Biological markers useful in cancer immunotherapy

Abstract

Methods are disclosed that are based on the finding that serum and plasma levels of eotaxin, MIP1?, and CRP act as important biomarkers that are useful for determining the feasibility in instigating immunotherapeutic treatment of cancer when immunizing with the GV1001 peptide (EARPALLTSRLRFIPK; derived from human telomerase protein), optionally when combined with state of the art combination treatment with Gemcitabine and Capecitabine. In particular, the present invention provides methods for determining whether patients should be treated GV1001 and for determining whether instigated treatment should be continued.

Claims

1. A method for treating an individual suffering from locally advanced and metastatic pancreatic cancer comprising: (a) determining the level of eotaxin (w/v) in a serum sample of the individual; (b) comparing the level of (a) to the average serum eotaxin (w/v) level for a population of individuals having locally advanced and metastatic pancreatic cancer, and if the individual's serum level is at least 10% higher than the average serum level, (c) administering a composition comprising a polypeptide consisting of SEQ ID NO: 1 to the individual concurrently with gemcitabine and capecitabine treatment, whereby survival time is increased.

2. The method according to claim 1, wherein the composition is administered in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF).

3. The method according to claim 1, wherein granulocyte-macrophage colony-stimulating factor (GM-CSF) is administered prior to administration of the composition.

4. The method according to claim 1, wherein the composition is administered parenterally.

5. The method according to claim 1, further comprising after the administration, measuring the level of CRP (w/v) in the serum of the individual and continuing the administration if the level of CRP exhibits a decrease of more than 10% compared to the population average of individuals suffering from the same cancer.

6. The method according to claim 3, wherein GM-CSF is administered 10 to 15 minutes before the composition is administered, GM-CSF and the composition are administered intradermally, and GM-CSF and the composition are administered three times during the first week of treatment, once during the second, third, fourth, and sixth weeks of treatment, and once every four weeks thereafter.

7. A method for treating an individual suffering from locally advanced and metastatic pancreatic cancer comprising: (a) determining the level of eotaxin (w/v) in a serum sample of the individual; (b) determining the level of CRP (w/v) in the serum sample of the individual; (c) comparing the level of (a) to the average serum eotaxin (w/v) level for a population of individuals having locally advanced and metastatic pancreatic cancer; (d) comparing the level of (b) to the average serum CRP (w/v) level for a population of individuals having locally advanced and metastatic pancreatic cancer; if the individual's serum eotaxin level is at least 10% higher than the average serum level and the level of CRP exhibits a decrease of at least 10% compared to the population average of individuals suffering from the same cancer, (e) administering a composition comprising a polypeptide consisting of SEQ ID NO: 1 to the individual concurrently with gemcitabine and capecitabine treatment, whereby survival time is increased.

Description

BRIEF DESCRIPTION OF DRAWINGS

(1) FIG. 1: Graphs showing levels of IL-4, IL-5, IL-7, IL-17, PDGF and VEGF in serum form baseline arm 2 and 3, arm 2 week 7 and arm 3 week 10 patients (p values uncorrected Kruskal-Wallis).

(2) FIG. 2: Graphs showing the change in levels of IFN?, IL-10, IL-7, PDGF, RANTES, TNF? and VEGF for arms 2 and 3. Also shown are the numbers of positive (+ve) and negative (?ve) changes along with p values.

(3) FIG. 3: Levels of CRP in arm 2 and 3 patients at baseline and following treatment.

(4) FIG. 4: Paired analysis of CRP in arm 2 patients (left) and 3 patients (right) at baseline and following treatment Also shown are the numbers of positive (+ve) and negative (?ve) changes along with p values.

(5) FIG. 5: Survival curves for IL-8 dichotomised at the median for baseline levels, post treatment levels and absolute change form baseline to post treatment.

(6) FIG. 6: Survival curves for Eotaxin dichotomised at the median for baseline levels, post treatment levels and absolute change form baseline to post treatment.

(7) FIG. 7: Survival curves for MIP1? dichotomised at the median for baseline levels, post treatment levels and absolute change form baseline to post treatment.

(8) FIG. 8: Survival curves for MIP1? dichotomised at the median for baseline levels, post treatment levels and absolute change form baseline to post treatment.

(9) FIG. 9: Survival curves for VEGF dichotomised at the median for baseline levels, post treatment levels and absolute change form baseline to post treatment.

(10) FIG. 10: Survival curves for CRP dichotomised at the median for baseline levels, post treatment levels and absolute change form baseline to post treatment.

(11) FIG. 11. Survival curves for CRP dichotomised at the median for post treatment levels in arm 3.

(12) FIG. 12: (A) Survival curves for eotaxin (high: median survival 493 days, n=16; low:median survival 239 days, n=25). (B) Survival curves for CRP (high: median survival 222 days, n=20; low: median survival 486 days, n=21).

(13) FIG. 13 shows profile plots of baseline and post-treatment means of log cytokine data from serum for Arm 2. BL and PT represent baseline and post treatment, respectively.

(14) FIG. 14 shows baseline and post treatment means of log cytokine data from serum for Arm 3.

(15) FIG. 15 shows a profile plot of the mean differences (post-treatment?baseline) for the cytokines in serum for each arm. Of note, 19 cytokines showed a statistically significant decrease between baseline and post-treatment in Arm 2 (PDGF, IL1?, IL-1ra, IL-2, IL-4, IL-5, IL-7, IL-10, IL-12, IL-13, IL-17, GCSF, IFN?, eotaxin, FGFb, MIP1?, RANTES, TNF?, VEGF; but not CRP, IL-6, IL-8, IL-9, IL-15, GM-CSF, IP10, MCP1, MIP1?) and none in Arm3.

(16) FIG. 16 shows the p-values obtained from a Wilcoxon signed-rank test used on each cytokine form serum for each arm to test for increase/decrease in values from baseline to post treatment. The significant differences (p<0.05) as seen are in bold grey font. The decreases were larger in Arm2 than in Arm3, noting that there were 19 significant decreases in Arm2 but none in Arm3.

(17) FIG. 17 shows the median difference of post-treatment minus baseline levels, for each cytokine in serum, for each arm of the study. Decreases are highlighted in light shadow and increases/no change are highlighted in dark shadow.

(18) FIG. 18 shows Cox proportional hazards models on baseline data for each cytokine in serum for each arm of the study. The table gives univariate analyses for the baseline data and shows hazard ratios with 95% confidence intervals and p-values. CRP, IL-1ra, IL-2, IL-10, Eotaxin and IFN? are significant (p<0.1) for Arm 2, while CRP, IL-1ra and Eotaxin are significant for Arm 3.

(19) FIG. 19a and FIG. 19b show levels of CRP at baseline in Arm 2 and Arm 3. Low levels of CRP gave a median survival of 337 days for Arm 2 and a median survival of 373 days for Arm 3. Baseline CRP levels predicted median (95% CI) overall survival in Arm3 (high CRP=250 [132-451] days; low CRP=372.5 [229-517] days; p=0.0500) but not in Arm2 (high CRP=195 [140-262] days; low CRP=337 [167-366] days; p=0.2534)

(20) FIG. 20a and FIG. 20b show levels of Eotaxin at baseline in Arm 2 and Arm 3. High levels of Eotaxin in serum give a median survival of 300 days for Arm 2 and a median survival of 451 days for Arm 3. Baseline eotaxin levels predicted median (95% CI) overall survival in Arm3 (high eotaxin=451 [308-623] days; low eotaxin=238.5 [178-344] days; p=0.0135) but not in Arm2 (high eotaxin=299.5 [167-358] days; low eotaxin=188 [102-320] days; p=0.1138)

(21) FIG. 21a and FIG. 21b show Proportional hazards models using dichotomized variables for the baseline data for CRP and Eotaxin in serum combined. When variables were combined at baseline the longest overall survival was predicted by a combination of low levels of CRP plus high levels of Eotaxin in Arm 2 (median survival=337 days) and similarly for Arm 3 (median survival=450 days).

(22) FIG. 22a and FIG. 22b show CRP in serum post treatment in Arm 2 and Arm 3. Low levels of CRP give a median survival of 337 days for Arm 2 and a median survival of 450 days for Arm 3.

(23) FIG. 23a and FIG. 23b show Eotaxin in serum post treatment in Arm 2 and Arm 3. High levels of Eotaxin give a median survival of 251 days for Arm 2 and a median survival of 364 days for Arm 3.

(24) FIGS. 24a and 24b show Proportional hazards models using dichotomized variables for the post-treatment data for serum CRP and serum Eotaxin combined. When variables were combined the longest survival was predicted by a combination of low levels of CRP plus high levels of Eotaxin in Arm 2 (median survival=355 days) and similarly for Arm 3 (median survival=535 days). When variables were combined at post-treatment the longest survival was predicted by a combination of low levels of CRP plus high levels of Eotaxin in Arm 2 (median survival=355 days) and similarly for Arm 3 (median survival=535 days).

(25) FIG. 25 shows the vaccination schedule employed in the Examples.

BEST MODE FOR CARRYING OUT THE INVENTION

Definitions

(26) GV1001 denotes the telomerase-derived peptide having SEQ ID NO: 1: EARPALLTSRLRFIPK

(27) Eotaxin denotes the protein having any one of the amino acid sequences SEQ ID NO: 2-4 (or allelic or naturally occurring isoforms or variants thereof), which can be encoded by any one of the nucleic acid sequences SEQ ID NO: 5-7, respectively.

(28) CRP is the protein having the amino acid sequence SEQ ID NO: 8 (or allelic or other naturally occurring isoforms or variants thereof), which can be encoded by the nucleic acid sequence SEQ ID NO: 9.

(29) MIP1? is the protein having the amino acid sequence SEQ ID NO: 10 (or allelic or other naturally occurring isoforms or variants thereof), which can be encoded by the nucleic acid sequence SEQ ID NO: 11.

Specific Embodiments of the Invention

(30) In one embodiment, the present invention provides a method for anti-cancer and/or anti-inflammatory treatment of an individual in need thereof by administering a therapeutically effective amount of a polypeptide, which comprises SEQ ID NO: 1 or comprises a fragment of SEQ ID NO: 1 of at least 8 amino acids (such as 8, 9, 10, 11, 12, 13, 14 or 15 amino acids), if said individual exhibits an increased serum level of eotaxin and/or MIP1? when compared to population average or to a population of individuals suffering from the same cancer and/or inflammatory condition.

(31) A related embodiment relates to a method for determining whether to instigate anti-cancer and/or anti-inflammatory treatment of an individual in need thereof, wherein said anti-cancer treatment and/or anti-inflammatory treatment involves administration of a polypeptide, which comprises SEQ ID NO: 1 or comprises a fragment of SEQ ID NO: 1 of at least 8 amino acids, comprising determining if said individual exhibits an increased serum level of eotaxin and/or MIP1? when comparing to the population average or to a population of individuals suffering from the same cancer and/or inflammatory condition, a positive determination indicating that said treatment is justified.

(32) As appears from the examples, it has been found by the present inventors that median survival of cancer patients receiving the medical treatments disclosed herein is at its highest when these patients exhibit a combined baseline serum level of high eotaxin and low CRP. Further, it is also found that patients that exhibit the same combination (high eotaxin, low CRP) post-treatment art those that have the highest median survival.

(33) Hence according to the present invention, the treatments of the present invention are preferably those where the patients subjected to the treatments are those who prior to treatment exhibit increased eotaxin and/or MIP-1? serum levels in combination with decreased CRP levelsagain the levels are determined either relative to the average (or median) in the general population or relative to the average or median in the relevant patient group.

(34) Depending on the exact route of administration, the effective amount administered according to the various embodiments of the invention may vary. If the polypeptide is administered as a vaccine, the amounts typically range from 0.5 ?g up to 500 mg, with preferred administration amounts ranging between 10 ?g to 1000 ?g, and in particular between 20 and 200 ?g. These ranges are also relevant when the polypeptide is administered as an anti-inflammatory agent, but it may be relevantfor instance if the polypepide is administered intraveneously or intraarteriallyto regulate the amounts administered on the basis of the individual's condition, body weight and age.

(35) Increased levels of eotaxin and/or MIP1? and/or CRP are in the relevant embodiments determined according to standardized assays generally known in the art-immune assays, for instance ELISAs, are preferred, but also assays that determine the activity of these cytokines on suitable target cells or suitable target molecules are relevant. If an assay is very sensitive and accurate, even small increases compared to standard values may be relevant, whereas less sensitive or accurate assays will require that larger deviations from standard values can be determined. As a rule, for a given assay for a particular cytokine there will exist a range of normal values and if the cytokine level is beyond these normal values, the level of eotaxin or MIP1? will be considered to be increased. Typically, the increased baseline level of eotaxin and/or MIP1? is at least 10%, but higher increases in values may be relevant: at least 15%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, and even at least 100%.

(36) Another embodiment of the invention relates to a method for anti-cancer and/or anti-inflammatory treatment of an individual in need thereof by administering a therapeutically effective amount of a polypeptide, which comprises SEQ ID NO: 1 or comprises a fragment of SEQ ID NO: 1 of at least 8 amino acids, wherein said treatment is continued after an initial stage of said treatment if said individual exhibits a decrease of CRP level in serum after said initial stage of said treatment. This is to mean, that the treatment has been instigated, but subsequently the measurement of CRP is used to gauge the efficacy of the treatment regimen. If serum CRP does not decrease or increases (cf. the remarks concerning assay sensitivity above), the findings of the present invention questions whether continued treatment with the GV1001-derived polypeptide is of value to the patient, meaning that it can be considered to terminate this part of the treatment and turn to possible alternatives or palliative treatment.

(37) Related to this embodiment is a method for determining the efficacy of therapeutic treatment of an individual with a polypeptide, which comprises SEQ ID NO: 1 or comprises a fragment of SEQ ID NO: 1 of at least 8 amino acids, comprising determining the serum level of CRP in said individual after an initial stage of said treatment and comparing with the serum level of CRP prior to said initial stage of treatment, where a decrease in said serum level indicates that said treatment is effective in terms of conferring an increase in survival time.

(38) Said decrease in the serum level of CRP should typically be at least 10%, but further decreases in values may be relevant: at least 15%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, and even at least 80%.

(39) The above-described embodiments have focussed on the use of the GV1001-derived polypeptide, but in important embodiments of the invention, the anti-cancer and/or anti-inflammatory treatment involves concurrent treatment with at least one cytostatic or cytotoxic agent. For instance, the concurrent treatment may involve administration of GemCap as in the present examples, but depending on the cancer or inflammatory disease in question, the GV1001-derived peptide may according to the present invention be combined with the administration of cytostatic/cytotoxic agents particular relevant for the treatment of the disease in question.

(40) Very important embodiments of the invention are those where the treatment is an anti-cancer treatment, and particularly preferred is treatment of pancreatic cancer. However, treatment of other cancer forms are contemplated, and the cancer may be selected from the group consisting of an epithelial cancer, a non-epithelial cancer, and a mixed cancer. The epithelial cancer may be both a carcinoma or an adenocarcinoma, and the non-epithelial or mixed cancer is typically a liposarcoma, a fibrosarcoma, a chondrosarcoma, an osteosarcoma, a leiomyosarcoma, a rhabomyosarcoma, a glioma, a neuroblastoma, a medullablastoma, a malignant melanoma, a malignant meningioma, a neurofibrosarcoma, a leukemia, a myeloproleferative disorder, a lymphoma, a he-mangiosarcoma, a Kaposi's sarcoma, a malignant teratoma, a dysgerminoma, a seminoma, or a choriosarcoma.

(41) Also, the anatomic location of the cancer can be anywhere in body. So the cancer may be a of the eye, the nose, the mouth, the tongue, the pharynx, the oesophagus, the stomach, the colon, the rectum, the bladder, the ureter, the urethra, the kidney, the liver, the pancreas, the thyroid gland, the adrenal gland, the breast, the skin, the central nervous system, the peripheral nervous system, the meninges, the vascular system, the testes, the ovaries, the uterus, the uterine cervix, the spleen, bone, or cartilage

(42) The polypeptide is administered typically parenterally, and when administered as a vaccine, the polypeptide will be normally be administered subcutaneously or intradermally. If the anti-inflammatory effect is most desired, also the intraveneous or intraarterial routes may be utilised.

(43) Determination of serum levels of the above mentioned is performed in vitro. Typically, a serum sample is subjected to an ELISA in order to determine the amount of the serum levels of the cytokines.

(44) In all of the above discussed embodiments, the polypeptide can preferably be SEQ ID NO: 1 (i.e. the 16-mer peptide as such) or a fragment of at least 8 amino acids of SEQ ID NO: 1; that is, it is contemplated that it will not be necessary to include further amino acids in the GV1001-derived peptides.

(45) In general embodiments are provided the use of eotaxin and/or MIP1? and/or CRP as a prognostic marker in anticancer and/or anti-inflammatory treatment, in particular if said treatment involves administration of a polypeptide, which comprises SEQ ID NO: 1 or comprises a fragment of SEQ ID NO: 1 of at least 8 amino acids. As mentioned above, the typical use will be as an agent captured/determined in an appropriate assay, so this aspect of the invention also covers use of antibodies and other agents that specifically bind to any one of the three cytokines.

(46) An interesting embodiment relates to a method for modulation of the activity of eotaxin and/or MIP1? and/or CRP in an individual in need thereof, said method comprising administering a therapeutically effective amount of a polypeptide as defined hereinsuch a method will be able to address the negative impact caused by abnormal levels of these cytokines in an individual. Consequently, this embodiment relates to the use of these polypeptides as modulators of eotaxin and/or MIP1? and/or CRP.

(47) Finally, a separate embodiment of the invention relates to a kit comprisinga) a pharmaceutical composition comprising a GV1001-derived polypeptide discussed above, and b) means for determining the serum concentration of eotaxin and/or means for determining the serum concentration of MIP1? and/or means for determining the serum concentration of CRP. These means may e.g. be in the form of a suitable immune assay.

MODE FOR THE INVENTION

Example

(48) The TeloVac trial recruited 1062 patients in 52 centres throughout the UK. There was no significant difference in overall survival between the groups that received the vaccine and the control group receiving chemotherapy (GemCap therapy, cf. below), but included an ambitious program of translational research, which is still undergoing evaluation. However, results show that the vaccine resulted in a significant anti-inflammatory response, and that simultaneous vaccination with chemotherapy provides an effective method for generating both an immune response and also promoting an anti-inflammatory effect. Importantly, biomarkers for an increased survival in response to the vaccine were identified in a subgroup of patients.

(49) Materials and Methods

(50) The TeloVac trial, was initiated in January 2007 comparing combination therapy with Gemcitabine and Capecitabine (GemCap) therapy with concurrent and sequential chemo-immunotherapy using GV1001 in locally advanced and metastatic pancreatic cancer.

(51) Vaccination Schedule

(52) FIG. 25 shows the vaccination schedule employed: GV1001 intradermal injections were given three times (preferably Monday, Wednesday and Friday) in the first week (week 1), and once a week in weeks 2, 3, 4, and 6. After this, GV1001 was administered once monthly. GM-CSF was administered separately as an intradermal injection 10-15 minutes before all GV1001 injections at the approximately same site.

(53) Patients with advanced pancreatic cancer have a short life expectancy and their immune system deteriorates rapidly. The window available for induction of immune response is hence limited. It is therefore important to use a frequent vaccination regimen in order to induce an efficient immune response as fast as possible. The vaccination regimen used for GV1001, with aggressive vaccination during the first six weeks of the treatment, was based on a similar regimen used for another peptide vaccine which has proven to be efficient for induction of immune response in patients with advanced pancreatic cancer.

(54) Inflammatory Cytokine Analysis

(55) Serum samples (Arm3 only) from week1 (baseline) and week10 (Gemcitabine+Capecitabine+GV1001) were analyzed by Luminex multiplex cytokine analysis. A total of 26 cytokines were analyzed, and the CRP level was analyzed by ELISA.

(56) Overview of Samples Analysed:

(57) TABLE-US-00001 Arm 1 Arm 2 Arm 3 Screening BaselinePlasma Baseline Plasma BaselinePlasma Urine30ml Urine 30 ml Urine30ml Week 1 Baseline Serum Baseline Serum Week 7 GemCap Serum Week 10 GemCap & GV1001Serum Week 14 GemCapPlasma GV1001 (+GemCap if GemCap& Urine30ml progressed)Plasma GV1001Serum Urine 30 ml Plasma Urine30ml Week 18 GV1001 (+GemCap if GemCap & progressed)Serum GV1001 Serum Week 22 GV1001 (+GemCap if progressed)Serum Week 26 GemCapPlasma GV1001 (+GemCap if GemCap& Urine30ml progressed)Serum GV1001Plasma Urine30ml Underlined: Plasma analyzed Italic letters: Serum analyzed

(58) Grey shading: Plasma analysed

(59) Italic letters: Serum analysed

(60) Arm 1: patients received GemCap only, i.e. a currently accepted standard chemotherapeutic treatment regimen for pancreatic cancer patients utilising a combination of Gemcitabine (administered iv weekly) and Capecitabine (adminstered as tablets twice daily). Arm 2: patients received GemCap therapy followed by gv1001 at week 7. Arm 3: patients received concurrent GemCap and GV1001 during the entire treatment period.

(61) Cytokines

(62) Grouping of some of the cytokines tested for:

(63) Factors associated with immune stimulatory functions

(64) INF-? Immune stimulatory

(65) IL-12 (p70) Immune stimulatory

(66) IL-1? Immune stimulatory

(67) IL-6 Immune stimulatory

(68) TNF-? Immune stimulatory

(69) Factors associated with immune suppressive functions:

(70) IL-10 Immune suppressive

(71) IL-1Ra Immune suppressive

(72) IL-4 Immune suppressive

(73) VEGF Immune suppressive

(74) Factors associated with chemotactic functions:

(75) Eotaxin Chemotactic

(76) IL-8 Chemotactic

(77) IP-10 Chemotactic

(78) MCP-1 Chemotactic

(79) MIP-1? Chemotactic

(80) MIP-1? Chemotactic

(81) RANTES Chemotactic

(82) Factors associated with vascular remodelling functions:

(83) FGF basic Vascular remodelling

(84) PDGF-BB Vascular remodelling

(85) VEGF Vascular remodelling

(86) Analysis of Patient Sera

(87) Cytokine Results: The Kruskal-Wallis comparison of Arm 2 and Arm 3 baseline (i.e. before treatment) with arm 2 week 7 (GemCap) with Arm 3 week 10 (GemCap and GV1001) serum samples are shown in table 1 below. Kruskal-Wallis testing identifies 18 cytokines with significantly different levels; following Bonferroni-Holm correction, 8 of these cytokines are still significant.

(88) Results

(89) The results are shown in Tables 1-6 and FIGS. 1-24.

(90) There were 7 cytokines (IL-4, IL-5, IL-7, IL-17, PDGF, VEGF and RANTES) that were at significantly higher levels after treatment with GV1001/GemCap compared to GemCap treatment alone. Using crude uncorrected 2-tailed Mann-Whitney PDGF (p<0.0001) and RANTES (p=0.002) were most significant. Following Bonferroni Holm correction both of these remained significant (Table 2 and FIG. 1).

(91) GemCap treatment resulted in decreased levels of a number of cytokines (pre-treatment compared to post treatment) in the serum fraction of blood (but not in plasma); this decrease was not evident in the presence of GV1001 (Table 3 and FIG. 2).

(92) C-Reactive Protein levels were significantly lower in serum from patients receiving GV1001/GemCap compared to patients receiving GemCap alone (see FIG. 3). There was no significant difference in CRP from baseline (before treatment) to post GemCap (n=38) or from baseline (before treatment) to post GemCap with GV1001 (n=41) (FIG. 4).

(93) Initial crude survival analysis of CRP levels showed that prior to treatment [at baseline] there was no evidence to show an association between overall survival and CRP levels (cut off 6 mg/l) in either arm 2 or arm 3. Further, after treatment in arm 2 there was no association between overall survival and CRP levels (cut off 9 mg/ml). In contrast, after treatment in arm 3, a low CRP was associated with higher overall survival and median survival (486 days) compared to patients with a high CRP (median 222 days; p=0.0002) (FIG. 11). Without being bound to theory, patients responding to the vaccine with reduction of CRP appear to have significantly longer survival times than those that do not.

(94) High baseline levels of eotaxin or MIP1? were associated with greatly increased survival in arm 3 (FIGS. 6 and 7). As with CRP post initial treatment this will need to be confirmed by minimizing potential biases from other prognostic criteria, but the effect is remarkable. Somewhat surprisingly, it did not appear that treatment with GV1001 could regulate the serum levels of eotaxin or MIP1?, as is clear from the following data:

(95) TABLE-US-00002 Arm 3 post Arm 2 (GemCap + Arm 2 (GemCap) Arm 3 GV100) serum baseline week 7 baseline Week 10 Eotaxin 172.75 pg/ml 132.24 pg/ml 84.22 pg/ml 85.28 pg/ml MIP1? 15.91 13.38 11.31 11.48 Arm 3 Arm 3 post Arm 1 Arm 1 (GemCap + (GemCap + (GemCap) (GemCap) GV1001) GV1001) plasma week 14 week 26 Week 14 Week 26 Eotaxin 77.92 pg/ml 81.89 79.06 pg/ml 87.81 MIP1? 15.92 14.45 16.23 17.62

(96) Serum Analysis:

(97) Table 1 shows Kruskal-Wallis comparison of Arms 2 and 3 baseline, Arm 2 week 7 (GemCap) with Arm 3 week 10 (GemCap and GV1001) serum.

(98) The comparison of Arm 2 week 7 (GemCap) with Arm 3 week 10 (GemCap and GV1001) serum samples are shown in Table 2.

(99) Mann Whitney analysis shows that there are significant increases in the levels of IL-17, IL-4, IL-5, IL-7, PDGF, RANTES and VEGF in serum samples from arm 3 week 10 patients that have received GemCap and GV1001 compared to serum samples from arm 2 week 7 patients that have received only GemCap. However, following Bonferroni-Holm correction only PDGF remains significant. Comparison graphs for IL-4, IL-5, IL7, IL-17, PDGF and VEGF cytokines in arms 2 and 3 at baseline and post treatment are shown in FIG. 1.

(100) Paired analysis was carried out for: Arm 2 patients at baseline and following 7 weeks of GemCap treatment. Arm 3 patients at baseline and following 10 weeks of GemCap and GV1001 treatment. The overall P value results of these tests are shown in Table 3.

(101) There was a clear difference in the p values from patients in arm 2 and arm 3. The paired Wilcoxon analysis indicated that there were significant differences in 19 cytokine levels between arm 2 baseline and post 7 weeks of GemCap treatment this decreases to 10 cytokines following Bonferroni Holm correction. However, in arm 3 only GM-CSF approached significance (p=0.052) between baseline and post 10 weeks of GV1001/GemCap treatment, this was no longer relevant following Bonferroni Holm correction.

(102) Graphs showing the paired analysis for both arm 2 and arm 3 patients for a selection of cytokines are shown in FIG. 2. The figure also includes the number of positive and negative changes seen in the patient samples from baseline to post treatment. In the majority of arm 2 patients the cytokines analysed decrease from baseline to week 7, i.e. during GemCap treatment. This is in contrast with the arm 3 results, where the numbers of positive and negative changes are relatively evenly distributed.

(103) CReactive Protein Results:

(104) The levels of serum CRP was analysed. FIG. 3 shows the levels of CRP in serum from patients in arms 2 and 3 at baseline and following treatment. The data shows that there is no significant difference in CRP levels at baseline, however the post treatment analysis shows that there is a significant difference, with the levels in patients receiving GV1001/GemCap being significantly lower than in patients receiving GemCap only. Table 4 shows the summary statistics for the CRP data split by arm and baseline post treatment.

(105) As with the cytokine data, paired analysis was carried out and is shown in FIG. 4. There were no significant differences in either arm 2 or 3 from baseline to post treatment.

(106) Analysis of Plasma

(107) Cytokine Results:

(108) The comparison of arm 1 week 14 (GemCap) with arm 3 week 14 (GemCap and GV1001) plasma samples are shown in Table 4, there are no significant differences. The comparison of arm 1 week 26 (GemCap) with arm 3 week 26 (GemCap and GV1001) plasma samples are shown in table 5, there are no significant differences.

(109) As with the serum analysis, plasma has been analysed with a paired Wilcoxon test, this has been carried out for the following comparisons with p values shown in Table 6: Arm 1 patients at baseline and following 14 weeks of GemCap treatment. Arm 3 patients at baseline and following 14 weeks of GemCap and GV1001 treatment. Arm 1 patients at baseline and following 26 weeks of GemCap treatment. Arm 3 patients at baseline and following 26 weeks of GemCap and GV1001 treatment.

(110) It was noted that the decrease seen in cytokines in the serum following GemCap treatment was not seen in plasma. There was only one significant difference seen in RANTES for arm 3 week 14 patients, where levels decreased following GemCap and GV1001 treatment, however this was no longer significant following Bonferroni Holm correction.

(111) Survival Analysis

(112) Serum Cytokines:

(113) Initial survival analyses of baseline, post treatment and absolute changes in cytokine levels revealed survival effects in one or both treatment arms with IL-8 (FIG. 5), Eotaxin (FIG. 6), MIP1? (FIG. 7), MIP1? (FIG. 8) and VEGF (FIG. 9).

(114) CRP:

(115) Although initial survival analysis has indicated an influence of baseline CRP on survival this did not reach significance. However, for arm 3 post treatment levels of CRP did appear to be significantly associated with a survival difference (median survival with high CRP 222 days, median survival with low CRP 486 days p=0.002, FIG. 11) this was not seen with arm 2 (FIG. 10).

(116) TABLE-US-00003 TABLE 1 The Kruskal-Wallis comparison of Arms 2 and 3 baseline, Arm 2 week 7 (Gem-Cap) with Arm 3 week 10 (Gem-Cap and GV1001) serum Kruskal- Bonferroni- Arm 2 Arm 2 Arm 3 Arm 3 Arm 2 Wallis Holm Baseline Week 7 Baseline Week 10 Baseline Analyte p-Value Corrected (pg/ml) (pg/ml) (pg/ml) (pg/ml) St Dev PDGF <0.0001 <0.0001 3924.92 2228.25 4272.13 4046.41 1791.72 IL-1ra <0.0001 0.002 943.93 625.12 166.09 137.21 4145.76 IL-4 0.0002 0.004 11.1 8.38 10.27 9.49 3.54 IL-7 0.0002 0.004 26.97 20.57 22.7 21.44 18.22 IL-17 0.0004 0.009 508.09 346.54 415.68 398.77 273.91 IFN-g 0.001 0.020 238.69 171.2 144.94 129.83 422.71 IL-5 0.001 0.024 21.39 16.59 20.58 19.51 5.41 IL-10 0.002 0.043 54.62 55.56 26.03 22.58 69.73 VEGF 0.004 0.063 117.1 77.44 102.78 99.79 79.67 RANTES 0.005 0.078 56156.98 31469.66 36870.07 107767.49 151062.34 TNF-a 0.012 0.192 144.33 104.02 101.93 105.26 172.05 IL-12 0.013 0.195 196 145.55 70.73 78.37 310 MIP-1b 0.016 0.224 150.03 122.84 135.39 128.02 50.93 IL-6 0.017 0.221 54.19 49.17 18.6 18.04 185.1 IL-9 0.030 0.360 24.21 19.91 17.97 14.94 17.16 IL-2 0.033 0.363 56.83 47.7 21.73 19.97 153.77 G-CSF 0.035 0.350 138.77 102.77 106.37 99.96 87.87 IL-8 0.040 0.360 119.06 108.03 104.82 96.83 43.98 IL-13 0.083 0.664 14.21 11.02 13.51 11.89 8.43 MIP-1a 0.095 0.665 15.91 13.38 11.31 11.48 12.39 IL-1b 0.135 0.810 11.16 8.53 4.71 4.67 36.67 Eotaxin 0.159 0.795 172.65 132.24 84.22 85.28 339.03 GM-CSF 0.200 0.800 61.03 69.49 48.4 11.54 155.05 FGF 0.227 0.681 131.11 110.15 94.46 94.02 95.71 IP-10 0.441 0.882 606.81 678.51 585.7 622.25 480.13 MCP-1 0.484 0.484 104.25 108.42 92.07 94.58 47.38 Arm 2 Arm 3 Arm 3 Arm 2 Arm 2 Arm 3 Arm 3 Week 7 Baseline Week 10 Baseline Week 7 Baseline Week 10 Analyte St Dev St Dev St Dev N= N= N= N= PDGF 1720.22 1793.54 1688.58 38 50 40 51 IL-1ra 2930.23 200.98 181.77 38 47 39 51 IL-4 3.36 2.89 2.71 38 50 40 51 IL-7 30.61 12.17 11.6 38 50 41 51 IL-17 279.11 162.26 169.65 38 49 40 51 IFN-g 350.35 52.4 54.29 38 50 40 51 IL-5 5.85 6.54 6.43 38 50 40 51 IL-10 116.86 27.16 21.85 38 48 40 51 VEGF 96.28 57.02 71.22 37 44 38 49 RANTES 44100.47 26046.57 521514.89 38 49 39 51 TNF-a 136.23 36.56 91.02 38 50 40 51 IL-12 265.81 70.43 119.01 38 47 39 50 MIP-1b 60.49 64.43 50.91 38 50 41 51 IL-6 137.33 7.97 9.32 38 50 39 51 IL-9 17.09 10.44 8.91 38 49 40 50 IL-2 123.67 12.14 13.09 36 33 36 40 G-CSF 61.97 37.99 43.2 38 50 40 51 IL-8 41.06 47.69 35.73 38 50 41 51 IL-13 7.85 9.95 7.7 38 50 41 51 MIP-1a 11.62 5.74 7.37 38 50 41 50 IL-1b 30.84 2.36 2.08 38 49 41 51 Eotaxin 285.05 49.63 64.19 38 44 39 47 GM-CSF 129.57 132.38 14.87 12 10 10 8 FGF 95.88 51.32 60.78 38 39 38 41 IP-10 1108.63 359.53 356.08 38 50 41 51 MCP-1 68.02 37.14 44.01 38 50 41 51

(117) TABLE-US-00004 TABLE 2 The comparison of Arm 2 week 7 (Gem-Cap) with Arm 3 week 10 (Gem-Cap and GV1001) serum Mann- Bonferroni Arm 2 Arm 3 Arm 2 Arn 3 Whitney Holm Correct Arm 2 Week 7 Arm 3 Week 10 Week 7 Week 10 Week 7 Week 10 Analyte P-Value P Value Mean (pg/ml) Mean (pg/ml) Std Dev Std Dev N= N= Eotaxin 0.987 0.987 132.24 85.28 285.05 64.19 44 47 FGF basic 0.859 1.718 110.15 94.02 95.88 60.78 39 41 G-CSF 0.694 3.470 102.77 99.96 61.97 43.2 50 51 GM-CSF 0.091 1.729 69.49 11.54 129.57 14.87 10 8 IFN-g 0.828 2.484 171.2 129.83 350.35 54.29 50 51 IL-10 0.454 3.632 55.56 22.58 116.86 21.85 48 51 IL-12(p70) 0.468 3.276 145.55 78.37 265.81 119.01 47 50 IL-13 0.596 3.576 11.02 11.89 7.85 7.7 50 51 IL-17 0.00694 0.167 346.54 398.77 279.11 169.65 49 51 IL-1b 0.296 3.848 8.53 4.67 30.84 2.08 49 51 IL-1ra 0.39 3.510 625.12 137.21 2930.23 181.77 47 51 IL-2 0.273 3.822 47.7 19.97 123.67 13.09 33 40 IL-4 0.036 0.756 8.38 9.49 3.36 2.71 50 51 IL-5 0.049 0.980 16.59 19.51 5.85 6.43 50 51 IL-6 0.12 2.160 49.17 18.04 137.33 9.32 50 51 IL-7 0.033 0.726 20.57 21.44 30.61 11.6 50 51 IL-8 0.133 2.128 108.03 96.83 41.06 35.73 50 51 IL-9 0.347 3.470 19.91 14.94 17.09 8.91 49 50 IP-10 0.121 2.057 678.51 622.25 1108.63 356.08 50 51 MCP-1 0.174 2.610 108.42 94.58 68.02 44.01 50 51 MIP-1a 0.791 3.164 13.38 11.48 11.62 7.37 50 50 MIP-1b 0.299 3.588 122.84 128.02 60.49 50.91 50 51 PDGF 5.31E?08 <0.001 2228.25 4046.41 1720.22 1688.58 50 51 RANTES 0.00203 0.051 31469.66 107767.49 44100.47 521514.89 49 51 TNF-a 0.31 3.410 104.02 105.26 136.23 91.02 50 51 VEGF 0.021 0.483 77.44 99.79 96.28 71.22 44 49

(118) TABLE-US-00005 TABLE 3 Shown are the p values for the paired comparison of arm 2 baseline versus week 7 and arm 3 baseline versus week 10 Wilcoxon Paired Test Bonferroni Holm Corrected Cytokine Arm 2 Arm 3 Arm 2 Arm 3 Eotaxin 0.0042 0.8307 0.059 2.492 FGF-Basic 0.0129 0.2477 0.142 4.211 G-CSF 0.0025 0.2357 0.045 4.714 GM-CSF 0.8394 0.0522 1.679 1.357 IFN-g 0.0008 0.2468 0.018 4.442 IL-10 0.014 0.2207 0.140 4.635 IL-12 0.0199 0.4106 0.179 4.106 IL-13 0.0454 0.396 0.363 4.356 IL-17 0.0003 0.2909 0.008 4.654 IL-1b 0.0027 0.5392 0.041 3.235 IL-1ra 0.0089 0.0959 0.107 2.302 IL-2 0.0009 0.2372 0.019 4.507 IL-4 0.0005 0.3747 0.012 4.496 IL-5 0.0004 0.5129 0.010 3.590 IL-6 0.4043 0.9535 1.213 1.907 IL-7 0.0025 0.4641 0.043 3.713 IL-8 0.0624 0.3029 0.437 4.544 IL-9 0.1617 0.0985 0.809 2.266 IP-10 0.1705 0.3279 0.682 4.591 MCP-1 0.9364 0.6927 0.936 3.464 MIP-1a 0.141 0.2183 0.846 4.803 MIP-1b 0.0018 0.4255 0.036 3.830 PDGF 0.0001 0.0696 0.003 1.740 RANTES 0.00464 0.7698 0.060 3.079 TNFa 0.0025 0.3609 0.040 4.692 VEFG 0.0023 0.9777 0.044 0.978

(119) TABLE-US-00006 TABLE 4 Summary statistics for CRP data Arm 2 Arm 2 Arm 3 Arm 3 Baseline Week 7 Baseline Week 10 n= 38 50 41 51 Range 5-238 5-175 5-77 5-97 Mean (mg/l) 20.70 21.60 15.96 13.60 Median (mg/l) 7.00 12.00 6.00 6.00 St Dev 40.40 26.60 18.00 18.27

(120) TABLE-US-00007 TABLE 5A The comparison of arm 1 week 14 (Gem-Cap) with arm 3 week 14 (Gem-Cap and GV1001) plasma Mann- Arm 1 Arm 3 Arm 1 Arn 3 Whitney Arm 1 Week 14 Arm 3 Week 14 Week 14 Week 14 Week 14 Week 14 Analyte P-Value Mean (pg/ml) Mean (pg/ml) Std Dev Std Dev N= N= Eotaxin 0.644 77.32 79.06 52.83 76.8 19 35 FGF basic 0.926 139.37 133.58 93.37 80.31 18 31 G-CSF 0.848 146.67 149.68 105.15 99.17 22 36 GM-CSF 0.904 25.2 28.13 22.74 25.59 14 24 IFN-g 0.817 222.03 212.81 184.02 166.71 21 36 IL-10 0.83 38.3 37.83 38.91 38.52 20 34 IL-12 0.566 71.28 72.41 66.42 55.71 19 30 IL-13 0.576 19.04 24.08 17.04 36.98 23 36 IL-17 0.287 310.21 242.25 236.38 204.02 18 36 IL-1b 0.832 7.55 7.36 6.21 5.37 21 35 IL-1ra 0.872 261.48 278.84 263.25 273.17 21 35 IL-2 0.468 31 35 27.32 24.55 16 26 IL-4 0.947 8.67 8.55 6.02 6.07 21 36 IL-5 0.768 22.74 23.96 18.29 17.48 23 36 IL-6 0.597 28.85 31.66 25.84 24.14 21 36 IL-7 0.938 26.02 25.36 18.7 17.65 23 36 IL-8 0.544 89.83 100.79 62.96 65.8 23 36 IL-9 0.436 31.43 22.68 32.3 19.28 19 34 IP-10 0.128 426.93 552.65 243.56 399.59 23 36 MCP-1 0.828 74.55 75.09 52.21 42.68 23 36 MIP-1a 0.689 15.92 16.23 10.79 8.56 22 36 MIP-1b 0.132 69.25 80.07 32.35 29.81 23 36 PDGF 0.694 843.99 841.71 763.73 790.98 20 36 RANTES 0.779 16082.77 16775.4 13640.29 13237.25 21 36 TNF-a 0.921 153.59 153.63 131.33 120.9 21 36 VEGF 0.792 50.63 48.63 53.93 44.09 14 25

(121) TABLE-US-00008 TABLE 5B The comparison of arm 1 week 26 (Gem-Cap) with arm 3 week 26 (Gem-Cap and GV1001) plasma Mann- Arm 1 Arm 3 Arm 1 Arn 3 Whitney Arm 1 Week 26 Arm 3 Week 26 Week 26 Week 26 Week 26 Week 26 Analyte P-Value Mean (pg/ml) Mean (pg/ml) Std Dev Std Dev N= N= Eotaxin 0.826 81.89 87.81 66.34 63.55 14 27 FGF basic 0.541 151.21 135.93 93.38 90.95 13 26 G-CSF 0.688 162.99 168.96 129.63 106.37 16 27 GM-CSF 0.237 66.4 29.1 89.19 30.16 9 18 IFN-g 0.709 230.92 252.86 203.79 202.9 17 27 IL-10 0.856 46.67 46.67 38.23 43.06 16 26 IL-12 0.969 73.72 79.1 81.14 84.54 15 27 IL-13 0.933 23.96 23.15 23.11 21.23 17 27 0.03 37.57 18.24 5.09 10.76 3 7 IL-17 0.805 299.09 274.4 219.64 206.66 14 27 IL-1b 0.368 7.75 10.12 6.35 8.44 17 24 IL-1ra 0.546 448.9 317.37 445.43 306.59 16 27 IL-2 0.59 36.09 39.65 29.95 28.5 14 21 IL-4 0.691 9.13 9.61 7.91 6.6 17 27 IL-5 0.555 25.23 28.35 20.13 20.34 17 27 IL-6 0.92 31.92 32.82 24.99 25.61 16 27 IL-7 0.763 28.02 30.06 18.16 18.47 17 27 IL-8 0.638 102.04 109.65 78.4 70.9 17 27 IL-9 0.978 28.03 26.7 23.7 19.85 15 25 IP-10 0.876 431.27 495.29 234.75 332.43 17 27 MCP-1 0.507 83.53 90.7 62.11 61.04 17 27 MIP-1a 0.242 14.45 17.62 9.88 9.28 17 27 MIP-1b 0.099 65.96 80.56 33.71 27.82 17 27 PDGF 0.844 1098.88 1044.5 940.97 961.42 15 27 RANTES 0.209 13632.77 20133.86 12204.71 16974.26 16 27 TNF-a 0.706 167.63 176.14 143.56 132.79 16 27 VEGF 0.962 64.83 61.7 47.07 41.9 10 18

(122) TABLE-US-00009 TABLE 6 P values for the paired comparison of arm 1 baseline versus arm 1 week 14 and arm 3 baseline versus arm 3 week 14 (left) and arm 1 baseline versus arm 1 week 26 and arm 3 baseline versus arm 3 week 26 (right). Week 14 Paired Wilcoxon P value Week 26 Paired Wilcoxon P value Cytokine Arm 1 Arm 3 Cytokine Arm 1 Arm 3 Eotaxin 0.5771 0.0827 Eotaxin 0.625 0.498 FGF-Basic 0.4648 0.2904 FGF-Basic 0.6953 0.7285 G-CSF 0.3396 0.2758 G-CSF 0.6772 0.6477 GM-CSF 0.5703 0.6226 GM-CSF 0.8438 0.8603 IFN-g 0.4143 0.3819 IFN-g 0.3804 0.7562 IL-10 0.3804 0.4237 IL-10 0.4131 0.8596 IL-12 0.4697 0.2238 IL-12 0.8984 1 IL-13 0.6355 0.8191 IL-13 0.5186 0.9563 IL-15 0.4375 0.25 IL-15 NA 0.8203 IL-17 0.2783 0.1578 IL-17 0.8457 0.6215 IL-1b 0.4548 0.2087 IL-1b 0.5186 0.89 IL-1ra 0.3804 0.1742 IL-1ra 0.4131 0.4091 IL-2 0.2783 0.1283 IL-2 0.9219 0.5798 IL-4 0.3396 0.313 IL-4 0.791 0.6742 IL-5 0.3396 0.3819 IL-5 0.791 0.7012 IL-6 0.5693 0.4593 IL-6 0.6377 0.4749 IL-7 0.5417 0.313 IL-7 1 0.8408 IL-8 0.5417 0.3674 IL-8 0.6772 0.7841 IL-9 0.3394 0.3967 IL-9 0.8311 0.6742 IP-10 0.0942 0.4273 IP-10 0.2334 0.4749 MCP-1 0.7354 0.5812 MCP-1 0.1294 0.9854 MIP-1a 0.4143 0.2758 MIP-1a 0.791 0.7285 MIP-1b 0.0681 0.7164 MIP-1b 0.1763 0.33 PDGF 0.1099 0.5272 PDGF 0.1099 0.5217 RANTES 0.8311 0.0299 RANTES 0.8984 0.7983 TNFa 0.4143 0.2528 TNFa 0.6772 0.6477 VEFG 0.4316 0.2305 VEFG 0.7344 0.9632

(123) Further Results of Analyses

(124) FIG. 13 shows profile plots of baseline and post-treatment means of log serum cytokine data for Arm 2.

(125) FIG. 14 shows baseline and post-treatment means of log serum cytokine data for Arm 3.

(126) FIG. 15 shows a profile plot of the mean differences (post-treatment?baseline) for the cytokines in serum for each arm.

(127) Of note, The analyses revealed that 19 cytokines showed a statistically significant decrease in serum between baseline and post-treatment in Arm 2 (PDGF, IL1?, IL-1r?, IL-2, IL-4, IL-5, IL-7, IL-10, IL-12, IL-13, IL-17, G-CSF, IFN?, eotaxin, FGFb, MIP1?, RANTES, TNF?, VEGF; but not CRP, IL-6, IL-8, IL-9, IL-15, GM-CSF, IP10, MCP1, MIP1?), whereas none showed a statistically significant decrease in Arm3. This appears from FIG. 16, which provides the p-values obtained from a Wilcoxon signed-rank test used on each cytokine for each arm to test for increase/decrease in values from baseline to post-treatment. The significant differences as seen are in bold grey font. The decreases were larger in Arm2 than in Arm3, noting that there were 19 significant decreases in Arm2 but none in Arm3.

(128) FIG. 17 shows the median difference of post-treatment minus baseline levels in serum for each cytokine and for each arm of the study. Decreases are highlighted in light shadow and increases/no change are highlighted in dark shadow.

(129) FIG. 18 shows Cox proportional hazards models on baseline data for each cytokine in serum for each arm of the study. The table provides univariate analyses for the baseline data and shows hazard ratios with 95% confidence intervals and p-values. CRP, IL-1ra, IL-2, IL-10, Eotaxin and IFN? are significant (p<0.1) for Arm 2, while CRP, IL-1ra and Eotaxin are significant for Arm 3.

(130) FIGS. 19a and 19b show serum levels of CRP at baseline in Arm 2 and Arm 3. Low levels of CRP gave a median survival of 337 days for Arm 2 and a median survival of 373 days for Arm 3. Baseline CRP levels predicted median (95% CI) overall survival in Arm3 (high CRP=250 [132-451] days; low CRP=372.5 [229-517] days; p=0.0500) but not in Arm2 (high CRP=195 [140-262] days; low CRP=337 [167-366] days; p=0.2534)

(131) FIGS. 20a and 20b show levels of Eotaxin at baseline in Arm 2 and Arm 3. High levels of Eotaxin give a median survival of 300 days for Arm 2 and a median survival of 451 days for Arm 3. Baseline eotaxin levels predicted median (95% CI) overall survival in Arm3 (high eotaxin=451 [308-623]days; low eotaxin=238.5 [178-344] days; p=0.0135) but not in Arm2 (high eotaxin=299.5 [167-358] days; low eotaxin=188 [102-320] days; p=0.1138)

(132) FIG. 21a and FIG. 21b shows Proportional hazards models using dichotomized variables for the baseline data for serum CRP and serum Eotaxin combined. When variables were combined at baseline the longest overall survival was predicted by a combination of low serum levels of CRP plus high serum levels of Eotaxin in Arm 2 (median survival=337 days) and similarly for Arm 3 (median survival=450 days).

(133) FIGS. 22a and 22b show serum CRP post treatment in Arm 2 and Arm 3. Low serum levels of CRP give a median survival of 337 days for Arm 2 and a median survival of 450 days for Arm 3.

(134) FIGS. 23a and 23b show serum Eotaxin post treatment in Arm 2 and Arm 3. High levels of serum Eotaxin give a median survival of 251 days for Arm 2 and a median survival of 364 days for Arm 3.

(135) FIGS. 24a and 24b show Proportional hazards models using dichotomized variables for the post-treatment data for serum CRP and serum Eotaxin combined. When variables were combined the longest survival was predicted by a combination of low levels of CRP plus high levels of Eotaxin in Arm 2 (median survival=355 days) and similarly for Arm 3 (median survival=535 days). When variables were combined at post-treatment the longest survival was predicted by a combination of low levels of CRP plus high levels of Eotaxin in Arm 2 (median survival=355 days) and similarly for Arm 3 (median survival=535 days).

(136) Sequence Listing Free Text

(137) Biologic Sequence Data

(138) TABLE-US-00010 SEQIDNO:1;GV1001aminoacidsequence: EARPALLTSRLRFIPK SEQIDNO:2;HumanEotaxin(Eotaxin1)(CCL11 chemokine(C-Cmotif)ligand11);Protein; UniProtID:P51671;Length:97aminoacids, MW:10.732 kDa:MKVSAALLWLLLIAAAFSPQGLAGPASVPTTCCFNLANRKIPLQR LESYRRITSGKCPQKAVIFKTKLAKDICADPKKKWVQDSMKYLDQKSPTP KP SEQIDNO:3;Humaneotaxin2(CCL24);Protein; UniProtID:O00175;Length:119aminoacids, MW:13.134 kDa:MAGLMTIVTSLLFLGVCAHHIIPTGSVVIPSPCCMFFVSKRIPEN RVVSYQLSSRSTCLKAGVIFTTKKGQQFCGDPKQEWVQRYMKNLDAKQKK ASPRARAVAVKGPVQRYPGNQTTC SEQIDNO:4;Humaneotaxin3(CCL26);Protein; UniProtID:Q9Y258;Length:94aminoacids, MW:10.648 kDa:MMGLSLASAVLLASLLSLHLGTATRGSDISKTCCFQYSHKPLPWT WVRSYEFTSNSCSQRAVIFTTKRGKKVCTHPRKKWVQKYISLLKTPKQL SEQIDNO:5;HumanEotaxin(Eotaxin1)(CCL11 chemokine(C-Cmotif)ligand11);nucleicacid; NCBIGeneBankID: NM_002986.2:ATGGGCAAAGGCTTCCCTGGAATCTCCCACACTGTCT GCTCCCTATAAAAGGCAGGCAGATGGGCCAGAGGAGCAGAGAGGCTGAGA CCAACCCAGAAACCACCACCTCTCACGCCAAAGCTCACACCTTCAGCCTC CAACATGAAGGTCTCCGCAGCACTTCTGTGGCTGCTGCTCATAGCAGCTG CCTTCAGCCCCCAGGGGCTCGCTGGGCCAGCTTCTGTCCCAACCACCTGC TGCTTTAACCTGGCCAATAGGAAGATACCCCTTCAGCGACTAGAGAGCTA CAGGAGAATCACCAGTGGCAAATGTCCCCAGAAAGCTGTGATCTTCAAGA CCAAACTGGCCAAGGATATCTGTGCCGACCCCAAGAAGAAGTGGGTGCAG GATTCCATGAAGTATCTGGACCAAAAATCTCCAACTCCAAAGCCATAAAT AATCACCATTTTTGAAACCAAACCAGAGCCTGAGTGTTGCCTAATTTGTT TTCCCTTCTTACAATGCATTCTGAGGTAACCTCATTATCAGTCCAAAGGG CATGGGTTTTATTATATATATATATTTTTTTTTTTAAAAAAAAAACGTAT TGCATTTAATTTATTGAGGCTTTAAAACTTATCCTCCATGAATATCAGTT ATTTTTAAACTGTAAAGCTTTGTGCAGATTCTTTACCCCCTGGGAGCCCC AATTCGATCCCCTGTCACGTGTGGGCAATGTTCCCCCTCTCCTCTCTTCC TCCCTGGAATCTTGTAAAGGTCCTGGCAAAGATGATCAGTATGAAAATGT CATTGTTCTTGTGAACCCAAAGTGTGACTCATTAAATGGAAGTAAATGTT GTTTTAGGAATACATAAAGTATGTGCATATTTTATTATAGTCACTAGTTG TAATTTTTTTGTGGGAAATCCACACTGAGCTGAGGGGG SEQIDNO:6;Humaneotaxin2(CCL24);nucleic acid;NCBIGeneBankID: NM_002991.2:ATGGCAGGCCTGATGACCATAGTAACCAGCCTTCTGT TCCTTGGTGTCTGTGCCCACCACATCATCCCTACGGGCTCTGTGGTCATC CCCTCTCCCTGCTGCATGTTCTTTGTTTCCAAGAGAATTCCTGAGAACCG AGTGGTCAGCTACCAGCTGTCCAGCAGGAGCACATGCCTCAAGGCAGGAG TGATCTTCACCACCAAGAAGGGCCAGCAGTTCTGTGGCGACCCCAAGCAG GAGTGGGTCCAGAGGTACATGAAGAACCTGGACGCCAAGCAGAAGAAGGC TTCCCCTAGGGCCAGGGCAGTGGCTGTCAAGGGCCCTGTCCAGAGATATC CTGGCAACCAAACCACCTGCTAA SEQIDNO:7;HumanEotaxin3(CCL26);nucleic acid;NCBIGeneBankID: NM_006072.4:CTGGAATTGAGGCTGAGCCAAAGACCCCAGGGCCGTC TCAGTCTCATAAAAGGGGATCAGGCAGGAGGAGTTTGGGAGAAACCTGAG AAGGGCCTGATTTGCAGCATCATGATGGGCCTCTCCTTGGCCTCTGCTGT GCTCCTGGCCTCCCTCCTGAGTCTCCACCTTGGAACTGCCACACGTGGGA GTGACATATCCAAGACCTGCTGCTTCCAATACAGCCACAAGCCCCTTCCC TGGACCTGGGTGCGAAGCTATGAATTCACCAGTAACAGCTGCTCCCAGCG GGCTGTGATATTCACTACCAAAAGAGGCAAGAAAGTCTGTACCCATCCAA GGAAAAAATGGGTGCAAAAATACATTTCTTTACTGAAAACTCCGAAACAA TTGTGACTCAGCTGAATTTTCATCCGAGGACGCTTGGACCCCGCTCTTGG CTCTGCAGCCCTCTGGGGAGCCTGCGGAATCTTTTCTGAAGGCTACATGG ACCCGCTGGGGAGGAGAGGGTGTTTCCTCCCAGAGTTACTTTAATAAAGG TTGTTCATAGAGTTGACTTGTTCAT SEQIDNO:8;HumanCRP(C-reactiveprotein); Protein;UniProtID:Q5VVP7; Length:102aminoacids,MW:11.632 kDa:MEKLLCFLVLTSLSHAFGQTDMSRKAFVFPKESDTSYVSLKAPLT KPLKAFTVCLHFYTELSSTHEINTIYLGGPFSPNVLNWRALKYEVQGEVF TKPQLWP SEQIDNO:9;HumanCRP(C-reactiveprotein); nucleicacid;NCBIGeneBankID: AAAGAATCAGAATTTGAGGTGTTTTGTTTTCATTTTTATTTCAAGTTGGA CAGATCTTGGAGATAATTTCTTACCTCACATAGATGAGAAAACTAACACC CAGAAAGGAGAAATGATGTTATAAAAAACTCATAAGGCAAGAGCTGAGAA GGAAGCGCTGATCTTCTATTTAATTCCCCACCCATGACCCCCAGAAAGCA GGAGGGCATTGCCCACATTCACAGGGCTCTTCAGTCTCAGAATCAGGACA CTGGCCAGGTGTCTGGTTTGGGTCCAGAGTGCTCATCATCATGTCATAGA ACTGCTGGGCCCAGGTCTCCTGAAATGGGAAGCCCAGCAATACCACGCAG TCCCTCCACTTTCTCAAAGCACACTGGAAAGGCCATTAGAATTGCCCCAG CAGAGCAGATCTGCTTTTTTTCCAGAGCAAAATGAAGCACTAGGTATAAA TATGTTGTTACTGCCAAGAACTTAAATGACTGGTTTTTGTTTGCTTGCAG TGCTTTCTTAATTTTATGGCTCTTCTGGGAAACTCCTCCCCTTTTCCACA CGAACCTTGTGGGGCTGTGAATTCTTTCTTCATCCCCGCATTCCCAATAT ACCCAGGCCACAAGAGTGGACGTGAACCACAGGGTGTCCTGTCAGAGGAG CCCATCTCCCATCTCCCCAGCTCCCTATCTGGAGGATAGTTGGATAGTTA CGTGTTCCTAGCAGGACCAACTACAGTCTTCCCAAGGATTGAGTTATGGA CTTTGGGAGTGAGACATCTTCTTGCTGCTGGATTTCCAAGCTGAGAGGAC GTGAACCTGGGACCACCAGTAGCCATCTTGTTTGCCACATGGAGAGAGAC TGTGAGGACAGAAGCCAAACTGGAAGTGGAGGAGCCAAGGGATTGACAAA CAACAGAGCCTTGACCACGTGGAGTCTCTGAATCAGCCTTGTCTGGAACC AGATCTACACCTGGACTGCCCAGGTCTATAAGCCAATAAAGCCCCTGTTT ACTTGAAAAAAAAAA SEQIDNO:10;HumanMIP1? (CCL3chemokine(C-C motif)ligand3);Protein;UniProtID: P10147;Length:92aminoacids,MW:10.085 kDa:MQVSTAALAVLLCTMALCNQFSASLAADTPTACCFSYTSRQIPQN FIADYFETSSQCSKPGVIFLTKRSRQVCADPSEEWVQKYVSDLELSA SEQIDNO:11;HumanMIP1? (CCL3chemokine(C-C motif)ligand3);nucleicacid;NCBIGeneBankID: NM_002983.2:AGCTGGTTTCAGACTTCAGAAGGACACGGGCAGCAGA CAGTGGTCAGTCCTTTCTTGGCTCTGCTGACACTCGAGCCCACATTCCGT CACCTGCTCAGAATCATGCAGGTCTCCACTGCTGCCCTTGCTGTCCTCCT CTGCACCATGGCTCTCTGCAACCAGTTCTCTGCATCACTTGCTGCTGACA CGCCGACCGCCTGCTGCTTCAGCTACACCTCCCGGCAGATTCCACAGAAT TTCATAGCTGACTACTTTGAGACGAGCAGCCAGTGCTCCAAGCCCGGTGT CATCTTCCTAACCAAGCGAAGCCGGCAGGTCTGTGCTGACCCCAGTGAGG AGTGGGTCCAGAAATATGTCAGCGACCTGGAGCTGAGTGCCTGAGGGGTC CAGAAGCTTCGAGGCCCAGCGACCTCGGTGGGCCCAGTGGGGAGGAGCAG GAGCCTGAGCCTTGGGAACATGCGTGTGACCTCCACAGCTACCTCTTCTA TGGACTGGTTGTTGCCAAACAGCCACACTGTGGGACTCTTCTTAACTTAA ATTTTAATTTATTTATACTATTTAGTTTTTGTAATTTATTTTCGATTTCA CAGTGTGTTTGTGATTGTTTGCTCTGAGAGTTCCCCTGTCCCCTCCCCCT TCCCTCACACCGCGTCTGGTGACAACCGAGTGGCTGTCATCAGCCTGTGT AGGCAGTCATGGCACCAAAGCCACCAGACTGACAAATGTGTATCGGATGC TTTTGTTCAGGGCTGTGATCGGCCTGGGGAAATAATAAAGATGCTCTTTT AAAAGGTAAAAAAAAAAAAAAAAAAA