Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • 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
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/425—Thiazoles
  • A61K31/428—Thiazoles condensed with carbocyclic rings
• • 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
  • A61K31/4375—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 six-membered ring having nitrogen as a ring heteroatom, e.g. quinolizines, naphthyridines, berberine, vincamine
• • 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
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/4985—Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—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
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • 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
  • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
  • A61K31/5375—1,4-Oxazines, e.g. morpholine
  • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents

Definitions

• KRas Kirsten Rat Sarcoma 2 Viral Oncogene Homolog
• GDP-bound inactive
• GTP-bound active
• cellular proliferation e.g., see Alamgeer et al., (2013) Current Opin Pharmcol. 13:394-401.
• Single nucleotide substitutions that result in missense mutations at codons 12 and 13 of the KRas primary amino acid sequence comprise approximately 40% of these KRas driver mutations in lung adenocarcinoma, with a G12C transversion being the most common activating mutation (e.g., see Dogan et al., (2012) Clin Cancer Res. 18(22):6169-6177, published online 2012 Sep 26. doi: 10.1 158/1078-0432.CCR- 1 1-3265).
• KRas inhibitor has demonstrated sufficient safety and/or efficacy to obtain regulatory approval (e.g., see
• KRas G12C inhibitors disclosed herein are potent inhibitors of KRas G12C enzymatic activity and exhibit single agent activity inhibiting the in vitro proliferation of cell lines harboring a KRas G12C mutation
• the relative potency and/or observed maximal effect of any given KRas G12C inhibitor can vary between KRAS mutant cell lines.
• the reason or reasons for the range of potencies and observed maximal effect is not fully understood but certain cell lines appear to possess differing intrinsic resistance.
• X is a 4-12 membered saturated or partially saturated monocyclic, bridged or spirocyclic ring, wherein the saturated or partially saturated monocyclic ring is optionally substituted with one or more R 8 ;
• Y is a bond, O, S or NR 5 ;
• R 2 is hydrogen, alkyl, hydroxyalkyl, dihydroxy alkyl, alkylaminylalkyl,
• dialkylaminylalkyl, -Z-NR 5 R 10 heterocyclyl, heterocyclylalkyl, aryl, heteroaryl, or heteroarylalkyl, wherein each of the Z, heterocyclyl, heterocyclylalkyl, aryl, heteroaryl, and heteroarylalkyl may be optionally substituted with one or more R 9 ;
• each R 5 is independently hydrogen or C1 - C3 alkyl
• R 6 is cycloalkyl, heterocyclyl, heterocyclylalkyl, aryl, or heteroaryl, wherein each of the cycloalkyl, heterocyclyl, aryl, or heteroaryl may be optionally substituted with one or more R 7 ;
• each R 7 is independently halogen, hydroxyl, C1 - C6 alkyl, cycloalkyl, alkoxy, haloalkyl, amino, cyano, heteroalkyl, hydroxyalkyl or Q-haloalkyl, wherein Q is O or S;
• R 8 is oxo, C1 - C3 alkyl, C2 - C4 alkynyl, heteroalkyl, cyano, -C(O)OR 5 , -C(O)N(R 5 ) 2 , - N(R 5 ) 2 , wherein the C1 - C3 alkyl may be optionally substituted with cyano, halogen, -OR 5 , - N(R 5 ) 2 , or heteroaryl
• each R 9 is independently hydrogen, oxo, acyl, hydroxyl, hydroxyalkyl, cyano, halogen, C1 - C6 alkyl, aralkyl, haloalkyl, heteroalkyl, cycloalkyl, heterocyclylalkyl, alkoxy, dialkylaminyl, dialkylamidoalkyl, or dialkylaminylalkyl, wherein the C1 - C6 alkyl may be optionally substituted with cycloalkyl;
• R 1 1 is haloalkyl
• R A is absent, hydrogen, deuterium, cyano, halogen, C1 - C-3 alkyl, haloalkyl, heteroalkyl, -C(O)N(R 5 ) 2 , or hydroxyalkyl;
• each R B is independently hydrogen, deuterium, cyano, C1 - C3 alkyl, hydroxyalkyl, heteroalkyl, C1 - C3 alkoxy, halogen, haloalkyl, -ZNR 5 R 11 , -C(O)N(R 5 ) , -NHC(O)C1 - C3 alkyl, -CH 2 NHC(O)C1 - C3 alkyl, heteroaryl, heteroarylalkyl, dialkylaminylalkyl, or heterocyclylalkyl wherein the heterocyclyl portion is substituted with one or more substituents independently selected from halogen, hydroxyl, alkoxy and C1 - C3 alkyl, wherein the heteroaryl or the heteroaryl portion of the heteroarylalkyl is optionally substituted with one or more R 7 ; [0027] m is zero or an integer between 1 and 2;
• KRas G12C inhibitor [0031] Also included for use in the methods provided herein are KRas G12C inhibitor
• R 1 , R 3 , R 4 , R 5 , R 10 , R 1 1 , L and m are as defined for Formula I, and the piperazinyl ring is optionally substituted with R 8 wherein R 8 is as defined for Formula I.
• KRas G12C inhibitor [0033] Also included for use in the methods provided herein are KRas G12C inhibitor
• R 1 , R 3 , R 4 , L and m are as defined for Formula I
• R 2 is heterocyclylalkyl optionally substituted with one or more R 9 where R 9 is as defined for Formula I
• the piperazinyl ring is optionally substituted with R 8 , where R 8 is as defined for Formula I.
• KRas G12C inhibitor compounds and Raf family kinase inhibitors are the only active agents in the provided combinations and methods.
• Raf family kinase inhibitors suitable for the provided compositions and methods include, but are not limited to, Encorafenib (LGX818): methyl (S)-(1-((4-(3-(5-chloro- 2-fluoro-3-(methylsulfonamido)phenyl)-1-isopropyl- 1H-pyrazol-4-yl)pyrimidin-2- yl)amino)propan-2-yl)carbamate; PLX-8394: N-(3-(5-(2-cyclopiOpylpyrimidin-5-yl)-3a,7a- dihydro-1H-pyrrolo[2,3-b]pyridine-3-carbonyl)-2,4-difluorophenyl)-3-fluoropynOlidine-1- sulfonamide; Raf-709: N-(2-methyl-5'-morpholino-6'-((tetrahydiO-2H-
• R05126766 N-[3-fluoiO-4-[[4-methyl-2-oxo-7-(2-pyrimidinyloxy)-2H-1-benzopyran-3-yl] methyl]-2-pyridinyl]-N' -methyl-sulfamide.
• the invention provides for methods for increasing the sensitivity of a cancer cell to a KRas G12C inhibitor, comprising contacting the cancer cell with a
• the contacting is in vitro. In one embodiment, the contacting is in vivo.
• a KRas G12C mutation e.g., a KRas G12C-associated cancer
• a regulatory agency-approved
• kits comprising a Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, for use in treating a KRas G12C cancer.
• the kit in some cases includes an insert with instructions for administration of a Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or pharmaceutically acceptable salt or a pharmaceutical composition thereof,.
• the insert may provide a user with one set of instructions for using the a Raf family kinase inhibitor, or pharmaceutically acceptable salt or a
• the patient before treatment with the compositions or methods of the invention, was treated with one or more of a chemotherapy, a targeted anticancer agent, radiation therapy, and surgery, and optionally, the prior treatment was unsuccessful; and/or the patient has been administered surgery and optionally, the surgery was unsuccessful; and/or the patient has been treated with a platinum- based chemotherapeutic agent, and optionally, the patient has been previously determined to be non-responsive to treatment with the platinum-based chemotherapeutic agent; and/or the patient has been treated with a kinase inhibitor, and optionally, the prior treatment with the kinase inhibitor was unsuccessful; and/or the patient was treated with one or more other therapeutic agent(s).
• the present invention relates to combination therapies for treating KRas G12C cancers.
• the present invention relates to methods of treating cancer in a subject in need thereof, comprising administering to the subject a therapeutically effective amount of a combination of a Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a KRAS G12C inhibitor of Formula (I), Formula I-A or Formula I-B, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, pharmaceutical compositions each separately comprising a therapeutically effective amount of the inhibitors, kits comprising the compositions and methods of use therefor.
• a“Raf family kinase” refers to a member of a mammalian
• serine/threonine kinases composed of three isoforms (C-Raf, B-Raf and A-Raf) and includes homodimers of each isoform as well as heterodimers between isoforms, e.g., C-Raf/B-Raf heterodimers.
• the term“pediatric patient” as used herein refers to a patient under the age of 16 years at the time of diagnosis or treatment.
• the term“pediatric” can be further be divided into various subpopulations including: neonates (from birth through the first month of life); infants (1 month up to two years of age); children (two years of age up to 12 years of age); and adolescents (12 years of age through 21 years of age (up to, but not including, the twenty-second birthday)).
• Berhman RE Kliegman R, Arvin AM, Nelson WE. Nelson Textbook of Pediatrics, 15th Ed. Philadelphia: W.B. Saunders Company, 1996; Rudolph AM, et al. Rudolph’s Pediatrics, 21st Ed. New York: McGraw-Hill, 2002; and Avery MD, First LR. Pediatric Medicine, 2nd Ed. Baltimore: Williams & Wilkins; 1994.
• an assay is used to determine whether the patient has KRas G12C mutation using a sample (e.g., a biological sample or a biopsy sample such as a paraffin-embedded biopsy sample) from a patient (e.g., a patient suspected of having a KRas G 12C-associated cancer, a patient having one or more symptoms of a KRas G12C-associated cancer, and/or a patient that has an increased risk of developing a KRas G12C-associated cancer) can include, for example, next generation sequencing, immunohistochemistry, fluorescence microscopy, break apart FISH analysis, Southern blotting, Western blotting, FACS analysis, Northern blotting, and PCR-based amplification (e.g., RT-PCR, quantitative real-time RT-PCR, allele-specific genotyping or ddPCR).
• a sample e.g., a biological sample or a biopsy sample such as a paraffin-embedded biopsy sample
• a patient
• amino refers to -NH 2 ;
• alkyl refers to straight and branched chain aliphatic groups having from 1 to 12 carbon atoms, 1-8 carbon atoms 1-6 carbon atoms, or 1-3 carbon atoms which is optionally substituted with one, two or three substituents.
• alkyl groups include, without limitation, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, sec-butyl, tert-butyl, pentyl, and hexyl.
• haloalkyl refers to an alkyl chain in which one or more hydrogen has been replaced by a halogen.
• haloalkyls are trifluoromethyl, difluoromethyl and fluoromethyl.
• alkylene group is an alkyl group, as defined hereinabove, that is positioned between and serves to connect two other chemical groups.
• alkylene groups include, without limitation, methylene, ethylene, propylene, and butylene.
• alkoxy refers to -OC1 -C6 alkyl.
• cycloalkyl as employed herein includes saturated and partially unsaturated cyclic hydrocarbon groups having 3 to 12 carbons, for example 3 to 8 carbons, and as a further example 3 to 6 carbons, wherein the cycloalkyl group additionally is optionally substituted.
• cycloalkyl groups include, without limitation, cyclopropyl, cyclobutyl,
• cyclopentyl cyclopentenyl, cyclohexyl, cyclohexenyl, cycloheptyl, and cyclooctyl.
• heteroalkyl refers to an alkyl group, as defined hereinabove, wherein one or more carbon atoms in the chain are replaced by a heteroatom selected from the group consisting of O, S, and N.
• hydroxyalkyl refers to -alkyl -OH.
• dihydroxyalkyl refers to an alkyl group as defined herein wherein two carbon atoms are each substituted with a hydroxyl group.
• alkylaminyl refers to -NR x -alkyl, wherein R x is hydrogen.
• alkylaminylalkyl refers to -alkyl-NR x -alkyl, wherein R x is hydrogen. In one embodiment, R x is hydrogen.
• aryl group is a C 6 -C 14 aromatic moiety comprising one to three aromatic rings, which is optionally substituted.
• the aryl group is a C 6 -C 10 aryl group.
• Examples of aryl groups include, without limitation, phenyl, naphthyl, anthracenyl, fluorenyl, and dihydrobenzofuranyl.
• an "aralkyl” or “arylalkyl” group comprises an aryl group covalently linked to an alkyl group, either of which may independently be optionally substituted or unsubstituted.
• An example of an aralkyl group is (C 1 - C 6 )alkyl(C 6 -C 10 )aryl, including, without limitation, benzyl, phenethyl, and naphthylmethyl.
• An example of a substituted aralkyl is wherein the alkyl group is substituted with hydroxyalkyl.
• a “heterocyclyl” or “heterocyclic” group is a ring structure having from about 3 to about 12 atoms, for example 4 to 8 atoms, wherein one or more atoms are selected from the group consisting of N, O, and S, the remainder of the ring atoms being carbon.
• the heterocyclyl may be a monocyclic, a bicyclic, a spirocyclic or a bridged ring system.
• the heterocyclic group is optionally substituted with R 7 on carbon or nitrogen at one or more positions, wherein R 7 is as defined for Formula I.
• the heterocyclic group is also independently optionally substituted on nitrogen with alkyl, aryl, aralkyl, alkylcarbonyl, alkylsulfonyl, arylcarbonyl, arylsulfonyl, alkoxycarbonyl, aralkoxycarbonyl, or on sulfur with oxo or lower alkyl.
• heterocyclic groups include, without limitation, epoxy, azetidinyl, aziridinyl, tetrahydrofuranyl, tetrahydropyranyl, pyrrolidinyl, pyrrolidinonyl, piperidinyl, piperazinyl, imidazolidinyl, thiazolidinyl, dithianyl, trithianyl, dioxolanyl, oxazolidinyl, oxazolidinonyl,
• heterocyclylalkyl refers to a heterocyclyl group as defined herein linked to the remaining portion of the molecule via an alkyl linker, wherein the alkyl linker of the heterocyclylalkyl may be optionally substituted with hydroxy or hydroxyalkyl.
• heteroaryl refers to groups having 5 to 14 ring atoms, preferably 5, 6, 9, or 10 ring atoms; having 6, 10, or 14 p electrons shared in a cyclic array; and having, in addition to carbon atoms, from one to three heteroatoms per ring selected from the group consisting of N, O, and S.
• heteroaryl groups include acridinyl, azocinyl, benzimidazolyl, benzofuranyl, benzothiofuranyl, benzothiophenyl, benzoxazolyl, benzthiazolyl, benztriazolyl, benztetrazolyl, benzisoxazolyl, benzisothiazolyl, benzimidazolinyl, carbazolyl, 4aH-carbazolyl, carbolinyl, chromanyl, chromenyl, cinnolinyl, furanyl, furazanyl, imidazolinyl, imidazolyl, 1H-indazolyl, indolenyl, indolinyl, indolizinyl, indolyl, 3H-indolyl,
• a "heteroarylalkyl” group comprises a heteroaryl group covalently linked to an alkyl group, wherein the radical is on the alkyl group, either of which is independently optionally substituted or unsubstituted.
• heteroarylalkyl groups include a heteroaryl group having 5, 6, 9, or 10 ring atoms bonded to a C1-C6 alkyl group.
• an effective amount of a compound is an amount that is sufficient to negatively modulate or inhibit the activity of the desired target, i.e., a Raf family kinase or KRas G12C. Such amount may be administered as a single dosage or may be administered according to a regimen, whereby it is effective.
• a "therapeutically effective amount of a combination" of two compounds is an amount that together synergistically increases the activity of the combination in comparison to the therapeutically effective amount of each compound in the combination, i.e., more than merely additive.
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in an increased duration of overall survival (“OS”) in subjects relative to treatment with only the KRas G12C inhibitor.
• OS overall survival
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in an increased duration of progression-free survival (“PFS”) in subjects relative to treatment with only the KRas G12C inhibitor.
• PFS progression-free survival
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, , or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in increased tumor regression in subjects relative to treatment with only the KRas G12C inhibitor.
• each compound in the combination may be the same or different than the therapeutically effective amount of each compound when administered alone as a monotherapy as long as the combination yields the desired anti-tumor effect. Such amounts may be administered as a single dosage or may be administered according to a regimen, whereby it is effective.
• treatment means any manner in which the symptoms or pathology of a condition, disorder or disease are ameliorated or otherwise beneficially altered. Treatment also encompasses any pharmaceutical use of the compositions herein.
• amelioration of the symptoms of a particular disorder by administration of a particular pharmaceutical composition refers to any lessening, whether permanent or temporary, lasting or transient that can be attributed to or associated with administration of the composition.
• the term“about” when used to modify a numerically defined parameter means that the parameter may vary by as much as 10% below or above the stated numerical value for that parameter.
• a dose of about 5 mg/kg may vary between 4.5 mg/kg and 5.5 mg/kg.
• “About” when used at the beginning of a listing of parameters is meant to modify each parameter.
• about 0.5 mg, 0.75 mg or 1.0 mg means about 0.5 mg, about 0.75 mg or about 1.0 mg.
• about 5% or more, 10% or more, 15% or more, 20% or more, and 25% or more means about 5% or more, about 10% or more, about 15% or more, about 20% or more, and about 25% or more.
• a method of treating cancer in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a KRAS G12C inhibitor of Formula (I), Formula I-A or Formula I-B, , or a pharmaceutically acceptable salt or a pharmaceutical composition thereof.
• the Raf family of kinases are serine/threonine kinases composed of three isoforms (C- Raf, B-Raf and A-Raf).
• the Raf family members share three conserved regions (CR) with distinct functions.
• CR1 contains a Ras-binding domain (RBD), which is necessary for the interaction with Ras and membrane recruitment, and a cysteine-rich domain (CRD), which is a secondary Ras-binding site and also necessary for the interaction of CR1 with the kinase domain for Raf autoinhibition.
• CR2 contains inhibitory phosphorylation sites participating in the negative regulation of Ras binding and Raf activation.
• CR3 features the kinase domain, including the activation segment, whose phosphorylation is crucial for kinase activation (see e.g.,
• the Raf family kinase inhibitor is active against wild type A-Raf/A-Raf, C-Raf/C-Raf and B-Raf/B-Raf homodimers as well as Raf
• heterodimers e.g., C-Raf/B-Raf heterodimers (e.g., see Lito et al., (2016) Science
• Raf family kinase inhibitors useful in the methods and compositions disclosed herein include, but are not limited to, Encorafenib (LGX818): methyl (S)-(1-((4-(3- (5-chloro-2-fluoro-3-(methylsulfonamido)phenyl)-1-isopropyl- 1H-pyrazol-4-yl)pyrimidin-2- yl)amino)propan-2-yl)carbamate; PLX-8394: N-(3-(5-(2-cyclopropylpyrimidin-5-yl)-3a,7a- dihydro-1H-pyrrolo[2,3-b]pyridine-3-carbonyl)-2,4-difluorophenyl)-3-fluoropyrrolidine-1- sulfonamide; Raf-709: N-(2-methyl-5 , -morpholino-6'-((tetrahydro-2H-pyran-4
• Raf family kinase inhibitors are well known to those skilled in the art and Raf family kinase inhibitors may be obtained from a wide-variety of commercial suppliers, in forms suitable for both research or human use.
• suitable Raf family kinase inhibitors for use in the compositions and methods disclosed herein and methods for preparing such inhibitors are disclosed in US Patent Application Publication Nos:
• the KRas G12C inhibitors used in the methods are compounds of Formula (I):
• R 1 is -C(O)C(R A ) C(R B ) p or -SO 2 C(R A ) C(R B ) p ;
• Z is C1 - C4 alkylene
• L is a bond, -C(O)-, or C1 - C3 alkylene;
• R 4 is hydrogen, cycloalkyl, heterocyclyl, aryl, aralkyl or heteroaryl, wherein each of the cycloalkyl, heterocyclyl, aryl, aralkyl and heteroaryl may be optionally substituted with one or more R 6 or R 7 ;
• each R 5 is independently hydrogen or C1 - C3 alkyl
• R 6 is cycloalkyl, heterocyclyl, heterocyclylalkyl, aryl, or heteroaryl, wherein each of the cycloalkyl, heterocyclyl, aryl, or heteroaryl may be optionally substituted with one or more R 7 ;
• each R 7 is independently halogen, hydroxyl, C1 - C6 alkyl, cycloalkyl, alkoxy, haloalkyl, amino, cyano, heteroalkyl, hydroxyalkyl or Q-haloalkyl, wherein Q is O or S;
• R 8 is oxo, C1 - C3 alkyl, C2 - C4 alkynyl, heteroalkyl, cyano, -C(O)OR 5 , -C(O)N(R 5 ) 2 , - N(R 5 ) 2 , wherein the C1 - C3 alkyl may be optionally substituted with cyano, halogen, -OR 5 , - N(R 5 ) 2 , or heteroaryl;
• each R 9 is independently hydrogen, oxo, acyl, hydroxyl, hydroxyalkyl, cyano, halogen, C1 - C6 alkyl, aralkyl, haloalkyl, heteroalkyl, cycloalkyl, heterocyclylalkyl, alkoxy,
• dialkylaminyl dialkylamidoalkyl, or dialkylaminylalkyl, wherein the C1 - C6 alkyl may be optionally substituted with cycloalkyl;
• R A is absent, hydrogen, deuterium, cyano, halogen, C1 - C-3 alkyl, haloalkyl, heteroalkyl, -C(O)N(R 5 ) 2 , or hydroxyalkyl;
• each R B is independently hydrogen, deuterium, cyano, C1 - C3 alkyl, hydroxyalkyl, heteroalkyl, C1 - C3 alkoxy, halogen, haloalkyl, -ZNR 5 R 11 , -C(O)N(R 5 ) 2 , -NHC(O)C1 - C3 alkyl, -CH 2 NHC(O)C1 - C3 alkyl, heteroaryl, heteroarylalkyl, dialkylaminylalkyl, or
• heterocyclylalkyl wherein the heterocyclyl portion is substituted with one or more substituents independently selected from halogen, hydroxyl, alkoxy and C1 - C3 alkyl, wherein the heteroaryl or the heteroaryl portion of the heteroarylalkyl is optionally substituted with one or more R 7 ; [0108] m is zero or an integer between 1 and 2;
• p is one or two; and wherein,
• KRas G12C inhibitors used in the methods herein includes compounds having the Formula I-A:
• R 1 , R 3 , R 4 , R 5 , R 10 , L and m are as defined for Formula I, R 1 1 is hydrogen, methyl or hydroxyalkyl, and the piperidinyl ring is optionally substituted with R 8 wherein R 8 is as defined for Formula 1.
• KRas G12C inhibitors used in the methods herein include compounds having the Formula I-B:
• KRas G12C inhibitor compounds of Formula (I), Formula I-A and Formula I-B useful in the methods disclosed herein are Example Nos 1-678 as disclosed in WO2019099524, including those selected from the group consisting of:
• the KRas G12C inhibitor is selected from:
• the KRas G12C inhibitor is:
• the KRas G12C inhibitor is:
• the KRas G12C inhibitor is:
• the KRas G12C inhibitors used in the methods of the present invention may have one or more chiral center and may be synthesized as stereoisomeric mixtures, isomers of identical constitution that differ in the arrangement of their atoms in space.
• the compounds may be used as mixtures or the individual components/isomers may be separated using commercially available reagents and conventional methods for isolation of stereoisomers and enantiomers well-known to those skilled in the art, e.g., using CHIRALPAK® (Sigma-Aldrich) or
• CHIRALCEL® (Diacel Corp) chiral chromatographic HPLC columns according to the manufacturer’s instructions.
• compounds of the present invention may be synthesized using optically pure, chiral reagents and intermediates to prepare individual isomers or enantiomers. Unless otherwise indicated, all chiral (enantiomeric and diastereomeric) and racemic forms are within the scope of the invention. Unless otherwise indicated, whenever the specification, including the claims, refers to compounds of the invention, the term“compound” is to be understood to encompass all chiral (enantiomeric and diastereomeric) and racemic forms. '
• the KRas G12C inhibitor compounds of Formula I, Formula I-A, or Formula I-B used in the methods include trifluoroacetic acid salts of the above compounds.
• WO2017201 161and WO2019099524 describe general reaction schemes for preparing compounds of Formula I, Formula I-A, or Formula I-B and also provide detailed synthetic routes for the preparation of each KRas G12C inhibitor disclosed herein.
• Raf family kinase inhibitors or a pharmaceutically acceptable salts thereof, and the KRas G12C compounds of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt thereof, may be formulated into pharmaceutical compositions.
• the invention provides pharmaceutical compositions comprising a Raf family kinase inhibitor and KRas G12C inhibitor according to the invention and a
• the Raf family kinase inhibitor and KRas G12C inhibitor may be any pharmaceutically acceptable carrier, excipient, or diluent that may be used in the methods disclosed herein.
• the Raf family kinase inhibitor and KRas G12C inhibitor may be any pharmaceutically acceptable carrier, excipient, or diluent that may be used in the methods disclosed herein.
• the Raf family kinase inhibitor and KRas G12C inhibitor may be any pharmaceutically acceptable carrier, excipient, or diluent that may be used in the methods disclosed herein.
• the Raf family kinase inhibitor and KRas G12C inhibitor may be any pharmaceutically acceptable carrier, excipient, or diluent that may be used in the methods disclosed herein.
• compositions may contain, in addition to the inhibitor, diluents, fillers, salts, buffers, stabilizers, solubilizers, and other materials well known in the art.
• diluents fillers, salts, buffers, stabilizers, solubilizers, and other materials well known in the art.
• the preparation of pharmaceutically acceptable formulations is described in, e.g., Remington's Pharmaceutical Sciences, 18th Edition, ed. A. Gennaro, Mack Publishing Co., Easton, Pa., 1990.
• the term pharmaceutically acceptable salt refers to salts that retain the desired biological activity of the above-identified compounds and exhibit minimal or no undesired toxicological effects.
• examples of such salts include, but are not limited to acid addition salts formed with inorganic acids (for example, hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid, and the like), and salts formed with organic acids such as acetic acid, oxalic acid, tartaric acid, succinic acid, malic acid, ascorbic acid, benzoic acid, tannic acid, pamoic acid, alginic acid, polyglutamic acid, naphthalenesulfonic acid, naphthalenedisulfonic acid, and polygalacturonic acid.
• inorganic acids for example, hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid, and the like
• organic acids such as acetic acid, oxalic acid, tartaric acid
• the pharmaceutical compositions comprising a Raf family kinase inhibitor and/or a KRas G12C inhibitor for use in the methods may be for simultaneous, separate or sequential use.
• the Raf family kinase inhibitor is administered prior to administration of the KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B.
• the Raf family kinase inhibitor is administered after administration of the KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B.
• the Raf family kinase inhibitor is administered at about the same time as administration of the KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B.
• Oncology drugs are typically administered at the maximum tolerated dose (“MTD”), which is the highest dose of drug that does not cause unacceptable side effects.
• MTD maximum tolerated dose
• the KRas G12C inhibitor and the Raf family kinase inhibitor are each dosed at their respective MTDs.
• the KRas G12C inhibitor is dosed at its MTD and the Raf family kinase inhibitor is dosed in an amount less than its MTD.
• the KRas G12C inhibitor is dosed at an amount less than its MTD and the Raf family kinase inhibitor is dosed at its MTD.
• the KRas G12C inhibitor and the Raf family kinase inhibitor are each dosed at less than their respective MTDs.
• the administration can be so timed that the peak pharmacokinetic effect of one compound coincides with the peak pharmacokinetic effect of the other.
• a single dose of KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof is administered per day (i.e., in about 24 hour intervals) (i.e., QD).
• the Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof is administered QD.
• the Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof is administered BID.
• the Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, of the invention is administered TID.
• a single dose of KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, and Raf family kinase inhibitor, or pharmaceutically acceptable salt or a pharmaceutical composition thereof, are each administered once daily.
• Raf family kinase inhibitors useful in the methods disclosed herein include, but are not limited to, Encorafenib (LGX818): methyl (S)-(1-((4-(3-(5-chloro-2-fluoro-3- (methylsulfonamido)phenyl)-1-isopropyl- 1H-pyrazol-4-yl)pyrimidin-2-yl)amino)propan-2- yl)carbamate; PLX-8394: N-(3-(5-(2-cyclopropylpyrimidin-5-yl)-3a,7a-dihydro-1H- pyrrolo[2,3-b]pyridine-3-carbonyl)-2,4-difluorophenyl)-3-fluoropyrrolidine-1-sulfonamide; Raf-709: N-(2-methyl-5'-morpholino-6 , -((tetrahydro-2H-pyran-4-
• the Raf family kinase inhibitor is Encoratinib (LGX818). In one embodiment, the Raf family kinase inhibitor is Sorafenib. In one embodiment, the Raf family kinase inhibitor is Lifirafenib (BGB-283).
• kits for treating cancer in a subject in need thereof comprising administering to the subject a therapeutically effective amount of a combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a KRAS G12C inhibitor of Formula (I), Formula l-A or Formula I-B, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof.
• the cancer is a KRas Gl2C-associated cancer.
• the KRas G12C-associated cancer is lung cancer.
• the invention provides for methods for increasing the sensitivity of a cancer cell to a KRas G12C inhibitor, comprising contacting the cancer cell with an effective amount of a combination of a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof, and a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or pharmaceutical composition thereof, wherein the Raf family kinase inhibitor synergistically increases the sensitivity of the cancer cell to the KRas G12C inhibitor.
• the contacting is in vitro. In one embodiment, the contacting is in vivo.
• the combination therapy comprises a combination of a compound having the formula:
• the Raf family kinase inhibitor is Encoratinib (LGX818). In one embodiment, the Raf family kinase inhibitor is Sorafenib. In one embodiment, the Raf family kinase inhibitor is Lifirafenib (BGB-283).
• the combination therapy comprises a combination of a compound having the formula:
• the Raf family kinase inhibitor is Encoratinib (LGX818). In one embodiment, the Raf family kinase inhibitor is Sorafenib. In one embodiment, the Raf family kinase inhibitor is Lifirafenib (BGB-283).
• the combination therapy comprises a combination of a compound having the formula:
• the Raf family kinase inhibitor is Encoratinib (LGX818). In one embodiment, the Raf family kinase inhibitor is Sorafenib. In one embodiment, the Raf family kinase inhibitor is Lifirafenib (BGB-283).
• the combination therapy comprises a combination of a compound having the formula:
• the Raf family kinase inhibitor is Encoratinib (LGX818). In one embodiment, the Raf family kinase inhibitor is Sorafenib. In one embodiment, the Raf family kinase inhibitor is Lifirafenib (BGB-283).
• the term "contacting” refers to the bringing together of indicated moieties in an in vitro system or an in vivo system.
• "contacting" a cancer cell includes the administration of a combination provided herein to an individual or subject, such as a human, having KRas G12C, as well as, for example, introducing a combination provided herein into a sample containing a cellular or purified preparation containing KRas G12C.
• the methods described herein are designed to inhibit undesired cellular proliferation resulting from enhanced KRas G12C activity within the cell.
• compositions and methods provided herein may be used for the treatment of a KRas Gl2C-associated cancer in a subject in need thereof, comprising administering to said subject a therapeutically effective amount of a combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof, wherein the Raf family kinase inhibitor synergistically increases the sensitivity of the KRas G 12C-associated cancer to the KRas G12C inhibitor.
• the KRas G 12C-associated cancer is lung cancer.
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in an increased duration of overall survival (“OS”) in subjects relative to treatment with only the KRas G12C inhibitor.
• OS overall survival
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in an increased duration of progression-free survival (“PFS”) in subjects relative to treatment with only the KRas G12C inhibitor.
• PFS progression-free survival
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in increased tumor regression in subjects relative to treatment with only the KRas G12C inhibitor.
• the therapeutically effective amount of the combination of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula (I), Formula I-A, or Formula I-B, or a pharmaceutically acceptable salt or pharmaceutical composition thereof results in increased tumor growth inhibition in subjects relative to treatment with only the KRas G12C inhibitor.
• the Raf family kinase inhibitor is selected from Encoratinib, Sorafenib or Lifirafenib.
• the therapeutic combination comprises therapeutically effective amounts of Example No. 234 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 234 and Sorafenib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 234 and Lifirafenib. In one embodiment, the therapeutic combination comprises a therapeutically effective amount of Example No. 359 and Encoratinib.
• the therapeutic combination comprises therapeutically effective amounts of Example No. 359 and Sorafenib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 359 and Lifirafenib. In one embodiment, the therapeutic combination comprises a therapeutically effective amount of Example No. 478 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 478 and Sorafenib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 478 and Lifirafenib. In one embodiment, the therapeutic combination comprises a therapeutically effective amount of Example No. 507 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 507 and Sorafenib.
• the therapeutic combination comprises therapeutically effective amounts of Example No. 507 and Lifirafenib.
• the combination is useful for treating a KRas G12C- associated cancer.
• the KRas Gl2C-associated cancer is lung cancer.
• the Raf family kinase inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof is administered in combination with the KRas G12C inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof once disease progression has been observed for KRas G12C monotherapy, in which the combination therapy results in enhanced clinical benefit or time of survival for the patient by increasing OS, PFS, tumor regression, tumor growth inhibition or the duration of stable disease in the patient.
• the KRas G12C inhibitor is a compound selected from compound Nos. 1-678 (as numbered in WO2019099524), or a pharmaceutically acceptable salt thereof (e.g., Example No. 234, 359, 478 or 507 or a pharmaceutically acceptable salt thereof).
• the Raf family kinase inhibitor is selected from Encoratinib, Sorafenib or
• the therapeutic combination comprises therapeutically effective amounts of Example No. 234 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 234 and Sorafenib.
• the therapeutic combination comprises therapeutically effective amounts of Example No. 234 and Lifirafenib. In one embodiment, the therapeutic combination comprises a therapeutically effective amount of Example No. 359 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 359 and Sorafenib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 359 and Lifirafenib. In one embodiment, the therapeutic combination comprises a therapeutically effective amount of Example No. 478 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 478 and Sorafenib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 478 and Lifirafenib.
• the therapeutic combination comprises a therapeutically effective amount of Example No. 507 and Encoratinib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 507 and Sorafenib. In one embodiment, the therapeutic combination comprises therapeutically effective amounts of Example No. 507 and Lifirafenib.
• the combination is useful for treating a KRas G 12C-associated cancer.
• the KRas G 12C-associated cancer is lung cancer.
• compositions and methods provided herein may be used for the treatment of a wide variety of cancers including tumors such as lung, colorectal, pancreas, prostate, breast, brain, skin, cervical carcinomas, testicular carcinomas, etc. More particularly, cancers that may be treated by the compositions and methods of the invention include, but are not limited to, tumor types such as astrocytic, breast, cervical, colorectal, endometrial, esophageal, gastric, head and neck, hepatocellular, laryngeal, lung, oral, ovarian, prostate and thyroid carcinomas and sarcomas. More specifically, these compounds can be used to treat: Cardiac: sarcoma
• angiosarcoma fibrosarcoma, rhabdomyosarcoma, liposarcoma
• myxoma rhabdomyoma, fibroma, lipoma and teratoma
• Lung bronchogenic carcinoma (squamous cell, undifferentiated small cell, undifferentiated large cell, adenocarcinoma), alveolar (bronchiolar) carcinoma, bronchial adenoma, sarcoma, lymphoma, chondromatous hamartoma, mesothelioma;
• Gastrointestinal esophagus (squamous cell carcinoma, adenocarcinoma, leiomyosarcoma, lymphoma), stomach (carcinoma, lymphoma, leiomyosarcoma), pancreas (ductal
• adenocarcinoma insulinoma, glucagonoma, gastrinoma, carcinoid tumors, vipoma
• small bowel adenocarcinoma, lymphoma, carcinoid tumors, Kaposi's sarcoma, leiomyoma, hemangioma, lipoma, neurofibroma, fibroma), large bowel (adenocarcinoma, tubular adenoma, villous adenoma, hamartoma, leiomyoma);
• Genitourinary tract kidney (adenocarcinoma,
• hepatoma hepatocellular carcinoma
• cholangiocarcinoma hepatoblastoma
• angiosarcoma hepatocellular adenoma
• Biliary tract gall bladder carcinoma, ampullary carcinoma, cholangiocarcinoma
• Bone osteogenic sarcoma (osteosarcoma), fibrosarcoma, malignant fibrous histiocytoma, chondrosarcoma, Ewing's sarcoma, malignant lymphoma (reticulum cell sarcoma), multiple myeloma, malignant giant cell tumor chordoma, osteochronfroma (osteocartilaginous exostoses), benign chondroma, chondroblastoma, chondromyxofibroma, osteoid osteoma and giant cell tumors; Nervous system: skull (osteoma, hemangioma, granuloma, xant
• meningiosarcoma meningiosarcoma, gliomatosis
• brain astrocytoma, medulloblastoma, glioma, ependymoma, germinoma (pinealoma), glioblastoma multiform, oligodendroglioma, schwannoma,
• retinoblastoma congenital tumors
• spinal cord neurofibroma meningioma
• glioma sarcoma
• Gynecological uterus (endometrial carcinoma), cervix (cervical carcinoma, pre-tumor cervical dysplasia), ovaries (ovarian carcinoma (serous cystadenocarcinoma, mucinous
• cystadenocarcinoma unclassified carcinoma
• granulosa-thecal cell tumors Sertoli-Leydig cell tumors, dysgerminoma, malignant teratoma), vulva (squamous cell carcinoma, intraepithelial carcinoma, adenocarcinoma, fibrosarcoma, melanoma), vagina (clear cell carcinoma, squamous cell carcinoma, botryoid sarcoma (embryonal rhabdomyosarcoma), fallopian tubes (carcinoma); Hematologic: blood (myeloid leukemia (acute and chronic), acute lymphoblastic leukemia, chronic lymphocytic leukemia, myeloproliferative diseases, multiple myeloma, myelodysplastic syndrome), Hodgkin's disease, non-Hodgkin's lymphoma (malignant lymphoma); Skin:
• malignant melanoma basal cell carcinoma, squamous cell carcinoma, Kaposi's sarcoma, moles dysplastic nevi, lipoma, angioma, dermatofibroma, keloids, psoriasis; and Adrenal glands:
• the cancer is non-small cell lung cancer.
• Also provided herein is a method for treating cancer in a subject in need thereof, the method comprising (a) determining that cancer is associated with a KRas G12C mutation (e.g., a KRas Gl2C-associated cancer) (e.g., as determined using a regulatory agency-approved, e.g., FDA-approved, assay or kit); and (b) administering to the patient a therapeutically effective amount of a combination of a Raf family inhibitor, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof and a KRas G12C inhibitor compound of Formula I, Formula I-A, Formula 1-B, or a pharmaceutically acceptable salt or a pharmaceutical composition thereof, wherein the Raf family kinase inhibitor synergistically increases the sensitivity of the KRas G12C-associated cancer to the KRas G12C inhibitor.
• a KRas G12C mutation e.g., a KRas Gl2C-associated cancer
• a compound of Formula I is administered as a capsule during the period of time.
• a tablet or capsule formulation of a compound of Formula I comprises about 10 mg to about 100 mg (e.g., about 10 mg to about 95 mg, about 10 mg to about 90 mg, about 10 mg to about 85 mg, about 10 mg to about 80 mg, about 10 mg to about 75 mg, about 10 mg to about 70 mg, about 10 mg to about 65 mg, about 10 mg to about 60 mg, about 10 mg to about 55 mg, about 10 mg to about 50 mg, about 10 mg to about 45 mg, about 10 mg to about 40 mg, about 10 mg to about 35 mg, about 10 mg to about 30 mg, about 10 mg to about 25 mg, about 10 mg to about 20 mg, about 10 mg to about 15 mg, about 15 mg to about 100 mg, about 15 mg to about 95 mg, about 15 mg to about 90 mg, about 15 mg to about 85 mg, about 15 mg to about 80 mg, about 15 mg to about 75 mg, about 15 mg to about 70 mg, about 15 mg to about 65
• a compound of Formula I is orally administered once a day (QD) on a daily basis during a period of time. In one embodiment, a compound of Formula I is orally administered twice a day (BID) on a daily basis during a period of time.
• QD once a day
• BID twice a day
• the combination therapy comprises oral administration of a compound of Formula I once or twice a day on a daily basis (during a period of time), e.g., in an amount of about 10 mg to about 400 mg (e.g., about 10 mg to about 380 mg, about 10 mg to about 360 mg, about 10 mg to about 340 mg, about 10 mg to about 320 mg, about 10 mg to about 300 mg, about 10 mg to about 280 mg, about 10 mg to about 260 mg, about 10 mg to about 240 mg, about 10 mg to about 220 mg, about 10 mg to about 200 mg, about 10 mg to about 180 mg, about 10 mg to about 160 mg, about 10 mg to about 140 mg, about 10 mg to about 120 mg, about 10 mg to about 100 mg, about 10 mg to about 80 mg, about 10 mg to about 60 mg, about 10 mg to about 40 mg, about 10 mg to about 20 mg, about 20 mg to about 400 mg, about 20 mg to about 380 mg, about 20 mg to about 360 mg, about 20 mg to about 340
• the addition of a Raf family kinase inhibitor synergistically increases the activity of KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B against cancer or cancer cell lines expressing KRas G12C. Any method for determining whether two compounds exhibit synergy may be used for determining the synergistic effect of the combination.
• “synergistic effect” as used herein refers to combination of a KRAS inhibitor or a pharmaceutically acceptable salt thereof, and a Raf family kinase inhibitor or a pharmaceutically acceptable salt thereof producing an effect, for example, any of the beneficial or desired results including clinical results or endpoints as described herein, which is greater than the sum of the effect observed when a compound of Formula I or a
• time of survival means the length of time between the identification or diagnosis of cancer (e.g., any of the cancers described herein) in a mammal by a medical professional and the time of death of the mammal (caused by the cancer). Methods of increasing the time of survival in a mammal having a cancer are described herein.
• the patient before treatment with the compositions or methods of the invention, was treated with one or more of a chemotherapy, a targeted anticancer agent, radiation therapy, and surgery, and optionally, the prior treatment was unsuccessful; and/or the patient has been administered surgery and optionally, the surgery was unsuccessful; and/or the patient has been treated with a platinum- based chemotherapeutic agent, and optionally, the patient has been previously determined to be non-responsive to treatment with the platinum-based chemotherapeutic agent; and/or the patient has been treated with a kinase inhibitor, and optionally, the prior treatment with the kinase inhibitor was unsuccessful; and/or the patient was treated with one or more other therapeutic agent(s).
• the present invention also relates to a kit comprising a Raf family kinase inhibitor and a KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B. Also provided is a kit comprising a Raf family kinase inhibitor, or a pharmaceutically acceptable salt thereof, and a KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or a
• the invention provides a kit containing a dose of a Raf family kinase inhibitor, or a pharmaceutically acceptable salt thereof, and dose of a KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or a pharmaceutically acceptable salt thereof, in an amount effective to inhibit proliferation of cancer cells, particularly KRas G12C- expressing cancer cells, in a subject.
• the kit in some cases includes an insert with instructions for administration of the a Raf family kinase inhibitor, or a pharmaceutically acceptable salt thereof, and a KRas G12C inhibitor compound of Formula (I), Formula I-A or Formula I-B, or a pharmaceutically acceptable salt thereof.
• This Example may be used to illustrate that the combination of exemplary KRas G12C inhibitor compounds of Formula I, Formula I-A and Formula 1-B or a pharmaceutically acceptable salt thereof (e.g., a compound selected from compound Example Nos 1-678, or a pharmaceutically acceptable salt thereof, e.g., Example No. 234, 359, 478 or 507, or a pharmaceutically acceptable salt thereof) and a Raf family kinase inhibitor or a
• a pharmaceutically acceptable salt thereof e.g., a compound selected from compound Example Nos 1-678, or a pharmaceutically acceptable salt thereof, e.g., Example No. 234, 359, 478 or 507, or a pharmaceutically acceptable salt thereof
• pharmaceutically acceptable salt thereof synergistically inhibits the growth of tumor cell lines that express KRas G12C.
• Assays for determining the synergy score for the pairwise combinations for each cell line are performed in triplicate. Three 96-well plates plus an additional 4 wells of a separate 96-well control plate for determining baseline luminescence are seeded with 2000 cells/well of a particular cell line in a total volume of 90ml of a suitable growth medium for that cell line, e.g., RPMI 1640 medium supplemented with 10% FBS and any cell line specific reagents need for growth. The plates are incubated overnight at 37°C in a 5% CO 2 atmosphere.
• a suitable growth medium for that cell line e.g., RPMI 1640 medium supplemented with 10% FBS and any cell line specific reagents need for growth.
• a series of working stock 1000X drug dilutions in 100% DMSO is prepared that includes an 8 point single agent dilution of the exemplary KRas G12C inhibitor of Formula (I) and a 5- point single agent dilution of the Raf family kinase inhibitor.
• the dilutions used for the KRas G12C inhibitor and the Raf family kinase inhibitor vary for each individual compound but are typically in the range of 3- to 6-fold/serial dilution.
• Exemplary KRas G12C inhibitors for testing in this Example include:
• Example Number refers to the example number for each compound as disclosed in
• a 10X intermediate dosing plate is prepared in serum free RPMI medium that contains arrayed single agent dilutions of exemplary KRas G12C inhibitor of Formula (I) or the Raf family kinase inhibitor ln addition, a matrix of 40 dilution combinations of exemplary KRas G12C inhibitor of Formula (I), Formula I-A or Formula I-B and the Raf family kinase inhibitor is prepared as test samples.
• the raw data and metadata files are used as input files to calculate percent effect for each treatment condition and can be analyzed using four independent mathematical reference models designed to determine whether the two test compounds demonstrate synergy: Loewe additivity, Bliss independence, Highest Single Agent and ZIP.
• mice were inoculated in the right hind flank with cells or patient derived tumor samples harboring a KRas G12C mutation. When tumor volumes reached between 200 - 400 mm 3 in size, the mice were divided into four groups of 5-12 mice each. The first group was administered vehicle only. The second group was administered a single agent dose of the KRas G12C inhibitor at a concentration that yields a maximal biological effect or a less than maximal biological effect, depending on the cell line and the single agent activity, that does not result in complete tumor regression.
• the third group was administered a single agent dose of the Raf family kinase inhibitor at a concentration that yields a maximal biological effect or a less than maximal biological effect, depending on the cell line and the single agent activity, that also does not result in complete tumor regression.
• the fourth group was administered the single agent dose of the KRas G12C inhibitor in combination with the single agent dose of the Raf family kinase inhibitor.
• the treatment period varies from cell line to cell line but typically was between 21-35 days. Tumor volumes were measured using a caliper every two - three days and tumor volumes are calculated by the formula: 0.5 x (Length x Width) 2 .
• a greater degree of tumor growth inhibition for the combination in this model demonstrated that the combination therapy was likely to have a clinically meaningful benefit to treated subjects relative to treatment with only a KRas G12C inhibitor or only a Raf family kinase inhibitor.
• mice were inoculated in the right hind limb with 5 x 10 6 NCI-H2122 cells.
• tumor volume reached -300 mm 3 (Study Day 0)
• 5 mice in each of the four groups were administered p.o. daily for 21 days: vehicle only (10% Captisol), 100 mg/kg QD of the KRas G12C inhibitor Compound 478 (10% Captisol in 50 mM citrate buffer, pH 5.0), 10 mg/kg B1D of the Raf family kinase inhibitor BGB-283 (0.5%
• mice were administered 100 mg/kg QD of KRas G12C inhibitor Compound 478 for 15 days.
• mice were administered 100 mg/kg QD of KRas G12C inhibitor Compound 478 in combination with 10 mg/kg BID of BGB-283 for an additional nine days.

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