Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/39558—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against tumor tissues, cells, antigens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6801—Drug-antibody or immunoglobulin conjugates defined by the pharmacologically or therapeutically active agent
  • A61K47/6803—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates
  • A61K47/68037—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates the drug being a camptothecin [CPT] or derivatives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6835—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site
  • A61K47/6851—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a determinant of a tumour cell
  • A61K47/6855—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a determinant of a tumour cell the tumour determinant being from breast cancer cell
• • 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
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/2863—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against receptors for growth factors, growth regulators
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/32—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against translation products of oncogenes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present application relates to the fields of chemistry, biochemistry and medicine. More particularly, disclosed herein are combination therapies, and methods of treating diseases and/or conditions with combination therapies described herein.
• Cancers are a family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. Cancer treatments today include surgery, hormone therapy, radiation, chemotherapy, immunotherapy, targeted therapy and combinations thereof. Survival rates vary by cancer type and by the stage at which the cancer is diagnosed. In 2019, roughly 1.8 million people will be diagnosed with cancer, and an estimated 606,880 people will die of cancer in the United States. Thus, there still exists a need for effective cancer treatments.
• a WEE1 inhibitor e.g., Compound A
• a CDK4/6 inhibitor or a HER-2 inhibitor for use in treating a disease or condition (e.g., cancer).
• the HER-2 inhibitor is selected from a HER-2 small molecule inhibitor, a HER- 2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody, or a pharmaceutically acceptable salt of any of the foregoing.
• the HER-2 inhibitor is selected from a HER-2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody, or a pharmaceutically acceptable salt of any of the foregoing.
• some embodiments provide a method of treating cancer comprising administering to a subject an effective amount of Compound (A) and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, wherein:
• Compound pharmaceutically acceptable salt thereof is selected from the group consisting of a CDK4/6 inhibitor, a HER-2 small molecule inhibitor, a HER-2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody, or a pharmaceutically acceptable salt of any of the foregoing.
• some embodiments provide a method of treating cancer comprising administering to a subject an effective amount of Compound (A) and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, wherein:
• Compound pharmaceutically acceptable salt thereof is selected from the group consisting of a HER-2 small molecule inhibitor, a HER-2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody, or a pharmaceutically acceptable salt of any of the foregoing.
• Compound (B) is a HER-2 small molecule inhibitor, or a pharmaceutically acceptable salt thereof.
• Compound (B) is a HER- 2 antibody.
• Compound (B) is a HER-2 antibody-drug conjugate, or a pharmaceutically acceptable salt thereof.
• Compound (B) is a HER-2 bispecific antibody, or a pharmaceutically acceptable salt thereof.
• some embodiments provide a method of treating cancer comprising administering to a subject an effective amount of Compound (A) and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, wherein:
• Compound pharmaceutically acceptable salt thereof is a CDK4/6 inhibitor, or a pharmaceutically acceptable salt thereof.
• some embodiments provide a method of treating triple negative breast cancer comprising administering to a subject an effective amount of Compound
• Compound (B) is fam-trastuzumab-deruxtecan-nxki (DS 820 la).
• Some embodiments described herein relate to a combination of compounds that can include an effective amount of Compound (A), or a pharmaceutically acceptable salt thereof, and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing.
• Some embodiments described herein relate to the use of a combination of compounds for treating a disease or condition, wherein the combination includes an effective amount of Compound (A), or a pharmaceutically acceptable salt thereof, and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing.
• Other embodiments described herein relate to the use of a combination of compounds in the manufacture of a medicament for treating a disease or condition, wherein the combination includes an effective amount of Compound (A), or a pharmaceutically acceptable salt thereof, and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing.
• the disease or condition can be a cancer described herein.
• some embodiments provide a use of a combination of compounds for treating a disease or condition, wherein the combination includes an effective amount of Compound (A) and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, wherein:
• Compound (B) is selected from the group consisting of a CDK4/6 inhibitor, a HER-2 small molecule inhibitor, a HER-2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody, or a pharmaceutically acceptable salt of any of the foregoing; wherein the CDK4/6 inhibitor is selected from the group consisting of palbociclib, abemaciclib, ribociclib, trilaciclib (G1T28), lerociclib (G1T38), SHR6390, FCN-437, AMG 925, BPI-1178, BPI-16350, Birociclib, BEBT-209, TY-302, TQB-3616, HS-10342, PF- 06842874, CS-3002 and MM-D37K, or a pharmaceutically acceptable salt of any of the foregoing; wherein the HER-2 antibody is selected from the group consisting of trastuzumab, trastuzumab-dkst, pertuzumab
• Exemplary HER-2 antibody-drug conjugates are described in Ferraro et al., Implementing antibody-drug conjugates (ADCs) in HER2 -positive breast cancer: state of the art and future directions.
• ADCs antibody-drug conjugates
• Compound (B) is a HER-2 small molecule inhibitor, or a pharmaceutically acceptable salt thereof.
• Compound (B) is a HER- 2 small molecule inhibitor selected from tucatinib, lapatinib and neratinib, or a pharmaceutically acceptable salt of any of the foregoing.
• Compound (B) is tucatinib, or a pharmaceutically acceptable salt thereof.
• Compound (B) is lapatinib, or a pharmaceutically acceptable salt thereof.
• Compound (B) is neratinib, or a pharmaceutically acceptable salt thereof.
• a HER-2 small molecule inhibitor is administered in combination with a HER-2 antibody (e.g., trastuzumab).
• Compound (B) is a CDK4/6 inhibitor, or a pharmaceutically acceptable salt thereof. In some embodiments, Compound (B) is a CDK4/6 inhibitor, or a pharmaceutically acceptable salt thereof selected from Figure 1.
• the CDK4/6 inhibitor is palbociclib.
• the CDK4/6 inhibitor is abemaciclib.
• the CDK4/6 inhibitor is ribociclib.
• the CDK4/6 inhibitor is trilaciclib.
• Compound (B) is an HER-2 antibody, or a pharmaceutically acceptable salt thereof.
• the HER-2 antibody is trastuzumab.
• Compound (B) is a HER-2 antibody-drug conjugate, or a pharmaceutically acceptable salt thereof. In some embodiments, Compound (B) is a trastuzumab antibody-drug conjugate, or a pharmaceutically acceptable salt thereof. In some embodiments, Compound (B) is fam-trastuzumab-deruxtecan-nxki (DS 820 la). [0024] In some embodiments, Compound (B) is a HER2 bispecific antibody, or a pharmaceutically acceptable salt thereof.
• Compound (B) is selected from Figure 2.
• Compound (B) is a HER-2 small molecule inhibitor, or a pharmaceutically acceptable salt thereof.
• Compound (B) is a HER- 2 small molecule inhibitor selected from tucatinib, lapatinib and neratinib, or a pharmaceutically acceptable salt of any of the foregoing.
• a HER-2 small molecule inhibitor is administered in combination with a HER-2 antibody (e.g., trastuzumab), or a pharmaceutically acceptable salt thereof.
• the disease or condition is a breast cancer.
• the disease or condition is selected from the group consisting of triple-negative breast cancer (TNBC) and estrogen receptor positive (ER+) breast cancer.
• TNBC triple-negative breast cancer
• ER+ estrogen receptor positive
• the breast cancer is ER positive (ER+) breast cancer.
• the breast cancer is ER positive, HER2-negative (ER+/HER2-) breast cancer.
• the breast cancer is triple-negative breast cancer (TNBC).
• the breast cancer is classified by HER2 status.
• the breast cancer is HER2-positive (HER2+) breast cancer.
• the breast cancer is HER2-low breast cancer.
• the breast cancer is classified as HER2 negative (HER2-) breast cancer.
• the disease or condition is lung cancer, gastric cancer or gastroesophageal junction adenocarcinoma.
• some embodiments provide use of an effective amount of Compound (A), or a pharmaceutically acceptable salt of any of the foregoing, in the preparation or manufacture of a medicament for treating ER+ breast cancer, wherein Compound (A) is pharmaceutically acceptable salt thereof.
• the breast cancer does not include any ER point mutations.
• the breast cancer has at least one point mutation within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERa), wherein the mutation is selected from the group consisting of: K3O3R, D538G, Y537S, E38OQ, Y537C, Y537N, A283V, A546D, A546T, A58T, A593D, A65V, C530L, D411H, E279V, E471D, E471V, E523Q, E542G, F461V, F97L, G145D, G160D, G274R, G344D, G420D, G442R, G557R, H524L, K252N, K481N, K531E, L370F, L453F, L466Q, L497R,
• ESRI Estrogen Receptor 1
• the breast cancer is ER positive breast cancer.
• the breast cancer is ER positive/HER2-negative breast cancer.
• the breast cancer is local breast cancer.
• the breast cancer is metastatic breast cancer.
• the breast cancer is recurrent breast cancer.
• the breast cancer has been previously treated with an endocrine therapy.
• the treatment was with a selective ER modulator (SERM).
• SERM selective ER modulator
• the selective ER modulator is selected from the group consisting of tamoxifen, raloxifene, ospemifene, apeledoxifene, toremifene and lasofoxifene, or a pharmaceutically acceptable salt of any of the foregoing.
• the previous treatment was with a selective ER degrader (SERD).
• SESD selective ER degrader
• the selective ER degrader is selected from the group consisting of fulvestrant, (E)-3-[3,5-Difluoro-4-[(lR,3R)-2-(2-fluoro-2-methylpropyl)-3- methyl-l,3,4,9-tetrahydropyrido[3,4-b]indol-l-yl]phenyl]prop-2-enoic acid (AZD9496), (R)- 6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5, 6,7,8- tetrahydronaphthalen-2-ol (elacestrant, RAD1901), (E)-3-(4-((E)-2-(2-chloro-4- fluorophenyl)-l-(lH-
• the previous treatment was with an aromatase inhibitor.
• the aromatase inhibitor is a steroidal aromatase inhibitor.
• the steroidal aromatase inhibitor is selected from the group consisting of exemestane and testolactone, or a pharmaceutically acceptable salt of any of the foregoing.
• the aromatase inhibitor is a non-steroidal aromatase inhibitor.
• the non-steroidal aromatase inhibitor is selected from the group consisting of anastazole and letrazole, or a pharmaceutically acceptable salt of any of the foregoing.
• the breast cancer has not been previously treated.
• the breast cancer is present in a woman.
• the woman is a premenopausal woman.
• the woman is a perimenopausal woman.
• the woman is a menopausal woman.
• the breast cancer is present in a postmenopausal woman.
• the breast cancer is present in a man.
• the breast cancer is present in a human subject. In some embodiments, the breast cancer is present in a subject that has a serum estradiol level in the range of >15 pg/mL to 350 pg/mL.
• the breast cancer is present in a subject that has a serum estradiol level in the range of >15 pg/mL to 300 pg/mL, >20 pg/mL to 350 pg/mL, >25 pg/mL to 350 pg/mL, >30 pg/mL to 350 pg/mL, >35 pg/mL to 350 pg/mL, >40 pg/mL to 350 pg/mE, >45 pg/mL to 350 pg/mL, >50 pg/mL to 350 pg/mL, >55 pg/mL to 350 pg/mL, >60 pg/mL to 350 pg/mL, >65 pg/mL to 350 pg/mL, >70 pg/mL to 350 pg/mL, >75 pg/mL to 350 pg/mL, >80
• the breast cancer is present in a subject that has a serum estradiol level ⁇ 15 pg/mL. In some embodiments, the breast cancer is present in a subject that has a serum estradiol level ⁇ 10 pg/mL.
• the breast cancer is present in a subject that has a serum estradiol level ⁇ 20 pg/mL, ⁇ 19 pg/mL, ⁇ 18 pg/mL, ⁇ 17 pg/mL ⁇ 16 pg/mL, ⁇ 15 pg/mL ⁇ 14 pg/mL ⁇ 13 pg/mL, ⁇ 12 pg/mL, ⁇ 11 pg/mL or ⁇ 10 pg/mL.
• some embodiments provide a method of treating cancer comprising administering to a subject an effective amount of Compound (A) and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, wherein:
• Compound (B) is selected from the group consisting of a CDK4/6 inhibitor, a HER- 2 small molecule inhibitor, a HER-2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody, or a pharmaceutically acceptable salt of any of the foregoing; wherein the CDK4/6 inhibitor is selected from the group consisting of palbociclib, abemaciclib, ribociclib, trilaciclib (G1T28), lerociclib (G1T38), SHR6390, FCN-437, AMG 925, BPI-1178, BPI-16350, Birociclib, BEBT-209, TY-302, TQB-3616, HS-10342, PF- 06842874, CS-3002 and MM-D37K, or a pharmaceutically acceptable salt of any of the foregoing; wherein the HER-2 antibody is selected from the group consisting of trastuzumab, trastuzumab-dkst, pertuzuma
• Compound (B) is a HER-2 small molecule inhibitor, or a pharmaceutically acceptable salt thereof.
• Compound (B) is a HER- 2 small molecule inhibitor selected from tucatinib, lapatinib and neratinib, or a pharmaceutically acceptable salt of any of the foregoing.
• a HER-2 small molecule inhibitor is administered in combination with a HER-2 antibody (e.g., trastuzumab), or a pharmaceutically acceptable salt thereof.
• Figure 1 provides examples of CDK4/6 inhibitors.
• Figure 2 provides examples of HER-2 antibodies, HER-2 antibody-drug conjugates and a HER2 bispecific antibodies.
• Figure 3 shows the results of an in vivo study of Compound (A), or a pharmaceutically acceptable salt thereof, in a MCF-7 xenograft model.
• Figure 4 shows the results of an in vivo study of Compound (A), or a pharmaceutically acceptable salt thereof, or Tamoxifen in a ZR-75-1 tamoxifen resistant tumor model.
• Figure 5 shows the results of an in vivo study of Compound (A), or a pharmaceutically acceptable salt thereof, in human HCC1428 breast cancer xenograft tumors.
• Figure 6 shows the results of an in vivo study of Compound (A), or a pharmaceutically acceptable salt thereof, as mono-therapy or in combination with a CDK4/6 inhibitor, Palbociclib, in a MCF-7 xenograft model.
• Figure 7 shows the results of an in vivo study of Compound (A), or a pharmaceutically acceptable salt thereof, as mono-therapy or in combination with a CDK4/6 inhibitor, palbociclib, in a MCF-7 xenograft model.
• Figure 8 provides the tumor volume changes in mice treated with vehicle, Compound (A), trastuzumab or combination of Compound (A) with trastuzumab.
• Figure 9 provides the tumor volume changes in mice treated with vehicle, Compound (A), trastuzumab or combination of Compound (A) with trastuzumab.
• Figure 10A and 10B provide changes in tumor volume and body weight, respectively, in palbociclib-resistant breast cancer patient derived xenograft (PDX) model (CTG-1207) mice treated with vehicle, Compound (A), palbociclib or combination of Compound (A) with palbociclib.
• PDX palbociclib-resistant breast cancer patient derived xenograft
• salts refers to a salt of a compound that does not cause significant irritation to an organism to which it is administered and does not abrogate the biological activity and properties of the compound.
• the salt is an acid addition salt of the compound.
• Pharmaceutical salts can be obtained by reacting a compound with inorganic acids such as hydrohalic acid (e.g., hydrochloric acid or hydrobromic acid), a sulfuric acid, a nitric acid and a phosphoric acid (such as 2,3- dihydroxypropyl dihydrogen phosphate).
• Pharmaceutical salts can also be obtained by reacting a compound with an organic acid such as aliphatic or aromatic carboxylic or sulfonic acids, for example formic, acetic, succinic, lactic, malic, tartaric, citric, ascorbic, nicotinic, methanesulfonic, ethanesulfonic, p-toluensulfonic, trifluoroacetic, benzoic, salicylic, 2- oxopentanedioic, or naphthalenesulfonic acid.
• an organic acid such as aliphatic or aromatic carboxylic or sulfonic acids
• Pharmaceutical salts can also be obtained by reacting a compound with a base to form a salt such as an ammonium salt, an alkali metal salt, such as a sodium, a potassium or a lithium salt, an alkaline earth metal salt, such as a calcium or a magnesium salt, a salt of a carbonate, a salt of a bicarbonate, a salt of organic bases such as dicyclohexylamine, N-methyl-D-glucamine, tris(hydroxymethyl)methylamine, C1-C7 alkylamine, cyclohexylamine, triethanolamine, ethylenediamine, and salts with amino acids such as arginine and lysine.
• a salt such as an ammonium salt, an alkali metal salt, such as a sodium, a potassium or a lithium salt, an alkaline earth metal salt, such as a calcium or a magnesium salt, a salt of a carbonate, a salt of a bicarbonate, a salt of organic bases such as
• a salt is formed by protonation of a nitrogen-based group (for example, NH2)
• the nitrogen-based group can be associated with a positive charge (for example, NH2 can become NH 3 + ) and the positive charge can be balanced by a negatively charged counterion (such as Cl’ )•
• each center may independently be of R-configuration or S -configuration or a mixture thereof.
• the compounds provided herein may be enantiomerically pure, enantiomerically enriched, racemic mixture, diastereomerically pure, diastereomerically enriched, or a stereoisomeric mixture.
• each double bond may independently be E or Z a mixture thereof.
• all tautomeric forms are also intended to be included.
• valencies are to be filled with hydrogens or isotopes thereof, e.g., hydrogen- 1 (protium) and hydrogen-2 (deuterium).
• each chemical element as represented in a compound structure may include any isotope of said element.
• a hydrogen atom may be explicitly disclosed or understood to be present in the compound.
• the hydrogen atom can be any isotope of hydrogen, including but not limited to hydrogen- 1 (protium) and hydrogen-2 (deuterium).
• reference herein to a compound encompasses all potential isotopic forms unless the context clearly dictates otherwise.
• the methods and combinations described herein include crystalline forms (also known as polymorphs, which include the different crystal packing arrangements of the same elemental composition of a compound), amorphous phases, salts, solvates, and hydrates.
• the compounds described herein exist in solvated forms with pharmaceutically acceptable solvents such as water, ethanol, or the like.
• the compounds described herein exist in unsolvated form.
• Solvates contain either stoichiometric or non- stoichiometric amounts of a solvent and may be formed during the process of crystallization with pharmaceutically acceptable solvents such as water, ethanol, or the like. Hydrates are formed when the solvent is water, or alcoholates are formed when the solvent is alcohol.
• the compounds provided herein can exist in unsolvated as well as solvated forms. In general, the solvated forms are considered equivalent to the unsolvated forms for the purposes of the compounds and methods provided herein.
• the term “comprising” is to be interpreted synonymously with the phrases “having at least” or “including at least”.
• the term “comprising” means that the process includes at least the recited steps but may include additional steps.
• the term “comprising” means that the compound, composition or device includes at least the recited features or components but may also include additional features or components.
• Some embodiments disclosed herein relate to the use of a combination of compounds for treating a disease or condition, wherein the combination can include an effective amount of Compound (A), or a pharmaceutically acceptable salt thereof, and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, wherein Compound (A) can be a WEE1 inhibitor, or a pharmaceutically acceptable salt thereof; and Compound (B) can be selected from a CDK4/6 inhibitor, a HER-2 antibody, a HER-2 antibody-drug conjugate and a HER2 bispecific antibody (including pharmaceutically acceptable salts of any of the foregoing).
• Compound (A), including pharmaceutically acceptable salts thereof, can be , including pharmaceutically acceptable salts thereof.
• Compound (B), including pharmaceutically acceptable salts thereof can be a CDK4/6 inhibitor selected from palbociclib, abemaciclib, ribociclib, trilaciclib (G1T28), lerociclib (G1T38), SHR6390, FCN-437, AMG 925, BPI-1178, BPI- 16350, Birociclib, BEBT- 209, TY-302, TQB-3616, HS-10342, PF-06842874, CS-3002 and MM-D37K (along with pharmaceutically acceptable salts of any of the foregoing).
• Compound (B), including pharmaceutically acceptable salts thereof can be a HER-2 small molecule inhibitor selected from tucatinib, lapatinib and neratinib, or a pharmaceutically acceptable salt of any of the foregoing.
• Compound (B), including pharmaceutically acceptable salts thereof can be a HER-2 antibody selected from trastuzumab, trastuzumab-dkst, pertuzumab and ZW25 (along with pharmaceutically acceptable salts of any of the foregoing).
• Compound (B), including pharmaceutically acceptable salts thereof can be a HER-2 antibody-drug conjugate selected from Ado- trastuzumab emtansine (T-DM1), ARX788, ALT-P7, DS8201a, MEDI4276, MM302, PF-
• Compound (B), including pharmaceutically acceptable salts thereof, can be HER2 bispecific antibody selected from margetuximab, ertumaxomab, HER2Bi-aATC, MM- 111, MCLA-128, BTRC4017A, GBR-1302 and PRS-343 (along with pharmaceutically acceptable salts of any of the foregoing).
• Embodiments of combinations of Compound (A) and Compound (B), including pharmaceutically acceptable salts of any of the foregoing, are provided in Table 1.
• Table 1 “A” indicates Compound (A) (including pharmaceutically acceptable salts thereof), the numbers 1A-18A represent a compound as provided in Figure 1 and numbers 1B-28B represent a compound as provided in Figure 2, including pharmaceutically acceptable salts thereof.
• a combination represented by 1A:A corresponds to a combination of palbociclib including pharmaceutically acceptable salts of any of the foregoing.
• Compound (A), including pharmaceutically acceptable salts thereof can be administered prior to all of Compound (B), or a pharmaceutically acceptable salt thereof.
• Compound (A), including pharmaceutically acceptable salts thereof can be administered prior to at least one Compound (B), or a pharmaceutically acceptable salt thereof.
• Compound (A), including pharmaceutically acceptable salts thereof can be administered concomitantly with Compound (B), or a pharmaceutically acceptable salt thereof.
• Compound (A), including pharmaceutically acceptable salts thereof can be administered subsequent to the administration of at least one Compound (B), or a pharmaceutically acceptable salt thereof.
• Compound (A), including pharmaceutically acceptable salts thereof can be administered subsequent to the administration of all Compound (B), or a pharmaceutically acceptable salt thereof.
• a combination as described herein of Compound (A), including pharmaceutically acceptable salts thereof, and Compound (B), or pharmaceutically acceptable salts thereof can decrease the number and/or severity of side effects that can be attributed to a compound described herein, such as Compound (B), or a pharmaceutically acceptable salt thereof.
• Using a combination of compounds described herein can results in additive, synergistic or strongly synergistic effect.
• a combination of compounds described herein can result in an effect that is not antagonistic.
• a combination as described herein of Compound (A), including pharmaceutically acceptable salts thereof, and Compound (B), or pharmaceutically acceptable salts thereof can result in an additive effect.
• a combination as described herein of Compound (A), including pharmaceutically acceptable salts thereof, and Compound (B), or pharmaceutically acceptable salts thereof can result in a synergistic effect.
• a combination as described herein of Compound (A), including pharmaceutically acceptable salts thereof, and Compound (B), or pharmaceutically acceptable salts thereof can result in a strongly synergistic effect.
• a combination as described herein of Compound (A), including pharmaceutically acceptable salts thereof, and Compound (B), or pharmaceutically acceptable salts thereof is not antagonistic.
• the term “antagonistic” means that the activity of the combination of compounds is less compared to the sum of the activities of the compounds in combination when the activity of each compound is determined individually (i.e., as a single compound).
• the term “synergistic effect” means that the activity of the combination of compounds is greater than the sum of the individual activities of the compounds in the combination when the activity of each compound is determined individually.
• the term “additive effect” means that the activity of the combination of compounds is about equal to the sum of the individual activities of the compounds in the combination when the activity of each compound is determined individually.
• a potential advantage of utilizing a combination as described herein may be a reduction in the required amount(s) of the compound(s) that is effective in treating a disease condition disclosed herein compared to when each compound is administered as a monotherapy.
• the amount of Compound (B), or a pharmaceutically acceptable salt thereof, used in a combination described herein can be less compared to the amount of Compound (B), or a pharmaceutically acceptable salt thereof, needed to achieve the same reduction in a disease marker (for example, tumor size) when administered as a monotherapy.
• Another potential advantage of utilizing a combination as described herein is that the use of two or more compounds having different mechanisms of action can create a higher barrier to the development of resistance compared to when a compound is administered as monotherapy.
• Additional advantages of utilizing a combination as described herein may include little to no cross resistance between the compounds of a combination described herein; different routes for elimination of the compounds of a combination described herein; and/or little to no overlapping toxicities between the compounds of a combination described herein.
• Compound (A), including pharmaceutically acceptable salts thereof, can be provided in a pharmaceutical composition.
• Compound (B), including pharmaceutically acceptable salts thereof, can be provided in a pharmaceutical composition.
• composition refers to a mixture of one or more compounds and/or salts disclosed herein with other chemical components, such as diluents, carriers and/or excipients.
• the pharmaceutical composition facilitates administration of the compound to an organism.
• Pharmaceutical compositions can also be obtained by reacting compounds with inorganic or organic acids such as hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, methanesulfonic acid, ethanesulfonic acid, p-toluenesulfonic acid, and salicylic acid.
• Pharmaceutical compositions will generally be tailored to the specific intended route of administration.
• a “carrier” refers to a compound that facilitates the incorporation of a compound into cells or tissues.
• DMSO dimethyl sulfoxide
• DMSO dimethyl sulfoxide
• a “diluent” refers to an ingredient in a pharmaceutical composition that lacks appreciable pharmacological activity but may be pharmaceutically necessary or desirable.
• a diluent may be used to increase the bulk of a potent drug whose mass is too small for manufacture and/or administration. It may also be a liquid for the dissolution of a drug to be administered by injection, ingestion or inhalation.
• a common form of diluent in the art is a buffered aqueous solution such as, without limitation, phosphate buffered saline that mimics the pH and isotonicity of human blood.
• an “excipient” refers to an essentially inert substance that is added to a pharmaceutical composition to provide, without limitation, bulk, consistency, stability, binding ability, lubrication, disintegrating ability etc., to the composition.
• stabilizers such as anti-oxidants and metal-chelating agents are excipients.
• the pharmaceutical composition comprises an anti-oxidant and/or a metal-chelating agent.
• a “diluent” is a type of excipient.
• Compounds (B), along with pharmaceutically acceptable salts thereof can be provided in a pharmaceutical composition that includes Compound (A), including pharmaceutically acceptable salts thereof.
• Compound (B), along with pharmaceutically acceptable salts thereof can be administered in a pharmaceutical composition that is separate from a pharmaceutical composition that includes Compound (A), including pharmaceutically acceptable salts thereof.
• compositions described herein can be administered to a human patient per se, or in pharmaceutical compositions where they are mixed with other active ingredients, as in combination therapy, or carriers, diluents, excipients or combinations thereof. Proper formulation is dependent upon the route of administration chosen. Techniques for formulation and administration of the compounds described herein are known to those skilled in the art.
• compositions disclosed herein may be manufactured in a manner that is itself known, e.g., by means of conventional mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping or tableting processes. Additionally, the active ingredients are contained in an amount effective to achieve its intended purpose. Many of the compounds used in the pharmaceutical combinations disclosed herein may be provided as salts with pharmaceutically compatible counterions.
• Compound (A), including pharmaceutically acceptable salts thereof can be administered orally.
• Compound (A), including pharmaceutically acceptable salts thereof can be provided to a subject by the same route of administration as Compound (B), along with pharmaceutically acceptable salts thereof.
• Compound (A), including pharmaceutically acceptable salts thereof can be provided to a subject by a different route of administration as Compound (B), along with pharmaceutically acceptable salts thereof.
• the liposomes will be targeted to and taken up selectively by the organ. For example, intranasal or pulmonary delivery to target a respiratory disease or condition may be desirable.
• compositions may, if desired, be presented in a pack or dispenser device which may contain one or more unit dosage forms containing the active ingredient.
• the pack may for example comprise metal or plastic foil, such as a blister pack.
• the pack or dispenser device may be accompanied by instructions for administration.
• the pack or dispenser may also be accompanied with a notice associated with the container in form prescribed by a governmental agency regulating the manufacture, use, or sale of pharmaceuticals, which notice is reflective of approval by the agency of the form of the drug for human or veterinary administration. Such notice, for example, may be the labeling approved by the U.S. Food and Drug Administration for prescription drugs, or the approved product insert.
• Compositions that can include a compound and/or salt described herein formulated in a compatible pharmaceutical carrier may also be prepared, placed in an appropriate container, and labeled for treatment of an indicated condition.
• a combination of compounds that includes an effective amount of Compound (A), including pharmaceutically acceptable salts thereof, and an effective amount of Compound (B), or a pharmaceutically acceptable salt of any of the foregoing, can be used to treat a disease or condition.
• a “subject” refers to an animal that is the object of treatment, observation or experiment.
• Animal includes cold- and warm-blooded vertebrates and invertebrates such as fish, shellfish, reptiles and, in particular, mammals.
• “Mammal” includes, without limitation, mice, rats, rabbits, guinea pigs, dogs, cats, sheep, goats, cows, horses, primates, such as monkeys, chimpanzees, and apes, and, in particular, humans.
• the subject can be human.
• the subject can be a child and/or an infant, for example, a child or infant with a fever.
• the subject can be an adult.
• treat do not necessarily mean total cure or abolition of the disease or condition. Any alleviation of any undesired signs or symptoms of the disease or condition, to any extent can be considered treatment and/or therapy. Furthermore, treatment may include acts that may worsen the subject’s overall feeling of well-being or appearance.
• an effective amount of compound, salt or composition can be the amount needed to prevent, alleviate or ameliorate symptoms of the disease or condition, or prolong the survival of the subject being treated. This response may occur in a tissue, system, animal or human and includes alleviation of the signs or symptoms of the disease or condition being treated. Determination of an effective amount is well within the capability of those skilled in the art, in view of the disclosure provided herein.
• the effective amount of the compounds disclosed herein required as a dose will depend on the route of administration, the type of animal, including human, being treated and the physical characteristics of the specific animal under consideration. The dose can be tailored to achieve a desired effect, but will depend on such factors as weight, diet, concurrent medication and other factors which those skilled in the medical arts will recognize.
• an effective amount of a compound, or radiation is the amount that results in: (a) the reduction, alleviation or disappearance of one or more symptoms caused by the cancer, (b) the reduction of tumor size, (c) the elimination of the tumor, and/or (d) long-term disease stabilization (growth arrest) of the tumor.
• the disease or condition can be selected from a lung cancer, a gastric cancer and a gastroesophageal junction adenocarcinoma.
• the disease or condition can be a breast cancer.
• the breast cancer can be ER positive (ER+) breast cancer.
• the breast cancer can be ER positive, HER2-negative (ER+/HER2-) breast cancer.
• the breast cancer is classified by HER2 status.
• the breast cancer is HER2-positive (HER2+) breast cancer.
• the breast cancer is HER2-low, breast cancer.
• the breast cancer can be local breast cancer (as used herein, “local” breast cancer means the cancer has not spread to other areas of the body).
• the breast cancer can be metastatic breast cancer.
• the breast cancer can be triple-negative breast cancer.
• a subject can have a breast cancer that has not been previously treated.
• a subject can relapse or have reoccurrence of breast cancer.
• the terms “relapse” and “reoccurrence” are used in their normal sense as understood by those skilled in the art.
• the breast cancer can be recurrent breast cancer.
• the subject has relapsed after a previous treatment for breast cancer.
• the subject has relapsed after receiving one or more treatments with a SERM, a SERD and/or aromatase inhibitor, such as those described herein.
• Some embodiments disclosed herein are relate to the use of a combination of compounds described herein, such as Compound (A) and Compound (B), along with pharmaceutically acceptable salts of any of the foregoing, in the manufacture for a medicament for treating breast cancer in a subject in need thereof, wherein the breast cancer has at least one point mutation (such as 1, 2, 3, 4 or more than 4 point mutations) within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc).
• ESRI Estrogen Receptor 1
• ERoc Estrogen receptor alpha
• kits for treating breast cancer in a subject in need thereof wherein the breast cancer has at least one point mutation within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc).
• ESRI Estrogen Receptor 1
• Still other embodiments disclosed herein are relate to a method of treating breast cancer in a subject in need thereof with a combination of compounds described herein (such as Compound (A) and Compound (B), along with pharmaceutically acceptable salts of any of the foregoing), wherein the breast cancer has at least one point mutation (for example, 1, 2, 3, 4 or more than 4 point mutations) within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc).
• ESRI Estrogen Receptor 1
• ERoc Estrogen receptor alpha
• the mutation can be in the ligand binding domain (LBD) of ESRI.
• one or more mutations can be at an amino acid selected from: A593, S576, G557, R555, L549, A546, E542, L540, D538, Y537, L536, P535, V534, V533, N532, K531, C530, H524, E523, M522, R503, L497, K481, V478, R477, E471, S463, F461, S432, G420, V418, D411, L466, S463, L453, G442, M437, M421, M396, V392, M388, E38O, G344, S338, L370, S329, K3O3, A283, S282, E279, G274, K252, R233, P222, G160, N156, P147, G145, F97, N69, A65, A58 and S47.
• one or more mutations can be at an amino acid selected from: D538, Y537, L536, P535, V534, S463, V392 and E38O. In some embodiments, one or more mutations can be at an amino acid selected from: D538 and Y537.
• one or more mutations can be selected from: K3O3R, D538G, Y537S, E38OQ, Y537C, Y537N, A283V, A546D, A546T, A58T, A593D, A65V, C530L, D411H, E279V, E471D, E471V, E523Q, E542G, F461V, F97L, G145D, G160D, G274R, G344D, G420D, G442R, G557R, H524L, K252N, K481N, K531E, L370F, L453F, L466Q, L497R, L536H, L536P, L536Q, L536R, L540Q, L549P, M388L, M396V, M421V, M437I, M522I, N156T, N53
• Some embodiments disclosed herein are relate to the use of a combination of compounds that includes an effective amount of Compound (A), including pharmaceutically acceptable salts thereof, and an effective amount of one or more of Compound (B), or a pharmaceutically acceptable salt thereof, in the manufacture for a medicament for treating breast cancer in a subject in need thereof, wherein the breast cancer does not include at least one point mutation (for example, a point mutation within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc)).
• ESRI Estrogen Receptor 1
• ERoc Estrogen receptor alpha
• FIG. 1 Another embodiments relate herein are directed to the use of a combination of compounds that includes an effective amount of Compound (A) and an effective amount of one or more of Compound (B), along with pharmaceutically acceptable salts of any of the foregoing, for treating breast cancer in a subject in need thereof, wherein the breast cancer does not include has at least one point mutation, such as a point mutation within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc).
• ESRI Estrogen Receptor 1
• ERoc Estrogen receptor alpha
• Still other embodiments disclosed herein are relate to a method of treating breast cancer in a subject in need thereof with a combination of compounds described herein (for example, a combination of Compound (A) and Compound (B), or a pharmaceutically acceptable salt of any of the foregoing), wherein the breast cancer does not include has at least one point mutation within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc) (for example, a point mutation within the Estrogen Receptor 1 (ESRI) that encodes Estrogen receptor alpha (ERoc)).
• ESRI Estrogen Receptor 1
• ERoc Estrogen receptor alpha
• ER-positive breast cancer is due to acquired mutations in ESRI due to endocrine therapy.
• the subject had been previously treated with one or more selective ER modulators.
• subject had been treated previously with one or more selected ER modulators selected from tamoxifen, raloxifene, ospemifene, apeledoxifene, toremifene and lasofoxifene, or a pharmaceutically acceptable salt of any of the foregoing.
• the subject had been treated previously with one or more selective ER degraders, such as fulvestrant, (E)-3-[3,5-Difluoro-4-[(lR,3R)-2-(2-fluoro-2-methylpropyl)-3-methyl-l,3,4,9- tetrahydropyrido[3,4-b]indol-l-yl]phenyl]prop-2-enoic acid (AZD9496), (R)-6-(2-(ethyl(4-(2- (ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol (elacestrant, RAD 1901), (E)-3-(4-((E)-2-(2-chloro-4-fluorophenyl)- 1 -( 1 H-indazol-5-yl)but- 1 -en- l-yl)phen
• the subject had been treated previously with one or more aromatase inhibitors.
• the aromatase inhibitors can be a steroidal aromatase inhibitor or a non-steroidal aromatase inhibitor.
• the one or more aromatase inhibitors can be selected from (exemestane (steroidal aromatase inhibitor), testolactone (steroidal aromatase inhibitor); anastazole (non-steroidal aromatase inhibitor) and letrazole (non-steroidal aromatase inhibitor), including pharmaceutically acceptable salts of any of the foregoing.
• the breast cancer can be present in subject, wherein the subject can be a woman. As women approach middle-age, a woman can be in a stage of menopause.
• the subject can be a premenopausal woman.
• the subject can be a perimenopausal woman.
• the subject can be a menopausal woman.
• the subject can be a postmenopausal woman.
• the breast cancer can be present in a subject, wherein the subject can be a man.
• the serum estradiol level of the subject can vary.
• the serum estradiol level (E2) of the subject can be in the range of >15 pg/mL to 350 pg/mL. In other embodiments, the serum estradiol level (E2) of the subject can be ⁇ 15 pg/mL. In other embodiments, the serum estradiol level (E2) of the subject can be ⁇ 10 pg/mL.
• the amount of compound, salt and/or composition required for use in treatment will vary not only with the particular compound or salt selected but also with the route of administration, the nature and/or symptoms of the disease or condition being treated and the age and condition of the patient and will be ultimately at the discretion of the attendant physician or clinician.
• dosages may be calculated as the free base.
• the useful in vivo dosage to be administered and the particular mode of administration will vary depending upon the age, weight, the severity of the affliction, the mammalian species treated, the particular compounds employed and the specific use for which these compounds are employed.
• the determination of effective dosage levels can be accomplished by one skilled in the art using routine methods, for example, human clinical trials, in vivo studies and in vitro studies.
• useful dosages of a compounds (A) and/or (B), or pharmaceutically acceptable salts of any of the foregoing can be determined by comparing their in vitro activity, and in vivo activity in animal models. Such comparison can be done by comparison against an established drug, such as cisplatin and/or gemcitabine)
• Dosage amount and interval may be adjusted individually to provide plasma levels of the active moiety which are sufficient to maintain the modulating effects, or minimal effective concentration (MEC).
• MEC minimal effective concentration
• the MEC will vary for each compound but can be estimated from in vivo and/or in vitro data. Dosages necessary to achieve the MEC will depend on individual characteristics and route of administration. However, HPLC assays or bioassays can be used to determine plasma concentrations. Dosage intervals can also be determined using MEC value.
• Compositions should be administered using a regimen which maintains plasma levels above the MEC for 10-90% of the time, preferably between 30-90% and most preferably between 50-90%. In cases of local administration or selective uptake, the effective local concentration of the drug may not be related to plasma concentration.
• the attending physician would know how to and when to terminate, interrupt or adjust administration due to toxicity or organ dysfunctions. Conversely, the attending physician would also know to adjust treatment to higher levels if the clinical response were not adequate (precluding toxicity).
• the magnitude of an administrated dose in the management of the disorder of interest will vary with the severity of the disease or condition to be treated and to the route of administration. The severity of the disease or condition may, for example, be evaluated, in part, by standard prognostic evaluation methods. Further, the dose and perhaps dose frequency, will also vary according to the age, body weight and response of the individual patient. A program comparable to that discussed above may be used in veterinary medicine.
• Compounds, salts and compositions disclosed herein can be evaluated for efficacy and toxicity using known methods.
• the toxicology of a particular compound, or of a subset of the compounds, sharing certain chemical moieties may be established by determining in vitro toxicity towards a cell line, such as a mammalian, and preferably human, cell line. The results of such studies are often predictive of toxicity in animals, such as mammals, or more specifically, humans.
• the toxicity of particular compounds in an animal model such as mice, rats, rabbits, dogs or monkeys, may be determined using known methods.
• the efficacy of a particular compound may be established using several recognized methods, such as in vitro methods, animal models, or human clinical trials. When selecting a model to determine efficacy, the skilled artisan can be guided by the state of the art to choose an appropriate model, dose, route of administration and/or regime.
• the antitumor activity of Compound (A) was assessed using the MCF-7 xenograft model. Each mouse was inoculated subcutaneously on the 2 nd right mammary fat pad with 1.5 x 10 7 MCF-7 tumor cells in 200 pL DMEM Matrigel mixture (1:1 ratio) without serum for the tumor development. In addition, estradiol benzoate injection was delivered by s.c. (40 ug/20 uL, twice weekly). When mean tumor size reached 204 mm 3 , animals were randomized into 2 groups (10 animals/group) and the treatments were initiated. Compound (A) or vehicle control was administered once daily by oral gavage and continued for 28-days. Study endpoints included daily body weight, clinical observations, tumor volume.
• Figure 3 showed that the dose level 80 mg/kg of Compound (A) as a single agent produced robust inhibition of tumor growth (132.6%) and tumor regression.
• the top line is vehicle, and the bottom line is Compound (A) (80 mg/kg qd x 22 p.o). There were no adverse clinical observations in any dose group and there was no significant impact on mean body weights.
• Compound (A)’s efficacy as a single agent was evaluated in ZR-75-1 tamoxifen resistant tumor model.
• the tamoxifen resistant ZR-75-1 tumor cells (ZR-75-1R) were maintained in vitro as monolayer culture in RPMI1640 Medium supplemented with 10% fetal bovine serum and 10 pM tamoxifen at 37°C in an atmosphere of 5% CO2 incubator. Each mouse was then inoculated subcutaneously on the right flank with 1 x 10 7 ZR-75-1R tumor cells in 100 F RPMI- 1640 Matrigel mixture (1:1 ratio) without serum for the tumor development. In addition, estradiol benzoate injection was delivered by s.c. (40 ug/ 20 uL, twice weekly). Mice were then randomized into 3 groups when mean tumor size reached 191 mm 3 and treatment was started.
• Tamoxifen was dosed at 100 mg/kg 5 days per week for three weeks, Compound (A) was orally dosed at 80 mg/kg daily for 28 days. Study endpoints included daily body weight, clinical observations, tumor volume.
• the top line is Tamoxifen (100 mg/kg)
• the middle line is vehicle
• the bottom line is Compound (A) (80 mg/kg).
• Tamoxifen induced -47.9% tumor growth inhibition post 28 days treatment and indicated this is tamoxifen resistant breast cancer model.
• Compound (A) at 80 mg/kg produced strong antitumor activities with 69.9%TGI (tumor growth inhibition). No other gross clinical abnormalities were observed during the treatment period and animal body loss was manageable by giving animals dosing holiday.
• the vehicle control or Compound (A) at 80 mg/kg was administrated once daily to the mice by oral gavage for 28 days.
• the top line is vehicle
• the bottom line is Compound (A).
• TGI tumor growth inhibition
• mice were randomized into 4 groups (8 mice per group) and treated with vehicle control, 60 mg/kg Compound (A) alone, 25 mg/kg Palbociclib alone, Compound (A) at 60 mg/kg in combination with 25 mg/kg palbociclib. Study endpoints included daily body weight, clinical observations, tumor volume. As shown in Figure 7, Compound (A) at 60 mg/kg alone (second from the bottom line) and palbociclib at 25 mg/kg alone (second from the top line indicated with triangles) induced 48.6% TGI and 14.2% TGI respectively, Compound (A) at 60 mg/kg in the combination with palbociclib at 25 mg/kg (bottom line indicated with triangles) resulted in 82.7% TGI. Thus, Compound (A) in combination with palbociclib significantly improved the efficacy. All animals were well tolerated for the treatment.
• the HER2+ JIMT-1 breast cancer cell line was used for tumor xenograft inoculations and subsequent treatment.
• the JIMT-1 breast cancer cell line has been described in literature to be relatively resistant to HER2-targeted therapy (JIMT-1 cell line was established from pleural metastasis of a 62-year-old patient with breast cancer who was clinically resistant to trastuzumab (See Tanner et al. Mol Cancer Ther (2004) 3(12): 1585-1592)), including to weekly administration of trastuzumab.
• NOD/SCID mice were inoculated subcutaneously on the right flank with the single cell suspension of 95% viable tumor cells (5 x 10 6 ) in 100 pL DMEM Matrigel mixture (1:1 ratio) for tumor development. Treatment was started when mean tumor size reached 204 mm 3 . Mice were then randomized into 5 groups and treatments were administered to the tumor-bearing mice accordingly to the study design in Table 2.
• TGI tumor growth inhibition
• mice in the two vehicle groups were randomized on Day 29 to be treated with either vehicle, Compound (A) alone, trastuzumab alone or the combination of Compound (A) with trastuzumab according to Table 4. At this point, tumors had reached approximately 1000 mm 3 and therefore, treatment of these mice occurred at high initial tumor burden.

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