WO2020057539A1 - 用于治疗小细胞肺癌的喹啉衍生物 - Google Patents

用于治疗小细胞肺癌的喹啉衍生物 Download PDF

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Publication number
WO2020057539A1
WO2020057539A1 PCT/CN2019/106406 CN2019106406W WO2020057539A1 WO 2020057539 A1 WO2020057539 A1 WO 2020057539A1 CN 2019106406 W CN2019106406 W CN 2019106406W WO 2020057539 A1 WO2020057539 A1 WO 2020057539A1
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Prior art keywords
acid
lung cancer
small cell
cell lung
compound
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PCT/CN2019/106406
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English (en)
French (fr)
Inventor
王善春
于鼎
王训强
彭邦安
刘璐
代洁
周航
缪亚东
Original Assignee
正大天晴药业集团股份有限公司
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Application filed by 正大天晴药业集团股份有限公司 filed Critical 正大天晴药业集团股份有限公司
Priority to CA3112946A priority Critical patent/CA3112946A1/en
Priority to CN201980052510.4A priority patent/CN112533600B/zh
Priority to US17/276,972 priority patent/US20220031689A1/en
Priority to SG11202102682SA priority patent/SG11202102682SA/en
Priority to CN202311015952.6A priority patent/CN117085017A/zh
Priority to EP19861634.4A priority patent/EP3854396A4/en
Priority to CN202311015937.1A priority patent/CN117085016A/zh
Priority to AU2019344764A priority patent/AU2019344764A1/en
Publication of WO2020057539A1 publication Critical patent/WO2020057539A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/4841—Filling excipients; Inactive ingredients
    • A61K9/4866—Organic macromolecular compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/4709—Non-condensed quinolines and containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
    • C07D401/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings
    • C07D401/12—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings linked by a chain containing hetero atoms as chain links

Definitions

  • the invention belongs to the field of medicine, in particular, the invention relates to the use of a quinoline derivative in the treatment of small cell lung cancer, a method for treating the same, a pharmaceutical composition and a kit.
  • Lung cancer is a malignant tumor with high incidence and death worldwide. In recent years, the incidence and mortality of lung cancer in China has increased rapidly. SCLC accounts for 15% -20% of all lung cancer cases. It is very different from non-small cell lung cancer in terms of tissue origin, biological characteristics, response to treatment and prognosis, so it is considered a systemic disease, and SCLC has the characteristics of high malignancy, strong invasiveness, and easy to transfer. SCLC is highly invasive and has a poor prognosis. The 5-year survival rate is less than 5%. The average survival time of patients without treatment is only 2-4 months.
  • Chemotherapy and radiotherapy are the main treatments of SCLC. Although the main treatment of SCLC is very sensitive to the initial treatment, most patients with SCLC relapse and metastasize soon after treatment. Because of rapid progress, prone to drug resistance, and poor prognosis, only a small number of patients have the opportunity to receive third-line treatment. Studies have reported that only 20% of SCLC have received third-line treatment. There is no standard treatment for chemotherapy. The development of chemotherapy resistance makes relapsed SCLC treatment more difficult, especially for relapsed refractory SCLC. Therefore, there is an urgent need to find new treatments to treat relapsed SCLC.
  • the present application provides a method of treating small cell lung cancer, the method comprising administering a therapeutically effective amount of Compound I or a pharmaceutically acceptable salt thereof to a patient in need of treatment.
  • the present application provides the use of Compound I or a pharmaceutically acceptable salt thereof in the treatment of small cell lung cancer or the preparation of a medicament for the treatment of small cell lung cancer.
  • the present application provides a pharmaceutical composition for treating small cell lung cancer, the pharmaceutical composition comprising Compound I or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable carrier.
  • the present application provides a kit for treating small cell lung cancer, comprising (a) a pharmaceutical composition of at least one unit dose of Compound I or a pharmaceutically acceptable salt thereof, and (b) Instructions for treating small cell lung cancer.
  • the small cell lung cancer is relapsed small cell lung cancer, including, but not limited to, small cell lung cancer that relapses and / or progresses due to failure of treatment with a chemotherapeutic drug and / or a targeted drug.
  • the small cell lung cancer is advanced small cell lung cancer.
  • the small cell lung cancer is small cell lung cancer that has failed treatment with at least two chemotherapy regimens.
  • the small cell lung cancer is small cell lung cancer that has failed second-line chemotherapy and / or more than second-line chemotherapy.
  • the small cell lung cancer is metastatic small cell lung cancer; wherein the metastatic lesions include, but are not limited to, lymph nodes, pleura, bone, brain, pericardium, adrenal gland, and liver.
  • the application provides a method of treating small cell lung cancer, the method comprising administering a therapeutically effective amount of Compound I or a pharmaceutically acceptable salt thereof to a patient in need of treatment.
  • the present application provides a method of treating at least two chemotherapy regimens for small cell lung cancer, which method comprises administering a therapeutically effective amount of Compound I or a pharmaceutically acceptable salt thereof to a patient in need of treatment.
  • the present application provides a method of treating small cell lung cancer in which second-line chemotherapy and / or above-line chemotherapy fails, which method comprises administering to a patient in need of treatment a therapeutically effective amount of Compound I or a pharmaceutically acceptable amount thereof Of salt.
  • the present application provides a method of treating refractory relapsed small cell lung cancer, the method comprising administering a therapeutically effective amount of Compound I or a pharmaceutically acceptable salt thereof to a patient in need of treatment.
  • the "refractory relapsed small cell lung cancer” refers to small cell lung cancer that has not been relieved by chemotherapy, and small cell lung cancer that is effective but has progressed within 3 months after the end of chemotherapy.
  • the chemotherapy includes first-line chemotherapy and second-line chemotherapy; including but not limited to one or more of podophyllum, alkylating agents, camptothecins, taxanes, antimetabolites, antibiotics and antitumor drugs; can Listed examples include, but are not limited to, cisplatin, etoposide, carboplatin, nedaplatin, oxaliplatin, mitoplatin, loplatin, irinotecan, topotecan, paclitaxel, docetaxel, temozolomide, changchun One or more of Ruibin, gemcitabine, cyclophosphamide, doxorubicin, vincristine, bendamustine, epirubicin, methotrexate, and amrubicin.
  • the small cell lung cancer is extensive stage small cell lung cancer.
  • the small cell lung cancer is metastatic small cell lung cancer, wherein the metastatic lesions include, but are not limited to, lymph nodes, pleura, bone, pericardium, adrenal gland, liver, and brain. In some embodiments, the small cell lung cancer is brain metastatic small cell lung cancer.
  • the small cell lung cancer is a refractory relapsed small cell lung cancer that has previously received second-line chemotherapy.
  • the second-line chemotherapy includes, but is not limited to, cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, loplatin, irinotecan, topotecan, paclitaxel, docetaxel, temozolomide, vinorelbine, One or more of gemcitabine, cyclophosphamide, doxorubicin, vincristine, bendamustine, epirubicin, methotrexate, and amrubicin.
  • the small cell lung cancer is a refractory small cell lung cancer that has previously been treated with one or more of irinotecan, platinum, paclitaxel, and docetaxel.
  • the small cell lung cancer is previously treated with irinotecan and platinum (e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin) Of refractory recurrent small cell lung cancer.
  • platinum e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin
  • platinum e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin
  • the application provides a method of treating brain metastatic small cell lung cancer, the method comprising administering a therapeutically effective amount of Compound I or a pharmaceutically acceptable salt thereof to a patient in need of treatment.
  • Compound I can be administered in its free base form, or in the form of its salts, hydrates, and prodrugs, which prodrugs are converted into the free base form of Compound I in vivo.
  • a pharmaceutically acceptable salt of Compound I is within the scope of the present invention, and the salt can be produced from different organic and inorganic acids according to methods known in the art.
  • the compound I is administered as the hydrochloride salt. In some embodiments, administration is in the form of Compound I monohydrochloride. In some embodiments, administration is in the form of Compound I dihydrochloride. In some embodiments, administration is in the form of a crystal of Compound I hydrochloride. In a particular embodiment, administration is in the form of a crystal of Compound I dihydrochloride. In some embodiments, administration is in the form of Compound I maleate.
  • Compound I or a pharmaceutically acceptable salt thereof can be administered by a variety of routes including, but not limited to, routes selected from the group consisting of oral, parenteral, intraperitoneal, intravenous, intraarterial, transdermal, sublingual, Intramuscular, rectal, buccal, intranasal, inhalation, vaginal, intraocular, topical, subcutaneous, intrafat, intra-articular, intraperitoneal and intrathecal. In some specific embodiments, it is administered orally.
  • the amount of Compound I or a pharmaceutically acceptable salt administered can be determined based on the severity of the disease, the response of the disease, any treatment-related toxicity, the age and health status of the patient.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 2 mg to 30 mg.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 6 mg to 20 mg.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg to 20 mg.
  • the daily dose of Compound 1 or a pharmaceutically acceptable salt thereof is 8 mg to 16 mg.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg to 14 mg.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 10 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 12 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 14 mg.
  • Compound I or a pharmaceutically acceptable salt thereof may be administered one or more times daily. In some embodiments, Compound I or a pharmaceutically acceptable salt thereof is administered once a day. In some embodiments, the oral solid formulation is administered once daily.
  • the method of administration can be comprehensively determined according to the activity, toxicity, and tolerance of the patient.
  • Compound I or a pharmaceutically acceptable salt thereof is administered in a spaced manner.
  • the interval administration includes an administration period and a withdrawal period, and Compound I or a pharmaceutically acceptable salt thereof may be administered one or more times per day during the administration period.
  • Compound I or a pharmaceutically acceptable salt thereof is administered daily during the administration period, and then the administration is stopped for a period of time during the withdrawal period, followed by the administration period, and then the withdrawal period, which can be repeated multiple times.
  • the ratio in days between the administration period and the withdrawal period is 2: 0.5 to 5, preferably 2: 0.5 to 3, more preferably 2: 0.5 to 2, and even more preferably 2: 0.5 to 1.
  • the administration is discontinued for 2 weeks for 2 weeks. In some embodiments, the dose is administered once a day for 14 days and then discontinued for 14 days.
  • the administration is discontinued for 2 weeks for 1 week. In some embodiments, the dose is administered once a day for 14 days and then discontinued for 7 days.
  • the dosing is discontinued for 5 days for 2 days. In some embodiments, the dose is administered once a day for 5 days and then discontinued for 2 days.
  • the drug is administered orally at a dose of 12 mg once a day for 2 weeks and then stopped for 1 week.
  • the drug is administered orally at a dose of 10 mg once a day for two consecutive weeks and one week off.
  • the drug is administered orally at a dose of 8 mg once a day for 2 weeks and then stopped for 1 week.
  • Compound I or a pharmaceutically acceptable salt thereof is administered alone as a sole active ingredient to a small cell lung cancer patient. In some embodiments, Compound I or a pharmaceutically acceptable salt thereof is administered to a small cell lung cancer patient simultaneously or sequentially with other antitumor drugs.
  • other antitumor drugs include, but are not limited to, antifolate antitumor drugs, podophyllum anticancer drugs, hormone antitumor drugs, alkylating agent antitumor drugs, camptothecin antitumor drugs, One or more of fluoropyrimidine derivatives, anthracyclines, taxanes, tyrosine kinase inhibitors (e.g., EGFR inhibitors, VEGFR inhibitors), mitomycin, trastuzumab .
  • antifolate antitumor drugs include, but are not limited to, antifolate antitumor drugs, podophyllum anticancer drugs, hormone antitumor drugs, alkylating agent antitumor drugs, camptothecin antitumor drugs, One or more of fluoropyrimidine derivatives, anthracyclines, taxanes, tyrosine kinase inhibitors (e.g., EGFR inhibitors, VEGFR inhibitors), mitomycin
  • the present application provides the use of Compound I or a pharmaceutically acceptable salt thereof in the treatment of small cell lung cancer or the preparation of a medicament for the treatment of small cell lung cancer.
  • the present application provides the use of Compound I or a pharmaceutically acceptable salt thereof in the treatment of small cell lung cancer in which at least two chemotherapy regimens have failed treatment or the preparation of a small Use in medicine for cell lung cancer.
  • the present application provides the use of compound I or a pharmaceutically acceptable salt thereof for the treatment of small cell lung cancer in which second-line chemotherapy and / or above-line chemotherapy fails, or for the preparation of second-line chemotherapy and / or above-line chemotherapy Use of Medicines for Chemotherapy Failure in Small Cell Lung Cancer
  • the present application provides the use of Compound I or a pharmaceutically acceptable salt thereof in the treatment of refractory relapsed small cell lung cancer or the preparation of a medicament for the treatment of refractory relapsed small cell lung cancer. use.
  • the "refractory relapsed small cell lung cancer” refers to small cell lung cancer that has not been relieved by chemotherapy, and small cell lung cancer that is effective but has progressed within 3 months after the end of chemotherapy.
  • the chemotherapy includes first-line chemotherapy and second-line chemotherapy; including but not limited to one or more of podophyllum, alkylating agents, camptothecins, taxanes, antimetabolites, antibiotics and antitumor drugs; can Listed examples include, but are not limited to, cisplatin, etoposide, carboplatin, nedaplatin, oxaliplatin, mitoplatin, loplatin, irinotecan, topotecan, paclitaxel, docetaxel, temozolomide, changchun One or more of Ruibin, gemcitabine, cyclophosphamide, doxorubicin, vincristine, bendamustine, epirubicin, methotrexate, and amrubicin.
  • the small cell lung cancer is extensive stage small cell lung cancer.
  • the small cell lung cancer is metastatic small cell lung cancer, wherein the metastatic lesions include, but are not limited to, lymph nodes, pleura, bone, pericardium, adrenal gland, liver, and brain. In some embodiments, the small cell lung cancer is brain metastatic small cell lung cancer.
  • the small cell lung cancer is a refractory relapsed small cell lung cancer that has previously received second-line chemotherapy.
  • the second-line chemotherapy includes, but is not limited to, cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, loplatin, irinotecan, topotecan, paclitaxel, docetaxel, temozolomide, vinorelbine, One or more of gemcitabine, cyclophosphamide, doxorubicin, vincristine, bendamustine, epirubicin, methotrexate, and amrubicin.
  • the small cell lung cancer is a refractory small cell lung cancer that has previously been treated with one or more of irinotecan, platinum, paclitaxel, and docetaxel.
  • the small cell lung cancer is previously treated with irinotecan and platinum (e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin) Of refractory recurrent small cell lung cancer.
  • platinum e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin
  • platinum e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin
  • the present application provides the use of Compound I or a pharmaceutically acceptable salt thereof in the treatment of brain metastatic small cell lung cancer or the preparation of a medicament for the treatment of brain metastatic small cell lung cancer.
  • Compound I may be in its free base form, or in the form of its salts, hydrates, and prodrugs, which prodrugs are converted into the free base form of Compound I in vivo.
  • the pharmaceutically acceptable salts of Compound I are within the scope of the present invention, and salts can be produced from different organic and inorganic acids according to methods well known in the art.
  • Compound I or a pharmaceutically acceptable salt thereof is the hydrochloride form of Compound I. In some embodiments, it is in the form of Compound I monohydrochloride. In some embodiments, it is in the form of Compound I dihydrochloride. In some embodiments, it is a crystalline form of Compound I hydrochloride. In a particular embodiment, it is a crystalline form of the dihydrochloride salt of Compound I. In some embodiments, it is in the form of Compound I maleate.
  • Compound I or a pharmaceutically acceptable salt thereof can be administered by a variety of routes including, but not limited to, routes selected from the group consisting of oral, parenteral, intraperitoneal, intravenous, intraarterial, transdermal, sublingual, Intramuscular, rectal, buccal, intranasal, inhalation, vaginal, intraocular, topical, subcutaneous, intrafat, intra-articular, intraperitoneal and intrathecal. In some specific embodiments, it is administered orally.
  • the amount of Compound I or a pharmaceutically acceptable salt thereof can be determined based on the severity of the disease, the response of the disease, any treatment-related toxicity, the age and health status of the patient.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 2 mg to 30 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 6 mg to 20 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg to 20 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg to 16 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg to 14 mg.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 10 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 12 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 14 mg.
  • Compound I or a pharmaceutically acceptable salt thereof may be administered one or more times daily. In some embodiments, Compound I or a pharmaceutically acceptable salt thereof is administered once a day. In some embodiments, the oral solid formulation is administered once daily.
  • the method of administration can be comprehensively determined according to the activity, toxicity, and tolerance of the patient.
  • Compound I or a pharmaceutically acceptable salt thereof is administered in a spaced manner.
  • the interval administration includes an administration period and a withdrawal period, and Compound I or a pharmaceutically acceptable salt thereof may be administered one or more times per day during the administration period.
  • Compound I or a pharmaceutically acceptable salt thereof is administered daily during the administration period, and then the administration is stopped for a period of time during the withdrawal period, followed by the administration period, and then the withdrawal period, which can be repeated multiple times.
  • the ratio in days between the administration period and the withdrawal period is 2: 0.5 to 5, preferably 2: 0.5 to 3, more preferably 2: 0.5 to 2, and even more preferably 2: 0.5 to 1.
  • the administration is discontinued for 2 weeks for 2 weeks. In some embodiments, the dose is administered once a day for 14 days and then discontinued for 14 days.
  • the administration is discontinued for 2 weeks for 1 week. In some embodiments, the dose is administered once a day for 14 days and then discontinued for 7 days.
  • the dosing is discontinued for 5 days for 2 days. In some embodiments, the dose is administered once a day for 5 days and then discontinued for 2 days.
  • the drug is administered orally at a dose of 12 mg once a day for 2 weeks and then stopped for 1 week.
  • the drug is administered orally at a dose of 10 mg once a day for two consecutive weeks and one week off.
  • the drug is administered orally at a dose of 8 mg once a day for 2 weeks and then stopped for 1 week.
  • Compound I or a pharmaceutically acceptable salt thereof is administered alone as a sole active ingredient to a small cell lung cancer patient. In some embodiments, Compound I or a pharmaceutically acceptable salt thereof is administered to a small cell lung cancer patient simultaneously or sequentially with other antitumor drugs.
  • other antitumor drugs include, but are not limited to, antifolate antitumor drugs, podophyllum anticancer drugs, hormone antitumor drugs, alkylating agent antitumor drugs, camptothecin antitumor drugs, One or more of fluoropyrimidine derivatives, anthracyclines, taxanes, tyrosine kinase inhibitors (e.g., EGFR inhibitors, VEGFR inhibitors), mitomycin, trastuzumab .
  • antifolate antitumor drugs include, but are not limited to, antifolate antitumor drugs, podophyllum anticancer drugs, hormone antitumor drugs, alkylating agent antitumor drugs, camptothecin antitumor drugs, One or more of fluoropyrimidine derivatives, anthracyclines, taxanes, tyrosine kinase inhibitors (e.g., EGFR inhibitors, VEGFR inhibitors), mitomycin
  • the present application provides a pharmaceutical composition for treating small cell lung cancer, which comprises Compound I or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable carrier.
  • the present application provides a pharmaceutical composition for the treatment of small cell lung cancer that has failed treatment with at least two chemotherapy regimens, which comprises Compound I or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable salt. a.
  • the present application provides a pharmaceutical composition for treating small cell lung cancer in which second-line chemotherapy and / or above-line chemotherapy fails, which comprises Compound I or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable Acceptable carrier.
  • the present application provides a pharmaceutical composition for the treatment of refractory relapsed small cell lung cancer, which comprises Compound I or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable carrier.
  • the "refractory relapsed small cell lung cancer” refers to small cell lung cancer that has not been relieved by chemotherapy, and small cell lung cancer that is effective but has progressed within 3 months after the end of chemotherapy.
  • the chemotherapy includes first-line chemotherapy and second-line chemotherapy; including but not limited to one or more of podophyllum, alkylating agents, camptothecins, taxanes, antimetabolites, antibiotics and antitumor drugs; can Listed examples include, but are not limited to, cisplatin, etoposide, carboplatin, nedaplatin, oxaliplatin, mitoplatin, loplatin, irinotecan, topotecan, paclitaxel, docetaxel, temozolomide, changchun One or more of Ruibin, gemcitabine, cyclophosphamide, doxorubicin, vincristine, bendamustine, epirubicin, methotrexate, and amrubicin.
  • the small cell lung cancer is extensive stage small cell lung cancer.
  • the small cell lung cancer is metastatic small cell lung cancer, wherein the metastatic lesions include, but are not limited to, lymph nodes, pleura, bone, pericardium, adrenal gland, liver, and brain. In some embodiments, the small cell lung cancer is brain metastatic small cell lung cancer.
  • the small cell lung cancer is a refractory relapsed small cell lung cancer that has previously received second-line chemotherapy.
  • the small cell lung cancer is a refractory small cell lung cancer that has previously been treated with one or more of irinotecan, platinum, paclitaxel, and docetaxel.
  • the small cell lung cancer is previously treated with irinotecan and platinum (e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin) Of refractory recurrent small cell lung cancer.
  • platinum e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin
  • platinum e.g., including but not limited to cisplatin, carboplatin, nedaplatin, oxaliplatin, miplatin, lopin
  • a pharmaceutical composition for treating brain metastatic small cell lung cancer which comprises Compound I or a pharmaceutically acceptable salt thereof, and at least one pharmaceutically acceptable carrier.
  • Compound I can be in its free base form, or in the form of salts, hydrates and prodrugs, which prodrugs are converted into the free base form of Compound I in vivo.
  • the pharmaceutically acceptable salts of Compound I are within the scope of the present invention, and salts can be produced from different organic and inorganic acids according to methods well known in the art.
  • Compound I or a pharmaceutically acceptable salt thereof is the hydrochloride form of Compound I. In some embodiments, it is in the form of Compound I monohydrochloride. In some embodiments, it is in the form of Compound I dihydrochloride. In some embodiments, it is a crystalline form of Compound I hydrochloride. In a particular embodiment, it is a crystalline form of the dihydrochloride salt of Compound I. In some embodiments, it is in the form of Compound I maleate.
  • the pharmaceutical composition may be suitable for oral, parenteral, intraperitoneal, intravenous, intraarterial, transdermal, sublingual, intramuscular, rectal, buccal, intranasal, inhalation, vaginal , Intraocular, topical, subcutaneous, intrafat, intra-articular, intraperitoneal and intrathecal formulations.
  • the amount of the pharmaceutical composition administered can be determined based on the severity of the disease, the response of the disease, any treatment-related toxicity, the age and health status of the patient.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 2 mg to 30 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 6 mg to 20 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof in the pharmaceutical composition is from 8 mg to 20 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg to 16 mg. In some embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is from 8 mg to 14 mg.
  • the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 8 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 10 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 12 mg. In some specific embodiments, the daily dose of Compound I or a pharmaceutically acceptable salt thereof is 14 mg.
  • the pharmaceutical composition is a formulation suitable for oral administration, including tablets, capsules, powders, granules, dripping pills, pastes, powders, and the like, preferably tablets and capsules.
  • the tablet can be an ordinary tablet, a dispersible tablet, an effervescent tablet, a sustained-release tablet, a controlled-release tablet, or an enteric tablet
  • the capsule can be an ordinary capsule, a sustained-release capsule, a controlled-release capsule, or an enteric capsule.
  • the oral preparation may be prepared by a conventional method using a pharmaceutically acceptable carrier known in the art.
  • the pharmaceutically acceptable carrier includes a filler, an absorbent, a wetting agent, a binder, a disintegrant, a lubricant, and the like.
  • Fillers include starch, lactose, mannitol, microcrystalline cellulose, etc .
  • absorbents include calcium sulfate, calcium hydrogen phosphate, calcium carbonate, etc .
  • wetting agents include water, ethanol, etc .
  • binders include hypromellose, polymer Retinone, microcrystalline cellulose, etc .
  • disintegrants include croscarmellose sodium, crospovidone, surfactants, low-substituted hydroxypropyl cellulose, etc .
  • lubricants include magnesium stearate, talc Powder, polyethylene glycol, sodium lauryl sulfate, micronized silica gel, talc, etc.
  • Pharmaceutical excipients also include colorants, sweeteners, and the like.
  • the pharmaceutical composition is a solid formulation suitable for oral administration.
  • the composition may be in the form of a tablet or capsule, for example.
  • the pharmaceutical composition is a capsule.
  • pharmaceutically acceptable carriers for oral solid preparations include mannitol, microcrystalline cellulose, hydroxypropyl cellulose, and magnesium stearate.
  • Compound I or a pharmaceutically acceptable salt thereof may be administered one or more times daily. In some embodiments, Compound I or a pharmaceutically acceptable salt thereof is administered once a day. In some embodiments, the oral solid formulation is administered once daily.
  • the method of administration can be comprehensively determined according to the activity, toxicity, and tolerance of the patient.
  • Compound I or a pharmaceutically acceptable salt thereof is administered in a spaced manner.
  • the interval administration includes an administration period and a withdrawal period, and Compound I or a pharmaceutically acceptable salt thereof may be administered one or more times per day during the administration period.
  • Compound I or a pharmaceutically acceptable salt thereof is administered daily during the administration period, and then the administration is stopped for a period of time during the withdrawal period, followed by the administration period, and then the withdrawal period, which can be repeated multiple times.
  • the ratio in days between the administration period and the withdrawal period is 2: 0.5 to 5, preferably 2: 0.5 to 3, more preferably 2: 0.5 to 2, and even more preferably 2: 0.5 to 1.
  • the administration is discontinued for 2 weeks for 2 weeks. In some embodiments, the dose is administered once a day for 14 days and then discontinued for 14 days.
  • the administration is discontinued for 2 weeks for 1 week. In some embodiments, the dose is administered once a day for 14 days and then discontinued for 7 days.
  • the dosing is discontinued for 5 days for 2 days. In some embodiments, the dose is administered once a day for 5 days and then discontinued for 2 days.
  • the drug is administered orally at a dose of 12 mg once a day for 2 weeks and then stopped for 1 week.
  • the drug is administered orally at a dose of 10 mg once a day for two consecutive weeks and one week off.
  • the drug is administered orally at a dose of 8 mg once a day for 2 weeks and then stopped for 1 week.
  • a pharmaceutical composition is formulated for treating refractory relapsed small cell lung cancer in a unit dosage form.
  • the pharmaceutical composition in the unit dosage form contains 2 mg to 30 mg of Compound I or a pharmaceutically acceptable salt thereof.
  • the pharmaceutical composition in a unit dosage form contains 6 mg to 20 mg of Compound I or a pharmaceutically acceptable salt thereof.
  • the pharmaceutical composition in the unit dosage form contains 8 mg to 20 mg of Compound I or a pharmaceutically acceptable salt thereof, preferably 8 mg to 16 mg of Compound I or a pharmaceutically acceptable salt thereof, 8 mg to 14 mg of Compound I or a pharmaceutically acceptable salt thereof is more preferable.
  • the pharmaceutical composition in the unit dosage form contains 8 mg of Compound I or a pharmaceutically acceptable salt thereof. In some specific embodiments, the pharmaceutical composition in the unit dosage form contains 10 mg of Compound I or a pharmaceutically acceptable salt thereof. In some specific embodiments, the unit dosage form pharmaceutical composition contains 12 mg of Compound I or a pharmaceutically acceptable salt thereof. In some specific embodiments, the unit dosage form pharmaceutical composition contains 14 mg of Compound I or a pharmaceutically acceptable salt thereof.
  • Compound I or a pharmaceutically acceptable salt thereof is administered alone as the sole active ingredient to a patient with relapsed small cell lung cancer. In some embodiments, Compound I or a pharmaceutically acceptable salt thereof is administered to a relapsed small cell lung cancer patient simultaneously or sequentially with other antitumor drugs.
  • other antitumor drugs include, but are not limited to, antifolate antitumor drugs, podophyllum anticancer drugs, hormone antitumor drugs, alkylating agent antitumor drugs, camptothecin antitumor drugs, One or more of fluoropyrimidine derivatives, anthracyclines, taxanes, tyrosine kinase inhibitors (e.g., EGFR inhibitors, VEGFR inhibitors), mitomycin, trastuzumab .
  • antifolate antitumor drugs include, but are not limited to, antifolate antitumor drugs, podophyllum anticancer drugs, hormone antitumor drugs, alkylating agent antitumor drugs, camptothecin antitumor drugs, One or more of fluoropyrimidine derivatives, anthracyclines, taxanes, tyrosine kinase inhibitors (e.g., EGFR inhibitors, VEGFR inhibitors), mitomycin
  • the present application provides a kit comprising (a) a pharmaceutical composition of at least one unit dose of Compound I or a pharmaceutically acceptable salt thereof, and (b) instructions for treating small cell lung cancer.
  • the application provides a kit comprising (a) a pharmaceutical composition of at least one unit dose of Compound I or a pharmaceutically acceptable salt thereof, and (b) for treating at least two types of chemotherapy Protocols for Protocols for Failure to Treat Small Cell Lung Cancer.
  • the application provides a kit comprising (a) a pharmaceutical composition of at least one unit dose of Compound I or a pharmaceutically acceptable salt thereof, and (b) for treating second-line chemotherapy and / Or instructions for small cell lung cancer that have failed second-line chemotherapy.
  • the present application provides a kit comprising (a) a pharmaceutical composition of at least one unit dose of Compound I or a pharmaceutically acceptable salt thereof, and (b) for treating refractory relapse Instructions for small cell lung cancer.
  • kits comprising (a) at least one unit dose of a suitable formulation for oral administration of Compound I or a pharmaceutically acceptable salt thereof, and (b) administered at intervals for treating difficult problems Instructions for the treatment of relapsed small cell lung cancer.
  • a kit is provided that comprises (a) at least one unit dose of a tablet or capsule of Compound I or a pharmaceutically acceptable salt thereof and (b) is administered at intervals Instructions for treating refractory small cell lung cancer.
  • radiotherapy and chemotherapy can also be received in an alternating, sequential or synchronous manner.
  • unit dose or unit dose refers to a pharmaceutical composition, such as each tablet or capsule, packaged in a single package for convenience.
  • a pharmaceutical composition in a unit dosage form means each tablet or capsule.
  • the crystal form of the hydrochloride salt of the compound I includes, but is not limited to, A, B, and C type crystals disclosed in Chinese patent application CN102344438A, wherein the A and B type crystals are crystals substantially free of crystal water and other solvents.
  • Type C crystals are crystals containing two crystal waters.
  • the crystalline form of the dihydrochloride salt of Compound I is Form A crystal.
  • Patient means a mammal, preferably a human.
  • “Pharmaceutically acceptable” means its use in the preparation of a pharmaceutical composition that is generally safe, non-toxic and neither biologically or otherwise undesirable, and includes that it is acceptable for human pharmaceutical use Accepted.
  • “Pharmaceutically acceptable salt” includes, but is not limited to, acid addition salts with inorganic or organic acids such as hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like; the organic acids such as acetic acid , Trifluoroacetic acid, propionic acid, hexanoic acid, heptanoic acid, cyclopentanepropionic acid, glycolic acid, pyruvate, lactic acid, malonic acid, succinic acid, malic acid, maleic acid, fumaric acid, tartaric acid, citric acid , Benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid, ethanesulfonic acid, 1,2-ethanedisulfonic acid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid, p-chlorobenzenesulfonic acid, p-toluenesulf
  • terapéuticaally effective amount is meant an amount of a compound that, when administered to a human for treating a disease, is sufficient to effect treatment of the disease.
  • Treatment means any administration of a therapeutically effective amount of a compound, and includes:
  • “Failure to treat” refers to intolerable toxic or side effects, disease progression during treatment, or relapse after treatment is completed.
  • Extensive phase means that the lesion extends beyond one side of the thorax and includes malignant and effusion or blood metastases.
  • EGFR inhibitor refers to an epidermal growth factor receptor inhibitor.
  • VEGFR inhibitor refers to a vascular endothelial growth factor receptor inhibitor.
  • CR refers to complete remission, that is, all target lesions disappear, and the short diameter of all pathological lymph nodes (including target and non-target nodules) must be reduced to ⁇ 10mm.
  • PR means partial remission, the sum of the diameters of the target lesions is reduced by at least 30% from the baseline level.
  • PD refers to disease progression, taking the minimum value of the sum of the diameters of all target lesions measured throughout the study as a reference, with a relative increase in diameter of at least 20% (if the baseline measurement is the smallest, the baseline value is used as a reference); and The relative value of the sum of the diameters must be increased by at least 5mm, and the occurrence of one or more new lesions is also considered to be disease progression.
  • SD means that the disease is stable, and the reduction of the target lesion does not reach the level of PR, and the increase does not reach the level of PD, somewhere in between.
  • PFS progression-free survival, the time from randomization to objective tumor progression or patient death.
  • DCR refers to the rate of disease control, including the complete response, partial response, and stable disease, and the percentage of patients who have maintained the disease for more than 4 weeks among the evaluable patients.
  • OS overall survival refers to the time from enrollment to death for any reason. In terms of days, lost follow-up subjects usually calculated the last follow-up time as death.
  • FES refers to the full analysis data set. According to the intention to analyze (ITT) principle, the efficacy analysis is performed on all cases where the drug is used at least once.
  • RECIST 1.1 refers to the standard 1.1 for evaluating the efficacy of solid tumors.
  • CI refers to the confidence interval, the estimated interval of the overall parameter constructed by the sample statistics.
  • Compound I or a pharmaceutically acceptable salt thereof in the present application has an unexpected therapeutic effect on small cell lung cancer, especially refractory recurrent small cell lung cancer, and can significantly prolong patients with refractory relapsed small cell lung cancer.
  • the survival time is also very significant for brain metastatic small cell lung cancer.
  • Example 24 in WO2008112407 1-[[[[4- (4-fluoro-2-methyl-1H-indol-5-yl) oxy-6-methoxyquinolin-7-yl was prepared. [Oxy] methyl] cyclopropylamine, and then referring to the preparation method of "Example of Salt Form" in the specification of WO2008112407, the title compound was prepared. Or it can be prepared by referring to the method disclosed in Chinese patent application CN102344438A.
  • Capsules of dihydrochloride of compound I with other contents can be prepared by referring to the above manner in corresponding proportions and prescriptions.
  • a multicenter, randomized, double-blind, placebo-controlled phase II clinical study was performed in patients with measurable lesions who had previously received standard treatment and relapsed.
  • 120 patients were enrolled and randomized to receive 12 mg / 0 mg of the compound I dihydrochloride capsule once a day.
  • Oral administration was discontinued for 2 weeks for 1 week, that is, 3 weeks (21 days) was a treatment cycle.
  • These patients were aged 18-75 years old, using the dihydrochloride capsules of Compound I and placebo, and had previously used other targeted drugs (such as sunitin, bevacizumab, endo), etc. Patients targeted were excluded.
  • Efficacy evaluation criteria are determined to be disease progression (PD) or clinically considered disease progression, use of other anti-tumor drug treatments (such as chemotherapy, targeted therapy or biologic therapy), accidental pregnancy, death, etc.
  • the test was discontinued (finally).
  • Patients with disease control (CR + PR + SD) who can tolerate adverse reactions continue to take the drug.
  • the investigator believes that the patient is not suitable for continued medication or is evaluated as PD according to the RECIST 1.1 criteria, the medication is terminated.
  • the investigator decides whether to adjust the dose, and the adjustable dose is 8mg / 0mg or 10mg / 0mg.
  • the primary efficacy indicators were progression-free survival (PFS), and the secondary efficacy indicators were overall survival (OS), objective response rate (ORR) (CR + PR), and disease control rate (DCR) (CR + PR + SD). ), Quality of life score, safety.
  • Objective efficacy indicators were evaluated according to the efficacy evaluation criteria for solid tumors (RECIST 1.1).
  • the product limit method was used, and 50% (median) PFS and PFS at different times after the start of treatment were calculated according to the actual situation of the data, and Log-Rank test was used to compare the two groups.
  • the product limit method was used for OS, and 50% (median) OS was calculated according to the actual situation of the data, and Log-Rank test was used to compare the two groups.
  • the statistical data set uses a Full Analysis Data Set (FAS). The research results are summarized in the following table.
  • TC regimen paclitaxel + carboplatin
  • TC regimen paclitaxel + carboplatin
  • the efficacy evaluation was PD.
  • an IP regimen 120 mg of irinotecan, d1 of 80 mg, d8; 100 mg of cisplatin
  • CT showed stable intrapulmonary and craniocerebral lesions, increased intrahepatic metastases, and the effect was evaluated as PD; target lesions (64mm): left inner lobe nodules and right posterior lobe nodules; non Target lesion: Multiple metastatic tumors in the brain.
  • target lesions 63mm; non-target lesions: non-CR / non-PD.
  • target lesions 65mm; non-target lesions: non-CR / non-PD.
  • target lesions 66mm; non-target lesions: non-CR / non-PD.
  • target lesions 72mm; non-target lesions: non-CR / non-PD.

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Abstract

本申请属于医药领域，提供一种用于治疗小细胞肺癌的喹啉衍生物。本申请所提供的1-[[[4-(4-氟-2-甲基-1H-吲哚-5-基)氧基-6-甲氧基喹啉-7-基]氧基]甲基]环丙胺或其药学上可接受的盐，可用于治疗小细胞肺癌，尤其是对于难治性复发的小细胞肺癌患者，能显著地延长其生存期，对于脑转移性小细胞肺癌的疗效也非常显著。

Description

用于治疗小细胞肺癌的喹啉衍生物
相关申请的交叉引用
本申请要求于2018年09月18日向中国国家知识产权局提交的第201811088089.6号中国专利申请的优先权和权益，所述申请公开的内容通过引用整体并入本文中。
技术领域
本发明属于医药领域，具体而言，本发明涉及喹啉衍生物在治疗小细胞肺癌中的用途及其治疗方法、药物组合物和试剂盒。
背景技术
肺癌是全世界范围内一种高发病率、死亡的恶性肿瘤。近年来，我国肺癌的发病率和死亡呈快速增长。SCLC占所有肺癌病例的15％-20％，无论从组织来源、生物学特征、对治疗的反应和预后等方面都与非小细胞肺癌迥然不同，所以被认为是一种全身性的疾病，且SCLC具有恶性程度高、侵袭性强、易发生转移的特点。SCLC侵袭性高，预后较差，5年生存率不足5％，不治疗的患者平均生存期仅2-4个月。
化疗和放疗是SCLC的主要治疗手段，尽管SCLC的主要治疗手段对初始治疗非常敏感，但大多数SCLC患者在治疗后很快出现复发和转移。因为进展快、易出现耐药且预后差，所以只有少数患者有机会接受三线治疗，有研究报道仅有20％的SCLC接受了三线治疗，三线治疗是否能够获益尚缺乏定论，且SCLC的三线化疗还没有标准治疗方案。其中化疗耐药的产生让复发的SCLC治疗变得更为棘手，尤其是复发难治性SCLC。因此，亟需寻求新的治疗方法治疗复发的SCLC。
发明内容
第一方面，本申请提供了一种治疗小细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐。
化合物I的化学名为1-[[[4-(4-氟-2-甲基-1H-吲哚-5-基)氧基-6-甲氧基喹啉-7-基]氧基]甲基]环丙胺，其具有如下的结构式：
Figure PCTCN2019106406-appb-000001
第二方面，本申请提供了化合物I或其药学上可接受的盐在治疗小细胞肺癌中的用途或制备用于治疗小细胞肺癌的药物中的用途。
第三方面，本申请提供了一种治疗小细胞肺癌的药物组合物，所述药物组合物包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体。
第四方面，本申请提供了一种用于治疗小细胞肺癌的试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的药物组合物和(b)用于治疗小细胞肺癌的说明书。
在一些实施方案中，所述小细胞肺癌为复发的小细胞肺癌，包括但不限于由化疗药物和/或靶向药物治疗失败引起复发和/或进展的小细胞肺癌。在一些实施方案中，所述小细胞肺癌为晚期小细胞肺癌。在一些实施方案中，所述小细胞肺癌为至少两种化疗方案治疗失败的小细胞肺癌。在一些实施方案中，所述小细胞肺癌为二线化疗和/或二线以上化疗失败的小细胞肺癌。在一些实施方案中，所述小细胞肺癌为转移性小细胞肺癌；其中转移病灶包括但不限于淋巴结、胸膜、骨、脑、心包、肾上腺、肝脏。
一方面，本申请提供了一种治疗小细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐。在一些实施方案中，本申请提供了一种至少两种化疗方案治疗失败的小 细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐。在一些实施方案中，本申请提供了一种治疗二线化疗和/或二线以上化疗失败的小细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐。在一个实施方案中，本申请提供了一种治疗难治性复发的小细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐。
所述“难治性复发的小细胞肺癌”是指化疗无缓解的小细胞肺癌，和化疗有效但在化疗结束后3个月内出现病情进展的小细胞肺癌。所述化疗包括一线化疗和二线化疗；包括但不限于鬼臼类、烷化剂类、喜树碱类、紫杉类、抗代谢类、抗生素类抗肿瘤药物中的一种或多种；可以列举的实例包括但不限于顺铂、依托泊苷、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星中的一种或多种。本领域技术人员可以理解的是，与所述化疗同时或者先后，患者也可以接受放疗。
在一些实施方案中，所述小细胞肺癌为广泛期小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为转移性小细胞肺癌，其中转移病灶包括但不限于淋巴结、胸膜、骨、心包、肾上腺、肝脏和脑。在一些实施方案中，所述小细胞肺癌为脑转移的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过二线化疗的难治性复发的小细胞肺癌。所述二线化疗包括但不限于顺铂、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星中的一种或多种。
在一些实施方案中，所述小细胞肺癌为在先接受过伊立替康、铂类、紫杉醇和多西他赛中的一种或者多种治疗的难治性复发的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过伊立替康和铂类(例如包括但不限于顺铂、卡铂、奈达铂、奥沙利铂、米铂、洛铂)治疗的难治性复发的小细胞肺癌。
在一些实施方案中，本申请提供了一种治疗脑转移的小细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐。
化合物I可以是它的游离碱形式，也可以是其盐、水合物和前药的形式给药，该前药在体内转换成化合物I的游离碱形式。例如，化合物I的药学上可接受的盐在本发明的范围内，可按照本领域公知的方法由不同的有机酸和无机酸产生所述盐。
在一些实施方案中，以化合物I盐酸盐的形式给药。在一些实施方案中，以化合物I一盐酸盐的形式给药。在一些实施方案中，以化合物I二盐酸盐的形式给药。在一些实施方案中，以化合物I盐酸盐的晶体形式给药。在特定的实施方案中，以化合物I二盐酸盐的晶体形式给药。在一些实施方案中，以化合物I马来酸盐的形式给药。
化合物I或其药学上可接受的盐可通过多种途径给药，该途径包括但不限于选自以下的途径：口服、肠胃外、腹膜内、静脉内、动脉内、透皮、舌下、肌内、直肠、透颊、鼻内、经吸入、阴道、眼内、经局部给药、皮下、脂肪内、关节内、腹膜内和鞘内。在一些特定的实施方案中，通过口服给药。
给予化合物I或其药学上可接受的盐的量可根据疾病的严重程度、疾病的响应、任何治疗相关的毒性、患者的年龄和健康状态来确定。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为2毫克至30毫克。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为6毫克至20毫克。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为8毫克至20毫克。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为8毫克至16毫克。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为8毫克至14毫克。在一些特定的实施方案中，给予化合物I或其药学上可接受的盐的日剂量为8毫克。在一些特定的实施方案中，给予化合物I或其药学上可接受的盐的日剂量为10毫克。在一些特定的实施方案中，给予化合物I或其药学上可接受的盐的日剂量为12毫克。在一些特定的实施方案中，给予化合物I或其药学上可接受的盐的日剂量为14毫克。
化合物I或其药学上可接受的盐可以每日施用一次或多次。在一些实施方案中，每天一次给予化合物I或其药学上可接受的盐。在一些实施方案中，以口服固体制剂每天给药一次。
给药的方法可根据药物的活性、毒性以及患者的耐受性等来综合确定。优选地，以间隔给药的方式给予化合物I或其药学上可接受的盐。所述间隔给药包括给药期和停药期，在给药期内可以每天一次或多次给予化合物I或其药学上可接受的盐。例如在给药期内每天给予化合物I或其药学上可接受的盐，然后停药期内停止给药一段时间，接着给药期，然后停药期，如此可以反复进行多次。其中，给药期和停药期的以天数计的比值为2:0.5～5，优选2:0.5～3，较优选2:0.5～2，更优选2:0.5～1。
在一些实施方案中，连续给药2周停药2周。在一些实施方案中，每天给药1次，持续给药14天，然后停药14天。
在一些实施方案中，连续给药2周停药1周。在一些实施方案中，每天给药1次，持续给药14天，然后停药7天。
在一些实施方案中，连续给药5天停药2天。在一些实施方案中，每天给药1次，持续给药5天，然后停药2天。
在某些特定的实施方案中，以每日一次12mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在某些特定的实施方案中，以每日一次10mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在某些特定的实施方案中，以每日一次8mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在一些实施方案中，化合物I或其药学上可接受的盐是作为唯一的活性成分单独给予小细胞肺癌患者。在一些实施方案中，化合物I或其药学上可接受的盐与其它抗肿瘤药物同时或依照次序给予小细胞肺癌患者。在一些实施方案中，其它抗肿瘤药物包括但不限于抗叶酸类抗肿瘤药物、鬼臼类抗癌药物、激素类抗肿瘤药物、烷化剂类抗肿瘤药物、喜树碱类抗肿瘤药、氟嘧啶衍生物、蒽环类药物、紫杉烷类化合物、酪氨酸激酶抑制剂(例如EGFR抑制剂、VEGFR抑制剂)、丝裂霉素、曲妥珠单抗中的一种或几种。
第二方面，本申请提供了化合物I或其药学上可接受的盐在治疗小细胞肺癌中的用途或者制备用于治疗小细胞肺癌的药物中的用途。在一些实施方案中，本申请提供了化合物I或其药学上可接受的盐在治疗至少两种化疗方案治疗失败的小细胞肺癌中的用途或者制备用于治疗至少两种化疗方案治疗失败的小细胞肺癌的药物中的用途。在一些实施方案中，本申请提供了化合物I或其药学上可接受的盐在治疗二线化疗和/或二线以上化疗失败的小细胞肺癌中的用途或者制备用于治疗二线化疗和/或二线以上化疗失败的小细胞肺癌的药物中的用途。在一个实施方案中，本申请提供了化合物I或其药学上可接受的盐在治疗难治性复发的小细胞肺癌中的用途或者制备用于治疗难治性复发的小细胞肺癌的药物中的用途。
所述“难治性复发的小细胞肺癌”是指化疗无缓解的小细胞肺癌，和化疗有效但在化疗结束后3个月内出现病情进展的小细胞肺癌。所述化疗包括一线化疗和二线化疗；包括但不限于鬼臼类、烷化剂类、喜树碱类、紫杉类、抗代谢类、抗生素类抗肿瘤药物中的一种或多种；可以列举的实例包括但不限于顺铂、依托泊苷、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星中的一种或多种。本领域技术人员可以理解的是，与所述化疗同时或者先后，患者也可以接受放疗和/或单抗(例如nivolumab和ipilimumab)治疗。
在一些实施方案中，所述小细胞肺癌为广泛期小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为转移性小细胞肺癌，其中转移病灶包括但不限于淋巴结、胸膜、骨、心包、肾上腺、肝脏和脑。在一些实施方案中，所述小细胞肺癌为脑转移的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过二线化疗的难治性复发的小细胞肺癌。所述二线化疗包括但不限于顺铂、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星的一种或多种。
在一些实施方案中，所述小细胞肺癌为在先接受过伊立替康、铂类、紫杉醇和多西他赛中的一种或者多种治疗的难治性复发的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过伊立替康和铂类(例如包括但不限于顺铂、卡铂、奈达铂、奥沙利铂、米铂、洛铂)治疗的难治性复发的小细胞肺癌。
在一些实施方案中，本申请提供了化合物I或其药学上可接受的盐在治疗脑转移的小细胞肺癌中的用途或者制备用于治疗脑转移的小细胞肺癌的药物中的用途。
化合物I可以是它的游离碱形式，也可以是其盐、水合物和前药的形式，该前药在体内转换成化合物I的游离碱形式。例如，化合物I药学上可接受的盐在本发明的范围内，可按照本领域公知的方法由不同的有机酸和无机酸产生盐。
在一些实施方案中，化合物I或其药学上可接受的盐为化合物I的盐酸盐形式。在一些实施方案中，为化合物I一盐酸盐的形式。在一些实施方案中，为化合物I二盐酸盐的形式。在一些实施方案中，为化合物I盐酸盐的晶体形式。在特定的实施方案中，为化合物I二盐酸盐的晶体形式。在一些实施方案中，为化合物I马来酸盐的形式。
化合物I或其药学上可接受的盐可通过多种途径给药，该途径包括但不限于选自以下的途径：口服、肠胃外、腹膜内、静脉内、动脉内、透皮、舌下、肌内、直肠、透颊、鼻内、经吸入、阴道、眼内、经局部给药、皮下、脂肪内、关节内、腹膜内和鞘内。在一些特定的实施方案中，通过口服给药。
化合物I或其药学上可接受的盐的量可根据疾病的严重程度、疾病的响应、任何治疗相关的毒性、患者的年龄和健康状态来确定。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为2毫克至30毫克。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为6毫克至20毫克。在一些实施方案中，化合物I或其药学上可接受的盐的日剂量为8毫克至20毫克。在一些实施方案中，化合物I或其药学上可接受的盐的日剂量为8毫克至16毫克。在一些实施方案中，化合物I或其药学上可接受的盐的日剂量为8毫克至14毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为8毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为10毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为12毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为14毫克。
化合物I或其药学上可接受的盐可以每日施用一次或多次。在一些实施方案中，每天一次给予化合物I或其药学上可接受的盐。在一些实施方案中，以口服固体制剂每天给药一次。
给药的方法可根据药物的活性、毒性以及患者的耐受性等来综合确定。优选地，以间隔给药的方式给予化合物I或其药学上可接受的盐。所述间隔给药包括给药期和停药期，在给药期内可以每天一次或多次给予化合物I或其药学上可接受的盐。例如在给药期内每天给予化合物I或其药学上可接受的盐，然后停药期内停止给药一段时间，接着给药期，然后停药期，如此可以反复进行多次。其中，给药期和停药期的以天数计的比值为2:0.5～5，优选2:0.5～3，较优选2:0.5～2，更优选2:0.5～1。
在一些实施方案中，连续给药2周停药2周。在一些实施方案中，每天给药1次，持续给药14天，然后停药14天。
在一些实施方案中，连续给药2周停药1周。在一些实施方案中，每天给药1次，持续给药14天，然后停药7天。
在一些实施方案中，连续给药5天停药2天。在一些实施方案中，每天给药1次，持续给药5天，然后停药2天。
在某些特定的实施方案中，以每日一次12mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在某些特定的实施方案中，以每日一次10mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在某些特定的实施方案中，以每日一次8mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在一些实施方案中，化合物I或其药学上可接受的盐是作为唯一的活性成分单独给予小细胞肺癌患者。在一些实施方案中，化合物I或其药学上可接受的盐与其它抗肿瘤药物同时或依照次序给予小细胞肺癌患者。在一些实施方案中，其它抗肿瘤药物包括但不限于抗叶酸类抗肿瘤药物、鬼臼类抗癌药物、激素类抗肿瘤药物、烷化剂类抗肿瘤药物、喜树碱类抗肿瘤药、氟嘧啶衍生物、蒽环类药物、紫杉烷类化合物、酪氨酸激酶抑制剂(例如EGFR抑制剂、VEGFR抑制剂)、丝裂霉素、曲妥珠单抗中的一种或几种。
第三方面，本申请提供了一种治疗小细胞肺癌的药物组合物，其包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体。在一些实施方案中，本申请提供了一种治疗至少两种化疗方案治疗失败的小细胞肺癌的药物组合物，其包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体。在一些实施方案中，本申请提供了一种治疗二线化疗和/或二线以上化疗失败的小细胞肺癌的药物组合物，其包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体。在一个实施方案中，本申请提供了一种治疗难治性复发的小细胞肺癌的药物组合物，其包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体。
所述“难治性复发的小细胞肺癌”是指化疗无缓解的小细胞肺癌，和化疗有效但在化疗结束后3个月内出现病情进展的小细胞肺癌。所述化疗包括一线化疗和二线化疗；包括但不限于鬼臼类、烷化剂类、喜树碱类、紫杉类、抗代谢类、抗生素类抗肿瘤药物中的一种或多种；可以列举的实例包括但不限于顺铂、依托泊苷、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星中的一种或多种。本领域技术人员可以理解的是，与所述化疗同时或者先后，患者也可以接受放疗和/或单抗(例如nivolumab和ipilimumab)治疗。
在一些实施方案中，所述小细胞肺癌为广泛期小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为转移性小细胞肺癌，其中转移病灶包括但不限于淋巴结、胸膜、骨、心包、肾上腺、肝脏和脑。在一些实施方案中，所述小细胞肺癌为脑转移的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过二线化疗的难治性复发的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过伊立替康、铂类、紫杉醇和多西他赛中的一种或者多种治疗的难治性复发的小细胞肺癌。
在一些实施方案中，所述小细胞肺癌为在先接受过伊立替康和铂类(例如包括但不限于顺铂、卡铂、奈达铂、奥沙利铂、米铂、洛铂)治疗的难治性复发的小细胞肺癌。
在一些实施方案中，提供了一种治疗脑转移的小细胞肺癌的药物组合物，其包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体。
化合物I可以是它的游离碱形式，也可以是盐、水合物和前药的形式，该前药在体内转换成化合物I的游离碱形式。例如，化合物I药学上可接受的盐在本发明的范围内，可按照本领域公知的方法由不同的有机酸和无机酸产生盐。
在一些实施方案中，化合物I或其药学上可接受的盐为化合物I的盐酸盐形式。在一些实施方案中，为化合物I一盐酸盐的形式。在一些实施方案中，为化合物I二盐酸盐的形式。在一些实施方案中，为化合物I盐酸盐的晶体形式。在特定的实施方案中，为化合物I二盐酸盐的晶体形式。在一些实施方案中，为化合物I马来酸盐的形式。
在一些实施方案中，所述药物组合物可以是适于口服、肠胃外、腹膜内、静脉内、动脉内、透皮、舌下、肌内、直肠、透颊、鼻内、经吸入、阴道、眼内、经局部给药、皮下、脂肪内、关节内、腹膜内和鞘内给药的制剂。
在一些实施方案中，所述药物组合物的给药量可根据疾病的严重程度、疾病的响应、任何治疗相关的毒性、患者的年龄和健康状态来确定。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为2毫克至30毫克。在一些实施方案中，给予化合物I或其药学上可接受的盐的日剂量为6毫克至20毫克。在一些实施方案中，该药物组合物中化合物I或其药学上可接受的盐的日剂量为8毫克至20毫克。在一些实施方案中，化合物I或其药学上可接受的盐的日剂量为8毫克至16毫克。在一些实施方案中，化合 物I或其药学上可接受的盐的日剂量为8毫克至14毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为8毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为10毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为12毫克。在一些特定的实施方案中，化合物I或其药学上可接受的盐的日剂量为14毫克。
在本申请的一些实施方案中，所述药物组合物是适于口服的制剂，包括片剂、胶囊剂、粉剂、颗粒剂、滴丸、糊剂、散剂等，优选片剂和胶囊剂。其中片剂可以是普通片剂、分散片、泡腾片、缓释片、控释片或肠溶片，胶囊剂可以是普通胶囊、缓释胶囊、控释胶囊或肠溶胶囊。所述口服制剂可使用本领域公知的药学上可接受的载体通过常规方法制得。所述药学上可接受的载体包括填充剂、吸收剂、润湿剂、粘合剂、崩解剂、润滑剂等。填充剂包括淀粉、乳糖、甘露醇、微晶纤维素等；吸收剂包括硫酸钙、磷酸氢钙、碳酸钙等；润湿剂包括水、乙醇等；粘合剂包括羟丙甲纤维素、聚维酮、微晶纤维素等；崩解剂包括交联羧甲基纤维素钠、交联聚维酮、表面活性剂、低取代羟丙基纤维素等；润滑剂包括硬脂酸镁、滑石粉、聚乙二醇、十二烷基硫酸钠、微粉硅胶、滑石粉等。药用辅料还包括着色剂、甜味剂等。
在一些实施方案中，该药物组合物是适于口服的固体制剂。该组合物例如可以是片剂或胶囊的形式。在一些特定的实施方案中，该药物组合物是胶囊。在本申请的一些特定实施方案中，口服固体制剂的药学上可接受的载体包括甘露醇、微晶纤维素、羟丙纤维素、硬脂酸镁。
化合物I或其药学上可接受的盐可以每日施用一次或多次。在一些实施方案中，每天一次给予化合物I或其药学上可接受的盐。在一些实施方案中，以口服固体制剂每天给药一次。
给药的方法可根据药物的活性、毒性以及患者的耐受性等来综合确定。优选地，以间隔给药的方式给予化合物I或其药学上可接受的盐。所述间隔给药包括给药期和停药期，在给药期内可以每天一次或多次给予化合物I或其药学上可接受的盐。例如在给药期内每天给予化合物I或其药学上可接受的盐，然后停药期内停止给药一段时间，接着给药期，然后停药期，如此可以反复进行多次。其中，给药期和停药期的以天数计的比值为2:0.5～5，优选2:0.5～3，较优选2:0.5～2，更优选2:0.5～1。
在一些实施方案中，连续给药2周停药2周。在一些实施方案中，每天给药1次，持续给药14天，然后停药14天。
在一些实施方案中，连续给药2周停药1周。在一些实施方案中，每天给药1次，持续给药14天，然后停药7天。
在一些实施方案中，连续给药5天停药2天。在一些实施方案中，每天给药1次，持续给药5天，然后停药2天。
在某些特定的实施方案中，以每日一次12mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在某些特定的实施方案中，以每日一次10mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在某些特定的实施方案中，以每日一次8mg的剂量口服给药，连续用药2周，停1周的给药方式给药。
在一些实施方案中，提供了一种治疗难治性复发的小细胞肺癌的配制成单位剂量形式的药物组合物。在一些实施方案中，该单位剂量形式的药物组合物含有2毫克至30毫克的化合物I或其药学上可接受的盐。在一些实施方案中，该单位剂量形式的药物组合物含有6毫克至20毫克的化合物I或其药学上可接受的盐。在一些实施方案中，该单位剂量形式的药物组合物含有8毫克至20毫克的化合物I或其药学上可接受的盐，优选8毫克至16毫克的化合物I或其药学上可接受的盐，较优选8毫克至14毫克的化合物I或其药学上可接受的盐。在一些特定的实施方案中，该单位剂量形式的药物组合物含有8毫克的化合物I或其药学上可接受的盐。在一些特定的实施方案中，该单位剂量形式的药物组合物含有10毫克的化合物I或其药学上可接受的盐。在一些特定的实施方案中，该单位剂量形式的药物组合物含有12毫克的化合物I或其药学上可接受的盐。在一些特定的实施方案中，该单位剂量形式的药物组合物含有14毫克的化合物I或其药学上可接受的盐。
在一些实施方案中，化合物I或其药学上可接受的盐是作为唯一的活性成分单独给予复发的小细胞肺癌患者。在一些实施方案中，化合物I或其药学上可接受的盐与其它抗肿瘤药物同时或依照次序给予复发的小细胞肺癌患者。在一些实施方案中，其它抗肿瘤药物包括但不限于抗叶酸类抗肿瘤药物、鬼臼类抗癌药物、激素类抗肿瘤药物、烷化剂类抗肿瘤药物、喜树碱类抗肿瘤药、氟嘧啶衍生物、蒽环类药物、紫杉烷类化合物、酪氨酸激酶抑制剂(例如EGFR抑制剂、VEGFR抑制剂)、丝裂霉素、曲妥珠单抗中的一种或几种。
第四方面，本申请提供了一种试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的药物组合物和(b)用于治疗小细胞肺癌的说明书。在一些实施方案中，本申请提供了一种试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的药物组合物和(b)用于治疗至少两种化疗方案治疗失败的小细胞肺癌的说明书。在一些实施方案中，本申请提供了一种试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的药物组合物和(b)用于治疗二线化疗和/或二线以上化疗失败的小细胞肺癌的说明书。在一个实施方案中，本申请提供了一种试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的药物组合物和(b)用于治疗难治性复发的小细胞肺癌的说明书。
本申请还提供了一种试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的适于口服的制剂和(b)以间隔给药的方式用于治疗难治性复发的小细胞肺癌的说明书。在一些特定的实施方案中，提供了一种试剂盒，其包含(a)至少一个单位剂量的化合物I或其药学上可接受的盐的片剂或胶囊和(b)以间隔给药的方式用于治疗难治性复发的小细胞肺癌的说明书。
本文中，本领域技术人员可以理解的是，在给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐期间，也可按照交替、序贯或者同步的方式接受放疗和化疗。
本文中，所述“单位剂量(unit dosage或unit dose)”是指为了服用的方便，包装在单个包装中的药物组合物，例如每片片剂或者胶囊。例如，对于片剂或胶囊而言，“单位剂量形式的药物组合物”意味着每片片剂或每颗胶囊。
本文中，除非另有说明，这里提供的剂量和范围都是基于化合物I游离碱形式的分子量。
本文中，所述化合物I的盐酸盐的晶体形式包括但不限于中国专利申请CN102344438A公开的A、B和C型结晶，其中A和B型结晶为基本上不含结晶水和其它溶剂的结晶，C型结晶为含两个结晶水的结晶。在一些实施方案中，所述化合物I的二盐酸盐的晶体形式为A型结晶。
除非另有说明，为本申请的目的，本说明书和权利要求书中所用的下列术语应具有下述含义。
“患者”是指哺乳动物，优选人。
“药学上可接受的”是指其用于制备药物组合物，该药物组合物通常是安全、无毒的并且既不在生物学上或其它方面不合乎需要，并且包括其对于人类药物使用是可接受的。
“药学上可接受的盐”包括，但不限于与无机酸或有机酸形成的酸加成盐，所述无机酸例如盐酸、氢溴酸、硫酸、硝酸、磷酸等；所述有机酸例如乙酸、三氟乙酸、丙酸、己酸、庚酸、环戊烷丙酸、乙醇酸、丙酮酸、乳酸、丙二酸、琥珀酸、苹果酸、马来酸、富马酸、酒石酸、柠檬酸、苯甲酸、肉桂酸、扁桃酸、甲磺酸、乙磺酸、1,2-乙二磺酸、2-羟基乙磺酸、苯磺酸、对氯苯磺酸、对甲苯磺酸、3-苯基丙酸、三甲基乙酸、叔丁基乙酸、十二烷基硫酸、葡糖酸、谷氨酸、羟基萘甲酸、水杨酸、硬脂酸等。
“治疗有效量”意指化合物被给予人用于治疗疾病时，足以实现对该疾病的治疗的量。
“治疗”意指治疗上有效量的化合物的任何施用，并且包括：
(1)抑制正经历或显示出所述疾病的病理学或症状学的人体中的该疾病(即，阻滞所述病理学和/或症状学的进一步发展)，或
(2)改善正经历或显示出所述疾病的病理学或症状学的人体中的该疾病(即逆转所述病理学和/或症状学)。
“治疗失败”是指毒副作用不可耐受、治疗过程中疾病进展或治疗结束后复发。
“广泛期”是指：病变超过一侧胸腔，且包括恶性和心积液或血行转移。
“EGFR抑制剂”是指表皮生长因子受体抑制剂。
“VEGFR抑制剂”是指血管内皮生长因子受体抑制剂。
“CR”是指完全缓解，即所有靶病灶消失，全部病理淋巴结(包括靶结节和非靶结节)短直径必须减少至＜10mm。
“PR”是指部分缓解，靶病灶直径之和比基线水平减少至少30％。
“PD”是指疾病进展，以整个研究过程中所有测得的靶病灶直径之和的最小值为参照，直径和相对增加至少20％(如果基线测量值最小就以基线值为参照)；且必须满足直径和的相对值增加至少5mm，若出现一个或多个新病灶也视为疾病进展。
“SD”是指疾病稳定，靶病灶减小的程度没达到PR水平，增加的程度也没达到PD水平，介于两者之间。
“PFS”是指无进展生存期，从随机分组直至肿瘤客观进展或患者死亡的时间。
“DCR”是指疾病控制率，包括完全缓解、部分缓解和疾病稳定并维持4周以上病例数在可评价疗效患者中的百分比。
“OS”总生存期，是指入组开始至因任何原因引起死亡的时间。以天数计，失访的受试者，通常将最后一次随访时间计算为死亡。
“FAS”是指全分析数据集，按照意向性分析(ITT)原则，对至少使用一次药物的全部病例进行疗效分析。
“RECIST1.1”是指实体瘤疗效评价标准1.1。
“CI”是指可信区间，由样本统计量所构造的总体参数的估计区间。
本申请中的化合物I或其药学上可接受的盐对于小细胞肺癌，尤其是难治性复发的小细胞肺癌有预料不到的治疗效果，能显著地延长难治性复发的小细胞肺癌患者的生存期，对于脑转移性小细胞肺癌的疗效也非常显著。
具体实施方式
下面结合具体实施例，进一步阐述本申请。应理解，这些实施例仅用于说明本申请而不用于限制本申请的保护范围。
实施例1 1-[[[4-(4-氟-2-甲基-1H-吲哚-5-基)氧基-6-甲氧基喹啉-7-基]氧基]甲基]环丙胺二盐酸盐(化合物I的二盐酸盐)
Figure PCTCN2019106406-appb-000002
参照WO2008112407中实施例24的方法制备得到1-[[[4-(4-氟-2-甲基-1H-吲哚-5-基)氧基-6-甲氧基喹啉-7-基]氧基]甲基]环丙胺，然后参照WO2008112407的说明书中“盐形式的实施例”的制备方法，制备得到标题化合物。或者参照中国专利申请CN102344438A中公开的方法制备得到。
实施例2 含有1-[[[4-(4-氟-2-甲基-1H-吲哚-5-基)氧基-6-甲氧基喹啉-7-基]氧基]甲基]环丙胺二盐酸盐(化合物I的二盐酸盐)的胶囊
Figure PCTCN2019106406-appb-000003
Figure PCTCN2019106406-appb-000004
将化合物I的二盐酸盐粉碎，过80目筛；然后与甘露醇、羟丙纤维素混合均匀；接着加入处方量的微晶纤维素，混合均匀，过0.8mm筛网；最后加入处方量的硬脂酸镁混合均匀，并填充胶囊。
对于化合物I的二盐酸盐为其它含量的胶囊，可参照上述方式以相应的比例和处方制备得到。
实施例3
在患有具有可测量病灶的、既往接受过标准治疗和复发的小细胞肺癌的患者中，实施了一项多中心、随机双盲、与安慰剂对照的II期临床研究。在该研究中，120位患者入组，并随机接受每天一次，每次1粒口服12mg/0mg的化合物I的二盐酸盐胶囊的治疗。连续口服2周停药1周，即3周(21天)为1个治疗周期。这些患者的年龄在18-75岁之间，采用化合物I的二盐酸盐胶囊与安慰剂对照，既往使用过其它靶向药物(比如舒尼替、贝伐单抗、恩度)等、免疫靶向药物的患者排除在外。出现疗效评价标准确定为疾病进展(PD)或者临床上认为疾病进展、使用其它影响疗效判断的抗肿瘤药物治疗(如化疗、靶向治疗或生物制剂治疗)、意外妊娠、死亡等情况时，受试者中(终)止用药。疾病控制(CR+PR+SD)且不良反应可以耐受的患者，持续用药。当研究者认为患者不适合继续用药或按RECIST 1.1标准评价为PD，则用药结束。用药过程中，根据患者出现的物相关性毒性反应度和可能的疗效受益情况，由研究者决定是否进剂量调整，可调整的剂量为8mg/0mg或10mg/0mg。
主要疗效评价的指标为无进展生存期(PFS)，次要疗效指标为总生存期(OS)、客观缓解率(ORR)(CR+PR)、疾病控制率(DCR)(CR+PR+SD)、生活质量评分、安全性。客观疗效指标按实体瘤的疗效评价标准(RECIST 1.1)进行评价。
所有统计分析采用SAS 9.2统计分析软件编程计算。所有的统计学检验均采用双侧检验，P值≤0.05被认为所检验的差别有统计意义，可信区间采用95％的可信度。
对于主要疗效指标PFS，采用乘积限法，并根据资料的实际情况分别计算50％(中位)PFS及治疗开始后不同时间的PFS，并采用Log-Rank检验对两组进行比较。对OS采用乘积限法，并根据资料的实际情况分别计算50％(中位)的OS，并采用Log-Rank检验对两组进行比较。统计数据集采用全分析数据集(FAS)。研究结果总结如下表中。
表1 患者的无进展生存期(PFS，月)
Figure PCTCN2019106406-appb-000005
表2 患者的总生存期(OS，月)
Figure PCTCN2019106406-appb-000006
表3 患者的无进展生存期的分析(PFS，月)
Figure PCTCN2019106406-appb-000007
表4 患者的总生存期的分析(OS，月)
Figure PCTCN2019106406-appb-000008
实施例4
49岁女性，2013年10月，术后病理诊断为左肺下叶小细胞肺癌。2016年12月24日MRI显示双侧大脑半球、小脑半球及脑干多发转移瘤，肝多发异常信号结节，考虑转移瘤，提示病情进展。患者入院接受脂质体紫杉醇+卡铂+替莫唑胺化疗1周期，12月28日出院。
2017年1月1月17日开始TC方案(紫杉醇+卡铂)化疗1周期，2017年2月10日，疗效评价PD。2017年2月16日进行IP方案(伊立替康120mg d1，80mg d8；顺铂100mg d1)化疗1周期。4月24日，CT提示肺内及颅脑病灶稳定，肝内转移瘤较前增大，疗效评估为PD；靶病灶(64mm)：肝左内叶结节和肝右后叶结节；非靶病灶：脑内多发转移瘤。
2017年5月12日，开始每日一次口服化合物I二盐酸的胶囊12mg治疗，连服2周停1周，每3周为一个给药周期，直至疾病进展或不能耐受。患者服药期间整体耐受性良好，可继续用药。
CT结果如下：
第1周期给药后：靶病灶：63mm；非靶病灶：非CR/非PD。
第2周期给药后：靶病灶：65mm；非靶病灶：非CR/非PD。
第4周期给药后：靶病灶：66mm；非靶病灶：非CR/非PD。
第6周期给药后：靶病灶：72mm；非靶病灶：非CR/非PD。

Claims (20)

  1. 化合物I或其药学上可接受的盐在制备用于治疗小细胞肺癌的药物中的用途，
    Figure PCTCN2019106406-appb-100001
  2. 根据权利要求1所述的用途，其特征在于，所述小细胞肺癌为至少两种化疗方案治疗失败的小细胞肺癌。
  3. 根据权利要求1或2所述的用途，其特征在于，所述小细胞肺癌为二线化疗和/或二线以上化疗失败的小细胞肺癌。
  4. 根据权利要求2或3所述的用途，其特征在于，所述化疗为顺铂、依托泊苷、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星中的一种或多种。
  5. 根据权利要求1-4任一项所述的用途，其特征在于，所述小细胞肺癌为难治性复发的小细胞肺癌。
  6. 根据权利要求1-5任一项所述的用途，其特征在于，所述的小细胞肺癌为广泛期小细胞肺癌。
  7. 根据权利要求1-6任一项所述的用途，其特征在于，所述的小细胞肺癌为脑转移的小细胞肺癌。
  8. 根据权利要求1-7任一项所述的用途，其特征在于，其药学上可接受的盐为化合物I与任意如下酸所形成的盐：盐酸、氢溴酸、硫酸、硝酸、磷酸、乙酸、三氟乙酸、丙酸、己酸、庚酸、环戊烷丙酸、乙醇酸、丙酮酸、乳酸、丙二酸、琥珀酸、苹果酸、马来酸、富马酸、酒石酸、柠檬酸、苯甲酸、肉桂酸、扁桃酸、甲磺酸、乙磺酸、1,2-乙二磺酸、2-羟基乙磺酸、苯磺酸、对氯苯磺酸、对甲苯磺酸、3-苯基丙酸、三甲基乙酸、叔丁基乙酸、十二烷基硫酸、葡糖酸、谷氨酸、羟基萘甲酸、水杨酸、硬脂酸；优选为盐酸盐或马来酸盐，更优选为二盐酸盐。
  9. 一种治疗小细胞肺癌的方法，所述方法包括给予需要治疗的患者治疗有效量的化合物I或其药学上可接受的盐，
    Figure PCTCN2019106406-appb-100002
  10. 根据权利要求9所述的方法，其特征在于，所述小细胞肺癌为至少两种化疗方案治疗失败的小细胞肺癌。
  11. 根据权利要求9或10所述的方法，其特征在于，所述小细胞肺癌为二线化疗和/或二线以上化疗失败的小细胞肺癌和/或难治性复发的小细胞肺癌。
  12. 根据权利要求10或11所述的方法，其特征在于，所述化疗为顺铂、依托泊苷、卡铂、奈达铂、奥沙利铂、米铂、洛铂、伊立替康、拓扑替康、紫杉醇、多西他赛、替莫唑胺、长春瑞滨、吉西他滨、环磷酰胺、阿霉素、长春新碱、苯达莫司汀、表阿霉素、甲氨蝶呤、氨柔比星中的一种或多种。
  13. 根据权利要求9-12任一项所述的方法，其特征在于，所述小细胞肺癌为广泛期小细胞肺癌和/或脑转移的小细胞肺癌。
  14. 根据权利要求9-13任一项所述的方法，其特征在于，其药学上可接受的盐为化合物I与任意如下酸所形成的盐：盐酸、氢溴酸、硫酸、硝酸、磷酸、乙酸、三氟乙酸、丙酸、己酸、庚酸、环戊烷丙酸、乙醇酸、丙酮酸、乳酸、丙二酸、琥珀酸、苹果酸、马来酸、富马酸、酒石酸、柠檬酸、苯甲酸、肉桂酸、扁桃酸、甲磺酸、乙磺酸、1,2-乙二磺酸、2-羟基乙磺酸、苯磺酸、对氯苯磺酸、对甲苯磺酸、3-苯基丙酸、三甲基乙酸、叔丁基乙酸、十二烷基硫酸、葡糖酸、谷氨酸、羟基萘甲酸、水杨酸、硬脂酸；优选为盐酸盐或马来酸盐，更优选为二盐酸盐。
  15. 根据权利要求9-14任一项所述的方法，其特征在于，给予所述化合物I或其药学上可接受的盐的日剂量为3毫克至30毫克，优选为5毫克至20毫克，更优选为8毫克至16毫克，进一步优选为8毫克至14毫克，最优选为8毫克、10毫克或12毫克。
  16. 根据权利要求9-15任一项所述的方法，其特征在于，所述化合物I或其药学上可接受的盐以给药期和停药期间隔的给药方式；优选的给药期和停药期以天数计的比值为2:0.5～5，更优选2:0.5～3，较优选2:0.5～2，进一步优选2:0.5～1；作为更进一步优选的间隔给药方式，为如下方式中的一种：连续给药2周停药2周、连续给药2周停药1周或连续给药5天停药2天。
  17. 一种治疗小细胞肺癌的药物组合物，所述药物组合物包含化合物I或其药学上可接受的盐，以及至少一种药学上可接受的载体，
    Figure PCTCN2019106406-appb-100003
  18. 根据权利要求17所述的药物组合物，其特征在于，所述小细胞肺癌为至少两种化疗方案治疗失败的小细胞肺癌。
  19. 根据权利要求17或18所述的药物组合物，其特征在于，所述小细胞肺癌为二线化疗和/或二线以上化疗失败的小细胞肺癌和/或难治性复发的小细胞肺癌。
  20. 一种试剂盒，所述试剂盒包含(a)至少一个单位剂量的权利要求17-19中任一项所述的药物组合物和(b)用于治疗小细胞肺癌的说明书、尤其是以间隔给药的方式用于治疗小细胞肺癌的说明书；所述药物组合物优选为适于口服的制剂，更优选为片剂或胶囊。
PCT/CN2019/106406 2018-09-18 2019-09-18 用于治疗小细胞肺癌的喹啉衍生物 WO2020057539A1 (zh)

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