The therapeutic composition of claim 5, further comprising an adjuvant selected from the group consisting of:

7. A compound that blocks the PD1 / PD-1L signaling pathway, Anti-PD1 Ab and Anti-PD-L1 Ab 2. The therapeutic composition of claim 1, selected from the group consisting of:

8. 8. The therapeutic composition of claim 7, wherein the anti-PD1 Ab is selected from the group consisting of nivolumab, pembrolizumab, cemiplimab, MEDI0608 and pidilizumab.

9. 8. The therapeutic composition of claim 7, wherein the anti-PD1L Ab is selected from the group consisting of atezolizumab, durvalumab, avelumab, and MDX-1105.

10. The therapeutic composition of any one of claims 1 to 9, wherein patients are selected by determining the presence or absence of wild-type KRAS in a sample of the patient's tumor cells, and patients in whom wild-type KRAS is detected in their tumor sample are selected for treatment.

11. The therapeutic composition according to any one of claims 1 to 9 for the treatment of a tumor selected from the group consisting of non-small cell lung cancer, head and neck squamous cell carcinoma, urothelial carcinoma, colorectal cancer, gastric cancer, esophageal cancer, cervical cancer, hepatocellular carcinoma, Merkel cell carcinoma, renal cell carcinoma, endometrial carcinoma, breast cancer and skin cancer.

12. A method for stratifying patients into responders or non-responders to treatment with a therapeutic composition comprising a compound that blocks EGF and an Ab that blocks the PD1 / PD-L1 signaling pathway, wherein patients are selected by determining the presence or absence of wild-type KRAS in a sample of the patient's tumor cells.

13. 13. The method of claim 12, wherein the patient is deemed responsive to the treatment if wild-type KRAS is detected in the tumor sample.

14. 14. The method of claim 13, wherein the patient's tumor sample has a PD-L1 level of less than 1%.

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