Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/2803—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily
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  • 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
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
  • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
• • A—HUMAN NECESSITIES
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  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/436—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having oxygen as a ring hetero atom, e.g. rapamycin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
  • A61K31/454—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. pimozide, domperidone
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
• • 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
  • A61K31/66—Phosphorus compounds
  • A61K31/675—Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/69—Boron compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6801—Drug-antibody or immunoglobulin conjugates defined by the pharmacologically or therapeutically active agent
  • A61K47/6803—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates
  • A61K47/68033—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates the drug being a maytansine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6835—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site
  • A61K47/6849—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a receptor, a cell surface antigen or a cell surface determinant
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
• • 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
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
  • C07K2317/24—Immunoglobulins specific features characterized by taxonomic origin containing regions, domains or residues from different species, e.g. chimeric, humanized or veneered

Definitions

• the present invention relates to anticancer combinations, pharmaceutical compositions comprising the same, and the use thereof in the treatment of cancer.
• the present invention is based on the discovery that the administration of a combination comprising at least one cell binding agent drug conjugate (e.g., an immunoconjugate) and one or more chemotherapeutic agent(s) selected from proteasome inhibitors (e.g., bortezomib), immunomodulatory agents/anti-angiogenic agents (e.g., thalidomide or lenalidomide), and DNA alkylating agents (e.g., melphalan), with the optional further addition of a corticosteroid (e.g., dexamethasone) has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the anticancer agent(s) alone.
• the present invention also provides methods of modulating the growth of selected cell populations, such as cancer cells, by administering a therapeutically effective amount of such combination.
• An isobol or isobologram is the graphic representation of all dose combinations of two drugs that have the same degree of effect, for example combinations of two cytotoxic drugs will affect the same degree of cell kill, such as 20% or 50% of cell kill.
• the equation is valid for any degree of effect and the graphic representation will have the same shape (page 54, line 1 , in Chou and Talalay), which is presented in Figure 11 D (page 5 in Chou and Talalay).
• a straight line indicates additive effects
• a concave curve (curve below the straight line) represents synergistic effects
• a convex curve (curve above the straight line) represents antagonistic effects.
• gef ⁇ tinib also known as Iressa
• cytotoxic drugs cisplatin, gemcitabine, oxaliplatin and treosulfan
• TGI tumor growth inhibition
• gefitinib in combination with different cytotoxic agents is a double- edged sword: their effect on growth rate may make some tumors more resistant to concomitant cytotoxic chemotherapy, while their effect on cytokine-mediated cell survival (anti-apoptotic) mechanisms may potentiate sensitivity to the same drugs in tumors from other individuals.
• cytotoxic agents cisplatin; gemcitabine; oxaliplatin; treosulfan and treosulfan + gemcitabine
• a maytansinoid immunoconjugate comprising a maytansinoid compound linked to a monoclonal antibody with that of a taxane compound, an epothilone compound, a platinum compound, an epipodophyllotoxin compound and a camptothecin compound.
• NRTIs nucleoside RT inhibitors
• NRTIs nonnucleoside RT inhibitors
• NRTI, AZT (zidovudine) and the NNRTI, nevirapin exhibit synergy when given in combination (Basavapathruni A et al., J. Biol. Chem., Vol. 279, Issue 8, 6221-6224, February 20, 2004).
• the present invention is based on the discovery that the administration of a combination comprising at least one cell binding agent drug conjugate (e.g., an immunoconjugate), hereinafter referred to as "Conjugate” and at least one chemotherapeutic agent selected from proteasome inhibitors (e.g., bortezomib), immunomodulatory agents/anti-angiogenic agents (e.g., thalidomide or lenalidomide), and DNA alkylating agents (e.g., melphalan), optionally further combined with a corticosteroid (e.g., dexamethasone) has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the immunoconjugate used alone, or the chemotherapeutic agent used alone or in combination with another chemotherapeutic agent, without the addition of the immunoconjugate.
• a cell binding agent drug conjugate e.g., an immunoconjugate
• chemotherapeutic agent selected from proteasome inhibitors (e.g.
• the conjugate and the chemotherapeutic agent(s) are administered in combination with a corticosteroid, such as, dexamethasone.
• a corticosteroid such as, dexamethasone.
• an immunoconjugate such as, humanized antibody N901-maytansinoid conjugate (huN901-DMl) is administered in combination with thalidomide/ dexamethasone, lenalidomide/ dexamethasone or bortezomib/ dexamethasone, wherein such combination has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the immunoconjugate used alone, the chemotherapeutic agent used alone or in combination with another chemotherapeutic agent, without the addition of the immunoconjugate.
• two or more chemotherapeutic agents are used in combination with the immunoconjugate.
• bortezomib and lenalidomide are used in combination with huN901 maytansinoid conjugate, in presence or absence of a corticosteroid, such as, dexamethasone, wherein such combination has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the immunoconjugate used alone, the chemotherapeutic agent used alone or in combination with another chemotherapeutic agent, without the addition of the immunoconjugate.
• chemotherapeutic synergy means combination of a conjugate and one or more chemotherapeutic agent(s) having a therapeutic effect greater than the additive effect of the combination of a conjugate and or one or more chemotherapeutic agent.
• Another obj ect of the present invention describes methods of ameliorating or treating cancer in a patient in need thereof by administering to the patient a therapeutically effective amount of at least one conjugate (e.g., immunoconjugate) and one or more chemotherapeutic agents, (e.g., a proteasome inhibitor, an immunomodulatory agent/anti-angiogenic agent, or a DNA alkylating agent), with the optional further addition of a corticosteroid (e.g. dexamethasone) such that the combination has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the anticancer agent(s) used alone or in combination, without the addition of the immunoconjugate.
• conjugate e.g., immunoconjugate
• chemotherapeutic agents e.g., a proteasome inhibitor, an immunomodulatory agent/anti-angiogenic agent, or a DNA alkylating agent
• a corticosteroid e.g. dexamethasone
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising an effective amount of a conjugate (e.g., immunoconjugate) and one or more of a chemotherapeutic agent (e.g., a proteasome inhibitor, an immunomodulatory agent/anti-angiogenic agent, or a DNA alkylating agent), optionally together with a pharmaceutically acceptable carrier.
• a conjugate e.g., immunoconjugate
• a chemotherapeutic agent e.g., a proteasome inhibitor, an immunomodulatory agent/anti-angiogenic agent, or a DNA alkylating agent
• the present invention still further provides the use of a conjugate (e.g., immunoconjugate) and a chemotherapeutic agent (e.g., a proteasome inhibitor, an immunomodulatory agent/anti-angiogenic agent, or a DNA alkylating agent) with the optional addition of a corticosteroid, for the preparation of a medicament for combination therapy by simultaneous, sequential or separate administration in the treatment of cancer or any disease resulting from abnormal proliferation of cells.
• a conjugate and the drug(s) can be administered on the same days or different days, using the optimal dosing schedule for each agent.
• the two compounds could be administered within ten days of each other, in another embodiment, within five days of each other, and yet in another embodiment within twenty-four hours of each other, or even simultaneously.
• huN901-DMl, the chemotherapeutic agent(s), corticosteroid, or any combination thereof could be administered every other day, on alternate days, on a weekly basis or time period that ranges between day 0 and 7 (e.g., day 0, 1 , 2, 3, 4, 5, 6, or 7) or ranges between 0 and 4 weeks (e.g., 0, 1 , 2, 3 or 4 weeks, including days that may add up between 1 or more weeks).
• a chemotherapeutic agent is administered first followed by conjugate.
• bortezomib is administered on day zero followed by huN901-DMl on day 3.
• the drug administration can be determined by one of skill in the art as the clinical situation warrants.
• the present invention also describes methods of modulating the growth of selected cell populations, such as cancer cells, by administering a therapeutically effective amount of at least one conjugate (e.g., an immunoconjugate) and one or more chemotherapeutic drug(s) (e.g., a proteasome inhibitor, an immunomodulatory agent/anti- angiogenic agent, or a DNA alkylating agent), with the optional addition of a corticosteroid, such that the combination has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the anticancer agent(s) used alone or in combination, without the addition of the immunoconjugate.
• the conjugate can comprise a cell binding agent and at least one therapeutic agent for killing selected cell populations.
• Figure IA shows a combination of huN901-DMl with melphalan in Molp-8 multiple myeloma xenografts.
• Figure IB is a table (Table 1) showing the data.
• Figure 2A shows a combination of huN901-DMl with thalidomide in Molp-8 multiple myeloma xenografts.
• Figure 2B is a table (Table 2) showing the data.
• Figure 3 A shows a combination of huN901-DMl with bortezomib in OPM2 multiple myeloma xenografts.
• Figure 3B is a table (Table 3) showing the data.
• Figure 4A shows a combination of huN901-DMl with bortezomib (low-dose) in large H929 multiple myeloma xenografts.
• Figure 4B is a table (Table 4a) showing the data.
• Figure 4C shows a combination of huN901-DMl with bortezomib (high-dose) in large H929 multiple myeloma xenografts.
• Figure 4D is a table (Table 4b) showing the data.
• Figure 5 A shows a combination of huN901-DMl with lenalidomide in OPM2 multiple myeloma xenografts.
• Figure 5B is a table (Table 5) showing the data.
• Figure 6 shows a schedule dependency of the anti-tumor activity of huN901 -DMl with bortezomib.
• Figure 7A shows a triple combination of huN901-DMl with lenalidomide plus low-dose dexamethasone in MOLP-8 multiple myeloma xenografts.
• Figure 7B is a table
• Figure 8 A shows immunohistochemical analysis of the apoptosis marker, caspase-
• Figure 8B shows the statistically significant synergistic increase in tumor cell apoptosis in MOLP-8 multiple myeloma xenografts treated with the triple combination of huN901-DMl with lenalidomide plus low-dose dexamethasone compared to treatment with either therapy separately.
• the present invention is based on the unexpected discovery that the administration of at least one conjugate (e.g., immunoconjugate) and at least one chemotherapeutic drug (e.g., a proteasome inhibitor, an immunomodulatory agent/anti- angiogenic agent, or a DNA alkylating agent), with the optional further addition of a corticosteroid (dexamethasone), has therapeutic synergy or improves the therapeutic index in the treatment of cancer over the immunoconjugate alone, the chemotherapeutic agent used alone or in combination with another chemotherapeutic agent, without the addition of the immunoconjugate.
• chemotherapeutic drug e.g., a proteasome inhibitor, an immunomodulatory agent/anti- angiogenic agent, or a DNA alkylating agent
• the conjugates of the present invention comprise at least one therapeutic agent for killing selected cell populations linked to a cell binding agent.
• the therapeutic agent for killing selected cell populations is preferably an antimitotic agent.
• Anti-mitotic agents which are known in the art, kill cells by inhibiting tubulin polymerization and, therefore, microtubule formation. Any anti-mitotic agent known in the art can be used in the present invention, including, for example, maytansinoids, Vinca alkaloids, dolastatins, auristatins, cryptophycins, tubulysin, and/or any other agent that kills cells by inhibiting tubulin polymerization.
• the antimitotic agent is a maytansinoid.
• the cell binding agent can be any suitable agent that binds to a cell, typically and preferably an animal cell (e.g., a human cell).
• the cell binding agent preferably is a peptide or a polypeptide.
• Suitable cell binding agents include, for example, antibodies (e.g., monoclonal antibodies and fragments thereof), lymphokines, hormones, growth factors, nutrient-transport molecules (e.g., transferrin).
• Therapeutic agents for killing selected cell populations and cell binding agents that could be part of the immunoconjugate are described below in greater detail. MAYTANSINOIDS
• Maytansinoids that can be used in the present invention are well known in the art and can be isolated from natural sources according to known methods or prepared synthetically according to known methods.
• Examples of suitable maytansinoids include maytansinol and maytansinol analogues.
• suitable maytansinol analogues include those having a modified aromatic ring and those having modifications at other positions.
• N- methyl-alanine-containing C-3 thiol moiety maytansinoid
• an iV-methyl-cysteine- containing C-3 thiol moiety maytansinoid, and analogues of each.
• N-methyl-alanine-containing C-3 thiol moiety maytansinoid derivatives useful in the present invention are represented by the formulae Ml, M2, M3, M6 and M7.
• / is an integer of from 1 to 10; and may is a maytansinoid.
• Ri and R 2 are H, CH 3 or CH 2 CH 3 , and may be the same or different; m is 0, 1, 2 or 3; and may is a maytansinoid.
• n is an integer of from 3 to 8; and may is a maytansinoid.
• Y 0 is Cl or H
• X 3 is H or CH 3 .
• Ri, R 2 , R 3 , R 4 are H, CH 3 or CH 2 CH 3 , and may be the same or different; m is 0, 1, 2 or 3; and
• N-methyl-cysteine-containing C-3 thiol moiety maytansinoid derivatives useful in the present invention are represented by the formulae M4 and M5.
• M4 wherein: o is 1, 2 or 3; p is an integer of 0 to 10; and
• M5 wherein: o is 1, 2 or 3; q is an integer of from 0 to 10;
• Y 0 is Cl or H
• X 3 is H or CH 3 .
• Preferred maytansinoids are those described in US Patents 5,208,020; 5,416,064; 6,333,410; 6,441,163; 6,716,821; RE39,151 and 7,276,497.
• Vinca alkaloid compounds e.g., vincristine
• dolastatin compounds e.g., dolastatin compounds
• cryptophycin compounds are describe in detail in WOO 1/24763.
• Auristatin include auristatin E, auristatin EB (AEB), auristatin EFP (AEFP), monomethyl auristatin E (MMAE) are described in U.S. Pat. No. 5,635,483, Int. J. Oncol. 15:367-72 (1999); Molecular Cancer Therapeutics, vol. 3, No. 8, pp. 921-932 (2004); U.S. Application Number 11/134826. US Publication Nos. 20060074008, 2006022925. Tubulysin compounds are described in US Publication Non. 20050249740. Many of the agents listed under this heading, if intended, can also be used as chemotherapeutic agents.
• the cell-binding agents used in this invention are proteins (e.g., immunoglobulin and non-immunoglobulin proteins) that bind specifically to target antigens on cancer cells.
• proteins e.g., immunoglobulin and non-immunoglobulin proteins
• These cell-binding agents include the following:
• -humanized or fully human antibodies are selected from, but not limited to, huMy9-6, huB4, huC242, huN901, DS6, CD38, IGF-IR, CNTO 95, B-B4, trastuzumab, bivatuzumab, sibrotuzumab, pertuzumab and rituximab (see, e.g., U.S. Patent Nos. 5,639,641, 5,665,357, and 7,342,110; U.S. Provisional Patent Application No. 60/424,332, International Patent Application WO 02/16,401, U.S. Patent Publication Number 20060045877, U.S.
• Patent Publication Number 20060127407 U.S. Patent Publication No. 20050118183, Pedersen et al., (1994) J. MoI. Biol. 235, 959-973, Roguska et al., (1994) Proceedings of the National Academy of Sciences, VoI 91, 969-973, Colomer et al., Cancer Invest., 19: 49-56 (2001), Heider et al., Eur. J. Cancer, 3 IA: 2385-2391 (1995), Welt et al, J Clin. Oncol, 12: 1193-1203 (1994), and Maloney et al., Blood, 90: 2188-2195 (1997).); and
• Additional cell-binding agents include other cell-binding proteins and polypeptides exemplified by, but not limited to:
• -interferons e.g. ⁇ , ⁇ , ⁇
• -lymphokines such as IL-2, IL-3, IL-4, IL-6;
• -hormones such as insulin, TRH (thyrotropin releasing hormones), MSH (melanocyte-stimulating hormone), steroid hormones, such as androgens and estrogens; and
• EGF EGF
• TGF- ⁇ TGF- ⁇
• IGF-I IGF-I
• G-CSF G-CSF
• M-CSF M-CSF
• GM-CSF GM-CSF
• the cell-binding agent is an antibody (e.g., a single chain antibody, an antibody fragment that binds to the target cell, a monoclonal antibody, a single chain monoclonal antibody, or a monoclonal antibody fragment thereof, a chimeric antibody, a chimeric antibody fragment thereof, a domain antibody, a domain antibody fragment thereof, a resurfaced antibody, a resurfaced single chain antibody, or a resurfaced antibody fragment thereof, a human antibody or a human antibody fragment thereof, a humanized antibody or a resurfaced antibody, a humanized single chain antibody, or a humanized antibody fragment thereof), it binds to an antigen that is a polypeptide and may be a transmembrane molecule (e.g.
• antigens include molecules such as renin; a growth hormone, including human growth hormone and bovine growth hormone; growth hormone releasing factor; parathyroid hormone; thyroid stimulating hormone; lipoproteins; alpha- 1 -antitrypsin; insulin A-chain; insulin B-chain; proinsulin; follicle stimulating hormone; calcitonin; luteinizing hormone; glucagon; clotting factors such as factor vmc, factor IX, tissue factor (TF), and von Willebrands factor; anti-clotting factors such as Protein C; atrial natriuretic factor; lung surfactant; a plasminogen activator, such as urokinase or human urine or tissue-type plasminogen activator (t-PA); bombesin; thrombin; hemopoietic growth factor; tumor necrosis factor-alpha and -beta; enkephalinase; RANTES (regulated on activation normally T-
• a plasminogen activator such as urokin
• GM-CSF which binds to myeloid cells can be used as a cell- binding agent to diseased cells from acute myelogenous leukemia.
• IL-2 which binds to activated T-cells can be used for prevention of transplant graft rejection, for therapy and prevention of graft- versus-host disease, and for treatment of acute T-cell leukemia.
• MSH which binds to melanocytes, can be used for the treatment of melanoma.
• Folic acid can be used to target the folate receptor expressed on ovarian and other tumors.
• Epidermal growth factor can be used to target squamous cancers such as lung and head and neck.
• Somatostatin can be used to target neuroblastomas and other tumor types.
• Cancers of the breast and testes can be successfully targeted with estrogen (or estrogen analogues) or androgen (or androgen analogues) respectively as cell-binding agents.
• Preferred antigens for antibodies encompassed by the present invention include CD proteins such as CD2, CD3, CD4, CD5, CD6, CD8, CDl 1, CD 14, CD18, CD19, CD20, CD 21, CD22, CD 25, CD26, CD28, CD30, CD33, CD36, CD37, CD38, CD40, CD44, CD52, CD55, CD56, CD70, CD79, CD80, CD81, CD103, CD105, CD134, CD137, CDl 38, and CD152; members of the ErbB receptor family such as the EGF receptor, HER2, HER3 or HER4 receptor; cell adhesion molecules such as LFA-I, Macl, pi 50.95, VLA-4, ICAM-I, VCAM, EpCAM, alpha4/beta7 integrin, and alpha v/beta3 integrin including either alpha or beta subunits thereof (e.g.
• anti-CDl Ia, anti-CD18 or anti-CD 1 Ib antibodies growth factors such as VEGF; tissue factor (TF); TGF- ⁇ .; alpha interferon (alpha-IFN); an interleukin, such as IL- 8; IgE; blood group antigens Apo2, death receptor; flk2/flt3 receptor; obesity (OB) receptor; mpl receptor; CTL A-4; protein C etc.
• growth factors such as VEGF; tissue factor (TF); TGF- ⁇ .; alpha interferon (alpha-IFN); an interleukin, such as IL- 8; IgE; blood group antigens Apo2, death receptor; flk2/flt3 receptor; obesity (OB) receptor; mpl receptor; CTL A-4; protein C etc.
• the most preferred targets herein are IGF-IR, CanAg, EphA2, MUCl, MUC 16, VEGF, TF, CDl 9, CD20, CD22, CD33, CD37, CD38, CD40, CD44, CD56, CDl 38, CA6, Her2/neu, EpCAM, CRIPTO (a protein produced at elevated levels in a majority of human breast cancer cells), darpins, alpha v /beta 3 integrin, alpha v /betas integrin, alpha v/betae integrin, TGF- ⁇ , CDl Ia, CD18, Apo2 and C242 or an antibody which binds to one or more tumor-associated antigens or cell-surface receptors disclosed in US Publication No. 20080171040 or US Publication No. 20080305044 and are incorporated in their entirety by reference.
• Preferred antigens for antibodies encompassed by the present invention also include CD proteins such as CD3, CD4, CD8, CDl 9, CD20, CD34, CD37, CD38, CD46, CD56 and CD138; members of the ErbB receptor family such as the EGF receptor, HER2, HER3 or HER4 receptor; cell adhesion molecules such as LFA-I, Macl, pl50.95, VLA-4, ICAM-I, VCAM, EpCAM, alpha4/beta7 integrin, and alpha v/beta3 integrin including either alpha or beta subunits thereof (e.g.
• anti-CDl Ia, anti-CDl 8 or anti- CDl Ib antibodies growth factors such as VEGF; tissue factor (TF); TGF- ⁇ .; alpha interferon (alpha-IFN); an interleukin, such as IL-8; IgE; blood group antigens Apo2, death receptor; flk2/flt3 receptor; obesity (OB) receptor; mpl receptor; CTLA-4; protein C, etc.
• growth factors such as VEGF; tissue factor (TF); TGF- ⁇ .; alpha interferon (alpha-IFN); an interleukin, such as IL-8; IgE; blood group antigens Apo2, death receptor; flk2/flt3 receptor; obesity (OB) receptor; mpl receptor; CTLA-4; protein C, etc.
• the most preferred targets herein are IGF-IR, CanAg, EGF-R, EphA2, MUCl, MUCl 6, VEGF, TF, CDl 9, CD20, CD22, CD33, CD37, CD38, CD40, CD44, CD56, CDl 38, CA6, Her2/neu, CRIPTO (a protein produced at elevated levels in a majority of human breast cancer cells), alpha v /beta 3 integrin, alpha v /beta 5 integrin, TGF- ⁇ , CDl Ia, CDl 8, Apo2, EpCAM and C242.
• Monoclonal antibody techniques allow for the production of specific cell-binding agents in the form of monoclonal antibodies.
• Particularly well known in the art are techniques for creating monoclonal antibodies produced by immunizing mice, rats, hamsters or any other mammal with the antigen of interest such as the intact target cell, antigens isolated from the target cell, whole virus, attenuated whole virus, and viral proteins such as viral coat proteins.
• Sensitized human cells can also be used.
• Another method of creating monoclonal antibodies is the use of phage libraries of sFv (single chain variable region), specifically human sFv (see, e.g., Griffiths et al, U.S. Patent No.
• the monoclonal antibody My9 is a murine IgG 2a antibody that is specific for the CD33 antigen found on Acute Myeloid Leukemia (AML) cells (Roy et al. Blood 77:2404-2412 (1991)) and can be used to treat AML patients.
• the monoclonal antibody anti-B4 is a murine IgG 1 that binds to the CD 19 antigen on B cells (Nadler et al, J Immunol. 131 :244-250 (1983)) and can be used if the target cells are B cells or diseased cells that express this antigen such as in non-Hodgkin's lymphoma or chronic lymphoblastic leukemia.
• the antibody N901 is a murine monoclonal IgG 1 antibody that binds to CD56 found on small cell lung carcinoma cells and on cells of other tumors of neuroendocrine origin (Roy et al. J Nat. Cancer Inst. 88:1136-1145 (1996)); huC242 is an antibody that binds to the CanAg antigen; Trastuzumab is an antibody that binds to HER2/neu; and anti-EGF receptor antibody binds to EGF receptor.
• Drugs that can be used in the present invention include chemotherapeutic agents.
• “Chemotherapeutic agent” is a chemical compound useful in the treatment of cancer.
• Preferred examples of chemotherapeutic agents are proteasome inhibitors, immunomodulatory agents, anti-angiogenic agents, alkylating agents or combinations thereof.
• proteasome inhibitors are drugs that block the action of proteasomes, cellular complexes that break down proteins.
• the proteasome inhibitor is selected from a group comprising: a) naturally occurring proteasome inhibitors comprising: peptide derivatives which have a C-terminal expoxy ketone structure, ⁇ -lactone-derivatives, aclacinomycin A, lactacystin, clastolactacystein; b) synthetic proteasome inhibitors comprising: modified peptide aldehydes such as N- carbobenzoxy-L-leucinyl-L-leucinyl-L-leucinal (also referred to as MGl 32 or zLLL), or the boronic acid derivative of MG232, N-carbobenzoxy-Leu-Nva-H (also referred to as MGl 15), N-acetyl-L-leucinyl-L-leucinyl-L-norle
• proteasome inhibitors described in Am J Clin Pathol 116(5):637-646, 2001 or the United States Application Number 10/522706 (filed July 31, 2003) are also encompassed to be within the vision of this present invention.
• the proteasome inhibitor is PS-341/bortezomib (VelcadeTM).
• immunomodulatory drugs or agents it is meant, e.g., agents which act on the immune system, directly or indirectly, e.g., by stimulating or suppressing a cellular activity of a cell in the immune system, e.g., T-cells, B-cells, macrophages, or antigen presenting cells (APC), or by acting upon components outside the immune system which, in turn, stimulate, suppress, or modulate the immune system, e.g., hormones, receptor agonists or antagonists, and neurotransmitters; immunomodulators can be, e.g., immunosuppressants or immunostimulants.
• anti-inflammatory drugs it is meant, e.g., agents which treat inflammatory responses, i.e., a tissue reaction to injury, e.g., agents which treat the immune, vascular, or lymphatic systems.
• Anti-inflammatory or immunomodulatory drugs or agents suitable for use in this invention include, but are not limited to, interferon derivatives, e.g., betaseron, ⁇ - interferon; prostane derivatives, e.g., compounds disclosed in PCT/DE93/0013, e.g., iloprost, cicaprost; glucocorticoid, e.g., Cortisol, prednisolone, methylprednisolone, dexamethasone; immunsuppressives, e.g., cyclosporine A, FK-506, methoxsalene, thalidomide, sulfasalazine, azathioprine, methotrexate; lipoxygenase inhibitors, e.g., zileutone, MK-886, WY-50295, SC-45662, SC-41661A, BI-L-357; leukotriene antagonists,
• immunomodulatory agents include, but are not limited to, methothrexate, leflunomide, cyclophosphamide, cyclosporine A, and macrolide antibiotics (e.g., FK506 (tacrolimus)), methylprednisolone (MP), corticosteroids, steroids, mycophenolate mofetil, rapamycin (sirolimus), mizoribine, deoxyspergualin, brequinar, malononitriloamindes (e.g., leflunamide), T cell receptor modulators, and cytokine receptor modulators.
• macrolide antibiotics e.g., FK506 (tacrolimus)
• MP methylprednisolone
• corticosteroids methylprednisolone
• steroids methylprednisolone
• mycophenolate mofetil e.g., rapamycin (sirolimus)
• mizoribine e.g.
• T cell receptor modulators include, but are not limited to, anti-T cell receptor antibodies (e.g., anti-CD4 monoclonal antibodies, anti-CD3 monoclonal antibodies, anti-CD8 monoclonal antibodies, anti-CD40 ligand monoclonal antibodies, anti-CD2 monoclonal antibodies) and CTLA4-immunoglobulin.
• anti-T cell receptor antibodies e.g., anti-CD4 monoclonal antibodies, anti-CD3 monoclonal antibodies, anti-CD8 monoclonal antibodies, anti-CD40 ligand monoclonal antibodies, anti-CD2 monoclonal antibodies
• CTLA4-immunoglobulin e.g., CTLA4-immunoglobulin.
• cytokine receptor modulators include, but are not limited to, soluble cytokine receptors (e.g., the extracellular domain of a TNF-alpha receptor or a fragment thereof, the extracellular domain of an IL-I ⁇ receptor or a fragment thereof, and the extracellular domain of an IL- 6 receptor or a fragment thereof), cytokines or fragments thereof (e.g., interleukin (IL)-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-IO, IL-11, IL-12, IL-15, TNF-alpha, interferon (IFN)-alpha, IFN-beta, IFN-gamma, and GM-CSF), anti-cytokine receptor antibodies (e.g., anti-IL-2 receptor antibodies, anti-IL-4 receptor antibodies, anti-IL-6 receptor antibodies, anti-IL-10 receptor antibodies, and anti-IL-12 receptor antibodies), anti- cytokine antibodies (e.g.,
• immunomodulatory drugs are those that are effective for the treatment of multiple myeloma, blood, plasma, or bone-related cancers.
• the immunomodulatory agent is selected from thalidomide (Thalomid) and lenalidomide (Revlimid).
• Anti-angiogenic agents include, but are not limited to, receptor tyrosine kinase inhibitors (RTKi), described in further detail in Unites States patent application number 11/ 612744 (filed December 19, 2006) or in 10/443254 (filed May 22, 2003); angiostatic cortisenes; MMP inhibitors; integrin inhibitors; PDGF antagonists; antiproliferatives; HIF-I inhibitors; fibroblast growth factor inhibitors; epidermal growth factor inhibitors; TIMP inhibitors; insulin-like growth factor inhibitors; TNF inhibitors; antisense oligonucleotides; anti-VEGF antibody, VEGF trap, NSAID, steroids, SiRNA etc., and prodrugs of any of the aforementioned agents.
• RTKi receptor tyrosine kinase inhibitors
• anti-VEGF antibody i.e., bevacizumab or ranibizumab
• VEGF trap siRNA molecules, or a mixture thereof, targeting at least two of the tyrosine kinase receptors
• glucocorticoids i.e., dexamethasone, fluoromethalone, medrysone, betamethasone, triamcinolone, triamcinolone acetonide, prednisone, prednisolone, hydrocortisone, rimexolone, and pharmaceutically acceptable salts thereof, prednicarbate, deflazacort, halomethasone, tixocortol, prednylidene (21-diethylaminoacetate), prednival, paramethasone, methylprednisolone, meprednisone, mazipredone, isoflupredone, halopredone acetate
• glucocorticoids i.e.,
• the anti-angiogenic agent is selected from thalidomide (Thalomid) and lenalidomide (Revlimid).
• thalidomide Thalomid
• lenalidomide Revlimid
• Alkylating agents or DNA alkylating agents operate by damaging DNA.
• DNA damage could be accomplished by any one of the following mechanisms: In the first mechanism an alkylating agent attaches alkyl groups to DNA bases. This alteration results in the DNA being fragmented by repair enzymes in their attempts to replace the alkylated bases.
• a second mechanism by which alkylating agents cause DNA damage is the formation of cross-bridges, bonds between atoms in the DNA. In this process, two bases are linked together by an alkylating agent that has two DNA binding sites. Cross-linking prevents DNA from being separated for synthesis or transcription.
• the third mechanism of action of alkylating agents causes the mispairing of the nucleotides leading to mutations.
• alkylating agents nitrogen mustards; ethylenimes; alkylsulfonates; triazenes; piperazines; and nitrosureas.
• allylating agents are, but limited to, thiotepa and cyclophosphamide (CYTOXANTM); alkyl sulfonates such as busulfan, improsulfan and piposulfan; aziridines such as benzodopa, carboquone, carmustine, meturedopa, and uredopa; ethylenimines and methylamelamines including altretamine, triethylenemelamine, trietylenephosphoramide, triethylenethiophosphaoramide and trimethylolomelamine; acetogenins (especially bullatacin and bullatacinone); a camptothecin (including the synthetic analogue topotecan); bryostatin; callystatin; CC- 1065
• Corticosteroids are drugs closely related to Cortisol, a hormone which is naturally produced in the adrenal cortex (the outer layer of the adrenal gland).
• Corticosteroid Drugs include: Betamethasone (Celestone), Budesonide (Entocort EC), Cortisone (Cortone), Dexamethasone (Decadron), Hydrocortisone (Cortef), Methylprednisolone (Medrol), Prednisolone (Prelone), Prednisone (Deltasone), and Triamcinolone (Kenacort, Kenalog).
• Preferred corticosteroid is Dexamethasone (including derivatives, such as but not limited to, dexamethasone sodium phosphate and dexamethasone acetate).
• Corticosteroids can be given orally, injected into the vein or muscle, applied locally to the skin, injected directly (for example, into inflamed joints).
• Corticosteroids can be used in conjunction with other drugs, and are prescribed for short-term and long-term use (e.g., given in pulse doses, doses administered for a short period of time, repeated at set intervals).
• Corticosteroids may range from 0.5 to 100 mg/day
• dexamethasone may be recommended at a range between 0.5 to 100 mg/day, more preferably between 10 to 80 mg/day, even more preferably at 15 to 70 mg/day or most preferably between 20 to 60mg/day for administration on the same day or on different days, such as, on Days 1 to 4, 9 to 12, and 17 to 20 of each 28-day cycle for the first 4 cycles of therapy and then 40 mg/day orally on Days 1 to 4 every 28 days. Dosing can be continued or modified based upon clinical and laboratory findings.
• the dose is initially quite high, then gradually tapered or vice a versa or that one may want to start you at a higher, or lower dose than what is recommended and may depend on the body weight of the mammalian (e.g., a human) being treated.
• the drug conjugates may be prepared by biochemical methods.
• a linking group is used.
• Suitable linking groups are well known in the art and include disulfide groups, acid labile groups, photolabile groups, peptidase labile groups, thioether groups and esterase labile groups.
• Preferred linking groups are disulfide and thioether groups.
• conjugates can be constructed using a disulfide exchange reaction between the appropriately modified antibody and the drug or prodrug, or by reaction of a thiol-containing drug with an antibody that has been modified to contain a maleimido group.
• the drug may contain a maleimido group and the antibody a thiol moiety.
• the drug molecules also can be linked to a cell-binding agent through an intermediary carrier molecule such as serum albumin.
• the cell-binding agent is modified by reacting a bifunctional crosslinking reagent with the cell-binding agent, thereby resulting in the covalent attachment of a linker molecule to the cell-binding agent.
• a "bifunctional crosslinking reagent” is any chemical moiety that covalently links a cell- binding agent to a drug, such as the drugs described herein.
• a portion of the linking moiety is provided by the drug.
• the drug comprises a linking moiety that is part of a larger linker molecule that is used to join the cell-binding agent to the drug.
• the ester side chain at the C-3 position of maytansine is modified to have a free sulfhydryl group (SH), as described in US Patents 5,208,020; 6,333,410; 7,276,497.
• SH free sulfhydryl group
• This thiolated form of maytansine can react with a modified cell-binding agent to form a conjugate. Therefore, the final linker is assembled from two components, one of which is provided by the crosslinking reagent, while the other is provided by the side chain from DMl or DM4.
• any suitable bifunctional crosslinking reagent can be used in connection with the invention, so long as the linker reagent provides for retention of the therapeutic, e.g., cytotoxicity, and targeting characteristics of the drug and the cell-binding agent, respectively.
• the linker molecule joins the drug to the cell-binding agent through chemical bonds (as described above), such that the drug and the cell-binding agent are chemically coupled (e.g., covalently bonded) to each other.
• the linking reagent is a cleavable linker. More preferably, the linker is cleaved under mild conditions, i.e., conditions within a cell under which the activity of the drug is not affected.
• cleavable linkers examples include disulfide linkers, acid labile linkers, photolabile linkers, peptidase labile linkers, and esterase labile linkers.
• Disulfide containing linkers are linkers cleavable through disulfide exchange, which can occur under physiological conditions.
• Acid labile linkers are linkers cleavable at acid pH. For example, certain intracellular compartments, such as endosomes and lysosomes, have an acidic pH (pH 4-5), and provide conditions suitable to cleave acid labile linkers.
• Photo labile linkers are useful at the body surface and in many body cavities that are accessible to light. Furthermore, infrared light can penetrate tissue.
• Peptidase labile linkers can be used to cleave certain peptides inside or outside cells (see e.g., Trouet et al., Proc. Natl. Acad. Sci. USA, 79: 626-629 (1982), and Umemoto et al., Int. J. Cancer, 43: 677-684 (1989)).
• the drug is linked to a cell-binding agent through a disulfide bond or a thioether bond.
• the linker molecule comprises a reactive chemical group that can react with the cell-binding agent.
• Preferred reactive chemical groups for reaction with the cell- binding agent are 7V-succinimidyl esters and TV-sulfosuccmimidyl esters.
• the linker molecule comprises a reactive chemical group, preferably a dithiopyridyl group that can react with the drug to form a disulfide bond.
• linker molecules include, for example, N-succinimidyl 3-(2-pyridyldithio)propionate (SPDP) (see, e.g., Carlsson et al., Biochem. J., 173: 723-737 (1978)), N-succinimidyl 4-(2- pyridyldithio)butanoate (SPDB) (see, e.g., U.S.
• SPDP N-succinimidyl 3-(2-pyridyldithio)propionate
• SPDB N-succinimidyl 4-(2- pyridyldithio)butanoate
• Patent 4,563,304 N-succinimidyl 4-(2- pyridyldithio)pentanoate (SPP) (see, e.g., CAS Registry number 341498-08-6), and other reactive cross-linkers which are described in U.S. Patent 6,913,748, which is incorporated herein in its entirety by reference.
• SPP N-succinimidyl 4-(2- pyridyldithio)pentanoate
• cleavable linkers preferably are used in the inventive method
• a non- cleavable linker also can be used to generate the above-described conjugate.
• a non- cleavable linker is any chemical moiety that is capable of linking a drug, such as a maytansinoid, a Vinca alkaloid, a dolastatin, an auristatin, or a cryptophycin, to a cell- binding agent in a stable, covalent manner.
• non-cleavable linkers are substantially resistant to acid-induced cleavage, light-induced cleavage, peptidase-induced cleavage, esterase-induced cleavage, and disulfide bond cleavage, at conditions under which the drug or the cell-binding agent remains active.
• non-cleavable linkers between a drug and the cell-binding agent are well known in the art.
• non-cleavable linkers include linkers having an N-succinimidyl ester or N-sulfosuccinimidyl ester moiety for reaction with the cell-binding agent, as well as a maleimido- or haloacetyl-based moiety for reaction with the drug.
• Crosslinking reagents comprising a maleimido-based moiety include N-succinimidyl 4-(maleimidomethyl)cyclohexanecarboxylate (SMCC), N- succinimidyl-4-(N-maleimidomethyl)-cyclohexane- 1 -carboxy-( ⁇ -amidocaproate), which is a "long chain" analog of SMCC (LC-SMCC), ⁇ -maleimidoundecanoic acid N- succinimidyl ester (KMUA), ⁇ -maleimidobutyric acid N-succinimidyl ester (GMBS), ⁇ - maleimidocaproic acid N-hydroxysuccinimide ester (EMCS), m-maleimidobenzoyl-N- hydroxysuccinimide ester (MBS), N-( ⁇ -maleimidoacetoxy)-succinimide ester (AMAS), succinimidyl-6-( ⁇ -maleimido
• Cross-linking reagents comprising a haloacetyl-based moiety include N-succinimidyl-4- (iodoacetyl)-aminobenzoate (SIAB), N-succinimidyl iodoacetate (SIA), N-succinimidyl bromoacetate (SBA), and N-succinimidyl 3-(bromoacetamido)propionate (SBAP).
• Other crosslinking reagents lacking a sulfur atom that form non-cleavable linkers can also be used in the inventive method.
• Such linkers can be derived from dicarboxylic acid based moieties. Suitable dicarboxylic acid based moieties include, but are not limited to, ⁇ , ⁇ -dicarboxylic acids of the general formula (IX): HOOC-X
• X is a linear or branched alkyl, alkenyl, or alkynyl group having 2 to 20 carbon atoms
• Y is a cycloalkyl or cycloalkenyl group bearing 3 to 10 carbon atoms
• Z is a substituted or unsubstituted aromatic group bearing 6 to 10 carbon atoms, or a substituted or unsubstituted heterocyclic group wherein the hetero atom is selected from N, O or S, and wherein 1, m, and n are each 0 or 1 , provided that 1, m, and n are all not zero at the same time.
• the drug can be first modified to introduce a reactive ester suitable to react with a cell-binding agent. Reaction of these maytansinoids containing an activated linker moiety with a cell-binding agent provides another method of producing a cleavable or non-cleavable cell-binding agent maytansinoid conjugate.
• the immunoconjugates and chemotherapeutic agents of the present invention can be administered in vitro, in vivo and/or ex vivo to treat patients and/or to modulate the growth of selected cell populations including, for example, cancer of the lung, blood, plasma, breast, colon, prostate, kidney, pancreas, brain, bones, ovary, testes, and lymphatic organs; autoimmune diseases, such as systemic lupus, rheumatoid arthritis, and multiple sclerosis; graft rejections, such as renal transplant rejection, liver transplant rejection, lung transplant rejection, cardiac transplant rejection, and bone marrow transplant rejection; graft versus host disease; viral infections, such as CMV infection, HIV infection, and AIDS; and parasite infections, such as giardiasis, amoebiasis, schistosomiasis, and the like.
• the immunoconjugates and chemotherapeutic agents of the invention are administered in vitro, in vivo and/or ex vivo to treat cancer in a patient and/or to modulate the growth of cancer cells, including, for example, cancer of the blood, plasma, lung, breast, colon, prostate, kidney, pancreas, brain, bones, ovary, testes, and lymphatic organs; preferably the cancer cells are breast cancer cells, prostate cancer cells, ovarian cancer cells, colorectal cancer cells, multiple myeloma cells, ovarian cancer cells, neuroblastoma cells, neuroendocrine cancer cells, gastric cancer cells, squamous cancer cells, small-cell lung cancer cells, or testicular cancer cells or a combination thereof.
• cancer cells including, for example, cancer of the blood, plasma, lung, breast, colon, prostate, kidney, pancreas, brain, bones, ovary, testes, and lymphatic organs; preferably the cancer cells are breast cancer cells, prostate cancer cells, ovarian cancer cells,
• Modulating the growth of selected cell populations includes inhibiting the proliferation of selected multiple myeloma cell populations (e.g., MOLP-8 cells, 0PM2 cells, H929 cells, and the like) from dividing to produce more cells; reducing the rate of increase in cell division as compared, for example, to untreated cells; killing selected cell populations; and/or preventing selected cell populations (such as cancer cells) from metastasizing.
• selected multiple myeloma cell populations e.g., MOLP-8 cells, 0PM2 cells, H929 cells, and the like
• the growth of selected cell populations can be modulated in vitro, in vivo or ex vivo.
• the immunoconjugates and chemotherapeutic agents can be administered in vitro, in vivo, or ex vivo separately or as components of the same composition.
• the combined administration includes co- administration, using separate formulations or a single pharmaceutical formulation, and consecutive administration in either order, wherein preferably there is a time period while both (or all) active agents simultaneously exert their biological activities.
• Preferably such combined therapy results in a synergistic therapeutic effect.
• the anti-cancer drugs that can be administered include a DNA alkylating agent, such as, melphalan; a proteasome inhibitor, such as, bortezomib (Velcade); and immunomodulatory or anti-angiogenic agents, such as, thalidomide and lenalidomide (Revlimid), along with the corticosteroid dexamethasone.
• a DNA alkylating agent such as, melphalan
• a proteasome inhibitor such as, bortezomib (Velcade)
• immunomodulatory or anti-angiogenic agents such as, thalidomide and lenalidomide (Revlimid)
• the antibody-maytansinoid conjugate can be combined with just one of the chemotherapeutic agents listed above or a combination two or more chemotherapeutic agents listed above.
• the antibody-maytansinoid conjugate can be combined with bortezomib and lenalidomide or thalidomide with or without added dexamethasone.
• the antibody-maytansinoid conjugate can be combined with melphalan and bortezomib or lenalidomide, with or without added dexamethasone.
• the order of administration and doses for each agent are readily determined by one skilled in the art using the approved schedule of administration for the individual agents (see for example Physicians Desk Reference, (PDR) 2006 discloses the preferred doses of treatment and dosing schedules for thalidomide (p 979-983) Velcade (p 2102-2106) and melphalan (p 976-979).
• the immunoconjugates and chemotherapeutic agents can be used with suitable pharmaceutically acceptable carriers, diluents, and/or excipients, which are well known, and can be determined, by one of skill in the art as the clinical situation warrants.
• suitable carriers, diluents and/or excipients include: (1) Dulbecco's phosphate buffered saline, pH about 6.5, which would contain about 1 mg/ml to 25 mg/ml human serum albumin, (2) 0.9% saline (0.9% w/v NaCl), and (3) 5% (w/v) dextrose.
• compositions described herein may be administered in appropriate form, preferably parenterally, more preferably intravenously.
• the compounds or compositions can be aqueous or nonaqueous sterile solutions, suspensions or emulsions.
• Propylene glycol, vegetable oils and injectable organic esters, such as ethyl oleate, can be used as the solvent or vehicle.
• the compositions can also contain adjuvants, emulsifiers or dispersants.
• the compositions can also be in the form of sterile solid compositions which can be dissolved or dispersed in sterile water or any other injectable sterile medium.
• the "therapeutically effective amount" of the chemotherapeutic agents and immunoconjugates described herein refers to the dosage regimen for inhibiting the proliferation of selected cell populations and/or treating a patient's disease, and is selected in accordance with a variety of factors, including the age, weight, sex, diet and medical condition of the patient, the severity of the disease, the route of administration, and pharmacological considerations, such as the activity, efficacy, pharmacokinetic and toxicology profiles of the particular compound used.
• the "therapeutically effective amount” can also be determined by reference to standard medical texts, such as the Physicians Desk Reference 2004.
• the patient is preferably an animal, more preferably a mammal, most preferably a human.
• the patient can be male or female, and can be an infant, child or adult.
• suitable protocols of immunoconjugate administration are as follows. Immunoconjugates can be given daily for about 5 days either as an i.v.bolus each day for about 5 days, or as a continuous infusion for about 5 days.
• Bolus doses are given in about 50 to about 400 ml of normal saline to which about 5 to about 10 ml of human serum albumin can be added.
• Continuous infusions are given in about 250 to about 500 ml of normal saline, to which about 25 to about 50 ml of human serum albumin can be added, per 24 hour period. Dosages will be about 10 pg to about 1000 mg/kg per person, i.v. (range of about 100 ng to about 10 mg/kg).
• About one to about four weeks after treatment the patient can receive a second course of treatment. Specific clinical protocols with regard to route of administration, excipients, diluents, dosages, and times can be determined by the skilled artisan as the clinical situation warrants.
• kits comprising one or more containers filled with one or more of the ingredients of the pharmaceutical compounds and/or compositions of the present invention, including, one or more immunoconjugates and one or more chemotherapeutic agents.
• kits can also include, for example, other compounds and/or compositions, a device(s) for administering the compounds and/or compositions, and written instructions in a form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals or biological products.
• Cancer therapies and their dosages, routes of administration and recommended usage are known in the art and have been described in such literature as the Physician's Desk Reference (PDR). The PDR discloses dosages of the agents that have been used in treatment of various cancers.
• the dosing regimen and dosages of these aforementioned chemotherapeutic drugs that are therapeutically effective will depend on the particular cancer being treated, the extent of the disease and other factors familiar to the physician of skill in the art and can be determined by the physician.
• the contents of the PDR are expressly incorporated herein in its entirety by reference.
• the 2006 edition of the Physician's Desk Reference (PDR) discloses the mechanism of action and preferred doses of treatment and dosing schedules for thalidomide (p 979-983) Velcade (p 2102-2106) and melphalan (p 976-979).
• the contents of the PDR are expressly incorporated herein in their entirety by reference.
• One of skill in the art can review the PDR, using one or more of the following parameters, to determine dosing regimen and dosages of the chemotherapeutic agents and conjugates that can be used in accordance with the teachings of this invention. These parameters include:
• therapeutic agents such as cytotoxic agents or chemotherapeutic agents
• each of the such agents described herein can be modified in such a manner that the resulting compound still retains the specificity and/or activity of the starting compound.
• the skilled artisan will also understand that many of these compounds can be used in place of the therapeutic agents described herein.
• the therapeutic agents of the present invention include analogues and derivatives of the compounds described herein.
• mice were inoculated with human multiple myeloma tumor cell lines and allowed to become established (average tumor size of about 100 mm 3 ) prior to treatment. Conjugate dosing is described based on DMl concentration. Efficacy is reported as both the % of tumor growth for treated vs. control (% T/C) and log cell kill (LCK) determined from the tumor doubling time and the tumor growth delay due to the treatment. Percent T/C values less than 42% and/or LCK values of 0.5 or greater are considered active; percent T/C values less than 10% are considered highly active (Bissery et al., Cancer Res, 51 : 4845-4852 (1991).
• Example 1 Anti-tumor effect of combination therapy of human multiple myeloma (MOLP-8) xenografts with huN901-DMl and melphalan
• mice The anti-tumor effect of a combination of huN901 -DM 1 and melphalan was evaluated in an established subcutaneous xenograft model of multiple myeloma.
• Balb/c nude mice (20 animals) were inoculated with MOLP-8 human multiple myeloma cells (1 x 10 7 cells/animal) injected subcutaneously into the right shoulder of the mice.
• MOLP-8 human multiple myeloma cells (1 x 10 7 cells/animal
• the mice were randomly divided into four groups (5 animals per group).
• the first group of mice was treated with huN901-DMl (DMl dose of 200 ⁇ g/kg single injection, day 22 post tumor cell inoculation) administered intravenously.
• a second group of animals was treated with melphalan (12 mg/kg, single injection, day 23 post tumor cell inoculation) administered intraperitoneally.
• the third group of mice received a combination of huN901-DMl and melphalan using the same doses, schedules and routes of administration as in groups 1 and 2.
• a control group of animals received phosphate- buffered saline (PBS) using the same schedules and routes of administration as in groups 1 and 2.
• Tumor growth was monitored by measuring tumor size twice per week. Tumor size was calculated with the formula: length x width x height x 1 A
• the combination treatment log cell kill (LCK) was 2.1, which is greater than the sum of LCK values for the individual drugs, indicating synergistic activity.
• Example 2 Anti-tumor effect of combination therapy of human multiple myeloma (MOLP-8) xenografts with huN901-DMl and thalidomide
• mice 36 animals were inoculated with MOLP-8 human multiple myeloma cells (1 x 10 7 cells/animal) injected subcutaneously into the right shoulder of the mice. When the tumors reached about 150 mm 3 in size (15 days after tumor cell inoculation), the mice were randomly divided into six groups (6 animals per group).
• mice Two groups of mice were treated with the single agent huN901-DMl at DMl doses of 100 ⁇ g/kg and 250 ⁇ g/kg, respectively (lqw x 2, days 16 and 23 post tumor cell inoculation) administered intravenously.
• a third group of mice was treated with the single agent thalidomide at a dose of 200 mg/kg (11 doses total on days 16, 18-22, and 25-29 post tumor cell inoculation), administered intraperitoneally as a suspension in 1% carboxymethylcellulose in PBS.
• Two groups were treated with combinations of huN901- DMl (100 ⁇ g/kg or 250 ⁇ g/kg) plus thalidomide using the same doses, schedules and administration routes used for single agent treated groups.
• a control group of animals received PBS administered intravenously (lqw x 2, days 16 and 23 post tumor cell inoculation). Tumor growth was monitored by measuring tumor size twice per week.
• Tumor size was calculated with the formula: length x width x height x Vi.
• FIG. 2A Tumor growth data are shown in Figure 2A.
• the combination of huN901-DMl plus thalidomide was active in MOLP-8 xenografts, resulting in additive to synergistic activity (Table 2 (Fig. 2B)).
• mice 36 animals were inoculated with OPM2 human multiple myeloma cells (1 x 10 7 cells/animal) injected subcutaneously into the right shoulder of the mice. When the tumors reached about 70 mm 3 in size (12 days after tumor cell inoculation), the mice were randomly divided into six groups (6 animals per group).
• mice Two groups of mice were treated with the single agent huN901-DMl at DMl doses of 100 ⁇ g/kg and 200 ⁇ g/kg, respectively (day 12 post tumor cell inoculation) administered intravenously.
• a third group of mice was treated with the single agent bortezomib at a dose of 1 mg/kg (days 13 and 16 post tumor cell inoculation), administered intravenously.
• Two groups were treated with combinations of huN901-DMl (100 ⁇ g/kg or 200 ⁇ g/kg) plus bortezomib using the same doses, schedules and administration routes used for single agent treated groups.
• a control group of animals received PBS administered intravenously (day 12 post tumor cell inoculation). Tumor growth was monitored by measuring tumor size twice per week. Tumor size was calculated with the formula: length x width x height x 1 A
• mice 54 animals were inoculated with H929 human multiple myeloma cells (1 x 10 7 cells/animal) injected subcutaneously into the right shoulder of the mice. When the tumors reached about 300 mm 3 in size (34 days after tumor cell inoculation), the mice were randomly divided into 11 groups (6 animals per group).
• mice Two groups of mice were treated with the single agent huN901-DMl at DMl doses of 50 ⁇ g/kg and 100 ⁇ g/kg, respectively (day 34 post tumor cell inoculation) administered intravenously.
• Two groups of mice were treated with the single agent bortezomib at a 0.5 mg/kg low dose and 1 mg/kg high dose (days 35 and 38 post tumor cell inoculation) administered intravenously.
• Four combination groups were evaluated, with combinations of each dose of huN901- DMl plus low- or high-dose bortezomib using the same schedules used for single agent treated groups.
• a control group of animals received PBS administered intravenously (day 34 post tumor cell inoculation).
• Tumor growth was monitored by measuring tumor size twice per week. Tumor size was calculated with the formula: length x width x height x 1 A [98]
• Combination of huN901 -DM 1 with low-dose bortezomib in H929 tumors was synergistic.
• Example 5 Anti-tumor effect of combination therapy of human multiple myeloma (OPM2) xenografts with huN901-DMl and lenalidomide
• mice (20 animals) were inoculated with OPM2 human multiple myeloma cells (1 x 10 7 cells/animal) injected subcutaneously into the right shoulder of the mice. When the tumors reached about 130 mm 3 in size (16 days after tumor cell inoculation), the mice were randomly divided into four groups (5 animals per group). One group of mice was treated with the single agent huN901-DMl (200 ⁇ g/kg, day 16 post tumor cell inoculation) administered intravenously.
• mice A second group of mice was treated with the single agent lenalidomide at (100 mg/kg, days 16-20, 22-26 post tumor cell inoculation), administered as a suspension in 1% carboxymethylcellulose/PBS by intraperitoneal injection.
• a third group was treated with a combination of huN901-DMl plus lenalidomide using the same doses, schedules and administration routes used for single agent treated groups.
• a control group of animals received PBS administered intravenously (day 16 post tumor cell inoculation). Tumor growth was monitored by measuring tumor size twice per week.
• mice (18 animals) were inoculated with OPM2 human multiple myeloma cells (1 x 10 7 cells/animal) injected subcutaneously into the right shoulder of the mice. When the tumors reached about 70 mm 3 in size (12 days after tumor cell inoculation), the mice were randomly divided into three groups (6 animals per group).
• mice The first group of mice was treated first with bortezomib at a dose of 1 mg/kg on days 0 and 3, followed by huN901-DMl at a dose of 13 mg/kg on day 3.
• the second group of mice was treated first with huN901-DMl at a dose of 13 mg/kg on day 0, followed 3 days later (days 3 and 6) with bortezomib at a dose of 1 mg/kg.
• a control group of animals received PBS administered intravenously (day 12 post tumor cell inoculation). Tumor growth was monitored by measuring tumor size twice per week. Tumor size was calculated with the formula: length x width x height X 1 A.
• Example 7 Anti-tumor effect of triple-combination therapy of human multiple myeloma (MOLP-8) xenografts with huN901-DMl and lenalidomide plus low-dose dexamethasone
• mice One group of mice was treated with the single agent huN901-DMl (150 ⁇ g/kg, administered intravenously on days 1 and 8).
• a second group of mice was treated with the combination of lenalidomide/low-dose dexamethasone (lenalidomide at 100 mg/kg, administered as a suspension in 1% carboxymethylcellulose/PBS by intraperitoneal injection on days 1-5, 8-12; dexamethasone at 1.5 mg/kg, administered by subcutaneous injection on days 1 and 8).
• a third group was treated with the triple-combination of huN901-DMl plus lenalidomide/dexamethasone using the same doses, schedules and administration routes used for individual treatment groups.
• a control group of animals received PBS administered intravenously (days 1 and 8). Tumor growth was monitored by measuring tumor size twice per week. Tumor size was calculated with the formula: length x width x height x 1 A

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