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  • G01N33/575—Immunoassay; Biospecific binding assay; Materials therefor for cancer
  • G01N33/5758—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumours, cancers or neoplasias, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides or metabolites
  • G01N33/57595—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumours, cancers or neoplasias, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides or metabolites involving intracellular compounds
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  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
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  • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
  • A61K31/4439—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. omeprazole
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  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
  • A61K31/453—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a six-membered ring with oxygen as a ring hetero atom
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  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
  • A61K31/454—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. pimozide, domperidone
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  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
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  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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  • A61K31/33—Heterocyclic compounds
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  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
  • A61K38/45—Transferases (2)
• • A—HUMAN NECESSITIES
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• • G—PHYSICS
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  • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
  • G01N33/575—Immunoassay; Biospecific binding assay; Materials therefor for cancer
  • G01N33/57515—Immunoassay; Biospecific binding assay; Materials therefor for cancer of the breast
• • G—PHYSICS
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  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
  • G01N33/6893—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids related to diseases not provided for elsewhere

Definitions

• This invention relates to the fields of cancer and cancer treatment and management. More specifically the invention provides diagnostic methods for identifying those subjects most likely to benefit from cdk4/cdk2 modulation and methods of treatment for subjects so identified.
• breast cancer is the second leading cause of cancer mortality in women in the USA, with -40,000 deaths per year.
• the American Cancer Society estimates 232,000 new cases of invasive breast cancer and -60,000 cases of ductal carcinoma in situ will occur this year.
• Advances in molecular diagnostics have revealed that breast cancer is not a single disease entity; rather, it is a diverse disease with extensive intertumoral and intratumoral
• heterogeneity i.e., subclones of cells with differing genetic, epigenetic, and/or phenotypic characteristics. This heterogeneity has significant clinical and therapeutic consequences in terms of patient prognosis and response to hormonal and targeted therapies, in addition to response to chemotherapies.
• An exemplary method comprises assessing pY88 phosphorylation levels in p27 in a biological sample comprising cancer cells from a subject and stratifying pY88
• phosphorylation levels as 0, 1, 2 or 3 as compared to pY88 phosphorylation levels observed in control tissues, where a level of 0 indicates no detectable sensitivity to cdk4 inhibition, a level of 1, low or no detectable sensitivity and a 2 or 3 indicates detectable sensitivity to cdk4 inhibition.
• Subjects identified as having tumors sensitive to cdk4 inhibition are then treated with a therapeutically effective amount of at least one cdk4 inhibitor for the alleviation of cancer burden or symptoms.
• Cdk4 inhibitors may be administered alone or in combination with other anti-cancer agents.
• Cancers to be treated in accordance with the invention include, without limitation, cancers of the breast, brain, thyroid, prostate, colorectum, pancreas, cervix, stomach, endometrium, liver, bladder, ovary, testis, head, neck, skin, mesothelial lining, white blood cell, esophagus, muscle, connective tissue, lung, adrenal gland, thyroid, kidney, bone, and stomach.
• the test and treat method of the invention is used for the treatment of breast cancer. While the invention encompasses treatment of a variety of mammals, preferably, the mammal is a human.
• Cdk inhibitors that can be employed in the practice of the invention are described herein and include the cdk inhibitors listed in Table 2.
• cdk4 and cdk2 inhibitors are administered in combination. This combination may or may not include additional anti -cancer agents.
• a preferred therapeutic for use in the invention includes a mimetic of p27 or an Alt-Brk mimetic.
• the cdk4 inhibitor is Palbociclib.
• an Alt-Brk mimetic is also administered which acts synergistically with Palbociclib to kill cancer cells.
• the present invention also provides a method for assessing efficacy of inhibition of cdk4 activity in cancer treatment comprising comparing pY88 phosphorylation levels in p27 in biological samples comprising cancer cells from said subject before and after treatment with an anti-cancer agent, wherein said anti-cancer agent comprises one or more cdk inhibitors samples and stratifying levels as 0, 1, 2, or 3, wherein a reduction in Y88 phosphorylation level is correlated with efficacy of cdk4 inhibition and reduced cancer cell proliferation and an increase of Y88 phosphorylation level is correlated with reduced or loss of efficacy of cdk4 inhibitor therapy.
• Kits for practicing the methods disclosed herein are also provided.
• Figures 1 A -ID Brk binds to p27 with high affinity in vitro.
• Fig. 1A p27 sequence highlighting the proline tracts of the three putative SH3 domain recruitment sites (PxxP): Kl (90-96), K2 (1 14- 117) and K3 (188-195) (SEQ ID NO: 1).
• Phage-ELISA-analysis of SFK SH3 interactions with p27 Fig. IB
• Fig. 1C Phage-ELISA-analysis of SFK SH3 interactions with p27
• Fig. 1C Phage-ELISA-analysis of SFK SH3 interactions with p27
• Fig. 1C Phage-ELISA-analysis of SFK SH3 interactions with p27
• Fig. 1C Phage-ELISA-analysis of SFK SH3 interactions with p27
• Fig. 1C Phage-ELISA-analysis of SFK SH3 interactions with p27
• Fig. 1C Phage-ELISA-analysis of SF
• FIG. 1 MCF7 cells that overexpressed WT Brk, or a catalytically inactive version (KM) were generated.
• p27 was immunoprecipitated from these cells, immunoblot analysis with anti pY88, pY74 or p27 antibodies was performed, demonstrating that increased pY88 was detected in the cells that overexpressed Brk.
• cdk4 was immunoprecipitated from these cells, and used in in vitro RB kinase assays with recombinant RB, increased cdk4 kinase activity was detected from the cells that expressed WT Brk.
• the cells that expressed WT Brk proliferated faster than the mock expressing cells.
• the MCF7-Wt Brk expressing cell s had an IC 50 value of -600 nM PD .
• Figure 3 Breast cancer cell panel showing Palbociclib sensitivity. IC50 values in nM plotted (from Finn, R.S., et al., Breast Cancer Res, 2009. 1 1(5): p. R77).
• Figures 4A - 4C Paraffin-embedded cell block material from high responders MCF7 (Fig. 4A), Moderate MDA MB 231 (Fig. 4B), or non-responders HCC1954 (Fig. 4C) with p27 (brown) and pY88 (red) antibodies and showing low (Fig. 3A), moderate (Fig. 3B) and high (Fig. 4C) pY88 levels.
• Figures 5A - 5C. p27 Y88 serves as a cdk4 biomarker.
• FIG. 5A Asynchronous MCF7, MDA MB231 or HCC1954 cells were treated with DMSO or MCF7 cells were treated with 400nM PD. Cells blocks were made after harvesting and fixing the cells with 10% Formalin. Immunohistochemistry was performed staining the slides with p27 (Brown) and pY88 (Pink).
• FIG. 5B Needle biopsies from normal mammary epithelium or ER/PR+ FIER2- breast cancer patients were stained with p27 (brown) and pY88 (pink) antibodies. Patients were categorized on the %pY88+ cells (green, yellow, brown) and whether the staining was pY88 strong (purple, grey, red). Staining was analyzed blindly by 2 independent pathologists.
• FIG. 5C Tables summarizing the staining results are shown.
• FIG. 6 Material discarded from lumpectomy or mastectomy from ER/PR+, Her2- patients at University Hospital was grown in explant culture for 48 h. in DMSO (green), high non- physiological Palbociclib (red), or a physiological concentration of Palbociclib (purple). After 48 h. material was fixed, paraffin embedded and stained for Ki67, as a marker of proliferation. The high concentration of drug (purple) was an internal control that
• Cyclin D-cdk4 provides an ideal therapeutic target because it drives cancer proliferation in a majority of human tumors, including ER/PR+, Her2- breast cancer. Cyclin D and cdk4 are over-expressed in a variety of tumors, but their levels are not accurate indicators of oncogenic activity because an accessory factor, e.g., p27Kipl, is required to assemble this unstable dimer into a ternary complex. Additionally, tyrosine (Y)
• phosphorylation of p27 is required to activate cdk4, acting as an ON/OFF "switch.”
• the present invention identifies an SH3 recruitment domain within p27 that modulates pY88, thereby modulating cdk4 activity.
• SH3 :PxxP interaction screen a Brk (Breast Tumor Kinase) was identified as a high-affinity p27 kinase. Further mutational studies of p27 enabled the present inventors to identify the SH3 recruitment domain required to permit Y phosphorylation in vitro and in vivo. Modulation of Brk in breast cancer cells modulates pY88 and increases resistance to the cdk4 inhibitor, PD0332991 (Palbociclib).
• ALTternatively-spliced form of Brk (Alt Brk), which contains its SH3 domain, blocks pY88 and acts as an endogenous cdk4 inhibitor, identifying a potentially targetable regulatory region within p27.
• Brk is overexpressed in 60% of breast carcinomas, suggesting that this facilitates cell cycle progression by modulating cdk4 through p27 Y phosphorylation.
• p27 has been considered a tumor suppressor, but the data herein strengthen the idea that it should also be considered an oncogene, responsible for cyclin D-cdk4 activity.
• cdk4 inhibition therapies cdk4i
• cdk4i cdk4 inhibition therapies
• a biomarker to pinpoint tumors and patients that would be responsive to cdk4 inhibition therapy does not exist.
• a tyrosine phosphorylation on residue Y88 and or Y89 of p27 is required to convert this ternary complex from an inhibited complex to an active complex.
• pY-associated p27 identified herein is advantageously used as a marker for cdk4 activity.
• the present invention encompasses compositions and methods using pY as a marker in human patient material to determine whether a particular tumor has the range of cdk4 activity that the present inventors have identified as responsive to treatment with cdk4 inhibitors.
• pY a marker in human patient material to determine whether a particular tumor has the range of cdk4 activity that the present inventors have identified as responsive to treatment with cdk4 inhibitors.
• cdk4 inhibitor therapy Approximately 75% of the ER/PR+/Her-2 breast cancer samples analyzed stained positive for pY (47% high staining, 25% moderate staining)
• the diagnostic test and treat method of the invention enables the clinician to more accurately identify those patients that will benefit from cdk inhibitor therapy. Patients identified as having cdk4 activity at levels amenable to therapy are then treated with cdk4 inhibitor therapy, alone or in combination with other chemotherapeutic or anti -proliferative agents.
• pY can also be used as a surrogate marker to assess efficacy of anti -cancer treatment in such patients. For example, if the cdk4i therapy is effective and cyclin D-cd4 activity is off, pY will not be phosphorylated. If the cdk4i therapy ceases to be effective, thereby restoring cyclinD-cdk4 activity, pY will again be present.
• a “therapeutically effective amount” of a compound or a pharmaceutical composition refers to an amount sufficient to modulate tumor growth or metastasis in an animal, especially a human, including without limitation decreasing tumor growth or size or preventing formation of tumor growth in an animal lacking any tumor formation prior to administration, i.e., prophylactic administration.
• “Pharmaceutically acceptable” indicates approval by a regulatory agency of the Federal or a state government or listed in the U.S. Pharmacopeia or other generally recognized pharmacopeia for use in animals, and more particularly in humans.
• a “carrier” refers to, for example, a diluent, adjuvant, excipient, auxilliary agent or vehicle with which an active agent of the present invention is administered.
• Such pharmaceutical carriers can be sterile liquids, such as water and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like. Water or aqueous saline solutions and aqueous dextrose and glycerol solutions are preferably employed as carriers, particularly for injectable solutions. Suitable pharmaceutical carriers are described in "Remington's Pharmaceutical Sciences" by E.W. Martin.
• antibody herein is used in the broadest sense and encompasses various antibody structures, including but not limited to monoclonal antibodies, polyclonal antibodies, multispecific antibodies (e.g., bispecific antibodies), and antibody fragments so long as they exhibit the desired antigen-binding activity.
• the term refers to a molecule comprising at least complementarity-determining region (CDR) 1, CDR2, and CDR3 of a heavy chain and at least CDR1, CDR2, and CDR3 of a light chain, wherein the molecule is capable of binding to antigen.
• CDR complementarity-determining region
• antibody includes, but is not limited to, fragments that are capable of binding antigen, such as Fv, single-chain Fv (scFv), Fab, Fab', and (Fab')2.
• antibody also includes, but is not limited to, chimeric antibodies, humanized antibodies, human antibodies, and antibodies of various species such as mouse, cynomolgus monkey, etc.
• heavy chain refers to a polypeptide comprising at least a heavy chain variable region, with or without a leader sequence.
• a heavy chain comprises at least a portion of a heavy chain constant region.
• full-length heavy chain refers to a polypeptide comprising a heavy chain variable region and a heavy chain constant region, with or without a leader sequence.
• heavy chain variable region refers to a region comprising a heavy chain complementary determining region (CDR) 1, framework region (FR) 2, CDR2, FR3, and CDR3 of the heavy chain.
• CDR complementary determining region
• FR framework region
• CDR2, FR3, and CDR3 of the heavy chain.
• a heavy chain variable region also comprises at least a portion of an FR1 and/or at least a portion of an FR4.
• a heavy chain CDRl corresponds to Kabat residues 31 to 35; a heavy chain CDR2 corresponds to Kabat residues 50 to 65; and a heavy chain CDR3 corresponds to Kabat residues 95 to ⁇ 02.
• Kabat Sequences of Proteins of Immunological Interest (1987 and 1991, NIH, Bethesda, Md.).
• light chain refers to a polypeptide comprising at least a light chain variable region, with or without a leader sequence. In some embodiments, a light chain comprises at least a portion of a light chain constant region.
• full-length light chain refers to a polypeptide comprising a light chain variable region and a light chain constant region, with or without a leader sequence.
• light chain variable region refers to a region comprising a light chain CDRl, FR2, HVR2, FR3, and HVR3. In some embodiments, a light chain variable region also comprises an FR1 and/or an FR4.
• a light chain CDRl corresponds to Kabat residues 24 to 34; a light chain CDR2 corresponds to Kabat residues 50 to 56; and a light chain CDR3 corresponds to Kabat residues 89 to 97. See, e.g., Kabat Sequences of Proteins of Immunological Interest (1987 and 1991, NUT, Bethesda, Md.).
• a “chimeric antibody” refers to an antibody in which a portion of the heavy and/or light chain is derived from a particular source or species, while the remainder of the heavy and/or light chain is derived from a different source or species.
• a chimeric antibody refers to an antibody comprising at least one variable region from a first species (such as mouse, rat, cynomolgus monkey, etc.) and at least one constant region from a second species (such as human, cynomolgus monkey, etc).
• a chimeric antibody comprises at least one mouse variable region and at least one human constant region.
• a chimeric antibody comprises at least one cynomolgus variable region and at least one human constant region. In some embodiments, all of the variable regions of a chimeric antibody are from a first species and all of the constant regions of the chimeric antibody are from a second species.
• a “humanized antibody” refers to an antibody in which at least one amino acid in a framework region of a non-human variable region has been replaced with the corresponding amino acid from a human variable region.
• a humanized antibody comprises at least one human constant region or fragment thereof.
• a humanized antibody is an Fab, an scFv, a (Fab') 2 , etc.
• human antibody refers to antibodies produced in humans, antibodies produced in non-human animals that comprise human immunoglobulin genes, such as XenoMouse®, and antibodies selected using in vitro methods, such as phage display, wherein the antibody repertoire is based on human immunoglobulin sequences.
• anti-cancer agent in this specification refers to a chemical substance having cytotoxic or anti-proliferative effects on cancer cells.
• chemotherapy in this specification is therapy for a malignant tumor in the living body by administering the anti-cancer agent into the living body.
• Chemotherapy for breast cancer includes, for example, CMF therapy (therapy by administering a combination of 3 agents, those are, cyclophosphamide, methotrexate and fluorouracil), therapy using taxane-based anticancer agents such as docetaxel, paclitaxel etc., CE therapy (therapy by administering a combination of 2 agents, that is, cyclophosphamide and epirubicin), AC therapy (therapy by administering 2 agents, that is, doxorubicin and cyclophosphamide), CAF therapy (therapy by administering a combination of 3 agents, that is, fluorouracil, doxorubicin and cyclophosphamide), FEC therapy (therapy by administering a combination of 3 agents, that is, fluorouracil, epirubicin and cyclophosphamide), therapy by administering a combination of 2 agents, that is, trastuzumab and paclitaxel, and therapy using capecitabine.
• RNA refers to a molecule involved in the RNA interference process for a sequence-specific post-transcriptional gene silencing or gene knockdown by providing small interfering RNAs (siRNAs) that has homology with the sequence of the targeted gene.
• siRNAs Small interfering RNAs
• siRNAs can be synthesized in vitro or generated by ribonuclease III cleavage from longer dsRNA and are the mediators of sequence-specific mRNA degradation.
• the siRNA of the invention are chemically synthesized using appropriately protected ribonucleosidephosphoramidites and a conventional DNA/RNA synthesizer.
• the siRNA can be synthesized as two separate, complementary RNA molecules, or as a single RNA molecule with two complementary regions.
• RNA molecules or synthesis reagents Commercial suppliers of synthetic RNA molecules or synthesis reagents include Applied Biosystems (Foster City, CA, USA), Proligo (Hamburg, Germany), Dharmacon Research (Lafayette, Colo., USA), Pierce Chemical (part of Perbio Science, Rockford, 111., USA), Glen Research (Sterling, Va., USA), ChemGenes (Ashland, Mass., USA) and Cruachem (Glasgow, UK).
• Specific siRNA constructs for inhibiting p27 mRNA may be between 15-35 nucleotides in length, and more typically about 21 nucleotides in length.
• mimetics of p27 can refer to a peptide variant, a fragment thereof, organic compound or small molecule which has the same function/structure-activity of the cdk4 modulating domains within p27.
• Alt-Brk the alternative transcript of Brk encodes a 134 amino acid protein, which shares the first 77 amino acid residues including the SH3 domain with full length Brk. Mimetics of BRK-alt (or the SH3 domain thereof) are also provided herein.
• the "mimetic" is a peptide variant, the length of its amino acid sequence is generally similar to that of the Kl-containing peptide, an SH3-binding peptide in p27 or an SH3 containing peptide in Alt-Brk.
• such "mimetic” can be the peptide variants having a shorter length of the amino acid sequence.
• Suitable mimetics or analogues can be generated by modeling techniques generally known in the art. This includes the design of "mimetics” which involves the study of the functional interactions and the design of compounds which contain functional groups arranged in such a manner that they could reproduce those interactions.
• vector relates to a single or double stranded circular nucleic acid molecule that can be infected, transfected or transformed into cells and replicate independently or within the host cell genome.
• a circular double stranded nucleic acid molecule can be cut and thereby linearized upon treatment with restriction enzymes.
• restriction enzymes An assortment of vectors, restriction enzymes, and the knowledge of the nucleotide sequences that are targeted by restriction enzymes are readily available to those skilled in the art, and include any replicon, such as a plasmid, cosmid, bacmid, phage or virus, to which another genetic sequence or element (either DNA or RNA) may be attached so as to bring about the replication of the attached sequence or element.
• a nucleic acid molecule of the invention can be inserted into a vector by cutting the vector with restriction enzymes and ligating the two pieces together.
• transformation refers to methods of inserting a nucleic acid and/or expression construct into a cell or host organism. These methods involve a variety of techniques, such as treating the cells with high concentrations of salt, an electric field, or detergent, to render the host cell outer membrane or wall permeable to nucleic acid molecules of interest, microinjection, peptide-tethering, PEG-fusion, and the like.
• oligonucleotide or "oligo” as used herein means a short sequence of DNA or DNA derivatives typically 8 to 35 nucleotides in length, primers, or probes.
• An oligonucleotide can be derived synthetically, by cloning or by amplification.
• An oligo is defined as a nucleic acid molecule comprised of two or more ribo- or deoxyribonucleotides, preferably more than three. The exact size of the oligonucleotide will depend on various factors and on the particular application and use of the oligonucleotide.
• the term “oligonucleotide” or “oligo” as used herein means a short sequence of DNA or DNA derivatives typically 8 to 35 nucleotides in length, primers, or probes.
• An oligonucleotide can be derived synthetically, by cloning or by amplification.
• An oligo is defined as a nucleic acid molecule
• “derivative” is intended to include any of the above described variants when comprising an additional chemical moiety not normally a part of these molecules. These chemical moieties can have varying purposes including, improving solubility, absorption, biological half life, decreasing toxicity and eliminating or decreasing undesirable side effects.
• “Sequentially” refers to the administration of one active agent used in the method followed by administration of another active agent. After administration of one active agent, the next active agent can be administered substantially immediately after the first, or the next active agent can be administered after an effective time period after the first active agent; the effective time period is the amount of time given for realization of maximum benefit from the administration of the first active agent.
• the term "subject” refers to mammalian subjects, including but not limited to humans, dogs, livestock, horses, cats, rabbits and the like. Preferably, the subject is a human subject.
• a “cdk4 inhibitor” or “cdki” is an agent (e.g., nucleic acid, protein/peptide, small molecule) that disrupts or interferes with cdk4 kinase activity.
• agents include, without limitation, agents listed in Table 2, Palbociclib, abemaciclib, and ribociclib. Also see US Patents 8,566,072 and 6,962,792.
• the present invention also provides pharmaceutical compositions comprising at least one agent, wherein the at least one agent is a compound which interferes with the interaction between p27Kipl and Brk and inhibits the phosphorylation event that turns p27 "on" in a pharmaceutically acceptable carrier.
• Preferred agents for use in the invention include small molecules, cdk4 inhibitors such as those listed in Table 2, mimetics based on the sequences provided in Figure 1, and siRNA
• Such a pharmaceutical composition may be administered, in a therapeutically effective amount, to a patient in need of cancer treatment.
• the mimetics/siRNA/inhibitors of the present invention may be used in a variety of treatment regimens for the treatment of malignant disease.
• Cancers that may be treated using the present protocol include, but are not limited to: cancers of the breast, brain, thyroid, prostate, colorectum, pancreas, cervix, stomach, endometrium, liver, bladder, ovary, testis, head, neck, skin (including melanoma and basal carcinoma), mesothelial lining, white blood cell (including lymphoma and leukemia) esophagus, muscle, connective tissue, lung
• small-cell lung carcinoma and non- small -cell carcinoma adrenal gland, thyroid, kidney, or bone; glioblastoma, mesothelioma, renal cell carcinoma, gastric carcinoma, sarcoma, choriocarcinoma, cutaneous basocellular carcinoma, and testicular seminoma.
• treatment may occur prior to tumor resection or following tumor resection for example.
• the present invention provides a pharmaceutical composition for the treatment of cancer in a patient comprising at least one agent that interferes with specific tyrosine (Y) phosphorylation, thereby maintaining p27 in the "off position and at least one
• chemotherapeutic agent in a pharmaceutically acceptable carrier.
• a method for treating cancer in a patient by administering an effective amount of at least one Y88 phosphorylation inhibiting agent.
• Such agent can be used alone or in combination with at least one other anti-cancer agent.
• Suitable agents include, but are not limited to, Palbociclib, abemaciclib, ribociclib, paclitaxel (Taxol®), cisplatin, docetaxel, carboplatin, vincristine, vinblastine, methotrexate, cyclophosphamide, CPT-11, 5-fluorouracil (5-FU), gemcitabine, estramustine, carmustine, adriamycin (doxorubicin), etoposide, arsenic trioxide, irinotecan, and epothilone derivatives. Such agents can be administered simultaneously or sequentially.
• compositions of the present invention can be administered by any suitable route, for example, by injection, by oral, pulmonary, nasal or other methods of administration.
• pharmaceutical compositions of the present invention comprise, among other things, pharmaceutically acceptable diluents, preservatives, solubilizers, emulsifiers, adjuvants and/or carriers.
• the carriers are nanoparticles.
• compositions can also include diluents of various buffer content (e.g., Tris-HCl, acetate, phosphate), pH and ionic strength; and additives such as detergents and solubilizing agents (e.g., Tween 80, Polysorbate 80), anti-oxidants (e.g., ascorbic acid, sodium metabi sulfite), preservatives (e.g., Thimersol, benzyl alcohol) and bulking substances (e.g., lactose, mannitol).
• the compositions can be incorporated into particulate preparations of polymeric compounds such as polylactic acid, polyglycolic acid, etc., or into liposomes.
• compositions may influence the physical state, stability, rate of in vivo release, and rate of in vivo clearance of components of a pharmaceutical composition of the present invention. See, e.g., Remington's Pharmaceutical Sciences, 18th Ed. (1990, Mack Publishing Co., Easton, PA 18042) pages 1435-1712 which are herein incorporated by reference.
• the pharmaceutical composition of the present invention can be prepared, for example, in liquid form, or can be in dried powder form (e.g., lyophilized). Particular methods of administering pharmaceutical compositions are described hereinabove.
• the pharmaceutical compositions of the present invention can be delivered in a controlled release system, such as using an intravenous infusion, an implantable osmotic pump, a transdermal patch, liposomes, or other modes of administration.
• a pump may be used (see Langer, supra; Sefton, CRC Crit. Ref. Biomed. Eng. (1987) 14:201; Buchwald et al., Surgery (1980) 88:507; Saudek et al., N. Engl. J. Med. (1989) 321 :574).
• polymeric materials may be employed (see Medical Applications of Controlled Release, Langer and Wise (eds ), CRC Press: Boca Raton, Florida (1974); Controlled Drug Bioavailability, Drug Product Design and
• a controlled release system can be placed in proximity of the target tissues of the animal, thus requiring only a fraction of the systemic dose (see, e.g., Goodson, in Medical Applications of Controlled Release, supra, (1984) vol. 2, pp.
• a controlled release device can be introduced into an animal in proximity of the site of inappropriate immune activation or a tumor.
• Other controlled release systems are discussed in the review by Langer (Science (1990) 249: 1527-1533).
• kits which can comprise one or more of antibodies immunospecific for Y88 and Y89 in phosphorylated and non phosphorylated forms, Y88 and Y89 antigens, said antibodies optionally being detectably labeled with a non naturally occurring detectable label, or optionally affixed and immobilized to a solid support, an oligonucleotide which is suitable for amplification or specific hybridization with p27 encoding nucleic acids, a non naturally occurring polypeptide mimetics of p27 and Alt-brk, a pharmaceutically acceptable carrier, instructions for use, a container, a vessel for administration, an assay substrate, a cdk inhibitor, an anti cancer agent, or any combination thereof.
• the following materials and methods are provided to facilitate the practice of the present invention.
• pY74, Y88 and Y89 phospho-specific antibodies were generated by immunization of rabbits with phosphor-specific p27 peptides (Invitrogen). Negative- and positive-affinity chromatography with non-phosphorylated and phosphorylated peptides respectively, were performed to purify the antibodies. The antibodies are specific only for Y88,Y89, Y74 phosphorylation respectively.
• Phage-ELISA Phage supernatants were generated and binding of SH3-phages to recombinantly produced His-tagged-p27 or GST-PxxP-peptides were analyzed as described (Asbach B. et al., (2012) PLoS One 6: e38540). Construction of mutants and peptides. Oligonucleotides encoding the PxxP-peptides Kl, K2 and K3 were annealed and directly ligated into pGEX-KG expression vector for production of N-terminally GST-tagged peptides. GST, GST-Brk SH3, GST-Brk SH2 expressing plasmids were described (Vasioukhin V. et al; (1997) Proc.
• E. coli BL21 cells transformed with these plasmids were grown in LB-ampicillin until an OD of 0.6 was reached and protein production was induced by addition of 1 mM IPTG. After 2hours, cells were harvested by centrifugation. Cell lysis and protein purification on GST-sepharose was carried out according to the GST-protein purification manual (GE Healthcare). Protein was eluted with an excess of glutathione and dialysed against PBS for further use. Purified, C-terminal histidine-tagged or N-terminal Flag tagged p27's were generated from E. coli as described previously (James M.K. et al. (2008) Mol. Cell. Biol.
• Human p27 cDNA was used as a template in PCR-mutagenesis with oligonucleotides carrying the point mutations: PPPP (SEQ ID NO: 7) 91, 92,94,95 AAAA (SEQ ID NO: 8) ( ⁇ 1); PKKP (SEQ ID NO: 9) 188, 189,190, 191 AAAA (SEQ ID NO:8) (AK3); or PPPP (SEQ ID NO: 7) 91,92,94, 95 AAAA (SEQ ID NO: 8) and PKKP (SEQ ID NO: 9) 188,189, 190,191 AAAA (SEQ ID NO: 8 ( ⁇ 1/ ⁇ 3).
• Oligonucleotides used to generate 58-106 were:
• His-tagged p27 mutants were purified by FPLC via his-trap affinity chromatography (His-Trap HP, GE Healthcare 71 - 5247-01). The affinity column was stripped according to manufacturer's protocol, then washed with 5 column volumes of 100 mM C0CI 2 . The crude material was applied with a loading buffer consisting of 6 M urea, 500 mM NaCl, 50mM Tris-HCl, pH 7.5 and 20% glycerol. The material was washed with 500 mM NaCl, 50 mM Tris-HCl, pH 7.5 and 10% glycerol. The purified material was eluted with 500 mM imidazole, 20 mM Hepes pH 7.4 and 1 M KC1. The protein was then dialyzed overnight in a solution of 25mM Hepes pH 7.7, 150 mM NaCl, 5 mM MgC12 and 0.05% NP40. All purified proteins were analyzed by
• Mimetics and mutants of this sequence can be generated by truncation of 3, 5, 10, 15 20, 25, 50 or more amino acids.
• Variants in which individual amino acids can be substituted by other amino acids which are closely related can also be generated.
• individual amino acid may be substituted as follows: any hydrophobic aliphatic amino acid may be substituted in place of any other hydrophobic aliphatic amino acid; any hydrophobic aromatic amino acid may be substituted in place of any other hydrophobic aromatic amino acid; any neutral amino acid with a polar side chain may be substituted in place of any other neutral amino acid with a polar side chain; an acidic amino acid may be substituted in place of an acidic amino acid; and a basic amino acid may be substituted in place of a basic amino acid.
• Variants and mutants having preferred properties and activities can also be generated by substitution of certain amino acids with amino acids that are not closely related, for example replacing a charged amino acid with a neutral amino acid. Fusion proteins of non contiguous amino acids could also generated. Specific alterations can be made using information available from previously solved 3D structures of a variety of Src family tyrosine kinases. Each of the mimetics should be effective to interfere with pY phosphorylation.
• Recombinant cyclin Dl-cdk4 Recombinant His-cyclin Dl-cdk4 was harvested from co- infected High5 cells and purified as described previously (James et al, supra). Recombinant GST-Rb (86 Kdversion) was purified and used in in vitro kinase assays.
• MCF10A, MCF7, MDA MB 231, MDA MB 468, T47D, PC3, MvlLu and HEK 293 were purchased from ATCC and maintained according to vendor's instructions. Insulin levels were adjusted to 0 (-), 10 (+) or 50 (+++) ⁇ g/ml and cells were grown for 2 weeks before being assayed as described. To arrest by contact, cells were grown to confluence and maintained for 6 days, replenishing the media every other day. Immunoprecipitation, immunofluorescence, PI staining were performed as described in materials and methods section. FACS analysis was performed as described (Nguyen K.D. et al. (2010) J. Pediatr. Gastroeneterol. Nutr. 5, 556-62). Cells were counted using the automated cell counter (BioRad TC-20). Viability was measured by Trypan Blue staining and counted using the cell counter.
• Cells were either lysed with Triton lysis buffer (25mM HEPES pH 7.4,100mM NaCl, ImM EDTA, 10% Glycerol, 1% Triton X-100) or Tween lysis buffer (50mM HEPES pH 7.4, 150mM aCl, ImM EDTA, 2.5 mM EGTA, 10% Glycerol, 0.1% Tween-20).
• the lysis buffers were supplemented with ImM PMSF, lOmM DTT, ImM NaV, lOng/ml Leupeptin and lng/ml Aprotinin.
• Lysates (lmg) were pre-cleared by incubation with Dynabeads A or G (Life Technologies) for lh at 4°C. Immunoprecipitations proceeded as described (James et al., supra). Immunofluorescence. Cell lines were split on day 0 into sub-confluent conditions and fixed on day 2 in microwell plates using 4% paraformaldehyde in IX PBS, pH 7.4, for 15 min at room temperature. They were permeabilized with 0.1% Triton X-100 and blocked with 5% BSA for lh at room temperature. They were incubated with the first round of primary antibodies in PBS for lhour at room temperature.
• the cells were washed with PBS and incubated with appropriate secondary antibodies (1 :500), diluted in 3% BSA/ PBS, for lhour at room temperature. They were then washed with PBS and incubated with 0.02% Triton X- 100/ 3% BSA for 30 min at room temperature to prepare them for a second round of incubation with antibodies. Cells were then washed with PBS and incubated with Hoechst stain (lmg/ml) 1 :5000 in PBS for 15 min at room temperature. They were rinsed with water and mounted on a slide with 90% gylcerol. Samples were incubated at 4°C before they were analyzed by confocal microscopy.
• Inhibitor treatment Cells were seeded on six well plates in duplicate, 5.0 x 10 4 per well. 24 hours post seeding, one well for each plate was treated with trypsin and counted using the Biorad Automated cell counter. 48 hours post seeding, another well was treated with trypsin and counted and the rest of the wells were treated with Palbociclib (SelleckChem) at 50 nM, 100 nM, 200 nM and 400 nM. DMSO was used as a negative control. Cells were counted again 24 and 48h post treatment.
• the IC5 0 values were determined by normalizing the number of viable cells treated with different concentrations of Palbociclib to the number of viable cells treated with DMSO for each cell line 48 hours post treatment. The number of viable cells treated with DMSO was considered 100%. The log of the viability values was obtained and the data was fitted to a nonlinear regression curve, which was used to generate the IC5 0 values using Graphpad Prism software.
• Lentiviral siRNA particles were purchased from Sigma
• MCF7 cells were plated on day 0, on day 1, the media was aspirated and the cells were infected with the siRNA lentiviral particles. Hexadimethrine bromide was used according to manufacturer's instructions to enhance the infection efficiency. Cells were incubated overnight, media was replenished on day 2 and the cells were incubated for 72 hrs, fixed with 4% Paraformaldehyde and immunofluorescence was performed as described.
• RNA extraction was performed using TRIzol reagent (Life Technologies).
• Palbociclib Each data point is the average of 4 samples (2 independent explant samples, and 2 independent immunohistochemistry stainings of each explant (runs A and B). Each sample was read blindly by two pathologists. Biopsy or resection material removed from the same patients at the time of lumpectomy or mastectomy was sent to DMC Pathology Department for fixing in 10% formalin and paraffin embedding. Material was then stained in the dual pY/p27 IHC assay as described.
• REAGENTS STAINING KIT: Enzo Lifesciences (ADI-950-100-0001); Antigen Retrieval Solution: Dako (SI 699); PAP Pen: Fisher Scientific (XT001-PP); Protein Block: Dako (X0909); Antibody Diluent: Dako (S3022); P27 Antibody: BD Biosciences (610242); Mounting Solution: Fisher Scientific (SP15-100)
• a IX solution of antigen retrieval was prepared from 10X stock and it was equilibrated at 100°C in the water bath. After the temperature of antigen retrieval solution reached 100°C, the slides were washed with TBS-0.1% Tween 20 3 times, 3 min each at R.T. Antigen retrieval was performed at 100°C for 30 min. After 30 min, the coplin jar was allowed to cool down at R.T. for another 20 min. The slides were then incubated in IX PBS for 3 min. P27kipl antibody (1 : 1000) dilution was prepared in the DAKO antibody diluent. Slides were incubated with p27kipl antibody overnight at 4°C.
• Rabbit AP chromogen buffer was mixed with 20ul (or one drop) of AP chromogen by inverting the tube and protecting it from light. Slides were then incubated with the activated AP substrate for 15 min at R.T and washed in TBS-0.1% Tween 20 3 times, 3 min each followed by a tap water wash for 5 min at R.T. Slides where then rinsed with 75%-95%-100% ethanol 3 times, 3 min each at R.T. and mounted using
• pY is used as a marker in human patient material to determine whether a particular tumor has the appropriate range of cdk4 activity suitable for inhibition by cdk4 inhibitors.
• a phosphospecific antibody for pY p27 and shown that it recognized pY in formalin fixed, paraffin embedded archival human breast cancer material (ER/PR+/Her2-). With 100% penetrance, the antibody did not stain benign tissue obtained from human mammary reduction surgery. 75% of the ER/PR+/Her-2 breast cancer samples analyzed stained positive for pY albeit with different intensities.
• p27 contains three putative SH3 recruitment sequences that contain the common PxxP core motif, designated Kl, K2 and K3 (Fig. 1 A).
• Kl contains a basic residue after the PxxP, thus qualifying it as a canonical type 2K SH3 target site (Cesareni G. et al., (2002) FEBS Lett. 513 : 38-44).
• K2 is only present in the human orthologue of p27 and thus is unlikely to mediate conserved functions in cell cycle control.
• K3 is at the C-terminus of p27, in a region that has shown to be dispensable for cdk interaction.
• SFKs non-receptor bound tyrosine kinases
• SFKs non-receptor bound tyrosine kinases
• Cyclin D-cdk4 (DK4) has been a highly sought after therapeutic target because it drives cancer proliferation in a majority of human tumors, including ER/PR+, Her2- breast cancer.
• DK4 Cyclin D-cdk4
• p27 Although known as a DK4 assembly factor and cdk2 inhibitor, p27 also acts as a DK4 ON/OFF "switch.” Tyrosine (Y) phosphorylation of p27 (pY) by Brk controls both ATP binding and CAK phosphorylation of cdk4' s T loop, which are essential for DK4 activation. This function is restricted to cdk4: p27's association with cdk2, whether Y phosphorylated or not, appears to be inhibitory. However, in vivo Y phosphorylated p27 is a target for cdk2-dependent ubiquitin-mediated degradation, reducing p27's association with cdk2, indirectly activating this complex.
• p27 pY would inactivate cdk4 directly and cdk2 indirectly, and thus represents a novel way to block cancer cell proliferation.
• pY also serves as a predictive biomarker of cdk4 inhibitor activity, tumor response to therapy and chemo-resi stance.
• ALT a small peptide ALT, which contains a portion of Brk's SH3 domain. ALT binds to p27, blocks Brk' s association and ability to phosphorylate p27, inhibiting cdk4 and increasingp27's ability to inhibit cdk2.
• pY levels correlated with cdk4 activity increasing or decreasing Brk expression increased or decreased pY and cdk4 activity respectively, which correlated with increased or decreased Palbociclib sensitivity.
• cdk4 may dictate arrest and a "speed limit" type model might explain these results: too little cdk4 as indicated by no pY staining (level 0) identifies complete non-responders, but too much cdk4 (level >3), as indicated by very high pY staining, can also identify non-responders because the concentration of Palbociclib needed to show a response in vivo, and inhibit this amount of cdk4, is toxic (>1000nm). In this instance, a different cdk4 inhibitor (described herein below) may function better than Palbociclib to inhibit cancer cell proliferation. Notably, when MCF7 cells were treated with 400 nM Palbociclib, pY staining decreased (0% of cells stained) and resulted in a 0 intensity.
• Palbociclib may be able to initially and transiently inhibit cdk4 (cell cycle arrest), but with time, cdk2 is able to compensate for this loss and overcome cytostasis
• pY88 antibody is specific for Y phosphorylation, and does not recognize non-phosphorylated p27.
• Table 1 100% of the ER/PR+, Her2- tumors analyzed were positive for p27 staining. Three stratifications of pY88 were detected in this tumor subgroup: 47% had high pY88 staining, 25.5% had low and focal pY88 staining and 25.5% had no pY88 staining.
• the second difference was that while the cell lines were clonal and every cell stained the same way, due to inherent tumor heterogeneity in the same tumor , in the tumor block, some cells stained and some did not.
• the data indicate that the 0 group would not respond to PD treatment, as these samples lacked pY and thus lacked cdk4 activity.
• Group 3 should respond to PD because the "druggable" target is present and indicative of cdk4 activity.
• the level of pY in group 3 can be correlated with a level of cdk4 activity that may require higher concentrations of
• Figure 7 shows the results from explant cultures of material discarded from lumpectomy or mastectomy from ER/PR+, Her2- patients treated with no (DMSO; green), high non-physiological Palbociclib (500 nM, red), or a physiological concentration of Palbociclib (100 nM, purple).
• Fixed, paraffin embedded blocks were stained for Ki67, as a marker of proliferation.
• the high concentration of drug (purple) was an internal control that proliferation could be inhibited.
• Each patient had an inherent different proliferation rate as measured by different Ki67 levels in the untreated sample (green).
• Palbociclib response was measured as a decrease in Ki67 in the presence of the physiological concentration of drug (red).
• Patients 1 and 3 responded. Each data point is the average of 4 samples (2 independent explant samples, and 2 independent immunohistochemistry stainings). Each sample was read blindly by two pathologists.
• pY can also be used as a biomarker to predict response in patient material obtained with IRB approval from biopsy and lumpectomy procedures.
• a dose response curve with three concentrations of Palbociclib is used to determine IC5 0 values.
• IC5o ⁇ 200 nM will be defined as high response, .
• a test and treat method is disclosed. First, a sample is taken from the tumor and Y88 phosphorylation levels assessed in order to determine cdk4 activity levels. As described at length in previous examples, patients having no detectable levels of Y88 phosphorylation relative to levels observed in normal tissues, are not likely to benefit from cdk4 inhibitor therapy, while patients having levels of 1, 2 or 3 of pY88 phosphorylation relative to levels observed in normal tissues, should benefit from cdk4 inhibitor therapy at differing concentrations.
• suitable agents targeting cdk2 and cdk4 disclosed in the Table 2and described in the Examples above can be administered in patients most likely to benefit, alone or in combination in order to reduce tumor burden in the patient. Such agents should be administered at the effective dose.
• the total treatment dose or doses can be administered to a subject as a single dose or can be administered using a fractionated treatment protocol, in which multiple/separate doses are administered over a more prolonged period of time, for example, over the period of a day to allow administration of a daily dosage or over a longer period of time to administer a dose over a desired period of time.
• the amount of cdk inhibitor required to obtain an effective dose in a subject depends on many factors, including the age, weight and general health of the subject, as well as the route of administration and the number of treatments to be administered. In view of these factors, the skilled artisan would adjust the particular dose so as to obtain an effective dose for treating an individual having cancer, particularly breast cancer.
• cdk inhibitor The effective dose of cdk inhibitor will depend on the mode of administration, and the weight of the individual being treated. In an individual suffering from cancer, in particular a more severe form of the disease, administration of cdk inhibitors can be particularly useful when administered in combination, for example, with a conventional agent for treating such a disease.
• the skilled artisan would administer the therapeutic agent(s), alone or in combination and would monitor the effectiveness of such treatment using routine methods such as radiologic, immunologic assays, or, where indicated, histopathologic methods.
• Y88 phosphorylation levels can be used to monitor effectiveness of treatment over time.
• a method for the synergistic treatment of cancer using the pharmaceutical agents disclosed in the present example in combinatorial approaches As described above, Alt-Brk (or another agent which interferes with Y88 phosphorylation) in combination with Palbociclib effectively synergize to arrest breast cancer cell proliferation.
• the synergistic method of this invention reduces the progression of cancer, or reduces symptoms associated with cancer in a mammalian host. The information provided herein guides the clinician in new treatment modalities for the management of breast cancer.
• the present invention also encompasses a pharmaceutical composition useful in the treatment of cancer, comprising the administration of a therapeutically effective amount of the combinations of this invention, with or without pharmaceutically acceptable carriers or diluents.
• the synergistic pharmaceutical compositions of this invention comprise two or more of the agents described in the previous examples, and/or listed in the table below and a pharmaceutically acceptable carrier.
• the compositions of the present invention may further comprise one or more pharmaceutically acceptable additional ingredient(s) such as alum, stabilizers, antimicrobial agents, buffers, coloring agents, flavoring agents, adjuvants, and the like.
• the anti-cancer compositions of the present invention may be administered orally or parenterally including the intravenous, intramuscular, intraperitoneal, subcutaneous, rectal and topical routes of administration.
• Certain cancers can be treated effectively with a plurality of the compounds listed above.
• Such triple and quadruple combinations can provide greater efficacy.
• the dosages can be determined according to known protocols.
• combinations of the instant invention may also be co-administered with other well known therapeutic agents that are selected for their particular usefulness against the condition that is being treated.
• Combinations of the instant invention may alternatively be used sequentially with known pharmaceutically acceptable agent(s) when a multiple combination formulation is inappropriate.
• the compounds described herein do not have to be administered in the same pharmaceutical composition, and may, because of different physical and chemical characteristics, have to be administered by different routes.
• first compound may be administered orally to generate and maintain good blood levels thereof, while a second compound may be administered intravenously.
• the initial administration can be made according to established protocols known in the art, and then, based upon the observed effects, the dosage, modes of administration and times of administration can be modified by the skilled clinician.
• the present inventor has identified a new marker for predicting long term survival and response to cancer therapy in breast cancer patients.
• CDKtargets with known drugs available are shown in Table 2. These drugs can be combined to synergistically treat cancer or to simultaneously reduce symptoms or progression of cancer, particularly breast cancer.
• Inhibitor (conipuin ) Main targets (oilier ta rgets)
• Flavopiridol also known as alvocidib CDK1, CDK2, CDK4, CDK6, CDK7 and CDK9 (Sanofi-Aventis) i (GSK3p)
• CDK 1 , CDK4 and CDK9 CDK2 CDK6 and
• R-roscovitine also known as CYC202 CDK1, CDK2, CDK5, CDK7 and CDK9 (CK1, and seliciclib (Cyclacel) GSK3a-P, DYRKIA, ERK1, ERK2 and PDXK
• R547 also known as Ro-4584820
• CDK1, CDK2, CDK4 and CDK7 (NA)
• CDK2, CDK7 and CDK9 CDK1 and CDK4
• ZK 304709 also known as MTGI and CDK1, CDK2, CDK4, CDK7 and CDK9 ZK-CDK (Schering AG) * (VEGFR1 VEGFR2, VEGFR3 and PDGFRp)
• Intravenous.*Oral. ⁇ Indisulam is not a direct CDK inhibitor: it causes a depletion of cyclin E levels, which reduces CDK2 activity, and a depletion of cyclin H levels, which reduces CDK7 activity.
• CDK cyclin-dependent kinase
• CLL chronic lymphocytic leukaemia
• CYC cyclin
• DYRK1A dual specificity tyrosine-phosphorylation-regulated kinase 1A
• ERK extracellular signal-regulated kinase
• Gl first gap
• GSK3beta glycogen synthase kinase 3beta
• IC50 compound concentration that caused 50% inhibition of kinase activity (in vitro kinase assays) or cellular proliferation (cell proliferation assays); Ki, inhibition constant; M, mitosis; NA, not available; NHL, non-Hodgkin's lymphoma; NSCLC, non-small-cell lung carcinoma; PDGFRbeta, platelet-derived growth factor receptor-beta; PDXK, pyridoxal kinase; RBI, retinoblastoma protein; S, synthesis; VEGFR,

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