Classifications

• • 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
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7028—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages
  • A61K31/7034—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages attached to a carbocyclic compound, e.g. phloridzin
  • A61K31/704—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages attached to a carbocyclic compound, e.g. phloridzin attached to a condensed carbocyclic ring system, e.g. sennosides, thiocolchicosides, escin, daunorubicin
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/18—Drugs for disorders of the alimentary tract or the digestive system for pancreatic disorders, e.g. pancreatic enzymes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/02—Antineoplastic agents specific for leukemia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/04—Antineoplastic agents specific for metastasis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention relates to pharmaceutical combinations useful in the treatment of cancer.
• the combinations of this invention relate to dioxolane nucleosides with at least one further therapeutic agent chosen from nucleoside analogues and/or chemotherapeutic agents.
• Cancer is the second leading cause of death in the United States. It is estimated that cancer is responsible for 30% of all deaths in the Western world. Lung, colorectal, breast and prostate cancers are the four biggest killers.
• nucleoside analogues have been found to possess anticancer activity. It was reported in (Weitman et al Clinical Cancer Research (2000), 6(4), pp 1574-1578 and Giles et al Journal of Clinical Oncology (2001), 19(3), pp 762-771 and also Gourdeau et al Cancer Chemother. Pharmacol . (2001), 47(3), pp 236-240) that troxacitabine ( ⁇ -L-dioxolane cytidine, ⁇ -L-OddC,
• TroxatylTM a nucleoside analogue
• various forms of cancers e.g. solid tumours, adult leukemia and lymphomas
• Cytarabine Ara-C
• fludarabine gemcitabine
• gemcitabine a nucleoside analogue
• cladribine a nucleoside analogue which are also well known in the treatment of cancer.
• combinations of cytarabine and anthracyclines have been the subject of most intense study.
• the current therapies fail to cure most cancers once they have recurred.
• the present invention provides combinations of troxacitabine with other nucleoside analogues and/or che otherapeutic agents which exhibit potent antitumor activity and would greatly aid in the development of new combination therapy against cancer.
• the present invention provides a novel pharmaceutical combination useful for the treatment of cancer in a mammal comprising at least one active compound of formula (1) :
• B is cytosine or 5-fluorocytosine and R is selected from the group comprising H, monophosphate, diphosphate, triphosphate, carbonyl substituted with a C ⁇ - 6 alkyl, C 2 - 6 alkenyl , C 2 - 6 alkynyl, C 6-10 aryl and O
• each Re is independently selected from the group comprising H, C ⁇ _ 6 alkyl, C 2 - 6 alkenyl, C 2 -s alkynyl and a hydroxy protecting group;
• nucleoside analogue and/or a chemotherapeutic agent .
• the pharmaceutical combinations of the present invention are useful in cancer therapy, in particular in the treatment of cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarco a, hepatocellular carcinoma, leukemia and lymphomas in patients.
• cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarco a, hepatocellular carcinoma, leukemia and lymphomas in patients.
• the pharmaceutical combinations of the present invention are useful in cancer therapy, in particular in the treatment of cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, and lymphomas in patients.
• the pharmaceutical combinations of the present invention are useful in cancer therapy, in particular in the treatment of leukemia.
• the pharmaceutical combinations of the present invention are useful in cancer therapy, in particular in the treatment of pancreatic cancer.
• a method of treating a patient having cancer comprising administering to said patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent.
• a method of treating a patient having cancer in particular in the treatment of cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, leukemia and lymphomas, comprising administering to said patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent.
• a method of treating a patient having a cancer, in particular a cancer other than leukemia comprising administering to said patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent.
• a method of treating a patient having cancer in particular in the treatment of cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, and lymphomas, comprising administering to said patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent.
• a method of treating a patient having cancer, in particular in the treatment of refractory leukemia comprising administering to said patient having refractory leukemia a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent.
• the further therapeutic agent is other than doxorubicin.
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• a pharmaceutical formulation comprising the combination of the compound of formula (I) and at least one further therapeutic agent in combination with at least a pharmaceutically acceptable carrier or excipient .
• the further therapeutic agent is other than doxorubicin.
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• Another aspect of the invention is the use of a compound according to formula (I) and at least one further therapeutic agent, for the manufacture of a medicament for treating cancer in a mammal .
• the further therapeutic agent is other than doxorubicin.
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• Figure 1 represents the graphical representation of tumor growth inhibition results of single and combination dosing of troxacitabine and gemcitabine in the MiaPaCa Human pancreatic tumor xenograft model .
• Figure 2 represents the graphical representation of tumor growth inhibition results of single and combination dosing of troxacitabine and gemcitabine in the Panc-01 Human pancreatic tumor xenograft model.
• Figure 3 represents the graphical results using CalcuSyn Analysis for the combination of troxacitabine and Ara-C as tested on the CCRF-CEM leukemia cell line.
• the present invention provides a novel pharmaceutical combination useful for the treatment of cancer in a mammal comprising at least one active compound of formula (I) :
• B is cytosine or 5- f luorocytosine and R is selected from the group comprising H, monophosphate, diphosphate , triphosphate , carbonyl substituted with a C ⁇ - 6 alkyl , C 2 -6 alkenyl , C 2 -6 alkynyl , C 6 - ⁇ o aryl and O
• each Re is independently selected from the group comprising H, C ⁇ - 6 alkyl, C 2 -s alkenyl, C 2 -6 alkynyl and a hydroxy protecting group;
• R is H.
• B is cytosine
• R is H and B is cytosine.
• B is 5-fluorocytosine .
• a compound of formula I is (-)- ⁇ -L- Dioxolane-Cytidine ( ⁇ -L-OddC) . In one embodiment, a compound of formula I is (-)- ⁇ - Dioxolane-5-fluoro-Cytidine (5-FddC) .
• the compounds of formula (I) of the present invention is substantially in the form of the (-) enantiomer.
• the compounds formula (I) present in the pharmaceutical combination of the present invention are in the form of the (-) enantiomer at least 95% free of the corresponding (+) enantiomer.
• the compounds formula (I) present in the pharmaceutical combination of the present invention are in the form of the (-) enantiomer at least 97% free of the corresponding (+) enantiomer.
• the compounds formula (I) present in the pharmaceutical combination of the present invention are in the form of the (-) enantiomer at least 99% free of the corresponding (+) enantiomer.
• the compounds of formula (I) contain at least two chiral centers.
• the compounds of formula (I) thus exist in the form of two different optical isomers (i.e. (+) or (-) enantiomers or ⁇ -L and ⁇ -D) . All such enantiomers and mixtures thereof including racemic mixtures are included within the scope of the invention.
• the single optical isomer or enantiomer can be obtained by method well known in the art, such as chiral HPLC, enzymatic resolution and chiral auxiliary.
• the enantiomers of the compounds of formula (I) can be synthesized by using optically active starting materials.
• the further therapeutic agent is a nucleoside analogue.
• the further therapeutic agent is a cytosine nucleoside analogue.
• the further therapeutic agent is a cytosine nucleoside analogue chosen from cytarabine or gemcitabine.
• the ratio of the compound of formula (I) to the further therapeutic agent is 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the further therapeutic agent is cytarabine.
• the ratio of the compound of formula (I) to cytarabine is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the further therapeutic agent is gemcitabine.
• the ratio of the compound of formula (I) to gemcitabine is 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the further therapeutic agent is a chemotherapeutic agent.
• the further therapeutic agent is idarubicin.
• the ratio of the compound of formula (I) to idarubicin is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• at least one compound of formula (I) of the present invention is employed together with cytarabine, gemcitabine, idarubicin, or combinations thereof.
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the individual components of such combinations as defined above may be administered either sequentially or simultaneously in separate or combined pharmaceutical formulations.
• compositions comprising a combination as defined above together with a pharmaceutically acceptable carrier therefor comprise a further aspect of the invention.
• the compound of formula (I) present in the pharmaceutical combination of the present invention is ( ⁇ -L-OddC) and at least one further therapeutic agent is chosen from cytarabine, gemcitabine and idarubicin.
• the ratio of ⁇ -L-OddC to the further therapeutic agent is 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the pharmaceutical combination of the present invention is a synergistic combination of therapeutic agents comprising ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin.
• the pharmaceutical combination of the present invention is ⁇ -L-OddC and cytarabine.
• the ratio of ⁇ -L-OddC to cytarabine is 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the pharmaceutical combination of the present invention is ⁇ -L-OddC and gemcitabine.
• the ratio of ⁇ -L-OddC to gemcitabine is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the pharmaceutical combination of the present invention is ⁇ -L-OddC and idarubicin.
• the ratio of ⁇ -L-OddC to idarubicin is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination for treating cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, leukemia and lymphomas in patients.
• the further therapeutic agent is other than doxorubicin.
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination for treating cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, and lymphomas in patients.
• the further therapeutic agent is other than doxorubicin.
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination as defined above for treating yelogenous leukemia, wherein the further therapeutic agent is preferably other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination as defined above for treating acute myelogenous leukemia, wherein the further therapeutic agent is preferably other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination as defined above for treating chronic myelogenous leukemia, wherein the further therapeutic agent is preferably other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination as defined above for treating refractory / relapsed leukemia, wherein the further therapeutic agent is preferably other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a combination as defined above for treating pancreatic cancer.
• the present invention provides a method of treating a patient having cancer comprising administering to said patient a therapeutically effective amount of a compound of formula (I) :
• B is cytosine or 5-fluorocytosine and R is selected from the group comprising H, monophosphate, diphosphate, triphosphate, carbonyl substituted with a C ⁇ - 6 alkyl, C 2 -s alkenyl, C 2 - s alkynyl, C 6 - ⁇ o aryl and O
• each Re is independently selected from the group comprising H, C ⁇ - 6 alkyl, C 2 - e alkenyl, C 2 -s alkynyl and a hydroxy protecting group;
• the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating myelogenous leukemia by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent.
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula
• (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating acute myelogenous leukemia by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent .
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating chronic myelogenous leukemia by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula
• (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating chronic myelogenous leukemia in blastic phase by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent.
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating refractory /relapsed leukemia by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent.
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient who has refractory / relapsed leukemia and which has been previously treated with cytarabine by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent.
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula (I) to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient who has refractory / relapsed leukemia and which has been previously treated with cytarabine and is resistant to cytarabine by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent.
• the further therapeutic agent is other than doxorubicin and the ratio of the compound of formula
• (I) to the further therapeutic agent is preferably
• the present invention provides a method for treating a patient who has refractory / relapsed leukemia and which has been previously treated with cytarabine by administering to the patient ⁇ -L-
• OddC and cytarabine wherein the ratio of ⁇ -L-OddC to cytarabine is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with leukemia by administering to the patient ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin, wherein the ratio of ⁇ -L- OddC to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with leukemia by administering to the patient a synergistic combination of ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin.
• the present invention provides a method for treating a patient with leukemia by administering to the patient ⁇ -L-OddC and cytarabine, wherein the ratio of ⁇ -L-OddC to cytarabine is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with leukemia by administering to the patient ⁇ -L-OddC and gemcitabine, wherein the ratio of ⁇ -L-OddC to gemcitabine is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with leukemia by administering to the patient ⁇ -L-OddC and idarubicin, wherein the ratio of ⁇ -L-OddC to idarubicin is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with cancer by administering to the patient ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin, wherein the ratio of ⁇ -L- OddC to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with cancer, in particular a cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, leukemia and lymphomas, by administering to the patient ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin, wherein the ratio of ⁇ -L-OddC to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with cancer, other than leukemia, by administering to the patient ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin, wherein the ratio of ⁇ -L-OddC to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• the present invention provides a method for treating a patient with cancer, in particular a cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, and lymphomas, by administering to the patient ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin, wherein the ratio of ⁇ -L- OddC to the further therapeutic agent is preferably 1:250 to 250:1, more preferably 1:50 to 50:1, especially 1:20 to 20:1.
• a cancer selected from the group comprising lung cancer, prostate cancer, bladder cancer, colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, ovarian cancer, soft tissue sarcoma, osteosarcoma, hepatocellular carcinoma, and lymphomas
• the present invention provides a method for treating a patient with cancer by administering to the patient a synergistic combination of ⁇ -L-OddC and at least one further therapeutic agent chosen from cytarabine, gemcitabine and idarubicin.
• the present invention provides a method for treating pancreatic cancer by administering to the patient a therapeutically effective amount of a compound of formula (I) and at least one further therapeutic agent chosen from a nucleoside analogue and/or a chemotherapeutic agent.
• the present invention provides a method for treating a patient with pancreatic cancer by administering to the patient ⁇ -L-OddC and gemcitabine.
• pharmaceutically acceptable salts of the compounds formula (I) present in the pharmaceutical combinations of the present invention are meant those derived from pharmaceutically acceptable inorganic and organic acids and bases.
• acids examples include hydrochloric, hydrobromic, sulphuric, nitric, perchloric, fumaric, maleic, phosphoric, glycollic, lactic, salicylic, succinic, toleune-p-sulphonic, tartaric, acetic, citric, methanesulphonic, formic, benzoic, malonic, naphthalene-2-sulphonic and benzenesulphonic acids.
• Other acids such as oxalic, while not in themselves pharmaceutically acceptable, may be useful as intermediates in obtaining the compounds of the invention and their pharmaceutically acceptable acid addition salts.
• Salts derived from appropriate bases include alkali metal (e.g. sodium), alkaline earth metal (e.g. magnesium) , ammonium and NR4+ (where R is C -4 alkyl) salts .
• references hereinafter to the pharmaceutical combinations according to the invention includes compounds of the general formula (I) or a pharmaceutically acceptable salt thereof.
• leukemia represents acute myelogenous leukemia or acute myeloid leukemia (AML) , chronic myelogenous leukemia or chronic myeloid leukemia (CML) , chronic lymphocytic leukemia (CLL) , acute lymphocytic leukemia (ALL) , hairy cell leukemia (HCL) , myelodysplastic syndromes (MDS) or chronic myelogenous leukemia (CML-BP) in blastic and all subtypes of these leukemias which are defined by morphological, histochemical and immunological techniques that are well known by those of skill in the art.
• AML acute myelogenous leukemia
• CML chronic myeloid leukemia
• CLL chronic lymphocytic leukemia
• ALL acute lymphocytic leukemia
• HCL hairy cell leukemia
• MDS myelodysplastic syndromes
• CML-BP chronic myelogenous leukemia
• myelogenous leukemia represent both acute and chronic myelogenous leukemias (AML, CML) which involve elements of the bone marrow (e.g. white cells, red cells and megakaryocytes) and includes all subtypes of these leukemias which are defined by morphological, histochemical and immunological techniques that are well known by those of skill in the art.
• refractory/relapsed leukemia represents previously treated patients which were either non responsive to treatment with chemotherapeutic agents or had a response to treatment and then relapsed.
• patient is defined as any diseased human.
• alkyl represents an unsubstituted or substituted (by a halogen, nitro, CONH 2 , COOH, 0-C ⁇ - 6 alkyl, 0-C 2 -6 alkenyl, 0-C 2 - 6 alkynyl, hydroxyl , amino, or COOQ, wherein Q is C ⁇ _ 6 alkyl; C 2 -e alkenyl; C 2 -6 alkynyl) straight chain, branched chain or cyclic hydrocarbon moiety (e.g., methyl, ethyl, n-propyl, isopropyl, butyl, pentyl, hexyl, fluorohexyl, cyclopropyl, cyclobutyl, cyclopentyl, or cyclohexyl) .
• Q is C ⁇ _ 6 alkyl; C 2 -e alkenyl; C 2 -6 alkynyl) straight chain, branched chain or cyclic hydrocarbon
• alkyl is also meant to include alkyls in which one or more hydrogen atoms is replaced by an halogen, more preferably, the halogen is fluoro (e.g., CF 3 - or CF 3 CH 2 -) .
• alkenyl and alkynyl represent an alkyl containing at least one unsaturated group (e.g., vinyl, 1-propenyl, allyl, 1-methylpropenyl , 2-butenyl, 2- butenyl, ethynyl, 1-propynyl, or 2-propynyl) .
• aryl represents an aromatic radical (e.g., phenyl and naphthyl) .
• hydroxy protecting group is well known in the field of organic chemistry. Such protecting groups may be found in T. Greene, Protective Groups In Organic Synthesis, (John Wiley & Sons, 1981) .
• Example of hydroxy protecting groups include but are not limited to acetyl-2-thioethyl ester, pivaloyloxymethyl ester and isopropyloxycarbonyloxymethyl ester.
• the first compound of formula (I) is administered to the patient at a dose between about 1 mg/m 2 and about 8 mg/m 2 ; the second therapeutic agent when cytarabine is administered to the patient at a dose between about 0.1 gm/m 2 and about 6 gm/m 2 .
• the first compound of formula (I) is administered to the patient at a dose between about 1 mg/m 2 and about 8 mg/m 2 ; the second therapeutic agent when gemcitabine is administered to the patient at a dose between about 0.1 gm/m 2 and about 6 gm/m 2 .
• the first compound of formula (I) is administered to the patient at a dose between about 1 mg/m 2 and about 8 mg/m 2 ; the second therapeutic agent when idarubicin is administered to the patient at a dose between about 1 mg/m 2 and about 30 gm/m 2 .
• ⁇ -L-OddC is administered at 6mg/m 2 over 30 minutes per day on days 1 to 5 and cytarabine is administered at lgm/m 2 over 2 hours daily on days 1 to 5.
• ⁇ -L-OddC is administered a 5mg/m 2 over 30 minutes per day on days 1 to 5 and idarubicin is administered at 12gm/m 2 over 2 hours daily on days 1 to 3.
• a suitable dose will be in a range of from about 0.1 to about 750 g/kg of body weight per day, preferable in the range of 0.5 to 500 mg/kg/day, most preferably in the range of 1 to 300 mg/kg/day.
• the desired dose may conveniently be presented in a single dose or as divided dose administered at appropriate intervals, for example as two, three, four or more doses per day.
• the pharmaceutical combination according to the present invention is conveniently administered in unit dosage form.
• the active ingredient should be administered to achieve peak plasma concentrations of the active compound of from about 1 to about 75 ⁇ M, preferably about 2 to 50 ⁇ M, most preferably about 3 to about 30 ⁇ M. This may be achieved, for example, by the intravenous injection of a 0.1 to 5% solution of the active ingredient, optionally in saline, or orally administered as a bolus containing about 1 to about 500 mg of the active ingredient. Desirable blood levels may be maintained by a continuous infusion to provide about 0.01 to about 5.0 mg/kg/hour or by intermittent infusions containing about 0.4 to about 15 mg/kg of the active ingredient .
• compositions comprising a combination as defined above together with a pharmaceutically acceptable carrier therefor comprise a further aspect of the invention.
• each compound may be either the same as or differ from that when the compound is used alone. Appropriate doses will be readily appreciated by those skilled in the art.
• the ratio of the compounds of formula (I) to the additional therapeutic agents in the present invention is between 1:250 to 250:1.
• the additional therapeutic agent is other than doxorubicin.
• the ratio of the compounds of formula (I) to the additional therapeutic agents in the present invention is between 1:50 to 50:1.
• the additional therapeutic agent is other than doxorubicin.
• the ratio of the compounds of formula (I) to the additional therapeutic agents in our invention is between 1:20 to 20:1.
• the additional therapeutic agent is other than doxorubicin.
• the additional therapeutic agent is other than doxorubicin. If a further therapeutic agent is added, ratios will be adjusted accordingly.
• a compound of the invention may be administered as the raw chemical it is preferable to present the active ingredient as a pharmaceutical formulation.
• the invention thus further provides a pharmaceutical formulation comprising a compound of formula (I) or a pharmaceutically acceptable derivative thereof together with one or more pharmaceutically acceptable carriers therefor and, optionally, other therapeutic and/or prophylactic ingredients.
• the carrier (s) must be "acceptable” in the sense of being compatible with the other ingredients of the formulation and not deleterious to the recipient thereof.
• compositions include those suitable for oral, rectal, nasal, topical (including buccal and sub- lingual) , transdermal, vaginal or parenteral (including intramuscular, sub-cutaneous and intravenous) administration or in a form suitable for administration by inhalation or insufflation.
• the formulations may, where appropriate, be conveniently presented in discrete dosage units and may be prepared by any of the methods well known in the art of pharmacy. All methods include the step of bringing into association the active compound with liquid carriers or finely divided solid carriers or both and then, if necessary, shaping the product into the desired formulation.
• composition suitable for oral administration may conveniently be presented as discrete units such as capsules, cachets or tablets each containing a predetermined amount of the active ingredient; as a powder or granules; as a solution, a suspension or as an emulsion.
• the active ingredient may also be presented as a bolus, electuary or paste.
• Tablets and capsules for oral administration may contain conventional excipients such as binding agents, fillers, lubricants, disintegrants, or wetting agents.
• the tablets may be coated according to methods well known in the art.
• Oral liquid preparations may be in the form of, for example, aqueous or oily suspensions, solutions, emulsions, syrups or elixirs, or may be presented as a dry product for constitution with water or other suitable vehicle before use.
• Such liquid preparations may contain conventional additives such as suspending agents, emulsifying agents, non-aqueous vehicles (which may include edible oils) , or preservatives.
• the pharmaceutical ' combination according to the invention may also be formulated for parenteral administration (e.g. by injection, for example bolus injection or continuous infusion) and may be presented in unit dose form in ampoules, pre-filled syringes, small volume infusion or in multi-dose containers with an added preservative.
• the compositions may take such forms as suspensions, solutions, or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing an/or dispersing agents.
• the active ingredient may be in powder form, obtained by aseptic isolation of sterile solid or by lyophilisation from solution, for constitution with a suitable vehicle, e.g. sterile, pyrogen-free water, before use.
• the pharmaceutical combination according to the invention may also be formulated for direct administration to the Central Nervous System by intravenous administration.
• administration to the heart may be achieved.
• the pharmaceutical combination according to the invention may be formulated as ointments, creams or lotions, or as a transdermal patch.
• Such transdermal patches may contain penetration enhancers such as linalool, carvacrol, thymol, citral, menthol and t-anethole.
• Ointments and creams may, for example, be formulated with an aqueous or oily base with the addition of suitable thickening and/or gelling agents.
• Lotions may be formulated with an aqueous or oily base and will in general also contain one or more emulsifying agents, stabilizing agents, dispersing agents, suspending agents, thickening agents, or colouring agents.
• Formulations suitable for topical administration in the mouth include lozenges comprising active ingredients in a flavored base, usually sucrose and acacia or tragacanth; pastilles comprising the active ingredient in an inert base such as gelatin and glycerin or sucrose and acacia; and mouthwashes comprising the active ingredient in a suitable liquid carrier.
• Pharmaceutical formulations suitable for rectal administration wherein the carrier is a solid are most preferably presented as unit dose suppositories. Suitable carriers include cocoa butter and other materials commonly used in the art, and the suppositories may be conveniently formed by admixture of the active compounds with the softened or melted carrier (s) followed by chilling and shaping in moulds.
• Formulations suitable for vaginal administration may be presented as pessaries, tampons, creams, gels, pastes, foams or sprays containing in addition to the active ingredient such carriers as are known in the art to be appropriate .
• the pharmaceutical combination according to the invention may be used as a liquid spray or dispersible powder or in the form of drops .
• Drops may be formulated with an aqueous or non- aqueous base also comprising one more dispersing agents, solubilising agents or suspending agents. Liquid sprays are conveniently delivered from pressurized packs.
• the pharmaceutical combination according to the present invention are conveniently delivered from an insufflator, nebulizer or a pressurized pack or other convenient means of delivering an aerosol spray.
• Pressurized packs may comprise a suitable propellant such as dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas.
• the dosage unit may be determined by providing a valve to deliver a metered amount.
• the pharmaceutical combination according to the invention may take the form of a dry powder composition, for example a powder mix of the compound and a suitable powder base such as lactose or starch.
• the powder composition may be presented in unit dosage form in, for example, capsules or cartridges or e.g. gelatin or blister packs from which the powder may be administered with the aid of an inhalator or insufflator.
• AML lymphocytic
• ALL lymphocytic
• MDS myelodysplastic syndromes
• CML-BP chronic myelogenous leukemia in blastic Phase
• AML acute myeloid leukemia
• MDS myelodysplastic syndromes
• CML-BP chronic myelogenous leukemia
• the initial doses of the combinations (Level 0) given to the patients were ⁇ -L OddC 5 mg/m 2 administered intravenously (IV) over 30 minutes per day for 5 consecutive days given with Ara-C 1 gm/m 2 administered IV over 2 hours daily days 1 through 5.
• CR Complete Remission
• CRp Complete Remission without platelet recovery
• the effect of the combination of ⁇ -L OddC and Ara-c on the survival of CRRF-CEM cells was measured using a standard MTT assay.
• This assay is based on the reduction of a tetrazolium compound to a soluble formazen derivative by the mitochondrial dehydrogenase enzymes of metabolically active and viable cells.
• the absorbance at 490 nm is directly proportional to the number of living cells in culture at a certain time point.
• Combinations of drugs were then generated around the IC 50 's of each drug to allow a constant ratio in order to determine if the combination was additive, synergistic or antagonistic.
• Combination indices were generated from the CalcuSyn software for each combination, in triplicate, using the results obtained from each drug alone and their effect in combination within the same experiment (see Table 1) .
• a CI below 1 is an indication of synergy, while a CI equal to 1 represents additivity, and a CI above 1 indicates antagonism.
• the initial doses of the combinations (Level 0) were ⁇ -L OddC 5 mg/m 2 administered IV over 30 minutes per day for 5 consecutive days given with idarubicin 12 mg/m 2 daily by rapid (1 to 5 minute) IV infusion on days 1 through 3.
• Gemcitabine (Eli Lilly, Lot# 4MT16M) was administered intraperitoneally at 40mg/kg and 80mg/kg on a q3dx4 schedule. In addition, troxacitabine and gemcitabine were administered together in a series of combinations using the same route, doses and schedule.
• mice were weighed twice weekly, and tumor measurements were taken by calipers twice weekly, starting on Day 1. These tumor measurements were converted to mg tumor weight by a well-known formula, (W 2 x L) /2. The experiment was terminated when the control group tumor size reached an average of 1 gram. Upon termination, the mice were weighed, sacrificed and their tumors were excised. The tumors were weighed, and the mean tumor weight per group was calculated. In these models, the change in mean treated tumor weight/the change in mean control tumor weight x 100 ( ⁇ T/ ⁇ C) was subtracted from 100% to give the tumor growth inhibition (TGI) for each group .
• TGI tumor growth inhibition
• Some drugs may cause tumor shrinkage in these tumor xenograft models.
• the final weight of a given tumor is subtracted from its own weight at the start of treatment on Day 1. This difference, divided by the initial tumor weight, is converted to percent shrinkage .
• the mean percent tumor shrinkage can be calculated from data from the mice in a group that experienced tumor regressions. If the tumor completely disappears in a mouse, it is considered a complete regression or complete tumor shrinkage.
• Combinations of troxacitabine and gemcitabine were tested in four groups of mice using 10 and 25 mg/kg of troxacitabine (route and schedule as tested above) with 40 and 80 mg/kg of gemcitabine administered i.p. on a q3dx4 schedule.
• the combination of lOmg/kg troxacitabine and 40 mg/kg gemcitabine produced no deaths , but there was weight loss of 6 percent on Day 5 and no weight gain until Day 12.
• the lOmg/kg troxacitabine and 80 mg/kg gemcitabine combination actually had less weight loss (4.8 percent on Day 5) with a more rapid return to weight gain.
• Table 2 represents tumor growth inhibition results of single and combination dosing of troxacitabine and gemcitabine against the MiaPaCa Human pancreatic tumor xenograft model. Graphical representation of the results is shown in Figure 1.
• Table 3 represents tumor growth inhibition results of single and combination dosing of troxacitabine and gemcitabine against the Panc-1 Human pancreatic tumor xenograft model. Graphical representation of the results is shown in Figure 2.
• Troxactabine 1 (10) 10 i.v.; qdx5 +0.2% +3.0% 872.7 ⁇ 171.1 23.9% 0 0 3
• Troxactabine 1 (10) 25 i.v.; qdx5 -3.9% +8.0% 813.4 ⁇ 57.9 29.7% 0 0 0 0
• Troxacitabine 1 (10) 10 i.v.; qdx5 -6.0% +3.5% 826.5 ⁇ 81.8 28.5% 0 0 0
• Troxacitabine 1 (10) 10 i.v.; qdx5 -9.8% -2.9% 483.4 ⁇ 97.5 60.0% 0 0 1
• Gemcitabine 2 80 i.p.; q3dx4 c m Troxacitabine 1 (10) 25 i.v.; qdx5 -8.4% +2.4% 492.3 ⁇ 52.3 59.7% 0 0 0 to Gemcitabine 2 40 i.p.; q3dx4
• Troxacitabine 1 (10) 25 i.v.; qdx ⁇ -9.7% -16.4% 316.3 ⁇ 58.7 76.3% 0 0 3 Gemcitabine 2 80 i.p.; q3dx4
• Troxacitabine 1 25 i.v.; qdx5 -15.4% +4.1% 14.0+1.4 73.1% 0 1

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