CA2366697A1 - Treatment regimen for hormone-sensitive cancers - Google Patents
Treatment regimen for hormone-sensitive cancers Download PDFInfo
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- CA2366697A1 CA2366697A1 CA002366697A CA2366697A CA2366697A1 CA 2366697 A1 CA2366697 A1 CA 2366697A1 CA 002366697 A CA002366697 A CA 002366697A CA 2366697 A CA2366697 A CA 2366697A CA 2366697 A1 CA2366697 A1 CA 2366697A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
- A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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Abstract
This invention provides for a novel schedule and dosage regimen of the combination paclitaxel-estramustine and chemical or surgical hormone depleti on to treat patients with advanced breast cancer who have not received previous therapy and are candidates for hormonal therapy. This invention differs from all current treatment strategies by the intercalation of cytotoxic chemotherapy (preferably paclitaxel and estramustine) at a specified interva l (two months; range 2 weeks to 6 months) after initiation of hormone depletio n therapy.
Description
DESCRIPTION
TREATMENT REGIMEN FOR HORMONE-SENSITIVE CANCERS
Field of the Invention The present invention broadly concerns a treatment regimen in patients with hormone-sensitive cancer. More specifically, the present invention relates to a therapeutic program or treatment schedule to juxtapose two different anticancer modalities; hormonal manipulation and a combination of cytotoxic drugs, preferably including a taxane, to patients with breast cancer in an effort to stabilize, reduce, or destroy the cancerous growth.
Specifically, the present invention concerns the timing of the introduction of cytotoxic chemotherapy, most preferably a combination of paclitaxel and estramustine, during hormonal manipulation.
Background of the Invention Breast cancer is the most prevalent hormone-sensitive cancer afflicting women.
Those who are treated by hormone manipulation often see an initial positive objective response, later followed by a resurgence in tumor burden characterized by hormone-independent tumors. A
predominance of hormone-dependent tumors at diagnosis coupled with an emergence of hormone-independent tumors after apparently successful initial therapy can be explained as follows. With unrelenting tumor growth, genetic instability and mutations accumulate sufficiently to allow hormone-independent growth mechanisms to occur de novo, or to be expressed phenotypically in the parental lines, and in later generations of tumor cells. This transformation of tumor cell populations presumably occurs immediately after hormonal therapy is introduced. Based on clinical relapses within the first two years of hormonal therapy, the rate and accumulation of such cells is a continuous process and is characterized by a Gompertzian type of growth curve. There is thus a continuing need for new treatment regimens for such hormone-sensitive cancer.
The subject invention concerns a novel treatment regimen for patients diagnosed with breast cancer whereby chemotherapy is administered in conduction with hormonal therapy. In practice, under standard hormone manipulation regimens a patient's general demeanor is vastly improved about the eighth week after hormonal therapy is initiated. This coincides with maximum depletion of hormone-dependent tumor (minimal tumor burden). According to the subject invention, this is the preferred time to introduce cytotoxic chemotherapy. Superimposing cytotoxic chemotherapy during a hormonal induction is contrary to prior art standards of care, and has no precedent in the treatment of breast cancer. The clinical significance of this invention is based upon the current incidence, prevalence, and outcomes of breast cancer patients in the United States.
Summary of the Invention It is an object of the present invention to provide a new and useful method for administration of cytotoxic chemotherapy and hormonal therapy to breast cancer patients. It is a further object of the present invention to increase the duration of clinically significant responses in breast cancer patients. Still a further object of the present invention is to provide a method allowing optimum cytotoxic activity against breast cancer. These and other objects of the present invention are accomplished by new methods of administration of cytotoxins, preferably, taxanes and estramustine.
This invention discloses a method for treating breast cancer with a combined application of any active hormonal therapy and any efficient cytotoxic chemotherapy at prescribed intervals.
The time of administration of the effective drug combination at minimal tumor burden, usually at about the eighth week of hormone ablative therapy, is the critical feature of this invention.
The novel combination of estramustine administration coupled with a recently patented scheduling for paclitaxel (Ainsworth et al., U.S. Patent No. 5,696,153) is also a part of the most preferred embodiment of this invention, but can be modified or replaced in the event that more efficient cytotoxic therapies are developed.
Breast cancer patients whose tumors are estrogen receptor positive (ER+) or progesterone receptor positive (PR+), and who are candidates for hormonal therapy, will benefit from this regimen upon demonstration of a clinically significant response such as, for example, a partial to complete objective response. More particularly, implementation of the chemotherapy program could begin upon observation of a > 50% decrease in measurable soft tissue metastases maintained over a period of time of at least one month.
In a preferred embodiment, paclitaxel is administered to the patient within a range of 45-135 mg/mz over a duration of 60-180 minutes for a plurality of times during a 21-day period, with each of these administrations being separated from the next by an interval of approximately 4-5 days. Preferably, this protocol is repeated for at least three (3) cycles of 21 days (63 days total) with the plurality of times of infusing the paclitaxel beginning on the second day of each of the cycles. The protocol can be repeated for more than 3 cycles, for example, 6 cycles or more, so long as the patient can tolerate the toxic effects. Preferably, the duration of each infusion is between about 60-80 minutes and there are three (3) treatment days in each cycle separated by four (4) non-treatment days. Moreover, it is preferred that the amount of paclitaxel infused be about 60 mg/mz.
TREATMENT REGIMEN FOR HORMONE-SENSITIVE CANCERS
Field of the Invention The present invention broadly concerns a treatment regimen in patients with hormone-sensitive cancer. More specifically, the present invention relates to a therapeutic program or treatment schedule to juxtapose two different anticancer modalities; hormonal manipulation and a combination of cytotoxic drugs, preferably including a taxane, to patients with breast cancer in an effort to stabilize, reduce, or destroy the cancerous growth.
Specifically, the present invention concerns the timing of the introduction of cytotoxic chemotherapy, most preferably a combination of paclitaxel and estramustine, during hormonal manipulation.
Background of the Invention Breast cancer is the most prevalent hormone-sensitive cancer afflicting women.
Those who are treated by hormone manipulation often see an initial positive objective response, later followed by a resurgence in tumor burden characterized by hormone-independent tumors. A
predominance of hormone-dependent tumors at diagnosis coupled with an emergence of hormone-independent tumors after apparently successful initial therapy can be explained as follows. With unrelenting tumor growth, genetic instability and mutations accumulate sufficiently to allow hormone-independent growth mechanisms to occur de novo, or to be expressed phenotypically in the parental lines, and in later generations of tumor cells. This transformation of tumor cell populations presumably occurs immediately after hormonal therapy is introduced. Based on clinical relapses within the first two years of hormonal therapy, the rate and accumulation of such cells is a continuous process and is characterized by a Gompertzian type of growth curve. There is thus a continuing need for new treatment regimens for such hormone-sensitive cancer.
The subject invention concerns a novel treatment regimen for patients diagnosed with breast cancer whereby chemotherapy is administered in conduction with hormonal therapy. In practice, under standard hormone manipulation regimens a patient's general demeanor is vastly improved about the eighth week after hormonal therapy is initiated. This coincides with maximum depletion of hormone-dependent tumor (minimal tumor burden). According to the subject invention, this is the preferred time to introduce cytotoxic chemotherapy. Superimposing cytotoxic chemotherapy during a hormonal induction is contrary to prior art standards of care, and has no precedent in the treatment of breast cancer. The clinical significance of this invention is based upon the current incidence, prevalence, and outcomes of breast cancer patients in the United States.
Summary of the Invention It is an object of the present invention to provide a new and useful method for administration of cytotoxic chemotherapy and hormonal therapy to breast cancer patients. It is a further object of the present invention to increase the duration of clinically significant responses in breast cancer patients. Still a further object of the present invention is to provide a method allowing optimum cytotoxic activity against breast cancer. These and other objects of the present invention are accomplished by new methods of administration of cytotoxins, preferably, taxanes and estramustine.
This invention discloses a method for treating breast cancer with a combined application of any active hormonal therapy and any efficient cytotoxic chemotherapy at prescribed intervals.
The time of administration of the effective drug combination at minimal tumor burden, usually at about the eighth week of hormone ablative therapy, is the critical feature of this invention.
The novel combination of estramustine administration coupled with a recently patented scheduling for paclitaxel (Ainsworth et al., U.S. Patent No. 5,696,153) is also a part of the most preferred embodiment of this invention, but can be modified or replaced in the event that more efficient cytotoxic therapies are developed.
Breast cancer patients whose tumors are estrogen receptor positive (ER+) or progesterone receptor positive (PR+), and who are candidates for hormonal therapy, will benefit from this regimen upon demonstration of a clinically significant response such as, for example, a partial to complete objective response. More particularly, implementation of the chemotherapy program could begin upon observation of a > 50% decrease in measurable soft tissue metastases maintained over a period of time of at least one month.
In a preferred embodiment, paclitaxel is administered to the patient within a range of 45-135 mg/mz over a duration of 60-180 minutes for a plurality of times during a 21-day period, with each of these administrations being separated from the next by an interval of approximately 4-5 days. Preferably, this protocol is repeated for at least three (3) cycles of 21 days (63 days total) with the plurality of times of infusing the paclitaxel beginning on the second day of each of the cycles. The protocol can be repeated for more than 3 cycles, for example, 6 cycles or more, so long as the patient can tolerate the toxic effects. Preferably, the duration of each infusion is between about 60-80 minutes and there are three (3) treatment days in each cycle separated by four (4) non-treatment days. Moreover, it is preferred that the amount of paclitaxel infused be about 60 mg/mz.
These treatments do not engender serious adverse drug-related effects because of the improved therapeutic efficiency and the absence of a need for excessive dosing to the maximally tolerated level.
Detailed Description of the Preferred Embodiment The subject invention is a result of the discovery that a fundamental shortcoming of the prior art treatments for hormone-sensitive cancer lies in the pattern of treatment scheduling rather than in the inadequacy of available treatment modalities. In this invention, I have designed a novel pattern of therapy taking into account the two most critical factors, selection of and timing of introduction of cytotoxic chemotherapy. The rationale and the utility of two preferred types of drugs, taxanes (preferably paclitaxel) and estramustine, has been amply described. See Panda et al. ( 1997) and Helson et al. ( 1993). Estramustine (EMP) has as its immediate target microtubule associated proteins making it a mitotic inhibitor (5-8). These observations have suggested that it might have complementary activity in combination with other mitotic inhibitors like paclitaxel. Preclinical (9) and pilot clinical trials ( 10) support this hypothesis. These two drugs combined may represent one of the best available synergistic therapeutic combinations for hormone-sensitive cancer. In view of the current state of the art's ability to administer any variety of combinations of taxanes and EMP, this invention is the concept that scheduling of administration is critical in differentiating the combination from a palliative application at failure of hormonal therapy, to a novel prophylactic treatment modality prior to failure as taught herein. In most cases, after induction with hormone ablative agents or procedures, about the eighth week of therapy coincides with maximum decrease in tumor burden (but this can vary from 2 weeks to 6 months after induction). According to the teachings herein, it is at this time that cytotoxic chemotherapy, preferably with a combination of paclitaxel and EMP, should begin. There follows diminished risk of normal tissue toxicity from the drug combination introduced at this time as well. This means that patients will have responded well enough at this time to tolerate a moderate chemotherapeutic treatment better than when they have relapsed and are in less advantageously positioned clinical states. There is also maximal efficiency in tumor cytotoxic effects because of the minimal tumor burden and increased residual cell cycling activity at this time in the majority of patients. There is the added benefit that hormone-independent tumor cells have enhanced cycling activity, and better vascularity and oxygenation, all of which improve the cytotoxic efficiency of the drugs. The importance of timing is essential as outlined in this discovery in the context of emergence of hormonally-refractory tumor cells. Because the population of these cells is at a minimum level at this time, and consequently easier to eliminate, or cytoreduce, the substantial reduction of any tumor cell population reduces the probability of genetic drift or evolution to even hardier tumor phenotypes. Accordingly, even if the emergent tumor type is not completely eliminated, the time to clinically detectible or symptomatic recurrence is substantially prolonged as compared to current standards of care and treatment. Thus the novel restructuring of the way patients who have advanced breast cancer at the time of diagnosis are treated.
The regimen of the subject invention is particularly novel in the requirement that tumor burden be monitored by means known in the art from the outset of hormone therapy, and that the cytotoxic chemotherapy portion of the regimen be initiated at a time of minimal tumor burden, usually 8 weeks but possibly from 2-24 weeks after the start of hormone therapy, as determined from the monitoring. Although examples of preferred cytotoxic combinations are provided herein, as those of skill in the art become aware of new effective cytotoxic combinations, those combinations can be substituted into the regimen of the subject invention and be administered at a time of minimal tumor burden as taught herein. The commercial embodiments of the subject invention are articles of manufacture comprising a container; a pharmaceutically acceptable cytotoxic composition disposed within the container; and, accompanying the container, instructions for administering the cytotoxic composition to a patient according to the novel scheduling and dosages disclosed herein. The instructions may either be affixed to the container or packaged with the container.
All patents and other publications cited or referred to herein are incorporated by reference as if fully set forth herein to the extent that they do not contradict the specific teachings herein. The following examples are provided by way of illustration only and not by way of limitation. Those of skill in the art will recognize a variety of non-critical parameters which could be changed or modified to yield essentially similar results without deviating from the subject invention.
Example 1 Many patients harbor a predominant hormone-dependent tumor and a limited hormone-independent tumor cell population at the time of diagnosis. Successful therapy with hormone manipulation reduces the hormone-dependent population to a minimum after approximately eight weeks, although variances depending upon the degree of hormone dependence may occur, with minimal disease status ranging from 2 weeks to 6 months. This response, if not entirely complete, sets the stage for emergence of a hormone-independent population, based on selection and/or induction, and possible regrowth of hormone-dependent tumor cells if hormone manipulation therapy is stopped. Thus, the eventual relapse of most breast cancer patients on hormonal treatment.
Non-hormonal chemotherapy is usually administered after relapse occurs, a period of increasing tumor burden and heterogeneity. Although counterintuitive, and not standard-of care dogma, according to the subject invention the preferred time to add cytotoxic chemotherapy is when there is maximal decrease in the hormone-dependent tumor burden, minimal hormone-s independent tumor burden, improved clinical performance status, and motivation on the part of the patient to accept chemotherapy. This time-treatment based strategy assumes a reasonable methodology to estimate minimal tumor burdens. An objective tumor marker such as >_50%
reduction in soft tissue metastases for at least one month is sufficient to determine their status.
Since smaller tumors generally respond better to cytotoxic chemotherapy than larger ones, this method extends the duration of disease control compared to most forms of sequentially administered treatments.
For purposes of the subject invention, any method which permits an objective evaluation of the level of hormone-sensitive tumor burden can be applied to determine the optimal time to begin the cytotoxic chemotherapy regimen.
In a preferred embodiment, this invention is the use of a novel cytotoxic drug combination of paclitaxel given as a one-hour infusion at 45-120 mg/mZ on days 2, 6, and 10 of a 21-day cycle, and estramustine given orally at well-known standard daily dosages of from about 280-840 mg/mz/d, or preferably, for example, 600 mg/mz/d, on days 1-11 of the 21-day cycle (hereinafter, the "Q4Dx3 taxol-estramustine combination"). The 21-day cycle is initiated at the first indication of minimal tumor burden after hormone manipulation therapy has begun.
Example 2 Additional embodiments of the subject invention include the administration of paclitaxel over alternative schedules which are well known to those of ordinary skill in the art for the administration of paclitaxel. For example, following pre-treatment of the patients to alleviate or minimize hypersensitivity responses, paclitaxel can be infused in dosages of between about 135 mg/mz and about 275 mg/m2, more preferably between about 135 mg/m2 and about 175 mg/mz, over a duration of about six hours or less, and preferably about one to three hours, on a 21-day cycle, beginning one day after initiation of oral administration of EMP
as taught in Example 1 above. Alternatively, paclitaxel dosages of between about 135 mg/mz and about 275 mg/m2, preferably between about 135 mg/m2 and about 175 mg/mz, can be administered via a 6- to 24-hour infusion, preferably a 24-hour infusion, following premedication and on a 21-day cycle, beginning one day after initiation of oral administration of EMP as taught in Example 1 above. Such alternative modes of paclitaxel administration are taught by, for example, U.S.
Patent No. 5,621,001 issued to Canetta et al.
Example 3 Yet another embodiment of a combination of cytotoxic chemicals which can be used in the regimen ofthe subject invention is disclosed in Pienta and Smith (1997).
For example, once it is observed that the initial hormone-sensitive tumor burden has been minimized, cytotoxic chemotherapy on a 21-day cycle can begin by administering estramustine at a dosage of 10 mg/kg/d orally for days 1-14 in combination with etoposide at 50 mg/m2/d orally for days 1-14, plus paclitaxel at 135 mg/mz infused over 1 hour on day 2. In a preferred variation of this embodiment, the paclitaxel is administered as a 1-hour infusion at from about 45-120 mg/m2, most preferably at about 60 mg/m2, on days 2, 6, and 10 of the 21-day cycle.
This cycle is to be administered at least once, and is preferably repeated from 3 to 6 times, but may be repeated even more as long as cumulative toxic effects are tolerable for the patient.
Detailed Description of the Preferred Embodiment The subject invention is a result of the discovery that a fundamental shortcoming of the prior art treatments for hormone-sensitive cancer lies in the pattern of treatment scheduling rather than in the inadequacy of available treatment modalities. In this invention, I have designed a novel pattern of therapy taking into account the two most critical factors, selection of and timing of introduction of cytotoxic chemotherapy. The rationale and the utility of two preferred types of drugs, taxanes (preferably paclitaxel) and estramustine, has been amply described. See Panda et al. ( 1997) and Helson et al. ( 1993). Estramustine (EMP) has as its immediate target microtubule associated proteins making it a mitotic inhibitor (5-8). These observations have suggested that it might have complementary activity in combination with other mitotic inhibitors like paclitaxel. Preclinical (9) and pilot clinical trials ( 10) support this hypothesis. These two drugs combined may represent one of the best available synergistic therapeutic combinations for hormone-sensitive cancer. In view of the current state of the art's ability to administer any variety of combinations of taxanes and EMP, this invention is the concept that scheduling of administration is critical in differentiating the combination from a palliative application at failure of hormonal therapy, to a novel prophylactic treatment modality prior to failure as taught herein. In most cases, after induction with hormone ablative agents or procedures, about the eighth week of therapy coincides with maximum decrease in tumor burden (but this can vary from 2 weeks to 6 months after induction). According to the teachings herein, it is at this time that cytotoxic chemotherapy, preferably with a combination of paclitaxel and EMP, should begin. There follows diminished risk of normal tissue toxicity from the drug combination introduced at this time as well. This means that patients will have responded well enough at this time to tolerate a moderate chemotherapeutic treatment better than when they have relapsed and are in less advantageously positioned clinical states. There is also maximal efficiency in tumor cytotoxic effects because of the minimal tumor burden and increased residual cell cycling activity at this time in the majority of patients. There is the added benefit that hormone-independent tumor cells have enhanced cycling activity, and better vascularity and oxygenation, all of which improve the cytotoxic efficiency of the drugs. The importance of timing is essential as outlined in this discovery in the context of emergence of hormonally-refractory tumor cells. Because the population of these cells is at a minimum level at this time, and consequently easier to eliminate, or cytoreduce, the substantial reduction of any tumor cell population reduces the probability of genetic drift or evolution to even hardier tumor phenotypes. Accordingly, even if the emergent tumor type is not completely eliminated, the time to clinically detectible or symptomatic recurrence is substantially prolonged as compared to current standards of care and treatment. Thus the novel restructuring of the way patients who have advanced breast cancer at the time of diagnosis are treated.
The regimen of the subject invention is particularly novel in the requirement that tumor burden be monitored by means known in the art from the outset of hormone therapy, and that the cytotoxic chemotherapy portion of the regimen be initiated at a time of minimal tumor burden, usually 8 weeks but possibly from 2-24 weeks after the start of hormone therapy, as determined from the monitoring. Although examples of preferred cytotoxic combinations are provided herein, as those of skill in the art become aware of new effective cytotoxic combinations, those combinations can be substituted into the regimen of the subject invention and be administered at a time of minimal tumor burden as taught herein. The commercial embodiments of the subject invention are articles of manufacture comprising a container; a pharmaceutically acceptable cytotoxic composition disposed within the container; and, accompanying the container, instructions for administering the cytotoxic composition to a patient according to the novel scheduling and dosages disclosed herein. The instructions may either be affixed to the container or packaged with the container.
All patents and other publications cited or referred to herein are incorporated by reference as if fully set forth herein to the extent that they do not contradict the specific teachings herein. The following examples are provided by way of illustration only and not by way of limitation. Those of skill in the art will recognize a variety of non-critical parameters which could be changed or modified to yield essentially similar results without deviating from the subject invention.
Example 1 Many patients harbor a predominant hormone-dependent tumor and a limited hormone-independent tumor cell population at the time of diagnosis. Successful therapy with hormone manipulation reduces the hormone-dependent population to a minimum after approximately eight weeks, although variances depending upon the degree of hormone dependence may occur, with minimal disease status ranging from 2 weeks to 6 months. This response, if not entirely complete, sets the stage for emergence of a hormone-independent population, based on selection and/or induction, and possible regrowth of hormone-dependent tumor cells if hormone manipulation therapy is stopped. Thus, the eventual relapse of most breast cancer patients on hormonal treatment.
Non-hormonal chemotherapy is usually administered after relapse occurs, a period of increasing tumor burden and heterogeneity. Although counterintuitive, and not standard-of care dogma, according to the subject invention the preferred time to add cytotoxic chemotherapy is when there is maximal decrease in the hormone-dependent tumor burden, minimal hormone-s independent tumor burden, improved clinical performance status, and motivation on the part of the patient to accept chemotherapy. This time-treatment based strategy assumes a reasonable methodology to estimate minimal tumor burdens. An objective tumor marker such as >_50%
reduction in soft tissue metastases for at least one month is sufficient to determine their status.
Since smaller tumors generally respond better to cytotoxic chemotherapy than larger ones, this method extends the duration of disease control compared to most forms of sequentially administered treatments.
For purposes of the subject invention, any method which permits an objective evaluation of the level of hormone-sensitive tumor burden can be applied to determine the optimal time to begin the cytotoxic chemotherapy regimen.
In a preferred embodiment, this invention is the use of a novel cytotoxic drug combination of paclitaxel given as a one-hour infusion at 45-120 mg/mZ on days 2, 6, and 10 of a 21-day cycle, and estramustine given orally at well-known standard daily dosages of from about 280-840 mg/mz/d, or preferably, for example, 600 mg/mz/d, on days 1-11 of the 21-day cycle (hereinafter, the "Q4Dx3 taxol-estramustine combination"). The 21-day cycle is initiated at the first indication of minimal tumor burden after hormone manipulation therapy has begun.
Example 2 Additional embodiments of the subject invention include the administration of paclitaxel over alternative schedules which are well known to those of ordinary skill in the art for the administration of paclitaxel. For example, following pre-treatment of the patients to alleviate or minimize hypersensitivity responses, paclitaxel can be infused in dosages of between about 135 mg/mz and about 275 mg/m2, more preferably between about 135 mg/m2 and about 175 mg/mz, over a duration of about six hours or less, and preferably about one to three hours, on a 21-day cycle, beginning one day after initiation of oral administration of EMP
as taught in Example 1 above. Alternatively, paclitaxel dosages of between about 135 mg/mz and about 275 mg/m2, preferably between about 135 mg/m2 and about 175 mg/mz, can be administered via a 6- to 24-hour infusion, preferably a 24-hour infusion, following premedication and on a 21-day cycle, beginning one day after initiation of oral administration of EMP as taught in Example 1 above. Such alternative modes of paclitaxel administration are taught by, for example, U.S.
Patent No. 5,621,001 issued to Canetta et al.
Example 3 Yet another embodiment of a combination of cytotoxic chemicals which can be used in the regimen ofthe subject invention is disclosed in Pienta and Smith (1997).
For example, once it is observed that the initial hormone-sensitive tumor burden has been minimized, cytotoxic chemotherapy on a 21-day cycle can begin by administering estramustine at a dosage of 10 mg/kg/d orally for days 1-14 in combination with etoposide at 50 mg/m2/d orally for days 1-14, plus paclitaxel at 135 mg/mz infused over 1 hour on day 2. In a preferred variation of this embodiment, the paclitaxel is administered as a 1-hour infusion at from about 45-120 mg/m2, most preferably at about 60 mg/m2, on days 2, 6, and 10 of the 21-day cycle.
This cycle is to be administered at least once, and is preferably repeated from 3 to 6 times, but may be repeated even more as long as cumulative toxic effects are tolerable for the patient.
Claims (122)
1. An article of manufacture, comprising:
a container;
a pharmaceutically acceptable cytotoxic composition disposed within said container; and accompanying said container, instructions for administration of said cytotoxic composition to a patient suffering from breast cancer, said instructions directing the initiation of cytotoxic composition administration to the patient at the time of maximum decrease in tumor burden after the patient has been subjected to hormone therapy.
a container;
a pharmaceutically acceptable cytotoxic composition disposed within said container; and accompanying said container, instructions for administration of said cytotoxic composition to a patient suffering from breast cancer, said instructions directing the initiation of cytotoxic composition administration to the patient at the time of maximum decrease in tumor burden after the patient has been subjected to hormone therapy.
2. An article of manufacture according to claim 1, wherein said instructions direct that the maximum decrease in tumor burden is indicated by at least 50% reduction in soft tissue metastases.
3. An article of manufacture according to claim 1, wherein said instructions direct that initiation of administration of said cytotoxic composition should be at a time of from 2 weeks to 6 months after induction of hormone therapy.
4. An article of manufacture according to claim 3, wherein said instructions direct that initiation of administration of said cytotoxic composition should be at a time of about 8 weeks after induction of hormone therapy.
5. An article of manufacture according to claim 1, wherein said cytotoxic composition comprises a taxane.
6. An article of manufacture according to claim 2, wherein said cytotoxic composition comprises a taxane.
7. An article of manufacture according to claim 3, wherein said cytotoxic composition comprises a taxane.
8. An article of manufacture according to claim 4, wherein said cytotoxic composition comprises a taxane.
9. An article of manufacture according to claim 5, wherein said taxane is paclitaxel.
10. An article of manufacture according to claim 6, wherein said taxane is paclitaxel.
11. An article of manufacture according to claim 7, wherein said taxane is paclitaxel.
12. An article of manufacture according to claim 8, wherein said taxane is paclitaxel.
13. An article of manufacture according to claim 1, wherein said cytotoxic composition comprises estramustine.
14. An article of manufacture according to claim 2, wherein said cytotoxic composition comprises estramustine.
15. An article of manufacture according to claim 3, wherein said cytotoxic composition comprises estramustine.
16. An article of manufacture according to claim 4, wherein said cytotoxic composition comprises estramustine.
17. An article of manufacture according to claim 1, wherein said cytotoxic composition comprises etoposide.
18. An article of manufacture according to claim 2 wherein said cytotoxic composition comprises etoposide.
19. An article of manufacture according to claim 3, wherein said cytotoxic composition comprises etoposide.
20. An article of manufacture according to claim 4, wherein said cytotoxic composition comprises etoposide.
21. An article of manufacture according to claim 9, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
22. An article of manufacture according to claim 10, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
23. An article of manufacture according to claim 11, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
24. An article of manufacture according to claim 12, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
25. An article of manufacture according to claim 21, wherein each of said 60-minute administrations is separated from the next by an interval of from about 4 to 5 days.
26. An article of manufacture according to claim 22, wherein each of said 60-minute administrations is separated from the next by an interval of from about 4 to 5 days.
27. An article of manufacture according to claim 23, wherein each of said 60-minute administrations is separated from the next by an interval of from about 4 to 5 days.
28. An article of manufacture according to claim 24, wherein each of said 60-minute administrations is separated from the next by an interval of from about 4 to 5 days.
29. An article of manufacture according to claim 25, wherein the dosage of paclitaxel is about 60 mg/m2 and the administrations are on days 2, 6, and 10 of a 21-day cycle.
30. An article of manufacture according to claim 9, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 for a duration of about 6 hours or less.
31. An article of manufacture according to claim 10, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6 hours or less.
32. An article of manufacture according to claim 11, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6 hours or less.
33. An article of manufacture according to claim 12, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6 hours or less.
34. An article of manufacture according to claim 30, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
35. An article of manufacture according to claim 31, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
36. An article of manufacture according to claim 32, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
37. An article of manufacture according to claim 33, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
38. An article of manufacture according to claim 9, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
39. An article of manufacture according to claim 10, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
40. An article of manufacture according to claim 11, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
41. An article of manufacture according to claim 12, wherein said instructions direct the administration of paclitaxel is to be at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
42. An article of manufacture according to claim 38, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
43. An article of manufacture according to claim 39, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
44. An article of manufacture according to claim 40, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
45. An article of manufacture according to claim 41, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
46. An article of manufacture according to claim 13, wherein said instructions direct the administration of estramustine is to be at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
47. An article of manufacture according to claim 14, wherein said instructions direct the administration of estramustine is to be at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
48. An article of manufacture according to claim 15, wherein said instructions direct the administration of estramustine is to be at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
49. An article of manufacture according to claim 16, wherein said instructions direct the administration of estramustine is to be at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
50. An article of manufacture according to claim 46, wherein the dosage of estramustine is about 600 mg/m2/d.
51. An article of manufacture according to claim 47, wherein the dosage of estramustine is about 600 mg/m2/d.
52. An article of manufacture according to claim 48, wherein the dosage of estramustine is about 600 mg/m2/d.
53. An article of manufacture according to claim 49, wherein the dosage of estramustine is about 600 mg/m2/d.
54. An article of manufacture according to claim 17, wherein said instructions direct the administration of etoposide is to be at a dosage of about 50 mg/m2/d on days 1-14.
55. An article of manufacture according to claim 18, wherein said instructions direct the administration of etoposide is to be at a dosage of about 50 mg/m2/d on days 1-14.
56. An article of manufacture according to claim 19, wherein said instructions direct the administration of etoposide is to be at a dosage of about 50 mg/m2/d on days 1-14.
57. An article of manufacture according to claim 20, wherein said instructions direct the administration of etoposide is to be at a dosage of about 50 mg/m2/d on days 1-14.
58. An article of manufacture according to claim 21, wherein said instructions direct the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
59. An article of manufacture according to claim 22, wherein said instructions direct the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
60. An article of manufacture according to claim 23, wherein said instructions direct the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
61. An article of manufacture according to claim 24, wherein said instructions direct the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
62. A method of treating a patient having symptoms of breast cancer, comprising the steps of:
initiating hormone therapy;
monitoring the patient's tumor burden; and initiating chemotherapy with at least one cytotoxic composition at a time of minimal tumor burden to the patient.
initiating hormone therapy;
monitoring the patient's tumor burden; and initiating chemotherapy with at least one cytotoxic composition at a time of minimal tumor burden to the patient.
63. A method according to claim 62, wherein said monitoring step comprises monitoring of reduction in soft tissue metastases.
64. A method according to claim 62, wherein said initiating chemotherapy step is at a time of from 2 weeks to 6 months after initiating hormone therapy.
65. A method according to claim 64, wherein said initiating chemotherapy step is at a time of about 8 weeks after initiating hormone therapy.
66. A method according to claim 62, wherein said cytotoxic composition comprises a taxane.
67. A method according to claim 63, wherein said cytotoxic composition comprises a taxane.
68. A method according to claim 64, wherein said cytotoxic composition comprises a taxane.
69. A method according to claim 65, wherein said cytotoxic composition comprises a taxane.
70. A method according to claim 66, wherein said taxane is paclitaxel.
71. A method according to claim 67, wherein said taxane is paclitaxel.
72. A method according to claim 68, wherein said taxane is paclitaxel.
73. A method according to claim 69, wherein said taxane is paclitaxel.
74. A method according to claim 62, wherein said cytotoxic composition comprises estramustine.
75. A method according to claim 63, wherein said cytotoxic composition comprises estramustine.
76. A method according to claim 64, wherein said cytotoxic composition comprises estramustine.
77. A method according to claim 65, wherein said cytotoxic composition comprises estramustine.
78. A method according to claim 62, wherein said cytotoxic composition comprises etoposide.
79. A method according to claim 63, wherein said cytotoxic composition comprises etoposide.
80. A method according to claim 64, wherein said cytotoxic composition comprises etoposide.
81. A method according to claim 65, wherein said cytotoxic composition comprises etoposide.
82. A method according to claim 70, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
83. A method according to claim 71, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
84. A method according to claim 72, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
85. A method according to claim 73, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from 45-135 mg/m2 over a duration of from 60-180 minutes for a plurality of times during a 21-day period.
86. A method according to claim 82, wherein each of said 60-180 minute administrations is separated from the next by an interval of from about 4 to 5 days.
87. A method according to claim 83, wherein each of said 60-180 minute administrations is separated from the next by an interval of from about 4 to 5 days.
88. A method according to claim 84, wherein each of said 60-180 minute administrations is separated from the next by an interval of from about 4 to 5 days.
89. A method according to claim 85, wherein each of said 60-180 minute administrations is separated from the next by an interval of from about 4 to 5 days.
90. A method according to claim 86, wherein the dosage of paclitaxel is about mg/m2 and the administrations are on days 2, 6, and 10 of a 21-day cycle.
91. A method according to claim 70, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 for a duration of about 6 hours or less.
92. A method according to claim 71, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6 hours or less.
93. A method according to claim 72, wherein said chemotherapy comprises administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6 hours or less.
94. A method according to claim 73, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6 hours or less.
95. A method according to claim 91, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
96. A method according to claim 92, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
97. A method according to claim 93, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
98. A method according to claim 94, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
99. A method according to claim 70, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
100. A method according to claim 71, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
101. A method according to claim 72, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
102. A method according to claim 73, wherein said chemotherapy comprises the administration of paclitaxel at a dosage of from about 120 mg/m2 to about 275 mg/m2 over a duration of about 6-24 hours.
103. A method according to claim 99, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
104. A method according to claim 100, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
105. A method according to claim 101, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
106. A method according to claim 102, wherein said dosage of paclitaxel is from about 135 mg/m2 to about 175 mg/m2.
107. A method according to claim 74, wherein said chemotherapy comprises the administration of estramustine at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
108. A method according to claim 75, wherein said chemotherapy comprises the administration of estramustine at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
109. A method according to claim 76, wherein said chemotherapy comprises the administration of estramustine at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
110. A method according to claim 77, wherein said chemotherapy comprises the administration of estramustine at a dosage of from 280-840 mg/m2/d on days 1-11 of a 21-day cycle.
111. A method according to claim 107, wherein the dosage of estramustine is about 600 mg/m2/d.
112. A method according to claim 108, wherein the dosage of estramustine is about 600 mg/m2/d.
113. A method according to claim 109, wherein the dosage of estramustine is about 600 mg/m2/d.
114. An method according to claim 110, wherein the dosage of estramustine is about 600 mg/m2/d.
18~
18~
115. A method according to claim 78, wherein said chemotherapy comprises the administration of etoposide at a dosage of about 50 mg/m2/d on days 1-14.
116. A method according to claim 79, wherein said chemotherapy comprises the administration of etoposide at a dosage of about 50 mg/m2/d on days 1-14.
117. A method according to claim 80, wherein said chemotherapy comprises the administration of etoposide at a dosage of about 50 mg/m2/d on days 1-14.
118. A method according to claim 81, wherein said chemotherapy comprises the administration of etoposide at a dosage of about 50 mg/m2/d on days 1-14.
119. A method according to claim 82, wherein said chemotherapy comprises the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
120. A method according to claim 83, wherein said chemotherapy comprises the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
121. A method according to claim 84, wherein said chemotherapy comprises the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
122. A method according to claim 85, wherein said chemotherapy comprises the administration of paclitaxel according to the Q4Dx3 taxol-estramustine combination.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US12209499P | 1999-02-26 | 1999-02-26 | |
| US60/122,094 | 1999-02-26 | ||
| PCT/US2000/004879 WO2000050022A2 (en) | 1999-02-26 | 2000-02-25 | Treatment regimen for hormone-sensitive cancers |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2366697A1 true CA2366697A1 (en) | 2000-08-31 |
Family
ID=22400570
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002366697A Abandoned CA2366697A1 (en) | 1999-02-26 | 2000-02-25 | Treatment regimen for hormone-sensitive cancers |
Country Status (5)
| Country | Link |
|---|---|
| EP (1) | EP1154819A2 (en) |
| JP (1) | JP2002537328A (en) |
| AU (1) | AU3606700A (en) |
| CA (1) | CA2366697A1 (en) |
| WO (1) | WO2000050022A2 (en) |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP1957065A1 (en) * | 2005-12-06 | 2008-08-20 | Cell Therapeutics, Inc. | Estrogen cancer therapy |
Family Cites Families (9)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4775660A (en) * | 1984-08-02 | 1988-10-04 | Fernand Labrie | Treatment of breast cancer by combination therapy |
| US5676978A (en) * | 1989-02-14 | 1997-10-14 | Amira, Inc. | Methods of inhibiting undesirable cell growth using a combination of a cyclocreatine compound and a hyperplastic inhibitory agent |
| GB9225475D0 (en) * | 1992-12-05 | 1993-01-27 | Imp Cancer Res Tech | Compounds to combat angiogenesis |
| US6143737A (en) * | 1995-06-23 | 2000-11-07 | Georgetown University | Progesterone analogs to reverse multidrug resistance |
| AU4751597A (en) * | 1996-10-04 | 1998-04-24 | Ilex Oncology, Inc. | Dfmo and taxol for the treatment or prevention of breast cancer |
| WO1998025603A1 (en) * | 1996-12-13 | 1998-06-18 | Ilex Oncology, Inc. | Isomeric pharmaceutical formulation containing dfmo for the treatment of cancer |
| US5900429A (en) * | 1997-01-28 | 1999-05-04 | The Procter & Gamble Company | Method for inhibiting the growth of cancers |
| PE11499A1 (en) * | 1997-05-16 | 1999-03-01 | Procter & Gamble | TREATMENT OF HIV AND CANCER |
| FR2775187B1 (en) * | 1998-02-25 | 2003-02-21 | Novartis Ag | USE OF EPOTHILONE B FOR THE MANUFACTURE OF AN ANTIPROLIFERATIVE PHARMACEUTICAL PREPARATION AND A COMPOSITION COMPRISING EPOTHILONE B AS AN IN VIVO ANTIPROLIFERATIVE AGENT |
-
2000
- 2000-02-25 WO PCT/US2000/004879 patent/WO2000050022A2/en not_active Application Discontinuation
- 2000-02-25 EP EP00914713A patent/EP1154819A2/en not_active Withdrawn
- 2000-02-25 CA CA002366697A patent/CA2366697A1/en not_active Abandoned
- 2000-02-25 AU AU36067/00A patent/AU3606700A/en not_active Abandoned
- 2000-02-25 JP JP2000600634A patent/JP2002537328A/en active Pending
Also Published As
| Publication number | Publication date |
|---|---|
| AU3606700A (en) | 2000-09-14 |
| WO2000050022A2 (en) | 2000-08-31 |
| JP2002537328A (en) | 2002-11-05 |
| EP1154819A2 (en) | 2001-11-21 |
| WO2000050022A3 (en) | 2001-02-01 |
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