US20200268726A1 - Methods of treatment of malignancies - Google Patents

Methods of treatment of malignancies Download PDF

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US20200268726A1
US20200268726A1 US15/781,019 US201615781019A US2020268726A1 US 20200268726 A1 US20200268726 A1 US 20200268726A1 US 201615781019 A US201615781019 A US 201615781019A US 2020268726 A1 US2020268726 A1 US 2020268726A1
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compound
mutation
idh1
ras
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Bin Wu
Sung Eun Choe
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Servier Pharmaceuticals LLC
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Agios Pharmaceuticals Inc
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Definitions

  • the methods for treating a malignancy comprise administering an IDH1 inhibitor or an IDH2 inhibitor in combination with one or more compounds that target RAS pathways wherein the malignancy is characterized by the presence of a mutant allele of IDH1 or IDH2 respectively, and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • an IDH1 inhibitor for use in methods of treating malignancies including hematological malignancies and solid tumors characterized by the presence of a mutant allele of IDH1, and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • an IDH1 inhibitor can be provided in combination with one or more compounds that target RAS pathways for use in methods for treating a malignancy, wherein the malignancy is characterized by the presence of a mutant allele of IDH1, and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • Isocitrate dehydrogenases catalyze the oxidative decarboxylation of isocitrate to 2-oxoglutarate (i.e., ⁇ -ketoglutarate). These enzymes belong to two distinct subclasses, one of which utilizes NAD(+) as the electron acceptor and the other NADP(+).
  • NAD(+) the electron acceptor
  • NADP(+)-dependent isocitrate dehydrogenases Five isocitrate dehydrogenases have been reported: three NAD(+)-dependent isocitrate dehydrogenases, which localize to the mitochondrial matrix, and two NADP(+)-dependent isocitrate dehydrogenases, one of which is mitochondrial and the other predominantly cytosolic. Each NADP(+)-dependent isozyme is a homodimer.
  • IDH1 isocitrate dehydrogenase 1 (NADP+), cytosolic
  • IDP isocitrate dehydrogenase 1
  • IDCD isocitrate dehydrogenase 1
  • PICD protein encoded by this gene
  • the protein encoded by this gene is the NADP(+)-dependent isocitrate dehydrogenase found in the cytoplasm and peroxisomes. It contains the PTS-1 peroxisomal targeting signal sequence.
  • the presence of this enzyme in peroxisomes suggests roles in the regeneration of NADPH for intraperoxisomal reductions, such as the conversion of 2,4-dienoyl-CoAs to 3-enoyl-CoAs, as well as in peroxisomal reactions that consume 2-oxoglutarate, namely the alpha-hydroxylation of phytanic acid.
  • the cytoplasmic enzyme serves a significant role in cytoplasmic NADPH production.
  • the human IDH1 gene encodes a protein of 414 amino acids.
  • the nucleotide and amino acid sequences for human IDH1 can be found as GenBank entries NM_005896.2 and NP_005887.2 respectively.
  • the nucleotide and amino acid sequences for IDH1 are also described in, e.g., Nekrutenko et al., Mol. Biol. Evol. 15:1674-1684 (1998); Geisbrecht et al., J. Biol. Chem. 274:30527-30533 (1999); Wiemann et al., Genome Res. 11:422-435 (2001); The MGC Project Team, Genome Res.
  • IDH2 isocitrate dehydrogenase 2 (NADP+), mitochondrial
  • IDH isocitrate dehydrogenase 2 (NADP+), mitochondrial
  • IDP isocitrate dehydrogenase 2
  • IDHM isocitrate dehydrogenase 2
  • ICD-M isocitrate dehydrogenase 2
  • mNADP-IDH isocitrate dehydrogenase 2 (NADP+), mitochondrial
  • the protein encoded by this gene is the NADP(+)-dependent isocitrate dehydrogenase found in the mitochondria. It plays a role in intermediary metabolism and energy production. This protein may tightly associate or interact with the pyruvate dehydrogenase complex.
  • Human IDH2 gene encodes a protein of 452 amino acids. The nucleotide and amino acid sequences for IDH2 can be found as GenBank entries NM_002168.2 and NP_002159.2 respectively.
  • nucleotide and amino acid sequence for human IDH2 are also described in, e.g., Huh et al., Submitted (November 1992) to the EMBL/GenBank/DDBJ databases; and The MGC Project Team, Genome Res. 14:2121-2127 (2004).
  • Non-mutant e.g., wild type, IDH1 and IDH2 catalyze the oxidative decarboxylation of isocitrate to ⁇ -ketoglutarate ( ⁇ -KG) thereby reducing NAD + (NADP + ) to NADH (NADPH), e.g., in the forward reaction:
  • hematologic malignancies in one embodiment, provided herein are methods of treating hematologic malignancies by administering to a subject a therapeutically effective amount of a mutant IDH1 inhibitor, wherein the hematologic malignancy is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • a mutant IDH1 inhibitor for use in the methods of treating hematologic malignancies, wherein the hematologic malignancy is characterized by the presence of a mutant allele of IDH1 and the absence of an NRAS mutation.
  • hematologic malignancies in one embodiment, provided herein are methods of treating hematologic malignancies by administering to a subject a therapeutically effective amount of a mutant IDH2 inhibitor, wherein the hematologic malignancy is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • provided herein are methods of treating hematologic malignancies by administering to a subject a therapeutically effective amount of a mutant IDH1 inhibitor in combination with a therapeutically effective amount of one or more compounds that target RAS pathways, wherein the hematologic malignancy is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • hematologic malignancies in one embodiment, provided herein are methods of treating hematologic malignancies by administering to a subject a therapeutically effective amount of a mutant IDH2 inhibitor in combination with a therapeutically effective amount of one or more compounds that target RAS pathways, wherein the hematologic malignancy is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • hematologic malignancies such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, comprising administering to a subject a therapeutically effective amount of 2-methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6- ⁇ [2-(trifluoromethyl)pyridin-4-yl]amino ⁇ -1,3,5-triazin
  • hematologic malignancies such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS, myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), each characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, comprising administering to a subject a therapeutically effective amount of (S)-N-((S)-1-(2-chlorophenyl)-2-((3,3-difluorocyclobutyl)amino)-2-oxoethyl)-1-(4-cyanopyridin-2-yl)-N-(5-fluoropyridin-3-yl)
  • AML acute myelogenous leukemia
  • the hematologic malignancy is an advanced hematologic malignancy.
  • the advanced hematologic malignancy is AML.
  • the advanced hematologic malignancy is relapsed or refractory AML.
  • COMPOUND 2 for use in the method of treating hematologic malignancies, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • CMML chronic myelomonocytic leukemia
  • myeloid sarcoma multiple myeloma
  • lymphoma e.g., T-cell
  • the advanced hematologic malignancy is AML, characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation. In one embodiment, the advanced hematologic malignancy is relapsed or refractory AML, characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 for use in a method of treating acute myelogenous leukemia (AML) characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 for use in a method of treating relapsed or refractory acute myelogenous leukemia (AML) characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 for use in a method of treating myelodysplastic syndrome (MDS) characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • MDS myelodysplastic syndrome
  • COMPOUND 2 for use in a method of treating chronic myelomonocytic leukemia (CMML) characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • CMML chronic myelomonocytic leukemia
  • COMPOUND 2 for use in a method of treating myeloid sarcoma characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 for use in a method of treating multiple myeloma characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 for use in a method of treating lymphoma (e.g., T-cell lymphoma or B-cell lymphoma) characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • lymphoma e.g., T-cell lymphoma or B-cell lymphoma
  • an RAS mutation such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 for use in a method of treating angioimmunoblastic T-cell lymphoma (AITL) characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • AITL angioimmunoblastic T-cell lymphoma
  • COMPOUND 2 for use in a method of treating blastic plasmacytoid dendritic cell neoplasm characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • hematologic malignancies such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, comprising administering to the subject a therapeutically effective amount of 2-methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6- ⁇ [2-(trifluoromethyl)pyridin-4-yl]amino ⁇ -1,3,5-triazin
  • COMPOUND 1 is administered to the subject in combination with a therapeutically effective amount of a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • hematologic malignancies such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS, myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), each characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, in a subject comprising administering to the subject a therapeutically effective amount of (S)-N-((S)-1-(2-chlorophenyl)-2-((3,3-difluorocyclobutyl)amino)-2-oxoethyl)-1-(4-cyanopyridin-2-yl)-N-(5-fluoropyridin-3
  • AML acute myelogenous leukemia
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating hematologic malignancies, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • CMML chronic myelomonocytic leukemia
  • myeloid sarcoma multiple myeloma
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating acute myelogenous leukemia (AML) characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • AML acute myelogenous leukemia
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating myelodysplastic syndrome (MDS) characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • MDS myelodysplastic syndrome
  • a COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in the method of treating chronic myelomonocytic leukemia (CMML) characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating myeloid sarcoma characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating multiple myeloma characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating lymphoma (e.g., T-cell lymphoma or B-cell lymphoma) characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating angioimmunoblastic T-cell lymphoma (AITL) characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • COMPOUND 2 in combination with one or more compounds that target RAS pathways for use in a method of treating blastic plasmacytoid dendritic cell neoplasm characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • COMPOUND 2 is administered to the subject in combination with a therapeutically effective amount of a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • the advanced hematologic malignancy is AML, characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • the advanced hematologic malignancy is relapsed or refractory AML, characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • COMPOUND 2 is administered to the subject in combination with trametinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with selumetinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with binimetinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with PD-325901. In one embodiment, COMPOUND 2 is administered to the subject in combination with cobimetinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with CI-1040. In one embodiment, COMPOUND 2 is administered to the subject in combination with PD035901.
  • provided herein are methods of treating solid tumors by administering to a subject a therapeutically effective amount of a mutant IDH1 inhibitor, wherein the solid tumor is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • a mutant IDH1 inhibitor for use in a method of treating solid tumors, wherein the solid tumor is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • kits for treating solid tumors by administering to a subject a therapeutically effective amount of a mutant IDH2 inhibitor, wherein the solid tumor is characterized by the presence of a mutant allele of IDH2 and the absence of a RAS mutation, such as an NRAS mutation or KRAS mutation.
  • the solid tumor is an advanced solid tumor.
  • provided herein are methods of treating solid tumors by administering to a subject a therapeutically effective amount of a mutant IDH1 inhibitor in combination with a therapeutically effective amount of one or more compounds that target RAS pathways, wherein the solid tumor is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • a mutant IDH1 inhibitor in combination with one or more compounds that target RAS pathways for use in the methods of treating solid tumors wherein the solid tumor is characterized by the presence of a mutant IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • the solid tumor is an advanced solid tumor.
  • provided herein are methods of treating solid tumors by administering to a subject a therapeutically effective amount of a mutant IDH2 inhibitor in combination with a therapeutically effective amount of one or more compounds that target RAS pathways, wherein the solid tumor is characterized by the presence of a mutant IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • the solid tumor is an advanced solid tumor.
  • a method of treating solid tumors such as glioma, melanoma, chondrosarcoma, or cholangiocarcinoma (e.g., glioma), or treating angioimmunoblastic T-cell lymphoma (AITL), each characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, comprising administering to a subject a therapeutically effective amount of COMPOUND 1.
  • solid tumors such as glioma, melanoma, chondrosarcoma, or cholangiocarcinoma (e.g., glioma)
  • AITL angioimmunoblastic T-cell lymphoma
  • a method of treating solid tumors such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, comprising administering to a subject a therapeutically effective amount of COMPOUND 2.
  • solid tumors such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, comprising administering to a subject a therapeutically
  • a method of treating solid tumors such as glioma, melanoma, chondrosarcoma, or cholangiocarcinoma (e.g., glioma), or treating angioimmunoblastic T-cell lymphoma (AITL), each characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, in a subject comprising administering to a subject a therapeutically effective amount of COMPOUND 1 in combination with a therapeutically effective amount of one or more compounds that target RAS pathways.
  • solid tumors such as glioma, melanoma, chondrosarcoma, or cholangiocarcinoma (e.g., glioma)
  • AITL angioimmunoblastic T-cell lymphoma
  • COMPOUND 1 is administered to the subject in combination with a therapeutically effective amount of a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a method of treating solid tumors such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, in a subject comprising administering to a subject a therapeutically effective amount of COMPOUND 2 in combination with a therapeutically effective amount of one or more compounds that target RAS pathways.
  • solid tumors such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as
  • COMPOUND 2 is administered to the subject in combination with a therapeutically effective amount of a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • COMPOUND 2 is administered to the subject in combination with trametinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with selumetinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with binimetinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with PD-325901. In one embodiment, COMPOUND 2 is administered to the subject in combination with cobimetinib. In one embodiment, COMPOUND 2 is administered to the subject in combination with CI-1040. In one embodiment, COMPOUND 2 is administered to the subject in combination with PD035901.
  • Treatment methods described herein can additionally comprise various evaluation steps prior to, during, or following treatment with COMPOUND 2.
  • the method comprises evaluating a subject prior to, during, or following treatment with COMPOUND 2, alone or in combination with a RAS pathway inhibitor, for example a RAS pathway inhibitor described herein.
  • the method comprises the step of evaluating for mutations, such as a RAS mutation, for example a NRAS mutation or a KRAS mutation. This evaluation may be achieved by analysis of sample types including bone marrow, peripheral blood and mononuclear cells isolated from bone marrow or peripheral blood.
  • a nucleic acid for example DNA, is extracted from the sample, and analyzed by sequencing to determine if a RAS mutation, for example a NRAS mutation or a KRAS mutation, is present.
  • FIG. 1 is an X-ray powder diffractogram (XPRD) of COMPOUND 1 form 1.
  • FIG. 2 is an X-ray powder diffractogram (XPRD) of COMPOUND 1 form 2.
  • FIG. 3 is an X-ray powder diffractogram (XPRD) of COMPOUND 1 form 3.
  • FIG. 4 is an X-ray powder diffractogram (XPRD) of COMPOUND 1 form 4.
  • FIG. 5 is an X-ray powder diffractogram (XPRD) of COMPOUND 1 form 5.
  • FIG. 6 is an X-ray powder diffractogram (XPRD) of COMPOUND 1 form 6.
  • FIG. 7 is an X-ray powder diffractogram (XPRD) of COMPOUND 2 form I.
  • FIG. 8 is a differential scanning calorimetry (DSC) profile of COMPOUND 2 form I.
  • FIG. 9 is a thermal gravimetric analysis (TGA) profile of COMPOUND 2 form I.
  • FIG. 10 is an X-ray powder diffractogram (XPRD) of COMPOUND 2 form II.
  • FIG. 11 is a differential scanning calorimetry (DSC) profile of COMPOUND 2 form II.
  • FIG. 12 is a thermal gravimetric analysis (TGA) profile of COMPOUND 2 form II.
  • FIG. 13 illustrates the comutations, including RAS mutation, such as an NRAS mutation or KRAS mutations, in samples treated with for COMPOUND 1 according to response categories.
  • RAS mutation such as an NRAS mutation or KRAS mutations
  • FIG. 14 illustrates the comutations, including RAS mutation, such as an NRAS mutation or KRAS mutations in samples treated with for COMPOUND 2 according to response categories.
  • a “mutant IDH2 inhibitor” or “inhibitor of IDH2 mutant(s)” means a molecule e.g., a polypeptide, peptide, or small molecule (e.g., a molecule of less than 1,000 daltons), or aptomer, that binds to an IDH2 mutant subunit and inhibits neoactivity, e.g., by inhibiting formation of a dimer, e.g., a homodimer of mutant IDH2 subunits or a heterodimer of a mutant and a wildype subunit.
  • the neoactivity inhibition is at least about 60%, 70%, 80%, 90%, 95% or 99% as compared to the activity in the absence of the mutant IDH2 inhibitor.
  • the mutant IDH2 inhibitor is COMPOUND 1.
  • a “mutant IDH1 inhibitor” or “inhibitor of IDH1 mutant(s)” means a molecule e.g., a polypeptide, peptide, or small molecule (e.g., a molecule of less than 1,000 daltons), or aptomer, that binds to an IDH1 mutant subunit and inhibits neoactivity, e.g., by inhibiting formation of a dimer, e.g., a homodimer of mutant IDH1 subunits or a heterodimer of a mutant and a wildype subunit.
  • the neoactivity inhibition is at least about 60%, 70%, 80%, 90%, 95% or 99% as compared to the activity in the absence of the mutant IDH1 inhibitor.
  • the mutant IDH1 inhibitor is COMPOUND 2.
  • wild type refers to the typical or most common form of a characteristic (for example, gene sequence or presence, or protein sequence, presence, level or activity), as it occurs in nature, and the reference against which all others are compared. As will be understood by one skilled in the art, when used herein, wild type refers to the typical gene sequence(s) or gene expression levels as they most commonly occur in nature.
  • co-occurring mutation refers to one or more gene mutations that are present in a cancer subject herein in addition to an IDH1 or an IDH2 mutation.
  • RAS pathway inhibitor or “RAS targeting compound” refers to a compound that inhibits RAS proteins association with the plasma membrane as well as compounds that target the signalling cascade downstream of RAS, including the RAF-MEK-ERK signalling cascade.
  • RAS pathway inhibitors for use herein include, but are not limited to trametinib (GSK1120212), selumetinib, binimetinib (MEK162), PD-325901, cobimetinib (XL518), CI-1040 and PD035901.
  • the term “elevated levels of 2HG” means 10%, 20% 30%, 50%, 75%, 100%, 200%, 500% or more 2HG is present in a subject that carries a mutant IDH1 allele than is present in a subject that does not carry a mutant IDH1 allele.
  • the term “elevated levels of 2HG” may refer to the amount of 2HG within a cell, within a tumor, within an organ comprising a tumor, or within a bodily fluid.
  • the term “bodily fluid” includes one or more of amniotic fluid surrounding a fetus, aqueous humour, blood (e.g., blood plasma), serum, Cerebrospinal fluid, cerumen, chyme, Cowper's fluid, female ejaculate, interstitial fluid, lymph, breast milk, mucus (e.g., nasal drainage or phlegm), pleural fluid, pus, saliva, sebum, semen, serum, sweat, tears, urine, vaginal secretion, or vomit.
  • blood e.g., blood plasma
  • serum Cerebrospinal fluid
  • cerumen cerumen
  • chyme chyme
  • Cowper's fluid female ejaculate
  • interstitial fluid lymph
  • breast milk mucus (e.g., nasal drainage or phlegm)
  • mucus e.g., nasal drainage or phlegm
  • pleural fluid pus, saliva, sebum, semen, serum
  • inhibitor or “prevent” include both complete and partial inhibition and prevention.
  • An inhibitor may completely or partially inhibit the intended target.
  • subject is intended to include human and non-human animals.
  • exemplary human subjects include a human patient (referred to as a patient) having a disorder, e.g., a disorder described herein or a normal subject.
  • non-human animals of one aspect of the invention includes all vertebrates, e.g., non-mammals (such as chickens, amphibians, reptiles) and mammals, such as non-human primates, domesticated and/or agriculturally useful animals, e.g., sheep, dog, cat, cow, pig, etc.
  • treat means decrease, suppress, attenuate, diminish, arrest, or stabilize the development or progression of a disease/disorder (e.g., an hematologic malignancy, including an advanced hematologic malignancy, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), or a solid tumor, including glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1; or acute myelogenous leukemia
  • AML
  • the advanced hematologic malignancy is relapsed or refractory.
  • the solid tumor is relapsed or refractory.
  • An amount of a compound, including a pharmaceutically acceptable salt, solvate, tautomer, stereoisomer, isotopologue, prodrug or a polymorph thereof, effective to treat a disorder, or a “therapeutically effective amount” or “therapeutically effective dose” refers to an amount of the compound, including a pharmaceutically acceptable salt, solvate, tautomer, stereoisomer, isotopologue, prodrug, or a polymorph thereof, which is effective, upon single or multiple dose administration to a subject, in treating a cell, or in curing, alleviating, relieving or improving a subject with a disorder beyond that expected in the absence of such treatment.
  • co-administering means that the additional cancer therapeutic agent may be administered together with a compound provided herein as part of a single dosage form (such as a composition comprising a compound and a second therapeutic agent as described above) or as separate, multiple dosage forms.
  • the additional cancer therapeutic agent may be administered prior to, consecutively with, or following the administration of a compound provided herein.
  • both the compounds provided herein and the second therapeutic agent(s) are administered by conventional methods.
  • compositions comprising both a compound provided herein and a second therapeutic agent, to a subject does not preclude the separate administration of that same therapeutic agent, any other second therapeutic agent or any compound provided herein to said subject at another time during a course of treatment.
  • co-administering as used herein with respect to an additional cancer treatment means that the additional cancer treatment may occur prior to, consecutively with, concurrently with or following the administration of a compound provided herein.
  • substantially free of other stereoisomers means a preparation enriched in a compound having a selected stereochemistry at one or more selected stereocenters by at least about 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99%.
  • enriched means that at least the designated percentage of a preparation is the compound having a selected stereochemistry at one or more selected stereocenters.
  • crystalline refers to a solid having a highly regular chemical structure.
  • a crystalline COMPOUND 1 may be produced as one or more single crystalline forms of COMPOUND 1 and a crystalline COMPOUND 2 may be produced as one or more single crystalline forms of COMPOUND 2.
  • the terms “crystalline form”, “single crystalline form” and “polymorph” are synonymous; the terms distinguish between crystals that have different properties (e.g., different XRPD patterns and/or different DSC scan results).
  • polymorph includes pseudopolymorphs, which are typically different solvates of a material, and thus their properties differ from one another.
  • each distinct polymorph and pseudopolymorph of COMPOUND 1 is considered to be a distinct single crystalline form herein
  • each distinct polymorph and pseudopolymorph of COMPOUND 2 is considered to be a distinct single crystalline form herein.
  • substantially crystalline refers to forms that may be at least a particular weight percent crystalline. Particular weight percentages are 10%, 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9%, or any percentage between 10% and 100%.
  • substantially crystalline COMPOUND 1 refers to a COMPOUND 1 that is at least 70% crystalline.
  • substantially crystalline COMPOUND 1 refers to a COMPOUND 1 that is at least 90% crystalline.
  • substantially crystalline COMPOUND 2 refers to a COMPOUND 2 that is at least 70% crystalline.
  • substantially crystalline COMPOUND 2 refers to a COMPOUND 2 that is at least 90% crystalline.
  • isolated refers to forms that may be at least a particular weight percent of a particular crystalline form of compound. Particular weight percentages are 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9%, or any percentage between 90% and 100%.
  • solvate or solvated means a physical association of a compound, including a crystalline form thereof, of this invention with one or more solvent molecules. This physical association includes hydrogen bonding. In certain instances the solvate will be capable of isolation, for example when one or more solvent molecules are incorporated in the crystal lattice of the crystalline solid. “Solvate or solvated” encompasses both solution-phase and isolable solvates. Representative solvates include, for example, a hydrate, ethanolates or a methanolate.
  • hydrate is a solvate wherein the solvent molecule is H 2 O that is present in a defined stoichiometric amount, and may, for example, include hemihydrate, monohydrate, dihydrate, or trihydrate.
  • mixture is used to refer to the combined elements of the mixture regardless of the phase-state of the combination (e.g., liquid or liquid/crystalline).
  • seeding is used to refer to the addition of a crystalline material to initiate recrystallization or crystallization.
  • antisolvent is used to refer to a solvent in which compounds, including crystalline forms thereof, are poorly soluble.
  • pharmaceutically acceptable carrier or adjuvant refers to a carrier or adjuvant that may be administered to a subject, together with a compound of one aspect of this invention, and which does not destroy the pharmacological activity thereof and is nontoxic when administered in doses sufficient to deliver a therapeutic amount of the compound.
  • a pharmaceutically-acceptable salt refers to non-toxic acid or base addition salts of the compound to which the term refers. Examples of pharmaceutically acceptable salts are discussed in Berge et al., 1977, “Pharmaceutically Acceptable Salts.” J. Pharm. Sci. Vol. 66, pp. 1-19.
  • COMPOUND 1 is 2-methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6- ⁇ [2-(trifluoromethyl)pyridin-4-yl]amino ⁇ -1,3,5-triazin-2-yl)amino]propan-2-ol, or a pharmaceutically acceptable salt, solvate, tautomer, stereoisomer, isotopologue, prodrug, metabolite, or a polymorph thereof, having the following formula:
  • COMPOUND 1 may also comprise one or more isotopic substitutions (“Isotopologues”).
  • H may be in any isotopic form, including 1 H, 2 H (D or deuterium), and 3 H (T or tritium);
  • C may be in any isotopic form, including 12 C, 13 C, and 14 C;
  • O may be in any isotopic form, including 16 O and 18 O; and the like.
  • COMPOUND 1 is enriched in a specific isotopic form of H, C and/or O by at least about 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99%.
  • COMPOUND 1 in certain embodiments may also be represented in multiple tautomeric forms, in such instances, one aspect of the invention expressly includes all tautomeric forms of COMPOUND 1 described herein, even though only a single tautomeric form may be represented (e.g., keto-enol tautomers). All such isomeric forms of COMPOUND 1 are expressly included herein. Synthesis of COMPOUND 1 is described in US published application US-2013-0190287-A1 published Jul. 25, 2013, which is incorporated by reference in its entirety.
  • COMPOUND 1 It may be convenient or desirable to prepare, purify, and/or handle a corresponding salt of COMPOUND 1, for example, a pharmaceutically-acceptable salt.
  • a pharmaceutically-acceptable salt examples of pharmaceutically acceptable salts are discussed in Berge et al., 1977, “Pharmaceutically Acceptable Salts.” J. Pharm. Sci. Vol. 66, pp. 1-19.
  • COMPOUND 1 is anionic, or has a functional group which may be anionic (e.g., —NH— may be —N— ⁇ )
  • a salt may be formed with a suitable cation.
  • suitable inorganic cations include, but are not limited to, alkali metal ions such as Na + and K + , alkaline earth cations such as Ca 2+ and Mg 2+ , and other cations such as Al 3+ .
  • Examples of some suitable substituted ammonium ions are those derived from: ethylamine, diethylamine, dicyclohexylamine, triethylamine, butylamine, ethylenediamine, ethanolamine, diethanolamine, piperazine, benzylamine, phenylbenzylamine, choline, meglumine, and tromethamine, as well as amino acids, such as lysine and arginine.
  • An example of a common quaternary ammonium ion is N(CH 3 ) 4 + .
  • COMPOUND 1 is cationic, or has a functional group that may be cationic (e.g., —NHR may be —NH 2 R + ), then a salt may be formed with a suitable anion.
  • suitable inorganic anions include, but are not limited to, those derived from the following inorganic acids: hydrochloric, hydrobromic, hydroiodic, sulfuric, sulfurous, nitric, nitrous, phosphoric, and phosphorous.
  • Suitable organic anions include, but are not limited to, those derived from the following organic acids: 2-acetyoxybenzoic, acetic, ascorbic, aspartic, benzoic, camphorsulfonic, cinnamic, citric, edetic, ethanedisulfonic, ethanesulfonic, fumaric, glucoheptonic, gluconic, glutamic, glycolic, hydroxymaleic, hydroxynaphthalene carboxylic, isethionic, lactic, lactobionic, lauric, maleic, malic, methanesulfonic, mucic, oleic, oxalic, palmitic, pamoic, pantothenic, phenylacetic, phenylsulfonic, propionic, pyruvic, salicylic, stearic, succinic, sulfanilic, tartaric, toluenesulfonic, and valeric.
  • COMPOUND 1 comprises the mesylate salt of 2-methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6- ⁇ [2-(trifluoromethyl)pyridin-4-yl]amino ⁇ -1,3,5-triazin-2-yl)amino]propan-2-ol.
  • suitable polymeric organic anions include, but are not limited to, those derived from the following polymeric acids: tannic acid, carboxymethyl cellulose.
  • COMPOUND 1 for use in the methods and pharmaceutical compositions provided herein therefore includes the COMPOUND 1 itself, as well as its pharmaceutically acceptable salts, solvates, tautomers, stereoisomers, isotopologues, prodrugs, metabolites, or polymorphs. Metabolites of COMPOUND 1 are disclosed in patent application publication WO2015/006592, which is incorporated herein by reference in its entirety. COMPOUND 1 provided herein may be modified and converted to a prodrug by appending appropriate functionalities to enhance selected biological properties, e.g., targeting to a particular tissue.
  • prodrugs are known in the art and include those which increase biological penetration into a given biological compartment (e.g., blood, lymphatic system, central nervous system), increase oral availability, increase solubility to allow administration by injection, alter metabolism and alter rate of excretion.
  • prodrugs include esters (e.g., phosphates, amino acid (e.g., valine) esters), carbamates and other pharmaceutically acceptable derivatives, which, upon administration to a subject, are capable of providing active compounds.
  • COMPOUND 1 can exist in a variety of solid forms. In one embodiment, provided herein are solid forms that include neat crystal forms. In another embodiment, provided herein are solid forms that include solvated forms and amorphous forms. The present disclosure provides certain solid forms of COMPOUND 1. In certain embodiments, the present disclosure provides compositions comprising COMPOUND 1 in a form described herein. In some embodiments of provided compositions, COMPOUND 1 is present as a mixture of one or more solid forms; in some embodiments of provided compositions, COMPOUND 1 is present in a single form.
  • COMPOUND 1 is a single crystalline form, or any one of the single crystalline forms described herein. Synthesis of crystalline forms of COMPOUND 1 is described in the international application publication WO 2015/017821 published Feb. 5, 2015 and the U.S. provisional application Ser. No. 61/112,127, filed Feb. 4, 2015, both incorporated by reference herein in their entireties. Also provided are pharmaceutical compositions comprising at least one pharmaceutically acceptable carrier or diluent; and COMPOUND 1, wherein COMPOUND 1 is a single crystalline form, or any one of the crystalline forms being described herein. Also provided are uses of COMPOUND 1, wherein COMPOUND 1 is a single crystalline form, or any one of the single crystalline forms described herein, to prepare a pharmaceutical composition.
  • At least a particular percentage by weight of COMPOUND 1 is crystalline. Particular weight percentages may be 10%, 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9%, or any percentage between 10% and 100%.
  • a particular percentage by weight of COMPOUND 1 is crystalline
  • the remainder of COMPOUND 1 is the amorphous form of COMPOUND 1.
  • Non-limiting examples of crystalline COMPOUND 1 include a single crystalline form of compound 1 or a mixture of different single crystalline forms.
  • COMPOUND 1 is at least 90% by weight crystalline. In some other embodiments, COMPOUND 1 is at least 95% by weight crystalline.
  • a particular percentage by weight of the crystalline COMPOUND 1 is a specific single crystalline form or a combination of single crystalline forms. Particular weight percentages may be 10%, 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9%, or any percentage between 10% and 100%.
  • COMPOUND 1 is at least 90% by weight of a single crystalline form.
  • COMPOUND 1 is at least 95% by weight of a single crystalline form.
  • COMPOUND 1 embodiments of the invention may be described with reference to a particular crystalline form of COMPOUND 1, as characterized by one or more properties as discussed herein.
  • the descriptions characterizing the crystalline forms may also be used to describe the mixture of different crystalline forms that may be present in a crystalline COMPOUND 1.
  • the particular crystalline forms of COMPOUND 1 may also be characterized by one or more of the characteristics of the crystalline form as described herein, with or without regard to referencing a particular crystalline form.
  • the crystalline forms are further illustrated by the detailed descriptions and illustrative examples given below.
  • the XRPD peaks described in Tables 1 to 6 may vary by ⁇ 0.2° depending upon the instrument used to obtain the data.
  • the intensity of the XRPD peaks described in Tables 1 to 6 may vary by 10%.
  • a single crystalline form, Form 1, of COMPOUND 1 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 1 , and data shown in Table 1 obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 1 , as shown in Table 1.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine of the peaks shown in Table 1.
  • Form 1 can be characterized by the peaks identified at 20 angles of 8.9, 13.0, 18.9, 23.8, and 28.1°. In another embodiment, Form 1 can be characterized by the peaks identified at 20 angles of 8.9, 18.9, and 23.8°.
  • a single crystalline form, Form 2, of COMPOUND 1 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 2 , and data shown in Table 2, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 2 , as shown in Table 2.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine of the peaks shown in Table 2.
  • Form 2 can be characterized by the peaks identified at 20 angles of 12.7, 17.1, 19.2, 23.0, and 24.2°. In another embodiment, Form 2 can be characterized by the peaks identified at 20 angles of 12.7, 19.2, and 24.2°.
  • a single crystalline form, Form 3, of COMPOUND 1 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 3 , and data shown in Table 3, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 3 , as shown in Table 3.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine of the peaks shown in Table 3.
  • Form 3 can be characterized by the peaks identified at 20 angles of 6.8, 10.6, 13.6, 14.2, and 19.2°. In another embodiment, Form 3 can be characterized by the peaks identified at 20 angles of 10.6, 14.2, and 19.2°.
  • a single crystalline form, Form 4, of COMPOUND 1 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 4 , and data shown in Table 4, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 4 , as shown in Table 4.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine of the peaks shown in Table 4.
  • Form 4 can be characterized by the peaks identified at 20 angles of 7.2, 13.6, 18.5, 19.3, 21.9, and 23.5°. In another embodiment, Form 4 can be characterized by the peaks identified at 20 angles of 13.6, 18.5, and 23.5°.
  • a single crystalline form, Form 5, of COMPOUND 1 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 5 , and data shown in Table 5, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 5 , as shown in Table 5.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine of the peaks shown in Table 5.
  • Form 5 can be characterized by the peaks identified at 20 angles of 6.4, 8.4, 9.8, 17.8, and 19.7°. In another embodiment, Form 5 can be characterized by the peaks identified at 20 angles of 8.4 and 9.8°.
  • a single crystalline form, Form 6, of COMPOUND 1 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 15 , and data shown in Table 6, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 6 , as shown in Table 6.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight of the peaks shown in Table 6.
  • Form 6 can be characterized by the peaks identified at 20 angles of 8.1, 14.1, 16.4, 17.3, 20.5, and 24.1°. In another embodiment, Form 6 can be characterized by the peaks identified at 20 angles of 8.1, 16.4, 17.3, and 24.1°.
  • COMPOUND 2 is (S)-N-((S)-1-(2-chlorophenyl)-2-((3,3-difluorocyclobutyl)amino)-2-oxoethyl)-1-(4-cyanopyridin-2-yl)-N-(5-fluoropyridin-3-yl)-5-oxopyrrolidine-2-carboxamide, a pharmaceutically acceptable salt, solvate, tautomer, stereoisomer, isotopologue, prodrug, or a polymorph thereof.
  • COMPOUND 2 has the following chemical structure:
  • COMPOUND 2 may also comprise one or more isotopic substitutions.
  • H may be in any isotopic form (“Isotopologues”), including 1 H, 2 H (D or deuterium), and 3 H (T or tritium);
  • C may be in any isotopic form, including 12 C, and 14 C;
  • O may be in any isotopic 13 C, form, including 16 O and 18 O; and the like.
  • COMPOUND 2 is enriched in a specific isotopic form of H, C and/or O by at least about 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99%.
  • COMPOUND 2 in certain embodiments may also be represented in multiple tautomeric forms, in such instances, one aspect of the invention expressly includes all tautomeric forms of COMPOUND 2 described herein, even though only a single tautomeric form may be represented (e.g., keto-enol tautomers). All such isomeric forms of COMPOUND 2 are expressly included herein. Synthesis of COMPOUND 2 is described in US published application US-2013-0190249-A1 published Jul. 25, 2013, which is incorporated by reference in its entirety.
  • COMPOUND 2 It may be convenient or desirable to prepare, purify, and/or handle a corresponding salt of COMPOUND 2, for example, a pharmaceutically-acceptable salt.
  • a pharmaceutically-acceptable salt examples of pharmaceutically acceptable salts are discussed in Berge et al., 1977, “Pharmaceutically Acceptable Salts.” J. Pharm. Sci. Vol. 66, pp. 1-19.
  • COMPOUND 2 is anionic, or has a functional group which may be anionic (e.g., —NH— may be —N— ⁇ ), then a salt may be formed with a suitable cation.
  • suitable inorganic cations include, but are not limited to, alkali metal ions such as Na + and K + , alkaline earth cations such as Ca 2+ and Mg 2+ , and other cations such as Al 3+ .
  • Examples of some suitable substituted ammonium ions are those derived from: ethylamine, diethylamine, dicyclohexylamine, triethylamine, butylamine, ethylenediamine, ethanolamine, diethanolamine, piperazine, benzylamine, phenylbenzylamine, choline, meglumine, and tromethamine, as well as amino acids, such as lysine and arginine.
  • An example of a common quaternary ammonium ion is N(CH 3 ) 4 + .
  • COMPOUND 2 is cationic, or has a functional group that may be cationic (e.g., —NHR may be —NH 2 R + ), then a salt may be formed with a suitable anion.
  • suitable inorganic anions include, but are not limited to, those derived from the following inorganic acids: hydrochloric, hydrobromic, hydroiodic, sulfuric, sulfurous, nitric, nitrous, phosphoric, and phosphorous.
  • Suitable organic anions include, but are not limited to, those derived from the following organic acids: 2-acetyoxybenzoic, acetic, ascorbic, aspartic, benzoic, camphorsulfonic, cinnamic, citric, edetic, ethanedisulfonic, ethanesulfonic, fumaric, glucoheptonic, gluconic, glutamic, glycolic, hydroxymaleic, hydroxynaphthalene carboxylic, isethionic, lactic, lactobionic, lauric, maleic, malic, methanesulfonic, mucic, oleic, oxalic, palmitic, pamoic, pantothenic, phenylacetic, phenylsulfonic, propionic, pyruvic, salicylic, stearic, succinic, sulfanilic, tartaric, toluenesulfonic, and valeric.
  • COMPOUND 2 for use in the methods and pharmaceutical compositions provided herein therefore includes COMPOUND 2 itself, as well as its pharmaceutically acceptable salts, solvates, tautomers, stereoisomers, isotopologues, prodrugs or polymorphs.
  • COMPOUND 2 provided herein may be modified and converted to a prodrug by appending appropriate functionalities to enhance selected biological properties, e.g., targeting to a particular tissue.
  • modifications i.e., prodrugs
  • prodrugs include those which increase biological penetration into a given biological compartment (e.g., blood, lymphatic system, central nervous system), increase oral availability, increase solubility to allow administration by injection, alter metabolism and alter rate of excretion.
  • prodrugs include esters (e.g., phosphates, amino acid (e.g., valine) esters), carbamates and other pharmaceutically acceptable derivatives, which, upon administration to a subject, are capable of providing active compounds.
  • COMPOUND 2 can exist in a variety of solid forms. In one embodiment, provided herein are solid forms that include neat crystal forms. In another embodiment, provided herein are solid forms that include solvated forms and amorphous forms.
  • the present disclosure provides certain solid forms of COMPOUND 2. In certain embodiments, the present disclosure provides compositions comprising COMPOUND 2 in a form described herein. In some embodiments of provided compositions, COMPOUND 2 is present as a mixture of one or more solid forms; in some embodiments of provided compositions, COMPOUND 2 is present in a single form.
  • COMPOUND 2 is a single crystalline form, or any one of the single crystalline forms described herein. Synthesis of crystalline forms of COMPOUND 2 is described in international application publications WO 2015/138837 and WO 2015/138839, both published Sep. 17, 2015, both incorporated by reference herein in their entireties. Also provided are pharmaceutical compositions comprising at least one pharmaceutically acceptable carrier or diluent; and COMPOUND 2, wherein COMPOUND 2 is a single crystalline form, or any one of the crystalline forms being described herein. Also provided are uses of COMPOUND 2, wherein COMPOUND 2 is a single crystalline form, or any one of the single crystalline forms described herein, to prepare a pharmaceutical composition.
  • At least a particular percentage by weight of COMPOUND 2 is crystalline. Particular weight percentages may be 10%, 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9%, or any percentage between 10% and 100%.
  • a particular percentage by weight of COMPOUND 2 is crystalline
  • the remainder of COMPOUND 2 is the amorphous form of COMPOUND 2.
  • Non-limiting examples of crystalline COMPOUND 2 include a single crystalline form of compound 1 or a mixture of different single crystalline forms.
  • COMPOUND 2 is at least 90% by weight crystalline. In some other embodiments, COMPOUND 2 is at least 95% by weight crystalline.
  • a particular percentage by weight of the crystalline COMPOUND 2 is a specific single crystalline form or a combination of single crystalline forms. Particular weight percentages may be 10%, 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.9%, or any percentage between 10% and 100%.
  • COMPOUND 2 is at least 90% by weight of a single crystalline form.
  • COMPOUND 2 is at least 95% by weight of a single crystalline form.
  • COMPOUND 2 embodiments of the invention may be described with reference to a particular crystalline form of COMPOUND 2, as characterized by one or more properties as discussed herein.
  • the descriptions characterizing the crystalline forms may also be used to describe the mixture of different crystalline forms that may be present in a crystalline COMPOUND 2.
  • the particular crystalline forms of COMPOUND 2 may also be characterized by one or more of the characteristics of the crystalline form as described herein, with or without regard to referencing a particular crystalline form.
  • the crystalline forms are further illustrated by the detailed descriptions and illustrative examples given below.
  • the XRPD peaks described in Tables 1 to 2 may vary by ⁇ 0.2° depending upon the instrument used to obtain the data.
  • the intensity of the XRPD peaks described in Tables 1 to 2 may vary by 10%.
  • a single crystalline form, Form I, of COMPOUND 2 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 7 , and data shown in Table 7, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 7 , as shown in Table 7.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine of the peaks shown in Table 7.
  • Form I can be characterized by the peaks identified at 20 angles of 8.6, 15.6, 18.5, 20.6, 21.6, and 26.4°. In another embodiment, Form I can be characterized by the peaks identified at 20 angles of 8.6, 15.6, 18.5, and 21.6°.
  • Form I can be characterized by the differential scanning calorimetry profile (DSC) shown in FIG. 8 .
  • the DSC graph plots the heat flow as a function of temperature from a sample, the temperature rate change being about 10° C./min.
  • the profile is characterized by an endothermic transition with an onset temperature of about 140.1° C. with a melt at about 149.9° C.
  • Form I can be characterized by thermal gravimetric analysis (TGA) shown in FIG. 9 .
  • TGA thermal gravimetric analysis
  • the TGA profile graphs the percent loss of weight of the sample as a function of temperature, the temperature rate change being about 10° C./min.
  • the weight loss represents a loss of about 0.44% of the weight of the sample as the temperature is changed from about 29.0° C. to 125.0° C.
  • a single crystalline form, Form II, of the COMPOUND 2 is characterized by the X-ray powder diffraction (XRPD) pattern shown in FIG. 10 , and data shown in Table 8, obtained using CuK ⁇ radiation.
  • the polymorph can be characterized by one or more of the peaks taken from FIG. 10 , as shown in Table 8.
  • the polymorph can be characterized by one or two or three or four or five or six or seven or eight or nine or ten of the peaks shown in Table 8.
  • Form II can be characterized by the peaks identified at 20 angles of 9.8, 11.6, 19.6, 22.5, 23.0, and 31.4°. In another embodiment, Form II can be characterized by the peaks identified at 20 angles of 9.8, 11.6, 19.6, and 23.0°.
  • Form II can be characterized by the differential scanning calorimetry profile (DSC) shown in FIG. 11 .
  • the DSC graph plots the heat flow as a function of temperature from a sample, the temperature rate change being about 10° C./min.
  • the profile is characterized by an endothermic transition with an onset temperature of about 62.7° C. with a melt at about 72.5° C., and an endothermic transition with an onset temperature of about 145.6° C. with a melt at about 153.6° C.
  • Form II can be characterized by thermal gravimetric analysis (TGA) shown in FIG. 12 .
  • TGA thermal gravimetric analysis
  • the TGA profile graphs the percent loss of weight of the sample as a function of temperature, the temperature rate change being about 10° C./min.
  • the weight loss represents a loss of about 0.57% of the weight of the sample as the temperature is changed from about 29.3° C. to 170.3° C.
  • COMPOUND 2 characterized by a combination of the aforementioned characteristics of any of the single crystalline forms discussed herein.
  • the characterization may be by any combination of one or more of the XRPD, TGA, and DSC described for a particular polymorph.
  • the single crystalline form of COMPOUND 2 may be characterized by any combination of the XRPD results regarding the position of the major peaks in a XRPD scan; and/or any combination of one or more of parameters derived from data obtained from a XRPD scan.
  • the single crystalline form of COMPOUND 2 may also be characterized by TGA determinations of the weight loss associated with a sample over a designated temperature range; and/or the temperature at which a particular weight loss transition begins. DSC determinations of the temperature associated with the maximum heat flow during a heat flow transition and/or the temperature at which a sample begins to undergo a heat flow transition may also characterize the crystalline form. Weight change in a sample and/or change in sorption/desorption of water per molecule of COMPOUND 2 as determined by water sorption/desorption measurements over a range of relative humidity (e.g., 0% to 90%) may also characterize a single crystalline form of COMPOUND 2.
  • the methods provided herein comprise co-administration of one or more second agent, wherein the second agent is a RAS targeting agent.
  • the second agent targets KRAS, NRAS and/or HRAS.
  • the second agent targets the downstream components of the RAS signaling pathways, such as the Raf-MEK-ERK or PI3K-AKT-mTOR pathways.
  • RAS signaling pathways such as the Raf-MEK-ERK or PI3K-AKT-mTOR pathways.
  • Exemplary second agents that target RAS oncogene are described by Takashima et al. in Expert Opin Ther Targets. 2013 May; 17(5): 507-531, incorporated by reference herein.
  • the second agent is a Raf kinase inhibitor. In one embodiment, the second agent is a MEK kinase inhibitor. In one embodiment, the second agent is a ERK kinase inhibitor. In one embodiment, the second agent is a PI3K kinase inhibitor. In one embodiment, the second agent is a AKT kinase inhibitor. In one embodiment, the second agent is m-TOR kinase inhibitor.
  • the second agent is a MEK kinase inhibitor.
  • the MEK kinase inhibitor is selected from trametinib (GSK1120212), selumetinib, binimetinib (MEK162), PD-325901, cobimetinib (XL518), CI-1040 and PD035901.
  • a pharmaceutical composition comprising a therapeutically effective amount of a mutant IDH2 inhibitor.
  • the mutant IDH1 inhibitor is COMPOUND 1.
  • a pharmaceutical composition comprising a therapeutically effective amount of a mutant IDH1 inhibitor.
  • the mutant IDH1 inhibitor is COMPOUND 2.
  • the compounds utilized in the methods provided herein may be formulated together with a pharmaceutically acceptable carrier or adjuvant into pharmaceutically acceptable compositions prior to be administered to a subject.
  • such pharmaceutically acceptable compositions further comprise additional therapeutic agents in amounts effective for achieving a modulation of disease or disease symptoms, including those described herein.
  • Pharmaceutically acceptable carriers, adjuvants and vehicles that may be used in the pharmaceutical compositions of one aspect of this invention include, but are not limited to, ion exchangers, alumina, aluminum stearate, lecithin, self-emulsifying drug delivery systems (SEDDS) such as d- ⁇ -tocopherol polyethyleneglycol 1000 succinate, surfactants used in pharmaceutical dosage forms such as Tweens or other similar polymeric delivery matrices, serum proteins, such as human serum albumin, buffer substances such as phosphates, glycine, sorbic acid, potassium sorbate, partial glyceride mixtures of saturated vegetable fatty acids, water, salts or electrolytes, such as protamine sulfate, disodium hydrogen phosphate, potassium hydrogen phosphate, sodium chloride, zinc salts, colloidal silica, magnesium trisilicate, polyvinyl pyrrolidone, cellulose-based substances, polyethylene glycol, sodium carboxymethylcellulose, polyacrylates, waxes,
  • Cyclodextrins such as ⁇ -, ⁇ -, and ⁇ -cyclodextrin, or chemically modified derivatives such as hydroxyalkylcyclodextrins, including 2- and 3-hydroxypropyl- ⁇ -cyclodextrins, or other solubilized derivatives may also be advantageously used to enhance delivery of COMPOUND 1 or COMPOUND 2 described herein.
  • the pharmaceutical composition comprises COMPOUND 1 and an excipient.
  • the pharmaceutical composition that comprises COMPOUND 1 and an excipient is for oral administration.
  • the excipient is a diluent, a binder, a disintegrant, a wetting agent, a stabilizer, a glidant, or a lubricant.
  • the pharmaceutical composition comprises COMPOUND 2 and an excipient.
  • the pharmaceutical composition that comprises COMPOUND 2 and an excipient is for oral administration.
  • the excipient is a diluent, a binder, a disintegrant, a wetting agent, a stabilizer, a glidant, or a lubricant.
  • the diluent is a microcrystalline cellulose.
  • the binder is a hydroxypropyl cellulose.
  • the disintegrant is sodium starch glycolate.
  • the wetting agent is sodium lauryl sulfate.
  • the stabilizer is hypromellose acetate succinate.
  • the glidant is colloidal silicon dioxide.
  • the lubricant is magnesium stearate.
  • the pharmaceutical composition comprises COMPOUND 1 or COMPOUND 2 and an excipient. In one embodiment, the pharmaceutical composition that comprises COMPOUND 1 or COMPOUND 2 and an excipient, is for oral administration.
  • Oral delivery formats for COMPOUND 1 or COMPOUND 2 include, but are not limited to, tablets, capsules, caplets, solutions, suspensions, and syrups, and may also comprise a plurality of granules, beads, powders or pellets that may or may not be encapsulated. Such formats may also be referred to herein as the “drug core” which contains COMPOUND 1 or COMPOUND 2.
  • the formulation is a tablet comprising COMPOUND 1 or COMPOUND 2.
  • the formulation is a capsule comprising COMPOUND 1 or COMPOUND 2.
  • the tablets or capsules provided herein optionally comprise one or more excipients, such as, for example, glidants, diluents, lubricants, colorants, disintegrants, granulating agents, binding agents, polymers, and coating agents.
  • the formulation is an immediate release tablet.
  • the formulation is a controlled release tablet releasing the active pharmaceutical ingredient (API), e.g., substantially in the stomach.
  • API active pharmaceutical ingredient
  • the formulation is a hard gelatin capsule. In certain embodiments, the formulation is a soft gelatin capsule. In certain embodiments, the capsule is a hydroxypropyl methylcellulose (HPMC) capsule. In certain embodiments, the formulation is an immediate release capsule. In certain embodiments, the formulation is an immediate or controlled release capsule releasing the API, e.g., substantially in the stomach. In certain embodiments, the formulation is a rapidly disintegrating tablet that dissolves substantially in the mouth following administration. In certain embodiments, embodiments herein encompass the use of COMPOUND 1 for the preparation of a pharmaceutical composition for treating a malignancy, characterized by the presence of a mutant allele of IDH2, wherein the composition is prepared for oral administration. In certain embodiments, embodiments herein encompass the use of COMPOUND 2 for the preparation of a pharmaceutical composition for treating a malignancy, characterized by the presence of a mutant allele of IDH1, wherein the composition is prepared for oral administration.
  • COMPOUND 1 for the preparation of a pharmaceutical composition for treating a malignancy,
  • compositions e.g., immediate release oral formulations and/or formulations that release the API substantially in the stomach
  • COMPOUND 1 or COMPOUND 2 that achieve a particular AUC value (e.g., AUC(0-t) or AUC(0- ⁇ )) in the subject (e.g., human) to which the formulation is orally administered.
  • AUC value e.g., AUC(0-t) or AUC(0- ⁇ )
  • Particular embodiments provide oral formulations that achieve an AUC value of at least about 25 ng-hr/mL, at least about 50 ng-hr/mL, at least about 75 ng-hr/mL, at least about 100 ng-hr/mL, at least about 150 ng-hr/mL, at least about 200 ng-hr/mL, at least about 250 ng-hr/mL, at least about 300 ng-hr/mL, at least about 350 ng-hr/mL, at least about 400 ng-hr/mL, at least about 450 ng-hr/mL, at least about 500 ng-hr/mL, at least about 550 ng-hr/mL, at least about 600 ng-hr/mL, at least about 650 ng-hr/mL, at least about 700 ng-hr/mL, at least about 750 ng-hr/mL, at least about 800 ng-hr/mL, at least
  • compositions e.g., immediate release oral formulations and/or formulations that release the API substantially in the stomach
  • COMPOUND 1 or COMPOUND 2 that achieve a particular maximum plasma concentration (“Cmax”) in the subject to which the formulation is orally administered.
  • Cmax maximum plasma concentration
  • Particular embodiments provide oral formulations that achieve a Cmax of COMPOUND 1 or COMPOUND 2 of at least about 25 ng/mL, at least about 50 ng/mL, at least about 75 ng/mL, at least about 100 ng/mL, at least about 150 ng/mL, at least about 200 ng/mL, at least about 250 ng/mL, at least about 300 ng/mL, at least about 350 ng/mL, at least about 400 ng/mL, at least about 450 ng/mL, at least about 500 ng/mL, at least about 550 ng/mL, at least about 600 ng/mL, at least about 650 ng/mL, at least about 700 ng/mL, at least about 750 ng/mL, at least about 800 ng/mL, at least about 850 ng/mL, at least about 900 ng/mL, at least about 950 ng/mL, at least about 1000 ng/mL, at least about
  • compositions e.g., immediate release oral formulations and/or formulations that release the API substantially in the stomach
  • COMPOUND 1 or COMPOUND 2 that achieve a particular time to maximum plasma concentration (“Tmax”) in the subject to which the formulation is orally administered.
  • Tmax time to maximum plasma concentration
  • Particular embodiments provide oral formulations that achieve a Tmax of the cytidine analog of less than about 10 min., less than about 15 min., less than about 20 min., less than about 25 min., less than about 30 min., less than about 35 min., less than about 40 min., less than about 45 min., less than about 50 min., less than about 55 min., less than about 60 min., less than about 65 min., less than about 70 min., less than about 75 min., less than about 80 min., less than about 85 min., less than about 90 min., less than about 95 min., less than about 100 min., less than about 105 min., less than about 110 min., less than about 115 min., less than about 120 min., less than about 130 min., less than about 140 min., less than about 150 min., less than about 160 min., less than about 170 min., less than about 180 min., less than about 190 min., less than about 200 min., less than about 210 min., less than about
  • compositions comprising COMPOUND 1 or COMPOUND 2 wherein the oral dosage forms have an enteric coating.
  • the permeable or partly permeable enteric-coated tablet releases COMPOUND 1 or COMPOUND 2 in an immediate release manner substantially in the stomach.
  • dosage forms designed to maximize the absorption and/or efficacious delivery of COMPOUND 1 or COMPOUND 2, upon oral administration, e.g., for release substantially in the stomach.
  • certain embodiments herein provide a solid oral dosage form of COMPOUND 1 or COMPOUND 2 using pharmaceutical excipients designed for immediate release of the API upon oral administration, e.g., substantially in the stomach.
  • Particular immediate release formulations comprise a specific amount of COMPOUND 1 or COMPOUND 2 and optionally one or more excipients.
  • the formulation may be an immediate release tablet or an immediate release capsule (such as, e.g., an HPMC capsule).
  • formulations provided herein comprising COMPOUND 1 or COMPOUND 2 provided herein (e.g., immediate release oral formulations and/or formulations that release the API substantially in the stomach).
  • the formulations provided herein may be prepared using conventional methods known to those skilled in the field of pharmaceutical formulation, as described, e.g., in pertinent textbooks.
  • formulations provided herein comprise COMPOUND 1 or COMPOUND 2 in a specific amount.
  • the specific amount of COMPOUND 1 or COMPOUND 2 in the formulation is, e.g., about 10 mg.
  • the specific amount is about 20 mg.
  • the specific amount is about 40 mg.
  • the specific amount is about 60 mg.
  • the specific amount is about 80 mg.
  • the specific amount is about 100 mg.
  • the specific amount is about 120 mg.
  • the specific amount is about 140 mg.
  • the specific amount is about 160 mg.
  • the specific amount is about 180 mg. In one embodiment, the specific amount is about 200 mg. In one embodiment, the specific amount is about 220 mg. In one embodiment, the specific amount is about 240 mg. In one embodiment, the specific amount is about 260 mg. In one embodiment, the specific amount is about 280 mg. In one embodiment, the specific amount is about 300 mg. In one embodiment, the specific amount is about 320 mg. In one embodiment, the specific amount is about 340 mg. In one embodiment, the specific amount is about 360 mg. In one embodiment, the specific amount is about 380 mg. In one embodiment, the specific amount is about 400 mg. In one embodiment, the specific amount is about 420 mg. In one embodiment, the specific amount is about 440 mg. In one embodiment, the specific amount is about 460 mg.
  • the specific amount is about 480 mg. In one embodiment, the specific amount is about 500 mg. In one embodiment, the specific amount is about 600 mg. In one embodiment, the specific amount is about 700 mg. In one embodiment, the specific amount is about 800 mg. In one embodiment, the specific amount is about 900 mg. In one embodiment, the specific amount is about 1000 mg. In one embodiment, the specific amount is about 1100 mg. In one embodiment, the specific amount is about 1200 mg. In one embodiment, the specific amount is about 1300 mg. In one embodiment, the specific amount is about 1400 mg. In one embodiment, the specific amount is about 1500 mg. In one embodiment, the specific amount is about 1600 mg. In one embodiment, the specific amount is about 1700 mg. In one embodiment, the specific amount is about 1800 mg.
  • the specific amount is about 1900 mg. In one embodiment, the specific amount is about 2000 mg. In one embodiment, the specific amount is about 2100 mg. In one embodiment, the specific amount is about 2200 mg. In one embodiment, the specific amount is about 2300 mg. In one embodiment, the specific amount is about 2400 mg. In one embodiment, the specific amount is about 2500 mg. In one embodiment, the specific amount is about 3000 mg. In one embodiment, the specific amount is about 4000 mg. In one embodiment, the specific amount is about 5000 mg.
  • the formulation is a tablet, wherein the tablet is manufactured using standard, art-recognized tablet processing procedures and equipment.
  • the method for forming the tablets is direct compression of a powdered, crystalline and/or granular composition comprising COMPOUND 1 or COMPOUND 2 alone or in combination with one or more excipients, such as, for example, carriers, additives, polymers, or the like.
  • the tablets may be prepared using wet granulation or dry granulation processes.
  • the tablets are molded rather than compressed, starting with a moist or otherwise tractable material.
  • compression and granulation techniques are used.
  • the formulation is a capsule, wherein the capsules may be manufactured using standard, art-recognized capsule processing procedures and equipments.
  • soft gelatin capsules may be prepared in which the capsules contain a mixture of COMPOUND 1 or COMPOUND 2 and vegetable oil or non-aqueous, water miscible materials such as, for example, polyethylene glycol and the like.
  • hard gelatin capsules may be prepared containing granules of COMPOUND 1 or COMPOUND 2 in combination with a solid pulverulent carrier, such as, for example, lactose, saccharose, sorbitol, mannitol, potato starch, corn starch, amylopectin, cellulose derivatives, or gelatin.
  • a hard gelatin capsule shell may be prepared from a capsule composition comprising gelatin and a small amount of plasticizer such as glycerol.
  • the capsule shell may be made of a carbohydrate material.
  • the capsule composition may additionally include polymers, colorings, flavorings and opacifiers as required.
  • the capsule comprises HPMC.
  • the formulation of COMPOUND 1 or COMPOUND 2 is prepared using aqueous solvents without causing significant hydrolytic degradation of the compounds.
  • the formulation of COMPOUND 1 or COMPOUND 2 is a tablet which contains a coating applied to the drug core using aqueous solvents without causing significant hydrolytic degradation of the compound in the formulation.
  • water is employed as the solvent for coating the drug core.
  • the oral dosage form of COMPOUND 1 or COMPOUND 2 is a tablet containing a film coat applied to the drug core using aqueous solvents.
  • water is employed as the solvent for film-coating.
  • the tablet containing COMPOUND 1 or COMPOUND 2 is film-coated using aqueous solvents without effecting degradation of the pharmaceutical composition.
  • water is used as the film coating solvent without effecting degradation of the pharmaceutical composition.
  • an oral dosage form comprising COMPOUND 1 or COMPOUND 2 and an aqueous film coating effects immediate drug release upon oral delivery.
  • the oral dosage form comprising COMPOUND 1 or COMPOUND 2 and an aqueous film coating effects controlled drug release to the upper gastrointestinal tract, e.g., the stomach, upon oral administration.
  • a tablet with an aqueous-based film coating comprises COMPOUND 1 or COMPOUND 2 as the API.
  • a controlled release pharmaceutical formulation for oral administration of COMPOUND 1 or COMPOUND 2 substantially in the stomach comprising: a) a specific amount of COMPOUND 1 or COMPOUND 2; b) a drug release controlling component for controlling the release of COMPOUND 1 or COMPOUND 2 substantially in the upper gastrointestinal tract, e.g., the stomach; and c) optionally one or more excipients.
  • the oral dosage form comprising COMPOUND 1 or COMPOUND 2 is prepared as a controlled release tablet or capsule which includes a drug core comprising the pharmaceutical composition and optional excipients.
  • a “seal coat” or “shell” is applied.
  • a formulation provided herein comprising COMPOUND 1 or COMPOUND 2 provided herein is a controlled release tablet or capsule, which comprises a therapeutically effective amount of COMPOUND 1 or COMPOUND 2, a drug release controlling component that controls the release of COMPOUND 1 or COMPOUND 2 substantially in the stomach upon oral administration, and optionally, one or more excipients.
  • a drug release controlling component that is a polymer matrix, which swells upon exposure to gastric fluid to effect the gastric retention of the formulation and the sustained release of COMPOUND 1 or COMPOUND 2 from the polymer matrix substantially in the stomach.
  • such formulations may be prepared by incorporating COMPOUND 1 or COMPOUND 2 into a suitable polymeric matrix during formulation. Examples of such formulations are known in the art. See, e.g., Shell et al., U.S. Patent Publication No. 2002/0051820 (application Ser. No. 09/990,061); Shell et al., U.S. Patent Publication No. 2003/0039688 (application Ser. No. 10/045,823); Gusler et al., U.S. Patent Publication No. 2003/0104053 (application Ser. No. 10/029,134), each of which is incorporated herein by reference in its entirety.
  • the drug release controlling component may comprise a shell surrounding the drug-containing core, wherein the shell releases COMPOUND 1 or COMPOUND 2 from the core by, e.g., permitting diffusion of COMPOUND 1 or COMPOUND 2 from the core and promoting gastric retention of the formulation by swelling upon exposure to gastric fluids to a size that is retained in the stomach.
  • such formulations may be prepared by first compressing a mixture of COMPOUND 1 or COMPOUND 2 and one or more excipients to form a drug core, and compressing another powdered mixture over the drug core to form the shell, or enclosing the drug core with a capsule shell made of suitable materials. Examples of such formulations are known in the art. See, e.g., Berner et al., U.S. Patent Publication No. 2003/0104062 application Ser. No. 10/213,823), incorporated herein by reference in its entirety.
  • the pharmaceutical formulations provided herein contain COMPOUND 1 or COMPOUND 2 and, optionally, one or more excipients to form a “drug core.”
  • excipients include, e.g., diluents (bulking agents), lubricants, disintegrants, fillers, stabilizers, surfactants, preservatives, coloring agents, flavoring agents, binding agents, excipient supports, glidants, permeation enhancement excipients, plasticizers and the like, e.g., as known in the art. It will be understood by those in the art that some substances serve more than one purpose in a pharmaceutical composition.
  • some substances are binders that help hold a tablet together after compression, yet are also disintegrants that help break the tablet apart once it reaches the target delivery site. Selection of excipients and amounts to use may be readily determined by the formulation scientist based upon experience and consideration of standard procedures and reference works available in the art.
  • formulations provided herein comprise one or more binders.
  • Binders may be used, e.g., to impart cohesive qualities to a tablet, and thus ensure that the tablet remains intact after compression.
  • Suitable binders include, but are not limited to, starch (including corn starch and pregelatinized starch), gelatin, sugars (including sucrose, glucose, dextrose and lactose), polyethylene glycol, propylene glycol, waxes, and natural and synthetic gums, e.g., acacia sodium alginate, polyvinylpyrrolidone, cellulosic polymers (including hydroxypropyl cellulose, hydroxypropylmethylcellulose, methyl cellulose, ethyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose and the like), veegum, carbomer (e.g., carbopol), sodium, dextrin, guar gum, hydrogenated vegetable oil, magnesium aluminum silicate, maltodextrin, polymeth
  • Binding agents also include, e.g., acacia, agar, alginic acid, cabomers, carrageenan, cellulose acetate phthalate, ceratonia, chitosan, confectioner's sugar, copovidone, dextrates, dextrin, dextrose, ethylcellulose, gelatin, glyceryl behenate, guar gum, hydroxyethyl cellulose, hydroxyethylmethyl cellulose, hydroxypropyl cellulose, hydroxypropyl starch, hypromellose, inulin, lactose, magnesium aluminum silicate, maltodextrin, maltose, methylcellulose, poloxamer, polycarbophil, polydextrose, polyethylene oxide, polymethylacrylates, povidone, sodium alginate, sodium carboxymethylcellulose, starch, pregelatinized starch, stearic acid, sucrose, and zein.
  • acacia e.g.,
  • the binding agent can be, relative to the drug core, in the amount of about 2% w/w of the drug core; about 4% w/w of the drug core, about 6% w/w of the drug core, about 8% w/w of the drug core, about 10% w/w of the drug core, about 12% w/w of the drug core, about 14% w/w of the drug core, about 16% w/w of the drug core, about 18% w/w of the drug core, about 20% w/w of the drug core, about 22% w/w of the drug core, about 24% w/w of the drug core, about 26% w/w of the drug core, about 28% w/w of the drug core, about 30% w/w of the drug core, about 32% w/w of the drug core, about 34% w/w of the drug core, about 36% w/w of the drug core, about 38% w/w of the drug core, about 40% w/w of the drug core, about 4
  • formulations provided herein comprise one or more diluents.
  • Diluents may be used, e.g., to increase bulk so that a practical size tablet is ultimately provided.
  • Suitable diluents include dicalcium phosphate, calcium sulfate, lactose, cellulose, kaolin, mannitol, sodium chloride, dry starch, microcrystalline cellulose (e.g., AVICEL), microfine cellulose, pregelitinized starch, calcium carbonate, calcium sulfate, sugar, dextrates, dextrin, dextrose, dibasic calcium phosphate dihydrate, tribasic calcium phosphate, kaolin, magnesium carbonate, magnesium oxide, maltodextrin, mannitol, polymethacrylates (e.g., EUDRAGIT), potassium chloride, sodium chloride, sorbitol and talc, among others.
  • EUDRAGIT EUDRAGIT
  • Diluents also include, e.g., ammonium alginate, calcium carbonate, calcium phosphate, calcium sulfate, cellulose acetate, compressible sugar, confectioner's sugar, dextrates, dextrin, dextrose, erythritol, ethylcellulose, fructose, fumaric acid, glyceryl palmitostearate, isomalt, kaolin, lacitol, lactose, mannitol, magnesium carbonate, magnesium oxide, maltodextrin, maltose, medium-chain triglycerides, microcrystalline cellulose, microcrystalline silicified cellulose, powered cellulose, polydextrose, polymethylacrylates, simethicone, sodium alginate, sodium chloride, sorbitol, starch, pregelatinized starch, sucrose, sulfobutylether- ⁇ -cyclodextrin, talc, tragacanth, trehalose, and
  • Diluents may be used in amounts calculated to obtain a desired volume for a tablet or capsule; in certain embodiments, a diluent is used in an amount of about 5% or more, about 10% or more, about 15% or more, about 20% or more, about 22% or more, about 24% or more, about 26% or more, about 28% or more, about 30% or more, about 32% or more, about 34% or more, about 36% or more, about 38% or more, about 40% or more, about 42% or more, about 44% or more, about 46% or more, about 48% or more, about 50% or more, about 52% or more, about 54% or more, about 56% or more, about 58% or more, about 60% or more, about 62% or more, about 64% or more, about 68% or more, about 70% ore more, about 72% or more, about 74% or more, about 76% or more, about 78% or more, about 80% or more, about 85% or more, about 90% or more, or about 95% or more, weight/weight
  • formulations provided herein comprise one or more lubricants.
  • Lubricants may be used, e.g., to facilitate tablet manufacture; examples of suitable lubricants include, for example, vegetable oils such as peanut oil, cottonseed oil, sesame oil, olive oil, corn oil, and oil of theobroma, glycerin, magnesium stearate, calcium stearate, and stearic acid.
  • stearates if present, represent no more than approximately 2 weight % of the drug-containing core.
  • lubricants include, e.g., calcium stearate, glycerin monostearate, glyceryl behenate, glyceryl palmitostearate, magnesium lauryl sulfate, magnesium stearate, myristic acid, palmitic acid, poloxamer, polyethylene glycol, potassium benzoate, sodium benzoate, sodium chloride, sodium lauryl sulfate, sodium stearyl fumarate, stearic acid, talc, and zinc stearate.
  • the lubricant is magnesium stearate.
  • the lubricant is present, relative to the drug core, in an amount of about 0.2% w/w of the drug core, about 0.4% w/w of the drug core, about 0.6% w/w of the drug core, about 0.8% w/w of the drug core, about 1.0% w/w of the drug core, about 1.2% w/w of the drug core, about 1.4% w/w of the drug core, about 1.6% w/w of the drug core, about 1.8% w/w of the drug core, about 2.0% w/w of the drug core, about 2.2% w/w of the drug core, about 2.4% w/w of the drug core, about 2.6% w/w of the drug core, about 2.8% w/w of the drug core, about 3.0% w/w of the drug core, about 3.5% w/w of the drug core, about 4% w/w of the drug core, about 4.5% w/w of the drug core, about 5% w/w of the drug core, about 6% w/w of
  • formulations provided herein comprise one or more disintegrants.
  • Disintegrants may be used, e.g., to facilitate disintegration of the tablet, and may be, e.g., starches, clays, celluloses, algins, gums or crosslinked polymers.
  • Disintegrants also include, e.g., alginic acid, carboxymethylcellulose calcium, carboxymethylcellulose sodium (e.g., AC-DI-SOL, PRIMELLOSE), colloidal silicon dioxide, croscarmellose sodium, crospovidone (e.g., KOLLIDON, POLYPLASDONE), guar gum, magnesium aluminum silicate, methyl cellulose, microcrystalline cellulose, polacrilin potassium, powdered cellulose, pregelatinized starch, sodium alginate, sodium starch glycolate (e.g., EXPLOTAB) and starch.
  • alginic acid carboxymethylcellulose calcium, carboxymethylcellulose sodium (e.g., AC-DI-SOL, PRIMELLOSE), colloidal silicon dioxide, croscarmellose sodium, crospovidone (e.g., KOLLIDON, POLYPLASDONE), guar gum, magnesium aluminum silicate, methyl cellulose, microcrystalline cellulose, polacrilin potassium,
  • disintegrants include, e.g., calcium alginate, chitosan, sodium docusate, hydroxypropyl cellulose, and povidone.
  • the disintegrant is, relative to the drug core, present in the amount of about 1% w/w of the drug core, about 2% w/w of the drug core, about 3% w/w of the drug core, about 4% w/w of the drug core, about 5% w/w of the drug core, about 6% w/w of the drug core, about 7% w/w of the drug core, about 8% w/w of the drug core, about 9% w/w of the drug core, about 10% w/w of the drug core, about 12% w/w of the drug core, about 14% w/w of the drug core, about 16% w/w of the drug core, about 18% w/w of the drug core, about 20% w/w of the drug core, about 22% w/w of the drug core, about
  • formulations provided herein comprise one or more stabilizers.
  • Stabilizers also called absorption enhancers
  • Stabilizing agents include, e.g., d-Alpha-tocopheryl polyethylene glycol 1000 succinate (Vitamin E TPGS), acacia, albumin, alginic acid, aluminum stearate, ammonium alginate, ascorbic acid, ascorbyl palmitate, bentonite, butylated hydroxytoluene, calcium alginate, calcium stearate, calcium carboxymethylcellulose, carrageenan, ceratonia , colloidal silicon dioxide, cyclodextrins, diethanolamine, edetates, ethylcellulose, ethyleneglycol palmitostearate, glycerin monostearate, guar gum, hydroxypropyl cellulose, hypromellose
  • the stabilizer is, relative to the drug core, present in the amount of about 1% w/w of the drug core, about 2% w/w of the drug core, about 3% w/w of the drug core, about 4% w/w of the drug core, about 5% w/w of the drug core, about 6% w/w of the drug core, about 7% w/w of the drug core, about 8% w/w of the drug core, about 9% w/w of the drug core, about 10% w/w of the drug core, about 12% w/w of the drug core, about 14% w/w of the drug core, about 16% w/w of the drug core, about 18% w/w of the drug core, about 20% w/w of the drug core, about 22% w/w of the drug core, about 24% w/w of the drug core, about 26% w/w of the drug core, about 28% w/w of the drug core, about 30% w/w of the
  • formulations provided herein comprise one or more glidants.
  • Glidants may be used, e.g., to improve the flow properties of a powder composition or granulate or to improve the accuracy of dosing.
  • Excipients that may function as glidants include, e.g., colloidal silicon dioxide, magnesium trisilicate, powdered cellulose, starch, tribasic calcium phosphate, calcium silicate, powdered cellulose, colloidal silicon dioxide, magnesium silicate, magnesium trisilicate, silicon dioxide, starch, tribasic calcium phosphate, and talc.
  • the glidant is, relative to the drug core, present in the amount of less than about 1% w/w of the drug core, about 1% w/w of the drug core, about 2% w/w of the drug core, about 3% w/w of the drug core, about 4% w/w of the drug core, about 5% w/w of the drug core, about 6% w/w of the drug core, about 7% w/w of the drug core, about 8% w/w of the drug core, about 9% w/w of the drug core, about 10% w/w of the drug core, about 12% w/w of the drug core, about 14% w/w of the drug core, about 16% w/w of the drug core, about 18% w/w of the drug core, about 20% w/w of the drug core, about 22% w/w of the drug core, about 24% w/w of the drug core, about 26% w/w of the drug core, about 28% w/w of
  • the pharmaceutical compositions provided herein may be administered orally, parenterally, by inhalation spray, topically, rectally, nasally, buccally, vaginally or via an implanted reservoir, preferably by oral administration or administration by injection.
  • the pharmaceutical compositions may contain any conventional non-toxic pharmaceutically-acceptable carriers, adjuvants or vehicles.
  • the pH of the formulation may be adjusted with pharmaceutically acceptable acids, bases or buffers to enhance the stability of the formulated compound or its delivery form.
  • parenteral as used herein includes subcutaneous, intracutaneous, intravenous, intramuscular, intraarticular, intraarterial, intrasynovial, intrasternal, intrathecal, intralesional and intracranial injection or infusion techniques.
  • the pharmaceutical compositions provided herein may be in the form of a sterile injectable preparation, for example, as a sterile injectable aqueous or oleaginous suspension.
  • This suspension may be formulated according to techniques known in the art using suitable dispersing or wetting agents (such as, for example, Tween 80) and suspending agents.
  • the sterile injectable preparation may also be a sterile injectable solution or suspension in a non-toxic parenterally acceptable diluent or solvent, for example, as a solution in 1,3-butanediol.
  • suitable vehicles and solvents that may be employed are mannitol, water, Ringer's solution and isotonic sodium chloride solution.
  • sterile, fixed oils are conventionally employed as a solvent or suspending medium.
  • any bland fixed oil may be employed including synthetic mono- or diglycerides.
  • Fatty acids, such as oleic acid and its glyceride derivatives are useful in the preparation of injectables, as are natural pharmaceutically-acceptable oils, such as olive oil or castor oil, especially in their polyoxyethylated versions.
  • These oil solutions or suspensions may also contain a long-chain alcohol diluent or dispersant, or carboxymethyl cellulose or similar dispersing agents which are commonly used in the formulation of pharmaceutically acceptable dosage forms such as emulsions and or suspensions.
  • surfactants such as Tweens or Spans and/or other similar emulsifying agents or bioavailability enhancers which are commonly used in the manufacture of pharmaceutically acceptable solid, liquid, or other dosage forms may also be used for the purposes of formulation.
  • compositions provided herein may also be administered in the form of suppositories for rectal administration.
  • suppositories for rectal administration.
  • These compositions can be prepared by mixing a compound of one aspect of this invention with a suitable non-irritating excipient which is solid at room temperature but liquid at the rectal temperature and therefore will melt in the rectum to release the active components.
  • suitable non-irritating excipient include, but are not limited to, cocoa butter, beeswax and polyethylene glycols.
  • Topical administration of the pharmaceutical compositions provided herein is useful when the desired treatment involves areas or organs readily accessible by topical application.
  • the pharmaceutical composition should be formulated with a suitable ointment containing the active components suspended or dissolved in a carrier.
  • Carriers for topical administration of the compounds of one aspect of this invention include, but are not limited to, mineral oil, liquid petroleum, white petroleum, propylene glycol, polyoxyethylene polyoxypropylene compound, emulsifying wax and water.
  • the pharmaceutical composition can be formulated with a suitable lotion or cream containing the active compound suspended or dissolved in a carrier with suitable emulsifying agents.
  • Suitable carriers include, but are not limited to, mineral oil, sorbitan monostearate, polysorbate 60, cetyl esters wax, cetearyl alcohol, 2-octyldodecanol, benzyl alcohol and water.
  • the pharmaceutical compositions provided herein may also be topically applied to the lower intestinal tract by rectal suppository formulation or in a suitable enema formulation. Topically-transdermal patches are also included herein.
  • compositions provided herein may be administered by nasal aerosol or inhalation.
  • Such compositions are prepared according to techniques well-known in the art of pharmaceutical formulation and may be prepared as solutions in saline, employing benzyl alcohol or other suitable preservatives, absorption promoters to enhance bioavailability, fluorocarbons, and/or other solubilizing or dispersing agents known in the art.
  • the compositions provided herein can, for example, be administered by injection, intravenously, intraarterially, subdermally, intraperitoneally, intramuscularly, or subcutaneously; or orally, buccally, nasally, transmucosally, topically, in an ophthalmic preparation, or by inhalation, with a dosage ranging from about 0.5 to about 100 mg/kg of body weight, alternatively dosages between 1 mg and 1000 mg/dose, every 4 to 120 hours, or according to the requirements of the particular drug.
  • the methods herein contemplate administration of an effective amount of compound or compound composition to achieve the desired or stated effect.
  • the pharmaceutical compositions are administered from about 1 to about 6 times per day or alternatively, as a continuous infusion.
  • Such administration can be used as a chronic or acute therapy.
  • the amount of active ingredient that may be combined with the carrier materials to produce a single dosage form varies depending upon the host treated and the particular mode of administration.
  • a typical preparation contains from about 5% to about 95% active compound (w/w).
  • such preparations contain from about 20% to about 80% active compound.
  • a maintenance dose of a compound, composition or combination provided herein may be administered, if necessary. Subsequently, the dosage or frequency of administration, or both, may be reduced, as a function of the symptoms, to a level at which the improved condition is retained when the symptoms have been alleviated to the desired level. Subjects may, however, require intermittent treatment on a long-term basis upon any recurrence of disease symptoms.
  • COMPOUND 2 is administered in compositions, comprising COMPOUND 2, and one or more polymer(s) as part of a solid dispersion (e.g., an amorphous solid dispersion).
  • the solid dispersion comprises COMPOUND 2, and one or more polymer(s).
  • the solid dispersion comprises COMPOUND 2, one or more polymer(s), and one or more surfactant(s).
  • the solid dispersion comprises COMPOUND 2, and one polymer.
  • the solid dispersion comprises COMPOUND 2, one polymer, and a surfactant.
  • the solid dispersions provided herein, comprising COMPOUND 2 enhance the solubility of COMPOUND 2 relative to a neat crystalline form of COMPOUND 2 (e.g., Form 1 or Form 2), and thus provide improved exposure upon oral dosing of the solid dispersion to a subject.
  • the solid dispersion comprises COMPOUND 2, one or more polymer(s), and optionally one or more solubility enhancing surfactant.
  • the aqueous solubility of Form 1 is about 0.025 mg/mL to about 0.035 mg/mL and the aqueous solubility of Form 2 is about 0.008 mg/mL to about 0.010 mg/mL.
  • Form 2 has a solubility of about 0.018 mg/mL in fasted state simulated intestinal fluid (FASSIF) at a pH of 6.1 at 4 hours.
  • amorphous spray-dried dispersions have a solubility of about 0.05 mg/mL to about 0.50 mg/mL in FASSIF at 3 hours.
  • the solid dispersion exhibits at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, or at least about 90% higher exposure of COMPOUND 2, when administered to a subject as compared to administration of in-situ amorphous COMPOUND 2. In some embodiments, the solid dispersion exhibits at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, or at least about 90% higher exposure of COMPOUND 2, when administered to a subject as compared to administration of neat crystalline COMPOUND 2.
  • COMPOUND 2 exposure is improved when solid dispersion dosage forms are administered as compared to neat crystalline COMPOUND 2 Form 2.
  • At least a portion of COMPOUND 2, in the solid dispersion is in the amorphous state (e.g., at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, at least about 98%, or at least about 99%).
  • the solid dispersion is substantially free of crystalline COMPOUND 2.
  • the composition is an amorphous solid (e.g. spray dried) dispersion comprising COMPOUND 2, and a polymer.
  • the amorphous solid dispersion can include, e.g., less than about 30%, less than about 20%, less than about 15%, less than about 10%, less than about 5%, less than about 4%, less than about 3%, less than about 2%, or less than about 1% of crystalline COMPOUND 2, e.g., be substantially free of crystalline COMPOUND 2.
  • the solid dispersion exhibits a predetermined level of physical and/or chemical stability.
  • the solid dispersion retains about 50%, about 60%, about 70%, about 80%, about 90%, about 95%, about 98%, or about 99%, of amorphous COMPOUND 2, when stored at 25° C. in a closed water tight container, e.g., an amber glass vial, high density polyethylene (HDPE) container or double polyethylene bags with twisted nylon tie placed in an HDPE container with desiccant.
  • a closed water tight container e.g., an amber glass vial, high density polyethylene (HDPE) container or double polyethylene bags with twisted nylon tie placed in an HDPE container with desiccant.
  • HDPE high density polyethylene
  • the polymer increases the chemical or physical stability (e.g., as measured by a Modulated Differential Scanning calorimeter) of COMPOUND 2, when stored (e.g., at 2-8° C., e.g. 4° C. or at room temperature) by at least about 10% (e.g., by at least about 20%, by at least about 30%, by at least about 40%, by at least about 50%, by at least about 60%, by at least about 70%, by at least about 80%, or by at least about 90%) compared to amorphous COMPOUND 2, without being in the presence of the polymer.
  • a Modulated Differential Scanning calorimeter e.g., as measured by a Modulated Differential Scanning calorimeter
  • a solid dispersion generally exhibits a glass transition temperature, where the dispersion makes a transition from a glassy solid to a rubbery composition.
  • the higher the glass transition temperature the greater the physical stability of the dispersion.
  • the existence of a glass transition temperature generally indicates that at least a large portion of the composition (e.g., dispersion) is in an amorphous state.
  • the glass transition temperature (Tg) of a solid dispersion suitable for pharmaceutical applications is generally at least about 50° C. In some embodiments, higher temperatures are preferred. Therefore, in some embodiments, a solid dispersion disclosed herein has a Tg of at least about 100° C.
  • the Tg is up to about 200° C. In some embodiments, the Tg is up to about 130° C.
  • the solid dispersion has a higher glass transition temperature than the glass transition temperature of amorphous COMPOUND 2, without being in the presence of the polymer(s). In some embodiments, the solid dispersion has a relaxation rate that is lower than the relaxation rate of amorphous COMPOUND 2, without being in the presence of the polymer(s).
  • polymers in the solid dispersion include cellulose derivatives (e.g., hydroxypropylmethylcellulose also known as hypromellose, (HPMC), hydroxypropylmethylcellulose phthalate, also known as hypromellose phthalate (HPMCP), hydroxypropylmethylcellulose acetate succinate, also known as hpromellose acetate succinate, (HPMCAS), hydroxypropylcellulose (HPC)), ethylcellulose, or cellulose acetate phthalate; polyvinylpyrrolidones (PVP); polyethylene glycols (PEG); polyvinyl alcohols (PVA); polyvinyl esters, such as Polyvinyl Acetate Phthalate (PVAP); acrylates, such as polymethacrylate (e.g., Eudragit® E); cyclodextrins (e.g., .beta.-cyclodextrin); Poly (D,L-lactide) (PLA), Poly (D,L-l
  • the solid dispersion includes one water-soluble polymer. In some embodiments, the solid dispersion includes one partially water-soluble polymer. In some embodiments, the polymer is a cellulose polymer.
  • the polymer is HPMCAS (e.g., HPMCAS of different grades: HPMCAS-M, HPMCAS-MG or HPMCAS-HG). In some embodiments, the polymer is PVAP.
  • the polymer is HPMC (e.g., HPMC of different grades: HMPC60SH50, HPMCE50 or HPMCE15).
  • HPMCP e.g., HPMCP of different grades: e.g., HMPCP-HP55.
  • the polymer is a pH-dependent enteric polymer.
  • pH-dependent enteric polymers include, but are not limited to, cellulose derivatives (e.g., cellulose acetate phthalate (CAP)), HPMCP, HPMCAS, carboxymethylcellulose (CMC) or a salt thereof (e.g., a sodium salt such as (CMC-Na)); cellulose acetate trimellitate (CAT), hydroxypropylcellulose acetate phthalate (HPCAP), hydroxypropylmethyl-cellulose acetate phthalate (HPMCAP), and methylcellulose acetate phthalate (MCAP), polymethacrylates (e.g., Eudragit S), or mixtures thereof.
  • cellulose derivatives e.g., cellulose acetate phthalate (CAP)
  • HPMCP HPMCAS
  • CMC carboxymethylcellulose
  • CMC-Na salt thereof e.g., a sodium salt such as (CMC-Na)
  • CAT cellulose acetate trimellitate
  • the polymer is hydroxypropylmethylcellulose acetate succinate, also known as hypromellose acetate succinate, (HPMCAS), e.g., HMPCAS-HG.
  • HPMCAS hypromellose acetate succinate
  • the polymer(s) is an insoluble cross-linked polymer, for example a polyvinylpyrrolidone (e.g., Crospovidone).
  • the polymer(s) is polyvinylpyrrolidone (PVP).
  • the one or more polymer(s) is present in the solid dispersion in an amount of between about 10% w/w and 90% w/w (e.g., between about 20% w/w and about 80% w/w; between about 30% w/w and about 70% w/w; between about 40% w/w and about 60% w/w; or between about 15% w/w and about 35% w/w).
  • the polymer(s) is present in the solid dispersion in an amount of from about 10% w/w to about 80% w/w, for example from about 30% w/w to about 75% w/w, or from about 40% w/w to about 65% w/w, or from about 45% w/w to about 55% w/w, for example, about 46% w/w, about 47% w/w, about 48% w/w, about 49% w/w, about 50% w/w, about 51% w/w, about 52% w/w, about 53% w/w, or about 54% w/w.
  • the polymer(s) is present in the solid dispersion in an amount of about 48% w/w, about 48.5% w/w, about 49% w/w, about 49.5% w/w, about 50% w/w, about 50.5% w/w, about 51% w/w, about 51.5% w/w, about 52% w/w, or about 52.5% w/w.
  • the polymer(s) is present in the solid dispersion in an amount of from about 30% w/w to about 70% w/w. In some embodiments, the polymer(s) is present in the solid dispersion in an amount of from about 35% w/w to about 65% w/w. In some embodiments, the polymer(s) is present in the solid dispersion in an amount of from about 40% w/w to about 60% w/w. In some embodiments, the polymer(s) is present in the solid dispersion in an amount of from about 45% w/w to about 55% w/w. In some embodiments, the polymer(s) is present in the solid dispersion in an amount of about 50% w/w.
  • COMPOUND 2 is present in the solid dispersion in an amount of from about 10% w/w and 90% w/w (e.g., between about 20% w/w and about 80% w/w; between about 30% w/w and about 70% w/w; between about 40% w/w and about 60% w/w; or between about 15% w/w and about 35% w/w).
  • COMPOUND 2 is present in the solid dispersion in an amount of from about 10% w/w to about 80% w/w, for example from about 30% w/w to about 75% w/w, or from about 40% w/w to about 65% w/w, or from about 45% w/w to about 55% w/w, for example, about 46% w/w, about 47% w/w, about 48% w/w, about 49% w/w, about 50% w/w, about 51% w/w, about 52% w/w, about 53% w/w, or about 54% w/w.
  • COMPOUND 2 is present in the solid dispersion in an amount of about 48% w/w, about 48.5% w/w, about 49% w/w, about 49.5% w/w, about 50% w/w, about 50.5% w/w, about 51% w/w, about 51.5% w/w, about 52% w/w, or about 52.5% w/w.
  • COMPOUND 2 is present in the solid dispersion in an amount of from about 30% w/w to about 70% w/w. In some embodiments, COMPOUND 2, is present in the solid dispersion in an amount of from about 35% w/w to about 65% w/w. In some embodiments, COMPOUND 2, is present in the solid dispersion in an amount of from about 40% w/w to about 60% w/w. In some embodiments, COMPOUND 2, is present in the solid dispersion in an amount of from about 45% w/w to about 55% w/w. In some embodiments, COMPOUND 2, is present in the solid dispersion in an amount of about 50% w/w.
  • the solid dispersion includes about 20% w/w to about 80% w/w COMPOUND 2, and about 20% w/w to about 80% of polymer(s). In another embodiment, the solid dispersion includes about 25% w/w to about 75% w/w COMPOUND 2, and about 25% w/w to about 75% of polymer(s). In another embodiment, the solid dispersion includes about 30% w/w to about 70% w/w COMPOUND 2, and about 30% w/w to about 70% of polymer(s). In another embodiment, the solid dispersion includes about 35% w/w to about 65% w/w COMPOUND 2, and about 35% w/w to about 65% of polymer(s).
  • the solid dispersion includes about 40% w/w to about 60% w/w COMPOUND 2, and about 40% w/w to about 60% of polymer(s). In another embodiment, the solid dispersion includes about 45% w/w to about 55% w/w COMPOUND 2, and about 45% w/w to about 55% of polymer(s). In another embodiment, the solid dispersion includes about 50% w/w COMPOUND 2, and about 50% w/w of polymer(s).
  • the solid dispersion includes about 45% w/w to about 55% w/w COMPOUND 2, and about 45% w/w to about 55% w/w HPMCAS (e.g., HPMCAS-MG or HPMCAS-HG, or other grades such as LF, MF, HF, or LG) or PVAP.
  • the solid dispersion includes about 50% w/w COMPOUND 2, and about 50% w/w of HPMCAS.
  • the solid dispersion also includes a surfactant or inert pharmaceutically acceptable substance.
  • surfactants in the solid dispersion include sodium lauryl sulfate (SLS), vitamin E or a derivative thereof (e.g., vitamin E TPGS), Docusate Sodium, sodium dodecyl sulfate, polysorbates (such as Tween 20 and Tween 80), poloxamers (such as Poloxamer 335 and Poloxamer 407), glyceryl monooleate, Span 65, Span 25, Capryol 90, pluronic copolymers (e.g., Pluronic F108, Pluronic P-123), and mixtures thereof.
  • the surfactant is SLS.
  • the surfactant is vitamin E or a derivative thereof (e.g., vitamin E TPGS).
  • the surfactant is present in the solid dispersion in an amount of from about 0.1% w/w to about 10% w/w, for example from about 0.5% w/w to about 2% w/w, or from about 1% w/w to about 3% w/w, from about 1% w/w to about 4% w/w, or from about 1% w/w to about 5% w/w.
  • the surfactant is present in the solid dispersion in an amount of about 0.1% w/w, about 0.2% w/w, about 0.3% w/w, about 0.4% w/w, about 0.5% w/w, about 0.6% w/w, about 0.7% w/w, about 0.8% w/w, about 0.9% w/w, or about 1% w/w.
  • the surfactant is present in the solid dispersion in an amount of about 0.5% w/w, about 1% w/w, about 1.5% w/w, about 2% w/w, about 2.5% w/w, about 3% w/w, about 3.5% w/w, about 4% w/w, about 4.5% w/w, or about 5% w/w.
  • the solid dispersion may be prepared according to a process described herein.
  • methods that could be used include those that involve rapid removal of solvent or solvent mixture from a mixture or cooling a molten sample. Such methods include, but are not limited to, rotational evaporation, freeze-drying (i.e., lyophilization), vacuum drying, melt congealing, and melt extrusion.
  • One embodiment of this disclosure involves solid dispersion obtained by spray-drying. In one embodiment, the product obtained by spray drying is dried to remove the solvent or solvent mixture.
  • Preparations disclosed herein can be obtained by spray-drying a mixture comprising COMPOUND 2, one or more polymer(s), and an appropriate solvent or solvent mixture.
  • Spray drying involves atomization of a liquid mixture containing, e.g., a solid and a solvent or solvent mixture, and removal of the solvent or solvent mixture.
  • the solvent or solvent mixture can also contain a nonvolatile solvent, such as glacial acetic acid. Atomization may be done, for example, through a two-fluid or pressure or electrosonic nozzle or on a rotating disk.
  • Spray drying converts a liquid feed to a dried particulate form.
  • Spray drying generally involves the atomization of a liquid feed solution into a spray of droplets and contacting the droplets with hot air or gas in a drying chamber.
  • the sprays are generally produced by either rotary (wheel) or nozzle atomizers. Evaporation of moisture from the droplets and formation of dry particles proceed under controlled temperature and airflow conditions.
  • a secondary drying process such as fluidized bed drying or vacuum drying, may be used to reduce residual solvents (and other additives, such as glacial acetic acid) to pharmaceutically acceptable levels.
  • spray-drying involves contacting a highly dispersed liquid suspension or solution (e.g., atomized solution), and a sufficient volume of hot air or gas (e.g., nitrogen, e.g., pure nitrogen) to produce evaporation and drying of the liquid droplets.
  • the preparation to be spray dried can be any solution, coarse suspension, slurry, colloidal dispersion, or paste that may be atomized using the selected spray-drying apparatus.
  • the preparation is sprayed into a current of warm filtered air (or into gas, e.g., nitrogen) that evaporates the solvent and conveys the dried product to a collector (e.g., a cyclone).
  • a collector e.g., a cyclone
  • the spent air or gas is then exhausted with the solvent (or solvent mixture including any additives such as glacial acetic acid), (e.g., then filtered) or alternatively the spent air or gas is sent to a condenser to capture and potentially recycle the solvent or solvent mixture.
  • a gas e.g., nitrogen
  • the gas is then optionally recycled, heated again and returned to the unit in a closed loop system.
  • Commercially available types of apparatus may be used to conduct the spray-drying.
  • commercial spray dryers are manufactured by Buchi Ltd. and Niro (e.g., the PSD line of spray driers manufactured by Niro).
  • Spray-drying typically employs solids loads of material from about 1% to about 30% or up to about 50% (i.e., therapeutically active compound plus and excipients), preferably at least about 10%. In some embodiments, solids loads of less than 10% may result in poor yields and unacceptably long run-times. In general, the upper limit of solids loads is governed by the viscosity of (e.g., the ability to pump) the resulting solution and the solubility of the components in the solution. Generally, the viscosity of the solution can determine the size of the particle in the resulting powder product.
  • the spray-drying is conducted with an inlet temperature of from about 40° C. to about 200° C., for example, from about 70° C. to about 150° C., preferably from about 40° C. to about 60° C., about 50° C. to about 55° C., or about 80° C. to about 110° C., e.g., about 90° C.
  • the spray-drying is generally conducted with an outlet temperature of from about 20° C. to about 100° C., for example from about 25° C. to about 30° C. (e.g., about 26° C.), about 40° C. to about 50° C., about 50° C. to about 65° C., e.g., about 56° C. to about 58° C.
  • Removal of the solvent or solvent mixture may require a subsequent drying step, such as tray drying, fluid bed drying (e.g., from about room temperature to about 100° C.), vacuum drying, microwave drying, rotary drum drying or biconical vacuum drying (e.g., from about room temperature to about 200° C.).
  • a subsequent drying step such as tray drying, fluid bed drying (e.g., from about room temperature to about 100° C.), vacuum drying, microwave drying, rotary drum drying or biconical vacuum drying (e.g., from about room temperature to about 200° C.).
  • the spray-drying is fluidized spray drying (FSD).
  • the steps in FSD can include, for example: preparing a liquid feed solution (e.g., containing COMPOUND 2, and optionally a polymer(s) and/or surfactant(s), dissolved or suspended in solvent(s)); atomizing (e.g., with a pressure nozzle, a rotary atomizer or disk, two-fluid nozzle or other atomizing methods) the feed solution upon delivery into the drying chamber of a spray dryer, e.g., operating in FSD mode; drying the feed solution in the drying chamber with heated air or a heated gas (e.g., nitrogen) to obtain a product, wherein larger particles of product separate out, e.g., drop out, while fines are carried by a stream of air or gas up to the top of the drying chamber (e.g., by natural convection) and to a cyclone, and re-introducing (e.g., at the top of the drying chamber or axially
  • the feed solution can instead be spray congealed, e.g., the chamber is at room temperature (e.g., 21 ⁇ 4° C.) or is cooled, e.g., cooled gas (e.g., nitrogen) is used for the process.
  • cooled gas e.g., nitrogen
  • FSD can further include collecting the agglomerated product in a first fluidizing chamber; which can be followed by discharging the agglomerated product from the first fluidizing chamber to a second fluidizing chamber, wherein a post-drying process can occur.
  • the agglomerated product (e.g., that separates out in the drying chamber) can then be transferred from the second fluidizing chamber to a third fluidizing chamber, where the agglomerated product is cooled.
  • the agglomerated product (e.g., a solid dispersion of an amorphous compound) can then be further processed.
  • the product can be directly compressed.
  • the product can optionally be blended with a surfactant, excipient, or pharmaceutically acceptable carrier, e.g., prior to direct compression.
  • the product can optionally be further processed, e.g., milled, granulated, blended, and/or mixed with a melt granulate, surfactant, excipient, and/or pharmaceutically acceptable carrier.
  • FSD can be performed in a commercial spray dryer operating in fluidized spray dryer mode (FSD mode). FSD can be accomplished in either open cycle mode or closed cycle mode (e.g., the drying gas, e.g., nitrogen, is recycled). Examples of suitable spray dryers for use in FSD include dryers from Niro (e.g., the PSD line of spray driers manufactured by Niro: PHARMASDTM; Chemical or SD line dryers). FSD can essentially be performed in any spray dryer that is configured to allow for the re-introduction of fines into the drying chamber.
  • FSD mode fluidized spray dryer mode
  • FSD can be accomplished in either open cycle mode or closed cycle mode (e.g., the drying gas, e.g., nitrogen, is recycled).
  • suitable spray dryers for use in FSD include dryers from Niro (e.g., the PSD line of spray driers manufactured by Niro: PHARMASDTM; Chemical or SD line dryers).
  • FSD can essentially be performed in any spray dryer
  • Additional post drying e.g., in a vacuum or fluidized bed dryer or a double cone or biconical post-dryer or a tumble dryer, can be performed if needed/applicable to remove further solvents.
  • a post-drying step is performed.
  • a dispersion e.g., powder
  • desirable properties e.g., median particle size (d50) of 40-200 microns 9 e.g., 40-150 microns
  • powder bulk density e.g., 0.2 to 0.5 g/ml
  • improved powder flowability e.g., low cohesion forces, low interparticle internal friction
  • dry powder with low OVIs Organic Volatile Impurities
  • the inlet temperature is between about 50° C. and about 200° C., e.g., between about 60° C. and about 150° C., between about 70° C. and about 100° C., between about 60° C. and about 95° C., between about 65° C. and about 85° C., between about 70° C. and about 90° C., between about 85° C. and about 95° C., or between about 70° C. and about 85° C.
  • the outlet temperature is between about room temperature (e.g., USP room temperature (e.g., 21 ⁇ 4° C.)) and about 80° C., e.g., between about 25° C. and about 75° C., between about 30° C. and about 65° C., between about 35° C. and about 70° C., between about 40° C. and about 65° C., between about 45° C. and about 60° C., between about 35° C. and about 45° C., between about 35° C. and about 40° C., or between about 37° C. and about 40° C.
  • room temperature e.g., USP room temperature (e.g., 21 ⁇ 4° C.)
  • 80° C. e.g., between about 25° C. and about 75° C., between about 30° C. and about 65° C., between about 35° C. and about 70° C., between about 40° C. and about 65° C., between about 45° C. and about 60° C., between
  • the temperature set points of the fluidized beds is between about room temperature (e.g., USP room temperature (e.g., 21 ⁇ 4° C.)) and about 100° C., e.g., between about 30° C. and about 95° C., between about 40° C. and about 90° C., between about 50° C. and about 80° C., between about 60° C. and about 85° C., between about 65° C. and about 95° C., or between about 80° C. and about 95° C.
  • room temperature e.g., USP room temperature (e.g., 21 ⁇ 4° C.)
  • 100° C. e.g., between about 30° C. and about 95° C., between about 40° C. and about 90° C., between about 50° C. and about 80° C., between about 60° C. and about 85° C., between about 65° C. and about 95° C., or between about 80° C. and about 95° C.
  • FSD can be performed on a mixture containing COMPOUND 2.
  • FSD can be performed on a mixture containing COMPOUND 2, and one or more polymer(s), and optionally one or more surfactant(s), and optionally one or more additional excipients(s)) to obtain a solid dispersion of amorphous COMPOUND 2 thereof, e.g., that can be directly compressed into an oral dosage form (e.g., tablet).
  • the dispersion can be blended with one or more excipients prior to compression.
  • the process for preparing a solid dispersion of COMPOUND 2 comprises:
  • the one or more polymer(s) and one or more solvent(s) may be any of those disclosed herein.
  • the solvent is removed by spray drying.
  • the solid dispersion is tray dried using a convection tray dryer.
  • the solid dispersion is screened.
  • COMPOUND 2 is crystalline. In another embodiment, COMPOUND 2 is amorphous.
  • spray drying may be done and is often done in the presence of an inert gas such as nitrogen.
  • processes that involve spray drying may be done in the presence of a supercritical fluid involving carbon dioxide or a mixture including carbon dioxide.
  • the process for preparing a solid dispersion of COMPOUND 2 comprises:
  • Post-drying and/or polishing the wet spray dried dispersion to below ICH or given specifications for residual solvents can optionally be performed.
  • the solvent comprises one or more volatile solvent(s) to dissolve or suspend COMPOUND 2 and the polymer(s). In some embodiments, the one or more solvent(s) completely dissolves COMPOUND 2 and the polymer(s).
  • the one or more solvent(s) is a volatile solvent (e.g., methylene chloride, acetone, methanol, ethanol, chloroform, tetrahydrofuran (THF), or a mixture thereof).
  • suitable volatile solvents include those that dissolve or suspend the therapeutically active compound either alone or in combination with another co-solvent.
  • the solvent(s) completely dissolves the therapeutically active compound.
  • the solvent is acetone.
  • the solvent is methanol.
  • the solvent is a non-volatile solvent (e.g., organic acids such as glacial acetic acid, dimethyl sulfoxide (DMSO), dimethylformamide (DMF), or water).
  • a non-volatile solvent is a component in a solvent system.
  • the non-volatile solvent is present as a component in a solvent from about 1% to about 20% w/w (e.g., from about 3% w/w to about 15% w/w, from about 4% w/w to about 12% w/w, or from about 5% w/w to about 10% w/w).
  • the solvent is a mixture of solvents.
  • the solvent can include from about 0% to about 30% acetone and from about 70% to about 100% methanol, or the solvent can include from about 0% to about 40% acetone and from about 60% to about 100% methanol.
  • Other exemplary ratios of methanol to acetone include 80:20, 75:25, 70:30, 60:40, 55:45, and 50:50.
  • the solvent is a combination of solvents including at least one non-volatile solvent.
  • the solvent is a combination of components that includes both a volatile solvent and a non-volatile solvent.
  • the solvent system is a combination of a volatile solvent or combination of solvents such as methanol and acetone with a non-volatile solvent such as glacial acetic acid.
  • the solvent system comprises from about 40% to about 80% methanol, from about 20% to about 35% acetone, and from about 1% to about 15% glacial acetic acid (e.g., from about 50% to about 70% methanol, from about 25% to about 30% acetone, and from about 3% to about 12% glacial acetic acid).
  • the solvent system is a combination of a volatile solvent or combination of solvents such as methanol and acetone with a non-volatile solvent such as water.
  • the solvent system comprises from about 40% to about 80% methanol, from about 20% to about 35% acetone, and from about 0.1% to about 15% water (e.g., from about 50% to about 70% methanol, from about 25% to about 30% acetone, and from about 1% to about 5% water).
  • the pharmaceutical compositions of the solid dispersion may be made by a process described herein.
  • compositions comprising: (a) a solid dispersion, comprising COMPOUND 2 and a polymer; and (b) one or more pharmaceutically acceptable carrier(s).
  • pharmaceutically acceptable carriers are fillers, disintegrants, wetting agents, glidants, and lubricants.
  • the pharmaceutical compositions may be orally administered in any orally acceptable dosage form including, but not limited to, capsules, tablets, emulsions and aqueous suspensions, dispersions and solutions.
  • the pharmaceutical composition is a tablet.
  • the pharmaceutical composition comprises a directly compressed dosage form of COMPOUND 2.
  • the pharmaceutical composition also includes a filler.
  • the filler can be, for example, microcrystalline cellulose, lactose, mannitol, ethyl cellulose, sorbitol, starch, sucrose, calcium phosphate, powdered cellulose, silicified microcrystalline cellulose, isomalt, or mixtures thereof.
  • the filler is microcrystalline cellulose.
  • the filler is present in the pharmaceutical composition in an amount of between about 10% w/w and 50% w/w (e.g., between about 15% w/w and about 45% w/w; between about 20% w/w and about 40% w/w; between about 25% w/w and about 35% w/w; or between about 28% w/w and about 32% w/w).
  • the filler is present in the pharmaceutical composition in an amount of from about 20% w/w to about 35% w/w, for example from about 25% w/w to about 34% w/w, or from about 26% w/w to about 33% w/w, or from about 27% w/w to about 32% w/w, for example, about 28% w/w, about 28.5% w/w, about 29% w/w, about 29.5% w/w about 30% w/w, about 30.5% w/w, about 31% w/w, or about 31.5% w/w.
  • the filler is present in the pharmaceutical composition in an amount of about 29% w/w, about 29.1% w/w, about 29.2% w/w, about 29.3% w/w, about 29.4% w/w, about 29.5% w/w, about 29.6% w/w, about 29.7% w/w, about 29.8% w/w, about 29.9% w/w, or about 30% w/w.
  • the filler is present in the pharmaceutical composition in an amount of between about 25% w/w and about 35% w/w.
  • the filler is present in the pharmaceutical composition in an amount of about 29.5% w/w.
  • the pharmaceutical composition also includes a disintegrant.
  • the disintegrant can be, for example, colloidal silicon dioxide, powdered cellulose, calcium silicate, crospovidone, calcium alginate, methyl cellulose, chitosan, carboxy methyl cellulose, croscarmellose sodium, carboxymethyl starch, sodium alginate, sodium starch glycolate, pregelatinized starch, or mixtures thereof.
  • the disintegrant is croscarmellose sodium.
  • the disintegrant is present in the pharmaceutical composition in an amount of between about 1% w/w and 15% w/w (e.g., between about 3% w/w and about 12% w/w; between about 4% w/w and about 10% w/w; between about 5% w/w and about 7% w/w; or between about 6% w/w and about 7% w/w).
  • the disintegrant is present in the pharmaceutical composition in an amount of about 3% w/w, about 3.5% w/w, about 4% w/w, about 49.5% w/w about 5% w/w, about 5.5% w/w, about 6% w/w, or about 6.5% w/w, about 7% w/w, about 7.5% w/w, about 8% w/w, about 8.5% w/w, about 9% w/w, about 9.5% w/w, or about 10% w/w.
  • the disintegrant is present in the pharmaceutical composition in an amount of between about 5% w/w and about 7% w/w. In some embodiments, the disintegrant is present in the pharmaceutical composition in an amount of about 6% w/w.
  • the pharmaceutical composition also includes a wetting agent.
  • the wetting agent can be, for example, sodium lauryl sulfate, sodium dodecyl sulfate, polysorbates (such as Tween 20 and Tween 80), poloxamers (such as Poloxamer 335 and Poloxamer 407), glyceryl monooleate, or mixtures thereof.
  • the wetting agent is sodium lauryl sulfate.
  • the wetting agent is present in the pharmaceutical composition in an amount of between about 0.1% w/w and 2% w/w (e.g., between about 0.5% w/w and about 2% w/w; between about 0.5% w/w and about 1.5% w/w; or between about 1% w/w and about 1.5% w/w).
  • the wetting agent is present in the pharmaceutical composition in an amount of about 0.1% w/w, about 0.2% w/w, about 0.3% w/w, about 0.4% w/w about 0.5% w/w, about 0.6% w/w, about 0.7% w/w, or about 0.8% w/w, about 0.9% w/w, about 1% w/w, about 1.1% w/w, about 1.2% w/w, about 1.3% w/w, about 1.4% w/w, about 1.5% w/w, about 1.6% w/w, about 1.7% w/w, about 1.8% w/w, about 1.9% w/w, or about 2% w/w.
  • the wetting agent is present in the pharmaceutical composition in an amount of between about 0.5% w/w and about 1.5% w/w. In some embodiments, the wetting agent is present in the pharmaceutical composition in an amount of about 1% w/w.
  • the pharmaceutical composition also includes a glidant.
  • the glidant can be, for example, silicon dioxide, colloidal silicon dioxide, tribasic calcium phosphate, magnesium stearate, magnesium trisilicate, powdered cellulose, talc, starch, and mixtures thereof.
  • the glidant is colloidal silicon dioxide.
  • the glidant is present in the pharmaceutical composition in an amount of between about 0.1% w/w and 5% w/w (e.g., between about 1% w/w and about 4% w/w; between about 1% w/w and about 3% w/w; or between about 1.5% w/w and about 2.5% w/w).
  • the glidant is present in the pharmaceutical composition in an amount of about 0.5% w/w, about 1% w/w, about 1.5% w/w, about 2% w/w about 2.5% w/w, about 3% w/w, about 3.5% w/w, or about 4% w/w, about 4.5% w/w, or about 5% w/w.
  • the glidant is present in the pharmaceutical composition in an amount of about 1.1% w/w, about 1.2% w/w, about 1.3% w/w, about 1.4% w/w, about 1.5% w/w, about 1.6% w/w, about 1.7% w/w, about 1.8% w/w, about 1.9% w/w, about 2% w/w, 2.1% w/w, about 2.2% w/w, about 2.3% w/w, about 2.4% w/w, about 2.5% w/w, about 2.6% w/w, about 2.7% w/w, about 2.8% w/w, about 2.9% w/w, or about 3% w/w.
  • the glidant is present in the pharmaceutical composition in an amount of between about 1% w/w and about 3% w/w. In some embodiments, the glidant is present in the pharmaceutical composition in an amount of about 2% w/w.
  • the pharmaceutical composition also includes a lubricant.
  • the lubricant can be, for example, magnesium stearate, talc, sodium stearyl fumarate, glyceryl behenate, hydrogenated vegetable oil, zinc stearate, calcium stearate, sucrose stearate, polyvinyl alcohol, magnesium lauryl sulfate, or mixtures thereof.
  • the lubricant is magnesium stearate.
  • the lubricant is present in the pharmaceutical composition in an amount of between about 0.1% w/w and 5% w/w (e.g., between about 1% w/w and about 4% w/w; between about 1% w/w and about 3% w/w; or between about 1% w/w and about 2% w/w).
  • the lubricant is present in the pharmaceutical composition in an amount of about 0.5% w/w, about 1% w/w, about 1.5% w/w, about 2% w/w about 2.5% w/w, about 3% w/w, about 3.5% w/w, or about 4% w/w, about 4.5% w/w, or about 5% w/w.
  • the lubricant is present in the pharmaceutical composition in an amount of about 0.1% w/w, about 0.2% w/w, about 0.3% w/w, about 0.4% w/w, about 0.5% w/w, about 0.6% w/w, about 0.7% w/w, about 0.8% w/w, about 0.9% w/w, about 1% w/w, about 1.1% w/w, about 1.2% w/w, about 1.3% w/w, about 1.4% w/w, about 1.5% w/w, about 1.6% w/w, about 1.7% w/w, about 1.8% w/w, about 1.9% w/w, about 2% w/w, 2.1% w/w, about 2.2% w/w, about 2.3% w/w, about 2.4% w/w, or about 2.5% w/w.
  • the lubricant is present in the pharmaceutical composition in an amount of between about 0.5% w/w and about 2.5% w/w. In some embodiments, the lubricant is present in the pharmaceutical composition in an amount of about 1.5% w/w.
  • the solid dispersion makes up about 25% to 85% by weight of the total weight of the pharmaceutical composition. In some embodiments, the solid dispersion makes up about 50% to about 70% by weight of the total weight of the pharmaceutical composition.
  • the COMPOUND 2 makes up about 15% to 45% of the total weight of the pharmaceutical composition, and the one or more polymer(s) makes up about 15% to 45% of the total weight of the pharmaceutical composition.
  • the COMPOUND 2 makes up about 20% w/w of the pharmaceutical composition
  • the one or more polymer(s) makes up about 40% w/w of the pharmaceutical composition.
  • the COMPOUND 2 makes up about 25% w/w of the pharmaceutical composition
  • the one or more polymer(s) makes up about 35% w/w of the pharmaceutical composition.
  • the COMPOUND 2 makes up about 30% w/w of the pharmaceutical composition
  • the one or more polymer(s) makes up about 30% w/w of the pharmaceutical composition.
  • the COMPOUND 2 makes up about 35% w/w of the pharmaceutical composition
  • the one or more polymer(s) makes up about 25% w/w of the pharmaceutical composition.
  • the solid dispersion makes up from between about 50% w/w to about 70% w/w of the pharmaceutical composition
  • the filler makes up from between about 25% w/w to about 35% w/w of the pharmaceutical composition
  • the disintegrant makes up from between about 5% w/w to about 7% w/w of the pharmaceutical composition
  • the wetting agent makes up from between about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition
  • the glidant makes up from between about 1% w/w to about 3% w/w of the pharmaceutical composition
  • the lubricant makes up from between about 0.5% w/w to about 2.5% w/w of the pharmaceutical composition thereby totaling 100% by weight of the composition.
  • the solid dispersion makes up about 60% w/w of the pharmaceutical composition
  • the filler makes up about 29.5% w/w of the pharmaceutical composition
  • the disintegrant makes up about 6% w/w of the pharmaceutical composition
  • the wetting agent makes up about 1% w/w of the pharmaceutical composition
  • the glidant makes up about 2% w/w of the pharmaceutical composition
  • the lubricant makes up about 1.5% w/w of the pharmaceutical composition.
  • the pharmaceutical composition comprises, from between about 25% w/w to about 35% w/w of COMPOUND 2 from between about 25% w/w to about 35% w/w of hypromellose acetate succinate (HPMCAS), from between about 25% w/w to about 35% w/w of microcrystalline cellulose, from between about 5% w/w to about 7% w/w croscarmellose sodium, from between about 0.5% w/w to about 1.5% w/w sodium lauryl sulfate, about from between about 1% w/w to about 3% w/w colloidal silicon dioxide, and rom between about 0.5% w/w to about 2.5% w/w of magnesium stearate, thereby totaling 100% by weight of the composition.
  • HPMCAS hypromellose acetate succinate
  • the pharmaceutical composition comprises, about 30% w/w of COMPOUND 2 about 30% w/w of hypromellose acetate succinate (HPMCAS), about 29.5% w/w of microcrystalline cellulose, about 6% w/w croscarmellose sodium, about 1% w/w sodium lauryl sulfate, about 2% w/w colloidal silicon dioxide, and about 1.5% w/w of magnesium stearate.
  • HPMCAS hypromellose acetate succinate
  • the solid dispersion, filler, disintegrant, wetting agent, glidant, and lubricant are added intragranularly. In some embodiments, an additional amount of the filler, disintegrant, glidant, and lubricant are added extragranularly.
  • the pharmaceutical composition comprises, the following intragranularly added components: the solid dispersion makes up from about 50% w/w to about 70% w/w of the pharmaceutical composition, the filler makes up from about 18% w/w to about 26% w/w of the pharmaceutical composition, disintegrant makes up from about 2% w/w to about 6% w/w of the pharmaceutical composition, wetting agent makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, glidant makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, and lubricant makes up from about 0.25% w/w to about 1% w/w of the pharmaceutical composition.
  • the solid dispersion makes up from about 50% w/w to about 70% w/w of the pharmaceutical composition
  • the filler makes up from about 18% w/w to about 26% w/w of the pharmaceutical composition
  • disintegrant makes up from about 2% w/w to about 6% w/w of the pharmaceutical
  • a the pharmaceutical composition comprises the following extragranularly added components: an additional amount of the filler makes up from about 4% w/w to about 12% w/w of the pharmaceutical composition, an additional amount of the disintegrant makes up from about 1% w/w to about 3% w/w of the pharmaceutical composition, an additional amount of the glidant makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, and an additional amount of the lubricant makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, and are added extragranularly.
  • the pharmaceutical composition comprises, the following intragranularly added components: the solid dispersion makes up about 60% w/w of the pharmaceutical composition, the filler makes up about 21.5% w/w of the pharmaceutical composition, disintegrant makes up about 4% w/w of the pharmaceutical composition, wetting agent makes up about 1% w/w of the pharmaceutical composition, glidant makes up about 1% w/w of the pharmaceutical composition, and lubricant makes up about 0.5% w/w of the pharmaceutical composition.
  • the solid dispersion makes up about 60% w/w of the pharmaceutical composition
  • the filler makes up about 21.5% w/w of the pharmaceutical composition
  • disintegrant makes up about 4% w/w of the pharmaceutical composition
  • wetting agent makes up about 1% w/w of the pharmaceutical composition
  • glidant makes up about 1% w/w of the pharmaceutical composition
  • lubricant makes up about 0.5% w/w of the pharmaceutical composition.
  • a the pharmaceutical composition comprises the following extragranularly added components: an additional amount of the filler makes up about 8% w/w of the pharmaceutical composition, an additional amount of the disintegrant makes up about 2% w/w of the pharmaceutical composition, an additional amount of the glidant makes up about 1% w/w of the pharmaceutical composition, and an additional amount of the lubricant makes up about 1% w/w of the pharmaceutical composition, and are added extragranularly.
  • the pharmaceutical composition comprises, the following intragranularly added components: the solid dispersion comprising COMPOUND 2 and hypromellose acetate succinate (HPMCAS), makes up from about 50% w/w to about 70% w/w of the pharmaceutical composition, microcrystalline cellulose makes up from about 18% w/w to about 26% w/w of the pharmaceutical composition, croscarmellose sodium makes up from about 2% w/w to about 6% w/w of the pharmaceutical composition, sodium lauryl sulfate makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, colloidal silicon dioxide makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, and magnesium stearate makes up from about 0.25% w/w to about 1% w/w of the pharmaceutical composition.
  • HPMCAS hypromellose acetate succinate
  • a the pharmaceutical composition comprises the following extragranularly added components: an additional amount of microcrystalline cellulose makes up from about 4% w/w to about 12% w/w of the pharmaceutical composition, an additional amount of croscarmellose sodium makes up from about 1% w/w to about 3% w/w of the pharmaceutical composition, an additional amount of colloidal silicon dioxide makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, and an additional amount of magnesium stearate makes up from about 0.5% w/w to about 1.5% w/w of the pharmaceutical composition, and are added extragranularly.
  • the pharmaceutical composition comprises, the following intragranularly added components: the solid dispersion comprising COMPOUND 2 and hypromellose acetate succinate (HPMCAS), makes up about 60% w/w of the pharmaceutical composition, microcrystalline cellulose makes up about 21.5% w/w of the pharmaceutical composition, croscarmellose sodium makes up about 4% w/w of the pharmaceutical composition, sodium lauryl sulfate makes up about 1% w/w of the pharmaceutical composition, colloidal silicon dioxide makes up about 1% w/w of the pharmaceutical composition, and magnesium stearate makes up about 0.5% w/w of the pharmaceutical composition.
  • HPMCAS hypromellose acetate succinate
  • a the pharmaceutical composition comprises the following extragranularly added components: an additional amount of microcrystalline cellulose makes up about 8% w/w of the pharmaceutical composition, an additional amount of croscarmellose sodium makes up about 2% w/w of the pharmaceutical composition, an additional amount of colloidal silicon dioxide makes up about 1% w/w of the pharmaceutical composition, and an additional amount of magnesium stearate makes up about 1% w/w of the pharmaceutical composition, and are added extragranularly.
  • NRAS oncogene is associated with responses in cancer characterized by the presence of a mutant allele of IDH2 when treated with COMPOUND 1 and in cancer characterized by the presence of a mutant allele of IDH1 when treated with COMPOUND 2. While not intending to be bound by any particular theory of operation, somatic mutations in NRAS oncogene may be associated with resistance to treatment with COMPOUND 1 in AML characterized by the presence of a mutant allele of IDH2, and resistance to treatment with COMPOUND 2 in AML characterized by the presence of a mutant allele of IDH1.
  • an RAS mutation such as an NRAS mutation or KRAS mutation at one or more sites selected from G12, G13 and Q61 may be associated with resistance to treatment with COMPOUND 2 in a cancer characterized by the presence of a mutant allele of IDH1.
  • an RAS mutation such as an NRAS mutation or KRAS mutation, co-occurring with 6 or more other mutations, may be associated with resistance to treatment with COMPOUND 2 in a cancer characterized by the presence of a mutant allele of IDH1.
  • an RAS mutation such as an NRAS mutation or KRAS mutation at one or more sites selected from G12, G13 and Q61 co-occurring with 6 or more other mutations, may be associated with resistance to treatment with COMPOUND 2 in a cancer characterized by the presence of a mutant allele of IDH1.
  • an RAS mutation such as an NRAS mutation or KRAS mutation at one or more sites selected from G12, G13 and Q61 may be associated with resistance to treatment with COMPOUND 2 in AML characterized by the presence of a mutant allele of IDH1.
  • an RAS mutation such as an NRAS mutation or KRAS mutation co-occurring with 6 or more other mutations, may be associated with resistance to treatment with COMPOUND 2 in AML characterized by the presence of a mutant allele of IDH1.
  • an RAS mutation such as an NRAS mutation or KRAS mutation at one or more sites selected from G12, G13 and Q61 co-occurring with 6 or more other mutations, may be associated with resistance to treatment with COMPOUND 2 in AML characterized by the presence of a mutant allele of IDH1.
  • the methods provided herein encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation by administering a therapeutically effective amount of an IDH2 inhibitor.
  • the IDH2 inhibitor is COMPOUND 1.
  • the methods provided herein encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the an IDH1 inhibitor is COMPOUND 2.
  • the cancer is relapsed or refractory.
  • the methods provided herein encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, for example at sites G12, G13 or Q61, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the cancer is relapsed or refractory.
  • the methods provided herein encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1, the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, and having 3 or less co-occurring mutations, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the cancer is relapsed or refractory.
  • the methods provided herein encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1, the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, at one or more sites selected from G12, G13 and Q61 and having 3 or less co-occurring mutations, by administering a therapeutically effective amount of an IDH2 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the cancer is relapsed or refractory.
  • provided herein is a method of treating, preventing, or managing solid tumors in a subject, wherein the solid tumor is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, by administering a therapeutically effective amount of COMPOUND 1.
  • the solid tumor is an advanced solid tumor.
  • provided herein is a method of treating, preventing, or managing solid tumors in a subject, wherein the solid tumor is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, by administering a therapeutically effective amount of COMPOUND 2.
  • the solid tumor is an advanced solid tumor.
  • the methods provided herein encompass treating, preventing, or managing a solid tumor in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, for example at sites G12, G13 or Q61, by administering a therapeutically effective amount of an IDH2 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the solid tumor is an advanced solid tumor.
  • the methods provided herein encompass treating, preventing, or managing a solid tumor in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1, the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, and having 3 or less co-occurring mutations, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the solid tumor is an advanced solid tumor.
  • the methods provided herein encompass treating, preventing, or managing a solid tumor in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1, the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, at one or more sites selected from G12, G13 and Q61 and having 3 or less co-occurring mutations, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the solid tumor is an advanced solid tumor.
  • hematological malignancy is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, by administering a therapeutically effective amount of COMPOUND 1.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • a method of treating, preventing, or managing hematological malignancies in a subject wherein the hematological malignancy is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, by administering a therapeutically effective amount of COMPOUND 2.
  • the hematologic malignancy is an advanced hematologic malignancy. In certain embodiments, the hematologic malignancy is relapsed or refractory.
  • the methods provided herein encompass treating, preventing, or managing hematological malignancies in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, for example at sites G12, G13 or Q61, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the hematologic malignancy is an advanced hematologic malignancy. In certain embodiments, the hematologic malignancy is relapsed or refractory.
  • the methods provided herein encompass treating, preventing, or managing hematological malignancies in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1, the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, and having 3 or less co-occurring mutations, by administering a therapeutically effective amount of an IDH1 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the hematologic malignancy is an advanced hematologic malignancy. In certain embodiments, the hematologic malignancy is relapsed or refractory
  • the methods provided herein encompass treating, preventing, or managing hematological malignancies in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1, the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, at one or more sites selected from G12, G13 and Q61 and having 3 or less co-occurring mutations, by administering a therapeutically effective amount of an IDH2 inhibitor.
  • the IDH1 inhibitor is COMPOUND 2.
  • the hematologic malignancy is an advanced hematologic malignancy. In certain embodiments, the hematologic malignancy is relapsed or refractory.
  • the methods encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS by administering a therapeutically effective amount of an IDH2 inhibitor, such as COMPOUND 1 in combination with a therapeutically effective amount of one or more compounds that target the RAS pathway.
  • the compound that targets the RAS pathway is a MEK kinase inhibitor compound.
  • the MEK kinase inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the methods encompass treating, preventing, or managing cancer in a subject, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, by administering a therapeutically effective amount of an IDH1 inhibitor, such as COMPOUND 2 in combination with a therapeutically effective amount of one or more compounds that target the RAS pathway.
  • the compound that targets the RAS pathway is a MEK kinase inhibitor compound.
  • the MEK kinase inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the methods encompass treating, preventing, or managing a solid tumor in a subject, wherein the solid tumor is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, by administering a therapeutically effective amount of an IDH2 inhibitor, such as COMPOUND 1 in combination with a therapeutically effective amount of one or more compounds that the target RAS pathway.
  • the compound that targets the RAS pathway is a MEK kinase inhibitor compound.
  • the MEK kinase inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the methods encompass treating, preventing, or managing a solid tumor in a subject, wherein the solid tumor is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, by administering a therapeutically effective amount of an IDH1 inhibitor, such as COMPOUND 2 in combination with a therapeutically effective amount of one or more compounds that target the RAS pathway.
  • the compound that targets the RAS pathway is a MEK kinase inhibitor compound.
  • the MEK kinase inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the solid tumor is an advanced solid tumor.
  • the methods encompass treating, preventing, or managing a hematologic malignancy in a subject, wherein the hematological malignancy is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, by administering a therapeutically effective amount of an IDH2 inhibitor, such as COMPOUND 1 in combination with a therapeutically effective amount of one or more compounds that target the RAS pathway.
  • the compound that targets the RAS pathway is a MEK kinase inhibitor compound.
  • the MEK kinase inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the methods encompass treating, preventing, or managing a hematologic malignancy in a subject, wherein the hematological malignancy is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS by administering a therapeutically effective amount of an IDH1 inhibitor, such as COMPOUND 2 in combination with a therapeutically effective amount of one or more compounds that target the RAS pathway.
  • the compound that targets the RAS pathway is a MEK kinase inhibitor compound.
  • the MEK kinase inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • methods provided herein comprise contacting a cancer cell in or from a subject, such as a patient, wherein the cancer cell is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, with a therapeutically effective amount of COMPOUND 1.
  • methods provided herein comprise contacting a cancer cell in or from a subject, such as a patient, wherein the cancer cell is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, with a therapeutically effective amount of COMPOUND 2.
  • the contacting can be in vitro, in vivo, or ex vivo.
  • the method comprises contacting the cancer cell in vivo.
  • a method of identifying a cancer subject suitable for treatment with an IDH1 inhibitor comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and an RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, identifying the subject as a cancer subject suitable for treatment with an IDH1 inhibitor.
  • the subjects identified as cancer subjects suitable for treatment with an IDH1 inhibitor are treated with an IDH1 inhibitor.
  • an IDH1 inhibitor for use in a method for treating cancer in a cancer subject, wherein the cancer subject has been identified by the method of identifying the cancer subject suitable for treatment with an IDH1 inhibitor, comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and an RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, identifying the subject as a cancer subject suitable for treatment with an IDH1 inhibitor.
  • a method of identifying a cancer subject suitable for treatment with an IDH2 inhibitor comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH2 mutation and an RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, identifying the subject as a cancer subject suitable for treatment with an IDH2 inhibitor.
  • the subjects identified as cancer subjects suitable for treatment with an IDH2 inhibitor are treated with an IDH2 inhibitor.
  • a method of identifying a cancer subject suitable for treatment with COMPOUND 1 comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH2 mutation and an RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, identifying the subject as a cancer subject suitable for treatment with COMPOUND 1.
  • the subjects identified as cancer subjects suitable for treatment with COMPOUND 1 are treated with COMPOUND 1.
  • a method of identifying a cancer subject suitable for treatment with COMPOUND 2 comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and an RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, identifying the subject as a cancer subject suitable for treatment with COMPOUND 2.
  • the subjects identified as cancer subjects suitable for treatment with COMPOUND 2 are treated with COMPOUND 2.
  • COMPOUND 2 for use in a method for treating cancer in a cancer subject, wherein the cancer subject has been identified by the method of identifying a cancer subject suitable for treatment with COMPOUND 2, comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and an RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, identifying the subject as a cancer subject suitable for treatment with COMPOUND 2.
  • the method comprises identifying one or more cancer subjects with a cancer characterized by the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation from the plurality of cancer subjects suitable for treatment with an IDH2 inhibitor.
  • one or more suitable subjects are treated with an IDH2 inhibitor.
  • the method comprises identifying one or more cancer subjects with a cancer characterized by the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation from the plurality of cancer subjects suitable for treatment with an IDH1 inhibitor.
  • one or more suitable subjects are treated with an IDH1 inhibitor.
  • the IDH1 inhibitor for use in a method for treating cancer in one or more cancer subjects with a cancer characterized by the presence of a mutant allele of IDH1, wherein the one or more cancer subjects are identified by the method comprising identifying one or more cancer subjects with a cancer characterized by the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, from the plurality of cancer subjects suitable for treatment with an IDH1 inhibitor.
  • an RAS mutation such as an NRAS mutation or KRAS mutation
  • the method comprises identifying one or more cancer subjects with a cancer characterized by the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, from the plurality of cancer subjects suitable for treatment with COMPOUND 1.
  • one or more suitable subjects are treated with COMPOUND 1.
  • the method comprises identifying one or more cancer subjects characterized by the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation, from the plurality of cancer subjects suitable for treatment with COMPOUND 2.
  • one or more suitable subjects are treated with COMPOUND 2.
  • COMPOUND 2 for use in a method for treating cancer in one or more cancer subjects with a cancer characterized by the presence of a mutant allele of IDH1, wherein the one or more cancer subjects are identified by the method comprising identifying one or more cancer subjects with a cancer characterized by the absence of a RAS mutation, such as an NRAS mutation or KRAS mutation, from the plurality of cancer subjects suitable for treatment with COMPOUND 2.
  • a RAS mutation such as an NRAS mutation or KRAS mutation
  • a method of identifying a cancer subject suitable for treatment with a combination of an IDH1 inhibitor and a RAS pathway inhibitor comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and a RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, identifying the subject as a cancer subject suitable for treatment with a combination therapy with an IDH1 inhibitor and a RAS pathway inhibitor.
  • the subjects identified as cancer subjects suitable for treatment with the combination therapy are treated with a combination of an IDH1 inhibitor and a RAS pathway inhibitor.
  • the RAS pathway inhibitor is a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a method of identifying a cancer subject suitable for treatment with a combination of an IDH2 inhibitor and a RAS pathway inhibitor comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH2 mutation and a RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, identifying the subject as a cancer subject suitable for treatment with a combination therapy with an IDH2 inhibitor and a RAS pathway inhibitor.
  • the subjects identified as cancer subjects suitable for treatment with the combination therapy are treated with a combination of an IDH2 inhibitor and a RAS pathway inhibitor.
  • the RAS pathway inhibitor is a MEK kinase inhibitor selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a method of identifying a cancer subject suitable for treatment with a combination of COMPOUND 1 and a RAS pathway inhibitor comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH2 mutation and a RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, identifying the subject as a cancer subject suitable for treatment with a combination therapy with COMPOUND 1 and a RAS pathway inhibitor.
  • the subjects identified as cancer subjects suitable for treatment with the combination therapy are treated with a combination of COMPOUND 1 and a RAS pathway inhibitor.
  • the RAS pathway inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • a method of identifying a cancer subject suitable for treatment with a combination of COMPOUND 2 and a RAS pathway inhibitor comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and a RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, identifying the subject as a cancer subject suitable for treatment with a combination therapy with COMPOUND 2 and a RAS pathway inhibitor.
  • the subjects identified as cancer subjects suitable for treatment with the combination therapy are treated with a combination of COMPOUND 2 and a RAS pathway inhibitor.
  • a combination of an IDH1 inhibitor and a RAS pathway inhibitor for use in a method for treating cancer in a cancer subject, wherein the cancer subject has been identified by the method of identifying a cancer subject suitable for treatment with a combination of an IDH1 inhibitor and a RAS pathway inhibitor, comprising: (a) obtaining a biological sample from a subject having cancer; (b) screening the biological sample for an IDH1 mutation and a RAS mutation, such as an NRAS mutation or KRAS mutation; and (c) if the cancer is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, identifying the subject as a cancer subject suitable for treatment with a combination therapy with an IDH1 inhibitor and a RAS pathway inhibitor.
  • the RAS pathway inhibitor is selected from trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 and PD035901.
  • an IDH2 inhibitor for example COMPOUND 1
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901
  • the method comprises identifying one or more cancer subjects, wherein the cancer is characterized by the presence of a mutant allele of IDH2 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, from the plurality of cancer subjects suitable for treatment with a combination therapy with an IDH2 inhibitor, for example COMPOUND 1, and RAS pathway inhibitor, for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • IDH2 inhibitor for example COMPOUND 1
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • one or more suitable subjects are treated with a combination of an IDH2 inhibitor, for example COMPOUND 1, and RAS pathway inhibitor, for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • an IDH2 inhibitor for example COMPOUND 1
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • an IDH1 inhibitor for example, COMPOUND 2
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901
  • the method comprises identifying one or more cancer subjects, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, from the plurality of cancer subjects suitable for treatment with a combination therapy with an IDH1 inhibitor, for example COMPOUND 2, and RAS pathway inhibitor, for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • IDH1 inhibitor for example COMPOUND 2
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • one or more suitable subjects are treated with a combination of an IDH1 inhibitor, for example COMPOUND 2, and RAS pathway inhibitor, for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • an IDH1 inhibitor for example COMPOUND 2
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • an IDH1 inhibitor for example COMPOUND 2
  • RAS pathway inhibitor for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901 for use in a method for treating cancer in one or more cancer subjects, wherein the one or more cancer subjects are identified by the method comprising identifying one or more cancer subjects, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and a mutant RAS, such as a mutant NRAS or a mutant KRAS, from the plurality of cancer subjects suitable for treatment with a combination therapy with an IDH1 inhibitor, for example COMPOUND 2, and RAS pathway inhibitor, for example, trametinib, selumetinib, binimetinib, PD-325901, cobimetinib, CI-1040 or PD035901.
  • one or more cancer subjects with a cancer characterized by the presence of a RAS mutation such as an NRAS mutation or KRAS mutation are not treated with an IDH1 inhibitor, for example COMPOUND 2.
  • one or more cancer subjects with a cancer characterized by the presence of a mutant RAS such as a mutant NRAS or a mutant KRAS are not treated with an IDH2 inhibitor, for example COMPOUND 1.
  • the inhibitory activity of COMPOUND 2 against IDH1 mutants can be tested by methods described in Example A of PCT Publication No. WO 2013/107291 and US Publication No. US 2013/0190249.
  • the inhibitory activity of COMPOUND 1 against IDH2 mutants can be tested by methods described in US Publication No. US2013/0190287, hereby incorporated by reference in their entireties, or analogous methods.
  • the hematologic malignancy is acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH2.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • CMML chronic myelomonocytic leukemia
  • myeloid sarcoma multiple myeloma
  • lymphoma e.g., T-cell lymphoma or B-cell lymphoma
  • AITL angioimmunoblastic T-cell lymphoma
  • the hematologic malignancy is acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), each characterized by the presence of a mutant allele of IDH1.
  • the hematologic malignancy is an advanced hematologic malignancy.
  • the hematologic malignancy is acute myelogenous leukemia (AML) characterized by the presence of a mutant allele of IDH1.
  • AML acute myelogenous leukemia
  • AML is relapse or refractory AML, characterized by the presence of a mutant allele of IDH1.
  • MDS myelodysplastic syndrome
  • the hematologic malignancy is chronic myelomonocytic leukemia (CMML) characterized by the presence of a mutant allele of IDH1.
  • CMML chronic myelomonocytic leukemia
  • the hematologic malignancy is myeloid sarcoma characterized by the presence of a mutant allele of IDH1.
  • the hematologic malignancy is lymphoma (e.g., T-cell lymphoma or B-cell lymphoma) characterized by the presence of a mutant allele of IDH1.
  • the hematologic malignancy is angioimmunoblastic T-cell lymphoma (AITL) characterized by the presence of a mutant allele of IDH1.
  • AITL angioimmunoblastic T-cell lymphoma
  • the hematologic malignancy is blastic plasmacytoid dendritic cell neoplasm characterized by the presence of a mutant allele of IDH1.
  • the solid tumor is glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH2.
  • the solid tumor is glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1.
  • cholangiocarcinoma including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC)
  • the solid tumor is glioma, characterized by the presence of a mutant allele of IDH1.
  • the solid tumor is melanoma characterized by the presence of a mutant allele of IDH1.
  • the solid tumor chondrosarcoma characterized by the presence of a mutant allele of IDH1.
  • the solid tumor is cholangiocarcinoma (e.g., glioma) characterized by the presence of a mutant allele of IDH1.
  • the solid tumor is angioimmunoblastic T-cell lymphoma (AITL) characterized by the presence of a mutant allele of IDH1.
  • AITL angioimmunoblastic T-cell lymphoma
  • the solid tumor is sarcoma characterized by the presence of a mutant allele of IDH1.
  • the solid tumor is non small cell lung cancer characterized by the presence of a mutant allele of IDH1.
  • the malignancy to be treated is characterized by a mutant allele of IDH1 or IDH2, wherein the IDH1 or IDH2 mutation results in a new ability of the enzyme to catalyze the NAPH dependent reduction of a ketoglutarate to R( ⁇ )-2-hydroxyglutarate in a patient.
  • the mutant IDH1 has an R132X mutation.
  • the R132X mutation is selected from R132H, R132C, R132L, R132V, R132S and R132G.
  • the R132X mutation is R132H or R132C.
  • the R132X mutation is R132H.
  • the mutant IDH2 has an R140X mutation.
  • the R140X mutation is a R140Q mutation. In another aspect of this embodiment, the R140X mutation is a R140W mutation. In another aspect of this embodiment, the R140X mutation is a R140L mutation. In another aspect of this embodiment, the mutant IDH2 has an R172X mutation. In another aspect of this embodiment, the R172X mutation is a R172K mutation. In another aspect of this embodiment, the R172X mutation is a R172G mutation.
  • a malignancy can be analyzed by sequencing cell samples to determine the presence and specific nature of (e.g., the changed amino acid present at) a mutation at amino acid 132 of IDH1. In one embodiment, a malignancy can be analyzed by sequencing cell samples to determine the presence and specific nature of (e.g., the changed amino acid present at) a mutation at amino acid 140 and/or 172 of IDH2.
  • mutant alleles of IDH1 wherein the IDH1 mutation results in a new ability of the enzyme to catalyze the NAPH-dependent reduction of ⁇ -ketoglutarate to R( ⁇ )-2-hydroxyglutarate, and in particular R132H mutations of IDH1, characterize a subset of all types of cancers, without regard to their cellular nature or location in the body.
  • COMPOUND 2 and methods desribed herein are useful to treat an hematologic malignancy, including an advanced hematologic malignancy, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), each characterized by the presence of a mutant allele of IDH1 imparting such activity and in particular an IDH1 R132H or R132C mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • MPN myeloproliferative neoplasms
  • CMML chronic myelomonocytic leukemia
  • B-ALL B-acute lymphoblastic leukemias
  • lymphoma e.g
  • the advanced hematologic malignancy to be treated is AML.
  • the AML is relapsed and/or refractory.
  • the AML is untreated.
  • the AML is relapsed and/or refractory in patients 60 years of age and older.
  • the AML is untreated in patients 60 years of age and older.
  • the AML is relapsed and/or refractory in patients under 60 years of age.
  • COMPOUND 2 is administered as a first line treatment for AML.
  • COMPOUND 2 is administered as a second line, third line, or fourth line treatment for AML.
  • COMPOUND 2 is administered after a first line treatment for AML. In one embodiment, COMPOUND 2 is administered after a second line, third line, or fourth line treatment for AML. In one embodiment, COMPOUND 2 is administered after a first relapse. In one embodiment, COMPOUND 2 is administered after primary induction failure. In one embodiment, COMPOUND 2 is administered after re-induction failure. In one embodiment, administration of COMPOUND 2 can occur prior to, during, or after transplant. In one embodiment, COMPOUND 2 is administered after a relapse that is post-transplant. In one embodiment, the AML presentation is subsequent to MPD. In one embodiment, the AML presentation is subsequent to MDS and CMML.
  • COMPOUND 2 and methods described herein are useful to treat a solid tumor, such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 imparting such activity and in particular an IDH1 R132H or R132C mutation.
  • a solid tumor such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 imparting such activity and in particular an IDH1 R132H or R132C mutation.
  • mutant alleles of IDH2 wherein the IDH2 mutation results in a new ability of the enzyme to catalyze the NAPH dependent reduction of a ketoglutarate to R( ⁇ ) 2 hydroxyglutarate, and in particular R140Q and/or R172K mutations of IDH2, characterize a subset of all types of cancers, without regard to their cellular nature or location in the body.
  • the compounds, compositions and methods provided herein are useful to treat any type of cancer that is characterized by the presence of a mutant allele of IDH2 imparting such activity and in particular an IDH2 R140Q and/or R172K mutation.
  • COMPOUND 1 and methods described herein are useful to treat an hematologic malignancy, including an advanced hematologic malignancy, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH2 imparting such activity and in particular an IDH2 R140Q and/or R172K mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • CMML chronic myelomonocytic leukemia
  • myeloid sarcoma multiple myeloma
  • COMPOUND 2 and methods described herein are useful to treat a solid tumor, such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH 2 imparting such activity and in particular IDH2 R140Q and/or R172K mutation.
  • a solid tumor such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH 2 imparting such activity and in particular IDH2 R140Q and/or R172K mutation.
  • the malignancy is a tumor wherein at least 30, 40, 50, 60, 70, 80 or 90% of the tumor cells carry an IDH1 mutation, and in particular an IDH1 R132H or R132C mutation, or an IDH2 mutation, and in particular an IDH2 R140Q, R140W, or R140L and/or R172K or R172G mutation, at the time of diagnosis or treatment.
  • the efficacy of treatment of malignancy is monitored by measuring the levels of 2HG in the subject. Typically levels of 2HG are measured prior to treatment, wherein an elevated level is indicated for the use of COMPOUND 1 or COMPOUND 2. Once the elevated levels are established, the level of 2HG is determined during the course of and/or following termination of treatment to establish efficacy. In certain embodiments, the level of 2HG is only determined during the course of and/or following termination of treatment. A reduction of 2HG levels during the course of treatment and following treatment is indicative of efficacy. Similarly, a determination that 2HG levels are not elevated during the course of or following treatment is also indicative of efficacy.
  • 2HG measurements are utilized together with other well-known determinations of efficacy of malignancy treatment, such as reduction in number and size of tumors and/or other cancer-associated lesions, improvement in the general health of the subject, and alterations in other biomarkers that are associated with malignancy treatment efficacy.
  • 2HG can be detected in a sample by the methods of PCT Publication No. WO 2011/050210 and US Publication No. US2012/0121515 hereby incorporated by reference in their entirety, or by analogous methods.
  • 2HG can be detected in a sample by LC/MS.
  • the sample is mixed 80:20 with methanol, and centrifuged at 3,000 rpm for 20 minutes at 4 degrees Celsius. The resulting supernatant can be collected and stored at ⁇ 80 degrees Celsius prior to LC-MS/MS to assess 2-hydroxyglutarate levels.
  • a variety of different liquid chromatography (LC) separation methods can be used.
  • Each method can be coupled by negative electrospray ionization (ESI, ⁇ 3.0 kV) to triple-quadrupole mass spectrometers operating in multiple reaction monitoring (MRM) mode, with MS parameters optimized on infused metabolite standard solutions.
  • ESI negative electrospray ionization
  • MRM multiple reaction monitoring
  • Metabolites can be separated by reversed phase chromatography using 10 mM tributyl-amine as an ion pairing agent in the aqueous mobile phase, according to a variant of a previously reported method (Luo et al. J Chromatogr A 1147, 153-64, 2007).
  • Another method is specific for 2-hydroxyglutarate, running a fast linear gradient from 50%-95% B (buffers as defined above) over 5 minutes.
  • a Synergi Hydro-RP, 100 mm ⁇ 2 mm, 2.1 ⁇ m particle size (Phenomonex) can be used as the column, as described above.
  • Metabolites can be quantified by comparison of peak areas with pure metabolite standards at known concentration. Metabolite flux studies from 13 C-glutamine can be performed as described, e.g., in Munger et al. Nat Biotechnol 26, 1179-86, 2008.
  • 2HG is directly evaluated.
  • a derivative of 2HG formed in process of performing the analytic method is evaluated.
  • a derivative can be a derivative formed in MS analysis.
  • Derivatives can include a salt adduct, e.g., a Na adduct, a hydration variant, or a hydration variant which is also a salt adduct, e.g., a Na adduct, e.g., as formed in MS analysis.
  • a metabolic derivative of 2HG is evaluated.
  • examples include species that build up or are elevated, or reduced, as a result of the presence of 2HG, such as glutarate or glutamate that will be correlated to 2HG, e.g., R-2HG.
  • Exemplary 2HG derivatives include dehydrated derivatives such as the compounds provided below or a salt adduct thereof:
  • 2HG is known to accumulate in the inherited metabolic disorder 2-hydroxyglutaric aciduria. This disease is caused by deficiency in the enzyme 2-hydroxyglutarate dehydrogenase, which converts 2HG to ⁇ -KG (Struys, E. A. et al. Am J Hum Genet 76, 358-60 (2005)).
  • 2-hydroxyglutarate dehydrogenase deficiencies accumulate 2HG in the brain as assessed by MRI and CSF analysis, develop leukoencephalopathy, and have an increased risk of developing brain tumors (Aghili, M., Zahedi, F. & Rafiee, J Neurooncol 91, 233-6 (2009); Kolker, S., Mayatepek, E. & Hoffmann, G. F.
  • 2HG may also be toxic to cells by competitively inhibiting glutamate and/or ⁇ KG utilizing enzymes.
  • These include transaminases which allow utilization of glutamate nitrogen for amino and nucleic acid biosynthesis, and ⁇ KG-dependent prolyl hydroxylases such as those which regulate Hifl-alpha levels.
  • Treatment methods described herein can additionally comprise various evaluation steps prior to and/or following treatment with COMPOUND 1 or COMPOUND 2.
  • the method prior to and/or after treatment with COMPOUND 1 or COMPOUND 2, alone or in combination with a RAS pathway inhibitor, the method further comprises the step of evaluating the growth, size, weight, invasiveness, stage and/or other phenotype of the malignancy.
  • the method comprises the step of evaluating for mutations, such as a RAS mutation, for example a NRAS mutation or a KRAS mutation.
  • This evaluation may be achieved by analysis of sample types including bone marrow, peripheral blood and mononuclear cells isolated from bone marrow or peripheral blood.
  • a nucleic acid for example DNA, is extracted from the sample, and analyzed by sequencing to determine if a RAS mutation, for example a NRAS mutation or a KRAS mutation, is present.
  • the method prior to and/or after treatment with COMPOUND 1, alone or in combination with a RAS pathway inhibitor, the method further comprises the step of evaluating the IDH2 genotype of the malignancy. This may be achieved by ordinary methods in the art, such as DNA sequencing, immuno analysis, and/or evaluation of the presence, distribution or level of 2HG. In one embodiment, prior to and/or after treatment with COMPOUND 2, alone or in combination with a RAS pathway inhibitor, the method further comprises the step of evaluating the IDH1 genotype of the malignancy. This may be achieved by ordinary methods in the art, such as DNA sequencing, immuno analysis, and/or evaluation of the presence, distribution or level of 2HG.
  • the method prior to and/or after treatment with COMPOUND 1 or COMPOUND 2, alone or in combination with a RAS pathway inhibitor, the method further comprises the step of determining the 2HG level in the subject.
  • This may be achieved by spectroscopic analysis, e.g., magnetic resonance-based analysis, e.g., MRI and/or MRS measurement, sample analysis of bodily fluid, such as serum or spinal cord fluid analysis, or by analysis of surgical material, e.g., by mass-spectroscopy.
  • COMPOUND 1 and a RAS pathway inhibitor are administered concurrently. In one embodiment, COMPOUND 1 and a RAS pathway inhibitor are administered sequentially. In one embodiment, COMPOUND 2 and a RAS pathway inhibitor are administered concurrently. In one embodiment, COMPOUND 2 and a RAS pathway inhibitor are administered sequentially.
  • COMPOUND 1 may be administered by oral, parenteral (e.g., intramuscular, intraperitoneal, intravenous, CIV, intracistemal injection or infusion, subcutaneous injection, or implant), inhalation, nasal, vaginal, rectal, sublingual, or topical (e.g., transdermal or local) routes of administration.
  • COMPOUND 1 may be formulated alone or together with one or more active agent(s), in suitable dosage unit with pharmaceutically acceptable excipients, carriers, adjuvants and vehicles, appropriate for each route of administration.
  • COMPOUND 2 may be administered by oral, parenteral (e.g., intramuscular, intraperitoneal, intravenous, CIV, intracistemal injection or infusion, subcutaneous injection, or implant), inhalation, nasal, vaginal, rectal, sublingual, or topical (e.g., transdermal or local) routes of administration.
  • COMPOUND 2 may be formulated alone or together with one or more active agent(s), in suitable dosage unit with pharmaceutically acceptable excipients, carriers, adjuvants and vehicles, appropriate for each route of administration.
  • the amount of COMPOUND 1 or COMPOUND 2 administered in the methods provided herein may range, e.g., between about 5 mg/day and about 2,000 mg/day. In one embodiment, the range is between about 10 mg/day and about 2,000 mg/day. In one embodiment, the range is between about 20 mg/day and about 2,000 mg/day. In one embodiment, the range is between about 50 mg/day and about 1,000 mg/day. In one embodiment, the range is between about 100 mg/day and about 1,000 mg/day. In one embodiment, the range is between about 100 mg/day and about 500 mg/day. In one embodiment, the range is between about 150 mg/day and about 500 mg/day. In one embodiment, the range is or between about 150 mg/day and about 250 mg/day.
  • particular dosages are, e.g., about 10 mg/day.
  • the dose is about 20 mg/day.
  • the dose is about 50 mg/day.
  • the dose is about 75 mg/day.
  • the dose is about 100 mg/day.
  • the dose is about 120 mg/day.
  • the dose is about 150 mg/day.
  • the dose is about 200 mg/day.
  • the dose is about 250 mg/day.
  • the dose is about 300 mg/day.
  • the dose is about 350 mg/day.
  • the dose is about 400 mg/day.
  • the dose is about 450 mg/day.
  • the dose is about 500 mg/day.
  • the dose is about 600 mg/day. In one embodiment, the dose is about 700 mg/day. In one embodiment, the dose is about 800 mg/day. In one embodiment, the dose is about 900 mg/day. In one embodiment, the dose is about 1,000 mg/day. In one embodiment, the dose is about 1,200 mg/day. In one embodiment, the dose is or about 1,500 mg/day. In certain embodiments, particular dosages are, e.g., up to about 10 mg/day. In one embodiment, the particular dose is up to about 20 mg/day. In one embodiment, the particular dose is up to about 50 mg/day. In one embodiment, the particular dose is up to about 75 mg/day. In one embodiment, the particular dose is up to about 100 mg/day.
  • the particular dose is up to about 120 mg/day. In one embodiment, the particular dose is up to about 150 mg/day. In one embodiment, the particular dose is up to about 200 mg/day. In one embodiment, the particular dose is up to about 250 mg/day. In one embodiment, the particular dose is up to about 300 mg/day. In one embodiment, the particular dose is up to about 350 mg/day. In one embodiment, the particular dose is up to about 400 mg/day. In one embodiment, the particular dose is up to about 450 mg/day. In one embodiment, the particular dose is up to about 500 mg/day. In one embodiment, the particular dose is up to about 600 mg/day. In one embodiment, the particular dose is up to about 700 mg/day.
  • the particular dose is up to about 800 mg/day. In one embodiment, the particular dose is up to about 900 mg/day. In one embodiment, the particular dose is up to about 1,000 mg/day. In one embodiment, the particular dose is up to about 1,200 mg/day. In one embodiment, the particular dose is up to about 1,500 mg/day.
  • the amount of COMPOUND 1 or COMPOUND 2 in the pharmaceutical composition or dosage form provided herein may range, e.g., between about 5 mg and about 2,000 mg. In one embodiment, the range is between about 10 mg and about 2,000 mg. In one embodiment, the range is between about 20 mg and about 2,000 mg. In one embodiment, the range is between about 50 mg and about 1,000 mg. In one embodiment, the range is between about 50 mg and about 500 mg. In one embodiment, the range is between about 50 mg and about 250 mg. In one embodiment, the range is between about 100 mg and about 500 mg. In one embodiment, the range is between about 150 mg and about 500 mg. In one embodiment, the range is between about 150 mg and about 250 mg.
  • particular amounts are, e.g., about 10 mg. In one embodiment, the particular amount is about 20 mg. In one embodiment, the particular amount is about 30 mg. In one embodiment, the particular amount is about 50 mg. In one embodiment, the particular amount is about 75 mg. In one embodiment, the particular amount is about 100 mg. In one embodiment, the particular amount is about 120 mg. In one embodiment, the particular amount is about 150 mg. In one embodiment, the particular amount is about 200 mg. In one embodiment, the particular amount is about 250 mg. In one embodiment, the particular amount is about 300 mg. In one embodiment, the particular amount is about 350 mg. In one embodiment, the particular amount is about 400 mg. In one embodiment, the particular amount is about 450 mg. In one embodiment, the particular amount is about 500 mg.
  • the particular amount is about 600 mg. In one embodiment, the particular amount is about 650 mg. In one embodiment, the particular amount is about 700 mg. In one embodiment, the particular amount is about 800 mg. In one embodiment, the particular amount is about 900 mg. In one embodiment, the particular amount is about 1,000 mg. In one embodiment, the particular amount is about 1,200 mg. In one embodiment, the particular amount is or about 1,500 mg. In certain embodiments, particular amounts are, e.g., up to about 10 mg. In one embodiment, the particular amount is up to about 20 mg. In one embodiment, the particular amount is up to about 50 mg. In one embodiment, the particular amount is up to about 75 mg. In one embodiment, the particular amount is up to about 100 mg. In one embodiment, the particular amount is up to about 120 mg.
  • the particular amount is up to about 150 mg. In one embodiment, the particular amount is up to about 200 mg. In one embodiment, the particular amount is up to about 250 mg. In one embodiment, the particular amount is up to about 300 mg. In one embodiment, the particular amount is up to about 350 mg. In one embodiment, the particular amount is up to about 400 mg. In one embodiment, the particular amount is up to about 450 mg. In one embodiment, the particular amount is up to about 500 mg. In one embodiment, the particular amount is up to about 600 mg. In one embodiment, the particular amount is up to about 700 mg. In one embodiment, the particular amount is up to about 800 mg. In one embodiment, the particular amount is up to about 900 mg. In one embodiment, the particular amount is up to about 1,000 mg. In one embodiment, the particular amount is up to about 1,200 mg. In one embodiment, the particular amount is up to about 1,500 mg.
  • COMPOUND 1 or COMPOUND 2 can be delivered as a single dose such as, e.g., a single bolus injection, or oral tablets or pills; or over time such as, e.g., continuous infusion over time or divided bolus doses over time.
  • compound 1 can be administered repetitively if necessary, for example, until the patient experiences stable disease or regression, or until the patient experiences disease progression or unacceptable toxicity. Stable disease or lack thereof is determined by methods known in the art such as evaluation of patient's symptoms, physical examination, visualization of the tumor that has been imaged using X-ray, CAT, PET, or MRI scan and other commonly accepted evaluation modalities.
  • COMPOUND 1 or COMPOUND 2 is administered to a patient in cycles (e.g., daily administration for one week, then a rest period with no administration for up to three weeks). Cycling therapy involves the administration of an active agent for a period of time, followed by a rest for a period of time, and repeating this sequential administration. Cycling therapy can reduce the development of resistance, avoid or reduce the side effects, and/or improves the efficacy of the treatment.
  • a method provided herein comprises administering COMPOUND 1 or COMPOUND 2 in 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, or greater than 40 cycles.
  • the median number of cycles administered in a group of patients is about 1. In one embodiment, the median number of cycles administered in a group of patients is about 2. In one embodiment, the median number of cycles administered in a group of patients is about 3. In one embodiment, the median number of cycles administered in a group of patients is about 4. In one embodiment, the median number of cycles administered in a group of patients is about 5. In one embodiment, the median number of cycles administered in a group of patients is about 6.
  • the median number of cycles administered in a group of patients is about 7. In one embodiment, the median number of cycles administered in a group of patients is about 8. In one embodiment, the median number of cycles administered in a group of patients is about 9. In one embodiment, the median number of cycles administered in a group of patients is about 10. In one embodiment, the median number of cycles administered in a group of patients is about 11. In one embodiment, the median number of cycles administered in a group of patients is about 12. In one embodiment, the median number of cycles administered in a group of patients is about 13. In one embodiment, the median number of cycles administered in a group of patients is about 14. In one embodiment, the median number of cycles administered in a group of patients is about 15. In one embodiment, the median number of cycles administered in a group of patients is about 16.
  • the median number of cycles administered in a group of patients is about 17. In one embodiment, the median number of cycles administered in a group of patients is about 18. In one embodiment, the median number of cycles administered in a group of patients is about 19. In one embodiment, the median number of cycles administered in a group of patients is about 20. In one embodiment, the median number of cycles administered in a group of patients is about 21. In one embodiment, the median number of cycles administered in a group of patients is about 22. In one embodiment, the median number of cycles administered in a group of patients is about 23. In one embodiment, the median number of cycles administered in a group of patients is about 24. In one embodiment, the median number of cycles administered in a group of patients is about 25.
  • the median number of cycles administered in a group of patients is about 26. In one embodiment, the median number of cycles administered in a group of patients is about 27. In one embodiment, the median number of cycles administered in a group of patients is about 28. In one embodiment, the median number of cycles administered in a group of patients is about 29. In one embodiment, the median number of cycles administered in a group of patients is about 30. In one embodiment, the median number of cycles administered in a group of patients is greater than about 30 cycles.
  • treatment cycles comprise multiple doses of COMPOUND 1 or COMPOUND 2 administered to a subject in need thereof over multiple days (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or greater than 14 days), optionally followed by treatment dosing holidays (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, or greater than 28 days).
  • days e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or greater than 14 days
  • treatment dosing holidays e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, or greater than 28 days.
  • the RAS pathway inhibitor such as a MEK kinase inhibitor
  • the RAS pathway inhibitor may be formulated, alone or together with COMPOUND 1 and/or one or more active agent(s), in suitable dosage unit with pharmaceutically acceptable excipients, carriers, adjuvants and vehicles, appropriate for each route of administration.
  • the RAS pathway inhibitor may be formulated, alone or together with COMPOUND 2 and/or one or more active agent(s), in suitable dosage unit with pharmaceutically acceptable excipients, carriers, adjuvants and vehicles, appropriate for each route of administration.
  • the RAS pathway inhibitor is administered by, e.g., intravenous (IV), subcutaneous (SC) or oral routes.
  • IV intravenous
  • SC subcutaneous
  • Certain embodiments herein provide co-administration of the RAS pathway inhibitor with COMPOUND 1 or COMPOUND 2 and/or one or more additional active agents to provide a synergistic therapeutic effect in subjects in need thereof.
  • the co-administered active agent(s) may be cancer therapeutic agents, as described herein.
  • the co-administered active agent(s) may be inhibitors of IDH1.
  • the co-administered active agent(s) may be inhibitors of IDH2.
  • the co-administered agent(s) may be dosed, e.g., orally or by injection (e.g., IV or SC).
  • treatment cycles comprise multiple doses of the RAS pathway inhibitor administered to a subject in need thereof over multiple days (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or greater than 14 days), optionally followed by treatment dosing holidays (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, or greater than 28 days).
  • Suitable dosage amounts for the methods provided herein include, e.g., therapeutically effective amounts and prophylactically effective amounts.
  • the RAS pathway inhibitor can be delivered as a single dose such as, e.g., a single bolus injection, or oral tablets or pills; or over time such as, e.g., continuous infusion over time or divided bolus doses over time.
  • the RAS pathway inhibitor can be administered repetitively if necessary, for example, until the patient experiences stable disease or regression, or until the patient experiences disease progression or unacceptable toxicity. Stable disease or lack thereof is determined by methods known in the art such as evaluation of patient's symptoms, physical examination, visualization of the tumor that has been imaged using X-ray, CAT, PET, or MRI scan and other commonly accepted evaluation modalities.
  • the RAS pathway inhibitor can be administered once daily or divided into multiple daily doses such as twice daily, three times daily, and four times daily.
  • the administration can be continuous (i.e., daily for consecutive days or every day), intermittent, e.g., in cycles (i.e., including days, weeks, or months of rest when no drug is administered).
  • the RAS pathway inhibitor is administered daily, for example, once or more than once each day for a period of time.
  • the RAS pathway inhibitor is administered intermittently, i.e., stopping and starting at either regular or irregular intervals.
  • the subject to be treated is an animal, for example a mammal or a non-human primate.
  • the subject is a human patient.
  • the subject can be male or female.
  • subjects amenable to treatment according to the methods provided herein include subjects with cancer, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and/or IDH2 and the absence of a RAS mutation, such as an NRAS mutation or KRAS mutation.
  • subjects amenable to treatment according to the methods provided herein include subjects with cancer, wherein the cancer is characterized by the presence of a mutant allele of IDH1 and/or IDH2 and further characterized by a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • a mutant allele of IDH1 and/or IDH2 and further characterized by a mutant RAS, such as a mutant NRAS or a mutant KRAS.
  • subjects amenable to treatment according to the methods provided herein include subjects with advanced hematologic malignancies, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS, myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), each characterized by the presence of a mutant allele of IDH1 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • MML myeloproliferative neoplasms
  • CMML chronic myelomonocytic leukemia
  • B-ALL B-acute lymphoblastic leukemias
  • lymphoma e.g., T-cell lymphoma
  • subjects amenable to treatment according to the methods provided herein include subjects with advanced hematologic malignancies, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • CMML chronic myelomonocytic leukemia
  • myeloid sarcoma multiple myeloma
  • lymphoma e.
  • subjects amenable to treatment according to the methods provided herein include subjects with a solid tumors, such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1, and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • a solid tumors such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1, and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • a solid tumors such as glioma,
  • subjects amenable to treatment according to the methods provided herein include subjects with a solid tumor, such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • a solid tumor such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH2 and the absence of an RAS mutation, such as an NRAS mutation or KRAS mutation.
  • subjects amenable to treatment according to the methods provided herein include subjects with advanced hematologic malignancies, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS, myeloproliferative neoplasms (MPN), chronic myelomonocytic leukemia (CMML), B-acute lymphoblastic leukemias (B-ALL), or lymphoma (e.g., T-cell lymphoma), each characterized by the presence of a mutant allele of IDH1 and further characterized by one or more RAS mutation(s), such as an NRAS mutation or KRAS mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • MML myeloproliferative neoplasms
  • CMML chronic myelomonocytic leukemia
  • B-ALL B-acute lymphoblastic leukemias
  • lymphoma e.g., T-
  • subjects amenable to treatment according to the methods provided herein include subjects with advanced hematologic malignancies, such as acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), chronic myelomonocytic leukemia (CMML), myeloid sarcoma, multiple myeloma, lymphoma (e.g., T-cell lymphoma or B-cell lymphoma), angioimmunoblastic T-cell lymphoma (AITL) or blastic plasmacytoid dendritic cell neoplasm, each characterized by the presence of a mutant allele of IDH2 and further characterized by one or more RAS mutation(s), such as an NRAS mutation or KRAS mutation.
  • AML acute myelogenous leukemia
  • MDS myelodysplastic syndrome
  • CMML chronic myelomonocytic leukemia
  • myeloid sarcoma multiple myeloma
  • subjects amenable to treatment according to the methods provided herein include subjects with a solid tumors, such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 and further characterized by one or more RAS mutation(s), such as an NRAS mutation or KRAS mutation.
  • a solid tumors such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (including intrahepatic cholangiocarcinoma (IHCC), prostate cancer, colon cancer, or non-small cell lung cancer (NSCLC), each characterized by the presence of a mutant allele of IDH1 and further characterized by one or more RAS mutation(s), such as an NRAS mutation or KRAS mutation.
  • subjects amenable to treatment according to the methods provided herein include subjects with a solid tumor, such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH2 and further characterized by one or more RAS mutation(s), such as an NRAS mutation or KRAS mutation.
  • a solid tumor such as glioma, melanoma, chondrosarcoma, cholangiocarcinoma (e.g., glioma), angioimmunoblastic T-cell lymphoma (AITL), sarcoma, or non small cell lung cancer, each characterized by the presence of a mutant allele of IDH2 and further characterized by one or more RAS mutation(s), such as an NRAS
  • the subject is a human patient at least 18 years old. In some embodiments, the patient is 10, 15, 18, 21, 24, 35, 40, 45, 50, 55, 65, 70, 75, 80, or 85 years old or older.
  • the methods provided herein encompass the treatment of subjects who have not been previously treated for cancer.
  • the methods encompass treating subjects who have been previously treated but are non-responsive to standard therapies as well as those who are currently being treated for cancer.
  • the subjects may have been previously treated or are currently being treated with a standard treatment regimen for cancer known to the practitioner of skill in the art.
  • COMPOUND 1 administered continuously as a single agent dosed orally on Days 1 to 28 of a 28-day cycle in subjects with advanced hematologic malignancies.
  • MTD maximum tolerated dose
  • MAD maximum administered dose
  • R2D recommended Phase 2 dose
  • DLTs dose-limiting toxicities
  • COMPOUND 1 As treatment for subjects with relapsed or refractory AML with an IDH2 mutation.
  • the study includes a dose escalation phase to determine MTD/MAD and/or RP2D, an expansion phase (Part 1) to further evaluate the safety, tolerability, and clinical activity of COMPOUND 1, and a Phase 2 to assess the clinical efficacy of COMPOUND 1 at the RP2D and to further evaluate safety in subjects with refractory and relapsed AML carrying an IDH2 mutation.
  • the study includes a dose escalation phase to determine MTD/MAD and/or the RP2D and an expansion phase (Part 1 Expansion) to further evaluate the safety, tolerability and clinical activity of COMPOUND 1 in select populations.
  • Part 1 Expansion an expansion phase to further evaluate the safety, tolerability and clinical activity of COMPOUND 1 in select populations.
  • the Phase 2 portion (previously Part 2 Expansion) will further inform on the efficacy, safety, tolerability and clinical activity of COMPOUND 1 in subjects with refractory or relapsed AML with an IDH2 mutation.
  • Dose Escalation Phase The dose escalation phase will utilize a standard “3+3” design. During the dose escalation phase, consented eligible subjects with relapsed or refractory acute myelogenous leukemia (AML), untreated AML ⁇ 60 years of age who are not candidates for standard therapy, or myelodysplastic syndrome with refractory anemia with excess blasts will be enrolled into sequential cohorts of increasing doses of COMPOUND 1 not to exceed 650 mg QD dose. Each dose cohort will enroll a minimum of 3 subjects.
  • AML acute myelogenous leukemia
  • COMPOUND 1 not to exceed 650 mg QD dose
  • the first 3 subjects enrolled in each dosing cohort during the dose escalation portion of the study will receive a single dose of study drug on Day ⁇ 3 (i.e., 3 days prior to the start of daily dosing) and undergo safety and PK/PD assessments over 72 hours to evaluate drug concentrations and 2-HG and ⁇ -KG levels.
  • the next dose of study drug will be on Cycle 1 Day 1 (C1D1) at which time daily dosing will begin.
  • the initial dosing schedule was twice daily (approximately every 12 hours). Based on the emerging data, a once daily dosing schedule also has been implemented.
  • Alternative dosing schedules may continue to be explored in the dose escalation and expansion phases as agreed upon by the Clinical Study Team. If there are multiple subjects in the screening process at the time the third subject within a cohort begins treatment, up to 2 additional subjects may be enrolled with approval of the Medical Monitor. For these additional subjects, the Day ⁇ 3 through Day 1 PK/PD assessments are optional following discussion with the Medical Monitor.
  • the safety of dosing during the dose escalation phase will be evaluated by the Clinical Study Team, comprised of the Sponsor designee (Responsible Medical Officer), Study Medical Monitor, and Investigators.
  • the Clinical Study Team will review the emerging safety data from each cohort to determine if dose escalation will occur.
  • NCI CTCAE National Cancer Institute Common Terminology Criteria for Adverse Events
  • Prolonged myelosuppression defined as persistence of ⁇ Grade 3 neutropenia or thrombocytopenia (by NCI CTCAE, version 4.03, leukemia-specific criteria, i.e., marrow cellularity ⁇ 5% on Day 28 or later from the start of study drug without evidence of leukemia) at least 42 days after the initiation of Cycle 1 therapy.
  • the study will proceed with dose escalation to the next cohort following safety review by the Clinical Study Team. If 1 of 3 subjects experiences a DLT during the first cycle, 3 additional subjects will be enrolled in that cohort. If none of the additional 3 subjects experience a DLT, dose escalation may continue to the next cohort following safety review by the Clinical Study Team. If 2 or more subjects in a cohort experience DLTs during the first cycle, dose escalation will be halted and the next lower dose level will be declared the MTD.
  • the MTD cohort included only 3 subjects, an additional 3 subjects will be enrolled at that dose level to confirm that ⁇ 2 of 6 subjects experience a DLT at that dose.
  • a dose level intermediate between the non-tolerated dose level and the previously tolerated dose level may be explored and declared the MTD if ⁇ 2 out of 6 subjects experience a DLT at that dose.
  • Increases in the dose of COMPOUND 1 for each dose cohort will be guided by an accelerated titration design, where the dose will be doubled (100% increase) from one cohort to the next until COMPOUND 1-related NCI CTCAE Grade 2 or greater toxicity is observed in any subject within the cohort. Following evaluation by the Clinical Study Team, subsequent increases in dose will be 50% or less until the MTD is determined. The absolute percent increase in the dose will be determined by the Clinical Study Team predicated on the type and severity of any toxicity seen in the prior dose cohorts. The MTD is the highest dose that causes DLTs in ⁇ 2 of 6 subjects.
  • intra-subject dose escalation will be permitted with approval of the Medical Monitor.
  • Arm 1 Relapsed or refractory AML and age ⁇ 60 years, or any subject with AML regardless of age who has relapsed following a bone marrow transplant (BMT).
  • BMT bone marrow transplant
  • Arm 2 Relapsed or refractory AML and age ⁇ 60 years, excluding subjects with AML who have relapsed following a BMT.
  • Arm 4 IDH2-mutated advanced hematologic malignancies not eligible for Arms 1 to 3.
  • Phase 2 the pivotal part of the study, will further establish the efficacy and safety profile of COMPOUND 1 at the recommended phase 2 dose (RP2D) determined in the ongoing dose escalation phase in subjects with IDH2-mutated relapsed or refractory AML defined as follows:
  • Additional screening procedures include medical, surgical, and medication history, a buccal swab for germ-line mutation analysis, physical examination, vital signs, Eastern Cooperative Oncology Group (ECOG) performance status (PS), 12-lead electrocardiogram (ECG), evaluation of left ventricular ejection fraction (LVEF), clinical laboratory assessments (hematology, chemistry, coagulation, and serum pregnancy test), bone marrow biopsy and aspirate, blood and bone marrow samples for 2-HG and ⁇ -KG measurement, and blood for determination of UGT1A1 mutation status.
  • ECG Eastern Cooperative Oncology Group
  • ECG 12-lead electrocardiogram
  • LVEF left ventricular ejection fraction
  • subjects in the Part 1 Expansion will have urine samples for 2-HG and ⁇ -KG measurement and blood samples for cholesterol, and 4 ⁇ -OH-cholesterol levels collected during screening.
  • a full 72-hour PK/PD profile will be conducted: subjects will be required to remain at the study site for 10 hours on Day ⁇ 3 and return on Days ⁇ 2, ⁇ 1, and 1 for 24-, 48-, and 72-hour samples, respectively.
  • subjects will be required to remain at the study site for 10 hours on Day ⁇ 3 and return on Days ⁇ 2, ⁇ 1, and 1 for 24-, 48-, and 72-hour samples, respectively.
  • clinical observation and serial 12-lead ECGs and vital signs assessments will be conducted.
  • Daily treatment with COMPOUND 1 will begin on C1D1; for subjects in the dose escalation phase and Part 1 Expansion who did not undergo the Day ⁇ 3 PK/PD assessments, clinical observation and serial 12-lead ECGs and vital signs assessments will be conducted over 8 hours following their first dose of COMPOUND 1 on C1D1.
  • Subjects in the dose escalation phase and Part 1 Expansion also will undergo PK/PD assessments over a 10-hour period on C1D15, C2D1, and C4D1.
  • Predose blood samples (trough) will be obtained on C1D1 (for those subjects who did not undergo the Day ⁇ 3 PK/PD assessments), C1D8, C1D22, C2D15, C3D1, C3D15, C5D1, and Day 1 of all cycles thereafter for determination of COMPOUND 1, 2-HG, and ⁇ -KG concentrations.
  • These subjects will have urine collected for PK/PD evaluation at screening; prior to dosing on C1D15, C2D1 and Day 1 of all cycles thereafter; and at the End of Treatment visit.
  • Available bone marrow biopsy samples also will be assessed for 2-HG and ⁇ -KG levels.
  • Subjects in the Phase 2 portion of the trial are not required to undergo the Day ⁇ 3 assessments; these subjects will undergo an 8-hour PK/PD profile conducted on Day 1 of Cycles 1 and 2, and predose blood samples (trough) on C1D2 and C2D2 will be obtained in order to assess PK/PD in a 24-hour period. Additional blood samples for PK/PD assessments will be drawn pre-dose (within 30 minutes) on Day 1 of Cycle 3, and at the End of Treatment visit. Time-matched 12-lead ECGs will be conducted in triplicate on Day 1 of Cycles 1 and 2; a triplicate ECG is also to be obtained at the End of Treatment visit. Single 12-lead ECGs will be conducted on Day 1 of every cycle beginning with Cycle 3, and at the Follow-up visit. Available bone marrow biopsy samples will be assessed for 2-HG and ⁇ -KG levels.
  • Subjects in the dose escalation phase and Part 1 Expansion will have the extent of their disease assessed, including bone marrow biopsies and/or aspirates and peripheral blood, at screening, on C1D15, C2D1, and C3D1, every 28 days (peripheral blood only) or every 56 days (bone marrow biopsies and/or aspirates and peripheral blood) thereafter while on study drug treatment, independent of dose delays and/or dose interruptions, and/or at any time when progression of disease is suspected.
  • Response to treatment and treatment decisions in all subjects will be determined by the Investigators based on modified International Working Group (IWG) response criteria or other appropriate response criteria for the malignancy under study.
  • IWG International Working Group
  • extent of disease including bone marrow biopsies and/or aspirates and peripheral blood
  • C2D1 For subjects enrolled in the Phase 2 portion of the trial, extent of disease, including bone marrow biopsies and/or aspirates and peripheral blood, will be assessed at screening, on C2D1, every 28 days thereafter through 12 months, and every 56 days thereafter while on study drug treatment, independent of dose delays and/or dose interruptions, and/or at any time when progression of disease is suspected. Eligibility, treatment decisions, and response to treatment will be determined by the Investigators based on modified International Working Group (IWG) response criteria. Response will be also be assessed retrospectively by an Independent Response Adjudication Committee (IRAC).
  • IRAC Independent Response Adjudication Committee
  • Subjects may continue treatment with COMPOUND 1 until disease progression or development of unacceptable toxicity.
  • COMPOUND 1 may produce antitumor effects by reversing the differentiation block induced by the IDH2 mutations and promoting appropriate cellular differentiation.
  • COMPOUND 1 Because of the unique mechanism of action of COMPOUND 1, clinical responses are different than those observed with cytotoxic agents. Responses with COMPOUND 1 may be occur after 2 or more cycles of therapy and they may occur after an initiation period of leukocytosis in the peripheral blood and/or bone marrow with, in rare cases, corresponding clinical signs and symptoms of fever, fluid retention, hypoxia, and skin rash which have been termed a differentiation-like syndrome.
  • PD progression of disease
  • Subjects with stable or progressive disease may continue to receive study treatment with COMPOUND 1 at the discretion of the Investigator and with Medical Monitor approval.
  • All subjects are to undergo an end of treatment assessment (within approximately 5 days of the last dose of study drug); in addition, a follow-up safety assessment is to be scheduled 28 days after the last dose. Furthermore, all subjects will be followed monthly for disease status, overall survival, and initiation of non-study anti-neoplastic therapy, until death, withdrawal of consent, or the end of the study, whichever occurs first.
  • HSCT hematopoietic stem cell transplant
  • Subjects who relapse following HSCT may be eligible to restart treatment with COMPOUND 1 with Medical Monitor approval and at the discretion of the Investigator, if they have confirmed recurrent IDH2 mutant positive disease, no other cancer treatment (with the exception of anti-neoplastic therapies used in the course of HSCT such as conditioning regimen or induction-type regimen and anti-GVHD prophylaxis [i.e., methotrexate]) besides HSCT was administered since the last dose of COMPOUND 1, the subject meets the safety parameters listed in the Inclusion/Exclusion criteria, and the trial is open. Subjects will resume COMPOUND 1 therapy at the same dose and schedule at the time of COMPOUND 1 treatment discontinuation prior to HSCT.
  • anti-neoplastic therapies used in the course of HSCT such as conditioning regimen or induction-type regimen and anti-GVHD prophylaxis [i.e., methotrexate]
  • the Phase 2 portion of the trial will enroll approximately 125 subjects with relapsed or refractory AML with an IDH2 mutation. Additional subjects may be needed for the replacement of subjects who are not evaluable for PK/PD, safety, and/or clinical activity, or for evaluation of alternative dosing regimens. The final total sample size may be adjusted according to the observed toxicity rate, and number of subjects enrolled for expanded evaluation.
  • COMPOUND 1 (mesylate salt of 2-methyl-1-[(4-[6-(trifluoromethyl)pyridin-2-yl]-6- ⁇ [2-(trifluoromethyl)pyridin-4-yl]amino ⁇ -1,3,5-triazin-2-yl)amino]propan-2-ol) will be provided as 5, 10, 25, 50, 100, 150 and 200 mg free-base equivalent strength tablets to be administered orally.
  • the first 3 subjects in each cohort in the dose escalation portion of the study and the first 15 subjects in each arm of Part 1 Expansion will receive a single dose of study drug on Day ⁇ 3; their next dose of study drug will be administered on C1D1 at which time subjects will start daily dosing on Days 1 to 28 in 28-day cycles. Starting with C1D1, dosing is continuous; there are no inter-cycle rest periods. Subjects who are not required to undergo the Day ⁇ 3 PK/PD assessments will initiate daily dosing with COMPOUND 1 on C1D1.
  • Subjects are required to fast (water is allowed) for 2 hours prior to study drug administration and for 1 hour following study drug administration.
  • the dose of COMPOUND 1 administered to a subject will be dependent upon which dose cohort is open for enrollment when the subject qualifies for the study.
  • the starting dose of COMPOUND 1 to be administered to the first cohort of subjects is 30 mg administered orally twice a day, and the maximum administered dose of COMPOUND 1 to be administered is 650 mg administered orally once a day.
  • the starting dose of COMPOUND 1 recommended for evaluation is 100 mg QD. This is based on the safety, PK, pharmacodynamics and clinical activity of COMPOUND 1 observed to date in AG221-C-001. Evaluation of pharmacodynamic response demonstrated sustained reduction in 2-HG plasma levels by Day 1 of Cycle 2 and up to 98% inhibition in most subjects with R140Q mutation at all doses. Increasing dose is associated with higher exposure and inhibition of 2-HG in subjects with R172K mutation. Importantly, preliminary efficacy data of the 44 subjects treated at 100 mg QD has shown an overall response rate of 36.4%. Thus a dose of 100 mg should adequately achieve inhibition of 2-HG in subjects with either R140Q or R172K mutation. Moreover, the safety profile at 100 mg, including ⁇ Grade 3, is consistent with that of lower doses.
  • Intra-subject dose escalation is possible.
  • Example 1 A subset of the clinical samples from the trial described in Example 1 were analyzed at screening. Sample types included bone marrow, peripheral blood and mononuclear cells isolated from bone marrow or peripheral blood. DNAs were extracted from these samples and sequenced at Foundation Medicine (Heme Panel, see http://foundationone.com/learn.php) using next generation sequencing technique.
  • Subjects may continue treatment with COMPOUND 1 until disease progression or development of unacceptable toxicity.
  • Subjects who experience disease progression per the applicable response criteria who are, in the opinion of the Investigator, benefiting from treatment may be allowed to continue on study drug with approval of the Medical Monitor.
  • AEs including determination of DLTs, serious adverse events (SAEs), and AEs leading to discontinuation; safety laboratory parameters; physical examination findings; vital signs; 12-lead ECGs; LVEF; and ECOG PS.
  • Overall response rate is defined as the rate of responders including complete remission (CR), CR with incomplete platelet recovery (CRp), marrow CR (mCR) (morphologic leukemia-free state [MLFS] for subjects with AML), CR with incomplete hematologic recovery (CRi), and partial remission (PR).
  • CR complete remission
  • CRp complete platelet recovery
  • mCR marrow CR
  • PR partial remission
  • Other measures of clinical activity including complete remission rate (CRR), duration of remission/response, event-free survival, overall survival, and time to remission/response will be summarized.
  • Part 1 For Phase 1 Dose Escalation/Part 1 Expansion, the efficacy analysis of response rates as assessed by the site Investigators using modified International Working Group (IWG) response criteria will be conducted in Full Analysis Set for each dose level, expansion arm, and overall if appropriate.
  • the analysis of Part 1 expansion arms may also include subjects from the dose-escalation phase who received the same dose/regimen as subjects in the expansion arms and who meet the eligibility criteria of individual arms.
  • COMPOUND 1 For Phase 2 portion of the trial, the primary efficacy analysis of COMPOUND 1 will be determined by the Investigators based on modified International Working Group (IWG) response criteria. Response will be also be assessed retrospectively by an Independent Response Adjudication Committee (IRAC) using the Full Analysis Set (FAS). Key supportive analyses will be based on independent central review of response in FAS.
  • IWG International Working Group
  • IRAC Independent Response Adjudication Committee
  • FAS Full Analysis Set
  • the patients with AML characterized by somatic mutations in NRAS are resistant to treatment of COMPOUND 1.
  • a combination therapy with COMPOUND 1 and one or more compounds that target RAS pathways is effective in treating AML in patients with AML characterized by somatic mutations in NRAS.
  • MEK compounds including Trametinib, Selumetinib, Binimetinib, PD-325901, Cobimetinib, CI-1040 or PD035901
  • MEK compounds including Trametinib, Selumetinib, Binimetinib, PD-325901, Cobimetinib, CI-1040 or PD035901
  • Example 1 A subset of the clinical samples from the trial described in Example 1 were analyzed at screening. Sample types included bone marrow, peripheral blood and mononuclear cells isolated from bone marrow or peripheral blood. DNAs were extracted from these samples and sequenced at Foundation Medicine (see http://foundationone.com/learn.php) using next generation sequencing technique.
  • FIG. 13 provides a visual of comutations, including NRAS mutations according to response categories.
  • FIG. 13 profiles bone marrow at screening visit for patients only where genes were mutated in ⁇ 2.
  • genes (y-axis) are shown in decreasing order of frequency, with the exception of IDH1, while patients (x-axis) are grouped by response then by similarity in alterations; only patients from dose escalation phase with an evaluable response included.
  • Mutation status positive (+) means any known mutation(s) in NRAS, and negative ( ⁇ ) means no mutation in NRAS was present.
  • Positive response stauts (+) includes CR, mCR and PR and negative response status ( ⁇ ) includes stable disease (SD) and pregressive disease (PD).
  • DLTs dose-limiting toxicities
  • This study is a Phase 1, multicenter, open-label, dose-escalation, safety, PK/PD, and clinical activity evaluation of orally administered COMPOUND 2 in subjects with advanced hematologic malignancies that harbor an IDH1 mutation.
  • the study includes a dose escalation phase to determine MTD and/or RP2D followed by expansion arms to further evaluate the safety, tolerability, and clinical activity of COMPOUND 2 in select populations.
  • the dose escalation phase will utilize a standard “3+3” design.
  • consented eligible subjects with relapsed or refractory AML, untreated AML ⁇ 60 years of age who are not candidates for standard therapy, or myelodysplastic syndrome (MDS) with refractory anemia with excess blasts will be enrolled into sequential cohorts of increasing doses of COMPOUND 2.
  • MDS myelodysplastic syndrome
  • Each dose cohort will plan to enroll a minimum of 3 subjects.
  • the first 3 subjects enrolled in each dosing cohort during the dose escalation phase of the study will initially receive a single dose of study drug on Day 3 (i.e., 3 days prior to the start of daily dosing) and undergo PK/PD assessments over 72 hours to evaluate drug concentrations and 2-HG levels.
  • the next dose of study drug will be on Cycle 1 Day 1 (C1D1) at which time daily dosing will begin.
  • the initial dosing regimen was twice daily (approximately every 12 hours). Based on the emerging data, a once daily (approximately every 24 hours) dosing schedule has been implemented.
  • Alternative dosing schedules including administration of the same total daily dose using different dosing schedules in concurrent cohorts, may be explored as agreed upon by the Clinical Study Team. If there are multiple subjects in the screening process at the time the third subject within a cohort begins treatment, up to 2 additional subjects may be enrolled with approval of the Medical Monitor. For these additional subjects, the Day 3 through Day 1 PK/PD assessments may be considered optional following discussion with the Medical Monitor.
  • the safety of dosing during the dose escalation phase will be evaluated by the Clinical Study Team, comprised of the Sponsor (Responsible Medical Officer), Study Medical Monitor, and Investigators.
  • the Clinical Study Team will review the emerging safety data from each cohort to determine if dose escalation will occur.
  • NCI CTCAE National Cancer Institute Common Terminology Criteria for Adverse Events
  • the study will proceed with dose escalation to the next cohort following safety review by the Clinical Study Team. If 1 of 3 subjects experiences a DLT during the first cycle, 3 additional subjects will be enrolled in that cohort. If none of the additional 3 subjects experience a DLT, dose escalation may continue to the next cohort following safety review by the Clinical Study Team. If 2 or more subjects in a cohort experience DLTs during the first cycle, dose escalation will be halted and the next lower dose level will be declared the MTD.
  • a dose level intermediate between the dose level exceeding MTD and the previous does level may be explored and declared MTD if ⁇ 2 out of 6 subjects experience a DLT at that dose. If the MTD cohort included only 3 subjects, an additional 3 subjects will be enrolled at that dose level to confirm that ⁇ 2 of 6 subjects experience a DLT at that dose.
  • Increases in the dose of AG-120 for each dose cohort will be guided by an accelerated titration design, where the daily dose may be doubled (100% increase) from one cohort to the next until AG-120-related CTCAE Grade 2 or greater toxicity is observed in any subject within the cohort. Following evaluation by the Clinical Study Team, subsequent increases in dose will be guided by the observed toxicity, and potentially PK and PK/PD data, until the MTD is determined. The absolute percent increase in the daily dose will be determined by the Clinical Study Team predicated on the type and severity of any toxicity seen in the prior dose cohorts (but will never exceed 100%). The MTD is the highest dose that causes DLTs in ⁇ 2 of 6 subjects.
  • dose escalation may continue for at least 2 dose levels above the projected maximum clinically effective exposure, as determined by an ongoing assessment of PK/PD and any observed clinical activity; this may occur in parallel with the expansion phase.
  • intra-subject dose escalation will be permitted with approval of the Medical Monitor.
  • the expansion phase will open to further explore the dose in subjects with specific hematologic malignancies.
  • 4 non-randomized arms of approximately 25 subjects per arm with IDH1-mutated hematologic malignancies will be enrolled as follows:
  • Arm 2 Untreated AML who are not candidates for standard therapy due to age, comorbid condition, performance status, and/or adverse risk factors, according to the Investigator and with approval of the Medical Monitor.
  • Arm 3 Other non-AML IDH1-mutated relapsed and/or refractory advanced hematologic malignancies, where no standard of care treatment option is available. Such as:
  • Arm 4 Relapsed AML patients not eligible for Arm 1 that have failed available standard of care or are unable to receive standard of care due to age, comorbid condition, performance status, and/or adverse risk factors, according to the Investigator and with approval of the Medical Monitor.
  • ORR objective response rate
  • CR complete remission
  • CRp CR with incomplete platelet recovery
  • MLFS morphologic leukemia-free state
  • CRi CR with incomplete hematologic recovery
  • PR partial remission
  • Additional screening procedures include medical, surgical, and medication history; a buccal swab for germ-line mutation analysis; complete physical examination; vital signs; Eastern Cooperative Oncology Group (ECOG) performance status (PS); 12-lead electrocardiogram (ECG); left ventricular ejection fraction (LVEF); clinical laboratory assessments (hematology, chemistry, coagulation, urinalysis, and serum pregnancy test); bone marrow biopsy and/or aspirate; and blood and bone marrow samples for 2-HG measurement and other exploratory assessments.
  • subjects in the dose escalation phase will have urine samples for 2 HG measurement and blood samples for determination of plasma cholesterol and 4 ⁇ -OH-cholesterol levels during screening.
  • Subjects in the dose escalation phase also will undergo PK/PD assessments over a 10-hour period on both C1D15 and C2D1. Additional pre-dose urine and/or blood sampling will be conducted on C1D8, C1D22, C2D15, C3D1, C3D15, and on Day 1 of all subsequent cycles for determination of COMPOUND 2 and 2-HG concentration. Available bone marrow biopsy samples also will be assessed for 2-HG levels.
  • Subjects in the expansion phase are not required to undergo the Day ⁇ 3 assessments; these subjects will undergo an 8-hour PK/PD profile conducted on Day 1 of Cycles 1 and 2. Additional blood samples for PK/PD assessments will be drawn pre-dose (within 30 minutes) on Days 8 and 15 of Cycle 1, Day 1 of Cycle 3, on Day 1 of all subsequent cycles, and at the End of Treatment visit. Time-matched 12-lead ECGs will be conducted in triplicate on Day 1 of Cycles 1 and 2; a triplicate ECG also will be conducted at the End of Treatment visit. Single 12-lead ECGs will be conducted at Screening, 4 hours post-dose on Days 8 and 15 of Cycle 1, on Day 1 of every cycle beginning with Cycle 3, and at the Follow-up visit. Available bone marrow biopsy samples will be assessed for 2-HG levels.
  • All subjects will have the extent of their disease assessed, including bone marrow biopsies and/or aspirates and peripheral blood, at screening, on Day 15 (dose escalation phase only), on Day 29, every 28 days thereafter through Month 12, and then every 56 days thereafter while on study drug treatment, independent of dose delays and/or dose interruptions, and/or at any time when progression of disease is suspected. Note that the Day 15 bone marrow evaluation during dose escalation should not be used to determine study treatment continuation status. Response to treatment and treatment decisions in all subjects will be determined by the Investigators based on modified International Working Group (IWG) response criteria or other appropriate response criteria for the malignancy under study. For subjects with relapsed or refractory AML enrolled in the expansion phase, response also will be assessed by an Independent Review Committee.
  • IWG International Working Group
  • Subjects may continue treatment with COMPOUND 2 until disease progression, development of other unacceptable toxicity, confirmed pregnancy, undergoing a hematopoietic stem cell transplant (HSCT), death, withdrawal of consent, lost to follow-up, or Sponsor ending the study, whichever occurs first.
  • Subjects who experience disease progression per the applicable response criteria who are, in the opinion of the Investigator, benefiting from treatment may be allowed to continue on study drug with approval of the Medical Monitor.
  • HSCT hematopoietic stem cell transplant
  • Subjects who achieve an adequate response to treatment with COMPOUND 2 and meet other criteria required to undergo HSCT may proceed to HSCT after discontinuation of COMPOUND 2 and will be followed on study for disease evaluation (approximately monthly, as standard of care) and any new bone marrow transplant (BMT) conditioning antineoplastic therapies received until disease relapse, death, withdrawal of consent, lost to follow-up, or end of study. If a subject discontinues COMPOUND 2 to undergo HSCT, but is then deemed ineligible for HSCT, the subject may restart COMPOUND 2 with Medical Monitor approval. Subjects who fail HSCT and have recurrent IDH1-mutant positive disease may be eligible to restart treatment with COMPOUND 2 with Medical Monitor approval.
  • BMT bone marrow transplant
  • All subjects including those who relapse following HSCT and elect not to restart treatment, will enter survival follow-up and will be contacted monthly for assessment of survival status and BMT conditioning antineoplastic therapies since discontinuation of study drug until death, withdrawal of consent, lost to follow-up, or end of study.
  • Additional subjects may be enrolled during dose escalation, for the replacement of subjects who are not evaluable for the assessment of dose escalation, for evaluation of alternative dosing regimens or for further exploring safety, PK, PK/PD, or preliminary clinical activity used to guide the selection of the RP2D.
  • Relapsed and/or primary refractory AML as defined by World Health Organization (WHO) criteria; or
  • Untreated AML ⁇ 60 years of age and are not candidates for standard therapy due to age, performance status, and/or adverse risk factors, according to the treating physician and with approval of the Medical Monitor;
  • Myelodysplastic syndrome with refractory anemia with excess blasts (subtype RAEB-1 or RAEB-2), or considered high-risk by the Revised International Prognostic Scoring System (IPSS-R) Greenberg et al. Blood. 2012; 120(12):2454-65 that is recurrent or refractory, or the subject is intolerant to established therapy known to provide clinical benefit for their condition (i.e., subjects must not be candidates for regimens known to provide clinical benefit), according to the treating physician and with approval of the Medical Monitor.
  • IPS-R Revised International Prognostic Scoring System
  • Arm 2 Untreated AML who are not candidates for standard therapy due to age, cormorbid condition, performance status, and/or adverse risk factors, according to the Investigator and with approval of the Medical Monitor.
  • Arm 3 Other non-AML IDH1-mutated relapsed and/or refractory advanced hematologic malignancies, where no standard of care treatment option is available. Such as:
  • Myelodysplastic syndrome that is recurrent or refractory after having failed hypomethylating agent(s) and with the approval of Medical Monitor.
  • non-AML IDH1-mutated relapsed and/or refractory advanced hematologic malignancy that have failed standard of care or no standard of care treatment option is available according to the Investigator and with the approval of the Medical Monitor.
  • Arm 4 Relapsed AML patients not eligible for Arm 1 that have failed available standard of care or are unable to receive standard of care due to age, comorbid condition, performance status, and/or adverse risk factors, according to the Investigator and with approval of the Medical Monitor.
  • IDH1 mutation may be based on local evaluation. (Centralized testing will be performed retrospectively.)
  • IDH1 gene-mutated disease For subjects in the expansion phase, central testing of IDH1 gene-mutated disease is required during screening to confirm eligibility.
  • Subjects must be amenable to serial bone marrow sampling, peripheral blood sampling, and urine sampling during the study.
  • AML or MDS will be made by bone marrow aspiration and/or biopsy. If an aspirate is unobtainable (i.e., a “dry tap”), the diagnosis may be made from the core biopsy.
  • Subject must be able to understand and willing to sign an informed consent.
  • a legally authorized representative may consent on behalf of a subject who is otherwise unable to provide informed consent, if acceptable to and approved by the site and/or site's Institutional Review Board (IRB).
  • IRS Institutional Review Board
  • Platelet count ⁇ 20,000/ ⁇ L (Transfusions to achieve this level are allowed.) Subjects with a baseline platelet count of ⁇ 20,000/ ⁇ L due to underlying malignancy are eligible with Medical Monitor approval.
  • AST Aspartate aminotransferase
  • ALT alanine aminotransferase
  • ALP alkaline phosphatase
  • Subjects must be recovered from any clinically relevant toxic effects of any prior surgery, radiotherapy, or other therapy intended for the treatment of cancer. (Subjects with residual Grade 1 toxicity, for example Grade 1 peripheral neuropathy or residual alopecia, are allowed with approval of the Medical Monitor.)
  • the first pregnancy test will be performed at screening (within 7 days prior to first study drug administration), and on the day of the first study drug administration and confirmed negative prior to dosing and Day 1 before dosing all subsequent cycles.
  • Subjects with reproductive potential must have a negative serum pregnancy test within 7 days prior to the start of therapy.
  • Subjects with reproductive potential are defined as sexually mature women who have not undergone a hysterectomy, bilateral oophorectomy or tubal occlusion or who have not been naturally postmenopausal (i.e., who have not menstruated at all) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).
  • Females of reproductive potential as well as fertile men and their partners who are female of reproductive potential must agree to abstain from sexual intercourse or to use two highly effective forms of contraception from the time of giving informed consent, during the study and for 90 days (females and males) following the last dose ofCOMPOUND 2.
  • a highly effective form of contraception is defined as hormonal oral contraceptives, injectables, patches, intrauterine devices, double-barrier method (e.g., synthetic condoms, diaphragm, or cervical cap with spermicidal foam, cream, or gel), or male partner sterilization.
  • double-barrier method e.g., synthetic condoms, diaphragm, or cervical cap with spermicidal foam, cream, or gel
  • male partner sterilization e.g., male partner sterilization.
  • HSCT hematopoietic stem cell transplant
  • GVHD graft-versus-host disease
  • the first dose of COMPOUND 2 should not occur before a period ⁇ 5 half-lives of the investigational agent has elapsed.
  • CYP 3A4 substrate medications Subjects taking sensitive cytochrome P450 (CYP) 3A4 substrate medications are excluded from the study unless they can be transferred to other medications within ⁇ 5 half-lives prior to dosing, or unless the medications can be properly monitored during the study.
  • CYP cytochrome P450
  • P-glycoprotein (P-gp) transporter-sensitive substrate medications are excluded from the study unless they can be transferred to other medications within ⁇ 5 half-lives prior to dosing, or unless the medications can be properly monitored during the study.
  • Subjects with an active severe infection that required anti-infective therapy or with an unexplained fever >38.5° C. during screening visits or on their first day of study drug administration (at the discretion of the Investigator, subjects with tumor fever may be enrolled).
  • NHA New York Heart Association
  • LVEF LVEF ⁇ 40% by echocardiogram (ECHO) or multi-gated acquisition (MUGA) scan obtained within approximately 28 days of C1D1.
  • ECHO echocardiogram
  • MUGA multi-gated acquisition
  • Subjects with bundle branch block and a prolonged QTc interval should be reviewed by the Medical Monitor for potential inclusion.
  • HIV human immunodeficiency virus
  • Subjects with any other medical or psychological condition deemed by the Investigator to be likely to interfere with a subject's ability to sign informed consent, cooperate, or participate in the study.
  • CNS central nervous system
  • Subjects with immediately life-threatening, severe complications of leukemia such as uncontrolled bleeding, pneumonia with hypoxia or shock, and/or disseminated intravascular coagulation.
  • COMPOUND 2 will be provided as 10, 50, 200, and 250 mg strength tablets to be administered orally.
  • the first 3 subjects in each dose escalation cohort in the dose escalation portion of the study will receive a single dose of study drug on Day ⁇ 3; their next dose of study drug will be administered on C1D1 at which time subjects will start dosing daily on Days 1 to 28 in 28-day cycles, with plans to explore alternative dosing regimens if warranted. Starting with C1D1, dosing is continuous; there are no inter-cycle rest periods. Subjects who are not required to undergo the Day ⁇ 3 PK/PD assessments will initiate daily dosing with COMPOUND 2 on C1D1.
  • the dose of COMPOUND 2 administered to a subject will be dependent upon which dose cohort is open for enrollment when the subject qualifies for the study.
  • the starting dose of AG-120 to be administered to the first cohort of subjects in the dose escalation phase is 100 mg administered orally twice a day (200 mg/day).
  • the starting dose and regimen for subjects in the expansion phase 500 mg QD was based on safety, PK, PK/PD, and clinical activity results from the dose-escalation phase of the study will be provided as 10, 50 and 200 mg strength tablets to be administered orally.
  • Subjects may continue treatment with COMPOUND 2 until disease progression, development of other unacceptable toxicity, confirmed pregnancy, undergoing HSCT, death, withdrawal of consent, lost to follow-up, or Sponsor ending the study, whichever occurs first.
  • Subjects who experience disease progression per the applicable response criteria who are, in the opinion of the Investigator, benefiting from treatment may be allowed to continue on study drug with approval of the Medical Monitor.
  • End of study is defined as the time at which all subjects have discontinued treatment with COMPOUND 2 and have been followed for survival for at least 12 months, or have died, been lost to follow up, or withdrew consent prior to 12 months of follow-up.
  • AEs including determination of DLTs, serious adverse events (SAEs), and AEs leading to discontinuation; safety laboratory parameters; physical examination findings; vital signs; 12-lead ECGs; LVEF; and ECOG PS.
  • Serial blood sampling for determination of concentration-time profiles of COMPOUND 2.
  • Blood and bone marrow sampling for determination of 2-HG levels.
  • Urine sampling for determination of urinary concentrations of COMPOUND 2 and 2-HG levels (dose escalation subjects only).
  • CRR complete remission rate
  • ORR objective response rate
  • the primary analysis of the clinical activity of COMPOUND 2 for the expansion phase will be based on Investigator review of response (CRR, ORR, and duration of remission/response) using the Full Analysis Set. Key supportive analyses will be based on the central independent review. Additional efficacy analyses may be conducted using the Efficacy Analysis Set.
  • FIG. 14 provides a visual of NRAS mutations according to response categories for COMPOUND 2.
  • FIG. 14 profiles bone marrow at screening visit for patients only where genes were mutated in ⁇ 2.
  • genes (y-axis) are shown in decreasing order of frequency, with the exception of IDH2, while patients (x-axis) are grouped by response then by similarity in alterations; only patients from dose escalation phase with an evaluable response included.
  • CRR complete remission rate
  • ORR objective response rate
  • the primary analysis of the clinical activity of COMPOUND 2 for the expansion phase will be based on Investigator review of response (CRR, ORR, and duration of remission/response) using the Full Analysis Set. Key supportive analyses will be based on the central independent review. Additional efficacy analyses may be conducted using the Efficacy Analysis Set.
  • FIG. 14 provides a visual of comutations, including NRAS mutations according to response categories for COMPOUND 2.
  • FIG. 14 profiles bone marrow at screening visit for patients only where genes were mutated in ⁇ 2.
  • genes (y-axis) are shown in decreasing order of frequency, with the exception of IDH2, while patients (x-axis) are grouped by response then by similarity in alterations; only patients from dose escalation phase with an evaluable response included.
  • the patients with AML characterized by somatic mutations in NRAS are resistant to treatment of COMPOUND 2.
  • a combination therapy with COMPOUND 2 and one or more compounds that target RAS pathways is effective in treating AML in patients with AML characterized by somatic mutations in NRAS.
  • MEK compounds including Trametinib, Selumetinib, Binimetinib, PD-325901, Cobimetinib, CI-1040 or PD035901
  • MEK compounds including Trametinib, Selumetinib, Binimetinib, PD-325901, Cobimetinib, CI-1040 or PD035901

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