Classifications

• • 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
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
  • A61K31/592—9,10-Secoergostane derivatives, e.g. ergocalciferol, i.e. vitamin D2
• • 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
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
  • A61K31/593—9,10-Secocholestane derivatives, e.g. cholecalciferol, i.e. vitamin D3
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/66—Phosphorus compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7135—Compounds containing heavy metals
  • A61K31/714—Cobalamins, e.g. cyanocobalamin, i.e. vitamin B12
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/06—Aluminium, calcium or magnesium; Compounds thereof, e.g. clay
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/16—Fluorine compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/22—Boron compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
  • A61K38/23—Calcitonins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/08—Drugs for disorders of the urinary system of the prostate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents

Definitions

• This invention relates generally to a method of treating hyperproliferative prostatic diseases, and in particular, to the use of active forms of vitamin D to inhibit the hyperproliferative cellular activity of these diseases and to promote differentiation of the cells.
• the prostate gland is found exclusively in male mammals and is subject to certain hyperproliferative diseases.
• a proliferation of basal and stroma cells of the prostate gland gives rise to benign prostatic hyperplasia which is one common prostate disease.
• Another common prostate disease is prostate cancer, especially prostatic adenocarcinoma.
• Adenocarcinoma of the prostate is the most common of the fatal pathophysiological prostate cancers, and typically involves a malignant transformation of epithelial cells in the peripheral region of the prostate gland.
• Both prostatic hyperplasia and prostate cancer have a high rate of incidence in the aging human male population. Approximately one out of every four males above the age of 55 suffers from a prostate disease of some form or another.
• Prostate cancer is currently the second most frequent cause of cancer death after lung cancer among American males.
• Mortality rates for prostate cancer increase logarithmically with age and are two times higher in U.S. blacks than whites.
• Internationally, mortality rates are highest in U.S. blacks and in northern Europe and are lowest in Japan. It is projected that by the year 2000, a 90% increase in annual incidence of the disease and a 37% increase in annual mortality rates will be observed.
• prostate cancer may be a relatively indolent neoplasm in the elderly, the overall decrease in life span in patients with this disease is approximately 10 years.
• markers e.g, prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), prostatic inhibin (PIP)
• PSA prostate-specific antigen
• PAP prostatic acid phosphatase
• PIP prostatic inhibin
• Treatment of prostate cancer in men under the age of 65 has focused on radical surgery, e.g., prostatectomy, and/or radiotherapy, but the impact of these aggressive approaches on overall survival remains debatable.
• the approach to treatment of men over the age of 65 historically has been more conservative, and is based on the ablation or control of testosterone production.
• Such ablation or control is usually achieved by surgical castration, by administration of pituitary gonadotropin inhibitors such as estrogens or luteinizing hormone releasing hormone (LHRH) analogues, or a combination of these treatment methods.
• pituitary gonadotropin inhibitors such as estrogens or luteinizing hormone releasing hormone (LHRH) analogues
• Estrogens such as diethylstilbestrol
• LH luteinizing hormone
• gonadotropin that regulates testosterone production
• estrogen administration can cause a fall in testosterone to castration levels.
• Maximum suppression of plasma testosterone is typically achieved by a dosage of 3 mg/day of diethylstilbestrol.
• Other estrogens such as conjugated estrogens are about as equally effective in the lowering of the plasma level as diethylstilbestrol.
• diethylstilbestrol has a poor cardiovascular profile, and death from cardiovascular disease is not uncommon in patients treated with large doses of diethylstilbestrol.
• dosages of up to 3 mg/day of diethylstilbestrol are typically safe, this treatment regime is not indicated for men with preexisting cardiovascular disease.
• Prostatic carcinoma often metastasizes to the pelvis and lumbar vertebrae, causing bone loss and associated pain. Hormone manipulation often may result in significant palliation of metastatic prostate cancer, with improvement of bone pain and other disease-associated symptoms. Androgen ablation is, thus, also a major adjunctive therapy in advanced metastatic prostate cancer. Despite initial improvement on hormonal treatment, a majority of patients with locally unresectable or metastatic disease will eventually fail to respond to further hormonal therapies. A recent study suggests that human prostate cancer cells may cycle between being androgen- independent and androgen-dependent. Such cycling may account for the return of the cancer after initial improvement. In this large group of patients, other forms of treatment, unfortunately, are far less effective. Radiotherapy often may relieve the symptoms of bone pain, but is not curative. Over time, the disease will progress with a fatal outcome.
• prostatic hyperplasia is another common hyperproliferative disease of the prostate gland.
• the disorder affects men over the age of 45 and increases in frequency with age.
• Prostatic hyperplasia begins in the periurethral region as a localized proliferation and progresses to compress the remaining normal gland. The hyperplasia can compress and obstruct the urethra.
• Treatment includes surgery, and administration of pituitary gonadotropin inhibitors and/or 5 ⁇ -reductase enzyme inhibitors.
• the vitamin D area extensive research during the past two decades has established important biologic roles for vitamin D apart from its classic role in bone and mineral metabolism.
• 1 ⁇ -hydroxyvitamin D compounds possess potent antileukemic activity by virtue of inducing the differentiation of malignant cells (specifically leukemia cells) to nonmalignant macrophages (monocytes), and are useful in the treatment of leukemia.
• Antiproliferative and differentiating actions of 1 ⁇ ,25- dihydroxyvitamin D 3 and other vitamin D 3 analogues have been reported with respect to prostate cancer cell lines. More recently, an association between vitamin D receptor gene polymorphism and prostate cancer risk has been reported, suggesting that vitamin D receptors may have a role in the development, and possible treatment, of prostate cancer.
• vitamin D 3 compounds Even though these compounds may indeed be highly effective in promoting differentiation in malignant cells in culture, their practical use in differentiation therapy as anticancer agents is severely limited because of their equally high potency as agents affecting calcium metabolism. At the levels required in vivo for effective use as, for example, antileukemic agents, these same compounds can induce markedly elevated and potentially dangerous blood calcium levels by virtue of their inherent calcemic activity. That is, the clinical use of 1 ⁇ ,25-dihydroxyvitamin D 3 and other vitamin D 3 analogues as anticancer agents is precluded, or severely limited, by the risk of hypercalcemia.
• the present invention provides a method of treating prostatic disease conditions such as those characterized by hyperproliferative cell growth and/or abnormal cell differentiation, e.g., prostate cancer and prostatic hyperplasia.
• the method includes use of active vitamin D compounds to inhibit abnormal cell growth and promote cell differentiation.
• the foregoing, and other advantages of the present invention are realized in one aspect thereof in a method of inhibiting the hyperproliferative activity of human neoplastic or hyperplastic cells, comprising treating the cells with an effective amount of a 1 ⁇ -hydroxyvitamin D compound having a hydrocarbon moiety substituted at the C-24 position on the sidechain of the molecule.
• the treating step includes inhibiting proliferation of, and inducing and enhancing differentiation in such prostatic cells.
• the 1 ⁇ -hydroxyvitamin D compound is an active vitamin D and is suitably represented by the formula (I) described hereinafter.
• Preferred among the compounds of formula (I), are 1 ⁇ ,24-dihydroxyvitamin D 2 , 1 ⁇ ,24-dihydroxyvitamin D 4 , 1 ⁇ ,25-dihydroxyvitamin D 4 , 1 ⁇ ,25-dihydroxy- vitamin D 2 , 1 ⁇ -hydroxyvitamin D 2 and 1 ⁇ -hydroxyvitamin D 4 .
• the effective or therapeutic amount of the 1 ⁇ -hydroxyvitamin D compound administrable in accordance with the present invention to patients in need on a daily basis per kilogram of body weight ranges from 0.01 ⁇ g/kg/day to 2.0 ⁇ g/kg/day.
• the invention is a method of treating human prostate cancer, comprising administering to a male subject who has prostate cancer an effective amount of an active vitamin D compound which has, or attains through metabolism in vivo, a vitamin D receptor (VDR) binding affinity substantially equivalent to the binding affinity of 1 ⁇ ,25-dihydroxyvitamin D 3 and a hypercalcemia risk substantially lower than that of 1 ⁇ ,25-dihydroxyvitamin D 3 , to decrease or stabilize the cellular abnormal proliferative activity of the cancer.
• VDR vitamin D receptor
• the active vitamin D is suitably administered alone as an active ingredient, i.e., as a first anticancer agent, in a pharmaceutical composition, or in a mixture including a second anticancer agent, an androgen abalation agent, a 5 ⁇ -reductase inhibitor or combinations thereof.
• the invention is a pharmaceutical composition which includes a first anticancer agent which is an active vitamin D compound; an agent selected from the group consisting of (i) a second anticancer agent, (ii) a bone agent, (iii) an androgen ablation agent and (iv) a 5 ⁇ -reductase inhibitor and combinations thereof; and a physiologically acceptable carrier.
• a first anticancer agent which is an active vitamin D compound
• an agent selected from the group consisting of (i) a second anticancer agent, (ii) a bone agent, (iii) an androgen ablation agent and (iv) a 5 ⁇ -reductase inhibitor and combinations thereof and a physiologically acceptable carrier.
• the present invention provides an effective method for the treatment of neoplastic and hyperplastic diseases.
• the present invention relates to therapeutic methods for inhibiting, ameliorating or alleviating the hyperproliferative cellular activity of diseases of the prostate, e.g., prostatic cancer and prostatic hyperplasia, and inducing, enhancing or promoting cell differentiation in the diseased cells.
• the present invention provides a novel treatment of a patient suffering from a hyperproliferative disease such as prostatic cancer or prostatic hyperplasia with an active vitamin D analogue having a hydrocarbon moiety substituted at the C-24 position of the sidechain of the molecule.
• the active vitamin D analogue is a 1 ⁇ -hydroxyvitamin D compound and is suitably represented by formula (I) as described hereinbelow.
• the active vitamin D analogue is provided to the patient without causing dose-limiting hypercalcemia and hypercalciuria, i.e., unphysiologically high and deleterious blood calcium levels and urine calcium levels, respectively. These attributes are achieved through specific chemical properties of the compounds of formula (I) described.
• the analogues of formula (I) when effective amounts of the analogues of formula (I) are administered to patients with prostatic cancer or prostatic hyperplasia, the proliferative activity of the abnormal prostatic cells is inhibited or alleviated, and cell differentiation is induced, promoted or enhanced, with significantly less hypercalcemia and hypercalciuria than is observed after the same amount of activated vitamin D 3 is administered in previously known formulations.
• the compounds of formula (I) have an improved therapeutic index relative to active forms of vitamin D 3 analogues.
• activated vitamin D or “active vitamin D” is intended to refer to a vitamin D compound or analogue that has been hydroxylated in at least the C-1 position of the A ring of the molecule and either the compound itself or its metabolites in the case of a prodrug, such as 1 ⁇ -hydroxyvitamin D 2 , binds the vitamin D receptor (VDR).
• prodrugs Such compounds undergo further hydroxylation in vivo and their metabolites bind the VDR.
• the term "lower" as a modifier for alkyl, alkenyl acyl, or cycloalkyi is meant to refer to a straight or branched, saturated or unsaturated hydrocarbon radical having 1 to 4 carbon atoms.
• hydrocarbon radicals are methyl, ethyl, propyl, isopropyl, butyl, isobutyl, f-butyl, ethenyl, propenyl, butenyl, isobutenyl, isopropenyl, formyl, acetyl, propionyl, butyryl or cyclopropyl.
• aromatic acyl is meant to refer to a unsubstituted or substituted benzoyl group.
• hydrocarbon moiety refers to a lower alkyl, a lower alkenyl, a lower acyl group or a lower cycloalkyi, i.e., a straight or branched, saturated or unsaturated C C 4 hydrocarbon radial.
• the compound in accordance with the present invention is an active vitamin D compound provided that such compound has a hydrocarbon moiety at the C-24 position, e.g., a lower alkyl, alkenyl or acyl group at the C-24 position.
• the active vitamin D in accordance with the present invention may have an unsaturated sidechain, e.g., there is suitably a double bond between C-22 and C-23, between C-25 and C-26 or between C-26 and C-27.
• the 1 ⁇ -hydroxyvitamin D of the present invention preferably has the general formula described in formula (I)
• R 1 and R 2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyi, or taken together with the carbon to which they are bonded, form a C 3 -C 8 cyclocarbon ring;
• R 3 is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl or lower cycloalkyi;
• X 1 is hydrogen or hydroxyl
• X 2 is hydrogen or hydroxyl, or, may be taken with R 1 or R 2 , to
• the 1 ⁇ -hydroxyvitamin D compounds of formula (I) of the present invention are those that have effective antiproliferative and cell differentiation activity (i.e., reversal of malignant transformation), particularly with respect to cells of prostatic diseases, e.g., prostatic cancer and prostatic hyperplasia, but have a lower tendency or inability to cause the undesired side effects of hypercalcemia and/or hypercalciuria.
• the compounds of formula (I) can be administered at dosages that allow them to act as antiproliferative agents and cell differentiation agents when exposed to malignant or other hyperproliferative cells without significantly altering calcium metabolism.
• the 1 ⁇ -hydroxyvitamin D compounds of formula (I) useful and preferred agents for safely inhibiting hyperproliferation and promoting malignant or hyperplastic cell differentiation.
• the 1 ⁇ -hydroxyvitamin D compounds of the present invention thus, overcome the shortcomings of the known active vitamin D 3 compounds described above, and can be considered preferred agents for the control and treatment of malignant diseases such as prostate cancer as well as benign prostatic hyperplasia.
• Preferred among the active vitamin D compounds of formula (I) are: 1 ⁇ ,24-dihydroxyvitamin D 2 , 1 ⁇ ,24-dihydroxyvitamin D 4 , 1 ⁇ ,25- dihydroxyvitamin D 2 , 1 ⁇ ,25-dihydroxyvitamin D 4 , 1 ⁇ -hydroxyvitamin D 2 , and 1 ⁇ -hydroxyvitamin D 4 Among those compounds of formula (I) that have a chiral center in the sidechain, such as at C-24, it is understood that both epimers (e.g., R and S) and the racemic mixture are within the scope of the present invention.
• epimers e.g., R and S
• the present invention provides a method of treating malignant prostatic cells as well as other hyperproliferative prostatic cells, (i.e., inhibiting their hyperproliferative activity and/or inducing and enhancing their differentiation) with an effective amount of a compound of formula (I).
• the effective dosage amount on a daily basis per kilogram of body weight of the patient ranges from about 0.01 ⁇ g/kg/day to about 2.0 ⁇ g/kg/day.
• the compounds of formula (I) are valuable for the treatment of prostate cancer and prostatic hyperplasia in a patient suffering therefrom.
• the invention is a method for treating a patient suffering from the hyperproliferative cellular effects of prostate cancer and prostatic hyperplasia by administering to the patient a therapeutically effective amount of a compound of formula (I), which is preferably 1 ⁇ ,24-dihydroxy- vitamin D 2 , 1 ⁇ ,24-dihydroxyvitamin D 4 , 1 ⁇ ,25-dihydroxyvitamin D 2 , 1 ⁇ ,25-dihydroxyvitamin D 4 , 1 ⁇ -hydroxyvitamin D 2 , and 1 ⁇ -hydroxy- vitamin D 4 .
• the compounds of formula (I) can be prepared as described, e.g., in U.S. Patent 5,448,1 20 issued to Knutson et al., U.S. Patent 4,554, 106 issued to DeLuca et al., and Slitnell et al., 310 Biochem. J. (1995) pp. 233-241 , all of which are incorporated herein by reference.
• the biopotencies of the compounds of formula (I) have been studied and compared to that of 1 ⁇ ,25-dihydroxyvitamin D 3 , the active hormonal form of vitamin D and the standard against which all vitamin D compounds and analogues are measured.
• VDR vitamin D receptor binding affinities of the compounds of formula (I), or their active metabolites, are substantially equivalent to (i.e., equal to or up to 3 times weaker than) the affinity of 1 ⁇ ,25-dihydroxyvitamin D 3 .
• Such receptor binding affinities are indicative of potent biological activity.
• Patent 5,104,864 both of which are incorporated herein by reference, it has been shown that 1 ⁇ -hydroxyvitamin D 2 has the same biopotency as 1 ⁇ -hydroxyvitamin D 3 and 1 ⁇ ,25-dihydroxyv ' .tamin D 3 but is much less toxic. Even dosages up to 10 ⁇ g/day of 1 ⁇ -hydroxyvitamin D 2 in women with postmenopausal osteoporosis elicited only mild hypercalciuria (U.Ca > 300 mg/24 hrs), and no marked hypercalcemia (S. Ca > 1 1 .0 mg/dL) solely due to 1 ⁇ -hydroxyvitamin D 2 was evident.
• the compound did not adversely affect kidney function, as determined by creatinine clearance and BUN; nor did it increase urinary excretion of hydroxyproline, indicating the absence of any stimulatory effect on bone resorption.
• Administration of 1 ⁇ -hydroxyvitamin D 2 to healthy adult males in dosages up to 8 ⁇ g/day showed no clinically significant hypercalcemia or other adverse effects.
• the compounds of formula (I) are useful as active compounds in pharmaceutical compositions having reduced side effects and low toxicity as compared with the known analogues of active forms of vitamin D 3 .
• the pharmacologically active compounds of this invention can be processed in accordance with conventional methods of pharmacy to produce medicinal agents for administration to patients, e.g., mammals including humans.
• the compounds of formula (I) can be employed in admixtures with conventional excipients, e.g., pharmaceutically acceptable carrier substances suitable for enteral (e.g., oral) or parenteral application which do not deleteriously react with the active compounds.
• Suitable pharmaceutically acceptable carriers include but are not limited to water, salt solutions, alcohols, gum arabic, vegetable oils (e.g., corn oil, cottonseed oil, peanut oil, olive oil, coconut oil), fish liver oils, oily esters such as Polysorbate 80, polyethylene glycols, gelatin, carbohydrates (e.g., lactose, amylose or starch), magnesium stearate, talc, silicic acid, viscous paraffin, fatty acid monoglycerides and diglycerides, pentaerythritol fatty acid esters, hydroxy methylcellulose, polyvinyl pyrrolidone, etc.
• the pharmaceutical preparations can be sterilized and, if desired, be mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or one or more other active agents.
• auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or one or more other active agents.
• auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or one or more other active agents.
• injectable, sterile solutions preferably oily or aqueous solution, as well as suspensions, emulsions, or implants, including suppositories
• compositions for enteral application, particularly suitable are tablets, dragees, liquids, drops, lozenges, powders, or capsules.
• a syrup, elixir, or the like can be used if a sweetened vehicle is desired.
• compounds are formed into a pharmaceutical composition containing a suppository base such as cacao oil or other triglycerides.
• a suppository base such as cacao oil or other triglycerides.
• the composition advantageously includes an antioxidant such as ascorbic acid, butylated hydroxyanisole or hydroquinone.
• the dosage of the compounds for the treatment of prostatic cancer or hyperplasia according to this invention generally is about 0.01 to about 2.0 g/kg/day, preferably about 0.01 to about 1 .O ⁇ g/kg/day.
• the compounds of this invention are dispensed by unit dosage form in a pharmaceutically acceptable carrier.
• the parenteral dosage of the compounds of formula (I) is about 0.01 ⁇ g/kg/day to about 1 .O ⁇ g/kg/day.
• the actual preferred amounts of active compound in a specific case will vary according to the efficacy of the specific compound employed, the particular compositions formulated, the mode of application, and the particular situs and organism being treated.
• the specific dose for a particular patient depends on age, body weight, general state of health, on diet, on the timing and mode of administration, on the rate of excretion, and on medicaments used in combination and the severity of the particular disorder to which the therapy is applied. Dosages for a given host can be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject compounds and of a known agent, such as by means of an appropriate conventional pharmacological protocol.
• a compound of formula (I) with known androgen control or ablation or testosterone level-lowering agents such as estrogens (e.g., diethylstilbestrol), LHRH analogues, 5 ⁇ -reductase enzyme inhibitors such as finasteride, antiestrogens (e.g., TamoxifenTM), and antiandrogens (e.g., flutamide).
• estrogens e.g., diethylstilbestrol
• LHRH analogues e.g., 5 ⁇ -reductase enzyme inhibitors
• finasteride e.g., antiestrogens (e.g., TamoxifenTM), and antiandrogens (e.g., flutamide).
• antiestrogens e.g., TamoxifenTM
• antiandrogens e.g., flutamide
• the co-administration of the active vitamin D of formula (I) with a second anticancer agent e.g., a cytotoxic agent, particularly in metastatic prostate cancer wherein relapse has occurred following hormonal treatment.
• a second anticancer agent e.g., a cytotoxic agent, particularly in metastatic prostate cancer wherein relapse has occurred following hormonal treatment.
• agents may suitably include estramustine phosphate, prednimustine, cisplatin, 5-fluoro-uracil, melphalan, hydroxyurea, mitomycin, idarubicin, methotrexate, adriamycin and daunomycin. It is anticipated that an active vitamin D of formula (I) used in combination with various anticancer drugs can give rise to a significantly enhanced cytotoxic effect on cancerous cells, thus providing an increased therapeutic effect.
• analogue of formula (I) in conjunction with administration of hormones or other agents, e.g., estrogens, which are known to ameliorate bone diseases or disorders.
• hormones or other agents e.g., estrogens
• prostate cancer often metastasizes to bone, causing bone loss and associated pain.
• bone agents may include conjugated estrogens or their equivalents, calcitonin, bisphosphonates, calcium supplements, cobalamin, pertussis toxin and boron. Possible dose ranges for these co-administered bone agents are provided in Table 1 .
• Cobalamin ( ⁇ g/day) 5-200 20-100 30-50
• Pertussis Toxin 0.1 -2000 10-1 500 100-1000
• Antiestrogens such as TamoxifenTM are also known bone agents and may be suitably used in conjunction with the 1 ⁇ -hydroxyvitamin D compounds of the present invention.
• the affinity of 1 ⁇ ,24-(OH) 2 D 2 for the mammalian vitamin D receptor (VDR) was assessed using a commercially available kit of bovine thy us VDR and standard 1 ,25-(OH) 2 D 3 solutions from Incstar (Stillwater, Minnesota).
• the half-maximal binding of chemically synthesized 1 ⁇ ,24-(OH) 2 D 2 was approximately 150 pg/ml whereas that of 1 ⁇ ,25-(OH) 2 D 3 was 80 pg/ml.
• the 1 ⁇ ,24-(OH) 2 D 2 had a very similar affinity for bovine thymus VDR as did 1 ⁇ ,25-(OH) 2 D 3 , indicating that 1 ⁇ ,24-(OH) 2 D 2 has potent biological activity.
• Example 2 1 ⁇ ,24-dihydroxy vitamin D 4 [1 ⁇ ,24-(OH) 2 D 4 ]
• the VDR affinity binding of 1 ⁇ ,24-(OH) 2 D 4 was investigated.
• the 1 ⁇ ,24-(OH) 2 D 4 was incubated with vitamin D receptor and radiolabeled tracer 1 ⁇ ,25-(OH) 2 D 3 . After incubation, the amount of radioactivity bound to the receptor was determined and compared with the amount bound after co-incubation of unlabeled and labeled 1 ⁇ ,25-(OH) 2 D 3 . It was found that 50 pg/tube of 1 ⁇ ,24-(OH) 2 D 4 was equivalent to approximately 20 pg 1 ⁇ ,25-(OH) 2 D 3 .
• VDR binding of vitamin D compounds by prostate cells is demonstrated using the techniques of Skowronski et al., 136 Endocrinology (1995) 20-26, which is incorporated herein by reference.
• Prostate-derived cell lines are cultured to near confluence, washed and harvested by scraping. Cells are washed by centrifugation, and the cell pellet resuspended in a buffered salt solution containing protease inhibitors. The cells are disrupted by sonication while cooling on ice. The supernatant obtained from centrifuging the disrupted cells at 207,000 x g for 35 min at 4°C is assayed for binding.
• Example 4 1 ⁇ ,24-dihydroxy vitamin D 4 [1 ⁇ ,24-(OH) 2 D 4 ]
• Example 3 The procedure of Example 3 is repeated using the active vitamin D analogue 1 ⁇ ,24-(OH) 2 D 4 , and the specific binding is determined. The results demonstrate that 1 ⁇ ,24-(OH) 2 D 4 has strong affinity for prostate VDR, indicating that 1 ⁇ ,24-(OH) 2 D 4 has potent biological activity in respect of prostate cells.
• Example 5 1 ⁇ ,25-dihydroxyvitamin D 4 [1 ,25-(OH) 2 D 4 ]
• Example 3 The procedure of Example 3 is repeated using the active vitamin D analogue 1 ⁇ ,25-(OH) 2 D 4 , and the specific binding is determined. The results demonstrate that 1 ⁇ ,25-(OH) 2 D 4 has strong affinity for prostate VDR, indicating that 1 ⁇ ,25-(OH) 2 D 4 has potent biological activity in respect of prostate cells.
• One plasmid contained the gene for Growth Hormone (GH) under the control of the vitamin D responsive element (VDRE) and the other plasmid contained the structural gene for the vitamin D receptor (VDR).
• GH Growth Hormone
• VDRE vitamin D responsive element
• VDR vitamin D receptor
• Example 7 1 ⁇ ,24(S)-dihydroxyvitamin D 2 and 1 ⁇ ,24(R)-dihydroxy- vitamin D 2 [1 ⁇ ,24(S)-(OH) 2 D 2 and 1 ⁇ ,24(R)-(OH) 2 D 2 ]
• Example 6 The gene expression study described in Example 6 was conducted to compare the biological activity in vitro of chemically synthesized 1 ⁇ ,24(S)-(OH) 2 D 2 and 1 ⁇ ,24(R)-(OH) 2 D 2 , with 1 ⁇ ,25-(OH) 2 D 3 and 25-OH-D 3 .
• the vitamin D-dependent transcriptional activation model system was used in which plasmids pSG5-hVDR1 /3 and p(CT4) 4 TKGH were co-transfected into Green monkey kidney, COS-1 cells.
• Vitamin D Inducible Growth Hormone
• Example 8 1 ⁇ ,24-dihydroxyvitamin D 2 [1 ⁇ ,24-(OH) 2 D 2 ]
• LNCaP and PC-3 which are derived from human prostate adenocarcinoma, are seeded in six-well tissue culture plates at a density of about 50,000 cells/plate. After the cells have attached and stabilized, about 2-3 days, the medium is replenished with medium containing vehicle or the active vitamin D analogue 1 ⁇ ,24-(OH) 2 D 2 , at concentrations from 10 ⁇ 1 1 M to 10 "7 M. Medium containing test analogue or vehicle is replaced every three days.
• the medium is removed, the cells are rinsed, precipitated with cold 5% trichloroacetic acid, and washed with cold ethanol.
• the cells are solubilized with 0.2 N sodium hydroxide, and the amount of DNA determined by standard procedures. The results show that cultures incubated with 1 ⁇ ,24-(OH) 2 D 2 in accordance with the present invention have significantly fewer cells than the control cultures.
• Example 9 1 ⁇ ,24-dihydroxy vitamin D 4 [1 ⁇ ,24-(OH) 2 D 4 ]
• Example 8 The procedure of Example 8 is repeated using the active vitamin D analogue 1 ⁇ ,24-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with 1 ⁇ ,24-(OH) 2 D 4 have significantly fewer cells than the control cultures.
• Example 10 1 ⁇ ,25-dihydroxyvitamin D 4 [1 ⁇ ,25-(OH) 2 D 4 ]
• Example 8 The procedure of Example 8 is repeated using the active vitamin D analogue 1 ⁇ ,25-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with 1 ,25-(OH) 2 D 4 have significantly fewer cells than the control cultures.
• Example 1 1 ⁇ ,24-dihydroxyvitamin D 2 [1 ⁇ ,24-(OH) 2 D 2 ]
• cells of the cell line, LNCaP which is derived from a human metastatic prostate adenocarcinoma and known to express PSA
• LNCaP which is derived from a human metastatic prostate adenocarcinoma and known to express PSA
• the medium is replenished with medium containing vehicle or the active vitamin D analogue, 1 ⁇ ,24-(OH) 2 D 2 , at concentrations from 10 "1 1 M to 10 7 M.
• the medium is removed and stored at -20°C for prostate specific antigen (PSA) analysis.
• PSA prostate specific antigen
• the cells from parallel cultures are rinsed, precipitated, and the amount of DNA determined by standard procedures.
• PSA is measured by standard known methods. Cultures incubated with 1 ⁇ ,24-(OH) 2 D 2 have significantly more PSA than control cultures when expressed as mass of PSA/cell.
• Example 12 1 ⁇ ,24-dihydroxyvitamin D 4 [1 ⁇ ,24-(OH) 2 D 4 ]
• Example 12 The procedure of Example 12 is repeated except the active vitamin D analogue is 1 ⁇ ,24-(OH) 2 D 4 .
• the PSA is measured and cultures incubated with 1 ⁇ ,24-(OH) 2 D 4 have significantly more PSA than control cultures when expressed as mass of PSA/cell.
• Example 13 1 ⁇ ,25-dihydroxyvitamin D 4 [1 ⁇ ,24-(OH) 2 D 4 ]
• Example 12 The procedure of Example 12 is repeated except the active vitamin D analogue is 1 ⁇ ,25-(OH) 2 D 4 .
• the PSA is measured and cultures incubated with 1 ⁇ ,25-(OH) 2 D 4 have significantly more PSA than control cultures when expressed as mass of PSA/cell.
• Patients with advanced androgen-independent prostate cancer participate in an open-labeled study of 1 ⁇ ,24-(OH) 2 D 2 .
• Qualified patients are at least 40 years old, exhibit histologic evidence of adenocarcinoma of the prostate, and present with progressive disease which had previously responded to hormonal intervention(s).
• patients begin a course of therapy with oral 1 ⁇ ,24-(OH) 2 D 2 lasting 26 weeks, while discontinuing any previous use of calcium supplements, vitamin D supplements, and vitamin D hormone replacement therapies.
• the patients are monitored at regular intervals for: (1 ) hypercalcemia, hyperphosphatemia, hypercalciuria, hyperphosphaturia and other toxicity; (2) evidence of changes in the progression of metastatic disease; and (3) compliance with the prescribed test drug dosage.
• the maximal tolerated dosage (MTD) of daily oral 1 ⁇ ,24-(OH) 2 D 2 is determined by administering progressively higher dosages to successive groups of patients. All doses are administered in the morning before breakfast.
• the first group of patients is treated with 25.0 ⁇ g of 1 ⁇ ,24-(OH) 2 D 2 .
• Subsequent groups of patients are treated with 50.0, 75.0 and 100.0 ⁇ g/day.
• Dosing is continued uninterrupted for the duration of the study unless serum calcium exceeds 1 1 .6 mg/dL, or other toxicity of grade 3 or 4 is observed, in which case dosing is held in abeyance until resolution of the observed toxic effect(s) and then resumed at a level which has been decreased by 10.0 ⁇ g.
• results from the first phase of the study show that the MTD for 1 ⁇ ,24-(OH) 2 D 2 is above 20.0 ⁇ g/day, a level which is 10- to 40-fold higher than can be achieved with 1 ⁇ ,25-(OH) 2 D 3 .
• Analysis of blood samples collected at regular intervals from the participating patients reveal that the levels of circulating 1 ⁇ ,24-(OH) 2 D 2 increase proportionately with the dosage administered, rising to maximum levels well above 100 pg/mL at the highest dosages, and that circulating levels of 1 ⁇ ,25-(OH) 2 D 3 are suppressed, often to undetectable levels. Serum and urine calcium are elevated in a dose responsive manner. Patients treated with the MTD of 1 ⁇ ,24-(OH) 2 D 2 for at least six months report that bone pain associated with metastatic disease is significantly diminished.
• CAT scans, X-rays and bone scans used for evaluating the progression of metastatic disease show stable disease or partial remission in many patients treated at the lower dosage, and stable disease and partial or complete remission in many patients treated at the higher dosage.
• Example 15 1 ⁇ -hydroxyvitamin D 2 [1 ⁇ -OH-D 2 ]
• the study of Example 14 is repeated for the active vitamin D compound, 1 ⁇ -OH-D 2 .
• the results of the phase one study indicate that patients treated with the MTD of 1 ⁇ -OH-D 2 for at least six months report that bone pain associated with metastatic disease is significantly diminished.
• the results of the phase two study indicate that after two years, CAT scans, X-rays and bone scans used for evaluating the progression of metastatic disease show stable disease or partial remission in many patients treated at the lower dosage, and stable disease and partial or complete remission in many patients treated at the higher dosage.

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