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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
  • A61K31/525—Isoalloxazines, e.g. riboflavins, vitamin B2
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
  • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
  • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
  • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
  • A61K31/7068—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines having oxo groups directly attached to the pyrimidine ring, e.g. cytidine, cytidylic acid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/177—Receptors; Cell surface antigens; Cell surface determinants
  • A61K38/179—Receptors; Cell surface antigens; Cell surface determinants for growth factors; for growth regulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/18—Growth factors; Growth regulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/02—Antineoplastic agents specific for leukemia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention relates to combinations of a VEGF inhibitor and a chemotoxic agent of the class of 5-fluorouracil or 5-fluoropyrimidines that are useful in the treatment of neoplastic diseases.
• VEGF inhibitors which are inhibitors of vascular endothelial growth factor, are, in the majority of cases, biological products chosen from soluble receptors, antisenses, RNA aptamers and antibodies.
• the 5-fluoropyrimidine derivatives are chosen from 5-fluorouracil, capecitabine or gemcitabine, which exhibit notable antitumoral and antileukemia properties; they are particularly useful in the treatment of ovarian cancer, breast cancer, lung cancer or colon cancer.
• the present combination is directed in particular toward the treatment of colon cancer or stomach cancer.
• the VEGF-Trap used in the invention is a fusion protein comprising the VEGFR1 signal sequence fused to the Ig domain D2 of the VEGFR1 receptor, itself fused to the Ig domain D3 of the VEGFR2 receptor, in turn fused to the Fc domain of IgG1, also called VEGFR1R2-Fc ⁇ C1 or Flt1D2.FlklD3.Fc ⁇ C 1.
• the doses used are between 20 and 800 micrograms per kilo when the administration is carried out subcutaneously and from 2 to 20 micrograms per kilo when the administration is carried out intravenously or, optionally, intranasally at a lower dose of the order of 0.01 picogram to 1 mg per kilo.
• the 5-fluorouracil is generally used intravenously at a dose of between 500 mg/m 2 and 5000 mg/m 2 per week; as regards the 5-fluoropyrimidine derivatives such as capecitabine, they are generally used, for the latter, orally at a dose of between 500 and 3000 mg/m 2 generally administered in two daily doses.
• Gemcitabine is generally used intravenously at a dose of between 500 and 2000 mg/m 2 per week.
• VEGF inhibitors can be considerably improved when they are administered in combination with at least one substance therapeutically useful in anticancer treatments that has a mechanism of action different from that of the VEGF inhibitors.
• the activity of the products depends on the doses used, it is possible to use higher doses and to increase the activity by decreasing the phenomena of toxicity or delaying their appearance through the combination with the VEGF inhibitors or with their analogs of other therapeutically active substances, of growth factors of hematopoietic type, such as G-CSF or GM-CSF, or certain interleukins.
• the invention relates to the combinations of VEGF-Trap with 5-fluorouracil or derivatives thereof such as capecitabine or gemcitabine. It also relates to the combinations also including folinic acid generally combined with 5-FU.
• a combination shows therapeutic synergism if it is therapeutically superior to one or other of the constituents used at its optimum dose [T. H. Corbett et al., Cancer Treatment Reports, 66, 1187 (1982)].
• T-C represents the delay in growth of the cells, which is the average time, in days, for the tumors of the treated group (T) and the tumors of the control group (C) to reach a predetermined value (1 g, for example) and T d represents the time, in days, required for the volume of the tumor to double in the control animals [T. H.
• a product is considered to be active if log 10 killed cells is greater than or equal to 0.7.
• a product is considered to be very active if the log 10 killed cells is greater than 2.8.
• each of the constituents will be present at a dose generally less than or equal to its maximum tolerated dose, which show therapeutic synergy when the log 10 killed cells is greater than the value of log 10 killed cells of the best constituent when it is administered alone.
• an MC 13/C mammary tumor fragment are transplanted bilaterally, subcutaneously, into the animals subjected to the experiment, generally mice, on day 0.
• the animals bearing the tumors are randomized before being subjected to the various treatments and controls. In the case of treatment of advanced tumors, the tumors are left to develop until the desired size, the animals having insufficiently developed tumors being eliminated.
• the animals selected are divided up randomly so as to undergo the treatments and the controls. Animals not bearing tumors can also be subjected to the same treatments as the tumor-bearing animals in order to be able to dissociate the toxic effect from the actual effect on the tumor.
• the chemotherapy generally begins from 3 to 22 days after the tumor transplant, according to the type of tumor, and the animals are observed every day.
• the various groups of animals are weighed three or four times a week until the maximum weight loss is obtained, and then the groups are weighed at least once a week until the end of the trial.
• the tumors are measured two or three times a week until the tumor reaches approximately 2 g or until the animal's death if the latter occurs before the tumor reaches 2 g.
• the animals are autopsied when they are sacrificed.
• the antitumor activity is determined as a function of the various parameters recorded.
• a product is considered to be active if the increased survival time is greater than 27% and it is considered to be very active if it is greater than 75% in the case of P388 leukemia.
• the present invention also relates to the pharmaceutical compositions containing the combinations according to the invention.
• the products that constitute the combination can be administered simultaneously, separately or spread out over time so as to obtain the maximum effectiveness of the combination; it being possible for each administration to have a variable duration ranging from complete rapid administration to continuous infusion.
• the combinations are not only limited to those which are obtained by physical combination of the constituents, but also to those which allow a separate administration which may be simultaneous or spread out over time.
• compositions according to the invention are preferably compositions that can be administered parenterally. However, these compositions may be administered orally.
• compositions for parenteral administration are generally sterile pharmaceutically acceptable solutions or suspensions which may optionally be prepared extemporaneously at the time of use.
• nonaqueous solutions or suspensions natural plant oils such as olive oil, sesame oil or paraffin oil or injectable organic esters such as ethyl oleate can be used.
• the aqueous sterile solutions may consist of a solution of the product in water.
• the aqueous solutions are suitable for intravenous administration insofar as the pH is suitably adjusted and isotonicity is effected, for example by means of a sufficient amount of sodium chloride or glucose.
• the sterilization can be carried out by heating or by any other means that does not impair the composition.
• the combinations may also be in the form of liposomes or in the form of a combination with carriers such as cyclodextrins or polyethylene glycols.
• the application of these constituents may be simultaneous, separate or spread out over time, it is particularly advantageous for the amount of VEGF-Trap derivative to represent from 2 to 80% by weight of the combination, it being possible for this content to vary according to the nature of the substance combined, to the desired effectiveness and to the nature of the cancer to be treated.
• “Pharmaceutically effective amount” is meant to describe an amount of the combinations according to the present invention, and constituents thereof, effective in producing the desired therapeutic effect.
• the constituents of the combinations according to the invention may be administered in dosages which are pharmaceutically effective for each constituent, or in dosages which are sub-clinical, i.e., less than pharmaceutically effective for each, or a combination thereof, provided that the combined dosages are pharmaceutically effective.
• the combinations according to the invention are particularly useful in the treatment of colon and/or stomach cancers.
• they may have the advantage of being able to use the constituents at doses that are much lower than those at which they are used alone.
• Ampoules of 1 cm 3 containing 25 mg of VEGF-Trap, which are diluted in a phosphate buffer, are prepared, according to the usual technique, for subcutaneous administration.
• 0.2 ml per mouse is prepared, according to the usual technique, for intravenous administration, from a commercial solution of 5 cm 3 containing 250 mg of 5 FU to be diluted with 5% glucose in water.
• the treatment can be repeated several times per day or per week until partial or complete remission or recovery.
• Dosage in mg/kg/day total dose in mg/kg) % sc VEGF- weight Trap loss at (day 4, 7, iv 5-FU Death due the 11, 14, 18, (day 4, 11, to the lowest T ⁇ C 21) 18) treatment point % T/C days lck 40 (240) — 0/5 2.3 4 12.7 1.4 25 (150) — 0/5 1.1 8 13.9 1.5 10 (60) — 0/5 1.1 9 12.1 1.3 2.5 (15) — 0/5 0.9 32 5.2 0.6 — 145 (435) 1/5 8.7 Toxic — — — 90 (270) 0/5 4.8 0 12.5 1.3 — 55.8 (167.4) 0/5 1.1 12 7.8 0.8 — 34.6 (103.8) 0/5 +2.3 34 4.6 0.5 40 (240) 90 (270) 0/5 8.0 0 25.2 2.7 25 (150) 90 (270

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