COMPOUNDS AND COMPOSITIONS FOR TREATING CONDITIONS ASSOCIATED WITH STING ACTIVITY

Abstract

This disclosure features chemical entities (e.g., a compound or a pharmaceutically acceptable salt, and/or hydrate, and/or cocrystal, and/or drug combination of the compound) that inhibit (e.g., antagonize) Stimulator of Interferon Genes (STING). Said chemical entities are useful, e.g., for treating a condition, disease or disorder in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the condition, disease or disorder (e.g., cancer) in a subject (e.g., a human). This disclosure also features compositions containing the same as well as methods of using and making the same.

Description

TECHNICAL FIELD

This disclosure features chemical entities (e.g., a compound or a pharmaceutically acceptable salt, and/or hydrate, and/or cocrystal, and/or drug combination of the compound) that inhibit (e.g., antagonize) Stimulator of Interferon Genes (STING). Said chemical entities are useful, e.g., for treating a condition, disease or disorder in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the condition, disease or disorder (e.g., cancer) in a subject (e.g., a human). This disclosure also features compositions containing the same as well as methods of using and making the same.

BACKGROUND

STING, also known as transmembrane protein 173 (TMEM173) and MPYS/MITA/ERIS, is a protein that in humans is encoded by the TMEM173 gene. STING has been shown to play a role in innate immunity. STING induces type I interferon production when cells are infected with intracellular pathogens, such as viruses, mycobacteria and intracellular parasites. Type I interferon, mediated by STING, protects infected cells and nearby cells from local infection in an autocrine and paracrine manner.

The STING pathway is pivotal in mediating the recognition of cytosolic DNA. In this context, STING, a transmembrane protein localized to the endoplasmic reticulum (ER), acts as a second messenger receptor for 2′,3′ cyclic GMP-AMP (hereafter cGAMP), which is produced by cGAS after dsDNA binding. In addition, STING can also function as a primary pattern recognition receptor for bacterial cyclic dinucleotides (CDNs) and small molecule agonists. The recognition of endogenous or prokaryotic CDNs proceeds through the carboxy-terminal domain of STING, which faces into the cytosol and creates a V-shaped binding pocket formed by a STING homodimer. Ligand-induced activation of STING triggers its re-localization to the Golgi, a process essential to promote the interaction of STING with TBK1. This protein complex, in turn, signals through the transcription factors IRF-3 to induce type I interferons (IFNs) and other co-regulated antiviral factors. In addition, STING was shown to trigger NF-κB and MAP kinase activation. Following the initiation of signal transduction, STING is rapidly degraded, a step considered important in terminating the inflammatory response.

Excessive activation of STING is associated with a subset of monogenic autoinflammatory conditions, the so-called type I interferonopathies. Examples of these diseases include a clinical syndrome referred to as STING-associated vasculopathy with onset in infancy (SAVI), which is caused by gain-of-function mutations in TMEM173 (the gene name of STING). Moreover, STING is implicated in the pathogenesis of Aicardi-Goutières Syndrome (AGS) and genetic forms of lupus. As opposed to SAVI, it is the dysregulation of nucleic acid metabolism that underlies continuous innate immune activation in AGS. Apart from these genetic disorders, emerging evidence points to a more general pathogenic role for STING in a range of inflammation-associated disorders such as systemic lupus erythematosus, rheumatoid arthritis and cancer. Thus, small molecule-based pharmacological interventions into the STING signaling pathway hold significant potential for the treatment of a wide spectrum of diseases

SUMMARY

This disclosure features chemical entities (e.g., a compound or a pharmaceutically acceptable salt, and/or hydrate, and/or cocrystal, and/or drug combination of the compound) that inhibit (e.g., antagonize) Stimulator of Interferon Genes (STING). Said chemical entities are useful, e.g., for treating a condition, disease or disorder in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the condition, disease or disorder (e.g., cancer) in a subject (e.g., a human). This disclosure also features compositions containing the same as well as methods of using and making the same.

An “antagonist” of STING includes compounds that, at the protein level, directly bind or modify STING such that an activity of STING is decreased, e.g., by inhibition, blocking or dampening agonist-mediated responses, altered distribution, or otherwise. STING antagonists include chemical entities, which interfere or inhibit STING signaling.

In one aspect, compounds of Formula (I), or a pharmaceutically acceptable salt thereof, are featured:

in which X¹, X², Y², Y³, Y⁴, Z, W, and R⁶ can be as defined anywhere herein.

In one aspect, pharmaceutical compositions are featured that include a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same) and one or more pharmaceutically acceptable excipients.

In one aspect, methods for inhibiting (e.g., antagonizing) STING activity are featured that include contacting STING with a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same). Methods include in vitro methods, e.g., contacting a sample that includes one or more cells comprising STING (e.g., innate immune cells, e.g., mast cells, macrophages, dendritic cells (DCs), and natural killer cells) with the chemical entity. Methods can also include in vivo methods; e.g., administering the chemical entity to a subject (e.g., a human) having a disease in which increased (e.g., excessive) STING signaling contributes to the pathology and/or symptoms and/or progression of the disease.

In one aspect, methods of treating a condition, disease or disorder ameliorated by antagonizing STING are featured, e.g., treating a condition, disease or disorder in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the condition, disease or disorder (e.g., cancer) in a subject (e.g., a human). The methods include administering to a subject in need of such treatment an effective amount of a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same).

In another aspect, methods of treating cancer are featured that include administering to a subject in need of such treatment an effective amount of a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same).

In a further aspect, methods of treating other STING-associated conditions are featured, e.g., type I interferonopathies (e.g., STING-associated vasculopathy with onset in infancy (SAVI)), Aicardi-Goutières Syndrome (AGS), genetic forms of lupus, and inflammation-associated disorders such as systemic lupus erythematosus, and rheumatoid arthritis. The methods include administering to a subject in need of such treatment an effective amount of a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same).

In another aspect, methods of suppressing STING-dependent type I interferon production in a subject in need thereof are featured that include administering to the subject an effective amount of a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same).

In a further aspect, methods of treating a disease in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the disease are featured. The methods include administering to a subject in need of such treatment an effective amount of a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same).

In another aspect, methods of treatment are featured that include administering an effective amount of a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same) to a subject; wherein the subject has (or is predisposed to have) a disease in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the disease.

In a further aspect, methods of treatment that include administering to a subject a chemical entity described herein (e.g., a compound described generically or specifically herein or a pharmaceutically acceptable salt thereof or compositions containing the same), wherein the chemical entity is administered in an amount effective to treat a disease in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the disease, thereby treating the disease.

Embodiments can include one or more of the following features.

The chemical entity can be administered in combination with one or more additional therapeutic agents and/or regimens. For examples, methods can further include administering one or more (e.g., two, three, four, five, six, or more) additional agents.

The chemical entity can be administered in combination with one or more additional therapeutic agents and/or regimens that are useful for treating other STING-associated conditions, e.g., type I interferonopathies (e.g., STING-associated vasculopathy with onset in infancy (SAVI)), Aicardi-Goutières Syndrome (AGS), genetic forms of lupus, and inflammation-associated disorders such as systemic lupus erythematosus, and rheumatoid arthritis.

The chemical entity can be administered in combination with one or more additional cancer therapies (e.g., surgery, radiotherapy, chemotherapy, toxin therapy, immunotherapy, cryotherapy or gene therapy, or a combination thereof; e.g., chemotherapy that includes administering one or more (e.g., two, three, four, five, six, or more) additional chemotherapeutic agents. Non-limiting examples of additional chemotherapeutic agents is selected from an alkylating agent (e.g., cisplatin, carboplatin, mechlorethamine, cyclophosphamide, chlorambucil, ifosfamide and/or oxaliplatin); an anti-metabolite (e.g., azathioprine and/or mercaptopurine); a terpenoid (e.g., a vinca alkaloid and/or a taxane; e.g., Vincristine, Vinblastine, Vinorelbine and/or Vindesine Taxol, Pacllitaxel and/or Docetaxel); a topoisomerase (e.g., a type I topoisomerase and/or a type 2 topoisomerase; e.g., camptothecins, such as irinotecan and/or topotecan; amsacrine, etoposide, etoposide phosphate and/or teniposide); a cytotoxic antibiotic (e.g., actinomycin, anthracyclines, doxorubicin, daunorubicin, valrubicin, idarubicin, epirubicin, bleomycin, plicamycin and/or mitomycin); a hormone (e.g., a lutenizing hormone releasing hormone agonist; e.g., leuprolidine, goserelin, triptorelin, histrelin, bicalutamide, flutamide and/or nilutamide); an antibody (e.g., Abciximab, Adalimumab, Alemtuzumab, Atlizumab, Basiliximab, Belimumab, Bevacizumab, Bretuximab vedotin, Canakinumab, Cetuximab, Ceertolizumab pegol, Daclizumab, Denosumab, Eculizumab, Efalizumab, Gemtuzumab, Golimumab, Golimumab, Ibritumomab tiuxetan, Infliximab, Ipilimumab, Muromonab-CD3, Natalizumab, Ofatumumab, Omalizumab, Palivizumab, Panitumuab, Ranibizumab, Rituximab, Tocilizumab, Tositumomab and/or Trastuzumab); an anti-angiogenic agent; a cytokine; a thrombotic agent; a growth inhibitory agent; an anti-helminthic agent; and an immune checkpoint inhibitor that targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1-PD-L1, PD-1-PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9-TIM3, Phosphatidylserine—TIM3, lymphocyte activation gene 3 protein (LAG3), MEW class II—LAG3, 4-1BB-4-1BB ligand, OX40-OX40 ligand, GITR, GITR ligand—GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25-TL1A, CD40L, CD40-CD40 ligand, HVEM-LIGHT-LTA, HVEM, HVEM-BTLA, HVEM-CD160, HVEM-LIGHT, HVEM-BTLA-CD160, CD80, CD80-PDL-1, PDL2-CD80, CD244, CD48 CD244, CD244, ICOS, ICOS-ICOS ligand, B7-H3, B7-H4, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86-CD28, CD86-CTLA, CD80-CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine—TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155 (e.g., CTLA-4 or PD1 or PD-L1).

The subject can have cancer; e.g., the subject has undergone and/or is undergoing and/or will undergo one or more cancer therapies.

Non-limiting examples of cancer include melanoma, cervical cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, urothelial carcinoma, bladder cancer, non-small cell lung cancer, small cell lung cancer, sarcoma, colorectal adenocarcinoma, gastrointestinal stromal tumors, gastroesophageal carcinoma, colorectal cancer, pancreatic cancer, kidney cancer, hepatocellular cancer, malignant mesothelioma, leukemia, lymphoma, myelodysplasia syndrome, multiple myeloma, transitional cell carcinoma, neuroblastoma, plasma cell neoplasms, Wilm's tumor, or hepatocellular carcinoma. In certain embodiments, the cancer can be a refractory cancer.

The chemical entity can be administered intratumorally.

The methods can further include identifying the subject.

Other embodiments include those described in the Detailed Description and/or in the claims.

Additional Definitions

To facilitate understanding of the disclosure set forth herein, a number of additional terms are defined below. Generally, the nomenclature used herein and the laboratory procedures in organic chemistry, medicinal chemistry, and pharmacology described herein are those well-known and commonly employed in the art. Unless defined otherwise, all technical and scientific terms used herein generally have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. Each of the patents, applications, published applications, and other publications that are mentioned throughout the specification and the attached appendices are incorporated herein by reference in their entireties.

As used herein, the term “STING” is meant to include, without limitation, nucleic acids, polynucleotides, oligonucleotides, sense and anti sense polynucleotide strands, complementary sequences, peptides, polypeptides, proteins, homologous and/or orthologous STING molecules, isoforms, precursors, mutants, variants, derivatives, splice variants, alleles, different species, and active fragments thereof.

The term “acceptable” with respect to a formulation, composition or ingredient, as used herein, means having no persistent detrimental effect on the general health of the subject being treated.

“API” refers to an active pharmaceutical ingredient.

The terms “effective amount” or “therapeutically effective amount,” as used herein, refer to a sufficient amount of a chemical entity being administered which will relieve to some extent one or more of the symptoms of the disease or condition being treated. The result includes reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system. For example, an “effective amount” for therapeutic uses is the amount of the composition comprising a compound as disclosed herein required to provide a clinically significant decrease in disease symptoms. An appropriate “effective” amount in any individual case is determined using any suitable technique, such as a dose escalation study.

The term “excipient” or “pharmaceutically acceptable excipient” means a pharmaceutically-acceptable material, composition, or vehicle, such as a liquid or solid filler, diluent, carrier, solvent, or encapsulating material. In one embodiment, each component is “pharmaceutically acceptable” in the sense of being compatible with the other ingredients of a pharmaceutical formulation, and suitable for use in contact with the tissue or organ of humans and animals without excessive toxicity, irritation, allergic response, immunogenicity, or other problems or complications, commensurate with a reasonable benefit/risk ratio. See, e.g., Remington: The Science and Practice of Pharmacy, 21st ed.; Lippincott Williams & Wilkins: Philadelphia, Pa., 2005; Handbook of Pharmaceutical Excipients, 6th ed.; Rowe et al., Eds.; The Pharmaceutical Press and the American Pharmaceutical Association: 2009; Handbook of Pharmaceutical Additives, 3rd ed.; Ash and Ash Eds.; Gower Publishing Company: 2007; Pharmaceutical Preformulation and Formulation, 2nd ed.; Gibson Ed.; CRC Press LLC: Boca Raton, Fla., 2009.

The term “pharmaceutically acceptable salt” refers to a formulation of a compound that does not cause significant irritation to an organism to which it is administered and does not abrogate the biological activity and properties of the compound. In certain instances, pharmaceutically acceptable salts are obtained by reacting a compound described herein, with acids such as hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, methanesulfonic acid, ethanesulfonic acid, p-toluenesulfonic acid, salicylic acid and the like. In some instances, pharmaceutically acceptable salts are obtained by reacting a compound having acidic group described herein with a base to form a salt such as an ammonium salt, an alkali metal salt, such as a sodium or a potassium salt, an alkaline earth metal salt, such as a calcium or a magnesium salt, a salt of organic bases such as di cyclohexyl amine, N-methyl-D-glucamine, tris(hydroxymethyl)methyl amine, and salts with amino acids such as arginine, lysine, and the like, or by other methods previously determined. The pharmacologically acceptable salt s not specifically limited as far as it can be used in medicaments. Examples of a salt that the compounds described hereinform with a base include the following: salts thereof with inorganic bases such as sodium, potassium, magnesium, calcium, and aluminum; salts thereof with organic bases such as methylamine, ethylamine and ethanolamine; salts thereof with basic amino acids such as lysine and ornithine; and ammonium salt. The salts may be acid addition salts, which are specifically exemplified by acid addition salts with the following: mineral acids such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, nitric acid, and phosphoric acid:organic acids such as formic acid, acetic acid, propionic acid, oxalic acid, malonic acid, succinic acid, fumaric acid, maleic acid, lactic acid, malic acid, tartaric acid, citric acid, methanesulfonic acid, and ethanesulfonic acid; acidic amino acids such as aspartic acid and glutamic acid.

The term “pharmaceutical composition” refers to a mixture of a compound described herein with other chemical components (referred to collectively herein as “excipients”), such as carriers, stabilizers, diluents, dispersing agents, suspending agents, and/or thickening agents. The pharmaceutical composition facilitates administration of the compound to an organism. Multiple techniques of administering a compound exist in the art including, but not limited to: rectal, oral, intravenous, aerosol, parenteral, ophthalmic, pulmonary, and topical administration.

The term “subject” refers to an animal, including, but not limited to, a primate (e.g., human), monkey, cow, pig, sheep, goat, horse, dog, cat, rabbit, rat, or mouse. The terms “subject” and “patient” are used interchangeably herein in reference, for example, to a mammalian subject, such as a human.

The terms “treat,” “treating,” and “treatment,” in the context of treating a disease or disorder, are meant to include alleviating or abrogating a disorder, disease, or condition, or one or more of the symptoms associated with the disorder, disease, or condition; or to slowing the progression, spread or worsening of a disease, disorder or condition or of one or more symptoms thereof. The “treatment of cancer”, refers to one or more of the following effects: (1) inhibition, to some extent, of tumor growth, including, (i) slowing down and (ii) complete growth arrest; (2) reduction in the number of tumor cells; (3) maintaining tumor size; (4) reduction in tumor size; (5) inhibition, including (i) reduction, (ii) slowing down or (iii) complete prevention, of tumor cell infiltration into peripheral organs; (6) inhibition, including (i) reduction, (ii) slowing down or (iii) complete prevention, of metastasis; (7) enhancement of anti-tumor immune response, which may result in (i) maintaining tumor size, (ii) reducing tumor size, (iii) slowing the growth of a tumor, (iv) reducing, slowing or preventing invasion and/or (8) relief, to some extent, of the severity or number of one or more symptoms associated with the disorder.

The term “halo” refers to fluoro (F), chloro (Cl), bromo (Br), or iodo (I).

The term “alkyl” refers to a hydrocarbon chain that may be a straight chain or branched chain, containing the indicated number of carbon atoms. For example, C_1-10 indicates that the group may have from 1 to 10 (inclusive) carbon atoms in it. Non-limiting examples include methyl, ethyl, iso-propyl, tert-butyl, n-hexyl.

The term “haloalkyl” refers to an alkyl, in which one or more hydrogen atoms is/are replaced with an independently selected halo.

The term “alkoxy” refers to an —O-alkyl radical (e.g., —OCH₃).

The term “alkylene” refers to a divalent alkyl (e.g., —CH₂-).

The term “alkenyl” refers to a hydrocarbon chain that may be a straight chain or branched chain having one or more carbon-carbon double bonds. The alkenyl moiety contains the indicated number of carbon atoms. For example, C_2-6 indicates that the group may have from 2 to 6 (inclusive) carbon atoms in it.

The term “alkynyl” refers to a hydrocarbon chain that may be a straight chain or branched chain having one or more carbon-carbon triple bonds. The alkynyl moiety contains the indicated number of carbon atoms. For example, C_2-6 indicates that the group may have from 2 to 6 (inclusive) carbon atoms in it.

The term “aryl” refers to a 6-20 carbon mono-, bi-, tri- or polycyclic group wherein at least one ring in the system is aromatic (e.g., 6-carbon monocyclic, 10-carbon bicyclic, or 14-carbon tricyclic aromatic ring system); and wherein 0, 1, 2, 3, or 4 atoms of each ring may be substituted by a substituent. Examples of aryl groups include phenyl, naphthyl, indacenyl, tetrahydronaphthyl, and the like.

The term “cycloalkyl” as used herein includes cyclic hydrocarbon groups having 3 to 20 ring carbons, preferably 3 to 16 ring carbons, and more preferably 3 to 12 ring carbons or 3-10 ring carbons or 3-6 ring carbons, wherein the cycloalkyl group may be optionally substituted. Examples of cycloalkyl groups include, without limitation, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, and cyclooctyl. Cycloalkyl may include multiple fused and/or bridged rings. Non-limiting examples of fused/bridged cycloalkyl includes: bicyclo[1.1.0]butane, bicyclo[2.1.0]pentane, bicyclo[1.1.1]pentane, bicyclo[3.0.1.0]hexane, bicyclo[2.1.1]hexane, bicyclo[3.2.0]heptane, bicyclo[4.1.0]heptane, bicyclo[2.2.1]heptane, bicyclo[3.1.1]heptane, bicyclo[4.2.0]octane, bicyclo[3.2.1]octane, bicyclo[2.2.2]octane, and the like. Cycloalkyl also includes spirocyclic rings (e.g., spirocyclic bicycle wherein two rings are connected through just one atom). Non-limiting examples of spirocyclic cycloalkyls include spiro[2.2]pentane, spiro[2.5]octane, spiro[3.5]nonane, spiro[3.5]nonane, spiro[3.5]nonane, spiro[4.4]nonane, spiro[2.6]nonane, spiro[4.5]decane, spiro[3.6]decane, spiro[5.5]undecane, and the like.

The term “cycloalkenyl” as used herein includes partially unsaturated cyclic hydrocarbon groups having 3 to 20 ring carbons, preferably 3 to 16 ring carbons, and more preferably 3 to 12 ring carbons or 3-10 ring carbons or 3-6 ring carbons, wherein the cycloalkenyl group may be optionally substituted. Examples of cycloalkenyl groups include, without limitation, cyclopentenyl, cyclohexenyl, cycloheptenyl, and cyclooctenyl. Cycloalkenyl groups may have any degree of saturation provided that none of the rings in the ring system are aromatic; and the cycloalkenyl group is not fully saturated overall. Cycloalkenyl may include multiple fused and/or bridged and/or spirocyclic rings.

The term “heteroaryl”, as used herein, means a mono-, bi-, tri- or polycyclic group having 5 to 20 ring atoms, alternatively 5, 6, 9, 10, or 14 ring atoms; and having 6, 10, or 14 pi electrons shared in a cyclic array; wherein at least one ring in the system is aromatic (but does not have to be a ring which contains a heteroatom, e.g. tetrahydroisoquinolinyl, e.g., tetrahydroquinolinyl), and at least one ring in the system contains one or more heteroatoms independently selected from the group consisting of N, O, and S. Heteroaryl groups can either be unsubstituted or substituted with one or more substituents. Examples of heteroaryl include thienyl, pyridinyl, furyl, oxazolyl, oxadiazolyl, pyrrolyl, imidazolyl, triazolyl, thiodiazolyl, pyrazolyl, isoxazolyl, thiadiazolyl, pyranyl, pyrazinyl, pyrimidinyl, pyridazinyl, triazinyl, thiazolyl benzothienyl, benzoxadiazolyl, benzofuranyl, benzimidazolyl, benzotriazolyl, cinnolinyl, indazolyl, indolyl, isoquinolinyl, isothiazolyl, naphthyridinyl, purinyl, thienopyridinyl, pyrido[2,3-cl]pyrimidinyl, pyrrolo[2,3-b]pyridinyl, quinazolinyl, quinolinyl, thieno[2,3-c]pyridinyl, pyrazolo[3,4-b]pyridinyl, pyrazolo[3,4-c]pyridinyl, pyrazolo[4,3-c]pyridine, pyrazolo[4,3-b]pyridinyl, tetrazolyl, chromane, 2,3-dihydrobenzo[b][1,4]dioxine, benzo[d][1,3]dioxole, 2,3-dihydrobenzofuran, tetrahydroquinoline, 2,3-dihydrobenzo[b][1,4]oxathiine, isoindoline, and others. In some embodiments, the heteroaryl is selected from thienyl, pyridinyl, furyl, pyrazolyl, imidazolyl, isoindolinyl, pyranyl, pyrazinyl, and pyrimidinyl.

The term “heterocyclyl” refers to a mon-, bi-, tri-, or polycyclic nonaromatic ring system with 3-16 ring atoms (e.g., 5-8 membered monocyclic, 8-12 membered bicyclic, or 11-14 membered tricyclic ring system) having 1-3 heteroatoms if monocyclic, 1-6 heteroatoms if bicyclic, or 1-9 heteroatoms if tricyclic or polycyclic, said heteroatoms selected from O, N, or S (e.g., carbon atoms and 1-3, 1-6, or 1-9 heteroatoms of N, O, or S if monocyclic, bicyclic, or tricyclic, respectively), wherein 0, 1, 2 or 3 atoms of each ring may be substituted by a substituent. Examples of heterocyclyl groups include piperazinyl, pyrrolidinyl, dioxanyl, morpholinyl, tetrahydrofuranyl, and the like. Heterocyclyl may include multiple fused and bridged rings. Non-limiting examples of fused/bridged heteorocyclyl includes: 2-azabicyclo[1.1.0]butane, 2-azabicyclo[2.1.0]pentane, 2-azabicyclo[1.1.1]pentane, 3-azabicyclo[3.1.0]hexane, 5-azabicyclo[2.1.1]hexane, 3-azabicyclo[3.2.0]heptane, octahydrocyclopenta[c]pyrrole, 3-azabicyclo[4.1.0]heptane, 7-azabicyclo[2.2.1]heptane, 6-azabicyclo[3.1.1]heptane, 7-azabicyclo[4.2.0]octane, 2-azabicyclo[2.2.2]octane, 3-azabicyclo[3.2.1]octane, 2-oxabicyclo[1.1.0]butane, 2-oxabicyclo[2.1.0]pentane, 2-oxabicyclo[1.1.1]pentane, 3-oxabicyclo[3.1.0]hexane, 5-oxabicyclo[2.1.1]hexane, 3-oxabicyclo[3.2.0]heptane, 3-oxabicyclo[4.1.0]heptane, 7-oxabicyclo[2.2.1]heptane, 6-oxabicyclo[3.1.1]heptane, 7-oxabicyclo[4.2.0]octane, 2-oxabicyclo[2.2.2]octane, 3-oxabicyclo[3.2.1]octane, and the like. Heterocyclyl also includes spirocyclic rings (e.g., spirocyclic bicycle wherein two rings are connected through just one atom). Non-limiting examples of spirocyclic heterocyclyls include 2-azaspiro[2.2]pentane, 4-azaspiro[2.5]octane, 1-azaspiro[3.5]nonane, 2-azaspiro[3.5]nonane, 7-azaspiro[3.5]nonane, 2-azaspiro[4.4]nonane, 6-azaspiro[2.6]nonane, 1,7-diazaspiro[4.5]decane, 7-azaspiro[4.5]decane 2,5-diazaspiro[3. 6]decane, 3-azaspiro[5. 5]undecane, 2-oxaspiro[2.2]pentane, 4-oxaspiro[2.5]octane, 1-oxaspiro[3.5]nonane, 2-oxaspiro[3.5]nonane, 7-oxaspiro[3.5]nonane, 2-oxaspiro[4.4]nonane, 6-oxaspiro[2.6]nonane, 1,7-dioxaspiro[4.5]decane, 2,5-dioxaspiro[3.6]decane, 1-oxaspiro[5. 5]undecane, 3-oxaspiro[5.5]undecane, 3-oxa-9-azaspiro[5.5]undecane and the like.

In addition, atoms making up the compounds of the present embodiments are intended to include all isotopic forms of such atoms. Isotopes, as used herein, include those atoms having the same atomic number but different mass numbers. By way of general example and without limitation, isotopes of hydrogen include tritium and deuterium, and isotopes of carbon include ¹³C and ¹⁴C.

In addition, the compounds generically or specifically disclosed herein are intended to include all tautomeric forms. Thus, by way of example, a compound containing the moiety:

encompasses the tautomeric form containing the moiety:

Similarly, a pyridinyl or pyrimidinyl moiety that is described to be optionally substituted with hydroxyl encompasses pyridone or pyrimidone tautomeric forms.

The details of one or more embodiments of the invention are set forth in the accompanying drawings and the description below. Other features and advantages of the invention will be apparent from the description and drawings, and from the claims.

DETAILED DESCRIPTION

This disclosure features chemical entities (e.g., a compound or a pharmaceutically acceptable salt, and/or hydrate, and/or cocrystal, and/or drug combination of the compound) that inhibit (e.g., antagonize) Stimulator of Interferon Genes (STING). Said chemical entities are useful, e.g., for treating a condition, disease or disorder in which increased (e.g., excessive) STING activation (e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the condition, disease or disorder (e.g., cancer) in a subject (e.g., a human). This disclosure also features compositions containing the same as well as methods of using and making the same.

Formula I Compounds

In one aspect, compounds of Formula (I), or a pharmaceutically acceptable salt thereof, are featured:

or a pharmaceutically acceptable salt thereof or a tautomer thereof,

wherein:

Z is selected from the group consisting of a bond, CR¹, C(R³)₂, N, and NR²;

each of Y¹, Y², and Y³ is independently selected from the group consisting of O, S, CR¹, C(R³)₂, N, and NR²;

Y⁴ is C or N;

X⁴ is selected from the group consisting of O, S, N, NR², and CR¹;

X² is selected from the group consisting of O, S, N, NR⁴, and CR⁵;

each is independently a single bond or a double bond, provided that the five-membered ring comprising Y⁴, X⁴, and X² is heteroaryl;

W is defined according to (A) or (B) below:

A

W is Q¹-Q²-A, wherein

Q¹ is selected from the group consisting of:

• • (a) phenyl optionally substituted with from 1-2 independently selected R^q1; and
  • (b) heteroaryl including from 5-6 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^q1;

Q² is selected from the group consisting of: a bond, —NH—, —N(C_1-3 alkyl)-, —O—, —C(═O), and S(O)_0-2—;

A is:

(i) —(Y^A1)_n—Y^A2, wherein:

• • n is 0 or 1;
  • Y^A1 is C_1-6 alkylene, which is optionally substituted with from 1-6 R^a; and
  • Y^A2 is:
    • (a) C_3-20 cycloalkyl, which is optionally substituted with from 1-4 R^b,
    • (b) C_6-20 aryl, which is optionally substituted with from 1-4 R^c;
    • (c) heteroaryl including from 5-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; or
    • (d) heterocyclyl including from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heterocyclyl ring is optionally substituted with from 1-4 independently selected R^b,

OR

(ii) —Z¹—Z²—Z³, wherein:

• • Z¹ is C_1-3 alkylene, which is optionally substituted with from 1-4 R^a;
  • Z² is N(H)—, —N(R^d)—, —O—, or —S—; and
  • Z³ is C_2-7 alkyl, which is optionally substituted with from 1-4 R^a;

OR

(iii) C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a,

OR

B

W is selected from the group consisting of:

(a) C_7-20 bicyclic or polycyclic aryl, which is optionally substituted with from 1-4 R^c; and

(b) bicyclic or polycyclic heteroaryl including from 7-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c;

each occurrence of R¹ is independently selected from the group consisting of

• • H;
  • halo;
  • cyano;
  • C_1-6 alkyl optionally substituted with 1-2 R^a;
  • C_2-6 alkenyl optionally substituted with 1-2 R^a;
  • C_2-6 alkynyl optionally substituted with 1-2 R^a;
  • C_1-4 haloalkyl;
  • C_1-4 alkoxy;
  • C_1-4 haloalkoxy;
  • -L³-L⁴-Rⁱ;
  • —S(O)_1-2(C_1-4 alkyl),
  • —S(O)(═NH)(C_1-4 alkyl),
  • SF₅,
  • —NR^eR^f,
  • —OH,
  • oxo,
  • —S(O)_1-2 (NR′R″),
  • —C_1-4 thioalkoxy,
  • —NO₂,
  • —C(═O)(C_1-4 alkyl),
  • —C(═O)O(C_1-4 alkyl),
  • —C(═O)OH, and
  • —C(═O)N(R′)(R″);

or a pair of R¹ on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy,

each occurrence of R² is independently selected from the group consisting of:

• • (i) C_1-6 alkyl, which is optionally substituted with from 1-2 independently selected R^a.
  • (ii) C_3-6 cycloalkyl;
  • (iii) heterocyclyl including from 3-10 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2;
  • (iv) C_6-10 aryl;
  • (v) heteroaryl including from 5-10 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2;
  • (vi) —C(O)(C_1-4 alkyl);
  • (vii) —C(O)O(C_1-4 alkyl);
  • (viii) —CON(R′)(R″);
  • (ix) —S(O)_1-2 (NR′R″);
  • (x) —S(O)_1-2(C_1-4 alkyl);
  • (xi) —OH;
  • (xii) C_1-4 alkoxy; and
  • (xiii) H;

or a pair of R¹ and R² on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms (in addition to the nitrogen atom to which the R² is attached) are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy,

each occurrence of R³ is independently selected from H; C_1-6 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; —F; —Cl; —Br; —NR^eR^f; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; —C(═O)N(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2(C_1-4 alkyl); cyano; and C_3-6 cycloalkyl optionally substituted with from 1-4 independently selected C_1-4 alkyl; or

two R³ on the same carbon combine to form an oxo; or

a pair of R³, taken together with the atom(s) connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy; or

a pair of R¹ and R³ on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy; or

or a pair of R² and R³ on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms (in addition to the nitrogen atom to which the R² is attached) are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy;

R⁴ is selected from H and C_1-6 alkyl;

R⁵ is selected from H and halo;

R⁶ is selected from H; C_1-6 alkyl; —OH; C_1-4 alkoxy; C(═O)H; C(═O)(C_1-4 alkyl); CN; C_6-10 aryl optionally substituted with from 1-4 independently selected C_1-4 alkyl; and heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected C_1-4 alkyl;

each occurrence of R^q1 is independently selected from the group consisting of:

• • (a) halo;
  • (b) cyano;
  • (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a;
  • (d) C_2-6 alkenyl;
  • (e) C_2-6 alkynyl;
  • (f) C_3-6 cycloalkyl;
  • (g) C_1-4 alkoxy;
  • (h) C_1-4 haloalkoxy;
  • (i) —S(O)_1-2(C_1-4 alkyl);
  • (j) —NR^eR^f;
  • (k) OH;
  • (l) —S(O)_1-2 (NR′R″);
  • (m) —C_1-4 thioalkoxy;
  • (n) —NO₂;
  • (o) —C(═O)(C_1-4 alkyl);
  • (p) —C(═O)O(C_1-4 alkyl);
  • (q) —C(═O)OH;
  • (r) —C(═O)N(R′)(R″); and
  • (s) oxo;

each occurrence of R^a is independently selected from the group consisting of: —OH; —F; —Cl; —Br; NR^eR^f; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)O(C_1-4 alkyl); —C(═O)(C_1-4 alkyl); —C(═O)OH; —CON(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2 (C_1-4 alkyl); cyano; and C_3-6 cycloalkyl optionally substituted with from 1-4 independently selected C_1-4 alkyl;

each occurrence of R^b is independently selected from the group consisting of: C_1-10 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; oxo; —F; —Cl; —Br; NR^eR^f; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; —C(═O)N(R′)(R″); —S(O)_1-2(NR′R″); —S(O)₁-2(C_1-4 alkyl); cyano; and -L¹-L²-R^h;

each occurrence of R^c is independently selected from the group consisting of:

(a) halo; (b) cyano; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)₁-2(C_1-4 alkyl); (j) —NR^eR^f; (k) OH; (l) —S(O)_1-2(NR′R″); (m) —C_1-4 thioalkoxy; (n) —NO₂; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (r) —C(═O)N(R′)(R″); (s) -L¹-L²-R^b; and (t) oxo;

R^d is selected from the group consisting of: C_1-6 alkyl; C_3-6 cycloalkyl; —C(O)(C_1-4 alkyl); —C(O)O(C_1-4 alkyl); —CON(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2(C_1-4 alkyl); —OH; and C_1-4 alkoxy;

each occurrence of R^e and R^f is independently selected from the group consisting of: H; C_1-6 alkyl optionally substituted with from 1-2 substituents each independently selected from halo, OH, C_1-4 alkoxy, C_1-4 haloalkoxy, and CN; C_1-6 haloalkyl; C_3-6 cycloalkyl; —C(O)(C_1-4 alkyl); —C(O)O(C_1-4 alkyl); —CON(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)₁-2(C_1-4 alkyl); —OH; and C_1-4 alkoxy; or R^e and R^f together with the nitrogen atom to which each is attached forms a ring including from 3-8 ring atoms, wherein the ring includes: (a) from 1-7 ring carbon atoms, each of which is substituted with from 1-2 substituents independently selected from H and C_1-3 alkyl; and (b) from 0-3 ring heteroatoms (in addition to the nitrogen atom attached to R^e and R^f), which are each independently selected from the group consisting of N(R^d), NH, O, and S;

-L¹ is a bond or C_1-3 alkylene optionally substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN;

-L² is —O—, —N(H)—, —S(O)_0-2—, or a bond;

R^h is selected from:

• • C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl (in certain embodiments, it is provided that when R^h is C_3-6 cycloalkyl optionally substituted with from 1-4 substituents independently selected C_1-4 alkyl, -L¹ is a bond, or -L² is —O—, —N(H)—, or —S—);
  • heterocyclyl, wherein the heterocyclyl includes from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;
  • heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;

-L³ is a bond; C_1-3 alkylene optionally substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN; CH═CH; or C≡C;

-L⁴ is —O—, —N(H)—, —S(O)_0-2—, or a bond;

Rⁱ is selected from:

• • C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;
  • heterocyclyl, wherein the heterocyclyl includes from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;
  • heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and

each occurrence of R′ and R″ is independently selected from the group consisting of: H, C_1-4 alkyl, and C_6-10 aryl optionally substituted with from 1-2 substituents selected from halo, C_1-4 alkyl, and C_1-4 haloalkyl; or R′ and R″ together with the nitrogen atom to which each is attached forms a ring including from 3-8 ring atoms, wherein the ring includes: (a) from 1-7 ring carbon atoms, each of which is substituted with from 1-2 substituents independently selected from the group consisting of H and C_1-3 alkyl; and (b) from 0-3 ring heteroatoms (in addition to the nitrogen atom attached to R′ and R″), which are each independently selected from the group consisting of N(H), N(C_1-6 alkyl), O, and S.

The Variables Z, Y¹, Y², Y³, and Y⁴

In some embodiments, the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic.

In some embodiments (e.g., when the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic), Z is selected from the group consisting of CR¹, N, and NR².

In certain embodiments, Z is CR¹. In some embodiments (e.g., when Z is selected from the group consisting of CR¹, N, and NR² (e.g., when Z is CR⁴)), each of Y¹, Y², and Y³ is independently selected from the group consisting of CR¹, N, and NR² (e.g., CR¹ and N). In certain embodiments (e.g., when Z is selected from the group consisting of CR¹, N, and NR² (e.g., when Z is CR⁴)), each of Y¹, Y², and Y³ is independently CR¹.

In certain embodiments, the

moiety is

In certain embodiments (e.g., when Z is selected from the group consisting of CR¹, N, and NR² (e.g., when Z is CR⁴)), from 1-2 of Y¹, Y², and Y³ is independently N or NR² (e.g., N).

In certain embodiments (e.g., when Z is selected from the group consisting of CR¹, N, and NR² (e.g., when Z is CR⁴)), one of Y¹, Y², and Y³ is N or NR² (e.g., N).

In certain embodiments (e.g., when from 1-2 (e.g., 1) of Y¹, Y², and Y³ is independently N or NR² (e.g., N)), each of the remaining Y¹, Y², and Y³ is an independently selected CR¹.

In certain embodiments,

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In certain embodiments,

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In certain embodiments,

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In some embodiments (e.g., when the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic), Z is N.

In some embodiments (e.g., when Z is N), each of Y¹, Y², and Y³ is independently selected from the group consisting of CR¹ and N.

In certain embodiments, each of Y¹, Y², and Y³ is independently CR¹ (e.g., the

moiety is

wherein the asterisk denotes point of attachment to Y⁴)

In certain embodiments, the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In some embodiments (e.g., when the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic), Z is a bond.

In certain of these embodiments, Y¹ is selected from the group consisting of CR¹, N, O, and S (e.g., CR¹, N, and S).

In certain embodiments (when Z is a bond; and the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic), Y² is selected from the group consisting of CR¹ and NR².

In certain embodiments (when Z is a bond; and the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic), Y³ is selected from the group consisting of CR¹, N, O, and S (e.g., CR¹, N, and S).

In certain embodiments, the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In certain embodiments, the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In certain embodiments, the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In some embodiments, the ring that includes Z, Y¹, Y², Y³, and Y⁴ is partially saturated.

In certain of these embodiments, Z is C(R³)₂ or a bond (e.g., Z is C(R³)₂).

In certain embodiments (when the ring that includes Z, Y¹, Y², Y³, and Y⁴ is partially saturated), each of Y², and Y³ is independently selected from the group consisting of C(R³)₂, O, NR², and S.

In certain of these embodiments, one of Y¹, Y², and Y³ (e.g., Y¹ or Y²) is independently O or NR²; and each of the remaining Y¹, Y², and Y³ is an independently selected C(R³)₂.

In certain of the foregoing embodiments, Y¹ is O or NR² (e.g., NR²). In certain other embodiments, Y² is O or NR² (e.g., O).

In certain embodiments, the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

In certain embodiments, the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

The Variables X¹ and X²

In some embodiments, Y⁴ is C.

In some embodiments, X¹ is NR² (e.g., NH).

In some embodiments, X² is CR⁵ (e.g., CH).

In some embodiments, X² is N.

In certain embodiments, Y⁴ is C; and X¹ is NR².

In certain embodiments, Y⁴ is C; X¹ is NR² (e.g., NH); and X² is CR⁵ (e.g., CH).

In certain embodiments, Y⁴ is C; X¹ is NH; and X² is CH.

Non-Limiting Combinations of Z, Y¹, Y², Y³, Y⁴, X¹, and X²

In certain embodiments, the compound is selected from a compound of the following formulae:

In certain embodiments, the compound has formula (Ia):

As a non-limiting example of the foregoing embodiments, the compound has formula (Ia-0):

As a non-limiting example of the foregoing embodiments, the compound has formula (Ia-1):

As further non-limiting examples, the compound has formula (Ia-2), formula (Ia-3), formula (Ia-4), or formula (Ia-5):

In certain embodiments, the compound has formula (Ib):

As a non-limiting example of the foregoing embodiments, the compound has formula (Ib-1)

In certain embodiments, the compound has formula (Ic):

As a non-limiting example of the foregoing embodiments, the compound has formula (Ic-1):

In certain embodiments, the compound has formula (Id):

As non-limiting examples of the foregoing embodiments, the compound has formula (Id-1) or formula (Id-2):

In certain embodiments, the compound has formula (Ie):

As a non-limiting example of the foregoing embodiments, the compound has formula (Ie-1)

In certain embodiments, the compound is selected from a compound of the following formulae:

In certain embodiments, the compound is selected from a compound of the following formulae:

The Variable R¹

In some embodiments, R¹ is selected from the group consisting of: H; halo; cyano; C_1-6 alkyl optionally substituted with 1-2 R^a; C_2-6 alkenyl optionally substituted with 1-2 R^a; C_2-6 alkynyl optionally substituted with 1-2 R^a; C_1-4 haloalkyl; C_1-4 alkoxy; C_1-4 haloalkoxy; -L³-L⁴-Rⁱ; —S(O)_1-2(C_1-4 alkyl); —S(O)(═NH)(C_1-4 alkyl); SF₅; —NR^eR^f; —S(O)_1-2(NR′R″); —C_1-4 thioalkoxy; —NO₂; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; and —C(═O)N(R′)(R″).

In some embodiments, from —O—3 (e.g., 0, 1, 2, or 3 (e.g., 0, 1, or 2)) occurrences of R¹ is other than H; and each of the remaining occurrences of R¹ is H. In certain embodiments, each occurrence of R¹ is H. In certain embodiments, from 1-3 (e.g., 1, 2, or 3 (e.g., 1 or 2)) occurrences of R¹ is other than H.

In certain embodiments, one occurrence of W is halo (e.g., F or Cl (e.g., F)).

In certain embodiments, one occurrence of W is C_1-6 alkyl (e.g., C_1-3 alkyl) optionally substituted with 1-2 R^a. In certain of these embodiments, R^a is selected from OH, NR^eR^f, C(═O)OH, C_1-4 alkoxy, and C_1-4 haloalkoxy. As non-limiting examples of the foregoing embodiments, R¹ is selected from the group consisting of methyl, isopropyl, CH₂OH, C(OH)Me₂, CH(Me)(OMe), CH₂C(═O)OH, CH₂C(═O)NHMe, and CH₂C(═O)NH(CH₂CH₂OH).

In certain embodiments, one occurrence of R¹ is C_2-6 alkynyl or C_2-6 alkenyl, each of which is optionally substituted with 1-2 R^a (e.g., C_2-6 alkynyl optionally substituted with 1-2 R^a). In certain of these embodiments, R^a is selected from OH, NR^eR^f, C(═O)OH, C_1-4 alkoxy, and C_1-4 haloalkoxy. As non-limiting examples of the foregoing embodiments, one occurrence of R¹ is selected from the group consisting of:

In certain embodiments, one occurrence of R¹ is —C(═O)(C_1-4 alkyl) (e.g., —C(═O)Me) or CN. In certain embodiments, one occurrence of R¹ is C(═O)N(R′)(R″) (e.g., C(═O)NHMe or C(═O)NMe²). In certain embodiments, one occurrence of R¹ is C_1-4 haloalkyl (e.g., CF₃ or CH₂CF³). In certain embodiments, one occurrence of R¹ is S(O)_1-2(C_1-4 alkyl) or S(O)(═NH)(C_1-4 alkyl) (e.g., S(O)₂Me or S(O)(═NH)(Me)). In certain embodiments, one occurrence of R¹ is SF₅. In certain embodiments, one occurrence of R¹ is —NR^eR^f (e.g., NHS(O)₂(C_1-4 alkyl (e.g., NHS(O)₂Me)).

In certain embodiments, one occurrence of R¹ is -L³-L⁴-Rⁱ.

In certain of these embodiments, leis selected from the group consisting of:

• • heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl.

In certain of the foregoing embodiments, Rⁱ is C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl. As a non-limiting example of the foregoing embodiments, Rⁱ is C₆ aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl (e.g., leis unsubstituted phenyl).

In certain embodiments (when R¹ is -L³-L⁴-Rⁱ), Rⁱ is heteroaryl including from 5-10 (e.g., 5-6) ring atoms, wherein from 1-4 (e.g., from 1-2) ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl.

In certain of these embodiments (when R¹ is -L³-L⁴-Rⁱ), Rⁱ is selected from pyridyl, pyrimidinyl, thiazolyl, and pyrazolyl, each of which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl.

As non-limiting examples of the foregoing embodiments, Rⁱ is selected from:

In certain embodiments (when R¹ is -L³-L⁴-Rⁱ), Rⁱ is selected from the group consisting of:

• • C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • heterocyclyl, wherein the heterocyclyl includes from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalky.

In certain of these embodiments, Rⁱ is C_3-8 cycloalkyl optionally substituted with from 1-4 (e.g., 1-2) substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl. As non-limiting examples of the foregoing embodiments, Rⁱ is

In certain embodiments (when R¹ is -L³-L⁴-Rⁱ), Rⁱ is heterocyclyl, wherein the heterocyclyl includes from 3-8 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalky. As a non-limiting example of the foregoing embodiments, Rⁱ is

In certain embodiments (when R¹ is -L³-L⁴-10, -L³ is a bond. In certain embodiments (when R¹ is -L³-L⁴-10, -L³ is C_1-3 alkylene (e.g., CH₂). In certain embodiments (when R¹ is -L³-L⁴-Rⁱ), -L³ is C_1-3 alkylene substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN. As a non-limiting example of the foregoing embodiments, -L³ is —CH(MnO₂)—.

In certain embodiments (when R⁴ is -L³-L⁴-Rⁱ), -L⁴ is a bond. In certain embodiments (when R¹ is -L³-L⁴-10, -L⁴ is —O—or —S—.

In certain embodiments (when R¹ is -L³-L⁴-10, -L³ is a bond; and -L⁴ is a bond. In certain embodiments (when R¹ is -L³-L⁴-10, -L³ is C_1-3 alkylene; and -L⁴ is a bond. In certain embodiments (when R¹ is -L³-L⁴-Rⁱ), -L³ is C_1-3 alkylene optionally substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN; and -L⁴ is a bond. In certain embodiments (when R³ is L³-L⁴-10, -L³ is a bond; and -L⁴ is —O—or —S—.

As non-limiting examples when R¹ is -L³-L⁴-Rⁱ, R¹ is selected from the group consisting of:

As further non-limiting examples when R³ is -L³-L⁴-Rⁱ, R¹ is selected from the group consisting of:

In one or more of the foregoing embodiments of one occurrence of R¹, each remaining R¹ is H.

In one or more of the foregoing embodiments of one occurrence of R¹, one or two other occurrences of R¹ is independently halo (e.g., F) or C_1-4 alkyl; and each remaining R¹ is H.

The Variable R²

In some embodiments, R² is H.

In certain embodiments, when X¹ is NR², the R² group of X¹ is H.

In some embodiments, R² is C_1-6 alkyl, which is optionally substituted with from 1-2 independently selected R^a (e.g., unsubstituted C₁-3 alkyl); or R² is C_1-4 haloalkyl (e.g., CH₂CF₃).

In some embodiments, R² is —C(O)(C_1-4 alkyl) (e.g., C(O)Me).

In some embodiments, R² is C_6-10 aryl (e.g., phenyl).

The Variable R³

In some embodiments, each occurrence of R³ is independently selected from: H; C_1-6 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; —F; —Cl; NR^eR^f; C_1-4 alkoxy; and C_1-4 haloalkoxy; or

two R³ on the same carbon combine to form an oxo.

In some embodiments, each occurrence of R³ is independently H, C_1-6 alkyl, or C_1-4 haloalkyl; or two R³ on the same carbon combine to form an oxo.

The Variable R⁵

In some embodiments, R⁵ is H.

In some embodiments, R⁵ is halo.

The Variable R⁶

In some embodiments, R⁶ is H.

In some embodiments, R⁶ is C_1-6 alkyl (e.g., C₁, C₂, C₃ alkyl).

The Variable W

Embodiments when W is as defined according to (A) In some embodiments, W is defined according to (A).

In certain embodiments, Q¹ is phenyl optionally substituted with from 1-2 independently selected WO.

In certain embodiments, Q¹ is

wherein the asterisk denotes point of attachment of Q².

In certain embodiments, Q¹ is heteroaryl including from 5-6 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^q1.

In certain of these embodiments, Q¹ is heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1 (e.g., Q¹ is oxazolyl, thiazolyl, or thiadiazolyl).

In certain of the foregoing embodiments, Q¹ heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1, wherein one ring atom of Q¹ is S or O (e.g., S; or e.g., O). As non-limiting examples of the foregoing embodiments, Q¹ is selected from the group consisting of:

wherein the asterisk denotes point of attachment of Q². As non-limiting examples of the foregoing embodiments, Q¹ is selected from the group consisting of:

wherein the asterisk denotes point of attachment of Q².

In certain embodiments (when Q¹ is heteroaryl including from 5-6 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^q1), Qi is heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1.

In certain of these embodiments, Q¹ is pyridyl or pyrimidinyl, each of which is optionally substituted with 1-2 independently selected R^q1. As non-limiting examples of the foregoing embodiments, Q¹ is selected from the group consisting of:

each of which is optionally substituted with 1-2 independently selected R^q1, wherein the asterisk denotes point of attachment of Q².

In certain embodiments, each R^q1 is independently selected from the group consisting of: halo; cyano; C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a (e.g., unsubstituted C₁-10 alkyl); C_3-6 cycloalkyl; and oxo.

In certain embodiments, Q² is a bond.

In certain other embodiments, Q² is —O—, —NH—, or S(O)_0-2 (e.g., Q² is —O—; or Q² is —NH—; or Q² is S(O)₂—).

In certain embodiments, A is —(Y^A1)_n—Y^A2.

In certain of these embodiments, n is 0.

In other embodiments, n is 1. In certain of these embodiments, Y^A1 is C_1-6 alkylene, which is optionally substituted with from 1-2 R^a.

In certain embodiments, Y^A2 is C_6-10 aryl, which is optionally substituted with from 1-3 R^c, such as wherein Y^A2 is C₆ aryl, which is optionally substituted with from 1-3 R^c; or

Y^A2 is C_7-15 bicyclic or tricyclic aryl which is optionally substituted with from 1-3 R^c, such as wherein Y^A2 is naphthyl, tetrahydronaphthyl, indacenyl, or 1′,3′-dihydrospiro[cyclopropane-1,2′-indene] such as

each of which is optionally substituted with from 1-3 R^c.

In certain embodiments, Y^A2 is C_6-10 aryl, which is optionally substituted with from 1-3 R^c.

In certain embodiments, Y^A2 is C₆ aryl, which is optionally substituted with from 1-3 R^c (e.g., Y^A2 is unsubstituted phenyl; or Y^A2 is phenyl which is substituted with from 1-3 (e.g., 1, 2, or 3) R^c).

Y^A2 In certain embodiments, Y is phenyl substituted with from 1-3 R^c, wherein one R^c is at the ring carbon para to the point of attachment to Y^A1.

In certain embodiments, Y^A2 is phenyl substituted with from 1-3 R^c, wherein from 1-2 R^c is at the ring carbons meta to the point of attachment to Y^A1.

In certain embodiments, Y^A2 is C_7-15 bicyclic or tricyclic aryl which is optionally substituted with from 1-3 R^c (e.g., naphthyl, tetrahydronaphthyl, indacenyl, or 1′,3′-dihydrospiro[cyclopropane-1,2′-indene]

each of which is optionally substituted with from 1-3 R^c).

In certain embodiments, Y^A2 is heteroaryl including from 5-14 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments, Y^A2 is heteroaryl including 6 ring atoms (e.g., pyridyl or pyrimidinyl (e.g., pyridyl

wherein from 1-2 ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-3 independently selected R^c.

In certain embodiments, each occurrence of R^c is independently selected from the group consisting of: (a) halo; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (m) —C_1-4 thioalkoxy; (o) —C(═O)(C_1-4 alkyl); and (s) L¹-L²-R^h.

In one or more of the foregoing embodiments, one occurrence of R^c is halo.

In certain embodiments, one occurrece of R^c is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a.

In certain of these embodiments, one occurrence of R^c is unsubstituted C_1-10 alkyl (e.g., C₂, C₃, C₄, C₅, C₆, or C_7-10.

In certain embodiments (when one occurrece of R^c is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a), one occurrece of R^c is C_1-10 alkyl which is substituted with from 1-6 independently selected R^a.

In certain embodiments, Y^A2 is C_3-10 cycloalkyl, which is optionally substituted with from 1-4 R^b. In certain of these embodiments, Y^A2 is C₆ cycloalkyl, which is substituted with from 1-4 (e.g., from 1-2) R^b (e.g., Y^A2 is

In certain embodiments (when Y^A2 is C_3-10 cycloalkyl, which is optionally substituted with from 1-4 R^b), Y^A2 is C_8-10 cycloalkyl, which is optionally substituted with from 1-4 R^b (e.g., Y^A2 is

In certain embodiments, Y^A2 is heterocyclyl including from 3-12 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heterocyclyl ring is optionally substituted with from 1-4 independently selected R^b. In certain of these embodiments, Y^A2 is heterocyclyl including from 4-12 (e.g., 4-8) ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heterocyclyl ring is optionally substituted with from 1-4 independently selected R^b (e.g., Y^A2 is tetrahydropyranyl, morpholinyl, azetidinyl, or oxetanyl, each of which is optionally substituted with from 1-4 independently selected R^b). As non-limiting examples of the foregoing embodiments, Y^A2 is selected from the group consisting of:

In one or more of the foregoing embodiments, each occurrence of R^b is independently selected from the group consisting of: C_1-10 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; —F; —Cl; —Br; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —S(O)_1-2(C_1-4 alkyl); cyano; and -L¹-L²-R^h.

In certain embodiments, one occurrece of R^b is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a. In certain of these embodiments, one occurrence of R^b is unsubstituted C₁-10 alkyl (e.g., C₂, C₃, C₄, C₅, C₆, or C_7-10).

In certain embodiments, one occurrence of R^b is —F or —Cl (e.g., —F).

In certain embodiments, one occurrence of R^b is -L¹-L²-R^b. In certain of these embodiments, -L¹ is a bond. In certain embodiments (when one occurrence of R^b is -L¹-L²-R^h), -L² is a bond. In certain embodiments (when one occurrence of R^b is -L¹-L²-R_h), R^h is C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl. In certain embodiments (when one occurrence of R^b is -L¹-L²-R^h), R^h is C_6-10 aryl (e.g., C₆), which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, or C_1-4 haloalkyl (e.g., R^h is unsubstituted phenyl).

In certain embodiments, A is C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a. In certain embodiments, A is C_4-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a. In certain embodiments, A is C_1-10 alkyl, which is substituted with from 1-6 independently selected R^a (e.g., CF₃). In certain embodiments, A is C_1-3 alkyl, which is substituted with from 2-6 independently selected R^a. In certain embodiments, A is unsubstituted C_4-10 alkyl (e.g., butyl).

Non-limiting examples of W when W is defined according to (A) includes:

Non-limiting examples of W when W is defined according to (A) also include:

Non-limiting examples of W when W is defined according to (A) also include:

Embodiments when W is as defined according to (B)

In some embodiments, W is defined according to (B).

In certain embodiments, W is C_7-20 bicyclic or polycyclic aryl, which is optionally substituted with from 1-4 R^c. In certain embodiments, W is C_9-12 bicyclic aryl, which is optionally substituted with from 1-4 R^c. In certain of these embodiments, W is C_0-10 (e.g., C₁₀) bicyclic aryl, which is optionally substituted with from 1-4 R^c (e.g., naphthyl, tetrahydronaphthyl, or indacenyl). As a non-limiting example of the foregoing embodiments, W is

In certain embodiments, W is bicyclic or polycyclic heteroaryl including from 7-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments, W is selected from the group consisting of:

wherein:

W^a, W^b, W^c, W^d, W^e, W^f, and W^g are each independently selected from the group consisting of: N, CH, and CR^c, provided that from 1-4 of W^a-W^g is N, and no more than 4 of W^a-W^g are CR^c;

W^h and Wⁱ are independently selected from the group consisting of N, NH, NR^d, O, S, CH, and CR^c;

W^j and W^o are independently N or C;

W^k, W^l, W^m, and Wⁿ are independently N, CH, or CR^c, provided that:

• from 1-4 of W^h-W^o are heteroatoms,
• no more than 4 of W^h-W^o are CR^c, and
• when one of W^h and Wⁱ is N, the other one of W^h and Wⁱ is CH, CR^c, O or S;

each is independently a single bond or a double bond, provided that the 5-membered ring including Wⁱ, W^j, W^o, and W^h is aromatic, and the 6-membered ring including W^o, W^j, W^k, W^l, W^m, and Wⁿ is aromatic.

In certain of the foregoing embodiments, W^a is N; and W^b and W^c are CH. In certain embodiments, W^b is N; and W^a and W^c are CH. In certain embodiments, W is CR^c or CH (e.g., W is CR^c). In certain of these embodiments, W^g, W^e, and W^d are each independently CH or CR^c (e.g., each CH). As a non-limiting example of the foregoing embodiments, W can be

In certain embodiments, one of W^h and Wⁱ is selected from the group consisting of O and S; and the other one of W^h and Wⁱ is N. In certain of these embodiments, W^o and W^j are C. In certain embodiments, each of W^k, W^l, W^m, and Wⁿ is independently CH or CR^c (e.g., CH). As a non-limiting example of the foregoing embodiments, W can be:

In certain embodiments, W is bicyclic heteroaryl including from 9-12 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain of these embodiments, W is bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments (W is bicyclic heteroaryl including from 9-12 (e.g., 9-10) ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c), W includes a ring sulfur atom or ring oxygen atom. As a non-limiting example of the foregoing embodiments, W is

which is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments (when W is bicyclic or polycyclic heteroaryl (e.g., bicyclic heteroaryl) including from 7-20 (e.g., 9-12 (e.g., 9-10)) ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c), W includes a pyridine (including pyridone) ring.

In certain embodiments (W is bicyclic heteroaryl including from 9-12 (e.g., 9-10) ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c), W includes a pyridine (including pyridone) ring or a pyrimidine (including pyrimidone) ring (e.g., W includes a pyridine (including pyridone) ring).

As non-limiting examples of the foregoing embodiments, W is selected from the group consisting of:

(such as

and each of which is further optionally substituted with from 1-3 independently selected R^c.

In certain embodiments, W is tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c. In certain of these embodiments, W includes a pyridine ring. As non-limiting examples of the foregoing embodiments, W is selected from the group consisting of:

each of which is optionally substituted with from 1-4 independently selected R^c.

In one or more of the foregoing embodiments (e.g., when W is defined according to (B)), each occurrence of R^c is independently selected from the group consisting of: (a) halo; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (m) —C_1-4 thioalkoxy; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (s) -L¹-L²R^h; and (t) oxo.

In certain embodiments, one occurrence of R^c is halo.

In certain embodiments, one occurrece of R^c is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a. In certain of these embodiments, one occurrence of R^c is unsubstituted C_1-10 alkyl (e.g., C₂, C₃, C₄, C₅, C₆, or C_7-10). In certain embodiments (when one occurrece of R^c is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a), one occurrece of R^c is C_1-10 alkyl which is substituted with from 1-6 independently selected R^a.

In certain embodiments, one occurrence of R^c is —C(═O)OH. In certain embodiments, one occurrence of R^c is V-L²-R^h. In certain of these embodiments, -L¹ is a bond. In certain embodiments, -L² is a bond. In certain embodiments (when R^c is -L¹-L²-R^h), R^h is C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl. In certain of these embodiments, R^h is C₆ aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl (e.g., R^h is unsubstituted phenyl).

Non-limiting examples of W when W is defined according to (B) include:

Non-Limiting Combinations

In some embodiments, the compound has the following formula:

wherein Q¹ is selected from the group consisting of:

• • (a)

wherein the asterisk denotes point of attachment to Q².

• • (b) heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1; and
  • (c) heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1; and

Q² is a bond or O.

In certain embodiments of formula (I-1), Q¹ is

In certain embodiments of formula (I-1), Q¹ is heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1. In certain of these embodiments, one ring atom of Q¹ is S or O. As non-limiting examples of the foregoing embodiments, Q¹ is selected from:

wherein the asterisk denotes point of attachment of Q².

In certain embodiments of formula (I-1), Q¹ is heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1. In certain of these embodiments, Q¹ is pyridyl or pyrimidinyl, each of which is optionally substituted with 1-2 independently selected R^q1. As non-limiting examples of the foregoing embodiments, Q¹ is selected from the group consisting of:

each of which is optionally substituted with 1-2 independently selected R^q1, wherein the asterisk denotes point of attachment of Q².

In certain embodiments of formula (I-1), Q² is a bond.

In certain embodiments of formula (I-1), Q² is —O—, —NH—, or S(O)_0-2 (e.g., Q² is O—; or Q² is —NH—; or Q² is S(O)₂—).

In certain embodiments of formula (I-1), A is —(Y^A1)_n—Y^A2. In certain of these embodiments, n is 0.

In certain embodiments of formula (I-1) (when A is —(Y^A1)_n—Y^A2), Y^A2 is as defined in any one of clauses 118-129 (e.g., 118; e.g., 119; e.g., 120; e.g., 121 or 122; e.g., 123 or 124).

In certain embodiments of formula (I-1) (when A is —(Y^A1)_n—Y^A2), wherein Y^A2 is as defined in any one of clauses 130-132 (e.g., 130; e.g., 131; e.g., 132) and 136-144 (e.g., each R^b substituent of Y^A2 is as defined in clause 136, 137, 138, 139, or 140).

In certain embodiments of formula (I-1) (when A is —(Y^A1)_n—Y^A2)_n—Y^A2 is as defined in any one of clauses 133-135 (e.g., 133; e.g., 134; e.g., 135) and 136-144 (e.g., each R^b substituent of Y^A2 is as defined in clause 136, 137, 138, 139, or 140).

In certain embodiments of formula (I-1), A is C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a. In certain embodiments, A is C_1-10 alkyl, which is substituted with from 1-6 independently selected R^a (e.g., CF₃). As a non-limiting example of the foregoing embodiments, A is unsubstituted C_4-10 alkyl (e.g., butyl).

In certain embodiments, the compound has the following formula:

wherein Q¹ is selected from the group consisting of:

• • heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O,
  • and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1; and
  • heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1;

Q² is a bond or O; and

A is —(Y^A1)_n—Y^A2, optionally wherein n is 0.

In certain of these embodiments, Q¹ is selected from the group consisting of:

wherein the asterisk denotes point of attachment of Q².

In certain other embodiments, Q¹ is selected from the group consisting of:

each of which is optionally substituted with 1-2 independently selected R^q1, wherein the asterisk denotes point of attachment of Q².

In certain of the foregoing embodiments, Y^A2 is C_6-10 aryl, which is optionally substituted with from 1-3 R^c, such as: wherein Y^A2 is C₆ aryl, which is optionally substituted with from 1-3 R^c.

In certain embodiments, Y^A2 is C_7-15 bicyclic or tricyclic aryl which is optionally substituted with from 1-3 R^c, such as wherein Y^A2 is naphthyl, tetrahydronaphthyl, indacenyl, or 1′,3′-dihydrospiro[cyclopropane-1,2′-indene] such as

each of which is optionally substituted with from 1-3 R^c.

In some embodiments, the compound has the following formula:

wherein W² is selected from the group consisting of:

• • (a) C_9-10 (e.g., C₁₀) bicyclic aryl, which is optionally substituted with from 1-4 R^c;
  • (b) bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; and
  • (c) tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments of formula (I-2), W² is C_9-10 (e.g., C₁₀) bicyclic aryl, which is optionally substituted with from 1-4 R^c (e.g., napthyl, tetrahydronaphthyl, or indacenyl). As a non-limiting example of the foregoing embodiments, W² is

In certain embodiments of formula (I-2), W² is bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain of these embodiments, W² includes a ring sulfur atom or ring oxygen atom (e.g., W² is

which is optionally substituted with from 1-4 independently selected R^c).

In certain embodiments of formula (I-2) (when W² is bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c), W² includes a pyridine (including pyridone) ring or a pyrimidine (including pyrimidone) ring (e.g., W² includes a pyridine (including pyridone) ring).

As non-limiting examples of the foregoing embodiments, W² is selected from the group consisting of:

and each of which is further optionally substituted with from 1-3 independently selected R^c.

In certain embodiments of formula (I-2), W² is tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c. In certain of these embodiments, W² includes a pyridine ring. As non-limiting examples of the foregoing embodiments, W² is selected from the group consisting of:

each of which is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments, the compound has the following formula:

wherein W² is selected from the group consisting of:

• • bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; and
  • tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In certain of these embodiments, W² is selected from the group consisting of:

wherein:

• • W^a, W^b, W^c, W^d, W^e, W^f, and W^g are each independently selected from the group consisting of: N, CH, and CR^c, provided that from 1-4 of W^a-W^g is N, and no more than 4 of W^a-W^g are CR^c;

W^h and Wⁱ are independently selected from the group consisting of N, NH, NR^d, O, S, CH, and CR^c;

W^j and W^o are independently N or C;

W^k, W¹, W^m, and Wⁿ are independently N, CH, or CR^c, provided that:

from 1-4 of W^h-W^o are heteroatoms,

no more than 4 of W^h-W^o are CR^c, and

when one of W^h and Wⁱ is N, the other one of W^h and Wⁱ is CH, CR^c, O or S;

each is independently a single bond or a double bond, provided that the 5-membered ring including Wⁱ, W^j, W^o, and W^h is aromatic, and the 6-membered ring including W^o, W^j, W^k, W^l, W^m, and Wⁿ is aromatic.

In certain of the foregoing embodiments, W^a is N; and W^b and W^c are CH. In certain embodiments, W^b is N; and W^a and W^c are CH. In certain embodiments, W is CR^c or CH (e.g., W^f is CR^c). In certain of these embodiments, W^g, W^e, and W^d are each independently CH or CR^c (e.g., each CH). As a non-limiting example of the foregoing embodiments, W² can be

In certain embodiments, one of W^h and Wⁱ is selected from the group consisting of O and S; and the other one of W^h and Wⁱ is N. In certain of these embodiments, W^o and W^j are C. In certain embodiments, each of W^k, W^l, W^m, and Wⁿ is independently CH or CR^c (e.g., CH). As a non-limiting example of the foregoing embodiments, W² can be:

In certain embodiments, W² is selected from the group consisting of:

each of which is further optionally substituted with from 1-3 independently selected R^c.

In certain other embodiments, W² is selected from the group consisting of:

each of which is optionally substituted with from 1-4 independently selected R^c.

In certain embodiments of formula (I-2), each occurrence of R^c is independently selected from the group consisting of:

• • (a) halo; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (m) —C_1-4 thioalkoxy; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (s)-L¹-L²-R^h; and (t) oxo.

In certain embodiments of formula (I-2), one occurrence of R^c is as defined in any one of clauses 164-173 (e.g., 164; e.g., 165 (e.g., 166 or 167); e.g., 169 (e.g., R^c is R^h); e.g., 173).

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), the

moiety is

In certain embodiments of formula (I-1) and/or formula (I-2), each R¹ is as defined in clause 50.

In certain embodiments of formula (I-1) and/or formula (I-2), from 1-3 (e.g., 1, 2, or 3 (e.g., 1 or 2)) occurrences of R¹ is other than H.

In certain of these embodiments, one occurrence of R¹ is as defined in any one of clauses 54-65 (e.g., 54; e.g., 55). In certain of these embodiments, each remaining R¹ is H. In certain other embodiments, one or two other occurrences of R¹ is independently halo (e.g., F) or C_1-4 alkyl; and each remaining R¹ is H.

In certain embodiments of formula (I-1) and/or formula (I-2) (when from 1-3 (e.g., 1, 2, or 3 (e.g., 1 or 2)) occurrences of R¹ is other than H), one occurrence of R¹ is as defined in any one of clauses 66-89 (clause 88 or 89; or e.g., R¹ is Rⁱ, and R¹ is as defined in e.g., clause 69, clause 71, clause 72, or 73). In certain of these embodiments, each remaining R¹ is H. In certain other embodiments, one or two other occurrences of R¹ is independently halo (e.g., F) or C_1-4 alkyl; and each remaining R¹ is H.

In certain embodiments of formula (I-1) and/or formula (I-2), when X¹ is NR², the R² group of X¹ is H.

In certain embodiments of formula (I-1) and/or formula (I-2), when X¹ is NR², the R² group of X¹ is —C(O)(C_1-4 alkyl), C_1-4 alkyl, or C_6-10 aryl.

In certain embodiments of formula (I-1) and/or formula (I-2) (when X¹ is NR², and the R² group of X¹ is H; or when X¹ is NR², and the R² group of X¹ is —C(O)(C_1-4 alkyl), C_1-4 alkyl, or C_6-10 aryl), each remaining occurrence of R² is selected from the group consisting of: H; C_1-6 alkyl, which is optionally substituted with from 1-2 independently selected R^a (e.g., unsubstituted C₁-3 alkyl); C_1-4 haloalkyl (e.g., CH₂CF₃); —C(O)(C_1-4 alkyl) (e.g., C(O)Me); and C_6-10 aryl (e.g., phenyl).

In certain embodiments of formula (I-1) or formula (I-2), each occurrence of R³ is independently selected from: H; C_1-6 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; —F; —Cl; —NR^eR^f; C_1-4 alkoxy; and C_1-4 haloalkoxy; or two R³ on the same carbon combine to form an oxo.

In certain embodiments of formula (I-1) or formula (I-2), R⁵ is H.

This specification concludes with a list of 287 clauses, which further describe the compounds, compositions, methods, and other subject matter described herein. For ease of exposition, certain variable definitions refer to one or more specifically numbered clauses. For the avoidance of doubt, use of a phrase, such as “each R¹ is as defined in clause 50” is intended to mean that: R¹ is selected from the group consisting of: H; halo; cyano; C_1-6 alkyl optionally substituted with 1-2 R^a; C_2-6 alkenyl optionally substituted with 1-2 R^a; C_2-6 alkynyl optionally substituted with 1-2 R^a; C_1-4 haloalkyl; C_1-4 alkoxy; C_1-4 haloalkoxy; -L³-L⁴-1e; —S(O)_1-2(C_1-4 alkyl); —S(O)(═NH)(C_1-4 alkyl); SF₅; —NR^eR^f; —S(O)_1-2 (NR′R″); —C_1-4 thioalkoxy; —NO₂; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; and —C(═O)N(R′)(R″).

OTHER EMBODIMENTS

In some embodiments, the compound of Formula I is other than a compound selected from the group consisting of: N-(2-(aminomethyl)pyrimidin-4-yl)-1H-indol-3-amine; 5-(aminomethyl)-N-(1H-indol-3-yl)thiazol-2-amine; N4-(2-aminoethyl)-N6-(1H-indol-3-yl)pyrimidine-4,6-diamine; N-(2-(2-aminoethyl)pyrimidin-4-yl)-1H-indol-3-amine; N-(2-(2-(methylamino)ethyl)pyrimidin-4-yl)-1H-indol-3-amine; 2-((6-((1H-indol-3-yl)amino)pyrimidin-4-yl)amino)ethan-1-ol; N-(2-((methyl amino)methyl)pyrimidin-4-yl)-1H-indol-3-amine; N-(1H-indol-3-yl)-1H-benzo[d]imidazol-2-amine; 6-(1H-indol-3-yl)amino)-2-methylpyrimidine-4-carbonitrile; N2-(1H-indol-3-yl)-3-methylpyridine-2,5-diamine; N-(1H-indol-3-yl)-1-methyl-1H-benzo[d]imidazol-2-amine; N2-(1H-indol-3-yl)-4-methylpyridine-2,5-diamine; N4-ethyl-N6-(1H-indol-3-yl)pyrimidine-4,6-diamine; N4-(1H-indol-3-yl)-N6-isopropylpyrimidine-4,6-diamine; 2-((6-((1H-indol-3-yl)amino)pyrimidin-4-yl)amino)acetonitrile; N2-(1H-indol-3-yl)-6-methylpyridine-2,5-diamine; N-(5-bromo-4-methylpyridin-2-yl)-1H-indol-3-amine; 4-(1H-indol-3-yl)amino)-2-methylpyrimidine-5-carboxylic acid; N-(5-bromo-6-methylpyridin-2-yl)-1H-indol-3-amine; N-(5-bromo-3-methylpyridin-2-yl)-1H-indol-3-amine; 2-(1H-indol-3-yl)amino)-6-methylpyrimidine-4-carboxylic acid; N4-(1H-indol-3-yl)-N6-methylpyrimidine-4,6-diamine; N2,N4-di(1H-indol-3-yl)pyri do[2,3-d]pyrimidine-2,4-diamine; N-(6-(6-m ethoxy-5-(4-methyl-1H-imidazol-1-yl)pyri din-2-yl)-4-methylpyridazin-3-yl)-1H-indol-3-amine; 3-((2-chloro-6-methylpyrimidin-4-yl)amino)-1H-indol -5-ol; 3-((4-chloro-6-methylpyrimidin-2-yl)amino)-1H-indol-5-ol; 3-((2-chloro-6-methylpyrimidin-4-yl)amino)-1H-indol-5-ol; 3-((4-chloro-6-methyl pyri mi din-2-yl)amino)-1H-indol-5-ol

In some embodiments, the compound of Formula I is other than a compound selected from the group consisting of:

In some embodiments, W cannot be: pyrimidinyl substituted with from 1-2 substituents each independently selected from the group consisting of: methyl; —CH₂═NH₂; —CH₂N(H)Me; —CH₂CH₂NH₂; —CH₂CH₂N(H)Me; —N(H)Me; —N(H)Et; —N(H)CH₂CH₂NH₂; —N(H)CH₂CH₂OH; —N(H)iPr; —N(H)CH₂CN; cyano; C(═O)OH; and —Cl;

thiazolyl substituted with —CH₂NH₂; or

pyridinyl substituted with from 1-2 substituents each independently from the group consisting of: NH₂; methyl; and Br.

In some embodiments, when Z, Y², and Y³ are each CH; Y⁴ is C; Y⁴ is CH or C—OH; X¹ is NH; and X² is CH, then W cannot be: pyrimidinyl substituted with from 1-2 substituents each independently selected from the group consisting of: methyl; —CH₂NH₂; —CH₂N(H)Me; —CH₂CH₂NH₂; —CH₂CH₂N(H)Me; —N(H)Me; —N(H)Et; —N(H)CH₂CH₂NH₂; —N(H)CH₂CH₂OH; —N(H)iPr; —N(H)CH₂CN; cyano; C(═O)OH; and —Cl (e.g., W cannot be pyrimidinyl substituted with one substituent selected from the group consisting of CH₂NH₂; —CH₂N(H)Me; —CH₂CH₂NH₂; —CH₂CH₂N(H)Me; —N(H)Me; —N(H)Et; —N(H)CH₂CH₂NH₂; —N(H)CH₂CH₂OH; —N(H)iPr; and —N(H)CH₂CN; or W cannot be pyrimidinyl substituted with two substituents each independently selected from the group consisting of: methyl, C(═O)OH, cyano, and Cl);

thiazolyl substituted with —CH₂NH₂; or

pyridinyl substituted with from 1-2 (e.g., 2) substituents each independently from the group consisting of: NH₂; methyl; and Br.

In some embodiments, W is other than the structures delineated below:

In some embodiments, when Z, Y², and Y³ are each CH; Y⁴ is C; Y¹ is CH or C—OH; X⁴ is NH; and X² is CH, then W is other than the structures delineated below:

In some embodiments, when W is as defined according to (A); and A is C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a, then A is selected from the group consisting of: C_4-10 alkyl optionally substituted with from 1-6 independently selected R^a; and C_1-3 alkyl substituted with 2-6 independently selected R^a.

In some embodiments, when Z, Y², and Y³ are each CH; Y⁴ is C; Y¹ is CH or C—OH; X¹ is NH; X² is CH; W is as defined according to (A); and A is C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a, then A is selected from the group consisting of: C_4-10 alkyl optionally substituted with from 1-6 independently selected R^a; and C_1-3 alkyl substituted with 2-6 independently selected R^a.

In some embodiments, when W is as defined according to (A); and Q¹ is pyrimidinyl, pyridinyl, or thiazolyl, then A is —(Y^A1)_n—Y^A2.

In some embodiments, when Z, Y², and Y³ are each CH; Y⁴ is C; Y¹ is CH or C—OH; X¹ is NH; X² is CH; W is as defined according to (A); and Q¹ is pyrimidinyl, pyridinyl, or thiazolyl, then A is (Y^A1)_n—Y^A2.

In some embodiments, each occurrence of R^c is independently selected from the group consisting of: (a) halo; (b) cyano; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (j) —NR^eR^f; (k) OH; (l) —S(O)_1-2(NR′R″); (m) —C_1-4 thioalkoxy; (n) —NO₂; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (r) —C(═O)N(R′)(R″); and (t) oxo.

In some embodiments, when Z, Y², and Y³ are each CH; Y⁴ is C; V is CH or C—OH; X⁴ is NH; and X² is CH, then each occurrence of R^c is independently selected from the group consisting of: (a) halo; (b) cyano; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (j) —NR^eR^f; (k) OH; (l) —S(O)_1-2(NR′R″); (m) —C_1-4 thioalkoxy; (n) —NO₂; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (r) —C(═O)N(R′)(R″); and (t) oxo.

In some embodiments, when W is defined according to (B), then W is selected from the group consisting of:

bicyclic heteroaryl including from 9 ring atoms, wherein 1 or from 3-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c;

bicyclic heteroaryl including from 9 ring atoms, wherein 2 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, provided that one ring atom is O or S; and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; and bicyclic or polycyclic heteroaryl including from 7-8 or 10-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

In some embodiments, when Z, Y², and Y³ are each CH; Y⁴ is C; Y⁴ is CH or C—OH; X⁴ is NH; X² is CH; and W is defined according to (B), then W is selected from the group consisting of: bicyclic heteroaryl including from 9 ring atoms, wherein 1 or from 3-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c;

bicyclic heteroaryl including from 9 ring atoms, wherein 2 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, provided that one ring atom is O or S; and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; and

bicyclic or polycyclic heteroaryl including from 7-8 or 10-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

Non-Limiting Examples

In some embodiments, the compound is selected from the group consisting of the compounds delineated in Table C1 or a pharmaceutically acceptable salt thereof.

TABLE C1
Compound Structure
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191

Pharmaceutical Compositions and Administration

General

In some embodiments, a chemical entity (e.g., a compound that inhibits (e.g., antagonizes) STING, or a pharmaceutically acceptable salt, and/or hydrate, and/or cocrystal, and/or drug combination thereof) is administered as a pharmaceutical composition that includes the chemical entity and one or more pharmaceutically acceptable excipients, and optionally one or more additional therapeutic agents as described herein.

In some embodiments, the chemical entities can be administered in combination with one or more conventional pharmaceutical excipients. Pharmaceutically acceptable excipients include, but are not limited to, ion exchangers, alumina, aluminum stearate, lecithin, self-emulsifying drug delivery systems (SEDDS) such as d-α-tocopherol polyethylene glycol 1000 succinate, surfactants used in pharmaceutical dosage forms such as Tweens, poloxamers or other similar polymeric delivery matrices, serum proteins, such as human serum albumin, buffer substances such as phosphates, tris, glycine, sorbic acid, potassium sorbate, partial glyceride mixtures of saturated vegetable fatty acids, water, salts or electrolytes, such as protamine sulfate, disodium hydrogen phosphate, potassium hydrogen phosphate, sodium-chloride, zinc salts, colloidal silica, magnesium trisilicate, polyvinyl pyrrolidone, cellulose-based substances, polyethylene glycol, sodium carboxymethyl cellulose, polyacrylates, waxes, polyethylene-polyoxypropylene-block polymers, and wool fat. Cyclodextrins such as α-, β, and γ-cyclodextrin, or chemically modified derivatives such as hydroxyalkylcyclodextrins, including 2- and 3-hydroxypropyl-β-cyclodextrins, or other solubilized derivatives can also be used to enhance delivery of compounds described herein. Dosage forms or compositions containing a chemical entity as described herein in the range of 0.005% to 100% with the balance made up from non-toxic excipient may be prepared. The contemplated compositions may contain 0.001%-100% of a chemical entity provided herein, in one embodiment 0.1-95%, in another embodiment 75-85%, in a further embodiment 20-80%. Actual methods of preparing such dosage forms are known, or will be apparent, to those skilled in this art; for example, see Remington: The Science and Practice of Pharmacy, 22^nd Edition (Pharmaceutical Press, London, U K. 2012).

Routes of Administration and Composition Components

In some embodiments, the chemical entities described herein or a pharmaceutical composition thereof can be administered to subject in need thereof by any accepted route of administration. Acceptable routes of administration include, but are not limited to, buccal, cutaneous, endocervical, endosinusial, endotracheal, enteral, epidural, interstitial, intra-abdominal, intra-arterial, intrabronchial, intrabursal, intracerebral, intraci sternal, intracoronary, intradermal, intraductal, intraduodenal, intradural, intraepidermal, intraesophageal, intragastric, intragingival, intraileal, intralymphatic, intramedullary, intrameningeal, intramuscular, intraovari an, intraperitoneal, intraprostatic, intrapulmonary, intrasinal, intraspinal, intrasynovial, intratesticular, intrathecal, intratubular, intratumoral, intrauterine, intravascular, intravenous, nasal, nasogastric, oral, parenteral, percutaneous, peridural, rectal, respiratory (inhalation), subcutaneous, sublingual, submucosal, topical, transdermal, transmucosal, transtracheal, ureteral, urethral and vaginal. In certain embodiments, a preferred route of administration is parenteral (e.g., intratumoral).

Compositions can be formulated for parenteral administration, e.g., formulated for injection via the intravenous, intramuscular, sub-cutaneous, or even intraperitoneal routes. Typically, such compositions can be prepared as injectables, either as liquid solutions or suspensions; solid forms suitable for use to prepare solutions or suspensions upon the addition of a liquid prior to injection can also be prepared; and the preparations can also be emulsified. The preparation of such formulations will be known to those of skill in the art in light of the present disclosure.

The pharmaceutical forms suitable for injectable use include sterile aqueous solutions or dispersions; formulations including sesame oil, peanut oil, or aqueous propylene glycol; and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases the form must be sterile and must be fluid to the extent that it may be easily injected. It also should be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms, such as bacteria and fungi.

The carrier also can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), suitable mixtures thereof, and vegetable oils. The proper fluidity can be maintained, for example, by the use of a coating, such as lecithin, by the maintenance of the required particle size in the case of dispersion, and by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin.

Sterile injectable solutions are prepared by incorporating the active compounds in the required amount in the appropriate solvent with various of the other ingredients enumerated above, as required, followed by filtered sterilization. Generally, dispersions are prepared by incorporating the various sterilized active ingredients into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum-drying and freeze-drying techniques, which yield a powder of the active ingredient, plus any additional desired ingredient from a previously sterile-filtered solution thereof.

Intratumoral injections are discussed, e.g., in Lammers, et al., “Effect of Intratumoral Injection on the Biodistribution and the Therapeutic Potential of HPMA Copolymer-Based Drug Delivery Systems” Neoplasia. 2006, 10, 788-795.

Pharmacologically acceptable excipients usable in the rectal composition as a gel, cream, enema, or rectal suppository, include, without limitation, any one or more of cocoa butter glycerides, synthetic polymers such as polyvinylpyrrolidone, PEG (like PEG ointments), glycerine, glycerinated gelatin, hydrogenated vegetable oils, poloxamers, mixtures of polyethylene glycols of various molecular weights and fatty acid esters of polyethylene glycol Vaseline, anhydrous lanolin, shark liver oil, sodium saccharinate, menthol, sweet almond oil, sorbitol, sodium benzoate, anoxid SBN, vanilla essential oil, aerosol, parabens in phenoxyethanol, sodium methyl p-oxybenzoate, sodium propyl p-oxybenzoate, diethylamine, carbomers, carbopol, methyloxybenzoate, macrogol cetostearyl ether, cocoyl caprylocaprate, isopropyl alcohol, propylene glycol, liquid paraffin, xanthan gum, carboxy-metabisulfite, sodium edetate, sodium benzoate, potassium metabisulfite, grapefruit seed extract, methyl sulfonyl methane (MSM), lactic acid, glycine, vitamins, such as vitamin A and E and potassium acetate.

In certain embodiments, suppositories can be prepared by mixing the chemical entities described herein with suitable non-irritating excipients or carriers such as cocoa butter, polyethylene glycol or a suppository wax which are solid at ambient temperature but liquid at body temperature and therefore melt in the rectum and release the active compound. In other embodiments, compositions for rectal administration are in the form of an enema.

In other embodiments, the compounds described herein or a pharmaceutical composition thereof are suitable for local delivery to the digestive or GI tract by way of oral administration (e.g., solid or liquid dosage forms).

Solid dosage forms for oral administration include capsules, tablets, pills, powders, and granules. In such solid dosage forms, the chemical entity is mixed with one or more pharmaceutically acceptable excipients, such as sodium citrate or dicalcium phosphate and/or: a) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and silicic acid, b) binders such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidinone, sucrose, and acacia, c) humectants such as glycerol, d) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate, e) solution retarding agents such as paraffin, f) absorption accelerators such as quaternary ammonium compounds, g) wetting agents such as, for example, cetyl alcohol and glycerol monostearate, h) absorbents such as kaolin and bentonite clay, and i) lubricants such as talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, and mixtures thereof. In the case of capsules, tablets and pills, the dosage form may also comprise buffering agents. Solid compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polyethylene glycols and the like.

In one embodiment, the compositions will take the form of a unit dosage form such as a pill or tablet and thus the composition may contain, along with a chemical entity provided herein, a diluent such as lactose, sucrose, dicalcium phosphate, or the like; a lubricant such as magnesium stearate or the like; and a binder such as starch, gum acacia, polyvinylpyrrolidine, gelatin, cellulose, cellulose derivatives or the like. In another solid dosage form, a powder, marume, solution or suspension (e.g., in propylene carbonate, vegetable oils, PEG's, poloxamer 124 or triglycerides) is encapsulated in a capsule (gelatin or cellulose base capsule). Unit dosage forms in which one or more chemical entities provided herein or additional active agents are physically separated are also contemplated; e.g., capsules with granules (or tablets in a capsule) of each drug; two-layer tablets; two-compartment gel caps, etc. Enteric coated or delayed release oral dosage forms are also contemplated.

Other physiologically acceptable compounds include wetting agents, emulsifying agents, dispersing agents or preservatives that are particularly useful for preventing the growth or action of microorganisms. Various preservatives are well known and include, for example, phenol and ascorbic acid.

In certain embodiments the excipients are sterile and generally free of undesirable matter. These compositions can be sterilized by conventional, well-known sterilization techniques. For various oral dosage form excipients such as tablets and capsules sterility is not required. The USP/NF standard is usually sufficient.

In certain embodiments, solid oral dosage forms can further include one or more components that chemically and/or structurally predispose the composition for delivery of the chemical entity to the stomach or the lower GI; e.g., the ascending colon and/or transverse colon and/or distal colon and/or small bowel. Exemplary formulation techniques are described in, e.g., Filipski, K. J., et al., Current Topics in Medicinal Chemistry, 2013, 13, 776-802, which is incorporated herein by reference in its entirety.

Examples include upper-GI targeting techniques, e.g., Accordion Pill (Intec Pharma), floating capsules, and materials capable of adhering to mucosal walls.

Other examples include lower-GI targeting techniques. For targeting various regions in the intestinal tract, several enteric/pH-responsive coatings and excipients are available. These materials are typically polymers that are designed to dissolve or erode at specific pH ranges, selected based upon the GI region of desired drug release. These materials also function to protect acid labile drugs from gastric fluid or limit exposure in cases where the active ingredient may be irritating to the upper GI (e.g., hydroxypropyl methylcellulose phthalate series, Coateric (polyvinyl acetate phthalate), cellulose acetate phthalate, hydroxypropyl methylcellulose acetate succinate, Eudragit series (methacrylic acidmethyl methacrylate copolymers), and Marcoat). Other techniques include dosage forms that respond to local flora in the GI tract, Pressure-controlled colon delivery capsule, and Pulsincap.

Ocular compositions can include, without limitation, one or more of any of the following: viscogens (e.g., Carboxymethylcellulose, Glycerin, Polyvinylpyrrolidone, Polyethylene glycol); Stabilizers (e.g., Pluronic (triblock copolymers), Cyclodextrins); Preservatives (e.g., Benzalkonium chloride, ETDA, SofZia (boric acid, propylene glycol, sorbitol, and zinc chloride; Alcon Laboratories, Inc.), Purite (stabilized oxychloro complex; Allergan, Inc.)).

Topical compositions can include ointments and creams. Ointments are semisolid preparations that are typically based on petrolatum or other petroleum derivatives. Creams containing the selected active agent are typically viscous liquid or semisolid emulsions, often either oil-in- water or water-in-oil. Cream bases are typically water-washable, and contain an oil phase, an emulsifier and an aqueous phase. The oil phase, also sometimes called the “internal” phase, is generally comprised of petrolatum and a fatty alcohol such as cetyl or stearyl alcohol; the aqueous phase usually, although not necessarily, exceeds the oil phase in volume, and generally contains a humectant. The emulsifier in a cream formulation is generally a nonionic, anionic, cationic or amphoteric surfactant. As with other carriers or vehicles, an ointment base should be inert, stable, nonirritating and non-sensitizing.

In any of the foregoing embodiments, pharmaceutical compositions described herein can include one or more one or more of the following: lipids, interbilayer crosslinked multilamellar vesicles, biodegradeable poly(D,L-lactic- co-glycolic acid) [PLGA]-based or poly anhydride-based nanoparticles or microparticles, and nanoporous particle-supported lipid bilayers.

Dosages

The dosages may be varied depending on the requirement of the patient, the severity of the condition being treating and the particular compound being employed.

Determination of the proper dosage for a particular situation can be determined by one skilled in the medical arts. The total daily dosage may be divided and administered in portions throughout the day or by means providing continuous delivery.

In some embodiments, the compounds described herein are administered at a dosage of from about 0.001 mg/Kg to about 500 mg/Kg (e.g., from about 0.001 mg/Kg to about 200 mg/Kg; from about 0.01 mg/Kg to about 200 mg/Kg; from about 0.01 mg/Kg to about 150 mg/Kg; from about 0.01 mg/Kg to about 100 mg/Kg; from about 0.01 mg/Kg to about 50 mg/Kg; from about 0.01 mg/Kg to about 10 mg/Kg; from about 0.01 mg/Kg to about 5 mg/Kg; from about 0.01 mg/Kg to about 1 mg/Kg; from about 0.01 mg/Kg to about 0.5 mg/Kg; from about 0.01 mg/Kg to about 0.1 mg/Kg; from about 0.1 mg/Kg to about 200 mg/Kg; from about 0.1 mg/Kg to about 150 mg/Kg; from about 0.1 mg/Kg to about 100 mg/Kg; from about 0.1 mg/Kg to about 50 mg/Kg; from about 0.1 mg/Kg to about 10 mg/Kg; from about 0.1 mg/Kg to about 5 mg/Kg; from about 0.1 mg/Kg to about 1 mg/Kg; from about 0.1 mg/Kg to about 0.5 mg/Kg).

Regimens

The foregoing dosages can be administered on a daily basis (e.g., as a single dose or as two or more divided doses) or non-daily basis (e.g., every other day, every two days, every three days, once weekly, twice weeks, once every two weeks, once a month).

In some embodiments, the period of administration of a compound described herein is for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 12 months, or more. In a further embodiment, a period of during which administration is stopped is for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 12 months, or more. In an embodiment, a therapeutic compound is administered to an individual for a period of time followed by a separate period of time. In another embodiment, a therapeutic compound is administered for a first period and a second period following the first period, with administration stopped during the second period, followed by a third period where administration of the therapeutic compound is started and then a fourth period following the third period where administration is stopped. In an aspect of this embodiment, the period of administration of a therapeutic compound followed by a period where administration is stopped is repeated for a determined or undetermined period of time. In a further embodiment, a period of administration is for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 12 months, or more. In a further embodiment, a period of during which administration is stopped is for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11 months, 12 months, or more.

Methods of Treatment

In some embodiments, methods for treating a subject having condition, disease or disorder in which increased (e.g., excessive)STING activity (e.g., e.g., STING signaling) contributes to the pathology and/or symptoms and/or progression of the condition, disease or disorder (e.g., immune disorders, cancer) are provided.

Indications

In some embodiments, the condition, disease or disorder is cancer. Non-limiting examples of cancer include melanoma, carcinoma, lymphoma, blastoma, sarcoma, and leukemia or lymphoid malignancies. More particular examples of such cancers include breast cancer, colon cancer, rectal cancer, colorectal cancer, kidney or renal cancer, clear cell cancer lung cancer including small-cell lung cancer, non-small cell lung cancer, adenocarcinoma of the lung and squamous carcinoma of the lung, squamous cell cancer (e.g. epithelial squamous cell cancer), cervical cancer, ovarian cancer, prostate cancer, prostatic neoplasms, liver cancer, bladder cancer, cancer of the peritoneum, hepatocellular cancer, gastric or stomach cancer including gastrointestinal cancer, gastrointestinal stromal tumor, pancreatic cancer, head and neck cancer, glioblastoma, retinoblastoma, astrocytoma, thecomas, arrhenoblastomas, hepatoma, hematologic malignancies including non-Hodgkins lymphoma (NHL), multiple myeloma, myelodysplasia disorders, myeloproliferative disorders, chronic myelogenous leukemia, and acute hematologic malignancies, endometrial or uterine carcinoma, endometriosis, endometrial stromal sarcoma, fibrosarcomas, choriocarcinoma, salivary gland carcinoma, vulval cancer, thyroid cancer, esophageal carcinomas, hepatic carcinoma, anal carcinoma, penile carcinoma, nasopharyngeal carcinoma, laryngeal carcinomas, Kaposi's sarcoma, mast cell sarcoma, ovarian sarcoma, uterine sarcoma, melanoma, malignant mesothelioma, skin carcinomas, Schwannoma, oligodendroglioma, neuroblastomas, neuroectodermal tumor, rhabdomyosarcoma, osteogenic sarcoma, leiomyosarcomas, Ewing Sarcoma, peripheral primitive neuroectodermal tumor, urinary tract carcinomas, thyroid carcinomas, Wilm's tumor, as well as abnormal vascular proliferation associated with phakomatoses, edema (such as that associated with brain tumors), and Meigs' syndrome. In some cases, the cancer is melanoma.

In some embodiments, the condition, disease or disorder is a neurological disorder, which includes disorders that involve the central nervous system (brain, brainstem and cerebellum), the peripheral nervous system (including cranial nerves), and the autonomic nervous system (parts of which are located in both central and peripheral nervous system). Non-limiting examples of cancer include acquired epileptiform aphasia; acute disseminated encephalomyelitis; adrenoleukodystrophy; age-related macular degeneration; agenesis of the corpus callosum; agnosia; Aicardi syndrome; Alexander disease; Alpers' disease; alternating hemiplegia; Alzheimer's disease; Vascular dementia; amyotrophic lateral sclerosis; anencephaly; Angelman syndrome; angiomatosis; anoxia; aphasia; apraxia; arachnoid cysts; arachnoiditis; Anronl-Chiari malformation; arteriovenous malformation; Asp erger syndrome; ataxia telegiectasia; attention deficit hyperactivity disorder; autism; autonomic dysfunction; back pain; Batten disease; Behcet's disease; Bell's palsy; benign essential blepharospasm; benign focal; amyotrophy; benign intracranial hypertension; Binswanger's disease; blepharospasm; Bloch Sulzberger syndrome; brachial plexus injury; brain abscess; brain injury; brain tumors (including glioblastoma multiforme); spinal tumor; Brown-Sequard syndrome; Canavan disease; carpal tunnel syndrome; causalgia; central pain syndrome; central pontine myelinolysis; cephalic disorder; cerebral aneurysm; cerebral arteriosclerosis; cerebral atrophy; cerebral gigantism; cerebral palsy; Charcot-Marie- Tooth disease; chemotherapy-induced neuropathy and neuropathic pain; Chiari malformation; chorea; chronic inflammatory demyelinating polyneuropathy; chronic pain; chronic regional pain syndrome; Coffin Lowry syndrome; coma, including persistent vegetative state; congenital facial diplegia; corti cob asal degeneration; cranial arteritis; craniosynostosis; Creutzfeldt-Jakob disease; cumulative trauma disorders; Cushing's syndrome; cytomegalic inclusion body disease; cytomegalovirus infection; dancing eyes-dancing feet syndrome; Dandy-Walker syndrome; Dawson disease; De Morsier's syndrome; Dejerine-Klumke palsy; dementia; dermatomyositis; diabetic neuropathy; diffuse sclerosis; dysautonomia; dysgraphia; dyslexia; dystonias; early infantile epileptic encephalopathy; empty sella syndrome; encephalitis; encephaloceles; encephalotrigeminal angiomatosis; epilepsy; Erb's palsy; essential tremor; Fabry's disease; Fahr's syndrome; fainting; familial spastic paralysis; febrile seizures; Fisher syndrome; Friedreich's ataxia; fronto-temporal dementia and other “tauopathies”; Gaucher's disease; Gerstmann's syndrome; giant cell arteritis; giant cell inclusion disease; globoid cell leukodystrophy; Guillain-Barre syndrome; HTLV-1-associated myelopathy; Hallervorden-Spatz disease; head injury; headache; hemifacial spasm; hereditary spastic paraplegia; heredopathia atactica polyneuritiformis; herpes zoster oticus; herpes zoster; Hirayama syndrome; HIV-associated dementia and neuropathy (also neurological manifestations of AIDS); holoprosencephaly; Huntington's disease and other polyglutamine repeat diseases; hydranencephaly; hydrocephalus; hypercortisolism; hypoxia; immune-mediated encephalomyelitis; inclusion body myositis; incontinentia pigmenti; infantile phytanic acid storage disease; infantile refsum disease; infantile spasms; inflammatory myopathy; intracranial cyst; intracranial hypertension; Joubert syndrome; Kearns-Sayre syndrome; Kennedy disease Kinsbourne syndrome; Klippel Feil syndrome; Krabbe disease; Kugelberg-Welander disease; kuru; Lafora disease; Lambert-Eaton myasthenic syndrome; Landau-Kleffner syndrome; lateral medullary (Wallenberg) syndrome; learning disabilities; Leigh's disease; Lennox-Gustaut syndrome; Lesch-Nyhan syndrome; leukodystrophy; Lewy body dementia; Lissencephaly; locked-in syndrome; Lou Gehrig's disease (i.e., motor neuron disease or amyotrophic lateral sclerosis); lumbar disc disease; Lyme diseaseneurological sequelae; Machado-Joseph disease; macrencephaly; megalencephaly; Melkersson-Rosenthal syndrome; Menieres disease; meningitis; Menkes disease; metachromatic leukodystrophy; microcephaly; migraine; Miller Fisher syndrome; mini-strokes; mitochondrial myopathies; Mobius syndrome; monomelic amyotrophy; motor neuron disease; Moyamoya disease; mucopolysaccharidoses; milti-infarct dementia; multifocal motor neuropathy; multiple sclerosis and other demyelinating disorders; multiple system atrophy with postural hypotension; p muscular dystrophy; myasthenia gravis; myelinoclastic diffuse sclerosis; myoclonic encephalopathy of infants; myoclonus; myopathy; myotonia congenital; narcolepsy; neurofibromatosis; neuroleptic malignant syndrome; neurological manifestations of AIDS; neurological sequelae of lupus; neuromyotonia; neuronal ceroid lipofuscinosis; neuronal migration disorders; Niemann-Pick disease; O'Sullivan-McLeod syndrome; occipital neuralgia; occult spinal dysraphism sequence; Ohtahara syndrome; olivopontocerebellar atrophy; opsoclonus myoclonus; optic neuritis; orthostatic hypotension; overuse syndrome; paresthesia; Parkinson's disease; paramyotonia congenital; paraneoplastic diseases; paroxysmal attacks; Parry Romberg syndrome; Pelizaeus-Merzbacher disease; periodic paralyses; peripheral neuropathy; painful neuropathy and neuropathic pain; persistent vegetative state; pervasive developmental disorders; photic sneeze reflex; phytanic acid storage disease; Pick's disease; pinched nerve; pituitary tumors; polymyositis; porencephaly; post-polio syndrome; postherpetic neuralgia; postinfectious encephalomyelitis; postural hypotension; Prader-Willi syndrome; primary lateral sclerosis; prion diseases; progressive hemifacial atrophy; progressive multifocal leukoencephalopathy; progressive sclerosing poliodystrophy; progressive supranuclear palsy; pseudotumor cerebri; Ramsay-Hunt syndrome (types I and II); Rasmussen's encephalitis; reflex sympathetic dystrophy syndrome; Refsum disease; repetitive motion disorders; repetitive stress injuries; restless legs syndrome; retrovirus-associated myelopathy; Rett syndrome; Reye's syndrome; Saint Vitus dance; Sandhoff disease; Schilder's disease; schizencephaly; septo-optic dysplasia; shaken baby syndrome; shingles; Shy-Drager syndrome; Sjögren's syndrome; sleep apnea; Soto's syndrome; spasticity; spina bifida; spinal cord injury; spinal cord tumors; spinal muscular atrophy; Stiff-Person syndrome; stroke; Sturge-Weber syndrome; subacute sclerosing panencephalitis; subcortical arteriosclerotic encephalopathy; Sydenham chorea; syncope; syringomyelia; tardive dyskinesia; Tay-Sachs disease; temporal arteritis; tethered spinal cord syndrome; Thomsen disease; thoracic outlet syndrome; Tic Douloureux; Todd's paralysis; Tourette syndrome; transient ischemic attack; transmissible spongiform encephalopathies; transverse myelitis; traumatic brain injury; tremor; trigeminal neuralgia; tropical spastic paraparesis; tuberous sclerosis; vascular dementia (multi-infarct dementia); vasculitis including temporal arteritis; Von Hippel-Lindau disease; Wallenberg's syndrome; Werdnig-Hoffman disease; West syndrome; whiplash; Williams syndrome; Wildon's disease; amyotrophe lateral sclerosis and Zellweger syndrome.

In some embodiments, the condition, disease or disorder is STING-associated conditions, e.g., type I interferonopathies (e.g., STING-associated vasculopathywith onset in infancy (SAVI)), Aicardi-Goutières Syndrome (AGS), genetic forms of lupus, and inflammation-associated disorders such as systemic lupus erythematosus, and rheumatoid arthritis. In certain embodiments, the condition, disease or disorder is an autoimmune disease (e.g., a cytosolic DNA-triggered autoinflammatory disease). Non-limiting examples include rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, inflammatory bowel diseases (IBDs) comprising Crohn disease (CD) and ulcerative colitis (UC), which are chronic inflammatory conditions with polygenic susceptibility. In certain embodiments, the condition is an inflammatory bowel disease. In certain embodiments, the condition is Crohn's disease, autoimmune colitis, iatrogenic autoimmune colitis, ulcerative colitis, colitis induced by one or more chemotherapeutic agents, colitis induced by treatment with adoptive cell therapy, colitis associated by one or more alloimmune diseases (such as graft-vs-host disease, e.g., acute graft vs. host disease and chronic graft vs. host disease), radiation enteritis, collagenous colitis, lymphocytic colitis, microscopic colitis, and radiation enteritis. In certain of these embodiments, the condition is alloimmune disease (such as graft-vs-host disease, e.g., acute graft vs. host disease and chronic graft vs. host disease), celiac disease, irritable bowel syndrome, rheumatoid arthritis, lupus, scleroderma, psoriasis, cutaneous T-cell lymphoma, uveitis, and mucositis (e.g., oral mucositis, esophageal mucositis or intestinal mucositis).

In some embodiments, modulation of the immune system by STING provides for the treatment of diseases, including diseases caused by foreign agents. Exemplary infections by foreign agents which may be treated and/or prevented by the method of the present invention include an infection by a bacterium (e.g., a Gram-positive or Gram-negative bacterium), an infection by a fungus, an infection by a parasite, and an infection by a virus. In one embodiment of the present invention, the infection is a bacterial infection (e.g., infection by E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella spp., Staphylococcus aureus, Streptococcus spp., or vancomycin-resistant enterococcus), or sepsis. In another embodiment, the infection is a fungal infection (e.g. infection by a mould, a yeast, or a higher fungus). In still another embodiment, the infection is a parasitic infection (e.g., infection by a single-celled or multicellular parasite, including Giardia duodenalis, Cryptosporidium parvum, Cyclospora cayetanensis, and Toxoplasma gondiz). In yet another embodiment, the infection is a viral infection (e.g., infection by a virus associated with AIDS, avian flu, chickenpox, cold sores, common cold, gastroenteritis, glandular fever, influenza, measles, mumps, pharyngitis, pneumonia, rubella, SARS, and lower or upper respiratory tract infection (e.g., respiratory syncytial virus)).

In some embodiments, the condition, disease or disorder is hepatitis B (see, e.g., WO 2015/061294).

In some embodiments, the condition, disease or disorder is selected from cardiovascular diseases (including e.g., myocardial infarction).

In some embodiments, the condition, disease or disorder is age-related macular degeneration.

In some embodiments, the condition, disease or disorder is mucositis, also known as stomatitis, which can occur as a result of chemotherapy or radiation therapy, either alone or in combination as well as damage caused by exposure to radiation outside of the context of radiation therapy.

In some embodiments, the condition, disease or disorder is uveitis, which is inflammation of the uvea (e.g., anterior uveitis, e.g., iridocyclitis or iritis; intermediate uveitis (also known as pars planitis); posterior uveitis; or chorioretinitis, e.g., pan-uveitis).

In some embodiments, the condition, disease or disorder is selected from the group consisting of a cancer, a neurological disorder, an autoimmune disease, hepatitis B, uvetitis, a cardiovascular disease, age-related macular degeneration, and mucositis.

Still other examples can include those indications discussed herein and below in contemplated combination therapy regimens.

Combination Therapy

This disclosure contemplates both monotherapy regimens as well as combination therapy regimens.

In some embodiments, the methods described herein can further include administering one or more additional therapies (e.g., one or more additional therapeutic agents and/or one or more therapeutic regimens) in combination with administration of the compounds described herein.

In certain embodiments, the methods described herein can further include administering one or more additional cancer therapies.

The one or more additional cancer therapies can include, without limitation, surgery, radiotherapy, chemotherapy, toxin therapy, immunotherapy, cryotherapy, cancer vaccines (e.g., HPV vaccine, hepatitis B vaccine, Oncophage, Provenge) and gene therapy, as well as combinations thereof. Immunotherapy, including, without limitation, adoptive cell therapy, the derivation of stem cells and/or dendritic cells, blood transfusions, lavages, and/or other treatments, including, without limitation, freezing a tumor.

In some embodiments, the one or more additional cancer therapies is chemotherapy, which can include administering one or more additional chemotherapeutic agents.

In certain embodiments, the additional chemotherapeutic agent is an immunomodulatory moiety, e.g., an immune checkpoint inhibitor. In certain of these embodiments, the immune checkpoint inhibitor targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1 PD-L1, PD-1 PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9-TIM3, Phosphatidylserine TIM3, lymphocyte activation gene 3 protein (LAG3), MHC class II LAG3, 4-IBB-4-IBB ligand, OX40-OX40 ligand, GITR, GITR ligand GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25TL1A, CD40L, CD40CD40 ligand, HVEMLIGHTLTA, HVEM, HVEM BTLA, HVEM CD160, HVEM LIGHT, HVEMBTLACD160, CD80, CD80 PDL-1, PDL2 CD80, CD244, CD48 CD244, CD244, ICOS, ICOSICOS ligand, B7-H3, B7-H4, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86-CD28, CD86-CTLA, CD80-CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine—TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155; e.g., CTLA-4 or PD1 or PD-L1). See, e.g., Postow, M. J. Clin. Oncol. 2015, 33, 1.

In certain of these embodiments, the immune checkpoint inhibitor is selected from the group consisting of: Urelumab, PF-05082566, MEDI6469, TRX518, Varlilumab, CP-870893, Pembrolizumab (PD1), Nivolumab (PD1), Atezolizumab (formerly MPDL3280A) (PDL1), MEDI4736 (PD-L1), Avelumab (PD-L1), PDR001 (PD1), BMS-986016, MGA271, Lirilumab, IPH2201, Emactuzumab, INCB024360, Galunisertib, Ulocuplumab, BKT140, Bavituximab, CC-90002, Bevacizumab, and MNRP1685A, and MGA271.

In certain embodiments, the additional chemotherapeutic agent is an alkylating agent. Alkylating agents are so named because of their ability to alkylate many nucleophilic functional groups under conditions present in cells, including, but not limited to cancer cells. In a further embodiment, an alkylating agent includes, but is not limited to, Cisplatin, carboplatin, mechlorethamine, cyclophosphamide, chlorambucil, ifosfamide and/or oxaliplatin. In an embodiment, alkylating agents can function by impairing cell function by forming covalent bonds with the amino, carboxyl, sulfhydryl, and phosphate groups in biologically important molecules or they can work by modifying a cell's DNA. In a further embodiment an alkylating agent is a synthetic, semisynthetic or derivative.

In certain embodiments, the additional chemotherapeutic agent is an anti-metabolite. Anti-metabolites masquerade as purines or pyrimidines, the building-blocks of DNA and in general, prevent these substances from becoming incorporated in to DNA during the “S” phase (of the cell cycle), stopping normal development and division. Anti-metabolites can also affect RNA synthesis. In an embodiment, an antimetabolite includes, but is not limited to azathioprine and/or mercaptopurine. In a further embodiment an anti-metabolite is a synthetic, semisynthetic or derivative.

In certain embodiments, the additional chemotherapeutic agent is a plant alkaloid and/or terpenoid. These alkaloids are derived from plants and block cell division by, in general, preventing microtubule function. In an embodiment, a plant alkaloid and/or terpenoid is a vinca alkaloid, a podophyllotoxin and/or a taxane. Vinca alkaloids, in general, bind to specific sites on tubulin, inhibiting the assembly of tubulin into microtubules, generally during the M phase of the cell cycle. In an embodiment, a vinca alkaloid is derived, without limitation, from the Madagascar periwinkle, Catharanthus roseus (formerly known as Vinca rosea). In an embodiment, a vinca alkaloid includes, without limitation, Vincristine, Vinblastine, Vinorelbine and/or Vindesine. In an embodiment, a taxane includes, but is not limited, to Taxol, Paclitaxel and/or Docetaxel.

In a further embodiment a plant alkaloid or terpernoid is a synthetic, semisynthetic or derivative. In a further embodiment, a podophyllotoxin is, without limitation, an etoposide and/or teniposide. In an embodiment, a taxane is, without limitation, docetaxel and/or ortataxel. [021] In an embodiment, a cancer therapeutic is a topoisomerase. Topoisomerases are essential enzymes that maintain the topology of DNA. Inhibition of type I or type II topoisomerases interferes with both transcription and replication of DNA by upsetting proper DNA supercoiling. In a further embodiment, a topoisomerase is, without limitation, a type I topoisomerase inhibitor or a type II topoisomerase inhibitor. In an embodiment a type I topoisomerase inhibitor is, without limitation, a camptothecin. In another embodiment, a camptothecin is, without limitation, exatecan, irinotecan, lurtotecan, topotecan, BNP 1350, CKD 602, DB 67 (AR67) and/or ST 1481. In an embodiment, a type II topoisomerase inhibitor is, without limitation, epipodophyllotoxin. In a further embodiment an epipodophyllotoxin is, without limitation, an amsacrine, etoposid, etoposide phosphate and/or teniposide. In a further embodiment a topoisomerase is a synthetic, semisynthetic or derivative, including those found in nature such as, without limitation, epipodophyllotoxins, substances naturally occurring in the root of American Mayapple (Podophyllum peltatum).

In certain embodiments, the additional chemotherapeutic agent is a stilbenoid. In a further embodiment, a stilbenoid includes, but is not limited to, Resveratrol, Piceatannol, Pinosylvin, Pterostilbene, Alpha-Viniferin, Ampelopsin A, Ampelopsin E, Diptoindonesin C, Diptoindonesin F, Epsilon-Vinferin, Flexuosol A, Gnetin H, Hemsleyanol D, Hopeaphenol, Trans-Diptoindonesin B, Astringin, Piceid and Diptoindonesin A. In a further embodiment a stilbenoid is a synthetic, semisynthetic or derivative.

In certain embodiments, the additional chemotherapeutic agent is a cytotoxic antibiotic. In an embodiment, a cytotoxic antibiotic is, without limitation, an actinomycin, an anthracenedione, an anthracycline, thalidomide, dichloroacetic acid, nicotinic acid, 2-deoxyglucose and/or chlofazimine. In an embodiment, an actinomycin is, without limitation, actinomycin D, bacitracin, colistin (polymyxin E) and/or polymyxin B. In another embodiment, an antracenedione is, without limitation, mitoxantrone and/or pixantrone. In a further embodiment, an anthracycline is, without limitation, bleomycin, doxorubicin (Adriamycin), daunorubicin (daunomycin), epirubicin, idarubicin, mitomycin, plicamycin and/or valrubicin. In a further embodiment a cytotoxic antibiotic is a synthetic, semisynthetic or derivative.

In certain embodiments, the additional chemotherapeutic agent is selected from endostatin, angiogenin, angiostatin, chemokines, angioarrestin, angiostatin (plasminogen fragment), basement-membrane collagen-derived anti-angiogenic factors (tumstatin, canstatin, or arrestin), anti-angiogenic antithrombin III, signal transduction inhibitors, cartilage-derived inhibitor (CDI), CD59 complement fragment, fibronectin fragment, gro-beta, heparinases, heparin hexasaccharide fragment, human chorionic gonadotropin (hCG), interferon alpha/beta/gamma, interferon inducible protein (IP-10), interleukin-12, kringle 5 (plasminogen fragment), metalloproteinase inhibitors (TIMPs), 2-methoxyestradiol, placental ribonuclease inhibitor, plasminogen activator inhibitor, platelet factor-4 (PF4), prolactin 16 kD fragment, proliferin-related protein (PRP), various retinoids, tetrahydrocortisol-S, thrombospondin-1 (TSP-1), transforming growth factor-beta (TGF-(3), vasculostatin, vasostatin (calreticulin fragment) and the like.

In certain embodiments, the additional chemotherapeutic agent is selected from abiraterone acetate, altretamine, anhydrovinblastine, auristatin, bexarotene, bicalutamide, BMS 184476, 2,3,4,5,6-pentafluoro-N-(3-fluoro-4-methoxyphenyl)benzene sulfonamide, bleomycin, N,N-dimethyl- L-valyl-L-valyl- N-methyl- L-valyl-L-proly- l-Lproline- t-butylamide, cachectin, cemadotin, chlorambucil, cyclophosphami de, 3′,4′-didehydro-4′-deoxy-8′-norvin-caleukoblastine, docetaxol, doxetaxel, cyclophosphamide, carboplatin, carmustine, cisplatin, cryptophycin, cyclophosphamide, cytarabine, dacarbazine (DTIC), dactinomycin, daunorubicin, decitabine dolastatin, doxorubicin (adriamycin), etoposide, 5-fluorouracil, finasteride, flutamide, hydroxyurea and hydroxyureataxanes, ifosfamide, liarozole, lonidamine, lomustine (CCNU), MDV3100, mechlorethamine (nitrogen mustard), melphalan, mivobulin isethionate, rhizoxin, sertenef, streptozocin, mitomycin, methotrexate, taxanes, nilutamide, onapristone, paclitaxel, prednimustine, procarbazine, RPR109881, stramustine phosphate, tamoxifen, tasonermin, taxol, tretinoin, vinblastine, vincristine, vindesine sulfate, and vinflunine.

In certain embodiments, the additional chemotherapeutic agent is platinum, cisplatin, carboplatin, oxaliplatin, mechlorethamine, cyclophosphamide, chlorambucil, azathioprine, mercaptopurine, vincristine, vinblastine, vinorelbine, vindesine, etoposide and teniposide, paclitaxel, docetaxel, irinotecan, topotecan, amsacrine, etoposide, etoposide phosphate, teniposide, 5-fluorouracil, leucovorin, methotrexate, gemcitabine, taxane, leucovorin, mitomycin C, tegafur-uracil, idarubicin, fludarabine, mitoxantrone, ifosfamide and doxorubicin. Additional agents include inhibitors of mTOR (mammalian target of rapamycin), including but not limited to rapamycin, everolimus, temsirolimus and deforolimus.

In still other embodiments, the additional chemotherapeutic agent can be selected from those delineated in U.S. Pat. No. 7,927,613, which is incorporated herein by reference in its entirety.

In some embodiments, the additional therapeutic agent and/or regimen are those that can be used for treating other STING-associated conditions, e.g., type I interferonopathies (e.g., STING-associated vasculopathywith onset in infancy (SAVI)), Aicardi-Goutières Syndrome (AGS), genetic forms of lupus, and inflammation-associated disorders such as systemic lupus erythematosus, and rheumatoid arthritis and the like.

Non-limiting examples of additional therapeutic agents and/or regimens for treating rheumatoid arthritis include non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen and naproxen), corticosteroids (e.g, prednisone), disease-modifying antirheumatic drugs (DMARDs; e.g., methotrexate (Trexall®, Otrexup®, Rasuvo®, Rheumatrex®), leflunomide (Arava®), hydroxychloroquine (Plaquenil), PF-06650833, iguratimod, tofacitinib (Xeljanz®), ABBV-599, evobrutinib, and sulfasalazine (Azulfidine®)), and biologics (e.g., abatacept (Orencia®), adalimumab (Humira®), anakinra (Kineret®), certolizumab (Cimzia®), etanercept (Enbrel®), golimumab (Simponi®), infliximab (Remicade®), rituximab (Rituxan®), tocilizumab (Actemra®), vobarilizumab, sarilumab (Kevzara®), secukinumab, ABP 501, CHS-0214, ABC-3373, and tocilizumab (ACTEMRAg)).

Non-limiting examples of additional therapeutic agents and/or regimens for treating lupus include steroids, topical immunomodulators (e.g., tacrolimus ointment (Protopic®) and pimecrolimus cream (Elidel®)), thalidomide (Thalomid®), non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen and naproxen), antimalarial drugs (e.g., Hydroxychloroquine (Plaquenil)), corticosteroids (e.g, prednisone) and immunomodulators (e.g., evobrutinib, iberdomide, voclosporin, cenerimod, azathioprine (Imuran®), cyclophosphamide (Cytoxan®, Neosar®, Endoxan®), and cyclosporine (Neoral, Sandimmune®, Gengraf®), and mycophenolate mofetil) baricitinb, iguratimod, filogotinib, GS-9876, rapamycin, and PF-06650833), and biologics (e.g., belimumab (Benlysta®), anifrolumab, prezalumab, MEDI0700, obinutuzumab, vobarilizumab, lulizumab, atacicept, PF-06823859, and lupizor, rituximab, BT063, BI655064, BI113059, aldesleukin (Proleukin®), dapirolizumab, edratide, IFN-α-kinoid, OMS721, RC18, RSLV-132, theralizumab, XmAb5871, and ustekinumab (Stelara®)). For example, non-limiting treatments for systemic lupus erythematosus include non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen and naproxen), antimalarial drugs (e.g., Hydroxychloroquine (Plaquenil)), corticosteroids (e.g, prednisone) and immunomodulators (e.g., iberdomide, voclosporin, azathioprine (Imuran®), cyclophosphamide (Cytoxan®, Neosar®, Endoxan®), and cyclosporine (Neoral, Sandimmune®, Gengraf®), and mycophenolate mofetil, baricitinb, filogotinib, and PF-06650833), and biologics (e.g., belimumab (Benlysta®), anifrolumab, prezalumab, MEDI0700, vobarilizumab, lulizumab, atacicept, PF-06823859, lupizor, rituximab, BT063, BI655064, BIB3059, aldesleukin (Proleukin®), dapirolizumab, edratide, IFN-α-kinoid, RC18, RSLV-132, theralizumab, XmAb5871, and ustekinumab (Stelara®)). As another example, non-limiting examples of treatments for cutaneous lupus include steroids, immunomodulators (e.g., tacrolimus ointment (Protopic®) and pimecrolimus cream (Elidel®)), GS-9876, filogotinib, and thalidomide (Thalomid®). Agents and regimens for treating drug-induced and/or neonatal lupus can also be administered.

Non-limiting examples of additional therapeutic agents and/or regimens for treating STING-associated vasculopathy with onset in infancy (SAVI) include JAK inhibitors (e.g., tofacitinib, ruxolitinib, filgotinib, and baricitinib).

Non-limiting examples of additional therapeutic agents and/or regimens for treating Aicardi-Goutières Syndrome (AGS) include physiotherapy, treatment for respiratory complications, anticonvulsant therapies for seizures, tube-feeding, nucleoside reverse transcriptase inhibitors (e.g., emtricitabine (e.g., Emtriva®), tenofovir (e.g., Viread®), emtricitabine/tenofovir (e.g., Truvada®), zidovudine, lamivudine, and abacavir), and JAK inhibitors (e.g., tofacitinib, ruxolitinib, filgotinib, and baricitinib).

Non-limiting examples of additional therapeutic agents and/or regimens for treating IBDs include 6-mercaptopurine, AbGn-168H, ABX464, ABT-494, adalimumab, AJM300, alicaforsen, AMG139, anrukinzumab, apremilast, ATR-107 (PF0530900), autologous CD34-selected peripheral blood stem cells transplant, azathioprine, bertilimumab, BI 655066, BMS-936557, certolizumab pegol (Cimzia®), cobitolimod, corticosteroids (e.g., prednisone, Methylprednisolone, prednisone), CP-690,550, CT-P13, cyclosporine, DIMS0150, E6007, E6011, etrasimod, etrolizumab, fecal microbial transplantation, figlotinib, fingolimod, firategrast (SB-683699) (formerly T-0047), GED0301, GLPG0634, GLPG0974, guselkumab, golimumab, GSK1399686, HMPL-004 (Andrographis paniculata extract), IMU-838, infliximab, Interleukin 2 (IL-2), Janus kinase (JAK) inhibitors, laquinimod, masitinib (AB1010), matrix metalloproteinase 9 (MMP 9) inhibitors (e.g., GS-5745), MEDI2070, mesalamine, methotrexate, mirikizumab (LY3074828), natalizumab, NNC 0142-0000-0002, NNC0114-0006, ozanimod, peficitinib (JNJ-54781532), PF-00547659, PF-04236921, PF-06687234, QAX576, RHB-104, rifaximin, risankizumab, RPC1063, SB012, SHP647, sulfasalazine, TD-1473, thalidomide, tildrakizumab (MK 3222), TJ301, TNF-Kinoid®, tofacitinib, tralokinumab, TRK-170, upadacitinib, ustekinumab, UTTR1147A, V565, vatelizumab, VB-201, vedolizumab, and vidofludimus.

Non-limiting examples of additional therapeutic agents and/or regimens for treating irritable bowel syndrome include alosetron, bile acid sequesterants (e.g., cholestyramine, colestipol, colesevelam), chloride channel activators (e.g., lubiprostone), coated peppermint oil capsules, desipramine, dicyclomine, ebastine, eluxadoline, farnesoid X receptor agonist (e.g., obeticholic acid), fecal microbiota transplantation, fluoxetine, gabapentin, guanylate cyclase-C agonists (e.g., linaclotide, plecanatide), ibodutant, imipramine, JCM-16021, loperamide, lubiprostone, nortriptyline, ondansetron, opioids, paroxetine, pinaverium, polyethylene glycol, pregabalin, probiotics, ramosetron, rifaximin, and tanpanor.

Non-limiting examples of additional therapeutic agents and/or regimens for treating scleroderma include non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen and naproxen), corticosteroids (e.g, prednisone), immunomodulators (e.g., azathioprine, methotrexate (Trexall®, Otrexup®, Rasuvo®, Rheumatrex®), cyclophosphamide (Cytoxan®, Neosar®, Endoxan®), and cyclosporine (Neoral®, Sandimmune®, Gengraf®), antithymocyte globulin, mycophenolate mofetil, intravenous immunoglobulin, rituximab, sirolimus, and alefacept), calcium channel blockers (e.g., nifedipine), alpha blockers, serotonin receptor antagonists, angiotensin II receptor inhibitors, statins, local nitrates, iloprost, phosphodiesterase 5 inhibitors (e.g., sildenafil), bosentan, tetracycline antibiotics, endothelin receptor antagonists, prostanoids, and tyrosine kinase inhibitors (e.g., imatinib, nilotinib and dasatinib).

Non-limiting examples of additional therapeutic agents and/or regimens for treating Crohn's Disease (CD) include adalimumab, autologous CD34-selected peripheral blood stem cells transplant, 6-mercaptopurine, azathioprine, certolizumab pegol (Cimzia®), corticosteroids (e.g., prednisone), etrolizumab, E6011, fecal microbial transplantation, figlotinib, guselkumab, infliximab, IL-2, JAK inhibitors, matrix metalloproteinase 9 (MMP 9) inhibitors (e.g., GS-5745), MEDI2070, mesalamine, methotrexate, natalizumab, ozanimod, RHB-104, rifaximin, risankizumab, SHP647, sulfasalazine, thalidomide, upadacitinib, V565, and vedolizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating UC include AbGn-168H, ABT-494, ABX464, apremilast, PF-00547659, PF-06687234, 6-mercaptopurine, adalimumab, azathioprine, bertilimumab, brazikumab (MEDI2070), cobitolimod, certolizumab pegol (Cimzia®), CP-690,550, corticosteroids (e.g., multimax budesonide, Methylprednisolone), cyclosporine, E6007, etrasimod, etrolizumab, fecal microbial transplantation, figlotinib, guselkumab, golimumab, IL-2, IMU-838, infliximab, matrix metalloproteinase 9 (MMP9) inhibitors (e.g., GS-5745), mesalamine, mesalamine, mirikizumab (LY3074828), RPC1063, risankizumab (BI 6555066), SHP647, sulfasalazine, TD-1473, TJ301, tildrakizumab (MK 3222), tofacitinib, tofacitinib, ustekinumab, UTTR1147A, and vedolizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating autoimmune colitis include corticosteroids (e.g., budesonide, prednisone, prednisolone, Beclometasone dipropionate), diphenoxylate/atropine, infliximab, loperamide, mesalamine, TIP60 inhibitors (see, e.g., U.S. Patent Application Publication No. 2012/0202848), and vedolizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating iatrogenic autoimmune colitis include corticosteroids (e.g., budesonide, prednisone, prednisolone, Beclometasone dipropionate), diphenoxylate/atropine, infliximab, loperamide, TIP60 inhibitors (see, e.g., U.S. Patent Application Publication No. 2012/0202848), and vedolizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating colitis induced by one or more chemotherapeutics agents include corticosteroids (e.g., budesonide, prednisone, prednisolone, beclometasone dipropionate), diphenoxylate/atropine, infliximab, loperamide, mesalamine, TIP60 inhibitors (see, e.g., U.S. Patent Application Publication No. 2012/0202848), and vedolizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating colitis induced by treatment with adoptive cell therapy include corticosteroids (e.g., budesonide, prednisone, prednisolone, beclometasone dipropionate), diphenoxylate/atropine, infliximab, loperamide, TIP60 inhibitors (see, e.g., U.S. Patent Application Publication No. 2012/0202848), and vedolizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating colitis associated with one or more alloimmune diseases include corticosteroids (e.g., budesonide, prednisone, prednisolone, beclometasone dipropionate), sulfasalazine, and eicopentaenoic acid.

Non-limiting examples of additional therapeutic agents and/or regimens for treating radaiation enteritis include teduglutide, amifostine, angiotensin-converting enzyme (ACE) inhibitors (e.g., benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril), probiotics, selenium supplementation, statins (e.g., atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, and pitavastatin), sucralfate, and vitamin E.

Non-limiting examples of additional therapeutic agents and/or regimens for treating collagenous colitis include 6-mercaptopurine, azathaioprine, bismuth subsalicate, Boswellia serrata extract, cholestyramine, colestipol, corticosteroids (e.g., budesonide, prednisone, prednisolone, beclometasone dipropionate), loperami de, mesalamine, methotrexate, probiotics, and sulfasalazine.

Non-limiting examples of additional therapeutic agents and/or regimens for treating lyphocytic colitis include 6-mercaptopurine, azathioprine, bismuth subsalicylate, cholestyramine, colestipol, corticosteroids (e.g., budesonide, prednisone, prednisolone, beclometasone dipropionate), loperamide, mesalamine, methotrexate, and sulfasalazine.

Non-limiting examples of additional therapeutic agents and/or regimens for treating microscopic colitis include 6-mercaptopurine, azathioprine, bismuth sub salicylate, Bosw ellia serrata extract, cholestyramine, colestipol, corticosteroids (e.g., budesonide, prednisone, prednisolone, beclometasone dipropionate), fecal microbial transplantation, loperami de, mesalamine, methotrexate, probiotics, and sulfasalazine.

Non-limiting examples of additional therapeutic agents and/or regimens for treating alloimmune disease include intrauterine platelet transfusions, intravenous immunoglobin, maternal steroids, abatacept, alemtuzumab, alphal-antitrypsin, AMG592, antithymocyte globulin, barcitinib, basiliximab, bortezomib, brentuximab, cannabidiol, corticosteroids (e.g., methylprednisone, prednisone), cyclosporine, dacilzumab, defribrotide, denileukin diftitox, glasdegib, ibrutinib, IL-2, infliximab, itacitinib, LBH589, maraviroc, mycophenolate mofetil, natalizumab, neihulizumab, pentostatin, pevonedistat, photobiomodulation, photopheresis, ruxolitinib, sirolimus, sonidegib, tacrolimus, tocilizumab, and vismodegib.

Non-limiting examples of additional therapeutic agents and/or regimens for treating multiple sclerosis (MS) include alemtuzumab (Lemtrada®), ALKS 8700, amiloride, ATX-MS-1467, azathioprine, baclofen (Lioresal (ID), beta interferons (e.g., IFN-β-1a, IFN-β-1b), cladribine, corticosteroids (e.g., methylprednisolone), daclizumab, dimethyl fumarate (Tecfidera®), fingolimod (Gilenya®), fluoxetine, glatiramer acetate (Copaxone®), hydroxychloroquine, ibudilast, idebenone, laquinimod, lipoic acid, losartan, masitinib, MD1003 (biotin), mitoxantrone, montelukast, natalizumab (Tysabri®), NeuroVax™, ocrelizumab, ofatumumab, pioglitazone, and RPC1063.

Non-limiting examples of additional therapeutic agents and/or regimens for treating graft-vs-host disease include abatacept, alemtuzumab, alphal-antitrypsin, AMG592, antithymocyte globulin, barcitinib, basiliximab, bortezomib, brentuximab, cannabidiol, corticosteroids (e.g., methylprednisone, prednisone), cyclosporine, dacilzumab, defribrotide, denileukin diftitox, glasdegib, ibrutinib, IL-2, imatinib, infliximab, itacitinib, LBH589, maraviroc, mycophenolate mofetil, natalizumab, neihulizumab, pentostatin, pevonedistat, photobiomodulation, photopheresis, ruxolitinib, sirolimus, sonidegib, tacrolimus, tocilizumab, and vismodegib.

Non-limiting examples of additional therapeutic agents and/or regimens for treating acute graft-vs-host disease include alemtuzumab, alpha-1 antitrypsin, antithymocyte globulin, basiliximab, brentuximab, corticosteroids (e.g., methylprednisone, prednisone), cyclosporine, dacilzumab, defribrotide, denileukin diftitox, ibrutinib, infliximab, itacitinib, LBH589, mycophenol ate mofetil, natalizumab, neihulizumab, pentostatin, photopheresis, ruxolitinib, sirolimus, tacrolimus, and tocilizumab.

Non-limiting examples of additional therapeutic agents and/or regimens for treating chronic graft vs. host disease include abatacept, alemtuzumab, AMG592, antithymocyte globulin, basiliximab, bortezomib, corticosteroids (e.g., methylprednisone, prednisone), cyclosporine, dacilzumab, denileukin diftitox, glasdegib, ibrutinib, IL-2, imatinib, infliximab, mycophenolate mofetil, pentostatin, photobiomodulati on, photopheresis, ruxolitinib, sirolimus, sonidegib, tacrolimus, tocilizumab, and vismodegib.

Non-limiting examples of additional therapeutic agents and/or regimens for treating celiac disease include AMG 714, AMY01, Aspergillus niger prolyl endoprotease, BL-7010, CALY-002, GBR 830, Hu-Mik- Beta-1, IMGX003, KumaMax, Larazotide Acetate, Nexvan2®, pancrelipase, TIMP-GLIA, vedolizumab, and ZED1227.

Non-limiting examples of additional therapeutic agents and/or regimens for treating psoriasis include topical corticosteroids, topical crisaborole/AN2728, topical SNA-120, topical SAN021, topical tapinarof, topical tocafinib, topical IDP-118, topical M518101, topical calcipotriene and betamethasone dipropionate (e.g., MC2-01 cream and Taclonex®), topical P-3073, topical LEO 90100 (Enstilar®), topical betamethasone dipropriate (Sernivo®), halobetasol propionate (Ultravate®), vitamin D analogues (e.g., calcipotriene (Dovonex®) and calcitriol (Vectical®)), anthralin (e.g., Dritho-scalp® and Dritho-creme®), topical retinoids (e.g., tazarotene (e.g., Tazorac® and Avage®)), calcineurin inhibitors (e.g., tacrolimus (Prograf®) and pimecrolimus (Elidel®)), salicylic acid, coal tar, moisturizers, phototherapy (e.g., exposure to sunlight, UVB phototherapy, narrow band UVB phototherapy, Goeckerman therapy, psoralen plus ultraviolet A (PUVA) therapy, and excimer laser), retinoids (e.g., acitretin (Soriatane®)), methotrexate (Trexall®, Otrexup®, Rasuvo®, Rheumatrex®), Apo805K1, baricitinib, FP187, KD025, prurisol, VTP-43742, XP23829, ZPL-389, CF101 (piclidenoson), LAS41008, VPD-737 (serlopitant), upadacitinib (ABT-494), aprmilast, tofacitibin, cyclosporine (Neoral®, Sandimmune®, Gengraf®), biologics (e.g., etanercept (Enbrel®), entanercept-szzs (Elrezi®), infliximab (Remicade®), adalimumab (Humira®), adalimumab-adbm (Cyltezo®), ustekinumab (Stelara®), golimumab (Simponi®), apremilast (Otezla®), secukinumab (Cosentyx®), certolixumab pegol, secukinumab, tildrakizumab-asmn, infliximab-dyyb, abatacept, ixekizumab (Taltz®), ABP 710, BCD-057, B1695501, bimekizumab (UCB4940), CHS-1420, GP2017, guselkumab (CNTO 1959), HD203, M923, MSB11022, Mirikizumab (LY3074828), PF-06410293, PF-06438179, risankizumab (B1655066), SB2, SB4, SB5, siliq (brodalumab), namilumab (MT203, tildrakizumab (MK-3222), and ixekizumab (Taltz®)), thioguanine, and hydroxyurea (e.g., Droxia® and Hydrea®).

Non-limiting examples of additional therapeutic agents and/or regimens for treating cutaneous T-cell lymphoma include phototherapy (e.g., exposure to sunlight, UVB phototherapy, narrow band UVB phototherapy, Goeckerman therapy, psoralen plus ultraviolet A (PUVA) therapy, and excimer laser), extracorporeal photopheresis, radiation therapy (e.g., spot radiation and total skin body electron beam therapy), stem cell transplant, corticosteroids, imiquimod, bexarotene gel, topical bis-chloroethyl-nitrourea, mechlorethamine gel, vorinostat (Zolinza®), romidepsin (Istodax®), pralatrexate (Folotyn®) biologics (e.g., alemtuzumab (Campath®), brentuximab vedotin (SGN-35), mogamulizumab, and IPH4102).

Non-limiting examples of additional therapeutic agents and/or regimens for treating uveitis include corticosteroids (e.g., intravitreal triamcinolone acetonide injectable suspensions), antibiotics, antivirals (e.g., acyclovir), dexamethasone, immunomodulators (e.g., tacrolimus, leflunomide, cyclophosphamide (Cytoxan®, Neosar®, Endoxan®), and cyclosporine (Neoral®, Sandimmune®, Gengraf®), chlorambucil, azathioprine, methotrexate, and mycophenolate mofetil), biologics (e.g., infliximab (Remicade®), adalimumab (Humira®), etanercept (Enbrel®), golimumab (Simponi®), certolizumab (Cimzia®), rituximab (Rituxan®), abatacept (Orencia®), basiliximab (Simulect®), anakinra (Kineret®), canakinumab (Ilarisg), gevokixumab (X⁰MA052), tocilizumab (Actemra®), alemtuzumab (Campath®), efalizumab (Raptiva®), LFG316, sirolimus (Santen®), abatacept, sarilumab (Kevzara®), and daclizumab (Zenapax®)), cytotoxic drugs, surgical implant (e.g., fluocinolone insert), and vitrectomy.

Non-limiting examples of additional therapeutic agents and/or regimens for treating mucositis include AG013, SGX942 (dusquetide), amifostine (Ethyol®), cryotherapy, cepacol lonzenges, capsaicin lozenges, mucoadhesives (e.g., MuGard®) oral diphenhydramine (e.g., Benadry® elixir), oral bioadherents (e.g., polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair®)), oral lubricants (e.g., Oral Balance®), caphosol, chamomilla recutita mouthwash, edible grape plant exosome, antiseptic mouthwash (e.g., chlorhexidine gluconate (e.g., Peridex® or Periogard®), topical pain relievers (e.g., lidocaine, benzocaine, dyclonine hydrochloride, xylocaine (e.g., viscous xylocaine 2%), and Ulcerease® (0.6% phenol)), corticosteroids (e.g., prednisone), pain killers (e.g., ibuprofen, naproxen, acetaminophen, and opioids), GC4419, palifermin (keratinocyte growth factor; Kepivance®), ATL-104, clonidine lauriad, IZN-6N4, SGX942, rebamipide, nepidermin, soluble β-1,3/1,6 glucan, P276, LP-0004-09, CR-3294, ALD-518, IZN-6N4, quercetin, granules comprising vaccinium myrtillus extract, macleaya cordata alkaloids and echinacea angustifolia extract (e.g., SAMITAL®), and gastrointestinal cocktail (an acid reducer such aluminum hydroxide and magnesium hydroxide (e.g., Maalox), an antifungal (e.g., nystatin), and an analgesic (e.g., hurricane liquid)). For example, non-limiting examples of treatments for oral mucositis include AG013, amifostine (Ethyol®), cryotherapy, cepacol lonzenges, mucoadhesives (e.g., MuGard®) oral diphenhydramine (e.g., Benadry® elixir), oral bioadherents (e.g., polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair®)), oral lubricants (e.g., Oral Balance®), caphosol, chamomilla recutita mouthwash, edible grape plant exosome, antiseptic mouthwash (e.g., chlorhexidine gluconate (e.g., Peridex® or Periogard®), topical pain relievers (e.g., lidocaine, benzocaine, dyclonine hydrochloride, xylocaine (e.g., viscous xylocaine 2%), and Ulcerease® (0.6% phenol)), corticosteroids (e.g., prednisone), pain killers (e.g., ibuprofen, naproxen, acetaminophen, and opioids), GC4419, palifermin (keratinocyte growth factor; Kepivance®), ATL-104, clonidine lauriad, IZN-6N4, SGX942, rebamipide, nepidermin, soluble (3-1,3/1,6 glucan, P276, LP-0004-09, CR-3294, ALD-518, IZN-6N4, quercetin, and gastrointestinal cocktail (an acid reducer such aluminum hydroxide and magnesium hydroxide (e.g., Maalox), an antifungal (e.g., nystatin), and an analgesic (e.g., hurricane liquid)). As another example, non-limiting examples of treatments for esophageal mucositis include xylocaine (e.g., gel viscous Xylocaine 2%). As another example, treatments for intestinal mucositis, treatments to modify intestinal mucositis, and treatments for intestinal mucositis signs and symptoms include gastrointestinal cocktail (an acid reducer such aluminum hydroxide and magnesium hydroxide (e.g., Maalox), an antifungal (e.g., nystatin), and an analgesic (e.g., hurricane liquid)).

In certain embodiments, the second therapeutic agent or regimen is administered to the subject prior to contacting with or administering the chemical entity (e.g., about one hour prior, or about 6 hours prior, or about 12 hours prior, or about 24 hours prior, or about 48 hours prior, or about 1 week prior, or about 1 month prior).

In other embodiments, the second therapeutic agent or regimen is administered to the subject at about the same time as contacting with or administering the chemical entity.

By way of example, the second therapeutic agent or regimen and the chemical entity are provided to the subject simultaneously in the same dosage form. As another example, the second therapeutic agent or regimen and the chemical entity are provided to the subject concurrently in separate dosage forms.

In still other embodiments, the second therapeutic agent or regimen is administered to the subject after contacting with or administering the chemical entity (e.g., about one hour after, or about 6 hours after, or about 12 hours after, or about 24 hours after, or about 48 hours after, or about 1 week after, or about 1 month after).

Patient Selection

In some embodiments, the methods described herein further include the step of identifying a subject (e.g., a patient) in need of such treatment (e.g., by way of biopsy, endoscopy, or other conventional method known in the art). In certain embodiments, the STING protein can serve as a biomarker for certain types of cancer, e.g., colon cancer and prostate cancer. In other embodiments, identifying a subject can include assaying the patient's tumor microenvironment for the absence of T-cells and/or presence of exhausted T-cells, e.g., patients having one or more cold tumors. Such patients can include those that are resistant to treatment with checkpoint inhibitors. In certain embodiments, such patients can be treated with a chemical entity herein, e.g., to recruit T-cells into the tumor, and in some cases, further treated with one or more checkpoint inhibitors, e.g., once the T-cells become exhausted.

In some embodiments, the chemical entities, methods, and compositions described herein can be administered to certain treatment-resistant patient populations (e.g., patients resistant to checkpoint inhibitors; e.g., patients having one or more cold tumors, e.g., tumors lacking T-cells or exhausted T-cells).

Compound Preparation

As can be appreciated by the skilled artisan, methods of synthesizing the compounds of the formulae herein will be evident to those of ordinary skill in the art. For example, the compounds described herein can be synthesized, e.g., using one or more of the methods described herein and/or using methods described in, e.g., US 2015/0056224, the contents of each of which are hereby incorporated by reference in their entirety. Synthetic chemistry transformations and protecting group methodologies (protection and deprotection) useful in synthesizing the compounds described herein are known in the art and include, for example, those such as described in R. Larock, Comprehensive Organic Transformations, VCH Publishers (1989); T. W. Greene and RGM. Wuts, Protective Groups in Organic Synthesis, 2d. Ed., John Wiley and Sons (1991); L. Fieser and M. Fieser, Fieser and Fieser's Reagents for Organic Synthesis, John Wiley and Sons (1994); and L. Paquette, ed., Encyclopedia of Reagents for Organic Synthesis, John Wiley and Sons (1995), and subsequent editions thereof. The starting materials used in preparing the compounds of the invention are known, made by known methods, or are commercially available. The skilled artisan will also recognize that conditions and reagents described herein that can be interchanged with alternative art-recognized equivalents. For example, in many reactions, triethylamine can be interchanged with other bases, such as non-nucleophilic bases (e.g. diisopropylamine, 1,8-diazabicycloundec-7-ene, 2,6-di-tert-butylpyridine, or tetrabutylphosphazene).

The skilled artisan will recognize a variety of analytical methods that can be used to characterize the compounds described herein, including, for example, ¹H NMR, heteronuclear NMR, mass spectrometry, liquid chromatography, and infrared spectroscopy. The foregoing list is a subset of characterization methods available to a skilled artisan and is not intended to be limiting.

To further illustrate the foregoing, the following non-limiting, exemplary synthetic schemes are included. Variations of these examples within the scope of the claims are within the purview of one skilled in the art and are considered to fall within the scope of the invention as described, and claimed herein. The reader will recognize that the skilled artisan, provided with the present disclosure, and skill in the art is able to prepare and use the invention without exhaustive examples.

EXAMPLES

LCMS Method A:)(Bridge BEH C18, 50*3 mm, 0.7 μL injection, 1.0 mL/min flowrate, 30-900 amu scan range, 254 nm UV detection. Mobile Phase A (MPA):

Water+5 mmolNH4HCO3 and Mobile Phase B (MPB): Acetonitrile. Elution 5% MPB to 95% in 0.99 min, hold at 95% MPB for 0.7 min, 95% MPB to 5% in 0.10 min, then equilibration to 5% MPB for 0.2 min.

LCMS Method B: Shim-pack XR-ODS, 50*3 mm, 4.0 μL injection, 1.2 mL/min flowrate, 90-900 amu scan range, 254 nm UV detection. Mobile Phase A (MPA): Water+0.05% TFA and Mobile Phase B (MPB): Acetonitrile+0.05% TFA. Elution 5% MPB to 100% in 1.99 min, hold at 100% MPB for 0.7 min, 100% MPB to 5% in 0.05 min, then equilibration to 5% MPB for 0.25 min.

Example 1. Synthesis of Compound 101

Synthesis of 5-fluoro-1H-pyrrolo[2,3-13]pyridine-3-carbonyl azide

5—Fluoro-1H-pyrrolo[2,3-b]pyridine-3-carboxylic acid (5.00 g, 27.76 mmol, 1.00 equiv) was dissolved in THF (100 mL). DPPA (11.46 g, 41.6 mmol, 1.5 equiv) and TEA (5.62 g, 55.51 mmol, 2 equiv) were added under the atmosphere of nitrogen. Upon stirring for 16 hr at 25° C., the resulting mixture was concentrated under vacuum. The resulting mixture was diluted with water, extracted with 3×100 mL of ethyl acetate. The organic layers was combined, dried over anhydrous sodium sulfate and concentrated. 3.9 g (68.49%) of 5—Fluoro-1H-pyrrolo[2,3-b]pyridine-3-carbonyl azide obtained as a light yellow crude solid.

Synthesis of tert-butyl N-[5-fluoro-1H-pyrrolo[2,3-13]pyridin-3-yl]carbamate

5—Fluoro-1H-pyrrolo[2,3-b]pyridine-3-carbonyl azide (1.00 g, 4.87 mmol, 1.00 equiv) was dissolved in t-BuOH (20 mL). Upon stirring for 1 hr at 90° C., the resulting solution was concentrated. Crude product was applied onto a silica gel column with ethyl acetate/petroleum ether (1/2). 600 mg (48.99%) of Tert-butyl N-[5-fluoro-1H-pyrrolo[2,3-b]pyridin-3-yl]carbamate was obtained as a off-white solid.

Synthesis of 6-fluoro-1H-pyrrolo[2,3-b]pyridin-3-amine hydrochloride

Tert-butyl N-[6-fluoro-1H-pyrrolo[2,3-b]pyridin-3-yl]carbamate (500.00 mg, 1.990 mmol, 1.00 equiv) was dissolved in dichloromethane, HCl in 1,4-dioxane (4M, 8 mL) was added. Upon stirring for 2 hr at 25° C., the resulting mixture was concentrated. This resulted in 180 mg (59.85%) of 6-fluoro-1H-pyrrolo[2,3-b]pyridin-3-amine hydrochloride as a off-white crude solid.

Synthesis of N-[5-fluoro-1H-pyrrolo[2,3-b]pyridin-3-yl]-5-phenyl-1,3-oxazol-2-amine

5—Fluoro-1H-pyrrolo[2,3-b]pyridin-3-amine hydrochloride (150 mg, 0.80 mmol, 1.00 equiv) was dissolved in dioxane (8 mL). 2—Bromo-5-phenyl-1,3-oxazole (215 mg, 0.96 mmol, 1.20 equiv), P(t-Bu)₃.HBF₄ (23 mg, 0.08 mmol, 0.10 equiv), Cs₂CO₃ (521 mg, 1.60 mmol, 2.00 equiv) and P(t-Bu)₃ Palladacycle Gen. 3 (46 mg, 0.08 mmol, 0.1 equiv) were added under nitrogen. Upon stirring for 16 hr at 90° C. in an oil bath under the atmosphere of nitrogen, the resulting solution was diluted with of H₂O, and then extracted with 3×30 mL of ethyl acetate and the organic layers combined. It was dried over anhydrous sodium sulfate and concentrated. The crude product was purified by Prep-HPLC with the following conditions: Column: Xselect CSH OBD Column 30*150 mm Sum; Mobile Phase A:Water(10 MMOL/L NH₄HCO₃+0.1% NE₃.H₂O), Mobile Phase B:ACN; Flow rate:60 mL/min; Gradient:33 B to 63 B in 7 min; 254/210 nm; RT1:5.95.22.7 mg (9.65%) of N-[5-fluoro-1H-pyrrolo[2,3-b]pyridin-3-yl]-5-phenyl-1,3-oxazol -2-amine was obtained as a light yellow solid.

Example 2. Synthesis of Compound 102

Synthesis of 3-nitro-1H-pyrrolo[3,2-13]pyridine

1H-pyrrolo[3,2-b]pyridine (10 g, 84.7 mmol, 1.0 equiv) was dissolved in conc. H₂SO₄ (40 mL). KNO₃ (10.3 g, 101.6 mmol, 1.2 equiv) was added in several portions at 0° C. Upon stirring 4 hours at 0° C., the resulting solution pH was adjusted to 8 by dropwise adding NaOH (1 mol/L) solution. The solid was collected by filtration and washed with water (200 mL×5). 3-Nitro-1H-pyrrolo[3,2-b]pyridine(11 g, 80%) was obtained as a dark solid.

Synthesis of 1H-pyrrolo[3,2-b]pyridin-3-amine dihydrochloride

3-Nitro-1H-pyrrolo[3,2-b]pyridine (10 g, 61.3 mmol, 1.0 equiv) was dissolved in MeOH (40 mL). The flask was charged with Pd/C (10% wt., 1 g) under nitrogen atmosphere. Upon stirring 16 hours at 0° C. under H₂ atmosphere, then the solid was filtered out. To the above filtrate solution was added HCl/dioxane (4 M, 40 mL). Upon stirring 0.5 hours at 0° C., the product was precipitated and collected by filtration. 1H-pyrrolo[3,2-b]pyridin-3-amine dihydrochloride (4.8 g, 38.1%) was isolated as a dark yellow solid.

Synthesis of N-(4-phenylpyridin-2-yl)-1H-pyrrolo[3,2-b]pyridin-3 amine

1H-pyrrolo[3,2-b]pyridin-3-amine dihydrochloride (200 mg, 0.98 mmol, 1.0 equiv) was dissolved in dioxane (10 mL). 2-chloro-4-phenylpyridine (185 mg, 0.98 mmol, 1.0 equiv), Ephos (52 mg, 0.098 mmol, 0.1 equiv) and Cs₂CO₃ (1.6 g, 4.9 mmol, 5.0 equiv) were added. The flask was evacuated and flushed three times with nitrogen, then Ephos Pd G4 (90 mg, 0.098 mmol, 0.1 equiv) was added immediately. Then the system was evacuated and flushed three times with nitrogen again. Upon stirring 3 hours at 90° C. under N₂ and cooling to ambient temperature, the resulting solution was diluted with MeOH (20 mL) and filtered through celite. After evaporation of the resulting filtrate under vacuum, the residue was pre-purified by silica-gel column with DCM/MeOH(10:1). Then the crude product was further purified by Prep-HPLC with following conditions: Column: XBridge Shield RP18 OBD Column, 30*150 mm, 5 um; Mobile Phase A:Water(10 MMOL/L NH₄HCO₃), Mobile Phase B:ACN; Flow rate:60 mL/min; Gradient:35 B to 54 B in 7 min; 254 nm; RT1:5.97. N-(4-phenylpyridin-2-yl)-1H-pyrrolo[3,2-b]pyridin-3-amine (30 mg, 10.7%) was isolated as a white solid.

Compounds 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, and 160 are synthesized using methods similar to those in Examples 1 and 2.

Example 3. Synthesis of Compound 162

Step 1: Synthesis of 5,6-difluoro-1-(triisopropylsilyl)-1H-indole 5,6-Difluoro-1H-indole (1.5 g, 9.8 mmol, 1.0 equiv.) was dissolved in THF (10.0 mL) and cooled to 0° C. and then NaH (60% wt/wt in mineral oil, 784.0 mg, 19.6 mmol, 2.0 equiv.) was added. After 30 min, TIPSCl (2.8 g, 9.7 mmol, 1.5 equiv.) was added. The resulting solution was stirred overnight at ambient temperature and then quenched by the addition of water. The solution was adjusted to pH 7 with HCl aqueous (1M). The resulting solution was extracted with ethyl acetate and concentrated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with ethyl acetate/petroleum ether (1:2) to give 5,6-difluoro-1-(triisopropylsilyl)-1H-indole (1.6 g) as a yellow solid. LCMS Method A: [M+H]⁺=310.

Step 2: Synthesis of 3-bromo-5,6-difluoro-1-(triisopropylsilyl)-1H-indole

5,6-Difluoro-1-(triisopropylsilyl)-1H-indole (2.0 g, 6.5 mmol, 1.0 equiv.) was dissolved in DMF (10.0 mL), then NBS (1.7 g, 12.9 mmol, 2.0 equiv.) was added. The resulting solution was stirred overnight at ambient temperature and then concentrated under reduced pressure. The resulting mixture was diluted with water and the resulting solution was extracted with ethyl acetate and the organic layers were concentrated under reduced pressure to give 3-bromo-5,6-difluoro-1-(triisopropylsilyl)-1H-indole (1.8 g) as a yellow solid. LCMS Method A: [M+H]^P=388.

Step 3: Synthesis of N-[5,6-difluoro-1-(triisopropylsilyl)indol-3-yl]-7-(trifluoromethyl)quinolin-2-amine

3—Bromo-5,6-difluoro-1-(triisopropylsilyl)indole (300.0 mg, 0.8 mmol, 1.0 equiv.) was dissolved in dioxane (5.0 mL), then 7-(trifluoromethyl)quinolin-2-amine (180.3 mg, 0.9 mmol, 1.1 equiv.), t-BuONa (148.5 mg, 1.5 mmol, 2.0 equiv.) and Brettphos Pd G3 (70.0 mg, 0.1 mmol, 0.1 equiv.) were added. The resulting mixture was stirred overnight at 90° C. and then cooled to ambient temperature and concentrated under reduced pressure. The residue was diluted with water and the resulting mixture was extracted with ethyl acetate, dried over anhydrous Na₂SO₄ and concentrated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with ethyl acetate/petroleum ether (1:1) to give N-[5,6-difluoro-1-(triisopropylsilypindol-3-yl]-7-(trifluoromethyl)quinolin-2-amine (180 mg) as a yellow solid. LCMS Method A: [M+H]⁺=520.

Step 4: Synthesis of N-(5,6-difluoro-1H-indol-3-yl)-7-(trifluoromethyl)quinolin-2-amine

N-[5,6-difluoro-1-(triisopropylsilyl)indol-3-yl]-7-(trifluoromethyl)quinolin-2-amine (180.0 mg, 0.3 mmol, 1.0 equiv.) was dissolved in THF (5.0 mL), then TBAF (21.8 mg, 0.1 mmol, 0.2 equiv.) was added. The resulting solution was stirred overnight at ambient temperature and then concentrated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with ethyl acetate/petroleum ether (1:1), then further purified by Prep-HPLC with the following conditions: Column, SunFire Prep C18 OBD Column, 19*150 mm, 5 μm 10 nm; mobile phase, Water (0.1% FA) and ACN (31% Phase B up to 61% in 7 min); Detector, UV 254 nm. This resulted in 16.0 mg of N-(5,6-difluoro-1H-indol-3-yl)-7-(trifluoromethyl)quinolin-2-amine as a yellow solid. LCMS Method B: [M+H]^P=364. ¹H NMR (300 MHz, DMSO-d₆) δ 10.95 (br s, 1H), 9.47 (s, 1H), 8.42 (s, 1H), 8.13-8.09 (m, 1H), 8.01 (s, 1H), 7.94-7.86 (m, 2H), 7.50-7.47 (m, 1H), 7.41-7.35 (m, 1H), 7.26 (d, 1H).

Example 4. Synthesis of Compound 161

Step 1: Synthesis of N-[5,6-difluoro-1-(triisopropylsilyl)indol-3-yl]-6-(trifluoromethyl)quinolin-2-amine

3—Bromo-5,6-difluoro-1-(triisopropylsilyl)indole (300.0 mg, 0.8 mmol, 1.0 equiv.) was dissolved in dioxane (5.0 mL), then 6-(trifluoromethyl)quinolin-2-amine (180.3 mg, 0.9 mmol, 1.1 equiv.), t-BuONa (148.5 mg, 1.5 mmol, 2.0 equiv.) and Brettphos Pd G3 (70.0 mg, 0.1 mmol, 0.1 equiv.) were added. The resulting mixture was stirred overnight at 90° C. and then cooled to ambient temperatures and concentrated under reduced pressure. The residue was diluted with water and the resulting mixture was extracted with ethyl acetate, dried over anhydrous Na₂SO₄ and concentrated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with ethyl acetate/petroleum ether (1:1) to give N-[5,6-difluoro-1-(triisopropylsilypindol-3-yl]-6-(trifluoromethyl)quinolin-2-amine (185 mg) as a yellow solid. LCMS Method A: [M+H]⁺=520.

Step 2: Synthesis of N-(5,6-difluoro-1H-indol-3-yl)-6-(trifluoromethyl)quinolin-2-amine

N-[5,6-difluoro-1-(triisopropylsilyl)indol-3-yl]-6-(trifluoromethyl)quinolin-2-amine (150.0 mg, 0.3 mmol, 1.0 equiv.) was dissolved in THF (3.0 mL), then TBAF (18.6 mg, 0.1 mmol, 0.2 equiv.) was added. The resulting solution was stirred overnight at room temperature and then concentrated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with ethyl acetate/petroleum ether (1:1), then further purified by Prep-HPLC with the following conditions: Column, YMC-Actus

Triart C18, 30*250,5 μm; mobile phase, Water (10 M NH₄HCO3+0.1% NH₄OH) and ACN (55% Phase B up to 70% in 10 min); Detector, UV 254 nm. This resulted in 5.2 mg of N-(5,6-difluoro-1H-indol-3-yl)-6-(trifluoromethyl)quinolin-2-amine as a yellow solid. LCMS Method B: [M+H]^P=364. ¹H NMR (300 MHz, DMSO-d₆) δ 10.99 (br s, 1H), 9.51 (s, 1H), 8.36 (br s, 1H), 8.15-8.12 (m, 2H), 7.84-7.78 (m, 3H), 7.41-7.35 (m, 1H), 7.21 (d, 1H).

Example 5. Synthesis of Compound 163

Step 1: Synthesis of 2-chloro-6-phenylpyrimidin-4(1H)-one

2,4-Dichloro-6-phenylpyrimidine (1.0 g, 4.4 mmol, 1.0 equiv.) was dissolved in DMSO (10.0 mL), then aqueous NaOH (2 N, 4.0 mL) was added. The resulting solution heated to 85° C. for 10 min, then cooled to ambient temperature. The solution was adjusted to pH 6 with aqueous HCl (3 M). The resulting solution was extracted with ethyl acetate, washed with brine, dried over anhydrous sodium sulfate and concentrated under vacuum. The residue was purified by flash column chromatography on silica gel, eluting with ethyl acetate/petroleum ether (1:6) to give 2-chloro-6-phenylpyrimidin-4(1H)-one (210 mg) as a white solid. LCMS Method B: [M+H]^P=207.

Step 2: Synthesis of 2-[(5,6-difluoro-1H-indol-3-yl)amino]-6-phenyl-1H-pyrimidin-4-one

2-Chloro-6-phenylpyrimidin-4(1H)-one (200 mg, 1.0 mmol, 1.0 equiv.) was dissolved in i-PrOH (5.0 mL), then 5,6-difluoro-1H-indol-3-amine (163 mg, 1.0 mmol, 1.0 equiv.) and TsOH (333 mg, 1.9 mmol, 2.0 equiv.) were added. The resulting solution was stirred for 2 hours at 90° C. and then concentrated under vacuum. The crude product was purified by Prep-HPLC with the following conditions: Column,)(Bridge Shield RP18 OBD Column, 19*250 mm, 10 μm; mobile phase, Water (0.1% FA) and ACN (38% Phase B up to 68% in 7 min); Detector, uv 254 nm. This resulted in 52.3 mg of 2-[(5,6-difluoro-1H-indol-3-yl)amino]-6-phenyl-1H-pyrimidin-4-one as a yellow solid. LCMS Method B: [M+H]^P=339. ¹H NMR (300 MHz, DMSO-d₆) δ 11.08 (s, 1H), 10.64 (br s, 1H), 8.79 (br s, 1H), 7.99-7.96 (m, 2H), 7.85-7.83 (m, 1H), 7.47-7.37 (m, 5H), 6.31 (s, 1H).

The following compounds delineated in Table C1 were synthesized using methods similar to those described in Examples 1-5:

	Compound #	m/z (LC/MS)	Compound #	m/z (LC/MS)
	103	266.0	165	292.0
	158	287.3	166	260.0
	159	261.0	167	260.1
	160	304.2	168	304.2
	164	263.0	169	287.1

Biological Assays

STING pathway activation by the compounds described herein is measured using THP1 Dual™ cells (KO-IFNAR2).

THP1-Dual™ KO-IFNAR2 Cells (obtained from invivogen) are maintained in RPMI, 10% FCS, 5 ml P/S, 2 mM L-glut, 10 mM Hepes, and 1 mM sodium pyruvate. Compounds are spotted in empty 384 well tissue culture plates (Greiner 781182) by Echo for a final concentration of 0.0017-100 μM. Cells are plated into the TC plates at 40 μL per well, 2×10E6 cells/mL. For activation with STING ligand, 2′3′cGAMP (MW 718.38, obtained from Invivogen), is prepared in Optimem media.

The following solutions are prepared for each 1×384 plate:

• • Solution A: 2 mL Optimem with one of the following stimuli:
    • 60 uL of 10 mM 2′3′cGAMP ->150 μM stock
  • Solution B: 2 mL Optimem with 60 μL Lipofectamine 2000->Incubate 5 min at RT

2 mL of solution A and 2 ml Solution B is mixed and incubated for 20 min at room temperature (RT). 20 uL of transfection solution (A+B) is added on top of the plated cells, with a final 2′3′cGAMP concentration of 15 μM. The plates are then centrifuged immediately at 340 g for 1 minute, after which they are incubated at 37° C., 5% CO₂, >98% humidity for 24 h. Luciferase reporter activity is then measured. EC₅₀ values were calculated by using standard methods known in the art.

Luciferase reporter assay: 10 μL of supernatant from the assay is transferred to white 384-plate with flat bottom and squared wells. one pouch of QUANTI-Luc™ Plus is dissolved in 25 mL of water. 100 μL of QLC Stabilizer per 25 mL of QUANTI-Luc™ Plus solution was added. 50 μL of QUANTI-Luc™ Plus/QLC solution per well is then added. Luminescence is measured on a Platereader (e.g., Spectramax I3X (Molecular Devices GF3637001)).

Luciferase reporter activity is then measured. EC₅₀ values are calculated by using standard methods known in the art.

Table BA shows the activity of compounds in STING reporter assay: <0.008 μM=“++++++”; ≥0.008 and <0.04 μM=“+++++”; ≥0.04 and <0.2 μM=“++++”; ≥0.2 and <1 μM=“+++”; ≥1 and <5 μM=“++”; ≥5 and <30 μM=“+”.

Compound Human STING Reporter
#        Assay EC50 (μM)
101      +++
102      +
103      ++
158      ++
159      +
160      ++
161      ++
162      +++
163      +
164      >30.0000
165      +++
166      ++
167      ++
168      >100.0000
169      +

The compounds, compositions, methods, and other subject matter described herein are further described in the following numbered clauses:

1. A compound of Formula I as described in claim 1 of 62/854,288, filed on May 29, 2019; e.g., a compound of Formula I:

or a pharmaceutically acceptable salt thereof or a tautomer thereof,

wherein:

Z is selected from the group consisting of a bond, CR¹, C(R³)₂, N, and NR²;

each of Y¹, Y², and Y³ is independently selected from the group consisting of O, S, CR¹, C(R³)₂, N, and NR²;

Y⁴ is C or N;

X¹ is selected from the group consisting of O, S, N, NR², and CR¹;

X² is selected from the group consisting of O, S, N, NR⁴, and CR⁵;

each is independently a single bond or a double bond, provided that the five-membered ring comprising Y⁴, X¹, and X² is heteroaryl;

W is defined according to (A) or (B) below:

• • (A)
  • W is Q¹-Q²-A, wherein

Q¹ is selected from the group consisting of:

• • (a) phenyl optionally substituted with from 1-2 independently selected R^q1; and
  • (b) heteroaryl including from 5-6 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^q1;

Q² is selected from the group consisting of: a bond, —NH—, —N(C_1-3 alkyl)-, —O—, —C(═O), and S(O)_0-2—;

A is:

(i) —(Y_A1)_n—Y^A2, wherein:

• • n is 0 or 1;
  • Y^A1 is C_1-6 alkylene, which is optionally substituted with from 1-6 R^a; and
  • Y^A2 is:
    • (a) C_3-20 cycloalkyl, which is optionally substituted with from 1-4 R^b,
    • (b) C_6-20 aryl, which is optionally substituted with from 1-4 R^c;
      • (c) heteroaryl including from 5-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; or
    • (d) heterocyclyl including from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heterocyclyl ring is optionally substituted with from 1-4 independently selected R^b,

OR

(ii) Z¹—Z²—Z³, wherein:

• • Z¹ is C_1-3 alkylene, which is optionally substituted with from 1-4 R^a;
  • Z² is N(H)—, —N(R^d)—, —O—, or —S—; and
  • Z³ is C_2-7 alkyl, which is optionally substituted with from 1-4 R^a;

OR

(iii) C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a,

OR

B

• • W is selected from the group consisting of:

(a) C_7-20 bicyclic or polycyclic aryl, which is optionally substituted with from 1-4 R^c; and

(b) bicyclic or polycyclic heteroaryl including from 7-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c;

each occurrence of R¹ is independently selected from the group consisting of

• • H;
  • halo;
  • cyano;
  • C_1-6 alkyl optionally substituted with 1-2 R^a;
  • C_2-6 alkenyl optionally substituted with 1-2 R^a;
  • C_2-6 alkynyl optionally substituted with 1-2 R^a;
  • C_1-4 haloalkyl;
  • C_1-4 alkoxy;
  • C_1-4 haloalkoxy;
  • -L³-L⁴-Rⁱ;
  • —S(O)_1-2(C_1-4 alkyl);
  • —S(O)(═NH)(C_1-4 alkyl);
  • SF₅;
  • —NR^eR^f;
  • —OH;
  • oxo;
  • —S(O)_1-2 (NR′R″);
  • —C_1-4 thioalkoxy;
  • —NO₂;
  • —C(═O)(C_1-4 alkyl);
  • —C(═O)O(C_1-4 alkyl);
  • —C(═O)OH; and
  • —C(═O)N(R′)(R″);

or a pair of R¹ on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl,—OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy,

each occurrence of R² is independently selected from the group consisting of:

(i) C_1-6 alkyl, which is optionally substituted with from 1-2 independently selected R^a;

(ii) C_3-6 cycloalkyl;

(iii) heterocyclyl including from 3-10 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2;

(iv) C_6-10 aryl;

(v) heteroaryl including from 5-10 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2;

(vi) —C(O)(C_1-4 alkyl);

(vii) —C(O)O(C_1-4 alkyl);

(viii) —CON(R′)(R″);

(ix) —S(O)_1-2 (NR′R″);

(x) —S(O)_1-2(C_1-4 alkyl);

(xi) —OH;

(xii) C_1-4 alkoxy; and

(xiii) H;

or a pair of R¹ and R² on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms (in addition to the nitrogen atom to which the R² is attached) are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy,

each occurrence of R³ is independently selected from H; C_1-6 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; —F; —Cl; —Br; NR^eR^f; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; —C(═O)N(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2(C_1-4 alkyl); cyano; and C_3-6 cycloalkyl optionally substituted with from 1-4 independently selected C_1-4 alkyl; or

two R³ on the same carbon combine to form an oxo; or

a pair of R³, taken together with the atom(s) connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy; or

a pair of R² and R³ on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl,—OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy; or

or a pair of R² and R³ on adjacent atoms, taken together with the atoms connecting them, form a ring including from 3-10 ring atoms, wherein from 0-2 ring atoms (in addition to the nitrogen atom to which the R² is attached) are heteroatoms each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2; and wherein the ring is optionally substituted with from 1-4 substituents each independently selected from C_1-6 alkyl, halo, C_1-6 haloalkyl, —OH, NR^eR^f, C_1-6 alkoxy, and C_1-6 haloalkoxy;

R⁴ is selected from H and C_1-6 alkyl;

R⁵ is selected from H and halo;

R⁶ is selected from H; C_1-6 alkyl; —OH; C_1-4 alkoxy; C(═O)H; C(═O)(C_1-4 alkyl); CN; C_6-10 aryl optionally substituted with from 1-4 independently selected C_1-4 alkyl; and heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected C_1-4 alkyl;

each occurrence of R^q1 is independently selected from the group consisting of:

(a) halo; (b) cyano; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (f) C_3-6 cycloalkyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (j) —NR^eR^f; (k) OH; (l) —S(O)_i—2(NR′R″); (m) —C_1-4 thioalkoxy; (n) —NO₂; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (r) —C(═O)N(R′)(R″); and (s) oxo;

each occurrence of R^a is independently selected from the group consisting of: OH; —F; —Cl; —Br; NR^eR^f; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)O(C_1-4 alkyl); —C(═O)(C_1-4 alkyl); —C(═O)OH; —CON(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2 (C_1-4 alkyl); cyano; and C_3-6 cycloalkyl optionally substituted with from 1-4 independently selected C_1-4 alkyl;

each occurrence of R^b is independently selected from the group consisting of: C_1-10 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; oxo; —F; —Cl; —Br; NR^eR^f; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; —C(═O)N(R′)(R″); —S(O)_1-2(NR′R″); —S(O)_1-2(C_1-4 alkyl); cyano; and -L¹-L²-R^h;

each occurrence of R^c is independently selected from the group consisting of:

(a) halo; (b) cyano; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (j) —NR^eR^f; (k) OH; (l) —S(O)_1-2(NR′R″); (m) —C_1-4 thioalkoxy; (n) —NO₂; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (r) —C(═O)N(R′)(R″); (s) -L¹-L²-R^h; and (t) oxo;

R^d is selected from the group consisting of: C_1-6 alkyl; C_3-6 cycloalkyl; —C(O)(C_1-4 alkyl); —C(O)O(C_1-4 alkyl); —CON(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2(C_1-4 alkyl); —OH; and C_1-4 alkoxy;

each occurrence of R^e and R^f is independently selected from the group consisting of: H; C_1-6 alkyl optionally substituted with from 1-2 substituents each independently selected from halo, OH, C_1-4 alkoxy, C_1-4 haloalkoxy, and CN; C_1-6 haloalkyl; C_3-6 cycloalkyl; —C(O)(C_1-4 alkyl); —C(O)O(C_1-4 alkyl); —CON(R′)(R″); —S(O)_1-2 (NR′R″); —S(O)_1-2(C_1-4 alkyl); —OH; and C_1-4 alkoxy; or R^e and R^f together with the nitrogen atom to which each is attached forms a ring including from 3-8 ring atoms, wherein the ring includes: (a) from 1-7 ring carbon atoms, each of which is substituted with from 1-2 substituents independently selected from H and C_1-3 alkyl; and (b) from 0-3 ring heteroatoms (in addition to the nitrogen atom attached to R^e and R^f), which are each independently selected from the group consisting of N(R^d), NH, O, and S;

-L¹ is a bond or C_1-3 alkylene optionally substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN;

-L² is —O—, —N(H)—, —S(O)_0-2—, or a bond;

R^h is selected from:

• • C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl (in certain embodiments, it is provided that when R^h is C_3-6 cycloalkyl optionally substituted with from 1-4 substituents independently selected C_1-4 alkyl, -L¹ is a bond, or -L² is —O—, —N(H)—, or —S—);
  • heterocyclyl, wherein the heterocyclyl includes from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;
  • heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;

-L³ is a bond; C_1-3 alkylene optionally substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN; CH═CH; or C≡C;

-L⁴ is —O—, —N(H)—, —S(O)_0-2—, or a bond;

Rⁱ is selected from:

• • C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;
  • heterocyclyl, wherein the heterocyclyl includes from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl;
  • heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and

each occurrence of R′ and R″ is independently selected from the group consisting of: H, C_1-4 alkyl, and C_6-10 aryl optionally substituted with from 1-2 substituents selected from halo, C_1-4 alkyl, and C_1-4 haloalkyl; or R′ and R″ together with the nitrogen atom to which each is attached forms a ring including from 3-8 ring atoms, wherein the ring includes: (a) from 1-7 ring carbon atoms, each of which is substituted with from 1-2 substituents independently selected from the group consisting of H and C_1-3 alkyl; and (b) from 0-3 ring heteroatoms (in addition to the nitrogen atom attached to R′ and R″), which are each independently selected from the group consisting of N(H), N(C_1-6 alkyl), O, and S;

provided that the compound is other than a compound selected from the group consisting of:

and

further provided that when Z, Y², and Y³ are each CH; Y⁴ is C; Y¹ is CH or C—OH; X¹ is NH; and X² is CH, then W cannot be:

• • pyrimidinyl substituted with from 1-2 substituents each independently selected from the group consisting of: methyl; —CH₂NH₂; —CH₂N(H)Me; —CH₂CH₂NH₂; —CH₂CH₂N(H)Me; —N(H)Me; —N(H)Et; —N(H)CH₂CH₂NH₂; —N(H)CH₂CH₂OH; —N(H)iPr; —N(H)CH₂CN; cyano; C(═O)OH; and —Cl;
  • thiazolyl substituted with —CH₂NH₂; or
  • pyridinyl substituted with from 1-2 substituents each independently from the group consisting of: NH₂; methyl; and Br.

2. The compound of clause 1, wherein the ring that includes Z, Y¹, Y², Y³, and Y⁴ is aromatic.

3. The compound of any one of clauses 1-2, wherein Z is selected from the group consisting of CRI, N, and NR².

4. The compound of any one of clauses 1-3, wherein Z is CR¹.

5. The compound of any one of clauses 1-4, wherein each of Y¹, Y², and Y³ is independently selected from the group consisting of CRI, N, and NR² (e.g., CRI and N).

6. The compound of any one of clauses 1-5, wherein each of Y¹, Y², and Y³ is independently CR¹.

7. The compound of any one of clauses 1-6, wherein the

moiety is

8. The compound of any one of clauses 1-5, wherein from 1-2 of Y¹, Y², and Y³ is independently N or NR² (e.g., N).

9. The compound of any one of clauses 1˜4 and 8, wherein one of Y¹, Y², and Y³ is N or NR² (e.g., N).

10. The compound of any one of clauses 8-9, wherein each of the remaining Y¹, Y², and Y³ is an independently selected CR¹.

11. The compound of any one of clauses 1-5 and 8-10, wherein

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

12. The compound of any one of clauses 1-5 and 8-10, wherein

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

13. The compound of any one of clauses 1-5 and 8-10, wherein

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

14. The compound of any one of clauses 1-3, wherein Z is N.

15. The compound of any one of clauses 1-2 and 14, wherein each of Y¹, Y², and Y³ is independently selected from the group consisting of CR¹ and N.

16. The compound of any one of clauses 1-2 and 14-15, wherein each of Y², and Y³ is independently CR¹ (e.g., the

moiety is

wherein the asterisk denotes point of attachment to Y⁴).

17. The compound of any one of clauses 1-2, wherein Z is a bond.

18. The compound of clause 17, wherein Y¹ is selected from the group consisting of CR¹, N, O, and S (e.g., CR¹, N, and S).

19. The compound of any one of clauses 17-18, wherein Y² is selected from the group consisting of CR¹ and NR².

20. The compound of any one of clauses 17-19, wherein Y³ is selected from the group consisting of CR¹, N, O, and S (e.g., CR¹, N, and S).

21. The compound of any one of clauses 17-20, wherein the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

22. The compound of any one of clauses 17-20, wherein the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

23. The compound of any one of clauses 17-20, wherein the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

24. The compound of clause 1, wherein the ring that includes Z, Y¹, Y², Y³, and Y⁴ is partially saturated.

25. The compound of clause 24, wherein Z is C(R³)₂ or a bond (e.g., Z is C(R³)₂).

26. The compound of any one of clauses 24-25, wherein each of Y¹, Y², and Y³ is independently selected from the group consisting of C(R³)₂, O, NR², and S.

27. The compound of any one of clauses 24-26, wherein one of Y¹, Y², and Y³ (e.g., Y¹ or Y²) is independently 0 or NR²; and each of the remaining Y², and Y³ is an independently selected C(R³)₂.

28. The compound of clause 27, wherein Y¹ is O or NR² (e.g., NR²).

29. The compound of clause 27, wherein Y² is O or NR² (e.g., O).

30. The compound of any one of clauses 24-28, wherein the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

31. The compound of any one of clauses 24-27 and 29, wherein the

moiety is

wherein the asterisk denotes point of attachment to Y⁴.

32. The compound of any one of clauses 1-31, wherein Y⁴ is C.

33. The compound of any one of clauses 1-32, wherein X⁴ is NR² (e.g., NH).

34. The compound of any one of clauses 1-33, wherein X² is CR⁵ (e.g., CH).

35. The compound of any one of clauses 1-33, wherein X² is N.

36. The compound of any one of clauses 1-3, wherein the compound is selected from a compound of the following formulae:

37. The compound of any one of clauses 1-3 and 36, wherein the compound has formula (Ia):

38. The compound of clause 37, wherein the compound has formula (Ia-1):

39. The compound of clause 37, wherein the compound has formula (Ia-2), formula (Ia-3), formula (Ia-4), or formula (Ia-5):

40. The compound of any one of clauses 1-3 and 36, wherein the compound has formula (Ib):

41. The compound of clause 40, wherein the compound has formula (Ib-1):

42. The compound of any one of clauses 1-3 and 36, wherein the compound has formula (Ic):

43. The compound of clause 42, wherein the compound has formula (Ic-1):

44. The compound of any one of clauses 1-3 and 36, wherein the compound has formula (Id):

45. The compound of clause 44, wherein the compound has formula (Id-1) or formula (Id-2):

46. The compound of any one of clauses 1-3 and 36, wherein the compound has formula (Ie):

47. The compound of clause 46, wherein the compound has formula (Ie-1):

48. The compound of any one of clauses 1-2 and 17, wherein the compound is selected from a compound of the following formulae:

49. The compound of any one of clauses 1 and 24, wherein the compound is selected from a compound of the following formulae:

50. The compound of any one of clauses 1-23 and 32-48, wherein R¹ is selected from the group consisting of: H; halo; cyano; C_1-6 alkyl optionally substituted with 1-2 R^a; C_2-6 alkenyl optionally substituted with 1-2 R^a; C_2-6 alkynyl optionally substituted with 1-2 R^a; C_1-4 haloalkyl; C_1-4 alkoxy; C_1-4 haloalkoxy; -L³-L⁴-Rⁱ; —S(O)_1-2(C_1-4 alkyl); —S(O)(═NH)(C_1-4 alkyl); SF₅; —NR^eR^f; —S(O)_1-2(NR′R″); —C_1-4 thioalkoxy; —NO₂; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —C(═O)OH; and —C(═O)N(R′)(R″).

51. The compound of any one of clauses 1-23, 32-48, and 50, wherein from 0-3 (e.g., 0, 1, 2, or 3 (e.g., 0, 1, or 2)) occurrences of R¹ is other than H; and each of the remaining occurrences of R¹ is H.

52. The compound of any one of clauses 1-23, 32-48, and 50-51, wherein each occurrence of R¹ is H.

53. The compound of any one of clauses 1-23, 32-48, and 50-51, wherein from 1-3 (e.g., 1, 2, or 3 (e.g., 1 or 2)) occurrences of R¹ is other than H.

54. The compound of clause 53, wherein one occurrence of R¹ is halo (e.g., F or C₁ (e.g., F)).

55. The compound of clause 53, wherein one occurrence of R¹ is C_1-6 alkyl (e.g., C_1-3 alkyl) optionally substituted with 1-2 R^a.

56. The compound of clause 55, wherein R^a is selected from OH, NR^eR^f, C(═O)OH, C_1-4 alkoxy, and C_1-4 haloalkoxy.

57. The compound of clause 56, wherein R¹ is selected from the group consisting of methyl, isopropyl, CH₂OH, C(OH)Me₂, CH(Me)(OMe), CH₂C(═O)OH, CH₂C(═O)NHMe, and CH₂C(═O)NH(CH₂CH₂OH).

58. The compound of clause 53, wherein one occurrence of R¹ is C_2-6 alkynyl or C_2-6 alkenyl, each of which is optionally substituted with 1-2 R^a (e.g., C_2-6 alkynyl optionally substituted with 1-2 R^a).

59. The compound of clause 58, wherein R^a is selected from OH, NR^eR^f, C(═O)OH, C_1-4 alkoxy, and C_1-4 haloalkoxy (e.g., one occurrence of R¹ is selected from the group consisting of:

60. The compound of clause 53, wherein one occurrence of R¹ is —C(═O)(C_1-4 alkyl) (e.g., —C(═O)Me) or CN.

61. The compound of clause 53, wherein one occurrence of R¹ is C(═O)N(R′)(R″) (e.g., C(═O)NHMe or C(═O)NMe₂).

62. The compound of clause 53, wherein one occurrence of R¹ is C_1-4 haloalkyl (e.g., CF₃ or CH₂CF₃).

63. The compound of clause 53, wherein one occurrence of R¹ is S(O)_1-2(C_1-4 alkyl) or S(O)(═NH)(C_1-4 alkyl) (e.g., S(O)₂Me or S(O)(═NH)(Me)).

64. The compound of clause 53, wherein one occurrence of R¹ is SF₅.

65. The compound of clause 53, wherein one occurrence of R₁ is —NR^eR^f (e.g., NHS(O)₂(C_1-4 alkyl (e.g., NHS(O)₂Me)).

66. The compound of clause 53, wherein one occurrence of R₁ is -L³-L⁴-Rⁱ.

67. The compound of clause 66, wherein Rⁱ is selected from the group consisting of:

• • heteroaryl including from 5-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl.

68. The compound of clause 67, wherein Rⁱ is C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl.

69. The compound of clause 68, wherein Rⁱ is C₆ aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl (e.g., Rⁱ is unsubstituted phenyl).

70. The compound of clause 67, wherein Rⁱ is heteroaryl including from 5-10 (e.g., 5-6) ring atoms, wherein from 1-4 (e.g., from 1-2) ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2 and wherein the heteroaryl ring is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl.

71. The compound of clause 70, wherein Rⁱ is selected from pyridyl, pyrimidinyl, thiazolyl, and pyrazolyl, each of which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl.

72. The compound of clause 71, wherein Rⁱ is selected from:

73. The compound of clause 66, wherein Rⁱ is selected from the group consisting of:

• • C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl; and
  • heterocyclyl, wherein the heterocyclyl includes from 3-16 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalky.

74. The compound of clause 73, wherein Rⁱ is C_3-8 cycloalkyl optionally substituted with from 1-4 (e.g., 1-2) substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl.

75. The compound of clause 74, wherein Rⁱ is

76. The compound of clause 73, wherein Rⁱ is heterocyclyl, wherein the heterocyclyl includes from 3-8 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, wherein the heterocyclyl is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalky.

77. The compound of clause 76, wherein Rⁱ is

78. The compound of any one of clauses 66-77, wherein -L³ is a bond.

79. The compound of any one of clauses 66-77, wherein -L³ is C_1-3 alkylene (e.g., CH₂).

80. The compound of any one of clauses 66-77, wherein -L³ is C_1-3 alkylene substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN.

81. The compound of any one of clause 80, wherein -L³ is —CH(NMe₂)—.

82. The compound of any one of clauses 66-81, wherein -L⁴ is a bond.

83. The compound of any one of clauses 66-81, wherein -L⁴ is —O—or —S—.

84. The compound of any one of clauses 66-78, wherein -L³ is a bond; and L⁴ is a bond.

85. The compound of any one of clauses 66-77 and 79, wherein -L³ is C_1-3 alkylene; and -L⁴ is a bond.

86. The compound of any one of clauses 66-77 and 80, wherein -L³ is C_1-3 alkylene optionally substituted with from 1-2 substituents each independently selected from the group consisting of halo, NR^eR^f, OH, C_1-4 alkoxy, and CN; and -L⁴ is a bond.

87. The compound of any one of clauses 66-78, wherein -L³ is a bond; and -L⁴ is —O—or —S—.

88. The compound of clause 66, wherein R¹ is selected from the group consisting of:

89. The compound of clause 66, wherein R¹ is selected from the group consisting of:

90. The compound of any one of clauses 53-89, wherein each remaining R¹ is H.

91. The compound of any one of clauses 53-89, wherein one or two other occurrences of R¹ is independently halo (e.g., F) or C_1-4 alkyl; and each remaining R¹ is H.

92. The compound of any one of clauses 1-91, wherein R² is H.

93. The compound of any one of clauses 1-91, wherein R² is C_1-6 alkyl, which is optionally substituted with from 1-2 independently selected R^a (e.g., unsubstituted C₁-3 alkyl); or R² is C_1-4 haloalkyl (e.g., CH₂CF₃).

94. The compound of any one of clauses 1-91, wherein R² is —C(O)(C_1-4 alkyl) (e.g., C(O)Me).

95. The compound of any one of clauses 1-91, wherein R² is C_6-10 aryl (e.g., phenyl).

96. The compound of any one of clauses 1-91, wherein when X¹ is NR², the R² group of X¹ is H.

97. The compound of any one of clauses 1, 24-35, 49, and 92-96, wherein each occurrence of R³ is independently selected from: H; C_1-6 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; —F; NR^eR^f; C_1-4 alkoxy; and C_1-4 haloalkoxy; or two R³ on the same carbon combine to form an oxo.

98. The compound of clause 97, wherein each occurrence of R³ is independently H, C_1-6 alkyl, or C_1-4 haloalkyl; or two R³ on the same carbon combine to form an oxo.

99. The compound of any one of clauses 1-98, wherein R⁵ is H.

100. The compound of any one of clauses 1-98, wherein R⁵ is halo.

101. The compound of any one of clauses 1-100, wherein W is defined according to (A).

102. The compound of any one of clauses 1-101, wherein Q¹ is phenyl optionally substituted with from 1-2 independently selected R^q1.

103. The compound of any one of clauses 1-102, wherein Q¹ is

wherein the asterisk denotes point of attachment of Q².104. The compound of any one of clauses 1-101, wherein Q¹ is heteroaryl including from 5-6 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^q1.

105. The compound of clause 104, wherein Q¹ is heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1 (e.g., Q¹ is oxazolyl, thiazolyl, or thiadiazolyl).

106. The compound of clause 105, wherein Q¹ heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1, wherein one ring atom of Q¹ is S or O (e.g., S; or e.g., O).

107. The compound of any one of clauses 105-106, wherein Q¹ is selected from the group consisting of:

wherein the asterisk denotes point of attachment of Q².

108. The compound of clause 104, wherein Q¹ is heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1.

109. The compound of clause 108, wherein Q¹ is pyridyl or pyrimidinyl, each of which is optionally substituted with 1-2 independently selected R^q1.

110. The compound of clause 109, wherein Q¹ is selected from the group consisting of:

each of which is optionally substituted with 1-2 independently selected R^q1, wherein the asterisk denotes point of attachment of Q².

111. The compound of any one of clauses 102-110, wherein each R^q1 is independently selected from the group consisting of: halo; cyano; C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a (e.g., unsubstituted C_1-10 alkyl); C_3-6 cycloalkyl; and oxo.

112. The compound of any one of clauses 101-111, wherein Q² is a bond.

113. The compound of any one of clauses 101-111, wherein Q² is —O—, —NH—, or S(O)_0-2 (e.g., Q² is —O—; or Q² is —NH—; or Q² is —S(O)₂—).

114. The compound of any one of clauses 1-113, wherein A is —(Y^A1)_n—Y^A2.

115. The compound of any one of clauses 1-114, wherein n is 0.

116. The compound of any one of clauses 1-114, wherein n is 1.

117. The compound of clause 116, wherein Y^A1 is C_1-6 alkylene, which is optionally substituted with from 1-2 R^a.

118. The compound of any one of clauses 1-117, wherein Y^A2 is C_6-10 aryl, which is optionally substituted with from 1-3 R^c.

119. The compound of any one of clauses 1-118, wherein Y^A2 is C₆ aryl, which is optionally substituted with from 1-3 R^c (e.g., Y^A2 is unsubstituted phenyl; or Y^A2 is phenyl which is substituted with from 1-3 (e.g., 1, 2, or 3) R^c).

120. The compound of any one of clauses 1-117, wherein Y^A2 is C_7-15 bicyclic or tricyclic aryl which is optionally substituted with from 1-3 R^c (e.g., naphthyl, tetrahydronaphthyl, indacenyl, or 1′,3′—dihydrospiro[cyclopropane—1,2′-indene]

each of which is optionally substituted with from 1-3 R^c).

121. The compound of any one of clauses 1-119, wherein Y^A2 is phenyl substituted with from 1-3 R^c, wherein one R^c is at the ring carbon para to the point of attachment to Y^A1.

122. The compound of any one of clauses 1-119 wherein Y^A2 is phenyl substituted with from 1-3 R^c, wherein from 1-2 R^c is at the ring carbons meta to the point of attachment to Y^A1.

123. The compound of any one of clauses 1-117, wherein Y^A2 is heteroaryl including from 5-14 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

124. The compound of any one of clauses 1-117 and 123, wherein Y^A2 is heteroaryl including 6 ring atoms (e.g., pyridyl or pyrimidinyl (e.g., pyridyl

wherein from 1-2 ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-3 independently selected R^c.

125. The compound of any one of clauses 118-124, wherein each occurrence of R^c is independently selected from the group consisting of: (a) halo; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (m) —C_1-4 thioalkoxy; (o) —C(═O)(C_1-4 alkyl); and (s) -L¹-L²-R^h.

126. The compound of any one of clauses 118-125, wherein one occurrence of R^c is halo.

127. The compound of any one of clauses 118-125, wherein one occurrece of R^c is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a.

128. The compound of clause 127, wherein one occurrence of R^c is unsubstituted C_1-10 alkyl (e.g., C₂, C₃, C₄, C₅, C₆, or C_7-10).

129. The compound of clause 127, wherein one occurrece of R^c is C_1-10 alkyl which is substituted with from 1-6 independently selected R^a.

130. The compound of any one of clauses 1-117, wherein Y^A2 is C_3-10 cycloalkyl, which is optionally substituted with from 1-4 R^b.

131. The compound of clause 130, wherein Y^A2 is C₆ cycloalkyl, which is substituted with from 1-4 (e.g., from 1-2) R^b (e.g., Y^A2 is

132. The compound of clause 130, wherein Y^A2 is C_8-10 cycloalkyl, which is optionally substituted with from 1-4 R^b (e.g., Y^A2 is

133. The compound of any one of clauses 1-117, wherein Y^A2 is heterocyclyl including from 3-12 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heterocyclyl ring is optionally substituted with from 1-4 independently selected R^b.

134. The compound of clause 133, wherein Y^A2 is heterocyclyl including from 4-12 (e.g., 4-8) ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heterocyclyl ring is optionally substituted with from 1-4 independently selected R^b (e.g., Y^A2 is tetrahydropyranyl, morpholinyl, azetidinyl, or oxetanyl, each of which is optionally substituted with from 1-4 independently selected R^b).

135. The compound of clause 134, wherein Y^A2 is selected from the group consisting of:

136. The compound of any one of clauses 130-135, wherein each occurrence of R^b is independently selected from the group consisting of: C_1-10 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; —F; —Cl; —Br; C_1-4 alkoxy; C_1-4 haloalkoxy; —C(═O)(C_1-4 alkyl); —C(═O)O(C_1-4 alkyl); —S(O)_1-2(C_1-4 alkyl); cyano; and -L¹-L²-R^h.

137. The compound of any one of clauses 130-136, wherein one occurrece of R^b is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a.

138. The compound of clause 137, wherein one occurrence of R^b is unsubstituted C_1-10 alkyl (e.g., C₂, C₃, C₄, C₅, C₆, or C_7-10).

139. The compound of any one of clauses 130-136, wherein one occurrence of R^b is —F or —Cl (e.g., —F). 140. The compound of any one of clauses 13-136, wherein one occurrence of R^b is -L¹-L²-R^h.

141. The compound of clause 140, wherein L1 is a bond.

142. The compound of any one of clauses 140-141, wherein L² is a bond.

143. The compound of any one of clauses 140-142, wherein R^h is C_3-8 cycloalkyl optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, and C_1-4 haloalkyl.

144. The compound of any one of clause 140-142, wherein R^h is C_6-10 aryl (e.g., C₆), which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, or C_1-4 haloalkyl (e.g., R^h is unsubstituted phenyl).

145. The compound of any one of clauses 1-113, wherein A is C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a.

146. The compound of any one of clauses 1-113 and 145, wherein A is C_1-10 alkyl, which is substituted with from 1-6 independently selected R^a (e.g., CF3).

147. The compound of any one of clauses 1-113 and 145, wherein A is unsubstituted C_4-10 alkyl (e.g., butyl).

148. The compound of any one of clauses 1-100, W is defined according to (B).

149. The compound of any one of clauses 1-100 and 148, wherein W is C_7-20bicyclic or polycyclic aryl, which is optionally substituted with from 1-4 R^c.

150. The compound of any one of clauses 1-100 and 148-149, wherein W is C_9-12 bicyclic aryl, which is optionally substituted with from 1-4 R^c.

151. The compound of clause 150, wherein W is C_9-10 (e.g., C₁₀) bicyclic aryl, which is optionally substituted with from 1-4 R^c (e.g., naphthyl, tetrahydronaphthyl, or indacenyl).

152. The compound of clause 151, wherein W is

153. The compound of any one of clauses 1-100 and 148, wherein W is bicyclic or polycyclic heteroaryl including from 7-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

154. The compound of any one of clauses 1-100, 148, and 153, wherein W is bicyclic heteroaryl including from 9-12 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

155. The compound of clause 154, wherein W is bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

156. The compound of any one of clauses 154-155, wherein W includes a ring sulfur atom or ring oxygen atom.

157. The compound of clause 156, wherein W is

which is optionally substituted with from 1-4 independently selected R^c.

158. The compound of any one of clauses 153-155, wherein W includes a pyridine (including pyridone) ring or a pyrimidine (including pyrimidone) ring (e.g., W includes a pyridine (including pyridone) ring).

159. The compound of clause 158, wherein W is selected from the group consisting of:

and each of which is further optionally substituted with from 1-3 independently selected R^c.

160. The compound of any one of clauses 1-100, 148, and 153, wherein W is tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

161. The compound of clause 160, wherein W includes a pyridine ring.

162. The compound of clause 161, wherein W is selected from the group consisting of:

each of which is optionally substituted with from 1-4 independently selected R^c.

163. The compound of any one of clauses 148-162, wherein each occurrence of R^c is independently selected from the group consisting of: (a) halo; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (m) —C_1-4 thioalkoxy; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (s) -L¹-L²-R^h; and (t) oxo.

164. The compound of any one of clauses 148-163, wherein one occurrence of R^c is halo.

165. The compound of any one of clauses 148-163, wherein one occurrece of R^c is C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a.

166. The compound of clause 165, wherein one occurrence of R^c is unsubstituted C_1-10 alkyl (e.g., C₂, C₃, C₄, C₅, C₆, or C_7-10).

167. The compound of clause 165, wherein one occurrece of R^c is C_1-10 alkyl which is substituted with from 1-6 independently selected R^a.

168. The compound of any one of clauses 148-163, wherein one occurrence of R^c is —C(═O)OH.

169. The compound of any one of clauses 148-163, wherein one occurrence of R^c is -L¹-L²-R^h.

170. The compound of clause 169, wherein is a bond.

171. The compound of any one of clauses 169-170, wherein -L² is a bond.

172. The compound of any one of clauses 169-171, wherein R^h C_6-10 aryl, which is optionally substituted with from 1-4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl.

• 173. The compound of clause 172, wherein R^h is C₆ aryl, which is optionally substituted with from 1—4 substituents independently selected from the group consisting of halo, C_1-4 alkyl, hydroxyC_1-4 alkyl, and C_1-4 haloalkyl (e.g., R^h is unsubstituted phenyl).

174. The compound of clause 1, wherein the compound has the following formula:

wherein Q¹ is selected from the group consisting of:

• • (d)

wherein the asterisk denotes point of attachment to Q²;

• • (e) heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1; and
  • (f) heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1; and

Q² is a bond or O.

175. The compound of clause 174, wherein Q¹ is

176. The compound of clause 174, wherein Q¹ is heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected 10¹.

177. The compound of clause 176, wherein one ring atom of Q¹ is S or O.

178. The compound of clause 177, wherein Q¹ is selected from:

wherein the asterisk denotes point of attachment of Q².

179. The compound of clause 174, wherein Q¹ is heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1.

180. The compound of clause 179, wherein Q¹ is pyridyl or pyrimidinyl, each of which is optionally substituted with 1-2 independently selected R^q1.

181. The compound of clause 180, wherein Q¹ is selected from the group consisting of:

each of which is optionally substituted with 1-2 independently selected R^q1, wherein the asterisk denotes point of attachment of Q².

182. The compound of any one of clauses 174-181, wherein Q² is a bond.

183. The compound of any one of clauses 174-181, wherein Q² is —O—, —NH—, or —S(O)_0-2 (e.g., Q² is —O—; or Q² is —NH—; or Q² is —S(O)₂—).

184. The compound of any one of clauses 174-183, wherein A is —(Y^A1)_n—Y^A2.

185. The compound of clause 184, wherein n is 0.

186. The compound of any one of clauses 184-185, wherein Y^A2 is as defined in any one of clauses 118-129 (e.g., 118; e.g., 119; e.g., 120; e.g., 121 or 122; e.g., 123 or 124).

187. The compound of any one of clauses 184-185, wherein Y^A2 is as defined in any one of clauses 130-132 (e.g., 130; e.g., 131; e.g., 132) and 136-144 (e.g., each R^b substituent of Y^A2 is as defined in clause 136, 137, 138, 139, or 140).

188. The compound of any one of clauses 184-185, wherein Y^A2 is as defined in any one of clauses 133-135 (e.g., 133; e.g., 134; e.g., 135) and 136-144 (e.g., each R^b substituent of Y^A2 is as defined in clause 136, 137, 138, 139, or 140).

189. The compound of any one of clauses 174-183, wherein A is C_1-10 alkyl, which is optionally substituted with from 1-6 independently selected R^a.

190. The compound of clause 189, wherein A is C_1-10 alkyl, which is substituted with from 1-6 independently selected R^a (e.g., CF3).

191. The compound of clause 189, wherein A is unsubstituted C_4-10 alkyl (e.g., butyl).

192. The compound of clause 1, wherein the compound has the following formula:

• • wherein W² is selected from the group consisting of:
  • (d) C_9-10 (e.g., C₁₀) bicyclic aryl, which is optionally substituted with from 1-4 R^c;
  • (e) bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; and
  • (f) tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.
  • 193. The compound of clause 192, wherein W² is C_9-10 (e.g., C₁₀) bicyclic aryl, which is optionally substituted with from 1-4 R^c (e.g., napthyl, tetrahydronaphthyl, or indacenyl).

194. The compound of clause 193, wherein W² is

195. The compound of clause 192, wherein W² is bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c, such as:

• • wherein W² is selected from the group consisting of:

• • wherein:
  • W^a, W^b, W^c, W^d, W^e, W^f, and W^g are each independently selected from the group consisting of: N, CH, and CR^c, provided that from 1-4 of W^a-W^g is N, and no more than 4 of W^a-W^g are CR^c;
  • W^h and Wⁱ are independently selected from the group consisting of N, NH, NR^d, O, S, CH, and CR^c;
  • W^j and W^o are independently N or C;
  • W^k, W^l, W^m, and Wⁿ are independently N, CH, or CR^c, provided that:
  • from 1-4 of W^h-W^o are heteroatoms,
  • no more than 4 of W^h-W^o are CR^c, and
  • when one of W^h and Wⁱ is N, the other one of W^h and Wⁱ is CH, CR^c, O or S;
  • each is independently a single bond or a double bond, provided that the 5-membered ring including Wⁱ, W^j, W^o, and W^h is aromatic, and the 6-membered ring including W^o, W^j, W^k, W^l, W^m, and Wⁿ is aromatic. 196. The compound of clause 195, wherein W² includes a ring sulfur atom or ring oxygen atom (e.g., W² is

which is optionally substituted with from 1-4 independently selected R^c).

197. The compound of clause 195, wherein W² includes a pyridine (including pyridone) ring or a pyrimidine (including pyrimidone) ring (e.g., W² includes a pyridine (including pyridone) ring).

198. The compound of clause 197, wherein W² is selected from the group consisting of:

(such as

each of which is further optionally substituted with from 1-3 independently selected R^c.

199. The compound of clause 192, wherein W² is tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

200. The compound of clause 199, wherein W² includes a pyridine ring.

201. The compound of clause 200, wherein W² is selected from the group consisting of:

each of which is optionally substituted with from 1-4 independently selected R^c.

202. The compound of any one of clauses 192-201, wherein each occurrence of R^c is independently selected from the group consisting of: (a) halo; (c) C_1-10 alkyl which is optionally substituted with from 1-6 independently selected R^a; (d) C_2-6 alkenyl; (e) C_2-6 alkynyl; (g) C_1-4 alkoxy; (h) C_1-4 haloalkoxy; (i) —S(O)_1-2(C_1-4 alkyl); (m) —C_1-4 thioalkoxy; (o) —C(═O)(C_1-4 alkyl); (p) —C(═O)O(C_1-4 alkyl); (q) —C(═O)OH; (s) -L¹-L²-R^h; and (t) oxo.

203. The compound of any one of clauses 192-202, wherein one occurrence of R^c is as defined in any one of clauses 164-173 (e.g., 164; e.g., 165 (e.g., 166 or 167); e.g., 169 (e.g., R^c is R^h); e.g., 173).

204. The compound of any one of clauses 174-203, wherein the

moiety is

205. The compound of any one of clauses 174-203, wherein the

moiety is

206. The compound of any one of clauses 174-203, wherein the

moiety is

207. The compound of any one of clauses 174-203, wherein the

moiety is

208. The compound of any one of clauses 174-203, wherein the

moiety is

209. The compound of any one of clauses 174-203, wherein the

moiety is

210. The compound of any one of clauses 174-203, wherein the

moiety is

211. The compound of any one of clauses 174-209, wherein each R¹ is as defined in clause 50.

212. The compound of any one of clauses 174-209 and 211, wherein from 1-3 (e.g., 1, 2, or 3 (e.g., 1 or 2)) occurrences of R¹ is other than H.

213. The compound of clause 212, whereon one occurrence of R¹ is as defined in any one of clauses 54-65 (e.g., 54; e.g., 55).

214. The compound of clause 212, wherein one occurrence of R¹ is as defined in any one of clauses 66-89 (clause 88 or 89; or e.g., R¹ is Rⁱ, and Rⁱ is as defined in e.g., clause 69, clause 71, clause 72, or 73).

215. The compound of any one of clauses 212-214, wherein each remaining R¹ is H.

216. The compound of any one of clauses 212-214, wherein one or two other occurrences of R¹ is independently halo (e.g., F) or C_1-4 alkyl; and each remaining R¹ is H.

217. The compound of any one of clauses 174-216, wherein when X¹ is NR², the R² group of X¹ is H.

218. The compound of any one of clauses 174-216, wherein when X¹ is NR², the R² group of X¹ is —C(O)(C_1-4 alkyl), C_1-4 alkyl, or C_6-10 aryl.

219. The compound of any one of clauses 217-218, wherein each remaining occurrence of R² is selected from the group consisting of: H; C_1-6 alkyl, which is optionally substituted with from 1-2 independently selected R^a (e.g., unsubstituted C₁-3 alkyl); C_1-4 haloalkyl (e.g., CH₂CF₃); —C(O)(C_1-4 alkyl) (e.g., C(O)Me); and C_6-10 aryl (e.g., phenyl).

220. The compound of any one of clauses 174-203, 210, and 217-219, wherein each occurrence of R³ is independently selected from: H; C_1-6 alkyl optionally substituted with from 1-6 independently selected R^a; C_1-4 haloalkyl; OH; —F; —Cl; NR^eR^f; C_1-4 alkoxy; and C_1-4 haloalkoxy; or two R³ on the same carbon combine to form an oxo.

221. The compound of any one of clauses 174-220, wherein R⁵ is H.

222. The compound of any one of clauses 1-221, wherein R⁶ is H.

223. The compound of clause 1, wherein the compound is selected from the group consisting of the compounds delineated in Table C1 or a pharmaceutically acceptable salt thereof.

224. A pharmaceutical composition comprising a compound of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof, and one or more pharmaceutically acceptable excipients.

225. A method for inhibiting STING activity, the method comprising contacting STING with a compound as described in any one of clauses 1-223 or 279-287 or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224.

226. The method of clause 225, wherein the inhibiting comprises antagonizing STING.

227. The method of any one of clauses 225-226, which is carried out in vitro.

228. The method of clause 227, wherein the method comprises contacting a sample comprising one or more cells comprising STING with the compound.

229. The method of clause 227 or 228, wherein the one or more cells are one or more cancer cells.

230. The method of clause 228 or 229 wherein the sample further comprises one or more cancer cells (e.g., wherein the cancer is selected from the group consisting of melanoma, cervical cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, urothelial carcinoma, bladder cancer, non-small cell lung cancer, small cell lung cancer, sarcoma, colorectal adenocarcinoma, gastrointestinal stromal tumors, gastroesophageal carcinoma, colorectal cancer, pancreatic cancer, kidney cancer, hepatocellular cancer, malignant mesothelioma, leukemia, lymphoma, myelodysplasia syndrome, multiple myeloma, transitional cell carcinoma, neuroblastoma, plasma cell neoplasms, Wilm's tumor, or hepatocellular carcinoma).

231. The method of clause 225, which is carried out in vivo.

232. The method of clause 231, wherein the method comprises administering the compound to a subject having a disease in which increased (e.g., excessive) STING signaling contributes to the pathology and/or symptoms and/or progression of the disease.

233. The method of clause 232, wherein the subject is a human.

234. The method of clause 232, wherein the disease is cancer.

235. The method of clause 234, wherein the cancer is selected from the group consisting of melanoma, cervical cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, urothelial carcinoma, bladder cancer, non-small cell lung cancer, small cell lung cancer, sarcoma, colorectal adenocarcinoma, gastrointestinal stromal tumors, gastroesophageal carcinoma, colorectal cancer, pancreatic cancer, kidney cancer, hepatocellular cancer, malignant mesothelioma, leukemia, lymphoma, myelodysplasia syndrome, multiple myeloma, transitional cell carcinoma, neuroblastoma, plasma cell neoplasms, Wilm's tumor, or hepatocellular carcinoma.

236. The method of clause 234 or 235, wherein the cancer is a refractory cancer.

237. The method of clause 232, wherein the compound is administered in combination with one or more additional cancer therapies.

238. The method of clause 237, wherein the one or more additional cancer therapies comprises surgery, radiotherapy, chemotherapy, toxin therapy, immunotherapy, cryotherapy or gene therapy, or a combination thereof.

239. The method of clause 238, wherein chemotherapy comprises administering one or more additional chemotherapeutic agents.

240. The method of clause 239, wherein the one or more additional chemotherapeutic agents is selected from an alkylating agent (e.g., cisplatin, carboplatin, mechlorethamine, cyclophosphamide, chlorambucil, ifosfamide and/or oxaliplatin); an anti-metabolite (e.g., azathioprine and/or mercaptopurine); a terpenoid (e.g., a vinca alkaloid and/or a taxane; e.g., Vincristine, Vinblastine, Vinorelbine and/or Vindesine Taxol, Pacllitaxel and/or Docetaxel); a topoisomerase (e.g., a type I topoisomerase and/or a type 2 topoisomerase; e.g., camptothecins, such as irinotecan and/or topotecan; amsacrine, etoposide, etoposide phosphate and/or teniposide); a cytotoxic antibiotic (e.g., actinomycin, anthracyclines, doxorubicin, daunorubicin, valrubicin, idarubicin, epirubicin, bleomycin, plicamycin and/or mitomycin); a hormone (e.g., a lutenizing hormone releasing hormone agonist; e.g., leuprolidine, goserelin, triptorelin, histrelin, bicalutamide, flutamide and/or nilutamide); an antibody (e.g., Abciximab, Adalimumab, Alemtuzumab, Atlizumab, Basiliximab, Belimumab, Bevacizumab, Bretuximab vedotin, Canakinumab, Cetuximab, Ceertolizumab pegol, Daclizumab, Denosumab, Eculizumab, Efalizumab, Gemtuzumab, Golimumab, Golimumab, Ibritumomab tiuxetan, Infliximab, Ipilimumab, Muromonab-CD3, Natalizumab, Ofatumumab, Omalizumab, Palivizumab, Panitumuab, Ranibizumab, Rituximab, Tocilizumab, Tositumomab and/or Trastuzumab); an anti-angiogenic agent; a cytokine; a thrombotic agent; a growth inhibitory agent; an anti-helminthic agent; and an immune checkpoint inhibitor that targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1-PD-L1, PD-1-PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9-TIM3, Phosphatidylserine -TIM3, lymphocyte activation gene 3 protein (LAG3), MEW class II -LAG3,4-1BB-4-1BB ligand, OX40-OX40 ligand, GITR, GITR ligand -GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25-TL1A, CD40L, CD40-CD40 ligand, HVEM-LIGHT-LTA, HVEM, HVEM-BTLA, HVEM-CD160, HVEM-LIGHT, HVEM-BTLA-CD160, CD80, CD80-PDL-1, PDL2-CD80, CD244, CD48-CD244, CD244, ICOS, ICOS-ICOS ligand, B7-H₃, B7-H₄, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86-CD28, CD86-CTLA, CD80-CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine -TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155 (e.g., CTLA-4 or PD1 or PD-L1).

241. The method of any one of clauses 232-240, wherein the compound is administered intratumorally.

242. A method of treating cancer, comprising administering to a subject in need of such treatment an effective amount of a compound as described in any one of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224.

243. The method of clause 242, wherein the cancer is selected from the group consisting of melanoma, cervical cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, urothelial carcinoma, bladder cancer, non-small cell lung cancer, small cell lung cancer, sarcoma, colorectal adenocarcinoma, gastrointestinal stromal tumors, gastroesophageal carcinoma, colorectal cancer, pancreatic cancer, kidney cancer, hepatocellular cancer, malignant mesothelioma, leukemia, lymphoma, myelodysplasia syndrome, multiple myeloma, transitional cell carcinoma, neuroblastoma, plasma cell neoplasms, Wilm's tumor, or hepatocellular carcinoma.

244. The method of clause 242 or 243, wherein the cancer is a refractory cancer.

245. The method of clause 242, wherein the compound is administered in combination with one or more additional cancer therapies.

246. The method of clause 245, wherein the one or more additional cancer therapies comprises surgery, radiotherapy, chemotherapy, toxin therapy, immunotherapy, cryotherapy or gene therapy, or a combination thereof.

247. The method of clause 246, wherein chemotherapy comprises administering one or more additional chemotherapeutic agents.

248. The method of clause 247, wherein the one or more additional chemotherapeutic agents is selected from an alkylating agent (e.g., cisplatin, carboplatin, mechlorethamine, cyclophosphamide, chlorambucil, ifosfamide and/or oxaliplatin); an anti-metabolite (e.g., azathioprine and/or mercaptopurine); a terpenoid (e.g., a vinca alkaloid and/or a taxane; e.g., Vincristine, Vinblastine, Vinorelbine and/or Vindesine Taxol, Pacllitaxel and/or Docetaxel); a topoisomerase (e.g., a type I topoisomerase and/or a type 2 topoisomerase; e.g., camptothecins, such as irinotecan and/or topotecan; amsacrine, etoposide, etoposide phosphate and/or teniposide); a cytotoxic antibiotic (e.g., actinomycin, anthracyclines, doxorubicin, daunorubicin, valrubicin, idarubicin, epirubicin, bleomycin, plicamycin and/or mitomycin); a hormone (e.g., a lutenizing hormone releasing hormone agonist; e.g., leuprolidine, goserelin, triptorelin, histrelin, bicalutamide, flutamide and/or nilutamide); an antibody (e.g., Abciximab, Adalimumab, Alemtuzumab, Atlizumab, Basiliximab, Belimumab, Bevacizumab, Bretuximab vedotin, Canakinumab, Cetuximab, Ceertolizumab pegol, Daclizumab, Denosumab, Eculizumab, Efalizumab, Gemtuzumab, Golimumab, Golimumab, Ibritumomab tiuxetan, Infliximab, Ipilimumab, Muromonab-CD3, Natalizumab, Ofatumumab, Omalizumab, Palivizumab, Panitumuab, Ranibizumab, Rituximab, Tocilizumab, Tositumomab and/or Trastuzumab); an anti-angiogenic agent; a cytokine; a thrombotic agent; a growth inhibitory agent; an anti-helminthic agent; and an immune checkpoint inhibitor that targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1 PD-L1, PD—1-PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9-TIM3, Phosphatidylserine -TIM3, lymphocyte activation gene 3 protein (LAG3), MHC class II -LAG3, 4-1BB-4-1BB ligand, OX40-OX40 ligand, GITR, GITR ligand -GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25-TL1A, CD40L, CD40-CD40 ligand, HVEM-LIGHT-LTA, HVEM, HVEM-BTLA, HVEM-CD160, HVEM-LIGHT, HVEM-BTLA-CD160, CD80, CD80-PDL-1, PDL2-CD80, CD244, CD48-CD244, CD244, ICOS, ICOS-ICOS ligand, B7-H₃, B7-H₄, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86-CD28, CD86-CTLA, CD80-CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine -TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155 (e.g., CTLA-4 or PD1 or PD-L1).

249. The method of any one of clauses 242-248, wherein the compound is administered intratumorally.

250. A method of inducing an immune response in a subject in need thereof, the method comprising administering to the subject an effective amount of a compound as described in any one of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224.251. The method of clause 250, wherein the subject has cancer.

252. The method of clause 251, wherein the subject has undergone and/or is undergoing and/or will undergo one or more cancer therapies.

253. The method of clause 251, wherein the cancer selected from the group consisting of melanoma, cervical cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, urothelial carcinoma, bladder cancer, non-small cell lung cancer, small cell lung cancer, sarcoma, colorectal adenocarcinoma, gastrointestinal stromal tumors, gastroesophageal carcinoma, colorectal cancer, pancreatic cancer, kidney cancer, hepatocellular cancer, malignant mesothelioma, leukemia, lymphoma, myelodysplasia syndrome, multiple myeloma, transitional cell carcinoma, neuroblastoma, plasma cell neoplasms, Wilm's tumor, or hepatocellular carcinoma.

254. The method of clause 253, wherein the cancer is a refractory cancer.

255. The method of clause 250, wherein the immune response is an innate immune response.

256. The method of clause 255, wherein the at least one or more cancer therapies comprises surgery, radiotherapy, chemotherapy, toxin therapy, immunotherapy, cryotherapy or gene therapy, or a combination thereof.

257. The method of clause 256, wherein chemotherapy comprises administering one or more additional chemotherapeutic agents.

258. The method of clause 257, wherein the one or more additional chemotherapeutic agents is selected from alkylating agent (e.g., cisplatin, carboplatin, mechlorethamine, cyclophosphamide, chlorambucil, ifosfamide and/or oxaliplatin); an anti-metabolite (e.g., azathioprine and/or mercaptopurine); a terpenoid (e.g., a vinca alkaloid and/or a taxane; e.g., Vincristine, Vinblastine, Vinorelbine and/or Vindesine Taxol, Pacllitaxel and/or Docetaxel); a topoisomerase (e.g., a type I topoisomerase and/or a type 2 topoisomerase; e.g., camptothecins, such as irinotecan and/or topotecan; amsacrine, etoposide, etoposide phosphate and/or teniposide); a cytotoxic antibiotic (e.g., actinomycin, anthracyclines, doxorubicin, daunorubicin, valrubicin, idarubicin, epirubicin, bleomycin, plicamycin and/or mitomycin); a hormone (e.g., a lutenizing hormone releasing hormone agonist; e.g., leuprolidine, goserelin, triptorelin, histrelin, bicalutamide, flutamide and/or nilutamide); an antibody (e.g., Abciximab, Adalimumab, Alemtuzumab, Atlizumab, Basiliximab, Belimumab, Bevacizumab, Bretuximab vedotin, Canakinumab, Cetuximab, Ceertolizumab pegol, Daclizumab, Denosumab, Eculizumab, Efalizumab, Gemtuzumab, Golimumab, Golimumab, Ibritumomab tiuxetan, Infliximab, Ipilimumab, Muromonab-CD3, Natalizumab, Ofatumumab, Omalizumab, Palivizumab, Panitumuab, Ranibizumab, Rituximab, Tocilizumab, Tositumomab and/or Trastuzumab); an anti-angiogenic agent; a cytokine; a thrombotic agent; a growth inhibitory agent; an anti-helminthic agent; and an immune checkpoint inhibitor that targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1 PD-L1, PD-1-PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9 TIM3, Phosphatidylserine TIM3, lymphocyte activation gene 3 protein (LAG3), MHC class II -LAG3, 4-1BB-4-1BB ligand, OX40-OX40 ligand, GITR, GITR ligand -GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25-TL1A, CD40L, CD40-CD40 ligand, HVEM-LIGHT-LTA, HVEM, HVEM-BTLA, HVEM-CD160, HVEM-LIGHT, HVEM-BTLA-CD160, CD80, CD80-PDL-1, PDL2-CD80, CD244, CD48-CD244, CD244, ICOS, ICOS-ICOS ligand, B7-H₃, B7-H₄, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86-CD28, CD86-CTLA, CD80-CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine -TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155 (e.g., CTLA-4 or PD1 or PD-L1).

259. A method of treatment of a disease in which increased (e.g., excessive) STING signaling contributes to the pathology and/or symptoms and/or progression of the disease, comprising administering to a subject in need of such treatment an effective amount of a compound as described in any one of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224.

260. A method of treatment comprising administering to a subject having a disease in which increased (e.g., excessive) STING signaling contributes to the pathology and/or symptoms and/or progression of the disease an effective amount of a compound as described in any one of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224.

261. A method of treatment comprising administering to a subject a compound as described in any one of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224, wherein the compound or composition is administered in an amount effective to treat a disease in which increased (e.g., excessive) STING signaling contributes to the pathology and/or symptoms and/or progression of the disease, thereby treating the disease.

262. The method of any one of clauses 259-261, wherein the disease is cancer.

263. The method of clause 262, wherein the cancer is selected from the group consisting of melanoma, cervical cancer, breast cancer, ovarian cancer, prostate cancer, testicular cancer, urothelial carcinoma, bladder cancer, non-small cell lung cancer, small cell lung cancer, sarcoma, colorectal adenocarcinoma, gastrointestinal stromal tumors, gastroesophageal carcinoma, colorectal cancer, pancreatic cancer, kidney cancer, hepatocellular cancer, malignant mesothelioma, leukemia, lymphoma, myelodysplasia syndrome, multiple myeloma, transitional cell carcinoma, neuroblastoma, plasma cell neoplasms, Wilm's tumor, or hepatocellular carcinoma.

264. The method of clause 262 or 263, wherein the cancer is a refractory cancer. 265. The method of any one of clauses 262-264, wherein the compound is administered in combination with one or more additional cancer therapies.

266. The method of clause 265, wherein the one or more additional cancer therapies comprises surgery, radiotherapy, chemotherapy, toxin therapy, immunotherapy, cryotherapy or gene therapy, or a combination thereof.

267. The method of clause 266, wherein chemotherapy comprises administering one or more additional chemotherapeutic agents.

268. The method of clause 267, wherein the one or more additional chemotherapeutic agents is selected from an alkylating agent (e.g., cisplatin, carboplatin, mechlorethamine, cyclophosphamide, chlorambucil, ifosfamide and/or oxaliplatin); an anti-metabolite (e.g., azathioprine and/or mercaptopurine); a terpenoid (e.g., a vinca alkaloid and/or a taxane; e.g., Vincristine, Vinblastine, Vinorelbine and/or Vindesine Taxol, Pacllitaxel and/or Docetaxel); a topoisomerase (e.g., a type I topoisomerase and/or a type 2 topoisomerase; e.g., camptothecins, such as irinotecan and/or topotecan; amsacrine, etoposide, etoposide phosphate and/or teniposide); a cytotoxic antibiotic (e.g., actinomycin, anthracyclines, doxorubicin, daunorubicin, valrubicin, idarubicin, epirubicin, bleomycin, plicamycin and/or mitomycin); a hormone (e.g., a lutenizing hormone releasing hormone agonist; e.g., leuprolidine, goserelin, triptorelin, histrelin, bicalutamide, flutamide and/or nilutamide); an antibody (e.g., Abciximab, Adalimumab, Alemtuzumab, Atlizumab, Basiliximab, Belimumab, Bevacizumab, Bretuximab vedotin, Canakinumab, Cetuximab, Ceertolizumab pegol, Daclizumab, Denosumab, Eculizumab, Efalizumab, Gemtuzumab, Golimumab, Golimumab, Ibritumomab tiuxetan, Infliximab, Ipilimumab, Muromonab-CD3, Natalizumab, Ofatumumab, Omalizumab, Palivizumab, Panitumuab, Ranibizumab, Rituximab, Tocilizumab, Tositumomab and/or Trastuzumab); an anti-angiogenic agent; a cytokine; a thrombotic agent; a growth inhibitory agent; an anti-helminthic agent; and an immune checkpoint inhibitor that targets an immune checkpoint receptor selected from the group consisting of CTLA-4, PD-1, PD-L1, PD-1-PD-L1, PD-1-PD-L2, interleukin-2 (IL-2), indoleamine 2,3-dioxygenase (IDO), IL-10, transforming growth factor-β (TGFβ), T cell immunoglobulin and mucin 3 (TIM3 or HAVCR2), Galectin 9-TIM3, Phosphatidylserine -TIM3, lymphocyte activation gene 3 protein (LAG3), MEW class II -LAG3, 4-1BB-4-1BB ligand, OX40-OX40 ligand, GITR, GITR ligand -GITR, CD27, CD70-CD27, TNFRSF25, TNFRSF25-TL1A, CD40L, CD40-CD40 ligand, HVEM-LIGHT-LTA, HVEM, HVEM-BTLA, HVEM-CD160, HVEM-LIGHT, HVEM-BTLA-CD160, CD80, CD80-PDL-1, PDL2-CD80, CD244, CD48-CD244, CD244, ICOS, ICOS-ICOS ligand, B7-H₃, B7-H₄, VISTA, TMIGD2, HHLA2-TMIGD2, Butyrophilins, including BTNL2, Siglec family, TIGIT and PVR family members, KIRs, ILTs and LIRs, NKG2D and NKG2A, MICA and MICB, CD244, CD28, CD86-CD28, CD86-CTLA, CD80-CD28, CD39, CD73 Adenosine-CD39-CD73, CXCR4-CXCL12, Phosphatidylserine, TIM3, Phosphatidylserine -TIM3, SIRPA-CD47, VEGF, Neuropilin, CD160, CD30, and CD155 (e.g., CTLA-4 or PD1 or PD-L1).

269. The method of any one of clauses 259-268, wherein the compound is administered intratumorally.

270. A method of treatment of a disease, disorder, or condition associated with STING, comprising administering to a subject in need of such treatment an effective amount of a compound as described in any one of clauses 1-223 or 279-287, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as described in clause 224.

271. The method of clause 270, wherein the disease, disorder, or condition is selected from type I interferonopathies, Aicardi-Goutières Syndrome (AGS), genetic forms of lupus, inflammation-associated disorders, and rheumatoid arthritis.

272. The method of clause 271, wherein the disease, disorder, or condition is a type I interferonopathy (e.g., STING-associated vasculopathywith onset in infancy (SAVI)).

273. The method of clause 272, wherein the type I interferonopathy is STING-associated vasculopathy with onset in infancy (SAVI)).

274. The method of clause 271, wherein the disease, disorder, or condition is Aicardi-Goutières Syndrome (AGS).

275. The method of clause 271, wherein the disease, disorder, or condition is a genetic form of lupus. 276. The method of clause 271, wherein the disease, disorder, or condition is inflammation-associated disorder.

277. The method of clause 276, wherein the inflammation-associated disorder is systemic lupus erythematosus.

278. The method of any one of clauses 225-277, wherein the method further comprises identifying the subject.

279. The compound of clause 1, wherein the compound has the following formula:

wherein Q¹ is selected from the group consisting of:

• • heteroaryl including 5 ring atoms, wherein from 1-3 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1; and
  • heteroaryl including 6 ring atoms, wherein from 1-3 (e.g., 1-2) ring atoms are ring nitrogen atoms, and wherein the heteroaryl ring is optionally substituted with from 1-2 independently selected R^q1;

Q² is a bond or O; and

A is —(Y^A1)_n_Y^A2, optionally wherein n is 0.

280. The compound of clause 279, wherein Q¹ is selected from the group consisting of:

wherein the asterisk denotes point of attachment of Q²; or

wherein Q¹ is selected from the group consisting of:

each of which is optionally substituted with 1-2 independently selected R^q1, wherein the asterisk denotes point of attachment of Q².

281. The compound of clauses 279 or 280, wherein Y^A2 is C_6-10 aryl, which is optionally substituted with from 1-3 R^c, such as: wherein Y^A2 is C₆ aryl, which is optionally substituted with from 1-3 R^c; or

wherein Y^A2 is C_7-15 bicyclic or tricyclic aryl which is optionally substituted with from 1-3 R^c, such as wherein Y^A2 is naphthyl, tetrahydronaphthyl, indacenyl, or 1 ‘,3’—dihydrospiro[cyclopropane-1,2′-indene] such as

each of which is optionally substituted with from 1-3 R^c.

282. The compound of clause 1, wherein the compound has the following formula:

wherein W² is selected from the group consisting of:

• • bicyclic heteroaryl including from 9-10 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c; and
  • tricyclic heteroaryl including from 12-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(R^d), O, and S(O)_0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected R^c.

283. The compound of clause 282, wherein W² is selected from the group consisting of:

wherein:

W^a, W^b, W^c, W^d, W^e, W^f and W^g are each independently selected from the group consisting of: N, CH, and CR^c, provided that from 1-4 of W^a-W^g is N, and no more than 4 of W^a-W^g are CR^c;

W^h and Wⁱ are independently selected from the group consisting of N, NH, NR^d, O, S, CH, and CR^c;

W^j and W^o are independently N or C;

W^k, W^l, W^m, and Wⁿ are independently N, CH, or CR^c, provided that:

• • from 1-4 of W^h-W^o are heteroatoms,
  • no more than 4 of W^h-W^o are CR^c, and
  • when one of W^h and Wⁱ is N, the other one of W^h and Wⁱ is CH, CR^c, O or S;

each is independently a single bond or a double bond, provided that the 5-membered ring including Wⁱ, W^j, W^o, and W^h is aromatic, and the 6-membered ring including W^o, W^j, W^k, W^l, W^m, and Wⁿ is aromatic.

284. The compound of clause 282, wherein W² is selected from the group consisting of:

each of which is further optionally substituted with from 1-3 independently selected R^c; or

wherein W² is selected from the group consisting of:

each of which is optionally substituted with from 1-4 independently selected R^c.

285. The compound of any one of clauses 279-284, wherein the

moiety is

such as

286. The compound of any one of clauses 279-284, wherein the

moiety is

(such as

(such as

(such as

(such as

287. The compound of clauses 285 or 286, wherein R² is H; and R⁵ is H.

Claims

1. A compound of Formula I:

2. The compound of claim 1, wherein the ring that includes Z, Y1, Y2, Y3, and Y4 is aromatic.

3. The compound of claim 1 or 2, wherein X1 is NR2, such as NH.

4. The compound of any one of claims 1-3, wherein X2 is CR5, such as CH.

5. The compound of any one of claims 1-4, wherein W is defined according to (A).

6. The compound of any one of claims 1-5, wherein Q1 is heteroaryl including from 5-6 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(Rd), O, and S, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected Rq1.

7. The compound of any one of claims 1-6, wherein Q2 is a bond.

8. The compound of any one of claims 1-7, wherein A is —(YA1)n—YA2.

9. The compound of any one of claims 1-8, wherein YA2 is C6-10 aryl, which is optionally substituted with from 1-3 Rc, such as wherein YA2 is C6 aryl, which is optionally substituted with from 1-3 Rc; or wherein YA2 is C7-15 bicyclic or tricyclic aryl which is optionally substituted with from 1-3 Rc, such as wherein YA2 is naphthyl, tetrahydronaphthyl, indacenyl, or 1′,3′-dihydrospiro[cyclopropane-1,2′-indene] such as

10. The compound of any one of claims 1-4, wherein W is defined according to (B).

11. The compound of claim 10, wherein W is bicyclic or polycyclic heteroaryl including from 7-20 ring atoms, wherein from 1-4 ring atoms are heteroatoms, each independently selected from the group consisting of N, N(H), N(Rd), O, and S(O)0-2, and wherein the heteroaryl ring is optionally substituted with from 1-4 independently selected Rc.

12. The compound of claim 11, wherein W2 is selected from the group consisting of:

13. The compound of any one of claims 1-12, wherein the

14. The compound of any one of claims 1-12, wherein from 1-2 of Y1, Y2, and Y3 is independently N or NR2, such as N.

15. The compound of any one of claim 1-12 or 14, wherein the

16. The compound of claim 1, wherein the compound is selected from the group consisting of the compounds delineated in Table C1 or a pharmaceutically acceptable salt thereof.

17. A pharmaceutical composition comprising a compound of any one of claims 1-16, or a pharmaceutically acceptable salt thereof, and one or more pharmaceutically acceptable excipients.

18. A method for inhibiting STING activity, the method comprising contacting STING with a compound as claimed in any one of claims 1-16, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as claimed in claim 17.

19. A method of inducing an immune response in a subject in need thereof, the method comprising administering to the subject an effective amount of a compound as claimed in any one of claims 1-16, or a pharmaceutically acceptable salt thereof; or a pharmaceutical composition as claimed in claim 17.

20. A method of treatment of disease, disorder, or condition associated with STING, such as a disease, disorder, or condition, in which increased STING signaling, such as excessive STING signaling, contributes to the pathology and/or symptoms and/or progression of the disease, such as cancer, comprising administering to a subject in need of such treatment an effective amount of a compound as claimed in any one of claims 1-16, or a pharmaceutically acceptable salt thereof, or a pharmaceutical composition as claimed in claim 17.