WO2022221834A2 - Method for treating lung cancer and non-small cell lung cancer - Google Patents
Method for treating lung cancer and non-small cell lung cancer Download PDFInfo
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Definitions
- NSCLC non-small cell lung cancer
- Adenocarcinoma is the most common form of lung cancer and is the lung cancer most frequently found in both smokers and non- smokers.
- Squamous cell carcinoma is generally found in a proximal bronchus.
- Early-stage NSCLC tends to be localized, and if detected early it can often be treated by surgery with a favorable outcome and improved survival.
- NSCLC is staged by the size of the tumor and its presence in other tissues including lymph nodes.
- cancer cells are found in sputum samples or lavage samples and no tumor is detectable in the lungs.
- stage 0 only the innermost lining of the lungs exhibit cancer cells and the tumor has not grown through the lining.
- stage IA the cancer is considered invasive and has grown deep into the lung tissue but the tumor is less than 3 cm across. In this stage, the tumor is not found in the bronchus or lymph nodes.
- stage IB the tumor is either larger than 3 cm across or has grown into the bronchus or pleura, but has not grown into the lymph nodes.
- stage IIA the tumor is more than 3 cm across and has grown into the lymph nodes.
- stage IIB the tumor has either been found in the lymph nodes and is greater than 3 cm across or grown into the bronchus or pleura; or the cancer is not in the lymph nodes but is found in the chest wall, diaphragm, pleura, bronchus, or tissue that surrounds the heart.
- stage IIIA cancer cells are found in the lymph nodes near the lung and bronchi and in those between the lungs but on the side of the chest where the tumor is located.
- Stage IIIB cancer cells are located on the opposite side of the chest from the tumor and in the neck. Other organs near the lungs may also have cancer cells and multiple tumors may be found in one lobe of the lungs.
- NSCLC non-small-cell lung cancer
- SUMMARY This application discloses a method of treating lung cancer and NSCLC in an individual. The method includes administering to the individual an effective amount of a composition comprising nanomolar potent particles comprising acylfulvene.
- compositions such as pharmaceutical compositions
- medicine, kits, and unit dosages useful for the methods described herein.
- Another aspect of this application includes a method for treating lung cancer and NSCLC using an effective amount of hydroxyureamethyl-acylfulvene together with an effective amount of one or more of an additional therapeutic agent selected from the group consisting of temozolomide, bevacizumab, everolimus, carmustine, lomustine, procarbazine, vincristine, irinotecan, cisplatin, carboplatin, methotrexate, etoposide, vinblastine, bleomycin, actinomycin, cyclophosphamide, and ifosfamide.
- an additional therapeutic agent selected from the group consisting of temozolomide, bevacizumab, everolimus, carmustine, lomustine, procarbazine, vincristine, irinotecan, cisplatin, carboplatin, methotrexate, etoposide, vinblastine, bleomycin, actinomycin, cyclophosphamide, and
- Another aspect of this application includes a method for treating lung cancer and NSCLC using an effective amount of hydroxyureamethyl-acylfulvene together with radiation therapy.
- the radiation therapy can be selected from lung irradiation, fractionated radiotherapy, radio surgery, and a combination thereof.
- the radiation may be applied before, during, and after any treatment with an effective amount of hydroxyureamethyl-acylfulvene.
- Another aspect of this application includes a method in which the patient is human or animal.
- FIG. 1 shows hydroxyureamethyl-acylfulvene exhibits nanomolar potency in a range of NSCLC cell lines; [0014] FIG.
- FIG. 2 shows hydroxyureamethyl-acylfulvene sensitivity on an X axis and PTGR1 transcript levels across 19 NSCLC cell lines;
- FIG. 3 shows hydroxyureamethyl-acylfulvene potency in terms of nanomolar IC50s compared among Oxaliplatin, Cisplatin, Pemetrexed, Paclitaxel and Gemcitabine obtained from the GDSC database; [0016] FIG.
- FIG. 4 shows hydroxyureamethyl-acylfulvene exhibits nanomolar potency in a brain metastasis model LXFE 2478, originating from primary lung cancer, in terms of nanomolar IC50s (Y axis) as compared Erlotinib, Gefitinib and Osimertinib;
- SEQ ID NO: 1 amino acid sequence of PTGR1
- SEQ ID NO:2 amino acid sequence of KEAP1
- SEQ ID NO:3 amino acid sequence of KRAS
- SEQ ID NO:4--amino acid sequence of TP53 SEQ ID NO:5 ⁇ amino acid sequence of STK11.
- Amino acid sequence aligned with the amino acid sequence set out in SEQ ID NO: X (when referring to a variant polypeptide) means that the variant amino acid sequence and the amino acid sequence set out in SEQ ID NO: X are aligned by a suitable method which allows comparison of the sequences with each other and identifications of the positions in the amino acid sequence of the variant wherein either the same amino acid is present (identical position), or another amino acid is present (substitution), or one or more extra amino acids are present (insertion or extension) or no amino acid is present (deletion or truncation) if compared with the amino acid sequence set out in SEQ ID NO: X.
- the term "based upon” includes assessing, determining, or measuring the patient characteristics as described herein (and preferably selecting a patient suitable for receiving treatment).
- the term “concurrent administration” means that the administration of the first therapy and that of a second therapy in a combination therapy overlap with each other.
- the term "effective amount” used herein refers to an amount of a compound or composition sufficient to treat a specified disorder, condition or disease such as ameliorate, palliate, lessen, and/or delay one or more of its symptoms.
- an effective amount comprises an amount sufficient to cause a tumor to shrink and/or to decrease the growth rate of the tumor (such as to suppress tumor growth) or to prevent or delay other unwanted cell proliferation in NSCLC.
- an effective amount is an amount sufficient to delay development of NSCLC. In some embodiments, an effective amount is an amount sufficient to prevent or delay recurrence.
- An effective amount can be administered in one or more administrations.
- the effective amount of the drug or composition may: (i) reduce the number of NSCLC cells; (ii) reduce tumor size; (iii) inhibit, retard, slow to some extent and preferably stop NSCLC cancer cell infiltration into peripheral organs; (iv) inhibit (i.e., slow to some extent and preferably stop) tumor metastasis; (v) inhibit tumor growth; (vi) prevent or delay occurrence and/or recurrence of tumor; and/or (vii) relieve to some extent one or more of the symptoms associated with NSCLC.
- a “reference level” means a level of the compound of the present invention or additional biomarker(s) that is indicative of a particular disease state, phenotype, or lack thereof, as well as combinations of disease states, phenotypes, or lack thereof.
- a “reference sample” refers to a sample containing reference level of a biomarker.
- a reference sample can be obtained from a subject that does not have a particular disease, disease state or phenotype, such as cancer or acute injury.
- "Likely to respond” or “responsiveness” as used herein refers to any kind of improvement or positive response either clinical or non-clinical selected from, but not limited to, measurable reduction in tumor size or evidence of disease or disease progression, complete response, partial response, stable disease, increase or elongation of progression free survival, or increase or elongation of overall survival.
- lung tissue refers to tissue or cancer, respectively, of the lungs themselves, as well as the tissue adjacent to and/or within the strata underlying the lungs and supporting structures such as the pleura, intercostal muscles, ribs, and other elements of the respiratory system.
- the respiratory system itself is taken in this context as representing nasal cavity, sinuses, pharynx, larynx, trachea, bronchi, lungs, lung lobes, aveoli, aveolar ducts, aveolar sacs, aveolar capillaries, bronchioles, respiratory bronchioles, visceral pleura, parietal pleura, pleural cavity, diaphragm, epiglottis, adenoids, tonsils, mouth and tongue, and the like.
- the tissue or cancer may be from a mammal and is preferably from a human, although monkeys, apes, cats, dogs, cows, horses and rabbits are within the scope of the present invention.
- lung condition refers to a disease, event, or change in health status relating to the lung, including for example lung cancer and various non-cancerous conditions.
- lung condition refers to a disease, event, or change in health status relating to the lung, including for example lung cancer and various non-cancerous conditions.
- substantially similarity means that two peptide sequences, when optimally aligned, such as by the programs GAP or BESTFIT using default gap weights, share at least 95% sequence identity, even more preferably at least 98% or 99% sequence identity.
- residue positions which are not identical differ by conservative amino acid substitutions.
- a “conservative amino acid substitution” is one in which an amino acid residue is substituted by another amino acid residue having a side chain (R group) with similar chemical properties (e.g., charge or hydrophobicity).
- R group side chain
- a conservative amino acid substitution will not substantially change the functional properties of a protein.
- the percent sequence identity or degree of similarity may be adjusted upwards to correct for the conservative nature of the substitution. Means for making this adjustment are well-known to those of skill in the art. See, e.g., Pearson (1994) Methods Mol. Biol.24: 307-331.
- Examples of groups of amino acids that have side chains with similar chemical properties include (1 ) aliphatic side chains: glycine, alanine, valine, leucine and isoleucine; (2) aliphatic-hydroxyl side chains: serine and threonine; (3) amide-containing side chains: asparagine and glutamine; (4) aromatic side chains: phenylalanine, tyrosine, and tryptophan; (5) basic side chains: lysine, arginine, and histidine; (6) acidic side chains: aspartate and glutamate, and (7) sulfur-containing side chains are cysteine and methionine.
- Preferred conservative amino acids substitution groups are: valine-leucine-isoleucine, phenylalanine- tyrosine, lysine-arginine, alanine-valine, glutamate-aspartate, and asparagine-glutamine.
- a conservative replacement is any change having a positive value in the PAM250 log-likelihood matrix disclosed in Gonnet et al. (1992) Science 256: 1443-1445.
- a “moderately conservative” replacement is any change having a nonnegative value in the PAM250 log- likelihood matrix.
- beneficial or desired clinical results include, but are not limited to, one or more of the following: alleviating one or more symptoms resulting from the disease, diminishing the extent of the disease, stabilizing the disease (e.g., preventing or delaying the worsening of the disease), preventing or delaying the spread (e.g., metastasis) of the disease, preventing or delaying the recurrence of the disease, delay or slowing the progression of the disease, ameliorating the disease state, providing a remission (partial or total) of the disease, decreasing the dose of one or more other medications required to treat the disease, delaying the progression of the disease, increasing the quality of life, and/or prolonging survival.
- treatment is a reduction of pathological consequence of NSCLC or lung cancer.
- the methods of the invention contemplate any one or more of these aspects of treatment.
- therapeutic effect refers to a beneficial local or systemic effect in animals, particularly mammals, and more particularly humans, caused by administration of a compound or composition of the invention.
- therapeutically-effective amount means that amount of a compound or composition of the invention that is effective to treat a disease or condition caused by aberrant biological activity at a reasonable benefit/risk ratio.
- the therapeutically effective amount of hydroxyureamethyl-acylfulvene or a pharmaceutically acceptable salt thereof is selected from the group consisting of 0.5 mg/day, 1 mg/day, 2.5 mg/day, 5 mg/day, 10 mg/day, 20 mg/day, 30 mg/day, 60 mg/day, 90 mg/day, 120 mg/day, 150 mg/day, 180 mg/day, 210 mg/day, 240 mg/day, 270 mg/day, 300 mg/day, 360 mg/day, 400 mg/day, 440 mg/day, 480 mg/day, 520 mg/day 580 mg/day, 600 mg/day, 620 mg/day, 640 mg/day, 680 mg/day, and 720 mg/day.
- This application discloses methods of treating non-small-cell lung cancer (NSCLC) and lung cancer in an individual in need thereof, comprising administering to the individual an effective amount of a composition comprising nanomolar potent acylfulvene.
- NSCLC non-small-cell lung cancer
- One embodiment includes a method for treating patients with lung cancer and/or non- small cell lung carcinoma or non-small cell lung carcinoma in which hydroxyureamethyl acylfulvene or salt thereof is administered in a therapeutically effective amount to the patient with lung cancer or non-small cell lung carcinoma.
- HydroxyUreaMethyl Acylfulvene or hydroxyureamelhyl-acylfulvene is a semisynthetic or synthetic antitumor agent derived from the mushroom toxin illudin S. The structure of each isomer is shown below. [0040] Specific embodiments are applicable to multiple histological types of NSCLC.
- the NSCLC may be squamous cell carcinoma (i.e., epidermoid carcinoma), large cell carcinoma, adenocarcinoma, adenosquamous carcinoma, carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements, carcinoid tumor, or salivary gland carcinoma.
- the NSCLC is squamous cell carcinoma.
- the squamous cell carcinoma is papillary, clear cell, small cell, or basaloid.
- the NSCLC is adenocarcinoma.
- the adenocarcinoma is acinar, papillary, bronchioloalveolar carcinoma (e.g., nonmucinous, mucinous, mixed mucinous and nonmucinous or indeterminate cell type), solid adenocarcinoma with mucin, adenocarcinoma with mixed subtypes, well-differentiated fetal adenocarcinoma, mucinous (colloid) adenocarcinoma, mucinous cystadenocarcinoma, signet ring adenocarcinoma, or clear cell adenocarcinoma.
- bronchioloalveolar carcinoma e.g., nonmucinous, mucinous, mixed mucinous and nonmucinous or indeterminate cell type
- solid adenocarcinoma with mucin e.g., nonmucinous, mucinous, mixed mucinous and nonmucinous or indeterminate cell type
- the large cell carcinoma is large-cell neuroendocrine carcinoma, combined large-cell neuroendocrine carcinoma, basaloid carcinoma, lymphoepithelioma-like carcinoma, clear cell carcinoma, or large cell carcinoma with rhabdoid phenotype.
- the carcinoma with pleomorphic, sarcomatoid, or sarcomatous elements is carcinomas with spindle and/or giant cells, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, or pulmonary blastoma.
- the carcinoma of salivary-gland type is mucoepidermoid carcinoma or adenoid cystic carcinoma.
- hydroxyureamethyl acylfulvene or its salt may be administered either prior to, concomitantly with, or subsequent to the administration of a chemotherapeutic agent or agents.
- the NSCLC of any of the methods herein may be an occult tumor, a stage 0 tumor, a stage I tumor (stage IA (T1, N0, M0) or stage IB (T2, N0, M0)), a stage II tumor (stage IIA (T1, N1, M0) and stage IIB (T2, N1, M0)), a stage IIIA tumor (T1, N2, M0, T2, N2, M0, T3, N1, M0, or T3, N2, M0), a stage IIIB tumor (Any T, N3, M0 or T4, any N, M0), or a stage IV tumor (Any T, any N, M1).
- the NSCLC is early stage NSCLC, non-metastatic NSCLC, primary NSCLC, advanced NSCLC, locally advanced NSCLC, metastatic NSCLC, NSCLC in remission, or recurrent NSCLC.
- the NSCLC is localized resectable, localized unresectable, or unresectable.
- the NSCLC is unresectable stage IV NSCLC.
- the NSCLC is inoperable Stage IIIA and/or IIIB NSCLC, PS 0-1, and FEV 1>800 ml.
- any of the above methods of treatment comprises the further step of co-administering to the patient one or more second therapeutic agents.
- the choice of a combination of agent or second therapeutic agent may be made from any second therapeutic agent known to be useful for co-administration with hydroxyureamethyl acylfulvene or salt.
- the choice of second therapeutic agent is also dependent upon the particular disease or condition to be treated. Examples of second therapeutic agents that may be employed in the methods of this application are those set forth above for use in combination compositions comprising a compound of this invention and a second therapeutic agent.
- the second therapeutic is one or more chemotherapeutic agents selected from camptothecin derivatives, paclitaxel, docetaxel, epothilone B, 5-FU, gemcitabine, oxaliplatin, cisplatinum, carboplatin, melphalam, dacarbazine, temozolomide, doxorubicin, imatinib, erlotinib, bevacizumab, cetuximab and a Raf kinase inhibitor.
- the second therapeutic is one or more chemotherapeutic agents selected from paclitaxel or cisplatinum.
- Some embodiments include a treatment for lung cancer or NSCLC that includes (I) conducting a physical exam of the patient; (2) using a magnetic resonance imaging (“MRI”) to confirm the presence of a tumor in the patient’s lung; (3) conducting a lung biopsy to obtain genetic information about the cancer, which includes molecular subtype and genetic markers; and (4) prescribing effective treatment of hydroxyureamethyl-acyifulvene to a subject having lung cancer or NSCLC.
- Another embodiment includes a method of treating lung cancer or NSCLC that includes detecting, in a human subject, the presence of certain genetic information; administering hydroxyureamethyl-acyifulvene or a pharmaceutically acceptable salt thereof, to the subject, if the human subject overexpress or under expresses certain markers.
- the marker can be substantially similar to PTGR1 (SEQ ID NO: 1), KEAP1 (SEQ ID NO: 2), KRAS (SEQ ID NO: 3), TP53 (SEQ ID NO: 4), and STK11 (SEQ ID NO: 5).
- Another embodiment includes a method of treating lung cancer or NSCLC in a subject, comprising: (a) obtaining or having obtained an expression level in a sample from a subject for a plurality of targets, wherein the plurality of targets comprises the group consisting of PTGR1 (SEQ ID NO: 1) together with one or more of the following, KEAP1, KRAS, TP53 and STK11; (b) determining that the subject is sensitive to a treatment with a Hydroxyureamethyl- acylfulvene; and (c) administering a cancer treatment including a hydroxyureamethyl- acylfulvene.
- the administration period can be a multi-week treatment cycle as long as the tumor remains under control and the regimen is clinically tolerated.
- a single dosage of hydroxyureamethyl-acyifulvene or other therapeutic agent can be administered once a week, and preferably once on each of day 1 and day 8 of a three- week (21 -day) treatment cycle.
- a single dosage of hydroxyureamethyl-acyifulvene or other therapeutic agent can be administered once a week, twice a week, three times per week, four times per week, five times per week, six times per week, or daily during a one-week, two-week, three-week, four-week, or five-week treatment cycle.
- the administration can be on the same or different day of each week in the treatment cycle.
- Protein sequences of certain proteins identified herein include PTGR1 (SEQ ID NO: 1), KEAP1 (SEQ ID NO: 2), KRAS (SEQ ID NO: 3), TP53 (SEQ ID NO: 4), and STK11 (SEQ ID NO: 5).
- Therapeutically effective doses can vary, as recognized by those skilled in the art, depending on the diseases treated, the severity of the disease, the route of administration, the age and general health condition of the patient, excipient usage, the possibility of co-usage with other therapeutic treatments such as use of other agents and the judgment of the treating physician. For example, guidance for selecting an effective dose can be determined by reference to the prescribing information for hydroxyureamethyl acylfulvene or journal discussion of the same.
- Hydroxyureamethyl-acylfulvene for use in accordance with the present invention can be mainly administered by parenteral administration, specifically including subcutaneous administration, intramuscular administration, intravenous administration, transcutaneous administration, intrahecal administration, epidural administration, intra joint administration and local administration, or may also be administered in various dosage forms, for example by oral administration if possible.
- the injections for administration include for example sterile, aqueous or non-aqueous solutions, suspensions and emulsions.
- the aqueous solutions and suspensions include for example distilled water for injections and physiological saline.
- the non-aqueous solutions and suspensions include for example propylene glycol, polyethylene glycol, vegetable oils such as olive oil, alcohols such as ethanol, and Polysorbate 80 (under trade name).
- Such composition may contain auxiliary agents such as preservatives, moistening agents, emulsifying agents, dispersing agents, stabilizers (for example, lactose) and dissolution auxiliary agents (for example, meglumine). These are sterilized by filtering through bacteria-retaining filters, blending sterilizing agents, or irradiation. Alternatively, these may be produced once into a sterile solid composition and then dissolved or suspended in sterile water or sterile solvents for injections, prior to use.
- the dosage ranges for the administration of an agent according to the methods described herein depend upon, for example, the form of the agent, its potency, and the extent to which symptoms, markers, or indicators of a condition described herein are desired to be reduced, for example the percentage reduction desired for tumor growth.
- the dosage should not be so large as to cause adverse side effects.
- the dosage will vary with the age, condition, and sex of the patient and can be determined by one of skill in the art.
- the dosage can also be adjusted by the individual physician in the event of any complication.
- the efficacy of an agent described herein in, e.g. the treatment of a condition described herein, or to induce a response as described herein e.g.
- lung cancer can be determined by the skilled clinician.
- a treatment is considered “effective treatment,” as the term is used herein, if one or more of the signs or symptoms of a condition described herein are altered in a beneficial manner, other clinically accepted symptoms are improved, or even ameliorated, or a desired response is induced e.g., by at least 10% following treatment according to the methods described herein.
- Efficacy can be assessed, for example, by measuring a marker, indicator, symptom, and/or the incidence of a condition treated according to the methods described herein or any other measurable parameter appropriate, e.g. tumor size and/or growth rate.
- Treatment includes any treatment of a disease in an individual or an animal (some non-limiting examples include a human or an animal) and includes: (1) inhibiting the disease, e.g., preventing a worsening of symptoms (e.g. pain or inflammation); or (2) relieving the severity of the disease, e.g., causing regression of symptoms.
- An effective amount for the treatment of a disease means that amount which, when administered to a subject in need thereof, is sufficient to result in effective treatment as that term is defined herein, for that disease.
- Efficacy of an agent can be determined by assessing physical indicators of a condition or desired response. It is well within the ability of one skilled in the art to monitor efficacy of administration and/or treatment by measuring any one of such parameters, or any combination of parameters. Efficacy can be assessed in animal models of a condition described herein, for example treatment of lung cancer in a mouse model. When using an experimental animal model, efficacy of treatment is evidenced when a statistically significant change in a marker is observed, e.g. tumor size and/or growth rate.
- the therapeutically effective amount of hydroxyureamethyl-acylfulvene or a pharmaceutically acceptable salt thereof is selected from the group consisting of 0.5 mg/day, 1 mg/day, 2.5 mg/day, 5 mg/day, 10 mg/day, 20 mg/day, 30 mg/day, 60 mg/day, 90 mg/day, 120 mg/day, 150 mg/day, 180 mg/day, 210 mg/day, 240 mg/day, 270 mg/day, 300 mg/day, 360 mg/day, 400 mg/day, 440 mg/day, 480 mg/day, 520 mg/day 580 mg/day, 600 mg/day, 620 mg/day, 640 mg/day, 680 mg/day, and 720 mg/day.
- the methods described herein are useful for various aspects of lung cancer or NSCLC treatment.
- the method comprises a method of inhibiting NSCLC cell proliferation (such as NSCLC tumor growth) in an individual, comprising administering to the individual a) an effective amount of a composition comprising particles comprising hydroxyureamethyl-acylfulvene.
- NSCLC cell proliferation such as NSCLC tumor growth
- the method of treatment results in an objective response (such as a partial response or complete response).
- the method of treatment results in improved quality of life.
- a specific dosage and treatment regimen for any particular patient will depend upon a variety of factors, including the activity of the specific compound employed, the age, body weight, general health, sex, diet, time of administration, rate of excretion, drug combination, and the judgment of the treating physician and the severity of the particular disease being treated.
- the amount of a compound of the present invention in the composition will also depend upon the particular compound in the composition. It may be preferable to give the maximum tolerable dose.
- the treatment may include the use of one or more biomarkers. The biomarker may be less than, greater than, or equal to the level of those markers in healthy people.
- upregulation of the following genes could be implicated in increased sensitivity to hydroxyureamethyl-acylfulvene: CD55, GLIS3, PRKCDBP, EGF, GLRX, SLC16A7, ABLIM3, DUSP4, ABCG2, HSPB8, TSPAN8, FKBP7, RGS2, CCPG1, DDIT4L, CTSL, PMP22, ACS33, HYAL1, KRT83, SLC16A14, AKR1B10, CA12, SDC2, HHIPL2, MCTP1 [0060]
- expression level is determined by measuring the expression level of a gene of interest for a given patient population, determining the median expression level of that gene for the population, and comparing the expression level of the same gene for a single patient to the median expression level for the given patient population.
- the single patient has NSCLC and the patient population does not have cancer (i.e., normal).
- the single patient has one histological type of NSCLC (e.g., squamous cell carcinoma) and the patient population has a second histological type of NSCLC (e.g., adenocarcinoma).
- the single patient and the patient population have the same histological type of NSCLC (e.g., squamous cell carcinoma).
- NSCLC e.g., squamous cell carcinoma.
- Methods for measuring gene expression and/or determining sequence for detection of polymorphism include, but are not limited to, immunological assays, nuclease protection assays, northern blots, in situ hybridization, ELISA, reverse transcriptase Polymerase Chain Reaction (RT-PCR), Real-Time Polymerase Chain Reaction, expressed sequence tag (EST) sequencing, cDNA microarray hybridization or gene chip analysis, subtractive cloning, Serial Analysis of Gene Expression (SAGE), Massively Parallel Signature Sequencing (MPSS), and Sequencing- By-Synthesis (SBS). Diagnostic procedures can also be performed in situ directly upon tissue sections (fixed and/or frozen) of patient tissue obtained from biopsies or resections.
- Example 1 Nineteen human NSCLC cell lines representing diverse molecular, demographic, and histological features were treated with hydroxyureamethyl-acylfulvene in a 96 well format in triplicate wells, across concentrations ranging from 14 nM to 10 ⁇ M. The treatments were carried out for 72 hours and cell viability was assayed using Promega’s CellTiter Fluor reagent. Drug sensitivity was measured in terms of IC50 value generated from the dose response curve plotted in GraphPad Prism, as shown in FIG.1. Representative dose response curves are not shown.
- LP_184 exhibited strong nanomolar potency in the majority of NSCLC cell lines tested, indicating broad anti-tumor cytotoxicity in this panel. In these 19 NSCLC cell lines, the IC50 range was 45 to 1805 nM, with median IC50 of 371 nM and mean IC50 of 571 nM.
- Example 2 This study of hydroxyureamethyl-acylfulvene responses in primary NSCLC cell lines was extended to in vitro models of brain metastases originating from primary lung cancers. Two such models LXFA 983 and LXFE 2478 were tested for their sensitivity to hydroxyureamethyl-acylfulvene both in 2D and 3D culture systems.
- the CellTiter-Glo® assay provided a cell viability readout whereas for 3D cultures, the 3D Clonogenic assay provided a vital stain-based colony formation readout.
- hydroxyureamethyl-acylfulvene retained efficacy in these models, ranging between IC50 of 88 nM and 3209 nM.
- the mean hydroxyureamethyl-acylfulvene IC50 value of 571 nM was used to divide the NSCLC cell lines in high and low sensitivity groups.
- PTGR1 expression was compared among two groups of NSCLC cell lines tested: 11 cell lines with hydroxyureamethyl-acylfulvene IC50 ⁇ 571 nM and 8 cell lines with IC50 > 571 nM.
- PTGR1 expression was compared, among two groups of cell lines: 7 cell lines with KEAP1 mutation and 12 cell lines without KEAP1 mutation. We found that the difference in PTGR1 expression between KEAP1 mutant and wild type cell lines is significant upon one-tailed t-test analysis (p value 0.0253).
- Example 3 A broad comparison in selected NSCLC cell lines was performed using hydroxyureamethyl-acylfulvene responses with previously published responses of commonly prescribed standard chemotherapeutics obtained from the GDSC database. Among those were Oxaliplatin and Cisplatin that also act as DNA alkylating agents but likely via a mechanism not overlapping with that perceived for hydroxyureamethyl- acylfulvene. Known responses were obtained to the antimetabolites Pemetrexed and Gemcitabine, also currently considered as a standard therapy option for NSCLC.
- Lung adenocarcinomas can also be treated with taxanes.
- Publicly available IC50 data on Oxaliplatin, Cisplatin, Pemetrexed, Paclitaxel and Gemcitabine gathered after a 72-hour treatment as with hydroxyureamethyl-acylfulvene , and typically reported as mean values without standard error were obtained from the GDSC database.
- hydroxyureamethyl- acylfulvene turned out to be up to 3800 times more potent than some of these chemotherapeutics approved for medical use in NSCLC.
- Example 4 The brain metastasis model LXFE 2478 harbors a heterozygous EGFR-activating mutation, i.e., EGFR exon 20 insertion (M766_A767insASV). The patient from whom this model was derived was reported to be resistant to radiotherapy, cisplatin/erlotinib/pemetrexed combination and PD-L1 antibody treatments.
- mice were included in the vehicle control and treatment groups. As shown in FIG.5, hydroxyureamethyl-acylfulvene treatment was conducted using a regimen of five 5 mg/kg injections administered intraperitoneally on days 1, 3, 6, 9 and 12. The individual mouse tumor volumes and body weights on the sampling days are not shown. This treatment yielded statistically significant differences in mean tumor volumes of vehicle control and treatment groups on days 8, 12 and 15. hydroxyureamethyl-acylfulvene thus demonstrated anti-tumor efficacy in a lung cancer model. [0076]
- Example 6 [0077] PTGR1 expression status in relation to multiple relevant genes’ mutation status in clinical datasets of NSCLC was investigated.
- PTGR1 was found to be highly expressed in KEAP1 mutated samples.
- the value adjacent to the highly mutated gene is the permutation test p-value of PTGR1 relative gene expression between driver mutated (black) and not-mutated (white) samples. This result is the most statistically significant for KEAP1 (p value 0.00126), with PTGR1 being highly expressed in KEAP1 mutated samples.
- KEAP1 p value 0.00126
- SEQ ID NO.: 1 [0080] SEQ ID NO.: 2 [0082] SEQ ID NO.: 3 [0084] SEQ ID NO.: 4 [0086] SEQ ID NO.: 5
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