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
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
  • A61K31/52—Purines, e.g. adenine
  • A61K31/522—Purines, e.g. adenine having oxo groups directly attached to the heterocyclic ring, e.g. hypoxanthine, guanine, acyclovir
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
  • A61K9/0021—Intradermal administration, e.g. through microneedle arrays, needleless injectors
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention relates to methods and pharmaceutical preparations for contributing to the treatment of chemotherapy-induced (e.g., cisplatin-induced) neuropathy.
• chemotherapy-induced e.g., cisplatin-induced
• chemotherapeutic agents are vital to cancer treatment, their use may be limited by side effects such as neuropathy, which may result in at least a partial loss of bodily sensation.
• An example of one such chemotherapy agent is cisplatin, which is used extensively in the treatment of several types of cancers including bladder, testicular and ovarian tumors (Williams et al., (1979) Br. Med. J. 1 : 1689-1691 ). While cisplatin can provide beneficial effects in the treatment of cancers, the total dose that can be administered is limited by its toxic effects in the peripheral nervous system (Mollman, (1990) N. Engl. J. Med 322: 126-127).
• a variety of agents have shown potential activity as nerve protectants against cisplatin-induced nerve damage in clinical trials.
• Some of these agents include an ACTH 4-9 fragment with growth factor activity (ORG2766) (Gerritsen et al., (1990) N. Engl. J. Med. 322: 89-94), and the thiols amifostine (Kemp et al., (1996) J. Clin. Oncol. 14: 2101-2112) and glutathione (Pirovano et al., (1992) Tumori 78: 253-257).
• compounds such as nerve growth factor (Apfel et at., (1992) Ann. Neurol.
• neurotrophin-3 (Gao et al., (1995) Ann. Neurol. 38 (1 ): 30-37) and glutamate (Boyle et ai, (1999) J. NeuroOncol. 41 : 107-116) have shown an ability to help prevent nerve damage caused by cisplatin. While all of these agents have shown the potential to aid in the prevention of cisplatin-induced nerve damage, there remains a need for additional agents that can achieve this function. The present invention provides such an agent.
• the present invention is directed to compositions that contain leteprinim (in any of its various forms including salts and acids of leteprinim) and their use to contribute to the prevention of chemotherapy-induced (e.g., cisplatin-induced) nerve damage in cancer patients.
• the present invention also provides methods of administering leteprinim and leteprinim formulations to help mitigate chemotherapy-induced neuropathy.
• the present invention encompasses methods and pharmaceutical preparations that can be used to contribute to the prevention of chemotherapy-induced (e.g., cisplatin-induced) nerve damage.
• one embodiment according the present invention includes a method comprising administering leteprinim (SPI-082) to a patient thereby contributing to the treatment of chemotherapy-induced neuropathy.
• Another one embodiment according the present invention includes a method comprising administering leteprinim (SPI-082) to a patient thereby contributing to the treatment of cisplatin-induced neuropathy.
• Another method according to the present invention comprises administering a chemotherapeutic (e.g., cisplatin) to contribute to the treatment of a cancer and administering leteprinim thereby contributing to the treatment of chemotherapeutic-induced (e.g., cisplatin-induced) neuropathy.
• Another method according to the present invention comprises administering cisplatin to contribute to the treatment of a cancer and administering leteprinim thereby contributing to the treatment of cisplatin-induced neuropathy.
• leteprinim administration may precede the beginning of treatment with a chemotherapeutic (e.g., cisplatin) or leteprinim administration may begin after the beginning of treatment with a chemotherapeutic (e.g., cisplatin).
• a chemotherapeutic e.g., cisplatin
• leteprinim may be administered, without limitation, less than once per day on a weekly basis (i.e., up to six times per seven day week), more preferably twice weekly (i.e., twice per seven day week).
• a chemotherapeutic may be administered, without limitation, from any effective amount up to its toxic amount.
• cisplatin may be administered twice weekly.
• leteprinim and chemotherapeutic (e.g., cisplatin) administration also may occur substantially simultaneously.
• leteprinim and the chemotherapeutic (e.g., cisplatin) can be part of different or part of the same pharmaceutical preparations.
• Appropriate doses of leteprinim may include, without limitation, from about 25 mg/kg to about 100 mg/kg, e.g., about 50 mg/kg.
• leteprinim and, optionally, another active agent(s) may be formulated as a suspension, optionally, a buffered suspension.
• Embodiments of the present invention also include pharmaceutical preparations comprising leteprinim wherein the pharmaceutical preparation is sold with instructional information that directs the administration of the pharmaceutical preparation to contribute to the treatment of a chemotherapeutic-induced (e.g., cisplatin-induced) neuropathy.
• the instructional information will direct the administration of the leteprinim in a manner of one or more of the above-described methods.
• the pharmaceutical preparations accompanied by such instructional information can include leteprinim as the only active ingredient or can further comprise at least one other active agent (e.g., a chemotherapeutic like cisplatin). These pharmaceutical preparations also may include other active or inactive ingredients.
• compositions according to the present invention can also include those comprising chemotherapeutic (e.g., cisplatin) and leteprinim wherein the chemotherapeutic in the pharmaceutical preparation is intended to contribute to the treatment of a cancer and the leteprinim is intended to contribute to the treatment of cisplatin-induced neuropathy.
• chemotherapeutic e.g., cisplatin
• leteprinim e.g., cisplatin
• FiG. 1 shows the effect of leteprinim on cisplatin-induced changes in body weight.
• FIG. 2 shows the effect of leteprinim on cisplatin-induced changes in sensory perception as measured in a hot piate paradigm.
• FIGS. 3 and 4 show the effect of leteprinim on cisplatin-induced changes in H- wave amplitude and latency respectively.
• [00012JFIG. 5 shows the effect of leteprinim on cisplatin-induced changes in sensitive nerve conduction velocity (SNCV).
• FIG. 6 shows the effect of leteprinim on cisplatin-induced changes in axon diameter.
• FIG. 7 shows the effect of leteprinim on cispiatin-induced changes in g-ratio.
• FIG. 8 shows the effect of leteprinim on changes in the proportion of degenerated to non-degenerated fibers following cisplatin administration
• Instructional Information shall mean material accompanying a pharmaceutical preparation that provides a description of how to administer the pharmaceutical preparation. This instructional information generally is regarded as the "label" for a pharmaceutical preparation. Instructional information can come in many forms including, without limitation, a paper insert, c.d. rom or directions to a web site containing information relating to the pharmaceutical preparation.
• Prodrug shall mean compounds that transform rapidly in vivo to a compound useful in the invention, for example, by hydrolysis.
• prodrugs shall mean compounds that transform rapidly in vivo to a compound useful in the invention, for example, by hydrolysis.
• a thorough discussion of prodrugs is provided in Higuchi et al., Prodrugs as Novel Delivery Systems, Vol. 14, of the A.C.S.D. Symposium Series, and in Roche (ed.), Bioreversible Carriers in Drug Design, American Pharmaceutical Association and Pergamon Press, 1987.
• Substantially Simultaneously As used herein, the term “substantially simultaneously” shall mean that two pharmaceutical preparations (i.e. leteprinim and cisplatin) are administered at the same time.
• treat should be read to include exactly simultaneously as well as within about ten minutes.
• Treat, Treatment and Contributing to the Treatment Of shall mean preventing, inhibiting, slowing, or partially or fully reversing the development of nerve damage following cisplatin administration.
• the terms include preventing, retarding the progression or growth of, shrinking, or eliminating a cancer including a solid tumor. As such, these terms include both medical therapeutic and/or prophylactic administration, as appropriate.
• the term "twice weekly" means that a pharmaceutical preparation is administered twice within a 7-day period. Generally, these administrations will be evenly spaced over the course of the 7-day period but this feature is not required and the two administrations can occur with any spacing between them over the course of the 7-day period.
• leteprinim refers to N-4-carboxyphenyl-3-(6- oxohydropurin-9-yl) propanamide and its various forms (e.g., leteprinim acid and salt forms). Leteprinim also variously is known as AIT-082, SPI-082, and SPl-205.
• the leteprinim compositions and methods of the present invention may be used to treat peripheral neuropathy associated at least in part with the administration of any chemotherapeutic agent(s).
• chemotherapeutic classes include, but are not limited to, podophyllotoxins, terpenoids (e.g., taxanes and vinca alkaloids), antimetabolites, anthracyclines, alkylating agents (e.g., platins), and other anti-tumour agents.
• Vinca alkaloids include, among others, vincristine vinblastine, vinorelbine, and vindesine.
• chemotherapeutic agents include, but are not limited to, etoposide, teniposide, cisplatin, carboplatin, oxaliplatin, paclitaxel, docetaxel, suramin, altretamine, chlorambucil, cytarabine, dacarbazine, docetaxel, etoposide, fludarabine, ifosfamide with mesna, tamoxifen, teniposide, and thioguanine.
• Peripheral neuropathy associated with the administration of oncolytic drugs is described in C. M. Haskell, "Cancer Treatment” ( ⁇ .sup.th Ed., W. B. Saunders, Philadelphia, 2001 ), Ch.
• the present invention is directed to treating drug-induced peripheral neuropathy associated with the administration of vinca alkaloids (e.g., vincristine), taxanes (e.g., paclitaxel/Taxol ® ), or alkylating agents (e.g., cisplatin).
• vinca alkaloids e.g., vincristine
• taxanes e.g., paclitaxel/Taxol ®
• alkylating agents e.g., cisplatin
• the present invention is directed to treating drug-induced peripheral neuropathy associated with the administration of cisplatin.
• Cisplatin is an antitumor agent widely used in the treatment of many common and therapeutically refractory tumors. Cisplatin is useful as an anticancer agent due to its effects as a DNA synthesis inhibitor which hinders cell division.
• neuropathy i.e.
• Cisplatin neuropathy affects predominantly large fibers sensory neurons and is generally associated with a reduction in the signal amplitude of the sensory nerves, resulting in a profound disabling sensory ataxia. This neuropathy can continue to progress after cessation of cisplatin treatment.
• the present invention shows that leteprinim can contribute to the treatment or prevention of cisplatin-induced nerve damage.
• the leteprinim compositions of the present invention may be administered in various doses and regimens to provide effective treatments. What constitutes an effective amount of the selected leteprinim composition will vary based upon factors including, but not limited to, the activity of the chemotherapeutic compound, the patient's physiology, the patient's disease or condition, and the method/frequency/mode of administration of the leteprinim and/or the chemotherapeutic agent(s). Initially, the dosage and dosing regimen may be modulated to determine the optimum dosage for a particular patient.
• Minimum leteprinim dosage concentrations (drug weight to patient weight) effective in mitigating chemotherapeutic-induced neuropathy are about 25 mg/kg, about 30 mg/kg, about 35 mg/kg, about 40 mg/kg, or about 45 mg/kg.
• Maximum dosage concentrations effective in mitigating chemotherapeutic-induced neuropathy are about 100 mg/kg, 75 mg/kg, about 65 mg/kg, about 60 mg/kg, or about 55 mg/kg.
• One dosage concentration effective in mitigating chemotherapeutic-induced (e.g., cisplatin- induced) neuropathy is about 50 mg/kg.
• the leteprinim compositions may be administered less than once per day weekly based on a seven day week (e.g., three to six times per week), or twice per week. Regardless of the regimen, the time interval between administrations need not, but may, be equal.
• the leteprinim compositions may be administered using a number of different routes including orally, topically, transdermal ⁇ , intraperitoneal ⁇ , subcutaneously, or intravenously. Effective amounts of the compounds also may be administered through injection into the cerebrospinal fluid or infusion directly into the brain. In one embodiment, the mode of administration is subcutaneous administration.
• the methods of the present invention may be affected using leteprinim administered to a patient (e.g., mamma! in need of treatment) either alone or as a pharmaceutical formulation. Further, the leteprinim may be combined with pharmaceutically acceptable excipients and carrier materials such as inert solid diluents, aqueous solutions or non-toxic organic solvents.
• these pharmaceutical formulations may also contain preservatives and stabilizing agents and the like, as well as minor amounts of auxiliary substances such as wetting or emulsifying agents, as well as pH buffering agents and the like which enhance the effectiveness of the active ingredient.
• the pharmaceutically acceptable carrier can be chosen from those generally known in the art, including, but not limited to, human serum albumin, ion exchangers, dextrose, alumina, lecithin, buffer substances such as phosphate, glycine, sorbic acid, potassium sorbate, propylene glycol, polyethylene glycol, and salts or electrolytes such as protamine sulfate, sodium chloride, or potassium chloride. Other carriers can be used.
• Liquid compositions may also contain liquid phases either in addition to or to the exclusion of water.
• additional liquid phases are glycerin, vegetable oils such as cottonseed oil, organic esters such as ethyl oleate, and water-oil emulsions.
• the leteprinim formulation may be an optionally buffered hydrophobic suspension
• the leteprinim formulation may be an optionally buffered lipid suspension.
• the formulations may be buffered with conventional buffers (e.g., acids or salts).
• the formulation is buffered with, for example, a salt or acid form of leteprinim (e.g., potassium salt form of leteprinim).
• the leteprinim formulation is a lipid suspension buffered with the potassium salt form of leteprinim.
• Animals were housed 2 per cage and maintained in a room with controlled temperature (21-22°C) and a reversed light-dark cycle (12h/12h) with food and water available ad libitum. All experiments were carried out in accordance with institutional guidelines.
• Electrophysiological recordings were performed using a Neuromatic 2000M electromyograph (EMG) (Dantec, Les Ulis, France). Rats were anaesthetized by i.p. injection of 60 mg/kg ketamine chlorhydrate (Imalgene 500, Rhone Merieux, Lyon, France) and 4 mg/kg hyaline (Rompum 2%, Bayer Pharma, Kiel, Germany). Normal body temperature was maintained at 30 0 C with a heating lamp and controlled by a contact thermometer (Quick, Bioblock Scientific, lllkirch, France) placed on the tail surface.
• EMG Neuromatic 2000M electromyograph
• H-wave reflex was recorded in the hind footpad muscle after stimulation of the sciatic nerve.
• a reference electrode and a ground needle were placed on the lower back of the rat.
• the sciatic nerve was stimulated with a single 0.2 ms pulse at supramaximal intensity.
• the amplitude (mV) and the latency of H waves were recorded.
• Sensitive nerve conduction velocity (SNCV) was also recorded.
• the tail skin electrodes were placed as follows: a reference needle inserted at the base of the tail and an anode needle placed 30 mm away from the reference needle towards the extremity of the tail, A ground needle electrode was inserted between the anode and reference needles.
• the caudal nerve was stimulated with a series of 20 pulses (for 0.2 ms) at an intensity of 12.8 mA. The velocity was expressed in m/s,
• the nerve samples were post-fixed in a 1 % osmium tetroxide (Sigma, L'lsle d'Abeau-Chesnes, France) solution in phosphate buffer solution for 2 h, dehydrated in serial alcohol solution, and embedded in Epon. Embedded tissues were then placed at +70 0 C during 3 days to allow the polymerization of tissue wax. Transverse sections of 1.5 ⁇ m were cut with a microtome, stained with a 1 % toluidine blue solution (Sigma, L'lsle d'Abeau-Chesnes, France) for 2 min, dehydrated and mounted in Eukitt.
• a 1 % osmium tetroxide Sigma, L'lsle d'Abeau-Chesnes, France
• Body weight was compared over the course of the experiment by two-way analysis of variance (ANOVA). Behavioral, electrophysiological and histological data were analyzed for each individual timepoint by ANOVA, followed by Fisher Protected Least Significant Difference as post-hoc tests (PLSD). The level of significance was set at p ⁇ 0.05. Results are expressed as mean ⁇ standard error of the mean (s.e.m,). RESULTS 1. Body weight
• Figure 2 shows that from week 2 onwards, rats from the cisplatin alone treatment group demonstrated a significant increase in threshold latency scores as compared to the control groups (p ⁇ 0.05, Fisher's PLSD test). The most severe dysfunction was observed at week 4 (the last week of cisplatin administration) with a time score of about 30% above control groups. Even at the end of the study, animals from the cisplatin alone treatment group did not recover to the performance level of control animals.
• Cisplatin rats treated with leteprinim acid or with leteprinim K salt demonstrated improved H-wave performance when compared to the cisplatin alone treatment group. These differences were evident as early as week 2, At week 4 where the loss of H-wave amplitude was maximal in the cisplatin alone treatment group, cisplatin rats receiving leteprinim showed H-wave amplitudes about only 20% below the control values. By week 5, cisplatin rats treated with leteprinim recovered to the H-wave score of control rats. These results also demonstrate that leteprinim can help to prevent or alleviate physiological changes associated with cisplatin administration. b. Latency of H wave
• Figure 4 shows a significant extension of H-wave latency in the cisplatin alone treatment group starting from week 2 as compared to that of control rats (p ⁇ 0.05, Fisher's test). The most severe alteration was observed at week 4 with a latency score extended by about 12%. Cisplatin alone-treated rats fully recovered on this measure by week 7.
• a method of the present invention can be accomplished using active ingredients as described above, or as a physiologically acceptable salt, derivative, prodrug, or solvate thereof.
• the active ingredients can be administered as the neat compound, or as a pharmaceutical preparation containing either or both entities.
• the pharmaceutical preparations include those wherein the active ingredients are administered in an effective amount to achieve their intended purpose. More specifically, a "therapeutically effective amount” means an amount effective to prevent development of, to eliminate, to retard the progression of, or to reduce the size of a solid tumor. Determination of a therapeutically effective amount is well within the capability of those skilled in the art, especially in light of the detailed disclosure provided herein.
• a “therapeutically effective dose” refers to that amount of the active ingredients that results in achieving the desired effect. Toxicity and therapeutic efficacy of such active ingredients can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., determining the LD 5O (the dose lethal to 50% of the population) and the ED 50 (the dose therapeutically effective in 50% of the population). The dose ratio between toxic and therapeutic effects is the therapeutic index, which is expressed as the ratio between LD5 0 and ED 5 0. A high therapeutic index is preferred. The data obtained can be used in formulating a range of dosage for use in humans. The dosage of the active ingredients preferably lies within a range of circulating concentrations that include the ED 50 with little or no toxicity. The dosage can vary within this range depending upon the dosage form employed, and the route of administration utilized.
• the amount of pharmaceutical preparation administered can be dependent on the subject being treated, on the subject's weight, the severity of the affliction, the manner of administration, and the judgment of the prescribing physician.
• the active ingredients can be administered alone, or in admixture with a pharmaceutical carrier selected with regard to the intended route of administration and standard pharmaceutical practice.
• Pharmaceutical preparations for use in accordance with the present invention thus can be formulated in a conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries that facilitate processing of the active ingredients into preparations which can be used pharmaceutically.
• the preparation can be in the form of a pyrogen-free, parenterally acceptable aqueous solution.
• parenterally acceptable solutions having due regard to pH, isotonicity, stability, and the like, is within the skill in the art.
• a preferred preparation for intravenous injection typically will contain an isotonic vehicle although this characteristic is not required.
• the active ingredients are administered as a suitably acceptable formulation in accordance with normal veterinary practice.
• the veterinarian can readily determine the dosing regimen that is most appropriate for a particular animal.

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