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
  • A61K31/16—Amides, e.g. hydroxamic acids
  • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
• • 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
• • 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
  • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents

Definitions

• This invention relates to methods for treating cancer in which an inhibitor of Heat Shock Protein 90 (“HSP90”) is combined with an enzyme inhibitor. More particularly, this invention relates to combinations of the HSP90 inhibitor geldanamycin and its derivatives, especially 17-alkylamino- 17-desmethoxygeldanamycin (“17-AAG”) and 17-(2-dimethylaminoethyl)amino-l 7-desmethoxygeldanamycin (“17-DMAG”), with an enzyme inhibitor (e.g., SAHA and Iressa).
• HSP90 Heat Shock Protein 90
• NAD(P)H quinone oxidoreductase: polymorphisms and allele frequencies n Caucasian, Chinese and Canadian Native Indian and Inuit populations.”
• Kelland et al "DT-Diaphorase expression and tumor cell sensitivity to 17- allylamino, 17-demethoxygeldanamycin, an inhibitor of heat shock protein 90." J. Natl.
• geldanamycin and 17-AAG appears to be a common mode of action among the benzoquinone ansamycins that further includes binding to Hsp90 and subsequent degradation of Hsp90-associated client proteins.
• the most sensitive client protein targets of the benzoquinone ansamycins are the Her kinases (also known as ErbB), Raf, Met tyrosine kinase, and the steroid receptors.
• Hsp90 is also involved in the cellular response to stress, including heat, radiation, and toxins.
• Certain benzoquinone ansamycins, such as 17-AAG have thus been studied to determine their interaction with cytotoxins that do not target Hsp90 client proteins.
• U.S. Patents 6,245,759, 6,306,874 and 6,313,138 each of which is incorporated herein by reference, disclose compositions comprising certain tyrosine kinase inhibitors together with 17-AAG and methods for treating cancer with such compositions.
• Munster, et al. "Modulation of Hsp90 function by ansamycins sensitizes breast cancer cells to chemotherapy-induced apoptosis in an RB- and schedule-dependent manner," Clinical Cancer Research (2001) 7:2228-2236, discloses that 17-AAG sensitizes cells in culture to the cytotoxic effects of Paclitaxel and doxorubicin.
• the Munster reference further discloses that the sensitization towards paclitaxel by 17-AAG is schedule-dependent in retinoblastoma protein-producing cells due to the action of these two drugs at different stages of the cell cycle: treatment of cells with a combination of paclitaxel and 17-AAG is reported to give synergistic apoptosis, while pretreatment of cells with 17-AAG followed by treatment with paclitaxel is reported to result in abrogation of apoptosis. Treatment of cells with paclitaxel followed by treatment with 17-AAG 4 hours later is reported to show a synergistic effect similar to coincident treatment.
• the present invention provides a method for treating cancer.
• the method involves the administration of an HSP90 inhibitor and an enzyme inhibitor, where the combined administration provides a synergistic effect.
• a method of treating cancer where a subject is treated with a dose of an HSP90 inhibitor in one step and a dose of an enzyme inhibitor in another step.
• a method of treating cancer is provided where a subject is first treated with a dose of an HSP90 inhibitor and subsequently treated with a dose of an enzyme inhibitor.
• a method of treating cancer where a subject is first treated with a dose of an enzyme inhibitor and subsequently treated with a dose of an HSP90 inhibitor.
• a method of treating cancer where a subject is first treated with a dose of an enzyme inhibitor (e.g., SAHA or Iressa). After waiting for a period of time sufficient to allow development of a substantially efficacious response of the enzyme inhibitor, a formulation comprising a synergistic dose of a benzoquinone ansamycm together with a second sub-toxic dose of the enzyme inhibitor is administered.
• an enzyme inhibitor e.g., SAHA or Iressa
• a method of treating cancer where a subject is treated first with a dose of a benzoquinone ansamycm, and second, a dose of an enzyme inhibitor. After waiting for a period of time sufficient to allow development of a substantially efficacious response of the enzyme inhibitor, a formulation comprising a synergistic dose of a benzoquinone ansamycin together with a second sub-toxic dose of the enzyme inhibitor drug is administered.
• a method for treating cancer where a subject is treated with a dose of an HSP90 inhibitor in one step and a dose of an enzyme inhibitor in another step, and where a side effect profile for the combined, administered drugs is substantially better than for the enzyme inhibitor alone.
• a method for treating breast or colorectal cancer where a subject is treated with a dose of an HSP90 inhibitor in one step and a dose of an enzyme inhibitor in another step.
• the HSP90 iri bitor for this aspect is typically 17-AAG, while the enzyme inhibitor is usually SAHA or Iressa.
• the enzyme inhibitor is typically administered before the 17-AAG. Definitions
• Enzyme inhibitor refers to a drug that stops, prevents or reduces the activity of an enzyme or a prodrug thereof. Enzyme inhibitors include, without limitation, histone deacetylation inhibitors (e.g., SAHA) and tyrosine kinase inhibitors (e.g., Iressa).
• HSP90 inhibitor refers to a compound that inhibits the activity of heat shock protein 90, which is a cellular protein responsible for chaperoning multiple client proteins necessary for cell signaling, proliferation and survival.
• One class of HSP90 inhibitors is the benzoquinone ansamycins.
• geldanamycin and geldanamycin derivatives e.g., 17-alkylamino-l 7-desmethoxygeldanamycin ("17-AAG”) and 17-(2-dimethylaminoethyl)amino-17-desmethoxy- geldanamycin (“17-DMAG”).
• 17-AAG 17-alkylamino-l 7-desmethoxygeldanamycin
• 17-DMAG 17-(2-dimethylaminoethyl)amino-17-desmethoxy- geldanamycin
• geldanamycin derivatives are 11-O- methyl-17-(2-(l-azetidinyl)ethyl)amino-17-demethoxygeldanamycin (A), 11-O-methyl- 17-(2-dimethylaminoethyl)amino- 17-demethoxygeldanamycin (B), and ll-O-methyl-17- (2-(l-pyrrolidinyl)ethyl)amino-17-demethoxygeldanamycin (C), whose synthesis is described in the co-pending commonly US patent application of Tian et al., serial no. 10/825,788, filed Apr.
• MTD refers to maximum tolerated dose.
• the MTD for a compound is determined using methods and materials known in the medical and pharmacological arts, for example through dose-escalation experiments.
• One or more patients is first treated with a low dose of the compound, typically about 10% of the dose anticipated to be therapeutic based on results of in vitro cell culture experiments.
• the patients are observed for a period of time to determine the occurrence of toxicity.
• Toxicity is typically evidenced as the observation of one or more of the following symptoms: vomiting, diarrhea, peripheral neuropathy, ataxia, neutropenia, or elevation of liver enzymes. If no toxicity is observed, the dose is increased about 2-fold, and the patients are again observed for evidence of toxicity. This cycle is repeated until a dose producing evidence of toxicity is eached.
• the dose immediately preceding the onset of unacceptable toxicity is taken as the MTD.
• Side effects refer to a number of toxicities typically seen upon treatment of a subject with an antineoplastic drug. Such toxicities include, without limitation, anemia, anorexia, bilirubm effects, dehydration, dermatology effects, diarrhea, dizziness, dyspnea, edema, fatigue, headache, hematemesis, hypokalemia, hypoxia, musculoskeletal effects, myalgia, nausea, neuro-sensory effects, pain, rash, serum glutamic oxaloacetic transaminase effects, serum glutamic pyruvic transaminase effects, stomatitis, sweating, taste effects, thrombocytopenia, voice change, and vomiting.
• toxicities include, without limitation, anemia, anorexia, bilirubm effects, dehydration, dermatology effects, diarrhea, dizziness, dyspnea, edema, fatigue, headache, hematemesis, hypokalemia, hypoxia, musculoskeletal effects, myal
• Side effect grading refers to National Cancer Institute common toxicity criteria (NCI CTC, Nersion 2). Grading runs from 1 to 4, with a grade of 4 representing the most serious toxicities.
• the present invention provides a method for treating cancer.
• the method involves the administration of an HSP90 inhibitor and an enzyme inhibitor, where the combined administration provides a synergistic effect.
• Suitable HSP90 inhibitors used in the present invention include benzoquinone ansamycins.
• the benzoquinone ansamycin is geldanamycin or a geldanamycin derivative.
• the benzoquinone ansamycin is a geldanamycin derivative selected from a group consisting of 17-alkylamino- 17-desmethoxy-geldanamycin ("17- AAG”) and 17-(2-dimethylaminoethyl)amino-l 7-desmethoxy-geldanamycin ("17- DMAG").
• Enzyme inhibitors employed in the present method include, without limitation, histone deacetylation inhibitors (e.g., SAHA) and tyrosine kinase inhibitors (e.g., Iressa).
• SAHA histone deacetylation inhibitors
• Iressa tyrosine kinase inhibitors
• the dose of enzyme inhibitor used as a partner in combination therapy with an HSP90 inhibitor is determined based on the maximum tolerated dose observed when the enzyme inhibitor is used as the sole therapeutic agent.
• the dose of enzyme inhibitor when used in combination therapy with a benzoquinone ansamycm is the MTD.
• the dose of enzyme inhibitor when used in combination therapy with a benzoquinone ansamycin is between about 1% of the MTD and the MTD, between about 5% of the MTD and the MTD, between about 5% of the MTD and 75% of the MTD, or between about 25% of the MTD and 75% of the MTD.
• Use of the benzoquinone ansamycm allows for use of a lower therapeutic dose of an enzyme inhibitor, thus significantly widening the therapeutic window for treatment.
• the therapeutic dose of enzyme inhibitor is lowered by at least about 10%.
• the therapeutic dose is lowered from about 10 % to 20%, from about 20% to 50%, from about 50% to 200%, or from about 100% to 1,000%.
• the typical oral dose of various enzyme inhibitors is as follows: SAHA — up to 500 mg/day; Iressa — 250 mg/day.
• the synergistic dose of the benzoquinone ansamycin used in combination therapy is determined based on the maximum tolerated dose observed when the ) benzoquinone ansamycin is used as the sole therapeutic agent.
• Clinical trials have determined an MTD for 17-AAG of about 40 mg/m 2 utilizing a daily x 5 schedule, and
• the dose of the benzoquinone ansamycin when used in combination therapy is the MTD.
• the does of the benzoquinone ansamycin when used in combination therapy is between about 1% of the MTD and the MTD, between about 5% of the MTD and the MTD, between about 5% of the MTD and 75% of the MTD, or between about 25% of the MTD and 75% of the MTD.
• the benzoquinone ansamycin is 17-AAG
• its therapeutic dose is typically between 50 mg/m 2 and 450 mg/m 2 .
• the dose is between 150 mg/m 2 and 350 mg/m 2 , and about 308 mg/m 2 is especially preferred.
• the therapeutic dose of 17-AAG is typically between 50 mg/m 2 and 250 mg/m 2 .
• the dose is between 150 mg/m 2 and 250 mg/m 2 , and about 220 mg/m 2 is especially preferred.
• a dosage regimen involving one or more administration of the combination per week is typical. Oftentimes, the combination is administered 2, 3, 4, 5, 6, or 7 times per week. Tables 1 and 2 below show a number of S AHA/17-AAG dosage combinations (i.e., dosage combinations 0001 to 0080).
• Table 1 SAHA/17-AAG dosage combinations.
• a dosage regimen involving one or more administration of the combination per week is typical. Oftentimes, the combination is administered 2, 3, 4, 5, 6, or 7 times per week. Tables 3 and 4 below show a number of Iressa/17-AAG dosage combinations (i.e., dosage combinations 0081 to 0160).
• Table 3 Iressa/17-AAG dosage combinations.
• the method of the present invention may be carried out in at least two basic ways.
• a subject may first be treated with a dose on an HSP90 inhibitor and subsequently be treated with a dose of an enzyme inhibitor.
• the subject may first be treated with a dose of an enzyme inhibitor and subsequently be treated with a dose of an HSP90 inhibitor.
• the appropriate dosing regimen depends on the particular enzyme inhibitor employed.
• a subject is first treated with a dose of an enzyme inhibitor (e.g., SAHA or Iressa).
• a formulation comprising a synergistic dose of a benzoquinone ansamycin together with a second sub-toxic dose of the enzyme inhibitor is administered.
• the appropriate period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor will depend upon the pharmacokinetics of the enzyme inhibitor, and will have been determined during clinical trials of therapy using the enzyme inhibitor alone.
• the period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor is between about 1 hour and 96 hours. In another aspect of the invention, the period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor is between about 2 hours and 48 hours.
• the period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor is between about 4 hours and 24 hours.
• a subject is treated first with one of the above-described benzoquinone ansamycins, and second, a dose of an enzyme inhibitor, such as, but not limited to, SAHA and Iressa. After waiting for a period of time sufficient to allow development of a substantially efficacious response of the enzyme inhibitor, a formulation comprising a synergistic dose of a benzoquinone ansamycin together with a second sub-toxic dose of the enzyme inhibitor is administered.
• the appropriate period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor will depend upon the pharmacokinetics of the enzyme inhibitor, and will have been determined during clinical trials of therapy using the enzyme inhibitor alone.
• the period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor is between about 1 hour and 96 hours, hi another aspect of the invention, the period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor is between about 2 hours and 48 hours. In another embodiment of the invention, the period of time sufficient to allow development of a substantially efficacious response to the enzyme inhibitor is between about 4 hours and 24 hours.
• the combination of an HSP90 inhibitor and an enzyme inhibitor allows for the use of a lower therapeutic dose of the enzyme inhibitor for the treatment of cancer. That a lower dose of enzyme inl ibitor is used oftentimes lessens the side effects observed in a subject. The lessened side effects can be measured both in terms of incidence and severity. Severity measures are provided through a grading process delineated by the National Cancer Institute (common toxicity criteria NCI CTC, Nersion 2). For instance, the incidence of side effects are typically reduced 10%. Oftentimes, the incidence is reduced 20%, 30%, 40% or 50%. Furthermore, the incidence of grade 3 or 4 toxicities for more common side effects associated with enzyme inhibitor administration (e.g., anemia, anorexia, diarrhea, fatigue, nausea and vomiting) is oftentimes reduced 10%, 20%, 30%, 40% or 50%.
• anemia, anorexia, diarrhea, fatigue, nausea and vomiting is oftentimes reduced 10%, 20%, 30%, 40% or 50%.
• Formulations used in the present invention may be in any suitable form, such as a solid, semisolid, or liquid form. See Pharmaceutical Dosage Forms and Drug Delivery Systems, 5 th edition, Lippicott Williams & Wilkins (1991), incorporated herein by reference.
• the pharmaceutical preparation will contain one or more of the compounds of the present invention as an active ingredient in admixture with an organic or inorganic carrier or excipient suitable for external, enteral, or parenteral application.
• the active ingredient may be compounded, for example, with the usual non-toxic, pharmaceutically acceptable carriers for tablets, pellets, capsules, suppositories, pessaries, solutions, emulsions, suspensions, and any other form suitable for use.
• the carriers that can be used include water, glucose, lactose, gum acacia, gelatin, mannitol, starch paste, magnesium trisilicate, talc, corn starch, keratin, colloidal silica, potato starch, urea, and other carriers suitable for use in manufacturing preparations in solid, semi-solid, or liquefied form.
• auxiliary stabilizing, thickening, and coloring agents and perfumes may be used.
• the compounds useful in the methods of the invention may be formulated as microcapsules and nanoparticles. General protocols are described, for example, by Microcapsules and Nanoparticles in Medicine and Pharmacy by Max Donbrow, ed., CRC Press (1992) and by U.S. Patent Nos.
• the compounds useful in the methods of the invention may also be formulated using other methods that have been previously used for low solubility drugs.
• the compounds may form emulsions with vitamin E or a PEGylated derivative thereof as described by PCT publications WO 98/30205 and WO 00/71163, each of which is incorporated herein by reference.
• the compound useful in the methods of the invention is dissolved in an aqueous solution containing ethanol (preferably less than 1% w/v).
• Vitamin E or a PEGylated- vitamin E is added.
• the ethanol is then removed to form a pre-emulsion that can be formulated for intravenous or oral routes of administration.
• Another method involves encapsulating the compounds useful in the methods of the invention in liposomes. Methods for forming liposomes as drug delivery vehicles are well known in the art. Suitable protocols include those described by U.S. Patent Nos. 5,683,715, 5,415,869, and 5,424,073 which are incorporated herein by reference relating to another relatively low solubility cancer drug paclitaxel and by PCT Publicaton WO 01/10412 which is incorporated herein by reference relating to epothilone B.
• particularly preferred lipids for making encapsulated liposomes include phosphatidylcholine and polyethyleneglycol-derivatized distearyl phosphatidyl- ethanoloamine.
• Biocompatible polymers can be categorized as biodegradable and non-biodegradable.
• Biodegradable polymers degrade in vivo as a function of chemical composition, method of manufacture, and implant structure.
• Illustrative examples of synthetic polymers include polyanhydrides, polyhydroxyacids such as polylactic acid, polyglycolic acids and copolymers thereof, polysters, polyamides, polyorthoesters and some polyphosphazenes.
• Naturally occurring polymers include proteins and polysaccharides such as collagen, hyaluronic acid, albumin, and gelatin.
• Another method involves conjugating the compounds useful in the methods of the invention to a polymer that enhances aqueous solubility.
• suitable polymers include polyethylene glycol, poly-(d-glutamic acid), poly-(l-glutamic acid), poly-(l -glutamic acid), poly-(d-aspartic acid), poly-(l-aspartic acid) and copolymers thereof.
• Polyglutamic acids having molecular weights between about 5,000 to about 100,000 are preferred, with molecular weights between about 20,000 and 80,000 being more preferred wand with molecular weights between about 30,000 and 60,000 being most preferred.
• the polymer is conjugated via an ester linkage to one or more hydroxyls of an inventive geldanamycin using a protocol as essentially described by U.S. Patent No. 5,977,163 which is incorporated herein by reference.
• the compounds useful in the methods of the invention are conjugated to a monoclonal antibody.
• This method allows the targeting of the inventive compounds to specific targets.
• General protocols for the design and use of conjugated antibodies are described in Monoclonal Antibody-Based Therapy of Cancer by Michael L. Grossbard, ED. (1998), which is incorporated herein by reference.
• the amount of active ingredient that may be combined with the carrier materials to produce a single dosage form will vary depending upon the subject treated and the particular mode of administration.
• a formulation for intravenous use comprises an amount of the inventive compound ranging from about 1 mg/mL to about 25 mg/mL, preferably from about 5 mg/mL, and more preferably about 10 mg/mL.
• Intravenous formulations are typically diluted between about 2 fold and about 30 fold with normal saline or 5% dextrose solution prior to use.
• 17-AAG is formulated as a pharmaceutical solution formulation comprising 17-AAG in an concentration of up to 15 mg/mL dissolved in a vehicle comprising (i) a first component that is ethanol, in an amount of between about 40 and about 60 volume %; (ii) a second component that is a polyethoxylated castor oil, in an amount of between about 15 to about 50 volume %; and (iii) a third component that is selected from the group consisting of propylene glycol, PEG 300, PEG 400, glycerol, and combinations thereof, in an amount of between about 0 and about 35 volume %.
• a vehicle comprising (i) a first component that is ethanol, in an amount of between about 40 and about 60 volume %; (ii) a second component that is a polyethoxylated castor oil, in an amount of between about 15 to about 50 volume %; and (iii) a third component that is selected from the group consisting of propylene glycol, PEG
• the aforesaid percentages are volume/volume percentages based on the combined volumes of the first, second, and third components.
• the lower limit of about 0 volume % for the third component means that it is an optional component; that is, it may be absent.
• the pharmaceutical solution formulation is then diluted into water to prepare a diluted formulation containing up to 3 mg/mL 17-AAG, for intravenous formulation.
• the second component is Cremophor EL and the third component is propylene glycol.
• the percentages of the first, second, and third components are 50%, 20-30%, and 20-30%, respectively.
• the method of the present invention is used for the treatment of cancer.
• the methods of the present invention are used to treat cancers of the head and neck, which include, but are not limited to, tumors of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, hypopharynx, salivary glands, and paragangliomas.
• the compounds of the present invention are used to treat cancers of the liver and biliary tree, particularly hepatocellular carcinoma.
• the compounds of the present invention are used to treat intestinal cancers, particularly colorectal cancer.
• the compounds, of the present invention are used to treat ovarian cancer.
• the compounds of the present invention are used to treat small cell and non-small cell lung cancer. In another embodiment, the compounds of the present invention are used to treat breast cancer. In another embodiment, the compounds of the present invention are used to treat sarcomas, including fibrosarcoma, malignant fibrous histiocytoma, embryonal O 2005/000213
• the compounds of the present invention are used to treat neoplasms of the central nervous systems, particularly brain cancer.
• the compounds of the present invention are used to treat lymphomas which include Hodgkin's lymphoma, lymphoplasmacytoid lymphoma, follicular lymphoma, mucosa-associated lymphoid tissue lymphoma, mantle cell lymphoma, B-lineage large cell lymphoma, Burkitt's lymphoma, and T-cell anaplastic large cell lymphoma.
• lymphomas which include Hodgkin's lymphoma, lymphoplasmacytoid lymphoma, follicular lymphoma, mucosa-associated lymphoid tissue lymphoma, mantle cell lymphoma, B-lineage large cell lymphoma, Burkitt's lymphoma, and T-cell anaplastic large cell lymphoma.
• DLD-1 human colon adenocarcmoma cell line
• SKBr-3 human breast adenocarcmoma cell line
• DLD-1 cells were maintained in RPMI 1640 medium supplemented with 10% fetal bovine serum
• SKBr-3 cells were cultured in McCoy's 5a medium supplemented with 10 % fetal bovine serum.
• 17-DMAG and 17-AAG were obtained using published procedures.
• Other cytotoxic agents were purchased commercially from suppliers such as Sigma Chemical Co. (St. Louis, MO) and Sequoia Research Products (Oxford, UK). Cell viability assay and combination effect analysis
• Cells were seeded in duplicate in 96-well microtiter plates at a density of 5,000 cells per well and allowed to attach overnight. Cells were treated with 17-AAG or 17-DMAG and the corresponding enzyme inhibitor at varying concentrations, ranging from 0.5 picomolar ("pM”) to 50 micromolar (“ ⁇ M”), for 3 days. Cell viability was determined usmg the MTS assay (Promega). For the drug combination assay, cells were seeded in duplicate in 96-well plates (5,000 cells/well). After an overnight incubation, cells were treated with drug alone or a combination and the IC 50 value (the concentration of drug required to inhibit cell growth by 50%) was determined.
• pM picomolar
• ⁇ M micromolar
• the quantities [D]i and [D] represent the concentrations of the first and second drug, respectively, that in combination provide a response of x % in the assay.
• the quantities [D x ]i and [D x ] 2 represent the concentrations of the first and second drug, respectively, that when used alone provide a response of x % in the assay.
• the "enhancing" effect of two drugs can also be determined.
• Results 17-AAG combination in DLD-1 cells [0091] The following table provides CI values for combinations of 17-AAG and the enzyme inhibitor Iressa in a DLD-1 cell assay. "Pre-administration” refers to the administration of 17-AAG to the cells before the administration of enzyme inhibitor; “post-administration” refers to the administration of 17-AAG to the cells after the administration of enzyme inhibitor.
• Table 5 CI values for combinations in DLD-1 cells human colorectal cancer cells . 17-AAG combination in SKSBr-3 cells [0092] The following table provides CI values for combinations of 17-AAG and the enzyme inhibitors SAHA, Trichostatin A, and Iressa in an SKBr-3 cell assay.
• Table 6 CI values for combinations in SKBr cells human breast cancer cells).

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