Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
  • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
  • A61K51/04—Organic compounds
  • A61K51/08—Peptides, e.g. proteins, carriers being peptides, polyamino acids, proteins
  • A61K51/088—Peptides, e.g. proteins, carriers being peptides, polyamino acids, proteins conjugates with carriers being peptides, polyamino acids or proteins
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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  • A61K51/04—Organic compounds
  • A61K51/0497—Organic compounds conjugates with a carrier being an organic compounds
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
  • A61K47/542—Carboxylic acids, e.g. a fatty acid or an amino acid
• • A—HUMAN NECESSITIES
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  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
  • A61K47/545—Heterocyclic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
  • A61K47/547—Chelates, e.g. Gd-DOTA or Zinc-amino acid chelates; Chelate-forming compounds, e.g. DOTA or ethylenediamine being covalently linked or complexed to the pharmacologically- or therapeutically-active agent
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
  • A61K47/548—Phosphates or phosphonates, e.g. bone-seeking
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/62—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being a protein, peptide or polyamino acid
  • A61K47/64—Drug-peptide, drug-protein or drug-polyamino acid conjugates, i.e. the modifying agent being a peptide, protein or polyamino acid which is covalently bonded or complexed to a therapeutically active agent
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
  • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
  • A61K51/04—Organic compounds
  • A61K51/0402—Organic compounds carboxylic acid carriers, fatty acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
  • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
  • A61K51/04—Organic compounds
  • A61K51/041—Heterocyclic compounds
  • A61K51/044—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine, rifamycins
  • A61K51/0453—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine, rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
  • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
  • A61K51/04—Organic compounds
  • A61K51/041—Heterocyclic compounds
  • A61K51/044—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine, rifamycins
  • A61K51/0455—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine, rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
  • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
  • A61K51/04—Organic compounds
  • A61K51/0474—Organic compounds complexes or complex-forming compounds, i.e. wherein a radioactive metal (e.g. 111In3+) is complexed or chelated by, e.g. a N2S2, N3S, NS3, N4 chelating group
  • A61K51/0482—Organic compounds complexes or complex-forming compounds, i.e. wherein a radioactive metal (e.g. 111In3+) is complexed or chelated by, e.g. a N2S2, N3S, NS3, N4 chelating group chelates from cyclic ligands, e.g. DOTA
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
  • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
  • A61K51/04—Organic compounds
  • A61K51/0489—Phosphates or phosphonates, e.g. bone-seeking phosphonates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents

Definitions

• the present invention relates to a smart drug delivery system and a pharmaceutical kit for dual nuclear medicine-cytotoxic theranostics.
• the smart drug delivery system includes
• Chel a residue of a chelator for complexing a radioisotope
• CT a residue of a cytotoxic compound
• TV a biological targeting vector
• LI and L each a linker
• S1, S2 and S are each a spacer.
• the pharmaceutical kit consists of
• Chel a residue of a chelator for complexing a radioisotope
• CT a residue of a cytotoxic compound
• TV a biological targeting vector
• LI and L each a linker
• S1, S2 and S are each a spacer.
• Cytotoxic pharmaceuticals such as doxorubicin have been used in chemotherapy for decades.
• the cytotoxic pharmaceutical is administered intravenously, orally or peritoneally in a relatively high dose.
• cytotoxic pharmaceuticals also damage healthy tissue, especially cells with a high division rate, and cause severe, sometimes life-threatening side effects, which often force treatment to be discontinued.
• targeting vectors conjugated with the cytotoxic agent.
• the targeting vectors are usually agonists (substrates) or antagonists (inhibitors) of membrane-bound proteins which are strongly overexpressed on the envelope of tumor cells in comparison to healthy body cells.
• Targeting vectors include simple organic compounds, oligopeptides with natural or derivatized amino acids, and aptamers.
• PET positron emission tomography
• SPECT single photon emission computed tomography
• the nuclear medical imaging diagnosis and treatment (theranostics) of cancer supports and complements chemotherapy.
• tumor cells are marked or irradiated with a radioactive isotope, such as 68 Ga or 177 Lu.
• Labeling precursors are used here which bind the respective radioisotope covalently ( 18 F) or coordinatively ( 68 Ga, 99m Tc, 177 Lu).
• the label precursors include in the case of metallic radioisotopes as an essential chemical component a chelator for the effective and stable complexation of the radioisotope and as a functional component a biological targeting vector that binds to target structures in tumor tissue, in particular membrane-based proteins.
• Targeting vectors with a high affinity for cancer cells are equally suitable for targeted chemotherapy as for nuclear medicine diagnostics and theranostics. Accordingly, research in these disciplines works in a complementary manner.
• a nuclear medicine marker precursor complexed with a radioisotope After intravenous injection into the bloodstream, a nuclear medicine marker precursor complexed with a radioisotope accumulates on or in tumor cells. In order to minimize the radiation dose during diagnostic examinations in healthy tissue, a small amount of a radioisotope with a short half-life of a few hours to days is used.
• the configuration and chemical properties of the targeting vector are modified by the chelator and, as a rule, its affinity for tumor cells is strongly influenced. Accordingly, the coupling between the chelator and the at least one targeting vector is tailored in complex trial-and-error experiments or so-called biochemical screenings. A large number of marker precursors comprising the chelator and a targeting vector are synthesized and in particular the affinity for tumor cells is quantified. The chelator and the chemical coupling with the targeting vector are decisive for the biological and nuclear medicine potency of the respective marker precursor.
• the label precursor In addition to a high affinity, the label precursor must meet other requirements, such as
• prostate cancer is the most common cancer and the third most common fatal cancer. Tumor growth is slow in this disease, and if diagnosed at an early stage, the 5-year survival rate is close to 100%. If the disease is only discovered after the tumor has metastasized, the survival rate drops dramatically. Too early and too aggressive an approach to the tumor can in turn unnecessarily impair the patient's quality of life. So z. B. the surgical removal of the prostate to incontinence and Cause impotence. A reliable diagnosis and information about the stage of the disease are essential for successful treatment with a high quality of life for the patient. A widespread diagnostic tool in addition to the scanning of the prostate by a doctor is the determination of tumor markers in the patient's blood.
• PSMA prostate-specific antigen
• NAAG N-acetyl-aspartyl-glutamate
• poly folic acid
• One strategy for molecular targeting of PSMA is to use antibodies to bind to the protein structure of the PSMA.
• Another approach is to take advantage of the enzymatic activity of PSMA, which is well understood.
• In the enzymatic binding pocket of PSMA there are two Zn 2+ ions that bind glutamate. In front of the center with the two Zn 2+ ions there is an aromatic binding pocket.
• the protein is able to expand and adapt to the binding partner (induced fit), so that it can bind folic acid in addition to NAAG, whereby the pteroic acid group docks in the aromatic binding pocket.
• the use of the enzymatic affinity of PSMA enables the substrate to be absorbed into the cell (endocytosis) independent of enzymatic cleavage of the substrate.
• PSMA inhibitors are particularly well suited as targeting vectors for imaging diagnostic and theranostic radiopharmaceuticals or radiotracers.
• the radioactively labeled inhibitors bind to the active center of the enzyme, but are not converted there. The bond between the inhibitor and the radioactive label is therefore not broken. Aided by endocytosis, the inhibitor with the radioactive label is absorbed into the cell and accumulated in the tumor cells.
• Inhibitors with a high affinity for PSMA usually contain a glutamate motif and an enzymatically non-cleavable structure.
• a highly effective PSMA inhibitor is 2-phosphonomethyl-glutaric acid or 2-phosphonomethyl-pentanedioic acid (2-PMPA), in which the glutamate motif is bound to a phosphonate group that cannot be cleaved by PSMA.
• Another group of PSMA inhibitors used in the clinically relevant radiopharmaceuticals PSMA-11 (Scheme 2) and PSMA-617 (Scheme 3) are urea-based inhibitors. It has proven advantageous to address the aromatic binding pocket of PSMA in addition to the binding pocket for the glutamate motif.
• L-lysine-urea-L-glutamate (KuE) is bound to the non-aromatic chelator DOTA (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetate), there is a reduced affinity and To ascertain accumulation in tumor tissue.
• DOTA L-lysine-urea-L-glutamate
• the linker must be adapted.
• tumors comprise malignant epithelial cells and are surrounded by several non-cancerous cell populations, including activated fibroblasts, endothelial cells, pericytes, immune regulatory cells, and cytokines in the extracellular matrix.
• activated fibroblasts endothelial cells
• pericytes pericytes
• immune regulatory cells cytokines in the extracellular matrix.
• cytokines in the extracellular matrix.
• stromal cells that surround the tumor play an important role in the development, growth and metastasis of carcinomas.
• a large part of the stromal cells are activated fibroblasts, which are known as cancer-associated fibroblasts (CAFs).
• CAFs cancer-associated fibroblasts
• CAFs change their morphology and biological function. These changes are induced by intercellular communication between cancer cells and CAFs.
• CAFs create a microenvironment that favors the growth of cancer cells. It has been shown that therapies that target cancer cells alone are inadequate.
• FAP inhibitors in particular are suitable as affine biological targeting vectors for FAP marker precursors - analogously to PSMA.
• FAP exhibits bimodal activity of dipeptidyl peptidases (DPP) and prolyl oligopeptidases (PREP) catalyzed by the same active site. Accordingly, two types of inhibitors come into consideration which inhibit the DPP and / or the PREP activity of FAP.
• Known inhibitors for the PREP activity of FAP have a low selectivity for FAP.
• PREP inhibitors can also be suitable as targeting vectors despite their low FAP selectivity.
• Scheme 4 shows a DOTA-conjugated FAP label precursor in which the chelator is attached to the pharmacophoric unit ((S) -N- (2- (2-cyano-4,4-difluoropyrolidin-l-yl) -2-oxoethyl) - 6- (4-aminobutyloxy) -quinoline-4-carboxamide is coupled to the quinoline via the 4-aminobutoxy functionality.
• Bone metastases express farnesyl pyrophosphate synthase (FPPS), an enzyme in the HMG-CoA reductase (mevalonate) pathway.
• FPPS farnesyl pyrophosphate synthase
• mevalonate HMG-CoA reductase
• FPPS farnesyl pyrophosphate synthase
• the production of farnesyl an important molecule for docking signal proteins to the cell membrane, is suppressed.
• the apoptosis of carcinogenic bone cells is induced.
• FPPS is inhibited by bisphosphonates such as alendronate, pamidronate and zoledronate.
• the tracer BPAMD with the targeting vector pamidronate is regularly used in the treatment of bone metastases.
• Zoledronate (ZOL), a hydroxy bisphosphonate with a heteroaromatic N unit, has proven to be a particularly effective tracer for theranostics of bone metastases.
• Zoledronate conjugated with the chelators NODAGA and DOTA (Scheme 5) are currently the most potent radio-theranostics for bone metastases.
• WO 2015055318 A1 discloses radiotracers for the diagnosis and theranostics of prostate or epithelial carcinomas, such as, inter alia, the compound PSMA-617 shown in scheme 3.
• the present invention has the object of providing pharmaceutical compounds and pharmaceutical kits for dual nuclear medicine-cytotoxic theranostics.
• Chel a residue of a chelator for complexing a radioisotope
• CT a residue of a cytotoxic compound
• TV a biological targeting vector
• LI and L each a linker
• S1, S2 and S are each a spacer.
• the invention creates a pharmaceutical kit for dual nuclear medicine-cytotoxic theranostics, consisting of
• Chel a residue of a chelator for complexing a radioisotope
• CT a residue of a cytotoxic compound
• TV a biological targeting vector
• LI and L each a linker
• S1, S2 and S are each a spacer.
• the invention also relates to a compound for dual nuclear medicine-cytotoxic theranostics with the structure
• Chel a residue of a chelator for complexing a radioisotope CT a residue of a cytotoxic compound; TV a biological targeting vector; LI a linker; and S1 is a spacer.
• the invention also relates to a compound for dual nuclear medicine-cytotoxic theranostics with the structure
• - TV is a targeting vector that is selected from one of the structures [1] to [18] with wherein structures [1] to [8] and [18] denote amino acid sequences;
• L and LI independently have a structure selected from
• - Clv is a cleavable group
• cytotoxic compound selected from Adozelesin, Alrestatin, Anastrozole, Anthramycin, Bicalutamide, Bizelesin, Bortezomib, Busulfan,
• - CT is a residue of a cytotoxic compound, selected from the groups of active substances:
• Antimetabolites such as Capecitabine, Cytarabine, Fludarabine, Fluorouracil (5-FU), Gemcitabine, Methotrexate;
• cytostatics such as Adozelesin, Bizelesin, Busulfan, Carzelesin, Chlorambucil, Cyclophosphamide, Ifosfamide, Lomustine (CCNU), dacarbazine (DTIC), Cisplatin, Carboplatin, Mechlorethamine, Melphalan (BCNU), Temozolomid; - topoisomerase inhibitors such as etoposide (VP-16);
• Mitosis inhibitors such as Vinblastine, Vincristine, Vinorelbine, Docetaxel, Paclitaxel, Tesetaxel, Mertansine, Milataxel, Monomethylauristatin E (MMAE), Mytansinoid, Napabucasin, Saridegib;
• Antibiotics such as dactinomycin, daunorubicin, doxorubicin, duocarmycin A, duocarmycin B1, duocarmycin B2, duocarmycin CI, duocarmycin C2, duocarmycin D, duocarmycin SA, idarubicin, anthramycin, salinomycin, mitoxantrone;
• - Enzyme inhibitors such as alrestatin, anastrozole, camptothecin, L-asparaginase, motesanib;
• Antiandrogens and antiestrogens such as bicalutamide, flutamide, fulvestrant, tamoxifen, megestrol acetate;
• - PARP inhibitors such as rucaparib, olaparib, niraparib, veliparib, iniparib;
• - proteasome inhibitors such as bortezomib
• the cleavable group Clv is selected from the group comprising
• the chelator Chel is selected from the group comprising hUpypa, EDTA
• DOTA Dodeca-1, 4,7,10- tetraamine-tetraacetate
• DOTAGA 2,47,10-tetraazacyclododecane-4, 7,10) -pentanedioic acid
• TRITA trideca-l, 4,7,10-tetraamine-tetraacetate
• TETA tetradeca-l, 4,8, ll-tetraamine-tetraacetate
• NOTA Nona-l, 4,7-triamine-triacetate
• NOTA Nona-l, 4,7-triamine-triacetate
• the first, second and third carrier substances are selected independently from the group comprising water, 0.45% aqueous NaCl solution, 0.9% aqueous NaCl solution, Ringer's solution (Ringer's lactate), 5% aqueous dextrose solution and aqueous alcohol solutions.
• the inventive smart drug delivery system and pharmaceutical kit enable a new form of targeted dual cancer treatment with a diagnostic and therapeutic modality (see FIG. 2 and Table 1).
• the same active ingredient conjugate or two biologically and pharmacokinetically analogous active ingredient conjugates are used in low and increased doses.
• FIGS. L, LI each have a cleavable linker group; Chel a chelator for labeling with a radioisotope; S is a cleavable linker or spacer group; S1, S2 each denotes a spacer group and TV denotes a biological targeting vector.
• the diagnostic and therapeutic modalities provided by the invention are illustrated in FIG. 2 with the aid of five membrane-bound receptors (i) to (v), the terms CT, L, LI, Chel, S, S1, S2 and TV having the same meaning , as explained above in connection with Fig. la to ld.
• the receptors (i) - (v) shown in Fig. 2 are in Table 1 the diagnostic and therapeutic modalities (A), (Bl), (B2) and (C), (Dl), (D2) each assigned in connection with a qualitative dose information.
• Table 1 Diagnostic and therapeutic modalities according to FIG. 1
• the targeting vectors TV used according to the invention have a high binding affinity for a membrane-bound receptor.
• the receptors addressed in the present invention are proteins such as prostate-specific membrane antigen (PSMA), fibroblast activation protein (FAP) or farnesyl pyrophosphate synthase (FPPS), which are found on the envelope of tumor cells in various cancers are overexpressed.
• PSMA prostate-specific membrane antigen
• FAP fibroblast activation protein
• FPPS farnesyl pyrophosphate synthase
• the spacers S, S1, S2 bind the chelator Chel to the targeting vector TV and at the same time function as a spacer and chemical modulator, which compensates for any impairment of the binding affinity of the targeting vector TV caused by the chelator Chel, for example due to steric hindrance.
• the linkers L and LI connect the chelator Chel with the cytotoxic active ingredient CT or with the targeting vector TV and modulate the pharmacokinetic properties.
• Numerous cytotoxic agents are hydrophobic and poorly soluble in blood serum.
• a highly pronounced lipophilicity of a cytotoxic active ingredient CT can be effectively compensated for with the aid of a linker L, LI containing polyethylene glycol (PEG), among other things. This approach is known in the art under the term "PEGylation".
• linkers L and LI contain a group Clv which, after being taken up by a tumor cell (endocytosis), is contained in late endosomes or in lysosomes Enzymes or molecules such as glutathione (yL-glutamyl-L-cysteinylglycine, abbreviated GSH) is cleaved and the cytotoxic agent CT is released.
• GSH glutathione
• the linkers L, LI are decisive for the pharmacokinetic properties and embody a central starting point for the invention, which is based on an identical or two biologically analogous drug conjugates for dual nuclear medicine and cytotoxic treatment and enables a direct translation from diagnosis into therapy.
• the present invention creates a pharmaceutical kit for targeted, simultaneous nuclear medicine-cytotoxic cancer treatment according to the above-explained modalities (B2) and (D2).
• a radioisotope suitable for molecular imaging using PET or SPECT is used to determine whether the targeting vector of the smart drug delivery system binds to a molecular target that is expressed in sufficient quantity by the patient's tumor tissue.
• a smart drug delivery system with a PSMA inhibitor is used as a targeting vector in patients with prostate cancer and must show a sufficiently high and selective accumulation in the primary tumor, in metastases of the lymphatic system, the viscera or bones.
• the Smart Drug Delivery System serves as a pre-therapeutic diagnostic tool and indicates the suitability of the therapy for the respective patient. Since it is the same SDDS, identical pharmacokinetic and pharmacodynamic properties are guaranteed. The response rate of the patient can be predicted with a high degree of certainty.
• Known SDDS only contain a cytostatic that is coupled to a targeting vector. Therefore, if known SDDS are used, suitability for the patient is not determined before the start of therapy. At most, the target expression of the patient is determined by means of a PET radiotracer different from the SDDS. However, the PET signal measured by means of a separate PET tracer is not representative of the binding and pharmacokinetics of the SDDS.
• the therapy can be carried out with or without radioactive labeling of the smart drug delivery system, i.e. purely cytotoxic or nuclear medicine-cytotoxic.
• reactive radicals reactive oxygen species: ROS
• ROS reactive oxygen species
• ABC transport channels ATP binding cassette: ABC
• rucaparib and some of its derivatives inhibit the enzyme PARP (poly-ADP-ribose polymerase), which is involved in the repair of single-strand breaks (ESB) in DNA.
• PARP inhibitors are based on synthetically induced lethality.
• DSB double-strand breaks
• HR homologous recombination
• BRCA1 and BRCA2 are significantly involved in HR. A mutation in these genes disrupts DNA repair and increases the risk of tumor formation.
• HR genes including BRCA1 / 2 are mutated in 20-25% of patients with mCRPC (metastatic castration-resistant prostate cancer). These patients benefit from treatment with PARP inhibitors, which have a high tumor specificity. BRCA deficiency can also be induced pharmaceutically.
• the active ingredient enzalutamide, an inhibitor of the androgen receptor signaling pathway, can down-regulate the BRCA genes. After administration of enzalutamide, patients without a BRCA mutation can also benefit from the selective tumor toxicity of rucaparib. The patient collective for PARP therapy can thus be expanded.
• Taxanes inhibit the depolymerization of microtubules and inhibit mitosis (cell division).
• Temozolomide is a galenically adapted active ingredient (prodrug) which, after metabolism and spontaneous hydrolytic cleavage, releases methylhydrazine (CH3 (NH) NH2), which methylates DNA bases and induces apoptosis.
• methylhydrazine CH3 (NH) NH2
• MMAE Monomethyl auristatin E
• MMAE is an antineoplastic agent that interrupts the cell cycle by inhibiting tubulin polymerisation and thus leads to apoptosis.
• Table 2 shows cytostatics used according to the invention.
• the chelator Chel is intended for the labeling of the active ingredient conjugate according to the invention with a radioisotope selected from the group comprising 44 Sc, 47 Sc, 5Sm, 159 Gd, 149 Tb, Ac and 232 Th.
• a radioisotope selected from the group comprising 44 Sc, 47 Sc, 5Sm, 159 Gd, 149 Tb, Ac and 232 Th.
• a variety of chelators for complexing the above radioisotopes are known in the art.
• Scheme 6 shows examples of chelators used according to the invention.
• amide coupling strategies offer a facile route to the synthesis of new compounds.
• Numerous reagents and protocols for amide coupling are known to those skilled in the art.
• the most common amide coupling strategy is based on the condensation of a carboxylic acid with an amine.
• the carboxylic acid is usually activated for this. Remaining functional groups are protected before activation.
• the reaction takes place in two steps either in a reaction medium (single pot) with direct conversion of the activated carboxylic acid or in two steps with isolation of an activated “trapped” carboxylic acid and reaction with an amine.
• the carboxylate reacts with a coupling reagent to form a reactive intermediate which can be isolated or reacted directly with an amine.
• a coupling reagent for carboxylic acid activation, such as acid halides (chloride, fluoride), azides, anhydrides or carbodiimides.
• esters such as pentafluorophenyl or hydroxysuccinic imidoesters can be formed as reactive intermediates.
• Intermediate products derived from acyl chlorides or azides are highly reactive. However, harsh reaction conditions and high reactivity often stand in the way of application for sensitive substrates or amino acids.
• amide coupling strategies that use carbodiimides such as DCC (dicyclohexylcarbodiimide) or DIC (diisopropylcarbodiimide) open up a wide range of applications.
• carbodiimides such as DCC (dicyclohexylcarbodiimide) or DIC (diisopropylcarbodiimide)
• additives are used to improve the reaction efficiency.
• Aminium salts are highly efficient peptide coupling reagents with short reaction times and minimal racemization. With some additives, such as HOBt, racemization can even be avoided completely.
• Aminium reagents are used in equimolar amounts to the carboxylic acid in order to prevent excessive reaction with the free amine of the peptide.
• Phosphonium salts react with carboxylate, which usually requires two equivalents of a base such as DIEA.
• a major advantage of phosphonium salts over iminium reagents is that phosphonium does not react with the free amino group of the amine component. This enables couplings in an equimolar ratio of acid and amine and helps to avoid the intramolecular cyclization of linear peptides and the excessive use of expensive amine components.
• chelators used according to the invention such as in particular DOTA, have one or more carboxy or amide groups. Accordingly, these chelators can be conjugated in a simple manner with the linkers L, LI and / or spacers S, S1, S2 using one of the amide coupling strategies known in the prior art.
• the cleavable group Clv contained in the linkers L, LI ensures the tumor-specific release of the cytotoxic agent CT and is stable in the systemic circulation, i.e. in the blood plasma. After absorption (endocytosis) in a cancer cell, the cleavable group Clv is split and the cytotoxic active ingredient CT is released.
• Scheme 9 shows a cleavable group or a linker of the p-aminobenzoic acid-valine-citrulline type, which is cleaved by intracellular proteases, in particular of the cathepsin family. Cathepsin proteases are overexpressed in prostate tumor cells.
• Scheme 10 shows a cleavable group or a linker of the p-aminobenzoic acid-glutamate-valine-citrulline type, which is also cleaved by cathepsins and is characterized by increased stability in mouse serum, which is a considerable advantage for preclinical studies.
• Scheme 11 shows a cleavable hydrazone group / linker that hydrolyzes in an acidic environment (pH ⁇ 6.2) - as is present in tumor tissue.
• the disulfide groups / linkers shown in Scheme 12 are cleaved by lysosomal glutathione (GSH: gL-glutamyl-L-cysteinylglycine) as part of a disulfide exchange reaction.
• GSH lysosomal glutathione
• Theranostics Diagnosis and therapy of cancer diseases using nuclear medicine pharmaceuticals.
• Marking precursor Chemical compound that contains a chelator or a functional group for marking with a radioisotope.
• Pharmaceutical kit one-part or multi-part pharmaceutical dosage form, which optionally comprises one or more containers with one or more active ingredients, which are optionally contained, dissolved, suspended or emulsified in one or more carrier substances.
• Containers vial, vial, injection vial or ampoule made of glass, metal or
• Carrier substance liquid or solid substance that serves as a galenic carrier for a pharmaceutical active ingredient and generally has no pharmaceutical activity.
• SDDS Smart Drug Delivery System
• Chelator as part of a chemical compound, in particular as part of an SDDS compound.
• Target biological target structure, in particular (membrane-bound) receptor, protein,
• Targeting vector Chemical group or residue that acts as a ligand, agonist, antagonist or
• Radiopharmaceutical radioactively labeled chemical compound or with a
• Radioisotope complexed marker precursors for nuclear medicine diagnostics or theranostics are Radioisotope complexed marker precursors for nuclear medicine diagnostics or theranostics.
• Linker structural unit, group or residue which comprises a biologically cleavable subgroup or subunit and via which a targeting vector, a cytotoxic active ingredient or a chelator is bound to a further structural unit.
• Cleavable group structural unit, group or residue that is cleaved by enzymes or molecules contained in the cytoplasm, endosomes or lysosomes.
• Spacer structural unit that acts as a spacer between a targeting vector and a chelator and counteracts steric hindrance of the targeting vector by the chelator.
• the spacer comprises a cleavable group and is designed as a linker.
• Drug Conjugate A compound that comprises a cytotoxic drug, a targeting vector, and a cleavable linker.
• Dual drug conjugate A compound that comprises a cytotoxic drug, a targeting vector, a chelator, a linker, and a spacer.
• Schemes IS to 22 show examples of dual active ingredient conjugates according to the invention according to FIG. La, which comprise a targeting vector, a chelator for labeling with a radioisotope and a cytotoxic active ingredient.
• Example 2 Dual active ingredient conjugates according to FIG.
• Schemes 23, 24, 25 and 26 show examples of dual active ingredient conjugates according to the invention according to FIG. 1b, which comprise a targeting vector, a chelator for labeling with a radioisotope, a cleavable linker and a cytotoxic active ingredient.
• Example 3 Active ingredient conifications according to FIG. Id
• Schemes 27, 28, 29 and 30 show examples of active ingredient conjugates according to the invention according to FIG. 1d, which comprise a targeting vector, a cleavable linker and a cytotoxic active ingredient.
• Squaric acid diesters are preferably used in the synthesis of the active ingredient conjugates according to the invention. As a result, a large number of, in some cases very complex, active ingredient conjugates can be represented by means of simple reactions. Squaric acid diesters are characterized by their selective reactivity with amines, so that no protective groups are required when coupling chelators, linkers, spacers and targeting vectors. In addition, the coupling reaction can be controlled via the pH value.
• the coupling can also be carried out in an organic medium with triethylamine as the base.
• the PSMA inhibitor L-lysine-urea-L-glutamate (KuE), for example, is synthesized as a target vector for PSMA using a known method (cf. Scheme 31b).
• lysine bound to a solid phase in particular a polymer resin and protected with tert-butyloxycarbonyl (tert-butyl)
• tert-butyl tert-butyl
• L-lysine-urea-L-glutamate is split off by TFA and at the same time completely deprotected.
• the product can then be separated from free lysine by means of semi-preparative HPLC with a yield of 71%.
• Scheme 31b solid phase synthesis of the PSMA inhibitor KuE; (a) DIPEA, triphosgene, DCM 0 ° C, 4h; (b) H-Lys (tBoc) -2CT-polystyrene solid phase, DCM, RT, 16h; (c) TFA, RT, 71%.
• the PSMA inhibitor KuE (1) can then be coupled to a labeling precursor using diethyl squarate as a coupling reagent (cf. scheme 32).
• KuE (1) is coupled to squaric acid diester in 0.5 M phosphate buffer at a pH value of 7. After adding both starting materials, the pH value must be readjusted with sodium hydroxide solution (1 M), since the buffer capacity of the phosphate buffer is insufficient is. At pH 7, the acid is simply amidated at room temperature with a short reaction time.
• KuE-QS (2) is obtained after HPLC purification with an overall yield of 16%.
• the KuE squaric acid monoester obtained in this way can be stored and used as a building block for further syntheses.
• Example 5 Solid-phase-based synthesis of the KuE unit and the PSMA-617 linker
• Scheme 33.2 Synthesis of the KuE unit and coupling to an aromatic linker; (b) 50% piperidine in DMF; (c) compound (I) in DCM;
• the benzyl protective group of the glutaric acid side chain of DOTAGA (COOtBu) 3 (NHBoc) -GABz 4 is removed reductively in order to enable coupling to the PSMA target vector via a linker.
• linker-PSMA conjugate is then coupled to the chelator 6 by means of amide coupling.
• Radiolabeling of the PSMA marking precursors 68 Ga was eluted with 0.05 M HCl from an ITG Ge / Ga generator and processed by means of aqueous ethanol elution over a cation exchange column. Radiolabeling takes place at pH values between 3.5 and 5.5 and temperatures between 25 ° C and 95 ° C, depending on the chelator. The course of the reaction was recorded by means of HPLC and IPTC in order to determine the kinetic parameters of the reaction.
• Example 9 Squaric acid as a complexation aid
• the first, second and / or third compounds contain one or more squaric acid residues QS. Coupling reactions can be considerably simplified by using squaric acid diesters.
• Example 10a Squaric Acid as Affinity Promoter
• the inventors have surprisingly found that the incorporation of squaric acid groups QS improves the pharmacological properties and increases the binding affinity of PSMA-specific targeting vectors.
• ARG463 is located in the so-called arginine patch from PSMA.
• Another putative mechanism of action is based on hydrogen bonds to Trp541, which increase the affinity for the arene binding pocket of PSMA.
• the squaric acid group interacts with Arg463 in the arginine-rich region (dark area) and with Trp541 in the arene binding pocket.
• the dashed light lines represent the distance in ⁇ .
• the zinc ions in the active binding pocket are shown as spheres.
• the structural data are based on the structure of PSMA in complex with PSMA 1007 (PDB 505T) determined by means of X-ray diffraction.
• FIG. 5 shows the putative binding mode of AAZTA.QS.KuE in the binding pocket of PSMA.
• the AAZTA chelator protrudes from the PSMA bag.
• the QS linker interacts with the hydrophobic part of the binding pocket.
• the binding motif is located in the pharmacophoric part of the pocket and is complexed by the two zinc ions.
• Figure 6 shows the putative binding mode of DATA.QS.EuE.
• the EuE binding motif causes an elongation of the linker and an accompanying spatial shift of the QS linker, which affects the electrostatic interaction with the amino acids of the binding pocket. Subsequent in v / tro assays confirmed the results of the docking analyzes.
• Example 10b Squaric acid as a modulator of excretion
• Scheme 38 shows an example of a drug conjugate or label precursor with a targeting vector for PSMA and a squaric acid group conjugated to the targeting vector.
• squaric acid (QA) reduces the accumulation in the kidneys and the associated superimposition or disruption of the PET signal of the neighboring prostate, which significantly improves the sensitivity and reliability of the imaging diagnosis of prostate cancer using PET.
• 7a and 7b show mRET recordings (60 min pi) of [ 68 Ga] Ga.DOTA.QS.PSMA (A), [ 68 Ga] Ga-PSMA-II (B) and [ 68 Ga] Ga-PSMA -617 (C) and a diagram with SUV values (Standard Uptake Value: SUV) for tumor tissue, kidneys and liver.
• Scheme 39 shows another QS derivative that was tested in vivo on tumor-bearing animals.
• DATA.QS.KuE was labeled with 68 Ga and tested in vivo on LNCaP tumor-bearing Balb / c mice. 8 shows the accumulation of [ 68 Ga] -DATA.QS.KuE in the organs (biodistribution). The selectivity of the binding was determined by means of competitive co-injection of the PSMA inhibitor PMPA. For comparison, FIG. 9 shows the biodistribution of [ 68 Gaj-PSMA-11.
• 10a and 10b show the maximum intensity projections from mRET studies with [ 68 Gaj-PSMA-11 and, respectively, [ 68 Ga] -DATA.QS.KuE in LNCaP tumor-bearing Balb / c mice.
• 11a and 11b show time-activity curves of [68 Ga] -PSMA-II and [ 68 Ga] -DATA.QS.KuE, respectively.
• DATA.QS.KuE im Compared to PSMA-11 a significantly lower kidney exposure or dose.
• DATA. QS.KuE a significant reduction in nephrotoxicity.
• Example 11a Evaluation of the in vitro PSMA binding affinity of selected compounds
• the affinity of the target vector linker units QS.KuE, QS.K.EuE and KuE with lipophilic linker - analogous to PSMA-617 - and the affinity of the substructures NH 2 .DOTAGA.6i7.KuE and NH 2 -DOTAGA. QS.KuE determined.
• the PSMA affinity of the structure MMAE.ValCit.QS.617.KuE (see scheme BO), which is preferred according to the invention, was determined.
• LNCaP cells were pipetted into multiwell plates (Merck Millipore Multiscreen TM).
• the compounds to be analyzed were each mixed in increasing concentrations with a defined amount or concentration of the reference compound 68 Ga [Ga] PSMA-10 with a known K d value and incubated for 45 min in the wells with the LNCaP cells.
• the cell-bound activity was determined after washing several times.
• the IC 50 values and K 1 values shown in Table 1 were calculated on the basis of the inhibition curves obtained.
• Both the TV linker units and the chelator TV linker units have a similar affinity for PSMA as the reference compound PSMA-617. Accordingly, the use of QS as a linker unit leads to an affinity comparable to that of the use of the peptide PSMA-617 linker. Both the coupling to the DOTAGA chelator and its labeling with the radionuclides gallium-68 and lutetium-177 lead to no decrease in affinity.
• Example 7b Determination of the cytotoxic effect of the dimeric compound
• the compound according to the invention MMAE. ValCitQS.617. KuE shows a somewhat lower cell cytotoxicity in vitro than the pure active ingredient MMAE, but is nonetheless in the lower nanomolar range.

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