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  • A61K31/7048—Compounds having saccharide radicals and heterocyclic rings having oxygen as a ring hetero atom, e.g. leucoglucosan, hesperidin, erythromycin, nystatin, digitoxin or digoxin
• • A—HUMAN NECESSITIES
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  • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
• • A—HUMAN NECESSITIES
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  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4738—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/4745—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems condensed with ring systems having nitrogen as a ring hetero atom, e.g. phenantrolines
• • A—HUMAN NECESSITIES
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  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/475—Quinolines; Isoquinolines having an indole ring, e.g. yohimbine, reserpine, strychnine, vinblastine
• • A—HUMAN NECESSITIES
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  • 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
  • A61K31/33—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
  • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
• • 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
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
• • 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
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
  • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
  • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
  • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
  • A61K31/7076—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines containing purines, e.g. adenosine, adenylic acid
• • 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
• • 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
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents

Definitions

• the technical field of the invention is the use of naphthalimides with antiproliferative agents to treat a host with a cellular proliferative disease.
• Conventional antiproliferative agents used in the treatment of cancer are broadly grouped as (1) chemical compounds which affect the integrity of nucleic acid polymers by binding, alkylating, inducing strand breaks, intercalating between base pairs or affecting enzymes which maintain the integrity and function of DNA and RNA; (2) chemical agents that bind to proteins to inhibit enzymatic action (e.g., antimetabolites) or the function of structural proteins necessary for cellular integrity (e.g., antitubulin agents).
• Other chemical compounds that have been identified to be useful in the treatment of some cancers include drugs which block steroid hormone action for the treatment of breast and prostate cancer, photochemically activated agents, radiation sensitizers, and protectors.
• Nucleic acid polymers such as DNA and RNA are prime targets for anticancer drugs.
• Alkylating agents such as nitrogen mustards, nitrosoureas, aziridine containing compounds directly attack DNA.
• Metal coordination compounds such as cisplatin and carboplatin similarly directly attack the nucleic acid structure resulting in lesions that are difficult for the cells to repair which, in turn, can result in cell death.
• nucleic acid affecting compounds include anthracycline molecules such as doxorubicin, which intercalates between the nucleic acid base pairs of DNA polymers, bleomycin, which causes nucleic acid strand breaks, fraudulent nucleosides such as pyrimidine and purine nucleoside analogs, which are inappropriately incorporated into nucleic polymer structures and ultimately cause premature DNA chain termination.
• anthracycline molecules such as doxorubicin, which intercalates between the nucleic acid base pairs of DNA polymers, bleomycin, which causes nucleic acid strand breaks
• fraudulent nucleosides such as pyrimidine and purine nucleoside analogs
• Certain enzymes that affect the integrity and functionality of the genome can also be inhibited in cancer cells by specific chemical agents and result in cancer cell death.
• ribonucleotide reductase e.g., hydroxyurea, gemcitabine
• topoisomerase I e.g., camptothecin
• topoisomerase II e.g., etoposide
• cisplatin cis- diamminedichloroplatinum II, CDDP. This compound is active against several human cancers including testicular, small-cell lung, bladder, cervical and head and neck cancer.
• the invention described herein demonstrates the novel use of the naphthalimides and analogs thereof, including amonafide, which can potentiate the antitumor effects of chemotherapeutic drugs, in particular, agents affecting the integrity of nucleic polymers such as DNA.
• compositions are provided for the treatment of a host having a cellular proliferative disease, particularly a neoplasia.
• pharmaceutically acceptable naphthalimide and an antiproliferative agent are administered in an amount sufficient to modulate the cellular proliferative disease..
• FIGURES Figure 1 depicts the general structure of a naphthalimide analog.
• R* and R 2 represent substitution groups.
• Figure 2 depicts the structure of the naphthalimide analog, amonafide.
• Figure 3 shows tumor growth delay, as tumor volume on days after treatment with the naphthalimide analog, amonafide, amonafide followed by CDDP, or CDDP alone.
• naphthalimide is administered, preferably systemically, in conjunction with an antiproliferative agent to improve the anticancer effects.
• the naphthali ⁇ " de provides a chemopotentiator effect.
• modulation of a cellular proliferative disease comprises a reduction in tumor growth.
• modulation of a disease comprises inhibition of tumor growth.
• modulation of a cellular proliferative disease comprises an increase in tumor volume quadrupling time (described below).
• modulation of a cellular proliferative disease comprises a chemopotentiator effect.
• modulation of a disease comprises a chemosensitizing effect.
• modulation of a disease comprises cytostasis.
• modulation of a disease comprises a cytotoxic effect.
• a chemical agent is a "chemopotentiator" when it enhances the effect of a known antiproliferative drug in a more than additive fashion relative to the activity of the chemopotentiator or antiproliferative agent used alone.
• a "chemosensitizing" effect may be observed. This is defined as the effect of use of an agent that if used alone would not demonstrate significant antitumor effects but would improve the antitumor effects of an antiproliferative agent in a more than additive fashion than the use of the antiproliferative agent by itself.
• naphthalimide includes all members of that chemical family including benzisoquinolinedione and analogs thereof.
• the naphthalimide family is defined by chemical structure as depicted in Figure 1.
• a naphthalimide analog is further defined but not limited to substituent changes in R, and R 2 ( Figure 1). Examples of R, and R 2 include those listed in Table 1. In a preferred embodiment, a naphthalimide analog has the structure of amonafide, shown in Figure 2.
• a naphthalimide analog is a further chemical refinement.
• a specific example of a naphthalimide analog is amonafide which is also known by the following chemical synonyms: Nafidamide; Benzisoquinolinedione; 5-amino-2-[(dimethylamine)ethyl]-lH- benz[de-]isoquinoline-l,3-(2H)-dione ( Figure 2).
• antiproliferative agents are compounds which induce cytostasis or cytotoxicity .
• Cytostasis is the inhibition of cells from growing while “cytotoxicity” is defined as the killing of cells.
• antiproliferative agents include: antimetabolites, such as methotrexate, 5-fluorouracil, gemcitabine, cytarabine, pentostatin, 6-mercaptopurine, 6-thioguanine, L- asparaginase, hydroxyurea, N-phosphonoacetyl-L-aspartate (PALA), fludarabine, 2- chlorodeoxyadenosine, and floxuridine; structural protein agents, such as the vinca alkaloids, including vinblastine, vincristine, vindesine, vinorelbine, paclitaxel, and colchicine; agents that affect NF-KB, such as curcumin and parthenolide; agents that affect protein synthesis, such as homoharringtonine; antibiotics, such as dactinomycin, daunorubicin, doxorubicin, idarubicin, bleomycins, plicamycin, and mitomycin; hormone antagonists, such as tamoxifen and
• Transplantable experimental murine fibrosarcomas (2x10 ⁇ RIF-1 cells) were grown intradermally in the flanks of 3 month old female C3H mice (Charles River, Holister, CA). When the tumors reached a volume of approximately lOOmm ⁇ , the mice were randomly assigned to each experimental group (4 mice per group).
• the chemopotentiator, amonafide was obtained from NCI and was made to the appropriate concentration in DMSO. Cisplatin (David Bull Laboratories- Mulgrave, Australia, lot. 5201844x) was made to the appropriate concentration in water for injection. The compositions were injected systemically (i.e., intraperitoneally, i.p.), in a volume of 100 microliters. For the treatment of group 3, the chemopotentiator, amonafide, was injected 30 minutes prior to the injection of cisplatin. After treatment, the growth of the tumors was monitored three times per week by caliper measurements of three pe ⁇ endicular diameters of the tumor and calculation of tumor volume from the formula:
• V ⁇ / 6 x D- x D 2 x D 3 , where Dj_3 is in mm.
• the tumors were followed until they reached a size of four times their day zero treatment volume (TVQT), or up to 30 days after treatment, whichever came first.
• the data is expressed as the "tumor volume quadrupling time" (TVQT) mean and as the “delay.”
• Mean TVQT is the mean days required for individual tumors to grow to four times the tumor volume at the initial treatment day.
• the "delay” is the median of days required for a tumor to grow to four times the mean size of the treated group, minus the median of days required to grow to four times the mean size of the control group.
• the data is also expressed as the ratio of the tumor volume quadrupling time of the treated tumor over the untreated control group (TVQT/CTVQT). Increasing values of this ratio indicate increased antitumor response.
• the RIF-1 murine fibrosarcoma tumor model was used to evaluate the antitumor activity of amonafide, alone and and in combination with various antiproliferative agents.
• the antiproliferative agents used include those that affect nucleic acid (e.g., DNA) integrity (e.g., cisplatin, etoposide, 5-fluorouracil), agents that affect structural or cytoplasmic proteins or their synthesis (e.g., homoharringtonine, paclitaxel, vinblastine, colchicine, curcumin or parthenolide).
• Amonafide-NCI was obtained from NCI as a powder.
• Amonafide-Penta was obtained from Penta Biotech (Union City, CA), Lot No.039-01, as a powder.
• Cisplatin for Injection, USP was obtained from David Bull Labs (Mulgrave, Australia), Lot No.5201844x, as a lypholized powder.
• Paclitaxel was obtained from Bristol Myers Squibb Co. (Princeton, NJ), Lot No. 9J16241, exp. Sep 2001, prediluted to 6 mg/mL in Cremaphor/EL.
• Vinblastine was obtained from Bedford Labs (Bedford, OH), Lot No.112647, as a lypholized powder.
• Etoposide was obtained from Pharmacia (Kalamazoo, MI), Lot No. ETA013, exp. 5/99, as a liquid prediluted to 20 mg/mL.
• 5-Fluorouracil was obtained from Pharmacia (Kalamazoo, MI), Lot No.FFA191, exp. 7/00, as a liquid prediluted to 50 mg/mL.
• Curcumin was obtained from Sigma (St. Louis, MO), Lot No. 69H3457.
• Parthenolide was obtained from Tocris (Ballwin, MO) Lot No. 7/18089.
• DMSO was obtained from Sigma (St. Louis, MO), Lot No.80K3695.
• USP 0.9% Sodium Chloride for Injection
• USP saline
• WFI Sterile Water for Injection
• Test preparations (treatment groups) are summarized in Table 4.
• amonafide was weighed into vials and dissolved in saline.
• paclitaxel prediluted in Cremaphor/EL and dehydrated alcohol to 6 mg/mL was further diluted to 3.3 mg/mL with WFI.
• Formulation 6 was made by adding 0.9% Sodium Chloride for Injection to a vial of 10 mg of vinblastine lypholized powder.
• Formulations 7-10 were prepared by diluting the appropriate amount of each test agent into saline (7- 2.5 mg/mL etoposide, 8- 7.5 mg/mL 5-fluorouracil, 9- 3.75 mg/mL 5-fluorouracil 10- 2.5 mg/mL colchicine,).
• Formulation 11 was undiluted HHT-Clin, used as received.
• Formulations 12 and 13 were prepared by diluting the appropriate amount of each test agent into DMSO (12- 6.25 mg/mL curcumin and 13- 5 mg/mL parthenolide).
• mice Female C3H mice (Charles River Laboratories, Holister, CA), approximately 3 months old, were used for the study. The average body weight was approximately 25 g. Animals were maintained in isolator cages on a 12-hour light-and-dark cycle. Food and water were available ad libitum.
• the RIF-1 murine fibrosarcoma cell line was maintained in in vitro culture (Waymouth medium supplemented with 20%) fetal bovine serum) at 37°C in a humidified 5% CO 2 incubator.
• Log-phase RIF-1 cells were trypsinized and harvested from cell culture flasks to yield a concentration of 4 x 10 6 cells/mL, then injected intradermally in a volume of 50 ⁇ L (equivalent to 2 x 10 5 cells per injection) into both flanks of each mouse.
• tumors reached approximately 100 mm 3 in size, the animals were randomized to different treatment groups.
• Treatment groups are summarized in Table 4. Four to five animals were assigned to each treatment group. The intraperitoneal injection volume was 100 ⁇ L. The oral administration volume was 100 ⁇ L. Combination treatments using two test agents were administered as two separate injections, with the second one following the first either immediately or after 30 minutes.
• Tumors were measured three times weekly for up to 22 days with Vernier calipers. Tumor volume (cubic millimeters, mm 3 ) was calculated according to the formula:
• V ⁇ / 6 x Di x D 2 x D 3
• D 1 . 3 are perpendicular diameters measured in millimeters (mm).
• TVQT Tumor volume quadrupling time
• Antitumor activity or modulation of tumor growth (as measured by delayed tumor growth, i.e. increases in TVQT values) by amonafide administered as a single agent or in combination with other chemotherapeutics is presented in Table 5.
• Amonafide-Penta formulated in saline at 30 mg/Kg was used for the remainder of the combination studies.
• amonafide had an average TVQT of 7.3 days.
• colchicine (10 mg/Kg) yielded a TVQT of 6.3 days.
• Amonafide in combination with colchicine increased the TVQT to 7.1 days.
• mice There were animal deaths in some groups that were recorded as follows: Two of four mice died after treatment of amonafide- ⁇ CI formulated in DMSO at 12.5 mg/mL.
• intraperitoneal administration of amonafide had antitumor activity in the RIF-1 murine fibrosarcoma tumor model.
• Intraperitoneal administration of amonafide in combination with cisplatin, paclitaxel, vinblastine, 5-fluorouracil and homoharringtonine had antitumor activity levels greater than amonafide alone, or the individual test agents.
• Amonafide in combination with colchicine had antitumor activity less than amonafide alone.
• Amonafide in combination with etoposide, curcumin or parthenolide was greater than that of amonafide alone, but less than that of the test agents, individually.

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