Patent Application
20200397796
The invention relates to methods, compositions and kits useful for inhibiting tumor growth. In particular, disclosed herein are methods of administering effective amounts of SRA737 useful for inhibiting tumor growth, e.g., tumor growth relating to cancer.
Cells activate a signal transduction pathway when DNA is damaged. Signals activate the cell-cycle machinery to induce DNA repair and/or cell death to mitigate propagation. Checkpoint kinase 1 (Chk1) is an important bridge in cells when sensing DNA damage. See Cancer Biology & Therapy (2004) 3:3, 305-313, incorporated herein by reference. Chk1 plays a role in regulating numerous and wide-ranging cellular functions including: immune and inflammation responses, spindle formation, DNA damage signal transduction and generally, cellular apoptosis. Chk1 inhibitors abrogate DNA damage-induced cell cycle arrest in S and/or G 2/M phases. Currently, there are no Chk1 inhibitors that are approved therapies for inhibition of tumor growth. One Chk1 inhibitor is SRA737. SRA737 is described in international patent application number PCT/GB2013/051233.
Disclosed herein is a method of treating a cancer, comprising administering to a subject with the cancer an effective amount of a SRA737 compound, wherein the effective amount is less than 2000 mg/day.
In some embodiments, the SRA737 compound is administered orally.
In some embodiments, wherein the SRA737 compound is administered daily. In some embodiments, the SRA737 compound is administered for at least 28 consecutive days. In some embodiments, the SRA737 compound is administered for at least 7 consecutive days.
In some embodiments, the SRA737 compound is administered intermittently. In some embodiments, the SRA737 compound is administered with at least ten (10) minutes, fifteen (15) minutes, twenty (20) minutes, thirty (30) minutes, forty (40) minutes, sixty (60) minutes, two (2) hours, three (3) hour, four (4) hours, six (6) hours, eight (8) hours, ten (10) hours, twelve (12) hours, fourteen (14) hours, eighteen (18) hours, twenty-four (24) hours, thirty-six (36) hours, forty-eight (48) hours, three (3) days, four (4) days, five (5) days, six (6) days, seven (7) days, eight (8) days, nine (9) days, ten (10) days, eleven (11) days, twelve (12) days, thirteen (13) days, fourteen (14) days, three (3) weeks, or four (4) weeks, delay between administrations.
In some embodiments, the SRA737 compound is administered over one or more 28 day cycles. In some embodiments, the SRA737 compound is administered on one or more days of the one or more 28 day cycles. In some embodiments, is administered on days 2, 3, 9, 10, 16, and 17 of the one or more 28 day cycles. In some embodiments, the method further comprises administering an initial dose of the SRA737 compound prior to the first of the one or more 28 day cycles. In some embodiments, the initial dose is administered 4 days, 5 days, 6 days, or 7 days prior to the first cycle of the one or more 28 day cycles. In some embodiments, the one or more 28 day cycles comprises 2, 3, 4, 5, 6 or more 28 day cycles.
In some embodiments, the SRA737 compound is administered following a dosing schedule selected from the group consisting of: 5 days of dosing followed by 2 days of non-dosing each week; 1 week of daily dosing followed by 1, 2, or 3 weeks of non-dosing; 2 or 3 weeks of daily dosing followed by 1, or 2 weeks of non-dosing; and dosing on days 2 and 3 of a weekly cycle.
In some embodiments, the effective amount is administered in a single dose once a day. In some embodiments, half of the effective amount is administered twice a day.
In some embodiments, the effective amount is less than 1500 mg/day. In some embodiments, the effective amount is less than 1300 mg/day. In some embodiments, the effective amount is 1000 mg/day or less. In some embodiments, the effective amount is 900 mg/day or less. In some embodiments, the effective amount is 800 mg/day or less. In some embodiments, the effective amount is 700 mg/day or less. In some embodiments, the effective amount is 600 mg/day or less. In some embodiments, the effective amount is 500 mg/day or less. In some embodiments, the effective amount is 400 mg/day or less. In some embodiments, the effective amount is between 600 mg/day and 1300 mg/day. In some embodiments, the effective amount is between 300 mg/day and 1300 mg/day. In some embodiments, the effective amount is between 300 mg/day and 1000 mg/day. In some embodiments, the effective amount is between 300 mg/day and 800 mg/day. In some embodiments, the effective amount is between 500 mg/day and 1300 mg/day. In some embodiments, the effective amount is between 500 mg/day and 1000 mg/day. In some embodiments, the effective amount is between 500 mg/day and 800 mg/day. In some embodiments, the effective amount is selected from the group consisting of: 600 mg/day, 700 mg/day, 800 mg/day, 900 mg/day, 1000 mg/day, 1100 mg/day, and 1200 mg/day. In some embodiments, the effective amount is selected from the group consisting of: 40 mg/day, 80 mg/day, 300 mg/day, 500 mg/day, 600 mg/day, 700 mg/day, and 800 mg/day. In some embodiments, the effective amount is 300 mg/day. In some embodiments, the effective amount is 400 mg/day. In some embodiments, the effective amount is 500 mg/day. In some embodiments, the effective amount is 600 mg/day. In some embodiments, the effective amount is 700 mg/day. In some embodiments, the effective amount is 800 mg/day. In some embodiments, the effective amount is 900 mg/day. In some embodiments, the effective amount is 1000 mg/day.
In some embodiments, the cancer is metastatic cancer. In some embodiments, the cancer is a condition or disorder selected from the group consisting of: colorectal cancer, ovarian cancer, high grade serous ovarian cancer (HGSOC), non-small cell lung cancer (NSCLC), small cell lung cancer, lung adenocarcinoma, prostate cancer, castration-resistant prostate cancer, bile duct cancer, cholangiocarcinoma, melanoma, uterine cancer, thyroid cancer, bladder cancer, breast cancer, cervical cancer, gastric cancer, endometrial cancer, hepatocellular cancer, leukemia, lymphoma, Non-Hodgkin's lymphoma, myeloma, brain cancer, neuroblastoma, squamous cell carcinoma, head and neck squamous cell carcinoma (HNSCC), and squamous cell carcinoma of the anus (SCCA), anogenital cancer, rectal cancer, pancreatic cancer, urothelial carcinoma, sarcoma and soft tissue sarcoma, metastatic colorectal cancer (CRC), platinum-resistant or intolerant HGSOC, advanced NSCLC, and metastatic castration-resistant prostate cancer (mCRPC), triple-negative breast cancer, invasive breast cancer, metastatic breast cancer, HER2 positive breast cancer and inflammatory breast cancer.
In some embodiments, the cancer is colorectal cancer. In some embodiments, the colorectal cancer is characterized as having a microsatellite instability or a deficiency in mismatch repair (MMR).
In some embodiments, the cancer is non-small cell lung cancer.
In some embodiments, the cancer is HNSCC.
In some embodiments, the cancer is SCCA.
In some embodiments, the cancer is anogenital cancer.
In some embodiments, the cancer is prostate cancer. In some embodiments, the prostate cancer is metastatic castration-resistant prostate cancer (mCRPC).
In some embodiments, the cancer is ovarian cancer. In some embodiments, the ovarian cancer is high-grade serous ovarian cancer (HGSOC). In some embodiments, a tumor associated with the HGSOC is identified as having an increased expression of a Cyclin E1 (CCNE) gene. In some embodiments, the increased expression is a result of genetic amplification. In some embodiments, the tumor is identified as having somatic or germline BRCA1 and BRCA2 wild-type status.
In some embodiments, a tumor associated with the cancer is identified as having a gain of function mutation, amplification or overexpression of at least one oncogenic driver gene or other gene implicated in Chk1 pathway sensitivity. In some embodiments, the oncogenic driver gene is selected from the group consisting of: MYC, MYCN, KRAS, and CCNE1.
In some embodiments, a tumor associated with the cancer is identified as having a loss of function or a deleterious mutation in at least one DNA damage repair (DDR) pathway gene implicated in Chk1 pathway sensitivity. In some embodiments, the DDR pathway gene is selected from the group consisting of: ATM, CDK12, BRCA1, BRCA2, MRE11A, ATR, and an FA pathway gene. In some embodiments, the loss of function or the deleterious mutation is determined by establishing microsatellite instability or a deficiency in mismatch repair (MMR).
In some embodiments, a tumor associated with the cancer is identified as having a gain of function mutation or amplification of at least one replication stress gene implicated in Chk1 pathway sensitivity. In some embodiments, the replication stress gene is ATR or CHK1.
In some embodiments, a tumor associated with the cancer is identified as having a deleterious mutation in a tumor suppressor (TS) gene implicated in Chk1 pathway sensitivity. In some embodiments, a tumor associated with the cancer suppressor gene is selected from the group consisting of: RB1, TP53, ATM, RAD50, FBXW7 and PARK2.
In some embodiments, the subject is human papillomavirus (HPV) positive.
In some embodiments, the subject is human.
In some embodiments, the method further comprises administering a second effective amount of a further treatment, wherein the further treatment is selected from the group consisting of: a chemotherapeutic agent, an antibody or antibody fragment, a radiation treatment, an external inducer of replication stress, and a combination thereof.
In some embodiments, the further treatment is selected from the group consisting of: gemcitabine, olaparib, niraparib, rucaparib, talazoparib, cisplatin, a ribonucleotide reductase inhibitor, etoposide, SN-38/CPT-11, mitomycin C, and combinations thereof. In some embodiments, the further treatment comprises gemcitabine. In some embodiments, the further treatment is administered daily. In some embodiments, the further treatment is administered on day 1 and the SRA737 compound is administered on days 2 and 3 of a weekly schedule. In some embodiments, the further treatment and the SRA737 compound are administered over one or more 28 day cycles. In some embodiments, the further treatment is administered on days 1, 8, and 15 of the one or more 28 day cycles, and the SRA737 compound is administered on days 2, 3, 9, 10, 16, and 17 of the one or more 28 day cycles. In some embodiments, the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the second effective amount of the further treatment is 600 mg/m2/day or less. In some embodiments, the second effective amount of the further treatment is between 50 and 600 mg/m2/day. In some embodiments, the second effective amount of the further treatment is between 50 and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 80 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 150 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 300 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 500 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 600 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 700 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 800 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 900 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day. In some embodiments, the effective amount of the SRA737 compound is 1000 mg/day and the second effective amount of the further treatment is selected from the group consisting of: 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, and 300 mg/m2/day.
In some embodiments, the cancer is urothelial carcinoma. In some embodiments, the urothelial carcinoma is selected from the group consisting of: (a) unresectable urothelial carcinomas of the bladder, upper urinary tract, or urethra, and (b) metastatic urothelial carcinomas of the bladder, upper urinary tract, or urethra. In some embodiments, the cancer is HGSOC. In some embodiments, a tumor associated with the HGSOC is identified as having somatic or germline BRCA1 and BRCA2 wild-type status In some embodiments, the cancer is small cell lung cancer. In some embodiments, the cancer is soft tissue sarcoma. In some embodiments, the soft tissue sarcoma is selected from the group consisting of: undifferentiated pleiomorphic sarcoma, malignant fibrous histiocytoma (MFH)/high-grade spindle cell sarcoma, pleomorphic liposarcomas, leiomyosarcoma, and dedifferentiated liposarcoma. In some embodiments, the cancer is cervical or anogenital cancer. In some embodiments, the cervical or anogenital cancer is selected from the group consisting of: advanced/metastatic squamous cell carcinoma of the anus, penis, vagina, and vulva.
In some embodiments, the method results in growth inhibition of a tumor associated with the cancer. In some embodiments, the growth inhibition of the tumor associated with the cancer is a minimum growth inhibition of at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, or at least 90% relative to an untreated tumor. In some embodiments, the method results in a regression of a tumor associated with the cancer relative to a baseline measurement. In some embodiments, the regression is a 30% regression of the tumor associated with the cancer relative to the baseline measurement. In some embodiments, the regression is a complete regression of the tumor associated with the cancer relative to the baseline measurement.
In some embodiments, the method results in cytotoxicity of a tumor associated with the cancer.
In some embodiments, the method results in a partial response, a complete response, or a stable disease in the subject relative to a baseline measurement. In some embodiments, the method results in a partial response in the subject relative to a baseline measurement. In some embodiments, the method results in a complete response in the subject relative to a baseline measurement. In some embodiments, the method results in a stable disease in the subject relative to a baseline measurement.
In some embodiments, the method results in a plasma Cmin of at least 100 ng/ml of the SRA737 compound for at least 24 hours in the subject after administration. In some embodiments, the method results in a plasma Cmin of at least 100 nM of the SRA737 compound for at least 24 hours in the subject after administration.
In some embodiments, the method results in a plasma AUC0-24 of at least 100 ng·h/mL, at least 300 ng·h/mL, at least 600 ng·h/mL, at least 800 ng·h/mL, at least 1000 ng·h/mL, at least 1600 ng·h/mL, at least 2300 ng·h/mL, at least 2500 ng·h/mL, at least 3000 ng·h/mL, at least 3500 ng·h/mL, at least 8000 ng·h/mL, at least 12000 ng·h/mL, at least 15000 ng·h/mL, at least 18000 ng·h/mL, at least 20000 ng·h/mL, at least 25000 ng·h/mL, or at least 29000 ng·h/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma AUC0-12 of at least 400 ng·h/mL, at least 500 ng·h/mL, at least 600 ng·h/mL, at least 1600 ng·h/mL, at least 2600 ng·h/mL, at least 4500 ng·h/mL, at least 5000 ng·h/mL, at least 8000 ng·h/mL, at least 8000 ng·h/mL, at least 1000 ng·h/mL of the SRA737 compound in the subject after administration.
In some embodiments, the method results in a plasma Cmax of at least 500 ng/mL, at least 600 ng/mL, at least 800 ng/mL, at least 100 ng/mL, at least 150 ng/mL, at least 175 ng/mL, at least 350 ng/mL, at least 990 ng/mL, at least 1980 ng/mL, at least 2000 ng/mL, or at least 3228 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, wherein the method results in a plasma Cmax of less than 500 ng/mL, less than 600 ng/mL, less than 800 ng/mL, less than 100 ng/mL, less than 150 ng/mL, less than 175 ng/mL, less than 350 ng/mL, less than 990 ng/mL, less than 1980 ng/mL, less than 2000 ng/mL, or less than 3228 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma Cmax between 500 and 3200 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma Cmax between 500 and 2400 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma Cmax between 500 and 650 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma Cmax between 500 and 550 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma Cmax between 500 and 5500 ng/mL of the SRA737 compound in the subject after administration. In some embodiments, the method results in a plasma Cmax between 500 and 4000 ng/mL of the SRA737 compound in the subject after administration.
In some embodiments, the subject has fasted prior to administering the effective amount of the SRA737 compound. In some embodiments, the subject has fasted 30 minutes or more, 1 hour or more, 2 hours or more, 3 hours or more, or 4 hours or more fasted prior to administering the effective amount of the SRA737 compound. In some embodiments, has fasted 2 hours or more fasted prior to administering the effective amount of the SRA737 compound.
In some embodiments, the method further comprises the subject fasting following administering the effective amount of the SRA737 compound. In some embodiments, the subject fasts 30 minutes or more, 1 hour or more, 2 hours or more, 3 hours or more, or 4 hours or more fasted following administering the effective amount of the SRA737 compound. In some embodiments, the subject fasts 1 hours or more following administering the effective amount of the SRA737 compound.
These and other features, aspects, and advantages of the present invention will become better understood with regard to the following description, and accompanying drawings, where:
Disclosed herein are methods of inhibiting tumor growth in a subject, e.g., a human, by administration of an effective amount of the Chk1 inhibitor SRA737. Also Disclosed herein are methods of inhibiting tumor growth in a subject, e.g., a human, by administration of an effective amount of the Chk1 inhibitor SRA737 in a combination therapy.
Terms used in the claims and specification are defined as set forth below unless otherwise specified.
The practice of the present invention includes the use of conventional techniques of organic chemistry, molecular biology (including recombinant techniques), microbiology, cell biology, biochemistry and immunology, which are within the skill of the art.
In this application, reference will be made to a number of technical designations. All numerical designations, e.g., pH, temperature, time, concentration, and weight, including ranges of each thereof, are approximations that typically may be varied (+) or (−) by increments of 0.1, 1.0, or 10.0, as appropriate. All numerical designations may be understood as preceded by the term “about.” Reagents described herein are exemplary and equivalents of such may be known in the art.
Compounds utilized in the present invention possess asymmetric carbon atoms (optical centers) or double bonds; the racemates, diastereomers, geometric isomers, regioisomers and individual isomers (e.g., separate enantiomers) are all intended to be encompassed within the scope of the present invention. The compounds of the present invention may also contain unnatural proportions of atomic isotopes at one or more of the atoms that constitute such compounds. For example, the compounds may be radiolabeled with radioactive isotopes, such as for example, and without limitation, tritium (3H), iodine-125 (125I), or carbon-14 (14C). All isotopic variations of the compounds of the present invention, whether radioactive or not, are intended to be encompassed within the scope of the present invention.
The term “subject” refers to any mammal including humans, and mammals such as those animals of veterinary and research interest that are including, but not limited to: simians, cattle, horses, dogs, cats, and rodents.
The term “administering” or “administration or” a drug and/or therapy to a subject (and grammatical equivalents of this phrase) refers to both direct or indirect administration, which may be administration to a subject by a medical professional, may be self-administration, and/or indirect administration, which may be the act of prescribing or inducing one to prescribe a drug and/or therapy to a subject.
The term “coadministration” refers to two or more compounds administered in a manner to exert their pharmacological effect during the same period of time. Such coadministration can be achieved by either simultaneous, contemporaneous, or sequential administration of the two or more compounds.
The term “treating” or “treatment of” a disorder or disease refers to taking steps to alleviate the symptoms of the disorder or disease, e.g., tumor growth or cancer, or otherwise obtain some beneficial or desired results for a subject, including clinical results. Any beneficial or desired clinical results may include, but are not limited to, alleviation or amelioration of one or more symptoms of cancer or conditional survival and reduction of tumor load or tumor volume; diminishment of the extent of the disease; delay or slowing of the tumor progression or disease progression; amelioration, palliation, or stabilization of the tumor and/or the disease state; or other beneficial results.
The term “in situ” or “in vitro” refers to processes that occur in a living cell growing separate from a living organism, e.g., growing in tissue culture.
The term “in vivo” refers to processes that occur in a living organism.
The term “Chk1” or “CHEK1” or “checkpoint kinase 1” refers to serine/threonine-protein kinase that is encoded by the CHEK1 gene.
The term “effective amount” means an amount sufficient to produce a desired effect, e.g., an amount sufficient to inhibit tumor growth.
The term “reduction” of a symptom or symptoms (and grammatical equivalents of this phrase) refers to decreasing the severity or frequency of the symptom(s), or elimination of the symptom(s).
It must be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise.
Methods of the Invention
Disclosed herein are methods of inhibiting tumor growth in a subject, e.g., a human, by administration of the Chk1 inhibitor SRA737. A detailed description of the compounds, kits comprising the compounds, and methods of use thereof are found below.
Tumor Inhibition
The present disclosure is directed to methods using an effective amount of the compound SRA737 to inhibit the progression of, reduce the size in aggregation of, reduce the volume of, and/or otherwise inhibit the growth of a tumor. Also provided herein are methods of treating the underlying disease, e.g., cancer, and extending the survival of the subject.
In some aspects, provided for is a method of inhibiting the growth of a tumor in a subject in need thereof, the method comprising administering to the subject an effective amount of SRA737. In some aspects, the disclosure provides for a method of administering to the subject an effective amount of SRA737 to inhibit growth of a tumor, wherein tumor growth is reduced by 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% as measured by tumor volume. In some aspects, the disclosure provides for a method of administering to the subject an effective amount of SRA737 to inhibit growth of a tumor, wherein tumor growth is reduced by 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% as measured by the absolute size of the tumor. In some aspects, the disclosure provides for a method of administering to the subject an effective amount of SRA737 to inhibit the growth of a tumor, wherein tumor growth is reduced by 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% as measured by the expression levels of tumor markers for that type of tumor.
In some aspects, provided for is a method of treating a cancer, comprising administering to a subject with the cancer an effective amount of a SRA737 compound. In some aspects, provided for is a method of treating a cancer, comprising administering to a subject with the cancer an effective amount of a SRA737 compound, wherein the method results in a regression of a tumor. The regression, in general, is determined relative to a baseline measurement. The regression can be a partial regression or a complete regression. The regression can, in general, be measured by any assay useful for quantitating size, volume, and/or growth of a tumor, e.g., medical imaging techniques known in the art. The regression can be a 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% regression as measured by tumor volume. The regression can be a 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% regression as measured by the absolute size of the tumor. The regression can be a 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% regression as measured by the expression levels of tumor markers for that type of tumor. The regression can be a 30% regression. The regression can be a 30% regression as measured by any assay useful for quantitating size, volume, and/or growth of a tumor, e.g., medical imaging techniques known in the art.
The present disclosure is also directed to methods using an effective amount of the compound SRA737 and a second effective amount of a further treatment to inhibit the progression of, reduce the size in aggregation of, reduce the volume of, and/or otherwise inhibit the growth of a tumor. Also provided herein are methods of treating the underlying disease, e.g., cancer, and extending the survival of the subject. In some aspects, provided for is a method of inhibiting the growth of a tumor in a subject in need thereof, the method comprising administering to the subject an effective amount of SRA737 and a second effective amount of a further treatment. In some aspects, the disclosure provides for a method of administering to the subject an effective amount of SRA737 and a second effective amount of a further treatment to inhibit growth of a tumor, wherein tumor growth is reduced by 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% as measured by tumor volume. In some aspects, the disclosure provides for a method of administering to the subject an effective amount of SRA737 and a second effective amount of a further treatment to inhibit growth of a tumor, wherein tumor growth is reduced by 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% as measured by the absolute size of the tumor. In some aspects, the disclosure provides for a method of administering to the subject an effective amount of SRA737 and a second effective amount of a further treatment to inhibit growth of a tumor, wherein tumor growth is reduced by 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% as measured by the expression levels of tumor markers for that type of tumor.
In some aspects, provided for is a method of treating a cancer, comprising administering to a subject with the cancer an effective amount of a SRA737 compound and a second effective amount of a further treatment. In some aspects, provided for is a method of treating a cancer, comprising administering to a subject with the cancer an effective amount of a SRA737 compound and a second effective amount of a further treatment, wherein the method results in a regression of a tumor. The regression, in general, is determined relative to a baseline measurement. The regression can be a partial regression or a complete regression. The regression can, in general, be measured by any assay useful for quantitating size, volume, and/or growth of a tumor, e.g., medical imaging techniques known in the art. The regression can be a 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% regression as measured by tumor volume. The regression can be a 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% regression as measured by the absolute size of the tumor. The regression can be a 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 14%, 16%, 18%, 20%, 22%, 24%, 26%, 28%, 30%, 32%, 34%, 36%, 38%, 40%, 42%, 44%, 46%, 48%, 50%, 52%, 54%, 56%, 58%, 60%, 62%, 64%, 66%, 68%, 70%, 72%, 74%, 76%, 78%, 80%, 82%, 84%, 86%, 88%, 90%, 92%, 94%, 96%, 98%, or 100% regression as measured by the expression levels of tumor markers for that type of tumor. The regression can be a 30% regression. The regression can be a 30% regression as measured by any assay useful for quantitating size, volume, and/or growth of a tumor, e.g., medical imaging techniques known in the art.
Types of Tumors
In some aspects, the present disclosure provides for methods of inhibiting the growth of a tumor wherein the tumor is from a cancer that is colorectal cancer, ovarian cancer, high grade serous ovarian cancer (HGSOC), non-small cell lung cancer (NSCLC), small cell lung cancer, lung adenocarcinoma, prostate cancer, castration-resistant prostate cancer, bile duct cancer, cholangiocarcinoma, melanoma, uterine cancer, thyroid cancer, bladder cancer, breast cancer, cervical cancer, gastric cancer, endometrial cancer, hepatocellular cancer, leukemia, lymphoma, Non-Hodgkin's lymphoma, myeloma, brain cancer, neuroblastoma, squamous cell carcinoma, head and neck squamous cell carcinoma (HNSCC), and squamous cell carcinoma of the anus (SCCA), anogenital cancer (e.g., anal cancer), rectal cancer, pancreatic cancer, urothelial carcinoma, sarcoma and soft tissue sarcoma, metastatic colorectal cancer (CRC), platinum-resistant or intolerant HGSOC, advanced NSCLC, and metastatic castration-resistant prostate cancer (mCRPC), triple-negative breast cancer, invasive breast cancer, metastatic breast cancer, HER2 positive breast cancer and inflammatory breast cancer.
Accordingly, the present disclosure also provides for methods of treating a cancer in a subject in need thereof, the method comprising administering an effective amount of SRA737 to the subject. In some aspects, methods are disclosed for the treatment of cancer wherein the cancer is colorectal cancer, ovarian cancer, high grade serous ovarian cancer (HGSOC), non-small cell lung cancer (NSCLC), small cell lung cancer, lung adenocarcinoma, prostate cancer, castration-resistant prostate cancer, bile duct cancer, cholangiocarcinoma, melanoma, uterine cancer, thyroid cancer, bladder cancer, breast cancer, cervical cancer, gastric cancer, endometrial cancer, hepatocellular cancer, leukemia, lymphoma, Non-Hodgkin's lymphoma, myeloma, brain cancer, neuroblastoma, squamous cell carcinoma, head and neck squamous cell carcinoma (HNSCC), and squamous cell carcinoma of the anus (SCCA), anogenital cancer (e.g., anal cancer), rectal cancer, pancreatic cancer, urothelial carcinoma, sarcoma and soft tissue sarcoma, metastatic colorectal cancer (CRC), platinum-resistant or intolerant HGSOC, advanced NSCLC, and metastatic castration-resistant prostate cancer (mCRPC), triple-negative breast cancer, invasive breast cancer, metastatic breast cancer, HER2 positive breast cancer and inflammatory breast cancer.
Clinical Endpoints
Provided herein are methods for inhibiting the growth of a tumor in a subject and/or cell, wherein the conditions of said methods are such that the method results in a clinically relevant endpoint.
Tumor growth occurs when one or more biological cells grow and divide much more rapidly resulting in an increase in the number of cells in comparison to the normal and healthy process of cells division. This phenomenon is an indication that the cells are in a disease state such as cancer or pre-cancer. Moreover, tumor growth oftentimes comes about in discrete stages prior to the agglomerated cells forming a tumor.
There are several methods the skilled artisan can use to measure cell replication rates. The overall metabolic activity inside a cell can be measured via a labeled biological product. For example, there are several commercially available dyes (e.g. MTT) that can penetrate the cell and interact with certain enzymes and other factors to produce a detectable product. Also, cellular biomarkers can be measured in a cell. For example, a BrdU assay can incorporate a thymidine derivative into cellular DNA and be detected with an antibody. Proliferating cell nuclear antigen (PCNA) is another such biomarker for detection. Besides tagging techniques, the skilled artisan can also use for example, microscopy or flow cytometry to allow for cell counts.
In one aspect, cellular replication is measured by a clinical endpoint that includes: a quality of life (QOL) score, duration of response (DOR, clinical benefit rate (CBR), patient reported outcomes (PRO), an objective response rate (ORR) score, a disease-free survival (DFS) or progression-free survival (PFS), a time to progression (TTP), an Overall Survival (OS), a time-to-treatment failure (TTF), RECIST criteria, and/or a Complete Response. the clinical endpoints can be determined using methods well known to one of skill in the art.
In some aspects, the present disclosure provides methods wherein the growth of the tumor is reduced no more than 5, 10, 20, 40, 50, 60, 80, 90, 95, 97, 99, or 99.9% after administration of the effective amount of SRA737.
In some aspects, the present disclosure provides methods wherein the % reduction is calculated based on measurement(s) of one or more clinical endpoints.
In some aspects, the present disclosure provides methods wherein the growth of the tumor is reduced as measured by an increase or a decrease in total cell count in a MTT assay, or by change in genetic profile as measured by a ctDNA assay, by no more than or at least 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 97, 99, or 99.9% after administration of the effective amount of SRA737.
In some aspects, the present disclosure provides methods wherein the growth of the tumor is reduced at least 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 97, 99, or 99.9% after administration of the effective amount of SRA737. In some aspects, the present disclosure provides methods wherein the growth of the tumor is reduced as measured by an increase or a decrease in total cell count in a MTT assay, or by change in genetic profile as measured by a ctDNA assay, by at least 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 97, 99, or 99.9% after administration of the effective amount of SRA737.
In some aspects, the present disclosure provides methods wherein administration results in an IC50 value below 10 μM and/or a GI50 value below 1 μM. In some aspects, the present disclosure provides methods wherein administration results in an IC50 value below 10 μM and/or a GI50 value below 1 μM at twenty-four (24) hours after administration. In some aspects, the present disclosure provides methods wherein administration results in an IC50 value below 10 μM and/or a GI50 value below 1 μM at forty-eight (48) hours after administration.
In some aspects, the present disclosure provides methods wherein the administration results in an AUC of at least 1, 10, 25, 50, 100, 200, 400, 600, 800, or 1000.
In some aspects, the present disclosure provides methods wherein the administration results in an IC50 value of no more than 0.001, 0.005, 0.01, 0.05, 0.1, 1, 3, 5, 10, 20, 40, 50, 60, 80, 90, 100, 200, 250, 300, 350, or 400 μM.
In some aspects, the present disclosure provides methods wherein the administration results in an EC50 value of at least 0.01, 0.1, 1, 3, 5, 10, 20, 40, 50, 60, 80, 90, 100, 200, 250, 300, 350, or 400 μM.
In some aspects, the present disclosure provides methods wherein the administration results in an therapeutic index (TI) value ranging from about 1.001:1 to about 50:1, about 1.1:1 to about 15:1, about 1.2:1 to about 12:1, about 1.2:1 to about 10:1, about 1.2:1 to about 5:1, or about 1.2:1 to about 3:1.
In some aspects, the present disclosure provides methods wherein the administration results in an GI50 value of at least 0.1 μM, 0.3 μM, 0.5 μM, 0.7 μM, 1 μM, 1.5 μM, 2 μM, 2.5 μM, 3 μM, 4 μM, 5 μM, or 10 μM.
In some aspects, the present disclosure provides methods wherein the administration results in a Maximum Response Observed (Max Response) value of no more than 0.1, 0.5, 1, 2 μM, 2.5 μM, 3 μM, 4 μM, 5 μM, or 10 μM.
Tumor growth can be expressed in terms of total tumor volume or total tumor size. There exist formulas, both generally speaking and specific to certain tumor models, that the skilled artisan can use to calculate tumor volume based upon the assumption that solid tumors are more or less spherical. In this regard, the skilled artisan can use experimental tools such as: ultrasound imaging, manual or digital calipers, ultrasonography, computed tomographic (CT), microCT, 18F-FDG-microPET, or magnetic resonance imaging (MM) to measure tumor volume. See for example Monga S P, Wadleigh R, Sharma A, et al. Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer. Am. J. Clin. Oncol. 2000; 23(4):386-392; Mary M. Tomayko C., Patrick Reynolds, 1989. Determination of subcutaneous tumor size in athymic (nude) mice. Cancer Chemotherapy and Pharmacology, Volume 24, Issue 3, pp 148-154; E Richtig, G Langmann, K Milliner, G Richtig and J Smolle, 2004. Calculated tumour volume as a prognostic parameter for survival in choroidal melanomas. Eye (2004) 18, 619-623; Jensen et al. BMC Medical Imaging 2008. 8:16; Tomayko et al. Cancer Chemotherapy and Pharmacology September 1989, Volume 24, Issue 3, pp 148-154; and Faustino-Rocha et al. Lab Anim (NY). 2013 June; 42(6):217-24, each of which are hereby incorporated by reference in their entirety. In an illustrative example, tumor growth and/or size can be measured as a sum of the diameters (longest for non-nodal lesions, short axis for nodal lesions) for all target lesions and can be, in general, calculated and reported as the baseline sum diameters. The baseline sum diameters can be, in general, used as reference to further characterize any objective tumor regression in a measurable dimension of the disease.
In some aspects, the present disclosure provides methods wherein administration results in a reduction in tumor size, of at least 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 97, 99 or 99.9% after administration of the effective amount of SRA737. In some aspects, the present disclosure provides methods wherein administration results in a reduction in tumor size of at least 30% after administration of the effective amount of SRA737. In some aspects, the present disclosure provides methods wherein administration results in a reduction in tumor volume of at least 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 97, 99 or 99.9% after administration of the effective amount of SRA737. In some aspects, the present disclosure provides methods wherein administration results in a reduction in tumor volume of at least 30% after administration of the effective amount of SRA737. In some aspects, the present disclosure provides methods wherein administration results in a reduction in tumor volume or tumor size after one (1), two (2), three (3), four (4), six (6), eight (8), twelve (12), sixteen (16), twenty (20), twenty four (24), thirty six (36), or fifty two (52) weeks. In some aspects, the present disclosure provides methods wherein administration results in a reduction in tumor volume or tumor size of at least 30% after one (1), two (2), three (3), four (4), six (6), eight (8), twelve (12), sixteen (16), twenty (20), twenty four (24), thirty six (36), or fifty two (52) weeks. Reductions in tumor volume or tumor size can be measured by medical imaging techniques. Reductions in tumor volume or tumor size are, in general, determined relative to a baseline measurement.
Subjects
The present disclosure provides for administering an effective amount of SRA737 to a subject that is in need thereof. The present disclosure provides for administering an effective amount of SRA737 in a combination therapy with a further treatment to a subject that is in need thereof. In some aspects, the tumor from a subject is screened with genetic testing and/sequencing prior to administration. In some aspects, the tumor from a subject is screened with genetic testing and/sequencing after administration. In some aspects, the tumor from a subject is screened both after and before administration. In some aspects, healthy cells from the subject are screened with genetic testing and/sequencing prior to administration, after administration, or both. In some aspects, the tumor from a subject is screened with other biological tests or assays to determine the level of expression of certain biomarkers. In some aspects, the tumor from a subject is screened with both genetic testing and/sequencing and other biomarker tests or assays.
In some aspects, the present disclosure provides for methods wherein the subject is a mammal. In some aspects, the present disclosure provides for methods wherein the subject is a primate.
In some aspects, the present disclosure provides for methods wherein the subject is a mouse.
In some aspects, the present disclosure provides for methods wherein the subject is a human.
In some aspects, the present disclosure provides for methods wherein the subject is a human that has a tumor having a genetic mutation in one or more of the following genes: a tumor suppressor gene, a DNA damage repair gene, a replication stress gene, or an oncogenic driver gene. In some aspects, the present disclosure provides for methods wherein the subject is suffering from cancer in which the cancer cells have a genetic mutation in one or more of the following genes: a tumor suppressor gene, a DNA damage repair gene, a replication stress gene, or an oncogenic driver gene.
In some aspects, the present disclosure provides for methods wherein the tumor is in a human suffering from cancer that is selected from the group consisting of: colorectal cancer, ovarian cancer, high grade serous ovarian cancer (HGSOC), non-small cell lung cancer (NSCLC), small cell lung cancer, lung adenocarcinoma, prostate cancer, castration-resistant prostate cancer, bile duct cancer, cholangiocarcinoma, melanoma, uterine cancer, thyroid cancer, bladder cancer, breast cancer, cervical cancer, gastric cancer, endometrial cancer, hepatocellular cancer, leukemia, lymphoma, Non-Hodgkin's lymphoma, myeloma, brain cancer, neuroblastoma, squamous cell carcinoma, head and neck squamous cell carcinoma (HNSCC), and squamous cell carcinoma of the anus (SCCA), anogenital cancer (e.g., anal cancer), rectal cancer, pancreatic cancer, urothelial carcinoma, sarcoma and soft tissue sarcoma, metastatic colorectal cancer (CRC), platinum-resistant or intolerant HGSOC, advanced NSCLC, and metastatic castration-resistant prostate cancer (mCRPC), triple-negative breast cancer, invasive breast cancer, metastatic breast cancer, HER2 positive breast cancer and inflammatory breast cancer.
In some aspects, subjects have:
In some aspects, subjects have one of the histologically or cytologically proven advanced malignancies described above and tumor tissue or ctDNA evidence that their tumor harbors one or more mutations that are expected to confer sensitivity to Chk1 inhibition. Eligibility can be determined by the sponsor's review of genetic abnormalities detected in genes in the following categories:
In some aspects, subjects are excluded based on the following criteria:
Administration
As disclosed herein, the methods of the invention include administration of the effective amount of SRA737. In an embodiment, the effective amount of SRA737 is administered as a monotherapy.
Also disclosed herein, the methods of the invention include a combination therapy administering an effective amount of SRA737 and coadministering a second effective amount of a further treatment. Further treatments include, but are not limited to, administering a chemotherapeutic agent, administering an antibody or antibody fragment (such as an immune checkpoint inhibitors), administering a radiation treatment, administering an external inducer of replication stress, and administering a combination thereof. Further treatments also include, but are not limited to, administering any one of gemcitabine, olaparib, niraparib, rucaparib, talazoparib, cisplatin, a ribonucleotide reductase inhibitor, etoposide, SN-38/CPT-11, mitomycin C, and combinations thereof. Coadministered encompasses methods where SRA737 and the further treatment are given simultaneously, where SRA737 and the further treatment are given sequentially, and where either one of, or both of, SRA737 and the further treatment are given intermittently or continuously, or any combination of: simultaneously, sequentially, intermittently and/or continuously. The skilled artisan will recognize that intermittent administration is not necessarily the same as sequential because intermittent also includes a first administration of an agent and then another administration later in time of that very same agent. Moreover, the skilled artisan understands that intermittent administration also encompasses sequential administration in some aspects because intermittent administration does include interruption of the first administration of an agent with an administration of a different agent before the first agent is administered again. Further, the skilled artisan will also know that continuous administration can be accomplished by a number of routes including i.v. drip or feeding tubes, etc.
Furthermore, and in a more general way, the term “coadministered” encompasses any and all methods where the individual administration of SRA737 and the individual administration of the further treatment to a subject overlap during any timeframe.
In one aspect, the frequency of administration of SRA737 or the further treatment to a subject includes, but is not limited to, Q1 d, Q2d, Q3d, Q4d, Q5d, Q6d, Q7d, Q8d, Q9d, Q10d, Q14d, Q21d, Q28d, Q30d, Q90d, Q120d, Q240d, or Q365d. The term “QnD or qnd” refers to drug administration once every “n” days. For example, QD (or qd) refers to once every day or once daily dosing, Q2D (or q2d) refers to a dosing once every two days, Q7D refers to a dosing once every 7 days or once a week, Q5D refers to dosing once every 5 days, and so on. In one aspect, SRA737 and the further treatment are administered on different schedules.
In another aspect, the frequency of administration of SRA737 or the further treatment to a subject includes, but is not limited to: 5 days of dosing followed by 2 days of non-dosing each week; 1 week of daily dosing followed by 1, 2, or 3 weeks of non-dosing; 2 or 3 weeks of daily dosing followed by 1, or 2 weeks of non-dosing; twice daily dosing; or dosing on days 2 and 3 of a weekly cycle. In one aspect, SRA737 and the further treatment are administered on different schedules.
In one aspect, the present disclosure provides for methods where either one of or both of or any combination thereof SRA737 and/or the further treatment are administered intermittently. In one aspect, the present disclosure provides for methods comprising administering either one of, or both of, or any combinations thereof, SRA737 or the further treatment, to a subject with at least ten (10) minutes, fifteen (15) minutes, twenty (20) minutes, thirty (30) minutes, forty (40) minutes, sixty (60) minutes, two (2) hours, three (3) hour, four (4) hours, six (6) hours, eight (8) hours, ten (10) hours, twelve (12) hours, fourteen (14) hours, eighteen (18) hours, twenty-four (24) hours, thirty-six (36) hours, forty-eight (48) hours, three (3) days, four (4) days, five (5) days, six (6) days, seven (7) days, eight (8) days, nine (9) days, ten (10) days, eleven (11) days, twelve (12) days, thirteen (13) days, fourteen (14) days, three (3) weeks, or four (4) weeks, delay between administrations. In such aspects, the administration with a delay follows a pattern where one of or both of or any combination thereof SRA737 and/or the further treatment are administered continuously for a given period of time from about ten (10) minutes to about three hundred and sixty five (365) days and then is not administered for a given period of time from about ten (10) minutes to about thirty (30) days. In one aspect, the present disclosure provides for methods where either one of or any combination of SRA737 and/or the further treatment are administered intermittently while the other is given continuously.
In one aspect, the present disclosure provides for methods where the combination of the effective amount of SRA737 is administered sequentially with the second effective amount of a further treatment.
In one aspect, the present disclosure provides for methods where SRA737 and the further treatment are administered simultaneously. In one aspect, the present disclosure provides for methods where the combination of the effective amount of SRA737 is administered sequentially with the second effective amount of a further treatment. In such aspects, the combination is also said to be “coadministered” since the term includes any and all methods where the subject is exposed to both components in the combination. However, such aspects are not limited to the combination being given just in one formulation or composition. In some cases, certain concentrations of SRA737 and the further treatment are more advantageous to deliver at certain intervals and as such, the effective amount of SRA737 and the second effective amount of the further treatment may change according to the formulation being administered.
In some aspects, the present disclosure provides for methods wherein SRA737 and the further treatment are administered simultaneously or sequentially. In some aspects, the present disclosure provides for methods where the effective amount of SRA737 is administered sequentially after the second effective amount of the further treatment. In some aspects, the present disclosure provides for methods where the second effective amount of the further treatment is administered sequentially after the effective amount of SRA737.
In some aspects, the present disclosure provides for methods where the combination is administered in one formulation. In some aspects, the present disclosure provides for methods where the combination is administered in two (2) compositions where the effective amount of SRA737 is administered in a separate formulation from the formulation of the second effective amount of the further treatment.
In some aspects, the present disclosure provides for methods where the effective amount of SRA737 is administered sequentially after the second effective amount of the further treatment. In some aspects, the present disclosure provides for methods where the second effective amount of the further treatment is administered sequentially after the effective amount of SRA737. In some aspects, the SRA737 and the further treatment are administered; and subsequently both SRA737 and the further treatment are administered intermittently for at least twenty-four (24) hours. In some aspects, SRA737 and the further treatment are administered on a non-overlapping every other day schedule. In some aspects, the further treatment is administered on day 1, and SRA737 is administered on days 2 and 3 of a weekly schedule.
In some aspects, the present disclosure provides for methods where the effective amount of SRA737 is administered no less than four (4) hours after the second effective amount of the further treatment. In one aspect, the present disclosure provides for methods where the effective amount of SRA737 is administered no less than ten (10) minutes, no less than fifteen (15) minutes, no less than twenty (20) minutes, no less than thirty (30) minutes, no less than forty (40) minutes, no less than sixty (60) minutes, no less than one (1) hour, no less than two (2) hours, no less than four (4) hours, no less than six (6) hours, no less than eight (8) hours, no less than ten (10) hours, no less than twelve (12) hours, no less than twenty four (24) hours, no less than two (2) days, no less than four (4) days, no less than six (6) days, no less than eight (8) days, no less than ten (10) days, no less than twelve (12) days, no less than fourteen (14) days, no less than twenty one (21) days, or no less than thirty (30) days after the second effective amount of the further treatment. In one aspect, the present disclosure provides for methods where the second effective amount of the further treatment is administered no less than ten (10) minutes, no less than fifteen (15) minutes, no less than twenty (20) minutes, no less than thirty (30) minutes, no less than forty (40) minutes, no less than sixty (60) minutes, no less than one (1) hour, no less than two (2) hours, no less than four (4) hours, no less than six (6) hours, no less than eight (8) hours, no less than ten (10) hours, no less than twelve (12) hours, no less than twenty four (24) hours, no less than two (2) days, no less than four (4) days, no less than six (6) days, no less than eight (8) days, no less than ten (10) days, no less than twelve (12) days, no less than fourteen (14) days, no less than twenty one (21) days, or no less than thirty (30) days after the effective amount of a SRA737.
In some aspects, the present disclosure provides for methods where either one of, or both of, or any combination thereof, SRA737 and/or a further treatment are administered by a route selected from the group consisting of: intravenous, subcutaneous, cutaneous, oral, intramuscular, and intraperitoneal. In some aspects, the present disclosure provides for methods where either one of, or both of, or any combination thereof, SRA737 and/or a further treatment are administered intravenously. In some aspects, the present disclosure provides for methods where either one of, or both of, or any combination thereof, SRA737 and/or a further treatment are administered orally.
It is understood by the skilled artisan that the unit dose forms of the present disclosure may be administered in the same or different physicals forms, i.e. orally via capsules or tablets and/or by liquid via i.v. infusion, and so on. Moreover, the unit dose forms for each administration may differ by the particular route of administration. Several various dosage forms may exist for either one of, or both of, SRA737 and a further treatment. Because different medical conditions can warrant different routes of administration, the same components of a combination of SRA737 and a further treatment described herein may be exactly alike in composition and physical form and yet may need to be given in differing ways and perhaps at differing times to alleviate the condition. For example, a condition such as persistent nausea, especially with vomiting, can make it difficult to use an oral dosage form, and in such a case, it may be necessary to administer another unit dose form, perhaps even one identical to other dosage forms used previously or afterward, with an inhalation, buccal, sublingual, or suppository route instead or as well. The specific dosage form may be a requirement for certain combinations of SRA737 and a further treatment, as there may be issues with various factors like chemical stability or pharmacokinetics.
Therapeutically Effective Amount and Unit Dose Form
The present disclosure provides for a method of treatment wherein the effective amount of SRA737 is administered to a subject. The term “effective amount” or “therapeutically effective amount” refers to an amount that is effective to ameliorate a symptom of a disease, e.g. an amount that is effective to inhibit the growth of a tumor. In some aspects, the effective amount of SRA737 is less than or equal to the maximum tolerated dose (MTD), less than or equal to the highest non-severely toxic dose (HNSTD), or less than or equal to the No-observed-adverse-effect-level (NOAEL) In some aspects, the effective amount of SRA737 is less than 2000 mg/day orally. In some aspects, the effective amount of SRA737 is less than 1500 mg/day orally. In some aspects, the effective amount of SRA737 is less than 1300 mg/day orally. In some aspects, the effective amount of SRA737 is greater than 600 mg/day orally. In some aspects, the effective amount of SRA737 is between 600-2000 mg/day orally. In some aspects, the effective amount of SRA737 is between 600-1500 mg/day orally. In some aspects, the effective amount of SRA737 is between 600-1300 mg/day orally. In some aspects, the effective amount of SRA737 is between 600-1000 mg/day orally. In some aspects, the effective amount of SRA737 is 600 mg/day, 700 mg/day, 800 mg/day, 900 mg/day, 1000 mg/day, 1100 mg/day, 1200 mg/day, 1300 mg/day, 1500 mg/day, or 2000 mg/day orally.
In specific embodiments of the invention, the effective amount of SRA737 is administered to a subject as a monotherapy. In some aspects, the effective amount of the SRA737 monotherapy is less than or equal to the maximum tolerated dose (MTD), less than or equal to the highest non-severely toxic dose (HNSTD), or less than or equal to the No-observed-adverse-effect-level (NOAEL) In some aspects, the effective amount of the SRA737 monotherapy is less than 2000 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is less than 1500 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is less than 1300 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is greater than 600 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is between 600-2000 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is between 600-1500 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is between 600-1300 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is between 600-1000 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is 600 mg/day, 700 mg/day, 800 mg/day, 900 mg/day, 1000 mg/day, 1100 mg/day, 1200 mg/day, 1300 mg/day, 1500 mg/day, or 2000 mg/day orally. In some aspects, the effective amount of the SRA737 monotherapy is 600 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 700 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 800 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 900 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 1000 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 1100 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 1200 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 1300 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is 1500 mg/day. In some aspects, the effective amount of the SRA737 monotherapy is or 2000 mg/day.
In specific embodiments of the invention, the effective amount of SRA737 is administered to a subject as a combination therapy. In some aspects, the effective amount of the SRA737 combination therapy is less than or equal to the maximum tolerated dose (MTD), less than or equal to the highest non-severely toxic dose (HNSTD), or less than or equal to the No-observed-adverse-effect-level (NOAEL). In some aspects, the effective amount of the SRA737 combination therapy is less than the effective amount of the SRA737 monotherapy. In some aspects, the effective amount of the SRA737 combination therapy is less than 2000 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is less than 1500 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is less than 1300 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is 600 mg/day or less orally. In some aspects, the effective amount of the SRA737 combination therapy is at least 300 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is at least 100 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is at least 600 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is between 100-2000 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is between 300-2000 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is between 600-2000 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is between 300-1500 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is between 300-1300 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is between 300-1000 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is 100 mg/day, 150 mg/day, 200 mg/day, 300 mg/day, 600 mg/day, 700 mg/day, 800 mg/day, 900 mg/day, 1000 mg/day, 1100 mg/day, 1200 mg/day, 1300 mg/day, 1500 mg/day, or 2000 mg/day orally. In some aspects, the effective amount of the SRA737 combination therapy is 300 mg/day, 400 mg/day, 500 mg/day, 600 mg/day, 700 mg/day, 800 mg/day, 900 mg/day, 1000 mg/day, 1100 mg/day, 1200 mg/day, 1300 mg/day, 1500 mg/day, or 2000 mg/day orally.
In some aspects, the effective amount of the SRA737 combination therapy is 300 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 400 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 500 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 600 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 700 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 800 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 900 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1000 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1100 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1200 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 300 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 400 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 500 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 600 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 700 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 800 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 900 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1000 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1100 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1200 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 300 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 400 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 500 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 600 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 700 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 800 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 900 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1000 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1100 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1200 mg/day or less.
In some aspects, the effective amount of the SRA737 combination therapy is 350 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 450 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 550 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 650 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 750 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 850 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 950 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1050 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1150 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1250 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 350 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 450 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 550 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 650 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 750 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 850 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 950 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1050 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1150 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1250 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 350 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 450 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 550 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 650 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 750 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 850 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 950 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1050 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1150 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1250 mg/day or less.
In some aspects, the effective amount of the SRA737 combination therapy is 325 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 425 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 525 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 625 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 725 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 825 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 925 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1025 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1125 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1225 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 325 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 425 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 525 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 625 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 725 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 825 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 925 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1025 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1125 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1225 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 325 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 425 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 525 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 625 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 725 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 825 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 925 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1025 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1125 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1225 mg/day or less.
In some aspects, the effective amount of the SRA737 combination therapy is 375 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 475 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 575 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 675 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 775 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 875 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 975 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1075 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1175 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 1275 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 375 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 475 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 575 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 675 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 775 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 875 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 975 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1075 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1175 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is at least 1275 mg/day. In some aspects, the effective amount of the SRA737 combination therapy is 375 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 475 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 575 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 675 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 775 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 875 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 975 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1075 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1175 mg/day or less. In some aspects, the effective amount of the SRA737 combination therapy is 1275 mg/day or less.
In specific embodiments of the invention, the effective amount of SRA737 is administered to a subject as a combination therapy with a second effective amount of a further treatment. In some aspects, the second effective amount is an amount from about 0.001 mg/kg to about 15 mg/kg. In some embodiments the second effective amount of the further treatment is 0.001, 0.005, 0.010, 0.020, 0.050, 0.1, 0.2, 0.5, 1.0, 2.0, 5.0, 10.0 or 15.0 mg/kg. In some embodiments the second effective amount of the further treatment is between 10-2000 mg/m2/day. In some embodiments the second effective amount of the further treatment is between 50-1250 mg/m2/day. In some embodiments the second effective amount of the further treatment is 50 mg/m2/day, 100 mg/m2/day, 150 mg/m2/day, 200 mg/m2/day, 250 mg/m2/day, 300 mg/m2/day, 350 mg/m2/day, 400 mg/m2/day, 450 mg/m2/day, 500 mg/m2/day, 550 mg/m2/day, 600 mg/m2/day, 650 mg/m2/day, 700 mg/m2/day, 750 mg/m2/day, 800 mg/m2/day, 850 mg/m2/day, 900 mg/m2/day, 950 mg/m2/day, 1000 mg/m2/day, 1050 mg/m2/day, 1100 mg/m2/day, 1150 mg/m2/day, 1200 mg/m2/day, or 1250 mg/m2/day.
In general, the compounds of the present technology will be administered in a therapeutically effective amount by any of the accepted modes of administration for agents that serve similar utilities. the actual amount of the compound of the present technology, i.e., the active ingredient, will depend upon numerous factors such as the severity of the disease to be treated, the age and relative health of the subject, the potency of the compound used, the route and form of administration, and other factors well known to the skilled artisan. The drug can be administered at least once a day, preferably once or twice a day.
An effective amount of such agents can readily be determined by routine experimentation, as can the most effective and convenient route of administration and the most appropriate formulation. Various formulations and drug delivery systems are available in the art. See, e.g., Gennaro, A. R., ed. (1995) Remington's Pharmaceutical Sciences, 18th ed., Mack Publishing Co.
A therapeutically effective dose can be estimated initially using a variety of techniques well-known in the art. Initial doses used in animal studies may be based on effective concentrations established in cell culture assays. Dosage ranges appropriate for human subjects can be determined, for example, using data obtained from animal studies and cell culture assays.
An effective amount or a therapeutically effective amount or dose of an agent, e.g., a compound of the present technology, refers to that amount of the agent or compound that results in amelioration of symptoms or a prolongation of survival in a subject. Toxicity and therapeutic efficacy of such molecules can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., by determining the maximum tolerated dose (MTD), the highest non-severely toxic dose (HNSTD), the No-observed-adverse-effect-level (NOAEL), or the LD50 (the dose lethal to 50% of the population) and the ED50 (the dose therapeutically effective in 50% of the population). the dose ratio of toxic to therapeutic effects is therapeutic index, which can be expressed as the ratio of the MTD, HNSTD, NOAEL, or LD50 to the ED50. Agents that exhibit high therapeutic indices are preferred.
The effective amount or therapeutically effective amount is the amount of the compound or pharmaceutical composition that will elicit the biological or medical response of a tissue, system, animal or human that is being sought by the researcher, veterinarian, medical doctor or other clinician. Dosages particularly fall within a range of circulating concentrations that includes the ED50 with little or no toxicity. Dosages may vary within this range depending upon the dosage form employed and/or the route of administration utilized. the exact formulation, route of administration, dosage, and dosage interval should be chosen according to methods known in the art, in view of the specifics of a subject's condition.
Dosage amount and interval may be adjusted individually to provide plasma levels of the active moiety that are sufficient to achieve the desired effects; i.e., the minimal effective concentration (MEC). the MEC will vary for each compound but can be estimated from, for example, in vitro data and animal experiments. Dosages necessary to achieve the MEC will depend on individual characteristics and route of administration. In cases of local administration or selective uptake, the effective local concentration of the drug may not be related to plasma concentration.
The amount of agent or composition administered may be dependent on a variety of factors, including the sex, age, and weight of the subject being treated, the severity of the affliction, the manner of administration, and the judgment of the prescribing physician.
A therapeutically effective amount can be the same or different than either one of, or both of, the effective amount of SRA737 and the second effective amount of the further treatment. This is because the present disclosure provides that the methods, as described herein, are effective even where neither the effective amount of SRA737 nor the second effective amount of the further treatment must be an amount that, alone, will ameliorate a symptom of a disease (e.g., the amount of the SRA737 and/or the further treatment may be considered a “sub-therapeutic” amount if administered as an individual therapy). However, the present disclosure does provide that a therapeutically effective amount of the combination must be provided, i.e. the combination does at least affect a treatment of a symptom of a disease.
A unit dose form is a term that is generally understood by the skilled artisan. A unit dose forms is a pharmaceutical drug product that is marketed for a specific use. The drug product includes the active ingredient(s) and any inactive components, most often in the form of pharmaceutically acceptable carriers or excipients. It is understood that multiple unit dose forms are distinct drug products. Accordingly, one unit dose form may be e.g. the combination of SRA737 and a further treatment of 250 mg at a certain ratio of each component, while another completely distinct unit dose form is e.g. the combination of SRA737 and a further treatment of 750 mg at the same certain ratio of each component referred to above. So from one unit dose form to another, the effective amount of SRA737 and the second effective amount of the further treatment may both remain the same. Of course, when the either one of the effective amount of SRA737 or the second effective amount of the further treatment changes, the unit dose form is distinct.
In some aspects, the effective amount is unique to the SRA737 compound, i.e. it is different than the second effective amount of the further treatment. In some aspects, the effective amount of SRA737 is an amount that is equivalent to a “therapeutically effective amount” or an amount that brings about a therapeutic and/or beneficial effect. In some aspects, the effective amount of SRA737 is a “therapeutically effective amount”. In some aspects, the second effective amount of the further treatment is a “therapeutically effective amount”. In some aspects, both the effective amount of SRA737 and second effective amount of the further treatment are not a “therapeutically effective amount”. In some aspects, the second effective amount is unique to the of the further treatment, i.e. the second effective amount is a different amount for different further treatments.
In some aspects, the SRA737 and the further treatment combination is formulated in one (1) unit dose form. In some aspects, the same unit dose form is administered for at least four (4) hours, six (6) hours, eight (8) hours, twelve (12) hours, twenty four (24) hours, one (1) day, two (2) days, three (3) days, seven (7) days, ten (10) days, fourteen (14) days, twenty one (21) days, or thirty (30) days.
In some aspects, the SRA737 and the further treatment combination is formulated in at least two (2) separately distinct unit dose forms. In some aspects, the first effective amount is different in the first unit dose form than in the second unit dose form. In some aspects, the effective amount of SRA737 is the same in the first unit dose form as it is in the second unit dose form.
In some aspects, the first unit dose form is the same as the second unit dose form. In some aspects, the first unit dose form is the same as the second and third unit dose forms. In some aspects, the first unit dose form is the same as the second, third, and fourth unit dose forms.
Compounds of the Invention
In one aspect, the present disclosure provides for methods of use of the compound SRA737.
SRA737
The compound SRA737 is also identified by the chemical name: 5-[[4-[[morpholin-2-yl]methylamino]-5-(trifluoromethyl)-2-pyridyl]amino]pyrazine-2-carbonitrile. Each of the enantiomers of SRA737 is useful for compositions, methods and kits disclosed herein.
SRA737 is a compound that is disclosed in international patent application no. PCT/GB2013/051233, which is herein incorporated by reference. The skilled artisan will find the how to synthesize SRA737 in international patent application no. PCT/GB2013/051233.
In one aspect, the SRA737 structures are as shown in the table below.
Combination Therapies
In another aspect, the present disclosure provides for methods of use of the compound SRA737 in a combination therapy with a further treatment.
Further treatments include, but are not limited to, administering a chemotherapeutic agent, administering an antibody or antibody fragment (such as an immune checkpoint inhibitor), administering a radiation treatment, administering an external inducer of replication stress, and administering a combination thereof.
The term “chemotherapy” refers to administration of any genotoxic agent (e.g., DNA damaging agent), including conventional or non-conventional chemotherapeutic agents, for the treatment or prevention of cancer. Chemotherapeutic agents include agents that have been modified, (e.g., fused to antibodies or other targeting agents). Examples of chemotherapeutic agents include, but are not limited to, platinum compounds (e.g., cisplatin, carboplatin, oxaliplatin), alkylating agents (e.g., cyclophosphamide, ifosfamide, chlorambucil, nitrogen mustard, thiotepa, melphalan, busulfan, procarbazine, streptozocin, temozolomide, dacarbazine, bendamustine, mitomycin C), antitumor antibiotics (e.g., daunorubicin, doxorubicin, idarubicin, epirubicin, mitoxantrone, bleomycin, plicamycin, dactinomycin), taxanes (e.g., paclitaxel, nab-paclitaxel and docetaxel), antimetabolites (e.g., 5-fluorouracil, cytarabine, premetrexed, thioguanine, floxuridine, capecitabine, and methotrexate), nucleoside analogues (e.g., fludarabine, clofarabine, cladribine, pentostatin, nelarabine, gemcitabine, 5-flurouracil), topoisomerase inhibitors (e.g., topotecan, irinotecan, SN-38, CPT-11), hypomethylating agents (e.g., azacitidine and decitabine), proteasome inhibitors (e.g., bortezomib), epipodophyllotoxins (e.g., etoposide and teniposide), DNA synthesis inhibitors (e.g., hydroxyurea), and vinca alkaloids (e.g., vincristine, vindesine, vinorelbine, and vinblastine). Chemotherapeutic agents includes DNA intercalating agents (e.g., pyrrolobenzodiazepines).
The term “external inducer of replication stress” refers to any agent that causes increased stalled replication forks, increased genomic instability, increased mutation and/or mutation rate, activation of DNA damage repair pathways, activation of the DNA damage response (DDR), activation or increased expression of replication stress gene(s), or combinations thereof. Examples of inducers of replication stress include, but are not limited to, genotoxic chemotherapeutic agents (e.g., gemcitabine and other nucleoside analogs, alkylating agents such as temozolomide, cisplatin, mitomycin C and others, topoisomerase inhibitors such as camptothecin and etoposide and others). External inducers of cell stress include agents that reduce the concentration of nucleotides in a cell (e.g., ribonucleotide reductase inhibitors and the like). External inducers of cell stress include agents also include PARP inhibitors.
The term “DNA damage repair (DDR) gene” or “DNA damage repair pathway gene” refers to any gene that directly or indirectly promotes repair of DNA mutations, breaks or other DNA damage or structural changes. DNA damage repair genes include, but are not limited to, the following genes: ATM, CDK12, BRCA1, BRCA2, MRE11A, ATR, and Rad50. DDR genes also include genes in the Fanconi anemia (FA) pathway. Genes in the FA pathway include, but are not limited to, Fanconi anemia complementation group (FANC) genes.
The term “immune checkpoint inhibitor” refers to binding molecules that bind to and block or inhibit the activity of one or more immune checkpoint molecules or drugs that inhibit immunosuppressive proteins. Illustrative immune checkpoints inhibitors include antibodies, or antigen binding fragments thereof, that target one or more of CTLA-4, PDL1, PDL2, PD1, B7-H3, B7-H4, BTLA, HVEM, TIM3, GALS, LAG3, TIM3, B7H3, B7H4, VISTA, KIR, 2B4, CD160, CGEN-15049, and IDO1.
The term “PARP inhibitor” or “PARPi” refers to an inhibitor of PARP. A PARPi may be a small molecule, an antibody or a nucleic acid. A PARPi may function to reduce the expression of PARP or the activity of PARP in cells, or combinations thereof. PARPi include inhibitors that do or do not alter the binding of PARP to DNA. PARPi may inhibit any members of the PARP family. PARPi include, but are not limited to: Olaparib, Rucaparib, Veliparib, Niraparib, Iniparib, Talazoparib, Veliparib, Fluzoparib, BGB-290, CEP-9722, BSI-201, EZ449, PF-01367338, AZD2281, INO-1001, MK-4827, SC10914, and 3-aminobenzamine.
In specific aspects, further treatments include, but are not limited to, administering any one of gemcitabine, olaparib, niraparib, rucaparib, talazoparib, cisplatin, a ribonucleotide reductase inhibitor, etoposide, SN-38/CPT-11, mitomycin C, and combinations thereof.
Pharmaceutical Compositions of the Invention
Methods for inhibiting the growth of a tumor, inhibiting the progression of or treating cancer are described herein. Said methods of the invention include administering an effective amount of SRA737 and a second effective amount of a further treatment. the SRA737 and the further treatment can each be formulated in pharmaceutical compositions. these pharmaceutical compositions may comprise, in addition to the active compound(s), a pharmaceutically acceptable excipient, carrier, buffer, stabilizer or other materials well known to those skilled in the art. Such materials should be non-toxic and should not interfere with the efficacy of the active ingredient. the precise nature of the carrier or other material can depend on the route of administration, e.g. oral, intravenous, cutaneous or subcutaneous, nasal, intramuscular, intraperitoneal routes.
Pharmaceutical compositions for oral administration can be in tablet, capsule, powder or liquid form. A tablet can include a solid carrier such as gelatin. Liquid pharmaceutical compositions generally include a liquid carrier such as water or oil, including oils of petroleum, animal, vegetable or synthetic origin, e.g., peanut oil, soybean oil, mineral oil, sesame oil, etc. Physiological saline solution, dextrose or other saccharide solution or glycols such as ethylene glycol, propylene glycol or polyethylene glycol can be included.
For intravenous, cutaneous or subcutaneous injection, or injection at the site of affliction, the active ingredient will be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability. Those of relevant skill in the art are well able to prepare suitable solutions using, for example, isotonic vehicles such as Sodium Chloride Injection, Ringer's Injection, Lactated Ringer's Injection. Preservatives, stabilizers, buffers, antioxidants and/or other additives can be included, as required.
A composition can be administered alone or in combination with other treatments, either simultaneously or sequentially dependent upon the condition to be treated.
The present technology is not limited to any particular composition or pharmaceutical carrier, as such may vary. In general, compounds of the present technology will be administered as pharmaceutical compositions by any one of the following routes: oral, systemic (e.g., transdermal, intranasal or by suppository), or parenteral (e.g., intramuscular, intravenous or subcutaneous) administration. The preferred manner of administration is oral using a convenient daily dosage regimen that can be adjusted according to the degree of affliction. Compositions can take the form of tablets, pills, capsules, semisolids, powders, sustained release formulations, solutions, suspensions, elixirs, aerosols, or any other appropriate compositions. Another preferred manner for administering compounds of the present technology is inhalation.
The choice of formulation depends on various factors such as the mode of drug administration and bioavailability of the drug substance. For delivery via inhalation the compound can be formulated as liquid solution, suspensions, aerosol propellants or dry powder and loaded into a suitable dispenser for administration. there are several types of pharmaceutical inhalation devices-nebulizer inhalers, metered dose inhalers (MDI) and dry powder inhalers (DPI). Nebulizer devices produce a stream of high velocity air that causes therapeutic agents (which are formulated in a liquid form) to spray as a mist that is carried into the subject's respiratory tract. MDI's typically are formulation packaged with a compressed gas. Upon actuation, the device discharges a measured amount of therapeutic agent by compressed gas, thus affording a reliable method of administering a set amount of agent. DPI dispenses therapeutic agents in the form of a free flowing powder that can be dispersed in the subject's inspiratory air-stream during breathing by the device. In order to achieve a free flowing powder, therapeutic agent is formulated with an excipient such as lactose. A measured amount of therapeutic agent is stored in a capsule form and is dispensed with each actuation.
Pharmaceutical dosage forms of a compound of the present technology may be manufactured by any of the methods well-known in the art, such as, for example, by conventional mixing, sieving, dissolving, melting, granulating, dragee-making, tabletting, suspending, extruding, spray-drying, levigating, emulsifying, (nano/micro-) encapsulating, entrapping, or lyophilization processes. As noted above, the compositions of the present technology can include one or more physiologically acceptable inactive ingredients that facilitate processing of active molecules into preparations for pharmaceutical use.
Recently, pharmaceutical formulations have been developed especially for drugs that show poor bioavailability based upon the principle that bioavailability can be increased by increasing the surface area i.e., decreasing particle size. For example, U.S. Pat. No. 4,107,288 describes a pharmaceutical formulation having particles in the size range from 10 to 1,000 nm in which the active material is supported on a crosslinked matrix of macromolecules. U.S. Pat. No. 5,145,684 describes the production of a pharmaceutical formulation in which the drug substance is pulverized to nanoparticles (average particle size of 400 nm) in the presence of a surface modifier and then dispersed in a liquid medium to give a pharmaceutical formulation that exhibits remarkably high bioavailability.
The compositions are comprised of in general, a compound of the present technology in combination with at least one pharmaceutically acceptable excipient. Acceptable excipients are non-toxic, aid administration, and do not adversely affect therapeutic benefit of the claimed compounds. Such excipient may be any solid, liquid, semisolid or, in the case of an aerosol composition, gaseous excipient that is generally available to one of skill in the art.
Solid pharmaceutical excipients include starch, cellulose, talc, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, magnesium stearate, sodium stearate, glycerol monostearate, sodium chloride, dried skim milk and the like. Liquid and semisolid excipients may be selected from glycerol, propylene glycol, water, ethanol and various oils, including oils of petroleum, animal, vegetable or synthetic origin, e.g., peanut oil, soybean oil, mineral oil, sesame oil, etc. Preferred liquid carriers, particularly for injectable solutions, include water, saline, aqueous dextrose, and glycols.
Compressed gases may be used to disperse a compound of the present technology in aerosol form. Inert gases suitable for this purpose are nitrogen, carbon dioxide, etc. Other suitable pharmaceutical excipients and their formulations are described in Remington's Pharmaceutical Sciences, edited by E. W. Martin (Mack Publishing Company, 18th ed., 1990).
In some embodiments, the pharmaceutical compositions include a pharmaceutically acceptable salt. The term “pharmaceutically acceptable salt” refers to salts derived from a variety of organic and inorganic counter ions well known in the art that include, by way of example only, sodium, potassium, calcium, magnesium, ammonium, and tetraalkylammonium, and when the molecule contains a basic functionality, salts of organic or inorganic acids, such as hydrochloride, hydrobromide, tartrate, mesylate, acetate, maleate, and oxalate. Suitable salts include those described in Stahl and Wermuth (Eds.), Handbook of Pharmaceutical Salts Properties, Selection, and Use; 2002.
The present compositions may, if desired, be presented in a pack or dispenser device containing one or more unit dosage forms containing the active ingredient. Such a pack or device may, for example, comprise metal or plastic foil, such as a blister pack, or glass, and rubber stoppers such as in vials. the pack or dispenser device may be accompanied by instructions for administration. Compositions comprising a compound of the present technology formulated in a compatible pharmaceutical carrier may also be prepared, placed in an appropriate container, and labeled for treatment of an indicated condition.
The amount of the compound in a formulation can vary within the full range employed by those skilled in the art. Typically, the formulation will contain, on a weight percent (wt %) basis, from about 0.01-99.99 wt % of a compound of the present technology based on the total formulation, with the balance being one or more suitable pharmaceutical excipients. Preferably, the compound is present at a level of about 1-80 wt %. Representative pharmaceutical formulations are described below.
The following are representative pharmaceutical formulations containing the SRA737 and a further treatment, either alone or in combination.
A composition can be administered alone or in combination with other treatments, either simultaneously or sequentially dependent upon the condition to be treated.
Kits
The present disclosure also provides for a kit comprising the combination of SRA737 and a further treatment and instructions for use. The present disclosure further provides for a kit comprising one or more pharmaceutical compositions where the pharmaceutical composition(s) comprise SRA737 and a further treatment, and instructions for use, optionally the combination includes at least one pharmaceutically acceptable carrier or excipient.
Individual components of the kit can be packaged in separate containers and, associated with such containers, can be a notice in the form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals or biological products, which notice reflects approval by the agency of manufacture, use or sale. The kit may optionally contain instructions or directions outlining the method of use or administration regimen for the antigen-binding construct.
In some aspects, the disclosure provides for a kit comprising a combination of SRA737 and a further treatment and at least one pharmaceutically acceptable carrier or excipient.
When one or more components of the kit are provided as solutions, for example an aqueous solution, or a sterile aqueous solution, the container means may itself be an inhalant, syringe, pipette, eye dropper, or other such like apparatus, from which the solution may be administered to a subject or applied to and mixed with the other components of the kit.
The components of the kit may also be provided in dried or lyophilized form and the kit can additionally contain a suitable solvent for reconstitution of the lyophilized components. Irrespective of the number or type of containers, the kits described herein also may comprise an instrument for assisting with the administration of the composition to a patient. Such an instrument may be an inhalant, nasal spray device, syringe, pipette, forceps, measured spoon, eye dropper or similar medically approved delivery vehicle.
In another aspect described herein, an article of manufacture containing materials useful for the treatment, prevention and/or diagnosis of the disorders described herein, e.g., inhibition of tumor growth is provided. The article of manufacture comprises a container and a label or package insert on or associated with the container. Suitable containers include, for example, bottles, vials, syringes, iv. solution bags, etc. The containers may be formed from a variety of materials such as glass or plastic. The container(s) holds a composition which is by itself or combined with another composition effective for treating, preventing and/or diagnosing the disorder and may have a sterile access port (for example the container may be an intravenous solution bag or a vial having a stopper pierceable by a hypodermic injection needle).
The article of manufacture in this embodiment described herein may further comprise a label or package insert indicating that the compositions can be used to treat a particular condition. Alternatively, or additionally, the article of manufacture may further comprise a second (or third) container comprising a pharmaceutically-acceptable buffer, such as bacteriostatic water for injection (BWFI), phosphate-buffered saline, Ringer's solution and dextrose solution. It may further include other materials desirable from a commercial and user standpoint, including other buffers, diluents, filters, needles, and syringes.
Polypeptides and Nucleic Acids
Described herein are polypeptide and nucleic acid sequences of genes useful for the invention, e.g., genes for CHK1. In some embodiments, polypeptide and nucleic acid sequences useful for the invention are at least 95, 96, 97, 98, or 99% identical to sequences described herein or referred to herein by a database accession number. In some embodiments, polypeptide and nucleic acid sequences useful for the invention are 100% identical to sequences described herein or referred to herein by a database accession number.
The term “percent identity,” in the context of two or more nucleic acid or polypeptide sequences, refer to two or more sequences or subsequences that have a specified percentage of nucleotides or amino acid residues that are the same, when compared and aligned for maximum correspondence, as measured using one of the sequence comparison algorithms described below (e.g., BLASTP and BLASTN or other algorithms available to persons of skill) or by visual inspection. Depending on the application, the percent “identity” can exist over a region of the sequence being compared, e.g., over a functional domain, or, alternatively, exist over the full length of the two sequences to be compared. For sequence comparison, typically one sequence acts as a reference sequence to which test sequences are compared. When using a sequence comparison algorithm, test and reference sequences are input into a computer, subsequence coordinates are designated, if necessary, and sequence algorithm program parameters are designated. The sequence comparison algorithm then calculates the percent sequence identity for the test sequence(s) relative to the reference sequence, based on the designated program parameters. Optimal alignment of sequences for comparison can be conducted, e.g., by the local homology algorithm of Smith & Waterman, Adv. Appl. Math. 2:482 (1981), by the homology alignment algorithm of Needleman & Wunsch, J. Mol. Biol. 48:443 (1970), by the search for similarity method of Pearson & Lipman, Proc. Nat'l. Acad. Sci. USA 85:2444 (1988), by computerized implementations of these algorithms (GAP, BESTFIT, FASTA, and TFASTA in the Wisconsin Genetics Software Package, Genetics Computer Group, 575 Science Dr., Madison, Wis.), or by visual inspection (see generally Ausubel et al., infra). One example of an algorithm that is suitable for determining percent sequence identity and sequence similarity is the BLAST algorithm, which is described in Altschul et al., J. Mol. Biol. 215:403-410 (1990). Software for performing BLAST analyses is publicly available through the National Center for Biotechnology Information (www.ncbi.nlm.nih.gov/).
Below are examples of specific embodiments for carrying out the present invention. the examples are offered for illustrative purposes only, and are not intended to limit the scope of the present invention in any way. Efforts have been made to ensure accuracy with respect to numbers used (e.g., amounts, temperatures, etc.), but some experimental error and deviation should, of course, be allowed for.
The practice of the present invention will employ, unless otherwise indicated, conventional methods of protein chemistry, biochemistry, recombinant DNA techniques and pharmacology, within the skill of the art. Such techniques are explained fully in the literature. See, e.g., T. E. Creighton, Proteins: Structures and Molecular Properties (W.H. Freeman and Company, 1993); A. L. Lehninger, Biochemistry (Worth Publishers, Inc., current addition); Sambrook, et al., Molecular Cloning: A Laboratory Manual (2nd Edition, 1989); Methods In Enzymology (S. Colowick and N. Kaplan eds., Academic Press, Inc.); Remington's Pharmaceutical Sciences, 18th Edition (Easton, Pa.: Mack Publishing Company, 1990); Carey and Sundberg Advanced Organic Chemistry 3rd Ed. (Plenum Press) Vols A and B (1992).
SRA737 was previously found to be a potent and selective inhibitor of Chk1 with limited off-target activity against other kinases, for example, as described in more detail in Walton et al. (Oncotarget. 2016 Jan. 19; 7(3): 2329-2342), herein incorporated by reference for all it teaches. In vitro, SRA737 potently inhibited genotoxic chemotherapy-induced Chk1 autophosphorylation and prevented downstream signal transduction (data not shown). This Chk1 inhibition produced the expected dose-dependent inhibition of genotoxicity-induced checkpoint arrest and a SRA737 dose-dependent potentiation of the cytotoxicity of genotoxic chemotherapeutic agents and targeted agents.
A program of in vivo efficacy studies was performed to assess the activity of SRA737 in combination with genotoxic chemotherapy and targeted agents, and as monotherapy.
Significant, dose-dependent antitumor activity of SRA737 in combination with standard-dose gemcitabine was noted in multiple cancer xenograft models including HT29 human colon cancer, SJSA-1 human osteosarcoma, SW620 mouse colon cancer, Calu6 human (NSCLC), KPC-1 pancreatic cancer and patient-derived bladder carcinoma (data not shown). Synergy was also observed with low-dose gemcitabine in the HT29, OVCAR3 and SJSA-1 CDX models as well as in a PDX model of TNBC; with gemcitabine and carboplatin in the Calu6 model, and with irinotecan in the HT29 model (data not shown). Significant antitumor activity was also observed in three syngeneic mouse models (mTmG, MC38 and Pan02) in combination with a PD1/PD-L1 inhibitor (data not shown). Significant antitumor activity of SRA737 presented as a single agent was observed in several HGSOC PDX models harboring CCNE1 amplifications accompanied by TP53 mutations (data not shown). One of these models also carried a MYCN amplification. A fourth HGSOC PDX model with partial resistance to PARPi was also sensitive to high dose SRA737 monotherapy. SRA737 also demonstrated single agent efficacy in the OVCAR3 model of HGSOC, Eμ-Myc model of B-cell lymphoma; MOLM-13 model of AML; TH-MYC model of neuroblastoma; MDA-MB-231 model of TNBC and in two syngeneic models of renal and lung cancers (Renca and LL/2, respectively) (data not shown).
The effect of SRA737 on Gemcitabine induced CHK1 S296 autophosphorylation was assessed as described in Walton et al. (Oncotarget. 2016 Jan. 19; 7(3): 2329-2342), herein incorporated by reference for all it teaches. Briefly, mice bearing HT29 tumor xenografts were administered (i) vehicle control or (ii) gemcitabine (100 mg/kg in saline, IV) or (iii) a combination of SRA737 (12.5, 25, 50 or 100 mg/kg in DTPW, oral) and gemcitabine (100 mg/kg) with SRA737 administered 24 hours following gemcitabine administration (n=3 per time point per treatment). Inhibition of pS296 Chk1 was observed at SRA737 doses greater than or equal to 12.5 mg/kg (
The PK/PD data showed that relatively low, plasma concentrations of SRA737 sustained above an effective concentration (e.g., SRA737 exceeding a 100 nM plasma concentration for 24 hours) elicited significant antitumor activity in mice and provides a PK/PD benchmark for application in a clinical setting.
Several studies have been conducted to evaluate the PK properties of SRA737, such as the absorption (in vitro permeability assays and in vivo PK following IV and oral administration), distribution (in vivo tissue distribution and in vitro plasma protein binding) and metabolism (in vitro hepatocyte and CYP inhibition and induction studies) of SRA737.
The PK of SRA737 have been determined in the mouse, rat, dog and monkey following oral and IV administration (Table 3). Very favorable absolute oral bioavailability (% F) was noted, particularly in the mouse (105%) and monkey (90-104%), consistent with the moderate metabolism and favorable permeability noted in in vitro models. An acceptable terminal elimination t1/2 was also observed in each species. In addition, the effect of prandial state on the PK of the SRA737 clinical drug product capsule presentation was evaluated in dogs. there was no significant effect of prandial state on oral bioavailability (Error! Reference source not found.4). The plasma protein binding of SRA737 at 1 and 10 μM was examined in mouse, minipig, monkey and human plasma using ultracentrifugation and in dog plasma (10 μM) using rapid equilibrium dialysis. Moderate plasma protein binding was observed in humans (˜87%) and the non-rodent toxicology species (˜80% and 87% for the minipig and monkey, respectively), whereas high plasma protein binding (˜94%) was observed in the mouse (Table 5).
aFasted: animals fasted overnight and only fed at 4 h postdose
bNon-fasted: animals fasted overnight and fed 1 h predose
The membrane permeability of SRA737 was assessed in the parallel artificial membrane permeability assay (PAMPA) and Caco-2 assays. Permeability in the PAMPA assay was classified as low. At 10 μM permeability in the Caco-2 assay was 20.7±9.1×10−6 cm/s with an efflux ratio (A>B/B>A) of 0.8, which indicated that SRA737 has a relatively high passive permeability and low efflux potential.
The formation of SRA737-related metabolites was determined in cryopreserved hepatocytes from human, mouse, rat, dog, minipig and monkey samples after incubation with SRA737 at a nominal concentration of 10 μM for up to 4 hours. The rank order of stability from most stable to least stable for the species was rat≈mouse>monkey≈human>>dog>>minipig. In the human hepatocyte preparation, approximately 67% of the parent remained after 4 hours of incubation compared to 75% and 7% in the rat and minipig preparations, respectively. Eight human SRA737 metabolites were observed. All SRA737 metabolites formed by human hepatocytes were also formed by monkey hepatocytes. Six metabolites were present at equal or greater abundance in the monkey. No human-specific metabolites were observed, but two of the human metabolites were not formed in any other species at equal or greater abundance.
The excretion of SRA737 has been studied in mice and rats administered SRA737 at either 5 mg/kg IV or 10 mg/kg orally. Urine and feces were collected for a 24-hour period after dosing. In mice, renal excretion of intact SRA737 was consistently low (less than 10% of dose) after both oral and IV administration. Following IV administration of SRA737, less than 8% of the dose was recovered as intact drug in the feces while after oral administration this figure was less than 3%. Excretion of intact SRA737 was lower in the rat than in the mouse with <1% of dose excreted renally over 24 hours and less than 1.5% of dose excreted into the feces over 24 hours.
No significant inhibition of major CYP enzymes (1A2, 2A6, 2C9, 2C19, 2D6 and 3A4) was observed at the highest concentration of SRA737 investigated (IC50>10-50 suggesting that the compound is unlikely to mediate significant metabolic drug-drug interactions. Minimal, concentration dependent induction of CYP1A2 (<10% positive control, omeprazole) was observed in vitro suggesting SRA737 in some cases minimally affected the metabolism of concomitantly administered drugs that are predominately metabolized by CYP1A2.
Taken together, the permeability, metabolic stability, and demonstrable oral bioavailability observed in preclinical species is suggestive of favorable oral absorption in humans.
The toxicity of SRA737 was assessed in Good Laboratory Practice (GLP) 28-day repeat oral dose studies in the mouse, minipig and monkey and in a three-cycle combination study with gemcitabine and cisplatin in the mouse.
Toxicokinetic data for SRA737 administered as a monotherapy are summarized in Error! Reference source not found.6. The pattern of toxicology findings observed in the pivotal studies in mouse, minipig and monkey were broadly similar and consistent with SRA737's mechanism of action although in general, the monkey appeared to be the least sensitive toxicological species. Data from studies in the monkey suggest higher exposures would likely be tolerated in humans than would be predicted from mouse and minipig data. Based on similarities between monkey and human data for plasma protein binding, stability in hepatocytes, and other ADMET data, the monkey has been confirmed as the most suitable nonclinical model for the determination of potential human toxicity.
Dose-dependent toxicological findings related to bone marrow toxicity, including variously decreased red and white cell parameters with increased medullary or extramedullary hematopoiesis and atrophy of lymphatic organs including the thymus was noted in the mouse and minipig pivotal studies. These findings were reversible on cessation of drug administration. Toxicological findings in the GI tract were also observed in the minipig and in early mouse and monkey studies and changes in reproductive organs, particularly the testes, were also observed in the minipig and mouse, but not monkey. these latter changes were not reversible in the mouse; however, the relevance of these findings in sexually immature animals to adult cancer patients appears limited.
The MTD was 75 mg/kg/day (225 mg/m2/day) in the mouse and the HNSTD was 10 mg/kg/day (350 mg/m2/day) in the minipig. An absence of toxicological findings was noted in the pivotal monkey toxicity study, thus the NOAEL of 20 mg/kg/day (240 mg/m2/day) was the highest dose tested.
Findings from a triple combination study in mice (SRA737 administered in combination with IV gemcitabine and cisplatin on an intermittent schedule over 18 days) mirrored those noted in the monotherapy toxicity study in this species, although reversible intestinal epithelial degeneration was also noted in the high dose triplet combination group. Only the reversible marrow toxicity, consequent splenomegaly, and the high-dose intestinal observations were deemed to have been exacerbated by administration of SRA737 over those observed following administration of the cisplatin/gemcitabine control group alone. Clinical combination of SRA737 and gemcitabine in some cases therefore elicited exacerbated hematological and GI toxicities.
A Phase 1 clinical trial was conducted in ‘all comers,’ i.e. no genetic selection was performed, to establish safety, tolerability and pharmacokinetics (“Dose Escalation Phase”). Cohorts consisting initially of a single subject received escalating doses of SRA737, starting in Cohort 1 with 20 mg/day administered orally on a continuous daily dosing schedule in 28 day cycles. the dose was escalated until the maximum tolerated dose (MTD) was identified.
In the Dose Escalation Phase, 18 subjects received SRA737 in 9 dose level cohorts, from 20 to 1300 mg QD; median treatment duration 62.5 days (range 1 to 226). Dose level cohorts of up to 1000 mg of SRA737 were completed without any dose-limiting toxicities (DLTs). Two of 3 subjects experienced DLTs at the 1300 mg once daily dose, each being an inability to receive 75% of the planned SRA737 dose due to GI intolerability, with the individual GI effects being low grade. Hence, 1300 mg exceeded the maximum tolerated dose with the once daily dosing regimen. A cohort receiving 500 mg twice daily was added to determine if a twice daily dosing schedule can improve GI tolerability, given the half-life of SRA737 is approximately 10 hours. One of 6 subjects experienced DLTs in the 500 mg twice daily cohort; this was an inability to receive 75% of the planned SRA737 dose due to grade 4 thrombocytopenia with grade 3 neutropenia and anemia. Based on overall tolerability and GI events (nausea, vomiting, and diarrhea), subjects were also enrolled at a dose level of 800 mg once daily and was overall better tolerated than 1000 mg (subjects required fewer dose reductions, experienced fewer severe (G3/4) AEs and significantly less fatigue AEs. The maximum tolerated dose (MTD) was established at 1000 mg QD or 500 mg BID.
Pharmacokinetic parameters for the monotherapy cohorts were monitored and are summarized in Table 7. The Cmax and AUC0-24 at 1000 mg QD were 2391 ng/mL and 26795 ng·h/mL respectively. Cmin was calculated at 1000 mg QD (411 ng/mL) and exceeded that determined in preclinical models to be effective. Doses≥300 mg QD also exceeded the preclinical models to be effective.
a20, 40, 80, 160, 300 mg − n = 1; 600 mg − n = 4; 800 mg − n = 25; 1000 mg − n = 43-44; and 1300 mg − n = 3
b20, 40, 80, 160, 300 mg − n = 1; 600 mg − n = 7; 800 mg − n = 12; 1000 mg − n = 17
A Phase 1 clinical trial was conducted in ‘all corners,’ i.e. no genetic selection was performed, to establish safety, tolerability and pharmacokinetics for SRA737 administered in combination with gemcitabine (“Dose Escalation Phase”). Cohorts consisting initially of a single subject received escalating doses of SRA737, starting in Cohort 1 with 40 mg/day administered orally on days 2, 3, 9, 10, 16, and 17 of each 28-day cycle. Cohorts also received various doses of gemcitabine, starting in Cohort 1 with 300 mg/m2/day administered IV over 30 minutes on days 1, 8, and 15 of each 28-day cycle.
Pharmacokinetic parameters for the monotherapy cohorts were monitored and are summarized in Table 8. The pharmacokinetic profile of SRA737 revealed AUC0-24 and Cmax of 3550 ng·h/mL and 548 ng/mL at 150 mg SRA737. At this dose, the Cmin (52 ng/mL) exceeded that determined in preclinical models to be effective.
a20 mg − n = 8-10; 40 mg − n = 6; 80 mg − n = 3; 150 mg − n = 4; 300 mg − n = 7; 500 mg − n = 29; and 600 mg − n = 4
b40 mg − n = 4; 80, 150 mg − n = 3; 300 mg − n = 7; 500 mg − n = 19-22; and 600 mg − n = 4
Additional cohorts are monitored escalating the dose of SRA737 until the maximum tolerated dose (MTD) is identified and to optimize combination dosing with gemcitabine. All enrolled subjects who receive at least 1 dose of SRA737 and provide at least 1 evaluable PK concentration or have evaluable data for each specific PDn assessment are evaluable for PK and PDn, respectively. Serious adverse events (SAEs) are collected starting on the date of informed consent. Radiological assessment are performed within 4 weeks from the first dose of SRA737 (or gemcitabine if the SRA737 dose for PK is omitted) and repeated every 6 weeks in Stage 1. In Stage 2, assessments are performed every 8 weeks and in long-term follow-up every 16 weeks. Assessments are performed more frequently, when clinically indicated. Cardiac assessments (echocardiogram [ECHO] and electrocardiogram [ECG]) are be conducted. Optional triplet tumor biopsies in some cases are collected within 28 days prior to receiving the first SRA737 dose. Within 7 days of the first dose of SRA737 (or gemcitabine if the SRA737 dose for PK is omitted), the following assessments are completed: complete physical examination, clinical disease assessment, SAE and concomitant medication, WHO performance status and local laboratory assessment of blood (for hematology, biochemistry, and pregnancy testing). At the single-dose PK run-in on Day −7 to Day −4 visit, concomitant medication, vital signs (including temperature, blood pressure, and pulse), height, weight, body surface area (BSA), and WHO performance status are collected. Blood samples are obtained predose for hematology, biochemistry, pregnancy testing, troponin I or T, as well as for tumor markers and tumor profiling. Adverse events (AEs) are collected starting at the administration of SRA737. Archival tissue is submitted for tumor profiling. PK samples are collected at up to 10 time points over a 48-hour time period on Day −7 to −4 (first dose of SRA737 for PK). The sponsor in some cases reduces the requirement for PK sampling, including modification or elimination of the Day −7 to Day −4 visit once sufficient data to evaluate the single-dose PK of SRA737 have been collected and analyzed. Dosing begins on Day 1 with the following procedures occurring at regular intervals:
An in-human clinical trial is conducted to confirm efficacy of SRA737 monotherapy methods of treatment and patient selection strategies disclosed herein for prospectively-selected genetically-defined subjects with tumor types known to have a high prevalence of genomic alterations expected to sensitize the tumor to Chk1 inhibition (“Cohort Expansion Phase”). the Cohort Expansion Phase consists of 6 indication-specific expansion cohorts of approximately 20 prospectively-selected genetically-defined subjects each. The cohorts are subjects with previously treated metastatic colorectal cancer [CRC], high grade serous ovarian cancer [HGSOC] without CCNE1 gene amplification, HGSOC with CCNE1 gene amplification (or alternative genetic alteration with similar functional effect), metastatic castration-resistant prostate cancer [mCRPC], advanced non-small cell lung cancer [NSCLC], and squamous cell carcinoma of the head and neck [HNSCC], or squamous cell carcinoma of the anus [SCCA]. Subjects are initially administered SRA737 following the dosing regimen established in Example 4. The dosing regimen in some cases changes during the course of the trial.
Subjects have tumor tissue or ctDNA evidence that their tumor harbors a combination of mutations which are expected to confer sensitivity to Chk1 inhibition. Subjects are selected based on prospective, tumor tissue genetic profiling using NGS.
Expansion cohort subjects have tumors that harbor genomic alterations expected to confer sensitivity to Chk1 inhibition in a minimum of two of the following categories (a)-(e):
In some aspects, subjects meet one of the following criteria (a-e):
Subjects, in general, have measurable disease (per Response Evaluation Criteria in Solid Tumors, version 1.1 [RECIST v1.1]) or, for mCRPC, evaluable disease per any of the following: Measurable disease per RECIST v1.1; increasing prostate specific antigen (PS); or circulating tumor cell (CTC) count of 5 or more cells per 7.5 ml of blood.
Enrollment to Expansion Cohorts in some cases occurs in parallel with the Dose Escalation Phase (see Example 5). A subject that qualifies for the Cohort Expansion Phase is enrolled into an Escalation Cohort whenever possible. Any such subject is considered to have enrolled in both phases simultaneously.
Disease is measured according to the RECIST v1.1 criteria for subjects with solid tumors, according to the revised IWG criteria (Cheson 2007) for subjects with NHL, and for subjects with mCRPC, using a composite of any one of the following: A) Measurable disease per RECIST v1.1; B) Increasing PSA; or C) CTC count of 5 or more cells per 7.5 ml of blood.
Baseline evaluations include radiological measurements of lesions appropriate to the nature of the malignancy. In some cases, this includes: CT scan, liver CT scan, abdominal CT scan, MRI, X-ray, bone scan and/or other radiological measurements as clinically indicated or clinical measurements as appropriate (e.g., assessment of palpable lesions or measurement of tumor markers). All areas of disease present are documented (even if specific lesions are not going to be followed for response) and the dimensions of all measurable lesions are recorded clearly on the scan reports. Any non-measurable lesions are stated as being present. For clinical measurements, documentation by color photography including a ruler to estimate the size of the lesion is strongly recommended, as this aids external independent review of responses.
Tumor assessments is repeated every 8 weeks or more frequently, when clinically indicated. Subjects with bone metastases being followed by bone scans are scanned every 8 weeks (±1 week) for the first 6 months and then every 16 weeks (±2 weeks) thereafter. During Long-term Follow-up, assessments for subjects who have not yet progressed and who have not initiated alternative anti-cancer therapy are done every 16 weeks, unless requested more frequently by the sponsor or investigator. All lesions measured at baseline are measured at every subsequent disease assessment, and recorded clearly on the scan reports. All non-measurable lesions noted at baseline are noted on the scan report as present or absent. All subjects, who are removed from the study treatment for reasons other than progressive disease (PD), should be re-evaluated at the time of treatment discontinuation, unless a tumor assessment was performed within the previous four weeks. Subjects are followed for PD until disease progression or withdrawal from trial.
All subjects who have measurable disease, receive at least one cycle of SRA737 and have a baseline plus at least 1 post-baseline assessment of disease are evaluable for response. Subjects who develop clear evidence of PD without a formal disease assessment and those without a formal disease assessment before study withdrawal are considered non-responders. Complete responses and PRs are required to be confirmed by a subsequent assessment at least 4 weeks later. Stable Disease (SD) determination requires that the relevant criteria be met at least once, a minimum of 6 weeks after the initial dose of SRA737 is given.
Should rapid tumor progression occur before the completion of 4 weeks of treatment, the subject is classified as having early progression.
Tumor response should be classified as “not evaluable” (NE), only when it is not possible to classify it under another response category, for example, when baseline and/or follow-up assessment is not performed or not performed appropriately.
Response criteria are defined below:
The results of this study confirm the efficacy of SRA737 monotherapy for the treatment of tumors with known genetic alterations expected to confer sensitivity to Chk1 inhibition.
An in-human clinical trial is conducted to confirm efficacy of SRA737 combination therapy methods of treatment and patient selection strategies disclosed herein for prospectively-selected genetically-defined subjects with tumor types known to have a high prevalence of genomic alterations expected to sensitize the tumor to Chk1 inhibition (“Cohort Expansion Phase”). In the Cohort Expansion Phase, approximately 20 prospectively-selected genetically-defined subjects are enrolled in each of 4 indication-specific cohorts: high-grade serous ovarian cancer (HGSOC), small cell lung cancer (SCLC), soft tissue sarcoma (STS), and cervical/anogenital cancer. Based on the PK data that established dosing resulting in an efficacious concentration of SRA737 (see Example 5), a starting dose level of 500 mg SRA737 and 100 mg/m2 gemcitabine was used. The dosing regimen in some cases changes during the course of the trial. SRA737 capsules are taken on an empty stomach (subjects fast for at least 2 hours pre- and 1 hour post-administration), unless otherwise instructed.
Subjects have:
b. Measurable disease per RECIST v1.1 (see below)
Alternatively, subjects have one of the histologically or cytologically proven advanced malignancies described above and tumor tissue or ctDNA evidence that their tumor harbors one or more mutations that are expected to confer sensitivity to Chk1 inhibition. Eligibility will be determined by the sponsor's review of genetic abnormalities detected in genes in the following categories:
b. The DNA damage response pathway including ATM, CDK12, BRCA1, BRCA2, mismatch repair genetic alterations and/or high microsatellite instability.
c. Genetic indicators of replicative stress such as gain of function/amplification of Chk1 or ATR or other related gene.
d. Oncogenic drivers such as MYC, KRAS, etc.
Subjects are excluded based on the following criteria:
All enrolled subjects who have measurable disease, receive at least 75% (Stage 1) or 83% (Stage 2) of SRA737 in 1 cycle (or the equivalent if the sponsor elects to evaluate an alternative dosing schedule), and have a baseline assessment of disease plus at least 1 postbaseline disease assessment are evaluated for response. All subjects who enroll into the Cohort Expansion Phase are evaluated for response if they have measurable disease, receive at least 1 cycle of study medication as defined above, have a baseline assessment of disease plus at least 1 postbaseline disease assessment and are confirmed as having met the genetic selection requirements.
In addition, subjects who have measurable disease and received at least 83% of SRA737 (if the sponsor elects to evaluate an alternative dosing schedule) in 1 cycle but developed PD, intolerable toxicity, or death prior to the postbaseline assessment are also evaluable and are classified as non-responders.
The analysis of all efficacy endpoints is based on the Response Evaluable Population and will be evaluated using RECIST v1.1 criteria, as described below.
Other endpoints include: Duration of response (DOR), Disease control rate (DCR), Time to response (TTR), PFS, Time to Progression (TTP), OS. Other exploratory objectives are described in Table 9.
Additional trials are conducted with SRA737 in combination with other therapies, including administering a chemotherapeutic agent, administering an antibody or antibody fragment, administering a radiation treatment, administering an external inducer of replication stress, or administering a combination thereof. Other trials are conducted with SRA737 in combination with other therapies, including administering olaparib, niraparib, rucaparib, talazoparib, cisplatin, a ribonucleotide reductase inhibitor, etoposide, SN-38/CPT-11, mitomycin C, or combinations thereof.
The results of this study confirm the efficacy of SRA737 combination therapy for the treatment of tumors with known genetic alterations expected to confer sensitivity to Chk1 inhibition.
Assessment of disease response in this study are performed according to the revised RECIST criteria v1.1. RECIST criteria are described in greater detail in Eisenhauer, et al. (New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer [Internet]. 2009), herein incorporated by reference for all it teaches.
At baseline, tumor lesions/lymph nodes are generally categorized measurable or non-measurable as follows:
Measurable
Tumor lesions: are generally accurately measured in at least one dimension (longest diameter in the plane of measurement is to be recorded) with a minimum size of:
Malignant lymph nodes: To be considered pathologically enlarged and measurable, a lymph node is generally 15 mm in the short axis when assessed by CT scan (CT scan slice thickness recommended to be no greater than 5 mm). At baseline and in follow-up, only the short axis is generally measured and followed.
Non-Measurable
All other lesions, including small lesions (longest diameter<10 mm or pathological lymph nodes with ≥10 to <15 mm short axis) as well as truly non-measurable lesions. Lesions considered truly non-measurable generally include: leptomeningeal disease, ascites, pleural or pericardial effusion, inflammatory breast disease, lymphangitic involvement of skin or lung, abdominal masses/abdominal organomegaly identified by physical exam that is not measurable by reproducible imaging techniques.
Bone lesions, cystic lesions, and lesions previously treated with local therapy require particular comment:
Bone lesions:
Cystic lesions:
Lesions with prior local treatment:
Method of Assessment
All measurements are generally recorded in metric notation, using calipers if clinically assessed. All baseline evaluations are generally performed as close as possible to the treatment start and never more than 4 weeks before the beginning of the treatment.
The same method of assessment and the same technique are generally used to characterize each identified and reported lesion at baseline and during follow-up. Imaging based evaluation are generally always done rather than clinical examination unless the lesion(s) being followed cannot be imaged but are assessable by clinical exam.
Clinical lesions are generally considered measurable when they are superficial and ≥10 mm diameter as assessed using calipers (e.g. skin nodules). For the case of skin lesions, documentation by color photography including a ruler to estimate the size of the lesion is suggested. As noted above, when lesions can be evaluated by both clinical exam and imaging, imaging evaluation is generally undertaken since it is more objective and in some cases is also reviewed at the end of the study.
Chest CT is generally preferred over chest X-ray, particularly when progression is an important endpoint, since CT is more sensitive than X-ray, particularly in identifying new lesions. However, in some cases, lesions on chest X-ray are considered measurable if they are clearly defined and surrounded by aerated lung
CT is generally the best currently available and reproducible method to measure lesions selected for response assessment. This guideline has defined measurability of lesions on CT scan based on the assumption that CT slice thickness is 5 mm or less. When CT scans have slice thickness greater than 5 mm, the minimum size for a measurable lesion is twice the slice thickness. MRI is also acceptable in certain situations (e.g. for body scans). More details concerning the use of both CT and MRI for assessment of objective tumor response evaluation are provided in the publication from Eisenhauer et al.
Ultrasound is generally not useful in assessment of lesion size and is generally not used as a method of measurement. Ultrasound examinations, in general, cannot be reproduced in their entirety for independent review at a later date and, because they are operator dependent, it generally cannot be guaranteed that the same technique and measurements will be taken from one assessment to the next (described in greater detail in Eisenhauer, et al. (2009). If new lesions are identified by ultrasound in the course of the study, confirmation by CT or MRI is generally advised. If there is concern about radiation exposure at CT, MRI in some cases is used instead of CT in selected instances.
The utilization of endoscopy and laparoscopy techniques for objective tumor evaluation is generally not advised. However, they are, in general, useful to confirm complete pathological response when biopsies are obtained or to determine relapse in trials where recurrence following complete response or surgical resection is an endpoint.
Tumor markers alone are generally not used to assess objective tumor response. If markers are initially above the upper normal limit, however, they are generally normalized for a subject to be considered in complete response.
Cytology and histology are generally used to differentiate between PR and CR in rare cases if required by protocol (for example, residual lesions in tumor types such as germ cell tumors, where known residual benign tumors can remain). When effusions are known to be a potential adverse effect of treatment (e.g. with certain taxane compounds or angiogenesis inhibitors), the cytological confirmation of the neoplastic origin of any effusion that appears or worsens during treatment are generally considered if the measurable tumor has met criteria for response or stable disease in order to differentiate between response (or stable disease) and progressive disease.
Tumor Response Evaluation
To assess objective response or future progression, the overall tumor burden at baseline is generally estimated and used as a comparator for subsequent measurements. Measurable disease is generally defined by the presence of at least one measurable lesion.
When more than one measurable lesion is present at baseline all lesions up to a maximum of five lesions total (and a maximum of two lesions per organ) representative of all involved organs are generally identified as target lesions and are recorded and measured at baseline (this means in instances where subjects have only one or two organ sites involved a maximum of two and four lesions respectively are recorded). Target lesions are generally selected on the basis of their size (lesions with the longest diameter) and are generally representative of all involved organs, but in addition are generally those that lend themselves to reproducible repeated measurements. In some cases, the largest lesion does not lend itself to reproducible measurement in which circumstance the next largest lesion which can be measured reproducibly is generally selected, as exemplified in
Lymph nodes merit special mention since they are normal anatomical structures which in some cases are visible by imaging even if not involved by tumor. Pathological nodes which are defined as measurable and in some cases are identified as target lesions, in general, meets the criterion of a short axis of ≥15 mm by CT scan. Only the short axis of these nodes generally contributes to the baseline sum. The short axis of the node is generally the diameter normally used by radiologists to judge if a node is involved by solid tumor. Nodal size is normally reported as two dimensions in the plane in which the image is obtained (for CT scan this is almost always the axial plane; for MRI the plane of acquisition in some cases are axial, sagital or coronal). The smaller of these measures is the short axis. For example, an abdominal node which is reported as being 20 mm×30 mm has a short axis of 20 mm and qualifies as a malignant, measurable node. In this example, 20 mm should be recorded as the node measurement. All other pathological nodes (those with short axis≥10 mm but<15 mm) are generally considered non-target lesions. Nodes that have a short axis<10 mm are generally considered non-pathological and are generally not recorded or followed.
A sum of the diameters (longest for non-nodal lesions, short axis for nodal lesions) for all target lesions is generally calculated and reported as the baseline sum diameters. If lymph nodes are to be included in the sum, then as noted above, only the short axis is added into the sum. The baseline sum diameters are generally used as reference to further characterize any objective tumor regression in the measurable dimension of the disease.
All other lesions (or sites of disease) including pathological lymph nodes are generally identified as non-target lesions and are generally recorded at baseline. Measurements are generally not required and these lesions are generally followed as ‘present’, ‘absent’, or in rare cases ‘unequivocal progression’ (more details to follow). In addition, it is possible to record multiple non-target lesions involving the same organ as a single item on the case record form (e.g. ‘multiple enlarged pelvic lymph nodes’ or ‘multiple liver metastases’).
Response Criteria
Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) are reduced in short axis to <10 mm.
Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum generally demonstrates an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is generally also considered progression).
Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters.
Lymph nodes identified as target lesions generally record the actual short axis measurement (measured in the same anatomical plane as the baseline examination), generally even if the nodes regress to below 10 mm. This means that when lymph nodes are included as target lesions, the ‘sum’ of lesions in some cases are not be zero even if complete response criteria are met, since a normal lymph node is generally defined as having a short axis of <10 mm. Case report forms or other data collection methods in some cases are therefore designed to have target nodal lesions recorded in a separate section where, in order to qualify for CR, each node generally achieves a short axis<10 mm. For PR, SD and PD, the actual short axis measurement of the nodes is preferably included in the sum of target lesions.
While on study, all lesions (nodal and non-nodal) recorded at baseline generally record their actual measurements at each subsequent evaluation, even when very small (e.g. 2 mm). However, sometimes lesions or lymph nodes which are recorded as target lesions at baseline become so faint on CT scan that the radiologist in some cases does not feel comfortable assigning an exact measure and in some cases report them as being ‘too small to measure’. When this occurs it is, in general, important that a value is recorded on the case report form. If it is the opinion of the radiologist that the lesion has likely disappeared, the measurement is generally recorded as 0 mm. If the lesion is believed to be present and is faintly seen but too small to measure, a default value of 5 mm is generally assigned. (Note: It is, in general, less likely that this rule is used for lymph nodes since they usually have a definable size when normal and are frequently surrounded by fat such as in the retroperitoneum; however, if a lymph node is believed to be present and is faintly seen but too small to measure, a default value of 5 mm is generally assigned in this circumstance as well). This default value is derived from the 5 mm CT slice thickness (but generally is not changed with varying CT slice thickness). The measurement of these lesions is potentially non-reproducible, therefore providing this default value generally prevents false responses or progressions based upon measurement error. To reiterate, however, if the radiologist is able to provide an actual measure, that is generally recorded, even if it is below 5 mm.
When non-nodal lesions ‘fragment’, the longest diameters of the fragmented portions are generally added together to calculate the target lesion sum. Similarly, as lesions coalesce, a plane between them are generally maintained that would aid in obtaining maximal diameter measurements of each individual lesion. If the lesions have truly coalesced such that they are no longer separable, the vector of the longest diameter in this instance generally is the maximal longest diameter for the ‘coalesced lesion’.
While some non-target lesions in some cases are actually measurable, they generally are not measured and instead are generally assessed only qualitatively at the time points specified in the protocol.
Complete Response (CR): Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes are non-pathological in size (<10 mm short axis).
Non-CR/Non-PD: Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.
Progressive Disease (PD): Unequivocal progression (see comments below) of existing non-target lesions. (Note: the appearance of one or more new lesions is also considered progression).
When the subject also has measurable disease, to achieve ‘unequivocal progression’ on the basis of the non-target disease, there generally is an overall level of substantial worsening in non-target disease such that, even in presence of SD or PR in target disease, the overall tumor burden has increased sufficiently to merit discontinuation of therapy. A modest ‘increase’ in the size of one or more non-target lesions is usually not sufficient to quality for unequivocal progression status. The designation of overall progression solely on the basis of change in non-target disease in the face of SD or PR of target disease is generally therefore extremely rare.
A subject having only non-measurable disease arises in some Phase III trials when it is not a criterion of study entry to have measurable disease. The same general concepts apply here as noted above, however, in this instance there is no measurable disease assessment to factor into the interpretation of an increase in non-measurable disease burden. Because worsening in non-target disease is generally not easily quantified (by definition: if all lesions are truly non-measurable) a useful test that can generally be applied when assessing subjects for unequivocal progression is to consider if the increase in overall disease burden based on the change in non-measurable disease is comparable in magnitude to the increase that would be required to declare PD for measurable disease: i.e. an increase in tumor burden representing an additional 73% increase in ‘volume’ (which is equivalent to a 20% increase diameter in a measurable lesion). Examples include an increase in a pleural effusion from ‘trace’ to ‘large’, an increase in lymphangitic disease from localized to widespread, or in some cases are described in protocols as ‘sufficient to require a change in therapy’. If ‘unequivocal progression’ is seen, the subject is generally considered to have had overall PD at that point. While it would be ideal to have objective criteria to apply to non-measurable disease, the very nature of that disease makes it generally very difficult to do so; therefore the increase generally is substantial.
The appearance of new malignant lesions generally denotes disease progression; therefore, some comments on detection of new lesions are generally important. There are generally no specific criteria for the identification of new radiographic lesions; however, the finding of a new lesion generally is unequivocal: i.e., generally not attributable to differences in scanning technique, change in imaging modality or findings thought to represent something other than tumor (for example, some ‘new’ bone lesions in some cases are simply healing or flare of pre-existing lesions). This is particularly important when the subject's baseline lesions show partial or complete response. For example, necrosis of a liver lesion is frequently reported on a CT scan report as a ‘new’ cystic lesion, which it generally is not.
A lesion identified on a follow-up study in an anatomical location that was not scanned at baseline is generally considered a new lesion and generally indicates disease progression. An example of this is the subject who has visceral disease at baseline and while on study has a CT or MM brain ordered which reveals metastases. The subject's brain metastases are generally considered to be evidence of PD even if he/she did not have brain imaging at baseline.
If a new lesion is equivocal, for example because of its small size, continued therapy and follow-up evaluation generally clarifies if it represents truly new disease. If repeat scans confirm there is definitely a new lesion, then progression is generally declared using the date of the initial scan.
While FDG-PET response assessments need additional study, it is sometimes reasonable to incorporate the use of FDG-PET scanning to complement CT scanning in assessment of progression (particularly possible ‘new’ disease). New lesions on the basis of FDG-PET imaging are generally identified according to the following algorithm:
a. Negative FDG-PET at baseline, with a positive* FDG-PET at follow-up is generally a sign of PD based on a new lesion. (* A ‘positive’ FDG-PET scan lesion generally means one which is FDG avid with an uptake greater than twice that of the surrounding tissue on the attenuation corrected image.)
b. No FDG-PET at baseline and a positive FDG-PET at follow-up:
Evaluation of Best Overall Response
The best overall response is generally the best response recorded from the start of the study treatment until the end of treatment. Should a response not be documented until after the end of therapy in this trial, post-treatment assessments generally are considered in the determination of best overall response as long as no alternative anti-cancer therapy has been given. The subject's best overall response assignment generally depends on the findings of both target and non-target disease and generally also takes into consideration the appearance of new lesions.
It is generally assumed that at each protocol-specified time point, a response assessment occurs. Table 10 provides a summary of the overall response status calculation at each time point for subjects who have measurable disease at baseline.
When subjects have non-measurable (therefore non-target) disease only, Table 11 is generally used.
When no imaging/measurement is done at all at a particular time point, the subject is generally not evaluable (NE) at that time point. If only a subset of lesion measurements are made at an assessment, usually the case is generally also considered NE at that time point, unless a convincing argument is made that the contribution of the individual missing lesion(s) does not change the assigned time point response. This would be most likely to happen in the case of PD. For example, if a subject had a baseline sum of 50 mm with three measured lesions and at follow-up only two lesions were assessed, but those gave a sum of 80 mm, the subject has generally achieved PD status, regardless of the contribution of the missing lesion.
The best overall response is generally determined once all the data for the subject is known.
Best response determination in trials where confirmation of complete or partial response is generally not required: Best response in these trials is generally defined as the best response across all time points (for example, a subject who has SD at first assessment, PR at second assessment, and PD on last assessment has a best overall response of PR). When SD is believed to be best response, it, in general, also meets the protocol specified minimum time from baseline. If the minimum time is not met when SD is otherwise the best time point response, the subject's best response generally depends on the subsequent assessments. For example, a subject who has SD at first assessment, PD at second and does not meet minimum duration for SD, will have a best response of PD. The same subject lost to follow-up after the first SD assessment is generally considered inevaluable.
When nodal disease is included in the sum of target lesions and the nodes decrease to ‘normal’ size (<10 mm), in some cases they still have a measurement reported on scans. This measurement is generally recorded even though the nodes are normal in order not to overstate progression should it be based on increase in size of the nodes. As noted earlier, this means that subjects with CR in some cases do not have a total sum of ‘zero’ on the case report form (CRF).
Subjects with a global deterioration of health status requiring discontinuation of treatment without objective evidence of disease progression at that time generally are reported as ‘symptomatic deterioration’. Every effort is generally made to document objective progression even after discontinuation of treatment. Symptomatic deterioration is generally not a descriptor of an objective response: it is a reason for stopping study therapy. The objective response status of such subjects is generally determined by evaluation of target and non-target disease as shown in Tables 10 and 11.
Conditions that define ‘EP, early death and inevaluability’ are study specific and are generally clearly described in each protocol (depending on treatment duration, treatment periodicity).
In some circumstances it is difficult to distinguish residual disease from normal tissue. When the evaluation of complete response depends upon this determination, it is generally recommended that the residual lesion be investigated (fine needle aspirate/biopsy) before assigning a status of complete response. In some cases, FDG-PET is used to upgrade a response to a CR in a manner similar to a biopsy in cases where a residual radiographic abnormality is thought to represent fibrosis or scarring.
For equivocal findings of progression (e.g. very small and uncertain new lesions; cystic changes or necrosis in existing lesions), treatment in some cases continues until the next scheduled assessment. If at the next scheduled assessment, progression is confirmed, the date of progression generally is the earlier date when progression was suspected.
Duration of Response
The duration of overall response is generally measured from the time measurement criteria are first met for CR/PR (whichever is first recorded) until the first date that recurrent or progressive disease is recorded on study).
The duration of overall complete response is generally measured from the time measurement criteria are first met for CR until the first date that recurrent disease is objectively documented.
Stable disease is generally measured from the start of the treatment (in randomized trials, from date of randomization) until the criteria for progression are met, taking as reference the smallest sum on study (if the baseline sum is the smallest, this is the reference for calculation of PD).
This application claims the benefit of US Provisional Application Nos.: 62/635,459 filed Feb. 26, 2018; 62/650,192, filed Mar. 29, 2018; and 62/743,993, filed Oct. 10, 2018, each of which is hereby incorporated by reference in its entirety.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2019/019643 | 2/26/2019 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62635459 | Feb 2018 | US | |
| 62650192 | Mar 2018 | US | |
| 62743993 | Oct 2018 | US |
