WO2018066278A1 - リンパ行性薬剤投与法で有効な薬剤 - Google Patents
リンパ行性薬剤投与法で有効な薬剤 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
- A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
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- A61K31/00—Medicinal preparations containing organic active ingredients
- 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
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- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/4353—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
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- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/47—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
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- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
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- A61P35/00—Antineoplastic agents
Definitions
- the present invention relates to a pharmaceutical composition suitable for a lymphatic drug administration method.
- Cancer is a disease that affects one of two Japanese people, and 90% of cancer patients are killed by metastasis. Many cancers, including breast cancer and head and neck cancer, metastasize to regional lymph nodes via lymphatic vessels. The lymph node that first metastasizes is called the sentinel lymph node.
- lymph node dissection and radiotherapy are commonly used to treat metastatic lymph nodes.
- Systemic chemotherapy cannot always achieve a satisfactory therapeutic result because it is easily reabsorbed by the capillaries in the surrounding stroma.
- An object of the present invention is to provide a more suitable pharmaceutical composition when an anticancer agent is administered into a lymph node.
- the present invention relates to the following (1) to (10).
- a pharmaceutical composition for treating or preventing cancer administered into a lymph node comprising one or more anticancer agents selected from antimetabolites and plant alkaloid anticancer agents as active ingredients .
- the lymph node to be administered is a lymph node for the purpose of treatment or prophylactic treatment or a lymph node located upstream of a lymphatic network to which the lymph node belongs, according to any one of (1) to (3) Pharmaceutical composition.
- the pharmaceutical composition for intralymphatic administration of the present invention exhibits an excellent antitumor effect at a low dose.
- administration into a lymph node located upstream of the lymphatic network makes it possible to treat a lymph node located downstream as a treatment target. Thereby, a lymph node in an early stage of metastasis or a lymph node having a high risk of metastasis can be targeted for treatment or prophylactic treatment.
- the figure of the drug administration using the inherent axillary lymph node metastasis model mouse and the mouse Transplanting tumor cells into the subiliac lymph node (SiLN) induces tumor cell metastasis through the lymphatic vessels to the intrinsic axillary lymph node (PALN).
- the drug is then administered to the accessory axillary lymph node (AALN) to deliver the drug to the specific axillary lymph node via the lymphatic vessel and treat the metastasized tumor cells.
- b is an enlarged ⁇ portion of a
- cor indicates a lymph node cortex
- T indicates a tumor.
- Tumor cells remain on the surface of the lymph node cortex, but no tumor cells are found in the area corresponding to the lymph node marginal sinus.
- a pathological photograph of an accessory axillary lymph node at day 9 T after administration of Solution C (a: 2 times, b: 10 times). b is an enlarged ⁇ portion of a, and F indicates fiberization.
- the pharmaceutical composition of the present invention contains one or more anticancer agents selected from antimetabolites and plant alkaloid anticancer agents, and is locally administered into lymph nodes.
- antimetabolites include 5-fluorouracil (5-FU), 5-FU prodrugs (eg, tegafur or a salt thereof), capecitabine or a salt thereof, TS-1 (also referred to as S-1; a modulator in tegafur).
- 5-FU 5-fluorouracil
- 5-FU prodrugs eg, tegafur or a salt thereof
- capecitabine or a salt thereof
- TS-1 also referred to as S-1; a modulator in tegafur
- fluoropyrimidine anticancer drugs such as carmofur and doxyfluridine, gemcitabine, cytarabine, enositabine, mercaptopurine, fludarabine, cladribine, methotrexate, pemetrexed, hydroxycarbamide, nelarabine, pentostatin and their pros Drugs and the like are mentioned, and fluorinated pyrimidine-based anticancer agents in which 5-fluorouracil is present in vivo are more preferable, and 5-fluorouracil or a salt thereof is particularly preferable.
- the salt includes a pharmaceutically acceptable inorganic acid (for example, hydrochloric acid, sulfuric acid, hydrobromic acid, hydroiodic acid, nitric acid, phosphoric acid) or an organic acid (for example, formic acid, acetic acid, propionic acid, malonic acid).
- a pharmaceutically acceptable inorganic acid for example, hydrochloric acid, sulfuric acid, hydrobromic acid, hydroiodic acid, nitric acid, phosphoric acid
- an organic acid for example, formic acid, acetic acid, propionic acid, malonic acid.
- Succinic acid glutaric acid, fumaric acid, maleic acid, lactic acid, malic acid, citric acid, tartaric acid, benzenesulfonic acid, p-toluenesulfonic acid, methanesulfonic acid).
- plant alkaloid anticancer agents include vincristine, vinblastine, vindesine, vinorelbine, etoposide, irinotecan or active metabolites thereof, or salts thereof, nogitecan, sobuzoxane, docetaxel, paclitaxel, paclitaxel injection, eribulin and the like.
- Irinotecan or a metabolite thereof or a salt thereof is preferable.
- An active metabolite of irinotecan includes 7-ethyl-10-hydroxycamptothecin (SN-38).
- salt of irinotecan include the above-mentioned salts with pharmaceutically acceptable inorganic acids or organic acids, and preferred are hydrochlorides.
- the content of the anticancer agent in the unit dosage form of the pharmaceutical composition of the present invention varies depending on the type, but is 1 ng to 1000 mg, preferably 10 ng to 100 mg, more preferably 100 ng to 10 mg, more preferably 1 ⁇ g. ⁇ 1 mg.
- Injectable dosage forms include injectable solutions, injectable suspensions, injectable emulsions, injectable gels, and injectable solid forms.
- injectable solid forms include lyophilized preparations and powder-filled preparations that are mixed with solvents such as water for injection, physiological saline for injection, glucose solution for injection, etc. so that they can be used as intralymphatic injections when used. It is done.
- the pharmaceutical composition of the present invention may contain a pharmaceutically acceptable carrier, diluent or excipient in addition to the anticancer agent.
- the pharmaceutically acceptable carrier, diluent or excipient may be appropriately selected from a water-soluble solvent or oil-based solvent, a dispersant, a tonicity agent, a preservative, a solubilizer, a stabilizer, and the like. it can.
- examples of the water-soluble solvent include distilled water, physiological saline, Ringer's solution, phosphate buffer (PBS), and the like.
- examples of the oil-soluble solvent include vegetable oils such as olive oil, castor oil, sesame oil, cottonseed oil, and corn oil.
- Examples of the dispersant include tween 20 or tween 80, polyethylene glycol, carboxymethyl cellulose, sodium alginate and the like.
- examples of isotonic agents include sodium chloride, glycerol, sorbic alcohol, glucose and the like.
- Examples of the solubilizer include sodium salicylate, poloxamer, sodium acetate and the like.
- examples of the preservative include methyl paraben, propyl paraben, benzyl alcohol, chlorobutanol, sodium benzoate, phenol and the like.
- Examples of the stabilizer include albumins such as human serum albumin and bovine serum albumin.
- the pharmaceutical composition can be prepared using the anticancer agent of the present invention using a known formulation technique.
- the anticancer agent of the present invention is dissolved, suspended or emulsified in a water-soluble solvent or oil-soluble solvent together with the above-mentioned dispersant, isotonic agent, preservative, solubilizer, stabilizer and the like.
- the pharmaceutical composition of the present invention preferably has a viscosity of 40 mPa ⁇ s or less, more preferably 30 mPa ⁇ s or less, more preferably 20 mPa ⁇ s or less, and more preferably 10 mPa ⁇ s, from the viewpoint of tumor reduction effect. s or less. Moreover, it is preferable that it is 0.5 mPa * s or more, More preferably, it is 1 mPa * s or more.
- the viscosity can be measured at 20 ° C. using a vibration viscometer (for example, a tuning fork vibration type viscometer ⁇ SV-1A, manufactured by A & D Co., Ltd.) as shown in the Examples below. is there.
- a vibration viscometer for example, a tuning fork vibration type viscometer ⁇ SV-1A, manufactured by A & D Co., Ltd.
- Viscosity can be adjusted using various hydrophilic polymers that are generally used as thickeners in injectable preparations.
- linear polysaccharides such as cellulose, amylose, pectin, gelatin, dextrin, alginate; cellulose derivatives (methylcellulose (MC), hydroxypropylcellulose (HPC), hydroxypropylmethylcellulose (HPMC), etc.
- Galactomannan such as guar gum, fenugreek gum, tara gum, locust bean gum, locust bean gum
- carbomer polyacrylic acid; Polyvinylpyrrolidone; Polyacrylamide; Polyvinyl alcohol; Derivatives and mixtures of polyvinyl acetate, stabilizers, surfactants, suspending agents, emulsifiers, dispersants, solvents, solubilizers, solubilizers, etc.
- polyoxyethylene sorbitan fatty acid esters can be used, and polyoxyethylene sorbitan fatty acid esters are preferably used from the viewpoint of tumor reduction effect.
- polyoxyethylene sorbitan fatty acid ester examples include polyoxyethylene sorbitan monolaurate (polysorbate 20, Tween 20), polyoxyethylene sorbitan monostearate (polysorbate 60, Tween 60), polyoxyethylene sorbitan tristearate (polysorbate 65, Tween 65), Polyoxyethylene sorbitan oleate (polysorbate 80, Tween 80) is preferred, and polyoxyethylene sorbitan oleate is more preferred.
- the lymph node to be administered may be a lymph node (target lymph node) itself for therapeutic or prophylactic treatment, or a lymph node located upstream of the lymph vessel network to which the lymph node belongs.
- a lymph node located upstream of the lymph vessel network to which the lymph node belongs.
- sentinel lymph nodes where tumor cells migrate from the primary lesion and develop metastases first
- regional lymph nodes around the primary lesion Examples include lymph nodes located upstream of the nodes, lymph nodes located upstream of the lymphatic network to which the regional lymph nodes belong.
- the pharmaceutical composition of the present invention is administered to the lymph node in the dissection area (upstream lymph node), and the lymph node outside the dissection area (downstream lymph node) via the lymphatic network. )
- upstream lymph node upstream lymph node
- downstream lymph node downstream lymph node
- the pharmaceutical composition of the present invention is administered to the lymph node in the dissection area (upstream lymph node), and the lymph node outside the dissection area (downstream lymph node) via the lymphatic network.
- the method of administration of the pharmaceutical composition of the present invention to the lymph node is not limited as long as the pharmaceutical composition of the present invention can be injected into the lymph node, and is injected into the exposed lymph node by incising the skin of the patient. It may be administered, or it may be injected by injection into a site that is identified as the position of the lymph node from above the patient's skin.
- 5-fluorouracil, irinotecan and docetaxel exhibit superior antitumor effects compared to doxorubicin when administered in a small amount of lymph node.
- Cell growth inhibitory activity (GI 50 value) against cancer cell lines is known to be much stronger for doxorubicin than 5-fluorouracil and irinotecan and comparable to docetaxel (see comparative example) ).
- Antitumor effects obtained by intralymphatic administration of 5-fluorouracil, irinotecan or docetaxel cannot be predicted at all from the conventional findings. Further, the antitumor effect is exerted by intralymphatic administration located upstream from the lymph node for the purpose of prevention or treatment.
- the pharmaceutical composition of the present invention can treat lymph nodes in the early stage of metastasis or lymph nodes with a high risk of metastasis, and is particularly useful in preventing recurrence and the like.
- treatment refers to treatment (immediate treatment) of a subject having cancer, and the state, or one or more symptoms caused by the state, are improved, reduced or eliminated. It means that “Preventive treatment” means treatment of a subject who is at risk of developing cancer but does not currently have the condition or symptoms.
- the type of malignant tumor that can be treated by administering the pharmaceutical composition of the present invention is not particularly limited as long as it is sensitive to the anticancer agent of the present invention.
- head and neck cancer, stomach cancer, colon cancer examples include rectal cancer, liver cancer, gallbladder / bile duct cancer, pancreatic cancer, lung cancer, breast cancer, bladder cancer, prostate cancer, uterine cancer, pharyngeal cancer, esophageal cancer, renal cancer, ovarian cancer and the like.
- High effects can be expected especially for colon cancer, rectal cancer, breast cancer, esophageal cancer, gastric cancer, head and neck cancer, lung cancer, pancreatic cancer, and gallbladder / bile duct cancer.
- the frequency and dose of administration of the pharmaceutical composition of the present invention to humans can be adjusted or changed as appropriate.
- the administration interval is, for example, once every 1 to 42 days, preferably once every 1 to 28 days. More preferably, it may be once a day for 1 to 21 days.
- a single dose is 1 ng to 100 mg, preferably 10 ng to 10 mg, more preferably 100 ng to 1 mg as an antimetabolite, and is about 1/10 9 to 1/3 of the amount used for conventional systemic administration.
- the plant alkaloid anticancer agent is 1 ng to 20 mg, preferably 10 ng to 10 mg, more preferably 100 ng to 1 mg, which is about 1/10 7 to 2/3 of the amount used for conventional systemic administration.
- Example 1 Antitumor activity by intralymphatic administration of 5-FU Material (a) Animal used According to the method of the previous report (J Immunol Methods 2013; 389 (1-2): 69-78 doi 10.1016 / j.jim.2013.01.004.), Lymph node swelling model mouse MXH10 / Mo / lpr / lpr (MXH10 / Mo / lpr) was produced. In the following examples, a total of 5 male and female mice of 15 to 18 weeks of age were used.
- KM-Luc / GFP cells were prepared according to the method described previously (PLoS One 2013; 8 (2): e55797 doi 10.1371 / journal.pone.0055797).
- KM-Luc / GFP cells are obtained by transfecting MRL / N1 cells, which are tumor cells derived from fibroblasts of MRL / MpTn-gld / gld mice, with pEGFPPLuc plasmid, and constitutively transferring a luciferase gene and a green fluorescent gene. Is expressed.
- the cells were treated with FBS (fetal bovine serum) 10%, L-Glutamine-P. S. It was used after being cultured using Dulbecco's modified Eagle's medium (manufactured by Sigma-Aldrich) containing 1% solution (manufactured by Thermo Fisher Science) and 0.5% G418.
- FBS fetal bovine serum
- 5-FU has greatly reduced the luciferase activity ratio, the tumor is shrinking, and even a very small dose (0.1 ⁇ g / g) has a tumor shrinking effect of 90% or more. It was confirmed. 5-FU is administered from the accessory axillary lymph node upstream of the lymph node, and antitumor activity has been confirmed in the downstream intrinsic axillary lymph node. Therefore, administration of a small amount of 5-FU to lymph nodes, especially upstream lymph nodes, is useful for cancer treatment, prevention of recurrence, prevention of metastasis, etc., especially treatment of downstream lymph nodes, prevention of recurrence It was suggested that the effect is high. Moreover, since it has antitumor activity even in a very small amount, it was suggested that this method has few side effects and high safety.
- Example 2 Antitumor activity by intralymphatic administration of irinotecan hydrochloride (CPT-11)
- CPT-11 irinotecan hydrochloride
- the same animals and cells as used in Example 1 were used.
- irinotecan hydrochloride manufactured by Yakult Honsha
- the concentration was adjusted by dissolving irinotecan hydrochloride in physiological saline so as to be 0 ⁇ g / g, 0.5 ⁇ g / g, and 5 ⁇ g / g per body weight of the mouse.
- Example 2 Method The procedure was the same as in Example 1 except that the test drug administered to the accessory axillary lymph node was changed to CPT-11.
- CPT-11 significantly reduced the luciferase activity ratio, the tumor was shrinking, and there was a tumor shrinkage effect of 90% or more even with a very small dose (0.5 ⁇ g / g). It was confirmed.
- CPT-11 is administered from the accessory axillary lymph node upstream of the lymph node, and antitumor activity has been confirmed in the downstream intrinsic axillary lymph node. Therefore, administration of a small amount of CPT-11 to lymph nodes, particularly upstream lymph nodes, is useful for cancer treatment, recurrence prevention, etc., and is particularly effective for treatment of downstream lymph nodes, recurrence prevention, etc. was suggested to be high. Moreover, since it has antitumor activity even in a very small amount, it was suggested that this method has few side effects and high safety.
- Example 3 Antitumor activity of docetaxel by intralymphatic administration Material (a) Animal used The animal used was the same as that used in Example 1.
- the FM3A-Luc cell is a cell obtained by introducing pGL4.51 into the FM3A cell using electroporation, and constantly expresses the luciferase gene.
- the cells were treated with FBS (fetal bovine serum) 10%, L-Glutamine-P. S. It was used after culturing with 1% solution (manufactured by Thermo Fisher Scientific) and RPMI-1640 (manufactured by Sigma-Aldrich) containing 0.5% G418.
- the docetaxel administration day is defined as day 0 T, and the luciferase activities of day 3 T (3 days after docetaxel administration) and day 6 T (6 days after docetaxel administration) are standardized by the following [Formula 4] (Normalized). After that, day3 T or day6 T and day-1 T standardized by the following [Equation 5] (the date on which the luciferase activity in the intrinsic axillary lymph node was confirmed to be 1.0 ⁇ 10 6 photos / sec or more. The luciferase activity ratio of the day before docetaxel administration was calculated.
- the obtained activity ratio was normalized according to the following [Equation 6] at each concentration administration of docetaxel when the normalized luciferase activity ratio of day3 T or day6 T and day-1 T at 100 ⁇ g / g administration was defined as 100.
- the ratio of luciferase activity between day3 T or day6 T and day-1 T was calculated.
- Docetaxel significantly reduced the luciferase activity ratio, and the tumor was shrinking. Even with a small dose (1 ⁇ g / g), a tumor reduction effect of 90% or more was observed on the sixth day after treatment. It was confirmed that there was.
- Docetaxel is administered from the accessory axillary lymph node upstream of the lymph node, and antitumor activity has been confirmed in the intrinsic axillary lymph node downstream. Therefore, administration of a small amount of docetaxel to lymph nodes, especially upstream lymph nodes, is useful for cancer treatment, prevention of recurrence, prevention of metastasis, etc., especially for treatment of downstream lymph nodes, prevention of recurrence, etc. It was suggested that the effect is high. Moreover, since it has antitumor activity even in a very small amount, it was suggested that this method has few side effects and high safety.
- Example 4 Antitumor activity by intralymphatic administration when the viscosity of docetaxel was changed Materials The same animals as those used in Example 1 were used. The same cells used in Example 4 were used. As docetaxel, 80 mg (manufactured by Sanofi) for intravenous injection of taxotere was used. Taxotere intravenous infusion 80 mg 2 mL was dissolved in 13% ethanol 6 mL to prepare a 10 mg / mL Stock solution. Thereafter, Solution A, Solution B, and Solution C were prepared at the mixing ratio shown in Table 4 so that the concentration of docetaxel was 1 ⁇ g / g per mouse body weight.
- docetaxel 80 mg (manufactured by Sanofi) for intravenous injection of taxotere was used. Taxotere intravenous infusion 80 mg 2 mL was dissolved in 13% ethanol 6 mL to prepare a 10 mg / mL Stock solution. Thereafter, Solution A, Solution B, and Solution C were prepared
- Luciferase activity was calculated by Equation 7 are the luciferase activity of Day9 T against day-1 T, smaller the value Day9 T when the tumor has shown that is shrinking. It was shown that Solution A and Solution B have low luciferase activity and a high tumor reduction effect. On the other hand, Solution C hardly confirmed the tumor reduction effect. From this, it is considered that the viscosity should be 40 mPa ⁇ s or less, particularly 1 to 10 mPa ⁇ s, in order to show the tumor shrinking effect when docetaxel is administered to the lymph nodes.
- docetaxel but also CPT-11 and SN-38, which are the same plant alkaloid anticancer agents, and 5-FU, which is an antimetabolite, do not have a viscosity of the drug when administering lymph nodes. It is thought that it is necessary to be 40 mPa ⁇ s or less.
- Example 2 Comparative Example Antitumor activity of doxorubicin administered in lymph nodes
- doxorubicin hydrochloride manufactured by Wako
- concentration was adjusted with physiological saline so as to be 0 ⁇ g / g, 0.1 ⁇ g / g, 1 ⁇ g / g, and 10 ⁇ g / g per mouse body weight.
- doxorubicin has a tumor reduction rate of about 25% at 10 ⁇ g / g, and the tumor reduction rate is less than 60% even at 1 ⁇ g / g with the best results. Even when the dose was less than 90%, the tumor shrinkage rate was 90% or more, and with docetaxel, 10 ⁇ g / g administration showed a tumor shrinkage rate of 80% or more. This suggested that the effects of 5-FU, CPT-11 and docetaxel were higher compared to doxorubicin.
- GI 50 value the cell growth inhibitory activity against cancer cell lines
- 5-FU and CPT-11 the cell growth inhibitory activity against cancer cell lines.
- docetaxel is known to be almost the same as doxorubicin.
- an anticancer agent can be administered to a lymph node before dissection, and the anticancer agent can be poured into a lymph node downstream from the administered lymph node.
- anticancer drugs can be poured into other lymph nodes where microscopic cancer may have metastasized. Can be prevented.
- the amount of the anticancer agent used is less than the amount used for conventional systemic administration, so there are few side effects and high safety.
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Abstract
Description
すなわち、本発明は以下の(1)~(10)に係るものである。
(1)代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤を有効成分とする、リンパ節内投与されるがんの治療又は予防的治療用医薬組成物。
(2)代謝拮抗剤が5-フルオロウラシル又はその塩である(1)記載の医薬組成物。
(3)植物アルカロイド系抗がん剤がイリノテカン、SN-38、ドセタキセル及びそれらの塩から選ばれる1種以上である(1)又は(2)記載の医薬組成物。
(4)投与対象のリンパ節が、治療又は予防的治療を目的とするリンパ節又は当該リンパ節が属するリンパ管ネットワーク上流に位置するリンパ節である(1)~(3)の何れかに記載の医薬組成物。
(5)単回投与量が、代謝拮抗剤として1ng~100mg及び/又は植物アルカロイド系抗がん剤として1ng~20mgである(1)~(4)の何れかに記載の医薬組成物。
(6)粘度が、40mPa・s以下である(1)~(5)の何れかに記載の医薬組成物。
(7)粘度が、1~10mPa・sである(1)~(5)の何れかに記載の医薬組成物。
(8)リンパ節内投与されるがんの治療又は予防的治療用医薬組成物を製造するための、代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤の使用。
(9)リンパ節内投与によりがんの治療又は予防的治療を行うための、代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤を含む医薬組成物。
(10)代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤を含む医薬組成物を患者にリンパ節内投与する、がんの治療又は予防的治療方法。
ここで、塩としては、薬学的に許容される無機酸(例えば塩酸、硫酸、臭化水素酸、ヨウ化水素酸、硝酸、リン酸)又は有機酸(例えばギ酸、酢酸、プロピオン酸、マロン酸、コハク酸、グルタル酸、フマル酸、マレイン酸、乳酸、リンゴ酸、クエン酸、酒石酸、ベンゼンスルホン酸、p-トルエンスルホン酸、メタンスルホン酸)との塩が挙げられる。
イリノテカンの塩としては、上述した薬学的に許容される無機酸又は有機酸との塩が挙げられ、好ましくは塩酸塩である。
注射可能な固体形態とは、使用時にリンパ節内注射として使用できるように、注射用水、注射用生理食塩水、注射用ブドウ糖液等の溶媒と混合される、凍結乾燥製剤や粉末充填製剤が挙げられる。
ここで、水溶性溶媒としては、例えば蒸留水、生理食塩水、リンゲル液又はリン酸塩緩衝液(PBS)等が挙げられる。油溶性溶媒としては、例えばオリーブ油、ヒマシ油、ごま油、綿実油、トウモロコシ油等の植物油が挙げられる。分散剤としては、例えばtween20若しくはtween80、ポリエチレングリコール、カルボキシメチルセルロース、アルギン酸ナトリウム等が挙げられる。等張化剤としては、例えば塩化ナトリウム、グリセロール、ソルビンアルコール、グルコース等が挙げられる。可溶化剤としては、例えばサリチル酸ナトリウム、ポロキサマー、酢酸ナトリウム等が挙げられる。防腐剤としては、例えばメチルパラベン、プロピルパラベン、ベンジルアルコール、クロロブタノール、安息香酸ナトリウム、フェノール等が挙げられる。安定剤としては、例えばヒト血清アルブミン、ウシ血清アルブミン等のアルブミンが挙げられる。
例えば、好ましくは0.5~40mPa・s、より好ましくは0.5~30mPa・s、より好ましくは0.5~20mPa・s、より好ましくは0.5~10mPa・s、さらに好ましくは1~10mPa・sである。
ここで、標的リンパ節は、がんを有しているか否かは問われない。例えば、リンパ節郭清する前に、郭清域内のリンパ節(上流側リンパ節)に本発明の医薬組成物を投与し、リンパ管ネットワークを介して郭清域外のリンパ節(下流側リンパ節)に抗がん剤を送達させて、郭清を実施することにより、下流側リンパ節の予防的治療が可能である。
また、当該抗腫瘍効果は、予防又は治療目的のリンパ節よりも上流に位置するリンパ節内投与により発揮される。よって、本発明の医薬組成物は、転移初期段階にあるリンパ節や転移する危険性が高いリンパ節を治療又は予防的治療の対象とすることができ、再発防止等において特に有用である。
なお、本明細書において、「治療」とは、がんを有する対象の治療(即時治療)のことを指し、その状態、またはその状態によって生じる1つ若しくは複数の症状を、改善、軽減又は消失させることを意味する。「予防的治療」とは、がんになるリスクはあるが、現時点ではその状態や症状を有しない対象の治療を意味する。
単回投与量は、代謝拮抗剤として、1ng~100mg、好ましくは10ng~10mg、より好ましくは100ng~1mgであり、従来の全身投与に用いる量の1/109~1/3程度である。また、植物アルカロイド系抗がん剤として、1ng~20mg、好ましくは10ng~10mg、より好ましくは100ng~1mgであり、従来の全身投与に用いる量の1/107~2/3程度である。
1.材料
(a)使用動物
既報(J Immunol Methods 2013;389(1-2):69-78 doi 10.1016/j.jim.2013.01.004.)の方法に従って、リンパ節腫脹モデルマウスMXH10/Mo/lpr/lpr(MXH10/Mo/lpr)を作製した。以下の実施例では、15~18週齢の当該モデルマウスを雄・雌合計5匹使用した。
既報(PLoS One 2013;8(2):e55797 doi 10.1371/journal.pone.0055797)の方法に従って、マウス線維芽細胞由来のKM-Luc/GFP細胞を作製した。KM-Luc/GFP細胞は、MRL/MpTn-gld/gldマウスの線維芽細胞由来の腫瘍細胞であるMRL/N1細胞にpEGFPLucプラスミドをトランスフェクションしたものであり、ルシフェラーゼ遺伝子と緑色蛍光遺伝子を恒常的に発現している。以下の実施例では、当該細胞を、FBS(ウシ胎児血清)10%、L-Glutamine-P.S.溶液1%(Thermo Fisher Scietific製)、G418を0.5%含むDulbecco’s modified Eagle’s medium(Sigma-Aldrich製)を用いて培養して、使用した。
5-FUは、5-FU注250mg(協和発酵キリン製)を使用した。マウスの体重あたり、0μg/g、0.1μg/g、1μg/g、10μg/gとなるように生理食塩水を用いて濃度調整した。
(a)固有腋窩リンパ節転移モデルマウスの作製
-80℃保存の腫瘍細胞を融解させた後、通算2回継代したKM-Luc/GFP細胞を、PBS(リン酸緩衝生理食塩水)を用いて1.0×106cells/mLに濃度調整した。その後、マトリゲル(Basement membrane matrix, Becton,Dickinson and Co.製)と混合して3.3×105cells/mLに希釈した後に、マウスの腸骨下リンパ節に60μLを接種した(図1)。腫瘍細胞を接種した日をday0とした。
生体発光イメージングシステム(IVIS,Caliper Life Science製)を用いて、腸骨下リンパ節および固有腋窩リンパ節の腫瘍細胞の増殖率を測定した。測定日は腫瘍細胞接種後0,6,9日目(day0,day6,day9)に行った。15mg/mLに調整したルシフェリン(Promega製)200μLをマウスの腹腔に注射し、10分後にIVISを用いてルシフェラーゼ活性を測定した。
腫瘍細胞接種後day6のマウスのうち、固有腋窩リンパ節でのルシフェラーゼ活性が1.0×106photos/sec以上であるマウスに対して、シリンジポンプ(KDS100,Muromachi製)を用いて、副腋窩リンパ節へ10μL/minの速度で5-FUを120μL投与した(図1)。
day6及びday9のルシフェラーゼ活性を下記〔式1〕により標準化(normalized)した。その後、下記〔式2〕により標準化したday9とday6のルシフェラーゼ活性比を算出した。得られた活性比について、下記〔式3〕により、0μg/g投与における標準化したday9とday6のルシフェラーゼ活性比を100とした時の、5-FUの各濃度投与における標準化したday9とday6のルシフェラーゼ活性比を計算した。
標準化したday6又はday9のルシフェラーゼ活性=((day6又はday9のルシフェラーゼ活性)/(day0のルシフェラーゼ活性))
標準化したday9とday6のルシフェラーゼ活性比=((標準化したday9のルシフェラーゼ活性)/(標準化したday6のルシフェラーゼ活性))
0μg/g投与における標準化したday9とday6のルシフェラーゼ活性比を100とした時の、5-FUの各濃度投与における標準化したday9とday6のルシフェラーゼ活性比=((5-FUの各濃度投与における標準化したday9とday6のルシフェラーゼ活性比)/(0μg/g投与における標準化したday9とday6のルシフェラーゼ活性比)×100)
結果を表1に示す。
1.材料
使用動物、使用細胞は、実施例1と同様のものを使用した。
被験薬として、CPT-11は、イリノテカン塩酸塩(ヤクルト本社製)を使用した。マウスの体重あたり、0μg/g、0.5μg/g、5μg/gとなるようにイリノテカン塩酸塩を生理食塩水にて溶解させ、濃度を調整した。
副腋窩リンパ節へ投与する被験薬をCPT-11に変更した以外はすべて実施例1と同様の方法で行った。
結果を表2に示す。
1.材料
(a)使用動物
使用動物は、実施例1と同様のものを使用した。
既報(J Immunol Methods 2013 Mar 29;389(1-2):69-78. doi: 10.1016/j.jim.2013.01.004.)の方法に従って、マウス乳がん細胞由来のFM3A-Lucを作製した。FM3A-Luc細胞は、FM3A細胞に電気穿孔法を用いてpGL4.51を遺伝子導入して得られた細胞であり、ルシフェラーゼ遺伝子を恒常的に発現している。以下の実施例では、当該細胞を、FBS(ウシ胎児血清)10%、L-Glutamine-P.S.溶液1%(Thermo Fisher Scietific製)、G418を0.5%含むRPMI-1640(Sigma-Aldrich社製)を用いて培養して、使用した。
ドセタキセルは、タキソテール点滴静注用80mg(サノフィ製)を使用した。タキソテール点滴静注用80mg 2mLを13%エタノール 6mLに溶解して、10mg/mLのStock溶液を調製し、その後、マウスの体重あたり、0μg/g、1μg/g、10μg/gとなるようにStock溶液を滅菌水にて溶解させ、濃度を調整した。
(a)固有腋窩リンパ節転移モデルマウスの作製
-80℃保存の腫瘍細胞を融解させた後、通算2回継代したFM3A-Luc細胞を、PBS(リン酸緩衝生理食塩水)を用いて1.0×106cells/mLに濃度調整した。その後、マトリゲル(Basement membrane matrix, Becton,Dickinson and Co.製)と混合して3.3×105cells/mLに希釈した後に、マウスの腸骨下リンパ節に60μLを接種した(図1)。腫瘍細胞を接種した日をday0とした。
生体発光イメージングシステム(IVIS,Caliper Life Science製)を用いて、腸骨下リンパ節および固有腋窩リンパ節の腫瘍細胞の増殖率を測定した。測定日は腫瘍細胞接種後0,7,14,17,20,23,26,29日目に行った。15mg/mLに調整したルシフェリン(Promega製)200μLをマウスの腹腔に注射し、10分後にIVISを用いてルシフェラーゼ活性を測定した。
固有腋窩リンパ節でのルシフェラーゼ活性が1.0×106photos/sec以上であることが確認されたマウスに対して、確認された翌日に、シリンジポンプ(KDS100,Muromachi製)を用いて、副腋窩リンパ節へ10μL/minの速度でドセタキセルを120μL投与した(図1)。
ドセタキセル投与日をday0Tと定義し、day3T(ドセタキセル投与後3日目)およびday6T(ドセタキセル投与後6日目)のルシフェラーゼ活性を下記〔式4〕により標準化(normalized)した。その後、下記〔式5〕により標準化したday3T又はday6Tとday-1T(固有腋窩リンパ節でのルシフェラーゼ活性が1.0×106photos/sec以上であることが確認された日であり、ドセタキセル投与の前日)のルシフェラーゼ活性比を算出した。得られた活性比について、下記〔式6〕により、0μg/g投与における標準化したday3T又はday6Tとday-1Tのルシフェラーゼ活性比を100とした時の、ドセタキセルの各濃度投与における標準化したday3T又はday6Tとday-1Tのルシフェラーゼ活性比を計算した。
標準化したday3T、day6T又はday-1Tのルシフェラーゼ活性=((day3T、day6T又はday-1Tのルシフェラーゼ活性)/(day0のルシフェラーゼ活性))
標準化したday3T又はday6Tとday-1のルシフェラーゼ活性比=((標準化したday3T又はday6Tのルシフェラーゼ活性)/(標準化したday-1Tのルシフェラーゼ活性))
0μg/g投与における標準化したday3T又はday6Tとday-1Tのルシフェラーゼ活性比を100とした時の、ドセタキセルの各濃度投与における標準化したday3T又はday6Tとday-1Tのルシフェラーゼ活性比=((ドセタキセルの各濃度投与における標準化したday3T又はday6Tとday-1Tのルシフェラーゼ活性比)/(0μg/g投与における標準化したday3T又はday6Tとday-1Tのルシフェラーゼ活性比)×100)
結果を表3に示す。
1.材料
使用動物は、実施例1と同様のものを使用した。
使用細胞は、実施例4と同様のものを使用した。
ドセタキセルは、タキソテール点滴静注用80mg(サノフィ製)を使用した。タキソテール点滴静注用80mg 2mLを13%エタノール 6mLに溶解して、10mg/mLのStock溶液を調製した。その後、ドセタキセルの濃度がマウスの体重あたり1μg/gとなるように、表4の配合比でSolution A、Solution B及びSolution Cを調製した。
(a)固有腋窩リンパ節転移モデルマウスの作製、(b)in vivoにおける腫瘍細胞増殖評価、(c)副腋窩リンパ節からの薬剤投与は、実施例4と同様の方法で行った。
(d)抗腫瘍活性の評価
Solution A、B又はCについて、投与日をday0Tと定義し、day-1T(固有腋窩リンパ節でのルシフェラーゼ活性が1.0×106photos/sec以上であることが確認された日であり、ドセタキセル投与の前日)に対するday9Tのルシフェラーゼ活性を下記〔式7〕により計算した。
day-1Tに対するday9Tのルシフェラーゼ活性=((day9Tのルシフェラーゼ活性)/(day-1Tのルシフェラーゼ活性))
音叉振動式粘度計(SV-1A:粘度測定域:0.3~10,000mPa・s、SV-1H:粘度測定域:0.3~1,000mPa・s、エー・アンド・デイ株式会社製)を用いて、日本薬局方粘度測定法に準じて、Solution A、Solution B及びSolution Cの粘度を測定した。
(f)病理図写真の撮影
Solution B又はSolution C投与後のday9T時に、倒立顕微鏡BX51(オリンパス社製)を用いて明視野観察法にて固有腋窩リンパ節および副腋窩リンパ節の病理図写真を撮影した。撮影倍率は、2倍及び10倍にて行った。
(a)粘度とルシフェラーゼ活性の関係
結果を表5に示す。
Solution B又はSolution Cを投与後、day9T時における固有腋窩リンパ節の病理図写真を図2および図3に示す。
Solution Bでは、リンパ節皮質表層に腫瘍細胞の残存を認めるが、リンパ節辺縁洞相当部に腫瘍細胞は見られなかった。一方、Solution Cでは、リンパ節実質および辺縁洞に腫瘍の浸潤・増殖が認められた。これより、粘度による腫瘍縮小効果は、固有腋窩リンパ節の病理図写真からも確認することができた。
なお、Solution Cの投与部位である副腋窩リンパ節の病理図写真を同様の方法で撮影したところ、リンパ節髄質を中心に広範な壊死と線維化が認められ、変異はリンパ節皮質および輸出リンパ管基部を含めたリンパ節被膜外にも及び、輸出リンパ管の通過障害が示唆された(図4)。これは、Solution Cが高粘度であるため、上流である副腋窩リンパ節に投与した際に、下流のリンパ節に流れずに副腋窩リンパ節に留まったためと考えられる。このため、ドセタキセルに限らず、同じ植物アルカロイド系抗がん剤であるCPT-11やSN-38、代謝拮抗剤である5-FUにおいても、リンパ節投与を行う場合には、薬剤の粘度を40mPa・s以下とする必要があると考えられる。
1.材料
使用動物、使用細胞は、実施例1と同様のものを使用した。
被験薬として、ドキソルビシンは、ドキソルビシン塩酸塩(Wako製)を使用した。マウスの体重あたり、0μg/g、0.1μg/g、1μg/g、10μg/gとなるように生理食塩水を用いて濃度調整した。
副腋窩リンパ節へ投与する被験薬をドキソルビシンに変更した以外はすべて実施例1と同様の方法で行った。
結果を表6に示す。ドキソルビシンの抗腫瘍活性と、5-FU、CPT-11及びドセタキセルの抗腫瘍活性を比較するために、実施例1~3の結果を併せて表6に示した。
また、手術で郭清できない領域のリンパ節にがんがある場合、外科的手術での治癒は不可能であるが、本発明の医薬組成物を用いることで、上流のリンパ節から抗がん剤を流して郭清できない領域のリンパ節の治療を行うことが可能である。さらに、本発明の医薬組成物においては、使用する抗がん剤の量は、従来の全身投与に用いる量よりも少ないため、副作用も少なく、安全性が高い。
Claims (10)
- 代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤を有効成分とする、リンパ節内投与されるがんの治療又は予防的治療用医薬組成物。
- 代謝拮抗剤が5-フルオロウラシル又はその塩である請求項1記載の医薬組成物。
- 植物アルカロイド系抗がん剤がイリノテカン、SN-38、ドセタキセル及びそれらの塩から選ばれる1種以上である請求項1又は2記載の医薬組成物。
- 投与対象のリンパ節が、治療又は予防的治療を目的とするリンパ節又は当該リンパ節が属するリンパ管ネットワーク上流に位置するリンパ節である請求項1~3の何れか1項記載の医薬組成物。
- 単回投与量が、代謝拮抗剤として1ng~100mg及び/又は植物アルカロイド系抗がん剤として1ng~20mgである請求項1~4の何れか1項記載の医薬組成物。
- 粘度が、40mPa・s以下である請求項1~5の何れか1項記載の医薬組成物。
- 粘度が、1~10mPa・sである請求項1~5の何れか1項記載の医薬組成物。
- リンパ節内投与されるがんの治療又は予防的治療用医薬組成物を製造するための、代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤の使用。
- リンパ節内投与によりがんの治療又は予防的治療を行うための、代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤を含む医薬組成物。
- 代謝拮抗剤及び植物アルカロイド系抗がん剤から選択される1種以上の抗がん剤を含む医薬組成物を患者にリンパ節内投与する、がんの治療又は予防的治療方法。
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JP2018543783A JP6960637B2 (ja) | 2016-10-05 | 2017-08-31 | リンパ行性薬剤投与法で有効な薬剤 |
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CN201780061797.8A CN110022899A (zh) | 2016-10-05 | 2017-08-31 | 在淋巴行性药剂投予法中有效的药剂 |
US16/339,545 US11559526B2 (en) | 2016-10-05 | 2017-08-31 | Drug effective for lymphogenous drug administrating method |
EP17858117.9A EP3524269B1 (en) | 2016-10-05 | 2017-08-31 | Anticancer composition to be administered into a lymph node |
RU2019109965A RU2759640C2 (ru) | 2016-10-05 | 2017-08-31 | Лекарственное средство, эффективное для лимфогенного способа введения лекарственного средства |
KR1020197007005A KR102431011B1 (ko) | 2016-10-05 | 2017-08-31 | 림프행성 약제 투여법으로 유효한 약제 |
CA3039442A CA3039442C (en) | 2016-10-05 | 2017-08-31 | Drug effective for lymphogenous drug administrating method |
AU2017340350A AU2017340350B9 (en) | 2016-10-05 | 2017-08-31 | Drug effective for lymphogenous drug administrating method |
US18/063,258 US20230119275A1 (en) | 2016-10-05 | 2022-12-08 | Drug effective for lymphogenous drug administrating method |
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JPS60190769A (ja) * | 1984-03-09 | 1985-09-28 | Sagami Chem Res Center | 5−フルオロウラシルの製造方法 |
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EP2025333A1 (en) * | 2007-08-14 | 2009-02-18 | Pharmatex Italia Srl | Injectable pharmaceutical formulation of taxoids |
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KR102431011B1 (ko) | 2022-08-09 |
CN110022899A (zh) | 2019-07-16 |
RU2019109965A (ru) | 2020-11-06 |
CA3039442A1 (en) | 2018-04-12 |
MX2019003943A (es) | 2019-09-18 |
AU2017340350A1 (en) | 2019-05-02 |
JPWO2018066278A1 (ja) | 2019-07-18 |
AU2017340350B2 (en) | 2022-12-22 |
KR20190064570A (ko) | 2019-06-10 |
RU2019109965A3 (ja) | 2020-12-14 |
TWI754666B (zh) | 2022-02-11 |
EP3524269B1 (en) | 2024-02-21 |
US20230119275A1 (en) | 2023-04-20 |
US20200038400A1 (en) | 2020-02-06 |
JP6960637B2 (ja) | 2021-11-05 |
TW201813668A (zh) | 2018-04-16 |
RU2759640C2 (ru) | 2021-11-16 |
CA3039442C (en) | 2023-07-04 |
US11559526B2 (en) | 2023-01-24 |
BR112019006949A2 (pt) | 2019-07-02 |
EP3524269A1 (en) | 2019-08-14 |
EP3524269A4 (en) | 2020-06-17 |
AU2017340350B9 (en) | 2023-02-09 |
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