US20190076436A1 - Macrocyclic compounds as ros1 kinase inhibitors - Google Patents

Macrocyclic compounds as ros1 kinase inhibitors Download PDF

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US20190076436A1
US20190076436A1 US16/199,867 US201816199867A US2019076436A1 US 20190076436 A1 US20190076436 A1 US 20190076436A1 US 201816199867 A US201816199867 A US 201816199867A US 2019076436 A1 US2019076436 A1 US 2019076436A1
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ros1
cancer
amino acid
alkyl
kinase
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Steven W. Andrews
James F. Blake
Julia Haas
Gabrielle R. Kolakowski
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Array Biopharma Inc
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Array Biopharma Inc
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Assigned to ARRAY BIOPHARMA INC. reassignment ARRAY BIOPHARMA INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: HAAS, JULIA, BLAKE, JAMES F., ANDREWS, STEVEN W., KOLAKOWSKI, Gabrielle R.
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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
    • A61K31/529—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim forming part of bridged ring systems
    • 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
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
    • A61K31/4545—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring hetero atom, e.g. pipamperone, anabasine
    • 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
    • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene
    • 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
    • A61K31/66—Phosphorus compounds
    • A61K31/675—Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
    • 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
    • A61P35/00—Antineoplastic agents
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
    • C12Q1/6886—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material for cancer
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
    • G01N33/57484—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumor, cancer, neoplasia, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides, metabolites
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/156—Polymorphic or mutational markers
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/90—Enzymes; Proenzymes
    • G01N2333/91—Transferases (2.)
    • G01N2333/912—Transferases (2.) transferring phosphorus containing groups, e.g. kinases (2.7)
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/52—Predicting or monitoring the response to treatment, e.g. for selection of therapy based on assay results in personalised medicine; Prognosis

Definitions

  • compositions comprising the compounds and the use of the compounds in therapy. More particularly, provided herein are certain macrocyclic compounds which exhibit ROS1 protein kinase inhibition, and which are useful in the treatment of cancer.
  • ROS1 is a receptor tyrosine kinase that is closely related to ALK, and, like ALK, it undergoes genomic rearrangement that creates fusion proteins in various cancers (Davies K D and Doebele R C (2013) Clin Cancer Res 19: 4040-4045). It is well established that these fusion proteins act as oncogenic drivers and that ROS1 inhibition is anti-proliferative in cells that express ROS1 fusions (Davies K D, Le A T, Theodoro M F, Skokan M C, Aisner D L, et al. (2012) Clin Cancer Res 18: 4570-4579). Thus, it appears that ROS1 targeted therapy will likely soon be the standard of care for this patient population. However, based on the experiences with other kinase inhibitors in various cancers, it is fully expected that acquired resistance to ROS1 inhibition will occur, and this will ultimately limit the treatment options for patients.
  • macrocyclic compounds are inhibitors of ROS1 kinase, and are useful for treating various cancers.
  • Compounds which are inhibitors of ROS1 may be useful in the treatment of multiple types of cancer including cancers exhibiting resistance to ROS1 inhibition.
  • the methods provided include administration of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I
  • ring A, ring B, W, m, D, R 2 , R 2a , R 3 , R 3a , and Z are as defined herein.
  • a compound of Formula I has the general formula:
  • the compound of Formula I is selected from the compounds of Table 1, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the compound of Formula I is selected from the group consisting of Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • a method for treating a cancer in a patient in need thereof comprising:
  • a method for treating a cancer in a patient in need thereof comprising:
  • Also provided herein is a method for treating cancer in a patient in need thereof, the method comprising administering to a patient identified or diagnosed as having a ROS1-associated cancer a therapeutically effective amount of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • a method of treating cancer in a patient in need thereof comprising:
  • a method of treating cancer in a patient in need thereof comprising:
  • Also provided herein is a method of treating a subject having a cancer, wherein the method comprises:
  • a method of treating a subject having a cancer comprising:
  • Also provided herein is a method of treating a subject having a cancer, wherein the method comprises:
  • a method of treating a subject having a cancer comprising:
  • Also provided herein is a method of treating a subject having a cancer, wherein the method comprises:
  • a method of treating a subject having a cancer comprising:
  • Also provided herein is a method of treating a patient, the method comprising administering a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, to a patient having a clinical record that indicates that the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • a method of selecting a treatment for a patient comprising selecting a treatment comprising administration of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, for a patient identified or diagnosed as having a ROS1-associated cancer.
  • a method of selecting a treatment for a patient having a cancer comprising:
  • Also provided herein is a method of selecting a patient for treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, the method comprising:
  • a method of selecting a patient having cancer for treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, the method comprising:
  • ring B is ring B-2 having the structure:
  • ring A is ring A-1 having the structure
  • ring A when represented by structure A-1 include the structures:
  • ring A is ring A-2 having the structure
  • ring A when represented by ring A-2 are the structures:
  • ring A is ring A-3 having the structure
  • ring A when represented by ring A-3 are the structures:
  • W is O.
  • W is NH
  • W is CH 2 .
  • D is carbon
  • R 2 and R 2a are independently H, F, (1-3 C)alkyl or OH (provided that R 2 and R 2a are not both OH)
  • R 3 and R 3a are independently H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl.
  • R 2 and R 2a are independently H, F, methyl or OH, provided that R 2 and R 2a are not both OH.
  • R 2 and R 2a are both H.
  • R 2 is H and R 2a is F.
  • R 2 and R 2a are both F.
  • R 2 is H and R 2a is OH.
  • R 2 is H and R 2a is methyl.
  • R 2 and R 2a are both methyl.
  • R 3 and R 3a are independently H, (1-3C)alkyl or hydroxy(1-3 C)alkyl.
  • R 3a is H. In some embodiments, R 3 is H. In some embodiments, both R 3 and R 3a are H.
  • R 3a is (1-3C)alkyl. Examples include methyl, ethyl, propyl and isopropyl. In some embodiments, R 3 is (1-3C)alkyl. Examples include methyl, ethyl, propyl and isopropyl.
  • R 3a is (1-3C)alkyl and R 3 is H. In some embodiments, R 3a is methyl and R 3 is H.
  • both R 3a and R 3 are (1-3C)alkyl. In some embodiments, R 3a and R 3a are both methyl.
  • R 3 is hydroxy(1-3C)alkyl. Examples include hydroxymethyl, 2-hydroxyethyl, 2-hydroxypropyl, and 3-hydroxypropyl. In some embodiments, R 3 is hydroxymethyl, 2-hydroxyethyl, 2-hydroxypropyl, or 3-hydroxypropyl and R 3a is H.
  • D is carbon or nitrogen
  • R 2 and R 3 are absent
  • R 2a and R 3a together with the atoms to which they are attached form a 5-6 membered heteroaryl ring having 1-2 ring heteroatoms.
  • R 2a and R 3a together with the atoms to which they are attached form a 5-6 membered heteroaryl ring having 1-2 ring nitrogen atoms.
  • heteroaryl rings include pyridyl and pyrazolyl rings. Specific examples of heteroaryl rings include the structures:
  • Z is *—NR 4a C( ⁇ O)—.
  • R 4a is H.
  • R 4a is (1-6C)alkyl. Examples include methyl, ethyl, propyl, isopropyl, butyl, and isobutyl.
  • R 4a is fluoro(1-6C)alkyl. Examples include fluoromethyl and 2-fluoroethyl.
  • R 4a is difluoro(1-6C)alkyl.
  • Example include difluoromethyl and 2,2-difluoroethyl.
  • R 4a is trifluoro(1-6C)alkyl. Examples include trifluoromethyl and 2,2,2-trifluoroethyl.
  • R 4a is hydroxy(1-6C alkyl). Examples include hydroxymethyl, 2-hydroxyethyl, 2-hydroxypropyl and 3-hydroxypropyl.
  • R 4a is dihydroxy(2-6C alkyl).
  • An example includes 2,3-dihydroxypropyl.
  • R 4a is H or (1-6C)alkyl. In some embodiments, R 4a is H or Me.
  • Z is *—NR 4b CH 2 —.
  • R 4b is H.
  • R 4b is selected from (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, and trifluoro(1-6C)alkyl.
  • R 4b is (1-6C)alkyl. Examples include methyl, ethyl, propyl, isopropyl, butyl and tert-butyl. In some embodiments, R 4b is methyl.
  • R 4b is fluoro(1-6C)alkyl. Examples include fluoromethyl and 2-fluoroethyl.
  • R 4b is difluoro(1-6C)alkyl.
  • Example include difluoromethyl and 2,2-difluoroethyl.
  • R 4b is trifluoro(1-6C)alkyl. Examples include trifluoromethyl and 2,2,2-trifluoroethyl.
  • R 4b is selected from (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar 1 C(O)— and HOCH 2 C(O)—.
  • R 4b is (1-6C alkyl)C(O)—. Examples include CH 3 C(O)—, CH 3 CH 2 C(O)—, CH 3 CH 2 CH 2 C(O)—, and (CH 3 ) 2 CHC(O)—. In some embodiments, R 4 is CH 3 C(O)—.
  • R 4b is (3-6C cycloalkyl)C(O)—. Examples include cyclopropylC(O)—, cyclobutylC(O)—, cyclopentylC(O)— and cyclohexylC(O)—.
  • R 4b is Ar 1 C(O)—.
  • An example is phenylC(O)—.
  • R 4b is HOCH 2 C(O)—.
  • R 4b is selected from (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, and Ar 2 (SO 2 )—.
  • R 4b is (1-6C alkyl)sulfonyl. Examples include methylsulfonyl, ethylsulfonyl and propylsulfonyl.
  • R 4b is (3-6C cycloalkyl)sulfonyl. Examples include cyclopropylsulfonyl, cyclobutylsulfonyl, cyclopentylsulfonyl and cyclohexylsulfonyl. In some embodiments, R 4 is methylsulfonyl.
  • R 4b is Ar 2 (SO 2 )—.
  • An example is phenylsulfonyl.
  • R 4b is HO 2 CCH 2 —.
  • R 4b is (1-6C alkyl)NH(CO)—. Examples include CH 3 NHC(O)—, CH 3 CH 2 NHC(O)—, CH 3 CH 2 CH 2 NHC(O)—, and (CH 3 ) 2 CHNHC(O)—. In some embodiments, R 4 is CH 3 NHC(O)—.
  • R 4b is selected from H, methyl, —C(O)CH 3 , methylsulfonyl, —C(O)CH 2 OH, —CH 2 COOH and —C(O)NHCH 2 CH 3 .
  • Z is *—OC( ⁇ O)—.
  • ring B is ring B-1:
  • R 5 and R 6 are independently H, F, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl. In some embodiments, R 5 is H and R 6 is H, F, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • R 5 and R 6 are independently H, F, OH, (1-3C)alkyl or hydroxy(1-3C)alkyl. In some embodiments, R 5 is hydrogen and R 6 is H, F, OH, (1-3C)alkyl or hydroxy(1-3C)alkyl.
  • R 5 and R 6 are independently H, F, OH, methyl, ethyl, HOCH 2 — or HOCH 2 CH 2 —. In some embodiments, R 5 is hydrogen and R 6 is H, F, OH, methyl, ethyl, HOCH 2 — or HOCH 2 CH 2 —.
  • R 5 and R 6 are independently H, F, or methyl. In some embodiments, R 5 is H and R 6 is H, F, or methyl.
  • R 5 is H and R 6 is F.
  • R 5 is H and R 6 is methyl.
  • R 5 and R 6 are both H.
  • R 5 and R 6 are both F.
  • R 5 and R 6 are both methyl.
  • ring B is ring B-1 which is optionally substituted with one or two substituents independently selected from OH and F, provided that two OH substituents are not on the same ring carbon atom.
  • ring B when represented by ring B-1 include the structures:
  • ring B is ring B-2 having the formula:
  • m is 0.
  • m is 1.
  • n is 2.
  • Formula IA includes compounds wherein:
  • X is N. In some embodiments, X is CH.
  • Formula IA includes compounds wherein:
  • Formula IA includes compounds wherein:
  • Formula IA includes compounds wherein:
  • Formula IA includes compounds wherein:
  • X is N. In some such embodiments of Formula IA where ring A is ring A-1, W is O. In some embodiments of Formula IA where ring A is ring A-1, W is CH 2 . In some embodiments of Formula IA where ring A is ring A-1, R 2 and R 2a are H. In some embodiments of Formula IA where ring A is ring A-1, R 2 and R 2a are independently F, (1-3 C)alkyl, or OH. In some embodiments of Formula IA where ring A is ring A-1, R 3 is (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-1, R 3 is H. In some embodiments of Formula IA where ring A is ring A-1, Z is *—NR 4a C( ⁇ O)—. In some embodiments of Formula IA where ring A is ring A-1, R 5 and R 6 are H.
  • Formula IA includes compounds wherein:
  • Y is F.
  • R 2 and R 2a are H.
  • R 2 and R 2a are independently H or (1-3 C)alkyl.
  • R 3 is (1-3 C)alkyl.
  • R 5 and R 6 are H.
  • Formula IA includes compounds wherein:
  • Y is F. In some embodiments of Formula IA where ring A is ring A-3, Y is H. In some embodiments of Formula IA where ring A is ring A-3, R 2 and R 2a are H. In some embodiments of Formula IA where ring A is ring A-3, R 2 and R 2a are independently H or (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-3, R 3 is (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-3, R 3 is H. In some embodiments of Formula IA where ring A is ring A-3, R 5 and R 6 are H.
  • certain compounds as provided herein may contain one or more centers of asymmetry and may therefore be prepared and isolated as a mixture of isomers such as a racemic or diastereomeric mixture, or in an enantiomerically or diastereomerically pure form. It is intended that all stereoisomeric forms of the compounds provided herein, including but not limited to, diastereomers, enantiomers and atropisomers, as well as mixtures thereof such as racemic mixtures, form part of the present disclosure.
  • compounds of the general Formula I wherein Ring B is ring B-1 have the absolute configuration of Formula 1-a:
  • compounds of the general Formula I wherein Ring B is ring B-1 have the absolute configuration of Formula 1-b:
  • stereochemistry of any particular chiral atom is not specified, then all stereoisomers are contemplated and included as the compounds of the disclosure. Where stereochemistry is specified by a solid wedge or dashed line representing a particular configuration, then that stereoisomer is so specified and defined.
  • (1-3C)alkyl and “(1-6C)alkyl” as used herein refer to saturated linear or branched-chain monovalent hydrocarbon radicals of one to three carbon atoms and one to six carbon atoms, respectively. Examples include, but are not limited to, methyl, ethyl, 1-propyl, isopropyl, 1-butyl, isobutyl, sec-butyl, tert-butyl, 2-methyl-2-propyl, pentyl, and hexyl.
  • fluoro(1-6C)alkyl refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms as defined herein, wherein one of the hydrogens is replaced by a fluorine atom.
  • difluoro(1-6C)alkyl refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms as defined herein, wherein two of the hydrogens are replaced by fluorine atoms.
  • trifluoro(1-6C)alkyl refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms as defined herein, wherein three of the hydrogens are replaced by fluorine atoms.
  • hydroxy(1-6Calkyl) refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms, wherein one of the hydrogens is replaced by a hydroxy (OH) group.
  • dihydroxy(2-6C alkyl) refers to saturated linear or branched-chain monovalent hydrocarbon radicals of two to six carbon atoms as defined herein, wherein two of the hydrogens are replaced by hydroxy (OH) groups, provided the hydroxy groups are not on the same carbon atom.
  • (1-6C alkyl)sulfonyl refers to a (1-6C alkyl)SO 2 — group, wherein the radical is on the sulfur atom and the (1-6C alkyl) portion is as defined above. Examples include methylsulfonyl (CH 3 SO 2 —) and ethylsulfonyl (CH 3 CH 2 SO 2 —).
  • (3-6C cycloalkyl)sulfonyl refers to a (3-6C cycloalkyl)SO 2 — group, wherein the radical is on the sulfur atom.
  • An example is cyclopropylsulfonyl.
  • (1-3C)alkoxy and “(1-6C)alkoxy”, as used herein refer to saturated linear or branched-chain monovalent alkoxy radicals of one to three carbon atoms or one to six carbon atoms, respectively, wherein the radical is on the oxygen atom. Examples include methoxy, ethoxy, propoxy, isopropoxy, and butoxy.
  • halogen includes fluoro, chloro, bromo and iodo.
  • Non-limiting examples of the compounds of Formula I include those in Table 1.
  • the compounds of Formula I include salts thereof.
  • the salts are pharmaceutically acceptable salts.
  • the compounds of Formula I include other salts of such compounds which are not necessarily pharmaceutically acceptable salts, and which may be useful as intermediates for preparing and/or purifying compounds of Formula I and/or for separating enantiomers of compounds of Formula I.
  • pharmaceutically acceptable indicates that the substance or composition is compatible chemically and/or toxicologically, with the other ingredients comprising a formulation, and/or the mammal being treated therewith.
  • the compounds provided herein may also contain unnatural proportions of atomic isotopes at one or more of the atoms that constitute such compounds. That is, an atom, in particular when mentioned in relation to a compound according to Formula I, comprises all isotopes and isotopic mixtures of that atom, either naturally occurring or synthetically produced, either with natural abundance or in an isotopically enriched form.
  • the compounds provided herein therefore also comprise compounds with one or more isotopes of one or more atom, and mixtures thereof, including radioactive compounds, wherein one or more non-radioactive atoms has been replaced by one of its radioactive enriched isotopes.
  • Radiolabeled compounds are useful as therapeutic agents, e.g., cancer therapeutic agents, research reagents, e.g., assay reagents, and diagnostic agents, e.g., in vivo imaging agents. All isotopic variations of the compounds of the present disclosure, whether radioactive or not, are intended to be encompassed within the scope of the present disclosure.
  • the compounds of Formula I or a salt thereof as defined herein can be prepared as described in U.S. Pat. No. 8,933,084, which is incorporated by reference in its entirety herein.
  • a process for preparing a compound of Formula I or a salt thereof as defined herein can include:
  • ring B is ring B-1 having the structure:
  • D is carbon
  • R 2 and R 2a are independently H, F, (1-3 C)alkyl or OH (provided that R 2 and R 2a are not both OH)
  • R 3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl
  • ring A, W, m, Z, Y, R 3a , R 5 and R 6 are as defined for Formula I.
  • the cyclization may be performed using conventional amide bond formation conditions, for example by treating the carboxylic acid with an activating agent, followed by addition of the amine in the presence of a base.
  • Suitable activating agents include EDCI, oxalyl chloride, thionyl chloride, HATU, and HOBt.
  • Suitable bases include amine bases, for example triethylamine, diisopropylethylamine, pyridine, or excess ammonia.
  • Suitable solvents include DCM, DCE, THF and DMF.
  • the leaving atoms L 1 and L 2 may be, for example a halogen atom such as Br, Cl or I.
  • L 1 and L 2 can be a leaving group, for example an arylsulfonyloxy group or an alkylsulfonyloxy group, such as a mesylate or a tosylate group.
  • Suitable bases include alkali metal carbonates, such as sodium carbonate, potassium carbonate or cesium carbonate.
  • Convenient solvents include aprotic solvents such as ethers (for example tetrahydrofuran or p-dioxane), DMF, or acetone.
  • the reaction can be conveniently performed at elevated temperatures, for example 50-150° C., for example at 85° C.
  • suitable coupling reagents include HATU, HBTU, TBTU, DCC, DIEC, and any other amide coupling reagents well known to persons skilled in the art.
  • Suitable bases include tertiary amine bases such as DIEA and triethylamine.
  • Convenient solvents include DMF, THF, DCM and DCE.
  • suitable reducing agents include Me 4 N(OAc) 3 BH, Na(OAc) 3 BH and NaCNBH 3 .
  • Suitable solvents include neutral solvents such as acetonitrile, THF and DCE. The reaction can be conveniently performed at ambient temperature.
  • the triphenylphosphine reagent is used in the form of a polystyrene-bound PPh 3 resin (sold as PS-PPh 3 by Biotage Systems).
  • the reaction is conveniently performed at ambient temperature.
  • Suitable solvents include neutral solvents, for example DCM.
  • the leaving atom L 3 may be a halogen, for example Cl or Br.
  • Suitable bases include tertiary amine bases such as diisopropylethylamine and triethylamine. The reaction is conveniently performed at ambient temperature.
  • suitable bases include tertiary amine bases such as DIEA and triethylamine.
  • the reaction is conveniently performed at ambient temperature.
  • the fluorination reagent may be, for example, bis(2-methoxyethyl)amino-sulfur trifluoride (Deoxo-FluorTM) or diethylaminosulfur trifluoride (DAST).
  • Suitable solvents include dichloromethane, chloroform, dichloroethane, and toluene. The reaction is conveniently performed at ambient temperature.
  • base may be, for example, an alkali metal carbonate, such as for example sodium carbonate, potassium carbonate or cesium carbonate.
  • Convenient solvents include aprotic solvents such as ethers (for example tetrahydrofuran or p-dioxane) or toluene.
  • the reaction can be conveniently performed at a temperature between ambient temperature and reflux, for example at 85° C.
  • Amine groups in compounds described in any of the above methods may be protected with any convenient amine protecting group, for example as described in Greene & Wuts, eds., “Protecting Groups in Organic Synthesis”, 2 nd ed. New York; John Wiley & Sons, Inc., 1991.
  • amine protecting groups include acyl and alkoxycarbonyl groups, such as t-butoxycarbonyl (BOC), and [2-(trimethylsilyl)ethoxy]methyl (SEM).
  • carboxyl groups may be protected with any convenient carboxyl protecting group, for example as described in Greene & Wuts, eds., “Protecting Groups in Organic Synthesis”, 2 nd ed.
  • carboxyl protecting groups include (1-6C)alkyl groups, such as methyl, ethyl and t-butyl.
  • Alcohol groups may be protected with any convenient alcohol protecting group, for example as described in Greene & Wuts, eds., “Protecting Groups in Organic Synthesis”, 2 nd ed. New York; John Wiley & Sons, Inc., 1991.
  • Examples of alcohol protecting groups include benzyl, trityl, silyl ethers, and the like.
  • test compounds to act as ROS1 inhibitors may be demonstrated by the assay described in Example A. IC 50 values are shown in Table 17.
  • inhibition of L2026M is similar to, or better than, that observed for wild-type ROS1.
  • inhibition of L2026M is within about 2-fold (e.g., about 5-fold, about 7-fold, about 10-fold) of inhibition of wild-type ROS1 (i.e. the compounds are similarly potent against wild-type ROS1 and L2026M).
  • inhibition of L2026M is about the same as inhibition of wild-type ROS1.
  • inhibition of L2026M is about 2-fold, 3-fold, 4-fold, 5-fold, 6-fold, 7-fold, 8-fold, 9-fold, 10-fold, or greater than inhibition of wild-type ROS1.
  • selectivity for a wildtype or L2026M ROS1 kinase over another kinase is measured in an enzyme assay (e.g., an enzyme assay as provided herein).
  • an enzyme assay e.g., an enzyme assay as provided herein.
  • the compounds provided herein exhibit selective cytotoxicity to ROS1-mutant cells.
  • inhibition of D2033N is similar to, or better than, that observed for wild-type ROS1. In some embodiments, inhibition of D2033N is within about 2-fold (e.g., about 5-fold, about 7-fold, about 10-fold) of inhibition of wild-type ROS1 (i.e. the compounds are similarly potent against wild-type ROS1 and D2033N). In some embodiments, inhibition of D2033N is about the same as inhibition of wild-type ROS1. In some embodiments, inhibition of D2033N is about 2-fold, 3-fold, 4-fold, 5-fold, 6-fold, 7-fold, 8-fold, 9-fold, 10-fold, or greater than inhibition of wild-type ROS1.
  • selectivity for a wildtype or D2033N ROS1 kinase over another kinase is measured in an enzyme assay (e.g., an enzyme assay as provided herein).
  • an enzyme assay e.g., an enzyme assay as provided herein.
  • the compounds provided herein exhibit selective cytotoxicity to ROS1-mutant cells.
  • ROS1-associated diseases and disorders e.g., proliferative disorders such as cancers, including hematological cancers and solid tumors.
  • treat or “treatment” refer to therapeutic or palliative measures.
  • Beneficial or desired clinical results include, but are not limited to, alleviation, in whole or in part, of symptoms associated with a disease or disorder or condition, diminishment of the extent of disease, stabilized (i.e., not worsening) state of disease, delay or slowing of disease progression, amelioration or palliation of the disease state (e.g., one or more symptoms of the disease), and remission (whether partial or total), whether detectable or undetectable.
  • Treatment can also mean prolonging survival as compared to expected survival if not receiving treatment.
  • the terms “subject,” “individual,” or “patient,” are used interchangeably, refers to any animal, including mammals such as mice, rats, other rodents, rabbits, dogs, cats, swine, cattle, sheep, horses, primates, and humans.
  • the patient is a human.
  • the subject has experienced and/or exhibited at least one symptom of the disease or disorder to be treated and/or prevented.
  • the subject has been identified or diagnosed as having a cancer with a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (a ROS1-associated cancer) (e.g., as determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit).
  • the assay is a liquid biopsy.
  • the subject has a tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (e.g., as determined using a regulatory agency-approved assay or kit).
  • the subject can be a subject with a tumor(s) that is positive for a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (e.g., identified as positive using a regulatory agency-approved, e.g., FDA-approved, assay or kit).
  • the assay is a liquid biopsy.
  • the subject can be a subject whose tumors have a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or a level of the same (e.g., where the tumor is identified as such using a regulatory agency-approved, e.g., FDA-approved, kit or assay).
  • the subject is suspected of having a ROS1-associated cancer.
  • the subject has a clinical record indicating that the subject has a tumor that has a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (and optionally the clinical record indicates that the subject should be treated with any of the compositions provided herein).
  • the patient is a pediatric patient.
  • the term “pediatric patient” as used herein refers to a patient under the age of 21 years at the time of diagnosis or treatment.
  • the term “pediatric” can be further be divided into various subpopulations including: neonates (from birth through the first month of life); infants (1 month up to two years of age); children (two years of age up to 12 years of age); and adolescents (12 years of age through 21 years of age (up to, but not including, the twenty-second birthday)).
  • Berhman R E, Kliegman R, Arvin A M Nelson W E. Nelson Textbook of Pediatrics, 15th Ed. Philadelphia: W.B. Saunders Company, 1996; Rudolph A M, et al. Rudolph's Pediatrics, 21st Ed.
  • a pediatric patient is from birth through the first 28 days of life, from 29 days of age to less than two years of age, from two years of age to less than 12 years of age, or 12 years of age through 21 years of age (up to, but not including, the twenty-second birthday).
  • a pediatric patient is from birth through the first 28 days of life, from 29 days of age to less than 1 year of age, from one month of age to less than four months of age, from three months of age to less than seven months of age, from six months of age to less than 1 year of age, from 1 year of age to less than 2 years of age, from 2 years of age to less than 3 years of age, from 2 years of age to less than seven years of age, from 3 years of age to less than 5 years of age, from 5 years of age to less than 10 years of age, from 6 years of age to less than 13 years of age, from 10 years of age to less than 15 years of age, or from 15 years of age to less than 22 years of age.
  • compounds of Formula I are useful for preventing diseases and disorders as defined herein (for example, cancer).
  • preventing means the prevention of the onset, recurrence or spread, in whole or in part, of the disease or condition as described herein, or a symptom thereof.
  • ROS1-associated disease or disorder refers to diseases or disorders associated with or having a dysregulation of a ROS1 gene, a ROS1 kinase (also called herein ROS1 kinase protein), or the expression or activity or level of any (e.g., one or more) of the same (e.g., any of the types of dysregulation of a ROS1 gene, a ROS1 kinase, a ROS1 kinase domain, or the expression or activity or level of any of the same described herein).
  • a non-limiting example of a ROS1-associated disease or disorder includes cancer.
  • ROS1-associated cancer refers to cancers associated with or having a dysregulation of a ROS1 gene, a ROS1 kinase (also called herein ROS1 kinase protein), or expression or activity, or level of any of the same.
  • ROS1 kinase protein also called herein ROS1 kinase protein
  • Non-limiting examples of a ROS1-associated cancer are described herein.
  • the phrase “dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same” refers to a genetic mutation (e.g., a ROS1 gene translocation that results in the expression of a fusion protein, a deletion in a ROS1 gene that results in the expression of a ROS1 protein that includes a deletion of at least one amino acid as compared to the wild-type ROS1 protein, a mutation in a ROS1 gene that results in the expression of a ROS1 protein with one or more point mutations, or an alternative spliced version of a ROS1 mRNA that results in a ROS1 protein having a deletion of at least one amino acid in the ROS1 protein as compared to the wild-type ROS1 protein) or a ROS1 gene amplification that results in overexpression of a ROS1 protein or an autocrine activity resulting from the overexpression of a ROS1 gene in a cell that results in a
  • a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same can be a mutation in a ROS1 gene that encodes a ROS1 protein that is constitutively active or has increased activity as compared to a protein encoded by a ROS1 gene that does not include the mutation.
  • a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same can be the result of a gene or chromosome translocation which results in the expression of a fusion protein that contains a first portion of ROS1 that includes a functional kinase domain, and a second portion of a partner protein that is not ROS1.
  • dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity or level of any of the same can be a result of a gene translocation of one ROS1 gene with another non-ROS1 gene.
  • Non-limiting examples of fusion proteins are described in Table 2.
  • Non-limiting examples of ROS1 kinase protein point mutations are described in Table 3 and Table 3a. Additional examples of ROS1 kinase protein mutations (e.g., point mutations) are ROS1 inhibitor resistance mutations.
  • Non-limiting examples of ROS1 inhibitor resistance mutations are described in Table 4.
  • wildtype when referring to a ROS1 nucleic acid or protein describes a nucleic acid (e.g., a ROS1 gene or a ROS1 mRNA) or protein (e.g., a ROS1 protein) that is found in a subject that does not have a ROS1-associated disease, e.g., a ROS1-associated cancer (and optionally also does not have an increased risk of developing a ROS1-associated disease and/or is not suspected of having a ROS1-associated disease), or is found in a cell or tissue from a subject that does not have a ROS1-associated disease, e.g., a ROS1-associated cancer (and optionally also does not have an increased risk of developing a ROS1-associated disease and/or is not suspected of having a ROS1-associated disease).
  • a ROS1-associated disease e.g., a ROS1-associated cancer
  • regulatory agency refers to a country's agency for the approval of the medical use of pharmaceutical agents with the country.
  • FDA U.S. Food and Drug Administration
  • a method of treating cancer e.g., a ROS1-associated cancer
  • the method comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof.
  • methods for treating a ROS1-associated cancer in a patient in need of such treatment comprising a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the patient; and b) administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more fusion proteins.
  • ROS1 gene fusion proteins are described in Table 2.
  • the fusion protein is one of SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more ROS1 kinase protein point mutations, insertions, and/or deletions.
  • ROS1 kinase protein point mutations are described in Table 3 and Table 3a.
  • the ROS1 kinase protein point mutations, insertions, and/or deletions are point mutations selected from the group consisting of A15G, R118N, G1025R, T1735M, R1948H, and R2072N.
  • a compound of Formula I is selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the cancer e.g., ROS1-associated cancer
  • the cancer is a hematological cancer.
  • the cancer e.g., ROS1-associated cancer
  • the cancer e.g., ROS1-associated cancer
  • lung cancer e.g., small cell lung carcinoma or non-small cell lung carcinoma
  • papillary thyroid cancer medullary thyroid cancer, differentiated thyroid cancer, recurrent thyroid cancer, refractory differentiated thyroid cancer, lung adenocarcinoma, bronchioles lung cell carcinoma, multiple endocrine neoplasia type 2A or 2B (MEN2A or MEN2B, respectively), pheochromocytoma, parathyroid hyperplasia, breast cancer, colorectal cancer (e.g., metastatic colorectal cancer), papillary renal cell carcinoma, ganglioneuromatosis of the gastroenteric mucosa, inflammatory myofibroblastic tumor, or cervical cancer.
  • lung cancer e.g., small cell lung carcinoma or non-small cell lung carcinoma
  • papillary thyroid cancer medullary thyroid cancer
  • differentiated thyroid cancer differentiated thyroid cancer
  • recurrent thyroid cancer refractory differentiated thyroid cancer
  • the cancer e.g., ROS1-associated cancer
  • ALL acute lymphoblastic leukemia
  • AML acute myeloid leukemia
  • adrenocortical carcinoma anal cancer
  • appendix cancer astrocytoma, atypical teratoid/rhabdoid tumor
  • basal cell carcinoma bile duct cancer
  • bladder cancer bone cancer
  • brain stem glioma brain tumor, breast cancer, bronchial tumor, Burkitt lymphoma
  • carcinoid tumor unknown primary carcinoma, cardiac tumors, cervical cancer, childhood cancers, chordoma, chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), chronic myeloproliferative neoplasms, colon cancer, colorectal cancer, craniopharyngioma, cutaneous T-cell lymphoma, bile duct cancer, duct
  • a hematological cancer is selected from the group consisting of leukemias, lymphomas (non-Hodgkin's lymphoma), Hodgkin's disease (also called Hodgkin's lymphoma), and myeloma, for instance, acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), acute promyelocytic leukemia (APL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), chronic myelomonocytic leukemia (CMML), chronic neutrophilic leukemia (CNL), acute undifferentiated leukemia (AUL), anaplastic large-cell lymphoma (ALCL), prolymphocytic leukemia (PML), juvenile myelomonocyctic leukemia (JMML), adult T-cell ALL, AML with triline
  • ALL acute lymphocytic leukemia
  • AML acute myeloid leukemia
  • hematological cancers include myeloproliferative disorders (MPD) such as polycythemia vera (PV), essential thrombocytopenia (ET) and idiopathic primary myelofibrosis (IMF/IPF/PMF).
  • MPD myeloproliferative disorders
  • PV polycythemia vera
  • ET essential thrombocytopenia
  • IMF/IPF/PMF idiopathic primary myelofibrosis
  • the hematological cancer e.g., the hematological cancer that is a RET-associated cancer
  • AML or CMML.
  • the cancer is a solid tumor.
  • solid tumors e.g., solid tumors that are ROS1-associated cancers
  • the cancer is selected from the group consisting of lung cancer (including, e.g., non-small-cell lung cancer), colorectal cancer, gastric cancer, adenocarcinoma (including, e.g., small bowel adenocarcinoma), cholangiocarcinoma, glioblastoma, ovarian cancer, angiocarcinoma, congenital gliobastoma multiforme, papillary thyroid carcinoma, inflammatory myofibroblastic tumour, a spitzoid neoplasm, anaplastic large cell lymphoma, diffuse large B cell lymphoma, and B-cell acute lymphoblastic leukemia.
  • lung cancer including, e.g., non-small-cell lung cancer
  • colorectal cancer gastric cancer
  • adenocarcinoma including, e.g., small bowel adenocarcinoma
  • cholangiocarcinoma including, e.g., small bowel a
  • the patient is a human.
  • a method for treating a patient diagnosed with or identified as having a ROS1-associated cancer comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, or a pharmaceutical composition thereof as defined herein.
  • Dysregulation of a ROS1 kinase, a ROS1 gene, or the expression or activity or level of any (e.g., one or more) of the same can contribute to tumorigenesis.
  • a dysregulation of a ROS1 kinase, a ROS1 gene, or expression or activity or level of any of the same can be a translocation, overexpression, activation, amplification, or mutation of a ROS1 kinase, a ROS1 gene, or a ROS1 kinase domain.
  • a translocation can include a translocation involving the ROS1 kinase domain
  • a mutation can include a mutation involving the ROS1 ligand-binding site
  • an amplification can be of a ROS1 gene.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes overexpression of wild-type ROS1 kinase (e.g., leading to autocrine activation).
  • the dysregulation of a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same includes overexpression, activation, amplification, or mutation in a chromosomal segment comprising the ROS1 gene or a portion thereof, including, for example, the kinase domain portion, or a portion capable of exhibiting kinase activity.
  • the dysregulation of a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same includes one or more chromosome translocations or inversions resulting in a ROS1 gene fusion.
  • the dysregulation of a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same is a result of genetic translocations in which the expressed protein is a fusion protein containing residues from a non-ROS1 partner protein, and includes a minimum of a functional ROS1 kinase domain.
  • ROS1 fusion proteins are shown in Table 2.
  • Non-small-cell lung cancer 1 SLC34A2 including Non-small-cell lung cancer 1 , Colorectal SLC34A2-ROS(S) 28 , cancer 14 , Gastric cancer 15 , Lung SLC34A2-ROS(L) 28 , and adenocarcinoma 24 SLC34A2-ROS(VS) 28 , SLC34A2-ROS (with a breakpoint at chr6: 117653720, chr4: 25678781) 24 TPM3 Non-small-cell lung cancer 1 SDC4 Non-small-cell lung cancer 1 , Adenocarcinoma 10 EZR Non-small-cell lung cancer 1 LRIG3 Non-small-cell lung cancer 1 KDELR2 Non-small-cell lung cancer 1 CCDC6 Non-small-cell lung cancer 1 FIG (GOPC, PIST) Non-small-cell lung cancer 2 , including FIG-ROS1(L) 29 , Cholangiocarcinoma 5 ,
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more deletions, insertions, or point mutation(s) in a ROS1 kinase. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes a deletion of one or more residues from the ROS1 kinase, resulting in constitutive activity of the ROS1 kinase domain.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes at least one point mutation in a ROS1 gene that results in the production of a ROS1 kinase that has one or more amino acid substitutions, insertions, or deletions as compared to the wild-type ROS1 kinase (see, for example, the point mutations listed in Table 3).
  • ROS1 Point Mutations ROS1 Mutation ROS1-Associated Cancer
  • Amino acid position 15 Diffuse large B cell lymphoma 1 (e.g., A15G) Amino acid position 118 B-cell acute lymphoblastic (e.g., R118N) leukemia 2 Amino acid position 122 Gastrointestinal stromal tumors (e.g., A122T) (GISTs) 3 Amino acid position 245 Uterine Corpus Endometrioid (e.g., R245I) Carcinoma 4 Amino acid position 1025 B-cell acute lymphoblastic (e.g., G1025R) leukemia 2 Amino acid position 1186 Non-Small-Cell Lung Cancer 5 (e.g., S1186F) Amino acid position 1539 Skin Cutaneous Melanoma 7 (e.g., P1539S) Amino acid position 1735 B-cell acute lymphoblastic (e.g., T17) Am
  • Amino acid position 1186 (e.g., S1186F 11 ) Amino acid position 1935 (e.g., E1935G6 10 ) Amino acid position 1945 (e.g., L1945Q 7 ) Amino acid position 1946 (e.g., T1946S 7 ) Amino acid position 1947 (e.g., L1947R 6, 10 , L1947M 7 ) Amino acid position 1948 (e.g., R1948S 7 ) Amino acid position 1951 (e.g., L1951R 5 , L1951V 7 ) Amino acid position 1958 (e.g., E1958V 7 ) Amino acid position 1959 (e.g., V1959E 7 ) Amino acid position 1961 (e.g., E1961K 7 ) Amino acid position 1962 (e.g., G1962E 7 ) Amino acid position 1971 (e.g., G1971E 6, 10 ) Amino acid position 1945 (e
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes a splice variation in a ROS1 mRNA which results in an expressed protein that is an alternatively spliced variant of ROS1 having at least one residue deleted (as compared to the wild-type ROS1 kinase) resulting in a constitutive activity of a ROS1 kinase domain.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes a splice variation in a ROS1 mRNA which results in an expressed protein that is an alternatively spliced variant of ROS1 having at least one residue added (as compared to the wild-type ROS1 kinase) resulting in a constitutive activity of a ROS1 kinase domain.
  • a “ROS1 kinase inhibitor” as defined herein includes any compound exhibiting ROS1 inhibition activity.
  • a ROS1 kinase inhibitor is selective for a wild type and/or mutant ROS1 kinase.
  • ROS1 kinase inhibitors can exhibit inhibition activity (IC 50 ) against a ROS1 kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein.
  • a ROS1 kinase inhibitors can exhibit inhibition activity (IC 50 ) against a ROS1 kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay as provided herein.
  • the ROS1 kinase inhibitor is a compound of Formula I.
  • a “first ROS1 kinase inhibitor” or “first ROS1 inhibitor” is a ROS1 kinase inhibitor as defined herein, but which does not include a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as defined herein.
  • a “second ROS1 kinase inhibitor” or a “second ROS1 inhibitor” is a ROS1 kinase inhibitor as defined herein. In some embodiments, a second ROS1 inhibitor does not include a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as defined herein.
  • ROS1 inhibitors When more than one ROS1 inhibitor is present in a method provided herein (e.g., both a first and a second ROS1 inhibitor are present in a method provided herein), the two ROS1 inhibitors are different (e.g., the first and second ROS1 kinase inhibitor are different). As provided herein, different ROS1 inhibitors are structurally distinct from one another.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes at least one point mutation in a ROS1 gene that results in the production of a ROS1 kinase that has one or more amino acid substitutions or insertions or deletions as compared to the wild-type ROS1 kinase.
  • the resulting ROS1 kinase is more resistant to inhibition of its phosphotransferase activity by one or more first ROS1 kinase inhibitor(s), as compared to a wildtype ROS1 kinase or a ROS1 kinase not including the same mutation.
  • Such mutations optionally, do not decrease the sensitivity of the cancer cell or tumor having the ROS1 kinase to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof (e.g., as compared to a cancer cell or a tumor that does not include the particular ROS1 inhibitor resistance mutation).
  • a ROS1 inhibitor resistance mutation can result in a ROS1 kinase that has one or more of an increased V max , a decreased K m for ATP, and an increased K D for a first ROS1 kinase inhibitor, when in the presence of a first ROS1 kinase inhibitor, as compared to a wildtype ROS1 kinase or a ROS1 kinase not having the same mutation in the presence of the same first ROS1 kinase inhibitor.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes at least one point mutation in a ROS1 gene that results in the production of a ROS1 kinase that has one or more amino acid substitutions as compared to the wild-type ROS1 kinase, and which has increased resistance to a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, as compared to a wildtype ROS1 kinase or a ROS1 kinase not including the same mutation.
  • a ROS1 inhibitor resistance mutation can result in a ROS1 kinase that has one or more of an increased V max , a decreased K m , and a decreased K D in the presence of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, as compared to a wildtype ROS1 kinase or a ROS1 kinase not having the same mutation in the presence of the same compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • ROS1 inhibitor resistance mutations can, e.g., include point mutations, insertions, or deletions in and near the ATP binding site in the tertiary structure of ROS1 kinase, including but not limited to the gatekeeper residue, P-loop residues, residues in or near the DFG motif, and ATP cleft solvent front amino acid residues. Additional examples of these types of mutations include changes in residues that may affect enzyme activity and/or drug binding including but are not limited to residues in the activation loop, residues near or interacting with the activation loop, residues contributing to active or inactive enzyme conformations, changes including mutations, deletions, and insertions in the loop proceeding the C-helix and in the C-helix.
  • ROS1 inhibitor resistance mutations include but are not limited to those listed in Table 4 based on the human wildtype ROS1 protein sequence (e.g., SEQ ID NO: 1). Changes to these residues may include single or multiple amino acid changes, insertions within or flanking the sequences, and deletions within or flanking the sequences.
  • compounds of Formula I and pharmaceutically acceptable salts and solvates are useful in treating patients that develop cancers with ROS1 inhibitor resistance mutations (e.g., that result in an increased resistance to a first ROS1 inhibitor, e.g., a substitution at amino acid position 2032 (e.g., G2032R), amino acid position 2026 (e.g., L2026M), amino acid position 2033 (e.g., D2033N), and/or one or more ROS1 inhibitor resistance mutations listed in Table 4) by either dosing in combination or as a follow-up therapy to existing drug treatments (e.g., ALK kinase inhibitors, TRK kinase inhibitors, other ROS1 kinase inhibitors, e.g., first and/or second ROS1 kinase inhibitors).
  • a first ROS1 inhibitor e.g., a substitution at amino acid position 2032 (e.g., G2032R), amino acid position 2026 (e.g., L
  • Exemplary ALK kinase inhibitors are described herein.
  • Exemplary TRK kinase inhibitors are described herein.
  • Exemplary first and second ROS1 kinase inhibitors are described herein.
  • a first or second ROS1 kinase inhibitor can be selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib.
  • compounds of Formula I or pharmaceutically acceptable salts and solvates thereof are useful for treating a cancer that has been identified as having one or more ROS1 inhibitor resistance mutations (that result in an increased resistance to a first or second ROS1 inhibitor, e.g., a substitution at amino acid position 2032 (e.g., G2032R), amino acid position 2026 (e.g., L2026M), amino acid position 2033 (e.g., D2033N)).
  • ROS1 inhibitor resistance mutations are listed in Table 4.
  • Amino acid position 1186 (e.g., S1186F 11 ) Amino acid position 1935 (e.g., E1935G6 10 ) Amino acid position 1945 (e.g., L1945Q 7 ) Amino acid position 1946 (e.g., T1946S 7 ) Amino acid position 1947 (e.g., L1947R 6, 10 , L1947M 7 ) Amino acid position 1948 (e.g., R1948S 7 ) Amino acid position 1951 (e.g., L1951R 5 , L1951V 7 ) Amino acid position 1958 (e.g., E1958V 7 ) Amino acid position 1959 (e.g., V1959E 7 ) Amino acid position 1961 (e.g., E1961K 7 ) Amino acid position 1962 (e.g., G1962E 7 ) Amino acid position 1971 (e.g., G1971E 6, 10 ) Amino acid position 1945 (e
  • ROS1 proto-oncogene is expressed in a variety of tumor types, and belongs to the sevenless subfamily of tyrosine kinase insulin receptor genes.
  • the protein encoded by this gene is a type I integral membrane protein with tyrosine kinase activity.
  • ROS1 shares structural similarity with the anaplastic lymphoma kinase (ALK) protein.
  • ALK anaplastic lymphoma kinase
  • ROS1 fusions have been detected in multiple other tumor histologies, including ovarian carcinoma, sarcoma, cholangiocarcinomas and others.
  • ALK is a receptor tyrosine kinase that belongs to the insulin growth factor receptor superfamily. ALK is believed to play a role in the development of the nervous system.
  • a variety of ALK gene fusions have been described, such as EML4, KIF5B, KLC1, and TRK-fused gene (TFG). Such fusion products result in kinase activation and oncogenesis.
  • NSCLC Non-small-cell lung cancer
  • ALK anaplastic lymphoma kinase gene
  • crizotinib which is an inhibitor of ALK and ROS1.
  • the additional therapeutic agent(s) includes any one of the above listed therapies or therapeutic agents which are standards of care in cancers wherein the cancer has a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same.
  • the additional therapeutic agent(s) includes any one of the above listed therapies or therapeutic agents which are standards of care in cancers wherein the cancer has a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same (e.g., an ALK-associated cancer).
  • the additional therapeutic agent(s) includes any one of the above listed therapies or therapeutic agents which are standards of care in cancers wherein the cancer has a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same (e.g., a TRK-associated cancer).
  • ALK-associated cancer refers to cancers associated with or having a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same. Exemplary ALK-associated cancers are provided herein.
  • the phrase “dysregulation of an ALK gene, an ALK kinase, or the expression or activity or level of any of the same” refers to a genetic mutation (e.g., an ALK gene translocation that results in the expression of a fusion protein, a deletion in an ALK gene that results in the expression of an ALK protein that includes a deletion of at least one amino acid as compared to the wild-type ALK protein, a mutation in an ALK gene that results in the expression of an ALK protein with one or more point mutations, or an alternative spliced version of an ALK mRNA that results in an ALK protein having a deletion of at least one amino acid in the ALK protein as compared to the wild-type ALK protein) or an ALK gene amplification that results in overexpression of an ALK protein or an autocrine activity resulting from the overexpression of an ALK gene in a cell that results in a pathogenic increase in the activity of a kinase domain of an ALK protein (e.g.,
  • a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same can be a mutation in an ALK gene that encodes an ALK protein that is constitutively active or has increased activity as compared to a protein encoded by an ALK gene that does not include the mutation.
  • a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same can be the result of a gene or chromosome translocation which results in the expression of a fusion protein that contains a first portion of ALK that includes a functional kinase domain, and a second portion of a partner protein that is not ALK.
  • dysregulation of an ALK gene, an ALK protein, or expression or activity or level of any of the same can be a result of a gene translocation of one ALK gene with another non-ALK gene.
  • Non-limiting examples of fusion proteins are described in Table 5. Additional examples of ALK kinase protein mutations (e.g., point mutations) are ALK inhibitor resistance mutations.
  • wildtype when referring to an ALK nucleic acid or protein describes a nucleic acid (e.g., an ALK gene or an ALK mRNA) or protein (e.g., an ALK protein) that is found in a subject that does not have an ALK-associated disease, e.g., an ALK-associated cancer (and optionally also does not have an increased risk of developing an ALK-associated disease and/or is not suspected of having an ALK-associated disease), or is found in a cell or tissue from a subject that does not have an ALK-associated disease, e.g., an ALK-associated cancer (and optionally also does not have an increased risk of developing an ALK-associated disease and/or is not suspected of having an ALK-associated disease).
  • the dysregulation of an ALK gene, an ALK kinase protein, or expression or activity or level of any of the same includes one or more chromosome translocations or inversions resulting in an ALK gene fusion.
  • the dysregulation of an ALK gene, an ALK kinase protein, or expression or activity or level of any of the same is a result of genetic translocations in which the expressed protein is a fusion protein containing residues from a non-ALK partner protein, and includes a minimum of a functional ALK kinase domain.
  • Non-limiting examples of ALK fusion proteins are shown in Table 5.
  • Anaplastic large cell lymphoma 1 Diffuse large B-cell lymphoma 1 , Neuroblastoma 8 , Lung adenocarcinoma 9
  • ALO17/RNF213 Anaplastic large cell lymphoma 1 TFG (e.g., TFGs, Anaplastic large cell lymphoma 1 , TFG L , TFG XL ) 38
  • Non-small cell lung cancer 1 Anaplastic thyroid carcinoma 1 MSN (e.g., MSNa Anaplastic large cell lymphoma 1 and MSNb) 38 TPM3 Anaplastic large cell lymphoma 1 , Inflammatory myofibroblastic tumour 1 , Renal medulla carcinoma/renal cell carcinoma 1 , Spitzoid neoplasm 5 TPM4 (e.g., type 1 Anaplastic large cell lymphoma 1 , and type 2) 38 Inflammatory myofibroblastic tumour 1 , Oesoph
  • the dysregulation of an ALK gene, an ALK kinase, or expression or activity or level of any of the same includes at least one point mutation in an ALK gene that results in the production of an ALK kinase that has one or more amino acid substitutions, insertions, or deletions as compared to the wild-type ALK kinase.
  • an ALK-associated cancer has been identified as having one or more ALK inhibitor resistance mutations (that result in an increased resistance to an ALK inhibitor.
  • Tropomyosin-related kinase is a receptor tyrosine kinase family of neurotrophin receptors that are found in multiple tissues types. Three members of the TRK proto-oncogene family have been described: TrkA, TrkB, and TrkC, encoded by the NTRK1, NTRK2, and NTRK3 genes, respectively.
  • TrkA, TrkB, and TrkC encoded by the NTRK1, NTRK2, and NTRK3 genes, respectively.
  • the TRK receptor family is involved in neuronal development, including the growth and function of neuronal synapses, memory development, and maintenance, and the protection of neurons after ischemia or other types of injury (Nakagawara, Cancer Lett. 169:107-114, 2001).
  • TRK was originally identified from a colorectal cancer cell line as an oncogene fusion containing 5′ sequences from tropomyosin-3 (TPM3) gene and the kinase domain encoded by the 3′ region of the neurotrophic tyrosine kinase, receptor, type 1 gene (NTRK1) (Pulciani et al., Nature 300:539-542, 1982; Martin-Zanca et al., Nature 319:743-748, 1986).
  • TPM3 tropomyosin-3
  • NTRK1 neurotrophic tyrosine kinase, receptor, type 1 gene
  • TRK gene fusions follow the well-established paradigm of other oncogenic fusions, such as those involving ALK and ROS1, which have been shown to drive the growth of tumors and can be successfully inhibited in the clinic by targeted drugs (Shaw et al., New Engl. J. Med. 371:1963-1971, 2014; Shaw et al., New Engl. J. Med. 370:1189-1197, 2014).
  • Oncogenic TRK fusions induce cancer cell proliferation and engage critical cancer-related downstream signaling pathways such as mitogen activated protein kinase (MAPK) and AKT (Vaishnavi et al., Cancer Discov. 5:25-34, 2015).
  • MAPK mitogen activated protein kinase
  • AKT AKT
  • NTRK1 and its related TRK family members NTRK2 and NTRK3 have been described (Vaishnavi et al., Cancer Disc. 5:25-34, 2015; Vaishnavi et al., Nature Med. 19:1469-1472, 2013). Although there are numerous different 5′ gene fusion partners identified, all share an in-frame, intact TRK kinase domain.
  • Trk inhibitors have been developed to treat cancer (see, e.g., U.S. Patent Application Publication No. 62/080,374, International Application Publication Nos.
  • TRK-associated cancer refers to cancers associated with or having a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same. Exemplary TRK-associated cancers are provided herein.
  • the phrase “dysregulation of a TRK gene, a TRK kinase, or the expression or activity or level of any of the same” refers to a genetic mutation (e.g., a TRK gene translocation that results in the expression of a fusion protein, a deletion in a TRK gene that results in the expression of a TRK protein that includes a deletion of at least one amino acid as compared to the wild-type TRK protein, a mutation in a TRK gene that results in the expression of a TRK protein with one or more point mutations, or an alternative spliced version of a TRK mRNA that results in a TRK protein having a deletion of at least one amino acid in the TRK protein as compared to the wild-type TRK protein) or a TRK gene amplification that results in overexpression of a TRK protein or an autocrine activity resulting from the overexpression of a TRK gene in a cell that results in a pathogenic increase in the activity of a kinase domain
  • a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same can be a mutation in a TRK gene that encodes a TRK protein that is constitutively active or has increased activity as compared to a protein encoded by a TRK gene that does not include the mutation.
  • a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same can be the result of a gene or chromosome translocation which results in the expression of a fusion protein that contains a first portion of TRK that includes a functional kinase domain, and a second portion of a partner protein that is not TRK.
  • dysregulation of a TRK gene, a TRK protein, or expression or activity or level of any of the same can be a result of a gene translocation of one TRK gene with another non-TRK gene.
  • Non-limiting examples of fusion proteins are described in Tables 6-8. Additional examples of TRK kinase protein mutations (e.g., point mutations) are TRK inhibitor resistance mutations.
  • wildtype when referring to a TRK nucleic acid or protein describes a nucleic acid (e.g., a TRK gene or a TRK mRNA) or protein (e.g., a TRK protein) that is found in a subject that does not have a TRK-associated disease, e.g., a TRK-associated cancer (and optionally also does not have an increased risk of developing a TRK-associated disease and/or is not suspected of having a TRK-associated disease), or is found in a cell or tissue from a subject that does not have a TRK-associated disease, e.g., a TRK-associated cancer (and optionally also does not have an increased risk of developing a TRK-associated disease and/or is not suspected of having a TRK-associated disease).
  • the dysregulation of a TRK gene, a TRK kinase protein, or expression or activity or level of any of the same includes one or more chromosome translocations or inversions resulting in a TRK gene fusion.
  • the dysregulation of a TRK gene, a TRK kinase protein, or expression or activity or level of any of the same is a result of genetic translocations in which the expressed protein is a fusion protein containing residues from a non-TRK partner protein, and includes a minimum of a functional TRK kinase domain. See, for example, Tables 6-8.
  • TrkA Fusion Proteins and Cancers Non-limiting Exemplary Trk-and Synonyms of Associated Fusion Protein Non-TrkA Fusion Partner Cancer(s) TP53-TrkA 1,11 Tumor Protein P53 Spitzoid Melanoma, Spitz tumors LMNA-TrkA 1, 12 Lamin A/C Spitzoid Melanoma, Spitz tumors, Undifferentiated Sarcoma, Adult Soft Tissue Sarcoma (e.g., Soft Tissue Sarcoma Metastatic to Lung), Soft Tissue Fibrosarcoma, Spindle Cell Sarcoma G , Congenital Infantile Fibrosarcoma H , Pediatric haemangiopericytoma-like sarcoma I , Colorectal Cancer K CD74-TrkA 2 MHC class II invariant chain Non-Small Cell Lung Cancer (NSCLC) Lung adenocarcimona TFG-TrkA (TRK-T3) 3 TRK-Fused Gene Pa
  • the dysregulation of a TRK gene, a TRK kinase, or expression or activity or level of any of the same includes at least one point mutation in a TRK gene that results in the production of a TRK kinase that has one or more amino acid substitutions, insertions, or deletions as compared to the wild-type TRK kinase.
  • a TRK-associated cancer has been identified as having one or more TRK inhibitor resistance mutations (that result in an increased resistance to a TRK inhibitor.
  • methods for treating a patient diagnosed with (or identified as having) a cancer that include administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • methods for treating a patient identified or diagnosed as having a ROS1-associated cancer that include administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof.
  • the patient that has been identified or diagnosed as having a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved test or assay for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the patient or by performing any of the non-limiting examples of assays described herein.
  • the test or assay is provided as a kit.
  • the assay is a liquid biopsy.
  • the cancer is a ROS1-associated cancer.
  • the ROS1-associated cancer can be a cancer that includes one or more ROS1 inhibitor resistance mutations.
  • Some embodiments of these methods further include administering to the subject one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor).
  • one or more additional anticancer agents e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor
  • one or more additional anticancer agents are administered after a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • one or more additional anticancer agents are administered with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the subject was previously treated with a first ROS1 inhibitor or previously treated with another anticancer treatment, e.g., treatment with another anticancer agent, resection of the tumor or radiation therapy.
  • the subject was previously treated with an ALK inhibitor, a TRK inhibitor, or both.
  • the patient is determined to have a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved test or assay for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the patient or by performing any of the non-limiting examples of assays described herein.
  • the test or assay is provided as a kit.
  • the assay is a liquid biopsy.
  • the cancer is a ROS1-associated cancer.
  • the ROS1-associated cancer can be a cancer that includes one or more ROS1 inhibitor resistance mutations.
  • Also provided are methods of treating a patient that include performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and administering (e.g., specifically or selectively administering) a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof to the patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • Some embodiments of these methods further include administering to the subject one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor).
  • one or more additional anticancer agents e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor
  • one or more additional anticancer agents e.g., a second ROS1 inhibitor (e.g., a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof), an ALK inhibitor, and/or a TRK inhibitor) are administered after a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • one or more additional anticancer agents e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor
  • the subject was previously treated with a first ROS1 inhibitor or previously treated with another anticancer treatment, e.g., treatment with another anticancer agent, resection of a tumor or radiation therapy.
  • the subject was previously treated with an ALK inhibitor, a TRK inhibitor, or both.
  • the patient is a patient suspected of having a ROS1-associated cancer, a patient presenting with one or more symptoms of a ROS1-associated cancer, or a patient having an elevated risk of developing a ROS1-associated cancer.
  • the assay utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH).
  • FISH fluorescence in situ hybridization
  • the assay is a regulatory agency-approved assay, e.g., FDA-approved kit.
  • the assay is a liquid biopsy. Additional, non-limiting assays that may be used in these methods are described herein. Additional assays are also known in the art.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • an assay e.g., an in vitro assay
  • a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for the manufacture of a medicament for treating a ROS1-associated cancer in a patient identified or diagnosed as having a ROS1-associated cancer through a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same where the presence of dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, identifies that the patient has a ROS1-associated cancer.
  • Some embodiments of any of the methods or uses described herein further include recording in the patient's clinical record (e.g., a computer readable medium) that the patient is determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, through the performance of the assay, should be administered a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof.
  • the assay utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH).
  • FISH fluorescence in situ hybridization
  • the assay is a regulatory agency-approved assay, e.g., FDA-approved kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for use in the treatment of a cancer in a patient in need thereof or a patient identified or diagnosed as having a ROS1-associated cancer. Also provided is the use of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for the manufacture of a medicament for treating a cancer in a patient identified or diagnosed as having a ROS1-associated cancer.
  • the cancer is a ROS1-associated cancer, for example, a ROS1-associated cancer having one or more ROS1 inhibitor resistance mutations.
  • a patient is identified or diagnosed as having a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved, kit for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the sample.
  • a ROS1-associated cancer includes those described herein and known in the art.
  • the patient has been identified or diagnosed as having a cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • the patient has a tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • the patient can be a patient with a tumor(s) that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • the patient can be a patient whose tumors have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • the patient is suspected of having a ROS1-associated cancer (e.g., a cancer having one or more ROS1 inhibitor resistance mutations).
  • provided herein are methods for treating a ROS1-associated cancer in a patient in need of such treatment, the method comprising a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the patient; and b) administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more fusion proteins.
  • Non-limiting examples of ROS1 gene fusion proteins are described in Table 2.
  • the fusion protein is SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more ROS1 kinase protein point mutations, insertions, and/or deletions. Non-limiting examples of ROS1 kinase protein point mutations are described in Table 3 and Table 3a.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • ROS1 inhibitor resistance mutations are described in Table 4.
  • the ROS1 inhibitor resistance mutation is selected from the group consisting of L2026M, G2032R, and D2033N.
  • the cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit.
  • the assay is a liquid biopsy.
  • the tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is a tumor positive for one or more ROS1 inhibitor resistance mutations.
  • the tumor with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit.
  • the assay is a liquid biopsy.
  • the patient has a clinical record indicating that the patient has a tumor that has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same (e.g., a tumor having one or more ROS1 inhibitor resistance mutations).
  • the clinical record indicates that the patient should be treated with one or more of the compounds of Formula I or a pharmaceutically acceptable salts or solvates thereof or compositions provided herein.
  • the cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is a cancer having one or more ROS1 inhibitor resistance mutations.
  • the cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit.
  • the assay is a liquid biopsy.
  • the tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is a tumor positive for one or more ROS1 inhibitor resistance mutations.
  • the tumor with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit.
  • the assay is a liquid biopsy.
  • Also provided are methods of treating a patient that include administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to a patient having a clinical record that indicates that the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. Also provided is the use of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for the manufacture of a medicament for treating a ROS1-associated cancer in a patient having a clinical record that indicates that the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • Some embodiments of these methods and uses can further include: a step of performing an on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and recording the information in a patient's clinical file (e.g., a computer readable medium) that the patient has been identified to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • the assay is an in vitro assay.
  • an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH).
  • FISH fluorescence in situ hybridization
  • the assay is a regulatory agency-approved, e.g., FDA-approved, kit.
  • the assay is a liquid biopsy.
  • the dysregulation of a ROS1 gene, ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • the method includes performing an assay on a sample obtained from the subject to determine whether the subject has a dysregulation of a ROS1 gene, a ROS1 protein, or expression or level of any of the same.
  • the method also includes administering to a subject determined to have a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the dysregulation in a ROS1 gene, a ROS1 kinase protein, or expression or activity of the same is a gene or chromosome translocation that results in the expression of a ROS1 fusion protein (e.g., any of the ROS1 fusion proteins described herein).
  • the ROS1 fusion can be selected from a SLC34A2 fusion, a CD74 fusion, a EZR fusion, a TPM3 fusion, or a SDC4 fusion.
  • the dysregulation in a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same is one or more point mutation in the ROS1 gene (e.g., any of the one or more of the ROS1 point mutations described herein).
  • the one or more point mutations in a ROS1 gene can result, e.g., in the translation of a ROS1 protein having one or more of the following amino acid substitutions: A15G, R118N, G1025R, T1735M, R1948H, and R2072N.
  • the dysregulation in a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same is one or more ROS1 inhibitor resistance mutations (e.g., any combination of the one or more ROS1 inhibitor resistance mutations described herein).
  • the one or more point mutations in a ROS1 gene can result, e.g., in the translation of a ROS1 protein having one or more of the following amino acid substitutions: L2026M, G2032R, and D2033N.
  • Some embodiments of these methods further include administering to the subject another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor).
  • another anticancer agent e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor.
  • the selected treatment can include administration of a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • Some embodiments can further include a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and identifying and diagnosing a patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, as having a ROS1-associated cancer.
  • the cancer is a ROS1-associated cancer having one or more ROS1 inhibitor resistance mutations.
  • the patient has been identified or diagnosed as having a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved, kit for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the patient.
  • the assay is a liquid biopsy.
  • the ROS1-associated cancers is a cancer described herein or known in the art.
  • the assay is an in vitro assay.
  • an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH).
  • FISH fluorescence in situ hybridization
  • the assay is a regulatory agency-approved, e.g., FDA-approved, kit.
  • the assay is a liquid biopsy.
  • Also provided herein are methods of selecting a treatment for a patient wherein the methods include a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same (e.g., one or more ROS1 inhibitor resistance mutations), and identifying or diagnosing a patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, as having a ROS1-associated cancer. Some embodiments further include administering the selected treatment to the patient identified or diagnosed as having a ROS1-associated cancer.
  • the selected treatment can include administration of a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to the patient identified or diagnosed as having a ROS1-associated cancer.
  • the assay is an in vitro assay.
  • an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH).
  • FISH fluorescence in situ hybridization
  • the assay is a regulatory agency-approved, e.g., FDA-approved, kit.
  • the assay is a liquid biopsy.
  • Also provided are methods of selecting a patient for treatment wherein the methods include selecting, identifying, or diagnosing a patient having a ROS1-associated cancer, and selecting the patient for treatment including administration of a therapeutically-effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • identifying or diagnosing a patient as having a ROS1-associated cancer can include a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and identifying or diagnosing a patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, as having a ROS1-associated cancer.
  • the method of selecting a treatment can be used as a part of a clinical study that includes administration of various treatments of a ROS1-associated cancer.
  • a ROS1-associated cancer is a cancer having one or more ROS1 inhibitor resistance mutations.
  • the assay is an in vitro assay. For example, an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH).
  • FISH fluorescence in situ hybridization
  • the assay is a regulatory agency-approved, e.g., FDA-approved, kit.
  • the assay is a liquid biopsy.
  • the dysregulation of the ROS1 gene, the ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • an assay used to determine whether the patient has a dysregulation of a ROS1 gene, or a ROS1 kinase, or expression or activity or level of any of the same, using a sample from a patient can include, for example, next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH), fluorescence microscopy, Southern blotting, Western blotting, FACS analysis, Northern blotting, and PCR-based amplification (e.g., RT-PCR and quantitative real-time RT-PCR).
  • FISH fluorescence in situ hybridization
  • the assays are typically performed, e.g., with at least one labelled nucleic acid probe or at least one labelled antibody or antigen-binding fragment thereof.
  • Assays can utilize other detection methods known in the art for detecting dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or levels of any of the same (see, e.g., the references cited herein).
  • the dysregulation of the ROS1 gene, the ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • the sample is a biological sample or a biopsy sample (e.g., a paraffin-embedded biopsy sample) from the patient.
  • the patient is a patient suspected of having a ROS1-associated cancer, a patient having one or more symptoms of a ROS1-associated cancer, and/or a patient that has an increased risk of developing a ROS1-associated cancer).
  • dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same can be identified using a liquid biopsy (variously referred to as a fluid biopsy or fluid phase biopsy).
  • a liquid biopsy (variously referred to as a fluid biopsy or fluid phase biopsy). See, e.g., Karachialiou et al., “Real-time liquid biopsies become a reality in cancer treatment”, Ann. Transl. Med., 3(3):36, 2016.
  • Liquid biopsy methods can be used to detect total tumor burden and/or the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same.
  • Liquid biopsies can be performed on biological samples obtained relatively easily from a subject (e.g., via a simple blood draw) and are generally less invasive than traditional methods used to detect tumor burden and/or dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same.
  • liquid biopsies can be used to detect the presence of dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same at an earlier stage than traditional methods.
  • the biological sample to be used in a liquid biopsy can include, blood, plasma, urine, cerebrospinal fluid, saliva, sputum, broncho-alveolar lavage, bile, lymphatic fluid, cyst fluid, stool, ascites, and combinations thereof.
  • a liquid biopsy can be used to detect circulating tumor cells (CTCs).
  • CTCs circulating tumor cells
  • a liquid biopsy can be used to detect cell-free DNA.
  • cell-free DNA detected using a liquid biopsy is circulating tumor DNA (ctDNA) that is derived from tumor cells.
  • Analysis of ctDNA can be used to identify dysregulation of a RET gene, a RET kinase, or the expression or activity or level of any of the same.
  • NGS next-generation sequencing
  • RET RET kinase
  • ctDNA derived from a single gene can be detected using a liquid biopsy.
  • ctDNA derived from a plurality of genes e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 or more, or any number of genes in between these numbers
  • a liquid biopsy e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 or more, or any number of genes in between these numbers
  • ctDNA derived from a plurality of genes can be detected using any of a variety of commercially-available testing panels (e.g., commercially-available testing panels designed to detect dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same ).
  • Liquid biopsies can be used to detect dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same including, without limitation, point mutations or single nucleotide variants (SNVs), copy number variants (CNVs), genetic fusions (e.g., translocations or rearrangements), insertions, deletions, or any combination thereof.
  • a liquid biopsy can be used to detect a germline mutation. In some embodiments, a liquid biopsy can be used to detect a somatic mutation. In some embodiments, a liquid biopsy can be used to detect a primary genetic mutation (e.g., a primary mutation or a primary fusion that is associated with initial development of a disease, e.g., cancer). In some embodiments, a liquid biopsy can be used to detect a genetic mutation that develops after development of the primary genetic mutation (e.g., a resistance mutation that arises in response to a treatment administered to a subject).
  • a primary genetic mutation e.g., a primary mutation or a primary fusion that is associated with initial development of a disease, e.g., cancer.
  • a liquid biopsy can be used to detect a genetic mutation that develops after development of the primary genetic mutation (e.g., a resistance mutation that arises in response to a treatment administered to a subject).
  • a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same identified using a liquid biopsy is also present in a cancer cell that is present in the subject (e.g., in a tumor).
  • any of the types of dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same described herein can be detected using a liquid biopsy.
  • a genetic mutation identified via a liquid biopsy can be used to identify the subject as a candidate for a particular treatment.
  • detection of dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in the subject can indicate that the subject will be responsive to a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt thereof.
  • Liquid biopsies can be performed at multiple times during a course of diagnosis, a course of monitoring, and/or a course of treatment to determine one or more clinically relevant parameters including, without limitation, progression of the disease, efficacy of a treatment, or development of resistance mutations after administering a treatment to the subject.
  • a first liquid biopsy can be performed at a first time point and a second liquid biopsy can be performed at a second time point during a course of diagnosis, a course of monitoring, and/or a course of treatment.
  • the first time point can be a time point prior to diagnosing a subject with a disease (e.g., when the subject is healthy), and the second time point can be a time point after subject has developed the disease (e.g., the second time point can be used to diagnose the subject with the disease).
  • the first time point can be a time point prior to diagnosing a subject with a disease (e.g., when the subject is healthy), after which the subject is monitored, and the second time point can be a time point after monitoring the subject.
  • the first time point can be a time point after diagnosing a subject with a disease, after which a treatment is administered to the subject, and the second time point can be a time point after the treatment is administered; in such cases, the second time point can be used to assess the efficacy of the treatment (e.g., if the genetic mutation(s) detected at the first time point are reduced in abundance or are undetectable) or to determine the presence of a resistance mutation that has arisen as a result of the treatment.
  • a treatment to be administered to a subject can include a compound of Formula I or a pharmaceutically acceptable salt thereof.
  • compositions provided herein may be, for example, surgery, radiotherapy, and chemotherapeutic agents, such as kinase inhibitors, signal transduction inhibitors and/or monoclonal antibodies.
  • chemotherapeutic agents such as kinase inhibitors, signal transduction inhibitors and/or monoclonal antibodies.
  • Compounds of Formula I therefore may also be useful as adjuvants to cancer treatment, that is, they can be used in combination with one or more additional therapies or therapeutic agents, for example a chemotherapeutic agent that works by the same or by a different mechanism of action.
  • the compound of Formula I (or a pharmaceutically acceptable salt or solvate thereof) is administered in combination with a therapeutically effective amount of at least one additional therapeutic agent selected from one or more additional therapies or therapeutic (e.g., chemotherapeutic) agents.
  • Non-limiting examples of additional therapeutic agents include: other ROS1-targeted therapeutic agents (i.e. a first or second ROS1 kinase inhibitor), ALK-targeted therapeutic agents (e.g., ALK kinase inhibitors), receptor tyrosine kinase-targeted therapeutic agents (e.g., TRK kinase inhibitors), kinase targeted therapeutics, signal transduction pathway inhibitors, checkpoint inhibitors, modulators of the apoptosis pathway (e.g. obataclax); cytotoxic chemotherapeutics, angiogenesis-targeted therapies, immune-targeted agents, including immunotherapy, and radiotherapy.
  • ROS1-targeted therapeutic agents i.e. a first or second ROS1 kinase inhibitor
  • ALK-targeted therapeutic agents e.g., ALK kinase inhibitors
  • receptor tyrosine kinase-targeted therapeutic agents e.g
  • the other ROS1-targeted therapeutic is a multikinase inhibitor exhibiting ROS1 inhibition activity. In some embodiments, the other ROS1-targeted therapeutic inhibitor is selective for a ROS1 kinase.
  • Exemplary ROS1 kinase inhibitors can exhibit inhibition activity (IC 50 ) against a ROS1 kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein.
  • a ROS1 kinase inhibitor can exhibit inhibition activity (IC 50 ) against a ROS1 kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay as provided herein.
  • ROS1-targeted therapeutic agents include (E)-5-chloro-2-(2-(1-(4-fluorophenyl)ethylidene)hydrazinyl)-N-(2-(isopropylsulfonyl)phenyl)pyrimidin-4-amine ( Eur. J. Org. Chem.
  • alectinib alectinib; brigatinib; cabozantinib; ceritinib; crizotinib; entrectinib; foretinib; herbimycin A; lorlatinib; lorlatinib des-methyl analogs; merestinib; ASP3026 (NCT01284192; Astellas Pharma); AZD3634 (AstraZeneca); and ASP3026 (Astrellas Pharma).
  • an ALK-targeted therapeutic is a multikinase inhibitor exhibiting ALK inhibition activity.
  • the ALK-targeted therapeutic inhibitor is selective for an ALK kinase.
  • Exemplary ALK kinase inhibitors can exhibit inhibition activity (IC 50 ) against an ALK kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein.
  • an ALK kinase inhibitor can exhibit inhibition activity (IC 50 ) against an ALK kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay.
  • Non-limiting examples of ALK-targeted therapeutic agents include “Amgen 36”; “Amgen 49”; “Cephalon 30”; “Chugai 13d”; 4-arylaminopyrimidine derivatives (see, e.g., Eur. J. Med. Chem.
  • a receptor tyrosine kinase targeted therapeutic is a multikinase inhibitor (e.g., TRK-targeted therapeutic inhibitor) exhibiting TRK inhibition activity.
  • the TRK-targeted therapeutic inhibitor is selective for a TRK kinase.
  • Exemplary TRK kinase inhibitors can exhibit inhibition activity (IC 50 ) against a TRK kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein.
  • a TRK kinase inhibitor can exhibit inhibition activity (IC 50 ) against a TRK kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay.
  • IC 50 inhibition activity against a TRK kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay.
  • a TRK inhibitor assay can be any of those provided in U.S. Pat. No. 8,933,084 (e.g., Example A or B).
  • Non-limiting examples of receptor tyrosine kinase (e.g., Trk) targeted therapeutic agents include afatinib, cabozantinib, cetuximab, crizotinib, dabrafenib, entrectinib, erlotinib, gefitinib, imatinib, lapatinib, lestaurtinib, nilotinib, pazopanib, panitumumab, pertuzumab, sunitinib, trastuzumab, 1-((3 S,4R)-4-(3-fluorophenyl)-1-(2-methoxyethyl)pyrrolidin-3-yl)-3-(4-methyl-3-(2-methylpyrimidin-5-yl)-1-phenyl-1H-pyrazol-5-yl)urea, AG 879, AR-772, AR-786, AR-256, AR-618, AZ-23,
  • Additional Trk targeted therapeutic agents include those described in U.S. Pat. Nos. 8,450,322; 8,513,263; 8,933,084; 8,791,123; 8,946,226; 8,450,322; 8,299,057; and 8,912,194; U.S. Publication No. 2016/0137654; 2015/0166564; 2015/0051222; 2015/0283132; and 2015/0306086; International Publication No.
  • Trk inhibitors can be found in U.S. Pat. No. 8,637,516, International Publication No. WO 2012/034091, U.S. Pat. No. 9,102,671, International Publication No. WO 2012/116217, U.S. Publication No. 2010/0297115, International Publication No. WO 2009/053442, U.S. Pat. No. 8,642,035, International Publication No. WO 2009092049, U.S. Pat. No. 8,691,221, International Publication No. WO2006131952, all of which are incorporated by reference in their entireties herein.
  • Exemplary Trk inhibitors include GNF-4256, described in Cancer Chemother. Pharmacol.
  • Trk inhibitors include those disclosed in U.S. Publication No. 2010/0152219, U.S. Pat. No. 8,114,989, and International Publication No. WO 2006/123113, all of which are incorporated by reference in their entireties herein.
  • Exemplary Trk inhibitors include AZ623, described in Cancer 117(6):1321-1391, 2011; AZD6918, described in Cancer Biol. Ther. 16(3):477-483, 2015; AZ64, described in Cancer Chemother. Pharmacol.
  • a Trk inhibitor can include those described in U.S. Pat. Nos. 7,615,383; 7,384,632; 6,153,189; 6,027,927; 6,025,166; 5,910,574; 5,877,016; and 5,844,092, each of which is incorporated by reference in its entirety.
  • Trk inhibitors include CEP-751, described in Int. J. Cancer 72:672-679, 1997; CT327, described in Acta Derm. Venereol. 95:542-548, 2015; compounds described in International Publication No. WO 2012/034095; compounds described in U.S. Pat. No. 8,673,347 and International Publication No. WO 2007/022999; compounds described in U.S. Pat. No. 8,338,417; compounds described in International Publication No. WO 2016/027754; compounds described in U.S. Pat. No. 9,242,977; compounds described in U.S. Publication No.
  • sunitinib N-(2-diethylaminoethyl)-5-[(Z)-(5-fluoro-2-oxo-1H-indol-3-ylidene)methyl]-2,4-dimethyl-1H-pyrrole-3-carboxamide
  • sunitinib N-(2-diethylaminoethyl)-5-[(Z)-(5-fluoro-2-oxo-1H-indol-3-ylidene)methyl]-2,4-dimethyl-1H-pyrrole-3-carboxamide
  • 4-aminopyrazolylpyrimidines e.g., AZ-23 (((S)-5-chloro-N2-(1-(5-fluoropyridin-2-yl)ethyl)-N4-(5-isopropoxy-1H-pyrazol-3-yl)pyrimidine-2,4-diamine)), as described in J. Med. Chem. 51(15):4672-4684, 2008; PHA-739358 (danusertib), as described in Mol. Cancer Ther.
  • Trk inhibitor to act as a TrkA, TrkB, and/or Trk C inhibitor may be tested using the assays described in Examples A and B in U.S. Pat. No. 8,513,263, which is incorporated herein by reference.
  • signal transduction pathway inhibitors include Ras-Raf-MEK-ERK pathway inhibitors (e.g., binimetinib, selumetinib, encorafinib, sorafenib, trametinib, and vemurafenib), PI3K-Akt-mTOR-S6K pathway inhibitors (e.g.
  • everolimus, rapamycin, perifosine, temsirolimus), and other kinase inhibitors such as baricitinib, brigatinib, capmatinib, danusertib, ibrutinib, milciclib, quercetin, regorafenib, ruxolitinib, semaxanib, AP32788, BLU285, BLU554, INCB39110, INCB40093, INCB50465, INCB52793, INCB54828, MGCD265, NMS-088, NMS-1286937, PF 477736 ((R)-amino-N-[5,6-dihydro-2-(1-methyl-1H-pyrazol-4-yl)-6-oxo-1Hpyrrolo[4,3,2-ef][2,3]benzodiazepin-8-yl]-cyclohexaneacetamide), PLX3397, PLX7486, PLX8394
  • Non-limiting examples of checkpoint inhibitors include ipilimumab, tremelimumab, nivolumab, pidilizumab, MPDL3208A, MEDI4736, MSB0010718C, BMS-936559, BMS-956559, BMS-935559 (MDX-1105), AMP-224, and pembrolizumab.
  • cytotoxic chemotherapeutics are selected from arsenic trioxide, bleomycin, cabazitaxel, capecitabine, carboplatin, cisplatin, cyclophosphamide, cytarabine, dacarbazine, daunorubicin, docetaxel, doxorubicin, etoposide, fluorouracil, gemcitabine, irinotecan, lomustine, methotrexate, mitomycin C, oxaliplatin, paclitaxel, pemetrexed, temozolomide, and vincristine.
  • Non-limiting examples of angiogenesis-targeted therapies include aflibercept and bevacizumab.
  • an immunotherapy refers to an agent that modulates the immune system.
  • an immunotherapy can increase the expression and/or activity of a regulator of the immune system.
  • an immunotherapy can decrease the expression and/or activity of a regulator of the immune system.
  • an immunotherapy can recruit and/or enhance the activity of an immune cell.
  • the immunotherapy is a cellular immunotherapy (e.g., adoptive T-cell therapy, dendritic cell therapy, natural killer cell therapy).
  • the cellular immunotherapy is sipuleucel-T (APC8015; ProvengeTM; Plosker (2011) Drugs 71(1): 101-108).
  • the cellular immunotherapy includes cells that express a chimeric antigen receptor (CAR).
  • the cellular immunotherapy is a CAR-T cell therapy.
  • the CAR-T cell therapy is tisagenlecleucel (KymriahTM).
  • the immunotherapy is an antibody therapy (e.g., a monoclonal antibody, a conjugated antibody).
  • the antibody therapy is bevacizumab (MvastiTM, Avastin®), trastuzumab (Herceptin®), avelumab (Bavencio®), rituximab (MabTheraTM, Rituxan®), edrecolomab (Panorex), daratumuab (Darzalex®), olaratumab (LartruvoTM), ofatumumab (Arzerra®), alemtuzumab (Campath®), cetuximab (Erbitux®), oregovomab, pembrolizumab (Keytruda®), dinutiximab (Unituxin®), obinutuzumab (Gazyva®), tremelimumab (CP-675,206), ramucirumab (C
  • the immunotherapy is an antibody-drug conjugate.
  • the antibody-drug conjugate is gemtuzumab ozogamicin (MylotargTM), inotuzumab ozogamicin (Besponsa®), brentuximab vedotin (Adcetris®), ado-trastuzumab emtansine (TDM-1; Kadcyla®), mirvetuximab soravtansine (IMGN853) or anetumab ravtansine
  • the immunotherapy includes blinatumomab (AMG103; Blincyto®) or midostaurin (Rydapt).
  • the immunotherapy includes a toxin. In some embodiments, the immunotherapy is denileukin diftitox (Ontak®).
  • the immunotherapy is a cytokine therapy.
  • the cytokine therapy is an interleukin 2 (IL-2) therapy, an interferon alpha (IFN ⁇ ) therapy, a granulocyte colony stimulating factor (G-CSF) therapy, an interleukin 12 (IL-12) therapy, an interleukin 15 (IL-15) therapy, an interleukin 7 (IL-7) therapy or an erythropoietin-alpha (EPO) therapy.
  • the IL-2 therapy is aldesleukin (Proleukin®).
  • the IFN ⁇ therapy is IntronA® (Roferon-A®).
  • the G-CSF therapy is filgrastim (Neupogen®).
  • the immunotherapy is an immune checkpoint inhibitor. In some embodiments, the immunotherapy includes one or more immune checkpoint inhibitors. In some embodiments, the immune checkpoint inhibitor is a CTLA-4 inhibitor, a PD-1 inhibitor or a PD-L1 inhibitor. In some embodiments, the CTLA-4 inhibitor is ipilimumab (Yervoy®) or tremelimumab (CP-675,206). In some embodiments, the PD-1 inhibitor is pembrolizumab (Keytruda®) or nivolumab (Opdivo®). In some embodiments, the PD-L1 inhibitor is atezolizumab (Tecentriq®), avelumab (Bavencio®) or durvalumab (ImfinziTM).
  • the immunotherapy is mRNA-based immunotherapy.
  • the mRNA-based immunotherapy is CV9104 (see, e.g., Rausch et al. (2014) Human Vaccin Immunother 10(11): 3146-52; and Kubler et al. (2015) J. Immunother Cancer 3:26).
  • the immunotherapy is bacillus Calmette-Guerin (BCG) therapy.
  • the immunotherapy is an oncolytic virus therapy.
  • the oncolytic virus therapy is talimogene alherparepvec (T-VEC; Imlygic®).
  • the immunotherapy is a cancer vaccine.
  • the cancer vaccine is a human papillomavirus (HPV) vaccine.
  • the HPV vaccine is Gardasil®, Gardasil9® or Cervarix®.
  • the cancer vaccine is a hepatitis B virus (HBV) vaccine.
  • the HBV vaccine is Engerix-B®, Recombivax HB® or GI-13020 (Tarmogen®).
  • the cancer vaccine is Twinrix® or Pediarix®.
  • the cancer vaccine is BiovaxID®, Oncophage®, GVAX, ADXS11-001, ALVAC-CEA, PROSTVAC®, Rindopepimut®, CimaVax-EGF, lapuleucel-T (APC8024; NeuvengeTM), GRNVAC1, GRNVAC2, GRN-1201, hepcortespenlisimut-L (Hepko-V5), DCVAX®, SCIB1, BMT CTN 1401, PrCa VBIR, PANVAC, ProstAtak®, DPX-Survivac, or viagenpumatucel-L (HS-110).
  • the immunotherapy is a peptide vaccine.
  • the peptide vaccine is nelipepimut-S(E75) (NeuVaxTM), IMA901, or SurVaxM (SVN53-67).
  • the cancer vaccine is an immunogenic personal neoantigen vaccine (see, e.g., Ott et al. (2017) Nature 547: 217-221; Sahin et al. (2017) Nature 547: 222-226).
  • the cancer vaccine is RGSH4K, or NEO-PV-01.
  • the cancer vaccine is a DNA-based vaccine.
  • the DNA-based vaccine is a mammaglobin-A DNA vaccine (see, e.g., Kim et al. (2016) Oncolmmunology 5(2): e1069940).
  • immune-targeted agents are selected from aldesleukin, interferon alfa-2b, ipilimumab, lambrolizumab, nivolumab, prednisone, and sipuleucel-T.
  • Non-limiting examples of radiotherapy include radioiodide therapy, external-beam radiation, and radium 223 therapy.
  • Additional kinase inhibitors include those described in, for example, U.S. Pat. Nos. 7,514,446; 7,863,289; 8,026,247; 8,501,756; 8,552,002; 8,815,901; 8,912,204; 9,260,437; 9,273,051; U.S. Publication No. US 2015/0018336; International Publication No.
  • kinase inhibitors include those described in, for example, WO 2016/081450; WO 2016/022569; WO 2016/011141; WO 2016/011144; WO 2016/011147; WO 2015/191667; WO 2012/101029; WO 2012/113774; WO 2015/191666; WO 2015/161277; WO 2015/161274; WO 2015/108992; WO 2015/061572; WO 2015/058129; WO 2015/057873; WO 2015/017528; WO/2015/017533; WO 2014/160521; and WO 2014/011900, each of which is hereby incorporated by reference in its entirety.
  • a kinase inhibitor as provided herein may have activity against more than one kinase (i.e. may be a multikinase inhibitor).
  • a mechanism of action e.g., ROS1, ALK, or TRK kinase inhibition
  • each of the compounds recited are structurally distinct from one another (e.g., the ROS1 inhibitor and the TRK inhibitor are not the same compound).
  • a method of treating cancer comprising administering to a patient in need thereof a pharmaceutical combination for treating cancer which comprises (a) a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, (b) an additional therapeutic agent, and (c) optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use for the treatment of cancer, wherein the amounts of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof and the additional therapeutic agent are together effective in treating the cancer.
  • additional therapeutic agents may be administered with one or more doses of the compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, or pharmaceutical composition thereof, as part of the same or separate dosage forms, via the same or different routes of administration, and/or on the same or different administration schedules according to standard pharmaceutical practice known to one skilled in the art.
  • a pharmaceutical combination for treating a cancer in a patient in need thereof which comprises (a) a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, (b) at least one additional therapeutic agent (e.g., any of the exemplary additional therapeutic agents described herein or known in the art), and (c) optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use for the treatment of cancer, wherein the amounts of the compound of Formula I or pharmaceutically acceptable salt or solvate thereof and of the additional therapeutic agent are together effective in treating the cancer; (ii) a pharmaceutical composition comprising such a combination; (iii) the use of such a combination for the preparation of a medicament for the treatment of cancer; and (iv) a commercial package or product comprising such a combination as a combined preparation for simultaneous, separate or sequential use; and to a method of treatment of cancer in a patient in need thereof.
  • the patient is a human.
  • the cancer is a ROS1-associated cancer
  • pharmaceutical combination refers to a pharmaceutical therapy resulting from the mixing or combining of more than one active ingredient and includes both fixed and non-fixed combinations of the active ingredients.
  • fixed combination means that a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof and at least one additional therapeutic agent (e.g., a chemotherapeutic agent), are both administered to a patient simultaneously in the form of a single composition or dosage.
  • non-fixed combination means that a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof and at least one additional therapeutic agent (e.g., chemotherapeutic agent) are formulated as separate compositions or dosages such that they may be administered to a patient in need thereof simultaneously, concurrently or sequentially with variable intervening time limits (e.g., 1 hour, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months), wherein such administration provides effective levels of the two or more compounds in the body of the patient.
  • variable intervening time limits e.g., 1 hour, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months
  • a method of treating a cancer comprising administering to a patient in need thereof a pharmaceutical combination for treating cancer which comprises (a) a compound of Formula I or pharmaceutically acceptable salt or solvate thereof, (b) an additional therapeutic agent, and (c) optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use for the treatment of cancer, wherein the amounts of the compound of Formula I or pharmaceutically acceptable salt or solvate thereof and the additional therapeutic agent are together effective in treating the cancer.
  • the compound of Formula I or pharmaceutically acceptable salt or solvate thereof, and the additional therapeutic agent are administered simultaneously as separate dosages.
  • the compound of Formula I or pharmaceutically acceptable salt or solvate thereof, and the additional therapeutic agent are administered as separate dosages sequentially in any order, in jointly therapeutically effective amounts, e.g. in daily or intermittently dosages.
  • the compound of Formula I or pharmaceutically acceptable salt or solvate thereof, and the additional therapeutic agent are administered simultaneously as a combined dosage.
  • the cancer is a ROS1-associated cancer.
  • a ROS1-associated cancer having one or more ROSlinhibitor resistance mutations.
  • the disease or disorder mediated by ROS1 is a dysregulation of ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • a disease or disorder mediated by ROS1 can include any disease, disorder or condition that is directly or indirectly linked to expression or activity of ROS1, including overexpression and/or abnormal activity levels.
  • the disease is cancer (e.g., a ROS1-associated cancer).
  • the cancer is any of the cancers or ROS1-associated cancers described herein.
  • tumorigenesis may vary between different cancer types, the cellular and molecular mechanisms required for metastasis appear to be similar for all solid tumor types.
  • the cancer cells lose growth inhibitory responses, undergo alterations in adhesiveness and produce enzymes that can degrade extracellular matrix components. This leads to detachment of tumor cells from the original tumor, infiltration into the circulation through newly formed vasculature, migration and extravasation of the tumor cells at favorable distant sites where they may form colonies.
  • a number of genes have been identified as being promoters or suppressors of metastasis.
  • the method comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof.
  • Such methods can be used in the treatment of one or more of the cancers described herein. See, e.g., US Publication No. 2013/0029925; International Publication No. WO 2014/083567; and U.S. Pat. No. 8,568,998.
  • the cancer is a ROS1-associated cancer.
  • the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is used in combination with an additional therapy or another therapeutic agent, including a chemotherapeutic agent, such as a kinase inhibitor, for example, a first or second ROS1 kinase inhibitor.
  • a chemotherapeutic agent such as a kinase inhibitor, for example, a first or second ROS1 kinase inhibitor.
  • tumor is an art known term and means the formation of an additional tumor (e.g., a solid tumor) at a site distant from a primary tumor in a subject or patient, where the additional tumor includes the same or similar cancer cells as the primary tumor.
  • additional tumor e.g., a solid tumor
  • Also provided are methods of decreasing the risk of developing a metastasis or an additional metastasis in a patient having a ROS1-associated cancer that include: selecting, identifying, or diagnosing a patient as having a ROS1-associated cancer, and administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to the patient selected, identified, or diagnosed as having a ROS1-associated cancer. Also provided are methods of decreasing the risk of developing a metastasis or an additional metastasis in a patient having a ROS1-associated cancer that includes administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvent thereof to a patient having a ROS1-associated cancer.
  • the decrease in the risk of developing a metastasis or an additional metastasis in a patient having a ROS1-associated cancer can be compared to the risk of developing a metastasis or an additional metastasis in the patient prior to treatment, or as compared to a patient or a population of patients having a similar or the same ROS1-associated cancer that has received no treatment or a different treatment.
  • the ROS1-associated cancer is a ROS1-associated cancer having one or more ROSlinhibitor resistance mutations.
  • risk of developing a metastasis means the risk that a subject or patient having a primary tumor will develop an additional tumor (e.g., a solid tumor) at a site distant from a primary tumor in a subject or patient over a set period of time, where the additional tumor includes the same or similar cancer cells as the primary tumor.
  • additional tumor e.g., a solid tumor
  • risk of developing additional metastases means the risk that a subject or patient having a primary tumor and one or more additional tumors at sites distant from the primary tumor (where the one or more additional tumors include the same or similar cancer cells as the primary tumor) will develop one or more further tumors distant from the primary tumor, where the further tumors include the same or similar cancer cells as the primary tumor. Methods for reducing the risk of developing additional metastasis are described herein.
  • the presence of one or more ROS1 inhibitor resistance mutations in a tumor causes the tumor to be more resistant to treatment with a first ROS1 inhibitor.
  • Methods useful when a ROS1 inhibitor resistance mutation causes the tumor to be more resistant to treatment with a first ROS1 inhibitor are described below.
  • methods of treating a subject having a cancer that include: identifying a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations; and administering to the identified subject a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is administered in combination with the first ROS1 inhibitor.
  • the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is administered in combination with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • methods for treating a ROS1-associated cancer in a subject in need of such treatment comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I selected from Example No.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof selected from the group consisting of a compound of Formula I selected from Example No.
  • a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROSlin a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof selected from the group consisting of a compound of Formula I selected from Example No.
  • methods for treating a ROS1-associated cancer in a subject in need of such treatment comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more of the point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the second ROS1 inhibitor is selected from the group consisting of alectinib
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the second ROS1 inhibitor is selected from the group consisting of alectinib
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more of the point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the second ROS1 inhibitor is selected from the group consisting of alect
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations.
  • another anticancer agent e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof
  • anticancer therapy e.g., surgery or radiation
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations.
  • another anticancer agent e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof
  • anticancer therapy e.g., surgery or radiation
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more ROS1 fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more of the point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof selected from the group consisting of a compound of Formula I selected from Example No.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations.
  • another anticancer agent e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof
  • anticancer therapy e.g., surgery or radiation
  • a second ROS1 inhibitor selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib is administered in step (d).
  • provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations.
  • another anticancer agent e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof
  • anticancer therapy e.g., surgery or radiation
  • a second ROS1 inhibitor selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib is administered in step (d).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include: identifying a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations; and selecting a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with a first ROS1 inhibitor.
  • the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is administered in combination with the first ROS1 inhibitor.
  • Also provided are methods of selecting a treatment for a subject having a cancer that include: selecting a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for a subject identified as having a cancer cell that has one or more ROS1 inhibitor resistance mutations. Also provided are methods of selecting a subject having a cancer for a treatment that does not include a first ROS1 inhibitor as a monotherapy that include: identifying a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations; and selecting the identified subject for a treatment that includes a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • Also provided are methods of selecting a subject having a cancer for a treatment that does not include a first ROS1 inhibitor as a monotherapy that include: selecting a subject identified as having a cancer cell that has one or more ROS1 inhibitor resistance mutations for a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of determining the likelihood that a subject having a cancer e.g., a ROS1-associated cancer
  • determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has a decreased likelihood of having a positive response (i.e. an increased likelihood of having a negative response) to treatment with a first ROS1 inhibitor as a monotherapy.
  • Also provided are methods of determining the likelihood that a subject having a cancer e.g., a ROS1-associated cancer
  • determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that a subject not having a cancer cell that has one or more ROS1 inhibitor resistance mutations has an increased likelihood of having a positive response to treatment with a first ROS1 inhibitor as a monotherapy as compared to a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations.
  • Also provided are methods of predicting the efficacy of treatment with a first ROS1 inhibitor as a monotherapy in a subject having cancer that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that treatment with a first ROS1 inhibitor as a monotherapy is less likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations.
  • Also provided are methods of predicting the efficacy of treatment with a first ROS1 inhibitor as a monotherapy in a subject having cancer that include: determining that treatment with a first ROS1 inhibitor as a monotherapy is less likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first ROS1 inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent (e.g., a second ROS1 inhibitor, an ALK inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor (e.g., a second ROS1 inhibitor).
  • another anticancer agent can be the first ROS1 inhibitor administered in step (a).
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2032, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first ALK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first ALK inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent (e.g., a second ALK inhibitor, a first ROS1 inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ALK inhibitor (e.g., a second ALK inhibitor).
  • another anticancer agent can be the first ALK inhibitor administered in step (a).
  • another anticancer agent can be another ROS1 inhibitor.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first TRK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first TRK inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent (e.g., a second TRK inhibitor, a first ROS1 inhibitor, an ALK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another TRK inhibitor (e.g., a second TRK inhibitor).
  • another anticancer agent can be the first TRK inhibitor administered in step (a).
  • another anticancer agent can be another ROS1 inhibitor.
  • the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same confers increased resistance to a cancer cell or tumor to treatment with the first TRK inhibitor.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first ROS1 inhibitor step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • Also provided are methods of treating a subject having a cancer e.g., a ROS1-associated cancer
  • a cancer e.g., a ROS1-associated cancer
  • methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor, has one or more ROS1 inhibitor resistance mutations; and (b) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • a cancer e.g., a ROS1-associated cancer
  • the subject can also be administered another anticancer agent (e.g., a second ROS1 inhibitor, an ALK inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent e.g., a second ROS1 inhibitor, an ALK inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor (e.g., a second ROS1 inhibitor).
  • another anticancer agent can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of treating a subject having a cancer e.g., a ROS1-associated cancer
  • a cancer e.g., a ROS1-associated cancer
  • methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell having one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ALK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • a cancer e.g., a ROS1-associated cancer
  • the subject can also be administered another anticancer agent (e.g., a second ALK inhibitor, a TRK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is can be another ALK inhibitor (e.g., a second ALK inhibitor).
  • another anticancer agent can be the first ALK inhibitor administered in step (a).
  • another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of treating a subject having a cancer e.g., a ROS1-associated cancer
  • a cancer e.g., a ROS1-associated cancer
  • methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and (b) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first TRK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • a cancer e.g., a ROS1
  • the subject can also be administered another anticancer agent (e.g., a second TRK inhibitor, an ALK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is can be another TRK inhibitor (e.g., a second TRK inhibitor).
  • another anticancer agent can be the first TRK inhibitor administered in step (a).
  • another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) administering a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) administering a ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ALK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be a ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent can be the first ALK inhibitor administered in step (a).
  • Also provided are methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and (b) administering a ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first TRK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the subject can also be administered another anticancer agent.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be a ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent can be the first TRK inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first ROS1 inhibitor of step (a) for the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the method can further include selecting doses of another anticancer agent for the subject.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor (e.g., a second ROS1 inhibitor).
  • another ROS1 inhibitor can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering a first ALK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first ALK inhibitor of step (a) for the subject if the subject has a cancer cell that does not have has one or more ROS1 inhibitor resistance mutations.
  • the method can further include selecting doses of another anticancer agent for the subject.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor.
  • another anticancer agent is the first ALK inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering one or more doses of a first TRK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first TRK inhibitor of step (a) for the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the method can further include selecting doses of another anticancer agent for the subject.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent can be another ROS1 inhibitor.
  • another anticancer agent is the first TRK inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first ROS1 inhibitor of step (a) for the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the method can further include selecting doses of another anticancer agent for the subject.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another ROS1 can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations; (b) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the method can further include selecting doses of another anticancer agent (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof) for the subject.
  • another anticancer agent e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is another ROS1 inhibitor (e.g., a second ROS1 inhibitor).
  • another ROS1 inhibitor can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first ALK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • a cancer e.g., a ROS1-associated cancer
  • the method can further include selecting doses of another anticancer agent (e.g., a second ALK inhibitor, a TRK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent e.g., a second ALK inhibitor, a TRK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is can be another ALK inhibitor (e.g., a second ALK inhibitor).
  • another anticancer agent can be the first ALK inhibitor administered in step (a).
  • another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of selecting a treatment for a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first TRK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • a cancer e.g., a ROS1-associated cancer
  • the method can further include selecting doses of another anticancer agent (e.g., a second TRK inhibitor, an ALK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another anticancer agent e.g., a second TRK inhibitor, an ALK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is can be another TRK inhibitor (e.g., a second TRK inhibitor).
  • another anticancer agent can be the first TRK inhibitor administered in step (a).
  • another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations; (b) selecting a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • the method can further include selecting doses of another anticancer agent (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof) for the subject.
  • another anticancer agent e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • another anticancer agent is any anticancer agent known in the art.
  • another anticancer agent is another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • another ROS1 can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of determining a subject's risk for developing a cancer that has some resistance to a first ROS1 inhibitor that include: determining whether a cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and identifying a subject having a cell that has one or more ROS1 inhibitor resistance mutations as having an increased likelihood of developing a cancer that has some resistance to the first ROS1 inhibitor. Also provided are methods of determining a subject's risk for developing a cancer that has some resistance to a first ROS1 inhibitor that include: identifying a subject having a cell that has one or more ROS1 inhibitor resistance mutations as having an increased likelihood of developing a cancer that has some resistance to the first ROS1 inhibitor.
  • Also provided are methods of determining the presence of a cancer that has some resistance to a first ROS1 inhibitor that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that the subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has a cancer that has some resistance to the first ROS1 inhibitor. Also provided are methods of determining the presence of a cancer that has some resistance to a first ROS1 inhibitor in a subject that include: determining that a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has a cancer that has some resistance to the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor.
  • the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4.
  • the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • a ROS1 inhibitor resistance mutation that confers increased resistance to a cancer cell or tumor to treatment with a first ROS1 inhibitor can be any of the ROS1 inhibitor resistance mutations listed in Table 4 (e.g., a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N).
  • Also provided are methods of determining the likelihood that a subject having a cancer will have a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that the subject having the cancer cell that has one or more ROS1 inhibitor resistance mutations has an increased likelihood of having a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy.
  • Also provided are methods of determining the likelihood that a subject having cancer will have a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy that include: determining that a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has an increased likelihood of having a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy.
  • Also provided are methods of predicting the efficacy of treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy in a subject having cancer that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy is likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations.
  • Also provided are methods of predicting the efficacy of treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy in a subject having cancer that include: determining that treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy is likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations.
  • Methods of determining the level of resistance of a cancer cell or a tumor to a ROS1 inhibitor can be determined using methods known in the art.
  • the level of resistance of a cancer cell to a ROS1 inhibitor can be assessed by determining the IC 50 of a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein or known in the art) on the viability of a cancer cell.
  • the level of resistance of a cancer cell to a ROS1 inhibitor can be assessed by determining the growth rate of the cancer cell in the presence of a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein).
  • the level of resistance of a tumor to a ROS1 inhibitor can be assessed by determining the mass or size of one or more tumors in a subject over time during treatment with a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein).
  • the level of resistance of a cancer cell or a tumor to a ROS1 inhibitor can be indirectly assessed by determining the activity of a ROS1 kinase including one or more of the ROS1 inhibitor resistance mutations (i.e., the same ROS1 kinase expressed in a cancer cell or a tumor in a subject).
  • the level of resistance of a cancer cell or tumor having one or more ROS1 inhibitor resistance mutations to a ROS1 inhibitor is relative to the level of resistance in a cancer cell or tumor that does not have one or more ROS1 inhibitor resistance mutations (e.g., a cancer cell or tumor that does not have the same ROS1 inhibitor resistance mutations, a cancer cell or a tumor that does not have any ROS1 inhibitor resistance mutations, or a cancer cell or a tumor that expresses a wildtype ROS1 protein).
  • the determined level of resistance of a cancer cell or a tumor having one or more ROS1 inhibitor resistance mutations can be greater than about 1%, greater than about 2%, greater than about 3%,greater than about 4%, greater than about 5%, greater than about 6%, greater than about 7%, greater than about 8%, greater than about 9%, greater than about 10%, greater than about 11%, greater than about 12%, greater than about 13%, greater than about 14%, greater than about 15%, greater than about 20%, greater than about 25%, greater than about 30%, greater than about 35%, greater than about 40%, greater than about 45%, greater than about 50%, greater than about 60%, greater than about 70%, greater than about 80%, greater than about 90%, greater than about 100%, greater than about 110%, greater than about 120%, greater than about 130%, greater than about 140%, greater than about 150%, greater than about 160%, greater than about 170%, greater than about 180%, greater than about 190%, greater than about 200%, greater than about 210%, greater than about 220%, greater
  • Also provided is a method for inhibiting ROS1 kinase activity in a cell comprising contacting the cell with a compound of Formula I.
  • the contacting is in vitro.
  • the contacting is in vivo.
  • the contacting is in vivo, wherein the method comprises administering an effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to a subject having a cell having ROS1 kinase activity.
  • the cell is a cancer cell.
  • the cancer cell is any cancer as described herein.
  • the cancer cell is a ROS1-associated cancer cell.
  • a method for inhibiting ROS1 kinase activity in a mammalian cell comprising contacting the cell with a compound of Formula I.
  • the contacting is in vitro.
  • the contacting is in vivo.
  • the contacting is in vivo, wherein the method comprises administering an effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to a mammal having a cell having ROSlkinase activity.
  • the mammalian cell is a mammalian cancer cell.
  • the mammalian cancer cell is any cancer as described herein.
  • the mammalian cancer cell is a ROS1-associated cancer cell.
  • contacting refers to the bringing together of indicated moieties in an in vitro system or an in vivo system.
  • “contacting” a ROS1 kinase with a compound provided herein includes the administration of a compound provided herein to an individual or patient, such as a human, having a ROS1 kinase, as well as, for example, introducing a compound provided herein into a sample containing a cellular or purified preparation containing the ROS1 kinase.
  • Also provided herein is a method of inhibiting cell proliferation, in vitro or in vivo, the method comprising contacting a cell with an effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, or a pharmaceutical composition thereof as defined herein
  • the phrase “effective amount” means an amount of compound that, when administered to a patient in need of such treatment, is sufficient to (i) treat a ROS1 kinase-associated disease or disorder, (ii) attenuate, ameliorate, or eliminate one or more symptoms of the particular disease, condition, or disorder, or (iii) delay the onset of one or more symptoms of the particular disease, condition, or disorder described herein.
  • the amount of a compound of Formula I that will correspond to such an amount will vary depending upon factors such as the particular compound, disease condition and its severity, the identity (e.g., weight) of the patient in need of treatment, but can nevertheless be routinely determined by one skilled in the art.
  • the compounds of Formula I can be administered in the form of pharmaceutical compositions.
  • These compositions can be prepared in a manner well known in the pharmaceutical art, and can be administered by a variety of routes, depending upon whether local or systemic treatment is desired and upon the area to be treated. Administration may be topical (including transdermal, epidermal, ophthalmic and to mucous membranes including intranasal, vaginal and rectal delivery), pulmonary (e.g., by inhalation or insufflation of powders or aerosols, including by nebulizer; intratracheal or intranasal), oral or parenteral.
  • Oral administration can include a dosage form formulated for once-daily or twice-daily (BID) administration.
  • Parenteral administration includes intravenous, intraarterial, subcutaneous, intraperitoneal intramuscular or injection or infusion; or intracranial, e.g., intrathecal or intraventricular, administration.
  • Parenteral administration can be in the form of a single bolus dose, or may be, for example, by a continuous perfusion pump.
  • Pharmaceutical compositions and formulations for topical administration may include transdermal patches, ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders. Conventional pharmaceutical carriers, aqueous, powder or oily bases, thickeners and the like may be necessary or desirable
  • compositions which contain, as the active ingredient, a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, in combination with one or more pharmaceutically acceptable carriers (excipients).
  • the composition is suitable for topical administration.
  • the active ingredient is typically mixed with an excipient, diluted by an excipient or enclosed within such a carrier in the form of, for example, a capsule, sachet, paper, or other container.
  • the excipient serves as a diluent, it can be a solid, semi-solid, or liquid material, which acts as a vehicle, carrier or medium for the active ingredient.
  • compositions can be in the form of tablets, pills, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments containing, for example, up to 10% by weight of the active compound, soft and hard gelatin capsules, suppositories, sterile injectable solutions, and sterile packaged powders.
  • the composition is formulated for oral administration.
  • the composition is formulated as a tablet or capsule.
  • compositions comprising a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof can be formulated in a unit dosage form, each dosage containing from about 5 to about 1,000 mg (1 g), more usually about 100 mg to about 500 mg, of the active ingredient.
  • unit dosage form refers to physically discrete units suitable as unitary dosages for human subjects and other patients, each unit containing a predetermined quantity of active material (i.e., a compound for Formula I as provided herein) calculated to produce the desired therapeutic effect, in association with a suitable pharmaceutical excipient.
  • the compositions provided herein contain from about 5 mg to about 50 mg of the active ingredient.
  • the active ingredient contains from about 5 mg to about 50 mg.
  • One having ordinary skill in the art will appreciate that this embodies compounds or compositions containing about 5 mg to about 10 mg, about 10 mg to about 15 mg, about 15 mg to about 20 mg, about 20 mg to about 25 mg, about 25 mg to about 30 mg, about 30 mg to about 35 mg, about 35 mg to about 40 mg, about 40 mg to about 45 mg, or about 45 mg to about 50 mg of the active ingredient.
  • compositions provided herein contain from about 50 mg to about 500 mg of the active ingredient.
  • the active ingredient contains from about 50 mg to about 500 mg of the active ingredient.
  • One having ordinary skill in the art will appreciate that this embodies compounds or compositions containing about 50 mg to about 100 mg, about 100 mg to about 150 mg, about 150 mg to about 200 mg, about 200 mg to about 250 mg, about 250 mg to about 300 mg, about 350 mg to about 400 mg, or about 450 mg to about 500 mg of the active ingredient.
  • the compositions provided herein contain from about 500 mg to about 1,000 mg of the active ingredient.
  • the active ingredient contains from about 500 mg to about 1,000 mg of the active ingredient.
  • this embodies compounds or compositions containing about 500 mg to about 550 mg, about 550 mg to about 600 mg, about 600 mg to about 650 mg, about 650 mg to about 700 mg, about 700 mg to about 750 mg, about 750 mg to about 800 mg, about 800 mg to about 850 mg, about 850 mg to about 900 mg, about 900 mg to about 950 mg, or about 950 mg to about 1,000 mg of the active ingredient.
  • the active compound may be effective over a wide dosage range and is generally administered in a pharmaceutically effective amount. It will be understood, however, that the amount of the compound actually administered will usually be determined by a physician, according to the relevant circumstances, including the condition to be treated, the chosen route of administration, the actual compound administered, the age, weight, and response of the individual patient, the severity of the patient's symptoms, and the like.
  • kits useful for example, in the treatment of RET-associated diseases or disorders, such as cancer or irritable bowel syndrome (IBS), which include one or more containers containing a pharmaceutical composition comprising a therapeutically effective amount of a compound provided herein.
  • kits can further include, if desired, one or more of various conventional pharmaceutical kit components, such as, for example, containers with one or more pharmaceutically acceptable carriers, additional containers, etc., as will be readily apparent to those skilled in the art.
  • Instructions, either as inserts or as labels, indicating quantities of the components to be administered, guidelines for administration, and/or guidelines for mixing the components, can also be included in the kit.
  • the potency of a compound inhibiting wild type and exemplary mutant ROS1 kinases was determined using CisBio's HTRF Kinease-TK assay technology.
  • the assays contained 5 nM wild type ROS1 (SignalChem—Cat. No. R14-11G), 5 nM G2032R ROS1 (SignalChem—Cat. No. R14-12BG), 5 nM L2026M ROS1 (Array Biopharma, p 1965), or 5 nM D2033N ROS1 (Array Biopharma, p 1994).
  • Each kinase is incubated with 250 nM TK-substrate biotin (CisBio, Cat. No.
  • 62TKOPEC and 1 mM ATP along with test compound in a buffer consisting of 25 mM MOPS [pH 7.4], 5 mM MgCl 2 , 0.005% Triton X-100, and 2% DMSO in a volume of 8 ⁇ L.
  • Compounds were prepared in a four-fold serial dilution in DMSO and added to the assay to give the appropriate final concentration. After a 120-minute incubation at 22° C., the reaction was quenched by adding 8 ⁇ L of quench solution containing 31.3 nM Sa-XL665 and 1 ⁇ TK-Ab-Cryptate in HTRF detection buffer (CisBio, Cat. No. 62TKOPEC).
  • Table 9 provides averaged IC 50 values for compounds tested in this assay.

Abstract

and pharmaceutically acceptable salts thereof, wherein ring A, ring B, W, m, D, R2, R2a, R3, R3a, and Z are as defined herein. The compounds and methods provided herein are useful in the treatment of cancer (e.g., ROS1-associated cancers as defined herein).

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • This application is a continuation of International Application No. PCT/US2018/022833, filed Mar. 16, 2018, which claims priority to U.S. Provisional Application No. 62/472,185, filed Mar. 16, 2017, the contents of which are incorporated by reference in their entirety herein.
    • TECHNICAL FIELD
  • Provided herein are compounds and pharmaceutical compositions comprising the compounds and the use of the compounds in therapy. More particularly, provided herein are certain macrocyclic compounds which exhibit ROS1 protein kinase inhibition, and which are useful in the treatment of cancer.
    • BACKGROUND
  • ROS1 is a receptor tyrosine kinase that is closely related to ALK, and, like ALK, it undergoes genomic rearrangement that creates fusion proteins in various cancers (Davies K D and Doebele R C (2013) Clin Cancer Res 19: 4040-4045). It is well established that these fusion proteins act as oncogenic drivers and that ROS1 inhibition is anti-proliferative in cells that express ROS1 fusions (Davies K D, Le A T, Theodoro M F, Skokan M C, Aisner D L, et al. (2012) Clin Cancer Res 18: 4570-4579). Thus, it appears that ROS1 targeted therapy will likely soon be the standard of care for this patient population. However, based on the experiences with other kinase inhibitors in various cancers, it is fully expected that acquired resistance to ROS1 inhibition will occur, and this will ultimately limit the treatment options for patients.
    • SUMMARY
  • It has now been found that macrocyclic compounds are inhibitors of ROS1 kinase, and are useful for treating various cancers. Compounds which are inhibitors of ROS1 may be useful in the treatment of multiple types of cancer including cancers exhibiting resistance to ROS1 inhibition.
  • Accordingly, in one aspect of the present disclosure, the methods provided include administration of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I
  • Figure US20190076436A1-20190314-C00002
  • or a pharmaceutically acceptable salt or solvate thereof, wherein ring A, ring B, W, m, D, R2, R2a, R3, R3a, and Z are as defined herein.
  • In some embodiments, a compound of Formula I has the general formula:
  • Figure US20190076436A1-20190314-C00003
  • or a pharmaceutically acceptable salt or solvate thereof, wherein ring A, W, m, R2, R2a, R3, and Z are as defined herein.
  • In some embodiments, the compound of Formula I is selected from the compounds of Table 1, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the compound of Formula I is selected from the group consisting of Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • Provided herein is a method for treating a cancer in a patient in need thereof, the method comprising:
      • (a) determining if the cancer is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and
      • (b) if the cancer is determined to be associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, administering to the patient a therapeutically effective amount of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • Provided herein is a method for treating a cancer in a patient in need thereof, the method comprising:
      • (a) detecting that the cancer is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and
      • (b) administering to the patient a therapeutically effective amount of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • Also provided herein is a method for treating cancer in a patient in need thereof, the method comprising administering to a patient identified or diagnosed as having a ROS1-associated cancer a therapeutically effective amount of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • In some embodiments of the present disclosure, a method of treating cancer in a patient in need thereof is provided. The method comprising:
      • (a) determining if the cancer in a patient is a ROS1-associated cancer; and
      • (b) administering to the patient determined to have a ROS1-associated cancer a therapeutically effective amount of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • In some embodiments of the present disclosure, a method of treating cancer in a patient in need thereof is provided. The method comprising:
      • (a) detecting that a cancer in a patient is a ROS1-associated cancer; and
      • (b) administering to the patient a therapeutically effective amount of a ROS1 inhibitor, wherein the ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • Further provided herein is a method of treating a subject having a cancer, wherein the method comprises:
      • (a) administering a first ROS1 inhibitor to the subject;
      • (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and
      • (c) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (d) administering additional doses of the first ROS1 inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • Also provided herein is a method of treating a subject having a cancer, wherein the method comprises:
      • (a) administering a first ALK inhibitor to the subject;
      • (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and
      • (c) administering a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (d) administering additional doses of the first ALK inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • In some embodiments, a method of treating a subject having a cancer is provided herein, wherein the method comprises:
      • (a) administering a first TRK inhibitor to the subject;
      • (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and
      • (c) administering a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (d) administering additional doses of the first TRK inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • Also provided herein is a method of treating a subject having a cancer, wherein the method comprises:
      • (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations that confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor that was previously administered to the subject; and
      • (b) administering a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations that confers increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor that was previously administered to the subject; or
      • (c) administering additional doses of the first ROS1 inhibitor to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations that confers increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor previously administered to the subject.
  • Further provided herein is a method of treating a subject having a cancer, wherein the method comprises:
      • (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and
      • (b) administering a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (c) administering additional doses of the first ALK inhibitor to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • In some embodiments, a method of treating a subject having a cancer is provided herein, wherein the method comprises:
      • (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor has one or more ROS1 inhibitor resistance mutations; and
      • (b) administering a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (c) administering additional doses of the first TRK inhibitor to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • Also provided herein is a method of treating a subject having a cancer, wherein the method comprises:
      • (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations that confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor previously administered to the subject; and
      • (b) administering a second ROS1 inhibitor to the subject as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations that confers increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor that was previously administered to the subject; or
      • (c) administering additional doses of the first ROS1 inhibitor that was previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations that confers increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor that was previously administered to the subject.
  • Further provided herein is a method of treating a subject having a cancer, wherein the method comprises:
      • (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered an ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and
      • (b) administering a ROS1 inhibitor to the subject as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (c) administering additional doses of the ALK inhibitor that was previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • In some embodiments, a method of treating a subject having a cancer is provided, wherein the method comprises:
      • (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a TRK inhibitor has one or more ROS1 inhibitor resistance mutations; and
      • (b) administering a ROS1 inhibitor to the subject as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or
      • (c) administering additional doses of the TRK inhibitor that was previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • Also provided herein is a method of treating a patient, the method comprising administering a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, to a patient having a clinical record that indicates that the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same.
  • Further provided herein is a method of selecting a treatment for a patient, the method comprising selecting a treatment comprising administration of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, for a patient identified or diagnosed as having a ROS1-associated cancer.
  • In some embodiments, provided herein is a method of selecting a treatment for a patient having a cancer, the method comprising:
      • (a) determining if the cancer in the patient is a ROS1-associated cancer; and
      • (b) selecting a treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, for a patient determined to have a ROS1-associated cancer.
  • Also provided herein is a method of selecting a patient for treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, the method comprising:
      • (a) identifying a patient having a ROS1-associated cancer; and
      • (b) selecting the patient for treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof.
  • Further provided herein is a method of selecting a patient having cancer for treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, the method comprising:
      • (a) determining if the cancer in the patient is a ROS1-associated cancer; and
      • (b) selecting a patient determined to have a ROS1-associated cancer for treatment including administration of a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof.
  • Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Methods and materials are described herein for use in the present invention; other, suitable methods and materials known in the art can also be used. The materials, methods, and examples are illustrative only and not intended to be limiting. All publications, patent applications, patents, sequences, database entries, and other references mentioned herein are incorporated by reference in their entirety. In case of conflict, the present specification, including definitions, will control.
  • Other features and advantages of the invention will be apparent from the following detailed description and figures, and from the claims.
    • DETAILED DESCRIPTION
  • Provided herein are methods for using compounds of the general Formula I containing a pyrazolo[1,5-a]pyrimidinyl ring and having the structure:
  • Figure US20190076436A1-20190314-C00004
  • or pharmaceutically acceptable salts or solvates thereof, wherein:
      • ring A is selected from rings A-1, A-2 and A-3 having the structures:
  • Figure US20190076436A1-20190314-C00005
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to ring B and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H, (1-3C)alkoxy or halogen;
      • ring B is selected from rings B-1 and B-2 having the structures:
  • Figure US20190076436A1-20190314-C00006
      • wherein the wavy line labeled 3 indicates the point of attachment to ring A and the wavy line labeled 4 indicates the point of attachment to the pyrazolo[1,5-a]pyrimidine ring of Formula I;
      • W is O, NH or CH2, wherein when ring A is A-2, then W is CH2;
      • m is 0, 1 or 2;
      • D is carbon;
      • R2 and R2a are independently H, F, (1-3 C)alkyl or OH, provided that R2 and R2a are not both OH;
      • R3 and R3a are independently H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • or D is carbon or nitrogen, R2 and R3 are absent and R2a and R3a together with the atoms to which they are attached form a 5-6 membered heteroaryl ring having 1-2 ring heteroatoms;
      • Z is *—NR4aC(═O)—, *—ONHC(═O)—, *—NR4bCH2— or *—OC(═O)—, wherein the asterisk indicates the point of attachment of Z to the carbon bearing R3;
      • R4a is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl) or dihydroxy(2-6C alkyl);
      • R4b is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl), dihydroxy(2-6C alkyl), (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar1C(O)—, HOCH2C(O)—, (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, Ar2(SO2)—, HO2CCH2— or (1-6C alkyl)NH(CO)—;
      • Ar1 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy;
      • Ar2 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy; and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments of Formula I, ring B is ring B-2 having the structure:
  • Figure US20190076436A1-20190314-C00007
      • D is carbon, R2 and R2a are independently (1-3 C)alkyl, and R3 and R3a are independently H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl, or
      • D is carbon or nitrogen, R2 and R3 are absent and R2a and R3a together with the atoms to which they are attached form a 5-6 membered heteroaryl ring having 1-2 ring heteroatoms.
  • In some embodiments of Formula I, ring A is ring A-1 having the structure
  • Figure US20190076436A1-20190314-C00008
      • wherein X, Y and R1 are as defined for Formula I. In some embodiments of Formula I, X is CH. In some embodiments, X is N. In some embodiments of Formula I, Y is F. In some embodiments, Y is H. In some embodiments of Formula I, R1 is H. In some embodiments, R1 is (1-3C)alkoxy. A particular example is methoxy. In some embodiments, R1 is halogen. In some embodiments, R1 is F.
  • Particular examples of ring A when represented by structure A-1 include the structures:
  • Figure US20190076436A1-20190314-C00009
  • In some embodiments, ring A is ring A-2 having the structure
  • Figure US20190076436A1-20190314-C00010
      • wherein Y is H or F. In some embodiments, Y is F. In some embodiments, Y is H. In some embodiments, R1 is H. In some embodiments, R1 is (1-3C)alkoxy. A particular example is methoxy. In some embodiments, R1 is halogen. In some embodiments, R1 is F.
  • Particular examples of ring A when represented by ring A-2 are the structures:
  • Figure US20190076436A1-20190314-C00011
  • In some embodiments of Formula I, ring A is ring A-3 having the structure
  • Figure US20190076436A1-20190314-C00012
      • wherein Y and R1 is as defined for Formula I. In some embodiments, Y is F. In some embodiments, Y is H. In some embodiments, R1 is H. In some embodiments, R1 is (1-3C)alkoxy. A particular example is methoxy. In some embodiments, R1 is halogen. In some embodiments, R1 is F.
  • Particular examples of ring A when represented by ring A-3 are the structures:
  • Figure US20190076436A1-20190314-C00013
  • In some embodiments of Formula I, W is O.
  • In some embodiments, W is NH.
  • In some embodiments, W is CH2.
  • In some embodiments of Formula I, D is carbon, R2 and R2a are independently H, F, (1-3 C)alkyl or OH (provided that R2 and R2a are not both OH), and R3 and R3a are independently H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl.
  • In some embodiments, R2 and R2a are independently H, F, methyl or OH, provided that R2 and R2a are not both OH.
  • In some embodiments, R2 and R2a are both H.
  • In some embodiments, R2 is H and R2a is F.
  • In some embodiments, R2 and R2a are both F.
  • In some embodiments, R2 is H and R2a is OH.
  • In some embodiments, R2 is H and R2a is methyl.
  • In some embodiments, R2 and R2a are both methyl.
  • In some embodiments, R3 and R3a are independently H, (1-3C)alkyl or hydroxy(1-3 C)alkyl.
  • In some embodiments, R3a is H. In some embodiments, R3 is H. In some embodiments, both R3 and R3a are H.
  • In some embodiments, R3a is (1-3C)alkyl. Examples include methyl, ethyl, propyl and isopropyl. In some embodiments, R3 is (1-3C)alkyl. Examples include methyl, ethyl, propyl and isopropyl.
  • In some embodiments, R3a is (1-3C)alkyl and R3 is H. In some embodiments, R3a is methyl and R3 is H.
  • In some embodiments, both R3a and R3 are (1-3C)alkyl. In some embodiments, R3a and R3a are both methyl.
  • In some embodiments, R3 is hydroxy(1-3C)alkyl. Examples include hydroxymethyl, 2-hydroxyethyl, 2-hydroxypropyl, and 3-hydroxypropyl. In some embodiments, R3 is hydroxymethyl, 2-hydroxyethyl, 2-hydroxypropyl, or 3-hydroxypropyl and R3a is H.
  • In some embodiments of Formula I, D is carbon or nitrogen, R2 and R3 are absent, and R2a and R3a together with the atoms to which they are attached form a 5-6 membered heteroaryl ring having 1-2 ring heteroatoms. In some embodiments, R2a and R3a together with the atoms to which they are attached form a 5-6 membered heteroaryl ring having 1-2 ring nitrogen atoms. Examples of heteroaryl rings include pyridyl and pyrazolyl rings. Specific examples of heteroaryl rings include the structures:
  • Figure US20190076436A1-20190314-C00014
  • In some embodiments, Z is *—NR4aC(═O)—.
  • In some embodiments, R4a is H.
  • In some embodiments, R4a is (1-6C)alkyl. Examples include methyl, ethyl, propyl, isopropyl, butyl, and isobutyl.
  • In some embodiments, R4a is fluoro(1-6C)alkyl. Examples include fluoromethyl and 2-fluoroethyl.
  • In some embodiments, R4a is difluoro(1-6C)alkyl. Example include difluoromethyl and 2,2-difluoroethyl.
  • In some embodiments, R4a is trifluoro(1-6C)alkyl. Examples include trifluoromethyl and 2,2,2-trifluoroethyl.
  • In some embodiments, R4a is hydroxy(1-6C alkyl). Examples include hydroxymethyl, 2-hydroxyethyl, 2-hydroxypropyl and 3-hydroxypropyl.
  • In some embodiments, R4a is dihydroxy(2-6C alkyl). An example includes 2,3-dihydroxypropyl.
  • In some embodiments, R4a is H or (1-6C)alkyl. In some embodiments, R4a is H or Me.
  • An example of Z when represented by *—NR4aC(═O)— is *—ONHC(═O)—.
  • In some embodiments, Z is *—NR4bCH2—.
  • In some embodiments, R4b is H.
  • In some embodiments, R4b is selected from (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, and trifluoro(1-6C)alkyl.
  • In some embodiments, R4b is (1-6C)alkyl. Examples include methyl, ethyl, propyl, isopropyl, butyl and tert-butyl. In some embodiments, R4b is methyl.
  • In some embodiments, R4b is fluoro(1-6C)alkyl. Examples include fluoromethyl and 2-fluoroethyl.
  • In some embodiments, R4b is difluoro(1-6C)alkyl. Example include difluoromethyl and 2,2-difluoroethyl.
  • In some embodiments, R4b is trifluoro(1-6C)alkyl. Examples include trifluoromethyl and 2,2,2-trifluoroethyl.
  • In some embodiments, R4b is selected from (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar1C(O)— and HOCH2C(O)—.
  • In some embodiments, R4b is (1-6C alkyl)C(O)—. Examples include CH3C(O)—, CH3CH2C(O)—, CH3CH2CH2C(O)—, and (CH3)2CHC(O)—. In some embodiments, R4 is CH3C(O)—.
  • In some embodiments, R4b is (3-6C cycloalkyl)C(O)—. Examples include cyclopropylC(O)—, cyclobutylC(O)—, cyclopentylC(O)— and cyclohexylC(O)—.
  • In some embodiments, R4b is Ar1C(O)—. An example is phenylC(O)—.
  • In some embodiments, R4b is HOCH2C(O)—.
  • In some embodiments, R4b is selected from (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, and Ar2(SO2)—.
  • In some embodiments, R4b is (1-6C alkyl)sulfonyl. Examples include methylsulfonyl, ethylsulfonyl and propylsulfonyl.
  • In some embodiments, R4b is (3-6C cycloalkyl)sulfonyl. Examples include cyclopropylsulfonyl, cyclobutylsulfonyl, cyclopentylsulfonyl and cyclohexylsulfonyl. In some embodiments, R4 is methylsulfonyl.
  • In some embodiments, R4b is Ar2(SO2)—. An example is phenylsulfonyl.
  • In some embodiments, R4b is HO2CCH2—.
  • In some embodiments, R4b is (1-6C alkyl)NH(CO)—. Examples include CH3NHC(O)—, CH3CH2NHC(O)—, CH3CH2CH2NHC(O)—, and (CH3)2CHNHC(O)—. In some embodiments, R4 is CH3NHC(O)—.
  • In some embodiments, R4b is selected from H, methyl, —C(O)CH3, methylsulfonyl, —C(O)CH2OH, —CH2COOH and —C(O)NHCH2CH3.
  • In some embodiments, Z is *—OC(═O)—.
  • In some embodiments of Formula I, ring B is ring B-1:
  • Figure US20190076436A1-20190314-C00015
      • where R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments, R5 and R6 are independently H, F, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl. In some embodiments, R5 is H and R6 is H, F, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments, R5 and R6 are independently H, F, OH, (1-3C)alkyl or hydroxy(1-3C)alkyl. In some embodiments, R5 is hydrogen and R6 is H, F, OH, (1-3C)alkyl or hydroxy(1-3C)alkyl.
  • In some embodiments, R5 and R6 are independently H, F, OH, methyl, ethyl, HOCH2— or HOCH2CH2—. In some embodiments, R5 is hydrogen and R6 is H, F, OH, methyl, ethyl, HOCH2— or HOCH2CH2—.
  • In some embodiments, R5 and R6 are independently H, F, or methyl. In some embodiments, R5 is H and R6 is H, F, or methyl.
  • In some embodiments, R5 is H and R6 is F.
  • In some embodiments, R5 is H and R6 is methyl.
  • In some embodiments, R5 and R6 are both H.
  • In some embodiments, R5 and R6 are both F.
  • In some embodiments, R5 and R6 are both methyl.
  • In some embodiments, ring B is ring B-1 which is optionally substituted with one or two substituents independently selected from OH and F, provided that two OH substituents are not on the same ring carbon atom.
  • Particular examples of ring B when represented by ring B-1 include the structures:
  • Figure US20190076436A1-20190314-C00016
  • In some embodiments of Formula I, ring B is ring B-2 having the formula:
  • Figure US20190076436A1-20190314-C00017
  • In some embodiments, m is 0.
  • In some embodiments, m is 1.
  • In some embodiments, m is 2.
  • Provided herein are compounds of the general Formula I or pharmaceutically acceptable salts or solvates thereof, wherein:
      • ring B is ring B-1:
  • Figure US20190076436A1-20190314-C00018
      • ring A is selected from rings A-1, A-2 and A-3 having the structures:
  • Figure US20190076436A1-20190314-C00019
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H, (1-3C)alkoxy or halogen;
      • W is O, NH or CH2, wherein when ring A is A-2, then W is CH2;
      • m is 0, 1 or 2;
      • D is carbon;
      • R2 and R2a are independently H, F, (1-3 C)alkyl or OH, provided that R2 and R2a are not both OH;
      • R3 and R3a are independently H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • or R2 and R3 are absent and R2a and R3a together with the atoms to which they are attached form a bivalent 5-6 membered heteroaryl ring having 1-2 ring nitrogen atoms;
      • Z is *—NR4aC(═O)—, *—ONHC(═O)—, *—NR4bCH2— or *—OC(═O)—, wherein the asterisk indicates the point of attachment of Z to the carbon bearing R3;
      • R4a is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl) or dihydroxy(2-6C alkyl);
      • R4b is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl), dihydroxy(2-6C alkyl), (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar1C(O)—, HOCH2C(O)—, (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, Ar2(SO2)—, HO2CCH2— or (1-6C alkyl)NH(CO)—;
      • Ar1 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy;
      • Ar2 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy; and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • Also provided herein are compounds of the general Formula IA
  • Figure US20190076436A1-20190314-C00020
      • or pharmaceutically acceptable salts or solvates thereof, wherein:
      • ring A is selected from rings A-1, A-2 and A-3 having the structures:
  • Figure US20190076436A1-20190314-C00021
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H, (1-3C)alkoxy or halogen;
      • W is O, NH or CH2, wherein when ring A is A-2, then W is CH2;
      • m is 0, 1 or 2;
      • R2 and R2a are independently H, F, or OH, provided that R2 and R2a are not both OH;
      • R3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, *—ONHC(═O)—, *—NR4bCH2— or *—OC(═O)—, wherein the asterisk indicates the point of attachment of Z to the carbon bearing R3;
      • R4a is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl) or dihydroxy(2-6C alkyl);
      • R4b is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl), dihydroxy(2-6C alkyl), (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar1C(O)—, HOCH2C(O)—, (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, Ar2(SO2)—, HO2CCH2— or (1-6C alkyl)NH(CO)—;
      • Ar1 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy;
      • Ar2 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy; and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-1 represented by the structure
  • Figure US20190076436A1-20190314-C00022
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H, (1-3C)alkyl, (1-3C)alkoxy or halogen;
      • W is O or NH;
      • m is 0, 1 or 2;
      • R2 and R2a are independently H, F, or OH, provided that R2 and R2a are not both OH;
      • R3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, *—ONHC(═O)—, or *—OC(═O)—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4a is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl) or dihydroxy(2-6C alkyl); and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments of Formula IA, X is N. In some embodiments, X is CH.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-2 represented by the structure
  • Figure US20190076436A1-20190314-C00023
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • Y is H or F;
      • R1 is H, (1-3C)alkyl, (1-3C)alkoxy or halogen;
      • m is 0, 1 or 2;
      • W is CH2;
      • m is 0, 1 or 2;
      • R2 and R2a are independently H, F, or OH, provided that R2 and R2a are not both OH;
      • R3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4a is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl) or dihydroxy(2-6C alkyl); and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-3 represented by the structure
  • Figure US20190076436A1-20190314-C00024
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • Y is H or F;
      • R1 is H, (1-3C)alkyl, (1-3C)alkoxy or halogen;
      • W is O;
      • m is 0, 1 or 2;
      • R2 and R2a are independently H, F, or OH, provided that R2 and R2a are not both OH;
      • R3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • Z is *—OC(═O)— or *—NR4aC(═O)—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4a is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl, hydroxy(1-6C alkyl) or dihydroxy(2-6C alkyl); and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-1 represented by the structure
  • Figure US20190076436A1-20190314-C00025
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H, (1-3C)alkyl, (1-3C)alkoxy or halogen;
      • W is O;
      • m is 0, 1 or 2;
      • R2 and R2a are independently H, F, or OH, provided that R2 and R2a are not both OH;
      • R3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl;
      • Z is *—NR4bCH2—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4b is H, (1-6C)alkyl, fluoro(1-6C)alkyl, difluoro(1-6C)alkyl, trifluoro(1-6C)alkyl (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar1C(O)—, HOCH2C(O)—, (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, Ar2(SO2)—, HO2CCH2— or (1-6C alkyl)NH(CO)—;
      • Ar1 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy;
      • Ar2 is phenyl optionally substituted with one or more substituents independently selected from halogen, (1-6C)alkyl, and (1-6C)alkoxy; and
      • R5 and R6 are independently H, halogen, OH, (1-6C)alkyl or hydroxy(1-6C)alkyl.
  • In some embodiments of general Formula IA,
      • ring A is selected from rings A-1, A-2 and A-3 having the structures:
  • Figure US20190076436A1-20190314-C00026
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H;
      • W is O or CH2, wherein when ring A is A-2, then W is CH2;
      • m is 0 or 1;
      • R2 and R2a are independently H, F, (1-3 C)alkyl, or OH, provided that R2 and R2a are not both OH;
      • R3 is H or (1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, *—NR4bCH2— or *—OC(═O)—, wherein the asterisk indicates the point of attachment of Z to the carbon bearing R3;
      • R4a is H;
      • R4b is (1-6C alkyl)C(O)—; and
      • R5 and R6 are independently H or halogen.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-1 represented by the structure
  • Figure US20190076436A1-20190314-C00027
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • X is N or CH;
      • Y is H or F;
      • R1 is H;
      • W is O or CH2;
      • m is 0 or 1;
      • R2 and R2a are independently H, F, (1-3 C)alkyl, or OH, provided that R2 and R2a are not both OH;
      • R3 is H or (1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4a is H; and
      • R5 and R6 are independently H or halogen.
  • In some embodiments of Formula IA where ring A is ring A-1, X is N. In some such embodiments of Formula IA where ring A is ring A-1, W is O. In some embodiments of Formula IA where ring A is ring A-1, W is CH2. In some embodiments of Formula IA where ring A is ring A-1, R2 and R2a are H. In some embodiments of Formula IA where ring A is ring A-1, R2 and R2a are independently F, (1-3 C)alkyl, or OH. In some embodiments of Formula IA where ring A is ring A-1, R3 is (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-1, R3 is H. In some embodiments of Formula IA where ring A is ring A-1, Z is *—NR4aC(═O)—. In some embodiments of Formula IA where ring A is ring A-1, R5 and R6 are H.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-2 represented by the structure
  • Figure US20190076436A1-20190314-C00028
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • Y is H or F;
      • R1 is H;
      • W is CH2;
      • m is 0 or 1;
      • R2 and R2a are independently H, F, (1-3 C)alkyl, or OH, provided that R2 and R2a are not both OH;
      • R3 is H or (1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4a is H; and
      • R5 and R6 are independently H or halogen.
  • In some embodiments of Formula IA where ring A is ring A-2, Y is F. In some embodiments of Formula IA where ring A is ring A-2, R2 and R2a are H. In some embodiments of Formula IA where ring A is ring A-2, R2 and R2a are independently H or (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-2, R3 is (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-2, R3 is H. In some embodiments of Formula IA where ring A is ring A-2, R5 and R6 are H.
  • In some embodiments, Formula IA includes compounds wherein:
      • ring A is ring A-3 represented by the structure
  • Figure US20190076436A1-20190314-C00029
      • wherein the wavy line labeled 1 indicates the point of attachment of ring A to the pyrrolidine ring of Formula I and the wavy line labeled 2 indicates the point of attachment of ring A to W;
      • Y is H or F;
      • R1 is H;
      • W is O;
      • m is 0 or 1;
      • R2 and R2a are independently H, F, (1-3 C)alkyl, or OH, provided that R2 and R2a are not both OH;
      • R3 is H or (1-3 C)alkyl;
      • Z is *—NR4aC(═O)—, wherein the asterisk indicates the point of attachment to the carbon bearing R3;
      • R4a is H; and
      • R5 and R6 are independently H or halogen.
  • In some embodiments of Formula IA where ring A is ring A-3, Y is F. In some embodiments of Formula IA where ring A is ring A-3, Y is H. In some embodiments of Formula IA where ring A is ring A-3, R2 and R2a are H. In some embodiments of Formula IA where ring A is ring A-3, R2 and R2a are independently H or (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-3, R3 is (1-3 C)alkyl. In some embodiments of Formula IA where ring A is ring A-3, R3 is H. In some embodiments of Formula IA where ring A is ring A-3, R5 and R6 are H.
  • It will be appreciated that certain compounds as provided herein may contain one or more centers of asymmetry and may therefore be prepared and isolated as a mixture of isomers such as a racemic or diastereomeric mixture, or in an enantiomerically or diastereomerically pure form. It is intended that all stereoisomeric forms of the compounds provided herein, including but not limited to, diastereomers, enantiomers and atropisomers, as well as mixtures thereof such as racemic mixtures, form part of the present disclosure.
  • In some embodiments, compounds of the general Formula I wherein Ring B is ring B-1 have the absolute configuration of Formula 1-a:
  • Figure US20190076436A1-20190314-C00030
  • In some embodiments, compounds of the general Formula I wherein Ring B is ring B-1 have the absolute configuration of Formula 1-b:
  • Figure US20190076436A1-20190314-C00031
  • In the structures shown herein, where the stereochemistry of any particular chiral atom is not specified, then all stereoisomers are contemplated and included as the compounds of the disclosure. Where stereochemistry is specified by a solid wedge or dashed line representing a particular configuration, then that stereoisomer is so specified and defined.
  • The terms “(1-3C)alkyl” and “(1-6C)alkyl” as used herein refer to saturated linear or branched-chain monovalent hydrocarbon radicals of one to three carbon atoms and one to six carbon atoms, respectively. Examples include, but are not limited to, methyl, ethyl, 1-propyl, isopropyl, 1-butyl, isobutyl, sec-butyl, tert-butyl, 2-methyl-2-propyl, pentyl, and hexyl.
  • The term “fluoro(1-6C)alkyl” as used herein refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms as defined herein, wherein one of the hydrogens is replaced by a fluorine atom.
  • The term “difluoro(1-6C)alkyl” as used herein refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms as defined herein, wherein two of the hydrogens are replaced by fluorine atoms.
  • The term “trifluoro(1-6C)alkyl” as used herein refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms as defined herein, wherein three of the hydrogens are replaced by fluorine atoms.
  • The term “hydroxy(1-6Calkyl) as used herein refers to saturated linear or branched-chain monovalent hydrocarbon radicals of one to six carbon atoms, wherein one of the hydrogens is replaced by a hydroxy (OH) group.
  • The term “dihydroxy(2-6C alkyl) as used herein refers to saturated linear or branched-chain monovalent hydrocarbon radicals of two to six carbon atoms as defined herein, wherein two of the hydrogens are replaced by hydroxy (OH) groups, provided the hydroxy groups are not on the same carbon atom.
  • The term “(1-6C alkyl)sulfonyl” as used herein refers to a (1-6C alkyl)SO2— group, wherein the radical is on the sulfur atom and the (1-6C alkyl) portion is as defined above. Examples include methylsulfonyl (CH3SO2—) and ethylsulfonyl (CH3CH2SO2—).
  • The term “(3-6C cycloalkyl)sulfonyl” as used herein refers to a (3-6C cycloalkyl)SO2— group, wherein the radical is on the sulfur atom. An example is cyclopropylsulfonyl.
  • The terms “(1-3C)alkoxy” and “(1-6C)alkoxy”, as used herein refer to saturated linear or branched-chain monovalent alkoxy radicals of one to three carbon atoms or one to six carbon atoms, respectively, wherein the radical is on the oxygen atom. Examples include methoxy, ethoxy, propoxy, isopropoxy, and butoxy.
  • The term “halogen” includes fluoro, chloro, bromo and iodo.
  • Non-limiting examples of the compounds of Formula I include those in Table 1.
  • TABLE 1
    Compound No. Compound Structure Compound Name
     1
    Figure US20190076436A1-20190314-C00032
         		(6R)-9-fluoro-2,11,15,19,20,23- hexaazapentacyclo[15.5.2.17,11.02,6.020,24] pentacosa-1(23),7,9,17(24),18,21- hexaene-16,25-dione
     2
    Figure US20190076436A1-20190314-C00033
         		(6R)-12-oxa-2,16,20,21,24,26- hexaazapentacyclo[16.5.2.17,11.02,6.021,25] hexacosa-1(24),7(26),8,10,18(25),19,22- heptaen-17-one
     3
    Figure US20190076436A1-20190314-C00034
         		(6R)-9-fluoro-13-oxa-2,11,17,21,22,25- hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
     4
    Figure US20190076436A1-20190314-C00035
         		(6R)-9-fluoro-15-hydroxy-13-oxa- 2,11,17,21,22,25- hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
     5
    Figure US20190076436A1-20190314-C00036
         		(6R,13S)-9-fluoro-13-hydroxy- 2,11,15,19,20,23-hexaazapentacyclo- [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-hexaene-16,25- dione
     5-B
    Figure US20190076436A1-20190314-C00037
         		(6R,13R)-9-fluoro-13-hydroxy- 2,11,15,19,20,23-hexaazapentacyclo- [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-heaene-16,25- dione
     6
    Figure US20190076436A1-20190314-C00038
         		(6R)-9-fluoro-15-hydroxy-13-oxa- 2,11,17,21,22,25-hexaazapentacyclo- [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7,9,11,19(26),20,23-heptaen-18- one
     7
    Figure US20190076436A1-20190314-C00039
         		(6R,15R)-9-fluoro-15-hydroxy-13-oxa- 2,11,17,21,22,25-hexaazapentacyclo- [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7,9,11,19(26),20,23-heptaen-18- one
     7-B
    Figure US20190076436A1-20190314-C00040
         		(6R,15S)-9-fluoro-15-hydroxy-13-oxa- 2,11,17,21,22,25-hexaazapentacyclo- [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7,9,11,19(26),20,23-heptaen-18- one
     8
    Figure US20190076436A1-20190314-C00041
         		(6R,13R)-9-fluoro-13-hydroxy- 2,11,15,19,20,23-hexaazapentacyclo- [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-hexaene-16,25- dione
     8-B
    Figure US20190076436A1-20190314-C00042
         		(6R,13S)-9-fluoro-13-hydroxy- 2,11,15,19,20,23-hexaazapentacyclo- [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-hexaene-16,25- dione
     9
    Figure US20190076436A1-20190314-C00043
         		(6R)-9-fluoro-13-oxa-2,11,16,20,21,24- hexaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    10
    Figure US20190076436A1-20190314-C00044
         		(6R)-9-fluoro-13-oxa-2,11,18,22,23,26- hexaazapentacyclo[18.5.2.02,6.07,12.023,27] heptacosa-1(26),7,9,11,20(27),21,24- heptaen-19-one
    11
    Figure US20190076436A1-20190314-C00045
         		(6R)-9-fluoro-2,11,16,20,21,24- hexaazapentacyclo[16.5.2.17,11.02,6.021,25] hexacosa-1(24),7,9,18(25),19,22- hexaene-17,26-dione
    12
    Figure US20190076436A1-20190314-C00046
         		(6R)-9-fluoro-2,11,13,16,20,21,24- heptaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    13
    Figure US20190076436A1-20190314-C00047
         		(6R)-9-fluoro-2,11,13,17,21,22,25- heptaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
    14
    Figure US20190076436A1-20190314-C00048
         		(6R)-9-fluoro-13,16-dioxa-22,11,20,21,24- pentaazapentacyclo[16.5.2.02,6.07,12.021,25]- pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    15
    Figure US20190076436A1-20190314-C00049
         		(6R)-9-fluoro-14-oxa-2,11,18,19,22- pentaazapentacyclo[14.5.2.17,11.02,6.019,23] tetracosa-1(22),7,9,16(23),17,20- hexaene-15,24-dione
    16
    Figure US20190076436A1-20190314-C00050
         		(6R)-9-fluoro-13,16-dioxa- 2,11,17,21,22,25- hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
    17
    Figure US20190076436A1-20190314-C00051
         		(6R,13R)-9,13-difluoro-2,11,15,19,20,23- hexaazapentacyclo[15.5.2.17,11.02,6.020,24] pentacosa-1(23),7,9,17(24),18,21- hexaene-16,25-dione
    17-B
    Figure US20190076436A1-20190314-C00052
         		(6R,13S)-9,13-difluoro-2,11,15,19,20,23- hexaazapentacyclo[15.5.2.17,11.02,6.020,24] pentacosa-1(23),7,9,17(24),18,21- hexaene-16,25-dione
    18
    Figure US20190076436A1-20190314-C00053
         		(6R)-9-fluoro-17-methyl-13-oxa- 2,11,17,21,22,25- hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
    19
    Figure US20190076436A1-20190314-C00054
         		(6R)-9,15,15-trifluoro-13-oxa- 2,11,17,21,22,25- hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
    20
    Figure US20190076436A1-20190314-C00055
         		(6R)-9-fluoro-13-oxa-2,17,21,22,25- pentaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaen-18-one
    21
    Figure US20190076436A1-20190314-C00056
         		(6R)-9-fluoro-13-oxa-2,16,20,21,24- pentaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaene
    22
    Figure US20190076436A1-20190314-C00057
         		1-[(6R)-9-fluoro-13-oxa-2,16,20,21,24- pentaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-16-yl]ethan-1-one
    23
    Figure US20190076436A1-20190314-C00058
         		1-[(6R)-9-fluoro-13-oxa-2,16,20,21,24- pentaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-16-yl]-2-hydroxyethan-1-one
    24
    Figure US20190076436A1-20190314-C00059
         		(6R)-9-fluoro-13-oxa-2,17,21,22,25- pentaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,11,19(26),20,23- heptaene
    25
    Figure US20190076436A1-20190314-C00060
         		(6R)-9-fluoro-16-methanesulfonyl-13- oxa-2,16,20,21,24- pentaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaene
    26
    Figure US20190076436A1-20190314-C00061
         		2-[(6R)-9-fluoro-13-oxa-2,16,20,21,24- pentaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-16-yl]acetic acid
    27
    Figure US20190076436A1-20190314-C00062
         		(6R)-9-fluoro-17-methanesulfonyl-13- oxa-2,17,21,22,25- pentaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23- heptaene
    28
    Figure US20190076436A1-20190314-C00063
         		(6R)-N-ethyl-9-fluoro-13-oxa- 2,17,21,22,25-pentaazapentacyclo 17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7,9,11,19(26),20,23-heptaene-17- carboxamide
    29
    Figure US20190076436A1-20190314-C00064
         		(6R)-N-ethyl-9-fluoro-13-oxa- 2,16,20,21,24-pentaazapentacyclo- [16.5.2.02,6.07,12.021,25]pentacosa- 1(24),7,9,11,18(25),19,22-heptaene-16- carboxamide
    30
    Figure US20190076436A1-20190314-C00065
         		(6S)-9-fluoro-4,13-dioxa- 2,11,17,21,22,25-hexaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaene- 3,18-dione
    31
    Figure US20190076436A1-20190314-C00066
         		(6S)-9-fluoro-4,13-dioxa- 2,11,16,20,21,24-hexaazapentacyclo [16.5.2.02,6.07,12.021,25]pentacosa- 1(24),7(12),8,10,18(25),19,22-heptaene- 3,17-dione
    32
    Figure US20190076436A1-20190314-C00067
         		(6R)-9-fluoro-2,11,16,20,21,24- hexaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    33
    Figure US20190076436A1-20190314-C00068
         		(6R)-9-fluoro-15-methyl- 2,11,16,20,21,24- hexaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    33-A
    Figure US20190076436A1-20190314-C00069
         		(6R,15S)-9-fluoro-15-methyl- 2,11,16,20,21,24- hexaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    33-B
    Figure US20190076436A1-20190314-C00070
         		(6R,15R)-9-fluoro-15-methyl- 2,11,16,20,21,24- hexaazapentacyclo[16.5.2.02,6.07,12.021,25] pentacosa-1(24),7,9,11,18(25),19,22- heptaen-17-one
    34
    Figure US20190076436A1-20190314-C00071
         		(6R,13R)-9-fluoro-13-methyl- 2,11,15,19,20,23-hexaazapentacyclo [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-hexaene-16,25- dione
    35
    Figure US20190076436A1-20190314-C00072
         		(6R,13S)-9-fluoro-13-methyl- 2,11,15,19,20,23-hexaazapentacyclo [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-hexaene-16,25- dione
    36
    Figure US20190076436A1-20190314-C00073
         		(6R)-9-fluoro-15,15-dimethyl-13-oxa- 2,11,17,21,22,25-hexaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7,9,11,19(26),20,23-heptaen-18- one
    37
    Figure US20190076436A1-20190314-C00074
         		(6R)-9-fluoro-15,15-dimethyl- 2,11,16,20,21,24-hexaazapentacyclo [16.5.2.02,6.07,12.021,25]pentacosa- 1(24),7,9,11,18(25),19,22-heptaen-17- one
    38
    Figure US20190076436A1-20190314-C00075
         		(6R)-9-fluoro-13-oxa- 2,11,16,17,21,25,26,29-octaazahexacyclo [21.5.2.02,6.07,12.016,20.026,30]triaconta- 1(29),7,9,11,17,19,23(30),24,27-nonaen- 22-one
    39
    Figure US20190076436A1-20190314-C00076
         		(6R)-9-fluoro-13-oxa- 2,11,19,21,25,26,29-heptaazahexacyclo [21.5.2.02,6.07,12.015,20.026,30]triaconta- 1(29),7,9,11,15(20),16,18,23(30),24,27- decaen-22-one
    40
    Figure US20190076436A1-20190314-C00077
         		(6R)-9-fluoro-13,13-dimethyl- 2,11,15,19,20,23-hexaazapentacyclo [15.5.2.17,11.02,6.020,24]pentacosa- 1(23),7,9,17(24),18,21-hexaene-16,25- dione
    41
    Figure US20190076436A1-20190314-C00078
         		(4R,6R,15S)-9-fluoro-4,15-dihydroxy- 13-oxa-2,17,21,22,25- pentaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaen- 18-one
    41-B
    Figure US20190076436A1-20190314-C00079
         		(4R,6S,15S)-9-fluoro-4,15-dihydroxy- 13-oxa-2,17,21,22,25- pentaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaen- 18-one
    42
    Figure US20190076436A1-20190314-C00080
         		(4R,6R)-9-fluoro-4-hydroxy-13-oxa- 2,17,21,22,25-pentaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaen- 18-one
    42-B
    Figure US20190076436A1-20190314-C00081
         		(4R,6S)-9-fluoro-4-hydroxy-13-oxa- 2,17,21,22,25-pentaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaen- 18-one
    43
    Figure US20190076436A1-20190314-C00082
         		(4R,6R)-9-fluoro-4-hydroxy-13-oxa- 2,16,20,21,24-pentaazapentacyclo [16.5.2.02,6.07,12.021,25]pentacosa- 1(24),7,9,11,18(25),19,22-heptaen-17- one
    43-B
    Figure US20190076436A1-20190314-C00083
         		(4R,6S)-9-fluoro-4-hydroxy-13-oxa- 2,16,20,21,24-pentaazapentacyclo [16.5.2.02,6.07,12.021,25]pentacosa- 1(24),7,9,11,18(25),19,22-heptaen-17- one
    44
    Figure US20190076436A1-20190314-C00084
         		(4R,6R,15R)-9-fluoro-4,15-dihydroxy- 13-oxa-2,17,21,22,25- pentaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaen- 18-one
    44-B
    Figure US20190076436A1-20190314-C00085
         		(4R,6S,15R)-9-fluoro-4,15-dihydroxy-13- oxa-2,17,21,22,25-pentaazapentacyclo [17.5.2.02,6.07,12.022,26]hexacosa- 1(25),7(12),8,10,19(26),20,23-heptaen- 18-one
    45
    Figure US20190076436A1-20190314-C00086
         		Diastereomer 1 and Diastereomer 2 of (15S)-4,4,9-trifluoro-15-hydroxy-13-oxa- 2,17,21,22,25- pentaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7(12),8,10,19(26),20,23- heptaen-18-one
  • It will also be appreciated that certain compounds of Formula I may be used as intermediates for the preparation of further compounds of Formula I.
  • The compounds of Formula I include salts thereof. In certain embodiments, the salts are pharmaceutically acceptable salts. In addition, the compounds of Formula I include other salts of such compounds which are not necessarily pharmaceutically acceptable salts, and which may be useful as intermediates for preparing and/or purifying compounds of Formula I and/or for separating enantiomers of compounds of Formula I.
  • The term “pharmaceutically acceptable” indicates that the substance or composition is compatible chemically and/or toxicologically, with the other ingredients comprising a formulation, and/or the mammal being treated therewith.
  • It will further be appreciated that the compounds of Formula I and their salts may be isolated in the form of solvates, and accordingly that any such solvate is included within the scope of the present disclosure.
  • The compounds provided herein may also contain unnatural proportions of atomic isotopes at one or more of the atoms that constitute such compounds. That is, an atom, in particular when mentioned in relation to a compound according to Formula I, comprises all isotopes and isotopic mixtures of that atom, either naturally occurring or synthetically produced, either with natural abundance or in an isotopically enriched form. For example, when hydrogen is mentioned, it is understood to refer to 1H, 2H, 3H or mixtures thereof; when carbon is mentioned, it is understood to refer to 11C, 12C, 13C, 14C or mixtures thereof; when nitrogen is mentioned, it is understood to refer to 13N, 14N, 15N or mixtures thereof; when oxygen is mentioned, it is understood to refer to 14O, 15O, 16O, 17O, 18O or mixtures thereof; and when fluoro is mentioned, it is understood to refer to 18F, 19F or mixtures thereof. The compounds provided herein therefore also comprise compounds with one or more isotopes of one or more atom, and mixtures thereof, including radioactive compounds, wherein one or more non-radioactive atoms has been replaced by one of its radioactive enriched isotopes. Radiolabeled compounds are useful as therapeutic agents, e.g., cancer therapeutic agents, research reagents, e.g., assay reagents, and diagnostic agents, e.g., in vivo imaging agents. All isotopic variations of the compounds of the present disclosure, whether radioactive or not, are intended to be encompassed within the scope of the present disclosure.
  • The compounds of Formula I or a salt thereof as defined herein can be prepared as described in U.S. Pat. No. 8,933,084, which is incorporated by reference in its entirety herein. For example, a process for preparing a compound of Formula I or a salt thereof as defined herein can include:
      • (a) for a compound of Formula I wherein Z is *—NHC(═O)—, and ring A, ring B, W, D, R2, R2a, R3, R3a and m are as defined for Formula I, cyclizing a corresponding compound having the formula II
  • Figure US20190076436A1-20190314-C00087
      • where P1 is H or a carboxyl protecting group, in the presence of a coupling reagent and a base; or
      • (b) for a compound of Formula I wherein W is O, ring A is formula A-1:
  • Figure US20190076436A1-20190314-C00088
      • X is N, and ring B, D, Z, Y, R1, R2, R2a, R3, R3a and m are as defined for Formula I, cyclizing a corresponding compound having the formula III
  • Figure US20190076436A1-20190314-C00089
      • where n is 1, 2, 3 or 4 and L1 is a leaving group or atom, in the presence of a base;
        or
      • (c) for a compound of Formula I wherein W is CH2, ring A is formula A-2:
  • Figure US20190076436A1-20190314-C00090
      • and ring B, Z, D, Y, R1, R2, R2a, R3, R3a and m are as defined for Formula I, cyclizing a corresponding compound having the formula IV
  • Figure US20190076436A1-20190314-C00091
      • where L2 is a leaving group or atom, in the presence of a base; or
      • (d) for a compound of Formula I wherein Z is *—NHC(═O)—, and ring A, ring B, W, D, R2, R2a, R3, R3a and m are as defined for Formula I, cyclizing a corresponding compound having the formula V
  • Figure US20190076436A1-20190314-C00092
      • in the presence of a base and a coupling reagent; or
      • (e) for a compound of Formula I wherein Z is *—NHCH2—, and ring A, ring B, W, D, R2, R2a, R3, R3a and m are as defined for Formula I, cyclizing a corresponding compound having the formula VI
  • Figure US20190076436A1-20190314-C00093
      • in the presence of a reducing agent; or
      • (f) for a compound of Formula I wherein Z is *—NHCH2—, and ring A, ring B, W, D, R2, R2a, R3, R3a and m are as defined for Formula I, cyclizing a corresponding compound having the formula VII
  • Figure US20190076436A1-20190314-C00094
      • in the presence of triphenylphosphine; or
      • (g) for a compound of Formula I wherein ring A, ring B, W, D, m, R2, R2a, R3, and R3a are as defined for Formula I, Z is *—NR4bCH2—, and R4b is (1-6C alkyl)C(O)—, (3-6C cycloalkyl)C(O)—, Ar1C(O)—, HOCH2C(O)—, (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, (1-6C alkyl)sulfonyl, (3-6C cycloalkyl)sulfonyl, or Ar2(SO2)—, coupling a corresponding compound having the formula VIII
  • Figure US20190076436A1-20190314-C00095
      • with a reagent having the formula (1-6C alkyl)C(O)-L3, (3-6C cycloalkyl)C(O)-L3, Ar1C(O)-L3, HOCH2C(O)-L3, (1-6C alkyl)(SO2)-L3, (3-6C cycloalkyl)(SO2)-L3, or Ar2(SO2)-L3, respectively, where L3 is a leaving atom, in the presence of a base; or
      • (h) for a compound of Formula I wherein ring A, ring B, W, D, R2, R2a, R3, R3a and m are as defined for Formula I, Z is *—NR4bCH2—, and R4b is (1-6C alkyl)NH(CO)—, reacting a compound having the formula VIII
  • Figure US20190076436A1-20190314-C00096
      • with a reagent having the formula (1-6C alkyl)N═C═O in the presence of a base; or
      • (i) for a compound of Formula I wherein R2 is F, R2a is H, and ring A, ring B, Z, W, D, R3, R3a, and m are as defined for Formula I, reacting a corresponding compound having the formula IX
  • Figure US20190076436A1-20190314-C00097
      • with a fluorination reagent;
      • (j) for a compound of Formula I wherein W is O, ring A is formula A-1,
  • Figure US20190076436A1-20190314-C00098
      • X is CH, and Y, R1, D, ring B, Z, R2, R2a, R3 and m are as defined for Formula I, cyclizing a corresponding compound having the formula X
  • Figure US20190076436A1-20190314-C00099
      • where n is 1, 2, 3 or 4 and L1 is a leaving group or atom, in the presence of a base; and
      • optionally removing any protecting groups and optionally preparing a salt thereof.
  • In some embodiments of the above-described methods (a)-(j), ring B is ring B-1 having the structure:
  • Figure US20190076436A1-20190314-C00100
  • D is carbon, R2 and R2a are independently H, F, (1-3 C)alkyl or OH (provided that R2 and R2a are not both OH), R3 is H, (1-3 C)alkyl or hydroxy(1-3 C)alkyl, and ring A, W, m, Z, Y, R3a, R5 and R6 are as defined for Formula I.
  • Referring to method (a), the cyclization may be performed using conventional amide bond formation conditions, for example by treating the carboxylic acid with an activating agent, followed by addition of the amine in the presence of a base. Suitable activating agents include EDCI, oxalyl chloride, thionyl chloride, HATU, and HOBt. Suitable bases include amine bases, for example triethylamine, diisopropylethylamine, pyridine, or excess ammonia. Suitable solvents include DCM, DCE, THF and DMF.
  • Referring to methods (b) and (c), the leaving atoms L1 and L2 may be, for example a halogen atom such as Br, Cl or I. Alternatively, L1 and L2 can be a leaving group, for example an arylsulfonyloxy group or an alkylsulfonyloxy group, such as a mesylate or a tosylate group. Suitable bases include alkali metal carbonates, such as sodium carbonate, potassium carbonate or cesium carbonate. Convenient solvents include aprotic solvents such as ethers (for example tetrahydrofuran or p-dioxane), DMF, or acetone. The reaction can be conveniently performed at elevated temperatures, for example 50-150° C., for example at 85° C.
  • Referring to method (d), suitable coupling reagents include HATU, HBTU, TBTU, DCC, DIEC, and any other amide coupling reagents well known to persons skilled in the art. Suitable bases include tertiary amine bases such as DIEA and triethylamine. Convenient solvents include DMF, THF, DCM and DCE.
  • Referring to method (e), suitable reducing agents include Me4N(OAc)3BH, Na(OAc)3BH and NaCNBH3. Suitable solvents include neutral solvents such as acetonitrile, THF and DCE. The reaction can be conveniently performed at ambient temperature.
  • Referring to method (f), in certain embodiments the triphenylphosphine reagent is used in the form of a polystyrene-bound PPh3 resin (sold as PS-PPh3 by Biotage Systems). The reaction is conveniently performed at ambient temperature. Suitable solvents include neutral solvents, for example DCM.
  • Referring to method (g), the leaving atom L3 may be a halogen, for example Cl or Br. Suitable bases include tertiary amine bases such as diisopropylethylamine and triethylamine. The reaction is conveniently performed at ambient temperature.
  • Referring to method (h), suitable bases include tertiary amine bases such as DIEA and triethylamine. The reaction is conveniently performed at ambient temperature.
  • Referring to method (i), the fluorination reagent may be, for example, bis(2-methoxyethyl)amino-sulfur trifluoride (Deoxo-Fluor™) or diethylaminosulfur trifluoride (DAST). Suitable solvents include dichloromethane, chloroform, dichloroethane, and toluene. The reaction is conveniently performed at ambient temperature.
  • Referring to method (j), base may be, for example, an alkali metal carbonate, such as for example sodium carbonate, potassium carbonate or cesium carbonate. Convenient solvents include aprotic solvents such as ethers (for example tetrahydrofuran or p-dioxane) or toluene. The reaction can be conveniently performed at a temperature between ambient temperature and reflux, for example at 85° C.
  • Amine groups in compounds described in any of the above methods may be protected with any convenient amine protecting group, for example as described in Greene & Wuts, eds., “Protecting Groups in Organic Synthesis”, 2nd ed. New York; John Wiley & Sons, Inc., 1991. Examples of amine protecting groups include acyl and alkoxycarbonyl groups, such as t-butoxycarbonyl (BOC), and [2-(trimethylsilyl)ethoxy]methyl (SEM). Likewise, carboxyl groups may be protected with any convenient carboxyl protecting group, for example as described in Greene & Wuts, eds., “Protecting Groups in Organic Synthesis”, 2nd ed. New York; John Wiley & Sons, Inc., 1991. Examples of carboxyl protecting groups include (1-6C)alkyl groups, such as methyl, ethyl and t-butyl. Alcohol groups may be protected with any convenient alcohol protecting group, for example as described in Greene & Wuts, eds., “Protecting Groups in Organic Synthesis”, 2nd ed. New York; John Wiley & Sons, Inc., 1991. Examples of alcohol protecting groups include benzyl, trityl, silyl ethers, and the like.
  • The ability of test compounds to act as ROS1 inhibitors may be demonstrated by the assay described in Example A. IC50 values are shown in Table 17.
  • In some embodiments, inhibition of L2026M is similar to, or better than, that observed for wild-type ROS1. For example, inhibition of L2026M is within about 2-fold (e.g., about 5-fold, about 7-fold, about 10-fold) of inhibition of wild-type ROS1 (i.e. the compounds are similarly potent against wild-type ROS1 and L2026M). In some embodiments, inhibition of L2026M is about the same as inhibition of wild-type ROS1. In some embodiments, inhibition of L2026M is about 2-fold, 3-fold, 4-fold, 5-fold, 6-fold, 7-fold, 8-fold, 9-fold, 10-fold, or greater than inhibition of wild-type ROS1. In some embodiments, selectivity for a wildtype or L2026M ROS1 kinase over another kinase is measured in an enzyme assay (e.g., an enzyme assay as provided herein). In some embodiments, the compounds provided herein exhibit selective cytotoxicity to ROS1-mutant cells.
  • In some embodiments, inhibition of D2033N is similar to, or better than, that observed for wild-type ROS1. In some embodiments, inhibition of D2033N is within about 2-fold (e.g., about 5-fold, about 7-fold, about 10-fold) of inhibition of wild-type ROS1 (i.e. the compounds are similarly potent against wild-type ROS1 and D2033N). In some embodiments, inhibition of D2033N is about the same as inhibition of wild-type ROS1. In some embodiments, inhibition of D2033N is about 2-fold, 3-fold, 4-fold, 5-fold, 6-fold, 7-fold, 8-fold, 9-fold, 10-fold, or greater than inhibition of wild-type ROS1. In some embodiments, selectivity for a wildtype or D2033N ROS1 kinase over another kinase is measured in an enzyme assay (e.g., an enzyme assay as provided herein). In some embodiments, the compounds provided herein exhibit selective cytotoxicity to ROS1-mutant cells.
  • Compounds of Formula I are useful for treating diseases and disorders which can be treated with a ROS1 kinase inhibitor, such as ROS1-associated diseases and disorders, e.g., proliferative disorders such as cancers, including hematological cancers and solid tumors.
  • As used herein, terms “treat” or “treatment” refer to therapeutic or palliative measures. Beneficial or desired clinical results include, but are not limited to, alleviation, in whole or in part, of symptoms associated with a disease or disorder or condition, diminishment of the extent of disease, stabilized (i.e., not worsening) state of disease, delay or slowing of disease progression, amelioration or palliation of the disease state (e.g., one or more symptoms of the disease), and remission (whether partial or total), whether detectable or undetectable. “Treatment” can also mean prolonging survival as compared to expected survival if not receiving treatment.
  • As used herein, the terms “subject,” “individual,” or “patient,” are used interchangeably, refers to any animal, including mammals such as mice, rats, other rodents, rabbits, dogs, cats, swine, cattle, sheep, horses, primates, and humans. In some embodiments, the patient is a human. In some embodiments, the subject has experienced and/or exhibited at least one symptom of the disease or disorder to be treated and/or prevented. In some embodiments, the subject has been identified or diagnosed as having a cancer with a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (a ROS1-associated cancer) (e.g., as determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit). In some embodiments, the assay is a liquid biopsy. In some embodiments, the subject has a tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (e.g., as determined using a regulatory agency-approved assay or kit). The subject can be a subject with a tumor(s) that is positive for a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (e.g., identified as positive using a regulatory agency-approved, e.g., FDA-approved, assay or kit). In some embodiments, the assay is a liquid biopsy. The subject can be a subject whose tumors have a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or a level of the same (e.g., where the tumor is identified as such using a regulatory agency-approved, e.g., FDA-approved, kit or assay). In some embodiments, the subject is suspected of having a ROS1-associated cancer. In some embodiments, the subject has a clinical record indicating that the subject has a tumor that has a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same (and optionally the clinical record indicates that the subject should be treated with any of the compositions provided herein). In some embodiments, the patient is a pediatric patient.
  • The term “pediatric patient” as used herein refers to a patient under the age of 21 years at the time of diagnosis or treatment. The term “pediatric” can be further be divided into various subpopulations including: neonates (from birth through the first month of life); infants (1 month up to two years of age); children (two years of age up to 12 years of age); and adolescents (12 years of age through 21 years of age (up to, but not including, the twenty-second birthday)). Berhman R E, Kliegman R, Arvin A M, Nelson W E. Nelson Textbook of Pediatrics, 15th Ed. Philadelphia: W.B. Saunders Company, 1996; Rudolph A M, et al. Rudolph's Pediatrics, 21st Ed. New York: McGraw-Hill, 2002; and Avery M D, First L R. Pediatric Medicine, 2nd Ed. Baltimore: Williams & Wilkins; 1994. In some embodiments, a pediatric patient is from birth through the first 28 days of life, from 29 days of age to less than two years of age, from two years of age to less than 12 years of age, or 12 years of age through 21 years of age (up to, but not including, the twenty-second birthday). In some embodiments, a pediatric patient is from birth through the first 28 days of life, from 29 days of age to less than 1 year of age, from one month of age to less than four months of age, from three months of age to less than seven months of age, from six months of age to less than 1 year of age, from 1 year of age to less than 2 years of age, from 2 years of age to less than 3 years of age, from 2 years of age to less than seven years of age, from 3 years of age to less than 5 years of age, from 5 years of age to less than 10 years of age, from 6 years of age to less than 13 years of age, from 10 years of age to less than 15 years of age, or from 15 years of age to less than 22 years of age.
  • In certain embodiments, compounds of Formula I are useful for preventing diseases and disorders as defined herein (for example, cancer). The term “preventing” as used herein means the prevention of the onset, recurrence or spread, in whole or in part, of the disease or condition as described herein, or a symptom thereof.
  • The term “ROS1-associated disease or disorder” as used herein refers to diseases or disorders associated with or having a dysregulation of a ROS1 gene, a ROS1 kinase (also called herein ROS1 kinase protein), or the expression or activity or level of any (e.g., one or more) of the same (e.g., any of the types of dysregulation of a ROS1 gene, a ROS1 kinase, a ROS1 kinase domain, or the expression or activity or level of any of the same described herein). A non-limiting example of a ROS1-associated disease or disorder includes cancer.
  • The term “ROS1-associated cancer” as used herein refers to cancers associated with or having a dysregulation of a ROS1 gene, a ROS1 kinase (also called herein ROS1 kinase protein), or expression or activity, or level of any of the same. Non-limiting examples of a ROS1-associated cancer are described herein.
  • The phrase “dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same” refers to a genetic mutation (e.g., a ROS1 gene translocation that results in the expression of a fusion protein, a deletion in a ROS1 gene that results in the expression of a ROS1 protein that includes a deletion of at least one amino acid as compared to the wild-type ROS1 protein, a mutation in a ROS1 gene that results in the expression of a ROS1 protein with one or more point mutations, or an alternative spliced version of a ROS1 mRNA that results in a ROS1 protein having a deletion of at least one amino acid in the ROS1 protein as compared to the wild-type ROS1 protein) or a ROS1 gene amplification that results in overexpression of a ROS1 protein or an autocrine activity resulting from the overexpression of a ROS1 gene in a cell that results in a pathogenic increase in the activity of a kinase domain of a ROS1 protein (e.g., a constitutively active kinase domain of a ROS1 protein) in a cell. As another example, a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same, can be a mutation in a ROS1 gene that encodes a ROS1 protein that is constitutively active or has increased activity as compared to a protein encoded by a ROS1 gene that does not include the mutation. For example, a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same, can be the result of a gene or chromosome translocation which results in the expression of a fusion protein that contains a first portion of ROS1 that includes a functional kinase domain, and a second portion of a partner protein that is not ROS1. In some examples, dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity or level of any of the same can be a result of a gene translocation of one ROS1 gene with another non-ROS1 gene. Non-limiting examples of fusion proteins are described in Table 2. Non-limiting examples of ROS1 kinase protein point mutations are described in Table 3 and Table 3a. Additional examples of ROS1 kinase protein mutations (e.g., point mutations) are ROS1 inhibitor resistance mutations. Non-limiting examples of ROS1 inhibitor resistance mutations are described in Table 4.
  • The term “wildtype” or “wild-type” when referring to a ROS1 nucleic acid or protein describes a nucleic acid (e.g., a ROS1 gene or a ROS1 mRNA) or protein (e.g., a ROS1 protein) that is found in a subject that does not have a ROS1-associated disease, e.g., a ROS1-associated cancer (and optionally also does not have an increased risk of developing a ROS1-associated disease and/or is not suspected of having a ROS1-associated disease), or is found in a cell or tissue from a subject that does not have a ROS1-associated disease, e.g., a ROS1-associated cancer (and optionally also does not have an increased risk of developing a ROS1-associated disease and/or is not suspected of having a ROS1-associated disease).
  • The term “regulatory agency” refers to a country's agency for the approval of the medical use of pharmaceutical agents with the country. For example, a non-limiting example of a regulatory agency is the U.S. Food and Drug Administration (FDA).
  • Provided herein is a method of treating cancer (e.g., a ROS1-associated cancer) in a patient in need of such treatment, the method comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof. For example, provided herein are methods for treating a ROS1-associated cancer in a patient in need of such treatment, the method comprising a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the patient; and b) administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more fusion proteins. Non-limiting examples of ROS1 gene fusion proteins are described in Table 2. In some embodiments, the fusion protein is one of SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more ROS1 kinase protein point mutations, insertions, and/or deletions. Non-limiting examples of ROS1 kinase protein point mutations are described in Table 3 and Table 3a. In some embodiments, the ROS1 kinase protein point mutations, insertions, and/or deletions are point mutations selected from the group consisting of A15G, R118N, G1025R, T1735M, R1948H, and R2072N. In some embodiments, a compound of Formula I is selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof.
  • In some embodiments of any of the methods or uses described herein, the cancer (e.g., ROS1-associated cancer) is a hematological cancer. In some embodiments of any of the methods or uses described herein, the cancer (e.g., ROS1-associated cancer) is a solid tumor. In some embodiments of any of the methods or uses described herein, the cancer (e.g., ROS1-associated cancer) is lung cancer (e.g., small cell lung carcinoma or non-small cell lung carcinoma), papillary thyroid cancer, medullary thyroid cancer, differentiated thyroid cancer, recurrent thyroid cancer, refractory differentiated thyroid cancer, lung adenocarcinoma, bronchioles lung cell carcinoma, multiple endocrine neoplasia type 2A or 2B (MEN2A or MEN2B, respectively), pheochromocytoma, parathyroid hyperplasia, breast cancer, colorectal cancer (e.g., metastatic colorectal cancer), papillary renal cell carcinoma, ganglioneuromatosis of the gastroenteric mucosa, inflammatory myofibroblastic tumor, or cervical cancer. In some embodiments of any of the methods or uses described herein, the cancer (e.g., ROS1-associated cancer) is selected from the group of: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), cancer in adolescents, adrenocortical carcinoma, anal cancer, appendix cancer, astrocytoma, atypical teratoid/rhabdoid tumor, basal cell carcinoma, bile duct cancer, bladder cancer, bone cancer, brain stem glioma, brain tumor, breast cancer, bronchial tumor, Burkitt lymphoma, carcinoid tumor, unknown primary carcinoma, cardiac tumors, cervical cancer, childhood cancers, chordoma, chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), chronic myeloproliferative neoplasms, colon cancer, colorectal cancer, craniopharyngioma, cutaneous T-cell lymphoma, bile duct cancer, ductal carcinoma in situ, embryonal tumors, endometrial cancer, ependymoma, esophageal cancer, esthesioneuroblastoma, Ewing sarcoma, extracranial germ cell tumor, extragonadal germ cell tumor, extrahepatic bile duct cancer, eye cancer, fallopian tube cancer, fibrous histiocytoma of bone, gallbladder cancer, gastric cancer, gastrointestinal carcinoid tumor, gastrointestinal stromal tumors (GIST), germ cell tumor, gestational trophoblastic disease, glioma, hairy cell tumor, hairy cell leukemia, head and neck cancer, heart cancer, hepatocellular cancer, histiocytosis, Hodgkin's lymphoma, hypopharyngeal cancer, intraocular melanoma, islet cell tumors, pancreatic neuroendocrine tumors, Kaposi sarcoma, kidney cancer, Langerhans cell histiocytosis, laryngeal cancer, leukemia, lip and oral cavity cancer, liver cancer, lung cancer, lymphoma, macroglobulinemia, malignant fibrous histiocytoma of bone, osteocarcinoma, melanoma, Merkel cell carcinoma, mesothelioma, metastatic squamous neck cancer, midline tract carcinoma, mouth cancer, multiple endocrine neoplasia syndromes, multiple myeloma, mycosis fungoides, myelodysplastic syndromes, myelodysplastic/myeloproliferative neoplasms, myelogenous leukemia, myeloid leukemia, multiple myeloma, myeloproliferative neoplasms, nasal cavity and paranasal sinus cancer, nasopharyngeal cancer, neuroblastoma, non-Hodgkin's lymphoma, non-small cell lung cancer, oral cancer, oral cavity cancer, lip cancer, oropharyngeal cancer, osteosarcoma, ovarian cancer, pancreatic cancer, papillomatosis, paraganglioma, paranasal sinus and nasal cavity cancer, parathyroid cancer, penile cancer, pharyngeal cancer, pheochromosytoma, pituitary cancer, plasma cell neoplasm, pleuropulmonary blastoma, pregnancy and breast cancer, primary central nervous system lymphoma, primary peritoneal cancer, prostate cancer, rectal cancer, renal cell cancer, retinoblastoma, rhabdomyosarcoma, salivary gland cancer, sarcoma, Sezary syndrome, skin cancer, small cell lung cancer, small intestine cancer, soft tissue sarcoma, squamous cell carcinoma, squamous neck cancer, stomach cancer, T-cell lymphoma, testicular cancer, throat cancer, thymoma and thymic carcinoma, thyroid cancer, transitional cell cancer of the renal pelvis and ureter, unknown primary carcinoma, urethral cancer, uterine cancer, uterine sarcoma, vaginal cancer, vulvar cancer, and Wilms' tumor.
  • In some embodiments, a hematological cancer (e.g., hematological cancers that are ROS1-associated cancers) is selected from the group consisting of leukemias, lymphomas (non-Hodgkin's lymphoma), Hodgkin's disease (also called Hodgkin's lymphoma), and myeloma, for instance, acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), acute promyelocytic leukemia (APL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), chronic myelomonocytic leukemia (CMML), chronic neutrophilic leukemia (CNL), acute undifferentiated leukemia (AUL), anaplastic large-cell lymphoma (ALCL), prolymphocytic leukemia (PML), juvenile myelomonocyctic leukemia (JMML), adult T-cell ALL, AML with trilineage myelodysplasia (AML/TMDS), mixed lineage leukemia (MLL), myelodysplastic syndromes (MDSs), myeloproliferative disorders (MPD), and multiple myeloma (MM). Additional examples of hematological cancers include myeloproliferative disorders (MPD) such as polycythemia vera (PV), essential thrombocytopenia (ET) and idiopathic primary myelofibrosis (IMF/IPF/PMF). In some embodiments, the hematological cancer (e.g., the hematological cancer that is a RET-associated cancer) is AML or CMML.
  • In some embodiments, the cancer (e.g., the ROS1-associated cancer) is a solid tumor. Examples of solid tumors (e.g., solid tumors that are ROS1-associated cancers) include, for example, thyroid cancer (e.g., papillary thyroid carcinoma, medullary thyroid carcinoma), lung cancer (e.g., lung adenocarcinoma, small-cell lung carcinoma), pancreatic cancer, pancreatic ductal carcinoma, breast cancer, colon cancer, colorectal cancer, prostate cancer, renal cell carcinoma, head and neck tumors, neuroblastoma, and melanoma. See, for example, Nature Reviews Cancer, 2014, 14, 173-186.
  • In some embodiments, the cancer is selected from the group consisting of lung cancer (including, e.g., non-small-cell lung cancer), colorectal cancer, gastric cancer, adenocarcinoma (including, e.g., small bowel adenocarcinoma), cholangiocarcinoma, glioblastoma, ovarian cancer, angiocarcinoma, congenital gliobastoma multiforme, papillary thyroid carcinoma, inflammatory myofibroblastic tumour, a spitzoid neoplasm, anaplastic large cell lymphoma, diffuse large B cell lymphoma, and B-cell acute lymphoblastic leukemia.
  • In some embodiments, the patient is a human.
  • Compounds of Formula I and pharmaceutically acceptable salts and solvates thereof are also useful for treating a ROS1-associated cancer.
  • Accordingly, also provided herein is a method for treating a patient diagnosed with or identified as having a ROS1-associated cancer, e.g., any of the exemplary ROS1-associated cancers disclosed herein, comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, or a pharmaceutical composition thereof as defined herein.
  • Dysregulation of a ROS1 kinase, a ROS1 gene, or the expression or activity or level of any (e.g., one or more) of the same can contribute to tumorigenesis. For example, a dysregulation of a ROS1 kinase, a ROS1 gene, or expression or activity or level of any of the same can be a translocation, overexpression, activation, amplification, or mutation of a ROS1 kinase, a ROS1 gene, or a ROS1 kinase domain. A translocation can include a translocation involving the ROS1 kinase domain, a mutation can include a mutation involving the ROS1 ligand-binding site, and an amplification can be of a ROS1 gene.
  • In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes overexpression of wild-type ROS1 kinase (e.g., leading to autocrine activation). In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same, includes overexpression, activation, amplification, or mutation in a chromosomal segment comprising the ROS1 gene or a portion thereof, including, for example, the kinase domain portion, or a portion capable of exhibiting kinase activity.
  • In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same, includes one or more chromosome translocations or inversions resulting in a ROS1 gene fusion. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same, is a result of genetic translocations in which the expressed protein is a fusion protein containing residues from a non-ROS1 partner protein, and includes a minimum of a functional ROS1 kinase domain.
  • Non-limiting examples of ROS1 fusion proteins are shown in Table 2.
  • TABLE 2
    Exemplary ROS1 Fusion Proteins
    CD74 Non-small-cell lung cancer1
    SLC34A2 including Non-small-cell lung cancer1, Colorectal
    SLC34A2-ROS(S)28, cancer14, Gastric cancer15, Lung
    SLC34A2-ROS(L)28, and adenocarcinoma24
    SLC34A2-ROS(VS)28,
    SLC34A2-ROS (with a
    breakpoint at chr6:
    117653720, chr4:
    25678781)24
    TPM3 Non-small-cell lung cancer1
    SDC4 Non-small-cell lung cancer1, Adenocarcinoma10
    EZR Non-small-cell lung cancer1
    LRIG3 Non-small-cell lung cancer1
    KDELR2 Non-small-cell lung cancer1
    CCDC6 Non-small-cell lung cancer1
    FIG (GOPC, PIST) Non-small-cell lung cancer2,
    including FIG-ROS1(L)29, Cholangiocarcinoma5, Glioblastoma8, Ovarian
    FIG-ROS1(S)29, and cancer16, Small bowel adenocarcinomas
    FIG-ROS1(VL)29, (SBAs)22, Acral lentiginous melanoma (ALM)25
    FIG-ROS1 (XL)30
    TPD52L1 Non-small-cell lung cancer3
    CEP85L Angiosarcoma4 Pediatric gliomas31
    ZCCHC8 Congenital gliobastoma multiforme6
    CCDC30 Papillary thyroid carcinoma7
    TFG Inflammatory myofibroblastic tumour9,
    Sarcomas26
    TMEM106B Adenocarcinoma11
    YWHAE Inflammatory myofibroblastic tumor12
    MSN Lung cancer13
    PWWP2A Spitzoid neoplasm17
    FYN Non-small-cell lung cancer18
    MKX Non-small-cell lung cancer18
    PPFIBP1 Spitzoid neoplasm19
    ERCl Spitzoid neoplasm19
    MY05A Spitzoid neoplasm19
    CLIP1 Spitzoid neoplasm19
    HLA-A Spitzoid neoplasm19
    KIAA1598 (SHTN1) Spitzoid neoplasm19
    ZCCHC8 Spitzoid neoplasm19
    CLTC Non-small-cell lung cancer20
    LIMA1 Non-small-cell lung cancer20
    NFkB2 Anaplastic Large Cell Lymphoma21
    NCOR2 Anaplastic Large Cell Lymphoma21
    KLC1 Pediatric low-grade glioma24
    TBL1XR1 Juvenile myelomonocytic leukemia (JMML)27
    1Davies and Dobele, Clin. Cancer Res, 19(15):4040-5, 2013.
    2Rimkunas et al., Clin. Cancer Res., 18:4449-58, 2012.
    3Zhu et al., Lung Cancer, 97:48-50, doi: 10.1016/j.lungcan.2016.04.013, 2012.
    4Giacomini et al., PLoS Gene.t, 9(4):e1003464, 2013.
    5Saborowski et al., Proc.Natl. Acad. Sci. U.S.A., 110(48):19513-19518, 2013.
    6Cocce et al., Genes Chromosomes Cancer, 55(9):677-87, 2016.
    7Ritterhouse et al., Thyroid, 26(6):794-7, 2016.
    8Das et al., Cancer Growth Metastasis, 8:51-60, doi: 10.4137/CGM.S32801, 2015.
    9Yamamoto et al., Histopathology, 69(1):72-83, 2016.
    10Fu et al., PLoS One, 10(4):e0124354, 2015.
    11Ou et al., Lung Cancer, 88(3):352-4, 2015.
    12Hornick et al., Mod. Pathol., 28(5):732-9, 2015.
    13Zheng et al.,Nat Med., (12):1479-84, 2014.
    14Aisner et al., Mol. Cancer Res., 12(1):111-8, 2014.
    15Lee et al., Cancer, 119(9):1627-1635, 2013.
    16Birch et al., PLoS One, 6(12):e28250, 2011.
    17Weisner et al., Nature Comm., 5:3116, doi:10.1038/ncomms4116, 2014.
    18U.S. Patent Application Publication No. 2016/0032396A1.
    19PCT Patent Application Publication No. WO 2014/130975A1.
    20Australian Patent Application Publication No. AU 2015/101722A4
    21Crescenzo et al., Cancer Cell., 27(4):516-32, 2015.
    22Schrock et al., Annals of Oncology. Vol. 27, Supp_6, 613O, 2016.
    24Nakano et al. Pediatr Blood Cancer. Vol. 64, S54-S55 Suppe. 4. O13-1-7, 2017.
    25Couts et al. Pigment Cell Melanoma Res. Vol. 30, No. 5, pp. e61, 2017.
    26Ikeda et al. Annals of Oncology. Vol. 28 (suppl_10): x1-x6. 10.1093/annonc/mdx652, 2017.
    27Murakami et al. Blood, blood-2017-07-798157; DOI: 10.1182/blood-2017-07-798157, 2018.
    28EP Patent Application Publication No. EP3266795A1
    29U.S. Patent Publication No. US9782400B2
    30PCT Patent Application Publication No. WO 2010/093928
    31Johnson et al., Oncologist. 22(12):1478-1490, doi:10.1634/theoncologist.2017-0242, 2017.
  • In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes one or more deletions, insertions, or point mutation(s) in a ROS1 kinase. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes a deletion of one or more residues from the ROS1 kinase, resulting in constitutive activity of the ROS1 kinase domain.
  • In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes at least one point mutation in a ROS1 gene that results in the production of a ROS1 kinase that has one or more amino acid substitutions, insertions, or deletions as compared to the wild-type ROS1 kinase (see, for example, the point mutations listed in Table 3).
  • TABLE 3
    Exemplary ROS1 Point Mutations
    ROS1 Mutation ROS1-Associated Cancer
    Amino acid position 15 Diffuse large B cell lymphoma1
    (e.g., A15G)
    Amino acid position 118 B-cell acute lymphoblastic
    (e.g., R118N) leukemia2
    Amino acid position 122 Gastrointestinal stromal tumors
    (e.g., A122T) (GISTs)3
    Amino acid position 245 Uterine Corpus Endometrioid
    (e.g., R245I) Carcinoma4
    Amino acid position 1025 B-cell acute lymphoblastic
    (e.g., G1025R) leukemia2
    Amino acid position 1186 Non-Small-Cell Lung Cancer5
    (e.g., S1186F)
    Amino acid position 1539 Skin Cutaneous Melanoma7
    (e.g., P1539S)
    Amino acid position 1735 B-cell acute lymphoblastic
    (e.g., T1735M) leukemia2
    Amino acid position 1948 Diffuse large B cell
    (e.g., R1948H) lymphoma1
    Amino acid position 2033 Colorectal adenocarcinoma6
    (e.g., D2033Y)
    Amino acid position 2072 B-cell acute lymphoblastic
    (e.g., R2072N) leukemia2
    Amino acid position 2126 Breast, melanoma6
    (e.g., R2126W, R2126Q,
    R2126L)
    Amino acid position 2308 Kidney renal clear cell
    (e.g., E2308, E2308Q) carcinoma, Skin cutaneous
    melanoma, Head and neck
    squamous cell carcinoma7
    1U.S. Patent Application Publication No. 2016/0032404A1.
    2de Smith et al., Oncotarget., doi: 10.18632/oncotarget. 12238, 2016.
    3Qiu et al., J. Clin. Oncol. 35:15_suppl, e22507-e22507, 2017.
    4PCT Patent Application Publication No. WO 2016/187508A2
    5Gainor et al., JCO Precis Oncol. 10.1200/PO.17.00063, 2017.
    6The Cancer Genome Atlas: http://cancergenome.nih.gov/
    7Wang, University of Hong Kong, Pokfulam, Hong Kong SAR (Thesis). Retrieved from http://dx.doi.org/10.5353/th_b5659723.
  • Additional exemplary ROS1 mutations are provided in Table 3a.
  • TABLE 3a
    Exemplary ROS1 Mutations
    Amino acid position 1186 (e.g., S1186F11)
    Amino acid position 1935 (e.g., E1935G610)
    Amino acid position 1945 (e.g., L1945Q7)
    Amino acid position 1946 (e.g., T1946S7)
    Amino acid position 1947 (e.g., L1947R6, 10, L1947M7)
    Amino acid position 1948 (e.g., R1948S7)
    Amino acid position 1951 (e.g., L1951R5, L1951V7)
    Amino acid position 1958 (e.g., E1958V7)
    Amino acid position 1959 (e.g., V1959E7)
    Amino acid position 1961 (e.g., E1961K7)
    Amino acid position 1962 (e.g., G1962E7)
    Amino acid position 1971 (e.g., G1971E6, 10)
    Amino acid position 1974 (e.g., E1974K9)
    Amino acid position 1981 (e.g., T1981M7)
    Amino acid position 1982 (e.g., L1982F5, 10, L1982R6)
    Amino acid position 1986 (e.g., S1986Y1, S1986F1)
    Amino acid position 1990 (e.g., E1990G5, E1990L7)
    Amino acid position 1993 (e.g., E1993K7)
    Amino acid position 1994 (e.g., F1994L5)
    Amino acid position 2000 (e.g., L2000V7)
    Amino acid position 2002 (e.g., S2002N7)
    Amino acid position 2004 (e.g., F2004L7, F2004I9,
    F2004V9, F2004C9)
    Amino acid position 2008 (e.g., N2008H7)
    Amino acid position 2009 (e.g., I2009L7)
    Amino acid position 2010 (e.g., L2010M7)
    Amino acid position 2011 (e.g., K2011N7)
    Amino acid position 2016 (e.g., C2016G7)
    Amino acid position 2019 (e.g., N2019D7, N2019Y7)
    Amino acid position 2020 (e.g., E2020k9)
    Amino acid position 2022 (e.g., Q2022H7)
    Amino acid position 2026 (e.g., L2026M3)
    Amino acid position 2028 (e.g., L2028M7)
    Amino acid position 2029 (e.g., M2029K7)
    Amino acid position 2030 (e.g., E2030K7)
    Amino acid position 2032 (e.g., G2032R2)
    Amino acid position 2033 (e.g., D2033G7, D2033N8)
    Amino acid position 2035 (e.g., L2035I7)
    Amino acid position 2036 (e.g., T2036I7, T2036N7)
    Amino acid position 2039 (e.g., R2039G7, R2039H7,
    R2039M7, R2039N7, R2039S7)
    Amino acid position 2040 (e.g., K2040E7, K2040Q7)
    Amino acid position 2052 (e.g., T2052S7)
    Amino acid position 2059 (e.g., L2059P7)
    Amino acid position 2060 (e.g., C2060G6, 10)
    Amino acid position 2075 (e.g., F2075C9, F2075I9, F2075V9)
    Amino acid position 2077 (e.g., H2077P7)
    Amino acid position 2078 (e.g., R2078W7)
    Amino acid position 2087 (e.g., V2087I7)
    Amino acid position 2091 (e.g., D2091N7)
    Amino acid position 2092 (e.g., Y2092N7)
    Amino acid position 2094 (e.g., S2094N7)
    Amino acid position 2098 (e.g., V2098I6, 10)
    Amino acid position 2099 (e.g., K2099N7)
    Amino acid position 2100 (e.g., I2100V7)
    Amino acid position 2101 (e.g., G2101A7)
    Amino acid position 2106 (e.g., A2106P7)
    Amino acid position 2107 (e.g., R2107T7)
    Amino acid position 2112 (e.g., N2112K9)
    Amino acid position 2113 (e.g., D2113N9 D2113G9)
    Amino acid position 2116 (e.g., R2116T7, R2116K9)
    Amino acid position 2125 (e.g., V2125G7, V2125L7)
    Amino acid position 2127 (e.g., W2127G7, W21279)
    Amino acid position 2128 (e.g., M2128T9)
    Amino acid position 2131 (e.g., E2131D7, E2131K7)
    Amino acid position 2134 (e.g., M2134I7)
    Amino acid position 2139 (e.g., T2139I7, T2139S7)
    Amino acid position 2141 (e.g., Q2141H7)
    Amino acid position 2142 (e.g., S2142Y7)
    Amino acid position 2148 (e.g., G2148E7)
    Amino acid position 2151 (e.g., I2151N7)
    Amino acid position 2154 (e.g., I2154M7)
    Amino acid position 2155 (e.g., L2155S4)
    Amino acid position 2160 (e.g., Q2160H7)
    Amino acid position 2165 (e.g., H2165D7)
    Amino acid position 2181 (e.g., E2181D7)
    Amino acid position 2184 (e.g., R2184T7)
    Amino acid position 2201 (e.g., E2201D7)
    Amino acid position 2205 (e.g., R2205I7)
    Amino acid position 2207 (e.g., T2207I7)
    Amino acid position 2209 (e.g., H2209P7)
    Amino acid position 2212 (e.g., Q2212H7, Q2212P7)
    Amino acid position 2223 (e.g., L22239)
    Amino acid position 2224 (e.g., N2224K9)
    1Facchinetti et al., Clin.Cancer Res., DOI: 10.1158/1078-0432.CCR-16-0917, 2016.
    2Awad et al.,N. Engl. J. Med., 368(25):2395-401, 2013.
    3Zou et al., Proc. Natl.Acad.Sci. U.S.A., 112(11):3493-8, 2015.
    4Song et al., Clin. Cancer Res., 21(10):2379-87, 2015.
    5Katayama et al., Clin. Cancer Res., 21(1):166-74, 2015.
    6PCT Patent Application Publication No. WO 2014/134096A1.
    7PCT Patent Application Publication No. WO 2014/152777A2.
    8Drilon et al., Clin. Cancer Res., 22(10):2351-8, 2016.
    9Davare et al., Proc. Natl. Acad. Sci. U.S.A., 112(39):E5381-90, 2015.
    10Davare et al., Proc. Natl. Acad. Sci. U.S.A., 110(48):19519-24, 2013.
    11Gainor et al., JCO Precis Oncol. 10.1200/PO.17.00063, 2017.
  • In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes a splice variation in a ROS1 mRNA which results in an expressed protein that is an alternatively spliced variant of ROS1 having at least one residue deleted (as compared to the wild-type ROS1 kinase) resulting in a constitutive activity of a ROS1 kinase domain. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes a splice variation in a ROS1 mRNA which results in an expressed protein that is an alternatively spliced variant of ROS1 having at least one residue added (as compared to the wild-type ROS1 kinase) resulting in a constitutive activity of a ROS1 kinase domain.
  • A “ROS1 kinase inhibitor” as defined herein includes any compound exhibiting ROS1 inhibition activity. In some embodiments, a ROS1 kinase inhibitor is selective for a wild type and/or mutant ROS1 kinase. In some embodiments, ROS1 kinase inhibitors can exhibit inhibition activity (IC50) against a ROS1 kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein. In some embodiments, a ROS1 kinase inhibitors can exhibit inhibition activity (IC50) against a ROS1 kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay as provided herein. In some embodiments, the ROS1 kinase inhibitor is a compound of Formula I.
  • As used herein, a “first ROS1 kinase inhibitor” or “first ROS1 inhibitor” is a ROS1 kinase inhibitor as defined herein, but which does not include a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as defined herein. As used herein, a “second ROS1 kinase inhibitor” or a “second ROS1 inhibitor” is a ROS1 kinase inhibitor as defined herein. In some embodiments, a second ROS1 inhibitor does not include a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as defined herein. When more than one ROS1 inhibitor is present in a method provided herein (e.g., both a first and a second ROS1 inhibitor are present in a method provided herein), the two ROS1 inhibitors are different (e.g., the first and second ROS1 kinase inhibitor are different). As provided herein, different ROS1 inhibitors are structurally distinct from one another.
  • In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes at least one point mutation in a ROS1 gene that results in the production of a ROS1 kinase that has one or more amino acid substitutions or insertions or deletions as compared to the wild-type ROS1 kinase. In some cases, the resulting ROS1 kinase is more resistant to inhibition of its phosphotransferase activity by one or more first ROS1 kinase inhibitor(s), as compared to a wildtype ROS1 kinase or a ROS1 kinase not including the same mutation. Such mutations, optionally, do not decrease the sensitivity of the cancer cell or tumor having the ROS1 kinase to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof (e.g., as compared to a cancer cell or a tumor that does not include the particular ROS1 inhibitor resistance mutation). In such embodiments, a ROS1 inhibitor resistance mutation can result in a ROS1 kinase that has one or more of an increased Vmax, a decreased Km for ATP, and an increased KD for a first ROS1 kinase inhibitor, when in the presence of a first ROS1 kinase inhibitor, as compared to a wildtype ROS1 kinase or a ROS1 kinase not having the same mutation in the presence of the same first ROS1 kinase inhibitor.
  • In other embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, includes at least one point mutation in a ROS1 gene that results in the production of a ROS1 kinase that has one or more amino acid substitutions as compared to the wild-type ROS1 kinase, and which has increased resistance to a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, as compared to a wildtype ROS1 kinase or a ROS1 kinase not including the same mutation. In such embodiments, a ROS1 inhibitor resistance mutation can result in a ROS1 kinase that has one or more of an increased Vmax, a decreased Km, and a decreased KD in the presence of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, as compared to a wildtype ROS1 kinase or a ROS1 kinase not having the same mutation in the presence of the same compound of Formula I or a pharmaceutically acceptable salt or solvate thereof.
  • Examples of ROS1 inhibitor resistance mutations can, e.g., include point mutations, insertions, or deletions in and near the ATP binding site in the tertiary structure of ROS1 kinase, including but not limited to the gatekeeper residue, P-loop residues, residues in or near the DFG motif, and ATP cleft solvent front amino acid residues. Additional examples of these types of mutations include changes in residues that may affect enzyme activity and/or drug binding including but are not limited to residues in the activation loop, residues near or interacting with the activation loop, residues contributing to active or inactive enzyme conformations, changes including mutations, deletions, and insertions in the loop proceeding the C-helix and in the C-helix. Specific residues or residue regions that may be changed (e.g., ROS1 inhibitor resistance mutations) include but are not limited to those listed in Table 4 based on the human wildtype ROS1 protein sequence (e.g., SEQ ID NO: 1). Changes to these residues may include single or multiple amino acid changes, insertions within or flanking the sequences, and deletions within or flanking the sequences.
  • In some embodiments, compounds of Formula I and pharmaceutically acceptable salts and solvates are useful in treating patients that develop cancers with ROS1 inhibitor resistance mutations (e.g., that result in an increased resistance to a first ROS1 inhibitor, e.g., a substitution at amino acid position 2032 (e.g., G2032R), amino acid position 2026 (e.g., L2026M), amino acid position 2033 (e.g., D2033N), and/or one or more ROS1 inhibitor resistance mutations listed in Table 4) by either dosing in combination or as a follow-up therapy to existing drug treatments (e.g., ALK kinase inhibitors, TRK kinase inhibitors, other ROS1 kinase inhibitors, e.g., first and/or second ROS1 kinase inhibitors). Exemplary ALK kinase inhibitors are described herein. Exemplary TRK kinase inhibitors are described herein. Exemplary first and second ROS1 kinase inhibitors are described herein. In some embodiments, a first or second ROS1 kinase inhibitor can be selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib.
  • In some embodiments, compounds of Formula I or pharmaceutically acceptable salts and solvates thereof are useful for treating a cancer that has been identified as having one or more ROS1 inhibitor resistance mutations (that result in an increased resistance to a first or second ROS1 inhibitor, e.g., a substitution at amino acid position 2032 (e.g., G2032R), amino acid position 2026 (e.g., L2026M), amino acid position 2033 (e.g., D2033N)). Non-limiting examples of ROS1 inhibitor resistance mutations are listed in Table 4.
  • TABLE 4
    Exemplary ROS1 Resistance Mutations
    Amino acid position 1186 (e.g., S1186F11)
    Amino acid position 1935 (e.g., E1935G610)
    Amino acid position 1945 (e.g., L1945Q7)
    Amino acid position 1946 (e.g., T1946S7)
    Amino acid position 1947 (e.g., L1947R6, 10, L1947M7)
    Amino acid position 1948 (e.g., R1948S7)
    Amino acid position 1951 (e.g., L1951R5, L1951V7)
    Amino acid position 1958 (e.g., E1958V7)
    Amino acid position 1959 (e.g., V1959E7)
    Amino acid position 1961 (e.g., E1961K7)
    Amino acid position 1962 (e.g., G1962E7)
    Amino acid position 1971 (e.g., G1971E6, 10)
    Amino acid position 1974 (e.g., E1974K9)
    Amino acid position 1981 (e.g., T1981M7)
    Amino acid position 1982 (e.g., L1982F5, 10, L1982R6)
    Amino acid position 1986 (e.g., S1986Y1, S1986F1)
    Amino acid position 1990 (e.g., E1990G5, E1990L7)
    Amino acid position 1993 (e.g., E1993K7)
    Amino acid position 1994 (e.g., F1994L5)
    Amino acid position 2000 (e.g., L2000V7)
    Amino acid position 2002 (e.g., S2002N7)
    Amino acid position 2004 (e.g., F2004L7,
    F2004I9, F2004V9, F2004C9)
    Amino acid position 2008 (e.g., N2008H7)
    Amino acid position 2009 (e.g., I2009L7)
    Amino acid position 2010 (e.g., L2010M7)
    Amino acid position 2011 (e.g., K2011N7)
    Amino acid position 2016 (e.g., C2016G7)
    Amino acid position 2019 (e.g., N2019D7, N2019Y7)
    Amino acid position 2020 (e.g., E2020k9)
    Amino acid position 2022 (e.g., Q2022H7)
    Amino acid position 2026 (e.g., L2026M3)
    Amino acid position 2028 (e.g., L2028M7)
    Amino acid position 2029 (e.g., M2029K7)
    Amino acid position 2030 (e.g., E2030K7)
    Amino acid position 2032 (e.g., G2032R2)
    Amino acid position 2033 (e.g., D2033G7, D2033N8)
    Amino acid position 2035 (e.g., L2035I7)
    Amino acid position 2036 (e.g., T2036I7, T2036N7)
    Amino acid position 2039 (e.g., R2039G7,
    R2039H7, R2039M7, R2039N7, R2039S7)
    Amino acid position 2040 (e.g., K2040E7, K2040Q7)
    Amino acid position 2052 (e.g., T2052S7)
    Amino acid position 2059 (e.g., L2059P7)
    Amino acid position 2060 (e.g., C2060G6, 10)
    Amino acid position 2075 (e.g., F2075C9,
    F2075I9, F2075V9)
    Amino acid position 2077 (e.g., H2077P7)
    Amino acid position 2078 (e.g., R2078W7)
    Amino acid position 2087 (e.g., V2087I7)
    Amino acid position 2091 (e.g., D2091N7)
    Amino acid position 2092 (e.g., Y2092N7)
    Amino acid position 2094 (e.g., S2094N7)
    Amino acid position 2098 (e.g., V2098I6, 10)
    Amino acid position 2099 (e.g., K2099N7)
    Amino acid position 2100 (e.g., I2100V7)
    Amino acid position 2101 (e.g., G2101A7)
    Amino acid position 2106 (e.g., A2106P7)
    Amino acid position 2107 (e.g., R2107T7)
    Amino acid position 2112 (e.g., N2112K9)
    Amino acid position 2113 (e.g., D2113N9 D2113G9)
    Amino acid position 2116 (e.g., R2116T7, R2116K9)
    Amino acid position 2125 (e.g., V2125G7, V2125L7)
    Amino acid position 2127 (e.g., W2127G7, W21279)
    Amino acid position 2128 (e.g., M2128T9)
    Amino acid position 2131 (e.g., E2131D7, E2131K7)
    Amino acid position 2134 (e.g., M2134I7)
    Amino acid position 2139 (e.g., T2139I7, T2139S7)
    Amino acid position 2141 (e.g., Q2141H7)
    Amino acid position 2142 (e.g., S2142Y7)
    Amino acid position 2148 (e.g., G2148E7)
    Amino acid position 2151 (e.g., I2151N7)
    Amino acid position 2154 (e.g., I2154M7)
    Amino acid position 2155 (e.g., L2155S4)
    Amino acid position 2160 (e.g., Q2160H7)
    Amino acid position 2165 (e.g., H2165D7)
    Amino acid position 2181 (e.g., E2181D7)
    Amino acid position 2184 (e.g., R2184T7)
    Amino acid position 2201 (e.g., E2201D7)
    Amino acid position 2205 (e.g., R2205I7)
    Amino acid position 2207 (e.g., T2207I7)
    Amino acid position 2209 (e.g., H2209P7)
    Amino acid position 2212 (e.g., Q2212H7, Q2212P7)
    Amino acid position 2223 (e.g., L22239)
    Amino acid position 2224 (e.g., N2224K9)
    1Facchinetti et al., Clin. Cancer Res., DOI: 10.1158/1078-0432.CCR-16-0917, 2016.
    2Awad et al., N. Engl. J. Med., 368(25):2395-401, 2013.
    3Zou et al., Proc. Natl. Acad. Sci. U.S.A., 112(11):3493-8, 2015.
    4Song et al., Clin. Cancer Res., 21(10):2379-87, 2015.
    5Katayama et al., Clin. Cancer Res., 21(1):166-74, 2015.
    6PCT Patent Application Publication No. WO 2014/134096A1.
    7PCT Patent Application Publication No. WO 2014/152777A2.
    8Drilon et al., Clin. Cancer Res., 22(10):2351-8, 2016.
    9Davare et al., Proc. Natl. Acad. Sci. U.S.A., 112(39):E5381-90, 2015.
    10Davare et al., Proc. Natl. Acad. Sci. U.S.A., 110(48):19519-24, 2013.
    11Gainor et al., JCO Precis Oncol. 10.1200/PO.17.00063, 2017.
  • The ROS1 proto-oncogene is expressed in a variety of tumor types, and belongs to the sevenless subfamily of tyrosine kinase insulin receptor genes. The protein encoded by this gene is a type I integral membrane protein with tyrosine kinase activity. ROS1 shares structural similarity with the anaplastic lymphoma kinase (ALK) protein. Gene rearrangements involving ROS1 have been identified in a variety of cancers. The small molecule tyrosine kinase inhibitor, crizotinib, has been approved for the treatment of patients with metastatic NSCLC whose tumors are ROS1-positive or ALK-positive. Although the most preclinical and clinical studies of ROS1 gene fusions have been performed in lung cancer, ROS1 fusions have been detected in multiple other tumor histologies, including ovarian carcinoma, sarcoma, cholangiocarcinomas and others.
  • ALK is a receptor tyrosine kinase that belongs to the insulin growth factor receptor superfamily. ALK is believed to play a role in the development of the nervous system. A variety of ALK gene fusions have been described, such as EML4, KIF5B, KLC1, and TRK-fused gene (TFG). Such fusion products result in kinase activation and oncogenesis. Non-small-cell lung cancer (NSCLC) harboring the anaplastic lymphoma kinase gene (ALK) rearrangement is sensitive to the small molecule tyrosine kinase inhibitor crizotinib, which is an inhibitor of ALK and ROS1.
  • In some embodiments, the additional therapeutic agent(s) includes any one of the above listed therapies or therapeutic agents which are standards of care in cancers wherein the cancer has a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same. In some embodiments, the additional therapeutic agent(s) includes any one of the above listed therapies or therapeutic agents which are standards of care in cancers wherein the cancer has a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same (e.g., an ALK-associated cancer). In some embodiments, the additional therapeutic agent(s) includes any one of the above listed therapies or therapeutic agents which are standards of care in cancers wherein the cancer has a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same (e.g., a TRK-associated cancer).
  • The term “ALK-associated cancer” as used herein refers to cancers associated with or having a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same. Exemplary ALK-associated cancers are provided herein.
  • The phrase “dysregulation of an ALK gene, an ALK kinase, or the expression or activity or level of any of the same” refers to a genetic mutation (e.g., an ALK gene translocation that results in the expression of a fusion protein, a deletion in an ALK gene that results in the expression of an ALK protein that includes a deletion of at least one amino acid as compared to the wild-type ALK protein, a mutation in an ALK gene that results in the expression of an ALK protein with one or more point mutations, or an alternative spliced version of an ALK mRNA that results in an ALK protein having a deletion of at least one amino acid in the ALK protein as compared to the wild-type ALK protein) or an ALK gene amplification that results in overexpression of an ALK protein or an autocrine activity resulting from the overexpression of an ALK gene in a cell that results in a pathogenic increase in the activity of a kinase domain of an ALK protein (e.g., a constitutively active kinase domain of an ALK protein) in a cell. As another example, a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same, can be a mutation in an ALK gene that encodes an ALK protein that is constitutively active or has increased activity as compared to a protein encoded by an ALK gene that does not include the mutation. For example, a dysregulation of an ALK gene, an ALK protein, or expression or activity, or level of any of the same, can be the result of a gene or chromosome translocation which results in the expression of a fusion protein that contains a first portion of ALK that includes a functional kinase domain, and a second portion of a partner protein that is not ALK. In some examples, dysregulation of an ALK gene, an ALK protein, or expression or activity or level of any of the same can be a result of a gene translocation of one ALK gene with another non-ALK gene. Non-limiting examples of fusion proteins are described in Table 5. Additional examples of ALK kinase protein mutations (e.g., point mutations) are ALK inhibitor resistance mutations.
  • The term “wildtype” or “wild-type” when referring to an ALK nucleic acid or protein describes a nucleic acid (e.g., an ALK gene or an ALK mRNA) or protein (e.g., an ALK protein) that is found in a subject that does not have an ALK-associated disease, e.g., an ALK-associated cancer (and optionally also does not have an increased risk of developing an ALK-associated disease and/or is not suspected of having an ALK-associated disease), or is found in a cell or tissue from a subject that does not have an ALK-associated disease, e.g., an ALK-associated cancer (and optionally also does not have an increased risk of developing an ALK-associated disease and/or is not suspected of having an ALK-associated disease).
  • In some embodiments, the dysregulation of an ALK gene, an ALK kinase protein, or expression or activity or level of any of the same, includes one or more chromosome translocations or inversions resulting in an ALK gene fusion. In some embodiments, the dysregulation of an ALK gene, an ALK kinase protein, or expression or activity or level of any of the same, is a result of genetic translocations in which the expressed protein is a fusion protein containing residues from a non-ALK partner protein, and includes a minimum of a functional ALK kinase domain.
  • Non-limiting examples of ALK fusion proteins are shown in Table 5.
  • TABLE 5
    Exemplary ALK Fusion Proteins
    ALK Partner ALK-Associated Cancer
    NPM/NPM1 Anaplastic large cell lymphoma1,
    Diffuse large B-cell lymphoma1,
    Neuroblastoma8,
    Lung adenocarcinoma9
    ALO17/RNF213 Anaplastic large cell lymphoma1
    TFG (e.g., TFGs, Anaplastic large cell lymphoma1,
    TFGL, TFGXL)38 Non-small cell lung cancer1,
    Anaplastic thyroid carcinoma1
    MSN (e.g., MSNa Anaplastic large cell lymphoma1
    and MSNb)38
    TPM3 Anaplastic large cell lymphoma1,
    Inflammatory myofibroblastic
    tumour1, Renal medulla
    carcinoma/renal cell carcinoma1,
    Spitzoid neoplasm5
    TPM4 (e.g., type 1 Anaplastic large cell lymphoma1,
    and type 2)38 Inflammatory myofibroblastic
    tumour1, Oesophageal squamous cell
    carcinoma1
    ATIC Anaplastic large cell lymphoma1.
    Inflammatory myofibroblastic
    tumour1
    MYH9 Anaplastic large cell lymphoma1
    CLTC Anaplastic large cell lymphoma1,
    Inflammatory myofibroblastic
    tumour1, Diffuse large B-cell
    lymphoma1
    TRAF1 Anaplastic large cell lymphoma1
    EML4* Non-small cell lung cancer1, Renal
    medulla carcinoma/renal cell
    carcinoma1, Breast cancer1, Colon
    cancer1, Anaplastic thyroid
    carcinoma1, Squamous cell
    carcinoma14, Lung
    adenocarcinoma18, Colorectal
    Adenocarcinoma19
    KIF5B Non-small cell lung cancer1
    KLC1 Non-small cell lung cancer1
    PTPN3 Non-small cell lung cancer1
    HIP1 Non-small cell lung cancer1
    TPR Non-small cell lung cancer1
    STRN Non-small cell lung cancer1,
    Anaplastic thyroid carcinoma1,
    Colorectal Adenocarcinoma19, Renal
    Cell Carcinoma20
    SEC31A/SEC31L138 Inflammatory myofibroblastic
    (e.g., type 1 and type tumour1, Diffuse large B-cell
    2)38 lymphoma1, Lung adenocarcinoma21
    RANBP2 Inflammatory myofibroblastic
    tumour1, Pediatric acute myeloid
    leukemia11
    PPFIBP1 Inflammatory myofibroblastic
    tumour1
    CARS Inflammatory myofibroblastic
    tumour1
    SQSTM1 Diffuse large B-cell lymphoma1
    VCL Renal medulla carcinoma/renal cell
    carcinoma1
    C2orf44 Colon cancer1
    FN1 Serous ovarian carcinoma1,
    Gastrointestinal leiomyoma36
    GFPT1 Anaplastic thyroid carcinoma1
    KIAA1618 Blood Cancer2
    MEL4 Unspecified3
    ROS1 Unspecified4
    DCTN1 Spitzoid neoplasm5, Sarcoma26
    MDCF2 Lung adenocarcinoma6
    STK32B Breast cancer6
    TPM1 Unspecified7
    PRKAR1A Unspecified7
    NCOA1 Unspecified7
    GTF2IRD1 Unspecified7
    CLTCL1 Neuroblastoma8
    LMNA Neuroblastoma8
    PRKAR1A Neuroblastoma8, Non-small cell
    lung cancer15, Colorectal
    Adenocarcinoma19
    SPTBN1 Lung adenocarcinoma10
    EIF2AK3 Lung adenocarincoma12, Non-small
    cell lung cancer15
    EML4-EXOC6B Lung adenocarincoma13
    PPM1B Non-small cell lung cancer15
    MALAT1 (lncRNA Triple-negative breast cancer16
    gene fusion)
    HOOK1 Renal cell carcinoma17
    CAD Colorectal Adenocarcinoma19
    PPP1T21 Colorectal Adenocarcinoma19
    SENPF Colorectal Adenocarcinoma19
    MAPRE3 Colorectal Adenocarcinoma19
    SPDYA Non-small cell lung cancer22
    ASXL2 Non-small cell lung cancer22
    IGL@ Diffuse large B-cell lymphoma23
    PPP1R21 Colorectal Adenocarcinoma24
    PRKAP1B Colorectal Adenocarcinoma24
    BIRC6 Non-small cell lung cancer25
    PICALM Non-small cell lung cancer25
    KCL Lung adenocarcinoma27
    CRIM1 Non-small cell lung cancer28
    EEF1G Anaplastic large cell lymphoma29
    DCTN1 Advanced Sarcoma30, Inflammatory
    myofibroblastic tumor33, Spitzoid
    tumors33
    GTF2IRD1 Pediatric, adolescent and young
    adult (PAYA) thyroid carcinoma31
    BEND5 Neuroblastoma32
    PPP1CB Astrocytoma32
    CUX Non-small-cell Lung cancer34
    FAM179A Non-small-cell Lung cancer35
    COL25A1 Non-small-cell Lung cancer35
    BIRC6 Non-small-cell Lung Cancer37
    PICALM Non-small-cell Lung Cancer37
    GTF3C2 Spitz tumor39
    IGFBP5 Soft Tissue Sarcoma40
    MYO18A Adenosarcoma41
    *There are a number of different ALK-EML4 fusion variants: 1, 2, 3a, 3b, 4, 5a, 5b, 6, 7, 8a, 8b, 4′, 5′ (Ann. Oncol., 27(3):iii6-iii24, 2016)
    1Hallberg and Palmer, Ann. Oncology, 27 (Suppl 3):iii4-iii15. doi: 10.1093/annonc/mdw301, 2016.
    2U.S. Patent Publication No. 9,469,876B2.
    3U.S. Patent Application Publication No. 2016/0145237A1.
    4U.S. Patent Application Publication No. 2016/0108123A1.
    5U.S. Patent Application Publication No. 2016/0010068A1.
    6U.S. Patent Application Publication No. 2016/00009785A1.
    7European Patent Application Publication No. 2986736A2.
    8Katayama, et al. Clin Cancer Res, 21(10):2227-35, May 2015.
    9Dacic et al., Oncotarget, 2016: doi: 10.18632/oncotarget.12705.
    10Gu et al., J Hematol Oncol, 9(1): 66, 2016.
    11Hayashi et al., Blood Cancer J, 6(8): e456, 2016.
    12Won et al., BMC Cancer, 16:568, 2016.
    13Ma et al., Oncotarget, 2016, doi: 10.18632/oncotarget.10560.
    14Yamamoto et al., Mol Clin. Oncol. 5(1): 61-63, 2016.
    15Ali et al., Oncologist, 21(6): 762-70, 2016.
    16Shaver et al., Cancer Res, 76(16): 4850-60, 2016.
    17Cajaiba et al., Genes Chromosomes Cancer, 55(10): 814-7, 2016.
    18Hainsworth et al., Drugs Real World Outcomes, 3:115-120, 2016.
    19Yakirevich et al., Clin Cancer Res, 22(15): 3831-40, 2016.
    20Kusano, Am J. Surg Pathol. 40(6): 761-9, 2016.
    21Kim et al., Cancer Res Treat, 48(1): 298-402, 2016.
    22Rosenbaum et al., Laboratory Investigation, Vol. 96, Supp. SUPPL. 1, pp. 481A-482A, Abstract Number: 1914, 105th Annual Meeting of the United States and Canadian Academy of Pathology, Seattle, WA, 2016.
    23Pan et al., Laboratory Investigation, Vol. 96, Supp. SUPPL. 1, pp. 367A, Abstract Number: 1450, 105th Annual Meeting of the United States and Canadian Academy of Pathology, Seattle, WA, 2016.
    24Yakirevich et al., Laboratory Investigation, Vol. 96, Supp. SUPPL. 1, pp. 209A, Abstract Number: 827, 105th Annual Meeting of the United States and Canadian Academy of Pathology, Seattle, WA, 2016.
    25Ying et al., J. Clin. Oncology, Vol. 34, Supp. Supplement 15, Abstract Number: e20506, 2016 Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, 2016.
    26Groisberg et al., J. Clin. Oncology, Vol. 34, Supp. Supplement 15, Abstract Number: 11046, 2016 Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, 2016.
    27Ihuegby et al., J. Clin. Oncology, Vol. 34, Supp. Supplement 15, Abstract Number: e20643, 2016 Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, 2016.
    28Tan et al., J. Clin. Oncology, Vol. 34, Supp. Supplement 15, Abstract Number: 9064, 2016 Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, 2016.
    29Wlodarska et al., Blood, Vol. 126(23):3654, 57th Annual Meeting of the American Society of Hematology, San Diego, CA, 2015.
    30Groisberg et al., Journal of Clinical Oncology, Vol. 34, Supp. Supplement 15; Abstract Number: 11046; 2016 Annual Meeting of the American Society of Clinical Oncology, ASCO 2016, Chicago, IL. 3-7 June 2016.
    31Vanden et al., Annals of Oncology, Vol. 27, Supp. Supplement 6. Abstract Number: 427PD′ 41st European Society for Medical Oncology Congress, ESMO 2016; Copenhagen, Denmark; 7-11 October 2016.
    32Chmielecki et al., Cancer Research, 2017 Jan 9. doi: 10.1158/0008-5472.CAN-16-1106.
    33Holla et al., Cold Spring Harb Mol Case Stud, 2017 Jan;3(1):a001115. doi: 10.1101/mcs.a001115.
    34Yu et al., Oncotarget, 2016 Dec 10. doi: 10.18632/oncotarget.13886.
    35Cui et al., Oncotarget. 2016 Dec 1. doi: 10.18632/oncotarget.13741.
    36Panagopoulos et al., Modern Pathology 29: 1415-1423, 2016
    37Li et al., J. Thorac. Oncol. 2017 Jan;12(1):94-101. doi: 10.1016/j.jtho.2016.08.145.
    38European Patent Application Number EP2558490B1.
    39PCT Application No. WO2017001491A2.
    40Chmielecki et al., Cancer Research, Vol. 76, No. 14, Supp. Supplement. Abstract Number: LB-178. 107th Annual meeting of the American Association for Cancer Research, AACR. New Orleans, LA. April 16-20 2016.
    41Majweska et al., Cancer Research, Vol. 76, No. 14, Supp. Supplement. Abstract Number: 3190. 107th Annual meeting of the American Association for Cancer Research, AACR. New Orleans, LA. April 16-20 2016.
  • In some embodiments, the dysregulation of an ALK gene, an ALK kinase, or expression or activity or level of any of the same, includes at least one point mutation in an ALK gene that results in the production of an ALK kinase that has one or more amino acid substitutions, insertions, or deletions as compared to the wild-type ALK kinase.
  • In some embodiments, an ALK-associated cancer has been identified as having one or more ALK inhibitor resistance mutations (that result in an increased resistance to an ALK inhibitor.
  • Tropomyosin-related kinase (TRK) is a receptor tyrosine kinase family of neurotrophin receptors that are found in multiple tissues types. Three members of the TRK proto-oncogene family have been described: TrkA, TrkB, and TrkC, encoded by the NTRK1, NTRK2, and NTRK3 genes, respectively. The TRK receptor family is involved in neuronal development, including the growth and function of neuronal synapses, memory development, and maintenance, and the protection of neurons after ischemia or other types of injury (Nakagawara, Cancer Lett. 169:107-114, 2001).
  • TRK was originally identified from a colorectal cancer cell line as an oncogene fusion containing 5′ sequences from tropomyosin-3 (TPM3) gene and the kinase domain encoded by the 3′ region of the neurotrophic tyrosine kinase, receptor, type 1 gene (NTRK1) (Pulciani et al., Nature 300:539-542, 1982; Martin-Zanca et al., Nature 319:743-748, 1986). TRK gene fusions follow the well-established paradigm of other oncogenic fusions, such as those involving ALK and ROS1, which have been shown to drive the growth of tumors and can be successfully inhibited in the clinic by targeted drugs (Shaw et al., New Engl. J. Med. 371:1963-1971, 2014; Shaw et al., New Engl. J. Med. 370:1189-1197, 2014). Oncogenic TRK fusions induce cancer cell proliferation and engage critical cancer-related downstream signaling pathways such as mitogen activated protein kinase (MAPK) and AKT (Vaishnavi et al., Cancer Discov. 5:25-34, 2015). Numerous oncogenic rearrangements involving NTRK1 and its related TRK family members NTRK2 and NTRK3 have been described (Vaishnavi et al., Cancer Disc. 5:25-34, 2015; Vaishnavi et al., Nature Med. 19:1469-1472, 2013). Although there are numerous different 5′ gene fusion partners identified, all share an in-frame, intact TRK kinase domain. A variety of different Trk inhibitors have been developed to treat cancer (see, e.g., U.S. Patent Application Publication No. 62/080,374, International Application Publication Nos. WO 11/006074, WO 11/146336, WO 10/033941, and WO 10/048314, and U.S. Pat. Nos. 8,933,084, 8,791,123, 8,637,516, 8,513,263, 8,450,322, 7,615,383, 7,384,632, 6,153,189, 6,027,927, 6,025,166, 5,910,574, 5,877,016, and 5,844,092).
  • The term “TRK-associated cancer” as used herein refers to cancers associated with or having a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same. Exemplary TRK-associated cancers are provided herein.
  • The phrase “dysregulation of a TRK gene, a TRK kinase, or the expression or activity or level of any of the same” refers to a genetic mutation (e.g., a TRK gene translocation that results in the expression of a fusion protein, a deletion in a TRK gene that results in the expression of a TRK protein that includes a deletion of at least one amino acid as compared to the wild-type TRK protein, a mutation in a TRK gene that results in the expression of a TRK protein with one or more point mutations, or an alternative spliced version of a TRK mRNA that results in a TRK protein having a deletion of at least one amino acid in the TRK protein as compared to the wild-type TRK protein) or a TRK gene amplification that results in overexpression of a TRK protein or an autocrine activity resulting from the overexpression of a TRK gene in a cell that results in a pathogenic increase in the activity of a kinase domain of a TRK protein (e.g., a constitutively active kinase domain of a TRK protein) in a cell. As another example, a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same, can be a mutation in a TRK gene that encodes a TRK protein that is constitutively active or has increased activity as compared to a protein encoded by a TRK gene that does not include the mutation. For example, a dysregulation of a TRK gene, a TRK protein, or expression or activity, or level of any of the same, can be the result of a gene or chromosome translocation which results in the expression of a fusion protein that contains a first portion of TRK that includes a functional kinase domain, and a second portion of a partner protein that is not TRK. In some examples, dysregulation of a TRK gene, a TRK protein, or expression or activity or level of any of the same can be a result of a gene translocation of one TRK gene with another non-TRK gene. Non-limiting examples of fusion proteins are described in Tables 6-8. Additional examples of TRK kinase protein mutations (e.g., point mutations) are TRK inhibitor resistance mutations.
  • The term “wildtype” or “wild-type” when referring to a TRK nucleic acid or protein describes a nucleic acid (e.g., a TRK gene or a TRK mRNA) or protein (e.g., a TRK protein) that is found in a subject that does not have a TRK-associated disease, e.g., a TRK-associated cancer (and optionally also does not have an increased risk of developing a TRK-associated disease and/or is not suspected of having a TRK-associated disease), or is found in a cell or tissue from a subject that does not have a TRK-associated disease, e.g., a TRK-associated cancer (and optionally also does not have an increased risk of developing a TRK-associated disease and/or is not suspected of having a TRK-associated disease).
  • In some embodiments, the dysregulation of a TRK gene, a TRK kinase protein, or expression or activity or level of any of the same, includes one or more chromosome translocations or inversions resulting in a TRK gene fusion. In some embodiments, the dysregulation of a TRK gene, a TRK kinase protein, or expression or activity or level of any of the same, is a result of genetic translocations in which the expressed protein is a fusion protein containing residues from a non-TRK partner protein, and includes a minimum of a functional TRK kinase domain. See, for example, Tables 6-8.
  • TABLE 6
    Exemplary TrkA Fusion Proteins and Cancers
    Non-limiting Exemplary Trk-and Synonyms of Associated
    Fusion Protein Non-TrkA Fusion Partner Cancer(s)
    TP53-TrkA1,11 Tumor Protein P53 Spitzoid Melanoma, Spitz tumors
    LMNA-TrkA1, 12 Lamin A/C Spitzoid Melanoma, Spitz tumors, Undifferentiated Sarcoma,
    Adult Soft Tissue Sarcoma (e.g., Soft Tissue Sarcoma
    Metastatic to Lung), Soft Tissue Fibrosarcoma, Spindle Cell
    SarcomaG, Congenital Infantile FibrosarcomaH, Pediatric
    haemangiopericytoma-like sarcomaI, Colorectal CancerK
    CD74-TrkA2 MHC class II invariant chain Non-Small Cell Lung Cancer (NSCLC) Lung adenocarcimona
    TFG-TrkA (TRK-T3)3 TRK-Fused Gene Papillary Thyroid Carcinoma (PTC), Soft Tissue Solitary
    Fibrous Tumor
    TPM3-TrkA3 Tropomyosin 3 Lung Cancer, Papillary Thyroid Carcinoma (PTC), Acute
    Myeloid Leukemia (AML), Sarcoma, Pediatric Gliomas,
    Colorectal Cancer (CRC), Soft Tissue Schwannoma, Spitzoid
    melanocytic tumorsJ
    NFASC-TrkA4 Neurofascin Gliobastoma multiforme (GBM); Glioblastoma
    BCAN-TrkA4 Brevican Glioblastoma multiforme (GBM)
    MPRIP-TrkA5, E Myosin Phosphatase Rho Non-small cell lung cancer (NSCLC), Lung adenocarcinoma
    Interacting Protein or Rho
    Interacting Protein 3
    TPR-TrkA (TRK-T1 Translocated Promoter Papillary Thyroid Carcinoma (PTC), Colorectal Cancer (CRC)A,
    or TRK-T2)3 Region, Nuclear Basket Non-small cell lung cancer (NSCLC)
    Protein
    RFWD2-TrkA6 Ring Finger and WD Repeat Large Cell Neuroendrocine Cancer (LCNEC); NSCLC
    Domain 2
    IRF2BP2-TrkA7 Interferon Regulatory Factor Thyroid Cancer; Thyroid Gland Carcinoma
    2 Binding Protein 2
    SQSTM1-TrkA7 Sequestosome 1 Thyroid Cancer (e.g., Papillary Thyroid Cancer), Thyroid
    Gland Carcinoma, Soft Tissue Fibrosarcoma,
    Non-small-cell lung cancerL
    SSBP2-TrkA7 Single-Stranded DNA Thyroid Cancer (e.g., Papillary Thyroid Cancer); Thyroid
    Binding Protein 2 Gland Carcinoma
    RABGAP1L-TrkA8 RAB GTPase Activating Intrahepatic Cholangicarcinoma (ICC)
    Protein 1-Like
    C18ORF8-TrkA9 Chromosome 18 Open Non-Small Cell Lung Cancer (NSCLC)
    Reading Frame 8
    RNF213-TrkA9 Ring Finger Protein 213 Non-Small Cell Lung Cancer (NSCLC)
    TBC1D22A-TrkA9 TBC1 Domain Family, Non-Small Cell Lung Cancer (NSCLC)
    Member 22A
    C20ORF112-TrkA9 Chromosome 20 Open Non-Small Cell Lung Cancer (NSCLC)
    Reading Frame 112
    DNER-TrkA9 Delta/Notch-Like EGF Non-Small Cell Lung Cancer (NSCLC)
    Repeat Containing
    ARHGEF2-TrkA13 Rho Guanine Nucleotide Glioblastoma
    Exchange Factor 2
    CHTOP-TrkA13 Chromatin Target of PRMT1 Glioblastoma
    PPL-TrkA13 Periplakin Thyroid Carcinoma
    PLEKHA6-TrkA Pleckstrin Homology
    Domain-Containing
    Family A Member 6
    PEAR1-TrkA Platelet Endothelial
    Aggregation Receptor 1
    MRPL24-TrkA 39S Ribosomal Protein
    L24, Mitochondrial
    MDM4-TrkA Human Homolg of
    Mouse Double Minute 4
    LRRC71-TrkA Leucine Rich Repeat
    Containing 71
    GRIPAP1-TrkA GRIP1 Associated
    Protein 1
    EPS15-TrkA Epidermal Growth Factor
    Receptor Substrate 15
    DYNC2H1-TrkAB Dynein, Cytoplasmic 2, Sarcoma
    Heavy Chain 1
    CEL-TrkA Carboxyl Ester Lipase Pancreatic adenocarcinoma sampleD
    EPHB2-TrkAB EPH Receptor B2 Lower Grade Glioma
    TGF-TrkAC Transforming Growth Factor Papillary Thyroid Cancer
    NELL1-TrkAF Cytoplasmic Protein That Non-Small Cell Lung Cancer (NSCLC)
    Contains Epidermal Growth
    Factor (Egf)-Like Repeats
    EPL4-TrkAF EPH-Related Receptor Non-Small Cell Lung Cancer (NSCLC)
    Tyrosine Kinase Ligand
    4/Ephrin-A4 Protein
    CTNND2-TrkAF Catenin (Cadherin-Associated Non-Small Cell Lung Cancer (NSCLC)
    Protein), Delta 2
    TCEANC2-TrkAF Transcription Elongation Non-Small Cell Lung Cancer (NSCLC)
    Factor A (Sll) N-Terminal
    And Central Domain
    ACréancier et al., Cancer Lett. 365(1):107-111, 2015.J
    BU.S. Patent Application Publication No. 2015/0315657.
    CU.S. Patent Application Publication No. 2015/0283132.
    DEgren et al., Cancer Res. 75(15 Supplement): 4793, 2015.
    EU.S. Patent Application Publication No. 2015/0073036.
    FP.C.T. Patent Application Publication No. WO2015184443A1.
    GHaller et al., The Journal of pathology 238.5 (2016): 700-710.
    HWong et al., J Natl Cancer Inst 2016;108: djv307.
    IHaller et al., J. Pathol. 238(5): 700-10.
    JGang et al., Mod Pathol. 2016 Apr;29(4):359-69.
    KKonicek et al., Cancer research, Vol. 76, No. 14, Supp. Supplement. Abstract Number: 2647; 107th Annual Meeting of the American Association for Cancer Research, AACR 2016. New Orleans,LA; 16-20 Apr 2016.
    LDtilon et al., Cancer research, Vol. 76, No. 14, Supp. Supplement. Abstract Number: CT007; 107th Annual Meeting of the American Association for Cancer Research, AACR 2016. New Orleans,LA; 16-20 Apr 2016.
  • TABLE 7
    Exemplary TrkB Fusion Proteins and Cancers
    Non-limiting Exemplary
    Trk-and Synonyms of
    Fusion Protein Non-TrkB Fusion Partner Associated Cancer(s)
    NACC2-TrkB10 NACC Family Member 2, Pilocytic Astrocytoma
    BEN and BTB (POZ)
    Domain Containing
    QKI-TrkB10 QKI, KH Domain Pilocytic Astrocytoma
    Containing, RNA Binding
    AFAP1-TrkB7 Actin Filament Lower-grade Glioma,
    Associated Protein 1 In vitro (murine Ba/F3
    cells)B, Pilocytic
    astrocytoma with
    anaplasia (PAA)E
    PAN3-TrkB7 PAN3 Poly(A) Specific Head and Neck
    Ribonuclease Subunit Squamous Cell
    Carcinoma
    SQSTM1-TrkB7 Sequestosome 1 Lower-Grade Glioma
    TRIM24-TrkB7 Tripartite Motif Containing 24 Lung adenocarcinoma
    VCL-TrkB11 Vinculin Pediatric gliomas
    AGBL4-TrkB11 ATP/GTP Binding Protein- Pediatric gliomas
    Like 4
    DAB2IP-TrkB Disabled Homolog 2-
    Interacting Protein
    NTRK2-TERTA Telomerase Reverse Thyroid Cancer
    Transcriptase
    TEL-TrkBC ETS Variant 6 In vitro (murine
    (ETV6) Ba/F3 cells)
    QKI-TrkBD Protein Quaking Astrocytoma
    APCT Patent Application Publication No. WO 2015/183836A1
    BDrilon et al., Ann Oncol. 2016 May;27(5):920-6.
    CYuzugullu et al., Cell Discov. 2: 16030, 2016.
    DNi et al., Neuro Oncol. 2017 Jan;19(1):22-30.
    ELin et al., Neuro-Oncol, Vol. 18, Supp. Supplement 3, pp. iii58, Abstract Number: HG-48; 17th International Symposium on Pediatric Neuro-Oncology, ISPNO 2016. Liverpool, UK, 12 Jun 2016-15 Jun 2016.
  • TABLE 8
    Exemplary TrkC Fusion Proteins and Cancers
    Fusion Protein Non-TrkB Fusion Partner Non-limiting Exemplary Trk-and Synonyms of Associated Cancer(s)
    ETV6-TrkC11 ETS Variant 6 Salivary Gland Cancer, Secretory Breast Carcinoma, Acute Myeloid Leukemia,
    (TEL; or Fibrosarcoma, Nephroma, Melanoma, Colorectal Cancer (CRC), Breast Cancer,
    chromosomal Pediatric Gliomas, Thyroid Cancer (e.g., Papillary Thyroid Cancer), Infantile
    translocation Fibrosarcoma, Soft Tissue Hemangioma, Gastrointestinal Stromal Tumor (GIST)
    t(12;15) (e.g., c-kit-negative GIST), Mammary Carcinoma (e.g., Mammary Analogue
    (p13;q25))J Secretory Carcinoma, Secretory Breast Carcinoma (SBSC)K, Congenital
    Fibrosarcoma, Acute Myelogenous Leukemia, Polymorphous low-grade
    adenocarcinomaD, ALK-negative inflammatory myofibroblastic tumors (IMT)E,
    Infantile Fibrosarcoma (IFS)F, Acinic cell carcinoma (AcCC)G, Cellular
    mesoblastic nephromaH, Promyelocytic leukemiaI, Burkitt LymphomaI, B-cell
    lymphomaI, multiple myelomaI, medulloblastomaI, neuroblastomaI, ovarian
    cancerI, intestinal cancerI
    BTBD1-TrkC11 BTB (POZ) Domain Pediatric Gliomas
    Containing 1
    LYN-TrkC7 V-Yes-1 Yamaguchi Sarcoma Head and Neck Squamous Cell Carcinoma
    Viral Related Oncogene
    Homolog (also known as
    Lck/Yes-Related Novel
    Protein Tyrosine Kinase)
    RBPMS-TrkC7 RNA Binding Protein with Thyroid Cancer (e.g., Papillary Thyroid Cancer)
    Multiple Splicing
    EML4-TrkCA Echinoderm Microtubule- Fibrosarcoma (e.g., Pediatric FibrosarcomaL)
    Associated Protein-Like 4
    HOMER2-TrkC Homer Protein Homolog 2 Soft Tissue Sarcoma
    TFG-TrkC TRK-Fused Gene Soft Tissue Solitary Fibrous Tumor
    FAT1-TrkC FAT Atypical Cadherin 1 Cervical Squamous Cell CarcinomaB
    MYO5A-TrkC Myosin VA Spitz tumorC
    MYH9-TrkC Myosin Heavy Chain 9 Spitz tumorC
    ATannenbaum et al., Cold Spring Harb. Mol. Case Stud. 1: a000471, 2015.
    BU.S. Patent Application Publication No. 2015/0315657.
    CYeh et al., J Pathol. 240(3): 282-90, 2016
    DMontalli et al., J Oral Pathol Med. doi: 10.1111/jop.12491, 2016
    EAlassiri et al., Am J Surg Pathol. 2016 Aug;40(8):1051-61.
    FNagasubramanian et al., Pediatr Blood Cancer. 2016 Aug;63(8):1468-70.
    GChintakuntlawar et al., Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 May;121(5):542-549.e1.
    HU.S. Patent Application Publication No. US15030713A.
    IU.S. Patent Application Publication No. US9447135B2.
    JSkalova et al., Modern Pathology 30, S27-S43, 2017.
    KHyrcza et al., Vol. 469, Supp. Supplement 1, pp. S17. Abstract Number: OFP-1997-7; 31st International Congress of the International Academy of Pathology and the 28th Congress of the European Society of Pathology, Cologne, Germany. 25-29 September 2016.
    LSims et al., Journal of Immunotherapy of Cancer, Vol. 4, Supp. Supplement 1; Abstract Number: P280; 31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer, SITC 2016. National Harbor, MD; 9-13 November 2016.
  • In some embodiments, the dysregulation of a TRK gene, a TRK kinase, or expression or activity or level of any of the same, includes at least one point mutation in a TRK gene that results in the production of a TRK kinase that has one or more amino acid substitutions, insertions, or deletions as compared to the wild-type TRK kinase.
  • In some embodiments, a TRK-associated cancer has been identified as having one or more TRK inhibitor resistance mutations (that result in an increased resistance to a TRK inhibitor.
  • Accordingly, provided herein are methods for treating a patient diagnosed with (or identified as having) a cancer that include administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. Also provided herein are methods for treating a patient identified or diagnosed as having a ROS1-associated cancer that include administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof. In some embodiments, the patient that has been identified or diagnosed as having a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved test or assay for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the patient or by performing any of the non-limiting examples of assays described herein. In some embodiments, the test or assay is provided as a kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the cancer is a ROS1-associated cancer. For example, the ROS1-associated cancer can be a cancer that includes one or more ROS1 inhibitor resistance mutations.
  • Also provided are methods for treating cancer in a patient in need thereof, the method comprising: (a) determining if the cancer in the patient is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and (b) if the cancer is determined to be associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof. Some embodiments of these methods further include administering to the subject one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor). In some embodiments, one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor) are administered before a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor) are administered after a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor) are administered with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the subject was previously treated with a first ROS1 inhibitor or previously treated with another anticancer treatment, e.g., treatment with another anticancer agent, resection of the tumor or radiation therapy. In some embodiments, the subject was previously treated with an ALK inhibitor, a TRK inhibitor, or both. In some embodiments, the patient is determined to have a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved test or assay for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the patient or by performing any of the non-limiting examples of assays described herein. In some embodiments, the test or assay is provided as a kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the cancer is a ROS1-associated cancer. For example, the ROS1-associated cancer can be a cancer that includes one or more ROS1 inhibitor resistance mutations.
  • Also provided are methods of treating a patient that include performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and administering (e.g., specifically or selectively administering) a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof to the patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. Some embodiments of these methods further include administering to the subject one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor). In some embodiments, one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor) are administered before a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, one or more additional anticancer agents (e.g., a second ROS1 inhibitor (e.g., a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof), an ALK inhibitor, and/or a TRK inhibitor) are administered after a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, one or more additional anticancer agents (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor) are administered with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments of these methods, the subject was previously treated with a first ROS1 inhibitor or previously treated with another anticancer treatment, e.g., treatment with another anticancer agent, resection of a tumor or radiation therapy. In some embodiments, the subject was previously treated with an ALK inhibitor, a TRK inhibitor, or both. In some embodiments, the patient is a patient suspected of having a ROS1-associated cancer, a patient presenting with one or more symptoms of a ROS1-associated cancer, or a patient having an elevated risk of developing a ROS1-associated cancer. In some embodiments, the assay utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH). In some embodiments, the assay is a regulatory agency-approved assay, e.g., FDA-approved kit. In some embodiments, the assay is a liquid biopsy. Additional, non-limiting assays that may be used in these methods are described herein. Additional assays are also known in the art. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • Also provided is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof for use in treating a ROS1-associated cancer in a patient identified or diagnosed as having a ROS1-associated cancer through a step of performing an assay (e.g., an in vitro assay) on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, where the presence of a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, identifies that the patient has a ROS1-associated cancer. Also provided is the use of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for the manufacture of a medicament for treating a ROS1-associated cancer in a patient identified or diagnosed as having a ROS1-associated cancer through a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same where the presence of dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, identifies that the patient has a ROS1-associated cancer. Some embodiments of any of the methods or uses described herein further include recording in the patient's clinical record (e.g., a computer readable medium) that the patient is determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, through the performance of the assay, should be administered a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof. In some embodiments, the assay utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH). In some embodiments, the assay is a regulatory agency-approved assay, e.g., FDA-approved kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • Also provided is a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, for use in the treatment of a cancer in a patient in need thereof or a patient identified or diagnosed as having a ROS1-associated cancer. Also provided is the use of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for the manufacture of a medicament for treating a cancer in a patient identified or diagnosed as having a ROS1-associated cancer. In some embodiments, the cancer is a ROS1-associated cancer, for example, a ROS1-associated cancer having one or more ROS1 inhibitor resistance mutations. In some embodiments, a patient is identified or diagnosed as having a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved, kit for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the sample. As provided herein, a ROS1-associated cancer includes those described herein and known in the art.
  • In some embodiments of any of the methods or uses described herein, the patient has been identified or diagnosed as having a cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. In some embodiments of any of the methods or uses described herein, the patient has a tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. In some embodiments of any of the methods or uses described herein, the patient can be a patient with a tumor(s) that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. In some embodiments of any of the methods or uses described herein, the patient can be a patient whose tumors have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. In some embodiments of any of the methods or uses described herein, the patient is suspected of having a ROS1-associated cancer (e.g., a cancer having one or more ROS1 inhibitor resistance mutations). In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a patient in need of such treatment, the method comprising a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the patient; and b) administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more fusion proteins. Non-limiting examples of ROS1 gene fusion proteins are described in Table 2. In some embodiments, the fusion protein is SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more ROS1 kinase protein point mutations, insertions, and/or deletions. Non-limiting examples of ROS1 kinase protein point mutations are described in Table 3 and Table 3a. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations. Non-limiting examples of ROS1 inhibitor resistance mutations are described in Table 4. In some embodiments, the ROS1 inhibitor resistance mutation is selected from the group consisting of L2026M, G2032R, and D2033N. In some embodiments, the cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is a tumor positive for one or more ROS1 inhibitor resistance mutations. In some embodiments, the tumor with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit. In some embodiments, the assay is a liquid biopsy.
  • In some embodiments of any of the methods or uses described herein, the patient has a clinical record indicating that the patient has a tumor that has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same (e.g., a tumor having one or more ROS1 inhibitor resistance mutations). In some embodiments, the clinical record indicates that the patient should be treated with one or more of the compounds of Formula I or a pharmaceutically acceptable salts or solvates thereof or compositions provided herein. In some embodiments, the cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is a cancer having one or more ROS1 inhibitor resistance mutations. In some embodiments, the cancer with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the tumor that is positive for a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is a tumor positive for one or more ROS1 inhibitor resistance mutations. In some embodiments, the tumor with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same is determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit. In some embodiments, the assay is a liquid biopsy.
  • Also provided are methods of treating a patient that include administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to a patient having a clinical record that indicates that the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. Also provided is the use of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for the manufacture of a medicament for treating a ROS1-associated cancer in a patient having a clinical record that indicates that the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. Some embodiments of these methods and uses can further include: a step of performing an on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and recording the information in a patient's clinical file (e.g., a computer readable medium) that the patient has been identified to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. In some embodiments, the assay is an in vitro assay. For example, an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH). In some embodiments, the assay is a regulatory agency-approved, e.g., FDA-approved, kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the dysregulation of a ROS1 gene, ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • Also provided herein is a method of treating a subject. The method includes performing an assay on a sample obtained from the subject to determine whether the subject has a dysregulation of a ROS1 gene, a ROS1 protein, or expression or level of any of the same. The method also includes administering to a subject determined to have a dysregulation of a ROS1 gene, a ROS1 protein, or expression or activity, or level of any of the same a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the dysregulation in a ROS1 gene, a ROS1 kinase protein, or expression or activity of the same is a gene or chromosome translocation that results in the expression of a ROS1 fusion protein (e.g., any of the ROS1 fusion proteins described herein). In some embodiments, the ROS1 fusion can be selected from a SLC34A2 fusion, a CD74 fusion, a EZR fusion, a TPM3 fusion, or a SDC4 fusion. In some embodiments, the dysregulation in a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same is one or more point mutation in the ROS1 gene (e.g., any of the one or more of the ROS1 point mutations described herein). The one or more point mutations in a ROS1 gene can result, e.g., in the translation of a ROS1 protein having one or more of the following amino acid substitutions: A15G, R118N, G1025R, T1735M, R1948H, and R2072N. In some embodiments, the dysregulation in a ROS1 gene, a ROS1 kinase protein, or expression or activity or level of any of the same is one or more ROS1 inhibitor resistance mutations (e.g., any combination of the one or more ROS1 inhibitor resistance mutations described herein). The one or more point mutations in a ROS1 gene can result, e.g., in the translation of a ROS1 protein having one or more of the following amino acid substitutions: L2026M, G2032R, and D2033N. Some embodiments of these methods further include administering to the subject another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, an ALK inhibitor, and/or a TRK inhibitor).
  • Also provided are methods (e.g., in vitro methods) of selecting a treatment for a patient identified or diagnosed as having a ROS1-associated cancer. Some embodiments can further include administering the selected treatment to the patient identified or diagnosed as having a ROS1-associated cancer. For example, the selected treatment can include administration of a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. Some embodiments can further include a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and identifying and diagnosing a patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, as having a ROS1-associated cancer. In some embodiments, the cancer is a ROS1-associated cancer having one or more ROS1 inhibitor resistance mutations. In some embodiments, the patient has been identified or diagnosed as having a ROS1-associated cancer through the use of a regulatory agency-approved, e.g., FDA-approved, kit for identifying dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, in a patient or a biopsy sample from the patient. In some embodiments, the assay is a liquid biopsy. In some embodiments, the ROS1-associated cancers is a cancer described herein or known in the art. In some embodiments, the assay is an in vitro assay. For example, an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH). In some embodiments, the assay is a regulatory agency-approved, e.g., FDA-approved, kit. In some embodiments, the assay is a liquid biopsy.
  • Also provided herein are methods of selecting a treatment for a patient, wherein the methods include a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same (e.g., one or more ROS1 inhibitor resistance mutations), and identifying or diagnosing a patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, as having a ROS1-associated cancer. Some embodiments further include administering the selected treatment to the patient identified or diagnosed as having a ROS1-associated cancer. For example, the selected treatment can include administration of a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to the patient identified or diagnosed as having a ROS1-associated cancer. In some embodiments, the assay is an in vitro assay. For example, an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH). In some embodiments, the assay is a regulatory agency-approved, e.g., FDA-approved, kit. In some embodiments, the assay is a liquid biopsy.
  • Also provided are methods of selecting a patient for treatment, wherein the methods include selecting, identifying, or diagnosing a patient having a ROS1-associated cancer, and selecting the patient for treatment including administration of a therapeutically-effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, identifying or diagnosing a patient as having a ROS1-associated cancer can include a step of performing an assay on a sample obtained from the patient to determine whether the patient has a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, and identifying or diagnosing a patient determined to have a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same, as having a ROS1-associated cancer. In some embodiments, the method of selecting a treatment can be used as a part of a clinical study that includes administration of various treatments of a ROS1-associated cancer. In some embodiments, a ROS1-associated cancer is a cancer having one or more ROS1 inhibitor resistance mutations. In some embodiments, the assay is an in vitro assay. For example, an assay that utilizes next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH). In some embodiments, the assay is a regulatory agency-approved, e.g., FDA-approved, kit. In some embodiments, the assay is a liquid biopsy. In some embodiments, the dysregulation of the ROS1 gene, the ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations.
  • In some embodiments of any of the methods or uses described herein, an assay used to determine whether the patient has a dysregulation of a ROS1 gene, or a ROS1 kinase, or expression or activity or level of any of the same, using a sample from a patient can include, for example, next generation sequencing, pyrosequencing, immunohistochemistry, an enzyme-linked immunosorbent assay, and/or fluorescence in situ hybridization (FISH) (e.g., break apart FISH or dual-fusion FISH), fluorescence microscopy, Southern blotting, Western blotting, FACS analysis, Northern blotting, and PCR-based amplification (e.g., RT-PCR and quantitative real-time RT-PCR). As is well-known in the art, the assays are typically performed, e.g., with at least one labelled nucleic acid probe or at least one labelled antibody or antigen-binding fragment thereof. Assays can utilize other detection methods known in the art for detecting dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or levels of any of the same (see, e.g., the references cited herein). In some embodiments, the dysregulation of the ROS1 gene, the ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations. In some embodiments, the sample is a biological sample or a biopsy sample (e.g., a paraffin-embedded biopsy sample) from the patient. In some embodiments, the patient is a patient suspected of having a ROS1-associated cancer, a patient having one or more symptoms of a ROS1-associated cancer, and/or a patient that has an increased risk of developing a ROS1-associated cancer).
  • In some embodiments, dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same can be identified using a liquid biopsy (variously referred to as a fluid biopsy or fluid phase biopsy). See, e.g., Karachialiou et al., “Real-time liquid biopsies become a reality in cancer treatment”, Ann. Transl. Med., 3(3):36, 2016. Liquid biopsy methods can be used to detect total tumor burden and/or the dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same. Liquid biopsies can be performed on biological samples obtained relatively easily from a subject (e.g., via a simple blood draw) and are generally less invasive than traditional methods used to detect tumor burden and/or dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same. In some embodiments, liquid biopsies can be used to detect the presence of dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same at an earlier stage than traditional methods. In some embodiments, the biological sample to be used in a liquid biopsy can include, blood, plasma, urine, cerebrospinal fluid, saliva, sputum, broncho-alveolar lavage, bile, lymphatic fluid, cyst fluid, stool, ascites, and combinations thereof. In some embodiments, a liquid biopsy can be used to detect circulating tumor cells (CTCs). In some embodiments, a liquid biopsy can be used to detect cell-free DNA. In some embodiments, cell-free DNA detected using a liquid biopsy is circulating tumor DNA (ctDNA) that is derived from tumor cells. Analysis of ctDNA (e.g., using sensitive detection techniques such as, without limitation, next-generation sequencing (NGS), traditional PCR, digital PCR, or microarray analysis) can be used to identify dysregulation of a RET gene, a RET kinase, or the expression or activity or level of any of the same.
  • In some embodiments, ctDNA derived from a single gene can be detected using a liquid biopsy. In some embodiments, ctDNA derived from a plurality of genes (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 or more, or any number of genes in between these numbers) can be detected using a liquid biopsy. In some embodiments, ctDNA derived from a plurality of genes can be detected using any of a variety of commercially-available testing panels (e.g., commercially-available testing panels designed to detect dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same ). Liquid biopsies can be used to detect dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same including, without limitation, point mutations or single nucleotide variants (SNVs), copy number variants (CNVs), genetic fusions (e.g., translocations or rearrangements), insertions, deletions, or any combination thereof. In some embodiments, a liquid biopsy can be used to detect a germline mutation. In some embodiments, a liquid biopsy can be used to detect a somatic mutation. In some embodiments, a liquid biopsy can be used to detect a primary genetic mutation (e.g., a primary mutation or a primary fusion that is associated with initial development of a disease, e.g., cancer). In some embodiments, a liquid biopsy can be used to detect a genetic mutation that develops after development of the primary genetic mutation (e.g., a resistance mutation that arises in response to a treatment administered to a subject). In some embodiments, a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same identified using a liquid biopsy is also present in a cancer cell that is present in the subject (e.g., in a tumor). In some embodiments, any of the types of dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same described herein can be detected using a liquid biopsy. In some embodiments, a genetic mutation identified via a liquid biopsy can be used to identify the subject as a candidate for a particular treatment. For example, detection of dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in the subject can indicate that the subject will be responsive to a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt thereof.
  • Liquid biopsies can be performed at multiple times during a course of diagnosis, a course of monitoring, and/or a course of treatment to determine one or more clinically relevant parameters including, without limitation, progression of the disease, efficacy of a treatment, or development of resistance mutations after administering a treatment to the subject. For example, a first liquid biopsy can be performed at a first time point and a second liquid biopsy can be performed at a second time point during a course of diagnosis, a course of monitoring, and/or a course of treatment. In some embodiments, the first time point can be a time point prior to diagnosing a subject with a disease (e.g., when the subject is healthy), and the second time point can be a time point after subject has developed the disease (e.g., the second time point can be used to diagnose the subject with the disease). In some embodiments, the first time point can be a time point prior to diagnosing a subject with a disease (e.g., when the subject is healthy), after which the subject is monitored, and the second time point can be a time point after monitoring the subject. In some embodiments, the first time point can be a time point after diagnosing a subject with a disease, after which a treatment is administered to the subject, and the second time point can be a time point after the treatment is administered; in such cases, the second time point can be used to assess the efficacy of the treatment (e.g., if the genetic mutation(s) detected at the first time point are reduced in abundance or are undetectable) or to determine the presence of a resistance mutation that has arisen as a result of the treatment. In some embodiments, a treatment to be administered to a subject can include a compound of Formula I or a pharmaceutically acceptable salt thereof.
  • In the field of medical oncology it is normal practice to use a combination of different forms of treatment to treat each patient with cancer. In medical oncology the other component(s) of such conjoint treatment or therapy in addition to compositions provided herein may be, for example, surgery, radiotherapy, and chemotherapeutic agents, such as kinase inhibitors, signal transduction inhibitors and/or monoclonal antibodies. Compounds of Formula I therefore may also be useful as adjuvants to cancer treatment, that is, they can be used in combination with one or more additional therapies or therapeutic agents, for example a chemotherapeutic agent that works by the same or by a different mechanism of action.
  • In some embodiments of any the methods described herein, the compound of Formula I (or a pharmaceutically acceptable salt or solvate thereof) is administered in combination with a therapeutically effective amount of at least one additional therapeutic agent selected from one or more additional therapies or therapeutic (e.g., chemotherapeutic) agents.
  • Non-limiting examples of additional therapeutic agents include: other ROS1-targeted therapeutic agents (i.e. a first or second ROS1 kinase inhibitor), ALK-targeted therapeutic agents (e.g., ALK kinase inhibitors), receptor tyrosine kinase-targeted therapeutic agents (e.g., TRK kinase inhibitors), kinase targeted therapeutics, signal transduction pathway inhibitors, checkpoint inhibitors, modulators of the apoptosis pathway (e.g. obataclax); cytotoxic chemotherapeutics, angiogenesis-targeted therapies, immune-targeted agents, including immunotherapy, and radiotherapy.
  • In some embodiments, the other ROS1-targeted therapeutic is a multikinase inhibitor exhibiting ROS1 inhibition activity. In some embodiments, the other ROS1-targeted therapeutic inhibitor is selective for a ROS1 kinase. Exemplary ROS1 kinase inhibitors can exhibit inhibition activity (IC50) against a ROS1 kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein. In some embodiments, a ROS1 kinase inhibitor can exhibit inhibition activity (IC50) against a ROS1 kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay as provided herein.
  • Non-limiting examples of ROS1-targeted therapeutic agents include (E)-5-chloro-2-(2-(1-(4-fluorophenyl)ethylidene)hydrazinyl)-N-(2-(isopropylsulfonyl)phenyl)pyrimidin-4-amine (Eur. J. Org. Chem. 2016, 123, 80-89); alectinib; brigatinib; cabozantinib; ceritinib; crizotinib; entrectinib; foretinib; herbimycin A; lorlatinib; lorlatinib des-methyl analogs; merestinib; ASP3026 (NCT01284192; Astellas Pharma); AZD3634 (AstraZeneca); and ASP3026 (Astrellas Pharma).
  • In some embodiments, an ALK-targeted therapeutic is a multikinase inhibitor exhibiting ALK inhibition activity. In some embodiments, the ALK-targeted therapeutic inhibitor is selective for an ALK kinase. Exemplary ALK kinase inhibitors can exhibit inhibition activity (IC50) against an ALK kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein. In some embodiments, an ALK kinase inhibitor can exhibit inhibition activity (IC50) against an ALK kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay.
  • Non-limiting examples of ALK-targeted therapeutic agents include “Amgen 36”; “Amgen 49”; “Cephalon 30”; “Chugai 13d”; 4-arylaminopyrimidine derivatives (see, e.g., Eur. J. Med. Chem. 2016, 123, 80-99); alectinib; anti-ALK monoclonal antibodies; brigatinib; ceritinib; crizotinib; dorsomorphin; ensartinib; entrectinib; ganetespib; lorlatinib; PF-02341066 (Pfizer); IPI-504 (Infinity); TSR-011 (Tesaro, Inc.); CT-707 (Centaurus Biopharma); AUY922; TEW-7197 (Medpacto); CEP-28122 (Teva Pharmaceuticals); CEP-37440 (Teva Pharmaceuticals); ASP3026 (Astellas Pharma); 17-AAG; IPI-504; GSK 1838705 (GlaxoSmithKline); KRCA 0008; AZD3463 (AstraZeneca); NVP-TAE684 (Novartis); “3-39” (Novartis); LDN193189; SB 525334; SB 505124; and TAE684.
  • In some embodiments, a receptor tyrosine kinase targeted therapeutic is a multikinase inhibitor (e.g., TRK-targeted therapeutic inhibitor) exhibiting TRK inhibition activity. In some embodiments, the TRK-targeted therapeutic inhibitor is selective for a TRK kinase. Exemplary TRK kinase inhibitors can exhibit inhibition activity (IC50) against a TRK kinase of less than about 1000 nM, less than about 500 nM, less than about 200 nM, less than about 100 nM, less than about 50 nM, less than about 25 nM, less than about 10 nM, or less than about 1 nM as measured in an assay as described herein. In some embodiments, a TRK kinase inhibitor can exhibit inhibition activity (IC50) against a TRK kinase of less than about 25 nM, less than about 10 nM, less than about 5 nM, or less than about 1 nM as measured in an assay. For example, a TRK inhibitor assay can be any of those provided in U.S. Pat. No. 8,933,084 (e.g., Example A or B).
  • Non-limiting examples of receptor tyrosine kinase (e.g., Trk) targeted therapeutic agents, include afatinib, cabozantinib, cetuximab, crizotinib, dabrafenib, entrectinib, erlotinib, gefitinib, imatinib, lapatinib, lestaurtinib, nilotinib, pazopanib, panitumumab, pertuzumab, sunitinib, trastuzumab, 1-((3 S,4R)-4-(3-fluorophenyl)-1-(2-methoxyethyl)pyrrolidin-3-yl)-3-(4-methyl-3-(2-methylpyrimidin-5-yl)-1-phenyl-1H-pyrazol-5-yl)urea, AG 879, AR-772, AR-786, AR-256, AR-618, AZ-23, AZ623, DS-6051, Go 6976, GNF-5837, GTx-186, GW 441756, LOXO-101, MGCD516, PLX7486, RXDX101, TPX-0005, and TSR-011. Additional Trk targeted therapeutic agents include those described in U.S. Pat. Nos. 8,450,322; 8,513,263; 8,933,084; 8,791,123; 8,946,226; 8,450,322; 8,299,057; and 8,912,194; U.S. Publication No. 2016/0137654; 2015/0166564; 2015/0051222; 2015/0283132; and 2015/0306086; International Publication No. WO 2010/033941; WO 2010/048314; WO 2016/077841; WO 2011/146336; WO 2011/006074; WO 2010/033941; WO 2012/158413; WO 2014078454; WO 2014078417; WO 2014078408; WO 2014078378; WO 2014078372; WO 2014078331; WO 2014078328; WO 2014078325; WO 2014078323; WO 2014078322; WO 2015175788; WO 2009/013126; WO 2013/174876; WO 2015/124697; WO 2010/058006; WO 2015/017533; WO 2015/112806; WO 2013/183578; and WO 2013/074518, all of which are hereby incorporated by reference in their entireties.
  • Further examples of Trk inhibitors can be found in U.S. Pat. No. 8,637,516, International Publication No. WO 2012/034091, U.S. Pat. No. 9,102,671, International Publication No. WO 2012/116217, U.S. Publication No. 2010/0297115, International Publication No. WO 2009/053442, U.S. Pat. No. 8,642,035, International Publication No. WO 2009092049, U.S. Pat. No. 8,691,221, International Publication No. WO2006131952, all of which are incorporated by reference in their entireties herein. Exemplary Trk inhibitors include GNF-4256, described in Cancer Chemother. Pharmacol. 75(1):131-141, 2015; and GNF-5837 (N-[3-[[2,3-dihydro-2-oxo-3-(1H-pyrrol-2-ylmethylene)-1H-indol-6-yl]amino]-4-methylphenyl]-N′-[2-fluoro-5-(trifluoromethyl)phenyl]-urea), described in ACS Med. Chem. Lett. 3(2):140-145, 2012, each of which is incorporated by reference in its entirety herein.
  • Additional examples of Trk inhibitors include those disclosed in U.S. Publication No. 2010/0152219, U.S. Pat. No. 8,114,989, and International Publication No. WO 2006/123113, all of which are incorporated by reference in their entireties herein. Exemplary Trk inhibitors include AZ623, described in Cancer 117(6):1321-1391, 2011; AZD6918, described in Cancer Biol. Ther. 16(3):477-483, 2015; AZ64, described in Cancer Chemother. Pharmacol. 70:477-486, 2012; AZ-23 ((S)-5-Chloro-N2-(1-(5-fluoropyridin-2-yl)ethyl)-N4-(5-isopropoxy-1H-pyrazol-3-yl)pyrimidine-2,4-diamine), described in Mol. Cancer Ther. 8:1818-1827, 2009; and AZD7451; each of which is incorporated by reference in its entirety.
  • A Trk inhibitor can include those described in U.S. Pat. Nos. 7,615,383; 7,384,632; 6,153,189; 6,027,927; 6,025,166; 5,910,574; 5,877,016; and 5,844,092, each of which is incorporated by reference in its entirety.
  • Further examples of Trk inhibitors include CEP-751, described in Int. J. Cancer 72:672-679, 1997; CT327, described in Acta Derm. Venereol. 95:542-548, 2015; compounds described in International Publication No. WO 2012/034095; compounds described in U.S. Pat. No. 8,673,347 and International Publication No. WO 2007/022999; compounds described in U.S. Pat. No. 8,338,417; compounds described in International Publication No. WO 2016/027754; compounds described in U.S. Pat. No. 9,242,977; compounds described in U.S. Publication No. 2016/0000783; sunitinib (N-(2-diethylaminoethyl)-5-[(Z)-(5-fluoro-2-oxo-1H-indol-3-ylidene)methyl]-2,4-dimethyl-1H-pyrrole-3-carboxamide), as described in PLoS One 9:e95628, 2014; compounds described in International Publication No. WO 2011/133637; compounds described in U.S. Pat. No. 8,637,256; compounds described in Expert. Opin. Ther. Pat. 24(7):731-744, 2014; compounds described in Expert Opin. Ther. Pat. 19(3):305-319, 2009; (R)-2-phenylpyrrolidine substituted imidazopyridazines, e.g., GNF-8625, (R)-1-(6-(6-(2-(3-fluorophenyl)pyrrolidin-1-yl)imidazo[1,2-b]pyridazin-3-yl)-[2,4′-bipyridin]-2′-yl)piperidin-4-ol as described in ACS Med. Chem. Lett. 6(5):562-567, 2015; GTx-186 and others, as described in PLoS One 8(12):e83380, 2013; K252a ((9S-(9α,10β,12α))-2,3,9,10,11,12-hexahydro-10-hydroxy-10-(methoxycarbonyl)-9-methyl-9,12-epoxy-1H-diindolo[1,2,3-fg:3′,2′,1′-kl]pyrrolo[3,4-i][1,6]benzodiazocin-1-one), as described in Mol. Cell Biochem. 339(1-2):201-213, 2010; 4-aminopyrazolylpyrimidines, e.g., AZ-23 (((S)-5-chloro-N2-(1-(5-fluoropyridin-2-yl)ethyl)-N4-(5-isopropoxy-1H-pyrazol-3-yl)pyrimidine-2,4-diamine)), as described in J. Med. Chem. 51(15):4672-4684, 2008; PHA-739358 (danusertib), as described in Mol. Cancer Ther. 6:3158, 2007; Go 6976 (5,6,7,13-tetrahydro-13-methyl-5-oxo-12H-indolo[2,3-a]pyrrolo[3,4-c]carbazole-12-propanenitrile), as described in J. Neurochem. 72:919-924, 1999; GW441756 ((3Z)-3-[(1-methylindol-3-yl)methylidene]-1H-pyrrolo[3,2-b]pyridin-2-one), as described in IJAE 115:117, 2010; milciclib (PHA-848125AC), described in J. Carcinog. 12:22, 2013; AG-879 ((2E)-3-[3,5-Bis(1,1-dimethylethyl)-4-hydroxyphenyl]-2-cyano-2-propenethioamide); altiratinib (N-(4-((2-(cyclopropanecarboxamido)pyridin-4-yl)oxy)-2,5-difluorophenyl)-N-(4-fluorophenyl)cyclopropane-1,1-dicarboxamide); cabozantinib (N-(4-((6,7-Dimethoxyquinolin-4-yl)oxy)phenyl)-N′-(4-fluorophenyl)cyclopropane-1,1-dicarboxamide); lestaurtinib ((5 S,6S,8R)-6-Hydroxy-6-(hydroxymethyl)-5-methyl-7,8,14,15-tetrahydro-5H-16-oxa-4b,8a,14-triaza-5,8-methanodibenzo[b,h]cycloocta[jkl]cyclopenta[e]-as-indacen-13(6H)-one); dovatinib (4-amino-5-fluoro-3-[6-(4-methylpiperazin-1-yl)-1H-benzimidazol-2-yl]quinolin-2(1H)-one mono 2-hydroxypropanoate hydrate); sitravatinib (N-(3-fluoro-4-((2-(5-(((2-methoxyethyl)amino)methyl)pyridin-2-yl)thieno[3,2-b]pyridin-7-yl)oxy)phenyl)-N-(4-fluorophenyl)cyclopropane-1,1-dicarboxamide); ONO-5390556; regorafenib (4-[4-({[4-Chloro-3-(trifluoromethyl)phenyl]carbamoyl}amino)-3-fluorophenoxy]-N-methylpyridine-2-carboxamide hydrate); and VSR-902A; all of the references above are incorporated by reference in their entireties herein.
  • The ability of a Trk inhibitor to act as a TrkA, TrkB, and/or Trk C inhibitor may be tested using the assays described in Examples A and B in U.S. Pat. No. 8,513,263, which is incorporated herein by reference.
  • In some embodiments, signal transduction pathway inhibitors include Ras-Raf-MEK-ERK pathway inhibitors (e.g., binimetinib, selumetinib, encorafinib, sorafenib, trametinib, and vemurafenib), PI3K-Akt-mTOR-S6K pathway inhibitors (e.g. everolimus, rapamycin, perifosine, temsirolimus), and other kinase inhibitors, such as baricitinib, brigatinib, capmatinib, danusertib, ibrutinib, milciclib, quercetin, regorafenib, ruxolitinib, semaxanib, AP32788, BLU285, BLU554, INCB39110, INCB40093, INCB50465, INCB52793, INCB54828, MGCD265, NMS-088, NMS-1286937, PF 477736 ((R)-amino-N-[5,6-dihydro-2-(1-methyl-1H-pyrazol-4-yl)-6-oxo-1Hpyrrolo[4,3,2-ef][2,3]benzodiazepin-8-yl]-cyclohexaneacetamide), PLX3397, PLX7486, PLX8394, PLX9486, PRN1008, PRN1371, RXDX103, RXDX106, RXDX108, and TG101209 (N-tert-butyl-3-(5-methyl-2-(4-(4-methylpiperazin-1-yl)phenylamino)pyrimidin-4-ylamino)benzenesulfonamide).
  • Non-limiting examples of checkpoint inhibitors include ipilimumab, tremelimumab, nivolumab, pidilizumab, MPDL3208A, MEDI4736, MSB0010718C, BMS-936559, BMS-956559, BMS-935559 (MDX-1105), AMP-224, and pembrolizumab.
  • In some embodiments, cytotoxic chemotherapeutics are selected from arsenic trioxide, bleomycin, cabazitaxel, capecitabine, carboplatin, cisplatin, cyclophosphamide, cytarabine, dacarbazine, daunorubicin, docetaxel, doxorubicin, etoposide, fluorouracil, gemcitabine, irinotecan, lomustine, methotrexate, mitomycin C, oxaliplatin, paclitaxel, pemetrexed, temozolomide, and vincristine.
  • Non-limiting examples of angiogenesis-targeted therapies include aflibercept and bevacizumab.
  • The term “immunotherapy” refers to an agent that modulates the immune system. In some embodiments, an immunotherapy can increase the expression and/or activity of a regulator of the immune system. In some embodiments, an immunotherapy can decrease the expression and/or activity of a regulator of the immune system. In some embodiments, an immunotherapy can recruit and/or enhance the activity of an immune cell.
  • In some embodiments, the immunotherapy is a cellular immunotherapy (e.g., adoptive T-cell therapy, dendritic cell therapy, natural killer cell therapy). In some embodiments, the cellular immunotherapy is sipuleucel-T (APC8015; Provenge™; Plosker (2011) Drugs 71(1): 101-108). In some embodiments, the cellular immunotherapy includes cells that express a chimeric antigen receptor (CAR). In some embodiments, the cellular immunotherapy is a CAR-T cell therapy. In some embodiments, the CAR-T cell therapy is tisagenlecleucel (Kymriah™).
  • In some embodiments, the immunotherapy is an antibody therapy (e.g., a monoclonal antibody, a conjugated antibody). In some embodiments, the antibody therapy is bevacizumab (Mvasti™, Avastin®), trastuzumab (Herceptin®), avelumab (Bavencio®), rituximab (MabThera™, Rituxan®), edrecolomab (Panorex), daratumuab (Darzalex®), olaratumab (Lartruvo™), ofatumumab (Arzerra®), alemtuzumab (Campath®), cetuximab (Erbitux®), oregovomab, pembrolizumab (Keytruda®), dinutiximab (Unituxin®), obinutuzumab (Gazyva®), tremelimumab (CP-675,206), ramucirumab (Cyramza®), ublituximab (TG-1101), panitumumab (Vectibix®), elotuzumab (Empliciti™), avelumab (Bavencio®), necitumumab (Portrazza™), cirmtuzumab (UC-961), ibritumomab (Zevalin®), isatuximab (SAR650984), nimotuzumab, fresolimumab (GC1008), lirilumab (INN), mogamulizumab (Poteligeo®), ficlatuzumab (AV-299), denosumab (Xgeva®), ganitumab, urelumab, pidilizumab or amatuximab.
  • In some embodiments, the immunotherapy is an antibody-drug conjugate. In some embodiments, the antibody-drug conjugate is gemtuzumab ozogamicin (Mylotarg™), inotuzumab ozogamicin (Besponsa®), brentuximab vedotin (Adcetris®), ado-trastuzumab emtansine (TDM-1; Kadcyla®), mirvetuximab soravtansine (IMGN853) or anetumab ravtansine
  • In some embodiments, the immunotherapy includes blinatumomab (AMG103; Blincyto®) or midostaurin (Rydapt).
  • In some embodiments, the immunotherapy includes a toxin. In some embodiments, the immunotherapy is denileukin diftitox (Ontak®).
  • In some embodiments, the immunotherapy is a cytokine therapy. In some embodiments, the cytokine therapy is an interleukin 2 (IL-2) therapy, an interferon alpha (IFNα) therapy, a granulocyte colony stimulating factor (G-CSF) therapy, an interleukin 12 (IL-12) therapy, an interleukin 15 (IL-15) therapy, an interleukin 7 (IL-7) therapy or an erythropoietin-alpha (EPO) therapy. In some embodiments, the IL-2 therapy is aldesleukin (Proleukin®). In some embodiments, the IFNα therapy is IntronA® (Roferon-A®). In some embodiments, the G-CSF therapy is filgrastim (Neupogen®).
  • In some embodiments, the immunotherapy is an immune checkpoint inhibitor. In some embodiments, the immunotherapy includes one or more immune checkpoint inhibitors. In some embodiments, the immune checkpoint inhibitor is a CTLA-4 inhibitor, a PD-1 inhibitor or a PD-L1 inhibitor. In some embodiments, the CTLA-4 inhibitor is ipilimumab (Yervoy®) or tremelimumab (CP-675,206). In some embodiments, the PD-1 inhibitor is pembrolizumab (Keytruda®) or nivolumab (Opdivo®). In some embodiments, the PD-L1 inhibitor is atezolizumab (Tecentriq®), avelumab (Bavencio®) or durvalumab (Imfinzi™).
  • In some embodiments, the immunotherapy is mRNA-based immunotherapy. In some embodiments, the mRNA-based immunotherapy is CV9104 (see, e.g., Rausch et al. (2014) Human Vaccin Immunother 10(11): 3146-52; and Kubler et al. (2015) J. Immunother Cancer 3:26).
  • In some embodiments, the immunotherapy is bacillus Calmette-Guerin (BCG) therapy.
  • In some embodiments, the immunotherapy is an oncolytic virus therapy. In some embodiments, the oncolytic virus therapy is talimogene alherparepvec (T-VEC; Imlygic®).
  • In some embodiments, the immunotherapy is a cancer vaccine. In some embodiments, the cancer vaccine is a human papillomavirus (HPV) vaccine. In some embodiments, the HPV vaccine is Gardasil®, Gardasil9® or Cervarix®. In some embodiments, the cancer vaccine is a hepatitis B virus (HBV) vaccine. In some embodiments, the HBV vaccine is Engerix-B®, Recombivax HB® or GI-13020 (Tarmogen®). In some embodiments, the cancer vaccine is Twinrix® or Pediarix®. In some embodiments, the cancer vaccine is BiovaxID®, Oncophage®, GVAX, ADXS11-001, ALVAC-CEA, PROSTVAC®, Rindopepimut®, CimaVax-EGF, lapuleucel-T (APC8024; Neuvenge™), GRNVAC1, GRNVAC2, GRN-1201, hepcortespenlisimut-L (Hepko-V5), DCVAX®, SCIB1, BMT CTN 1401, PrCa VBIR, PANVAC, ProstAtak®, DPX-Survivac, or viagenpumatucel-L (HS-110).
  • In some embodiments, the immunotherapy is a peptide vaccine. In some embodiments, the peptide vaccine is nelipepimut-S(E75) (NeuVax™), IMA901, or SurVaxM (SVN53-67). In some embodiments, the cancer vaccine is an immunogenic personal neoantigen vaccine (see, e.g., Ott et al. (2017) Nature 547: 217-221; Sahin et al. (2017) Nature 547: 222-226). In some embodiments, the cancer vaccine is RGSH4K, or NEO-PV-01. In some embodiments, the cancer vaccine is a DNA-based vaccine. In some embodiments, the DNA-based vaccine is a mammaglobin-A DNA vaccine (see, e.g., Kim et al. (2016) Oncolmmunology 5(2): e1069940).
  • In some embodiments, immune-targeted agents are selected from aldesleukin, interferon alfa-2b, ipilimumab, lambrolizumab, nivolumab, prednisone, and sipuleucel-T.
  • Non-limiting examples of radiotherapy include radioiodide therapy, external-beam radiation, and radium 223 therapy.
  • Additional kinase inhibitors include those described in, for example, U.S. Pat. Nos. 7,514,446; 7,863,289; 8,026,247; 8,501,756; 8,552,002; 8,815,901; 8,912,204; 9,260,437; 9,273,051; U.S. Publication No. US 2015/0018336; International Publication No. WO 2007/002325; WO 2007/002433; WO 2008/080001; WO 2008/079906; WO 2008/079903; WO 2008/079909; WO 2008/080015; WO 2009/007748; WO 2009/012283; WO 2009/143018; WO 2009/143024; WO 2009/014637; 2009/152083; WO 2010/111527; WO 2012/109075; WO 2014/194127; WO 2015/112806; WO 2007/110344; WO 2009/071480; WO 2009/118411; WO 2010/031816; WO 2010/145998; WO 2011/092120; WO 2012/101032; WO 2012/139930; WO 2012/143248; WO 2012/152763; WO 2013/014039; WO 2013/102059; WO 2013/050448; WO 2013/050446; WO 2014/019908; WO 2014/072220; WO 2014/184069; and WO 2016/075224, all of which are hereby incorporated by reference in their entireties.
  • Further examples of kinase inhibitors include those described in, for example, WO 2016/081450; WO 2016/022569; WO 2016/011141; WO 2016/011144; WO 2016/011147; WO 2015/191667; WO 2012/101029; WO 2012/113774; WO 2015/191666; WO 2015/161277; WO 2015/161274; WO 2015/108992; WO 2015/061572; WO 2015/058129; WO 2015/057873; WO 2015/017528; WO/2015/017533; WO 2014/160521; and WO 2014/011900, each of which is hereby incorporated by reference in its entirety.
  • In some embodiments, a kinase inhibitor as provided herein may have activity against more than one kinase (i.e. may be a multikinase inhibitor). When more than one mechanism of action is recited in a method herein (e.g., ROS1, ALK, or TRK kinase inhibition), each of the compounds recited are structurally distinct from one another (e.g., the ROS1 inhibitor and the TRK inhibitor are not the same compound).
  • Accordingly, also provided herein is a method of treating cancer, comprising administering to a patient in need thereof a pharmaceutical combination for treating cancer which comprises (a) a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, (b) an additional therapeutic agent, and (c) optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use for the treatment of cancer, wherein the amounts of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof and the additional therapeutic agent are together effective in treating the cancer.
  • These additional therapeutic agents may be administered with one or more doses of the compound of Formula I, or a pharmaceutically acceptable salt or solvate thereof, or pharmaceutical composition thereof, as part of the same or separate dosage forms, via the same or different routes of administration, and/or on the same or different administration schedules according to standard pharmaceutical practice known to one skilled in the art.
  • Also provided herein is (i) a pharmaceutical combination for treating a cancer in a patient in need thereof, which comprises (a) a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, (b) at least one additional therapeutic agent (e.g., any of the exemplary additional therapeutic agents described herein or known in the art), and (c) optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use for the treatment of cancer, wherein the amounts of the compound of Formula I or pharmaceutically acceptable salt or solvate thereof and of the additional therapeutic agent are together effective in treating the cancer; (ii) a pharmaceutical composition comprising such a combination; (iii) the use of such a combination for the preparation of a medicament for the treatment of cancer; and (iv) a commercial package or product comprising such a combination as a combined preparation for simultaneous, separate or sequential use; and to a method of treatment of cancer in a patient in need thereof. In some embodiments the patient is a human. In some embodiments, the cancer is a ROS1-associated cancer, e.g., a ROS1-associated cancer having one or more ROS1 inhibitor resistance mutations.
  • The term “pharmaceutical combination”, as used herein, refers to a pharmaceutical therapy resulting from the mixing or combining of more than one active ingredient and includes both fixed and non-fixed combinations of the active ingredients. The term “fixed combination” means that a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof and at least one additional therapeutic agent (e.g., a chemotherapeutic agent), are both administered to a patient simultaneously in the form of a single composition or dosage. The term “non-fixed combination” means that a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof and at least one additional therapeutic agent (e.g., chemotherapeutic agent) are formulated as separate compositions or dosages such that they may be administered to a patient in need thereof simultaneously, concurrently or sequentially with variable intervening time limits (e.g., 1 hour, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months), wherein such administration provides effective levels of the two or more compounds in the body of the patient. These also apply to cocktail therapies, e.g. the administration of three or more active ingredients
  • Accordingly, also provided herein is a method of treating a cancer, comprising administering to a patient in need thereof a pharmaceutical combination for treating cancer which comprises (a) a compound of Formula I or pharmaceutically acceptable salt or solvate thereof, (b) an additional therapeutic agent, and (c) optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use for the treatment of cancer, wherein the amounts of the compound of Formula I or pharmaceutically acceptable salt or solvate thereof and the additional therapeutic agent are together effective in treating the cancer. In some embodiments, the compound of Formula I or pharmaceutically acceptable salt or solvate thereof, and the additional therapeutic agent are administered simultaneously as separate dosages. In some embodiments, the compound of Formula I or pharmaceutically acceptable salt or solvate thereof, and the additional therapeutic agent are administered as separate dosages sequentially in any order, in jointly therapeutically effective amounts, e.g. in daily or intermittently dosages. In some embodiments, the compound of Formula I or pharmaceutically acceptable salt or solvate thereof, and the additional therapeutic agent are administered simultaneously as a combined dosage. In some embodiments, the cancer is a ROS1-associated cancer. For example, a ROS1-associated cancer having one or more ROSlinhibitor resistance mutations.
  • Also provided herein is a method of treating a disease or disorder mediated by ROS1 in a patient in need of such treatment, the method comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof. In some embodiments, the disease or disorder mediated by ROS1 is a dysregulation of ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same. For example, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same includes one or more ROS1 inhibitor resistance mutations. A disease or disorder mediated by ROS1 can include any disease, disorder or condition that is directly or indirectly linked to expression or activity of ROS1, including overexpression and/or abnormal activity levels. In some embodiments, the disease is cancer (e.g., a ROS1-associated cancer). In some embodiments, the cancer is any of the cancers or ROS1-associated cancers described herein.
  • Although the genetic basis of tumorigenesis may vary between different cancer types, the cellular and molecular mechanisms required for metastasis appear to be similar for all solid tumor types. During a metastatic cascade, the cancer cells lose growth inhibitory responses, undergo alterations in adhesiveness and produce enzymes that can degrade extracellular matrix components. This leads to detachment of tumor cells from the original tumor, infiltration into the circulation through newly formed vasculature, migration and extravasation of the tumor cells at favorable distant sites where they may form colonies. A number of genes have been identified as being promoters or suppressors of metastasis.
  • Accordingly, also provided herein are methods for inhibiting, preventing, aiding in the prevention, or decreasing the symptoms of metastasis of a cancer in a patient in need thereof, the method comprising administering to the patient a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof or a pharmaceutical composition thereof. Such methods can be used in the treatment of one or more of the cancers described herein. See, e.g., US Publication No. 2013/0029925; International Publication No. WO 2014/083567; and U.S. Pat. No. 8,568,998. In some embodiments, the cancer is a ROS1-associated cancer. In some embodiments, the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is used in combination with an additional therapy or another therapeutic agent, including a chemotherapeutic agent, such as a kinase inhibitor, for example, a first or second ROS1 kinase inhibitor.
  • The term “metastasis” is an art known term and means the formation of an additional tumor (e.g., a solid tumor) at a site distant from a primary tumor in a subject or patient, where the additional tumor includes the same or similar cancer cells as the primary tumor.
  • Also provided are methods of decreasing the risk of developing a metastasis or an additional metastasis in a patient having a ROS1-associated cancer that include: selecting, identifying, or diagnosing a patient as having a ROS1-associated cancer, and administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to the patient selected, identified, or diagnosed as having a ROS1-associated cancer. Also provided are methods of decreasing the risk of developing a metastasis or an additional metastasis in a patient having a ROS1-associated cancer that includes administering a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvent thereof to a patient having a ROS1-associated cancer. The decrease in the risk of developing a metastasis or an additional metastasis in a patient having a ROS1-associated cancer can be compared to the risk of developing a metastasis or an additional metastasis in the patient prior to treatment, or as compared to a patient or a population of patients having a similar or the same ROS1-associated cancer that has received no treatment or a different treatment. In some embodiments, the ROS1-associated cancer is a ROS1-associated cancer having one or more ROSlinhibitor resistance mutations.
  • The phrase “risk of developing a metastasis” means the risk that a subject or patient having a primary tumor will develop an additional tumor (e.g., a solid tumor) at a site distant from a primary tumor in a subject or patient over a set period of time, where the additional tumor includes the same or similar cancer cells as the primary tumor. Methods for reducing the risk of developing a metastasis in a subject or patient having a cancer are described herein.
  • The phrase “risk of developing additional metastases” means the risk that a subject or patient having a primary tumor and one or more additional tumors at sites distant from the primary tumor (where the one or more additional tumors include the same or similar cancer cells as the primary tumor) will develop one or more further tumors distant from the primary tumor, where the further tumors include the same or similar cancer cells as the primary tumor. Methods for reducing the risk of developing additional metastasis are described herein.
  • In some embodiments, the presence of one or more ROS1 inhibitor resistance mutations in a tumor causes the tumor to be more resistant to treatment with a first ROS1 inhibitor. Methods useful when a ROS1 inhibitor resistance mutation causes the tumor to be more resistant to treatment with a first ROS1 inhibitor are described below. For example, provided herein are methods of treating a subject having a cancer that include: identifying a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations; and administering to the identified subject a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is administered in combination with the first ROS1 inhibitor. Also provided are methods of treating a subject identified as having a cancer cell that has one or more ROS1 inhibitor resistance mutations that include administering to the subject a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is administered in combination with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • For example, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof selected from the group consisting of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • For example, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROSlin a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a first ROS1 inhibitor, wherein the first ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof selected from the group consisting of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the first ROS1 inhibitor of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • As another example, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more of the point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a second ROS1 inhibitor, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I, or a pharmaceutically acceptable salt of solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more of the point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering a second ROS1 inhibitor, wherein the second ROS1 inhibitor is selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib, as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (e) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations.
  • Also, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations. In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting a dysregulation of a ROS1 gene, a ROS1 kinase, or the expression or activity or level of any of the same in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations.
  • In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more ROS1 fusion proteins of Table 2 and/or one or more ROS1 kinase protein point mutations, insertions, and/or deletions (e.g., one or more of the point mutations of Table 3 or Table 3a) in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof selected from the group consisting of a compound of Formula I selected from Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations of Table 4; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations. In some embodiments, a second ROS1 inhibitor selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib is administered in step (d). In some embodiments, provided herein are methods for treating a ROS1-associated cancer in a subject in need of such treatment, the method comprising (a) detecting one or more of the fusion proteins SLC34A2-ROS1, CD74-ROS1, EZR-ROS1, TPM3-ROS1, or SDC4-ROS1 in a sample from the subject; and (b) administering to the subject a therapeutically effective amount of a compound of Formula I selected Example No. 2, 3, 7, 9, 14, 19, 20, 22, 33-A, 33-B, 35, 36, and 45, or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the methods further comprise (after (b)) (c) determining whether a cancer cell in a sample obtained from the subject has one or more of the ROS1 inhibitor resistance mutations L2026M, G2032R, or D2033N; and (d) administering additional doses of the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof of step (b) to the subject as a monotherapy or in conjunction with another anticancer agent (e.g., a second ROS1 inhibitor, a second compound of Formula I, an ALK inhibitor, a TRK inhibitor, or a pharmaceutically acceptable salt thereof) or anticancer therapy (e.g., surgery or radiation) if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations. In some embodiments, a second ROS1 inhibitor selected from the group consisting of alectinib, brigatinib, cabozantinib, ceritinib, crizotinib, entrectinib, foretinib, lorlatinib, and mesestinib is administered in step (d).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include: identifying a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations; and selecting a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with a first ROS1 inhibitor. In some embodiments, the compound of Formula I or a pharmaceutically acceptable salt or solvate thereof is administered in combination with the first ROS1 inhibitor. Also provided are methods of selecting a treatment for a subject having a cancer that include: selecting a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof for a subject identified as having a cancer cell that has one or more ROS1 inhibitor resistance mutations. Also provided are methods of selecting a subject having a cancer for a treatment that does not include a first ROS1 inhibitor as a monotherapy that include: identifying a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations; and selecting the identified subject for a treatment that includes a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. Also provided are methods of selecting a subject having a cancer for a treatment that does not include a first ROS1 inhibitor as a monotherapy that include: selecting a subject identified as having a cancer cell that has one or more ROS1 inhibitor resistance mutations for a treatment that includes administration of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. In some embodiments, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of determining the likelihood that a subject having a cancer (e.g., a ROS1-associated cancer) will have a positive response to treatment with a first ROS1 inhibitor as a monotherapy that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has a decreased likelihood of having a positive response (i.e. an increased likelihood of having a negative response) to treatment with a first ROS1 inhibitor as a monotherapy. Also provided are methods of determining the likelihood that a subject having a cancer (e.g., a ROS1-associated cancer) will have a positive response to treatment with a first ROS1 inhibitor as a monotherapy that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that a subject not having a cancer cell that has one or more ROS1 inhibitor resistance mutations has an increased likelihood of having a positive response to treatment with a first ROS1 inhibitor as a monotherapy as compared to a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations. Also provided are methods of predicting the efficacy of treatment with a first ROS1 inhibitor as a monotherapy in a subject having cancer that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that treatment with a first ROS1 inhibitor as a monotherapy is less likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations. Also provided are methods of predicting the efficacy of treatment with a first ROS1 inhibitor as a monotherapy in a subject having cancer that include: determining that treatment with a first ROS1 inhibitor as a monotherapy is less likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first ROS1 inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ROS1 inhibitor of step (a), the subject can also be administered another anticancer agent (e.g., a second ROS1 inhibitor, an ALK inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor (e.g., a second ROS1 inhibitor). In some embodiments of step (c), another anticancer agent can be the first ROS1 inhibitor administered in step (a). In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2032, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first ALK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first ALK inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ALK inhibitor of step (a), the subject can also be administered another anticancer agent (e.g., a second ALK inhibitor, a first ROS1 inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ALK inhibitor (e.g., a second ALK inhibitor). In some embodiments of step (c), another anticancer agent can be the first ALK inhibitor administered in step (a). In some embodiments of step (c), another anticancer agent can be another ROS1 inhibitor. In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first TRK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first TRK inhibitor of step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first TRK inhibitor of step (a), the subject can also be administered another anticancer agent (e.g., a second TRK inhibitor, a first ROS1 inhibitor, an ALK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another TRK inhibitor (e.g., a second TRK inhibitor). In some embodiments of step (c), another anticancer agent can be the first TRK inhibitor administered in step (a). In some embodiments of step (c), another anticancer agent can be another ROS1 inhibitor. In some embodiments, the dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same confers increased resistance to a cancer cell or tumor to treatment with the first TRK inhibitor. In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • Also provided are methods of treating a subject having a cancer that include: (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) administering a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) administering additional doses of the first ROS1 inhibitor step (a) to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ROS1 inhibitor of step (a), the subject can also be administered another anticancer agent. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof).
  • Also provided are methods of treating a subject having a cancer (e.g., a ROS1-associated cancer) that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor, has one or more ROS1 inhibitor resistance mutations; and (b) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ROS1 inhibitor previously administered to the subject, the subject can also be administered another anticancer agent (e.g., a second ROS1 inhibitor, an ALK inhibitor, a TRK inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor (e.g., a second ROS1 inhibitor). In some embodiments of step (b), another anticancer agent can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of treating a subject having a cancer (e.g., a ROS1-associated cancer) that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell having one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ALK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ALK inhibitor previously administered to the subject, the subject can also be administered another anticancer agent (e.g., a second ALK inhibitor, a TRK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiment, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is can be another ALK inhibitor (e.g., a second ALK inhibitor). In some embodiments of step (b), another anticancer agent can be the first ALK inhibitor administered in step (a). In some embodiments of step (b), another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of treating a subject having a cancer (e.g., a ROS1-associated cancer) that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and (b) administering a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first TRK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first TRK inhibitor previously administered to the subject, the subject can also be administered another anticancer agent (e.g., a second TRK inhibitor, an ALK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is can be another TRK inhibitor (e.g., a second TRK inhibitor). In some embodiments of step (b), another anticancer agent can be the first TRK inhibitor administered in step (a). In some embodiments of step (b), another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) administering a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ROS1 inhibitor previously administered to the subject, the subject can also be administered another anticancer agent. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments of (b), another anticancer agent can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) administering a ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first ALK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first ALK inhibitor previously administered to the subject, the subject can also be administered another anticancer agent. In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be a ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments of (b), another anticancer agent can be the first ALK inhibitor administered in step (a).
  • Also provided are methods of treating a subject having a cancer that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor is associated with a dysregulation of a ROS1 gene, a ROS1 kinase, or expression or activity or level of any of the same; and (b) administering a ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent to the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) administering additional doses of the first TRK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where the subject is administered additional doses of the first TRK inhibitor previously administered to the subject, the subject can also be administered another anticancer agent. In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be a ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments of (b), another anticancer agent can be the first TRK inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first ROS1 inhibitor of step (a) for the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, when additional doses of the first ROS1 inhibitor of step (a) are selected for the subject, the method can further include selecting doses of another anticancer agent for the subject. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor (e.g., a second ROS1 inhibitor). In some embodiments of step (c), another ROS1 inhibitor can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering a first ALK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first ALK inhibitor of step (a) for the subject if the subject has a cancer cell that does not have has one or more ROS1 inhibitor resistance mutations. In some embodiments, when additional doses of the first ALK inhibitor of step (a) are selected for the subject, the method can further include selecting doses of another anticancer agent for the subject. In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments of step (c), another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor. In some embodiments of step (c), another anticancer agent is the first ALK inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering one or more doses of a first TRK inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first TRK inhibitor of step (a) for the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, when additional doses of the first TRK inhibitor of step (a) are selected for the subject, the method can further include selecting doses of another anticancer agent for the subject. In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments of step (c), another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent can be another ROS1 inhibitor. In some embodiments of step (c), another anticancer agent is the first TRK inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) administering a first ROS1 inhibitor to the subject for a period of time (e.g., 1 month, 2 months, 3 months, 6 months, 9 months, 1 year); (b) after (a), determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and (c) selecting a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (d) selecting additional doses of the first ROS1 inhibitor of step (a) for the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, when additional doses of the first ROS1 inhibitor of step (a) are selected for the subject, the method can further include selecting doses of another anticancer agent for the subject. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, another ROS1 can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations; (b) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, when additional doses of the first ROS1 inhibitor previously administered to the subject are selected for the subject, the method can further include selecting doses of another anticancer agent (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof) for the subject. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is another ROS1 inhibitor (e.g., a second ROS1 inhibitor). In some embodiments of step (c), another ROS1 inhibitor can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of selecting a treatment for a subject having a cancer (e.g., a ROS1-associated cancer) that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ALK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first ALK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where additional doses of the first ALK inhibitor previously administered to the subject are selected for the subject, the method can further include selecting doses of another anticancer agent (e.g., a second ALK inhibitor, a TRK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is can be another ALK inhibitor (e.g., a second ALK inhibitor). In some embodiments of step (b), another anticancer agent can be the first ALK inhibitor administered in step (a). In some embodiments of step (b), another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of selecting a treatment for a subject having a cancer (e.g., a ROS1-associated cancer) that include: (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first TRK inhibitor has one or more ROS1 inhibitor resistance mutations; and (b) selecting a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first TRK inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, where additional doses of the first TRK inhibitor previously administered to the subject are selected for the subject, the method can further include selecting doses of another anticancer agent (e.g., a second TRK inhibitor, an ALK inhibitor, a first ROS1 inhibitor, or a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, the ROS1 inhibitor resistance mutation includes one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, a ROS1 inhibitor resistance mutation can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is can be another TRK inhibitor (e.g., a second TRK inhibitor). In some embodiments of step (b), another anticancer agent can be the first TRK inhibitor administered in step (a). In some embodiments of step (b), another anticancer agent can be another ROS1 inhibitor.
  • Also provided are methods of selecting a treatment for a subject having a cancer that include (a) determining whether a cancer cell in a sample obtained from a subject having a cancer and previously administered a first ROS1 inhibitor has one or more ROS1 inhibitor resistance mutations; (b) selecting a second ROS1 inhibitor as a monotherapy or in conjunction with another anticancer agent for the subject if the subject has a cancer cell that has one or more ROS1 inhibitor resistance mutations; or (c) selecting additional doses of the first ROS1 inhibitor previously administered to the subject if the subject has a cancer cell that does not have one or more ROS1 inhibitor resistance mutations. In some embodiments, when additional doses of the first ROS1 inhibitor previously administered to the subject are selected for the subject, the method can further include selecting doses of another anticancer agent (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof) for the subject. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N. In some embodiments, another anticancer agent is any anticancer agent known in the art. For example, another anticancer agent is another ROS1 inhibitor (e.g., a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof). In some embodiments, another ROS1 can be the first ROS1 inhibitor administered in step (a).
  • Also provided are methods of determining a subject's risk for developing a cancer that has some resistance to a first ROS1 inhibitor that include: determining whether a cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and identifying a subject having a cell that has one or more ROS1 inhibitor resistance mutations as having an increased likelihood of developing a cancer that has some resistance to the first ROS1 inhibitor. Also provided are methods of determining a subject's risk for developing a cancer that has some resistance to a first ROS1 inhibitor that include: identifying a subject having a cell that has one or more ROS1 inhibitor resistance mutations as having an increased likelihood of developing a cancer that has some resistance to the first ROS1 inhibitor. Also provided are methods of determining the presence of a cancer that has some resistance to a first ROS1 inhibitor that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that the subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has a cancer that has some resistance to the first ROS1 inhibitor. Also provided are methods of determining the presence of a cancer that has some resistance to a first ROS1 inhibitor in a subject that include: determining that a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has a cancer that has some resistance to the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations confer increased resistance to a cancer cell or tumor to treatment with the first ROS1 inhibitor. In some embodiments, the one or more ROS1 inhibitor resistance mutations include one or more ROS1 inhibitor resistance mutations listed in Table 4. For example, the one or more ROS1 inhibitor resistance mutations can include a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N.
  • In some embodiments of any of the methods described herein, a ROS1 inhibitor resistance mutation that confers increased resistance to a cancer cell or tumor to treatment with a first ROS1 inhibitor can be any of the ROS1 inhibitor resistance mutations listed in Table 4 (e.g., a substitution at one or more of amino acid positions 2026, 2032, or 2033, e.g., L2026M, G2032R, or D2033N).
  • Also provided are methods of determining the likelihood that a subject having a cancer will have a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that the subject having the cancer cell that has one or more ROS1 inhibitor resistance mutations has an increased likelihood of having a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy. Also provided are methods of determining the likelihood that a subject having cancer will have a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy that include: determining that a subject having a cancer cell that has one or more ROS1 inhibitor resistance mutations has an increased likelihood of having a positive response to treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy. Also provided are methods of predicting the efficacy of treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy in a subject having cancer that include: determining whether a cancer cell in a sample obtained from the subject has one or more ROS1 inhibitor resistance mutations; and determining that treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy is likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations. Also provided are methods of predicting the efficacy of treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy in a subject having cancer that include: determining that treatment with a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof as a monotherapy is likely to be effective in a subject having a cancer cell in a sample obtained from the subject that has one or more ROS1 inhibitor resistance mutations.
  • Methods of determining the level of resistance of a cancer cell or a tumor to a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein or known in the art) can be determined using methods known in the art. For example, the level of resistance of a cancer cell to a ROS1 inhibitor can be assessed by determining the IC50 of a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein or known in the art) on the viability of a cancer cell. In other examples, the level of resistance of a cancer cell to a ROS1 inhibitor can be assessed by determining the growth rate of the cancer cell in the presence of a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein). In other examples, the level of resistance of a tumor to a ROS1 inhibitor can be assessed by determining the mass or size of one or more tumors in a subject over time during treatment with a ROS1 inhibitor (e.g., any of the ROS1 inhibitors described herein). In other examples, the level of resistance of a cancer cell or a tumor to a ROS1 inhibitor can be indirectly assessed by determining the activity of a ROS1 kinase including one or more of the ROS1 inhibitor resistance mutations (i.e., the same ROS1 kinase expressed in a cancer cell or a tumor in a subject). The level of resistance of a cancer cell or tumor having one or more ROS1 inhibitor resistance mutations to a ROS1 inhibitor is relative to the level of resistance in a cancer cell or tumor that does not have one or more ROS1 inhibitor resistance mutations (e.g., a cancer cell or tumor that does not have the same ROS1 inhibitor resistance mutations, a cancer cell or a tumor that does not have any ROS1 inhibitor resistance mutations, or a cancer cell or a tumor that expresses a wildtype ROS1 protein). For example, the determined level of resistance of a cancer cell or a tumor having one or more ROS1 inhibitor resistance mutations can be greater than about 1%, greater than about 2%, greater than about 3%,greater than about 4%, greater than about 5%, greater than about 6%, greater than about 7%, greater than about 8%, greater than about 9%, greater than about 10%, greater than about 11%, greater than about 12%, greater than about 13%, greater than about 14%, greater than about 15%, greater than about 20%, greater than about 25%, greater than about 30%, greater than about 35%, greater than about 40%, greater than about 45%, greater than about 50%, greater than about 60%, greater than about 70%, greater than about 80%, greater than about 90%, greater than about 100%, greater than about 110%, greater than about 120%, greater than about 130%, greater than about 140%, greater than about 150%, greater than about 160%, greater than about 170%, greater than about 180%, greater than about 190%, greater than about 200%, greater than about 210%, greater than about 220%, greater than about 230%, greater than about 240%, greater than about 250%, greater than about 260%, greater than about 270%, greater than about 280%, greater than about 290%, or greater than about 300% of the level of resistance in a cancer cell or tumor that does not have one or more ROS1 inhibitor resistance mutations (e.g., a cancer cell or tumor that does not have the same ROS1 inhibitor resistance mutations, a cancer cell or a tumor that does not have any ROS1 inhibitor resistance mutations, or a cancer cell or a tumor that expresses a wildtype ROS1 protein).
  • Also provided is a method for inhibiting ROS1 kinase activity in a cell, comprising contacting the cell with a compound of Formula I. In some embodiments, the contacting is in vitro. In some embodiments, the contacting is in vivo. In some embodiments, the contacting is in vivo, wherein the method comprises administering an effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to a subject having a cell having ROS1 kinase activity. In some embodiments, the cell is a cancer cell. In some embodiments, the cancer cell is any cancer as described herein. In some embodiments, the cancer cell is a ROS1-associated cancer cell.
  • Also provided is a method for inhibiting ROS1 kinase activity in a mammalian cell, comprising contacting the cell with a compound of Formula I. In some embodiments, the contacting is in vitro. In some embodiments, the contacting is in vivo. In some embodiments, the contacting is in vivo, wherein the method comprises administering an effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof to a mammal having a cell having ROSlkinase activity. In some embodiments, the mammalian cell is a mammalian cancer cell. In some embodiments, the mammalian cancer cell is any cancer as described herein. In some embodiments, the mammalian cancer cell is a ROS1-associated cancer cell.
  • As used herein, the term “contacting” refers to the bringing together of indicated moieties in an in vitro system or an in vivo system. For example, “contacting” a ROS1 kinase with a compound provided herein includes the administration of a compound provided herein to an individual or patient, such as a human, having a ROS1 kinase, as well as, for example, introducing a compound provided herein into a sample containing a cellular or purified preparation containing the ROS1 kinase.
  • Also provided herein is a method of inhibiting cell proliferation, in vitro or in vivo, the method comprising contacting a cell with an effective amount of a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, or a pharmaceutical composition thereof as defined herein
  • The phrase “effective amount” means an amount of compound that, when administered to a patient in need of such treatment, is sufficient to (i) treat a ROS1 kinase-associated disease or disorder, (ii) attenuate, ameliorate, or eliminate one or more symptoms of the particular disease, condition, or disorder, or (iii) delay the onset of one or more symptoms of the particular disease, condition, or disorder described herein. The amount of a compound of Formula I that will correspond to such an amount will vary depending upon factors such as the particular compound, disease condition and its severity, the identity (e.g., weight) of the patient in need of treatment, but can nevertheless be routinely determined by one skilled in the art.
  • When employed as pharmaceuticals, the compounds of Formula I can be administered in the form of pharmaceutical compositions. These compositions can be prepared in a manner well known in the pharmaceutical art, and can be administered by a variety of routes, depending upon whether local or systemic treatment is desired and upon the area to be treated. Administration may be topical (including transdermal, epidermal, ophthalmic and to mucous membranes including intranasal, vaginal and rectal delivery), pulmonary (e.g., by inhalation or insufflation of powders or aerosols, including by nebulizer; intratracheal or intranasal), oral or parenteral. Oral administration can include a dosage form formulated for once-daily or twice-daily (BID) administration. Parenteral administration includes intravenous, intraarterial, subcutaneous, intraperitoneal intramuscular or injection or infusion; or intracranial, e.g., intrathecal or intraventricular, administration. Parenteral administration can be in the form of a single bolus dose, or may be, for example, by a continuous perfusion pump. Pharmaceutical compositions and formulations for topical administration may include transdermal patches, ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders. Conventional pharmaceutical carriers, aqueous, powder or oily bases, thickeners and the like may be necessary or desirable
  • Also provided herein are pharmaceutical compositions which contain, as the active ingredient, a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof, in combination with one or more pharmaceutically acceptable carriers (excipients). In some embodiments, the composition is suitable for topical administration. In making the compositions provided herein, the active ingredient is typically mixed with an excipient, diluted by an excipient or enclosed within such a carrier in the form of, for example, a capsule, sachet, paper, or other container. When the excipient serves as a diluent, it can be a solid, semi-solid, or liquid material, which acts as a vehicle, carrier or medium for the active ingredient. Thus, the compositions can be in the form of tablets, pills, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments containing, for example, up to 10% by weight of the active compound, soft and hard gelatin capsules, suppositories, sterile injectable solutions, and sterile packaged powders. In some embodiments, the composition is formulated for oral administration. In some embodiments, the composition is formulated as a tablet or capsule.
  • The compositions comprising a compound of Formula I or a pharmaceutically acceptable salt or solvate thereof can be formulated in a unit dosage form, each dosage containing from about 5 to about 1,000 mg (1 g), more usually about 100 mg to about 500 mg, of the active ingredient. The term “unit dosage form” refers to physically discrete units suitable as unitary dosages for human subjects and other patients, each unit containing a predetermined quantity of active material (i.e., a compound for Formula I as provided herein) calculated to produce the desired therapeutic effect, in association with a suitable pharmaceutical excipient.
  • In some embodiments, the compositions provided herein contain from about 5 mg to about 50 mg of the active ingredient. One having ordinary skill in the art will appreciate that this embodies compounds or compositions containing about 5 mg to about 10 mg, about 10 mg to about 15 mg, about 15 mg to about 20 mg, about 20 mg to about 25 mg, about 25 mg to about 30 mg, about 30 mg to about 35 mg, about 35 mg to about 40 mg, about 40 mg to about 45 mg, or about 45 mg to about 50 mg of the active ingredient.
  • In some embodiments, the compositions provided herein contain from about 50 mg to about 500 mg of the active ingredient. One having ordinary skill in the art will appreciate that this embodies compounds or compositions containing about 50 mg to about 100 mg, about 100 mg to about 150 mg, about 150 mg to about 200 mg, about 200 mg to about 250 mg, about 250 mg to about 300 mg, about 350 mg to about 400 mg, or about 450 mg to about 500 mg of the active ingredient.
  • In some embodiments, the compositions provided herein contain from about 500 mg to about 1,000 mg of the active ingredient. One having ordinary skill in the art will appreciate that this embodies compounds or compositions containing about 500 mg to about 550 mg, about 550 mg to about 600 mg, about 600 mg to about 650 mg, about 650 mg to about 700 mg, about 700 mg to about 750 mg, about 750 mg to about 800 mg, about 800 mg to about 850 mg, about 850 mg to about 900 mg, about 900 mg to about 950 mg, or about 950 mg to about 1,000 mg of the active ingredient.
  • The active compound may be effective over a wide dosage range and is generally administered in a pharmaceutically effective amount. It will be understood, however, that the amount of the compound actually administered will usually be determined by a physician, according to the relevant circumstances, including the condition to be treated, the chosen route of administration, the actual compound administered, the age, weight, and response of the individual patient, the severity of the patient's symptoms, and the like.
  • Provided herein are pharmaceutical kits useful, for example, in the treatment of RET-associated diseases or disorders, such as cancer or irritable bowel syndrome (IBS), which include one or more containers containing a pharmaceutical composition comprising a therapeutically effective amount of a compound provided herein. Such kits can further include, if desired, one or more of various conventional pharmaceutical kit components, such as, for example, containers with one or more pharmaceutically acceptable carriers, additional containers, etc., as will be readily apparent to those skilled in the art. Instructions, either as inserts or as labels, indicating quantities of the components to be administered, guidelines for administration, and/or guidelines for mixing the components, can also be included in the kit.
  • One skilled in the art will recognize that, both in vivo and in vitro trials using suitable, known and generally accepted cell and/or animal models are predictive of the ability of a test compound to treat or prevent a given disorder.
  • One skilled in the art will further recognize that human clinical trials including first-in-human, dose ranging and efficacy trials, in healthy patients and/or those suffering from a given disorder, may be completed according to methods well known in the clinical and medical arts.
    • EXAMPLES Example A. Inhibition of ROS1 Kinase
  • The potency of a compound inhibiting wild type and exemplary mutant ROS1 kinases was determined using CisBio's HTRF Kinease-TK assay technology. The assays contained 5 nM wild type ROS1 (SignalChem—Cat. No. R14-11G), 5 nM G2032R ROS1 (SignalChem—Cat. No. R14-12BG), 5 nM L2026M ROS1 (Array Biopharma, p 1965), or 5 nM D2033N ROS1 (Array Biopharma, p 1994). Each kinase is incubated with 250 nM TK-substrate biotin (CisBio, Cat. No. 62TKOPEC) and 1 mM ATP along with test compound in a buffer consisting of 25 mM MOPS [pH 7.4], 5 mM MgCl2, 0.005% Triton X-100, and 2% DMSO in a volume of 8 μL. Compounds were prepared in a four-fold serial dilution in DMSO and added to the assay to give the appropriate final concentration. After a 120-minute incubation at 22° C., the reaction was quenched by adding 8 μL of quench solution containing 31.3 nM Sa-XL665 and 1×TK-Ab-Cryptate in HTRF detection buffer (CisBio, Cat. No. 62TKOPEC). After a 1 hour incubation at 22° C., the extent of reaction was determined using a PerkinElmer EnVision multimode plate reader via HTRF dual wavelength detection, and the percent of control (POC) was calculated using a ratiometric emission factor. 100 POC is determined using no test compound and 0 POC is determined in the absence of enzyme. The POC values are fit to a 4-parameter logistic curve and the IC50 value is calculated based on the point at which the curve crosses 50 POC.
  • Table 9 provides averaged IC50 values for compounds tested in this assay.
  • TABLE 9
    ROS1 ROS1 ROS1 ROS1
    Compound wT G2032R L2026M D2033N
    No. Structure IC50 (nM) IC50 (nM) IC50 (nM) IC50 (nM)
     2
    Figure US20190076436A1-20190314-C00101
         		80.3 1062.2 67.0 11.9
     3
    Figure US20190076436A1-20190314-C00102
         		1.2 9.4 1.2 0.3
     7
    Figure US20190076436A1-20190314-C00103
         		3.1 29.2 2.9 0.6
     9
    Figure US20190076436A1-20190314-C00104
         		9.2 98.6 10.2 1.7
    14
    Figure US20190076436A1-20190314-C00105
         		28.9 107.3 30.3 7.6
    19
    Figure US20190076436A1-20190314-C00106
         		2.4 14.4 2.4 1.2
    20
    Figure US20190076436A1-20190314-C00107
         		2.5 21.6 2.2 2.8
    22
    Figure US20190076436A1-20190314-C00108
         		330.6 3980.2 712.9 396.9
    33-A
    Figure US20190076436A1-20190314-C00109
         		19.2 157.1 19.6 14.3
    33-B
    Figure US20190076436A1-20190314-C00110
         		2.7 20.4 3.6 0.5
    35
    Figure US20190076436A1-20190314-C00111
         		779.1 4931.9 589.3 260.1
    36
    Figure US20190076436A1-20190314-C00112
         		0.7 6.5 0.5 0.2
    45
    Figure US20190076436A1-20190314-C00113
         		6.1 113.6 4.6 16.8
    • Other Embodiments
  • It is to be understood that while the disclosure has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the disclosure, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of the following claims.

Claims (16)

1. A method for treating a ROS1-associated cancer in a subject in need thereof, wherein the cancer has a fusion selected from the group consisting of: TPD52L1-ROS1, CCDC30-ROS1, FYN-ROS1, MKX-ROS1, and LIMA1-ROS1, the method comprising administering a compound selected from the group consisting of:
(6R)-9-fluoro-15-hydroxy-13-oxa-2,11,17,21,22,25-hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one;
(6R,15R)-9-fluoro-15-hydroxy-13-oxa-2,11,17,21,22,25-hexaazapentacyclo-[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one;
(6R)-9-fluoro-13-oxa-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7, 9,11,18(25), 19,22-heptaen-17-one;
(6R)-9-fluoro-13-oxa-2,11,18,22,23,26-hexaazapentacyclo[18.5.2.02,6.07,12.023,27]heptacosa-1(26),7,9,11,20(27),21,24-heptaen-19-one;
(6R)-9-fluoro-2,11,13,16,20,21,24-heptaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25),19,22-heptaen-17-one;
(6R)-9-fluoro-2,11,13,17,21,22,25-heptaazapentacyclo[17.5.2.02,6.07,12.022,26]hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one;
(6R)-9-fluoro-17-methyl-13-oxa-2,11,17,21,22,25-hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one;
(6R)-9,15,15-trifluoro-13-oxa-2,11,17,21,22,25-hexaazapentacyclo[17.5.2.02,6.07,12.022,26]hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one;
(6R)-9-fluoro-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25),19,22-heptaen-17-one;
(6R)-9-fluoro-15-methyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25),19,22-heptaen-17-one;
(6R,15R)-9-fluoro-15-methyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25),19,22-heptaen-17-one;
(6R)-9-fluoro-15,15-dimethyl-13-oxa-2,11,17,21,22,25-hexaazapentacyclo [17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one; and
(6R)-9-fluoro-15,15-dimethyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25),19,22-heptaen-17-one;
TPX-0005;
brigatinib; and
crizotinib;
or a pharmaceutically acceptable salt thereof.
2. The method of claim 1, wherein the compound is (6R)-9-fluoro-15-hydroxy-13-oxa-2,11,17,21,22,25-hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one, or a pharmaceutically acceptable salt thereof.
3. The method of claim 1, wherein the compound is (6R,15R)-9-fluoro-15-hydroxy-13-oxa-2,11,17,21,22,25-hexaazapentacyclo-[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one, or a pharmaceutically acceptable salt thereof.
4. The method of claim 1, wherein the compound is (6R)-9-fluoro-13-oxa-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7, 9,11,18(25), 19,22-heptaen-17-one, or a pharmaceutically acceptable salt thereof.
5. The method of claim 1, wherein the compound is (6R)-9-fluoro-13-oxa-2,11,18,22,23,26-hexaazapentacyclo[18.5.2.02,6.07,12.023,27]heptacosa-1(26),7,9,11,20(27),21,24-heptaen-19-one, or a pharmaceutically acceptable salt thereof.
6. The method of claim 1, wherein the compound is (6R)-9-fluoro-2,11,13,16,20,21,24-heptaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25), 19,22-heptaen-17-one, or a pharmaceutically acceptable salt thereof.
7. The method of claim 1, wherein the compound is (6R)-9-fluoro-2,11,13,17,21,22,25-heptaazapentacyclo[17.5.2.02,6.07,12.022,26]hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one, or a pharmaceutically acceptable salt thereof.
8. The method of claim 1, wherein the compound is (6R)-9-fluoro-17-methyl-13-oxa-2,11,17,21,22,25-hexaazapentacyclo[17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one, or a pharmaceutically acceptable salt thereof.
9. The method of claim 1, wherein the compound is (6R)-9,15,15-trifluoro-13-oxa-2,11,17,21,22,25-hexaazapentacyclo[17.5.2.02,6.07,12.022,26]hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one, or a pharmaceutically acceptable salt thereof.
10. The method of claim 1, wherein the compound is (6R)-9-fluoro-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25), 19,22-heptaen-17-one, or a pharmaceutically acceptable salt thereof.
11. The method of claim 1, wherein the compound is (6R)-9-fluoro-15-methyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25), 19,22-heptaen-17-one, or a pharmaceutically acceptable salt thereof.
12. The method of claim 1, wherein the compound is (6R,15R)-9-fluoro-15-methyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25), 19,22-heptaen-17-one, or a pharmaceutically acceptable salt thereof.
13. The method of claim 1, wherein the compound is (6R)-9-fluoro-15,15-dimethyl-13-oxa-2,11,17,21,22,25-hexaazapentacyclo [17.5.2.02,6.07,12.022,26] hexacosa-1(25),7,9,11,19(26),20,23-heptaen-18-one, or a pharmaceutically acceptable salt thereof.
14. The method of claim 1, wherein the compound is (6R)-9-fluoro-15,15-dimethyl-2,11,16,20,21,24-hexaazapentacyclo[16.5.2.02,6.07,12.021,25]pentacosa-1(24),7,9,11,18(25), 19,22-heptaen-17-one, or a pharmaceutically acceptable salt thereof.
15. The method of claim 1, wherein the compound is TPX-0005, or a pharmaceutically acceptable salt thereof.
16. The method of claim 1, wherein the ROS1-associated cancer is one or more of non-small-cell lung cancer and papillary thyroid carcinoma.
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Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10588908B2 (en) 2016-04-04 2020-03-17 Loxo Oncology, Inc. Methods of treating pediatric cancers
US10590139B2 (en) 2008-09-22 2020-03-17 Array Biopharma Inc. Method of treatment using substituted imidazo[1,2b]pyridazine compounds
US10647730B2 (en) 2010-05-20 2020-05-12 Array Biopharma Inc. Macrocyclic compounds as TRK kinase inhibitors
US10655186B2 (en) 2015-10-26 2020-05-19 Loxo Oncology, Inc. Point mutations in TRK inhibitor-resistant cancer and methods relating to the same
US10668072B2 (en) 2016-04-04 2020-06-02 Loxo Oncology, Inc. Liquid formulations of (S)-N-(5-((R)-2-(2,5-difluorophenyl)-pyrrolidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide
US10688100B2 (en) 2017-03-16 2020-06-23 Array Biopharma Inc. Macrocylic compounds as ROS1 kinase inhibitors
US10758542B2 (en) 2009-07-09 2020-09-01 Array Biopharma Inc. Substituted pyrazolo[l,5-a]pyrimidine compounds as Trk kinase inhibitors
US10774085B2 (en) 2008-10-22 2020-09-15 Array Biopharma Inc. Method of treatment using substituted pyrazolo[1,5-A] pyrimidine compounds
WO2020198379A1 (en) * 2019-03-26 2020-10-01 Ventyx Biosciences, Inc. Tyk2 pseudokinase ligands
US10799505B2 (en) 2014-11-16 2020-10-13 Array Biopharma, Inc. Crystalline form of (S)-N-(5-((R)-2-(2,5-difluorophenyl)-pyrrolidin-1-yl)-pyrazolo[1,5-A]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide hydrogen sulfate
CN113004305A (en) * 2019-12-19 2021-06-22 成都倍特药业股份有限公司 Macrocyclic compounds, their preparation and use
US11091486B2 (en) 2016-10-26 2021-08-17 Array Biopharma, Inc Process for the preparation of pyrazolo[1,5-a]pyrimidines and salts thereof
US11214571B2 (en) 2016-05-18 2022-01-04 Array Biopharma Inc. Process for the preparation of (S)-N-(5-((R)-2-(2,5-difluorophenyl)pyrrolidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide and salts thereof
WO2022182845A1 (en) * 2021-02-25 2022-09-01 Blossomhill Therapeutics, Inc. Macrocycles and their use
US11753411B2 (en) 2019-11-08 2023-09-12 Ventyx Biosciences, Inc. Substituted pyrazolo[1,5-a]pyrimidines as TYK2 pseudokinase ligands

Families Citing this family (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP6986789B2 (en) * 2017-11-10 2021-12-22 エンジェクス ファーマシューティカル インコーポレイテッド Compounds, pharmaceutically acceptable salts thereof, use of compounds and pharmaceutical compositions.
AU2019354771A1 (en) * 2018-10-05 2021-04-01 The Board Of Trustees Of The University Of Illinois Combination therapy for the treatment of uveal melanoma
MX2021004538A (en) 2018-10-22 2021-09-10 Esker Therapeutics Inc Tyk2 inhibitors and uses thereof.
EP3938369A4 (en) * 2019-03-11 2023-01-25 Alumis Inc. Tyk2 inhibitors and uses thereof
WO2020188015A1 (en) 2019-03-21 2020-09-24 Onxeo A dbait molecule in combination with kinase inhibitor for the treatment of cancer
WO2021077013A1 (en) * 2019-10-16 2021-04-22 Health Research, Inc. Combination therapy for treatment of cancers
AU2020378630A1 (en) 2019-11-08 2022-05-26 INSERM (Institut National de la Santé et de la Recherche Médicale) Methods for the treatment of cancers that have acquired resistance to kinase inhibitors
JP7374532B2 (en) 2019-11-18 2023-11-07 クワンチョウ ジョーヨー ファーマテック カンパニー，リミティド Compounds and uses thereof as highly selective ROS1 inhibitors
CN112812128B (en) * 2019-11-18 2024-04-02 正大天晴药业集团股份有限公司 Macrocyclic compounds as ALK and ROS modulators
WO2021148581A1 (en) 2020-01-22 2021-07-29 Onxeo Novel dbait molecule and its use
CA3187834A1 (en) * 2020-07-10 2022-01-13 Blossomhill Therapeutics, Inc. Macrocycles and their use
CN113072564A (en) * 2021-03-23 2021-07-06 南京奥利墨斯医药科技有限公司 Heteroaromatic ring compound and application thereof

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6463922B2 (en) * 2000-01-24 2002-10-15 Graniterie Des Ecorces Wedge intended to be inserted in a cutting slot
US8933084B2 (en) * 2010-05-20 2015-01-13 Array Biopharma Inc. Macrocyclic compounds as Trk kinase inhibitors
US20160032404A1 (en) * 2014-08-01 2016-02-04 Pharmacyclics Llc Biomarkers for predicting response of dlbcl to treatment with a btk inhibitor
US20160367547A1 (en) * 2015-06-19 2016-12-22 Macau University Of Science And Technology Oncogenic ros1 and alk kinase inhibitor

Family Cites Families (386)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1017286A (en) 1909-03-01 1912-02-13 Du Pont Powder Co Apparatus for treating explosive powder.
US1013712A (en) 1911-06-03 1912-01-02 Alfred D Williams Tie and rail-fastener.
EP0009517A1 (en) 1978-10-04 1980-04-16 THE PROCTER & GAMBLE COMPANY Vaginal contraceptive
NZ234143A (en) 1989-06-28 1991-10-25 Mcneil Ppc Inc Aqueous pharmaceutical suspension formulation for administering substantially insoluble pharmaceutical agents
CN1061036C (en) 1993-11-30 2001-01-24 G·D·瑟尔公司 Substituted pyrazolyl benzenesulfonamides for treating inflammation
US5430021A (en) 1994-03-18 1995-07-04 Pharmavene, Inc. Hydrophobic drug delivery systems
US5877016A (en) 1994-03-18 1999-03-02 Genentech, Inc. Human trk receptors and neurotrophic factor inhibitors
US5844092A (en) 1994-03-18 1998-12-01 Genentech, Inc. Human TRK receptors and neurotrophic factor inhibitors
US6677135B1 (en) 1996-05-08 2004-01-13 Biogen, Inc. Ret ligand (RetL) for stimulating neutral and renal growth
ATE335003T1 (en) 1996-05-08 2006-08-15 Biogen Idec Inc RET LIGAND 3 (RETL3) TO STIMULATE NEURAL AND RENAL GROWTH
CA2206201A1 (en) 1996-05-29 1997-11-29 Yoshiaki Isobe Pyrazole derivatives and their pharmaceutical use
US6682921B1 (en) 1996-08-21 2004-01-27 New York University Crystals of the tyrosine kinase domain of non-insulin receptor tyrosine kinases
JP3898296B2 (en) 1996-08-28 2007-03-28 ポーラ化成工業株式会社 Pyrrolopyrazolopyrimidine compounds and pharmaceuticals containing the same as active ingredients
KR100389192B1 (en) 1997-04-25 2003-06-27 다케다 야쿠힌 고교 가부시키가이샤 Condensed pyridazine derivatives, their production and use
US6531152B1 (en) 1998-09-30 2003-03-11 Dexcel Pharma Technologies Ltd. Immediate release gastrointestinal drug delivery system
UA74546C2 (en) 1999-04-06 2006-01-16 Boehringer Ingelheim Ca Ltd Macrocyclic peptides having activity relative to hepatitis c virus, a pharmaceutical composition and use of the pharmaceutical composition
WO2001016169A2 (en) 1999-09-01 2001-03-08 Biogen, Inc. RET LIGAND 5 (Retl5) FROM HUMAN AND MOUSE
US6534085B1 (en) 1999-09-23 2003-03-18 Bioresponse L.L.C. Phytochemicals for promoting weight loss
FI20000403A0 (en) 2000-02-22 2000-02-22 Hannu Sariola Use of GDNF family-related compounds for the preparation of testicular cancer treatment products
AU2001271422B2 (en) 2000-06-22 2005-12-22 Genentech, Inc. Agonist anti-trk-C monoclonal antibodies
TWI312347B (en) 2001-02-08 2009-07-21 Eisai R&D Man Co Ltd Bicyclic nitrogen-containing condensed ring compounds
EP2340849A1 (en) 2001-05-30 2011-07-06 Genentech, Inc. Anti-NGF antibodies for the treatment of various disorders
WO2003020698A2 (en) 2001-09-06 2003-03-13 Prochon Biotech Ltd. Protein tyrosine kinase inhibitors
US7101572B2 (en) 2001-12-07 2006-09-05 Unilab Pharmatech, Ltd. Taste masked aqueous liquid pharmaceutical composition
US20030199525A1 (en) 2002-03-21 2003-10-23 Hirst Gavin C. Kinase inhibitors
AU2003227437A1 (en) 2002-04-23 2003-11-10 Shionogi And Co., Ltd. PYRAZOLO(1,5-a)PYRIMIDINE DERIVATIVE AND NAD(P)H OXIDASE INHIBITOR CONTAINING THE SAME
US7449488B2 (en) 2002-06-04 2008-11-11 Schering Corporation Pyrazolopyrimidines as protein kinase inhibitors
ITMI20021620A1 (en) 2002-07-23 2004-01-23 Novuspharma Spa ANTI-TUMORAL ACTIVITY COMPOUND
CA2493000A1 (en) 2002-07-24 2004-01-29 University Of Cincinnati 4-4(methylpiperazin-1-ylmethyl)-n-[4-methyl-3-(pyridin-3-yl)pyrimidin-2-ylamino)phenyl]-benzamide for treating mutated-ret kinase associated diseases
JP4024624B2 (en) 2002-08-26 2007-12-19 富士通株式会社 Semiconductor device manufacturing method and manufacturing apparatus
US7196078B2 (en) 2002-09-04 2007-03-27 Schering Corpoartion Trisubstituted and tetrasubstituted pyrazolopyrimidines as cyclin dependent kinase inhibitors
ATE469903T1 (en) 2002-09-04 2010-06-15 Schering Corp PYRAZOLOPYRIMIDINES SUITABLE FOR THE TREATMENT OF CANCER DISEASES
US7119200B2 (en) 2002-09-04 2006-10-10 Schering Corporation Pyrazolopyrimidines as cyclin dependent kinase inhibitors
US8580782B2 (en) 2002-09-04 2013-11-12 Merck Sharp & Dohme Corp. Substituted pyrazolo[1,5-a]pyrimidines as cyclin dependent kinase inhibitors
US7262199B2 (en) 2002-12-11 2007-08-28 Merck & Co., Inc. Tyrosine kinase inhibitors
AU2003299651A1 (en) 2002-12-11 2004-06-30 Merck And Co., Inc. Tyrosine kinase inhibitors
GB0303910D0 (en) 2003-02-20 2003-03-26 Merck Sharp & Dohme Therapeutic agents
EP1597251B1 (en) 2003-02-20 2009-06-10 SmithKline Beecham Corporation Pyrimidine compounds
US20070037150A1 (en) 2003-02-21 2007-02-15 The Johns Hopkins University Tyrosine kinome
JP2004277337A (en) 2003-03-14 2004-10-07 Sumitomo Pharmaceut Co Ltd PYRAZOLO[1,5-a]PYRIMIDINE DERIVATIVE
EP1608652A1 (en) 2003-03-31 2005-12-28 Vernalis (Cambridge) Limited Pyrazolopyrimidine compounds and their use in medicine
US20060094699A1 (en) 2003-04-11 2006-05-04 Kampen Gita Camilla T Combination therapy using an 11beta-hydroxysteroid dehydrogenase type 1 inhibitor and a glucocorticoid receptor agonist to minimize the side effects associated with glucocorticoid receptor agonist therapy
EP1615697A2 (en) 2003-04-11 2006-01-18 Novo Nordisk A/S New pyrazolo[1,5-a] pyrimidine derivatives and pharmaceutical use thereof
EP1615667A2 (en) 2003-04-11 2006-01-18 Novo Nordisk A/S Combinations of an 11-beta-hydroxysteroid dehydrogenase type 1 inhibitor and a glucocorticoid receptor agonist
US20070042941A1 (en) 2003-04-28 2007-02-22 Mitsuomi Hirashima Galectin 9-inducing factors
JO2785B1 (en) 2003-05-27 2014-03-15 شركة جانسين فارماسوتيكا ان. في Quinazoline derivatives
JP2005008581A (en) 2003-06-20 2005-01-13 Kissei Pharmaceut Co Ltd NEW PYRAZOLO[1,5-a]PYRIMIDINE DERIVATIVE, MEDICINAL COMPOSITION CONTAINING THE SAME AND APPLICATION THEREOF
EA009517B1 (en) 2003-06-27 2008-02-28 Байер Кропсайенс Аг Pyrazolopyrimidines
NZ544751A (en) 2003-07-15 2009-05-31 Amgen Inc Human anti-NGF neutralizing antibodies as selective NGF pathway inhibitors
US7491794B2 (en) 2003-10-14 2009-02-17 Intermune, Inc. Macrocyclic compounds as inhibitors of viral replication
US20090143399A1 (en) 2003-10-14 2009-06-04 Arizona Board Of Regents On Behalf Of The University Of Arizona Protein Kinase Inhibitors
CA2543116A1 (en) 2003-10-27 2005-05-19 Genelabs Technologies, Inc. Methods for preparing 7-(2'-substituted-.szlig.-d-ribofuranosyl)-4-(nr2r3)-5-(substituted ethyn-1-yl)-pyrrolo[2,3-d]pyrimidine derivatives
MY141220A (en) 2003-11-17 2010-03-31 Astrazeneca Ab Pyrazole derivatives as inhibitors of receptor tyrosine kinases
PL1687305T3 (en) 2003-11-21 2008-12-31 Novartis Ag 1h-imidazoquinoline derivatives as protein kinase inhibitors
TW200529849A (en) 2003-11-28 2005-09-16 Novartis Ag Diaryl urea derivatives in the treatment of protein kinase dependent diseases
AU2004298448B2 (en) 2003-12-18 2010-09-09 Janssen Pharmaceutica N.V. Pyrido- and pyrimidopyrimidine derivatives as anti- proliferative agents
EP1696920B8 (en) 2003-12-19 2015-05-06 Plexxikon Inc. Compounds and methods for development of ret modulators
GB0330042D0 (en) 2003-12-24 2004-01-28 Pharmacia Italia Spa Pyrrolo [2,3-b] pyridine derivatives active as kinase inhibitors process for their preparation and pharmaceutical compositions them
GB0330043D0 (en) 2003-12-24 2004-01-28 Pharmacia Italia Spa Pyrrolo [2,3-b] pyridine derivatives active as kinase inhibitors process for their preparation and pharmaceutical compositions comprising them
WO2005068424A1 (en) 2004-01-20 2005-07-28 Cell Therapeutics Europe S.R.L. Indolinone derivatives as receptor tyrosine kinase ihibitors
AR049769A1 (en) 2004-01-22 2006-09-06 Novartis Ag DERIVATIVES OF PIRAZOLO (1,5-A) PIRIMIDIN 7-IL-AMINA TO BE USED IN THE TREATMENT OF DEPENDENT DISEASES OF PROTEIN KINASE
US20050222171A1 (en) 2004-01-22 2005-10-06 Guido Bold Organic compounds
WO2005099363A2 (en) 2004-03-26 2005-10-27 Whitehead Institute For Biomedical Research Methods of diagnosing, preventing and treating cancer metastasis
UA91677C2 (en) 2004-03-30 2010-08-25 Интермюн, Инк. Macrocyclic compounds as inhibitors of hcv replication
GB0512324D0 (en) 2005-06-16 2005-07-27 Novartis Ag Organic compounds
TW200615268A (en) 2004-08-02 2006-05-16 Osi Pharm Inc Aryl-amino substituted pyrrolopyrimidine multi-kinase inhibiting compounds
PE20060664A1 (en) 2004-09-15 2006-08-04 Novartis Ag BICYCLE AMIDAS AS KINASE INHIBITORS
US7855205B2 (en) 2004-10-29 2010-12-21 Janssen Pharmaceutica Nv Pyrimidinyl substituted fused-pyrrolyl compounds useful in treating kinase disorders
WO2006052913A1 (en) 2004-11-04 2006-05-18 Vertex Pharmaceuticals Incorporated PYRAZOLO[1,5-a]PYRIMIDINES USEFUL AS INHIBITORS OF PROTEIN KINASES
JO3088B1 (en) 2004-12-08 2017-03-15 Janssen Pharmaceutica Nv Macrocyclic Quinazoline derivatives and their use as MTKI
DE102005003687A1 (en) 2005-01-26 2006-07-27 Sphingo Tec Gmbh Immunodiagnostic determination of neurotensin in mammal blood, comprises injecting immune active N-terminal mammal proneurotensin in to the serum- or plasma- sample
GB0501999D0 (en) 2005-02-01 2005-03-09 Sentinel Oncology Ltd Pharmaceutical compounds
CN101119996A (en) 2005-02-16 2008-02-06 阿斯利康(瑞典)有限公司 Chemical compouns
KR20070104936A (en) 2005-02-16 2007-10-29 아스트라제네카 아베 Chemical compounds
WO2006089298A2 (en) 2005-02-18 2006-08-24 Attenuon, Llc Pyrimidine-fused diazepine derivatives and indole-fused pteridines
AU2006227300B2 (en) 2005-03-21 2012-02-02 Eli Lilly And Company Imidazopyridazine compounds
GB0507575D0 (en) 2005-04-14 2005-05-18 Novartis Ag Organic compounds
US7402579B2 (en) 2005-04-15 2008-07-22 Cylene Pharmaceuticals, Inc. Quinobenzoxazine analogs and compositions
EP1877057A1 (en) 2005-04-27 2008-01-16 AstraZeneca AB Use of pyrazolyl-pyrimidine derivatives in the treatment of pain
EP1899323A2 (en) 2005-05-16 2008-03-19 AstraZeneca AB Pyrazolylaminopyrimidine derivatives useful as tyrosine kinase inhibitors
US20100047777A1 (en) 2005-05-26 2010-02-25 The Johns Hopkins University Methods for identifying mutations in coding and non-coding dna
EP1896462A2 (en) 2005-05-31 2008-03-12 The Pfahl Family Trust (Dated 9 July 1996) Substituted biarylheterocycle derivatives as protein kinase inhibitors for the treatment of cancer and other diseases
WO2006130673A1 (en) 2005-05-31 2006-12-07 Janssen Pharmaceutica, N.V. 3-benzoimidazolyl-pyrazolopyridines useful in treating kinase disorders
CN100406650C (en) 2005-06-05 2008-07-30 徐斌 Modular comb type expansion joint installation of girder capable of resisting super displacement
ITRM20050290A1 (en) 2005-06-07 2006-12-08 Lay Line Genomics Spa USE OF MOLECULES ABLE TO INHIBIT THE BOND BETWEEN NGF AND ITS TRKA RECEPTOR AS AN EXTENDED EFFECT ANALGESICS.
EP3088400A1 (en) 2005-06-22 2016-11-02 Plexxikon Inc. Pyrrolo[2,3-b]pyridine derivatives as protein kinase inhibitors
US20070025540A1 (en) 2005-07-07 2007-02-01 Roger Travis Call center routing based on talkativeness
GB0515026D0 (en) 2005-07-21 2005-08-31 Novartis Ag Organic compounds
AU2006276246B2 (en) 2005-07-25 2012-09-27 Intermune, Inc. Novel macrocyclic inhibitors of hepatitis C virus replication
US20100216798A1 (en) 2005-07-29 2010-08-26 Astellas Pharma Inc Fused heterocycles as lck inhibitors
CN101232871A (en) 2005-08-03 2008-07-30 伊士曼化工公司 Tocopheryl polyethylene glycol succinate powder and process for preparing same
US7763624B2 (en) 2005-08-22 2010-07-27 Amgen Inc. Substituted pyrazolo[3,4-d]pyrimidines as ACK-1 and LCK inhibitors
US20070049591A1 (en) 2005-08-25 2007-03-01 Kalypsys, Inc. Inhibitors of MAPK/Erk Kinase
SI1919979T2 (en) 2005-08-25 2017-07-31 Creabilis Therapeutics S.P.A. Polymer conjugates of k-252a and derivatives thereof
DE102005042742A1 (en) 2005-09-02 2007-03-08 Schering Ag Substituted imidazo [1,2b] pyridazines as kinase inhibitors, their production and use as pharmaceuticals
US20070078136A1 (en) 2005-09-22 2007-04-05 Bristol-Myers Squibb Company Fused heterocyclic compounds useful as kinase modulators
CN101316847A (en) 2005-10-06 2008-12-03 先灵公司 Pyrazolo(1, 5A) pyrimidines as protein kinase inhibitors
NZ567151A (en) 2005-10-06 2012-03-30 Schering Corp Pyrazolo [1,5 -A] pyrimidine derivatives and their use for inhibiting Checkpoint kinases
EP1948633B1 (en) 2005-10-11 2011-08-10 Centre National De La Recherche Scientifique (Cnrs) 3 -hydroxyflavone derivatives for the detection and the quantification of cell apoptosis
UA93990C2 (en) 2005-10-11 2011-03-25 Интермюн, Инк. Compounds and methods for inhibiting hepatitis c viral replication
ATE517874T1 (en) 2005-10-21 2011-08-15 Exelixis Inc PYRIMIDINONES AS MODULATORS OF CASEINKINASE II (CK2)
WO2007053776A1 (en) 2005-11-03 2007-05-10 Sgx Pharmaceuticals, Inc. Pyrimidinyl-thiophene kinase modulators
EP1785420A1 (en) 2005-11-14 2007-05-16 4Sc Ag Thiazole analogues and uses thereof
US20070149523A1 (en) 2005-11-14 2007-06-28 Jan Ehlert Thiazole Analogues and Uses Thereof
WO2007057399A2 (en) 2005-11-15 2007-05-24 Boehringer Ingelheim International Gmbh Treatment of cancer with indole derivatives
WO2007057397A1 (en) 2005-11-15 2007-05-24 Boehringer Ingelheim International Gmbh Treatment of cancer
GB0524436D0 (en) 2005-11-30 2006-01-11 Novartis Ag Organic compounds
WO2007065664A2 (en) 2005-12-08 2007-06-14 Novartis Ag Pyrazolo[1,5-a]pyridine-3-carboxylic acids as ephb and vegfr2 kinase inhibitors
EP1968579A1 (en) 2005-12-30 2008-09-17 Astex Therapeutics Limited Pharmaceutical compounds
US20080108611A1 (en) 2006-01-19 2008-05-08 Battista Kathleen A Substituted thienopyrimidine kinase inhibitors
EP1978958A4 (en) 2006-01-24 2009-12-02 Merck & Co Inc Ret tyrosine kinase inhibition
CA2636701C (en) 2006-01-27 2014-08-05 Shanghai Hengrui Pharmaceutical Co. Ltd. Pyrrolo [3,2-c] pyridine-4-one 2-indolinone protein kinase inhibitors
KR100846988B1 (en) 2006-03-06 2008-07-16 제일약품주식회사 Novel thienopyrimidine derivatives or pharmaceutically acceptable salts thereof, process for the preparation thereof and pharmaceutical composition comprising the same
KR20080110783A (en) 2006-03-07 2008-12-19 어레이 바이오파마 인크. Heterobicyclic pyrazole compounds and methods of use
AU2007227602A1 (en) 2006-03-16 2007-09-27 Novartis Ag Heterocyclic organic compounds for the treatment of in particular melanoma
PT2001892E (en) 2006-03-17 2013-07-04 Ambit Biosciences Corp Imidazolothiazole compounds for the treatment of proliferative diseases
US8263604B2 (en) 2006-03-27 2012-09-11 Nerviano Medical Sciences S.R.L. Pyridyl- and pyrimidinyl-substituted pyrrole-, thiophene- and furane-derivatives as kinase inhibitors
GB0606805D0 (en) 2006-04-04 2006-05-17 Novartis Ag Organic compounds
RU2439074C2 (en) 2006-04-26 2012-01-10 Ф. Хоффманн-Ля Рош Аг THIENO[3,2-d]PYRIMIDINE DERIVATIVE AS PHOSPHATIDYL INOSITOL-3-KINASE (PI3K) INHIBITOR
RU2008149245A (en) 2006-05-15 2010-06-20 Айрм Ллк (Bm) COMPOSITIONS AND METHODS FOR INHIBITING RECEPTOR KINASES FGF
CN101443009A (en) 2006-05-18 2009-05-27 卫材R&D管理有限公司 Antitumor agent for thyroid cancer
EP1873157A1 (en) 2006-06-21 2008-01-02 Bayer Schering Pharma Aktiengesellschaft Pyrazolopyrimidines and salts thereof, pharmaceutical compositions comprising same, methods of preparing same and uses of same
TW201345908A (en) 2006-07-05 2013-11-16 Mitsubishi Tanabe Pharma Corp A pyrazolo [1,5-a] pyrimidine compound
US20100029619A1 (en) 2006-08-04 2010-02-04 Takeda Pharmaceutical Company Limted Fused heterocyclic compound
US7531539B2 (en) 2006-08-09 2009-05-12 Bristol-Myers Squibb Company Pyrrolotriazine kinase inhibitors
US8063225B2 (en) 2006-08-14 2011-11-22 Chembridge Corporation Tricyclic compound derivatives useful in the treatment of neoplastic diseases, inflammatory disorders and immunomodulatory disorders
AU2007292924A1 (en) 2006-09-07 2008-03-13 Biogen Idec Ma Inc. IRAK modulators for treating an inflammatory condition, cell proliferative disorder, immune disorder
WO2008031551A2 (en) 2006-09-12 2008-03-20 Novartis Forschungsstiftung, Zweigniederlassung Non-neuroendocrine cancer therapy
ES2565683T3 (en) 2006-09-15 2016-04-06 Xcovery, Inc. Kinase Inhibitor Compounds
BRPI0717564A2 (en) 2006-09-29 2013-10-22 Novartis Ag PIRAZOLOPYRIMIDINES AS PI3K LIPID KINASE INHIBITORS
US20120225057A1 (en) 2006-10-11 2012-09-06 Deciphera Pharmaceuticals, Llc Methods and compositions for the treatment of myeloproliferative diseases and other proliferative diseases
EP1918291A1 (en) 2006-10-30 2008-05-07 Novartis AG 3-Aminocarbonyl-substituted fused pyrazolo-derivatives as protein kinase modulators
EP2089393A1 (en) 2006-10-30 2009-08-19 Novartis AG Heterocyclic compounds as antiinflammatory agents
MX2009004700A (en) 2006-11-06 2009-05-15 Supergen Inc Imidazo[1,2-b]pyridazine and pyrazolo[1,5-a]pyrimidine derivatives and their use as protein kinase inhibitors.
HUE035868T2 (en) 2006-11-15 2018-05-28 Ym Biosciences Australia Pty Inhibitors of kinase activity
WO2008079909A1 (en) 2006-12-21 2008-07-03 Plexxikon, Inc. Pyrrolo [2,3-b] pyridines as kinase modulators
MX2009006688A (en) 2006-12-21 2009-06-30 Plexxikon Inc Compounds and methods for kinase modulation, and indications therefor.
PE20121126A1 (en) 2006-12-21 2012-08-24 Plexxikon Inc PIRROLO [2,3-B] PYRIDINES COMPOUNDS AS KINASE MODULATORS
US20080199426A1 (en) 2007-01-11 2008-08-21 Sukhatme Vikas P Methods and compositions for the treatment and diagnosis of vascular inflammatory disorders or endothelial cell disorders
US20100173954A1 (en) 2007-01-19 2010-07-08 Bayer Healthcare Llc Treatment of cancers having resistance to chemotherapeutic agents
US20080234267A1 (en) 2007-03-20 2008-09-25 Karen Elizabeth Lackey Compounds and Methods of Treatment
US20080234262A1 (en) 2007-03-21 2008-09-25 Wyeth Pyrazolopyrimidine analogs and their use as mtor kinase and pi3 kinase inhibitors
WO2008116898A1 (en) 2007-03-28 2008-10-02 Biovitrum Ab (Publ) Pyrazolo [1,5-a]pyrimidines as inhibitors of stearoyl-coa desaturase
BRPI0809998B8 (en) 2007-04-03 2021-05-25 Array Biopharma Inc imidazo[1,2-a]pyridine compound as receptor tyrosine kinase inhibitors, their uses, their preparation processes and pharmaceutical compositions
US20110189167A1 (en) 2007-04-20 2011-08-04 Flynn Daniel L Methods and Compositions for the Treatment of Myeloproliferative Diseases and other Proliferative Diseases
EA019524B1 (en) 2007-05-04 2014-04-30 Айрм Ллк COMPOUNDS AND COMPOSITIONS AS c-kit AND PDGFR KINASE INHIBITORS
WO2008138184A1 (en) 2007-05-14 2008-11-20 Shanghai Hengrui Pharmaceutical Co.Ltd. Derivatives of pyrroloazacycles, the method of making them and the use thereof as inhibitors of protein kinases
AU2008265104B2 (en) 2007-06-21 2013-09-12 Janssen Pharmaceutica Nv Indolin-2-ones and aza-indolin-2-ones
US20090012045A1 (en) 2007-06-26 2009-01-08 Rigel Pharmaceuticals, Inc. Methods of Treating Cell Proliferative Disorders
AU2008273889B2 (en) 2007-07-09 2012-03-08 Astrazeneca Ab Trisubstituted pyrimidine derivatives for the treatment of proliferative diseases
WO2009012262A1 (en) 2007-07-16 2009-01-22 The Regents Of The University Of California Protein kinase modulating compounds and methods for making and using them
NZ582772A (en) 2007-07-17 2012-06-29 Plexxikon Inc Compounds and methods for kinase modulation, and indications therefor
AR067585A1 (en) 2007-07-19 2009-10-14 Schering Corp AMIDAS HETEROCICLICAL COMPOUNDS AS INHIBITORS OF PROTEINCINASE
WO2009013126A1 (en) 2007-07-20 2009-01-29 Nerviano Medical Sciences S.R.L. Substituted indazole derivatives active as kinase inhibitors
WO2009017838A2 (en) 2007-08-01 2009-02-05 Exelixis, Inc. Combinations of jak-2 inhibitors and other agents
WO2009021137A2 (en) 2007-08-07 2009-02-12 Purdue Research Foundation Kinase inhibitors and uses thereof
ME00977B (en) 2007-08-10 2012-06-20 Regeneron Pharma High affinity human antibodies to human nerve growth factor
EP2025678A1 (en) 2007-08-17 2009-02-18 Oncalis AG Pyrazolo[3,4-d]pyrimidine compounds and their use as modulators of protein kinase
WO2009042646A1 (en) 2007-09-24 2009-04-02 Curis, Inc. Anti-proliferative agents
AU2008312631A1 (en) 2007-10-16 2009-04-23 Wyeth Llc Thienopyrimidine and pyrazolopyrimidine compounds and their use as mTOR kinase and PI3 kinase inhibitors
CN101909647A (en) 2007-10-23 2010-12-08 诺瓦提斯公司 Use of TrkB antibodies for the treatment of respiratory disorders
EP2217601A1 (en) 2007-11-08 2010-08-18 Centro Nacional de Investigaciones Oncológicas (CNIO) Imidazopyridazines for use as protein kinase inhibitors
MX2010005950A (en) 2007-11-28 2010-06-17 Schering Corp 2-fluoropyrazolo[1,5-a]pyrimidines as protein kinase inhibitors.
EP2215091B1 (en) 2007-12-04 2016-03-30 Nerviano Medical Sciences S.r.l. Substituted dihydropteridin-6-one derivatives, process for their preparation and their use as kinase inhibitors
WO2009092049A1 (en) 2008-01-17 2009-07-23 Irm Llc Improved anti-trkb antibodies
US20090227556A1 (en) 2008-01-31 2009-09-10 Eisai R&D Management Co., Ltd. Receptor tyrosine kinase inhibitors comprising pyridine and pyrimidine derivatives
TW200942537A (en) 2008-02-01 2009-10-16 Irm Llc Compounds and compositions as kinase inhibitors
US20090209496A1 (en) 2008-02-15 2009-08-20 David Chaplin Methods and compositions for enhancing the efficacy of rtk inhibitors
JP5628145B2 (en) 2008-03-19 2014-11-19 ケムブリッジ・コーポレーション Novel tyrosine kinase inhibitor
US8822500B2 (en) 2008-03-19 2014-09-02 Chembridge Corporation Tyrosine kinase inhibitors
US8207165B2 (en) 2008-03-28 2012-06-26 Nerviano Medical Sciences S.R.L. 3,4-dihydro-2H-pyrazino[1,2-A]indol-1-one derivatives active as kinase inhibitors, process for their preparation and pharmaceutical compositions comprising them
EP2300469B1 (en) 2008-05-13 2015-06-24 Novartis AG Fused nitrogen containing heterocycles and compositions thereof as kinase inhibitors
US8158636B2 (en) 2008-05-19 2012-04-17 Plexxikon Inc. Compounds and methods for kinase modulation, and indications therefor
PE20091846A1 (en) 2008-05-19 2009-12-16 Plexxikon Inc PIRROLO [2,3-d] -PYRIMIDINE DERIVATIVES AS KINE MODULATORS
JP5351254B2 (en) 2008-05-23 2013-11-27 ノバルティス アーゲー Quinoxaline- and quinoline-carboxamide derivatives
EP2313411A1 (en) 2008-06-10 2011-04-27 Plexxikon, Inc. 5h-pyrr0l0 [2,3-b]pyrazine derivatives for kinase modulation, and indications therefor
US20110212053A1 (en) 2008-06-19 2011-09-01 Dapeng Qian Phosphatidylinositol 3 kinase inhibitors
EP2313091A4 (en) 2008-07-14 2012-04-04 Univ Kingston Pharmaceutical compositions comprising ret inhibitors and methods for the treatment of cancer
ES2532732T3 (en) 2008-07-29 2015-03-31 Nerviano Medical Sciences S.R.L. Use of a CDK inhibitor for the treatment of glioma
WO2010028254A2 (en) 2008-09-05 2010-03-11 Auspek Pharmaceuticals, Inc. Substituted quinazoline inhibitors of growth factor receptor tyrosine kinases
EP2161271A1 (en) 2008-09-08 2010-03-10 Università Degli Studi Di Milano - Bicocca Alpha-carboline inhibitors of NMP-ALK, RET, and Bcr-Abl
ES2536730T3 (en) 2008-09-19 2015-05-28 Nerviano Medical Sciences S.R.L. 3,4-Dihydro-2H-pyrrolo [1,2-a] pyrazin-1-one derivatives
WO2010033941A1 (en) 2008-09-22 2010-03-25 Array Biopharma Inc. Substituted imidazo[1,2b]pyridazine compounds as trk kinase inhibitors
KR101718386B1 (en) 2008-09-26 2017-03-21 내셔날 헬스 리서치 인스티튜트 Fused multicyclic compounds as protein kinase inhibitors
UY32192A (en) 2008-10-22 2011-05-31 Array Biopharma Inc PIRAZOLO COMPOUNDS [1,5-a] PIRIMIDINE REPLACED AS TRK CINASA INHIBITORS
KR101686685B1 (en) 2008-10-31 2016-12-14 제넨테크, 인크. Pyrazolopyrimidine jak inhibitor compounds and methods
EP2358725A1 (en) 2008-11-06 2011-08-24 Ambit Biosciences Corporation Imidazolothiazole compounds as modulators of protein kinase
EP2376084B1 (en) 2008-11-24 2013-07-17 Nerviano Medical Sciences S.r.l. CDK inhibitor for the treatment of mesothelioma
KR101061599B1 (en) 2008-12-05 2011-09-02 한국과학기술연구원 Novel indazole derivatives that are protein kinase inhibitors for the treatment of abnormal cell growth diseases, pharmaceutically acceptable salts thereof, and pharmaceutical compositions containing the same as active ingredients
JO3265B1 (en) 2008-12-09 2018-09-16 Novartis Ag Pyridyloxyindoles Inhibitors of VEGF-R2 and Use Thereof for Treatment of Disease
CA2744236C (en) 2009-02-12 2021-03-16 Cell Signaling Technology, Inc. Mutant ros expression in human cancer
WO2010111527A1 (en) 2009-03-26 2010-09-30 Plexxikon, Inc. Pyrazolo [ 3, 4 -b] pyridines as kinase inhibitors and their medical use
US8492374B2 (en) 2009-04-29 2013-07-23 Industrial Technology Research Institute Azaazulene compounds
MX2011011875A (en) 2009-05-08 2011-12-08 Astellas Pharma Inc Diamino heterocyclic carboxamide compound.
JP6073677B2 (en) 2009-06-12 2017-02-01 デイナ ファーバー キャンサー インスティチュート，インコーポレイテッド Fused heterocyclic compounds and their use
JP5789602B2 (en) 2009-06-15 2015-10-07 ネルビアーノ・メデイカル・サイエンシーズ・エツセ・エルレ・エルレ Substituted pyrimidinyl pyrrolopyridinone derivatives, methods for their preparation and their use as kinase inhibitors
AR077468A1 (en) 2009-07-09 2011-08-31 Array Biopharma Inc PIRAZOLO COMPOUNDS (1,5-A) PYRIMIDINE SUBSTITUTED AS TRK-QUINASA INHIBITORS
KR101256018B1 (en) 2009-08-20 2013-04-18 한국과학기술연구원 1,3,6-Substituted indole derivatives having inhibitory activity for protein kinase
KR101147550B1 (en) 2009-10-22 2012-05-17 한국과학기술연구원 2,7-Substituted thieno[3,2-d]pyrimidine compounds as protein kinase inhibitors
KR101116756B1 (en) 2009-10-27 2012-03-13 한국과학기술연구원 Novel 1,6-disubstituted indole compounds as protein kinase inhibitors
US8404677B2 (en) 2009-10-29 2013-03-26 Genosco Kinase inhibitors
CA2780892C (en) 2009-11-13 2017-02-14 Genosco Kinase inhibitors
KR101094446B1 (en) 2009-11-19 2011-12-15 한국과학기술연구원 2,4,7-Substituted thieno[3,2-d]pyrimidine compounds as protein kinase inhibitors
CA2784807C (en) 2009-12-29 2021-12-14 Dana-Farber Cancer Institute, Inc. Type ii raf kinase inhibitors
SG182361A1 (en) 2010-01-29 2012-08-30 Hanmi Science Co Ltd THIENO[3,2-d]PYRIMIDINE DERIVATIVES HAVING INHIBITORY ACTIVITY ON PROTEIN KINASES
WO2011092120A1 (en) 2010-01-29 2011-08-04 Nerviano Medical Sciences S.R.L. 6,7- dihydroimidazo [1,5-a] pyrazin-8 (5h) - one derivatives as protein kinase modulators
KR101483215B1 (en) 2010-01-29 2015-01-16 한미약품 주식회사 Bicyclic heteroaryl derivatives having inhibitory activity for protein kinases
WO2011101408A1 (en) 2010-02-18 2011-08-25 INSERM (Institut National de la Santé et de la Recherche Médicale) Method for preventing cancer metastasis
BR112012025593A2 (en) 2010-04-06 2019-06-25 Caris Life Sciences Luxembourg Holdings circulating biomarkers for disease
US8383793B2 (en) 2010-04-15 2013-02-26 St. Jude Children's Research Hospital Methods and compositions for the diagnosis and treatment of cancer resistant to anaplastic lymphoma kinase (ALK) kinase inhibitors
TWI619713B (en) 2010-04-21 2018-04-01 普雷辛肯公司 Compounds and methods for kinase modulation, and indications therefor
PL3333188T3 (en) 2010-08-19 2022-05-09 Zoetis Belgium S.A. Anti-ngf antibodies and their use
UY33597A (en) 2010-09-09 2012-04-30 Irm Llc COMPOUNDS AND COMPOSITIONS AS INHIBITORS OF THE TRK
WO2012034095A1 (en) 2010-09-09 2012-03-15 Irm Llc Compounds and compositions as trk inhibitors
WO2012047017A2 (en) 2010-10-05 2012-04-12 크리스탈지노믹스(주) 2,3-dihydro-isoindol-1-one derivative and a composition comprising the same
JP2014005206A (en) 2010-10-22 2014-01-16 Astellas Pharma Inc Arylamino heterocyclic carboxamide compound
CA2821515A1 (en) 2010-12-01 2012-06-07 Alder Biopharmaceuticals, Inc. Anti-ngf compositions and use thereof
US8618146B2 (en) 2011-01-03 2013-12-31 Dr. Reddy's Laboratories Limited Epothilone compound formulations
BR112013018515B1 (en) 2011-01-26 2021-06-29 Nerviano Medical Sciences S.R.I TRICYCLICAL PYRROL DERIVATIVES, PROCESS FOR THEIR PREPARATION AND USE AS KINASE INHIBITORS
EP2668188B1 (en) 2011-01-26 2016-05-18 Nerviano Medical Sciences S.r.l. Tricyclic derivatives, process for their preparation and their use as kinase inhibitors
CN102093421B (en) 2011-01-28 2014-07-02 北京康辰药业有限公司 Phosphorus substituent group-containing quinoline compound and preparation method of quinoline compound as well as pharmaceutical composition containing quinoline compound and application of pharmaceutical composition
PT2672967T (en) 2011-02-07 2018-12-07 Plexxikon Inc Compounds and methods for kinase modulation, and indications therefor
CN103403002B (en) 2011-02-24 2016-06-22 内尔维阿诺医学科学有限公司 Thiazolylphenyl-benzderivativesido derivativesido as inhibitors of kinases
PE20140378A1 (en) 2011-02-25 2014-03-28 Irm Llc COMPOUNDS AND COMPOSITIONS AS INHIBITORS OF TRK
US8791112B2 (en) 2011-03-30 2014-07-29 Arrien Pharmaceuticals Llc Substituted 5-(pyrazin-2-yl)-1H-pyrazolo [3, 4-B] pyridine and pyrazolo [3, 4-B] pyridine derivatives as protein kinase inhibitors
BR112013025387B1 (en) 2011-04-01 2021-07-27 University Of Utah Research Foundation REPLACED N-FENYLPYRIMIDIN-2-AMINE ANALOGUE COMPOUNDS AS KINASE AXL INHIBITORS, USE OF SUCH COMPOUNDS FOR THE TREATMENT OF AN UNCONTROLLED CELL PROLIFERATION DISORDER, AS WELL AS KIT INCLUDING SUCH COMPOUNDS
EP2702055A1 (en) 2011-04-11 2014-03-05 Nerviano Medical Sciences S.r.l. Pyrazolyl-pyrimidine derivatives as kinase inhibitors
RU2621732C2 (en) 2011-04-19 2017-06-07 НЕРВИАНО МЕДИКАЛ САЙЕНСИЗ С.р.л. Substituted pyrimidinyl pyrroles active as kinase inhibitors
ES2611779T3 (en) 2011-05-12 2017-05-10 Nerviano Medical Sciences S.R.L. Active substituted indazole derivatives as kinase inhibitors
LT2712358T (en) 2011-05-13 2017-01-25 Array Biopharma, Inc. Pyrrolidinyl urea, pyrrolidinyl thiourea and pyrrolidinyl guanidine compounds as trka kinase inhibitors
RU2477723C2 (en) 2011-06-16 2013-03-20 Общество С Ограниченной Ответственностью "Фьюжн Фарма" Protein kinase inhibitor (versions), use thereof for treating oncological diseases and based pharmaceutical composition
EP2736514B1 (en) 2011-07-28 2017-10-18 Nerviano Medical Sciences S.r.l. Alkynyl substituted pyrimidinyl-pyrroles active as kinases inhibitors
WO2013016720A2 (en) 2011-07-28 2013-01-31 Gerinda Therapeutics, Inc. Novel substituted biarylheterocycle derivatives as protein kinase inhibitors for the treatment of cancer and other diseases
CA2848369A1 (en) 2011-08-04 2013-02-07 National Cancer Center Fusion gene of kif5b gene and ret gene, and method for determining effectiveness of cancer treatment targeting fusion gene
EP2748192B2 (en) 2011-08-23 2022-04-20 Foundation Medicine, Inc. Kif5b-ret fusion molecules and uses thereof
AU2012341028C1 (en) 2011-09-02 2017-10-19 Mount Sinai School Of Medicine Substituted pyrazolo[3,4-D]pyrimidines and uses thereof
WO2013036232A2 (en) 2011-09-08 2013-03-14 Deciphera Pharmaceuticals, Llc Methods and compositions for the treatment of myeloproliferative diseases and other proliferative diseases
WO2013042137A1 (en) 2011-09-19 2013-03-28 Aurigene Discovery Technologies Limited Bicyclic heterocycles as irak4 inhibitors
CN102408411B (en) 2011-09-19 2014-10-22 北京康辰药业股份有限公司 Hydroximic acid compound containing quinolyl and preparation method thereof, and drug composition containing the compound and use thereof
JP5998223B2 (en) 2011-10-07 2016-09-28 ネルビアーノ・メデイカル・サイエンシーズ・エツセ・エルレ・エルレ Substituted 3,4-dihydropyrrolo [1,2-a] pyrazin-1 (2H) -one derivatives as kinase inhibitors
WO2013050448A1 (en) 2011-10-07 2013-04-11 Nerviano Medical Sciences S.R.L. 4-ALKYL SUBSTITUTED 3,4-DIHYDROPYRROLO[1,2-a]PYRAZIN-1(2H)-ONE DERIVATIVES AS KINASES INHIBITORS
WO2013059740A1 (en) 2011-10-21 2013-04-25 Foundation Medicine, Inc. Novel alk and ntrk1 fusion molecules and uses thereof
JP2014533286A (en) 2011-11-14 2014-12-11 テサロ， インコーポレイテッド Regulation of specific tyrosine kinases
JPWO2013081188A1 (en) 2011-11-30 2015-04-27 独立行政法人国立がん研究センター Induced malignant stem cells
MX356401B (en) 2011-12-12 2018-05-21 Dr Reddys Laboratories Ltd Substituted pyrazolo[1,5-a] pyridine as tropomyosin receptor kinase (trk) inhibitors.
PE20141404A1 (en) 2011-12-30 2014-10-28 Hanmi Pharm Ind Co Ltd DERIVATIVES OF HAVE [3,2-D] PYRIMIDINE WHICH HAVE INHIBITING ACTIVITY BY KINASES OF PROTEINS
US8377946B1 (en) 2011-12-30 2013-02-19 Pharmacyclics, Inc. Pyrazolo[3,4-d]pyrimidine and pyrrolo[2,3-d]pyrimidine compounds as kinase inhibitors
JP2015109806A (en) 2012-03-22 2015-06-18 アステラス製薬株式会社 Method for detecting new ret fused body
TW201350479A (en) 2012-04-26 2013-12-16 Ono Pharmaceutical Co TrK inhibitor compound
JP2013226108A (en) 2012-04-27 2013-11-07 Astellas Pharma Inc Method for detecting new ntrk2 activating mutation
EP2849751A1 (en) 2012-05-10 2015-03-25 Synta Pharmaceuticals Corp. Treating cancer with hsp90 inhibitory compounds
CN104395308B (en) 2012-05-23 2016-08-24 内尔维阿诺医学科学有限公司 The preparation method of N-[5-(3,5-diiluoro-benzyl)-1H-indazole-3-base]-4-(4-thyl-piperazin-1-base)-2-(ttetrahydro-pyran-4-base amino)-Benzoylamide
TWI585088B (en) 2012-06-04 2017-06-01 第一三共股份有限公司 Imidazo[1,2-b]pyridazine analogues as kinase inhibitors
RS62233B1 (en) 2012-07-11 2021-09-30 Blueprint Medicines Corp Inhibitors of the fibroblast growth factor receptor
JPWO2014017491A1 (en) 2012-07-26 2016-07-11 国立研究開発法人国立がん研究センター Fusion gene of CEP55 gene and RET gene
EP2689778A1 (en) 2012-07-27 2014-01-29 Pierre Fabre Medicament Derivatives of azaindoles or diazaindoles for treating pain
US9688661B2 (en) 2012-08-02 2017-06-27 Nerviano Medical Sciences S.R.L. Substituted pyrroles active as kinases inhibitors
JP6223451B2 (en) 2012-08-31 2017-11-01 ザ リージェンツ オブ ザ ユニヴァーシティ オブ コロラド，ア ボディ コーポレイト Cancer diagnosis and treatment methods
JP6513567B2 (en) 2012-09-07 2019-05-15 エクセリクシス， インク． Inhibitors of MET, VEGFR, and RET for use in the treatment of lung adenocarcinoma
US20140084039A1 (en) 2012-09-24 2014-03-27 Electro Scientific Industries, Inc. Method and apparatus for separating workpieces
CA3077553C (en) 2012-09-25 2022-08-02 Chugai Seiyaku Kabushiki Kaisha Ret inhibitor
JP2014082984A (en) 2012-10-23 2014-05-12 Astellas Pharma Inc Method for detecting novel ntrk2 activating mutation
CA2890207A1 (en) 2012-11-05 2014-05-08 Foundation Medicine, Inc. Novel ntrk1 fusion molecules and uses thereof
AU2013337264B2 (en) 2012-11-05 2018-03-08 Foundation Medicine, Inc. Novel fusion molecules and uses thereof
ES2755772T3 (en) 2012-11-07 2020-04-23 Nerviano Medical Sciences Srl Pyrimidinyl and substituted pyridinylpyrrolopyridinones, process for their preparation and use as kinase inhibitors
EA029706B1 (en) 2012-11-12 2018-05-31 Игнайта, Инк. Bendamustine alkyl esters and methods of using same
WO2014078322A1 (en) 2012-11-13 2014-05-22 Array Biopharma Inc. Thiazolyl and oxazolyl urea, thiourea, guanidine and cyanoguanidine compounds as trka kinase inhibitors
US9809578B2 (en) 2012-11-13 2017-11-07 Array Biopharma Inc. Pyrazolyl urea, thiourea, guanidine and cyanoguanidine compounds as trkA kinase inhibitors
US9969694B2 (en) 2012-11-13 2018-05-15 Array Biopharma Inc. N-(arylalkyl)-N′-pyrazolyl-urea, thiourea, guanidine and cyanoguanidine compounds as TrkA kinase inhibitors
NZ708028A (en) 2012-11-13 2018-12-21 Array Biopharma Inc N-pyrrolidinyl, n’-pyrazolyl- urea, thiourea, guanidine and cyanoguanidine compounds as trka kinase inhibitors
US9828360B2 (en) 2012-11-13 2017-11-28 Array Biopharma Inc. Pyrrolidinyl urea, thiourea, guanidine and cyanoguanidine compounds as TrkA kinase inhibitors
WO2014078408A1 (en) 2012-11-13 2014-05-22 Array Biopharma Inc. Bicyclic heteroaryl urea, thiourea, guanidine and cyanoguanidine compounds as trka kinase inhibitors
WO2014078325A1 (en) 2012-11-13 2014-05-22 Array Biopharma Inc. N-(monocyclic aryl),n'-pyrazolyl-urea, thiourea, guanidine and cyanoguanidine compounds as trka kinase inhibitors
WO2014078372A1 (en) 2012-11-13 2014-05-22 Array Biopharma Inc. Pyrrolidinyl urea, thiourea, guanidine and cyanoguanidine compounds as trka kinase inhibitors
WO2014078328A1 (en) 2012-11-13 2014-05-22 Array Biopharma Inc. N-bicyclic aryl,n'-pyrazolyl urea, thiourea, guanidine and cyanoguanidine compounds as trka kinase inhibitors
DK2920166T3 (en) 2012-11-13 2017-02-06 Array Biopharma Inc SUITABLE BICYCLIC UREA, THIOUREA, GUANIDINE AND CYANOGUANIDE COMPOUNDS FOR PAIN TREATMENT
EP2925359A2 (en) 2012-11-29 2015-10-07 Yeda Research and Development Co., Ltd. Methods of preventing tumor metastasis, treating and prognosing cancer and identifying agents which are putative metastasis inhibitors
WO2014086284A1 (en) 2012-12-04 2014-06-12 上海医药集团股份有限公司 Deuterated 3-cyano quinoline compound, pharmaceutical composition, preparation method and use thereof
US9447135B2 (en) 2012-12-14 2016-09-20 University Of Kentucky Research Foundation Semi-synthetic mithramycin derivatives with anti-cancer activity
FR3000492B1 (en) 2012-12-28 2015-09-11 Oribase Pharma NOVEL AZAINDOLE DERIVATIVES AS MULTIKINASE INHIBITORS
BR112015015477B1 (en) 2012-12-28 2022-07-12 Crystalgenomics, Inc 2,3-DI-HYDRO-ISOINDOL-1-ONA DERIVATIVES AND METHODS OF USING THEM AS BTK INHIBITORS
FR3000493A1 (en) 2012-12-28 2014-07-04 Oribase Pharma NEW INHIBITORS OF PROTEIN KINASES
FR3000494B1 (en) 2012-12-28 2015-08-21 Oribase Pharma NOVEL AZAINDOLE DERIVATIVES AS INHIBITORS OF PROTEIN KINASES
US9127055B2 (en) 2013-02-08 2015-09-08 Astellas Pharma Inc. Method of treating pain with anti-human NGF antibody
MX346411B (en) 2013-02-19 2017-03-17 Ono Pharmaceutical Co Trk-INHIBITING COMPOUND.
WO2014130975A1 (en) 2013-02-22 2014-08-28 Bastian Boris C Fusion polynucleotides and fusion polypeptides associated with cancer and particularly melanoma and their uses as therapeutic and diagnostic targets
WO2014134096A1 (en) 2013-02-27 2014-09-04 Oregon Health & Science University Methods of treating cancers characterized by aberrent ros1 activity
RS55710B1 (en) 2013-03-15 2017-07-31 Glaxosmithkline Ip Dev Ltd Pyridine derivatives as rearranged during transfection (ret) kinase inhibitors
US9499522B2 (en) 2013-03-15 2016-11-22 Blueprint Medicines Corporation Compositions useful for treating disorders related to kit
US8937071B2 (en) 2013-03-15 2015-01-20 Glaxosmithkline Intellectual Property Development Limited Compounds as rearranged during transfection (RET) inhibitors
WO2014150751A2 (en) * 2013-03-15 2014-09-25 Novartis Ag Biomarkers associated with brm inhibition
WO2014151117A1 (en) 2013-03-15 2014-09-25 The Board Of Trustees Of The Leland Stanford Junior University Identification and use of circulating nucleic acid tumor markers
WO2014152777A2 (en) 2013-03-15 2014-09-25 Insight Genetics, Inc. Methods and compositions for the diagnosis and treatment of cancers resistant to ros1 inhibitors
WO2014151734A1 (en) 2013-03-15 2014-09-25 The Trustees Of Columbia University In The City Of New York Fusion proteins and methods thereof
US10072298B2 (en) 2013-04-17 2018-09-11 Life Technologies Corporation Gene fusions and gene variants associated with cancer
AU2014254394B2 (en) 2013-04-17 2020-06-18 Life Technologies Corporation Gene fusions and gene variants associated with cancer
EP2997030B1 (en) 2013-05-14 2017-08-09 Nerviano Medical Sciences S.R.L. Pyrrolo[2,3-d]pyrimidine derivatives, process for their preparation and their use as kinase inhibitors
AU2014274093B2 (en) 2013-05-30 2018-11-08 Plexxikon Inc. Compounds for kinase modulation, and indications therefor
RU2656591C2 (en) 2013-07-11 2018-06-06 Бетта Фармасьютикалз Ко., Лтд Protein tyrosine kinase modulators and methods of use
WO2015012397A1 (en) 2013-07-26 2015-01-29 公益財団法人がん研究会 Method for detecting ntrk3 fusant
WO2015017533A1 (en) 2013-07-30 2015-02-05 Blueprint Medicines Corporation Ntrk2 fusions
WO2015017528A1 (en) 2013-07-30 2015-02-05 Blueprint Medicines Corporation Pik3c2g fusions
EP3037547A1 (en) 2013-08-20 2016-06-29 National Cancer Center New fusion gene detected in lung cancer
KR20160055170A (en) 2013-08-30 2016-05-17 암비트 바이오사이언시즈 코포레이션 Biaryl acetamide compounds and methods of use thereof
WO2015039006A1 (en) 2013-09-16 2015-03-19 The General Hospital Corporation Methods of treating cancer
US9334263B2 (en) 2013-10-17 2016-05-10 Blueprint Medicines Corporation Compositions useful for treating disorders related to kit
EP3057969B1 (en) 2013-10-17 2018-06-13 Blueprint Medicines Corporation Compositions useful for treating disorders related to kit
WO2015061229A1 (en) 2013-10-24 2015-04-30 Georgetown University Methods and compositions for treating cancer
CA2928042C (en) 2013-10-25 2022-05-10 Blueprint Medicines Corporation Inhibitors of the fibroblast growth factor receptor
JPWO2015064621A1 (en) 2013-10-29 2017-03-09 公益財団法人がん研究会 Novel fusion and detection method thereof
GB201321146D0 (en) 2013-11-29 2014-01-15 Cancer Rec Tech Ltd Quinazoline compounds
EP3076966A2 (en) 2013-12-02 2016-10-12 BerGenBio AS Use of kinase inhibitors
US9695165B2 (en) 2014-01-15 2017-07-04 Blueprint Medicines Corporation Inhibitors of the fibroblast growth factor receptor
ES2933350T3 (en) 2014-01-24 2023-02-06 Turning Point Therapeutics Inc Diaryl macrocycles as modulators of protein kinases
PT3102555T (en) 2014-02-05 2021-06-04 VM Oncology LLC Compositions of compounds and uses thereof
US10501418B2 (en) 2014-02-14 2019-12-10 Exelixis, Inc. Crystalline solid forms of N-{4-[(6,7-dimethoxyquinolin-4-yl)oxy]phenyl}-N′-(4-fluorophenyl) cyclopropane-1,1-dicarboxamide, processes for making, and methods of use
US10231965B2 (en) 2014-02-20 2019-03-19 Ignyta, Inc. Molecules for administration to ROS1 mutant cancer cells
EP3132054B1 (en) 2014-04-18 2021-06-30 Blueprint Medicines Corporation Met fusions
US20170044622A1 (en) 2014-04-18 2017-02-16 Blueprint Medicines Corporation Pik3ca fusions
ES2746530T3 (en) 2014-05-15 2020-03-06 Array Biopharma Inc 1 - ((3S, 4R) -4- (3-fluorophenyl) -1- (2-methoxyethyl) pyrrolidin-3-yl) -3- (4-methyl-3- (2-methylpyrimidin-5-yl) - 1-phenyl-1H-pyrazol-5-yl) urea as a TrkA kinase inhibitor
WO2015183836A1 (en) 2014-05-27 2015-12-03 Brian Haynes Compositions, methods, and uses related to ntrk2-tert fusions
WO2015183837A1 (en) 2014-05-27 2015-12-03 Brian Haynes Compositions, methods, and uses related to ntrk2-tert fusions
WO2015184443A1 (en) 2014-05-30 2015-12-03 The Regents Of The University Of Colorado Activating ntrk1 gene fusions predictive of kinase inhibitor therapy
WO2015191666A2 (en) 2014-06-10 2015-12-17 Blueprint Medicines Corporation Raf1 fusions
WO2015191667A1 (en) 2014-06-10 2015-12-17 Blueprint Medicines Corporation Pkn1 fusions
EP3169804B3 (en) 2014-07-17 2019-09-18 Blueprint Medicines Corporation Fgr fusions
US10065934B2 (en) 2014-07-17 2018-09-04 Sunshine Lake Pharma Co., Ltd. Substituted urea derivatives and pharmaceutical uses thereof
WO2016011144A1 (en) 2014-07-17 2016-01-21 Blueprint Medicines Corporation Tert fusions
WO2016011147A1 (en) 2014-07-17 2016-01-21 Blueprint Medicines Corporation Prkc fusions
WO2016022569A1 (en) 2014-08-04 2016-02-11 Blueprint Medicines Corporation Compositions useful for treating disorders related to kit
HUE045237T2 (en) 2014-08-18 2019-12-30 Ono Pharmaceutical Co Acid-addition salt of trk-inhibiting compound
KR20170047396A (en) 2014-09-08 2017-05-04 글락소스미스클라인 인털렉츄얼 프로퍼티 디벨로프먼트 리미티드 Crystalline forms of 2-(4-(4-ethoxy-6-oxo-1,6-dihydropyridin-3-yl)-2-fluorophenyl)-n-(5-(1,1,1-trifluoro-2-methylpropan-2-yl)isoxazol-3-yl)acetamide
HUE044604T2 (en) 2014-09-10 2019-11-28 Glaxosmithkline Ip Dev Ltd Pyridone derivatives as rearranged during transfection (ret) kinase inhibitors
CR20170094A (en) 2014-09-10 2017-05-08 Glaxosmithkline Ip Dev Ltd NEW COMPOUNDS AS REORGANIZED INHIBITORS DURING TRANSFECTION (RET)
TWI538914B (en) 2014-10-03 2016-06-21 國立交通大學 Selective inhibitors for protein kinases, a pharmaceutical composition and an use thereof
AU2015333687B2 (en) 2014-10-14 2021-03-18 Dana-Farber Cancer Institute, Inc. Antibody molecules to PD-L1 and uses thereof
CA2967125C (en) 2014-11-14 2022-10-25 Nerviano Medical Sciences S.R.L. 6-amino-7-bicyclo-7-deaza-purine derivatives as protein kinase inhibitors
KR102649887B1 (en) 2014-11-16 2024-03-22 어레이 바이오파마 인크. Crystalline form of (s)-n-(5-((r)-2-(2,5-difluorophenyl)-pyrrolidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide hydrogen sulfate
EP3221700B1 (en) 2014-11-18 2022-06-22 Blueprint Medicines Corporation Prkacb fusions
AU2015365587B2 (en) 2014-12-15 2020-07-23 Cmg Pharmaceutical Co., Ltd. Fused ring heteroaryl compounds and their use as TRK inhibitors
WO2016096709A1 (en) 2014-12-16 2016-06-23 Eudendron S.R.L. Heterocyclic derivatives modulating activity of certain protein kinases
WO2016127074A1 (en) 2015-02-06 2016-08-11 Blueprint Medicines Corporation 2-(pyridin-3-yl)-pyrimidine derivatives as ret inhibitors
KR101675984B1 (en) 2015-02-23 2016-11-14 한양대학교 에리카산학협력단 Thienodiazepine derivatives or pharmaceutically acceptable salt thereof, and pharmaceutical composition comprising the same as an active ingredient
EP3265079A4 (en) 2015-03-03 2019-01-02 Caris MPI, Inc. Molecular profiling for cancer
CA3227242A1 (en) 2015-03-16 2016-09-22 Personal Genome Diagnostics Inc. Systems and methods for analyzing nucleic acid
CN108137593B (en) 2015-04-21 2021-01-05 上海交通大学医学院附属瑞金医院 Preparation and use of protein kinase inhibitors
IL255769B2 (en) 2015-05-20 2023-09-01 Broad Inst Inc Shared neoantigens
CA2987281A1 (en) 2015-05-29 2016-12-08 Ignyta, Inc. Compositions and methods for treating patients with rtk mutant cells
EA201792679A1 (en) 2015-06-01 2018-06-29 Локсо Онколоджи, Инк. METHODS OF DIAGNOSTICS AND TREATMENT OF MALIGNANT TUMOR
AU2015101722A4 (en) 2015-06-19 2016-05-19 Macau University Of Science And Technology Oncogenic ros1 and alk kinase inhibitor
GB201511546D0 (en) 2015-07-01 2015-08-12 Immatics Biotechnologies Gmbh Novel peptides and combination of peptides for use in immunotherapy against ovarian cancer and other cancers
KR102599788B1 (en) * 2015-07-02 2023-11-07 터닝 포인트 테라퓨틱스, 인크. Chiral diaryl macrocycles as regulators of protein kinases
GB201512365D0 (en) 2015-07-15 2015-08-19 King S College London Novel therapy
TN2018000027A1 (en) 2015-07-16 2019-07-08 Array Biopharma Inc Substituted pyrazolo[1,5-a]pyridine compounds as ret kinase inhibitors
EP3120851A1 (en) 2015-07-21 2017-01-25 Pangaea Biotech S.L. 4-amino-6-(2,6-dichlorophenyl)-8-methyl-2-(phenylamino)-pyrido[2,3-d]pyrimidin-7(8h)-one for treatment of solid cancers
KR101766194B1 (en) 2015-08-07 2017-08-10 한국과학기술연구원 Novel 3-(isoxazol-3-yl)-pyrazolo[3,4-d]pyrimidin-4-amine compounds as RET kinase inhibitor
WO2017027883A1 (en) 2015-08-13 2017-02-16 San Diego State University Research Foundation Atropisomerism for increased kinase inhibitor selectivity
MA41559A (en) 2015-09-08 2017-12-26 Taiho Pharmaceutical Co Ltd CONDENSED PYRIMIDINE COMPOUND OR A SALT THEREOF
WO2017049462A1 (en) 2015-09-22 2017-03-30 合肥中科普瑞昇生物医药科技有限公司 Novel flt3 kinase inhibitor and uses thereof
CN105255927B (en) 2015-09-30 2018-07-27 温州医科大学附属第一医院 A kind of KIAA1217-RET fusions
TN2018000138A1 (en) 2015-10-26 2019-10-04 Array Biopharma Inc Point mutations in trk inhibitor-resistant cancer and methods relating to the same
TWI757256B (en) 2015-11-02 2022-03-11 美商纜圖藥品公司 Inhibitors of ret
US20190002988A1 (en) 2015-12-08 2019-01-03 Boehringer Ingelheim International Gmbh Method of using a ret fusion gene as a biomarker to select non small cell lung cancer (nsclc) and thyroid cancer patients for a cancer treatment
JP6871869B2 (en) 2016-01-15 2021-05-19 公益財団法人がん研究会 New fusion and its detection method
US20170224662A1 (en) 2016-01-22 2017-08-10 The Medicines Company Aqueous Formulations and Methods of Preparation and Use Thereof
TWI620748B (en) 2016-02-05 2018-04-11 National Health Research Institutes Aminothiazole compounds and use thereof
WO2017145050A1 (en) 2016-02-23 2017-08-31 Glaxosmithkline Intellectual Property Development Limited Pyridylpyridone derivative useful as a ret kinase inhibitor in the treatment of ibs and cancer
EP3269370B1 (en) 2016-02-23 2020-01-08 Taiho Pharmaceutical Co., Ltd. Novel condensed pyrimidine compound or salt thereof
TW201733580A (en) 2016-03-11 2017-10-01 小野藥品工業股份有限公司 Treating agent for cancer having TrK inhibitor resistance
AR107912A1 (en) 2016-03-17 2018-06-28 Blueprint Medicines Corp RET INHIBITORS
MX2018012163A (en) 2016-04-04 2019-07-08 Loxo Oncology Inc Liquid formulations of (s)-n-(5-((r)-2-(2,5-difluorophenyl)-pyrro lidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine- 1-carboxamide.
US10045991B2 (en) 2016-04-04 2018-08-14 Loxo Oncology, Inc. Methods of treating pediatric cancers
RS63609B1 (en) 2016-04-15 2022-10-31 Cancer Research Tech Ltd Heterocyclic compounds as ret kinase inhibitors
JP6943876B2 (en) 2016-04-15 2021-10-06 キャンサー・リサーチ・テクノロジー・リミテッドＣａｎｃｅｒ Ｒｅｓｅａｒｃｈ Ｔｅｃｈｎｏｌｏｇｙ Ｌｉｍｉｔｅｄ Heterocyclic compounds as RET kinase inhibitors
WO2017184597A1 (en) 2016-04-19 2017-10-26 Exelixis, Inc. Triple negative breast cancer treatment method
CN109790143A (en) 2016-05-10 2019-05-21 C4医药公司 The C of amine connection for target protein degradation3Glutarimide degron body
JP7443057B2 (en) 2016-05-18 2024-03-05 ロクソ オンコロジー， インコーポレイテッド (S)-N-(5-((R)-2-(2,5-difluorophenyl)pyrrolidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine -1-Preparation of carboxamide
WO2017201156A1 (en) 2016-05-18 2017-11-23 Duke University Method of treating kras wild-type metastatic colorectal cell carcinoma using cabozantinib plus panitumumab
US20170349953A1 (en) 2016-06-01 2017-12-07 Roche Sequencing Solutions, Inc. Novel mutations in anaplastic lymphoma kinase predicting response to alk inhibitor therapy in lung cancer patients
WO2018017983A1 (en) 2016-07-22 2018-01-25 Blueprint Medicines Corporation Compounds useful for treating disorders related to ret
TWI704148B (en) 2016-10-10 2020-09-11 美商亞雷生物製藥股份有限公司 Substituted pyrazolo[1,5-a]pyridine compounds as ret kinase inhibitors
JOP20190092A1 (en) 2016-10-26 2019-04-25 Array Biopharma Inc PROCESS FOR THE PREPARATION OF PYRAZOLO[1,5-a]PYRIMIDINES AND SALTS THEREOF
AU2018210397B2 (en) 2017-01-20 2024-02-29 Exelixis, Inc. Combinations of cabozantinib and atezolizumab to treat cancer
CN108456163A (en) 2017-02-20 2018-08-28 中国科学院上海药物研究所 Compound and its preparation method and application containing adjacent amino heteroaryl cycloalkynyl radical
JOP20190213A1 (en) 2017-03-16 2019-09-16 Array Biopharma Inc Macrocyclic compounds as ros1 kinase inhibitors
MA50456A (en) 2017-10-26 2020-09-02 Array Biopharma Inc MACROCYCLIC KINASE TRK INHIBITOR FORMULATIONS

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6463922B2 (en) * 2000-01-24 2002-10-15 Graniterie Des Ecorces Wedge intended to be inserted in a cutting slot
US8933084B2 (en) * 2010-05-20 2015-01-13 Array Biopharma Inc. Macrocyclic compounds as Trk kinase inhibitors
US20160032404A1 (en) * 2014-08-01 2016-02-04 Pharmacyclics Llc Biomarkers for predicting response of dlbcl to treatment with a btk inhibitor
US20160367547A1 (en) * 2015-06-19 2016-12-22 Macau University Of Science And Technology Oncogenic ros1 and alk kinase inhibitor

Cited By (23)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10590139B2 (en) 2008-09-22 2020-03-17 Array Biopharma Inc. Method of treatment using substituted imidazo[1,2b]pyridazine compounds
US11267818B2 (en) 2008-10-22 2022-03-08 Array Biopharma Inc. Method of treatment using substituted pyrazolo[1,5-a] pyrimidine compounds
US10774085B2 (en) 2008-10-22 2020-09-15 Array Biopharma Inc. Method of treatment using substituted pyrazolo[1,5-A] pyrimidine compounds
US10758542B2 (en) 2009-07-09 2020-09-01 Array Biopharma Inc. Substituted pyrazolo[l,5-a]pyrimidine compounds as Trk kinase inhibitors
US10647730B2 (en) 2010-05-20 2020-05-12 Array Biopharma Inc. Macrocyclic compounds as TRK kinase inhibitors
US10813936B2 (en) 2014-11-16 2020-10-27 Array Biopharma, Inc. Crystalline form of (S)-N-(5-((R)-2-(2,5-difluorophenyl)-pyrrolidin-1-YL)-pyrazolo[1,5-A]pyrimidin-3-YL)-3-hydroxypyrrolidine-1-carboxamide hydrogen sulfate
US10799505B2 (en) 2014-11-16 2020-10-13 Array Biopharma, Inc. Crystalline form of (S)-N-(5-((R)-2-(2,5-difluorophenyl)-pyrrolidin-1-yl)-pyrazolo[1,5-A]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide hydrogen sulfate
US10655186B2 (en) 2015-10-26 2020-05-19 Loxo Oncology, Inc. Point mutations in TRK inhibitor-resistant cancer and methods relating to the same
US10724102B2 (en) 2015-10-26 2020-07-28 Loxo Oncology, Inc. Point mutations in TRK inhibitor-resistant cancer and methods relating to the same
US10907215B2 (en) 2015-10-26 2021-02-02 Loxo Oncology, Inc. Point mutations in TRK inhibitor-resistant cancer and methods relating to the same
US11484535B2 (en) 2016-04-04 2022-11-01 Loxo Oncology, Inc. Liquid formulations of (S)-N-(5-((R)-2-(2,5-difluorophenyl)-pyrrolidin-1-yl)-pyrazolo[1,5-a] pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide
US10668072B2 (en) 2016-04-04 2020-06-02 Loxo Oncology, Inc. Liquid formulations of (S)-N-(5-((R)-2-(2,5-difluorophenyl)-pyrrolidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide
US10588908B2 (en) 2016-04-04 2020-03-17 Loxo Oncology, Inc. Methods of treating pediatric cancers
US11191766B2 (en) 2016-04-04 2021-12-07 Loxo Oncology, Inc. Methods of treating pediatric cancers
US11214571B2 (en) 2016-05-18 2022-01-04 Array Biopharma Inc. Process for the preparation of (S)-N-(5-((R)-2-(2,5-difluorophenyl)pyrrolidin-1-yl)-pyrazolo[1,5-a]pyrimidin-3-yl)-3-hydroxypyrrolidine-1-carboxamide and salts thereof
US11091486B2 (en) 2016-10-26 2021-08-17 Array Biopharma, Inc Process for the preparation of pyrazolo[1,5-a]pyrimidines and salts thereof
US10966985B2 (en) 2017-03-16 2021-04-06 Array Biopharma Inc. Macrocyclic compounds as ROS1 kinase inhibitors
US10688100B2 (en) 2017-03-16 2020-06-23 Array Biopharma Inc. Macrocylic compounds as ROS1 kinase inhibitors
WO2020198379A1 (en) * 2019-03-26 2020-10-01 Ventyx Biosciences, Inc. Tyk2 pseudokinase ligands
US11780842B2 (en) 2019-03-26 2023-10-10 Ventyx Biosciences, Inc. TYK2 pseudokinase ligands
US11753411B2 (en) 2019-11-08 2023-09-12 Ventyx Biosciences, Inc. Substituted pyrazolo[1,5-a]pyrimidines as TYK2 pseudokinase ligands
CN113004305A (en) * 2019-12-19 2021-06-22 成都倍特药业股份有限公司 Macrocyclic compounds, their preparation and use
WO2022182845A1 (en) * 2021-02-25 2022-09-01 Blossomhill Therapeutics, Inc. Macrocycles and their use

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