WO2011153382A1 - Procédés de traitement d'un cancer des ovaires récurrent et sensible au platine avec du 4-iodo-3-nitrobenzamide en combinaison avec un antimétabolite et un composé de platine. - Google Patents

Procédés de traitement d'un cancer des ovaires récurrent et sensible au platine avec du 4-iodo-3-nitrobenzamide en combinaison avec un antimétabolite et un composé de platine. Download PDF

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Publication number
WO2011153382A1
WO2011153382A1 PCT/US2011/038974 US2011038974W WO2011153382A1 WO 2011153382 A1 WO2011153382 A1 WO 2011153382A1 US 2011038974 W US2011038974 W US 2011038974W WO 2011153382 A1 WO2011153382 A1 WO 2011153382A1
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platinum
patient
iodo
nitrobenzamide
ovarian cancer
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PCT/US2011/038974
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English (en)
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Charles Bradley
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Bipar Sciences, Inc.
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Priority claimed from CA 2725026 external-priority patent/CA2725026A1/fr
Application filed by Bipar Sciences, Inc. filed Critical Bipar Sciences, Inc.
Publication of WO2011153382A1 publication Critical patent/WO2011153382A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/166—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the carbon of a carboxamide group directly attached to the aromatic ring, e.g. procainamide, procarbazine, metoclopramide, labetalol
    • 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
    • A61K31/555—Heterocyclic compounds containing heavy metals, e.g. hemin, hematin, melarsoprol
    • 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
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
    • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
    • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
    • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
    • A61K31/7068—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines having oxo groups directly attached to the pyrimidine ring, e.g. cytidine, cytidylic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61P35/04—Antineoplastic agents specific for metastasis

Definitions

  • Cancer is a complex family of diseases affecting nearly every tissue in the body and characterized by aberrant control of cell growth.
  • the annual incidence of all cancer types is estimated to be in excess of 1.3 million cases in the United States alone.
  • first line therapies for the treatment of different types of cancer have been deployed with varying degrees of success, including surgical resection, radiation therapy, chemotherapy, and hormone therapy, it remains the second leading cause of death in the U.S., with an estimated 560,000 Americans dying from cancer every year.
  • Ovarian cancer is the 8th most common cancer in women worldwide with estimated 225,500 new diagnoses per year and estimated 140,200 deaths per year.
  • the current standard of care for first-line chemotherapy of ovarian cancer is a combination of a platinum compound (e.g., cisplatin, carboplatin, and oxaliplatin) with a taxane.
  • a platinum compound e.g., cisplatin, carboplatin, and oxaliplatin
  • the majority of newly-diagnosed ovarian cancer patients will respond to first-line platinum-based and paclitaxel chemotherapy. However, 50-80% of the patients who respond to this combination therapy will eventually relapse. See, e.g., Herzog, "Update on the role of topotecan in the treatment of recurrent ovarian cancer," The Oncologist 7(Suppl.
  • the platinum-sensitive recurrent ovarian cancer is epithelial ovarian carcinoma.
  • the platinum-sensitive recurrent ovarian cancer is fallopian tube cancer.
  • the platinum-sensitive recurrent ovarian cancer is primary peritoneal carcinoma.
  • the treatment comprises at least about 1 treatment cycle (e.g., about any of 2 cycles, 3 cycles, 4 cycles, 5 cycles, 6 cycles, 7 cycles, 8 cycles, 9 cycles,
  • each cycle comprises administering an effective amount of (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin.
  • the treatment comprises at least about 4 to about 12 (e.g., at least about 4 to about 7) treatment cycles, wherein each of the cycles comprises administering an effective amount of (i) 4-iodo- 3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin.
  • the patient has not received a prior cytotoxic chemotherapy in the recurrent setting.
  • the effective amount is administered over a 21 -day treatment cycle, wherein (i) carboplatin is administered to the patient at 4 mg/ml » minute (AUC 4) on day 1 of the treatment cycle; (ii) gemcitabine is administered to the patient at a dose of 1000 mg/m on days 1 and 8 of the treatment cycle; and (iii) 4-iodo-3-nitrobenzamide or a metabolite or a pharmaceutically acceptable salt thereof is administered to the patient at a dose of 5.6 mg/kg twice weekly on days 1, 4, 8, and
  • the effective amount produces at least one therapeutic effect selected from the group consisting of reduction in size of an ovarian tumor, reduction in metastasis, complete remission, partial remission, stable disease, increase in overall response rate, or a pathologic complete response.
  • the method further comprises surgery, radiation therapy, chemotherapy, gene therapy, DNA therapy, viral therapy, RNA therapy, adjuvant therapy, neoadjuvant therapy, immunotherapy, nanotherapy or a combination thereof.
  • the method further comprises administering to the patient gamma irradiation.
  • the patient has platinum-sensitive recurrent ovarian cancer.
  • the platinum- sensitive recurrent ovarian cancer is selected from the group consisting of epithelial, germ cell, and stromal cell tumors. In some embodiments, the platinum- sensitive recurrent ovarian cancer is metastatic. In some embodiments, 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof is administered intravenously. In some
  • gemcitabine is administered intravenously.
  • carboplatin is administered intravenously.
  • the patient has measurable disease.
  • the platinum-sensitive recurrent ovarian cancer is serous ovarian cancer. In some embodiments, the platinum-sensitive recurrent ovarian cancer is serous
  • the platinum-sensitive recurrent ovarian cancer is papillary serous ovarian cancer. In some embodiments, the platinum- sensitive recurrent ovarian cancer is endometrioid ovarian cancer. In some embodiments, the platinum-sensitive recurrent ovarian cancer is clear cell ovarian cancer. In some
  • the platinum-sensitive recurrent ovarian cancer comprises ovarian tumor of any grade, for example, any of grade 1, 2, or 3.
  • the patient has platinum compound- free interval of about or at least about 6 months (e.g., about or at least about any of 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, 36 months, or 42 months).
  • the method further comprises administering granulocyte colony- stimulating factor ("G-CSF") to the patient.
  • G-CSF granulocyte colony- stimulating factor
  • the method does not further comprise administering G-CSF to the patient.
  • the treatment provides improved clinical benefit rate compared to treatment with gemcitabine and carboplatin administered without 4-iodo-3- nitrobenzamide.
  • the improvement of clinical benefit rate is about 20% or higher.
  • the therapeutic effect is an increase in overall response rate.
  • the overall response rate is greater than 40%.
  • the overall response rate is greater than 50%.
  • the overall response rate is greater than 60%.
  • the patient has platinum- sensitive recurrent ovarian cancer.
  • the platinum-sensitive recurrent ovarian cancer is deficient in homologous recombination DNA repair.
  • the homologous recombination DNA repair In some embodiments, the homologous
  • the recombination DNA repair-deficient platinum-sensitive recurrent ovarian cancer is BRCA deficient.
  • the BRCA-deficient platinum- sensitive recurrent ovarian cancer is BRCAl -deficient.
  • the BRCA-deficient platinum-sensitive recurrent ovarian cancer is BRCA2-deficient.
  • the BRCA-deficient platinum-sensitive recurrent ovarian cancer is both BRCAl -deficient and BRCA2-deficient.
  • the platinum-sensitive recurrent ovarian cancer comprises at least one mutation in BRCAl. In some embodiments, the platinum-sensitive recurrent ovarian cancer does not comprise a mutation in BRCAl.
  • the platinum-sensitive recurrent ovarian cancer comprises at least one mutation in BRCA2. In some embodiments, the platinum- sensitive recurrent ovarian cancer does not comprise a mutation in BRCA2. In some embodiments, the platinum-sensitive recurrent ovarian cancer comprises at least one mutation in BRCAl and at least one mutation in BRCA2. In some embodiments, the platinum-sensitive recurrent ovarian cancer does not comprise a mutation in BRCAl or BRCA2.
  • compositions used for treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to said patient a) 4- iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof, b) an antimetabolite, and (c) a platinum compound, wherein the
  • antimetabolite is selected from the group consisting of citabine, capecitabine, gemcitabine or valopicitabine, and wherein the platinum compound is selected from the group consisting of cisplatin; cis-diamminediaquoplatinum (Il)-ion; chloro(diethylenetriamine) -platinum (II) chloride; dichloro(ethylenediamine) -platinum (II); diammine(l,l-cyclobutanedicarboxylato) platinum (II) (carboplatin); spiroplatin; iproplatin; diammine(2-ethylmalonato)platinum (II); ethylenediaminemalonatoplatinum (II); aqua(l,2-diaminodicyclohexane)sulfatoplatinum (II); aqua(l,2-diaminodicyclohexane)malonatoplatinum (II); (1,2- diaminocycl
  • kits for treating platinum- sensitive recurrent ovarian cancer in a patient comprise (a) 4-iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof, (b) an antimetabolite, and (c) a platinum compound.
  • the kits may further comprise a product or package insert or a label comprising instructions and/or information for using an effective amount of (a) 4-iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof, (b) an antimetabolite, and (c) a platinum compound, in accordance with any of the methods described herein.
  • kits comprise 4-iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof and a product or package insert or a label comprising instructions and/or information for using an effective amount of 4-iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof in combination with an antimetabolite (e.g., gemcitabine) and a platinum compound (e.g., carboplatin) for treating platinum-sensitive recurrent ovarian cancer in a patient in accordance with any of the methods described herein.
  • an antimetabolite e.g., gemcitabine
  • a platinum compound e.g., carboplatin
  • the antimetabolite is gemcitabine
  • the platinum compound is carboplatin.
  • the effective amount is
  • the platinum- sensitive recurrent ovarian cancer is epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma.
  • the patient has not received a prior cytotoxic chemotherapy in the recurrent setting.
  • the patient has measurable disease.
  • GO refers to gemcitabine
  • carbplatin and iniparib refers to progressive disease.
  • PD refers to progressive disease.
  • platinum-sensitive refers to a type of ovarian cancer (e.g., recurrent ovarian cancer).
  • the current standard of care for first-line chemotherapy of ovarian cancer is a combination of a platinum compound (e.g., cisplatin, carboplatin, and oxaliplatin) with a taxane.
  • a platinum compound e.g., cisplatin, carboplatin, and oxaliplatin
  • the majority of newly-diagnosed ovarian cancer patients will respond to first-line platinum-based and paclitaxel chemotherapy. However, 50-80% of the patients who respond to this combination therapy will eventually relapse. See, e.g., Herzog, "Update on the role of topotecan in the treatment of recurrent ovarian cancer," The
  • surgery refers to any therapeutic or diagnostic procedure that involves methodical action of the hand or of the hand with an instrument, on the body of a human or other mammal, to produce a curative, remedial, or diagnostic effect.
  • Random therapy refers to exposing a patient to high-energy radiation, including without limitation x-rays, gamma rays, and neutrons. This type of therapy includes without limitation external-beam therapy, internal radiation therapy, implant radiation, brachytherapy, systemic radiation therapy, and radiotherapy.
  • “Chemotherapy” refers to the administration of one or more anti-cancer drugs such as, antineoplastic chemotherapeutic agents, chemopreventative agents, and/or other agents to a patient with platinum- sensitive ovarian cancer (e.g., recurrent ovarian cancer) by various methods, including intravenous, oral, intramuscular, intraperitoneal, intravesical, subcutaneous, transdermal, buccal, or inhalation or in the form of a suppository.
  • chemotherapy as used herein is not intended to refer to the administration of 4-iodo-3-nitrobenzamide, an antimetabolite (e.g.
  • Chemotherapy may be given prior to surgery to shrink a large tumor prior to a surgical procedure to remove it, prior to radiation therapy, or after surgery and/or radiation therapy to prevent the growth of any remaining ovarian cancer cells in the body. Chemotherapy may also occur during the course of radiation therapy.
  • phrases “effective amount” or “pharmaceutically effective amount” refer to a sufficient amount of an agent to provide the desired biological, therapeutic, and/or
  • an "effective amount" for therapeutic uses is the amount of a) 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt or solvate thereof; b) an antimetabolite (e.g.
  • a platinum compound e.g., carboplatin
  • a composition comprising a) 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt or solvate thereof; b) an antimetabolite (e.g., gemcitabine), or pharmaceutically acceptable salt or solvate thereof; and c) a platinum compound (e.g., carboplatin) provided herein required to provide a clinically significant decrease in the platinum-sensitive ovarian cancer (e.g. , recurrent ovarian cancer) or slowing of progression of the platinum- sensitive ovarian cancer (e.g. , recurrent ovarian cancer).
  • Methodabolite refers to a compound produced through any in vitro or in vivo metabolic process which results in a product that is different in structure than that of the starting compound.
  • the term “metabolite” includes the metabolite compounds of 4-iodo-3-nitrobenzamide.
  • a metabolite can include a varying number or types of substituents that are present at any position relative to a precursor compound.
  • the terms “metabolite” and “metabolite compound” are used interchangeably herein.
  • pharmaceutically acceptable is meant a material which is not biologically or otherwise undesirable, i.e., the material may be administered to a patient without causing any undesirable biological effects or interacting in a deleterious manner with any of the components of the composition in which it is contained.
  • treating and its grammatical equivalents as used herein include achieving a therapeutic benefit and/or a prophylactic benefit.
  • therapeutic benefit is meant eradication or amelioration of the underlying disorder being treated.
  • therapeutic benefit includes eradication or amelioration of the underlying ovarian cancer, e.g., slowing of progression of the ovarian cancer.
  • a therapeutic benefit is achieved with the eradication or amelioration of one or more of the physiological symptoms associated with the underlying disorder (e.g., ovarian cancer) such that an improvement is observed in the patient, notwithstanding the fact that the patient may still be afflicted with the underlying disorder (e.g., ovarian cancer).
  • a method of the invention may be performed on, or a composition of the invention administered to a patient at risk of developing platinum- sensitive ovarian cancer (e.g., recurrent ovarian cancer), or to a patient reporting one or more of the physiological symptoms of platinum-sensitive ovarian cancer (e.g., recurrent ovarian cancer), even though a diagnosis of platinum- sensitive ovarian cancer (e.g.
  • recurrent ovarian cancer may not have been made.
  • the patient being treated has been diagnosed with a platinum-sensitive ovarian cancer (e.g., recurrent ovarian cancer) described herein.
  • a platinum-sensitive ovarian cancer e.g., recurrent ovarian cancer
  • Reference to "about” a value or parameter herein includes (and describes) variations that are directed to that value or parameter per se. For example, description referring to "about X" includes description of "X”.
  • ovarian tumors There are three basic types of ovarian tumors: epithelial, germ cell, and stromal cell tumors.
  • Epithelial tumors start from the cells that cover the outer surface of the ovary; most ovarian tumors are epithelial cell tumors.
  • Germ cell tumors start from the cells that produce the eggs.
  • Stromal tumors start from cells that hold the ovary together and make the female hormones.
  • a significant risk factor for ovarian cancer includes deficiencies in DNA repair via homologous recombination, such as mutations in the BRCA1 or BRCA2 gene. Those genes were originally identified in families with multiple cases of breast cancer, but have been associated with approximately 5 to 10 percent of ovarian cancers.
  • Possible treatments for ovarian cancer include surgery, immunotherapy, chemotherapy, hormone therapy, radiation therapy, or a combination thereof.
  • Surgical procedures for the treatment of ovarian cancer include debulking, and a unilateral or bilateral oophorectomy and/or a unilateral or bilateral salpigectomy.
  • Anti-cancer drugs that have also been used to treat ovarian cancer include cyclophosphamide, etoposide, altretamine, and ifosfamide.
  • Hormone therapy with the drug tamoxifen is also used to shrink ovarian tumors.
  • Radiation therapy optionally includes external beam radiation therapy and/or brachytherapy.
  • kits for treating platinum-sensitive recurrent ovarian cancer in a patient comprising administering to the patient 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite, and a platinum compound.
  • the antimetabolite is selected from the group consisting of citabine, capecitabine, gemcitabine or valopicitabine.
  • the antimetabolite is gemcitabine.
  • the platinum compound is selected from the group consisting of cisplatin; cis-diamminediaquoplatinum (Il)-ion;
  • the platinum compound is carboplatin.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering an effective amount of (i) 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin.
  • the patient has platinum- sensitive recurrent ovarian cancer.
  • at least one therapeutic effect is obtained, said at least one therapeutic effect being reduction in size of a tumor, reduction in metastasis, complete remission, partial remission, pathologic complete response, or stable disease.
  • the method further comprises surgery, radiation therapy, chemotherapy, gene therapy, viral therapy, RNA therapy, DNA therapy, adjuvant therapy, neoadjuvant therapy, immunotherapy, nanotherapy or a combination thereof.
  • the method further comprises administering to the patient gamma irradiation.
  • the platinum-sensitive recurrent ovarian cancer is selected from the group consisting of epithelial, germ cell, and stromal cell tumors.
  • the platinum- sensitive recurrent ovarian cancer is metastatic.
  • the platinum-sensitive recurrent ovarian cancer is not metastatic.
  • the platinum-sensitive recurrent ovarian cancer comprises invasive malignancy.
  • the platinum- sensitive recurrent ovarian cancer does not comprise invasive malignancy.
  • the present invention provides a method of treating platinum- sensitive ovarian cancer (e.g., platinum- sensitive recurrent ovarian cancer) in a patient, comprising administering to the patient having ovarian cancer (e.g., platinum resistant ovarian cancer) an effective amount of: (i) 4-iodo-3-nitrobenzamide or a metabolite or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin.
  • platinum- sensitive ovarian cancer e.g., platinum- sensitive recurrent ovarian cancer
  • ovarian cancer e.g., platinum resistant ovarian cancer
  • the effective amount is administered over a 21 -day treatment cycle, wherein (i) the effective amount of carboplatin is administered to the patient at 4 mg/ml » minute (AUC 4) (or about AUC4) on day 1 of the treatment cycle; (ii) the effective amount of gemcitabine is administered to the patient at a dose of 1000 mg/m 2 (or about 1000 mg/m 2 ) on days 1 and 8 of the treatment cycle; and (iii) the effective amount of 4-iodo-3-nitrobenzamide or a metabolite or a pharmaceutically acceptable salt thereof is administered to the patient at a dose of 5.6 mg/kg (or about 5.6 mg/kg) twice weekly on days 1, 4, 8, and 11 of the treatment cycle.
  • AUC 4 mg/ml » minute AUC 4 mg/ml » minute
  • gemcitabine is administered to the patient at a dose of 1000 mg/m 2 (or about 1000 mg/m 2 ) on days 1 and 8 of the treatment cycle
  • the effective amount produces at least one therapeutic effect selected from the group consisting of reduction in size of an ovarian tumor, reduction in metastasis, complete remission, partial remission, stable disease, increase in overall response rate, or a pathologic complete response.
  • the improvement of clinical benefit rate is about 20% or higher.
  • the therapeutic effect is an increase in overall response rate. In some embodiments, the overall response rate is greater than 40%.
  • the overall response rate is greater than 50%. In some embodiments, the overall response rate is greater than 60%. In some embodiments, the method further comprises surgery, radiation therapy, chemotherapy, gene therapy, viral therapy, RNA therapy, DNA therapy, adjuvant therapy, neoadjuvant therapy, immunotherapy, nanotherapy or a combination thereof. In some embodiments, the method further comprises administering to the patient gamma irradiation.
  • the platinum-sensitive ovarian cancer e.g., platinum- sensitive recurrent ovarian cancer
  • the platinum-sensitive ovarian cancer is selected from the group consisting of epithelial, germ cell, and stromal cell tumors. In some embodiments, the platinum-sensitive ovarian cancer is recurrent ovarian cancer.
  • the platinum-sensitive ovarian cancer (e.g., platinum-sensitive recurrent ovarian cancer) is metastatic.
  • the platinum- sensitive ovarian cancer e.g., platinum-sensitive recurrent ovarian cancer
  • the platinum-sensitive ovarian cancer is deficient in homologous recombination DNA repair.
  • the homologous recombination DNA repair-deficient platinum- sensitive ovarian cancer is BRCA deficient.
  • the BRCA-deficient platinum- sensitive ovarian cancer is BRCA 1 -deficient.
  • the BRCA-deficient platinum-sensitive ovarian cancer is BRCA2-deficient.
  • the BRCA- deficient platinum-sensitive ovarian cancer is both BRCA 1 -deficient and BRCA2-deficient.
  • the platinum-sensitive recurrent ovarian cancer comprises at least one mutation in BRCA1.
  • the platinum-sensitive recurrent ovarian cancer does not comprise a mutation in BRCA1.
  • the platinum-sensitive recurrent ovarian cancer comprises at least one mutation in BRCA2.
  • the platinum-sensitive recurrent ovarian cancer does not comprise a mutation in BRCA2.
  • the platinum-sensitive recurrent ovarian cancer comprises at least one mutation in BRCA1 and at least one mutation in BRCA2.
  • the platinum-sensitive recurrent ovarian cancer does not comprise a mutation in BRCA1 or in BRCA2.
  • the platinum- sensitive recurrent ovarian cancer is deficient in homologous recombination DNA repair.
  • the homologous recombination DNA repair-deficient platinum- sensitive recurrent ovarian cancer is BRCA deficient.
  • a deficiency in a BRCA gene is detected in the ovarian cancer patient.
  • the deficiency is a genetic defect in the BRCA gene.
  • the genetic defect is a mutation, insertion, substitution, duplication or deletion of the BRCA gene.
  • the BRCA gene is BRCA 1.
  • the BRCA gene is BRCA-2.
  • the BRCA-deficient platinum- sensitive recurrent ovarian cancer is BRCA1- deficient. In some embodiments, the BRCA-deficient platinum- sensitive recurrent ovarian cancer is BRCA2-deficient. In some embodiments, the BRCA-deficient platinum-sensitive recurrent ovarian cancer is both BRCA 1 -deficient and BRCA2-deficient.
  • a method of treating platinum- sensitive recurrent ovarian cancer comprising administering an effective amount of 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite (e.g., gemcitabine), and a platinum compound (e.g., carboplatin).
  • the platinum-sensitive recurrent ovarian cancer is epithelial ovarian carcinoma.
  • the platinum-sensitive recurrent ovarian cancer is fallopian tube cancer.
  • the platinum- sensitive recurrent ovarian cancer is primary peritoneal carcinoma.
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising administering to the patient having the platinum- sensitive recurrent ovarian cancer an effective amount of: (i) 4-iodo-3-nitrobenzamide or a metabolite or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin.
  • the ovarian cancer described herein may be epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma.
  • the platinum-sensitive recurrent ovarian cancer is serous ovarian cancer.
  • the platinum-sensitive recurrent ovarian cancer is serous adenocarcinoma ovarian cancer.
  • the platinum-sensitive recurrent ovarian cancer is papillary serous ovarian cancer. In some embodiments, the platinum-sensitive recurrent ovarian cancer is endometrioid ovarian cancer. In some embodiments, the platinum- sensitive recurrent ovarian cancer is clear cell ovarian cancer.
  • the patient has measurable disease (such as measurable disease according to RECIST 1.1).
  • the measurable disease may be defined by at least one lesion that can be accurately measured in at least one dimension (such as longest dimension), and is > 20 mm when measured by conventional techniques (e.g., palpation, plain x-ray, computed tomography, or magnetic resonance imaging) or > 10 mm when measured by spiral CT.
  • the patient has not received 2 or more prior chemotherapies (e.g., cytotoxic chemotherapyies).
  • the platinum-sensitive recurrent ovarian cancer comprises ovarian tumor of any grade, for example, any of grade 1, 2, or 3.
  • Grading of ovarian tumor may be in accordance with any of the methods known to one skilled in the art.
  • grade 0 may refer to non-invasive tumors or borderline tumors.
  • Grade 1 tumors may have cells that are well differentiated (look very similar to the normal tissue) and may be the ones with the best prognosis.
  • Grade 2 tumors may be moderately well differentiated and may be made up by cells that resemble the normal tissue.
  • Grade 3 tumors may have the worst prognosis and their cells may be abnormal, referred to as poorly differentiated.
  • the patient has not received a prior chemotherapy (e.g., cytotoxic chemotherapy) in the recurrent setting.
  • a prior chemotherapy e.g., cytotoxic chemotherapy
  • the patient has not been treated with more than 1 line of cytotoxic chemotherapy and 1 line of biologies such as anti-VEGF antibody (e.g., bevacizumab) for greater than about 6 months (hormones do not count as a line of treatment).
  • the patient has not received a prior chemotherapy comprising 4-iodo- 3-nitrobenzamide or a metabolite or a pharmaceutically acceptable salt thereof.
  • the patient has not received a prior chemotherapy comprising a PARP inhibitor (e.g., Olaparib, ABT-888 (Veliparib), AGO 14699, CEP 9722, MK 4827, KU-0059436 (AZD2281), or LT-673).
  • a PARP inhibitor e.g., Olaparib, ABT-888 (Veliparib), AGO 14699, CEP 9722, MK 4827, KU-0059436 (AZD2281), or LT-673.
  • the patient has platinum compound-free interval of about or at least about 6 months (e.g., about or at least about any of 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, 36 months, or 42 months).
  • the method further comprises administering granulocyte colony- stimulating factor ("G-CSF") to the patient. In some embodiments, the method does not further comprise administering G-CSF to the patient.
  • G-CSF granulocyte colony- stimulating factor
  • the dosing regimen for 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite (e.g., gemcitabine), and a platinum compound (e.g., carboplatin) may be according to any of the dosing schedule or dosing regimen described in the Section "Formulations, Routes of administration, and Dosing Regimen" described below.
  • the term "patient” or “subject” refers to a human patient or subject.
  • the platinum-sensitive recurrent ovarian cancer can be any stage. In some embodiments of any of the methods described herein, the platinum-sensitive recurrent ovarian cancer is not metastatic. In some embodiments, the platinum- sensitive recurrent ovarian cancer is metastatic. In some embodiments, the platinum-sensitive recurrent ovarian cancer is any of stage 1, 2, 3 or 4. In some embodiments, the platinum-sensitive recurrent ovarian cancer is any of stage la, lb, lc, 2a, 2b, 2c, 3a, 3b, 3c, or 4.
  • the staging may be according to any of the methods known to one skilled in the art. For example, the staging may be in accordance with the staging described at
  • At least one therapeutic effect is obtained, said at least one therapeutic effect being reduction in size of an ovarian tumor, reduction in metastasis, complete remission, partial remission, pathologic complete response, increase in overall response rate or stable disease.
  • the treatment provides improved clinical benefit rate compared to treatment without 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof.
  • the improvement of clinical benefit rate is at least about any of 20%, 30%, 40%, 50%, 60%, 70%, 80%, or more.
  • the therapeutic effect is an increase in overall response rate.
  • the increase in overall response rate is about any of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80% or more.
  • the methods for treating platinum-sensitive recurrent ovarian cancer further comprise administering 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof in combination with an anti-tumor agent (or at least one anti-tumor agent).
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering an effective amount of (a) 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, (b) an antimetabolite (e.g.,
  • the anti-tumor agent is an antitumor alkylating agent, antitumor antimetabolite, antitumor antibiotics, plant-derived antitumor agent, antitumor platinum complex, antitumor camptothecin derivative, antitumor tyrosine kinase inhibitor, monoclonal antibody, interferon, biological response modifier, hormonal anti-tumor agent, anti-tumor viral agent, angiogenesis inhibitor, differentiating agent, or other agent that exhibits anti-tumor activities, or a pharmaceutically acceptable salt thereof.
  • the platinum complex is cisplatin, carboplatin, oxaplatin or oxaliplatin.
  • the antimetabolite is citabine, capecitabine, gemcitabine or valopicitabine.
  • the methods further comprise administering to the patient 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof in combination with more than one anti-tumor agent.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite (e.g., gemcitabine), and a platinum compound (e.g., carboplatin) in combination with at least more than one anti-tumor agent.
  • an antimetabolite e.g., gemcitabine
  • a platinum compound e.g., carboplatin
  • the anti-tumor agent is administered prior to, concomitant with or subsequent to administering 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite (e.g., gemcitabine), and/or a platinum complex (e.g., carboplatin).
  • the anti-tumor agent is an anti- angiogenic agent, such as Avastin or a receptor tyrosine kinase inhibitor including but not limited to Sutent, Nexavar, Recentin, ABT-869, and Axitinib.
  • the anti-tumor agent is a topoisomerase inhibitor including but not limited to irinotecan, topotecan, or camptothecin.
  • the anti-tumor agent is a taxane including but not limited to paclitaxel, docetaxel and Abraxane.
  • the anti-tumor agent is an agent targeting Her-2, Herceptin or lapatinib.
  • the antitumor agent is a hormone analog, for example, progesterone.
  • the anti- tumor agent is tamoxifen, a steroidal aromatase inhibitor, a non-steroidal aromatase inhibitor, or Fulvestrant.
  • the anti-tumor agent is an agent targeting a growth factor receptor.
  • such agent is an inhibitor of epidermal growth factor receptor (EGFR) including but not limited to Cetuximab and Panitumimab.
  • the agent targeting a growth factor receptor is an inhibitor of insulin-like growth factor 1 (IGF-1) receptor (IGF1R) such as CP-751871.
  • the method further comprises surgery, radiation therapy, chemotherapy, gene therapy, DNA therapy, adjuvant therapy, neoadjuvant therapy, viral therapy, RNA therapy, immunotherapy, nanotherapy or a combination thereof.
  • at least one therapeutic effect is obtained, said at least one therapeutic effect being reduction in size of a tumor, reduction in metastasis, complete remission, partial remission, pathologic complete response, or stable disease.
  • the treatment comprises a treatment cycle of at least 11 days, e.g., about 11 to about 30 days in length, wherein on from 1 to 10 separate days of the cycle, the patient receives about 1 to about 100 mg/kg of 4-iodo-3-nitrobenzamide or a molar equivalent of a metabolite thereof. In some embodiments, on from 1 to 10 separate days of the cycle, the patient receives about 1 to about 50 mg/kg of 4-iodo-3-nitrobenzamide or a molar equivalent of a metabolite thereof.
  • the patient receives about 1, 2, 3, 4, 5, 5.6, 6, 8, 10, 11.2, 12, 14, 16, 18 or 20 mg/kg of 4-iodo-3-nitrobenzamide.
  • the treatment further comprises an antimetabolite (e.g., gemcitabine), and a platinum compound (e.g., carboplatin).
  • Some embodiments described herein provide a method of treating platinum- sensitive recurrent ovarian cancer in a patient (e.g., a patient having a deficiency in a BRCA gene), comprising during a 21 day treatment cycle on days 1, 4, 8 and 11 of the cycle, administering to the patient about 10 to about 100 mg/kg of 4-iodo-3-nitrobenzamide or a molar equivalent of a metabolite thereof.
  • the 4-iodo-3- nitrobenzamide is administered orally or as a parenteral injection or infusion, or inhalation.
  • the treatment further comprises an antimetabolite (e.g., gemcitabine), and a platinum compound (e.g., carboplatin).
  • Some embodiments described herein provide a method of treating platinum- sensitive recurrent ovarian cancer in a patient (e.g., a patient having a deficiency in a BRCA gene), comprising: (a) establishing a treatment cycle of about 10 to about 30 days in length; (b) on from 1 to 10 separate days of the cycle, administering to the patient about 1 mg/kg to about 50 mg/kg of 4-iodo-3-nitrobenzamide, or a molar equivalent of a metabolite thereof.
  • the 4-iodo-3-nitrobenzamide is administered orally or as a parenteral injection or infusion, or inhalation.
  • the treatment further comprises an antimetabolite (e.g., gemcitabine), and a platinum compound (e.g., carboplatin).
  • Some embodiments provided herein include a method of treating ovarian cancer in a patient in need of such treatment, comprising: (a) obtaining a sample from the patient; (b) testing the sample to determine if there is a deficiency in a BRCA gene; (c) if the testing indicates that the patient has a deficiency in a BRCA gene, treating the patient with 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof; and (d) if the testing does not indicate that the patient has a deficiency in a BRCA gene, selecting a different treatment option.
  • At least one therapeutic effect is obtained, said at least one therapeutic effect being reduction in size of an ovarian tumor, reduction in metastasis, complete remission, partial remission, pathologic complete response, increase in overall response rate, or stable disease.
  • the clinical benefit rate is at least about 30%.
  • the sample is a tissue or bodily fluid sample.
  • the sample is a tumor sample, a blood sample, a blood plasma sample, a peritoneal fluid sample, an exudate or an effusion.
  • the ovarian cancer is a metastatic ovarian cancer.
  • the BRCA gene is BRCA-1. In other embodiments, the BRCA gene is BRCA-2. In some embodiments, the BRCA gene is BRCA-1 and BRCA-2. In other embodiments, the deficiency is a genetic defect in the BRCA gene. In some
  • the genetic defect is a mutation, insertion, substitution, duplication or deletion of the BRCA gene.
  • 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof may be capable of being present in a variety of physical forms— e.g., free base, salts (especially pharmaceutically acceptable salts), hydrates, polymorphs, solvates, etc.
  • a chemical name is intended to encompass all physical forms of the named chemical.
  • 4-iodo-3-nitrobenzamide, without further qualification is intended to generically encompass the free base as well as all
  • a platinum compound e.g., carboplatin
  • a platinum compound is administered as an intravenous infusion.
  • 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof is administered orally or as a parenteral injection or infusion, or inhalation.
  • an anti-metabolite e.g., gemcitabine
  • an intravenous infusion is administered as an intravenous infusion.
  • the method comprises treating a patient with at least three chemically distinct substances, one of which is anti-metabolite (e.g. gemcitabine), one of which is a platinum-containing complex (e.g., carboplatin or cisplatin) and 4-iodo-3-nitrobenzamide or a metabolite thereof or a
  • anti-metabolite e.g. gemcitabine
  • platinum-containing complex e.g., carboplatin or cisplatin
  • one or more of these substances may be capable of being present in a variety of physical forms— e.g., free base, salts (especially pharmaceutically acceptable salts), hydrates, polymorphs, solvates, or metabolites, etc.
  • use of a chemical name is intended to encompass all physical forms of the named chemical.
  • recitation of 4-iodo-3- nitrobenzamide, without further qualification is intended to generically encompass the free base as well as all pharmaceutically acceptable salts, polymorphs, hydrates, and metabolites thereof.
  • pharmaceutically acceptable salt or solvate thereof is to be administered to the patient in combination with an antimetabolite (e.g., gemcitabine) and a platinum compound (e.g., carboplatin).
  • an antimetabolite e.g., gemcitabine
  • a platinum compound e.g., carboplatin
  • the use as provided herein is with respect to or in accordance with any of the methods described herein.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) antimetabolite such as gemcitabine; and (iii) a platinum
  • Antitumor agents that may be used in the present invention include but are not limited to antitumor alkylating agents, antitumor antimetabolites, antitumor antibiotics, plant-derived antitumor agents, antitumor platinum-complex compounds, antitumor camptothecin derivatives, antitumor tyrosine kinase inhibitors, anti-tumor viral agent, monoclonal antibodies, interferons, biological response modifiers, and other agents that exhibit anti-tumor activities, or a pharmaceutically acceptable salt thereof.
  • (i) 4-iodo-3- nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) antimetabolite such as gemcitabine; and (iii) a platinum compound such as carboplatin are used in combination with an anti-angiogenic agent.
  • (i) 4-iodo-3- nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) antimetabolite such as gemcitabine; and (iii) a platinum compound such as carboplatin are used in combination with a topoisomerase inhibitor such as irinotecan.
  • the ovarian cancer is a metastatic cancer.
  • the anti-tumor agent is an alkylating agent.
  • alkylating agent generally refers to an agent giving an alkyl group in the alkylation reaction in which a hydrogen atom of an organic compound is substituted with an alkyl group.
  • anti-tumor alkylating agents include but are not limited to nitrogen mustard N-oxide, cyclophosphamide, ifosfamide, melphalan, busulfan, mitobronitol, carboquone, thiotepa, ranimustine, nimustine, temozolomide or carmustine.
  • the anti-tumor agent is an antimetabolite.
  • antimetabolite used herein includes, in a broad sense, substances which disturb normal metabolism and substances which inhibit the electron transfer system to prevent the production of energy-rich intermediates, due to their structural or functional similarities to metabolites that are important for living organisms (such as vitamins, coenzymes, amino acids and saccharides).
  • antimetabolites that have anti-tumor activities include but are not limited to methotrexate, 6-mercaptopurine riboside, mercaptopurine, 5-fluorouracil, tegafur, doxifluridine, carmofur, cytarabine, cytarabine ocfosfate, enocitabine, S-l, gemcitabine, fludarabine or pemetrexed disodium, and preferred are 5-fluorouracil, S-l, gemcitabine and the like.
  • the anti-tumor agent is an antitumor antibiotic.
  • antitumor antibiotics include but are not limited to actinomycin D, doxorubicin, daunorubicin, neocarzinostatin, bleomycin, peplomycin, mitomycin C, aclarubicin, pirarubicin, epirubicin, zinostatin stimalamer, idarubicin, sirolimus or valrubicin.
  • the anti-tumor agent is a plant-derived antitumor agent.
  • plant-derived antitumor agents include but are not limited to vincristine, vinblastine, vindesine, etoposide, sobuzoxane, docetaxel, paclitaxel and vinorelbine, and preferred are docetaxel and paclitaxel.
  • the anti-tumor agent is a camptothecin derivative that exhibits anti-tumor activities.
  • anti-tumor camptothecin derivatives include but are not limited to camptothecin, 10- hydroxycamptothecin, topotecan, irinotecan or 9-aminocamptothecin, with camptothecin, topotecan and irinotecan being preferred.
  • irinotecan is metabolized in vivo and exhibits antitumor effect as SN-38.
  • camptothecin derivatives are believed to be virtually the same as those of camptothecin (e.g., Nitta, et al., Gan to Kagaku Ryoho, 14, 850-857 (1987)).
  • the anti-tumor agent is an organoplatinum compound or a platinum coordination compound having antitumor activity.
  • organoplatinum compound platinum compound
  • platinum complex platinum complex
  • Preferred organoplatinum compounds include but are not limited to cisplatin; cis-diamminediaquoplatinum (Il)-ion; chloro(diethylenetriamine)- platinum (II) chloride; dichloro(ethylenediamine)-platinum (II); diammine(l,l- cyclobutanedicarboxylato) platinum (II) (carboplatin); spiroplatin; iproplatin; diammine(2- ethylmalonato)platinum (II); ethylenediaminemalonatoplatinum (II); aqua(l,2- diaminodicyclohexane)sulfatoplatinum (II); aqua(l,2- diaminodicyclohexane)malonatoplatinum (II) ; ( 1 ,2-diaminocyclohexane)malonatoplatinum (II); (4-carboxyphthalato)( 1,2-di
  • tetraplatin carboplatin, nedaplatin and oxaliplatin, and preferred is carboplatin or oxaliplatin.
  • carboplatin, nedaplatin and oxaliplatin and preferred is carboplatin or oxaliplatin.
  • other antitumor organoplatinum compounds mentioned in the specification are known and are commercially available and/or producible by a person having ordinary skill in the art by conventional techniques.
  • the anti-tumor agent is an antitumor tyrosine kinase inhibitor.
  • tyrosine kinase inhibitor refers to a chemical substance inhibiting "tyrosine kinase” which transfers a ⁇ -phosphate group of ATP to a hydroxyl group of a specific tyrosine in protein.
  • anti-tumor tyrosine kinase inhibitors include but are not limited to gefitinib, imatinib, erlotinib, Sutent, Nexavar, Recentin, ABT-869, and Axitinib.
  • the anti-tumor agent is an antibody or a binding portion of an antibody that exhibits anti-tumor activity. In some embodiments, the anti-tumor agent is a monoclonal antibody.
  • Examples thereof include but are not limited to abciximab, adalimumab, alemtuzumab, basiliximab, bevacizumab, cetuximab, daclizumab, eculizumab, efalizumab, ibritumomab, tiuxetan, infliximab, muromonab-CD3, natalizumab, omalizumab, palivizumab, panitumumab, ranibizumab, gemtuzumab ozogamicin, rituximab, tositumomab, trastuzumab, or any antibody fragments specific for antigens.
  • the anti-tumor agent is an interferon.
  • interferon has antitumor activity, and it is a glycoprotein which is produced and secreted by most animal cells upon viral infection. It has not only the effect of inhibiting viral growth but also various immune effector mechanisms including inhibition of growth of cells (in particular, tumor cells) and enhancement of the natural killer cell activity, thus being designated as one type of cytokine.
  • anti-tumor interferons include but are not limited to interferon a, interferon a -2a, interferon a- 2b, interferon ⁇ , interferon ⁇ -la and interferon ⁇ - ⁇ .
  • the anti-tumor agent is a biological response modifier. It is generally the generic term for substances or drugs for modifying the defense mechanisms of living organisms or biological responses such as survival, growth or differentiation of tissue cells in order to direct them to be useful against tumor, infection or other diseases.
  • biological response modifier include but are not limited to krestin, lentinan, sizofiran, picibanil and ubenimex.
  • the anti-tumor agents include but are not limited to mitoxantrone, L-asparaginase, procarbazine,
  • antimetabolite "antitumor antibiotic”, “plant-derived antitumor agent”, “antitumor platinum coordination compound”, “antitumor camptothecin derivative”, “antitumor tyrosine kinase inhibitor”, “monoclonal antibody”, “interferon”, “biological response modifier” and “other antitumor agent” are all known and are either commercially available or producible by a person skilled in the art by methods known per se or by well-known or conventional methods. The process for preparation of gefitinib is described, for example, in U.S. Pat. No.
  • antitumor alkylating agents are commercially available, as exemplified by the following: nitrogen mustard N-oxide from Mitsubishi Pharma Corp. as Nitrorin (tradename); cyclophosphamide from Shionogi & Co., Ltd. as Endoxan (tradename); ifosfamide from Shionogi & Co., Ltd. as Ifomide (tradename); melphalan from Mitsubishi Pharma Corp. as Nitrorin (tradename); cyclophosphamide from Shionogi & Co., Ltd. as Endoxan (tradename); ifosfamide from Shionogi & Co., Ltd. as Ifomide (tradename); melphalan from
  • GlaxoSmithKline Corp. as Alkeran (tradename); busulfan from Takeda Pharmaceutical Co., Ltd. as Mablin (tradename); mitobronitol from Kyorin Pharmaceutical Co., Ltd. as Myebrol (tradename); carboquone from Sankyo Co., Ltd. as Esquinon (tradename); thiotepa from Sumitomo Pharmaceutical Co., Ltd. as Tespamin (tradename); ranimustine from Mitsubishi Pharma Corp. as Cymerin (tradename); nimustine from Sankyo Co., Ltd. as Nidran
  • antitumor antimetabolites are commercially available, as exemplified by the following: methotrexate from Takeda Pharmaceutical Co., Ltd. as
  • Methotrexate (tradename); 6-mercaptopurine riboside from Aventis Corp. as Thioinosine (tradename); mercaptopurine from Takeda Pharmaceutical Co., Ltd. as Leukerin (tradename); 5-fluorouracil from Kyowa Hakko Kogyo Co., Ltd. as 5-FU (tradename); tegafur from Taiho Pharmaceutical Co., Ltd. as Futraful (tradename); doxyfluridine from Nippon Roche Co., Ltd. as Furutulon (tradename); carmofur from Yamanouchi Pharmaceutical Co., Ltd. as Yamafur (tradename); cytarabine from Nippon Shinyaku Co., Ltd.
  • Cylocide tradename
  • cytarabine ocfosfate from Nippon Kayaku Co., Ltd. as Strasid(tradename); enocitabine from Asahi Kasei Corp. as Sanrabin (tradename); S-1 from Taiho Pharmaceutical Co., Ltd. as TS-1 (tradename); gemcitabine from Eli Lilly & Co. as Gemzar (tradename); fludarabine from Nippon Schering Co., Ltd. as Fludara (tradename); and pemetrexed disodium from Eli Lilly & Co. as Alimta (tradename).
  • antitumor antibiotics are commercially available, as exemplified by the following: actinomycin D from Banyu Pharmaceutical Co., Ltd. as Cosmegen (tradename); doxorubicin from Kyowa Hakko Kogyo Co., Ltd. as adriacin
  • vinblastine from Kyorin Pharmaceutical Co., Ltd. as Vinblastine (tradename); vindesine from Shionogi & Co., Ltd. as Fildesin (tradename); etoposide from Nippon Kayaku Co., Ltd. as Lastet (tradename); sobuzoxane from Zenyaku Kogyo Co., Ltd. as Perazolin (tradename); docetaxel from Aventis Corp. as Taxsotere (tradename); paclitaxel from Bristol- Myers Squibb Co. as Taxol (tradename); and vinorelbine from Kyowa Hakko Kogyo Co., Ltd. as Navelbine (tradename).
  • camptothecin derivatives are commercially available, as exemplified by the following: irinotecan from Yakult Honsha Co., Ltd. as Campto (tradename); topotecan from GlaxoSmithKline Corp. as Hycamtin (tradename); and camptothecin from Aldrich Chemical Co., Inc., U.S.A.
  • antitumor tyrosine kinase inhibitors are commercially available, as exemplified by the following: gefitinib from AstraZeneca Corp. as Iressa (tradename); imatinib from Novartis AG as Gleevec (tradename); and erlotinib from OSI Pharmaceuticals Inc. as Tarceva (tradename).
  • interferon a from Sumitomo Pharmaceutical Co., Ltd. as Sumiferon
  • interferon a-2b from Schering-Plough Corp. as Intron A (tradename); interferon ⁇ from Mochida Pharmaceutical Co., Ltd. as IFN.beta. (tradename); interferon ⁇ -la from Shionogi & Co., Ltd. as Imunomax- ⁇ (tradename); and interferon ⁇ - ⁇ from Otsuka
  • krestin from Sankyo Co., Ltd. as krestin (tradename);
  • lentinan from Aventis Corp. as Lentinan (tradename); sizofiran from Kaken Seiyaku Co., Ltd. as Sonifiran (tradename); picibanil from Chugai Pharmaceutical Co., Ltd. as Picibanil (tradename); and ubenimex from Nippon Kayaku Co., Ltd. as Bestatin (tradename).
  • the above-mentioned other antitumor agents are commercially available, as exemplified by the following: mitoxantrone from Wyeth Lederle Japan, Ltd. as Novantrone (tradename); L-asparaginase from Kyowa Hakko Kogyo Co., Ltd. as Leunase (tradename); procarbazine from Nippon Roche Co., Ltd. as Natulan (tradename); dacarbazine from Kyowa Hakko Kogyo Co., Ltd. as dacarbazine (tradename); hydroxycarbamide from Bristol-Myers Squibb Co. as Hydrea (tradename); pentostatin from Kagaku Oyobi Kessei Ryoho
  • Kenkyusho as Coforin (tradename); tretinoin from Nippon Roche Co., Ltd. As Vesanoid (tradename); alefacept from Biogen plec Inc. as Amevive (tradename); darbepoetin alfa from Amgen Inc. as Aranesp (tradename); anastrozole from AstraZeneca Corp. as Arimidex (tradename); exemestane from Pfizer Inc. as Aromasin (tradename); bicalutamide from AstraZeneca Corp. as Casodex (tradename); leuprorelin from Takeda Pharmaceutical Co., Ltd. as Leuplin (tradename); flutamide from Schering-Plough Corp.
  • Eulexin tradename
  • Faslodex tradename
  • pegaptanib octasodium from Gilead Sciences, Inc. as Macugen (tradename); denileukin diftitox from Ligand
  • Ontak tradename
  • aldesleukin from Chiron Corp. as Proleukin
  • thyrotropin alfa from Genzyme Corp. as Thyrogen
  • arsenic trioxide from Cell Therapeutics, Inc. as Trisenox (tradename); bortezomib from Millennium
  • antitumor agent includes the above-described antitumor alkylating agent, antitumor antimetabolite, antitumor antibiotic, plant-derived antitumor agent, antitumor platinum coordination compound, antitumor camptothecin derivative, antitumor tyrosine kinase inhibitor, monoclonal antibody, interferon, biological response modifier, and other antitumor agents.
  • anti-tumor agents or anti-neoplastic agents can be used in combination with benzopyrone compounds.
  • suitable anti-tumor agents or anti-neoplastic agents include, but are not limited to, 13-cis-Retinoic Acid, 2-CdA, 2-Chlorodeoxyadenosine, 5-Azacitidine, 5-Fluorouracil, 5-FU, 6-Mercaptopurine, 6-MP, 6-TG, 6-Thioguanine, Abraxane, Accutane, Actinomycin-D, Adriamycin, Adrucil, Agrylin, Ala-Cort, Aldesleukin, Alemtuzumab, ALIMTA, Alitretinoin, Alkaban-AQ, Alkeran, All-transretinoic Acid, Alpha Interferon, Altretamine, Amethopterin, Amifostine, Aminoglutethimide, Anagrelide, Anandron,
  • Anastrozole Arabinosylcytosine, Ara-C, Aranesp, Aredia, Arimidex, Aromasin, Arranon, Arsenic Trioxide, Asparaginase, ATRA, Avastin, Azacitidine, BCG, BCNU, Bendamustine, Bevacizumab, Bexarotene, BEXXAR, Bicalutamide, BiCNU, Blenoxane, Bleomycin, Bortezomib, Busulfan, Busulfex, C225, Calcium Leucovorin, Campath, Camptosar,
  • Chlorambucil Cisplatin, Citrovorum Factor, Cladribine, Cortisone, Cosmegen, CPT-11, Cyclophosphamide, Cytadren, Cytarabine, Cytarabine Liposomal, Cytosar-U, Cytoxan, dacarbazine, Dacogen, Dactinomycin, Darbepoetin Alfa, Dasatinib, Daunomycin,
  • Daunorubicin Daunorubicin Hydrochloride, Daunorubicin Liposomal, DaunoXome, Decadron, Decitabine, Delta-Cortef, Deltasone, Denileukin Diftitox, DepoCytTM,
  • Dexamethasone Dexamethasone Acetate, Dexamethasone Sodium Phosphate, Dexasone, Dexrazoxane, DHAD, DIC, Diodex, Docetaxel, Doxil, Doxorubicin, Doxorubicin Liposomal, DroxiaTM, DTIC, DTIC-Dome, Duralone, Efudex, Eligard, Ellence, Eloxatin, Elspar, Emcyt, Epirubicin, Epoetin Alfa, Erbitux, Erlotinib, Erwinia L-asparaginase, Estramustine, Ethyol, Etopophos, Etoposide, Etoposide Phosphate, Eulexin, Evista, Exemestane, Fareston,
  • Faslodex Femara, Filgrastim, Floxuridine, Fludara, Fludarabine, Fluoroplex, Fluorouracil, Fluorouracil (cream), Fluoxymesterone, Flutamide, Folinic Acid, FUDR , Fulvestrant, G- CSF, Gefitinib, Gemcitabine, Gemtuzumab ozogamicin, Gemzar & Gemzar Side Effects - Chemotherapy Drugs, Gleevec, Gliadel Wafer, GM-CSF, Goserelin, Granulocyte - Colony Stimulating Factor, Granulocyte Macrophage Colony Stimulating Factor, Halotestin,
  • Antimetabolites are drugs that interfere with normal cellular metabolic processes. Since cancer cells are rapidly replicating, interference with cellular metabolism affects cancer cells to a greater extent than host cells.
  • An antimetabolite such as gemcitabine may be used in any one of the methods provided herein, for example, gemcitabine may be used in
  • Gemcitabine has the following structure:
  • Gemcitabine is available, for example, as GEMZAR from Eli Lilly and
  • Gemcitabine used herein also includes any pharmaceutically acceptable salt form (e.g., gemcitabine HC1 or other salt forms).
  • Gemcitabine also known as 4-amino-l- [(2R,4R,5R)-3,3-difluoro-4-hydroxy-5-(hydroxymethyl)tetrahydrofuran-2-yl]pyrimidin- 2(lH)-one or 2'-deoxy-2',2'-difluorocytidine
  • the dosage of an antimetabolite such as gemcitabine may be adjusted to a particular patient.
  • the dosage of gemcitabine when used in combination with 4-iodo-3-nitrobenzamide (or a metabolite thereof or a pharmaceutically acceptable salt thereof) and a platinum compound such as carboplatin in any of the methods provided herein, may be in the range of about 100 mg/m 2 to about 5000 mg/m 2 , about 100 mg/m 2 to about 2000 mg/m 2 , about 200 to about 4000 mg/m 2 , about 300 to about 3000 mg/m 2 , about 400 to about 2000 mg/m 2 , about 500 to about 1500 mg/m 2 , about 750 to about 1500 mg/m 2 , about 800 to about 1500 mg/m 2 , about 900 to about 1400 mg/m 2 , about 900 to about 1250 mg/m 2 , about 1000 to about 1500 mg/m 2 , about 1000 mg/m 2 , about 1050 mg/m 2 , about 1100 mg/m 2 , about 1150 mg/m 2 , about 1200 mg/m 2 , about 1250 mg/
  • the dimensions mg/m 2 refer to the amount of gemcitabine in milligrams (mg) per unit surface area of the patient in square meters (m ).
  • Gemcitabine may be administered by intravenous (IV) infusion, e.g., over a period of about 10 to about 300 minutes, about 15 to about 180 minutes, about 20 to about 60 minutes, about 10 minutes, about 20 minutes, or about 30 minutes.
  • IV intravenous
  • the term "about” in this context indicates the normal usage of approximately; and in some embodiments indicates a tolerance of + 10% or + 5%.
  • Taxanes are drugs that are derived from the twigs, needles and bark of Pacific yew tress, Taxus brevifolia.
  • paclitaxel may be derived from 10-deacetylbaccatin through known synthetic methods.
  • Taxanes such as paclitaxel and its derivative docetaxel have demonstrated antitumor activity in a variety of tumor types.
  • the taxanes interfere with normal function of microtubule growth by hyperstabilizing their structure, thereby destroying the cell's ability to use its cytoskeleton in a normal manner. Specifically, the taxanes bind to the ⁇ subunit of tubulin, which is the building block of microtubules.
  • Paclitaxel induces programmed cell death (apoptosis) in cancer cells by binding to an apoptosis-inhibiting protein called Bcl-2 (B-cell leukemia 2), thereby preventing Bcl-2 from inhibiting apoptosis.
  • Bcl-2 B-cell leukemia 2
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin in combination with a taxane (e.g., paclitaxel, docetaxel, or Abraxane).
  • a taxane e.g., paclitaxel, docetaxel, or Abraxane.
  • the dosage of taxane such as paclitaxel may vary depending upon the height, weight, physical condition, tumor size and progression state, etc.
  • the dosage of taxane such as paclitaxel will be in the range of about 10 to about 2000 mg/m 2 , about 10 to about 200 mg/m 2 or about 100 to about 175 mg/m 2. In some embodiments, the taxane such as paclitaxel will be administered over a period of up to about 10 hours, up to about 8 hours or up to about 6 hours.
  • the term "about” in this context indicates the normal usage of approximately; and in some embodiments indicates a tolerance of + 10% or + 5%.
  • taxanes include but are not limited to docetaxel, paclitaxel, and Abraxane. Platinum complexes
  • Platinum complexes are pharmaceutical agents or pharmaceutical compositions used to treat cancer, which contain at least one platinum center complexed with at least one organic group. Platinum complexes include, for example, carboplatin, cisplatin, and oxaliplatin. "Platinum complex” and “platinum agent” are used interchangeably.
  • a platinum complex (or platinum compound) such as carboplatin may be used in any one of the methods provided herein, for example, carboplatin may be used in combination with 4-iodo-3- nitrobenzamide (or a metabolite thereof or a pharmaceutically acceptable salt thereof) and an antimetabolite such as gemcitabine in treating platinum- sensitive recurrent ovarian cancer in accordance with the present disclosure.
  • Carboplatin has the following structure:
  • Carboplatin is available, for example, from Bedford Laboratories.
  • Carboplatin also known as cis-Diammine(l,l-cyclobutanedicarboxylato)platinum(II)
  • is a platinum complex (or platinum compound) which is also marketed under the brand names Paraplatin® and Paraplatin-AQ.
  • Carboplatin used herein also includes any pharmaceutically acceptable salt form. The dosage of a platinum compound such as carboplatin may be adjusted to a particular patient.
  • the dosage of a platinum compound is determined by calculating the area under the blood plasma concentration versus time curve (AUC) in mg/mL » minute by methods known to those skilled in the cancer chemotherapy art, taking into account the patient' s renal activity estimated by measuring creatinine clearance or glomerular filtration rate.
  • AUC blood plasma concentration versus time curve
  • the dosage of a platinum complex such as carboplatin used in combination with an antimetabolite (e.g., gemcitabine) and 4-iodo-3-nitrobenzamide (or a metabolite thereof or a pharmaceutically acceptable salt thereof) is calculated to provide an AUC of about 0.1-8 mg/ml » min, about 0.1-7 mg/ml » min, about 0.1-6 mg/ml » min, about 1- 6 mg/ml » min, about 1-5 mg/ml » min, about 2-5 mg/ml » min, about 3-6 mg/ml » min, about 3-5 mg/ml » min, about 1-3 mg/ml » min, about 1.5 to about 2.5 mg/ml » min, about 1.75 to about 2.25 mg/ml » min, about 2 mg/ml » min (AUC 2, for example, is shorthand for 2 mg/ml » minute), about AUC 2.5, about AUC 3, about AUC3.5, about AUC 4, about AUC 4.5, about AUC 5, about AUC 5.5, or about
  • the dosage of platinum compound e.g., carboplatin
  • a suitable dose of carboplatin is about 10 to about 400 mg/m 2 , e.g., about 360 mg/m 2.
  • Platinum complexes, such as carboplatin are normally administered intravenously (IV) over a period of about 10 to about 300 minutes, about 30 to about 180 minutes, about 45 to about 120 minutes or about 60 minutes.
  • IV intravenously
  • the term "about” has its normal meaning of approximately. In some embodiments, about means +10% or ⁇ 5%.
  • topoisomerase inhibitors are agents designed to interfere with the action of topoisomerase enzymes (topoisomerase I and II), which are enzymes that control the changes in DNA structure by catalyzing the breaking and rejoining of the phosphodiester backbone of DNA strands during the normal cell cycle. Topoisomerases have become popular targets for cancer chemotherapy treatments. It is thought that topoisomerase inhibitors block the ligation step of the cell cycle, generating single and double stranded breaks that harm the integrity of the genome. Introduction of these breaks subsequently lead to apoptosis and cell death.
  • Topoisomerase inhibitors are often divided according to which type of enzyme it inhibits. Topoisomerase I, the type of topoisomerase most often found in eukaryotes, is targeted by topotecan, irinotecan, lurtotecan and exatecan, each of which is commercially available. Topotecan is available from GlaxoSmithKline under the trade name Hycamtim ® . Irinotecan is available from Pfizer under the trade name Camptosar ® . Lurtotecan may be obtained as a liposomal formulation from Gilead Sciences Inc. Topoisomerase inhibitors may be administered at an effective dose. In some embodiments an effective dose for treatment of a human will be in the range of about 0.01 to about 10 mg/m /day. The treatment may be repeated on a daily, bi-weekly, semi-weekly, weekly, or monthly basis. In some embodiments an effective dose for treatment of a human will be in the range of about 0.01 to about 10 mg/m /
  • a treatment period may be followed by a rest period of from one day to several days, or from one to several weeks.
  • (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and/or (iii) carboplatin and the topoisomerase inhibitor may be dosed on the same day or may be dosed on separate days.
  • topoisomerase poisons which target the topoisomerase-DNA complex
  • topoisomerase inhibitors which disrupt catalytic turnover.
  • Topo II poisons include but are not limited to eukaryotic type II topoisomerase inhibitors (topo II): amsacrine, etoposide, etoposide phosphate, teniposide, amrubicin and doxorubicin. These drugs are anti-cancer therapies.
  • topoisomerase inhibitors include ICRF-193. These inhibitors target the N- terminal ATPase domain of topo II and prevent topo II from turning over.
  • An angiogenesis inhibitor is a substance that inhibits angiogenesis (the growth of new blood vessels). Every solid tumor (in contrast to leukemia) needs to generate blood vessels to keep it alive once it reaches a certain size. Tumors can grow only if they form new blood vessels. Usually, blood vessels are not built elsewhere in an adult body unless tissue repair is actively in process. The angiostatic agent endostatin and related chemicals can suppress the building of blood vessels, preventing the cancer from growing indefinitely. In tests with patients, the tumor became inactive and stayed that way even after the endostatin treatment is finished. The treatment has very few side effects but appears to have very limited selectivity. Other angiostatic agents such as thalidomide and natural plant-based substances are being actively investigated.
  • VEGF vascular endothelial growth factor
  • carboxyamidotriazole TNF-470, CM101, IFN-alpha, IL-12, platelet factor-4, suramin, SU5416, thrombospondin, angiostatic steroids + heparin, cartilage-derived angiogenesis inhibitory factor, matrix metalloproteinase inhibitors, angiostatin, endostatin, 2- methoxyestradiol, tecogalan, thrombospondin, prolactin, ⁇ 3 inhibitors and linomide.
  • Any of the methods provided herein may further comprise Herceptin in treating platinum-sensitive recurrent ovarian cancer (e.g., HER2-positive ovarian cancer).
  • Her-2 overexpression has been found in ovarian carcinomas and HER2 overexpression and amplification is associated with advanced ovarian cancer (AOC) (Hellstrom et al., Cancer Research 61, 2420-2423, March 15, 2001).
  • Herceptin may be used for the adjuvant treatment of HER2-overexpressing ovarian cancers.
  • Herceptin can be used several different ways: as part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel; with docetaxel and carboplatin; or as a single agent following multi-modality anthracycline-based therapy.
  • Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing ovarian cancer.
  • Herceptin as a single agent is approved for treatment of HER2-overexpressing ovarian cancer in patients who have received one or more chemotherapy regimens for metastatic disease.
  • Lapatinib or lapatinib ditosylate is an orally active chemotherapeutic drug treatment for solid tumours such as breast cancer.
  • Lapatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
  • Drugs used in chemotherapy, such as topotecan work in different ways to stop the growth of tumor cells, either by killing the cells or by preventing them from dividing. Giving lapatinib together with topotecan may have enhanced anti-tumor efficacy.
  • Any of the methods provided herein may further comprise a hormone therapy.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administration to the patient an effective amount of: (i) 4-iodo-3- nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, in combination with a hormone therapy.
  • Tamoxifen (marketed as Nolvadex) slows or stops the growth of cancer cells present in the body.
  • Tamoxifen is a type of drug called a selective estrogen-receptor modulator (SERM). It functions as an anti-estrogen. As tamoxifen may have stabilized rapidly advancing recurrent ovarian cancer, its role in the primary treatment of ovarian cancer in combination with cytotoxic chemotherapy should be considered.
  • SERM selective estrogen-receptor modulator
  • Aromatase inhibitors are a class of drugs used in the treatment of ovarian cancer in postmenopausal women that block the aromatase enzyme. Aromatase inhibitors lower the amount of estrogen in post-menopausal women who have hormone-receptor-positive ovarian cancer. With less estrogen in the body, the hormone receptors receive fewer growth signals, and cancer growth can be slowed down or stopped.
  • Aromatase inhibitor medications include Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole). Each is taken by pill once a day, for up to five years. But for women with advanced (metastatic) disease, the medicine is continued as long as it is working well.
  • AIs are categorized into two types: irreversible steroidal inhibitors such as exemestane that form a permanent bond with the aromatase enzyme complex; and nonsteroidal inhibitors (such as anastrozole, letrozole) that inhibit the enzyme by reversible competition.
  • irreversible steroidal inhibitors such as exemestane that form a permanent bond with the aromatase enzyme complex
  • nonsteroidal inhibitors such as anastrozole, letrozole
  • Fulvestrant also known as ICI 182,780, and "Faslodex” is a drug treatment of hormone receptor-positive ovarian cancer in postmenopausal women with disease
  • Estrogen can cause the growth of ovarian epithelial cancer cells.
  • Fulvestrant is an estrogen receptor antagonist with no agonist effects, which works both by down-regulating and by degrading the estrogen receptor. It is administered as a once-monthly injection.
  • Any of the methods provided herein may further comprise an inhibitor targeting a growth factor receptor including but not limited to epidermal growth factor receptor (EGFR) and insulin-like growth factor 1 receptor (IGFIR).
  • EGFR epidermal growth factor receptor
  • IGFIR insulin-like growth factor 1 receptor
  • EGFR is overexpressed in the cells of certain types of human carcinomas including ovarian cancers.
  • EGFR over-expression in ovarian cancer has been associated with poor prognosis.
  • Increased expression of EGFR may contribute to a drug resistant phenotype.
  • EGFR inhibitors include but are not limited to cetuximab, which is a chimeric monoclonal antibody given by intravenous injection for treatment of cancers including but not limited to metastatic colorectal cancer and head and neck cancer.
  • Panitumimab is another example of EGFR inhibitor. It is a humanized monoclonal antibody against EGFR.
  • Panitumimab has been shown to be beneficial and better than supportive care when used alone in patients with advanced colon cancer and is approved by the FDA for this use.
  • IGFIR insulin-like growth factor receptor
  • CP-751871 is a human monoclonal antibody that selectively binds to IGFIR, preventing IGF1 from binding to the receptor and subsequent receptor
  • IGFIR autophosphorylation Inhibition of IGFIR autophosphorylation may result in a reduction in receptor expression on tumor cells that express IGFIR, a reduction in the anti-apoptotic effect of IGF, and inhibition of tumor growth.
  • IGF1R is a receptor tyrosine kinase expressed on most tumor cells and is involved in mitogenesis, angiogenesis, and tumor cell survival.
  • Any of the methods provided herein may further comprise an inhibitor of PI3K pathway and/or an inhibitor of mTOR.
  • Phosphatidylinositol-3-kinase (PI3K) pathway deregulation is a common event in human cancer, either through inactivation of the tumor suppressor phosphatase and tensin homologue deleted from chromosome 10 or activating mutations of pl l0-a. These hotspot mutations result in oncogenic activity of the enzyme and contribute to therapeutic resistance to the anti-HER2 antibody trastuzumab.
  • Akt and mTOR phosphorylation is also frequently detected in ovarian cancer.
  • the PI3K pathway is, therefore, an attractive target for cancer therapy.
  • NVP-BEZ235 a dual inhibitor of the PI3K and the downstream mammalian target of rapamycin (mTOR) has been shown to have antiproliferative and antitumoral activity in cancer cells with both wild-type and mutated pl l0-a (Violeta Serra, et al., Cancer Research 68, 8022-8030, October 1, 2008).
  • Any of the methods provided herein may further comprise an Hsp90 inhibitor.
  • These drugs target heat shock protein 90 (hsp90).
  • Hsp90 is one of a class of chaperone proteins, whose normal job is to help other proteins acquire and maintain the shape required for those proteins to do their jobs. Chaperone proteins work by being in physical contact with other proteins. Hsp90 can also enable cancer cells to survive and even thrive despite genetic defects which would normally cause such cells to die. Thus, blocking the function of HSP90 and related chaperone proteins may cause cancer cells to die, especially if blocking chaperone function is combined with other strategies to block cancer cell survival.
  • any of the methods provided herein may further comprise a tubulin inhibitor.
  • Tubulins are the proteins that form microtubules, which are key components of the cellular cytoskeleton (structural network). Microtubules are necessary for cell division (mitosis), cell structure, transport, signaling and motility. Given their primary role in mitosis, microtubules have been an important target for anticancer drugs— often referred to as antimitotic drugs, tubulin inhibitors and microtubule targeting agents. These compounds bind to tubulin in microtubules and prevent cancer cell proliferation by interfering with the microtubule formation required for cell division. This interference blocks the cell cycle sequence, leading to apoptosis.
  • any of the methods provided herein may further comprise an inhibitor of apoptosis.
  • the inhibitors of apoptosis are a family of functionally- and structurally- related proteins, originally characterized in Baculovirus, which serve as endogenous inhibitors of apoptosis.
  • the human IAP family consists of at least 6 members, and IAP homologs have been identified in numerous organisms.
  • 10058-F4 is a c-Myc inhibitor that induces cell-cycle arrest and apoptosis. It is a cell-permeable thiazolidinone that specifically inhibits the c-Myc-Max interaction and prevents transactivation of c-Myc target gene expression.
  • GNF-2 belongs to a new class of Bcr-abl inhibitors. GNF-2 appears to bind to the myristoyl binding pocket, an allosteric site distant from the active site, stabilizing the inactive form of the kinase. It inhibits Bcr-abl phosphorylation with an IC 50 of 267 nM, but does not inhibit a panel of 63 other kinases, including native c-Abl, and shows complete lack of toxicity towards cells not expressing Bcr- Abl.
  • GNF-2 shows great potential for a new class of inhibitor to study Bcr-abl activity and to treat resistant Chronic myelogenous leukemia (CML), which is caused the Bcr- Abl oncoprotein.
  • Pifithrin-a is a reversible inhibitor of p53-mediated apoptosis and p53- dependent gene transcription such as cyclin G, p21/wafl, and mdm2 expression.
  • Pifithrin-a enhances cell survival after genotoxic stress such as UV irradiation and treatment with cytotoxic compounds including doxorubicin, etopoxide, paclitaxel, and cytosine-P-D- arabinofuranoside.
  • Pifithrin- ⁇ protects mice from lethal whole body ⁇ -irradiation without an increase in cancer incidence.
  • 4-iodo-3-nitrobenzamide is a small molecule that acts on tumor cells without exerting toxic effects in normal cells.
  • 4-iodo-3-nitrobenzamide is very lipophilic and distributes rapidly and widely into tissues, including the brain and cerebrospinal fluid (CSF). It is active against a broad range of cancer cells in vitro, including against drug resistant cell lines.
  • CSF cerebrospinal fluid
  • 4-iodo-3-nitrobenzamide may be administered in any pharmaceutically acceptable form, e.g., as a pharmaceutically acceptable salt, solvate, or complex.
  • 4-iodo-3-nitrobenzamide is capable of tautomerizing in solution
  • the tautomeric form of 4-iodo-3-nitrobenzamide is intended to be embraced by the term BA (or the equivalent 4-iodo-3-nitrobenzamide), along with the salts, solvates or complexes.
  • 4-iodo-3-nitrobenzamide may be administered in combination with a cyclodextrin, such as hydroxypropylbetacyclodextrin.
  • a cyclodextrin such as hydroxypropylbetacyclodextrin.
  • 4-iodo-3-nitrobenzamide may be administered in combination with a cyclodextrin, such as hydroxypropylbetacyclodextrin.
  • other active and inactive agents may be combined with 4- iodo-3-nitrobenzamide; and recitation of 4-iodo-3-nitrobenzamide will, unless otherwise stated, include all pharmaceutically acceptable forms thereof.
  • the dosage of 4-iodo-3-nitrobenzamide is in the range of any one of about 0.1 mg/kg to about 50 mg/kg, about 1 mg/kg to about 100 mg/kg, about 1 mg/kg to about 50 mg/kg, about 1 mg/kg to about 25 mg/kg, about 2 to about 70 mg/kg, about 2 mg/kg to about 50 mg/kg, about 2 mg/kg to about 40 mg/kg, about 3 mg/kg to about 30 mg/kg, about 4 to about 100 mg, about 4 to about 25 mg/kg, about 4 to about 20 mg/kg, about 4 to about 15 mg/kg, about 5 to about 20 mg/kg, about 5 to about 15 mg/kg, about 50 to about 100 mg/kg or about 25 to about 75 mg/kg.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) is administered at about 1 mg/kg, about 2 mg/kg, about 4 mg/kg, about 5 mg/kg, about 5.6 mg/kg, about 6 mg/kg, about
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) is administered at a dose of at least any of about 2 mg/kg, about 4 mg/kg, about 5 mg/kg, about 5.6 mg/kg, about 6 mg/kg, about 7 mg/kg, about
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) may be administered intravenously, e.g., by IV infusion over about 10 to about 300 minutes, about 30 to about 180 minutes, about 45 to about 120 minutes or about 60 minutes (i.e., about 1 hour).
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein 4- iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof is intravenously administered to the patient at about 5 to about 20 mg/kg or about 5 mg/kg to about 15 mg/kg.
  • 4-iodo-3-nitrobenzamide may alternatively be administered orally.
  • the term "about" has its normal meaning of
  • about means +20%, +10%, or +5%.
  • 4-iodo-3-nitrobenzamide is described in United States Patent No. 5,464,871, which is incorporated herein by reference in its entirety.
  • 4-iodo-3-nitrobenzamide may be prepared in concentrations of 10 mg/mL and may be packaged in a convenient form, e.g., in 10 mL vials.
  • BA means 4-iodo-3-nitrobenzamide
  • BNO means 4-iodo-3- nitrosobenzamide
  • BNHOH means 4-iodo-3-hydroxyaminobenzamide.
  • R 1 ; R 2 , R 3 , R 4 , and R5 are, independently selected from the group consisting of hydrogen, hydroxy, amino, nitro, iodo, (Ci -C 6 ) alkyl, (Ci -C 6 ) alkoxy, (C 3 -C 7 ) cycloalkyl, and phenyl, wherein at least two of the five R 1 ; R 2 , R 3 , R 4 , and R 5 substituents are always hydrogen, at least one of the five substituents are always nitro, and at least one substituent positioned adjacent to a nitro is always iodo, and pharmaceutically acceptable salts, solvates, isomers, tautomers, metabolites, analogs, or pro-drugs thereof.
  • R 1 ; R 2 , R , R 4 , and R5 can also be a halide such as chloro, fluoro, or bromo substituents.
  • at least one of the R 1 ; R 2 , R 3 , R ⁇ , and R 5 substituents is always nitro or nitroso and at least one substituent positioned adjacent to the nitro or nitroso is always iodo.
  • the compound of formula la is a compound of formula IA or a metabolite or pharmaceutically acceptable salt, solvate, isomer, or tautomer thereof.
  • the compound of formula la is a compound of formula IA or pharmaceutically acceptable salt, solvate, isomer, or tautomer thereof.
  • 4-iodo-3-nitrobenazmide also known as iniparib or "BA” has the formula:
  • 4-iodo-3-nitrobenzamide may be prepared in concentrations of 10 mg/mL and may be packaged in a convenient form, e.g., in 10 mL vials.
  • 4-iodo-3- nitrobenazmide or a pharmaceutically acceptable salt thereof is administered.
  • a metabolite of 4-iodo-3-nitrobenazmide e.g., BNO
  • pharmaceutically acceptable salt thereof is administered.
  • R 1; R 2 , R 3 , R 4 , and R5 substituent is always a sulfur- containing substituent, and the remaining substituents R 1; R 2 , R 3 , R 4 , and R5 are
  • R 1; R 2 , R 3 , R 4 , and R5 substituents are always hydrogen; or (2) at least one of R 1; R 2 , R 3 , R 4 , and R5 substituents is not a sulfur-containing substituent and at least one of the five substituents R 1; R 2 , R 3 , R4, and R 5 is always iodo, and wherein said iodo is always adjacent to a R 1; R 2 , R 3 , R4, or R 5 group that is either a nitro, a nitroso, a
  • the compounds of (2) are such that the iodo group is always adjacent to a R 1; R 2 , R 3 , R* or R 5 group that is a nitroso, hydroxyamino, hydroxy or amino group. In some embodiments, the compounds of (2) are such that the iodo group is always adjacent to a R 1; R 2 , R 3 , R4 or R5 group that is a nitroso, hydroxyamino, or amino group.
  • any of the compounds with structure formula la or Ila may be used for the treatment of platinum-sensitive recurrent ovarian cancer.
  • an effective amount of a compound with structure formula la or Ila in combination with gemcitabine and carboplatin is administered to a patient with platinum-sensitive recurrent ovarian cancer.
  • the compound with structure formula la or Ila is 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof.
  • R 6 is selected from the group consisting of hydrogen, alkyl (C r C 8 ), alkoxy (C r C 8 ), isoquinolinones, indoles, thiazole, oxazole, oxadiazole, thiophene, or phenyl.
  • IABA 4-iodo-3-aminobenzoic acid
  • 4-iodo-3-aminobenzamide examples include, for example, 4-iodo-3-aminobenzoic acid (“IABA”), 4-iodo-3-aminobenzamide
  • 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof is administered.
  • 4-iodo-3-nitrobenzamide or a pharmaceutically acceptable salt thereof is administered.
  • a metabolite of 4-iodo-3- nitrobenzamide is administered.
  • the metabolite of 4-iodo-3- nitrobenzamide is 4-iodo-3-aminobenzoic acid or 4-iodo-3-aminobenzamide.
  • nitrobenzamide metabolite compounds have selective cytotoxicity upon malignant cancer cells but not upon non-malignant cancer cells. See Rice et at., Proc. Natl. Acad. Sci. USA 89:7703-7707 (1992), incorporated herein in it entirety.
  • the nitrobenzamide metabolite compounds utilized in the methods of the present invention may exhibit more selective toxicity towards tumor cells than non-tumor cells.
  • the metabolites according to the invention may thus be administered to a patient in need of such treatment in conjunction with chemotherapy with at least one an antimetabolite (e.g., gemcitabine) in addition to the at least one platinum complex (e.g., carboplatin, cisplatin, etc.)
  • the dosage range for any of the metabolites described herein used for treating platinum-sensitive recurrent ovarian cancer may be in the range of about 0.0004 to about 0.5 mmol/kg (millimoles of metabolite per kilogram of patient body weight), which dosage corresponds, on a molar basis, to a range of about 0.1 to about 100 mg/kg of 4-iodo-3- nitrobenzamide.
  • Other effective ranges of dosages for metabolites are 0.0024-0.5 mmol/kg and 0.0048-0.25 mmol/kg.
  • Such doses may be administered on a daily, every-other-daily, twice-weekly, weekly, bi-weekly, monthly or other suitable schedule.
  • Essentially the same modes of administration may be employed for the metabolites as for 4-iodo-3- nitrobenzamide— e.g., oral, i.v., i.p., etc.
  • 4-iodo-3-nitrobenzamide or a pharmaceutically acceptable salt thereof is administered.
  • a metabolite of 4-iodo-3-nitrobenzamide or a pharmaceutically acceptable salt of a metabolite of 4-iodo-3-nitrobenzamide is administered.
  • pharmaceutically acceptable salt means those salts which retain the biological effectiveness and properties of the compounds used herein, and which are not biologically or otherwise undesirable. For example, a pharmaceutically acceptable salt does not interfere with the beneficial effect of the compound described herein in treating platinum- sensitive recurrent ovarian cancer.
  • Typical salts are those of the inorganic ions, such as, for example, sodium, potassium, calcium and magnesium ions.
  • Such salts include salts with inorganic or organic acids, such as hydrochloric acid, hydrobromic acid, phosphoric acid, nitric acid, sulfuric acid, methanesulfonic acid, p-toluenesulfonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, mandelic acid, malic acid, citric acid, tartaric acid or maleic acid.
  • suitable bases include sodium hydroxide, potassium hydroxide, ammonia, cyclohexylamine, dicyclohexyl-amine, ethanolamine, diethanolamine and triethanolamine.
  • 4-iodo-3-nitrobenzamide is formulated in 25% (w/v) hydroxypropyl- ⁇ - cyclodextrin and 10 mM phosphate buffer for intravenous administration as described in U.S. Patent Application Publication No. 2010/0160442, which is incorporated herein by reference.
  • Any of the methods described herein may further comprise another anti-cancer therapy including but not limited to surgery, radiation therapy (e.g. , X rays), gene therapy, DNA therapy, adjuvant therapy, neoadjuvant therapy, viral therapy, immunotherapy, RNA therapy, or nanotherapy.
  • radiation therapy e.g. , X rays
  • gene therapy e.g. , DNA therapy, adjuvant therapy, neoadjuvant therapy, viral therapy, immunotherapy, RNA therapy, or nanotherapy.
  • the non- drug treatment may be conducted at any suitable time so long as a beneficial effect from the co-action of the combination of the therapeutic agents and non-drug treatment is achieved. For example, in appropriate cases, the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, by a significant period of time.
  • the conjugate and the other pharmacologically active agent may be administered to a patient simultaneously, sequentially or in combination. It will be appreciated that when using a combination of the invention, the compound of the invention and the other pharmacologically active agent may be in the same pharmaceutically acceptable carrier and therefore administered simultaneously. They may be in separate pharmaceutical carriers such as conventional oral dosage forms which are taken simultaneously.
  • the term "combination" further refers to the case where the compounds are provided in separate dosage forms and are administered sequentially.
  • Radiotherapy is the medical use of ionizing radiation as part of cancer treatment to control malignant cells. Radiotherapy may be used for curative or adjuvant cancer treatment. It is used as palliative treatment (where cure is not possible and the aim is for local disease control or symptomatic relief) or as therapeutic treatment (where the therapy has survival benefit and it can be curative). Radiotherapy is used for the treatment of malignant tumors and may be used as the primary therapy. It is also common to combine radiotherapy with surgery, chemotherapy, hormone therapy or some mixture of the three. Most common cancer types can be treated with radiotherapy in some way. The precise treatment intent (curative, adjuvant, neoadjuvant, therapeutic, or palliative) will depend on the tumour type, location, and stage, as well as the general health of the patient.
  • Radiation therapy is commonly applied to the cancerous tumor.
  • the radiation fields may also include the draining lymph nodes if they are clinically or radiologically involved with tumor, or if there is thought to be a risk of subclinical malignant spread. It is necessary to include a margin of normal tissue around the tumor to allow for uncertainties in daily set-up and internal tumor motion.
  • Radiation therapy works by damaging the DNA of cells.
  • the damage is caused by a photon, electron, proton, neutron, or ion beam directly or indirectly ionizing the atoms which make up the DNA chain. Indirect ionization happens as a result of the ionization of water, forming free radicals, notably hydroxyl radicals, which then damage the DNA.
  • free radicals notably hydroxyl radicals
  • most of the radiation effect is through free radicals.
  • cells have mechanisms for repairing DNA damage, breaking the DNA on both strands proves to be the most significant technique in modifying cell characteristics.
  • cancer cells generally are undifferentiated and stem cell-like, they reproduce more, and have a diminished ability to repair sub-lethal damage compared to most healthy differentiated cells.
  • the DNA damage is inherited through cell division, accumulating damage to the cancer cells, causing them to die or reproduce more slowly.
  • Proton radiotherapy works by sending protons with varying kinetic energy to precisely stop at the tumor.
  • Gamma rays may be used to treat any of the ovarian cancers described herein.
  • multiple concentrated beams of gamma rays are directed on the growth in order to kill the cancerous cells.
  • the beams are aimed from different angles to focus the radiation on the growth while minimizing damage to the surrounding tissues.
  • Radiosensitizers are known to increase the sensitivity of cancerous cells to the toxic effects of electromagnetic radiation. Many cancer treatment protocols currently employ radiosensitizers activated by the electromagnetic radiation of x-rays. Examples of x-ray activated radiosensitizers include, but are not limited to, the following: metronidazole, misonidazole, desmethylmisonidazole, pimonidazole, etanidazole, nimorazole, mitomycin C, RSU 1069, SR 4233, E09, RB 6145, nicotinamide, 5-bromodeoxyuridine (BUdR), 5- iododeoxyuridine (IUdR), bromodeoxycytidine, fluorodeoxyuridine (FudR), hydroxyurea, cisplatin, and therapeutically effective analogs and derivatives of the same.
  • metronidazole misonidazole
  • desmethylmisonidazole pimonidazole
  • Photodynamic therapy (PDT) of cancers employs visible light as the radiation activator of the sensitizing agent.
  • photodynamic radiosensitizers include the following, but are not limited to: hematoporphyrin derivatives, photofrin, benzoporphyrin derivatives, NPe6, tin etioporphyrin SnET2, pheoborbide-alpha, bacteriochlorophyll-alpha, naphthalocyanines, phthalocyanines, zinc phthalocyanine, and therapeutically effective analogs and derivatives of the same.
  • Gene therapy agents insert copies of genes into a specific set of a patient' s cells, and can target both cancer and non-cancer cells.
  • the goal of gene therapy can be to replace altered genes with functional genes, to stimulate a patient's immune response to cancer, to make cancer cells more sensitive to chemotherapy, to place "suicide" genes into cancer cells, or to inhibit angiogenesis.
  • Genes may be delivered to target cells using viruses, liposomes, or other carriers or vectors. This may be done by injecting the gene-carrier composition into the patient directly, or ex vivo, with infected cells being introduced back into a patient. Such compositions are suitable for use in the present invention.
  • Adjuvant therapy includes a treatment given after the primary treatment to increase the chances of a cure.
  • Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.
  • the method further comprises administering granulocyte colony- stimulating factor ("G- CSF"). In some embodiments, the method does not further comprise administering G-CSF.
  • G- CSF granulocyte colony- stimulating factor
  • adjuvant therapy Because the principal purpose of adjuvant therapy is to kill any cancer cells that may have spread, treatment is usually systemic (uses substances that travel through the bloodstream, reaching and affecting cancer cells all over the body). For example, adjuvant therapy for ovarian cancer involves chemotherapy or hormone therapy, either alone or in combination.
  • Adjuvant chemotherapy is the use of drugs to kill cancer cells.
  • Adjuvant chemotherapy is usually a combination of anticancer drugs, which has been shown to be more effective than a single anticancer drug.
  • Radiation therapy is sometimes used as a local adjuvant treatment. Radiation therapy is considered adjuvant treatment when it is given before or after surgical treatment, e.g., a mastectomy. Such treatment is intended to destroy cancer cells that have spread to nearby parts of the body, such as the chest wall or lymph nodes.
  • Various therapies including but not limited to hormone therapy, e.g., tamoxifen, or gonadotropin-releasing hormone (GnRH) analogues, and radioactive monoclonal antibody therapy have been used to treat ovarian cancer.
  • hormone therapy e.g., tamoxifen, or gonadotropin-releasing hormone (GnRH) analogues
  • GnRH gonadotropin-releasing hormone
  • radioactive monoclonal antibody therapy have been used to treat ovarian cancer.
  • Neoadjuvant therapy refers to a treatment given before the primary treatment.
  • examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy.
  • Neoadjuvant chemotherapy in gynecological cancers is an approach that is shown to have positive effects on survival. It increases the rate of resectability in ovarian and cervical cancers and thus contributes to survival (Ayhan A. et. al. European journal of gynaecological oncology. 2006, vol. 27).
  • Viral therapy for cancer utilizes a type of viruses called oncolytic viruses.
  • An oncolytic virus is a virus that is able to infect and lyse cancer cells, while leaving normal cells unharmed, making them potentially useful in cancer therapy. Replication of oncolytic viruses both facilitates tumor cell destruction and also produces dose amplification at the tumor site. They may also act as vectors for anticancer genes, allowing them to be specifically delivered to the tumor site.
  • Transductional targeting involves modifying the specificity of viral coat protein, thus increasing entry into target cells while reducing entry to non-target cells.
  • Non-transductional targeting involves altering the genome of the virus so it can only replicate in cancer cells. This can be done by either transcription targeting, where genes essential for viral replication are placed under the control of a tumor- specific promoter, or by attenuation, which involves introducing deletions into the viral genome that eliminate functions that are dispensable in cancer cells, but not in normal cells. There are also other, slightly more obscure methods.
  • Viral agents administered intravenously can be particularly effective against metastatic cancers, which are especially difficult to treat conventionally.
  • bloodborne viruses can be deactivated by antibodies and cleared from the blood stream quickly e.g., by Kupffer cells (extremely active phagocytic cells in the liver, which are responsible for adenovirus clearance). Avoidance of the immune system until the tumour is destroyed could be the biggest obstacle to the success of oncolytic virus therapy. To date, no technique used to evade the immune system is entirely satisfactory. It is in conjunction with conventional cancer therapies that oncolytic viruses show the most promise, since combined therapies operate synergistically with no apparent negative effects.
  • oncolytic viruses have the potential to treat a wide range of cancers including ovarian cancer with minimal side effects.
  • Oncolytic viruses have the potential to solve the problem of selectively killing cancer cells.
  • Nanometer- sized particles have novel optical, electronic, and structural properties that are not available from either individual molecules or bulk solids. When linked with tumor-targeting moieties, such as tumor-specific ligands or monoclonal antibodies, these nanoparticles can be used to target cancer- specific receptors, tumor antigens (biomarkers), and tumor vasculatures with high affinity and precision.
  • tumor-targeting moieties such as tumor-specific ligands or monoclonal antibodies
  • these nanoparticles can be used to target cancer- specific receptors, tumor antigens (biomarkers), and tumor vasculatures with high affinity and precision.
  • the formulation and manufacturing process for cancer nanotherapy is disclosed in patent US7179484, and article M. N. Khalid, P. Simard, D. Hoarau, A. Dragomir, J. Leroux, Long Circulating Poly(Ethylene
  • RNA including but not limited to siRNA, shRNA, microRNA may be used to modulate gene expression and treat cancers.
  • Double stranded oligonucleotides are formed by the assembly of two distinct oligonucleotide sequences where the oligonucleotide sequence of one strand is complementary to the oligonucleotide sequence of the second strand; such double stranded oligonucleotides are generally assembled from two separate oligonucleotides (e.g., siRNA), or from a single molecule that folds on itself to form a double stranded structure (e.g., shRNA or short hairpin RNA).
  • each strand of the duplex has a distinct nucleotide sequence, wherein only one nucleotide sequence region (guide sequence or the antisense sequence) has complementarity to a target nucleic acid sequence and the other strand (sense sequence) comprises nucleotide sequence that is homologous to the target nucleic acid sequence.
  • MicroRNAs are single- stranded RNA molecules of about 21-23 nucleotides in length, which regulate gene expression. miRNAs are encoded by genes that are transcribed from DNA but not translated into protein (non-coding RNA); instead they are processed from primary transcripts known as pri-miRNA to short stem-loop structures called pre-miRNA and finally to functional miRNA. Mature miRNA molecules are partially complementary to one or more messenger RNA (mRNA) molecules, and their main function is to downregulate gene expression.
  • mRNA messenger RNA
  • RNA inhibiting agents may be utilized to inhibit the expression or translation of messenger RNA (“mRNA”) that is associated with a cancer phenotype.
  • mRNA messenger RNA
  • RNA inhibiting agents suitable for use herein include, but are not limited to, Cand5, Sirna- 027, fomivirsen, and angiozyme.
  • Certain small molecule therapeutic agents are able to target the tyrosine kinase enzymatic activity or downstream signal transduction signals of certain cell receptors such as epidermal growth factor receptor ("EGFR") or vascular endothelial growth factor receptor (“VEGFR”). Such targeting by small molecule therapeutics can result in anti-cancer effects.
  • EGFR epidermal growth factor receptor
  • VEGFR vascular endothelial growth factor receptor
  • agents suitable for use herein include, but are not limited to, imatinib, gefitinib, erlotinib, lapatinib, canertinib, ZD6474, sorafenib (BAY 43-9006), ERB-569, and their analogues and derivatives.
  • cancer metastasis The process whereby cancer cells spread from the site of the original tumor to other locations around the body is termed cancer metastasis.
  • Certain agents have anti- metastatic properties, designed to inhibit the spread of cancer cells. Examples of such agents suitable for use herein include, but are not limited to, marimastat, bevacizumab, trastuzumab, rituximab, erlotinib, MMI- 166, GRN163L, hunter-killer peptides, tissue inhibitors of metalloproteinases (TIMPs), their analogues, derivatives and variants.
  • marimastat marimastat
  • bevacizumab trastuzumab
  • rituximab rituximab
  • erlotinib MMI- 166
  • GRN163L hunter-killer peptides
  • TRIPs tissue inhibitors of metalloproteinases
  • Certain pharmaceutical agents such as chemopreventative agents may be used in combination with any of the methods provided herein. These agents can be used to prevent initial occurrences of cancer, or to prevent recurrence or metastasis. Administration with such chemopreventative agents in combination with any one of the treatments described herein can act to both treat and prevent the recurrence of cancer. Examples of
  • chemopreventative agents suitable for use herein include, but are not limited to, tamoxifen, raloxifene, tibolone, bisphosphonate, ibandronate, estrogen receptor modulators, aromatase inhibitors (letrozole, anastrozole), luteinizing hormone-releasing hormone agonists, goserelin, vitamin A, retinal, retinoic acid, fenretinide, 9-cis-retinoid acid, 13-cis-retinoid acid, all-trans- retinoic acid, isotretinoin, tretinoid, vitamin B6, vitamin B 12, vitamin C, vitamin D, vitamin E, cyclooxygenase inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, ibuprofen, celecoxib, polyphenols, polyphenol E, green tea extract, folic acid, glucaric acid, interferon-alpha, anethole dithiolethione, zinc, pyr
  • chemopreventative agents suitable for use in the present invention is cancer vaccines. These can be created through immunizing a patient with all or part of a cancer cell type that is targeted by the vaccination process.
  • Clinical efficacy may be measured by any of the methods known in the art.
  • clinical efficacy of the therapeutic treatments described herein may be determined by measuring the clinical benefit rate (CBR).
  • CBR clinical benefit rate
  • the clinical benefit rate is measured by determining the sum of the percentage of patients who are in complete remission (CR), the number of patients who are in partial remission (PR) and the number of patients having stable disease (SD) at a time point at least 6 months out from the end of therapy.
  • an antimetabolite e.g. , gemcitabine
  • a platinum compound e.g.
  • CBR G EM/CARBO/BA 4-iodo-3-nitrobenzamide
  • an antimetabolite e.g. , gemcitabine
  • a platinum compound e.g., carboplatin
  • CBR G EM/CARBO is at least about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80% or more. In some embodiments, the CBR is at least about 30%, at least about 40%, or at least about 50%.
  • At least one therapeutic effect is obtained, said at least one therapeutic effect being reduction in size of an ovarian tumor, reduction in metastasis, complete remission, partial remission, pathologic partial response, pathologic complete response, increase in overall response rate or objective response rate, or stable disease.
  • the improvement of clinical benefit rate is at least about any of 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 95%.
  • the administration of 4-iodo-3-nitrobenzamide (or a metabolite thereof or a pharmaceutically acceptable salt thereof) in combination with gemcitabine and carboplatin results in a complete response, partial response, or stable disease.
  • the patient has measurable disease.
  • Measurable disease may be determined by RECIST version 1.1 criteria, which is described in Eisenhauer EA et al. 2009, Eur J Cancer., 45(2):228-47, the disclosure of which is incorporated by reference in its entirety.
  • Measurable disease may also be defined by at least one lesion that can be accurately measured in at least one dimension (longest dimension to be recorded), and is > 20 mm when measured by conventional techniques (palpation, plain x-ray, computed tomography (CT), or magnetic resonance imaging (MRI)) or > 10 mm when measured by spiral CT.
  • CT computed tomography
  • MRI magnetic resonance imaging
  • Response rates may be determined according to RECIST version 1.1 criteria.
  • complete response may be defined as disappearance of all target lesions; any pathological lymph nodes (whether target or nontarget) must have reduction in short axis to ⁇ 10 mm.
  • partial response may be defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters (baseline sum diameters may be a sum of the diameters (longest for non-nodal lesions, short axis for nodal lesions) for all target lesions).
  • progressive disease may be defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum may also demonstrate an absolute increase of at least 5 mm.
  • stable disease may be defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD (taking as reference the smallest sum diameters while on study).
  • non-target lesion CR may be disappearance of all non-target lesions and normalization of tumour marker level (all lymph nodes may be non-pathological in size ( ⁇ 10mm short axis)).
  • non-CR/non-PD may be persistence of one or more non-target lesion(s) and/or maintenance of tumour marker level above the normal limits.
  • progressive disease PD
  • PD may be unequivocal progression of existing non-target lesions. The appearance of one or more new lesions may be considered progression.
  • Overall response may be determined according to Eisenhauer EA et al. 2009, Eur J Cancer., 45(2):228-47 such as Tables 1-3, the disclosure of which is incorporated by reference in its entirety.
  • Efficacy parameters may be determined by any of methods known to one skilled in the art. For example, they may be determined according to RECIST version 1.1 criteria.
  • Progression-free survival may be defined as the time from the date of starting treatment (or date of initiation of study treatment or date of randomization) until the date of first observation of disease progression or the date of death.
  • Overall survival may be defined as the time from the date of starting treatment (or date of initiation of study treatment or date of randomization) until the date of death.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) an antimetabolite such as gemcitabine; and (iii) a platinum compound such as carboplatin, wherein the treatment results in reduction in size of an ovarian tumor in the patient.
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in reduction in metastasis of ovarian cancer in the patient.
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4- iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in complete response in the patient.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in pathological complete response in the patient.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in partial response in the patient.
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4- iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in stable disease in the patient.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in reduction in metastasis of ovarian cancer in the patient.
  • metastasis is inhibited (e.g., compared to metastasis before the administration of (i) 4- iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin).
  • any of the methods is used to inhibit metastasis to lymph node.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein the treatment results in reduction in size of an ovarian tumor in the patient.
  • the tumor size is reduced by at least about 10% (including for example at least about any of 20%, 30%, 40%, 60%, 70%, 80%, 90%, or 100%) (e.g. , compared to tumor size before the administration of (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin).
  • the administration of 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof, the administration of gemcitabine, and/or the administration of carboplatin have a synergistic effect.
  • a lower amount of each pharmaceutically active compound is used as part of a combination therapy compared to the amount generally used for individual therapy.
  • the same or greater therapeutic benefit is achieved using a combination therapy than by using any of the individual compounds alone.
  • the same or greater therapeutic benefit is achieved using a smaller amount (e.g. , a lower dose or a less frequent dosing schedule) of a pharmaceutically active compound in a combination therapy than the amount generally used for individual therapy.
  • the use of a small amount of pharmaceutically active compound may result in a reduction in the number, severity, frequency, or duration of one or more side-effects associated with the compound.
  • formulations e.g., pharmaceutical formulations
  • 4-iodo-3-nitrobenzamide or a metabolite thereof, or a
  • the formulations may include optical isomers, diastereomers, carriers, or pharmaceutically acceptable salts of the compounds disclosed herein.
  • the carrier is a cyclodextrin, or a derivative thereof, e.g., hydroxypropyl-B-cyclodextrin (HPBCD).
  • the formulations are formulated for intravenous
  • compositions of the present invention may be provided as a prodrug and/or may be allowed to interconvert to 4-iodo-3-nitrobenzamide form in vivo after administration. That is, either 4-iodo-3-nitrobenzamide or metabolites thereof or
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof), an antimetabolite (e.g. , gemcitabine) and a platinum compound (e.g. , carboplatin) provided herein may be formulated in separate formulations or in the same formulation.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof), an antimetabolite (e.g., gemcitabine) and a platinum compound (e.g. , carboplatin) provided herein may be administered through different administration route or using same administration routes.
  • synergistic compositions used for treating platinum- sensitive recurrent ovarian cancer in a patient comprising (i) 4-iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt thereof, (ii) gemcitabine, and (iii) carboplatin.
  • a formulation may comprise both the 4-iodo-3-nitrobenzamide compound and acid forms in particular proportions, depending on the relative potencies of each and the intended indication.
  • the two forms may be formulated together or in different formulations. They may be in the same dosage unit e.g. in one cream, suppository, tablet, capsule, or packet of powder to be dissolved in a beverage; or each form may be formulated in a separate unit, e.g., two creams, two suppositories, two tablets, two capsules, a tablet and a liquid for dissolving the tablet, a packet of powder and a liquid for dissolving the powder, etc.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof), an antimetabolite (e.g., gemcitabine) and a platinum compound (e.g., carboplatin) provided herein may be coadministered to the patient.
  • Co-administration is meant to include simultaneous or sequential administration of the compounds individually or in combination (more than one compound), such as described herein.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof), an antimetabolite (e.g., gemcitabine) and a platinum compound (e.g., carboplatin) provided herein may be coadministered to the patient.
  • Co-administration is meant to include simultaneous or sequential administration of the compounds individually or in combination (more than one compound), such as described herein.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof), an antimetabolite (e.g., gemcitabine) and a platinum compound (e.g., carboplatin) provided herein
  • antimetabolite e.g. , gemcitabine
  • a platinum compound e.g. , carboplatin
  • “Not continuously” means that the compound or composition provided herein is not administered to the patient over a period of time, e.g., there is a resting period when the patient does not receive the compound or composition. It may be that one compound is administered continuously administered to a patient while the second compound is not administered continuously administered to the patient.
  • antimetabolite e.g. , gemcitabine
  • a platinum compound e.g., carboplatin
  • the three compounds and/or forms of a compound may be formulated together, in the same dosage unit e.g., in one cream, suppository, tablet, capsule, or packet of powder to be dissolved in a beverage; or each form may be formulated in separate units, e.g., three creams, three suppositories, three tablets, three capsules, a tablet and a liquid for dissolving the tablet, a packet of powder and a liquid for dissolving the powder, etc.
  • pharmaceutically acceptable salt means those salts which retain the biological effectiveness and properties of the compounds used in the present invention, and which are not biologically or otherwise undesirable.
  • a pharmaceutically acceptable salt does not interfere with the beneficial effect of a compound provided herein in treating platinum-sensitive recurrent ovarian cancer.
  • Typical salts are those of the inorganic ions, such as, for example, sodium, potassium, calcium and magnesium ions.
  • Such salts include salts with inorganic or organic acids, such as hydrochloric acid, hydrobromic acid, phosphoric acid, nitric acid, sulfuric acid, methanesulfonic acid, p toluenesulfonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, mandelic acid, malic acid, citric acid, tartaric acid or maleic acid.
  • suitable bases include sodium hydroxide, potassium hydroxide, ammonia, cyclohexylamine, dicyclohexyl-amine, ethanolamine, diethanolamine and triethanolamine.
  • compositions may be formulated for administration in aqueous solutions, preferably in physiologically compatible buffers such as phosphate buffers, Hank's solution, or Ringer's solution.
  • physiologically compatible buffers such as phosphate buffers, Hank's solution, or Ringer's solution.
  • Such compositions may also include one or more excipients, for example, preservatives, solubilizers, fillers, lubricants, stabilizers, albumin, and the like.
  • Formulations of 4-iodo-3-nitrobenzamide are described in US Pat. Publ. No. 2008/0176946 Al, which is incorporated by reference in its entirety, particularly with reference to intravenous (e.g., hydroxypropyl-P-cyclodextrin, etc.) and oral (e.g., sodium lauryl sulfate, etc.) formulations.
  • 4-iodo-3-nitrobenzamide is formulated in 25% (w/v) hydroxypropyl-P-cyclodext
  • the formulation has 10 mg/mL 4- iodo-3-nitrobenzamide, 25% (w/v) hydroxypropyl-P-cyclodextrin, and 10 mM phosphate buffer, pH 7.4.
  • compositions described herein may also be formulated for transmucosal administration, buccal administration, for administration by inhalation, for parental administration, for transdermal administration, and rectal administration.
  • compositions suitable for use as described herein include compositions wherein the active ingredients are present in an effective amount, i.e., in an amount effective to achieve therapeutic and/or prophylactic benefit in at least one of the platinum-sensitive ovarian cancers ⁇ e.g., recurrent ovarian cancer) described herein.
  • the actual amount effective for a particular administration will depend on the platinum-sensitive recurrent ovarian cancer ⁇ e.g., recurrent ovarian cancer) being treated, the condition of the subject, the formulation, and the route of administration, as well as other factors known to those of skill in the art in view of the specific teaching provided herein.
  • optimization of an effective amount of 4-iodo-3-nitrobenzamide, antimetabolite ⁇ e.g., gemcitabine), and/or platinum compound ⁇ e.g., carboplatin) provided herein, within the ranges specified, may be determined.
  • the composition or formulation is administered in unit dosage form.
  • the unit dosage form is adapted for oral or parenteral administration.
  • at least one therapeutic effect is obtained, said at least one therapeutic effect being reduction in size of a tumor, reduction in metastasis, complete remission, partial remission, pathologic complete response, increase in overall response rate, or stable disease.
  • the improvement of clinical benefit rate is at least about 20%.
  • the improvement of clinical benefit rate is at least about any of 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75% or more.
  • the amount of 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof, the amount of gemcitabine, and/or the amount of carboplatin is an amount sufficient to decrease the size of a tumor, decrease the number of cancer cells, or decrease the growth rate of a tumor (including decrease in metastasis) by at least about any of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95% or 100% compared to the corresponding tumor size, number of cancer cells, or tumor growth rate in the same patient at the time of starting treatment or compared to the corresponding activity in other patients not receiving the treatment. Standard methods can be used to measure the magnitude of this effect.
  • the amount of 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof, the amount of gemcitabine, and/or the amount of carboplatin is below the level that induces a toxicological effect (e.g. , an effect above a clinically acceptable level of toxicity) or is at a level where a potential side effect can be controlled or tolerated.
  • the amount of 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof, the amount of gemcitabine, and/or the amount of carboplatin is close to a maximum tolerated dose (MTD). In some embodiments, the amount is at least about any of 80%, 90%, 95%, or 98% of the MTD.
  • compositions or compounds described herein may be administered to a patient through appropriate route, such as, but are not limited to intradermal, intramuscular, intraperitoneal, intravenous, intraarterial, subcutaneous, intranasal, epidural, and oral routes.
  • the composition or compound(s) provided herein is administered by the parenteral route, e.g., intravenously, intraperitoneally, subcutaneously, intradermally, or intramuscularly.
  • compositions or compounds described herein may be administered by any convenient route, for example by infusion or bolus injection, by absorption through epithelial or mucocutaneous linings (e.g., oral mucosa, rectal and intestinal mucosa, etc.) and may be administered in combination with other biologically active agents, e.g., such as described herein. Administration can be systemic or local.
  • the dosage of 4-iodo-3-nitrobenzamide is in the range of any one of about 0.1 mg/kg to about 50 mg/kg, about 1 mg/kg to about 100 mg/kg, 2 mg/kg to about 50 mg/kg, about 2 mg/kg to about 10 mg/kg, about 4 mg/kg to about 8 mg/kg, about 5 mg/kg to about 7 mg/kg, about 1 mg/kg to about 50 mg/kg, about 1 mg/kg to about 25 mg/kg, about 2 to about 70 mg/kg, about 2 mg/kg to about 50 mg/kg, about 2 mg/kg to about 40 mg/kg, about 3 mg/kg to about 30 mg/kg, about 4 to about 100 mg/kg, about 4 to about 25 mg/kg, about 4 to about 20 mg/kg, about 4 to about 15 mg/kg, about 5 to about 20 mg/kg,
  • the dosage of 4-iodo-3-nitrobenzamide is about any of 1 mg/kg, 2 mg/kg, 3 mg/kg, 4 mg/kg, 5 mg/kg, 5.6 mg/kg, 6 mg/kg, 7 mg/kg, 8 mg/kg, 9 mg/kg, 10 mg/kg, 11 mg/kg, 11.2 mg/kg, 12.5 mg/kg, 15 mg/kg, 20 mg/kg, 30 mg/kg, 50 mg/kg, 75 mg/kg, or 100 mg/kg.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) is administered at a dose of at least any of about lmg/kg, 2 mg/kg, about 4 mg/kg, about 5 mg/kg, about 5.6 mg/kg, about 6 mg/kg, about 7 mg/kg, about 8 mg/kg, about 9 mg/kg, about 10 mg/kg, about 11 mg/kg, about 11.2 mg/kg, about 12 mg/kg, about 13 mg/kg, about 14 mg/kg, about 15 mg/kg, about 16 mg/kg, about 17 mg/kg, about 18 mg/kg, about 19 mg/kg, about 20 mg/kg, about 25 mg/kg, about 30 mg/kg, about 35 mg/kg, about 40 mg/kg, about 50 mg/kg, about 60 mg/kg, about 75 mg/kg, or about 90 mg/kg.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) may be administered intravenously, e.g., by IV infusion over about 10 to about 300 minutes, about 30 to about 180 minutes, about 45 to about 120 minutes or about 60 minutes (i.e., about 1 hour).
  • 4-iodo-3-nitrobenzamide or its metabolite or its pharmaceutically acceptable salt thereof may be administered weekly, twice every week, once every three weeks, twice every three weeks, three times out of four weeks, four times out of three weeks, four times out of five weeks, or five times out of six weeks.
  • 4-iodo-3- nitrobenzamide or its metabolite or its pharmaceutically acceptable salt thereof may be administered on 2 days or 4 days of a treatment cycle, e.g., on days 1 and 8 (with the dosage of about 11.2 mg/kg) or days 1, 4, 8, and 11 (with the dosage of about 5.6 mg/kg) of a 21-day treatment cycle.
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising administering to the patient an effective amount of: (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin, wherein 4-iodo-3- nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof is intravenously administered to the patient at about 5 to about 20 mg/kg or about 5 mg/kg to about 15 mg/kg.
  • 4-iodo-3-nitrobenzamide may alternatively be administered orally.
  • the dosage of an antimetabolite provided herein may vary depending upon the patient's age, height, weight, overall health, etc. In some embodiments, the dosage of the antimetabolite
  • a gemcitabine e.g., gemcitabine
  • the antimetabolite e.g., gemcitabine
  • An antimetabolite e.g., gemcitabine
  • 2 2 2 may be administered at a dose of at least about any of 50 mg/m", 75 mg/m", 100 mg/m", 125 mg/m 2 , 150 mg/m 2 , 175 mg/m 2 , 200 mg/m 2 , 250 mg/m 2 , 300 mg/m 2 , 400 mg/m 2 , 450 mg/m 2 , 500 mg/m 2 , 550 mg/m 2 , 600 mg/m 2 , 650 mg/m 2 , 700 mg/m 2 , 750 mg/m 2 , 800 mg/m 2 , 850 mg/m 2 , 900 mg/m 2 , 1000 mg/m 2 , 1050 mg/m 2 , 1100 mg/m 2 , 1150 mg/m 2 , 1200 mg/m 2 , 1250 mg/m 2 , 1300 mg/m 2 , 1350 mg/m 2 , 1400 mg/m 2 , 1450 mg/m 2 , 1500 mg/m 2 , 1550 mg/m 2 , 1600 mg
  • An antimetabolite provided herein may be administered weekly, once every three weeks, twice every week, twice every three weeks, three times out of four weeks, four times out of three weeks, four times out of five weeks, or five times out of six weeks.
  • an antimetabolite provided herein e.g., gemcitabine
  • An antimetabolite e.g., gemcitabine
  • An antimetabolite may be administered intravenously, e.g., by IV infusion over about 10 to about 500 minutes, about 10 to about 300 minutes, about 15 to about 180 minutes, about 30 to about 180 minutes, about 30 to about 60 minutes, about 45 to about 120 minutes, about 20 to about 60 minutes, about 10 minutes, about 20 minutes, about 30 minutes, about 60 minutes (i.e. about 1 hour) or about 30 minutes.
  • An antimetabolite e.g., gemcitabine
  • the dosage of a platinum compound provided herein may vary depending upon the patient' s age, height, weight, overall health, etc.
  • the dosage of a platinum compound, e.g., carboplatin is determined by calculating the area under the blood plasma concentration versus time curve (AUC) in mg/mL » minute by methods known to those skilled in the cancer chemotherapy art, taking into account the patient' s renal activity estimated by measuring creatinine clearance or glomerular filtration rate.
  • the dosage of a platinum compound provided herein (e.g., carboplatin) used in combination with an antimetabolite (e.g., gemcitabine) and 4-iodo-3-nitrobenzamide is calculated to provide an AUC of about 0.1 to about 8 mg/ml » min, about 0.1 to about 7 mg/ml » min, about 0.1 to about 6 mg/ml » min, about 1 to about 6 mg/ml » min, about 1 to about 5 mg/ml » min, about 2 to about 5 mg/ml » min, about 3 to about 6 mg/ml » min, about 3 to about 5 mg/ml » min, about 1 to about 3 mg/ml » min, about 1.5 to about 2.5 mg/ml » min, about 1.75 to about 2.25 mg/ml » min, about 2 mg/ml » min (or AUC 2 ("AUC 2" is shorthand for 2 mg/ml « minute)), about AUC 2.5, about AUC 3, about AUC 3.5, about AUC 4, about AUC 4, about AUC 2
  • a platinum compound provided herein (e.g., carboplatin) is about 10 to about 400 mg/m , e.g., about 360 mg/m .
  • a platinum compound provided herein may be administered weekly, twice every week, once every three weeks, twice every three weeks, three times out of four weeks, four times out of three weeks, four times out of five weeks, or five times out of six weeks.
  • carboplatin may be administered on 1 day of a treatment cycle, e.g., on day 1 (with the dosage of about AUC 4) of a 21 -day treatment cycle.
  • Platinum complexes platinum compound (e.g. , carboplatin) are normally administered intravenously (IV) over a period of about 10 to about 500 minutes, about 10 to about 300 minutes, about 30 to about 180 minutes, about 45 to about 120 minutes or about 60 minutes.
  • IV intravenously
  • about has its normal meaning of approximately. In some embodiments, about means +20%, +10%, or +5%.
  • a beneficial effect is achieved when the administration of the antimetabolite (e.g. , gemcitabine) and the platinum compound (e.g., carboplatin) is temporally removed from the administration of the 4-iodo-3-nitrobenazmide (or
  • a significant period of time e.g., about 12 hours, about 24 hours, about 36 hours, about 48 hours, etc.
  • administration may be on different days of a treatment cycle, such as the treatment cycles described herein.
  • the interval between administration of the 4-iodo-3-nitrobenzamide, the antimetabolite (e.g. , gemcitabine), and the platinum compound e.g.
  • carboplatin may vary within a treatment cycle (e.g., administration is not always spaced apart by 1 day, but may be at intervals of 1 day followed by an interval of 3 days, etc.).
  • the 4-iodo-3-nitrobenzamide, the antimetabolite (e.g. , gemcitabine), and the platinum compound (e.g. , carboplatin) may be administered at the same time, and at other points during the treatment administered at different times.
  • the treatment includes 1 cycle, 2 cycles, 3 cycles, 4 cycles, 5 cycles, 6 cycles, 7 cycles, 8 cycles, 9 cycles, 10 cycles, 11 cycles, 12 cycles, 13 cycles, 14 cycles, 15 cycles, 16 cycles, 17 cycles, 18 cycles, 19 cycles, or 20 cycles.
  • the term "cycle” means "treatment cycle.”
  • the method comprises at least one treatment cycle (e.g., one cycle, two cycles, three cycles, four cycles, five cycles, six cycles, seven cycles, eight cycles, nine cycles, or ten cycles, or at least any one of one cycle, two cycles, three cycles, four cycles, five cycles, six cycles, seven cycles, eight cycles, nine cycles, ten cycles, twelve cycles, fourteen cycles, sixteen cycles, or twenty cycles) comprising the administration of an effective amount of (a) 4-iodo-3-nitrobenzamide or a metabolite thereof or a
  • the treatment includes at most any of 2 cycles, 3 cycles, 4 cycles, 5 cycles, 6 cycles, 7 cycles, 8 cycles, 9 cycles, or 10 cycles.
  • the cycle e.g., the treatment cycle
  • the cycle is a period of about any of 1 week, 10 days, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, or 10 weeks.
  • the cycle is a period of at least about any of 1 week, 10 days, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, or 10 weeks.
  • the cycle (e.g., the treatment cycle) is a period of no more than about any of 1 week, 10 days, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, or 10 weeks.
  • the treatment comprises a treatment cycle of at least about any of 1 week, 10 days, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 12 weeks, or 15 weeks.
  • any of the methods provided herein may comprise at least one treatment cycle (e.g., 2 cycles, 3 cycles, 4 cycles, 5 cycles, 6 cycles, 7 cycles, 8 cycles, 9 cycles, 10 cycles, 11 cycles, 12 cycles, 13 cycles, 14 cycles, or 15 cycles), wherein the cycle is a period of 3 weeks, wherein the cycle comprises the administration of (a) 4-iodo- 3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, (b) gemcitabine, and (c) carboplatin.
  • at least one treatment cycle e.g., 2 cycles, 3 cycles, 4 cycles, 5 cycles, 6 cycles, 7 cycles, 8 cycles, 9 cycles, 10 cycles, 11 cycles, 12 cycles, 13 cycles, 14 cycles, or 15 cycles
  • the cycle is a period of 3 weeks
  • the cycle comprises the administration of (a) 4-iodo- 3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, (b) gemcitabine, and (c) carboplatin.
  • 4-iodo-3-nitrobenzamide may be administered every day of the treatment cycle, or administered every day of the treatment cycle, or on certain days but not on every day of the treatment cycle.
  • 4-iodo-3-nitrobenzamide is administered daily, once a week, twice a week, three times a week, four times a week, five times a week, six times a week, once 10 days, once every two weeks, once every three weeks, once every four weeks, once every six weeks, or once every eight weeks.
  • 4-iodo-3-nitrobenzamide may be administered on the selected days of each treatment cycle, for example, 4-iodo-3- nitrobenzamide is administered daily for the period of 1 (or 2, 3, 4, 5, 6, 7, 8, 9, 10) days of the treatment cycle, and 4-iodo-3-nitrobenzamide is not administered on other days of the treatment cycle.
  • the intervals between each administration of 4-iodo- 3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof are less than about any of 6 months, 3 months, 1 month, 20 days, 15, days, 14 days, 13 days, 12 days, 11 days, 10 days, 9 days, 8 days, 7 days, 6 days, 5 days, 4 days, 3 days, 2 days, or 1 day.
  • the interval between each administration is no more than about any of 3 weeks, 2 weeks, or 1 week. In some embodiments, the interval between each administration is about a week, about two weeks, or about three weeks.
  • 4-iodo-3-nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) may be administered (e.g., at about 5.6 mg/kg) on 4 days of a treatment cycle, e.g. , on days 1, 4, 8, 11 of a 21-day treatment cycle.
  • 4-iodo-3- nitrobenzamide (or a metabolite thereof, or a pharmaceutically acceptable salt thereof) may be administered (e.g.
  • An antimetabolite (e.g., gemcitabine) provided herein may be administered daily, e.g., every day of the treatment cycle, or administered on certain days but not on every day of the treatment cycle.
  • the antimetabolite (e.g., gemcitabine) provided herein is administered daily, once a week, twice a week, three times a week, four times a week, five times a week, six times a week, once every 10 days, once every two weeks, once every three weeks, once every four weeks, once every six weeks, or once every eight weeks.
  • An antimetabolite (e.g., gemcitabine) provided herein may be administered on the selected days of each treatment cycle, for example, the antimetabolite (e.g.
  • gemcitabine is administered daily for the period of 1 (or 2, 3, 4, 5, 6, 7, 8, 9, 10) days of the treatment cycle, and the antimetabolite (e.g., gemcitabine) is not administered on other days of the treatment cycle.
  • the intervals between each administration of gemcitabine are less than about any of 6 months, 3 months, 1 month, 21 days, 20 days, 15, days, 14 days, 13 days, 12 days, 11 days, 10 days, 9 days, 8 days, 7 days, 6 days, 5 days, 4 days, 3 days, 2 days, or 1 day.
  • the interval between each administration is no more than about any of 3 weeks, 2 weeks, or 1 week. In some embodiments, the interval between each administration is about a week, about two weeks, or about three weeks.
  • Gemcitabine may be administered (e.g. , at about 1000 mg/m ) on 2 days of a treatment cycle, e.g., on days 1 and 8 of a 21 -day treatment cycle.
  • a platinum compound (e.g., carboplatin) provided herein may be administered daily, e.g., every day of the treatment cycle, or administered on certain days but not on every day of the treatment cycle.
  • the platinum compound (e.g., carboplatin) provided herein is administered daily, once a week, twice a week, three times a week, four times a week, five times a week, six times a week, once every 10 days, once every two weeks, once every three weeks, once every four weeks, once every six weeks, or once every eight weeks.
  • a platinum compound (e.g., carboplatin) provided herein may be administered on the selected days of each treatment cycle, for example, the platinum compound (e.g., carboplatin) is administered daily for the period of 1 (or 2, 3, 4, 5, 6, 7, 8, 9, 10) days of the treatment cycle, and the platinum compound (e.g., carboplatin) is not administered on other days of the treatment cycle.
  • the intervals between each administration of carboplatin are less than about any of 6 months, 3 months, 1 month, 21 days, 20 days, 15, days, 14 days, 13 days, 12 days, 11 days, 10 days, 9 days, 8 days, 7 days, 6 days, 5 days, 4 days, 3 days, 2 days, or 1 day.
  • the interval between each administration is no more than about any of 3 weeks, 2 weeks, or 1 week. In some embodiments, the interval between each administration is about a week, about two weeks, or about three weeks.
  • Carboplatin may be administered (e.g. , at about AUC4) on 1 day of a treatment cycle, e.g., on day 1 of a 21-day treatment cycle.
  • the method comprises 15, 12, 10, 9, 8, 7, 6 or fewer dosing cycles, wherein each cycle contains a period of 21 days.
  • 4- iodo-3-nitrobenzamide or the pharmaceutically acceptable salt thereof is administered at about 5.1 mg/kg to about 8.6 mg/kg on days 1, 4, 8, and 11 of each cycle, the antimetabolite
  • the platinum compound e.g., carboplatin
  • AUC 4 mg/ml » minute
  • a method of treating platinum- sensitive recurrent ovarian cancer in a patient comprising at least one treatment cycle comprising administering (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin to the patient, wherein (i) carboplatin is administered to the patient at about AUC3 to about AUC5 (e.g., AUC4) once over the treatment cycle (e.g. , on day 1 of a treatment cycle such as a 21-day cycle), wherein
  • gemcitabine is administered to the patient at about 500 to about 1500 mg/m (e.g., 1000 mg/m ) twice over the treatment cycle (e.g. , on days 1 and 8 of a treatment cycle such as a 21-day cycle), and wherein (iii) 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof is administered to the patient at about 5 mg/kg to about 20 mg/kg (or about 5 mg/kg to about 15 mg/kg) (e.g., 5.6 mg/kg) once, twice, three times, or four times over the treatment cycle (e.g., on days 1 and 8 of a treatment cycle such as a 21 -day cycle, or on days 1, 4, 8, and 11 of a treatment cycle such as a 21 -day cycle).
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising at least one treatment cycle comprising administering (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin to the patient, wherein (i) carboplatin is administered to the patient at about AUC4 once over the treatment cycle (e.g., on day 1 of a treatment cycle such as a 21 -day cycle), wherein (ii) gemcitabine is administered to the patient at about 1000 mg/m twice over the treatment cycle (e.g.
  • a method of treating platinum-sensitive recurrent ovarian cancer in a patient comprising at least one treatment cycle comprising administering (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin to the patient, wherein (i) carboplatin is administered to the patient at about AUC4 once over the treatment cycle (e.g., on day 1 of a treatment cycle such as a 21 -day cycle), wherein (ii) gemcitabine is administered to the patient at about 1000 mg/m twice over the treatment cycle (e.g.
  • kits and articles of manufacture for administration of 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, a antimetabolite such as gemcitabine and a platinum compound such as carboplatin as provided herein.
  • the kits or articles of manufacture comprise (i) 4-iodo-3- nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, (ii) an antimetabolite (e.g., gemcitabine), and (iii) a platinum compound (e.g., carboplatin) for treating platinum-sensitive recurrent ovarian cancer in a patient.
  • kits described herein may further comprise instructions (e.g., on a product insert, a package insert or a label) for using (i) 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, (ii) gemcitabine, and (iii) carboplatin in accordance with any of the methods provided herein.
  • kits comprise 4-iodo-3-nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof and a product or package insert or a label comprising instructions and/or information for using 4-iodo-3- nitrobenzamide, or a metabolite thereof, or a pharmaceutically acceptable salt or solvate thereof in combination with gemcitabine and carboplatin in accordance with any of the methods described herein for treating platinum-sensitive recurrent ovarian cancer in a patient.
  • the platinum-sensitive recurrent ovarian cancer is epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma.
  • the patient has not received a prior cytotoxic chemotherapy in the recurrent setting.
  • the patient has measurable disease.
  • the kit may comprise instructions for treating platinum- sensitive recurrent ovarian cancer in a patient, comprising at least one treatment cycle comprising administering (i) 4-iodo-3-nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof; (ii) gemcitabine; and (iii) carboplatin to the patient, wherein (i) carboplatin is administered to the patient at about AUC3 to about AUC5 once over the treatment cycle (e.g., on day 1 of a treatment cycle such as a 21 -day cycle), wherein (ii) gemcitabine is administered to the patient at about 500 to about 1500 mg/m twice over the treatment cycle (e.g., on days 1 and 8 of a treatment cycle such as a 21 -day cycle), and wherein (iii) 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof is administered to the patient at about 5 mg/kg to about 20 mg/kg (or about 5
  • the treatment comprises a 21 -day treatment cycle, wherein (i) carboplatin is administered to the patient at 4 mg/ml » minute (AUC 4) on day 1 of the treatment cycle; (ii) gemcitabine is administered to the patient at a dose of 1000 mg/m on days 1 and 8 of the treatment cycle; and (iii) 4-iodo-3- nitrobenzamide or a metabolite or a pharmaceutically acceptable salt thereof is administered to the patient at a dose of 5.6 mg/kg twice weekly on days 1, 4, 8, and 11 of the treatment cycle.
  • the platinum-sensitive recurrent ovarian cancer is epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma.
  • the patient has not received a prior cytotoxic chemotherapy in the recurrent setting.
  • the patient has measurable disease.
  • kits may include a dosage amount of at least one composition as disclosed herein. Kits may further comprise suitable packaging and/or instructions for use of the formulation. Kits may also comprise a means for the delivery of the formulation thereof.
  • kits may include other pharmaceutical agents (such as the side-effect limiting agents, chemotherapy agents, gene therapy agents, DNA therapy agents, RNA therapy agents, viral therapy agents, nanotherapy agents, small molecule enzymatic inhibitors, anti-metastatic agents, etc.), for use in conjunction with 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite (e.g. , gemcitabine) provided herein, and a platinum compound (e.g. , carboplatin) provided herein.
  • pharmaceutical agents such as the side-effect limiting agents, chemotherapy agents, gene therapy agents, DNA therapy agents, RNA therapy agents, viral therapy agents, nanotherapy agents, small molecule enzymatic inhibitors, anti-metastatic agents, etc.
  • agents may be provided in a separate form, or mixed with 4-iodo-3-nitrobenzamide or a metabolite thereof or a pharmaceutically acceptable salt thereof, an antimetabolite (e.g., gemcitabine) provided herein, and a platinum compound (e.g. , carboplatin) provided herein, provided such mixing does not reduce the effectiveness of 4-iodo-3-nitrobenzamide (or a metabolite thereof or a pharmaceutically acceptable salt thereof), an antimetabolite (e.g. , gemcitabine) provided herein or a platinum compound (e.g., carboplatin) provided herein, and is compatible with the route of administration.
  • an antimetabolite e.g., gemcitabine
  • a platinum compound e.g., carboplatin
  • kits may include additional agents for adjunctive therapy or other agents known to the skilled artisan as effective in the treatment or prevention of platinum-sensitive ovarian cancer (e.g. , recurrent ovarian cancer) described herein.
  • the kits may optionally include appropriate instructions for preparation and administration of the composition, side effects of the composition, and any other relevant information.
  • the instructions may be in any suitable format, including, but not limited to, printed matter, videotape, computer readable disk, optical disc or directions to internet-based instructions.
  • kits for treating a patient who suffers from or is susceptible to the platinum- sensitive ovarian cancer (e.g. , recurrent ovarian cancer) described herein comprising a first container comprising a dosage amount of a formulation as disclosed herein, and instructions for use.
  • the container may be any of those known in the art and appropriate for storage and delivery of intravenous formulation.
  • the kit further comprises a second container comprising a pharmaceutically acceptable carrier, diluent, adjuvant, etc. for preparation of the composition to be administered to the patient.
  • Kits may also be provided that contain sufficient dosages of 4-iodo-3- nitrobenzamide, a metabolite thereof, or a pharmaceutically acceptable salt thereof (including formulation thereof) as disclosed herein to provide effective treatment for a patient for an extended period, such as 1-3 days, 1-5 days, a week, 2 weeks, 3, weeks, 4 weeks, 6 weeks, 8 weeks, 3 months, 4 months, 5 months, 6 months, 7 months, 8 months, 9 months or more.
  • Kits may also include multiple doses of any of the compounds described herein and instructions for use and packaged in quantities sufficient for storage and use in pharmacies, for example, hospital pharmacies and compounding pharmacies.
  • kits may include the compounds as described herein packaged in either a unit dosage form or in a multi-use form.
  • the kits may also include multiple units of the unit dose form.
  • the compositions may be provided in a multi-dose form (e.g., a blister pack, etc.).
  • Example 1 Phase II study of 4-iodo-3-nitrobenzamide in combination with gemcitabine and carboplatin in platinum-sensitive recurrent ovarian cancer.
  • a Phase II trial to evaluate the efficacy of 4-iodo-3-nitrobenzamide (BA) in combination with gemcitabine and carboplatin in the treatment of platinum-sensitive recurrent ovarian cancer is conducted.
  • Platinum-sensitivity is defined by relapse or recurrence of ovarian cancer six months or more after receiving the last dose of a platinum- based chemo therapeutic.
  • Inclusion Criteria (1) At least 18 years of age; (2) Histological diagnosis of epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma; (3) Completion of only one previous course of chemotherapy which contained a platinum therapy, with sensitivity to that regimen.
  • Platinum-sensitivity is defined by a relapse greater than 6 months after termination of platinum-based chemotherapy; (4) Measurable disease, defined by at least one lesion that can be accurately measured in at least one dimension (longest dimension to be recorded), and is > 20 mm when measured by conventional techniques (palpation, plain x-ray, computed tomography [CT], or magnetic resonance imaging [MRI]) or > 10 mm when measured by spiral CT; (5) Adequate organ function defined as: absolute neutrophil count (ANC) > l,500/mm3, platelets > 100,000/mm3, creatinine clearance > 50mL/min, alanine aminotransferase (ALT) and aspartate
  • ANC absolute neutrophil count
  • ALT alanine aminotransferase
  • AST aminotransferase
  • UPN upper limit of normal
  • ECOG Eastern Cooperative Oncology Group
  • IRB Institutional review board
  • Concurrent invasive malignancy not including: (i) Non- melanomatous skin cancer; (ii) In situ malignancies; (iii) Concurrent superficial endometrial carcinoma, if their endometrial carcinoma is superficial or invades less than 50% the thickness of the myometrium); (iv) Low risk breast cancer (localized, non-inflammatory) treated with curative intent; (v) Lesions identifiable only by positron emission tomography (PET); (vi) Prior treatment with 4-iodo-3-nitrobenzamide or poly (ADP-ribose) polymerase (PARP) inhibitors; (vii) Major medical conditions that might affect study participation (i.e., uncontrolled pulmonary, renal, or hepatic dysfunction, uncontrolled infection); (viii) Other significant co-morbid condition which the investigator feels might compromise effective and safe participation in the study, including a history of congestive cardiac failure or an electrocardiogram (ECG) suggesting significant conduction defect or myocardial ischemia; (ix
  • a maximum of 41 patients with platinum-sensitive recurrent ovarian cancer are being treated in this study using a Simon two-stage design.
  • the primary endpoint is an improved overall response rate compared to patients receiving treatment with gemcitabine and carboplatin alone determined using historical data from a previous trial.
  • the secondary endpoints are improved progression-free survival and patient safety.
  • the exploratory endpoints are BRCA status and translational medicine.
  • study participants are receiving 4-iodo-3- nitrobenzamide intravenously at a dose of 5.6 mg/kg on days 1, 4, 8, and 11 of each cycle, gemcitabine at a dose of 1000 mg/m on days 1 and 8 of each cycle, and carboplatin at AUC 4 (i.e., at 4 mg/ml » minute) on day 1 of each cycle.
  • Example 2 Phase II study of 4-iodo-3-nitrobenzamide in combination with gemcitabine and carboplatin in platinum-sensitive recurrent ovarian cancer.
  • the primary objective of this study is to evaluate the objective response rate (ORR) of gemcitabine/carboplatin in combination with 4-iodo-3-nitrobenzamide.
  • the secondary objectives of this study are (1) to determine the nature and degree of toxicity of gemcitabine/carboplatin in combination with 4-iodo-3-nitrobenzamide and (2) to evaluate progression-free survival (PFS).
  • the exploratory objectives of this study may include relationship of BRCA status with response.
  • Eligible subjects must meet the following criteria to be enrolled in the study (inclusion criteria): 1) At least 18 years of age; 2) Histological diagnosis of epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma; 3) Completion of only one previous course of cytotoxic chemotherapy which must have contained a platinum therapy, with sensitivity to that regimen.
  • Platinum sensitivity is defined by a relapse greater than 6 months after last dose of platinum-based chemotherapy; 4) Measurable disease, defined by at least one lesion that can be accurately measured in at least one dimension (longest dimension to be recorded), and is > 20 mm when measured by conventional techniques (palpation, plain x-ray, computed tomography (CT), or magnetic resonance imaging (MRI)) or > 10 mm when measured by spiral CT; 5) Adequate organ function defined as: absolute neutrophil count
  • ANC ANC
  • ANC 1,500/mm 3
  • platelets > 100,000/mm 3
  • creatinine clearance > 50mL/min
  • ALT alanine aminotransferase
  • AST aspartate aminotransferase
  • total bilirubin ⁇ 1.5 mg/dL
  • ECOG Eastern Cooperative Oncology Group
  • IRS Institutional Review board
  • Eligible subjects must not have any of the following to be enrolled in the study (exclusion criteria): 1) Concurrent invasive malignancy, not including: (a) non-melanomatous skin cancer; (b) in situ malignancies; (c) concurrent superficial endometrial carcinoma, if their endometrial carcinoma is superficial or invades less than 50% the thickness of the myometrium); (d) low risk breast cancer (localized, non-inflamatory) treated with curative intent; 2) Lesions identifiable only by positron emission tomography (PET); 3) Been treated with more than 1 line of cytotoxic chemotherapy and 1 line of biologies such as avastin for greater than 6 months (hormones do not count as a line of treatment); 4) Treatment with chemotherapy/biologic agent within 3 weeks before enrollment; 5) Prior treatment with 4- iodo-3-nitrobenzamide or poly (ADP-ribose) polymerase (PARP) inhibitors; 6) Major medical conditions that might affect study participation (i.e., un
  • investigational device or drug study, or current treatment with other investigational agents 9) Concurrent radiation therapy to treat primary disease throughout the course of the study; 10) Inability to comply with the requirements of the study; 11) Pregnancy or lactation; 12) Leptomeningeal disease or brain metastases requiring steroids or other therapeutic intervention.
  • Treatment continues for at least 6 cycles in the absence of disease progression or unacceptable toxicity. Subjects can continue for an additional 4 cycles, up to a possible 10 cycles, at physician discretion. 4-iodo-3-nitrobenzamide can be continued beyond 10 cycles, as maintenance at physician discretion, until progressive disease (PD). Subjects that discontinue treatment before PD will undergo regular staging evaluation for objective response rate every 90 ( ⁇ 10) days until PD or death.
  • the first scheduled tumor response measurement for measurable disease is performed after every other cycle or approximately every 6 weeks, in addition to initial staging at baseline. Tumor response according to the modified Response Evaluation Criteria in Solid Tumors (RECIST) is used to establish disease progression by CT or MRI (the same technique used during screening must be used).
  • RECIST modified Response Evaluation Criteria in Solid Tumors
  • Example 3 Phase II study of 4-iodo-3-nitrobenzamide in combination with gemcitabine and carboplatin ("GC”) in platinum-sensitive recurrent ovarian cancer.
  • Example 4 Phase II study of 4-iodo-3-nitrobenzamide in combination with gemcitabine and carboplatin ("GC”) in platinum-sensitive recurrent ovarian cancer.
  • the study design and treatment schedule are shown in Figure 1.
  • Carboplatin AUC 4; intravenous (“IV”); day 1), gemcitabine (1000 mg/m ; IV; days 1 and 8), and 4-iodo-3-nitrobenzamide (5.6 mg/kg; IV; days 1, 4, 8, and 11) were given on a 21 -day cycle.
  • the data in this Example are based on preliminary analysis.
  • Eligible patients were >18 years with epithelial ovarian carcinoma, fallopian tube cancer, or primary peritoneal carcinoma and demonstration of platinum-sensitive disease, defined as radiological relapse > 6 months after the last dose of platinum-based
  • the primary endpoint was overall response rate ("ORR") based on patients who received at least 1 dose of study drug and had 2 post-baseline assessments or
  • the secondary endpoints were (1) progression-free survival ("PFS") based on patients who received at least 1 dose of study drug and had 1 post -baseline assessment or progression/death within 60 days of last assessment and (2) safety based on all patients who received at least 1 dose of study drug (NCTCTCAE v3.0).
  • PFS progression-free survival
  • NCTCTCAE v3.0
  • the exploratory endpoint was relationship between BRCA status and response.
  • Table 4 shows response by BRCA mutation status of efficacy population.
  • SAE treatment emergent adverse event

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Abstract

La présente invention concerne un procédé de traitement d'un cancer des ovaires récurrent et sensible au platine chez un patient, qui comprend l'administration au patient d'une quantité efficace de 4-iodo-3-nitrobenzamide ou d'un métabolite ou d'un sel pharmaceutiquement acceptable de celui-ci ; de gemcitabine ; et de carboplatine.
PCT/US2011/038974 2010-06-04 2011-06-02 Procédés de traitement d'un cancer des ovaires récurrent et sensible au platine avec du 4-iodo-3-nitrobenzamide en combinaison avec un antimétabolite et un composé de platine. WO2011153382A1 (fr)

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US35178510P 2010-06-04 2010-06-04
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CA 2725026 CA2725026A1 (fr) 2010-06-04 2010-12-10 Methodes de traitement de cancer ovarien recurrent sensible au platine avec du 4-iodo-3-nitrobenzamide en combinaison avec un anti-metabolite et un compose du platine
CA2725026 2010-12-10
AU2010249295 2010-12-13
AU2010249295A AU2010249295A1 (en) 2010-06-04 2010-12-13 Methods of treating platinum -sensitive recurrecent ovarian cancer with 4-iodo-3-nitrobenzamide in combination with an anti-metabolite and a platinum compound
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