Classifications

• • 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
  • A61K31/568—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 substituted in positions 10 and 13 by a chain having at least one carbon atom, e.g. androstanes, e.g. testosterone
  • A61K31/5685—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 substituted in positions 10 and 13 by a chain having at least one carbon atom, e.g. androstanes, e.g. testosterone having an oxo group in position 17, e.g. androsterone
• • 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
  • A61K31/566—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 having an oxo group in position 17, e.g. estrone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
  • A61P19/10—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease for osteoporosis

Definitions

• the present invention relates to methods for modulating disrupted balance between bone resorption and bone formation in a woman with natural or induced postmenopausal.
• the method comprises administering to such woman in need thereof a therapeutically effective amount of exemestane or 17-hydro-exemestane, either alone or in combination with a further biologically active compound.
• the present invention also provides pharmaceutical compositions and kits useful for carrying out these methods.
• Osteoporosis is a systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a subsequent increase in bone fragility and susceptibility to fracture.
• Post-menopausal osteoporosis is a chronic disease which affects millions of women throughout the world and it has an enormous economical and social impact on society. Bone loss in the spine after menopause occurs at a rate of 2% per year. Bone metastasis results from spreading of primary tumours to bone, where the cancer cells can interfere with the normal bone remodelling process through local regulation of osteoblast and/or osteoclast activities.
• Agents such as calcitonin and bisphosphonates are able to suppress bone resorption and have been used for prevention and treatment of osteoporosis and or osteolyticytic bone metastasis.
• steroid hormones especially oestrogen
• these therapeutic agents fail to achieve satisfactory effects in some cases, due to subject limitation or uncertain efficacy, and particularly for preventive medication in osteoporosis risk groups compliance is low.
• there is not yet a curative treatment for bone metastasis and all currently used measures for bone metastatic patients are of palliative type. There is therefore need for a new prophylactic/therapeutic method for preventing and treating accentuated bone resorption in postmenopausal and oophorectomized women.
• exemestane and 17-hydro- exemestane are able to modulate, and thus normalise, deranged balance between bone resorption and bone formation in a woman with natural or induced post-menopausal. In this way, in particular, a reduction in progression of bone resorption and bone fragility is provided and the conditions of such patient can be improved.
• a first object of the present invention is to provide a method for normalize disrupted balance between bone resorption and bone formation, in a postmenopausal or oophorectomized woman in need of such treatment, by administering to said woman a therapeutically effective amount of exemestane or 17-hydro-exemestane.
• a further object is to provide a method for preventing and treating abnormal metabolic bone disorders in a postmenopausal or oophorectomized woman in need of such treatment, by administering to said woman a therapeutically effective amount of exemestane or 17-hydro-exemestane.
• abnormal metabolic bone disorders means in particular a disease status wherein deranged balance between bone resorption and bone formation causes a degree of bone resorption that exceeds the bone formation, either locally, or in the skeleton as a whole, thus resulting in bone loss and bone fragility.
• metabolic bone disorders include, but are not limited to, osteoporosis, periprosthetic bone loss or osteolysis, and osteolytic bone metastasis. The preferred example being osteoporosis.
• the invention also provide a method of using these compounds in a pharmaceutical composition suitable therefore in the treatment of the above diseases.
• exemestane or 17-hydro-exemestane may be used in combination therapy with other therapeutic agents thus providing a beneficial effect on bone mass.
• the present invention also provides a method for normalize disrupted balance between bone resorption and bone formation, in a postmenopausal or oophorectomized woman in need of such treatment, by administering simultaneously, separatey or sequentially to said woman exemestane or 17-hydro-exemestane and a further therapeutic agent, in amounts and close in time to achieve a therapeutically useful effect.
• a further object of the present invention is to provide a method for preventing and treating abnormal metabolic bone disorders in a postmenopausal or oophorectomized woman in need of such treatment by administering simultaneously, separatey or sequentially to said woman exemestane or 17-hydro-exemestane and a further therapeutic agent, in amounts and close in time to achieve a therapeutically useful effect.
• oophorectomized woman is meant to include both patients who underwent surgery oophorectomy and patients who underwent “medical” oophorectomy induced e.g. by GnRH agonists, for instance triptorelin, leuprorelin or goserelin.
• GnRH agonists for instance triptorelin, leuprorelin or goserelin.
• terapéuticaally effective amount means that amount of exemestane, 17-hydro-exemestane and, if the case, of the "further therapeutic agent” that is able to elicit “a therapeutically useful effect”. Namely an amount that is able to normalise deranged balance between bone resorption and bone formation.
• normalise as used herein, in particular is therefore meant a method of slowing, stopping or inhibiting bone resorption, and recovering bone formation.
• exemestane or 17-hydro-exemestane and the "further therapeutic agent” are administered during the same day in either order.
• the invention also provides the use of exemestane or 17-hydro-exemestane in the manufacture of a medicament for normalize disrupted balance between bone resorption and bone formation, in a postmenopausal or oophorectomized woman.
• a further object of the present invention is to the use of exemestane or 17-hydro- exemestane in the manufacture of a medicament for preventing and treating abnormal metabolic bone disorders in a postmenopausal or oophorectomized woman
• the present invention also provides the use of exemestane or 17-hydro-exemestane in the manufacture of a medicament for preventing and treating abnormal metabolic bone disorders in a postmenopausal or oophorectomized woman undergoing a simultaneous, separate or sequential treatment with another therapeutic agent.
• the combination preparation according to the invention can also include combination packs or compositions in which the constituents are placed side by side and can be administered simultaneously, separately of sequentially to one and the same woman. Accordingly, exemestane, 17-hydro-exemestane and the additional therapeutic agent may be present within a single or distinct container.
• the inventors of the present invention have also found that prevention and control of the above mentioned disorders by combined administration of a therapeutically effective amount of exemestane or 17-hydro-exemestane and a therapeutically effective amount of a further therapeutic agent, can produce a therapeutic effect which is greater than that obtainable by single administration of a therapeutically effective amount of either sole exemestane or 17-hydro-exemestane or the sole "additional" therapeutic agent. Namely, such combined therapy provides a synergistic or superadditive therapeutic effect.
• Product exemestane is compound 6-methylenandrost-l,4-diene-3,17-dione which is known for instance from US Pat. No. 4,808,616.
• Product 17-hydro-exemestane is compound 6-methylenandrost-l,4-diene-17 ⁇ -ol-3-one, which is an active metabolite of exemestane and is known from EP 307135.
• Compound 6-methylenandrost-l,4-diene-17 ⁇ -ol-3-one can be salified with a pharmaceutically acceptable base, as described in EP 307135, in particular as sodium or potassium salt.
• a pharmaceutically acceptable base as described in EP 307135, in particular as sodium or potassium salt.
• 17-hydro-exemestane refers to such compound both as a free acohol and as a pharmaceutically acceptable salt thereof.
• the "additional" therapeutic agent for combination therapy with exemestane or 17- hydro-exemestane of the above mentioned bone disorders, is for instance an agent selected from the group costing of a selective estrogen receptor modulator (SERM), an ⁇ v ⁇ 3 inhibitor or antagonist, a vitamin D or a vitamin D derivative, sodium fluoride, a COX-2 inhibitor and a biphosphonate compound, or a mixture thereof.
• SERM selective estrogen receptor modulator
• ⁇ v ⁇ 3 inhibitor or antagonist a vitamin D or a vitamin D derivative
• sodium fluoride a COX-2 inhibitor and a biphosphonate compound, or a mixture thereof.
• a therapeutic agent mixture, according to the invention, which can be administered in combination with exemestane or 17-hydro-exemestane can comprise one or more, preferably 2 to 4, in particular 2 to 3, therapeutic agents as defined above.
• a vitamin D is e.g. ergocalciferol or cholecalciferol.
• a vitamin D derivative is e.g. 1,25- dihydrocalciferol (calcitrol) or Roche Bioscience compound Ro-26-9228.
• a selective estrogen receptor modulator is for instance raloxifene, tamoxifen, toremifene, arzoxifene, idoxifene, fulvestrant , droloxifene and Universite Laval compound EM-800 i.e. propanoic acid, 2,2-dimethyl-,4-[(2S)-7-(2,2-dimethyl-l- oxopropoxy)-4-methyl-2-[4-[2-(l- ⁇ iperidinyl)ethoxy]phenyI]-2H-l-benzopyran-3- yljphenyl ester.
• An av ⁇ 3 integrin inhibitors or antagonists is for instance selected from Vitaxin antibody (Ixsys); cilengitide i.e. (cyclo[RGDf-N(Me)V-] (Merck); GlaxoSmithKline compound SB-273005; Aventis compound HMR 1392; Merck compound L 806977;
• a biphosphonate compound is for instance selected from alendronic acid , alendronate, cimadronate, clodronoc acid, clodronate, Leo Pharmaceutical Products compound EB- 1053, etidronic acid, etidronate, ibandronate, neridronate, olpadronate, pamidronate, piridronate, risedronate, tiludronate and zolendronate or a pharmaceutically acceptable salt thereof and mixtures thereof.
• alendronate Preferably it is selected from alendronate, cimadronate, clodronate, tiludronate, etidronate, ibandronate, neridronate, risedronate, piridronate, pamidronate and pamidronate or a pharmaceutically acceptable salt thereof.
• These compounds are known for instance from WO 01/15703.
• a COX-2 inhibitor is for instance celecoxib, rofecoxib, parecoxib and valdecoxib, in particular celecoxib.
• the present data show the potent effect of exemestane in preventing bone loss.
• exemestane and 17-hydro-exemestane are expected to be useful in preventing and treating abnormal metabolic bone disorders in a postmenopausal or oophorectomized woman, in particular, undergoing adjuvant cancer therapy or chemoprevention.
• administered or “administering” as used herein is meant any acceptable manner of administering a drug to a patient which is medically acceptable including parenteral, oral and rectal administration.
• parenteral is meant intravenous, subcutaneous, intra-nasal, pulmonary, intradermal or intramuscular administration.
• Oral administration includes administering exemestane, 17-hydro-exemestane or, if the case, the constituents of the combined preparation in a suitable oral form such as, e.g., tablets, capsules, suspensions, solutions, emulsions, powders, syrups and the like.
• a suitable oral form such as, e.g., tablets, capsules, suspensions, solutions, emulsions, powders, syrups and the like.
• the actual preferred method and order of administration of the combined preparations of the invention may vary according to, inter alia, the particular pharmaceutical formulation of exemestane or 17-hydro-exemestane being utilized, the particular pharmaceutical formulation of the additional therapeutic being utilized, the particular metabolic bone disorder to be prevented or treated and the particular patient being treated.
• exemestane or 17-hydro-exemestane may thus be administered simultaneously or concomitantly with the further therapeutic agent or the compounds may be admimstered sequentially, in either order.
• the compounds are administered concomitantly during the same day in either order.
• the dosage ranges for the administration of exemestane, 17-hydro-exemestane and, if the case, the additional therapeutic agent in order to achieve a therapeutically useful effect may vary with the age, condition and extent of the disease in the patient and can be determined by one of skill in the art.
• exemestane for instance can be administered orally in a dosage range varying from about 2.5 mg daily to about 600 mg daily, in particular from about 10 to about 50, more preferably from about 10 to about 25 mg daily, or parenterally in a dosage ranging from about 50 to about 500 mg per injection.
• 17-hydro-exemestane for instance can be administered orally in a dosage range varying from about 0.25 to about 100 mg, in particular from about 0.5 mg daily to about 50 mg , more preferably from about 1 to about 5 mg daily, or parenterally in a dosage ranging from about 5 to about 50 mg per injection.
• a therapeutically effective amount of another therapeutic agent means an amount of a compound, which when administered in combination with exemestane or
• 17-hydro-exemestane is effective to prevent or treat abnormal metabolic bone disorders, as herein defined. Such amount is well within the capability of those skilled in the art.
• 1,25-dihydrocalciferol calcitrol
• sodium fluoride for instance an amount ranging from about 0.5 to about 2.5 mg/day can be administered.
• ⁇ v/33 integrin inhibitors or antagonists for instance an effective amount of compound SD 7784 is from about 10 to about 300 mgkg, preferably per os, in particular from about 20 to about 200 mg/kg.
• a selective estrogen receptor modulator can be administered in a dosage according to the common practice, e.g. in a dosage of about 0.1 to about 30 mg g body weight per day.
• An effective amount of tamoxifen may be in the range of about 10 to about 40 mg/day.
• An effective amount of fulvestrant may be in the range of about 50 mg to about
• An effective amount of raloxifen may be in the range of about 5 to about 350 mg/day, in particular about 60 mg/day.
• a biphosphonate compounds, for instance alendronate can be administered at a dosage ranging from about 3 mg to about 250 mg, depending on dosing interval, in particular from about 5 to about 20 mg/day.
• An effective amount of a COX-2 inhibitor may be in the range of about 0.1 to about 2000 mg, preferably in the range of about 0.5 to about 500 and most preferably between about 1 and about 200 mg.
• a daily dosage of about 0.01 to about 100 mg/Kg boyd weight, preferably between about 0.1 and about 50 mg Kg body weight may be appropriate.
• the daily dosage can be administered in one to four doses per day. More particularly, as to celecoxib a dosage from about 50 to about 500 mg, in particular about 200 mg, once or twice a day may be appropriate.
• the dosage normally ranges from about 12.5 to about 50 mg/day.
• the route of administration is preferably systemic e.g. oral or parenteral, in particular intravenous or intramuscularly.
• a pharmaceutically composition containing exemestane and/or another therapeutic agent according to the invention can be prepared according to well known techniques to those skilled in the art.
• a pharmaceutical composition containing exemestane or 17-hydro- exemestane can be prepared according to US 4,808,616 or EP 307135, respectively.

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  • 2002-09-30 IL IL16116202A patent/IL161162A0/xx unknown
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