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
  • 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

• This invention relates generally to a method of treating hyperprohferative diseases, and in particular, to the use of active forms of hypocalcemic vitamin D to inhibit the hyperprohferative cellular activity of these diseases and to promote differentiation of the cells.
• vitamin D the hormonally active form of vitamin D
• LNCaP human prostatic carcinoma cell line
• Vitamin D receptors have also been described for many other neoplastic cells, e.g., carcinomas of the breast and the colon.
• vitamin D compounds and analogues are potent inhibitors of malignant cell proliferation and are inducers/stimulators of cell differentiation.
• U.S. Patent No. 4,391,802 issued to Suda et al. discloses that l ⁇ -hydroxyvitamin D compounds, specifically l ⁇ ,25-dihydroxyvitamin D and l ⁇ -hydroxyvitamin D 3 , possess potent antileukemic activity by virtue of inducing the differentiation of malignant cells (specifically leukemia cells) to nonmalignant macrophages (monocytes), and are useful in the treatment of leukemia.
• vitamin D 3 compounds Even though these compounds may indeed be highly effective in promoting differentiation in malignant cells in culture, their practical use in differentiation therapy as anticancer agents is severely limited because of their equally high potency as agents affecting calcium metabolism. At the levels required in vivo for effective use as, for example, antileukemic agents, these same compounds can induce markedly elevated and potentially dangerous blood calcium levels by virtue of their inherent calcemic activity. That is, the clinical use of l ⁇ ,25-dihydroxyvitamin D 3 and other vitamin D analogues as anticancer agents is precluded, or severely limited, by the risk of hypercalcemia. This indicates a need for compounds with greater specific activity and selectivity of action, i.e., vitamin D compounds with antiproliferative and differentiating effects but which have less calcemic activity.
• the present invention provides a method of treating hyperprohferative disease conditions such as those characterized by hyperproliferative cell growth and/or abnormal cell differentiation.
• the method includes use of active vitamin D compounds to inhibit abnormal cell growth and promote cell differentiation.
• a method of inhibiting the hyperproliferative activity of neoplastic or hyperplastic cells comprising treating the cells with an effective amount of a hypocalcemic vitamin D compound.
• the treating step includes inhibiting proliferation of, and inducing and enhancing differentiation in such cells.
• the hypocalcemic vitamin D compounds of the present invention include vitamin D compounds having a hydrocarbon moiety substituted at the C-24 position on the sidechain of the molecule and a hydroxy group substituted in at least one of the Ci, C 24 or C 25 positions.
• the vitamin D compound of the present invention is an active vitamin D and is suitably represented by the formula (I) described hereafter.
• the compounds of formula (I) suitably include l ⁇ ,24-dihydroxyvitamin D 2 , l ⁇ ,24-dihydroxyvitamin D 4 , l ⁇ ,25- dihydroxyvitamm D , l ⁇ ,25-dihydroxyvitamin D 2 , l ⁇ -hydroxyvitamin D and l ⁇ - hydroxyvitamin D 4 .
• hypocalcemic vitamin D compounds are valuable for the treatment of breast and colon cancer, as well as other neoplasms such as pancreatic cancer, endometrial cancer, small cell and non-small cell cancer of the lung (including squamous, adneocarcinoma and large cell types), squamous cell cancer of the head and neck, bladder, ovarian and cervical cancers, myeloid and lymphocyltic leukemia, lymphoma, hepatic tumors, medullary thyroid carcinoma, multiple myeloma, melanoma, retinoblastoma, and sarcomas of the soft tissue and bone.
• neoplasms such as pancreatic cancer, endometrial cancer, small cell and non-small cell cancer of the lung (including squamous, adneocarcinoma and large cell types), squamous cell cancer of the head and neck, bladder, ovarian and cervical cancers, myeloid and lymphocy
• the proliferative activity of the abnormal neoplastic cells is inhibited, reduced, or stabilized, and cell differentiation is induced, promoted or enhanced, with significantly less hypercalcemia and hypercalciuria than is observed after the same amount of an activated vitamin D 3 (e.g., l ⁇ -OH D 3 , l ⁇ ,25-(OH) 2 D 3 ) is administered in previously known formulations.
• an activated vitamin D 3 e.g., l ⁇ -OH D 3 , l ⁇ ,25-(OH) 2 D 3
• the compound in accordance with the present invention has an improved therapeutic index relative to active forms of vitamin D 3 analogues.
• another aspect of the invention is a method of treating human cancer comprising administering to a subject who has cancer an effective amount of hypocalcemic vitamin D compound which has or attains through metabolism in vivo, a vitamin D receptor (VDR) binding affinity substantially equivalent to the binding affinity of l ⁇ ,25-dihydroxyvitamin D 3 and a hypercalcemia risk substantially lower that that of l ⁇ ,25-dihydroxyvitamin D 3 , to inhibit, decrease or stabilize the cellular abnormal proliferative activity of the cancer.
• VDR vitamin D receptor
• hypocalcemic vitamin D compounds can be suitably administered alone as an active ingredient, as an antiproliferative agent in a pharmaceutical composition, or co- administered with an anticancer agent.
• vitamin D of formula (I) with a cytotoxic or anticancer agent.
• agents suitably include antimetabolites (e.g., 5-fluoro-uracil, methotrexate, fludarabine), antimicrotubule agents (e.g., vincristine, vinblastine, taxanes such as paclitaxel, docetaxel), an alkylating agent (e.g., cyclophasphamide, melphalan, biochoroethylnitrosurea, hydroxyurea), platinum agents (e.g.
• cisplatin carboplatin, oxaliplatin, JM-216, CI-973
• anthracyclines e.g., doxrubicin, daunorubicin
• antibiolitics e.g., mitomycin, idarubicin, adriamycin, daunomycin
• topoisomerase inhibitiors e.g., etoposide, camptothecins
• any other antineoplastic agents estramustine phosphate, prednimustine.
• hypocalcemic vitamin D compounds used in combination with various anticancer drugs can give rise to a significantly enhanced cytotoxic effect on cancerous cells, thus providing an increased therapeutic effect.
• a significantly increased growth-inhibitory effect is obtained with the above disclosed combinations utilizing lower concentrations of the anticancer drugs compared to the treatment regimes in which the drugs are used alone, there is the potential to provide therapy wherein adverse side effects associated with the anticancer drugs are considerably reduced than normally observed with the anticancer drugs used alone in larger doses.
• Possible dose ranges of these co-administered anticancer agents are about 0.1 to 20 mg/kg/day.
• analogue of formula (I) in conjunction with administration of hormones or other agents, e.g., estrogens, which are known to ameliorate bone diseases or disorders.
• hormones or other agents e.g., estrogens
• prostate cancer often metastasizes to bone, causing bone loss and associated pain.
• bone agents may include conjugated estrogens or their equivalents, calcitonin, bisphosphonates, calcium supplements, cobalamin, pertussis toxin and boron.
• the invention is a pharmaceutical composition which includes an anticancer agent which is an active vitamin D compound; an agent selected from the group consisting of (i) an anticancer agent, (ii) a bone agent, and combinations thereof; and a physiologically acceptable carrier.
• the present invention provides an effective method for the treatment of neoplasms and hyperproliferative diseases.
• the present invention relates to therapeutic methods for inhibiting, reducing or stabilizing the hyperproliferative cellular activity of diseased cells, and inducing, enhancing or promoting cell differentiation in the diseased cells.
• the present invention provides a novel treatment of a patient suffering from a hyperproliferative disease such as prostatic cancer or prostatic hype ⁇ lasia with a hypocalcemic hydroxyvitamin D analogue.
• the vitamin D analogue is suitably a l ⁇ -hydroxyvitamin D or a 24-hydroxyvitamin D compound.
• hypocalcemic hydroxyvitamin D analogue represented by formula (I) as described hereinbelow is provided to the patient without causing dose-limiting hypercalcemia and hypercalciuria, i.e., unphysiologically high and deleterious blood calcium levels and urine calcium levels, respectively. These attributes are achieved through specific chemical properties of the hypocalcemic vitamin D compounds as described.
• hypocalcemic vitamin D compounds when effective amounts of the hypocalcemic vitamin D compounds are administered to patients with cancer or hype ⁇ lasia, the proliferative activity of the abnormal cells is inhibited, maintained, or alleviated, and cell differentiation is induced, promoted or enhanced, with significantly less hypercalcemia and hypercalciuria than is observed after the same amount of activated vitamin D 3 is administered in previously known formulations.
• the hypocalcemic vitamin D compounds of the present invention have an improved therapeutic index relative to active forms of vitamin D 3 analogues.
• vitamin D 3 must be hydroxylated in the C-1 and C-25 positions before it is activated, i.e., before it will produce a biological response.
• the term "activated vitamin D” or “active vitamin D” is intended to refer to a vitamin D compound or analogue that has been hydroxylated in at least the C-1, C-24 or C-25 position of the molecule and either the compound itself or its metabolites in the case of a prodrug, such as l ⁇ -hydroxyvitamin D 2 , binds the vitamin D receptor (VDR).
• vitamin D "prodrugs” include compounds which are hydroxylated in the C-1 position. Such compounds undergo further hydroxylation in vivo and their metabolites bind the VDR.
• hypocalcemic vitamin D compound is in reference to active vitamin
• D analogs which demonstrate reduced calcemic activity relative to the calcemic activity of l ⁇ ,25-dihydroxyvitamin D 3 .
• Such compounds include 24-hydroxyvitamin D compounds, 25-hydroxyvitamin D compounds and l ⁇ -hydroxyvitamin D compounds.
• the calcemic activity of these compounds ranges from 0.001 to 0.5 that of l ⁇ ,25- dihydroxyvitamin D 3 .
• the term "lower" as a modifier for alkyl, alkenyl acyl, or cycloalkyl is meant to refer to a straight or branched, saturated or unsaturated hydrocarbon radical having 1 to 4 carbon atoms.
• hydrocarbon radicals are methyl, ethyl, propyl, isopropyl, butyl, isobutyl, t-butyl, ethenyl, propenyl, butenyl, isobutenyl, isopropenyl, formyl, acetyl, propionyl, butyryl or cyclopropyl.
• aromatic acyl is meant to refer to a unsubstituted or substituted benzoyl group.
• hydrocarbon moiety refers to a lower alkyl, a lower alkenyl, a lower acyl group or a lower cycloalkyl, i.e., a straight or branched, saturated or unsaturated C i -C 4 hydrocarbon radial.
• the compound in accordance with the present invention is an active hypocalcemic vitamin D compound.
• the active vitamin D in accordance with the present invention may have an unsaturated sidechain, e.g., there is suitably a double bond between C-22 and C-23, between C-25 and C-26 or between C-26 and C-27.
• a hypocalcemic hydroxyvitamin D of the present invention has the general formula described in formula (I)
• R 1 and R 2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyl with the proviso that both R 1 and R 2 cannot both be an alkenyl, or taken together with the carbon to which they are bonded, form a C 3 -C 8 cyclocarbon ring;
• R 3 is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl or lower cycloalkyl;
• X 1 is hydrogen or hydroxyl, X 2
• a l ⁇ -hydroxyvitamin D compound of formula (I) is characterized by the general formula (II):
• a 1 and A each are hydrogen or a carbon-carbon bond, thus forming a double bond between C-22 and C-23;
• R 1 and R 2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyl with the proviso that both R 1 and R 2 cannot both be an alkenyl, or taken together with the carbon to which they are bonded, form a C 3 -C 8 cyclocarbon ring;
• R is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, 1
• O-lower acyl, O-aromatic acyl or lower cycloalkyl X is hydrogen or hydroxyl, X is hydrogen or hydroxyl, or, may be taken with R 1 or R 2 , to constitute a double bond, and Y is a methylene group if the bond to Y is a double bond or is a methyl group or hydrogen if the bond to Y is a single bond.
• R 1 and R 2 are identical or different and are hydrogen, hydroxyl, lower alkyl, lower fluoroalkyl, O-lower alkyl, lower alkenyl, lower fluoroalkenyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl, lower cycloalkyl with the proviso that both R 1 and R 2 cannot both be an alkenyl, or taken together with the carbon to which they are bonded, form a C 3 -C 8 cyclocarbon ⁇ ng; R is lower alkyl, lower alkenyl, lower fluoroalkyl, lower fluoroalkenyl, O-lower alkyl, O-lower alkenyl, O-lower acyl, O-aromatic acyl or lower cycloalkyl; X 1 is hydrogen or hydroxyl, and X
• hypocalcemic vitamin D compounds of the present invention are those that have effective antiproliferative and cell differentiation activity (i.e., reversal of malignant transformation), but have a lower tendency or inability to cause the undesired side effects of hypercalcemia and/or hypercalciuria.
• the compounds of the present invention can be administered at dosages that allow them to act as antiproliferative agents and cell differentiation agents when exposed to malignant or other hype ⁇ roliferative cells without significantly altering calcium metabolism. This selectivity and specificity of action makes the hypocalcemic vitamin D compounds useful and preferred agents for safely inhibiting hype ⁇ roliferation and promoting malignant or hype ⁇ lastic cell differentiation.
• the compounds of the present invention overcome the shortcomings of the known active vitamin D 3 compounds described above, and can be considered preferred agents for the control and treatment of malignant diseases such breast, prostate, testicular and colon cancer, as well as other neoplasms such as pancreatic cancer, endometrial cancer, small cell and non-small cell cancer of the lung (including squamous, adneocarcinoma and large cell types), squamous cell of the head and neck, bladder, ovarian and cervical cancers, myeloid and lymphocyltic leukemia, lymphoma, hepatic tumors, medullary thyroid carcinoma, multiple myeloma, melanoma, retinoblastoma, and sarcomas of the soft tissue and bone, i.e. neoplasms that express a vitamin D receptor.
• malignant diseases such breast, prostate, testicular and colon cancer
• other neoplasms such as pancreatic cancer, endometrial cancer, small
• the present invention provides a method of treating malignant cells as well as other hype ⁇ roliferative cells, (i.e., inhibiting their hype ⁇ roliferative activity and/or inducing and enhancing their differentiation) with an effective amount of a hypocalcemic vitamin D compound.
• the effective dosage amount on a daily basis per kilogram of body weight of the patient ranges from about 0.01 ⁇ g/kg/day to about
• the compounds in accordance with the present invention can be given in daily dose or episodic dose, e.g., once every 2-6 days or once a week, the dose in each day can be a single dose or divided into 2-4 subdoses which can be given, e.g., an hour apart until the total dose is given.
• the compounds in accordance with the present invention are administered in an amount that raises a serum vitamin D level to a supraphysiological level for a sufficient period of time to induce differentiation or regression of a tumor or neoplasm with causing hypercalcemia.
• the hypocalcemic properties of the compound permit such supraphysiologic levels.
• the compounds of formula (I) are valuable for the treatment of cancer and neoplasms in a patient suffering therefrom.
• the invention is a method for treating a patient suffering from the hype ⁇ roliferative cellular effects of cancer and other neoplasms by administering to the patient a therapeutically effective amount of a compound of formula (I), which is suitably l ⁇ ,24-dihydroxyvitamin D 2 , l ⁇ ,24- dihydroxyvitamin D , l ⁇ ,25-dihydroxyvitamin D 2 , l ⁇ ,25-dihydroxyvitamin D 4 , l ⁇ - hydroxyvitamin D 2 , and l ⁇ -hydroxyvitamin D 4.
• a compound of formula (I) which has a chiral center in the sidechain, such as at C-24, it is understood that both epimers (e.g., R and S) and the racemic mixture are within the scope of the present invention.
• the compounds of formula (I) can be prepared as described, e.g., in U.S. Patent 5,488,120 issued to Knutson et al., U.S. Patents 4,554,106, 4,670,190 and 5,486,636 issued to DeLuca et al., and Slitnell et al., 310 Biochem. J. (1995) pp. 233-241, all of which are inco ⁇ orated herein by reference.
• the biopotencies of the compounds of formula (I) have been studied and compared to that of l ⁇ ,25-dihydroxyvitamin D 3 , the active hormonal form of vitamin D and the standard against which all vitamin D compounds and analogues are measured.
• VDR vitamin D receptor
• the vitamin D receptor (VDR) binding affinities of the compounds of formula (I), or their active metabolites are substantially equivalent to (i.e., equal to or up to 3 times weaker than) the affinity of l ⁇ ,25 -dihydroxyvitamm D 3 .
• Such receptor binding affinities are indicative of potent biological activity.
• Patent 5,104,864 both of which are inco ⁇ orated herein by reference, it has been shown that l ⁇ -hydroxyvitamin D 2 has the same biopotency as l ⁇ -hydroxyvitamin D 3 and 1 ⁇ ,25 -dihydroxyvitamm D 3 but is much less toxic. Even dosages up to lO ⁇ g/day of l ⁇ -hydroxyvitamin D 2 in women with postmenopausal osteoporosis elicited only mild hypercalciuria (U.Ca >300 mg/24 hrs), and no marked hypercalcemia (S. Ca>11.0 mg/dL) solely due to 1 ⁇ -hydroxyvitamin D 2 was evident.
• the compound did not adversely affect kidney function, as determined by creatinine clearance and BUN; nor did it increase urinary excretion of hydroxyproline, indicating the absence of any stimulatory effect on bone reso ⁇ tion.
• Administration of l ⁇ -hydroxyvitamin D 2 to healthy adult males in dosages up to 8 ⁇ g/day showed no clinically significant hypercalcemia or other adverse effects.
• the compounds of formula (I) are useful as active ingredients in pharmaceutical compositions having reduced side effects and low toxicity as compared with the known analogues of active forms of vitamin D 3 .
• the pharmacologically active compounds of this invention can be processed in accordance with conventional methods of pharmacy to produce medicinal agents for administration to patients, e.g., mammals including humans.
• the hypercalcemic vitamin D compounds of the present invention can be employed in admixtures with conventional excipients, e.g., pharmaceutically acceptable carrier substances suitable for enteral (e.g., oral), parenteral or topical application which do not deleteriously react with the active compounds.
• Suitable pharmaceutically acceptable carriers include but are not limited to water, salt solutions, alcohols, gum arabic, vegetable oils (e.g., almond oil, corn oil, cottonseed oil, peanut oil, olive oil, coconut oil), mineral oil, fish liver oils, oily esters such as Polysorbate 80, polyethylene glycols, gelatine, carbohydrates (e.g., lactose, amylose or starch), magnesium stearate, talc, silicic acid, viscous paraffin, fatty acid monoglycerides and diglycerides, pentaerythritol fatty acid esters, hydroxy methylcellulose, polyvinyl pyrrolidone, etc.
• vegetable oils e.g., almond oil, corn oil, cottonseed oil, peanut oil, olive oil, coconut oil
• mineral oil fish liver oils
• oily esters such as Polysorbate 80
• polyethylene glycols gelatine
• carbohydrates e.g., lactose, amylose or starch
• magnesium stearate
• the pharmaceutical preparations can be sterilized and, if desired, be mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or one or more other active compounds, for example, vitamin D 3 and its l ⁇ -hydroxylated metabolites, conjugated estrogens or their equivalents, anti-estrogens, calcitonin, biphosphonates, calcium supplements, cobalamin, pertussis toxin and boron.
• auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or one or more other active compounds, for example, vitamin D 3 and its l ⁇ -hydroxylated metabolites, conjugated estrogens or their equivalents, anti-estrogens, calcitonin, bi
• parenteral administration suitably includes subcutaneous, intramuscular, or intravenous injection, nasopharyngeal or mucosal abso ⁇ tion, or transdermal abso ⁇ tion.
• the compounds of formula (I) may be given by direct injection into the tumor, e.g., parathyroid adenoma, or by regional delivery, e.g.,by intraarterial delivery or delivery via the portal vein. Regional delivery is especially suitable for treatment of hepatic cancers. Ampoules are convenient unit dosages.
• Suitable enteral application particularly suitable are tablets, dragees, liquids, drops, suppositories, lozenges, powders, or capsules.
• a syrup, elixir, or the like can be used if a sweetened vehicle is desired.
• suitable nonsprayable viscous, semi-solid or solid forms can be employed which include a carrier compatible with topical application and having a dynamic viscosity preferably greater than water, for example, mineral oil, almond oil, self-emulsifying beeswax, vegetable oil, white soft paraffin, and propylene glycol.
• suitable formulations include, but are not limited to, creams, ointments, lotions, solutions, suspensions, emulsions, powders, liniments, salves, aerosols, transdermal patches, etc., which are, if desired, sterilized or mixed with auxiliary agents, e.g., preservatives, stabilizers, demulsifiers, wetting agents, etc.
• a cream preparation in accordance with the present invention suitably includes, for example, mixture of water, almond oil, mineral oil and self-emulsifying beeswax; an ointment preparation suitably includes, for example, almond oil and white soft paraffin; and a lotion preparation suitably includes, for example, dry propylene glycol.
• Topical preparations of the compound in accordance with the present invention useful for the treatment of skin disorders may also include epithelialization-inducing agents such as retinoids (e.g., vitamin A), chromanols such as vitamin E, ⁇ -agonists such as isoproterenol or cyclic adenosine monophosphate (cAMP), anti-inflammatory agents such as corticosteroids (e.g., hydrocortisone or its acetate, or dexamethasone) and keratoplastic agents such as coal tar or anthralin.
• epithelialization-inducing agents such as retinoids (e.g., vitamin A), chromanols such as vitamin E, ⁇ -agonists such as isoproterenol or cyclic adenosine monophosphate (cAMP), anti-inflammatory agents such as corticosteroids (e.g., hydrocortisone or its acetate, or dexamethasone) and kera
• Effective amounts of such agents are, for example, vitamin A about 0.003 to about 0.3% by weight of the composition; vitamin E about 0.1 to about 10%; isoproterenol about 0.1 to about 2%; cAMP about 0.1 to about 1%; hydrocortisone about 0.25 to about 5%; coal tar about 0.1 to about 20%; and anthralin about 0.05 to about 2%.
• the compound is formed into a pharmaceutical composition containing a suppository base such as cacao oil or other triglycerides.
• a suppository base such as cacao oil or other triglycerides.
• the composition advantageously includes an antioxidant such as ascorbic acid, butylated hydroxyanisole or hydroquinone.
• the compound of this invention is dispensed by unit dosage form comprising about 0.5 ⁇ g to about 25 ⁇ g in a pharmaceutically acceptable carrier per unit dosage.
• the dosage of the compound according to this invention generally is about 0.01 to about 1.0 ⁇ g/kg/day, preferably about 0.04 to about 0.3 ⁇ g/kg/day.
• Oral dosing for the treatment of cancers and neoplasms and other hype ⁇ roliferative diseases generally is about lO ⁇ g to 200 ⁇ g/day.
• the dosage of the compound of the present invention in a topical composition generally is about 0.01 ⁇ g to about 50 ⁇ g per gram of composition.
• the dosage of the hypocalcemic vitamin D compound in a locally applied composition generally is about 0.01 ⁇ g to 100 ⁇ g per gram composition.
• the dosage of the compounds for the treatment of cancer or neoplasms according to this invention generally is about 0.01 to about 2.0 ⁇ g/kg/day, preferably about 0.01 to about 1.0 ⁇ g/kg/day.
• dosing of the hypocalcemic vitamin D compounds in accordance with the present invention can be done on an episodic basis, in which higher does can be used, generally about 20 ⁇ g to about 200 ⁇ g given once every 2-7 days.
• the compounds of this invention are dispensed by unit dosage form in a pharmaceutically acceptable carrier.
• the actual preferred amounts of active compound in a specific case will vary according to the efficacy of the specific compound employed, the particular compositions formulated, the mode of application, and the particular situs and organism being treated.
• the specific dose for a particular patient depends on age, body weight, general state of health, on diet, on the timing and mode of administration, on the rate of excretion, and on medicaments used in combination and the severity of the particular disorder to which the therapy is applied. Dosages for a given host can be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject compounds and of a known agent, such as by means of an appropriate conventional pharmacological protocol.
• agents may suitably include antimetabolites (e.g., 5-fluoro- uracil, methotrexate, fludarabine), antimicrotubule agents (e.g., vincristine, vinblastine, taxanes such as paclitaxel, docetaxel), an alkylating agent (e.g., cyclophasphamide, melphalan, biochoroethylnitrosurea, hydroxyurea), platinum agents (e.g.
• antimetabolites e.g., 5-fluoro- uracil, methotrexate, fludarabine
• antimicrotubule agents e.g., vincristine, vinblastine, taxanes such as paclitaxel, docetaxel
• an alkylating agent e.g., cyclophasphamide, melphalan, biochoroethylnitrosurea, hydroxyurea
• platinum agents e.g.
• cisplatin carboplatin, oxaliplatin, JM-216, CI-973
• anthracyc lines e.g., doxrubicin, daunorubicin
• antibiolitics e.g., mitomycin, idarubicin, adriamycin, daunomycin
• topoisomerase inhibitiors e.g., etoposide, camptothecins
• any other antineoplastic agents estramustine phosphate, prednimustine.
• co-administration is meant to refer to any administration route in which two or more agents are administered to a patient or subject.
• the agents may be administered together, or before or after each other.
• the agents may be administered by different routes, e.g., one agent may be administered intravenously while the second agent is administered intramuscularly, intravenously or orally.
• the agents may be administered simultaneously or sequentially, as long as they are given in a manner sufficient to allow both agents to achieve effective concentrations in the body.
• the agents also may be in an admixture, as, for example, in a single tablet.
• sequential administration one agent may directly follow administration of the other or the agents may be give episodically, i.e., one can be given at one time followed by the other at a later time, typically within a week.
• An example of a suitable co- administration regimen is where a hypocalcemic vitamin D compound is administered from 0.5 to 7 days prior to administration of a cytotoxic agent.
• ⁇ ии also included within the scope of the present invention is the co-administration of effective dosages of hypercalcemic vitamin D compounds in conjunction with administration of hormones or other agents, e.g., estrogens, which are known to ameliorate bone diseases or disorders.
• hormones or other agents e.g., estrogens
• prostate cancer often metastasizes to bone, causing bone loss and associated pain.
• bone agents may include conjugated estrogens or their equivalents, calcitonin, bisphosphonates, calcium supplements, cobalamin, pertussis toxin and boron. Possible dose ranges for these co-administered bone agents are provided in Table 1.
• Cobalamin ( ⁇ g/day) 5-200 20-100 30-50
• Pertussis Toxin 0.1-2000 10-1500 100-1000
• Antiestrogens such as Tamoxifen
• Tamoxifen are also known bone agents and may be suitably used in conjunction with the l ⁇ -hydroxyvitamin D compounds of the present invention.
• Example 1 1 ⁇ ,24-dihydroxyvitamin D 2 [ 1 ⁇ ,24-(OH) 2 D 2 ]
• VDR mammalian vitamin D receptor
• the affinity of l ⁇ ,24-(OH) 2 D 2 for the mammalian vitamin D receptor (VDR) was assessed using a commercially available kit of bovine thymus VDR and standard l,25-(OH) 2 D 3 solutions from Incstar (Stillwater, Minnesota).
• the half-maximal binding of chemically synthesized l ⁇ ,24-(OH) 2 D 2 was approximately 150 pg/ml whereas that of l ⁇ ,25-(OH) 2 D 3 was 80 pg/ml.
• the l ⁇ ,24-(OH) 2 D 2 had a very similar affinity for bovine thymus VDR as did l ⁇ ,25-(OH) 2 D 3 , indicating that 1 ⁇ ,24-(OH) 2 D 2 has potent biological activity.
• Example 2 1 ⁇ ,24-dihydroxy vitamin D 4 [ 1 ⁇ ,24-(OH) 2 D 4 ]
• the VDR affinity binding of l ⁇ ,24-(OH) 2 D 4 was investigated.
• the l ⁇ ,24-(OH) 2 D 4 was incubated with vitamin D receptor and radiolabeled tracer l ⁇ ,25-(OH) 2 D 3 . After incubation, the amount of radioactivity bound to the receptor was determined and compared with the amount bound after co-incubation of unlabeled and labeled l ⁇ ,25-(OH) 2 D 3 . It was found that 50 pg/tube of l ⁇ ,24-(OH) 2 D 4 was equivalent to approximately 20 pg l ⁇ ,25-(OH) 2 D .
• Example 3 1 ⁇ ,24-dihydroxyvitamin D 2 [ 1 ⁇ ,24-(OH) 2 D 2 ]
• VDR binding of vitamin D compounds by prostate cells is demonstrated using the techniques of Skowronski et al., 136 Endocrinology (1995) 20-26, which is inco ⁇ orated herein by reference.
• Prostate-derived cell lines are cultured to near confluence, washed and harvested by scraping. Cells are washed by centrifugation, and the cell pellet resuspended in a buffered salt solution containing protease inhibitors. The cells are disrupted by sonication while cooling on ice. The supernatant obtained from centrifuging the disrupted cells at 207,000 x g for 35 min at 4EC is assayed for binding.
• Example 4 1 ⁇ ,24-dihydroxy vitamin D 4 [ 1 ⁇ ,24-(OH) 2 D 4 ]
• the procedure of Example 3 is repeated using the active vitamin D analogue l ⁇ ,24-(OH) 2 D 4 , and the specific binding is determined.
• the results demonstrate that l ⁇ ,24-(OH) 2 D has strong affinity for prostate VDR, indicating that l ⁇ ,24-(OH) 2 D 4 has potent biological activity in respect of prostate cells.
• Example 3 The procedure of Example 3 is repeated using the active vitamin D analogue l ⁇ ,25-(OH) 2 D 4 , and the specific binding is determined.
• the results demonstrate that l ⁇ ,25-(OH) 2 D 4 has strong affinity for prostate VDR, indicating that l ⁇ ,25-(OH) 2 D has potent biological activity in respect of prostate cells.
• Example 6 1 ⁇ ,24-dihydroxy vitamin D 4 [ 1 ⁇ ,24-(OH) 2 D 4 ]
• One plasmid contained the gene for Growth Hormone (GH) under the control of the vitamin D responsive element (VDRE) and the other plasmid contained the structural gene for the vitamin D receptor (VDR).
• GH Growth Hormone
• VDRE vitamin D responsive element
• VDR vitamin D receptor
• Example 7 l ⁇ ,24(S)-dihydroxyvitamin D 2 and l ⁇ ,24(R)-dihydroxy- vitamin D 2 [l ⁇ ,24(S)-(OH) 2 D 2 and l ⁇ ,24(R)-(OH) 2 D 2 ]
• Example 6 The gene expression study described in Example 6 was conducted to compare the biological activity in vitro of chemically synthesized l ⁇ ,24(S)-(OH) 2 D 2 and l ⁇ ,24(R)-(OH) 2 D 2 , with l ⁇ ,25-(OH) 2 D 3 and 25-OH-D 3 .
• the vitamin D-dependent transcriptional activation model system was used in which plasmids pSG5-hVDRl/3 and p(CT4) 4 TKGH were co-transfected into Green monkey kidney, COS-1 cells.
• Example 8 l ⁇ ,24-dihydroxyvitamin D 2 [l ⁇ ,24-(OH) 2 D 2 ]
• Example 9 1 ⁇ ,24-dihydroxy vitamin D 4 [ 1 ⁇ ,24-(OH) 2 D 4 ]
• the procedure of Example 8 is repeated using the active vitamin D analogue l ⁇ ,24-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with l ⁇ ,24- (OH) 2 D 4 have significantly fewer cells than the control cultures.
• Example 10 l ⁇ ,25-dihydroxyvitamin D 4 [l ⁇ ,25-(OH) 2 D 4 ]
• Example 8 The procedure of Example 8 is repeated using the active vitamin D analogue l ⁇ ,25-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with l ⁇ ,25-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with l ⁇ ,25-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with l ⁇ ,25-(OH) 2 D 4 , and the cell number is determined. Cultures incubated with l ⁇ ,25-
• Example 11 1 ⁇ ,24-dihydroxyvitamin D 2 [ 1 ⁇ ,24-(OH) 2 D 2 ]
• cells of the cell line, LNCaP which is derived from a human metastatic prostate adenocarcinoma and known to express PSA
• LNCaP which is derived from a human metastatic prostate adenocarcinoma and known to express PSA
• the medium is replenished with medium containing vehicle or the active vitamin D analogue, l ⁇ ,24-(OH) 2 D 2 , at concentrations from 10 " " M to 10 "7 M. After 6-7 days, the medium is removed and stored at -20EC for prostate specific antigen (PSA) analysis.
• PSA prostate specific antigen
• the cells from parallel cultures are rinsed, precipitated, and the amount of DNA determined by standard procedures.
• PSA is measured by standard known methods. Cultures incubated with l ⁇ ,24-(OH) 2 D 2 have significantly more PSA than control cultures when expressed as mass of PSA/cell.
• Example 12 1 ⁇ ,24-dihydroxyvitamin D 4 [ 1 ⁇ ,24-(OH) 2 D 4 ]
• Example 12 The procedure of Example 12 is repeated except the active vitamin D analogue is l ⁇ ,24-(OH) 2 D 4 .
• the PSA is measured and cultures incubated with l ⁇ ,24-(OH) D 4 have significantly more PSA than control cultures when expressed as mass of PSA/cell.
• Example 12 The procedure of Example 12 is repeated except the active vitamin D analogue is l ⁇ ,25-(OH) 2 D 4 .
• the PSA is measured and cultures incubated with l ⁇ ,25-(OH) D have significantly more PSA than control cultures when expressed as mass of PSA/cell.
• Patients with a known vitamin D receptor positive tumor participate in an open-label study of a hypocalcemic vitamin D compound in accordance with the present invention.
• Patients are placed on a reduced calcium diet prior to treatment, to help minimize intestinal abso ⁇ tion and allow ever higher doses of the hypocalcemic vitamin D.
• This reduced calcium diet may be continued for the duration of treatment, and for one week after the last dose of the l ⁇ ,24(S)-dihydroxyvitamin D 2 .
• the diet ideally restricts daily calcium intake to 400- 500 mg. Patients also discontinue use of any vitamin D supplements or vitamin D replacement therapies. Each patient is also asked to drink 4-6 cups of fluid more than usual intake to assure adequate oral hydration.
• Each subject is monitored at regular intervals for: (1) hypercalcemia, hype ⁇ hosphatemia, hypercalciuria, hype ⁇ hosphaturia and other toxicity; (2) evidence of changes in the progression of metastatic disease; and (3) compliance with the prescribed test drug dosage.
• the dosing regimen is typically on a daily dose basis of 10 ⁇ g or 20 ⁇ g per day to about 100 ⁇ g/day for 24 months.
• a non-daily dosing regimen can be used, e.g., 40 ⁇ g given every other day, 100 ⁇ g given once a week.
• the route of administration can vary from oral to intravenous to regional delivery (e.g., arterial infusion, via the portal vein). Oral is, of course, the easiest and most cost effective route.
• Regional delivery permits high dosing and generally avoids any production of hypercalcemia.
• the compound of the present invention the compound is substantially hypocalcemic.
• CAT CAT
• scans X-rays and bone scans used for evaluating the progress of metastatic disease or partial remission in many patients treated at the lower dosage , and stable disease and partial or complete remission in many patients treated at the higher dosage.
• Example 15 Treatment of prostate cancer with l ⁇ ,24-dihydroxy vitamin D 2 [l ⁇ ,24-(OH) 2 D 2 ]
• the patients are monitored at regular intervals for: (1) hypercalcemia, hype ⁇ hosphatemia, hypercalciuria, hype ⁇ hosphaturia and other toxicity; (2) evidence of changes in the progression of metastatic disease; and (3) compliance with the prescribed test drug dosage.
• the maximal tolerated dosage (MTD) of daily oral l ⁇ ,24-(OH) 2 D 2 is determined by administering progressively higher dosages to successive groups of patients. All doses are administered in the morning before breakfast.
• the first group of patients is treated with 25.0 ⁇ g of l ⁇ ,24-(OH) 2 D 2 .
• Subsequent groups of patients are treated with 50.0, 75.0 and 100.0 ⁇ g/day.
• Dosing is continued uninterrupted for the duration of the study unless serum calcium exceeds 11.6 mg/dL, or other toxicity of grade 3 or 4 is observed, in which case dosing is held in abeyance until resolution of the observed toxic effect(s) and then resumed at a level which has been decreased by 10.0 ⁇ g.
• results from the first phase of the study show that the MTD for l ⁇ ,24-(OH) 2 D 2 is above 20.0 ⁇ g/day, a level which is 10- to 40-fold higher than can be achieved with l ⁇ ,25-(OH) 2 D .
• Analysis of blood samples collected at regular intervals from the participating patients reveal that the levels of circulating l ⁇ ,24-(OH) 2 D 2 increase proportionately with the dosage administered, rising to maximum levels well above lOO pg/mL at the highest dosages, and that circulating levels of l ⁇ ,25-(OH) 2 D are suppressed, often to undetectable levels. Serum and urine calcium are elevated in a dose responsive manner. Patients treated with the MTD of l ⁇ ,24-(OH) 2 D 2 for at least six months report that bone pain associated with metastatic disease is significantly diminished.
• Example 14 The study of Example 14 is repeated for the active vitamin D compound, l ⁇ -OH-D 2 .
• the results of the phase one study indicate that patients treated with the MTD of 1 ⁇ -OH-D 2 for at least six months report that bone pain associated with metastatic disease is significantly diminished.
• the results of the phase two study indicate that after two years, CAT scans, X-rays and bone scans used for evaluating the progression of metastatic disease show stable disease or partial remission in many patients treated at the lower dosage, and stable disease and partial or complete remission in many patients treated at the higher dosage.
• Example 14 The method of Example 14 is used to treat patients with metastatic malignant melanoma of, e.g., the jaw. After 18 months of treatment, the progress of the metastatic disease shows stable disease or partial remission.
• Example 18 Treatment of retinoblastoma
• Example 14 The method of Example 14 is used is used to treat patients with metastatic retinoblastoma. After 18 months of treatment, the progress of the metastatic disease shows stable disease or partial remission.
• Example 14 The method of Example 14 is used to treat patients with hepatoma.
• the regional delivery of the compound in accordance with the present invention i.e., via arterial infusion, is used. After 18 months of treatment, the progress of the metastatic disease shows stable disease or partial remission.

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