US20130337091A1 - Pharmaceutical use - Google Patents

Pharmaceutical use Download PDF

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US20130337091A1
US20130337091A1 US13/982,162 US201213982162A US2013337091A1 US 20130337091 A1 US20130337091 A1 US 20130337091A1 US 201213982162 A US201213982162 A US 201213982162A US 2013337091 A1 US2013337091 A1 US 2013337091A1
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aromatase
inhibitor
pharmaceutical medication
medication
active ingredients
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Alfred Schmidt
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Lucolas-Md Ltd
LUCOLAS M D Ltd
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LUCOLAS M D Ltd
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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
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
    • A61K31/568—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol substituted in positions 10 and 13 by a chain having at least one carbon atom, e.g. androstanes, e.g. testosterone
    • A61K31/5685—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol substituted in positions 10 and 13 by a chain having at least one carbon atom, e.g. androstanes, e.g. testosterone having an oxo group in position 17, e.g. androsterone
    • 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
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
    • A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline 
    • 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
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
    • A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline 
    • A61K31/353—3,4-Dihydrobenzopyrans, e.g. chroman, catechin
    • 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
    • A61K31/38—Heterocyclic compounds having sulfur as a ring hetero atom
    • A61K31/381—Heterocyclic compounds having sulfur as a ring hetero atom having five-membered 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
    • A61K31/38—Heterocyclic compounds having sulfur as a ring hetero atom
    • A61K31/385—Heterocyclic compounds having sulfur as a ring hetero atom having two or more sulfur atoms in the same ring
    • 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
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/558—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes
    • 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
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/558—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes
    • A61K31/5585—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes having five-membered rings containing oxygen as the only ring hetero atom, e.g. prostacyclin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00—Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18—Magnoliophyta (angiosperms)
    • A61K36/185—Magnoliopsida (dicotyledons)
    • A61K36/82—Theaceae (Tea family), e.g. camellia
    • 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
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P13/00—Drugs for disorders of the urinary system
    • A61P13/08—Drugs for disorders of the urinary system of the prostate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/04—Centrally acting analgesics, e.g. opioids
    • 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
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the invention concerns a medication and a pharmaceutical composition for the treatment of sex hormone-dependent diseases, in particular of breast cancer.
  • Sex hormone-dependent diseases have a high prevalence in the population.
  • Breast cancer for example, is the most frequently diagnosed cancer disease in women in Europe. 350,000 new cases are expected every year, while in the same period 130,000 women die of breast cancer (INCR Cancer Fact Sheets, Vol. 2, December 2002). Thus, 26.5% of all cancer diseases are breast cancer; 17.5% of all death caused by cancer, are caused by breast cancer.
  • the therapy in the individual case depends on the staging of the tumor, for example, according to the stadium of the disease the biology of the tumor such as the expression of hormone receptors by the tumor cells.
  • the expression of estrogen receptors (ER) or progesterone receptors (PR) allows for a medicinal therapy (e.g. as adjuvant therapy after mastectomy) with the estrogen antagonist Tamoxifen (Early Breast Cancer Trialists' Collaborative Group. N Engl J Med 1988; 319:1681-1692).
  • aromatase catalyzes the conversion of androgens to estrogens. Postmenopausally, this reaction takes place mainly in the peripheral tissues, where the estrogen synthesized there exerts its effects locally, i.e. in the cell. This process can be described by the concept known as “Intracrinology” (Labrie F., Molecular and Cellular Endocrinology 1991; 78:C113-C118; as well as labrie F., Nature Clinical Practice Endocrinology & Metabolism 2007, Vol 3 No. 8; cf. also FIG. 3 ).
  • the present invention concerns the use of a pharmaceutical medication, which contains an aromatase inhibitor and an antioxidant as active ingredient, and active component, respectively, for the treatment of sex hormone-dependent diseases.
  • the invention concerns a composition, which contains a steroidal aromatase inactivator and ⁇ -lipoic acid as antioxidant.
  • a composition which contains a steroidal aromatase inactivator and ⁇ -lipoic acid as antioxidant.
  • the combination of an aromatase inhibitor and ⁇ -lipoic acid is particularly suitable for the treatment of sex hormone-dependent diseases.
  • an aromatase inhibitor preferably a steroidal aromatase inactivator
  • an antioxidant preferably a steroidal aromatase inactivator
  • the beneficial effects enhance each other significantly and in disproportionate manner.
  • the therapeutic concept according to the invention provides that the aromatase inhibitor (aromatase inactivator) is particularly effective due to the concomitant use of an antioxidant. It is assumed that the antioxidant in the specific combination supports the prophylactic or therapeutic effectiveness of the aromatase inhibitors and that a synergistic interaction takes place.
  • Antioxidants in the meaning of the present invention act as so-called radical scavengers in the organism, i.e. they deactivate highly-reactive radicals induced by exogeneous noxious agents (e.g. nicotine or alcohol), and endogeneously induced.
  • exogeneous noxious agents e.g. nicotine or alcohol
  • “Pharmaceutical medication” in the context of the present invention means that the active ingredients and active components, respectively, are administered, produced or provided in separate forms of application or dosage units, or as a combined composition, such as in a common application or dosage unit or in the form of a kit.
  • both active ingredients are administered and the medication is prepared, respectively, in such a way that their physiological effects are exerted simultaneously, in the same manner and at the same site, and that the time intervals overlap, respectively, during which the single active ingredients are physiologically effective.
  • the surprising reciprocal enhancement of the active ingredients leads to an improved efficacy of the medication in the therapy and prophylaxis of sex hormone-dependent diseases in general and of cancer, mastopathie, mastodynia, mastalgia, lipomas or lipomatoses, in particular.
  • FIG. 1 shows the result of the treatment of a female patient with an ER-positive tumor in the right breast with the combination according to the invention.
  • FIG. 1A shows mammographies
  • FIG. 1B the evaluation of the radiological measurements of the tumor volume at the beginning of the treatment and 29 days later.
  • FIG. 2 shows the result of the treatment of a further female patient with an ER-positive tumor in the left breast.
  • FIG. 2A shows the mammographies
  • FIG. 2B the analysis of the results of the radiological measurements of the tumor volume at the beginning of the treatment and 14 days later.
  • FIG. 3 shows the preferred concept according to the principle of “Intracrinology” and the corresponding preferred target of the inventive applications.
  • the medication according to the invention Due to the particular effect of the use of the medication according to the invention, its application can further be considered in the treatment or prophylaxis of tumors that grow in a hormone-dependent manner in general, breast cancer being merely one example. Because of the use of the antioxidant in the combination according to the invention, the invention is particularly useful in the prophylaxis and therapy of such diseases or conditions, in which a reduction of the number of free radicals in the organism, but, above all, also in the affected organ and tissue, respectively, has a positive effect. Due to the simultaneous additional use of an aromatase inhibitor, the use according to the invention is particularly effective in the case of sex hormone-dependent diseases.
  • Sex hormone-dependent diseases in the meaning of the invention are any diseases and pathological conditions, which are generated by the effect of one or more sex hormones, caused by the imbalance of the local (extragonodal) production of sex hormones in the affected organs or affected tissue, or influenced in their progression.
  • Relevant sex hormonal influencing factors and targets, in particular with regard to relevant steroidogenic enzymes in peripheral (“intracrine”) tissue, that can be in connection with the therapy of sex hormone-dependent diseases according to the invention are clear from FIG. 3 , which depicts a schematic representation of the role of ovarian and adrenaline sources of sex hormones, which are in particular typical for post-menopausal women, which however shall make clear herein the preferred embodiments of the present invention.
  • DHEA is converted to androgens and/or estrogens via the concept of “intracrinology”. Only small amounts of these peripherally composed sex hormones reach the systemic circulation.
  • the inventive application can indeed and very effectively take action in peripheral target tissue, and thus in particular take action locally, and above all via topical application.
  • the invention concerns the use of the medication for prophylaxis or therapy of breast cancer in female and in male patients.
  • an anti-androgen therapy such as 5-alpha-reductase inhibitors, LH-RH-analoga or androgen receptor blockers
  • prostate hypertrophy and prostate cancer can be treated with particular success.
  • Growth of the prostate is sex hormone-dependent in healthy individuals as well as in the special situation of prostate carcinoma.
  • the local hormonal balance i.e. the interaction of estrogens and androgens, are of significant importance in the target tissue for prostate cancer (Kelloff et al., Cancer Epidemiology, Biomarkers and Prevention 1998; 7:65-78).
  • an antioxidant in combination with an aromatase inhibitor is therapeutically particularly effective in diseases or conditions, whose origin or progression are influenced by estrogen or its precursors or derivatives.
  • the positive effect of aromatase inhibitors has been demonstrated, in particular in tumors expressing estrogen receptor (ER-positive tumors) (review article: Labrie F., Nature Clinical Practice 2007; 3:584-593). It is assumed that the concomitant use of an aromatase inhibitor and of an antioxidant the synergism is achieved by the specific effect on different physiological processes.
  • Aromatase inhibitors in the meaning of the present invention are all substances, which—independently from their structure—are characterized by the common feature that they effectively inhibit or even inactivate aromatase (review article: Santen et al., Endocrine Reviews 2009; 30:343-375).
  • the capacity of a substance to inhibit or inactivate aromatase can be determined by methods, which are known to the skilled person.
  • a radiometric essay allows for the measurement of aromatase activity in a single step by determining tritium-release from a tritium-labelled substrate (Thompson und Siiteri, Journal of Biological Chemistry 1974; 249:5364-5372).
  • the group of aromatase inhibitors is structurally heterogeneous and comprises steroidal as well as non-steroidal compounds, wherein representatives of both groups are relevant for the medication in the meaning of the invention.
  • non-steroidal aromatase inhibitors e.g. Anastrazol, Letrozol und Vorozol
  • Preferred steroidal aromatase-inhibitors are 4-hydroxyandrostenedione, Exemestane, 4-acetoxyandrostenedione, 5- ⁇ -androst-3-ene-17-one and 3- ⁇ ,4- ⁇ -epoxy-5- ⁇ -androstane-17-one.
  • Further examples of known aromatase-inhibitors are listed in pharmacopoeas such as the “Rote Liste”.
  • An antioxidant according to the present invention is a “radical scavenger”, which captures free radicals or terminates their harmful impact in the cell.
  • the administration of an antioxidant in combination with an aromatase-inhibitor apparently counteracts the origin and the proliferation of cancer, slows down the proliferation of a tumor or causes the reduction of the tumor mass, for example via apoptosis.
  • These characteristics are of critical importance in the therapy and secondary prophylaxis as well as in the primary prophylaxis of breast/prostate cancer.
  • the primary origin of the tumor can be avoided if the mutagenic potential is decreased by reduction of the exogeneously (e.g. use of nicotine or alcohol) or endogeneously (e.g.
  • the group of antioxidants is structurally very heterogeneous. Suitable substances in the meaning of the invention are selected due to their capability to prevent the oxidation of other molecules. The skilled person is capable of identifying an antioxidant using established and published methods.
  • the amount of free radicals can be measured, for example, by EPR ( Electric Paramagnetic Resonance ; Lo Scalzo, EJEAFChe 2010; 9:1360-1371).
  • antioxidants can be substances of various chemical classes and various origin.
  • Non-enzymatic antioxidants comprise, in particular, flavonoids (e.g. oligomeric proanthocyanidines (OPC), anthocyanes or polyphenoles such as quercetin or catechin); vitamins (e.g. vitamin C, vitamin E); carotenoides (e.g. beta-carotin, lycopen, lutein); minerals (e.g. copper, manganese, zinc, selenium); hormones (e.g. melatonin); steroids (e.g.
  • flavonoids e.g. oligomeric proanthocyanidines (OPC), anthocyanes or polyphenoles such as quercetin or catechin
  • vitamins e.g. vitamin C, vitamin E
  • carotenoides e.g. beta-carotin, lycopen, lutein
  • minerals e.g. copper, manganese, zinc, selenium
  • hormones e.g. melatonin
  • steroids e.g
  • ubiquinones N-acetylcystein
  • ⁇ -lipoic acid an extract of green tea containing an antioxidative effective composition of polyphenols, optionally also amino acids, mineral nutrients (trace elements) and polysaccharides, and in particular which contains the specific highly antioxidative effective polyphenols epicatechin and epigallocatechin (e.g. OM24®, available from Omnimedica, Switzerland); and glutathion.
  • Some enzymes fulfil the function of antioxidants and are termed enzymatic antioxidants, such as, for example, glutathionperoxidase, superoxide dismutase and katalase.
  • the intentionally administered amount of antioxidant is at least 0.05, further preferred at least 0.1 wt.-% and in particular 0.5 wt.-% of the total composition, and/or that the antioxidant is administered locally in a targeted way at the desired treatment site, in particular locally-topically, or if so pulmonally or nasally.
  • the antioxidant which is used together with an aromatase inhibitor, is ⁇ -lipoic acid (1,2-dithiolane-3-pentanoic acid) or green tea extract containing polyphenols, in particular OM24®.
  • ⁇ -lipoic acid is active in the aqueous phases as well as in the lipid phases of cells. The substance is excellently absorbed gastro-intestinally as well as via the skin. This allows for various possibilities of administration.
  • ⁇ -lipoic acid is quickly converted to dihydrolipoic acid in the organism.
  • Dihydrolipoic acid regenerates other, also endogeneous, antioxidants, such as vitamin C and vitamin E, which can lead to further enhanced effects, when ⁇ -lipoic acid is administered.
  • ⁇ -lipoic acid furthermore induces the synthesis of glutathione in the tissue.
  • ⁇ -lipoic regenerates glutathione from glutathione disulfide.
  • the term “treatment” relates to the therapy as well as to the prophylaxis of sex hormone-dependent diseases and conditions.
  • the inventive use of the medication is applied in the therapy and in the prophylaxis of cancer diseases and tumor diseases, respectively, in particular in the case of breast cancer.
  • the use of aromatase inhibitors in combination with an antioxidant is particularly effective in the case of ER-positive tumors in post-menopausal female patients or in ER-positive tumors in male patients.
  • the aromatase inhibitor and the antioxidant are applied to the skin. This can be performed by using a combination preparation or by the simultaneous, or sequential but overlapping application of both active agents in the form of two separate dosage forms. Alternatively, both active agents can also be administered by different administration routes, as long as it is ensured that the aromatase inhibitor as well as the antioxidant exert their effects simultaneously and that the duration of effectiveness of one substance overlaps with that of the other substance, respectively.
  • an active agent or both active agents are applied to the tissue to be treated and onto the skin area surrounding the tissue to be treated, respectively, in suitable carriers (e.g. creams, ointments, etc.).
  • suitable carriers e.g. creams, ointments, etc.
  • the active agent or the active agents directly reach the target cells of the tissue to be treated, i.e. without systemic indirection and without liver passage (First Pass Effect).
  • the active agent amount and the intervals of application are selected in such a manner that preferably no systemic plasma levels, but only locally active concentrations are reached. This has the advantage that besides the direct, immediate effect, side effects of the systemic administration of the active ingredient can be reduced or avoided. Also in the case of longer treatment periods or long-term therapy (e.g. in the situation of prophylactic use), undesired side-effects can thus be avoided or limited.
  • the medication according to the invention comprises hyaluronic acid.
  • hyaluronic acid improves the absorption of the active agent or its diffusion across the callused skin, respectively, while at the same time retaining the active agent in the hypoderm and in the fat tissue (depot) and allowing for the local efficacy and avoiding the systemic distribution of the active agent via the blood circle, respectively (Brown and Jones, JEADV 2005; 19:308-318).
  • the amount ratios are dependent from the physicochemical properties of the active agents, the intervals of application and the formulations which are used.
  • the skilled person is capable of adapting the use according to the invention to the respective therapeutic or prophylactic situation.
  • steroidal aromatase inactivators such as exemestane, 4-hydroxyandrostenedione or 4-acetoxyandrostenedione, preferably ⁇ -lipoic acid or green tea extract containing polyphenols, in particular OM24®, are administered via the skin together with an antioxidant. Due to their lipophilic properties, steroidal aromatase inactivators are particularly well absorbed and reach the target tissue, such as the female breast and the tumor tissue, via skin layers that are rich in fat. This applies in particular manner to the case of the further combination with hyaluronic acid.
  • the active agents can be administered orally, parenterally (intravenously or intravascularly), pulmonally (inhalation), transnasally or rectally.
  • the medication according to the invention is preferably applied in the adjuvant and in the neoadjuvant therapy of breast cancer.
  • the medication is used for prophylaxis of breast cancer.
  • a suitable basic cream e.g. DAC basic cream having a composition, in which 100 g DAC contain: 0.5-10 g, preferably 2-7 g, e.g. 4.0 g glycerol monostearate; 0.5-10 g, preferably 3-8 g, e.g.
  • a secondary prophylaxis is performed after surgical therapy.
  • the contra-lateral breast is co-treated prophylactically, e.g. applying the following therapy schedule: twice per day (morning and evening) 0.5-4 g each on every breast: 0.05-5 weight-%, preferably 0.1-1 weight-%, e.g. 0.5% ⁇ -lipoic acid and 0.1 to 5 weight-%, preferably 0.5-2.5 weight-%, e.g. 1.5% acetoxyandrostenedione integrated in a basic cream (e.g. DAC).
  • a basic cream e.g. DAC
  • the aromatase inactivator 4-hydroxyandrostenedione is used together with ⁇ -lipoic acid, in particular in the neoadjuvant therapy of ER-positive breast cancer.
  • the active agents are applied topically to the breast either together or separately from each other.
  • the concentrations of ⁇ -lipoic acid are preferably in a range from 0.5 weight-% to 2 weight %.
  • the concentrations of the steroidal aromatase inactivator are preferably in a range of 1 weight-% to 3 weight-%.
  • the dosage regime is preferably identical to the therapy regime in the secondary prophylaxis (adjuvant therapy). Exemplary dosage regimes are:
  • the duration of the neoadjuvant therapy depends on the size of the primary tumor and the intentions of the surgeon. Since the effect of the therapy is visible and measurable already after two weeks, the therapeutic goal can be defined in a relatively precise manner. Normally, however, the neoadjuvant therapy should not be carried out for more than about three months before the surgical intervention.
  • the efficacy and compatibility of the composition according to the invention are so convincing that elder patients can be treated solely by topical therapy. A surgical intervention poses a risk particularly in old age.
  • the invention relates to a pharmaceutical composition
  • a pharmaceutical composition comprising an aromatase inhibitor and specifically ⁇ -lipoic acid.
  • the composition is a combination preparation, by which use the special technical effects as laid out above are obtained.
  • the effect of the aromatase inhibitor and the effect of ⁇ -lipoic acid therein are synergistic as already described above.
  • FIGS. 1 and 2 show the results of the treatment of two female patients with ER-positive tumors of the breast.
  • a reduction of the tumor volume by 78.5% has been measured after 29 treatment days ( FIGS. 1A , 1 B)
  • a reduction of the tumor volume by 61.8% has been achieved after 14 days of treatment ( FIGS. 2A , 2 B).
  • a pharmaceutical medication comprising an aromatase inhibitor or aromatase inactivator and an antioxidant is used for the treatment of hormone-dependent diseases.
  • breast cancer is one of the diseases in which the medication is used.
  • the medication can further be used for the treatment of mastopathy, mastodynia and for probation in mastalgia.
  • Mastopathy is a benign change of the mammary gland of the breast. It occurs at least in each second woman and thus is the most frequent disease of the mammary gland of the woman. The affected women are in most cases 35 to 50 years; a mastopathy in women being younger than 25 years or being menopausal occurs very rarely.
  • mastopathy Depending on the change of the mammary gland of the breast, different forms of mastopathy can be distinguished:
  • mastopathy a classification in three groups takes place, which definition respectively depends on the severity of the change of the tissue of the mammary gland. By characterizing the severity, the risk for breast cancer of the affected women can be estimated.
  • the therapy aims at alleviating the symptoms developed from the changes of the tissue of the mammary gland.
  • the treatment essentially aimes at balancing the excess of estrogen via gestagen.
  • prolactin-inhibitors are effective in treating tension states and cystic changes of the breast occurring during a mastopathy. If the mastopathy causes severe symptoms, additionally Danazol, which inhibits the release of estrogen, can be administered for therapy.
  • Example 6 shows the “disappearance” of a fibrocystic mastopathy in a 49 year old woman after an about 12-month treatment with the medication according to the invention.
  • mastodynia and mastalgia are amongst the so-called functional disturbances of the breast. Both terms are used frequently in the technical language for the discrimination between cycle-dependent (ca. 80%) and cycle-independent (ca. 20%) pain.
  • mastodynia represents cycle- and hormone (estrogen)-dependent pain
  • mastalgia cycle-independent pain which is rarely hormone-dependent.
  • the symptoms are cycle-dependent and occur in the period before and during menstruation.
  • a therapy with pharmaceutic substances is indicated in at least 300 of the female patients with severe symptoms.
  • progesterone (and diclofenac) gel a systemic application of the estrogen antagonist Tamoxifen, the testosterone derivative Danazol, the administration of Bromocriptin (a dopamine agonist/prolactine secretion inhibitor) is prescribed.
  • the side-effects of these thereapies are in part substantial.
  • a further field of application of the invention are benign tumors, which grow in a sex hormone-dependent manner and are caused by a local increase of fatty tissue.
  • Estrogen enhances the increase of fatty tissue.
  • the newly synthesized fat increases the body's own production of estrogen and free radicals by fat cells.
  • the activity of the enzyme aromatase increases in the fat cells, thus increasing the activity of converting testosterone to estrogen and the generation of free radicals.
  • the number of receptors, at which estrogen and free radicals can become effective increases in the cells. This, on the other hand, leads to an enhanced effect of the estrogens and free radicals.
  • a fatty tissue immanent autonomous vicious circle-situation which is effectively counteracted by the medication according to the invention.
  • the lipoma benign tumor of the cells of the fatty tissue
  • the lipomatosis are benign fatty tumors which proliferate in a sex hormone-dependent manner.
  • Lipomatosis is a diffuse increase of fatty tissue at distinct sites of the body—in the majority of cases starting from the subcutaneous fat tissue —, e.g. the neck, the upper trunk (e.g. back) or the hips, or also all in combination or together can be affected.
  • the subcutaneous fat tissue e.g. the neck, the upper trunk (e.g. back) or the hips, or also all in combination or together can be affected.
  • synonyms for lipomatosis are used amongst others:
  • symmetric adenolipomatosis Lipomatosis symmetrica; diffuse symmetric lipomatosis; generalized symmetric lipomatosis; multiple symmetric lipomatosis; localized symmetric lipomatosis; Lipomatosis simplex indolens;
  • Example 9 the shrinking of an egg-shaped lipoma of about 12 cm above the left shoulder joint of a 71 year old patient.
  • Examples 1-5 illustrate the inventive use of the medication in the therapy of breast cancer
  • FIG. 1A An ER-positive tumor has been diagnosed in the right breast of a 59-year-old female patient.
  • the tumor Prior to the start of the treatment, the tumor has been measured mammographically ( FIG. 1A ).
  • ⁇ -lipoic acid 0.5% and 4-hydroxyandrostenedione 1.5% integrated in the basic cream DAC
  • FIG. 1B the tumor volume before and after the treatment has been shown graphically in a diagram
  • the tumor volume has been reduced by 78.5% over the course of the 29 days of treatment.
  • a 69-year-old female patient has been diagnosed with an ER-positive tumor in the left breast.
  • a treatment of the breasts was carried out for 14 days by topical administration of ⁇ -lipoic acid 0.5% and 4-hydroxyandrostenedione 1.5% (integrated into the basic cream DAC) twice per day, 2 g each.
  • the tumor volume has been determined before and after the treatment as described under Example 1 ( FIG. 2A ).
  • the tumor volume after treatment was reduced by 61.8%.
  • An ER-positive tumor has been diagnosed in the right breast of a 53-year-old female patient. Prior to the start of the treatment, the tumor was measured mammographically. In the following 24 days ⁇ -lipoic acid 0.5% and 4-hydroxyandrostenedione 1,5% (integrated into the basic cream DAC) have been administered topically onto each breast twice per day, 2 g each. Subsequently, the tumor has been measured again and the tumor volume has been compared. The tumor volume has been reduced by 76% over the course of the 24 days of treatment.
  • An ER-positive tumor has been diagnosed in the left breast of a 62-year-old female patient.
  • a treatment was carried out by topical application using the composition according to the invention.
  • ⁇ -lipoic acid 0.5% and 4-hydroxyandrostenedione 1.5% integrated into the basic cream DAC
  • the tumor volume before and after the treatment has been determined as described under Example 1.
  • the volume of the tumor has been reduced by 64.5% after the treatment.
  • a fibrocystic mastopathy grade II has been diagnosed in the patient.
  • a therapeutic trial has been carried out by using the above combination, once per day, 2 g onto each breast.
  • the mastopathy (mastopathia fibrosa cystica) has been degenerated completely after 11 months of application.
  • the breast tissue exhibited an ordered structure without any micro-calcification.
  • ⁇ -lipoic acid 0.5%, 4-acetoxyandrostenedione 1.0%, hyaluronic acid 0.2% (merely as a facilitator of absorption and distribution).
  • Anamnesis Menstrual pain occurring monthly since age 13, becoming so strong during the preparation of High School exams (at age 18), that her gynaecologist carried out a mammography, which however merely revealed as a result a slight mastopathy in the upper quadrants.
  • Previous prescription Voltaren gel applied multiple times per day as needed.
  • Anamnesis Pre-menstrual syndrome with symptoms of strong pain in both breasts since puberty. Dynamic increase of the symptoms since age 27 with extremely strong tactile sensitivity, strong sensation of swelling and tension with pain symptoms diffusely radiating into the chest and the arms, which becomes virtually unbearable until the beginning of the menstruation. Unable to work because of these conditions for 2-4 days per month since 3 years. Intimate touching not possible for 14 days per month due to the pathologic tactile hyper-sensitivity. Fading-away of the symptoms only 7-10 days after the beginning of the menstruation.
  • menstruation further decrease of the sensation of swelling and tension, reduced pain, remaining only in the breasts, substantially reduced tactile sensitivity, no incapacity to work.
  • ⁇ -lipoic acid 1.0%
  • 4-hydroxyandrostenedione 1.5%
  • hyaluronic acid 0.2% (as a local delivery system) integrated into a basic cream (DAC).
  • E.M.S. 56 years, female: the patient suffers from a very rare, extreme disorder in fat distribution (incidence: 1:25.000 in men and 1:300.000 in women) caused by a Madelung's diseases since almost 15 years, which has led, on the one hand, to a grotesque redistribution of fatty tissue with substantial shrinkage of the breasts and the posterior and to a symmetric lipomatosis focussed on the upper trunk and, on the other hand, to impaired motility due to the disturbing fat tumors.
  • Ms. S. suffers from considerable pain in the fat tumors on the neck, on the back, at the throat, at the lateral thoracic wall, the sides above the shoulder and at the upper arms.
  • the composition according to the invention is massaged into all the fat tumors twice per day. Weekly measurements are carried out of the following regions: neck, breast, left and right upper arms, hip and throat.
  • neck from 36 cm to 31.5 cm
  • breast from 116 cm to 111.5 cm
  • upper arm left from 42 cm to 34 cm
  • upper arm right from 36 cm to 33 cm
  • hip from 104 cm to 101 cm
  • throat circumference from 42 cm to 38.5 cm (see Table 1)
  • the patient consumed about 100 g per week of the composition according to the invention, which means, in an application twice per day, a concentration of the active ingredients of
  • the lipoma enlarged to an egg-shaped structure of about 12 cm longitudinal section, 8 cm latitudinal section, and 2.5 cm in height.
  • the lipoma influences the up-and-down movements of the left arm and the shoulder joint by causing pain, since the lipoma apparently triggers substantial pain during movement by exerting pressure on the supraspinal ligament in the shoulder joint. The patient was willing to undergo surgical treatment.
  • the lipoma shrank in the longitudinal section from 12 cm to 7 cm, in the latitudinal section from 8 cm to 4 cm, in height from 2.5 cm to 1 cm.
  • composition according to the invention is not only highly effective, but also mediates a pleasant skin sensation, the trial cure is continued.

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