PROCESSES AND COMPOSITIONS FOR THE TREATMENT OF CANCER

Description

FIELD OF INVENTION

[0001] This invention provides compositions for use in treating, reducing the incidence of, and inducing immune responses against a WT1-expressing cancer.SUMMARY OF THE INVENTION

[0002] The invention is as defined in the appended claims.

[0003] The present invention provides the combination of the four WT1 peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125), and at least one antibody PD1 inhibitor, for use in treating, reducing the incidence of, or inducing an immune response against a WT1-expressing cancer.

[0004] In an embodiment, the WT1 peptides are administered with a carrier, excipient or diluent, or an adjuvant such as QS21, Montanide, Freund's complete or incomplete adjuvant, aluminum phosphate, aluminum hydroxide, BCG, a cytokine or alum.

[0005] In an embodiment, the PD1 inhibitor is nivolumab, pembrolizumab, pidilizumab, or MEDI0680 (AMP-514).

[0006] In an embodiment, one or more of the WT1 peptides are administered separately.

[0007] In an embodiment, two or more of the WT1 peptides are administered together within the same formulation.

[0008] In an embodiment, the WT1 peptides and the PD1 inhibitor are present in the same composition.

[0009] In an embodiment, the WT1 peptides and the PD1 inhibitor are administered concurrently, or in an overlapping schedule, or wherein the last administration of the WT1 peptides precedes the first administration of the PD1 inhibitor.

[0010] In an embodiment, the cancer is ovarian cancer, mesothelioma, leukemia, Wilms' tumor, acute myelogenous leukemia (AML), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS), melanoma, stomach cancer, prostate cancer, biliary cancer, urinary system cancer, glioblastoma, soft tissue sarcoma, osteosarcoma, or non-small cell lung cancer (NSCLC).

[0011] In an embodiment, one or more of the peptides NLMNLGATL (SEQ ID NO:21), WNLMNLGATLKGVAA (SEQ ID NO:26), LVRHHNMHQRNMTKL (SEQ ID NO:3), NKRYFKLSHLQMHSR (SEQ ID NO:4), SGQARMFPNAPYLPSCLES (SEQ ID NO:5), QARMFPNAPYLPSCL (SEQ ID NO:6), RMFPNAPYL (SEQ ID NO:7), SLGEQQYSV (SEQ ID NO:8), ALLPAVPSL (SEQ ID NO:9), NLGATLKGV (SEQ ID NO:10), DLNALLPAV (SEQ ID NO:11), GVFRGIQDV (SEQ ID NO:12), KRYFKLSHL (SEQ ID NO:13), ALLLRTPYS (SEQ ID NO:14), CMTWMQMNL (SEQ ID NO:15), NMHQRNMTK (SEQ ID NO:16), QMNLGATLK (SEQ ID NO:17), FMCAYPGCNK (SEQ ID NO:18), KLSHLQMHSR (SEQ ID NO:19), QAYMFPNAPYLPSCL (SEQ ID NO:126), YLGEQQYSV (SEQ ID NO:127), YLLPAVPSL (SEQ ID NO:128), YLGATLKGV (SEQ ID NO:129), YLNALLPAV (SEQ ID NO:130), GLRRGIQDV (SEQ ID NO:131), KLYFKLSHL (SEQ ID NO:132), ALLLRTPYV (SEQ ID NO:133), YMTWNQMNL (SEQ ID NO:134), NMYQRNMTK (SEQ ID NO:135), NMHQRVMTK (SEQ ID NO:136), NMYQRVMTK (SEQ ID NO: 137), QMYLGATLK (SEQ ID NO:138), QMNLGVTLK (SEQ ID NO:139), QMYLGVTLK (SEQ ID NO: 140), FMYAYPGCNK (SEQ ID NO:141), FMCAYPFCNK (SEQ ID NO:142), FMYAYPFCNK (SEQ ID NO:143), KLYHLQMHSR (SEQ ID NO:144), KLSHLQMHSK (SEQ ID NO:145), KLYHLQMHSK (SEQ ID NO:146), NQMNLGATL (SEQ ID NO:20), NYMNLGATL (SEQ ID NO:22), CMTWNQMNLGATLKG (SEQ ID NO:23), CMTWNLMNLGATLKG (SEQ ID NO:24), WNQMNLGATLKGVAA (SEQ ID NO:25), MTWNQMNLGATLKGV (SEQ ID NO:27), TWNQMNLGATLKGVA (SEQ ID NO:28), MTWNLMNLGATLKGV (SEQ ID NO:30), TWNLMNLGATLKGVA (SEQ ID NO:31), MTWNYMNLGATLKGV (SEQ IDNO:33), TWNYMNLGATLKGVA (SEQ ID NO:34), CMTWNQMNLGATLKGVA (SEQ ID NO:35), WNQMNLGAT (SEQ ID NO:36), TWNQMNLGA (SEQ ID NO:37), MTWNQMNLG (SEQ ID NO:38), CMTWNLMNLGATLKGVA (SEQ ID NO:39), WNLMNLGAT (SEQ ID NO:40), MNLGATLKG (SEQ ID NO:41), CMTWNYMNLGATLKGVA (SEQ ID NO:43), GALRNPTAC (SEQ ID NO:46), GYLRNPTAC (SEQ ID NO:47), GALRNPTAL (SEQ ID NO:48), YALRNPTAC (SEQ ID NO:49), GLLRNPTAC (SEQ ID NO:50), RQRPHPGAL (SEQ ID NO:51), RYRPHPGAL (SEQ ID NO:52), YQRPHPGAL (SEQ ID NO:53), RLRPHPGAL (SEQ ID NO:54), RIRPHPGAL (SEQ ID NO:55), QFPNHSFKHEDPMGQ (SEQ ID NO:61), HSFKHEDPM (SEQ ID NO:63), HSFKHEDPY (SEQ ID NO:64), HSFKHEDPK (SEQ ID NO:65), KRPFMCAYPGCYKRY (SEQ ID NO:66), SEKRPFMCAYPGCNK (SEQ ID NO:67), KRPFMCAYPGCNK (SEQ ID NO:68), FMCAYPGCN (SEQ ID NO:69), FMCAYPGCY (SEQ ID NO:70), and FMCAYPGCK (SEQ ID NO:71) is also administered.

[0012] In an embodiment, 200 mcg of each peptide is emulsified with Montanide ISA 51 VG and administered subcutaneously on weeks 0, 2, 4, 6, 8 and 10.

[0013] In an embodiment, 3 mg / kg of nivolumab is administered intravenously on weeks 0, 2, 4, 6, 8, 10 and 12.

[0014] In an embodiment, the treating, reducing the incidence of, or inducing an immune response against a WT1-expressing cancer is greater than achieved by administering the WT1 peptides alone or the at least one PD1 inhibitor alone.

[0015] The present invention also provides a composition comprising the four WT1 peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125), and at least one antibody PD1 inhibitor.

[0016] In an embodiment, the PD1 inhibitor is nivolumab, pembrolizumab, pidilizumab, or MEDI0680 (AMP-514).DETAILED DESCRIPTION OF THE INVENTION

[0017] Ovarian cancer is one of the most common gynecologic malignancies and the fifth most frequent cause of cancer death in women in the United States. Over 22,000 cases are diagnosed annually, and there are an estimated 15,500 deaths per year [1]. The majority of patients have widespread disease at presentation [2]. The 5-year survival for advanced-stage disease remains less than 30% [1]. Although a complete clinical remission following initial chemotherapy can be anticipated for many patients, a review of second-look laparotomy when it was often performed as a matter of routine care indicates that less than 50% of patients are actually free of disease [3]. Furthermore, nearly half of patients with a negative second look procedure relapse and require additional treatment [4]. Many patients will achieve a second complete clinical response with additional chemotherapy. However, almost all patients will relapse after a short remission interval of 9-11 months. [5]. Effective strategies to prolong remission or to prevent relapse are required, as subsequent remissions are of progressively shorter duration until chemotherapy resistance broadly develops [2].

[0018] Both antibody and T cell effectors have been shown to provide benefit in ovarian cancer models. Antibodies have been noted to curtail early tissue invasion [6]. Preclinical models have also demonstrated the clearance of circulating tumor cells and the elimination of systemic micro metastasis through the use of both passively administered and vaccine induced antibodies. With regards to T cell effectors, a globally activated immune response has been shown to be associated with improved clinical outcome in patients with advanced ovarian cancer. Zhang et al showed that the presence of tumor infiltrating T cells within tumor cell islets was associated with improvement in both progression free and overall survival [7]. Conversely, the infiltration of T-regulatory cells confers a worse prognosis [8].

[0019] Data in patients with ovarian cancer in second or greater remission confirms them to relapse in a predictable fashion [9]. In recent years, ovarian cancer has been targeted by a variety of novel immune based approaches. Antibody therapy has included oregovomab

[10] which is a monoclonal antibody therapy targeting the CA125 antigen; abagovomab

[11] which is an anti-idiotypic antibody targeting CA-125; and trastuzumab

[12] which is a monoclonal humanized anti-HER2 antibody. Other strategies have included cytokine therapy such as Interferon-y [13, 14] and IL-2

[15] . Active immunization with other antigens such as Lewis y

[16] , MUC1

[17] , the HLA restricted peptide NY-ESO-1b

[18] and the KH-1-KLH conjugate have also been evaluated. Previous strategies have been ineffective and new therapeutic modalities are needed to increase the efficacy of therapies for ovarian as well as numerous other cancers that are ineffectively treated with currently available therapies.

[0020] WT1 refers to Wilms' tumor 1 or the gene product of the WT1 gene. The Wilms' tumor suppressor gene, WT1, was first identified in childhood renal tumors, but WT1 is also highly expressed in multiple other hematologic malignancies and solid tumors including mesothelioma [19, 20]. WT1 was originally identified by cDNA mapping to a region of chromosome 11p13. The WT1 cDNA encodes a protein containing four Kruppel zinc fingers and contains a complex pattern of alternative splicing resulting in four different transcription factors. Each WT1 isoform has different DNA binding and transcriptional activities

[21] , and can positively or negatively regulate various genes involved in cellular proliferation, differentiation, apoptosis, organ development and sex determination. WT1 is normally expressed in tissues of the mesodermal origin during embryogenesis including the kidney, gonads, heart, mesothelium and spleen

[22] . In normal adult tissues, WT1 expression is limited to low levels in the nuclei of normal CD34+ hematopoietic stem cells, myoepithelial progenitor cells, renal podocytes and some cells in the testis and ovary

[23] . WT1 is highly homologous in mice and humans (96% at the amino acid level) and has similar tissue distribution and function [24, 25]. Although originally described as a tumor suppressor gene, the WT1 proteins appear to be involved in tumorigenesis.

[0021] The strong expression of WT1 protein in ovarian cancer coupled with its proposed mechanism of action makes it a rational target for immunotherapy, among many other cancers that also express WT1 protein, such as mesothelioma, leukemia, Wilms' tumor, acute myelogenous leukemia (AML), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS), melanoma, stomach cancer, prostate cancer, biliary cancer, urinary system cancer, glioblastoma, soft tissue sarcoma, osteosarcoma, and non-small cell lung cancer (NSCLC). In ovarian cancer, the expression is so frequent that pathologists routinely use immunohistochemical stains for WT1 (with a standardized convention for describing expression and determining as "positive" or "negative" to help distinguish epithelial ovarian cancers from other tumors. WT1 is a particularly sensitive and specific marker for serous ovarian cancer

[26] . Ovarian tissue microarrays suggest that 70-80% of serous ovarian cancers express WT1 such that the majority of patients will have the target and be eligible for study participation. Vaccination with four synthetic peptides derived from WT1 has been shown to induce T-cell responses in patients with complete remission from acute myeloid leukemia

[60] .

[0022] In one aspect, the present invention provides the combination of (a) the four WT1 peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125), and (b) at least one antibody PD1 inhibitor, for use in treating, reducing the incidence of, or inducing an immune response against a WT1-expressing cancer.

[0023] The WT1 peptides RSDELVRHHNMHQRNMTKL (SEQ ID NO:1) and PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO:2) are native peptides which are fragments of the WT1 protein.

[0024] The native WT1 peptides are described in WO2005053618, WO2007047764, and WO2007120673.

[0025] The WT1 peptides YMFPNAPYL (SEQ ID NO:124) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125) are modified WT1 peptide fragments containing one or more heteroclitic modifications to enhance immunogenicity against the native peptide sequence.

[0026] The modified WT1 peptides are described in WO2005053618, WO2007047764, and WO2007120673.

[0027] In an embodiment, the peptides may be administered in combination with a carrier, diluent or excipient. In one embodiment, the peptides are administered in combination with an adjuvant. Each peptide may be administered with a different adjuvant or combination of adjuvants, or peptides may be administered in a combination of two or more peptides, with an adjuvant of combination of adjuvants. The immunogen or composition containing the one or more peptides may be referred to herein as a vaccine, a peptide vaccine, a WT1 vaccine, and the like.

[0028] The adjuvant may be of any class such as alum salts and other mineral adjuvants, bacterial products or bacteria-derived adjuvants, tensoactive agents (e.g., saponins), oil-in-water (o / w) and water-in-oil (w / o) emulsions, liposome adjuvants, cytokines (e.g., IL-2, GM-CSF, IL-12, and IFN-gamma), and alpha-galactosylceramide analogs. Nonlimiting examples of adjuvants include Montanide emulsions, QS21, Freund's complete or incomplete adjuvant, aluminum phosphate, aluminum hydroxide, Bacillus Calmette-Guerin (BCG), and alum. In one embodiment, the adjuvant is an agent that enhances the immune system's CTL response against the WT1 peptide, such as the surfactant mannide monooleate containing vegetable-grade (VG) oleic acid derived from olive oil (Montanide ISA 51 VG w / o emulsion). The adjuvant may be administered in the same composition as the one or more WT1 peptides, or in the same composition as the at least one PD1 inhibitor, or in the same composition as both the one or more WT1 peptides and the at least one PD1 inhibitor, or in a composition separate from the one or more WT1 peptides and the at least one PD1 inhibitor.

[0029] In one embodiment, one or more other peptides may be used together with the aforementioned combination of the four peptides: YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125) for the purposes herein.

[0030] Thus, in an embodiment, one or more of the peptides NLMNLGATL (SEQ ID NO:21), WNLMNLGATLKGVAA (SEQ ID NO:26), LVRHHNMHQRNMTKL (SEQ ID NO:3), NKRYFKLSHLQMHSR (SEQ ID NO:4), SGQARMFPNAPYLPSCLES (SEQ ID NO:5), QARMFPNAPYLPSCL (SEQ ID NO:6), RMFPNAPYL (SEQ ID NO:7), SLGEQQYSV (SEQ ID NO:8), ALLPAVPSL (SEQ ID NO:9), NLGATLKGV (SEQ ID NO:10), DLNALLPAV (SEQ ID NO:11), GVFRGIQDV (SEQ ID NO:12), KRYFKLSHL (SEQ ID NO:13), ALLLRTPYS (SEQ ID NO:14), CMTWMQMNL (SEQ ID NO:15), NMHQRNMTK (SEQ ID NO:16), QMNLGATLK (SEQ ID NO:17), FMCAYPGCNK (SEQ ID NO:18), KLSHLQMHSR (SEQ ID NO:19), QAYMFPNAPYLPSCL (SEQ ID NO:126), YLGEQQYSV (SEQ ID NO:127), YLLPAVPSL (SEQ ID NO:128), YLGATLKGV (SEQ ID NO:129), YLNALLPAV (SEQ ID NO:130), GLRRGIQDV (SEQ ID NO:131), KLYFKLSHL (SEQ ID NO:132), ALLLRTPYV (SEQ ID NO:133), YMTWNQMNL (SEQ ID NO:134), NMYQRNMTK (SEQ ID NO:135), NMHQRVMTK (SEQ ID NO:136), NMYQRVMTK (SEQID NO: 137), QMYLGATLK (SEQ ID NO:138), QMNLGVTLK (SEQ ID NO:139), QMYLGVTLK (SEQ ID NO: 140), FMYAYPGCNK (SEQ ID NO:141), FMCAYPFCNK (SEQ ID NO:142), FMYAYPFCNK (SEQ ID NO:143), KLYHLQMHSR (SEQ ID NO:144), KLSHLQMHSK (SEQ ID NO:145), KLYHLQMHSK (SEQ ID NO:146), NQMNLGATL (SEQ ID NO:20), NYMNLGATL (SEQ ID NO:22), CMTWNQMNLGATLKG (SEQ ID NO:23), CMTWNLMNLGATLKG (SEQ ID NO:24), WNQMNLGATLKGVAA (SEQ ID NO:25), MTWNQMNLGATLKGV (SEQ ID NO:27), TWNQMNLGATLKGVA (SEQ ID NO:28), MTWNLMNLGATLKGV (SEQ ID NO:30), TWNLMNLGATLKGVA (SEQ ID NO:31), MTWNYMNLGATLKGV (SEQ IDNO:33), TWNYMNLGATLKGVA (SEQ ID NO:34), CMTWNQMNLGATLKGVA (SEQ ID NO:35), WNQMNLGAT (SEQ ID NO:36), TWNQMNLGA (SEQ ID NO:37), MTWNQMNLG (SEQ ID NO:38), CMTWNLMNLGATLKGVA (SEQ ID NO:39), WNLMNLGAT (SEQ ID NO:40), MNLGATLKG (SEQ ID NO:41), CMTWNYMNLGATLKGVA (SEQ ID NO:43), GALRNPTAC (SEQ ID NO:46), GYLRNPTAC (SEQ ID NO:4 7), GALRNPTAL (SEQ ID NO:48), YALRNPTAC (SEQ ID NO:49), GLLRNPTAC (SEQ ID NO:50), RQRPHPGAL (SEQ ID NO:51), RYRPHPGAL (SEQ ID NO:52), YQRPHPGAL (SEQ ID NO:53), RLRPHPGAL (SEQ ID NO:54), RIRPHPGAL (SEQ ID NO:55), QFPNHSFKHEDPMGQ (SEQ ID NO:61), HSFKHEDPM (SEQ ID NO:63), HSFKHEDPY (SEQ ID NO:64), HSFKHEDPK (SEQ ID NO:65), KRPFMCAYPGCYKRY (SEQ ID NO:66), SEKRPFMCAYPGCNK (SEQ ID NO:67), KRPFMCAYPGCNK (SEQ ID NO:68), FMCAYPGCN (SEQ ID NO:69), FMCAYPGCY (SEQ ID NO:70), FMCAYPGCK (SEQ ID NO:71) is also administered.

[0031] In another embodiment, one or more native or modified WT1 peptides from among those disclosed in WO2014113490, such as NQMNLGATL (SEQ ID NO:147), NLMNLGATL (SEQ ID NO:148), NYMNLGATL (SEQ ID NO:149), CMTWNQMNLGATLKG (SEQ ID NO:150), CMTWNLMNLGATLKG (SEQ ID NO:151), WNQMNLGATLKGVAA (SEQ ID NO:152), WNLMNLGATLKGVAA (SEQ ID NO:153), MTWNQMNLGATLKGV (SEQ ID NO:154), TWNQMNLGATLKGVA (SEQ ID NO: 155), MTWNLMNLGATLKGV (SEQ ID NO:157), TWNLMNLGATLKGVA (SEQ ID NO:158), MTWNYMNLGATLKGV (SEQ ID NO:160), TWNYMNLGATLKGVA (SEQ ID NO:161), CMTWNQMNLGATLKGVA (SEQ ID NO:162), WNQMNLGAT (SEQ ID NO:163), TWNQMNLGA (SEQ ID NO:164), MTWNQMNLG (SEQ ID NO:165), CMTWNLMNLGATLKGVA (SEQ ID NO:166), WNLMNLGAT (SEQ ID NO:167), MNLGATLKG (SEQ ID NO:168), CMTWNYMNLGATLKGVA (SEQ ID NO:170), GALRNPTAC (SEQ ID NO:173), GYLRNPTAC (SEQ ID NO:174), GALRNPTAL (SEQ ID NO:175), YALRNPTAC (SEQ ID NO:176), GLLRNPTAC (SEQ ID NO:177), RQRPHPGAL (SEQ ID NO:178), RYRPHPGAL (SEQ ID NO:179), YQRPHPGAL (SEQ ID NO:180), RLRPHPGAL (SEQ ID NO:181), RIRPHPGAL (SEQ ID NO:182), QFPNHSFKHEDPMGQ (SEQ ID NO:188), HSFKHEDPM (SEQ ID NO:190), HSFKHEDPY (SEQ ID NO:191), HSFKHEDPK (SEQ ID NO:192), KRPFMCAYPGCYKRY (SEQ ID NO:194), SEKRPFMCAYPGCNK (SEQ ID NO:194), KRPFMCAYPGCNK (SEQ ID NO:195), FMCAYPGCN (SEQ ID NO:196), FMCAYPGCY (SEQ ID NO:197), or FMCAYPGCK (SEQ ID NO:198) is also administered.

[0032] Each peptide of a combination may be administered separately within its own formulation, or two, three, four, five, or more peptides of a combination may be administered together within the same formulation.

[0033] The dose level or each peptide, the frequency of administration of each or combinations of peptides, the duration of administration and other aspects of the immunization with WT1 peptides may be optimized in accordance with the patient's clinical presentation, duration or course of the disease, comorbidities, and other aspects of clinical care.

[0034] In one embodiment, the WT-1 vaccine comprises 280 mcg of each of the four aforementioned peptides (YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125)) combined in a total volume of 0.7 ml (0.4 mg / ml of each peptide). In one embodiment, 200 mcg of each peptide is administered at each dose (0.5 ml). In one embodiment 100 to 2000 mcg of each peptide is administered at each dose. In one embodiment, the foregoing dose is administered every other week over a course of 10 weeks (i.e., 6 administrations). In one embodiment, administration is subcutaneous. In one embodiment, an adjuvant is mixed (emulsified) with the vaccine before dosing. In one embodiment 0.5 mL of vaccine (i.e., 200 mcg of each peptide) is emulsified with 1.0 mL of adjuvant before administration. In another embodiment, the adjuvant is injected at the same site as the vaccine, before or after the vaccine is injected. In one embodiment, the adjuvant is an emulsion. In one embodiment, the emulsion is a Montanide emulsion. In one embodiment, the Montanide emulsion is the immunologic adjuvant Montanide ISA 51 VG. In the practice of the invention, a PD1 inhibitor is also administered to the subject with the WT1 vaccine, as described further below.

[0035] The PD1 inhibitor is an immune checkpoint inhibitor. Immune checkpoints regulate T cell function in the immune system. T cells play a central role in cell-mediated immunity. Checkpoint proteins interact with specific ligands which send a signal into the T cell and essentially switch off or inhibit T cell function. Cancer cells take advantage of this system by driving high levels of expression of checkpoint proteins on their surface which results in control of the T cells expressing checkpoint proteins on the surface of T cells that enter the tumor microenvironment, thus suppressing the anticancer immune response. As such, inhibition of checkpoint proteins would result in restoration of T cell function and an immune response to the cancer cells. An immune checkpoint inhibitor (or checkpoint inhibitor) is a compound or agent that blocks or inhibits immune checkpoint proteins (i.e., that blocks or inhibits checkpoint receptors or checkpoint receptor ligands). Other checkpoint proteins include CTLA-4, PD-L1, PD-L2, PD1, B7-H3, B7-H4, BTLA, HVEM, TIM3, GAL9, LAG3, VISTA, IDO, KIR, 2B4 (belongs to the CD2 family of molecules and is expressed on all NK cells, and memory CD8 +< T cells), CD160 (also referred to as BY55), CGEN-15049, CHK 1 and CHK2 kinases, A2aR, and various B-7 family ligands.

[0036] Programmed Death-1 (PD-1) is a member of the immunoglobulin superfamily (IGSF) of molecules involved in regulation of T cell activation. PD-1 acquired its name 'programmed death' when it was identified in 1992 as a gene upregulated in T cell hybridoma undergoing cell death. The structure of PD-1 is composed of one IGSF domain, a transmembrane domain, and an intracellular domain containing an immunoreceptor tyrosine-based inhibitory motif (ITIM) and an immunoreceptor tyrosine-based switch motif (ITSM)

[38] . PD-1 has two binding partners: PD-L1 (B7-H1, CD274) and PD-L2 (B7-DC, CD273). PD-L1 is expressed broadly on both hematopoietic and non-hematopoietic lineages [39, 40]. It is found on T cell, B cells, macrophages, NK cells, DCs, and mast cells as well as in peripheral tissues. [41, 42]. PD-1 engagement represents one means by which tumors evade immunosurveillance and clearance

[43] . Blockade of the PD-1 pathway has been demonstrated by nivolumab, which shows activity in immunocompetent mouse cancer models

[44] .

[0037] In this invention, the PD1 checkpoint inhibitor is an antibody. Examples of antibodies include nivolumab (OPDIVO), pembrolizumab (KEYTRUDA), pidilizumab (CT-011), and MEDI0680 (AMP-514).

[0038] Nivolumab (OPDIVO) is a fully human IgG4 monoclonal antibody targeted against PD-1 receptor on activated T and B lymphocytes

[47] . Pembrolizumab (KEYTRUDA) is another example of an antibody that targets PD-1. Examples of PD1 inhibitors are listed in Table 1. Examples of other checkpoint inhibitors are listed in Table 2. Table 1. Examples of PD1 InhibitorsNameClass of AgentTargetNivolumab (a.k.a. ONO-4538; BMS-936558; MDX1106; marketed as Opdivo)IgG4 human mAbProgrammed death-1 (PD-1)Pembrolizumab (a.k.a., MK-3475; lambrolizumab; marketed as Keytruda)IgG4 humanized mAbPD-1Pidlizumab (a.k.a. CT-011)IgG1 humanized mAbPD-1MEDI0680 (a.k.a. AMP-514)IgG4 humanized mAbPD-1AMP-224Fc-PD-L2 fusion proteinPD-1AUNP-12Branched, 29-amino acid peptidePD-1 Table 2: Examples of Other Checkpoint Inhibitors NameClass of AgentTargetIpilumumab (a.k.a. MDX-010; MDX-101; BMS-734016; marketed as Yervoy)IgG1 human mAbCytotoxic T-lymphocyte antigen 4 (CTLA-4)Tremelimumab (a.k.a. ticilimumab; CP-675-206)IgG2 human mAbCTLA-4BMS-936559IgG4 human mAbProgrammed death ligand-1 (PD-L1)Atezolizumab (a.k.a. MPDL3280A; RG7446)IgG1 humanized mAbPD-L1Durvalumab (a.k.a. MEDI4736)IgG1 human mAbPD-L1Avelumab (a.k.a. MSB0010718C)IgG1 human mAbPD-L1BMS935559 (a.k.a. MDX-1105)IgG4 human mAbPD-L1rHIgM12B7IgM human mAbProgrammed death ligand-2 (PD-L2)BMS-986016mABLymphocyte activation gene-3 (LAG-3; a.k.a. CD223)GSK2831781Humanized afuscated mAbLAG-3IMP321Soluble LAG-3LAG-3Lirilumab (a.k.a. BMS-986015)IgG4 human mAbKiller cell immunoglobulin-like receptor (KIR)IPH2101 (a.k.a. 1-7F9)Anti-inhibitor monoclonal AbKIRIndoximod (a.k.a. NLG 9189; CAS # 110117-83-4)Small molecule (D isomer of 1-methyl-tryptophan)Indoleamine-2,3-dioxygenase 1 (IDOl)NLG 919 (CAS # 1402836-58-1)Small moleculeIDOlINCB024360 (CAS # 914471-09-3)Small moleculeIDOlPF-05082566IgG2 human mAB4-1BB (a.k.a. CD137)Urelumab (a.k.a. BMS-663513)IgG4 humanized mAb4-1BBMEDI6469IgG1 mouse antihuman AbOX40 (a.k.a. CD134)

[0039] In one embodiment, a combination of two or more checkpoint inhibitors is administered to the subject. In one embodiment, the combination of inhibitors is selected from among those in Tables 1 and 2. The two or more inhibitors can be administered simultaneously or consecutively with respect to one another and with respect to the WT1 peptides. Thus, two or more checkpoint inhibitors targeting two different checkpoint proteins, such as PD-1 (e.g., nivolumab or other antibody PD-1 inhibitor) and CTLA-4 (e.g., ipilumumab or other CTLA-4 inhibitor), may be administered to the subject simultaneously or consecutively with respect to one another and with respect to the one or more WT1 peptides.

[0040] The dose level, frequency of dosing, duration of dosing and other aspects of administration of the checkpoint inhibitor may be optimized in accordance with the patient's clinical presentation, duration or course of the disease, comorbidities, and other aspects of clinical care.

[0041] In one embodiment, a nivolumab dose and schedule selection of 3mg / kg every 2 weeks over a course of 12 weeks is employed. In one embodiment, administration is intravenous. In one embodiment, the course of PD1 inhibitor administration is concurrent with that of the WT1 vaccine administration. In one embodiment the course of PD1 inhibitor administration overlaps with that of the WT1 vaccine administration. In one embodiment the course of PD1 inhibitor administration starts at about the same time as the course of the WT1 vaccine administration.

[0042] In one embodiment, the WT1 vaccine comprises 200 mcg of each of the peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125) combined in a total volume of 0.5 ml emulsified with 1.0 mL Montanide ISA 51 VG and administered subcutaneously every 2 weeks for 6 administrations; and nivolumab, 3 mg / kg, is administered intravenously by 60 minute infusion every two weeks for 7 administrations, starting at the same time as the WT1 vaccine.

[0043] In one embodiment, the one or more WT1 peptides and the one or more antibody PD1 inhibitors are each administered to a subject according to a schedule that maximally benefits the patient. The one or more WT 1 peptide and the one or more PD 1 inhibitor are therefore not necessarily administered at the same time or even in the same composition or each for the same duration. Each WT1 peptide may be administered in accordance with a particular schedule, as may be each PD1 inhibitor. In one non-limiting embodiment, the one or more WT1 peptide and one or more the PD1 inhibitor are present in the same composition.

[0044] As noted herein, the dose level and dosing schedule including frequency and duration of the WT1 peptide or peptides (separately or administered together) and that of the one or more PD1 inhibitors (administered separately or together), the route of administration, and other aspects of administration are optimized for maximal benefit to the patient subject.

[0045] In another aspect, the present invention also provides a composition comprising the four peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125) and at least one antibody PD1 inhibitor. In one embodiment the composition comprises nivolumab, pembrolizumab, or the combination thereof. The composition may further comprise an excipient, diluent or carrier. The composition may also comprise one or more adjuvants.

[0046] The foregoing embodiments provide improved compositions for use in treating, reducing the incidence of, and inducing immune responses against a WT1-expressing cancer.

[0047] In one embodiment, the aforementioned compositions for use in treating a WT1 expressing cancer, reducing the incidence of a WT1 expressing cancer or inducing the formation and proliferation of a WT1 protein specific T cell response, are achieved with greater effect than if such compositions employ only the WT1 peptides alone or the PD1 inhibitor(s) alone. In one embodiment, the course of administration of the WT1 vaccine and the course of administration of the one or more PD1 inhibitors are concurrent, overlap, or are contemporaneous such that the biological response to the vaccine is enhanced by the administration of the one or more PD1 inhibitors. In one embodiment, the course of WT1 vaccine administration can end before the course of PD1 inhibitor therapy begins, insofar as the effectiveness of the CTLs elicited by the WT1 vaccine administration is enhanced by the PD1 inhibitor therapy. In one embodiment, the first administration of PD1 inhibitor therapy is on the same day as the last WT1 vaccine administration. In one embodiment the end of WT1 vaccination and the start of PD1 inhibitor therapy is separated by from 1-7 days or from 1-4 weeks.

[0048] In another embodiment, a peptide for use in the present invention is immunogenic. The term "immunogenic" refers to an ability to stimulate, elicit or participate in an immune response. In another embodiment, the immune response elicited is a cell-mediated immune response. In another embodiment, the immune response is a combination of cell-mediated and humoral responses.

[0049] As disclosed herein, an encounter of a T cell with a peptide for use in this invention induces its differentiation into an effector and / or memory T cell. Subsequent encounters between the effector or memory T cell and the same peptide, or, in another embodiment, with a heteroclitic peptide, leads to a faster and more intense immune response. Such responses are gauged, in another embodiment, by measuring the degree of proliferation of the T cell population exposed to the peptide.

[0050] In another embodiment, as described herein, when the subject is exposed to a peptide, or a composition comprising a peptide for use in this invention, which differs from the native protein expressed, subsequently a host immune response cross-reactive with the native protein / antigen develops.

[0051] In another embodiment, peptides, compositions, and vaccines for use in this invention stimulate an immune response that results in tumor cell lysis. In all of the foregoing embodiments, the concurrent use of the PD1 inhibitor enhances the immune response against the tumor.

[0052] In an embodiment, the WT1 molecule has the sequence:

[0053] In another embodiment, the WT1 molecule has the sequence:

[0054] In another embodiment, the WT1 molecule has the sequence:

[0055] In another embodiment, the WT1 molecule comprises the sequence:

[0056] In other embodiments, the WT1 protein comprises one of the sequences set forth in one of the following GenBank sequence entries: NM_024426, NM_024425, NM_024424, NM_000378, S95530, D13624, D12496, D12497, AH003034, or X77549.

[0057] In certain embodiments, the composition of the present invention is a vaccine.

[0058] In another embodiment, the combination of treatment agents for use in the present invention may be for inducing an anti-mesothelioma immune response in a subject, treating a subject with a mesothelioma, or for reducing the incidence of a mesothelioma, or its relapse, in a subject.

[0059] In another embodiment, the composition comprising the four WT1 peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125) and the at least one antibody PD1 inhibitor further comprises a pharmaceutically acceptable carrier. In another embodiment, the composition further comprises an adjuvant. In another embodiment, the composition further comprises any of the additives, compounds, or excipients set forth herein below. In another embodiment, the adjuvant is an alum salt or other mineral adjuvant, bacterial product or bacteria-derived adjuvant, tensoactive agent (e.g., saponin), o / w or w / o emulsion, liposome adjuvant, cytokine (e.g., IL-2, GM-CSF, IL-12, and IFN-gamma), or alpha-galactosylceramide analog. In another embodiment, the adjuvant is QS21, Freund's complete or incomplete adjuvant, aluminum phosphate, aluminum hydroxide, BCG or alum. In other embodiments, the carrier is any carrier enumerated herein. In other embodiments, the adjuvant is any adjuvant enumerated herein.

[0060] In another embodiment, the composition may be a vaccine composition or an immunogenic composition.

[0061] In another embodiment, the term "vaccine" refers to a material or composition that, when introduced into a subject, provides a prophylactic or therapeutic response for a particular disease, condition, or symptom of same. In another embodiment, this invention comprises peptide-based vaccines, optionally further including immunomodulating compounds such as cytokines, adjuvants, etc.

[0062] In other embodiments, the composition further comprises an adjuvant. In another embodiment, the adjuvant is Montanide ISA 51. Montanide ISA 51 contains a natural metabolizable oil and a refined emulsifier. In another embodiment, the adjuvant is GM-CSF. In another embodiment, the adjuvant is keyhole limpet hemocyanin (KLH), which may be conjugated to the peptide antigen or may be administered together with the peptide. Recombinant GM-CSF is a human protein grown, in another embodiment, in a yeast (S. cerevisiae) vector. GM-CSF promotes clonal expansion and differentiation of hematopoietic progenitor cells, APC, and dendritic cells and T cells.

[0063] In another embodiment, the adjuvant is a cytokine. In another embodiment, the adjuvant is a growth factor. In another embodiment, the adjuvant is a cell population. In another embodiment, the adjuvant is QS21. In another embodiment, the adjuvant is Freund's incomplete adjuvant. In another embodiment, the adjuvant is aluminum phosphate. In another embodiment, the adjuvant is aluminum hydroxide. In another embodiment, the adjuvant is BCG. In another embodiment, the adjuvant is alum. In another embodiment, the adjuvant is an interleukin. In another embodiment, the adjuvant is a chemokine. In another embodiment, the adjuvant is any other type of adjuvant known in the art. In another embodiment, the WT1 vaccine comprises two of the above adjuvants. In another embodiment, the WT1 vaccine comprises more than two of the above adjuvants.

[0064] This invention provides the combination of treatment agents for use in treating a subject with a WT1-expressing cancer. In another embodiment, the present invention provides the combination of treatment agents for use in suppressing or halting the progression of a WT1-expressing cancer in a subject. In another embodiment, the present invention provides the combination of treatment agents for use in reducing the incidence of a WT1-expressing cancer in a subject.. In another embodiment, the present invention provides the combination of treatment agents for use in reducing the incidence of relapse of a WT1-expressing cancer in a subject. In another embodiment, the present invention provides the combination of treatment agents for use in overcoming T cell tolerance of a subject to a WT1-expressing cancer.

[0065] It is also disclosed that the composition of the present invention can be used in a method of treating a subject having a WT1-expressing cancer, comprising (a) inducing in a donor formation and proliferation of human cytotoxic T lymphocytes (CTL) that recognize a malignant cell of the cancer; and (b) infusing the human CTL into the subject, thereby treating a subject having a cancer. Methods for ex vivo immunotherapy are well known in the art and are described, for example, in Davis ID et al (Blood dendritic cells generated with Flt3 ligand and CD40 ligand prime CD8+ T cells efficiently in cancer patients. J Immunother. 2006 Sep-Oct;29(5):499-511) and Mitchell MS et al (The cytotoxic T cell response to peptide analogs of the HLA-A∗0201-restricted MUC1 signal sequence epitope, M1.2. Cancer Immunol Immunother. 2006 Jul 28).

[0066] It is disclosed that the treatment of the present invention may act by inducing in a subject formation and proliferation of a WT1 protein-specific CTL. In another embodiment, the immunogenic composition may further comprises an antigen presenting cell (APC).

[0067] It is disclosed that the treatment of the present invention may act by generating a heteroclitic immune response in a subject, wherein the heteroclitic immune response is directed against a WT1-expressing cancer.

[0068] In an embodiment, the WT1-expressing cancer is an acute myelogenous leukemia (AML). In another embodiment, the WT1-expressing cancer is a chronic myelogenous leukemia (CML). In another embodiment, the WT1-expressing cancer is associated with a myelodysplastic syndrome (MDS). In another embodiment, the WT1-expressing cancer is an MDS. In another embodiment, the WT1-expressing cancer is a non-small cell lung cancer (NSCLC). In another embodiment, the WT1-expressing cancer is an esophageal squamous cell carcinoma. In another embodiment, the WT1-expressing cancer is an acute lymphoblastic leukemia (ALL). In another embodiment, the WT1-expressing cancer is a bone or soft tissue sarcoma. In another embodiment, the WT1-expressing cancer is a Wilms' tumor. In another embodiment, the WT1-expressing cancer is a leukemia. In another embodiment, the WT1-expressing cancer is a hematological cancer. In another embodiment, the WT1-expressing cancer is a lymphoma. In another embodiment, the WT1-expressing cancer is a desmoplastic small round cell tumor. In another embodiment, the WT1-expressing cancer is a mesothelioma. In another embodiment, the WT1-expressing cancer is a malignant mesothelioma. In another embodiment, the WT1-expressing cancer is a gastric cancer. In another embodiment, the WT1-expressing cancer is a colon cancer. In another embodiment, the WT1-expressing cancer is a lung cancer. In another embodiment, the WT1-expressing cancer is a breast cancer. In another embodiment, the WT1-expressing cancer is a germ cell tumor.. In another embodiment, the WT1-expressing cancer is a malignant pleural mesothelioma. In another embodiment, the WT1-expressing cancer is multiple myeloma. In another embodiment, the WT1-expressing cancer is myeloid leukemia. In another embodiment, the WT1-expressing cancer is an astrocytic cancer. In another embodiment, the WT1-expressing cancer is a glioblastoma (e.g., glioblastoma multiforme). In another embodiment, the WT1-expressing cancer is a colorectal adenocarcinoma. In another embodiment, the WT1-expressing cancer is an ovarian cancer (e.g., serous, epithelial, or endometrial). In another embodiment, the WT1-expressing cancer is breast cancer. In another embodiment, the WT1-expressing cancer is melanoma. In another embodiment, the WT1-expressing cancer is head and neck squamous cell carcinoma. In another embodiment, the WT1-expressing cancer is pancreatic ductal cell carcinoma. In another embodiment, the WT1-expressing cancer is a neuroblastoma. In another embodiment, the WT1-expressing cancer is a uterine cancer. In another embodiment, the WT1-expressing cancer is a thyroid cancer. In another embodiment, the WT1-expressing cancer is a hepatocellular carcinoma. In another embodiment, the WT1-expressing cancer is a thyroid cancer. In another embodiment, the WT1-expressing cancer is a liver cancer. In another embodiment, the WT1-expressing cancer is a renal cancer (e.g., renal cell carcinoma). In another embodiment, the WT1-expressing cancer is a Kaposi's sarcoma. In another embodiment, the WT1-expressing cancer is a sarcoma. In another embodiment, the WT1-expressing cancer is any other carcinoma or sarcoma.

[0069] In another embodiment, the WT1-expressing cancer is a solid tumor. In another embodiment, the solid tumor is associated with a WT1-expressing cancer. In another embodiment, the solid tumor is associated with a myelodysplastic syndrome (MDS). In another embodiment, the solid tumor is associated with a non-small cell lung cancer (NSCLC). In another embodiment, the solid tumor is associated with a lung cancer. In another embodiment, the solid tumor is associated with a breast cancer. In another embodiment, the solid tumor is associated with a colorectal cancer. In another embodiment, the solid tumor is associated with a prostate cancer. In another embodiment, the solid tumor is associated with an ovarian cancer. In another embodiment, the solid tumor is associated with a renal cancer. In another embodiment, the solid tumor is associated with a pancreatic cancer. In another embodiment, the solid tumor is associated with a brain cancer. In another embodiment, the solid tumor is associated with a gastrointestinal cancer. In another embodiment, the solid tumor is associated with a skin cancer. In another embodiment, the solid tumor is associated with a melanoma.

[0070] In another embodiment, the cancer or tumor treated by the present invention is suspected to express WT 1. In another embodiment, WT 1 expression has not been verified by testing of the actual tumor sample. In another embodiment, the cancer or tumor is of a type known to express WT1 in many cases. In another embodiment, the type expresses WT1 in the majority of cases.

[0071] A non-exhaustive list of WT1-expressing cancer types that may be treated using the compositions of the invention is provided in Table 3. Table 3. Examples of Cancer Types Acute Lymphoblastic Leukemia, Adult Acute Lymphoblastic Leukemia, Childhood Acute Myeloid Leukemia, Adult Acute Myeloid Leukemia, Childhood Adrenocortical Carcinoma Adrenocortical Carcinoma, Childhood AIDS-Related Cancers AIDS-Related Lymphoma Anal Cancer Astrocytoma, Childhood Cerebellar Astrocytoma, Childhood CerebralHairy Cell Leukemia Head and Neck Cancer Hepatocellular (Liver) Cancer, Adult (Primary) Hepatocellular (Liver) Cancer, Childhood (Primary) Hodgkin's Lymphoma, Adult Hodgkin's Lymphoma, Childhood Hodgkin's Lymphoma During Pregnancy Hypopharyngeal Cancer Hypothalamic and Visual Pathway Glioma, ChildhoodIntraocular Melanoma Islet Cell Carcinoma (Endocrine Pancreas)Kaposi's Sarcoma Kidney (Renal Cell) Cancer Kidney Cancer, ChildhoodBasal Cell Carcinoma Bile Duct Cancer, Extrahepatic Bladder Cancer Bladder Cancer, Childhood Bone Cancer, Osteosarcoma / Malignant Fibrous Histiocytoma Brain Stem Glioma, Childhood Brain Tumor, Adult Brain Tumor, Brain Stem Glioma, Childhood Brain Tumor, Cerebellar Astrocytoma, Childhood Brain Tumor, Cerebral Astrocytoma / Malignant Glioma, Childhood Brain Tumor, Ependymoma, Childhood Brain Tumor, Medulloblastoma, Childhood Brain Tumor, Supratentorial Primitive Neuroectodermal Tumors, Childhood Brain Tumor, Visual Pathway and HypothalamicLaryngeal Cancer Laryngeal Cancer, Childhood Leukemia, Acute Lymphoblastic, Adult Leukemia, Acute Lymphoblastic, Childhood Leukemia, Acute Myeloid, Adult Leukemia, Acute Myeloid, Childhood Leukemia, Chronic Lymphocytic Leukemia, Chronic Myelogenous Leukemia, Hairy Cell Lip and Oral Cavity Cancer Liver Cancer, Adult (Primary) Liver Cancer, Childhood (Primary) Lung Cancer, Non-Small Cell Lung Cancer, Small Cell Lymphoma, AIDS-Related Lymphoma, Burkitt's Lymphoma, Cutaneous T-Cell, see Mycosis Fungoides and Sezary Syndrome Lymphoma, Hodgkin's, Adult Lymphoma, Hodgkin's, Childhood Lymphoma, Hodgkin's During Pregnancy Lymphoma, Non-Hodgkin's, Adult Lymphoma, Non-Hodgkin's, ChildhoodGlioma, Childhood Brain Tumor, Childhood Breast Cancer Breast Cancer, Childhood Breast Cancer, Male Bronchial Adenomas / Carcinoids, Childhood Burkitt's Lymphoma Carcinoid Tumor, Childhood Carcinoid Tumor, Gastrointestinal Carcinoma of Unknown Primary Central Nervous System Lymphoma, Primary Cerebellar Astrocytoma, Childhood Cerebral Astrocytoma / Malignant Glioma, Childhood Cervical Cancer Childhood Cancers Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia Chronic Myeloproliferative Disorders Colon Cancer Colorectal Cancer, Childhood Cutaneous T-Cell Lymphoma, see Mycosis Fungoides and Sezary SyndromeLymphoma, Non-Hodgkin's During Pregnancy Lymphoma, Primary Central Nervous SystemMacroglobulinemia, Waldenström's Malignant Fibrous Histiocytoma of Bone / Osteosarcoma Medulloblastoma, Childhood Melanoma Melanoma, Intraocular (Eye) Merkel Cell Carcinoma Mesothelioma, Adult Malignant Mesothelioma, Childhood Metastatic Squamous Neck Cancer with Occult Primary Multiple Endocrine Neoplasia Syndrome, Childhood Multiple Myeloma / Plasma Cell Neoplasm Mycosis Fungoides Myelodysplastic Syndromes Myelodysplastic / Myeloproliferative Diseases Myelogenous Leukemia, Chronic Myeloid Leukemia, Adult Acute Myeloid Leukemia, Childhood Acute Myeloma, Multiple Myeloproliferative Disorders, ChronicNasal Cavity and Paranasal Sinus Cancer Nasopharyngeal Cancer Nasopharyngeal Cancer, Childhood Neuroblastoma Non-Hodgkin's Lymphoma, Adult Non-Hodgkin's Lymphoma, Childhood Non-Hodgkin's Lymphoma During Pregnancy Non-Small Cell Lung CancerEndometrial Cancer Ependymoma, Childhood Esophageal Cancer Esophageal Cancer, Childhood Ewing's Family of Tumors Extracranial Germ Cell Tumor, Childhood Extragonadal Germ Cell Tumor Extrahepatic Bile DuctOral Cancer, Childhood Oral Cavity Cancer, Lip and Oropharyngeal Cancer Osteosarcoma / Malignant Fibrous Histiocytoma of Bone Ovarian Cancer, Childhood Ovarian Epithelial Cancer Ovarian Germ Cell Tumor Ovarian Low Malignant PotentialCancer Eye Cancer, Intraocular Melanoma Eye Cancer, RetinoblastomaTumorPancreatic Cancer Pancreatic Cancer, Childhood Pancreatic Cancer, Islet Cell Paranasal Sinus and Nasal Cavity Cancer Parathyroid Cancer Penile Cancer Pheochromocytoma Pineoblastoma and Supratentorial Primitive Neuroectodermal Tumors, Childhood Pituitary Tumor Plasma Cell Neoplasm / Multiple Myeloma Pleuropulmonary Blastoma Pregnancy and Breast Cancer Pregnancy and Hodgkin's Lymphoma Pregnancy and Non-Hodgkin's Lymphoma Primary Central Nervous System Lymphoma Prostate CancerGallbladder Cancer Gastric (Stomach) Cancer Gastric (Stomach) Cancer, Childhood Gastrointestinal Carcinoid Tumor Germ Cell Tumor, Extracranial, Childhood Germ Cell Tumor, Extragonadal Germ Cell Tumor, Ovarian Gestational Trophoblastic Tumor Glioma, Adult Glioma, Childhood Brain Stem Glioma, Childhood Cerebral Astrocytoma Glioma, Childhood Visual Pathway and HypothalamicRectal Cancer Renal Cell (Kidney) Cancer Renal Cell (Kidney) Cancer, Childhood Renal Pelvis and Ureter, Transitional Cell Cancer Retinoblastoma Rhabdomyosarcoma, ChildhoodSkin Cancer (Melanoma) Skin Carcinoma, Merkel Cell Small Cell Lung Cancer Small Intestine Cancer Soft Tissue Sarcoma, Adult Soft Tissue Sarcoma, Childhood Squamous Cell Carcinoma, see Skin Cancer (non-Melanoma) Squamous Neck Cancer with Occult Primary, Metastatic Stomach (Gastric) Cancer Stomach (Gastric) Cancer, Childhood Supratentorial Primitive Neuroectodermal Tumors, ChildhoodSalivary Gland Cancer Salivary Gland Cancer, Childhood Sarcoma, Ewing's Family of Tumors Sarcoma, Kaposi's Sarcoma, Soft Tissue, Adult Sarcoma, Soft Tissue, Childhood Sarcoma, Uterine Sezary Syndrome Skin Cancer (non-Melanoma) Skin Cancer, ChildhoodStomach CancerT-Cell Lymphoma, Cutaneous, see MycosisFungoides and Sezary Syndrome Testicular Cancer Thymoma, Childhood Thymoma and Thymic Carcinoma Thyroid Cancer Thyroid Cancer, Childhood Transitional Cell Cancer of the Renal Pelvis and Ureter Trophoblastic Tumor, GestationalUnknown Primary Site, Carcinoma of, Adult Unknown Primary Site, Cancer of, Childhood Unusual Cancers of Childhood Ureter and Renal Pelvis, Transitional Cell Cancer Urethral Cancer Uterine Cancer, Endometrial Uterine SarcomaVaginal Cancer Visual Pathway and Hypothalamic Glioma, Childhood Vulvar CancerWaldenström's Macroglobulinemia Wilms' Tumor

[0072] As provided herein, the heteroclitic peptides for use in the invention elicit antigen-specific CD8 +< T cell responses. In another embodiment, antigen-specific CD4 +< T cell responses assist in induction and maintenance of CD8 +< cytotoxic T cell (CTL) responses.

[0073] It is disclosed that, in another embodiment, the WT1 peptides for use in the present invention, together with at least one PD1 inhibitor, exhibit an enhanced ability to elicit CTL responses, due to their ability to bind both HLA class I and HLA class II molecules. This might be due to the ability of the PD1 inhibitor to increase the survival and proliferation of WT1 specific CTLs. In another embodiment, vaccines of the present invention with the at least one PD1 inhibitor have the advantage of activating or eliciting both CD4 +< and CD8 +< T cells that recognize WT1 antigens. In another embodiment, activation or eliciting both CD4 +< and CD8 +< T cells provides a synergistic anti-WTl immune response, relative to activation of either population alone. In another embodiment, the enhanced immunogenicity of the WT1 peptides for use in the present invention is exhibited in individuals of multiple HLA class II subtypes, due to the ability of the peptides to bind multiple HLA class II subtypes.

[0074] It is also disclosed that, in another embodiment, activated CD4 +< cells enhance immunity by licensing dendritic cells, thereby sustaining the activation and survival of the cytotoxic T cells. In another embodiment, activated CD4 +< T cells induce tumor cell death by direct contact with the tumor cell or by activation of the apoptosis pathway. Mesothelioma tumor cells, for example, are able to process and present antigens in the context of HLA class I and class II molecules.

[0075] It is also disclosed that peptides, vaccines, and / or immunogenic compositions administered together with at least one PD1 inhibitor have the advantage of activating or eliciting WT1-specific CD4 +< T cells containing multiple different HLA class II alleles. In another embodiment, the vaccines have the advantage of activating or eliciting WT1-specific CD4 +< T cells in a substantial proportion of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 10% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 15% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 20% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 25% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 30% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 35% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 40% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 45% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 50% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 55% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 60% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 70% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 75% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 80% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 85% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 90% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in 95% of the population. In another embodiment, the peptides activate WT1-specific CD4 +< T cells in greater than 95% of the population. In another embodiment, the vaccines activate or elicit WT1-specific CD4 +< T cells in a substantial proportion of a particular population (e.g. American Caucasians).

[0076] It is also disclosed that, in another embodiment, compositions for use in the present invention provide for an improvement in an immune response that has already been mounted by a subject. In another embodiment, the compositions may be administered one more time or two more times. In another embodiment, the combination of treatment agents provide for the initiation of an immune response against an antigen of interest in a subject in which an immune response against the antigen of interest has not already been initiated. In another embodiment, the CTL that are induced proliferate in response to presentation of the peptide on the APC or cancer cell. In other embodiments, reference to modulation of the immune response involves, either or both the humoral and cell-mediated arms of the immune system, which is accompanied by the presence of Th2 and Th1 T helper cells, respectively, or in another embodiment, each arm individually.

[0077] It is also disclosed that, in other embodiments, affecting the growth of a tumor result in (1) the direct inhibition of tumor cell division, or (2) immune cell mediated tumor cell lysis, or both, leads to a suppression in the net expansion of tumor cells. The use of the WT1 peptides together with at the least one PD1 inhibitor increases the direct inhibition of tumor cell division, the immune cell mediated cell lysis, or both, greater than without the use of the PD1 inhibitor.

[0078] Inhibition of tumor growth by either of these two mechanisms can be readily determined by one of ordinary skill in the art based upon a number of well-known methods. In another embodiment, tumor inhibition is determined by measuring the actual tumor size over a period of time. In another embodiment, tumor inhibition can be determined by estimating the size of a tumor (over a period of time) utilizing methods well known to those of skill in the art. More specifically, a variety of radiologic imaging methods (e.g., single photon and positron emission computerized tomography; see generally, "Nuclear Medicine in Clinical Oncology," Winkler, C. (ed.) Springer-Verilog, New York, 1986), can be utilized to estimate tumor size. Such methods can also utilize a variety of imaging agents, including for example, conventional imaging agents (e.g., Gallium-67 citrate), as well as specialized reagents for metabolite imaging, receptor imaging, or immunologic imaging (e.g., radiolabeled monoclonal antibody specific tumor markers). In addition, non-radioactive methods such as ultrasound (see, "Ultrasonic Differential Diagnosis of Tumors", Kossoff and Fukuda, (eds.), Igaku-Shoin, New York, 1984), can also be utilized to estimate the size of a tumor.

[0079] In addition to the in vivo methods for determining tumor inhibition discussed above, a variety of in vitro methods can be utilized in order to determine in vivo tumor inhibition. Representative examples include lymphocyte mediated anti-tumor cytolytic activity determined for example, by a 51< Cr release assay, tumor dependent lymphocyte proliferation (Ioannides, et al., J. Immunol. 146(5):1700-1707, 1991), in vitro generation of tumor specific antibodies (Herlyn, et al., J. Immunol. Meth. 73:157-167, 1984), cell (e.g., CTL, helper T-cell) or humoral (e.g., antibody) mediated inhibition of cell growth in vitro (Gazit, et al., Cancer Immunol Immunother 35:135-144, 1992), and, for any of these assays, determination of cell precursor frequency (Vose, Int. J. Cancer 30:135-142 (1982), and others.

[0080] In another embodiment, suppressing tumor growth indicates a growth state that is curtailed compared to growth without contact with, or exposure to a peptide administered together with at least one checkpoint inhibitor of this invention. Tumor cell growth can be assessed by any means known in the art, including measuring tumor size, determining whether tumor cells are proliferating using a 3< H-thymidine incorporation assay, or counting tumor cells. "Suppressing" tumor cell growth refers, in other embodiments, to slowing, delaying, or stopping tumor growth, or to tumor shrinkage.

[0081] In another embodiment, WT1 expression is measured before administration of the treatment, after administration of the treatment, or both before and after administration of the treatment. In another embodiment, WT1 transcript expression is measured. In another embodiment, WT1 protein levels in the tumor or cancer cells are measured. In another embodiment, WT1 protein or peptides shed from cancer cells or tumor cells into circulation or other bodily fluids such as urine are measured.

[0082] In another embodiment, expression of the checkpoint protein PD1 targeted by the one or more PD1 inhibitors is measured (at the transcript level or protein level) in the tumor or cancer cells, or in whole blood, serum, or plasma, before administration of the treatment (baseline), after administration of the treat, or both before and after administration of the treatment. In one embodiment, expression of two or more of PD1, PD2, and CTLA4 is measured before administration of the treatment, after administration of the treatment, or both before and after administration of the treatment. In one embodiment, protein expression is measured at a primary tumor site. In another embodiment, the cancer is metastatic and the protein expression is measured at a metastatic site, or the primary tumor site, or both.

[0083] In another embodiment, one or more of the following markers are measured before administration of the treatment (baseline), after administration of the treatment, or both before and after administration of the treatment: monocytic myeloid-derived suppressor cells (m-MDSCs), C-reactive protein (CRP), absolute lymphocytes, absolute lymphocytes, and lactate dehydrogenase (LDH). In another embodiment, use of one or more markers for predicting or identifying responsiveness to checkpoint modulation is embraced herein.

[0084] Methods of determining the presence and magnitude of an immune response are well known in the art. In another embodiment, lymphocyte proliferation assays, wherein T cell uptake of a radioactive substance, e.g. 3< H-thymidine is measured as a function of cell proliferation. In other embodiments, detection of T cell proliferation is accomplished by measuring increases in interleukin-2 (IL-2) production, Ca 2+< flux, or dye uptake, such as 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium. Each possibility represents a separate embodiment of the present invention.

[0085] In another embodiment, CTL stimulation is determined by means known to those skilled in the art, including detection of cell proliferation, cytokine production and others. Analysis of the types and quantities of cytokines secreted by T cells upon contacting ligand-pulsed targets can be a measure of functional activity. Cytokines can be measured by ELISA, ELISPOT assays or fluorescence-activated cell sorting (FACS) to determine the rate and total amount of cytokine production. (Fujihashi K. et al. (1993) J. Immunol. Meth. 160:181; Tanguay S. and Killion J. J. (1994) Lymphokine Cytokine Res. 13:259).

[0086] In another embodiment, CTL activity is determined by 51< Cr-release lysis assay. Lysis of peptide-pulsed 51< Cr-labeled targets by antigen-specific T cells can be compared for target cells pulsed with control peptide. In another embodiment, T cells are stimulated with a peptide of this invention, and lysis of target cells expressing the native peptide in the context of MHC can be determined. The kinetics of lysis as well as overall target lysis at a fixed timepoint (e.g., 4 hours) are used, in another embodiment, to evaluate ligand performance. (Ware C. F. et al. (1983) J Immunol 131: 1312).

[0087] In other embodiments, a peptide for use in the invention is conjugated to one of various other molecules, as described hereinbelow, which can be via covalent or non-covalent linkage (complexed), the nature of which varies, in another embodiment, depending on the particular purpose. In another embodiment, the peptide is covalently or non-covalently complexed to a macromolecular carrier, (e.g. an immunogenic carrier), including natural and synthetic polymers, proteins, polysaccharides, polypeptides (amino acids), polyvinyl alcohol, polyvinyl pyrrolidone, and lipids. In another embodiment, a peptide for use in this invention is linked to a substrate. In another embodiment, the peptide is conjugated to a fatty acid, for introduction into a liposome (U.S. Pat. No. 5,837,249). In another embodiment, a peptide for use in the invention is complexed covalently or non-covalently with a solid support, a variety of which are known in the art. In another embodiment, linkage of the peptide to the carrier, substrate, fatty acid, or solid support serves to increase an elicited an immune response.

[0088] In other embodiments, the carrier is thyroglobulin, an albumin (e.g. human serum albumin), tetanus toxoid, polyamino acids such as poly (lysine: glutamic acid), an influenza protein, hepatitis B virus core protein, keyhole limpet hemocyanin, an albumin, or another carrier protein or carrier peptide; hepatitis B virus recombinant vaccine, or an APC.

[0089] In another embodiment, the terms "cancer," "neoplasm," "neoplastic" or "tumor," are used interchangeably and refer to cells that have undergone a malignant transformation that makes them pathological to the host organism. The cancer may be of any stage within the numbered staging system (e.g., stage 0, stage 1, stage 2, stage 3, or stage 4), and any stage in the TNM staging system. Primary cancer cells (that is, cells obtained from near the site of malignant transformation) can be readily distinguished from non-cancerous cells by well-established techniques, particularly histological examination. The definition of a cancer cell, as used herein, includes not only a primary cancer cell, but also any cell derived from a cancer cell ancestor. This includes metastasized cancer cells, and in vitro cultures and cell lines derived from cancer cells. In another embodiment, a tumor is detectable on the basis of tumor mass; e.g., by such procedures as CAT scan, magnetic resonance imaging (MRI), X-ray, ultrasound or palpation, and in another embodiment, is identified by biochemical or immunologic findings, the latter which is used to identify cancerous cells, as well, in other embodiments. A tumor may be a solid tumor or non-solid tumor.

[0090] Methods for synthesizing peptides are well known in the art. In another embodiment, the peptides for use in this invention are synthesized using an appropriate solid-state synthetic procedure (see for example, Steward and Young, Solid Phase Peptide Synthesis, Freemantle, San Francisco, Calif. (1968); Merrifield (1967) Recent Progress in Hormone Res 23: 451). The activity of these peptides is tested, in other embodiments, using assays as described herein.

[0091] In another embodiment, the peptides are purified by standard methods including chromatography (e.g., ion exchange, affinity, and sizing column chromatography), centrifugation, differential solubility, or by any other standard technique for protein purification. In another embodiment, immuno-affinity chromatography is used, whereby an epitope is isolated by binding it to an affinity column comprising antibodies that were raised against that peptide, or a related peptide of the invention, and were affixed to a stationary support.

[0092] In another embodiment, affinity tags such as hexa-His (Invitrogen), Maltose binding domain (New England Biolabs), influenza coat sequence (Kolodziej et al. (1991) Meth. Enzymol. 194:508-509), glutathione-S-transferase, or others, are attached to the peptides of this invention to allow easy purification by passage over an appropriate affinity column. Isolated peptides can also be physically characterized, in other embodiments, using such techniques as proteolysis, nuclear magnetic resonance, and x-ray crystallography.

[0093] In another embodiment, the peptides are produced by in vitro translation, through known techniques, as will be evident to one skilled in the art. In another embodiment, the peptides are differentially modified during or after translation, e.g., by phosphorylation, glycosylation, cross-linking, acylation, proteolytic cleavage, linkage to an antibody molecule, membrane molecule or other ligand, (Ferguson et al. (1988) Ann. Rev. Biochem. 57:285-320).

[0094] In another embodiment, the peptides may further comprise a detectable label, which in another embodiment, is fluorescent, or in another embodiment, luminescent, or in another embodiment, radioactive, or in another embodiment, electron dense. In other embodiments, the dectectable label comprises, for example, green fluorescent protein (GFP), DS-Red (red fluorescent protein), secreted alkaline phosphatase (SEAP), beta-galactosidase, luciferase, 32< P, 125< I, 3< H and 14< C, fluorescein and its derivatives, rhodamine and its derivatives, dansyl and umbelliferone, luciferin or any number of other such labels known to one skilled in the art. The particular label used will depend upon the type of immunoassay used.

[0095] In another embodiment, a peptide for use in this invention is linked to a substrate, which, in another embodiment, serves as a carrier. In another embodiment, linkage of the peptide to a substrate serves to increase an elicited an immune response.

[0096] In another embodiment, peptides are linked to other molecules, as described herein, using conventional cross-linking agents such as carbodimides. Examples of carbodimides are 1-cyclohexyl-3-(2-morpholinyl-(4-ethyl) carbodiimide (CMC), 1-ethyl-3-(3-dimethyaminopropyl) carbodiimide (EDC) and 1-ethyl-3-(4-azonia-44-dimethylpentyl) carbodiimide.

[0097] In other embodiments, the cross-linking agents comprise cyanogen bromide, glutaraldehyde and succinic anhydride. In general, any of a number of homo-bifunctional agents including a homo-bifunctional aldehyde, a homo-bifunctional epoxide, a homo-bifunctional imido-ester, a homo-bifunctional N-hydroxysuccinimide ester, a homo-bifunctional maleimide, a homo-bifunctional alkyl halide, a homo-bifunctional pyridyl disulfide, a homo-bifunctional aryl halide, a homo-bifunctional hydrazide, a homo-bifunctional diazonium derivative and a homo-bifunctional photoreactive compound can be used. Also envisioned, in other embodiments, are hetero-bifunctional compounds, for example, compounds having an amine-reactive and a sulfhydryl-reactive group, compounds with an amine-reactive and a photoreactive group and compounds with a carbonyl-reactive and a sulfhydryl-reactive group.

[0098] In other embodiments, the homo-bifunctional cross-linking agents include the bifunctional N-hydroxysuccinimide esters dithiobis(succinimidylpropionate), disuccinimidyl suberate, and disuccinimidyl tartarate; the bifunctional imido-esters dimethyl adipimidate, dimethyl pimelimidate, and dimethyl suberimidate; the bifunctional sulfhydryl-reactive crosslinkers 1,4-di-[3'-(2'-pyridyldithio)propionamido]butane, bismaleimidohexane, and bis-N-maleimido-1,8-octane; the bifunctional aryl halides 1,5-difluoro-2,4-dinitrobenzene and 4,4'-difluoro-3,3'-dinitrophenylsulfone; bifunctional photoreactive agents such as bis-[b-(4-azidosalicylamido)ethyl]disulfide; the bifunctional aldehydes formaldehyde, malondialdehyde, succinaldehyde, glutaraldehyde, and adipaldehyde; a bifunctional epoxide such as 1,4-butaneodiol diglycidyl ether; the bifunctional hydrazides adipic acid dihydrazide, carbohydrazide, and succinic acid dihydrazide; the bifunctional diazoniums o-tolidine, diazotized and bis-diazotized benzidine; the bifunctional alkylhalides N1N'-ethylene-bis(iodoacetamide), N1N'-hexamethylene-bis(iodoacetamide), N1N'-undecamethylene-bis(iodoacetamide), as well as benzylhalides and halomustards, such as ala'-diiodo-p-xylene sulfonic acid and tri(2-chloroethyl)amine, respectively.

[0099] In other embodiments, hetero-bifunctional cross-linking agents used to link the peptides to other molecules, as described herein, include SMCC (succinimidyl-4-(N-maleimidomethyl)cyclohexane-1-carboxylate), MBS (m-maleimidobenzoyl-N-hydroxysuccinimide ester), SIAB (N-succinimidyl(4-iodoacteyl)aminobenzoate), SMPB (succinimidyl-4-(p-maleimidophenyl)butyrate), GMBS (N-(.gamma.-maleimidobutyryloxy)succinimide ester), MPBH (4-(4-N-maleimidopohenyl) butyric acid hydrazide), M2C2H (4-(N-maleimidomethyl) cyclohexane-1-carboxyl-hydrazide), SMPT (succinimidyloxycarbonyl-a-methyl-a-(2-pyridyldithio)toluene), and SPDP (N-succinimidyl 3-(2-pyridyldithio)propionate).

[0100] In another embodiment, the peptides of the invention are formulated as non-covalent attachment of monomers through ionic, adsorptive, or biospecific interactions. Complexes of peptides with highly positively or negatively charged molecules can be accomplished, in another embodiment, through salt bridge formation under low ionic strength environments, such as in deionized water. Large complexes can be created, in another embodiment, using charged polymers such as poly-(L-glutamic acid) or poly-(L-lysine), which contain numerous negative and positive charges, respectively. In another embodiment, peptides are adsorbed to surfaces such as microparticle latex beads or to other hydrophobic polymers, forming non-covalently associated peptide-superantigen complexes effectively mimicking cross-linked or chemically polymerized protein, in other embodiments. In another embodiment, peptides are non-covalently linked through the use of biospecific interactions between other molecules. For instance, utilization of the strong affinity of biotin for proteins such as avidin or streptavidin or their derivatives could be used to form peptide complexes. The peptides, according to this aspect, and in another embodiment, can be modified to possess biotin groups using common biotinylation reagents such as the N-hydroxysuccinimidyl ester of D-biotin (NHS-biotin), which reacts with available amine groups.

[0101] In another embodiment, a peptide for use in the present invention is linked to a carrier. In another embodiment, the carrier is KLH. In other embodiments, the carrier is any other carrier known in the art, including, for example, thyroglobulin, albumins such as human serum albumin, tetanus toxoid, polyamino acids such as poly (lysine:glutamic acid), influenza, hepatitis B virus core protein, hepatitis B virus recombinant vaccine and the like.

[0102] In another embodiment, the peptides are conjugated to a lipid, such as P3 CSS. In another embodiment, the peptides are conjugated to a bead.

[0103] In another embodiment, immunomodulating compounds may also be administered to the patient. In other embodiments, the immunomodulating compound is a cytokine, chemokine, or complement component that enhances expression of immune system accessory or adhesion molecules, their receptors, or combinations thereof. In some embodiments, the immunomodulating compound include interleukins, for example interleukins 1 to 15, interferons alpha, beta or gamma, tumor necrosis factor, granulocyte-macrophage colony stimulating factor (GM-CSF), macrophage colony stimulating factor (M-CSF), granulocyte colony stimulating factor (G-CSF), chemokines such as neutrophil activating protein (NAP), macrophage chemoattractant and activating factor (MCAF), RANTES, macrophage inflammatory peptides MIP-1a and MIP-1b, complement components, or combinations thereof. In other embodiments, the immunomodulating compound stimulate expression, or enhanced expression of OX40, OX40L (gp34), lymphotactin, CD40, CD40L, B7.1, B7.2, TRAP, ICAM-1, 2 or 3, cytokine receptors, or combination thereof.

[0104] In another embodiment, the immunomodulatory compound induces or enhances expression of co-stimulatory molecules that participate in the immune response.

[0105] In one embodiment, patients administered the combination of agents in accordance with the invention also are administered GM-CSF prior to or on the day of first vaccination, or the combination thereof. In one embodiment, a patient is administered 70 mcg of GM-CSF subcutaneously two days before and on the day of first vaccine administration.

[0106] In another embodiment, the composition comprises a solvent, including water, dispersion media, cell culture media, isotonic agents and the like. In another embodiment, the solvent is an aqueous isotonic buffered solution with a pH of around 7.0. In another embodiment, the composition comprises a diluent such as water, phosphate buffered saline, or saline. In another embodiment, the composition comprises a solvent, which is non-aqueous, such as propyl ethylene glycol, polyethylene glycol and vegetable oils.

[0107] In another embodiment, the composition is formulated for administration by any of the many techniques known to those of skill in the art. For example, this invention provides for administration of the pharmaceutical composition parenterally, intravenously, subcutaneously, intradermally, intramucosally, topically, orally, or by inhalation.

[0108] In another embodiment, the vaccine may further comprise a cell population, which, in another embodiment, comprises lymphocytes, monocytes, macrophages, dendritic cells, endothelial cells, stem cells or combinations thereof, which, in another embodiment are autologous, syngeneic or allogeneic, with respect to each other. In another embodiment, the cell population takes up the peptide. In one embodiment, the cell is an antigen presenting cell (APC). In a further embodiment, the APC is a professional APC.

[0109] In another embodiment, the cell populations are obtained from in vivo sources, such as, for example, peripheral blood, leukopheresis blood product, apheresis blood product, peripheral lymph nodes, gut associated lymphoid tissue, spleen, thymus, cord blood, mesenteric lymph nodes, liver, sites of immunologic lesions, e.g. synovial fluid, pancreas, cerebrospinal fluid, tumor samples, granulomatous tissue, or any other source where such cells can be obtained. In another embodiment, the cell populations are obtained from human sources, which are, in other embodiments, from human fetal, neonatal, child, or adult sources. In another embodiment, the cell populations are obtained from animal sources, such as, for example, porcine or simian, or any other animal of interest. In another embodiment, the cell populations are obtained from subjects that are normal, or in another embodiment, diseased, or in another embodiment, susceptible to a disease of interest.

[0110] In another embodiment, the cell populations are separated via affinity-based separation methods. Techniques for affinity separation include, in other embodiments, magnetic separation, using antibody-coated magnetic beads, affinity chromatography, cytotoxic agents joined to a monoclonal antibody or use in conjunction with a monoclonal antibody, for example, complement and cytotoxins, and "panning" with an antibody attached to a solid matrix, such as a plate, or any other convenient technique. In other embodiment, separation techniques include the use of fluorescence activated cell sorters, which can have varying degrees of sophistication, such as multiple color channels, low angle and obtuse light scattering detecting channels, impedance channels, etc.

[0111] In another embodiment, the dendritic cells are from the diverse population of morphologically similar cell types found in a variety of lymphoid and non-lymphoid tissues, qualified as such (Steinman (1991) Ann. Rev. Immunol. 9:271-296). In another embodiment, the dendritic cells are isolated from bone marrow, or in another embodiment, derived from bone marrow progenitor cells, or, in another embodiment, from isolated from / derived from peripheral blood, or in another embodiment, derived from, or are a cell line.

[0112] In another embodiment, the cell populations are isolated from the white blood cell fraction of a mammal, such as a murine, simian or a human (See, e.g., WO 96 / 23060). The white blood cell fraction can be, in another embodiment, isolated from the peripheral blood of the mammal.

[0113] Methods of isolating dendritic cells are well known in the art. In another embodiment, the DC are isolated via a method which includes the following steps: (a) providing a white blood cell fraction obtained from a mammalian source by methods known in the art such as leukophoresis; (b) separating the white blood cell fraction of step (a) into four or more subfractions by countercurrent centrifugal elutriation; (c) stimulating conversion of monocytes in one or more fractions from step (b) to dendritic cells by contacting the cells with calcium ionophore, GM-CSF and IL-13 or GM-CSF and IL-4, (d) identifying the dendritic cell-enriched fraction from step (c); and (e) collecting the enriched fraction of step (d), preferably at about 4° C.

[0114] In another embodiment, the dendritic cell-enriched fraction is identified by fluorescence-activated cell sorting, which identifies, in another embodiment, at least one of the following markers: HLA-DR, HLA-DQ, or B7.2, and the simultaneous absence of the following markers: CD3, CD14, CD16, 56, 57, and CD 19, 20.

[0115] In another embodiment, the cell population comprises lymphocytes, which are, in another embodiment, T cells, or in another embodiment, B cells. The T cells are, in other embodiments, characterized as NK cells, helper T cells, cytotoxic T lymphocytes (CTL), TILs, naive T cells, or combinations thereof. It is to be understood that T cells which are primary, or cell lines, clones, etc., may be used. In another embodiment, the T cells are CTL, or CTL lines, CTL clones, or CTLs isolated from tumor, inflammatory, or other infiltrates.

[0116] In another embodiment, the cell populations may comprise hematopoietic stem or early progenitor cells. In another embodiment, such populations are isolated or derived, by leukapheresis. In another embodiment, the leukapheresis follows cytokine administration, from bone marrow, peripheral blood (PB) or neonatal umbilical cord blood. In another embodiment the stem or progenitor cells are characterized by their surface expression of the surface antigen marker known as CD34 +< , and exclusion of expression of the surface lineage antigen markers, Lin-.

[0117] In another embodiment, the subject is administered the combination of agents in conjunction with bone marrow cells. In another embodiment, the administration together with bone marrow cells follows previous irradiation of the subject, as part of the course of therapy, in order to suppress, inhibit or treat cancer in the subject.

[0118] In another embodiment, the combination of treatment agents for use in this invention are administered to a subject in combination with other anti-cancer compounds and chemotherapeutics, including monoclonal antibodies directed against alternate cancer antigens, or, in another embodiment, epitopes that consist of an AA sequence which corresponds to, or in part to, that from which the peptides of this invention are derived.

[0119] As used herein, the terms "patient", "subject", and "individual" are used interchangeably and are intended to include human and non-human animal species. For example, the subject may be a human or non-human mammal. In some embodiments, the subject is a non-human animal model or veterinary patient. The subject may be any age or gender.

[0120] An immunogenic composition of the present invention comprises, in another embodiment, an APC associated with the mixture of the WT1 peptides.

[0121] A composition of the present invention is, in another embodiment, an immunogenic composition. In another embodiment, the composition is a pharmaceutical composition.

[0122] Various embodiments of dosage ranges are contemplated by this invention. In another embodiment, the dosage is 20 µg per peptide per day. In another embodiment, the dosage is 10 µg / peptide / day. In another embodiment, the dosage is 30 µg / peptide / day. In another embodiment, the dosage is 40 µg / peptide / day. In another embodiment, the dosage is 60 µg / peptide / day. In another embodiment, the dosage is 80 µg / peptide / day. In another embodiment, the dosage is 100 µg / peptide / day. In another embodiment, the dosage is 150 µg / peptide / day. In another embodiment, the dosage is 200 µg / peptide / day. In another embodiment, the dosage is 300 µg / peptide / day. In another embodiment, the dosage is 400 µg / peptide / day. In another embodiment, the dosage is 600 µg / peptide / day. In another embodiment, the dosage is 800 µg / peptide / day. In another embodiment, the dosage is 1000 µg / peptide / day.

[0123] In another embodiment, the dosage is 10 µg / peptide / dose. In another embodiment, the dosage is 30 µg / peptide / dose. In another embodiment, the dosage is 40 µg / peptide / dose. In another embodiment, the dosage is 60 µg / peptide / dose. In another embodiment, the dosage is 80 µg / peptide / dose. In another embodiment, the dosage is 100 µg / peptide / dose. In another embodiment, the dosage is 150 µg / peptide / dose. In another embodiment, the dosage is 200 µg / peptide / dose. In another embodiment, the dosage is 300 µg / peptide / dose. In another embodiment, the dosage is 400 µg / peptide / dose. In another embodiment, the dosage is 600 µg / peptide / dose. In another embodiment, the dosage is 800 µg / peptide / dose. In another embodiment, the dosage is 1000 µg / peptide / dose.

[0124] In another embodiment, the dosage is 10-20 µg / peptide / dose. In another embodiment, the dosage is 20-30 µg / peptide / dose. In another embodiment, the dosage is 20-40 µg / peptide / dose. In another embodiment, the dosage is 30-60 µg / peptide / dose. In another embodiment, the dosage is 40-80 µg / peptide / dose. In another embodiment, the dosage is 50-100 µg / peptide / dose. In another embodiment, the dosage is 50-150 µg / peptide / dose. In another embodiment, the dosage is 100-200 µg / peptide / dose. In another embodiment, the dosage is 200-300 µg / peptide / dose. In another embodiment, the dosage is 300-400 µg / peptide / dose. In another embodiment, the dosage is 400-600 µg / peptide / dose. In another embodiment, the dosage is 500-800 µg / peptide / dose. In another embodiment, the dosage is 800-1000 µg / peptide / dose.

[0125] In another embodiment, the total amount of peptide per dose or per day is one of the above amounts. In another embodiment, the total peptide dose per dose is one of the above amounts.EXAMPLEEvaluation of efficacy of WT1 peptide vaccine administered together with nivolumab in patients with ovarian cancer

[0126] Eligible patients diagnosed with ovarian cancer will start the vaccination schedule within 4 months of completion of chemotherapy. Patients will initially receive 6 vaccinations of WT1 peptides over 12 weeks, and 7 infusions of the immune checkpoint inhibitor nivolumab over 14 weeks. Toxicity assessments will be performed with each dose of vaccine, and 3 weeks after the completion of therapy at week 15. Patients will be observed by the study staff for up to 30 minutes following treatment. No dose escalation is planned. Routine toxicity assessments will continue throughout the trial.

[0127] Patients who do not have disease progression at the week 15 evaluation are permitted to receive 4 additional vaccines administered approximately every 8 weeks. This maintenance vaccine course would begin at week 19.

[0128] Immune responses will be evaluated from 40ml heparinized blood samples at 6 separate time-points: baseline (at consent and before first dose in order to determine baseline variations), before vaccines 5 and 6 as well as 3 weeks after the last nivolumab infusion. If feasible, an additional blood draw will be obtained at the 3-month follow-up.

[0129] Using ELISA, antibody levels generated against the 4 WT1 peptides in the vaccine will be measured. Antibodies are generally present by completion of the fourth vaccination. T-cell proliferative response assays will be performed on peripheral blood lymphocytes including: flow cytometry for phenotypic analysis with FACS including leukocyte subset analysis, T regulatory cell assay (including CD3, CD4, CD8, FOXP3, ICOS and PD1) and myeloid derived suppressor cells (MDSCs, CD14+HLA-DRlow cells) in peripheral blood and also in tumor (if optional biopsy obtained). WT1 T cell specific CD4 and CD8 proliferative response will be measured using polyfunctional intracellular cytokine staining (ICS) and flow cytometric based cytotoxicity assays using Meso Scale Discovery System with functionality measured by IFN-gamma production. Detailed procedures for blood sample processing, T cell monitoring, antibody ELISA and polyfunctional T cell assay, are described in

[29] .

[0130] Baseline values and T cell response results will be correlated with duration of clinical remission.

[0131] If a patient is removed from study prior to week 15, blood for post study immunologic studies will be obtained. A CT scan will be performed at baseline and week 15 (or sooner if deemed medically necessary) and every 3 months thereafter for up to 1 year until disease progression. MRI abdomen and pelvis may be used in lieu of the CT abdomen and pelvis. The reference radiologist will use immune-related response criteria to determine disease progression

[57] . CA125 will be obtained at baseline, weeks 6 and 15 and then every 3 months thereafter for up to 1 year until disease progression. CA125 will not be used to determine disease progression due to the confounding possibility of inflammation in vaccinated patients. Patients will remain on study until the time of progression, development of unacceptable toxicity, completion of the vaccine sequence or patient withdrawal.

[0132] WT1 Vaccine: The vaccine that will be used in this study contains four separate WT1 peptides: YMFPNAPYL (SEQ ID NO:124; WT1-A1): HLA class I peptide with a mutated amino acid R126Y to stimulate CD8+ responses. SGQAYMFPNAPYLPSCLES (SEQ ID NO:125; WT1-122A1 long): HLA class II peptide containing an embedded WT1-A1 heteroclitic sequence within the longer peptide to stimulate both CD4+ and CD8+ responses according to data from preclinical and phase 1 studies. RSDELVRHHNMHQRNMTKL (SEQ ID NO:1; WT1-427 long) and PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO:2; WT1-331 long): HLA class II peptides inducing CD4+ responses that could provide help for long lasting CD8+ T cell responses.

[0133] Drug Product: The four peptides are provided in a sterile solution with phosphate buffered saline to produce the vaccine product ("WT1 Vax"). Each vial contains 280 mcg of each peptide in a total volume of 0.7 ml (0.4 mg / ml of each peptide, overfill of 40%). Vialing under GMP conditions and sterility testing was performed. The vaccine emulsion will be individually prepared prior to use. This will require mixture of the peptide solution with the immunologic adjuvant Montanide ISA 51 VG.

[0134] Intended Dose: The 200 mcg dose for each peptide is chosen because it is within the range of safe and active doses used by others. Peptide vaccines have generated immune and clinical responses within a wide range of doses (100-2000 mcg injected) without clear evidence of dose-response relationships. Higher doses have the theoretical possibility of stimulating lower affinity TCRs on T cells and making a reduced response [30, 33, 34]. Vial Size: Each single-dose vial contains 0.7ml Route of Administration: Subcutaneous

[0135] Nivolumab: Intended Dose: 3mg / kg; Vial Size: 10mL; Route of Administration: Intravenous. Nivolumab will be dosed at 3 mg / kg and administered intravenously as a 60-minute IV infusion once every 2 weeks. At the end of the infusion, flush the line with a sufficient quantity of normal saline. If the subject's weight differs >10% from the previous weight used to calculate the required dose, a required dose, a corrected dose should be calculated. There will be no dose escalations or reductions of nivolumab allowed. There are no premedications recommended for the first nivolumab treatment.

[0136] Subjects may be dosed no less than 12 days between nivolumab doses and no more than 3 days after the scheduled dosing date. Dose given after the 3 days window is considered a dose delay. Treatment may be delayed for up to a maximum of 6 weeks from the previous dose.

[0137] Tumor assessments by CT or MRI should continue as per protocol even if dosing is delayed.

[0138] TREATMENT / INTERVENTION PLAN Patients will be treated as outpatients. WT1 vaccines will be administered on weeks 0, 2, 4, 6, 8 and 10. All injections will be administered subcutaneously with sites rotating between extremities. All patients will receive Sargramostim (GM-CSF) 70mcg injected subcutaneously on days 0 and -2. Patients may self administer the GM-CSF if they have been appropriately instructed on SQ injection administration. Patients will be informed of the expected reactions such as irritation at the injection site. Patients will keep a logbook noting the time and placement of the injection. Patients will also receive 1.0ml of emulsion of WT1 peptides with Montanide. It will be administered by a nurse (it may not be self-administered) subcutaneously at the same anatomical site as the GM-CSF. Patients will be observed for approximately 30 minutes after vaccination. Nivolumab will be administered intravenously as a 60-minute infusion on weeks 0, 2, 4, 6, 8, 10 and 12. Subjects may be dosed no less than 12 days between nivolumab doses and no more than 3 days after the scheduled dosing date. Dose given after the 3-day window is considered a dose delay. Treatment may be delayed for up to a maximum of 6 weeks from the previous dose.

[0139] Combination treatment of the WT1 vaccine and nivolumab is expected to increase the WT1 specific CTL population in the patient and afford increased activity against the WT1 expressing tumor, as compared to WT1 vaccination alone or nivolumab treatment alone.REFERENCES

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Pinilla-Ibarz, J., et al., Improved human T-cell responses against synthetic HLA-0201 analog peptides derived from the WT1 oncoprotein. Leukemia, 2006. 20(11): p. 2025-33. 28. May, R.J., et al., Peptide epitopes from the Wilms' tumor 1 oncoprotein stimulate CD4+ and CD8+ T cells that recognize and kill human malignant mesothelioma tumor cells. Clin Cancer Res, 2007. 13(15 Pt 1): p. 4547-55. 29. Krug, L.M., et al., WT1 peptide vaccinations induce CD4 and CD8 T cell immune responses in patients with mesothelioma and non-small cell lung cancer. Cancer Immunol Immunother, 2010. 59(10): p. 1467-79. 30. Oka, Y., et al., Induction of WT1 (Wilms' tumor gene)-specific cytotoxic T lymphocytes by WT1 peptide vaccine and the resultant cancer regression. Proc Natl Acad Sci U S A, 2004. 101(38): p. 13885-90. 31. Letsch, A., et al., Effect of vaccination of leukemia patients with a MHC class I peptide of Wilms tumor gene 1 (WT1) peptide with unspecific T helper stimulation on WT1-specific IgM responses and on IgG responses. J Clin Oncol, 2008. 26: p. Abstr 3054. 32. Ohno, S., et al., Wilms' tumor 1 (WT1) peptide immunotherapy for gynecological malignancy. Anticancer Res, 2009. 29(11): p. 4779-84. 33. Schaed, S.G., et al., T-cell responses against tyrosinase 368-376(370D) peptide in HLA ∗< A0201+ melanoma patients: randomized trial comparing incomplete Freund's adjuvant, granulocyte macrophage colony-stimulating factor, and QS-21 as immunological adjuvants. Clin Cancer Res, 2002. 8(5): p. 967-72. 34. Slingluff, C.L., Jr., et al., Clinical and immunologic results of a randomized phase II trial of vaccination using four melanoma peptides either administered in granulocyte-macrophage colony-stimulating factor in adjuvant or pulsed on dendritic cells. J Clin Oncol, 2003. 21(21): p. 4016-26. 35. Faries, M.B., et al., Effect of granulocyte / macrophage colony-stimulating factor on vaccination with an allogeneic whole-cell melanoma vaccine. Clin Cancer Res, 2009. 15(22): p. 7029-35. 36. Keilholz, U., et al., A clinical and immunologic phase 2 trial of Wilms tumor gene product 1 (WT1) peptide vaccination in patients with AML and MDS. Blood, 2009. 113(26): p. 6541-8. 37. Weber, J., et al., Granulocyte-macrophage-colony-stimulating factor added to a multipeptide vaccine for resected Stage II melanoma. Cancer, 2003. 97(1): p. 186-200. 38. Keir, M.E., et al., PD-1 and its ligands in tolerance and immunity. Annu Rev Immunol, 2008. 26: p. 677-704. 39. Freeman, G.J., et al., Engagement of the PD-1 immunoinhibitory receptor by a novel B7 family member leads to negative regulation of lymphocyte activation. J Exp Med, 2000. 192(7): p. 1027-34. 40. Latchman, Y., et al., PD-L2 is a second ligand for PD-1 and inhibits T cell activation. Nat Immunol, 2001. 2(3): p. 261-8. 41. Hamanishi, J., et al., Programmed cell death 1 ligand 1 and tumor-infiltrating CD8+ T lymphocytes are prognostic factors of human ovarian cancer. Proc Natl Acad Sci U S A, 2007. 104(9): p. 3360-5. 42. Mu, C.Y., et al., High expression of PD-L1 in lung cancer may contribute to poor prognosis and tumor cells immune escape through suppressing tumor infiltrating dendritic cells maturation. Med Oncol, 2011. 28(3): p. 682-8. 43. Pardoll, D.M., The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer, 2012. 12(4): p. 252-64. 44. Nivolumab (BMS-936558) Investigator Brochure, Version 12. 2013. 45. Hwang, W.T., et al., Prognostic significance of tumor-infiltrating T cells in ovarian cancer: a meta-analysis. Gynecol Oncol, 2012. 124(2): p. 192-8. 46. Matsuzaki, J., et al., Tumor-infiltrating NY-ESO-1-specific CD8+ T cells are negatively regulated by LAG-3 and PD-1 in human ovarian cancer. Proc Natl Acad Sci USA, 2010. 107(17): p. 7875-80. 47. Brahmer, J.R., et al., Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med, 2012. 366(26): p. 2455-65. 48. Page, D.B., et al., Immune modulation in cancer with antibodies. Annu Rev Med, 2014. 65: p. 185-202. 49. Harrison, M.L., et al., Duration of second or greater complete clinical remission in ovarian cancer: exploring potential endpoints for clinical trials. Gynecol Oncol, 2007. 106(3): p. 469-75. 50. Juretzka, M., et al., A phase 2 trial of oral imatinib in patients with epithelial ovarian, fallopian tube, or peritoneal carcinoma in second or greater remission. Eur J Gynaecol Oncol, 2008. 29(6): p. 568-72. 51. Levine, D., et al., A phase II evaluation of goserelin and bicalutamide in patients with ovarian cancer in second or higher complete clinical disease remission. Cancer, 2007. 110(11): p. 2448-56. 52. Walter, S., et al., Multipeptide immune response to cancer vaccine IMA901 after single-dose cyclophosphamide associates with longer patient survival. Nat Med, 2012. 53. Wolchok, J.D., et al., Development of ipilimumab: a novel immunotherapeutic approach for the treatment of advanced melanoma. Ann N Y Acad Sci, 2013. 1291(1): p. 1-13. 54. Hodi, F.S., et al., Immunologic and clinical effects of antibody blockade of cytotoxic T lymphocyte-associated antigen 4 in previously vaccinated cancer patients. Proc Natl Acad Sci U S A, 2008. 105(8): p. 3005-10. 55. Quezada, S.A., et al., CTLA4 blockade and GM-CSF combination immunotherapy alters the intratumor balance of effector and regulatory T cells. J Clin Invest, 2006. 116(7): p. 1935-45. 56. Duraiswamy, J., et al., Dual blockade of PD-1 and CTLA-4 combined with tumor vaccine effectively restores T-cell rejection function in tumors. Cancer Res, 2013. 73(12): p. 3591-603. 57. Wolchok, J.D., et al., Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res, 2009. 15(23): p. 7412-20. 58. Dupont, J., et al., Wilms Tumor Gene (WT1) and p53 expression in endometrial carcinomas: a study of 130 cases using a tissue microarray. Gynecol Oncol, 2004. 94(2): p. 449-55. 59. Eisenhauer, E.A., et al., New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009. 45(2): p. 228-47. 60. Maslak, P.G., et al., Vaccination with synthetic analog peptides derived from WT1 oncoprotein induces T-cell responses in patients with complete remission from acute myeloid leukemia. Blood, 2010. 116(2): p. 171-179. SEQUENCE LISTING

[0141] <110> Memorial Sloan Kettering Cancer Center <120> METHODS AND COMPOSITIONS FOR TREATING CANCER <130> P-79550-EP <140> EP 16867262.4 <141> 2016-11-18 <150> US 62 / 258134 <151> 2015-11-20 <160> 204 <170> PatentIn version 3.5 <210> 1 <211> 19 <212> PRT <213> Homo sapiens <400> 1 <210> 2 <211> 22 <212> PRT <213> Homo sapiens <400> 2 <210> 3 <211> 15 <212> PRT <213> Homo sapiens <400> 3 <210> 4 <211> 15 <212> PRT <213> Homo sapiens <400> 4 <210> 5 <211> 19 <212> PRT <213> Homo sapiens <400> 5 <210> 6 <211> 15 <212> PRT <213> Homo sapiens <400> 6 <210> 7 <211> 9 <212> PRT <213> Homo sapiens <400> 7 <210> 8 <211> 9 <212> PRT <213> Homo sapiens <400> 8 <210> 9 <211> 9 <212> PRT <213> Homo sapiens <400> 9 <210> 10 <211> 9 <212> PRT <213> Homo sapiens <400> 10 <210> 11 <211> 9 <212> PRT <213> Homo sapiens <400> 11 <210> 12 <211> 9 <212> PRT <213> Homo sapiens <400> 12 <210> 13 <211> 9 <212> PRT <213> Homo sapiens <400> 13 <210> 14 <211> 9 <212> PRT <213> Homo sapiens <400> 14 <210> 15 <211> 9 <212> PRT <213> Homo sapiens <400> 15 <210> 16 <211> 9 <212> PRT <213> Homo sapiens <400> 16 <210> 17 <211> 9 <212> PRT <213> Homo sapiens <400> 17 <210> 18 <211> 10 <212> PRT <213> Homo sapiens <400> 18 <210> 19 <211> 10 <212> PRT <213> Homo sapiens <400> 19 <210> 20 <211> 9 <212> PRT <213> Homo sapiens <400> 20 <210> 21 <211> 9 <212> PRT <213> Mutated Homo sapiens <400> 21 <210> 22 <211> 9 <212> PRT <213> Mutated Homo sapiens <400> 22 <210> 23 <211> 15 <212> PRT <213> Homo sapiens <400> 23 <210> 24 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 24 <210> 25 <211> 15 <212> PRT <213> Homo sapiens <400> 25 <210> 26 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 26 <210> 27 <211> 15 <212> PRT <213> Homo sapiens <400> 27 <210> 28 <211> 15 <212> PRT <213> Homo sapiens <400> 28 <210> 29 <211> 15 <212> PRT <213> Homo sapiens <400> 29 <210> 30 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 30 <210> 31 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 31 <210> 32 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 32 <210> 33 <211> 15 <212> PRT <213> Homo sapiens <400> 33 <210> 34 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 34 <210> 35 <211> 17 <212> PRT <213> Homo sapiens <400> 35 Ala <210> 36 <211> 9 <212> PRT <213> Homo sapiens <400> 36 <210> 37 <211> 9 <212> PRT <213> Homo sapiens <400> 37 <210> 38 <211> 9 <212> PRT <213> Homo sapiens <400> 38 <210> 39 <211> 17 <212> PRT <213> Mutated Homo sapiens <400> 39 <210> 40 <211> 9 <212> PRT <213> Mutated Homo sapiens <400> 40 <210> 41 <211> 9 <212> PRT <213> Mutated Homo sapiens <400> 41 <210> 42 <211> 9 <212> PRT <213> Homo sapiens <400> 42 <210> 43 <211> 17 <212> PRT <213> Mutated Homo sapiens <400> 43 <210> 44 <211> 9 <212> PRT <213> Homo sapiens <400> 44 <210> 45 <211> 9 <212> PRT <213> Homo sapiens <400> 45 <210> 46 <211> 9 <212> PRT <213> Homo sapiens <400> 46 <210> 47 <211> 9 <212> PRT <213> Homo sapiens <400> 47 <210> 48 <211> 9 <212> PRT <213> Homo sapiens <400> 48 <210> 49 <211> 9 <212> PRT <213> Homo sapiens <400> 49 <210> 50 <211> 9 <212> PRT <213> Homo sapiens <400> 50 <210> 51 <211> 9 <212> PRT <213> Homo sapiens <400> 51 <210> 52 <211> 9 <212> PRT <213> Homo sapiens <400> 52 <210> 53 <211> 9 <212> PRT <213> Homo sapiens <400> 53 <210> 54 <211> 9 <212> PRT <213> Homo sapiens <400> 54 <210> 55 <211> 9 <212> PRT <213> Homo sapiens <400> 55 <210> 56 <211> 9 <212> PRT <213> Homo sapiens <400> 56 <210> 57 <211> 9 <212> PRT <213> Homo sapiens <400> 57 <210> 58 <211> 9 <212> PRT <213> Homo sapiens <400> 58 <210> 59 <211> 9 <212> PRT <213> Homo sapiens <400> 59 <210> 60 <211> 9 <212> PRT <213> Homo sapiens <400> 60 <210> 61 <211> 15 <212> PRT <213> Homo sapiens <400> 61 <210> 62 <211> 15 <212> PRT <213> Homo sapiens <400> 62 <210> 63 <211> 9 <212> PRT <213> Homo sapiens <400> 63 <210> 64 <211> 9 <212> PRT <213> Homo sapiens <400> 64 <210> 65 <211> 9 <212> PRT <213> Homo sapiens <400> 65 <210> 66 <211> 15 <212> PRT <213> Homo sapiens <400> 66 <210> 67 <211> 15 <212> PRT <213> Homo sapiens <400> 67 <210> 68 <211> 13 <212> PRT <213> Homo sapiens <400> 68 <210> 69 <211> 9 <212> PRT <213> Homo sapiens <400> 69 <210> 70 <211> 9 <212> PRT <213> Homo sapiens <400> 70 <210> 71 <211> 9 <212> PRT <213> Homo sapiens <400> 71 <210> 72 <211> 9 <212> PRT <213> Homo sapiens <400> 72 <210> 73 <211> 9 <212> PRT <213> Homo sapiens <400> 73 <210> 74 <211> 9 <212> PRT <213> Homo sapiens <400> 74 <210> 75 <211> 9 <212> PRT <213> Homo sapiens <400> 75 <210> 76 <211> 9 <212> PRT <213> Homo sapiens <400> 76 <210> 77 <211> 9 <212> PRT <213> Homo sapiens <400> 77 <210> 78 <211> 9 <212> PRT <213> Homo sapiens <400> 78 <210> 79 <211> 11 <212> PRT <213> Homo sapiens <400> 79 <210> 80 <211> 9 <212> PRT <213> Homo sapiens <400> 80 <210> 81 <211> 9 <212> PRT <213> Homo sapiens <400> 81 <210> 82 <211> 10 <212> PRT <213> Homo sapiens <400> 82 <210> 83 <211> 10 <212> PRT <213> Homo sapiens <400> 83 <210> 84 <211> 9 <212> PRT <213> Homo sapiens <400> 84 <210> 85 <211> 9 <212> PRT <213> Homo sapiens <400> 85 <210> 86 <211> 11 <212> PRT <213> Homo sapiens <400> 86 <210> 87 <211> 9 <212> PRT <213> Homo sapiens <400> 87 <210> 88 <211> 9 <212> PRT <213> Homo sapiens <400> 88 <210> 89 <211> 9 <212> PRT <213> Homo sapiens <400> 89 <210> 90 <211> 9 <212> PRT <213> Homo sapiens <400> 90 <210> 91 <211> 9 <212> PRT <213> Homo sapiens <400> 91 <210> 92 <211> 9 <212> PRT <213> Homo sapiens <400> 92 <210> 93 <211> 9 <212> PRT <213> Homo sapiens <400> 93 <210> 94 <211> 9 <212> PRT <213> Homo sapiens <400> 94 <210> 95 <211> 9 <212> PRT <213> Homo sapiens <400> 95 <210> 96 <211> 9 <212> PRT <213> Homo sapiens <400> 96 <210> 97 <211> 9 <212> PRT <213> Homo sapiens <400> 97 <210> 98 <211> 9 <212> PRT <213> Homo sapiens <400> 98 <210> 99 <211> 9 <212> PRT <213> Homo sapiens <400> 99 <210> 100 <211> 10 <212> PRT <213> Homo sapiens <400> 100 <210> 101 <211> 9 <212> PRT <213> Homo sapiens <400> 101 <210> 102 <211> 9 <212> PRT <213> Mutated Homo sapiens <400> 102 <210> 103 <211> 11 <212> PRT <213> Homo sapiens <400> 103 <210> 104 <211> 15 <212> PRT <213> Homo sapiens <400> 104 <210> 105 <211> 9 <212> PRT <213> Homo sapiens <400> 105 <210> 106 <211> 10 <212> PRT <213> Homo sapiens <400> 106 <210> 107 <211> 8 <212> PRT <213> Homo sapiens <400> 107 <210> 108 <211> 9 <212> PRT <213> Homo sapiens <400> 108 <210> 109 <211> 10 <212> PRT <213> Homo sapiens <400> 109 <210> 110 <211> 11 <212> PRT <213> Homo sapiens <400> 110 <210> 111 <211> 9 <212> PRT <213> Homo sapiens <400> 111 <210> 112 <211> 10 <212> PRT <213> Homo sapiens <400> 112 <210> 113 <211> 10 <212> PRT <213> Homo sapiens <400> 113 <210> 114 <211> 9 <212> PRT <213> Homo sapiens <400> 114 <210> 115 <211> 10 <212> PRT <213> Homo sapiens <400> 115 <210> 116 <211> 9 <212> PRT <213> Homo sapiens <400> 116 <210> 117 <211> 9 <212> PRT <213> Homo sapiens <400> 117 <210> 118 <211> 9 <212> PRT <213> Homo sapiens <400> 118 <210> 119 <211> 9 <212> PRT <213> Homo sapiens <400> 119 <210> 120 <211> 10 <212> PRT <213> Homo sapiens <400> 120 <210> 121 <211> 10 <212> PRT <213> Homo sapiens <400> 121 <210> 122 <211> 9 <212> PRT <213> Homo sapiens <400> 122 <210> 123 <211> 15 <212> PRT <213> Homo sapiens <400> 123 <210> 124 <211> 9 <212> PRT <213> Mutated Homo sapiens <400> 124 <210> 125 <211> 19 <212> PRT <213> Mutated Homo sapiens <400> 125 <210> 126 <211> 15 <212> PRT <213> Mutated Homo sapiens <400> 126 <210> 127 <211> 9 <212> PRT <213> Homo sapiens <400> 127 <210> 128 <211> 9 <212> PRT <213> Homo sapiens <400> 128 <210> 129 <211> 9 <212> PRT <213> Homo sapiens <400> 129 <210> 130 <211> 9 <212> PRT <213> Homo sapiens <400> 130 <210> 131 <211> 9 <212> PRT <213> Homo sapiens <400> 131 <210> 132 <211> 9 <212> PRT <213> Homo sapiens <400> 132 <210> 133 <211> 9 <212> PRT <213> Homo sapiens <400> 133 <210> 134 <211> 9 <212> PRT <213> Homo sapiens <400> 134 <210> 135 <211> 9 <212> PRT <213> Homo sapiens <400> 135 <210> 136 <211> 9 <212> PRT <213> Homo sapiens <400> 136 <210> 137 <211> 9 <212> PRT <213> Homo sapiens <400> 137 <210> 138 <211> 9 <212> PRT <213> Homo sapiens <400> 138 <210> 139 <211> 9 <212> PRT <213> Homo sapiens <400> 139 <210> 140 <211> 9 <212> PRT <213> Homo sapiens <400> 140 <210> 141 <211> 10 <212> PRT <213> Homo sapiens <400> 141 <210> 142 <211> 10 <212> PRT <213> Homo sapiens <400> 142 <210> 143 <211> 10 <212> PRT <213> Homo sapiens <400> 143 <210> 144 <211> 10 <212> PRT <213> Homo sapiens <400> 144 <210> 145 <211> 10 <212> PRT <213> Homo sapiens <400> 145 <210> 146 <211> 10 <212> PRT <213> Homo sapiens <400> 146 <210> 147 <211> 9 <212> PRT <213> Homo sapiens <400> 147 <210> 148 <211> 9 <212> PRT <213> Homo sapiens <400> 148 <210> 149 <211> 9 <212> PRT <213> Homo sapiens <400> 149 <210> 150 <211> 15 <212> PRT <213> Homo sapiens <400> 150 <210> 151 <211> 15 <212> PRT <213> Homo sapiens <400> 151 <210> 152 <211> 15 <212> PRT <213> Homo sapiens <400> 152 <210> 153 <211> 15 <212> PRT <213> Homo sapiens <400> 153 <210> 154 <211> 15 <212> PRT <213> Homo sapiens <400> 154 <210> 155 <211> 15 <212> PRT <213> Homo sapiens <400> 155 <210> 156 <211> 15 <212> PRT <213> Homo sapiens <400> 156 <210> 157 <211> 15 <212> PRT <213> Homo sapiens <400> 157 <210> 158 <211> 15 <212> PRT <213> Homo sapiens <400> 158 <210> 159 <211> 15 <212> PRT <213> Homo sapiens <400> 159 <210> 160 <211> 15 <212> PRT <213> Homo sapiens <400> 160 <210> 161 <211> 15 <212> PRT <213> Homo sapiens <400> 161 <210> 162 <211> 17 <212> PRT <213> Homo sapiens <400> 162 <210> 163 <211> 9 <212> PRT <213> Homo sapiens <400> 163 <210> 164 <211> 9 <212> PRT <213> Homo sapiens <400> 164 <210> 165 <211> 9 <212> PRT <213> Homo sapiens <400> 165 <210> 166 <211> 17 <212> PRT <213> Homo sapiens <400> 166 <210> 167 <211> 9 <212> PRT <213> Homo sapiens <400> 167 <210> 168 <211> 9 <212> PRT <213> Homo sapiens <400> 168 <210> 169 <211> 9 <212> PRT <213> Homo sapiens <400> 169 <210> 170 <211> 17 <212> PRT <213> Homo sapiens <400> 170 <210> 171 <211> 9 <212> PRT <213> Homo sapiens <400> 171 <210> 172 <211> 9 <212> PRT <213> Homo sapiens <400> 172 <210> 173 <211> 9 <212> PRT <213> Homo sapiens <400> 173 <210> 174 <211> 9 <212> PRT <213> Homo sapiens <400> 174 <210> 175 <211> 9 <212> PRT <213> Homo sapiens <400> 175 <210> 176 <211> 9 <212> PRT <213> Homo sapiens <400> 176 <210> 177 <211> 9 <212> PRT <213> Homo sapiens <400> 177 <210> 178 <211> 9 <212> PRT <213> Homo sapiens <400> 178 <210> 179 <211> 9 <212> PRT <213> Homo sapiens <400> 179 <210> 180 <211> 9 <212> PRT <213> Homo sapiens <400> 180 <210> 181 <211> 9 <212> PRT <213> Homo sapiens <400> 181 <210> 182 <211> 9 <212> PRT <213> Homo sapiens <400> 182 <210> 183 <211> 9 <212> PRT <213> Homo sapiens <400> 183 <210> 184 <211> 9 <212> PRT <213> Homo sapiens <400> 184 <210> 185 <211> 9 <212> PRT <213> Homo sapiens <400> 185 <210> 186 <211> 9 <212> PRT <213> Homo sapiens <400> 186 <210> 187 <211> 9 <212> PRT <213> Homo sapiens <400> 187 <210> 188 <211> 15 <212> PRT <213> Homo sapiens <400> 188 <210> 189 <211> 15 <212> PRT <213> Homo sapiens <400> 189 <210> 190 <211> 9 <212> PRT <213> Homo sapiens <400> 190 <210> 191 <211> 9 <212> PRT <213> Homo sapiens <400> 191 <210> 192 <211> 9 <212> PRT <213> Homo sapiens <400> 192 <210> 193 <211> 15 <212> PRT <213> Homo sapiens <400> 193 <210> 194 <211> 15 <212> PRT <213> Homo sapiens <400> 194 <210> 195 <211> 13 <212> PRT <213> Homo sapiens <400> 195 <210> 196 <211> 9 <212> PRT <213> Homo sapiens <400> 196 <210> 197 <211> 9 <212> PRT <213> Homo sapiens <400> 197 <210> 198 <211> 9 <212> PRT <213> Homo sapiens <400> 198 <210> 199 <211> 449 <212> PRT <213> Homo sapiens <400> 199 <210> 200 <211> 453 <212> PRT <213> Homo sapiens <400> 200 <210> 201 <211> 514 <212> PRT <213> Homo sapiens <400> 201 <210> 202 <211> 168 <212> PRT <213> Homo sapiens <400> 202 <210> 203 <211> 18 <212> PRT <213> Homo sapiens <400> 203 <210> 204 <211> 15 <212> PRT <213> Homo sapiens <400> 204

Claims

1. The combination of (a) the four WT1 peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO: 125), and (b) at least one antibody PD1 inhibitor, for use in treating, reducing the incidence of, or inducing an immune response against a WT1-expressing cancer.

2. The combination for use according to claim 1 wherein the WT1 peptides are administered with a carrier, excipient or diluent, or an adjuvant such as QS21, Montanide, Freund's complete or incomplete adjuvant, aluminum phosphate, aluminum hydroxide, BCG, a cytokine or alum.

3. The combination for use according to claim 1 wherein the PD1 inhibitor is nivolumab, pembrolizumab, pidilizumab, or MEDI0680 (AMP-514).

4. The combination for use according to claim 1 wherein one or more of the WT1 peptides are administered separately.

5. The combination for use according to claim 1 wherein two or more of the WT1 peptides are administered together within the same formulation.

6. The combination for use according to claim 1 wherein the WT1 peptides and the PD1 inhibitor are present in the same composition.

7. The combination for use according to claim 1 wherein the WT1 peptides and the PD1 inhibitor are administered concurrently, or in an overlapping schedule, or wherein the last administration of the WT1 peptides precedes the first administration of the PD1 inhibitor.

8. The combination for use according to claim 1 wherein the cancer is ovarian cancer, mesothelioma, leukemia, Wilms' tumor, acute myelogenous leukemia (AML), chronic myeloid leukemia (CML), myelodysplastic syndrome (MDS), melanoma, stomach cancer, prostate cancer, biliary cancer, urinary system cancer, glioblastoma, soft tissue sarcoma, osteosarcoma, or non-small cell lung cancer (NSCLC).

9. The combination for use according to claim 1 wherein one or more of the peptides NLMNLGATL (SEQ ID NO:21), WNLMNLGATLKGVAA (SEQ ID NO:26), LVRHHNMHQRNMTKL (SEQ ID NO:3), NKRYFKLSHLQMHSR (SEQ ID NO:4), SGQARMFPNAPYLPSCLES (SEQ ID NO:5), QARMFPNAPYLPSCL (SEQ ID NO:6), RMFPNAPYL (SEQ ID NO:7), SLGEQQYSV (SEQ ID NO:8), ALLPAVPSL (SEQ ID NO:9), NLGATLKGV (SEQ ID NO:10), DLNALLPAV (SEQ ID NO:11), GVFRGIQDV (SEQ ID NO:12), KRYFKLSHL (SEQ ID NO:13), ALLLRTPYS (SEQ ID NO:14), CMTWMQMNL (SEQ ID NO:15), NMHQRNMTK (SEQ ID NO:16), QMNLGATLK (SEQ ID NO:17), FMCAYPGCNK (SEQ ID NO:18), KLSHLQMHSR (SEQ ID NO:19), QAYMFPNAPYLPSCL (SEQ ID NO:126), YLGEQQYSV (SEQ ID NO:127), YLLPAVPSL (SEQ ID NO:128), YLGATLKGV (SEQ ID NO:129), YLNALLPAV (SEQ ID NO:130), GLRRGIQDV (SEQ ID NO:131), KLYFKLSHL (SEQ ID NO:132), ALLLRTPYV (SEQ ID NO:133), YMTWNQMNL (SEQ ID NO:134), NMYQRNMTK (SEQ ID NO:135), NMHQRVMTK (SEQ ID NO:136), NMYQRVMTK (SEQ ID NO: 137), QMYLGATLK (SEQ ID NO:138), QMNLGVTLK (SEQ ID NO:139), QMYLGVTLK (SEQ ID NO: 140), FMYAYPGCNK (SEQ ID NO:141), FMCAYPFCNK (SEQ ID NO:142), FMYAYPFCNK (SEQ ID NO:143), KLYHLQMHSR (SEQ ID NO:144), KLSHLQMHSK (SEQ ID NO:145), KLYHLQMHSK (SEQ ID NO:146), NQMNLGATL (SEQ ID NO:20), NYMNLGATL (SEQ ID NO:22), CMTWNQMNLGATLKG (SEQ ID NO:23), CMTWNLMNLGATLKG (SEQ ID NO:24), WNQMNLGATLKGVAA (SEQ ID NO:25), MTWNQMNLGATLKGV (SEQ ID NO:27), TWNQMNLGATLKGVA (SEQ ID NO:28), MTWNLMNLGATLKGV (SEQ ID NO:30), TWNLMNLGATLKGVA (SEQ ID NO:31), MTWNYMNLGATLKGV (SEQ IDNO:33), TWNYMNLGATLKGVA (SEQ ID NO:34), CMTWNQMNLGATLKGVA (SEQ ID NO:35), WNQMNLGAT (SEQ ID NO:36), TWNQMNLGA (SEQ ID NO:37), MTWNQMNLG (SEQ ID NO:38), CMTWNLMNLGATLKGVA (SEQ ID NO:39), WNLMNLGAT (SEQ ID NO:40), MNLGATLKG (SEQ ID NO:41), CMTWNYMNLGATLKGVA (SEQ ID NO:43), GALRNPTAC (SEQ ID NO:46), GYLRNPTAC (SEQ ID NO:47), GALRNPTAL (SEQ ID NO:48), YALRNPTAC (SEQ ID NO:49), GLLRNPTAC (SEQ ID NO:50), RQRPHPGAL (SEQ ID NO:51), RYRPHPGAL (SEQ ID NO:52), YQRPHPGAL (SEQ ID NO:53), RLRPHPGAL (SEQ ID NO:54), RIRPHPGAL (SEQ ID NO:55), QFPNHSFKHEDPMGQ (SEQ ID NO:61), HSFKHEDPM (SEQ ID NO:63), HSFKHEDPY (SEQ ID NO:64), HSFKHEDPK (SEQ ID NO:65), KRPFMCAYPGCYKRY (SEQ ID NO:66), SEKRPFMCAYPGCNK (SEQ ID NO:67), KRPFMCAYPGCNK (SEQ ID NO:68), FMCAYPGCN (SEQ ID NO:69), FMCAYPGCY (SEQ ID NO:70), and FMCAYPGCK (SEQ ID NO:71) is also administered.

10. The combination for use according to claim 1 wherein 200 mcg of each peptide is emulsified with Montanide ISA 51 VG and administered subcutaneously on weeks 0, 2, 4, 6, 8 and 10.

11. The combination for use according to claim 10 wherein 3 mg / kg of nivolumab is administered intravenously on weeks 0, 2, 4, 6, 8, 10 and 12.

12. The combination for use according to claim 1 wherein the treating, reducing the incidence of, or inducing an immune response against a WT1-expressing cancer is greater than achieved by administering the WT1 peptides alone or the at least one PD1 inhibitor alone.

13. A composition comprising the four WT1 peptides YMFPNAPYL (SEQ ID NO:124), RSDELVRHHNMHQRNMTKL (SEQ ID NO:1), PGCNKRYFKLSHLQMHSRKHTG (SEQ ID NO: 2) and SGQAYMFPNAPYLPSCLES (SEQ ID NO:125), and at least one antibody PD1 inhibitor.

14. The composition according to claim 13 wherein the PD1 inhibitor is nivolumab, pembrolizumab, pidilizumab, or MEDI0680 (AMP-514).