TW201215610A - Combinational compositions and methods for treatment of cancer - Google Patents

Combinational compositions and methods for treatment of cancer Download PDF

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Publication number
TW201215610A
TW201215610A TW100123353A TW100123353A TW201215610A TW 201215610 A TW201215610 A TW 201215610A TW 100123353 A TW100123353 A TW 100123353A TW 100123353 A TW100123353 A TW 100123353A TW 201215610 A TW201215610 A TW 201215610A
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Taiwan
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administered
gemcitabine
trans
dihydro
dione
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TW100123353A
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Chinese (zh)
Inventor
Giovanni Abbadessa
Dennis S France
Chang-Rung Chen
Thomas C K Chan
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Arqule Inc
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Publication of TW201215610A publication Critical patent/TW201215610A/en

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Abstract

The present invention provides methods of treating a cell proliferative disorder, such as a cancer, by administering to a subject in need thereof a therapeutically effective amount of a pyrroloquinolinyl-pyrrole-2, 5-dione compound or a pyrroloquinolinyl-pyrrolidine-2, 5-dione compound in combination with a therapeutically effective amount of a second anti-proliferative agent.

Description

201215610 六、發明說明: 相關申請案之交互參照 本申請案主張在2010年7月1日提出申請之美國臨時申 請案第61 /3 60,758號和2011年4月15日提出申請之美國臨 時申請案第61 /4 75,9 95號之優先權及利益。這些申請案之 內容以其全文引用方式納入本文中。 0 【發明所屬之技術領域】 本發明係關於治療細胞增生疾病(諸如癌症)之方法 、組合物及套組,其中利用治療有效量之吡咯並喹啉基-吡咯-2,5-二酮化合物或吡咯並喹啉基-吡咯啶-2,5-二酮化 合物組合治療有效量之第二種抗增生劑。 【先前技術】 發明背景 〇 在美國癌症是第二大死因,僅次於心臟疾病。(Cancer201215610 VI. INSTRUCTIONS: Cross-references to related applications This application claims US Provisional Application No. 61 / 3 60, 758, filed on July 1, 2010, and US application filed on April 15, 2011 Priority and benefit of 61/4 75, 9 95. The contents of these applications are incorporated herein by reference in their entirety. TECHNICAL FIELD OF THE INVENTION The present invention relates to methods, compositions and kits for treating cell proliferative diseases, such as cancer, wherein a therapeutically effective amount of pyrroloquinolinyl-pyrrole-2,5-dione compound is utilized. Or a pyrroloquinolinyl-pyrrolidine-2,5-dione compound in combination with a therapeutically effective amount of a second anti-proliferative agent. [Prior Art] Background of the Invention 癌症 Cancer is the second leading cause of death in the United States, second only to heart disease. (Cancer

Facts^J Figures 2004, American Cancer Society, Inc.) » 儘 管在癌症診斷及治療上之最新進展使得手術及放射線治療 可得以治癒早期發現之癌症,但是目前用於轉移性疾病之 藥物治療大多爲緩和治療,很少提供長期治癒。即使新的 化學治療不斷進入市場,仍然持續需要:在單一療法中或 與現有藥劑組合中有效作爲抗腫瘤治療中的第一線療法, 以及作爲第二線和第三線療法的新穎藥物。 ’ 癌細胞據定義爲異質性。例如,在單一組織或細胞類 -5- 201215610 型中’多種突變‘機制’可導致癌症發展。因此,取自起源 於不同個體的相同組織及相同組織型(histiotype)之腫瘤的 癌細胞之間時常存在異質性。經常觀察到的與一些癌症有 關之突變‘機制’在一種組織類型與另一種組織類型之間可 能不同(例如導致結腸癌之經常觀察到的突變“機制”可能 與導致白血病之經常觀察到的‘機制’不同)。因此時常難 以預測特定癌症是否將對特定化學治療劑有所反應。 (Cancer Medicine,第 5版.,Bast 等人編輯,B.C. Decker Inc., Hamilton, Ontario) 〇 調節正常細胞生長及分化之細胞訊息傳遞途徑的成分 當失調時,可導致細胞增生性疾病及癌症的發生。細胞傳 訊蛋白質之突變可能造成該等蛋白質在細胞週期期間以不 適當之量或於不適當時間變爲表現或活化,其轉而可能導 致不受控制之細胞生長或細胞-細胞附接性質之改變。例 如,因突變、基因重排、基因放大及受體、配體二者之過 度表現所導致之受體酪胺酸激酶失調已涉及人癌症之發展 及進展。 c-Met受體酪胺酸激酶爲肝細胞生長因數(HGF)唯一已 知的高親和性受體’亦稱爲分散因數。HGF結合於c-Met 細胞外配體結合域導致在c-Met之細胞內部份中多個酪胺 酸殘基之受體多聚化及磷酸化。c_Met之活化導致接器 (adaptor)蛋白質諸如Gab-1、Grb-2、She及c-Cbl之結合及 磷'酸化,及訊息傳遞物諸如PI3K、PLC1、STAT、ERK1 和2及FAK之後續活化。在人癌症中c-Met及HGF失調’且 -6- 201215610 可在疾病進展及轉移期間促成細胞生長失調、腫瘤細胞散 播及腫瘤侵入(參見,例如Journal of Clinical Investigation 1 09 : 863-867(2002)及 Cancer Cell pp 5-6Facts^J Figures 2004, American Cancer Society, Inc.) Although recent advances in cancer diagnosis and treatment have enabled surgery and radiation therapy to cure early-stage cancers, current drug treatments for metastatic disease are mostly palliative Treatment, rarely provides long-term cure. Even as new chemotherapy continues to enter the market, there is a continuing need to be effective as a first-line therapy in anti-tumor therapy, as well as a novel drug for second- and third-line therapy, in monotherapy or in combination with existing agents. Cancer cells are defined as heterogeneous. For example, 'multiple mutations' mechanisms in a single tissue or cell type -5 - 201215610 can lead to cancer development. Therefore, heterogeneity often occurs between cancer cells derived from the same tissue originating from different individuals and tumors of the same histiotype. Frequently observed mutational 'mechanisms' associated with some cancers may differ between one tissue type and another (eg, the often observed mutation "cause" that causes colon cancer may be associated with the often observed 'leukemia' The mechanism 'different'. It is therefore often difficult to predict whether a particular cancer will respond to a particular chemotherapeutic agent. (Cancer Medicine, 5th ed., Bast et al., BC Decker Inc., Hamilton, Ontario) 成分 A component of the cellular signaling pathway that regulates normal cell growth and differentiation, when dysregulated, can lead to cell proliferative diseases and cancer. occur. Mutations in cell signaling proteins may cause such proteins to become manifested or activated in an inappropriate amount or at inappropriate times during the cell cycle, which in turn may result in uncontrolled cell growth or changes in cell-cell attachment properties. . For example, receptor tyrosine kinase dysregulation due to mutation, gene rearrangement, gene amplification, and excessive expression of both receptors and ligands has been implicated in the development and progression of human cancer. The c-Met receptor tyrosine kinase is the only known high affinity receptor for hepatocyte growth factor (HGF), also known as the dispersing factor. Binding of HGF to the c-Met extracellular ligand binding domain results in receptor multimerization and phosphorylation of multiple tyrosine residues in the internal fraction of c-Met cells. Activation of c_Met leads to the binding of adaptor proteins such as Gab-1, Grb-2, She and c-Cbl and phosphorylation, and subsequent activation of messenger such as PI3K, PLC1, STAT, ERK1 and 2 and FAK . c-Met and HGF are dysregulated in human cancers and -6-201215610 can contribute to cell growth disorders, tumor cell dissemination, and tumor invasion during disease progression and metastasis (see, for example, Journal of Clinical Investigation 1 09: 863-867 (2002) ) and Cancer Cell pp 5-6

July 2004)。相對於周圍組織,c-Met及HGF在許多癌中被 高度表現,且彼等之表現與病患不良預後有關(參見,例 如 Journal of Cellular Biochemistry 86 : 665-677(2002) ;Int. J. Cancer (Pred. Oncol.) 74 : 3 0 1 -3 09( 1 997); 〇 Clinical Cancer Research 9 : 1480-1488(2003);及July 2004). c-Met and HGF are highly expressed in many cancers relative to surrounding tissues, and their performance is associated with poor prognosis of patients (see, for example, Journal of Cellular Biochemistry 86: 665-677 (2002); Int. J. Cancer (Pred. Oncol.) 74 : 3 0 1 -3 09 ( 1 997); 〇 Clinical Cancer Research 9 : 1480-1488 (2003);

Cancer Research 62: 589-596(2002))。不意欲被理論所束 縛,c-Met及HGF可防止腫瘤受到DNA損害劑所引發之細 胞死亡,且因此可促成腫瘤之抗化學性及抗放射線性。不 意欲被任何理論限制,c-Met之抑制劑可用作治療增生性 疾病包括乳癌之治療劑(參見’例如Cancer and Metastasis Reviews 22 : 309-325(2003)) ° 本文中所引證之參考文獻不被認爲是所申請專利之發 〇 明的先前技術。 【發明內容】 發明槪述 本發明提供一種治療細胞增生性疾病之方法,該方法 包含將治療有效量之式111、IIIa、IVa、IVb、Va或Vb之化 合物或其醫藥上可接受的鹽、或其前藥或代謝物,組合治 療有效量之第二種抗增生劑投予至對象,其中該式III、 Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上可接受的鹽 201215610 、或其即藥或代謝物’和第二種抗增生劑不同時投予。 本發明也提供一種治療細胞增生性疾病之方法,該方 法包含將治療有效量之式III、Ilia、IVa、IVb、Va或Vb之 化合物或其醫藥上可接受的鹽、或其前藥或代謝物,組合 治療有效量之第二種抗增生劑投予至對象,其中該式ΙΠ 、Ilia、IVa、IVb、Va或¥1)之化合物或其醫藥上可接受的 鹽、或其前藥或代謝物係在投予第二種抗增生劑之後投予 〇 本發明也提供一種治療細胞增生性疾病之方法,該方 法包含將治療有效量之式III、Ilia、IVa、IVb、Va或Vb之 化合物或其醫藥上可接受的鹽、或其前藥或代謝物,組合 治療有效量之第二種抗增生劑投予至對象,其中第二種抗 增生劑係在投予式III、Ilia、IVa、IVb、Va或Vb之化合物 或其醫藥上可接受的鹽、或其前藥或代謝物之後投予。 式 III、Ilia、IVa、IVb、Va 或 Vb之化合物可爲( + )-順-3-(5,6-二氫-4^1-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲 哄-3-基)卩比略陡-2,5 - 一嗣、(-) -順- 3- (5,6 - _氣- 4H-耻略并 [3,2,1 - ij ]喹啉-1 -基)-4 - (1 Η -吲哚-3 -基)吡咯啶-2,5 -二酮、 (+ )-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨〗]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮、或(-)-反-3-(5,6-二氫-4Η-吡 咯并[3,2,1 - ij ]喹啉-1 -基)-4 - (1 Η -吲哚-3 -基)吡咯啶-2,5 -二 酮。較佳地,該化合物爲(-)-反-3-(5,6-二氫-4Η-吡咯并 [3,2,1-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶- 2,5-二酮。 第二種抗增生劑可爲激酶抑制劑、烷化劑、抗生素、 -8 - 201215610 抗代謝物、解毒劑、幹擾素、多株或單株抗體、HER2抑 制劑、組蛋白去乙醯酶抑制劑' 荷爾蒙、有絲分裂抑制劑 、MTOR抑制劑、紫杉烷或紫杉烷衍生物、芳香酶抑制劑 、蒽環類、微管標靶藥、拓樸異構酶毒藥、腺苷類似物藥 、鳥苷類似物藥、甲基尿苷類似物藥、或胞苷類似物藥。 較佳地,胞苷類似物爲吉西他濱(gemcitabine)。較佳地, 該激酶抑制劑爲絲胺酸/蘇胺酸激酶抑制劑或酪胺酸激酶 Q 抑制劑。較佳激酶抑制劑包括但不限於索拉非尼 (sorafenib)、舒尼替尼(sunitinib)、埃羅替尼(erlotinib)、 伊馬替尼(imatinib)或吉非替尼(gefitinib)。較佳烷化劑包 括但不限於順鉬(cisplatin)或卡鉑(carboplatin)。較佳抗代 謝物包括但不限於吉西他濱、氟尿嘧啶(flu〇rouracil)(5-FU)、TS-1或卡培他濱(capecitabine)。較佳有絲分裂抑制 劑包括但不限於喜樹鹼(camptothecin)或伊立替康 (irino tec an)。較佳紫杉烷或紫杉烷衍生物包括但不限於太 平洋紫杉醇(paclitaxel)或多西他賽(docetaxel)。 細胞增生性疾病可爲前癌狀態或癌。細胞增生性疾病 可爲血液腫瘤或惡性腫瘤,或固體腫瘤(或腫瘤等)。該治 療癌之方法包含使腫瘤尺寸減少。替換地或另外地,該癌 係轉移性癌且此治療之方法包括抑制轉移性癌細胞侵入。 該方法可另包含放射線治療。該癌可爲肺癌、小細胞肺癌 、非小細胞肺癌(NSCLC)、結腸癌、乳癌、胰癌、前列腺 癌、腎癌、子宮頸癌、腦癌、胃癌、子宮癌、小腸癌、肝 癌、慢性骨髓性白血病、黑色素瘤、卵巢癌、轉移相關性 -9- 201215610 腎細胞癌(RCC)、泡狀軟組織肉瘤(ASPS)、透明細胞肉瘤 (CCS)或肝細胞癌(HCC)。 具有增生性疾病之細胞可包含編碼c-Met之DNA。替 換地或另外地,具有增生性疾病之細胞具有組成性增強之 c-Met活性。較佳地,該細胞增生性疾病爲癌,且特佳地 該等高度表現c-Met或表現活性c-Met之癌。因此,本發明 提供一種治療細胞增生性疾病之方法,其中該等細胞高度 表現c-Met或表現活性c-Met。本發明另提供一種治療細胞 增生性疾病之方法,該方法包含選擇性調節c-Met之活性 ,但不顯著抑制蛋白質激酶C之活性。 較佳地,對象爲哺乳動物。更佳地,該對象爲人。 較佳地,本文中所述方法之式III、Ilia、IVa、IVb、 Va或Vb之化合物爲(-) -反-3- (5,6-二氫-41^-吡略并[3,2,1-1】] 喹啉-卜基)-4-(1 H-吲哚-3-基)吡咯啶-2,5-二酮且係以3 60毫 克之劑量投予,一天提供二次。或者,該組成物係以720 毫克之最大每日劑量投予。 較佳地,式III、nia、IVa、IVb、Va或Vb之化合物及 該第二種抗增生劑係經靜脈內、口服或腹腔內投予。該第 二種抗增生劑可在包含式III、Ilia、IVa、IVb、Va或Vb之 化合物之組成物投予之前或投予之後投予。 較佳地’式III、Ilia、IVa、IVb、Va或Vb之化合物爲 (_)_ 反 _3-(5,6-二氫-4H-吡略并[3,2,l-ij]喹啉-l-基)-4-(lH-吲哚-3-基)吡咯啶-2,5-二酮和第二種抗增生劑爲吉西他濱 且(-)-反-3 - ( 5,6 -二氫-4 Η -吡咯并[3,2,1 - i j ]喹啉-1 -基)-4- -10- 201215610 (1H_吲哚-3-基)吡略啶-2,5-二酮係在投予吉西他濱之後投 予至少 12小時。(-)_反·3·(5,6-—氫略并[3,2,l-ij]唾 咐_1_基)_4-(111-11引晩-3-基)卩比咯11定_2,5-二酮也可在投予吉 西他濱之後投予至少2 4小時、至少4 8小時、至少7 2小時或 至少9 6小時。 較佳地,對象在投予吉西他濱之前至少1 2小時、至少 2 4小時或至少4 8小時沒有被投予任何藥物。 0 較佳地,對象至少24小時沒有被投予任何藥物’然後 投予吉西他濱不大於24小時’和然後投予(-)_反·3-(5,6 -二 氯-4Η-啦咯并[3,2,1-ϋ]唾啉-I-基)_4-(1Η-Β引探-3-基)Π比咯 啶-2,5 -二酮至少7 2小時。 較佳地,吉西他濱係以單—劑量投予不超過3 0分鐘、 不超過1小時、不超過1 2小時或不超過2 4小時。較佳地’ (-)·反 _3_(5,6_二氫-4Η-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3 -基)吡咯啶-2,5 -二酮係投予至少2 4小時、至少4 8小 〇 時或至少7 2小時。 較佳地,式III、Ilia、IVa、IVb、Va或Vb之化合物爲 (-)-反- 3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶-2,5-二酮,係在吉西他濱在該對象中之 濃度或數量低於其起始濃度或數量的約90%、低於約50% 、低於約20%、低於約1 0%、低於約5%、或低於約1 %之後 投予。 除非另外定義,本文中所使用之所有技術及科學用語 具有與本發明所屬之領域中一般技術之人士所通常瞭解者 -11 - 201215610 相同之意義°在本說明書中’除非上下文清楚地另外說明 ,否則單數形式亦包括複數形式。雖然與本文中所描述之 方法及材料_#$等效者可被實測^本發日月’但 適當方法及材料係描述於下。本文中提及之所有公開公報 、專利申請案、專利及其他參考文獻係以引用方式納入本 文中。本文中所引證之參考文獻不被認爲是該申請專利發 明之先前技術。在衝突之情況下將以本說明書包括定義爲 主。此外,該材料、方法及實例僅爲說明且不意圖作爲限 制。 本發明之其他特色及優點將從下列詳細說明及申請專 利範圍中顯而易見。 發明之詳細說明 1 .治療之方法 本發明提供治療細胞增生性疾病之方法,該方法包含 將治療有效量之式III、Ilia、iVa、IVb、Va或Vb之化合物 ’或其醫藥上可接受的鹽、或其前藥或代謝物,與一或多 種醫藥上可接受之載劑或賦形劑,組合治療有效量之第二 種抗增生劑,與一或多種醫藥上可接受之載劑或賦形劑投 予至需要其之對象,其中治療該細胞增生性疾病。 本發明提供一種用於治療細胞增生性疾病之醫藥組成 物’其包含(a)治療有效量之式m、IIIa、IVa、IVb、Va 或Vb之化合物’或其醫藥上可接受的鹽、或其前藥或代 謝物’組合(b)治療有效量之第二種抗增生劑。一或多種 -12- 201215610 醫藥上可接受之載劑或賦形劑係隨意包括在該組成物中。 第二種抗增生劑較佳爲第二種化學治療劑。 該細胞增生性疾病可爲前癌狀態或癌。該細胞增生性 疾病可爲血液腫瘤或惡性腫瘤、或固體腫瘤(或腫瘤等)。 此治療癌之方法包含腫瘤體積減少。替換地或另外地,該 癌係轉移性癌且此治療之方法包括抑制轉移性癌細胞侵入 〇 O m κ匕,治龍 (亦稱爲抗腫瘤劑或抗增生劑)可爲 烷化劑;抗生素;抗代謝物;解毒劑;幹擾素;多株或單 株抗體;EGFR抑制劑;HER2抑制劑;組織蛋白去乙醯酶 抑制劑;荷爾蒙;有絲分裂抑制劑;MTOR抑制劑;多激 酶抑制劑;絲胺酸/蘇胺酸激酶抑制劑;酪胺酸激酶抑制 劑;VEGF/VEGFR抑制劑;紫杉烷或紫杉烷衍生物、芳香 酶抑制劑、蒽環類、微管標靶藥、拓樸異構酶毒藥、分子 標靶或酶之抑制劑(例如激酶抑制劑)、胞苷類.似物藥或任 ❹ 何列示於 www.cancer.org/docroot/cdg/cdgO.asp中之化學治 療劑、抗腫瘤劑或抗增生劑。 典型烷基化劑包括但不限於環磷醯胺(Cytoxan ; Neosar);氯芥苯丁酸(chlorambucil)(Leukeran);美法命 (melphalan)(Alkeran);卡莫司汀(carmustine)(BiCNU); 白消安(busulfan)(Busulfex);洛莫司汀(lomustine) (CeeNU);達卡巴嗪(dacarbazine)(DTIC -Dome);草酸鉑 (oxaliplatin)(Eloxatin);卡莫司汀(carmustine)(Gliadel); 異環 磷醯胺 (ifosfamide)(Ifex) ; 氮 芥 -13- 201215610 (mechlorethamine)(Mustargen) ; 白 消 安(busulfan) (Myleran);卡鉛(carboplatin)(Paraplatin);順鉛 (cisplatin)(CDDP ; Platinol);替莫哩胺(temozolomide) (Temodar);噻替派(thiotepa)(Thioplex);苯達莫司汀 (bendamustine)(Treanda);或鏈脲佐菌素(streptozocin) (Zanosar)。 典型抗生素包括但不限於阿黴素(doxorubicin)((阿德 力黴素(adriamycin));阿黴素脂質體(Doxil);米托惠酿 (mitoxantrone)(Novantrone);博來黴素(bleomycin) (Blenoxane);道諾黴素(daunorubicin)(Cerubidine);道諾 黴素脂質體(DaunoXome);更生黴素(dactinomycin) (Cosmegen):表阿黴素(epirubicin)(Ellence);依達比星 (idarubicin)(Idamycin);普卡徽素(plicamycin)(Mithracin) ;絲裂黴素(mit〇mycin)(Mutamycin);噴司他丁 (pentostatin)(Nipent);或戊柔比星(valrubicin)(Valstar)。 典型抗代謝物包括但不限於氟尿嘧啶(Adrucil);卡培 他濱(capecitabine)(Xeloda);經基脲(Hydrea);疏基嚷哈 (Purinethol);培美曲塞(pemetrexed)(Alimta);氟達拉濱 (fludarabine)(Fludara);奈拉濱(nelarabine)(Arranon);克 拉屈濱(cladribine)(Cladribine Novaplus);克羅拉濱 (clofarabine)(Clolar);阿糖胞苷(cytarabine)(Cytosar-U) ;地西他濱(decitabine)(Dacogen);阿糖胞苷脂質體 (DepoCyt);經基脲(Droxia);普拉曲沙(pralatrexate) (Folotyn);氟尿苷(fl〇XUridine)(FUDR);吉西他濱 -14- 201215610 (Gemzar);克拉屈濱(Leustatin);氣達拉濱(Oforta);甲 胺喋時(methotrexate)(ΜTX ; Rheumatrex);甲胺喋哈 (Trexall);硫鳥嗓 H令(thioguanine)(Tabloid) ; TS-1或阿糖 胞苷(Tarabine PFS)。 典型解毒劑包括但不限於阿米福汀(amifostine) (Ethyol)或美司鈉(mesna)(Mesnex)。Cancer Research 62: 589-596 (2002)). Without wishing to be bound by theory, c-Met and HGF prevent tumors from being killed by DNA-damaging agents and thus contribute to the chemical and radio-radiation of tumors. Without wishing to be bound by any theory, inhibitors of c-Met may be used as therapeutic agents for the treatment of proliferative diseases, including breast cancer (see 'For example, Cancer and Metastasis Reviews 22: 309-325 (2003)) ° References cited herein It is not considered to be the prior art of the patent application. SUMMARY OF THE INVENTION The present invention provides a method of treating a cell proliferative disorder comprising administering a therapeutically effective amount of a compound of formula 111, IIIa, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, Or a prodrug or metabolite thereof, in combination with a therapeutically effective amount of a second antiproliferative agent, wherein the compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt thereof is 201215610, Or its drug or metabolite' and the second anti-proliferative agent are not administered at the same time. The invention also provides a method of treating a cell proliferative disorder, the method comprising administering a therapeutically effective amount of a compound of Formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolism thereof And administering to the subject a therapeutically effective amount of a second antiproliferative agent, wherein the compound of formula I, Ilia, IVa, IVb, Va or ¥1), or a pharmaceutically acceptable salt thereof, or a prodrug thereof Metabolites are administered after administration of a second anti-proliferative agent. The invention also provides a method of treating a cell proliferative disorder comprising administering a therapeutically effective amount of Formula III, Ilia, IVa, IVb, Va or Vb. A compound, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, is administered to a subject in combination with a therapeutically effective amount of a second antiproliferative agent, wherein the second antiproliferative agent is administered Formula III, Ilia, A compound of IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, is administered. The compound of formula III, Ilia, IVa, IVb, Va or Vb may be ( + )-cis-3-(5,6-dihydro-4^1-pyrrolo[3,2,1-indenyl]quinoline. -1-yl)-4-(111-indol-3-yl)pyrene is slightly steeper -2,5 - one 嗣, (-) - cis - 3 (5,6 - qi - 4H-shame And [3,2,1 - ij ]quinolin-1 -yl)-4 - (1 Η -吲哚-3 -yl)pyrrolidine-2,5-dione, (+)-trans-3-( 5,6-dihydro-411-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione Or (-)-trans-3-(5,6-dihydro-4Η-pyrrolo[3,2,1 - ij ]quinolin-1-yl)-4 - (1 Η -吲哚-3 - Pyrrolidine-2,5-dione. Preferably, the compound is (-)-trans-3-(5,6-dihydro-4Η-pyrrolo[3,2,1-ij]quinolin-1-yl)-4-(1Η-吲) Indole-3-yl)pyrrolidine-2,5-dione. The second antiproliferative agent can be a kinase inhibitor, an alkylating agent, an antibiotic, an anti-metabolite of -8 - 201215610, an antidote, an interferon, a multi- or monoclonal antibody, a HER2 inhibitor, and a histone deacetylase inhibitor. 'hormone, mitotic inhibitor, MTOR inhibitor, taxane or taxane derivative, aromatase inhibitor, anthracycline, microtubule target drug, topoisomerase poison, adenosine analog drug, A guanosine analog drug, a methyl uridine analog drug, or a cytidine analog drug. Preferably, the cytidine analog is gemcitabine. Preferably, the kinase inhibitor is a serine/threonine kinase inhibitor or a tyrosine kinase Q inhibitor. Preferred kinase inhibitors include, but are not limited to, sorafenib, sunitinib, erlotinib, imatinib or gefitinib. Preferred alkylating agents include, but are not limited to, cisplatin or carboplatin. Preferred anti-metabolites include, but are not limited to, gemcitabine, flu〇rouracil (5-FU), TS-1 or capecitabine. Preferred mitotic inhibitors include, but are not limited to, camptothecin or irino tec an. Preferred taxane or taxane derivatives include, but are not limited to, paclitaxel or docetaxel. The cell proliferative disorder can be a pre-cancerous state or cancer. The cell proliferative disease may be a blood tumor or a malignant tumor, or a solid tumor (or a tumor, etc.). The method of treating cancer involves reducing tumor size. Alternatively or additionally, the cancer is a metastatic cancer and the method of treatment comprises inhibiting metastatic cancer cell invasion. The method may additionally comprise radiation therapy. The cancer can be lung cancer, small cell lung cancer, non-small cell lung cancer (NSCLC), colon cancer, breast cancer, pancreatic cancer, prostate cancer, kidney cancer, cervical cancer, brain cancer, stomach cancer, uterine cancer, small intestine cancer, liver cancer, chronic Myeloid leukemia, melanoma, ovarian cancer, metastasis-related -9- 201215610 Renal cell carcinoma (RCC), vesicular soft tissue sarcoma (ASPS), clear cell sarcoma (CCS) or hepatocellular carcinoma (HCC). A cell having a proliferative disease may comprise DNA encoding c-Met. Alternatively or additionally, cells having a proliferative disease have constitutively enhanced c-Met activity. Preferably, the cell proliferative disorder is cancer, and particularly preferably, the cancer exhibiting c-Met or exhibiting active c-Met. Accordingly, the present invention provides a method of treating a cell proliferative disorder, wherein the cells exhibit a high degree of c-Met or an active c-Met. The invention further provides a method of treating a cell proliferative disorder comprising selectively modulating the activity of c-Met but not significantly inhibiting the activity of protein kinase C. Preferably, the subject is a mammal. More preferably, the object is a human. Preferably, the compound of formula III, Ilia, IVa, IVb, Va or Vb of the process described herein is (-)-trans-3-(5,6-dihydro-41^-pyrho[3, 2,1-1]] quinoline-bu)-4-(1 H-indol-3-yl)pyrrolidine-2,5-dione and administered at a dose of 3 60 mg, one for two Times. Alternatively, the composition is administered at a maximum daily dose of 720 mg. Preferably, the compound of formula III, nia, IVa, IVb, Va or Vb and the second antiproliferative agent are administered intravenously, orally or intraperitoneally. The second anti-proliferative agent can be administered prior to or after administration of a composition comprising a compound of formula III, Ilia, IVa, IVb, Va or Vb. Preferably, the compound of formula III, Ilia, IVa, IVb, Va or Vb is (_)_trans-3-(5,6-dihydro-4H-pyrido[3,2,l-ij]quina Phenyl-l-yl)-4-(lH-indol-3-yl)pyrrolidine-2,5-dione and a second antiproliferative agent are gemcitabine and (-)-trans-3 - (5,6 -Dihydro-4 Η-pyrrolo[3,2,1 - ij ]quinolin-1 -yl)-4- -10- 201215610 (1H_indol-3-yl)pyrrolidine-2,5- The diketone is administered for at least 12 hours after administration of gemcitabine. (-)_反·3·(5,6--hydrogen succinyl[3,2,l-ij] sputum_1_yl)_4-(111-11 晩-3-yl) 卩 咯 11 The _2,5-dione can also be administered for at least 24 hours, at least 48 hours, at least 72 hours, or at least 9.6 hours after administration of gemcitabine. Preferably, the subject is not administered any medication for at least 12 hours, at least 24 hours, or at least 48 hours prior to administration of the gemcitabine. 0 Preferably, the subject is not administered any drug for at least 24 hours 'then and then is given gemcitabine for no more than 24 hours' and then administered (-)-trans-3-(5,6-dichloro-4?-la- [3,2,1-ϋ]Salantaline-I-yl)_4-(1Η-Β引-3-yl)pyridinium-2,5-dione is at least 7 hours. Preferably, the gemcitabine is administered in a single dose at no more than 30 minutes, no more than 1 hour, no more than 12 hours, or no more than 24 hours. Preferably '(-)·anti_3_(5,6-dihydro-4Η-pyrrolo[3,2,l-ij]quinolin-1-yl)-4-(1Η-吲哚-3 - The pyrrolidine-2,5-diketone is administered for at least 24 hours, at least 48 hours, or at least 72 hours. Preferably, the compound of formula III, Ilia, IVa, IVb, Va or Vb is (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline -1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione, which is about 90% of the concentration or amount of gemcitabine in the subject being less than its initial concentration or amount Administration after %, less than about 50%, less than about 20%, less than about 10%, less than about 5%, or less than about 1%. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by persons of ordinary skill in the art to which the invention pertains. -11 - 201215610 In the present specification 'unless the context clearly dictates otherwise, Otherwise, the singular form also includes the plural. Although equivalent to the method and material _#$ described herein can be measured, the appropriate method and material are described below. All publications, patent applications, patents and other references mentioned herein are hereby incorporated by reference. The references cited herein are not to be considered as prior art to the patent application. In the event of a conflict, this specification will be defined as the main. In addition, the materials, methods, and examples are illustrative only and are not intended to be limiting. Other features and advantages of the invention will be apparent from the description and appended claims. DETAILED DESCRIPTION OF THE INVENTION 1. Methods of Treatment The present invention provides a method of treating a cell proliferative disorder comprising a therapeutically effective amount of a compound of Formula III, Ilia, iVa, IVb, Va or Vb' or a pharmaceutically acceptable compound thereof a salt, or a prodrug or metabolite thereof, in combination with one or more pharmaceutically acceptable carriers or excipients, in combination with a therapeutically effective amount of a second antiproliferative agent, together with one or more pharmaceutically acceptable carriers or The excipient is administered to a subject in need thereof, wherein the cell proliferative disorder is treated. The present invention provides a pharmaceutical composition for treating a cell proliferative disease comprising: (a) a therapeutically effective amount of a compound of the formula m, IIIa, IVa, IVb, Va or Vb' or a pharmaceutically acceptable salt thereof, or Its prodrug or metabolite 'combines (b) a therapeutically effective amount of a second anti-proliferative agent. One or more -12-201215610 A pharmaceutically acceptable carrier or excipient is optionally included in the composition. The second anti-proliferative agent is preferably a second chemotherapeutic agent. The cell proliferative disorder can be a pre-cancerous state or cancer. The cell proliferative disease may be a hematological tumor or a malignant tumor, or a solid tumor (or a tumor or the like). This method of treating cancer involves a reduction in tumor volume. Alternatively or additionally, the cancer is a metastatic cancer and the method of treatment comprises inhibiting the invasion of metastatic cancer cells into 〇O m κ匕, and the therapeutic agent (also known as an anti-tumor agent or anti-proliferative agent) may be an alkylating agent; Antibiotics; antimetabolites; antidote; interferon; multi- or monoclonal antibodies; EGFR inhibitors; HER2 inhibitors; tissue protein deacetylase inhibitors; hormones; mitotic inhibitors; MTOR inhibitors; ; a serine/threonine kinase inhibitor; a tyrosine kinase inhibitor; a VEGF/VEGFR inhibitor; a taxane or a taxane derivative, an aromatase inhibitor, an anthracycline, a microtubule target drug, Topoisomerase poisons, molecular targets or inhibitors of enzymes (eg kinase inhibitors), cytidines, or any of the drugs listed at www.cancer.org/docroot/cdg/cdgO.asp a chemotherapeutic agent, an antitumor agent or an anti-proliferative agent. Typical alkylating agents include, but are not limited to, cyclophosphamide (Cytoxan; Neosar); chlorambucil (Leukeran); melphalan (Alkeran); carmustine (BiCNU) ); Busulfan (Busulfex); lomustine (CeeNU); dacarbazine (DTIC-Dome); oxaliplatin (Eloxatin); carmustine (carmustine) (Gliadel); ifosfamide (Ifex); nitrogen mustard-13- 201215610 (mechlorethamine) (Mustargen); busulfan (Myleran); carboplatin (Paraplatin); Lead (cisplatin) (CDDP; Platinol); temozolomide (Temodar); thiotepa (Thioplex); bendamustine (Treanda); or streptozotocin ( Streptozocin) (Zanosar). Typical antibiotics include, but are not limited to, doxorubicin (adriamycin); doxorubicin liposomes (Doxil); mitoxantrone (Novantrone); bleomycin (Blenoxane); daunorubicin (Cerubidine); daunomycin liposome (DaunoXome); dactinomycin (Cosmegen): epirubicin (Ellence); Idamycin (Idamycin); plicamycin (Mithracin); mit〇mycin (Mutamycin); pentostatin (Nipent); or valrubicin (Valstar). Typical antimetabolites include, but are not limited to, fluorouracil (Adrucil); capecitabine (Xeloda); ureea (Hydrea); thiophene (Purinethol); pemetrexed (pemetrexed) (Alimta); fludarabine (Fludara); nelarabine (Arranon); cladribine (Cladribine Novaplus); clofarabine (Clolar); Cytarabine (Cytosar-U); decitabine (Dacogen); cytarabine liposome (DepoCyt); transurea (Droxia ); pralatrexate (Folotyn); fluorouridine (fl〇XUridine) (FUDR); gemcitabine-14- 201215610 (Gemzar); clasmin (Leustatin); gas dalabin (Oforta); Methretrexate (ΜTX; Rheumatrex); Trexall; thioguanine (Tabloid); TS-1 or cytarabine (Tarabine PFS). Typical antidote includes but Not limited to amifostine (Ethyol) or mesna (Mesnex).

典型幹擾素包括但不限於幹擾素a-2b((內含子 (Intr〇n)A))或幹擾素 a-2a(羅飛龍(Roferon)-A)。 典型多株或單株抗體包括但不限於曲妥珠單抗 (trastuzumab)(Herceptin);歐法妥莫單抗(ofatumumab) (Arzerra);貝伐珠單抗(bevacizumab)(Avastin);利妥昔單 抗(rituximab)(Rituxan);西妥昔單抗(cetuximab)(Erbitux) :帕尼單抗(p a n i t u m u m a b) (V e c t i b i X ); 托西莫單抗 (tositumomab)/碘;托西莫單抗(Bexxar);阿寄單抗 (alemtuzumab)(Campath);伊比妥莫單抗(ibritumomab) (In-111 Zevalin);吉妥珠單抗(gemtuzumab)(Mylotarg); 艾庫珠單抗(eculizumabKSoliris);伊比妥莫單抗(Y-90 Zevalin);迪諾珠單抗(denosumab)或伊比妥莫單抗 (Zevalin)。 典型EGFR抑制劑包括但不限於吉非替尼(Iressa);拉 帕替尼(lapatinib)(Tykerb);西妥昔單抗(Erbitux);埃羅 替尼(Tarceva);帕尼單抗(Vectibix); PKI-166:卡奈替尼 (canertinib)(CI- 1 033);馬妥珠單抗(matuzumab) (Emd7200)或 EKB-569。 -15- 201215610 典型HER2抑制劑包括但不限於曲妥珠單抗 (Herceptin);拉帕替尼(Tykerb)或 AC-480。 組蛋白去乙醯酶抑制劑包括但不限於伏立諾他 (vorinostat)(Zolinza) ° 典型激素包括但不限於他莫昔芬 (tamoxifen)(Soltamox ; Nolvadex);雷洛昔芬(raloxifene) (Evista);甲地經孕酮(megestrol)(Megace);亮丙瑞林 (1 e up r ο 1 i d e) (L u p r ο η ; Lupron Depot ; Eligard ; Viadur); 氟 維 司 群(fulvestrant)(Faslodex); 來 曲 哩 (letrozole)(Femara);曲普瑞琳(triptorelin)(Trelstar LA ; Trelstar Depot);依西美坦(exemestane)(Aromasin);戈舍 瑞林(g〇serelin)(Zoladex);比卡魯胺(bicalutamide) (Casodex);阿那曲哩(anastrozole) (Arimidex);籤甲睾酮 (fluoxymesterone)(Androxy ; Halotestin);甲經助孕酮 (medroxyprogesterone)(Provera ; Depo-Provera);雌莫司 汀(estramustine)(Emcyt);氟他胺(flutamide)(Eulexin); 托瑞米芬 (toremifene)(Fareston); 地加瑞利 (degarelix)(Firmagon);尼魯米特(nilutamide)(Nilandron) ;阿巴瑞克(abarelix)(Plenaxis)或睪內酯(testolactone) (Teslac)。 典型有絲分裂抑制劑包括但不限於太平洋紫杉醇 (Taxol; Onxol; Abraxane);多西他賽(Taxotere);長春新 鹼(vincristine)(Oncovin ; Vincasar PFS);長春花鹼 (vinblastine)(Velban);依託泊苷(etoposide)(Toposar ; -16- 201215610Typical interferons include, but are not limited to, interferon a-2b ((Intr〇n) A) or interferon a-2a (Roferon-A). Typical multi-strain or monoclonal antibodies include, but are not limited to, trastuzumab (Herceptin); ofatumumab (Arzerra); bevacizumab (Avastin); Rituximab (Rituxan); cetuximab (Erbitux): panitumumab (V ectibi X ); tositumomab/iodine; tosimo (Bexxar); alemtuzumab (Campath); ibritumomab (In-111 Zevalin); gemtuzumab (Mylotarg); eculizumab KSoliris ); Y-90 Zevalin; denosumab or Zevalin. Typical EGFR inhibitors include, but are not limited to, gefitinib (Iressa); lapatinib (Tykerb); cetuximab (Erbitux); erlotinib (Tarceva); panitumumab (Vectibix) PKI-166: canertinib (CI-1 033); matuzumab (Emd7200) or EKB-569. -15- 201215610 Typical HER2 inhibitors include, but are not limited to, trastuzumab (Herceptin); lapatinib (Tykerb) or AC-480. Histone deacetylase inhibitors include, but are not limited to, vorinostat (Zolinza). Typical hormones include, but are not limited to, tamoxifen (Soltamox; Nolvadex); raloxifene (raloxifene) Evista); megestrol (Megace); leuprolide (1 e up r ο 1 ide) (L upr ο η; Lupron Depot; Eligard; Viadur); fulvestrant (fulvestrant) Faslodex); Letrozole (Femara); Triptorelin (Trelstar LA; Trelstar Depot); exemestane (Aromasin); Goserelin (Z〇dex) ); bicalutamide (Casodex); anastrozole (Arimidex); fluoxymesterone (Androxy; Halotestin); medroxyprogesterone (Provera; Depo-Provera) ; estramustine (Emcyt); flutamide (Eulexin); toremifene (Fareston); degarelix (Firmagon); nilutamide (Nilandron); abarelix (Plenaxis) or testolactone (Teslac). Typical mitotic inhibitors include, but are not limited to, paclitaxel (Taxol; Onxol; Abraxane); docetaxel (vintexine); vincristine (Oncovin; Vincasar PFS); vinblastine (Velban); Etoposide (Toposar; -16- 201215610

Etopophos; VePesid);替尼泊苷(teniposide)(Vumon);伊 沙匹隆(ixabepilone)(Ixempra);諾考達唾(nocodazole); 埃博黴素(epothilone);長春拉賓(vinorelbine)(Navelbine) ;喜樹鹼(CPT);伊立替康(irinotecan)(Camptosar);托泊 替康(topotecan)(Hycamtin);安 dY B定(amsacrine)或片螺素 (lamellarin)D(LAM-D)。 典型mTOR抑制劑包括但不限於依維莫司 〇 (everolimus)(Afinitor)或替西羅莫司(temsirolimus) (Torisel)、 雷帕黴素(rapamune)、 瑞達羅莫司 (r i d a f 〇 r ο 1 i m u s)或 A P 2 3 5 7 3。Etopophos; VePesid); teniposide (Vumon); ixabepilone (Ixempra); nocodazole; epothilone; vinorelbine Navelbine); camptothecin (CPT); irinotecan (Camptosar); topotecan (Hycamtin); amsacrine or mellatin D (LAM-D) ). Typical mTOR inhibitors include, but are not limited to, everolimus (Afinitor) or temsirolimus (Torisel), rapamune, ridafromos (ridaf 〇r ο 1 imus) or AP 2 3 5 7 3.

典型激酶抑制劑包括但不限於貝伐珠單抗 (Bevacizumab)(標靶 VEGF)、BIB W2 9 9 2 (標靶 E GF R和 Er b2) 、西妥昔單抗(Cetuximab)/Erbitux(標耙Erbl)、依馬替尼 (Imatinib)/Gleevic(標 IE Bcr-Abl、PDGFRs 和 c-Kit)、曲妥 珠單抗 (Trastuzumab)(標耙 Erb2)、 吉非替尼 〇 (Gefitinib)/Iressa(標靶 EGFR)、雷珠單抗(RanibizumabK 標靶VEGF)、培加他尼(Pegaptanib)(標靶VEGF)、埃羅替 尼(Erlotinib)/Tarceva(標耙 Erbl)、尼羅替尼(Nilotinib)(標 革巴 Bcr-Abl)、拉帕替尼(lapatinib)(標耙 Erbl 和 Erb2/Her2) 、GW-572016/拉帕替尼二甲苯擴酸鹽(Lapatinib ditosylate)(標粑 HER2/Erb2)、帕尼單抗(Panitumumab) /Vectibix(標耙 EGFR)、凡德替尼(Vandetinib)(標祀 RET/VEGFR)、E7080(包括RET和VEGFR的多重標靶)、賀 癌平(Herceptin)(標靶 HER2/Erb2)、PKI-16 6(標靶 EGFR)、 -17- 201215610 卡奈替尼(Canertinib)/CI- 1 03 3(標靶EGFR)、舒尼替尼 (Sunitinib)/SU-11464/妤癌特(Sutent)(標靶 EGFR 和 FLT3) 、馬妥珠單抗(Matuzumab)/Emd7200(標靶 EGFR)、EKB-569(標靶 EGFR)、Zd6474(標靶 EGFR 和 VEGFR)、PKC-412( 標靶 VEGR 和 FLT3)、 瓦他拉尼 (Vatalanib) /Ptk78 7/ZK2225 84(標靶 VEGR)、C E P - 7 0 1 (標靶 F L T 3 )、 SU5614(標靶 FLT3)、M LN 5 1 8 (標靶 F L T 3 )、XL999(標靶 FLT3)、VX-322(標靶 FLT3)、Azd 0 5 3 0 (標靶 S RC )、BMS-354825(標耙 SRC)、SKI-606(標靶 SRC)、CP-690(標靶 JAK) 、AG-490(標靶 JAK)、WHI-P154(標靶 JAK)、WHI-P131(標 耙JAK)、索拉非尼(sorafenib)/雷莎瓦(Nexavar)(標粑RAF 激酶、VEGFR-1、VEGFR-2、VEGFR-3、PDGFR-β、KIT 、FLT-3 和 RET)、達沙替尼(Dasatinib)/Sprycel(BCR/Abl 和Src)、AC-220(標靶Flt3)、AC-4 8 0(標靶所有的HER蛋白 質,“pan-HER”)、莫替沙尼(Motesanib)二磷酸鹽(標靶 VEGF1-3 ' PDGFR 和 c-kit)、地諾單抗(Denosumab)(標祀 RANKL,抑制 SRC)、AMG888(標耙 HER3)及 AP24534(包括 Flt3的多重標靶)。 典型多激酶抑制劑包括但不限於索拉非尼(Nexavar) 、舒尼替尼(Sutent)、BIBW 29 92、E7080、Zd6474、PKC-412、莫替沙尼或AP24534。 典型絲胺酸/蘇胺酸激酶抑制劑包括但不限於伊利盧 (eril)/伊舒地爾(easudil)鹽酸鹽;雷帕黴素(Rapamune)(標 靶 mTOR/FRAPl);狄羅莫司(Deforolimus)(標靶 mTOR); -18- 201215610 卓定康(Certican)/依維莫司(Everolimus))(標紀 mTOR/FRAPl) ; AP23 5 73 (標靶 mTOH/FRAPl);伊利盧 (Eril)/法舒地爾(Fasudil)鹽酸鹽(標靶RHO);夫拉平度 (Flavopiridol)(標靶 CDK);希利西力伯(Seliciclib) /CYC202/ 羅斯可威(Roscovitrine)(標靶 CDK) ; SNS-032/BMS-3 87032(標靶 CDK);魯伯斯塔(Ruboxistaurin)(標 $EPKC); Pkc412(標靶 PKC);拜由斯達汀(Bryostatin)(標 0 靶 PKC) ; KAI-9803C 標靶 PKC) ; SF1126(標靶 PI3K) ; VX-6 8 0(標靶極光(人1!1:〇1^)激酶);八2(11152(標靶極光激酶); Arry- 1 42886/AZD-6244(標靶 MAP/MEK) ; SCIO-469(標靶 MAP/MEK) ; GW6 8 1 3 23 (標靶 MAP/MEK) ; CC-401(標靶 JNK); CEP-1347(標靶 JNK);及 PD332991(標靶 CDK)。 典型酪胺酸激酶抑制劑包括但不限於埃羅替尼 (Tarceva);吉非替尼(Iressa);依馬替尼(Gleevec);索拉 非尼(Nexavar);舒尼替尼(Sutent);曲妥珠單抗 〇 (Herceptin);貝伐珠單抗(Avastin);利妥昔單抗(Rituxan) :拉帕替尼(Tykerb);西妥昔單抗(Erbitux);帕尼單抗 (Vectibix);依維莫司(Afinitor);阿盡單抗(Campath);吉 妥珠單抗(Mylotarg);替西羅莫司(Torisel);帕唑帕尼 (pazopanib)(Votrient);達沙替尼(dasatinib)(Sprycel);尼 羅替尼(nilotinib)(Tasigna);凡特尼布(vatalanib)(Ptk787 ZK2225 84) ; CEP-70 1 ; SU5614 ; MLN518 ; XL999 ; VX-3 2 2 ; Azd05 3 0 ; BMS-3 54825 ; SKI-606 CP-690 ; AG-490 ;WHI-P154 ; WHI-P1 3 1 ; AC-220 ;或 AMG888。 -19- 201215610 典型VEGF/VEGFR抑制劑包括但不限於貝伐珠單抗 (Avastin):索拉非尼(Nexavar);舒尼替尼(Sutent) :雷珠單抗、培加他尼;或凡德替尼(vandetinib)。 典型芳香酶抑制劑包括但不限於胺格魯米特 (aminoglutethimide)、睪內酯(Teslac)、阿那曲哩 (Arimidex)、來曲哩(Letrozole)(Femara)、依西美坦 (Aromasin)、伏氯哩(Vorozole)(Rivizor)、福美司坦 (Formestane)(Lentaron)、法曲哩(Fadrozole)(Afema)、4-雄甾烯-3,6,17-三酮(6-OXO)、1,4,6-雄甾三烯-3,17-二酮 (ATD)及4-羥基雄甾二酮。 典型蒽環類包括但不限於道諾黴素(紅比黴素 (Daunomycin))、阿黴素((阿德力黴素)、表阿黴素、伊達 比星及戊柔比星。 典型胞苷類似物包括但不限於吉西他濱、氮雜胞苷( 例如,5-氮雜胞苷)、和胞嘧啶阿拉伯醣(阿糖胞苷、araC 、Cytosar)。 典型性微管標靶藥包括但不限於太平洋紫杉醇、多西 他賽、長春新鹼、長春花鹼、諾考達唑、埃博黴素和溫諾 平(navelbine)。 典型拓撲異構酶毒藥包括但不限於替尼泊苷、依託泊 苷、阿德力黴素、喜樹鹼、道諾黴素、更生黴素、米托意; 醌、安吖啶、表阿黴素和伊達比星。 典型紫杉烷或紫杉烷衍生物包括但不限於太平洋紫杉 醇和多西他賽。 -20- 201215610 典型一般化學治療劑、抗腫瘤劑及抗增生劑包括但不 限於六甲蜜胺(altretamine)(Hexalen); 異維A酸 (isotretinoin)(Accutane ; Amnesteem ; Claravis ; Sotret) ; 維 A 酸(tretinoin)( Vesanoid); 阿 紮胞苷 (a z a c i t i d i n e) (V i d a z a );硼替左米(b o r t e z o m i b) (V e 1 c a d e) 天冬酸胺酶(asparaginase)(Elspar); 左旋四咪哩 (levamisole)(Ergamisol);米托坦(mitotane)(Lysodren); ◎ 甲基节肼(procarbazine)(Matulane);培門冬酶 (pegaspargase)(Oncaspar);地尼白介素(denileukin diftitox)(Ontak);卩卜吩姆(p〇rfimer)(Photofrin);阿地白介 素(aldesleukin)(Proleukin);來那度胺(lenalidomide) (Revlimid);萑薩羅丁(bexarotene)(Targretin);沙利竇邁 (thalidomide)(Thalomid);替西羅莫司(Torisel);三氧化 二砷(Trisenox);維替泊芬(verteporfin)(Visudyne);含羞 草驗(mimosine)(Leucenol) ; (1M替加氟(tegafur)-0.4M 5-〇 氯-2,4-二羥嘧啶-1M氧嗪酸鉀)或他汀類(例如洛伐他汀 (lovastatin)、阿托伐他汀(atorvastatin)、西立伐他汀 (cerivastatin)、氟伐他汀(fluvastatin)、美伐他汀 (mevastatin)、匹伐他汀(pitavastatin)、普伐他汀 (pravastatin)、羅蘇伐他汀(rosuvastatin)及辛伐他汀 (simvastatin) 〇 本發明也提供一種治療細胞增生性疾病之方法,該方 法包含將治療有效量之式III、Ilia、IVa、ivb、Va或Vb之 化合物或其醫藥上可接受的鹽、或其前藥或代謝物,組合 -21 - 201215610 有治療有效量之第二種抗增生劑,投予至對象,其中該式 III、Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上可接受 的鹽、或其前藥或代謝物和該第二種抗增生劑不同時投予 〇 在某些較佳體系中,式III、Ilia、IVa、IVb、Va或Vb 之化合物爲(-)-反-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]唾啉-卜基)-4-(lH-吲哚-3-基)吡咯啶-2,5-二酮。 在某些較佳體系中,第二種抗增生劑爲胞苷類似物, 包括但不限於吉西他濱、氮雜胞苷(例如,5-氮雜胞苷)、 和胞嚼陡阿拉伯醣(阿糖胞苷、araC、Cytosar)。較佳地, 胞苷類似物爲吉西他濱。 在另一體系中,第二種抗增生劑爲細胞週期之G1/S期 的抑制劑。 在某些較佳體系中,式III、Ilia、IVa、IVb、Va或Vb 之化合物或其醫藥上可接受的鹽、或其前藥或代謝物係在 投予該第二種抗增生劑之後投予。 在一體系中,式ΙΠ、Ilia' IVa、IVb、Va或Vb之化合 物或其醫藥上可接受的鹽、或其前藥或代謝物係在投予第 二種抗增生劑之後以單一劑量投予12小時、24小時、36小 時、48小時、60小時、72小時、4天、5天、6天、7天、10 天、2週、3週、或4週。 較佳地,第二種抗增生劑係投予不超過1 2或2 4小時且 式III、Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上可接 受的鹽、或其前藥或代謝物係在投予第二種抗增生劑之後 -22- 201215610 投予24小時。最佳地,其中在投予第二種抗增生劑之前至 少12小時或24小時沒有投予藥物。 更佳地,當化合物或藥劑投予至對象時,式III、Ilia 、IVa、IVb、Va或Vb之化合物或其醫藥上可接受的鹽、 或其前藥或代謝物係在第二種抗增生劑在該對象中之濃度 或數量低於其起始濃度或起始數量的90%、80%、70%、 6 0 %、5 0 %、4 0 %、3 0 %、2 0 % 或 1 0 % 後投予 2 4 小時。較佳 0 地,化合物或藥劑之濃度或數量低於其起始濃度的5 0%。 更佳地,化合物或藥劑之濃度或數量低於其起始濃度或起 始數量的 1 0 %、9 %、8 %、7 %、6 %、5 %、4 %、3 %、2 %、 1 %。 在一體系中,對象在式III、Ilia、IVa、IVb、Va或Vb 之化合物或其醫藥上可接受的鹽、或其前藥或代謝物投予 至對象之前12小時、24小時、36小時、48小時、60小時、 72小時、4天、5天、6天、7天、10天、2週、3週、或4週 ❹ 爲“無”(沒有投予)第二種抗增生劑的藥。較佳地,對象在 式III、Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上可接 受的鹽、或其前藥或代謝物投予之前至少24小時、至少48 小時或至少72小時爲“無”第二種抗增生劑的藥。 在某些較佳體系中,第二種抗增生劑係在投予式III 、Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上可接受的 鹽、或其前藥或代謝物之後投予。 在一體系中,第二種抗增生劑係在投予式III、Ilia、 IVa、IVb、Va或Vb之化合物或其醫藥上可接受的鹽、或 -23- 201215610 其前藥或代謝物投予至對象之後以單一劑量投予3 0分鐘、 1小時、1 2小時、2 4小時' 3 6小時、4 8小時、6 0小時、7 2 小時、4天、5天、6天、7天、1〇天、2週、3週、或4週。 較佳地,式III、Ilia、IVa、IVb、Va或Vb之化合物或 其醫藥上可接受的鹽、或其前藥或代謝物係投予至少24小 時或48小時且第二種抗增生劑係在投予式III、Illa、IVa 、IVb、Va或Vb之化合物或其醫藥上可接受的鹽、或其前 藥或代謝物之後投予48小時。最佳地,在投予第二種抗增 生劑之前至少1 2小時或至少2 4小時沒有投予藥物。 更佳地,當化合物或藥劑投予至對象時,第二種抗增 生劑係在式III、Ilia、IVa、IVb、Va或Vb之化合物或其醫 藥上可接受的鹽、或其前藥或代謝物在該對象中之濃度或 數量低於其起始濃度或起始數量的90%、80%、70%、60% 、5 0 %、4 0 %、3 0 %、2 0 %或1 〇 %後投予4 8小時。較佳地, 化合物或藥劑之濃度或數量低於其起始濃度的5 0 %。更佳 地,化合物或藥劑之濃度或數量低於其起始濃度或起始數 量的 1 0 %、9 %、8 %、7 %、6 %、5 %、4 %、3 %、2 %、1 %。 在一體系中,對象在第二種抗增生劑投予至對象之前 1 2小時、2 4小時、3 6小時、4 8小時、6 0小時、7 2小時、4 天、5天、6天、7天、1〇天、2週、3週、或4週,爲”無”式 III、Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上可接受 的鹽、或其前藥或代謝物的藥。較佳地,對象在第二種抗 增生劑投予之前至少2 4小時、至少4 8小時或至少7 2小時爲 "無"式III、Ilia、IVa、IVb、Va或Vb之化合物或其醫藥上 -24- 201215610 可接受的鹽、或其前藥或代謝物的藥。 如使用於本文中,"無藥的"表示沒有藥物投予至對象 。也可表示對象沒有接受任何的藥物。較佳地,無藥的表 示對象沒有被投予任何抗增生劑或抗癌劑。 較佳組合療法包括但不限於(-)-反-3-(5,6-二氫-411-吡 咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二 酮與吉西他濱組合投予。在某些體系中,對象或病患接受 〇 吉西他濱,投予於約25 00毫克/米2至約50毫克/米2,每天 一次。在某些體系中,吉西他濱係以減少劑量投予,以減 少毒性。例如,吉西他濱係投予於1 0 00毫克/米2、750毫 克/米2、500毫克/米2、250毫克/米2、100毫克/米2、或50 毫克/米2,每天一次。在某些體系中,對象或病患每天二 次接受於360毫克之(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1- ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶-2,5-二酮。(_)_反_ 3-(5,6-二氫-411-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3- 〇 基)吡咯啶-2,5-二酮之較佳劑型包括但不限於膠囊和錠劑 〇 本實施例證明當(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-i j ]喹啉-1 -基)-4 - (1 Η -吲哚· 3 -基)吡咯啶-2,5 -二酮與吉西他 濱組合投予時,對各癌症具有增效或至少相加之活體外及 活體內抗增生作用。該等癌包括但不限於肺癌、小細胞肺 癌、非小細胞肺癌、結腸癌、乳癌、胰癌、前列腺癌、腎 癌、子宮頸癌、腦癌、胃癌、子宮癌、小腸癌、肝癌、慢 性骨髓性白血病、黑色素瘤、卵巢癌、轉移相關性腎細胞 -25- 201215610 癌(RCC)、泡狀軟組織肉瘤(ASPS)、透明細胞肉瘤(CCS) 和肝細胞癌。該等組合性治療之抗增生效果於其中受影響 之細胞組成性表現或過度表現c-Met之細胞增生性疾病及 癌中被增加/增強。 (-)-反-3-(5,6-二氫-41吡咯并[3,2,1-丨〗]喹啉-1-基)-4-(1H-吲哚-3-基)吡略啶-2,5-二酮是一種非ATP競爭性小分 子,其選擇性地標靶c-Met的受體酪胺酸激酶。將表現c-Met癌細胞系暴露於(-)-反- 3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-l-基)-4-(lH-吲哚-3-基)吡咯啶-2,5-二酮導致磷酸 化-c-Met含量之減少且最終細胞凋亡的細胞死亡。在多小 鼠異體移植效力硏究中(-) -反-3-(5,6 -二氫-4H-吡咯并 [3,2,1-ij]喹啉-卜基)-4-(1Η-吲哚-3-基)吡咯啶-2,5-二酮也 抑制人腫瘤之生長(Munshi N,等人 ”ARQ 197,a Novel and Selective Inhibitor of the Human c-Met receptor Tyrosine Kinase with Antitumor Activity”. Mol Cancer Ther (2010 May 18)) o 吉西他濱是一種抗癌化療藥物且用以治療胰癌、非小 細胞肺癌、膀胱癌、軟組織肉瘤和轉移性乳癌。吉西他濱 被分類爲抗代謝物。在DN A複製期間吉西他濱之三磷酸鹽 類似物替換胞苷,產生DN A合成之抑制和細胞凋亡之誘發 。吉西他濱之二磷酸鹽類似物鈍化核糖核苷酸還原酶酵素 (RNR)且抑制DNA複製和修補所需之去氧核苷酸的產生, 及誘發細胞凋亡。吉西他濱已顯示將癌細胞停滯於G 1 / S期 (Cerqueira, P. A. Fernandes, M. J. Ramos (2 007), -26- 201215610 "Understanding ribonucleotide reductase inactivation by gemcitabine", Chemistry, a European Journal 13 (30): 8507-15)° 本發明式III、Ilia、IVa、IVb、Va或Vb之化合物,或 其醫藥上可接受之鹽、前藥、代謝物、類似物或衍生物可 被納入適合於投予之醫藥組成物中。該等組成物通常包含 該化合物(也就是包括該活性化合物)及醫藥上可接受之賦 〇 形劑或載劑。如使用於本文中,“醫藥上可接受之賦形劑” 或“醫藥上可接受之載劑”意欲包括任何及所有相容於醫藥 投予之溶劑、分散介質、塗料、抗細菌和抗真菌劑、等張 劑、吸收延遲劑、等等。適當之載劑係描述於最新版之 Remington’s Pharmaceutical Sciences中,此爲該領域之標 準參考書目。該等載劑或稀釋劑之較佳例子包括但不限於 水、鹽水、林格氏液、葡萄糖液及5 %人血清白蛋白。 醫藥上可接受之載劑包括固體載劑諸如乳糖、白土、 〇 蔗糖、滑石、明膠、洋菜、果膠、阿拉伯膠、硬脂酸鎂、 硬脂酸、等等。典型液體載劑包括糖漿、花生油、橄欖油 、水、等等。類似地,該載劑或稀釋劑可包括該技藝已知 之時間延遲材料,諸如單獨或與蠟一起之單硬脂酸甘油酯 或二硬脂酸甘油酯、乙基纖維素、羥丙基甲基纖維素、甲 基丙烯酸甲酯或該類似物。其他塡充劑、賦形劑、香料及 其他添加劑諸如該技藝已知者亦可被包括於根據本發明之 醫藥組成物中。脂質體及非水溶性媒液諸如不揮發油亦可 被使用。該等介質及試劑使用於醫藥活性物質係該技藝所 -27- 201215610 廣爲週知的。除了任何習知之介質或試劑 不相容之情況以外,彼等使用於組成物係 活性化合物亦可被納入該組成物中。 一方面,式 III、Ilia、IVa、IVb、Va 其醫藥上可接受之鹽、前藥、代謝物、類 以適當之劑型投予,該劑型係根據習知步 有效量(例如足以透過抑制腫瘤生長、殺 療或預防細胞增生性疾病等等以達所欲治 量)的式 III、Ilia、IVa、IVb、Va 或 Vb 之 上可接受之鹽、前藥、代謝物、類似物写 性成分)與標準醫藥載劑或稀釋劑(意即藉 醫藥組成物)而製備。該等步驟可酌情包 壓縮或溶解該等成分以獲得所要之製劑。 如使用於本文中,“對象”可爲任何哺 人類、靈長類動物、小鼠、大鼠、狗、貓 綿羊、山羊、駱駝。較佳地,對象爲人類 如使用於本文中,“需要其之對象,’爲 疾病之對象,或相對於一般族群具有增加 患病風險之對象。一方面,需要其之對象 一較佳方面,需要其之對象患有癌症。 如使用於本文中,術語”細胞增生性g 經調節或不正常生長或二者之細胞的情況 或不爲癌症的非所要之症狀或疾病發展。 胞增生性疾病包含其中細胞分裂失調的各 與該活性化合物 被考慮。補充性 或Vb之化合物或 似物或衍生物係 驟藉由組合治療 死腫瘤細胞、治 療效果之有效含 化合物或其醫藥 g衍生物(作爲活 由製備本發明之 括混合、造粒及 乳類動物,例如 、牛、馬、豬、 〇 具有細胞增生性 細胞增生性疾病 具有前癌狀態。 ξ病”係指其中未 可導致可爲癌症 本發明的典型細 種症狀。典型細 -28- 201215610 胞增生性疾病包括但不限於腫瘤、良性腫瘤、惡性腫瘤、 前癌狀態、原位腫瘤、有膜腫瘤、轉移性腫瘤、液體腫瘤 、固體腫瘤、免疫性腫瘤、血液腫瘤、癌症、癌、白血病 、淋巴瘤、肉瘤及快速分裂細胞。術語“快速分裂細胞”如 使用在本文中係定義成以超過或大於相同組織內相鄰或並 置的細胞之間所預期或觀察的速度之速度分裂的任何細胞 。細胞增生性疾病包括初癌或前癌狀態。細胞增生性疾病 〇 包括癌。較佳地,本文中所提供之方法被用於治療或減輕 癌癌徵候。術語“癌”包括固體腫瘤以及血液腫瘤及/或惡 性腫瘤。“初癌細胞”或“前癌細胞”爲顯現初癌或前癌狀態 之細胞增生性疾病的細胞。“癌細胞(cancer cell)”或“癌性 細胞(cancerous cell)”爲顯現癌之細胞增生性疾病的細胞 。任何可重現的測量方式可用於鑑定癌細胞或前癌細胞。 癌細胞或前癌細胞可藉由組織樣品(例如,生物檢體樣品) 的組織學分類或分級鑑定。癌細胞或前癌細胞可透過使用 〇 適當的分子標記物鑑定。 典型非癌症狀或病症包括但不限於類風濕性關節炎; 發炎;自體免疫疾病;淋巴增生症狀;肢端肥大症;類風 濕性脊椎炎;骨關節炎;痛風,其他關節性症狀;敗血症 ;敗血性休克;內毒性休克;革蘭(gram)陰性敗血症;毒 性休克症候群;氣喘;成人呼吸窘迫症候群;慢性阻塞性 肺疾病;慢性肺發炎;發炎性腸病;克隆氏(Crohn)病; 牛皮癬;濕疹;潰瘍性結腸炎;胰纖維化;肝纖維化;急 性和慢性腎疾病;腸躁症;pyresis ;血管再狹窄症;大腦 -29- 201215610 瘧疾;中風和局部缺血傷害;神經創傷;阿耳滋海默氏病 (Alzheimer’s disease);亨爾頓氏病(Huntington’s disease) :帕金森氏病(Parkinson’s disease);急性和慢性疼痛; 過敏性鼻炎;過敏性結膜炎;慢性心臟衰竭;急性冠狀動 脈症候群;惡病體質;瘧疾;麻瘋;萊什曼原蟲病;萊姆 (Lyme)病;萊特氏(Reiter)症候群:急性滑膜炎;肌肉退 化;滑囊炎;肌腱炎;腱鞘炎;椎間板軟骨脫出、破裂或 突出症候群;骨硬化症;血栓;血管再狹窄症;矽肺病; 肺肉瘤;骨再吸收疾病(諸如骨質疏鬆症);移植對宿主反 應;多發性硬化症:狼瘡;纖維肌痛;AIDS和其他病毒 性疾病(諸如帶狀皰疹;單純皰疹I或II ;流行性感冒病毒 和細胞巨大病毒);及糖尿病。 典型癌症包括但不限於腎上腺皮質癌、AID S相關癌 症、AIDS相關淋巴瘤、直腸癌、肛門癌、肛道癌、闌尾 癌、兒童小腦星狀細胞瘤、兒童大腦星狀細胞瘤、基底細 胞癌、皮膚癌(非黑色素癌)、膽管癌、肝外膽管癌、肝內 膽管癌、膀腕癌、泌尿膀腕癌、骨頭和關節癌症、骨肉瘤 和惡性纖維組織球瘤、腦癌、腦瘤、腦幹膠質細胞瘤、小 腦星狀細胞瘤、大腦星狀細胞瘤/惡性神經膠質瘤、室管 膜瘤、神經管胚細胞瘤、天幕上原始性神經外胚細胞腫瘤 、視覺路徑和腦下垂體之腦神經膠質瘤、乳癌、支氣管腺 瘤/類癌、類癌腫瘤、胃腸道、神經系統癌症、神經系統 淋巴瘤、中樞神經系統癌症、中樞神經系統淋巴瘤、子宮 頸癌、兒童癌症、慢性淋巴細胞白血病、慢性骨髓性白血 -30- 201215610 病、慢性骨髓增生症、結腸癌、結直腸癌、皮膚T細胞淋 巴瘤、淋巴腫瘤、蕈狀肉芽腫、Seziary症候群、子宮內 膜癌' 食道癌、顱外生殖細胞腫瘤、性腺外生殖細胞腫瘤 、肝外膽管癌、眼癌、眼內黑色素瘤、視網膜母細胞瘤、 膽囊癌、胃(gastric)(胃(stomach))癌、胃腸道類癌、胃腸 道間質瘤(GIST)、生殖細胞腫瘤、卵巢生殖細胞腫瘤、妊 娠滋養細胞腫瘤、神經膠質瘤、頭頸癌、肝細胞(肝)癌、 〇 何傑金(Hodgkin)淋巴瘤 '咽下癌、眼內黑色素瘤、眼癌 、胰小島細胞腫瘤(內分泌胰腺瘤)、卡波西(Kaposi)肉瘤 、腎臟癌(kidney cancer)、腎癌(renal cancer)、喉頭癌、 急性淋巴球性白血病、急性骨髓性白血病、慢性淋巴細胞 白血病、慢性骨髓性白血病、毛細胞白血病、唇和口腔癌 、肝癌、肺癌、非小細胞肺癌、小細胞肺癌、AIDS相關 淋巴瘤、非何傑金淋巴瘤、原發性中樞神經系統淋巴瘤、 沃登斯翠(Waldenstram)巨球蛋白血症、神經管胚細胞瘤 〇 、黑色素瘤、眼內(眼睛)黑色素瘤、梅克爾(merkel)細胞 癌、惡性間皮瘤、間皮瘤、轉移性鱗狀頸部癌、口腔癌、 舌癌、多發性內分泌腫瘤症候群、蕈狀肉芽腫、骨髓增生 異常症候群、骨髓增生異常/骨髓增生症、慢性骨髓性白 血病、急性髓系白血病、多發性骨髓瘤、慢性骨髓增生症 、鼻咽癌、神經母細胞瘤、口癌、口腔癌、口咽癌、卵巢 癌、卵巢上皮癌、低惡性度卵巢腫瘤、胰癌、胰小島細胞 胰癌、鼻竇和鼻腔癌、甲狀旁腺癌、陰莖癌、咽癌、嗜絡 細胞瘤、松果體母細胞瘤和天幕上原始神經外胚層腫瘤、 -31 - 201215610 腦下垂體腫瘤、槳細胞腫瘤/多發性骨髓瘤、胸膜肺母細 胞瘤、前列腺癌、直腸癌、腎盂和輸尿管、移行細胞癌、 視網膜母細胞瘤、橫紋肌肉瘤、唾腺癌、尤文(E w i n g)家 族腫瘤、卡波西肉瘤、子宫癌、子宮肉瘤、皮膚癌(非黑 色素瘤)、皮膚癌(黑色素瘤)、梅克爾細胞皮膚癌、小腸 癌、軟組織肉瘤、鱗狀細胞癌、胃(胃)癌、天幕上原始神 經外胚層腫瘤、睪九癌、喉癌、胸腺瘤、胸腺瘤和胸腺癌 、甲狀腺癌、腎盂和輸尿管與其他的泌尿器官的移行細胞 癌、妊娠滋養細胞腫瘤、尿道癌、子宮內膜癌、子宮肉瘤 、子宮體癌、陰道癌、外陰癌及威爾姆氏(Wilm’s)腫瘤。 “血液系統的細胞增生性疾病”爲一種涉及血液系統之 細胞的細胞增生性疾病。一方面,血液系統的細胞增生性 疾病包括淋巴瘤、白血病、骨髓腫瘤、肥胖細胞腫瘤、骨 髓發育不良、良性單株球蛋白症、淋巴瘤樣肉芽腫、淋巴 瘤樣丘疹、真性紅血球增多症、慢性骨髓細胞白血病、原 因不明性骨髓化生及原發性血小板增多症。另一方面,血 液系統之細胞增生性疾病包括血液系統之細胞過度增生、 發育不良和化生。一較佳方面,本發明之組成物可用以治 療選自由本發明之血液癌或本發明之血液細細胞增生性疾 病所組成之群組的癌。一方面,本發明之血液癌包括多發 性骨髓瘤、淋巴瘤(包括霍奇金氏淋巴瘤、非霍奇金氏淋 巴瘤、孩童淋巴瘤和淋巴球及皮膚起源之淋巴瘤)、白血 病(包括孩童白血病、毛細胞白血病、急性淋巴球性白血 病、急性骨髓性白血病、慢性淋巴球性白血病、慢性髓細 -32- 201215610 胞性白血病、慢性骨髓性白血病、和肥胖細胞性白血病) 、骨髓瘤、和肥胖細胞瘤》 “肺的細胞增生性疾病”爲一種涉及肺細胞的細胞增生 性疾病。一方面,肺的細胞增生性疾病包括影響肺細胞的 所有形式之細胞增生性疾病。一方面,肺的細胞增生性疾 病包括肺癌、肺的初癌或前癌狀態、肺之良性生長或病灶 、肺之惡性生長或病灶、和除肺以外的體內組織和器官中 〇 的轉移性病灶。一較佳方面,本發明之組成物可用以治療 肺癌或肺的細胞增生性疾病。一方面,肺癌包括所有形式 之肺癌。另一方面,肺癌包括惡性肺腫瘤、原位癌、典型 類癌瘤及非典型類癌瘤。另一方面,肺癌包括小細胞肺癌 ("SCLC”)、非小細胞肺癌("NSCLC")、鱗狀細胞癌、腺癌 、小細胞癌、大細胞癌、腺鱗狀細胞癌及間皮瘤。另一方 面,肺癌包括“瘢痕癌”、支氣管肺泡癌、巨大細胞癌、紡 錘狀細胞癌及大細胞神經內分泌癌。另一方面,肺癌包括 〇 具有組織及超微結構異質性(例如混合細胞類型)之肺腫瘤 〇 一方面,肺的細胞增生性疾病包括影響肺細胞的所有 形式之細胞增生性疾病。一方面,肺的細胞增生性疾病包 括肺癌、肺的前癌狀態。一方面,肺的細胞增生性疾病包 括肺的增生、化生及發育不良。另一方面,肺的細胞增生 性疾病包括石棉誘發之增生、鱗狀化生及良性反應性間皮 化生。另一方面,肺的細胞增生性疾病包括以複層鱗狀上 皮置換柱狀上皮及黏膜發育不良。另一方面,暴露於吸入 -33- 201215610 有害環境試劑(諸如香煙及石棉)的個體可能增加發展出肺 的細胞增生性疾病之風險。另一方面,可使個體易發展出 肺的細胞增生性疾病的先前肺疾病包括慢性間質肺病、壞 死性肺病、硬皮病、類風濕病、肉狀瘤病、間質性肺炎、 肺結核、重複性肺炎、特發性肺纖維化、肉芽腫、矽肺病 、纖維硬化之肺泡炎及霍奇金氏病。 “結腸的細胞增生性疾病”爲一種涉及結腸細胞的細胞 增生性疾病。一較佳方面,結腸的細胞增生性疾病爲結腸 癌。一較佳方面,本發明組成物可用以治療結腸癌或結腸 的細胞增生性疾病。一方面,結腸癌包括所有形式之結腸 癌。另一方面,結腸癌包括偶發性和遺傳性結腸癌。另一 方面,結腸癌包括惡性結腸腫瘤、原位癌、典型類癌瘤及 非典型類癌瘤。另一方面,結腸癌包括腺癌、鱗狀細胞癌 及腺鱗狀細胞癌。另一方面,結腸癌係與選自由遺傳性非 息肉症結腸直腸癌、家族性腺瘤息肉症、嘉氏(Gardner)症 候群、皮捷(Peutz-Jeghers)症候群、透氏(Turcot)症候群 及幼年型息肉症所組成之群組的遺傳性症候群有關。另一 方面,結腸癌可由選自由遺傳性非息肉症結腸直腸癌、家 族性腺瘤息肉症、嘉氏症候群、皮捷症候群、透氏症候群 及幼年型息肉症所組成之群組的遺傳性症候群引起。 一方面,結腸的細胞增生性疾病包括影響結腸細胞的 所有形式之細胞增生性疾病。一方面’結腸的細胞增生性 疾病包括結腸癌、結腸的前癌狀態、結腸的腺瘤性息肉及 結腸的異時性病灶。一方面,結腸的細胞增生性疾病包括 -34- 201215610 腺瘤。一方面,結腸的細胞增生性疾病係以結腸的增生、 化生及發育不良爲特徵。另一方面,可使個體易發展出結 腸的細胞增生性疾病的前結腸疾病包括前結腸癌。另一方 面,可使個體易發展出結腸的細胞增生性疾病的當前疾病 包括克隆氏病及潰瘍性結腸炎。一方面,結腸的細胞增生 性疾病係與在選自由p53、ras、FAP及DCC所組成群組之 基因中的突變有關。另一方面,由於在選自由p53、ras、 () FAP及DCC所組成群組之基因中的突變存在,故個體會具 有發展出結腸的細胞增生性疾病之提高風險。 “前列腺的細胞增生性疾病”爲一種涉及前列腺細胞的 細胞增生性疾病。一方面,前列腺的細胞增生性疾病包括 影響前列腺細胞的所有形式之細胞增生性疾病。一方面, 前列腺的細胞增生性疾病包括前列腺癌、前列腺的初癌或 前癌狀態、前列腺之良性生長或病灶、及前列腺之惡性生 長或病灶、和除前列腺以外的體內組織和器官中的轉移性 〇 病灶。另一方面,前列腺的細胞增生性疾病包括前列腺的 增生、化生、和發育不良。 “皮膚的細胞增生性疾病”爲一種涉及皮膚細胞的細胞 增生性疾病。一方面,皮膚的細胞增生性疾病包括影響皮 膚細胞的所有形式之細胞增生性疾病。一方面,皮膚的細 胞增生性疾病包括皮膚的初癌或前癌狀態、皮膚的良性生 長或病灶、黑色素瘤、惡性黑色素瘤和皮膚的其他惡性生 長或病灶、及除了皮膚以外的體內組織與器官中的轉移性 病灶。另一方面,皮膚的細胞增生性疾病包括皮膚的增生 -35- 201215610 、化生、牛皮癖及發育不良。 “卵巢的細胞增生性疾病”爲一種涉及卵巢細胞的細胞 增生性疾病。一方面,卵巢的細胞增生性疾病包括影響卵 巢細胞的所有形式之細胞增生性疾病。一方面,卵巢的細 胞增生性疾病包括卵巢的初癌或前癌狀態、卵巢的良性生 長或病灶、卵巢癌、卵巢的惡性生長或病灶、及除了卵巢 以外的體內組織與器官中的轉移性病灶。另一方面,卵巢 的細胞增生性疾病包括卵巢細胞的增生、化生及發育不良 〇 “乳房的細胞增生性疾病”爲一種涉及乳房細胞的細胞 增生性疾病。一方面,乳房的細胞增生性疾病包括影響乳 房細胞的所有形式之細胞增生性疾病。一方面,乳房的細 胞增生性疾病包括乳癌、乳房的初癌或前癌狀態、乳房的 良性生長或病灶、和乳房的惡性生長或病灶、及除了乳房 以外的體內組織與器官中的轉移性病灶。另一方面,乳房 的細胞增生性疾病包括乳房的增生、化生及發育不良。 一方面,乳房的細胞增生性疾病爲乳房的前癌狀態。 一方面,本發明之組成物可用以治療乳房的前癌狀態。一 方面,乳房的前癌狀態包括乳房的非典型增生、原位導管 癌(DCIS)、導管內癌、小葉原位癌(LCIS)、小葉瘤、乳房 的0期或0級生長或病灶(例如0期或0級乳癌、或原位癌)。 另一方面,乳房的前癌狀態可根據美國癌症聯合委員會 (AJCC)所接受的TNM分類方案進行分期,其中原發腫瘤 (T)已指定爲T0或Tis期;及其中區域淋巴結(N)已指定爲 -36- 201215610 NO期;及其中遠距轉移(Μ)被指定爲MO期。 一較佳方面,乳房的細胞增生性疾病可爲乳癌。一較 佳方面,本發明組成物可用以治療乳癌。一方面,乳癌包 括所有形式之乳癌。乳癌包括原發性上皮乳癌。另一方面 ,乳癌包括其中乳房涉及其他腫瘤諸如淋巴瘤、肉瘤或黑 色素瘤之癌症。另一方面,乳癌包括乳房之癌、乳房之導 管癌、乳房之小葉癌、乳房之未分化癌、乳房之葉狀囊肉 〇 瘤、乳房之血管肉瘤及乳房之原發性淋巴瘤。一方面,乳 癌包括第I、II、ΠΙΑ、IIIB、IIIC和IV期乳癌。一方面, 乳房之導管癌包括侵襲性癌、以導管內成分爲主之侵襲性 原位癌瘤、發炎性乳癌及具有選自由粉刺、黏液素(膠體) 、髓質、伴淋巴浸潤液之髓質、乳頭狀、硬性及管狀所組 成群組之組織形式的乳房之導管癌。一方面,乳房之小葉 癌包括以原位成分爲主之侵襲性小葉癌、侵襲性小葉癌及 浸潤性小葉癌。一方面,乳癌包括佩吉特氏病(Paget’s O disease)、具有導管內癌之佩吉特氏病及具有侵襲性導管 癌之佩吉特氏病。另一方面,乳癌包括具有組織及超微結 構異質性(例如混合細胞形式)之乳房腫瘤。 一較佳方面,式III、Ilia、IVa、IVb、Va或Vb之化合 物可用以治療乳癌。一方面,欲治療之乳癌包括家族性乳 癌。另一方面,欲治療之乳癌包括偶發性乳癌。一方面, 欲治療之乳癌可發生於男性對象中。一方面,欲治療之乳 癌可發生於女性對象中。一方面,欲治療之乳癌可發生於 停經前女性對象或停經後女性對象中。一方面,欲治療之 -37- 201215610 乳癌可發生於等於或大於30歲之對象,或小於3〇歲之對象 中。一方面,欲治療之乳癌可發生於等於或大於50歲之對 象,或小於50歲之對象中。一方面,欲治療之乳癌可發生 於等於或大於70歲之對象,或小於70歲之對象中。 一方面,欲治療之乳癌已分類,以確認在BRCA 1、 BRCA2、或p53中的家族性或自發性突變。一方面,欲治 療之乳癌已分類爲具有HER2/neu基因放大、過度表現 HER2/neu或具有低、中或高度HER2/neu表現。另一方面 ,欲治療之乳癌已對選自由雌激素受體(ER)、黃體素受體 (PR)、人表皮生長因數受體-2、Ki-67、CA15-3、CA 27-29及c-Met所組成之群組標記物進行分類。一方面,欲治 療之乳癌已分類爲ER-未知、ER-豐富或ER-匱乏。另一方 面,欲治療之乳癌已分類爲ER-陰性或ER-陽性。乳癌之 ER -分類可藉由任何可重現的方式進行。一較佳方面’乳 癌之ER分類可如Onkologie 27: 175-179(2004)中所述進行 。一方面,欲治療之乳癌已分類爲PR-未知、PR-豐富或 PR-匱乏。另一方面’欲治療之乳癌已分類爲PR-陰性或 PR-陽性。另一方面’欲治療之乳癌已分類爲受體陽性或 受體陰性。一方面欲治療之乳癌已分類爲與CA 15-3或CA 27-29或二者的血液含量提高有關。 一方面,欲治療之乳癌包括局部性乳房腫瘤。一方面 ,欲治療之乳癌包括與陰性前哨淋巴結(SLN)生物檢體有 關的乳房腫瘤。一方面’欲治療之乳癌包括與陽性前B肖淋 巴結(S L N)生物檢體有關的乳房腫瘤。另一方面’欲治療 -38- 201215610 之乳癌包括與一或多個陽性腋下淋巴結有關的乳房腫瘤, 其中腋下淋巴結已藉由任何可適用方法分期。另一方面, 欲治療之乳癌包括已分類爲具有淋巴結陰性狀態(例如, 淋巴結陰性)或淋巴結陽性狀態(例如,淋巴結陽性)的乳 房腫瘤。另一方面,欲治療之乳癌包括已轉移至身體其他 區域的乳房腫瘤。一方面,可將欲治療之乳癌分類爲已轉 移至選自由骨骼、肺、肝或腦所組成之群組的區域。另一 0 方面可將欲治療之乳癌根據選自之轉移性、局部性、區域 性、局部區域性、局部進行期、遠端、多中心、兩側、單 側、對側、新診斷、復發及無法手術所組成之群組的特徵 分類。 一方面,式III、Ilia、IVa、IVb、Va或Vb之化合物可 用以治療或預防相對於一般族群具有增加乳癌患病風險之 對象的乳房之細胞增生性疾病,或用以治療或預防乳癌。 一方面,相對於一般族群具有增加乳癌患病風險之對象爲 〇 具有乳癌家族史或個人病史之女性對象。另一方面,相對 於一般族群具有增加乳癌患病風險之對象爲在BRCA1或 BRCA2或二者中具有生殖系列突變或自發性突變之女性對 象。一方面,相對於一般族群具有增加乳癌患病風險之對 象爲具有乳癌之家族史及在BRCA1或BRCA2或二者中具有 生殖系突變或自發性突變之女性對象。另一方面,相對於 一般族群具有增加乳癌患病風險之對象爲大於3 0歲、大於 40歲、大於50歲、大於60歲、大於70歲、大於80歲或大於 90歲之女性。一方面,相對於一般族群具有增加乳癌患病 -39- 201215610 風險之對象爲患有非典型乳房增生、原位導管癌(DCIS)、 導管內癌、小葉原位癌(LCIS)、小葉腫瘤或乳房之0期生 長或病灶(例如,〇期或〇級乳癌或原位癌)之對象。 另一方面,可將欲治療之乳癌根據史考夫-布姆-瑞查 森(Scarff-Bloom-Richardson)系統以組織學分級,其中乳 房腫瘤已指定1、2或3的有絲分裂計數分數;1、2或3的核 多形性分數;1、2、或3的細管形成分數;及介於3與9之 間的史考夫-布姆-瑞查森總分。另一方面,可將欲治療之 乳癌根據乳癌治療的國際共識評審(International Consensus Panel on the Treatment of Breast Cancer)已指 定選自由1級、1-2級、2級、2-3級或3級所組成之群組的 腫瘤等級。 一方面,欲治療之癌症已根據美國癌症聯合委員會 (AJCC)TNM分類系統分期,其中腫瘤(T)已指定成TX、T1 、Tlmic、T1 a ' Tib、Tic、T2、T3、Τ4、T4a、T4b、T4c 或T4d期;及其中區域淋巴結(N)已指定成NX、NO、N1、 N2、N2a、N2b、N3、N3a、N3b 或 N3c 期;及其中將遠端 轉移(M)已指定成MX、MO或Ml期。另一方面,欲治療之 癌症已根據美國癌症聯合委員會(AJCC)分類分期爲I期、 IIA期、IIB期、IIIA期、IIIB期、IIIC期或IV期。另一方 面,可將欲治療之癌症根據AJCC分類指定爲GX級(例如, 無法評估的等級)、1級、2級、3級或4級之級。另一方面 ,欲治療之癌症已根據ρΝΧ、ρΝΟ、ρΝΟ(Ι-)、ΡΝ0(Ι + )、 PNO(mol-)、PN0(mol + )、PN1、PNl(mi)、PNla、PNlb、 -40- 201215610 PNlc、pN2、pN2a、pN2b、pN3、pN3a、pN3b 或 pN3c 的 AJCC病理分類(pN)分期。 一方面,欲治療之癌症包括已測定爲小於或等於約2 公分直徑的腫瘤。另一方面,欲治療之癌症包括已測定爲 從約2至約5公分直徑的腫瘤。另一方面,欲治療之癌症包 括已測定爲大於或等於約3公分直徑的腫瘤。另一方面, 欲治療之癌症包括已測定爲大於5公分直徑的腫瘤。另一 0 方面,欲治療之癌症可藉由顯微外觀分類爲分化良好、中 度分化、分化不良或未分化。另一方面,欲治療之癌症可 藉由關於有絲分裂計數(例如,細胞分裂數量)或核多形性 (例如,細胞改變)的顯微外觀分類。另一方面,欲治療之 癌症可藉由與壞死面積(例如,瀕死或退化細胞的面積)有 關的顯微外觀分類。一方面,欲治療之癌症分類爲具有異 常核型、具有異常的染色體數目或具有一或多個外觀異常 的染色體。一方面,欲治療之癌症分類爲非整倍體、三倍 Ο 體、四倍體或具有改變倍體的染色體。一方面,欲治療之 癌症分類爲具有染色體轉位或整個染色體刪除或倍增,或 一部分染色體之刪除、倍增或放大的區域。 一方面’欲治療之癌症可藉由DNA細胞計數法、流動 式細胞計數法或影像細胞計數法評估。一方面,欲治療之 癌症已分類爲具有1 0 %、2 0 %、3 0 %、4 0 %、5 0 %、6 0 %、 70%、80%或90%之細胞於細胞分裂的合成期(例如,在細 胞分裂的S期)。一方面,欲治療之癌症已分類爲具有低s_ 期細胞分率或高S -期細胞分率。 -41 - 201215610 如使用於本文中,“正常細胞”爲不可分類爲“細胞增 生性疾病”的部分之細胞。一方面,正常細胞缺乏可導致 非所要的症狀或疾病發展的失調或異常生長或二者。較佳 地,正常細胞具有正常作用的細胞週期檢查點控制機制。 如使用於本文中,“接觸細胞”係指其中化合物或其他 物質之組成物與細胞直接接觸或足夠接近以在細胞中誘發 所要生物效應的狀況。 如使用於本文中,“候選化合物”係指已於或將於一或 多項活體外或活體內生物分析法中測試的式III、Ilia、 IVa、IVb、Va或Vb化合物,以便測定該化合物是否可能 在細胞、組織、全身、動物或人體中誘發硏究員或臨床醫 師尋求的所要生物或醫學反應。一方面,候選化合物爲式 III或Ilia之化合物;另一方面,候選化合物爲式IVa、IVb 、Va或Vb之化合物。一較佳方面,生物或醫藥反應爲癌 症的治療。另一方面,生物或醫學反應爲細胞增生性疾病 的治療或預防。一方面,活體外或活體內生物分析法包括 (但不限於)酵素活性分析法、電泳位移分析法、報導基因 分析法、活體外細胞存活率分析法及多種分析法。 如使用於本文中,“單一療法”係指將單一活性化合物 或治療性化合物投予至需要其之對象。較佳地,單一療法 包含投予治療有效量之活性化合物。例如,使用(±)-順-3 -(5,6-二氫-411-吡咯并[3,2,1-^]喹啉-;1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮之癌症單一療法包含將治療有效量之 (± )-順-3 - ( 5,6 -二氫-4 Η -吡咯并[3,2 , 1 - ij ]喹啉-1 -基)-4 - ( 1 Η - -42- 201215610 吲哚-3-基)吡咯啶-2,5-二酮,或其醫藥上可接受之鹽、前 藥、代謝物、類似物或衍生物投予至需要治療癌症之對象 。可將單一療法與組合療法作對照,其中組合療法係投予 多種活性化合物之組合,較佳地組合的每個組份係以治療 有效量存在。一方面,式III、Ilia、IVa、IVb、Va或Vb之 化合物的單一療法在誘發所要生物效應上比組合療法更爲 有效。式III、Ilia、IVa、IVb、Va或Vb之化合物的單一療 0 法有效性係顯示於PCT公開號wo 2006/0 86484中。 如使用於本文中,“治療”描述爲了對抗疾病、症狀或 病症爲目的來管理與照護病人,且包括包括降低或減輕症 狀或倂發症或消除疾病、症狀或病症。 如使用於本文中,“預防”描述停止疾病、症狀或病症 的徵候或倂發症之肇始。 一方面,治療癌症導致腫瘤大小之減少。腫瘤大小的 減少亦可稱爲“腫瘤消退”。較佳地,治療之後,相對於其 〇 治療前的大小,腫瘤大小減少5 %或更大;更佳地,腫瘤 大小減少1 0 %或更大;更佳地,減少2 0 %或更大;更佳地 ,減少30%或更大;更佳地,減少40%或更大;甚至更佳 地,減少5 0 %或更大;及最佳地減少大於7 5 %或更大。腫 瘤大小可藉由任何可重現的測量方式測量。一較佳方面, 腫瘤大小可以腫瘤之直徑測量。 另一方面,治療癌症導致腫瘤體積之減少。較佳地, 治療之後,相對於其治療前的體積,腫瘤體積減少5%或 更大;更佳地,腫瘤體積減少1 〇%或更大;更佳地,減少 -43- 201215610 2 〇 %或更大’更佳地,減少3 0 %或更大,更佳地,減少 4 0 %或更大’甚至更佳地,減少5 0 %或更大,及最佳地減 少大於75%或更大。腫瘤體積可藉由任何可重現的測量方 式測量。 另一方面,治療癌症導致腫瘤數目之減少。較佳地, 治療之後,相對於治療前的數目,腫瘤數目減少5%或更 大;更佳地,腫瘤數目減少1 0%或更大;更佳地,減少 2 〇 %或更大;更佳地,減少3 0 %或更大;更佳地,減少 4 〇 %或更大;甚至更佳地,減少5 0 %或更大;及最佳地減 少大於7 5 %。腫瘤數目可藉由任何可重現的測量方式測量 。一較佳方面,腫瘤數目可藉由裸眼目測或以特定放大倍 率計數腫瘤來測量。一較佳方面,特定放大倍率爲2χ、3χ 、4χ、5χ、1 Οχ或 5 Οχ 0 另一方面,治療癌症導致在遠離原發性腫瘤位置的其 他組織或器官中之轉移病灶數目的減少。較佳地,治療之 後,相對於治療前的數目,轉移病灶的數目減少5%或更 大;更佳地,轉移病灶的數目減少1 0%或更大;更佳地, 減少2 0 %或更大;更佳地,減少3 0 %或更大:更佳地,減 少40%或更大;甚至更佳地減少50%或更大;及最佳地減 少大於75%。轉移病灶的數目可藉由任何可重現的測量方 式測量。一較佳方面,轉移病灶的數目可藉由裸眼目測或 以特定放大倍率計數轉移病灶來測量。一較佳方面,特定 放大倍率爲 2χ、3χ、4χ、5χ、10χ 或 50χ。 另一方面,治療癌症導致治療對象族群相較於接受單 -44 - 201215610 獨載劑之族群的平均存活時間增加。較佳地,平 間增加超過30天;更佳地,超過60天;更佳地, :且最佳地,超過120天。族群的平均存活時間 藉由任何可重現的方式測量。一較佳方面,族群 活時間之增加可例如藉由在以活性化合物開始治 族群的平均存活長度來測量。另一較佳方面,族 存活時間之增加亦可例如藉由在以活性化合物的 0 治療完成後計算族群的平均存活長度來測量。 另一方面,相較於未經治療之對象族群,治 致治療對象族群的平均存活時間的增加。較佳地 活時間增加超過30天;更佳地,超過60天;更佳 90天;且最佳地,超過120天。族群的平均存活 加可藉由任何可重現的方式測量。一較佳方面, 均存活時間之增加可例如藉由在以活性化合物開 計算族群的平均存活長度來測量。另一較佳方面 〇 均存活時間之增加亦可例如藉由在以活性化合物 合治療完成後計算族群的平均存活長度來測量。 另一方面,相較於接受不是用式III、Ilia、 、Va或Vb之化合物或其醫藥上可接受之鹽、前 物、類似物或衍生物的藥物之單一療法的族群, 導致治療對象之族群的平均存活時間之增加。較 均存活時間增加超過30天;更佳地,超過60天; 超過90天;且最佳地,超過120天。族群的平均 之增加可藉由任何可重現的方式測量。一較佳方 .均存活時 超過90天 之增加可 的平均存 療後計算 群的平均 第一回合 療癌症導 ,平均存 地*超過 時間之增 族群的平 始治療後 族群的平 的第一回 IVa ' IVb 藥、代謝 治療癌症 佳地,平 更佳地, 存活時間 面,族群 -45- 201215610 的平均存活時間之增加可例如藉由在以活性化合物開始治 療後計算族群的平均存活長度來測量。另一較佳方面,族 群的平均存活時間之增加亦可例如藉由在以活性化合物的 第一回合治療完成後計算族群的平均存活長度來測量。 另一方面,相較於接受單獨載劑之族群,治療癌症導 致治療對象之族群的死亡率之減少。另一方面,相較於未 經治療之對象族群,治療癌症導致治療對象之族群的死亡 率之減少。另一方面,相較於接受不是用式III、Ilia、 IVa、IVb、Va或Vb之化合物或其醫藥上可接受之鹽、前 藥、代謝物、類似物或衍生物的藥物之單一療法之族群, 治療癌症產生治療對象之族群的死亡率之減少。較佳地, 死亡率減少超過2% ;更佳地,超過5% ;更佳地,超過 1 〇 % ;及最佳地,超過2 5 %。一較佳方面,治療對象之族 群的死亡率之減少可藉由任何可重現的方式測量。另一較 佳方面,族群的死亡率之減少可例如藉由在開始以活性化 合物治療後計算族群每單位時間與疾病有關的死亡之平均 數目來測量。另一較佳方面’族群的死亡率之減少亦可例 如藉由在以活性化合物的第一回合治療完成後計算每單位 時間與疾病有關的死亡之族群平均數目來測量。 另一方面,治療癌症的結果導致腫瘤生長速率之減少 。較佳地,相對於治療前的腫瘤生長速率’治療之後’腫 瘤生長速率減少至少5 % ;更佳地’腫瘤生長速率減少至 少1 0 %,更佳地,減少至少2 0 % ’更佳地,減少至少3 0 % ,更佳地,減少至少4 0 % ’更佳地’減少至少5 0 % ’甚至 -46- 201215610 更佳地減少至少5 Ο %,且最佳地減少至少7 5 %。腫瘤生長 速率可藉由任何可重現的測量方式測量。一較佳方面,腫 瘤生長速率可根據每單位時間腫瘤直徑的改變來測量。 另一方面,治療癌症導致腫瘤再生長之減少。較佳地 ,治療之後,腫瘤再生長小於5%;更佳地,腫瘤再生長 小於10% ;更佳地,小於20% ;更佳地,小於30% ;更佳 地,小於4 0 % ;更佳地,小於5 0 % ;甚至更佳地,小於 0 50% ;及最佳地,小於75%。腫瘤再生長可藉由任何可重 現的測量方式測量。一較佳方面,腫瘤再生長可例如藉由 測量在治療後先前腫瘤縮小後腫瘤直徑的增加來測量。腫 瘤再生長之減少指示治療停止後腫瘤無法復發。 另一方面,治療或預防細胞增生性疾病導致細胞增生 速率的減少。較佳地,治療之後,細胞增生減少至少5% ;更佳地,至少1 〇 % ;更佳地,至少2 0 % ;更佳地,至少 3 0% ;更佳地,至少40% ;更佳地,至少50% ;甚至更佳 Q 地,至少50% ;及最佳地至少75%。細胞增生之速率可藉 由任何可重現的測量方式測量。一較佳方面,細胞增生之 速率可例如藉由測量每單位時間在組織樣品中分裂細胞之 數量來測量。 另一方面,治療或預防細胞增生性疾病導致增生細胞 比例之減少。較佳地,治療之後,增生細胞之比例減少至 少5 % ;更佳地,至少1 〇 % ;更佳地,至少2 0 % ;更佳地, 至少3 0 % ;更佳地,至少4 0 °/〇 ;更佳地,至少5 0 % ;甚至 更佳地至少5 0 % ;及最佳地至少7 5 %。增生細胞之比例可 -47- 201215610 藉由任何可重現的測量方式測量。一較 之比例係例如藉由定量在組織樣品中分 未分裂細胞數目來測量。另一較佳方面 可等於有絲分裂指數。 另一方面,治療或預防細胞增生性 之面積或區域的數目之減少。較佳地, 生之面積或區域的大小相對於其治療ϊ 5 % ;更佳地,減少至少1 〇 % ;更佳地, 佳地,減少至少3 0% ;更佳地,減少至 減少至少5 0 % ;甚至更佳地,減少至少 少至少7 5 %。細胞增生面積或區域大小 的測量方式測量。一較佳方面,細胞增 可以細胞增生之面積或區域之直徑或寬 另一方面,治療或預防細胞增生性 外觀或形態的細胞之數目或比例減少。 ,具有異常形態的細胞數目相對於其治 少5% ;更佳地,減少至少1 0% ;更佳地 更佳地,減少至少3 0 % ;更佳地,減少 ,減少至少5 0 % ;甚至更佳地,減少至 減少至少75%。異常的細胞外觀或形態 的測量方式測量。一方面,異常的細胞 (例如使用反相組織培養顯微鏡)測量。 胞形態可呈現核多形性之形式。 如使用於本文中,術語“選擇性地” 佳方面,增生細胞 裂細胞數目相對於 ,增生細胞之比例 疾病導致細胞增生 治療之後,細胞增 ϊίί的大小減少至少 減少至少20% ;更 少40% ;更佳地, 5 0 % ;及最佳地減 可藉由任何可重現 生面積或區域大小 度測量。 疾病導致具有異常 較佳地,治療之後 療前的數目減少至 ,減少至少2 0 % ; 至少40% ;更佳地 少5 0 % ;及最佳地 可藉由任何可重現 形態可藉由顯微術 一方面,異常的細 表示傾向在一族群 -48- 201215610 中發生的頻率比在另一組族群中更高。一方面,比較的族 群爲細胞族群。一較佳方面,式III、Ilia、IVa、IVb、Va 或Vb之化合物或其醫藥上可接受之鹽、前藥、代謝物、 類似物或衍生物選擇性地作用於癌細胞或前癌細胞,但不 作用於正常細胞。另一較佳方面,式111、111 a、IV a、IV b 、Va或Vb之化合物或其醫藥上可接受之鹽、前藥、代謝 物、類似物或衍生物選擇性地作用以調節一種分子標靶( 〇 例如’ c-Met),但不顯著地調節另一分子標靶(例如,蛋 白質激酶C)。一較佳方面,本發明提供一種選擇性地抑制 酵素(諸如激酶)的活性之方法。較佳地,若一個事件在族 群A中比在族群B中更頻繁地發生大於二倍時,則較佳地 該事件係相對於族群B而選擇性地發生於族群A中。更佳 地’若一個事件在族群A中更頻繁地發生大於五倍時,則 該事件係選擇性地發生。更佳地,若一個事件在族群A中 比在族群B中更頻繁地發生大於十倍;更佳地在族群a中 Ο 比在族群B中更頻繁地大於50倍;甚至更佳地大於100倍; 而最佳地大於1 000倍時,則該事件係選擇性地發生。例如 ,若在癌細胞中的細胞死亡比正常細胞更頻繁地發生大於 二倍時,則細胞死亡可謂選擇性發生於癌細胞中。 —較佳方面,式III、Ilia、IVa、IVb、Va或Vb之化合 物或其醫藥上可接受之鹽、前藥、代謝物、類似物或衍生 物調節分子標靶(例如,c-Met)之活性。一方面,調節係 指刺激或抑制分子標靶之活性。較佳地,相對於在相同條 件下但僅缺乏該化合物存在下的分子標靶之活性,若式 -49- 201215610 III、Ilia、IVa、IVb、Va或Vb之化合物刺激或抑制分子標 靶之活性至少2倍時,則該化合物較佳地調節分子標靶活 性。更佳地,對於在相同條件下但僅缺乏該化合物存在下 的分子標靶之活性時,若式ΠΙ、Ilia、IVa、IVb、Va或Vb 之化合物刺激或抑制分子標靶之活性至少5倍、至少1 0倍 、至少2 0倍、至少5 0倍、至少1 0 0倍,相則該化合物調節 分子標靶之活性。分子標靶之活性可藉由任何可重現方式 測量。分子標靶之活性可於活體外或活體內測量。例如, 分子標靶之活性可藉由酵素活性分析法或DN A結合分析法 而於活體外測量,或分子標靶之活性可藉於分析報導基因 的表現而於活體內測量。 一方面,相對於在相同條件下但僅缺乏該化合物存在 下的分子標靶之活性,若化合物的添加不刺激或抑制分子 標靶之活性大於1 〇%,則式III、Ilia、IVa、IVb、Va或Vb 之化合物或其醫藥上可接受之鹽、前藥、代謝物、類似物 或衍生物不顯著地調節分子標靶之活性。一較佳方面,式 III、Ilia、IVa、IVb、Va或Vb之化合物不顯著地調節蛋白 質激酶C之活性。 如使用於本文中,術語“同功酵素選擇性”表示相較於 酵素的第二同功型,優先抑制或刺激酵素之第一同功型( 例如,相較於激酶同功酵素β,優先抑制或刺激激酶同功 酵素〇〇。較佳地,式III、Ilia、IVa、IVb、Va或Vb之化合 物證明在達成生物效應所需之劑量上有最少4倍之差異, 較佳地有10倍之差異,更佳地有50倍之差異。較佳地,式 -50- 201215610 III、Ilia、IVa、IVb、Va或Vb之化合物證明此跨越抑制範 圍的差異,且對感興趣之分子標靶的差異係以IC5Q(亦即 5 0%之抑制作用)舉例說明。 在一較佳體系中,式III、Ilia、IVa、IVb、Va或Vb之 化合物或其醫藥上可接受之鹽、前藥、代謝物、類似物或 衍生物投予至需要其之細胞或對象導致c-Met之活性的調 節作用(亦即刺激或抑制作用)。如使用於本文中,c-Met 0 之活性係指由c-Met進行的任何生物功能或活性。例如, c-Met的功能包括下游標靶蛋白質的磷酸化作用。c-Met的 其他功能包括自磷酸化作用、接器(adaptor)蛋白質(諸如 Gab-1、Grb-2、She、SHP2及c-Cbl)的結合及訊號轉導子( 諸如 Ras、Src、PI3K、PLC-γ、STATs、ERK 1 和 2 及 FAK) 的活化作用。c-Met基因敲除已被顯示以細胞類型特異性 方式抑制癌細胞之生長。1^10八-\18-231、:^(:1-11661、:^(:1-H441、MIA PaCa-2、HT29 及 MKN-45人癌細胞。c-Met 基 Ο 因敲除以細胞類型特異性方式誘發半胱天冬酶(caspase)依 賴性細胞凋亡。因此,本發明係關於細胞增生性疾病之治 療,其中該細胞表現高量c-Met或表現活性c-Met。 在一較佳體系中,式III、Ilia、IVa、IVb、Va或Vb之 化合物或其醫藥上可接受之鹽、前藥、代謝物、類似物或 衍生物投予至需要其之細胞或對象導致ERK 1或ERK 2或 二者之活性的調節作用(亦即刺激或抑制作用)。如使用於 本文中,ERK 1或ERK 2之活性係指由ERK 1或ERK 2進行 的任何生物功能或活性。例如 ,ERK 1或ERK 2之功能包 -51 - 201215610 括下游標靶蛋白質的磷酸化作用。 一方面,活化係指使物質(例如,蛋白質或核酸)之組 成物處於適合進行所欲生物功能之狀態。一方面,能夠被 活化的物質之組成物亦具有未活化狀態。一方面,物質之 活化組成物可具有抑制或刺激的生物功能或二者。 一方面,升高係指增加物質(例如,蛋白質或核酸)之 組成物的所欲生物活性。升高可經由增加物質之組成物的 濃度而發生。 如使用於本文中,“細胞週期檢查點路徑”係指涉及細 胞週期檢查點之調節的生化路徑。細胞週期檢查點路徑可 對一或多種包含細胞週期檢查點的功能具有刺激或抑制效 果或二者。細胞週期檢查點路徑係由至少兩種之物質(較 佳爲蛋白質)的組成物所組成,其二者促成細胞週期檢查 點之調節。細胞週期檢查點路徑可透過細胞週期檢查點路 徑中之一或多個成員的活化作用而活化。較佳地,細胞週 期檢查點路徑較佳爲生化傳訊路徑。 如使用於本文中,“細胞週期檢查點調節劑”係指可至 少部分具有調節細胞週期檢查點之功能的物質之組成物。 細胞週期檢查點調節劑可對一或多種包含細胞週期檢查點 的功能具有刺激或抑制效果或二者。一方面,細胞週期檢 查點調節劑可爲蛋白質。另一方面,細胞週期檢查點調節 劑不爲蛋白質。 一方面,治療癌症或細胞增生性疾病導致細胞死亡, 且較佳地,細胞死亡導致族群中之細胞數量減少至少1 0% -52- 201215610 。更佳地,細胞死亡表示減少至少2 0 % ;更佳地減少至少 30% ;更佳地減少至少40% ;更佳地減少至少50°/。;最佳 地減少至少75%。族群中之細胞數量可藉由任何可再現之 方法測量》—方面,族群中之細胞數量係藉由螢光活化細 胞分選(FACS)測量。另一方面,族群中之細胞數量係藉由 免疫螢光顯微法測量。另一方面,族群中之細胞數量係藉 由光學顯微鏡加以測量。另一方面,測量細胞死亡之方法 f) 係顯示於 Li 等人,(2003) Proc Natl Acad Sci USA · 1 00(5): 2674-8。一方面,細胞死亡藉由細胞凋亡發生。 一較佳方面,有效量之式III、Ilia、IVa、IVb、Va或 Vb之化合物或其醫藥上可接受之鹽、前藥、代謝物、類 似物或衍生物對正常細胞不具顯著細胞毒性。化合物若以 治療有效量投予而不誘發大於10%之正常細胞的細胞死亡 ,則該治療有效量之化合物對正常細胞不具顯著細胞毒性 。化合物若以治療有效量投予而不誘發大於10%之正常細 〇 胞的細胞死亡,則該治療有效量之化合物不顯著影響正常 細胞之存活性。一方面,細胞死亡藉由細胞凋亡發生。 一方面,使細胞與式III、Ilia、IVa、IVb、Va或Vb之 化合物或其醫藥上可接受之鹽、前藥、代謝物、類似物或 衍生物接觸,在癌細胞中選擇性地誘發或活化細胞死亡。 較佳地,將式III、Ilia、IVa、IVb、Va或Vb之化合物或其 醫藥上可接受之鹽、前藥、代謝物、類似物或衍生物投予 至需要其之對象,在癌細胞中選擇性地誘發或活化細胞死 亡。另一方面,使細胞與式III、Ilia、IVa、IVb、Va或Vb -53- 201215610 之化合物或其醫藥上可接受之鹽、前藥、代謝物、類似物 或衍生物接觸’在一或多種受細胞增生性疾病影響之細胞 中選擇性地誘發細胞死亡。較佳地,將式III、Ilia、IVa 、IVb、Va或Vb之化合物或其醫藥上可接受之鹽、前藥、 代謝物、類似物或衍生物投予至需要其之對象,在一或多 種受細胞增生性疾病影響之細胞中選擇性地誘發細胞死亡 。一較佳方面,本發明關於一種,藉由將式III、Ilia、 IVa、IVb、Va或Vb之化合物或其醫藥上可接受之鹽、前 藥、代謝物、類似物或衍生物投予至需要其之對象而治療 或預防癌症之方法,其中式III、Ilia、IVa、IVb、Va或Vb 化合物的投予導致下列一或多者:細胞累積在細胞週期的 G1期及/或S期中、經由癌細胞中的細胞死亡而正常細胞中 沒有顯著量的細胞死亡之胞毒性、在具有治療指數至少2 之動物中的抗腫瘤活性、及細胞週期檢查點的活化作用。 如使用於本文中,“治療指數”爲最大耐受劑量除以有效劑 量。熟諳此技藝者可參考一般參考文本有關本文中所討論 之已知技術或同等技術之詳細說明。該等文本包括 A m u s a b 1 e 等人,C u r r e n t P r o t 〇 c ο 1 s i η Μ ο 1 e c u 1 a r B i ο 1 〇 g y, John Wiley and Sons, Inc. (2005) ; Sam brook 等人,Typical kinase inhibitors include, but are not limited to, Bevacizumab (target VEGF), BIB W2 9 9 2 (target E GF R and Er b2), Cetuximab/Erbitux (standard)耙Erbl), Imatinib/Gleevic (IE Bcr-Abl, PDGFRs and c-Kit), Trastuzumab (Erb2), Gefitinib/Iressa (target EGFR), ranibizumab (RanibizumabK target VEGF), pegaptanib (target VEGF), erlotinib (Erlotinib)/Tarceva (standard Erbl), nilotinib ( Nilotinib) (Bcr-Abl), lapatinib (standards Erbl and Erb2/Her2), GW-572016/Lapatinib ditosylate (standard HER2/ Erb2), Panitumumab/Vectibix (labeled EGFR), Vandetinib (labeled RET/VEGFR), E7080 (including multiple targets of RET and VEGFR), Herceptin ) (target HER2/Erb2), PKI-16 6 (target EGFR), -17- 201215610 Cannitinib/CI-1 03 3 (target EGFR), sunitinib (Sunitinib)/ SU-11464/Sutent (targets EGFR and FLT3), Matuzumab/Emd7200 (target EGFR), EKB-569 (target EGFR), Zd6474 (target EGFR and VEGFR), PKC-412 (target VEGR and FLT3), Vatalanib / Ptk78 7/ZK2225 84 (target VEGR), CEP - 7 0 1 (target FLT 3 ), SU5614 (target FLT3), M LN 5 1 8 (target FLT 3), XL999 (target FLT3), VX-322 (target FLT3), Azd 0 5 3 0 (target S RC ), BMS-354825 (standard SRC), SKI-606 (target SRC), CP -690 (target JAK), AG-490 (target JAK), WHI-P154 (target JAK), WHI-P131 (standard JAK), sorafenib (Sorafenib) / Resava (Nexavar) ( Standard RAF kinase, VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-β, KIT, FLT-3 and RET), Dasatinib/Sprycel (BCR/Abl and Src), AC-220 (target Flt3), AC-4 80 (all target HER proteins, "pan-HER"), Motesanib bisphosphate (target VEGF1-3 'PDGFR and c-kit), Denosumab (standard RANKL, inhibition of SRC), AMG888 (marker HER3) and AP24534 (including multiple targets of Flt3). Exemplary multi-kinase inhibitors include, but are not limited to, Sexapini (Nexavar), Sunitinib (Sutent), BIBW 29 92, E7080, Zd6474, PKC-412, motetanil or AP24534. Typical serine/threonine kinase inhibitors include, but are not limited to, eril/easudil hydrochloride; rapamune (target mTOR/FRAPl); Deforolimus (target mTOR); -18- 201215610 Certican/Everolimus (standard MTOR/FRAPl); AP23 5 73 (target mTOH/FRAPl); Illulu ( Eril) / Fasudil hydrochloride (target RHO); Flavopiridol (target CDK); Seliciclib / CYC202 / Roscovitrine Target CDK); SNS-032/BMS-3 87032 (target CDK); Ruboxistaurin (standard $EPKC); Pkc412 (target PKC); Byrytin (Byostatin) PKC); KAI-9803C target PKC); SF1126 (target PI3K); VX-6 8 0 (target aurora (human 1!1: 〇1^) kinase); 八 2 (11152 (target aurora kinase) Arry- 1 42886/AZD-6244 (target MAP/MEK); SCIO-469 (target MAP/MEK); GW6 8 1 3 23 (target MAP/MEK); CC-401 (target JNK); CEP-1347 (target JNK); and PD332991 (target CDK). Typical tyrosine kinase inhibitors include, but are not limited to, Ero Tarceva; Iressa; Gleevec; Nexavar; Sutent; Herceptin; Bevacizum Antibiotic (Avastin); Rituxan: ractatinib (Tykerb); cetuximab (Erbitux); panitumumab (Vectibix); everimox (Afinitor); Antibiotic (Campath); jitozumab (Mylotarg); temsirolimus (Torisel); pazopanib (Votrient); dasatinib (Sprycel); nilotinib ( Nilotinib) (Tasigna); vatalanib (Ptk787 ZK2225 84); CEP-70 1 ; SU5614; MLN518; XL999; VX-3 2 2 ; Azd05 3 0 ; BMS-3 54825 ; SKI-606 CP- 690 ; AG-490 ; WHI-P154 ; WHI-P1 3 1 ; AC-220 ; or AMG888. -19- 201215610 Typical VEGF/VEGFR inhibitors include, but are not limited to, bevacizumab (Avastin): Sorafenib (Nexavar); Sunitinib (Sutent): ranibizumab, pegaptanib; or Vandetinib (vandetinib). Typical aromatase inhibitors include, but are not limited to, aminoglutethimide, Teslac, Arimidex, Letrozole (Femara), Exemestane (Aromasin), Vorozole (Rivizor), Formestane (Lentaron), Fadrozole (Afema), 4-androstene-3,6,17-trione (6-OXO), 1,4,6-androstene-3,17-dione (ATD) and 4-hydroxyandrostenedione. Typical anthracyclines include, but are not limited to, daunorubicin (Daunomycin), doxorubicin ((addrimycin), epirubicin, idarubicin, and valrubicin. Glycoside analogs include, but are not limited to, gemcitabine, aza-cytidine (eg, 5-azacytidine), and cytosine arabinose (cytarabine, araC, Cytosar). Typical microtubule targets include but not Limited to paclitaxel, docetaxel, vincristine, vinblastine, norcodazole, epothilone, and velopene (navelbine). Typical topoisomerase poisons include, but are not limited to, teniposide, relying on Bovine, adrimycin, camptothecin, daunorubicin, dactinomycin, mitoxantrone; guanidine, ampicillin, epirubicin and idarubicin. typical taxane or taxane derived Materials include, but are not limited to, paclitaxel and docetaxel. -20- 201215610 Typical general chemotherapeutic, antitumor, and antiproliferative agents including, but not limited to, altretamine (Hexalen); isotretinoin (isotretinoin) ) (Accutane ; Amnesteem ; Claravis ; Sotret ) ; Vitamin A acid (tretinoin) ( Vesanoid); azacitidine (V idaza ); bortezomib (V e 1 cade) asparaginase (Elspar); levamisole (Ergamisol) ); mitotane (Lysodren); ◎ procarbazine (Matulane); pegaspargase (Oncaspar); denileukin diftitox (Ontak); (p〇rfimer) (Photofrin); aldesleukin (Proleukin); lenalidomide (Revlimid); bexarotene (Targretin); thalidomide (Thalomid) ); Torisel; Trisenox; verteporfin (Visudyne); mimosine (Leucenol); (1M tegafur (tegafur)-0. 4M 5-indole chloride-2,4-dihydroxypyrimidine-1M potassium oxonate) or statins (eg lovastatin, atorvastatin, cerivastatin, fluvastatin) Fluvastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin 〇 The present invention also provides a treatment for cell proliferation. A method of treating a therapeutically effective amount of a compound of formula III, Ilia, IVa, ivb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, in combination - 21 - 201215610 An effective amount of a second anti-proliferative agent, which is administered to a subject, wherein the compound of formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, and the same The two antiproliferative agents are not administered at the same time. In some preferred systems, the compound of formula III, Ilia, IVa, IVb, Va or Vb is (-)-trans-3-(5,6-dihydro-4H). -pyrrolo[3,2,l-ij]salostino-pyl)-4-(lH-indol-3-yl)pyrrolidine-2,5-dione. In a preferred system, the second antiproliferative agent is a cytidine analog, including but not limited to gemcitabine, aza-cytidine (eg, 5-azacytidine), and chewing steep arabinose (cytarabine, araC Preferably, the cytidine analog is gemcitabine. In another system, the second anti-proliferative agent is an inhibitor of the G1/S phase of the cell cycle. In certain preferred systems, Formula III, A compound of Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, is administered after administration of the second anti-proliferative agent. In a system, A compound of Ilia' IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, is administered in a single dose for 12 hours, 24 hours, 36 after administration of the second anti-proliferative agent. Hour, 48 hours, 60 hours, 72 hours, 4 days, 5 days, 6 days, 7 days, 10 days, 2 weeks, 3 weeks, or 4 weeks. Preferably, the second anti-proliferative agent is administered without a compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt thereof, or a prodrug or metabolism thereof, in excess of 12 or 24 hours The administration is carried out for 24 hours after administration of the second anti-proliferative agent -22-201215610. Preferably, no drug is administered at least 12 hours or 24 hours before administration of the second anti-proliferative agent. More preferably, A compound of Formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, is administered to a second antiproliferative agent when the compound or agent is administered to a subject The concentration or amount in the object is less than 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20% or 10% of its starting concentration or starting amount. Vote for 2 4 hours. Preferably, the concentration or amount of the compound or agent is less than 50% of its initial concentration. More preferably, the concentration or amount of the compound or agent is less than the initial concentration or the initial amount of 10%, 9%, 8%, 7%, 6%, 5%, 5%, 3%, 3%, 2%, 1 %. In one system, the subject is administered to a subject in the form of a compound of formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, 12 hours, 24 hours, 36 hours before administration to a subject. , 48 hours, 60 hours, 72 hours, 4 days, 5 days, 6 days, 7 days, 10 days, 2 weeks, 3 weeks, or 4 weeks ❹ "None" (no administration) second anti-proliferative agent Medicine. Preferably, the subject is administered at least 24 hours, at least 48 hours or at least 72 hours prior to administration of the compound of Formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof thereof. A drug that is "none" a second anti-proliferative agent. In certain preferred systems, the second anti-proliferative agent is administered after administration of a compound of Formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof Give. In one system, the second antiproliferative agent is administered a compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt thereof, or -23-201215610, a prodrug or metabolite thereof After administration to a subject, a single dose is administered for 30 minutes, 1 hour, 12 hours, 24 hours '36 hours, 48 hours, 60 hours, 72 hours, 4 days, 5 days, 6 days, 7 Days, 1 day, 2 weeks, 3 weeks, or 4 weeks. Preferably, the compound of formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof, is administered for at least 24 hours or 48 hours and a second anti-proliferative agent The compound is administered for 48 hours after administration of a compound of formula III, Illa, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt thereof, or a prodrug or metabolite thereof. Most preferably, no drug is administered at least 12 hours or at least 24 hours prior to administration of the second anti-proliferative agent. More preferably, when the compound or agent is administered to a subject, the second antiproliferative agent is a compound of Formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt thereof, or a prodrug thereof or The concentration or amount of the metabolite in the subject is less than 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20% or 1 of its starting concentration or starting amount. After 〇%, it was administered for 48 hours. Preferably, the concentration or amount of the compound or agent is less than 50% of its initial concentration. More preferably, the concentration or amount of the compound or agent is less than the initial concentration or the initial amount of 10%, 9%, 8%, 7%, 6%, 5%, 5%, 3%, 3%, 2%, 1 %. In one system, the subject is administered 12 hours, 24 hours, 36 hours, 48 hours, 60 hours, 72 hours, 4 days, 5 days, 6 days before the second anti-proliferative agent is administered to the subject. , 7 days, 1 day, 2 weeks, 3 weeks, or 4 weeks, is a compound of the formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt thereof, or a prodrug thereof or Metabolite drug. Preferably, the subject is at least 24 hours, at least 48 hours or at least 72 hours prior to administration of the second anti-proliferative agent as "no" compounds of formula III, Ilia, IVa, IVb, Va or Vb or It is a medicine of the acceptable salt, or its prodrug or metabolite. As used herein, "unmedicated" means that no drug is administered to the subject. It can also mean that the subject does not receive any medication. Preferably, the drug-free representation of the subject is not administered any anti-proliferative or anti-cancer agent. Preferred combination therapies include, but are not limited to, (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(111 -Ind-3-yl)pyrrolidine-2,5-dione was administered in combination with gemcitabine. In some systems, the subject or patient receives gemcitabine and is administered from about 25 mg/m2 to about 50 mg/m2 once daily. In some systems, gemcitabine is administered at a reduced dose to reduce toxicity. For example, gemcitabine is administered at 100 mg/m2, 750 mg/m2, 500 mg/m2, 250 mg/m2, 100 mg/m2, or 50 mg/m2 once daily. In some systems, the subject or patient receives twice a day (360 mg) of (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1- ij]quinoline- 1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione. (_)_反_ 3-(5,6-Dihydro-411-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(111-indole-3-indenyl) Preferred dosage forms of pyrrolidine-2,5-dione include, but are not limited to, capsules and lozenges. This example demonstrates that (-)-trans-3-(5,6-dihydro-411-pyrrolo[3] , 2,1-ij]quinolin-1 -yl)-4 - (1 Η -吲哚·3 -yl)pyrrolidine-2,5-dione in combination with gemcitabine, has synergistic effects on various cancers Or at least add anti-proliferative effects in vitro and in vivo. Such cancers include, but are not limited to, lung cancer, small cell lung cancer, non-small cell lung cancer, colon cancer, breast cancer, pancreatic cancer, prostate cancer, kidney cancer, cervical cancer, brain cancer, stomach cancer, uterine cancer, small intestine cancer, liver cancer, chronic Myeloid leukemia, melanoma, ovarian cancer, metastasis-related renal cells-25- 201215610 cancer (RCC), vesicular soft tissue sarcoma (ASPS), clear cell sarcoma (CCS), and hepatocellular carcinoma. The anti-proliferative effects of such combination therapies are increased/enhanced in cell proliferative diseases in which the affected cells are constitutively characterized or overexpressed c-Met. (-)-trans-3-(5,6-dihydro-41 pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(1H-indol-3-yl)pyridinium L-pyridine-2,5-dione is a non-ATP competitive small molecule that selectively targets the receptor tyrosine kinase of c-Met. Exposure of the c-Met cancer cell line to (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline-l-yl)-4-( lH-Indol-3-yl)pyrrolidine-2,5-dione causes a decrease in phosphorylation-c-Met content and eventual apoptosis of cells. In the multi-mouse allograft efficacy study (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,1-ij]quinoline-buyl)-4-(1Η -Indole-3-yl)pyrrolidine-2,5-dione also inhibits the growth of human tumors (Munshi N, et al.) ARQ 197, a Novel and Selective Inhibitor of the Human c-Met receptor Tyrosine Kinase with Antitumor Activity ".  Mol Cancer Ther (2010 May 18)) o Gemcitabine is an anti-cancer chemotherapy drug used to treat pancreatic cancer, non-small cell lung cancer, bladder cancer, soft tissue sarcoma, and metastatic breast cancer. Gemcitabine is classified as an antimetabolite. Gemcitabine triphosphate analogues replace cytidine during DN A replication, resulting in inhibition of DN A synthesis and induction of apoptosis. The gemcitabine bisphosphonate analog inactivates the ribonucleotide reductase enzyme (RNR) and inhibits the production of deoxynucleotides required for DNA replication and repair, and induces apoptosis. Gemcitabine has been shown to arrest cancer cells in the G 1 / S phase (Cerqueira, P.  A.  Fernandes, M.  J.  Ramos (2 007),  -26- 201215610 " Understanding ribonucleotide reductase inactivation by gemcitabine" ,  Chemistry,  a European Journal 13 (30):  8507-15)° Formula III of the present invention, Ilia, IVa, IVb, a compound of Va or Vb, Or its pharmaceutically acceptable salt, Prodrug, Metabolites, The analog or derivative can be incorporated into a pharmaceutical composition suitable for administration. Such compositions typically comprise the compound (i.e., including the active compound) and a pharmaceutically acceptable excipient or carrier. As used in this article, "Pharmaceutically acceptable excipient" or "pharmaceutically acceptable carrier" is intended to include any and all solvents which are compatible with pharmaceutical administration, Dispersing medium, coating, Antibacterial and antifungal agents, Isotonic agent, Absorption delay agent, and many more. Suitable carriers are described in the latest edition of Remington’s Pharmaceutical Sciences. This is the standard bibliography for this field. Preferred examples of such carriers or diluents include, but are not limited to, water, brine, Ringer's solution, Glucose solution and 5% human serum albumin.  Pharmaceutically acceptable carriers include solid carriers such as lactose, White clay,  蔗糖 sucrose, talc, gelatin, agar, Pectin, Gum arabic, Magnesium stearate,  Stearic acid, and many more. Typical liquid carriers include syrup, Peanut oil, Olive oil, water, and many more. Similarly, The carrier or diluent may comprise a time delay material as is known in the art. Such as glyceryl monostearate or glyceryl distearate, alone or together with a wax, Ethyl cellulose, Hydroxypropylmethylcellulose, Methyl methacrylate or the like. Other sputum, excipient, Flavors and other additives such as those known in the art can also be included in the pharmaceutical compositions according to the present invention. Liposomes and water-insoluble vehicle fluids such as fixed oils can also be used. The use of such media and reagents in pharmaceutically active substances is well known in the art. -27-201215610. Except where any conventional media or reagents are incompatible, They are used in the composition system. The active compound can also be incorporated into the composition.  on the one hand, Formula III, Ilia, IVa, IVb, Va, its pharmaceutically acceptable salt, Prodrug, Metabolites, In the appropriate dosage form, The dosage form is effective according to conventional steps (for example, sufficient to inhibit tumor growth, Formula III for killing or preventing cell proliferative diseases, etc. Ilia, IVa, IVb, An acceptable salt of Va or Vb, Prodrug, Metabolites, The analog component is prepared in accordance with a standard pharmaceutical carrier or diluent (i.e., by means of a pharmaceutical composition). These steps may, as appropriate, include compressing or dissolving the ingredients to obtain the desired formulation.  As used in this article, "Object" can be any human, Primates, Mouse, Rat, dog, Cat, sheep, goat, camel. Preferably, The object is human, as used in this article, "The object that needs it, ‘for the object of disease, Or an object that increases the risk of disease relative to the general population. on the one hand, a preferred aspect of the object The subject in need of it has cancer.  As used in this article, The term "cell proliferative g is regulated or abnormally grown or the condition of the cells of both or does not develop as an undesired symptom or disease of cancer.  Cytoproliferative diseases encompassing each of the active compounds in which cell division is dysregulated. Supplemental or Vb compounds or analogs or derivatives are used to treat dead tumor cells by combination, An effective therapeutic effect of a compound or a pharmaceutical g derivative thereof (as a living preparation of the present invention, Granulation and dairy animals, E.g , Cattle, horse, pig,  〇 Has cell proliferative cell proliferative disease with a pre-cancerous state.  "rickets" refers to typical fine symptoms in which the present invention is not caused to cause cancer. Typical fine -28- 201215610 Cytoproliferative diseases include but are not limited to tumors, Benign tumor, Malignant tumor,  Precancerous state, In situ tumor, Membrane tumor, Metastatic tumor, Liquid tumor, Solid tumor, Immune tumor, Blood tumor, cancer, cancer, Leukemia, Lymphoma, Sarcoma and rapidly dividing cells. The term "rapidly dividing cells" as used herein is defined as any cell that divides at a rate that exceeds or is greater than the rate expected or observed between adjacent or juxtaposed cells within the same tissue. Cell proliferative disorders include primary cancer or pre-cancerous conditions. Cell proliferative diseases 〇 include cancer. Preferably, The methods provided herein are used to treat or alleviate cancer signs. The term "cancer" includes solid tumors as well as hematological and/or malignant tumors. The "primary cancer cell" or "pre-cancerous cell" is a cell which exhibits a cell proliferative disease in a primary cancer or a pre-cancerous state. A "cancer cell" or a "cancerous cell" is a cell which exhibits a cell proliferative disease of cancer. Any reproducible measurement can be used to identify cancer cells or pre-cancerous cells.  Cancer cells or pre-cancerous cells can be sampled by tissue (for example, Histological or grading identification of biological samples. Cancer cells or pre-cancerous cells can be identified by using appropriate molecular markers.  Typical non-cancer conditions or conditions include, but are not limited to, rheumatoid arthritis;  inflammation; Autoimmune disease Lymphatic hyperplasia symptoms; Acromegaly; Rheumatoid spondylitis; Osteoarthritis; gout, Other joint symptoms; Sepsis ; Septic shock Endotoxic shock; Gram-negative sepsis; Toxic shock syndrome; asthma; Adult respiratory distress syndrome; Chronic obstructive pulmonary disease; Chronic pulmonary inflammation; Inflammatory bowel disease; Crohn's disease;  Psoriasis; eczema; Ulcerative colitis; Pancreatic fibrosis; Liver Fibrosis; Acute and chronic kidney disease; Intestinal fistula; Pyresis ; Vascular restenosis; Brain -29- 201215610 malaria; Stroke and ischemic injury; Neurological trauma Alzheimer’s disease; Huntington’s disease: Parkinson’s disease; Acute and chronic pain;  Allergic rhinitis; Allergic conjunctivitis; Chronic heart failure; Acute coronary artery syndrome; Physique malaria; Leprosy Leishmaniasis; Lyme disease; Reiter syndrome: Acute synovitis; Muscle regression Bursitis; Tendinitis Tenosynovitis Intervertebral plate cartilage prolapse, Rupture or prominent syndrome; Osteosclerosis; thrombus; Vascular restenosis; Silicosis  Pulmonary sarcoma; Bone resorption disease (such as osteoporosis); Transplantation to the host; Multiple sclerosis: lupus; Fibromyalgia; AIDS and other viral diseases (such as herpes zoster; Herpes simplex I or II; Influenza virus and huge cell virus); And diabetes.  Typical cancers include, but are not limited to, adrenocortical carcinoma, AID S related cancer, AIDS-related lymphoma, Rectal cancer, Anal cancer, Anal cancer, Appendix cancer, Child cerebellar stellate cell tumor, Children's brain astrocytoma, Basal cell carcinoma, Skin cancer (non-melanoma), Cholangiocarcinoma, Extrahepatic cholangiocarcinoma, Intrahepatic cholangiocarcinoma, Breast cancer, Urinary bladder cancer, Bone and joint cancer, Osteosarcoma and malignant fibrous tissue tumors, Brain cancer, Brain tumor, Brain stem glioblastoma, Cerebellar stellate cell tumor, Cerebral stellate cell tumor/malignant glioma, Ependymoma, Neural tube blastoma, Primitive neuroectodermal tumor on the sky, Visual pathway and pituitary gland glioma, Breast cancer, Bronchial adenoma/carcinoid, Carcinoid tumor, Gastrointestinal tract Nervous system cancer, Nervous system lymphoma, Central nervous system cancer, Central nervous system lymphoma, Cervical cancer, Childhood cancer, Chronic lymphocytic leukemia Chronic myelogenous white blood -30- 201215610 Chronic myeloproliferative disorder, Colon cancer, Colorectal cancer, Skin T cell lymphoma, Lymphoma, Sickle granuloma, Seziary syndrome, Endometrial cancer' esophageal cancer, Extracranial germ cell tumor, Extragonadal germ cell tumor, Extrahepatic cholangiocarcinoma, Eye cancer, Intraocular melanoma, Retinoblastoma,  Gallbladder cancer, Gastric (stomach) cancer, Gastrointestinal carcinoid, Gastrointestinal stromal tumor (GIST), Germ cell tumor, Ovarian germ cell tumor, Pregnancy trophoblastic tumor, Glioma, Head and neck cancer, Hepatocyte (liver) cancer,  〇 Hodgkin's lymphoma 'in swallow cancer, Intraocular melanoma, Eye cancer, Pancreatic islet cell tumor (endocrine pancreatic tumor), Kaposi sarcoma, Kidney cancer, Renal cancer, Throat cancer,  Acute lymphocytic leukemia, Acute myeloid leukemia, Chronic lymphocytic leukemia, Chronic myelogenous leukemia, Hairy cell leukemia, Lip and oral cancer, Liver cancer, Lung cancer, Non-small cell lung cancer, Small Cell Lung Cancer, AIDS-related lymphoma, Non-Hodgkin's lymphoma, Primary central nervous system lymphoma,  Waldenstram macroglobulinemia, Neural tube blastoma 〇 , Melanoma, Intraocular (eye) melanoma, Merkel cell carcinoma, Malignant mesothelioma, Mesothelioma, Metastatic squamous neck cancer, Oral Cancer,  Tongue cancer, Multiple endocrine neoplasia syndrome, Sickle granuloma, Myelodysplastic syndrome, Myelodysplastic/myeloablative, Chronic myelopathic leukemia, Acute myeloid leukemia, Multiple myeloma, Chronic myeloproliferative disorder, Nasopharyngeal carcinoma, Neuroblastoma, Oral cancer, Oral Cancer, Oropharyngeal cancer, Ovarian cancer, Ovarian epithelial cancer, Low-grade ovarian tumors, Pancreatic cancer, Pancreatic islet cells, pancreatic cancer, Sinus and nasal cancer, Parathyroid carcinoma, Penile cancer, Pharyngeal cancer, Trophoblastoma, Pineal mesoblastoma and opioid primitive neuroectodermal tumor,  -31 - 201215610 Pituitary tumor, Paddle cell tumor/multiple myeloma, Pleural pulmonary blastoma, Prostate cancer, Rectal cancer, Renal pelvis and ureter, Transitional cell carcinoma,  Retinoblastoma, Rhabdomyosarcoma, Salivary gland cancer, Ew i n g family tumors, Kaposi's sarcoma, Uterine cancer, Uterine sarcoma, Skin cancer (non-melanoma), Skin cancer (melanoma), Merkel cell skin cancer, Small intestine cancer, Soft tissue sarcoma, Squamous cell carcinoma, Stomach (stomach) cancer, Primitive ectodermal tumors on the sky, 睪9 cancer, Laryngeal cancer, Thymoma, Thymoma and thymic cancer, Thyroid cancer, Transitional cell carcinoma of the renal pelvis and ureters and other urinary organs, Gestational trophoblastic tumor, Urethral cancer, Endometrial cancer, Uterine sarcoma, Uterine body cancer, Vaginal cancer, Vulvar cancer and Wilm's tumors.  "Cellular proliferative disease of the blood system" is a cell proliferative disease involving cells of the blood system. on the one hand, Cell proliferative diseases of the blood system include lymphoma, leukemia, Bone marrow tumor, Obese cell tumor, Osteomyelopathy, Benign monogenic globulin, Lymphomatoid granuloma, Lymphoma-like papules, True erythrocytosis, Chronic myeloid leukemia, Causes of unexplained myelosynthesis and essential thrombocytosis. on the other hand, Cell proliferative diseases of the blood system include excessive cell proliferation of the blood system,  Dysplasia and metaplasia. a preferred aspect, The composition of the present invention can be used to treat a cancer selected from the group consisting of the blood cancer of the present invention or the blood cell proliferative disease of the present invention. on the one hand, The blood cancer of the present invention includes multiple myeloma, Lymphoma (including Hodgkin's lymphoma, Non-Hodgkin's lymphoma, Children with lymphoma and lymphocytes and lymphoma of skin origin), White blood disease (including childhood leukemia, Hairy cell leukemia, Acute lymphocytic leukemia, Acute myeloid leukemia, Chronic lymphocytic leukemia, Chronic myeloid -32- 201215610 Cytogenous leukemia, Chronic myelogenous leukemia, And obese cell leukemia), Myeloma, And obese cell tumor "cell proliferative disease of the lung" is a cell proliferative disease involving lung cells. on the one hand, Cell proliferative disorders of the lung include all forms of cell proliferative disorders affecting lung cells. on the one hand, Cellular proliferative diseases of the lung include lung cancer, Primary or precancerous condition of the lung, Benign growth or lesions of the lungs, Malignant growth or lesions of the lungs, And metastatic lesions of sputum in tissues and organs other than the lungs. a preferred aspect, The composition of the present invention can be used to treat cell proliferative diseases of lung cancer or lung. on the one hand, Lung cancer includes all forms of lung cancer. on the other hand, Lung cancer includes malignant lung tumors, Carcinoma in situ, Typical carcinoid tumors and atypical carcinoid tumors. on the other hand, Lung cancer includes small cell lung cancer (" SCLC"), Non-small cell lung cancer ("NSCLC" ), Squamous cell carcinoma, Adenocarcinoma, Small cell carcinoma, Large cell carcinoma, Adenoid squamous cell carcinoma and mesothelioma. on the other hand, Lung cancer includes "scar cancer", Bronchoalveolar carcinoma, Giant cell carcinoma, Spindle cell carcinoma and large cell neuroendocrine carcinoma. on the other hand, Lung cancer includes 肺 lung tumors with tissue and ultrastructural heterogeneity (eg mixed cell types) 一方面 Cell proliferative disorders of the lung include all forms of cell proliferative disorders affecting lung cells. on the one hand, Cell proliferative diseases of the lung include lung cancer, The precancerous state of the lungs. on the one hand, Cell proliferative diseases of the lung include hyperplasia of the lungs, Metaplasia and dysplasia. on the other hand, Cell proliferative diseases of the lung include asbestos-induced hyperplasia, Squamous metaplasia and benign reactive mesothelial metaplasia. on the other hand, Cell proliferative disorders of the lung include replacement of columnar epithelium with stratified squamous epithelium and mucosal dysplasia. on the other hand, Exposure to inhalation -33- 201215610 Individuals with harmful environmental agents such as cigarettes and asbestos may increase the risk of developing cell proliferative diseases of the lung. on the other hand, Previous lung diseases that cause individuals to develop cell proliferative diseases of the lungs include chronic interstitial lung disease, Bad lung disease, scleroderma, Rheumatoid disease, Sarcoidosis, Interstitial pneumonia,  tuberculosis, Repetitive pneumonia, Idiopathic pulmonary fibrosis, Granuloma, Silicosis, Fibrous sclerosis and Hodgkin's disease.  "Cellular proliferative disease of the colon" is a cell proliferative disease involving colon cells. a preferred aspect, The cell proliferative disorder of the colon is colon cancer. a preferred aspect, The composition of the present invention can be used to treat cell proliferative diseases of colon cancer or colon. on the one hand, Colon cancer includes all forms of colon cancer. on the other hand, Colon cancer includes sporadic and hereditary colon cancer. on the other hand, Colon cancer includes malignant colon tumors, Carcinoma in situ, Typical carcinoid tumors and atypical carcinoid tumors. on the other hand, Colon cancer includes adenocarcinoma, Squamous cell carcinoma and adenosquamous cell carcinoma. on the other hand, Colon cancer line and selected from hereditary nonpolyposis colorectal cancer, Familial adenomatous polyposis, Gardner syndrome, Peutz-Jeghers syndrome, It is related to the hereditary syndrome of the group consisting of Turcot syndrome and juvenile polyposis. on the other hand, Colon cancer can be selected from hereditary non-polyposis colorectal cancer, Family adenomatous polyposis, Jiashi syndrome, Pijie syndrome, Induced by hereditary syndromes in a group consisting of diarrhea syndrome and juvenile polyposis.  on the one hand, Cell proliferative disorders of the colon include all forms of cell proliferative disorders affecting colon cells. On the one hand, cell proliferative diseases of the colon include colon cancer, Precancerous state of the colon, Adenomatous polyps of the colon and metachronous lesions of the colon. on the one hand, Cell proliferative disorders of the colon include -34- 201215610 adenomas. on the one hand, Colonic cell proliferative disease is caused by colonic hyperplasia,  Metaplasia and dysplasia are characteristic. on the other hand, Pro-colon diseases that allow individuals to develop cell proliferative diseases of the colon, including pre-colon cancer. on the other hand, Current diseases that make individuals susceptible to cell proliferative diseases of the colon include Crohn's disease and ulcerative colitis. on the one hand, The cell proliferative disorder of the colon is selected from p53, Ras, The mutations in the genes of the FAP and DCC groups are related. on the other hand, Due to being selected from p53, Ras,  () Mutations in the genes of the group consisting of FAP and DCC exist, Therefore, individuals will have an increased risk of developing cell proliferative diseases of the colon.  "Cellular proliferative disease of the prostate" is a cell proliferative disease involving prostate cells. on the one hand, Cell proliferative diseases of the prostate include all forms of cell proliferative diseases affecting prostate cells. on the one hand,  Proliferative diseases of the prostate include prostate cancer, Primary or precancerous condition of the prostate, Benign growth or lesions of the prostate, And the malignant growth or lesions of the prostate, And metastatic sputum in tissues and organs other than the prostate. on the other hand, Proliferative diseases of the prostate include prostate hyperplasia, Metaplasia, And dysplasia.  "Cellular proliferative disease of the skin" is a cell proliferative disease involving skin cells. on the one hand, Cell proliferative diseases of the skin include all forms of cell proliferative diseases affecting the skin cells. on the one hand, Cell proliferative diseases of the skin include the initial or precancerous condition of the skin, Benign growth or lesions of the skin, Melanoma, Malignant melanoma and other malignant growth or lesions of the skin, And metastatic lesions in tissues and organs in the body other than the skin. on the other hand, Cell proliferative diseases of the skin include hyperplasia of the skin -35 - 201215610 Metaplasia, Psoriasis and dysplasia.  "Cellular proliferative disease of the ovary" is a cell proliferative disease involving ovarian cells. on the one hand, Cell proliferative diseases of the ovary include all forms of cell proliferative diseases affecting the ovarian cells. on the one hand, Cytoproliferative diseases of the ovary include primary or precancerous conditions of the ovary, Benign growth or lesions of the ovary, Ovarian cancer, Malignant growth or lesions of the ovaries, And metastatic lesions in tissues and organs other than the ovaries. on the other hand, Cell proliferative diseases of the ovary include proliferation of ovarian cells, Metaplasia and dysplasia 〇 “Cellular proliferative disease of the breast” is a cell proliferative disease involving breast cells. on the one hand, Cell proliferative disorders of the breast include all forms of cell proliferative disorders affecting the cells of the breast. on the one hand, Cellular proliferative diseases of the breast include breast cancer, Primary or precancerous condition of the breast, Benign growth or lesions of the breast, And the malignant growth or lesions of the breast, And metastatic lesions in tissues and organs in the body other than the breast. on the other hand, Cell proliferative diseases of the breast include breast hyperplasia, Metaplasia and dysplasia.  on the one hand, The cell proliferative disease of the breast is the precancerous state of the breast.  on the one hand, The compositions of the invention can be used to treat the pre-cancerous condition of the breast. on the one hand, The precancerous state of the breast includes atypical hyperplasia of the breast, In situ ductal carcinoma (DCIS), Intraductal cancer, Lobular carcinoma in situ (LCIS), Lobular tumor, Growth or lesions of the 0 or 0 grade of the breast (eg stage 0 or grade 0 breast cancer, Or carcinoma in situ).  on the other hand, The pre-cancerous status of the breast can be staged according to the TNM classification scheme accepted by the American Joint Committee on Cancer (AJCC). The primary tumor (T) has been designated as T0 or Tis; And its regional lymph node (N) has been designated as -36- 201215610 NO phase; And its medium-distance transfer (Μ) is designated as the MO period.  a preferred aspect, The cell proliferative disease of the breast may be breast cancer. a better aspect, The compositions of the invention may be used to treat breast cancer. on the one hand, Breast cancer includes all forms of breast cancer. Breast cancer includes primary epithelial breast cancer. on the other hand , Breast cancer includes breasts involving other tumors such as lymphoma, A cancer of sarcoma or melanoma. on the other hand, Breast cancer, including cancer of the breast, Breast cancer, Lobular carcinoma of the breast, Undifferentiated carcinoma of the breast, The lobular sac of the breast is a tumor, Angiosarcoma of the breast and primary lymphoma of the breast. on the one hand, Breast cancer includes the first, II, Oh, IIIB, Stage IIIC and IV breast cancer. on the one hand,  Breast ductal cancer includes invasive cancer, Invasive carcinoma in situ, which is mainly composed of intraductal components, Inflammatory breast cancer and having an acne selected from Mucin (colloid), Medulla, With the medulla of lymphatic infusion, Papillary, A ductal carcinoma of the breast in the form of a group consisting of a hard and a tubular group. on the one hand, Lobular lobular carcinoma of the breast includes invasive lobular carcinoma, which is predominantly in situ. Invasive lobular carcinoma and invasive lobular carcinoma. on the one hand, Breast cancer includes Paget’s O disease, Paget's disease with intraductal carcinoma and Paget's disease with invasive ductal carcinoma. on the other hand, Breast cancer includes breast tumors that have both tissue and ultrastructural heterogeneity (e.g., mixed cell forms).  a preferred aspect, Formula III, Ilia, IVa, IVb, Compounds of Va or Vb can be used to treat breast cancer. on the one hand, Breast cancer to be treated includes familial breast cancer. on the other hand, Breast cancer to be treated includes sporadic breast cancer. on the one hand,  Breast cancer to be treated can occur in male subjects. on the one hand, Breast cancer to be treated can occur in female subjects. on the one hand, The breast cancer to be treated can occur in a female subject before menopause or in a female subject after menopause. on the one hand, To treat -37- 201215610 Breast cancer can occur in subjects equal to or greater than 30 years old. Or less than 3 years old. on the one hand, Breast cancer to be treated can occur in an object equal to or greater than 50 years old. Or in an object younger than 50 years old. on the one hand, Breast cancer to be treated can occur in subjects equal to or greater than 70 years old. Or less than 70 years old.  on the one hand, Breast cancer to be treated has been classified, To confirm in BRCA 1,  BRCA2 Or a familial or spontaneous mutation in p53. on the one hand, Breast cancer to be treated has been classified as having HER2/neu gene amplification, Excessive performance HER2/neu or low, Medium or high HER2/neu performance. on the other hand , The breast cancer to be treated has been selected from the estrogen receptor (ER), Lutein receptor (PR), Human epidermal growth factor receptor-2, Ki-67, CA15-3, Group markers consisting of CA 27-29 and c-Met were classified. on the one hand, Breast cancer to be treated has been classified as ER-unknown, ER-rich or ER-starved. on the other hand, Breast cancer to be treated has been classified as ER-negative or ER-positive. The ER-classification of breast cancer can be performed in any reproducible manner. A preferred aspect 'The ER classification of breast cancer can be as good as Onkologie 27:  Performed as described in 175-179 (2004). on the one hand, Breast cancer to be treated has been classified as PR-unknown, PR-rich or PR-deficient. On the other hand, breast cancer to be treated has been classified as PR-negative or PR-positive. On the other hand, breast cancer to be treated has been classified as receptor-positive or receptor-negative. On the one hand, breast cancer to be treated has been classified as being associated with an increase in blood levels of CA 15-3 or CA 27-29 or both.  on the one hand, Breast cancer to be treated includes a localized breast tumor. on the one hand , Breast cancer to be treated includes breast tumors associated with negative sentinel lymph node (SLN) biopsies. On the one hand, breast cancer to be treated includes breast tumors associated with positive pre-B sputum (S L N) biopsies. On the other hand, breast cancer to be treated -38-201215610 includes breast tumors associated with one or more positive axillary lymph nodes,  The axillary lymph nodes have been staged by any applicable method. on the other hand,  Breast cancer to be treated includes a condition that has been classified as having a negative lymph node (eg,  Nitrate negative) or lymph node positive status (for example, Breast tumors with positive lymph nodes. on the other hand, Breast cancer to be treated includes breast tumors that have been transferred to other areas of the body. on the one hand, The breast cancer to be treated can be classified as having been transferred to be selected from bones, lung, The area of the group consisting of the liver or brain. Another aspect is that the breast cancer to be treated can be selected according to the transferability, Locality, Regional, Localized, Partial period, remote, Multi-center, On both sides, One side, Opposite side, New diagnosis, Classification of features of groups of relapsed and inoperable patients.  on the one hand, Formula III, Ilia, IVa, IVb, The compound of Va or Vb can be used to treat or prevent cell proliferative diseases of the breast relative to a general population having a risk of increasing the risk of breast cancer. Or to treat or prevent breast cancer.  on the one hand, The target of increasing the risk of breast cancer relative to the general population is 女性 a female subject with a family history of breast cancer or a personal medical history. on the other hand, The subject who has an increased risk of breast cancer relative to the general population is a female subject having a reproductive series mutation or a spontaneous mutation in BRCA1 or BRCA2 or both. on the one hand, An object that increases the risk of breast cancer relative to the general population is a female subject with a family history of breast cancer and a germline mutation or spontaneous mutation in BRCA1 or BRCA2 or both. on the other hand, Relative to the general population, the risk of increasing the risk of breast cancer is greater than 30 years old. More than 40 years old, More than 50 years old, More than 60 years old, More than 70 years old, Women older than 80 or older than 90. on the one hand, Relative to the general population with increased risk of breast cancer -39- 201215610 The risk is for atypical breast hyperplasia, In situ ductal carcinoma (DCIS),  Intraductal cancer, Lobular carcinoma in situ (LCIS), Growth or lesions of the lobular tumor or breast stage 0 (for example, Subjects of sputum or graded breast cancer or carcinoma in situ).  on the other hand, The breast cancer to be treated can be graded according to histology according to the Scarf-Bloom-Richardson system. Among them, the breast tumor has been designated 1. a mitotic count score of 2 or 3; 1, a nuclear polymorphism score of 2 or 3; 1, 2, Or a thin tube of 3 to form a score; And the total score of Skov-Bom-Richardson between 3 and 9. on the other hand, The International Consensus Panel on the Treatment of Breast Cancer may be selected to be selected from Level 1, Level 1-2, level 2, Tumor grade of a group consisting of 2-3 or 3 grades.  on the one hand, The cancer to be treated has been staged according to the American Joint Committee on Cancer (AJCC) TNM classification system. Where the tumor (T) has been designated as TX, T1, Tlmic, T1 a ' Tib, Tic, T2 T3, Τ4, T4a, T4b, T4c or T4d period; And its regional lymph nodes (N) have been designated as NX, NO, N1  N2 N2a, N2b, N3, N3a, N3b or N3c period; And its central remote transfer (M) has been designated as MX, MO or Ml period. on the other hand, The cancer to be treated has been classified as stage I according to the American Joint Committee on Cancer (AJCC).  Phase IIA, Phase IIB, Phase IIIA, Phase IIIB, Stage IIIC or IV. on the other hand, The cancer to be treated can be designated as GX grade according to the AJCC classification (for example,  Level that cannot be evaluated), Level 1, level 2, Level 3 or Level 4. on the other hand , The cancer to be treated has been based on ρΝΧ, ΝΟ, ΝΟΝΟ(Ι-), ΡΝ0(Ι + ),  PNO (mol-), PN0 (mol + ), PN1 PNl(mi), PNla, PNlb,  -40- 201215610 PNlc, pN2 pN2a, pN2b, pN3, pN3a, AJCC pathological classification (pN) staging of pN3b or pN3c.  on the one hand, The cancer to be treated includes tumors that have been determined to be less than or equal to about 2 cm in diameter. on the other hand, Cancers to be treated include tumors that have been determined to be from about 2 to about 5 centimeters in diameter. on the other hand, The cancer to be treated includes tumors that have been determined to be greater than or equal to about 3 cm in diameter. on the other hand,  Cancers to be treated include tumors that have been determined to be greater than 5 cm in diameter. Another 0 aspect, The cancer to be treated can be classified as well differentiated by microscopic appearance. Moderately differentiated, Poorly differentiated or undifferentiated. on the other hand, The cancer to be treated can be counted by mitosis (for example, Number of cell divisions) or nuclear polymorphism (for example, Classification of microscopic appearance of cell changes). on the other hand, The cancer to be treated can be treated with a necrotic area (for example, Classification of microscopic appearance related to the area of sudden or degraded cells. on the one hand, The cancer to be treated is classified as having an abnormal karyotype, A chromosome with an abnormal number of chromosomes or one or more abnormalities in appearance. on the one hand, The cancer to be treated is classified as aneuploid, Triple scorpion, Tetraploid or a chromosome with altered ploidy. on the one hand, The cancer to be treated is classified as having a chromosomal translocation or an entire chromosome deletion or doubling, Or the deletion of a part of the chromosome, Multiplied or enlarged area.  On the one hand, the cancer to be treated can be diagnosed by DNA cytometry, Flow cytometry or image cytometry evaluation. on the one hand, The cancer to be treated has been classified as having 10%, 20%, 30%, 40%, 50%, 60%,  70%, 80% or 90% of cells are in the synthesis phase of cell division (for example, In the S phase of cell division). on the one hand, The cancer to be treated has been classified as having a low s_phase cell fraction or a high S-phase cell fraction.  -41 - 201215610 As used in this article, "Normal cells" are cells that are not classified as "cell-proliferating diseases". on the one hand, Lack of normal cells can lead to dysregulation or abnormal growth of both unwanted symptoms or diseases or both. Preferably, Normal cells have a normal functioning cell cycle checkpoint control mechanism.  As used in this article, "Contacting a cell" refers to a condition in which a composition of a compound or other substance is in direct contact with the cell or is sufficiently close to induce a desired biological effect in the cell.  As used in this article, "Candidate compound" means Formula III that has been or will be tested in one or more in vitro or in vivo bioassays, Ilia,  IVa, IVb, Va or Vb compound, To determine if the compound is likely to be in the cell, organization, whole body, The desired biological or medical response sought by the researcher or clinician in the animal or human body. on the one hand, The candidate compound is a compound of formula III or Ilia; on the other hand, The candidate compound is of formula IVa, IVb, A compound of Va or Vb. a preferred aspect, Biological or medical reactions are treatments for cancer. on the other hand, Biological or medical reactions are the treatment or prevention of cell proliferative diseases. on the one hand, In vitro or in vivo bioassays including, but not limited to, enzyme activity assays, Electrophoretic displacement analysis, Reporting genetic analysis, In vitro cell viability assay and various assays.  As used in this article, "Monotherapy" means the administration of a single active compound or therapeutic compound to a subject in need thereof. Preferably, Monotherapy comprises administering a therapeutically effective amount of the active compound. E.g, Use (±)-cis-3 - (5, 6-dihydro-411-pyrrolo[3, 2, 1-^]quinoline-; 1-yl)-4-(111-indol-3-yl)pyrrolidine-2, 5-diketone cancer monotherapy comprises a therapeutically effective amount of (±)-cis-3 - (5, 6-dihydro-4 Η-pyrrolo[3, 2 ,  1 - ij ] quinoline-1-yl)-4 - ( 1 Η - -42- 201215610 ind-3-yl)pyrrolidine-2, 5-diketone, Or a pharmaceutically acceptable salt thereof, Prodrug, Metabolites, The analog or derivative is administered to a subject in need of treatment for cancer. Monotherapy can be compared to combination therapy, Wherein combination therapy is administered in combination with a plurality of active compounds, Each component that is preferably combined is present in a therapeutically effective amount. on the one hand, Formula III, Ilia, IVa, IVb, Monotherapy of a compound of Va or Vb is more effective than a combination therapy in inducing a desired biological effect. Formula III, Ilia, IVa, IVb, The effectiveness of the single treatment of compounds of Va or Vb is shown in PCT Publication No. WO 2006/0 86484.  As used in this article, "Treatment" is described in order to fight disease, Symptoms or illnesses for the purpose of managing and caring for patients, And include including reducing or alleviating symptoms or complications or eliminating disease, Symptom or condition.  As used in this article, "Prevention" describes stopping the disease, The onset of signs or symptoms of symptoms or conditions.  on the one hand, Treating cancer results in a reduction in tumor size. A reduction in tumor size can also be referred to as "tumor regression." Preferably, After treatment, Relative to the size of the 前 before treatment, Tumor size is reduced by 5% or more; More preferably, Tumor size is reduced by 10% or more; More preferably, Reduce by 20% or more; More preferably, Reduce by 30% or more; More preferably, Reduce by 40% or more; Even better, Reduce by 50% or more; And optimally reduce by more than 7 5 % or more. Tumor size can be measured by any reproducible measurement. a preferred aspect,  Tumor size can be measured as the diameter of the tumor.  on the other hand, Treating cancer results in a reduction in tumor volume. Preferably,  After treatment, Relative to its pre-treatment volume, Tumor volume is reduced by 5% or more; More preferably, Tumor volume is reduced by 1% or more; More preferably, Decrease -43- 201215610 2 〇 % or greater ‘More preferably, Reduced by 30% or more, More preferably, Reduce 40% or more' or even better, Reduce by 50% or more, And optimally reduce by more than 75% or more. Tumor volume can be measured by any reproducible measurement.  on the other hand, Treating cancer results in a reduction in the number of tumors. Preferably,  After treatment, Relative to the number before treatment, The number of tumors is reduced by 5% or more; More preferably, The number of tumors is reduced by 10% or more; More preferably, Reduce by 2 〇 % or more; More preferably, Reduce by 30% or more; More preferably, Reduce by 4 〇 % or more; Even better, Reduce by 50% or more; And optimally reduce by more than 75 percent. The number of tumors can be measured by any reproducible measurement. a preferred aspect, The number of tumors can be measured by visual inspection by naked eye or by counting tumors at a specific magnification. a preferred aspect, The specific magnification is 2χ, 3χ, 4χ, 5χ, 1 Οχ or 5 Οχ 0 On the other hand, Treating cancer results in a reduction in the number of metastatic lesions in other tissues or organs that are remote from the location of the primary tumor. Preferably, After treatment, Relative to the number before treatment, The number of metastatic lesions is reduced by 5% or more; More preferably, The number of metastatic lesions is reduced by 10% or more; More preferably,  Reduce by 20% or more; More preferably, Reduce by 30% or more: More preferably, Reduce by 40% or more; Even better by 50% or more; And optimally reduce by more than 75%. The number of metastatic lesions can be measured by any reproducible measurement. a preferred aspect, The number of metastatic lesions can be measured by visual inspection by naked eye or by counting metastatic lesions at a specific magnification. a preferred aspect, Specific magnification is 2χ, 3χ, 4χ, 5χ, 10χ or 50χ.  on the other hand, Treatment of cancer resulted in an increase in the average survival time of the population of the treated subject compared to the group receiving the single agent. Preferably, The increase in the floor is more than 30 days; More preferably, More than 60 days; More preferably,  : And optimally, More than 120 days. The average survival time of the population is measured by any reproducible method. a preferred aspect, The increase in the live time of the population can be measured, for example, by the average length of survival of the ethnic group starting with the active compound. Another preferred aspect, An increase in the survival time of the family can also be measured, for example, by calculating the average survival length of the population after completion of treatment with the active compound.  on the other hand, Compared to the untreated target group, Treatment increases the average survival time of the subject population. Preferably, the live time is increased by more than 30 days; More preferably, More than 60 days; Better 90 days; And optimally, More than 120 days. The average survival of the population can be measured by any reproducible method. a preferred aspect,  An increase in the mean survival time can be measured, for example, by calculating the average length of survival of the population in terms of active compound opening. Another preferred aspect 增加 an increase in the mean survival time can also be measured, for example, by calculating the average survival length of the population after completion of treatment with the active compound.  on the other hand, Compared to accepting, instead of using Formula III, Ilia,  , a compound of Va or Vb or a pharmaceutically acceptable salt thereof, Precursor a monotherapy group of drugs or analogues of drugs,  This results in an increase in the average survival time of the population of the subject. The average survival time increased by more than 30 days; More preferably, More than 60 days;  More than 90 days; And optimally, More than 120 days. The average increase in ethnicity can be measured in any reproducible manner. A better party. The average first-pass treatment of cancer after the average survival of the surviving group was more than 90 days. The average deposit* exceeded the time of the group. The first group of IVa medicines of the group after the initial treatment group. Preferably, the increase in mean survival time of the population-45-201215610 can be measured, for example, by calculating the average survival length of the population after starting treatment with the active compound. In another preferred aspect, the increase in the average survival time of the population can also be measured, for example, by calculating the average survival length of the population after completion of the first round of treatment with the active compound. On the other hand, treating cancer results in a reduction in mortality in the population of the subject compared to a group receiving a separate carrier. On the other hand, treating cancer results in a reduction in the mortality rate of the population of the subject compared to the untreated subject population. In another aspect, a monotherapy of a drug that accepts a compound that is not a compound of Formula III, Ilia, IVa, IVb, Va, or Vb, or a pharmaceutically acceptable salt, prodrug, metabolite, analog, or derivative thereof Ethnicity, treatment of cancer produces a reduction in mortality in the population of the subject. Preferably, the mortality rate is reduced by more than 2%; more preferably, more than 5%; more preferably, more than 1%; and optimally, more than 25%. In a preferred aspect, the reduction in mortality of the subject of the subject can be measured by any reproducible means. In another preferred aspect, the reduction in mortality of the ethnic group can be measured, for example, by calculating the average number of disease-related deaths per unit time of the population after initiation of treatment with the active compound. Another preferred aspect' reduction in mortality of the population can also be measured, for example, by calculating the average number of populations associated with disease-related death per unit time after completion of the first round of treatment with the active compound. On the other hand, the treatment of cancer results in a reduction in the rate of tumor growth. Preferably, the tumor growth rate is reduced by at least 5% relative to the pre-treatment tumor growth rate after treatment; more preferably, the tumor growth rate is reduced by at least 10%, and more preferably by at least 20%. , reduce by at least 30%, more preferably, by at least 40% 'better' by at least 50% 'even -46- 201215610 better by at least 5 Ο %, and optimally reduce by at least 7 5 % . The tumor growth rate can be measured by any reproducible measurement. In a preferred aspect, the tumor growth rate can be measured based on changes in tumor diameter per unit time. On the other hand, treating cancer leads to a reduction in tumor regrowth. Preferably, after treatment, the tumor regrowth is less than 5%; more preferably, the tumor regrowth is less than 10%; more preferably, less than 20%; more preferably, less than 30%; more preferably, less than 40%; More preferably, less than 50%; even more preferably less than 0 50%; and optimally, less than 75%. Tumor regrowth can be measured by any reproducible measurement. In a preferred aspect, tumor regrowth can be measured, for example, by measuring an increase in tumor diameter after previous tumor shrinkage after treatment. A decrease in tumor regrowth indicates that the tumor cannot relapse after treatment has stopped. On the other hand, treatment or prevention of cell proliferative diseases results in a decrease in the rate of cell proliferation. Preferably, after treatment, cell proliferation is reduced by at least 5%; more preferably, at least 1%; more preferably, at least 20%; more preferably, at least 30%; more preferably, at least 40%; Good, at least 50%; even better Q, at least 50%; and optimally at least 75%. The rate of cell proliferation can be measured by any reproducible measurement. In a preferred aspect, the rate of cell proliferation can be measured, for example, by measuring the number of dividing cells in a tissue sample per unit time. On the other hand, the treatment or prevention of cell proliferative diseases results in a decrease in the proportion of proliferating cells. Preferably, after treatment, the proportion of proliferating cells is reduced by at least 5%; more preferably, at least 1%; more preferably, at least 20%; more preferably, at least 30%; more preferably, at least 40 °/〇; more preferably, at least 50%; even more preferably at least 50%; and optimally at least 75%. The proportion of proliferating cells can be measured by any reproducible measurement method -47- 201215610. A greater ratio is measured, for example, by quantifying the number of undivided cells in a tissue sample. Another preferred aspect may be equal to the mitotic index. On the other hand, the number of areas or regions for treating or preventing cell proliferation is reduced. Preferably, the size of the area or region of birth is 5% compared to its treatment; more preferably, at least 1% reduction; more preferably, preferably, at least 30% reduction; more preferably, reduction to at least reduction 50%; even better, reduce at least 75% less. The measurement of the area of cell proliferation or the size of the area is measured. In a preferred aspect, the cell can increase the diameter or width of the area or region of cell proliferation. On the other hand, the number or proportion of cells that treat or prevent the appearance or morphology of the cell proliferative is reduced. The number of cells having an abnormal morphology is 5% less than that of the treatment; more preferably, at least 10%; more preferably, at least 30%; more preferably, less, less than 50%; Even better, reduce to at least 75%. Measurement of abnormal cell appearance or morphology. On the one hand, abnormal cells (for example using a reverse phase tissue culture microscope) are measured. The cell morphology can take the form of nuclear polymorphism. As used herein, the term "selectively" is preferred in that the number of proliferating cell fissure cells is relative to that of proliferating cells. After the disease causes cell proliferation therapy, the size of the cell growth is reduced by at least 20%; less 40%. More preferably, 50%; and the best reduction can be measured by any reproducible area or area size. The disease results in an abnormally better, the number of pre-treatment treatments is reduced to at least 20%; at least 40%; more preferably 50%; and optimally by any reproducible form Microscopy On the one hand, the anomalous fine representation tends to occur more frequently in one population -48-201215610 than in another group. On the one hand, the compared population is the cell population. In a preferred aspect, the compound of Formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof selectively acts on cancer cells or pre-cancerous cells But does not act on normal cells. In another preferred aspect, the compound of Formula 111, 111 a, IV a, IV b , Va or Vb, or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof, selectively acts to modulate one Molecular targets (eg, 'c-Met), but do not significantly modulate another molecular target (eg, protein kinase C). In a preferred aspect, the invention provides a method of selectively inhibiting the activity of an enzyme, such as a kinase. Preferably, if an event occurs more than twice as frequently in population A than in group B, then preferably the event occurs selectively in population A relative to group B. More preferably, if an event occurs more than five times more frequently in ethnic group A, then the event occurs selectively. More preferably, an event occurs more than ten times more frequently in ethnic group A than in ethnic group B; more preferably greater than 50 times more frequently in ethnic group a than in ethnic group B; even more preferably greater than 100 The event occurs selectively when it is optimally greater than 1,000 times. For example, if cell death in cancer cells occurs more than twice as frequently as normal cells, cell death can occur selectively in cancer cells. In a preferred aspect, a compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof modulating a molecular target (eg, c-Met) Activity. In one aspect, regulation refers to stimulating or inhibiting the activity of a molecular target. Preferably, a compound of the formula -49-201215610 III, Ilia, IVa, IVb, Va or Vb stimulates or inhibits the molecular target relative to the activity of the molecular target in the absence of the compound under the same conditions. When the activity is at least 2 fold, the compound preferably modulates the molecular target activity. More preferably, a compound of formula I, Ilia, IVa, IVb, Va or Vb stimulates or inhibits the activity of the molecular target at least 5 times for the activity of the molecular target in the absence of the compound under the same conditions. At least 10 times, at least 20 times, at least 50 times, at least 100 times, the compound modulates the activity of the molecular target. The activity of the molecular target can be measured by any reproducible method. The activity of the molecular target can be measured in vitro or in vivo. For example, the activity of a molecular target can be measured in vitro by enzyme activity assay or DN A binding assay, or the activity of a molecular target can be measured in vivo by analyzing the expression of the reporter gene. In one aspect, Formula III, Ilia, IVa, IVb, if the addition of the compound does not stimulate or inhibit the activity of the molecular target by more than 1% relative to the activity of the molecular target in the absence of the compound under the same conditions. The compound of Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof does not significantly modulate the activity of the molecular target. In a preferred aspect, the compound of formula III, Ilia, IVa, IVb, Va or Vb does not significantly modulate the activity of protein kinase C. As used herein, the term "synergy enzyme selectivity" means that the first isoform of the enzyme is preferentially inhibited or stimulated compared to the second isoform of the enzyme (eg, compared to the kinase isozyme beta, which is preferred). Inhibiting or stimulating the kinase isozyme 〇〇. Preferably, the compound of formula III, Ilia, IVa, IVb, Va or Vb demonstrates a minimum of 4 fold difference in the dose required to achieve a biological effect, preferably 10 The difference is more preferably 50 times different. Preferably, the compound of the formula -50 - 201215610 III, Ilia, IVa, IVb, Va or Vb demonstrates this difference in the range of inhibition and the molecular label of interest The difference in target is exemplified by IC5Q (i.e., 50% inhibition). In a preferred system, a compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt thereof, Administration of a drug, metabolite, analog or derivative to a cell or subject in need thereof results in modulation (i.e., stimulation or inhibition) of the activity of c-Met. As used herein, the activity of c-Met 0 Refers to any biological function or activity performed by c-Met. For example, c- The function of Met includes phosphorylation of downstream target proteins. Other functions of c-Met include autophosphorylation, adaptor proteins (such as Gab-1, Grb-2, She, SHP2, and c-Cbl). Activation of binding and signal transductions (such as Ras, Src, PI3K, PLC-γ, STATs, ERK 1 and 2, and FAK). The c-Met knockout has been shown to inhibit cancer cells in a cell type-specific manner. Growth. 1^108-\18-231, :^(:1-11661::^(:1-H441, MIA PaCa-2, HT29, and MKN-45 human cancer cells. c-Met base cause knockout Caspase-dependent apoptosis is induced in a cell type-specific manner. Accordingly, the present invention relates to the treatment of cell proliferative diseases in which the cells exhibit high amounts of c-Met or exhibit active c-Met. In a preferred system, a compound of formula III, Ilia, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof, is administered to a cell or subject in need thereof A modulatory effect (ie, stimulation or inhibition) that results in the activity of ERK 1 or ERK 2 or both. As used herein, E The activity of RK 1 or ERK 2 refers to any biological function or activity by ERK 1 or ERK 2. For example, the functional package of ERK 1 or ERK 2 -51 - 201215610 includes phosphorylation of a downstream target protein. Activation refers to the state in which a composition of a substance (eg, a protein or nucleic acid) is in a state suitable for performing the desired biological function. On the one hand, the composition of the substance that can be activated also has an unactivated state. In one aspect, the activating composition of the substance can have a biological function that inhibits or stimulates or both. In one aspect, elevated refers to increasing the desired biological activity of a composition of a substance (e.g., a protein or nucleic acid). Elevation can occur by increasing the concentration of the constituents of the substance. As used herein, "cell cycle checkpoint pathway" refers to a biochemical pathway involved in the regulation of a cell cycle checkpoint. The cell cycle checkpoint pathway can have a stimulatory or inhibitory effect or both on one or more functions comprising cell cycle checkpoints. The cell cycle checkpoint pathway consists of a composition of at least two substances, preferably proteins, which contribute to the regulation of cell cycle checkpoints. The cell cycle checkpoint pathway can be activated by activation of one or more members of the cell cycle checkpoint pathway. Preferably, the cell cycle checkpoint path is preferably a biochemical communication pathway. As used herein, "cell cycle checkpoint modulator" refers to a composition of a substance that has at least a portion of the function of regulating cell cycle checkpoints. The cell cycle checkpoint modulator can have a stimulatory or inhibitory effect or both on one or more functions comprising a cell cycle checkpoint. In one aspect, the cell cycle checkpoint modulator can be a protein. On the other hand, cell cycle checkpoint modulators are not proteins. In one aspect, treating cancer or a cell proliferative disorder results in cell death, and preferably, cell death results in a reduction in the number of cells in the population by at least 10% -52 - 201215610. More preferably, cell death means a reduction of at least 20%; a better reduction of at least 30%; a better reduction of at least 40%; and a reduction of at least 50°/. ; optimally reduce by at least 75%. The number of cells in the population can be measured by any reproducible method. The number of cells in the population is measured by fluorescence activated cell sorting (FACS). On the other hand, the number of cells in the ethnic group is measured by immunofluorescence microscopy. On the other hand, the number of cells in the population is measured by optical microscopy. On the other hand, a method for measuring cell death f) is shown in Li et al. (2003) Proc Natl Acad Sci USA · 1 00(5): 2674-8. On the one hand, cell death occurs through apoptosis. In a preferred aspect, an effective amount of a compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof is not significantly cytotoxic to normal cells. A compound that is therapeutically effective will not be significantly cytotoxic to normal cells if the compound is administered in a therapeutically effective amount without inducing cell death of greater than 10% of normal cells. A therapeutically effective amount of a compound does not significantly affect the viability of normal cells if the compound is administered in a therapeutically effective amount without inducing cell death of greater than 10% of normal cells. On the one hand, cell death occurs through apoptosis. In one aspect, the cell is contacted with a compound of Formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof, selectively induced in cancer cells Or activate cell death. Preferably, a compound of the formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analogue or derivative thereof is administered to a subject in need thereof, in a cancer cell Selectively induce or activate cell death. In another aspect, contacting the cell with a compound of Formula III, Ilia, IVa, IVb, Va or Vb-53-201215610, or a pharmaceutically acceptable salt, prodrug, metabolite, analog or derivative thereof, in one or A variety of cells affected by cell proliferative diseases selectively induce cell death. Preferably, a compound of the formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analogue or derivative thereof is administered to a subject in need thereof, in one or A variety of cells affected by cell proliferative diseases selectively induce cell death. In a preferred aspect, the invention relates to a method of administering a compound of formula III, Ilia, IVa, IVb, Va or Vb or a pharmaceutically acceptable salt, prodrug, metabolite, analogue or derivative thereof to A method of treating or preventing cancer in need thereof, wherein administration of a compound of Formula III, Ilia, IVa, IVb, Va or Vb results in one or more of the following: cells accumulate in the G1 phase and/or S phase of the cell cycle, There is no significant amount of cell death cytotoxicity in normal cells, anti-tumor activity in animals with a therapeutic index of at least 2, and activation of cell cycle checkpoints via cell death in cancer cells. As used herein, "therapeutic index" is the maximum tolerated dose divided by the effective dose. Those skilled in the art can refer to the general reference text for a detailed description of known techniques or equivalent techniques discussed herein. The texts include A m u s a b 1 e et al., C u r r e n t P r o t 〇 c ο 1 s i η ο ο 1 e c u 1 a r B i ο 1 〇 g y, John Wiley and Sons, Inc.  (2005); Sam brook et al.

Molecular Cloning,A Laboratory Manual (第 3 版),Cold Spring Harbor Press, Cold Spring Harbor, New York (2000); Collagen等人,Current Protocols in Immunology, John Wiley & Sons, N. Y. I Anna等人,Current Protocols in Pharmacology, John Wiley & Sons, N.Y. ; Final 等人, -54- 201215610Molecular Cloning, A Laboratory Manual (3rd Edition), Cold Spring Harbor Press, Cold Spring Harbor, New York (2000); Collagen et al, Current Protocols in Immunology, John Wiley & Sons, NY I Anna et al., Current Protocols In Pharmacology, John Wiley & Sons, NY ; Final et al, -54- 201215610

The Pharmacological Basis of The rapeutics ( 1 975), Remington's Pharmaceutical Sciences, Mack Publishing Co.,Easton, PA,18版(1990)。當然在進行或使用本發明 的觀點時也參考這些文本。 2 .吡咯並喹啉基-吡咯-2,5 -二酮及吡咯並喹啉基-吡 咯啶-2,5 -二酮 Q 式III及Ilia之吡咯並喹啉基-吡咯·2,5-二酮化合物爲The Pharmacological Basis of The rapeutics (1 975), Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, PA, 18 (1990). Of course, these texts are also referred to when conducting or using the ideas of the present invention. 2. Pyrroloquinolinyl-pyrrole-2,5-dione and pyrroloquinolinyl-pyrrolidine-2,5-dione Q Formula III and Ilia pyrroloquinolinyl-pyrrole 2,5- Diketone compound

其中: Ο 111、112及113係獨立地選自由氫、1?、<^1、81'、1、- NR5R6、-(Ci-C6)烷基、-(Ci-C6)經取代之院基、-(C3-C9) 環烷基、-(C3-C9)經取代之環院基、-〇-(ci_c6)烷基、-〇-(Ci-Cd經取代之烷基、-〇_(C3-C9)環院基和- 〇- (c3_c9)經 取代之環烷基、芳基、雜芳基、雜環基所組成之群組; R4爲獨立地選自由氫、_(Cl_C6)院基、_CH2R7所組成 之群組; R5及R6係獨立地選自由氫和_(Cl_C6)院基所組成之群 組; -55- 201215610 R7 爲獨立地選自由-0-Ρ( = 0)(0Η2)、-0-Ρ( = 0)(-0Η)(-0-(Ci-C6) ^ S ) ' -O-PpOK-O-iCi-Ce)烷基)2 ' -O- p( = o)(-oh)(-o-(ch2)-苯基)、-o-p( = o)(-o-(ch2)-苯基)2 、羧酸基團、胺基羧酸基團和肽所組成之群組; Q係選自由方基、雜方基、-〇 -方基、-S -芳基、-0 -雜 芳基和-S-雜芳基所組成之群組; X係選自由-(CH2)-、-(NR8)-、S和0所組成之群組; R8係獨立地選自由氫、-(CrCfi)烷基、-(c^-Cs)經取 代之烷基、-(C3-C9)環烷基、-(C3-C9)經取代之環烷基、 和-0-(Ci-C6)院基、-C( = 0)-0-(Ci-C6)院基和-C( = 0)-0_ (CrCd經取代之烷基所組成之群組; Y係選自由-(ch2)-或鍵所組成之群組; 其中該芳基、雜芳基、-〇-芳基、-S-芳基、_〇_雜芳 基或-S-雜芳基基團可經一或多個取代基取代,該取代基 獨立地選自由 F、Cl、Br、I、-NR5R6、-(CpCe)院基、-(Ci-C6)經取代之院基、-(C3-C9)環院基、-(c3-C9)經取代 之環烷基、-〇-(<^-(:6)烷基、-0-(Κ6)經取代之院基、· o-(c3-c9)環烷基、-o-(c3-c9)經取代之環烷基、_芳基、_ 芳基- (Ci-C6)院基、-芳基-0-(Ci-C6)院基、芳基、 (C1-C4)院基-方基、雜方基、雜環基、院基 環和-(SbOhhiCi-C6)烷基所組成之群組;及 m爲1或2。 對於式Ilia之化合物而言,Q係選自由芳基、雜芳基 、-〇_芳基、_S-芳基、-0-雜芳基和-S_雜芳基所組成之群 -56- 201215610 組,其先決條件爲當R4爲氫或(CrCd烷基時,Q不爲3-吲 哚基或經取代之3-吲哚基。 式1¥3、1¥1?、¥&或¥1)之吡咯並喹啉基-吡咯啶-2,5-二 酮化合物爲:Wherein: Ο 111, 112 and 113 are independently selected from the group consisting of hydrogen, 1?, <^1, 81', 1, -NR5R6, -(Ci-C6)alkyl, -(Ci-C6) , -(C3-C9)cycloalkyl, -(C3-C9) substituted ring, -〇-(ci_c6)alkyl, -〇-(Ci-Cd substituted alkyl, -〇_ (C3-C9) ring group and - 〇-(c3_c9) group of substituted cycloalkyl, aryl, heteroaryl, heterocyclic groups; R4 is independently selected from hydrogen, _(Cl_C6) Group of _CH2R7; R5 and R6 are independently selected from the group consisting of hydrogen and _(Cl_C6) yards; -55- 201215610 R7 is independently selected from -0-Ρ (= 0) (0Η2), -0-Ρ( = 0)(-0Η)(-0-(Ci-C6) ^ S ) ' -O-PpOK-O-iCi-Ce)alkyl)2 ' -O- p( = o) (-oh)(-o-(ch2)-phenyl), -op(=o)(-o-(ch2)-phenyl)2, a carboxylic acid group, an aminocarboxylic acid group and a group consisting of peptides; the Q group is selected from the group consisting of a aryl group, a heteroaryl group, a -〇-square group, an -S-aryl group, an -0-heteroaryl group, and a -S-heteroaryl group; Is selected from the group consisting of -(CH2)-, -(NR8)-, S and 0; R8 is independently selected from hydrogen, -(CrCfi)alkyl, -(c^-Cs) Alkyl, -(C3-C9)cycloalkyl, -(C3-C9) substituted cycloalkyl, and -0-(Ci-C6), -C(=0)-0-(Ci- C6) a group consisting of -C(=0)-0_(CrCd substituted alkyl group; Y system selected from the group consisting of -(ch2)- or a bond; wherein the aryl group, heteroaryl The group, -〇-aryl, -S-aryl, _〇_heteroaryl or -S-heteroaryl group may be substituted by one or more substituents independently selected from F, Cl, Br, I, -NR5R6, -(CpCe), -(Ci-C6) substituted, -(C3-C9) ring, -(c3-C9) substituted cycloalkyl, - 〇-(<^-(:6)alkyl,-0-(Κ6) substituted substituted, · o-(c3-c9)cycloalkyl, -o-(c3-c9) substituted ring Alkyl, aryl, _aryl-(Ci-C6), aryl-O-C(Ci-C6), aryl, (C1-C4), aryl, quaternary a group consisting of a heterocyclic group, a terpenyl ring, and a -(SbOhhiCi-C6)alkyl group; and m is 1 or 2. For a compound of the formula Ilia, the Q system is selected from the group consisting of an aryl group, a heteroaryl group, and a group consisting of 〇_aryl, _S-aryl, -0-heteroaryl and -S_heteroaryl-56-201215610, the prerequisite of which is when R4 is hydrogen or In the case of a CrCd alkyl group, Q is not a 3-indenyl group or a substituted 3-indenyl group. The pyrroloquinolinyl-pyrrolidine-2,5-dione compound of the formula 1 ¥3, 1 ¥1?, ¥& or ¥1) is:

其中:among them:

Rl、R2及R3係獨立地選自由氫、F、cl、Br、卜_ NR5R6、-(Ci-C6)燒基、-(Ci-C6)經取代之院基、-(C3-C9) 環烷基、-(c3-c9)經取代之環烷基、-〇-(Ci-c6)烷基、-〇-(CrCd經取代之烷基、-0-(C3-C9)環烷基和-0-(C3-C9)經 取代之環烷基、芳基、雜芳基、雜環基所組成之群組; R4爲獨立地選自由氫、-(Ci-C6)烷基、-CH2R7所組成 之群組; R5、R6係獨立地選自氫或- (Ci_C6)院基所組成之群組 201215610 R7爲獨立地選自由-0-Ρ( = 〇)(〇η2;)、-0-p( = 0)(-OH)(-CMq-Cd 烷基)、-0-P( = 0)(-0-(Cl-C6)烷基)2、-0-P( = 〇)(-oh)(-o-(ch2)-苯基)、-o-p( = o)(-〇_(CH2)-苯基)2、羧酸基 團、胺基羧酸基團和肽所組成之群組; Q係選自由芳基、雜芳基、-0 -芳基、-S -芳基、-〇 -雜 芳基和-S-雜芳基所組成之群組; X係選自由-(CH2)-、-(NR8)-、s和Ο所組成之群組; R8係獨立地選自由氫、-(CrCd烷基、-(Ci-CJ經取 代之烷基、-(C3-C9)環烷基、-(C3-C9)經取代之環烷基、 和-0-(Ci-C6)院基、-(^( = 0)-0-((^-(^6)院基及-C( = 〇)-〇-(C ,-(:6)經取代之烷基鍵所組成之群; Y係選自由-(ch2)-或鍵所組成之群組; 其中該芳基、雜芳基、-0-芳基、-S-芳基、-〇-雜芳 基或-S-雜芳基基團可經一或多個取代基取代,該取代基 獨立地選自由 F、Cl、Br、I、-NR5R6、-(C!-C6)烷基、-經取代之烷基、-(C3-C9)環烷基、-(C3-C9)經取代 之環烷基、烷基、-CMQ-Cd經取代之烷基、-〇-(C3-C9)環烷基、-〇-(C3-C9)經取代之環烷基、-芳基、_ 芳基-(Ci-Cd烷基、-芳基-0-((^-(^6)烷基、-〇-芳基、-0-(d-CU)烷基-芳基、雜芳基、雜環基、烷基-雜 環和-(spcoo^Ci-C6)烷基所組成之群組;及 m爲1或2。 式III、Ilia、IVa、IVb、Va或Vb之化合物的製備係描 述於國際申請案 PCT/US20 1 0/023 8 93中,其全部內容以 -58- 201215610 引用方式合倂於本文中。 2.1定義 術語“烷基”係指包含碳及氫且無不飽和性之基團。烷 基基團可爲直鏈或分支。典型烷基基團包括但不限於曱基 、乙基'丙基、異丙基、己基、三級丁基、二級丁基、等 等。醯基基團可以範圍表示,因此,例如,(Ci-C6)院基 〇 基團係指在直鏈或分支烷基骨架中包含1至6個碳原子之烷 基基團。經取代及未經取代之烷基基團可獨立地爲(C !-c5)烷基、(C丨-C6)烷基、(C丨-Cio)烷基、(c3-c丨〇)烷基或 (C5-C1Q)烷基。除非明白地表示,術語“烷基”不包括“環烷 基”。 “環烷基”基團係指在“環部分”具有該指示數目之碳原 子的環狀烷基基團,其中該“環部分”可由一或多個稠環、 螺環或橋環之結構組成。例如,C3至C6環烷基(例如(C3-O Ce)環烷基)係指環中具有介於3至6個碳原子之環結構。當 沒有指定範圍時,則該環烷基在環部分具有介於3至9個碳 原子((C3-C9)環烷基)。典型環烷基基團包括但不限於環丙 基、環丁基、環戊基、環己基、環庚基及金剛烷基。較佳 環烷基基團在環結構中具有三、四、五、六、七、八、九 個或自三至九個碳原子。 術語經取代之烷基及經取代之環烷基係指經一或多個 取代基取代之如上定義之烷基及環烷基基團,該取代基獨 立地選自由氟、芳基、雜芳基、-CMCi-Cs)烷基或-NR5R6 -59- 201215610 所組成之群組,其中R5及R6係獨立地選自由氫及-(q-Cd 烷基所組成之群組。 術語“芳基”係指具有一、二或三個芳族環之芳族碳環 基團。典型芳基基團包括但不限於苯基、萘基、等等。芳 基基團包括與一或多個具有4至9員之額外非芳族碳環或雜 環稠合之一、二或三個芳族環結構。稠合芳基基團之例子 包括苯並環丁烯基、二氫茚基、四氫伸萘基、1,2,3,4-四 氫菲基、四氫蒽基、1,4-二氫-1,4-甲撐萘基、苯並二氧雜 環戊烯基。 術語“雜芳基”係指具有一、二或三個芳族環之雜芳族 (雜芳基)基團,該芳族環中包含1至4個雜原子(諸如氮、 硫或氧)。雜芳基基團包括與一或多個具有4-9員的額外非 芳族環稠合之一、二或三個包含1至4個雜原子之芳族環結 構。在芳族環中包含單一類型之雜原子的雜芳基基團係以 彼等所包含之雜原子類型表示,因此含氮雜芳基、含氧雜 芳基及含硫雜芳基分別代表包含一或多個氮、氧或硫原子 之雜芳族基團。典型雜芳基基團包括但不限於吡啶基、喃 啶基、三唑基、喹啉基、喹嗤啉基、噻唑基、苯并[b]苯 硫基、呋喃基、咪唑基、吲哚基、等等。 術語“雜環基”或“雜環”係指飽和或不飽和之穩定非芳 族環結構’該結構可經稠合、螺合或橋接以形成額外之環 。各雜環係由一或多個碳原子及自1至4個選自氮、氧或硫 之雜原子組成。“雜環基”或“雜環”包括穩定之非芳族3至7 員單環雜環環結構及8至11員雙環雜環環結構。雜環基基 -60- 201215610 團可被連接於任何導致產生穩定結構之內環碳或氮原子上 。較佳雜環包括3-7員單環雜環(更佳地5至7員單環雜環) 及8至10員雙環雜環。該等基團之例子包括哌啶基、哌哄 基、吡喃基、吡咯啶基、嗎啉基、硫代嗎啉基、側氧哌啶 基、側氧吡咯啶基、側氧氮呼基、氮呼基、異噁唑基、四 〇R1, R2 and R3 are independently selected from the group consisting of hydrogen, F, cl, Br, _NR5R6, -(Ci-C6) alkyl, -(Ci-C6) substituted, -(C3-C9) ring Alkyl, -(c3-c9) substituted cycloalkyl, -〇-(Ci-c6)alkyl, -oxime-(CrCd substituted alkyl,-0-(C3-C9)cycloalkyl and a group consisting of a substituted cycloalkyl, aryl, heteroaryl, heterocyclic group; R4 is independently selected from hydrogen, -(Ci-C6)alkyl, -CH2R7 a group consisting of; R5, R6 are independently selected from hydrogen or - (Ci_C6) group consisting of 201215610 R7 are independently selected from -0-Ρ(= 〇)(〇η2;), -0 -p( = 0)(-OH)(-CMq-Cd alkyl),-0-P(=0)(-0-(Cl-C6)alkyl)2,-0-P( = 〇)( -oh)(-o-(ch2)-phenyl), -op(=o)(-〇_(CH2)-phenyl)2, a carboxylic acid group, an aminocarboxylic acid group and a peptide Group; Q is selected from the group consisting of aryl, heteroaryl, -O-aryl, -S-aryl, -〇-heteroaryl, and -S-heteroaryl; X is selected from - a group consisting of (CH2)-, -(NR8)-, s and oxime; R8 is independently selected from hydrogen, -(CrCd alkyl, -(Ci-CJ substituted alkyl, -(C3-C9 ) cycloalkyl, - (C3-C9) substituted cycloalkyl, and -0-(Ci-C6) yard, -(^( = 0)-0-((^-(^6)) and -C( = 〇 a group consisting of -C-(:6) substituted alkyl bond; Y group selected from the group consisting of -(ch2)- or a bond; wherein the aryl group, heteroaryl group, - The 0-aryl, -S-aryl, -fluorene-heteroaryl or -S-heteroaryl group may be substituted by one or more substituents independently selected from F, Cl, Br, I , -NR5R6, -(C!-C6)alkyl, -substituted alkyl, -(C3-C9)cycloalkyl, -(C3-C9) substituted cycloalkyl, alkyl, -CMQ- Cd substituted alkyl, -〇-(C3-C9)cycloalkyl, -〇-(C3-C9) substituted cycloalkyl, -aryl, _aryl-(Ci-Cd alkyl, - Aryl-0-((^-(^6)alkyl, -〇-aryl,-0-(d-CU)alkyl-aryl, heteroaryl, heterocyclyl, alkyl-heterocyclic and a group consisting of -(spcoo^Ci-C6)alkyl; and m is 1 or 2. The preparation of a compound of formula III, Ilia, IVa, IVb, Va or Vb is described in International Application PCT/US20 1 0 /023 8 93, the entire contents of which are incorporated herein by reference. 2.1 Definitions The term "alkyl" refers to a group containing carbon and hydrogen and having no unsaturation. The alkyl group can be straight or branched. Typical alkyl groups include, but are not limited to, decyl, ethyl 'propyl, isopropyl, hexyl, tert-butyl, secondary butyl, and the like. The thiol group may be represented by a range, and thus, for example, the (Ci-C6) fluorene group means an alkyl group having 1 to 6 carbon atoms in a linear or branched alkyl skeleton. The substituted and unsubstituted alkyl group may independently be (C!-c5)alkyl, (C丨-C6)alkyl, (C丨-Cio)alkyl, (c3-c丨〇) alkane. Or a (C5-C1Q) alkyl group. The term "alkyl" does not include "cycloalkyl" unless explicitly stated. "Cycloalkyl" group refers to a cyclic alkyl group having the indicated number of carbon atoms in the "ring moiety", wherein the "ring moiety" may be composed of one or more fused, spiro or bridged rings composition. For example, a C3 to C6 cycloalkyl group (e.g., (C3-O Ce)cycloalkyl) refers to a ring structure having from 3 to 6 carbon atoms in the ring. When no range is specified, the cycloalkyl group has from 3 to 9 carbon atoms ((C3-C9) cycloalkyl group) in the ring portion. Typical cycloalkyl groups include, but are not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, and adamantyl. Preferably, the cycloalkyl group has three, four, five, six, seven, eight, nine or from three to nine carbon atoms in the ring structure. The term substituted alkyl and substituted cycloalkyl refers to alkyl and cycloalkyl groups as defined above substituted by one or more substituents independently selected from fluoro, aryl, heteroaryl. a group consisting of -CMCi-Cs)alkyl or -NR5R6 -59- 201215610, wherein R5 and R6 are independently selected from the group consisting of hydrogen and -(q-Cd alkyl. The term "aryl" "" refers to an aromatic carbocyclic group having one, two or three aromatic rings. Typical aryl groups include, but are not limited to, phenyl, naphthyl, and the like. The aryl group includes one or more An additional non-aromatic carbocyclic or heterocyclic fused, one or two or three aromatic ring structures of 4 to 9 members. Examples of fused aryl groups include benzocyclobutenyl, indanyl, and tetra Hydronylnaphthyl, 1,2,3,4-tetrahydrophenanthryl, tetrahydroindenyl, 1,4-dihydro-1,4-methylnaphthyl, benzodioxolyl. "Heteroaryl" refers to a heteroaromatic (heteroaryl) group having one, two or three aromatic rings containing from 1 to 4 heteroatoms (such as nitrogen, sulfur or oxygen). Heteroaryl groups include one or more having 4-9 members An additional non-aromatic ring is fused to one, two or three aromatic ring structures containing from 1 to 4 heteroatoms. Heteroaryl groups containing a single type of heteroatom in the aromatic ring are included The hetero atom type indicates that the nitrogen-containing heteroaryl group, the oxygen-containing heteroaryl group, and the sulfur-containing heteroaryl group respectively represent a heteroaromatic group containing one or more nitrogen, oxygen or sulfur atoms. Typical heteroaryl groups These include, but are not limited to, pyridyl, pyridinyl, triazolyl, quinolyl, quinoxalinyl, thiazolyl, benzo[b]phenylthio, furanyl, imidazolyl, fluorenyl, and the like. "Heterocyclyl" or "heterocycle" refers to a saturated or unsaturated, stable non-aromatic ring structure which can be fused, fused or bridged to form an additional ring. Each heterocyclic ring system consists of one or more a carbon atom and consisting of 1 to 4 heteroatoms selected from nitrogen, oxygen or sulfur. "Heterocyclyl" or "heterocycle" includes a stable non-aromatic 3 to 7 membered monocyclic heterocyclic ring structure and 8 to 11 Bicyclic heterocyclic ring structure. Heterocyclyl-60-201215610 Groups can be attached to any internal ring carbon or nitrogen atom which results in a stable structure. Heterocycles include 3-7 membered monocyclic heterocycles (more preferably 5 to 7 membered monocyclic heterocycles) and 8 to 10 membered bicyclic heterocycles. Examples of such groups include piperidinyl, piperidinyl, pyran. Base, pyrrolidinyl, morpholinyl, thiomorpholinyl, oxetoxypiperidinyl, oxoperyrrolidinyl, oxoxime, oxime, isoxazolyl, tetraterpenoid

氫吡喃基、四氫呋喃基、二噁唑基、二噁哄基、氧硫雜環 戊二儲基(oxathiolyl)、二硫代基(dithiolyl)、環丁 颯基、 二噁烷基、二氧戊環基、四氫呋喃並二氫呋喃基、四氫啦 喃並二氫-呋喃基、二氫卩比喃基、四氫呋喃並呋喃基、四 氫吡喃並呋喃、奎寧啶基(1-氮雜雙環[2.2.2]辛院基)及托 烷基(8-甲基-8-氮雜雙環[3.2.1]辛烷基)。 爲了 Q取代基之目的,術語“經取代之3 - Π引哄基,,係指 經一或多個取代基取代之3 -吲哚基,該取代基選自由F、 Cl、Br、I、-NR5R6、-(C 丨-C6)烷基、-(Cl_c6)經取代之焼 基、-(c3-c9)環院基、-(c3-c9)經取代之環院基、·〇 (c c6)烷基、經取代之烷基、-0_(C3_c9)環垸基、 〇-(C3-C9)經取代之環烷基、-芳基、-芳基_(Ci_C6)院基、_ 芳基-0-(c 芳基、雜環基、-(MCrCU)烷基-雜環和= 烷基所組成之群組;其中R5、R6係獨立地選自由氮和6_ (Ci-Ce)烷基所組成之群組。 爲了 R7取代基之目的’術語“羧酸基團,,係指_〇_ CpOHCi-Ce)院基、-〇-C( = 〇)-(C3-C9)環院基、_〇 c卜〇卜 芳基、_〇-C( = 〇)-雜芳基、-0_C( = 0)_雜環、_〇 c卜 -61 - 201215610 c6)烷基-芳基、= 烷基-雜芳基或_〇_(:( = 〇)_ (C^C:6)烷基-雜環形式之基團。包括“羧酸基團,’中者爲經 一或多個取代基取代之-04( = 0)-((^-(:6)烷基、-0-c( = 0)-(C3-C9)環烷基、_〇_c( = 0)_ 芳基、-0_(:( = 〇)_雜芳基、-〇· c(=o)-雜環、-〇_c( = 0)_(Cl_c6)烷基-芳基、-〇-C( = 0)_(Cl· C6)院基-雜芳基或_0_c( = 0)_(Cl_c6)烷基-雜環形式之基團 ’該取代基係獨立地選自由F、Cl、Br、Ϊ、-OH、-SH、-NR5R6、Ά-(:6)烷基、-(C,-。)經取代之烷基、-(C3-C9) 環烷基、-(C3-C9)經取代之環烷基、-O-CC^-Ce)烷基、-0-(CrCd經取代之烷基、_s_(Cl-c6)烷基、-〇_(C3_C9)環烷 基、-0-(C3-C9)經取代之環烷基、-芳基、-〇-芳基、-〇-(Ci-C4)烷基-芳基、雜芳基、雜環基、-〇_(Cl_C4)烷基-雜 環、-(S( = 〇)2)_(Cl_c6)烷基、-NH-C( = NH)-NH2(例如胍基) 、-COOH或-c( = 〇)-NR5R6所組成之群組,其中R5和R6係 獨立地選自由氫和-(G-Ce)烷基所組成之群組。此外,爲 了 R7取代基之目的,術語“胺基羧酸基團”係指羧酸基團, 包括經一或多個上述取代基取代之羧酸基團,該羧酸基團 帶有一或多個經獨立選擇之-NR5R6形式之胺基基團,其 中R5及R6係獨立地選自由氫和(C^-Cs)烷基所組成之群組 〇 在本發明之一體系中,R7爲α-胺基酸或亞胺基酸,包 括但不限於丙胺酸、精胺酸、天冬醯胺酸、天冬胺酸、半 胱胺酸、麩醯胺酸、麩胺酸、甘胺酸、組胺酸、異白胺酸 、白胺酸、離胺酸、甲硫胺酸、苯丙胺酸、脯胺酸、絲胺 -62- 201215610 酸、蘇胺酸、色胺酸、酪胺酸、纈胺酸或其立體異構物或 外消旋混合物。在本發明之另一體系中,R7係選自由L-丙 胺酸、L-精胺酸、L-天冬醯胺酸、L-天冬胺酸、L-半胱胺 酸、L -麩醯胺酸、L-麩胺酸、L -甘胺酸、L -組胺酸、L-異 白胺酸、L-白胺酸、L-離胺酸、L-甲硫胺酸、L-苯丙胺酸 、L-脯胺酸、L-絲胺酸、L-蘇胺酸、L-色胺酸、L-酪胺酸 或L-纈胺酸所組成群組之α-胺基酸或亞胺基酸。 〇 爲了 R7取代基之目的,術語“肽”係指二肽、三肽、四 肽或五肽,當水解時其分別釋放二、三、四或五個胺基酸 或亞胺基酸(例如脯胺酸)。爲了 R7之目的,肽係經由酯鍵 聯.連結至該分子之其他部分。在一體系中,R7之肽係由α-胺基酸或亞胺基酸組成,包括但不限於丙胺酸、精胺酸、 天冬醯胺酸、天冬胺酸、半胱胺酸、麩醯胺酸、麩胺酸、 甘胺酸、組胺酸、異白胺酸、白胺酸、離胺酸、甲硫胺酸 、苯丙胺酸、脯胺酸、絲胺酸、蘇胺酸、色胺酸、酪胺酸 Ο 、纈胺酸或其立體異構物或外消旋混合物;及在此體系之 較佳版本中,參與酯鍵之羧基基團爲該肽之羧基端COOH 基團而不是側鏈羧基。在本發明之另一體系中,R7係選自 由L-丙胺酸、L-精胺酸、L-天冬醯胺酸、L-天冬胺酸、L-半胱胺酸、L -麩醯胺酸、L -麩胺酸、L -甘胺酸、L -組胺酸 、L-異白胺酸、L·白胺酸、L_離胺酸、L_甲硫胺酸、L·苯 丙胺酸、L-脯胺酸、L-絲胺酸、L-蘇胺酸、L-色胺酸、L-酪胺酸或L-纈胺酸所組成群組之α_胺基酸或亞胺基酸;且 在此較佳體系之更佳版本中,參與酯鍵之羧基基團爲該肽 -63- 201215610 之羧基端COOH基團有關側鏈羧基。 2.2較佳化合物 包括在較佳體系中者爲式III、Ilia、IVa、IVb、Va或Hydropyranyl, tetrahydrofuranyl, bisoxazolyl, dioxin, oxathiolyl, dithiolyl, cyclobutenyl, dioxo, dioxolane Base, tetrahydrofuro-dihydrofuranyl, tetrahydrofuran dihydro-furanyl, indanylpyranyl, tetrahydrofurofuranyl, tetrahydropyranopylfuran, quinuclidinyl (1-azabicyclo[ 2.2.2] 辛院基) and tropyl (8-methyl-8-azabicyclo[3.2.1]octyl). For the purposes of a Q substituent, the term "substituted 3 - fluorenyl" refers to a 3-indenyl group substituted with one or more substituents selected from the group consisting of F, Cl, Br, I, -NR5R6, -(C 丨-C6)alkyl, -(Cl_c6) substituted fluorenyl, -(c3-c9) ring-based, -(c3-c9) substituted ring-based, 〇(c C6) alkyl, substituted alkyl, -0(C3_c9)cyclodecyl, fluorene-(C3-C9) substituted cycloalkyl, -aryl, -aryl_(Ci_C6), _ 芳a group consisting of -O-aryl, heterocyclyl, -(MCrCU)alkyl-heterocycle and =alkyl; wherein R5, R6 are independently selected from nitrogen and 6-(Ci-Ce) alkane Group of groups. For the purpose of R7 substituents, the term 'carboxylic acid group' means _〇_CpOHCi-Ce), 〇-C( = 〇)-(C3-C9) Base, _〇cBu aryl, _〇-C(= 〇)-heteroaryl, -0_C(= 0)_heterocycle, _〇cbu-61 - 201215610 c6)alkyl-aryl, = alkane a group of a hetero-heteroaryl or _〇_(:( = 〇)_(C^C:6)alkyl-heterocyclic ring group, including a "carboxylic acid group," which is one or more substituted The base is substituted by -04( = 0)-((^-(:6)alkyl,-0-c( = 0)-(C3-C9)cycloalkyl, _〇_c(=0)_aryl,-0_(:(= 〇)_heteroaryl, -〇·c(=o)-heterocycle,- 〇_c( = 0)_(Cl_c6)alkyl-aryl, -〇-C( = 0)_(Cl·C6), ortho-aryl or _0_c( = 0)_(Cl_c6)alkyl a heterocyclic form of the group 'The substituent is independently selected from the group consisting of F, Cl, Br, fluorene, -OH, -SH, -NR5R6, fluorenyl-(:6)alkyl, -(C,-.) Substituted alkyl, -(C3-C9)cycloalkyl, -(C3-C9) substituted cycloalkyl, -O-CC^-Ce)alkyl,-0-(CrCd substituted alkyl, _s_(Cl-c6)alkyl, -〇_(C3_C9)cycloalkyl,-0-(C3-C9) substituted cycloalkyl, -aryl, -〇-aryl, -〇-(Ci- C4) alkyl-aryl, heteroaryl, heterocyclic, -〇-(Cl_C4)alkyl-heterocycle, -(S(= 〇)2)_(Cl_c6)alkyl, -NH-C( = a group of NH)-NH2 (eg, fluorenyl), -COOH, or -c(= 〇)-NR5R6, wherein R5 and R6 are independently selected from the group consisting of hydrogen and -(G-Ce)alkyl Further, for the purposes of the R7 substituent, the term "amino carboxylic acid group" refers to a carboxylic acid group, including a carboxylic acid group substituted with one or more substituents described above, the carboxylic acid group having a Or more An independently selected amino group of the form -NR5R6 wherein R5 and R6 are independently selected from the group consisting of hydrogen and (C^-Cs)alkyl. In one system of the invention, R7 is a- Amino acid or imido acid, including but not limited to alanine, arginine, aspartic acid, aspartic acid, cysteine, glutamic acid, glutamic acid, glycine, group Aminic acid, isoleucine, leucine, lysine, methionine, phenylalanine, valine, silk-62-201215610 acid, sulphate, tryptophan, tyrosine, guanamine An acid or a stereoisomer or a racemic mixture thereof. In another system of the invention, R7 is selected from the group consisting of L-alanine, L-arginine, L-aspartic acid, L-aspartic acid, L-cysteine, L-bran Amine acid, L-glutamic acid, L-glycine, L-histamine, L-isoleucine, L-leucine, L-lysine, L-methionine, L-amphetamine Alpha-amino acid or imine consisting of acid, L-proline, L-serine, L-threonine, L-tryptophan, L-tyrosine or L-proline Base acid. For the purposes of the R7 substituent, the term "peptide" refers to a dipeptide, tripeptide, tetrapeptide or pentapeptide which, when hydrolyzed, releases two, three, four or five amino acids or imido acids, respectively (eg Proline). For the purpose of R7, the peptide is linked to other parts of the molecule via an ester linkage. In one system, the peptide of R7 consists of an alpha-amino acid or an imido acid, including but not limited to alanine, arginine, aspartic acid, aspartic acid, cysteine, bran Proline, glutamic acid, glycine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, valine, serine, threonine, color Aminic acid, guanyl tyrosine, valine or a stereoisomer or racemic mixture thereof; and in preferred versions of the system, the carboxyl group participating in the ester bond is the carboxyl terminal COOH group of the peptide Not a side chain carboxyl group. In another system of the invention, R7 is selected from the group consisting of L-alanine, L-arginine, L-aspartic acid, L-aspartic acid, L-cysteine, L-bran Amine acid, L-glutamic acid, L-glycine, L-histamine, L-isoleucine, L-leucine, L-lysine, L-methionine, L-amphetamine Α-amino acid or imine consisting of acid, L-proline, L-serine, L-threonine, L-tryptophan, L-tyrosine or L-proline The base acid; and in a more preferred version of this preferred system, the carboxyl group participating in the ester bond is the carboxyl group-terminal COOH group of the peptide-63-201215610. 2.2 Preferred Compounds Included in the preferred system are Formula III, Ilia, IVa, IVb, Va or

Vb之化合物’其中Q係選自由芳基、雜芳基、-〇_芳基、-S -芳基、-〇 -雜芳基和-S -雜芳基所組成之群組,其先決條 件爲Q不爲3 -吲哚基或經取代之3 _吲哚基。在其他較佳體 系中,Q選自由芳基、雜芳基、-〇-芳基、-S-芳基、-0-雜 芳基和-S -雜芳基所組成之群組,其先決條件爲當R 4爲氫 '環烷基或烷基時’ Q不爲3 -吲哚基或經取代之3 -吲哚基 。在其他仍較佳體系中,Q係選自由芳基、雜芳基、-0-芳 基、-S-芳基、-0-雜芳基和-S-雜芳基所組成之群組,其先 決條件爲當R4爲氫、(C3-C4)環烷基或(CrCO烷基時,則Q 不爲3 -吲哚基或經取代之3 -吲哚基。在另一較佳體系中, Q爲3 -吲哚基或經取代之3 -吲哚基,其先決條件爲R4不爲 氫、環烷基或烷基。在另一仍較佳體系中,Q爲3 -吲哚基 或經取代之3-吲哚基,其先決條件爲R4不爲氫、(C3-C4) 環烷基或(Ch-Cd烷基。 其他較佳體系包括式III、Ilia、IVa、IVb、Va或Vb之 化合物’其中R4爲·CH2R7。這些化合物可作爲其中R4爲Η 之該對應式ΠΙ、Ilia、IVa ' IVb、Va或Vb之化合物的前藥 形式。該前藥形式係藉由水解裂解而釋放其中R4爲Η之該 對應化合物。該水解可藉由備製對應羥基亞甲基衍生物之 酶催化或非酶催化途徑發生,該衍生物在後續水解時導致 -64 - 201215610 釋放其中R4爲Η之化合物。在—該較佳體系中’以爲-CH2R7,其中 R7 爲-〇-ρ( = 〇)(οη)2、-〇-Ρ( = 〇)(_ΟΗ)(-〇-(c丨-c6)烷基)或- 〇-p( = 〇)(-〇-(Ci_C6)院基)2 ° 在其中”爲-0-P( = 0)〇0-(Ci-C6)院基)2的體系中’該院基基團係經獨 立地選擇。在另一較佳體系中’ R4爲_CH2R7,其中R7爲 羧酸基團或胺基羧酸基團。在另一較佳體系中,R7爲狀; 其中在更佳體系中’該肽係經由與該肽鏈之錢基端C00H 0 基團所形成之酯鍵連結至該化合物之其餘部分。在式111 、Ilia、IVa、IVb、Va或Vb之化合物的其他較佳個別及獨 立體系中,其中R4爲- CH2R7且R7爲肽’該肽可爲二肽、 三肽、四肽或五肽。該R7官能性之肽的較佳胺基酸組成係 描述於上。 式III、Ilia、IVa、IVb、Va或Vb之化合物的體系包括 該等其中X選自由-(NR8)-、S或Ο所組成之群組者,其中 R8係獨立地選自由氫、-(G-C6)烷基、-(山-(:6)經取代之 ϋ 烷基、-(C3-C9)環烷基、-(c3-c9)經取代之環烷基和-0-(Q-C6)烷基所組成之群組。式III、Ilia、IVa、IVb、Va或 Vb之化合物的其他體系包括該等其中χ爲-CH2-者。在式 III、Ilia、IVa、IVb、Va或Vb之化合物的體系中’ X爲氧 (〇)。在其他式III、Ilia、IVa、IVb、Va或Vb之化合物的 其他體系中’ X爲硫(S)。在式III、Ilia、IVa、IVb、Va或 Vb之化合物的其他體系中,又爲_^118)-,其中R8係獨立 地選自由氫、-(Κ6)烷基、_(Cl_c6)經取代之烷基、· (c3-c9)環院基、-(c3-c9)經取代之環烷基或_0_(Cl_C6)烷 -65 - 201215610 基所組成之群組。 本發明之其他較佳體系包括式III或Ilia之化合物,其 中Q爲雜芳基或經隨意地取代之雜芳基基團。在式III或 111 a之化合物的4個個別替代性較佳體系中,Q爲經隨意地 取代之單環雜芳基基團、經隨意地取代之雙環雜芳基基團 ,其先決條件爲該雙環雜芳基基團不爲吲哚基或經取代之 吲哚基、或經隨意地取代之三環雜芳基基團。隨意取代基 當存在時係獨立地選自該等芳基、雜芳基、-〇-芳基、-s-芳基、-0-雜芳基或-S-雜芳基所述者。 包括在本發明之較佳體系中者爲式IVa、IVb、Va或 Vb之化合物,其中Q爲雜芳基或經隨意地取代之雜芳基基 團。在式IVa、IVb、Va或Vb之化合物的4個個別替代性較 佳體系中,Q爲經隨意地取代之單環雜芳基基團、經隨意 地取代之雙環雜芳基基團,其先決條件爲該雙環雜芳基基 團不爲吲哚基、或經隨意地取代之三環雜芳基基團。在一 更佳體系中,Q爲經隨意取代之含氮雜芳基基團。在相關 體系中,q爲經隨意取代之吲哚基。隨意取代基當存在時 係獨立地選自該等芳基、雜芳基、-〇-芳基、-S-芳基、-0-雜芳基或-S-雜芳基所引述者。 本發明之較佳體系包括式IVa和IVb之化合物的混合物 ,包括外消旋混合物。在另一較佳體系中’式1 V a及1V b之 化合物爲(±)-順-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉_卜 基)-4 - ( 1 Η -吲哚-3 -基)吡咯啶-2,5 _二酮之個別鏡像異構物 。在此體系中,(士)-順-3-(5,6-二氫-4Η-吡咯并[3,2,l-ij]喹 -66 - 201215610 啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶_2,5_二酮之製備係以起 始物質1,2,3,4 -四氫喹啉及吲哚-3 -乙酶胺開始而製備成混 合物。如實施例1步驟1-5中所述’該H 3,4·四氫喹啉被 轉化成5,6-二氫-4H-吡咯并[3,2,l_ij]喹啉-1-基)乙醛酸甲 酯。該5,6-二氫-4H-吡咯并[3,2,1-U]喹啉-1-基)乙醛酸甲 酯係如實施例1步驟6中所述與吲哚-3 -乙醯胺反應’以產 生 3-(5,6-二氫-4H-吡咯并[3,2,1-ϋ]喹啉-1-基)-4-(1Η-吲 0 哚-3-基)吡咯-2,5 -二酮。接著如實施例2中所述使用步驟B ,藉由催化氫化作用製備該(±)-順-3-(5,6-二氫-4H-吡咯并 [3,2,l-ij]喹琳-1-基)-4-(1Η-吲哚-3-基)吡咯啶-2,5-二酮之 混合物。 本發明之較佳體系亦包括式Va及Vb之化合物的混合 物,包括外消旋混合物。在另一較佳體系中,式Va及Vb 之化合物爲(±)-反- 3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-l-基)-4-(lH-吲哚-3-基)吡咯啶-2,5-二酮之個別鏡像異構 〇 物。在此體系中,該等化合物係如上所述藉由先製備(±)_ 順-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲 哚-3-基)吡咯啶-2,5 -二酮之混合物加以製備。如實施例3 中所述,該順式化合物之混合物接著以三級丁醇鉀於三級 丁醇中的混合物處理以獲得(±)-反-3-(5,6-二氫- 4H-吡咯并 [3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶_2,5_二酮之 混合物。 本發明之化合物的所有立體異構物皆被考慮,不論是 呈混合或純的或實質上純的形式,包括外消旋混合物之結 -67- 201215610 晶形式及個別異構物之結晶形式。根據本發明之化合物的 定義包括所有可能的立體異構物(例如各不對稱中心之R及 S構型)及彼等之混合物。該定義特別地包括外消旋形式及 該具有特定活性之經分離的光學異構物。該外消旋形式可 藉由物理方法解析,諸如舉例來說分段結晶、非鏡像異構 衍生物之分離或結晶、藉由掌性管柱層析法或超臨界流體 層析法分離。該個別光學異構物可藉由習知方法從外消旋 物獲得,諸如舉例來說以光學活性酸形成鹽,接著結晶化 。另外,所有幾何異構物(諸如雙鍵之E-及Z-構型)係包含 在本發明之範圍內,除非另外說明。本發明之某些化合物 可以互變異構形式存在。所有該等互變異構形式之化合物 被認爲是包含在本發明之範圍內,除非另外說明。本發明 亦包括一或多種類似物或衍生物之區位異構 (regioisomeric)混合物。 如使用於本文中,術語"鹽"爲醫藥上可接受之鹽且可 包括酸加成鹽,包括鹽酸鹽類、氫溴酸鹽類、磷酸鹽類、 硫酸鹽類、硫酸氫鹽、烷基磺酸鹽類、芳基磺酸鹽類、乙 酸鹽類、苯甲酸鹽類、檸檬酸鹽類、順丁烯二酸鹽類、反 丁烯二酸鹽類、琥珀酸鹽類、乳酸鹽類、及酒石酸鹽類; 鹼金屬陽離子諸如Na+、K+、Li+、鹼土金屬鹽諸如Mg2 +或 Ca2+、或有機胺鹽。 如使用於本文中,術語"代謝物”表示式111、111 a、 IVa、IVb、Va或Vb之化合物、或其醫藥上可接受之鹽、 類似物或衍生物之代謝產物,其顯示與式III、Ilia、IVa -68- 201215610 、IVb、Va或Vb之化合物相似的活體內活性。 如使用於本文中,術語"前藥"表示共價連接至一或多 個前部分(諸如胺基酸部分或其他水溶性部分)之式ΠΙ、 Ilia、IVa、IVb、Va 或 Vb之化合物。式 III、Ilia、IVa、 IVb、Va或Vb之化合物可經由水解、氧化及/或酶釋放機 制而從前部分釋放出來。在一體系中,本發明之前藥組成 物顯示增加之水溶解度、改良之穩定性和改良之藥代動力 C) 學分佈的附加利益。可選擇前部分以獲得所要之前藥特性 。例如,可根據溶解度、穩定性、生物利用率、及/或活 體內遞送或吸收來選擇前部分(例如,胺基酸部分或其他 水溶性部分諸如R4中之磷酸酯)。 3.醫藥組成物及調配物 本發明之醫藥組成物係經調配成與其所欲投予途徑相 容。投予途徑之例子包括非經腸(例如靜脈內、皮內、皮 〇 下)、經口(例如吸入)、經皮(局部)及經黏膜投予。用於非 經腸、皮內或皮下應用之溶液或懸浮液可包括下列成分: 無菌稀釋劑諸如注射用水、鹽水溶液、不揮發油、聚乙二 醇、甘油、丙二醇或其他合成溶劑;抗細菌劑諸如苯甲醇 或徑苯甲酸甲酯;抗氧化劑諸如抗壞血酸或亞硫酸氫鈉; 螯合劑諸如伸乙二胺四乙酸;緩衝劑諸如乙酸鹽、檸檬酸 鹽或碟酸鹽及用於調整張力之試劑諸如氯化鈉或葡萄糖。 pH可以酸或鹼(諸如鹽酸或氫氧化鈉)調整。非經腸製劑可 被包封於安瓿、丟棄式針筒或以玻璃或塑膠製成之多劑量 -69- 201215610 小瓶中。 本發明之化合物或醫藥組成物可利用目前用於化學治 療性治療之許多眾所周知之方法投予至對象。例如,爲了 治療癌症,本發明之化合物可被直接注射至腫瘤中、注射 至血流或體腔中或經口服用或以貼布貼在皮膚上。該選擇 之劑量應足以組成有效治療,但不至於高到造成無法接受 之副作用。在治療期間及治療後之合理期間應較佳地密切 監測疾病狀況(例如癌、前癌、等等)之狀態及該病患之健 康情形。 術語“治療有效量”,如使用於本文中,係指用於治療 、改善或預防經鑑定之疾病或症狀或顯示可偵測之治療或 抑制效果之藥劑的量。效果可藉由此技藝中已知的任何分 析方法偵測。用於對象的精確有效量將取決於對象體重、 身材和健康;症狀本性和程度;及經選擇用於投予之治療 或治療組合而定。用於既定情況的治療有效量可藉由在臨 床醫師的技巧及判斷範圍內按慣例經驗來決定。一較佳方 面,欲治療之疾病或症狀爲癌症。另一方面,欲治療之疾 病或症狀爲細胞增生症。 對於任何化合物,治療有效量可以例如腫瘤細胞的細 胞培養分析法或經常以大鼠、小鼠、兔、狗或豬的動物模 式初步評估。動物模式亦可用以測定適當的濃度範圍及投 予途徑。該資訊然後可用以測定投予至人類的有效劑量及 途徑。治療/預防效力及毒性可在細胞培養物或實驗動物 中以標準醫藥程式測定,例如ED5D(在50%之族群中有療效 -70- 201215610 的劑量)及LD5G(對50%之族群的致死劑量)。在毒性與療效 之間的劑量比爲治療指數,且其可以LD5〇/ED5()之比表示 。以顯示大的治療指數之醫藥組成物爲較佳。劑量可視所 使用之劑型、病患敏感度及投予途徑而在此範圍內變動。 劑量及投予係經調整以提供足夠的活性劑含量或維持 所要效果。可列入考慮的因素包括疾病狀態嚴重性、對象 的一般健康狀況、對象的年齡、體重和性別、飮食、投予 0 時間和頻率、藥物組合、反應敏感度及對治療的耐受性/ 反應。長效醫藥組成物可視特定調配物之半生期及清除率 而以每3至4天、每週或每兩週投予一次。 包含本發明活性化合物的醫藥組成物可以一般已知的 方式製造,例如以習知的混合、溶解、造粒、糖衣錠製造 、磨光、乳化、囊封、捕捉或凍乾法的方式製造。醫藥組 成物可以習知方式使用一種或多種醫藥上可接受之載劑調 配,該載劑包含促使活性化合物加工成可醫藥上使用的製 〇 劑之賦形劑及/或輔助劑。當然,適當的調配物係視所選 擇之投予途徑而定。 適合於注射使用的醫藥組成物包括無菌水溶液(水溶 性)或分散液及供即時製備無菌可注射溶液或分散液之無 菌粉末。對於靜脈內投予,適當載劑包括生理食鹽水、抑 菌水、Cremophor EL™ (BASF, Parsippany,N.J.)或磷酸鹽 緩衝食鹽水(PBS)。在所有情況中,組成物必須爲無菌且 應爲以易注射性存在的程度之流體。其在製造及貯存條件 下必須爲安定的且必須以對抗微生物(諸如細菌和真菌)的 -71 - 201215610 污染作用予以保存。載劑可爲包含例如水、乙醇、多元醇 (例如,甘油、丙二醇及液體聚乙二醇、等等)及其適當混 合物之溶劑或分散介質。適當的流動性可例如藉由使用塗 膜(諸如卵磷脂)、在分散液的情況中藉由維持所需的粒徑 及藉由使用介面活性劑而維持。預防微生物作用可藉由各 種抗細菌劑及抗真菌劑(例如對羥苯甲酸酯、氯丁醇、酚 、抗壞血酸、硫柳汞、等等)而達成。在許多情況下,較 佳的是在組成物中包括等張劑(例如,糖)、多元醇(諸如 甘露醇、山梨醇)、氯化鈉。可注射組成物的延長吸收可 藉由在組成物中包括延遲吸收之試劑(例如單硬脂酸鋁和 明膠)而引起。 無菌可注射溶液可藉由將活性化合物以所需的量與上 述列舉之成分中之一或組合一起倂入適當的溶劑中,若必 需時,接著過濾滅菌而製造。通常,分散液係藉由將活性 化合物倂入含有基本分散介質及來自上述列舉之所要其他 成分的無菌媒液中而製造。在用於製造無菌可注射溶液之 無菌粉末的情況中,製造方法爲真空乾燥及凍乾,其產生 活性成分加上來自其先前經無菌過濾之溶液的任何額外所 要成分之粉末。 口服組成物通常包括惰性稀釋劑或可食用的醫藥上可 接受之載劑。彼等可封裝於明膠膠囊內或壓縮成錠劑。爲 了 口服治療投予之目的,可將活性化合物與賦形劑合倂且 以錠劑、菱形錠或膠囊形式使用。口服組成物亦可使用作 爲漱口水的流體載劑製造,其中在流體載劑中的化合物係 -72- 201215610 經口施予且漱口,並吐出或吞嚥。醫藥上可相容之黏合劑 及/或佐劑材料可包括作爲組成物的一部分。錠劑、九劑 、膠囊、菱形錠等等可包含任何下列成分或類似性質之化 合物:黏合劑諸如微晶纖維素、黃蓍膠或明膠;賦形劑諸 如澱粉或乳糖;崩散劑諸如藻酸' 普姆膠(Primo gel)、或 玉米澱粉;潤滑劑諸如硬脂酸鎂或史特羅(Sterotes);助 滑劑諸如膠體二氧化矽;甜味劑諸如蔗糖或糖精;或調味 ζ) 劑諸如薄荷、柳酸甲酯或柳橙口味。 對於經由吸入投予,化合物係以氣溶膠噴霧形式從包 含適當推進劑(例如,氣體諸如二氧化碳)之加壓容器或配 送器,或噴霧器輸送。 全身性投予亦可藉由穿透黏膜或穿透皮膚的方式。對 於穿透黏膜或穿透皮膚投予,適合於穿透障壁的穿透劑係 用於此調配物中。該等穿透劑通常爲此技藝中已知的,且 包括例如用於穿透黏膜投予、清潔劑、膽鹽及梭鏈孢酸 〇 (fusidic acid)衍生物。穿透黏膜投予可經由使用鼻噴霧劑 或栓劑而實現。對於穿透皮膚投予,活性化合物係調配成 如通常該技藝中已知的軟膏、油膏、凝膠或乳膏。 一方面,活性化合物係用防止化合物從身體快速消除 的醫藥上可接受之載劑製造’諸如控制釋放調配物,包括 植入物及微囊封輸送系統。可使用生物可降解且生物可相 容之聚合物’諸如乙烯乙酸乙烯酯、聚酐、聚乙醇酸、膠 原蛋白、聚原酸酯及聚乳酸。備製該等調配物之方法爲該 等熟諳此技藝者顯而易見者。材料亦可商業上得自Alza公 -73- 201215610 司及Nova藥學公司。微脂體懸浮液(包括以對病毒抗原 之單株抗體靶定受感染之細胞的微脂體)亦可用作爲醫藥 上可接受之載劑。這些可根據該等熟諳此技藝者已知的方 法製造,例如美國專利案第4,522,8 1 1號中所述。 爲了劑量之容易投予及均勻,將口服或非經腸組成物 調配成單位劑型尤其有利。單位劑型如使用在本文中係指 適合作爲用於欲治療之對象的單一劑量的物理分離單位元 ;每個單位包含與所需醫藥載劑結合的經計算以產生所欲 療效之預定量的活性化合物。本發明的單位劑型之規格係 由且直接視活性化合物的獨特特徵及欲達成之特定療效而 定。 在治療應用中,根據本發明所使用之醫藥組成物的劑 量係視試劑、服藥病患的年齡、體重和臨床症狀、及投予 治療的臨床醫師或執業醫師之經驗和判斷以及其他影響所 選劑量因素而改變。通常,劑量應足以導致腫瘤生長減慢 ,且較佳地消退,且亦較佳地引起癌症完全消退。劑量可 在從每天約〇.〇1毫克/公斤至每天約3000毫克/公斤之範圍 。一較佳方面,劑量可在約每天1毫克/公斤至約每天1000 毫克/公斤之範圍。一方面,劑量將在約0.1毫克/天至約50 公克/天;約0.1毫克/天至約25公克/天;約0.1毫克/天至約 1 〇公克/天;約〇,1毫克/天至約3公克/天;或約0 = 1毫克/天 至約1公克/天之範圍內,其爲單次、分次或連續劑量(該 劑量可以公斤計之病患體重、以平方公尺計之體表面積及 以歲計之年齡而調整)。有效量之藥劑爲其提供由臨床醫 -74- 201215610 師或其他具資格之觀察者所注意到之客觀可辨識之改善。 例如,在病患中的腫瘤消退可參考腫瘤直徑測量。腫瘤直 徑之減少表示消退。消退亦藉由停止治療後腫瘤不再復發 來表示。如使用於本文中,術語“劑量有效方式”係指在對 象或細胞中產生所要的生物效果之活性化合物的量。 較佳地,(-)-反-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹 啉-1-基)-4-( 1H-吲哚-3-基)吡咯啶-2,5-二酮係以一天二次 0 360毫克之劑量投予,最大每日劑量爲720毫克。(-)-反-3- (5,6-二氫-411-吡略并[3,2,1-丨〗]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶- 2,5-二酮係隨意以初始劑量1〇毫克一天二次投 予至對象或病患,最大每日劑量20毫克,並使劑量漸增至 以360毫克一天二次投予,最大每日劑量720毫克。(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1七]喹啉-1-基)-4-(1^1-吲哚-3-基)吡咯啶-2,5-二酮之較佳劑型包括但不限於膠囊錠 (caplet)、錠劑、九劑及凍乾粉末。例如,將一顆3 60毫克 〇 之膠囊錠一天二次投予至對象或病患,或者,二顆180毫 克之膠囊錠一天二次,以達最大每日劑量720毫克。(-)-反- 3- (5,6 -二氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η -吲 哚-3-基)吡咯啶- 2,5-二酮膠囊錠或錠劑亦可被調製成60毫 克劑量。 該醫藥組成物可包括任何本文中所描述之化合物的共 同調配物。 醫藥組成物可與投予指示一起包括於容器、包裝或配 送器內。 -75- 201215610 【實施方式】 實例 於下提供實例以進一步說明本發明之不同特色。該等 實例亦說明實施本發明之有用方法。這些實施例不限制該 申請專利之發明。 製備式III、Ilia、IVa、IVb、Va或Vb之化合物(包括 ( + )-順-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-l-基)-4-(lH-吲哚-3-基)批略D定-2,5-二酮、(-)_順_3-(5,6-二氫-4H-卩比略 并[3,2,l-ij]喹啉-1-基)-4-(1Η -吲哚-3-基)吡咯啶- 2,5-二酮 、(+ )-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨』]喹琳-1-基)-4-(111-卩引哄-3-基)卩比略11定-2,5-二酮、和(-)_反-3-(5,6-二氨-4 Η -吡咯并[3,2,1 - ij ]喹啉-1 -基)-4 - (1 Η -吲哚-3 -基)吡咯啶-2,5-二酮)及其用途’單獨或組合治療有效量之第二種抗增 生劑之實例係描述於國際專利申請案PCT/US20 1 0/023 8 93 中’爲了所有目的其以全文引用方式合倂於本文中。 實例 材料及方法 除非另外說明,下列材料及方法適用於本文中所述之 生物分析。 細胞培養及試劑:ΑΝ3 CA、ASPC-1、MDA-MB-231 、NCI-H 1 229、SK-OV-3和Panc-Ι癌細胞系(美國菌種保存 中心)係培養於含10 %胎牛血清、100單位/毫升青黴素、 -76- 201215610 100微克/毫升鏈黴素及2毫莫耳L-麩醯胺酸之杜比可氏改 良伊格爾氏培養基(Dulbecco’s modified Eagle’s medium) ο 等效線圖分析:對每種細胞系及藥物組合而言,藉由 ΜΤΤ增生終點分析或藉由集落形成分析測定每種個別藥物 及於等效固定比之組合的72小時1C 5()値。例如,在Α和Β藥 物之情形中,其中1C 5。値分別爲1 μΜ及5 μΜ,等效比爲1 :5。因此,最高組合濃度之連續稀釋(8 X至0.12 5Χ,其中 X係IC5Q比濃度)被用於產生劑量反應曲線。此分析中細胞 增生之抑制程度相較於未經暴露之對照組被稱爲“效果”, 其在從〇.〇(無抑制)至1.0(無MTT或MTS試劑之細胞轉化, 表示細胞完全死亡)之範圍。每種細胞系/藥物組合進行二 次獨立試驗。接著以Calcusyn TM (英國劍橋Biosoft公司) 數據分析軟體進行數據分析。 組合指數。平行進行2個獨立試驗。採用周氏(Chou) 演算法以計算如表1中所示之組合指數(c〗)。 表1 ___________ -------- 絹合指數(CI)之標準 CK0.3 強增效性 0.3<CI<0.85 增效性 0.85<CI<1.2 相加性 1,2<CI<3.3 拮抗性 Cl >3.3 ---—__— -.-----1 強拮抗性 組合指數係根據周氏之方法測定(C h 0 u,T ·_ C . 1 9 9 1 · -77- 201215610a compound of Vb wherein Q is selected from the group consisting of aryl, heteroaryl, -〇-aryl, -S-aryl, -〇-heteroaryl and -S-heteroaryl, preconditions thereof Q is not a 3-mercapto group or a substituted 3 吲哚 group. In other preferred systems, Q is selected from the group consisting of aryl, heteroaryl, -〇-aryl, -S-aryl,-0-heteroaryl and -S-heteroaryl, the prerequisite The condition is that when R 4 is hydrogen 'cycloalkyl or alkyl, 'Q is not a 3-indenyl group or a substituted 3-indenyl group. In other still preferred systems, the Q system is selected from the group consisting of aryl, heteroaryl, -O-aryl, -S-aryl,-0-heteroaryl, and -S-heteroaryl. The prerequisite is that when R4 is hydrogen, (C3-C4)cycloalkyl or (CrCO alkyl, then Q is not 3-indenyl or substituted 3-indolyl. In another preferred system And Q is a 3-indenyl or substituted 3-indenyl group, the prerequisite of which is that R4 is not hydrogen, a cycloalkyl or an alkyl group. In another still preferred system, Q is a 3-indenyl group. Or a substituted 3-indenyl group, the prerequisite is that R4 is not hydrogen, (C3-C4)cycloalkyl or (Ch-Cd alkyl. Other preferred systems include formula III, Ilia, IVa, IVb, Va Or a compound of Vb wherein R4 is ·CH2R7. These compounds can be used as prodrug forms of the compound wherein R4 is 对应 of the corresponding oxime, Ilia, IVa 'IVb, Va or Vb. The prodrug form is hydrolyzed by hydrolysis And releasing the corresponding compound wherein R4 is oxime. The hydrolysis can be carried out by preparing an enzyme-catalyzed or non-enzymatic pathway corresponding to the hydroxymethylene derivative, which in the subsequent hydrolysis causes -64 - 201215610 to release R4 a compound of hydrazine. In the preferred system, 'thinks -CH2R7, where R7 is -〇-ρ( = 〇)(οη)2, -〇-Ρ( = 〇)(_ΟΗ)(-〇-(c丨-c6)alkyl) or - 〇-p( = 〇)(-〇-(Ci_C6) yard base) 2 ° in which " is -0-P( = 0)〇0-(Ci-C6) yard base) In the system of 2, the radical group is independently selected. In another preferred system, 'R4 is _CH2R7, wherein R7 is a carboxylic acid group or an aminocarboxylic acid group. In another preferred system Wherein R7 is in the form; wherein in a better system the peptide is linked to the remainder of the compound via an ester bond formed with the hydroxyl end C00H0 group of the peptide chain. In Formula 111, Ilia, IVa, Other preferred individual and independent systems of compounds of IVb, Va or Vb, wherein R4 is -CH2R7 and R7 is a peptide'. The peptide may be a dipeptide, a tripeptide, a tetrapeptide or a pentapeptide. The R7 functional peptide Preferred amino acid compositions are described above. Systems of compounds of formula III, Ilia, IVa, IVb, Va or Vb include those wherein X is selected from the group consisting of -(NR8)-, S or hydrazine, Wherein R8 is independently selected from the group consisting of hydrogen, -(G-C6)alkyl, -(Mountain-(:6) substituted ϋ a group consisting of alkyl, -(C3-C9)cycloalkyl, -(c3-c9) substituted cycloalkyl and -0-(Q-C6)alkyl. Formula III, Ilia, IVa, IVb Other systems of compounds of Va or Vb include those wherein - is -CH2-. In the system of compounds of formula III, Ilia, IVa, IVb, Va or Vb, 'X is oxygen (oxime). In other systems of other compounds of formula III, Ilia, IVa, IVb, Va or Vb, 'X is sulfur (S). In other systems of compounds of formula III, Ilia, IVa, IVb, Va or Vb, further _^118)-, wherein R8 is independently selected from hydrogen, -(Κ6)alkyl, _(Cl_c6) a group consisting of an alkyl group, a (c3-c9) ring-based group, a -(c3-c9) substituted cycloalkyl group or a _0_(Cl_C6)alkane-65 - 201215610 group. Other preferred systems of the invention include compounds of formula III or Ilia wherein Q is a heteroaryl or optionally substituted heteroaryl group. In four individual preferred preferred systems of the compound of formula III or 111a, Q is an optionally substituted monocyclic heteroaryl group, optionally substituted bicyclic heteroaryl group, with the proviso that The bicyclic heteroaryl group is not a fluorenyl or substituted fluorenyl group or a optionally substituted tricyclic heteroaryl group. Random substituents, when present, are independently selected from the group consisting of such aryl, heteroaryl, -fluorene-aryl, -s-aryl,-0-heteroaryl or -S-heteroaryl. Compounds of formula IVa, IVb, Va or Vb are included in the preferred embodiment of the invention wherein Q is a heteroaryl or optionally substituted heteroaryl group. In four individual preferred embodiments of the compound of Formula IVa, IVb, Va or Vb, Q is an optionally substituted monocyclic heteroaryl group, optionally substituted bicyclic heteroaryl group, It is a prerequisite that the bicyclic heteroaryl group is not a fluorenyl group or a tricyclic heteroaryl group which is optionally substituted. In a preferred system, Q is an optionally substituted nitrogen-containing heteroaryl group. In the related system, q is an optionally substituted thiol group. The optional substituents, when present, are independently selected from the aryl, heteroaryl, -indolyl, -S-aryl,-0-heteroaryl or -S-heteroaryl groups. Preferred systems of the invention include mixtures of the compounds of formula IVa and IVb, including racemic mixtures. In another preferred embodiment, the compound of Formula 1 V a and 1 V b is (±)-cis-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline _ Individual mirror image isomers of 4-(1-indole-3-yl)pyrrolidine-2,5-dione. In this system, (士)-cis-3-(5,6-dihydro-4Η-pyrrolo[3,2,l-ij]quino-66 - 201215610 phenyl-1-yl)-4-(1Η -Indole-3-yl)pyrrolidine-2,5-dione is prepared as a mixture starting from the starting materials 1,2,3,4-tetrahydroquinoline and indole-3-ethylamine. . 'H 3,4·tetrahydroquinoline was converted to 5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl as described in Steps 1-5 of Example 1. Methyl glyoxylate. The methyl 5,6-dihydro-4H-pyrrolo[3,2,1-U]quinolin-1-yl)glyoxylate is as described in Step 6 of Example 1 with 吲哚-3-B Indoleamine reaction to produce 3-(5,6-dihydro-4H-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(1Η-吲0 哚-3-yl) Pyrrole-2,5-dione. The (±)-cis-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinine was prepared by catalytic hydrogenation using Step B as described in Example 2. Mixture of -1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione. Preferred systems of the invention also include mixtures of compounds of formula Va and Vb, including racemic mixtures. In another preferred embodiment, the compound of formula Va and Vb is (±)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline-l-yl ) Individual image isomers of -4-(lH-indol-3-yl)pyrrolidine-2,5-dione. In this system, the compounds are prepared by first preparing (±)-cis-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1- A mixture of 4-(1Η-indol-3-yl)pyrrolidin-2,5-dione is prepared. The mixture of cis compounds was then treated as a mixture of potassium tert-butoxide in tertiary butanol to give (±)-trans-3-(5,6-dihydro-4H- as described in Example 3. Mixture of pyrrolo[3,2,l-ij]quinolin-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione. All stereoisomers of the compounds of the present invention are contemplated, whether in mixed or pure or substantially pure form, including the crystalline form of the racemic mixture of -67-201215610 and the crystalline form of the individual isomers. The definition of a compound according to the invention includes all possible stereoisomers (e.g., the R and S configurations of each asymmetric center) and mixtures thereof. This definition specifically includes racemic forms and the isolated optical isomers having a particular activity. The racemic form can be resolved by physical methods such as, for example, fractional crystallization, separation or crystallization of a non-imagewise derivative, separation by palm column chromatography or supercritical fluid chromatography. The individual optical isomers can be obtained from the racemate by conventional methods, such as, for example, the formation of a salt with an optically active acid followed by crystallization. Additionally, all geometric isomers, such as the E- and Z-configurations of the double bonds, are included within the scope of the invention unless otherwise indicated. Certain compounds of the invention may exist in tautomeric forms. All such tautomeric forms of the compounds are considered to be within the scope of the invention unless otherwise indicated. The invention also includes a regioisomeric mixture of one or more analogs or derivatives. As used herein, the term "salt" is a pharmaceutically acceptable salt and may include acid addition salts, including hydrochlorides, hydrobromides, phosphates, sulfates, hydrogen sulfate, Alkyl sulfonates, aryl sulfonates, acetates, benzoates, citrates, maleates, fumarates, succinates, lactic acid Salts, and tartrates; alkali metal cations such as Na+, K+, Li+, alkaline earth metal salts such as Mg2+ or Ca2+, or organic amine salts. As used herein, the term "metabolite" means a metabolite of a compound of formula 111, 111 a, IVa, IVb, Va or Vb, or a pharmaceutically acceptable salt, analog or derivative thereof, which is shown and A similar in vivo activity of a compound of Formula III, Ilia, IVa-68-201215610, IVb, Va or Vb. As used herein, the term "prodrug" means covalently attached to one or more anterior moieties (such as a compound of the formula, Ilia, IVa, IVb, Va or Vb of an amino acid moiety or other water soluble moiety. Compounds of formula III, Ilia, IVa, IVb, Va or Vb may be hydrolyzed, oxidized and/or enzymatically released The mechanism is released from the previous part. In a system, the prodrug composition of the present invention exhibits an added benefit of increased water solubility, improved stability, and improved pharmacokinetic C) distribution. Pharmaceutical properties. For example, the anterior moiety (e.g., an amino acid moiety or other water soluble moiety such as a phosphate in R4) can be selected based on solubility, stability, bioavailability, and/or in vivo delivery or absorption. 3. Pharmaceutical Compositions and Formulations The pharmaceutical compositions of the present invention are formulated to be compatible with the route of administration desired. Examples of routes of administration include parenteral (e.g., intravenous, intradermal, subcutaneous), menstrual Oral (eg inhalation), transdermal (topical) and transmucosal administration. Solutions or suspensions for parenteral, intradermal or subcutaneous use may include the following ingredients: Sterile diluents such as water for injection, saline solution, fixed oils , polyethylene glycol, glycerin, propylene glycol or other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl benzoate; antioxidants such as ascorbic acid or sodium hydrogen sulfite; chelating agents such as ethylenediaminetetraacetic acid; buffers such as Acetate, citrate or disc acid salt and reagents for adjusting tension such as sodium chloride or glucose. The pH can be adjusted with an acid or a base such as hydrochloric acid or sodium hydroxide. The parenteral preparation can be encapsulated in ampoules, Disposable syringes or multiple doses made of glass or plastic - 69 - 201215610 vials. The compounds or pharmaceutical compositions of the invention may utilize many of the current public therapeutic uses The method of the present invention is administered to a subject. For example, in order to treat cancer, the compound of the present invention can be directly injected into a tumor, injected into a bloodstream or a body cavity, or administered orally or applied to the skin with a patch. It should be sufficient to constitute an effective treatment, but not so high as to cause unacceptable side effects. The state of the disease (eg, cancer, pre-cancerous, etc.) and the patient should be closely monitored during the treatment period and during the reasonable period after treatment. The health condition. The term "therapeutically effective amount", as used herein, refers to an amount of an agent that is used to treat, ameliorate or prevent an identified disease or condition or to exhibit a detectable therapeutic or inhibitory effect. Detection is detected by any analytical method known in the art. The precise effective amount for the subject will depend on the subject's weight, body and health; the nature and extent of the symptoms; and the combination of treatments or treatments selected for administration. The therapeutically effective amount for a given condition can be determined by routine experience within the skill and judgment of the clinician. In a preferred aspect, the disease or condition to be treated is cancer. On the other hand, the disease or symptom to be treated is cell hyperplasia. For any compound, a therapeutically effective amount can be initially assessed, for example, by cell culture assays of tumor cells or often in animal models of rats, mice, rabbits, dogs or pigs. Animal models can also be used to determine the appropriate concentration range and route of administration. This information can then be used to determine the effective dose and route of administration to humans. Therapeutic/prophylactic efficacy and toxicity can be determined in standard cell procedures in cell culture or laboratory animals, such as ED5D (dose in 50% of the population - 70-201215610) and LD5G (lethal dose to 50% of the population) ). The dose ratio between toxicity and efficacy is the therapeutic index and can be expressed as the ratio LD5〇/ED5(). A pharmaceutical composition exhibiting a large therapeutic index is preferred. The dosage may vary within this range depending on the dosage form employed, the sensitivity of the patient, and the route of administration. Dosage and administration are adjusted to provide sufficient active agent level or to maintain the desired effect. Factors that may be considered include the severity of the disease state, the general health of the subject, the age, weight and sex of the subject, foraging, time and frequency of administration, drug combination, response sensitivity, and tolerance to treatment/ reaction. The long-acting pharmaceutical composition can be administered once every three to four days, every week, or every two weeks, depending on the half-life and clearance rate of the particular formulation. The pharmaceutical composition comprising the active compound of the present invention can be produced in a generally known manner, for example, by conventional mixing, dissolving, granulating, dragee-making, buffing, emulsifying, encapsulating, capturing or lyophilizing methods. The pharmaceutical compositions may be formulated in a conventional manner using one or more pharmaceutically acceptable carriers, which comprise excipients and/or adjuvants which facilitate the processing of the active compound into pharmaceutically acceptable elixirs. Of course, the appropriate formulation will depend on the route of administration chosen. The pharmaceutical compositions suitable for injectable use include sterile aqueous solutions (water-soluble) or dispersions and sterile powders for the preparation of sterile injectable solutions or dispersions. For intravenous administration, suitable carriers include physiological saline, bacteriostatic water, Cremophor ELTM (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS). In all cases, the composition must be sterile and should be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and suitable mixtures thereof. Proper fluidity can be maintained, for example, by the use of a coating film (such as lecithin), by the maintenance of the required particle size in the case of dispersions, and by the use of an surfactant. Prevention of the action of microorganisms can be achieved by various antibacterial and antifungal agents (e.g., parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, etc.). In many cases, it is preferred to include an isotonic agent (e.g., a sugar), a polyhydric alcohol (such as mannitol, sorbitol), sodium chloride in the composition. Prolonged absorption of the injectable compositions can be brought about by the inclusion of agents which delay absorption in the compositions, such as aluminum monostearate and gelatin. The sterile injectable solution can be prepared by incorporating the active compound in the required amount with one or a combination of the above-mentioned ingredients in a suitable solvent, if necessary, followed by filtration sterilization. Generally, the dispersion is prepared by incorporating the active compound into a sterile vehicle containing the base dispersion medium and the other ingredients enumerated above. In the case of sterile powders for the manufacture of sterile injectable solutions, the methods of manufacture are vacuum drying and lyophilization which yields the active ingredient plus a powder of any additional desired ingredient from the previously sterile filtered solution thereof. Oral compositions typically include an inert diluent or an edible, pharmaceutically acceptable carrier. They can be encapsulated in gelatin capsules or compressed into tablets. For the purpose of oral therapeutic administration, the active compound may be combined with excipients and used in the form of lozenges, lozenges or capsules. Oral compositions can also be prepared using a fluid carrier as a mouthwash, wherein the compound in the fluid carrier is administered orally and rinsed and spit or swallowed. Pharmaceutically compatible adhesives and/or adjuvant materials can be included as part of the composition. Tablets, nine doses, capsules, diamond ingots and the like may contain any of the following ingredients or compounds of similar nature: binders such as microcrystalline cellulose, tragacanth or gelatin; excipients such as starch or lactose; disintegrating agents such as alginic acid 'Primo gel, or corn starch; lubricants such as magnesium stearate or Strotes; slip agents such as colloidal cerium oxide; sweeteners such as sucrose or saccharin; or flavoring agents Such as mint, methyl salicylate or orange flavor. For administration via inhalation, the compound is delivered in the form of an aerosol spray from a pressurized container or dispenser containing a suitable propellant (e.g., a gas such as carbon dioxide), or a nebulizer. Systemic administration can also be achieved by penetrating the mucosa or penetrating the skin. For penetrating the mucosa or penetrating the skin, penetrants suitable for penetrating the barrier are used in this formulation. Such penetrants are generally known in the art and include, for example, for penetrating mucosal administration, detergents, bile salts, and fusidic acid derivatives. Penetrating mucosal administration can be accomplished via the use of nasal sprays or suppositories. For penetration through the skin, the active compound is formulated as an ointment, salve, gel or cream as is conventional in the art. In one aspect, the active compound is formulated with a pharmaceutically acceptable carrier that prevents rapid elimination of the compound from the body' such as controlled release formulations, including implants and microencapsulated delivery systems. Biodegradable and biocompatible polymers such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic acid can be used. Methods of preparing such formulations are apparent to those skilled in the art. Materials are also commercially available from Alza-73-201215610 and Nova Pharmaceuticals. The liposome suspension (including the liposome of the cells infected with the monoclonal antibody against the viral antigen) can also be used as a pharmaceutically acceptable carrier. These can be made in accordance with methods known to those skilled in the art, for example, as described in U.S. Patent No. 4,522,81. It is especially advantageous to formulate oral or parenteral compositions in unit dosage form for ease of administration and uniformity of the dosage. Dosage unit form, as used herein, refers to a physically discrete unit that is suitable as a single dose for the subject to be treated; each unit comprises a predetermined amount of the activity in association with the desired pharmaceutical carrier calculated to produce the desired therapeutic effect. Compound. The specifications of the unit dosage form of the present invention are determined by the unique characteristics of the active compound and the particular therapeutic effect desired. In therapeutic applications, the dosage of the pharmaceutical composition used in accordance with the present invention is selected based on the agent, the age, weight and clinical symptoms of the patient being treated, and the experience and judgment of the clinician or practitioner who is being treated, and other effects. The dosage factor changes. Generally, the dose should be sufficient to cause tumor growth to slow down, and preferably resolve, and preferably also cause complete regression of the cancer. The dosage may range from about 1 mg/kg per day to about 3000 mg/kg per day. In a preferred aspect, the dosage can range from about 1 mg/kg per day to about 1000 mg/kg per day. In one aspect, the dosage will be from about 0.1 mg/day to about 50 g/day; from about 0.1 mg/day to about 25 g/day; from about 0.1 mg/day to about 1 g/day; about 〇, 1 mg/day Up to about 3 g/day; or about 0 = 1 mg/day to about 1 g/day, which is a single, divided or continuous dose (the patient's body weight in kilograms, in square meters) The surface area of the body and the age of the age are adjusted). An effective amount of the agent provides an objectively identifiable improvement as noted by the clinician or other qualified observer. For example, tumor regression in a patient can be referred to tumor diameter measurement. A decrease in tumor diameter indicates regression. Regression is also indicated by the fact that the tumor does not recur after stopping treatment. As used herein, the term "dose effective means" refers to the amount of active compound that produces the desired biological effect in an object or cell. Preferably, (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl)-4-( 1H-indole-3 The pyridyl-2,5-dione is administered at a dose of 0 360 mg twice daily for a maximum daily dose of 720 mg. (-)-trans-3-(5,6-dihydro-411-pyrolo[3,2,1-indol]]quinolin-1-yl)-4-(111-indol-3-yl) The pyrrolidine-2,5-dione is optionally administered to the subject or patient twice a day at an initial dose of 1 mg, with a maximum daily dose of 20 mg, and the dose is gradually increased to a dose of 360 mg twice a day. The maximum daily dose is 720 mg. (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-7]quinolin-1-yl)-4-(1^1-indol-3-yl) Preferred dosage forms of pyrrolidine-2,5-dione include, but are not limited to, caplets, lozenges, nine doses, and lyophilized powders. For example, a capsule of 3 60 mg of bismuth is administered to a subject or patient twice a day, or two 180 mg capsules are administered twice a day to achieve a maximum daily dose of 720 mg. (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl)-4-(1Η-indol-3-yl)pyrrole The pyridine-2,5-dione capsules or lozenges can also be formulated to a 60 mg dose. The pharmaceutical composition can include a co-formulation of any of the compounds described herein. The pharmaceutical composition can be included with the administration instructions in a container, package or dispenser. -75-201215610 [Embodiment] EXAMPLES Examples are provided below to further illustrate the different features of the present invention. These examples also illustrate useful methods of practicing the invention. These examples do not limit the invention of the patent application. Preparation of compounds of formula III, Ilia, IVa, IVb, Va or Vb (including ( + )-cis-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline-l -yl)-4-(lH-indol-3-yl) batch D-but-2,5-dione, (-)_cis_3-(5,6-dihydro-4H-indole [3,2,l-ij]quinolin-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione, (+)-trans-3-(5, 6-Dihydro-411-pyrrolo[3,2,1-indole]quinolin-1-yl)-4-(111-卩 哄-3-yl) 卩比略11定-2,5- Diketone, and (-)-trans-3-(5,6-diamino-4 Η-pyrrolo[3,2,1 - ij ]quinolin-1-yl)-4 - (1 Η -吲哚-3 -ylpyrrolidine-2,5-dione) and its use 'Examples of a therapeutically effective amount of a second anti-proliferative agent, alone or in combination, are described in International Patent Application PCT/US20 1 0/023 8 93 'For all purposes, it is incorporated herein by reference in its entirety. EXAMPLES Materials and Methods The following materials and methods are applicable to the biological assays described herein unless otherwise stated. Cell culture and reagents: ΑΝ3 CA, ASPC-1, MDA-MB-231, NCI-H 1 229, SK-OV-3 and Panc-Ι cancer cell lines (American Type Culture Collection) are cultured in 10% fetal Bovine serum, 100 units/ml penicillin, -76-201215610 100 μg/ml streptomycin and 2 mmoles of L-glutamic acid in Dulbecco's modified Eagle's medium ο etc. Line graph analysis: For each cell line and drug combination, 72 hours of 1C 5() 每种 for each individual drug and a combination of equivalent fixed ratios was determined by ΜΤΤ hyperplasia endpoint analysis or by colony formation analysis. For example, in the case of sputum and sputum, 1C 5 . The 値 is 1 μΜ and 5 μΜ, respectively, and the equivalent ratio is 1:5. Thus, serial dilutions of the highest combined concentrations (8 X to 0.12 5 Χ, where the X-line IC5Q specific concentration) were used to generate a dose response curve. The degree of inhibition of cell proliferation in this assay is referred to as the "effect" compared to the unexposed control group, which is from 〇.〇 (no inhibition) to 1.0 (cell transformation without MTT or MTS reagent, indicating complete cell death) The scope of). Two independent experiments were performed for each cell line/drug combination. Data analysis was then performed using CalcusynTM (Cambridge Biosoft, UK) data analysis software. Combination index. Two independent experiments were performed in parallel. The Chou algorithm was used to calculate the combination index (c) as shown in Table 1. Table 1 ___________ -------- Standard CK0.3 of the Matching Index (CI) Strong synergy 0.3<CI<0.85 Synergies 0.85<CI<1.2 Additive 1,2<CI< 3.3 Antagonistic Cl >3.3 ----__— -.-----1 Strong antagonistic combination index is determined according to Zhou's method (C h 0 u, T · _ C. 1 9 9 1 · - 77- 201215610

The median-effect principle and the combination index for quantitation of synergism and antagonism,p. 6 1-10 2. In T . - C . Chou and D . C · Ri d e o u t (e d . ) ? Synergism and antagonism in chemotherapy. Academic Press,S an Diego, Calif)。圖2,區塊A,顯示其中d和 d分別爲A藥及B藥 在達成與A藥及B藥之混合物相同效果時之個別濃度。等 效線圖分析將藥物組合分類爲增效·性、相加性或拮抗性。 具體地說,圖2,區塊B,顯示特定效果(例如50%之最大 値)之等效線圖分析,其中A藥單獨劑量爲A = 20及B藥單獨 劑量爲B = 1 00。連接這些截點之直線係相加線,該線根據 這些效力應產生相同效果。實際劑量對諸如Q點以較少之 量達成此效果,且爲超相加性或增效性,而R點所表示之 劑量對係指需要較高之量且因此爲次相加性。出現在該線 以下之點諸如P應爲單純相加性。 細胞存活性分析。在一些實驗中,細胞存活性係由3 -(4,5-二甲基噻唑-2 -基)-2,5-二苯基溴化四唑(MTT)試驗檢 測。簡言之,以每孔5 - 1 0,000個細胞接種於96孔板’於完 全生長培養基中培養24小時,然後以各種藥物及藥物組合 處理72小時。加入MTT至0·5毫克/毫升之最終濃度,並培 養1小時,接著使用微孔板讀取儀於5 70奈米波長評估細胞 存活性。數據對未經處理之對照組正規化’並以Microsoft E x c e 1分析。 細胞增生分析。呈指數生長之細胞以每孔2,000個接 種於6孔細胞培養板,並使細胞貼附24小時。然後將漸增 -78- 201215610 濃度之個別藥物及彼等之組合加至培養基中經另外2 4小時 。經過24小時暴露之後,移除藥物,並在接下來的14至21 天添加新鮮培養基,使集落形成。將細胞固定並以 GIEMSA(Gibc〇 BRL)染色。超過50個細胞之集落被記錄爲 存活,及對細胞存活性百分比作圖以決定IC5Q値。 吉西他濱和(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨门喹 啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶-2,5-二酮二者在癌細胞 〇 中誘發細胞週期停滯,但於不同期。吉西他濱誘發G1/S期 停滯,導致基本同期化和細胞群積累在G1/S期。(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-^]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮將細胞停滯於細胞週期之G2/M期。將 標準錨定依賴性MTS細胞毒性分析修改並延長至七天以測 試(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-"]喹啉-1-基)-4-(1H-吲哚-3-基)吡咯啶-2,5-二酮組合吉西他濱之增強抗增 生活性。 Ο 修改之MTS分析顯示於圖3中。在〇天覆蓋(plated)細The median-effect principle and the combination index for quantitation of synergism and antagonism, p. 6 1-10 2. In T . - C Chou and D. C · Ri deout (ed . ) Synergism and antagonism in chemotherapy. Press, S an Diego, Calif). Figure 2, Block A, shows the individual concentrations of d and d for the A and B drugs, respectively, when the same effect as the mixture of drug A and drug B is achieved. Equivalent line graph analysis classifies drug combinations as synergistic, additive, or antagonistic. Specifically, Figure 2, Block B, shows an isobologram analysis of a particular effect (e.g., 50% of the maximum 値), where the single dose of drug A is A = 20 and the dose of drug B alone is B = 100. The line connecting these intercept points is the addition line, which should produce the same effect depending on these effects. The actual dose achieves this effect in a small amount such as the Q point, and is superadditive or synergistic, while the dose pair represented by the R point requires a higher amount and is therefore a sub-additive. Points that appear below the line, such as P, should be purely additive. Cell viability analysis. In some experiments, cell viability was detected by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Briefly, 5 - 10,000 cells per well were seeded in 96-well plates' for 24 hours in complete growth medium and then treated with various drugs and drug combinations for 72 hours. MTT was added to a final concentration of 0.5 mg/ml and cultured for 1 hour, and then cell viability was evaluated at a wavelength of 5 70 nm using a microplate reader. Data were normalized to the untreated control' and analyzed by Microsoft Exc e1. Cell proliferation analysis. The exponentially growing cells were seeded in a 6-well cell culture plate at 2,000 per well, and the cells were attached for 24 hours. The individual drugs at increasing concentrations of -78-201215610 and their combinations are then added to the medium for an additional 24 hours. After 24 hours of exposure, the drug was removed and fresh media was added over the next 14 to 21 days to allow colony formation. The cells were fixed and stained with GIEMSA (Gibc® BRL). Colonies of more than 50 cells were recorded as viable and plotted against cell viability as a percentage to determine IC5Q値. Gemcitabine and (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indolizine-1-yl)-4-(1Η-indol-3-yl) Both pyrrolidine-2,5-dione induce cell cycle arrest in cancer cells, but at different stages. Gemcitabine induced G1/S phase arrest, leading to a basic synchronization and accumulation of cell populations in the G1/S phase. (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-^]quinolin-1-yl)-4-(111-indol-3-yl)pyrrole The pyridine-2,5-dione stagnates the cells in the G2/M phase of the cell cycle. The standard anchor-dependent MTS cytotoxicity assay was modified and extended to seven days to test (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-"]quinoline- The anti-proliferative activity of 1-methyl)-4-(1H-indol-3-yl)pyrrolidine-2,5-dione in combination with gemcitabine.修改 The modified MTS analysis is shown in Figure 3. Plaped fine in the day

胞。在計畫A和C中,在第2天將二種藥劑(即,(-)-反-3-(5,6-二氫-41^吡咯并[3,2,1-丨_]]喹啉-1-基)-4-(111-吲哚-3-基)耻咯啶-2,5-二酮,標識爲A藥劑,及吉西他濱)之第一 種引進細胞歷時24小時,接著在第3天洗出第一種藥劑。 在第5天在引進第二種藥劑之前將細胞在沒有第一種藥劑 下培養48小時。在第6天在洗出第二種藥劑之前將細胞用 第二種藥劑培養24小時。在第8或9天將細胞在沒有第二種 藥劑下進一步培養細胞直到實施MTS分析。在計畫B和D -79- 201215610 中,進行第一種或第二種藥劑之沒有洗出。 實例1 . c-Met抑制劑與吉西他濱之組合用於治療各種 抗增生性疾病和癌症 -以圖3中所示之各種脈衝式計畫給予吉西他濱和(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1七]喹啉-1-基)-4-(11^-吲 哚-3-基)吡咯啶-2,5-二酮。如果癌細胞沒有暴露於二種藥 劑一起,也就是說,當沒有兩個藥劑之洗出時,則癌細胞 對二種藥劑之抗增生作用更敏感。 在各種格式中當吉西他濱和(-) -反-3-(5,6-二氫-411-吡 咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶-2,5-二 酮二者同時組合,或當沒有進行洗出時,這兩種藥劑經常 是掊抗性。本發明將這種拮抗作用轉換成最低,相加作用 ,和在許多情況下,增效作用協。 (-)-反-3-(5,6-二氫-411-耻略并[3,2,1-丨』]卩奎咐-1_基)-4-(1 Η -吲哚-3 -基)吡略啶-2,5 -二酮與吉西他濱在連續劑量條 件下之組合數據係顯示於表2中。 -80- 201215610 表2. 人癌細胞系 來源組織 組合指數 分類 RT4 膀胱 1.10 相 加 性 HCI-H526 肺 1.11 相 加 性 SNU3 98 肝 1.15 相 加 性 SNU-1 6 胃 1.16 相 加 性 LO VO 結腸 1.19 相 加 性 U93 7 血液 1.2 1 掊 抗 性 SK-HEP1 肝 1.23 拮 抗 性 HCT-1 1 6 結腸 1.26 拮 抗 性 ASPC-1 胰 1.27 拮 抗 性 KG-1 a 血液 1.28 拮 抗 性 786-0 腎 1.29 拮 抗 性 THP- 1 血液 1.31 拮 抗 性 KG-1 血液 1.32 掊 抗 性 NCI-H 1 299 肺 1.33 拮 抗 性 RT1 1 2 膀胱 1.39 拮 抗 性 DU 1 45 前列腺 1.4 1 拮 抗 性 DU4475 乳房 1.42 拮 抗 性 CAKI-1 腎 1.42 拮 抗 性 CCS-292 軟組織 1.46 拮 抗 性 A549 肺 1.47 掊 抗 性 SK-LMS- 1 外陰 1.50 掊 抗 性 DLD- 1 結腸 1.51 拮 抗 性 NCI-H520 肺 1.5 1 拮 抗 性 HT29 結腸 1.57 拮 抗 性 WM-266.4 皮膚 1.63 掊 抗 性 U266 血液 1.64 拮 抗 性 COLO-205 結腸 1.67 拮 抗 性 K562 血液 1.67 拮 抗 性 HEP-3B 肝 1.68 拮 抗 性 BX-PC3 胰 1 .72 拮 抗 性 LS41 IN 結腸 1.74 掊 抗 性 HL-60 血液 1.76 拮 抗 性 NCI-H460 肺 1.87 拮 抗 性 BDCM 血液 1.9 1 拮 抗 性 NCI-H1 993 肺 1.93 拮 抗 性 J urkat 血液 1 .99 拮 抗 性 MDA MB-23 1 乳房 2.3 1 拮 抗 性 SNU-387 肝 3.90 拮 抗 性 NCI-H66 1 肺 4.08 拮 抗 性 PANC-1 胰 5.20 拮 抗 性 -81 - 201215610 表3和4顯示連續劑量和具有無藥期的脈衝式劑量之間 的比較。在這些表中化合物(-) -反-3-(5,6 -二氫-4H -吡略并 [3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶- 2,5,-二酮係 標識爲“A藥劑”。指示癌細胞系之特性和組織來源。“吉西 他濱—A藥劑”表示A藥劑係在吉西他濱之後投予和“A藥劑 —吉西他濱”顯示吉西他濱係在A藥劑之後投予。 表3 · 癌細胞系 組織類型 吉西他濱—A藥劑 A藥劑—吉西他濱 發生於其間 的洗出 沒有洗出 發生於其間 的洗出 沒有洗出 CI 效果 CI 效果 CI 效果 CI 效果 NCI-H1299 NSCLC (非小細肺) 0.87 相加性 1.25 拮抗性 1.05 相加性 1.25 拮抗性 AsPC-1 胰 0.43 增效性 1.47 拮抗性 1.68 拮抗性 1.27 拮抗性 MDA MB-231 乳房 0.41 增效性 1.52 拮抗性 1..01 相加性 2.04 拮抗性 AN3CA 子宮 0.66 增效性 1.36 拮抗性 0.79 增效性 1.96 拮抗性 在表4中;^0.8之得分爲增效作用之指示,> 0.85- $1.2 之得分爲相加作用之指示和> 1.2- $3.3之得分爲拮抗作用 之指示。 在“並行”劑量方案中,細胞係在進行MTS細胞增生分 析之前用吉西他濱和A藥劑同時地治療72小時。 在“順序-連續”劑量方案中,細胞係用第一種藥劑(吉 西他濱或A藥劑)單獨治療經歷所指示的時間間隔,接著在 沒有除去第一種藥劑下進行第二種藥劑治療(和第一種藥 劑不同)。在進行MTS細胞增生分析之前將細胞用化合物 二者培養所指示的時間間隔。具體來說,連續I表示第一 種藥劑之投予歷時24小時,接著第二種藥劑之投予(沒有 -82- 201215610 除去第一種藥劑)歷時48小時。連續II表示第一種藥劑之 投予歷時48小時,接著第二種藥劑之投予(沒有除去第一 種藥劑)歷時48小時。連續 III表示第一種藥劑之投予歷 時72小時,接著第二種藥劑之投予(沒有除去第一種藥劑) 歷時9 6小時。 在“順序-脈衝式”劑量方案中,細胞係用第一種藥劑( 吉西他濱或A藥劑)單獨治療經歷24小時,接著在無藥培養 Q 基中繼續培養。然後在用第二種藥劑(和第一種藥劑不同) 治療經歷24小時之前細胞給予〇、24或48小時之無藥期。 然後在進行MTS細胞增生分析之前給予細胞另外24或72小 時無藥培養。具體來說,脈衝式I表示第一種藥劑之投予 歷時24小時,接著0小時之無藥期’接著第二種藥劑之投 予經24小時,接著24小時之無藥期。脈衝式I表示第—種 藥劑之投予歷時24小時’接著24小時之無藥期’接著第二 種藥劑之投予經2 4小時’接著2 4小時之無藥期。脈衝式 t) III表示第一種藥劑之投予歷時24小時,接著48小時之無 藥期,接著第二種藥劑之投予經2 4小時’接著7 2小時之無 藥期。 圖4-7顯示吉西他濱和(-)·反-3_(5,6-二氫_4H_啦略并 [3,2,1-丨』]喹琳_1-基)-4-(111-1]引噪_3-基)[1比略11定-2,5-—酮治 療在 AN3 CA(區塊 A)、ASPC-1(區塊 B)、MDA-MB-231(區 塊C)及NCI-H1299(區塊D)細胞中的等效線圖分析。具體來 說,圖4顯示吉西他濱治療接著(-)-反-3_(5,6-二氫-4H-啦 咯并[3,2,1-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶_2,5_二 -83- 201215610 酮治療並洗出吉西他濱的等效線圖。圖5顯示吉西他濱治 療接著(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-4]喹啉-1-基)-4 - (1 Η -吲哚-3 -基)吡咯啶-2,5 -二酮治療並沒有洗出吉西他 濱的等效線圖。圖6顯示(-)-反_3-(5,6-二氫-411-吡咯并 [3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮治 療接著吉西他濱治療並洗出(-)-反-3_(5,6-二氫- 4Η_®略并 [3,2,1-丨〗]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮的 等效線圖。圖7顯示(-)-反-3-(5,6-二氫-4Η-卩比略并[3,2,1-ij]喹啉-1-基)-4-(1 H-吲哚-3-基)吡咯啶·2,5-二酮治療接著 吉西他濱治療並沒有洗出(-)-反-3_(5,6-二氫-4H-啦略并 [3,2,1 - ij ]喹啉-1 -基)-4 - (1 Η -吲哚-3 -基)吡咯啶-2,5 -二酮的 等效線圖。 圖8爲圖3中所提出之劑量方案Α的細胞週期分析’顯 示反應吉西他濱治療之S-期停滯和反應(-)_反-3-( 5,6·二 氫_ 4 Η -吡咯并[3,2,1 - i j ]喹啉-:1 -基)-4 - (1 Η —吲哚—3 基)11 比咯 啶-2,5 -二酮治療之G2/M停滯。圖9顯不圖3中所提出之劑 量方案Α期間藉由吉西他濱的細胞週期檢查點之活化作用 〇 圖10顯示如所示之吉西他濱和(-) -反_3_(5,6_二氫_4H_ 吡咯并[3,2,1-ij]喹啉-1-基)-4-(lH-吲哚-3-基)吡咯啶- 2,5-二酮治療之後的M D A - Μ B - 2 3 1細胞之細胞週期分析(A和B ) 〇 具體來說,MDA-MB-231細胞係使用所指示之劑量方 案以0.4 mM的吉西他濱和3.3 mM的(-)_反_3_(5,6-二氫·4Η_ -84 - 201215610 吡咯并[3,2,1“门喹琳-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5- 二酮治療。在指示之時間點收集樣品並進行流動式細胞分 析。硏究也使用A5 49細胞進行,而具有相同結果。 從區塊A和B中進行之實驗收集一部分之MDA-MB-23 1 細胞並溶解及使用抗-磷酸化_Chkl、磷酸化組蛋白 H3(SerlO)和β-肌動蛋白抗體進行免疫墨點分析,分別如 圖10區塊C和D中所顯示。Cell. In the plans A and C, two agents were placed on the second day (ie, (-)-trans-3-(5,6-dihydro-41^pyrrolo[3,2,1-丨_]] Quinoline-1-yl)-4-(111-indol-3-yl) zizalidine-2,5-dione, identified as A drug, and gemcitabine, the first introduced cell for 24 hours, followed by The first agent was washed out on the third day. On day 5, the cells were cultured for 48 hours without the first agent prior to introduction of the second agent. Cells were incubated with the second agent for 24 hours before washing out the second agent on day 6. The cells were further cultured on day 8 or 9 without the second agent until MTS analysis was performed. In Plan B and D-79-201215610, the first or second agent was not washed out. Example 1. Combination of a c-Met inhibitor and gemcitabine for the treatment of various anti-proliferative diseases and cancer - giving gemcitabine and (-)-trans-3-(5,6) in various pulsed schemes as shown in Figure 3. -Dihydro-411-pyrrolo[3,2,1-7-quinolin-1-yl)-4-(11^-indol-3-yl)pyrrolidine-2,5-dione. If the cancer cells are not exposed to the two agents, that is, when no two agents are washed out, the cancer cells are more sensitive to the anti-proliferative effects of the two agents. In various formats, gemcitabine and (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,l-ij]quinolin-1-yl)-4-(1Η-吲) Both indole-3-yl)pyrrolidine-2,5-dione are combined at the same time, or when not washed out, the two agents are often resistant to cockroaches. The present invention converts this antagonism to a minimum, additive effect, and in many cases, a synergistic effect. (-)-trans-3-(5,6-dihydro-411-shame and [3,2,1-丨]]卩奎咐-1_yl)-4-(1 Η -吲哚-3 The combined data of piramiridin-2,5-dione and gemcitabine under continuous dosage conditions are shown in Table 2. -80- 201215610 Table 2. Human cancer cell line source tissue combination index classification RT4 bladder 1.10 additive HCI-H526 lung 1.11 additive SNU3 98 liver 1.15 additive SNU-1 6 stomach 1.16 additive LO VO colon 1.19 Additive U93 7 Blood 1.2 1 掊 Resistant SK-HEP1 Liver 1.23 Antagonistic HCT-1 1 6 Colon 1.26 Antagonist ASPC-1 Pancreas 1.27 Antagonistic KG-1 a Blood 1.28 Antagonist 786-0 Kidney 1.29 Antagonistic THP - 1 blood 1.31 antagonistic KG-1 blood 1.32 掊 resistance NCI-H 1 299 lung 1.33 antagonistic RT1 1 2 bladder 1.39 antagonistic DU 1 45 prostate 1.4 1 antagonist DU4475 breast 1.42 antagonist CAKI-1 kidney 1.42 antagonistic CCS-292 soft tissue 1.46 antagonistic A549 lung 1.47 掊 resistance SK-LMS- 1 vulva 1.50 掊 resistance DLD-1 colon 1.51 antagonist NCI-H520 lung 1.5 1 antagonist HT29 colon 1.57 antagonist WM-266.4 skin 1.63 掊 抗U266 blood 1.64 antagonistic COLO-205 colon 1.67 antagonistic K562 blood 1.67 antagonistic HEP-3B liver 1.68 antagonistic BX-PC3 pancreas 1.72 Antagonistic LS41 IN Colon 1.74 掊 Resistant HL-60 Blood 1.76 Antagonistic NCI-H460 Lung 1.87 Antagonistic BDCM Blood 1.9 1 Antagonistic NCI-H1 993 Lung 1.93 Antagonistic J urkat Blood 1.99 Antagonistic MDA MB-23 1 Breast 2.3 1 antagonistic SNU-387 liver 3.90 antagonistic NCI-H66 1 lung 4.08 antagonistic PANC-1 pancreas 5.20 antagonistic -81 - 201215610 Tables 3 and 4 show the continuous dose and the pulsed dose with no drug phase Comparison. In these tables the compound (-)-trans-3-(5,6-dihydro-4H-pyrido[3,2,l-ij]quinolin-1-yl)-4-(1Η-吲哚) The -3-yl)pyrrolidine-2,5,-dione is identified as "A Agent". Indicates the characteristics of the cancer cell line and the source of the tissue. "Gemcitabine-A agent" means that the A drug system was administered after gemcitabine and "A drug - gemcitabine" showed that the gemcitabine was administered after the A agent. Table 3 · Cancer cell line tissue type Gemcitabine - A drug A agent - Gemcitabine occurred during the washout without washing out occurred in the washout without washing out CI effect CI effect CI effect CI effect NCI-H1299 NSCLC (non-small Lung) 0.87 additive 1.25 antagonistic 1.05 additive 1.25 antagonistic AsPC-1 pancreas 0.43 synergistic 1.47 antagonistic 1.68 antagonistic 1.27 antagonistic MDA MB-231 breast 0.41 synergistic 1.52 antagonistic 1..01 phase Additive 2.04 Antagonistic AN3CA Uterine 0.66 Synergistic 1.36 Antagonist 0.79 Synergist 1.96 Antagonist is shown in Table 4; ^0.8 score is an indication of synergy, > 0.85- $1.2 score is an indication of additive effect And the score of > 1.2- $3.3 is an indication of antagonism. In a "parallel" dosing regimen, cell lines were treated simultaneously with gemcitabine and A agents for 72 hours prior to MTS cell proliferation assay. In a "sequential-continuous" dosage regimen, the cell line is treated with the first agent (gemcitabine or A agent) alone for the indicated time interval, followed by a second agent treatment without removing the first agent (and A different agent). The cells were incubated with the compound for the indicated time interval prior to performing MTS cell proliferation assay. Specifically, continuous I indicates that the administration of the first agent lasted for 24 hours, followed by administration of the second agent (no -82-201215610 removal of the first agent) for 48 hours. Continuous II indicates that the administration of the first agent lasted for 48 hours, followed by administration of the second agent (without removal of the first agent) for 48 hours. Succession III indicates that the first agent was administered for 72 hours, followed by administration of the second agent (without removing the first agent) for a period of 96 hours. In a "sequential-pulsed" dosing regimen, the cell line was treated with the first agent (gemcitabine or A agent) alone for 24 hours, followed by continued culture in the drug-free culture Q-base. The cells were then given a sputum, 24 or 48 hour drug-free period 24 hours prior to treatment with the second agent (different from the first agent). The cells were then given an additional 24 or 72 hours of drug-free culture prior to MTS cell proliferation assay. Specifically, Pulse Formula I indicates that the administration of the first agent lasts for 24 hours, followed by the 0 hour drug-free period, followed by the administration of the second agent for 24 hours, followed by the 24-hour drug-free period. Pulsed Formula I indicates that the administration of the first agent is administered for 24 hours 'and then 24 hours of drug-free period' followed by the administration of the second agent for 24 hours' followed by 24 hours of drug-free period. Pulsed t) III indicates that the first agent is administered for 24 hours, followed by a 48 hour drug-free period, followed by administration of the second agent over a 24 hour' followed by a 72 hour drug-free period. Figure 4-7 shows gemcitabine and (-)·trans-3_(5,6-dihydro_4H_lao[3,2,1-丨]]quinolin-1-yl)-4-(111- 1] Noisy _3-base) [1 ratio slightly 11 -2, 5-ketone treatment in AN3 CA (block A), ASPC-1 (block B), MDA-MB-231 (block C And isobologram analysis in NCI-H1299 (block D) cells. Specifically, Figure 4 shows that gemcitabine treatment followed by (-)-trans-3_(5,6-dihydro-4H-prado[3,2,1-ij]quinolin-1-yl)-4-( 1Η-吲哚-3-yl)pyrrolidine_2,5_di-83- 201215610 Ketone treatment and washing out the equivalent line diagram of gemcitabine. Figure 5 shows gemcitabine treatment followed by (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-4]quinolin-1-yl)-4 - (1 Η-吲The 哚-3-ylpyrrolidine-2,5-dione treatment did not elute the equivalent line diagram of gemcitabine. Figure 6 shows (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(111-吲哚-3 -based) pyrrolidine-2,5-dione treatment followed by gemcitabine treatment and washing out (-)-trans-3_(5,6-dihydro-4Η_® succinyl[3,2,1-丨]]quinoline An isobologram of -1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione. Figure 7 shows (-)-trans-3-(5,6-dihydro-4Η-indolebi[3,2,1-ij]quinolin-1-yl)-4-(1 H-oxime Treatment with -3-yl)pyrrolidine·2,5-dione followed by gemcitabine did not wash out (-)-trans-3_(5,6-dihydro-4H-lao[3,2,1 - ij An equivalent diagram of quinoline-1-yl)-4-(1 Η-indol-3-yl)pyrrolidine-2,5-dione. Figure 8 is a cell cycle analysis of the dosage regimen set forth in Figure 3 'showing S-phase arrest and reaction (-)-trans-3-(5,6·dihydro-4 Η-pyrrolo[ 3,2,1 - ij ]quinoline-:1 -yl)-4 - (1 Η-吲哚-3 base) 11 G2/M arrested with pyridin-2,5-dione. Figure 9 shows the activation of the cell cycle checkpoint by gemcitabine during the dosing regimen presented in Figure 3. Figure 10 shows gemcitabine and (-)-anti-3_(5,6-dihydro-_ as shown) MDA - Μ B - 2 after treatment with 4H_pyrrolo[3,2,1-ij]quinolin-1-yl)-4-(lH-indol-3-yl)pyrrolidine-2,5-dione Cell cycle analysis of 3 1 cells (A and B) 〇 Specifically, the MDA-MB-231 cell line uses the indicated dosage regimen with 0.4 mM gemcitabine and 3.3 mM (-) _ anti_3_ (5, 6 -Dihydro·4Η_ -84 - 201215610 Pyrrolo[3,2,1"-menistrin-1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione treatment. Samples were collected and flow cytometric analysis was performed at the indicated time points. The study was also performed using A5 49 cells with the same results. A portion of MDA-MB-23 1 cells were collected and dissolved in experiments performed in blocks A and B. Immunoblot analysis was performed using anti-phosphorylation _Chkl, phosphorylated histone H3 (SerlO) and β-actin antibodies, as shown in panels 10 and D, respectively.

-85- 201215610 表4. 細胞系 A549 NCK- H1299 RT4 RT112 ASPC -1 PANC -1 MDA- MB-231 MDA- MB- 468 sv· OV-3 A2780 AN3 CA NOZ 組織來源 肺 肺 膀 胱 膀胱 胰 胰 乳房 乳房 卵巢 卵巢 子宮 膽囊 GEM+ A藥劑並 行 1.3 1.8 1.3 2.0 4.7 6.5 ND 2.2 2.2 1.7 4.0 2.5 GEM— A藥劑 連續I 1.2 1.8 1.7 1.9 5.1 1.7 0.4 1.6 2.2 1.4 2.2 0.3 GEM-> A藥劑 連續II 1.3 1.7 ND 1.4 1.6 ND 1.1 1.8 1.6 1.5 1.3 0.5 GEM— A藥劑 連續in 1.1 ί.3 1.9 1.2 1.2 1.4 1.2 1.7 1.4 1.2 1.3 U GEM— A藥劑 脈衝式I 1.0 1.5 1.1 2.1 4.1 ND 9.1 0.1 2.2 1.3 10.3 2.0 GEM— A藥劑 脈衝式π 1.3 1.0 1.2 1.3 0.5 ND 1.6 1.3 1.6 1.5 0.7 0.6 GEM— A藥劑 脈衝式πι 0.7 1,0 1.2 1.0 0.6 1.1 0.6 1.2 0.8 1.1 0.9 0.7 A藥劑— GEM 連續I 2.0 4.4 3.8 ND 1.4 0.8 0.5 1.5 2.2 1.7 2.8 0.3 —一·— 藥齊IJA— GEM 連續 1.9 ND ND ND ND 1.3 ND 1.3 ND 1.6 ND 0.1 ____—1 實例2.活體內硏究 在爲期一周的計畫中,無藥期之後,將吉西他濱以每 天1 000毫克/米2之劑量投予至病患。吉西他濱治療接著另 -86- 201215610 一無藥期。然後將A藥劑以每天二次360毫克投予至病患 ,歷時4天。密切注意活體外和活體內吉西他濱和A藥劑 之間的細胞毒增益作用並以適當異種移植模型證實。 【圖式簡單說明】 圖1說明(±)-順-3-(5,6-二氫-411-吡咯并[3,2,1士]喹啉· 1_基)_4-(11€-吲哚-3-基)吡咯啶-2,5-二酮和(±)-反-3-(5,6-0 二氫-4H-吡咯并[3,2,1-ij]喹啉-1-基)-4-(1 H-吲哚-3-基)吡 咯啶-2,5-二酮之化學結構。 圖2 A-B爲用於評估藥理協同性之計算工具的繪圖。 圖2A顯示組合指數(CI)的計算及圖2B顯示等效線分析圖。 圖3顯示(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨_)]喹啉-i-基)_4-(lH-吲哚-3-基)吡咯啶_2,5_二酮/吉西他濱組合之 劑量方案。 圖4顯示吉西他濱治療後接著(-)-反- 3- (5,6 -二氫-4H-〇 吡咯并[3,2,1-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶- 2,5-二酮治療並洗出吉西他濱的等效線圖。 圖5顯示吉西他濱治療後接著(-)-反-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-l-基)-4-(lH-吲哚-3-基)吡咯啶-2,5-二酮治療並沒有洗出吉西他濱的等效線圖。 圖6顯示(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨_]‘]喹啉-1-基)-4-(1 H-吲哚-3-基)吡略啶-2,5-二酮治療後接著吉西 他濱治療並洗出(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-〖』]喹 啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶- 2,5-二酮的等效線圖。 -87- 201215610 圖7顯示(-)-反- 3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉_ 1-基)-4-(1 H-吲哚-3-基)吡咯啶-2,5-二酮治療後接著吉西 他濱治療並沒有洗出(-)-反- 3-(5,6-二氫-4H-吡咯并[3,2,卜 ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯啶- 2,5-二酮的等效線 圖。 圖8爲圖3中所提出之劑量方案A的細胞週期分析,顯 示反應吉西他濱治療之S-期停滯和反應(-)-反-3-(5,6-二 氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯 啶-2,5-二酮治療之02/:\1停滯。 圖9顯示圖3中所提出之劑量方案A期間藉由吉西他濱 的細胞週期檢查點之活化作用。 圖10顯示按照如所示之吉西他濱和(-)-反-3-(5,6-二 氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基)吡咯 啶-2,5-二酮治療的MDA-MB-231細胞之細胞週期分析(區 塊A和B)。區塊C和D顯示使用抗-磷酸化- Chkl、磷酸化組 蛋白H3(SerlO)和β -肌動蛋白抗體的MDA-MB-231細胞之免 疫墨點(分別得自區塊Α和Β中的硏究)。-85- 201215610 Table 4. Cell Line A549 NCK- H1299 RT4 RT112 ASPC -1 PANC -1 MDA- MB-231 MDA- MB- 468 sv· OV-3 A2780 AN3 CA NOZ Tissue Source Lung, Lung, Bladder, Pancreas, Pancreas, Pancreas, Breast Ovarian ovary uterine gallbladder GEM+ A agent parallel 1.3 1.8 1.3 2.0 4.7 6.5 ND 2.2 2.2 1.7 4.0 2.5 GEM—A pharmaceutical continuous I 1.2 1.8 1.7 1.9 5.1 1.7 0.4 1.6 2.2 1.4 2.2 0.3 GEM-> A pharmaceutical continuous II 1.3 1.7 ND 1.4 1.6 ND 1.1 1.8 1.6 1.5 1.3 0.5 GEM—A pharmaceutical continuous in 1.1 ί.3 1.9 1.2 1.2 1.4 1.2 1.7 1.4 1.2 1.3 U GEM—A pharmaceutical pulse I 1.0 1.5 1.1 2.1 4.1 ND 9.1 0.1 2.2 1.3 10.3 2.0 GEM— A Pharmacy pulse type π 1.3 1.0 1.2 1.3 0.5 ND 1.6 1.3 1.6 1.5 0.7 0.6 GEM— A drug pulse type πι 0.7 1,0 1.2 1.0 0.6 1.1 0.6 1.2 0.8 1.1 0.9 0.7 A drug — GEM continuous I 2.0 4.4 3.8 ND 1.4 0.8 0.5 1.5 2.2 1.7 2.8 0.3 —1— Pharmaceutical Qi IJA — GEM Continuous 1.9 ND ND ND ND 1.3 ND 1.3 ND 1.6 ND 0.1 ____—1 Example 2. In vivo study in a one-week plan, after the drug-free period , gemcitabine at 1,000 mg / m 2 per day The amount administered to the patient. Gemcitabine treatment followed by another -86- 201215610 a drug-free period. The A agent was then administered to the patient twice a day for 360 days for 4 days. Close attention was paid to the cytotoxic gain between gemcitabine and A agents in vitro and in vivo and confirmed by appropriate xenograft models. [Simple description of the diagram] Figure 1 illustrates (±)-cis-3-(5,6-dihydro-411-pyrrolo[3,2,1 s]quinoline·1_yl)_4-(11€- Indole-3-yl)pyrrolidine-2,5-dione and (±)-trans-3-(5,6-0 dihydro-4H-pyrrolo[3,2,1-ij]quinoline- The chemical structure of 1-yl)-4-(1 H-indol-3-yl)pyrrolidine-2,5-dione. Figure 2 A-B is a plot of a calculation tool for assessing pharmacological synergy. FIG. 2A shows the calculation of the combination index (CI) and FIG. 2B shows the equivalent line analysis diagram. Figure 3 shows (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indolyl]]quinoline-i-yl)_4-(lH-indole-3) Dosage regimen of pyridinium-2,5-dione/gemcitabine combination. Figure 4 shows the treatment of gemcitabine followed by (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,1-ij]quinolin-1-yl)-4-(1Η- The equivalent line diagram of gemcitabine was treated with indole-3-yl)pyrrolidine-2,5-dione. Figure 5 shows the treatment of gemcitabine followed by (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline-l-yl)-4-(lH-indole) The indole-3-yl)pyrrolidine-2,5-dione treatment did not elute the equivalent line diagram of gemcitabine. Figure 6 shows (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indolyl]]quinolin-1-yl)-4-(1 H-oxime) Indole-3-yl)pyrrolidine-2,5-dione treatment followed by gemcitabine treatment and washing out (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1 -" 』] Quinoline-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione equivalent line diagram. -87- 201215610 Figure 7 shows (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinoline-1-yl)-4-(1 H- Treatment with indole-3-yl)pyrrolidine-2,5-dione followed by gemcitabine did not wash out (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2, An equivalent line diagram of ij ij quinolin-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione. Figure 8 is a cell cycle analysis of the dose regimen A presented in Figure 3, showing S-phase arrest and reaction (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3] in response to gemcitabine treatment. , 2,l-ij]quinolin-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione treatment 02/:\1 stagnant. Figure 9 shows the activation of cell cycle checkpoints by gemcitabine during the dose regimen A presented in Figure 3. Figure 10 shows gemcitabine and (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl)-4-(as shown). Cell cycle analysis of MDA-MB-231 cells treated with pyridinium-2,5-dione (blocks A and B). Blocks C and D show immunoblots of MDA-MB-231 cells using anti-phospho-Chkl, phosphorylated histone H3 (SerlO) and β-actin antibodies (respectively from blocks and sputum) Study).

Claims (1)

201215610 七、申請專利範圍: 1. 一種治療細胞增生性疾病之方法’該方法包含將 治療有效量之(-) -反- 3- (5,6 - —氫- 4H -卩比略并[3,2,l-ij]唾琳-1-基)-4-(1Η -吲哚-3-基)吡咯啶_2,5·二酮,或其醫藥上可接 受的鹽、前藥或代謝物,組合治療有效量之第二種抗增生 劑投予至對象,其中該(-)_反_3-(5,6_二氫·4Η_吡咯并 [3,2,1七]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮, 〇 或其醫藥上可接受的鹽、前藥或代謝物和該第二種抗增生 劑不同時投予。 2. 如申請專利範圍第1項之方法,其中該(-)-反-3-(5,6-二氨-411-啦咯并[3,2,1-丨_]]唾琳-1-基)-4-(111-卩引哄-3-基 )吡咯啶-2,5-二酮,或其醫藥上可接受的鹽、前藥或代謝 物係在投予該第二種抗增生劑之後投予。 3. 如申請專利範圍第2項之方法,其中該第二種抗增 生劑爲細胞週期之G1/S期的抑制劑。 Ο 4.如申請專利範圍第2項之方法,其中該第二種抗增 生劑爲腺苷類似物、鳥苷類似物、甲基尿苷類似物或胞苷 類似物。 5- 如申請專利範圍第2項之方法,其中該第二種抗增 生劑爲吉西他濱(gemcitabine)。 6- 如申請專利範圍第5項之方法,其中該吉西他濱係 投予不超過30分鐘。 7 ·如申請專利範圍第5項之方法,其中該吉西他濱係 投予不超過1小時。 -89- 201215610 8 ·如申請專利範圍第5項之方法,其中該吉西他濱係 投予不超過12小時。 9 .如申請專利範圍第5項之方法,其中該吉西他濱係 投予不超過24小時。 10. 如申請專利範圍第1項之方法,其中該(-)-反-3 -(5,6-二氫- 4H-吡咯并[3,2,1-ij]喹啉-1-基)-4-(1Η -吲哚-3-基 )吡咯啶-2,5-二酮係投予至少24小時。 11. 如申請專利範圍第1項之方法,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1士]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係投予至少48小時。 12-如申請專利範圍第1項之方法,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,14_)]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5 -二酮係投予至少7 2小時。 13. 如申請專利範圍第1項之方法,其中該(-)-反-3-(5,6 -二氫-4 Η -吡咯并[3,2,1 - ij ]喹啉-1 -基)-4 - (1 Η -吲哚-3 -基 )啦略U定-2,5 - 一嗣係投予至少9 6小時。 14. 如申請專利範圍第5項之方法,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨_]]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係在投予吉西他濱之後投予至少12小時 〇 1 5 ·如申請專利範圍第5項之方法,其中該(-)-反-3 -(5,6-二氫-411-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係在投予吉西他濱之後投予至少24小時 -90- 201215610 16. 如申請專利範圍第5項之方法,其中在投予吉西 他濱之前至少1 2小時沒有投予藥物。 17. 如申請專利範圍第5項之方法,其中在投予吉西 他濱之前至少2 4小時沒有投予藥物。 1 8 ·如申請專利範圍第5項之方法,其中在投予吉西 他濱之前至少48小時沒有投予藥物。 19. 如申請專利範圍第5項之方法,其中該(_)-反_3_ 〇 (5,6-二氫-411-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5 -二酮係在吉西他濱在該對象中之濃度或數量 低於其起始濃度或數量的約50%之後投予。 20. 如申請專利範圍第5項之方法,其中該(-)-反- 3-(5,6-二氫- 4H-吡咯并[3,2,1“』]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5 -二酮係在吉西他濱在該對象中之濃度或數量 低於其起始濃度或數量的約1 0%之後投予。 21. 如申請專利範圍第5項之方法,其中該(-)-反-3_ 〇 (5,6-二氫-411-吡咯并[3,2,1-丨】]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係在吉西他濱在該對象中之濃度或數量 低於其起始濃度或數量的約5%之後投予。 22. 如申請專利範圍第5項之方法,其中該(-)-反-3_ (5,6-二氫-411-吡咯并[3,2,1“〗]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係在吉西他濱在該對象中之濃度或數量 低於其起始濃度或數量的約1 %之後投予。 23 . —種供治療對象細胞增生性疾病之組合物,該組 合物包含治療有效量之(-) -反-3-(5,6 -二氫-4 H-吡咯并 -91 - 201215610 [3,2,l-ij]喹琳-1-基)-4-(1Η-卩引喂-3-基)耻略陡_2,5_二酮, 或其醫藥上可接受的鹽、前藥或代謝物,並組合有治療有 效量之第二種抗增生劑’其中該(-) -反_3-(5,6-二氣-411-[]比 咯并[3,2,1-丨』]唾啉-1-基)-4-(111-[1引噪-3-基)啦略|1定-2,5-二 酮’或其醫藥上可接受的鹽、前藥或代謝物和該第二種抗 增生劑不同時投予。 24.如申請專利範圍第23項之組合物,其中該(_)_反_ 3-(5,6-二氫-41{-吡咯并[3,2,1“】]喹啉-1_基)_4_(111_吲哚-3- 基)吡略陡-2,5-二酮,或其醫藥上可接受的鹽、前藥或代 謝物,係在投予該第二種抗增生劑之後投予。 2 5 ·如申請專利範圍第2 4項之組合物,其中該第二種 抗增生劑爲細胞週期之G1/S期之抑制劑。 26.如申請專利範圍第24項之組合物,其中該第二種 抗增生劑爲腺苷類似物、鳥苷類似物、甲基尿苷類似物或 胞苷類似物。 2 7.如申請專利範圍第24項之組合物,其中該第二種 抗增生劑爲吉西他濱。 28. 如申請專利範圍第27項之組合物,其中該吉西他 濱係投予不超過30分鐘。 29. 如申請專利範圍第27項之組合物,其中該吉西他 濱係投予不超過1小時。 3 0 .如申請專利範圍第2 7項之組合物,其中該吉西他 濱係投予不超過12小時。 3 1 .如申請專利範圍第2 7項之組合物,其中該吉西他 -92- 201215610 濱係投予不超過24小時。 32.如申請專利範圍第23項之組合物,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-1_1]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮係投予至少24小時。 3 3.如申請專利範圍第23項之組合物,其中該(-)-反_ 3-(5,6-二氫-411-吡咯并[3,2,1-丨〗]喹啉-1-基)-4-(1只-吲哚-3-基)吡咯啶-2,5-二酮係投予至少48小時。 Ο 34. 如申請專利範圍第23項之組合物,其中該(-)-反- 3-(5,6-二氫-411-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3· 基)吡咯啶-2,5-二酮係投予至少72小時。 35.如申請專利範圍第23項之組合物,其中該(-)-反-3-(5,6-二氫-41吡咯并[3,2,1-丨_)]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5-二酮係投予至少96小時。 3 6.如申請專利範圍第27項之組合物,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨_]]喹啉-1-基)-4-(111-吲哚-3-〇 基)吡咯啶-2,5-二酮係在投予吉西他濱之後投予至少12小 時。 37·如申請專利範圍第27項之組合物,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1士]喹啉-1-基)-4-(111-吲哚-3- 基)吡咯啶-2,5-二酮係在投予吉西他濱之後投予至少24小 時。 3 8 .如申請專利範圍第2 7項之組合物,其中在投予吉 西他濱之前至少1 2小時沒有投予藥物。 39.如申請專利範圍第2.7項之組合物,其中在投予吉 -93- 201215610 西他濱之前至少2 4小時沒有投予藥物。 4 0 ·如申請專利範圍第2 7項之組合物,其中在投予吉 西他濱之前至少4 8小時沒有投予藥物。 41. 如申請專利範圍第27項之組合物,其中該(-)_反_ 3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚- 3-基)吡咯啶-2,5-二酮係在吉西他濱在該對象中之濃度或數 量低於其起始濃度或數量的約5 0 %之後投予。 42. 如申請專利範圍第27項之組合物,其中該(-)-反_ 3-(5,6-二氫-411-吡咯并[3,2,1-4]喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶-2,5 -二酮係在吉西他濱在該對象中之濃度或數 量低於其起始濃度或數量的約1 0 %之後投予。 43. 如申請專利範圍第27項之組合物,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-〖门喹啉-1-基)-4-(111-吲哚-3-基)吡咯啶_2,5_二酮係在吉西他濱在該對象中之濃度或數 量低於其起始濃度或數量的約5%之後投予。 44. 如申請專利範圍第27項之組合物,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1七]喹啉-1-基)-4-(11^-吲哚-3-基)吡咯啶-2,5 -二酮係在吉西他濱在該對象中之濃度或數 量低於其起始濃度或數量的約1 %之後投予。 4 5 · —種供治療對象細胞增生性疾病之套組,該套組 包含治療有效量之(-)-反- 3-(5,6-二氫-4H-吡略并[3,2,l-ij] 喹啉-1 -基)-4 - (1 Η -吲哚-3 -基)吡咯啶-2,5 -二酮,或其醫藥 上可接受的鹽、前藥或代謝物,並組合有治療有效量之第 二種抗增生劑,其中該(_)_反-3-(5,6-二氫-4Η-吡咯并 -94- 201215610 [3,2,1-丨』]喹啉-1-基)-4-(11€-吲哚-3-基)吡咯啶-2,5-二酮, 或其醫藥上可接受的鹽、前藥或代謝物和該第二種抗增生 劑不同時投予。 46.如申請專利範圍第45項之套組,其中該(-)-反-3-(5,6-二氫- 4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3_基 )吡咯啶-2,5 -二酮,或其醫藥上可接受的鹽、前藥或代謝 物,係在投予該第二種抗增生劑之後投予。 0 47.如申請專利範圍第46項之套組,其中該第二種抗 增生劑爲細胞週期之G 1 /S期之抑制劑》 48.如申請專利範圍第46項之套組,其中該第二種抗 增生劑爲腺苷類似物、鳥苷類似物、甲基尿苷類似物或胞 苷類似物。 4 9.如申請專利範圍第46項之套組,其中該第二種抗 增生劑爲吉西他濱。 5 0.如申請專利範圍第49項之套組,其中該吉西他濱 Ο 係投予不超過30分鐘。 5 1 .如申請專利範圍第49項之套組,其中該吉西他濱 係投予不超過1小時。 52.如申請專利範圍第49項之套組,其中該吉西他濱 係投予不超過1 2小時。 5 3.如申請專利範圍第49項之套組,其中該吉西他濱 係投予不超過24小時。 54·如申請專利範圍第45項之套組,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(111-吲哚-3-基 -95- 201215610 )吡略啶-2,5-二酮係投予至少24小時。 55.如申請專利範圍第45項之套組’其中該(-)-反-3-(5,6-二氫-4H-吡咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基 )吡咯啶-2,5-二酮係投予至少48小時。 5 6.如申請專利範圍第45項之套組’其中該(-)-反-3-(5,6-二氫- 4H-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(11吲哚-3-基 )吡略啶-2,5-二酮係投予至少72小時。 5 7.如申請專利範圍第45項之套組,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1“』]喹啉-1-基)-4-(1^吲哚-3-基 )吡咯啶-2,5-二酮係投予至少96小時。 58. 如申請專利範圍第49項之套組,其中該(-)-反-3- (5,6-二氫-411-吡咯并[3,2,1-1』]喹啉-1-基)-4-(1^1-吲哚-3-基 )吡咯啶-2,5-二酮係在吉西他濱投予之後投予至少12小時 〇 59. 如申請專利範圍第49項之套組,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1七]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係在投予吉西他濱之後投予至少24小時 〇 6 0.如申請專利範圍第49項之套組,其中在投予吉西 他濱之前至少1 2小時沒有投予藥物。 6 1 .如申請專利範圍第4 9項之套組,其中在投予吉西 他濱之前至少2 4小時沒有投予藥物。 62.如申請專利範圍第49項之套組,其中在投予吉西 他濱之前至少4 8小時沒有投予藥物。 -96- 201215610 63. 如申請專利範圍第49項之套組,其中該(-)-反-3-(5,6-二氫-4^1-吡咯并[3,2,1-丨』]喹啉-1-基)-4-(1^1-吲哚-3-基 )吡咯啶-2,5 -二酮係在吉西他濱在該對象中之濃度或數量 低於其起始濃度或數量的約50%之後投予。 64. 如申請專利範圍第49項之套組’其中該(-)-反-3-(5,6-二氮-4H-卩j^;略并[3,2,l-ij]唾琳-l-基)-4-(lH-卩引噪-3-基 )吡咯啶-2,5 -二酮係在吉西他濱在該對象中之濃度或數量 〇 低於其起始濃度或數量的約1 〇%之後投予。 65. 如申請專利範圍第49項之套組,其中該(-)-反-3-(5,6-二氫-411-吡咯并[3,2,1-丨_|]喹啉-1-基)-4-(111-吲哚-3-基 )吡咯啶-2,5-二酮係在吉西他濱在該對象中之濃度或數量 低於其起始濃度或數量的約5 %之後投予。 66. 如申請專利範圍第49項之套組,其中該(-)-反_3_ (5,6-二氫- 4H-毗咯并[3,2,l-ij]喹啉-1-基)-4-(1Η-吲哚-3-基 )吡咯啶-2,5_二酮係在吉西他濱在該對象中之濃度或數量 Q 低於其起始濃度或數量的約1%之後投予。 -97-201215610 VII. Scope of Application: 1. A method for treating cell proliferative diseases. The method comprises treating a therapeutically effective amount of (-)-trans-3-(5,6--hydro- 4H-卩 略 并 [ [ , 2,l-ij]salin-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5·dione, or a pharmaceutically acceptable salt, prodrug or metabolism thereof And administering a therapeutically effective amount of a second anti-proliferative agent to the subject, wherein the (-)-trans-3-(5,6-dihydro- 4Η-pyrrolo[3,2,1-7]quinoline 1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione, hydrazine or a pharmaceutically acceptable salt, prodrug or metabolite thereof and the second anti-proliferation The agents are not administered at the same time. 2. The method of claim 1, wherein the (-)-trans-3-(5,6-diamino-411-la-do[3,2,1-丨_]] salin-1 -yl)-4-(111-indole-3-yl)pyrrolidine-2,5-dione, or a pharmaceutically acceptable salt, prodrug or metabolite thereof, administered the second antibody The proliferative agent is administered later. 3. The method of claim 2, wherein the second anti-proliferator is an inhibitor of the G1/S phase of the cell cycle. 4. The method of claim 2, wherein the second anti-proliferative agent is an adenosine analog, a guanosine analog, a methyl uridine analog or a cytidine analog. 5- The method of claim 2, wherein the second anti-proliferation agent is gemcitabine. 6- The method of claim 5, wherein the gemcitabine is administered for no more than 30 minutes. 7. The method of claim 5, wherein the gemcitabine is administered for no more than one hour. -89-201215610 8 • The method of claim 5, wherein the gemcitabine is administered for no more than 12 hours. 9. The method of claim 5, wherein the gemcitabine is administered for no more than 24 hours. 10. The method of claim 1, wherein the (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,1-ij]quinolin-1-yl) 4-(1Η-indol-3-yl)pyrrolidine-2,5-dione is administered for at least 24 hours. 11. The method of claim 1, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1 quinolin-1-yl)- 4-(111-Indol-3-yl)pyrrolidine-2,5-dione is administered for at least 48 hours. 12- The method of claim 1, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,14-)]quinolin-1-yl)- 4-(111-Indol-3-yl)pyrrolidine-2,5-dione is administered for at least 72 hours. 13. The method of claim 1, wherein the (-)-trans-3-(5,6-dihydro-4 Η-pyrrolo[3,2,1 - ij ]quinolin-1 -yl group ) -4 - (1 Η -吲哚-3 -yl) Rabbi U--2,5 - One-line is administered for at least 9 6 hours. 14. The method of claim 5, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indol]]quinolin-1- The 4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered for at least 12 hours after administration of gemcitabine. The method of claim 5, wherein the method of claim 5, wherein (-)-trans-3 -(5,6-dihydro-411-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(111-indol-3-yl) Pyrrolidine-2,5-dione is administered for at least 24 hours after administration of gemcitabine - 90 - 201215610 16. The method of claim 5, wherein at least 12 hours prior to administration of gemcitabine is not administered drug. 17. The method of claim 5, wherein no drug is administered for at least 24 hours prior to administration of gemcitabine. 1 8 The method of claim 5, wherein no drug is administered for at least 48 hours prior to administration of gemcitabine. 19. The method of claim 5, wherein the (_)-trans_3_ 〇(5,6-dihydro-411-pyrrolo[3,2,1-indenyl]quinolin-1-yl The -4-(111-indol-3-yl)pyrrolidine-2,5-diketone is administered after the concentration or amount of gemcitabine in the subject is less than about 50% of its initial concentration or amount. 20. The method of claim 5, wherein the (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,1""]quinolin-1-yl) The -4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered after the concentration or amount of gemcitabine in the subject is less than about 10% of its initial concentration or amount. 21. The method of claim 5, wherein the (-)-trans-3_ oxime (5,6-dihydro-411-pyrrolo[3,2,1-indol]]quinolin-1-yl The -4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered after gemcitabine has a concentration or amount in the subject that is less than about 5% of its initial concentration or amount. 22. The method of claim 5, wherein the (-)-trans-3_(5,6-dihydro-411-pyrrolo[3,2,1"]quinolin-1-yl)- 4-(111-Indol-3-yl)pyrrolidine-2,5-dione is administered after gemcitabine has a concentration or amount in the subject that is less than about 1% of its initial concentration or amount. A composition for treating a proliferative disease in a subject, the composition comprising a therapeutically effective amount of (-)-trans-3-(5,6-dihydro-4 H-pyrrolo-91 - 201215610 [3] , 2,l-ij]quinolin-1-yl)-4-(1Η-卩)-3-yl) schizophrenia _2,5-dione, or a pharmaceutically acceptable salt or prodrug thereof Or a metabolite, and combined with a therapeutically effective amount of a second anti-proliferative agent, wherein the (-)-trans-3-(5,6-digas-411-[] is more than [3,2,1-唾 』] sialolin-1-yl)-4-(111-[1 γ -3-yl) lysole|1 determinate-2,5-dione' or its pharmaceutically acceptable salt, prodrug or The metabolite is administered at the same time as the second anti-proliferative agent. 24. The composition of claim 23, wherein the (_)-trans-3-(5,6-dihydro-41{-pyrrolo[3,2,1"]]quinoline-1_ a _4_(111_吲哚-3-yl)pyrrolidole-2,5-dione, or a pharmaceutically acceptable salt, prodrug or metabolite thereof, administered to the second anti-proliferative agent 2. The composition of claim 24, wherein the second anti-proliferative agent is an inhibitor of the G1/S phase of the cell cycle. 26. The combination of claim 24 And the second anti-proliferation agent is an adenosine analog, a guanosine analog, a methyl uridine analog or a cytidine analog. 2 7. The composition of claim 24, wherein the The two anti-proliferative agents are gemcitabine. 28. The composition of claim 27, wherein the gemcitabine is administered for no more than 30 minutes. 29. The composition of claim 27, wherein the gemcitabine is administered For a period of not more than one hour. 3 0. The composition of claim 27, wherein the gemcitabine is administered for no more than 12 hours. 3 1 . A composition of 7th, wherein the gemcitabine-92-201215610 is administered in a period of no more than 24 hours. 32. The composition of claim 23, wherein the (-)-trans-3-(5, 6-Dihydro-411-pyrrolo[3,2,1-1_1]quinolin-1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione At least 24 hours. 3 3. The composition of claim 23, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-丨] Quinoline-1-yl)-4-(1 -indol-3-yl)pyrrolidine-2,5-dione is administered for at least 48 hours. Ο 34. The composition of claim 23 Wherein (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indolyl]quinolin-1-yl)-4-(111-indole-3) · Pyridinyl-2,5-dione is administered for at least 72 hours. 35. The composition of claim 23, wherein the (-)-trans-3-(5,6-dihydro- 41 pyrrolo[3,2,1-indolyl]]quinolin-1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered for at least 96 hours. 3. The composition of claim 27, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indol]]quinoline- 1-base)- The 4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered for at least 12 hours after administration of gemcitabine. 37. The composition of claim 27, wherein -)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1 quinolin-1-yl)-4-(111-indol-3-yl)pyrrolidine- The 2,5-diketone is administered for at least 24 hours after administration of gemcitabine. 3 8. The composition of claim 27, wherein no drug is administered for at least 12 hours prior to administration of gemcitabine. 39. The composition of claim 2.7, wherein no drug is administered for at least 24 hours prior to administration of ji-93-201215610 citabine. 40. The composition of claim 27, wherein no drug is administered for at least 48 hours prior to administration of gemcitabine. 41. The composition of claim 27, wherein the (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl group -4-(1Η-吲哚-3-yl)pyrrolidine-2,5-dione is administered after gemcitabine has a concentration or amount in the subject that is less than about 50% of its initial concentration or amount. . 42. The composition of claim 27, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-4]quinolin-1-yl group -4-(111-Indol-3-yl)pyrrolidine-2,5-dione is administered after gemcitabine has a concentration or amount in the subject that is less than about 10% of its initial concentration or amount. . 43. The composition of claim 27, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-[ quinolin-1-yl) The -4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered after the concentration or amount of gemcitabine in the subject is less than about 5% of its initial concentration or amount. 44. The composition of claim 27, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-7]quinolin-1-yl) The -4-(11^-indol-3-yl)pyrrolidine-2,5-diketone is administered after the concentration or amount of gemcitabine in the subject is less than about 1% of its initial concentration or amount. 4 5 · A kit for the treatment of cell proliferative diseases, the kit comprising a therapeutically effective amount of (-)-trans-3-(5,6-dihydro-4H-pyro[3,2, L-ij] quinoline-1-yl)-4-(1 Η-indol-3-yl)pyrrolidine-2,5-dione, or a pharmaceutically acceptable salt, prodrug or metabolite thereof, And combining a therapeutically effective amount of a second anti-proliferative agent, wherein the (_)-trans-3-(5,6-dihydro-4?-pyrrolo-94-201215610 [3,2,1-丨"] Quinolin-1-yl)-4-(11 €-indol-3-yl)pyrrolidine-2,5-dione, or a pharmaceutically acceptable salt, prodrug or metabolite thereof and the second Anti-proliferative agents are administered at different times. 46. The kit of claim 45, wherein the (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl group -4-(1Η-吲哚-3_yl)pyrrolidine-2,5-dione, or a pharmaceutically acceptable salt, prodrug or metabolite thereof, administered by the second anti-proliferative agent Then voted. 0 47. The kit of claim 46, wherein the second anti-proliferative agent is an inhibitor of the G 1 /S phase of the cell cycle. 48. The kit of claim 46, wherein The second anti-proliferative agent is an adenosine analog, a guanosine analog, a methyl uridine analog or a cytidine analog. 4 9. The kit of claim 46, wherein the second anti-proliferative agent is gemcitabine. 50. If the kit of claim 49 is applied, the gemcitabine is administered for no more than 30 minutes. 5 1. A kit of claim 49, wherein the gemcitabine is administered for no more than one hour. 52. The kit of claim 49, wherein the gemcitabine is administered for no more than 12 hours. 5 3. For the kit of claim 49, the gemcitabine is administered for no more than 24 hours. 54. The kit of claim 45, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-indenyl]quinoline-1- The base -4-(111-indol-3-yl-95-201215610) pirolidin-2,5-dione is administered for at least 24 hours. 55. The kit of claim 45, wherein the (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,l-ij]quinolin-1-yl group -4-(1Η-indol-3-yl)pyrrolidine-2,5-dione is administered for at least 48 hours. 5 6. For the kit of claim 45, where the (-)-trans-3-(5,6-dihydro-4H-pyrrolo[3,2,1-indolyl]quinoline-1 -yl)-4-(11吲哚-3-yl)pyrrolidine-2,5-dione is administered for at least 72 hours. 5 7. The kit of claim 45, wherein the (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1""]quinoline-1- The base 4-(1^吲哚-3-yl)pyrrolidine-2,5-dione is administered for at least 96 hours. 58. As in the kit of claim 49, wherein the (-)- Trans-3-(5,6-dihydro-411-pyrrolo[3,2,1-1]]quinolin-1-yl)-4-(1^1-indol-3-yl)pyrrolidine The -2,5-diketone is administered for at least 12 hours after administration of gemcitabine. 59. For the kit of claim 49, wherein the (-)-trans-3-(5,6-dihydro- 411-pyrrolo[3,2,1-7-quinolin-1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione is administered at least after administration of gemcitabine 24 hours 〇 6 0. If the kit of claim 49 is applied, no drug is administered at least 12 hours before the administration of gemcitabine. 6 1. If the kit of claim 49 is applied, No drug was administered for at least 24 hours prior to gemcitabine. 62. For the kit of claim 49, no drug was administered at least 48 hours prior to administration of gemcitabine. -96- 201215610 63. The kit of claim 49, wherein the (-)-trans-3-(5,6-dihydro-4^1-pyrrolo[3,2,1-indenyl]quinolin-1-yl group -4-(1^1-indol-3-yl)pyrrolidine-2,5-dione is administered after gemcitabine has a concentration or amount in the subject that is less than about 50% of its initial concentration or amount. 64. For example, in the case of claim 49, the (-)-trans-3-(5,6-diaza-4H-卩j^; slightly [3,2,l-ij] The concentration or amount of gemcitabine-2,5-diketone in gemcitabine in this subject is lower than its initial concentration or amount. After about 1%, it is administered. 65. For the kit of claim 49, where (-)-trans-3-(5,6-dihydro-411-pyrrolo[3,2,1 -丨_|]quinolin-1-yl)-4-(111-indol-3-yl)pyrrolidine-2,5-dione is present in gemcitabine at a concentration or amount lower than its origin After about 5% of the concentration or amount is administered. 66. For the kit of claim 49, where (-)-anti_3_(5,6-dihydro-4H-pyrrolo[3,2 ,l-ij]quinolin-1-yl)-4-(1Η-indol-3-yl)pyrrolidine-2,5-dione is in gemcitabine The concentration or amount Q in the subject is administered after about 1% of its initial concentration or amount. -97-
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