Enhanced Cancer Vaccine Effectiveness with NKTR-214, a CD122-Biased Cytokine
Jonathan ZalevskySVP, Biology and Preclinical Development
Nektar Therapeutics
SMI Cancer Vaccines, September 2017
Biopharmaceutical company leveraging polymer conjugation technologies to develop new therapies in multiple disease areas
Strong heritage of partnership with top biopharma companies
~ 450 employees• R&D Center and Headquarters
in San Francisco, CA
• Pharmaceutical Development & Manufacturing in Huntsville, AL
• R&D support in Hyderabad, India
2
Nektar Therapeutics
San Francisco, CA
Huntsville, AL
Hyderabad, India
100,000-sq.ft.State-of-the-Art
R&D Center
114,000-sq.ft.Manufacturing
Facility
88,000-sq.ft.R&D Support
Facility
Wet macular degeneration
2004
2003
Acromegaly
Evolution of Nektar‘s Polymer Conjugation Technology
3
Hepatitis C
2001
Hepatitis C Chronic kidney disease anemia
2007 2014
2002
Neutropenia
2008
Crohn’s
Opioid inducedconstipation
Hemophilia A
R&D
NKTR-214
NKTR-255
NKTR-262
2015
Small molecule
Biologics
Large Molecule Half-life Extension
Concentration in Diseased Tissue
Small Molecule Compartmental
Distribution
Bias Receptor Activity
NKTR-358
NKTR-181
Overview
An introduction to IO research at Nektar
NKTR-214• CD122 biased agonist based on PEG-conjugation of IL-2
Combination of NKTR-262 + pMEL-1 Melanoma Vaccine • pMEL-1 cell expansion and functional activation in the tumor microenvironment
4
The Immunity Cycle and Multiple Points of Intervention for I-O Therapies
5
4. Trafficking of T cells to tumor
5. Infiltration of T cells
into tumors
6. Recognition of cancer cells
by T cells
7. Killing of cancer cells1. Release of
cancer cell antigens
2. Cancer antigen presentation
3. Priming and
activation
Source:Oncology Meets Immunology: The Cancer-Immunity CycleChen and MellmanImmunity, Volume 39, Issue 1, 1 - 10
4. Trafficking of T cells to tumor (CTLs)
5. Infiltration of T cells into tumors (CTLs, endothelial
cells)
6. Recognition of cancer cells
by t cells (CTLs, cancer
cells)
7. Killing of cancer cells (immune and cancer
cells)
1. Release of cancer cell antigens (cancer
cell death)
2. Cancer antigen
presentation (dendritic
cells/APCs)
3. Priming and activation
(APCs & T cells)
Nektar’s Immuno-Oncology Strategy to Create Therapies that Cover the Immunity Cycle
6
Therapies need to be
accessible as medicines
Target as many steps as possible in the cycle with as few therapies as
possible
3. Priming and activation
(APCs & T cells)
6. Recognition of cancer cells
by t cells (CTLs, cancer
cells)
5. Infiltration of T cells into tumors (CTLs, endothelial
cells)
7. Killing of cancer cells (immune and cancer
cells)
1. Release of cancer cell antigens (cancer
cell death)
2. Cancer antigen
presentation (dendritic
cells/APCs)
Nektar’s Immuno-Oncology Strategy to Create Therapies that Cover the Immunity Cycle
7
4. Trafficking of T cells to tumor (CTLs)
Therapies need to be
accessible as medicines
Target as many steps as possible in the cycle with as few therapies as
possible
NKTR-214 (CD122 Agonist)
Prime, Proliferate, Activate & Increase Tumor-Infiltrating
Lymphocytes (TILs), Increase PD-1 expression
NKTR-214: Biasing Action to CD 122, or IL-2R Beta, to Stimulate T-Cell Production
Biases signaling to favor the CD122 Receptor (IL-2Rβγ complex)
Eliminates over-activation of IL-2 pathway that results in serious safety issues
Achieves antibody-like dosing schedule in outpatient setting
8
CTLs
CD8+ T-Cellsand NK Cells
NKTR-214
Stimulates ImmuneResponse to Kill
Tumor Cells
CD4+ Regulatory T-Cells
Tregs
Down-Regulates Proliferation of CD8+ T-cells
and Suppresses Immune Response
NKTR-214 Is A CD122-biased Cytokine, Designed To Improve Efficacy And Mitigate Toxicity of the IL-2 Pathway
9
IL-2: purple IL-2Rα: blueIL-2Rβ: cyan IL-2Rγ: green
Structural model of IL-2docked with IL-2Rαβγ
IL-2
IL-2Rα(CD25)
IL-2Rβ(CD122)
IL-2Rγ(CD132) IL-2 cytokine core
• rhIL-2, same amino acid sequence as clinically validated molecule (aldesleukin)
High molecular weight hydrolyzable polymers located at strategic sites
NKTR-214
NKTR-214: Biased Signaling And Prodrug Design To Improve Risk/Benefit Profile
10
NKTR-214 (essentially inactive)
% P
hosp
ho-S
TAT5
Charych, D., et al. AACR 2013, Abstract #482
NKTR-214: Biased Signaling And Prodrug Design To Improve Risk/Benefit Profile
11
Active Species(Biased signaling, increased potency
with fewer PEGs)
NKTR-214 (essentially
inactive)
% P
hosp
ho-S
TAT5
Charych, D., et al. AACR 2013, Abstract #482
NKTR-214: Biased Signaling And Prodrug Design To Improve Risk/Benefit Profile
12
Active Species(Biased signaling, increased potency
with fewer PEGs)
NKTR-214 (essentially
inactive)
% P
hosp
ho-S
TAT5
Charych, D., et al. AACR 2013, Abstract #482
NKTR-214: Biased Signaling And Prodrug Design To Improve Risk/Benefit Profile
13
Active Species(Biased signaling, increased potency with fewer PEGs)
NKTR-214 (essentially
inactive)
% P
hosp
ho-S
TAT5
Charych, D., et al. AACR 2013, Abstract #482
NKTR-214 Mechanism of Action Delivers a Controlled and Biased Signal to the IL-2 Pathway
14
pSTAT5 is a biomarker of IL-2 receptor target engagement. pSTAT5= signal transducer and activator of transcription 5 p=phosphorylated (activated)
C57BL/6 mice were treated with either one dose of NKTR-214 (blue) or aldesleukin (red); blood samples were collected at various time points post-dose. pSTAT5 in peripheral blood CD3+ T cells was assessed using flow cytometry. Top graph is an inset showing the 0-4 hour time period. Bottom
graph shows the full 10 day time course of the experiment. Histograms on right depict pSTAT5 MFI for IL-2 (red) and NKTR-214 (blue)
In mice, a single dose of NKTR-214 gradually builds and sustains pSTAT5 levels through seven days post-dose. In contrast, IL-2 produces a rapid burst of pSTAT that declines four hours post-dose.
Charych, D., et al. AACR 2013, Abstract #482
B16F10 melanoma, C57Bl/6 mice; N=9-12/groupNKTR-214, 2mg/kg i.v. q9dx3; Aldesleukin, 3mg/kg i.p. bidx5, 2 cycles*, p<0.05, ANOVA with Tukey’s post-test (left) or Log-Rank (right) w.r.t. vehicle‡, p<0.05, Student’s T-test (left) or Log-Rank (right) w.r.t. Aldesleukin
NKTR-214 Increases The Quality And Quantity Of The T-cell Response in Mice
> 400-fold increased ratio of CD8 to Treg cells
15
0 2 4 6 8 10 12 14 16
0
200
400
600
800
1000
1200
1400
1600
Days
*
*
‡
treatment duration
Mouse melanoma model
Tota
l C
D8
/ Tre
g ra
tio
CD8/Treg ratio
NKTR-214 Selectively Grows T Cells, NK Cells in Tumor Microenvironment in Cancer Patients
NKTR-214 drives immune activation in the tumor • Increase in total T cells, NK and CD8 T
cells • No increase in Tregs• Increase in PD-1 positive CD8 T cells• Increase in newly proliferating CD8 T cells• Activation and expression of anti-tumor
genes• Change in T cell clonality in the tumor
16
Fold change expressed as Week 3 / predoseShown are results from N=10 patients
Analysis of T cell Populations in Tumor
0
10
20
30
40
CD8 Tregs
1.6
29.8
3. Priming and activation
(APCs & T cells)
6. Recognition of cancer cells
by t cells (CTLs, cancer
cells)
5. Infiltration of T cells into tumors (CTLs, endothelial
cells)
7. Killing of cancer cells (immune and cancer
cells)
1. Release of cancer cell antigens (cancer
cell death)
2. Cancer antigen
presentation (dendritic
cells/APCs)
Nektar’s Immuno-Oncology Strategy to Create Therapies that Cover the Immunity Cycle
17
4. Trafficking of T cells to tumor (CTLs)NKTR-214 (CD122 Agonist)
Prime, Proliferate, Activate & Increase Tumor-Infiltrating
Lymphocytes (TILs), Increase PD-1 expression
CheckpointInhibitors
NKTR-214: Combination With Anti-PD-1 Consistently Produces Durable Responses in Mice
NKTR-214 + anti-PD-1 is superior to anti-CTLA-4 + anti-PD-1
18
0 20 40 60 800
25
50
75
100
Days
*NKTR-214 + anti-PD-1
anti-CTLA-4 + anti-PD-1
0 20 40 60 80 1000
25
50
75
100
Days
*
*
VehicleAnti-CTLA-4Anti PD-1
NKTR-214
Anti CTLA-4 + Anti PD-1
NKTR-214 + Anti PD-1
CT26 colon carcinoma, Balb/c mice, N=10/groupAnti-CTLA-4, 100µg i.p., twice-weekly; Anti-PD-1, 200µg i.p., twice weeklyNKTR-214, 0.8mg/kg i.v. q9dx3*, p<0.05, ANOVA with Tukey’s post-test (left) or Log-Rank (right) w.r.t. vehicle
Long-term survivalColon Cancer Model
Long-term survivalBreast Cancer Model
EMT6 breast carcinoma, Balb/c mice, N=10/groupAnti-CTLA-4, 100µg i.p., twice-weekly; Anti-PD-1, 200µg i.p., twice weekly NKTR-214, 0.8mg/kg i.v. q9dx3*, p<0.05, ANOVA with Tukey’s post-test (left) or Log-Rank (right) w.r.t. vehicle
NKTR-214 Drives Greater T-cell Expansion And T-Cell Clonality in Mice
19
Vehicle
aPD-1
aCTLA-4
NKTR-214
aCTLA4 + aPD-1 NKTR-214 + aCTLA4
NKTR-214 + aPD-1
ImmunoSeq Data(in collaboration with Adaptive Biotechnologies)
0 5 10 15 20 25 30 35
0
200
400
600
800
1000
1200
1400
1600
1800
Days
Mea
n Tu
mor
Vol
ume
(mm
3 )
0 5 10 15 20 25 30 35
0
200
400
600
800
1000
1200
1400
1600
Days
NKTR-214 + aPD-1
NKTR-214 + aCTLA4
aCTLA4 + aPD-1
Harnessing the IL-2 Pathway the Right Way to Increase TILs
20
Prodrug design to enable safe, outpatient dosing Q2w or Q3w
Active cytokine species bias signaling through the heterodimeric IL-2 receptor pathway (IL-2Rβγ)
Biased and sustained signaling to preferentially activate and expand effector CD8+ T and NK cells over Tregs in the tumor microenvironment
Prodrug (inactive)
Currently in multiple clinical trials• NKTR-214 + checkpoint
‒ Combo with nivolumab: 14 tumor types‒ Combo with pembrolizumab in 2 tumors‒ Combo with atezolizumab in 2 tumors
• Other NKTR-214 combination trials to begin 2018
3. Priming and activation
(APCs & T cells)
6. Recognition of cancer cells
by t cells (CTLs, cancer
cells)
5. Infiltration of T cells into tumors (CTLs, endothelial
cells)
7. Killing of cancer cells (immune and cancer
cells)
1. Release of cancer cell antigens (cancer
cell death)
2. Cancer antigen
presentation (dendritic
cells/APCs)
Nektar’s Immuno-Oncology Strategy to Create Therapies that Cover the Immunity Cycle
21
4. Trafficking of T cells to tumor (CTLs)
Therapies need to be
accessible as medicines
Target as many steps as possible in the cycle with as few therapies as
possible
NKTR-214 (CD122 Agonist)
Prime, Proliferate, Activate & Increase Tumor-Infiltrating
Lymphocytes (TILs), Increase PD-1 expression
Vaccine Model
Provide Antigens Activate Dendritic
Cell Response
CheckpointInhibitors
Melanoma Vaccine Mouse Model to Study NKTR-214
Pmel-1 cancer vaccine developed by Overwijk and Rosenberg• Pmel-1 cells adoptive transfer + peptide
vaccination for killing B16F10 tumors• IL-2 is essential for driving anti-tumor pMEL-1
response
Pmel-1 are genetically marked killer T cells• Easy to track in tumor and blood• Responsive to anti-melanoma vaccine• Kill melanoma cells
Use model to study effect of NKTR-214
22
Vaccine Vaccine + IL-2
Overwijk et al. JEM 2003
o Adoptive transfer of gp100-specific Pmel-1 cells
o Gp100 peptide (50 ug/mouse)-L-tyr (adjuvant)
o anti –CD40 (50 ug/mouse)
o TLR-7 agonist (Imiquimod- 5 mice/pack)
o Recombinant IL-2 (100,000 IU X 5 doses_ Day 0, D1 and D2) or
NKTR-214 (0.2mg/kg)
Evaluation of NKTR-214 in Pmel-1 Vaccine Model
23
1. No treatment
2. Aldesleukin
3. NKTR-214
4. Vaccine
5. Vaccine + Aldesleukin (IL-2)
6. Vaccine + NKTR-214
Pmel-1 Cell Transfer
Vaccine = gp100 peptide + anti-CD40 + TLR-7 agonist
Aldesleukin (IL-2) – 100,00 IU b.i.d_D0,D1,D2_q8d
NKTR-214- 0.2 mg/kg_q8d
Collaboration with Meenu Sharma, Willem
Overwijk Laboratory, MD Anderson Cancer Center
NKTR-214 More Effective that Aldesleukin to Delay Tumor Growth in Mouse Melanoma Vaccine Model
24M. Sharma, Willem Overwijk Laboratory, MD Anderson Cancer Center
NKTR-214 Promotes Massive Pmel-1 Cell Expansion After Vaccination
25
NKTR-214-vaccine significantly enhanced Pmel-1 T cell response as compared to Aldesleukin-vaccine
p= <0.001
M. Sharma, Willem Overwijk Laboratory, MD Anderson Cancer Center
D3 D5 D7 D100
200000
400000
600000 Untreated
Vaccine + NKTR-214 Vaccine + Aldesleukin Vaccine
***
Days after vaccination
Num
ber o
f Thy
1.1+
CD8
T c
ells
/ gr
am o
f tum
orNKTR-214 Vaccine Combination Superior to Aldesleukin for Pmel-1 CD8 T Cell Expansion in Tumor and Spleen
26
Tumor
D3 D5 D7 D100
500000
1000000
1500000
2000000
No Tx
Vaccine + NKTR-214 Vaccine + Aldesleukin Vaccine
Days after vaccination
Num
ber o
f Thy
1.1+
CD8
T c
ells
/Spl
een ***Untreated
Vaccine + NKTR-214 Vaccine + Aldesleukin Vaccine
***
Untreated
Vaccine + NKTR-214 Vaccine + Aldesleukin Vaccine
***Spleen
M. Sharma, Willem Overwijk Laboratory, MD Anderson Cancer Center
NKTR-214 Promotes Higher Pmel-1/Treg Ratio than Aldesleukin in Tumor and Spleen
27
0 1000 2000 3000 4000
Day 10
Day 7
Day 5
Day 3
Pmel-1/Tregs (Tumor)
No TreatmentVaccineVaccine + AldesleukinVaccine + NKTR-214
0 50 100 150
Day 10
Day 7
Day 5
Day 3
Pmel-1/Tregs (Spleen)
ure 5
B
M. Sharma, Willem Overwijk Laboratory, MD Anderson Cancer Center
NKTR-214 Preferentially Drives Pmel-1 Proliferation
28
As compared to Vaccine alone and aldesleukin-vaccine combination, NKTR-vaccine treatment
significantly maintained higher proliferation of Pmel-1 T cells and lower proliferation of Tregs in
tumor as well as in spleen
Day 7
M. Sharma, Willem Overwijk Laboratory, MD Anderson Cancer Center
NKTR-214 Preferentially Promotes Pmel-1 Survival
In tumor, addition of NKTR-214 to vaccine reduced annexin V expression on Pmel-1 and enhanced it on Tregs though no significant change was exhibited in Aldesleukin-Vaccine treatment group
In contrast to tumor, Annexin V expression in spleen was reduced on both Pmel-1 T cells and Tregs, in NKTR-vaccine group as compared to vaccine alone
29
Day 7
M. Sharma, Willem Overwijk Laboratory, MD Anderson Cancer Center
Summary and Conclusions
NKTR-214 is a CD122-biased agonist that effectively activates the IL-2 receptor pathway in preclinical and clinical settings
Addition of NKTR-214 to peptide vaccine drives enhanced Pmel-1 T cells in tumor as well as in spleen
• NKTR-214 is better than Aldesleukin in stably maintaining high CD8+ (Pmel-1 cells) and low Treg numbers in tumor
At the peak of Pmel-1 response on day 7, number of Tregs dramatically reduced in tumor of NKTR-vaccine treated group
Relative expression of Ki67 and Annexin V indicated that NKTR-vaccine treatment supports proliferation and survival of Pmel-1 T cells in tumor as well as in spleen
Reduced proliferation and moderately enhanced apoptosis in intratumoral Tregs, seem to contribute to observed low number of Tregs in tumor of NKTR-vaccine treated mice
30
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