WO 2015/116868 A2 6 August 2015 (06.08.2015) P O P C T

(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2015/116868 A2 6 August 2015 (06.08.2015) P O P C T

(51) International Patent Classification: (74) Agent: AKHAVAN, Ramin; Caris MPI, INC., 6655 N. C12Q 1/68 (2006.0 1) G01N 33/574 (2006.0 1) MacArthur Blvd., Irving, TX 75039 (US). (21) International Application Number: (81) Designated States (unless otherwise indicated, for every PCT/US2015/013618 kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (22) Date: International Filing BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, 29 January 2015 (29.01 .2015) DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (25) Filing Language: English HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, (26) Publication Language: English MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, (30) Priority Data: PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, 61/933,268 29 January 2014 (29.01.2014) US SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, 61/935,825 4 February 2014 (04.02.2014) US TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. 61/971,506 27 March 2014 (27.03.2014) US (84) Designated States (unless otherwise indicated, for every 61/989,419 6 May 2014 (06.05.2014) US kind of regional protection available): ARIPO (BW, GH, 61/991,346 9 May 2014 (09.05.2014) US GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, 62/002,1 18 22 May 2014 (22.05.2014) US TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, 62/032,455 1 August 2014 (01.08.2014) US TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, (71) Applicant: CARIS MPI, INC. [US/US]; 6655 N. Macar- DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, thur Blvd., Irving, TX 75039 (US). LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, (72) Inventors: GATALICA, Zoran; 9243 N 81st Street, GW, KM, ML, MR, NE, SN, TD, TG). Scottsdale, AZ 85258 (US). BASU, Gargi; 2 1112 N 72nd Place, Scottsdale, AZ 85255 (US). FELDMAN, Rebecca; Published: 3892 E Old Stone Circle, Chandler, AZ 85249 (US). MIL- — without international search report and to be republished LIS, Sherri; 1215 W. Rose Lane, Phoenix, AZ 85013 upon receipt of that report (Rule 48.2(g)) (US).

< oo 00

o (54) Title: MOLECULAR PROFILING OF IMMUNE MODULATORS (57) Abstract: Provided herein are methods and systems of molecular profiling of diseases, such as cancer. In some embodiments, the molecular profiling can be used to identify treatments for the disease, such as treatments that provide likely benefit or likely lack of benefit for the disease. The molecular profiling can include analysis of immune modulators such as PD-1 and/or its ligand PD-Ll . MOLECULAR PROFILING OF IMMUNE MODULATORS

CROSS-REFERENCE [0001] This application claims the benefit of priority to United States Provisional Patent Application Serial Nos. 61/933,268, filed on January 29, 2014, 61/935,825, filed on February 4, 2014, 61/971,506, filed on March 27, 2014, 61/989,419, filed on May 6, 2014, 61/991,346, filed on May 9, 2014,

62/002,1 18, filed on May 22, 2014 and 62/032,455, filed on August 1, 2014; all of which applications are incorporated by reference herein in their entirety.

BACKGROUND [0002] Disease states in patients are typically treated with treatment regimens or therapies that are selected based on clinical based criteria; that is, a treatment therapy or regimen is selected for a patient based on the determination that the patient has been diagnosed with a particular disease (which diagnosis has been made from classical diagnostic assays). Although the molecular mechanisms behind various disease states have been the subject of studies for years, the specific application of a diseased individual's molecular profile in determining treatment regimens and therapies for that individual has been disease specific and not widely pursued. [0003] Some treatment regimens have been determined using molecular profiling in combination with clinical characterization of a patient such as observations made by a physician (such as a code from the International Classification of Diseases, for example, and the dates such codes were determined), laboratory test results, x-rays, biopsy results, statements made by the patient, and any other medical information typically relied upon by a physician to make a diagnosis in a specific disease. However, using a combination of selection material based on molecular profiling and clinical characterizations (such as the diagnosis of a particular type of cancer) to determine a treatment regimen or therapy presents a risk that an effective treatment regimen may be overlooked for a particular individual since some treatment regimens may work well for different disease states even though they are associated with treating a particular type of disease state. [0004] Patients with refractory or metastatic cancer are of particular concern for treating physicians. The majority of patients with metastatic or refractory cancer eventually run out of treatment options or may suffer a cancer type with no real treatment options. For example, some patients have very limited options after their tumor has progressed in spite of front line, second line and sometimes third line and beyond) therapies. For these patients, molecular profiling of their cancer may provide the only viable option for prolonging life. [0005] More particularly, additional targets or specific therapeutic agents can be identified assessment of a comprehensive number of targets or molecular findings examining molecular mechanisms, genes, gene expressed proteins, and/or combinations of such in a patient's tumor. Identifying multiple agents that can treat multiple targets or underlying mechanisms would provide cancer patients with a viable therapeutic alternative on a personalized basis so as to avoid standar therapies, which may simply not work or identify therapies that would not otherwise be considered by the treating physician. [0006] There remains a need for better theranostic assessment of cancer vicitims, including molecular profiling analysis that identifies at least one individual profile to provide more informed and effective personalized treatment options, resulting in improved patient care and enhanced treatment outcomes. The present invention provides methods and systems for identifying treatments for these individuals by molecular profiling a sample from the individual. The molecular profiling can include analysis of immune modulators such as PD-1 and/or its ligand PD-L1.

SUMMARY OF THE INVENTION [0007] The present invention provides methods and system for molecular profiling, using the results from molecular profiling to identify treatments for individuals. In some embodiments, the treatments were not identified initially as a treatment for the disease or disease lineage. The molecular profiling can include analysis of an immune checkpoint related gene or gene product. The immune checkpoint related gene or gene product can be PD-1 or a PD-1 ligand such as PD-L1 or PD-L2. [0008] In an aspect, the invention provides a method of identifying at least one treatment associated with a cancer in a subject, comprising: a) determining a molecular profile for at least one sample from the subject by assessing a plurality of gene or gene products, wherein the plurality of gene or gene products comprises at least one of PD-1 and PD-L1; and b) identifying, based on the molecular profile, at least one of: i) at least one treatment that is associated with benefit for treatment of the cancer; ii) at least one treatment that is associated with lack of benefit for treatment of the cancer; and iii) at least one treatment associated with a clinical trial. [0009] The plurality of gene or gene product may further comprise other immune modulating biomarkers as desired.