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
• • 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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/138—Aryloxyalkylamines, e.g. propranolol, tamoxifen, phenoxybenzamine
• • 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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents

Definitions

• the present invention is concerned with pharmaceutical compositions suitable for the treatment of cancer, and in particular, with pharmaceutical compositions containing vitamin D or a precursor, analogue or metabolite thereof and the use of these compositions in the treatment of a tumor in a subject.
• Vitamin D is an isoprenoid compound made up of activated 5-carbon units.
• the most abundant form of vitamin D is vitamin D 3 , or cholecalciferol.
• Vitamin D 3 arises from biosynthesis of 7-dehydrocholesterol, an intermediate in cholesterol biosynthesis.
• Vitamin D 3 is metabolised in the liver to 25- hydroxycholecalciferol [25(OH)D 3 ] which is a major form of Vitamin D circulating in the blood compartment.
• 25(OH)D 3 is converted by the kidney to produce two principal dihydroxylated metabolites, namely, 1,25- dihydroxycholecalciferol [l,25(OH) 2 D 3 ] and 24,25-dihydroxycholecalciferol [24R,25(OH) 2 D 3 ].
• l,25(OH) 2 D 3 is the most biologically active naturally occurring form of vitamin D 3 and is transported in the bloodstream to its major site of action in the mucosal cells of the intestine, where calcium absorption is stimulated.
• vitamin D 3 may be regarded as a prohormone because it is converted to a metabolite that acts analogously to a steroid hormone. It regulates calcium and phosphorous metabolism particularly in the synthesis of the inorganic matrix of bones. Systemic administration of high doses of vitamin D 3 or its metabolites is limited by the production of hypercalcaemia. This has led to the development of analogues of activated vitamin D (D 3 ) which have a greater effect on cell growth than on calcium metabolism. These compounds have been found to be effective in the inhibition of growth of breast, rectal, colorectal and prostate cancer cells. Disclosure of the Invention
• tumors in certain organs for example, primary and secondary tumors in the liver, can be treated by regional delivery of high concentrations of l,25(OH) 2 D 3 to the affected organ without giving rise to hypercalcaemia.
• PCT/AU98/00440 discloses a method for the treatment of liver cancer by means of regional delivery of vitamin D or its metabolite or analogues to the liver.
• the effect on tumors is very dose dependent and there is therefore advantage in delivering higher concentrations of vitamin D compounds such as l,25(OH) 2 D 3 .
• a conventional carrier such as water places an upper limit on the concentration of the compound that can be delivered to the organ. Delivery of vitamin D 3 intra-arterially in a conventional carrier limits the vitamin D 3 concentration in the blood going to the liver to at most 10 "7 mole per litre.
• vitamin D compound such as l,25(OH) 2 D 3
• a lipid for example, an iodised or non-iodised oil.
• an oil as the carrier for the vitamin D compound is that some oils are concentrated in certain cancers allowing the achievement of very high tumor concentrations of vitamin D 3 .
• the use of a lipid as the carrier for the vitamin D compound results in a sustained antiproliferative activity of the vitamin D compound and the compound is retained for considerably longer periods within the tumor.
• the present invention provides a pharmaceutical composition suitable for use in the treatment of cancer cells in an organ by regional delivery of the composition to the organ, the composition including a vitamin D compound and a pharmaceutically acceptable lipid, wherein the concentration of the vitamin D compound in the composition is greater than about 1 x 10 " mole per litre.
• vitamin D compound we include the biologically active and inactive forms of vitamin D.
• the vitamin D compound may be a precursor, metabolite or analogue of vitamin D.
• the vitamin D compound may be any analogue having anti-tumor properties.
• the vitamin D compound may be cholecalciferol, 25(OH)D 3 or l,25(OH) 2 D 3 .
• analogues of vitamin D include, but are not restricted to, EB1089, OCT (22-oxa- l,25(OH) 2 D 3 ), l ⁇ 25(OH) 2 , 22,24 diene, 24, 26, 27 trihomo D 3 , MC903 (calcipotriol) and KH1060, l,25(OH) 2 -16-ene 23-yne vitamin D 3 and its hexadeutero form.
• the vitamin D compound may be vitamin D 5 or an analogue thereof.
• the concentration of vitamin D compound in the composition of the invention is at least about 1 x 10 "6 mole per litre.
• the concentration of vitamin D compound may be at least about 1 x 10 "5 mole per litre.
• the concentration may be at least about 1 x 10 "4 mole per litre.
• the concentration may be at least 1 x 10 "3 mole per litre.
• a preferred concentration of the vitamin D compound is about 1 x 10 " to 50 x 10 "5 mole per litre.
• the lipid used is one for which the tumor is avid so that high concentrations of the vitamin D compound are delivered to the tumor.
• lipid avid To determine whether the tumor being treated is lipid avid or not, a small dose of lipid may be given into the hepatic artery by a percutaneous or surgically placed catheter. A tumor that is not lipid avid is unlikely to benefit from the treatment to the same extent as a tumor that is avid to the the lipid used.
• the pharmaceutically acceptable lipid may be an oil.
• a non-iodised oil is preferred.
• the non-iodised oil may be any pharmaceutically acceptable oil in which the vitamin D compound is soluble.
• the non-iodised oil may be a vegetable oil.
• the oil may be, for example, poppy seed oil, soybean oil, sesame oil, safflower oil, peanut oil, cremophore, Liposyn or Intralipid.
• the oil may be derived from shark liver oil including squalane and squalene.
• the lipid may be medium chain triglycerides (MCT).
• iodised oil such as iodised poppy seed oil (lipiodol) can be used, however, the iodine has the effect of making the vitamin D compound more light sensitive.
• the lipid may be in the form of an emulsion of these oils prepared with pharmaceutically acceptable emulsifying agents including, but not limited to, natural and synthetic phospholipids, Spans, Tweens or Pluronics.
• the higher concentrations of vitamin D compounds achievable in the composition of the invention provide a reservoir of the vitamin D compound, which is released over time, thus allowing for "one shot” administration of the composition.
• composition of the invention is capable of providing higher concentrations of vitamin D, even non-active forms of vitamin D may be used to treat tumors. Although at low concentrations these non-active forms may not be effective treating tumors, at very high concentrations they may become effective.
• composition of the invention may further include one or more other components.
• the present composition may contain a component that is capable of increasing vitamin D receptor expression.
• the composition may include an estrogen, estrogen-like compound or estrogen antagonist.
• the component may be tamoxifen.
• the composition may be used to treat primary or secondary tumors in any organ to which the composition can be administered by regional delivery. Accordingly, the present invention further extends to a method for the treatment of a tumor in an organ in a subject, the method including regional administration to the organ of a composition in accordance with the present invention.
• the regional delivery may be by means of intra-arterial delivery, for example, by intra-arterial infusion.
• the composition of the invention may be delivered to the portal vein.
• the tumor may be a primary or secondary tumor.
• the organ treated may be the liver, breast, prostate, bone tumor or kidney.
• the composition of the invention may also be used to treat colorectal cancer or sarcomas.
• the method and composition of the present invention are particularly suitable for the treatment of hepatoma.
• the vitamin D compound may be dissolved in lipid as described above, for example, iodised or non-iodised poppy seed oil to the desired concentration of vitamin D compound.
• the method of the invention may be repeated at monthly, or other, intervals. It will be readily apparent that the composition and method of the present invention provide the capability of delivering very high local concentration of vitamin D substance delivered by the composition of the present invention will achieve tumor control and whilst avoiding hypercalcaemia.
• Figure 1 is a photograph taken under a microscope showing uptake of lipiodol by HepG2 cells exposed to a medium with 1% lipiodol or without lipiodol (control). Lipiodol is stained red using the Oil red O technique.
• Figure 6 provides bar graphs showing the 1 hour post injection level of radioactive vitamin D 3 in the liver, tumor and plasma of Sprague-Dawley rats following administration of vitamin D 3 /Tween, vitamin D 3 /MCT and vitamin D 3 /lipiodol respectively as described in paragraph 2 below (In vivo studies in tumor bearing rats ).
• Figure 7 is a bar graph giving a summary of the 1 hour results shown in Figure 6.
• Figure 8 provides bar graphs showing the 1 day post injection level of radioactive vitamin D 3 in the liver, tumor and plasma of Sprague-Dawley rats following of vitamin D 3 /Tween, vitamin D 3 /MCT and vitamin D 3 /lipiodol respectively as described in paragraph 2.
• Figure 9 is a bar graph giving a summary of the 1 day results shown in Figure 8.
• Figure 10 provides bar graphs showing the 3 day post injection level of radioactive vitamin D 3 in the liver, tumor and plasma of Sprague-Dawley rats following administration of vitamin D 3 /Tween, vitamin D 3 /MCT and vitamin D 3 /lipiodol respectively as described in paragraph 2.
• Figure 11 is a bar graph giving a summary of the 3 day results shown in Figure 10.
• Figure 12 provides graphs showing the effect of intra-hepatic arterial administration of vitamin D 3 (50 ⁇ g) on AFP and calcium levels in a patient with HCC.
• the control cells for the vitamin D 3 /lipiodol group were treated with a lipiodol-containing medium (1%).
• a lipiodol-containing medium 1%
• cells were plated in six well plates at a concentration of 5 x 10 4 cells per well.
• Cell treatment procedure was a described for the thymidine assay.
• cells were trypsinised and counted with a hemocytometer. All counts were obtained in quadruplicate and each experiment was repeated at least twice. Unpaired Student's t-test was used for comparisons of treated versus control values and p ⁇ 0.05 was considered to represent a significant difference.
• HepG2 cells exposed to lipiodol consistently demonstrated multiple intracellular red vesicles of lipiodol on oil-red O impregnation, while, there was no sign of lipiodol in control cells (Fig 1).
• HepG2 cells When treated chronically, HepG2 cells showed significant reduction in thymidine incorporation at all concentrations of vitamin D 3 and in both delivery systems used. However, in cells exposed to the vitamin iyiipiodol delivery system, the degree of inhibition of thymidine incorporation was significantly greater (Fig 2).
• Groups 7-9 receiving 100 ⁇ l of MCT • Groups 10-12 receiving vitamin D3 (hot + cold) in 100 ⁇ l of MCT
• liver and the tumor of each animal was excised, weighed and frozen in the freezer until analysis. After tissue homogenization, liver, tumor or plasma was extracted with dichloromethane. The amount of hot vitamin D3 present in each sample was determined using a ⁇ -counter.
• Patients suffering from primary HCC were selected according to the inclusion/exclusion criteria. After conduction of all medical and paramedical tests, patients received a single dose of 50 ⁇ g vitamin D 3 dissolved in 5 ml of lipiodol through the hepatic artery administered by an expert radiologist. Drug formulation was carried out under complete aseptic conditions in the oncology pharmacy unit of the hospital. Every 24 hours post drug administration, blood samples were withdrawn for the determination of serum AFP, calcium and vitamin D 3 levels daily for 3 days after which the patient was discharged from the hospital and visited once a week for 4 weeks
• vitamin D 3 is a drug which due to its chemical structure is vulnerable to extensive metabolism and to add to this
• HepG2 is a cell line with extensive metabolizing capacities (4).

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• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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• 1998
  • 1998-05-04 AU AUPP3328A patent/AUPP332898A0/en not_active Abandoned
• 1999
  • 1999-05-04 KR KR1020007012271A patent/KR20010052305A/ko not_active Abandoned
  • 1999-05-04 CN CNB998081574A patent/CN1204893C/zh not_active Expired - Fee Related
  • 1999-05-04 HK HK02105428.9A patent/HK1044117B/zh not_active IP Right Cessation
  • 1999-05-04 JP JP2000546727A patent/JP2002513733A/ja active Pending
  • 1999-05-04 EP EP99916716A patent/EP1124557A4/en not_active Withdrawn
  • 1999-05-04 WO PCT/AU1999/000323 patent/WO1999056697A2/en not_active Ceased
• 2000
  • 2000-11-27 ZA ZA200006953A patent/ZA200006953B/en unknown
• 2001
  • 2001-05-22 US US09/861,865 patent/US6664246B2/en not_active Expired - Fee Related

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