Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/56—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule
  • A61K47/61—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule the organic macromolecular compound being a polysaccharide or a derivative thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08B—POLYSACCHARIDES; DERIVATIVES THEREOF
  • C08B37/00—Preparation of polysaccharides not provided for in groups C08B1/00 - C08B35/00; Derivatives thereof
  • C08B37/006—Heteroglycans, i.e. polysaccharides having more than one sugar residue in the main chain in either alternating or less regular sequence; Gellans; Succinoglycans; Arabinogalactans; Tragacanth or gum tragacanth or traganth from Astragalus; Gum Karaya from Sterculia urens; Gum Ghatti from Anogeissus latifolia; Derivatives thereof
  • C08B37/0063—Glycosaminoglycans or mucopolysaccharides, e.g. keratan sulfate; Derivatives thereof, e.g. fucoidan
  • C08B37/0072—Hyaluronic acid, i.e. HA or hyaluronan; Derivatives thereof, e.g. crosslinked hyaluronic acid (hylan) or hyaluronates
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
  • C08L5/00—Compositions of polysaccharides or of their derivatives not provided for in groups C08L1/00 or C08L3/00
  • C08L5/08—Chitin; Chondroitin sulfate; Hyaluronic acid; Derivatives thereof

Definitions

• the present invention describes a pharmaceutical composition essentially consisting of paclitaxel prodrug associated with pharmacologically acceptable diluents/excipients, for use in the treatment of non-muscle invasive bladder cancer (NMIBC) through intravesical instillations according to a therapeutic scheme that involves the administration of a single weekly dose of 600 mg of said prodrug, or two weekly doses equal to a total of 1200 mg, for 12 or 6 consecutive weeks of treatment.
• NMIBC non-muscle invasive bladder cancer
• the paclitaxel prodrug used was prepared according to a process of indirect synthesis between molecules of hyaluronic acid (HA) and paclitaxel by introducing a spacer (4-bromobutyric acid) between the hyaluronic acid and chemotherapeutic agent.
• bladder cancer Malignant tumours of the bladder are usually formed from its epithelial tissue and are therefore carcinomas. Only in very few cases does bladder cancer have a different origin and it therefore belongs to the categories of melanomas, lymphomas or sarcomas. Most bladder tumours are transitional (or urothelial) carcinomas as they derive from the transition epithelium. Squamous cell bladder carcinomas and adenocarcinomas are much rarer.
• MIBC muscle-invasive carcinoma
• NMIBC non-muscle-invasive bladder carcinoma
• hematuria blood in the urine
• macro-hematuria or macroscopic hematuria visible to the naked eye.
• the suspicion of carcinoma may also be seen in patients with non-specific symptoms affecting the lower urinary tract, associated with an increase in urinary stimulus and its frequency with dysuria (difficult emission of urine).
• These symptoms are more frequent in patients with CIS with respect to papillary tumours, in all cases they suggest the need for a urological evaluation.
• the absence of specific tumour markers and the variability with which hematuria occurs are among the main causes of underestimation of this tumour.
• the diagnostic confirmation is obtained with a histological examination using transurethral biopsy.
• Radical cystectomy is a surgical procedure that involves removing the bladder and possibly other pelvic organs.
• BCG is a poorly tolerated drug that can give different side-effects such as prostatitis, orchitis, arthritis and rarely also urethral obstructions.
• a patient who is not responsive to BCG is a patient who does not benefit from this therapy, he/she generally belongs to the group of patients who have previously been treated with BCG but who subsequently no longer respond to the same therapy, whereas patients defined as refractory are those for whom the toxic effects of the drug far outweigh the benefits.
• bladder cancer is one of the most expensive due to the high rates of recurrence which therefore require intensive surveillance strategies with periodic examinations (cystoscopy, blood and urine tests).
• NMIBC non-muscle-invasive tumours
• MIBC invasive tumours
• bladder cancer is the 5th cancer in the Western world by incidence and the 2nd among urinary tract tumours after carcinoma of the prostate.
• Paclitaxel (Taxol®) is an antitumor agent (Huizing M T et al., Cancer Inv., 1995, 13: 381-404) which exerts its antiproliferative action by acting on the microtubule organization of the cellular cytoskeletal system, preventing its normal reorganization during the mitotic division (Manfredi J J et al., J Cell Biol, 1982, 94: 688-696).
• paclitaxel The main therapeutic indications of paclitaxel are the treatment of advanced breast cancer, lung cancer, ovarian cancer resistant to standard chemotherapy treatment, bladder cancer, prostate cancer and endometrium. Due to its high lipophilicity, the administration of this chemotherapeutic agent generates numerous problems, but, due to its efficacy, it is certainly also a candidate for the local treatment of bladder cancer; the high concentrations of drug used for bladder instillations, however, cause paclitaxel to penetrate the urothelium resulting in a significant systemic, toxic absorption of this drug.
• solubilization solvent currently used in normal clinical protocols for the administration of paclitaxel is Cremophor EL which, however, causes multiple hypersensitivity phenomena.
• PEG poly-ethylene-glycol
• paclitaxel release system was developed by conjugating it with the serum albumin protein (HSA): the paclitaxel-HSA conjugate was found to be extremely water-soluble, capable of carrying up to 30 molecules of chemotherapeutic agent, but in vitro experiments revealed a lower antitumour efficacy compared to paclitaxel per se (Nuijen B et al., Investigational New Drugs, 2001, 19: 143-153).
• HSA serum albumin protein
• paclitaxel with hyaluronic acid (HA) derivatized with hydrazide molecules bound to the carboxyl group of HA by an amide bond was also recently synthesized (Luo Y et al., Biomacromolecules. 2000, 1 (2): 208-218).
• paclitaxel The bond between paclitaxel and HA allows the drug to reach the surface of the tumour cell membrane directly, said cell being characterized by an over-expression of the HA receptor, CD44.
• Paclitaxel conjugated with HA consequently proves to be capable of binding specifically to the CD44 of the tumour cell, allowing it to enter the cellular cytoplasm where it is activated thanks to the hydrolysis of the drug/HA bond.
• This selective drug transport mechanism is referred to as “targeting” to the target cell.
• HA is a hetero-polysaccharide composed of alternating residues of D-glucuronic acid and N-acetyl-D-glucosamine. It is a linear chain polymer with a molecular weight ranging from 50,000 to 13 ⁇ 10 6 Da, depending on the source from which it is obtained and the preparation methods used. It is present in nature in pericellular gels, in the fundamental substance of the connective tissue of vertebrate organisms (of which it represents one of the main components), in the synovial fluid of the joints, in the vitreous humor and in the umbilical cord.
• the present invention proposes to overcome the drawbacks of the prior art described above and relates to a pharmaceutical composition essentially consisting of paclitaxel prodrug associated with pharmacologically acceptable diluents/excipients, for use in the treatment of non-infiltrating bladder cancer by intravesical instillations according to a therapeutic scheme that involves the administration of a single weekly dose of 600 mg of said prodrug, or two weekly doses equal to a total of 1,200 mg, for 12 (in the case of 600 mg as a single dose) or for 6 (in the case of 1,200 mg as double dose) consecutive weeks of treatment.
• the paclitaxel prodrug used in the therapeutic scheme described above was prepared according to an indirect synthesis process between molecules of hyaluronic acid (HA) and paclitaxel, by introducing a spacer (4-bromobutyric acid) between the hyaluronic acid and chemotherapeutic agent.
• HA hyaluronic acid
• spacer 4-bromobutyric acid
• conjugation with HA makes paclitaxel soluble: its administration can therefore take place without the multiple phenomena of hypersensitization that normally occur during the use of the drug due to the presence of Cremophor EL, the solubilization solvent currently used in normal clinical protocols for the administration of paclitaxel, as a liposoluble drug.
• the present invention relates to a pharmaceutical composition consisting of a paclitaxel prodrug associated with pharmacologically acceptable diluents/excipients, for use in the treatment of non-muscle invasive bladder cancer (NMIBC) by intravesical instillation, in particular bladder carcinoma in situ (CIS) and preferably in the treatment of non-responsive or refractory CIS to treatment with the bacillus Calmette-Guérin (BCG), wherein said pharmaceutical composition is administered:
• NMIBC non-muscle invasive bladder cancer
• CIS bladder carcinoma in situ
• BCG bacillus Calmette-Guérin
• the pharmaceutical composition for use according to the present invention is preferably for use in the treatment of CIS non-responsive or refractory to treatment with BCG and the paclitaxel-HA prodrug consists in the chemical conjugate between paclitaxel and hyaluronic acid with a derivatization degree within the range 18-21% weight/weight.
• the pharmaceutical composition for use according to the present invention is preferably for use in the treatment of non-muscle invasive bladder carcinoma (NMIBC), particularly bladder carcinoma in situ (CIS) and preferably in the treatment of CIS non-responsive or refractory to treatment with BCG, and the paclitaxel-HA prodrug consists of the chemical conjugate between paclitaxel and hyaluronic acid with a derivatization degree equal to 20% weight/weight.
• NMIBC non-muscle invasive bladder carcinoma
• CIS bladder carcinoma in situ
• the paclitaxel-HA prodrug consists of the chemical conjugate between paclitaxel and hyaluronic acid with a derivatization degree equal to 20% weight/weight.
• the pharmaceutical composition for use according to the present invention is even more preferably for use in the treatment of bladder carcinoma in situ (CIS) non-responsive or refractory to treatment with BCG.
• CIS bladder carcinoma in situ
• the pharmaceutical composition for use according to the present invention is for use in the treatment of bladder carcinoma in situ (CIS) non-responsive or refractory to treatment with BCG, wherein said pharmaceutical composition is administered as a single weekly dose of 600 mg for 12 consecutive weeks of treatment and said prodrug consists of the chemical conjugate between paclitaxel and HA having a weight average molecular weight ranging from 160,000 to 230,000 Da, preferably with a derivatization degree equal to 20% weight/weight.
• CIS bladder carcinoma in situ
• the pharmaceutical composition for use according to the present invention is for use in the treatment of bladder carcinoma in situ (CIS) non-responsive or refractory to treatment with BCG, wherein said pharmaceutical composition is administered as a double weekly dose for a total of 1,200 mg of composition per week for 6 consecutive weeks of treatment and wherein said prodrug consists of the chemical conjugate between paclitaxel and HA having a weight average molecular weight ranging from 160,000 to 230,000 Da, preferably with a derivatization degree equal to 20% w/w.
• CIS bladder carcinoma in situ
• the paclitaxel prodrug is preferably formulated in sterile isotonic water containing 5% glucose.
• the present invention therefore relates to a pharmaceutical composition consisting of paclitaxel prodrug associated with pharmacologically acceptable diluents/excipients, for use in the treatment of bladder cancer by intravesical instillation, wherein said pharmaceutical composition is administered (i.e. is instilled in the bladder):
• the Applicant intends to define the weight percentage of paclitaxel vs the weight of the paclitaxel-HA prodrug, therefore 100 mg of said prodrug with a derivatization degree ranging from 18% to 21% w/w, will contain 18 mg, 19 mg, 20 mg or 21 mg of the above-mentioned paclitaxel chemotherapeutic agent depending on the derivatization degree indicated: consequently, to further illustrate, the derivatization degree at 20% w/w contains 20 mg of paclitaxel per 100 mg of prodrug.
• the paclitaxel-HA prodrug used in the therapeutic scheme described above was prepared according to an indirect synthesis process (described in EP2045270) between molecules of hyaluronic acid and paclitaxel by introducing molecules of 4-bromobutyric acid as a spacer between the acid hyaluronic acid and the above-mentioned chemotherapeutic agent, and is summarized hereunder in a broad outline as follows:
• the paclitaxel-HA prodrug claimed by the Applicant has an ester bond between the carboxyl of the above-mentioned polysaccharide and the spacer, in turn bound (again with an ester bond) through its carboxyl to the hydroxyl group of carbon in C2′ of paclitaxel.
• the HA used for the synthesis of the paclitaxel-HA prodrug can derive from any source, for example by extraction from rooster combs (for example according to EP0138572 or WO2018020458), or by technological means (for example according to EP2614088 or EP2614087), or preferably by fermentation (for example according to EP0716688), and having a weight average molecular weight ranging from 400 to 3 ⁇ 10 6 Da, in particular from 400 to 1 ⁇ 10 6 Da, even more particularly from 160,000 to 230,000 Da (weight average molecular weight refers to that calculated by the “intrinsic viscosity” method (Terbojevich et al., Carbohydr Res, 1986, 363-377)).
• the paclitaxel-HA prodrug with a derivatization degree ranging from 18% to 21% w/w described and claimed by the Applicant is preferably prepared from an HA of a fermentative origin with a weight average molecular weight ranging from 160,000 to 230,000 Da; the prodrug with a degree of 20% w/w is preferable, again prepared from an HA of a fermentative origin with a weight average molecular weight ranging from 160,000 to 230,000 Da, therefore 600 mg of the above-mentioned paclitaxel-HA prodrug contain 120 mg of paclitaxel chemotherapeutic agent.
• the paclitaxel-HA prodrug claimed by the Applicant in the treatment of non-muscle-invasive bladder cancer, therefore has the ester bond between the carboxyl of the HA and the 4-bromobutyric acid spacer, in turn bound with an ester bond by its carboxyl to the hydroxyl group of carbon in C2′ of paclitaxel, with a derivatization degree ranging from 18% to 21% w/w;
• the prodrug used in the in vivo trial described hereunder was prepared from an HA of a fermentative origin with a weight average molecular weight ranging from 160,000 to 230,000 Da and with a derivatization degree of 20% w/w.
• the paclitaxel-HA prodrug described and claimed is prepared as a pharmaceutical composition with pharmacologically acceptable diluents/excipients; said prodrug is preferably prepared in sterile, isotonic water, containing 5% glucose, in order to obtain this composition as a sterile and isotonic aqueous solution essentially consisting of the prodrug itself.
• the HA ester derivative (the HA used for this synthesis has a weight average molecular weight ranging from 160,000 to 230,000 Da) with paclitaxel with an esterification degree of the carboxyl of 20% w/w:
• 164 mg of this intermediate were added to a solution of 566 mg of HA-TBA (HA salt with tetrabutylammonium) dissolved in 26 ml of NMP. After 2 days of reaction at T 38° C., 1 ml of saturated sodium bromide was added to the solution. After 1 hour, ethanol was slowly added dropwise. The product obtained was then precipitated in pure ethanol and washed in ethanol-water (8.5/1.5), rewashed with 100% ethanol, then dried at 40° C. The product was analyzed by HPLC analysis to control the actual derivatization degree and the degree of purity of the prodrug prepared.
• HA-TBA HA salt with tetrabutylammonium
• the Applicant demonstrated how the treatment through intravesical instillation of the prodrug at 20% (described above) in patients with CIS not responsive or refractory to BCG, as a single administration at a weekly dose of 600 mg for 12 consecutive weeks of treatment, caused the complete resolution of the CIS carcinoma in 15 patients out of the 20 treated, thus subtracting them from radical cystectomy otherwise necessary for avoiding the progression of this carcinoma towards its metastatic form.
• patient with complete positive response is defined as a patient who, at the end of the 12 instillations, has both the bioptic examination with cytology and the relative cystoscopy negative, i.e. no tumour cells are present or detectable throughout the thickness of the mucosa; 2. assess the safety and tolerability of the treatment with said prodrug, by analyzing/recording not only all the adverse events that occur during and at the end of the treatment, but also evaluating the possible systemic absorption of paclitaxel following administration of the prodrug. To this end, patients are periodically subjected to hematological analyses with urine analysis and a medical examination.
• the final pharmaceutical form was presented as a solution for intravesical instillation consisting of 600 mg of the paclitaxel-HA prodrug previously described, prepared in 50 ml of sterile isotonic water containing 2.5 mg of glucose (the prodrug was therefore prepared in a 5% glucose).
• This solution had a final concentration of prodrug in glucose of 12 mg/ml.
• the solution in glucose containing the prodrug was slowly infused into the bladder (within 5 minutes) by an intravesical catheter, followed by a residence time of the drug in the bladder of 120 minutes; during this treatment the patient was instructed to turn on his right side alternating with his left side every 30 minutes to ensure complete contact of the composition on the entire inner surface of the bladder.
• a pharmaceutical composition essentially consisting of the prodrug paclitaxel-HA associated with pharmacologically acceptable diluents/excipients, for use in the treatment of non-muscle-invasive bladder cancer (NMIBC) by intravesical instillation, in particular of bladder carcinoma in situ (CIS), preferably in the treatment of CIS non-responsive or refractory to treatment with BCG, wherein this pharmaceutical composition is administered:
• NMIBC non-muscle-invasive bladder cancer
• CIS bladder carcinoma in situ

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