TW202348233A - 給予kras抑制劑治療癌症 - Google Patents
給予kras抑制劑治療癌症 Download PDFInfo
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Abstract
本文提供了向癌症受試者投與KRAS G12C抑制劑之方法。
Description
本發明關於向癌症受試者投與KRAS G12C抑制劑之方法。
KRAS基因突變在胰臟癌、肺腺癌、大腸直腸癌、膽囊癌、甲狀腺癌和膽管癌中是常見的。在約25%的NSCLC患者中也觀察到
KRAS突變,並且一些研究已指示,
KRAS突變在NSCLC患者中是陰性預後因子。最近,已發現V-Ki-ras2 Kirsten大鼠肉瘤病毒癌基因同源物(
KRAS)突變在大腸直腸癌中賦予對表皮生長因子受體(EGFR)靶向療法的抗性;因此,
KRAS之突變狀態可以在開具TKI療法之前提供重要資訊。總體而言,需要針對胰臟癌、肺腺癌或大腸直腸癌的患者之新醫學治療,特別是那些已被診斷出患有以
KRAS突變表徵的此類癌症的患者並且包括那些化療後進展之患者。殘基G12、G13和Q61之致癌性
KRAS突變代表了實體惡性腫瘤中最常見的RAS突變。最近已經證明,KRAS
G12C可以被共價小分子抑制劑靶向,該抑制劑與鄰近開關II口袋(switch II pocket,SIIP)的突變半胱胺酸反應,將
KRAS鎖定在其非活性GDP結合狀態。
KRAS係人類癌症中最頻繁突變之癌基因,並編碼腫瘤中的關鍵傳訊蛋白。KRAS
G12C突變體帶有一個半胱胺酸,其已被用於設計具有有前景的臨床前活性的共價抑制劑。我們優化了一系列具有新穎結合相互作用與顯著增強的效力和選擇性之抑制劑。該等努力導致了AMG 510(在本文中也稱為化合物A)的發現,AMG 510係臨床開發中的第一種KRAS
G12C抑制劑。臨床前AMG 510治療可使
KRAS p.G12C腫瘤消退,並且顯著提高化療和靶向藥物之抗腫瘤功效。在免疫活性的小鼠中,AMG 510治療產生促炎性腫瘤微環境,並結合免疫檢查點抑制產生持久治癒。治癒的小鼠排斥等基因
KRAS p.G12D腫瘤之生長,這表明對共有抗原的適應性免疫。AMG 510在首次給藥佇列(cohort)中展示了臨床抗腫瘤活性的初步證據,並且代表了對缺乏有效治療的患者的潛在轉化療法。
KRAS癌蛋白係一種GTP酶,其係參與腫瘤細胞生長和生存的細胞內傳訊通路之重要介質。在正常細胞中,KRAS充當分子開關,在非活性GDP結合狀態與活性GTP結合狀態之間交替。載入GTP並活化KRAS的鳥嘌呤核苷酸交換因子(GEF)和GTP水解促進了該等狀態之間的轉換,GTP水解藉由GTP酶激活蛋白(GAP)催化而使KRAS失活。GTP與KRAS的結合促進了效應子之結合以觸發訊號轉導通路,包括RAF-MEK-ERK(MAPK)。KRAS中的體細胞激活突變係癌症的標誌並防止GAP締合,從而穩定效應子結合並增強KRAS傳訊。患有
KRAS突變腫瘤的患者的結果顯著更不良,並且預後更差。儘管臨床上批准了若干種MAPK通路蛋白(例如MEK、BRAF、EGFR)的抑制劑(針對一小組腫瘤類型),但迄今為止尚無對
KRAS突變型腫瘤具有選擇性的臨床分子。此外,由於缺乏臨床功效,因此禁止使用若干種MAPK通路靶向療法來治療
KRAS突變腫瘤。此外,由於抑制了正常細胞中的MAPK傳訊,因此非腫瘤或非突變的選擇性療法可能會引入中靶(on-target)毒性。這可能會限制將此類藥劑與護理標準或免疫療法結合使用的效用。因此,對開發未引入對正常細胞的負擔的腫瘤選擇性療法存在明顯未滿足的需求。
KRAS p.G12C存在於約13%的肺腺癌、3%的大腸直腸癌和2%的其他實性瘤中。KRAS
G12C的突變半胱胺酸與非活性GDP結合形式的KRAS中存在的口袋(P2)相鄰。P2和突變半胱胺酸的接近導致對共價抑制劑的廣泛搜索。首次報導的對KRAS
G12C的親電篩選最終鑒定出ARS-1620,這在臨床前
KRAS p.G12C模型中顯示了體內功效。儘管Araxes Pharma公司的ARS-1620係概念驗證突變選擇性KRAS抑制的里程碑,但其已被定位為臨床前研究的工具化合物。我們鑒定了一系列新穎的基於丙烯醯胺之分子,該等分子利用了KRAS
G12C中以前未被利用的表面凹槽,從而實質上提高了效能及選擇性。密集型親電篩選和基於結構之設計最終導致了AMG 510的發現,AMG 510係首款在人體中進行臨床測試的KRAS
G12C抑制劑(參見www.clinicaltrials.gov NCT03600883)。在這裡,我們介紹了AMG 510令人信服的臨床活性。
本文提供了治療癌症之方法,該方法包括給有需要的受試者投與每日劑量為180 mg、360 mg、720 mg或960 mg的化合物A。在各種情況下,每日劑量為180 mg。在各種情況下,每日劑量為360 mg。在各種情況下,每日劑量為720 mg。在各種情況下,每日劑量為960 mg。該劑量可口服投與。該劑量可以作為單個日劑量投與。在各種情況下,向受試者投與化合物A至少一個月或至少三個月或至少六個月。
在本文揭露之方法中投與化合物的受試者患有癌症。癌症可為實性瘤。癌症可為KRAS G12C突變之癌症。在某些情況下,癌症係非小細胞肺癌。在某些情況下,癌症係大腸直腸癌。在某些情況下,癌症係胰臟癌。在各種情況下,受試者係在開始使用化合物A的療法之前經歷了至少一種(例如,至少兩種)其他全身性癌症療法之受試者。
在各種情況下,投與化合物A至少一個月的受試者沒有表現出任何與化合物A治療相關的3級或4級不良事件。在某些情況下,在投與化合物A至少三個月後受試者沒有表現出任何與化合物A治療相關的3級或4級不良事件。在各種情況下,受試者在投與化合物A後表現出至少穩定的疾病。在某些情況下,受試者在投與化合物A後表現出至少部分反應。
在各種情況下,本文揭露之方法可以進一步包括化學治療劑的投與。在某些情況下,化學治療劑包含抗PD1抗體。在某些情況下,抗PD1抗體係帕博利珠單抗(Pembrolizumab)(Keytruda)、尼沃魯單抗(Nivolumab)、AUNP-12、AMG 404或匹地利珠單抗(Pidilizumab)。在某些情況下,化學治療劑包含抗PDL1抗體。在某些情況下,抗PDL1抗體係阿特利珠單抗(Atezolizumab)、MPDL3280A、阿維魯單抗(Avelumab)或度伐魯單抗(Durvalumab)。在某些情況下,化學治療劑包含MEK抑制劑。在某些情況下,MEK抑制劑係曲美替尼(trametinib)、匹馬塞替尼(pimasertib)、PD-325901、MEK162、TAK-733、GDC-0973或AZD8330。在某些情況下,化學治療劑包含CDK4/6抑制劑。在某些情況下,CDK4/6抑制劑包含阿貝西利(abemaciclib)或帕柏西利(palbociclib)。在某些情況下,化學治療劑包含PI3K抑制劑。在某些情況下,PI3K抑制劑包含AMG 511或布帕尼西(buparlisib)。
本申請要求於2019年5月14日提交的美國臨時申請案號62/847,862和於2019年6月27日提交的美國臨時申請案號62/867,747的權益,這兩個申請藉由引用以其整體併入本文並且出於所有目的視為在此完全闡述。
本文提供了藉由將化合物A投與給有需要的受試者來治療癌症之方法。化合物A的結構係
。在某些情況下,化合物A被稱為AMG 510。化合物A可以作為藥學上可接受的同位素標記的形式存在,其中一個或多個原子被具有相同原子序數但原子質量或質量數不同於自然界中通常發現的原子質量或質量數的原子取代。可以摻入化合物A的同位素的實例包括氫、碳、氮、氧和氟的同位素、例如分別是
2H、
3H、
11C、
13C、
14C、
13N、
15N、
15O、
17O、
18O和
18F。該等放射性標記的化合物可用於説明藉由表徵例如作用位點或方式,或與藥理學上重要的作用位點的結合親和性,來確定或測量化合物A的有效性。化合物A的某些同位素標記形式,(例如,那些摻入放射性同位素的化合物)可用於藥物和/或底物組織分佈研究中。鑒於易於摻入以及即用的檢測方式,放射性同位素氚(即
3H)和碳-14(即
14C)尤其可用於這個目的。
經較重同位素,諸如氘,即
2H取代可由於代謝穩定性較高,例如活體內半衰期增加或劑量要求降低而提供某些治療益處,且因此在一些情況下是較佳的。
用正電子發射同位素,諸如
11C、
18F、
15O及
13N取代可用於正電子發射斷層掃描(PET)研究中以檢查底物受體佔有率。通常可以藉由熟悉該項技術者已知的常規技術製備同位素標記的結構 (I) 之化合物。如本文揭露的同位素標記的化合物通常可以藉由熟悉該項技術者已知的常規技術來製備。
化合物A可以立體異構物(即,只有原子的空間排布不同的異構物)存在,包括光學異構物和構象異構物(或構象體)。除非另有說明,否則本文中提及的化合物A包括作為純的個別立體異構物製劑和每一種的富集製劑的所有立體異構物、以及此類立體異構物的外消旋混合物以及可以根據熟悉該項技術者已知之方法分離的個別非鏡像異構物和鏡像異構物。在某些情況下,化合物A作為以下提供:4-((S)-4-丙烯醯基-2-甲基哌𠯤-1-基)-6-氟-7-(2-氟-6-羥基苯基)-1-(2-異丙基-4-甲基吡啶-3-基)吡啶并[2,3-d]嘧啶-2(1H)-酮:
。
化合物A可以作為構型異構物存在,其為在由於與分子其他部分的空間相互作用,圍繞分子中單鍵的旋轉被阻止或大大減慢時出現之構象立體異構物。除非另有說明,當本文中提及化合物A時包括作為純的個別構型異構物製劑、每一種的富集製劑或者每一種的非特定混合物之所有構型異構物。如果圍繞單鍵的旋轉勢壘足夠高,並且構象之間的互變足夠緩慢,那麼可以容許異構物種類的分離和分開。異構物種類的分離和分開藉由熟知並且廣為接受的符號「M」或「P」適當表示。在某些情況下,化合物A作為以下提供:4-((S)-4-丙烯醯基-2-甲基哌𠯤-1-基)-6-氟-7-(2-氟-6-羥基苯基)-1-(2-異丙基-4-甲基吡啶-3-基)吡啶并[2,3-d]嘧啶-2(1H)-酮和M-構型異構物(atropisomer):
。在某些情況下,化合物A作為以下提供:4-((R)-4-丙烯醯基-2-甲基哌𠯤-1-基)-6-氟-7-(2-氟-6-羥基苯基)-1-(2-異丙基-4-甲基吡啶-3-基)吡啶并[2,3-d]嘧啶-2(1H)-酮和M-構型異構物:
在某些情況下,化合物A作為以下提供:4-((S)-4-丙烯醯基-2-甲基哌𠯤-1-基)-6-氟-7-(2-氟-6-羥基苯基)-1-(2-異丙基-4-甲基吡啶-3-基)吡啶并[2,3-d]嘧啶-2(1H)-酮和P-構型異構物:
。在某些情況下,化合物A作為以下提供:4-((R)-4-丙烯醯基-2-甲基哌𠯤-1-基)-6-氟-7-(2-氟-6-羥基苯基)-1-(2-異丙基-4-甲基吡啶-3-基)吡啶并[2,3-d]嘧啶-2(1H)-酮和P-構型異構物:
。在某些情況下,化合物A以上述異構物的混合物形式提供。
化合物A可以如先前報導的製備,例如通常如WO 2018/119183中揭露的或具體如WO 2018/217651中揭露的。
化合物A可以其藥學上可接受的鹽形式提供。藥學上可接受的鹽的預期實例包括鹼加成鹽和酸加成鹽。藥學上可接受的鹼加成鹽可以用金屬或胺(例如鹼金屬和鹼土金屬或有機胺)來形成。化合物的藥學上可接受的鹽也可以用藥學上可接受的陽離子來製備。適合的藥學上可接受的陽離子係熟悉該項技術者所熟知的並且包括鹼金屬陽離子、鹼土金屬陽離子、銨陽離子和季銨陽離子。碳酸鹽或碳酸氫鹽也係為可能的。用作陽離子的金屬的實例係鈉、鉀、鎂、銨、鈣或三價鐵等。適合的胺的實例包括異丙胺、三甲胺、組胺酸、N,N'-二苄基乙二胺、氯普魯卡因(chloroprocaine)、膽鹼、二乙醇胺、二環己胺、乙二胺、N-甲基葡糖胺和普魯卡因。藥學上可接受的酸加成鹽包括無機酸鹽或有機酸鹽。適合的酸鹽的實例包括鹽酸鹽、甲酸鹽、乙酸鹽、檸檬酸鹽、水楊酸鹽、硝酸鹽、磷酸鹽。其他適合的藥學上可接受的鹽係熟悉該項技術者所熟知的並且包括例如甲酸、乙酸、檸檬酸、草酸、酒石酸或苦杏仁酸、鹽酸、氫溴酸、硫酸或磷酸;與有機甲酸、磺酸、磺酸基酸或磷酸基酸或N-取代的胺基磺酸,例如乙酸、三氟乙酸(TFA)、丙酸、乙醇酸、琥珀酸、馬來酸、羥基馬來酸、甲基馬來酸、富馬酸、蘋果酸、酒石酸、乳酸、草酸、葡糖酸、葡糖二酸、葡糖醛酸、檸檬酸、苯甲酸、肉桂酸、苦杏仁酸、水楊酸、4-胺基水楊酸、2-苯氧基苯甲酸、2-乙醯氧基苯甲酸、撲酸、菸酸或異菸酸的鹽;以及與胺基酸,例如在自然界中參與蛋白質合成的20種α胺基酸,例如麩胺酸或天冬胺酸,以及與苯乙酸、甲磺酸、乙磺酸、2-羥基乙磺酸、乙烷1,2-二磺酸、苯磺酸、4-甲基苯磺酸、萘2-磺酸、萘1,5-二磺酸、2-磷酸甘油酸或3-磷酸甘油酸、葡萄糖6-磷酸、N-環己基胺基磺酸(用於環己胺磺酸鹽的形成),或與其他酸性有機化合物,例如抗壞血酸的鹽。
可以將化合物A與藥學上可接受的賦形劑組合以提供藥物配製物(也可互換地稱為組成物)。賦形劑可為稀釋劑或載體。適合藥物配製物可以由技術人員根據投與途徑及所需劑量決定。參見例如,Remington’s Pharmaceutical Sciences [雷明頓藥物科學], 1435-712(第18版, 賓夕法尼亞州伊斯頓市馬克出版公司(Mack Publishing Co), 1990)。配製物可以影響所投與的藥劑的物理狀態、穩定性、或體內釋放速率及活體內清除速率。取決於投與途徑,可以根據體重、體表面積或器官大小來計算適合劑量。熟悉該項技術者在不進行過度實驗的情況下,尤其根據本文所揭露的劑量資訊和測定以及可藉由動物或人類臨床試驗獲得的藥物動力學數據,以常規方式進行決定適當治療劑量所需計算的進一步精化。短語「藥學上可接受的」或「藥理學上可接受的」係指在投與動物或人類時不產生不良反應、過敏反應或其他不利反應的分子實體和組成物。如本文所用,「藥學上可接受的」包括任何和所有溶劑、分散介質、包衣、抗細菌劑和抗真菌劑、等滲劑和吸收延遲劑等。此類賦形劑用於藥學活性物質的使用係本領域所熟知的。除非任何常規介質或藥劑與治療組成物不相容,否則考慮將其用於治療組成物中。還可以將補充性活性成分摻入組成物中。在示例性實施方式中,配製物可以包含玉米糖漿固體、高油酸紅花油、椰子油、大豆油、L-白胺酸、磷酸三鈣、L-酪胺酸、L-脯胺酸、乙酸L-離胺酸、DATEM(乳化劑)、L-麩醯胺酸、L-纈胺酸、磷酸氫二鉀、L-異白胺酸、L-精胺酸、L-丙胺酸、甘胺酸、L-天冬醯胺一水合物、L-絲胺酸、檸檬酸鉀、L-蘇胺酸、檸檬酸鈉、氯化鎂、L-組胺酸、L-甲硫胺酸、抗壞血酸、碳酸鈣、L-麩胺酸、L-胱胺酸二鹽酸鹽、L-色胺酸、L-天冬胺酸、氯化膽鹼、牛磺酸、m-肌醇、硫酸亞鐵、抗壞血酸棕櫚酸酯、硫酸鋅、L-肉鹼、α-生育酚乙酸酯、氯化鈉、菸醯胺、混合生育酚、泛酸鈣、硫酸酮、氯化硫胺素鹽酸鹽、維生素A棕櫚酸酯、硫酸錳、核黃素、鹽酸吡哆辛、葉酸、β-胡蘿蔔素、碘化鉀、葉綠醌、生物素、硒酸鈉、氯化鉻、鉬酸鈉、維生素D3和氰鈷胺。
含有化合物A的藥物組成物能以常規方式來製造,例如藉由常規混合、溶解、造粒、糖衣丸製備、磨細、乳化、囊封、捕集或凍乾方法。適當的配製物取決於所選的投與途徑。
對於口服投與,可以藉由將化合物A與本領域熟知的藥學上可接受的賦形劑(例如載體)組合來容易地配製適合的組成物。此類賦形劑和載體使得能將化合物A配製為片劑、丸劑、糖衣丸、膠囊、液體、凝膠、糖漿、漿液、懸浮液等,以供要治療的患者口服攝食。用於口服使用的藥物製劑可以藉由以下方式來獲得:向化合物A添加固體賦形劑,視需要研磨所得混合物,並且在添加適合的輔助劑後(如果需要)加工顆粒混合物,獲得片劑或糖衣丸核心。適合的賦形劑包括例如填充劑和纖維素製劑。如果需要,可以添加崩解劑。用於各種類型的配製物的藥學上可接受的成分係熟知的,並且可為例如用於各種配製物類型的黏合劑(例如,天然或合成聚合物)、潤滑劑、表面活性劑、甜味和矯味劑、包衣材料、防腐劑、染料、增稠劑、佐劑、抗微生物劑、抗氧化劑和載體。
在口服投與治療有效量的化合物A時,組成物典型地呈固體(例如,片劑、膠囊、丸劑、粉末或糖錠)或液體配製物(例如,水性懸浮液、溶液、酏劑或糖漿)之形式。在一個實施方式中,將治療有效量的化合物A(例如960 mg)以片劑或多個片劑(例如8 x 120 mg片劑)的形式口服投與。
在以片劑形式投與時,組成物可以另外含有功能性固體和/或固體載體,例如明膠或佐劑。片劑、膠囊和粉末可以含有約1%至約95%化合物A,並且較佳的是約15%至約90%化合物A。
在以液體或懸浮液形式投與時,可以添加功能性液體和/或液體載體,例如水、石油或動物或植物來源的油。組成物的液體形式可以進一步含有生理鹽水溶液、糖醇溶液、右旋糖或其他糖溶液或二醇。在以液體或懸浮液形式投與時,組成物可以含有以重量計約0.5%至約90%化合物A,並且較佳的是約1%至約50%化合物A。在預期的一個實施方式中,液體載體係非水性的或基本上非水性的。對於以液體形式投與,組成物可以作為快速溶解的固體配製物來供應,用於在即將投與前溶解或懸浮。
在藉由靜脈內、經皮膚或皮下注射投與治療有效量的化合物A時,組成物呈無熱原、腸胃外可接受的水溶液的形式。此類腸胃外可接受的溶液的製備應充分考慮pH、等滲性、穩定性等,係在本領域技術範圍的。除了化合物A以外,用於靜脈內、經皮膚或皮下注射的較佳的組成物通常含有等滲媒劑。此類組成物可以經製備用於作為與表面活性劑(例如羥丙基纖維素)適當混合的游離鹼或藥理學上可接受的鹽於水中的溶液來投與。還可以在甘油、液體聚乙二醇及其混合物中以及在油中製備分散液。在普通的儲存和使用條件下,該等製劑可以視需要含有防腐劑以防止微生物生長。
可注射組成物可以包括無菌水性溶液、懸浮液或分散液,以及用於臨時製備無菌可注射溶液、懸浮液或分散液的無菌粉末。在所有實施方式中,該形式必須是無菌的,並且流動性必須達到存在易可注射性的程度。其必須在製造和儲存條件下穩定,並且必須藉由視需要包括防腐劑來抵抗微生物(例如細菌和真菌)的污染作用。載體可為溶劑或分散介質,其含有例如水、乙醇、多元醇(例如,甘油、丙二醇和液體聚乙二醇等)、其適合的混合物以及植物油。在預期的一些實施方式中,載體係非水性的或基本上非水性的。適當流動性可以例如藉由以下方式來保持:藉由使用包衣,例如卵磷脂;在分散液的實施方式中藉由保持化合物的所需粒徑;以及藉由使用表面活性劑。對微生物作用的防止可以藉由各種抗細菌劑和抗真菌劑來實現,例如對羥苯甲酸酯、氯丁醇、酚、山梨酸、硫柳汞等。在許多實施方式中,包括等滲劑(例如,糖或氯化鈉)將是較佳的。可注射組成物的延長吸收可以藉由在組成物中使用吸收延遲劑(例如,單硬脂酸鋁和明膠)來實現。
無菌可注射溶液係藉由將化合物A以所要求的量與不同的以上列舉的其他成分(根據需要)合併在適當的溶劑中、隨後進行過濾滅菌來製備的。通常,分散液藉由以下方式來製備:將各種經滅菌活性成分摻入無菌媒劑中,該媒劑含有基礎分散介質和來自上文所列舉的那些的其他所需成分。在用於製備無菌可注射溶液的無菌粉末的實施方式中,較佳的製備方法係真空乾燥和冷凍乾燥技術,其產生活性成分加來自其預先經無菌過濾的溶液的任何所需的其他成分的粉末。
還可以製備緩慢釋放或持續釋放配製物,以實現在胃腸道中與體液接觸的化合物A的受控釋放,並且在血漿中提供基本上恒定且有效的活性化合物水平。例如,可以藉由溶解、擴散和離子交換中的一種或多種來控制釋放。另外,緩慢釋放方法可以藉由胃腸道內的可飽和或限制通路促進吸收。例如,出於這個目的,可以將化合物包埋於生物可降解聚合物、水溶性聚合物或二者的混合物以及視需要適合的表面活性劑的聚合物基質中。在這種情況下,包埋可以意指在聚合物基質中摻入微粒。還藉由經由已知的分散液或乳液包衣技術囊封經分散的微粒或經乳化的微滴來獲得受控釋放配製物。
對於藉由吸入投與,化合物A以氣溶膠噴霧呈遞的形式從加壓包裝或霧化器使用適合的推進劑來遞送。在加壓氣溶膠的實施方式中,可以藉由提供閥來確定劑量單位,以遞送經計量之量。用於吸入器或吹入器的例如明膠的膠囊和藥筒可以經配製含有化合物與適合的粉末基質(例如乳糖或澱粉)之粉末混合物。
化合物A可以經配製用於藉由注射(例如,藉由推注或連續輸注)腸胃外投與。注射用配製物能以單位劑型(例如,於安瓿中或於多劑量容器中)呈現,並添加有防腐劑。組成物可以採取例如以下等形式:於油性或水性媒劑中的懸浮液、溶液或乳液,並且可以含有配製劑,例如懸浮劑、穩定劑和/或分散劑。
用於腸胃外投與的藥物配製物包括呈水溶性形式的化合物A之水溶液。另外,可以將懸浮液製備為適當的油性注射懸浮液。適合的親脂性溶劑或媒劑包括脂肪油或合成脂肪酸酯。水性注射懸浮液可以含有提高懸浮液黏度之物質。視需要,懸浮液還可以含有適合的穩定劑或提高化合物A的溶解度並允許製備高度濃縮的溶液之試劑。可替代地,本發明組成物可以呈粉末形式以供在使用前用適合的媒劑(例如,無菌無熱原水)構造。
化合物A還可以配製於直腸組成物中,例如栓劑或滯留型灌腸劑(例如,含有常規栓劑基質)。除了先前所述之配製物以外,可以將化合物A配製為長效製劑。此類長效配製物可以藉由植入(例如,皮下或肌內)或藉由肌內注射來投與。因此,例如,化合物A可以用適合的聚合或疏水材料(例如,作為可接受的油中的乳液)或離子交換樹脂,或作為微溶衍生物(例如,作為微溶鹽)來配製。
特別地,化合物A能以含有賦形劑(例如澱粉或乳糖)的片劑的形式,或以單獨的或與賦形劑混合的膠囊或珠囊(ovule),或以含有矯味劑或著色劑的酏劑或懸浮液的形式,口服、經頰或舌下投與。此類液體製劑可以用藥學上可接受的添加劑(例如懸浮劑)來製備。還可以腸胃外注射化合物A,例如靜脈內、肌內、皮下或冠狀動脈內。對於腸胃外投與,化合物最佳地以無菌水溶液的形式來使用,其可以含有其他物質,例如鹽或糖醇(例如甘露醇)或葡萄糖,以使溶液與血液等滲。
對於獸用,化合物A根據正規獸醫實踐作為適合地可接受的配製物來投與。獸醫可以容易地確定對於特定動物最適合的給藥方案和投與途徑。
在一些實施方式中,可以將用於使用化合物A(單獨的或與傳統地用於治療這種疾病的另一種藥劑或干預組合的)治療KRAS相關障礙的所有所需組分包裝至套組(kit)中。具體地,本揭露提供了用於疾病的治療干預的套組,該套組包含經包裝的成套藥物,包括化合物A以及用於製備所述藥物的可遞送形式的緩衝液和其他組分;和/或用於遞送此類藥物的裝置;和/或用於與化合物A的組合療法的任何藥劑;和/或與藥物一起包裝的疾病治療說明書。說明書可以固定於任何可觸摸介質中,例如印刷紙張、或電腦可讀取的磁性或光學介質、或參考遠端電腦數據來源的說明,例如可藉由互聯網存取的萬維網網頁。
「治療有效量」意指有效治療或預防所治療受試者的已有症狀的發展或減輕已有症狀之量。尤其根據本文所提供的詳細揭露,有效量的確定完全在熟悉該項技術者的能力範圍內。通常,「治療有效劑量」係指導致實現所需效果的化合物A之量。例如,與對照相比,治療有效量的化合物A將KRAS活性降低至少5%、至少10%、至少15%、至少20%、至少25%、至少30%、至少35%、至少40%、至少45%、至少50%、至少55%、至少60%、至少65%、至少70%、至少75%、至少80%、至少85%或至少90%。
「治療有效量」意指有效治療或預防所治療受試者的已有症狀的發展或減輕已有症狀之量。尤其根據本文所提供的詳細揭露,有效量的確定完全在熟悉該項技術者的能力範圍內。通常,「治療有效劑量」係指導致實現所需效果的化合物之量。例如,在一個較佳的實施方式中,與對照相比,治療有效量的本文所揭露的化合物將KRAS活性降低至少5%、至少10%、至少15%、至少20%、至少25%、至少30%、至少35%、至少40%、至少45%、至少50%、至少55%、至少60%、至少65%、至少70%、至少75%、至少80%、至少85%或至少90%。
雖然個體需求不同,但化合物的有效量的最佳範圍的確定係在本領域技術範圍的。對於在本文所鑒別的病症和障礙的治癒性或預防性治療中投與人類,例如,本揭露的化合物的典型劑量可為約0.05 mg/kg/天至約50 mg/kg/天,例如至少0.05 mg/kg、至少0.08 mg/kg、至少0.1 mg/kg、至少0.2 mg/kg、至少0.3 mg/kg、至少0.4 mg/kg或至少0.5 mg/kg,並且較佳的是50 mg/kg或更少、40 mg/kg或更少、30 mg/kg或更少、20 mg/kg或更少或10 mg/kg或更少,例如,其可為約2.5 mg/天(0.5 mg/kg x 5 kg)至約5000 mg/天(50 mg/kg x 100 kg)。例如,化合物的劑量可為約0.1 mg/kg/天至約50 mg/kg/天、約0.05 mg/kg/天至約10 mg/kg/天、約0.05 mg/kg/天至約5 mg/kg/天、約0.05 mg/kg/天至約3 mg/kg/天、約0.07 mg/kg/天至約3 mg/kg/天、約0.09 mg/kg/天至約3 mg/kg/天、約0.05 mg/kg/天至約0.1 mg/kg/天、約0.1 mg/kg/天至約1 mg/kg/天、約1 mg/kg/天至約10 mg/kg/天、約1 mg/kg/天至約5 mg/kg/天、約1 mg/kg/天至約3 mg/kg/天、約1 mg/天至約960 mg/天、約20 mg/天至約720 mg/天、約3 mg/天至約500 mg/天、約5 mg/天至約360 mg/天、約10 mg/天至約100 mg/天、約3 mg/天至約10 mg/天、約100 mg/天至約250 mg/天。此類劑量能以單一劑量來投與,或者可以將其分為多個劑量。
在具體的實施方式中,將化合物A每天一次口服投與給有需要之受試者。在一些情況下,向受試者投與的總每日量係180 mg、360 mg、720 mg或960 mg。在某些情況下,化合物A的總每日量係180 mg。在某些情況下,化合物A的總每日量係360 mg。在某些情況下,化合物A的總每日量係720 mg。在某些情況下,化合物A的總每日量係960 mg。在某些情況下,化合物A以分開的日劑量投與,如每天兩次、三次、四次、五次或六次。
實施方式
在第一實施方式中,本揭露提供了治療癌症之方法,該方法包括以180 mg、360 mg、720 mg或960 mg的日劑量向有需要的受試者投與化合物A,其中化合物A具有以下結構
。
在第2實施方式中,本揭露提供了如實施方式1所述之方法,其中化合物A具有結構
。
在第3實施方式中,本揭露提供了如實施方式1所述之方法,其中化合物A具有結構
。
在第4實施方式中,本揭露提供了如實施方式1、2或3中任一項所述之方法,其中該癌症係實性腫瘤。
在第5實施方式中,本揭露提供了如實施方式1、2、3或4中任一項所述之方法,其中該癌症係非小細胞肺癌。
在第6實施方式中,本揭露提供了如實施方式1-4中任一項所述之方法,其中該癌症係大腸直腸癌。
在第7實施方式中,本揭露提供了如實施方式1-4中任一項所述之方法,其中該癌症係胰臟癌。
在第8實施方式中,本揭露提供了如實施方式1至7中任一項所述之方法,其中該癌症係KRAS G12C突變之癌症。
在第9實施方式中,本揭露提供了如實施方式1至8中任一項所述之方法,其中該受試者在開始化合物A療法之前已經經歷了至少一種其他全身性癌症療法。
在第10實施方式中,本揭露提供了如實施方式9所述之方法,其中該受試者經歷了至少兩種其他全身性癌症療法。
在第11實施方式中,本揭露提供了如實施方式1至9中任一項所述之方法,其中化合物A經口服投與。
在第12實施方式中,本揭露提供了如實施方式1至11中任一項所述之方法,其中該化合物A以單個日劑量投與。
在第13實施方式中,本揭露提供了如實施方式1至12中任一項所述之方法,其中該受試者在投與化合物A至少1個月後沒有表現出與化合物A療法相關的任何3級或4級不良事件。
在第14實施方式中,本揭露提供了如實施方式13所述之方法,其中該受試者在投與化合物A至少3個月後沒有表現出與化合物A療法相關的任何3級或4級不良事件。
在第15實施方式中,本揭露提供了如實施方式1至14中任一項所述之方法,其中該化合物A的劑量係180 mg。
在第16實施方式中,本揭露提供了如實施方式1-14中任一項所述之方法,其中化合物A的劑量係360 mg。
在第17實施方式中,本揭露提供了如實施方式1至14中任一項所述之方法,其中化合物A的劑量係720 mg。
在第18實施方式中,本揭露提供了如實施方式1-14中任一項所述之方法,其中化合物A的劑量係960 mg。
在第19實施方式中,本揭露提供了如實施方式1至18中任一項所述之方法,其中向該受試者投與化合物A至少一個月。
在第20實施方式中,本揭露提供了如實施方式1至18中任一項所述之方法,其中向該受試者投與化合物A至少三個月。
在第21實施方式中,本揭露提供了如實施方式1至18中任一項所述之方法,其中向該受試者投與化合物A至少六個月。
在第22實施方式中,本揭露提供了如實施方式19至21中任一項所述之方法,其中該受試者至少表現出穩定性疾病(SD)。
在第23實施方式中,本揭露提供了如實施方式22所述之方法,其中該受試者至少表現出部分反應(PR)。
在第24實施方式中,本揭露提供了如實施方式1至23中任一項所述之方法,其中該受試者沒有表現出劑量限制性毒性(DLT)。
在第25實施方式中,本揭露提供了如實施方式1至24中任一項所述之方法,其中化合物A係作為M構型異構物。
在第26實施方式中,本揭露提供了如實施方式1至25中任一項所述之方法,其進一步包括向該受試者投與化學治療劑。
在第27實施方式中,本揭露提供了如實施方式24所述之方法,其中該化學治療劑包含抗PD1抗體。
在第28實施方式中,本揭露提供了如實施方式25所述之方法,其中該抗PD1抗體係帕博利珠單抗(Keytruda)、尼沃魯單抗、AUNP-12、AMG 404或匹地利珠單抗。
在第29實施方式中,本揭露提供了如實施方式26所述之方法,其中該化學治療劑包含抗PDL1抗體。
在第30實施方式中,本揭露提供了如實施方式29所述之方法,其中該抗PDL1抗體係阿特利珠單抗、MPDL3280A、阿維魯單抗或度伐魯單抗。
在第31實施方式中,本揭露提供了如實施方式26所述之方法,其中該化學治療劑包含MEK抑制劑。
在第32實施方式中,本揭露提供了如實施方式31所述之方法,其中該MEK抑制劑係曲美替尼、匹馬塞替尼、PD-325901、MEK162、TAK-733、GDC-0973或AZD8330。
在第33實施方式中,本揭露提供了如實施方式26所述之方法,其中該化學治療劑包含CDK4/6抑制劑。
在第34實施方式中,本揭露提供了如實施方式33所述之方法,其中該CDK4/6抑制劑包含阿貝西利或帕柏西利。
在第35實施方式中,本揭露提供了如實施方式26所述之方法,其中該化學治療劑包含PI3K抑制劑。
在第36實施方式中,本揭露提供了如實施方式35所述之方法,其中該PI3K抑制劑包含AMG 511或布帕尼西。
在第37實施方式中,本揭露提供了如實施方式22所述之方法,其中該穩定性疾病係既不足夠退縮以符合PR,也不足夠增加以符合PD。
在第38實施方式中,本揭露提供了如實施方式23所述之方法,其中該部分反應係靶病變直徑的總和至少降低30%。
在可替代的第一實施方式中,本揭露提供了日劑量180 mg、360 mg、720 mg或960 mg的化合物A,用於治療癌症,其中化合物A具有以下結構
。
在另一個可替代的第一實施方式中,本揭露提供了日劑量180 mg、360 mg、720 mg或960 mg的化合物A在製備用於治療癌症的藥物中之用途,其中化合物A具有以下結構
。
使用化合物 A 之方法
在本文揭露之方法的實施方式中,以揭露的劑量向受試者投與化合物A至少一個月、至少六個星期、至少兩個月、至少三個月、至少四個月、至少五個月或至少六個月。
在本文揭露之方法的一些實施方式中,以揭露的劑量每天至少一次(QD)向受試者口服投與化合物A。
在本文揭露之方法的一些實施方式中,以揭露的劑量每天至少兩次(BID)向受試者口服投與化合物A。
本揭露提供了抑制RAS介導的細胞傳訊之方法,該方法包括使細胞與有效量的化合物A接觸。可以藉由本領域已知的多種方式來評估和證明對RAS介導的訊號轉導的抑制。非限制性實例包括顯示 (a) RAS的GTP酶活性降低;(b) GTP結合親和力降低或GDP結合親和力增加;(c) GTP的K
off增加或GDP的K
off減少;(d) RAS通路中下游訊號轉導分子水平的降低,例如pMEK、pERK或pAKT水平的降低;和/或 (e) RAS複合物與下游傳訊分子的結合減少,該下游傳訊分子包括但不限於Raf。可以利用套組和市售測定來確定上述項中的一種或多種。
本揭露還提供了使用本揭露的化合物A或藥物組成物治療疾病病症之方法,該等疾病病症包括但不限於受累於G12C KRAS、HRAS或NRAS突變的病症(例如,癌症)。
在一些實施方式中,提供了治療癌症之方法,該方法包括向有需要的受試者投與有效量的如本文揭露的化合物A。在一些實施方式中,癌症係由KRAS、HRAS或NRAS G12C突變介導的。在各種實施方式中,癌症係胰臟癌、大腸直腸癌或肺癌(例如,非小細胞肺癌(局部晚期或轉移性))。在一些實施方式中,癌症係膽囊癌、甲狀腺癌和膽管癌。
在一些實施方式中,本揭露提供了治療有需要的受試者的障礙之方法,其中所述方法包括確定受試者是否具有KRAS、HRAS或NRAS G12C突變,以及如果確定受試者具有KRAS、HRAS或NRAS G12C突變,那麼向受試者投與治療有效劑量的化合物A或其藥學上可接受的鹽。
所揭露化合物抑制非錨定依賴性細胞生長,並且因此具有抑制腫瘤轉移的潛力。因此,本揭露的另一個實施方式提供了抑制腫瘤轉移之方法,該方法包括投與有效量的化合物A。
還已經在血液惡性腫瘤(例如,影響血液、骨髓和/或淋巴結的癌症)中鑒別出KRAS、HRAS或NRAS G12C突變。因此,某些實施方式關於將化合物A(例如,呈藥物組成物形式)投與需要治療血液惡性腫瘤之患者。此類惡性腫瘤包括但不限於白血病和淋巴瘤。例如,化合物A可以用於治療例如以下等疾病:急性淋巴細胞性白血病(ALL)、急性骨髓性白血病(AML)、慢性淋巴球性白血病(CLL)、小淋巴細胞淋巴瘤(SLL)、慢性髓性白血病(CML)、急性單核球性白血病(AMoL)和/或其他白血病。在其他實施方式中,化合物A可用於治療淋巴瘤,例如所有亞型的何杰金氏淋巴瘤或非何杰金氏淋巴瘤。在各個實施方式中,化合物A可用於治療漿細胞惡性腫瘤,例如多發性骨髓瘤、外膜細胞淋巴瘤和華氏巨球蛋白血症。
確定腫瘤或癌症是否包含G12C KRAS、HRAS或NRAS突變可以藉由評估編碼KRAS、HRAS或NRAS蛋白的核苷酸序列,藉由評估KRAS、HRAS或NRAS蛋白的胺基酸序列,或藉由評估推定的KRAS、HRAS或NRAS突變體蛋白的特徵來進行。野生型人類KRAS、HRAS或NRAS的序列係本領域已知的(例如,登錄號NP203524)。
檢測KRAS、HRAS或NRAS核苷酸序列中的突變之方法係熟悉該項技術者已知的。該等方法包括但不限於聚合酶鏈式反應-限制性片段長度多態性(PCR-RFLP)測定、聚合酶鏈式反應-單股構象多態性(PCR-SSCP)測定、即時PCR測定、PCR定序、突變體等位基因特異性PCR擴增(MASA)測定、直接定序、引物延伸反應、電泳、寡核苷酸連接測定、雜交測定、TaqMan測定、SNP基因分型測定、高解析度熔解測定和微陣列分析。在一些實施方式中,藉由即時PCR針對G12C KRAS、HRAS或NRAS突變評估樣本。在即時PCR中,使用對KRAS、HRAS或NRAS G12C突變具特異性的螢光探針。在突變存在時,探針結合並檢測到螢光。在一些實施方式中,使用KRAS、HRAS或NRAS基因中的特定區域(例如,外顯子2和/或外顯子3)的直接定序方法來鑒別KRAS、HRAS或NRAS G12C突變。這種技術將鑒別所定序區域中所有可能的突變。
用於檢測KRAS、HRAS或NRAS蛋白中的突變之方法係熟悉該項技術者已知的。該等方法包括但不限於使用對突變體蛋白具特異性的結合劑(例如,抗體)檢測KRAS、HRAS或NRAS突變體、蛋白質電泳和蛋白質印跡法、以及直接肽定序。
用於確定腫瘤或癌症是否包含G12C KRAS、HRAS或NRAS突變之方法可以使用多種樣本。在一些實施方式中,樣本取自患有腫瘤或癌症之受試者。在一些實施方式中,樣本係新鮮腫瘤/癌症樣本。在一些實施方式中,樣本係冷凍腫瘤/癌症樣本。在一些實施方式中,樣本係福馬林固定的石蠟包埋的樣本。在一些實施方式中,樣本係循環腫瘤細胞(CTC)樣本。在一些實施方式中,樣本經處理成細胞溶解產物。在一些實施方式中,樣本經處理成DNA或RNA。
本揭露還關於治療哺乳動物的過度增生障礙之方法,該方法包括向所述哺乳動物投與治療有效量的化合物A或其藥學上可接受的鹽。在一些實施方式中,所述方法涉及治療患有癌症的受試者,該癌症係例如急性髓樣白血病、青少年癌症、兒童腎上腺皮質癌、AIDS相關癌症(例如,淋巴瘤和卡波西氏肉瘤)、肛門癌、闌尾癌、星形細胞瘤、非典型類畸胎瘤、基底細胞癌、膽管癌、膀胱癌、骨癌、腦幹細胞神經膠質瘤、腦瘤、乳腺癌、支氣管腫瘤、柏基特氏淋巴瘤、類癌瘤、非典型類畸胎瘤、胚胎瘤、胚細胞瘤、原發性淋巴瘤、宮頸癌、兒童癌症、脊索瘤、心臟腫瘤、慢性淋巴球性白血病(CLL)、慢性髓性白血病(CML)、慢性骨髓增生性障礙、大腸癌、大腸直腸癌、顱咽管瘤、皮膚T細胞淋巴瘤、肝外導管原位癌(DCIS)、胚胎瘤、CNS癌症、子宮內膜癌、室管膜瘤、食管癌、鼻腔神經膠質瘤、尤文氏肉瘤、顱外胚細胞瘤、性腺外胚細胞瘤、眼癌、骨纖維組織細胞瘤、膽囊癌、胃癌、胃腸類癌瘤、胃腸道間質瘤(GIST)、胚細胞瘤、妊娠滋養細胞瘤、毛細胞白血病、頭頸癌、心臟癌症、肝癌、何杰金氏淋巴瘤、下嚥癌、眼內黑色素瘤、胰島細胞瘤、胰腺神經內分泌腫瘤、腎癌、喉癌、嘴唇和口腔癌、肝癌、小葉原位癌(LCIS)、肺癌、淋巴瘤、轉移性伴隱匿性原發性鱗狀頸癌、中線癌、口腔癌、多發性內分泌瘤綜合症、多發性骨髓瘤/漿細胞腫瘤、蕈樣真菌病、骨髓發育不良症候群、骨髓化生不良/骨髓增生腫瘤、多發性骨髓瘤、梅克爾細胞癌、惡性間皮瘤、骨惡性纖維組織細胞瘤和骨肉瘤、鼻腔和副鼻竇癌、鼻咽癌、神經母細胞瘤、非何杰金氏淋巴瘤、非小細胞肺癌(NSCLC)、口癌、嘴唇和口腔癌、口咽癌、卵巢癌、胰臟癌、乳頭瘤病、副神經節瘤、副鼻竇和鼻腔癌、副甲狀腺癌、陰莖癌、咽癌、胸膜肺母細胞瘤、原發性中樞神經系統(CNS)淋巴瘤、前列腺癌、直腸癌、移行細胞癌、視網膜母細胞瘤、橫紋肌肉瘤、涎腺癌、皮膚癌、胃(stomach/gastric)癌、小細胞肺癌、小腸癌、軟組織肉瘤、T細胞淋巴瘤、睾丸癌、咽喉癌、胸腺瘤和胸腺癌、甲狀腺癌、腎盂和輸尿管移行細胞癌、滋養細胞瘤、兒童罕見癌症、尿道癌、子宮肉瘤、陰道癌、外陰癌或病毒誘發的癌症。在一些實施方式中,所述方法涉及治療非癌性過度增生障礙,例如皮膚的良性增生(例如,牛皮癬)、再狹窄或前列腺(例如,良性前列腺肥大(BPH))。
在一些實施方式中,治療方法涉及治療肺癌,該等方法包括向有此需要的受試者投與有效量的化合物A(或包含該化合物的藥物組成物)。在某些實施方式中,肺癌係非小細胞肺癌(NSCLC),例如腺癌、鱗狀細胞肺癌或大細胞肺癌。在一些實施方式中,肺癌係小細胞肺癌。可用所揭露化合物治療的其他肺癌包括但不限於腺瘤、類癌瘤和未分化癌。
本揭露進一步提供了調節G12C突變體KRAS、HRAS或NRAS蛋白活性之方法,其藉由使該蛋白與有效量的化合物A接觸來進行。調節可為抑制或激活蛋白質活性。在一些實施方式中,本揭露提供了抑制蛋白質活性之方法,其藉由使G12C突變體KRAS、HRAS或NRAS蛋白與有效量的化合物A在溶液中接觸來進行。在一些實施方式中,本揭露提供了抑制G12C突變體KRAS、HRAS或NRAS蛋白活性之方法,其藉由接觸表現感興趣的蛋白質的細胞、組織或器官來進行。在一些實施方式中,本揭露提供了在包括但不限於齧齒動物和哺乳動物(例如,人類)的受試者中抑制蛋白質活性之方法,其藉由向該受試者投與有效量的化合物A來進行。在一些實施方式中,調節百分比超過25%、30%、40%、50%、60%、70%、80%或90%。在一些實施方式中,抑制百分比超過25%、30%、40%、50%、60%、70%、80%或90%。
在一些實施方式中,本揭露提供了抑制細胞中的KRAS、HRAS或NRAS G12C活性之方法,其藉由使所述細胞與一定量的化合物A接觸來進行,該量足以抑制所述細胞中KRAS、HRAS或NRAS G12C的活性。在一些實施方式中,本揭露提供了抑制組織中的KRAS、HRAS或NRAS G12C活性之方法,其藉由使所述組織與一定量的化合物A接觸來進行,該量足以抑制所述組織中KRAS、HRAS或NRAS G12C的活性。在一些實施方式中,本揭露提供了抑制生物體中的KRAS、HRAS或NRAS G12C活性之方法,其藉由使所述生物體與一定量的化合物A接觸來進行,該量足以抑制所述生物體中KRAS、HRAS或NRAS G12C的活性。在一些實施方式中,本揭露提供了抑制動物中的KRAS、HRAS或NRAS G12C活性之方法,其藉由使所述動物與一定量的化合物A接觸來進行,該量足以抑制所述動物中KRAS、HRAS或NRAS G12C的活性。在一些實施方式中,本揭露提供了抑制哺乳動物中的KRAS、HRAS或NRAS G12C活性之方法,其藉由使所述哺乳動物與一定量的化合物A接觸來進行,該量足以抑制所述哺乳動物中KRAS、HRAS或NRAS G12C的活性。在一些實施方式中,本揭露提供了抑制人類中的KRAS、HRAS或NRAS G12C活性之方法,其藉由使所述人類與一定量的化合物A接觸來進行,該量足以抑制所述人類中KRAS、HRAS或NRAS G12C的活性。本揭露提供了治療需要這種治療的受試者的由KRAS、HRAS或NRAS G12C活性介導的疾病之方法。
受試者選擇和治療結果
在一些實施方式中,在所揭露之方法中用化合物A治療的受試者係已經經歷了至少一種或多種先前的全身性癌症療法(例如,化合物A係二線或三線療法)之受試者。在一些實施方式中,在所揭露之方法中用化合物A治療的受試者係在至少一種先前的全身性癌症療法(即化合物A係二線療法)之後疾病進展之受試者。在一些實施方式中,在所揭露之方法中用化合物A治療的受試者係在至少兩種先前的全身性癌症療法(即化合物A係三線療法)之後疾病進展之受試者。先前的全身性癌症療法可為任何經監管機構(例如FDA或EMA)批准的治療給定癌症類型和階段之療法。在某些情況下,先前的全身性癌症療法係未經監管機構批准但正在進行臨床試驗的癌症療法。如果受試者已經進行了先前的全身性癌症療法,在某些情況下,在開始本文所揭露之化合物A的療法之前,受試者已經至少一個月、至少兩個月、至少三個月、至少四個月、至少五個月或至少六個月沒有進行任何全身性癌症療法。
在一些實施方式中,該受試者將表現出病理學證明的,具有藉由分子測試鑒定的
KRAS p G12C 突變的局部晚期或轉移性惡性腫瘤。該突變將在登記前由中心測試確認。
在一些實施方式中,對於NSCLC,受試者可以在接受AMG 510(化合物A)之前接受基於鉑的組合療法和/或靶向療法(即,如果分子測試已經鑒定出EGFR、ALK或原癌基因酪胺酸蛋白激酶ROS[ROS1]或計劃性死亡配位基[PD-L1]表現中的突變)。
在一些實施方式中,受試者中的NSCLC在接受抗PD1或抗PD-L1免疫療法(除非禁忌)和/或基於鉑的的組合化療和靶向療法(如果鑒定出可作用的致癌驅動突變[即EGFR、ALK和ROS1])之後必須已經進展。受試者必須已經接受不超過3個先前的療法線。
在大腸直腸癌(CRC)的一些實施方式中,在轉移情況下受試者必須接受至少2種先前的全身性方案。對於那些患有MSI-H腫瘤的CRC受試者,如果他們在臨床上能夠接受抑制劑,並且其中1種藥劑在該地區或國家被批准用於該適應症,則先前的全身性方案中的至少1種必須是用尼沃魯單抗或帕博利珠單抗治療。
在一些實施方式中,受試者的CRC必須在接受氟嘧啶和奧沙利鉑和伊立替康後進展。對於那些患有MSI-H腫瘤的CRC受試者,如果他們在臨床上能夠接受抑制劑,並且其中該等藥劑中的1種在該地區或國家被批准用於該適應症,則先前的全身性方案中的至少1種必須包括抗PD1療法。
在一些實施方式中,對於除NSCLC或CRC之外的晚期實性腫瘤類型,受試者必須已經接受過至少一種不能耐受的或不符合已知提供臨床益處的可用療法的先前全身性療法。
在一些實施方式中,可以視需要將化合物A的劑量與食物一起(例如食用標準化的高脂肪、高卡路里膳食)或者在空腹狀態(無食物或液體(除了水)≥ 10小時)或投與給受試者。在一個實施方式中,化合物A的劑量(例如每天一次960 mg)與食物一起或不與食物一起投與。
在療法過程中監測接受治療的受試者的不良事件(AE)。與治療有關的AE係與治療藥物相關的AE。治療緊急AE係受試者在療法開始前不存在的在治療過程中發生的AE。在某些情況下,治療緊急AE與治療本身無關或被懷疑與治療本身無關。AE的特徵在於五個級別:1級為輕度AE;2級為中度AE;3級為嚴重AE;4級為危及生命或致殘的AE;5級為AE相關死亡。在某些情況下,受試者沒有表現出任何與治療相關的3級AE。在某些情況下,受試者沒有表現出任何3級AE。在某些情況下,受試者沒有表現出任何與治療相關的4級AE。在某些情況下,受試者沒有表現出任何4級AE。在各種情況下,受試者在投與化合物A至少一個月或至少三個月後沒有表現出與治療相關的3級或4級AE。
在各種情況下,在本文揭露之方法中用化合物A治療的受試者在投與的劑量下不表現出任何劑量限制性毒性(DLT)。DLT係在化合物A的第一個治療週期(第1天至第21天)中發生的符合以下標準的任何AE,其中不能排除與藥物的關係。AE的分級係基於CTCAE 5.0版中提供的指南。用於DLT評估的AE:
血液學毒性:發熱性嗜中性白血球減少症;嗜中性白血球減少症性感染;4級嗜中性白血球減少症;≥ 3級血小板減少 > 7天;3級血小板減少伴 ≥ 2級出血;4級血小板減少;4級貧血
非血液學毒性分級 ≥ 4級,嘔吐或腹瀉;儘管有最佳醫療支持,但3級腹瀉或3級嘔吐持續3天以上;儘管有最佳的醫療支持,但 ≥ 3級噁心持續3天或3天以上;任何其他 ≥ 3級AE
在各種情況下,所揭露之方法的受試者表現出對療法的反應。在某些情況下,由於投與化合物A,該受試者至少表現出穩定性疾病(SD)。在某些情況下,由於投與化合物A,該受試者至少表現出部分反應(PR)。藉由RECIST 1.1定義的標準(例如,Eisenhauer等人,
Eur J Cancer[ 歐洲癌症雜誌 ],45:228-247 (2009)中所討論的)評估受試者的反應。完全反應(CR)係所有靶病變消失,並且任何病理淋巴結短軸降低到10 mm以下。部分反應(PR)係以基線總直徑為參考,靶病變直徑總和至少減少30%。進展性疾病係指以研究中的最小和(如果基線和係研究中的最小和,則包括基線和)為參考,靶病變直徑和至少增加20%,並且除了20%的相對增加之外,還必須有至少5 mm的絕對增加。穩定性疾病係既不足夠退縮以符合PR,也不足夠增加符合以PD。受控的疾病狀態係患者可以在表現出穩定性疾病和部分反應之間交替。腫瘤大小可以藉由放射照相掃描來測量。
組合療法
本揭露還提供了用於組合療法之方法,其中將已知可調節其他途徑或相同途徑的其他組分、或甚至靶標酶的重疊集合的藥劑與化合物A或其藥學上可接受的鹽組合使用。一方面,此類療法包括但不限於本文所揭露的化合物A與化學治療劑的組合以提供協同或累加的治療作用。
許多化學治療劑係本領域目前已知的,並且可以與化合物A組合使用。在一些實施方式中,化學治療劑選自由以下組成之群組:有絲分裂抑制劑、烷基化劑、抗代謝藥、嵌入抗生素、生長因子抑制劑、細胞週期抑制劑、酶、拓撲異構酶抑制劑、生物反應修飾劑、抗激素藥、血管發生抑制劑和抗雄激素。非限制性實例係化學治療劑、細胞毒性劑和非肽小分子,例如Gleevec®(甲磺酸伊馬替尼)、Kyprolis®(卡非佐米(carfilzomib))、Velcade®(硼替佐米(carfilzomib))、Casodex(比卡魯胺)、Iressa®(吉非替尼(gefitinib))、Venclexta
TM(維納妥拉(venetoclax))和Adriamycin
TM(多柔比星(docorubicin))以及多種化學治療劑。化學治療劑的非限制性實例包括烷基化劑,例如噻替派(thiotepa)和環磷醯胺(cyclosphosphamide)(Cytoxan
TM);烷基磺酸酯,例如白消安(busulfan)、英丙舒凡(improsulfan)和哌泊舒凡(piposulfan);氮丙啶,例如苯佐替哌(benzodopa)、卡波醌(carboquone)、美妥替哌(meturedopa)和烏瑞替哌(uredopa);乙烯亞胺和甲基蜜胺(methylamelamine),包括六甲蜜胺、三伸乙基蜜胺、三伸乙基磷醯胺、三伸乙基硫代磷醯胺(triethylenethiophosphaoramide)和三羥甲基蜜胺(trimethylolomelamine);氮芥(nitrogen mustard),例如苯丁酸氮芥、萘氮芥、氯環磷醯胺、雌氮芥、異環磷醯胺、二氯甲基二乙胺、鹽酸甲氧氮芥(mechlorethamine oxide hydrochloride)、美法侖(melphalan)、新恩比興(novembichin)、苯芥膽甾醇(phenesterine)、潑尼莫司汀(prednimustine)、曲磷胺、尿嘧啶氮芥;亞硝基脲,例如卡莫司汀(carmustine)、氯脲黴素(chlorozotocin)、福莫司汀(fotemustine)、洛莫司汀(lomustine)、尼莫司汀(nimustine)、雷莫司汀(ranimustine);抗生素,例如阿克拉黴素(aclacinomysin)、放線菌素(actinomycin)、安麯黴素(authramycin)、重氮絲胺酸、博來黴素、放線菌素(cactinomycin)、卡奇黴素(calicheamicin)、卡柔比星(carabicin)、洋紅黴素(carminomycin)、嗜癌菌素(carzinophilin)、Casodex
TM、色黴素(chromomycins)、更生黴素(dactinomycin)、道諾黴素(daunorubicin)、地托比星(detorubicin)、6-重氮基-5-側氧基-L-正白胺酸、多柔比星(doxorubicin)、表柔比星(epirubicin)、依索比星(esorubicin)、伊達比星(idarubicin)、麻西羅黴素(marcellomycin)、絲裂黴素(mitomycins)、黴酚酸(mycophenolic acid)、諾加黴素(nogalamycin)、橄欖黴素(olivomycins)、培洛黴素(peplomycin)、泊非黴素(potfiromycin)、嘌呤黴素(puromycin)、三鐵阿黴素(quelamycin)、羅多比星(rodorubicin)、鏈黑菌素(streptonigrin)、鏈脲黴素(streptozocin)、殺結核菌素(tubercidin)、烏苯美司(ubenimex)、淨司他丁(zinostatin)、佐柔比星(zorubicin);抗代謝藥,例如胺甲喋呤和5-氟尿嘧啶(5-FU);葉酸類似物,例如二甲葉酸(denopterin)、胺甲喋呤、蝶羅呤(pteropterin)、三甲曲沙(trimetrexate);嘌呤類似物,例如氟達拉濱、6-巰嘌呤、硫咪嘌呤、硫鳥嘌呤;嘧啶類似物,例如安西他濱(azacitidine)、阿紮胞苷、6-氮雜尿苷、卡莫氟(carmofur)、阿糖胞苷、二去氧尿苷、去氧氟尿苷、依諾他濱、氟尿苷,雄激素例如卡普睾酮、屈他雄酮丙酸酯(dromostanolone propionate)、環硫雄醇、美雄烷、睾內酯;抗腎上腺藥,例如氨魯米特(aminoglutethimide)、米托坦(mitotane)、曲洛司坦(trilostane);葉酸補充劑,例如亞葉酸(frolinic acid);醋葡醛內酯(aceglatone);醛磷醯胺糖苷(aldophosphamide glycoside);胺基乙醯丙酸(aminolevulinic acid;);安吖啶(amsacrine);倍曲布西(bestrabucil);比生群(bisantrene);依達曲沙(edatraxate);地磷醯胺(defofamine);秋水仙胺(demecolcine);地吖醌(diaziquone);依氟鳥胺酸(elfomithine);依利醋銨(elliptinium acetate);依託格魯(etoglucid);硝酸鎵(gallium nitrate);羥基脲(hydroxyurea);香菇多糖(lentinan);氯尼達明(lonidamine);米托胍腙(mitoguazone);米托蒽醌(mitoxantrone);莫哌達醇(mopidamol);硝胺丙吖啶(nitracrine);噴司他汀(pentostatin);蛋胺氮芥(phenamet);吡柔比星(pirarubicin);鬼臼酸(podophyllinic acid);2-乙基醯肼(2-ethylhydrazide);丙卡巴肼(procarbazine);PSK;丙亞胺(razoxane);西佐喃(sizofiran);鍺螺胺(spirogermanium);細交鏈孢菌酮酸(tenuazonic acid);三亞胺醌(triaziquone);2,2',2''-三氯三乙胺;烏拉坦(urethan);長春地辛(vindesine);達卡巴𠯤(dacarbazine);甘露莫司汀(mannomustine);二溴甘露醇(mitobronitol);二溴衛矛醇(mitolactol);哌泊溴烷(pipobroman);加賽特辛(gacytosine);阿拉伯糖苷(「Ara-C」);環磷醯胺;噻替派;紫杉烷(taxane),例如太平洋紫杉醇(paclitaxel)及多西他賽(docetaxel);視黃酸(retinoic acid);埃斯波黴素(esperamicin);卡培他濱(capecitabine);以及上述任何一種的藥學上可接受的鹽、酸或衍生物。
作為適合的化學治療性細胞調理劑還包括用於調節或抑制激素對腫瘤的作用的抗激素劑,例如抗雌激素藥,包括例如他莫昔芬(Nolvadex
TM)、雷洛昔芬、芳香酶抑制性4(5)-咪唑、4-羥基他莫昔芬、曲沃昔芬、可莫昔芬(keoxifene)、LY 117018、奧那司酮和托瑞米芬(法樂通);和抗雄激素藥,例如氟他胺(flutamide)、尼魯米特(nilutamide)、比卡魯胺(bicalutamide)、亮丙瑞林(leuprolide)及戈舍瑞林(goserelin);苯丁酸氮芥(chlorambucil);吉西他濱(gemcitabine);6-硫鳥嘌呤;巰嘌呤;胺甲喋呤;鉑類似物,例如順鉑和卡鉑;長春鹼(vinblastine);鉑;依託泊苷(etoposide)(VP-16);異環磷醯胺;絲裂黴素C;米托蒽醌(mitoxantrone);長春新鹼(vincristine);長春瑞濱(vinorelbine);諾維本(navelbine);諾安托(novantrone);替尼泊苷(teniposide);道諾黴素(daunomycin);胺基蝶呤;希羅達(xeloda);伊班膦酸鹽(ibandronate);喜樹鹼-11(CPT-11);拓樸異構酶抑制劑RFS 2000;二氟甲基鳥胺酸(DMFO)。
化合物A可以與通常開具的抗癌藥物組合使用,例如Herceptin®、Avastin®、Erbitux®、Rituxan®、Taxol®、Arimidex®、Taxotere®、ABVD、阿維金(AVICINE)、阿巴伏單抗(Abagovomab)、吖啶羧醯胺(Acridine carboxamide)、阿德木單抗(Adecatumumab)、17-N-烯丙基胺基-17-去甲氧基格爾德黴素、阿法雷丁(Alpharadin)、阿瓦昔地(Alvocidib)、3-胺基吡啶-2-甲醛胺基硫脲、胺萘非特(Amonafide)、蒽二酮(Anthracenedione)、抗CD22免疫毒素、抗腫瘤藥、抗腫瘤發生草藥(Antitumorigenic herbs)、阿帕茲醌(Apaziquone)、阿替莫德(Atiprimod)、硫唑嘌呤(Azathioprine)、貝洛替康(Belotecan)、苯達莫司汀(Bendamustine)、BIBW 2992、比立考達(Biricodar)、伯斯塔利辛(Brostallicin)、苔蘚抑素(Bryostatin)、丁硫胺酸亞碸胺(Buthionine sulfoximine)、CBV(化學療法)、花萼海綿誘癌素(Calyculin)、細胞週期非特異性抗腫瘤劑、二氯乙酸、圓皮海綿內酯(Discodermolide)、依沙蘆星(Elsamitrucin)、依諾他濱(Enocitabine)、埃博黴素(Epothilone)、艾日布林(Eribulin)、依維莫司(Everolimus)、依沙替康(Exatecan)、依昔舒林(Exisulind)、鐵銹醇(Ferruginol)、氟羅德辛(Forodesine)、磷雌酚(Fosfestrol)、ICE化學治療方案、IT-101、伊美克(Imexon)、咪喹莫特(Imiquimod)、吲哚并咔唑(Indolocarbazole)、伊羅夫文(Irofulven)、拉尼喹達(Laniquidar)、拉洛他賽(Larotaxel)、來那度胺(Lenalidomide)、硫蒽酮(Lucanthone)、勒托替康(Lurtotecan)、馬磷醯胺(Mafosfamide)、米托唑胺(Mitozolomide)、萘福昔定(Nafoxidine)、奈達鉑(Nedaplatin)、奧拉帕尼(Olaparib)、沃塔紫杉醇(Ortataxel)、PAC-1、木瓜(Pawpaw)、匹杉瓊(Pixantrone)、蛋白酶體抑制劑、蝴蝶黴素(Rebeccamycin)、瑞喹莫德(Resiquimod)、魯比特康(Rubitecan)、SN-38、鹽孢菌醯胺A(Salinosporamide A)、沙帕他濱(Sapacitabine)、斯坦福V(Stanford V)、苦馬豆素(Swainsonine)、他拉泊芬(Talaporfin)、塔利喹達(Tariquidar)、優福定(Tegafur-uracil)、特莫多(Temodar)、替司他賽(Tesetaxel)、四硝酸三鉑(Triplatin tetranitrate)、三(2-氯乙基)胺、曲沙他濱(Troxacitabine)、烏拉莫司汀(Uramustine)、瓦帝莫澤(Vadimezan)、長春氟寧(Vinflunine)、ZD6126或唑喹達(Zosuquidar)。
預期將化合物A與化學治療劑在共同療法中使用,該化學治療劑係抗腫瘤藥劑,例如醋孟南(acemannan)、阿柔比星、阿地白介素、阿侖單抗(alemtuzumab)、阿利維A酸(alitretinoin)、六甲蜜胺、胺磷汀、胺基乙醯丙酸、胺柔比星、安吖啶、阿那格雷、阿那曲唑、ANCER、安西司亭(ancestim)、阿加來必(ARGLABIN)、三氧化二砷、BAM 002(諾夫洛斯公司(Novelos))、貝沙羅汀(bexarotene)、比卡魯胺、溴尿苷、卡培他濱、西莫白介素、西曲瑞克、克拉屈濱、克黴唑、阿糖胞苷十八烷基磷酸鹽(cytarabine ocfosfate)、DA 3030(Dong-A)、達克珠單抗(daclizumab)、地尼白介素(denileukin diftitox)、地洛瑞林(deslorelin)、右雷佐生、地拉卓(dilazep)、多西他賽、二十二醇、度骨化醇(doxercalciferol)、去氧氟尿苷、多柔比星、溴隱亭、卡莫司汀、阿糖胞苷、氟尿嘧啶、HIT雙氯酚酸、干擾素-α、道諾黴素、多柔比星、維甲酸、依地福新、依決洛單抗、依氟鳥胺酸(eflornithine)、乙嘧替氟、表柔比星、紅血球生成素β、磷酸依託泊苷、依西美坦、依昔舒林(exisulind)、法倔唑、非格司亭(filgrastim)、非那雄胺、磷酸氟達拉濱、福美司坦(formestane)、福莫司汀、硝酸鎵、吉西他濱、吉妥珠單抗奧唑米星(gemtuzumab zogamicin)、吉美拉西(gimeracil)/奧替拉西(oteracil)/替加氟組合、格萊克濱(glycopine)、戈舍瑞林、庚鉑(heptaplatin)、人絨毛膜促性腺素、人類胎兒甲胎蛋白、伊班膦酸、伊達比星、咪喹莫特、干擾素-α、干擾素-α、天然干擾素-α-2、干擾素-α-2a、干擾素-α-2b、干擾素-α-N1、干擾素-α-n3、干擾素alfacon-1、干擾素α、天然干擾素β、干擾素β-1a、干擾素β-1b、干擾素γ、天然干擾素γ-1a、干擾素γ-1b、白介素-1β、碘苄胍、伊立替康、伊索拉定(irsogladine)、蘭瑞肽(lanreotide)、LC 9018(養樂多集團(Yakult))、來氟米特、來格司亭(lenograstim)、硫酸香菇多糖、來曲唑、白血球α干擾素、亮丙瑞林、左旋咪唑 + 氟尿嘧啶、利阿唑(liarozole)、洛鉑、氯尼達明、洛伐他汀、馬索羅酚、美拉胂醇、甲氧氯普胺、米非司酮、米替福新、米立司亭、錯配雙股RNA、米托胍腙、二溴衛矛醇、米托蒽醌、莫拉司亭(molgramostim)、那法瑞林、納洛酮 + 噴他佐辛、那托司亭(nartograstim)、奈達鉑、尼魯米特(nilutamide)、那可丁、新穎紅血球生成刺激蛋白、NSC 631570奧曲肽、奧普瑞白介素(oprelvekin)、奧沙特隆、奧沙利鉑(oxaliplatin)、紫杉酚、帕米膦酸(pamidronic acid)、培門冬酶、聚乙二醇干擾素-α-2b、木聚硫鈉(pentosan polysulfate sodium)、噴司他丁、畢西巴尼(picibanil)、吡柔比星、兔抗胸腺細胞多株抗體、聚乙二醇干擾素-α-2a、卟吩姆鈉、雷洛昔芬、雷替曲塞、拉斯伯門特(rasburiembodiment)、羥乙膦酸錸(Re 186)、RII維甲醯酚胺(RII retinamide)、利妥昔單抗、羅莫肽、來昔決南釤(153 Sm)(samarium (153 Sm) lexidronam)、沙格司亭(sargramostim)、西佐喃、索布佐生、索納明(sonermin)、氯化鍶-89、蘇拉明、他索那明(tasonermin)、他紮羅汀、替加氟、替莫泊芬(temoporfin)、替莫唑胺、替尼泊苷、四氯十氧化物、沙利度胺、胸腺法新、促甲狀腺素α、托泊替康(topotecan)、托瑞米芬、托西莫單抗(tositumomab)-碘131、曲妥珠單抗、曲奧舒凡、維甲酸、曲洛司坦、三甲曲沙、曲普瑞林、腫瘤壞死因子α、天然烏苯美司、膀胱癌疫苗、丸山(Maruyama)疫苗、黑色素瘤裂解物疫苗、戊柔比星(valrubicin)、維替泊芬、長春瑞濱、維魯利秦(VIRULIZIN)、淨司他丁斯酯(zinostatin stimalamer)或唑來膦酸;阿巴瑞克(abarelix);AE 941(依特納公司(Aeterna))、胺莫司汀(ambamustine)、反義寡核苷酸、bcl-2(珍塔公司(Genta))、APC 8015(丹德里昂公司(Dendreon))、西妥昔單抗、地西他濱(decitabine)、德胺魯米特(dexaminoglutethimide)、地吖醌、EL 532(義隆公司(Elan))、EM 800(英杜裡奇公司(Endorecherche))、恩尿嘧啶、依他硝唑、芬維A銨(fenretinide)、非格司亭SD01(安進公司(Amgen))、氟維司群、加洛他濱、胃泌素17免疫原、HLA-B7基因療法(偉科公司(Vical))、粒細胞-巨噬細胞群落刺激因子、組胺二鹽酸鹽、替伊莫單抗、伊洛馬司他、IM 862(興創公司(Cytran))、白介素-2、艾潑昔芬(iproxifene)、LDI 200(米克豪公司(Milkhaus))、來立司亭(leridistim)、林妥珠單抗(lintuzumab)、CA 125 MAb(巴米拉公司(Biomira))、癌症MAb(日本製藥發展公司(Japan Pharmaceutical Development))、HER-2和Fc MAb(梅達拉公司(Medarex))、獨特型105AD7 MAb(CRC技術公司(CRC Technology))、獨特型CEA MAb(特裡萊公司(Trilex))、LYM-1-碘131 MAb(特尼克隆公司(Techniclone))、多態性上皮黏液素-釔90 MAb(安特索瑪公司(Antisoma))、馬立馬司他(marimastat)、美諾立爾、米妥莫單抗(mitumomab)、莫特沙芬釓(motexafin gadolinium)、MX 6(高德美公司(Galderma))、奈拉濱(nelarabine)、諾拉曲塞(nolatrexed)、P 30蛋白、培維索孟(pegvisomant)、培美曲塞、泊非黴素(porfiromycin)、普馬司他(prinomastat)、RL 0903(夏爾公司(Shire))、魯吡替康、沙鉑(satraplatin)、苯乙酸鈉、斯帕磷酸(sparfosic acid)、SRL 172(SR製藥公司(SR Pharma))、SU 5416(蘇根公司(SUGEN))、TA 077(田邊公司(Tanabe))、四硫鉬酸鹽、厚果糖松草鹼(thaliblastine)、血小板生成素、本紫紅素乙酯錫(tin ethyl etiopurpurin)、替拉紮明、癌症疫苗(巴米拉公司)、黑色素瘤疫苗(紐約大學(New York University))、黑色素瘤疫苗(斯隆-凱特琳研究所(Sloan Kettering Institute))、黑色素瘤腫瘤裂解物疫苗(紐約醫學院(New York Medical College))、病毒黑色素瘤細胞溶解產物疫苗(皇家紐卡斯爾醫院(Royal Newcastle Hospital))或伐司朴達(valspodar)。
化合物A可與作為PD1抑制劑、PDL1抑制劑、MEK抑制劑、PI3K抑制劑或CDK4/6抑制劑的化學治療劑組合使用。
本揭露的KRAS
G12C抑制劑可以與MEK抑制劑組合使用。可以在本揭露的組合中使用的特定的MEK抑制劑包括PD-325901、曲美替尼、匹馬塞替尼、MEK162[也稱為比尼替尼]、TAK-733、GDC-0973和AZD8330。可以在本揭露的組合中與KRAS
G12C抑制劑一起使用的特定MEK抑制劑係曲美替尼(商品名:Mekinist
®,可購自諾華製藥公司(Novartis Pharmaceuticals Corp.))。另一種特定的MEK抑制劑係N-(((2R)-2,3-二羥丙基)氧基)-3,4-二氟-2-((2-氟-4-碘苯基)胺基)苯甲醯胺,也稱為AMG 1009089、1009089或PD-325901。可用於本揭露組合的另一種特定的MEK抑制劑包括考比替尼(cobimetinib)。在某些情況下,MEK抑制劑係CI-1040、AZD6244、PD318088、PD98059、PD334581、RDEA119、ARRY-142886、ARRY-438162或PD-325901。
在另一方面,化合物A可以與一種或多種作為磷脂醯肌醇3-激酶(PI3K)途徑中的蛋白質的抑制劑的藥劑組合使用。PI3K途徑中的蛋白質實例包括PI3K、mTOR和PKB(也稱為Akt或AKT)。PI3K蛋白以若干種同種型存在,包括α、β、δ或γ。預期PI3K抑制劑可以對一種或多種同種型具有選擇性。選擇性係指該化合物與其他同種型相比,更多地抑制一種或多種同種型。選擇性係熟悉該項技術者熟知的概念,並且可以用熟知的體外或基於細胞的活性測定法進行測量。較佳的選擇性包括對一種或多種同種型的選擇性,與其他同種型相比,大於2倍,較佳的是大於10倍,或更較佳的是100倍更大。在一方面,可與化合物A組合使用的PI3K抑制劑係PI3Kα選擇性抑制劑。在另一方面,化合物係PI3Kδ選擇性抑制劑。在又另一方面,化合物係PI3Kβ選擇性抑制劑。
可與化合物A組合使用的PI3K抑制劑的實例包括以下揭露的那些:PCT公開申請案號WO 2010/151791;PCT公開申請案號WO 2010/151737;PCT公開申請案號WO 2010/151735;PCT公開申請案號WO 2010151740;PCT公開申請案號WO 2008/118455;PCT公開申請案號WO 2008/118454;PCT公開申請案號WO 2008/118468;美國公開申請案號US 20100331293;美國公開申請案號US 20100331306;美國公開申請案號US 20090023761;美國公開申請案號US 20090030002;美國公開申請案號US 20090137581;美國公開申請案號US 2009/0054405;美國公開申請案號U.S. 2009/0163489;美國公開申請案號US 2010/0273764;美國公開申請案號U.S. 2011/0092504;或PCT公開申請案號WO 2010/108074。
特別地,PI3K抑制劑包括但不限於渥曼青黴素、WO 06/044453中描述的17-羥基渥曼青黴素類似物、4-[2-(1H-吲唑-4-基)-6-[[4-(甲磺醯基)哌𠯤-1-基]甲基]噻吩并[3,2-d]嘧啶-4-基]𠰌啉(還稱為GDC 0941,並且描述於PCT公開案號WO 09/036,082和WO 09/055,730中)、2-甲基-2-[4-[3-甲基-2-側氧基-8-(喹啉-3-基)-2,3-二氫咪唑并[4,5-c]喹啉-1-基]苯基]丙腈(還稱為BEZ 235或NVP-BEZ 235,並且描述於PCT公開案號WO 06/122806中)、(S)-1-(4-((2-(2-胺基嘧啶-5-基)-7-甲基-4-𠰌啉代噻吩并[3,2-d]嘧啶-6-基)甲基)哌𠯤-1-基)-2-羥基丙-1-酮(描述於PCT公開案號WO 2008/070740中)、LY294002(2-(4-𠰌啉基)-8-苯基-4H-1-苯并哌喃-4-酮,可從艾克松醫學化學公司(Axon Medchem)獲得)、PI 103鹽酸鹽(3-[4-(4-𠰌啉基吡啶并-[3',2':4,5]呋喃并[3,2-d]嘧啶-2-基]苯酚鹽酸鹽,可從艾克松醫學化學公司獲得)、PIK 75(N'-[(1E)-(6-溴代咪唑并[1,2-a]吡啶-3-基)亞甲基]-N,2-二甲基-5-硝基苯磺醯基-醯肼鹽酸鹽,可從艾克松醫學化學公司獲得)、PIK 90(N-(7,8-二甲氧基-2,3-二氫-咪唑并[1,2-c]喹唑啉-5-基)-菸醯胺,可從艾克松醫學化學公司獲得)、GDC-0941二甲磺酸鹽(2-(1H-吲唑-4-基)-6-(4-甲烷磺醯基-哌𠯤-1-基甲基)-4-𠰌啉-4-基-噻吩并[3,2-d]嘧啶二甲磺酸鹽,可從艾克松醫學化學公司獲得)、AS-252424(5-[1-[5-(4-氟-2-羥基-苯基)-呋喃-2-基]-甲-(Z)-亞基]-四氫噻唑-2,4-二酮,可從艾克松醫學化學公司獲得)以及TGX-221(7-甲基-2-(4-𠰌啉基)-9-[1-(苯基胺基)乙基]-4H-吡啶并-[1,2-a]嘧啶-4-酮,可從艾克松醫學化學公司獲得)、XL-765和XL-147。其他PI3K抑制劑包括去甲氧基綠膠黴素(demethoxyviridin)、哌立福辛、CAL101、PX-866、BEZ235、SF1126、INK1117、IPI-145、BKM120、XL147、XL765、帕羅米德529(Palomid 529)、GSK1059615、ZSTK474、PWT33597、IC87114、TG100-115、CAL263、PI-103、GNE-477、CUDC-907和AEZS-136。
與本揭露的化合物組合使用的較佳的PI3K抑制劑包括:
,也稱為布帕尼西,一種來自諾華製藥公司(Novartis Pharmaceuticals)的研究小分子,
;
;
;或
;或其藥學上可接受的鹽。
作為PI3K抑制劑,還較佳的是下式IIa的化合物或其藥學上可接受的鹽,
,其中X
1係氟或氫;Y
1係氫或甲基;以及Z
1係氫或甲基。可用於組合的特定PI3K抑制劑係AMG 511(也稱為AMG 2539965或2539965),其係公開的PCT申請WO 2010/126895的實例148。
可在本文揭露的組合中與化合物A組合使用的其他PI3K抑制劑包括Pan-PI3K抑制劑,例如BKM120和GDC-0941;PI3Kα選擇性抑制劑,例如AMG 511和BYL719;和PI3Kβ選擇性抑制劑,例如GSK-2636771。
抑制PI3K和mTOR兩者的化合物(雙重抑制劑)係已知的。在又另一方面,本揭露提供了PI3K和mTOR雙重抑制劑與KRAS
G12C抑制劑組合使用之用途。特定的雙重抑制劑的實例係GDC-0980。
mTOR係PI3K途徑中的蛋白質。本揭露的另一方面係將mTOR抑制劑與KRAS
G12C抑制劑組合使用。可與化合物A組合使用的mTOR抑制劑包括以下文獻中揭露的那些:PCT公開申請案號WO2010/132598和PCT公開申請案號WO2010/096314。可與化合物A組合使用的mTOR抑制劑包括AZD2014和MLN0128。
PKB(AKT)也是PI3K途徑中的蛋白質。另一方面係將AKT抑制劑與化合物A組合使用。可以使用的AKT抑制劑包括以下文獻中揭露的那些:美國專利案號7,354,944;美國專利案號7,700,636;美國專利案號7,919,514;美國專利案號7,514,566;美國專利申請公開案號US 2009/0270445 A1;美國專利案號7,919,504;美國專利案號7,897,619;或PCT公開申請案號WO 2010/083246 A1。可用於組合的特定AKT抑制劑包括MK-2206、GDC-0068和AZD5363。
化合物A也可以與CDK4和/或CDK6抑制劑組合使用。可以用於本發明組合的CDK4和/或CDK6抑制劑包括但不限於以下文件中揭露的那些:PCT公開申請案號WO 2009/085185或美國專利申請公開案號US 2011/0097305。
抗PD-1抗體包括但不限於帕博利珠單抗(Keytruda™)、尼沃魯單抗、AUNP-12、AMG401和匹地利珠單抗。示例性抗PD-1抗體及其使用方法描述於以下文獻中:Goldberg等人,
Blood[血液] 110(1):186-192(2007);Thompson等人,
Clin. Cancer Res.[臨床癌症研究] 13(6):1757-1761(2007);和Korman等人, 國際申請案號PCT/JP 2006/309606(公開案號WO 2006/121168 A1),將其各自藉由引用明確併入本文。
化合物A可以與本文所揭露的藥劑或其他適合的藥劑組合使用,這取決於所治療的病症。因此,在一些實施方式中,化合物A將與如上所述之其他藥劑共投與。在用於組合療法中時,化合物A與第二藥劑同時或分開投與。這種組合投與可以包括以相同劑型同時投與兩種藥劑、以單獨劑型同時投與和分開投與。也就是說,化合物A和上述任何藥劑可以一起配製於相同劑型中並同時投與。可替代地,化合物A和上述任何藥劑可以同時投與,其中兩種藥劑存在於單獨配製物中。在另一個替代方案中,可以在投與化合物A後立即投與上述任何藥劑,或反之亦然。在單獨投與方案的一些實施方式中,化合物A和上述任何藥劑的投與相隔幾分鐘,或相隔幾小時,或相隔幾天。
實例 化合物 A 的 1 期研究 A. 第一結果
化合物A給藥研究:被鑒定為具有KRAS G12C突變的癌症患者被登記入研究。患者為局部晚期或轉移性KRAS G12 C突變型實性腫瘤的成年患者。根據腫瘤類型和疾病分期,所有患者先前均接受了的標準療法。沒有患者出現活動性腦轉移。給藥研究中的患者有以下診斷: 非小細胞肺癌(NSCLC)14名,大腸直腸癌(CRC)10名,另外KRAS G12 C突變型實性腫瘤兩名。化合物A按指定劑量每日口服一次。患者被給予180 mg,360 mg,720 mg或960 mg化合物A的劑量,並且每六週進行一次放射學掃描。
服用化合物A時報告的不良事件見下文表1和表2。在報告的六例嚴重不良事件中,沒有一例報告與化合物A有關。六例嚴重不良事件係3級兩例(肺炎1例、惡性膽道梗阻1例);4級1例(心包積液);死亡3例(1例呼吸困難,2例大腸直腸癌轉移)。無患者報告任何DLT,4級相關不良事件,或嚴重相關不良事件。
[
表 1]
- 治療緊急不良事件
[
表 2]
- 與治療有關的不良事件
a患者在基線時具有2級貧血;
b持續2天
不良事件 | 1 級 n | 2 級 n | 3 級 n | 所有級別 n |
任何治療緊急不良事件 | 25 | |||
食欲下降 | 3 | 3 | 0 | 6 |
泄瀉 | 5 | 0 | 1 | 6 |
疲勞 | 1 | 3 | 1 | 5 |
頭痛 | 3 | 1 | 1 | 5 |
咳嗽 | 2 | 2 | 0 | 4 |
潮熱 | 4 | 0 | 0 | 4 |
噁心 | 4 | 0 | 0 | 4 |
不良事件 | 1級 n | 2級 n | 不良事件 | 1級 n | 2級 n |
泄瀉 | 3 | 腸胃氣脹 | 1 | ||
食欲下降 | 2 | 嘔吐 | 1 | ||
噁心 | 2 | 疲勞 | 1 | ||
肌酸磷酸激酶升高 | 1 | 高鉀血症 | 1 | ||
AST升高或改變 | 1 | 1 | WBC減少 | 1 | |
ALT升高或改變 | 1 | 1 | 蛋白尿 | 1 | |
鹼性磷酸酶 | 1 | 1 | 發熱 | 1 | |
唇炎 | 1 | 關節痛 | 1 | ||
口乾 | 1 | 潮熱 | 1 |
3級不良事件 | n |
貧血 | 1 |
腹瀉 | 1 |
對化合物A療法的個體反應:情況1:一名2010年診斷為KRAS G12C轉移性NSCLC的61歲女性曾接受過以下療法:從2010年8月至2010年10月卡鉑/紫杉醇(Taxol);然後從2016年10月至2017年6月卡鉑/培美曲塞;然後是2017年8月至2018年4月的尼沃魯單抗;然後以180 mg劑量投與化合物A。在六週的評估中,她在180 mg劑量下表現出部分反應(-34%)。她已經耐受了這種藥物,並繼續服用超過27週。
情況2:一名2013年被診斷為KRAS G12 C轉移性NSCLC的59歲男性曾接受過以下療法:2014年2月至2015年2月卡鉑/培美曲塞;2015年4月至2015年6月厄洛替尼;2015年8月至2017年8月尼沃魯單抗;2016年7月至2017年8月達沙替尼;2017年10月至2017年11月M3541(靶向生物製劑);然後以360 mg劑量投與化合物A。在六週的評估中,他表現出部分反應(-80%)。他已經耐受了這種藥物,並繼續服用超過14週。
情況3:一名2014年診斷為KRAS G12C轉移性結腸腺癌的34歲女性曾接受過以下療法:2015年8月FOLFOX和HIPEC,隨後是FOLOX直至2015年12月;2016年8月FOLFIRI與PD;2016年10月HIPEC;2017年8月卡培他濱+貝伐單抗;2018年3月-6月I期臨床試驗;然後被登記入化合物A的OCT 2018 I期臨床試驗並以360 mg的劑量投與化合物A。在六週的評估中,她表現出穩定性疾病(-18%)。她還表現出生化反應,其中她的生物標誌物CA 19-9和CAE在投與化合物A後迅速下降,並在化合物A療法過程中保持在較低水平(圖1)。她已經耐受了這種藥物,並繼續接受治療超過22週。
NSCLC腫瘤反應:KRAS G12C NSCLC患者每天給予180 mg,360 mg,720 mg或960 mg的劑量,並且根據每六週進行的放射照相掃描,10名研究的患者中有9名對療法至少表現出穩定性疾病反應--結果如圖2所示,每個長條圖下方注明指定劑量。NSCLC研究中受試者的持續時間和治療也如圖3所示,其中前四個柱為接受960 mg總日劑量的患者,接下來六個柱為接受720 mg總日劑量的患者;接下來的柱為接受360 mg總日劑量的患者,並且底部三個柱為接受180 mg總日劑量之患者。
CRC和其他實性腫瘤反應:具有KRAS G12C CRC和其他實性腫瘤的患者每天給予180 mg,360 mg,720 mg或960 mg之劑量,並且圖4中顯示了研究的19名患者中17名患者的結果(未顯示的兩例患者在第6週前進展,且未接受首次六週評估)。圖4中的結果係基於每六週評估時進行的放射照相掃描。該CRC/其他研究中受試者的持續時間和治療也如圖5所示,其中前兩個柱為接受960 mg總日劑量的患者,接下來五個柱為接受720 mg總日劑量之患者;接下來的七個柱為接受360 mg總日劑量的患者,並且底部三個柱為接受180 mg總日劑量之患者。
化合物A 1期研究結果:三十五名KRAS G12C癌患者(19名CRC,14名NSCLC,2名其他-闌尾)被登記入化合物A的1期研究。所有患者均有2個或更多個先前的療法線。沒有報告DLT。十六名患者報告了與化合物A相關的不良事件,其中兩名具有3級相關不良事件(貧血和腹瀉)。列出了最佳的腫瘤反應,並且26名患者仍在研究中。結果顯示在下表3中。
[
表 3]
- 與治療有關的不良事件
29* 名患者中的最佳腫瘤反應 | ||
頻率 | 反應或疾病穩定的持續時間 ** | |
NSCLC(n = 10) | ||
部分反應 | 5 (2名確認) | 7.3 - 27.4週 |
疾病穩定 | 4 | 8.4 - 25.1週 |
疾病進展 | 1*** | n/a |
CRC/其他(n = 19) | ||
疾病穩定 | 14 | 7.3 - 24.0週 |
疾病進展 | 5*** | n/a |
*六名患者(4 NSCLC; 2 CRC/其他)截至數據截止日期(2019年4月4日)未進行基線後放射照相掃描。 **截至數據截止日期的反應持續時間。截至數據截止日期所有5名具有部分反應的患者仍在進行治療。 ***這些患者中的兩名(1 NSCLC; 1 CRC)患有早期(第6週之前)臨床進展性疾病。 |
960 mg口服投與劑量的A化合物的藥物動力學如下:C
最大為7.84 µg mL(SD為8.09);AUC
0-24 小時140 hr*µg/mL(SD為117);以及t
1/2,z6.5小時(SD為4.2-8.0)。
B. 更新的結果
這項研究的更新的結果已由Govindan, R.等人, 「Phase 1 Study of AMG 510, a Novel KRAS
G12CInhibitor, in Advanced Solid Tumors With
KRAS p. G12CMutation, [AMG 510,一種新穎KRAS
G12C抑制劑,在具有
KRAS p. G12C 突變的晚期實性腫瘤中的
1 期研究]」在2019年9月27-10月1日在西班牙巴賽隆納舉行的歐洲醫學腫瘤學會(ESMO)會議上作為海報展示,其內容全部併入本文。這項研究的另外的結果由以下展示:Fakih, M. G.,等人, 「CodeBreak 100: activity of AMG 510, a novel small molecule inhibitor of KRAS
G12C, in patients with advanced colorectal cancer, [代碼突破100:新穎KRAS
G12C小分子抑制劑AMG 510在晚期大腸直腸癌患者中的活性]」和Hong, D. S.,等人, 「CodeBreak 100: Phase 1 study of AMG 510, a novel KRAS
G12Cinhibitor, in patients with advanced solid tumors other than non-small-cell lung cancer (NSCLC) and colorectal cancer (CRC) [代碼突破100:新穎KRAS
G12C抑制劑AMG 510在具有非小細胞肺癌(NSCLC)和大腸直腸癌(CRC)以外的晚期實性腫瘤的患者中的1期研究],」在美國臨床腫瘤學會(ASCO)會議上, 2020年5月29日至31日(實際上)。
該研究還發表為「A Phase 1/2, Study Evaluating the Safety, Tolerability, PK, and Efficacy of AMG 510 in subjects with a Specific KRAS Mutation (CodeBreak 100), [1/2期研究評估AMG 510在具有特定KRAS突變的受試者中的安全性、耐受性、PK和功效(代碼突破100)]」臨床試驗政府標識編號NCT03600883,https://clinicaltrials.gov/ct2/show/NCT03600883(最後存取時間為2020年5月3日),其內容全部併入本文。
以下數據表明,化合物A在具有
KRAS p. G12C突變的晚期實性腫瘤(如NSCLC、CRC以及其他腫瘤類型)患者中顯示出早期有希望的抗腫瘤活性。
臨床試驗設計在下面的方案中簡要描述。
a治療結束後30(+7)天進行安全性跟蹤;每12週進行一次長期跟蹤。PK:藥物動力學:PFS:無進展生存。
I. 非小細胞肺癌( NSCLC )患者
2018年8月27日登記入組首名患者。截止日期2019年7月17日,登記入76名患者,其中34名為NSCLC(1名為SCLC(這一患者在數據截止時被記錄為SCLC(「其他腫瘤類型」類別),並且截止後被參與網站改為NSCLC)。45名患者登記入升級佇列(180 mg總日劑量(n = 6),360 mg總日劑量(n = 13),720 mg總日劑量(n = 11),960 mg總日劑量(n = 15))並且31名患者登記入擴展佇列(960 mg總日劑量(n = 31)),從而產生55名可評估患者,他們進行了首次6週掃描或具有早期進展性疾病(PD)。在登記入的76名患者中,52名繼續接受治療並且24名因PD(N = 22)和死亡(N = 2)而中止治療。值得注意的是,沒有一例中止係由治療相關的不良反應引起的。
[
表 4]
- 基線特徵
a這一患者的腫瘤類型到數據截止記錄為SCLC(其他腫瘤類型);截止後,參與站站將腫瘤類型更新為NSCLC。CRC = 大腸直腸癌;ECOG = 東部合作腫瘤學組;NSCLC = 非小細胞肺癌;SCLC = 小細胞肺癌。
基線特徵 | N = 76 |
中位年齡(範圍)-歲 | 59.0(33.0-78.0) |
女-n(%) | 40(52.6) |
原發性腫瘤類型-n(%) | |
NSCLC | 34(44.7) |
CRC | 36(47.4) |
SCLC a | 1(1.3) |
闌尾癌 | 3(3.9) |
子宮內膜癌 | 1(1.3) |
小腸癌 | 1(1.3) |
基線時的ECOG表現狀態-n(%) | |
0 | 20(26.3) |
1 | 53(69.7) |
2 | 3(3.9) |
先前的全身性抗癌療法線-n(%) | |
1 | 5(6.6) |
2 | 9(11.8) |
> 2 | 62(81.6) |
先前的全身性抗癌療法的數量-中位數(範圍) | 4.0(1-10) |
下表總結了患者不良事件(AE)的發生率。沒有報導劑量限制性毒性。此外,沒有報導與治療相關的嚴重或致命的AE。最重要的是,沒有治療相關的AE導致治療中止。結果,將960 mg化合物A的總日劑量確定為擴展劑量和推薦的2期劑量。
[
表 5]
- 不良事件( AE )的患者發病率總結
a七名患者具有以下致命的AE:呼吸困難、誤吸、肺癌轉移、大腸直腸癌轉移、以及脊柱壓縮性骨折;沒有一個與治療相關。
b兩名CRC患者因轉移性大腸直腸癌的AE而中止治療。
C一名NSCLC患者有呼吸道感染,在快照中最初作為治療相關的嚴重AE報告;快照後,研究網站證實這不是歸因於治療,而是潛在疾病。
CRC = 大腸直腸癌;NSCLC =非小細胞肺癌。
所有 AE ( N = 76 ) -n ( % ) | 所有與治療相關的 AE ( N=76 ) -n ( % ) | |
任何級別 | 57(75.0) | 26(34.2) |
≥ 2級 | 44(57.9) | 14(18.4) |
≥ 3級 | 24(31.6) | 6(7.9) |
≥ 4級 | 8(10.5) | 0(0) |
劑量限制性毒性 | 0(0) | 0(0) |
嚴重AE | 17(22.4) | 0(0) c |
致命AE | 7(9.2) a | 0(0) |
導致治療中止的AE | 2(2.6) b | 0(0) |
下表詳細顯示了與治療相關的不良事件(AE)的患者發生率。總之,76名患者中有26名(34.2%)報告了與治療相關的AE,其中大多數為1級或2級。76名患者中有6名(7.9%)報告了1種或3種以上與治療相關的不良事件(腹瀉和貧血)。沒有4級或4級以上的治療相關不良事件。
[
表 6]
- 與治療相關的不良事件( AE )的患者發生率
ALT = 丙胺酸胺基轉移酶;AST = 天冬胺酸胺基轉移酶。
任何級別( N = 76 ) n ( % ) | 3 級( N = 76 ) n ( % ) | |
任何與治療相關的 AE | 26 ( 34.2 ) | 6 ( 7.9 ) |
腹瀉 | 11(14.5) | 4(5.3) |
噁心 | 3(3.9) | 0(0) |
口乾 | 2(2.6) | 0(0) |
腹痛 | 1(1.3) | 0(0) |
唇炎 | 1(1.3) | 0(0) |
噯氣 | 1(1.3) | 0(0) |
腸胃氣脹 | 1(1.3) | 0(0) |
嘔吐 | 1(1.3) | 0(0) |
ALT升高 | 2(2.6) | 0(0) |
AST升高 | 2(2.6) | 0(0) |
血鹼性磷酸鹽升高 | 2(2.6) | 0(0) |
血肌酸磷酸激酶升高 | 2(2.6) | 0(0) |
丙胺酸胺基轉移酶 | 1(1.3) | 0(0) |
天冬胺酸胺基轉移酶 | 1(1.3) | 0(0) |
淋巴細胞計數下降 | 1(1.3) | 0(0) |
白血球計數下降 | 1(1.3) | 0(0) |
貧血 | 3(3.9) | 3(3.9) |
白血球減少 | 1(1.3) | 0(0) |
食欲下降 | 2(2.6) | 0(0) |
高鉀血症 | 1(1.3) | 0(0) |
低鉀血症 | 1(1.3) | 0(0) |
疲勞 | 2(2.6) | 0(0) |
味覺障礙 | 1(1.3) | 0(0) |
周圍神經病 | 1(1.3) | 0(0) |
關節痛 | 1(1.3) | 0(0) |
蛋白尿 | 1(1.3) | 0(0) |
鼻出血 | 1(1.3) | 0(0) |
皮疹 | 1(1.3) | 0(0) |
潮熱 | 1(1.3) | 0(0) |
化合物A(960 mg口服總日劑量)截至PK截止日期2019年7月24日(N=32,包括NSCLC和CRC患者)的藥物動力學(PK)曲線如下(幾何平均值;%變異係數(CV)):最大血清濃度(C
最大)7.50 µg/mL(98.3%),曲線下面積(AUC)65.3 hr*µg/mL(81.7%),消除半衰期(t
1/2,z)5.5小時(1.8)。在2小時細胞磷酸化細胞外訊號調節激酶(pERK)測定中,投與後血清濃度保持至少22小時高於體外90%抑制濃度(IC
90)。
下表報告了所有劑量水平和960 mg劑量的NSCLC患者的最佳腫瘤反應。
[
表 7]
- 與治療相關的不良事件( AE )的患者發生率
a反應的評估係基於修改的RECIST 1.1標準。
b第6週時的PR或SD。
PR:部分反應;SD:穩定性疾病;PD:進展性疾病。可評估的患者:具有首次6週掃描或具有早期PD之患者。
功效結果 | 可評估的患者( N = 23 ) | 接受 960 mg 的可評估的患者( N = 13 ) |
最佳總體反應 | ||
PR-n(%) | 11(48) | 7(54) |
SD-n(%) | 11(48) | 6(46) |
PD-n(%) | 1(4) | 0(0) |
客觀反應率 a | 48% | 54% |
疾病控制率 b | 96% | 100% |
化合物A在NSCLC患者中的功效如圖6所示(最長直徑總和與基線相比的%變化相比於具有可用的基線後腫瘤數據的NSCLC患者(N = 22)。值得注意的是,最右邊的柱所代表的用960 mg總日劑量治療的患者對靶病變有完全反應。
圖7顯示了化合物A在NSCLC患者中的療效,觀察到反應時間和治療持續時間(可評估的NSCLC患者(N = 23)相比於治療持續時間(週))。11名患者顯示部分反應(PR),群眾中位持續時間為15.1個治療週(範圍4.1-42.3)。這11名患者中有8名正在繼續研究。此外,11名患者表現為穩定性疾病(SD),中位持續時間為10.0個治療週(範圍4.1-35.1)。這11名患者中有8名正在繼續研究。
總之,化合物A在具有
KRAS p. G12C突變的晚期實性腫瘤(如NSCLC)患者中顯示出早期有希望的抗腫瘤活性。此外,已發現化合物A在所測試的劑量水平下具有良好的安全性--沒有觀察到劑量限制性毒性,並且沒有注意到延長治療的累積毒性。
II. 大腸直腸癌( CRC )患者
截止日期2020年1月8日,登記入42名CRC患者(佇列1:3名患者,180 mg總日劑量;佇列2:10名患者,360 mg總日劑量;佇列3:4名患者,720 mg總日劑量;佇列4:25名患者,960 mg總日劑量)。中位跟蹤期為7.9個月(範圍:4.2-15.9個月)。8名患者正在繼續治療。由於疾病進展(32名)和患者的要求(2名),有34名患者中止。所有登記入的患者均接受了先前的全身性抗癌療法線。45%的患者接受了3個以上的治療線。
[
表 8]
- 基線特徵
ECOG = 東部合作腫瘤學組
基線特徵 | N = 42 |
中位年齡(範圍)-歲 | 57.5(33-82) |
女-n(%) | 21(50) |
基線時的ECOG表現狀態-n(%) | |
0 | 17(40.5) |
1 | 25(59.5) |
先前的全身性抗癌療法線-n(%) | |
1 | 2(4.8) |
2 | 11(26.2) |
3 | 10(23.8) |
> 3 | 19(45.2) |
先前的全身性抗癌療法的數量-中位數(範圍) | 3(1-4) |
以下兩個表總結了患者不良事件(AE)的發生率。42名患者中有20名報告了與治療相關的不良事件,其中大多數為2級或更低。據報導,腹瀉和貧血係與治療相關的3級AE,各自發生在1名患者中。沒有劑量限制性毒性。如上所述,將960 mg化合物A的總日劑量確定為擴展劑量和推薦的2期劑量。
[
表 9]
- 不良事件( AE )的患者發病率總結
AE:不良事件
[
表 10]
- 發生在 > 1 名患者中的任何級別的與治療相關的 TEAE
治療緊急 AE ( TEAE ), N = 42 , n ( % ) | 與治療相關的 TEAE N = 42 , n ( % ) | |
任何級別 ≥ 2級 ≥ 3級 ≥ 4級 | 38(90.5) 29(69.0) 13(31.0) 3(7.1) | 20(47.6) 9(21.4) 2(4.8) 0(0.0) |
劑量限制性毒性 | 0(0.0) | 0(0.0) |
嚴重AE | 10(23.8) | 0(0.0) |
致命AE | 3(7.1) | 0(0.0) |
導致治療中止的AE | 2(4.8) | 0(0.0) |
發生在 > 1 名患者中的任何級別的與治療相關的 TEAE | N = 42 , n ( % ) |
腹瀉 | 8(19.0) |
疲勞 | 4(9.5) |
噁心 | 2(4.8) |
血肌酸磷酸激酶升高 | 2(4.8) |
貧血 | 2(4.8) |
嘔吐 | 2(4.8) |
下表報告了所有劑量水平和960 mg總日劑量的CRC患者的腫瘤反應。至於功效,在3名患者中觀察到確認的部分反應,所有患者均接受960 mg劑量。反應係持久的,並且截至數據截止日仍在反應。此外,29名患者具有穩定性疾病,使得疾病控制率為76.2%。
[
表 11]
- 腫瘤反應
a患者有臨床進展,並且無基線後測量。
+:截尾值。
腫瘤反應 | 所有劑量水平 N = 42 , n ( % ) | 總日劑量 960 mg N = 25 , n ( % ) |
最佳總體反應 確認的部分反應-n(%) 穩定性疾病-n(%) 進展性疾病-n(%) 未完成-n(%) a | 3(7.1) 29(69.0) 9(21.4) 1(2.4) | 3(12.0) 17(68.0) 4(16.0) 1(4.0) |
客觀反應率-% (95% CI) | 7.1 (1.50,19.48) | 12.0 (2.55,31.22) |
疾病控制率-% (95% CI) | 76.2 (60.55,87.95) | 80.0 (59.30,93.17) |
3個反應者的反應持續時間-月 | 1.4+、4.2+、4.3+ | 1.4+、4.2+、4.3+ |
穩定性疾病的持續時間-月 中位數(最小,最大) | 4.2(2.5+,11.0) | 4.2(2.6,5.7+) |
無進展生存(PFS)如圖8所示。所有劑量水平的無進展生存為4.0個月(中位數(最小,最大),0.7,11.0),960 mg情況下為4.2個月(中位數(最小,最大),1.2,5.7+;+:截尾值)。所有劑量的3個月和6個月PFS率分別為58.5%和20.6%。960 mg總日劑量的3個月PFS率為59.7%。總生存(OS)如圖9所示。在所有劑量水平下的總生存為10.1個月(中位數(最小,最大),1.3+,11.4+;+:截尾值;NR:未達到),在960 mg情況下NE(2.3、8.0+)。所有劑量的6個月OS率為76.4%,總日劑量960 mg情況下為82.9%。
化合物A在CRC患者中的功效如圖10所示(最長直徑總和與基線相比的%變化相比於具有可用的基線後腫瘤數據的CRC患者(N = 39)。由於缺少基線後腫瘤數據(1名PD,1名SD,1名由於臨床進展未完成),3名患者未包括在圖10的圖表中。
圖11-15顯示了在所有四種劑量的化合物A(圖11;總日劑量180 mg、360 mg、720 mg和960 mg)並且對於各單獨劑量(圖12-15)下CRC患者的腫瘤負荷隨時間相比於基線的變化。
圖16和17顯示了以各種劑量的化合物A給藥的CRC患者的反應時間和隨時間的治療。
總之,42名具有嚴重預處理的
KRASp.G12C突變型轉移性CRC的患者中有3名(7.1%)對化合物A有持久的部分反應。除3名反應者外,29名也患者實現了疾病控制,導致疾病控制率為76.2%,並且中位無進展生存(PFS)為4.0個月(範圍:0.7-11.0)。此外,化合物A在CRC患者中耐受性良好,與治療相關的毒性較輕,這與先前的結果一致。
III. 具有 NSCLC 和 CRC 以外的晚期實性腫瘤的患者
截止2020年1月8日,登記入25名具有如下腫瘤類型的患者:胰臟癌(10名)、闌尾癌(4名)、子宮內膜癌(2名)、不明原發癌(2名)、膽管癌(1名)、鼻竇癌(1名)、壺腹癌(1名)、小腸癌(1名)、黑色素瘤(1名)、小細胞肺癌(1名)和食道癌(1例)。2名闌尾癌患者分別接受360 mg和720 mg化合物A的總日劑量。其餘23名患者接受總日劑量960 mg的化合物A,中位跟蹤係4.3個月(範圍:0.1-12.6個月)。22名患者已經被跟蹤 ≥ 7週,並且能夠評估反應。到截止日期,12名患者中止治療,其中疾病進展係最常見的原因。所有登記入的患者都接受了先前的全身性抗癌療法線,並且登記入的患者中的84%接受了1個以上的先前療法線。
[
表 12]
- 基線特徵
ECOG = 東部合作腫瘤學組
基線特徵 | N = 25 |
中位年齡(範圍)-歲 | 60.0(40-75) |
女-n(%) | 9(36.0) |
基線時的ECOG表現狀態-n(%) | |
0 | 7(28.0) |
1 | 14(56.0) |
2 | 4(16.0) |
先前的全身性抗癌療法線-n(%) | |
1 | 4(16.0) |
2 | 5(20.0) |
3 | 6(24.0) |
> 3 | 9(36.0) |
丟失 | 1(4.0) |
先前的全身性抗癌療法的數量-中位數(範圍) | 3(1-4) |
下表總結了患者不良事件(AE)的發生率。報告的一名以上患者的治療相關TEAE為腹瀉(25名患者中有2名)和疲勞(25名患者中有2名)。報告的3級治療相關AE為腹瀉(25名患者中有1名)和肺炎(25名患者中有1名)。沒有劑量限制性毒性,並且沒有導致中止的治療相關不良事件。如上所述,將960 mg化合物A的總日劑量確定為擴展劑量和推薦的2期劑量。
[
表 13]
- 不良事件( AE )的患者發病率總結
AE:不良事件
所有的治療緊急 AE ( TEAE ), N = 25 , n ( % ) | 所有的與治療相關的 TEAE N = 25 , n ( % ) | |
任何級別 ≥ 2級 ≥ 3級 ≥ 4級 | 20(80.0) 17(68.0) 15(60.0) 4(16.0) | 9(36.0) 4(16.0) 2(8.0) 0(0.0) |
劑量限制性毒性 | 0(0.0) | 0(0.0) |
嚴重AE | 13(52.0) | 1(4.0) |
致命AE | 4(16.0) | 0(0.0) |
導致治療中止的AE | 3(12.0) | 0(0.0) |
該等患者的腫瘤反應在下表中報告。22名患者可評估腫瘤反應。3名具有確認的部分反應,13名疾病穩定,6名疾病進展。3名部分反應者分別具有闌尾癌、黑色素瘤和子宮內膜癌。實現疾病穩定的13名患者包括胰臟癌6名、闌尾癌2名、壺腹癌1名、膽管癌1名、子宮內膜癌1名、鼻竇癌1名、以及不明原發癌1名。3名實現疾病穩定的胰臟癌患者按照RECIST 1.1具有近30%的下降。
[
表 14]
- 腫瘤反應
最佳腫瘤反應 | 可評估的患者, N = 22 |
確認的部分反應-n 腫瘤類型(n) | 3 闌尾癌(1) 黑色素瘤(1) 子宮內膜癌(1) |
疾病穩定-n 腫瘤類型(n) | 13 胰臟癌(6) 闌尾癌(2) 壺腹癌(1) 膽管癌(1) 子宮內膜癌(1) 鼻竇癌(1) 不明的原發癌(1) |
進展性疾病-n 腫瘤類型(n) | 6 胰臟癌(2) 闌尾癌(1) 小細胞肺癌(1) 食道癌(1) 小腸癌(1) |
化合物A在該等患者中的功效如圖18所示(最長直徑總和與基線相比的%變化相比於具有可用的基線後腫瘤數據的患者(N = 19)。由於缺少基線後腫瘤數據(2名闌尾癌患者(1名PD,1名SD)和一名胰臟癌患者(PD)),3名患者未包括在圖18的圖表中。
圖19顯示了該等患者的反應時間和隨時間的治療。
總之,已觀察到具有KRAS G12C的多種腫瘤類型中的令人鼓舞的抗癌活性。在具有闌尾癌、黑色素瘤和子宮內膜癌的3名患者中分別觀察到確認的部分反應。8名可評估的胰臟癌患者中有6名實現疾病穩定--其中三名的腫瘤負擔降低30%。與化合物A相關的毒性係輕度和可控的,與先前的結果一致。
雖然已經參照本某些特定實施方式描述和說明了本發明,但是熟悉該項技術者將理解,在不脫離本發明之精神和範圍情況下,可以對程序和方案進行各種適應、改變、修改、替換、刪除或添加。因此,旨在本發明由所附申請專利範圍之範圍來定義,並且該等申請專利範圍被合理地廣泛地解釋。
無
在下面的圖中,PD表示進展性疾病,PR表示部分反應,SD表示穩定性疾病。
[圖1]顯示了在具有轉移性結腸腺癌且以360 mg的總日劑量投與化合物A的患者中CA 19-9和CAE生物標誌物反應。
[圖2]顯示了接受所示的各種總日劑量化合物A的九名NSCLC癌症患者的非小細胞肺癌(NSCLC)腫瘤反應,藉由每六週的放射照相掃描測量。
[圖3]顯示了按以下總日劑量投與化合物A的NSCLC患者之反應和治療持續時間-前四個柱960 mg;接下來的六個柱720 mg;下一個柱360 mg;和底部三個柱180 mg。
[圖4]顯示了以如所示的不同總日劑量接受化合物A的CRC和其他實性腫瘤癌症患者的大腸直腸癌(CRC)和其他實性腫瘤之反應,藉由每六週的放射照相掃描測量。
[圖5]顯示了以以下總日劑量投與化合物A的CRC和其他實性腫瘤患者之反應和治療持續時間-前兩個柱960 mg;接下來的五個柱720 mg;接下來的七個柱360 mg;和底部三個柱180 mg。
[圖6]顯示了化合物A在NSCLC患者中作為相比於基線的腫瘤負荷變化之功效。最右邊柱上的上標「a」表示患者具有對靶病變的完全反應。上標「b」表示1名患者在第1次評估前因臨床PD而中止研究,沒有可用的基線後腫瘤負荷數據,因此未在圖中顯示。
[圖7]顯示了化合物A對NSCLC患者在反應時間和治療持續時間方面之功效。圖中的每個直條圖(總計23個柱)代表某位患者(N = 23),該患者接受特定的總日劑量(從圖頂部開始計數,柱1-3(180 mg)、柱4(360 mg)、柱5-10(720 mg)和柱11-23(960 mg)。柱9的上標「a」表示該圖係根據截至數據截止時從參與網站接收的數據繪製的。該患者(柱9)的治療持續時間數據可能從研究網站丟失。
[圖8]顯示了CRC患者無進展生存概率。
[圖9]顯示了CRC患者的總生存概率。
[圖10]顯示了CRC患者相比於基線變化之腫瘤負擔。
[圖11]顯示了在所有四種劑量的化合物A(總日劑量180 mg,360 mg,720 mg和960 mg)下CRC患者的腫瘤負荷隨時間相比於基線之變化。
[圖12]顯示了圖11所示CRC患者子集的腫瘤負荷相比於基線隨時間之變化。具體地說,圖12顯示了每天給藥180 mg化合物A之患者。
[圖13]顯示了圖11所示CRC患者子集的腫瘤負荷相比於基線隨時間之變化。具體地說,圖13顯示了每天給藥360 mg化合物A之患者。
[圖14]顯示了圖11所示CRC患者子集的腫瘤負荷相比於基線隨時間之變化。具體地說,圖14顯示了每天給藥720 mg化合物A之患者。
[圖15]顯示了圖11所示CRC患者子集的腫瘤負荷相比於基線隨時間之變化。具體地說,圖15顯示了每天給藥960 mg化合物A之患者。
[圖16]顯示了給予化合物A的CRC患者的反應時間和隨時間之治療(從圖頂部開始計數:柱1-4(720 mg)、柱5-14(360 mg)和柱15-17(180 mg)。
[圖17]顯示了每天給予960 mg化合物A的CRC患者的反應時間和隨時間之治療。
[圖18]顯示了化合物A在患有NSCLC和CRC以外的晚期實性腫瘤的患者中作為相比於基線的腫瘤負荷變化之功效。某些柱上的上標「a」表示患者未確診PR。在某些標記為PR的三個柱的上標「b」表示一名闌尾癌患者接受720 mg總日劑量之化合物A,並且另外兩名患者(子宮內膜癌和黑色素瘤)每人接受960 mg總日劑量之化合物A。
[圖19]顯示了患有NSCLC和CRC以外的晚期實性瘤的患者的反應時間和隨時間之治療。
無
Claims (7)
- 一種下式化合物之用途, 其係用於製備治療患者中KRAS G12C介導大腸直腸癌之藥物,其中該治療包含每日一次投與該患者960 mg之該化合物。
- 如請求項1之用途,其中該患者在第一次投與該化合物前已經經歷至少一種全身性癌症療法。
- 如請求項1之用途,其中該患者在第一次投與該化合物前已經經歷至少兩種全身性癌症療法。
- 如請求項1至3中任一項之用途,其中該化合物係口服投與。
- 如請求項4之用途,其中該化合物係以錠劑投與。
- 如請求項1至3中任一項之用途,其中該藥物進一步包含化學治療劑或與化學治療劑併用投與。
- 如請求項6之用途,其中該化學治療劑係5-氟尿嘧啶(5-FU)、伊立替康(irinotecan)、奧沙利鉑(oxaliplatin)、癌症單株抗體,或其組合。
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- 2021-11-04 IL IL287838A patent/IL287838A/en unknown
-
2022
- 2022-07-22 US US17/871,178 patent/US20220378787A1/en not_active Abandoned
-
2023
- 2023-04-13 JP JP2023065418A patent/JP7300076B1/ja active Active
- 2023-06-15 JP JP2023098289A patent/JP2023116708A/ja active Pending
Also Published As
Publication number | Publication date |
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JP2021534080A (ja) | 2021-12-09 |
TWI824148B (zh) | 2023-12-01 |
JP6963146B1 (ja) | 2021-11-05 |
TW202108142A (zh) | 2021-03-01 |
US11426404B2 (en) | 2022-08-30 |
BR112021022812A2 (pt) | 2021-12-28 |
JP7265600B2 (ja) | 2023-04-26 |
EP3738593A1 (en) | 2020-11-18 |
AU2020275845A1 (en) | 2021-12-02 |
IL287838A (en) | 2022-01-01 |
MA55959A (fr) | 2022-03-23 |
US20220378787A1 (en) | 2022-12-01 |
EP3968998A1 (en) | 2022-03-23 |
JP2022009090A (ja) | 2022-01-14 |
CN113840606A (zh) | 2021-12-24 |
JP2023116708A (ja) | 2023-08-22 |
SG11202112432PA (en) | 2021-12-30 |
JP7300076B1 (ja) | 2023-06-28 |
MX2021013788A (es) | 2022-05-18 |
WO2020232130A1 (en) | 2020-11-19 |
TWI826344B (zh) | 2023-12-11 |
US20200360374A1 (en) | 2020-11-19 |
JP2023095870A (ja) | 2023-07-06 |
CA3139519A1 (en) | 2020-11-19 |
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