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
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/196—Carboxylic acids, e.g. valproic acid having an amino group the amino group being directly attached to a ring, e.g. anthranilic acid, mefenamic acid, diclofenac, chlorambucil
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—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
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • 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
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the invention relates to a combination which comprises (a) a nitrogen mustard analogue selected from chlorambucil, chlornaphazine, estramustine, mechlorethamine, mechlorethamine oxide hydrochloride, navembichin, phenestrine, prednimustine, trofosfamide or uracil mustard and (b) 4-(4-methylpiperazin-l-ylmethyl)-N-[4-methyl-3-(4-pyridin-3-yl)pyrimidin-2- ylamino)phenyl]-benzamide (hereinafter: "Compound I”); a pharmaceutical composition comprising such a combination and optionally at least one pharmaceutically acceptable carrier for simultaneous, separate or sequential use, in particular for the treatment chronic lymphocytic leukemia (CLL); the use of such a combination for the preparation of a medicament for the treatment of CLL; a commercial package or product comprising such a combination; and to a method of treatment of a warm-blooded animal, especially
• CLL Chronic lymphocytic leukemia
• US United States
• alkylating agents such as chlorambucil (CLB) or cyclophosphamide
• purine analogs such as fludarabine
• Compound I is 4-(4-methylpiperazin-l-ylmethyl)-N-[4-methyl-3- (4-pyridin-3-yl)pyrimidin-2-ylamino)phenyl]-benzamide having the following formula
• Salt I The monomethanesulfonic acid addition salt of Compound I (hereinafter "Salt I”) and a preferred crystal form thereof are described in WO 99/03854 published on January 28, 1999.
• the structure of the active agents cited may be taken from the actual edition of the standard compendium "The Merck Index" or from databases, e.g. Patents International, e.g. IMS World Publications. The corresponding content thereof is hereby incorporated by reference. Any person skilled in the art is fully enable, based on these references, to manufacture and test the pharmaceutical indications and properties in standard test models, both in vitro and in vivo. It will be understood that references to the combination partners (a) and (b) are meant to also include their respective pharmaceutically acceptable salts. If the combination partner has at least one basic group, it can form acid addition salts. The combination partner having an acid group, for example COOH, can also form salts with bases.
• the combination partner (a) or (b) or a pharmaceutically acceptable salt thereof may also be used in form of a hydrate or include other solvents used for crystallization.
• the 4-(4-methylpiperazin-l-ylmethyl)-N-[4-methyl-3-(4- pyridin-3-yl)pyrimidin-2-ylamino)phenyl]-benzamide, i.e. combination partner (b), is preferably used in the present invention in the form of its monomethanesulfonate salt, e.g. the beta crystal form of the monomethanesulfonate salt.
• Compound I is used as a first line treatment of chronic myelogenous leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL).
• CML chronic myelogenous leukemia
• ALL Philadelphia chromosome-positive acute lymphoblastic leukemia
• CML cases express a constitutively active c-able kinase as a consequence of the t(9, 22) (q34, 11) translocation.
• BCR/ABL translocations have not been reported.
• the anti-proliferative effect on cells from patients with chronic lymphocytic leukemia of a combination comprising a nitrogen mustard analogue, especially, chlorambucil and Compound I is greater than the maximum effect that can be achieved with either type of ingredient alone.
• the present invention reports that a combination comprising a nitrogen mustard analogue selected from chlorambucil, chlornaphazine, estramustine, mechlorethamine, mechlorethamine oxide hydrochloride, navembichin, phenestrine, prednimustine, trofosfamide or uracil mustard, particularly chlorambucil (CLB) and Compound I, can produce a therapeutic effect which is greater than that obtainable by administration of a therapeutically effective amount of either a sole nitrogen mustard analogue, in particular chlorambucil or the sole Compound I.
• a nitrogen mustard analogue selected from chlorambucil, chlornaphazine, estramustine, mechlorethamine, mechlorethamine oxide hydrochloride, navembichin, phenestrine, prednimustine, trofosfamide or uracil mustard, particularly chlorambucil (CLB) and Compound I
• the present invention pertains to a combination for simultaneous, separate or sequential use, such as a combined preparation or a pharmaceutical fixed combination, which comprises (a) a nitrogen mustard analogue and (b) Compound I in which the active ingredients (a) and (b) are present in each case in free form or in the form of a pharmaceutically acceptable salt, and optionally at least one pharmaceutically acceptable carrier.
• a combined preparation defines especially a "kit of parts" in the sense that the combination partners (a) and (b) as defined above can be dosed independently of each other or by use of different fixed combinations with distinguished amounts of the combination partners (a) and (b), i.e. simultaneously or at different time points.
• the parts of the kit of parts can then, e.g. be administered simultaneously or chronologically staggered, that is at different time points and with equal or different time intervals for any part of the kit of parts.
• the time intervals are chosen such that the effect on the treated disease in the combined use of the parts is larger than the effect which would be obtained by use of only any one of the combination partners (a) and (b).
• the ratio of the total amounts of the combination partner (a) to the combination partner (b) to be administered in the combined preparation can be varied, e.g. in order to cope with the needs of a patient sub-population to be treated or the needs of the single patient which different needs can be due to age, sex, body weight, etc. of the patients.
• there is at least one beneficial effect e.g. a mutual enhancing of the effect of the combination partners (a) and (b), in particular a synergism, e.g.
• treatment comprises the administration of the combination partners to a warmblooded animal in need of such treatment with the aim to cure the disease or to have an effect on disease regression or on the delay of progression of a disease.
• delay of progression means that the disease progression is at least slowed down or hampered by the treatment and that patients exhibit higher survival rates than patients not being treated or being treated with the monotherapy.
• nitrogen mustard analogue is meant chlorambucil, chlornaphazine, estramustine, mechlorethamine, mechlorethamine oxide hydrochloride, navembichin, phenestrine, prednimustine, trofosfamide, uracil mustard.
• chlorambucil-resistant chronic lymphocytic leukemia defines especially a chronic lymphocytic leukemia in which chlorambucil is no longer efficient or shows a reduction of its therapeutic effectiveness.
• Chlorambucil can be prepared according to the process described in US patent 3,046,301, hereby incorporated by reference.
• a combination which comprises (a) a nitrogen mustard analogue, preferably chlorambucil and (b) Compound I in which the active ingredients are present in each case in free form or in the form of a pharmaceutically acceptable salt and optionally at least one pharmaceutically acceptable carrier, will be referred to hereinafter as a COMBINATION OF THE INVENTION.
• the COMBINATIONS OF THE INVENTION inhibit chronic lymphocytic leukemia. Furthermore, the COMBINATIONS OF THE INVENTION exhibit beneficial effects in the treatment of chronic lymphocytic leukemia.
• the proliferative disease to be treated with a COMBINATION OF THE INVENTION is chronic lymphocytic leukemia and preferably chlorambucil-resistant chronic lymphocytic leukemia. All the more surprising is the experimental finding that in vivo on human, the administration of a COMBINATION OF THE INVENTION compared to a monotherapy applying only one of the pharmaceutically active ingredients used in the COMBINA ⁇ ON OF THE INVENTION results not only in a more beneficial, especially synergistic, e.g.
• the COMBINATIONS OF THE INVENHON are suitable in particular in the treatment of chronic lymphocytic leukemia refractory to chemotherapeutics known as anti-cancer agents such as chronic lymphocytic leukemia refractory to nitrogen mustard analogue treatment, especially refractory to chlorambucil treatment.
• a further benefit is that lower doses of the active ingredients of the COMBINA ⁇ ON OF THE INVENTION can be used, for example, that the dosages need not only often be smaller but are also applied less frequently, or can be used in order to diminish the incidence of side-effects, e.g. diarrhea or nausea, observed with one of the combination partners alone. This is in accordance with the desires and requirements of the patients to be treated.
• Suitable clinical studies are in particular randomized, double-blind, parallel studies in cancer patients with late stage disease. Such studies are, in particular, suitable to compare the effects of a mono-therapy using the active ingredients and a therapy using a COMBINATION OF THE INVENTION, and to prove in particular the synergism of the active ingredients of the COMBINATIONS OF THE INVENHON.
• the primary endpoints in such studies can be the effect on pain scores, analgesic use, performance status, Quality of Life scores or time to progression of the disease.
• the evaluation of tumors by in regular time periods, e.g. every 4, 6 or 8 weeks, is a suitable approach to determine the effect of the COMBINATION OF THE INVENHON.
• patients are, for example, receiving per treatment cycle of 2 weeks, Compound I daily at a dose ranging from 50 to 1000 mg of the active substance and chlorambucil at a dose ranging from 0.2 to 1 mg kg/day.
• the minimum duration of such a study should be about, e.g. 4 weeks.
• It is one objective of this invention to provide a pharmaceutical composition comprising a quantity, which is jointly therapeutically effective against chronic lymphocytic leukemia comprising the COMBINATION OF THE INVENHON.
• the combination partners (a) and (b) can be administered together, one after the other or separately in one combined unit dosage form or in two separate unit dosage forms.
• the unit dosage form may also be a fixed combination.
• compositions according to the invention can be prepared in a manner known per se and are those suitable for enteral, such as oral or rectal, and parenteral administration to mammals (warm-blooded animals), including man, comprising a therapeutically effective amount of at least one pharmacologically active combination partner alone or in combination with one or more pharmaceutically acceptable carries, especially suitable for enteral or parenteral application.
• enteral such as oral or rectal
• parenteral administration to mammals (warm-blooded animals), including man
• one or more of the active ingredients are administered orally.
• the novel pharmaceutical composition contain, for example, from about 10 % to about 100 %, preferably from about 20 % to about 60 %, of the active ingredients.
• Pharmaceutical preparations for the combination therapy for enteral or parenteral administration are, for example, those in unit dosage forms, such as sugar-coated tablets, tablets, capsules or suppositories, and furthermore ampoules. If not indicated otherwise, these are prepared in a manner known per se, for example by means of conventional mixing, granulating, sugar- coating, dissolving or lyophilizing processes. It will be appreciated that the unit content of a combination partner contained in an individual dose of each dosage form need not in itself constitute an effective amount since the necessary effective amount can be reached by administration of a plurality of dosage units.
• a therapeutically effective amount of each of the combination partners of the COMBINATION OF THE INVENHON may be administered simultaneously or sequentially and in any order, and the components may be administered separately or as a fixed combination.
• the method of delay of progression or treatment of a proliferative disease according to the invention may comprise (i) administration of the first combination partner in free or pharmaceutically acceptable salt form and (ii) administration of the second combination partner in free or pharmaceutically acceptable salt form, simultaneously or sequentially in any order, in jointly therapeutically effective amounts, preferably in synergistically effective amounts, e.g. in daily dosages corresponding to the amounts described herein.
• the individual combination partners of the COMBINA ⁇ ON OF THE INVENTION can be administered separately at different times during the course of therapy or concurrently in divided or single combination forms.
• administering also encompasses the use of a pro-drug of a combination partner that convert in vivo to the combination partner as such.
• the instant invention is therefore to be understood as embracing all such regimes of simultaneous or alternating treatment and the term "administering" is to be interpreted accordingly.
• the effective dosage of each of the combination partners employed in the COMBINA ⁇ ON OF THE INVENTION may vary depending on the particular compound or pharmaceutical composition employed, the mode of administration, the condition being treated, the severity of the condition being treated.
• the dosage regimen the COMBINATION OF THE INVENTION is selected in accordance with a variety of factors including the route of administration and the renal and hepatic function of the patient.
• a physician, clinician or veterinarian of ordinary skill can readily determine and prescribe the effective amount of the single active ingredients required to prevent, counter or arrest the progress of the condition.
• Optimal precision in achieving concentration of the active ingredients within the range that yields efficacy without toxicity requires a regimen based on the kinetics of the active ingredients' availability to target sites. This involves a consideration of the distribution, equilibrium, and elimination of the active ingredients.
• Chlorambucil herein after also designated CLB, can be administered at a dose range of 0.1 to 1 mg/kg day, preferably at a dose range of 0.2 to 0.8 mg/kg day, most preferably, CLB can be administered at a preferred dose of 0.3 to 0.6 mg/kg/day, e.g. 0.3 mg/kg/day.
• Chlorambucil can be administered orally. Chlorambucil can be administered, e.g. for 5 consecutive days every four weeks, e.g. at a dose of 0.3 mg/kg of body weight.
• Compound I e.g. Salt I
• CLB can be administered continuously and Compound I, e.g. Salt I, can be administered daily.
• Compound I and CLB are administered orally daily.
• CLB and Compound I is administered at a daily dose of 400 to 800 mg per day and CLB is administered daily at a dose of 0.1 mg/kg of body weight per day.
• Compound I e.g. Salt I, and CLB are administered as a fixed combination.
• a further embodiment of the invention pertains to a fixed combination CLB and Compound I, e.g. Salt I.
• 119.5 mg of Salt I correspond to 100 mg of Compound I (free base) as active substance.
• effective doses of Salt I for example daily doses corresponding to about 50 to 1000 mg of Compound I, preferably 50 to 600 mg, are administered to warm-blooded animals of about 70 kg bodyweight.
• a starting dose of 400 mg daily can be recommended.
• dose escalation can be safely considered and patients may be treated as long as they benefit from treatment and in the absence of limiting toxicities.
• the invention relates also to a method for administering to a human subject suffering from chronic lymphocytic leukemia, Compound I or a pharmaceutically acceptable salt thereof, which comprises administering daily a pharmaceutically effective amount of Compound I or a pharmaceutically acceptable salt thereof to said human subject for a period exceeding 3 months.
• the invention relates especially to such method wherein a daily dose of 50 to 800 mg of Compound I, preferably 50 to 400 mg, is administered.
• the COMBINA ⁇ ON OF THE INVENHON can be a combined preparation or a pharmaceutical composition.
• the present invention relates to a method of treating a warm-blooded animal having a chronic lymphocytic leukemia comprising administering to said animal a COMBINATION OF THE INVENTION in a quantity which is jointly therapeutically effective against said leukemia and in which the combination partners can also be present in the form of their pharmaceutically acceptable salts.
• the COMBINA ⁇ ON OF THE INVENHON is co-administered with an anti-diarrheal agent.
• the treatment can comprise radiotherapy, cryotherapy and immunotherapy.
• the present invention pertains to the use of a COMBINA ⁇ ON OF THE INVENHON for the treatment of chronic lymphocytic leukemia and for the preparation of a medicament for the treatment of chronic lymphocytic leukemia.
• the present invention pertains to the use of chlorambucil in combination with Compound I or a pharmaceutically acceptable salt thereof, e.g. Salt I, for the preparation of a medicament for the treatment of chronic lymphocytic leukemia.
• the present invention also pertains to the use of Compound I or a pharmaceutically acceptable salt therefore, e.g. Salt I, in combination with chlorambucil for the preparation of medicament for the treatment of chronic lymphocytic leukemia resistant to chlorambucil.
• the present invention provides a commercial package comprising as active ingredients COMBINATION OF THE INVENTION, together with instructions for simultaneous, separate or sequential use thereof in the treatment of chronic lymphocytic leukemia.
• Example I Compound I sensitizes CLL lymphocytes to CLB A-Material and Methods
• CLL Lymphocytes and cell culture Lymphocytes are isolated from the peripheral blood of CLL patients by sedimentation centrifugation on Ficoll Hypaque (Pharmacia, Uppsala, Sweden) as described previously, e.g. in Christodoulopolis G. et al., Cancer Research, 1999, 5:2178-84. Aliquots containing 1x10 6 cells/ml are sent for T- lymphocyte analysis. The percentage of contaminating T lymphocytes is determined using fluorescence-activated cell sorting analysis with CD3 antibody. The percentage of T- lymphocyte contamination in the isolated B-lymphocytes population determined by FACS analysis and expressed as a mean% ⁇ SE is 6.4 ⁇ 1.8.
• the WSU cell line is a B-lymphocytic cell line derived from a CLL patient (Mohammad R.M., et al., Leukemia, 1996, 10:130-7).
• the 183 cell line is a B-type chronic lymphocytic leukemia cell line (Carlsson M. et al, Eur. J. Immunol., 1989, 19:913-21).
• lymphocytes and WSU and 183 CLL lymphocytes are seeded into 96- ell plates in 200 ⁇ l suspensions containing 1.5x10 6 lymphocytes/ml and 1.25x10 5 cells/ml respectively in RPMI supplemented with 10% FBS. Only dose responses with linear plating efficiencies are analyzed.
• the lymphocytes are then incubated at 37° C in the presence of various concentrations of Compound I (0-100 ⁇ M) alone, CLB (0-100 ⁇ M) alone, or various concentrations of both drugs together.
• the MTT assay is performed 72 hours after plating as described before (ChristodoulopoHs G et al., Cancer Research, 1998, 58:1789-92) by addition of 20 ⁇ l of a solution of 5 mg/ml MTT (3-[4,5-dimethylthiazol-2-yl]2,5-diphenyl-tetrazolium bromide) in RPMI media to each well.
• the LD50 of CLB alone, Compound I alone or CLB in the presence of Compound I is defined as to be the drug concentration required to reduce the absorbance reading to 50% of the control value.
• the percentage of surviving cells after treatment respect to vehicle treated cells (control) is calculated as (OD treated cells/OD untreated cells)xl00.
• Example 2 Capsules with 4-[(4-methyl-l-piperazin-l-ylmethyl)-N-[4-methyl-3-[[4-(3- pyridinyl)-2-pyrimidinyllamino1phenynbenzamide methanesulfonate. beta crystal form
• Capsules containing 119.5 mg of Salt I corresponding to 100 mg of Compound I (free base) as active moiety are prepared in the following composition: Composition: Salt I 119.5 mg
• the capsules are prepared by mixing the components and filling the mixture into hard gelatin capsules, size 1.
• Example 3 Capsules with 4-[(4-methyl-l-piperazin-l-ylmethyl)-N-[4-methyl-3-
• Capsules containing 119.5 mg of Salt I corresponding to 100 mg of Compound I (free base) as active moiety are prepared in the following composition:
• composition Salt I 119.5 mg
• the capsules are prepared by mixing the components and filling the mixture into hard gelatin capsules, size 1.
• Compound I decreases the concentration of CLB necessary to produce an IC50 to 1.1 ⁇ M-59 ⁇ M.

Landscapes

• Health & Medical Sciences (AREA)
• Chemical & Material Sciences (AREA)
• Medicinal Chemistry (AREA)
• Pharmacology & Pharmacy (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Epidemiology (AREA)
• Emergency Medicine (AREA)
• Chemical Kinetics & Catalysis (AREA)
• General Chemical & Material Sciences (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Organic Chemistry (AREA)
• Hematology (AREA)
• Oncology (AREA)
• Engineering & Computer Science (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
• Medicines Containing Plant Substances (AREA)

Priority Applications (9)

Applications Claiming Priority (2)

Related Child Applications (2)

Publications (1)

Family

ID=32312996

Family Applications (1)

Country Status (11)

Cited By (3)

Families Citing this family (6)

Citations (1)

Family Cites Families (2)

• 2003
  • 2003-11-10 BR BR0316126-9A patent/BR0316126A/pt not_active IP Right Cessation
  • 2003-11-10 ES ES03772561T patent/ES2348140T3/es not_active Expired - Lifetime
  • 2003-11-10 DE DE60332762T patent/DE60332762D1/de not_active Expired - Lifetime
  • 2003-11-10 CA CA2504665A patent/CA2504665C/en not_active Expired - Fee Related
  • 2003-11-10 AU AU2003280191A patent/AU2003280191A1/en not_active Abandoned
  • 2003-11-10 CN CNB2003801031558A patent/CN100475212C/zh not_active Expired - Fee Related
  • 2003-11-10 AT AT03772561T patent/ATE468855T1/de not_active IP Right Cessation
  • 2003-11-10 JP JP2004551110A patent/JP4854198B2/ja not_active Expired - Fee Related
  • 2003-11-10 EP EP03772561A patent/EP1578426B1/en not_active Expired - Lifetime
  • 2003-11-10 WO PCT/IB2003/005454 patent/WO2004043466A1/en not_active Ceased
  • 2003-11-10 US US10/534,573 patent/US20060122186A1/en not_active Abandoned
• 2009
  • 2009-08-19 US US12/543,868 patent/US8492383B2/en not_active Expired - Fee Related

Patent Citations (1)

Non-Patent Citations (5)

Also Published As

Similar Documents

Legal Events