Classifications

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  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
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  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/337—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
• • A—HUMAN NECESSITIES
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  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
  • A61K31/351—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom not condensed with another ring
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/437—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a five-membered ring having nitrogen as a ring hetero atom, e.g. indolizine, beta-carboline
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4738—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/4745—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems condensed with ring systems having nitrogen as a ring hetero atom, e.g. phenantrolines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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  • A61K31/66—Phosphorus compounds
  • A61K31/664—Amides of phosphorus acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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  • A61K31/66—Phosphorus compounds
  • A61K31/675—Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
• • 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
  • A61K31/7028—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages
  • A61K31/7034—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages attached to a carbocyclic compound, e.g. phloridzin
  • A61K31/704—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages attached to a carbocyclic compound, e.g. phloridzin attached to a condensed carbocyclic ring system, e.g. sennosides, thiocolchicosides, escin, daunorubicin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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  • A61K33/24—Heavy metals; Compounds thereof
• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • 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
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present invention relates to the field of chemistry and medicine. More particularly, the present invention relates to a method of reducing neutropenia.
• cancer therapies can have deleterious side effects.
• many chemotherapeutic agents have myelosuppressive effects that can cause neutropenia.
• radiation therapy can be a cause of neutropenia.
• therapeutics that can counter the neutropenia caused by cancer therapy.
• Some embodiments disclosed herein include a method of reducing neutropenia in a subject, comprising administering plinabulin or a pharmaceutically acceptable salt thereof to the subject in need thereof, wherein the neutropenia is induced by administration of a first chemotherapeutic composition comprising one or more chemotherapeutic agents, wherein the chemotherapeutic composition does not comprise docetaxel, or by administration of radiation therapy.
• Figure 1 is a graph of neutrophil count 24 hours post dosing of cyclophosphamide, plinabulin, or the combination of cyclophosphamide and plinabulin.
• Figure 2 is a graph of neutrophil count 48 hours post dosing of cyclophosphamide, plinabulin, or the combination of cyclophosphamide and plinabulin.
• Figure 3 is a graph of the time course of neutrophil count after administration of cyclophosphamide, plinabulin, or the combination of cyclophosphamide and plinabulin.
• Figure 4 shows the absolute neutrophil count (ANC) on Day 1 and Day 3 post dosing of cyclophosphamide, the combination of cyclophosphamide and plinabulin, and control groups.
• Figure 5 shows the ANC levels on Day 3 post dosing of cyclophosphamide, plinabulin, or the combination of cyclophosphamide and plinabulin as expressed as percentage of the ANC of the control group.
• Figure 6 shows the ANC level on Day 3 post dosing of cyclophosphamide and the combination of cyclophosphamide and plinabulin.
• Figure 7 is a graph of the time course of ANC level after administration of naive, doxorubicin, plinabulin, and the combination of doxorubicin and plinabulin.
• Figure 8 is a graph of the time course of ANC level expressed as a percentage of the ANC level of the naive group after administration of doxorubicin and the combination of doxorubicin and plinabulin.
• Figure 9 shows the ANC levels on Day 3 post the administration of cisplatin, plinabulin, and the combination of cisplatin and plinabulin.
• Figure 10 shows a dose response curve for plinabulin on cisplatin induced neutropenia with the ANC level change expressed as percentage of the ANC level in cisplatin treatment alone group.
• Figures 11A and 11B show the ANC levels post the administration of control, plinabulin, and the combination of topotecan and plinabulin:
• Figure 11A shows the ANC levels when 0.25 mg/kg topotecan and 7.5 mg/kg plinabulin were administered;
• Figure 11B shows the ANC levels when 1 mg/kg topotecan and 3.75 mg/kg plinabulin were administered.
• Plinabulin, (3Z,6Z)-3-Benzylidene-6- ⁇ [5-(2-methyl-2-propanyl)-lH- imidazol-4-yl]methylene ⁇ -2,5-piperazinedione, is a synthetic analog of the natural compound phenylahistin.
• Plinabulin can be readily prepared according to methods and procedures detailed in U.S. Patents 7,064,201 and 7,919,497, which are incorporated herein by reference in their entireties.
• Some embodiments relate to the use of Plinabulin or a pharmaceutically effective salt thereof to reduce neutropenia.
• the neutropenia is induced by chemotherapy, for example, by administration of drugs that have a myelosuppresive effect.
• the neutropenia is induced by radiation therapy. Definitions
• Subject as used herein, means a human or a non-human mammal, e.g., a dog, a cat, a mouse, a rat, a cow, a sheep, a pig, a goat, a non-human primate or a bird, e.g., a chicken, as well as any other vertebrate or invertebrate.
• mammal is used in its usual biological sense. Thus, it specifically includes, but is not limited to, primates, including simians (chimpanzees, apes, monkeys) and humans, cattle, horses, sheep, goats, swine, rabbits, dogs, cats, rodents, rats, mice guinea pigs, or the like.
• primates including simians (chimpanzees, apes, monkeys) and humans, cattle, horses, sheep, goats, swine, rabbits, dogs, cats, rodents, rats, mice guinea pigs, or the like.
• an "effective amount” or a “therapeutically effective amount” as used herein refers to an amount of a therapeutic agent that is effective to relieve, to some extent, or to reduce the likelihood of onset of, one or more of the symptoms of a disease or condition, and includes curing a disease or condition.
• Treatment refers to administering a compound or pharmaceutical composition to a subject for prophylactic and/or therapeutic purposes.
• prophylactic treatment refers to treating a subject who does not yet exhibit symptoms of a disease or condition, but who is susceptible to, or otherwise at risk of, a particular disease or condition, whereby the treatment reduces the likelihood that the patient will develop the disease or condition.
• therapeutic treatment refers to administering treatment to a subject already suffering from a disease or condition.
• pharmaceutically acceptable salt refers to salts that retain the biological effectiveness and properties of a compound and, which are not biologically or otherwise undesirable for use in a pharmaceutical.
• the compounds disclosed herein are capable of forming acid and/or base salts by virtue of the presence of amino and/or carboxyl groups or groups similar thereto.
• Pharmaceutically acceptable acid addition salts can be formed with inorganic acids and organic acids. Inorganic acids from which salts can be derived include, for example, hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like.
• Organic acids from which salts can be derived include, for example, acetic acid, propionic acid, glycolic acid, pyruvic acid, oxalic acid, maleic acid, malonic acid, succinic acid, fumaric acid, tartaric acid, citric acid, benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonic acid, p-toluenesulfonic acid, salicylic acid, and the like.
• Pharmaceutically acceptable salts can also be formed using inorganic and organic bases.
• Inorganic bases from which salts can be derived include, for example, bases that contain sodium, potassium, lithium, ammonium, calcium, magnesium, iron, zinc, copper, manganese, aluminum, and the like; particularly preferred are the ammonium, potassium, sodium, calcium and magnesium salts.
• treatment of the compounds disclosed herein with an inorganic base results in loss of a labile hydrogen from the compound to afford the salt form including an inorganic cation such as Li + , Na + , K + , Mg 2+ and Ca 2+ and the like.
• Organic bases from which salts can be derived include, for example, primary, secondary, and tertiary amines, substituted amines including naturally occurring substituted amines, cyclic amines, basic ion exchange resins, and the like, specifically such as isopropylamine, trimethylamine, diethylamine, triethylamine, tripropylamine, and ethanolamine.
• Many such salts are known in the art, as described in WO 87/05297, Johnston et al., published September 11, 1987 (incorporated by reference herein in its entirety).
• plinabulin can be effective in ameliorating or treating chemotherapy or radiotherapy related neutropenia (including sever neutropenia such as FN). Patients receiving plinabulin treatment showed less bone pain, lower hospitalization frequency, and lower frequency of grade 4 neutropenia in cycle 1 when compared with other treatment method (e.g., G-CSF). In addition, plinabulin treatment also resulted in minimum or less febrile neutropenia when compared with other treatment methods (e.g., G-CSF).
• chemotherapy or radiotherapy related neutropenia including sever neutropenia such as FN.
• patients receiving plinabulin treatment showed less bone pain, lower hospitalization frequency, and lower frequency of grade 4 neutropenia in cycle 1 when compared with other treatment method (e.g., G-CSF).
• other treatment method e.g., G-CSF
• plinabulin treatment also resulted in minimum or less febrile neutropenia when compared with other treatment methods (e.g., G-CSF).
• plinabulin can be used together with G-CSF to reduce, ameliorate, or prevent neutropenia caused by a chemotherapeutic composition. Consistent with the benefit of neutropenia prevention, patients receiving plinabulin may require less G-CSF treatment. [0024] Patients receiving plinabulin treatment are less likely to require chemotherapeutic agent dose reduction. The safety profile of plinabulin is better than other drugs that are used to treat or ameliorate chemotherapeutic agent induced neutropenia (e.g., G-CSF treatment).
• Patients receiving plinabulin treatment can show at least one of the following conditions: 1) lower incidence of Grade 4 neutropenia (absolute neutrophil count [ANC] ⁇ 0.5 109/L); 2) lower incidence of febrile neutropenia (FN) (ANC ⁇ 0.5 ⁇ 109/L and body temperature > 38.3°C); 3) higher neutrophil count during the treatment cycle; 4) lower incidence of documented infections in Cycles 1 to 4; 5) lower incidence and shorter duration of hospitalizations due to FN during the treatment cycle; 6) better health-related Quality of Life.
• Grade 4 neutropenia absolute neutrophil count [ANC] ⁇ 0.5 109/L
• FN febrile neutropenia
• plinabulin treatment When compared with the G-CSF treatment (e.g., pegfilgrastim or filgrastim), plinabulin treatment showed lower incidence of antibiotic use, lower incidence of docetaxel dose delay, dose reduction, and/or dose discontinuation, lower Incidence, occurrence, and severity of adverse events (AEs)/serious adverse events (SAEs), lower incidence, occurrence and severity of bone pain, better systemic tolerance (physical examination and safety laboratory assessments).
• G-CSF treatment e.g., pegfilgrastim or filgrastim
• Some embodiments relate to a method of reducing or preventing neutropenia induced by one or more chemotherapeutic agents in the first chemotherapeutic composition, the method comprising administering plinabulin to the patient undergoing a chemotherapy treatment.
• the neutropenia is induced by one agent in the first chemotherapeutic composition.
• the neutropenia is induced by two or more agents in a first chemotherapeutic composition.
• the neutropenia is induced by one or more chemotherapeutic agents present in at least one additional chemotherapeutic composition.
• the neutropenia is induced by chemotherapeutic agents in the first chemotherapeutic composition and at least one additional chemotherapeutic composition. In some embodiments, the neutropenia is induced by the chemotherapeutic agent in the first chemotherapeutic composition and docetaxel. In some embodiments, the first chemotherapeutic composition does not comprise taxane. In some embodiments, the first chemotherapeutic composition does not comprise docetaxel.
• plinabulin is useful in preventing, treating, or ameliorating neutrophil reduction arising from a chemotherapy treatment.
• Some embodiments relate to a method of treating a patient being administered one or more chemotherapeutic compositions in an amount sufficient to cause neutropenia, the method comprising: administering plinabulin at a dose effective to alleviate or prevent neutrophil reduction in the patient.
• Some embodiments relate to using plinabulin to relieve the degree of neutropenia and to shorten the severe duration of neutropenia.
• the absolute neutrophil count (ANC) of the subject prior to administration of plinabulin is less than 500/mm 3 .
• the ANC of the subject prior to administration of plinabulin is in the range of about 500 to about 1000/mm 3 .
• the ANC of the subject prior to administration of plinabulin is in the range of about 1000 to about 1500/mm 3 .
• the ANC of the subject prior to administration of plinabulin is greater than 1500/mm 3 .
• the ANC of the subject show an increase of at least 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 12%, 15%, 17%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, 100%, 125%, 150%, or 175%), 200% post the administration of plinabulin.
• the ANC of the subject show an increase of less than 10%, 12%, 15%, 17%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 99%, 100%, 125%, 150%, or 175%), 200% post the administration of plinabulin.
• the ANC of the subject show an increase in the range of about 5% - 40%, 10%-40%, 12.5%-40%, 5% - 50%, 10%-50%, 12.5%-50%, 15%-50%, 17.5%-50%, 20%-50%, 25%-50%, 27.5%-50%, 30%- 50%, 5% - 60%, 10%-60%, 12.5%-60%, 15%-60%, 17.5%-60%, 20%-60%, 25%-60%, 27.5%-60%, 30%-60%, 35%-60%, 37.5%-60%, 40%-60%, 45%-70%, or 50%-80% post the administration of plinabulin.
• the subject has a grade 4 neutropenia induced by the chemotherapy (e.g., the first chemotherapeutic composition) or radiation therapy.
• the subject has a grade 3 neutropenia induced by the chemotherapy (e.g., the first chemotherapeutic composition) or radiation therapy.
• the subject has a grade 2 neutropenia induced by chemotherapy (e.g., the first chemotherapeutic composition) or radiation therapy.
• the subject has a grade 1 neutropenia induced by chemotherapy (e.g., the first chemotherapeutic composition) or radiation therapy.
• Some embodiments relate to treating chemotherapy or radiation therapy induced neutropenia in a subject having advanced or metastatic breast cancer, comprising identifying a patient having advanced or metastatic breast cancer; and administering a pharmaceutically effective amount of plinabulin.
• Some embodiments relate to a method of treating chemotherapy or radiation therapy induced neutropenia in a subject having non-small cell lung cancer, comprising: identifying a patient having non-small cell lung cancer; and administering a pharmaceutically effective amount of plinabulin.
• Some embodiments relate to a method of treating chemotherapy or radiation therapy induced neutropenia in a subject having hormone refractory metastatic prostate cancer, comprising: identifying a patient having hormone refractory metastatic prostate cancer; and administering a pharmaceutically effective amount of plinabulin.
• the neutropenia is a febrile neutropenia. In some embodiments, the neutropenia is a drug-induced neutropenia. In some embodiments, the neutropenia is a taxane-induced neutropenia. In some embodiments, the neutropenia is induced by cyclophosphamide. In some embodiments, the neutropenia is induced by cisplatin. In some embodiments, the neutropenia is induced by doxorubicin. In some embodiments, the neutropenia is induced by topotecan.
• the method includes administering one or more additional chemotherapeutic compositions to the subject. In some embodiments, the method includes administering a second chemotherapeutic composition. In some embodiments, the method includes administering a third chemotherapeutic composition. In some embodiments, the method includes administering a fourth chemotherapeutic composition. In some embodiments, the method includes administering a fifth chemotherapeutic composition. In some embodiments, the method includes administering a sixth chemotherapeutic composition. In some embodiments, the method includes administering a seventh chemotherapeutic composition. In some embodiments, the method includes administering an eighth chemotherapeutic composition.
• each chemotherapeutic composition can independently comprise one or more chemotherapeutic agents.
• one or more chemotherapeutic compositions may comprise one or more chemotherapeutic agents in common with one or more other chemotherapeutic compositions.
• each agent in the composition can be administered separately.
• each agent in the composition can be administered sequentially.
• the method described herein can include administering a second chemotherapeutic composition.
• the second chemotherapeutic composition can be administered after the administration of plinabulin.
• the second chemotherapeutic composition can be administered before the administration of plinabulin.
• the second chemotherapeutic composition can be administered simultaneously with plinabulin.
• the second chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the second chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the second chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering a third chemotherapeutic composition.
• the third chemotherapeutic composition can be administered prior to the administration of plinabulin.
• the third chemotherapeutic composition can be administered after the administration of plinabulin.
• the third chemotherapeutic composition can be administered simultaneously with plinabulin.
• the third chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the third chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the third chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering a fourth chemotherapeutic composition.
• the fourth chemotherapeutic composition can be administered prior to the administration of plinabulin.
• the fourth chemotherapeutic composition can be administered after the administration of plinabulin.
• the fourth chemotherapeutic composition can be administered simultaneously with plinabulin.
• the fourth chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the fourth chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the fourth chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering a fifth chemotherapeutic composition.
• the fifth chemotherapeutic composition can be administered prior to the administration of plinabulin.
• the fifth chemotherapeutic composition can be administered after the administration of plinabulin.
• the fifth chemotherapeutic composition can be administered simultaneously with plinabulin.
• the fifth chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the fifth chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the fifth chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering a sixth chemotherapeutic composition.
• the sixth chemotherapeutic composition can be administered prior to the administration of plinabulin.
• the sixth chemotherapeutic composition can be administered after the administration of plinabulin.
• the sixth chemotherapeutic composition can be administered simultaneously with plinabulin.
• the sixth chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the sixth chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the sixth chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering a seventh chemotherapeutic composition.
• the seventh chemotherapeutic composition can be administered prior to the administration of plinabulin.
• the seventh chemotherapeutic composition can be administered after the administration of plinabulin.
• the seventh chemotherapeutic composition can be administered simultaneously with plinabulin.
• the seventh chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the seventh chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the seventh chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering an eighth chemotherapeutic composition.
• the eighth chemotherapeutic composition can be administered prior to the administration of plinabulin.
• the eighth chemotherapeutic composition can be administered after the administration of plinabulin.
• the eighth chemotherapeutic composition can be administered simultaneously with plinabulin.
• the eighth chemotherapeutic composition can be administered before the first chemotherapeutic composition.
• the eighth chemotherapeutic composition can be administered after the first chemotherapeutic composition.
• the eighth chemotherapeutic composition can be administered simultaneously with the first chemotherapeutic composition.
• the method described herein can include administering plinabulin prior to administration of the first chemotherapeutic composition; and administering the additional one or more chemotherapeutic compositions after administration of the first chemotherapeutic composition.
• the method described herein can include administering the first chemotherapeutic composition prior to administration of the plinabulin; and administering the additional one or more chemotherapeutic compositions after administration of the plinabulin.
• the method described herein can include administering the first chemotherapeutic composition prior to administration of the additional one or more chemotherapeutic compositions; and administering the plinabulin after administration of the additional one or more chemotherapeutic agents.
• the method described herein can include a period of time between administration of each of plinabulin, the first chemotherapeutic composition, and the additional one or more chemotherapeutic compositions is independently selected between about 1 minute and 24 hours.
• the one or more additional chemotherapeutic compositions can independently include one or more agents selected from the group consisting of methotrexate, vinblastine, doxorubicin, cisplatin, MVAC (methotrexate, vinblastine, doxorubicin and cisplatin), docetaxel, trastuzumab, cyclophosphamide, paclitaxel, dose-dense AC followed by T (i.e., doxorubicin, cyclophosphamide, paclitaxel), TAC (docetaxel, doxorubicin, cyclophosphamide), fluorouracil, bleomycin, etoposide, vincristine, procarbazine, prednisone, BEACOPP (bleomycin, etoposide, doxorubic
• the one or more additional chemotherapeutic compositions can independently include one or more agents selected from the group consisting of methotrexate, vinblastine, doxorubicin, cisplatin, docetaxel, trastuzumab, cyclophosphamide, paclitaxel, fluorouracil, bleomycin, etoposide, vincristine, procarbazine, prednisone, gemcitabine, ifosfamide, carboplatin, mesna, novantrone, cytarabine methylprednisolone, rituximab dacarbazine, vinblastine, topotecan, gemcitabine, irincotecan, epirubicin, 5-fluorouracil, capecitabine, bortezomib, and cabazitaxel.
• the first chemotherapeutic composition can include one or more agents selected from the group consisting of methotrexate, vinblastine, doxorubicin, cisplatin, MVAC (methotrexate, vinblastine, doxorubicin and cisplatin), trastuzumab, cyclophosphamide, dose-dense AC followed by T (i.e., doxorubicin, cyclophosphamide, paclitaxel), fluorouracil, bleomycin, etoposide, vincristine, procarbazine, prednisone, BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone), gemcitabine, ifosfamide, carboplatin, ICE (ifosfamide, carboplatin, etoposide), rituxim
• the gemcitabine CMF classic (cyclophosphamide, methotrexate, fluorouracil), AC (doxorubicin, cyclophosphamide), FEC (fluorouracil, epirubicin, cyclophosphamide), cisplatin/topotecan, paclitaxel/cisplatin, irincotecan, FOLFOX (fluorouracil, leucovorin, oxaliplatin), irincotecan/cisplatin, epirubicin/cisplatin/5- fluorouracil, epirubicin/cisplatin/capecitabine, DT-PACE
• the first chemotherapeutic compositions can include one or more agents selected from the group consisting of methotrexate, vinblastine, doxorubicin, cisplatin, trastuzumab, cyclophosphamide, fluorouracil, bleomycin, etoposide, vincristine, procarbazine, prednisone, gemcitabine, ifosfamide, carboplatin, mesna, novantrone, cytarabine methylprednisolone, rituximab dacarbazine, vinblastine, topotecan, gemcitabine, irincotecan, epirubicin, 5- fluorouracil, capecitabine, and bortezomib.
• Some embodiments relate to a method of stimulating neutrophil survival, comprising administering plinabulin at a dose in the range of about 1 mg/m 2 to about 50 mg/m 2 .
• the plinabulin is administered at a dose in the range of about 1-50 mg/m 2 of the body surface area.
• the plinabulin is administered at a dose in the range of about 1-2, 1-3, 1-4, 1-5, 1-6, 1-7, 1-8, 1-9, 1-10, 1-11, 1-12, 1-13, 1- 13.75, 1-14, 1-15, 1-16, 1-17, 1-18, 1-19, 1-20, 1-22.5, 1-25, 1-27.5, 1-30, 1.5-2, 1.5-3, 1.5-4, 1.5-5, 1.5-6, 1.5-7, 1.5-8, 1.5-9, 1.5-10, 1.5-11, 1.5-12, 1.5-13, 1.5-13.75, 1.5-14, 1.5-15, 1.5- 16, 1.5-17, 1.5-18, 1.5-19, 1.5-20, 1.5-22.5, 1.5-25, 1.5-27.5, 1.5-30, 2.5-2, 2.5-3, 2.5-4, 2.5- 5, 2.5-6, 2.5-7, 2.5-8, 2.5-9, 2.5-10, 2.5-11, 2.5-12, 2.5-13, 2.5-13.75, 2.5-14, 2.5-15, 2.5-16, 2.5-17, 2.5-18, 2.5-19, 2.5-20, 2.5-22.5, 2.5-25, 1.5-27.5, 1.5-30, 2.5-2, 2.5-3, 2.5-4, 2.5-
• the plinabulin is administered at a dose of about 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, 20, 20.5, 21, 21.5, 22, 22.5, 23, 23.5, 24, 24.5, 25, 25.5, 26, 26.5, 27, 27.5, 28, 28.5, 29, 29.5, 30, 30.5, 31,
• the plinabulin is administered at a dose less than about 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, 20, 20.5, 21, 21.5, 22, 22.5, 23, 23.5, 24, 24.5, 25, 25.5, 26, 26.5, 27, 27.5, 28, 28.5, 29, 29.5, 30, 30.5, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 mg/m 2 of the body surface area.
• the plinabulin is administered at a dose greater than about 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, 20, 20.5, 21, 21.5, 22, 22.5, 23, 23.5, 24, 24.5, 25, 25.5, 26, 26.5, 27, 27.5, 28, 28.5, 29, 29.5, 30, 30.5, 31, 32,
• the plinabulin dose is about 5 mg - 300 mg, 5 mg - 200 mg, 7.5 mg - 200 mg, 10 mg - 100 mg, 15 mg - 100 mg, 20 mg - 100 mg, 30 mg - 100 mg, 40 mg - 100 mg, 10 mg - 80 mg, 15 mg - 80 mg, 20 mg - 80 mg, 30 mg - 80 mg, 40 mg - 80 mg, 10 mg - 60 mg, 15 mg - 60 mg, 20 mg - 60 mg, 30 mg - 60 mg, or about 40 mg - 60 mg.
• the plinabulin administered is about 20 mg - 60 mg, 27 mg - 60 mg, 20 mg - 45 mg, or 27 mg - 45 mg.
• the plinabulin administered is about 5 mg-7.5 mg, 5 mg-9 mg, 5 mg-10 mg, 5 mg-12mg, 5mg-14mg, 5mg-15 mg, 5 mg-16 mg, 5 mg-18 mg, 5 mg-20 mg, 5 mg-22 mg, 5 mg-24 mg, 5 mg-26 mg, 5 mg-28mg, 5mg- 30mg, 5mg-32mg, 5mg-34mg, 5mg-36mg, 5mg-38mg, 5mg-40mg, 5mg-42mg, 5mg-44mg, 5mg-46mg, 5mg-48mg, 5mg-50mg, 5mg-52mg, 5mg-54mg, 5mg-56mg, 5mg-58mg, 5mg- 60mg, 7 mg-7.7 mg, 7 mg-9 mg, 7 mg-10 mg, 7 mg-12mg, 7mg-14mg, 7mg-15 mg, 7 mg-16 mg, 7 mg
• the plinabulin dose is greater than about 5 mg, about 10 mg, about 12.5 mg, about 13.5 mg, about 15 mg, about 17.5 mg, about 20 mg, about 22.5 mg, about 25 mg, about 27 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 125 mg, about 150mg, or about 200 mg.
• the plinabulin dose is about less than about 5 mg, about 10 mg, about 12.5 mg, about 13.5 mg, about 15 mg, about 17.5 mg, about 20 mg, about 22.5 mg, about 25 mg, about 27 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 125 mg, about 150mg, or about 200 mg.
• the chemotherapeutic composition or chemotherapeutic agent can be administered in an effective amount suitable for the treatment.
• the method described herein comprises administering one or more chemotherapeutic agents (e.g., cisplatin, doxorubicin, cyclophosphamide, topotecan) at a dose in the range of about 40-50 mg/kg in divided doses over 2-5 days.
• chemotherapeutic agents e.g., cisplatin, doxorubicin, cyclophosphamide, topotecan
• the method described herein comprises administering one or more chemotherapeutic agents at a dose in the range of about 10-30, 5-100, 10-200, 10-100, 10-90, 10-80, 10-70, 10-60, 10-50, 10-40, 10-30, 10-20, 20- 200, 20-100, 20-90, 20-80, 20-70, 20-60, 20-50, 20-40, 20-30, 30-200, 30-100, 30-90, 30-80, 30-70, 30-60, 30-50, 30-40, 40-200, 40-100, 40-90, 40-80, 40-70, 40-60, 40-50, 50-300, 50- 200, 50-100, 50-90, 50-80, 50-70, 50-60, 60-300, 60-200, 60-100, 60-90, 60-80, 60-70, 70- 300, 70-200, 70-100, 70-90, 70-80, 80-300, 80-200, 80-100, 80-90, or 90-300, 90-200, 90- 100, 100-500, 100-
• the method described herein comprises administering one or more chemotherapeutic agents at a dose in the range of about 10-15 mg/kg in divided doses over 7- 10 days or 3-5 mg/kg twice weekly. In some embodiments, the method described herein comprises administering one or more chemotherapeutic agents at a dose in the range of about 10-30, 5-100, 10-200, 10-100, 10-90, 10-80, 10-70, 10-60, 10-50, 10-40, 10-30, 10-20, 20- 200, 20-100, 20-90, 20-80, 20-70, 20-60, 20-50, 20-40, 20-30, 30-200, 30-100, 30-90, 30-80, 30-70, 30-60, 30-50, 30-40, 40-200, 40-100, 40-90, 40-80, 40-70, 40-60, 40-50, 50-300, 50- 200, 50-100, 50-90, 50-80, 50-70, 50-60, 60-300, 60-200, 60-100, 60-90, 60-80, 60-70, 70-
• the method further comprises administering one or more chemotherapeutic agents (e.g., cisplatin, doxorubicin, cyclophosphamide, topotecan) at a dose in the range of about 10-30, 5-100, 10-200, 10-100, 10-90, 10-80, 10-70, 10-60, 10- 50, 10-40, 10-30, 10-20, 20-200, 20-100, 20-90, 20-80, 20-70, 20-60, 20-50, 20-40, 20-30, 30-200, 30-100, 30-90, 30-80, 30-70, 30-60, 30-50, 30-40, 40-200, 40-100, 40-90, 40-80, 40- 70, 40-60, 40-50, 50-300, 50-200, 50-100, 50-90, 50-80, 50-70, 50-60, 60-300, 60-200, 60- 100, 60-90, 60-80, 60-70, 70-300, 70-200, 70-100, 70-90, 70-80, 50-70, 50-60, 60
• the method further comprises administering one or more chemotherapeutic agents at a dose of 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900 or 1000 mg/m 2 per cycle once every 4 weeks.
• the method further comprises administering one or more chemotherapeutic agents at a dose of 10-30, 5-100, 10- 200, 10-100, 10-90, 10-80, 10-70, 10-60, 10-50, 10-40, 10-30, 10-20, 20-200, 20-100, 20-90, 20-80, 20-70, 20-60, 20-50, 20-40, 20-30, 30-200, 30-100, 30-90, 30-80, 30-70, 30-60, 30- 50, 30-40, 40-200, 40-100, 40-90, 40-80, 40-70, 40-60, 40-50, 50-300, 50-200, 50-100, 50- 90, 50-80, 50-70, 50-60, 60-300, 60-200, 60-100, 60-90, 60-80, 60-70, 70-300, 70-200, 70- 100, 70-90, 70-80, 80-300, 80-200, 80-100, 80-90, or 90-300, 90-200, 90-100, 100-500, 100- 400, 100-300,
• the method further comprises administering one or more chemotherapeutic agents at a dose of 50 mg/m 2 per cycle repeated every 4 weeks.
• the method further comprises administering one or more chemotherapeutic agents (e.g., cisplatin) at a dose in the range of about 10-30, 5-100, 10-200, 10-100, 10-90, 10-80, 10-70, 10-60, 10-50, 10-40, 10-30, 10-20, 20-200, 20-100, 20-90, 20-80, 20-70, 20-60, 20-50, 20-40, 20-30, 30-200, 30-100, 30-90, 30- 80, 30-70, 30-60, 30-50, 30-40, 40-200, 40-100, 40-90, 40-80, 40-70, 40-60, 40-50, 50-300, 50-200, 50-100, 50-90, 50-80, 50-70, 50-60, 60-300, 60-200, 60-100, 60-90, 60-80, 60-70, 70-300, 70-200,
• the method further comprises administering one or more chemotherapeutic agents at a dose of 30-70 or 40-60 mg/m 2 per cycle once every 3 weeks or every 4 weeks.
• the dose of each of the chemotherapeutic agent administered can be independently selected from any one of the dose ranges described herein.
• one or more chemotherapeutic agents are administered at an amount of about 10-30, 5-100, 10-500, 10-400, 10-300, 10-200, 10-100, 10-90, 10-80, 10-70, 10-60, 10-50, 10-40, 10-30, 10-20, 20-500, 20-400, 20-300, 20-200, 20-100, 20-90, 20-80, 20-70, 20-60, 20-50, 20-40, 20-30, 30-500, 30-400, 30-300, 30-200, 30-100, 30-90, 30-80, 30-70, 30-60, 30-50, 30-40, 40-500, 40-400, 40-300, 40-200, 40-100, 40-90, 40-80, 40-70, 40-60, 40-50, 50-500, 50-400, 50-300, 50-200, 50-100, 50-90, 50-80, 50-70, 50-60, 60-500, 60-400, 60-300, 50-200, 50-100, 50-90, 50-80, 50-70, 50-60, 60-500, 60-400,
• the plinabulin is administered prior to the administration of the chemotherapeutic agent or chemotherapeutic composition. In some embodiments, the plinabulin is administered concurrently with the chemotherapeutic agent or chemotherapeutic composition. In some embodiments, the plinabulin is administered after the chemotherapeutic agent is administered or chemotherapeutic composition.
• the plinabulin is administered about 1 min, 5min, 10 min, 15 min, 20 min, 25 min, 30 min, lh, 1.5h, 2h, 2.5h, 3h, 4h, 5h, 6h, 7h, 8h, 9h, lOh, l lh, 12h, 13h, 14h, 15h, 16h, 17h, 18h, 19h, 20h, 24h, 30h, 36h, 40h, or 48h after the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin is administered in less than about 1 min, 5min, 10 min, 15 min, 20 min, 25 min, 30 min, lh, 1.5h, 2h, 2.5h, 3h, 4h, 5h, 6h, 7h, 8h, 9h, lOh, l lh, 12h, 13h, 14h, 15h, 16h, 17h, 18h, 19h, 20h, 21h, 22h, 23h, 24h, 30h, 36h, 40h, or 48h after the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin is administered in more than about 1 min, 5min, 10 min, 15 min, 20 min, 25 min, 30 min, lh, 1.5h, 2h, 2.5h, 3h, 4h, 5h, 6h, 7h, 8h, 9h, lOh, l lh, 12h, 13h, 14h, 15h, 16h, 17h, 18h, 19h, 20h, 21h, 22h, 23h, 24h30h, 36h, 40h, or 48h after the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin is administered in about lmin-5min, Imin-lOmin, lmin-15min, lmin-20min, 1 min-25min, 1 min-30min, 0.25h-0.5h, 0.25-0.75h, 0.25-lh,0.5h-lh, 0.5h-2h, 0.5h-2.5h, lh-2h, lh-3h, lh-5h, lh-24h, lmin-24h, or 1 min-2h, 1 day- 2days, lday - 3days, 1 day-4 days, 1 day-5 days, or 1 day-6 days after the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin when plinabulin is administered prior to a chemotherapeutic agent or chemotherapeutic composition administration, the plinabulin is administered about lmin-5min, Imin-lOmin, lmin-15min, lmin-20min, 1 min-25min, 1 min- 30min, 0.25h-0.5h, 0.25-0.75h, 0.25-lh,0.5h-lh, 0.5h-2h, 0.5h-2.5h, lh-2h, lh-3h, lh-5h, lh- 24h, lmin-lh, lmin-2h, lmin-5h, lmin-24h, 1 day- 2days, lday - 3 days, 1 day-4 days, 1 day- 5 days, or 1 day-6 days before the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin is administered about 1 min, 5min, 10 min, 15 min, 20 min, 25 min, 30 min, lh, 1.5h, 2h, 2.5h, 3h, 4h, 5h, 6h, 7h, 8h, 9h, lOh, 1 lh, 12h, 30h, 36h, 40h, 48h, 4 days, 5 days, 6 days, or 7 days before the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin is administered in less than about 1 min, 5min, 10 min, 15 min, 20 min, 25 min, 30 min, lh, 1.5h, 2h, 2.5h, 3h, 4h, 5h, 6h, 7h, 8h, 9h, lOh, 1 lh, 12h, 13h, 14h, 15h, 16h, 17h, 18h, 19h, 20h, 21h, 22h, 23h, 24h, 30h, 36h, 40h, 48h, 4 days, 5 days, 6 days, or 7 days before the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the plinabulin is administered in more than about 1 min, 5min, 10 min, 15 min, 20 min, 25 min, 30 min, lh, 1.5h, 2h, 2.5h, 3h, 4h, 5h, 6h, 7h, 8h, 9h, lOh, 1 lh, 12h, 13h, 14h, 15h, 16h, 17h, 18h, 19h, 20h, 21h, 22h, 23h, 24h, 30h, 36h, 40h, 48h, 3 days, 4 days, 5 days, 6 days, or 7 days before the administration of a chemotherapeutic agent or chemotherapeutic composition.
• the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin once every 3 weeks. In some embodiments, the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin once every 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks. In some embodiments, the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin two times every 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin once every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin twice every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 8, and day 15 of a 21 -day treatment cycle.
• co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin includes administering the chemotherapeutic agent prior to administering plinabulin. In some embodiments, co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin includes administering the chemotherapeutic agent after administering plinabulin. In some embodiments, coadministration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin includes administering the chemotherapeutic agent concurrently with plinabulin.
• the chemotherapeutic composition described in this paragraph can independently be a first, second, third, fourth, fifth, sixth, seventh, or eighth chemotherapeutic composition.
• the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin every day of the week for a week. In some embodiments, the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin every day of the week for 2 weeks, 3 weeks, or 4 weeks. In some embodiments, the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1 in weekly treatment. In some embodiments, the treatment schedule includes co-administration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1 and day 2 in weekly treatment.
• the treatment schedule includes coadministration of the chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 2, and day 3 in weekly treatment. In some embodiments, the treatment schedule includes co-administration of the chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 2, day 3 in weekly treatment. In some embodiments, the treatment schedule includes co-administration of the chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 2, day 3, and day 4 in weekly treatment. In some embodiments, the treatment schedule includes coadministration of the chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 2, day 3, day 4, and day 5 in weekly treatment.
• the treatment schedule includes co-administration of the chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 2, day 3, day 4, day 5, and day 6 in weekly treatment. In some embodiments, the treatment schedule includes coadministration of a chemotherapeutic agent or chemotherapeutic composition and plinabulin on day 1, day 3, and day 5 in weekly treatment. In some embodiments, the chemotherapeutic composition used on each administration day can be the same or different. In some embodiments, the chemotherapeutic composition used on the first administration day is different from the chemotherapeutic composition used on the rest of the administration days.
• the chemotherapeutic composition used on the first administration day is the same as or different from the chemotherapeutic composition used on the second administration day. In some embodiments, the chemotherapeutic composition used on the first administration day is the same as or different from the chemotherapeutic composition used on the third administration day. In some embodiments, the chemotherapeutic composition used on the first administration day is the same as or different from the chemotherapeutic composition used on the fourth administration day. In some embodiments, the chemotherapeutic composition used on the first administration day is the same as or different from the chemotherapeutic composition used on the fifth administration day.
• the chemotherapeutic composition used on the first administration day is the same as or different from the chemotherapeutic composition used on the sixth administration day. In some embodiments, the chemotherapeutic composition used on the first administration day is the same as or different from the chemotherapeutic composition used on the seventh administration day.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition (e.g., the first, the second, the third, the fourth, the fifth, the sixth, the seventh, or the eighth) once every 3 weeks.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition once every 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition two times every 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition once every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks. In some embodiments, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition twice every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition three times (e.g., day 1, 2, 3, or day 1, 3, 5) every week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition day 1, day 8, and day 15 of a 21 -day treatment cycle.
• the chemotherapeutic composition described in this paragraph can independently be the first, second, third, fourth, fifth, sixth, seventh, or eighth chemotherapeutic composition.
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition every day of the week for a week. In some embodiments, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition every day of the week for 2 weeks, 3 weeks, or 4 weeks. In some embodiments, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1 in weekly treatment. In some embodiments, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1 and day 2 in weekly treatment. In some embodiments the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day 2, day 3, and day 4 in weekly treatment. In some embodiments, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day
• the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day 2, day 3, day 4, and day 5 in weekly treatment, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day 2, day 3, day 4, and day 5 in weekly treatment, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day 2, day 3, day 4, and day 5 in weekly treatment, the treatment schedule includes administration of a chemotherapeutic agent or chemotherapeutic composition on day 1, day
• the treatment schedule includes administration of plinabulin once every 3 weeks.
• the treatment schedule includes administration of plinabulin once every 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of plinabulin two times every 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of plinabulin once every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of plinabulin twice every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of plinabulin three times (e.g., day 1, 2, 3, or day 1, 3, 5) every 1 week in a treatment cycle of 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks.
• the treatment schedule includes administration of plinabulin day 1, day 8, and day 15 of a 21 -day treatment cycle.
• the chemotherapeutic composition described in this paragraph can independently be the first, second, third, fourth, fifth, sixth, seventh, or eighth chemotherapeutic composition.
• the treatment schedule includes administration of plinabulin every day of the week for a week. In some embodiments, the treatment schedule includes administration of plinabulin every day of the week for 2 weeks, 3 weeks, or 4 weeks. In some embodiments, the treatment schedule includes administration of plinabulin on day 1 in weekly treatment. In some embodiments, the treatment schedule includes administration of plinabulin on day 1 and day 2 in weekly treatment. In some embodiments the treatment schedule includes administration of plinabulin on day 1, day 2, and day 3 in weekly treatment. In some embodiments, the treatment schedule includes administration of plinabulin on day 1, day 3, day 5 in weekly treatment. In some embodiments, the treatment schedule includes administration of plinabulin on day 1, day 2, day 3, and day 4 in weekly treatment. In some embodiments, the treatment schedule includes administration of plinabulin on day 1, day 2, day 3, day 4, and day 5 in weekly treatment, the treatment schedule includes administration of plinabulin on day 1, day 2, day 3, day 4, day 5 in weekly treatment, the treatment schedule includes administration of plinabulin on day 1, day 2, day 3, day 4,
• the treatment cycle can be repeated as long as the regimen is clinically tolerated.
• the treatment cycle for the chemotherapeutic agent and plinabulin is repeated for n times, wherein n is an integer in the range of 2 to 30. In some embodiments, n is 2, 3, 4, 5, 6, 7, 8, 9, or 10.
• a new treatment cycle can occur immediately after the completion of the previous treatment cycle. In some embodiments, a new treatment cycle can occur a period of time after the completion of the previous treatment cycle. In some embodiments, a new treatment cycle can occur after 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, or 7 weeks after the completion of the previous treatment cycle.
• the use of plinabulin can reduce the incidence of Grade 1 or 2 neutropenia by at least about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, or 100%).
• the use of plinabulin can reduce the incidence of Grade 3 or 4 neutropenia by at least about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, or 100%).
• the use of plinabulin can reduce the incidence of Grade 3 or 4 neutropenia by less than about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, or 100%).
• the use of plinabulin can reduce the incidence of Grade 3 or 4 neutropenia in the range of about 5% - 40%, 10%-40%, 12.5%-40%, 5% - 50%, 10%-50%, 12.5%-50%, 15%-50%, 17.5%-50%, 20%-50%, 25%-50%, 27.5%-50%, 30%-50%, 5% - 60%, 10%-60%, 12.5%-60%, 15%-60%, 17.5%-60%, 20%-60%, 25%-60%, 27.5%-60%, 30%-60%, 35%-60%, 37.5%-60%, 40%-60%, 45%-70%, or 50%-80%.
• the use of plinabulin can be about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, or 500% more effective than the use of G-CSF (e.g., pegfilgrastim) in reducing the incidence of Grade 3 or 4 neutropenia.
• G-CSF e.g., pegfilgrastim
• the use of plinabulin can be greater than about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, or 500% more effective than the use of G-CSF (e.g., pegfilgrastim) in reducing the incidence of Grade 3 or 4 neutropenia.
• G-CSF e.g., pegfilgrastim
• the use of plinabulin can be less than about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, or 500% more effective than the use of G-CSF (e.g., pegfilgrastim) in reducing the incidence of Grade 3 or 4 neutropenia.
• G-CSF e.g., pegfilgrastim
• the use of plinabulin can be greater than about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, or 500% more effective than the use of G-CSF (e.g., pegfilgrastim) in reducing the incidence of Grade 3 or 4 neutropenia.
• G-CSF e.g., pegfilgrastim
• the use of plinabulin can reduce the duration of severe neutropenia by about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, 500%, 600%, 700%, 800%, 900%, 10 times, 1 1 times, 12 times, 13 times, 14 times, 15 times, or 16 times.
• the use of plinabulin can reduce the duration of severe neutropenia by greater than about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, 500%, 600%, 700%, 800%, 900%, 10 times, 11 times, 12 times, 13 times, 14 times, 15 times, or 16 times.
• the use of plinabulin can reduce the duration of severe neutropenia by less than about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, 500%, 600%, 700%, 800%, 900%, 10 times, 11 times, 12 times, 13 times, 14 times, 15 times, or 16 times.
• the use of plinabulin can reduce the duration of severe neutropenia in the range
• plinabulin can be about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, 100%, 110%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, 500%, 600%, 700%, 800%, 900%, 10 times, 11 times, 12 times, 13 times, 14 times, 15 times, or 16 times more effective than G-CSF (e.g., pegfilgrastim) in reducing the duration of severe neutropenia.
• G-CSF e.g.,
• plinabulin can be greater than about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, 100%, 1 10%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, 500%, 600%, 700%, 800%, 900%), 10 times, 1 1 times, 12 times, 13 times, 14 times, 15 times, or 16 times more effective than G-CSF (e.g., pegfilgrastim) in reducing the duration of severe neutropenia.
• G-CSF e
• plinabulin can be less than about 5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.5%, 40%, 42.5%, 45%, 47.5%, 50%, 52.5%, 55%, 57.5%, 60%, 62.5%, 65%, 67.5%, 70%, 72.5%, 75%, 77.5%, 80%, 82.5%, 85%, 87.5%, 90%, 95%, 100%, 1 10%, 120%, 130%, 140%, 150%, 160%, 170%, 180%, 190%, 200%, 225%, 250%, 275%, 300%, 350% 400%, 450%, 500%, 600%, 700%, 800%, 900%, 10 times, 1 1 times, 12 times, 13 times, 14 times, 15 times, or 16 times more effective than G-CSF (e.g., pegfilgrastim) in reducing the duration of severe neutropenia.
• G-CSF e.
• plinabulin can be in the range of about 5% -15 times, 20% - 10 times, or 50%-500% more effective than G-CSF (e.g., pegfilgrastim) in reducing the duration of severe neutropenia.
• G-CSF e.g., pegfilgrastim
• the administration period can be a multi-week treatment cycle as long as the tumor remains under control and the regimen is clinically tolerated.
• a single dosage of plinabulin or other therapeutic agent can be administered once a week, and preferably once on each of day 1 and day 8 of a three-week (21 day) treatment cycle.
• a single dosage of plinabulin or other therapeutic agent can be administered once a week, twice a week, three times per week, four times per week, five times per week, six times per week, or daily during a one-week, two-week, three- week, four-week, or five-week treatment cycle.
• the administration can be on the same or different day of each week in the treatment cycle.
• the treatment cycle can be repeated as long as the regimen is clinically tolerated.
• the treatment cycle is repeated for n times, wherein n is an integer in the range of 2 to 30.
• n is 2, 3, 4, 5, 6, 7, 8, 9, or 10.
• a new treatment cycle can occur immediately after the completion of the previous treatment cycle.
• a new treatment cycle can occur a period of time after the completion of the previous treatment cycle.
• Administration of the pharmaceutical compositions described herein can be via any of the accepted modes of administration for agents that serve similar utilities including, but not limited to, orally, sublingually, buccally, subcutaneously, intravenously, intranasally, topically, transdermally, intradermally, intraperitoneally, intramuscularly, intrapulmonarilly, vaginally, rectally, intraocularly, or intragastrically (e.g., gastric feeding tube. Oral and parenteral administrations are customary in treating the indications that are the subject of the preferred embodiments.
• Some embodiments relate to a method of reducing neutropenia in a subject, comprising administering plinabulin or a pharmaceutically acceptable salt thereof to a subject in need thereof.
• the neutropenia is chemotherapy-induced.
• the neutropenia is induced by administration of the first chemotherapeutic composition that is myelosuppresive.
• the chemotherapeutic composition can include one or more chemotherapeutic agents.
• the chemotherapeutic agent is selected from the group consisting of cyclophosphamide, doxorubicin, paclitaxel, carboplatin, cisplatin, irinotecan, topotecan, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing, or combinations of one or more of the foregoing and docetaxel.
• the chemotherapeutic agent is selected from the group consisting of phosphamides, rubicins, platins, tecans, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing, or combinations of one or more of the foregoing and docetaxel.
• the chemotherapeutic agent is selected from the group consisting of phosphamides, rubicins, platins, tecans, taxanes, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing.
• the first chemotherapeutic composition can comprises one or more agents selected from the group consisting of phosphamides, rubicins, platins, tecans, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing.
• the chemotherapeutic composition (e.g., the second, the third, the fourth, the fifth, the sixth, the seventh, the eighth chemotherapeutic composition) can comprises one or more agents selected from the group consisting of phosphamides, rubicins, platins, tecans, taxanes, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing.
• the platin can be one or more selected from the group consisting of cisplatin, carboplatin, and oxaliplatin, nedaplatin, triplatin tetranitrate, phenanthriplatin, picoplatin, and satraplatin.
• the tecan can be topotecan, irinotecan, or combination thereof.
• the phosphamides can be cyclophosphamide, ifosamide, or combination thereof.
• the taxane can be selected from the group consisting of docetaxel, paclitaxel, cabazitaxel.
• the rubicin can be one or more selected from doxorubicin, epirubicin, daunorubicin, and valrubicin.
• the neutropenia is induced by radiation therapy. Some embodiments include reducing the likelihood of onset of, or reducing the severity of, neutropenia in a subject, comprising administering plinabulin to a subject in need thereof.
• Some embodiments of the foregoing methods comprise administering plinabulin or a pharmaceutically acceptable salt thereof and one or more additional chemotherapeutic agents.
• the additional chemotherapeutic agent is selected from the group consisting of cyclophosphamide, doxorubicin, paclitaxel, carboplatin, cisplatin, irinotecan, topotecan, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing, or combinations of one or more of the foregoing and docetaxel.
• plinabulin and the one or more additional chemotherapeutic agent are administered simultaneously. In one such embodiment, administration in combination is accomplished by combining the agents in a single dosage form.
• the agents are administered sequentially. In one embodiment the agents are administered through the same route, such as orally or intravenously. In another embodiment, the agents are administered through different routes, such as one being administered orally and another being administered i.v.
• the time period between administration of one or more agent and administration of the coadministered one or more agent can be about 1 hour, 2 hours, 3 hours, 5 hours, 8 hours, 10 hours, 12 hours, 15 hours, 18 hours, 20 hours, 24 hours, 36 hours, 48 hours, 3 days, 4 days, 5 days, 6 days, 7 days, 10 days, 14 days, 21 days, 28 days, or 30 days.
• plinabulin is administered prior to administration of the one or more additional chemotherapeutic agents.
• the additional chemotherapeutic agents are administered prior to plinabulin.
• the method described herein comprises coadministering one or more chemotherapeutic agents and plinabulin. In some embodiments, the method described herein comprises co-administering two chemotherapeutic agents and plinabulin. In some embodiments, the method described herein comprises co-administering three chemotherapeutic agents and plinabulin. In some embodiments, the method described herein comprises co-administering four chemotherapeutic agents and plinabulin.
• the second or third chemotherapeutic agent when a second and/or third chemotherapeutic agents are administered with the first chemotherapeutic agent and plinabulin, can be administered prior to, after, or concurrently with the coadministration of the first chemotherapeutic agent and plinabulin.
• the administration schedule of the second or third chemotherapeutic agent can be different from the first chemotherapeutic agent.
• the administration schedule of the second or third chemotherapeutic agent can be the same as the first chemotherapeutic agent.
• the additional chemotherapeutic agent does not include docetaxel. In some embodiments, the additional chemotherapeutic agent does not include a taxane.
• Some embodiments comprise administering plinabulin or a pharmaceutically acceptable salt thereof and radiation therapy to a subject
• Some embodiments include identifying that a subject is suffering from neutropenia and then administering plinabulin or a pharmaceutically acceptable salt thereof to the subject.
• Other embodiments include administrating plinabulin or a pharmaceutically acceptable salt thereof to a subject before detection of neutropenia to reduce the incidence or severity thereof.
• some embodiments include identifying a subject that is at risk for developing neutropenia (e.g., due to myelosuppressive chemotherapy or radiation therapy) but does not yet exhibit neutropenia, and then administering plinabulin or a pharmaceutically acceptable salt thereof to the subject.
• no additional agent that acts to reduce neutropenia are administered.
• the methods are practiced without administering a granulocyte-colony stimulating factor (e.g., filgrastim).
• the methods are practiced without administering any additional active agent beyond the agents recited in above.
• the subject is a human.
• the methods described above can be achieved by administering plinabulin and any additional chemotherapeutic agents via any of the accepted modes of administration for agents that serve similar utilities including, but not limited to, orally, sublingually, buccally, subcutaneously, intravenously, intranasally, topically, transdermally, intradermally, intraperitoneally, intramuscularly, intrapulmonarilly, vaginally, rectally, intraocularly, or intragastrically. Oral and parenteral administrations are customary in treating the indications that are the subject of the preferred embodiments.
• the administration period can be a multi-week treatment cycle.
• a single dosage of plinabulin or other therapeutic agent can be administered once a week, and preferably once on each of day 1 and day 8 of a three-week (21 day) treatment cycle.
• a single dosage of plinabulin or other therapeutic agent can be administered once a week, twice a week, three times per week, four times per week, five times per week, six times per week, or daily during a one-week, two-week, three- week, four-week, or five-week treatment cycle.
• the administration can be on the same or different day of each week in the treatment cycle.
• the treatment cycle can be repeated as long as the regimen is clinically tolerated.
• the treatment cycle is repeated for n times, wherein n is an integer in the range of 2 to 30.
• n is 2, 3, 4, 5, 6, 7, 8, 9, or 10.
• a new treatment cycle can occur immediately after the completion of the previous treatment cycle.
• a new treatment cycle can occur a period of time after the completion of the previous treatment cycle.
• compositions comprising plinabulin or a pharmaceutically effective salt thereof and an additional chemotherapeutic agent.
• the additional chemotherapeutic agent is selected from the group consisting of phosphamides, rubicins, platins, tecans, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing, or combinations of one or more of the foregoing and docetaxel.
• the additional chemotherapeutic agent is not taxane.
• the additional chemotherapeutic agent is not docetaxel.
• the additional chemotherapeutic agent is selected from the group consisting of cyclophosphamide, doxorubicin, carboplatin, cisplatin, topotecan, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing, or combinations of one or more of the foregoing and docetaxel.
• the additional chemotherapeutic agent is selected from the group consisting of cyclophosphamide, doxorubicin, paclitaxel, carboplatin, cisplatin, irinotecan, and pharmaceutically acceptable salts thereof, or combinations of two or more of the foregoing, or combinations of one or more of the foregoing and docetaxel.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof and doxorubicin or a pharmaceutically effective salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof, doxorubicin or a pharmaceutically effective salt thereof, and docetaxel or a pharmaceutically effective salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof and paclitaxel or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof and carboplatin or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof, paclitaxel or a pharmaceutically acceptable salt thereof, and carboplatin or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof and cisplatin or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof and irinotecan or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition comprises plinabulin or a pharmaceutically effective salt thereof and cyclophosphamide or a pharmaceutically acceptable salt thereof.
• the pharmaceutical composition does not comprise docetaxel.
• the pharmaceutical composition does not comprise a taxane.
• the pharmaceutical compositions described above do not comprise any additional agent that acts to reduce neutropenia.
• the pharmaceutical compositions do not include a granulocyte-colony stimulating factor (e.g., filgrastim).
• the pharmaceutical compositions do not include any additional active agent beyond the agents recited in the compositions above.
• compositions include two or more separate pharmaceutical compositions, one of which comprises plinabulin or a pharmaceutically acceptable salt thereof, and one or more other pharmaceutical compositions that comprise additional chemotherapeutic agents.
• the additional chemotherapeutic agent is selected from the group consisting of cyclophosphamide, doxorubicin, paclitaxel, carboplatin, cisplatin, irinotecan, and pharmaceutically acceptable salts thereof.
• the compositions described above can further include one or more pharmaceutically acceptable diluents.
• the pharmaceutically acceptable diluent can include Kolliphor HS-15® (Polyethylene glycol (15)-hydroxystearate, kolliphor).
• the pharmaceutically acceptable diluent can include propylene glycol.
• the pharmaceutically acceptable diluents can include kolliphor and propylene glycol.
• the pharmaceutically acceptable diluents can include kolliphor and propylene glycol, wherein the kolliphor is about 40% by weight and propylene glycol is about 60% by weight based on the total weight of the diluents.
• the composition can further include one or more other pharmaceutically acceptable excipients.
• compositions described above can further include one or more pharmaceutically acceptable carrier or excipient.
• pharmaceutically acceptable carrier or “pharmaceutically acceptable excipient” includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents and the like. The use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated. In addition, various adjuvants such as are commonly used in the art may be included. Considerations for the inclusion of various components in pharmaceutical compositions are described, e.g., in Gilman et al. (Eds.) (1990); Goodman and Gilman's: The Pharmacological Basis of Therapeutics, 8th Ed., Pergamon Press, which is incorporated herein by reference in its entirety.
• substances which can serve as pharmaceutically- acceptable carriers or components thereof, are sugars, such as lactose, glucose and sucrose; starches, such as corn starch and potato starch; cellulose and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose, and methyl cellulose; powdered tragacanth; malt; gelatin; talc; solid lubricants, such as stearic acid and magnesium stearate; calcium sulfate; vegetable oils, such as peanut oil, cottonseed oil, sesame oil, olive oil, corn oil and oil of theobroma; polyols such as propylene glycol, glycerin, sorbitol, mannitol, and polyethylene glycol; alginic acid; emulsifiers, such as the TWEENS; wetting agents, such sodium lauryl sulfate; coloring agents; flavoring agents; tableting agents, stabilizers; antioxidants; preservatives; pyr
• compositions described herein are preferably provided in unit dosage form.
• a "unit dosage form" is a composition containing an amount of a compound or composition that is suitable for administration to an animal, preferably a mammalian subject, in a single dose, according to good medical practice.
• the preparation of a single or unit dosage form does not imply that the dosage form is administered once per day or once per course of therapy.
• Such dosage forms are contemplated to be administered once, twice, thrice or more per day and may be administered as infusion over a period of time (e.g., from about 30 minutes to about 2-6 hours), or administered as a continuous infusion, and may be given more than once during a course of therapy, although a single administration is not specifically excluded.
• the skilled artisan will recognize that the formulation does not specifically contemplate the entire course of therapy and such decisions are left for those skilled in the art of treatment rather than formulation.
• Standard pharmaceutical formulation techniques can be used to make the pharmaceutical compositions described herein, such as those disclosed in Remington's The Science and Practice of Pharmacy, 21st Ed., Lippincott Williams & Wilkins (2005), incorporated herein by reference in its entirety.
• compositions as described above may be in any of a variety of suitable forms for a variety of routes for administration, for example, for oral, sublingual, buccal, nasal, rectal, topical (including transdermal and intradermal), ocular, intracerebral, intracranial, intrathecal, intra-arterial, intravenous, intramuscular, or other parental routes of administration.
• routes for administration for example, for oral, sublingual, buccal, nasal, rectal, topical (including transdermal and intradermal), ocular, intracerebral, intracranial, intrathecal, intra-arterial, intravenous, intramuscular, or other parental routes of administration.
• oral and nasal compositions include compositions that are administered by inhalation, and made using available methodologies.
• a variety of pharmaceutically- acceptable carriers well-known in the art may be used.
• Pharmaceutically-acceptable carriers include, for example, solid or liquid fillers, diluents, hydrotropies, surface-active agents, and encapsulating substances.
• Optional pharmaceutically-active materials may be included, which do not substantially interfere with the activity of the compound or composition.
• the amount of carrier employed in conjunction with the compound or composition is sufficient to provide a practical quantity of material for administration per unit dose of the compound.
• Various oral dosage forms can be used, including such solid forms as tablets, capsules ⁇ e.g., liquid gel capsule and solid gel capsule), granules and bulk powders. Tablets can be compressed, tablet triturates, enteric-coated, sugar-coated, film-coated, or multiple-compressed, containing suitable binders, lubricants, diluents, disintegrating agents, coloring agents, flavoring agents, flow-inducing agents, and melting agents.
• Liquid oral dosage forms include aqueous solutions, emulsions, suspensions, solutions and/or suspensions reconstituted from non-effervescent granules, and effervescent preparations reconstituted from effervescent granules, containing suitable solvents, preservatives, emulsifying agents, suspending agents, diluents, sweeteners, melting agents, coloring agents and flavoring agents.
• the pharmaceutically-acceptable carriers suitable for the preparation of unit dosage forms for peroral administration is well-known in the art.
• Tablets typically comprise conventional pharmaceutically-compatible adjuvants as inert diluents, such as calcium carbonate, sodium carbonate, mannitol, lactose and cellulose; binders such as starch, gelatin and sucrose; disintegrants such as starch, alginic acid and croscarmelose; lubricants such as magnesium stearate, stearic acid and talc.
• Glidants such as silicon dioxide can be used to improve flow characteristics of the powder mixture.
• Coloring agents such as the FD&C dyes, can be added for appearance.
• Sweeteners and flavoring agents such as aspartame, saccharin, menthol, peppermint, and fruit flavors, are useful adjuvants for chewable tablets.
• Capsules typically comprise one or more solid diluents disclosed above. The selection of carrier components depends on secondary considerations like taste, cost, and shelf stability, which are not critical, and can be readily made by a person skilled in the art.
• Peroral compositions also include liquid solutions, emulsions, suspensions, and the like.
• the pharmaceutically-acceptable carriers suitable for preparation of such compositions are well known in the art.
• Typical components of carriers for syrups, elixirs, emulsions and suspensions include ethanol, glycerol, propylene glycol, polyethylene glycol, liquid sucrose, sorbitol and water.
• typical suspending agents include methyl cellulose, sodium carboxym ethyl cellulose, AVICEL RC-591, tragacanth and sodium alginate;
• typical wetting agents include lecithin and polysorbate 80; and typical preservatives include methyl paraben and sodium benzoate.
• Peroral liquid compositions may also contain one or more components such as sweeteners, flavoring agents and colorants disclosed above.
• compositions may also be coated by conventional methods, typically with pH or time-dependent coatings, such that the subject composition is released in the gastrointestinal tract in the vicinity of the desired topical application, or at various times to extend the desired action.
• dosage forms typically include, but are not limited to, one or more of cellulose acetate phthalate, polyvinyl acetate phthalate, hydroxypropyl methyl cellulose phthalate, ethyl cellulose, Eudragit coatings, waxes and shellac.
• compositions useful for attaining systemic delivery of the subject compounds include sublingual, buccal and nasal dosage forms.
• Such compositions typically comprise one or more of soluble filler substances such as sucrose, sorbitol and mannitol; and binders such as acacia, microcrystalline cellulose, carboxymethyl cellulose and hydroxypropyl methyl cellulose. Glidants, lubricants, sweeteners, colorants, antioxidants and flavoring agents disclosed above may also be included.
• a liquid composition which is formulated for topical ophthalmic use, is formulated such that it can be administered topically to the eye.
• the comfort may be maximized as much as possible, although sometimes formulation considerations (e.g. drug stability) may necessitate less than optimal comfort.
• the liquid may be formulated such that the liquid is tolerable to the patient for topical ophthalmic use.
• an ophthalmically acceptable liquid may either be packaged for single use, or contain a preservative to prevent contamination over multiple uses.
• solutions or medicaments are often prepared using a physiological saline solution as a major vehicle.
• Ophthalmic solutions may preferably be maintained at a comfortable pH with an appropriate buffer system.
• the formulations may also contain conventional, pharmaceutically acceptable preservatives, stabilizers and surfactants.
• Preservatives that may be used in the pharmaceutical compositions disclosed herein include, but are not limited to, benzalkonium chloride, PHMB, chlorobutanol, thimerosal, phenylmercuric, acetate and phenylmercuric nitrate.
• a useful surfactant is, for example, Tween 80.
• various useful vehicles may be used in the ophthalmic preparations disclosed herein. These vehicles include, but are not limited to, polyvinyl alcohol, povidone, hydroxypropyl methyl cellulose, poloxamers, carboxymethyl cellulose, hydroxyethyl cellulose and purified water.
• Tonicity adjustors may be added as needed or convenient. They include, but are not limited to, salts, particularly sodium chloride, potassium chloride, mannitol and glycerin, or any other suitable ophthalmically acceptable tonicity adjustor.
• buffers include acetate buffers, citrate buffers, phosphate buffers and borate buffers. Acids or bases may be used to adjust the pH of these formulations as needed.
• Ophthalmically acceptable antioxidants include, but are not limited to, sodium metabi sulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole and butyl ated hydroxytoluene.
• compositions which may be included in the ophthalmic preparations, are chelating agents.
• a useful chelating agent is edetate disodium (EDTA), although other chelating agents may also be used in place or in conjunction with it.
• EDTA edetate disodium
• Topical formulations may generally be comprised of a pharmaceutical carrier, co-solvent, emulsifier, penetration enhancer, preservative system, and emollient.
• compositions described herein may be dissolved or dispersed in a pharmaceutically acceptable diluent, such as a saline or dextrose solution.
• a pharmaceutically acceptable diluent such as a saline or dextrose solution.
• Suitable excipients may be included to achieve the desired pH, including but not limited to NaOH, sodium carbonate, sodium acetate, HC1, and citric acid.
• the pH of the final composition ranges from 2 to 8, or preferably from 4 to 7.
• Antioxidant excipients may include sodium bisulfite, acetone sodium bisulfite, sodium formaldehyde, sulfoxylate, thiourea, and EDTA.
• excipients found in the final intravenous composition may include sodium or potassium phosphates, citric acid, tartaric acid, gelatin, and carbohydrates such as dextrose, mannitol, and dextran. Further acceptable excipients are described in Powell, et al., Compendium of Excipients for Parenteral Formulations, PDA J Pharm Sci and Tech 1998, 52 238-311 and Nema et al., Excipients and Their Role in Approved Injectable Products: Current Usage and Future Directions, PDA J Pharm Sci and Tech 2011, 65 287-332, both of which are incorporated herein by reference in their entirety.
• Antimicrobial agents may also be included to achieve a bacteriostatic or fungistatic solution, including but not limited to phenylmercuric nitrate, thimerosal, benzethonium chloride, benzalkonium chloride, phenol, cresol, and chlorobutanol.
• compositions for intravenous administration may be provided to caregivers in the form of one or more solids that are reconstituted with a suitable diluent such as sterile water, saline or dextrose in water shortly prior to administration.
• a suitable diluent such as sterile water, saline or dextrose in water shortly prior to administration.
• the compositions are provided in solution ready to administer parenterally.
• the compositions are provided in a solution that is further diluted prior to administration.
• the combination may be provided to caregivers as a mixture, or the caregivers may mix the two agents prior to administration, or the two agents may be administered separately.
• a single dose of Plinabulin or other therapeutic agent may be from about 5 mg/m 2 to about 150 mg/m 2 of body surface area, from about 5 mg/m 2 to about 100 mg/m 2 of body surface area, from about 10 mg/m 2 to about 100 mg/m 2 of body surface area, from about 10 mg/m 2 to about 80 mg/m 2 of body surface area, from about 10 mg/m 2 to about 50 mg/m 2 of body surface area, from about 10 mg/m 2 to about 40 mg/m 2 of body surface area, from about 10 mg/m 2 to about 30 mg/m 2 of body surface area, from about 13.5 mg/m 2 to about 100 mg/m 2 of body surface area, from about 13.5 mg/m 2 to about 80 mg/m 2 of body surface area, from about 13.5 mg/m 2 to about 50 mg/m 2 of body
• a single dose of plinabulin or other therapeutic agent may be from about 13.5 mg/m 2 to about 30 mg/m 2 of body surface area.
• a single dose of plinabulin or other therapeutic agent may be about 5 mg/m 2 , about 10 mg/m 2 , about 12.5 mg/m 2 , about 13.5 mg/m 2 , about 15 mg/m 2 , about 17.5 mg/m 2 , about 20 mg/m 2 , about 22.5 mg/m 2 , about 25 mg/m 2 , about 27.5 mg/m 2 , about 30 mg/m 2 , about 40 mg/m 2 , about 50 mg/m 2 , about 60 mg/m 2 , about 70 mg/m 2 , about 80 mg/m 2 , about 90 mg/m 2 , or about 100 mg/m 2 , of body surface area.
• a single dose of plinabulin or other therapeutic agent may be from about 5 mg to about 300 mg, from about 5 mg to about 200 mg, from about 7.5 mg to about 200 mg, from about 10 mg to about 100 mg, from about 15 mg to about 100 mg, from about 20 mg to about 100 mg, from about 30 mg to about 100 mg, from about 40 mg to about 100 mg, from about 10 mg to about 80 mg, from about 15 mg to about 80 mg, from about 20 mg to about 80 mg, from about 30 mg to about 80 mg, from about 40 mg to about 80 mg, from about 10 mg to about 60 mg, from about 15 mg to about 60 mg, from about 20 mg to about 60 mg, from about 30 mg to about 60 mg, or from about 40 mg to about 60 mg, In some embodiments, a single dose of plinabulin or other therapeutic agent may be from about 20 mg to about 60 mg, from about 27 mg to about 60 mg, from about 20 mg to about 45 mg, or from about 27 mg to about 45 mg.
• a single dose of plinabulin or other therapeutic agent may be about 5 mg, about 10 mg, about 12.5 mg, about 13.5 mg, about 15 mg, about 17.5 mg, about 20 mg, about 22.5 mg, about 25 mg, about 27 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 125 mg, about 150mg, or about 200 mg.
• compositions described herein can be administered or used in combination with other treatments such as radiation or biologic therapies.
• PMI Nutrition International Certified Rodent Chow No. 5CR4 was provided ad libitum throughout the study, except during designated procedures. The same diet in meal form was provided to individual animals as warranted by clinical signs (e.g., broken/damaged incisors or other health changes).
• Figure 1 is a graph of neutrophil count 24 hours post dosing of cyclophosphamide, plinabulin, or the combination of cyclophosphamide and plinabulin (i.e., from the 20 rats that were terminated on Day 2).
• the results indicate that administration of cyclophosphamide caused a decrease in neutrophil count while the combination of plinabulin and cyclophosphamide maintained the neutrophil count.
• Figure 3 depicts results from all rats, including the Day -1 bleed as well as the terminations on Days 2, 3, and 10. Again, the results indicate that plinabulin reduced the neutropenia caused by cyclophosphamide.
• control group showed some changes from the baseline (Day -1), and this change was compared with the changes in other treatment groups. These were expressed as a percentage of the control level on Day 3.
• Table 5 and Figure 5 show the ANC levels in each group on Day 3, and the difference between the chemotherapeutic with and without plinabulin treatment is shown in Table 6 and Figure 6.
• chemotherapeutic agents cyclophosphamide respectively induced neutropenia in rats at around 48h after a single intra-peritoneal injection.
• the doxorubicin was administered intravenously, and plinabulin was administered through intraperitoneal injection.
• the doxorubicin induced a long-lasting neutropenia in the rat, when it was administered at a dose of 3.0 mg/kg.
• Plinabulin significantly reduced the doxorubicin- induced neutropenia as doses of 3.5 and 7.5 mg/kg IP, when administered one hour after doxorubicin.
• Vehicle (lOml/kg) Single, lh post cis-platin c Vehicle + Vehicle (for cis-platin), Plinabulin 4.9 mg/kg (4.9
• Table 13 shows the ANC levels on Day 3 after treatment expressed as percentage of the baseline (Day -1 pretreatment)
• the ANC levels in the Control Group were not significantly different between predose and Day 3, and a direct comparison can be made between groups.
• Cisplatin at 6.5 mg/kg in the rat induced a statistically significant neutropenia on Day 3 post dosing.
• Plinabulin at 4.9 mg/kg did not change ANC levels.
• plinabulin 2.3 mg/kg, 4.9 mg/kg and 7.5 mg/kg
• Table 14 shows the ANC levels on Day 3 for various test groups.
• Figure 9 shows the ANC levels on day 3 for the cisplatin alone group and the cis-platin and plinabulin combination groups.
• Figure 10 shows the dose-response curve for plinabulin on cis-platin induced neutropenia in the rat, with the ANC data expressed as percentage of the ANC levels measured in the cis-platin only treatment group.
• the ANC levels in the cis-platin and plinabulin combination dosed groups were expressed as the percent of ANC in the cis-platin alone group (Day 3)
• plinabulin exhibited a dose-response effect in decreasing the neutropenia observed in the cis-platin alone group.
• the control sample contained 7.1% Tween 80 (v/v), 25.5% Propylene glycol (v/v), and 67.4% D5W(5% dextrose in water) (v/v).
• Topotecan (0.25 or 1.0 mg/kg IV) was administered to adult male Sprague-Dawley rats on Days 1, 3 and 5. Topotecan was administered by intravenous infusion over a period of 30 minutes using a syringe infusion pump and sterile disposable syringes at a dose volume of lOmL/kg.
• Plinabulin (3.75 mg/kg, IP) was dosed 1 hour post topotecan following each topotecan dose.
• Plinabulin (7.5 mg/kg IP) was dosed 1 hour after the topotecan dose (0.25 mg/kg) on Day 1 only.
• FIGs 11A and 11B illustrate the change of ANC levels post the administration of control, plinabulin, and the combination of topotecan and plinabulin.
• the topotecan induced a long-lasting neutropenia in the rat, when it was administered at a dose of 1 or 0.25 mg/kg.
• Plinabulin significantly reduced the topotecan-induced neutropenia as doses of 3.75 and 7.5 mg/kg IP, when administered one hour after topotecan.
• a study can be performed to evaluate the effect of Plinabulin in reducing or treating a test chemotherapeutic agent-induced neutropenia.
• An effective amount of the test chemotherapeutic agent is administered to a test subject (e.g., adult male Sprague- Dawley rats) on Days 1, 3 and 5.
• Plinabulin in the range of about 3.75 mg/kg to 40 mg/kg is dosed after the test chemotherapeutic agent is administered to the test subject.
• Blood collection is performed Days -2, 0, 2, 4, 6, 7, 8, 9, 10 for the pilot and Days -2, 0, 2, 3, 4, 5, 6, 7, 8, 10, 15 for the main study. Blood samples are analyzed for total and differential blood cell counts.
• a study can be performed to evaluate the effect of Plinabulin in reducing or treating a tecan compound induced neutropenia.
• An effective amount of the tecan compound is administered to a test subject (e.g., adult male Sprague-Dawley rats).
• Plinabulin in the range of about 3.75 mg/kg to 40 mg/kg is dosed after the tecan compound is administered to the test subject.
• Blood collection is performed Days -2, 0, 2, 4, 6, 7, 8, 9, 10 for the pilot and Days -2, 0, 2, 3, 4, 5, 6, 7, 8, 10, 15 for the main study. Blood samples are analyzed for total and differential blood cell counts.
• a study can be performed to evaluate the effect of Plinabulin in reducing or treating a platin compound induced neutropenia.
• An effective amount of the platin compound is administered to a test subject (e.g., adult male Sprague-Dawley rats) on Days 1, 3 and 5.
• Plinabulin in the range of about 3.75 mg/kg to 40 mg/kg is dosed after the platin compound is administered to the test subject.
• Blood collection is performed Days -2, 0, 2, 4, 6, 7, 8, 9, 10 for the pilot and Days -2, 0, 2, 3, 4, 5, 6, 7, 8, 10, 15 for the main study. Blood samples are analyzed for total and differential blood cell counts.
• a study can be performed to evaluate the effect of Plinabulin in reducing or treating a phosphamide compound induced neutropenia.
• An effective amount of the phosphamide compound is administered to a test subject (e.g., adult male Sprague-Dawley rats) on Days 1, 3 and 5.
• Plinabulin in the range of about 3.75 mg/kg to 40 mg/kg is dosed after the phosphamide compound is administered to the test subject.
• Blood collection is performed Days -2, 0, 2, 4, 6, 7, 8, 9, 10 for the pilot and Days -2, 0, 2, 3, 4, 5, 6, 7, 8, 10, 15 for the main study. Blood samples are analyzed for total and differential blood cell counts.
• a study can be performed to evaluate the effect of Plinabulin in reducing or treating a rubicin compound induced neutropenia.
• An effective amount of the rubicin compound is administered to a test subject (e.g., adult male Sprague-Dawley rats) on Days 1, 3 and 5.
• Plinabulin in the range of about 3.75 mg/kg to 40 mg/kg is dosed after the rubicin compound is administered to the test subject.
• Blood collection is performed Days -2, 0, 2, 4, 6, 7, 8, 9, 10 for the pilot and Days -2, 0, 2, 3, 4, 5, 6, 7, 8, 10, 15 for the main study. Blood samples are analyzed for total and differential blood cell counts.
• a study can be performed to evaluate the effect of Plinabulin in reducing or treating radiation therapy induced neutropenia.
• a radiation therapy is administered to a test subject (e.g., adult male Sprague-Dawley rats) on days 1, 3 and 5.
• Plinabulin in the range of about 3.75 mg/kg to 40 mg/kg is dosed after the radiation is administered to the test subject.
• Blood collection is performed Days -2, 0, 2, 4, 6, 7, 8, 9, 10 for the pilot and Days - 2, 0, 2, 3, 4, 5, 6, 7, 8, 10, 15 for the main study. Blood samples are analyzed for total and differential blood cell counts.

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