TWI557108B - 用於治療乳癌之來納替尼(neratinib) - Google Patents
用於治療乳癌之來納替尼(neratinib) Download PDFInfo
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- TWI557108B TWI557108B TW103110561A TW103110561A TWI557108B TW I557108 B TWI557108 B TW I557108B TW 103110561 A TW103110561 A TW 103110561A TW 103110561 A TW103110561 A TW 103110561A TW I557108 B TWI557108 B TW I557108B
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- therapy
- treatment
- agent
- cancer
- trastuzumab
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Description
乳癌係女性中最常診斷出之惡性病,且居全球女性癌症死亡率之首要因素。據估計,於未來十年中,全球的乳癌發病率將高達5百萬女性[Parkin,DM及Fernandez LM,Use of statistics to assess the g1obal burden of breast cancer.Breast Journal.2006;(12,Suppl 1):S70-80;World Health Statistics.2008,World Health Organization]。於2007年,乳癌死亡人數占全世界約540,000例[World Health Organization Fact Sheet No.297.2008;獲自WHO網站]
TKI(酪胺酸激酶抑制劑)之erbB(成紅血球細胞白血病病毒致癌基因同系物)家族係由4組分構成:erbB-l(EGFR[表皮生長因子受體]、erbB-2(HER-2,neu)、erbB-3(HER-3)及erbB-4(HER-4)。受體之erbB家族參與細胞增殖、腫瘤發生、及癌轉移,且會異常表現在多種腫瘤類型中。HER2-陽性乳癌,亦即,針對稱為人類EGFR之蛋白質測試為陽性者,係與Erb-2-蛋白質過度表現有關或乳癌腫瘤中之erbB-2基因擴增係與更多侵入性臨床疾病及不良預後相關[Slamon D,Human breast cancer:correlation of relapse and survival with amplification of the HER-2/neu oncogene.Science.1987(235):177-182]。
曲司佐單抗(Trastuzumab)係一種會選擇性結合人類erbB-2受體之人源化之單株抗體,可改良罹患erbB-2陽性乳癌之女性之預後。罹患
erbB-2過度表現之轉移性乳癌病患中,曲司佐單抗結合化療可改善腫瘤退化、延長發展成腫瘤之時間並延長單獨接受化療後之存活時間中值,使其被認可為轉移性治療之第一線療法。[Ligibel JA及Winer EP.Trastuzumab/chemotherapy combinations in metastatic breast cancer.Seminars in Oncology.2002;29(3 Suppl 11):38-43]。赫賽汀(Herceptin)(曲司佐單抗)[包裝內頁,Genentech(2008)]。曲司佐單抗亦已核准作為輔助療法,用於與治療erbB-2過度表現之淋巴結陽性或淋巴結陰性(雌激素受體/黃體激素受體[ER/PgR]陰性)轉移性乳癌之其他藥物組合治療。因此,曲司佐單抗已用作以下療法之一部份:(a)由阿黴素(doxorubicin)、環磷醯胺及紫杉醇或多烯紫杉醇(docetaxel)組成之療法;(b)與多烯紫杉醇及卡鉑組合之療法;及(c)作為基於多重模式蒽環黴素療法之後之單一藥劑。
診斷為HER+乳癌後之治療之現行標準係外科手術,接著輔助治療一年。標準輔助治療係指化療、放射、用於ER/PR陽性疾病之激素療法與曲司佐單抗之某些組合。即使輔助療法完成後,罹患早期乳癌之病患仍具有復發風險。曲司佐單抗療法之公開報導顯示,無病存活率係介於80.6%存活三年[Smith I,等人,於HER2-陽性乳癌中進行輔助化療後在緊接2年內投與曲司佐單抗:隨機對照試驗。Lancet 2007;369:29-36]至85.9%至82%存活四年之間[Perez EA,等人,罹患HER2-陽性乳癌之病患中結合/非結合曲司佐單抗之NCCTG N9831及NSABP B-31輔佐化療之組合分析更新結果。Journal of Clinical Oncology.ASCO Annual Meeting Proceedings.2007;25(18S):512及Slamon D,等人,於HER2陽性早期乳癌病患之輔助治療中將AC-T與AC-TH及與TCH比較之III期試驗:第二次中期效能分析。由Slamon D於SABCC 2006發表]。
已描述HKI-272(來納替尼(neratinib))用於治療腫瘤[美國專利案
第6,288,081號]。來納替尼係一種強力的不可逆型pan erbB抑制劑。來納替尼一種抑制細胞內酪胺酸激酶功能部位處之erbB-1、erbB-2及erbB-4之口服用小分子,其作用機理不同於曲司佐單抗。來納替尼會降低erbB-1及erbB-2自體磷酸化、下游信號傳導、及依賴erbB-1與erbB-2之細胞株之生長。臨床前期數據顯示,來納替尼於erbB-1及/或erbB-2表現癌細胞株中具有抗腫瘤活性,其細胞IC50<100nM[Rabindran SK,等人,Antitumor activity of HKI-272,an orally active,irreversible inhibitor of the HER-2 tyrosine kinase.Cancer Research.2004;64(11):1958-65]。
需要一種可改善病患存活率之藥物及療法及/或降低主要及輔助治療後之乳癌復發之藥物及療法。
於一方面,本發明提供一種治療HER-2/neu過度表現/擴增之新生瘤之療法,其包括對HER-2/neu過度表現/擴增之癌症病患進行以來納替尼療法作為曲司佐單抗輔助療法之延伸療程,例如,於手術及標準輔助療法完成後投與來納替尼。
另一方面,本發明提供一種方法或療法,當與僅接受主要及曲司佐單抗輔助療法之病患比較時,可降低HER-2/neu過度表現/擴增之乳癌病患之復發率。該方法涉及對接受主要療法及採用曲司佐單抗之標準輔助療法後之該等病患投與來納替尼。於一實施例中,該方法亦係於一或多種一般前輔助或標準輔助療法完成後進行。
於另一方面,本發明提供一種用於改善無侵入性疾病存活期之療法,其包括於主要療法及採用曲司佐單抗之標準輔助療法完成後,以來納替尼治療癌症病患。於一實施例中,來納替尼之治療係於手術後及採用曲司佐單抗之標準輔助療法後之兩星期至48個月內進行。
本發明之其他方面及優勢很容易由以下本發明之詳細論述了
解。
於一實施例中,本發明提供一種用於治療HER-2/neu過度表現/擴增之癌症之延伸輔助療法,其包括對HER-2/neu過度表現/擴增之癌症病患投與來納替尼療法之療程。該延伸輔助療法涉及在曲司佐單抗之輔助療法完成後開始來納替尼療法。此延伸輔助療法係用於改善無侵入性疾病之存活期(IDFS)或無病存活(DFS)-乳管原位癌(DCIS)及/或改善總體存活期、到達遠端復發之時間、及無遠端疾病存活期。
如本文所使用,無侵入性疾病存活期(IDFS)係定義為隨機日期至IDFS事件發生之時間,包括:侵入性同側乳腺腫瘤復發、局部/區域性侵入性復發、遠端復發、任何原因引起之死亡、侵入性對側乳癌、及二次原發侵入性癌症(非乳房)。DFS-DCIS係定義為隨機日期至任何IDFS事件或原位乳管癌首次病發之時間。無遠端疾病存活期(DDFS)係指隨機日期至首次遠端復發、或任何原因引起之死亡之時間。遠端復發之時間(TTDR)係定義為隨機日期至首次遠端腫瘤復發(不包含局部復發及二次乳房或非乳房癌且包括於遠端乳癌復發前作為最終事件之死亡)之間之時間。
因此,利用來納替尼之本發明之延伸輔助療法可藉由降低復發或死亡機率來延長無病存活期。於一實施例中,與曲司佐單抗療法之一般觀察結果比較,該延伸來納替尼輔助療法可使癌症復發或死亡機率,亦即危害率降低30%或20%。
於另一實施例中,利用本文描述之延伸來納替尼療法,少於15%、少於10%及/或少於5%已接受主要及輔助療法之病患於療法開始後三年時罹患癌症。於又一實施例中,利用於本文描述之該延伸來
納替尼療法,少於20%、少於15%及/或少於5%接受主要及輔助療法之病患於療法開始後五年時罹患癌症。
如本文所使用,來納替尼係指HKI-272,其具有呈游離鹼形式之以下核心結構:
視情況,可使用其醫藥可接受鹽或水合物。上述核心結構係一種稱為HKI-272或來納替尼之特殊的HKI-272化合物,其具有化學名稱:[(2E)-N-[4-[[3-氯-4-[(吡啶-2-基)甲氧基]苯基]胺基]-3-氰基-7-乙氧喹啉-6-基]-4-(二甲胺基)-丁-2-烯醯胺]。
儘管為次佳,但亦可改用另一HKI-272化合物代替來納替尼。於一實施例中,「HKI-272化合物」係指自上述來納替尼之核結構衍生之化合物。合適的衍生物可包括,例如,酯、醚或胺基甲酸鹽。此HKI-272化合物可具有以下結構:
其中:R1係鹵原子;R2係吡啶基、苯硫基、嘧啶基、噻唑基或苯基,其中R2係視情況
經至多三個取代基取代;R3係O或S;R4係CH3或CH2CH2OCH3;R5係CH3或CH2CH3;及n係0或1。
如本文所使用之術語「鹵原子」係指Cl、Br、I及F。
亦包含來納替尼之醫藥可接受鹽、水合物及前藥及/或本文所描述之其他HKI化合物。「醫藥可接受鹽及酯」係指醫藥可接受且具有所需醫藥動力學特性之鹽及酯。此等鹽包括例如,存在於化合物中之酸性質子能與無機或有機鹼反應所形成之鹽。合適無機鹽包括例如,彼等與鹼金屬或鹼土金屬,例如鈉、鉀、鎂、鈣、鋁形成之鹽類。合適的有機鹽亦包括例如,彼等與諸如胺鹼之有機鹼(例如,乙胺、二乙胺、三乙胺、胺丁三醇、N-甲基葡糖胺等)形成之鹽類,及彼等可形成N-四烷基銨鹽,如N-四丁基銨鹽之鹽類。醫藥可接受鹽亦包括自母體化合物之鹼性基團,如胺,與無機酸(例如,氫氯酸及氫溴酸)及有機酸(例如乙酸、檸檬酸、馬來酸、丙酸、乳酸、酒石酸、琥珀酸、富馬酸、馬來酸、丙二酸、杏仁酸、蘋果酸、鄰苯二甲酸、氫氯酸、氫溴酸、磷酸、硝酸、硫酸、及烷烴-與芳烴磺酸,如甲磺酸及苯磺酸、萘磺酸、甲苯磺酸、樟腦磺酸)反應所形成之酸加成鹽。其他合適的醫藥可接受鹽實例包括,但非限於,硫酸鹽、檸檬酸鹽、乙酸鹽、草酸鹽、氯化物、溴化物、碘化物、硝酸鹽、硫酸氫鹽、磷酸鹽、酸式磷酸鹽、異菸鹼酸鹽、乳酸鹽、水楊酸鹽、酸式檸檬酸鹽、酒石酸鹽、油酸鹽、單寧酸鹽、泛酸鹽、酒石酸氫鹽、抗壞血酸鹽、琥珀酸鹽、馬來酸鹽、龍膽酸鹽、富馬酸鹽、葡萄糖酸鹽、葡糖醛酸鹽、蔗糖酸鹽、甲酸鹽、苯甲酸鹽、麩胺酸鹽、甲磺酸鹽、乙磺酸鹽、苯磺酸鹽、對甲苯磺酸鹽、雙羥萘酸鹽(即,1,1’-亞甲基-雙-(2-
羥基-3-萘酸鹽))、及脂肪酸鹽,如己酸鹽、月桂酸鹽、豆蔻酸鹽、棕櫚酸鹽、硬脂酸鹽、油酸鹽、亞油酸鹽、亞麻酸鹽。
醫藥可接受酯包括自存在於本發明之化合物中之羧基、磺醯基氧基及亞磷羧氧基形成之酯,例如,具有1至6個碳原子之直鏈型烷基酯或含有1至6個碳原子之分支鏈型烷基,包括甲基、乙基、丙基、丁基、2-甲基丙基及1,1-二甲基乙基酯;環烷基酯、烷芳基酯、苯甲基酯等。當有兩個酸性基團存在時,醫藥可接受鹽或酯可為單酸單鹽或酯,或二鹽或酯;且相似地,當有多於兩個酸性基團存在時,一部份或所有此等基團可形成鹽或酯化。本文所利用之化合物可呈未形成鹽或非酯化形式,或呈鹽及/或酯化形式存在,且此等化合物之命名意欲包括原有(未形成鹽或非酯化)化合物及其醫藥可接受鹽及酯。此外,本文所利用之一或多種化合物可呈多於一種之立體異構形式存在,且此等化合物之命名意欲包括所有單一立體異構體及此等立體異構體之所有混合物(不論是否消旋)。
HKI-272化合物(其中一種係來納替尼)之製備詳細描述於美國專利申請公開案第2005/0059678號中,該案係以引用之方式併入本文。亦可參見,美國專利案第6,288,082號、美國專利案第6,002,008號、美國專利案第6,297,258號及美國專利申請公開案第2007/0104721號中,該等案號係以引用之方式併入本文。描述於此等文獻中之方法亦可用於製備來納替尼及/或其他HKI-272及本文所使用之經取代之3-喹啉化合物且係以引用之方式併入本文。除描述於此等文獻中之方法外,以引用之方式併入本文之國際專利公開案第WO-96/33978號及WO-96/33980號描述可用於製備此等HKI-272化合物之方法。雖然此等方法描述特定喹啉之製備,然而其等亦可用於製備相應之經取代之3-氰基喹啉且係以引用之方式併入本文。
術語「治療」係指對受試者投與來納替尼以預防或延緩、減輕
或中止或抑制與新生瘤有關之症狀或病症發生。
曲司佐單抗及其製造及調配方法已有說明。參見,例如,美國專利案6,821,515、美國專利案第6,399,063號及美國專利案第6,387,371號。曲司佐單抗可自Genentech購得名稱為「赫賽汀(Herceptin)」之商品。如本文所使用,術語「曲司佐單抗」包括曲司佐單抗及曲司佐單抗之變化形式及衍生物。術語「曲司佐單抗」包括彼等針對Her-2受體上抗原決定基之標靶與曲司佐單抗針對之標靶相同之藥劑。該抗原決定基係自H.S.Cho等人,Structure of the extracellular region of HER2 alone and in complex with the Herceptin Fab,Nature 421(2003),第756至760頁中已知。
如本文所使用,可擴增/過度表現erbB-2(可與Her-2及neu交換使用)之新生瘤包括某些乳癌及其他新生瘤,包括卵巢、膀胱、胃、胰臟、結腸直腸、前列腺及肺癌,包括非小細胞肺癌。表現或過度表現ErbB1之其他新生瘤包括各種人類腫瘤,包括非小細胞肺癌(NSCL)、前列腺癌、乳癌、結腸直腸癌及卵巢癌。用於篩選樣本以確定新生瘤是否過度表現erb-1及/或erbB-2/Her-2之方法係熟習本技藝技術者已知。
如本文所定義,主要療法係指於診斷新生瘤,如HER-2/neu過度表現/擴增之新生瘤後對病患提供之最初療法。主要療法亦稱為確定性局部療法。針對HER-2/neu過度表現/擴增之新生瘤之主要療法包括單獨或組合手術(若治療乳癌時,可包括腫塊切除、改良式根治性全乳房切除、全乳房切除術)及/或放射療法。輔助療法係指於最初或主要療法後常提供用於提高痊癒可能性之療法。目前,用於HER-2/neu過度表現/擴增之新生瘤之標準輔助療法包括例如,化療及/或抗體療法。一般而言,若於主要療法(例如,手術)前實施其中一種或多種輔
助療法時,則其稱為前輔助療法。於本說明書以下部份通篇,術語「前/輔助」係簡短代表前輔助及標準輔助療法兩者。可同時實施一或多種輔助療法。
於一實施例中,病患係已接受涉及投與蒽環黴素或紫杉烷或任何環磷醯胺、甲胺蝶啶及5-氟尿嘧啶療程之化療法。此等化療法可包括一種或多種蒽環黴素,諸如阿黴素、環磷醯胺、紫杉醇、多烯紫杉醇及卡鉑。另一合適的前/輔助療法係基於多重模式蒽環黴素之療法。其他前/輔助療法特別包括拉帕替尼(lapatinib)[二對甲苯磺酸拉帕替尼,TYKERB®]、皮妥珠單抗(pertuzumab)[Roche,Genentech]、貝伐單抗(bevacizumab)[Avastin®,Genentech]、曲司佐單抗(trastuzumab)-DM-1[Genentech]。前輔助或輔助療法之選擇不會限制本發明。本發明之延伸輔助療法係於曲司佐單抗療法完成後開始。曲司佐單抗一般係於化療完成後投藥或作為化療之維持療法一起投藥。就曲司佐單抗而言,可包括單劑量及多劑量。於一實施例中,曲司佐單抗之單一投藥劑量係於第1日呈90分鐘靜脈輸注,依約4至5mg/kg範圍投與,接著自第8日開始,依約每周2mg/kg投與。一般而言,以3周作為1個循環。自第1至第2再至第3個循環之間可能間隔數周。於另一實施例中,曲司佐單抗係利用8mg/kg作為負載劑量及6mg/kg作為維持劑量,依每3週投藥一次之療程投與。曲司佐單抗亦可每3至4週投與一次6mg/kg的劑量。亦可設計及利用其他曲司佐單抗投藥療程。
於一實施例中,除了曲司佐單抗前/輔助療法外,病患亦可接受主要及其他前/輔助療法。於一實施例中,在該延伸輔助療法期間,於完成曲司佐單抗療法後,可緊接一或多個輔助療法。適宜地,於開始進行本發明延伸來納替尼療法之前,主要療法或前/輔助療法任一者皆不涉及來納替尼療法。
於一實施例中,本文所述之延伸來納替尼療法係於主要療法後約一年、約兩年或約三年時開始。該延伸來納替尼輔助療法係於曲司佐單抗之前/輔助療法完成後開始。
本文所說明該延伸療法可在曲司佐單抗前/輔助療法完成至少一劑、至少3週循環、至少3個3週循環後、完成後至少4個月、至少6個月、至少8個月或至少一年時開始。在一項實施例中,該延伸療法係在曲司佐單抗前/輔助療法完成後至少約2週、至少約一個月、至少約6個月、至少約9個月或約一年時開始。
如本文所說明,該延伸來納替尼療法係用於降低HER-2/neu過度表現/擴增之乳癌病患之復發率。此等機率可係於治療開始後之時間點:6個月、1年、3年、或5年時測定。該療法涉及繼主要及前/輔助療法後,對此等病患投與來納替尼。於另一實施例中,該延伸來納替尼係用於改善癌症病患之無侵入性疾病存活期、DFS-DCIS、無遠端疾病存活期及/或到達遠端復發之時間。
本發明之此延伸輔助療法可涉及於曲司佐單抗療法完成後僅投與單一劑量之來納替尼。然而,於另一實施例中,該延伸來納替尼療法係以1個月、2個月、至少6個月、至少1年、至少18個月之時間內或如所需或所要求之更長時間內投與。於另一實施例中,以來納替尼治療病患約8個月至約5年、約12個月(1年)至約3年、或由醫師所確定之較長或較短之時間。
如本文所使用,關於提供來納替尼之術語「提供」意指直接投與化合物或組合物,或投與可於體內形成有效量之來納替尼化合物之前藥衍生物,或類似物。
如本文所使用且除非另外說明,術語「個體」、「受試者」及「病患」可交換使用,且係指任何動物,包括哺乳動物,較佳係小
鼠、大老鼠、其他齧齒動物、兔、犬、貓、豬、牛、羊、馬、非人靈長類動物、及人類。較佳地,術語「個體」、「受試者」及「病患」係指人類。於大部份實施例中,受試者或病患係需要醫療治療。因此,如本文所使用之術語「受試者」或「病患」意指可接受投與所申請療法之任何哺乳動物病患或受試者。
如本文所使用,當投與受試者以治療新生瘤時,術語「有效量」或「醫藥有效量」係足以抑制、減緩、降低或消除受試者中之病灶或腫瘤生長,或抑制、減緩、或降低疾病惡化及/或增加受試者之無惡化存活率。
來納替尼(或所選擇之HKI-272化合物)可(例如)以約0.01至100mg/kg之劑量範圍經口投與。於一實施例中,來納替尼係以約0.1至約90mg/kg之劑量範圍投與。於另一實施例中,來納替尼係以約1至約80mg/kg之劑量範圍投與。於又一實施例中,來納替尼係以約10至約70mg/kg之劑量範圍投與。於再一實施例中,來納替尼係以約15至約60mg/kg之劑量範圍投與。於又再一實施例中,於投藥循環之各天內,來納替尼係以每日約20至約240mg之劑量範圍,以至少約40mg、至少約120mg、或至少約160mg之劑量投與。熟習本技藝技術者可按進行實證活性測試,以於生物學分析法中確定化合物之生物活性,進而確定當藉由其他途徑投與該化合物時需投與之劑量。
於一實施例中,來納替尼之口服劑量係至少約700mg/週。於另一實施例中,來納替尼之口服劑量係約800mg/週至至少高達約1700mg/週。於另一實施例中,來納替尼之口服劑量係約840mg/週至約1680mg/週。於另一實施例中,來納替尼之口服劑量係約900mg/週至約1600mg/週。於又一實施例中,來納替尼之口服劑量係約1000mg/週至約1500mg/週。於再一實施例中,來納替尼之口服劑量係約1100mg/週至約1400mg/週。於又再一實施例中,來納替尼之口服劑
量係約1200mg/週至約1300mg/週。準確劑量係藉由投藥醫師根據所治療之個別受試者之情況確定。其他劑量療程及變化係可預測並藉由醫師指導來確定。
就來納替尼而言,該化合物需呈單位劑量形式。來納替尼可依約0.01至100mg/kg之劑量範圍或0.1至10mg/kg之劑量範圍投與。於一實施例中,來納替尼係每日1至6次,更一般而言係每日1至4次經口投與。合適的單位劑型包括錠劑、膠囊及含於藥袋或瓶中之粉末。此等單位劑型可含有0.1至300mg之來納替尼、2至100mg,每日劑量120至300mg,或每日240mg。或者,來納替尼可經由另一合適路徑,例如,靜脈內投與。於又一實施例中,來納替尼係每週投與一次。於特定情況中,可於治療療程之一段短暫期間內(例如,1、2或3週)延緩或間斷投與來納替尼。於治療療程期間,該延緩或間斷投藥可發生一次或更多次。有效量係為熟習本項技術者已知,其亦依據化合物形式而定。熟習本項技術者可按常規進行實驗性活性測試,以於生物學分析法中決定化合物之生物活性,進而確定需投與之劑量。
於一實施例中,本文所使用醫藥載劑之合適實例包括,但非限於,賦形劑、稀釋劑、填充劑、崩解劑、潤滑劑及其他可用作載劑之試劑。術語「醫藥可接受賦形劑」意指可用於製備通常為安全、非毒性且合乎需要之醫藥組合物之賦形劑,且包括獸醫用途及人類醫藥用途可接受之賦形劑。此等賦形劑可為固體、液體、半固體、或若呈氣溶膠組合物時,則為氣態。醫藥組合物係根據可接受的醫藥製程製備,如於Remingtons Pharmaceutical Sciences,第17版,Alfonoso R.Gennaro,Mack Publishing Company,Easton,Pa.(1985)中所描述者。醫藥可接受載劑係彼等可與調配物中其他成份相容且為生物學可接受者。就錠劑或膜衣錠調配物而言,合適的醫藥可接受賦形劑或載劑包括例如,諸如乳糖、碳酸鈉、磷酸鈣或碳酸鈣之惰性賦形劑、諸
如玉米澱粉或海藻酸之造粒及崩解劑;諸如凝膠或澱粉之黏結劑;諸如硬脂酸鎂、硬脂酸或滑石之潤滑劑;諸如4-羥基苯甲酸乙酯或丙酯之防腐劑,及諸如抗壞血酸之抗氧化劑。錠劑或膜衣錠調配物可未包覆包衣或已包覆包衣,以修飾其崩解性及活性成份隨後於胃腸道內之吸收性,或利用本技藝已知之習知包衣劑及製程改善其等穩定性及/或外觀。
於一實施例中,本發明提供一種治療HER-2/neu過度表現/擴增之癌之延伸療法,其包括對HER-2/neu過度表現之癌症病患實施延伸來納替尼療法之療程。該延伸療法涉及在手術及/或輔助療法完成後,開始該來納替尼療法。該延伸療法係用於提供改善之無侵入性疾病存活期及/或改善之總體存活期、到達遠端復發之時間、及無遠端疾病存活期。
如本文所描述,該延伸來納替尼療法係在最初療法開始後至少1年、至少2年或至少3年時開始。於一實施例中,來納替尼療法係於在主要及標準前/輔助療法完成後至少約2週時及至長約4年時開始。
於一實施例中,經選擇之伴隨療法可用於與該延伸來納替尼療法組合。例如,病患可進一步接受採用雙磷酸鹽之伴隨療法,以治療骨質減少或骨質疏鬆症。於另一實施例中,病患可進一步伴隨接受內分泌療法。視需要,此等伴隨療法可為非輔助療法,而是用於治療病患所具有之其他病況或病症。
本發明包括一種含有針對單一哺乳動物之抗新生瘤治療療程之產品或醫藥包裝,其包含一或多個具有一個、一至四個、或更多個單位之來納替尼及視需要選用之一個、一至四個、或更多個單位之其他活性藥劑之容器。
於另一實施例中,該等醫藥包裝含有針對單一哺乳動物之抗新
生瘤治療療程,其包含一個含有呈單位劑型之一個單位雷帕黴素之容器,一個含有一個單位來納替尼之容器及視需要選用之一個含有其他活性藥劑之容器。
於某些實施例中,本發明組合物係呈現成可投與之包裝形式。於其他實施例中,本發明組合物係呈濃縮包裝形式,其視需要含有製造最終溶液所需之稀釋劑,以作投藥用。於其他實施例中,該產品含有可呈固體形式用於本發明之化合物,及視需要包含另一個含有可用於本發明之化合物之合適溶劑或載劑之獨立容器。
於另外其他實施例中,以上包裝/套組包括其他組件,例如,指示該產品之稀釋、混合及/或投與法之說明書、其他容器、注射器、針頭等。其他包裝/套組組件係為熟習本項技術者瞭解。
以下實例將說明本發明組合物之用途。咸瞭解,可針對熟習本項技術者之目的改變或修飾例如,組分之調配、投與路徑、及劑量。
已於罹患轉移性erbB-2陽性乳癌之受試者之第2期試驗中研究作為單一藥劑之來納替尼。將曾接受基於曲司佐單抗療法之66位受試者編排至A組;將未曾接受任何曲司佐單抗治療之70位受試者編排至B組。採用客觀反應率及無惡化存活期中值作估測抗腫瘤活性。
根據基於曾接受曲司佐單抗治療之獨立的放射學評估之初步數據,總反應率(ORR)為26%(95可信指數(CI))及無惡化存活期中值(PFS)為23週(95% CI)。未曾接受曲司佐單抗治療之受試者之ORR為57%(95% CI)及中值PFS為40週(95% CI)。以A組中抗腫瘤活性作為測試來納替尼於曲司佐單抗難以治愈之受試者中作為單一藥劑之基礎。
於A組中,曲司佐單抗治療時間中值為60週。28%受試者接受曲司佐單抗作為輔助或前輔助療法。於轉移性病例中,大多數(48%)受試者接受一種基於曲司佐單抗之療法,且約43%為了轉移性疾病而接
受基於第二或第三種基於曲司佐單抗之療法。A組受試者亦曾積極接受細胞毒性治療,其中53%受試者曾接受2至3次療法及另27%曾接受>3次細胞毒性療法。總而言之,此等治療特徵說明A組中經積極前治療且可能難以治愈的研究人群。因此於難以治愈的人群中達26%之ORR顯示,來納替尼可為針對erbB-2陽性乳癌之高活性藥劑。
與來納替尼相關之主要不良反應係腹瀉,其一般可藉由藥物治療、中斷治療、或修改劑量來處控制。其他常見不良反應係噁心、嘔吐、疲勞及厭食。
於隨機化、雙盲、以安慰劑為對照控制的第3期試驗中,於罹患早期HER-2/neu過度表現/擴增之乳癌女性中投與曲司佐單抗後,比較來納替尼與安慰劑。受試者必須已先接受曲司佐單抗輔助療程。若投與曲司佐單抗之時間少於12個月,則需至少先投藥8劑且需明確指出該受試者不適合或無法接受曲司佐單抗之進一步輔助療法。於涉及至少8個月,及較佳12個月之先前曲司佐單抗輔助療法後,受試者便具有接受本文所述療法治療的資格。曲司佐單抗之最後一次投藥需在隨機分組開始後之>2週且<4週時進行。將依據以下因素隨機分組:ER及/或PgR陽性對ER及PgR陰性;淋巴結狀態(0、1至3、4或更多);預後<或>3年;曲司佐單抗與化療依序進行對曲司佐單抗與化療同時進行。
合格的受試者係依1:1之比例分派至以下兩組中之一組:於1年內每日投與240mg來納替尼或於1年內每日投與安慰劑。於中斷研究治療後,針對疾病復發及存活持續追蹤受試者,直至達到無侵入性疾病存活(IDFS)事件之計畫人數,並針對其後之存活期追蹤直至該研究結束。利用分層對數-分級測試法分析IDFS之主要效能終點及直到事件發生之第二終點。由Cox比例危害迴歸模式推算危害比及相應的
95%可信區間[DR Cox,1972,「Regression Models and Life Tables(with Discussion)」,Journal of the Royal Statistical Society,B系列34:187-220]。採用Kaplan-Meier法分析直到事件發生之時間中值及相關的95%可信區間[Kaplan,E.L.及Meier,Paul.「Nonparametric estimation from incomplete observations」J.Am.Stat.Assoc.53,457-481(1958)]。主要效能分析係針對計畫治療由所有隨機受試者所定義之人群進行。不良事件及嚴重不良反應係針對由接受來納替尼或安慰劑之所有受試者所定義之安全人群經過分組治療所概括得到之結果。亦概括第3級或更嚴重腹瀉之發病率並利用Mantel-Haenszel測試法測定治療組之間之差異[Mantel N & Haenszel W.Statistical aspects of the analysis of data from retrospective studies of disease.J.Nat.Cancer Inst.22:719-48,1959]。
本說明所引用之所有公開案係以引用的方式併入本文。雖然本發明已藉由參考具體實施例得以描述,然而應瞭解可於不脫離本發明之精神下進行修改。此等修改係屬於附屬專利申請範圍之範圍內。
Claims (10)
- 一種來納替尼(neratinib)之用途,其係用於製備於患者治療早期HER-2/neu過度表現/擴增之癌及改善無侵入性疾病存活期(IDFS)之藥劑,其中該藥劑係用於至少12個月之曲司佐單抗(transtuzumab)輔助療法完成時之癌症治療;且其中該藥劑係用於至少12個月之癌症治療。
- 如請求項1之用途,其中該藥劑係用於手術及標準輔助療法完成後約2週至約1年時開始之癌症治療。
- 如請求項1之用途,其中該藥劑係製備用於經口投與。
- 如請求項1之用途,其中該藥劑係製備成錠劑形式。
- 如請求項1之用途,其中該藥劑係製備用於每日投藥。
- 如請求項1之用途,其中該藥劑係製備用於投與來納替尼120mg至300mg之每日劑量。
- 如請求項6之用途,其中該藥劑係製備用於投與來納替尼240mg之劑量。
- 如請求項1之用途,其中該患者已接受由曲司佐單抗及一或多種化療組成之標準輔助療法。
- 如請求項1之用途,其中該化療涉及阿黴素(doxorubicin)、環磷醯胺、紫杉醇(paclitaxel)、多烯紫杉醇(docetaxel)、卡鉑(carboplatin)、拉帕替尼(lapatinib)、皮妥珠單抗(pertuzumab)、貝伐單抗(bevacizumab)、曲司佐單抗-DM-1或蒽環黴素療法之一或多者。
- 如請求項1之用途,其中該患者進一步接受伴隨療法,該伴隨療法選自一或多者之針對骨質減少或骨質疏鬆之雙磷酸鹽及內分泌療法。
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