Patent Application
20050227929
The present invention relates to therapeutic combinations and methods for use thereof for treatment or prevention of neoplasia disorders.
More than 1.2 million Americans develop cancer each year, making cancer the second leading cause of death in the United States. In 2000, cancer accounted for 23% of all deaths in the United States. U.S. Dept. of Health and Human Services, National Center for Health Statistics, National Vital Statistics Report, Vol. 50, No. 16 (2002). Consequently, novel treatment therapies are needed to counter the growing threat of cancer.
Cancer is a disorder arising from one or more genetic mutations that ultimately give rise to development of neoplasia. It is known that exposure of a cell to carcinogens, such as certain viruses, chemicals and radiation, can lead to DNA alteration that either inactivates a “suppressive” gene or activates an “oncogene”.
“Suppressive” genes are growth regulatory genes, which upon mutation can no longer control cell growth. “Oncogenes” are initially normal genes (protooncogenes) that by mutation or altered context of expression become transforming genes. The protein products of transforming genes cause inappropriate cell growth. This occurs through activation of several intracellular signaling pathways, including the protein kinase C/mitogen-activated protein kinase (PKC/MAPK) pathway and the Ras/Raf/MEK 1/2/ERK ½ pathway. Transformed cells differ from normal cells in many ways, including cell morphology, cell-to-cell interactions, membrane content, cytoskeletal structure, protein secretion, gene expression and loss of apoptosis.
Oncogene transformed cells and cells that have lost suppressive gene regulation undergo uncontrolled proliferation, modified control of apoptosis, and initiation of angiogenesis. All three of these effects are characteristic for development of neoplasia and neoplasms.
Neoplasia is an abnormal, unregulated and disorganized proliferation of cell growth that is distinguished from normal cells by autonomous growth and somatic mutations. As neoplastic cells grow and divide they pass on their genetic mutations and proliferative characteristics to progeny cells. A neoplasm, or tumor, is an accumulation of neoplastic cells. A neoplasm can be benign or malignant.
Although several advances have been made in detection and therapy of cancer, no universally successful method for prevention or treatment is currently available. Cancer therapy currently relies on a combination of early diagnosis and aggressive treatment, which can include surgery, chemotherapy, radiation therapy and/or hormone therapy.
Surgery involves bulk removal of neoplasms. While surgery is sometimes effective in removing tumors located at certain sites, for example in the breast, colon or skin, it cannot be used in treatment of tumors located in other areas, such as the backbone, nor in treatment of disseminated neoplastic conditions such as leukemia. Moreover, surgical treatments are generally successful only if the cancer is detected at an early stage and before the cancer has metastasized to major organs, thus making surgery non-feasible.
Chemotherapy involves disruption of cell replication and/or cell metabolism. It is used most often in treatment of breast, lung and testicular cancer. The adverse effects of systemic chemotherapy used in treatment of neoplastic disease is problematic for patients undergoing cancer treatment. Of these adverse effects nausea and vomiting are the most common and severe side effects. Other adverse side effects include cytopenia, infection, cachexia, mucositis in patients receiving high doses of chemotherapy with bone marrow rescue or radiation therapy, alopecia (hair loss), cutaneous complications including pruritus, urticaria and angioedema, and neurological, pulmonary, cardiac, reproductive and endocrine complications. See Abeloff et al. (1992) Alopecia and Cutaneous Complications, in Abeloff et al. (ed.) Clinical Oncology, pp. 755-756. New York: Churchill Livingston.
The adverse side effects induced by chemotherapeutic agents and radiation therapy have become of major importance to the clinical management of cancer patients.
Chemotherapy-induced side effects significantly impact quality of life of the patient and can dramatically influence patient compliance with treatment. Additionally, adverse side effects associated with chemotherapeutic agents are generally the major dose-limiting toxicity (DLT) in the administration of these drugs. For example, mucositis is a major DLT for several anticancer agents, including the antimetabolite cytotoxic agents 5-FU (5-fluorouracil), methotrexate and antitumor antibiotics such as doxorubicin. Many of these chemotherapy-induced side effects, if severe, can lead to hospitalization, or require treatment with analgesics for management of pain.
Likewise, radiation therapy is not without side effects such as nausea, fatigue and fever.
Novel cancer treatment strategies that eliminate need for surgical intervention and/or reduce chemotherapy-induced or radiation-induced side effects would, therefore, benefit many cancer sufferers.
Due to the high incidence and high mortality rate associated with cancer, a wealth of research is going on in this field. Of particular interest is the recent discovery that use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with prevention and treatment of several types of cancer. Thun et al. (2002) J. National Cancer Inst. 94(4), 252-266. Historically, physicians have treated inflammation-related disorders with a regimen of NSAIDs such as, for example, aspirin and ibuprofen. Undesirably, however, some NSAIDs are known to cause gastrointestinal (GI) bleeding or ulcers in patients undergoing consistent long term regimens of NSAID therapy. Henry et al. (1991) Lancet 337, 730.
A reduction of unwanted side effects of common NSAIDs was made possible by the discovery that two cyclooxygenases are involved in transformation of arachidonic acid as the first step in the prostaglandin synthesis pathway. These enzymes exist in two forms and have been termed cyclooxygenase-1 (Cox-1) and cyclooxygenase-2 (Cox-2). Needleman et al. (1997) J. Rheumatol. 24, Suppl. 49, 6-8.
Cox-1 is a constitutive enzyme responsible for biosynthesis of prostaglandins in the gastric mucosa and in the kidney. Cox-2 is an enzyme that is produced by an inducible gene that is responsible for biosynthesis of prostaglandins in inflammatory cells. Inflammation causes induction of Cox-2, leading to release of prostanoids (prostaglandin E2), which sensitize peripheral nociceptor terminals and produce localized pain hypersensitivity, inflammation and edema. Samad et al. (2001) Nature 410(6827), 471-475.
Many common NSAIDs are now known to be inhibitors of both Cox-1 and Cox-2. Accordingly, when administered in sufficiently high levels, these NSAIDs not only alleviate the inflammatory consequences of Cox-2 activity, but also inhibit the beneficial gastric maintenance activities of Cox-1.
Research into the area of arachidonic acid metabolism has resulted in the discovery of compounds that selectively inhibit the Cox-2 enzyme to a greater extent than they inhibit Cox-1. These Cox-2 selective inhibitors are believed to offer advantages that include the capacity to prevent or reduce inflammation while avoiding harmful side effects associated with the inhibition of Cox-1. Thus, Cox-2 selective inhibitors have shown great promise for use in therapies, especially in therapies that require maintenance administration, such as for pain and inflammation control.
Of particular importance for the present invention is that overexpression of Cox-2 has been documented in several premalignant and malignant tissues. Subbaramaiah & Dannenberg (2003) Trends Pharmacol. Sci. 24, 96-102. This increase in expression is thought to be a product of stimulation of PKC signaling, which stimulates activity of MAPK, enhancing transcription of Cox-2 by nuclear factors. Additionally, enhanced stability of Cox-2 mRNA transcripts in cancer cells due to augmented binding of the RNA-binding protein HuR, as well as activation of extracellular signal related kinase 1/2 (ERK 1/2) and p38, contributes to increased expression of Cox-2. Id.
Recently, several new chemotherapeutic agents have been reported to be efficacious in treating or preventing neoplasia-related disorders. Nevertheless, even with the multitude of chemotherapeutic agents that are now available or in clinical trials, neoplasia is still a disorder that defies most attempts at eradication. At best, remission of an existing neoplasia disorder is the only available prognosis. In addition, conventional chemotherapeutic agents have the marked disadvantage of causing a wide array of debilitating side effects.
From the foregoing, it can be seen that a need exists for improved methods and therapeutic compositions to treat neoplasia and neoplasia-related disorders. It would also be useful to provide an improved method and composition for reducing the symptoms associated with neoplasia. Likewise, methods and compositions that improve patient outcomes following radiation and chemotherapy treatment regimens for neoplasms would also be desirable. Also, methods and compositions that reduce dosages or reduce unwanted side effects in conventional treatments for neoplasia or neoplasia-related disorders are desirable. Finally, methods and compositions that improve the efficacy of treating neoplasia or a neoplasia-related disorder that is considered resistant or intractable to known methods of therapy alone would also be desirable.
Combination therapies comprising a Cox-2 inhibitor and an antineoplastic agent for treatment or prevention of neoplasia are disclosed in U.S. Pat. No. 5,972,986, incorporated herein in its entirety by reference.
Combination therapies comprising a Cox-2 inhibitor and an antineoplastic agent for treatment or prevention of angiogenic disorders are disclosed in U.S. Pat. No. 6,025,353, incorporated herein in its entirety by reference.
Combination therapies comprising a substituted benzopyran derivative Cox-2 inhibitor and an antineoplastic agent for treatment of neoplasia are disclosed in U.S. Pat. No. 6,034,256, incorporated herein in its entirety by reference.
Combination therapies comprising a Cox-2 inhibitor and an antineoplastic agent for treatment or prevention of neoplasia are disclosed in International Patent Publication No. WO 00/38730, incorporated herein in its entirety by reference.
Briefly, the present invention is directed to a combination comprising a Cox-2 inhibitor and an antineoplastic agent selected from a group defined hereinbelow, in amounts effective when used in combination therapy for treatment or prevention of neoplasia or a neoplasia-related disorder.
The invention is also directed to a method for treating or preventing neoplasia or a neoplasia-related disorder in a subject, the method comprising administering in combination therapy to the subject a Cox-2 inhibitor and an antineoplastic agent selected from a group defined hereinbelow, in amounts effective when used in said combination therapy for treatment or prevention of the neoplasia or neoplasia-related disorder.
The present invention is further directed to a method for treating or preventing a pathological condition or physiological disorder characterized by or associated with neoplasia in a subject that is in need of such prevention or treatment, the method comprising administering to the subject a Cox-2 inhibitor in combination with an antineoplastic agent selected from a group defined hereinbelow.
An “antineoplastic agent” herein can be an agent administrable to a subject by any method or route known in the art for treatment or prevention of neoplasia, a neoplasia-related disorder, or a pathological condition or physiological disorder characterized by or associated with neoplasia. Such an agent can illustratively be an antineoplastic (including anti-angiogenic) drug, an adjunctive agent, an immunotherapeutic agent, a vaccine or a radiotherapeutic agent, and can be administrable by means of a pharmaceutical dosage form or otherwise.
The invention is still further directed to a kit comprising a first dosage form that comprises a Cox-2 inhibitor in a first amount and a second dosage form that comprises an antineoplastic agent, selected from a group defined hereinbelow, in a second amount; wherein said antineoplastic agent is administrable in a dosage form; and wherein said first and second amounts are effective when used in combination therapy for treating or preventing neoplasia or a neoplasia-related disorder.
The invention is yet further directed to a pharmaceutical composition comprising a combination as defined herein.
In all of the above embodiments, the antineoplastic agent can be selected from agents listed in Tables 3-17 herein, and more particularly from the group consisting of:
Among several advantages found to be achieved by the present invention, therefore, may be noted the provision, in certain embodiments, of combinations, methods, kits and compositions that are directed to preventing or treating neoplasia, for example cancers such as colon cancer, lung cancer, prostate cancer and breast cancer, in a subject that is in need of such prevention or treatment. Also provided in certain embodiments are improved combinations, methods, kits and compositions for reducing symptoms, including inflammation and pain, associated with neoplasia. Further, according to certain embodiments, combinations, methods, kits and compositions are provided that improve patient outcomes following radiation and chemotherapy treatment regimens for neoplasms and acute neoplasia episodes. Still further, according to certain embodiments, combinations, methods, kits and compositions are provided that reduce dosages or reduce unwanted side effects in conventional treatments for neoplasia or neoplasia-related disorders. Still further, according to certain embodiments, combinations, methods, kits and compositions are provided that improve the efficacy of treating neoplasia or a neoplasia-related disorder that is considered resistant or intractable to known methods of therapy alone.
In some embodiments, administration of a Cox-2 inhibitor in combination with an antineoplastic agent as described herein for prevention or treatment of neoplasia or a neoplasia-related disorder can be unexpectedly superior to the use of either agent alone. Therefore, according to such embodiments, treatment or prevention of neoplasia can be accomplished by administering to a subject suffering from or needing prevention of neoplasia or a neoplasia-related disorder a combination therapy comprising a Cox-2 inhibitor and an antineoplastic agent as described herein.
In certain of such embodiments, the dosage amount of one or both components of the combination can be reduced without sacrificing therapeutic efficacy. Use of low doses of certain antineoplastic agents can reduce incidence and/or severity of undesirable side effects.
Moreover, in certain of such embodiments, a combination therapy demonstrates synergistic efficacy for treating and preventing neoplasia or a neoplasia-related disorder, wherein the efficacy is greater than would be expected from simply combining the two component monotherapies.
As used herein, the term “neoplasia” refers to new cell growth that results from a loss of responsiveness to normal growth controls, e.g., “neoplastic” cell growth. For purposes of the present invention, cancer is one subtype of neoplasia. As used herein, the term “neoplasia-related disorder” encompasses neoplasia, but also encompasses other cellular abnormalities, such as hyperplasia, metaplasia and dysplasia. The terms neoplasia, metaplasia, dysplasia and hyperplasia collectively refer generally to cells experiencing abnormal cell growth.
Both neoplasia and neoplasia-related disorders can involve a neoplasm or tumor, which can be benign, premalignant, metastatic or malignant. The present invention thus encompasses methods and compositions useful for treating or preventing benign, premalignant, metastatic and malignant neoplasias, and benign, premalignant, metastatic and malignant tumors. Tumors are generally known in the art to be formed from a mass of neoplastic cells. It is to be understood, however, that even one neoplastic cell is considered, for purposes of the present invention, to be a neoplasm or alternatively, neoplasia.
The phrase “combination therapy” or “co-therapy” describes administration of two or more therapeutic agents, in the present instance a Cox-2 inhibitor and an antineoplastic agent, as part of a treatment regimen intended to provide a beneficial effect from co-action of these therapeutic agents. Such beneficial effect of the combination includes, but is not limited to, pharmacokinetic or pharmacodynamic co-action.
Combination therapy generally does not encompass administration of two or more therapeutic agents as part of separate monotherapy regimens that are incidental to one another.
Combination therapy embraces administration of therapeutic agents in a sequential manner, that is, wherein each therapeutic agent is administered at a different time. Sequential administration can occur within any time period that allows for co-action, for example within about 1 day, or about 6 hours, or about 3 hours, or about 1 hour, or about 30 minutes, or about 10 minutes.
Combination therapy also embraces administration of therapeutic agents in a substantially simultaneous manner. Substantially simultaneous administration can be accomplished, for example, by administering to the subject a single dosage form, such as a capsule, having a fixed ratio of the therapeutic agents, or in a plurality of individual dosage forms each containing one of the therapeutic agents.
Sequential or substantially simultaneous administration of therapeutic agents can be effected by any appropriate route including, but not limited to, oral, intravenous, intramuscular and subcutaneous routes and direct absorption through mucous membrane tissues. The therapeutic agents can be administered by the same route or by different routes. For example, a Cox-2 inhibitor can be administered orally and an antineoplastic agent parenterally, for example by intravenous injection or infusion. The sequence in which the therapeutic agents are administered is not narrowly critical.
Combination therapy can also embrace administration of the therapeutic agents as described herein in further combination with one or more other agents, for example a second and different antineoplastic agent or a non-drug therapy, for example surgery or radiation treatment. Where the combination therapy further comprises radiation treatment, the radiation treatment can be conducted at any suitable time. In one embodiment, the timing of administration of the combination of the invention and of radiation treatment are such as to enable a beneficial effect from co-action of the combination of the therapeutic agents and the radiation treatment. Such a beneficial effect can be achieved in some cases when the radiation treatment is temporally removed from the administration of the therapeutic agents, for example by days or even weeks.
The phrases “low dose” or “low dose amount”, in characterizing a therapeutically effective amount of a Cox-2 inhibitor or antineoplastic agent, defines a quantity that is capable of having a preventive or ameliorating effect on neoplasia or a neoplasia-related disorder while reducing or avoiding one or more side effects, such as myelosupression, cardiac toxicity, alopecia, nausea or vomiting.
The phrase “adjunctive therapy” describes treatment of a subject with agents that reduce or avoid side effects associated with cancer therapy, including, but not limited to, agents that reduce the toxic effect of anticancer drugs (e.g., bone resorption inhibitors and cardioprotective agents), prevent or reduce incidence of nausea and vomiting associated with chemotherapy, radiotherapy or surgery, or reduce the incidence of infection associated, for example, with administration of myelosuppressive anticancer drugs.
An “immunotherapeutic agent” is an agent used to transfer the immunity of an immune donor, e.g., another person or an animal, to a host by inoculation. Examples of use of immunotherapeutic agents are serum or gamma globulin containing preformed antibodies produced by another individual or an animal; nonspecific systemic stimulation; adjuvants; active specific immunotherapy; and adoptive immunotherapy. Adoptive immunotherapy refers to treatment of a disease by therapy or agents that include host inoculation of sensitized lymphocytes, transfer factor, immune RNA, or antibodies in serum or gamma globulin.
“Vaccines” herein include agents that induce a subject's immune system to mount an immune response against a tumor by attacking cells that express tumor associated antigens (TAAs).
The phrase “radiotherapeutic agent” refers to the use of electromagnetic or particulate radiation in treatment of neoplasia.
The amount or dosage of a combination therapy comprising a Cox-2 inhibitor and an antineoplastic agent is one that provides a therapeutically effective amount of the combination. Respective amounts of the Cox-2 inhibitor and of the antineoplastic agent are such as to provide such a therapeutically effective amount of the combination.
The term “therapy” herein refers to administration of agent(s) to a subject for purposes of prevention of occurrence of a condition or disorder and/or treatment of an existing condition or disorder. “Therapeutic” and “therapeutically effective” likewise embrace prevention as well as treatment.
Therapeutic effectiveness can include one or more of the following: (1) reduction in number of cancer cells; (2) reduction in tumor size; (3) inhibition (i.e., slowing or stopping) of cancer cell infiltration into peripheral organs; (4) inhibition of tumor metastasis; (5) inhibition of tumor growth; (6) relieving or reducing to some extent one or more symptoms associated with the neoplasia or neoplasia-related disorder; and (7) relieving or reducing side effects associated with administration of anticancer agents.
In one embodiment, a combination of the present invention is administered for prevention of neoplasia or a neoplasia-related disorder. As used herein, the term “prevention” refers to any reduction, no matter how slight, of a subject's predisposition or risk for developing a neoplasia or neoplasia-related disorder. For purposes of prevention herein, the subject is one that is at some degree of risk for, or is to some degree predisposed to, developing a neoplasia or a neoplasia-related disorder.
As used herein, a subject that is “predisposed to” or “at risk for” developing neoplasia or a neoplasia-related disorder or condition includes any subject having an increased chance or statistical probability for such development. Such increased chance or probability can be due to various factors, including genetic predisposition, diet, age, exposure to neoplasia causing agents, physiological factors such as anatomical and biochemical abnormalities and certain autoimmune diseases, and the like.
In another embodiment, a combination of the present invention is administered for treating an existing neoplasia or neoplasia-related disorder.
The terms “treat”, “treating” and “treatment” include alleviating symptoms, eliminating the causation of symptoms, either on a temporary or permanent basis, or altering or slowing the appearance of symptoms.
In still another embodiment, the present invention provides a method for preventing or treating neoplasia or a neoplasia-related disorder in a subject that is in need of such prevention or treatment, the method comprising administering to the subject a combination comprising a Cox-2 inhibitor and an antineoplastic agent as described herein, in further combination with radiation therapy, for example conventional radiation therapy. Thus in one embodiment a three-way combination of a Cox-2 inhibitor, an antineoplastic agent as described herein and radiation therapy is administered to a subject in need thereof.
As used herein, the term “alkyl”, alone or in combination, means an alkyl radical, linear, cyclic or branched, which, unless otherwise noted, typically contains 1 to about 10 carbon atoms, and more typically 1 to about 6 carbon atoms. Examples of such radicals include methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, tert-butyl, pentyl, iso-amyl, hexyl, octyl and the like. Cyclic alkyl (“cycloalkyl”) radicals contain 3 to about 7 carbon atoms, typically 3 to 6 carbon atoms, for example cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl and cycloheptyl. The term “cycloalkyl” additionally encompasses spiro systems wherein the cycloalkyl ring has a carbon ring atom in common with the seven-membered heterocyclic ring of benzothiepine.
Alkyl radicals can optionally be substituted with substituent groups as defined below. Examples of such substituted alkyl radicals include chloroethyl, hydroxyethyl, trifluoromethyl, cyanobutyl, aminopentyl, and the like.
The term “alkenyl” refers to an unsaturated, hydrocarbon radical, linear, cyclic or branched, that contains at least one double bond. Unless otherwise noted, such radicals typically contain 2 to about 6 carbon atoms, more typically 2 to 4 carbon atoms, for example 2 to 3 carbon atoms. Cyclic alkenyl (“cycloalkenyl”) radicals have 3 to about 10 carbon atoms, and include cyclopropenyl, cyclobutenyl, cyclopentenyl, cyclohexenyl and cycloheptenyl. Alkenyl radicals can optionally be substituted with substituent groups as defined below. Examples of suitable alkenyl radicals include propenyl, 2-chloropropenyl, buten-1-yl, isobutenyl, penten-1-yl, 2-methylbuten-1-yl, 3-methylbuten-1-yl, hexen-1-yl, 3-hydroxyhexen-1-yl, hepten-1-yl, octen-1-yl, and the like.
The term “hydrido” denotes a single hydrogen atom (H). A hydrido radical can be attached, for example, to an oxygen atom to form a hydroxyl radical or two hydrido radicals may be attached to a carbon atom to form a methylene (—CH2—) radical.
The term “halo” means a halogen group such as fluoro, chloro, bromo or iodo radicals. The term “haloalkyl” describes alkyl radicals that is substituted with a halo group as defined above. Specifically embraced are monohaloalkyl, dihaloalkyl and polyhaloalkyl radicals. A monohaloalkyl radical, for example, can have either a bromo, chloro or fluoro group attached to the alkyl radical. Dihalo radicals can have two or more of the same halo group or a combination of different halo groups, and polyhaloalkyl radicals can have more than two of the same halo group or a combination of different halo groups.
The term “hydroxyalkyl” describes a linear or branched alkyl radical having 1 to about 10 carbon atoms, any one of which can be substituted with one or more hydroxyl radicals.
The terms “alkoxy” and “alkoxyalkyl” describe linear or branched oxy-containing radicals each having alkyl portions of 1 to about 10 carbon atoms, such as a methoxy radical. The term “alkoxyalkyl” describes alkyl radicals having one or more alkoxy radicals attached thereto, to form for example a monoalkoxyalkyl or dialkoxyalkyl radical. Alkoxy or alkoxyalkyl radicals can be further substituted with one or more halo atoms, such as fluoro, chloro or bromo, to provide “haloalkoxy” or “haloalkoxyalkyl” radicals. Examples of alkoxy and haloalkoxy radicals include methoxy, ethoxy, propoxy, isopropoxy, isobutoxy, fluoromethoxy, chloromethoxy, trifluoromethoxy, difluoromethoxy, trifluoroethoxy, fluoroethoxy, tetrafluoroethoxy, pentafluoroethoxy and fluoropropoxy.
The term “aryl”, alone or in combination, means a carbocyclic aromatic system containing one, two or three rings wherein such rings may be attached together in a pendent manner or may be fused. The term “aryl” includes aromatic radicals such as phenyl, naphthyl, tetrahydronapthyl, indane and biphenyl.
The term “heterocyclyl” or “heterocyclic” means a saturated or unsaturated mono- or multi-ring carbocycle wherein one or more carbon atoms is replaced by N, S, P, or O. This includes, for example, structures such as
wherein Z, Z1, Z2 and Z3 are C, S, P, O or N, with the proviso that at least one of Z, Z1, Z2 and Z3 is other than carbon, but is not O or S when attached to another Z atom by a double bond or when attached to another O or S atom. Furthermore, optional substituents are understood to be attached to Z, Z1, Z2 or Z3 only when the Z atom is C. Heterocyclic radicals can be saturated, partially saturated or unsaturated heteroatom-containing ring-shaped radicals, where the heteroatoms are selected from N, S and O. Examples of saturated heterocyclic radicals include piperazinyl, dioxanyl, tetrahydrofuranyl, oxiranyl, aziridinyl, morpholinyl, pyrrolidinyl, piperidinyl, thiazolidinyl, and others. Examples of unsaturated heterocyclic radicals, also termed “heteroaryl” radicals, include thienyl, pyrryl, furyl, pyridyl, pyrimidyl, pyrazinyl, pyrazolyl, oxazolyl, isoxazolyl, imidazolyl, thiazolyl, pyranyl, quinolinyl, isoquinolinyl, benzothienyl, indolyl and tetrazolyl. Also included are radicals where a heterocyclic ring is fused with an aryl ring. Examples of fused bicyclic radicals include benzofuran, benzothiophene, and the like.
The term “sulfonyl”, whether used alone or linked to other terms as in “alkylsulfonyl”, denotes the divalent radical —SO2—. “Alkylsulfonyl” denotes an alkyl radical attached to a sulfonyl radical, where alkyl is defined as above. The term “arylsulfonyl” denotes a sulfonyl radical substituted with an aryl radical. The terms “sulfamyl” or “sulfonamidyl”, whether alone or linked to other terms as in “N-alkylsulfamyl”, “N-arylsulfamyl”, “N,N-dialkylsulfamyl” and “N-alkyl-N-arylsulfamyl”, denote a sulfonyl radical substituted with an amine radical, forming a sulfonamide (—SO2NH2). The terms “N-alkylsulfamyl” and “N,N-dialkylsulfamyl” denote sulfamyl radicals substituted with 1 to 2 alkyl radicals or a cycloalkyl ring. The terms “N-arylsulfamyl” and “N-alkyl-N-arylsulfamyl” denote sulfamyl radicals substituted, respectively, with one aryl radical, or with one alkyl and one aryl radical.
The terms “carboxy” or “carboxyl”, whether used alone or linked to other terms, as in “carboxyalkyl”, denote —CO2H. The term “carboxyalkyl” denotes a carboxy radical as defined above, attached to an alkyl radical.
The term “carbonyl”, whether used alone or linked to other terms, as in “alkylcarbonyl”, denotes —(C═O)—. The term “alkylcarbonyl” denotes a carbonyl radical substituted with an alkyl radical, for example CH3—(C═O)—. “Alkylcarbonylalkyl” denotes an alkyl radical substituted with an alkylcarbonyl radical. The term “alkoxycarbonyl” means a radical containing an alkoxy group, attached via an oxygen atom to a carbonyl radical, for example (CH3)3CO—C(═O)— or —(O═)C—OCH3. The term “alkoxycarbonylalkyl” denotes a radical having alkoxycarbonyl, as defined above, attached to an alkyl radical. Examples of such alkoxycarbonylalkyl radicals include (CH3)3CO—C(═O)(CH2)2— and —(CH2)2(═O)C—OCH3.
The term “amido” when used by itself or linked to other terms as in “amidoalkyl”, “N-monoalkylamido”, “N-monoarylamido”, “N,N-dialkylamido”, “N-alkyl-N-arylamido”, “N-alkyl-N-hydroxyamido” and “N-alkyl-N-hydroxyamidoalkyl”, denotes a carbonyl radical substituted with an amino radical. The terms “N-alkylamido” and “N,N-dialkylamido” denote amido groups which have been substituted with one or two alkyl radicals, respectively. The terms “N-monoarylamido” and “N-alkyl-N-arylamido” denote amido radicals substituted, respectively, with one aryl radical, or with one alkyl and one aryl radical. The term “N-alkyl-N-hydroxyamido” denotes an amido radical substituted with a hydroxyl radical and with an alkyl radical. The term “N-alkyl-N-hydroxyamidoalkyl” denotes an alkyl radical substituted with an N-alkyl-N-hydroxyamido radical. The term “amidoalkyl” denotes an alkyl radical substituted with one or more amido radicals. The term “aminoalkyl” denotes an alkyl radical substituted with one or more amino radicals. The term “alkylaminoalkyl” denotes an aminoalkyl radical having the nitrogen atom of the amino group substituted with an alkyl radical. The term “amidino” denotes a —C(═NH)—NH2 radical. The term “cyanoamidino” denotes a —C(═N—CN)—NH2 radical.
The term “heterocycloalkyl” denotes a heterocyclic-substituted alkyl radical such as pyridylmethyl or thienylmethyl.
The term “aralkyl” denotes an aryl-substituted alkyl radical such as benzyl, diphenylmethyl, triphenylmethyl, phenethyl or diphenethyl. The terms benzyl and phenylmethyl are interchangeable.
The term “alkylthio” denotes a radical containing a linear or branched alkyl radical of 1 to about 10 carbon atoms, attached to a divalent sulfur atom. An example is methylthio, (CH3—S—). The term “alkylsulfinyl” denotes a radical containing a linear or branched alkyl radical of 1 to about 10 carbon atoms, attached to a divalent —S(═O)-group. The term “alkylthioalkyl” denotes an alkylthio radical attached to an alkyl group, an example being methylthiomethyl.
The terms “N-alkylamino” and “N,N-dialkylamino” denote amino groups which have been substituted with one alkyl radical or with two alkyl radicals, respectively.
The term “acyl”, whether used alone or within a term such as “acylamino”, denotes a radical provided by the residue after removal of hydroxyl from an organic acid. The term “acylamino” denotes an amino radical substituted with an acyl group, an example being acetylamine (CH3C(═O)—NH—).
In either heterocyclyl or heteroaryl rings, the point of attachment to the molecule of interest can be at the heteroatom or elsewhere within the ring.
The term “oxo” means a doubly-bonded oxygen.
As used herein, “organic halide” means a compound having fluorine, chlorine, bromine, iodine or astatine covalently coupled with an alkyl, alkenyl, alkynyl, alkoxy, aralkyl, aryl, carbonyl, cycloalkyl, benzyl, phenyl, alicyclic or heterocyclic group.
As used herein, the term “carbamoyl” refers to a carbonyl group covalently bonded at the oxo carbon to an amino group.
As used herein, the term “hydroxamate” refers to a carbonyl group covalently bonded at the oxo carbon to an amino group, wherein the amino group is in turn bonded to a hydroxyl group.
The term “oxime” means a radical comprising ═NOH.
The terms “cyclooxygenase-2 inhibitor” and “Cox-2 inhibitor”, which can be used interchangeably herein, denote compounds which inhibit the cyclooxygenase-2 enzyme (Cox-2) regardless of the degree of inhibition of the cyclooxygenase-1 enzyme (Cox-1), and include pharmaceutically acceptable racemates, enantiomers, tautomers, salts, esters and prodrugs of those compounds. Thus, for purposes of the present invention, a compound is considered a Cox-2 inhibitor although the compound inhibits Cox-2 to an equal, greater, or lesser degree than it inhibits Cox-1. Cox-2 inhibitors herein therefore encompass many traditional non-selective NSAIDs (non-steroidal anti-inflammatory drugs).
Suitable NSAIDs include ibuprofen, naproxen, benoxaprofen, flurbiprofen, fenoprofen, fenbufen, ketoprofen, indoprofen, pirprofen, carprofen, oxaprozin, prapoprofen, miroprofen, tioxaprofen, suprofen, alminoprofen, tiaprofenic acid, fluprofen, bucloxic acid, indomethacin, sulindac, tolmetin, zomepirac, diclofenac, fenclofenac, alclofenac, ibufenac, isoxepac, furofenac, tiopinac, zidometacin, acetyl salicylic acid, indomethacin, piroxicam, tenoxicam, nabumetone, ketorolac, azapropazone, mefenamic acid, tolfenamic acid, diflunisal, podophyllotoxin derivatives, acemetacin, droxicam, floctafenine, oxyphenbutazone, phenylbutazone, proglumetacin, acemetacin, fentiazac, clidanac, oxipinac, mefenamic acid, meclofenamic acid, flufenamic acid, niflumic acid, flufenisal, sudoxicam, etodolac, piprofen, salicylic acid, choline magnesium trisalicylate, salicylate, benorylate, fentiazac, clopinac, feprazone, isoxicam, 2-fluoro-a-methyl[1,1′-biphenyl]-4-acetic acid, 4-(nitrooxy)butyl ester (See Wenk et al. (2002) Europ. J. Pharmacol. 453, 319-324, incorporated herein by reference) and mixtures thereof.
Particular NSAIDs of interest include ibuprofen, naproxen, sulindac, ketoprofen, fenoprofen, tiaprofenic acid, suprofen, etodolac, carprofen, ketorolac, piprofen, indoprofen, salicylic acid, flurbiprofen and mixtures thereof.
Further Cox-2 inhibitors useful according to embodiments of the present invention are agents and compounds that selectively or preferentially inhibit Cox-2 to a greater degree than they inhibit Cox-1. Such agents and compounds are termed “Cox-2 selective inhibitors” herein.
In practice, in a test for selectivity of a Cox-2 selective inhibitor, the observed selectivity varies depending upon the conditions under which the test is performed and on the compound being tested. However, for the present purpose, selectivity of a Cox-2 inhibitor can be measured as a ratio of the in vitro or in vivo IC50 value for inhibition of Cox-1, divided by the corresponding IC50 value for inhibition of Cox-2 (Cox-1 IC50/Cox-2 IC50). A Cox-2 selective inhibitor herein is thus any inhibitor for which Cox-1 IC50/Cox-2 IC50 is greater than 1. In various embodiments this ratio is greater than about 2, greater than about 5, greater than about 10, greater than about 50, or greater than about 100.
The term “IC50” with respect to a Cox-2 inhibitor refers to the concentration of a compound that is required to produce 50% inhibition of activity of Cox-1 or Cox-2. In various embodiments, Cox-2 selective inhibitors useful in the present invention can have a Cox-2 IC50 of less than about 1 μM, less than about 0.5 μM, or less than about 0.2 μM. Cox-2 selective inhibitors useful in the present invention can have a Cox-1 IC50 of greater than about 1 μM, for example greater than about 20 μM.
Cox-2 inhibitors exhibiting a high degree of selectivity for Cox-2 over Cox-1 inhibition can indicate ability to reduce incidence of common NSAID-induced side effects.
A Cox-2 selective inhibitor can be used in a form of a prodrug thereof. In the present context, a “prodrug” is a compound that can be converted into an active Cox-2 selective inhibitor by metabolic or simple chemical processes within the body of the subject. One example of a prodrug for a Cox-2 selective inhibitor is parecoxib, for example in a form of a salt such as parecoxib sodium, which is a therapeutically effective prodrug of the tricyclic Cox-2 selective inhibitor valdecoxib. A class of prodrugs of Cox-2 selective inhibitors is described in U.S. Pat. No. 5,932,598, incorporated herein by reference.
In one embodiment the Cox-2 selective inhibitor is meloxicam or a pharmaceutically acceptable salt or prodrug thereof.
In another embodiment the Cox-2 selective inhibitor is RS 57067 (6-[[5-(4-chlorobenzoyl)-1,4-dimethyl-1H-pyrrol-2-yl]methyl]-3(2H)-pyridazinone) or a pharmaceutically acceptable salt or prodrug thereof.
In another embodiment the Cox-2 selective inhibitor is of the chromene or chroman structural class that is a substituted benzopyran or a substituted benzopyran analog, for example selected from the group consisting of substituted benzothiopyrans, dihydroquinolines and dihydronaphthalenes. These compounds can have a structure as shown in any of formulas (I), (II), (III), (IV), (V) and (VI) below, and as illustrated in Table 1, and can be diastereomers, enantiomers, racemates, tautomers, salts, esters, amides and prodrugs of such compounds.
Benzopyrans that can serve as a COX-2 selective inhibitor of the present invention include substituted benzopyran derivatives that are described in U.S. Pat. No. 6,271,253, incorporated herein by reference. One such class of compounds is defined by the general formula shown below in formula (I):
wherein:
Another class of benzopyran derivatives that can serve as the COX-2 selective inhibitor of the present invention includes a compound having the structure of formula (II):
wherein:
Other benzopyran COX-2 selective inhibitors useful in the practice of the present invention are described in U.S. Pat. Nos. 6,034,256 and 6,077,850, incorporated herein by reference. The general formula for these compounds is shown in formula (III):
wherein:
A related class of compounds useful as COX-2 selective inhibitors in the present invention is described by formulas (IV) and (V):
wherein:
Formula (V) is:
wherein:
The COX-2 selective inhibitor can be a compound of Formula (V), wherein:
The COX-2 selective inhibitor can be a compound of Formula (V), wherein:
The COX-2 selective inhibitor can be a compound of Formula (V), wherein:
The COX-2 selective inhibitor can be a compound of Formula (V), wherein:
Another class of benzopyran derivatives that can serve as the COX-2 selective inhibitor of the present invention includes a compound having the structure of formula (VI):
wherein:
The COX-2 selective inhibitor can be a compound of Formula (VI), wherein:
or an isomer or prodrug thereof.
In other embodiments the COX-2 selective inhibitor can be selected from the class of tricyclic COX-2 selective inhibitors represented by the general structure of formula (VII):
wherein:
The COX-2 selective inhibitor of formula (VII) can be selected from the group of compounds illustrated in Table 2, which includes celecoxib (B-18), valdecoxib (B-19), deracoxib (B-20), rofecoxib (B-21), etoricoxib or MK-663 (B-22) and JTE-522 (B-23), and pharmaceutically acceptable salts and prodrugs thereof.
Additional information about these COX-2 selective inhibitors can be found in patents individually cited below and incorporated herein by reference.
U.S. Pat. No. 5,466,823.
U.S. Pat. No. 5,840,924.
International Patent Publication No. WO 00/25779.
International Patent Publication No. WO 98/03484.
In certain embodiments of the invention, the Cox-2 selective inhibitor is selected from the group consisting of celecoxib, rofecoxib and etoricoxib.
In one embodiment of the invention, parecoxib (see, e.g., U.S. Pat. No. 5,932,598), which is a therapeutically effective prodrug of the tricyclic Cox-2 selective inhibitor valdecoxib, B-19 (see, e.g., U.S. Pat. No. 5,633,272), may be advantageously employed as a source of a Cox-2 inhibitor.
Parecoxib can be used as a salt, for example parecoxib sodium.
In another embodiment of the invention, the compound ABT-963 having the formula:
previously described in International Patent Publication No. WO 00/24719, is another tricyclic COX-2 selective inhibitor which can be advantageously employed.
Examples of specific compounds that are useful as the COX-2 selective inhibitor include, without limitation:
In a further embodiment of the invention, the Cox-2 selective inhibitor used in the present invention can be selected from the class of phenylacetic acid derivatives represented by the general structure of formula (VIII):
wherein:
A phenylacetic acid derivative Cox-2 selective inhibitor that is described in International Patent Publication No. WO 99/11605, incorporated by reference herein, is a compound that has the structure shown in formula (VIII), wherein:
Another phenylacetic acid derivative Cox-2 selective inhibitor is a compound that has the structure shown in formula (VIII), wherein:
Another phenylacetic acid derivative Cox-2 selective inhibitor, described in International Patent Publication No. WO 02/20090, incorporated by reference herein, is COX-189, also known as lumiracoxib, having the structure shown in formula (VIII), wherein:
Cox-2 selective inhibitor compounds that have a structure similar to that shown in formula (VIII) are described in the patents individually cited below and incorporated herein by reference.
U.S. Pat. No. 6,310,099.
U.S. Pat. No. 6,291,523.
U.S. Pat. No. 5,958,978.
Other Cox-2 selective inhibitors that can be used in the present invention have the general structure shown in formula (IX), wherein the J group is a carbocycle or a heterocycle. Illustrative embodiments have the structure:
wherein:
Materials that can serve as the Cox-2 selective inhibitor of the present invention include diarylmethylidenefuran derivatives that are described in U.S. Pat. No. 6,180,651. Such diarylmethylidenefuran derivatives have the general formula shown below in formula (X):
wherein:
Particular compounds of this family of compounds, which can serve as the Cox-2 selective inhibitor in the present invention, include N-(2-cyclohexyloxynitrophenyl)methanesulfonarmide and (E)-4-[(4-methylphenyl) (tetrahydro-2-oxo-3-furanylidene)methyl]benzenesulfonamide.
Cox-2 selective inhibitors that are useful in the present invention include darbufelone of Pfizer, CS-502 of Sankyo, LAS 34475 and LAS 34555 of Almirall Profesfarma, S-33516 of Servier, SD-8381 of Pharmacia, described in U.S. Pat. No. 6,034,256, BMS-347070 of Bristol Myers Squibb, described in U.S. Pat. No. 6,180,651, MK-966 of Merck, L-783003 and L-748731 of Merck, T-614 of Toyama, D-1367 of Chiroscience, CT3 of Atlantic Pharmaceutical, CGP-28238 of Novartis, BF-389 of Biofor/Scherer, GR-253035 of Glaxo Wellcome, 6-dioxo-9H-purin-8-yl cinnamic acid of Glaxo Wellcome, and S-2474 of Shionogi.
Information about S-33516, mentioned above, can be found in Current Drugs Headline News, at http://www.current-drugs.com/NEWS/Inflam1.htm (2001), where it was reported that S-33516 has IC50 values of 0.1 and 0.001 mM against Cox-1 and Cox-2 respectively.
Compounds that can act as Cox-2 selective inhibitors include multibinding compounds containing from 2 to 10 ligands covalently attached to one or more linkers, as described in U.S. Pat. No. 6,395,724.
Compounds that can act as Cox-2 inhibitors include a conjugated linoleic acid as described in U.S. Pat. No. 6,077,868.
Compounds that can act as Cox-2 selective inhibitors include heterocyclic aromatic oxazole compounds as described in the patents individually cited below and incorporated herein by reference.
U.S. Pat. No. 5,994,381.
U.S. Pat. No. 6,362,209.
Such heterocyclic aromatic oxazole compounds have the formula shown below in formula (XI):
wherein:
Cox-2 selective inhibitors useful herein include compounds described in the patents individually cited below and incorporated herein by reference.
U.S. Pat. No. 6,080,876.
U.S. Pat. No. 6,133,292.
Such compounds are described by formula (XII):
wherein:
Compounds that can act as Cox-2 selective inhibitors include pyridines described in the patents individually cited below and incorporated herein by reference.
U.S. Pat. No. 6,369,275.
U.S. Pat. No. 6,127,545.
U.S. Pat. No. 6,130,334.
U.S. Pat. No. 6,204,387.
U.S. Pat. No. 6,071,936.
U.S. Pat. No. 6,001,843.
U.S. Pat. No. 6,040,450.
Such compounds have the general formula described by formula (XIII):
wherein:
Compounds that can act as Cox-2 selective inhibitors include diarylbenzopyran derivatives as described in U.S. Pat. No. 6,340,694, incorporated herein by reference. Such diarylbenzopyran derivatives have the general formula shown below in formula (XIV):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 1-(4-sulfamylaryl)-3-substituted-5-aryl-2-pyrazolines as described in U.S. Pat. No. 6,376,519, incorporated herein by reference. Such compounds have the formula shown below in formula (XV):
wherein:
Compounds that can act as Cox-2 selective inhibitors of the present invention include heterocycles as described in U.S. Pat. No. 6,153,787, incorporated herein by reference. Such heterocycles have the general formulas shown below in formulas (XVI) and (XVII):
wherein:
Formula (XVII) is:
wherein X10 is fluoro or chloro.
Compounds that can act as Cox-2 selective inhibitors include 2,3,5-trisubstituted pyridines as described in U.S. Pat. No. 6,046,217, incorporated herein by reference. Such compounds have the general formula shown below in formula (XVIII):
or a pharmaceutically acceptable salt thereof, wherein:
One exemplary embodiment of the Cox-2 selective inhibitor of formula (XVIII) is that wherein X is a bond.
Another exemplary embodiment of the Cox-2 selective inhibitor of formula (XVIII) is that wherein X is O.
Another exemplary embodiment of the Cox-2 selective inhibitor of formula (XVIII) is that wherein X is S.
Another exemplary embodiment of the Cox-2 selective inhibitor of formula (XVIII) is that wherein R83 is CH3.
Another exemplary embodiment of the Cox-2 selective inhibitor of formula (XVIII) is that wherein R84 is halo or C1-6 fluoroalkyl.
Compounds that can act as Cox-2 selective inhibitors include diaryl bicyclic heterocycles as described in U.S. Pat. No. 6,329,421. Such compounds have the general formula shown below in formula (XIX):
and pharmaceutically acceptable salts thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include salts of a 5-amino- or substituted amino-1,2,3-triazole compound as described in U.S. Pat. No. 6,239,137. These salts are of a class of compounds of formula (XX):
wherein:
Compounds that can act as Cox-2 selective inhibitors include pyrazole derivatives as described in U.S. Pat. No. 6,136,831. Such compounds have the formula shown below in formula (XXI):
wherein:
Compounds that can act as Cox-2 selective inhibitors include substituted derivatives of benzosulfonamides as described in U.S. Pat. No. 6,297,282. Such compounds have the formula shown below in formula (XXII):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 3-phenyl-4-(4(methylsulfonyl)phenyl)-2-(5H)-furanones as described in U.S. Pat. No. 6,239,173. Such compounds have the formula shown below in formula (XXIII):
or pharmaceutically acceptable salts thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include bicyclic carbonyl indole compounds as described in U.S. Pat. No. 6,303,628. Such compounds have the formula shown below in formula (XXIV):
or pharmaceutically acceptable salts thereof, wherein:
Compounds that can act as a Cox-2 selective inhibitors include benzimidazole compounds as described in U.S. Pat. No. 6,310,079. Such compounds have the formula shown below in formula (XXV):
or a pharmaceutically acceptable salt thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include indole compounds that are described in U.S. Pat. No. 6,300,363. Such compounds have the formula shown below in formula (XXVI):
and pharmaceutically acceptable salts thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include aryl phenylhydrazides as described in U.S. Pat. No. 6,077,869. Such compounds have the formula shown below in formula (XXVII):
wherein X23 and Y6 are selected from hydrogen, halogen, alkyl, nitro, amino and other oxygen- and sulfur-containing functional groups such as hydroxy, methoxy and methylsulfonyl.
Compounds that can act as Cox-2 selective inhibitors include 2-aryloxy-4-aryl furan-2-ones as described in U.S. Pat. No. 6,140,515. Such compounds have the formula shown below in formula (XXVIII):
or a pharmaceutically acceptable salt thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include bisaryl compounds as described in U.S. Pat. No. 5,994,379. Such compounds have the formula shown below in formula (XXIX):
or a pharmaceutically acceptable salt, ester or tautomer thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include 1,5-diarylpyrazoles as described in U.S. Pat. No. 6,028,202. Such compounds have the formula shown below in formula (XXX):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 2-substituted imidazoles as described in U.S. Pat. No. 6,040,320. Such compounds have the formula shown below in formula (XXXI):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 1,3- and 2,3-diarylcycloalkano- and cycloalkenopyrazoles as described in U.S. Pat. No. 6,083,969. Such compounds have the general formulas (XXXII) and (XXXIII) shown below:
wherein:
Compounds that can serve as Cox-2 selective inhibitors include esters derived from indolealkanols and amides derived from indolealkylamides as described in U.S. Pat. No. 6,306,890. Such compounds have the general formula shown below in formula (XXXIV):
wherein:
Compounds that can act as Cox-2 selective inhibitors include pyridazinone compounds as described in U.S. Pat. No. 6,307,047. Such compounds have the formula (XXXV):
or a pharmaceutically acceptable salt, ester, or prodrug thereof, wherein:
Compounds that can act as Cox-2 selective inhibitors include benzosulfonamide derivatives as described in U.S. Pat. No. 6,004,948. Such compounds have the formula (XXXVI):
wherein:
Compounds that can act as Cox-2 selective inhibitors include methanesulfonyl-biphenyl derivatives as described in U.S. Pat. No. 6,583,321. Such compounds have the formula (XXXVII):
wherein R207 and R208 are individually hydrogen; C1-C4 alkyl, substituted or not substituted by halogen atoms; C3-C7 cycloalkyl; C1-C5 alkyl containing 1-3 ether bonds and/or an aryl substitute; substituted or unsubstituted phenyl; or substituted or unsubstituted 5- or 6-ring-cycled heteroaryl containing more than one hetero atom selected from the group consisting of nitrogen, sulfur and oxygen (wherein phenyl or heteroaryl can be mono- or multi-substituted by a substituent selected from the group consisting of hydrogen, methyl, ethyl and isopropyl).
Compounds that can act as Cox-2 selective inhibitors include 1H-indole derivatives as described in U.S. Pat. No. 6,599,929. Such compounds have the formula (XXXVIII):
wherein:
Compounds that can act as Cox-2 selective inhibitors include prodrugs as described in U.S. Pat. No. 6,436,967 and U.S. Pat. No. 6,613,790. Such compounds have the formula (XXXIX):
wherein:
Specific non-limiting examples of substituted sulfonamide prodrugs of Cox-2 inhibitors disclosed in U.S. Pat. No. 6,436,967 that are useful in the present invention include:
Prodrugs disclosed in U.S. Pat. No. 6,613,790 have formula (XXXIX) wherein:
Specific non-limiting examples of substituted sulfonamide prodrugs of Cox-2 inhibitors disclosed in U.S. Pat. No. 6,613,790 that are useful in the present invention include:
Compounds that can act as Cox-2 selective inhibitors include sulfamoylheteroaryl pyrazole compounds as described in U.S. Pat. No. 6,583,321. Such compounds have the formula (XL):
wherein:
Compounds that can act as Cox-2 selective inhibitors include heteroaryl substituted amidinyl and imidazolyl compounds as described in U.S. Pat. No. 6,555,563. Such compounds have the formula (XLI):
wherein:
Compounds that can act as Cox-2 selective inhibitors include substituted hydroxamic acid derivatives as described in U.S. Pat. No. 6,432,999, U.S. Pat. No. 6,512,121, U.S. Pat. No. 6,515,014 and U.S. Pat. No. 6,555,563. These compounds also act as inhibitors of the lipoxygenase-5 enzyme. Such compounds have the formulas (XLII) and (XLIII):
Pyrazole-substituted hydroxamic acid derivatives described in U.S. Pat. No. 6,432,999 can have formula (XLII), wherein:
Pyrazole-substituted hydroxamic acid derivatives described in U.S. Pat. No. 6,432,999 can alternatively have formula (XLIII), wherein:
Heterocyclo-substituted hydroxamic acid derivatives described in U.S. Pat. No. 6,512,121 can have formula (XLII), wherein:
Heterocyclo-substituted hydroxamic acid derivatives described in U.S. Pat. No. 6,512,121 can alternatively have formula (XLIII), wherein:
Thiophene-substituted hydroxamic acid derivatives described in U.S. Pat. No. 6,515,014 can have formula (XLII), wherein:
Thiophene substituted hydroxamic acid derivatives described in U.S. Pat. No. 6,515,014 can alternatively have formula (XLIII), wherein:
Compounds that can act as Cox-2 selective inhibitors include pyrazolopyridine compounds as described in U.S. Pat. No. 6,498,166. Such compounds have the formula (XLIV):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 4,5-diaryl-3(2H)-furanone derivatives as described in U.S. Pat. No. 6,492,416. Such compounds have the formula (XLV):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 2-phenyl-1,2-benzisoselenazol-3(2H)-one derivatives and 2-phenylcarbamylphenylselenyl derivatives as described in U.S. Pat. No. 6,492,416. Such compounds have the formulas (XLVI) and (XLVII):
wherein:
Compounds that can act as Cox-2 selective inhibitors include pyrones as described in U.S. Pat. No. 6,465,509. Such compounds have the formula (XLVIII):
wherein:
Examples of pyrone compounds that are useful as Cox-2 selective inhibitors of the present invention include, but are not limited to:
Compounds that can act as Cox-2 selective inhibitors include free-B-ring flavonoids as described in U.S. Patent Application Publication No. 2003/0165588. Such compounds, organically synthesized or purified from plant sources, have the formula (XLIX):
wherein R246, R247, R248, R249 and R250 are independently selected from the group consisting of —H, —OH, —SH, —OR, —SR, —NH2, —NHR245, —N(R245)2, —N(R245)3+X35−, a carbon, oxygen, nitrogen or sulfur glycoside of a single or a combination of multiple sugars selected from aldopentoses, methyl-aldopentose, aldohexoses, ketohexose and chemical derivatives thereof; where R245 is an alkyl group having 1-10 carbon atoms, and X35 is selected from the group of pharmaceutically acceptable counter-anions consisting of hydroxyl, chloride, iodide, sulfate, phosphate, acetate, fluoride and carbonate.
Compounds that can act as Cox-2 selective inhibitors include heterocycloalkylsulfonyl pyrazoles as described in European Patent Publication No. EP 1 312 367. Such compounds have the formula (L):
wherein:
Compounds that can act as Cox-2 selective inhibitors include 2-phenylpyran-4-one derivatives as described in U.S. Pat. No. 6,518,303. Such compounds have the formula (LI):
wherein:
Examples of 2-phenylpyran-4-one derivatives useful in the present invention include, but are not limited to:
Cox-2 selective inhibitors useful in the subject methods and compositions can include compounds described in the patents individually cited below and incorporated herein by reference.
U.S. Pat. No. 6,472,416.
U.S. Pat. No. 6,451,794.
U.S. Pat. No. 6,169,188.
U.S. Pat. No. 6,020,343.
U.S. Pat. No. 5,981,576.
U.S. Pat. No. 6,222,048.
U.S. Pat. No. 6,057,319.
U.S. Pat. No. 6,046,236.
U.S. Pat. No. 6,002,014.
U.S. Pat. No. 5,945,539.
U.S. Pat. No. 6,359,182.
U.S. Pat. No. 6,538,116.
Cox-2 selective inhibitors useful in the present invention can be supplied by any source as long as the Cox-2 selective inhibitor is pharmaceutically acceptable. Cox-2 selective inhibitors can be isolated and purified from natural sources or can be synthesized. Cox-2 selective inhibitors should be of a quality and purity that is conventional in the trade for use in pharmaceutical products.
Celecoxib useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in U.S. Pat. No. 5,466,823.
Valdecoxib useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in U.S. Pat. No. 5,633,272.
Parecoxib useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in U.S. Pat. No. 5,932,598.
Rofecoxib useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in U.S. Pat. No. 5,968,974.
Japan Tobacco JTE-522 useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in Japanese Patent Publication No. JP 90/52882.
Pyrazoles useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 95/15316.
Pyrazoles can also be prepared as set forth in International Patent Publication No. WO 95/15315.
Pyrazoles can also be prepared as set forth in International Patent Publication No. WO 96/03385.
Thiophene analogs useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 95/00501.
Thiophene analogs can also be prepared as set forth in International Patent Publication No. WO 94/15932.
Oxazoles useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 95/00501.
Oxazoles can also be prepared as set forth in International Patent Publication No. WO 94/27980.
Isoxazoles useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 96/25405.
Imidazoles useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 96/03388.
Imidazoles can also be prepared as set forth in International Patent Publication No. WO 96/03387.
Cyclopentene Cox-2 inhibitors useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in U.S. Pat. No. 5,344,991.
Cyclopentene Cox-2 inhibitors can also be prepared as set forth in International Patent Publication No. WO 95/00501.
Terphenyl compounds useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 96/16934.
Thiazole compounds useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 96/03,392.
Pyridine compounds useful in the combinations, method, kits and compositions of the invention can be prepared, for example, as set forth in International Patent Publication No. WO 96/03392.
Pyridine compounds can also be prepared as set forth in International Patent Publication No. WO 96/24585.
Illustratively, a Cox-2 selective inhibitor can be a tricyclic compound, for example a compound of formula (VII), a substituted benzopyran derivative, for example a compound of formulas (I) to (VI), or a phenylacetic acid derivative, for example a compound of formula (VIII).
Illustratively, the Cox-2 selective inhibitor can be selected from the group consisting of celecoxib, parecoxib, deracoxib, valdecoxib, etoricoxib, meloxicam, rofecoxib, lumiracoxib, RS 57067, T-614, BMS-347070, JTE-522, S-2474, SVT-2016, CT-3, ABT-963, SC-58125, nimesulide, flosulide, NS-398, L-745337, RWJ-63556, L-784512, darbufelone, CS-502, LAS-34475, LAS-34555, S-33516, SD-8381, prodrugs of any of them, and mixtures thereof.
More particularly, the Cox-2 selective inhibitor can be selected from the group consisting of celecoxib, valdecoxib, parecoxib, rofecoxib, etoricoxib, lumiracoxib, and pharmaceutically acceptable salts thereof.
In one embodiment the Cox-2 selective inhibitor comprises celecoxib.
In another embodiment the Cox-2 selective inhibitor comprises valdecoxib.
In yet another embodiment the Cox-2 selective inhibitor comprises parecoxib sodium.
In certain embodiments, the Cox-2 selective inhibitor is selected from compounds of formulas (XXXVII) to (LI) hereinabove.
The antineoplastic agent for use according to the invention can illustratively be selected from the agents listed in Tables 3-17 below. Grouping of agents by function or mode of action below does not limit the invention to embodiments wherein the antineoplastic agent operates by the function or mode of action indicated.
The invention encompasses all novel combinations of (a) a Cox-2 inhibitor, more particularly a selective Cox-2 inhibitor such as celecoxib, parecoxib, deracoxib, valdecoxib, lumiracoxib, etoricoxib, rofecoxib, and prodrugs and pharmaceutically acceptable salts thereof including, for example, parecoxib sodium, and (b) an antineoplastic agent selected from those disclosed in Tables 3-17 below.
The invention further encompasses all novel combinations of (a) a Cox-2 selective inhibitor selected from compounds of formulas (XXXVII) to (LI) above, and (b) an antineoplastic agent disclosed in above-cited International Patent Publication No. WO 00/38730 or its priority document U.S. Provisional Patent Application Ser. No. 60/113,786, both of which are incorporated herein in their entirety by reference. For convenience, a non-limiting list of illustrative antineoplastic agents is presented in Table 18 below.
In one embodiment of the present invention, a combination comprising a Cox-2 inhibitor and an antineoplastic agent is administered to a subject by a standard route of drug delivery, such standard routes being well known to one of ordinary skill in the art.
Either or both of the Cox-2 inhibitor and the antineoplastic agent can optionally be supplied in the form of a pharmaceutically active salt, a prodrug, an isomer, a racemic mixture, or in any other chemical form or combination.
Illustrative pharmaceutically acceptable salts are prepared from formic, acetic, propionic, succinic, glycolic, gluconic, lactic, malic, tartaric, citric, ascorbic, glucuronic, maleic, fumaric, pyruvic, aspartic, glutamic, benzoic, anthranilic, mesylic, stearic, salicylic, p-hydroxybenzoic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, ethanesulfonic, benzenesulfonic, pantothenic, toluenesulfonic, 2-hydroxyethanesulfonic, sulfanilic, cyclohexylaminosulfonic, algenic, β-hydroxybutyric, galactaric and galacturonic acids.
Suitable pharmaceutically-acceptable base addition salts include metallic ion salts and organic ion salts. Metallic ion salts include, but are not limited to, appropriate alkali metal (group Ia) salts, alkaline earth metal (group IIa) salts and other physiologically acceptable metal ions. Such salts can be made from the ions of aluminum, calcium, lithium, magnesium, potassium, sodium and zinc. Organic salts can be made from tertiary amines and quaternary ammonium salts, including in part, trimethylamine, diethylamine, N,N′-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine (N-methylglucamine) and procaine. All of the above salts can be prepared by those skilled in the art by conventional means from the corresponding compound.
A combination of a Cox-2 inhibitor and an antineoplastic agent can be provided in a pharmaceutically acceptable carrier or excipient to form a pharmaceutical composition. Pharmaceutical compositions can also include stabilizers, antioxidants, colorants and diluents. Pharmaceutically acceptable carriers and additives are chosen such that side effects from the pharmaceutical compound are minimized and the performance of the compound is not canceled or inhibited to such an extent that treatment is ineffective. In one embodiment, a Cox-2 inhibitor and an antineoplastic agent are administered to a subject together in one pharmaceutical carrier. In another embodiment, they are administered separately.
The pharmaceutical compositions may be administered enterally and/or parenterally. Oral (intra-gastric) is a typical route of administration. Pharmaceutically acceptable carriers can be in solid dosage forms, including tablets, capsules, pills and granules, which can be prepared with coatings and shells, such as enteric coatings and others well known in the art. Liquid dosage forms for oral administration include pharmaceutically acceptable emulsions, solutions, suspensions, syrups and elixirs.
Parenteral administration includes subcutaneous, intramuscular, intradermal, intramammary, intravenous, and other routes known in the art. Enteral administration includes solution, tablets, sustained release capsules, enteric coated capsules, and syrups. When administered, the pharmaceutical composition can be at or near body temperature.
Compositions intended for oral use can be prepared according to any method known in the art for the manufacture of pharmaceutical compositions and such compositions can contain one or more agents selected from the group consisting of sweetening agents, flavoring agents, coloring agents and preserving agents in order to provide pharmaceutically elegant and palatable preparations. Tablets contain the active ingredient in admixture with non-toxic pharmaceutically acceptable excipients, which are suitable for the manufacture of tablets. These excipients may be, for example, inert diluents, such as calcium carbonate, sodium carbonate, lactose, calcium phosphate or sodium phosphate, granulating and disintegrating agents, for example, maize starch, or alginic acid, binding agents, for example starch, gelatin or acacia, and lubricating agents, for example magnesium stearate, stearic acid, or talc. Tablets can be uncoated or they can be coated by known techniques, for example to delay disintegration and absorption in the gastrointestinal tract and thereby provide sustained action over a longer period. For example, a time delay material such as glyceryl monostearate or glyceryl distearate can be employed.
Formulations for oral use can also be presented as hard gelatin capsules wherein the active ingredients are mixed with an inert solid diluent, for example, calcium carbonate, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredients are present as such, or mixed with water or an oil medium, for example, peanut oil, liquid paraffin or olive oil.
Aqueous suspensions can be produced that contain the active materials in a mixture with excipients suitable for the manufacture of aqueous suspensions. Such excipients include suspending agents, for example, sodium carboxymethylcellulose, methylcellulose, hydroxypropylmethylcellulose, sodium alginate, polyvinylpyrrolidone, gum tragacanth and gum acacia; dispersing or wetting agents can be naturally-occurring phosphatides, for example lecithin, or condensation products of an alkylene oxide with fatty acids, for example polyoxyethylene stearate, or condensation products of ethylene oxide with long chain aliphatic alcohols, for example heptadecaethyleneoxycetanol, or condensation products of ethylene oxide with partial esters derived from fatty acids and a hexitol such as polyoxyethylene sorbitol monooleate, or condensation products of ethylene oxide with partial esters derived from fatty acids and hexitol anhydrides, for example polyoxyethylene sorbitan monooleate.
Aqueous suspensions can also contain one or more preservatives, for example, ethyl or n-propyl p-hydroxybenzoate, one or more coloring agents, one or more flavoring agents, or one or more sweetening agents, such as sucrose or saccharin.
Oily suspensions may be formulated by suspending the active ingredients in an omega-3 fatty acid, a vegetable oil, for example, arachis oil, olive oil, sesame oil or coconut oil, or in a mineral oil such as liquid paraffin. The oily suspensions can contain a thickening agent, for example beeswax, hard paraffin or cetyl alcohol.
Sweetening agents, such as those set forth above, and flavoring agents can be added to provide a palatable oral preparation. These compositions can be preserved by addition of an antioxidant such as ascorbic acid.
Dispersible powders and granules suitable for preparation of an aqueous suspension by addition of water provide the active ingredient in admixture with a dispersing or wetting agent, a suspending agent and one or more preservatives. Suitable dispersing or wetting agents and suspending agents are exemplified by those already mentioned above. Additional excipients, for example sweetening, flavoring and coloring agents, can also be present.
Syrups and elixirs containing a Cox-2 inhibitor and/or an antineoplastic agent can be formulated with sweetening agents, for example glycerol, sorbitol, or sucrose. Such formulations can also contain a demulcent, a preservative and flavoring and coloring agents.
A Cox-2 inhibitor and an antineoplastic agent can be administered parenterally, for example subcutaneously, intravenously, intramuscularly or intrasternally, or by infusion techniques, in the form of sterile injectable aqueous or oleaginous suspensions. Such suspensions can be formulated according to known art using suitable dispersing or wetting agents and suspending agents such as those mentioned above or other acceptable agents. A sterile injectable preparation can be a sterile injectable solution or suspension in a non-toxic parenterally acceptable diluent or solvent, for example a solution in 1,3-butanediol. Among acceptable vehicles and solvents that can be employed are water, Ringer's solution and isotonic sodium chloride solution. In addition, sterile fixed oils are conventionally employed as a solvent or suspending medium. For this purpose, any bland fixed oil may be employed, including synthetic mono- or diglycerides. In addition, omega-3 polyunsaturated fatty acids can find use in preparation of injectables.
Administration can also be by inhalation, in the form of aerosols or solutions for nebulizers, or rectally, in the form of suppositories prepared by mixing the drug with a suitable non-irritating excipient which is solid at ordinary temperature, but liquid at rectal temperature and will therefore, melt in the rectum to release the drug. Such materials are cocoa butter and polyethylene glycols.
Also encompassed by the present invention is buccal and sub-lingual administration, including administration in the form of lozenges, pastilles or a chewable gum comprising the compounds set forth herein. The compounds can be deposited in a flavored base, usually sucrose, and acacia or tragacanth.
Other methods for administration of the Cox-2 inhibitor and the antineoplastic agent include dermal patches that release the medicaments directly into and/or through a subject's skin.
Topical delivery systems are also encompassed by the present invention and include ointments, powders, sprays, creams, jellies, collyriums, solutions or suspensions.
Powders have the advantage of sticking to moist surfaces, and consequently, can remain active for longer periods. Therefore, powders are especially attractive for treating neoplasms in, for example, the otic canal. For much the same reason, creams are also effective pharmaceutically acceptable carriers.
Compositions of the present invention can optionally be supplemented with additional agents such as, for example, viscosity enhancers, preservatives, surfactants and penetration enhancers.
Viscosity-building agents include, for example, polyvinyl alcohol, polyvinyl pyrrolidone, methylcellulose, hydroxypropylmethylcellulose, hydroxyethylcellulose, carboxymethylcellulose, hydroxypropylcellulose or other agents known to those skilled in the art. Such agents are typically employed at a level of about 0.01% to about 2% by weight of a pharmaceutical composition.
Preservatives are optionally employed to prevent microbial growth prior to or during use. Suitable preservatives include polyquaternium-1, benzalkonium chloride, thimerosal, chlorobutanol, methylparaben, propylparaben, phenylethyl alcohol, edetate disodium, sorbic acid, or other agents known to those skilled in the art. Typically, such preservatives are employed at a level of about 0.001% to about 1.0% by weight of a pharmaceutical composition.
Solubility of components of the present compositions can be enhanced by a surfactant or other appropriate cosolvent in the composition. Such cosolvents include polysorbates 20, 60 and 80, polyoxyethylene/polyoxypropylene surfactants (e.g., Pluronic™ F-68, F-84 and P-103), cyclodextrin, or other agents known to those skilled in the art. Typically, such cosolvents are employed at a level of about 0.01% to about 2% by weight of a pharmaceutical composition.
Pharmaceutically acceptable excipients and carriers encompass all the foregoing and the like. The above considerations concerning effective formulations and administration procedures are well known in the art and are described in standard textbooks. See, e.g., Remington: The Science and Practice of Pharmacy, 20th Edition, (Lippincott, Williams and Wilkins), 2000; Lieberman et al., ed., Pharmaceutical Dosage Forms, Marcel Decker, New York, N.Y., 1980; and Kibbe et al., ed., Handbook of Pharmaceutical Excipients (3rd Edition), American Pharmaceutical Association, Washington, 1999.
For purposes of the present invention, where a Cox-2 inhibitor and an antineoplastic agent are used in a combination therapy, the amount of the Cox-2 inhibitor and the amount of the antineoplastic agent should comprise an effective amount of the combination of the two treatment agents.
Thus, the present invention encompasses a method of treating or preventing neoplasia or a neoplasia-related disorder in a subject in need of such treatment or prevention, the method comprising administering a first amount of a Cox-2 inhibitor in combination with a second amount of an antineoplastic agent, wherein the amount of the combination, i.e., the total of said first and second amounts, is therapeutically effective for such treatment or prevention.
In determining an effective amount or dose, a number of factors are considered by the attending physician, including, but not limited to, the potency and duration of action of the compounds used, the nature and severity of the illness to be treated, as well as the sex, age, weight, general health and individual responsiveness of the patient to be treated, and other relevant circumstances. Those skilled in the art will appreciate that dosages can also be determined with guidance from Goodman & Goldman's The Pharmacological Basis of Therapeutics, Ninth Edition (1996), Appendix II, pp. 1707-1711.
It will be appreciated that the amount of the combination comprising a Cox-2 inhibitor and an antineoplastic agent required for use in the treatment or prevention of neoplasia and neoplasia-related disorders will vary within wide limits and will be adjusted to the individual requirements in each particular case. In general, for administration to adults, an appropriate daily dosage is described herein, although the limits that are identified as being preferred can be exceeded if expedient. The daily dosage can be administered as a single dosage or in divided dosages.
The dosage level of an antineoplastic agent will necessarily depend on the particular agent that is used. Appropriate dosages can be readily determined by one of skill in the art based upon the present specification and published information on the agent in question, available for example on the Internet. However, an appropriate dosage level of an antineoplastic agent is generally from about 0.0001 mg/kg to about 200 mg/kg subject body weight per day, administered in single or multiple doses. More typically, the dosage level is about 0.1 mg/kg to about 25 mg/kg per day.
A combination therapy comprising a Cox-2 inhibitor and an antineoplastic agent has an appropriate dosage level of the Cox-2 inhibitor that is generally from about 0.01 mg/kg to about 140 mg/kg subject body weight per day, administered in single or multiple doses. More typically, the dosage level is about 0.01 mg/kg to about 50 mg/kg per day, for example about 0.1 mg/kg to about 25 mg/kg per day, about 0.1 mg/kg to about 10 mg/kg per day, or about 0.5 mg/kg to about 10 mg/kg per day.
In larger mammals, for example humans, a typical indicated dose for the Cox-2 inhibitor is about 0.5 mg to about 7 grams orally per day. A compound can be administered on a regimen of several times per day, for example 1 to about 4 times per day, preferably once or twice per day.
The amount of the Cox-2 inhibitor that can be combined with carrier materials to produce a single dosage form varies depending upon the subject to be treated and the particular mode of administration. For example, a formulation intended for oral administration to humans can contain about 0.5 mg to about 7 g of active agent compounded optionally with an appropriate and convenient amount of carrier material which can vary from about 5 to about 95 percent of the total composition. Dosage unit forms for the Cox-2 inhibitor generally contain about 1 mg to about 500 mg of the active ingredient, for example 5 mg, 10 mg, 20 mg, 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg, 500 mg, 600 mg, 800 mg or 1000 mg.
The exact dosage and regimen for administering a Cox-2 inhibitor in combination with an antineoplastic agent will necessarily depend upon the potency and duration of action of the compounds used, the nature and severity of the illness to be treated, as well as the sex, age, weight, general health and individual responsiveness of the patient to be treated, and other relevant circumstances. Those skilled in the art will appreciate that dosages may also be determined with guidance from Goodman & Goldman's The Pharmacological Basis of Therapeutics, Ninth Edition (1996), Appendix II, pp. 1707-1711.
The effectiveness of a particular dosage of a combination therapy comprising a Cox-2 inhibitor and an antineoplastic agent can be determined by monitoring the effect of a given dosage on the progression of the disorder or prevention of a neoplasia disorder.
In one embodiment, the effectiveness of a particular dosage is determined by staging the disorder at multiple points during a subject's treatment. For example, once a histological diagnosis is made, staging (i.e., determination of the extent of disease) helps determine treatment decisions and prognosis. Clinical staging uses data from the patient's history, physical examination, and noninvasive studies. Pathologic staging requires tissue specimens.
Pathological staging is performed by obtaining a biopsy of the neoplasm or tumor. A biopsy is performed by obtaining a tissue specimen of the tumor and examining the cells microscopically. A bone marrow biopsy is especially useful in determining metastases from malignant lymphoma and small cell lung cancer. Marrow biopsy will be positive in 50 to 70% of patients with malignant lymphoma (low and intermediate grade) and in 15 to 18% of patients with small cell lung cancer at diagnosis. See The Merck Manual of Diagnosis & Therapy, 17th edition (1999), Sec. 11, Chapter 84, Hematology and Oncology, Overview of Cancer.
Determination of serum chemistries and enzyme levels can also help staging. Elevation of liver enzymes (alkaline phosphatase, LDH and ALT) suggests presence of liver metastases. Elevated alkaline phosphatase and serum Ca may be the first evidence of bone metastases. Elevated acid phosphatase (tartrate inhibited) suggests extracapsular extension of prostate cancer. Fasting hypoglycemia may indicate an insulinoma, hepatocellular carcinoma, or retroperitoneal sarcoma. Elevated BUN or creatinine levels may indicate an obstructive uropathy secondary to a pelvic mass, intrarenal obstruction from tubular precipitation of myeloma protein, or uric acid nephropathy from lymphoma or other cancers. Elevated uric acid levels often occur in myeloproliferative and lymphoproliferative disorders, α-Fetoprotein may be elevated in hepatocellular carcinoma and testicular carcinomas, carcinoembryonic antigen-S in colon cancer, human chorionic gonadotropin in choriocarcinoma and testicular carcinoma, serum immunoglobulins in multiple myeloma, and DNA probes (bcr probe to identify the chromosome 22 change) in CML.
Tumors may synthesize proteins that produce no clinical symptoms, e.g., human chorionic gonadotropin, α-fetoprotein, carcinoembryonic antigen, CA 125, and CA 153. These protein products can be used as tumor markers in serial evaluation of patients for determining disease recurrence or response to therapy. Thus, monitoring a subject for these tumor markers is indicative of progress of a neoplasia disorder. Such monitoring is also indicative of how well the methods, combinations and compositions of the present invention are treating or preventing a neoplasia disorder. Likewise, tumor marker monitoring is effective to determine appropriate dosages of a combination or composition of the present invention for treating neoplasia.
Other techniques include mediastinoscopy, which is especially valuable in the staging of non-small cell lung cancer. If mediastinoscopy shows mediastinal lymph node involvement, then the subject would not usually benefit from a thoracotomy and lung resection. Imaging studies, especially CT and MRI, can detect metastases to brain, lung, spinal cord, or abdominal viscera, including the adrenal glands, retroperitoneal lymph nodes, liver, and spleen. MRI (with gadolinium) is the procedure of choice for recognition and evaluation of brain tumors.
Ultrasonography can be used to study orbital, thyroid, cardiac, pericardial, hepatic, pancreatic, renal, and retroperitoneal areas. It may guide percutaneous biopsies and differentiate renal cell carcinoma from a benign renal cyst. Lymphangiography reveals enlarged pelvic and low lumbar lymph nodes and is useful in the clinical staging of patients with Hodgkin's disease, but it has generally been replaced by CT.
Liver-spleen scans can identify liver metastases and splenomegaly. Bone scans are sensitive in identifying metastases before they are evident on x-ray. Because a positive scan requires new bony formation (i.e., osteoblastic activity), this technique is useless in neoplasms that are purely lytic (e.g., multiple myeloma); routine bone x-rays are the study of choice in such diseases. Gallium scans can help in staging lymphoid neoplasms. Radiolabeled monoclonal antibodies (e.g., to carcinoembryonic antigen, small cell lung cancer cells) provide important staging data in various neoplasms (e.g., colon cancer, small cell lung cancer). See The Merck Manual of Diagnosis & Therapy, 17th edition (1999), Sec. 11, Chapter 84, Hematology and Oncology, Overview of Cancer.
As used herein, the term “subject” for purposes of treatment is one that is in need of the treatment of neoplasia or a neoplasia-related disorder. For purposes of prevention, the subject is one that is at risk for, or is predisposed to, developing neoplasia or a neoplasia-related disorder, including relapse of a previously occurring neoplasia or neoplasia-related disorder.
As used herein, the phrase “subject in need of” includes any subject that is suffering from or is predisposed to neoplasia or any neoplasia-related disorder described herein. The phrase “subject in need of” also includes any subject that requires a lower dose of conventional neoplasia treatment agents. In addition, a “subject in need of” includes any subject that requires a reduction in the side-effects of a conventional treatment agent. Furthermore, a “subject in need of” includes any subject that requires improved tolerability to any conventional treatment agent for a neoplasia disorder therapy.
The subject is an animal, typically a mammal, including humans, domestic and farm animals, zoo, sports and pet animals, such as dogs, horses, cats, cattle, etc. The subject is most typically a human subject.
The methods, combinations and compositions of the present invention can be used for treatment or prevention of several neoplasia disorders and neoplasia-related disorders including, but are not limited to, acral lentiginous melanoma, actinic keratosis, adenocarcinoma, adenoid cystic carcinoma, adenoma, adenosarcoma, adenosquamous carcinoma, adrenocortical carcinoma, AIDS-related lymphoma, anal cancer, astrocytic tumors, bartholin gland carcinoma, basal cell carcinoma, bile duct cancer, bladder cancer, brain stem glioma, brain tumor, breast cancer, bronchial gland carcinoma, capillary carcinoma, carcinoids, carcinoma, carcinosarcoma, cavernous cell carcinoma, central nervous system lymphoma, cerebral astrocytoma, childhood cancers, cholangiocarcinoma, chondrosarcoma, chorioid plexus papilloma and carcinoma, clear cell carcinoma, colon cancer, colorectal cancer, cutaneous T-cell lymphoma, cystadenoma, endodermal sinus tumor, endometrial hyperplasia, endometrial stromal sarcoma, endometrioid adenocarcinoma, ependymal cancer, epithelioid carcinoma, esophageal cancer, Ewing's sarcoma, extragonadal germ cell tumor, fibrolamellar carcinoma, focal nodular hyperplasia, gallbladder cancer, gastrinoma, germ cell tumors, gestational trophoblastic tumor, glioblastoma, glioma, glucagonoma, hemangioblastoma, hemangioendothelioma, hemangioma, hepatic adenoma, hepatic adenomatosis, hepatocellular carcinoma, Hodgkin's lymphoma, hypopharyngeal cancer, hypothalamic and visual pathway glioma, insulinoma, interepithelial squamous cell neoplasia, intraepithelial neoplasia, intraocular melanoma, invasive squamous cell carcinoma, islet cell carcinoma, Kaposi's sarcoma, kidney cancer, large cell carcinoma, laryngeal cancer, leiomyosarcoma, lentigo maligna melanoma, leukemia-related disorders, lip and oral cavity cancer, liver cancer, lung cancer, lymphoma, malignant mesothelial tumors, malignant thymoma, medulloblastoma, medulloepithelioma, melanoma, meningeal carcinoma, merkel cell carcinoma, mesothelial carcinoma, metastatic carcinoma, mucoepidermoid carcinoma, multiple myeloma/plasma cell neoplasm, mycosis fungoides, myelodysplastic syndrome, myeloproliferative disorders, nasal cavity and paranasal sinus cancer, nasopharyngeal cancer, neuroblastoma, neuroepithelial adenocarcinoma, nodular melanoma, non-Hodgkin's lymphoma, oat cell carcinoma, oligodendroglial carcinoma, oral cancer, oropharyngeal cancer, osteosarcoma, ovarian cancer, ovarian germ cell tumor, pancreatic cancer, papillary serous adenocarcinoma, parathyroid cancer, penile cancer, pheochromocytoma, pineal and supratentorial primitive neuroectodermal tumors, pineal cell carcinoma, pituitary tumors, plasma cell neoplasm, plasmacytoma, pleuropulmonary blastoma, prostate cancer, pseudosarcoma, pulmonary blastoma, rectal cancer, renal cell carcinoma, retinoblastoma, rhabdomyosarcoma, sarcoma, serous carcinoma, small cell carcinoma, small intestine cancer, soft tissue carcinomas, somatostatin-secreting tumor, squamous cell carcinoma, submesothelial carcinoma, superficial spreading melanoma, thyroid cancer, undifferentiated carcinoma, urethral cancer, uterine sarcoma, uveal melanoma, vaginal cancer, verrucous carcinoma, vipoma, vulvar cancer, Waldenstrom's macroglobulinemia, well differentiated carcinoma, and Wilm's tumor.
All references cited in this specification are incorporated by reference into this specification in their entireties. Discussion of any reference herein is intended merely to summarize statements made by its authors and no admission is made as to accuracy, pertinence or status as prior art of any reference. Applicant reserves the right to challenge the accuracy and pertinence of the cited references.
In view of the above, it will be seen that several advantages of the invention are achieved and other advantageous results obtained.
As various changes could be made in the above methods and compositions without departing from the scope of the invention, it is intended that all matter contained in the above detailed description shall be interpreted as illustrative and not in a limiting sense.
This application claims the benefit of U.S. provisional application Ser. No. 60/519,701, filed on Nov. 13, 2003, the disclosure of which in its entirety is incorporated by reference herein.
| Number | Date | Country | |
|---|---|---|---|
| 60519701 | Nov 2003 | US |
