AU2001281134A1 - Methods of treating cancer and the pain associated therewith using endothelin antagonists - Google Patents

Description

Methods of Treating Cancer And The Pain Associated Therewith

Using Endothelin Antagonists

Field of the Invention

The instant invention is directed to methods for the

inhibition of bone metastases, methods for the prevention of

growth of new metastases, methods for the inhibition of bone

turnover, and methods for the prevention of bone loss in

patients, including cancer patients, using an endothelin ET-A

receptor antagonist.

Background of the Invention

Endothelin (ET) , a 21 amino acid peptide, is produced by

enzymatic cleavage of a precursor peptide by an endothelin

converting enzyme. First discovered in vascular endothelial

cells, ET and ET/ET receptor binding are now known to modulate

smooth muscle tone, blood flow, cell proliferation and

dif erentation, protein synthesis, and metabolic function in a

variety of tissues and cell types such as ovary, prostate,

skin, and brain. ET/ET receptor binding has been shown to constrict

arteries and veins; increase mean arterial blood pressure;

decrease incardiac output; increase cardiac contractility in

vitro; stimulate mitogenesis in vascular smooth muscle cells

in vitro; contract non-vascular smooth muscle such as guinea

pig trachea, human urinary bladder strips and rat uterus in

vitro; increase airway resistance in vivo; induce formation of

gastric ulcers; stimulate release of atrial natriuretic factor

in vitro and in vivo; increase plasma levels of vasopressin,

aldosterone, and catecholamines; inhibit release of renin in

vitro; and stimulate release of gonadotropins in vitro .

ET/ET receptor binding also causes vasoconstriction on

vascular smooth muscle (Nature 332 411 (1988) , FEBS Letters

231 440 (1988) and Biochem. Biophys. Res. Commun. 154 868

(1988)) . In fact, an anti-ET antibody has been shown to

ameliorate adverse effects of renal ischemia on renal vascular

resistance and glomerular filtration rate (J. Clin. Invest. j33_

1762 (1989) ) . In addition, an anti-ET antibody attenuated

both the nephrotoxic effects of intravenously administered

cyclosporin (Kidney Int. 3_7 1487 (1990)) and the infarct size

in a coronary artery ligation-induced myocardial infarction

model (Nature 344 114 (1990)). A nonpeptide ET antagonist prevents post-ischaemic renal

vasoconstriction in rats, prevents the decrease in cerebral

blood flow due to subarachnoid hemorrhage in rats, and

decreases MAP in sodium-depleted squirrel monkeys when dosed

orally (Nature 365 : 759-761 (1993) ) . A similar effect of an

ET antagonist on arterial calibera has also been recently

reported (Biochem. Biophys. Res. Comm. , 195: 969-75 (1993).

An ET receptor antagonist reduced injury in a rat model

of colitis (EUR. J. Pharmacol. 1996, 309, 261-269) and

prevented ischemia-reperfusion injury in kidney

transplantation (Transplant Int 1996, _9, 201-207) . The use of

ET antagonists in the treatment of angina, pulmonary

hypertension, Raynaud's disease, and migraine has also been

suggested (Drugs 1996, 51,12-27). In malignant growth

disorders, ET and its growth-promoting effects have been best

characterized_ in prostate cancer, (Nature Medicine 1995, 1,

944-949) wherein ET acts as a modulator in osteoblastic bone

lesion (UROLOGY 53:1063-1069, 1999).

Given the results from these and other reports which

illuminate the role of ET/ET receptor binding in disease

states, and the knowledge that blocking ET/ET receptor binding

results in improvement or reversal of endothelin-induced disease states, agents which antagonize ET/ET receptor binding

activity, designated as ET receptor antagonists, can provide

substantial benefit in many therapeutic areas.

Summary of the Invention

In one embodiment of the instant invention, therefore, is disclosed a method for inhibiting bone metastases in a patient

which comprises administering to the patient in need thereof a therapeutically effective amount of an endothelin ET-A receptor antagonist.

In another embodiment of the invention is disclosed a method for preventing new bone metastases in a patient which comprises administering to the patient in need thereof a therapeutically effective amount of an endothelin ET-A receptor antagonist.

In another embodiment of the instant invention, therefore, is disclosed a method for inhibiting metastatic

growth in a patient which comprises administering to the

patient in need thereof a therapeutically effective amount of

an endothelin ET-A receptor antagonist .

In another embodiment of the invention is disclosed a

method for inhibiting bone loss in a patient which comprises administering to the patient in need thereof a therapeutically

effective amount of an endothelin ET-A receptor antagonist .

In another embodiment of the instant invention, is

disclosed a method for inhibiting bone turnover in a patient

which comprises administering to the patient in need thereof a

therapeutically effective amount of an endothelin ET-A

receptor antagonist .

In another embodiment of the invention is disclosed a

method for the reduction of cancer related pain in a patient

in need thereof which comprises administering to the patient a

therapeutically effective amount of an endothelin ET-A

receptor antagonist .

In another embodiment of the instant invention is

disclosed therapeutically acceptable formulations of an

endothelin ET-A receptor antagonist, optionally in the

presence of a co-therapeutic agent, for use in these methods.

Brief Description of the Drawings

Figure 1 illustrates levels of interleukin-6 (IL-6) in a

subject population treated with a placebo or 2.5 mg or 10 mg

ABT-627. Figure 2 illustrates levels of prostate specific antigen

(PSA) in a subject population treated with a placebo or 2.5 mg

or 10 mg of ABT-627.

Figure 3 illustrates VAS score levels relating to pain

assessment in a subject population treated with a placebo or

2.5 mg or 10 mg of ABT-627.

Figure 4 illustrates crosslinked N-telopeptides

(degradation) in a subject population treated with a placebo

or 10 mg ABT-627.

Figure 5 illustrates bone alkaline phosphatase

(BAP) (formation) in a subject population treated with a

placebo or 10 mg ABT-627.

Figure 6 illustrates skeletal involvement in a subject

population treated with -a placebo or 10 mg ABT-627.

Figure 7 illustrates acid phosphatase levels in a subject

population treated with a placebo or 10 mg ABT-627. Detailed Description of the Invention

Endothelin receptor antagonists are employed in the

practice of the instant invention. Endothelins are a family

of peptides mainly synthesized and released by endothelial

cells. The term "endothelin" refers to a family of homologous

21-amino acid peptides found in 3 distinct isoforms: ET-1, ET-

2, and ET-3.

The term "endothelin ET-A receptor antagonist" includes

both compounds which antagonize the ET-A receptor in a

selective manner, as well as compounds which antagonize the

ET-A receptor in a non-selective manner. An example of the

latter type of compound would be a compound that antagonizes

the ET-A receptor and also antagonizes the ET-B receptor.

The term "primary cancer" means cancer in a specific

tissue, which is first in time or in order of development.

Primary cancers include, but are not limited to, breast,

prostate, lung, kidney, thyroid, brain, heart, intestine,

ovary, myeloma, lymphoma, sarcoma, and osteosarcoma.

The term "cancer-related pain" includes pain which arises

from direct invasion or expansion of a tumor into tissue, such

as bone or nerve; pain which arises from the consequences of

tumor invasion or expansion, such as bone collapse due to cancer erosion or secretion of noxious agents which modulate

or produce pain; and pain mediated by ischemia, i.e. reduced

blood flow.

Specifically, a compound of formula I may be employed in

the practice of the instant invention

a

wherein

R is - (CH₂)_m-W;

Z is selected from -C(Rιs) (R19) - and -C(O)-;

Rl and R2 are independently selected from hydrogen,

loweralkyl, alkenyl, alkynyl, alkoxyalkyl,

alkoxycarbonylalkyl, hydroxyalkyl, haloalkyl, haloalkoxyalkyl,

alkoxyalkoxyalkyl , thioalkoxyalkoxyalkyl , cycloalkyl,

cycloalkylalkyl, aminocarbonylalkyl , alkylaminocarbonylalkyl,

dialkylaminocarbonylalkyl , aminocarbonylalkenyl ,

alkylaminocarbonylalkenyl , dialkylaminocarbonylalkenyl ,

hydroxyalkenyl , aryl, arylalkyl, aryloxyalkyl , arylalkoxyalkyl , (N-alkanoyl-N-alkyl) aminoalkyl,

alkylsulfonylamidoalkyl, heterocyclic, (heterocyclic) alkyl,

and (R_aa) (R_bb)N-R_cc-,

with the proviso that one or both of R-_j_ and R2 is other

than hydrogen;

R3 is selected from R_ι-C(0)-R5-, R4-Rs_a-, R4~C(0)-R5-

^' N⁽Rg)-, R₆-S(0)₂-R7- R26-S(0)-R₂7~, R22"0-C (O) -R₂3 - ,

loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

aryl, arylalkyl, aryloxyalkyl , heterocyclic,

(heterocyclic) alkyl, alkoxyalkyl, alkoxyalkoxyalkyl, and R13-

C(0)-CH(Ri4) -;

R4 and Rς are independently selected from (Rn) (Ri2)N-,

loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

aryl, arylalkyl, heterocyclic, (heterocyclic) alkyl,

alkoxyalkyl, hydroxyalkyl, haloalkyl, haloalkenyl,

haloalkoxyalkyl, haloalkoxy, alkoxyhaloalkyl, alkylaminoalkyl,

dialkylaminoalkyl, alkoxy, and

R5 is selected from a covalent bond, alkylene, alkenylene, -N(R2θ)^-R8-/ ^-R8a^~N ^^R20^ ^_R8^~ ' ^_0-R9^~/ ^and

-R_9a-0-R₉-;

R6 is selected from loweralkyl, haloalkyl, alkoxyalkyl,

haloalkoxyalkyl, aryl or arylalkyl;

R7 is a covalent bond, alkylene, alkenylene - (R21) -^R10- /

and -R_10a-N(R2l) -^R10~;

R8 is selected from alkylene and alkenylene;

R9 is alkylene;

RlO is selected from alkylene and alkenylene;

R11 and R12 are independently selected from hydrogen,

loweralkyl, haloalkyl, alkoxyalkyl, haloalkoxyalkylalkenyl,

alkynyl, cycloalkyl, cycloalkylalkyl, aryl, heterocyclic,

arylalkyl, (heterocyclic) alkyl, hydroxyalkyl, alkoxy,

aminoalkyl, trialkylaminoalkyl, alkylaminoalkyl,

dialkylaminoalkyl, and carboxyalkyl ;

Rl3 is selected from amino, alkylamino and dialkylamino;

Rl4 is selected from aryl and R]_5-C(0)-;

Rl5 is selected from amino, alkylamino and dialkylamino;

Rl6 is selected from loweralkyl, haloalkyl, aryl and

dialkylamino;

Rl7 is loweralkyl; Rl8 and R 9 are independently selected from hydrogen and

loweralkyl ;

R20 is selected from hydrogen, loweralkyl, alkenyl,

haloalkyl, alkoxyalkyl, haloalkoxyalkyl, cylcoalkyl and

cycloalkylalkyl;

R21 is selected from hydrogen, loweralkyl, alkenyl,

haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl and arylalkyl;

R22 s selected from a carboxy protecting group and

heterocyclic ;

R23 is selected from covalent bond, alkylene, alkenylene

and -N⁽R₂4⁾ -^R25^~;

R₂4 is selected from hydrogen and loweralkyl;

R25 is alkylene;

R₂6 i selected from loweralkyl, haloalkyl, alkenyl,

alkynyl, cycloalkyl, cycloalkylalkyl, aryl, arylalkyl,

heterocyclic, (heterocyclic) alkyl, alkoxyalkyl and alkoxy-

substituted haloalkyl;

R27 i selected from alkylene and alkenylene;

R5a is selected from alkylene and alkenylene;

R7_a is alkylene;

R_8a is selected from alkylene and alkenylene; Rg_a is alkylene;

R-_j__Qa is selected from alkylene and alkenylene;

R_aa is selected from aryl and arylalkyl;

kk is selected from hydrogen and alkanoyl;

R_cc is alkylene;

m is 0-6;

n is 0 or 1;

z is 0-5;

E is selected from hydrogen, loweralkyl and arylalkyl;

G is selected from hydrogen and a carboxy protecting

group; and

is selected from -C(0)2-G; -PO3H2, -P(O) (OH) (E) ,

-CN, -C(0)NHRi7, alkylaminocarbonyl, dialkylaminocarbonyl,

tetrazolyl, hydroxy, alkoxy, sulfonamido, -C (O) NHS (O) 2 16 _/ -

S(0)₂NHC(0)Ri6,

or a pharmaceutically acceptable salt thereof.

A preferred embodiment of the a compound of formula I is

a compound of formula II

II

wherein the substituents -R2 ^-R and -Ri exist in a

trans , trans relationship and Z, n, R, R]_, R2 , and R3 are as

defined above.

Compounds of formulas I and II are endothelin

antagonists, specifically ET_A-selective endothelin antagonists.

Another preferred- embodiment of the invention is a

compound of formula I or II wherein n is 0 and Z is

-CH2-.

Another preferred embodiment of the invention is a

compound of formula I or II wherein n is 1 and Z is

-CH2-.

Another preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, Z is -CH2-, and R3 is R₄-C(0)-R₅- , R₆-S(0)₂-^R7- or R₂6~S (0) -R₂7" wherein R₄ , R₅ ,

Rg , Ry, R2g and R27 are as defined above.

Another preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, Z is -CH2-, and R3

is alkoxyalkyl or alkoxyalkoxyalkyl .

A more preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, Z is -CH2-, and R3

is R4-C(0)-R5- wherein R4 is (Rn) (Ri2)N- as defined above and

R5 is alkylene or R3 is R6-S(0)2~R7- or R26-S (O) -R27- wherein

R7 is alkylene, R27 is alkylene and Rβ and R26 ^are defined as

above .

Another more preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, Z is

-CH2- and R3 is R4-C (O) -N (R20) " 8" or

Rς-S (O) 2~N(R2i) -Rio- wherein Rs and Rio are alkylene and R4 ,

^R6/ ^R20 and R21 are defined as above.

An even more preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, R is tetrazolyl or

-C(0)2~G wherein G is hydrogen or a carboxy protecting group

or R is tetrazolyl or R is

-C(O) -NHS (0) 2^R16 wherein R₁₆ is loweralkyl, haloalkyl or aryl, Z is -CH2-; Ri and R2 are independently selected from (i)

loweralkyl, (ii) cycloalkyl, (iii) substituted aryl wherein

aryl is phenyl substituted with one, two or three substituents

independently selected from loweralkyl, alkoxy, halo,

alkoxyalkoxy and carboxyalkoxy, (iv) substituted or

unsubstituted heterocyclic, (v) alkenyl, (vi) heterocyclic

(alkyl) , (vii) arylalkyl, (viii) aryloxyalkyl, (ix) (N-

alkanoyl-N-alkyl) aminoalkyl and (x) alkylsulfonylamidoalkyl,

and R3 is R4-C(0)-Rs- wherein R4 is (Rn) (Ri2)N- wherein R_1:]_

and R₁₂ ^are independently selected from loweralkyl, haloalkyl,

alkoxyalkyl, haloalkoxyalkyl, aryl, arylalkyl, heterocyclic,

hydroxyalkyl, alkoxy, aminoalkyl, and trialkylaminoalkyl, and

R5 is alkylene; or R3 is R4-C (0) -N (R20) -^R8~ or Rg-S(0)2-

N(R2i)-Rio- wherein R4 is loweralkyl, aryl, alkoxy,

alkylamino, aryloxy or arylalkoxy and Rβ is loweralkyl,

haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl or arylalkyl, Rs

and Rio are alkylene and R20 and R21 are loweralkyl; or R3 is

R6-S(0)2-^R7- or R26^_s (°) ^_R27- wherein Rς is loweralkyl or

haloalkyl, R7 is alkylene, R26 is loweralkyl and R27 is

alkylene.

A yet more preferred embodiment of the invention is a compound of formula I or II wherein n is 0, R is -C(0)₂-G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (O) -NHS (O) ₂ ^Ri6 wherein R₁₆ is loweralkyl,

haloalkyl or aryl, Z is -CH₂-_/ Ri is (i) loweralkyl, (ii)

alkenyl, (iii) alkoxyalkyl, (iv) cycloalkyl, (v) phenyl, (vi)

pyridyl, (vii) furanyl, (viii) substituted or unsubstituted 4-

methoxyphenyl , 4 - luorophenyl, 3 -fluorophenyl, 4-ethoxyphenyl,

4-ethylphenyl, 4-methylphenyl, 4-trifluoromethylphenyl, 4-

pentafluoroethylphenyl , 3 -fluoro-4 -methoxyphenyl, 3-fluoro-4-

ethoxyphenyl , 2-fluorophenyl, 4-methoxymethoxyphenyl, 4-

hydroxyphenyl , 4-t-butylphenyl, 1, 3-benzodioxolyl, 1,4-

benzodioxanyl or dihydrobenzofuranyl wherein the substituent

is selected from alkoxy, alkoxyalkoxy and carboxyalkoxy, (ix)

heterocyclic (alkyl) , (x) arylalkyl, (xi) aryloxyalkyl , (xii)

(N-alkanoyl-N-alkyl) aminoalkyl, or (xiii)

alkylsulfonylamidoalkyl, R₂ is substituted or unsubstituted

1, 3-benzodioxolyl, 7-methoxy-1, 3-benzodioxolyl, 1,4-

benzodioxanyl , 8 -methoxy-1 , 4 -benzodioxanyl ,

dihydrobenzofuranyl, benzofurnayl, 4-methoxyphenyl,

dimethoxyphenyl, fluorophenyl or difluorophenyl and R3 is R4-

C⁽0⁾-N⁽R o)- 8- or R6-S (O) 2-N (R21) -Rio- wherein Rs and Rio are alkylene, R20 and

R21 are loweralkyl, R4 is loweralkyl, aryl, alkoxy,

alkylamino, aryloxy or arylalkoxy and Rg is loweralkyl,

haloalkyl, alkoxyalkyl, aryl or arylalkyl.

Another yet more preferred embodiment of the invention is

a compound of formula I or II wherein n is 0, R is -C(0)2^_G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (O) -NHS (O) ₂ ^Rιg wherein R-_j_g is loweralkyl,

haloalkyl or aryl, Z is -CH2-, Ri is (i) loweralkyl, (ii)

alkenyl, (iii) alkoxyalkyl, (iv) cycloalkyl, (v) phenyl, (vi)

pyridyl, (vii) furanyl, (viii) substituted or unsubstituted 4-

methoxyphenyl , 4-fluorophenyl, 3 -fluorophenyl, 4-ethoxyphenyl,

4-ethylphenyl, 4-methylphenyl, 4-trifluoromethylphenyl, 4-

pentafluoroethylphenyl , 3 -fluoro-4-methoxyphenyl, 3-fluoro-4-

ethoxyphenyl , 2-fluorophenyl, 4-methoxymethoxyphenyl, 4-

hydroxyphenyi , 4-t-butylphenyl, 1, 3-benzodioxolyl, 1,4-

benzodioxanyl or dihydrobenzofuranyl wherein the substituent

is selected from alkoxy, alkoxyalkoxy and carboxyalkoxy, (ix)

heterocyclic (alkyl) , (x) arylalkyl, (xi) aryloxyalkyl , (xii)

(N-alkanoyl-N-alkyl) aminoalkyl, or (xiii)

alkylsulfonylamidoalkyl, R₂ is substituted or unsubstituted 1, 3-benzodioxolyl, 7-methoxy-1, 3-benzodioxolyl, 1,4-

benzodioxanyl , 8-methoxy-1 , 4-benzodioxanyl ,

dihydrobenzofuranyl, benzofurnayl , 4 -methoxyphenyl ,

dimethoxyphenyl, fluorophenyl or difluorophenyl and R3 is R4-

C(0)-R5- wherein R5 is alkylene and R4 is (Rn) (Rχ2)N- wherein

R_]_^ and R₁₂ are independently selected from loweralkyl,

haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl, arylalkyl,

heterocyclic, hydroxyalkyl, alkoxy, aminoalkyl, and

trialkylaminoalkyl .

Another yet more preferred embodiment of the invention is

a compound of formula I or II wherein n is 0, R is -C(0)2~G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (O) -NHS (O) ₂R₁₆ wherein R₁₆ is loweralkyl,

haloalkyl or aryl, Z is -CH₂-, Ri is (i) loweralkyl, (ii)

alkenyl, (iii) heterocyclic (alkyl) , (iv) aryloxyalkyl, (v)

arylalkyl, (vi) aryl, (vii) (N-alkanoyl-N-alkyl) aminoalkyl, or

(viii) alkylsulfonylamidoalkyl, R₂ is substituted or

unsubstituted 1, 3-benzodioxolyl, 7-methoxy-1, 3-benzodioxolyl,

1 , 4-benzodioxanyl , 8 -methoxy-1 , 4 -benzodioxanyl ,

dihydrobenzofuranyl, benzofurnayl, 4-methoxyphenyl,

dimethoxyphenyl, fluorophenyl or difluorophenyl wherein the substituent is selected from loweralkyl, alkoxy and halogen

and R3 is R4-C(0)-Rs- wherein R5 is alkylene and R4 is

(Rll) (Ri2) - wherein R-^ is loweralkyl and R₁₂ is aryl,

arylalkyl, hydroxyalkyl, alkoxy, aminoalkyl,

trialkylaminoalkyl, or heterocyclic.

Another yet more preferred embodiment of the invention is

a compound of formula I or II wherein n is 0, R is -C(0)2~G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (O) -NHS (0) ₂R₁₆ wherein R₁₆ is loweralkyl,

haloalkyl or aryl, Z is -CH2-, Ri is (i) loweralkyl, (ii)

alkenyl, (iii) heterocyclic (alkyl) , (iv) aryloxyalkyl, (v)

arylalkyl, (vi) (N-alkanoyl-N-alkyl) aminoalkyl, or (vii)

alkylsulfonylamidoalkyl, (vii) phenyl, or (ix) substituted or

unsubstituted 4-methoxyphenyl, 3 -fluoro-4 -methoxyphenyl, 3-

fluorophenyl, 3-fluoro-4-ethoxyphenyl, 2 -fluorophenyl, 4-

methoxymethoxyphenyl , 1, 3-benzodioxolyl, 1, 4-benzodioxanyl or

dihydrobenzofuranyl wherein the substituent is selected from

loweralkyl, haloalkyl, alkoxy, alkoxyalkoxy and carboxyalkoxy,

R₂ is substituted or unsubstituted 1, 3-benzodioxolyl, 7-

methoxy-1, 3-benzodioxolyl, 1, 4-benzodioxanyl, 8-methoxy-1, 4-

benzodioxanyl, dihydrobenzofuranyl, 4 -methoxyphenyl, dimethoxyphenyl, fluorophenyl or difluorophenyl wherein the

substituent is selected from loweralkyl, alkoxy and halogen

and R3 is Rg-S (O) 2~N(R2i) -^R10^_ wherein Rio is alkylene, Rg is

loweralkyl, haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl or

arylalkyl and R₂ι is loweralkyl, haloalkyl, alkoxyalkyl,

haloalkoxyalkyl , aryl or arylalkyl .

Another yet more preferred embodiment of the invention is

a compound of formula I or II wherein n is 0, R is -C(0)₂-G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (O) -NHS (O) ₂R₁₆ wherein R₁₆ is loweralkyl,

haloalkyl or aryl, Z is -CH2-, Ri is (i) substituted or

unsubstituted 4-methoxyphenyl, 3 -fluoro-4 -methoxyphenyl, 3-

fluorophenyl, 3 -fluoro-4-ethoxyphenyl, 4-methoxymethoxyphenyl,

1, 3-benzodioxolyl or 1, 4-benzodioxanyl wherein the substituent

is selected from loweralkyl, haloalkyl, alkoxy and

alkoxyalkoxy, (ii) loweralkyl, (iii) alkenyl, (iv)

heterocyclic (alkyl) , (v) aryloxyalkyl, (vi) arylalkyl, (vii)

(N-alkanoyl-N-alkyl) aminoalkyl, (viii)

alkylsulfonylamidoalkyl, or (ix) phenyl, R₂ is substituted or

unsubstituted 1, 3-benzodioxolyl, 7-methoxy-1, 3-benzodioxolyl,

1 , 4-benzodioxanyl , 8-methoxy-1, 4-benzodioxanyl, dihydrobenzofuranyl, 4 -methoxyphenyl , dimethoxyphenyl,

fluorophenyl or difluorophenyl wherein the substituent is

selected from loweralkyl, alkoxy and halogen and R3 is

alkoxycarbonyl or Rg-S (O) ₂-N (R₂ι) -Rio- wherein Rio is

alkylene, Rg is loweralkyl, haloalkyl, alkoxyalkyl or

haloalkoxyalkyl and R₂ι is loweralkyl, haloalkyl, alkoxyalkyl

or haloalkoxyalkyl .

Another yet more preferred embodiment of the invention is

a compound of formula I or II wherein n is 0, R is -C(0)₂-G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (0) -NHS (O) ₂R-_]_g wherein R-_j_g is loweralkyl or

haloalkyl, Z is -CH₂-, R is loweralkyl, alkenyl, heterocyclic

(alkyl) , aryloxyalkyl, aryalkyl, aryl, (N-alkanoyl-N-

alkyl) aminoalkyl, , or alkylsulfonylamidoalkyl, and R3 is R4-

C(0)-R5- wherein R5 is alkylene and R4 is (Rn) (Rι )N- wherein

R-_|_l and R₁₂ are independently selected from alkyl, aryl,

hydroxyalkyl, alkoxy, aminoalkyl, trialkylaminoalkyl, and

heterocyclic .

A still more preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, R is

-C(0) -G wherein G is hydrogen or a carboxy protecting group, tetrazolyl or -C (0) -NHS (O) ₂R-_]_ wherein R₁₆ is loweralkyl or

haloalkyl, Z is -CH₂-, Ri is substituted or unsubstituted 4-

methoxyphenyl , 4-fluorophenyl, 2 -fluorophenyl, 4-methylphenyl,

4-trifluoromethylphenyl, 4-pentafluoroethylphenyl, 4-

methoxymethoxyphenyl , 4-hydroxyphenyl, 4-ethylphenyl, 1,3-

benzodioxolyl, 1, 4-benzodioxanyl or dihydrobenzofuranyl

wherein the substituent is selected from alkoxy, alkoxyalkoxy

and carboxyalkoxy, (ii) loweralkyl, (iii) alkenyl, (iv)

heterocyclic (alkyl), (v) aryloxyalkyl, (vi) arylalkyl, (vii)

(N-alkanoyl-N-alkyl) aminoalkyl, (viii)

alkylsulfonylamidoalkyl, or (ix) phenyl, R₂ is 1,3-

benzodioxolyl, 1, 4-benzodioxanyl, dihydrobenzofuranyl,

benzofuranyl, 4-methoxyphenyl, dimethoxyphenyl, fluorophenyl

or difluorophenyl and R3 is R4-C(0)-Rs- wherein R5 is alkylene

and R4 is (^Rn) (Rι₂)N- wherein and R-_j_₂ are independently

selected from loweralkyl, aryl, arylalkyl, hydroxyalkyl,

alkoxy, aminoalkyl, trialkylaminoalkyl, or heterocyclic.

Another still more preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, R is -C(0) -G

wherein G is hydrogen or a carboxy protecting group,

tetrazolyl or -C (0) -NHS (0) ₂R₁₆ wherein R-_j_g is loweralkyl or haloalkyl, Z is -CH -, Ri is loweralkyl, alkenyl, heterocyclic

(alkyl) , aryloxyalkyl, arylalkyl, (N-alkanoyl-N-

alkyl) aminoalkyl, alkylsulfonylamidoalkyl, phenyl, or

alkoxyalkyl, R₂ is 1, 3-benzodioxolyl, 1, -benzodioxanyl,

dihydrobenzofuranyl, benzofuranyl, 4-methoxyphenyl,

dimethoxyphenyl, fluorophenyl or difluorophenyl and R3 is R4-

C(0)-R5- wherein R5 is alkylene and R4 is (Rn) (Rι₂)N- wherein

^Rll ^an<^ ^R12 ^are independently selected from loweralkyl, aryl,

arylalkyl, hydroxyalkyl, alkoxy, aminoalkyl,

trialkylaminoalkyl, or heterocyclic.

A most highly preferred embodiment of the invention is a

compound of formula I or II wherein n is 0, R is -C(0)2~G

wherein G is hydrogen or a carboxy protecting group, Z is -

CH2-, ^Ri is substituted or unsubstituted 4-methoxyphenyl, 4-

fluorophenyl, 2 -fluorophenyl, 4-methylphenyl, 4-

trifluoromethylphenyl , 4-pentafluoroethylphenyl, 4-

methoxymethoxyphenyl , 4-hydroxyphenyl, 4-ethylphenyl, 1,3-

benzodioxolyl, 1, 4 -benzodioxanyl or dihydrobenzofuranyl

wherein the substituent is selected from alkoxy, alkoxyalkoxy

and carboxyalkoxy, R₂ is 1, 3-benzodioxolyl, 1, 4 -benzodioxanyl,

dihydrobenzofuranyl, benzofuranyl, 4-methoxyphenyl, dimethoxyphenyl, fluorophenyl or difluorophenyl and R3 is R4-

C(0)-R5- wherein R5 is alkylene and R4 is (Rn) (Ri2)N- wherein

^Rll ^an<^ ^R12 ^are independently selected from loweralkyl .

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, R is -C(0)2~G

wherein G is hydrogen or a carboxy protecting group, Z is -

CH2-, Ri is substituted or unsubstituted 4 -methoxyphenyl, 4-

fluorophenyl, 2-fluorophenyl, 4-methylphenyl, 4-

trifluoromethylphenyl, 4-pentafluoroethylphenyl, 4-

methoxymethoxyphenyl , 4-hydroxyphenyl, 4-ethylphenyl, 1,3-

benzodioxolyl, 1, 4 -benzodioxanyl or dihydrobenzofuranyl

wherein the substituent is selected from alkoxy, alkoxyalkoxy

and carboxyalkoxy, R₂ is 1, 3-benzodioxolyl, 1, 4 -benzodioxanyl,

dihydrobenzofuranyl, benzofuranyl, 4 -methoxyphenyl,

dimethoxyphenyl, fluorophenyl or difluorophenyl and R3 is R4-

C(0)-R5~ wherein R5 is alkylene and R4 is (R11) (Ri2)N- wherein

R-_|__. is loweralkyl and R₁₂ is aryl .

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, R is -C(0)₂-G

wherein G is hydrogen or a carboxy protecting group,- Z is -

CH₂-, Rl is substituted or unsubstituted 4-methoxyphenyl, 3- fluoro-4-methoxyphenyl, 3 -fluorophenyl, 2 -fluorophenyl, 3-

fluoro-4-ethoxyphenyl, 4-methoxymethoxyphenyl, 1,3-

benzodioxolyl, 1, 4 -benzodioxanyl or dihydrobenzofuranyl

wherein the substituent is selected from loweralkyl,

haloalkyl, alkoxy, alkoxyalkoxy and carboxyalkoxy, R₂ is

substituted or unsubstituted 1, 3-benzodioxolyl, 7-methoxy-1, 3-

benzodioxolyl, 1, 4-benzodioxanyl, 8-methoxy-1, 4-benzodioxanyl,

dihydrobenzofuranyl, 4-methoxyphenyl, dimethoxyphenyl,

fluorophenyl or difluorophenyl wherein the substituent is

selected from loweralkyl, alkoxy and halogen and R3 is Rg-

S (0) ₂- (R ι) -Rio- wherein io is alkylene, Rg is loweralkyl,

haloalkyl, alkoxyalkyl or haloalkoxyalkyl and R₂ι is

loweralkyl, haloalkyl or alkoxyalkyl.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, R is -C(0)₂-G

wherein G is hydrogen or a carboxy protecting group, Z is -

CH2-, ^Ri is substituted or unsubstituted 4 -methoxyphenyl, 3-

fluoro-4 -methoxyphenyl, 3 -fluorophenyl, 2 -fluorophenyl, 3-

fluoro-4 -ethoxyphenyl , 4 -methoxymethoxyphenyl , 1,3-"

benzodioxolyl, 1, -benzodioxanyl or dihydrobenzofuranyl

wherein the substituent is selected from loweralkyl, haloalkyl, alkoxy, alkoxyalkoxy and carboxyalkoxy, R₂ is

substituted or unsubstituted 1, 3-benzodioxolyl, 7-methoxy-1, 3-

benzodioxolyl, 1, 4-benzodioxanyl, 8-methoxy-1, 4-benzodioxanyl,

dihydrobenzofuranyl, 4 -methoxyphenyl , dimethoxyphenyl,

fluorophenyl or difluorophenyl wherein the substituent is

selected from loweralkyl, alkoxy and halogen and R3 is R4-

C(0)-R5~ wherein R5 is alkylene and R4 is (Rn) (Rι₂)N- wherein

R_l;L is alkyl and R₁₂ is selected from aryl, aminoalkyl,

trialkylaminoalkyl, and heterocyclic.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, R is -C(0)2~G

wherein G is hydrogen or a carboxy protecting group, Z is -

CH₂-, ^Ri is loweralkyl, alkenyl, heterocyclic (alkyl),

aryloxyalkyl, aryalkyl, aryl, (N-alkanoyl-N-alkyl) aminoalkyl,

or alkylsulfonylamidoalkyl, and R3 is R4-C(0)-Rs- wherein R5

is alkylene and R4 is (Rn) (Rι₂)N- wherein R-^ and R₁₂ are

independently selected from alkyl, aryl, hydroxyalkyl, alkoxy,

aminoalkyl, trialkylaminoalkyl, and heterocyclic, with the

proviso that one or -^ and R₁₂ is alkyl.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH2-, and R3 is R4-C(0)-Rs- wherein R4 is (Rn) (Rι₂)N- as defined

therein and R5 is alkylene.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH2-,

Ri is loweralkyl, and R3 is R4-C(0)-Rs- wherein R4 is

(Rll) (Ri₂)N- as defined therein and R5 is alkylene.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH₂-,

Rl is alkenyl, and R3 is R4-C(0)-Rs- wherein R4 is

(R11) (Ri₂)N- as defined therein and R5 is alkylene.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH2-,

R is heterocyclic (alkyl) , and R3 is

R4-C(0)-R5- wherein R4 is (Rn) (Rι₂)N- as defined therein and

R5 is alkylene.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH₂-,

Rl is aryloxyalkyl, and R3 is R4-C(0)-Rs- wherein R4 is

(Rll) (Rι₂)N- as defined therein and R5 is alkylene.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH -, R_l is arylalkyl, and R₃ is R₄-C(0)-Rs- wherein R₄ is

(R_ll) (Rι₂)N- as defined therein and R₅ is alkylene.

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH₂-,

Ri is aryl, and R₃ is R₄-C(0)-Rs- wherein R₄ is (Rn) (Rι₂)N-

as defined therein and R₅ is alkylene.

Another most highly preferred embodiment of the invention is a compound of formula I or II wherein n is 0, Z is -CH -,

R_l is (N-alkanoyl-N-alkyl) aminoalkyl, and R₃ is R₄-C(0)-Rs-

wherein R₄ is (Rn) (Rι₂)N- as defined therein and R₅ is

alkylene ..

Another most highly preferred embodiment of the invention

is a compound of formula I or II wherein n is 0, Z is -CH₂-,

R_l is alkylsulfonylamidoalkyl, and R₃ is R₄-C(0)-Rs- wherein

R₄ is (Rn) (Ri₂)N- as defined therein and R₅ is alkylene.

A particularly preferred compound of formula I is a

compound of formula III, also known as ABT-627:

I I I

Compounds of formula I, II, and III may be synthesized by

methods provided in commonly owned U.S. patent application

Serial No. 09/048,955, filed March 27, 1998, U.S. patent

application Serial No. 08/794,506, filed February 4, 1997,

U.S. patent application Serial No. 08/600,625, filed February

13, 1996, U.S. patent application Serial No. 08/497,998, filed

August 2, 1995, U.S. patent application Serial No. 08/442,575,

filed May 30, 1995, U.S. patent application Serial No.

08/334,717, filed November 4, 1994, and U.S. patent

application Serial No. 08/293,349, filed August 19, 1994, the

disclosures of which are herein incorporated by reference.

Other suitable endothelin ET-A receptor antagonist may be used, such as those disclosed in U.S. Patent Nos.

6,048,893, 6,017,951, and 5,998,468.

The term "inhibit" is defined to include its generally

accepted meaning which includes preventing, prohibiting,

restraining, and slowing, stopping or reversing progression,

or severity, and holding in check and/or treating existing

characteristics. The present method includes both medical

therapeutic and/or prophylactic treatment, as appropriate.

The methods of the present invention are useful in men as

well as in women. Preferably, however, the methods of the

present invention are useful in men, more preferably men with

prostate cancer.

The ability of the compounds of formula I, II, and III to

treat cancers can be demonstrated according to the method

described in J. Clin. Invest. 87 1867 (1991) . Types of cancer

includes primary cancer such as breast, prostate, lung,

kidney, thyroid, myeloma, lymphoma, sarcoma, osteosarcoma, and

ovarian.

The ability of the compounds of the invention to treat

nociception can be demonstrated according to the method

described in J. Pharmacol. Exp. Therap . 271 156 (1994).

The compounds of the present invention can be used in the form of salts derived from inorganic or organic acids. These

salts include but are not limited to the following: acetate,

adipate, alginate, citrate, aspartate, benzoate,

benzenesulfonate, bisulfate, butyrate, camphorate,

camphorsulfonate, digluconate, cyclopentanepropionate,

dodecylsulfate, ethanesulfonate, glucoheptanoate ,

glycerophosphate, hemisulfate, heptanoate, hexanoate,

fumarate, hydrochloride, hydrobromide, hydroiodide, 2-hydroxy-

ethanesulfonate, lactate, maleate, methanesulfonate,

nicotinate, 2-naphthalenesulfonate, oxalate, pamoate,

pectinate, persulfate, 3-phenylpropionate, picrate, pivalate,

propionate, succinate, tartrate, thiocyanate, p-

toluenesulfonate and undecanoate . Also, the basic nitrogen-

containing groups can be quaternized with such agents as

loweralkyl halides, such as methyl, ethyl, propyl, and butyl

chloride, bromides, and iodides; dialkyl sulfates like

dimethyl, diethyl, dibutyl, and diamyl sulfates, long chain

halides such as decyl, lauryl, myristyl and stearyl chlorides,

bromides and iodides, aralkyl halides like benzyl and

phenethyl bromides, and others. Water or oil-soluble or

dispersible products are thereby obtained.

Examples of acids which may be employed to form pharmaceutically acceptable acid addition salts include such

inorganic acids as hydrochloric acid, sulphuric acid and

phosphoric acid and such organic acids as oxalic acid, maleic

acid, succinic acid and citric acid.

Basic addition salts can be prepared in si tu during the

final isolation and purification of the compounds of formula

I, or separately by reacting the carboxylic acid function with

a suitable base such as the hydroxide, carbonate or

bicarbonate of a pharmaceutically acceptable metal cation or

with ammonia, or an organic primary, secondary or tertiary

amine. Such pharmaceutically acceptable salts include, but

are not limited to, cations based on the alkali and alkaline

earth metals, such as sodium, lithium, potassium, calcium,

magnesium, aluminum salts and the like, as well as nontoxic

ammonium, quaternary ammonium, and amine cations, including,

but not limited to ammonium, tetramethylammonium,

tetraethylammonium, methylamine, dimethylamine,

trimethylamine, triethylamine, ethylamine, and the like.

Other representative organic amines useful for the formation

of base addition salts include diethylamine, ethylenediamine,

ethanolamine, diethanolamine, piperazine and the like.

The compounds of formulas I, II and III are useful for antagonizing endothelin in humans or other mammals . Total

daily dose administered to a host in single or divided doses

may be in amounts, for example, from 0.001 to 1000 mg/kg body

weight daily and more usually 0.1 to 100 mg/kg for oral

administeration or 0.01 to 10 mg/kg for parenteral

administeration. Dosage unit compositions may contain such

amounts of submultiples thereof to make up the daily dose.

Pharmaceutical formulations may be prepared by procedures

known in the art. The amount of active ingredient that may be

combined with the carrier materials to produce a single dosage

form will vary depending upon the host treated and the

particular mode of administeration.

It will be understood, however, that the specific dose

level for any particular patient will depend upon a variety of

factors including the activity of the specific compound

employed, the age, body weight, general health, sex, diet,

time of administeration, route of administeration, rate of

excretion, drug combination, and the severity of the

particular disease undergoing therapy.

The compounds of the present invention may be

administered orally, buccally, parenterally, sublingually, by

inhalation spray, rectally, or topically in dosage unit formulations containing conventional nontoxic pharmaceutically

acceptable carriers, adjuvants, and vehicles as desired.

Topical administeration may also involve the use of

transdermal administeration such as transdermal patches or

iontophoresis devices. The term parenteral as used herein

includes subcutaneous injections, intravenous, intramuscular,

intrasternal injection, transcutaneous, intradermal, or

infusion techniques.

Injectable preparations, for example, sterile injectable

aqueous or oleagenous suspensions may be formulated according

to the known art using suitable dispersing or wetting agents

and suspending agents. The sterile injectable preparation may

also be a sterile injectable solution or suspension in a

nontoxic parenterally acceptable diluent or solvent, for

example, as a solution in 1, 3-propanediol . Among the

acceptable vehicles and solvents that may be employed are

water, Ringer's solution, and isotonic sodium chloride

solution. In addition, sterile, fixed oils are conventionally

employed as a solvent or suspending medium. For this purpose

any bland fixed oil may be employed including synthetic mono-

or diglycerides . In addition, fatty acids such as oleic acid

find use in the preparation of injectables. Suppositories for rectal administeration of the drug can

be prepared by mixing the drug with a suitable nonirritating

excipient such as cocoa butter and polyethylene glycols which

are solid at ordinary temperatures but liquid at the rectal

temperature and will therefore melt in the rectum and release

the drug .

Solid dosage forms for oral administeration may include

capsules, tablets, pills, powders, and granules. In such

solid dosage forms, the active compound may be admixed with at

least one inert diluent such as sucrose lactose or starch.

Such dosage forms may also comprise, as is normal practice,

additional substances other than inert diluents, e.g.,

lubricating agents such as magnesium stearate. In the case of

capsules, tablets, and pills, the dosage forms may also

comprise buffering agents. Tablets and pills can additionally

be prepared with enteric coatings.

Liquid dosage forms for oral administeration may include

pharmaceutically acceptable emulsions, solutions, suspensions,

syrups, and elixirs containing inert diluents commonly used in

the art, such as water. Such compositions may also comprise

adjuvants, such as wetting agents, emulsifying and suspending

agents, and sweetening, flavoring, and perfuming agents. The compounds of the present invention can also be

administered in the form of liposomes. As is known in the

art, liposomes are generally derived from phospholipids or

other lipid substances. Liposomes are formed by mono- or

multi-lamellar hydrated liquid crystals that are dispersed in

an aqueous medium. Any non-toxic, physiologically acceptable

and metabolizable lipid capable of forming liposomes can be

used. The present compositions in liposome form can contain,

in addition to a compound of the present invention,

stabilizers, preservatives, excipients, and the like. The

preferred lipids are the phospholipids and phosphatidyl

cholines (lecithins), both natural and synthetic.

Methods to form liposomes are known in the art. See, for

example, Prescott, Ed., Methods in Cell Biology, Volume XIV,

Academic Press, New York, N.Y. (1976) , p. 33 et seq.

A representative solid dosage form, for example, a tablet

or a capsule, comprises:

Compound of the invention: 35% w/w

Starch, Pregelatinized, NF 50% w/w

Microcrystalline Cellulose, NF 10% w/w

Talc, Powder, USP 5% w/w

While the compounds of the invention can be administered as the sole active therapeutic agent, they can also be used in

combination with one or more co-therapeutic agents, such as

anticancer drugs or methods including, but not limited to,

hormonal agents, such as leuprolide (Lupron ) ; gonadorelin

antagonists, such as goserelin (Zoladeχ^β) and abarelix;

bicalutamide; nilutamide; flutamide; vitamin D; vitamin D

analogues; estrogen and estrogen analogues, such as

diethylstibestrol; prednisone; hydrocortisone; ketoconazole;

cyproterone acetate; progesterone; 5-alpha reductase

inhibitors, such as finasteride; bone-seeking radionuclides,

such as samarium (Quadramet ) , strontium (Metastron^®) , and

¹⁸⁶rhenium; external beam radiation, including three

dimensional conformal radiation; brachytherapy, which is the

implantation of radioactive seeds directly into the prostate;

monoclonal antibodies such as trastuzumab (Herceptin ) ; anti-

angiogenic agents such as thrombospondin peptide or kringle 5;

matrix metalloproteinase inhibitors; farnesyl transferase

inhibitors; lycopenes; urokinase; plasminogen activator

inhibitors; plasminogen activator receptor blockers; apoptosis

inducers; selective and non-selective alpha blockers; platinum

agents, such as cis-platinum and carbo-platinum; taxane class

agents, such as docitaxil and paclitaxil; estramustine; gemcytabine; adriamycin; doxorubicin; daunorubicin;

mitoxantrone; vinblastine; vincristine; capecitabine;

irinotecan; topotecan;

5-fluorouracil; interferons; cytoxan; methotrexate;

cytokines, such as IL-2; PPAR agonists, such as thiazolidine

diones; retinoid-type agents, 5-lipooxygenase inhibitors, such

as zyfo (Zilueton^*) , COX-2 inhibitors; gene-therapy based

therapeutics, including sense and anti-sense genes;

cholesterol lowering drugs, such as lovastatin, pravastatin,

and simvistatin; bisphosphonates; osteoprotegrin; and

antibodies, both monoclonal and polyclonal; antibody-coupled

radionucleotides; antibody-coupled cytotoxic agents; antibody-

coupled radionucleotides ; viral-vector delivered agents;

vaccines directed at protein, carbohydrate, or nucleic acid

targets; aminoglutethimide; and suramin.

These combinations can be administered as separate

compositions or as a single dosage form containing both or all

agents. When administered as a combination, the therapeutic

agents can be formulated as separate compositions, which are

given at the same time or different times, or the therapeutic

agents can be given as a single composition.

In addition, the compounds invention can be used in combination with one or more co-therapeutic agents which

impede net bone loss, such as estrogens, bisphosphonates, and

estrogen receptor modulators, such as raloxifene, and

calcitonin.

The compounds of the invention can additionally be

administered in combination with surgery, such as radical

prostatectomy, cryotherapy, transurethral resection of the

prostate as an adjuvant, and the like, or prior to surgery as

a neoadjuvant agent.

The current major diseases or conditions of bone which

are of public concern include, but are not limited to, post-

menopausal osteoporosis, ovariectomy patients, senile

osteoporosis, patients undergoing long-term treatment of

corticosteroids, side effects from glucocorticoid or steroid

treatment, patients suffering from Cushings ' s syndrome,

gonadal dysgenesis, periarticular erosions in rheumatoid

arthritis, osteoarthritis, Paget ' s disease, osteohalisteresis,

osteomalacia, hypercalcemia of malignancy, osteopenia due to

bone metastases, periodontal disease, hyperparathyroidism,

osteroperosis from Lupron therapy, and starvation. All of

these conditions are characterized by bone loss, resulting

from an imbalance between the degradation of bone (bone resorption) and the formation of new healthy bone. This

turnover of bone continues normally throughout life and is the

mechanism by which bone regenerates. However, the conditions

stated above will tip the balance towards bone loss such that

the amount of bone resorbed is inadequately replaced with new

bone, resulting in net bone loss.

Examples

Studies were performed on male subjects with asymptomatic

hormone refractory prostate cancer with rising PSA levels and

on male subjects with symptomatic hormone refractory prostate

cancer with rising PSA levels and pain. Subjects in the phase

II studies had castrate levels of testosterone, either due to

pharmacologic intervention, via leuprolide (Lupron) or

goserelin (Zoladex ) , or via surgical castration. Subjects

received ABT-627 or placebo. The following tests were

conducted:

ABT-627 was formulated in 2.5 and 10 mg doses. An oral

liquid formulation of ABT-627 was also prepared as follows: 1

mg/ml ABT-627, 50% glycerin, 14% alcohol, and water. Matching

placebos were also provided.

A number of recognized or putative biochemical markers of disease progression have been used to monitor treatment of

individuals with prostate cancer. Among these markers are

serum Prostate Specific Antigen (PSA) , serum acid Phosphatase,

Interleukin-6, and Chromagranin-A. As currently accepted,

favorable treatment is marked by a decrease or slower rate of

increase for PSA, acid phosphatase, and Interleukin-6, while a

favorable response is marked by an increase in Chromagranin-A.

Serum samples were obtained from subjects during

treatment with the ET antagonist ABT-627 in order to determine

PSA, acid phosphatase, IL-6, and Chromagranin-A values.

Prostate Specific Antigen Level Assay

The effect of ABT-627 administeration on prostate

specific antigen (PSA) levels in human subject serum samples

was determined using the procedure described in the Chiron

Diagnostics ACS: Centaur PSA2 Assay. This assay is a two-site

sandwich immunoassay which uses direct chemiluminescense and

constant amounts of two antibodies. The first antibody, the

Lite Reagent, is an affinity purified polyclonal sheep anti-

PSA antibody labeled with acridinium ester. The Lite Reagent

is purchased as a 5.0 mL reagent pack comprising the

polyclonal sheep anti-PSA antibody (3.1 μg) in buffered saline with sodium azide (0.1%). The second antibody, the Solid

Phase, is a monoclonal mouse anti-PSA antibody covalently

coupled to paramagnetic particles. The Solid Phase is

purchased as a 25.0 mL reagent pack comprising the covalently

coupled monoclonal mouse anti-PSA antibody (316 μg) in

buffered saline with sodium azide (0.1%) . The assay was

performed at Quintiles Laboratories (Smyrna, GA) using Chiron

Diagnostics ACS: Centaur⁸ Automated Chemiluminescence Systems.

Briefly, a subject population was treated with a placebo

or 2.5 mg or 10 mg of ABT-627. Blood samples were collected,

allowed to adequately clot, centrifuged at 1000 x g for 15-20

minutes, and stored at -20 °C if not assayed within 48 hours.

A cuvette was charged sequentially with serum, Lite Reagent

(50 μL) , and Solid Phase (250 μL) . The resulting mixture was

incubated for 7.5 minutes at 37 °C, separated, and treated

with the solution of Acid Reagent and Base Reagent to initiate

the chemiluminescent reaction. A direct relationship exists

between the amount of PSA present in the patient sample and

the RLU's (relative light units) detected. As shown by the

area under the curve (AUC) in Figure 2, the rate of increase

of PSA in the serum samples decreases after the adminsteration

of ABT-627, demonstrating the effectivness of ABT-627 as an agent for treating prostate cancer.

Acid Phosphatase Levels

The effect of ABT-627 administeration on Acid Phosphatase

levels in human subject serum samples was determined at

Quintiles Laboratories using the chemical test described in

Sigma Diagnostics Acid Phosphatase (ACP) Procedure No. 435.

The enzyme Acid Phosphatase (ACP) catalyzes the hydrolysis of

alpha-naphthyl phosphate to alpha-naphthoi and inorganic

phosphate. The alpha-naphthol immediately reacts with fast

red TR salt to produce a yellow chromophore with an absorbance

maximum at 405 nm. The rate of increase in absorbance at 405

nm is directly proportional to ACP activity in the sample.

ACP activity was determined in the presence and absence of L-

tartrate, the difference being attributed to prostatic acid

phosphatase activity.

Briefly, a subject population was treated with a placebo

or 2.5 mg or 10 mg of ABT-627. Blood samples were collected,

allowed to adequately clot, centrifuged at 1000 x g for 15-20

minutes, and stored at -20 °C if not assayed within 48 hours.

Assays were performed on a Hitachi Spectrophotomer . A cuvette

was charged sequentially with ACP reagent (1 mL) , prepared as described in the assay protocol, and serum (0.1 mL) . The

mixture was agitated and incubated for 5 minutes, and an

absorbance (A) at 405 nm (versus water as a reference) was

read to provide an initial absorbance . The mixture was

incubated for another 5 minutes, and a second absorbance was

read to provide a final absorbance. A change A/5 minute value

was obtained by subtracting the initial absorbance from the

final absorbance and was used to calculate total ACP activity.

To provide the tartrate-resistant acid phosphatase

activity, the above procedure was repeated with the addition

of ACP tartrate reagent (0.01 mL) to the cuvette containing

the ACP reagent and mixing before adding the serum. Prostatic

acid phosphatase activity was calculated by subtracting the

the tartrate-resistant acid phosphatase activity from the ACP

activity. As shown shown by the (AUC) in Figure 7, the rate

of increase and the average change from baseline for acid

phosphatase was decreased in those subjects treated with ABT-

627, again demonstrating the effectivness of ABT-627 as an

agent for treating prostate cancer.

Chromagranin-A Levels The effect of ABT-627 adminstration on Chromagranin-A

levels in human serum samples was determined by proprietary

assay conducted at the Nichols Institute. The procedure is a

two site chemiluminescence assay (ICMA) using one monoclonal

antibody conjugated with biotin, another monoclonal antibody

labeled with an acridinium ester, and an avidin-coated solid

phase. The antibody/Chromagranin-A/antibody complex is bound

to the solid phase by the avidin-biotin interaction and

unbound materials are removed by washing. The bound,

acridinium-labeled material produces light that is detected in

a luminometer after addition of triggering agents. The Limit

of Detection (LOD) for the assay was 0.07 ng/mL. As shown by

the AUC in Figure 8, the average change from baseline for

Chromagranin-A was higher for subjects treated with 2.5 mg/day

of ABT-627, again demonstrating the effectivness of ABT-627 as

an agent for treating prostate cancer.

Interleukin-6 Levels

The effect of ABT-627 adminstration on Interleukin-6

levels in human serum samples was determined at Quintiles

Laboratories using a sandwich immunoassay. Human serum

samples and standards were incubated in microtiter plate wells coated with a monoclonal anti-IL-6 antibody, in the presence

of a second monoclonal anti IL-6 antibody, linked to

acetylcholinesterase . After incubation, the wells were

washed, and the bound enzymatic activity was measured using a

chromogenic substrate. The intensity of the color was

proportional to the concentration of IL-6 in the sample or

standard. As shown by the AUC Figure 1, the average change in

baseline for Interleukin-6 was lower in those subjects treated

with ABT-627, demonstrating the effectivness of ABT-627 as an

agent for reducing inflammation and ameliorating pain.

Bone Scan Methodology

Bone scans were performed with an NDA approved, Tc-99m

phosphonate type radiopharmaceutical . This technique uses

whole body format (skull to feet) so that anterior and

posterior images are presented when using a 510 K-approved

gamma camera. Alternatively, spot views covering both

anterior and posterior projections of the total body can be

obtained. Interpretation was performed according to standard

nuclear medicine criteria, on a bone by bone basis, by

recording the number of lesions at each site. Each site was

evaluated against a confidence score of 1 to 5, where 1 is negative, 2 is probably negative, 3 is equivocal, 4 is

probably positive, and 5 is definitely positive. The MSKCC

(Clin. Can. Res. 1998; 4:1765-1772) was used to record these

findings. For the purposes of scoring the extent of disease

or the response to treatment, lesions with a confidence score

of 4 and 5 were considered positive, and all other lesions

were considered negative. In addition, in a blinded study, a

reference nuclear medicine physician interpreted the bone

scans quantitatively as follows: the percent of involved bone

was estimated for each individual bone, and the individual

bone involvement was summed to calculate a global percent bone

scan index (BSI) . More specifically, the bone scan was

separated into three indices. The first was the appindicular

scan which involved arms and legs (i.e. the humorous and all

bones distal to the humerous and the femur and everything

distal to the femur) . The second was the axial (everything

but the arms and the legs) . The results of these scans were

combined to provide the total BSI .

Bone scans were conducted on each subject on day one of

the study, and on the final day of the study, and the

changes from baseline in bone scan index scores were analysed

by mean change and mean percent change, adjusting for baseline characteristics as co-variates using SAS version XXX software.

As shown in Figure 6 , bone scans indicated a decrease in

the proportion of total skeketal involvement in those subjects

receiving ABT-627 versus placebo, demonstrating the

effectivness of ABT-627 as an agent for reducing the fraction

of total skeletal involvement by tumor.

VAS Methodology/Administeration/Analysis

The Visual Analog Scale (VAS) is a common instrument of

pain assessment performed by having a subject draw a vertical

line on a 10 cm scale at the point that best describes his or

her pain on average in the last 24 hours. A diagram of the

scale is shown below:

No pain I 1 Pain as bad as it could

possibly be

(not to scale)

During the course of the study, pain asessments were done

daily, at bedtime, by the subject. If the subject was unable

to maintain the log, a caregiver could complete the log on his

or her behalf . The log also contained a table on which was

recorded all daily pain medication consumed by the patient. The logs of daily VAS scores and analgesic consumption were

collected at biweekly visits of the subject to the clinic when

a new log was distributed. Clinical personnel who received

the logs measured the score by measuring the distance (in mm)

from the "no pain" end mark to the point where the subject's

line crossed the VAS line. The number was written into the

case report form next to the date the subject completed that

page of the logbook .

Subjects with pain were initially stabilized in their

pain so that their pain was treated to a tolerable and

constant level. For this study, "tolerable and constant"

refers to a pain score less than or equal to 5 cm on the VAS

for an average of seven successive days while using four or

less rescue doses of pain medication per day. A rescue

medication dose refers to a dose equal to one single dose a

patient used for common timed pain relief.

The weekly VAS scores were calculated excluding the

lowest and highest score for each week and averaging the

remaining five scores. If there were two days with the same

VAS score, the day with the highest analgesic use was discarded.

The weekly mean VAS score was used to define subjects as responders or non-responders . A subject was considered a

responder based on the reduction in the pain intensity: a

weekly VAS score reduction of greater than or equal to 25%

during at least two consecutive weeks without an increase of

analgesic use during the same period (compared to baseline) .

Alternatively, a subject was considered a responder if his

pain analgesic consumption was reduced by at least 25% during

at least two consecutive weeks without a concomitant increase

in VAS score .

The percentage of responders in each treatment group was

compared to evaluate drug efficacy. The comparison was

subjected to an adjustment for baseline characteristics and

prognostic factors as co-variates, and the analysis was

performed using the Cochran-Mantel-Haenszel test or a

generalized linear model.

Weekly VAS scores are examined using a longitudinal

analysis method to explore trends over time. The duration of

the response, defined as the time from baseline to the last

weekly assessment for which the responder definition was

satisfied, was analyzed using the Kaplan-Meier methodology and

logrank test. Cox proportional hazard models were used as

needed (see U.S. Department of Health and Human Services. Management of Cancer Pain Clinical Practice Guidelines. AHCPR

Publication #94-0592, Rockville, MD (1994) . As shown by the

AUC in Figure 3, VAS scores showed a decrease in pain,

independent of the effects of morphine, after treatment with

with ABT-627, demonstrating the effectivness of ABT-627 as an

agent for ameliorating pain.

Osteoblastiσ Activity and Bone Markers

Markers of osteoblastic activity were assessed using

urine samples. Bone markers include bone alkaline phosphatase

(BAP) , deoxypridinoline, and N-telopeptide of Type I collagen.

Blood samples were collected prior to dosing on Day 1, Day 42,

Day 84, Day 168, and every 28 days after Day 168, with a final

collection on the last day of the study.

Bone Alkaline Phosphatase

Bone Alkaline Phosphatase levels were determined using

the bone-specific Alkphase-B^s assay published by Metra

Biosystems (Mountain View, CA) . As shown by the AUC in Figure

5, BAP levels decreased in subjects treated with ABT-627,

demonstrating the effectivness of ABT-627 as an agent for

inhibiting abnormal bone remodeling. Crosslinked N-Telopeptide Levels;

Cross-linked N-telopeptide levels were determined using

the DiaSorin (Stillwater, MN) assay for the quantitative

determination of carboxyterminal cross-linked telopeptide of

type I collagen (ICTP) in human serum by equilibrium

radioimmunoassay (RIA) . Briefly, samples were incubated with

the ¹²⁵I ICTP tracer and ICTP primary antibody for 2 hours at

37 °C. Following the 2 hour incubation, a pre-precipitated

second antibody complex was added to separate the bound from

free tracer. The assay was then centrifuged and decanted

after a 30 minute incubation at room temperature. The bound

tracer in the pellet was counted with a gamma counter. Counts

were inversely proportional to the amount of ICTP present in

each sample. As shown by the AUC in Figure 4, Crosslinked N-

telopeptide levels decreased in subjects treated with ABT-627,

demonstrating the effectivness of ABT-627 as an agent for

inhibiting the bone remodeling associated with bone diseases.

Claims (1)

1. We Claim :

   1. A method for inhibiting bone metastases and

   metastatic growth in a patient which comprises administering

   to the patient in need thereof a therapeutically effective

   amount of an endothelin ET-A receptor antagonist.

   2. The method of Claim 1 wherein the bone metastases

   are osteoblastic .

   3. The method of Claim 2 wherein the osteoblastic bone

   metastases result from the spread of a primary cancer selected

   from breast, prostate, lung, kidney, thyroid, myeloma,

   lymphoma, sarcoma, osteosarcoma, and ovarian.

   4. The method of Claim 3 wherein the primary cancer is

   prostate cancer and the patient is male.

   5. The method of Claim 1 which additionally comprises

   co-administeration of an anticancer drug.

   6. The method of Claim 5 wherein the anticancer drug agent is selected from leuprolide, goserelin, bicalutamide,

   nilutamide, flutamide, vitamin D, vitamin D analogues,

   estrogen, estrogen analogues, prednisone, hydrocortisone,

   ketoconazole, cyproterone acetate, and progesterone.

   7. The method of Claim 1 which additionally comprises

   the administeration of radiation therapy.

   8. The method of Claim 1 which additionally comprises

   the administeration of at least one therapeutic -agent which

   impedes net bone loss.

   9. The method of Claim 8 wherein the therapeutic agent

   is a bisphosphonate.

   10. The method of Claim 1 wherein the endothelin

   antagonist is an ET_A-selective endothelin antagonist.

   11. A method for the inhibition of bone loss in a

   patient which comprises administering to the patient in need

   thereof a therapeutically effective amount of an endothelin

   ET-A receptor antagonist .

   12. The method of Claim 11 wherein the patient has

   cancer.

   13. The method of Claim 11 wherein the cancer is

   prostate cancer and the patient is male.

   1 . The method of Claim 11 which additionally comprises

   the administeration of at least one therapeutic agent which

   impedes net bone loss .

   15. The method of Claim 14 wherein the therapeutic agent

   is a bisphosphonate.

   16. A method for the reduction of cancer-related pain in

   a patient which comprises administering to the patient in need

   thereof a therapeutically effective amount of an endothelin

   ET-A receptor antagonist .

   17. The method of Claim 16 wherein the cancer is

   prostate cancer and the patient is male.

   18. The method of Claim 16 which additionally comprises

   the administeration of an anticancer drug.

   19. The method of Claim 18 wherein the anticancer drug

   is selected from leuprolide, goserelin, bicalutamide,

   nilutamide, flutamide, vitamin D, vitamin D analogues,

   estrogen, estrogen analogues, prednisone, hydrocortisone,

   ketoconazole, cyproterone acetate, and progesterone.

   20. The method of Claim 17 which additionally comprises

   the administeration of radiation therapy.

   21. A method for inhibiting bone metastases in a patient

   which comprises administering to the patient in need thereof a

   therapeutically effective amount of a compound of formula I :

   wherein

   R is -(CH₂)_m-W; Z is selected from -C(Rιs) (R19) - and -C(O)-;

   Rl and R₂ are independently selected from hydrogen,

   loweralkyl, alkenyl, alkynyl, alkoxyalkyl,

   alkoxycarbonylalkyl, hydroxyalkyl, haloalkyl, haloalkoxyalkyl,

   alkoxyalkoxyalkyl , thioalkoxyalkoxyalkyl , cycloalkyl ,

   cycloalkylalkyl, aminocarbonylalkyl, alkylaminocarbonylalkyl,

   dialkylaminocarbonylalkyl , aminocarbonylalkenyl ,

   alkylaminocarbonylalkenyl , dialkylaminocarbonylalkenyl ,

   hydroxyalkenyl , aryl , arylalkyl , aryloxyalkyl ,

   arylalkoxyalkyl, (N-alkanoyl-N-alkyl) aminoalkyl,

   alkylsulfonylamidoalkyl, heterocyclic, (heterocyclic) alkyl,

   and (R_aa) (R_bb)N-R_cc-,

   with the proviso that one or both of R-^ and R₂ is other

   than hydrogen;

   R3 is selected from R4-C(0)-Rs-, R4~R5_a-, R4-C(0)-Rs-

   N(Rg)-, Rg-S(0⁾ ₂-^R7" ^R26-S(0)-R₂7", R22-0-C (O) -R₂3 - ,

   loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

   aryl, arylalkyl, aryloxyalkyl, heterocyclic,

   (heterocyclic) alkyl, alkoxyalkyl, alkoxyalkoxyalkyl, and R13-

   C(0) -CH(Ri4) -;

   R4 and Rg are independently selected from (Rn) (Rι₂)N-, loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

   aryl, arylalkyl, heterocyclic, (heterocyclic) alkyl,

   alkoxyalkyl, hydroxyalkyl, haloalkyl, haloalkenyl,

   haloalkoxyalkyl, haloalkoxy, alkoxyhaloalkyl, alkylaminoalkyl,

   dialkylaminoalkyl, alkoxy, and

   R5 is selected from a covalent bond, alkylene,

   alkenylene, -N⁽R2θ⁾- 8^{- _R}8a^_N^^R20^ ^_R8^~ ' ^_0^_R9^_/ and

   -R_9a-0-Rg-;

   Rg is selected from loweralkyl, haloalkyl, alkoxyalkyl,

   haloalkoxyalkyl, aryl or arylalkyl;

   R7 is a covalent bond, alkylene, alkenylene - (R₂l) ^_ 10~

   and -R_10a-N(R2i) -Riθ~;

   R8 is selected from alkylene and alkenylene;

   R9 is alkylene;

   RlO is selected from alkylene and alkenylene;

   Rll and R12 are independently selected from hydrogen,

   loweralkyl, haloalkyl, alkoxyalkyl, haloalkoxyalkylalkenyl,

   alkynyl, cycloalkyl, cycloalkylalkyl, aryl, heterocyclic, arylalkyl, (heterocyclic) alkyl, hydroxyalkyl, alkoxy,

   aminoalkyl , trialkylaminoalkyl , alkylaminoalkyl ,

   dialkylaminoalkyl, and carboxyalkyl ;

   Rl3 is selected from amino, alkylamino and dialkylamino;

   Ri4 is selected from aryl and Rχ5-C(0)-;

   Rl5 is selected from amino, alkylamino and dialkylamino;

   Rl6 is selected from loweralkyl, haloalkyl, aryl and

   dialkylamino ;

   Rl7 is loweralkyl;

   Ri8 and Rig are independently selected from hydrogen and

   loweralkyl ;

   R20 i selected from hydrogen, loweralkyl, alkenyl,

   haloalkyl, alkoxyalkyl, haloalkoxyalkyl, cylcoalkyl and

   cycloalkylalkyl ;

   R21 is selected from hydrogen, loweralkyl, alkenyl,

   haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl and arylalkyl ;

   R is selected from a carboxy protecting group and

   heterocyclic ;

   R23 is selected from covalent bond, alkylene, alkenylene

   and -N⁽R24) - 25^~;

   R24 is selected from , hydrogen and loweralkyl; R25 is alkylene;

   R26 is selected from loweralkyl, haloalkyl, alkenyl,

   alkynyl, cycloalkyl, cycloalkylalkyl, aryl, arylalkyl,

   heterocyclic, (heterocyclic) alkyl, alkoxyalkyl and alkoxy-

   substituted haloalkyl;

   R27 is selected from alkylene and alkenylene;

   . Rsa is selected from alkylene and alkenylene;

   R_7a is alkylene;

   Rg_a is selected from alkylene and alkenylene;

   Rg_a is alkylene;

   ^R10_a is selected from alkylene and alkenylene;

   R_aa is selected from aryl and arylalkyl;

   R_j-_jj-, is selected from hydrogen and alkanoyl;

   R_cc is alkylene;

   m is 0-6;

   n is 0 or 1;

   z is 0-5;

   E is selected from hydrogen, loweralkyl and arylalkyl;

   G is selected from hydrogen and a carboxy protecting

   group; and W is selected from -C(0)2~G; -PO3H2, -P(O) (OH) (E) ,

   -CN, -C(0)NHRi7, alkylaminocarbonyl, dialkylaminocarbonyl,

   tetrazolyl, hydroxy, alkoxy, sulfonamido, -C (O) NHS (0) ₂ ^R16₁

   S (0) ₂NHC (0) Rιg ,

   or a pharmaceutically acceptable salt thereof.

   22. The method of Claim 21 wherein the bone metastases

   are osteoblastic .

   23. The method of Claim 22 wherein the osteoblastic bone

   metastases result from the spread of a primary cancer selected

   from breast, prostate, lung, kidney, thyroid, myeloma,

   lymphoma, sarcoma, osteosarcoma, and ovarian.

   24. The method of Claim 23 wherein the primary cancer is prostate cancer and the patient is male.

   25. The method of Claim 21 which additionally comprises

   the administeration of an anticancer drug.

   26. The method of Claim 25 wherein the additional

   anticancer drug is selected from leuprolide, goserelin,

   bicalutamide, nilutamide, flutamide, vitamin D, vitamin D

   analogues, estrogen, estrogen analogues, prednisone,

   hydrocortisone, ketoconazole, cyproterone acetate, and

   progesterone .

   27. The method of Claim 21 which additionally comprises

   the administeration of radiation therapy.

   28. The method of Claim 21 which additionally comprises

   the administeration of at least one therapeutic agent which

   impedes net bone loss .

   29. The method of Claim 28 wherein the therapeutic agent

   is a bisphosphonate .

   30. A method for the inhibition of bone loss in cancer

   patients which comprises administering to the patient in need

   thereof a therapeutically effective amount of a compound of

   formula I :

   wherein

   R is -(CH₂)_m-W;

   Z is selected from -C(Rιs) (Rig)- and -C(O)-;

   Ri and R2 are independently selected from hydrogen,

   loweralkyl , alkenyl , alkynyl , alkoxyalkyl ,

   alkoxycarbonylalkyl, hydroxyalkyl, haloalkyl, haloalkoxyalkyl,

   alkoxyalkoxyalkyl, thioalkoxyalkoxyalkyl, cycloalkyl,

   cycloalkylalkyl, aminocarbonylalkyl, alkylaminocarbonylalkyl,

   dialkylaminocarbonylalkyl, aminocarbonylalkenyl,

   alkylaminocarbonylalkenyl , dialkylaminocarbonylalkenyl ,

   hydroxyalkenyl , aryl, arylalkyl, aryloxyalkyl,

   arylalkoxyalkyl , (N-alkanoyl-N-alkyl) aminoalkyl,

   alkylsulfonylamidoalkyl, heterocyclic, (heterocyclic) alkyl, and (R_aa) (R_bb ) N-R_{c c} - ,

   with the proviso that one or both of R-_]_ and R₂ is other

   than hydrogen;

   R3 is selected from R4-C(0)-Rs-, R4-R5_51.-, R4-C(0)-Rs-

   N(Rg)-, Rg-S⁽0)₂-^R7- R26-S(0)-R₂7-, R22~0-C ⁽O⁾ -R₂3^~ ,

   loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

   aryl, arylalkyl, aryloxyalkyl, heterocyclic,

   (heterocyclic) alkyl, alkoxyalkyl, alkoxyalkoxyalkyl, and R13-

   C(O) -CH(Ri4) -;

   R4 and Rg are independently selected from (Rn) (Rχ2)N-,

   loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

   aryl, arylalkyl, heterocyclic, (heterocyclic) alkyl,

   alkoxyalkyl, hydroxyalkyl, haloalkyl, haloalkenyl,

   haloalkoxyalkyl, haloalkoxy, alkoxyhaloalkyl, alkylaminoalkyl,

   dialkylaminoalkyl, alkoxy, and

   R5 is selected from a covalent bond, alkylene,

   alkenylene, -N⁽R2θ)-^R8-/ ^~R8a^~N(^R2θ) ^~R8^~ ' -°^_R9"' ^and

   -R_9a-0-R₉-; Rg is selected from loweralkyl, haloalkyl, alkoxyalkyl,

   haloalkoxyalkyl, aryl or arylalkyl;

   R7 is a covalent bond, alkylene, alkenylene -N(R₂χ) -Rχo~

   and -R_10a-N(R2χ) -Rχo~;

   Rs is selected from alkylene and alkenylene;

   Rg is alkylene;

   Rχθ is selected from alkylene and alkenylene;

   ll ^an Rχ2 are independently selected from hydrogen,

   loweralkyl, haloalkyl, alkoxyalkyl, haloalkoxyalkylalkenyl,

   alkynyl, cycloalkyl, cycloalkylalkyl, aryl, heterocyclic,

   arylalkyl, (heterocyclic) alkyl, hydroxyalkyl, alkoxy,

   aminoalkyl , trialkylaminoalkyl , alkylaminoalkyl ,

   dialkylaminoalkyl, and carboxyalkyl ;

   Rχ3 is selected from amino, alkylamino and dialkylamino;

   Rχ4 is selected from aryl and Rχs-C(O)-;

   Rχ5 is selected from amino, alkylamino and dialkylamino;

   Rx is selected from loweralkyl, haloalkyl, aryl and

   dialkylamino;

   Rχ7 is loweralkyl;

   Ri8 and Rx are independently selected from hydrogen and

   loweralkyl ; R₂0 is selected from hydrogen, loweralkyl, alkenyl,

   haloalkyl, alkoxyalkyl, haloalkoxyalkyl, cylcoalkyl and

   cycloalkylalkyl ;

   R21 is selected from hydrogen, loweralkyl, alkenyl,

   haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl and arylalkyl;

   R₂ is selected from a carboxy protecting group and

   heterocyclic ;

   R₂3 is selected from covalent bond, alkylene, alkenylene

   and -N(R₂₄)-R₂₅-_;

   R 4 is selected from hydrogen and loweralkyl;

   R₂5 is alkylene;

   R₂g is selected from loweralkyl, haloalkyl, alkenyl,

   alkynyl, cycloalkyl, cycloalkylalkyl, aryl, arylalkyl,

   heterocyclic, (heterocyclic) alkyl, alkoxyalkyl and alkoxy-

   substituted haloalkyl;

   R27 is selected from alkylene and alkenylene; °

   R5a is selected from alkylene and alkenylene;

   R_7a is alkylene;

   R_8a is selected from alkylene and alkenylene;

   Rg_a is alkylene;

   ^R10a ^^s selected from alkylene and alkenylene; R_aa is selected from aryl and arylalkyl;

   ^Rbb ^^s selected from hydrogen and alkanoyl;

   R_cc is alkylene;

   m is 0-6;

   n is 0 or 1;

   z is 0-5 ;

   E is selected from hydrogen, loweralkyl and arylalkyl;

   G is selected from hydrogen and a carboxy protecting

   grou ; and

   W is selected from -C(0)₂-G; -PO3H2, -P (O) (OH) (E) ,

   -CN, -C(0)NHRχ7, alkylaminocarbonyl, dialkylaminocarbonyl,

   tetrazolyl, hydroxy, alkoxy, sulfonamido, -C (O) NHS (0) 2 16_/

   S(0)₂NHC(0)Rχg,

   or a pharmaceutically acceptable salt thereof.

   31. The method of Claim 30 wherein the cancer is

   prostate cancer and the patient is male,

   32. The method of Claim 30 which additionally comprises

   the administeration of at least one therapeutic agent which

   impedes net bone loss .

   33. The method of Claim 32 wherein the therapeutic agent

   is a bisphosphonate.

   34. A method for the reduction of cancer-related pain

   which comprises administering to a patient in need thereof a

   therapeutically effective amount of a compound of formula I :

   wherein

   R is -(CH )m-W;

   Z is selected from -C(Rχ₈) (Rxg) - and -C(O)

   Rx and R2 are independently selected from hydrogen, loweralkyl, alkenyl, alkynyl, alkoxyalkyl,

   alkoxycarbonylalkyl, hydroxyalkyl, haloalkyl, haloalkoxyalkyl,

   alkoxyalkoxyalkyl, thioalkoxyalkoxyalkyl , cycloalkyl,

   cycloalkylalkyl, aminocarbonylalkyl, alkylaminocarbonylalkyl,

   dialkylaminocarbonylalkyl , aminocarbonylalkenyl ,

   alkylaminocarbonylalkenyl , dialkylaminocarbonylalkenyl ,

   hydroxyalkenyl , aryl, arylalkyl, aryloxyalkyl,

   arylalkoxyalkyl, (N-alkanoyl-N-alkyl) aminoalkyl,

   alkylsulfonylamidoalkyl, heterocyclic, (heterocyclic) alkyl,

   and ⁽R_aa) ^(R b^)N~Rcc-'

   with the proviso that one or both ,of R-_j_ and R₂ is other

   than hydrogen;

   R3 is selected from R4-C(0)-R5~, R4-Rs_a-, R4-C(0)-Rs-

   N(Rg)-, Rg-S(0)₂- 7- ^R26-S(0)-R₂₇-, R₂₂-0-C (O) -R₂₃- ,

   loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

   aryl, arylalkyl, aryloxyalkyl, heterocyclic,

   (heterocyclic) alkyl, alkoxyalkyl, alkoxyalkoxyalkyl, and Rχ3~

   C(0) -CH(Rχ4)-;

   R4 and Rg are independently selected from (Rxx) (Rχ₂)N-,

   loweralkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,

   aryl, arylalkyl, heterocyclic, (heterocyclic) alkyl, alkoxyalkyl, hydroxyalkyl, haloalkyl, haloalkenyl,

   haloalkoxyalkyl, haloalkoxy, alkoxyhaloalkyl, alkylaminoalkyl,

   dialkylaminoalkyl , alkoxy, and

   - R5 is selected from a covalent bond, alkylene,

   alkenylene, -N(R₂o)-Rs-, -R_8a-N(R₂₀) -R_g- -O-Rg-, and

   -^Rg_a ^_0-Rg- ;

   Rg is selected from loweralkyl, haloalkyl, alkoxyalkyl,

   haloalkoxyalkyl, aryl or arylalkyl;

   R7 is a covalent bond, alkylene, alkenylene -N (R₂χ) -Rχo- ,

   and -^R _10a-N⁽R2X⁾ -^RX0-;

   Rs is selected from alkylene and alkenylene;

   Rg is alkylene;

   Rχθ is selected from alkylene and alkenylene;

   Rxx and Rχ₂ are independently selected from hydrogen,

   loweralkyl, haloalkyl, alkoxyalkyl, haloalkoxyalkylalkenyl,

   alkynyl, cycloalkyl, cycloalkylalkyl, aryl, heterocyclic,

   arylalkyl, (heterocyclic) alkyl, hydroxyalkyl, alkoxy,

   aminoalkyl , trialkylaminoalkyl , alkylaminoalkyl , dialkylaminoalkyl, and carboxyalkyl ;

   Rχ3 is selected from amino, alkylamino and dialkylamino;

   Rχ4 is selected from aryl and Rχ5~C(0)-;

   Rχ5 is selected from amino, alkylamino and dialkylamino;

   Rxg is selected from loweralkyl, haloalkyl, aryl and

   dialkylamino;

   Rχ7 is loweralkyl;

   Rχ8 and Rxg are independently selected from hydrogen and

   loweralkyl ;

   R₂o is selected from hydrogen, loweralkyl, alkenyl,

   haloalkyl, alkoxyalkyl, haloalkoxyalkyl, cylcoalkyl and

   cycloalkylalkyl ;

   R χ is selected from hydrogen, loweralkyl, alkenyl,

   haloalkyl, alkoxyalkyl, haloalkoxyalkyl, aryl and arylalkyl;

   R₂₂ is selected from a carboxy protecting group and

   heterocyclic ;

   R₂3 is selected from covalent bond, alkylene, alkenylene

   and -N(R₂4) -R₂5~;

   R 4 is selected from hydrogen and loweralkyl;

   R₂5 is alkylene;

   R26 is selected from loweralkyl, haloalkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl, aryl, arylalkyl,

   heterocyclic, (heterocyclic) alkyl, alkoxyalkyl and alkoxy-

   substituted haloalkyl;

   R27 is selected from alkylene and alkenylene;

   R5_a is selected from alkylene and alkenylene;

   R_7a is alkylene;

   Rg_a is selected from alkylene and alkenylene;

   Rg_a is alkylene;

   Rχo_a is selected from alkylene and alkenylene;

   R_aa is selected from aryl and arylalkyl;

   is selected from hydrogen and alkanoyl;

   R_cc is alkylene;

   m is 0-6;

   n is 0 or 1;

   z is 0-5;

   E is selected from hydrogen, loweralkyl and arylalkyl;

   G is selected from hydrogen and a carboxy protecting

   group ; and

   W is selected from -C(0)2~G; -PO3H2, -P(0) (OH) (E) ,

   -CN, -C(0)NHRχ7, alkylaminocarbonyl, dialkylaminocarbonyl , tetrazolyl, hydroxy, alkoxy, sulfonamido, -C (0) NHS (0) 2^R16 ^_

   S (0) ₂NHC (0) Rχg ,

   or a pharmaceutically acceptable salt thereof.

   35. The method of Claim 34 wherein the cancer is

   prostate cancer and the patient is male.

   36. The method of Claim 34 which additionally comprises

   the administeration of an anticancer drug.

   37. The method of Claim 36 wherein the additional

   anticancer, drug is selected from leuprolide, goserelin,

   bicalutamide, nilutamide, flutamide, vitamin D, vitamin D

   analogues, estrogen, estrogen analogues, prednisone,

   hydrocortisone, ketoconazole, cyproterone acetate, and

   progesterone .

   38. A method for inhibiting bone metastases in a patient

   which comprises administering to the patient in need thereof a

   therapeutically effective amount of a compound of formula III

   III.

   39. The method of Claim 38 wherein the bone metastases are osteoblastic.

   40. The method of Claim 39 wherein the osteoblastic bone metastases result from the spread of a primary cancer selected

   from breast, prostate, lung, kidney, thyroid, myeloma,

   lymphoma, sarcoma, osteosarcoma, and ovarian.

   41. The method of Claim 40 wherein the primary cancer is prostate cancer and the patient is male.

   42. The method of Claim 40 which additionally comprises

   the administeration of an anticancer drug.

   43. The method of Claim 42 wherein the additional

   anticancer drug is selected from leuprolide, goserelin,

   bicalutamide, nilutamide, flutamide, vitamin D, vitamin D

   analogues, estrogen, estrogen analogues, prednisone,

   hydrocortisone, ketoconazole, cyproterone acetate, and

   progesterone .

   44. The method^' of Claim 40 which additionally comprises

   the administeration of radiation therapy.

   45. The method of Claim 40 which additionally comprises

   the administeration of at least one therapeutic agent which

   impedes net bone loss .

   46. The method of Claim 45 wherein the agent is a bisphosphonate .

   47. The method of Claim 40 wherein the endothelin

   antagonist is an ET_A-selective endothelin antagonist.

   48. A method for the inhibition of bone loss in cancer

   patients which comprises administering to the patient in need thereof a therapeutically effective amount of a compound of

   formula III

   III.

   49. The method of Claim 48 wherein the cancer is

   prostate cancer and the patient is male,

   50. The method of Claim 48 which additionally comprises the administeration of at least one therapeutic agent which impedes net bone loss.

   51. The method of Claim 50 wherein therapeutic agent is

   a bisphosphonate .

   52. A method for the reduction of cancer-related pain

   which comprises administering to a patient in need thereof a therapeutically effective amount of a compound of formula III

   III.

   53. The method of Claim 52 wherein the cancer is

   prostate cancer and the patient is male.

   54. The method of Claim 52 which additionally comprises the administeration of an anticancer drug.

   55. The method of Claim 54 wherein the anticancer drug

   is selected from leuprolide, goserelin, bicalutamide,

   nilutamide, flutamide, vitamin D, vitamin D analogues,

   estrogen, estrogen analogues, prednisone, hydrocortisone,

   ketoconazole, cyproterone acetate, and progesterone.

   56. A method for preventing new bone metastases in a

   patient which comprises administring to the patient in need

   thereof a therapeutically effective amount of an endothelin

   ET-A receptor antagonist .

   57. A method for inhibiting metastatic growth in a

   patient which, comprises administring to the patient in need

   thereof a therapeutically effective amount of an endothelin

   ET-A receptor antagonist .

   58. A method for inhibiting bone turnover in a patient

   which comprises administring to the patient in need thereof a

   therapeutically effective amount of an endothelin ET-A

   receptor antagonist.