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
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
• • 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
  • A61K31/50—Pyridazines; Hydrogenated pyridazines
  • A61K31/5025—Pyridazines; Hydrogenated pyridazines ortho- or peri-condensed with heterocyclic ring systems
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D487/00—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, not provided for by groups C07D451/00 - C07D477/00
  • C07D487/02—Heterocyclic compounds containing nitrogen atoms as the only ring hetero atoms in the condensed system, not provided for by groups C07D451/00 - C07D477/00 in which the condensed system contains two hetero rings
  • C07D487/04—Ortho-condensed systems
• • 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
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/02—Antineoplastic agents specific for leukemia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• This invention relates to pharmaceutical compositions and therapeutic methods based on the multi-kinase inhibitor, ponatinib ("compound 1") for the treatment of disorders associated with pathological cellular proliferation, such as neoplasms, cancer, and conditions associated with pathological
• the protein kinases are a large family of proteins which play a central role in the regulation of a wide variety of cellular processes.
• a partial, non limiting, list of such kinases includes abl, Akt, BCR-ABL, Blk, Brk, c-KIT, c- met, c-src, CDK1, CDK2, CD 3, CDK4, CDK5, CDK6, CDK7, CDK8, CDK9, CDK10, cRafl , CSK, EGFR, ErbB2, ErbB3, ErbB4, Erk, Pak, fes, FGFR1, FGFR2, FGFR3, FGFR4, FGFR5, Fgr, FLT1, FLT3, Fps, Frk, Fyn, Hck, IGF-1R, INS-R, Jak, KDR, Lck, Lyn, MEK, p38, PDGFR, PIK, PKC, PYK2, ros, tie, tie2, TRK,
• Kinase inhibitors have been developed and used therapeutically with some important successes. However, not all of the targeted patients respond to those kinase inihibitors, and some become refractory to a given inhibitor through the emergence of mutation in the kinase or by other mechanisms.
• BCR-ABL The abnormal tyrosine kinase, BCR-ABL, for example, is the hallmark of chronic myeloid leukemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL).
• CML chronic myeloid leukemia
• Ph+ ALL Philadelphia chromosome positive acute lymphoblastic leukemia
• TKI tyrosine inhibitor
• tyrosine kinases implicated in the initiation and progression of multiple cancers include FMS-like tyrosine kinase 3 (FLT3), fibroblast growth factor receptors (FGFR), vascular endothelial growth factor (VEGF) receptors, and the angiopoietin receptor, TIE2.
• FLT3 FMS-like tyrosine kinase 3
• FGFR fibroblast growth factor receptors
• VEGF vascular endothelial growth factor
• TIE2 angiopoietin receptor
• Fibroblast growth factor receptors are known to be activated in several solid tumors, including endometrial cancer, breast cancer, non-small cell lung cancer (NSCLC) and gastric cancer, as well as multiple myeloma.
• VEGFR VEGFR
• other kinases Inappropriate angiogenesis mediated by VEGFR and other kinases is implicated in various cancers such as glioblastoma and colorectal cancer and in a variety of other proliferative disorders as well.
• This invention concerns a potent, orally active inhibitor, ponatinib ("compound 1”) and pharmaceutical compositions and uses thereof.
• a very promising pharmacological profile of compound 1 has taken shape, based on biochemical testing, cell-based experiments, animal studies and results to date from human clinical studies.
• compound 1 is an orally active multi-targeted kinase inhibitor. It is the most potent BCR-ABL inhibitor yet described and the first pan-BCR-ABL inhibitor able to inhibit all known mutant forms of the target, including the currently untreatable T3151 mutant that leads to resistance to other drugs.
• phase 1 clinical trial it demonstrated an attractive safety profile and substantial antileukemic activity in patients with refractory hematological cancers (including a majority of patients with CML and Ph + ALL), including patients in which dasatinib and nilotinib are not effective.
• compound 1 inhibited FLT3, all 4 members of the FGF receptor family, all 3 VEGF receptors, the angiopoietin receptor TIE2, but was inactive against numerous other kinase classes including the insulin receptor, Aurora kinase, and cyclin-dependent kinase families.
• the invention thus features pharmaceutical compositions and kits containing 3-(imidazo[ 1 ,2-b]pyridazin-3-ylethynyl)-4-methyl-N-(4-((4- methylpiperazin-l-yl)-methyl)-3-(trifluoromethyl)phenyl)benzamide
• an aspect of the invention features a pharmaceutical composition suitable for oral administration including compound 1 , or a pharmaceutically acceptable salt thereof, in an amount effective to treat a neoplasm, a cancer, or a hyperproliferative disorder when administered to a subject, and one or more pharmaceutically acceptable excipients.
• the compound 1, or a pharmaceutically acceptable salt thereof can be, for example, the hydrochloride salt.
• the hydrochloride salt can be, for example, the hydrochloride salt.
• the unit dosage form can contain from 30 to 300 mg of compound 1.
• Exemplary unit dosage forms include from 5 to 100 mg, 5 to 80 mg, 5 to 50 mg, 5 to 20 mg, 7 to 100 mg, 7 to 80 mg, 7 to 50 mg, 7 to 20 mg, 10 to 100 mg, 10 to 80 mg, 10 to 50 mg, 15 to 100 mg, 15 to 80 mg, 15 to 60 mg, 15 mg to 50 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain from 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 + 8 mg, 45 ⁇ 9 mg.
• Exemplary unit dosage forms include those having 5 + 1 mg, 7 ⁇ 1.5 mg, 10 ⁇ 2 mg, 15 ⁇ 3 mg, 20 + 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg, 55 ⁇ 11 mg, 60 ⁇ 12 mg, 65 ⁇ 13 mg, 70 ⁇ 14 mg, 75 ⁇ 15 mg, 80 ⁇ 16 mg, 90 ⁇ 18 mg, 100 ⁇ 20 mg, 120 ⁇ 24 mg, 140 ⁇ 28 mg, 160 ⁇ 32 mg, 180 ⁇ 36 mg, 200 ⁇ 40 mg, 220 ⁇ 44 mg, 240 + 48 mg, or 260 ⁇ 52 mg of compound 1 or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition is formulated in a solid unit dosage form (e.g., a tablet, a soft capsule, or a hard capsule).
• the unit dosage form can contain from 30 to 300 mg of compound 1.
• Exemplary unit dosage forms include from 5 to 100 mg, 5 to 80 mg, 5 to 50 mg, 5 to 20 mg, 7 to 100 mg, 7 to 80 mg, 7 to 50 mg, 7 to 20 mg, 10 to 100 mg, 10 to 80 mg, 10 to 50 mg, 15 to 100 mg, 15 to 80 mg, 15 to 60 mg, 15 mg to 50 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg,
• the unit dosage form can contain from 5 ⁇ 1 mg, 7 ⁇ 1.5 mg, 10 + 2 mg, 15 + 3 mg, 20 ⁇ 4 mg, 25 + 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg.
• Exemplary unit dosage forms include those having 5 ⁇ 1 mg, 7 + 1.5 mg, 10 + 2 mg, 15 ⁇ 3 mg, 20 ⁇ 4 mg, 25 + 5 mg, 30 ⁇ 6 mg, 40 + 8 mg, 45 ⁇ 9 mg, 55 + 1 1 mg, 60 ⁇ 12 mg, 65 + 13 mg, 70 ⁇ 14 mg, 75 + 15 mg, 80 ⁇ 16 mg, 90 + 18 mg, 100 ⁇ 20 mg, 120 ⁇ 24 mg, 140 ⁇ 28 mg, 160 + 32 mg, 180 + 36 mg, 200 ⁇ 40 mg, 220 ⁇ 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1 or a pharmaceutically acceptable salt thereof.
• the invention features a method of treating a neoplasm, a cancer, or a hyperproliferative disorder in a subject in need thereof by orally administering to said subject from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• Exemplary unit dosage forms include from 5 to 100 mg, 5 to 80 mg, 5 to 50 mg, 5 to 20 mg, 7 to 100 mg, 7 to 80 mg, 7 to 50 mg, 7 to 20 mg, 10 to 100 mg, 10 to 80 mg, 10 to 50 mg, 15 to 100 mg, 15 to 80 mg, 15 to 60 mg, 15 mg to 50 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1 , or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain from 5 ⁇ 1 mg, 7 + 1.5 mg, 10 ⁇ 2 mg, 15 ⁇ 3 mg, 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg.
• Exemplary unit dosage forms include those having 5 ⁇ 1 mg, 7 ⁇ 1.5 mg, 10 + 2 mg, 15 + 3 mg, 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 + 9 mg, 55 ⁇ 11 mg, 60 + 12 mg, 65 ⁇ 13 mg, 70 ⁇ 14 mg, 75 ⁇ 15 mg, 80 ⁇ 16 mg, 90 ⁇ 18 mg, 100 + 20 mg, 120 ⁇ 24 mg, 140 ⁇ 28 mg, 160 ⁇ 32 mg, 180 ⁇ 36 mg, 200 + 40 mg, 220 + 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1 or a pharmaceutically acceptable salt thereof.
• an average daily dose of from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof is orally administered to the subject in a unit dosage form (e.g., an average daily dose of from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof; or an average daily dose of 20 ⁇ 4 mg, 25 + 5 mg, 30 ⁇ 6 mg, 40 + 8 mg, 45 + 9 mg, 55 + 1 1 mg, 60 ⁇ 12 mg, 65 + 13 mg, 70 + 14 mg, 75 + 15 mg, 80 + 16 mg, 90 ⁇ 18 mg,
• Compound 1, or a pharmaceutically acceptable salt thereof can be administered to the subject more than one day a week or on average 4 to 7 times every 7 day period (e.g., 4 times a week, 5 times a week, 6 times a week, or 7 times a week).
• compound 1, or a pharmaceutically acceptable salt thereof is administered to the subject daily.
• the subject has chronic myelogenous leukemia, acute lymphoblastic leukemia, acute myelogenous leukemia, a myelodysplastic syndrome, gastric cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, prostate cancer, lung cancer, colorectal cancer, renal cancer, or glioblastoma.
• the subject has a condition refractory to treatment with imatinib, nilotinib, or dasatinib. In further embodiments, the subject has a condition intolerant to treatment with imatinib, nilotinib, or dasatinib. In other embodiments, the subject has a Philadelphia chromosome positive condition. In yet other embodiments, the subject has a solid cancer refractory to treatment with a VEGF or VEGF-R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• a VEGF or VEGF-R inhibitor or antagonist e.g., bevacizumab, sorafenib, or sunitinib.
• the subject has a condition intolerant to treatment with a VEGF or VEGF-R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• a VEGF or VEGF-R inhibitor or antagonist e.g., bevacizumab, sorafenib, or sunitinib.
• the subject has a cancer expressing a BCR-ABL mutant (e.g., BCR-ABL T3151 , BCR-ABL F3 ,7L , or BCR- ABL F359C ).
• the subject has a cancer expressing a FLT3, KIT, FGFR1, or PDGFR mutant (e.g., FLT3-ITD, c-KIT, FGFR10P2- FGFR 1 , or F 1 P 1 L 1 -PDGFRa).
• the compound 1 , or a pharmaceutically acceptable salt thereof is administered together or concurrently with an mTOR inhibitor each in an amount that together is effective to treat said neoplasm, cancer, or hyperproliferative disorder.
• the mTOR inhibitor is selected from sirolimus, everolimus, temsirolimus, ridaforolimus, biolimus, zotarolimus, LY294002, Pp242, WYE- 354, Ku-0063794, XL765, AZD8055, NVP-BEZ235, OSI-027, wortmannin, quercetin, myricentin, and staurosporine, and pharmaceutically acceptable salts thereof.
• kits including (i) a
• the subject has chronic myelogenous leukemia, acute
• lymphoblastic leukemia acute myelogenous leukemia, a myelodysplastic syndrome, gastric cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, prostate cancer, lung cancer, colorectal cancer, renal cancer, or glioblastoma.
• the invention features a method of treating a neoplasm, a cancer, or a hyperproliferative disorder in a subject in need thereof by orally administering to said subject from 5 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• Exemplary unit dosage forms include from 5 to 100 mg, 5 to 80 mg, 5 to 50 mg, 5 to 20 mg, 7 to 100 mg, 7 to 80 mg, 7 to 50 mg, 7 to 20 mg, 10 to 100 mg, 10 to 80 mg, 10 to 50 mg, 15 to 100 mg, 15 to 80 mg, 15 to 60 mg, 15 mg to 50 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the following 10 to 100 mg, 10 to 80 mg, 10 to 50 mg, 15 to 100 mg, 15 to 80 mg, 15 to 60 mg, 15 mg to 50 mg
• the unit dosage form can contain from 5 ⁇ 1 mg, 7 ⁇ 1.5 mg, 10 ⁇ 2 mg, 15 ⁇ 3 mg, 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg, 55 ⁇ 11 mg, 60 ⁇ 12 mg, 65 ⁇ 13 mg, 70 ⁇ 14 mg, 75 ⁇ 15 mg, 80 ⁇ 16 mg, 90 ⁇ 18 mg, 100 + 20 mg, 120 + 24 mg, 140 ⁇ 28 mg, 160 ⁇ 32 mg, 180 ⁇ 36 mg, 200 ⁇ 40 mg, 220 ⁇ 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1 or a pharmaceutically acceptable salt thereof.
• an average daily dose of from 5 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof is orally administered to the subject in a unit dosage form (e.g., an average daily dose of from 5 to 100 mg, 5 to 80 mg, 5 to 50 mg, 5 to 20 mg, 7 mg to 100 mg, 7 mg to 80 mg, 7 to 50 mg, 7 to 20 mg, 10 mg to 100 mg, 10 mg to 80 mg, 10 to 50 mg, 15 mg to 100 mg, 15 mg to 80 mg, 15 to 60 mg, 15 mg to 50 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of
• the method includes inhibiting the proliferation of cancer cells in a subject by administering to the subject compound 1, or a pharmaceutically acceptable salt thereof, in an amount, dosing frequency, and for a period of time which produces a mean steady state trough concentration for compound 1 of from 40 to 600 nM; inhibiting angiogenesis in a subject by administering to the subject compound 1, or a pharmaceutically acceptable salt thereof, in an amount, dosing frequency, and for a period of time which produces a mean steady state trough concentration for compound 1 of from 40 to 600 nM; inhibiting angiogenesis in a subject in need thereof by orally administering daily to the subject from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof; inhibiting the proliferation of BC -ABL-expressing cells in a subject by administering to the subject compound 1, or a pharmaceutically acceptable salt thereof, in an amount, dosing frequency, and for a period of time which produces a mean steady state trough concentration for compound 1 of from 40 to 600 nM; inhibiting the proliferation of
• the amount of compound 1 in a unit dosage form and the average daily dose can be modified for lower dosing (e.g., lower dosing for a child).
• the unit dosage includes from 5 to 300 mg or the average daily dose is of 5 to 300 mg.
• the unit dosage form can contain from 5 to 100 mg, 5 to 80 mg, 5 to 50 mg, 5 to 20 mg, 7 to 100 mg, 7 to 80 mg, 7 to 50 mg, 7 to 20 mg, 10 to 100 mg, 10 to 80 mg, 10 to 50 mg, 15 to 100 mg, 15 to 80 mg, 15 to 60 mg, 15 mg to 50 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a
• Exemplary unit dosage forms include those having 5 ⁇ 1 mg, 7 + 1.5 mg, 10 + 2 mg, 15 + 3 mg, 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 + 6 mg, 40 ⁇ 8 mg, 45 + 9 mg, 55 ⁇ 1 1 mg, 60 ⁇ 12 mg, 65 ⁇ 13 mg, 70 + 14 mg, 75 ⁇ 15 mg, 80 ⁇ 16 mg, 90 + 18 mg, 100 + 20 mg, 120 ⁇ 24 mg, 140 ⁇ 28 mg, 160 + 32 mg, 180 + 36 mg, 200 ⁇ 40 mg, 220 + 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1 or a pharmaceutically acceptable salt thereof.
• the invention features a pharmaceutical composition formulated for oral administration in unit dosage form including from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain 20 + 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 + 8 mg, 45 + 9 mg, 55 + 11 mg, 60 ⁇ 12 mg, 65 + 13 mg, 70 + 14 mg, 75 + 15 mg, 80 + 16 mg, 90 + 18 mg, 100 ⁇ 20 mg, 120 + 24 mg, 140 + 28 mg, 160 + 32 mg, 180 + 36 mg, 200 ⁇ 40 mg, 220 + 44 mg, 240 ⁇ 48 mg, or 260 + 52 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the compound 1 , or a pharmaceutically acceptable salt thereof can be, for example, the hydrochloride salt.
• the invention features a method of inhibiting the proliferation of cancer cells in a subject by administering to the subject compound 1 , or a pharmaceutically acceptable salt thereof, in an amount, dosing frequency, and for a period of time which produces a mean steady state trough concentration for compound 1 of from 40 to 600 nM.
• the mean steady state trough concentration for compound 1 is from 40 to 200 nM, 50 to 200 nM, 60 to 200 nM, 70 to 200 nM, 80 to 200 nM, 90 to 200 nM, 40 to 120 nM, 50 to 120 nM, 60 to 120 nM, 70 to 120 nM, 80 to 120 nM, 200 to 600 nM, 220 to 600 nM, 240 to 600 nM, 250 to 600 nM, 270 to 600 nM, 280 to 600 nM, 200 to 400 nM, 200 to 300 nM, 250 to 400 nM, 300 to 500 nM, 3 0 to 550 nM, 400 to 600 nM, or 450 to 600 nM.
• Compound 1, or a pharmaceutically acceptable salt thereof can be administered to the subject on average 4 to 7 times every 7 day period (e.g., 4 times a week, 5 times a week, 6 times a week, or 7 times a week). In certain embodiments, compound 1, or a pharmaceutically acceptable salt thereof, is administered to the subject daily. In particular embodiments, an average daily dose of from 30 to 300 mg of compound 1 , or a pharmaceutically acceptable salt thereof, is orally
• the subject has gastric cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, or any other cancer described herein.
• the subject has chronic myelogenous leukemia, acute lymphoblastic leukemia, or acute myelogenous leukemia.
• the subject has a myelodysplastic syndrome (e.g., refractory anemia with excess of blasts group 1 (RAEBI) or refractory anemia with excess of blasts group 2 (RAEBII)).
• the invention features a method of inhibiting the proliferation of cancer cells in a subject in need thereof by orally administering daily to the subject from 30 to 300 mg of compound 1 , or a pharmaceutically acceptable salt thereof.
• a pharmaceutically acceptable salt thereof from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof, is administered orally to the subject each day.
• the subject has gastric cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, or any other cancer described herein.
• the subject has chronic myelogenous leukemia, acute lymphoblastic leukemia, or acute myelogenous leukemia.
• the subject has a myelodysplastic syndrome (e.g., refractory anemia with excess of blasts group 1 (RAEBI) or refractory anemia with excess of blasts group 2 (RAEBII)).
• the invention features a method of inhibiting angiogenesis in a subject by administering to the subject compound 1, or a pharmaceutically acceptable salt thereof, in an amount, dosing frequency, and for a period of time which produces a mean steady state trough concentration for compound 1 of from 40 to 600 nM.
• the mean steady state trough concentration for compound 1 is from 40 to 200 nM, 50 to 200 nM, 60 to 200 nM, 70 to 200 nM, 80 to 200 nM, 90 to 200 nM, 40 to 120 nM, 50 to 120 nM, 60 to 120 nM, 70 to 120 nM, 80 to 120 nM, 200 to 600 nM, 220 to 600 nM, 240 to 600 nM, 250 to 600 nM, 270 to 600 nM, 280 to 600 nM, 200 to 400 nM, 200 to 300 nM, 250 to 400 nM, 300 to 500 nM, 350 to 550 nM, 400 to 600 nM, or 450 to 600 nM.
• Compound 1, or a pharmaceutically acceptable salt thereof can be administered to the subject on average 4 to 7 times every 7 day period (e.g., 4 times a week, 5 times a week, 6 times a week, or 7 times a week). In certain embodiments, compound 1, or a
• an average daily dose of from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof is orally administered to the subject in a unit dosage form (e.g., an average daily dose of from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof; or an average daily dose of 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg, 55 ⁇ 11 mg, 60 ⁇ 12 mg, 65 ⁇ 13 mg, 70 ⁇ 14
• the subject has prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer, or glioblastoma.
• the subject has a solid cancer that is refractory to treatment with a VEGF or VEGF-R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• a VEGF or VEGF-R inhibitor or antagonist e.g., bevacizumab, sorafenib, or sunitinib
• the subject has a solid cancer that is intolerant to treatment with a VEGF or VEGF-R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• the subject has a condition associated with aberrant angiogenesis, such as diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, or a cardiovascular disease.
• aberrant angiogenesis such as diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, or a cardiovascular disease.
• the invention also features a method of inhibiting angiogenesis in a subject in need thereof by orally administering daily to the subject from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• a pharmaceutically acceptable salt thereof from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof, is administered orally to the subject each day.
• the subject has prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer, or glioblastoma.
• the subject has a solid cancer that is refractory to treatment with a VEGF or VEGF- inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• a VEGF or VEGF- inhibitor or antagonist e.g., bevacizumab, sorafenib, or sunitinib.
• the subject has a solid cancer that is intolerant to treatment with a VEGF or VEGF-R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• a VEGF or VEGF-R inhibitor or antagonist e.g., bevacizumab, sorafenib, or sunitinib.
• the subject has a condition associated with aberrant angiogenesis, such as diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, or a cardiovascular disease.
• the invention features a kit including (i) a
• composition formulated for oral administration in unit dosage form including from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof, and (ii) instruction for administering the pharmaceutical composition to a subject for the treatment of cancer or for the treatment of a condition associated with aberrant angiogenesis.
• the unit dosage form can contain from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain 20 + 4 mg, 25 ⁇ 5 mg, 30 + 6 mg, 40 + 8 mg, 45 ⁇ 9 mg, 55 + 1 1 mg, 60 + 12 mg, 65 ⁇ 13 mg, 70 + 14 mg, 75 + 15 mg, 80 ⁇ 16 mg, 90 ⁇ 18 mg, 100 ⁇ 20 mg, 120 ⁇ 24 mg, 140 ⁇ 28 mg, 160 + 32 mg, 180 ⁇ 36 mg, 200 ⁇ 40 mg, 220 ⁇ 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the subject has gastric cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, chronic myelogenous leukemia, acute lymphoblastic leukemia, acute myelogenous leukemia, o a myelodysplastic syndrome (e.g., refractory anemia with excess of blasts group 1 (RAEBI) or refractory anemia with excess of blasts group 2 (RAEBII)), or any other cancer described herein.
• the subject has diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, or a cardiovascular disease.
• the invention features a method of inhibiting the proliferation of BCR-ABL-expressing cells in a subject by administering to the subject compound 1, or a pharmaceutically acceptable salt thereof, in an amount, dosing frequency, and for a period of time which produces a mean steady state trough concentration for compound 1 of from 40 to 600 nM.
• the mean steady state trough concentration for compound 1 is from 40 to 200 nM, 50 to 200 nM, 60 to 200 nM, 70 to 200 nM, 80 to 200 nM, 90 to 200 nM, 40 to 120 nM, 50 to 120 nM, 60 to 120 nM, 70 to 120 nM, 80 to 120 nM, 200 to 600 nM, 220 to 600 nM, 240 to 600 nM, 250 to 600 nM, 270 to 600 nM, 280 to 600 nM, 200 to 400 nM, 200 to 300 nM, 250 to 400 nM, 300 to 500 nM, 350 to 550 nM, 400 to 600 nM, or 450 to 600 nM.
• Compound 1 can be administered in an amount sufficient to suppress the emergence of resistant subclones or administered in an amount sufficient to suppress the emergence of compound mutants.
• Compound 1, or a pharmaceutically acceptable salt thereof can be administered to the subject on average 4 to 7 times every 7 day period (e.g., 4 times a week, 5 times a week, 6 times a week, or 7 times a week), and for a period including 2 weeks, 1 month, 2 months, 4 months, 8 months, 1 year, or 18 months of uninterrupted therapy.
• compound 1, or a pharmaceutically acceptable salt thereof is administered to the subject daily.
• an average daily dose of from 30 to 300 mg of compound 1 , or a pharmaceutically acceptable salt thereof is orally
• the subject has a condition selected from chronic myelogenous leukemia, acute lymphoblastic leukemia, or acute myelogenous leukemia.
• the condition is refractory to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is refractory to treatment with imatinib, nilotinib, or dasatinib).
• the subject has a solid cancer that is intolerant to treatment with a VEGF or VEGF- R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• the invention features a method of inhibiting the proliferation of BCR-ABL-expressing cells while suppressing the emergence of resistant subclones by contacting the cells with compound 1 , or a
• the cells can be contacted with from 20 nM to 320 nM, 30 nM to 320 nM, 20 nM to 220 nM, 30 nM to 220 nM, 20 nM to 120 nM, 30 nM to 120 nM, 40 nM to 320 nM, 40 nM to 220 nM, 40 nM to 120 nM, 50 nM to 320 nM, 50 nM to 220 nM, 50 nM to 120 nM, 70 nM to 320 nM, 70 nM to 220 nM, 90 nM to 320 nM, 90 nM to 220 nM, 1 10 nM to 320 nM, or 110 nM to 220 nM of compound 1, or a pharmaceutically acceptable salt thereof.
• the cells can be contacted with compound 1, or a
• the invention further features a method of inhibiting the proliferation of BCR-ABL-expressing cells while suppressing the emergence of compound mutants, the method including contacting the cells with compound 1, or a pharmaceutically acceptable salt thereof, in an amount sufficient to suppress the emergence of compound mutants.
• the cells can be contacted with from 160 nM to 1 ⁇ , 260 nM to 1 ⁇ , 360 nM to 1 ⁇ , 160 nM to 800 nM, 260 nM to 800 nM, 360 nM to 800 nM, 160 nM to 600 nM, 260 nM to 600 nM, 360 nM to 600 nM, 160 nM to 400 nM, 260 nM to 400 nM, 360 nM to 500 nM, or 460 nM to 600 nM of compound 1, or a
• the cells can be contacted with compound 1 , or a pharmaceutically acceptable salt thereof, for a period including 2 weeks, 1 month, 2 months, 4 months, 8 months, 1 year, or 18 months of uninterrupted exposure.
• the cells can be refractory to treatment with a kinase inhibitor other than compound 1 (e.g., refractory to treatment with imatinib, nilotinib, or dasatinib).
• the cells can be intolerant to treatment with a VEGF or VEGF-R inhibitor or antagonist (e.g., bevacizumab, sorafenib, or sunitinib).
• the invention also features a method of inhibiting the proliferation of BCR-ABL-expressing cells or a mutant thereof in a subject in need thereof by orally administering daily to the subject from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• a pharmaceutically acceptable salt thereof from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof, is administered orally to the subject each day.
• the subject has a condition selected from chronic myelogenous leukemia, acute lymphoblastic leukemia, or acute myelogenous leukemia.
• the condition is refractory to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is refractory to treatment with imatinib, nilotinib, or dasatinib).
• the condition is intolerant to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is intolerant to treatment with imatinib, nilotinib, or dasatinib).
• Compound 1 or a pharmaceutically acceptable salt thereof, can be
• compound 1, or a pharmaceutically acceptable salt thereof is administered to the subject daily.
• the invention features a kit including (i) a
• composition formulated for oral administration in unit dosage form including from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof, and (ii) instruction for administering the pharmaceutical composition to a subject suffering from a condition associated with the proliferation of BCR-ABL-expressing cells.
• the unit dosage form can contain from 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain 20 ⁇ 4 mg, 25 + 5 mg, 30 ⁇ 6 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg, 55 ⁇ 1 1 mg, 60 ⁇ 12 mg, 65 ⁇ 13 mg, 70 ⁇ 14 mg, 75 ⁇ 15 mg, 80 + 16 mg, 90 + 18 mg, 100 ⁇ 20 mg, 120 ⁇ 24 mg, 140 ⁇ 28 mg, 160 + 32 mg, 180 + 36 mg, 200 ⁇ 40 mg, 220 + 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1 , or a pharmaceutically acceptable salt thereof.
• the compound 1 , or a pharmaceutically acceptable salt thereof can be, for example, the hydrochloride salt.
• the subject has a condition selected from chronic myelogenous leukemia, acute lymphoblastic leukemia, or acute myelogenous leukemia.
• the condition is refractory to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is refractory to treatment with imatinib, nilotinib, or dasatinib).
• the condition is intolerant to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is intolerant to treatment with imatinib, nilotinib, or dasatinib).
• the invention features a method of inhibiting the proliferation of mutant-expressing cells in a subject in need thereof by orally administering daily to said subject from 30 to 300 mg of compound 1 , or a pharmaceutically acceptable salt thereof.
• the mutant is a FLT3 mutant (e.g., FLT3- ITD), a KIT mutant (e.g., c-KIT or N822K), a FGFR mutant (e.g., FGFR1OP2- FGFR1), a PDGFRa mutant (e.g., F IP 1L1 -PDGFRa), or any mutant described herein.
• the subject has acute myelogenous leukemia or a myelodysplastic syndrome (e.g., refractory anemia with excess of blasts group 1 (RAEBI) or refractory anemia with excess of blasts group 2
• the condition is refractory to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is refractory to treatment with imatinib, nilotinib, or dasatinib).
• the condition is intolerant to treatment with a kinase inhibitor other than compound 1 (e.g., a condition is intolerant to treatment with imatinib, nilotinib, or dasatinib).
• Compound 1, or a pharmaceutically acceptable salt thereof can be administered to the subject on average 4 to 7 times every 7 day period (e.g., 4 times a week, 5 times a week, 6 times a week, or 7 times a week), and for a period including 2 weeks, 1 month, 2 months, 4 months, 8 months, 1 year, or 18 months of uninterrupted therapy.
• compound 1 , or a pharmaceutically acceptable salt thereof is administered to the subject daily.
• the invention features a method of treating a cancer in a subject in need thereof by administering to the subject compound 1 , or a pharmaceutically acceptable salt thereof, together or concurrently with an mTOR inhibitor each in an amount that together is effective to treat the cancer.
• the invention also features a method of treating a neoplasm in a subject in need thereof by administering to the subject compound 1 , or a pharmaceutically acceptable salt thereof, together or concurrently with an mTOR inhibitor each in an amount that together is effective to treat the neoplasm.
• the invention further features a method of inhibiting angiogenesis in a subject in need thereof by administering to the subject compound 1, or a pharmaceutically acceptable salt thereof, together or concurrently with an mTOR inhibitor each in an amount that together is effective to inhibit the angiogenesis.
• the invention features a method of inhibiting the proliferation of cells by contacting the cells with compound 1, or a pharmaceutically acceptable salt thereof, together or concurrently with an mTOR inhibitor each in an amount that together is sufficient to inhibit the proliferation.
• the mTOR inhibitor is a rapamycin macrolide selected from sirolimus, everolimus, temsirolimus, ridaforolimus, biolimus, zotarolimus, and pharmaceutically acceptable salts thereof.
• the mTOR inhibitor is ridaforolimus or a pharmaceutically acceptable salt thereof.
• the mTOR inhibitor is a non- rapamycin analog selected from LY294002, Pp242, WYE-354, Ku-0063794, XL765, AZD8055, NVP-BEZ235, OSI-027, wortmannin, quercetin, myricentin, staurosporine, and pharmaceutically acceptable salts thereof.
• the combination therapy can include a regimen in which compound 1 , or a pharmaceutically acceptable salt thereof, and the mTOR inhibitor are administered concurrently within 12 days, 8 days, 5 days, 4 days, 3 days, or 2 days of each other; compound 1, or a pharmaceutically acceptable salt thereof, and the mTOR inhibitor are administered concurrently within 24 hours of each other; or compound 1 , or a pharmaceutically acceptable salt thereof, and the mTOR inhibitor are administered together.
• Compound 1 and the mTOR inhibitor can be administered as a combination therapy of the invention using any regimen described herein.
• compound 1 is administered at a low dose; the mTOR inhibitor is administered at a low dose; or both compound 1 and the mTOR inhibitor are administered at a low dose.
• the combination therapy includes
• the mean steady state trough concentration for compound 1 can be from 10 to 100 nM, 10 to 60 nM, 15 to 100 nM, 15 to 70 nM, 20 to 100 nM, 40 to 200 nM, 50 to 200 nM, 60 to 200 nM, 70 to 200 nM, 80 to 200 nM, 90 to 200 nM, 40 to 120 nM, 50 to 120 nM, 60 to 120 nM, 70 to 120 nM, 80 to 120 nM, 200 to 600 nM, 220 to 600 nM, 240 to 600 nM, 250 to 600 nM, 270 to 600 nM, 280 to 600 nM, 200 to 400 nM, 200 to 300 nM, 250 to 400 nM, 300 to 500 nM, 10 to 60 nM, 15 to 100 nM, 20 to 100 nM, 40 to 200 nM, 50 to 200 nM, 60 to 200 nM, 70 to 200 nM, 80 to 200 n
• compound 1, or a pharmaceutically acceptable salt thereof is administered to the subject daily.
• an average daily dose of from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof is orally administered to the subject in a unit dosage form (e.g., an average daily dose of from 10 to 70 mg, 10 to 50 mg, 10 to 30 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof; or an average daily dose of 7 ⁇ 1.5 mg, 10 ⁇ 2 mg, 15 + 3 mg, 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 40 + 8 mg, 45 + 9 mg, 55 ⁇ 11 mg
• the combination therapy of the invention can be used to treat a subject with a carcinoma of the bladder, breast, colon, kidney, liver, lung, head and neck, gall-bladder, ovary, pancreas, stomach, cervix, thyroid, prostate, or skin; squamous cell carcinoma; endometrial cancer; multiple myeloma; a
• hematopoietic tumor of lymphoid lineage e.g., leukemia, acute lymphocytic leukemia, acute lymphoblastic leukemia, B-cell lymphoma, T-cell-lymphoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, hairy cell lymphoma, or Burkitt's lymphoma
• a hematopoietic tumor of myelogenous lineage e.g., acute myelogenous leukemia, chronic myelogenous leukemia, multiple myelogenous leukemia, myelodysplasia syndrome, or promyelocytic leukemia
• a tumor of mesenchymal origin e.g., fibrosarcoma or
• the subject has non-small-cell lung cancer, breast cancer, ovarian cancer, bladder cancer, prostate cancer, salivary gland cancer, pancreatic cancer, endometrial cancer, colorectal cancer, kidney cancer, head and neck cancer, stomach cancer, multiple myeloma, thyroid follicular cancer, or glioblastoma multiforme.
• the combination therapy of the invention can be used to treat a subject having a condition associated with aberrant angiogenesis.
• the condition associated with aberrant angiogenesis can be a solid tumor (e.g., prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer,
• glioblastoma or any solid tumor described herein
• diabetic retinopathy rheumatoid arthritis
• psoriasis atherosclerosis
• chronic inflammation obesity, macular degeneration, or a cardiovascular disease.
• the invention features a pharmaceutical composition including compound 1 , or a pharmaceutically acceptable salt thereof, an mTOR inhibitor, and a pharmaceutically acceptable carrier or diluent.
• the mTOR inhibitor is a rapamycin macrolide selected from sirolimus, everolimus, temsirolimus, ridaforolimus, biolimus, zotarolimus, and pharmaceutically acceptable salts thereof.
• the mTOR inhibitor is ridaforolimus or a pharmaceutically acceptable salt thereof.
• the mTOR inhibitor is a non-rapamycin analog selected from LY294002, Pp242, WYE-354, Ku-0063794, XL765, AZD8055, NVP-BEZ235, OSI-027, wortmannin, quercetin, myricentin, staurosporine, and
• the invention further features a kit including (i) a first pharmaceutical composition formulated for oral administration in unit dosage form including from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof, and (ii) a second pharmaceutical composition including an mTOR inhibitor, wherein the first pharmaceutical composition and the second pharmaceutical composition are formulated separately in individual dosage amounts.
• the invention also features a kit including a pharmaceutical composition formulated for oral administration in unit dosage form including from 30 to 300 mg of compound 1, or a pharmaceutically acceptable salt thereof, and an mTOR inhibitor.
• the unit dosage form can contain from 10 to 70 mg, 10 to 50 mg, 10 to 30 mg, 20 to 100 mg, 20 to 80 mg, 20 to 50 mg, 30 to 100 mg, 35 to 100 mg, 40 to 100 mg, 50 to 100 mg, 60 to 100 mg, 70 to 100 mg, 30 to 80 mg, 35 to 80 mg, 40 to 80 mg, 50 to 80 mg, 60 to 80 mg, 50 to 300 mg, 60 to 300 mg, 70 to 300 mg, 50 to 200 mg, 60 to 200 mg, 70 to 200 mg, 100 to 300 mg, 120 to 300 mg, 140 to 300 mg, or 100 to 200 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the unit dosage form can contain 7 + 1.5 mg, 10 ⁇ 2 mg, 15 + 3 mg, 20 ⁇ 4 mg, 25 + 5 mg, 30 + 6 mg, 40 + 8 mg, 45 + 9 mg, 55 + 1 1 mg, 60 + 12 mg, 65 ⁇ 13 mg, 70 + 14 mg, 75 + 15 mg, 80 + 16 mg, 90 ⁇ 18 mg, 100 + 20 mg, 120 ⁇ 24 mg, 140 + 28 mg, 160 ⁇ 32 mg, 180 ⁇ 36 mg, 200 + 40 mg, 220 + 44 mg, 240 ⁇ 48 mg, or 260 ⁇ 52 mg of compound 1, or a pharmaceutically acceptable salt thereof.
• the mTOR inhibitor is a rapamycin macrolide selected from sirolimus, everolimus, temsirolimus, ridaforolimus, biolimus, zotarolimus, and pharmaceutically acceptable salts thereof.
• the mTOR inhibitor is a non- rapamycin analog selected from LY294002, Pp242, WYE-354, Ku-0063794, XL765, AZD8055, NVP-BEZ235, OSI-027, wortmannin, quercetin, myricentin, staurosporine, and pharmaceutically acceptable salts thereof.
• kits of the invention can further include instructions for
• a subject for the treatment of cancer e.g., a subject that has carcinoma of the bladder, breast, colon, kidney, liver, lung, head and neck, gall-bladder, ovary, pancreas, stomach, cervix, thyroid, prostate, or skin;
• hematopoietic tumor of lymphoid lineage e.g., leukemia, acute lymphocytic leukemia, acute lymphoblastic leukemia, B-cell lymphoma, T-cell-lymphoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, hairy cell lymphoma, or Burkitt's lymphoma
• a hematopoietic tumor of myelogenous lineage e.g., acute myelogenous leukemia, chronic myelogenous leukemia, multiple myelogenous leukemia, myelodysplastic syndrome, or promyelocytic leukemia
• a tumor of mesenchymal origin e.g., fibrosarcoma or
• rhabdomyosarcoma a tumor of the central or peripheral nervous system (e.g., astrocytoma, neuroblastoma, glioma, or schwannomas); melanoma; seminoma; teratocarcinoma; osteosarcoma; or Kaposi's sarcoma) or a subject that has a condition associated with aberrant angiogenesis (e.g., a solid tumor, diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic
• the dosage and frequency of administration of compound 1 and the mTOR inhibitor can be controlled independently.
• one compound may be administered orally each day, while the second compound may be administered intravenously once per day.
• the compounds may also be formulated together such that one
• administration delivers both of the compounds.
• the exemplary dosage of mTOR and compound 1 to be administered will depend on such variables as the type and extent of the disorder, the overall health status of the subject, the therapeutic index of the selected mTOR inhibitor, and their route of administration. Standard clinical trials maybe used to optimize the dose and dosing frequency for any particular combination of the invention.
• Compounds useful in the present invention include those described herein in any of their pharmaceutically acceptable forms, including isomers, such as diastereomers and enantiomers, mixtures of isomers, and salts thereof.
• BCR-ABL-expressing cells refers cells expressing either native BCR-ABL, resistant subclones, or compound mutants of BCR-ABL.
• mean steady state trough concentration refers to the average plasma concentration of compound 1 observed for a group of subjects as part of a dosing regimen for a therapy of the invention administered over a period of time sufficient to produce steady state pharmacokinetics (i.e., a period of 23 days of daily dosing), wherein the mean trough concentration is the average circulating concentration over all of the subjects at a time just prior to (i.e., within 1 hour of) the next scheduled administration in the regimen (e.g., for a daily regimen the trough concentration is measured about 24 hours after an administration of compound 1 and just prior to the subsequent daily administration).
• an amount sufficient to suppress the emergence of compound mutants is meant an amount of compound 1 which measurably reduces the emergence of compound mutants in vitro or in vivo in comparison to the rate of emergence of compound mutants which occurs at the minimal concentration of compound 1 required to inhibit the proliferation of BCR-ABL-expressing cells.
• an amount sufficient to suppress the emergence of resistant subclones is meant an amount of compound 1 which measurably reduces the emergence of resistant subclones in vitro or in vivo in comparison to the rate of emergence of resistant subclones which occurs at the minimal concentration of compound 1 required to inhibit the proliferation of BCR-ABL-expressing cells.
• inhibiting the proliferation of BCR-ABL-expressing cells measurably slows, stops, or reverses the growth rate of the BCR-ABL- expressing cells cells in vitro or in vivo.
• a slowing of the growth rate is by at least 20%, 30%, 50%, or even 70%, as determined using a suitable assay for determination of cell growth rates (e.g., a cell growth assay described herein).
• inhibiting the proliferation of cancer cells measurably slows, stops, or reverses the growth rate of the cancer cells in vitro or in vivo.
• a slowing of the growth rate is by at least 20%, 30%, 50%, or even 70%, as determined using a suitable assay for determination of cell growth rates (e.g., a cell growth assay described herein).
• inhibiting the proliferation of cells measurably slows, stops, or reverses the growth rate of the cells in vitro or in vivo.
• a slowing of the growth rate is by at least 20%, 30%, 50%, or even 70%, as determined using a suitable assay for determination of cell growth rates (e.g., a cell growth assay described herein).
• administration refers to a method of giving a dosage of a pharmaceutical composition to a mammal, where the method is, e.g., oral, intravenous, intraperitoneal, intraarterial, or intramuscular.
• the preferred method of administration can vary depending on various factors, e.g., the components of the pharmaceutical composition, site of the potential or actual disease and severity of disease. While compound 1 will generally be administered per orally, other routes of administration can be useful in carrying out the methods of the invention.
• unit dosage form refers to physically discrete units suitable as unitary dosages, such as a pill, tablet, caplet, hard capsule or soft capsule, each unit containing a predetermined quantity of compound 1.
• the term "pharmaceutically acceptable salt” refers to any pharmaceutically acceptable salt, such as a non-toxic acid addition salt or metal complex, commonly used in the pharmaceutical industry.
• acid addition salts include organic acids, such as acetic, lactic, pamoic, maleic, citric, malic, ascorbic, succinic, benzoic, palmitic, suberic, salicylic, tartaric, methanesulfonic, toluenesulfonic, or trifluoroacetic acids, and inorganic acids, such as hydrochloric acid, hydrobromic acid, sulfuric acid, and phosphoric acid.
• treating refers to administering a
• prevent disease refers to prophylactic treatment of a subject who is not yet ill, but who is susceptible to, or otherwise at risk of, a particular disease.
• treat disease or use for “therapeutic treatment” refers to administering treatment to a subject already suffering from a disease to improve or stabilize the subject's condition.
• treating is the administration to a subject either for therapeutic or prophylactic purposes.
• mTOR inhibitor and compound 1 by administration of mTOR inhibitor and compound 1 "concurrently" is meant that the mTOR inhibitor and compound 1 are formulated separately and administered separately within 2, 3, 4, 5, 6, or 7 days of each other.
• an amount effective to treat" a neoplasm, cancer, or hyperproliferative disorder refers to an amount of compound 1 that slows the growth, slows the spreading of cells from a site of origin to other parts of the body, or relieves symptoms caused by the neoplasm, cancer, or
• hyperproliferative disorder The symptoms relieved when a neoplasm, cancer, or hyperproliferative disorder responds to the therapies described herein include pain, and other types of discomfort.
• an amount effective to treat refers to an amount of compound 1 and an mTOR inhibitor that together slows the growth, slows the spreading of cells from a site of origin to other parts of the body, or relieves symptoms caused by the neoplasm or cancer.
• the symptoms relieved when a neoplasm or cancer responds to the combination therapies described herein include pain, and other types of discomfort.
• a human or another mammal e.g., mouse, rat, rabbit, dog, cat, cattle, swine, sheep, horse or primate
• a disease or disorder e.g., cancer, a neoplasm, or aberrant angiogenesis
• the subject is a human being.
• cancer refers to the physiological condition in mammals that is typically characterized by unregulated cell growth. Examples include, but are not limited to, carcinoma, lymphoma, blastoma, sarcoma, and leukemia. More particularly, examples of such cancers include squamous cell carcinoma, small-cell lung cancer, non-small cell lung cancer, pancreatic cancer, glioblastoma multiforme, esophageal/oral cancer, cervical cancer, ovarian cancer, endometrial cancer, prostate cancer, bladder cancer, hepatoma, breast cancer, colon or colorectal cancer, head and neck cancer, gastric cancer, multiple myeloma, renal cancer, chronic myelogenous leukemia, acute lymphoblastic leukemia, acute myelogenous leukemia, a myelodysplasia syndrome, and any other cancer described herein.
• neoplasm refers to the physiological condition in mammals that is typically characterized by abnormal cellular proliferation.
• Non-limiting examples of neoplasms include any tumor described herein, such as solid tumors. More particularly, examples of neoplasms include solid tumors from gastric or gastrointestinal cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, prostate cancer, lung cancer, colorectal cancer, renal cancer, and glioblastoma multiforme.
• hyperproliferative disorder refers to disorders associated with pathological cellular proliferation or pathological angiogenesis.
• conditions associated with aberrant angiogenesis include solid tumors, diabetic retinopathy, rheumatoid arthritis, psoriasis,
• Atherosclerosis chronic inflammation
• obesity obesity
• macular degeneration a cardiovascular disease
• low dose is meant a dose that is less than a dose of an agent that would typically be given to a subject in a monotherapy for treatment of a neoplasm, cancer, or a condition associated with aberrant angiogenesis (e.g., less than 70%, 60%, 50%, 40%, or 30% of the amount administered as a monotherapy).
• the combinations of the invention can be used to reduce the dosage of the individual components of the combination therapy substantially to a point significantly below the dosages which would be required to achieve the same effects by administering an mTOR inhibitor or compound 1 alone as a monotherapy.
• Exemplary low doses of compound 1 and mTOR inhibitors are as follows: compound 1 at 7-42 mg orally daily (e.g., 7 + 1.5 mg, 10 + 2 mg, 15 + 3 mg, 20 ⁇ 4 mg, 25 + 5 mg, 30 ⁇ 6 mg, or 35 ⁇ 7 mg orally daily);
• ridaforolimus at 7-28 mg orally qdx5/week e.g., 7 ⁇ 1.5 mg, 10 + 2 mg, 15 ⁇ 3 mg, 20 ⁇ 4 mg, or 25 ⁇ 3 mg orally qdx5/week
• everolimus at 2-7 mg orally daily e.g., 2 ⁇ 0.4 mg, 3 ⁇ 0.6 mg, 4 + 0.8 mg, 5 ⁇ 0.9 mg, or 6 ⁇ 1.2 mg orally daily
• temsirolimus 3-21 mg i.v. infusion weekly e.g., 3 ⁇ 0.6 mg, 5 + 1 mg, 7.5 ⁇ 1.5 mg, 10 ⁇ 2 mg, 15 ⁇ 3 mg, or 18 ⁇ 3.5 mg i.v. infusion weekly
• 3 ⁇ 0.6 mg, 5 + 1 mg, 7.5 ⁇ 1.5 mg, 10 ⁇ 2 mg, 15 ⁇ 3 mg, or 18 ⁇ 3.5 mg i.v. infusion weekly e.g., 3 ⁇ 0.6 mg, 5 + 1
• sirolimus at 0.5-12 mg orally daily (e.g., 0.5 ⁇ 0.1 mg, 1 ⁇ 0.2 mg, 2 ⁇ 0.4 mg, 3 ⁇ 0.6 mg, 4 ⁇ 0.8 mg, 5 ⁇ 0.9 mg, 6 ⁇ 1.2 mg, 8 ⁇ 1.5 mg, or 10 ⁇ 2 mg orally daily); biolimus at 100-600 ⁇ g i.v. infusion daily (e.g., 100 ⁇ 20 ⁇ g, 150 ⁇ 30 ⁇ g, 200 ⁇ 40 ⁇ g, 300 ⁇ 50 )ig, 400 ⁇ 50 pg, or 500 ⁇ 50 ⁇ g i.v. infusion daily); zotarolimus at 100-600 ⁇ g i.v.
• NVP-BEZ235 at 5-50 mg orally daily (e.g., 5 ⁇ 1 mg, 10 ⁇ 1.5 mg, 15 ⁇
• wortmannin at 10-70 mg orally daily (e.g., 10 ⁇ 2 mg,
• quercetin at 1-5 g orally daily (e.g., 1 ⁇ 0.1 mg, 2 ⁇ 0.2 mg, 3 ⁇ 0.3 mg,
• myricentin at 15-100 mg orally daily (e.g., 15 ⁇ 5 mg, 20 ⁇ 6 mg, 30 ⁇ 7 mg, 40 ⁇ 8 mg, 50 ⁇ 9 mg, 75 ⁇ 10 mg, or 100 ⁇ 25 mg orally daily); and staurosporine at 10-50 mg orally daily (e.g., 10 ⁇ 1.5 mg, 15 ⁇ 3 mg, 20 ⁇ 4 mg, 25 ⁇ 5 mg, 30 ⁇ 6 mg, 35 ⁇ 7 mg, 40 ⁇ 8 mg, 45 ⁇ 9 mg, or 50 ⁇ 10 mg orally daily).
• the following compounds can be administered in doses that are lower than those currently described for a monotherapy: LY294002, Pp242, WYE-354, Ku-0063794, XL765, AZD8055, and OSI-027.
• Figures 1 A and IB are graphs demonstrating that compound 1 inhibits
• FIG. 1 A depicts an immunoblot analysis of CrkL phosphorylation in Ba/F3 cells expressing native BCR-ABL treated with imatinib, nilotinib, dasatinib, or compound 1.
• Cells were cultured for 4 hours in the presence of inhibitors, harvested, lysed, and analyzed by immunoblot using an antibody for CrkL, a substrate of BCR-ABL whose phosphorylation is an established clinical marker of BCR-ABL kinase activity. Both the phosphorylated and non-phosphorylated forms are resolved by electrophoretic mobility, and bands are quantitated by densitometry and expressed as a % phosphorylated CrkL.
• Figure IB depicts an immunoblot analysis of CrkL phosphorylation in Ba/F3 BCR-ABL -expressing cells treated with imatinib, nilotinib, dasatinib, or compound 1. Assays and analysis were carried out as described above in panel (A). Abbreviations: NT, no treatment. Figures 1A and IB demonstrate that compound 1 inhibits BCR-ABL signaling in CML cell lines expressing native BCR-ABL or BCR-ABL 13151 .
• Figures 2A-C demonstrate that ex vivo treatment of CML primary cells with compound 1 inhibits cellular proliferation and BCR-ABL-mediated signaling.
• M-BC myelogenous blast crisis
• Figure 2B is a graph depicting the immunoblot analysis of CrkL phosphorylation in mononuclear cells from a CML lymphoid blast crisis (L-BC) patient harboring BCR-ABL 13151 following ex vivo exposure to compound 1, imatinib, nilotinib, or dasatinib.
• L-BC CML lymphoid blast crisis
• Cells were cultured for overnight in the presence of inhibitors, harvested, lysed, and analyzed by CrkL immunoblot. Both the phosphorylated and non-phosphorylated forms were resolved by electrophoretic mobility, and bands were quantitated by densitometry and expressed as a % phosphorylated CrkL.
• Figure 2C is a graph depicting FACS analysis of global tyrosine phosphorylation in mononuclear cells from the CML L-BC BCR-ABL 13151 patient in Figure 2B. After overnight culture in the presence of inhibitors, cells were fixed and permeabilized, incubated with a FITC-labeled antibody for phosphorylated tyrosine, and analyzed by FACS. Values reported are as fold increase in mean fluorescence intensity relative to unstained controls. Abbreviations: NT, no treatment.
• Figures 3 A and 3B are graphs of colony formation assays for against compound 1.
• Figure 3 A is a graph of colony formation assays in the presence of compound 1, nilotinib, and dasatinib using mononuclear cells from a CML AP patient harboring BCR-ABL T3151 .
• Figure 3B is a graph of colony formation assays in the presence of compound 1 using mononuclear cells from a healthy individual.
• Mononuclear cells from a CML accelerated phase (AP) patient harboring BCR-ABL T3151 and from a healthy individual were plated in methylcellulose containing nilotinib, dasatinib, or compound 1 and cultured for 14-18 days. Colonies were counted under an inverted microscope, and results were expressed as the mean of three replicates (error bars represent S.E.M.).
• Figures 4A-4C demonstrate that compound 1 is effective in mouse xenograft models of BCR-ABL-Driven and BCR-ABL T3151 -driven tumor growth.
• Figures 4A and 4B are graphs showing the effect of compound 1 on survival of SCID mice after intravenous injection of Ba/F3 cells expressing either native BCR-ABL ( Figure 4A) or BCR-ABL T3151 ( Figure 4B).
• Ba/F3 cells expressing native BCR-ABL or BCR-ABL 13151 were injected into the tail vein of SCID mice, and animals were treated once daily by oral gavage with vehicle, compound 1, or dasatinib for the indicated dosing period (days 3-21).
• Figure 4C shows the in vivo efficacy of and suppression of BCR-ABL phosphorylation by compound 1 in a subcutaneous xenograft model using Ba/F3 cells expressing BCR-ABL 1 151 .
• Cells were implanted subcutaneously into the right flank of nude mice, and when the average tumor volume reached approximately 500 mm J , and animals were treated once daily by oral gavage with vehicle or compound 1 for 19 consecutive days (dosing period indicated). Each compound 1 treatment group was compared to the vehicle group using Dunnett's test, and statistical significance (p ⁇ 0.05) is indicated by an asterisk.
• BCR-ABL phosphorylation was evaluated in animals treated with a single dose of either vehicle or 30 mg/kg compound 1 by oral gavage (N-3 per group). Six hours after dosing, mice were sacrificed and tumor samples were analyzed by immunoblot analysis with antibodies against pBCR-ABL and eIF4E (loading control).
• Figure 5 is a graph showing the effect of dasatinib in mouse models using Ba F3 cells expressing BCR-ABLT315I. Survival curves are shown for mice treated during the indicated dosing period with vehicle or dasatinib.
• Figures 6 A and 6B are graphs depicting the BCR-ABL mutants recovered in the presence of various concentrations of compound 1.
• Figure 6 A shows the resistant subclones recovered from ENU-treated Ba/F3 cells starting from native BCR-ABL cultured in the presence of graded concentrations of compound 1 (10, 20, 40 nM). Each bar represents the relative percentage of the indicated BCR-ABL kinase domain mutant among recovered subclones. Since the percentage of surviving resistant subclones and the concentration of compound 1 are inversely related, a different number of sequenced subclones are represented in the graph for each concentration of compound 1 (see Table 2). The percent of wells surveyed that contained outgrowth is indicated to the right of each graph.
• Figure 6B shows the resistant subclones recovered from ENU-treated Ba F3 cells expressing BCR-ABL 13151 cultured in the presence of graded concentrations of compound 1 (40, 80, 160, 320, 640 nM).
• a this assay started from cells expressing BCR-ABL 73151 , all recovered subclones contain the T315I mutation in addition to the specific secondary mutation indicated on each graph.
• the data demonstrates that compound 1, as a single agent, can suppress resistant outgrowth in cell-based mutagenesis screens.
• Figures 7A-7D are graphs of pharmacokinetic data for compound 1.
• Figure 7 A shows Cmax for various doses of compound 1 at cycle 1, day 1 (ClDl) and cycle 2, day 1 (C2D1).
• Figure 7B shows AUC for various doses of compound 1 at cycle 1, day 1 (ClDl) and cycle 2, day 1 (C2D1).
• Figure 7C shows concentration time profiles C1D1 following a single oral dose.
• Figure 7D shows concentration time profiles C2D1 following multiple oral doses.
• Figures 8A-8E show pharmacodynamics data for compound 1.
• Figure 8A is a graph showing pharmacodynamics data for compound 1 in all patients in the clinical study and in patients having the T3151 mutation.
• Figures 8B-8E are graphs showing pharmacodynamics data for compound 1 at 15 mg in patient having the F359C mutation (Figure 8B), for compound 1 at 30 mg in patient having no mutation ( Figure 8C), for compound 1 at 45 mg in patient having the F359C mutation ( Figure 8D), and for compound 1 at 60 mg in patient having the T3151 mutation (Figure 8E).
• Figure 9 is a graph showing inhibition of receptor phosphorylation of activated tyrosine kinases in AML cell lines.
• AML cell were incubated with increasing concentrations of compound 1 for 72 hours, and cell viability assessed using an MTS assay.
• MV4-1 1 Kasumi-1 and EOL-1 data are presented as means ⁇ SD from 3 experiments and KG1 data is presented as means ⁇ SD from 2 experiments.
• Figure 10 is a graph showing inhibition of growth and induction of apoptosis in MV4-1 1 cells.
• MV4-1 1 cells were seeded in 96-well plates, treated with increasing concentrations of compound 1 and caspase 3/7 activity measured at the indicated times. Data is expressed as fold induction of caspase activity relative to vehicle treated cells and is presented as means ⁇ SD from 3 individual experiments
• Figures 1 1 A and 1 IB show efficacy and target inhibition of V4-11 xenograft.
• Figure 1 1 A is a graph of tumor growth for various doses of compound 1.
• Daily oral administration of vehicle or compound 1 for 4 weeks at doses of 1, 2.5, 5, 10 and 25 mg/kg day was initiated when MV4-1 1 flank xenograft tumors reached approximately 200 mm3 (10 mice/group).
• Mean tumor volumes ( ⁇ SEM) are plotted.
• Three of ten animals in the vehicle control group were sacrificed before the last treatment on day 28 due to tumor burden. Therefore tumor growth inhibition was calculated from day 0 to day 24 (as indicated by the asterisk), the next to last time point for tumor measurement during the dosing phase.
• Figure 1 IB is a graph showing inhibition of -FLT3 and p-STAT5 for various doses of compound 1.
• Mice bearing established MV4-11 tumor xenografts were administered a single oral dose of compound 1 (4 mice/group) at the level indicated; control animals received vehicle alone (5 mice). Tumors were harvested 6 hours later, and analyzed for levels of phosphorylated and total FLT3 and STAT5 by immunoblotting. GAPDH was examined as a control. Quantification by densitometry of the relative phosphorylation of FLT3 and STAT5 as mean ( ⁇ SEM) from two independent experiments are shown. FLT3 phosphorylation was normalized to GAPDH and STAT5 phosphorylation was normalized to total STAT5 protein.
• Figure 12 is a graph showing ex vivo treatment of primary AML cells with compound 1 selectively inhibits FLT3-ITD cells.
• Primary leukemic blast cells were isolated from peripheral blood from 4 individual AML patients. FLT3-ITD status was determined by the pathology report and confirmed by PCR. Primary cell cultures were treated with the indicated concentrations of compound 1 for 72 hours, at which time viability was assessed using an MTS assay. All values were normalized to the viability of cells incubated in the absence of drug.
• Figure 13 is a graph showing the effect of compound 1 on acute myelogenous leukemia (AML)-derived KG1 cells in a cell growth assay.
• AML acute myelogenous leukemia
• Figure 14 is a graph showing the effect of compound 1 on SNUl 6 gastric cancer cells with amplified FGFR2, compared to wtFGFR2 SNUl cells, in a cell growth assay.
• Figure 15 is a graph showing the effect of compound 1 on SNUl 6 gastric cancer cells in a soft agar colony formation assay.
• Figure 16 is a graph showing the effect of compound 1 on AN3CA endometrial cancer cells with mutant FGFR2 (N549 ), compared to wtFGFR2 HeclB cells, in a cell growth assay.
• Figure 17 is a graph showing the effect of compound 1 on MGH-U3 cells that express mutant FGFR3b (Y375C), compared to wtFGFR3 RT112 cells, in a cell growth assay.
• Figure 18 is a graph showing the effect of compound 1 on OPM2 multiple myeloma (“MM”) cells that carry t(4;14) translocation and express mutant FGFR3 (K650E), compared to wtFGFR3 NCI-H929 cells, in a cell growth assay.
• MM multiple myeloma
• Figure 19 is a graph showing the effect of compound 1 on MDA-MB- 453 breast cancer cells that express mutant FGFR4 (Y367C) in a cell growth assay.
• Figure 20 is a graph showing the effect of oral dosing of compound 1 on tumor growth in a xenograft model with FGFR2-driven AN3CA endometrial cancer cells.
• Figure 21 is a graph showing in vivo pharmacodynamics
• Figure 22 is a graph showing the results of a cell growth assay with endometrial cancer cell lines (AN3CA and MFE-296) and wild type FGFR2 cell lines (Hec-l-B and RL95-2) upon treatment with compound 1.
• Figure 23 is a graph showing the effect of oral dosing of compound 1 in an AN3CA endometrial tumor xenograft on tumor growth.
• Figures 24A and 24B are graphs showing the effect of a combination of compound 1 with ridaforolimus on FGFR2-mutant endometrial cancer cells in a cell growth assay.
• Figure 24A shows the results of a cell growth assay with the AN3CA endometrial cancer cell line.
• the lxEC50 concentration used to treat AN3CA cells for compound 1 is 30 nM and for ridaforolimus is 0.4 nM.
• Figure 24B shows the results of a cell growth assay with the MFE-296 endometrial cancer cell line.
• the lxEC50 concentration used to treat MFE-296 cells for compound 1 is 100 nM and for ridaforolimus is 1 nM. Data are shown for ridaforolimus alone ("Ridaforolimus"), compound 1 alone (“Compound 1”), and a combination of compound 1 with ridaforolimus (“Combination").
• Figures 25A and 25B are graphs showing median effect analyses of a combination of compound 1 with ridaforolimus. Data are shown for the AN3CA cell line ( Figure 25A) and the MFE-296 cell line ( Figure 25B).
• Figure 26 is a graph showing cell cycle analysis in the AN3CA cell line following treatment. Data are shown cells with no treatment ("untreated") or cells treated with ridaforolimus alone, compound 1 alone, or a combination of compound 1 with ridaforolimus.
• Figure 27 is a schematic showing a possible FGFR2/MAPK pathway and mTOR pathway (modified from Katoh M., J. Invest. Dermatol., 2009, 128: 1861-1867).
• Figures 28 A and 28B are graphs showing the effect of oral dosing of compound 1 with ridaforolimus in an AN3CA endometrial tumor xenograft.
• Figure 28A shows data for a low dose combination of 10 mg/kg compound 1 with ridaforolimus.
• Figure 28B shows data for a high dose combination of 30 mg/kg compound 1 with ridaforolimus. Data are shown for ridaforolimus alone (“Rid”), compound 1 alone (“Compound 1”), and a combination of compound 1 with ridaforolimus (“Compound I, Rid”). Dosages are provided in parenthesis as units of mg/kg.
• Figure 29 shows pharmacokinetics and pharmacodynamics data for oral dosing of ridaforolimus alone, compound 1 alone, and a combination of compound 1 with ridaforolimus. Data are shown for various concentrations of ridaforolimus ("Rid”) and compound 1 ("Compound 1").
• the invention provides methods for treating cancer, involving administration of a compound 1.
• cancers include those that result in solid tumors, such as acute myelogenous leukemia, gastric or gastrointestinal cancer, endometrial cancer, bladder cancer, multiple myeloma, or breast cancer.
• Other examples of cancers include myelogenous leukemia, acute lymphoblastic leukemia, acute myelogenous leukemia, or a myelodysplastic syndrome (e.g., refractory anemia with excess of blasts group 1 (RAEBI) or refractory anemia with excess of blasts group 2 (RAEBII)).
• RAEBI refractory anemia with excess of blasts group 1
• RAEBII refractory anemia with excess of blasts group 2
• compositions of the invention can be used to treat the following types of cancers, as well as others: skin (e.g., squamous cell carcinoma, basal cell carcinoma, or melanoma), prostate, brain and nervous system, head and neck, testicular, lung, liver (e.g., hepatoma), kidney, bone, endocrine system (e.g., thyroid and pituitary tumors), and lymphatic system (e.g., Hodgkin's and non- Hodgkin's lymphomas) cancers.
• Other types of cancers that can be treated using the methods of the invention include fibrosarcoma, neurectodermal tumor, mesothelioma, epidermoid carcinoma, and Kaposi's sarcoma.
• Compound 1 has been found to possess strong antiangiogenic properties and, therefore, can be useful for the treatment of condition associated with aberrant angiogenesis, including solid cancers (e.g., prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer, and glioblastoma), diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, and a cardiovascular disease.
• solid cancers e.g., prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer, and glioblastoma
• diabetic retinopathy e.g., rheumatoid arthritis
• psoriasis e.g., atherosclerosis
• chronic inflammation e.g., obesity, macular degeneration
• obesity e.g., macular degeneration
• compound 1 is a pan-BCR-ABL inhibitor.
• Inhibition of the oncogenic BCR-ABL tyrosine kinase by imatinib induces durable responses in many patients with chronic phase chronic myelogenous leukemia (CML), while relapse is common in advanced CML and Ph+ acute
• pan-BCR-ABL tyrosine kinase inhibitor such as compound 1 offers important therapeutic advantages in a first-line capacity by minimizing the emergence of BCR-ABL kinase domain mutation-based drug resistance during treatment.
• Non- limiting examples of cancers that can be treated using the compositions, methods, or kits of the invention include carcinoma of the bladder, breast, colon, kidney, liver, lung, head and neck, gall-bladder, ovary, pancreas, stomach, cervix, thyroid, prostate, or skin; squamous cell carcinoma;
• a hematopoietic tumor of lymphoid lineage e.g., leukemia, acute lymphocytic leukemia, acute lymphoblastic leukemia, B-cell lymphoma, T-cell-lymphoma, Hodgkin's lymphoma, non- Hodgkin's lymphoma, hairy cell lymphoma, or Burkitt's lymphoma
• a hematopoietic tumor of myelogenous lineage e.g., acute myelogenous leukemia, chronic myelogenous leukemia, multiple myelogenous leukemia, myelodysplastic syndrome, or promyelocytic leukemia
• a tumor of lymphoid lineage e.g., leukemia, acute lymphocytic leukemia, acute lymphoblastic leukemia, B-cell lymphoma, T-cell-lymphoma, Hodgkin's lymphoma, non- Hodgkin
• mesenchymal origin e.g., fibrosarcoma or rhabdomyosarcoma
• a tumor of the central or peripheral nervous system e.g., astrocytoma, neuroblastoma, glioma, or schwannomas
• melanoma e.g., seminoma; teratocarcinoma; osteosarcoma; or Kaposi's sarcoma.
• Non-limiting examples of conditions associated with aberrant angiogenesis which can be treated using the compositions, methods, or kits of the invention include solid tumors (e.g., prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer, or glioblastoma), diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, and a cardiovascular disease.
• solid tumors e.g., prostate cancer, lung cancer, breast cancer, colorectal cancer, renal cancer, or glioblastoma
• diabetic retinopathy e.g., rheumatoid arthritis
• psoriasis e.g., atherosclerosis
• chronic inflammation e.g., obesity, macular degeneration
• obesity e.g., macular degeneration
• macular degeneration e.g., a cardiovascular disease.
• Compound 1 can be synthesized at described in Scheme 1 and as described in PCT Publication No. WO 2007/075869.
• the acid chloride utilized in step can be replaced with a methyl ester as depicted in Scheme 2 which describes the modification of step 5.
• the mono-hydrochloride salt of compound 1 was used for carrying out clinical trials instead of the significantly less water soluble free base.
• the mono-HCl salt was found to be a crystalline, anhydrous solid formed from a range of solvents reproducibly.
• the hydrochloride salt of compound 1 has a thermodynamic solubility in unbuffered water of 1.7 mg/niL at pH 3.7.
• Further identifying information for compound 1 includes:
• Compound 1 or preferably a pharmaceutically acceptable salt thereof, such as the mono HCl salt, may be formulated for oral administration using any of the materials and methods useful for such purposes.
• compositions may be in solution, suspension or emulsion form, solid dosage forms such as capsules, tablets, gel caps, caplets, etc. are of greatest current interest.
• solid dosage forms such as capsules, tablets, gel caps, caplets, etc. are of greatest current interest.
• Compound 1 may be provided neat in capsules, or combined with one or more optional, pharmaceutically acceptable excipients such as fillers, binders, stabilizers, preservatives, glidants, disintegrants, colorants, film coating, etc., as illustrated below.
• white opaque capsules were prepared containing nominally 2 mg of compound 1 free base, provided as the hydrochloride salt, with no excipients.
• White opaque capsules were also prepared containing 5 mg, 15 mg, or 20 mg of compound 1 free base, provided as the hydrochloride salt, mixed with conventional excipients.
• Inactive ingredients used as excipients in an illustrative capsule blend include one or more of a filler, a flow enhancer, a lubricant, and a disintegrant.
• a capsule blend was prepared for the 5, 15 and 20 mg capsules, containing the compound 1 HCl salt plus colloidal silicon dioxide (ca. 0.3% w/w, a flow enhancer), lactose anhydrous (ca.
• the capsule shell contains gelatin and titanium dioxide.
• the formulation process used conventional blending and encapsulation processes and machinery.
• the hydrochloride salt of compound 1 and all blend excipients except magnesium stearate were mixed in a V-blender and milled through a screening mill. Magnesium stearate was added and the material was mixed again.
• the V-blender was sampled to determine blend uniformity. The blend was tested for bulk density, tap density, flow, and particle size distribution. The blend was then encapsulated into size "3", size "4", or size "1" capsule shells, depending upon the strength of the unit dosage form.
• Compound 1 was also formulated into tablets using conventional pharmaceutical excipients, including one or more of a filler or a mixture of fillers, a disintegrant, a glidant, a lubricant, a film coating, and a coating solvent in a blend similar to that used in the higher strength capsules.
• conventional pharmaceutical excipients including one or more of a filler or a mixture of fillers, a disintegrant, a glidant, a lubricant, a film coating, and a coating solvent in a blend similar to that used in the higher strength capsules.
• tablets may be prepared using the following relative amounts and proportions (weight/weight): compound 1 (90 g provided as the HC1 salt, 15.0% w/w), colloidal silicon dioxide (1.2 g, 0.2% w/w), lactose monohydrate (240.9 g, 40.15% w/w), magnesium stearate (3 g, 0.5% w/w), microcrystalline cellulose (240.9 g, 40.15% w/w), and sodium starch glycolate (24 g, 4.0% w/w), with the amount of lactose monohydrate adjusted based on the amount of drug used.
• compound 1 90 g provided as the HC1 salt, 15.0% w/w
• colloidal silicon dioxide 1.2 g, 0.2% w/w
• lactose monohydrate 240.9 g, 40.15% w/w
• magnesium stearate 3 g, 0.5% w/w
• microcrystalline cellulose 240.9 g, 40.15% w/w
• sodium starch glycolate 24 g, 4.0%
• Compound 1 and the excipients may be mixed using the same sort of machinery and operations as was used in the case of capsules.
• the resultant, uniform blend may then be compressed into tablets by conventional means, such as a rotary tablet press adjusted for target tablet weight, e.g. 300 mg for 45 mg tablets or 100 mg for 15 mg tablets; average hardness of e.g., 13 kp for 45 mg tablets and 3 kp for 15 mg tablets; and friability no more than 1%.
• the tablet cores so produced may be sprayed with a conventional film coating material, e.g., an aqueous suspension of Opadry® II White, yielding for example a ⁇ 2.5% weight gain relative to the tablet core weight.
• mTOR Inhibitors e.g., an aqueous suspension of Opadry® II White
• rapamycin The mammalian target of rapamycin, commonly known as mTOR, is a serine/threonine protein kinase that regulates cell growth, cell proliferation, cell motility, cell survival, protein synthesis, and transcription.
• mTOR inhibitors including rapamycin and its analogues, are a class of therapeutics that specifically inhibit signaling from mTOR or a combination of kinases including mTOR (e.g., such agents which act as inhibitors of both PI3K and mTOR).
• mTOR is a key intermediary in multiple mitogenic signaling pathways and plays a central role in modulating proliferation and angiogenesis in normal tissues and neoplastic processes.
• Rapamycin is an immunosuppressive lactam macrolide that is produced by Streptomyces hygroscopicus. See, for example, J.B. McAlpine et al., J. Antibiotics, 1991, 44: 688; S.L. Schreiber et al., J. Am. Chem. Soc, 1991, 113: 7433; and U.S. Patent No. 3,929,992, incorporated herein by reference.
• Desirable rapamycin macrolides for use in the combination therapy of the invention include, but are not limited to, rapamycin (sirolimus or
• Rapamune (Wyeth)
• temsirolimus or CCI-779 (Wyeth, see, U.S. Pat. Nos. 5,362,718 and 6,277,983, the contents of which are incorporated by reference herein in their entirety)
• everolimus or RAD001 Novartis
• ridaforolimus or AP23573 Ariad
• biolimus Nobori
• zotarolimus ABT 578
• Temsirolimus is a soluble ester prodrug of rapamycin, rapamycin 42- ester with 3-hydroxy-2-(hydroxymethyl)-2-methylpropionic acid, which is disclosed in U.S. Pat. No. 5,362,718. Temsirolimus has demonstrated significant inhibitory effects on tumor growth in both in vitro and in vivo models. Temsirolimus exhibits cytostatic, as opposed to cytotoxic properties, and may delay the time to progression of tumors or time to tumor recurrence.
• CCI-779 may be useful for the treatment of cancers of various origins, including renal, breast, cervical, uterine, head and neck, lung, prostate, pancreatic, ovarian, colon, lymphoma, and melanoma.
• Everolimus is 40-O-(2-hydroxy)ethyl-rapamycin, the structure and synthesis of which is disclosed in WO 94/09010.
• Everolimus which has been shown to be a potent immunosuppressive agent (U.S. Pat. No. 5,665,772), also exhibits evidence of antineoplastic properties (see, e.g., A. Boulay et al., Cancer Res., 2004, 64: 252-261).
• everolimus is currently marketed in certain countries as an immunosuppressant for prevention of allograft rejection (B. Nashan, Ther. Drug. Monit., 2002, 24: 53- 58) and has undergone clinical testing as an anti-cancer agent (S. Huang and PJ.
• Zotarolimus is the 43-epi isomer thereof, e.g., as disclosed in WO 99/15530, or rapamycin analogs as disclosed in No. WO 98/02441 and WO 05/016252.
• Ridaforolimus is a phosphorous-containing rapamycin derivative (see WO 03/064383, Example 9 therein). Like temsirolimus and everolimus, ridaforolimus has demonstrated antiproliferative activity in a variety of PTEN- deficient tumor cell lines, including glioblastoma, prostate, breast, pancreas, lung and colon (E.K. Rowinsky, Curr. Opin. Oncol., 2004, 16: 564-575).
• Ridaforolimus has been designated as a fast-track product by the U.S. Food and Drug Administration for the treatment of soft-tissue and bone sarcomas.
• Ridaforolimus has been tested in multiple clinical trials targeting hematologic malignancies (e.g., leukemias and lymphomas) and solid tumors (e.g., sarcomas, prostate cancer, and glioblastoma multiforme).
• hematologic malignancies e.g., leukemias and lymphomas
• solid tumors e.g., sarcomas, prostate cancer, and glioblastoma multiforme.
• Rapamycin macrolides which can be used in the methods, kits, and compositions of the invention include 42-desmethoxy derivatives of rapamycin and its various analogs, as disclosed, e.g., in WO 2006/095185 (in which such compounds are referred to as "39-desmethoxy" compounds based on their numbering system).
• the derivatives of rapamycin are of particular current interest in practicing this invention
• rapalogs include, among others, variants of rapamycin having one or more of the following modifications relative to rapamycin: demethylation, elimination or replacement of the methoxy at C7, C42 and/or C29; elimination, derivatization or replacement of the hydroxy at CI 3, C43 and/or C28;
• mTOR inhibitors include, for example, 43- and/or 28-esters, ethers, carbonates, carbamates, etc. of rapamycin including those described in the following patents, which are all hereby incorporated by reference: alkyl esters (U.S. Patent No. 4,316,885); aminoalkyl esters (U.S. Patent No.
• Patent No. 5,1 18,677 ; carbamate esters (U.S. Patent No. 5,118, 678); silyl esters (U.S. Patent No. 5,120,842); aminodiesters (U.S. Patent No. 5,162,333); sulfonate and sulfate esters (U.S. Patent No. 5,177,203); esters (U.S. Patent No. 5,221 , 670); alkoxyesters (U.S. Patent No. 5,233,036); O-aryl, -alkyl, -alkenyl, and -alkynyl ethers (U.S. Patent No. 5,258,389); carbonate esters (U.S. Patent
• Patent No. 5,385,910 amino alkanoic esters (U.S. Patent No. 5,389,639); phosphorylcarbamate esters (U.S. Patent No. 5,391,730); carbamate esters
• Patent No. 5,491,231) biotin esters (U.S. Patent No. 5,504,091); O-alkyl ethers (U.S. Patent No. 5,665,772); and PEG esters of rapamycin (U.S. Patent No. 5,491,231) ; biotin esters (U.S. Patent No. 5,504,091); O-alkyl ethers (U.S. Patent No. 5,665,772); and PEG esters of rapamycin (U.S. Patent No. Patent No. 5,491,231) ; biotin esters (U.S. Patent No. 5,504,091); O-alkyl ethers (U.S. Patent No. 5,665,772); and PEG esters of rapamycin (U.S. Patent No. Patent No. Patent No. Patent No. 5,491,231) ; biotin esters (U.S. Patent No. 5,504,091); O-alkyl ethers (U.S. Patent No
• Non-rapamycin analog mTO inhibiting compounds include, but are not limited to, LY294002, Pp242 (Chemdea Cat. No. CD0258), WYE-354 (Chemdea Cat. No. CD0270), Ku-0063794 (Chemdea Cat. No. CD0274), XL765 (Exelixis; J. Clin. Oncol., 2008, 2008 ASCO Annual Meeting
• NVP-BEZ235 OSI-027 Other non-rapamycin analog mTOR inhibiting compounds which can be used in the methods, kits, and compositions of the invention include those described in PCT Publication Nos. WO2009008992; WO2009007750;
• Formulations of mTOR inhibitors are very well well known in the art, including, e.g., solid dosage forms suitable for oral administration for sirolimus, temsirolimus, ridaforolimus, and everolimus, as well as other compositions of temsirolimus and ridaforolimus for i.v. administration.
• Formulations of the non-macrolide mTOR inhibitors are disclosed in the patent documents referenced above.
• Compound 1 may be formulated together with the mTOR inhibitor, but more typically would be formulated separately to avoid complicating the formulation process and to permit independent scheduling of administration and dosing regiments of the two agents and to permit more convenient subsequent adjustments in dose of either agent.
• a treatment may consist of a single dose or a plurality of doses over a period of time.
• Compound 1 may be administered alone or concurrently with
• compound 1 and the mTOR inhibitor may be administered sequentially.
• compound 1 may be administered prior to or following administration of the mTOR inhibitor (e.g., one or more day(s) before and/or one or more day(s) after).
• Administration may be one or multiple times daily, weekly (or at some other multiple day interval) or on an intermittent schedule, with that cycle repeated a given number of times (e.g., 2-10 cycles) or indefinitely.
• effective doses may be calculated according to the body weight, body surface area, or organ size of the subject to be treated. Optimization of the appropriate dosages can readily be made by one skilled in the art in light of pharmacokinetic data observed in human clinical trials.
• the final dosage regimen will be determined by the attending physician, considering various factors which modify the action of the drugs, e.g., the drug's specific activity, the severity of the damage and the responsiveness of the subject, the age, condition, body weight, sex and diet of the subject, the severity of any present infection, time of administration, the use (or not) of concomitant therapies, and other clinical factors. As studies are conducted using the inventive combinations, further information will emerge regarding the appropriate dosage levels and duration of treatment.
• compound 1 is typically administered in a repeating cycle of total daily doses of 10 - 500 mg of compound 1 orally each day.
• the mTOR inhibitor can be given before, after or simultaneously with the compound 1 , and on the same or different dosing schedules and by the same or different routes of administration.
• Dose levels for the mTOR inhibitor in this combination therapy are generally in the range of 10 - 800 mg overall per week of treatment, e.g., in some cases 35 - 250 mg/week.
• Such overall weekly dosage levels may be achieved using a variety of routes of administration and dosing schedules.
• the dosing schedule may be intermittent. "Intermittent" dosing refers to schedules providing intervening periods between doses, e.g.
• intermittent dosing including dosing on fewer than seven days per week as well as dosing cycles of one week of QDx4, QDx5, QDx6 or daily dosing followed by a period without drug, e.g., one, two or three weeks, then resuming with another week of drug treatment followed by a week (or weeks) without drug treatment, and so on.
• administration of 60 mg QDx6 every other week provides a weekly dose of 360 mg of drug on an intermittent basis (i.e., every other week).
• 2 - 160 mg of the drug can be given one or more days per week, e.g. every day (QDx7), six days per week (QDx6), five days per week (QDx5), etc.
• cvcrolimus may be given QDx7 at doses of 3 - 20 mg/day, e.g., 5mg or 10 mg.
• Ridaforolimus may be given QDx7 p.o. at doses of 10 - 25 mg/day, e.g., 10, 12.5 or 15 mg/day; or sirolimus at 2 or 4 mg p.o. QDx7, in some cases with a 6, 8, or 10 mg loading dose.
• the dosing schedule may be intermittent, as illustrated by QDx4, QDx5, and QDx6 schedules.
• Examples include oral administration of the mTOR inhibitor at 30 - lOOmg QDx5 or QDx6.
• ridaforolimus, everolimus, temsirolimus or sirolimus is administered orally at levels of 10 50 mg QDx5.
• the desired overall level of exposure to the mTOR inhibitor can alternatively be achieved by various schedules of parenteral delivery.
• 10 - 250 mg of the mTOR inhibitor is administered, for example, by i.v. infusion over 15 - 60 minutes, often 30 - 60 minutes, one or more times per 1- to 4-week period.
• the mTOR inhibitor is administered in a 30 - 60 minute i.v. infusion once each week for three or four weeks every 4- week cycle.
• the delivery is of particular interest in the case of ridaforolimus, sirolimus and temsirolimus, which can be provided, for example, in weekly doses of 10 - 250 mg, e.g., 25, 50, 75, 100, 150, 200, or 250 mg/week, for three or four weeks of each 4-week cycle. Dose levels of 50 and 75 mg are of particular current interest.
• the mTOR inhibitor is administered by i.v. infusion of 5 - 25 mg of the drug QDx5 every two weeks (e.g., with i.v. infusions Monday through Friday, every 2d week). Doses of 10, 12.5, 15, 17.5, and 20 mg are of particular current interest.
• combination therapies in which dose levels and/or dosing schedules result in a low dose (i.e., less than those amounts used for monotherapy) of mTOR inhibitor and/or compound 1 being administered to the subject.
• the methods, kits, and compositions of the invention can be used to treat disorders associated with pathological cellular proliferation, such as neoplasms, cancer, and conditions associated with pathological angiogenesis.
• disorders associated with pathological cellular proliferation such as neoplasms, cancer, and conditions associated with pathological angiogenesis.
• conditions associated with aberrant angiogenesis include solid tumors, diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, and macular degeneration.
• compositions of the invention can be used to treat primary and/or metastatic cancers, and other cancerous conditions.
• inventive compositions and methods should be useful for reducing size of solid tumors, inhibiting tumor growth or metastasis, treating various lymphatic cancers, and/or prolonging the survival time of mammals (including humans) suffering from these diseases.
• cancers such as any described herein. Additional cancers include chronic myelogenous leukemia, acute lymphoblastic leukemia, and acute myelogenous leukemia.
• conditions associated with proliferation of FLT-3 mutant expressing cells include cancer and conditions associated with cancer, such as any cancer described herein.
• Activating mutations in FLT3 are the most common type of genetic alteration in acute myelogenous leukemia (AML). A majority of these mutations arise from an internal tandem
• MDS myelodysplastic syndromes
• RAEB refractory anemia with excess of blasts
• CMML chronic myelomonocytic leukemia
• a-CML atypical chronic myelogenous leukemia
• FGFR1, PDGFRa, and KIT are associated with conditions associated with FGFR1, PDGFRa, and KIT.
• Translocations affecting the activity of FGFR1 and PDGFRa are found in a subset of rare myeloproliferative neoplasms (MPNs).
• MPNs rare myeloproliferative neoplasms
• Translocations involving the FGFR1 gene and a range of other chromosome partners such as the FGFR1OP2 gene are characteristic of 8pl 1
• EMS myeloproliferative syndrome
• the FIP1 LI -PDGFRa fusion protein is found in approximately 10-20% of patients with chronic eosinophilic leukemia/idiopathic hypereosinophilia (CEL/HEL) and it has been reported that these patients respond well to PDGFR inhibition.
• CEL/HEL chronic eosinophilic leukemia/idiopathic hypereosinophilia
• the T674I mutant of PDGFRa is mutated at the position analogous to the T3151 gatekeeper reside of BCR-ABL.
• Activating mutations in KIT e.g., cKIT or N822K
• KIT mutations are less common and are found in specific cytogenetic subsets of AML with an overall frequency 2-8%.
• cancers cells that result in solid tumors.
• solid tumors include gastric or gastrointestinal cancer, endometrial cancer, bladder cancer, multiple myeloma, breast cancer, prostate cancer, lung cancer, colorectal cancer, renal cancer, and glioblastoma multiforme.
• cancers and cancer conditions examples include, but are not limited to, tumors of the brain and central nervous system (e.g., tumors of the meninges, brain, spinal cord, cranial nerves, and other parts of the CNS, such as glioblastomas or medulla blastomas); head and/or neck cancer; breast tumors; tumors of the circulatory system (e.g., heart,
• tumors of the blood and lymphatic system e.g., Hodgkin's disease, Non-Hodgkin's disease lymphoma, Burkitt's lymphoma, AIDS-related lymphomas, malignant immunoproliferative diseases, multiple myeloma, malignant plasma cell neoplasms, lymphoid leukemia, myelogenous leukemia, acute or chronic lymphocytic leukemia, monocytic leukemia, other leukemias of specific cell type, leukemia of unspecified cell type, unspecified malignant neoplasms of lymphoid, hematopoietic and related tissues, such as diffuse large cell lymphoma, T-cell lymphoma, or cutaneous T- cell lymphoma); tumors of the excretory system (e.g., kidney, renal pelvis, ureter, bladder, and other urinary of lymphoid leukemia, lymphoid, hematopoietic and related tissues, such as
• kits, compositions, and methods of the invention can be used to treat sarcomas.
• the compositions and methods of the present invention are used in the treatment of bladder cancer, breast cancer, chronic lymphoma leukemia, head and neck cancer, endometrial cancer, non-Hodgkin's lymphoma, non-small cell lung cancer, ovarian cancer, pancreatic cancer, and prostate cancer.
• Tumors that can be advantageously treated using compositions and methods of the present invention include PTEN-deficient tumors (see, for example, M.S. Neshat et al., PNAS, 2001, 98: 10314-10319; K. Podsypanina et al., PNAS, 2001, 98: 101320-10325; G.B. Mills et al., PNAS, 2001, 98: 10031- 10033; and M. Hidalgo and E.K. Rowinski, Oncogene, 2000, 19: 6680-6686).
• the FRAP/mTOR kinase is located downstream of the phosphatidyl inositol 3-kinase/Akt-signaling pathway, which is up- regulated in multiple cancers because of loss the PTEN tumor suppressor gene.
• PTEN-deficient tumors may be identified, using genotype analysis and/or in vitro culture and study of biopsied tumor samples.
• Non-limiting examples of cancers involving abnormalities in the phosphatidyl-inositol 3 kinase/ Akt- mTOR pathway include, but are not limited to, glioma, lymphoma and tumors of the lung, bladder, ovary, endometrium, prostate, or cervix, which are associated with abnormal growth factor receptors (e.g., EGFR, PDGFR, IGF-R and IL-2); ovarian tumors which are associated with abnormalities in P13 kinase; melanoma and tumors of the breast, prostate, or endometrium which are associated with abnormalities in PTEN; breast, gastric, ovarian, pancreatic, and prostate cancers associated with abnormalities with Akt; lymphoma, cancers of the breast or bladder, and head and neck carcinoma associated with
• abnormal growth factor receptors e.g., EGFR, PDGFR, IGF-R and IL-2
• ovarian tumors which are associated with abnormalities in P13
• abnormalities in elF-4E mantle cell lymphoma, breast cancer, and head and neck carcinomas associated with abnormalities in Cyclin D; and familial melanoma and pancreas carcinomas associated with abnormalities in PI 6.
• kits, compositions, and methods of the invention can also be used to treat diseases with aberrant angiogenesis, such as diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, and a cardiovascular disease.
• aberrant angiogenesis such as diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic inflammation, obesity, macular degeneration, and a cardiovascular disease.
• kits of the invention include one or more containers (e.g., vials, ampoules, test tubes, flasks, or bottles) containing one or more of the ingredients of a pharmaceutical composition including compound 1 and/or an mTOR inhibit, allowing for the administration of the compound 1 alone or mTOR inhibitor and compound 1 together or concurrently.
• the kits optionally include instructions for the dosing, administration, and/or patient population being treated.
• the different ingredients of a pharmaceutical package may be supplied in a solid (e.g., lyophilized) or liquid form. Each ingredient will generally be suitable as aliquoted in its respective container or provided in a concentrated form.
• Pharmaceutical packs or kits may include media for the reconstitution of lyophilized ingredients.
• the individual containers of the kit will preferably be maintained in close confinement for commercial sale.
• compound 1 and the mTOR inhibitor are both formulated to be administered orally (e.g., kits containing compound 1 in unit dosage form for oral delivery and either ridaforolimus, sirolimus, or everolimus also in unit dosage form for oral delivery).
• Products formulated for oral administration e.g., capsules, tablets, etc., may be packaged in blister packs, which can laid out and/or labeled in accordance with a selected dosing schedule.
• Imatinib was dissolved in PBS to generate a 10.0 mM stock solution, distributed into 10 aliquots, and stored at -20 °C.
• Compound 1, nilotinib, and dasatinib were dissolved in DMSO to generate 10.0 mM stock solutions, distributed into ⁇ 0 ⁇ ⁇ aliquots, and stored at -20 °C.
• Serial dilutions of 10.0 mM stock solutions were carried out just prior to use in each
• Compound 1 (3-(imidazo[l,2b]pyridazin-3-ylethynyl)-4-methyl- N-(4-((4-methylpiperazin- 1 -yl)methyl)-3-(trifluoromethyl)phenyl)benzamide) can be prepared as described herein.
• ABL rCompound 1 Complex the kinase domain of murine ABL
• X-ray diffraction data were collected at 100K at beamline 19 BM (Advanced Photon Service, Argonne, IL). The data were indexed and scaled in space group P21 by using HKL2000 package.
• the structure of compound 1 in complex with ABL T3151 was determined by molecular replacement by AMoRe using the structure of native ABL bound with imatinib (PDB code: HEP). There were two ABL T3151 molecules in the asymmetric unit.
• the structure was refined with CNX combined with manual rebuilding in Quanta (Accelrys Inc., San Diego, CA), and compound 1 was built into the density after several cycles of refinement and model building. Further refinement and model building were carried out until convergence was reached.
• the final model refined to 1.95 A, consists of residues 228 through 511, except 386-397 in the activation loop, which are disordered.
• the electron density for the bound inhibitor compound 1 as well as the side chain of 1315 was well resolved in both complexes, leaving no ambiguities for the binding mode of the inhibitor.
• Ba/F3 transfectants (expressing full-length, native BCR- ABL or BCR-ABL with a single kinase domain mutation) were maintained in RPMI 1640 supplemented with 10% FCS, 1 unit/mL penicillin G, and 1 mg/mL streptomycin (complete media) at 37 °C and 5% C0 2 .
• the Ba/F3 cell line expressing BCR-ABL 1315A was a kind gift of Dr. Neil Shah, UCSF.
• Ba/F3 cells expressing either native BCR-ABL or BCR-ABl/ 3151 (5 ⁇ 10 6 per well) were cultured 4 h in RPMI supplemented with 10% FBS, L-glutamine, and
• penicillin/streptomycin in the absence of inhibitor or in the presence of imatinib (2000 nM), dasatinib (50 nM), nilotinib (500 nM), or compound 1 (0.1-1000 nM).
• Cells were lysed directly into boiling SDS-PAGE loading buffer supplemented with protease and phosphatase inhibitors. Lysates were subjected to SDS-PAGE and immunoblotted with anti-CrkL antibody C-20 (Santa Cruz). Phosphorylated and non-phosphorylated CrkL were
• Mononuclear cells (5 x 10 6 cells/well) were cultured overnight in serum-free IMDM media (Invitrogen) supplemented with 20% BIT (StemCell), 40 g/mL human low-density lipoprotein, and 100 ⁇ ⁇ - mercaptoethanol in the absence of inhibitor or in the presence of imatinib (1000 nM), dasatinib (50 nM), nilotinib (200 nM), or compound 1 (50 nM, 500 nM). Cells were lysed directly into boiling SDS-PAGE loading buffer supplemented with protease and phosphatase inhibitors. Lysates were subjected to SDS- PAGE and immunoblotted with anti-CrkL antibody C-20 (Santa Cruz).
• Phosphorylated and non-phosphorylated CrkL were distinguished based on differential band migration. Band signal intensities were quantified by densitometry on a Lumi Imager (Roche).
• Cells were plated in triplicate (5 ⁇ 10 4 cells/plate) in 1 mL of IMDM.methylcellulose media (1 :9 v/v) containing 50 ng/mL SCF, 10 ng/mL GM-CSF, and 10 ng/mL IL-3 (Methocult GF H4534; Stem Cell Technologies, Vancouver, British Columbia, Canada) to assess granulocyte/macrophage colony formation (CFU-GM). Cells were cultured at 37°C in a humidified incubator for 14-18 days. Colonies were counted with >50 cells/colony as the criterion for positive colony scoring. Results are reported as the percentage of colonies relative to untreated control ⁇ SEM.
• Pharmacokinetics The pharmacokinetic profile of compound 1 (in citrate buffer, pH 2.74) was assessed in CD-I female mice after a single dose administered by oral gavage. Blood samples were collected at various time points and compound 1 concentrations in plasma determined by an internal standard LC/MS/MS method using protein precipitation and calibration standards prepared in blank mouse plasma. Reported concentrations are average values from 3-mice/time point/dose group.
• Ba/F3 survival model Ba F3 cells expressing native BCR-ABL or BCR-ABL 13151 were injected into the tail vein of female SCID mice (100 ⁇ . of a 1 x 10 7 cells/mL suspension in serum-free medium). Beginning 72 hours later mice were treated once daily by oral gavage with vehicle (25 mM citrate buffer, pH 2.75), compound 1, or dasatinib for up to 19 consecutive days.
• vehicle 25 mM citrate buffer, pH 2.75
• mice at necropsy was consistent with death due to splenomegaly caused by tumor cell infiltration.
• the survival data was analyzed using Kaplan-Meier method, and statistical significance was evaluated with a Log-rank test (GraphPad PRISM) by comparing the survival time of each treatment group with the vehicle group. A value of p ⁇ 0.05 was considered to be statistically significant and p ⁇ 0.01 to be highly statistically significant.
• T injtial was the tumor volume at the start of treatment
• T ina i was the volume at the time the animal was sacrificed.
• the mean tumor volume change of each treatment group was compared to all other groups using a one-way ANOVA test (GraphPad).
• mice were treated with a single dose of either vehicle or 30 mg/kg compound 1 by oral gavage. Six hours after dosing mice
• Compound 1 Ba/F3 cells expressing native BCR-ABL were treated overnight with N-ethyl-N-nitrosourea (ENU; 50 ⁇ g/mL), pelleted, resuspended in fresh media, and distributed into 96-well plates at a density of 1 x 10 5 cells/well in 200 complete media supplemented with graded concentrations of compound 1. The wells were observed for cell growth by visual inspection under an inverted microscope and media color change every two days throughout the course of the 28-day experiment. The contents of wells in which cell outgrowth was observed were transferred to a 24-well plate containing 2 mL complete media supplemented with compound 1 at the same concentration as in the initial 96-well plate.
• ENU N-ethyl-N-nitrosourea
• AGCTCTCCTGGAGGTCCTC 3' PCR products were bi-directionally sequenced by a commercial contractor (Agencourt Bioscience Corporation, Beverly, MA) using primers ABL3335F (5 '
• Cellular proliferation assays were performed with parental Ba/F3 cells and Ba/F3 cells expressing native BCR-ABL or BCR-ABL with a single mutation in the kinase domain (M244V, G250E, Q252H, Y253F, Y253H, E255K, E255V, T315A, T315I, F317L, F317V, M351T, F359V, or H396P).
• Compound 1 potently inhibited proliferation of Ba/F3 cells expressing native BCR-ABL (IC 50 : 0.5 nM).
• CMK 1652 (4) Compound 1 Inhibits BCR-ABL-Mediated Signaling in Cells
• compound 1 induced a selective reduction of viable cell numbers with IC 50 values approximately 500- fold lower in primary CML cells compared with normal cells ( Figure 2A).
• Compound 1 Inhibits BCR-ABL 1JJ51 Kinase Activity and Colony Formation in Primary CML Cells With Minimal Toxicity to Normal Cells.
• Oral Compound 1 Prolongs Survival and Reduces Tumor Burden in Mice with BCR-ABL T315, -Dependent Disease.
• CD-I mice were administered a single dose of compound 1 (either 2.5 or 30 mg/kg) by oral gavage, and plasma concentrations of compound 1 were measured by LC/MS MS at 2, 6, and 24 h post-dose.
• Compound 1 was orally bioavailable, with mice treated with a dose of 2.5 mg/kg achieving mean plasma levels of 89.6, 58.2, and 1.9 nM at 2, 6, and 24 h, respectively.
• mean plasma levels reached 781.7, 561.3, and 7.9 nM at 2, 6, and 24 h, respectively.
• P-loop residues G250, Q252, Y253, and E255
• K285, E292, and L298 a cluster at or near the C-helix
• T315I T315I
• F317, V339, F359, L387, and S438 Among the recovered mutations, nearly all have been previously encountered in imatinib resistance (or nilotinib or dasatinib resistance) (reviewed in O'Hare et al., Blood 110:2242 (2007)). No novel mutations were encountered that were specific for compound 1. Positions Y253, T315, and F317 are contact residues, and K285 is adjacent
• E25SV 3 9,4 9.4 EJS5 3 9.420 nM 480 1 1 E256V 1 100.0 100.0 E255 1 100.040 nM 480 0 0 ... —
• Ba/F3 cells expressina BCR-ABL ⁇ 55 "
• Compound 1 is an ABL kinase inhibitor that binds to the inactive, DFG- out conformation of the kinase domain of ABL and ABL T3151 and features a carbon-carbon triple bond linkage proximal to the T3151 mutation.
• X-ray crystallographic studies confirmed that compound 1 binds to ABL T3151 in the DFG-out binding mode.
• Compound 1 maintained an extensive hydrogen- bonding network, and also occupied a region of the kinase that overlaps significantly with the binding site of imatinib.
• Compound 1 formed five hydrogen bonds to the kinase, together with numerous van der Waals contacts, resulting in potent inhibition of the kinase (ABL T3151 IC 50 : 2.0 nM; native ABL IC 50 : 0.37 nM). Additionally, the triple bond itself is optimally positioned to make productive hydrophobic contact with the side chain of 1315, while its linear-shape and rigid geometry enforce a conformational constraint avoiding steric clashes and acting as an inflexible connector that positions the other two sectors of compound 1 into their established binding pockets.
• BCR-ABL T3151 - expressing cells As reactivation of BCR-ABL signaling is a frequently observed feature of kinase domain mutation-mediated resistance to clinical ABL inhibitors, particularly in patients with chronic phase disease, we analyzed BCR-ABL T3151 - expressing cells by immunoblot analysis for CrkL phosphorylation, an established direct substrate of native and mutant BCR-ABL. In both Ba/F3 cells in vitro and primary CML BCR-ABL T3151 cells ex vivo, treatment with compound 1 resulted in a marked reduction in % pCrkL, while none of the three clinical ABL inhibitors showed any effect (Figure IB and Figure 2B).
• both the ABL/Aurora kinase inhibitors MK-0457 and PHA-739358 require intravenous administration to achieve doses sufficient to inhibit BCR-ABL activity (Giles et al., Blood 109:500 (2007); Gontarewicz et al., Blood
• Y253H/T3151 and E255V/T3151 are predicted to be the most resistant pairings with respect to compound 1 ( Figure 6B and Tables 3 and 4).
• the presence of the T3151 component implies that none of the currently approved clinical BCR-ABL inhibitors would be active against these mutants.
• compound 1 has the capability to eliminate compound mutations involving T315I and E255V that would be that would be predicted to be highly resistant to all other inhibitors.
• Compound 1 is an orally available tyrosine kinase inhibitor that potently inhibits the enzymatic activity of BCR-ABL 73151 , the native enzyme and all other tested variants. It also inhibits survival of cell lines expressing these BCR-ABL variants with IC50s of ⁇ 40 nM.
• Hematologic malignancies refractory to treatment (or relapsed or having no available standard therapy), ECOG status ⁇ 2, QTcF ⁇ 450 ms, adequate hepatic and renal function, and normal cardiac function were eligible and received a single daily oral dose of compound 1.
• Hematological malignancies included CML (any phase), ALL, AML, MDS, MM, or CLL. Furthermore, patients must not have had chemotherapy > 21 days or
• Preliminary safety and efficacy data showed the following: for the 2 to 30 mg cohorts: no DLTs; for the 45 mg cohort: a reversible rash was seen with one patient; and for the 60 mg cohort: four patients developed reversible pancreatic related DLT (pancreatitis).
• the most common drug-related adverse events of any grade (AE) were thrombocytopenia (25%), anemia, lipase increase, nausea, and rash (12% each), and arthralgia, fatigue, and pancreatitis (11% each).
• Classification for PD effects included not evaluable (p-CRKL ⁇ 20% at baseline or too few samples for analysis), transient (p-CRKL inhibition > 50%* at 2 or more post-dose timepoints, but not sustained throughout cycle 1), sustained (p-CRKL inhibition > 50%* at 2 or more post-dose timepoints that is sustained throughout cycle 1), or no effect (no p-CRKL inhibition by the above criteria). * indicates > 25% inhibition is acceptable if baseline p-CRKL is too low (e.g., 35%) to reliably quantitate a > 50% decrease.
• the mean steady state trough level when dosing daily at 60 mg is about 45 ng/mL, which corresponds to a circulating plasma concentration of about 90 nM, a circulating concentration that can be useful for suppressing the emergence of resistant subclones in these subjects.
• doses of 30 mg or higher trough levels surpassed 40 nM (21 ng/mL), the concentration in which the mutation assay demonstrated complete suppression of emergent clones (as in Figure 6A).
• PD data demonstrate inhibition of CrkL phosphorylation at doses of 8 mg and higher.
• sustained target inhibition was observed at doses > 8 mg in the overall population and at doses > 15 mg in T3151 patients.
• Figures 8B-8E show pharmacodynamics data for different doses and in patients having different mutations.
• Overall best hematologic responses were complete hematologic response (CHR) in 22 of 22 CP patients (85%), including new and baseline CHR, and major hematologic response (MHR) in 5 of 12 AP, BP, or ALL patients.
• Cytogenetic responses were 8 complete cytogenetic responses (CCyR) and 12 MCyR.
• Best hematologic responses in the T3151 subset were CHR in 8 of 9 CP pts (89%), including new and baseline CHR, and MHR in 3 of 8 AP, BP, or ALL patients.
• CHR in 8 of 9 CP pts 89%
• MHR in 3 of 8 AP, BP, or ALL patients were evaluable for CyR: 5 CP and 1 AP, BP, or ALL patients achieved CCyR, and 6 CP and 3 AP, BP, or ALL achieved MCyR.
• EOL1 cells obtained from DSMZ (Braunschweig, Germany). Cells were maintained and cultured according to standard techniques at 37 °C in 5% (v/v) C0 2 using RPMI 1640 supplemented with 10% FBS (20% FBS for Kasumi-1 cells).
• Compound 1 was synthesized at ARIAD Pharmaceuticals (Cambridge, MA), and sorafenib and sunitinib were purchased from American Custom Chemical Corporation (San Diego, CA). All compounds were prepared as 10 mM stock solutions in DMSO.
• Cell viability assays Cell viability was assessed using the Cell Titer 96 Aqueous One Solution Cell Proliferation Assay (Promega, Madison WI).
• Exponentially growing cell lines were plated into 96-well plates and incubated overnight at 37 °C. Twenty-four hours after plating, cells were treated with compound or vehicle (DMSO) for 72 hours. Fluorescence was measured using a Wallac Victor microplate reader (PerkinElmer, Waltham, MA). Data are plotted as percent viability relative to vehicle-treated cells and the IC 50 values (the concentration that causes 50% inhibition) are calculated using XLfit version 4.2.2 for Microsoft Excel. Data are shown as mean ( ⁇ SD) from 3 separate experiments, each tested in triplicate.
• Immunoblot analysis To examine inhibition of receptor tyrosine kinase signaling, cells were treated with compound 1 over a range of concentrations (0.03-100 nM) for 1 hour. Cells were lysed in ice-cold SDS lysis buffer (0.06 M Tris-HCL. 1% SDS and 10% glycerol) and protein concentration was determined using a BCA Protein assay (Thermo Scientific, Rockford, IL). Cellular lysates (50 ⁇ g) were resolved by electrophoresis and transferred to nitrocellulose membranes using NuPage reagents (Invitrogen, Carlsbad, CA).
• Membranes were immunoblotted with phosphorylated antibodies and then stripped with Restore Western Blot Stripping Buffer (Thermo Scientific) and immunoblotted with total protein antibodies.
• the IC 50 values were calculated by plotting percent phosphorylated protein in compound 1 -treated cells relative to vehicle-treated cells.
• Apoptosis assays For measurement of caspase activity, MV4-11 cells were seeded into black-walled 96-well plates at 1 x 10 4 cells/well for 24 hours and then treated with compound 1 for the indicated time-points. Apo-One Homogeneous Caspase 3/7 reagent (Promega, Madison, WI) was added according to the manufacturer's protocol, and fluorescence was measured in the Wallac Victor microplate reader. To measure PARP cleavage, MV4-1 1 cells were plated in 6-well plates and, the following day, were treated for 24 hours with compound 1. At the end of treatment cells were lysed with SDS buffer and immunoblotted to measure for both total PARP and cleaved PARP expression (Cell Signaling Technology).
• the tumor volume data were collected and analyzed with a one-way ANOVA test (GraphPad Prism, San Diego, CA) to determine the overall difference among groups.
• Each compound 1 treatment group was further compared to the vehicle control group for statistical significance using Dunnett's Multiple Comparison Test.
• a p-value ⁇ 0.05 was considered to be statistically significant and a p-value ⁇ 0.01 to be highly statistically significant.
• Compound 1 inhibited signaling and proliferation in hematopoietic cell lines driven by mutant, constitutively active FLT3, KIT, FGFRl and
• Compound 1 inhibits the in vitro kinase activity of FLT3, KIT, FGFRl and PDGFRa with IC 50s of 13, 13, 2 and 1 nM, respectively.
• the activity of compound 1 was evaluated in a panel of leukemic cell lines that harbor activating mutations in FLT3 (FLT3-ITD; MV4-11 cells) and KIT (N822K; Kasumi-1 cells), or activating fusions of FGFRl (FGFRl OP2-FGFR1 ; KG-1 cells) and PDGFRa (FIP1L1 -PDGFRa; EOL- 1 cells).
• Compound 1 inhibited phosphorylation of all 4 RTKs in a dose-dependent manner, with IC 50s between 0.3 - 20 nM (Table 7).
• compound 1 also potently inhibited the viability of all 4 cell lines with IC 50s of 0.5 - 17 nM ( Figure 9, Table 7). In contrast, the IC 50 for inhibition of RS4;11 cells, which lack activating mutations in these 4 receptors, was >100 nM.
• the potency and activity profile of compound 1 was next compared to that of two other multi-targeted kinase inhibitors, sorafenib and sunitinib, by examining their effects on viability of the same panel of cell lines in parallel. While potent inhibitory activity of sorafenib and sunitinib was observed against FLT3 (IC 50s of 4 and 12 nM, respectively) and PDGFRa (0.5 and 3 nM), neither compound exhibited the high potency that compound 1 has against KIT (59 and 56 nM) or FGFR1 (>100 and >100 nM) (Table 7).
• compound 1 (1 25 mg/kg), or vehicle, was administered orally, once daily for 28 days, to mice bearing MV4-1 1 xenografts.
• compound 1 potently inhibited tumor growth in a dose- dependent manner.
• Administration of 1 mg kg, the lowest dose tested, led to significant inhibition of tumor growth (TGI 46%, p ⁇ 0.01) and doses of 2.5 mg/kg or greater resulted in tumor regression.
• dosing with 10 or 25 mg/kg led to complete and durable tumor regression with no palpable tumors detected during a 31 -day follow up.
• mice bearing MV4-1 1 xenografts were administered a single oral dose of vehicle or compound 1 at 1, 2.5, 5 or 10 mg/kg. Tumors were harvested after 6 hours and levels of phosphorylated FLT3 and STAT5 were evaluated by immunoblot analysis.
• a single dose of 1 mg/kg compound 1 had a modest inhibitory effect on FLT3 signaling, decreasing levels of p-FLT3 and p-STAT5 by approximately 30%.
• Increased doses of compound 1 led to increased inhibition of signaling with 5 and 10 mg/kg doses inhibiting signaling by approximately 75 and 80%, respectively.
• Pharmacokinetic analysis demonstrated a positive association between the concentration of compound 1 in plasma and inhibition of FLT3-ITD signaling ( Figure 1 IB).
• compound 1 exhibits activity against kinases a discrete set of kinases, implicated in the pathogenesis of hematologic malignancies (FLT3, KIT, and members of the FGFR and PDGFR families) with potency similar to that observed for BCR-ABL, i.e., IC 50s for inhibition of target protein phosphorylation and cell viability ranged from 0.3 - 20 nM and 0.5 - 17 nM, respectively.
• Other multitargeted kinase inhibitors such as sorafenib and sunitinib, have previously been shown to have inhibitory activity against a subset of these kinases.
• compound 1 was unique in its ability to inhibit activity of all four kinase with high potency. Since compound 1 exhibits comparably potency against FLT3, KIT, FGFR1 and PDGFRa in the models tested here, compound 1 can be useful for the treatment of diseases in which these kinases play a role.
• MPNs with genetic rearrangements of FGFR1 and PDGFRa are considered to be rare; however, it has been demonstrated that the resulting fusion proteins play a major role in the pathogenesis of these diseases (Gotlib et al., Leukemia 22:1999-2010 (2008); Macdonald et al., Acta Haematol.
• EMS is an aggressive disease that can rapidly transform to AML in the absence of treatment.
• compound 1 potently inhibits viability of the AML KG1 cell line, which is driven by an FGFR1OP2-FGFR1 fusion protein, supporting the clinical applicability of compound 1 in this disease type.
• HEL/CEL patients with a PDGFRa fusion achieve dramatic hematological responses when treated with the PDGFR inhibitor imatinib (Gotlib et al., Leukemia 22:1999-2010 (2008)) and we have shown that compound 1 has potent activity against the FIPlLl-PDGFRa fusion protein as demonstrated in the leukemic EOL cell line.
• T674I mutant of PDGFRa which is mutated at the position analogous to the T315I gatekeeper residue in BCR-ABL, has been demonstrated to confer resistance to imatinib in patients (Gotlib et al., Leukemia 22:1999-2010 (2008)).
• compound 1 has potent activity against the PDGFRa T674I mutant kinase, with an IC 50 of 3 nM, support the application of compound 1 for the treatment of patients who carry this fusion protein.
• a daily oral dose of 1 mg/kg compound 1 led to significant inhibition of tumor growth and a dose of 5 mg/kg or greater led to tumor regression. Consistent with the effects on tumor growth being due to inhibition of FLT3, a single dose of 1 mg/kg compound 1 led to a partial inhibition of FLT3-ITD and STAT5 phosphorylation, while doses of 5 and 10 mg/kg led to substantial inhibition. Finally, compound 1 potently inhibited viability of primary blasts isolated from a FLT3-ITD positive AML patient (IC 50 of 4 nM), but not those isolated from three FLT3 wild-type patients (IC 50 >100 nM).
• Compound 1 is a multi-targeted kinase inhibitor that displays potent inhibition of FLT3 and is cytotoxic to AML cells harboring the FLT3-ITD mutation. Importantly, this agent exhibits activity against additional RTKs, FGFRl, KIT and PDGFRa, which have also been shown to play roles in the pathogenesis of hematologic malignancies. Notably, the potency of compound 1 against these RTKs in vitro and plasma levels of compound 1 observed in humans support a clinical role for compound 1 against these targets. Taken together, these observations provide strong preclinical support for the development of compound 1 as a novel therapy for AML and other
• hematologic malignancies such as those driven by KIT, FGFRl or PDGFRa is warranted.
• Compound 1 was synthesized, as described herein. The following compounds were purchased: PD 173074 (Calbiochem, Gibbstown, NJ), BMS-540215 (American Custom Chemical, San Diego, CA), CHIR-258 and BIBF-1120 (Selleck Chemical Co, London ON, Canada).
• Kinase inhibition assays were performed at Reaction Biology Corporation (RBC, Malvern, PA USA).
• Cell growth assay Cell growth was assessed using either Cell Titer 96 Aqueous One Solution Cell Proliferation Assay (Promega, Madison, WI) or CyQuant Cell proliferation Assay (Invitrogen, Carlsbad, CA). Cells were treated with compound 24 hours after plating and grown for 72 hours. The concentration that causes 50% growth inhibition (GI50) was determined by correcting for the cell count at time zero (time of treatment) and plotting data as percent growth relative to vehicle (dimethyl sulfoxide, DMSO) treated cells using XLfit version 4.2.2 for Microsoft Excel. Data are shown as mean ( ⁇ SD) from 3 separate experiments tested in triplicate.
• GI50 concentration that causes 50% growth inhibition
• Soft agar colony formation assay The soft agar assay was performed using the CytoSelect 96-Well Cell Transformation Assay (Cell Biolabs, San Diego, CA). Briefly, cells were resuspended in 0.08% agar and plated on 0.06% agar in 96-well plates. Cells were treated once with Compound 1 at the time of plating and incubated for 8-10 days. Cells were either stained with iodonitrotetrazoliumchloride (Sigma, St. Louis, MO) or solubilized and quantified with CyQuant Dye according to the manufacturer's protocol. "ND" indicated not determined.
• Pharmacodynamics/Pharmacokinetics For pharmacodynamic analysis tumor samples were frozen upon collection, homogenized in Phospho- SafeTM buffer and analyzed by Western immunoblotting. Inhibitor concentrations in plasma were determined by an internal standard LC/MS/MS method using protein precipitation and calibration standards prepared in blank mouse plasma. Data shown are mean values from 3 mice/timepoint/group.
• Compound 1 was found to inhibit members of the PDGFR, FGFR, and VEGFR families of receptor tyrosine kinases (such as FLT1, FLT4, and KDR) (Table 1).
• Compound 1 is a potent inhibitor of all four FGF receptors: FGFR1, FGFR 2, FGFR 3, FGFR 4, as well as FGFR1(V561M) and
• FGFR2(N549H) Fable 8
• Fable 8 which is unique when compared to other multi- targeted kinase inhibitors that do not inhibit all four FGFRs (e.g. sunitinib, sorafenib, and dasatinib).
• compound 1 did not inhibit Aurora or insulin kinase family members, nor did it inhibit cyclin-dependent kinase 2 (CDK2)/Cyclin E.
• CDK2 cyclin-dependent kinase 2
• Example 6 Effect of compound 1 in cellular models of cancer
• Compound 1 affected cellular activity in various cancer cell lines. Experimental procedures were performed as described in Example 5. In acute myelogenous leukemia-derived KG1 cell line that expressed the FGFR1- FGFR10P2 fusion gene, compound 1 inhibited cell growth and the
• Figure 13A shows the growth inhibition of compound 1 on the KG1 cell line with a determined GI50 of 10 nM.
• Compound 1 inhibited phosphorylation of FGFR1 with an IC 50 of 10 nM, which was determined by Western immunoblot analysis of P-FGFR1, T- FGFR1, and glyceraldehyde-3 -phosphate dehydrogenase ("GADPH”) expression in KG1 cells treated with compound 1. Data for GAPDH was used as a control.
• Compound 1 can also selectively affect the cellular activity of cancer cells, as compared to normal cells.
• Compound 1 selectively inhibited SNUl 6 gastric cancer cells with amplified FGFR2, when compared to wtFGFR2 SNUl cells ( Figure 14).
• Compound 1 inhibited signaling in SNUl 6, as determined by the reduced presence of phosphorylated FGFR2, FRS2a, and Erk 1/2 in a Western immunoblot analysis for protein expression in SNU16 gastric cancer cells.
• Compound 1 also selectively inhibited SNUl 6 colony formation in soft agar, when compared to wtFGFR2 SNU l cells ( Figure 15).
• Table 9 provides a summary of the activity of compound 1 in gastric cancer cell lines SNUl 6 and KatoIII, as compared to the wtFGFR2 SNUl cell line.
• Compound 1 selectively inhibited cell growth and phosphorylation of FRS2a and Erk 1/2 of gastric cancer cells SNUl 6 and KatoIII, as compared to wt SNUl.
• Compound 1 selectively inhibited AN3CA endometrial cancer cells with mutant FGFR2 (N549K), when compared to wtFGFR2 HeclB cells.
• Compound 1 inhibited cell growth of AN3CA cells with a GI50 of 30 nM, as compared to HeclB cells with a GI50 of 490 nM ( Figure 16). Compound 1 also inhibited signaling in AN3CA cells, particularly the phosphorylation of FRS2a and Erk 1/2, as determined by Western immunoblot analysis of protein expression in AN3CA endometrial cancer cells treated with compound 1.
• Table 10 provides a summary of the activity of compound 1 in endometrial cancer cell line AN3CA, as compared to the wtFGFR2 HeclB and RL95 cell lines.
• Compound 1 inhibited FGFR3 in cellular models for bladder cancer and multiple myeloma (MM).
• Compound 1 selectively inhibited the growth of bladder cancer MGH-U3 cells that express mutant FGFR3b (Y375C), when compared to wtFGFR3 RT1 12 cells ( Figure 17).
• Compound 1 selectively inhibited the growth of OPM2 MM cells that carry the t(4; 14) translocation and express mutant FGFR3 (K650E), when compared to wtFGFR3 NCI-H929 cells ( Figure 18). FGFR3 signaling was inhibited by compound 1 in OPM2 cells, as determined by
• Compound 1 inhibited FGFR4 in a cellular model for breast cancer.
• Table 11 provides a comparison of RTK inhibitor activities in FGFR 10 models for various kinase inhibitors, including CHIR-258, BIBF-1 120, BMS- 540215, and PD 173074.
• IC50 (nM) data are shown for kinase assays performed by RBC and GI50 (nM) data shown for cell growth assays.
• Compound 1 is an orally active kinase inhibitor that exhibits potent activity against all four FGF receptors in kinase and cellular assays. Signaling and growth was inhibited in models expressing all four FGFRs with the most potent activity observed against FGFRl and FGFR2. Activity of Compound 1 was observed in multiple cancer types, including gastric, endometrial, bladder and multiple myeloma. The activity of Compound 1 compared favorably to other RTK inhibitors with known FGFR activity that are being evaluated in the clinic.
• Example 7 Oral delivery of compound 1 was effective in reducing solid tumor growth in a FGFR2-driven AN3CA xenograft model.
• Compound 1 inhibited AN3CA tumor growth by 36% and 62% at 10 and 30 mg/kg oral dosages, respectively (Figure 20). Though daily dosage regimens are provided, intermittent dosage regimens may be also efficacious.
• Oral delivery of compound 1 potently inhibited tumor growth in an endometrial cancer model that expressed the clinically relevant FGFR2 (N549K) mutation. Inhibition of cellular growth correlated with inhibition of downstream signaling in the tumor.
• Reagents Compound 1 and ridaforolimus (AP23573, K-8669) were synthesized by ARIAD Pharmaceuticals. The following compounds were purchased: BMS-540215 (American Custom Chemical, San Diego, CA), CHIR-258 and AZD2171 and BIBF-1 120 (Selleck Chemical Co., London ON, Canada).
• Kinase inhibition assays to determine IC50s were performed at Reaction Biology Corporation (RBC, Malvern, PA USA). Compounds were tested at 10 ⁇ ATP using a 10-point curve with 3 -fold serial dilutions starting at 1 ⁇ . Average data from 2 assays are shown.
• Cell growth assay Cell growth was assessed using either Cell Titer 96 Aqueous One Solution Cell Proliferation Assay (Promega, Madison, WI) or CyQuant Cell proliferation Assay (Invitrogen, Carlsbad, CA). Twenty four hours after plating, cells were treated with compound and grown for 72 hours. The concentration that causes 50% growth inhibition (GI50) was determined by correcting for the cell count at time zero (time of treatment) and plotting data as percent growth relative to vehicle (DMSO) treated cells using XLfit version 4.2.2 for Microsoft Excel.
• GI50 concentration that causes 50% growth inhibition
• Combination assay and analysis The Effective Dose @ 50% maximum inhibition (ED50) was determined for each compound tested and defined as lx. The drug concentrations used ranged from 0.125x to 8x at a fixed ED ratio. Combinatorial effects on cell growth were analyzed using the Chou and Talalay method (CalcuSyn software, Biosoft).
• Subcutaneous tumor models AN3CA cells were implanted into the right flank of nude mice. For analysis of efficacy, when the average tumor volume reached -200 mm 3 , inhibitor was administered by either daily oral dosing for 21 days for compound 1 or i.p. dosing QDX5 for 3 weeks. Mean tumor volumes ( ⁇ SE; tumor volume ⁇ L x W x 0.5) were calculated for each treatment group.
• Pharmacodynamics/Pharmacokinetics For pharmacodynamic analysis tumor samples were frozen upon collection, homogenized in Phospho- Safe and analyzed by Western immunoblotting. Inhibitor concentrations in plasma were determined by an internal standard LC/MS/MS method using 5 protein precipitation and calibration standards prepared in blank mouse plasma.
• Compound 1 affected cellular activity in various cancer cell lines.
• Table 12 provides a comparison of RTK inhibitor activities in FGFR cellular models for various kinase inhibitors, including AZD2171, CHIR-258, BIBF-1 120, and0 BMS-540215.
• Compound 1 is a potent inhibitor for FGFR1-FGFR4.
• IC50 (nM) data for kinase assays were performed by RBC.
• Table 12 shows GI50 (nM) data for cell growth assay and IC50 (nM) data for signaling.
• Leukemia Cell growth 10 23 40 221 900 wt Kinase 2 33 50 63 202
• Compound 1 selectively inhibited growth and signaling of FGFR2- mutant endometrial cancer cell lines.
• Compound 1 inhibited endometrial cancer cell lines AN3CA and MFE-296, as compared to wtFGFR2 Hec-l-B and RL95-2 cell lines ( Figure 22).
• Compound 1 inhibited signaling in AN3CA cells, particularly the phosphorylation of FRS2a and Erk 1/2, as determined by Western immunoblot analysis for the effect of various concentrations of compound 1 on AN3CA cells.
• Table 13 provides a summary of the activity of compound 1 in endometrial cancer cell lines AN3CA and MFE-296, as compared to the wtFGFR2 Hec-l-B and RL95-2 cell lines.
• Compound 1 inhibited pharmacodynamic markers 6 hours post-dose. Oral dosing of compound 1 inhibited FRS2a and Erk 1/2 signaling in the AN3CA xenograft, as determined by Western immunoblot analysis 6h post-dose for phosphorylated and non-phosphorylated FRS2a, phosphorylated and non- phosphorylated Erkl/, and glyceraldehyde-3-phosphate dehydrogenase as a control (data not shown).
• FGFR inhibitor Activity has been seen in multiple cancer types, including gastric, endometrial, bladder, and multiple myeloma. The activity of compound 1 compared favorably to other inhibitors with known FGF activity, where these inhibitors are being evaluated in the clinic. In addition, oral compound 1 potently inhibits tumor growth in an endometrial cancer model that expresses the clinically relevant N549K mutation for FGFR2.
• Example 9 Synergistic anti-tumor activity of compound 1 with an mTOR inhibitor in cancer models.
• Figure 24 A shows the growth inhibition of compound 1 on the AN3CA cell line for various concentrations of ridaforolimus, compound 1 , and a combination of compound 1 with ridaforolimus.
• Figure 24B shows the growth inhibition of compound 1 on the MFE-296 cell line for various concentrations of ridaforolimus, compound 1, and a combination of compound 1 with ridaforolimus. Concentrations are given as function of EC50.
• Figure 27 is a schematic showing a possible model of the FGFR2 and mTOR pathway. Without wishing to be limited by theory, compound 1 appears to inhibit the FGFR2/MAPK pathway and ridaforolimus appears to inhibit the mTOR pathway in this model.
• Figure 28A shows the inhibition of AN3CA tumor growth for a combination of a low dose of compound 1 (10 mg/kg) with ridaforolimus (0.3 mg/kg or 1.0 mg/kg).
• Figure 28B shows the inhibition of AN3CA tumor growth for a combination of a high dose of compound 1 (30 mg/kg) with ridaforolimus (0.3 mg/kg or 1.0 mg/kg). Results are shown for oral dosing of compound 1 daily (black lines in Figures 28A and 28B) and of ridaforolimus daily for five days of the week (gray lines in Figures 28A and 28B).
• Table 14 provides a summary of the efficacy of compound 1 and ridaforolimus in an AN3CA xenograft model, where "TGI" indicates tumor growth inhibition relative to vehicle.
• Synergistic activity of compound 1 and ridaforolimus was observed against FGFR2-mutant endometrial cancer cell growth. These data provide that compound 1 and ridaforolimus have potent combinatorial activity in FGFR2 -mutant endometrial cancer models. Without wishing to be limited by theory, potent dual inhibition was achieved through the FGFR2/MAPK and mTOR pathways by compound 1 and ridaforolimus, respectively. Synergistic effects of the combination of compound 1 with ridaforolimus were observed via cell growth assays in vitro and tumor regression induced in vivo.
• Compound 1 is a pan-FGFR inhibitor with potent activity in a variety of FGFR-driven tumor models. Dual inhibition of FGFR2 signaling by
• Non-limiting examples of cancers which can be treated using the compositions, methods, or kits of the invention include carcinoma of the bladder, breast, colon, kidney, liver, lung, head and neck, gall-bladder, ovary, pancreas, stomach, cervix, thyroid, prostate, or skin; squamous cell carcinoma; endometrial cancer; multiple myeloma; a
• hematopoietic tumor of lymphoid lineage e.g., leukemia, acute lymphocytic leukemia, acute lymphoblastic leukemia, B-cell lymphoma, T-cell-lymphoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, hairy cell lymphoma, or Burkitt's lymphoma
• a hematopoietic tumor of myelogenous lineage e.g., acute myelogenous leukemia, chronic myelogenous leukemia, multiple myelogenous leukemia, myelodysplasia syndrome, or promyelocytic leukemia
• a tumor of mesenchymal origin e.g., fibrosarcoma or
• rhabdomyosarcoma a tumor of the central or peripheral nervous system (e.g., astrocytoma, neuroblastoma, glioma, or schwannomas); melanoma; seminoma; teratocarcinoma; osteosarcoma; and Kaposi's sarcoma.
• a tumor of the central or peripheral nervous system e.g., astrocytoma, neuroblastoma, glioma, or schwannomas
• melanoma a
• seminoma teratocarcinoma
• osteosarcoma teratocarcinoma
• Kaposi's sarcoma Kaposi's sarcoma.
• Non-limiting examples of conditions associated with aberrant angiogenesis which can be treated using the compositions, methods, or kits of the invention include solid tumors, diabetic retinopathy, rheumatoid arthritis, psoriasis, atherosclerosis, chronic

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