WO1999004817A1 - Chemotherapy synergistic agent - Google Patents

Chemotherapy synergistic agent Download PDF

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Publication number
WO1999004817A1
WO1999004817A1 PCT/US1998/015052 US9815052W WO9904817A1 WO 1999004817 A1 WO1999004817 A1 WO 1999004817A1 US 9815052 W US9815052 W US 9815052W WO 9904817 A1 WO9904817 A1 WO 9904817A1
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Prior art keywords
cancer
biosynthesis inhibitor
porphyrin biosynthesis
compound
subject
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PCT/US1998/015052
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French (fr)
Inventor
James W. Winkelman
Kenneth R. Bridges
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Brigham & Women's Hospital, Inc.
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Application filed by Brigham & Women's Hospital, Inc. filed Critical Brigham & Women's Hospital, Inc.
Priority to AU85771/98A priority Critical patent/AU8577198A/en
Publication of WO1999004817A1 publication Critical patent/WO1999004817A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/24—Heavy metals; Compounds thereof
    • A61K33/244—Lanthanides; Compounds 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
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/66—Phosphorus compounds
    • A61K31/675—Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • 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
    • A61K33/24—Heavy metals; Compounds thereof
    • A61K33/243—Platinum; Compounds thereof

Definitions

  • the present invention pertains to the field of chemotherapy, particularly to the chemotherapy of neoplastic diseases. More specifically, the present invention relates to the potentiation of chemotherapeutic agents by certain chemical compounds.
  • Chemotherapy is one tool used for treating cancer. In 1945, there was but a single agent known to be effective against cancer. Today, there are more than 50, and chemotherapy has become an accepted modality for the treatment of cancer. Included among chemotherapies for cancer is the use of combinational therapy, in which two or more chemotherapeutic agents having different mechanisms of action are given concurrently. The results typically can be additive, although not synergistic.
  • the search for effective anti-cancer drugs and drug combinations has, if anything, intensified in an effort to find even more effective agents for treating the myriad of cancers that threaten and take the lives of so many.
  • One aspect of this search is to locate compounds and treatment regimens which lower the toxic side effects of chemotherapeutics which often have low therapeutic indexes.
  • a method for treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a potentiator.
  • the anti-cancer agent and the potentiator are administered to subjects in need of such treatment in a combined amount effective to inhibit growth of the cancer.
  • the combined amount is an amount of the anti-cancer agent and an amount of the potentiator, wherein the amount of the potentiator is effective to potentiate the effect of the amount of the anti-cancer agent versus the same amount of the anti-cancer agent if administered without the potentiator (e.g. to produce the same anti-cancer effect with a much lesser amount of anti-cancer agent).
  • the treatments according to the invention include treatment of the cancers listed in the detailed description below.
  • Particularly important cancers are lymphomas, leukemias and epithelial cell cancers.
  • the potentiator is administered to the subject as an oral formulation.
  • the potentiator is administered to the subject prior to administering the anti-cancer agent.
  • Preferred potentiators are compounds selected from the group consisting of the compound of Formula I and its metabolites.
  • a particularly preferred potentiator is the compound of Formula I.
  • Preferred metabolites of the compound of Formula I are the compounds of Formulas II-IV. All of the preferred potentiators of the invention are described in the detailed description below.
  • a method for treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a porphyrin biosynthesis inhibitor.
  • the anti-cancer agent and the porphyrin biosynthesis inhibitor are administered to subjects in need of such treatment in a combined amount effective to inhibit growth of the cancer.
  • the combined amount is an amount of the anti- cancer agent and an amount of the porphyrin biosynthesis inhibitor, wherein the amount of the porphyrin biosynthesis inhibitor is effective to potentiate the effect of the amount of the anti- cancer agent versus the same amount of the anti-cancer agent if administered without the porphyrin biosynthesis inhibitor (e.g. to produce the same anti-cancer effect with a much lesser amount of anti-cancer agent).
  • the treatments according to the invention include treatment of the cancers listed in the detailed description below.
  • Particularly important cancers are lymphomas, leukemias and epithelial cell cancers.
  • the porphyrin biosynthesis inhibitor is administered to the subject as an oral formulation.
  • the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
  • Preferred porphyrin biosynthesis inhibitors are inliibitors of the enzymatic conversion of protoporphyrinogen IX to heme, and particularly preferred are inliibitors of the enzyme protoporphyrinogen oxidase.
  • Preferred potentiators are described in the detailed description below, and a representative class of potentiators is the class of compounds disclosed in U.S. Patent No. 4,818,275.
  • a particularly preferred porphyrin biosynthesis inhibitor is a compound of Formula I below.
  • a method is provided for treating a subject having a cancer. An amount of an anti-cancer agent is administered to the subject. Substantially simultaneously therewith, an amount of a porphyrin biosynthesis inhibitor is administered to the subject. The combined amounts are effective for inhibiting growth of the cancer. Important embodiments and preferred compounds are as described above. According to still another aspect of the invention, an improvement to methods for treating cancer is provided.
  • the improvement is to the prior art method for treating cancer with an anti-cancer agent by administering to a subject in need of such treatment an anti- cancer agent in an amount effective to inhibit growth of the cancer.
  • the improvement involves co-administering to the subject a porphyrin biosynthesis inhibitor in an amount effective to potentiate the anti-cancer agent's inhibition of growth of the cancer. It further can involve improving the therapeutic index of the anti-cancer agent and administering the anti- cancer agent at a dose which is lower than a conventional dose.
  • important embodiments and preferred compounds are as described above.
  • the invention also embraces the use of a porphyrin biosynthesis inhibitor in the manufacture of a medicament for treating cancer.
  • the porphyrin biosynthesis inhibitors, anti- cancer agents and cancers are described above, including those in preferred embodiments. These and other aspects of the invention are described in greater detail below.
  • Figures 1A and IB show the Mean Tumor Size (cm) in Groups of animals treated with the compound of Formula I (FP-1) and Cyclophosphamide (Cytoxan) as compared to controls, over 15 days.
  • Figure 2B shows the changes in Tumor Size (mm) in Groups of animals treated with the compound of Formula I (FP846) and Cyclophosphamide (Cytoxan) as compared to controls, over 19 days.
  • Figure 3 depicts a kit comprising a potentiator, an anti-cancer agent, and instuctions for administering such agents to a subject.
  • the methods of the invention involve in one aspect treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a porphyrin biosynthesis inhibitor, in a combined amount effective to inhibit growth of the cancer.
  • the porphyrin biosynthesis inhibitor potentiates the anti-cancer agent and improves the therapeutic index of the anti-cancer agent.
  • a potentiator as used herein means a compound which, when administered together with an anti-cancer agent, alters favorably the therapeutic index of the anti-cancer agent. In this manner, less of the anti-cancer agent can be used to achieve a medically desirable anti-cancer effect when administered with the potentiator than when administered without the potentiator.
  • anti-cancer agents with a limited range of uses due to high toxicity can find a broader range of uses when the effective dose is reduced by using the anti-cancer agent with a potentiator as described herein.
  • the potentiators themselves are not necessarily cytotoxic and, typically, are not cytotoxic or are only weakly cytotoxic when used alone.
  • the combinations of potentiator and anti-cancer agents according to the invention appear to have a synergistic effect.
  • a subject as used herein means: humans, primates, horses, cows, pigs, sheep, goats, dogs, cats and rodents.
  • the invention is used in connection with treating cancers.
  • Cancers include the following categories of cancers: epithelial cell cancers, leukemias, lymphomas, and sarcomas.
  • Important cancers are biliary tract cancer; brain cancer, including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer; gastric cancer; hematological neoplasms, including acute lymphocytic and myelogeneous leukemia; multiple myeloma; AIDS associates leukemias and adult T-cell leukemia lymphoma; intraepithelial neoplasms, including Bowen's disease and Paget's disease; liver cancer; lung cancer; lymphomas, including Hodgkin's disease and lymphocytic lymphomas; neuroblastomas; oral cancer, including squamous cell carcinoma; ovarian cancer, including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreas cancer; prostate cancer; rectal cancer; sarcomas, including leiomyosarcoma
  • the invention involves co-administering with an anti-cancer agent certain compounds that are potentiators of the anti-cancer agent.
  • the potentiators of this invention are porphyrin biosynthesis inhibitors.
  • Porphyrin biosynthesis inhibitors are known to those of ordinary skill in the art. They include compounds that inhibit the enzymatic conversion of protoporphyrinogen IX to heme, such inhibition believed to be by inhibiting the enzyme protoporphyrinogen oxidase, or other steps in the biosynthesis of porphyrins.
  • a preferred class of potentiators is the class of herbicidal compounds disclosed in U.S. Patent No. 4,818,275.
  • a particularly preferred compound has the structure shown in Formula I.
  • Certain of its metabolites, also useful according to the invention, are shown in Formulas II- IV.
  • halogens of the compounds of Formulas I-IV can be replaced by other halogens.
  • Certain compounds useful according to the invention are those in which either or both chlorine (Cl) atom(s) of Formula I (Compound 1), or its metabolites (II -IV), are replaced by fluorine (F) atoms.
  • Additional inhibitors which may be employed as potentiators in the practice of this invention are those disclosed in U.S. Patent 5,298,502 (Method And Composition For Photodynamic Treatment And Detection of Tumors) and those disclosed in International Application (PCT) Publication No. WO95/34659 (Manipulation of Protoporphyrinogen Oxidase Enzyme Activity In Eukaryotic Organism).
  • potentiators useful according to the invention are the herbicidal compounds disclosed in U.S. Patent Nos. 5,262,382; 5,399,543; 5,250,504; 5,321,002; 5,344,812, 5,310,723; 5,346,881; 5,391,541; and 5,521,147.
  • the entire disclosures of the foregoing patents and patent application are incorporated herein by reference.
  • Anti-cancer agents include those disclosed in Chapter 52, Antineoplastic Agents (Paul Calabresi and Bruce A. Chabner), and the introduction thereto, 1202-1263, of Goodman and Gilman's "The Pharmacological Basis of Therapeutics", Eighth Edition, 1990, McGraw-Hill, Inc. (Health Professions Division), incorporated herein by reference and hereinafter referred to as "Calabresi and Chabner in G & G”.
  • Suitable chemotherapeutic agents may have various mechanisms of action.
  • the classes of suitable chemotherapeutic agents include (a) Alkylating Agents such as nitrogen mustard (e.g.
  • methotrexate methotrexate
  • pyrimidine analogs e.g. 5-fluorouracil floxuridine, cytarabine, and azauridine and its prodrug form azaribine
  • purine analogs and related materials e.g. 6-mercaptopurine, 6-thioguanine, pentostatin
  • Natural Products such as the vinca alkaloids (e.g. vinblastine, Vincristine), epipodophylotoxins (e.g.
  • antibiotics e.g dactinomycin which is also known as actinomycin-D, daunorubicin, doxorubicin, bleomycin, plicamycin, mitomycin, epirubicin, which is 4-epidoxorubicin, idarubicin which is 4-dimethoxydaunorubicin, and mitoxanthrone
  • enzymes e.g L- asparaginase
  • biological response modifiers e.g. Interferon alfa
  • Miscellaneous Agents such as the platinum coordination complexes (e.g. cisplatin, carboplatin), substituted ureas (e.g.
  • hydroxyurea methylhydiazine derivatives (e.g. procarbazine), adreocortical suppressants (e.g. mitotane, aminoglutethimide) taxol; and (e) Hormones and Antagonists such as adrenocorticosteroids (e.g. prednisone or the like), progestins (e.g. hydroxyprogesterone caproate, medroxyprogesterone acetate, megestrol acetate), estrogens (e.g. diethyestilbestrol, ethinyl estradiol, and the like), antiestrogens (e.g.
  • adrenocorticosteroids e.g. prednisone or the like
  • progestins e.g. hydroxyprogesterone caproate, medroxyprogesterone acetate, megestrol acetate
  • estrogens e.g. diethy
  • tamoxifen e.g. testosterone propionate, fluoxymesterone, and the like
  • antiandrogens e.g. flutamide
  • gonadotropin-releasing hormone analogs e.g. leuprolide
  • Other approved anti-cancer agents include: Acivicin; aclarubicin; acodazole hydrochloride; acronine; adozelesin; aldesleukin; altretamine; ambomycin; ametantrone acetate; amsacrine; anastrozole; anthramycin; asperlin; azacitidine; azetepa; azotomycin; batimastat; benzodepa; bicalutamide; bisantrene hydrochloride; bisnafide dimesylate; bizelesin; brequinar sodium; bropirimine; cactinomycin; calusterone; caracemide; carbetimer; carubicin hydrochloride; carzelesin; cedefingol; cirolemycin; cladribine; crisnatol mesylate; dacarbazine; decitabine; dexormaplatin; dezaguanine;
  • anti-cancer agents under development include: 20-epi-l,25 dihydroxyvitamin D3; 5-ethynyluracil; abiraterone; aclarubicin; acylfulvene; adecypenol; adozelesin; aldesleukin; ALL-TK antagonists; altretamine; ambamustine; amidox; amifostine; aminolevulinic acid; amrubicin; amsacrine; anagrelide; anastrozole; andrographolide; angiogenesis inhibitors; antagonist D; antagonist G; antarelix; anti- dorsalizing morphogenetic protein- 1; antiandrogen, prostatic carcinoma; antiestrogen; antineoplaston; antisense oligonucleotides; aphidicolin glycinate; apoptosis gene modulators; apoptosis regulators; apurinic acid; ara-CDP-DL-PTBA; arg
  • chemotherapeutic agents synergized in accordance with the present invention are, for example, the inhibition of adenosine deaminase (e.g. pentostatin), inhibition of purine ring biosynthesis and nucleotide interconversions (e.g. 6-mercaptopurine, 6-thioguanine), inhibition of purine ring biosynthesis and dTMP synthesis (e.g. methotrexate), inhibition of pyrimidine biosynthesis (e.g. N- phosphonoacetyl-L-aspartate, azaribine), inhibition of ribonucleotide reductase (e.g.
  • adenosine deaminase e.g. pentostatin
  • purine ring biosynthesis and nucleotide interconversions e.g. 6-mercaptopurine, 6-thioguanine
  • inhibition of purine ring biosynthesis and dTMP synthesis e.g. methotrexate
  • hydroxyurea inhibition of dTMP synthesis (e.g. 5-fluorouracil), inhibition of DNA synthesis (e.g. cytarabine), damaging of DNA and prevention of repair (e.g. bleomycins, etoposide, teniposide), intercalation with DNA and inhibition of RNA synthesis (e.g. dactinomycin, daunorubicin, doxorubicin, mitoxantrone), cross-linkage of DNA (e.g.
  • alkylating agents mitomycin, cisplatin, procarbazine
  • deamination of asparagine and inhibition of protein synthesis L-asparaginase
  • inhibition of the function of microtubules V-asparaginase
  • anti-cancer chemotherapeutic agents for use in the present invention are cyclophosphamide, cisplatin, doxorubicin hydrochloride, and 5-fluorouracil.
  • the potentiator is administered in an amount effective to alter favorably the therapeutic index of the anti-cancer agent (i.e. increase the ratio of the desirable medical benefit to the undersireable and perhaps toxic side effects of the anti-cancer agent).
  • the combination of the potentiator and anti-cancer agent is administered in an effective amount.
  • An effective amount is that amount necessary to inhibit the progression of or halt altogether progression of the particular cancer being treated or kill cancer cells with reduction or effective elimination of the cancer. Such amounts will depend, of course, on the particular condition being treated, the severity of the condition, the individual patient parameters including age, physical condition, size and weight, the duration of the treatment, the nature of concurrent therapy (if any), the specific route of administration and like factors within the knowledge and expertise of the health practioner.
  • a maximum dose of the combination be used, that is, the highest safe dose according to sound medical judgment. It will be understood by those of ordinary skill in the art, however, that a patient may insist upon a lower dose or tolerable dose for medical reasons, psychological reasons or for virtually any other reasons.
  • doses of administered compounds would be from about 0.01 mg/kg per day to 1000 mg/kg per day. It is expected that doses ranging from 50-500 mg/kg will be suitable and in one or several administrations per day. Lower doses will result from other forms of administration, such as intravenous administration. In the event that a response in a subject is insufficient at the initial doses applied, higher doses (or effectively higher doses by a different, more localized delivery route) may be employed to the extent that patient tolerance permits. Multiple doses per day are contemplated to achieve appropriate systemic levels of compounds.
  • the pharmaceutical preparations of the invention are applied in pharmaceutically-acceptable amounts and in pharmaceutically-acceptably compositions.
  • Such preparations may routinely contain salts, buffering agents, preservatives, compatible carriers, and optionally other therapeutic agents.
  • the salts should be pharmaceutically acceptable, but non-pharmaceutically acceptable salts may conveniently be used to prepare pharmaceutically-acceptable salts thereof and are not excluded from the scope of the invention.
  • Such pharmacologically and pharmaceutically-acceptable salts include, but are not limited to, those prepared from the following acids: hydrochloric, hydrobromic, sulfuric, nitric, phosphoric, maleic, acetic, salicylic, citric, formic, malonic, succinic, and the like.
  • pharmaceutically-acceptable salts can be prepared as alkaline metal or alkaline earth salts, such as sodium, potassium or calcium salts.
  • the potentiators (and/or anti-cancer agent) useful according to the invention may be combined, optionally, with a pharmaceutically-acceptable carrier.
  • pharmaceutically-acceptable carrier means one or more compatible solid or liquid fillers, diluents or encapsulating substances which are suitable for administration into a human.
  • carrier denotes an organic or inorganic ingredient, natural or synthetic, with which the active ingredient is combined to facilitate the application.
  • the components of the pharmaceutical compositions also are capable of being co-mingled with the molecules of the present invention, and with each other, in a manner such that there is no interaction which would substantially impair the desired pharmaceutical efficacy.
  • the pharmaceutical compositions may contain suitable buffering agents, including: acetic acid in a salt; citric acid in a salt; boric acid in a salt; and phosphoric acid in a salt.
  • suitable buffering agents including: acetic acid in a salt; citric acid in a salt; boric acid in a salt; and phosphoric acid in a salt.
  • compositions also may contain, optionally, suitable preservatives, such as: benzalkonium chloride; chlorobutanol; parabens and thimerosal.
  • suitable preservatives such as: benzalkonium chloride; chlorobutanol; parabens and thimerosal.
  • a variety of administration routes are available. The particular mode selected will depend, of course, upon the particular drug selected, the severity of the condition being treated and the dosage required for therapeutic efficacy.
  • the methods of the invention may be practiced using any mode of administration that is medically acceptable, meaning any mode that produces effective levels of the active compounds without causing clinically unacceptable adverse effects.
  • modes of administration include oral, rectal, topical, nasal, interdermal, or parenteral routes.
  • parenteral includes subcutaneous, intravenous, intramuscular, or infusion. Intravenous or intramuscular routes are not particularly suitable for long-term therapy and prophylaxis. Oral administration of the potentiator is preferred.
  • compositions may conveniently be presented in unit dosage form and may be prepared by any of the methods well-known in the art of pharmacy. All methods include the step of bringing the active agent into association with a carrier which constitutes one or more accessory ingredients. In general, the compositions are prepared by uniformly and intimately bringing the active compound into association with a liquid carrier, a finely divided solid carrier, or both, and then, if necessary, shaping the product.
  • compositions suitable for oral administration may be presented as discrete units, such as capsules, tablets, lozenges, each containing a predetermined amount of the active compound.
  • Other compositions include suspensions in aqueous liquids or non-aqueous liquids such as a syrup, elixir or an emulsion.
  • compositions suitable for parenteral administration conveniently comprise a sterile aqueous preparation of the potentiator (and or anti-cancer agent), which is preferably isotonic with the blood of the recipient.
  • This aqueous preparation may be formulated according to known methods using suitable dispersing or wetting agents and suspending agents.
  • the sterile injectable preparation also may be a sterile injectable solution or suspension in a non-toxic parenterally-acceptable diluent or solvent, for example, as a solution in 1,3 -butane diol.
  • acceptable vehicles and solvents that may be employed are 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 di-glycerides.
  • fatty acids such as oleic acid may be used in the preparation of injectables.
  • Carrier formulation suitable for oral, subcutaneous, intravenous, intramuscular, etc. administrations can be found in Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, PA.
  • Other delivery systems can include time-release, delayed release or sustained release delivery systems. Such systems can avoid repeated administrations of the active compound, increasing convenience to the subject and the physician.
  • Many types of release delivery systems are available and known to those of ordinary skill in the art. They include polymer base systems such as poly(lactide-glycolide), copolyoxalates, polycaprolactones, polyesteramides, polyorthoesters, polyhydroxybutyric acid, and polyanhydrides. Microcapsules of the foregoing polymers containing drugs are described in, for example, U.S. Patent 5,075,109.
  • Delivery systems also include non-polymer systems that are: lipids including sterols such as cholesterol, cholesterol esters and fatty acids or neutral fats such as mono-di-and tri-glycerides; hydrogel release systems; sylastic systems; peptide based systems; wax coatings; compressed tablets using conventional binders and excipients; partially fused implants; and the like.
  • lipids including sterols such as cholesterol, cholesterol esters and fatty acids or neutral fats such as mono-di-and tri-glycerides
  • hydrogel release systems such as cholesterol, cholesterol esters and fatty acids or neutral fats such as mono-di-and tri-glycerides
  • sylastic systems such as cholesterol, cholesterol esters and fatty acids or neutral fats such as mono-di-and tri-glycerides
  • peptide based systems such as fatty acids
  • wax coatings such as those described in U.S. Patent Nos.
  • a long-term sustained release implant may be desireable. Long-term release, are used herein, means that the implant is constructed and arranged to delivery therapeutic levels of the active ingredient for at least 30 days, and preferably 60 days. Long-term sustained release implants are well-known to those of ordinary skill in the art and include some of the release systems described above.
  • the potentiator is administered substantially simultaneously with the anti-cancer agent.
  • substantially simultaneously it is meant that the potentiator is administered to the subject close enough in time with the administration of the anti-cancer agent, whereby the potentiator (or its metabolites) may exert a potentiating effect on the anti-cancer activity of the anti-cancer agent.
  • the porphyrin biosynthesis inhibitor (potentiator) is used in the manufacture of a medicament for treating cancer.
  • the medicament can be placed in a vial and be incorporated into a kit to be used in the treatment of cancer.
  • an anti-cancer agent placed in a vial can also be included in the same kit.
  • kits can include instructions or other printed material on how to administer the anti-cancer agent and the porphyrin biosynthesis inhibitor.
  • the anti-cancer agent can be part of a kit that does not include a porphyrin biosynthesis inhibitor, but includes instructions or other printed material on how to combine the agent with a porphyrin biosynthesis inhibitor.
  • Kit 11 is comprised of the following major elements: packaging 15, a porphyrin biosynthesis inhibitor 17, an anti-cancer agent 19 and instructions 21.
  • Packaging 15 is a box-like structure for holding a vial containing porphyrin biosynthesis inhibitor 17, a vial containing an anti-cancer agent 19, and instructions 21. Individuals skilled in the art can readily modify packaging 15 to suit individual needs. In the following examples, the beneficial in vivo effects of one potentiator used in combination with cyclophosphamide, as the anti-cancer agent, are established.
  • Cyclophosphamide (Cytoxan) was obtained from Bristol-Myers Squibb, of Princeton, NJ.
  • mice Male C57BL/6 mice (Charles River Laboratories, Wilmington, MA), 6 to 8 weeks of age, were used throughout the study. Animals were housed in small groups and given food and water ad libitum. All procedures were done in accordance with guidelines set by Harvard Medical Area Standing Committee on Animals.
  • the murine EL4 lymphoma cell line was maintained as ascites within syngeneic C57BL/6 mice. McCoy's 5 A modified medium containing L-glutamine, 25mM HEPES buffer, and 10% (v/v) heat-inactivated bovine fetal serum was used. Cells were harvested, suspended in 10 ml of media, and centrifuged at 1000 rpm and 4°C for 10 minutes. Cells were washed a second time, counted and evaluated for viability by trypan blue exclusion. The concentration was adjusted to a final concentration for 5 x 10 6 cells per ml. Mice were given 5 x 10 5 cells in 0.1 ml by intraperitonial injection. Ascite passage was performed every ninth day.
  • Example 1 Synergistic effects of Compound 1 and Cyclophosphamide on murine EL4 lymphoma
  • mice Sixty-seven mice were divided into eight groups. All procedures were done under anesthesia in the form of diethyl ether. On day 0, all animals were given 5 x 10 5 EL4 cells in 0.1 ml by subcutaneous injection within the mid dorsum. Test groups were given cyclophosphamide (Cytoxan) by intraperitoneal injection at a dose of 40 mg/kg and/or Compound 1 laced chow (2000 ppm) ad libitum following the schedule below. The following test groups were evaluated:
  • Example 2 Synergistic effects of Compound 1 and Cyclophosphamide on murine EL4 lymphoma
  • mice Forty eight mice were randomized, segregated into six equally sized groups and prepared for tumor implantation. All procedures were done under anesthesia in the form of diethyl ether. On day 0, all animals were given 5 x 10 5 EL4 cells in 0.1 ml by subcutaneous injection in the lumbar region. Group identity was established after implantation. The following test groups were evaluated:
  • CP cyclophosphamide
  • mice in Groups 1 (no treatment control) and 2 (Compound 1 control) were randomized and segregated into Groups 4 (vehicle + 93 mg/kg CP) and 6 (Compound 1 + 93 mg/kg CP), and treated in accordance with their new group identity as described above. All other animals underwent a second course of treatment nine days following presentation with palpable tumor.
  • mice in Group 5 demonstrated slower tumor progression than animals in Group 3 (Vehicle + 35 mg/kg CP).
  • groups 4 Vehicle + 93mg/kg CP
  • 6 Compound 1 + 93 mg/kg CP
  • mice in Group 6 had larger tumors at presentation (day 0) than animals in Group 4 and there were three animals in Group 6 versus eight in Group 4 from day 0 to 8 of the study.
  • tumor growth was slowed or even reversed in animals treated with Compound 1. This effect was dose-dependent with respect to CP. Tumor progression was slower in Group 5 (Compound 1 + 35 mg/kg CP) than Group 3 (Vehicle + 35 mg/kg CP). Tumor regression was observed in both Groups 4 (Vehicle + 93 mg/kg CP) and 6 (Compound 1 + 93 mg/kg CP). Tumor regression in Group 4, however, occurred after rapid growth and was short lived. No tumor growth was observed in Group 6 (although average tumor size did increase after day 16 due to attrition). In comparison to Group 4, tumor regression in Group 6 occurred earlier and was also more pronounced.

Abstract

Methods for treating cancer are provided. The methods involve administering to subjects anti-cancer agents and a potentiator of the anti-cancer agents. The potentiator is a porphyrin biosynthesis inhibitor.

Description

CHEMOTHERAPY SYNERGISTIC AGENT
Field of the Invention
The present invention pertains to the field of chemotherapy, particularly to the chemotherapy of neoplastic diseases. More specifically, the present invention relates to the potentiation of chemotherapeutic agents by certain chemical compounds.
Background of the Invention
It has been said that one-third of all people in the United States will develop cancer. Although remarkable progress has been made in understanding the biological basis of and in treating cancer, cancer remains second only to cardiac disease as the main cause of death in the United States.
Chemotherapy is one tool used for treating cancer. In 1945, there was but a single agent known to be effective against cancer. Today, there are more than 50, and chemotherapy has become an accepted modality for the treatment of cancer. Included among chemotherapies for cancer is the use of combinational therapy, in which two or more chemotherapeutic agents having different mechanisms of action are given concurrently. The results typically can be additive, although not synergistic.
Notwithstanding the great strides made in developing improved drugs and regimens of treatment, the search for effective anti-cancer drugs and drug combinations has, if anything, intensified in an effort to find even more effective agents for treating the myriad of cancers that threaten and take the lives of so many. One aspect of this search is to locate compounds and treatment regimens which lower the toxic side effects of chemotherapeutics which often have low therapeutic indexes.
Summary of the Invention It has been discovered that certain compounds described herein alter favorably the therapeutic index of anti-cancer chemotherapeutic agents. These compounds themselves are not necessarily cytotoxic or only weakly cytotoxic when used alone. In combination with anti-cancer therapeutic agents, however, they are potentiators of these agents, allowing, for example, use of the chemotherapeutic agents at lesser amounts to obtain the same level of anti-cancer activity. Such lesser amounts of anti-cancer agents can be delivered and produce the same effect as a greater amount of the anti-cancer agent in the absence of the potentiator. Such compounds further can increase the benefit of certain chemotherapeutic agents which otherwise would be only marginally effective. This enhancement effect can overcome resistance of tumors to drugs at conventional doses. According to one aspect of the invention, a method is provided for treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a potentiator. The anti-cancer agent and the potentiator are administered to subjects in need of such treatment in a combined amount effective to inhibit growth of the cancer. The combined amount is an amount of the anti-cancer agent and an amount of the potentiator, wherein the amount of the potentiator is effective to potentiate the effect of the amount of the anti-cancer agent versus the same amount of the anti-cancer agent if administered without the potentiator (e.g. to produce the same anti-cancer effect with a much lesser amount of anti-cancer agent). The treatments according to the invention include treatment of the cancers listed in the detailed description below. Particularly important cancers are lymphomas, leukemias and epithelial cell cancers. In one embodiment, the potentiator is administered to the subject as an oral formulation. In another important embodiment, the potentiator is administered to the subject prior to administering the anti-cancer agent. Preferred potentiators are compounds selected from the group consisting of the compound of Formula I and its metabolites. A particularly preferred potentiator is the compound of Formula I. Preferred metabolites of the compound of Formula I are the compounds of Formulas II-IV. All of the preferred potentiators of the invention are described in the detailed description below.
According to another aspect of the invention, a method is provided for treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a porphyrin biosynthesis inhibitor. The anti-cancer agent and the porphyrin biosynthesis inhibitor are administered to subjects in need of such treatment in a combined amount effective to inhibit growth of the cancer. The combined amount is an amount of the anti- cancer agent and an amount of the porphyrin biosynthesis inhibitor, wherein the amount of the porphyrin biosynthesis inhibitor is effective to potentiate the effect of the amount of the anti- cancer agent versus the same amount of the anti-cancer agent if administered without the porphyrin biosynthesis inhibitor (e.g. to produce the same anti-cancer effect with a much lesser amount of anti-cancer agent). The treatments according to the invention include treatment of the cancers listed in the detailed description below. Particularly important cancers are lymphomas, leukemias and epithelial cell cancers. In one embodiment, the porphyrin biosynthesis inhibitor is administered to the subject as an oral formulation. In - another important embodiment, the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent. Preferred porphyrin biosynthesis inhibitors are inliibitors of the enzymatic conversion of protoporphyrinogen IX to heme, and particularly preferred are inliibitors of the enzyme protoporphyrinogen oxidase. Preferred potentiators are described in the detailed description below, and a representative class of potentiators is the class of compounds disclosed in U.S. Patent No. 4,818,275. A particularly preferred porphyrin biosynthesis inhibitor is a compound of Formula I below. According to another aspect of the invention, a method is provided for treating a subject having a cancer. An amount of an anti-cancer agent is administered to the subject. Substantially simultaneously therewith, an amount of a porphyrin biosynthesis inhibitor is administered to the subject. The combined amounts are effective for inhibiting growth of the cancer. Important embodiments and preferred compounds are as described above. According to still another aspect of the invention, an improvement to methods for treating cancer is provided. The improvement is to the prior art method for treating cancer with an anti-cancer agent by administering to a subject in need of such treatment an anti- cancer agent in an amount effective to inhibit growth of the cancer. The improvement involves co-administering to the subject a porphyrin biosynthesis inhibitor in an amount effective to potentiate the anti-cancer agent's inhibition of growth of the cancer. It further can involve improving the therapeutic index of the anti-cancer agent and administering the anti- cancer agent at a dose which is lower than a conventional dose. Again, important embodiments and preferred compounds are as described above.
The invention also embraces the use of a porphyrin biosynthesis inhibitor in the manufacture of a medicament for treating cancer. The porphyrin biosynthesis inhibitors, anti- cancer agents and cancers are described above, including those in preferred embodiments. These and other aspects of the invention are described in greater detail below.
Brief Description of the Drawings Figures 1A and IB show the Mean Tumor Size (cm) in Groups of animals treated with the compound of Formula I (FP-1) and Cyclophosphamide (Cytoxan) as compared to controls, over 15 days. Figure 2B shows the changes in Tumor Size (mm) in Groups of animals treated with the compound of Formula I (FP846) and Cyclophosphamide (Cytoxan) as compared to controls, over 19 days.
Figure 3 depicts a kit comprising a potentiator, an anti-cancer agent, and instuctions for administering such agents to a subject.
Detailed Description
The methods of the invention involve in one aspect treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a porphyrin biosynthesis inhibitor, in a combined amount effective to inhibit growth of the cancer. The porphyrin biosynthesis inhibitor potentiates the anti-cancer agent and improves the therapeutic index of the anti-cancer agent. A potentiator as used herein, means a compound which, when administered together with an anti-cancer agent, alters favorably the therapeutic index of the anti-cancer agent. In this manner, less of the anti-cancer agent can be used to achieve a medically desirable anti-cancer effect when administered with the potentiator than when administered without the potentiator. Unfavorable side effects, therefore, can be lessened or perhaps even eliminated. Likewise, anti-cancer agents with a limited range of uses due to high toxicity can find a broader range of uses when the effective dose is reduced by using the anti-cancer agent with a potentiator as described herein. The potentiators themselves are not necessarily cytotoxic and, typically, are not cytotoxic or are only weakly cytotoxic when used alone. Thus, the combinations of potentiator and anti-cancer agents according to the invention appear to have a synergistic effect.
A subject as used herein means: humans, primates, horses, cows, pigs, sheep, goats, dogs, cats and rodents. The invention is used in connection with treating cancers. Cancers include the following categories of cancers: epithelial cell cancers, leukemias, lymphomas, and sarcomas.
Important cancers are biliary tract cancer; brain cancer, including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer; gastric cancer; hematological neoplasms, including acute lymphocytic and myelogeneous leukemia; multiple myeloma; AIDS associates leukemias and adult T-cell leukemia lymphoma; intraepithelial neoplasms, including Bowen's disease and Paget's disease; liver cancer; lung cancer; lymphomas, including Hodgkin's disease and lymphocytic lymphomas; neuroblastomas; oral cancer, including squamous cell carcinoma; ovarian cancer, including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreas cancer; prostate cancer; rectal cancer; sarcomas, including leiomyosarcoma, rhabdomyosarcoma, liposarcoma, fibrosarcoma and osteosarcoma; skin cancer, including melanoma, Kaposi's sarcoma, basal cell cancer and squamous cell cancer; testicular cancer, including germinal tumors (seminoma, non-seminoma[teratomas, choriocarcinomas]), stromal tumors and germ cell tumors; thyroid cancer, including thyroid adenocarcinoma and medullar carcinoma; and renal cancer including adenocarcinoma and Wilms tumor. The invention involves co-administering with an anti-cancer agent certain compounds that are potentiators of the anti-cancer agent. The potentiators of this invention are porphyrin biosynthesis inhibitors. Porphyrin biosynthesis inhibitors are known to those of ordinary skill in the art. They include compounds that inhibit the enzymatic conversion of protoporphyrinogen IX to heme, such inhibition believed to be by inhibiting the enzyme protoporphyrinogen oxidase, or other steps in the biosynthesis of porphyrins.
A preferred class of potentiators is the class of herbicidal compounds disclosed in U.S. Patent No. 4,818,275. A particularly preferred compound has the structure shown in Formula I. Certain of its metabolites, also useful according to the invention, are shown in Formulas II- IV.
Figure imgf000007_0001
Formula II
Figure imgf000008_0001
Formula III
Figure imgf000008_0002
Formula IV
Figure imgf000008_0003
Any or all of the halogens of the compounds of Formulas I-IV can be replaced by other halogens. Certain compounds useful according to the invention are those in which either or both chlorine (Cl) atom(s) of Formula I (Compound 1), or its metabolites (II -IV), are replaced by fluorine (F) atoms. Additional inhibitors which may be employed as potentiators in the practice of this invention are those disclosed in U.S. Patent 5,298,502 (Method And Composition For Photodynamic Treatment And Detection of Tumors) and those disclosed in International Application (PCT) Publication No. WO95/34659 (Manipulation of Protoporphyrinogen Oxidase Enzyme Activity In Eukaryotic Organism). Other potentiators useful according to the invention are the herbicidal compounds disclosed in U.S. Patent Nos. 5,262,382; 5,399,543; 5,250,504; 5,321,002; 5,344,812, 5,310,723; 5,346,881; 5,391,541; and 5,521,147. The entire disclosures of the foregoing patents and patent application are incorporated herein by reference.
As mentioned herein previously, the potentiators useful according to the invention are used with anti-cancer agents. Anti-cancer agents include those disclosed in Chapter 52, Antineoplastic Agents (Paul Calabresi and Bruce A. Chabner), and the introduction thereto, 1202-1263, of Goodman and Gilman's "The Pharmacological Basis of Therapeutics", Eighth Edition, 1990, McGraw-Hill, Inc. (Health Professions Division), incorporated herein by reference and hereinafter referred to as "Calabresi and Chabner in G & G". Suitable chemotherapeutic agents may have various mechanisms of action. The classes of suitable chemotherapeutic agents include (a) Alkylating Agents such as nitrogen mustard (e.g. mechlorethamine, cylophosphamide, ifosfamide, melphalan, chlorambucil), ethylenimines and methylmelamines (e.g. hexamethylmelamine, thiotepa), alkyl sulfonates (e.g. busulfan), nitrosoureas (e.g. carmustine which is also known as BCNU, lomustine which is also known as CCNU semustine which is also known as methyl-CCNU, chlorozoticin, streptozocin), and triazines (e.g. dicarbazine which is also known as DTIC); (b) Antimetabolites such as folic acid analogs (e.g. methotrexate), pyrimidine analogs (e.g. 5-fluorouracil floxuridine, cytarabine, and azauridine and its prodrug form azaribine), and purine analogs and related materials (e.g. 6-mercaptopurine, 6-thioguanine, pentostatin); (c) Natural Products such as the vinca alkaloids (e.g. vinblastine, Vincristine), epipodophylotoxins (e.g. etoposide, teniposide), antibiotics (.e.g dactinomycin which is also known as actinomycin-D, daunorubicin, doxorubicin, bleomycin, plicamycin, mitomycin, epirubicin, which is 4-epidoxorubicin, idarubicin which is 4-dimethoxydaunorubicin, and mitoxanthrone), enzymes (.e.g L- asparaginase), and biological response modifiers (e.g. Interferon alfa); (d) Miscellaneous Agents such as the platinum coordination complexes (e.g. cisplatin, carboplatin), substituted ureas (e.g. hydroxyurea), methylhydiazine derivatives (e.g. procarbazine), adreocortical suppressants (e.g. mitotane, aminoglutethimide) taxol; and (e) Hormones and Antagonists such as adrenocorticosteroids (e.g. prednisone or the like), progestins (e.g. hydroxyprogesterone caproate, medroxyprogesterone acetate, megestrol acetate), estrogens (e.g. diethyestilbestrol, ethinyl estradiol, and the like), antiestrogens (e.g. tamoxifen), andorgens (e.g. testosterone propionate, fluoxymesterone, and the like), antiandrogens (e.g. flutamide), and gonadotropin-releasing hormone analogs (e.g. leuprolide). Other approved anti-cancer agents include: Acivicin; aclarubicin; acodazole hydrochloride; acronine; adozelesin; aldesleukin; altretamine; ambomycin; ametantrone acetate; amsacrine; anastrozole; anthramycin; asperlin; azacitidine; azetepa; azotomycin; batimastat; benzodepa; bicalutamide; bisantrene hydrochloride; bisnafide dimesylate; bizelesin; brequinar sodium; bropirimine; cactinomycin; calusterone; caracemide; carbetimer; carubicin hydrochloride; carzelesin; cedefingol; cirolemycin; cladribine; crisnatol mesylate; dacarbazine; decitabine; dexormaplatin; dezaguanine; dezaguanine mesylate; diaziquone; docetaxel; droloxifene; droloxifene citrate; dromostanolone propionate; duazomycin; edatrexate; eflomithine hydrochloride; elsamitrucin; enloplatin; enpromate; epipropidine; erbulozole; esorubicin hydrochloride; estramustine; estramustine phosphate sodium; etanidazole; etoprine; fadrozole hydrochloride; fazarabine; fenretinide; floxuridine; fludarabine phosphate; flurocitabine; fosquidone; fostriecin sodium; gemcitabine; gemcitabine hydrochloride; hydroxyurea; ilmofosine; interferon alfa-2a; interferon alfa-2b; interferon alfa-nl; interferon alfa-n3; interferon beta-I a; interferon gamma-I b; iproplatin; irinotecan hydrochloride; lanreotide acetate; letrozole; liarozole hydrochloride; lometrexol sodium; losoxantrone hydrochloride; masoprocol; maytansine; megestrol acetate; melengestrol acetate; menogaril; metoprine; meturedepa; mitindomide; mitocarcin; mitocromin; mitogillin; mitomalcin; mitosper; mycophenolic acid; nocodazole; nogalamycin; ormaplatin; oxisuran; pegaspargase; peliomycin; pentamustine; peplomycin sulfate; perfosfamide; pipobroman; piposulfan; piroxantrone hydrochloride; plomestane; porfimer sodium; porfiromycin; prednimustine; puromycin; puromycin hydrochloride; pyrazofurin; riboprine; rogletimide; safingol; safingol hydrochloride; simtrazene; sparfosate sodium; sparsomycin; spirogermanium hydrochloride; spiromustine; spiroplatin; streptonigrin; sulofenur; talisomycin; tecogalan sodium; tegafur; teloxantrone hydrochloride; temoporfin; teroxirone; testolactone; thiamiprine; tiazofurin; tirapazamine; topotecan hydrochloride; toremifene citrate; trestolone acetate; triciribine phosphate; trimetrexate; trimetrexate glucuronate; triptorelin; tubulozole hydrochloride; uracil mustard; uredepa; vapreotide; verteporfin; vindesine; vindesine sulfate; vinepidine sulfate; vinglycinate sulfate; vinleurosine sulfate; vinorelbine tartrate; vinrosidine sulfate; vinzolidine sulfate; vorozole; zeniplatin; zinostatin; zorubicin hydrochloride.
Other anti-cancer agents under development include: 20-epi-l,25 dihydroxyvitamin D3; 5-ethynyluracil; abiraterone; aclarubicin; acylfulvene; adecypenol; adozelesin; aldesleukin; ALL-TK antagonists; altretamine; ambamustine; amidox; amifostine; aminolevulinic acid; amrubicin; amsacrine; anagrelide; anastrozole; andrographolide; angiogenesis inhibitors; antagonist D; antagonist G; antarelix; anti- dorsalizing morphogenetic protein- 1; antiandrogen, prostatic carcinoma; antiestrogen; antineoplaston; antisense oligonucleotides; aphidicolin glycinate; apoptosis gene modulators; apoptosis regulators; apurinic acid; ara-CDP-DL-PTBA; arginine deaminase; asulacrine; atamestane; atrimustine; axinastatin 1; axinastatin 2; axinastatin 3; azasetron; azatoxin; azatyrosine; baccatin III derivatives; balanol; batimastat; BCR/ABL antagonists; benzochlorins; benzoylstaurosporine; beta lactam derivatives; beta-alethine; betaclamycin B; betulinic acid; bFGF inhibitor; bicalutamide; bisantrene; bisaziridinylspermine; bisnafide; bistratene A; bizelesin; breflate; bropirimine; budotitane; buthionine sulfoximine; calcipotriol; calphostin C; camptothecin derivatives; canarypox IL-2; capecitabine; carboxamide-amino- triazole; carboxyamidotriazole; CaRest M3; CARN 700; cartilage derived inhibitor; carzelesin; casein kinase inhibitors (ICOS); castanospermine; cecropin B; cetrorelix; chlorins; chloroquinoxaline sulfonamide; cicaprost; cis-porphyrin; cladribine; clomifene analogues; clotrimazole; collismycin A; collismycin B; combretastatin A4; combretastatin analogue; conagenin; crambescidin 816; crisnatol; cryptophycin 8; cryptophycin A derivatives; curacin A; cyclopentanthraquinones; cycloplatam; cypemycin; cytarabine ocfosfate; cytolytic factor; cytostatin; dacliximab; decitabine; dehydrodidemnin B; deslorelin; dexifosfamide; dexrazoxane; dexverapamil; diaziquone; didemnin B; didox; diethylnorspermine; dihydro-5- azacytidine; dihydrotaxol, 9-; dioxamycin; diphenyl spiromustine; docosanol; dolasetron; doxifluridine; droloxifene; dronabinol; duocarmycin SA; ebselen; ecomustine; edelfosine; edrecolomab; eflomithine; elemene; emitefur; epirubicin; epristeride; estramustine analogue; estrogen agonists; estrogen antagonists; etanidazole; etoposide phosphate; exemestane; fadrozole; fazarabine; fenretinide; filgrastim; finasteride; flavopiridol; flezelastine; fluasterone; fludarabine; fluorodaunorunicin hydrochloride; forfenimex; formestane; fostriecin; fotemustine; gadolinium texaphyrin; gallium nitrate; galocitabine; ganirelix; gelatinase inhibitors; gemcitabine; glutathione inhibitors; hepsulfam; heregulin; hexamethylene bisacetamide; hypericin; ibandronic acid; idarubicin; idoxifene; idramantone; ilmofosine; ilomastat; imidazoacridones; imiquimod; immunostimulant peptides; insulin-like growth factor- 1 receptor inhibitor; interferon agonists; interferons; interleukins; iobenguane; iododoxorubicin; ipomeanol, 4-; irinotecan; iroplact; irsogladine; isobengazole; isohomohalicondrin B; itasetron; jasplakinolide; kahalalide F; lamellarin-N triacetate; lanreotide; leinamycin; lenograstim; lentinan sulfate; leptolstatin; letrozole; leukemia inhibiting factor; leukocyte alpha interferon; leuprolide + estrogen + progesterone; leuprorelin; levamisole; liarozole; linear polyamine analogue; lipophilic disaccharide peptide; lipophilic platinum compounds; lissoclinamide 7; lobaplatin; lombricine; lometrexol; lonidamine; losoxantrone; lovastatin; loxoribine; lurtotecan; lutetium texaphyrin; lysofylline; lytic peptides; maitansine; mannostatin A; marimastat; masoprocol; maspin; matrilysin inhibitors; matrix metalloproteinase inhibitors; menogaril; merbarone; meterelin; methioninase; metoclopramide; MIF inhibitor; mifepristone; miltefosine; mirimostim; mismatched double stranded RNA; mitoguazone; mitolactol; mitomycin analogues; mitonafide; mitotoxin fibroblast growth factor-saporin; mitoxantrone; mofarotene; molgramostim; monoclonal antibody, human chorionic gonadotrophin; monophosphoryl lipid
A + myobacterium cell wall sk; mopidamol; multiple drug resistance gene inhibitor; multiple tumor suppressor 1 -based therapy; mustard anticancer agent; mycaperoxide B; mycobacterial cell wall extract; myriaporone; N-acetyldinaline; N-substituted benzamides; nafarelin; nagrestip; naloxone + pentazocine; napavin; naphterpin; nartograstim; nedaplatin; nemorubicin; neridronic acid; neutral endopeptidase; nilutamide; nisamycin; nitric oxide modulators; nitroxide antioxidant; nitrullyn; O6-benzylguanine; octreotide; okicenone; oligonucleotides; onapristone; ondansetron; ondansetron; oracin; oral cytokine inducer; ormaplatin; osaterone; oxaliplatin; oxaunomycin; paclitaxel analogues; paclitaxel derivatives; palauamine; palmitoylrhizoxin; pamidronic acid; panaxytriol; panomifene; parabactin; pazelliptine; pegaspargase; peldesine; pentosan polysulfate sodium; pentrozole; perflubron; perfosfamide; perillyl alcohol; phenazinomycin; phenylacetate; phosphatase inhibitors; picibanil; pilocarpine hydrochloride; pirarubicin; piritrexim; placetin A; placetin B; plasminogen activator inhibitor; platinum complex; platinum compounds; platinum-triamine complex; porfimer sodium; porfiromycin; propyl bis-acridone; prostaglandin J2; proteasome inhibitors; protein A-based immune modulator; protein kinase C inhibitor; protein kinase C inhibitors, microalgal; protein tyrosine phosphatase inhibitors; purine nucleoside phosphorylase inhibitors; purpurins; pyrazoloacridine; pyridoxylated hemoglobin polyoxyethylene conjugate; raf antagonists; raltitrexed; ramosetron; ras farnesyl protein transferase inhibitors; ras inhibitors; ras-GAP inhibitor; retelliptine demethylated; rhenium Re 186 etidronate; rhizoxin; ribozymes; RII retinamide; rogletimide; rohitukine; romurtide; roquinimex; rubiginone Bl; ruboxyl; safingol; saintopin; SarCNU; sarcophytol A; sargramostim; Sdi 1 mimetics; semustine; senescence derived inhibitor 1 ; sense oligonucleotides; signal transduction inhibitors; signal transduction modulators; single chain antigen binding protein; sizofiran; sobuzoxane; sodium borocaptate; sodium phenylacetate; solverol; somatomedin binding protein; sonermin; sparfosic acid; spicamycin D; spiromustine; splenopentin; spongistatin 1 ; squalamine; stem cell inhibitor; stem-cell division inhibitors; stipiamide; stromelysin inhibitors; sulfmosine; superactive vasoactive intestinal peptide antagonist; suradista; suramin; swainsonine; synthetic glycosaminoglycans; tallimustine; tamoxifen methiodide; tauromustine; tazarotene; tecogalan sodium; tegafur; tellurapyrylium; telomerase inhibitors; temoporfin; temozolomide; teniposide; tetrachlorodecaoxide; tetrazomine; thaliblastine; thalidomide; thiocoraline; thrombopoietin; thrombopoietin mimetic; thymalfasin; thymopoietin receptor agonist; thymotrinan; thyroid stimulating hormone; tin ethyl etiopurpurin; tirapazamine; titanocene dichloride; topotecan; topsentin; toremifene; totipotent stem cell factor; translation inhibitors; tretinoin; triacetyluridine; triciribine; trimetrexate; triptorelin; tropisetron; turosteride; tyrosine kinase inhibitors; tyrphostins; UBC inhibitors; ubenimex; urogenital sinus-derived growth inhibitory factor; urokinase receptor antagonists; vapreotide; variolin B; vector system, erythrocyte gene therapy; velaresol; veramine; verdins; verteporfin; vinorelbine; vinxaltine; vitaxin; vorozole; zanoterone; zeniplatin; zilascorb; zinostatin stimalamer. Among the various mechanisms of action of the chemotherapeutic agents synergized in accordance with the present invention are, for example, the inhibition of adenosine deaminase (e.g. pentostatin), inhibition of purine ring biosynthesis and nucleotide interconversions (e.g. 6-mercaptopurine, 6-thioguanine), inhibition of purine ring biosynthesis and dTMP synthesis (e.g. methotrexate), inhibition of pyrimidine biosynthesis (e.g. N- phosphonoacetyl-L-aspartate, azaribine), inhibition of ribonucleotide reductase (e.g. hydroxyurea), inhibition of dTMP synthesis (e.g. 5-fluorouracil), inhibition of DNA synthesis (e.g. cytarabine), damaging of DNA and prevention of repair (e.g. bleomycins, etoposide, teniposide), intercalation with DNA and inhibition of RNA synthesis (e.g. dactinomycin, daunorubicin, doxorubicin, mitoxantrone), cross-linkage of DNA (e.g. alkylating agents, mitomycin, cisplatin, procarbazine), deamination of asparagine and inhibition of protein synthesis (L-asparaginase), and inhibition of the function of microtubules (vinca alkaloids, colchicine and taxol).
Among the preferred anti-cancer chemotherapeutic agents for use in the present invention are cyclophosphamide, cisplatin, doxorubicin hydrochloride, and 5-fluorouracil.
The potentiator is administered in an amount effective to alter favorably the therapeutic index of the anti-cancer agent (i.e. increase the ratio of the desirable medical benefit to the undersireable and perhaps toxic side effects of the anti-cancer agent). The combination of the potentiator and anti-cancer agent is administered in an effective amount. An effective amount is that amount necessary to inhibit the progression of or halt altogether progression of the particular cancer being treated or kill cancer cells with reduction or effective elimination of the cancer. Such amounts will depend, of course, on the particular condition being treated, the severity of the condition, the individual patient parameters including age, physical condition, size and weight, the duration of the treatment, the nature of concurrent therapy (if any), the specific route of administration and like factors within the knowledge and expertise of the health practioner. It is generally preferred that a maximum dose of the combination be used, that is, the highest safe dose according to sound medical judgment. It will be understood by those of ordinary skill in the art, however, that a patient may insist upon a lower dose or tolerable dose for medical reasons, psychological reasons or for virtually any other reasons.
Generally, doses of administered compounds would be from about 0.01 mg/kg per day to 1000 mg/kg per day. It is expected that doses ranging from 50-500 mg/kg will be suitable and in one or several administrations per day. Lower doses will result from other forms of administration, such as intravenous administration. In the event that a response in a subject is insufficient at the initial doses applied, higher doses (or effectively higher doses by a different, more localized delivery route) may be employed to the extent that patient tolerance permits. Multiple doses per day are contemplated to achieve appropriate systemic levels of compounds.
When administered, the pharmaceutical preparations of the invention are applied in pharmaceutically-acceptable amounts and in pharmaceutically-acceptably compositions. Such preparations may routinely contain salts, buffering agents, preservatives, compatible carriers, and optionally other therapeutic agents. When used in medicine, the salts should be pharmaceutically acceptable, but non-pharmaceutically acceptable salts may conveniently be used to prepare pharmaceutically-acceptable salts thereof and are not excluded from the scope of the invention. Such pharmacologically and pharmaceutically-acceptable salts include, but are not limited to, those prepared from the following acids: hydrochloric, hydrobromic, sulfuric, nitric, phosphoric, maleic, acetic, salicylic, citric, formic, malonic, succinic, and the like. Also, pharmaceutically-acceptable salts can be prepared as alkaline metal or alkaline earth salts, such as sodium, potassium or calcium salts. The potentiators (and/or anti-cancer agent) useful according to the invention may be combined, optionally, with a pharmaceutically-acceptable carrier. The term "pharmaceutically-acceptable carrier" as used herein means one or more compatible solid or liquid fillers, diluents or encapsulating substances which are suitable for administration into a human. The term "carrier" denotes an organic or inorganic ingredient, natural or synthetic, with which the active ingredient is combined to facilitate the application. The components of the pharmaceutical compositions also are capable of being co-mingled with the molecules of the present invention, and with each other, in a manner such that there is no interaction which would substantially impair the desired pharmaceutical efficacy.
The pharmaceutical compositions may contain suitable buffering agents, including: acetic acid in a salt; citric acid in a salt; boric acid in a salt; and phosphoric acid in a salt.
The pharmaceutical compositions also may contain, optionally, suitable preservatives, such as: benzalkonium chloride; chlorobutanol; parabens and thimerosal.
A variety of administration routes are available. The particular mode selected will depend, of course, upon the particular drug selected, the severity of the condition being treated and the dosage required for therapeutic efficacy. The methods of the invention, generally speaking, may be practiced using any mode of administration that is medically acceptable, meaning any mode that produces effective levels of the active compounds without causing clinically unacceptable adverse effects. Such modes of administration include oral, rectal, topical, nasal, interdermal, or parenteral routes. The term "parenteral" includes subcutaneous, intravenous, intramuscular, or infusion. Intravenous or intramuscular routes are not particularly suitable for long-term therapy and prophylaxis. Oral administration of the potentiator is preferred.
The pharmaceutical compositions may conveniently be presented in unit dosage form and may be prepared by any of the methods well-known in the art of pharmacy. All methods include the step of bringing the active agent into association with a carrier which constitutes one or more accessory ingredients. In general, the compositions are prepared by uniformly and intimately bringing the active compound into association with a liquid carrier, a finely divided solid carrier, or both, and then, if necessary, shaping the product.
Compositions suitable for oral administration may be presented as discrete units, such as capsules, tablets, lozenges, each containing a predetermined amount of the active compound. Other compositions include suspensions in aqueous liquids or non-aqueous liquids such as a syrup, elixir or an emulsion.
Compositions suitable for parenteral administration conveniently comprise a sterile aqueous preparation of the potentiator (and or anti-cancer agent), which is preferably isotonic with the blood of the recipient. This aqueous preparation may be formulated according to known methods using suitable dispersing or wetting agents and suspending agents. The sterile injectable preparation also may be a sterile injectable solution or suspension in a non-toxic parenterally-acceptable diluent or solvent, for example, as a solution in 1,3 -butane diol. Among the acceptable vehicles and solvents that may be employed are water, Ringer's solution, and isotonic sodium chloride solution. In addition, sterile, fixed oils are conventionally employed as a solvent or suspending medium. For this purpose any bland fixed oil may be employed including synthetic mono-or di-glycerides. In addition, fatty acids such as oleic acid may be used in the preparation of injectables. Carrier formulation suitable for oral, subcutaneous, intravenous, intramuscular, etc. administrations can be found in Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, PA.
Other delivery systems can include time-release, delayed release or sustained release delivery systems. Such systems can avoid repeated administrations of the active compound, increasing convenience to the subject and the physician. Many types of release delivery systems are available and known to those of ordinary skill in the art. They include polymer base systems such as poly(lactide-glycolide), copolyoxalates, polycaprolactones, polyesteramides, polyorthoesters, polyhydroxybutyric acid, and polyanhydrides. Microcapsules of the foregoing polymers containing drugs are described in, for example, U.S. Patent 5,075,109. Delivery systems also include non-polymer systems that are: lipids including sterols such as cholesterol, cholesterol esters and fatty acids or neutral fats such as mono-di-and tri-glycerides; hydrogel release systems; sylastic systems; peptide based systems; wax coatings; compressed tablets using conventional binders and excipients; partially fused implants; and the like. Specific examples include, but are not limited to: (a) erosional systems in which the active compound is contained in a form within a matrix such as those described in U.S. Patent Nos. 4,452,775, 4,667,014, 4,748,034 and 5,239,660 and (b) difusional systems in which an active component permeates at a controlled rate from a polymer such as described in U.S. Patent Nos. 3,832,253, and 3,854,480. In addition, pump-based hardware delivery systems can be used, some of which are adapted for implantation. Use of a long-term sustained release implant may be desireable. Long-term release, are used herein, means that the implant is constructed and arranged to delivery therapeutic levels of the active ingredient for at least 30 days, and preferably 60 days. Long-term sustained release implants are well-known to those of ordinary skill in the art and include some of the release systems described above. In one aspect of the invention, the potentiator is administered substantially simultaneously with the anti-cancer agent. By substantially simultaneously, it is meant that the potentiator is administered to the subject close enough in time with the administration of the anti-cancer agent, whereby the potentiator (or its metabolites) may exert a potentiating effect on the anti-cancer activity of the anti-cancer agent. In another aspect of the invention, the porphyrin biosynthesis inhibitor (potentiator) is used in the manufacture of a medicament for treating cancer. The medicament can be placed in a vial and be incorporated into a kit to be used in the treatment of cancer. In one embodiment, an anti-cancer agent placed in a vial can also be included in the same kit. The kits can include instructions or other printed material on how to administer the anti-cancer agent and the porphyrin biosynthesis inhibitor. In certain embodiments the anti-cancer agent can be part of a kit that does not include a porphyrin biosynthesis inhibitor, but includes instructions or other printed material on how to combine the agent with a porphyrin biosynthesis inhibitor. A kit embodying features of the present invention, generally designated by the numeral 11, is illustrated in Figure 3. Kit 11 is comprised of the following major elements: packaging 15, a porphyrin biosynthesis inhibitor 17, an anti-cancer agent 19 and instructions 21. Packaging 15 is a box-like structure for holding a vial containing porphyrin biosynthesis inhibitor 17, a vial containing an anti-cancer agent 19, and instructions 21. Individuals skilled in the art can readily modify packaging 15 to suit individual needs. In the following examples, the beneficial in vivo effects of one potentiator used in combination with cyclophosphamide, as the anti-cancer agent, are established.
Examples
Experimental Procedures Potentiator
Compound 1 (Formula I), U.S. Patent 4,818,275, was employed at a purity of 99.3 %.
Anti-cancer Chemotherapeutic Agent
Cyclophosphamide (Cytoxan) was obtained from Bristol-Myers Squibb, of Princeton, NJ.
Animals
Male C57BL/6 mice (Charles River Laboratories, Wilmington, MA), 6 to 8 weeks of age, were used throughout the study. Animals were housed in small groups and given food and water ad libitum. All procedures were done in accordance with guidelines set by Harvard Medical Area Standing Committee on Animals.
Tumor Cells Murine EL4 lymphoma cells (DCTDC Tumor Repository, NCI-Frederick Cancer
Research and Development Center, Frederick, MD) were used throughout the studies.
Ascites
The murine EL4 lymphoma cell line was maintained as ascites within syngeneic C57BL/6 mice. McCoy's 5 A modified medium containing L-glutamine, 25mM HEPES buffer, and 10% (v/v) heat-inactivated bovine fetal serum was used. Cells were harvested, suspended in 10 ml of media, and centrifuged at 1000 rpm and 4°C for 10 minutes. Cells were washed a second time, counted and evaluated for viability by trypan blue exclusion. The concentration was adjusted to a final concentration for 5 x 106 cells per ml. Mice were given 5 x 105 cells in 0.1 ml by intraperitonial injection. Ascite passage was performed every ninth day.
Example 1 : Synergistic effects of Compound 1 and Cyclophosphamide on murine EL4 lymphoma
Sixty-seven mice were divided into eight groups. All procedures were done under anesthesia in the form of diethyl ether. On day 0, all animals were given 5 x 105 EL4 cells in 0.1 ml by subcutaneous injection within the mid dorsum. Test groups were given cyclophosphamide (Cytoxan) by intraperitoneal injection at a dose of 40 mg/kg and/or Compound 1 laced chow (2000 ppm) ad libitum following the schedule below. The following test groups were evaluated:
Figure imgf000019_0001
Outcome measures included short (days 0-15) and long (>day 15) term survival and short and long term tumor size. Animals were observed and weighed daily throughout the study. Beginning on day 6, and continuing throughout the study, palpable tumors were measured by Boli gauge. Measurements were taken along greatest dimension of tumor (long axis). Multiple tumor growths were reported as the addition of the measurement taken for individual tumors. For humane reasons, animals with cumulative tumor burdens greater than or equal to 3.0 cm after day 14 were euthanized on the first day this tumor burden was observed.
Animals given Compound 1 laced chow consumed on average 4.40 mg of Compound 1 per day (2.20 grams total food).
Short Term Survival
Animals treated with both Compound 1 and cyclophosphamide outlived those treated with Compound 1 above or cyclophosphamide alone. All untreated animals and those treated with Compound 1 on days 5 through 13 died by day 15, whereas fifty percent of animals treated with cyclophosphamide alone on days 0 and 7 or 6 and 9 survived through day 15. All animals in Group 4 (Compound 1- days -1 to 9 and cyclophosphamide days 0 and 7) survived through day 15 as did 67% in Group 7 (Compound 1 days 5 to 13 and cyclophosphamide days 6 and 9) and 88% in Group 8 (Compound 1 days -1 to 13 and cyclophosphamide days 6 and 9).
Long Term Survival
All untreated animals as well as animals treated with Compound 1 or cyclophosphamide alone perished within fourteen to nineteen days of tumor implantation. At the conclusion of the study (day 25), 27% and 38% survived in Groups 4 and 8, respectively. Although all animals in Group 7 perished by day 25, life was extended as 17% survived through day 23.
Short and Long Term Tumor Growth
Untreated control animals developed tumors in excess of one centimeter by day 6 which grew to greater than three centimeters by day 14. Tumor growth kinetics of animals treated with Compound 1 on days -1 to 9 or cyclophosphamide on days 0 and 7 were pushed slightly to the right suggesting a slight reduction in initial tumor burden. In contrast, animals in Group 4 did not develop palpable tumors until day 14. Group 4 had significantly smaller tumors (p<0.05) than Group 1-3 on days 6-14, 6-15, and 7-17, respectively.
Animals treated with Compound 1 on days 5 through 13 or cyclophosphamide on days 6 and 9 demonstrated slight tumor regression. In both cases, however, tumor growth soon accelerated and resulted in early death. Group 8 exhibited marked tumor regression between 7 and 13. On day 13, the average tumor size in Group 8 was less than 0.3 centimeters. Group 8 had significantly smaller tumors (p<0.05) than Groups 5-7 on days 10-13, 10-15, and 10-16, respectively. Although Group 7 did not demonstrate tumor regression, tumor growth was halted from day 13 to day 20.
Tumor regression was not observed in any of the groups (4, 7, and 8) treated with Compound 1 on days 16 to 19 (18 to 19 in Group 7 only) and cyclophosphamide on day 18.
By day 12, all animals in Groups 1-3 and 5-7 had excessive tumor burden, defined as tumor size greater than 0.80 centimeters. As mentioned previously, Group 4 did not exhibit palpable tumors until day 14. Slightly more than fifty percent had excessive tumor burden by day 15 and all did by day 20. The percentage of animals in Group 8 with excessive tumor burden decreased from 100% on day 9 to 0% on day 12. By day 18, all animals in Group 8 had masses in excess of 0.80 centimeters.
The results described above are summarized in Figure 1.
Example 2: Synergistic effects of Compound 1 and Cyclophosphamide on murine EL4 lymphoma
Forty eight mice were randomized, segregated into six equally sized groups and prepared for tumor implantation. All procedures were done under anesthesia in the form of diethyl ether. On day 0, all animals were given 5 x 105 EL4 cells in 0.1 ml by subcutaneous injection in the lumbar region. Group identity was established after implantation. The following test groups were evaluated:
Figure imgf000021_0001
Outcome measures included tumor growth and survival. Animals were observed daily. Tumor growth was determined by measuring its greatest dimension with a digital caliper. Tumor growth continued without intervention until a palpable tumor (defined as ≥5mm) was observed. Upon presentation with palpable tumor, animals (except those in Group 1) were treated with lmg of Compound 1 dispersion (3.64 mg/ml) or vehicle for four concecutive days. Compound 1 dispersion was administered by subcutaneous injection.
On the second day of treatment with Compound 1 (or vehicle), cyclophosphamide (CP) treatment was initiated. CP was administered intraperitoneally, once daily, for three consecutive days. The CP doses (35 and 93 mg/kg) selected for this study were based on available phamacokinetic data in mice. A single bolus injection of CP at a dose of 35 (or 93) mg/kg results in a peak plasma concentration of 50 (or 150) μM.
On the fifteenth day following tumor implantation, animals in Groups 1 (no treatment control) and 2 (Compound 1 control) were randomized and segregated into Groups 4 (vehicle + 93 mg/kg CP) and 6 (Compound 1 + 93 mg/kg CP), and treated in accordance with their new group identity as described above. All other animals underwent a second course of treatment nine days following presentation with palpable tumor.
Tumor Growth
Following the first course of treatment, animals in Group 5 (Compound 1 + 35 mg/kg CP) demonstrated slower tumor progression than animals in Group 3 (Vehicle + 35 mg/kg CP). Although groups 4 (Vehicle + 93mg/kg CP) and 6 (Compound 1 + 93 mg/kg CP) both exhibited tumor regression, there was no appreciable differences. It is important to note, however, that animals in Group 6 had larger tumors at presentation (day 0) than animals in Group 4 and there were three animals in Group 6 versus eight in Group 4 from day 0 to 8 of the study.
Following the second course of treatment, tumor growth was slowed or even reversed in animals treated with Compound 1. This effect was dose-dependent with respect to CP. Tumor progression was slower in Group 5 (Compound 1 + 35 mg/kg CP) than Group 3 (Vehicle + 35 mg/kg CP). Tumor regression was observed in both Groups 4 (Vehicle + 93 mg/kg CP) and 6 (Compound 1 + 93 mg/kg CP). Tumor regression in Group 4, however, occurred after rapid growth and was short lived. No tumor growth was observed in Group 6 (although average tumor size did increase after day 16 due to attrition). In comparison to Group 4, tumor regression in Group 6 occurred earlier and was also more pronounced. Animals in Groups 1 (no treatment control) and 2 (Compound 1 control) were randomized and segregated into Groups 4 and 6 on day 9 as previously stated. The differences between Groups 4 and 6 observed after the second course of treatment were evident whether these animals were included in the analysis or not. Moreover, tumor regression was similar in both Groups 1 and 2 following treatment if viewed as split groups treated nine days after presentation. However, it is possible that tumors not previously treated with chemotherapy may exhibit different growth kinetics relative to tumors being treated with chemotherapy a second time and may thus act as a confounding factor when examining Groups 4 and 6 with animals from Groups 1 and 2 after the second treatment.
Survival None of the groups treated with Compound 1 dispersion benefited with respect to long-term survival as nearly all animals in those groups were dead by day 19. However, the attrition rate in Group 5 (Compound 1 + 35 mg/kg CP) was slower than that of Group 3 (Vehicle + 35 mg/kg CP). Compound 1 may enhance the myelosuppression associated with higher doses of CP as a marked reduction in the number of survivors was observed in Group 6 seven days following the second course of treatment.
The results described above are summarized. in Figure 2.
We claim:

Claims

1. A method for treating a subject having a cancer sensitive to treatment with a combination of an anti-cancer agent and a porphyrin biosynthesis inhibitor comprising: administering to a subject in need of such treatment the anti-cancer agent and the porphyrin biosynthesis inhibitor in a combined amount effective to inhibit growth of the cancer, said combined amount being an amount of anti-cancer agent and an amount of porphyrin biosynthesis inhibitor, wherein the amount of porphyrin biosynthesis inhibitor is effective to potentiate the amount of anti-cancer agent versus the same amount of the anti- cancer agent if administered without the porphyrin biosynthesis inhibitor.
2. The method of claim 1, wherein the porphyrin biosynthesis inhibitor is administered to the subject as an oral formulation.
3. The method of claim 1 , wherein the cancer is selected from the group consisting of biliary tract cancer; brain cancer, including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer; gastric cancer; hematological neoplasms, including acute lymphocytic and myelogeneous leukemia; multiple myeloma; AIDS associates leukemias and adult T-cell leukemia lymphoma; intraepithelial neoplasms, including Bo wen's disease and Paget's disease; liver cancer; lung cancer; lymphomas, including Hodgkin's disease and lymphocytic lymphomas; neuroblastomas; oral cancer, including squamous cell carcinoma; ovarian cancer, including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreas cancer; prostate cancer; rectal cancer; sarcomas, including leiomyosarcoma, rhabdomyosarcoma, liposarcoma, fibrosarcoma and osteosarcoma; skin cancer, including melanoma, Kaposi's sarcoma, basocellular cancer and squamous cell cancer; testicular cancer, including germinal tumors (seminoma, non-seminoma[teratomas, choriocarcinomas]), stromal tumors and germ cell tumors; thyroid cancer, including thyroid adenocarcinoma and medullar carcinoma; and renal cancer including adenocarcinoma and Wilms tumor.
4. The method of claim 1, wherein the cancer is selected from the group consisting of epithelial cell cancers, leukemia and lymphomas.
5. The method of claims 1, 2, 3 or 4, wherein the porphyrin biosynthesis inhibitor s the compound of Formula I or a metabolite thereof.
6. The method of claims 1, 2, 3 or 4, wherein the porphyrin biosynthesis inhibitor s the compound of Formula I.
7. The method of claims 1, 2, 3 or 4, wherein the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
8. The method of claim 6, wherein the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
9. A method for treating a subject having a cancer comprising: administering to the subject an amount of an anti-cancer agent, and administering substantially simultaneously therewith an amount of a porphyrin biosynthesis inhibitor, wherein said amounts when administered are effective for inhibiting growth of the cancer.
10. The method of claim 9, wherein the porphyrin biosynthesis inhibitor is administered to the subject as an oral formulation.
11. The method of claim 9, wherein the cancer is selected from the group consisting of biliary tract cancer; brain cancer, including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer; gastric cancer; hematological neoplasms, including acute lymphocytic and myelogeneous leukemia; multiple myeloma; AIDS associates leukemias and adult T-cell leukemia lymphoma; intraepithelial neoplasms, including Bowen's disease and Paget's disease; liver cancer; lung cancer; lymphomas, including Hodgkin's disease and lymphocytic lymphomas; neuroblastomas; oral cancer, including squamous cell carcinoma; ovarian cancer, including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreas cancer; prostate cancer; rectal cancer; sarcomas, including leiomyosarcoma, rhabdomyosarcoma, liposarcoma, fibrosarcoma and osteosarcoma; skin cancer, including melanoma, Kaposi's sarcoma, basocellular cancer and squamous cell cancer; testicular cancer, including germinal tumors (seminoma, non-seminoma[teratomas, choriocarcinomas]), stromal tumors and germ cell tumors; thyroid cancer, including thyroid adenocarcinoma and medullar carcinoma; and renal cancer including adenocarcinoma and Wilms tumor.
12. The method of claim 9, wherein the cancer is selected from the group consisting of epithelial cell cancers, leukemias, lymphomas and sarcomas.
13. The method of claims 9, 10, 11 or 12, wherein the porphyrin biosynthesis inhibitor is the compound of Formula I or a metabolite thereof.
14. The method of claims 9, 10, 11 or 12, wherein the porphyrin biosynthesis inhibitor is the compound of Formula I.
15. The method of claims 9, 10, 11 or 12, wherein the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
16. The method of claim 14, wherein the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
17. In a method for treating cancer with a anti-cancer agent by administering to a subject in need of such treatment an anti-cancer agent to inhibit growth of the cancer, the improvement comprising co-administering to the subject the porphyrin biosynthesis inhibitor in an amount effective to potentiate the anti-cancer agent's inhibition of growth of the cancer.
18. The method of claim 17, wherein the porphyrin biosynthesis inhibitor is administered to the subject as an oral formulation.
19. The method of claim 17, wherein the cancer is selected from the group consisting of biliary tract cancer; brain cancer, including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer; gastric cancer; hematological neoplasms, including acute lymphocytic and myelogeneous leukemia; multiple myeloma; AIDS associates leukemias and adult T-cell leukemia lymphoma; intraepithelial neoplasms, including Bowen's disease and Paget's disease; liver cancer; lung cancer; lymphomas, including Hodgkin's disease and lymphocytic lymphomas; neuroblastomas; oral cancer, including squamous cell carcinoma; ovarian cancer, including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreas cancer; prostate cancer; rectal cancer; sarcomas, including leiomyosarcoma, rhabdomyosarcoma, liposarcoma, fibrosarcoma and osteosarcoma; skin cancer, including melanoma, Kaposi's sarcoma, basocellular cancer and squamous cell cancer; testicular cancer, including germinal tumors (seminoma, non-seminoma[teratomas, choriocarcinomas]), stromal tumors and germ cell tumors; thyroid cancer, including thyroid adenocarcinoma and medullar carcinoma; and renal cancer including adenocarcinoma and Wilms tumor.
20. The method of claim 17, wherein the cancer is selected from the group consisting of epithelial cell cancers, leukemias, lymphomas and sarcomas.
21. The method of claims 17, 18, 19 or 20, wherein the porphyrin biosynthesis inhibitor is the compound of Formula I or a metabolite thereof.
22. The method of claims 17, 18, 19, or 20, wherein the porphyrin biosynthesis inhibitor is the compound of Formula I.
23. The method of claims 17, 18, 19 or 20, wherein the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
24. The method of claim 22, wherein the porphyrin biosynthesis inhibitor is administered to the subject prior to administering the anti-cancer agent.
25. A kit, comprising a package containing: a first vial containing an anti-cancer agent, and a second vial containing a porphyrin biosynthesis inhibitor.
26. The kit of claim 25, further comprising instructions for using the anti-cancer agent and the porphyrin biosynthesis inhibitor to treat a subject with cancer.
27. The kit of claim 25, wherein said porphyrin biosynthesis inhibitor is the compound of Formula I or a metabolite thereof.
28. The kit of claim 25, wherein said porphyrin biosynthesis inhibitor is the compound of Formula I.
29. A kit, comprising a package containing: a vial containing an anti-cancer agent, and instructions for using the anti-cancer agent in combination with a porphyrin biosynthesis inhibitor to treat a subject with cancer.
30. The kit of claim 29, wherein said porphyrin biosynthesis inhibitor is the compound of Formula I or a metabolite thereof.
31. The kit of claim 29, wherein said porphyrin biosynthesis inhibitor is the compound of Formula I.
32. A kit, comprising a package containing: a vial containing a porphyrin biosynthesis inhibitor, and instructions for using the porphyrin biosynthesis inhibitor in combination with an anti-cancer agent to treat a subject with cancer.
33. The kit of claim 32, wherein said porphyrin biosynthesis inhibitor is the compound of Formula I or a metabolite thereof.
34. The kit of claim 32, wherein said porphyrin biosynthesis inhibitor is the compound of Formula I .
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