Patent Description:
Despite the rapid development of cancer therapeutic agents, cancer is still one of the diseases with a high death rate worldwide. The main cancer treatment methods conventionally used clinically are surgery, radiation treatment, and anticancer agent treatment methods, or methods of maximally removing cancer cells from patients as a treatment in parallel with the same. However, these treatments exhibit treatment effects only when cancer cells are completely removed in a state where a relatively early cancer is not metastasized, and also kill other normal cells which are rapidly dividing, and thus have a disadvantage in that various side effects may be caused. Accordingly, studies have been recently conducted on the treatment of cancer using the tumor-specific immune activity of the body as an immunotherapeutic method.

However, it is difficult to perform the immune treatment because cancer has the ability not only to cleverly evade and destroy various host immune responses, and as a result continuously maintains the survival of tumors by inducing the immunosuppressive tumor microenvironment, but also to escape from the activated anti-tumor immune response even though the immune system is activated. Accordingly, in order to enhance the immune response against cancer cells by improving the immunosuppressive tumor microenvironment, studies using cytokine genes such as IL-<NUM>, IL-<NUM>, IL-<NUM>, interferon-gamma (IFN-γ), a granulocyte-macrophage colony-stimulating factor (GM-CSF), a tumor necrosis factor-alpha (TNF-α), costimulatory factors such as B7 molecules, dendritic cells (DCs) directly serving as antigen presenting cells (APCs), T cells activated by tumor antigens, natural killer cells (NKCs), and the like have been carried out in various directions. It is known that IL-<NUM> is produced by APCs such as monocytes, macrophages, and DCs, and by directly acting on cytotoxic T-lymphocytes (CTLs) and NK cells that can effectively remove cancer cells activates them, stimulates production of IFN-γ, as well as enhances an ability to kill cancer cells by directly acting on them. In addition, IL-<NUM> plays an important role in promoting differentiation into T helper <NUM> (TH1) cells by acting on naive CD4+ lymphocytes, and thus, activating an anticancer immune response by inducing and enhancing the cell-mediated immune response which plays a pivotal role in the anticancer immune response. Further, VEGF is a signal protein produced by cells that promote angiogenesis and vascularization, and affects T cell precursors in the bone marrow to not only suppress the proliferation and maturation of T cells and dendritic cells, but also play an important function in vascularization, thereby exhibiting a side effect called cancer metastasis. Accordingly, VEGF is not only a promoter of tumor growth, but also acts as a suppressor in anticancer immunity, and VEGF downregulation by VEGF shRNA (short hairpin ribonucleic acid) is expected to restore immune responses and to increase anticancer effects. Furthermore, GM-CSF serves to strengthen the immune responses of CD4+ and CD8+ T cells by stimulating DCs to promote the differentiation of DCs into APCs, and is also involved in the expression regulation of molecules constituting major histocompatibility complex (MHC) class II in primary monocytes. In addition, it has been reported that a strong anticancer immune response is induced by inducing many APCs to gather around tumors due to the effect of expression of GM-CSF in the tumors to effectively process tumor antigens.

Based on this, our laboratory also reported an anti-tumor effect of IL-<NUM> using YKL-<NUM> [Ad-E1B55] as an E1B-55kDa gene-deleted tumor-selective oncolytic adenovirus, and also reported an anti-tumor effect of GM-CSF using an RdB adenovirus with a tumor-selective killing ability more enhanced, due to the deletion of the E1B gene and a modification in an Rb binding site of E1A. However, although the immunosuppressive tumor microenvironment is improved, there are still many limitations in completely treating cancer due to the low immunogenicity of tumors using an immunotherapeutic method.

<NPL> relates to evolution of oncolytic adenovirus for cancer treatment. <NPL>, relates to optimization of DC vaccination by combination with oncolytic adenovirus co-expressing IL-<NUM> and GM-CSF. <NPL>, discloses that relaxin-expressing fiber chimeric oncolytic adenovirus prolongs survival of tumor-bearing mice. <NPL>, relates to relaxin expression from tumor-targeting adenoviruses and its intratumoral spread, apoptosis induction, and efficacy. <CIT> discloses a gene delivery system for co-expression of IL-<NUM>, GM-CSF, and HSV-TK that contains IL(interleukin)-<NUM>-encoding nucleotide sequence, GM-CSF(granulocyte-macrophage colony-stimulating factor)-encoding nucleotide sequence, and HSV-TK(Herpes simplex virus-thymidine kinase)-encoding nucleotide sequence. <CIT> relates to a gene delivery system and recombinant adenovirus comprising the relaxin-encoding sequence to enhance transduction efficiency of transgenes, a pharmaceutical anti-tumor composition comprising the recombinant adenovirus, a pharmaceutical composition having improve tissue penetration potency and a pharmaceutical composition for treating a disease or disorder associated with accumulation of excess extracellular matrix. <NPL>, relates to defining effective combinations of immune checkpoint blockade and oncolytic virotherapy. <NPL>, discloses that oncolytic adenovirus co-expressing interleukin-<NUM> and shVEGF restores antitumor immune function and enhances antitumor efficacy.

As a result of intensive research on developing an immunotherapy for overcoming the immune surveillance evasion of tumors, the present inventors not only confirmed an excellent anticancer effect of IL-<NUM> and GM-CSF-relaxin in vivo by preparing a recombinant adenovirus simultaneously expressing them, but also confirmed that an anticancer effect of the recombinant adenovirus was improved through co-administration with an immune checkpoint inhibitor, thereby completing the present invention based on this.

Accordingly, an object of the present invention is to provide a recombinant adenovirus simultaneously expressing IL-<NUM> and GM-CSF- Relaxin.

Another object of the present invention is to provide a medicinal use of the recombinant adenovirus for the prevention or treatment of cancer.

Still another object of the present invention is to provide a medicinal use of the recombinant adenovirus for the prevention or treatment of cancer as a combined formulation with an immune checkpoint inhibitor.

However, technical problems to be achieved by the present invention are not limited to the aforementioned problems, and other problems that are not mentioned may be clearly understood by those skilled in the art from the following description.

In order to achieve the objects of the present invention as described above, the present invention provides a recombinant oncolytic adenovirus comprising a gene encoding interleukin <NUM> (IL-<NUM>); a gene encoding a granulocyte-macrophage colony-stimulating factor (GM-CSF); and a gene encoding relaxin" wherein the recombinant oncolytic adenovirus simultaneously expresses the gene encoding IL-<NUM>, the gene encoding GM-CSF, and the gene encoding relaxin.

As an embodiment of the present invention, the recombinant adenovirus may have one or more regions selected from the group consisting of the E1 and E3 regions deleted.

As another embodiment of the present invention, the gene encoding IL-<NUM> may comprise an IL-12A (p35) gene sequence, an IRES sequence, and an IL-12B (p40) gene sequence, and may be inserted into the E1 or E3 region of the recombinant adenovirus.

As still another embodiment of the present invention, the genes encoding GM-CSF and relaxin may comprise a GM-CSF gene sequence, an IRES sequence, and a relaxin gene sequence, and may be inserted into the E1 or E3 region of the recombinant adenovirus.

Further, the present invention provides a pharmaceutical composition for preventing or treating cancer, the composition including: the recombinant adenovirus; and a pharmaceutically acceptable carrier.

As an embodiment of the present invention, the composition may be co-administered with any one immune checkpoint inhibitor selected from the group consisting of a PD-<NUM> (programmed cell death protein <NUM>) antagonist, a PD-L1 (programmed cell death protein ligand <NUM>) antagonist, a PD-L2 antagonist, a CD27 (cluster of differentiation <NUM>) antagonist, a CD28 antagonist, a CD70 antagonist, a CD80 antagonist, a CD86 antagonist, a CD137 antagonist, a CD276 antagonist, a KIRs (killer-cell immunoglobulin-like receptors) antagonist, a LAG3 (lymphocyte-activation gene <NUM>) antagonist, a TNFRSF4 (tumor necrosis factor receptor superfamily, member <NUM>) antagonist, a GITR (glucocorticoid-induced TNFR-related protein) antagonist, a GITRL (GITR ligand) antagonist, a <NUM>-1BBL (<NUM>-1BB ligand) antagonist, a CTLA-<NUM> (cytotoxic T lymphocyte associated antigen <NUM>) antagonist, an A2AR (adenosine A2A receptor) antagonist, a VTCN1 (V-set domain-containing T-cell activation inhibitor <NUM>) antagonist, a BTLA (B- and T-lymphocyte attenuator) antagonist, an IDO (Indoleamine <NUM>,<NUM>-dioxygenase) antagonist, a TIM-<NUM> (T-cell immunoglobulin and mucin-domain containing-<NUM>) antagonist, a VISTA (V-domain Ig suppressor of T cell activation) antagonist, a KLRA antagonist, and a combination thereof.

As another embodiment of the present invention, the composition may enhance anti-tumor immunity.

As still another embodiment of the present invention, the cancer may be selected from the group consisting of gastric cancer, lung cancer, non-small cell lung cancer, breast cancer, ovarian cancer, liver cancer, bronchial cancer, nasopharyngeal cancer, laryngeal cancer, pancreatic cancer, bladder cancer, colon cancer, cervical cancer, bone cancer, non-small cell bone cancer, hematologic malignancy, skin cancer, head or neck cancer, uterine cancer, colorectal cancer, anal near cancer, fallopian tube cancer, endometrial cancer, vaginal cancer, vulva cancer, Hodgkin's disease, esophageal cancer, small intestine cancer, endocrine cancer, thyroid cancer, parathyroid cancer, adrenal cancer, soft tissue sarcoma, urethral cancer, penile cancer, prostate cancer, chronic or acute leukemia, lymphocytic lymphoma, kidney or hydroureter cancer, renal cell carcinoma, renal pelvic carcinoma, salivary gland cancer, sarcoma cancer, pseudomyxoma peritonei, hepatoblastoma, testicular cancer, glioblastoma, cheilocarcinoma, ovarian germ cell tumors, basal cell carcinoma, multiple myeloma, gallbladder cancer, choroidal melanoma, cancer of the ampulla of Vater, peritoneal cancer, tongue cancer, small cell cancer, pediatric lymphoma, neuroblastoma, duodenal cancer, ureteral cancer, astrocytoma, meningioma, renal pelvis cancer, pudendum cancer, thymus cancer, central nervous system tumors, primary central nervous system lymphoma, spinal cord tumors, brain stem neuroglioma, and pituitary adenoma, and the cancer may also be a recurrent cancer.

The recombinant adenovirus having IL-<NUM> and GM-CSF-Relaxin inserted therein, according to the present invention, exhibits an excellent anticancer effect by improving immune functions, and such an anticancer effect has been confirmed to be remarkably enhanced through co-administration with an immune checkpoint inhibitor, and thus the present invention may be used as a key technique in the field of cancer treatment.

The present invention provides a recombinant oncolytic adenovirus including: a gene encoding Interleukin <NUM> (IL-<NUM>); a gene encoding a granulocyte-macrophage colony-stimulating factor (GM-CSF); and a gene encoding relaxin, wherein the recombinant oncolytic adenovirus simultaneously expresses the gene encoding IL-<NUM>, the gene encoding GM-CSF, and the gene encoding relaxin.

Although an immune gene therapy for cancer has developed as a more promising approach, tumors have also created numerous strategies to avoid the immune surveillance system. In order to overcome these obstacles and enhance the effects of anticancer immunity, an oncolytic adenovirus (RdB/IL12/shVEGF Ad, RdB/IL12/GMCSF-RLX Ad) system simultaneously expressing IL-<NUM> and a vascular endothelial growth factor (VEGF) short hairpin RNA (shRNA) or IL-<NUM> and GM-CSF-Relaxin was constructed as an appropriate therapeutic adjuvant for restoring immunosuppression and increasing anticancer immunity. IL-<NUM> serves to increase anti-tumor immunity by inducing the differentiation of T helper <NUM> cells and activating the cytotoxicity of cytotoxic T lymphocytes and natural killer cells. It is known that shVEGF and GM-CSF serve to strengthen the immune response of CD4+ and CD8+ T cells by promoting the proliferation and maturation of T cells and dendritic cells and stimulating DCs to promote the differentiation of DCs into APCs, respectively, and these effects are expected to further amplify the IL-<NUM> function. Thus, the present inventors attempted immune gene therapy using a technical feature of an adenovirus simultaneously expressing IL-<NUM> and shVEGF, or IL-<NUM> and GM-CSF-Relaxin in tumors for the first time. In an example of the present invention, as a result of administering the recombinant adenovirus (RdB/IL12/GMCSF-RLX Ad) to a melanoma animal model, it was experimentally confirmed that the tumor growth inhibition rate, complete remission rate, and survival rate of mice were increased.

In addition, IL-<NUM> has drawn much attention as a core cytokine for anticancer immunotherapy, and in particular, in an anticancer immunotherapeutic method for patients with impaired immunity in the body, repeated administration of IL-<NUM> has been frequently considered in order to obtain effective therapeutic efficacy. However, the IL-<NUM> is clinically known to have the cytokine-associated toxicity in the whole body, particularly, the kidneys, and thus has a technical limitation that the IL-<NUM> has to be used as a cancer therapeutic agent within a limited dose range. Based on this technical background, the recombinant adenovirus simultaneously expressing the IL-<NUM> gene according to the present invention and additional genes as defined in the claims has another technical feature of solving the toxicity problem for normal cells due to the high dose and repeated administration of IL-<NUM>, which has been pointed out as a limitation of the anticancer immunotherapy in the related art, by inducing a high oncolytic effect even at a low viral titer.

Accordingly, the recombinant adenovirus of the present invention is characterized by including a gene encoding IL-<NUM> and including a gene encoding GM-CSF, and a gene encoding relaxin.

The "gene encoding IL-<NUM>" used in the present invention comprises an IL-12A (p35) gene sequence and an IL-12B (p40) gene sequence, and may comprise an IRES sequence between the IL-12A (p35) gene sequence and the IL-12B (p40) gene sequence for the effective translation of a viral protein. Preferably, the IL-12A (p35) gene sequence, the IL-12B (p40) gene sequence, and the IRES sequence may consist of SEQ ID No. <NUM>, SEQ ID No. <NUM>, and SEQ ID No. <NUM>, respectively, but are not limited thereto.

The "gene encoding GM-CSF" and the "gene encoding relaxin" used in the present invention comprise a GM-CSF gene sequence and a relaxin gene sequence, respectively, and may also comprise an IRES sequence between the GM-CSF gene sequence and the relaxin gene sequence. Preferably, the GM-CSF gene sequence, the relaxin gene sequence, and the IRES sequence may consist of SEQ ID No. <NUM>, SEQ ID No. <NUM>, and SEQ ID No. <NUM>, respectively, but are not limited thereto.

It is interpreted that the gene sequences also comprise a gene sequence exhibiting substantial identity or substantial similarity. The aforementioned substantial identity refers to a random sequence differing from the sequence of the present invention and having at least <NUM>% homology, more preferably <NUM>% homology, and most preferably <NUM>% homology to the sequence of the present invention, when it is aligned to correspond to the sequence of the present invention as much as possible, and the aligned sequences are analyzed using an algorithm typically used in the art. The aforementioned substantial similarity collectively refers to all of the changes in a gene sequence, such as deletion or insertion of one or more bases, which do not affect the object of the present invention of minimizing homologous recombination with a recombinant adenovirus vector. Therefore, the gene sequence of the present invention is not limited to the sequences of exemplified SEQ ID NOS. <NUM> to <NUM>, and is interpreted to be comprised in the scope of the rights of the present invention as long as the sequence does not substantially affect the activity of the final product desired in the present invention.

Meanwhile, as the recombinant adenovirus of the present invention, an oncolytic adenovirus widely known in the art may be used. In an example of the present invention, the recombinant adenovirus comprises an activated E1A gene and an inactivated E1B-<NUM> gene, an inactivated E1B-<NUM> gene, or an inactivated E1B-<NUM>/E1B-<NUM> gene. In the present specification, the term inactivation used in conjunction with a gene means that the transcription and/or translation of the gene is not normally performed, and the function of a normal protein encoded by the gene is not exhibited. For example, the inactivated E1B-<NUM> gene is a gene incapable of producing the activated E1B-19kDa protein by a modification (substitution, addition, and partial or whole deletion) in the gene. The deletion of E1B-<NUM> may increase the ability to kill cells, and the deletion of the E1B-<NUM> gene makes a recombinant adenovirus tumor-specific (see <CIT>). The term "deletion" used in conjunction with a viral genomic sequence in the present specification has a meaning including complete deletion and partial deletion of the corresponding sequence.

According to an embodiment of the present invention, the recombinant adenovirus comprises an E1A region, has an E1B region, that is, E1B-19kDa and 55kDa (E1B) deleted, and an E3 region (E3) deleted. The recombinant adenovirus including the E1A gene will have replicable characteristics. The gene encoding IL-<NUM> is inserted into the deleted E1B region of the recombinant adenovirus, and the genes encoding GM-CSF and relaxin or the gene encoding a shRNA suppressing the expression of VEGF is inserted into the E3 region. Meanwhile, the E1A site has a modification in which the Glu <NUM> residue is substituted with Gly and a modification and in which the sequence of amino acids <NUM> to <NUM> is wholly substituted with Gly, in a nucleotide sequence encoding Rb binding site located in the E1A gene sequence.

Meanwhile, viruses other than the adenovirus may also be used in the present invention. The virus which may be used in the present invention may preferably be vaccinia viruses (<NPL>)), lentiviruses (<NPL>)), or herpes simplex viruses (<NPL>)) but is not limited thereto.

The recombinant adenovirus used in the present invention comprises a promoter that is operable in animal cells, preferably mammal cells. A promoter suitable for the present invention comprises a promoter derived from a mammalian virus and a promoter derived from the genome of mammalian cells, and comprises, for example, a cytomegalovirus (CMV) promoter, a U6 promoter and an H1 promoter, a murine leukemia virus (MLV) long terminal repeat (LTR) promoter, an adenovirus early promoter, an adenovirus late promoter, a vaccina virus <NUM> promoter, an simian virus <NUM> (SV40) promoter, a Herpes simplex virus-thymidine kinase (HSV tk) promoter, an rous sarcoma virus (RSV) promoter, an elongation factor-<NUM> alpha (EF1 α) promoter, a methallothionin promoter, a β-actin promoter, a human IL-<NUM> gene promoter, a human IFN gene promoter, a human IL-<NUM> gene promoter, a human lymphotoxin gene promoter, a human GM-CSF gene promoter, an inducible promoter, a cancer cell-specific promoter [for example, a telomerase reverse transcriptase (TERT) promoter, a modified TERT promoter, a prostate-specific antigen (PSA) promoter, a prostate-specific membrane antigen (PSMA) promoter, a carcinoembryonic antigen (CEA) promoter, a Survivin promoter, an E2F promoter, a modified E2F promoter, an alpha-fetoprotein (AFP) promoter, a modified AFP promoter, an E2F-AFP hybrid promoter, and an E2F-TERT hybrid promoter], a tissue-specific promoter (for example, an albumin promoter), a human phosphoglycerate kinase (PGK) promoter, and a mouse phosphoglycerate kinase (PGK) promoter, but is not limited thereto. Most preferably, the promoter is a CMV promoter. It is preferred that in an expression construct for expressing a trans gene, a polyadenylation sequence binds downstream of the trans gene. The polyadenylation sequence comprises a bovine growth hormone terminator (<NPL>)), an SV40-derived polyadenylation sequence (<NPL>)), HIV-<NUM> polyA (<NPL>)), β-globin polyA (<NPL>)), HSV TK polyA (<NPL>)), or polyomavirus polyA (<NPL>)), but is not limited thereto.

In the recombinant adenovirus used in the present invention, the IL-<NUM> gene sequence or the GM-CSF-Relaxin gene sequence are operably linked to a promoter. As used herein, the term "operably linked" refers to a functional binding between a nucleic acid expression regulatory sequence (for example: an array of a promoter, a signal sequence, and a transcription regulating factor-binding site) and a different nucleic acid sequence, and accordingly, the regulatory sequence regulates the transcription and/or translation of the different nucleic acid sequence.

The recombinant adenovirus of the present invention may further comprise an antibiotic resistance gene and a reporter gene (for example, green fluorescence protein (GFP), luciferase and β-glucuronidase) as selective markers. The antibiotic resistance gene comprises an antibiotic resistance gene typically used in the art, for example, a gene imparting resistance to ampicillin, gentamycin, carbenicillin, chloramphenicol, streptomycin, kanamycin, geneticin, neomycin and tetracycline, and preferably, is a neomycin resistance gene. The aforementioned selective marker may be expressed even in an expression system connected by a separate promoter or an IRES(internal ribosome entry site), 2A systems (F2A system, P2A system, T2A system), and the IRES that may be used in the present invention is a regulatory sequence that is found in RNAs of some types of viruses and cells.

Another aspect of the present invention provides: a pharmaceutical composition for preventing or treating cancer, the composition including the recombinant adenovirus; and a pharmaceutically acceptable carrier; a medicinal use of the recombinant adenovirus for the prevention or treatment of cancer; and a method for treating cancer, the method including a step of administering a therapeutically effective amount of the recombinant adenovirus to an individual.

Since the pharmaceutical composition of the present invention uses the above-described recombinant adenovirus, the description of the content common between the two will be omitted in order to avoid the excessive complexity of the present specification.

As used herein the term "prevention" refers to all actions that suppress cancer (tumors) or delay the onset of the cancer (tumors) by administering the pharmaceutical composition according to the present invention.

As used herein, the term "treatment" refers to all actions that ameliorate or beneficially change symptoms for cancer (tumors) by administering the pharmaceutical composition according to the present invention.

In the present invention, "an individual" refers to a subject in need of treatment of a disease, and more specifically, refers to a mammal such as a human or a non-human primate, a rodent (a rat, a mouse, a guinea pig, and the like), a mouse, a dog, a cat, a horse, a cow, a sheep, a pig, a goat, a camel, and an antelope.

"Cancer", which is a disease to be prevented or treated by the pharmaceutical composition of the present invention, collectively refers to diseases caused by cells having aggressive characteristics in which the cells ignore normal growth limits and divide and grow, invasive characteristics to infiltrate surrounding tissues, and metastatic characteristics of spreading to other sites in the body. In the present invention, the cancer is used in the same sense as a malignant tumor, and may comprise a solid tumor and a blood borne tumor. For example, the cancer may be any one selected from the group consisting of gastric cancer, lung cancer, non-small cell lung cancer, breast cancer, ovarian cancer, liver cancer, bronchial cancer, nasopharyngeal cancer, laryngeal cancer, pancreatic cancer, bladder cancer, colon cancer, cervical cancer, bone cancer, non-small cell bone cancer, hematologic malignancy, skin cancer, head or neck cancer, uterine cancer, colorectal cancer, anal near cancer, fallopian tube cancer, endometrial cancer, vaginal cancer, vulva cancer, Hodgkin's disease, esophageal cancer, small intestine cancer, endocrine cancer, thyroid cancer, parathyroid cancer, adrenal cancer, soft tissue sarcoma, urethral cancer, penile cancer, prostate cancer, chronic or acute leukemia, lymphocytic lymphoma, kidney or hydroureter cancer, renal cell carcinoma, renal pelvic carcinoma, salivary gland cancer, sarcoma cancer, pseudomyxoma peritonei, hepatoblastoma, testicular cancer, glioblastoma, cheilocarcinoma, ovarian germ cell tumors, basal cell carcinoma, multiple myeloma, gallbladder cancer, choroidal melanoma, cancer of the ampulla of Vater, peritoneal cancer, tongue cancer, small cell cancer, pediatric lymphoma, neuroblastoma, duodenal cancer, ureteral cancer, astrocytoma, meningioma, renal pelvis cancer, pudendum cancer, thymus cancer, central nervous system (CNS) tumors, primary central nervous system lymphoma, spinal cord tumors, brain stem neuroglioma, and pituitary adenoma, and may also be a recurrent cancer, but is not limited thereto.

Meanwhile, the pharmaceutical composition of the present invention may additionally comprise an immune checkpoint inhibitor.

As used herein, the term "immune checkpoint" collectively refers to a protein involved in causing stimulating or suppressing signals of an immune response on the surface of immune cells, and cancer cells evade the surveillance network of the immune system by being manipulated such that the stimulation of the immune response and the resulting inhibition of cancer cells are not properly performed through the immune checkpoint. Preferably, the immune checkpoint protein may be a PD-<NUM> antagonist, a PD-L1 antagonist, a PD-L2 antagonist, a CD27 antagonist, a CD28 antagonist, a CD70 antagonist, a CD80 antagonist, a CD86 antagonist, a CD137 antagonist, a CD276 antagonist, a KIRs antagonist, a LAG3 antagonist, a TNFRSF4 antagonist, a GITR antagonist, a GITRL antagonist, a <NUM>-1BBL antagonist, a CTLA-<NUM> antagonist, an A2AR antagonist, a VTCN1 antagonist, a BTLA antagonist, an IDO antagonist, a TIM-<NUM> antagonist, a VISTA antagonist, a KLRA antagonist, and a combination thereof, but is not limited thereto.

The immune checkpoint inhibitor is an antagonist or antibody targeting the immune checkpoint protein, and exhibits an anticancer effect caused by an immune response by enhancing a protein which stimulates the immune response or blocking a protein which suppresses the immune response. Since the immune checkpoint inhibitor uses an immune response system which is excellent in memory ability in addition to advantages of fewer side effects such as emesis or alopecia than general cytotoxic anticancer agents and large therapeutic effects, the therapeutic effect may be sustained for a long period of time even after the administration of a drug is stopped, but the enhancement of the anticancer effect through a co-administration with the recombinant adenovirus has not been known. Thus, the present inventors attempted co-administration with an immune checkpoint inhibitor in order to enhance the anticancer effect of the recombinant adenovirus, and there is another technical feature in that there is provided a medicinal use of the recombinant adenovirus for the prevention or treatment of cancer as a co-administration formulation with the immune checkpoint inhibitor.

The pharmaceutical composition of the present invention may comprise a pharmaceutically acceptable carrier in addition to the active ingredient. In this case, the pharmaceutically acceptable carrier is typically used during the formulation, and comprises lactose, dextrose, sucrose, sorbitol, mannitol, starch, gum acacia, calcium phosphate, alginate, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidinone, cellulose, water, syrup, methylcellulose, methyl hydroxybenzoate, propyl hydroxybenzoate, talc, magnesium stearate, mineral oil, and the like, but is not limited thereto. Furthermore, the pharmaceutically acceptable carrier may further comprise a lubricant, a wetting agent, a sweetening agent, a flavoring agent, an emulsifier, a suspending agent, a preservative, and the like, in addition to the aforementioned ingredients. Suitable pharmaceutically acceptable carriers and formulations are described in detail in <NPL>).

The pharmaceutical composition of the present invention may be administered orally or parenterally (for example, intravenously, subcutaneously, intraperitoneally, or applied topically), and according to an example of the present invention, the anti-tumor immunity enhancing composition of the present invention may be preferably directly administered intratumorally. The dose varies depending on the patient's condition and body weight, severity of the disease, drug form, administration route, and duration, but may be suitably selected by those skilled in the art.

The pharmaceutical composition of the present invention is administered in a pharmaceutically effective amount. In the present invention, "pharmaceutically effective amount" means an amount sufficient to treat diseases at a reasonable benefit/risk ratio applicable to medical treatment, and an effective dosage level may be determined according to factors including type of disease of patients, the severity of disease, the activity of drugs, sensitivity to drugs, administration time, administration route, excretion rate, treatment period, and simultaneously used drugs, and other factors well known in the medical field. Another pharmaceutical composition according to the present invention may be administered as an individual therapeutic agent or in combination with other therapeutic agents, may be administered sequentially or simultaneously with therapeutic agents in the related art, and may be administered in a single dose or multiple doses. It is important to administer the composition in a minimum amount that can obtain the maximum effect without any side effects, in consideration of all the aforementioned factors, and this amount may be easily determined by those skilled in the art.

Hereinafter, preferred Examples for helping the understanding of the present invention will be suggested. However, the following Examples are provided only to more easily understand the present invention, and the contents of the present invention are not limited by the following Examples.

<NUM>- to <NUM>-week old male C57BL/<NUM> mice were purchased from Charles River Laboratories International, Inc. (Wilmington, MA) and bred in a laminar air flow cabinet under a pathogen free condition. All animal experiments were carried out under the approval of the Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC), and performed in accordance with the guidelines established by the University of Hanyang Institutional Animal Care and Use Committee.

An adenovirus (Ad), in which IL-<NUM> and GM-CSF-Relaxin or shVEGF were introduced into the E1 region and the E3 region, respectively, was manufactured as illustrated in <FIG>.

Specifically, in order to construct an Ad E1 shuttle vector expressing IL-<NUM>, a pXC1RdB/IL12 E1 shuttle vector was manufactured by excising a mouse IL-<NUM> gene from pCA14/IL12 and sub-cloning the gene into a pXC1RdB E1 shuttle vector. Further, in order to construct a shVEGF-expressing E3 shuttle vector, full-length mouse shVEGF complementary DNA was cloned by RT-PCR using total RNA obtained from bone marrow-derived active dendritic cells. The shVEGF complementary DNA (nucleotides <NUM>-<NUM> of the National Center for Biotechnology Information L15435) was manufactured using the following primer set: sense (<NUM>'-gatcccggaaggagagcagaagtcccatgttcaagagacatgggacttctgctctcctt tttttttggaaa-<NUM>'), antisense (<NUM>'-tttccaaaaaaa aaggagagcagaagtcccatgtctcttgaacatgggacttctgctctccttccgggatc-<NUM>'). The PCR product was digested with BamHI/Hind III, and then cloned in a BamHI/Hind III-treated pSP72 E3/CMV-polA Ad E3 shuttle vector, thereby manufacturing a pSP72 E3/shVEGF E3 shuttle vector. Further, a pSP72 E3/GMCSF-RLX E3 shuttle vector was manufactured by cloning GMCSF-IRES-Relaxin gene in a pSP72 E3/CMV-polA Ad E3 shuttle vector.

For homologous recombination, E. coli BJ5183 was transformed simultaneously with the pXC1RdB/IL12 E1 shuttle vector and pdE1/shVEGF or pdE1/GMCSF-RLX, thereby manufacturing pRdB/IL12/shVEGF Ad and pRdB/IL12/GMCSF-RLX Ad. All viruses were manufactured using <NUM> cells, and the purification, titration, and quality analysis of the adenovirus were carried out according to the prior art.

B16-F10 cells (<NUM> x <NUM><NUM>) were injected subcutaneously into the right flank of <NUM>- to <NUM>-week old male C57BL/<NUM> immune-competent mice. When the tumor volume reached approximately <NUM><NUM>, the mice were divided into groups with similar tumor sizes, and the oncolytic adenoviruses (RdB/IL12/shVEGF Ad; RdB/IL12/GMCSF-RLX Ad) were administered intratumorally at a concentration of <NUM> x10<NUM> VP on day <NUM>, <NUM>, and <NUM>. In addition, in order to confirm the anticancer effect according to the co-administration with an immune checkpoint inhibitor, an anti PD-L1 antibody, an anti PD-<NUM> antibody, and an anti CTLA-<NUM> antibody as immune checkpoint inhibitors were administered intraperitoneally at a concentration of <NUM>µg to the oncolytic adenovirus-administered mice on day <NUM>, <NUM>, and <NUM>, and in order to further evaluate a synergistic effect by the co-administration with the immune checkpoint inhibitor, the same experiment as described above was performed again using the oncolytic adenovirus at a dose (<NUM> x <NUM><NUM> VP) which is five times lower than that of the previous experiment using <NUM> x <NUM><NUM> VP. Meanwhile, in the present experiment, a PBS-treated group (PBS) and groups treated with the immune checkpoint inhibitor alone (anti PD-L1 antibody, anti PD-<NUM> antibody, and anti CTLA-<NUM> antibody) were used as controls.

Thereafter, an anticancer effect was evaluated using an animal model by measuring a perpendicular tumor diameter using calipers to monitor the growth of tumors every day and confirming a change in survival rate over time. Meanwhile, tumor volume was calculated using the following formula: volume = <NUM> (W)<NUM>, in which L indicates a length and W indicates a width.

On day <NUM> after a primary tumor was injected into <NUM> animal models in which melanoma was induced, a secondary tumor was reinjected (rechallenge) into successfully treated mice (on day <NUM> from the time point when the primary tumor could not be promoted). Thereafter, in the same manner as described above, an anti-tumor immune memory effect was evaluated by measuring a perpendicular tumor diameter to monitor the growth of tumors every other day and calculating an average tumor volume. In the present experiment, a group in which melanoma was induced in normal mice (Normal) was used as a control.

All data was expressed as mean ± standard error. Comparisons were made using Stat View software (Abacus Concepts, Inc. , Berkeley, CA) and the Mann-Whitney test (non-parametric rank sum test). P values equal to or less than <NUM> indicate statistically significance (*, P < <NUM>; **, P < <NUM>).

The present inventors intended to confirm the anticancer effect of the recombinant adenovirus and/or the immune checkpoint inhibitor by comparing the volume of a tumor injected into melanoma mice, the presence of complete remission, and the survival rate of the mice.

As a result, it was confirmed that in the control treated with PBS or the anti PD-L1 antibody, tumors had proliferated rapidly enough for the tumor volume to reach <NUM>,<NUM><NUM> or more on day <NUM> or <NUM>, respectively, thereby exhibiting aggressive tumor growth, whereas in the group treated with RdB/IL12/shVEGF Ad or RdB/IL12/GMCSF-RLX Ad, as a result of comparison with the PBS-treated group on day <NUM>, tumor growth was suppressed by <NUM>% or <NUM>% (<FIG> and <FIG>), respectively. Furthermore, when the adenovirus and the anti PD-L1 antibody were co-administered (RdB/IL12/shVEGF Ad+PD-L1, RdB/IL12/GMCSF-RLX Ad+PD-L1), the tumor volume was more remarkably decreased than that of the group treated with the adenovirus or the anti PD-L1 antibody alone, in the same manner as described above. Although an anticancer effect similar to that of the group treated with the adenovirus alone (RdB/IL12/shVEGF Ad, RdB/IL12/GMCSF-RLX Ad) was exhibited until day <NUM>, from the time when one month had passed, the growth of tumors was continuously suppressed in the group to which the anti PD-L1 antibody was co-administered, whereas in the group treated with the adenovirus alone, the growth of tumors was increased over time, so that a significant difference in tumor volume could be confirmed between the group treated with the adenovirus alone and the group to the adenovirus and the antibody were co-administered (<FIG> and <FIG>). In addition, it could be seen that on day <NUM>, in the control treated with PBS or the anti PD-L1 antibody, complete remission could not be confirmed, whereas in the RdB/IL12/shVEGF Ad or RdB/IL12/GMCSF-RLX Ad group, the survival rates were <NUM>% (<NUM>/<NUM>) and <NUM>% (<NUM>/<NUM>), respectively, and when the adenovirus and the anti PD-L1 antibody were co-administered, the survival rates were <NUM>% (<NUM>/<NUM>) and <NUM>% (<NUM>/<NUM>) which is complete remission. Furthermore, it was confirmed that all the mice in the RdB/IL12/shVEGF Ad+PD-L1 or RdB/IL12/GMCSF-RLX Ad+PD-L1 group survived until day <NUM> or day <NUM>, respectively, whereas at the same time point, the RdB/IL12/shVEGF Ad or RdB/IL12/GMCSF-RLX Ad group exhibited a survival rate of <NUM>% (<NUM>/<NUM>), and all the mice in the control were killed by tumors (<FIG> and <FIG>). These results mean that the anticancer effect by treatment with the immune checkpoint inhibitor anti PD-L1 antibody alone was relatively insignificant, whereas RdB/IL12/shVEGF Ad or RdB/IL12/GMCSF-RLX Ad exhibited an excellent anticancer effect, and the anticancer effect of the recombinant adenovirus is further enhanced when co-administered with the anti PD-L1 antibody.

The present inventors compared the anticancer effects between only administration of the recombinant adenovirus and the co-administration of the recombinant adenovirus and the immune checkpoint inhibitor using the oncolytic adenovirus at a dose (<NUM> x <NUM><NUM> VP) which is five times lower than that of the previous experiment using <NUM> x <NUM><NUM> VP, in order to evaluate the synergistic effect by the co-administration with the immune checkpoint inhibitor in more detail. Further, based on the results, when the anti PD-L1 antibody, the anti PD-<NUM> antibody, or the anti CTLA-<NUM> antibody was used as the immune checkpoint inhibitor, the anticancer effects of these antibodies were compared, and in the present experiment, RdB/IL12/GMCSF-RLX Ad was used as the recombinant adenovirus.

As a result, on day <NUM>, as a result of comparison with the tumor volume of the PBS-treated group, the tumor growth suppression rate of the RdB/IL12/shVEGF Ad group was <NUM>%, but the tumor growth suppression rate was increased to <NUM>% by the co-administration with the anti PD-<NUM> antibody, and the tumor growth suppression rate of the RdB/IL12/GMCSF-RLX Ad group (<NUM>%) was also greatly increased to <NUM>% by the co-administration with the anti PD-<NUM> antibody (<FIG> and <FIG>). In addition, only <NUM>% (<NUM>/<NUM>) of the RdB/IL12/shVEGF Ad group underwent complete remission, but in the RdB/IL12/shVEGF Ad+PD-<NUM> group, the complete remission rate was <NUM>% (<NUM>/<NUM>), which is greatly increased.

Meanwhile, in order to confirm whether other types of recombinant adenoviruses also exhibited the synergistic effect by the co-administration with the immune checkpoint inhibitor, HmT-Rd19-K35/IL21 Ad, RdB/GMCSF/shVEGF Ad, or YKL-<NUM>/GMCSF/B7. <NUM> Ad and the anti PD-<NUM> antibody were co-administered, and then the anticancer effects thereof were confirmed. As a result, as illustrated in <FIG>, the fact was that in most of the recombinant adenoviruses, the tumor volume was decreased to some degree through the co-administration of the anti PD-<NUM> antibody, but most of the recombinant adenoviruses failed to exhibit a remarkable effect as much as the recombinant adenovirus of the present invention (RdB/IL12/GMCSF-RLX Ad) did, and in particular, the effect of YKL-<NUM>/GMCSF/B7. <NUM> Ad on the whole was not excellent as compared to that of the group treated with the anti PD-<NUM> antibody alone. From these results, it can be seen that the synergistic effect by the co-administration with the immune checkpoint inhibitor is not applicable to all recombinant adenoviruses, and is a unique effect of the recombinant adenovirus of the present invention.

Further, it was confirmed that as a result of confirming the anticancer effect by the type of immune checkpoint inhibitor, the control mice treated with PBS, the anti PD-L1 antibody, the anti PD-<NUM> antibody, or the anti CTLA-<NUM> antibody had proliferated rapidly enough for the tumor volume to reach <NUM>,<NUM><NUM> or more on day <NUM>, <NUM>, <NUM>, or <NUM>, respectively, thereby exhibiting aggressive tumor growth, whereas in the case of the groups treated with RdB/IL12/GMCSF-RLX Ad+anti PD-L1 antibody, RdB/IL12/GMCSF-RLX Ad+anti PD-<NUM> antibody, and RdB/IL12/GMCSF-RLX Ad+ anti CTLA-<NUM> antibody, on day <NUM>, as a result of comparison with the PBS-treated group, tumor growth was greatly suppressed by <NUM>%, <NUM>%, or <NUM>%, respectively (<FIG>, <FIG>, and <FIG>). In addition, on day <NUM>, in the RdB/IL12/GMCSF-RLX Ad group, the complete remission rate was <NUM>% (<NUM>/<NUM>), whereas when the anti PD-L1 antibody, the anti PD-<NUM> antibody, or the anti CTLA-<NUM> antibody was co-administered, the complete remission rate was <NUM>% (<NUM>/<NUM>), <NUM>% (<NUM>/<NUM>), and <NUM>% (<NUM>/<NUM>), respectively, which are increased. Furthermore, mice treated with RdB/IL12/GMCSF-RLX Ad+anti PD-L1 antibody, RdB/IL12/GMCSF-RLX Ad+anti PD-<NUM> antibody, and RdB/IL12/GMCSF-RLX Ad+anti CTLA-<NUM> antibody survived until day <NUM>, day <NUM>, or day <NUM>, respectively, whereas at the same time points, the RdB/IL12/GMCSF-RLX Ad group exhibited a survival rate of <NUM>% (<NUM>/<NUM>), <NUM> (<NUM>/<NUM>), and <NUM>% (<NUM>/<NUM>), respectively (<FIG>, <FIG>, and <FIG>). These results show that even when not only the anti PD-L1 antibody, but also the anti PD-<NUM> antibody, or the anti CTLA-<NUM> antibody are used, the anticancer effect of the recombinant adenovirus is enhanced, however, it could be seen that when the anti PD-L1 antibody or the anti PD-L1 antibody was co-administered, the anticancer effect-associated synergistic effect of RdB/IL12/GMCSF-RLX Ad was more predominant than that when the anti CTLA-<NUM> antibody was co-administered.

The present inventors intended to confirm an immune memory effect and an anticancer effect against a recurrent cancer according to the recombinant adenovirus of the present disclosure, or the co-administration of the recombinant adenovirus and the immune checkpoint inhibitor by comparing the volume of secondary tumors injected into melanoma mice, and the like.

As a result, it could be confirmed that in the RdB/IL12/shVEGF Ad group, the growth of secondary tumors was markedly inhibited (<FIG>), and particularly, the growth of secondary tumors was more remarkably inhibited by the co-administration with the immune checkpoint inhibitor anti PD-<NUM> antibody (<FIG>). These results mean that the RdB/IL12/shVEGF Ad group may prevent the recurrence of tumors in advance through the effect of enhancing the anti-tumor immune response by immune memory, suggesting that the effect may be enhanced by the co-administration with the immune checkpoint inhibitor as with the above-described anticancer effect.

In order to verify the anticancer effect according to the co-expression of IL-<NUM>, GM-CSF, and relaxin (RLX) genes, RdB/IL12/GMCSF-RLX Ad, which is an adenovirus in which the IL-<NUM> gene was inserted into the E1 region of an adenovirus and GM-CSF and relaxin genes were inserted into the E3 region of the adenovirus, was manufactured as described above. The RdB/IL12/GMCSF-RLX Ad is a cancer cell-specific oncolytic adenovirus in which an E1B gene as an initial gene of an adenovirus was deleted and an E1A gene was modified, and the expression level of IL-<NUM>, GM-CSF, or RLX by the manufactured adenovirus was confirmed. Specifically, a Syrian hamster pancreatic cancer cell line (Hap-T1) was infected with RdB/IL12/GMCSF-RLX at a multiplicity of infection (MOI) of <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>, and <NUM> hours later, the media thereof were collected. Thereafter, the expression levels of IL-<NUM> and GM-CSF were confirmed through enzyme-linked immunosorbent assay (ELISA), and the expression level of relaxin was confirmed through a reverse transcription polymerase chain reaction (RT-PCR).

As a result, as illustrated in <FIG>, the expression level of IL-<NUM>, GM-CSF, or relaxin was increased dependently on the MOI of the adenovirus, so that the co-expression of the genes could be experimentally confirmed.

In order to verify the enhancement of the anticancer effect by the co-administration of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, <NUM> x <NUM><NUM> viral particles (VP)/<NUM>µl of RdB/IL12/GMCSF-RLX Ad was administered intratumorally to a Syrian hamster tumor animal model induced by subcutaneously injecting a HaP-T1 pancreatic cancer cell line, and along with this, <NUM>/kg of αPD-<NUM> was administered intraperitoneally, and then the resulting change in volume of tumors was observed. Meanwhile, an RdB/IL12/GMCSF-RLX Ad only administration group was used as a comparative group.

As a result, as illustrated in <FIG>, in the tumor tissue to which RdB/IL12/GMCSF-RLX Ad was administered alone, tumors grew continuously, so that on day <NUM> after the first administration of the virus, the tumor volume reached <NUM> ± <NUM><NUM>, whereas in the co-administration group of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, the growth of tumors was suppressed until day <NUM> after the first administration of the virus, thereby suppressing the growth of tumors to a level of about <NUM>% as compared to the single administration group. Further, in the co-administration group of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, the complete remission rate of tumors was about <NUM>%, but in the RdB/IL12/GMCSF-RLX Ad only administration group, the complete remission was not observed at all (not illustrated). That is, these results suggest that the anticancer therapeutic efficacy of RdB/IL12/GMCSF-RLX Ad is remarkably improved by the co-administration with αPD-<NUM>.

In order to specifically confirm the change in tumor tissues by the co-administration of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, after <NUM> x <NUM><NUM> VP of RdB/IL12/GMCSF-RLX Ad and <NUM>/kg of αPD-<NUM> were co-administered as described above, the collected tumor tissues were immunohistologically evaluated. Meanwhile, an αPD-<NUM> or RdB/IL12/GMCSF-RLX Ad only administration group and a PBS administration group were used as a comparative group and a control, respectively.

As a result, as illustrated in <FIG>, it could be confirmed that in the tumor tissue to which PBS was administered, a necrosis site was hardly confirmed, whereas most of the tumor tissues to which RdB/IL12/GMCSF-RLX Ad and αPD-<NUM> were co-administered became necrotic. Further, the effect by the co-administration, that is, the remarkably low proliferation of tumor cells (PCNA) and the increased cell necrosis (TUNEL) were very remarkable as compared to the case where αPD-<NUM> or RdB/IL12/GMCSF-RLX Ad was administered alone.

In order to evaluate whether the infiltration and activation of T cells in tumor tissues could be induced as the infiltration of αPD-<NUM> in tumor tissues was increased by RdB/IL12/GMCSF-RLX Ad, a change in population of interferon (IFN)-γ-expressing CD4+ or CD8+ T cells was evaluated in the infiltrated lymphocytes in the draining lymph node (DLN) and tumor tissues. As a result, as illustrated in <FIG>, in the RdB/IL12/GMCSF-RLX Ad or αPD-<NUM> only administration group and the co-administration group of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, the population of IFN-γ-expressing CD4+ and CD8+ T cells was observed at a high level as compared to the PBS or αPD-<NUM> only administration group (P < <NUM> or P < <NUM>). In particular, it could be confirmed that in the co-administration group of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, the population of IFN-γ-expressing CD4+ and CD8+ T cells was also significantly increased as compared to the group to which RdB/IL12/GMCSF-RLX Ad or αPD-<NUM> was administered alone (P < <NUM>), and this result indicates that the co-administration of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM> induces the infiltration and activation of interferon (IFN)-γ-expressing CD4+ or CD8+ T cells in tumors.

In addition, in order to evaluate the expression level of IFN-γ in the tumor tissue to which the adenovirus was administered, tumor tissues were extracted from mice to which the adenovirus and the like were administered and finely ground, and then an IFN-γ ELISA analysis was carried out. As a result, as illustrated in <FIG>, it could be confirmed that when PBS or αPD-<NUM> was administered intratumorally alone, IFN-γ was not detected at all, and in the RdB/IL12/GMCSF-RLX Ad only administration group, only <NUM> pg/mg of IFN-γ per <NUM> of the tumor tissue was detected, whereas in the co-administration group of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM>, <NUM> pg/mg of IFN-γ per <NUM> of the tumor tissue was detected. That is, it was revealed that the aforementioned co-administration increased the activity of immune cells by increasing the expression of IFN-γ in tumors, and ultimately, contributed to the enhancement of the anticancer effect.

In order to evaluate whether the co-administration of RdB/IL12/GMCSF-RLX Ad and αPD-<NUM> could exhibit effective therapeutic efficacy under a condition of resistance to the immune checkpoint inhibitor, the effect of the co-administration to tumors pre-treated with αPD-<NUM> on suppression of the growth of tumors was evaluated. Specifically, when the growth of tumors was not effectively suppressed by the administration of αPD-<NUM> alone (on day <NUM> after the first treatment of the antibody), RdB/IL12/GMCSF-RLX Ad was administered four times in total at an interval of <NUM> days. Meanwhile, an αPD-<NUM> only administration group was used as a comparative group.

As a result, as illustrated in <FIG>, the administration of RdB/IL12/GMCSF-RLX Ad initiated when the tumor volume reached <NUM> ± <NUM><NUM> effectively suppressed the growth of tumors for <NUM> days from the first day of the administration. Interestingly, the αPD-<NUM> only administration group exhibited a rapid increase in tumor growth rate, and thus failed to suppress the growth of tumors, whereas the co-administration group continuously suppressed the growth of tumors even during the aforementioned period. Further, as a result of comparing a change in tumor volume (on day <NUM> after the administration), the effect of suppressing the growth in the co-administration group was the most remarkable. That is, the aforementioned co-administration exhibited effective anticancer therapeutic efficacy even under a condition of resistance to the immune checkpoint inhibitor. Accordingly, it is suggested that the aforementioned co-administration may become a therapy beneficial to a patient having tolerance to an immune checkpoint inhibitor single therapy.

It was predicted that the expression of RLX in tumor tissues would exhibit synergistic anticancer therapeutic efficacy by promoting the intratumoral infiltration of αPD-<NUM>. Accordingly, it was intended to evaluate whether RdB/IL12/GMCSF-RLX Ad increased the intratumoral infiltration of αPD-<NUM> into a desmoplastic pancreatic tumor tissue. RdB/IL12/GMCSF-RLX Ad was directly administered to tumor tissues on day <NUM> or day <NUM>, αPD-<NUM> was administered intraperitoneally on day <NUM> (c: RdB/IL12/GMCSF-RLX + Alexa <NUM>-anti PD-<NUM>), and an Alexa <NUM>-conjugated αPD-<NUM> only administration group (b; Alexa <NUM>-anti PD-<NUM>) and a PBS only administration group (a; PBS) were used as a comparative group and a control, respectively. The tumor tissue treated as described above was collected on day <NUM>, and the accumulation of Alexa <NUM>-αPD-<NUM> in the tumor tissue was quantified through an immunofluorescence analysis. As a result of quantifying the accumulation of Alexa <NUM>-αPD-<NUM> per tissue area, as illustrated in <FIG>, the PBS only administration group or αPD-<NUM> only administration group exhibited <NUM> ± <NUM> A. /µm<NUM> or <NUM> ± <NUM> A. /µm<NUM>, respectively, whereas the co-administration group exhibited <NUM> ± <NUM> A. From the result, it could be seen that RdB/IL12/GMCSF-RLX Ad remarkably improved the infiltration of αPD-<NUM> into tumor tissues and contributed to the improvement of localization of αPD-<NUM> in tumor tissues. Furthermore, in order to confirm whether the Alexa <NUM>-αPD-<NUM> was located at the expression site of CD4+ or CD8+ T cells, with respect to each tumor tissue to which PBS (a: PBS) or Alexa <NUM>-conjugated αPD-<NUM> (b: Alexa <NUM>- anti PD-<NUM>) are administered alone or RdB/IL12/GMCSF-RLX Ad and Alexa <NUM>-conjugated αPD-<NUM> were co-administered (c: RdB/IL12/GMCSF-RLX + Alexa <NUM>- anti PD-<NUM>), immunostaining was carried out on CD4+ CD8+. As a result, as illustrated in <FIG>, in the co-administration group, the co-localization of αPD-<NUM> and CD4+ or CD8+ T cells were observed at a higher level than in the Alexa <NUM>-αPD-<NUM> only administration group.

Claim 1:
A recombinant oncolytic adenovirus comprising: a gene encoding Interleukin <NUM> (IL-<NUM>); a gene encoding a granulocyte-macrophage colony-stimulating factor (GM-CSF); and a gene encoding relaxin, wherein the recombinant oncolytic adenovirus simultaneously expresses the gene encoding IL-<NUM>, the gene encoding GM-CSF, and the gene encoding relaxin.